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020-1075-10-500
FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER 4. f,577e Installation Address:&- & -�t��sr/n O Namo-�/�e+-men " °n 0,,vner Fame: Street: \1ail :address: /�� /Lz e Mail A�dddress- Cin\ State CO/.Zi 5 l city 05C-ed State Ldl• Zi 50.20 ?' 8230 Fax Phone C j/�.2y8"n6/Fax nonck / e mail , ,q n Q�WO. e e-mail rJoi �o►1Ei���vE, e INSTALLATION INFORMATION Model No. Blower Brand and Serial No. _ate of Installation D=of ast pump-out Size 2O GG�` wl ! I EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS- OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) I Visual Alarm Operating Audio Alarm Operating (if resent Blower (s): Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Poll xcessive Vibration Treatment Unit (s): Unusual Odor �� 7• Svstem Vent Punt out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT: LIMIT RESULT Estimated Daily Flow H (Standard Units) 6-9 S.U. Color Clear 'i Temperature Dissolved Oxygen effluent 2 m /L Odor Slightly Musty odor not septic) OWNER SIGNATURE TEC ICIAN—SIGNA4TU I SERVICE DATE 4A FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER crs- Installation Address:/3 r E 4,c(so-, p Nam a-�/�Ge Ke-'s Owner Name: Street: \\ail Address: (425-1 &i fe4 Mail Address: C111, State c,-)/.zip J city ��`Geo State Zip $Y690 � P h o n Fax Phone( /6.25/8'7'6JFax e-mail �q C,/wp, e�� e-mail �JO� ��o►1Ei��/LUG. e INSTALLATION INFORMATION Model No. Blower Brand and Serial No. � 1�te of Installation Date of las pump-out Size ZQ tP 3 3 I EQUIP1MENT DETAILED COMMENTS OF SITE CONDITIONS— OPERATION Y S NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating (if resent Blower (s): Air Inlet Filter Clean Blo�ker Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor _ Svstem Vent Pum out Required: Primary Settling one ' S :aerobic Treatment Zone EFFLUENT: LIMIT RESULT �e Estimated Dailv Flow t pH (Standard Units) 6-9 S.U. �c`S Color Clear ? Temperature Dissolved Oxygen effluent 2 m /L Odor Slightly Musty o (,v( not tic OWNER SIGNATURE TE H N1C IAN SI U SERVICE DATE i 6 Zo - /67f- /o - 500 27. Z` . / 9, 30 Z F FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PR OVIDER Installation Address:2r Ldscn p Namo�--Jfame�5 � .r►� Owner Name: Street: i Mail ,address: ,/5-1 /rt. e Mail Address,,,,,,,&,,,/&,,, r Ciro5"2StateCc) .Zi J City t�SG� � State L4)/ Zi -O i Phor, �7 � ,-,92W Fax Phone(�11.25!8'776JFax e-mail �q C ip• e e-mail eJOi �/oY1Ei��►L44 P INSTALLATION INFORMATION Model No. Blower Brand and Serial No. /Date of Installation Date of last pump-out Size 1 4 i EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS— OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating / (if present)l/ Blower(s): Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor Svstem Vent Pum >out Required: Primary Settling Zone -Nerobic Treatment Zone EFFLUENT: LIMIT RES LT Estimated Dail), Flow pH (Standard Units) 6-9 S.U. Color Clear Temperature Dissolved Oxygen effluent 2 m /L Odor Slightly Musty odor not se ti OWNER SIGNATURE TECHAICIAMIGNATURE SERVICE DATE 11Zd /LDS- FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER �4 ;�J Installation Address:2/' L" -Svrl O Namtr---JI—G�.ne�5 rrt Owner Name: Street: Mail .=address: 6l /Z2 e Mail A��s- State Ge) •Zi J Ci ©✓r-G� State U)� Zi $ DSO ?none? 8230 Fax Phon�(�1!;).2 7767F ax e-mail nq Ckov, �yrr� e-mail JOi /on�errLV� e INSTALLATION INFORMATION ,Iodel No. Blower Brand and Serial No. 'late of Installation Date of last pump-out Size J3 1 I EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS— I OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating .audio Alarm Operating (if resent Blower (s): Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor System Vent Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT: LIMIT RES LT Estimated Daily Flow (�✓ H (Standard Units) 6-9 S.U. Color Clear Temperature Dissolved Oxygen effluent 2 m /L Odor Slightly Musty odor b i not se tic OWNER SIGNATURE _f_IECHNICIAN SIGNATURE SERVICE DATE Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556399 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hudson Bridge for Youth, Inc. Hudson, Town of 020-1075-10-500 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: d • Al 27.29.19.302F TANK INFORMATION ELEVATION DATA TYPE r , MANUFACTURER .n S CAPACITY STATION BS HI FS ELEV. Septic " C-' ~ 3• S 5 / Benchmark 3 J67.65 7 my•T Dosing Alt. B!, Z- Z3 V)r- C IN Z, .37 Aeration Lil AL LA y" IMPS Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet G• ~5 /aa . TANK TO P/L WELL BLDG. Ven to Air ln ke ROAD Dt Inlet 6.p I Dt Bottom 6W►6 7 fD /Z. 1c) 9`x.4(, Dosing Zj f?d / 21 Header/Man. 4D 15 Aeration Dist. Pipe '/5 Holding Bot. System q,s X7.5 PUMP/SIPHON INFORMATION Final Grade ~Q~• Z • b `f Manufacturer Demand St Cover C.I . GPM SOD /ODd 4.A_ Z• bS Id 3 Model Number TDH Lift Friction Los System Head TDH F $.09 1. l5• ID yafvt. 0" ~•s ,5 Forcemain Length Dia. Z it Dist. to Well / 36 61 1 . 5/'m SOIL ABSORPTION SYSTEM 14t' 6 il-. , / Z , !S BEDITRENCH Width Length / No. Of Trenches PIT DIME SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 56 Z T SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION Type Of System: CHAMBER OR [ p ~,n.►e,~-r`dH ~a' 132- UNIT Mode ,Gq DISTRIBUTION SYSTEM Z 4--l Z c °L p Header/Manifold Distribution x Hole Size / x Hole Spacing/ VAi r Intake ~Z Pipe(s) Z5 Length Dia Length Dia Spacing I g Z• SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over q Depth Over xx Depth of 7d/Sodded 1xx M ned Bedfrrench Center L , /r3 Bed/Trench Edges \ Topsoil \ Yes C No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 651 Brakke Drive Hudson, WI 54Q16 (NE 1/4 SW 1/4 27 T29N R19W) Hudson Business Cent r'06 Loot 9 Parcel No: 27.29.19.302F 1.) Alt BM Description = `a J eJ d- 'S ~j ai t. a 2.) Bldg sewer length - - amount of cover Plan revision Required? ~ 0 Yes No Use other side for additional information.' Date Insepctor's i ature Cert No SBD-6710 (R.3/97) County Safety and Buildings Division St. Croix g t 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) & E Madison, WI 53707-7162 State Transaction Number p p Sany eNrplication governmental In accordance with SPS 383.21(2), Wis., Ql* submission of this fort to the appropriate _uw►it Project Address (if different than mailing address) is required prior to obtaining a sanitary~gt►iY Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Profes ' al Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m), Stats. Same I. A lication Information - Please Print All Information Parcel # Property Owner's Name The Bridge For Hudson Youth, Inc. 020-1075-10-500 ~ 3 6 2 Property Owner's Mailing Address Property Location Govt. Lot 651 Brakke Drive NE section 27 City, State Zip Code Phone Number _SW~'/,, (circle one) Hudson, WI 54016 (715) 381-8230 T 29 N; R 19 W II. Type of Building (check all that apply) Lot # 9 Subdivision Name El I or 2 Family Dwelling - Number of Bedrooms Block # CSM 4612431 blic/Commercial -Describe Use Life Skills Training Faciliri Na ❑ City of CSM Number El Village of ❑ State Owned -Describe Use CSM Vol. 13, Pg. 3751 own of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other modification to Existing system (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision 11 Change of Plumber El Permit Transfer to New ~ ~ ~ { ! 22 ZA6 3 Before Expiration Owner 7 IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non-Pressurized In Ground essurized 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. Dispersal/Treatment Area Information: 24 Infiltrator "Q-4 Plus" Standard chambers & 4 endca s, S tech STF-100A effluent filter Design Flow (gpd) Design Soil DisPersal Area Required (sf) Dispersal Area Proposed (sfl System Elevation ApplicationRate(gpdsf► 392.OOGpd 1.6 Gpd/Sq. Ft. 245.00 sq. ft. 245.36 Sq. Ft. 97.50' Capacity in Total # of Manufacturer „ W. Tank Info Gallons Gallons Units U° , New Tanks Existing Tanks a U ti is y septic or Holding Tank Wieser 500 Huffcut 800 1,300 2 Wieser & Huffcut Conc. X Dosing Chamber Wieser 1,000 1,000 1 Wieser Concrete X VII. Responsibility Statement- I, the nude igned, assu responsibility for installation of the POWT MP~RS on the Number shed Bus Hess Phone Number Plumber's Name (Print) Plumber's ignature James K. Thompson 5- - MPRS 30021 (715) 248-7767 Plumber's Address (Street, city, state, zip code 340 Pau son Lake Lane, Osceola, WI 54020 VIII. oun /De epartment Use Only Perrrr7777nnnnit Fee Q~ Date I ued sluing Agent ign e < Approved ❑ Disapproved $ I en G~ ❑ Owner Given Reason for Denial G 4: / IX. CSTditi provaUReasons for Disapproval ,6-) 11. Septic tank, effluent filter and (~Q'l dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained ~S y ttac to comp to plans for the and submit to the Con only impaper not less t6yn 8 r(~ s 11 i i s' J~ SBD-6398 (R- 11/11) ( $ ~ 9~EARTb~Y os'`' o Safety and Buildings 141 NW BARSTOW ST FL 4TH 3 WAUKESHA WI 53188-3789 Contact Through Relay 'moo www.dsps.wi.gov/sb/ o sti www.wisconsin. ov ssroNn~ 9 Scott Walker, Governor Dave Ross, Secretary November 28, 2012 CUST ID No. 30021 ATTN.• POWTS Inspector JAMES K THOMPSON ACE SOIL & SITE EVALUATIONS ZONING OFFICE 340 PAULSON LAKE LN ST CROIX COUNTY SPIA OSCEOLA ~4~ 54020 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/28/2014 Identification Numbers Transaction ID No. 2170059 SITE: Site ID No. 785822 The Bridge For Hudson Youth Please refer to tri h identification numbers, 651 Brakke Dr above, in all esp ondence with the Town of Hudson, 54016 a ency. St Croix County NE1/4, SW1/4, 527, T29N, R19W Lot: 9, FOR: Description- Pressurized In-Ground + ATU, Youth Facitity Object Type: POWTS Component Manual Regulated Object ID No.: 1400543 Maintenance required; Replacement system; 392 GPD Flow rate based on meter readings; 100 in Soil minimum depth to limiting factor from original grade; System(s): In-ground POWTS Component Manual, SBD-10705-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Aerobic Treatment Unit, Commercial System, Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBDtW06-P (N.01/01) and the "In-Ground Soil Absorption Component Manual for Private Onsite Wastew r Systems" SBD-10705-P (N.OJ/01). {~/y.. 4 _I .11. AL SPS 383.21(2)(c)4. The application for a sanitary permit shall be accompanied wit th a the master plumber or master plumber-restricted service who is to be responsible for the installati POWTS, has completed approved training on the proposed POWTS technology or meth: C t,1pn of the SPS 383.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. ' t. JAMES K THOMPSON Page 2 11/28/2012 The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. Per SPS 383.21(2)(c )5, Wis. Adm. Code, if any part of the POWTS management plan specifies required servicing or maintenance at an interval of 12 months or less, the activity must be recorded with the deed for the property. A sanitary permit may not be issued unless documentation that maintenance requirements for the POWTS technology or method have been recorded with the deed for he boner, In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 38354(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and. open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior t tY o commencement of constriction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. S, } ► JAMES K THOMPSON Page 3 11/28/2012 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397-6005, Fax: (608) 283-7481 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Conventional POWTS W/ ATU - Index & Tilte Sheet FtC-CEIVED Project Name: The Bridge for Hudson Youth, Inc. NO V 13 2012 Contact Name: Peg Gagnon - Manager SAFETY & BUILDINGS Owner's adress: 651 Brakke Drive, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 9 of CSM Vol. 13, Pg. 3751 - Exit Four Business Park Legal Description: NEIA SWIA, Sec. 27, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID 020-1075-10-500 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Daily Flow, Septic & DoseTank Sizing Calcuaations Page 4 Distribution Network & Dispersal Cell Sizing Calculations Page 5 Dose Tank Cross Section & Pump Curve Page 6 System Cross Section Page 7 System Management Plan Page 8 Filter Specifications Page 9 Septic 'rank/Pump Tank Specifications Page 10 Parcel map Page 11 Certification for Utilization of Existing Septic Tank Page 12 Septic Tank Maintenance Agreement Page 13 Waranty Deed Page 14 Aeration Treatment Unit Agreement Page 15 Aeration Treatment Unit Service Contract Attachments: Soil Evaluation Report by Grote Supporting Documentation of Waste Water Loads & Flows SludgeHammer letter of agreement Mater PI er Restrict d Service: James K. Thompson, De 't. of Safe & Professional Services Credential #3002 I,.1 psi f+i ~i~ Signature: Cyy~„t y-'- Date: ,1{;S OeGj~~/ AQN~F ge 1 *f5 ticF Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) .~F SvS~em QICd~'arr5 s~81" /►~Xi'S~%~5 ~~~c e le✓ 64.: T,o 0~4 olao b% 14 U /Oo.4,5- a JL c'Xi 5L'.l q S. 7- '17 1Z -6- 44X e4 ot6a...1) SE. rf e~ c Jo~.~l now, fv/d ° r18.7s L = 91~' 74e &,,dot ~~l~~daon'/out~, $qc • l~iS~ • e~//;~F/E~, do se~~aee loSJ ~3ra~,('c Gtr. ~'Xis~%t,q d%s~i; a6ifP~u~'~*~e= 97.7 o f/u cls~, cJ/, ~v/6 ~ UU Lot 9, e si r/ dW 13, 37.5/ E~ysw%~ SeC z7, 7'Z9?, ,P 19~v.,T•or~/~, ~.~,x G; bt,n Soac.~es So~~ C.ondi ~1m5 .n IOU.. *t oZO-107.5- /O-5'c ~ 5 ! o c.o.k4 01 ~c rJor-t7k a.-e- E i Sv'~t'9 h/u ~{Ccc~ cc.n Sw dab 1? PO u)•T~ cr GSe~'~e a5,4er'poi!ei/a/uafz~-, ~Poscdu9;ester~'ne~c GY•~co -b%v{u,be ~ u~soo/iux~'inQCor►~.Erno.~ 10 ,o c ~.x/s~~ Pro/bse,d d~.S•E~'i bu~i Uo-due' ~ Pv/~/.L~/~ PL-S~ 6,, a 6. r h drreuL all fJd c~onmerC~~~-Spe.sa(Ce/ W~cfr:~ 7V K o o y~ K 2G' ~ ~xClili,nq e bride e. on ,2 " S~ • el P. d.C. EXis~: We P ,,y~ h Rur c e m a,'eo c~xsE S,de o~~~'w ldin Se L/~' ~ qNs ~ o d; s ce = QpPrak.~' q d ~e c : T .:s n .T i3'Jr.-n ~ d/i Cot//: Elc v, = /o ~ 8~"ash • ioj 9D' S ~ . C~•o i X ~ . i~lSPe~~+ /'mer'i't: . c~.s p ka L~ Dr~~e~a►y ~poieciu6/~ 5/ope-5 press ro~ydu,~- area. 0 ,souk /of /.hc SB' 31J4 P~. zoF/S Bridge for Hudson Youth, Inc. Non-Residential ATU POWTS In accordance with In-ground POWTS Component Manual, Version 2.0, SBD-10705-P (N.01 /01) JOB DESCRIPTION: Installation of replacement in-ground POWTS to serve Life skills training facility. Soil evaluation report on record at the St. Croix County Zoning Dep't. indicates the site contains sandy soils that will accept effluent at a rate of 0.7/1.6 gpd/sq.ft./day- PROPOSAL: Install Sludge Hammer S-86 ATU into existing septic tank, install new Wieser 50011000 gal. combination septic tank/dose chamber with new PolyLok PL-525 effluent filter at outlet of 500 gal. ST. Demand dose out of 1,000 gal. dose chamber. Valve to be installed to allow future reuse of existing hydraulically failed dispersal cell. Wastewater Flow: 392.00 gallons per day 1. Monitored Wastewater Flow, August 9 - October 24, 2012: 260.85 Gpd Flow meter registered 14,086 gallons/54 operational days = 260.85 Gpd 2. Design Wastewater Flow: 391.28 Gpd (260.85Gpd estimated flow)(150% design safety factor) Wastewater Strength as Tested: B O D = 530 MeL, F O G = 17 Mg/L, T.S.S. = 106 Mg/L Aeration Treatment Apparatus Calculations: BOD Removal: Wastewater strength measured at 532 mg/1 BOD = 1.68 lbs. BOD to be removed/day. Manufacturer & Capacity: SludgeHammer S-86 designed to remove 3.0 - 6.0 Lbs BOD/day. Installation: One (1) SludgeHammer S-86 unit placed below inlet of existing 800 gal. septic tank. Septic Tank Capacity Calculations: Existing Septic Tank Manufacturer & Capacity: Huffcutt 800 gallon septic tank with Orenco Bio-tube effluent filter 1. Minimum required capacity: 758.05 gallons (392.00) + (11.61 x 2* x 5.23) + (46.77 x 5.23) = 758.05 *(Requires a two year maintenance cycle) 392.00 gpd / 75 gpd = 5.23gpd person equivalency 2. Additional S.T. Capacity & Manufacturer: Wieser 50011,000 gal. combination ST/DC. installed in series with existing 800 gallon Huffcut ST. 3. Capacity per SludgeHammer design specifications = 60 hr. - 72 hr. minimum retention time. 4. 1,300 gal. tank retention time = 79 hrs. 26 minutes (1,300 capacity/392.00 gpd DWF) Dose Chamber Capacih & Dose Volume Calculations: Manufacturer & Capacity: Wieser Concrete W 1000-MR (51.00" L 19.61 gal./inch = 1,000.10 gal. actual) 1. Pump Chamber Calculations: A) 24 Hr. holding capacity: 33.00" = 647.13 pal. B) Alarm setting: 2 00" = 39.22 gal. C) Dose volume + flow back: 4.00" = 78.44 gal. (392.00 gal./5 doses per day) + (0.0)(105') = 78.40 gal. max. dose volume (.064 gal./lineal foot of 1'/a" lateral)(48.0')(2) = 61.44 gal. min. dose volume D) Reserve storage: 12.00" = 235.32 gal. TOTAL: 51.00"= 1 000.11 gal. 2. Pump selection: Manufacturer: Zoeller Model number: BN 53 Min. discharge rate required: 20.50 gpm Pump discharge: 25.00+- gpin 1.3.46' TDI-I Pg. 3 of 15 Pressure Distribution Network: 1. Distribution pipe sizing: Laterals per cell: 2 Lateral length: 48.00' Lateral size: 1'/4" Orifice size: 1/8" Orifice spacing (x): 24" 1 st hole at 12" from manifold entrance into endcap) Orifices per lateral: 25 Network discharge rate: 20.50 gal. /minute (21aterals)(25 orifices/lateral)(0.43gal/orifice) 2. Manifold sizing: Location: End Length: 6.83' Diameter: 2" Friction loss Manifold: 0.50'(6.83')(1.39 ft./100ft.) = 0.08 ft. + 0.42' fittings 3. Force Main: Diameter: 2" Length: 105' Flow rate: 25.0 alg /min. Friction loss Forcemain: 1.46' (105')(1.39 ft./100ft.) = 1.46 ft. 4. Total dynamic head: 13.22' Min. supply pressure: 5.00' Vertical lift: 6.50' (high point of forcemain =103.0', pump off= 96.5') Friction loss (Forcemain): 1.46' Friction loss (Manifold): 0.50' Total dynamic head: 13.46' 5. Fluid Flow Calculations: 2.55 ft./second Effluent velocity = (.408)(25 gpm) = 2.55 ft./second (flow through PVC pipe to be 2 - 10 ft./sec.) 4 Lateral Construction Detail: 1. Pressure distribution laterals to be installed in accordance with manufacturer recommendations within "Installation Instructions for Quick 4 Pressure Distribution Systems". 2. Distribution lateral to start at entrance through multi-port end-cap. I" orifice located at 12" from entrance through end-cap, last orifice located at 12" from end cap. 3. Distribution laterals to be suspended from top of Infiltrator chambers by plastic pipe straps at chamber connections. 4. orifices to be drilled at 12 o'clock position with every 5t' orifice drilled at 6 o'clock position to allow effluent drainage upon completion of dose cycle. 5. Sim/Tech stf-106 orifice shield to be installed on downward facing orifices to dissipate hydraulic pressure. 6. 1'/4" lateral cleanout extension to be brought to finished grade by use of long sweep 90° elbow. Cleanouts to terminate within valve box. Dispersal Cell Calculations: 1. Design Wastewater Flow: = 381.00 gad Desigg Flow 2. Infiltrative capacity of natural soil = 1.6 gpd/sq. ft. 3. Absorption area required: 238.125 sq_ft. 4. Absorption area as proposed: 245.36 sq. ft. (24 chambers total) Infiltrator "Quick 4" = 9.64 sq.ft. ISA per chamber, Infiltrator "Quick 4" end cap = 3.50 sq.ft, ISA 238.125 sq. ft. - (4 endcapsx3.50) = 224.125 sq. ft. 224.125 sq. ft./9.64 = 23.25 chambers required Number of trenches: 2 a, 12 chambers per trench Trench width: 2.83' Trench length: 50.00' Total system area w/ 4' trench spacing: 9.66'x 50.00' Dispersal cell infiltrative surface elevation: 97.50 Pg. 4 of 15 - TOTAL DYNAMIC HEAD/FLOW PUMP PERFORMANCE CURVE PER MINUTE LL MODELS 53/55/57/59 EFFLUENTAND DEWATERING 6 20 MODEL 53/55/57/59 Feet Meters Gal. Liters 15 5 1.5 43 163 4 10 3.0 34 129 ° 15 4.6 19 72 ~ 10 o 7 Shut-off Head: 19.25 ft.(5.9m) ~ 2 5 x718 63116 ~ 516 - 1 12 •11 12 NaT 10 20 30 40 50 3 716 vALLONS LITERS "41-, 0 80 160 FLOW PER MINUTE 4 I Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC ~ 4 in. min. Disconnect Tank component is properly vented F- - Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 1000.11 Gallons - T Volume 19.61 gal/inch A Weep hole or anti- Dimension inches Gallons B siphon device A 33.00 647.11 C B 2.00 39.22 Pump off elevation (ft) C 4.00 78.46 -f 96.50 D I 12.00': 235.32 D Total 51.00 1000.11 Dom se tank elevation (ft) 3" Bedding un er tank. 95.50 Alarm Manuafacturer jSJE Rhombus PS Patrol System] Alarm Model Number PSP120V6H151P17A ; Pump Manufacturer Zoeller Pump Model Number BN 53 MAIL T0: P.O. BOX 16347 LouBvilla, KY 402:% 347 Manufactwe7s of.. O SHIP T0: 3649 Cann c , I(Y 40211.1861 QuaurrPcu+Pa SNCE /999 ® PUMP !O. (5021Louis'.'364 ille 7 FAX (502 X80.36° 4~PUMP h t tp Y7www.zo e11 er. c om ©Copynght 2004 Zoeller Co All rights reserved. 5' i m • 0 m ` In cn m i Z m Fn x c> x O m Cf) N m 3 m P. r m z m (n I T ~ > Dc p m z v m c) m c c) cn 3 v m m -i m v m I p o ~mc0 A(ncn -0 m < I ~C;u v N 5m0 m ZZ > Z --I m r n Dmm C') m z A p t D m ~ D ^ r t Z c O i r > o p I A r ~ ~ D OZ v ~ -C~. m co p C C/) w o > .~D.< D N m m m~~ < G) 0 0com f m z z m m i ~nn co LI) z z /^z = A m l l ~ p > > O v z z rm > p > O r n O A A m z T m pm p /~Z A J > ~ 10 ~ ~T m m Z I (gyp O Z z~ 2 P T ~ Z O I 67 I Z T v O iah.:. m O K I z X = cn z l7 Z D ins"d:m ~ Z O U I ~w~m~ ® Ow p w r~000 0m n cm m z D < n m nr S m K ;o 7', n c_ G D 3 o, P D •rnl~ m p W f N V U rn C ~vtNi!G, ~ e ~ C) S D If O m I~ (D r T D 717 (n m ~QA Q n A p ~ cmnAO z I r A (z n C=N m°Zi~< O 0_ rn ➢ to Im-0 > m T 7 m z i > m m p rn m I m W O_om~y 1 N M Z=G)O:~ r'4 c A co Zmy im Z n °Zpmvx ,l~II A JF'j J In-Ground Highly Treated Dispersal Cell Management Plan Pursuant to Dep't. of Safety & Professional Services 383.54, Wis. Adm. Code General The In-Ground septic system shall be operated in accordance with Dep't. of Safety & Professional Services 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10706-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Septic or pump tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. _Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every year by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1 /3 scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Dep't. of Safety & Professional Services, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once each year. All switches, alarms, and pumps shall be tested to verify proper operation. A diversion valve will be installed into the forcemain to allow future re-use of the failed cell. Dispersal Cell and Pressure Distribution System The dispersal cell shall be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) on the dispersal cell is not recommended. The pressure distribution system is provided with a flushing point at the end of each lateral. Each lateral should be flushed of accumulated solids at least once every 12 months. A pressure test should be performed with the results compared to the initial test taken at the time of system installation to determine if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Testing effluent quality The sewage effluent generated at this site may exceed the high strength effluent concentration levels as established by the Wisc. Dep't. of Safety & Professional Services. Influent quality entering the mound dispersal component of the POWTS may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Periodic testing of effluent concentration will begin 45 days after the system is placed in service and will continue at 4 - 6 day intervals for a period of 30 days with 6 samples being collected within that period. If concentration levels exceed Dep't. of Safety & Professional Services standards, a second ATU treatment component will be installed in the existing treatment tank. Effluent quality will be assessed as described earlier. Results of testing will be submitted to the County Zoning Department. Influent flow may not exceed maximum design flow specified in the system design and sanitary permit. ATU will be inspected and maintained as per Agreements on file with system design and approvals. Management Recommendations 1. Monitor wastewater flow from facility monthly. 2. Monitor existing trenches semi-annually to determine condition of bio-mat and remediation of hydraulic failure. 3. Clean effluent filter annually. 4. Pump out contents of septic tanks on a two year rotation. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the aeration unit, pump, pump controls, alarm or related wiring become defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the dispersal cell component fails to accept wastewater or begins to discharge wastewater to the ground surface, effluent flow will be diverted to the resting cell. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or your County Zoning Inspector at (715) 3864680. Pg. 7 Of 15 • • Filters PL-525 EFFLUENT FILTER 1,~ , (004 ) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD alarm (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16^ removed for cleaning, the ball will filtration slots Rated for over 10,000 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe' PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned' every time the tank is pumped or at least every three years. If the installed filter contains an optional Y" alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be ; Gas deflector done by a certified septic tank automatic shut-off pumper or installer. ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4 or 6 outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. P a z A cn 691" 93" mm 56" c m _ D Z 0 p 0 00 r m° HOC MQ 15" O u 0 "j z m 51 \ 0 X~A'' c°o c_ 0 ~ f Tl v 61 -=J5' U) 0 N ' Q N m C V J m m~7-~ C _ < I I D m ° 54" m ° O N 00 T N m c 0 Cn O r0 z z ° z o A m m m o D NZ D ~Z CmoZ~ZOOD~ ~S ° D 0 0° U) 0 x-0~c0 =r~* ~rZ 01 C N D 00 mD0 ~~O.O+yNN O 0 NC ~~C mZtO.. Om~ Am' - 8 (D X 0 co 4L -0 m 00 (nom ~ D~ Ln o- D v O 8to mD "1 ONO~i~~Nra 0 n Q v v s O +1 D r W a s ~a p ( - m TI E z yy D~ m0 ti b o°M D m °n v O H D r- __j n z v m z 2 Z Z ° W O U c DN y a N 0_n 0~ z v - 0,0 0 n ,0 V) ;o C 0 ~v m r L 3 r c r~ D H M r~ m M m v \ 2 DRAWN BY. SWT SCALE: 1/4"=l'-O" PRE-POUR: o ACE SOIL & SEPTIC MISER COACAETE REV. m PROJECT: BRIDGE FOR -I HUDSON YOUTH DATE: 10/4/12 DATE:. POST-P \ Z PH: 2815 RILEY ROAD PORTAGE, WI 53901 ° FAX: 715-248-7764 800-362-7220 FILE:elwro cnl&r&-hd* rarb lorl*e sd &soac-k*far wdm)whay 9 FILED MAR E; J s OCY201999► C1243:1 Ae 1Z sr. Ci?niy mum SL CEO'~C°'w` CERTIFIED SURVEY MA 'SR-- D IN PART OF THE NE 1/4 OF THE SW 1/4 OF SECTION 27, 29N, R 19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. PK N1/4 ITHAWI NOESSD CHECKS SECTIONR27R SCALE IN FEET 1" = 60' W MONUMENTS OF RECORD 100 0 100 N1% I %~i C\ZI 3 L o c) o0 ocu OWNER EAST - WEST 1/4 LINE ~ a III C.P.T. LLC r.l I 1809 NORTHWESTERN AVE. W1/4 CORNER N89.57'08"E ~I STILLWATER, MN 55082 SECTION 27 N89.57'08"E 2616.13' N i I LOT-1 C. S_. _M. 2604.21' EI/4 CORNER VOL_ 6. -PG.-1726 SECTION 27 oa) 3 ti M I th - BRAKKE _DRIVE - o WI o f'7 y ~ I S ' 7" 341.58 4 - ' - 278.66' I cu ~I PARKING SETBACK LITE VISION d I WI '••,TRIANGL~E z 0 ELI 1 _ I ~I A BUILDING. SE BACK LINE •`'zl v W ft~l '~I M I x•.15' .i M z - 1J~ -i u (L cu u co N N\ ©I MI N I Offal W Lid W t/1 ~ t- 3 t- N ~ 1 I W LOT 9 LI 3 0 ~ (4 ql ` 1.500 ACRES xl o ~ % , ° ~cl Ga 1-Z4 CD ~I p I a I 65,341 SQ. FT. I a CD Ca Q x o at O I ° I Z CD C) 50' ti p z v' Q I a ~i 25' I W wl z a I ~ W tt~~~ - - - - - - 33' 33' SETBACK LINE in SCI 'del LL---LPARKING - - - 308.58' - 33.00' I z I N89.50'37"W 341.58 Q'i UNPLATTED LANDS OWNED BY PLATTER ~ E-.41 LEGEND - , O - ALUMINUM COUNTY SECTION CORNER o o W z ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) &5-1,45r-aX, re D-. sal n, &j/. 550/6 located at: rlE '/4, 5[,) '/4, Section g.7 , Town .2-~ N, Range /!F W, Town of ✓s 9-, , St. Croix County Wisconsin. Upon inspection, 'I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.2, and it (the)-) appear(s) to be functioning properly. Most recent date of inspection or service Qcy- /6" Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: _ A gallons minutes Tank Capacity: 8co Construction: Prefab Concrete t,~ Steel Other Manufacturer (if known): //,t~~ ~aricr~e - Age - nk (if known): Q?~s P rmit nur ber (if known) _ 4?j?1,,3 icensed Plumber Signature) (Print Name) (Title) (L.icense Number,IPIZS 20/2- (Date) Form to be completed by licensed plumber- (Dept of Commerce Chapter and s. 14-5.06, Wisconsin Statutes) or licensed disposer (NR 1 13 Wisconsin Administrative Code) Rev. 9/2008 //o/ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owned e i_ e t cs~Srir, l d ~i~e Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State co/. Parcel Identification Number X07 J!~-Sl.~ 11~s~ LEGAL DESCRIPTION Property Location 1)9- '/4 '/4 , Sec. .2-7, T _ 29 N R _/y W, Town ofu Subdivision Plat: /4 - , Lot # . 9 Certified Survey Map # 6 /,Z 5/01 Volume _ 1,3 Page # -37S/ - Warranty Deed # 9d9 o~ _ _ (before 2007)Volume ,Z/93 , Page 337 _ Spec house 17~ Lot lines identifiable ~ ❑>w 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 (1) 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. 1/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 above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 39a~~~ SI A 1JRE OF APPLICANT(S) 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. 04/07) nnY"q_ ~.2 d~/S * 9 0 9 4 6 2 1 State Bar of Wisconsin Form 1-2003 909462 WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD, 12/31/2009 09:20AM THIS DEED, made between Weber Young Group, LLC, a Wisconsin Limited WARRANTY DEED Liability Company EXEMPT II ("Grantor," whether one or more), REC FEE: 11.00 and Bridge for Hudson Youth Inc. a Wisconsin Corporation TRANS FEE: 1755.00 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in I St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Part of the NE V4 of SW % of Section 27, Township 29 North, Range 19 West, St. File # 2804097 Croix County, Wisconsin described as follows: Lot 9 of Certified Survey Map filed October 20, 1999 in Volume 13, Page 3751, Document No. 612431 020-1075-10-500 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated December 29, 2009 Weber Young Group, LLC (SEAL (SEAL) * * Steven eber, Member (SEAL)~~^- _ (SEAL) * * Stephanie K. Weber, Member AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. St. Croix COUNTY ) STATE OF WISCONSIN * Personally came before me on December 29, 2009 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Steven J. Weber and Stephanie K. Weber, Members of Weber Young Group, LLC (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. 706.06) instrument d k vledge s e. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berk Notary Publ , State of Wisconsin/ 1200 Hosford Street Suite 201 Hudson WI 54016 My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 1 of 1 13 a71 Document No. POWTS AGREEMENT Owner name and address: The Bridge For Hudson Youth, Inc. 651 Brakke Drive Hudson, WI 54016 This indenture, made by "owner" and their successors in interest, own a POWTS (Private Onsite Wastewater Treatment System) requiring regular monitoring and maintenance in accordance with the manufacturers recommended Return to: procedures. These procedures must be performed by a manufacturer authorized St. Croix County Zoning Dep't. service provider licensed by the State of Wisconsin to perform these services. Results of these procedures shall be reported to the appropriate Governmental 1101 Carmichael Road Unit as required by code. Suite 1200 Hudson, W1 54016 Location of POWTS: 651 Brakke Drive, Lot: 9 Block: Na , Subdivision/CSM: CSM Vol. 13, Pg. 3751, being part of NE'/4SW'/o, Section 27, T. 29 N., R. 19 W., Tn. Of Hudson, St. Croix County, Wisconsin. Parcel Number: 020-1075-10-500 POWTS DESCRIPTION: Sludge Hammer S-86, pre-treated effluent discharged to new in-ground dispersal component with pressurized effluent distribution. OWNERSHIP RIGHTS AND RESPONSIBILTY FOR POWTS: Property "owner" as described holds sole ownership rights. "Owner" is responsible for insuring inspection, operation and maintenance of POWTS. pf2, Y , ~ , , _-zo/ (Owner s ature) (Date) (Owner signature) (Date) Acknowledgement: /TTse n~ fed, Peg Gagnon, known o me to be the person executing the foregoing instrument. Subscribed and' sworn to before me this 4day of~~ ~L-- 2012. TARY PUBLIC, State of Wisconsin My Commission Expires: _5tember 6 2015 Instrument Drafted By: James K. Thompson POWTS SERVICE CONTRACT The proper operation and maintenance of the components listed below will significantly influence the performance and life expectancy of the POWTS (Private Onsite Wastewater Treatment System). This agreement authorizes A.C.E. Soil & Site Evaluations, L.L.C. personnel (Service Provider) or their representative access to the POWTS components during regular business hours to perform regular inspections and routine maintenance of those components. It is herby agreed by and between Purchaser and Service Provider that in consideration of the payments provided for herein, Service Provider will provide a manufacturer trained and State licensed inspector to perform periodic inspections of the POWTS components as set forth below. Service Provider will prepare a written inspection report after each inspection containing any recommendations for the operation, maintenance, and or repair of the POWTS deemed appropriate by the Service Provider. A copy of the report will be provided to Purchaser and the appropriate Governmental Unit. Service Provider will supply additional services, parts, or labor only after authorization by purchaser. This agreement does not assume any responsibilities or obligations that are normally the responsibilities and obligations of the purchaser and does not cover any costs associated with operation, maintenance and or repair of the POWTS. In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property, or incidental economic loss due to equipment failure for any reason whatsoever. This agreement shall remain in effect for a period of two (2) years from the date of POWTS installation, and will be automatically renewed each year thereafter unless amended or cancelled by either party with 30 days written notice. This agreement may be cancelled by Purchaser only if replaced by a service contract with another service provider authorized to inspect and maintain the specific POWTS components in question. Purchaser agrees to pay Service Provider the sum Of _ 125.00 per inspection. Four (4) inspections will be provided over the first two-year period at six-month intervals. Payment for the first four inspections will be included in the cost of the POWTS design. One (1) inspection per year will be conducted thereafter with inspection fees billed at the time of inspection. POWTS DESCRIPTION: One (1) Sludge Hammer S-86 pre-treatment units, pre-treated effluent discharge to In-ground dispersal component constructed in compliance with In-Ground Soil Absorption Component Manual version 2.0, SBD-10705-P (N.01/01). POWTS Location: 561 Brakke Dr., Lot: 9, CSM Vol. 13, Pg. 3751 known as Exit Four Business Park, NE 1/4 SW '/4 of Sec. 27, T. 29 N., R. 19 W., Tn. of Hudson, St. Croix Co., WI, Parcel # 020-1075-10-500 Owner name and address: The Bridge for Hudson Youth, Inc. Peg Gagnon Executive Director 561 Brakke Drive Hudson, WI 54,01166 , (signatu (Date) Service Provider: A. oil & Site Evaluations, L.L.C. 0 Pauls n Lake Road Osceola, 1 54020 rvice Provider signature) (Date) Instrument Drafted By:_ James K. Thompson 04/16/2012 15:47 FAX 1 715 962 4030 CTL Q001/001 Commercial Testing Laboratory, Inc. 514 Main Street 6 P.O. Box 526 Colfax, Wisconsin 54730 WWW.CrLCOLFAX.COM Phone: 715-962-3121 Phone: 800-962-5227 Fax: 715-962-4030 ANALYTICAL REPORT Ben Morgan Report Numbert 12007845 Page= 1 Tri County Sanitation Report Datet 4/16/12 1029 4th Street Date Received: 4/10/12 Hudson WI 54016 Sample Date Number Sample ID Test Results Method LOD/LOU Analyzed - - - - - - 12-W9918 The Bridge BOD (5 Day), mg/L 530 SM521" 4/10/12 556 Brakke Dr Tot.Suspended Solids,mg/L 106 SM254$D 4/11/12 Hudson,WI 4/ 9/12 12-W9919 The Bridge Oil (3rease(Hexane)smg/L 17 166 3/10 4/13/12 556 Brakke Dr Hudson,WI 4/ 9/12 RESUL7-a: FAX'D ON: W ' PHONED ON: CALLER: _ WI DNR Laboratory Certification Numbert 617013980 Approved by: N 04/16/2012 15:47 FAX 1 715 962 4030 CTL 10001/001 I ne. Commercial Testing Lkoratory, 514 Main Street P.O. Box 526 Colfax, Wisconsin 54738 WWW.CrLdCOL;FAX.COM Phone: 715-962-3121 Phone: 800-962-5227 Fax: 715-962.4030 ANALYTICAL REPORT Ben Morgan Report Numbers 1207845 Page: 1 Tri County Sanitation Report Dates 4/16/12 1029 4th Street Date Received: 4/10/12 Hudson WI 54016 Sanpl4 Date Number Sample ID Test Results Method LOD/LOG! Analyzed 12--9919 The Bridge BCD (5 Day), mg/L 530 SM521N 4/10/12 556 Brekke Dr Tot.Suspended Solids,■g/L 106 SM2546D 4/11/12 Hudson,WI 4/ 9,/12 12-W9919 The Bridge Oil & Orease(Hexane),aig/L 17 1664A 3/10 4/13/12 556 Brakke Dr Hudson,WI 4/ 9/12 RESULTS: FAX'D ON: W- - PHONED ON-. CALLER: _ WI DNR Laboratory Certification Numbers 617013980 Approved by: ri Conventional Non-Residential POWTS Index & Tilte Sheet Project Name: The Bridge for Hudson Youth, Inc. Contact Name: Peg Gagnon - Manager Owner's adress: 651 Brakke Drive, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 9 of CSM Vol. 13, Pg. 3751 - Exit Four Business Park Legal Description: NE1/4 SWi/4, Sec. 27, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID 020-1075-10-500 Page 1 Index and Title Sheet Page 2 Septic Tank Maintenance Agreement Page 3 Existing Septic Tank Certification Page 4 Warrany Deed Attachments: State Approved Design Packet Mater P ber Restrict d Service: James K. Thom son, Dept. 'of Safe & Professional Services Credential #30021 Signature: Date:-3 Pagel Of5 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101; R. 10/12) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owned Mailing Address S )6,,~101 Property Address "e (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 0,2Z - /0,7,6'_- e)-Siz i 1-~c,~lsvr~ c LEGAL DESCRIPTION Property Location 12e_ '/4 , S~ '/4 , Sec. ,-'-7, T N R19 W, Town of 'Subdivision Plat: !/(Q , Lot # Certified Survey Map # ~o /,Z 5101 Volume /3 , Page # 37S-/ Warranty Deed # Yclf .Z _ _ (before 2007)Volume ,2/9,3 , Page # 337 _ Spec house i7/lyes~o Lot lines identifiable i~"yes Owe 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 Pianning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 I'lannin & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we ant/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. :dumber of bedrooms 39aP( i&I - / v i~Yi' /3- S1 . A RE OF APPLICANT(S) 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 it' reference is made in the warranty deed. (RE N. 09/07) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence- (Street address) &S/ A/aelf e Z'. located at: Z:) c,) 1/4, /1 %4, Section ~t-:7 , Town~N, Range W, Town of /c.GplS~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 7-012- Did flow back occur from absorption system? Yes 4----No (if no, skip next line.) Approximate volume or length of time: 1" 7jcnaygallons n w4-ninutes Tank Capacity: Z Construction: Prefab Concrete i,,~ Steel Other _ Manufacturer (if known): /&~/Cutfic ank (ifknown): 9 it n ber (if knownz9 113 ensed Plumber Signature) (Print Name) ~3c021 (Title) (License Number),MPRS A~ 3 0, 12- (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 * 9 0 4 6 2 State Bar of Wisconsin Form 1-2003 909462 WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 12/31/2009 09:20AN THIS DEED, made between Weber Young Group LLC, a Wisconsin Limited WARRANTY DEED Liability Company EXEMPT I ("Grantor," whether one or more), REC FEE: 11.00 and Bridge for Hudson Youth, Inc. a Wisconsin Corporation TRANS FEE: 1755.00 PAGES: 1 ("Grantee; ' whether one oT more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in 1 St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Tide, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Part of the NE of SW of Section 27, Township 29 North, Range 19 West, St. File # 2804097 Croix County, Wisconsin described as follows: Lot 9 of Certified Survey Map filed October 20, 1999 in Volume 13, Page 3751, Document No. 612431 020-1075-10-500 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of--way of record, if any. Dated December 29, 2009 Weber .,oung Group, LLC (SEAL (SEAL) 4__~X/ * * Steven eber, Member (SEAL) -c~re n (SEAL) * * Stephanie K. Weber, Member AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) K. 89 0- NG ) ss. authenticated on 11 • St. Croix COUNTY ) STATE OF WISCONSIN Personally came before me on December 29, 2009 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Steven J. Weber and Stephanie K. Weber, Members of Weber Young Group, LLC (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. 706.06) instrument d k wledge s e. THIS INSTRUMENT DRAFTED BY: e4- PM?"LaW Attorney Doug Berg Notary Publ , State of isconsi h 1200 Hosford Street, Suite 201 Hudson, WI 54016 My Commission (is permanent) (expires: 1 ) (Signatures may be authenticated or acknowledged. Both are not necessary,) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 1-1003 * Type name below signatures. 1 of 1 AIsconsin Depa-etjnent of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429913 0 GENERAL INFORMATION (ATTACH TO PERMIT) tate Plan ID UcL T- Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. = t ms. 4 Permit Holder's Name: City Village X Township Parcel Tax No: Weber Young Group Hudson Township 020-1075-10-500 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map' No: 109. n/ j O$•S' a j ` c sr B'" 27.29.19.302F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e-%-s% Benchmark 01 ~ Q Dosing Alt. BM Aeration Bldg. Sewer / • 3D o 20 Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet 'T 1• $ Afl TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ♦ _ Dt Bottom %tq >1dD la Dosing Header/Man. 80 Aeration Dist. Pipe .gyp : f Holding Bot. System )Q Final Grade r PUMP/SIPHON INFORMATION Go ~o;.~D Manufacturer Demand St Cover GPM •I~'«~,.uc, •aL. Model umber TDH 11-ift riction Loss System Head TDH Ft Force in Length Dia. OIL ABSORPTION SYSTEM BED/TRENCH Width Length No. f ~f Trenches - PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 $,D CZ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ManufaG4u n _ INFORMATION CHAMBER OR Ngel: Type Of System: ( UNIT Model Number: 12.44 z , lid tI . DISTRIBUTION SYSTEM L -V 40 r.~, . O . W ~ Vent to Air Intake Header! anifold / Distribution x Hole Size x Hole Spacing l1 Pipe Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [m-] Yes ❑ No Yes No COMMENTS: (Incjudgcodes[i encies pqn res t, etc.) Inspection #1: Inspection #2: 7 presto - ~is`Fw bl° L t'+~ it'i Location: 651 Brakke Drive Hudson, WI 54016 (NE 1/4 S 1/4 27 T29N R19W) Exit 4 Business Park Lot 9 Parcel No: 27.29.19.302F 1.) Alt BM Description = -5--r- NA&-kj-k CAIN/ 2.) Bldg sewer length = Z t.~ 3~ amoy~sof cover = J$ 0 d_ ~ Pla vision ,AA Yes No Use other side for additional information. I 1 i_- Date nsepctor's Signature Cert. No. SBD-6710 (R.3/97) - U Safety and Buildings Division County ~r m 201 W. Washington Ave., P.O. Box 7162 sr err v ` ~S~Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 4f2 (91 Department of Commerce State Plan I.D. Number Sanitary Permit Application ~~b T•~«s ro.'~ In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide / may be used for secondary purposes Privacy T,.,. „ p~ Project Address (if di mailing address) i_ ArOKKE 1. Application Informatio - P se Print All Information pc m W Z Property Owner' Name L•1 i u - P~arcfe1 # Lot # $le~ 4 Property Owner s Mailing s _ Property Location 7 Sr ,0% Slit 61J th, Section City, State Zip Code ~j Phone Number 7 ~~nwrn/~ ' ~'T K3 f Ar- 23 S ? S7~/ 10 / N; R, f cE irele or~V ) 11. Type of Building (check all that apply) Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms !x, Tv x'l/`ew _ u Public/Commercial -Describe Use QOrL. I I ~j~~► ❑ State Owned - Describe Use ' f ❑City_❑Villageownship of 111. Type of Permit: (Check only one box on line A. Complete line B If applicable) 02-ID -10 F, A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POW17S System: Check all that apply) Y Non -Pressurized In-Ground ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow o plication Rate(gpdsf) Dispersal Area Requir Dispersal Area Proposed (sf) System Elevation 2-./ La ig -330 ip VI. Tank In o ity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw Existing Tanks Tanks Septic rnwAiiikliap-Wank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the under assn nsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI i MP/MPRS Number Business Phone Number o L S1101- /Yip/3 9'f6 Z 7(J` Z Zb V~o Plumber's Address (Street, City, State, Zi Cod 01 Vlll. Count /De artment Use Only Approved ❑ Disapproved Sanitary Pennit Fee (includes Groundwater Date Issued Issuing Ag34 Signature (No s) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval ~s~ spa. she y_ r, lam c a ~~a~ j a4 S s~s.w. ttaeh compktc p (to the C only only) for the system on paper not than 1/2 i 11 inches lnee VA&k vv~ SBD-6398 (R. 01/03) 1 - ,~tsO U ~ ~ `0 f oil 4e (3) 0 4 K `J 00 1!4 C Ll S - r4 m v s ~ e ~ ~ ps5.o 4 c d rA c N \o ~ f 0 ~ o J 14 soy n' { d Q _ O C O h J J I Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD (608) 264-8777 ,sa0ns n www.commerce.state.wi.us/sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary April 15, 2003 CUST ID No. 139462 ATTN.- POWTS Inspector TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751-5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/15/2005 Identification Numbers Transaction ID No. 856788 SITE: Site ID No. 656801 Artful Decor Please refer to both identification numbers, Brakke Dr & Exchange Dr above, in all correspondence with the agency. Town of Hudson, 54016 St Croix County NEIA, SWIA, S27, T29N, R19W Lot: 9, FOR: Description: Commercial (Warehouse) Non-pressurized In-ground System Object Type: POWT System Regulated Object ID No.: 899266 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "In- ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10705-P (N.01101). com • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan APPi approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take DEPARTMEt precedence. N ~ • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance SEE CORE information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • The plumbing for this project discharges to a private sewage system. The approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes. • State and federal regulations prohibit the discharge of hazardous wastes to a private sewage system. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. TODD L SINZ Page 2 4115103 • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726-2544 Henry F Grote, Certified Soil Testing q _ Artful Decor Conventional System RECEIVED AFEr y 8 Construction Materials and Techniques 8LDGS DIV All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. !I Construction methods must comply with the following Component Manual: In-ground Absorption (v. 2.0) - SBD-10705-P Location: Lot 9, Exit Four Business Park NE '/4, S W '/4, Sec. 27, T 29 N, R 19W Town: Hudson County: St. Croix Date: April 15, 2003 Owner: Artful Decor Address: c/o Cedar Falls Building Systems 5455 Fre' g Drive Meno nie, WI 5475 Designer: Tod inz Signature: License # M49462 Attachments: 6748 Plan Approval Application SBD-8330 Page 1: cover 2: design criteria and sizing 3: plot plan 4: system cross section & plan view 7 eoMMER15 5: maintenance A~A UiLc;~os E NC Page 1 of 5 • , Design Criteria Wastewater Contaminant Load: 30 mg/L < BOD5 < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Estimated daily load gallons/day hydraulic load Design Calculations In situ designed loading rate n • 6l. gallons/sq. ft. per day Depth to estimated high ground water > Vs 2 in. Depth to bedrock I# L% -L in. Cross slope at system U%14' n % System Elevation Final Grade Elevation + Septic tank . 4 gallons Effluent filter 0 Yu- T Estimated Daily Load 15 FTE (includes proposed addition) 15 x 13 gpd = 195 gallons/day 1 floor drain 1 x 25 25 " Estimated Daily Flow = 220 gallons/day Design Flow 1.5 x 320 gpd = 330 gallons/day Septic Tank Sizing Septic tank sizing spreadsheet give a minimum 689 gallon septic tank for 330 gpd at a three year service frequency. Install a Huffcutt 800 gallon septic tank. Adsorption Cell Sizing Medium sands and loamy sands below 5.3 feet in B-1 (elevation 98.77) give a loading rate of 0.7 gpd/square foot. 330 gpd/0.7 gpd/sq ft requires 471.4 effective square feet of adsorption area. Using Standard Infiltrator stipulation 1099 chamber trenches with an EISA of 31.1 sq ft per chamber requires a minimum of 15.16 chambers. Install 16 chambers for an effective adsorption area of 497.6 square feet with a loading rate of 0.66 gpd/sq ft. System elevation of 98.1 will ut system elevation consistently into the medium sands and loamy sands. Specsxalcs.gravity Page Z of S t so c Q 3 A /1 r~ N d ~ S 4~p LA j 'A ~l 4) 4 i (-Ay - d v Gn J J a ~ t SQ f ~ c A 4.+ _ cJ o r ~ d j s a5 ~ cam- ~ sa elo - y ; ~c:i } J ~.n N f Irv ~ x /y o o rj 1 W J .v J - l T G1'y~,~,~~ ~ w i.' ~iMai~ ~ ~ S~,~k J "1' w \ ~l.'t' ~ O \ ~ "l.Q~ . i 1 1 C 1aw~ ~~l) S•l~ G1 w fit, `B •1 - C 2 S h.o ^ ti `O S Z ~ 0 ~ J Qa. V a~ is ply. r.. ~ ~ \ S OQ l7l .w Q Q AA I 0 0 :.$a O U1osctiv. 1~0~ X115 / ~l>~ gam :cc- System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T. L. Sinz Plumbing, 715-235-2644, or the St. Croix County Zoning Office should be contacted at 715-386-4680 for their assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at startup. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 4. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 5. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 6. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 7. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 8. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 9. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 5 of 5 ,..raw.. w,.~..~._....,~...«.,,,. ,ORIGIF~ 1711 Wisconsin Department of Commerce SOIL R Page 1 of 3 Certified Soil Testing Division of Safety and Buildings in accordance with Co m 85, Wis7.1- Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan mu t include, but not limited to: vertical and horizontal reference point (BM), d ection at~ percent slope, scale or dimensions, north arrow, and location and dista to nearest 7D. ST. C020-1075-10-500 Please print all information. ZODat e Personal information you provide may be used for secondary purposes (Privacy 22, - \ Property Owner Property Location Artful Decor Govt. Lot NE 1/4 SW 1/4 S 27 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# C/o Cedar Falls Bld'g Systems, 5455 Freitag D 9 Exit 4 Business Park City State Zip Code Phone Number City Village Ld Town Nearest Road Menomonie WI 54751 715-235-3541 Brakke Drive I New Construction Use: Residential / Number of bedrooms Code derived design flow rate 330 GPD Replacement ✓I Public or commercial - Describe office/warehouse Parent material sandy/loamy outwash Flood plain elevation, if applicable NA General comments and recommendations: install 2 - 2.83' x 49.76' (St'd-Infiltrator, 16 shells) stipulation 1099 chamber trenches @ system elevation of 98.1 FT] Boring # _j Boring ✓I Pit Ground Surface elev. 104.1 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-5 7.5YR 3/1 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 5-26 7.5YR 4/4 - sl 2 m sbk mvfr gs I lm .5 .9 3 26-64 7.5YR 4/4 - sl 0 m mfr cs - .3 .5 4 64-120 7.5YR 4/4 - s 0 sg dl - - .7 1.2 ID - horizon 3 has occasional stratified Is inclusions; horizon 4 has occasional gr cob Boring # Boring Pit Ground Surface elev. 104.1 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 7.5YR 3/1 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 10-21 10YR 5/4 - s 0 sg dl as - 7 1.2 3 21-100 7.5YR 4/4 - sl 0 m mfr - - .3 .5 obvious fill: 7.5YR 3/1 sl bands @ 26-28 & 65-68; pit to west of B-2 is also fill w/ similar profile ' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mgL CST Name (Please Print) Signatur CST Number Henry F. Grote 222774 11511~ ~Av Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 4/8/2003 715-233-0398 Property Owner Artful Decor Parcel ID # 020-1075-10-500 Page 2 of 3 3 ] Boring # Boring Pit Ground Surface elev. 103.7 ft. Depth to limiting factor > 132 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 7.5YR 3/1 - sl 2 f sbk mvfr cs 1 f/m .5 .9 2 10-36 7.5YR 4/4 - sl 0 m mfr cs 1 m .3 .5 3 36-76 7.5YR 4/4 - Is 0 sg dl cs .7 1.2 4 76-132 7.5YR 4/4 - s 0 sg dl - .7 1.2 horizon 3 has stratified, irregular & discontinuous, sl bands: 1/2" 7.5YR 3/4 @ 54 & 66 ❑ Boring # - Boring Pit Ground Surface elev. 105.3 ft. Depth to limiting factor > 132 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I __2-Q f/ ! in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 `Eff#2 1 0-13 1' 7.5YR 3/1 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 13-46 7.5YR 4/4 - sl 0 m mfr cs 1 m .3 j .5 3 j 46-72 7.5YR 4/6 - Is 0 sg dl cs 7 r 1.2 4 72-132 7.5YR 4/4 - s 0 sg dl - 7 1.2 D I I ~I ❑ 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 1 GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I i - i- j J ~ I I i Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you 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. SBD-8330 (R.07/00) Certified Soil Testing 1. i X - '04, ^p N►I 00 fA - d r ~ d s ,,J r-ol d ~ O d ~ s ~ 4n po f O j 06 .IV Cc b,- v U j 1 ~ IJ ~ ~ q N 1 ~y W J 0%2$%01 TUE Ig:ll POW175 366 OWNER'S MANST CRI CO ZONING UAL a AAAAutri mil rLAH ra~r ~odjl FILE INFORMATION SyST'>rM SPECIFICATIONS Owner L C/rt, Septic Tank Capacity gD D l ❑ NA Permit # ArAft Septic Tank Manufacturer ~,a? D NA DESIGN PARAMETM Effluent Filter Manufacturer D /'Cot cv ❑ NA AAA, Effluent Filter Model C: NA Number of Bedrooms Number of Commercial Units / ❑ NA Pump Tank Capacity gal 43.1 to Estimated flow (average) gal/day Pump Tank ManufacturerA Design flow (peak), (Esdmated x 1.S) V gal/day Pump Manufacturer .a'NA Soil Application Rate oal/day/ftl Pump Model 4RrlqA Influent/Effluent Quality Monthly average'' Pretreatment Unit ❑ NA C3 Sand/Gravel Filter ❑ Peat Filter Fats, Oil at Grease (FOG) g30 mg/L p Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 1220 mg/L p Disinfection U Other: Total Suspended Solids (TSS) 51 50 mgfL Manufacturer Pretreated Effluent Quality ' DNA Monthly average*' Dispersal Cell(s) Biochemical Oxygen Demand (BODs) <_30 ring/l. n-ground (gravity) q in-ground (pressurized} Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ❑ Mound Fecal Collform (geometric mean 5104 cfu/ 100m1 ❑ DM-fine D Other: Maximum Effluent Particle Size rl inch diameter * Values rypltal for domestic (non-tommertlal) wastewater and s9pdC tank effluent. * * values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service invent inspect condition of tank(s) At least once every 3 ❑ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (h) of tank volume Inspect dispersal cell(s) At least once every 3 © months Year(s) (Ma)dmum 3 Yrs.) Clean effluent filter At least once every ❑ months plyear(s) DQ A% inspect pump, pump controls ax.-alarm At least once every ❑ months La year(s) ❑ NA Flush laterals and pressure test At least once every o months la year(s) ❑ NA Cher; At least once every ❑ months ❑ year(s) O NA other- At least once every 0 months ❑ year(s) ❑ NA MAJNTI:NANCE INSTRUCTIONS 5pthe following licenses or tage Servicing Operator, u P Tan Inspeceo Inspections of tanks and essuiai edits shag be OWTS inyspector; POuaWT Mintainer; of Plumber; Master Plumber r ReRdd Sewer, any cracks or leaks, measure th must include a visual sInspection of ludge the and to tank(s) any b missing p or ponding of effluent identify on the grow d surface. The dt persai volume of combined sludge and scum and cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The pondinil of effluent on the ground surface may Indicate a failing condition and requires the immediate notlflcation of the local regulatory authority. tank NR 113, Wilsconsi ent When the combined accumulation oved sludge bServicing Operator land disposed o)f in or mre of accord n etwith chvo.lume content of the tank shall hall be be removed by a Septage Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at tcutervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPE*ATION For new construction, prior to use of the FIOWTS check treatment tank(s) for the presence of painting products or other chemic; that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conten! ,+r tho rarsk(sl romiewpd by a tent<we Servicing operztor prior to use. P.3/24,,,01 TUE 15:11 FAX 715 386 4686 ST CRX CO ZONING 01002 Y • ' Pact __of.,,,__ System start up shall not occur when soil conditions are frozen at i>1ie Inf9%r4y* sur'facrs. Durint power outages pump tanks may fill above norntai highwateyr levels. When power is renomd the excess wastewater will be dischargtd to the dispersal cell(s) in one large dose, overloading t1w cfli(s) and may result In the badtup or surfacr dSchaw u? efl9utnt. To avoid this situation have the Contents of the pump unk rernovtd ay a Sipup Servking Operawr•prior to restodr:t power to the effluent pump or contact a Plvmber or POWTS Milnta}ner to joist in manuaW operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehrcles over tanks and dispersal cells. Do not drive or park over, or otherwise d4wrb or compact, the area within 15 feet down slope of any mound or at-grade $oft absorption area. Reduction or elimination of the following from the wastewutrvtream may improve the performance and prolong tilt We of Cute POWTS: antibiotics; Way wipes; cigarette butts; condoms; cocoa swabs; degreasers; dental floss; diapers; dlslnfecianu; lit; foundation drain (sump pump) water; fruit and V*Vubie peetinIM gasollnoj grease; herV4d4s; meat scraps; medicat'wnc; oil; paindnit vroducts. oesticides: saniurv naokins, tampons: ind wetter softener b*". ARAN DON EM ENT When the POWTS fails and/or is permanently taken out of service the following soaps shall be taken to insurt that thr system is property and ;taftly abandoned in compilam with ch. Comm 85.33, Wisconsin Administrative Coder • All piping to tanks and pia shall bt 41seonn%ttd and *a abandoned isipe opsWnp sealed. The contenra of aft tanks and pits shall be removed and pmperhr. did of by a Septa ge Servicing Operator. 9 After purnping, all tanks and pits shall be excavated and removed or their covers removed and the void space (filed with soil, gravtt or another inert solid matrrial. CONTINGENCY PLAN If the POWT'S falls ants cannot by repaired the following measures have been, or must be taken, w provide a code compiiant replacement system; b A Mubic replacement area has been evaluated and nay be utiflud for the (oration of a replaeemsrg snit absorption syswm. The replacement area should be prowcud from dlswrbance and compaction and should not be infrhved upon by required setbacks from exIstin>t and ptoposed strvcwm, lot [Ines. and weals. Failure to protect the replacement area will result In ruse need for a new soli and rite evaluation to sstabilstl a suttatrte replaotm4 t area. Replacement systems rnwt mpiy with the rotes in eftect at that time. 4-- to alt reAluement area is not avallable due w stUmc'k• and/or soil f(triltations. t 4mrig advainm In POWTS wchnutaf"i a holding tank may be Iroulled as a {asst resort to replay the failed POWTS. O The site his not beat cviluated to Identify a svktabta m lactmer+t aria. ttipots faflum of Ow POW'TS a sell and site evaluation must be performed to locate a suulublr repliwerneetareal. if rso replacemmnt area is available a holding tank may W installed as a last resort W replace the failed POWTS, 0 Mound and at-grade soil absorption systerru may be reconsvwwd In place following removal of the biomat at the Jnllivatlve sunc~e. KtConswctions of such systems awst.cbmply with the ruks in effect at that time. t WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYQN. W NOT ENTER A SEPTIC, PUMP Olt OTHEER TUATMEWT TANK UNDIER ANY CIRCUMSTANCES. DEATH MAY RESULT, 99SCrVli OF A PERSON FROM TiFE INTLRIOR OF A TANK MAY BE DIFFICULT OR il.eMIMRl V. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name n/Z. ~i~~" N Gr Name iuZ N c- Phorte 21o S~ SEFTAGE SERVICING OPERATOR P MPER WCA& G TORY AUTH Name /~sncy S"' di Go rN r Phnnt thone I#O Apr 17 03 09:37a Artful Decor Inc. 715 381-5791 X0.2 U9!19iu4 rrLU lo:4t rAA 1104JOVIVU LhUAM rALLa OUILDINki ,Y5 WJUU3 a4/14 2gg3 14:57 FAX_71523.32592T L S IYZ PL1J9iBI?iG -INC eo02 ST CROIX COUNTY gEP I IC "PANIC MAINTLFNANCE AQRBBMSNr AND O nMRStUP CER'I'MCATION FORA G- ownet(Bayer mailing Addrass Property Address t.P e R t ij e (wririeatioa revwvd froze Planniag DePW"ent for new o9QSavstia5) Ciry/State Parcel Identification Number LEC:A , D SCRIPTxC1N ~Q'"' Prop~j L4catiaa L i✓ 't'ti ~ Sec. Tg.t~-R a_W. Town df .L SubdiVision Lot # - 1 Certified survey Map # oZ4'~J~ Velt~ne Page # 7c5 Warranty Deed # Volume _ • Poe # Spat douse © yes Is na Lot [jars identifiabto P Yes D ao Sys'PEK M,aII~IT~NA1~iCE lmproper use Sad ma~atGtaanceaf yvus septic sysmm could resultin its W00ature fatluzn to b:sdtewast- Proper msiattasaocc calwim of ptvapittg am the Septic tonic *YOU three ycasa or sooaer, if needed by a liceased.pumpe`. Wbat y" put into the system CAM aucar the function of the septic tank as it f matment seaac in the WLSW disposal WYMW= i- Tte p tarty owpcr s~cS to 6gbt;~ to St C.mix Z aipg Depe~~ a aetfestim form. Signed by tite owz= and by a eeast>rtptumbe , jotstoc5'~aPtambct, z<sttietedpimabex tsralieeesedpraaprtr~4B tbett(T) tbea:-sttewastewatadispotal 6rstem , is is proper operaviug condition and/or (7) after inipcetinn and pumping (if noccasssy), the septic tail; is team rhea 10 Foti of sttsd®e. Uwe, the oadrwisoed gave wAd the above ragairemonis Sad agtet: io maintain the p6vate jewage dipowl aystrm with the standards rat fottb• be"40, as set d r the Depatmwu of 00 awnetee and *C Deparaaast of NAttootl Rasoun=, . Catc of W&COneto. Ceeiflralien Autiag teat your septic system bas been mAt uWA must bt: eoaWleted sod retsuvedto the SL Cmiw Co=W X=jn& O410.1500 14 12- New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement [gPubtic or commercial - Describe: Code derived daily flow k gpd Recommended design loading rate bed, gpd/ft2-,-:V __trench, gpd/ft2 Absorption area required bed, ft 2trench, ft 2 Maximum design loading rate bed, gpolft2! , 5- trench, gpd* Recommended infiltration surface elevation (s) ft (as referred to site plan benchmark) Additional design/site conside on Parent matedW S ( (2 iA~ ra. 0. rs Flood plain elevation, if applicable N l" ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system s❑ u ❑ s W u rVS ❑ U XS ❑ U ❑ s V U ❑ s kru SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f12 in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 0-6 /o l ti 6 r ~W - .6 2 6 10 .S d r en At' Grrovund 3 i S r • ele ~v. 7: Depth to limiting factor Remarks: Boring # o-.7 o r z i Sr i r inGr1 e 5' ~G 2 7,10 ,s Y-r 4D- ,S r 1, .5 _ 7 ; Ground elev. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. c ha is C N~ls~h 71 S-4 Vt. -.1 ys~ Address ` Date CST Number iL/. ~ lauiA S/ Mo pi(h onk til 9--JO-9~ 27-7 397 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2- of PARCEL LD.# Boring # Horizon Depth Dominant Color Mottles Structure z in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Geptit Trench 6-6 r ; r 4, Ground ° evb-k Depth to limiting factor Remarks: Boring # 17 ' Ground Depth to limiting factor ; O0 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Ou. Sz. Cont_ Color Gr. Sz. Sh. Bed , Trench ' Boring # r Ground VV / " d elev. Depth to limiting factor )-L6-0 in. Remarks: Boring # Ground elev. ft. Depth to l'im'iting factor Remarks: SBD-8330 (R. 07/96) tmylpvmmtm I AL 57 PB1Qm 1432120` STMT, NEW RICHMOND, WISCONSIN 715-246-2454 Tom Nelsen Certified Soil Tester 227387-Registered Samtorm SROD713 aT q X L4 D L, S I, e S s T b rL~~ 5 IJ li S S cc 2-9 -1 LQ N 12 1 c.J -to "3 p ~1hctSor~ t~ 139 f3~ qb.~v b~ Ss~ a19~ "J e- r3 o 8 g, a3 Sfl ~j SCALE IT, = 4 v Tom Nelson RM1,T40P0 r a F S a roar, rZ e{ Q v J `t J 2 1 9 3 P 3 3 7 7 1 5 -7 .4 -7 STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number RECEIVED FOR RECORD This Deed, made between C.P.T., LLC, a Wisconsin Limited 04/03/2 Liability Company Grantor, and Weber. Young Group, LLC Grantee. 003 09:30AM WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee the EXEMPT # following described real estate in St. Croix County, State of Wisconsin (if more REC FEE: 11.00 space is needed, please attach addendum): TRANS FEE: 238.50 COPY FEE: Part of NE of SW of Section 27, Township 29 North, Range 19 West, St. CC FEE: Croix County, Wisconsin described as follows: Lot 9 of Certified Survey Map PAGES: 1 filed October 20, 1999 in Vol. 13, page 3751, Doc. No. 612431. Recording Area Exceptions to warranties: Easements, restrictions and right-of-way of Name and Return Address record, if any. 020-1075-10-500 Parcel Identification Number (PIN) This is not homestead property. Dated this day of fr►ca 2003. C.P.T., LLC ACKNOWLEDGMENT AUTHENTICATION STATE OF MINNESOTA } ) ss. Signature(s) authenticated this day (j) A=&jstiW County ) of , Personally came before me this Y- day of March, 2003, the above namein Limited * Liability Company on who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument (If not, authorized by §~~TA 706.06, Wis. Slats.) WAI &V * .1006 THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin C.P.T., LLC Donna M. Caywood 1809 Northwestern My Commission is permanent. (If not, state expiration date: Ave. Stillwater, MN 55082 } (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 a A r.. LW EXrr B VIII, loon wHirnTBRN AVZ \IocATBD IN PART OF T9 MLIXArSA MN 5608Z TNB S9114 OF TAB SI114. A ~+C' : "rye" SB114 ALL IN SECTION Y 1 y UNPLA' ti7 GR U i31X !00" ~ I T s• " I i a too P00 300 A i 00Al0 v s ' MED BY OTSBizs LIK TA muz:i I MW G% O 347---7M 4LW 0 SWW44T 114.9P mw I HRA5 m h I LOT 1s 3 ~ m col Ky i y 14. Lor 9 ° I j 1 STORK WAWA IaEj"im AKA a j m I m ~ I N ~ i o I 1 Lor 107Rf g I - - - - - - - - - - - - - j >w~ I iO „oc 7 Z9 AMMMT i . R of o Ya irr5~i ~ ' d ~ T~ ! ?r oil ~ !•1 W fit YvrN Y~~1l A/. 1 9 101113 A&DALM ffra - wieijf XaXS i l j l -WHIM L,.,M-j % nw r w.w 1 1q , , C 1 ~9j ~ 1►. l t 1 - «ti eooo i n lop 40 t Sa 1 f 02/05/00 WED 10:52 FAX 715 086 4687 REGISTER OF DEEDS Q002 s FILED OCT 2 0 1999 ► fi1~431 ~ ~TMtgrlH.wnlsH f2 co,wl CERTIFIED SURVEY MAP w D IN PART OF THE NE f/4 OF THE SW 1/4 OF SECTION 27, 29N, R 19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. PK N1/4 ITHAWITNESSD CHECKS SECTIONR27R SCALE IN FEET i" = BO W MONUMENTS OF RECORD 100 O >00 e+ I Cv 1 3 in ~I (14I OWNER EAST - WEST 1/4 LINE 8 ~I I I C.P.T. LLC ( 1809 NORTHWESTERN AVE. W1/4 CORNER N69'57'08"E STILLWATER, MN 55082 SECTION 27 N89.57'08"E ~I I I 2616.13' LOT 1 C. S. M. 2604.21' 41 E1/4 CORNER VOL_ 6. -PC._ 1726 SECTION 27 N T m - Zg B.RAKKE -DRIVE a S ~ WI A S89-50'37"E 341,58 I276.66' - .9 Q I m _ 1 I -'PAVKINN - SMAM- LTRr - ~ v 1 Olin, ::h.,, I wl -~1 '•tTR1~1NG~E alI z I ~ BUILDING SETBACK LINE •'•I m U w I cl~~ a cl °~I W y LOT 9~ 33 w l 1.500 ACRES I I op I W I p I I 63,341 SQ. FT. $ o d Q'il r- °o a I I ° I 8~ ~I O i z Iz5' I 4---- so• I " v°~ W W w E-41 33' 33' gl-- PARKING SETBACK LINE c%d ~I L! 308.3 33.00' ~i N89050'37"W 341.58:1 W~ UNPLA_ TTED LANDS _OWNED BY PLATTER I LEGEND ALUMINUM COUNTY SECTION CORNER ° v+ ~i MONUMENT FOUND CL,I • 1' IRON PIPE FOUND $ o W I O 1' X 24' IRON PIPE SET WEIGHING w° ►`~1 1.13 LBS. PER LINEAR FOOT S1/4 CORNER z 2' IRON PIPE FOUND SECTION 27 W °dc J - 10' WIDE DRAINAGE EASEMENT W r m - 15' WIDE DRAINAGE AND UTILITY EASEMENT W ' ° 5' WIDE UTILITY EASEMENT a w CURVE DATA NUMBER RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT ANGLE BEARING LENGTH LENGTH -CC 1 30.00' 89'50'38" S44'55'18"E 42.37' 47.04' S89'50'37'E S00.00'011W m U-1 ti Vol. 13 Page 3751 o* 3 m O t7 Lo1 r o 'A F c o CD :E 0 C Z O N C v N N• CD 0 =r cr 7 fD CO s a CD C tb N W 7 p 1 N CL 3 W Q C O O C m c co 7 ~N'I Cn A7 7 fA G) ? O r. !1 0 in In 23 r- c w cnzD F a0 m <o D a s ~ W c 03 Q. _ 4 -P~ v o °N~ O I o o CD 0 N W W CAD y ~ Qr • z OOOo_ o cn o co % N 3 N ~ 6 v o _v, A a fD M ~ 0 W a CD ° co W M y CD W CD N (n CD co Q rr z w O c z z ai 7 D o 77 :3 b O o o CA I ~ y w cu c N C CD W z m -I N o ~ o A 2 ~ N C M A ? N CL Z -a N W V ( mcNO-4 CL w " z y z C A ' O a CL o' w c z c O W S C y .y I ti ti,l N 0'q ~ O EA ~ ti py~ I O a ~ y ti Parcel 020-1075-10-500 02/09/2005 11:12 AM PAGE 1 OF 1 Alt. Parcel 27.29.19.302F 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WEBER YOUNG GROUP LLC WEBER YOUNG GROUP LLC /I t) 863 DAISY CIR LL HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 651 BRAKKE DR OR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.665 Plat: 0950-CSM 13/3751 SEC 27 T29N R19W PT NE SW BEING CSM Block/Condo Bldg: LOT 9 13/3751 LOT 9 1.50AC & INC RD DEDICATED TO PUBLIC 0.165AC 736 EXCHANGE DR Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 27-29N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 04/03/2003 715747 2193/337 WD 06/03/1998 580213 1328/322 WD 07/23/1997 831/444 2004 SUMMARY Bill Fair Market Value: Assessed with: 48231 431,400 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.665 61,700 272,000 333,700 NO Totals for 2004: General Property 1.665 61,700 272,000 333,700 Woodland 0.000 0 0 Totals for 2003: General Property 1.665 42,600 0 42,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wiscor*p Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page I of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. dm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 1 nrb C include, but not limited to: vertical and horizontal reference point (BM), direction and } percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ' 1ZL1 APPLICANT INFORMATION - Pleas Rev' a Date Personal information you provide may be used for s otrct purposes jvacy La ' ,t 5;A4 (i) (m)). A V Property Owner Property Locati s 0 T N,R E (or) ~Q, n h Ci, p G vt. Lot 1/4 S U)4, CW) Property Owner's Mailing Address ?wf t Block Sub me or CSM# 3 3 y u 2 r per -3,f, OR i W, City Stale zip Cod PFy fCB ~w Nearest Road i ❑ City F-1 Village Town 2f New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement 19 Public or commercial - Describe: t C t % , i \ ~ ti T, C,, Code derived daily flow lA n1(n o u ')gpd Recommended design loading rate r bed, gpd/ft2 'trench, trench, gpd/ft2 Absorption area required _ bed, ft2 trench, ft2 Maximum design loading rate + bed, d/ft2 ' CO g gp trench, gpd/ft2 Recommended infiltration surface elevation(s) So ft (as referred to site plan benchmark) Additional design/site considerations e q h t+ T c. I q v~ Q_ G, M b'e Parent material 10 e. 5 S C2 U C Q Q LKI Li G S } ! C~i: r1;' ~ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System Tin- Holding Tank U = Unsuitable for system E~S ❑ U Is ❑ U W S ❑ U [ S❑ U ❑ S M U E:1 S [ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 I 0-~ 10 r- 3/2, 5 I t~s k Fn Fr CLJ Z r 16 53 7, S r & L_ s C S,bk co v lr C ' Ground elev. t~3 S~.ft. Depth to limiting factor 'i7~in. Remarks: W t2s v 5 Boring # ~ ~ i ! 1 f` ~ 2. ~ Cr'15 • (I 1,x.7 ~ , to a-G i r' (a .S S rrl~-~~ 5 I 5, s 1-g~ 1a5vr 6J , 5 Ground elev. Depth to limiting factor 'tin. Remarks: W Q. G2 5 6 ' S CST Name (Please Print) Signature Telephone No. -TIN 01-X C& 5 1-)~ ISO w, IIS-1q~ -2y 54 Address Date CST Number [~{'2 CZU~~.S 'j, rtc~h %2® X27 33`7 SOIL DESCRIPTION REPORT PROPERTY OWNER (Al Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench I o- 0 10 r3 z - I 2~s lI ~~r CW ~ F ,S ~ Ground 3 30S 1.5 ( S ~ I'1Sbu (n I C. S - 7 , elev. Depth to limiting factor Remarks: Boring # I o-10 ~ C) \i s .1 2 r~sb u r e W 2' , G 3 ~,s fi c, - I S ~,s1, k e S , ~ ~ , 8 Ground ~jq 7, S\ r (r 1 S S , 7 elev. ~ IQ~ft. Depth to limiting factor 7 LqD in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fit in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# -fib lb r3 2 2 I 35 ~ o r - S .1 ~ c'1 s b GC r~ ~ r C 5 I ,,S ; , G 3 3S-I~0 -7,511 r Z S U S' r 7, Ground elev. ! o o.77 ft. Depth to limiting factor 1-'n' Remarks: Boring # I o ► o r 3/z - S I I r, s b K r C Z , 5;,~ -136 -7,50- S 1MSb14 Mjr CS 3 ~-7 -7,55 r61 - S rn1 - ~7 X13 Ground Qelev. 2 Depth to limiting factor ' in. Remarks: SBD-8330 (R. 07/96) ,,.Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page 3 of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S+ Cro 1 ~c percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location \ n 9~ Yl Govt. Lot ~ E1/4 W1/4,S a? T N,R ~ J E (o~V Property Owner's Mailing Add less Lot # Block# Subd. Name or CSM# m \33 eve (L rLeh r v City State Zip Code Phone Number El Nearest Road i Uf r`~w4 ~g f~J ( S4oV, (715 31. ( City El Village ® Town NwcRso ~ S-rM \2 New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building Replacement N Public or commercial - Describe: Code derived daily flow know gpd Recommended design loading rate bed, gpd/ft2_1 -<.-trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2__(P_trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations j Parent material to e S s (30 e q Q !A F 1~~ CS ~ sc,-0 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 7 i o-~5 rr 3'~. ~i I s~~ MFr C 2 , S Ground '~5 70 5 Co In y^ C c7 ~S elev. il (i Aft. 56 , S V r G (a Depth to limiting factor in. Remarks: Boring # Ground elev. ft ' Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. '7 1 5; Address Date CST Number 3 le?d h n bv~ c~ , )-1S ZZ'7--367 SOIL DESCRIPTION REPORT e* PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~pjft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to 1 limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to , limiting factor m. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) r Y OE516M FKVf*P0KAfKTAL 1432 120'h STREET, NEW RICHMOND, WISCONSIN 715-246-2454 Tom Nelson Certified Soil Tester 227387---Registered Sanitarian SR00713 R~0.n uy~.~~.~h I o~ g n~ ~W s~ yy g 27 , -T 29 N , v~ w Q~ p2 lei ~ 93 ~q 10!;. 00 ~S loo.~~ ~ a~ ci~,33 9-7 3 y,~o 7 s a 39 31 SCALE 1" = Tom Nelson BM1. Topor i" pvc PIPp- 4.100 loci BM 2 fOhn(Q S~.f~cc~ elev. 105-1 J 2 1 9 3 P 3 3 7 71574-7 STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number RECEIVED FOR RECORD This Deed, made between C.P.T., LLC, a Wisconsin Limited Liability Company Grantor, and Weber. Young Group, LLC Grantee. 04/03!2003 09:30A11 WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee the EXEMPT # following described real estate in St. Croix County, State of Wisconsin (if more REC FEE: 11.00 space is needed, please attach addendum): TRANS FEE: 238.50 COPY FEE: Part of NE '/4 of SW of Section 27, Township 29 North, Range 19 West, St. CC FEE: Croix County, Wisconsin described as follows: Lot 9 of Certified Survey Map PAGES: 1 filed October 20, 1999 in Vol. 13, page 3751, Doc. No. 612431. Recording Area Exceptions to warranties: Easements, restrictions and right-of-way of Name and Return Address record, if any. 020-1075-10-500 Parcel Identification Number (PIN) This is not homestead property. Dated this mil' day of 2003. C.P.T., LLC * ACKNOWLEDGMENT AUTHENTICATION STATE OF MINNESOTA ) ) ss. Signature(s) authenticated this day County ) of , Personally cameo before me this day of March, 2003, the above name4F .T , ~ in Limited * Liability Company t y NT on who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument and aclciow (If not, authorized by §PAMU A. LL 706.06, Wis. Stats.) f s all .2005 * THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin C.P.T., LLC Donna M. Caywood 1809 Northwestern My Commission is permanent. (If not, state expiration date: Ave. Stillwater, MN 55082 ) (Signatures may be authenticated or acknowled ed. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 cA o) s FILED 612431 OGT201999► r$TCR v"A lmm walstt CERTIFIED SURVEY MAP SRECORD w D IN PART OF THE NE 1/4 OF THE SW 1/4 OF SECTION 27, 29N, R 19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. PK N1/4 ITHAWI NOESS CHECKS SECTIONR27R SCALE IN FEET 1" = 60' W MONUMENTS OF RECORD 100 0 100 ~I 3 6 0 ,I o cu ~I I OWNER EAST - WEST 1/4 LINE N N II C.P.T. LLC ~I I I 1809 NORTHWESTERN AVE. W1/4 CORNER N89057'08"E I ~-I STILLWATER, MN 55082 SECTION 27 N89.57'08"E hl I 2616.13' of ► LOT > C. S. M. 2604.21' NI QI E1/4 CORNER 1726 SECTION 27 VOL. 6. _PG._ 0% m f") fU M c • T col Lo - ~ BRAKKE _DRIVE - o m W ° S8 •50'37"E 341,58' ' - - 0 N 278.66' ~n 2.92, 1 O I MI C3 PARKING SETBACK LINE VISION o 'r ~I '••.TRIANGL~E I Z o _ A '7 ~I W BUILDING, SE BACK LINE ••'•ZI co w I N A M l z x•.15' M (u Y I ' a N J co k j z _ I V-4 u I i- :c 3: N I A W ; I LOT 9 3 0.1 C) z 3 o rl vl . i p~q wl z 1.500 ACRES YI o ~ I i° ~I 83 l 65,341 SQ. FT. a CD W D Z' 'Q;I w ~I C n I I D'I o • o NI L O Z I I-- 50' N Q CD zz N q A ~ I 25' I A 4 z I-- E--''j A I 33 33' [ti I ~ ~I I PARKING SETBACK LINE in Q'il N I_ n- - 1-4 - 308.58' - N - 33.00' i z N89.50'37"W 341.58' ~I N Wi UNPLATTED LANDS OWNED BY PLATTER E-41 1 LEGEND 3 ALUMINUM COUNTY SECTION CORNER ° o ~0 L Z C-) NJ ~i MONUMENT FOUND o° ° ; ao ~I V IRON PIPE FOUND H C3 W o 11 O 1' X 24' IRON PIPE SET WEIGHING ~I 1.13 LBS. PER LINEAR FOOT w o ooDD