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020-1127-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569581 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: Woulfe, Shawn I Hudson, Town of 020-1127-70-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 13-3 G 5 17.29.19.592 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 14n(fs Benchmark Li' -7 1 2- '515 . 'tJ Pl ' s Zg� Alt.BM �I t" J.,•• —/. 3 ��� • S Bldg.Sewer c Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent t9 Air Intake ROAD DtInlet ��� 97�� J Septic _/ g �s Dt Bottom 2 ._7 13.7• Header/Man. 7.2, 73 Aeration Dist. Pipe 7.•a 7 , 2. Holding Bot.System Ir. Z. crz 11.0 911 Z. PUMP/SIPHON INFORMATION Final Grade 4.6 74•Z Manufacturer DePlmNand St Cdr f✓d �, '3 7D .5 Model Numb TDH Lift Friction Loss System Head TDH t Forcemain Length Dist.to Well SOIL ABSORPTION SYSTEM D MENSIONS Width r Length No.Of Tre^ches PIT DIMENSIONS No.Of Inside Di� Liquid. Depth 3 a z SETBACK SYSTEM TO I P/L JBLDG WELL LAKE/STREAM LEACHING Manuf ctyr�[:' INFORMATION /I /► r d dl� T �Of JtSystem: CHAMBER OR 7D �� �� �� UNIT Model Nu berg DISTRIBUTION SYSTEM E '61'J acw Z Z 4-ZZ = SF� Header/Manifol5 1( Distribution x Hole Size Ix Hole Spacing Vent to Air ntake 5 Dia Pipe(s) � �- �\ E^ S Length Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Z S BedlTrench Edges ` Topsoil ` ❑ Yes No Yes F No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 488 Park Lane Hudson,WI 54016(NE 1/4 NW 1/4 17 T29N R1 9W) Park View Estates 1st Add.Lot 11 Parcel No: 17.29.19.592 1.)Alt BM Description 2.)Bldg sewer length= �� -amount of cover 4-b � nn l �t Of i i✓i► aSG GpJt�. (.� �bG �v ji Plan revision Required? ❑ Yes No �� g Use other side for additional information. Date Insep is Sign re Cert.No. SBD-6710(R.3/97) I PLOT PLAN PROJECT Shawn Woulfe ADDRESS 488 Park Lane Hudson Wi 54016 NE 1/4 NE 1/4S 17 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX 5/29/14 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000/280 LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of shed slab ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 92.0/91.4' 6' below qrade Park Lane >611 Quick4 Standard All piping shall be SDR 30/34,within 10' Leaching Chamber of tank,piping shall be Schedule 40. of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps Scale is 1" = 40' 4' Long 12„ unless otherwise Grade at System Elevation 34" noted B-2 Existing 4 59' Bedroom House 2-3' X 90' Cells with 9% Slope >3'spacing B.M.* 63' 20 E B-3 • 32' 10' B-4 91'C.T 10' 50' 10' 2 ST �4 ents 313' Old Dry ells 98 Gj are to be 96' B-5 pumped and 100' buried B-1 52' 48' 134' 156' `� Safety and Buildings Division cot% 201 W.Washington Ave.,P.O.Box 7162 G gt Sanitary Permit Number(to be filled in by Co.) O��\fir Madison,WI 53707-7162 �N� N� to P 56 (75 <F ermit App a+t nn _ State Transaction Number In accordance with SPS is.Min.Code,submission of this form to the appropriate governmental unit A4 4 is required prior to o permit Note:Application forms for state-owned POWTS are submitted to Project Addresj(' diffcrem thao address the Department of d Professional Services. Personal information you provide may be used for secondary tt11 L ses in accordance with the Pri I.aw s.15. 1 m Stab. 7 348, �(L} L Application Information—Pease Print All Information Property Owner's Name P.(.1.I (�) Parcel# Property Owner's Mailing Address O �� �" �� /� �' 7d - Property Pa A I ►,�., �Pr��L.ocation - City,State Zip Code / 'l Phone Number Section J / l 0 KJ lnw IL 7-- of Bai{tiing(check sll that apply) Lot T�N; R Family Dwelling—N7,f Subdivision Name❑PubliUCommerciai—Descre �✓bG ❑City of ❑State Owned—Describe Use CSM Number ❑Village of Z 5 uJ ZZ a—ZZ dla 5 Of � J III.Type of Permit: (Check only o e box on line A. Complete line B if applicable) A' ❑New System laoement System ❑Treatm=VHoldm $Tank Replacement Only ❑Other Modification to Existing System(explain) B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration IV Type of POWTS S stcm/Com nent/Device: Check all that apply) � 'Pressurized In-Ground ❑Pr e..iud In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil t ❑Holding Tank ❑Other Dispersal Componertt(explain) ❑Pretreatrxuent Device(explain) V.Dis rsal/Trea ent Area information: Design Flow(gpd) Design Soil Application Rate(gpdst) Dispersal Area Required(s Dispersal Area Proposed(s System El on VL Tank Info Capacity in Total #of Manufachuer Gallons Gallons Units NOW TWO Existing Tanta �� C Septic a Holding Tank o r � 7C Dosing Clmmber VII,Responsibility Statement-1,the undersigned,assume wsposibifity for installation of the POWTS shown on the attached plans. ' Name nt) c Plumber's ' MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip y Z— s/,- oun /De artment Use Only Approvod Disapprov Permit yFee j /Date Z Is su // Issuing Signature Reason fa s /`� DL Cond��ns for Disapproval //� 1: Septia tank,effluent filter and .3) D( f �z..` 4� �. � w .t,p :dispersal cell must all be services/maintained GOt I as per management plan provided by'plumbef. A ddddLLLL���L�L 2: 1 fegUii'etineMs mast be.maintslhed SS aippiit a e�de/or ialitees Attach to comprete plans for the system and submit to the Couu ty o niy on paper not less than 8>R z 11 inches in site SBD-6398(R.11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/29/14 Owner: Shawn Woulfe Location: NE 1/4 NE 1/4 S17 T29 N,R19W 488 Park Lane Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specification eet 9. St.Croix County. ' ting Se tic Tank Form Signature License numb #226900 , PLOT PLAN PROJECT Shawn Woulfe ADDRESS 488 Park Lane Hudson Wi 54016 NE 1/4 NE 1/4S 17 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 5/29/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of shed slab ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 92.0/91.4' 6' below grade Park Lane >6„ Quick4 Standard All piping shall be SDR 30/34,within 10' of Cover Leaching Chamber of tank,piping shall be Schedule 40. with 20.0 ft2 of Area 5.6ft^2/pair of end caps Scale is 1" = 40' 4' Long 12" Grade at System Elevation unless otherwise 3417 noted AL B-279' Existing 4 59' Bedroom House 2-3' X 90' Cells with 9% Slope >3'spacing B.M.* 63' 20 Shed B-3 32' 10' B-4 91' T 10' 50' 0' 20' ST Vents 33' Old Drywells 98' are to be 96' B-5 L pumped and 100' buried B-1 52' 48' 134' 156' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 97.0' Vent ACI Grade �►, Vent 3' 4" 3' x/30/34 Septic Tank 5' Long VI 5' S' Long 199 3699 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90 ' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A-92.0' B 91.4' ST. CROIX COUNT''' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownermuyersly�,2 L: Mailing Address Property Address (Verification required from Planning&Zoning Department for new construction) City/State _ Parcel Identification Number O 0 LEGAL DESCRIPTION Property Location Jr r/4 , 1N4 r/a , Sec. , T 2,7_N R�� W, Town of Subdivision , Lot# . Certified Survey Map # _ _ , Volume ,Page# Warranty Deed# Vo[tune , Page# Spec house yes no Lot liner: identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prGinature 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 Coanty Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. 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 s form are true to the best of my/our knowledge. l/we andare the owner(s)of the property described above,by virtue of a ty deed recorded in Register of Deeds Office. Number of bedroo SIGNA F APPLICANTS) 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) POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page a FILE INFORMATION SYSTEM SPECIFICATIONS Owner ����� � Tank Manufacturer.&rl A'*gat >r✓ ❑ NA Permit# ,Septic ❑ Dose ❑ Holding Voltune:/Otro (9M) Tank Manufacturer: ❑NA DESIGN PARAMETERS Q Number Bedrooms: ❑NA Septic ❑Dose ❑Holding Volume: d (gal) Number of Public Facility Units: �NA Vertical Distance Tank Bottoms)to Service Pad: (ft) Estimated(average)Flow: Q (9auday) Horizontal Distance Tank(s)to Service Pad: 00 Specific servicing mechanics must be provided it vortical is>15 feet or Design(peak)now-(estimated x 1.5): (9811d8Y) If horizontal Is>150 feet. Spedit Instruction to be provided on back. In Situ Soil Application Rate: (gal/dayfft=) Effluent Filter Manufacturer: = NA of Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Fats,01&Grease (FOG) M.mgll. Pump Manufacturer: ANA Biochemical Oxygen Demand (BODs) sno mg/L ❑NA Pump Model: Total Suspando Solids SS 's150 High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - Manufacturer. NA (BODs) >220 mg& l —A ❑Mechanical Aeration [3 Pee Filter SS >150 m IL ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other. (BODE) s30 mg/L l Soil Absorption System (TSS) s3o4mg/L /�A / Ground(�evitY) [3 In-Ground(pressure) ❑ NA Fecal Colt(orm(geometric mean) 510 ❑At-Grade ❑Mound Maximum Effluent Particle Size Ya in dia. ❑ NA ❑Drip-Line ❑Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) W�combined sludge and scorn equals one-third()<s)of tank volume ❑When the high water alarm is activated Inspect condition of tank(s) •At least once every: 3 s)s1 (Maximum 3 years) ❑NA At least once every: .� month(s) (Maxirmurn 3 years) ❑NA Inspect dispersal cell(s) s) month(s) ❑ NA Clean effluent fitter At least once every: /< < y�(s) Inspect pump,pump controls&alarm At least once,every: ❑ s(s) -1 NA Flush laterals and pressure test At least once every:. ❑month(s) ❑NA yWs) Other: At least once every: m°r't8(s) p NA ❑Yeer( ) other: ❑NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tanks)to identify any missing or broken hardware,Identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to cheek for any ponding of effluent on the ground surface. The ponding of effluent on,the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals d disposed t one-third of in more of the tank accordance with chapter lame,the tiro contents of the tank shall be removed by a Septage Servicing Operator(pumper) Wisconsin Administrative Code: All other services,including but not limited to the servicing of effluent fitters,mechanical or pressurized components,pretreatment units, and any servicing at intervals of X12 months,shah be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority Within 30 days of completion of any service event. GM1W-005(02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process'and/or damage the soil absorption system. if high concentrations are detected have the contents of the tank(s)removed tty a Septage Servicing Operator(pumper)prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended,as the excess wastewater will bardisc barged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent,and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. Do not drive or parts vehicles over tanks or the soil'absorption system. Do not,drive or park over, or otherwise disturb or compact, the are@ within 15 feet down slope of any mound or at-grade still absorption.area. Reduction or elimination of the meowing from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes,-cigaretter'butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump)01scharge,fruit qnd vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,ails,painting products,pesticides,sans y napkins,solvents,tompons;'and water softener brine discharge. - ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s.Comm 83.33,Wisconsin Adminishitivve Code`.: • All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator(pumper). h, • After pumping, all tanks and pits shall be excavated and removed or their ewers removed and the void space Oiled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant Frepl ant system: uitable replacement area :�bean evaluated and may be'utilized for the location of a replacement soil absorption system. replacent area shoulprotdisturbance and compaction and should not be infringed upon by required backs from existing and prd structure,lot lines and wells. Failure to protect the replacement area will cesuR in the need for a new soil and site evaluation to establish a suitable replacement area. 'Replacem'ent systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area Is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed.as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the.biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in affect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name cz a AL/ Name Phone J_ �— C 1 Phone SEPTAGE SERVICING OPERA TO PUMPER LOCAL REGULATORY AUTHORITY Name Syr ✓n Name ` p Phone �— l Phone Oil This document was drafted by the staffs of the Green Lake, Marquette and Woushara County POWTS regulatory agencies in compliance with Sections Comm 83.22(2)(bH1Xd)&(f)and 83.54(1),(2)&(3).Wisconsin Administrative Code. 5 � FIL'TETa CARTRIDGE INSTRUCTIONS STEP s Dry a the NWr case orate the sad Of tine outlet pipe to ensure it is cantered under the access openYg. it not,then sieher hart mats pipe into the PIPs- through the outlet or solvent weld(gists)additiohal pipe onto the outlet STEP 2 While the case is still dry roped an the oudat DOE,measure the of it-teach pipe needed tna btaoe the fjW to the tarok end wall!f utgiziny t� Proceed to side s+DOmt.If side support method.Is not utilized, S- FP 3 For' 11 - tbns utMhtin9 the optional supplemental side support: solvent weld the'A-inch pipe oats the floc•case. N side support support is not used.proceed to step four. Solvent weld the Rfter case ore the outlet pipe. Insert the Sitar eardid9e into the ose,pressing down until the fotor lochs into the bottom of the rase. t ,1 If a AS switch is utlbwd:insert into the filter and kick by tuning s clockwise 9W. ;'•:,. Maintenance 1. The affluent"Duet should be cleaned every time the septic tank is serviced. 2. Open the outlet access opwWng to inspect the tank and I1I11taK 3. Pump the sepdc tank aoetpbt*, ore to remove the sludge " layer on the baattoeru d the tuck grad not Just the satin and efilumL <. Once the sAhwat level has been lowered blow the invert of the ` carbidge from the ease on the fgtar handle:to dislodge the S. Slide the cartridge up and out of the rase for cleaning. 6. V a VRS switch eatummted to an alarm is present,the switch should be nsrnavad by turning c 90.ant deaeuad { with watar Gay. 7. White holding the cWbUge an Its side(large oat surface 't down)over the access X11,rrnaldra9 ors an 'fuse off the cartridge witla water , gala nptwW is rinsed bs*into the tank_ 8 If VRS switch is utilized,nspisoe by inserting into fitter and turning dodkwisa 9M. 9, Insert the RItN cartrtilge the filar locks bsdk Into ties asst,greasing down until bottom of the case. 10.Raplsce card secure the in 4 access opening on the tenL •. . St lr•.:K?!":'cJl'aC:ak`R:lf(� r1�E-•'J A.:tarot' wwwbeWVnd (6534583) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK `Phis is to certify that I have inspected the septic tank presently serving the u/0L.A residence located at: % ice_; , Section / ) T Z-'7 N, R W, Town of _! 2._Zr-,/ . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: ell bid flow back occur from absorption system? Yes _>, No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known) :�G61�(rLJ{✓ Age of P (If known) .: �-�-�'►�n�-C•�� (S ature) (Name) Please print ( tle) (License Number) _!�;— --� . Date Form to be completed by licensed plumber (s. 145. 06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regar%n existing septic tank condition, I certify that the tank to the b of my knowledge will conform to the requirements of ILA83�, Wi dm. -Code (exce pt for inspection opening er outlet bz��/� Name �,. u�✓ SignatMP/MPRS - u,;1 .14 e7PAG� 27 6 s 2'0I:23"� KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 1-1982 REGISTER OF DEEDS ST_ CROIX CO., WI DOCUMENT NO. WARRANTY DEED RECEIVED FOR RECORD Seller: MARKWARDT Data ID: 19600 10-29-1999 10:00 AN Order No.: 133403 Job No.: 10519 WARRANTY DEED This Deed, made between DAVID A. MARKWARDT AND EXEMPT M GAIL L. ANDERSON, HUSBAND AND WIFE (hereinafter referred CERT COPY FEE: COPY FEE: to as Grantor,whether one or more), and TRANSFER FEE: 516.00 Shawn M. Woulfe and Terri L. Woulfe, RECORDING FEE: 12.00 PAGES: 2 husband and,wife (hereinafter referred to as Grantee, whether one or more), Witnesseth, That the said Grantor, for and in consideration of the sum of Ten and No/100 Dollars and other good and valuable consideration, the receipt and sufficiency of which are hereby THIS SPACE RESERVED FOR RECORDING DATA acknowledged, conveys to Grantee the following described real property NAME AND RETURN ADOR}SS: in St. Croix County, State of Wisconsin, to-wit: LOT 11,PARK VIEW ESTATES F_I S ADDITION IN THE Mver VaUeyAbstract&Zytle,Iaa. TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. PR0.Box 149 09_/U 3 7 The above legal description includes memberships and/or Hudson,W1 54016 ownerships of non-municipal water and/or sewer systems, if any. Together with all and singular the hereditaments and Tax Parcel No. 020-1127-70 appurtenances thereunto belonging. This – homestead property. (is) (is not) Property Address 488 Park Lane Hudson, Wisconsin 54016 This conveyance is made and accepted subject to the lien for current taxes and other assessments and all valid and subsisting restrictions,reservations,conditions,limitations,encumbrances,covenants, exceptions and easements as may appear of record, if any, affecting the above described property. TO HAVE AND TO HOLD the said premises, with their appurtenances unto the said Grantee, their heirs and assigns forever. And the said Grantor does hereby covenant to and with the said Grantee, that they are the owners in fee simple of said premises; that they are free from all encumbrances except as described herein, and that they will warrant and defend the same from all lawful claims whatsoever. The singular number shall include the plural, the plural the singular, and use of any gender shall be applicable to all genders. Dated this day of 19.4?9_. (SEAL) _ (SEAL) DAVID A. MARKWA DT—Grantor GAIL L. ANDERSON—Grantor STATE OF 5- CM-)'5k' - C0Y15 l n } }Ss. COUNTY OF SN C`ro`I k I Personally came before me this of I � day of J76fn�n�?(/ 19q_ the above named DAVID A. MARKWARDT to me known to be the person who executed t e foregoing instrument and acknowledged the same. JA IX Count Wis. �Uarbwr.. 3 Pw c Notary Public Y. My Commission is permanent. (If not, state expiration date: *Names of persons signing in any capacity should be typed or printed below their signatures. publtC 1�lota NISCOnsln gt4*Q °f f �, Burka [Acknowledgments Continued] Barbara '+ aGrtment�o�n\4 SOIL EVALUATION REPORT #1737 a Profes 226 Se t'� (`N a grdq�q#vy�h C�rn�$5'Wis.Adm.Code Page 1 of 3 ry, pM P4' j Schmitt Soil Testing,Inc. Attach complete site AlPmentsions,�� r�t less than 8%x 11 inches iA siae.-- must-must County St.Croix include,but not limitand horizontal reference point(BM),direction and percent slope,scale north arrow,and location and distance to nearest road. Parcel 1. . 020- 127- 0-000 Please print all information. Revi#4d By Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Z Property Owner Property Location Woulfe, Shawn&Terri Govt.Lot NE1/ ,NE1/4, S17,T29N, R19W Property Owner's Mailing Address Lot# Block# Subd.Ndme or CSM# 488 Park Lane Park View Estates 1 St Add'n City State Zip Code Phone Number City []Vllage ❑ Town Nearest Road Hudson WI 1 54016 1 715-381-5589 Hudson I Park Lane ❑New Construction Use: ❑ Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial-Describe: Parent material Outwash Sand and Gravel(Burkhardt series) Flood plain elevation,if applicable NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation is: T1=93.40',T2=91.40'. Slope of and recommendations: area is 9%. F-11 Boring# U Boring Z Pit Ground surface elev. 98.0 ft. Depth to limiting factor 115+ 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. *Erf#1 *Eff#2 1 0-8 10YR3/4 FILL SL 2FSBK MVFR AS 2VF 0.6 1.0 2 8-22 10YR4/6 FILL SL 2MSBK MVFR AS 1VF 0.6 1.0 3 22-31 10YR3/3 NONE SIL 2FSBK MFR GW 1VF 0.6 0.8 4 31-60 10YR4/6 NONE SL 2FSBK MVFR GW ------ 0.6 1.0 5 60-115 10YR6/4 NONE S OSG ML ---- ------ 0.7 1.6 ?Z �l F 2 Boring# Boring ❑ Pit Ground surface elev. 98.0 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-8 10YR3/2 NONE L 2MGR MVFR AS 2VF 0.6 0.8 2 8-23 10YR4/4 NONE SIL 2FSBK MVFR GW 2VF 0.6 0.8 3 23-33 10YR4/6 NONE SL 2MSBK MFR GW 1VF 0.6 1.0 4 33-110 10YR6/4 NONE S OSG ML ---- ------ 0.7 1.6 jI 1 f -7v *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<_30 mg/L and TSS s.30 mg/L CST Name(Please Print) Signature: — CST Number Av Thomas J.Schmitt 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,WI 54017 5/14/2014 715-760-1978 SBD-8330(R.07/OD) Property Owner Woulfe,Shawn&Terri Parcel ID# 020-1127-70-000 Page 2 of 3 F Boring Boring# Pit Ground surface elev. 95.50 ft. Depth to limiting factor 110+ in. Soil Application Rate • Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR3/2 NONE SL 2MGR MVFR AS 2VF 0.6 1.0 2 12-19 10YR4/4 NONE SIL 2FSBK MVFR GW 1VF 0.6 0.8 3 19-34 10YR4/6 NONE SL 2MSBK MFR GW 1VF 0.6 1.0 4 34-64 10YR6/4 NONE S OSG ML AS ------ 0.7 1.6 5 64-98 10YR5/6 NONE GRCOS OSG ML ---- ----- 0.7 1.6 j. It b F Boring '4 Boring# Pit Ground surface elev. 97.70 ft. Depth to limiting factor 77+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 •Eff#2 1 0-9 10YR3/2 NONE SL 214GR MVFR AS 2VF 0.6 1.0 2 8-24 10YR3/4 NONE SL 2FSBK MVFR GW 2VF 0.6 1.0 3 24-45 10YR4/4 NONE SL 2MSBK MFR GW 1VF 0.6 1.0 4 45-77 10YR6/4 NONE S OSG ML ---- ------ 0.7 1.6 ❑Boring 5 Boring# N Pit Ground surface elev. 101.29 ft. Depth to limiting factor 163+ 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 'Eft#2 1 0-7 10YR3/3 NONE SL 2FSBK MVFR AS 2VF 0.6 1.0 2 7-13 10YR4/4 NONE SCL 2MSBK MFR CS 1VF 0.4 0.6 3 13-20 10YR4/6 NONE LS OSG ML CW 1VF 0.7 1.6 4 20-48 10YR5/6 NONE S OSG ML AS 1VF 0.7 1.6 5 48-52 10YR5/4 NONE SL 1MSBK MFR AS 2F 0.4 0.7 6 52-163 10YR6/4 NONE S OSG ML ---- ------ 0.7 1.6 •Effluent#1=BODS>30<220 mg/L and TSS>30<_150 mg/L *Effluent#2=BOD5<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(R07/00) Sdtmltt Sob Tesum im. i . _ Page 3 of 3 s Coaducted 6y: _ -- Conducted,for.: Schmitt,Sojfi Te tmg�_Inc. 1 Nome? Tern Wlfe oy r _- _ Thomas J. Schmitt, CST 22742 Address: 48$Park Lane 1 159 72nd$Y City; tate;dip: Hud'sbn,--WI 54 016 New'Riphm nd,W1,64017 . 76a 1928 _ _7b-000 _ Phone:'715 PID: 024 1117 sign ue -- tdf No 11 Park View tat&lst AdO n - -_ cri tion N91/4-NEW-S 7 2N _ L I Des M; Baekhoe Pit Townahip„County:, Hgdson,St.Croix County — F - BeOch Mari 1 15L 1100._00'Tipp of cdncrste jard'l,shed' concrete eI b'SE`corner _- ' i A-1390ch QI A I Top bfconcrete y'and shod slab(ISE -- 1iAark 2 lrl 1 Slope= 9% *Bottom of wept drywell 9iUl *Outlet elevation of exis nq;septic tank 97. 9' Scale 40' :*Britton of'east d _ O t r : 1 r f f r , I , f i I f f i f � � , I ' t f t t l r - : , tf f u t , t t 1: i + r f _ 1 1n> , I 9 ' 4 f r i i j i } , -3 /_d F i , t i , + i i i r \ K \ 0 a m J =22 2 _ 00 oc &o $/Cj � (§ § e © m 6° ° - £ aB�7.00 $= a , (a E t »£L(D § EEa k£ 2 ; E . 822 ) 2 �k$ E© m2cm0 ) e <2 o m �£ c� Em� §\} f(D)$/ 4) E 2 ` ef3$ oEJ/k/ ) > � Ea-mac= ° � \ 3 a $ E. 0m0 2 � �2 [k § « \ § cl i \ E § : z' § B � 2 / $ a m ) § k C ; z - e a m w 2 . » 2 k $ E 3 Q / \ k U) k ; ) .. 2 � & � » � C 2 > o o a E { k CL 0 k k i § a CL a CL 4i & [ { o o ts J ) q \ R § § k _ O § § k CL g o - k = R § � \ I { ° ° / § ca ^ � k # § ƒ ) � ■ � ) § 5 ° � \ 9 # a E C) M 2 ; i = a I S 8 3 G 2 / m 2 . E § 7 2 f co 3 2 § § e a 2 k $ k \ w k 7 § ) ® 2 p I } 2 \ . 2 M / @ — , : h ; 2 CL # ' ( @ a § & L) a 3 (1) L Parcel #: 020 - 1127 -70 -000 12/27/2007 03:57 PM PAGE 1 OF 1 Alt. Parcel #: 17.29.19.592 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WOULFE, SHAWN M & TERRI L SHAWN M & TERRI L WOULFE 488 PARK LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 488 PARK LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.870 Plat: 04- 026 -PARK VIEW ESTATES 1ST ADDN SEC 17 T29N R19W PARK VIEW ESTATES 1ST Block /Condo Bldg: LOT 11 ADD. LOT 11 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 10/29/1999 612939 1467/027 WD 05/28/1998 579849 1326/545 WD 07/23/1997 541/586 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 203231 254,900 Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.870 69,100 164,600 233,700 NO Totals for 2007: General Property 1.870 69,100 164,600 233,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.870 69,100 164,600 233,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 112 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 R AUG 27 '99 09:39 FR PRUDENTIAL RELOCATION770 612 6163 TO 917153864686 P.01/05 FAX Date 8/27/99 ' Number of pages including cover sheet 05 TO: Kevin Grabel FROM. Sharon Duncan St. Croix County Zoning Prudential Real Estate & Relocation Solutions 1300 Parkwood Circle Suite 200 Atlanta, GA 30339 Phone Fax Phone 715- 386 -4686 Phone 770 -612 -6046 CC: Fax Phone 770.612 -6163 REMARKS: [l Urgent ® For your review Reply ASAP Please Comment Mr. Grabel, Per the request of David Markwardt property owner of 488 Park Lane, Hudson, WI 54016. The septic inspection on his property. d 7-- - - Io - 00 I1. 2°►. t�. S9 �- AUG 27 '99 09:39 FR PRUDENTIAL RELOCATION770 612 6163 TO 917153864686 P.02i05 TN! � Sep tiCheck On -Site Waste System Evaluation GENERAL TERMS, CONDITIONS, AND UMITATIONS The U.S. Inspect SeptiCheck On -Site Waste System Evaluation program was developed to encourage sound management of on -site waste systems. This page describes the basis, scope, and limitations of the SeptlCheck program. Please read and review carefully. Interested parties with concerns about the SeptiCheck Evaluation Report due to limitations described below and/or the inability of U.S. Inspect to provide a warranty or guarantee, should secure the services of an on -site waste systems professional, an engineer, or other qualified expert of their own choosing, for a full -scale invasive investigation and evaluation. 1. BASIS OF EVALUATION. The SeptiCheck Evaluation is an objective evaluation of an on -site waste system's components by an on -site waste management professional. The evaluation identities system components as either (i) acceptable, i.e., in fair to good condition and functioning satisfactorily, or (ii) unacceptable, i.e., in poor condition, not functioning properly, or nonfunctioning. The results of the evaluation are summarized in a SeptiCheck Evaluation Report which provides information about the type and condition of the on -site waste system and suggestions for additional testing of system components, if appropriate. 2. SCOPE OF EVALUATION. The SeptaCheck Evaluation is designed to detect visible on -site waste system deficiencies. The evaluation is based upon what an on -site waste management professional is able to observe at the t ime of the evaluation. The evaluation is limited to the areas identified in the SeptiCheck Evaluation Report and is only intended to determine whether or not one or more of the area identified on the report is /are functioning properly at the time of the evaluation; the evaluation is not exhaustive, nor is it intended to determine the source or cause of any on-site waste system problem. In instances where the on-site waste system is not functioning properly, U.S. Inspect will recommend that a professional on - site waste system contractor perform a full-scale invasive investigation of the system components which may include unearthing the distribution box and excavation of the absorption area. , 3. EVALUATION STANDARDS. The SeptiCheck Evaluatioit'.is pert ned in accordance with the SCOPE OF SERVICES described on the reverse side and established by U.S_ Inspot in the devespm of its SeptiCheck program. Interested parties are advised that the variables and unknowns listed w can Usi the proper functioning of on -site waste systems, as such , U.S. Inspect cannot be held responsible s can be attributed to these specific variables and unknowns: (i) Lack of routine maintenance. Syst umped or cleaned over an extended period of time can affect the absorption characteristics of underground - fields, dry wells, or cesspools - and are more susceptible to failure. On the avera ,,?n -site sewage tl systems should have accumulated solids removed every two to three years as part of a rotti�te ;W �zintenance program; (ii) Usage levels. A U.S. Inspect Evaluation Report neither confirms prior or current usage levels nor pra'• :.,. future usage levels. The number of system users and user habits can affect system performance; (iii) Non- usag@:,and reduced u�e..Systems which have not been used over an extended time period or have been used on a limited basis c zw . - 1 a problems) that would otherwise be apparent were the evaluation to be conducted at a time fu when the system was functio ' d$E ordinary usage conditions, and; (iv) Environmental conditions. The proper nctioning of underground leaching componen " Abe affected by various environmental conditions, including, but not limited to, surface and subsurface soil porosity, surface gradien ;water table factors, and rain and snow levels. 4. LIMITATIONS AND EKCLUSIONS. The S` Check Evaluation Report is not a warranty or guarantee that the on-site waste system will properly function for any period of time in the future. U.S. INSPECT PROVIDES NO WARRANTY, ARM OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR USE OR PURPOSE, OR ANY OTHER WARRANTY WHATSOEVER, THAT THE SYSTEM MEETS ANY CODE OR SPECIFICATIONS, OR WILL FUNCTION PROPERLY FOR ANY PERIOD OF TIME WHATSOEVER, OR OTHERWISE WILL NOT MALFUNCTION OR CAUSE CONTAMINATION OF THE GROUND OR WATERS. Because there are numerous factors which may effect the proper operation of an on -site waste system - including, but not limited to, usage, soil characteristics, and previous failures - as well as the inability of U.S. Inspect to supervise or monitor the use or the maintenance of the system, the ScptiCheck� Evaluation Report shall not be construed as a warranty by U.S, Inspect that the system will function properly for any prospective purchaser of the property. The SeptiChecO Evaluation does not include an evaluation of undisclosed "gray water" systems. ®19961996 U.S. lncpwL, Inc. All Rlnixe RewrVW. AUG 27 '99 09:40 FR PRUDENTIAL RELOCATION770 612 6163 TO 917153864686 P.03/05 EDINSPECT SeptiCheck SCOPE OF SERVICES The U.S. Inspect SeptiCheck On -Site Waste System Evaluation program was developed to encourage sound management of on -site waste systems. SepdCheck Evaluations are conducted by on -site waste management professionals ( "Service Providers ") selected from the U.S. Inspect network of quality providers. U.S. Inspect monitors its Service Providers to confirm that all work orders are performed in a timely manner and in accordance with the services listed below. Services are provided in a manner consistent with the level of care and skill ordinarily practiced by reputable members of the on -site waste management profession. This page describes the scope of services provided in a SeptiCheck Evalwtion. Please read and review carefully_ LOCATION DISCOVERY The Service provider will attempt to locate and access the septic tank or cesspool which handles the on -site waste. A majority of systems are located by observation and/or use of a probe or a transmitting device flushed through the drainage line system inside the home. In most instances, the system tank cover can be made accessible by using a shovel to remove grass and soil from die top of the tank. However, access to some systems can only be made by using equipment such as a backhoe, Additional charges are assessed in instances where equipment is necessary to gain access to the system. The Service Provider will shovel by hand up to eighteen inches (18 ") deep to gain access to the system tank cover. SYSTEM IDENTIFICATION The Service Provider will attempt to identify the type of system, approximate tank capacity, and absorption system components in place. For example, a septic tank may either be steel, concrete, or fiberglass, and a separate holding tank may be in place to capture effluent (liquid) from the tank for discharge. A cesspool may either,be brick, block or stone. Some systems, such as a seepage pit (a cesspool preceded by a septic tank), are a combination. As some on -site waste systems may be difficult to identity because of age or location, a positive identification of the system may not be possible. TANK CHECK I AND CLEAR LINE VERIFICATION The Service Provider will remove the system tank cover and note the effluent levels, scum thickness, and sludge depth. This is followed by introducing waste /water into the system to determine if there are problems with the delivery of wastewater from the house to the tank. TANK PUMPING The Service Provider will pump the tank and monitor for any effluent back flow from the absorption system. If present, a septic system holding tank for effluent will be activated to evaluate discharge capabilities. SeptiCheck purchasers are advised that holding tanks ARE NOT evaluated for function of tinter circuits, electrical connections, or alarm systems. SeptiCheck purchasers are advised further that Service Providers WILL NOT pump on -site waste systems in instances where the following conditions have been identified: (i) Effluent levels are either above or below the system outlet tube in a septic tank; (ii) Effluent levels are too close to the inlet tube in a cesspool, and; (iii) Minimal scum and sludge buildup in a septic tank indicating that the systenrx may have recently been pumped. U.S. inspect will contact SeptiCheck purchasers and discuss further evaluation options in instances where the conditions outlined above have been identified by the Service Provider, TANK CHECK 11 AND ABSORPTION AREA EVALUATION The Service Provider will visually examine the tank or cesspool interior, including baffles and /or sanitary tee inlets and outlets, for cracks, breaks, rust, or other signs of deterioration. This is followed by an evaluation of the absorption area (commonly referred to as the "leaching field ") for visible effluent seepage on the lawn, evidence of uneven distribution of effluent, lush vegetation, or other signs indicating absorption deficiencies. SeptiCheck purchasers are advised that evaluation of the absorption area DOES NOT include the following invasive procedures: (i) locating and uncovering the system distribution box to examine whether or not distribution of effluent into the absorption area is even, and, (iii) excavation of the absorption area. GROUNDS RESTORATION The Service Provider will conclude the SeptiCheck Evaluation by closing the tank system Cover and backfilling all disturbed areas covering and surrounding the tank. All disturbed areas will be seeded to bring the area to as close to its original condition as possible. SeptiCheck purchasers are advised that disturbed areas will be slightly raised following the grounds restoration process to allow for normal settlement of the soil_ 10..4&IM US. hts'puLt, W. All Rights Reserved. + AUG 27 '99 09:41 FR PRUDENTIAL RELOCATION770 612 6163 TO 917153864686 P.04/05 SPECIAL SEPTICHECK REPORT C1.IENT FILE # DATE 997999 05/17/99 U.S. 1neDect 3975 Peir Ridge Drive, xa50 North Tower U.S. INSPECT JOB d TOTAL ESTIMATED COST Pairfax, Yx 22033 - 7921 Ie405AN $ 0.00 CLIENT NAME NAMii OF PROPERTY OWNEWSELLER/PURCHASER Prudential covernment Aecouato David barkwardt CLIENT ADDRESS ADDRESS OF PROPERTY 1300 PaKkwood Circle #200 see Park Lane Atlanta, C1 30339 Hudson, NI 54016 CLIENT CONTACT uy TCLEPI•IONE NUMBER FAX NUMBER HOME TFIXPHONE OFRCF TELEPHONE Andrea Cl o wer0 (goo) 3s$ -6999 (770) 612 -6260 (715) 391.7061 (651) 436•4793 Results: REPAIRS NEEDED - Inspection Date: 8/09/99. Age of System: 23 YRS. Regarding: EVALUATION OF ON -SITE WASTE SYSTEM, Typical On -Site Testing Procedures: 1. LOCATED, ACCESSED, AND OPENED 'TANK COVER. 2. INTRODUCED WASTE /WATER INTO SYSTEM, 3_ PUMPED TANK, LISTENING FOR BACK -FLOW I NTO TANK. 4. CHECKED CONDITION OF TANK AND dr9RERV AFTER TANK WAS PUMPED. S, PROPERLY CLOSED TANK AND REPLACED DISTURBED SOIL. 6. PROBED PROPERTY TO DETERMINE LOCATION OF ABSORPTION AREA. 7. CHECKED ABSORPTION AREA FOR EXCESSIVE MOISTURE OR EFFLUENT OUTBREAK. System Information: 1 SEPTIC TANK WITH ABSORPTION AREA. System Findings: TWO CESSPOOLS PRESENT AND BOTH ARE UNACCEPTABLE AND ARE THREATENING PUBLIC HEALTH /SAFETY. System Correction! CONSULT WITH A LICENSED, RESPONSIBLE, ON -SITE WASTE SYSTEM CONTRACTOR FOR ADVICE ON REPAIR DESIGN AND COSTS. COSTS TO CORRECT MAY VARY DEPENDING ON THE EXTENT OF THE PROBLEM, SOH CONDITIONS, SYS� LOCATION OF THE SYSTEM, AND LOCAL SANITARY DEPARTMENT RN �b b��O9 9 : , 0T% V 401 u� is ov, make on s 60 a (be Se 'kov at yd � q�+N r � tet� � , e %r 5re� rb QT 1H ° p �6P SI cy °% tti sag ' h a , - a ' `0 1�g �g5` +on5, any b gy. Total Estimated Cost $ 0.00 Page 3 of 3 (Prinecd on OR 1 at 12:18) Cupyright (C) 1994 -98, U.S. lm*t MEMO -1 (04/16/98) I RUG 27 '99 09:41 FR PRUDENTIAL RELOCATION770 612 6163 TO 917153864686 P.05i05 OVERALL SUMMARY PAGE CLIENT PILE A DATE 097499 06/13/99 U.S. D Drive, 02t 39 U.S. INSPECT JOB N TOTAL ESTIMATED COST 75 11' #ir Ridge Drive, 1)250 liotlh 'lo.ar Pkiz9ax. VA 22033 -2914 SBOOSAN 6 0.00 CLIENT NAME NAME OF PROPERTY OWNER/SELLER/PURCHASER Prudential Op- oranlenc Accounts David tdarkwardt CLIENT ADDRESS ADDRESS OF PROPERTY 1300 Parkwood circle $200 nee PAxk Lao• Atlanta, QA 30339 Hudson, WX 51016 CLIENT CONTACT TELEPHONE NUMBER FAX NUMBER HOME TELEPHONE OFFICE TELEPHONE Andrea Clovers (800) 350 -6699 (770) 612 -6160 (715) 381 -7061 (651) 436 -4793 SCOPE OF THIS SUMMARY: ORIGINAL INSPECTIONS This summary only pertains to the Ilrat Inspections that were performed on the above property. All other ra- inspe00*ns will be summarized on a dlllerent Summary shoot. SUMMARY ITEMS ITEMIZED COSTS SEPTICHECK PROBLEM: TWO CESSPOOLS ARE PRESENT AND BOTH ARE UNACCEPTABLE AND THREATENING PUBLIC HEALTH /SAFETY. RECOMMENDATION: CONSULT WITH A LICENSED, RESPONSIBLE, ON -SITE WASTE SYSTEM CONTRACTOR FOR ADVICE ON REPAIR DESIGN AND COSTS. COSTS TO CORRECT MAY VARY BETWEEN $200 AND $20,000 DEpLNDING ON THE EXTENT OF THE PROBLEM, SOIL CONDITIONS, SYSTEM SIZE, LOCATION OF THE SYSTEM AND LOCAL SANITARY DEPARTMENT REQUIREMENTS. 0.00 Total Estimated Coot $ 0100 Page 1 of 1 (Printed on 08/23/99 at 09:29) Copyeight ICI 1992 -96, U.S_ Inspect OSUM -1 (04)21/98) TOTAL PAGE.05 **