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HomeMy WebLinkAbout020-1363-17-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ,, INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Glen Johnson Construction Hudson, Town of ;ST BM Elev: Insp. BM Etev: BM Description: /Ob 13 rYl ~ SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~, , ~. 5 Z ~ Dosing Aeration ~-e~ ~ ~~ Holding TANK SETBACK INFORMATION TANK TO ~ aP~/L l WELL BLDG. Vent to Air Intake ROAD Septic 3a' ~ /I C ~ ' / i Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Number TDH Li Friction Loss System TDH Ft Forcemain Length Dia. Dist. to well Sell ARSARPTI(~N SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 479287 0 State Plan ID No: Parcel Tax No: 020-1363-17-000 SectionlTown/Range/Map No: 27.29.19.2154 STATION BS HI FS ELEV. Benchmark 3.3(.P ~~ ~G /OD Z°t Alt. BM F.~ ~. ~~ x,35 ~. 3 Bldg. Sewer ~ `'17 ZS St/Ht Inlet ~ ~~c _J St/Ht Outlet g y~ Dt Inlet ~_ ~ Dt Bottom _, Header/Man. /~ O ~.$ ~n5 Dist. Pipe I ~ b ~ ~ S Bot. System Final Grade 5.b 9~.~,5 St Cover ~~ ~v , 3 J ~~ 3 ~ .~(. BEDfrRENCH DIMENSIONS Width 1 ~ Length I ` ~Z No. Of Trenches 7i f~G~~ PIT DIMENSIONS ~_ No. Of Pits Inside Dia. -- Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer.. n `~ ~ a. U-L- Type OAS \tem: ~; ~ ~ (~O ~ ~ ~ ~ ~ I ~~ ~ I /~ J ,V[f~ UNIT Model Number. ~/ ~J ~IGIC. T f11STRIRIITInN SYSTEM fl kL 1. ) ZF t'z`cS = Slo d"b~ Header/Manifold r~ ~ L[ Length ~ Dia ` Distribution pipe(s)) Length Dia \ Spacing x Hole Size ~ x Hole Spacing Ven~ Ajr Intake , -(,~~~ a.~..- F vK G !'.llll RCIVFR ., o.e~~...e c..~+e..,~ nn~., vv Mnnnrl nr A4.r~rada SvstPms Only Depth Over Depth Over - xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ Bed/Trench Edges ~ Topsoil ~ Yes ~ :_I No Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 634 Commerce DrivelHudson, WI 54016 (SE 1/4 SW 114 27 T29N R19W) Exit 4 Business Park Lot 17 Parcel No: 27.29.19.2154 1.) Alt BM Description = ~ I x'` Gdve~ i 2.) Bldg sewer length = ~'y -amount of cover= 3,5 ~It)5 ~'U I_. ~ i ~5~~ ~,.~ ~ri --- - - No r- -~_ _--- , i ~ Plan revision Required? ~~ Yes ~j i Use other side for additional informatio l_/~ i~~ -` , ~___ --- . --- -~ Date Insepct s Si tur SBD-6710 (R.3/97) s.2 Cert. No. - ------ - -- ~ ~ ~ Safety and Buildin s D 201 W. Washington Av P. ~ nt .- ,. ~ C, 1 r/~~~~5~~ Ma~isfln, Wl 53 07 7162 ' ~ ' .. '' attitary erm' Number (to be tilled in by Co.} ! Department of Commerce /„V) (608) 266- 151. ~/ ~'~' 4 JU s ~ ~ 7 ~Z Sanitary Permit A _.~ °mber ~ ~ I. . N "~~'~~' / r,, 7 ` /~ ~ ~~ 1n accord with Comm 83,21, Wis. Adm. Code, personal itt u vt~Q l ) -! / `~' ma be used for s d P i L 15 i i't °T y econ ary purposes vacy r aw, s n) . )( Add ss (if different than mailing address) -Pr ' I. A Ucat'lon Information -Please Print All Information PP / ~ (~ ` ~ (O~ ~ Cowl M P,([fZ. ~~ Property Owner's Na me Block # Parcel # Lot # \ n Pr operty Owrter's M ailing Address Property Location ~ p l ~ ®• ~ OX, g a a --- t ~~ ' 5 il~ 'k Secrion ~~ City, State Zip Code Phone Number - , . . .~.U~,c~~ ,~ ~ ~ J v 1 ~ r ~"1 (circle . e) T ~ N; R~E or Wi~ ~ II. Type of Building (check all that apply) ~ ~ ; . . n 1 or 2 Family Dwelling -Number of Bedrooms ~ 5ubdi~:isi~n Namq ~ CSM Number CJL 6 'f _. r __ ry~'/yri o r~ a.+-~ ~~,Public/Commercial -Describe Use ~ - ~'~S ~ ~ ~ 5 R ~\~ ~_ _ _ ^ State Owned -Describe Use 2 IJi~-,~_~~, ~ ' 7R' .1.-7 f{ l-~a _ ~~Ciry_LVillage~Township of __ - ~ Vs.S~'Di~~----a III. T ype of Permit: (Check only one isox an tine A. Complete line li if applicable) d2 -.. 17 - ~ _~ A' ~ New? gS st ,i~ ^ Replacement System ~; TreatmendHoiding 'Tank Replacement Only ^ Other Modification to Existing System ! B. ^ Permn Renewal Per v' i n ^ mtt Re is a r Chan a of g ^ Perini[ Transfer to Naw~ List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. T e of POWTS System: {Check all that ap ply) -- - Non -Pressurized In-Ground ^ Mound > 24 in. of suitable sail ^ Mound < 24 in. of suitable so il ^ At-Grade ^ Single Pass Sand Filter 1 ^ Constructed R'edand ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Lea^~ m _ rtp the ra - ^ Other (explain) V. Dispersai/Treatment Area Information: w~~ -- i Design Flow (gpd) Design Soil Application Rate(gpdsf} rsa rea equir rea Proposed (sf) System Elevation . . ~C,~ ~ ra~s7.3 ~~ a.~ o ,, s o~ ,~ _ VI. Tank Info Capacity in T'otaTNumber Manufacturer Prefab Site Steel Fiber ~ Plastic Concrete Constructed Glass Gallons Gallons of Units New Existing i ~ _~-! Tanks Tanks ~ ~ ~ ~ l j~G ~ ~~ Septic or Holding Tank ~ I si ..L~ ~ Aerobic Tream~ent Unit -t--- Uosing Chamber i -~ ~-~---- VIZ. Responsibility Statement- I, the undersigned, assume responsibility for ' aliation of the POWTS shown on the attached plans. __~ Susiness Phone Number ^ , P PRS Number Plumber's Si gnature Plutttber's Na me (Print) ~ ,2,7 2Y~~ r ~Q /~ SGh 11E j~r,66YC j' L[.J T l "~lS = ~ ~ /.2/ _- ~ f ip Code) e , 'L Plumber's Addre ss (Street, City, Stat / ~ p VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater ~ `- Date ss Issui gent Si atu (No S ps) ,Approved ^ pprov Surcharge Feel ~ ?jir a0 ; J~-CJ '7 jjs I - -- ^ weer ~ eason o \ ~ ~ .~ ~ IX. Conditions of Approval/Reasons for Disapproval S i ~r~ ~ a \ ~ /c ~ ~„ s~a ~ ~ . .n. o r 8Y8TEM OWI~R: J t i 8apdcri,nlc,,~nttertt inter and ~~~~-. t~l . ices /maintained r /~ l ~ d-(,,,; 5 Pe~',N- ~ ~-~ . ~ serv dispersal cell must al as per management plan provided by plumber. 2. Aa aelback requirements must be maintained as per applicable code !ordinances. i Attrch wtnplete plans tto the County only) for the system on paper not less than 5112 x l l inches in size ~ So;/eJa/lia>/o~~~ • ,C.oca~e.d ~OfO~t Sdsa /2r7~/1/ASOh ~OnS~4C~i /ot i7 Qr.'E 5/ Qus:~vss ~ Seg. 27 Tw. o~'iS4.cdsvn, ~ • CfbiX rey ,.J/. As~Ol,alt Propose-d O~,'-cQ/c,aa/e~iv Asp~c1E ~rimple~c Pfoj~OS2.ol W /~~S~f7 -r1tQ l1r0 OX~ Ca.nfa.'naf'y~ t~+,v,t' fA6L GtSed P ~n~ babe./.4-~~ e{e/uen~ t ~ az e u¢nE /iitC.•~+i..kc.~~GS Code. I ~ 1 I ~ I I i ~$ 1 1 ~ ~ ~ ~ ~ I ; I 1 1 1 J 1 1 1 ~ I 1 I 1 1 1 ~ 1 1 ~ 1 1 ~ I l ~ ~ ~ 1 I ~\ ` \ ~ , ` s(S~0 l~al ~ jJn.f/~;n \ Z 9q/S/oP~ YYIa • Tdia of c.o++~~ ~ ` y~e,se.rve /~~ ea ~ ~ep~u cwn`n~ ~ ~v~. , ay ~'s~-sc~ ~~~. ' ~ 99.a~' ----~' ~ . S/ of ~' ,_.-- C.Gt/e : / = s/O 6 /1trl ~J v~1gf 0-~/ ~On$~14C~/ ~O` /~ Q~it<Y QKSinoSS /l Sec. 27 T . o,F'l~u.dsen, As~Ol,alt Proposed O.F~;•ce/%,.kve~io Aspti~lE ~ Proposed/ w /GLY~/SUB -inQ n - I ~'atr1~•na~~ ~~ fA~! GtS¢a~ /-~f'~OPOXC~ 4,S ><WD r~10.M~/'f.0/ ~,oL~iG ~l.J~~~ ~~ ~ab~./,4-/tom e,S,e/u..n~ ~ ~ a2 e uantr liite..•T-ri,Jc~,(tt.~¢GS code. I t I ~ t t 1 t 4 S t ~ t ' ' ~ t ~ i I t 1 i i t t ~ 1 t ! ~ 1 / t 1 1 t ~ ~ . ~ ~ 5/oPP ` A5~0 ~4l ~ rJarl~;n ~ Z ~ ~. 11'lar : Toa o~ ~• Q3 ~ ~'~. 81 /at s~.~. E/e~ - vo zy ' 98.s0' ' " ~ • ` y~ese~/e fir ~ ~ ~ep /a ctn~n~ /v+~.~ aye .~lsp~-sue G~~~. ' , 99.0' ~,~t.~ ,~ J- J- ._ _.-l- _-!- .~--~- 1 commerce.wi.gov i ^ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 14, 2005 CUST ID No.227990 WILLIAM C SCHUMAKER SCHUMAKER PLUMBING 1070 SCOTT. RD HUDSON WI 54016 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/14/2007 SITE: Glen Johnson Contruction 634 Commercial Drive Town of Hudson, St Croix County SE1/4, SW1/4, 527, T29N, R19W Lot: 17, Subdivision: Business Park Identification Numbers Transaction ID No. 1144611 Site ID No. 700015 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Cormercial (Office/Warehouse) In-Ground System Object Type: POWTS Component Manual Regulated Object ID No.: 1023242 Maintenance required; 423 GPD Flow rate; 130 in Soil minimum depth to limiting factor from original grade; System: In-groundPOWTS Component Manual, SBD-10705-P t"N.O1/O1); Commercial System, Biofilter 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 CO~~ 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. pEFPR~~ The following conditions shall be met during construction or installation and prior to occupancy or use: NOF ~. Approval Requirements: $EE C< • 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.O1/O1). • 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. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan 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 precedence. WILLIAM C SCHUMAICI;R Page 2 6/l4/2005 • 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 cog, o~pproved plans specifications and this letter shall be on-site durine construction and open to inspection by authorized representatives of the Department, which may include local insyectors. 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 maybe made to me at the telephone number Iisted 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715)726-2544 NON-RESIDENTIAL SYSTEM DESIGN Conventional system INDEX AND TITLE SHEET Project: Glen Johnson Construction Office & Warehousing Complex Owner. Glen Johnson Address: P.O. Box 809 Hudson, WI 54016 Legal Description: SE1/4SW1/4, Sec. 27, T29N, R19W. Township: Hudson County: St. Croix Subdivision Name: Exit 4, Hudson Business Park Lot No.: 17 Parcel ID Number. 020-1363-17-000 Plan Transaction Number. RECEIV~~ JUN - 9 2005 SAFE-~ & gU1L~-'N~~ Index and title sheet System sizing calculations System cross section & detail Site plan Grading plan Septic tank cross section System Management Plan Attached soil evaluation report Page 1 Page 2 Page 3 ~n~lrry Page 4 Page 5 ~~~ Page 6 JF ~pNEFAEPCE Page 7 EY ~~GS Page 8 L ~SPOND~NCE License Number: MP227990 Designer: Bill Schumaker Signature: ~ L~~~_.-- Date: May 11, 2005 Phone No.: (715) 386-3121 System Design Calculations Johnson Office complex, Lot 17, Hudson Business Park JOB DESCRIPTION: Office complex with product warehousing. System design based on proposed facility with seven (7) office spaces, twelve (12) full time office employees, two (2) warehouse employees, 4,590 sq. ft. warehousing, & 4 floor drains. ABSORPTION AREA SIZING: 1. Design wastewater flow: 423.00 epd (282.00 gpd estimated wastewater flow)(150% conversion factor) = 423.00 gpd Design Flow (12 office occupants, all shifts) (13 gal. /occupant) = 156.00 gpd (2 warehouse employees)(13 gal. /employee) = 26.00 gpd (4 floor drains) (25 gal. /drain) = 100.00 end Estimated wastewater flow = 282.00 gpd 2. Existing grade elevation: 100.46' at B-~ 3. Depth to limiting factor: >130" (elev. =89.63') 4. Proposed system elev.: 95.00' 5. Infiltrative capacity of soil at or within 36" of system elevation = 0.4 gpd/sq.ft. 6. Absorption area required: 1,5,3Fh7"s~ ft. ~~~' $O 423.00 gpd design flow / 0.4 Gpd = 1,057.50 sq. ft. absorption area required /6 $I 7. Absorption area proposed: 1,0~2:86~. ft. (Two distribution trenches) 546.40 sq. ft. per distribution trench, two trenches proposed, 56 total I~ltrator Quick 4 Standard chambers. EISA per chamber = 19.10 sq.ft. ,EISA per pair end caps 5.8 sq. ft. 56 chambers X 19.10 sq. ft = 1,069.60 sq. ft. per cell 2 pair end caps X 5.8 sq. ft. = 2,3~'q. ft. per cell //, (p 1,0 sq. ft. per cell /OS! . 2 Number of trenches: Two (2) , 28 Quick 4 standard chambers per trench (56 chambers total) trench width (A): 34.0" trench length (B): 56.00' SEPTIC TANK CAPACITY: Design wastewater flow = 1,077.00 gpd 1,077.00 gpd / 75 gpd = 14.36 gpd person equivalency Minimum required capacity: 2,082.06 Gallons (1,077.00) + (11.61 x 14.36 x 2*) + (46.77 x 14.36) = 2,082.06 *(Requires a two year maintenance cycle) Proposed Capacity & Manufacturer:. EQUALIZED EFFLUENT DISTRIBUTION: Distribution valve to be installed to allow alternating use of dispersal cells. Distribution headers to be constructed to equally distribute effluent to all trenches. See detail at page 3. Pg. 2 of 8 ~ o ro j, A f1. ti ~0 (~ ~r P <~ ti~ s A ~ ~ ~ ~ ~ 4 r cr r. ~ ~ ~ ~ ~ ~\ ~ ~ l ~~ ~ ~ ~ \ ~ ~ ~ ~ \ W N ~ ro psi .~ 3 0 ~ u ~ o ~' A ~ ~. n y~ ____~- w .~ ~~ ~u ~= ~ P ~ F r ~ ~ `+ o ~ c ~ . ~ ~ ~ n A ~ •i ~I U ~ a~ ~ ~ tJi K ~ I ~` \ I I ~ j I I I ~ no Scn/e. ~~ ~ ~~ ~ ~y A1'.._~-_-.~- ^~1 ~~~~ '~ AI1~•~-- ~~~' ~''' !ltlws...,, Iu.s~'-~--~ ^~1® ~ _ ~~:~~--~ ~.~M m;' ew~i.:~ , ~®A spa ~ '~; '~ ~~ v ~~~ a '~ .~ ~ 3i ~~ a pop ~ R^ Qo ~ i r ~= J r ~, z ti w ~ 3 ~~ -T- d5/11/20N5 .3:45 ?153H62979 GLEN JOHNSON PHGE Fil ,.r,.~. -:a. ~~ ~' '~ 1 ~ ~t ~ ~ 1~ I~ r~ j i ly i 1 i O 1 ~ ~i } ~~ ~~ 1 a ~` y ~`1 f ~ ~ ~ ,~ ~, i, r ~ "r 1 { ~ 1 `~ ' 1~ ~ f i i ' ~ ~~*,~ ~~ C ~~ ~~ a "~ ,. e~l.l5' M1fa~d„rs - - ~---~ - ~ .r ~. ~ ~ T + R 17 ~~1~ i1 s_ ~; I _~ ~ I ~ V ~ r. ~ ~~ _ ~J S .. ~ I ;g~ ': ~ f~~~ ~°' ~`' ~ ~~s ~~ ~~ ~ ; ~~~ a ~~, ~_ ~.. ~~ ~, ~• ~ ~! ~ J g s K ~ E ~ ~ z E =~~ ? ~• f ~ ~ ~~~~Ir }} ,J J s IP _ ~ T 7- P ~ i k V ~ :~ V~C~ F r =~ ~ `Z U ~ ri ~~ i~ ~t '~---' µun~ ~ w i ~' ~ r, c ~~, F~5 2.~a r ~. a ~ a -_ y ~ t p~ ~~1 !v !~ qq7` ` ~'~ ?~~ ~~~~ ~:. ~;R pa, 5 a~~ 69~" ~ ~ D r ~ r~ m A ~_ s I I rn 1 i Z Z n c v, -, O ,~ r D ti o ~ r. ~,~ G O ~, ~ ~ Z Z _ ~ ~ ~~ .~ .-, ~ rte., ~ Z j ti ~ -, r O -~ r, -_ O ~ Z r z \ ~ z r, v_\z 0 W1000/500- MR SEPTIC MANUAL REV. JAN. 2004 D Z n O cn D a7 ~ Z ~ ~ m ~ n r~ ~ N C n r*1 ~ ~ ~ m ~ y ~ ~ (1 S N O m U n C ~ ~ D O ~ ~ ~5 I. C ~ r O r O Z r Z D C rTi ~ ~ ~ D D ~ Z Z ~ C7 C7 O ~ Z U1 r O ) D -i O C~ r l/ ~ ~ S ~ = cn n A ~ O r D O -~ N -r r < ? { NZr m 2 >- m -a ~ J ~ N < O I ~iO mm~ m rTi ~ Oo o~ ~ m D ~ A ~~~ ~ < O mmr m o m Z Z D D ~ < (/1 D r r \\ n D D = Z z ~ ~ Z Z DSO N ~ ~ D ~Vl ~ ~Om Z ~ -i m C m ~ ~ r m C7 ~ 0 ~ C~ O m ~ O v m ~ r O r~ Z m Z ~ r ~ m m ~ Z A'Z mp~~zmy00yQ D OCO~G~OZr*1-~rZ ~O f~Z~zm ~N D~ U r ~ O ~ J A N I m ONTO ~ N_' r m O ~ ~ ~ O o Q ~ O O rTl O C D r WIESER COIICAETE DRAWN BY SWT W3716 US HWY10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2001 800- 325- 8456 FILE: w~ooo/soo-MR D O T~ V 0 ^~^ T=J ^~I O JTT N O IZ V I REV ND. c u~ CATE p~ , ~ off' B Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.O1/O1). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, w7th bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. 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 a biannual 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 outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. 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 Department of Commerce, Safety and Buildings Division. Soil Absoration Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. 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. Contin~ency 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. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Bill Schumaker at (715) 386-3121, or the St. Croix County Zoning Department. Pg. 7 of 8 t3ureau of Integrated Services in accordance Attach complete site plan on paper not less than 8 1/2 x 11 inches in include, but not limited to: vertical and horizontal reference point (BM percent slope, scale or dimensions, north arrow, and location and disl ,~ ~• ~~ , , ~~ it~`ILt 83A~ Wis_ Adm. Code / `~~ ` _ a'~ ~ -.. ~ rPian must `'~ County itfe~tion.., ~ ~ ~ ~ ~. V t iCe.~}o ne i3st r~,r ~ E rcel LD. # APPLICANT INFORMATION -Please print all informatr n. ~Gi~n'ry ``C~"~'~OFFtCE Reviewed by Personal intarmation you provide may be used fior secondary purposes (Privacy Law, s~ t_S.Q+f (1) (m)). ~ Property Owner ~ 'kidpierty 4•ora6on rage + ot_ 7/5 /~ 5 cj g~4 C. ~c7 ~ ~ o!`+~ a o n Govt.ZZst`-.._...F~~, 114 ~' ~ 1/4,S ~', T ~. ~ ,N,R ~ ~ ~{eF) W Property Owner's Mailing Address Lot # 8iodc# Subd. Name or CSM# . ~>~~~ City State Zip Code Phone Number ~~ ~ ~! ~ ~~ ~ r ^ City ^ Viiiage [ Town Nearest Road New Construction use; ~ Residential /Number of bedrooms Addition to existing buitding ^ Replacement Public or commercial - Descri ~ Gl. -~ Code derived daily flow n vsan gpd Recommended design ding rate _ ~/ bed, gpd/ft2 ~ trench, gpolfiz Absorption area required bed, ft2 trench, ft2 Maximum design bading rate " ~ bed, gpolfi2 ~ ~ trench, gpd/(t2 Recommended infiltration surface elevation{s} ft (as referred to site plan benchmark) Additional design/site considerations Parent ma#eriai ~ sac ~ y C>ti~ tt„ ~.^~ c+8~~, }~ a^, . ~, _ f=lood plain elevation, if applicable h A ft S ~ Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in FIt holding Tank U = Unsuita~e for system ~ S ^ u (mss ^ u Cis ^ u ~s ^ u ^ S L~''u ^ s ~ u Boling # Ground elev. Depth io limiting factor '~ I~t~ in. Boring # ~' Ground elev. ~ Ot1 ~~{ Depth to limiting ^~~actor /i ~in. Cr1ff nf=ccotortnu ncanoT Horiaon Depth tn Dominant Color M i Mottles Texture Structure Consistence Boundary Roots GPDift2 . unsel Qu. Sz. Cont. Color Gr. 5z. Sh. Bed .Trench ~ Q - t 3 y h r- ; - °° ~ ~ ~ Serf' (~ irtt r t; ,,~ ~ ,~ ~ , ',~ ~ ii"1~ tm r ~~ts "' ~ - ~ S `,t.t"i5~j~'` K~'!~t°' C.S ~ ~ + ~ i ~... ( '~ Remarks: ~. fit. Remarks: GST Name (Please Printj Signature Telephone No. Address ,~ ~ ~ ~~ ~ ~•`°"~ ~ Date (~ ^ CST Number p ~g '~..~ ~~ ~".~S t' °1t., 4~t`~ ``a.r+~ I " d ~ " ~~ L~ Z..."L ~ ~ V / ' PROSPERITY OWNER PARCEL i,D.# Boring # Ground elec. _='ff. Depth to limiting factor I C~ in. Baring # Ground elev. ~ft. Depth t4 lirrdting factor ;> t 1 CI in. Boring # ~,-~:~;: ~5 w Ground elev. ~ft. Depth to limiting factor _~in. Boring # ..~ .. Ground elev. ft, SOIL DESCRIPTION REPORT Page ~ of Ho i D r zon epth in. Dominant Color Munselt Mottles Q S C Texture Structure Consistence Boundary Roots p u. z. ont. Color Gr. Sz. Sh. Bed .Trench L ~ f ~ Z F 7 C" 7 f _ 6 ~.8 '- a I ~ '2. 5"4 } ~ ~aA t~ } r' ~.. ~ I ~ r ~ ~ s sc r ) ~°~. ` ~ two ~ `~ r Remarks: C c~-i ~ -v r 3 t - I Z rt s ~u ~~~r" ~ ~J ;.~ ,3 f ~ Z t U -23 to- r ~` - ; ~ J.. r~ 4~k `,..`~" r.. ~. 5 t ~ ~ `~ ~ t~ Remarks: Horizon Depth in Dominant Color M Monies Texture Structure Consistence Bounda Roots GP ~ft2 . unsefl Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench f~~ ~~ 1o e ~ I y - S ~ ` n S ~ L.f ~ t '[v-~'r e. S 4 ~ . ~ , G ~ 7-7~ ~~~ r ~~~ -' ~ t ~ V~ ~ C 5 i r ff (' Remarks: Depth to ianniting fatxot in. Remarks: SBD-8330 {R. 07!96) ~, .. 1.432 1.2Q~' STREET, NEW RICHMOND, WISCONSIN 71s-zas-zasa T~~n Nclscm Certified Sod 'fester 227387--Registered Sanitarian SRO(T713 *s~****xr****s**a:***~~***~***s*a*sa~~x~s*s~*~s~**x***x~sa~*~~xs~~** ~' ~~ ~ ~~ ~~ ~~ N ~~;a 1 coo .~{ ~, ~~,~~.. ~.~~ ~ ~ SCALE 1" = t{ ~ BM 1. ta(~ ~~r~'` ~j~C. ~i(~e ~~~.v t00 BM 2 ~~ ~ ~ c- T ~ ~ ~ ,a '~ ~ ~7 rt, r°~ ~ P~ I ~fl Q , '~ ~' Tom N ~. ' ~ ST CROIX CU'UNTY ._ ~ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~ ~ ~1C Mailing Address ~O ~~ ~(~~ ~~cQC-~('\ ~~ S~QI ~p Property Address City/State (Verification required from Planning Department for new construe Parcel Identification Number 02 r5 - / 3(03 - / 7- Gib LEGAL DESCRIPTION Property Location„ ~ '/<, ~ '/a, Sec. ~, T~N-R ~ q Town of Subdivision ~ 1 + ~{ ~~ 1~1 ~~ ~~~ ,Lot # ~_. Certified Survey Map Warranty Deed # ~`~"~9Zj Volume ,Page # Volume Z~ S 3 ,Page # ~ S Spec house ^ yes ^ no Lot lines identifiable I~ yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/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 th epartment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your se tic syst has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of three r exp' ion date. CO / 70~/ SIGNATURE OF PLICANT DATE OWNER CERTIFICATION I (w certify th all statements on this farm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty d cribed ve, by virtue of a warranty deed recorded in Register of Deeds Office. rr~~~~~ /o~V SIGNATURE APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1/ U: 2 7 5 3 P 1 5 1 I STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED Document Number ~ This Deed, made between C.P.T., LLC, a Wisconsin Limited Liability Company Grantor, and Glen Johnson Construction, Inc. a Wisconsin Corporation Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 17, Plat of Exit Four Business Park in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and right-of--way of record, if any. ~8~9i~5 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIR Ct]. , YII RECEIVED FOR RECORD 02/22/2005 10:00AI9 MIARRANTY DEED Ei(l:t~~T # REC FEE: 11.00 TRANS FEE: 653.40 COPY FEE: CC FEE: PAGES: 1 Name and Return Address 020-1363-17-000 Parcel Identification Number (P~ This is not homestead property. Dated this 16th day of February, 2005. AUTHEN~Il~ ~ U~j~tC 'Pf , Y~ Signature(s) authe:tticatesi~~~''-~'s ~ l day of , ~-',,,-% TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY C.P.T., LLC Donna M. Caywood 1809 Northwestern Ave. Stillwater, MN 55082 be authenticated or acknowledeed. Both C.P.T., LI,2,--~~ Q ' C.R. Hackworthy, Manager ACKNOWLEDGMENT STATE OF ivf~t~ (~-._ ) ) SS. County ) Personally came before me this day of February, 2005, the above named C.P.T., LLC, a Wisconsin Limited Liab~ty Company to me known to be the person who executed the fore~oine instrum~fit and~nowledeed the same. Notary ic, tate of Wisconsin My Co fission is ermanent. (If not, state expiration date: •) '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 tttireau vt IntAgrated Services in accordance Attach complete site plan on paper not less than 8 1/2 x 11 inches in include, but not limited to; vertical and horizontal reference point {811 percent slope, scale or dimensions, north arrow, and location and dis ,.t> APPLICANT INFORMATION -Please print all informati fi Personal information you provide may be used for secondary purposes (Privacy Law, s. Property Ovmer tk Property Owner's Mailing Address IofJr1 ~oR~~t.~a,>~e.a..n (~U City State Zip Code Phone Number ____ ~~~llw~~ar ~ ~~ ~55o I~~ ~ (~S I ) ~{~t~- iScaa ~~~ , -.. i83.Q«g, Wis. Adm. Cade ('rr•~, , must~~ ts.;; ti~~ County /tbsfiro~i~ ~~~„ rcell.D.;at sr cfao+x COUNTY ' 2'ONIIVG QFFICE Reviewed by rage ~ _ of _ ~ J ~ ~r~~ a Date Govt'T.Zit=-•---~ ~. 114 ~ a~11/4,S ~ ~ T ~ q ,N,R (~ ~{~) W L 6t #' 81ock# ~ Subd. Name or CSM# - -" ~,`,~` S ~ L~ ~ ~r. . x ¢ C . ~ ~ S ^ City ^ Village ~ Town Nearest Road i-~ d.. ~~ ° ~.,.. ~ r~ ~ f '~., New Construction Use: Residential J Number of bedrooms Addition to existing building ^ Replacement ~ Public or commercial -Describe: Code derived daily flow n v°an_ gpd Recommended design loading rate ~•_ / bed, gpd/ft? ~ ~ trench, gpd/fi2 Absorption area required bed, ft2_ trench, ft2 Maximum design loading rate ~ had, gpd/ft? ~ ~ -trench, gpd/ft2 Recommended infiltration surface elevation(s) - __ ~ft (as referred to site plan benchmark) Additional design/site considerations Pareni material ! «c S 3 f>y+2 r~, r~v.~ ~„a~ ~ ~ ~~_____ --- Flood fain elevation, if a licable _ ~~~~ p PP _~.~___-- ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in FiII Holding Tank U = Unsuitable for system ~ S ^ U ~S ^ U ~ S ^ U ~S ^ U ^ S ~U ^ S ~ U Boring # i Ground elev. ~jJ~. Sift Depth to limiting factor i_Ls~in. Boring # Ground elev. ~ 0 U ~~ loft. Depth to limiting factor 71~~n. Remarks: CST Name (Please Print) f~ O t-,^ =.. c ~ Q! j u yam.. Address SOIL DESCRIPTION REPORT Horizon Depth in Dominant Color Munsell Mottles Q S Texturs Structure Consistence Boundary Roots CPQ1ftz . u. z. Cont. Color Gr. Sz. Sh. Bed .Trench 1 0 - ! 3 v h i r 3 f I - ' ---- ~ >kt r~ >~1:' Fr-t ~ r C v.) a ,~' , `~ , ~;? ~ t i'1-1 E~ r ~~ - _._ . _ ~ '~ ~ 2`~•yo 1.5~r^ `°t~~ - -- ) ~5 ~rrt :bGf t~'~*~c ~ S _ .~ , ;; ~Y `~ 1 Remarks: - ----~ - (- --`-~-- tom' Y-_t" ~ i+.~. C. ~ f F / ~i~ ~ ~ ~-130 1 , ~ r ~ ~ _. _ ~y ~.±~~ 3 ~ r~ ;A - ~ - i Signature ~} Q ------~ date ~~~©-4;~ Telephone No. d~~~.~1-~~i'~ CST Number 2~ ~ 3 ~ 7 ' PRO~ERiTI' OWNER PARCEL i.D.# Boring # Ground elev. `~1 ~9b` ff. Depth to limiting factor I Din. SOIL DESCRIPTION REPORT Page 2- of Horizon D th D ep in. ominant Color Munsell Mottles Qu. Sz Cont Color Texture Structure Consistence Bounda ~' Roots 2 I C.~-1 I lu ~ ~/ I . . - I Gr. Sz. Sh. Bed .Trench 2 ~ !~-2`f x-13 iv r~~l~! ~.5 r Sfc. - - s11e- ~ '1b~k5ai1 trt,rr t 6 v'~1'' C.~~ C,. a i~ ,'° :S ~ =L r Remarks: Boring # _~ ~~i:~=" ~ L- I ~ I o r 3 I ~ .._ Ground L ~~- { t p i, S r G G elegy. .ft. Depth to lirruting factor ~ 110 in. Remarks: Boring # ,~. 5 Ground elev. ~~ft. Depth to limiting factor .. ` I Z r~ S Js l-C ~''"l ~ r ~ ~J ~~ .5 ' r H i D or zon epth in. Dominant Color Munsell Mottles Q S C Texture Structure Consistence Boundary Roots PD/ft2 u. z. ont. Cobr Gr. Sz. Sh. Bed ,Trench 0-~,{i ~b r 3 ~ _ 1 ~ f"1 ~~~.° Mir" c ~1 z F rs • Z lr' ~-] 10 f '-~ ~ y S ~ ~ `` ~ f`1 S 0 ~! tyl ~r C S r 1 fi r 5 ~ (a ,i o ~•.y r ~U~ 2 ~~ TY- r `'.' ~ ~~.in. Remarks: Boring # ~~3 Ground elev. h. Depth to limiting facxor in. Remarks: SBO-8330 (R. 07/96) ~~ .. N ~'` ~- ~~`'~ ~ '"' ~..~ ~~`~,-~ Sec ~ ~ I 2_ ~ ~. t ~ l ~ t.,) ~ ) 0 ~ r`? ~ ~ ~ `~ t~ S a r"t Q ` ~' 2 61 ~U ~~ c .. . ~~~#~~NM~N ~-~ ~~! D~~~~N 1432 120` STREET, NEW RICHMOND, WISCONSIN ?15-24b-2454 Tarn Nelson Certified Sod Tester 227387--Registered Sanitarian SR007i3 *****+*:*s*#*s«sssa~*~:r•*~*s~s::***x~*::*:*:xs*«*~*#***~~«***xM*** f~~.y~ i 3 ~9 , ~ 2 ~3 ~~~Q~~~i- t q~ ~~~ ° ~ ~, ~ 1~,3•- ~~'~'~ scAi "F 1" _ ~ o BM 1. fob ~~, 2" ~dc ~~~¢ Ql~.v ~Oa BM 2 ~Cu~ o~ S~ ~af C~2rZ~,t'• 10Q,'~,~1 ~~~ ______ ~'1 _____--_ ;off Tom Neiso ~/'