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HomeMy WebLinkAbout020-1458-02-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563860 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: Morawitz, Barbara Hudson, Town of 020-1458-02-000 CST BM Elev: Insp. BM Elev: BM Descri tion: Section/Town/Range/Map No: ' '3 ef 5T 16.29.19.2938 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 9 3 g'~~ S9• • S Dosing Alt. BM Z f Aekiti&n l.~C~.~ Bldg. Sewer ~ ~ . ~ ~ D • Holding St/Ht Inlet 47• Z TANK SETBACK INFORMATION St/Ht Outlet 5 • ~t TANK TO P/L~ WELL BLDG. /Vent) Air In ke ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. S. co ~3 Aeration Dist. Pipe . 4 6.`7 77 Holding Bot. System (p. -7 .7Z. 7.7 W. PUMP/SIPHON INFORMATION Final Gra e 3 z5 9'S 4' A. Manufacturer Demand St Cover GPM YOWL Model Number 7 b TDH Friction Loss System Head H Ft Forcemain Length Dia. Dist. to Well - SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches ,_J PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J Z e✓~G~J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR -X-A4.1 Type Of System: 1.30 /1 AAr- UNIT Model umber: DISTRIBUTION SYSTEM ~ bb. eg' Z 7+-Z7 5': Header/Manifo~ / / Distribution x Hole Size x Hole Spacing Vent to Air Int:ke: Pipe(s) ,Q,a •hvt S L ength Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded Jxx Mulched Bed/Trench Center 3 7 Bed/Trench Edges Topsoil Yes N No Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 597 Grange Rd Hudson, WI 5401166 (NE 1/4 NE 1/4 16 T29N R1 9W) Willow Bluff Lot 2 Parcel No: 16.29.19.2938 1.) Alt BM Description V O J~ 1 0 Q v~ 2.) Bldg sewer length = 27 lna - amount of cover = 3 5L) f) aw- Plan revision Required? Fa Yes No Use other side for additional information. lY SBD-6710 (R.3/97) Date Insepctor ignatur Cert. No. PLOT PLAN PROJECT Barbara Morawitz ADDRESS 1391 250th St. Glenwood Citv Wi 54013 NE 1/4 NE 1/4S 16 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/30/13 BEDROOM 5 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000/630 LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 94.0/93.0 4' below qrade of tank, piping shall be Schedule 40. Well is to meet all setbacks required by WDNR Vent >6" Quick4 St da of Cover Leaching Ch ber 34" rd 50' with 20.0 ft2 f Area Pro 5 5.6ft^2/pair o end caps bedroom Long 12 house At stem Elevation i L 10' Huffcutt Combo Tank o 54' B-2 qq, 15' 2-3' X 110' cells ~Gith ' spacing 12' B-15, B.M.* 98.5' Vents 16' 14% Slo e 97'5 Scale is F = 40' B-3 unless otherwise 45' 60' noted 1 350' Property Line County - - ' i Industry Services Division Sanitar Permit Number (to be filled in by Co.) i 1400 E Washington Ave Y r"i► P.O. Box 7162 FS U Cj .t, Madison. WI 53707--7162 R Slag l iMt ygn Number Sanitary Permit Application In accordance Sp" .21(2), Wis. Adm. Code, submission of this form to the appropriate goven mental it / is required r' t~ p t obtair ing a sanitary permit, Nola: Application forms for state-owned POWTS are sub"ed to yro dress (if different than mailing address) the Department of Safety and Professional Servies, Personal information you provide may be used fa secon~d4~p or oses in accordance with the Privac _ Law, s. 15.04(l )(m), Slats. 1. Application Information - P - lease Print All Information Property Owner's Name _ v ~ l,! lCl 12L ~I Parcel o ~n dd W Cf / C-cam/ i✓ Properly Owner's Mailin@ Address Property Location J City, State Zip Code _ Govt. Lot _ / P Phon_e Number J • _''/a, SectionA 90 circle o Q. Type of B wilding (check al! th ` pply) - T N; 1Z t,o E W I or 2 Family Dwelling— Number of Bedrooms IV Oil Name l Ok c,Lir B oc Pub]ic/Commercial - Describe Use O ost ~ ❑ City of ❑ L / J ❑ State ~Owned - Describe Use CSM Number ❑ Village of _ Z Z 7 27 Town of-- - [if 'Typ of Permit: (Check only ne box on line A. C om!>,lete line B if - itpplicable) - Y-Nle-,w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. 13 Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber 11 Permit Transfer o New Before Expiration Owner J IV T e of POWTS S (tern/Component/Device: (Check all that apply) _ _ n-Pressurized In-GroUld 11 Pressurized In-Ground At-Grade a ❑ Mound > 24 in. 01 suitlble soil ❑ Mound < 24 in of suitable soil El Holding Tank ❑ Ot - Dispersal Component ex lain C ( P ) ❑ Pratr;aunent Device (explain) V. Dis ersal/T'reat sit Area Information: - - Desi Flow (gpd) Design Soil Application Rate (gp sf) Dispersal-Area Required (sl)~ Dispersal Area Pr -oposed I) System Glevati i~ -7 2 1 VI. Tank Info , Capacity in Total -To f cturer =0 v Gallons anufacturer - Gallons Units c New Tm ks Existing Tanks w ° w .2 ,b u U ~ Septic or Hording Tmk 'E U 4A_ 'A t4 ii, t7 n., Dosing Chmnber 3 0 _f~ - - VII. Responsibility Statement- 1, the undersigned, assum wnsibifity for installation ofthe POW'I'S shown on the attached plans. Plumber's Name (Print) Plumber" ature - - - MP/MI'RS Number Business Phone Number/ Plumber's Address (Street, Ciq,, z State, Z' Code) -le-13 2- vlrl, Count /De artment•CJse Only _ Approved •appro ~e Permit Fee Date 1 site Issui Ig nt Signa[ur - ❑ - eason for De I $ y7S. O 0/ /3 IX. Condi ' easons for Disapproval - - 1. Septic tank, effluent filter and ~J d / r t~ dispersal cell must all services / maintaineef , w1 L' as per management plan an provided by per, ~Q, eQ.~ 2: A I s9060 teguirements MW. be Mail nttiia~l 0 Arcach to complete plans for the system and submit to the County only on paper nut less Nan 8 uz x I I inches in size SBD-6398 (R03)3) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/29/13 Owner:Barbara Morawitz Location: NE1/4 NE1/4 S16 T29 N,R19W 597 Grange Road 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 Specifications Sheet Signature License number 26900 PLOT PLAN PROJECT Barbara Morawitz ADDRESS 1391 250th St. Glenwood Citv Wi 54013 NE 1/4 NE 1/4S 16 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/30/13 BEDROOM 5 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 94.0/93.0 4' below qrade of tank, piping shall be Schedule 40. Well is to meet all setbacks required by WDNR D1291 Pro 5 >6" uick4 Standard 50' of Cover aching Chamber h 20.0 ft2 of Area bedroom ft^2/pair of end caps 4 Lonhouse 34Grade at System Elevation 10' Huffcutt Combo Tank 54' B-2 15' 2-3' X 110' cells with >3' spacing 12' B-15, B.M.* 98.5' Vents 16' 14% Slope 95' 97.5' Scale is 1" = 40' B-3 unless otherwise 45' 60' noted 350' Property Line 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 ~ 98,0 Vent Grade Vent 3' 4" 3' X30/34 Septic Tank 99 99 5' Long 1 5' 5' Long 1 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 110' Cells Same on other end Observation tubeNent At end of cell A B 27 chambers per cell System elevations: A-94.0' B 93.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of PILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity L7 NA Septic Tank Manufacturer _ NA 7ESIGN PARAMETERS Effluent Filter Manufacturer /111 U NA Number of Bedrooms - El NA Effluent Pi ter Model NA Number of Public Facility Units )"A Pump Tank Capacity - qal NA Estimated flow (average) pump Tank Manufacturer - - gal/day NA I Design flow (peak), (Estimated x 1.5) 7J-v gal/day Pump Marufacturer T --i^ NA - Soil Application Rate aUda lit __p - - z Pump Model _ NA i Standard Influent/Effluent Quality Monthly average Pretreatmewnt Unit Fats, Oil & Grease (FOG) g FC)G 530 m /L 0 Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOns) <_220 mg/L EJ NA Ct Mechanical Aeration C Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection Cl Other: !i,"retreated Effluent Quality Monthly average Dispersal Cell(s) - 0 NA A Biochemical Oxygen Demand (BODs) s30 mg/L In-Grourd (gravity) El In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L l-1 At-Grades El Mound Fecal Coliform (geometric mean) 510`a cfu/100m1 O Drip-Line, El Other: iMaximum Effluent Particle'SIze X in dia, q Other. ~i~ther: Cl NA A Other: El NA "Values typical for domestic wastewater and septic tank effluent. Other: - ❑ NA MAINTENANCE SCHEDULE Service Event I- Service Frequency Inspect condition of tank(s) At least once every: moat t s) (Maximum 3 years) ❑ NA !Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume p NA (Inspect dispersal cell(s) At least once every: ^3 ~13 rear(s(s)-- (Maximum 3 years) 11 NA lean effluent filter At least once ever month(s) - y' ~ C year(s) 13 NA I aspect pump, pump controls $ alarm At least once every: - 0 month(s) - -.y I-] NA f=lush laterals and pressure test - At least once every: - 0 manths) - - - El NA year(s) fJ month(s) - At least once every: year(s) C7 NA ! . 0 NA MAINTENANCE INSTRUCTIONS w (inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master IPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank Inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of it,ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ivisually 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 indicate a failing condition and requires the immediate notification of the local I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ('X) or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 193, Wisconsin I1dministrative Code. All other services, including but not limited to the servicing of effluent filters, meschanicul or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. 10 service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION 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 car centrations are detected have the contents of the tank(s) removed by a septa.ge 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 Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the hump 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 ovar, 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 tt a 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; herbicides; meat scrap:; medications; oil; painting products; pesticides; sanitary napkins; 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 safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: All piping to tanks. and 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 Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their rovers 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: table replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. replacement area should be protected from disturbance and compaction and should riot be infringed upon by required setbacks from exiisting 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 replacement area is not available due to setback and/or soil limitations. Barnng 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 performed to locate a suitable replacement area. If no replacemen : 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 n emoval 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 GASES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUM:iTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER _ POWTS MAINTAINER Name Name C~,~C✓✓/ /Z Phone Phoney SEPTAGE SERVICING OPERAT R PUMPER LOCAL REGULATORY AUK" HORITY Name Names Phone Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wiscoi isin Administrative Code. 10 f~1 f~~~ ~i!'t 'ILTER CARTIUDGE INSTRUCTIONS $'r iv 7 Dry Ut the ldh9r cams, 040 the mod of Out uutkett pipe to etrsurr► it, is tentsara,d utsdar tine nn:s wm upwa9ng. If overt, them rittrer ins ol-t toure pierl hats. tow took khruuyh the uutiat er suivolist watd (glue) additJanal 14pe iltttu Ciro uutlet pipu_ Smp 2 yUhilsa tin; "He Jr. atfll dry Mail Vt1 the nutlet leh►a, rrtemturv tirw 0mytt, ,ar +t4-lods pipe mmiled to brae:,, thu Illbar to #aa Manic ,aril with if utllldlrig the a01401101 irupttatetantsal xlelet suwpurt•, If bide suplautt rrtitthud. Ili nut utltittd, promed to ste)114ttsr :r•'+'k.r+ ~ Pw• knotaltauoul; ttCpixin1l the uptimhol suptnletrt,nMV) sit„ supirwt_ snlueat WWII tise %.-ihcls plprk ard:u tier fitter Casio. udiiled, prueedd'tu step fou,; unto slrpputr trit,tFtdd hi loot 5ulvent Wbid the filter cooo dente ihr lititket pill". it.r esrl rite iiltei' cartridge iota the train, oweusirt l daft unfit thus filter I0&6 IrICu thv battcrir, or K the Caws. if a VkS swItrlt is ntikmd: hro"t; ihtu tins Altar sand lock try ttlrreiml Clockwise drfe. s l~►ainl~enan~~s 1. 'r'h,e efolUant filitur sbsrrild be a abased ovary tfsvto the t:vptlc tarsk W svrrvire,i. z. Opeti the outlet ames,a epenbtu to inr.pact the t'irnk rind RINK ` NJ pualp ti.a septic taltie ccani -owly, rntkitty worm to rsiiritnra the sludge layer tu► the hoboes or the tasnk aasatl n.►t gust the sr:inn Will tMumt►t. :>a otsce tine ollglue .t is veir has huutr tnwared bdluw tiro invert to tiru tsut)et pipe, firmly pull up oh the titter hundte to dislodge the ' ctrrttklyrr irotw tbrr case. 5. Slides the rartrldue up atid stir ui the cir>:a ti:ir Cleaning. w• G. W a VA6 switch olotittem ld to girt alarm 15 pMAInt, the switith sir'uuld be rawrewred by turw ntp + ourrCerduckwisa 9tt- and Alused with wratser only. r. while huldina the ciorkr'idde oil its sidd (carpe that s1104r:.a taeir.e A lsyiyy.,, dower) ever tiro atawray upuairit)r rhme ul' IN caltridip witit Winne At only, rr.akirry sure all metptagv: suaateriul is rhlsed back Intn the tank,. 8. Ir• VRS tiw#tch is utilixedl, ftPhim toy Iltrltrrtltia Tutu filter ilkid _.,.W_._._... . turrait.q cibekwica Wes, r 9. 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Z Z N K° m 531T 3 3; 3 3 W W ' r< N p H a Fl p m O 14t r r O nN O 1 ~I PBN ~m m tON~m N m rrrr ~yy°j m ..~Nm J JI b~~/$==y1 Z2 ZN Z z ~ c r Q a \ q 4'i Pm m m ~r W rv +0 m m~NNw ;it fr n '1 W lz r. u ~~r 0n46 ~i vUwi LI/I i17 Ml (h KO ~ 1 1 / /lt p/ < Vm N ~On!1mN F' i 3 e l \ J .St ! \ : / f" m a / .S2 Qi 1'i < H b m n ri ^ o vi Fi1d n V' \ .rv Ommm 6• zm V/ yo~~$~ m xa~ ~v QI -eq 01 \ J mN O Kn //W l e~tJ// > G. W W P.1 as r`7 °j NN m td4/~Y rl// ¢ .'35m 3 ~mmmWm Zi w -0000 m m_ n~cw~m r71 z z W O \ F I W~ v-i!f P O ~i[lgt~ m z~ m \ z~ / y4/nZ m °Obmo'm°°m 2 ~W Q/ Zv2 N2N0. ~t r s ? x \ \ \ q,4}9 '~19 \ V'Ari < 4.1 0 .'n•1 o n o Nm m 9°7 / \\V ?m y mm~ 0 orroin nH 1 u°m ~ it ~t n`~im n . ^ iti r S i~ $ 8$$ g g 8 v v L Oa\NT m gww °m °mm J~ nvnN l e, 1 h irx ~i ~ ~ ~ ~ 7\~8.Z35 3 ~xNO3p~ ,ntooooo / 351yy5 ~0 ° ° ~ C' / / s3 Nil lNM ~1 0 a g2\35 \Z E }`S ,.,•F~ S=~yp6 613 * V ST. CROIX COUNTY. SEP'TIQ T_AII "AMA ' ~ AG1kktTv4ENT ANA . • OWN N i S IP C'ERTIPICATI N FORM Fwu#a"+r1$uyer. " t7i Mailing Address O 91. _W O4W,1 ) WS 5613 ~ Pidtaerty t ddt~ss 'I R1wc& z t. '.4 F 4jp ('Vesification.-~ tM P. P iug ` Z4uMg Deo eut for new const=don.} , " Caty~Sta l~tlQejtli3~0 W*t Peel id ftcation NUmber Oxd -/~Si$•QL- 000 71. X Propmty Ideation " " tJ "lla nl ,:Sec.. ( T W ; -0 w~i cif - - Sub ivlsitm Wtoov) ° - , Lot # A - Volume ,Page # . } treriec $tir+vey -gp. sera tyDeed# VOW= Papa' 'i2 - - ~ LOC"liras idftii Sly Iowa d nou, MMAMMANO Izapaape= use and mai of out septic 0 cotild'resntt sn its »ret~ataare failure tfl.ha dls vsa5tes. "Fmpar -AeUl ma ►ietts c consists o€ out" t sep tic"t C evern tt a Ojo or. $ofraer, if needed, by a iic pamper." t you put into tk, syyste an afixct the fwetion'of septic talc as a"treater a V t}us a oe"d 1"ffi5►s . , Own" ms' e respo;~sitaiiities art specified is § as t x. 8~:52f 1~ and iu I2 St."Qvobt C mty SbMNy Ordi ce. TbA FroF ' " 6t Zoning Depwaaw t a ~iiation fortxi: Signed by the ownor ees to "submit to 5t Cw# County P3#~og" owner and by:a muter plug,"3 Y glumt~, x tslsicted"phwj= or a Howsed pumper t ag that (l) the on site.. z"eperatirgcoffin &or (z t ix s =tioa atut pwmpbV (tfuecessary~);. the septi : tarn is wastcwater,disposaI system is "in.prope at less'Fhan 113"full of sludge . " . : Uwe, tine u szgaed have zeal the above tfir$mews "d Io boaintam tM, liri site sewage disposal system with rhs stwdasils- fords, "here~d,`W* set by tkDepmtM. t bf t0,o ~id..t~ Delaa ofllat l itesotttccss:State of Wisco t- Cer W=fiors.statitig tlt Yuan septic: syyst= has beets ~ staM be computed and. rammed to the St. Croix' County P mdug ZoW4 Dcpamrtcr t within 30 days.of the L~ year.e7Cj)ira6orl.0010: -we huc ta.the best of ,lour kiM4,4 g+e. Uwe a nh~ the owwr(s.) of the Uwe'.certiriser all sEm is on this for-it fy} I' • prooea ty des %e i above, 5y'virtee of a waxraitEy deed meorde in w of Dr O#ficc: n . 12 DATE OFA PLICANT(S) . r : by."tbe Pgr.Loning Deparmaeu.k . ti•,. r Any, i»fcmztgtiou t3at sa .mgsiesenced *,y restttt iii the. satespert bed revoked lacluxie "Wts: this volicadoit a recorded war rancy deed fay the kegi of De e& Mm and -a copy of *a certified Survey imp, sr referismade in the wairan .med. 983061 r BETH PABST REGISTER OF DEEDS State Bar of Wisconsin Form 1-2003 ST. CROIX CO., WI _ WARRANTY DEED RECEIVED FOR RECORD 07/26/2013 09:06 AM Document Number Document Name EXEMPT # N/A REC FEE: 30.00 TRANS FEE: 165.00 THIS DEED, made between Welcome Homes, LLC, a Minnesota limited PAGES: 1 liability company Grantor," whether one or more), **The above recording information and Barbara A. Morawitz, a single person verifies that this document has been electronically recorded ("Grantee," whether one or more). & returned to the submitter Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in _ St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Edina Realty Title 400 South Second Street, #115 Lot 2, Plat of Willow Bluff in the Town of Hudson, St. Croix Hudson, WI 54016-1974 F County, Wisconsin File # 16q ! 0qq 020-1458-02-000 ii Parcel Identification Number (PIN) 3 i This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated July 22, 2013 Welcome Homes, LLC, a Minnesota limited liability company i (SEAL) - (SEAL) _ * ames T. a ik, President Brian T. Kindler, Vice President (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT f Signature(s) STATE OF WISCONSIN ) authenticat d on ) ss. jjnTARY UBU ST CROIX COUNTY ) STATE OF WiSC * Personally came before me on July 22, 2013 the above-named James T. Wazlawik, President and Brian T. Kindler, Vice TITLE: MEMBER STATE BAR OF WISCONSIN President of Welcome Homes, LLC, innes limited liability company (If not, to me known to be the pers s) w ecuted the foregoing authorized by Wis. Stat. § 706.06) instrument -4 owl.. e. THIS INSTRUMENT DRAFTED BY: Lorr" L DeMars Fran Iverson 1200 Hosford St. Suite 201 Hudson WI 54016 Not Public, St. of My omnl ssi (is permanent) (expires: March 20, 2016 ) (Signatures may be authentkate"r acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. 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Plan must St. Croix include, but not limited to: Vertical addh6rizontarr6f ` di ryau~ percent slope, scale or diremsions, north arrow, and I o n to road. Parcel I.D. - - P+se pA afl,inf mmation U R iewed By Date Personal information you provide mayy`Wused for"iecondary purposes (PAvacy Law, s.15.04 (1) (m)). Z Z Property Owner ^ Property Location L Govt. Lot na NE 1/4 NE 1/4 S 16 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# rz 2C; 1271 140th St 2 na Willow sasirPemikag ` City State Zip Code Phone Number City I Village 01 Town Nearest Road New Richmond WI 54017 715-381-5277 Hudson ~'S % 9Grange Rd 16 New Construction Use: 0 Residential / Number of bedrooms 4 ode derived design ow rate 600 GPD r- ~f Replacement J Public or commercial - Describe:na t Parent material outwash / C 0 Flood plain elevation, if apphc2 ~ e General comments and recommendations: Conventional system, system elevation 9 .50ft. Trenches spaced and depth to code 3.00ft below gr de Boring # Boring g Pit Ground Surface elev. 98.50 ft. Depth to limiting factor 120 in. Soil App n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10yr3/1 none I 2msbk mfr cs 2f .6 .8 2 14-60 7.5yr4/4 none cos osg ml cs na .7 1.6 3 60-120 7.5yr4/6 none ms osg ml na na .7 1.6 I( 3(o J~-Z ha Boring # I Boring 0 Pit Ground Surface elev. 98.50 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10yr3/1 none I 2msbk mfr cs 1f .6 .8 2 13-56 7.5yr4/4 none cos osg ml cs na .7 1.6 3 56-120 7.5yr4/6 none cos osg ml na na .7 1.6 3 lq'2- Cj t 11 {b * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 11/8/2004 715-6845680 Property Owner Hieb, Matt Parcel ID # Pending Page 2 of 3 3 ] Boring # ~j Boring fm Pit Ground Surface elev. 89.50 ft. Depth to limiting factor 120 in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/1 none I 2msbk mfr Cs 2f .6 .8 2 17-45 7.5yr4/4 none cos osg ml cs na .7 1.6 3 45-120 7.5yr4/6 none Cos osg ml na na .7 1.6 ❑ 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 P 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 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. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Matt Hieb 994200 th St. CST-POWTSM NE1/4,NE1/4,S16,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Bus.(715) 684-5680 Willow Falls, Lot 2 Fax.(715) 684-3449 Legend N 1" = 40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.45 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations BI = 98.50 ft B2 = 98.50 ft B3 = 89.50 ft B4 = 0.00 ft 4-1~1 r _ 6~ i w d m ` I I 4 p I ~ --GRANGE - - - - - - ' S00022' E 1287. ~I I J / d I 00 0 ti ca w L7 i . . AD- cc)/ ci / m / M 2 4 \ \ \ \ ` `O IC4 \\\\\\\s \ ` / / AQ;/ \ \ \ a \ \ \ ) i \ \ \ \ \ \ \ \ \ \ 00 \ \ \ \ ° a \ \ \ rw i . t