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HomeMy WebLinkAbout020-1419-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety arid Building Division INSPECTION REPORT Sanitary Permit No: 515272 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: Heiti, Robert & Penny Hudson, Town of 020 - 1419 -70 -000 CST BM Elev: Insp. BM Elev: BM Descripb C/ 1 Section/Town /Range /Map No: / °O' VC / 40 • !1S ( .dYl And 20.29.19.2665 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 2. 15 /oZ• /.S 0. Septic pao, /006 Benchmark �,� /Do. yr / Dosing _ 1/ A 1 � /� 1 1 � k cis r _ a,l= BJ"''�, -It4,., C aJ • 9 7 95 Aeration Bldg. Sewer ��� � till //. Z �,n Z5. Holding St/ I nlet � f St/Ht Outlet TANK SETBACK INFORMATION TANK TO 2 \ WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1�- t,�J t Septic , a Dt Bottom l J , Dosing / f / Header /Man. t, 3 >56 �, �., e /Isles ate- $.55 93- Cr Aeration J 2 /1 _ 4 �� Dist. Pipe $6 93. 3 x' Holding e n Bot. System 7,5 O 92. 35 Final Grade 7 PUMP /SIPHON INFORMATION 1. $1 ,V S7 Manufacturer / /� /Demand SIT: / �f Q l e) vA. cO j GPM 4, t:1 g f (' eS 4.2_ / Y /� Model Number CP O 4 47 Z !( it 3 c , -a , S TDH I Friction Los S System Heal TDH . 3 Ft For Length Dia. /1 Dist. to Well / i 2 So SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Le ngth il No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 /_ Z I f�, ( ,,.t„ `"1 , '_�- SETBACK SYSTEM TO vc+ P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION Ty Of System: / / 1 CHAMBER OR � i� �`( i — rg,+ /45 > )� UNIT Model Number: `, • Lh (�I DISTRIBUTION SYSTEM AZ Ara. � H 1-1( . 7 d( &, Header /Manifold if Distribution \ x Hole Size x Hole Spacing V�e/JJll to Air Air Intake Pipe `� Dia ......4..' ......4..' Spacing ��. eip a 7 2. Dia L P Lengh Length /± /� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 6115 3 f) A.ti.a. -.QA Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / Bed/Trench Edge Topsoil \..,... Yes No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I / D // 0 Inspection #2: / / Location: 852 Chebek Lane Hudson .4. , WI 54016 (NW 1/4 S 1/4 20 T29N R19W) he Glen / r "t ,(, ' f Parcel No: 20. 1.) Alt BM Description = FAIL", `"� . (r Go J ' `-- / a {l.a 1 -, `� 1 _ 0 2.) Bldg sewer length = i *- km. nu (.G� 7 k /�G� / S amount of cover = /0 / Y�.r / (�VV i1 e(Y f h t t d P �'�. �'rt i / -rie -e .r'r- /ia2U' lave, Plan revision Required? El Yes No Use other side for additional information. / I 1.* Date 1 Insepctor Signat/ Cert. No. SBD -6710 (R.3/97) j 1 , . i t . commerce.wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S t,C Vd k 'sco fl S i fl Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Departtnent of Commerce 6-1 5Z 7 2— Sanitary Permit Application State Tra Nu N' j / / �4 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailin address) submitted to the Department of Commerce. Personal information you provi'e may be used for secondary purposes in accordance with the Privacy Law, s. 15,04(1)(m), Stats. I CZ I. A , 1 lieation Information - 'Please Print All Information A Property Owner's Name Parcel # j 2 .,6a --- I A �°e,�,� y /7 % * ee / SEP 0 Z01 626. ii/i5". 7D - ecaa Property Owner's Mailing Address Property Location /. � C ) ST CROIX G J coulv�i� � .Lot �� t 0 . t City, State Zip Code P E ' A �,yuJ se- /,, Section e? �/^ s ya 1 (circle one�q 501/1 .L-- � T � N ; R /1' E ott4v II. Type of Building (check all that apply) ! Lot # 7 li or 2 Family Dwelling - Number of Bedrooms Subdivision Name C. K.._ Bloc A e- ,4 e.A-1 ❑ Public /Commercial - Describe Use ❑ City of ❑ State Owned -- Describe Use �/ Town of CSM Number ❑Village of 2 ITtC����,✓ 2. k 5 116 u) ) 104 -1 (0 -- �1�Je`� III. Type of Permit: (Check �nly 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) Y P Y g P Y g Y ( P ) B. ❑ Permit Renewal 1Persait Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration 1.� Owner IV. Type of POWTS System /Component/Device: (Check all that apply) Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis I ersal/Treat i• ent Area Information: Oak' 'c yB tie l Design Flow (gpd) Design Soil Application Rate(g sf) .ersal •. - Required • Dispersal Area Prot •. - d (s9 System Elevation 1 Y-5 V. 1 e 7 iy3 g , • ;ee404 coa, T' ✓ V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units �, O 7 New Tanks Existing Tanks Liz... �? N o L v .g' ``." � J w U v� cn w C7 0. Septic or Holding Tank ho / / f u Dosing Chamber X 41. ,, G / 4) ,' eS , e VII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTwn on the attached plans. Plumber's Name (Print) Plumber's Signature M PRS Number Business Phone Number I . - - - l a I �1; ll/a vx 9c lea "10.12 /��c v- Grl.�.d� — :2�2 ? T Z D �!S 3F� .� 1 Plumber's Address (Street, City, State, Zip Code) J e) _ j6 7e _<'G 0' 1/�Gl 1/je. , ' - _di/ r L - VIII, ounty/Department Use Only / Permit Fee Date /sue/ su issuing _• nt Signatur PP roved ■ Disapprove. PP / ❑ :: • $ iven Reason fo a enial V . 00 7 G 1-7 / / /�0 all IX. Conditttstgt�teasons for Disapproval eee / 1. Septic tank, effluent filte and 3. Perm•3 k— ; it $. n( /' / e. o 4. A et.�) dispersal cell must all be servk:es / maintained as per management plan provided by plumber. . ( Irole, I.- 10Ga.+4-i 2. All setbackTequi ments must be maintained _T Attach to complete plans �for rt the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD - 6398 (R. 02/09) Valid thru 02/11 / e-‘4' /er 7/ 7 .„„e,e ,,, 1/4_ds'a 4_. / , ' „. d.,/ ,. aAlc y.e10-7 sar6 l4G, ' - --- Z------ V :5 L Ai r /g04o.,,„,e ipli 4,;7..Aisacr... Y. s ) 1 4 0 II .■ / \ if tg All li il A 9 5 { CF CP a 2 ' /X / 7 �66ryT .� /✓/,, - / /07 77 as •e- J l,�dt d rg • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ ) Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S� . e n��C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 4Z . /9/ ?. 7j - deo Please print all information. � Revi /ed by / Date • ti A p'� Personal information you provide may be used for • • v. s. 15 1 (1) (m)). 1` 9/7 /e) P • • _ ■ • er Prop rty Location / / • L 4- - Pe. / , 'Q J _ _ N % Govt. of ` ) 1/45 1/4 • 2 41/T 2/ N R l 9 E ( ) W Property Owner's Mailing Address '„- ' Lot # Block # Subd M# ` l Si CROI v�� • F�d _ %G1S� ti City State Zip Code P or g & Z ■ ity ge •wn Nearest Road t >gReplacement New Construction Use'sidential / Number of bedrooms 5/ Code derived design flow rate b .I/ GPD ❑ Pub% or commercial - Describe: Parent material Li )t ' c lit.. Flood Plain elevation if applicable Al 1 ft. General comments and recommendations: l System T y p e O 4/t h°41_56 ,swr System Elevation 73 ' � # Boring pit Ground surface elev. 7‘ 5 Depth to limiting factor /0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 )0 / c3A— s / e - Z2 2 / . ( /4 ° S .. .3 ay w J -/y r---' �/ 2,7.1 -d ,27,- / wi> i ,/ z/ ig-py/ Ir e ----- / 5 ( r ,p_ , /1 / it/iif /vi, . -- 7 / • ❑ Boring / c Boring # FA Pit Ground surface elev. 19 1 ft. Depth to limiting factor /4.2 yin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 — ll /07,3/1._ .________, 5/ on77,--- ( (24A---- _ ‘ . g Z // 9 /®� es /y --- ( t / . in s ,� /' /17 7'112 /4 , ,/ , � Y6 a9/ / /v�/ ,S as- i / 'y ,),4 3/441/4- — 7 / j1 ittka 137/ • Effluent #1 = BOD> 30 < 220 mg/L and T >30 < 150 • ,✓ ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) �• e CST Number Bird Plumbing, Inc. Shaun Bird i 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 f—c72—./ 715- 246 -4516 Property Owner _ Parcel ID # Page of 3 Boring # • Boring 1 • it Ground surface elev. ft. Depth to limiting factor ) O- 1 in• l Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 o — q )o � 31z �� s,- dixyr (, tg - , -3 z 9 -2 Z/ 0 y cS /V ,�bK Pi) rv)7' / q 3 ac-(d7 /(ii,.//6 S Os /12 / A/1 - 14 - /vm - - --? Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 0 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 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 (8.6/00) 4 Property Owner _ Parcel ID # Page of 3 Boling # 1 Boring • it Ground surface elev.1 . <.-- ft. Depth to limiting factor / O t in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 O -q 1 o tz— --- ----, s,/ c9 � ,nr -- (,- /) 2 7 - , 0 rsry J � / • _ , / g 1 3 a — o j /( / �S /�j l �/1,� �v1.4 - y3 5 " Z. Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Boring # ❑ Boring . ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 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 (8.6/00) Soil Test Plot P14 9 Project Name Bob and Penny Heidi : 'rd Address STM #226900 Lot 7 1 Subdivision The Glen Date 9/2/10 N W 1/4 SE 1/4S 20 T 29 N /R19 W Township Hudson 0 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of concrete porch System Elevation TBD *HRpSame as Benchmark A Scale is 1" = 40' unless otherwise noted Property Line 1 r Pro 4 Bedroom House . NB.M. Ravine 20' 1 10' .II B -1 98.5 50' 5% Slope B -2 25' A rI 20' 20 I� B -3 30' 96.5' • Road L 0 O O» O , . 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Code, submission of this form to the appropriate governmental f unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal informatio ,!,..1 - defy . l 55 z 6,k �� .ur.oses in accordance with the Privac Law, s. 15,04 1 m , Stets. tl .1 �'� kyr 6 , I. AI • lication Information — Please Print All Information EN Property Owner's Name, -• 'eAA II Parcel # r d �e ►� ! /� ► ■! it . 1 DSO l q Ill - a o Property Owner's Mailing Address) - `^ n- /' Property Location • 2145 6 ✓ ! 's �ks - G Oak— ���`t, :. r r r, • r • . Govt. Lot 7 City, State Zip Code ''""" � ,j y Section 20 5 �! circle one II. Type of Building (check all that apply) 0 l Lo Xl or 2 Family Dwelling - Number of Bedrooms -.......-- f 4 Subdivision Name / >✓it/ ^�' Block # g G ��+ /. ❑ Public /Commercial - Describe Use f City of CSM Number ❑ Village of ❑ State Owned - Describe Use / I 2 1;e* CC,IIS L..) /41+4 to G�a�•�ee Town of yYu d�'d II1. Type of Permit: (Check o y one box on line A. Complete lin ' t if applicable) . A. Icy IL9 -New System ❑ Replacement System ❑ Treatment/Holding k Repiacef ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ■Transfer to New Before Expiration IV. T se of POWTS S stem/Com • onent/Device: Check all that a • I I _ O .Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ■ ound > 24 in. of • • • ble soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) . ❑ Pretre • • ent Device (explain) V. Dis iersal/Treatment Area Information: inVi n r•e s = — ..Q. Design Flow (gpd) Design Soil Application Rate(:..sf) r fi)t ''"al .• - a Required (s Dispe sal Area Pr .o (sf) System Elevation . ,, g,S'd . 7 <l3 6' ` - ti 3, / 204./ ca •tiT VI. Tank Info Capacity in ' Total # of Manufacture Gallons Gallons Units o' _ ) New Tanks Existing Tanks 6. R I I dk., 5z a i g N �. 6 Septic or Holding Tank 111 / ewe l 4 � = Dosing Chamber r- - VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWT5.x4wn on the attached plans. Plumber's Name (Print) Plumber's Signature (MP PRS Number Business Phone Number ...L u ma-*Ise' 1 ,z7 - d I-i - 3 rn - 3 Plumber's Address (Street, City, State, Zip Code) / it ? a S' c ,pt c.G_, 4d ,` ,- S d/ n VIII. County/Department Use Only roved III Disappr. Permit Fee . Date l sue Issuing t Signal e / CI b : even Reason for • ial $ "� � /a , 41 — IX. ConditipR for Disapproval / 1: Septic tank, effluent filter and dispersal cell must all be services / maintained] as per management plan provided by plumber. 2. Aq s black fequitements must be maintained as p o l lett It iftifsfhe system and submit to the County only on paper not less than 8 uz s 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 / °A 1/1— g e /` - >' 4,0 G.•+" ev,v f 11 e� v 4, P it eittx16 ys 7 / v 2. 55 Yrs-a vch ` \� �. ms`s � �, s o y 13.3 O � o p , r \p loam Cle*4 ti 'aa.e gee "7r 4® l TH4 41 e* TGdvv • le O tit .2 dc -e r YT reTa/ , U lV s • n3 eo o ` , r CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: / � -e �6 s Owner's Name: gd,d )-1 die Te' Owner's Address: Legal Description: ,Jed S1 �1� ,s'24 729 fi / Township: /1/24 fit rJ County: ,67 i • Subdivision Name: 7"4 +%- Lot Number: 7/ Parcel ID Number: C5a7� Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross- Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer /Plumber: GO/ l /( .1c X t )74 Number: _ 2 27 L'4'D Date: / /S/ /6 Phone Number Signature Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01). Page 1 1 1123 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sal Service County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and ^ G � percent slope, scale or dimemsions, north anew, and location and distance to nearest road. Parcel I.D. 6 , ) ' z ' L) 6 6i Please print all information. rwe2d BY 1 t� ►) Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Af �r ,_ . _ I r 3 7,, n 1 — Property Owner Property Location Sienna Corporation Govt. Lot NW 114 SE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # 6 '] Subd. Name or CSM# /; ' - ' ,�� 4940 Vilking Dr. Suite 608 71 / The Glen / l City �cA;74 State Zip Code Phone Number A City 1:2A Village it Town Nearest Road MN 55435 952 - 835 - 2808 Hudson Dorwin Rd. el New Construction Use: VI Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement „,;,> Public or commercial - Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments and recommendations: System elevation 97.60ft, trenches spaced and depth to code 3.50ft below grade 1 Boring # Boring el Pit Ground Surface elev. 101.60 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHtz *Eff#1 1 *Eff#2 1 0 -12 10yr3/4 none sil 2msbk mfr gw 2f .5 .8 2 12 -19 10yr4/4 none sci 2msbk mfr cs na .4 .6 3 19 -96 7.5yr4/4 none Is osg mvfr na na .7 1.2 a " 9 -Go it 18 /8 Y Boring 2 Boring # �� Pit Ground Surface elev. 101.10 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 I *Eff#2 1 0 -14 10yr3/3 none sil 2msbk mfr gw 2f .5 .8 2 14 -28 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 28 -37 5yr4 /4 none cos osg mvfr cs na .7 1.6 4 37 -96 7.5yr4/4 none Is osg mvfr na na .7 1.2 1 12/ * Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ,� /i � 248956 Address Steel Sal Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/13/2002 715 -246 -5085 Property Owner Sienna Corporation Parcel ID # pending Page 2 of 3 3 Boring # Boring le Pit Ground Surface elev. 97 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 1 0 -12 10yr3/4 none sic! 2msbk mfr gw 1 c .4 .6 2 12 -24 10yr4/4 none cos osg mvfr cs 1f .7 1.6 3 24 -96 7.5yr4/4 none Is osg mvfr na na .7 1.2 1,,a_ G- r 3 `r LiziaAAJ — c Boring # Boring `.j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 Boring # :,I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg /L and TSS <30 mg/L The Department of Commerce is an eqt 1 opportunity service provider and employer. If you need assistance to access services or . Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST - POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 NW1 /4,SE1 /4,S 20,T29,R19W (715) 246 -6200 Town of Hudson, St. Croix Co. (715) 246 -5085 The Glen lot 71 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was conducted. Legend 1 " =40' '�-- Benchmark El. 100.00Ft Top of 'h "pvc pipe Alt Benchmark EL 100,70Ft ` Top of /z" pvc pipe a = Borings „/ Boring Elevations �" B1= 10140Ft B2 = 101.1OFt B3 = 97.90Ft 175 51 l B4 =00.00Ft /06/0 f + fcA0 r~ 1 _ I,� (' 411AEIac B3 w i3d -1 7 •(? 3- �� Soli Absorption System Cross Section Final Grade 4" schedule 40 PVC Vent Pipe 91, e With Vent Cap �---- 44, Leaching ft Chamber System Elevation 3 ft 3 ft Soli Absorption System Plan View I ft 3 { 111111F1111IIIIII1NIIIIIIII1111111111IIIII1I1 11 Leaching Trench 1 ft Vent Or Observation Pipe Chambers IlllE flllllllllllllilllillll 1I 111111111111111111111111111 ;1111111 \ 4" pia. Trench 2 Header Leachino Chamber Specifications Manufacturer And Model , EISA Rating sq ft per chamber Soil Application Rate ._ -- gpd/sq ft '.�i gpd Design Flow + 7 soil Application Rate � EISA = Chamber 2 rows of chambers each. Page of SEPTIC T ANK PUM CHA'BER CROSS SEC � I U`� A NA SPLC:1r iLtj l � Lipa' 4" CI' VENT ' PIPE ' 12" MfN. 'ABOVE GRADE s WEATHERPROOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE • WITH CONDUIT MANHOLE C OVER W/ P 6 FINISHED GRADE r► WARNING LABEL 4" CI RISER --- 4. / MIN. �. tYL , 18" 1 MIN. i 6" MAX. ** ;; NLET oh 7,7t 1 � — It �� i , ‘Sailli � WATER TIGHT SEALS GAS A TIGHT ` :PROVED SEAL / JOINTS WITH _l.. ALM APPROVED PIPE :PROVED B ' ON 3' ONTO NTO IPE 3' ' "F"' SOLID SOIL OIL SOLID I + * RISER EXIT OIL PUMP OFF ELEV ELEV. FT. --�► OFF PERMITTED ONLY D IF TANK 3" APPROVED. BEDDING UNDER TANK MANUFACTURER HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: ii TANK MANUFACTURER: /,, eS y TANK SIZES: SEPTIC Jam' GAL. DOSE VOLUME INCLUDING GAL. DOSE a 673 GAL. FLOWBAC ALARM MANUFACTURER: j„ F �14 AA, �+ CAPACITIES: A = 'p 7 INCHES = ,3,5:V GAL. MODEL NUMBER: p s. v B = 2 INCHES = GAL. SWITCH TYPE: 711 erc PUMP MANUFACTURER: 1p o44,/.1 1 C = INCHES = Z_GAL. MODEL NUMBER: ,�',r9 a 4/ D = (� INCHES = VC GAL. SWITCH TYPE: hrle9^c REQUIRED DISCHARGE RATE __ _ GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • . _. 1 2--- FEET FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + ,r;© FEET FORCEMAIN X ..l.�JFT /1O0 FT. = /,,5 ,1.57 FEET /5 DIAMETER INTERNAL DIMENSIONS OF PUMP TANK LIQUID � ; y4 �G"..d` 7 /��' SIGNED: LICENSE NUMBER: ,2 2799d DATE: .j.,TZ,V..i.e......–..–A37 . 1/88 GO OLDS PUMPS Submersible �.. Effluent Pump t MODEL „.., Q 3 V 7 1 EP0EPO4 5 APPLICATIONS • Fully submerged in high • EP05 Impeller: Thermoplas- • Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the construction. p Y 9 lubrication and efficient improved performance. following uses: heat transfer. • Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion 0 Canadian standaMsAssodaaon • Farms manual operation. Auto- resistance. • Heavy duty sum p matic models include M echanical Float Switch • Motor Housing: Cast iron (CSA listed model numbers en • Water transfer • ~ • �� d assembled and preset at the for efficient heat transfer, in F or "C".) • Dewatering factory. p strength, and durability. • Motor Cover Thermoplastic Goulds Pumps is 150 9001 Registered. SPECIFICATIONS cover with integral handle and FEATURES • Solids handling capability: float switch attachment points. 3/a' maximum. • EPO4 Impeller: Thermoplas- • Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 111i' NPT. seal protection. • Mechanical seal: carbon- rotary /ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40°C) continuous METERS FEET 140°F (60°C) intermittent. 10 • Fasteners: 300 series ' eries , _, i- 5 GPM stainless steel. • Capable of running dry without damage to a 25Fr components. 25' - 0 7 , Motor: x •...� • EPO4 Single phase: 0.4 HP, 6 20 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with c 5 1 s _ -I EPOS automatic reset, a 4 ; • EP05 Single phase: 0.5 HP, o _ . 115 V, 60 Hz, 1550 RPM, '' 3 10' built in overload with 2 , .......... automatic reset. • Power cord: 10 foot 5 .... . standard length, 16/3 ' SJTOW with three prong GPM 0 0 grounding plug. Optional 20 0 10 20 30 40 foot length, 16/3 S1TW with 8 1 a t 2 m three prong grounding plug 0 2 4 6 (standard on EPOS). CAPACITY Goulds Pumps ITT Industries ®2000 Goulds Pumps Effective February, 2000 B3871 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 77' Sep tic Tank Capacity �(JQ gal p Permit # Septic Tank Manufacturer Effluent Filter Manufacturer i f �c •c ❑ NA DESIGN PARAMETERS . Number of Bedrooms 3 ❑ NA Effluent Filter Model r�,$� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Q •.al ❑ NA Pump Tank Manufacturer ` 'S6Y• ❑ NA Estimated flow (average) �f SQ alb /daY. / ❑ NA y5 gal /day Pump Manufacturer adu ! mac Design flow (peak), (Estimated x 1.5) ❑ NA Soil Application Rate gal /day /ft2 Pump Model Monthly average* Pretreatment Unit 0 NA Standard Influent /Effluent Quality Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: 5150 m /L Total Suspended Solids (TSS) Dispersal Cell(s) ❑ NA Monthly average Pretreated Effluent Quality ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Biochemical Oxygen Demand (B00 <_30 mg /L <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Total Suspended Solids (TSS) Other: : Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑Oth Other: ❑ NA Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA _ — Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks) At least once every: 3 yryearmonth( ) year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y3) of tank volume ❑ NA ❑ monthls) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 3 fl year(s) • month(s) ❑ NA Clean effluent filter At least once every: earls) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: r CI yearis) ❑ monthls} ❑ NA • Flush laterals and pressure test At least once every: r ❑ yearis) ❑ month(s) ❑ NA Other: At least once every: ❑ yearis) CI NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made OWTS lnspector POWTS Maintainer; Septage gServic$ng Operator. certifications: inspections Plumber; tion s must include a Master Plumber Restricted Sewe , pecs mus visual inspection of the tank(s) to to identify f any any backgup or broken pondng effluent the ground surface measure the volume of combined sludge and scum and ondinc The dispersal cell(s) shall be visually inspected to check fluent on f the ground surface may indicate a failing condition and a requires the of effluent on the ground d surface. The n ponding of immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals and disposed (Y3) of acct dance with chapter NR 113 contents of the tank shall be removed by a Septage Servicing Wisconsin Administrative Code. All other services, including but not limited months, shall h performed f by a certified POWTS Maintainercomponents, p units, and any servicing at intervals of 51 A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ______ or ...__. START UP.AND OPERATION For new construction, prior to use of the POWTS nhepk fropOrnent tonlrle) far the presence of painting products or other chemicals that may impede the treatment process and /or dart+lr + 1; ; 0 4400001:000). if high concentrations are detected have the contents of the teals) removed by a septage servicing operator prior t ' *b. , System start up shall not occur when soil conditiotld Br0 01MiSlt at the lnfiltrative surface. ' W hen power is restored the excess wastewater will be During power outages pump tanks may fill above bill II h $*V1. ne may result s the backup or surface discharge of discharged to the dispersal cell(s) in one large doltai 00 100 I q .;an d a gesult i Servicing Operator prior to restoring Of effluent. To avoid this situation have the contents - r E �t tn! , power to the effluent pump or contact a Plumber "1 '1' ' Mlik�itlikl' to assist in manually operating the pump controls to restore normal levels within the pump tank. , Oa Do not drive or park vehicles over tanks and dispe001 04 If 0 . notOrlim ar, park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at - grade $o il- 8oIPtl+ rd rah 0, Reduction or elimination of the following from the i#0000000000001 Improve the performance and prolong the life of the degreasers; dental floss; diapers; disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts} c►eMdrl lOCW' 040 04; tease; herbicides; meat scraps; medications; oil; foundation drain lsump pump) water; fnait and veplll l f 0lr% a, 1 tiol g Painting products; pesticides; sanitary napkins; tam I I din Slifltfit -• , ftf 1 it brine. ABANDONMENT steps shall be taken to insure that the system is When the POWTS fails and /or is permanently taken but df sentiliii th ' 01100/Wng properly and safely abandoned in compliance with chtlgt*r Chit r W ii onsin Administrative Code: • All piping to tanks and pits shall be disconrieCtitd drld the lsb+I1nd0 Pipe openings sealed. • The contents of all tanks and pits shall be r0e000.00 000 brp$tty dlapo of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be e0uvat0d lind terhwved I1 their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the fctlibi/iiirl{l Inalll ,40 have been, or must be taken, to provide a code compliant replacement system: Q A suitable replacement area has been evainet0 ndni•e be qtlilsed for the location of a replacement soil absorption system. The replacement area should be prptkritcd fr#rh dlpt0ilpot!.nn compaction ati to protect the not be infringed upon by required setbacks from existing and propoliaO�Itr ulr'Il l �ti ill $ result in the need for a new soil and site evalueiti0 to a it•pllIlb Ir 4U4ab1e replacement area Replacement systems must comply with the rules in effect at that time k ppdgr soil limitations. Barring advances in POWTS L7 A suitable replacement area is not avaii#0 iipe SO •Albs rt technology a holding tank may be installed 11$:�l �� r � , 8141004 the failed POWTS. as not en evaluated to idec area Upon failure of the POWTS a 8011 and site p The site` ntlf*,z! •aalf f r I e e l * , If no replacement area is available a holding tank evaluation be performed to locate a if l 1. fill lit may b ' taile s a last resort to replace tht s eta In place following removal of the biomat at the Q Mound and at - grade soil absorption systeltlp et;Be ri l"1ep IOd the rules in effect at that time. infiltrative surface. Reconstructions of such ity t"±e'niutlt b± rip ;. ,... . < GWARNiNG> > DIfIR INSUFFICIENT OXYGEN. DO NOT SEPTIC, PUMP AND OTHER TREATMENT TANKS M4Y' 0 l w ` .0 0 SES SES AN AN . DEATH MAY RESULT. RESCUE OF A ENTER A SEPTIC, PUMP OR OTHER TREATMENT T4 ! ° .1, t PERSON FROM THE INTERIOR OF A TANK MAY BE 1O r ° 1 . ADDITIONAL COMMENTS POWTS INSTALLER Name ' a i n `, , i TAMER #1 t� ' A h.. L ‘ �1dtl� Phone '715. ,... 3g, .....31A/ . SEPTAGE SERVICING OPERATOR IPUMPER) 4 l . ,.I AATORY AUTHORITY Name 54-. / ''// Phone Phbta. /5 - 3 zs,- 4/10: a , This document was dratted in compliance with chapter Comm 8 22( el alrid I Ii w3 .6Ait}, 421 & {3), Wisconsin Administrative Cocie ST. CROIX COUNTY . SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM - r Owner /Buyer e9A-r 4.Y1 efaiii 111 1 . Mailing Address 5S - (Jii i �-c'. 04, Ci r : Property Address S C -Lia =-- 1.fi-r\ e (Verification required from Planning & Zoning Department for new construction.) PI City /State 4\_Xl.- Soil U-.) Parcel Identification Number 4 2 0 - 1 `� / 1 1 — 1 — 6a D LEGAL DESCRIPTION 0 Property Location /∎( b- 1/4 ,-.)., 1/4 , Sec. O , T c J N R / � j W, Town of 04 sa n i Subdivision ' TU— C1,12/n - , Lot #1 / . Certified Survey Map # 02 6 • 2-- e - 1 q - c , (. < , Volume , Page # . Warranty Deed # , Volume , Page # . Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a lice -used 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num ,.• r of , edr 1 ■ GNATURE 0'I PPLICANT(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. 08/05) 111111111111111111111111111111 11111111111111111111 * 9 1 6 0 1 7 1* 916017 BETH PABST State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST, CROIX CO., WI RECEIVED FOR RECORD Document Number — — Document Name 05/13/2010 04:20PM WARRANTY DEED THIS DEED, made between Bane Corporation, a Minnesota corporation EXENPT 1 REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 404.70 and Robert V. Heiti and Penny L. Heiti, as Trustees, or the successor Trustees, of PAGES: 1 the Heiti Revocable Trust Agreement dated August 1, 2006 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more Recording Area space is needed, please attach addendum): l/- Edina Realty Title 400 South Second Street, #115 Lot 71, Block 7, The Glen in the Town of Hudson Hudson, WI 5401 -1974 Fil # • 020 - 1419- 70-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties:1) municipal and zoning ordinances and agreements entered under them; 2) recorded easements for the distribution of utility and municipal services; 3) recorded building and use restrictions and covenants; 4) general taxes levied in the year of closing; 5) Terms and Conditions of Notice recorded December 12, 2002 in Vol. 2079, Page 38, Doc No. 702098; 6) matters shown on the recorded plat; and 7) restrictions and covenants recorded in Vol. 2079, Page16, Doc No. 702097. Dated May 5, 2010 Bane ft • • • � on ._IBrr .... / i t __! ir,/ (SEAL) (SEAL) * b ilohn M. Nasseff / / It !Chief Executive Officer * (SEAL) (SEAL) AUTHENTICATION A KNOWLEDGMENT Signature(s) STATE OF ) authenticated on ��� ) ss. • Ci� COUNTY ) * Personally came before me on May 5, 2010 TITLE: MEMBER STATE BAR OF WISCONSIN the above -named John M. Nasseff, Chief Executive Officer (If not, of Bane Corporation authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS E. Gallaher INSTRUMENT T NISN OSIM A 3 1d.S Firry E. K ,i �' / ' ,�„ " Lockridge Grindal Nauen p! "�8� A� f � e -ota • t 100 Washington Avenue South -Suite 22 �{/ ` ot. Public, State of Minnesota Minneapolis, MN 55401 E H aAdls Y i VI:10Eraa y Commission (is permanent) (expires: a . Tel: (612) 339 -6900 (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. 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