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HomeMy WebLinkAbout020-1456-12-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563833 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: Killian, James P. Jr. & Elizabeth Hudson, Town of 020-1456-12-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 19- b . tip 2 a ay. 1,4t- ZAA;" 11.29.19.2928 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic N Benchmark ca, 20 -D 11_~ /n Alt. B d/sL 1t/J~ , Aeration ~/v V -C Bldg. S wer ding S tInlet ~ ' TANK SETBACK INFORMATION St/Ht Outlet TANK TO Py WELL BLDG Vent to Air Intake ROAD Dt Inlet Septic ~l f Dt Bottom 0_0 ~ZA D g Header er/Man. S t Z, 3 tit a ~-1 Aer ' n 5 Dis ~p(y~~ ~2. Hold' Bot. System APO Cr I. 1674 Final Gr Q 1 1w PUMP/SIPHON INFORMATION , K~._- S-V Ca Manufacturer Demand St r GPM y d~-/ 4 rJ . 3 Model Number ca y~~ qtr TDH Lift Frictio oss Syst Head TDH Ft Forcemain L th Dia. Dist. to SOIL ABSORPTION SYSTEM S cP ' r~: t BED/TRENCH Width Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia, iquid Depth DIMENSIONS - o SETBACK SYSTEM TO V P/L BLD WELL LAKE/STREAM LEACHING Man tur . INFORMATION TOf SystemL r I ) 001-1 Q CHAMBER , - _ UyIOR Mod Number: ~Z ~Q T {~ytd t. DIST BUTION SYSTEM 2ZG~i~ n / V10 ~o ('~~L f1~y AT-leadeq,fanifold Distribution / r x Hole Size x Hole Spacing Vent to ALU take / r Pipe(s) I~ Length V Dia Length Dia_ Spacing i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only lpY. td' Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedrrrench Center ti I Bed/Trench Edges Topsoil Yes FE~ No 0 Yes Eg No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: T LX Location: 1050 LaBarge Rd Hudson, WI 54016 (NE 1/4 NE 1/4 11 T29N R1 9W) Sunset Hills 1st Addf Lot 12 ~ Parcel No: 11.29.19.2928 F L( 1.) Alt BM Description = 1 ~~h / Wd ~C.p'V-- 'f"1OVO t , 5 I'e v ~~T~ , Li n - 5-~C. 2.) Bldg sewer length = G (UJ P/~Lf ~C ~~✓6 - amount of cover Z it G_5f 4V14 ai wi'+ h . j C(1J~ G /J r G - -4-Ali a Q - Plan revision Required? Yes No Use other side for additional information. 3 J _ _U Cam- SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No. AOL", S Ccnse-6 /x//s I D ub 'a d `v 4 5 t s ~ t 1 tt I , V", M J~~ z a,l CIA' ~~e. r ~ TopoFl~i"te.b~ur, Assumes/ ektA _ IcV.X.' 190' ~ t I - I ' -X X X X x x 417.34' 336.47 LOT 13 2.00 Acres ~1. 87,153 sq. ft +yo MNE= 98.00 LOT 12 3.24 Acres t r = ~`5p S 141,074 sq. It L.B.O. 900.0 LOT 11 N o _ _ _ _ _ ~ F9~,`9i~ ~ . 3 } 't-, + / fit- 9~►s 499.37 332.33 o Ito 471.55' 27.82 99.30' 191.55' 180.70 62'48 N89°44'56-W 831. 0' /"0' BENCHMARK \ \ I TOP OF PIPE \ \ I ELEV. = 897.22 W 33 ~ \ I ~ N o I I Z. I 1~I~ d04 ~ I I a ` ~ County Industry Services Divisl - 1400 E Washingtort A~ sanitary Permit Number (to be filled in by Co.) GGv 0 Box7162 '-°7~ Madison, WI 53707--716 +4?J S33 - Ic Tlansactiun Number Sa ermit Application In accordance with SAS :183 Wis. Adm. Cp~lsubmission of this form to the appropriate govert mental it /V is required prior to obtair m anitary ore: Application forms for state-owned POWTS are submitted to Project Address (if diftbrent than nl8iling address} the Department of Safety and Profs ~rvies. Personal information you provide may be used fo secondary ur oses in accordance with the &Facy Law, s. 15.04(1)(m) Slats. I. A lieation information - Please P irlt A 1 In ormation Property Owner's a Nme Parcel # Pr (~/•3~ operty Owner's Mailing Ad ress Property Location' ~s ! lJ ~rc _ Govt. [.or 7 Z Clty, tpit e Zip Code / Phone Nurnber ~y+ /1 1 IJLJ~- _ _ AIFE v., Section D rG9 - A" erclI one) II. Type of Building (check all that apply) Lot # ' N; It or W I or 2 Family Dwelling --Number of Bedrooms Subdivision Name w ❑ Public/Commercial - Describe Use ❑ City of'_ ❑'State Owned - Describe Use _ CSM Number ❑ illageof - Z LI4onlync?;Eox Z--Z_~ ( own of__ - Ill. Type Of Permit: (Check on line A. Complete line B If applicable) - ystem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Or,l Y ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of Pltnmber El Permit Transfer o New Before Expiration Owner _ I . T e of POWTS S utem/Component(Device• (Cheek all that apply) _ (X Pressurized In-Grou id El Pressurized In-Ground ❑ At-Grade Q Mound > 24 in. o1'suitible soil ❑ Mound < 24 in24 im. Of oil Holding Tank ❑ Othe- Dispersal Component (explain)--- 101. jfj ❑ Pretr;atrnenl Device (explain) V. Dis ersaVI'reatment Area Information: - a - Dg dgn low (gpd) Desi n Soil Application Ra[e(gpd Dispe sal Area equired (sf) Dispersal Area Proposed (s em Eee tiort VI. Tank Into , Capacityin Total - _40f - Gallons Manufacturer Gallons Units New Ttmks - n °o E Existing Tanks CL V in :n U. C7 Cl., Septic or Holding Tank - Dosing Chamber - _ _ VII. Responsibility Statement- I, the undersigned, assume r sibility for installation of the PO WTS shun r -he Plumber's Name (Print) w o t the attached plans. Plumber's S' tire MP/MPRS Number Business Plione Nu nber Plumber's Address (Street, Cily, State, Zip Code) 22/.~ % '"tom - VII oust /De artment Use Only Approved Disapp Permit Fee Date Is. led Issw ig Ag Signature _ Own _ en Reason nial -7 IX. Condit asons for Disa rov I pp a AS 'd~ 1 bisptic tank, e►iteM fflterand -dispersal cell+must all be services C Main tW I / as per Management plan provided by plumber. eQ ~'~2 aY. Aq a fsck to UirelrWr ite must be maintairlliif As P4 11110*" C" told I blam A ta01 to wmplete plans for the system and submit to the County only Un paper nut hss than 8 t!i x 1 I inches in size SDD-6398 (R0313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/2/13 Owner:Elizabeth Killian Location: NE1/4 NE1A S11 T29 N,R19W 1050 LaBarge Rd 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 Specificati Sheet Signature License nu 7 #226900 PLOT PLAN PROJECT Elizabeth Killian ADDRESS 1050 LaBarge Rd Hudson Wi 54016 NE 1/4 NE 1/4S 11 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/2/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 1/2" rebar ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION O 99.2/99.0 5' below arade Scale is 1" = 40' Property Line unless otherwise All piping shall be SDR 30/34, within 10' Property Line noted of tank, piping shall be Schedule 40. Well is to meet all setbacks required by Vent WDNR >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Property Line 3 4„ Grade at System Elevation 10' B-1 20' ST Pro 3 Bedroom B-3 House 100' i 50' 2-3' X 88' Cells with >3' spacing C. 1111 6 6 40' B-2 Vents 20' LaBarge B.M. * Rd Property Line 5 2290' L , 1 .4 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 To be >1' above grade 5.6ft^2 pair of end plates Finish grade elevation Typical Installation 99.0' Vent Grade Vent 3' 4" 3' ,A-;~30/34 Septic Tank 5' Long 1 ?9 5' 5' Long 191 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 B 22 chambers per cell System elevations: A_94.2' B 94.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN page- of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al O NA P ttlt # Septic Tenk Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer f^ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model qNA Number of Commercial Units Pump Tank Capacity al 11 Estimated flow (averaged) aUd Pump Tank Manufacturer 1 13 Design flow (peak), (Estimated x 1.5) 4GsO aVda . Pump Manufacturer NA Soil Application Rate al/da /fe Pump Model NA Influent/Effluent Quality Monthly average' Pretreatment Unit NA ---a- O SandlGrevel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) S30 mg/L Biochemical Oxygen Demand (BOD5) 420 mg/L ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) x150 m /L ❑ Disinfe.t€on ❑ Other. Manufactl firer Pretreated Effluent Quality ❑ NA Monthly average" Di persal Cell(s) Biochemical Oxygen Demand (6005) S30 mg/L -grou.id (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) 510` eful100ml ❑ Dri in3 ❑ Other. Maximum Effluent Parti+;:le Size Y. inch diameter Values typical for domestic (non-c:ommerdao wastewater and septic trnk effluent. " Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every U month ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every CI months V6ear(s) Inspect pump, pump controls & alarm At least once every CI months ❑ year(s) NA Flush laterals and pressure test At least once every CI months ❑ year(s) (tl NA Other: At least once every Cl months ❑ year(s) NA Other: At least once every CI months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying cne of the following licenses or certifications: Master Plumber,, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indii:ate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator anJ disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components; and any other maintenance or monitoring at irlervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servic0 report shall be ;provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal (ell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. START UP AND OPERATION Page of For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of panting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat-, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicide:;; meat scrap:; medications; oil; painting products; pesticides; sanitary nap.dris; tampons; and water softener brine. 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tangs and its s ~ 9 pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septago Servicing Operator. • After pumping, all tanks and its shall b p be excavated and removed or thei • covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: -1 suitable replat:.ement area has been evaluated and may be utilized for tie location of a replacement soil absorption system. The replacement area should be protected from disturbance and compai;tion and should not be infringed upon by required setbacks from eAsting and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable repla(ement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performi:.d 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 plai;e following ri-moval of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR, INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DE-ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAIN'T'AINER - Name Name Phone t ~:77/j ~ ~ Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUK°HORITY C~ Name - Name Phone 7Phone 3-,F 66 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3). Wisconsin Administrative Code. 10, A r, RLTER CARTRIDGE INSTRUCTIONS !~w Yt►rtlllirlltl~t,~t~tt 5 rep I Wry 11 tote mm, came aft ~ OW of OW ail" d U4re to ensue" it' it Cehtrrrrrd .1. Yh. ~prac lc waning. If -Ke tit somr Ins`ec't mwo pule" ii*o tiro tank through I aukart rwivent wood (riles") additluhai phre alma the uatiet pipe'- :5Z IEP a why}i tim t 4ry Mud on the a" plea, crwadswu the it>mo Or 4r-IPA:h tap nw+W S tote 'flltar to V- W* and MI k imtitUIPU dir updonrrl supp= Ou►t, Yf sWe sosppart tnatirod rx het tit Up "d, fain pratmed to A o s•: de.3 for ~ 4 %4NtMI'siri}y them ~mtl sae stsppur soiurrt wow t~e ~N-ifrch ' ptr rarrtu tins fitter r,ur_ If 4ide suirpurt trtethttd is rwt utlWed, pratr}td to oat, 4Y Y~M§Y , Sahq nC tiVo'to ilet +:r7GY Man tits wliiirt Dirty . "art the inter cartridge i"W he Cs"' {Oeasltsri dOM OW tote OW k)eks nett, tho 6utt2Yrr, u1' th" !Pe U~tS earitcdr in uttlk&.d- irreert irrtrc the ORL" and Lack Ity turning clockallse 9t)e, r F,; i. IMteJ<~Iirtt~liitltltC~ 7'he ertlUerdl flkor ~slwutd be cteeswd every t1+r%e U,,, McptfC COnk ly 3ervie~►d. Z. Open the olrttrt acleasds apeJ;Or© to rn","Gt the tank ttid fltt"m: f. pump drtr fl ttr hank rr +uwrrpJwtunly, meek;rli) sum's" to r"rrurVe lhel sludµu „f • ibyor rra the b0i'tw" Of tlrw Carnk end hot just the nr, urrt uhd u efliuritY - a. Ghee torn eiKuent tttvei has Liuriq tOwerOd bu& "1Jr outlet pipe, firmly pub up Orr the filter flmi#dte W the. i"Vttrt tvt t1m cirrtNriye frames tine rase, didjudye Oleo " _ s. S11de the rertriew rip and a1rr: of the rya !rN ~feairUtg, Y` u• !r a VAS swath (711f111!►r boa to am eiarhr Itrq~ferrtre sW,tt h with should be ratn:oWgd by j., Ei twrrain.y c4rsrturduckva1sa 40. wild dammed water urrlir. whq`e htdfllhy t'he t lrrtrldp~ on its flarge Hal down) Over Rtrr: rev , Y on, the castpid"At With ate a ,sy OLrerril rhr arrlyr making sx 1irsYtas9u: rusalarial rs iihseif Ga ~ yr e fr VxS switch Is utglxuri, depliir a iy r iC Ilrtn the, tutik, turning dnckwfsa sn~, Y Iiftur who into, It1tf►r• trrt °•p t►ssar•t term filter t,amrtri t ''yNir . i the filter lucks tck item b dtu the baktrscry tit t'hocat ~ Ar!labrhg dot*# ly tll the fa" place drfd ` Sur.1Ire this acculis fltmtlhHid rmp the Whit. _.--T--_,._-- 4 ` Y RECEIVED 1874 Wisconsin Department of Com 11 SOIL ALUATION REPORT Page 1 of 4 Division of Safety and Buildings i ~orlnUAS Co > Ackp. Code A.C.E. Soil & Site Evaluations h complete site plan on r no stt ( b(ir in County Attac St. Crow include, but not limited to: verti I and t (B r c percent slope, scale or dimem ce to st road. Parcel I. D. _ - ;,re' Pendin Please print all information. Re ' Drte Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Y~o -5 Property Owner Property Location Miller Govt. Lot NW 19 SE 19 S 11 T 29 N R 19 W perty Owner's Mailing Address Lo Block # Subd. Name or CSM# 868 Kelly Road 12 ) ~ I Sunset Hills First Addition City State Zip Code Phone Number ity J Village N Town Nearest Road /ot-,T; Hudson WI 54016 715-531-0714 Hudson LeBarge Road New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Recommend installing two trenches at 3'X 87.50' using twenty eight (28) 11" Standard Bio-Diffuser Chambers at elev. = 94.50' Boring # J Boring H Pit Ground Surface elev. 99.30 ft. Depth to limiting factor >1 14" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0-15 10yr3/3 none sl 2fsbk mfr as 2fm 0.6 1.0 2 15-27 10yr5/4 none sil 2fsbk mfr cw 2fm 0.6 0.8 3 27-35 10yr4/6 none Is 0 sg ml aw 1fm 0.7 1.6 4 35-114 10yr6/4 none s 0 sg dl - - 0.7 1.6 a Boring # J Boring IJ/ Pit Ground Surface elev. 99.10 ft. Depth to limiting factor > 110" in. Soil 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 1 0-10 10yr3/3 none sl 2fsbk mfr as 2fm 0.6 1.0 2 10-24 10yr5/4 none sit 2fsbk mfr cw 2fm 0.6 0.8 3 24-28 10yr4/6 none Is 0 sg ml aw lfm 07 1.6 4 28-110 10yr6/4 none s 0 sg dl - - 0.7 1.6 eo' if I * Effluent #1 = BOD y> 30 < 220 mg/L and TS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) nature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, 12/27/2004 715-248-7767 Property Owner Miller Homes Parcel ID # Pending from 020-1013-40-000 Page 2 of 4 3] Boring # Boring 1/ Pit Ground Surface elev. 99.04 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/3 none sl 2fsbk mfr as 2fm 0.6 1.0 2 9-38 10yr5/4 none sil 2fsbk mfr cw 2fm 0.6 0.8 3 38-48 10yr4/6 none Is 0 sg ml aw 1fm 0.7 1.6 4 48-115 10yr6/4 none s 0 sg dl - - 0.7 1.6 1 ❑ Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 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 = 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. PROPERTY OWNER: Miller Homes SOIL AND SITE EVALUATION 1874 Page 3 of 4 PARCEL I.D.# Pending from 020-1013-40-000 A.C.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed prior to plat review. Changes in lot line locations or building site may result in additional soil evaluations being required. Lot line locations must be verified prior to permit issuance and system installation. • a r ♦ E"leda'o,-, -j~ Ex,,.y6-,,T 4c rxth rre ~11 SCAIC • - J~ qqo c9 / i IS3 r ~ ♦ 1 ` J , 1 , ~ 1 Q ;'6~ AssurnCd elc~ ~ /~.c~.' ~Q 290 ST. 1CI : 5 ?P IC I`Al`+7Ii +lAll TBNANM AC'r EECv# I~I'T A . OWNn.41P L" C' "ICA `1# N l i~?v1 Owner$u ~r " EGt2A- P, ETU . AM4. ~E:S Kt.u.JA+J. IVtai1?ng At dress ~ jp50 LA 6AQ6£ &ArA T._ _ ~ds~ l u~L $tlbl fi PrOperty Address 10S0 1ABAe6E K~g4T_ ,p.ro4J wr 5r{ol~O (Verattion rFcSS from pbzia~ & . dot asst for nevi tsoastruetsen. j City!State~._SpN ~W J1'QwSaJ .Pat+cet IdejWfjcahcn Number ©ZG/yS~/ZQx1 IGAii D# x operiy ic~ u 114 NE.. ; Sec. ll ; T T,6wil 6f C os, Subdivision Svivser- (AtOr. AAQ t7tyk) Lot; 1Z IterrtMed Survey Mss # Voluiiie Page i . Wit Oe4 17 ~~~~z Nalume --L Jd Page _ Spec 11oitse cusp Lot roes ident ie Itrap wpei use`aaid rmiutft of ydiir septic system could'tesult inn hs tote.PaiWM tD hab&d wastes. T opar . Waiatemnce ciaasiss of r..av* out t1je septic: tatrlc every t Yew ar., der, ff needed,. by 'a lamed ArUt you put into tiie sYst an affect the function oft septa tank as .1k tteattrtettt S~w waste disposal system. nastier maintenance *esuttaibs dies are specified is §Co in. 83.52 1} did in 12 - St ux County Swiw'yS Or~db6nce. The Proveny o-Mor agrees to subm t.to St. Croix Couaty P iieg & Z DeparMMWt a Certjfl atioe fxM?_ signed by the. owner au(i by :a master plun**r,.lohmeyu~ pturnGer, restricted phn*w or it licensed ptuuper verMtjog that ti) xhe og-sire.. Wastewater disposal system is m.Froper Ocraung-cet4' *h arW*i (2)°' er insprwtion ind pumpmg (if necessary),, the septic rank is less than 113.l1tll of sludge.: , , ` I/we, the trs~dersigned vedead t above rsgtuismenb=d aV t -to mainta pistra~e sewage spasa! system .~v:th tt' standai is set fthor. hen,asset b dk Depmunei t bf ibom ce aid tie of Natural Resaitrcas;:Mate of Vtxiscti is sl: Cers aiiois.statiug that yoursep& system has beet majatained be comgsl~cted and retumod to t#e ft Croix' coziaty Pta6ing 8c Zoning Department witty 30 days.ofthe:fhree year:enpirati+on slate. Uwe.certify tha# all staff emcnts cra tl3is fo -are UUc.iD.'dw best of m3>/aur lenowiedge Jiw. ain/are the owners j of r~ .:properly desoribedsbove; b}. vise of a' atrzzn€dOW worded in ke&~er pf'D& 0#fim r ~G.....: ; S flF' PLrc lr~s~ LtA ~:*Aay infotz dou 116t is.imisrepres med may result *the.&*tary l b revoked bytim I'launizng/ .Lonitig Depiuxaxenz.. * li}vlutle wirtt tints aplrl3icatfott a r eordecl .ey cteisci frrnzi ti>o Regis of Death C 466:aril a copy of the certified survey' if refere is made in the warreuty deed. I ' _x x X x x X 417.34' 336.47 LOT 13 2.00 Acres 87,153 sq. It HWE= 898.00 tcam` ; N ui .;ham LOT 12 \ 3.24 Acres W 141,074 sq. ft _ LOT 11 10o \ L.B.O. 900.0 (n ` ~o / °o - ii 4l , 2 - \ c,~v ! 499.37 332.33 o 471.55' 27.82 99.30 191.55 180.70 62'48' N89°44'56 W 831.70' BENCHMARK \ I TOP OF PIPE \ \ I ELEV. = 897.22 _ 3\ } 1I' o O I i ZI 4 a II III 981768 BETH PABST REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 2 - 2000 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number 07/08/2013 09.46 AM THIS DEED, made between Daniel S. McDonald and Paula J. / EXEMPT # NA McDonald, husband and wife, Grantor, and James P. Killian, / REC FEE: 30.00 Jr. and Elizabeth A. Killian, husband and wife, as survivorship a/ TRANS FEE: 231.00 marital property, Grantee. PAGES: 3 Grantor for a valuable consideration conveys and warrants to **The above recording information Grantee the following described real estate in St. Croix County, verifies that this document has Wisconsin: been electronically recorded & returned to the submitter SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF Recording Area Name and Return Address: Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 1084893 Exceptions to warranties: 020-1456-12-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN) This is not homestead property. Dated this June 28, 2013 . Da S. McDonald Paula J. Mc onal i WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 1 of 3 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF in COUNTY OF W/~- authenticated this 1Z8' ~3 Personally came before me this I * the above Daniel S. McDonald and Paula J. TITLE: MEMBER STATE BAR OF WISCONSIN McDonald, husband and wife to me known to be the (If not, person or persons who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Martin D. Henschel 6800 France Avenue South, Suite 410 Cheri Bro Edina, MN 55435 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My commission is permanent. (If not, state the Both are not necessary.) expiration date: 03/01/2015) *Names of persons signing in any capacity must be typed or printed below their signature. CHERI BROWN NOTARY PUBLIC STATE OF WISCONSIN i WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 2 of 3 Exhibit A Legal Description Lot 12, Plat of Sunset Hills First Addition in the Town of Hudson, St. Croix County, Wisconsin. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 3of3 ts. Y twrYfVSf, IYI'J N..t •Ir y77)JrtoOM WW771714tDalOYA ! ~ ~ 3 wWY,bYhf Wtr YY0lYiv r yMWY.NA~^~WU7N► IIlMi/tlf •INO11J ~Ah1J NyW71 f71 Qa O IYIW I'JIIMIlY.11i .111~~ µYYW Y'MYWYUYYI.W'1•M•.YYYIYR YIYI Nd'ONNAQ♦rOw~MMM 1JIfJr1 NOA ftJMtlRNNN M rnpuawY miw~ ~ "•M•~. , • rYf103Ifl AroanosaIb`tt~Q?Xl2S w.o~.urr ouone ar+oa aes aa7, e mr Yana nrwf "I"- Ywwt ` „Y.•...w•IY«•r.+na..l .~.~r+~ ~ MW,AMJW •IYWW MY'~~ .YY pY1.YI N'Y Off' rM .t lr• . . i• t ! 'r I i y i •'YWl'Y q ~ ter. F• ~ b r t b t r ~ }r ~t ~ I ~ III b 9 ! 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ANI1[.l y.l.r Vtl +A ltal A JAI 4 ~r,e[[«rA A.rwwlAe~ AAy 1 Yy ~ ' Y ~ ~ ~ .r1 Ayr rs A d IVA JN elixvAAl ti 11 n ~ ~r YO ""RAO y 1 AIR ~JII eJr AA IY'A'11 ~ , 1 g POAI ~ I M AA4-4. N.1'VA ' Ili .,uy.......... AO' $ /9 avid OZ5Z9ZPSTL JNIIVZH XIO*doms wv VVSO £TOVZO'T" e R ~ y M ~ 1~7j(1~1 ti Parcel 020-1456-12-000 07/09/2013 01:27 PM PAGE 1 OF 1 Alt. Parcel M 11.29.19.2928 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 04/06/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - BONSE, KEITH J & ANN M KEITH J & ANN M BONSE 615 LEMON ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1050 LABARGE RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 3.240 Plat: 10-054-SUNSET HILLS 1ST LOTS 11/20 020-05 SEC 11 T29N R1 9W PT NW SE SUNSET HILLS Block/Condo Bldg: LOT 012 1 ST ADD'N ('05) LOT 12 (3.240AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 06/15/2005 797637 288/464 WD 04/06/2005 791515 10/054 PLAT 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/18/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.240 22,800 0 22,800 NO Totals for 2013: General Property 3.240 22,800 0 22,800 Woodland 0.000 0 0 Totals for 2012: General Property 3.240 22,800 0 22,800 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