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022-1012-80-075
I - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division M INSPECTION REPORT Sanitary Permit No: 488027 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: Hayes, James I Kinnickinnic, Town of 022 - 1012 -80 -075 CST BM Elev: 2 Insp. BM Elev: BM Des tion• Section/Town /Range/Map No: 1 r l 05.28.18.77B40 TANK INFORMATION LEVATI N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. .►'1 /65. 1Z ri9•G 5 Septic / Benchmark 2 I Dosing Alt. BM , sl.I( l �•� 2 Aeration Bldg Sewer �o! o sa s C_ o o' 7.�A . 2 Holding St/Ht Inlet J TANK SETBACK INFORMATION SUHt Outlet / TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , Q / Dt Bottom Dosing 1 l Head an. Aeration Dist. Pipe Holding Bot. System al Grade PUMP /SIPHON INFORMATION P ��l a7 0� p dF Manufacturer / l GPM nd St Cover /_ rl, /1>3.yg _ �/• o Model Number �Z TDH Lift Friction Loss System Head TDH t 1z•17 (a- 3. Z !. (4 5 --- .a Forcemain Leng� / Dia. Z ,� Dist. to well 9f 3e SOIL ABSORPTION SYSTEM Co,n�ovr ? j Gf u�+ovt Q ) one BEDITRENCH Width 1 Length No. Of T nche PIT DIMENSIONS No. Of Pits Inside Di ILiquidDepth �J DIMENSIONS 66 --- ___ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f ystem: /� ^ UNIT Model Number: 6 tJ A DISTRIBUTION SYSTEM Header /Manifold 1 Distribution (el of x Hole Size . r x Hole Spacing d Ve Intake Length _ Dia Z Length � Dia ` / Z Spacing 3 . !�� Z •�j Z d �.^— SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I I Depth Over xx Depth of xx Seeded!Sod ��Yls xx Mulch d Bed /Trench Center /.7 Bed/Trench Edges \ Topsoil t No No COMMENTS: (Include code discrepencies, persons pre sent, etc.) Inspection #1: / 7 Inspection #2: �- Location: 1091 Count oad N Roberts, WI 54023 (NE 1/4 SE 1/4 5 T28N R18W) NA Lot Parcel No: Rq� .28.18.77B 0 1.) Alt BM Description = ccue� 2.) Bldg sewer length - amount of cover = r Y Plan revision Required? i = Yes No ' Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) t Safi and Buildings Division County < �� ` an , W 201 Ave., PA. Box 7162 J C. ,����� M tso 8 26��� Sanitary Permit Number (to be filled in by Co.) Department of Commerce ED S90z- Sanitar Permit tioq [ /� Sla Plan .D. Number / In accord with Comm 83: Wis. Adm. Code, on ation o p�ovid"e 9 2005 / l- � tO Z_ may be used for secondary purposes Privacy Law, 5.04(i roject Address (if different than mailing address) ST. CRO I. Application Information - Please Print All Information G 0 Property Owner's Name r Parcel # t Block # �J Q,�yvtsl.� ( .33 Property Owner's Mailing Address Property Location -7� 1 L / 6 Y,,,!5 V,, Section •! / City, State, l Zip Code Phone Number �r�7 Jam/ �7 / 7 �s - 8 - 6 T O N, R E e) � II. Type of Building (check all that apply) a� S�mt ©k S CSM /k l or 2 Family Dwelling - Number of Bedrooms ubdivision Name umber D oe5 rti - — ❑ Public/Commercial - Describe Use ' 4 A Xii WL ❑ State Owned - Describe Use p un c ❑City ❑Village f k sbip of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) C) Z2 075 A. lk New� ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In- Ground ❑ Holding Tank Peat Filter Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ g Y g P Pe (explain) 5 ` dam t Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line El Pi ❑Other �A V. Dispersal/Treatment Area Information: Design Flow (gpd) sign Soil Application aDdst)_ Dispersal Area Required Dispersal Area Propos System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units r Concrete Constructed Glass New Existing /✓ 2,kk A. Tanks Tanks Septic or Holding Tank O A ✓' Aerobic Treatment Unit V Dosing Chamber 00 ^o / VII. Responsibility Statement I, the undersigned, assume responsibility for i stallation of the POWTS shown on the attached plans. Plu r Name (Print) Plum ignature /MPRS Number Business Phone Number Plumber's Address (Street, City, State Zip Code) If VIII. unt /De artment Use Onl pproved Sanitary Permit Fee (includes Groundwa Date Isst cd Issuil gent Sign tur o ps) Surcharge Fee) , /2 C 00 I Z 1 6 5 riven Reason for Denial -7 J IX. Conditions of Approval /Reasons for Disapproval Al SYSTEM OWNEW 31 N 10LJ CC 1. Septic tank, effluent finer and dispersal cell must all be services / jDa injIm �Lt. JC as per management plan provided by plumber. a'�� P �� 2. AM setback reWirements must be maintained �� O J as per appl o" code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/1 x 11 inches in size SBD -6398 (R. 01/03) J �3A tioql- 3 v , a 4 L7 � � 4-f j3- 3 IF t Do ml �q,3D 1 `l13U r N u / M 1 Ad- ® 13M a C n Luc, j3- 9 � y� amp- 30 � ( 13- `/ + Safety and Buildings c ommer0exi.gov 10541 N RANCH ROAD kAYWARD WI 54843 TDD #: (608) 264 -8777 t(le sconsin �/� e per1mwit of commerce ,nrwin►.wis�r�sin.gov Jim Doyle, Governor Mary P. Burke, Secretary November 21, 2005 CUST ID No. 220357 ATTN. • POMInspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/21/2007 Identification Numbers Transaction ID No. 1202462 SITE: Site ID No. 705873 James Hayes Please refer to both identification numbers, Cth N above, in all correspondence with the Town of Kinnickinnic agency- St Croix County NE1 /4, SETA, S5, T28N, R18W FOR Object Type: POWTS Component Manual Regulated Object ID No.: 1044499 Maintenance required; 600 GPD Flow rate; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01) 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. 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD - 10706- P(N01/01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) ". • Access to the filter for cleaning must be provided per ss. Comm 84.25 (7) and (8),Wis. Adm. Code product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. 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 to commencement of construction /insWbtion/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. Asper 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 X Balance Due $ 0.00 Duane R Steiner Wastewater Specialist, Integrated Services WiSMART code: 7633 (608)235-0608, W 7:15 -4:00 pm dsteiner @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 %% UND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application A �S• INDEX AND TITLE PAGE I l+ 4 Project Name: JAMES HAYES Owner's Name: JAMES HAYES Owner's Address: 1341 HWY 65 NEW RICHMOND WI 54017 P 0110y Legal Description: NE1 /4 SE1 /4 S5 T28 NR18 W �GS Township: KINNICKINNIC or,00 %01 4RA TEF'C'E 60 Woo Of County: ST. CROIX � SpQ NpENCE Subdivision Name: 17/4616 Bee- Lot Number: 3E Block Number. WA Parcel I.D. Number: 022- 1012 -80-075 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 plot plan Page 9 soil test Dew BRADY UTGARD License Number. 220357 Date: 11/16/05 Phone Number. 715- 26 8 -6995 � r Signature: J Q Desired PwsLm t to the Mound Component Manual for POWTS Version 2.0 SDB-10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 9 1. i 4 5� k oil Xrt i Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) I R Residential or Commercial Design Note: Sand fill (D) calculations 7fsor rrf*e 400.00 Estimated Wastewater Flow (gpd) Table s3 -44-3 in -situ sal timbr 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of 36 inch 600.00 Design Flow (gpd) 8.00 Site Slope ( %) 99.00 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the hi9q2g_pq Pressure Disribution Information in the distribution Y (c or e) c Center or End Manifold network? Enter Y or N 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest 0.188 Orifice Diameter (in) (e.g. 0.25) g point. 2.50 Estimated Orifice Spacing (ft) _ �ft%rifice 2.00 Forcemain Diameter (in) 70.00 Forcemain Length (ft) Does the forcemain drain back? Y 94.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 11.42 Forcemain Drainback (gal) X 6.8 Vertical Lift (ft) 90.53 5x Void Volume (gal) 3• � 3.81 Friction Loss (ft) 101.95 Minimum Dose Volume (gal) i 13.89 Total Dynamic Head (ft) 52.43 System Demand (gpm 7D `� ) Lateral Diameter Selection Manifold Diameter Selection in. dia. Mtions choic e in. dia. o tions choice 4z-- 0.75 1.25 1.00 1.50 1. 2.00 x x 1.50 X 3.00 2.00 x 3.00 x Treatment Tank Information Gallons /Inch Calculator (optional) 800.00 Total Tank Ca 1200.00 Se tic Tank Capacit Capacity (gal) pa ty (gal) 35.97 Total Working Liquid Depth (in) Wieser . Manufacturer 22.24 gal/in (enter result in cell B49) Dose Tank Information Effluent Fi Information 800.00 Dose Tank Capacity (gal) Zabel 22.24 Dose Tank Volume (gal /in) A100 Filter Manufacturer Wieser Filter Model Number Manufacturer Project: JAMES HAYES Page 2 of 9 Mound Plan View 1 /�, Observation Pipe 3❑ J F K ,ti•q r L • . 1 f 5 .f. ,ti••.•ti• W ' t, r, r, r.r•r•r, r, r, r•r.t•r.r, r, r•r•r, r, r.r, r•r, r, t•r•. •• .r•r•r•r•r•r• �' B . LJ . L Mound Component Dimensions A 6.00 ft E no. 76 in H 1.00 ft K 11.60 ft B 100.00 ft F 50 in z 14.23 ft L 123.19 ft D 22.00 in G 50 ft J 7.56 ft W 27.79 ft 600.00 (fe) Dispersal Cell Area 2023.03 (fe) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.63 (ft) —► F Dispersal Cell — 101.33 (ft) Lateral 100.83 (ft)-► — Invert Dispersal Cell :3 Elevation E D 4 4 99.00 (ft) Contour Elevation 8.0 % Site Slope Geotextile Fabric Cover Shading Key m a T . Dispersal Cell See lateral details on Q _ Topsoil Cap c = 1.5 ft • ., f• :,r,r,7 r•r•r•f Page 4 for number, size, a O ' S •r; •' •'••% Subsoil Cap ti ti '.• ?• r r and spacing of laterals. r ASTM C33 Sand 16 •• r•r rti • r:•,••, rtirtir ® . r; }�:ti :ti . ti•ti•ti;:.f;r�f F Laterals are equally m 0.5 ft rti T ical Lateral �•ti• Tilled Layer � � ti •,• „ spaced from the ❑ '�'�'� distribution Celt Aggregate r•r•r ~ r•r•r•r r•r•r•r , A � •° � �•'••�•ti•�•ti•'••'••ti•ti• s p —�-- t•r•r•r;r•r ;r�r;r•r;r � centerline in the A distribution cell (AxB). Project: JAMES HAYES Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection Wa tee or cross to manifold at any point Laterals are identical � P S •= Turn -up wdbal l valve or IE X— 3 IEW2 I �d2�1 Laterals & foroe main of PVC Sch 40 cl en n outplug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 49.34 ft Orifices per Lateral 20 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 13.11 gpm Manifold Length 3.00 ft System Flow Rate 52.43 gpm Manifold Diameter 2.00 in Total Dynamic Head 13.89 ft Forcemain Velocity 5.35 ft/sec Dose Tank Information Ong c ovar w th warning ►abet and locking device and Electrical as per NEC 300 and ---00 sealed Watertight Comm 16.28 WAC 4 in. min. Disconnect Tank component is property vented E — ARemate outlet location Forcemain diameter Wieser Manufacturer 2 in Capacityl 800.00 Gallons - Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B sips device A 23.39 520.13 B 2.00 44.48 C P m�off e ie'r�'°n (tt) C 4.58 101.95 94 D 6.001 133.44 I D Total .35.97 800.00 '� 3" Bedding under tank. � 94,00 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number I EPO5 Pump Must Deliver 52.43 gpm at 13.89 ft TDH Project: JAMES HAYES Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name BRADY UTGARD Phone 715 - 268 -6995 POWTS Regulator's Name ST. CROIX COUNTY ZONING Phone 715 -356 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow- Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliforml >10E4 cfu/100 mL Service Fre uenc a v Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for pond and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up nDetail p e ail Finished •..���......... ................ Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Later ra Long Swe 90 T wo 45 Degree Bends Same Diameter as Lateral Project: JAMES HAYES Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and rnai reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole 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 a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet finer shall be assessed at least once every 3 years by inspection. 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 sknugh off the filter when removed from its enclosure. If the filter is equipped with an alarm, the finer shall be serviced if the alarm is activated continuously. Intermittent fitter alarrns may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and 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, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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 dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: JAMES HAYES Page 6 of 9 Submersible Effluent Pump MODEL 3871 EPO4 EP05 Serie APPLICATIONS •Fully submerged in high ■EPOS Impeller: Thermoplas- ■ Bearings: S gs. Upper and lower pecifically designed for the grade turbine oil for lubrication and efficient tic enclosed design for llowing uses: heavy duty ball bearing fo improved performance. • Effluent systems heat transfer, construction. • Homes ■ Casing and Base: Rugged • Farms Available for automatic and thermoplastic design provides AGENCY LISTING • Heavy duty sump manual operation. Auto- superior strength and corrosion • Water transfer matic models include resistance, SP, Canadian Standards Assouauon • Dewatering Mechanical Float Switch ■ Motor Housing: Cast iron - r'te a LR3 8549 assembled and preset at the for efficient heat Goulds SPECIFICATIONS facto strength, and durability. Pum transfer, ps is !so 900, a facto e , ■ Motor Cover: Thermoplastic • Solids handling.capability: FEATURES cover with integral handle and maximum. ■ EPO4 Impeller: Thermoplas• float switch attachment points. • Capacities: up to 60 GPM. tic semi -open design with • Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water fesistant. • Discharge size: 1'12• NPT. • Mechanical seal: carbon- seal protection. r otary/ceramic- stationar BUNA -N elastomers. • Temperature: 104°F (409Q continuous 140-F (60Y) intermittent. METERS FEET • Fasteners: 300 series 10 Stainless steel. .... ........ - --- • Capable of running 9 30 i dry without damage to - E::1 - 5 8 a� —SGWa! - components. • o 25 t-25R Motor: Q W _ . EPO4 Single phase: 0.4 HP y 6 20 1 1 S or 230 V. 60 Hz, 1 550 2 `- - - -� RPM, built in overload with i 5 automatic reset. o is f • EPOS Single phase: 0.5 HP 4 9 115 v or 23OV, 60 Hz, 1550 ° RPM, built in overload with 3 to f E 5 automatic reset • Power cord: 10 foot EPO4 standard length. 5 16/3 _ S1TW with three prong 1 grounding plug. Optional 20 0 00 foot length, 1613 S1TW with 20 30 I - !hree prong grounding plug 40 50 GPM ( standard on EP05). 0 2 4 6 8 10 .2 A� Goulds Pumps `� Y i, L�" ",� IF ((11 CAPACIT 200 Gou1dt oum;s aa°' erne SOIL EVALUATION REPORT C Page m k of in accordance with Com 85, Wis. Adm. Code County S+ - a, .r on paper not less than 812 x 11 but to vertical and horizontal reference poin�� � Parcel I.D. d slope, Me or dimensions, north arrow, and loca ' and distance to nearest road �v a _ + Please print all informati n. , ± IJ N 5 Z 0 0 3 R awed a tO Persona) infammWon you provide may be used for secondary (Privacy Lew. s. 15.04 (1) Property Owner � - i d t_� ne 4 c Govt Lot r � 1/4 — 1 /4 S S T L N R (or)1� Property Owner's Mailing Address _ Lot #0 Block # Subd. Nr or CSM# . ZCO u vie �}C i .3 _. City State, Zip Code Phone Nuilhber 1, J City ._ ❑ Vllage Town Nearest Road ( ) is C /(/ E[ New Construction User. Residential / Number of bedrooms L Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Y d Lord ° raA 1 Parent material �,' f Plain elevation if applicable ft. General comments f� e%e ✓ : q1, 0 v S -j vw 3 and recommendations: 1 Boring # Boring ❑ y�rU� F - 1 pit Ground surface elev. 9fs. 3030 ft Depth to limiting factor ,J 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 2 C l �5 Z - tI 3 --- r c-) 3 t5 — W - 1 .5 r `4 Ct ' k mlfr — ❑ O n g # ❑ Boring p C, L�F pit Ground surface elev. / X 30 ft. Depth to limiting factor in. Soil Application Rate k izon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseli Qu. Sz. Cont. , Color Gr. Sz. Sh. •Eff#1 'Eff#2 _ `p I Zm m Tr CS 1 v , 5 Z Z 1 1 r Sid e — 3 i 5 S l Zxn5bL y4 - — 4 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 13013 : < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) 5igWure CST Number AS3 - Address Date Evaluation Conducted Telephone Number t i Property Owner LerN er+L Parcel ID # 1pla 51 Boring # 1 ®1 'rig eq. Pit Ground surface elev. 9 90 ft. Depth to limiting factor in. SoilAppl igtion Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff42 0_ Ip sit 2 - lv (v 0-22 .5 y I14 SCI IM a Boring # ❑ Boring Ground surface elev. ft Depth to limiting factor in. ❑ pit Soil Application Rate Horizon Depth Dorrauiant Color Redox Description Texture . Structure Consistence Boundary Roots GPDlftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz 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- 2648777. SarY8330 MOM) PAGE. OF 3 E N AME f��e e r i OT# �� LEGAL DESC &r %S `4 .s T Z8 �N�R.1 S w(or)d SCALE: I"= Q BM 1 ELEVATION /,00. C) BM 1 DESCRIPTION 200 o-,' 1 ' D✓ c ®- � T� BM 2 ELEVATION 6 7 9 - 0 BM 2 DESCRIPTION o 0 / 1, 3 ec SYSTEM ELEVATION 99 0 O SYSTEM TYPE )A 0 0 /t d CONTOUR ELEVATION 2-7,00 V a SIGNA E DATE — O PAGE 3 OF MF Liner z I OT# ,3 LEGAL DESCRIPTION SE S t4 ,S s T Zs ,N,R,1 S E(ode SCALE: I"= BM I ELEVATION U BM I DESCRIPTION p o / ',O✓ c- BM 2 ELEVATION 9 BM 2 DESCRIPTION o-," / SYSTEM ELEVATION 9% 0 0 SYSTEM TYPE rft o o A d CONTOUR ELEVATION c7;,00 a -3 o v ullcl 0 SIGNA E DATE — O Z 09 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CRTIFICATION FORM Owner/Buyer J I Mailing Address f ✓ y� J�y �,� /�rLc,✓ �.t S /� /� Property Address G l� (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location iUE %., �� 1 /,, Sec. , 5' - , T A N -R 9 W, Town of 1� , Subdivision , Lot # Certified Survey Map # 7 z /0 , Volume , Page # . Warranty Deed # g O O O , j Volume 90 , Page # - 63 Spec house ❑ yes ;& no Lot lines identifiable J!� 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 masterplumber, journeymanplumber, 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 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 Zoning Office within 30 days of the three year expiration date. SIbNATURE OF LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / / S NATURE OF� 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 2 8 9 2 P 5 6 3 em -712�11ZI3 i( KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 09/21/2005 09:40AN WARRANTY DEED EXBPT # THIS DEED, made between French Homes, Inc., REC FEE: 11.00 TRAITS FEE: 155.70 ("Grantor," whether one or more). COPY FEE: and James F. Haves j, a singe person CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Part of the NE 1/4 of the SE 1/4 of Section 5, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed in Vol. 17, Page 4616, Doc. No. 740870. RVAT 2684188 022 -10124 80-075 Parcel Identification Number (PM) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated September 2 0, 2005 Q (SEAL) �/ (SEAL) * *French Homes, Inc. (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF Wisconsin ) ) ss. St. Croix COUNTY ) TITLE: MEMBER STATE BAR 01 '�i, Personally came before me on September 2 2005 (If not, �`� , ' •cP�'% the above -named French Homes Inc. authorized by Wis. Stat. .4� R j. y = U : * •_ �c to me n to be the person(s) who execu d the foregoing THIS INSTRUMENT DRAFTED: , instr a and acknowledged the sam . ct j , • , ' O U B% .' g Attorney Kristina Ogland • ' �Q� ? ! Hudson O VW�` WI 54016 ��i — * Connie M. Gullixson tttttt Notary Public, State of Wisconsin My Commission (is permanent) (expires: 1 —11 - 2005 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO -PROTM Legal Forms 800. 855 -2021 www.infoprothrms.com 741mI$7t2) VOL 77 PAGE 4616 KAT}�MM H. MALSH — — REGISTER OF DEEDS ST. CROIX CO.. VI m ! ( RECEIVED FOR RECORD v - S H I O ® 09/22/2003 03:45PH i ; I I CERTIFIED SURVEY MAP 01 REC FEE: 15.00 c c � N-• vrn r� ry ti �rnrrn sN *+ r COPY FEE: 4.00 o N rn � rn z rq rn vf 0 r rm mr z c �g �$ =g Haan nQa� Ifl PAGES: 3 \� -1 I a '� pp -- Q WHO ?c zo �C ar�.1 Z rrn G '� "r1CpZ rnZ Z OA z m �- a 2 F A T n - n 8 V = c BEARINGS ARE REFERENCED u a a y r :z a z t - n (A �° m i O v z 2 N a ?1 �� TO THE EAST-WEST 1/4 A -c -� o , rn m W [ LINE OF SECTION 5. ASSUMED e v C rn G n v 6& TO BEAR S88'04'02"W �\ m m z MMn PO�Ca44f D dG�IG�JD3 / � �� N N o OWa110 Qv Pl auvlga o a - - -- - I N z WEST LINE OF THE NW CORNER OF THE z NE1 /4 OF THE SE1 /4 / NE OF THE SE1 /4 rn .SOWI 54 1 wW 412 ■75 OF SECTION 5 Z 818• i cn '� . 313.29 �I nO A ?WN a •I I � It 0 0 0 r ', N i G7 r y � - [v O r p p O C 0 �. jm �0..... I m ZQ II I G O O N ..►c i 40 1 _ , 8 U sm - A< i ` 7 i �S02°1 O• 33 "E 284.92• — — — — — D > �A - - -. - -- _7 -- Go oo�cn, —1 Q � -o ss.2s Road z o f�f CA W C =r 0 -11 1 _ 1 cn Z W N N I a rQ �Sn WZ Q� g...g.....�.• OI �L X1 CA 0 W ■O C N r O 41 3 yj 1 N OO Z .� ■�■ z m m ca. 111 v I m S y � i + I � 1 � zm "' m p I m w ai so0°3s 44"W Z p I a i m r 6 { cm Ppi S� �Qo �N381.10' 1 z iQi� z\ y 0 -m �i A SV a D D, j 1 1 C) '< N N 111 I 1 1 r , WI v Z I i �. , 1 1 c � D w0 1 cn I 1 in� o w r � N0 Wa rn I ! � cch 1 �I z 800 Q cn rNO.n°D 111 v c D n i Q° Q oD 378.90 �.._.._. m l m id D N O W j m I� N NO 01 W A CD 31 I �NI! f N D r tT j I 1 O ri r+i r*i ° CD z z �g oo N ♦ � ti l f*1 I 395.88• n a �_ c.w o pKQ7CUNIV I `� M00 '4 430 ■05 n 0 o CA �,,�,i� Z N Bnd paft C�''''!''� WEST LINE OF THE EAST 200' N I Z Z r•i rn m rn ' U OF THE NE1 /4 OF THE SE1 /4 m SEP 2 2 2003 1 r P&MC190. ON / m On g z pu If nod r.Corded within 30 days O d_L� 9 -0 / o Z approval date approval shad by null and void Iv m O m N CO C> al cm � o v,� cn- m I D m , � z �• w el ey C/' = m w ♦ o � G 8� = - Z to '� N a r < r"aa m N �� _ �� ■ �0�� 3: CD CA Is 4,9 L" (A z � Co o °' ,m,, = o °- Vo1.17 Page 4616 lv +r, �a �� ✓►'1 ,,,, l7 Pill C`0 0 r✓) 5 ,erce SOIL EVALUATION REPORT C Page of 3 in accordance with Comm 85, Wig. Adm. Code !r. u on paper not less than 8 1R x 1 tp=lm d but to: vertical and horizontal reference ' Parcel I.D. .t slope, ..d or dimensions, north arrow, and locati distapce to nearest roar Please print all informati aUN `0 5 2003 R Da Penal Axinadon you provide may be used for secondary levr, L 1504 Py Ow n er.. ZQNGkU ti I Govt. Lot 1/4 1/4 S r l L� LeY'lCl' Z., S T Z N R (or) Property Owners Mailing Address Lot # _ Block # Subd Na or CSM# 20, Live �xcha 1 3 L . ty .. .State Zip Code Phone NuMber, I %J ❑ Ct y _ ❑ Vtitage_ MTown Nearest Road E. New Constriction Uses Residential / Number of bedrooms Code derived design flow rate GPO ^ Parent t f E3 Public or commercial Describe: q S' d foci d r 1 Plain elevation If applicable General mme- rents y j �� ✓ : C 0 U . - . and reco S 1/L� D — rt rrunendations• / � ._. . Boring # -- ❑ Boring l Fi� .` �- Pit Ground surface elev. ft. Depth to limiting factor I J In , . Sob Application Rate Horizon Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(B In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. - 'Eff#'f 1 0#2 _ 413 r 3 15 1 C ZP 15 r Lt �sd T # ` j Boring �1 C' lit Pit Ground surface elev. / 9 .30 tL Depth to iirniting factor 5 in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fti In. • Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 "E11111112 I (� 3 r I Z ran- r cS 5 g Z _.. 1-1 3 sty C-- _ c2P .5 r -i SO bk r — , . �,. 1-4 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Efft dD < 30 mglL and TSS < 30 mg/L CST Name (Please Prints — i CST Number s B 4 Address Date Evaluation Conducted Telephone Number t* V737 Property Owner (--erl e T Parcel ID # Page _ 3 Boring # ❑ Boring E, pit Ground surface elev. 76 9'( ft. Depth to limiting factor !_..L in. sal ication . Appl Rau. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0- 51 ( r L5 �v� .$ 2 �3 _ 3 — sl' Zrno i C5 ( I0 L�l>? C.2' �.5 y 1�f SCI � o Boring # E] Boring pit Ground surface elev. , �1 ft. Depth to limiting factor in. . .;1 Application Rate Horizon Depth Dorniiant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W in. Wnsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - l ow 3i 3 i v 5 - d' le r F-1 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/ft= 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. SBD4330 (R07/00) PAGE,OF j E SCALE: I " — BM 1 ELEVATION //1U. C) BM 1 DESCRIPTION p_ 2 -4 BM 2 ELEVATION BM 2 DESCRIPTION ec SYSTEM ELEVATION 990 O I SYSTEM TYPE I'YI o o g d CONTOUR ELEVATION jj p m fi d6 c4, -7-L 4 r k 7� SIGNA E �i D 'E LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022 - 1012 -80 -075 Parcel Number 5.28.18.77B -30 OWNER NAME: First F %LIVESTOCK EXCHANGE BLD Last LENERTZ PROPERTY ADDRESS: Hs" -- -- n 1091 CTY RD N SECTION 5 TOWN 28N RANGE 18W %160 SE 1 /440 NE Line Description Line Description TOTAL ACREAGE 2.010 PLAT CSM 17 -4616 022 -03 LOT03 BLK 01 S 5 0 CS -4616 LOT 3 16 (2.01 AC) 17 04 18 05 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit Parcel #: 022- 1012 -80 -075 12/09/2005 03:13 PM PAGE 1 OF 1 Alt. Parcel #: 022 022 - TOWN OF KINNICKINNIC Current `X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-owner F %LIVESTOCK EXCHANGE BLD LENERTZ O - LENERTZ, F %LIVESTOCK EXCHANGE BLD PO BOX 292 SOUTH ST PAUL MN 55075 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1091 CTY RD N SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.010 Plat: 4616 -CSM 17 -4616 022 -03 SEC 5 T28N R18W PT NE SE CSM 17 -4616 LOT Block/Condo Bldg: LOT 03 3 (2.01 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 28N -18W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 09/22/2003 740870 17/4616 CSM 09/17/2003 740369 2412/516 CO AF 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 87937 49,500 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 50,000 0 50,000 NO Totals for 2005: General Property 2.010 50,000 0 50,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.010 30,000 0 30,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 III j a) 0i I '�► o U N j REC ED O O c ;v tn r; o) r - o - o ry in =1mrp-fn r.fno> r N v OC ZC Dm ZI IzZ;0� O''�NZZ Mz0c m O A 0 O C 6 - < v D - Z'� (7 Z o m _ 8 Z BEARIN S AREZM1WGKQM w D v - �m zZ a4 v ; 0 CD 00 � ;6 0 c7 i TO THE o y y M0 N z � - q CA- p O Z Z� � • < \ LINE OF SECTION 5, ASSUMED - N m -1 o m e m o W C M m F' ' M 616 TO BEAR S88'04'02 "W co N z � MG�1pdLQ44C D dLQ IDS 133, N > O z WEST LINE OF THE NW CORNER OF THE Z NEi /4 OF THE SE1 /4 NE1 /4 OF THE SE1 /4 M S00 °151 1 °W 412.7 OF SECTION 5 66.06': 313.29' ; t O �sl Z 6 6' 6 co O pwl O V�cc n y33'33'�v� :�� i Z � O W X I W V K) - � N fD W M i 0 ! m � � • .i 0 So l 0 0 0 �p o M 0 V W y j w fJ m; "'� v l 1,3 ``Wo �c�` �a r c0 0) - I cq �f o O 0 0 `O�c°- w �•• Z 0 8 0 N) ,.y a �.'= tQ IQ I m D I �` \m I S02 °10' 33 "E 284.92' = W CO 00 0 >0 �_ v 00tocnz3 O Ut N 9 - H U) - 1 Z � Zzfn ln IM0 m Q 0 ml W l o w , ° A 1 � t P 8r. 1 Zw N V N ... I N pp � CS ui LA . I O . , C A) 0 ....... I "�I O o 0D Eli •o r Z O Z J N ,p ° °D ° N 0 O 0 CA P� r o� 1� 0 w i N io �� 0 v N X '*1 �� �mri M - rn Z Q m 0 1 I � 1 I� W W �(n i i Zm o I�I� V V V V r-0 O I m W �- S00 °39'44 "VV I 0 w v 00 0o p 0 . '♦ CC Nnl z ' C o . N 361.10' ZI 40 I I 1 N Z IN�I ZM -I w� N tG O Z G i� V oo I 00 (n I Z O CD (M .P ••a H D I V N I O°� -1 I� I ? - � I � W o0 r w l N V 00 00 ol V V rD 00� I� a A (n W C 9) tNDI w t to s� Z m I� v �cn 101 ml +� I� i�i� n i4 0 MM S00 °39'44 "W W (nZZ(n -I W 0 I O N oD 0) L R1 a N O OD i I O 378.90' L. _ n l m l I i X j A 1 1 d fOD m m l - I p N I m I i i j c�� W N O .+� D 0 I N N O r N I Z I I J�- I uuu 1�1J O 'P IQ 1 n 11 ��mm0 mp I� N (An C w I `. '� ZO m ID° C9 fJ�p . rn! Z 00 p m 0 m „C OD zto 00000 z00 0 Z I Do cm r9� M 00 00 00 N O ' -1 i 395.86' 0 0- 3 O N W N y I ` fff��� 7 N00 °39'44 "E 436.05' o Z (D m CA co m g i W LINE OF THE EAST 200' NI -j N Z Z OF THE NE1 / OF THE SE1 /4 gl. m $ * z 01 G?aG°3C�C d �Grl_ 1 m-n 0 z o4_I?C�o O Fn W p n � � nom Z 33 33 - 71 ?O "� 6I 6 2 c tnN C7�N N �q C ; N to -iN� ° D 00A K Q c/) C `r m N (W ® oN�R+O Ci. O' 0051 - M (A i Z viii O 0 r r Z r O rl 0 -0 , o�M 01 rntnx r C/) a m' o 0r, o r- f- ' a .-n�'. j n .� r' x z -- 1 //fINN11►Nhh / I N O t I 141 0 oo - 10541 N RANCH ROAD Comtriel alml.W R E C E I V E D HAYWARD WI 54843 MD t. (608) 264-8777 is consi n N o ,�� www.corr fwceAA.gov/shl 1(► ap wwwmboonshgov artmenl of commeroe ST. CROIX COUNTY Jim Doyle, Governor ZONING OFFICE Mary P. Burke, Secretary November 21, 2005 CUST ID No. 220357 A77N.• POW7SInspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/21/2007 Identification Numbers Transaction ID No. 1202462 SITE: Site ID No. 705873 James Hayes Please refer to both identification numbers, Cth N above, in all correspondence with the Town of Kinnickinnic a St Croix County NEIA, SE1 /4, S5, T28N, R18W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1044499 Maintenance required; 600 GPD Flow rate, System(s): Mound Component Manual - Version 2.0, SBD -10691 P (N.01/01) 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s .145.06, scats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located W accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01/01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1101) "Pressure Distribution Component Manual for Private OtWte Wastewater Treatment Systems - Version 2.0" and/or the siring methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) ". • Access to the filter for cleaning must be provided per ss. Comm 84.25 (7) and (8),Wis. Adm. Code product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required A copy of the approved plans, specifications and this letter shall be on -site during construction Lion 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 to 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 BRADY J UTGARD Yage Z 11MIMUD 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 XC crti k c; Balance Due $ 0.00 Duane R Steiner Wastewater Specialist, Integrated Services WiSMART code: 7633 (608)235 -0608 , W 7:154:00 pm dsteiner@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i z ti > c 0 O O O ti O LL. co UJ 0 V z Go LLJ IL M z (D 0 z !t U) C*4 z z 4i ID E as I Cc 01 0p, 01 co 04 IL 2 E 0 : < U) U) U) cc Z > 1 R •I D i oftb A 6 0 0 0 iL B W 0 w 0 0 U) -i U z C, z N CY) 0 C < 0 z U) 9 1 , 0 0 0 0 4) a c E a m c co -E co *4 C � C4 co • ;0., cq L 6 .5 co 0 CD o 't CD z 0 z w IL • «t CL E o m 0 0 i arce SOIL EVALUATION REPORT Page k of in accordance with Comm 115, Wis. Adm. Code /v9 46 1 on paper not less than 812 x 11 inch ' County Si - �V 1 but to: vertical and horizontal reference point : irec6o7i — Parcel I.D. ,t slope, -.4 or dimenswns north arrow, and locati and distance to nearest road." _ Please print all informafi a. JU 0 5 20 � R awed Da llp Personal information you provide may be used for secondary (Pm+a s 15.04 (1) (m)). t .I —7 Property Owner .('_. ZCI� .lU = Govt. Lot ly 1' 1/4 a 114 S s T L N R (or) 10 Property Owner's Mailing Address Lot # f Block # Subd. Na a or CSM# City State Zip Code Phone ❑ City _ ❑ Village Town Nearest Road New Construction User. Residential / Number of bedrooms Code derived design flow rate GPD C] Replacement �r ❑ Public or commercial - Describe: S d Loyd ` rkz;t�`�1 Parent material o90 Plain elevation if applicable U ft. General comments 5 f e/ z �d�l, 0 U .. ��d-f 4,: B 3 - -`YL � ' and recommendations: C�,, 11 I 2 /,? v . !7�" cl sytrn 1 'f a� �k.� -i— vw F I ❑ Boring Boring # _ f �. pit Ground surface elev. . 'o 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. S z. Cont. Color Gr. Sz. Sh. - Eff#1 I - Eff#2 I - Z tI3 r c — -� 3 15 - � I C �. � •� r �t � c..t • 2r k �r — -- . � - F 2 - - 1 Ong # Boring p 0i pit Ground surface elev. 1 0• 30 ft Depth to limiting factor � 5 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 I 0 Id 3 i I Zvm mTr CS 1 VL . 5 . $ 2 -1-1 3 5 icl k C-3 I CW 1.5 r'y SO b�- nn r _ . L Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " ' Eftlue D < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) i CST Number Address Date Evaluation Conducted Telephone Number Property Owner LerN P r +Z Parcel ID # P . s ® Boring # ❑1 Boring 90 ep. Pit Ground surface elev. ft. Depth to limiting factor ) in, Soil, Appl ication R auy Horizon Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 'Eff#2 D -L 10 5I f r C S l v � ,$ -J3 3 sl' 2n—,0 Cs — -� f fn to C.2' �,5 y Iq Sri - !o t- --l- -t Boring # Baring Ground surface surface elev ft. Depth to limiting factor�� in. Pit Soil Application Rate Horizon Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fIF in. MUTIsell Qu. Sz. Cont, Color Gr. Sz. Sh. / J 'Eff#1 •E ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Sal Application hate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz 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 mgll_ 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. ssn -030 M071W) PAGE OF E I I NAME elr e r Z i OT# ;3 LEGAL DESCRIPTION &6- Y4 SF'4 ,S T Z9 MN. 19 E(or)& SCALE: 1 " = -- - - -- - — BM 1 ELEVATION 1,o1 Q • C) BM I DESCRIPTION -1c:),e o-f 1 "p✓ c ®T r BM 2 ELEVATION 9' 8'0 BM 2 DESCRIPTION ,�a o-r" / ,oec- 4 . 4:t 3 ec SYSTEM ELEVATION 99 0 0 SYSTEM TYPE Ill oy n d , CONTOUR ELEVATION J!-7,00 �S a ,3 eon 4,,r - /t 00 t ��o ti 8 k � SIGNA E DATE Parcel #: 022- 1012- 80-075 05/05/2006 04:30 PM PAGE 1 OF 1 Alt. Parcel M 5.28.18.77B -30 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JAMES E HAYES O - HAYES, JAMES E 520 BOUNDARY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1091 CTY RD N SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.010 Plat: 4616 -CSM 17 -4616 022 -03 SEC 5 T28N R18W PT NE SE CSM 17 -4616 LOT Block/Condo Bldg: LOT 03 3 (2.01 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 28N -18W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 09/21/2005 807003 2892/563 WD 04/20/2004 760195 2553/234 WD 09/22/2003 740870 17/4616 CSM 09/17/2003 740369 2412/516 CO AF 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: p8/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 50,000 0 50,000 NO Totals for 2006: General Property 2.010 50,000 0 50,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.010 50,000 0 50,000 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 . § j CD � §D- 2 ) E2 « \§' I ° $00 .� . i § -E _ ;2 \ }i $ §§« c 0 au \ Cl ) {f01 z22a 2 0 $ [ ) % § \ I <= =.a CD # I ■ / j E t § z 2 4 2 LO § z a ■ 4 I 0 z k k (D z 7 / t % t I / ) � � ) 0 k k _ .. 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