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HomeMy WebLinkAbout020-1420-00-000Wiscon n ~ ~tment of Commerce P VA AGE SYSTEM Safety and Building Division RI TE SEW INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you Drovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Fitz erald, Mark & Marybeth Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 'Z,,~, yc ~ ~~ F' ~ 000 Dasiag- F,'' /o SZ S F, r Aeration Holding TANK SETBACK INFORMATION TANK TO L P!L IOJ ~ WELL BLDG. VeCnt to A,irwlntake J~Sti~`^~ ROAD Septic Z~ / ~S J / ' ~ $, Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Syste H Ft Forcemain Length Dia. Dist. to well SOIL_ AF3SORPTION SYSTEM county: St. Croix Sanitary Permit No: 515190 0 State Plan ID No: Parcel Tax No: 020-1420-00-000 Section/Town/Range/Map No: 20.29.19.2668 ELEVATION DATA STATION BS HI FS ELEV. Ben~tmar~ / E y 3 G 4~~ ~ U/, S M Alt. B F' 4 3~ ` ~63• (p Bldg. sewer lk /', Z 9~. 77 SUHt Inlet G ~ ~ / Q,7 SbHt Outlet Dt Inlet ~ `~ Dt Bottom ~- Header/Man. 9.3 9 ~-S Dist. Pipe 9 ~ ~~ Bot. System Q. 7 l0 • 7 Final Grade s . 3 ~a~ ' S BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 4 ~ Z ` ` ~_ ~ ~` _ SETBACK SYSTEM TO ~ 5 P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:..-~ (~ L J~ ' ~ ~ INFORMATION CHAMBER OR n, i / Type Of Syste~~ Go~/ Z5 ' L~'g ~ 56 ' ~ /,~ ~V UNIT Model Number: t d r)IRTRIRIITION SYSTEM ~_ .~ 7 ~, / t'a ~'/ (v = c3 ~d ~aQ Header/Manifol // S ~ ~, Length Dia Distribution ~ Pipe(s) ~ \ ~, Length Dia Spacing x Hole Size _~ x Hole Spacing ~ Vent to Ainlnta~r e ~~e~' r S(lll CCIVFR ., o.e~~~~.o c.,~+o..,~ n.,l., ,rv Mn~~nrl nr et_C;rarie Systems Only ~- Depth Over Bed/Trench Center . j Depth Over BedlTrench Edges \ xx Depth of Topsoil ~ xx Seeded/Sodded -_ : Yes ~ No xx Mulched ~ Yes ~ No ~ . COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: y / ~~' / ~C Inspection #2:_,/ /_ Location: 858 Chebek Lane Hudson, W(I,~54016 (SW 1/4 NE 1/4 20 T29N R19W) The Glen Lot 74 Parcel No: 20.29.19.2668 1.)AItBMDescription= ~' ~~"~'~ ~"J~~ C~~+~ ~ ~a~~ ~"` 2.) Bldg sewer length = 33 - amount of cover = ~ ~¢~ ~ b0 ~; ~~L~ ~, Q,,ti,~ ~~~ Plan revision Required 0 Yes ~ No I ~ ~ll 'I ~ ~ I 1z~ Id ~-f e I Ica ntMar cirla fnr arlrlitinnal infnrmatinn ~ I ~. / i_ l __ _-___! !.____ _. .._ _..._ . - _ _. ~ cotnmert:e.wl.gov Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 71b2 Y ~ ~ < ' ~~'Q ~~' ~ Madison, WI 53707-716 ~i Hilary Per it Number (to be filled in by Co.} Depatfrttertt of Cbttrtrnerce ~ Sa)tlitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u oses in accordance with the Privac Law, s. 15.04 1 m Slats. ~ Q Q I. A lication Information -'Pl se Pr'nt All Information V L~ Pro pe r ty Owner's Name D Parcel # ~ ~ f 1 ~1 Property Owner's Mailing Address ~ ~ ~On9 f V Property Location / _~ ~~Q (, « O ~ ~ City, State Zip Code Phone Num~p~a,~ G GFFIG~ oNIN /~ y, ii~_ %, Section ~D •2~ = --f L Lc ®.,rJ t t ~" Y 16' CANNING & z (circle one R~E~ T ~ ~ N II T f B ildi L ; _ . ype o u ng (check all that apply) ~~ ~ ot # ~ d 1 or 2 Family Dwelling -Number of Bedrooms "~ Subdivision Name t I 7vv-f ~ atti.. 'Sll Block /~ t°_. IL 't° „J ^ Public/Commercial-Describe Use ^ Cityaf ^ State Owned -Describe Use CSM Number ^ Village of // ' / J ~ ~' ~ ~ ~ / ~ Town of ~/~ sO/1~ Z .vtlpe( 10 ~ III. Ty p e of Permit: (Check. o one box on Line A. Complete line B if applicable) A ~ r ~ New System ..~--~-~ ^ Replacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~~ e I l ~ ~T IV. T e of POWTS S stem/Com onent/Device: Check all that a I on-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersallTreat ent Area Information: Design Flow (gpd) Design Soil Application Ra pdsfj Dispersal Area Required ( Dispersal Area Pro se (s~ ~ System Elevation ~v~b . 7 ~' ~.~ ~~~ 4~ ' ~~ [ 6 Ce' VI. Tank Info Capacity in Total # of Manufacturer ' Gallons Gallons Units ~ ~ ~ $ y .a New Tanks Existing Tanks n o ;1 ~ ~ ~ `~ ~ ~~ ~ ~~ f/ a V in rn , w t7 a. Septic or Holding Tank ' GG4 -' •e ~- Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWYS non the attached plans. Plumber's Name (Print) Plumber's Signature P RS Number Business Phone Number Plumber's Address (Street, Cily, State, Zip Code) JO rr- ~ °a U1 i ~ lJ' ~ G VIII. Coun /De artment Use On! pproved ^ Di Permit Fee $ ~~• ~ Date I ued ~ ~~ IOC / I Issuing A Signature ^ Owner ven Reason for Denial IX. Conditi~t~'~q~~easons for Disapproval 3, ~G•~ 4c.~ CA. 1. Septic tank, effluent filter and dispersal cell must all be servk:es /maintained ~~ a.,a'~.Q.w f lN.o~ ~ P~ef/t~ ~~/ ~ as per management plan provided by plumber. !!! ~ ~``e/~(_ _ _ _ _ _ ~t 2. All ttetback tequlreme~ts must be maiMakled ~/-p,~,r,~ q,~,~,~ t.aJ~ r'Gna.n.cx as bk Attaeh to complete plans for the system and submit M the County only on paper not less than a llx x r r cncnes m size ~~ f's SBD-6398 (R. 02/09) Valid thru 02/11 ~, e Z A\ ~~ ~ ~ ~ ~ ti ~ ~ ~`: ~ ~ Q 1 \ Q 2 h ~1~ tt``V v~ {A` l c ~, ~ ~ 1` ~ q Q 1 Q \r ~_ , ! i S~ ~ . Vi/isconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1122 Page 1 of 3 Steel Soil Service County Attach complete site plan an paper not less than 8'/: x 1t inches in size. Plan must St. Crooc include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parce{ t.D. C?~,Z ~I - r~ -.~ Gi - C~~~ Pease print a-I information. awed gy Date Personal information you provide may be used for secondary purposes (Privacy L eru, s. 15.04 (1) (m}). ~ G r~ - 3 Property Owner ~ ~ . ~ ~, ~~, Pr Location Sienna Corporation Govt. of SW 1/4 NE 1/4 S 20 T 29 N R 19 Properly Owner's Mailing Address Lot Block # , Subd. Name or CSM# 4940 Viking Dr, Suite 608 ~~ 7 ~ ~ ~QQ~ 4 7 The Glen ~ Zly ~~~ City ,~~bq State Zip a ~P~hTOne Number _r City Village Town Nearest Road MN 55 5 `~3Y4;~ j ~'' Hudson Carmichael Rd. #~ New Construction Use: ~/ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material Pitted outwash Flood plain elevation, if applic~le na General comments and recommendations: system elevation 100.12f ,trenches spaced and depth to code 4.08ft below grade Boring # _.< Boring 103 Pit Ground Surface elev. 104.20 ft. in. Soil Application Rate Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2 *Eff#1 *Eff#2 1 0-11 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 11-27 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 27-103 7.5yr4/4 none cos ~ osg mvfr na na .7 1.6 _ Q cc~ /~ . I Z- so t 1~ c.~.e.~.- ~ ~^+~-- ~ S ~ S t~ o ~~-`~~ g`{•9h Boring # Boring ~! Pit Ground Surface elev. 104.20 ft. Depth to limiting factor 96 in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-9 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 9-22 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 22-96 7.5yr4/6 none ms osg ml na na .7 1.2 `f~• ~ ~~~f 96 - tnruem ;F~ = rsw 5> su < zzu mgiL and r ss >su < ~ bo mglL * Effluent #2 = BODS < 30 mg/L and TSS < 3D mg/L CST Name (Please Print) Signature: / CST Number David J. Steel ~~~I ~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 154017 9/11/2002 715-246-5085 1~t ; i Property owner Sienna Corporation Parcel ID # Pending Page 2 of 3 Boring # Boring 101 50 De th to ft limiting factor 96 i Pit . Ground Surface elev. p . n. ~~ gpplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Raots 6PDffP *Eff#1 *Eff#2 1 0-13 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 13-37 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 37-96 7.5yr4/6 none ms osg m( na na .7 12 Boring # Boring * Effluent #1 = BOD e' 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS a 30 mg/L The Department of Commeece is an equal opportunity service provider and employer. If you need assistance to access services or Boring # !Boring _. _ .. .. ... _ Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna. Corporation .New Richmond, WI 54017 Lic. # 248956 SW1/4,NE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot 74 This soil evaluation. was conducted to satisfy a zoning requirement,. it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not estahlished at the time the soil test was conducted. Legend 1" = 40' Benchmark. EL 100.00Ft ,,,Qp of lh"pvc pipe / s~=-Alt Benchmark E1.99.20Ft op of/z" pvc pipe a =Borings Boring Elevations B1 =104.20Ft i`~.ZoFr 7iMM t , O.. i ,i i / J~ ' ~~. ~p 1 ,~.'. Y _. .. ~ .. , , , ~. ~ 7 >. ~- : ! • _ _ _ ,_ .~'~ _ i . ... ~. .. t ! •.1 yt .. -.. 1 _ ~ >j 5 Ii 't/ .. : f : J` s l / a :. y P QCi ep ~ 7 ' ` f7V / ,. 1 `, /`~ 4 ,1 ~, - , - ,,, - - 34a .. '-. `~ T' '.. . Y l ~ . ! 96 r 'v ' ~\ y. ' ... 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CitylState '-J ~5 ~ ~n ~~~~ ~~~ ~~° Parcel Identification Number LEGAL DESCRIPTION Property Location ~ t/a , t/a ,Sec. ~ , T N RAW, Town of ~tL-f ~ ~ y ~ ~ .~ ~ / ,Lot # ~. Subdivision ~--' ~ ~~ - Certified Survey Map # ,Volume ,Page # Warranty Deed # ,Volume ,Page # Spec house yes no Lot lines identifiable ~e no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of. pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (t) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the, St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described bove, by virtue of a warranty deed recorded in Register of Deeds Office. .~ ~r_____L _~ .P L,.~I~~.. .. ' SI~~t"A~tItJRE OF APPLICANT(S) /l 13 I~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Standard Erosion Control Plan for 1- & 2-Family Dwelling Construction Sites According to Chapters ILHR 20 St 21 of the Wisconsin Uniform Dwelling Code, soil erosion contro( information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- bt 2-family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. ~ PROJECTLOCATION~a-~~t~ ~~~~~ ~~~ ~-~;a.~t-,~ ~'-~,'~~ ~ Please indicate north BUILDER4~~=~.~~~ 1~l'1V1Sob1 .`~~~"~'a OWNERY~:.~l~Z.~~~Pt~6~f-4~1'x'~`''K-~~w~bycompletingthearrow. WORKSHEET COMPLETED BY ~ c~hv~w ~~.~ 8~ ~ DATE -N- SITE DIAGRAM scale: finch = j °(~feet I EROSION CONTROL PLAN LEGEND _ _ PROPERTY LINE EXISTING --' DRAINAGE -~- TD TEMPORARY DIVERSION FINISHED -'-~ DRAINAGE _ _ _ LIMITS OF GRADING SILT •--'-"~ FENCE ~• STRAW BALES ~. GRAVEL 1 VEGETATION SPECIFICATION ~\ TREE ~. ~ PRESERVATION STOCKPILED SOIL POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner QY ~2CCS~ Permit # DESIGN PARAMETERS Number of Bedrooms 3 ^~ NA Number of Public Facility Units ^ NA Estimated fbw laveragel !f,$-O al/da Desig,~ flow {peak), (Estimated x 1.5) ~Q al/da Soil Application Rate of/da /ft~ Standard Influent/Effluent Quality Monthly average * Fats, Oil & Grease {FOG) S30 mg/L Biochemical Oxygen Demand (BODe} 5220 mglL ^ NA Total Suspended Solids (TSS} 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mglL Total Suspended Sol'cds {TSS} 530 mglL ^ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ya in die. ^ NA Other: ^ NA *Valries typical for domestic wastewater and septic tank effluent. SXS7'EM SPECIFICATIONS ; SE eptic Tank Capacity ~j'©Q al ^ NA Septic Tank Manufacturer ~'Cs~a W O NA Effluent Filter Manufacturer Pc~ i ~ C ~ ' ^ NA Effluent Filtec Model ~~~''- ^ NA Pump Tank Capacity 4 al O NA Pump Tank Manufacturer sgy. ^ NA Pump Manufacturer ~a.A ~ ^ NA Pump Model ~ ^ ~` Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Celtls} ^.NA ^ tn-Ground (gravity) ^ In-Ground {pressurized} ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA other: ^ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the fotlowing licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank identify any cracks or leaks, inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, measure the volume of combined sludge and scum and to check for any back up or pond'mg of effluent on the ground sond ng The dispersal cellfs} shall be visually inspected to check the effluent levels in the observation pipes and to check for any p of effluent on the ground surface. The ponding of affluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third {Y3} or .more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized rsompone~ts, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory aurthority within 10 days of completion of any service event. Page of START UP AND OPERAT{ON roducts or other chemicals For new construction, prior to use of the POWTS rheck treatment tanklsi for the presence of pa~nttng p that may impede the'treatment process and/or damage-the dispersal cell{sl. If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operaco~ prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill at-ove normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells! in one large dose, overloading the celNsi and may result in the backup or surface discharge of effluent. To avoid this. situation have- the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance diapers` d si ectantsf fat POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; foundation drain {sump pump! water; fruit .and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected- and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINt3ENCY Pi.AIV taken, to provide a code compliant If the POWTS fails and cannot be repaired the .following measures have been, or=must be replacement system: ^ A suitable replacement- area h should bevalotected f om disturbaniaeeand compact on'oand should snot be infr niged uponiby system. The replacement area P required setbacks from existing„an a s to eve uat on to8establi h a suttablel replacement areae Replacement cyst ms mus' result in the need for a new soil an comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations• Barring advances in POWT: technology a holding tank may-L!e installed as a last resort to replace the failed POWTS..'Q ^f the: ppul-'rS a sail and sits ,a f ~ ^ T it tan e a ^ Mound and at-grade soil absorption systems stemsbmustccomply wth thelr~utes inlleffec9 "at hat time.me biomat at th infiltrative surface. Reconstructions of such sy < <WARNINti> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY u~NDTER, ANY Ci1RCUMSTANCES.!bEATH MAY RESULTY6RESCUE OF ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS . POWTS MAINTAINER POWTS INSTALLER •• // ~~ ~ Name Name ~c~6lr u ~+ ~.`•~ Phone Phone 7 l _ ~ y .y j','Z LOCAL REQULATORY AUTHORITY SEPTAOE SERVICIN{i OPERATOR (PUMPER) Name Name G(oi x ~~ Phone /S . to - (o d Phone This document was drafted in compliance with chapter Comm 83.22(21Ib-i11(d}&Ifi and 83.54{11. {21 & (3}, Wisconsin Admir~strative Code. f ~, SEPTIC TANK ~ PUMP CHAMBiR CROSS SECT"IUN AND SPECIFICATIONS 4" CT VENT PIPE 12" MIN. ABOVE GRADE ~ IiEATHERPROQF ?'25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W / PADLOCK ~ FINISHED GRADE WARNING LABEL 4 " C I RISER ~,•.,,,,_ 4 " MIN . 18" IN. 6" MAX. e ~ - ~ ~`~` ', 5.. t 'NLET ~ WATER TIGHT SEALS l.'IA S•~ 1 TIGHTS ° °° ~IAPPROVEA A SEAL ~ JOIf~TS WITH ._!_.,. ; ALM APPROVED PIPE PPROVED B ~ ' ~ ON 3' ONTO IPA 3' € I `i"' ~ SOLID SAIL nT0 SOL IO C ~ ~ OI~• PUMP OFF ELEV . I'T • --~•- OFF ~~ RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. F~EDDII3G UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: fJ,'~_.._..~.,_ NUMBER DQSES FER DEFY: ~~,_ TANK SIZES : SEPTIC .~.`J,~,_.-- GAL, DOSE ~ ~`~ GAL. AL_A__RM MANUFACTURER: ~/~,~L~~e_,,,, a~~ MODEL NUMBER : ~ s- y SWITCH TYPE: ~e° PUMP MANUFACTURER : Gocti~GL ,,,,,,,, MODEL NUMBER : ~,d a ~~ SWITCH TYPE: rn~~c REQUIRED DISCHARGE RATE ~~ GPM DOSE V PLUME INC LUDING FLOWBACK: ~~.? GAL. CAPACITIES: A = ~ INCHES = ~~GAL. H = 2 INCHES = 3__~,~__ GAL. C ~ INCHES =~~GAL. p ~ INCHES = _ GAL. PUMP ~ ALARM WIRING AS PER ILHR 16.23 WAC ~1~ FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ,~ FEET + MINIMUM NETWORK SUPPLY PRESSURE `""~ FEET + ~ FEET FORCEMAIN X ~. ~"T/1~0 F~©TALIDYNAMXCAHEAD •_• ~~ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH~r_; DIAME"'ER ____~~,,,, LIQUID L~~ •• ~` ,,~ /~.~ r ~ , SIGNED: ly;~-~ LICENSE Iv'UMBER: ~~79g0 DATE: ~=,~--~?°~-~ 1/88 ~GOULDS PUMPS • Fully submerged in high grade turbine oil #or lubrication and effiaent heat transfer. 3Q~1 EP04 o . EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capabil'tty: a/a" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'!z' NPT. • Mechanical seat: carbon- rotarylceramic-stationary, BONA-N elastomers. • Temperature: 104°F (40°C}continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry wrthout damage to components. Motor: • EP44 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, buih in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power card:l0 foot standard length, 1613 SITOW with three prong grounding plug. Optional 20 foot length,1613 S1TW with three prong grounding plug (standard on EP05). ~ 2000 Goulds Pumps Effective February, 2000 83871 Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller. Thermoplas- tic endoseddesign for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effident heat transfer, strength, and durability. ^ Molar Caver: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. METERS FEET ;..... ....................... __. ; _. 10 ~__.. , ,.._ . 9 30 ...~ .............._., ~`` 1 ..............._...._ a zs~.._ .._.,... `~ ' ~ ~ ' x _....w.__~...__m.._..._..-,.; .. 6 2a' .'~ u ' ;.._ ,.... „_ ~_.. ~ s p 15t.._....._.. ......i ,.. .... _ .~ q , ....... o ~ ' 3 tOj .._._.._w..,.._.._...._~... y z _ ___ .._ 5 ................... i 1 0 00._ ... __........10 20 Submersible Efi~lueut Pump ~~ ~ 30 ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~• canarsan standards AssodaCan (CSA listed model numbers end in "F" or "C".) Goulds Pumps a X50 9001 Registered. B 1 a 12 m'/fi 0 2 4 6 cAPACmr Goulds Pumps 4~ ITT Industries State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number U Document Name THIS DEED, made between Bane Corporation, a Minnesota corporation ("Grantor," whether one or more), and Mark A. Fitzgerald and Marybeth Fitzgerald, husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 74, Block 7, Plat of The Glen in the Tovm of Hudson flllll Illil 11!11 liiil 111i1111111i1i lilili 1111111! * s o s s o z 1 ~~~~~~ BETH PABST REGISTER OF DEEDS ST. CRflIX Cfl., WI RECEIVED FOR RECORD 11/11/2049 02:30PM WARRANTY DEED EzE~Pr ~ REC FEE: 11.00 TRANS FEE: 351.00 PAGES: 1 Recording Area Name and Retum dress Harry E. Gallahe Lockridg 1 Nauen P.L.L.P. 100 Wash' n Avenue South, Suite 2200 Minnea is, N 55401 Tel: 12) 339 900 fK~ b 020-1420-00-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: l) municipal and zoning ordinances and agreements entered under them; 2) recorded easements for the distribution of utility and municipal services; 3) recorded building and use restrictions and covenants; 4) general taxes levied in the year of closing; and 5) Terms and Conditions of Notice recorded December 12, 2002 in Vol. 2079, Page 38, Doc No. 702098. Dated November 10, 2009 Bane AUTHENTICATION Signature(s) authenticated on ACKNOWLEDGMENT STATE OF MINNESOTA ) ss. RAMSEY COUNTY ) .) * Personally came before me on November 10, 2009 , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named John M. Nasseff, Chief Executive Officer (If not, of Bane Co optiott""~ authorized by Wis. Stat. § 706.06) to me Isrt6wn to be w~wited~tliR~A14@AW~nM ins '` n and a e s °°''E~ HARRY E. GALLAHER THIS INSTRUMENT DRAFTED BY: ~--,:! Notary Fu:;;,c-Nr,;te~c;a Q « .Harry E. Ga a at,2ota Notary Publ' , tate of Minnesota My Co ssion (is permanent) (expires:01/31/2010 ) (Signatures may be authenticated or actmowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANX MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 * Type name below signatures. 1 of 1 1~ ` t/ (SEAL) (SEAL) * ~;/ Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code #1122 Page 1 of 3 Steel's Soil Service Attach complete site plan on paper not less than 8'/2 x 11 inches in s~ i clud t li b t it l d h d t ti i t l f Plan must i d County St. Croix n u no m e, e o: ver ca an or zon a re er percent slope, scale or dimensions, n ~ dista on an irect a to nearest road. Parcel I. . QQ pending Please prin all irffa mation. Revie ed By Date Personal information you provide may be us d for secondary pur s rlyacy La , s. 15.04 (1) (m)). UU d ~ ~O 7 Property Owner P perty Location Sienna Corporation ROiXCOUN'i`( .Lot SW1/ , NE1/4, S20, T29N, R19W Property Owner's Mailing Address PlANN1NG & of # Block # Subd. Name or CSM# 4940 Vilking Dr. Suite 608 74 na The Glen City State Zip Code Phone Number I ~ City j Village I, 'Town Nearest Road Minneapolis MN 55435 952-835-2808 Hudson Carmichael Rd. New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement ~ Public or commercial -Describe: ( Parent material Pitted outwash Flood plain elevation, if applicable na ft. General comments system elevation 100.12ft, trenches spaced and depth to code 4.08ft below grade and recommendations: 1 Boring Boring # ~. 'Pit Ground surface elev. 104.20 ft. Depth to limiting factor 103 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ 'Eff#1 *Eff#z 1 0-il 10yr3/3 none sil 2msbk mfr cs if .5 .8 2 11-27 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 27-103 7.5yr4/4 none cos osg mvfr na na .7 1.6 'Boring 2 Boring # j Pit Ground surface elev. 104.20 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0-9 10yr3/3 none sil 2msbk mfr cs if .5 .8 2 9-22 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 22-96 7.5yr4/6 none ms osg ml na na .7 1.2 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) na CST Number David J. Steel 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 1699 150th St New Richmond, WI 540 9/11/2002 715-760-0347 SBD-8330 (R.07/00) Property Owner Sienna Corporation Parcel ID # Pending Page 2 of 3 Boring 3 Boring # pit Ground surface elev. 101.50 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10yr3/3 none sil 2msbk mfr cs if .5 .8 2 13-37 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 37-96 7.5yr4/6 none ms osg ml na na .7 1.2 4 Boring Boring # pit Ground surface elev. ft. Depth to limiting factor 125 in. ~' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sil 2msbk mfr cs 1f 0.6 0.8 2 12-34 10yr4/4 none sicl 2msbk mfr cs n/a 0.4 0.6 3 34-125 7.5yr4/6 none ms osg ml n/a n/a .7 1.6 ' ~ , This boring is an addendum to the septic system that was installed on 4/16/20 0. Its purpose is to provide enough room for the alternate septic site should the present one fail. Boring Boring # pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mglL and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. Ifyou need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sB~-ss3o (R.o7/o0) Steel's Soil Service Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 SWI/4,NE1/4,S ZO,T29,R19W (715) 246-6200 Tawas afHudson, St. Croix Co. (71 ~ 246-5085 The Glen lot 74 This soil evaluation. was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test mayor may not be as shown as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' • = BenchmarkBL LOO.OOFt Top of 1/2"pvc pipe • =Alt Benchmark E1.99.20Ft Top of %Z" pvc pipe a =Borings Boring Elevations B1 =104.20Ft j`-.2~+' i ~..,- -~