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042-1086-20-020
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567273 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: Payne, Timothy Warren, Town of 042-1086-20-020 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 31.29.18.482A2 TANK INFORMATION ELEVA19ON DATA TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. 3 Benchmark Septic /z cJ 17.tO 5 Z. l�S'Z �lis Alt. BM�f'( Z.�.o� 6 . �P Aeration Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 3 .7� /��•3 j TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet e64— s Septic S� Q 1-7 Dt Bottom Dosing Header/Man. 7-Z, . Aeration Dist. Pipe •r� `�ti 9 Holding Bot.System (y •1W 7 •�P . PUMP/SIPHON INFORMATION Final Grade 7• f' 101.z Manufacturer Demand St Cover 1• GPM p'� Model Nu,tuber •� TDH Lift Friction Loss System Head H Ft Forcemain Length to Well SOIL ABSORPTION SYSTEM 12 BED/TRENCH Width L�pZ hJ'JO / No.Of Trenches t � PIT DIMENSIONS No.Of Pits Dia. Liquid Depth DIMENSIONS .7 ,wC ik�3�f_ )�\ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur��JJ'++ L INFORMATION CHAMBER OR Type Of System: n ^/ UNIT Mod I Num er: Cain ana Q� 7 >1fi A a,l DISTRIBUTION SYSTEM AJ r A., / / /ems /�/ �-/ fj•5© Header/Manifold f( Distribution Ix Hole Size x Hole Spacing Length 64 Vent to Air Intake �'<? Pipe(s) 1 Dia l Length Dia � Spacing � -- °�t„•�. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No s No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 1 Z/ S / 13 Inspection#2: Location: 900 Alex Lane Hudson,WI 54016(SW 1/4 NW 1/4 31 T29N R1 8W) NA Lot 6 ' Parcel No:C31.29.118.482A2 1.)Alt BM Description= ` ` j G �.1e�. - �`�L_, O� 77 / f �a•^^ 2.)Bldg sewer length -amount of cover Plan revision Required? Yes , No Use other side for additional information. Date In pctor' gnature Cert.No. SBD-6710(R.3/97) P�� ,8 d� 417 Z 04:D'dG' 1611. SA �n O KNUDTSON PLUMBING 0�• '- X �,! CONTRACTING, LLC 1 , 927150TH ST.648447MPRS ROBERTS,WI 54023-8525 CELL.651-470-1737 �1..a l �o�wc�•t � y Best � w o s 5 T 9 z F r g z e-)C L a 1 � eitt Coun ` 1 ` i Safety and Buildings Division ���,.0 t ft• $ 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to tWffiled in by Co.) is cl$'a i Madison,WI 53707-7162 Its 5 ■ 72 73 p ber --." ' it Application State Tra In accordance with SPS 38. 1 . ,is.A . ode,submission of this form to the appropri to governmental unit is required prior to obtaini+ 4 . it unit. Note:Application forms for state-owned are submitted to Project Address(if different than mailing address) the Department of Safety: A of ssional Servies. Personal information yo . e vide may b d�fpqr secondary jk purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. f �[ ) �� L A: 1 lication Information—Please Print All Information if °` ;. U(/ G ' Property Owner's Name , ., Parcel#„:._.— Pr 7-:: ' y0L y/Owner's ailing dress ''1,--,�. Property Location (iilz 666 h//LC 4fr cekelm 1 /4Tk Govt.Lot R ^ 2 City,State ' Zip Code Phone Number S to y CJC,�/,, Section 3f 7/U en, f ircle one IL Type of Building(check all that apply) Lot; T� N; R / E o [1 or 2 Family Dwelling-Number of Bedrooms 4') Subdivision Name or CA - ❑Public/Commercial-Describe Use P t Cave,,, - ❑ City of CSM Number ❑Village of ❑State Owned-�De�sccriibbee Use L[ r �” 3 iu l is k- ( �CJJ 1...J1 pi l-N-f 15 C.No N l / 1 7! f� Town of �',-,-.4,/f III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Mew System ❑Replacement System ep y ❑Treatment/Holding 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 Owner z -relf el qk{i-�. nv Z if IV.T pe of POWTS System/Component/Device: (Check all that apply) ) 5-4 .0a_4. P/i. �ilww�eri Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treatment Area Information: / _ Design Flow(gpd) 7 Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area Proposed(si'1 System Elevation TY 44 (� 2 ,�„ I/ 7/- 995"r96•,� Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units �b L �J 4,1 U$ CJ New Tanks Existing Tanks j":"6"----- TiLree- w U vi 4 v-, i=,5 w Septic or Holding Tank /AS-C) ^__ 2& f t.-( ` e$ w''. Dosing Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume ponsibility for in.tallation of th POWTS shown on the attached plans. Plumber's Name(Print) P1 ber' gnature MP/MPRS Number Business Phone Number �Gi < ` _ 3 / ��d-rte lumber's Address( ,city,State,Zip Code) 1 e.ef 7 456 ----34 "5"7' , ,g, :. Zee,-7/..7 i Z-C-) r ounty/Department Use Only Za04— e Approved ED]D. ved Permit Fee Date sued Issuin gent Signature / n Reason for nial $ 475' /I 45/1.-3 IX.Condit£ TuffMeasons for Disapproval 1. Septic tank,effluent filter and 3) l 4 c e.w��, . 0. .Ca. ✓A b 4- le�r dispersal cen•must ali be loirtr:a Maintained / as per management plan provided by plumber. 2. All setback requirements must be Maintained as per applicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 In x 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Payne Best Sewer Owners Name: Tim Payne and Kim Best Owners Address: 660 Hillary Farm Road Hudson Wi Legal Description: SW 1/4 NW 1/4 Sec 31 T 29 N R 18 Township: Warren County: St. Croix Subdivision Name: Lot Number. 6 Parcel ID Number: 042-1086-20-020 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber. Keith Knudtson License Number 648443 Date: 11/06/2013 Phone Number (651) 470-1737 4 ..J Signature , / _ •"/0=:, Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 I g sP/Ke - 7-..z is 67 tl 7 __AT./ KNUDTSON PLUMBING& 042'/ X a./ CONTRACTING, LLC / 927 150TH ST.648447MPRS ROBERTS,WI 54023-8526 CELL 1-4 0-1737 •La feo".ej ` / 0 dyne- -'east 8,/ too.el?I \ / ( e-A t°..<7/ � `� 0-3 cfr. / I T,/ Eat) q').,c, /',,� r 2 ?4,6-1 s /::.."..)"6 Lc,/.es- - 1 r /AO 57- 'T•�-7e� 5:- ; 4✓ 4.1. 1 Q 41;'!< ■ '' -c e d 1 ..--- / 4 I 2az0, O!o .• - /9'Z e..K Z ca Soil Absorption System Cross Section tt T 110 ft a•Sdiodule 40 a � Flnal Grade With Vent Cap _ ft Chamber --► /�O '�� — g7-� 3f, Soil Absorption System Plan View ft ft 111111011111IIIIIIIIIIIIIIII MIIIIIIIIIIIII1111111111111 111111111111111111111 11111111 ft Leaching Trench 1 Chambers ----i IIIIIIIi)i).l111111II1I111J111_ 111]1111111[1111111111111111111111111111111111111/11IIIiIIE \ .D Trench 2 Header Vent Or Observation Pipe 11111N111111111111111111111111111111111111111111111111111111111111111111111111H 1111111 Trench 3 . Leaching'Chamber Specifications. Manufacturer And Model f y� f, ��-�{d am/ c 1(-'274 EISA Rating °ZU sq ft per chamber Soil Application Rate • 7 gpd/sq ft �O gpd Design Flow+ - 2 Soil Application Rate -: A U EISA= 11,F Chambers .L/`'rows of /le chambers each. / r►owtql 41— Page of :,--- - _ __, X Filters- ,,,...,:. s 4fM -525 EFFLUENT FILTER I, PL-525 Filter is rated for x 10,000 GPD (gallons per day) 1/16" Filtration Slots ---rig it one of the largest fitters —41 class.It has 525 linear feet 10 000 GPD 6"filtration slots. Like the- ' :yak PL-122,the Polylok Extension 131-525 has an automatic shut ball installed with every filter. = n the filter is removed for = _ nErig,the ball will float up and '°- oorarily shut off the system so } effluent won't leave the tank. 575 linear FL of fflff No other filter on the market can Filtration S ''Z' `e Rend for acv -snake that claim. MOOD GPO - PL-525 , 4'$6 5 �![a��ter�ace. 5ca+aaoApe i, The PL-525 Effluent Filter should ).. €perate efficiently for several years ;_ under normal conditions before ;squiring cleaning. It is recom- e4 _"-mended that the filter be cleaned ': eery time the tank is pumped or e�res - _' at least every three years. If the _ installed fitter contains an optional r � -, ' alarm,the owner will be notified ri" by an alarm when the filter needs _-9 Lk.a s g. ervicing. Servicing should be , - • done by a certified septic tank �J y, -s s,� pumper or installer. U.S.Patent No#6,015,488 wirer--®Bad When filter is 1..Locate the outlet of the rya 5,071,640 septic tank. 2. Remove tank cover and pump tank if necessary. PL 525 Installation: 3. Glue the filter housing to . 3. Do not use plumbing when the 4" or 6" outlet pipe. If ,.r filter is removed. Ideal for residential and corn- the filter is not centered r 4. Pull PL-525 out of the housing. mercial waste flows up to under the access opening ,. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). use a Polylok Extend & P Lok or piece of pipe to is- tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page back into septic tank. septic tank. 19-21 for Extend & Lok 6. Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is property aligned into its housing. and completely inserted. 5. Replace and secure the septic tank cover. 7. Replace septic tank cover. Y isimis POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pose I ni; 2 FILE INFORMATION SYSTEM SPECIFICATIONS re Ov ner y=- . Pa_y , �f r / a.t Septic Tank Capacity f z6 a gal ❑ NA Permit# Septic Tank Manufacturer � e5ef-+ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Pt)L4 10 ❑ NA Number of Bedrooms 4 ❑ NA Effluent Fitter Model 52 ❑ NA Number of Public Facility Units ■IA Pump Tank Capacity gal NrflA Estimated flow(average) ifa gavday Pump Tank Manufacturer IVIA Design flow (peak), (Estimated x 1.5) ( gal/day Pump Manufacturer Soil Application Rate 6.'7 galday/ft2 Pump Model Ikr k Standard Influent/Effluent Quaky Monthly average* Pretreatment Unit )07k Fats, Oil & Grease (FOG). 530 mg/L ❑ Sand/Gravel Fitter ❑ Peat Fitter Biochemical Oxygen Demand (BODS) 5120 mg/L ❑ NA ❑ Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Di al Cells) I (i-!i,}j a;cir--4 ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L round (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑At-Grade ❑Mound Fecal Calif orm (geometric mean) :5_104 cfu/100m1 ❑ Drip-Line 13 Other: Maximum Effluent Particle Size deTn dia. ❑ NA Other: ❑ NA • Other: 0 NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) - At least once every: 3 �+T mh)(s) (Maximum 3 years) ❑ NA yearts Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA kybeoarngs)Inspect dispersal cell(s) At least once every: 3 (Maximum 3 years) ❑ NA Clean effluent fitter At least once every: nth(s) Z / �year(s) ❑ NA Inspect pump, pump controls &alarm At least once every: ❑ nth(s) y�,� Y )‘IA Rush laterals and pressure test At least once every: J (s) NA Y Otter: At least once every: ❑ month(s) 0 NA ❑ year(s) Other: 4 ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one 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 indicate 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 013) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, 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<_12 months, shall be performed by a certified POWTS Maintainer. A 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 painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells}. if high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the lor;)l,etive 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 califs) in one large dose, overloading the cents) 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 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; herbicides; meat scraps; 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 safely 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 property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing 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. Barring advances in POWTS technology a holding tank may be installed.as a last resort to replace the failed POWTS. a aluati•. .. -, r,. :. a Ping tank •.� -be it- _ - ._ . i.•ra111 F,ss:-e a s. • • . ?t2W418 rr Dg_Al- a)A.r 72UcTt pnJ ❑ 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 effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. 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 I - Name Phone I (D5 f— 4-7O.- /'7 3 -7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) J LOCAL REGULATORY AUTHORITY Name I P o 1.4s pi's s4 r,, a T,-er.^ Name S- Cez( )1 C u 2 0 d irkid- Phone 1 7/5-- V 6- r 3"7 C'f a Phone -7 I - 3 - '/la gb This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)1d)&(f) and 83.54(1). (2) &(3),Wisconsin Administrative Code. 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 or other chemicals that may impede the treatment process and/or damage the dispersal ceilts}. If high concentrations are detected have the contents setae servicing operator prior to use. of the tanks) removed by a p g 9 p P 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 ceil(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 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; herbicides; meat scraps; 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 safely 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 covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN tf the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: - ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing 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. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Wfialuati.• •• sn r_t. .r-.ra a o 5 ing tank •be - - . i.* :ra `e - ea '• - ?RN-41821S 3!2-Ale"I j i ituucrt o1 ❑ 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 effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICiENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. 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 l - .— e%, Name Phone I (951- 14-76- ) 3 -7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name I PO .•••5' S4H#....AS/-e.••. Name 9- Ckb( 1�/ Cr u aly 2odtar- Phone I ',/s 76- Phone —7(s— 3 c.e— This document was dratted in compliance with chapter Comm 8 •?'(2)(b)(111d)&(f) and 83.54(1).(2) &(31,Wisconsin Administrative Code. t I f 7 7 m Z 2 6 VOL18 PAGE 4798 KATE:ERE N. WALSH REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR RECORD X cli S 07/29/2004 02330PR FEI: SURVEY RAP REC 1 1 — C.00PYY FEE: 3.OR 1 to >1 .... BEARINGS ARE REFEREN THE 0 II WEST UNE OF THE NW1/4 OF SECTION S m _ 31, ASSUMED TO BEAR NO118'3rW LOT 46 g NO116'3a'1N 2020 37' / COTTONWOOD LOT 30 I LOT 29 RIDGE I I C OTTONWOOD RIDGE_ i rWEST UNE OF THE NW1/4 1 703.09' i I I l N01"16'38"W I: .81' i 1481.87J� 2 i F 2 1.4,< = ' O i� ; I �,. 0 r ;� ; m 2> rrli 11 g P $ $ g D Z ; $.8$ �B�`` - -I Z— Z I ' srnla•�'E 4ss.s1• IC A z rn • 5• t r p0 1 ; I74 a$ p ;z Z. wi � S0118'38 E 433.81's. • E a C as x 4'n So t � �aq m ^' �. S03 33'48'W 318.42' Hifi., .. UNPLATTEDL- -------- ---------------ANDS Q� qgi f » mirt ____ , Z -.: co l!MI i - 1 Ngsil 6; g 533i -•- �§ s ! El P < $i wr�_ 1 1/ 11 i 0 ' g "SOO5647E I-4 c•- b 213.08' Ii al $g ° j:tAl , §R ‘11114 0 : a311 34 1 co 1 0 iiii I 1.1 �..'' SHEET 1 OF 2 SHEETS X Vol 18 Page 4798 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Tim Payne & Kim Best Mailing Address 660 Hillary Farm Rd ,, . Property Address � , 7� //.. .., ? t (Verification required from-Planning&Zoning Department for new construction.) ' City/State Hudson M. Parcel Identification Number 042-1086-20-020 LEGAL DESCRIPTION sw nw 31 29 , 18 Warren Property Location A , ?�, cue P ,-ow Subdivision Plat. Lot# Certified Survey Map# 18-4798 Volume Page#_.. Warranty Deed# (before 2007)Volume Page# Spec house❑yesOno Lot lines identifiable fl yesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the.system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-Si Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a 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. 1/we,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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification statine that y{,re r yip 1.ha_:.ti_e.. *.n., r: nst he completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this fo, m are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a wan-an deed recorded in Register of Deeds Office. Number of bedrooms 4 / SIGNATU /OF APPIANT(S)-• :IC DACE ***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.04/12) b 111111111 111111 I 8 Tx:4 34828 5 STATE BAR OF WISCONSIN FORM 1 -2000 981076 BETH PABST Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Richard 0. Stout&Janet P. Stout,husband& 06/25/2013 1:48 PM wife, Grantor, and Kimberly M. Best and Timothy D. Payne, EXEMPT#: N/A wife and•hu rd;as axvivozship irerital prcperty Grantee. REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 195.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: "Property"): SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. #402830 2200 W County Road C.Ste 2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. Parcel Identification Number(PIN)042-1086-20-020 This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements,Restrictions,Reservations,Roadways and Rights of way,if any,of record Dated this 29th day of May,2013 . R:ak.11-& .2-b-t-tt /d-Thcx- * Richard 0.Stout * net P. Stout I��Ir •� AUTHENTICATION ,44 \\.EE `�' B� ACKNOWLEDGMENT %Signature(s) �° ti TE OF WISCONSIN ) 4tiy . •TARY S ROIX COUNTY. )ss. authenticated this * a•410' t'Personally came before me this 29th day of May, 2013 the PUBLIC �'`e named Richard 0. Stout & Janet P. Stout, husband & * 634v, to me known to be the person(s) who executed the •TITLE: MEMBER STATE BAR OF WISCC."9_°� OF w`S('j0 't egoing instrument . kno ledged the same. (If not, 4,11 11 4.2 authorized by§706.06, Wis.Stats.) ' * eri e- J. Bune THIS INSTRUMENT WAS DRAFTED BY Notary Pu•lic,State of sconsin My commission is permanent. (If not,state expiration date: Larry S. Mountain,Attorney At Law 10/27/2013 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature 1 of 3 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.1-2000 EXHIBIT A / Lot Six(6)of Certified Survey Map recorded in Volume 18 of Certified Survey Maps on Page 4798 as Document No.770226,located in part of the Southwest Quarter of the Northwest Quarter(SW 1/4 of NW 1/4),Section Thirty-one(31),Township Twenty-nine(29), Range Eighteen(18)West,Town of Warren,St.Croix County, Wisconsin. 2 of 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in atx;ordance with Comm 85,Wis. Adm. Code County ST.CROIX Attach complete site p o r s than 8 1/2 x 11 inches in size.Plan must a1Q include,but not li ,,r;.t erti nd horizontal reference point(BM),direction and #vl,l,p. 042- 1086-20-020 percent slope,s - �, •im ions,north arrow,and location and distance to nearest road. N:if Please print all information. OCT ;Reviewed ; Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1) ). k5<9 ,2� 'C((/ ,-- ! ' 0/r (3 Property Loca i6 / Property Owner -I Q KIMBERLY M.BEST/TIMOTHY D PAYNE Govt.Lot ----SV0'19 ,T 1/4 S 31 T 29 N R 18 E(or)W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 660 Hillary Farm Road 6 -- CSM#18-4798 City State Zip Code Phone Number laity ID Village cl Town Nearest Road Hudson, ! WI 1 54016 ! ( ) Warren ! Alex Lane 0 New Construction Use Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD ©Replacement ❑ Public or commercial-Describe: Parent material sandy outwash Flood Plain elevation if applicable NA ft. General comments Conventional in-ground trenches--0.7 loading rate and recommendations: Property Address: 900 Alex Lane 1 Boring# 0 Boring Q pit Ground surface elev. 100.47 ft. Depth to limiting factor 88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR2/2 - 1 3f-mabk&gr dsh cs 3vf-m 0.6 0.8 2 12-23 7.5YR3/4 — sl 2fabk dsh cs 2vf-m 0.6 1.0 3 7.5YR4/6 — is Osg dl cs lvf-m 0"'-- 1.6 4 36-88 7.5YR4/6 -- s Osg dl -- lvf-f 0.7 1.6 All horizons have some gr. 2 Boring# © Boring 100.27 90 0 Pit Ground surface elev. ft. Depth to limiting factor in. I Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots , GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10YR2/2 -- 1 3fgr ds cs 3vf-m 0.6 0.8 2 6-24 10YR2/2 -- 1 2f-mabk dsh cs 2vf-m 0.6 0.8 3 24-3710YR3/4 — sl 2fsbk dsh cs lvf-m 0.6 1.0 40 7.5YR4/6 — s Osg dl -- lvf-f 0.7 1.6 some gr; moist in bottom of pit. *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signa ` CST Number MARY JO HUPPERT,Hollister's Soil Testing&Design L 224832 Address Date Eva uat n ducted Telephone Number W9875 690th Avenue, River Falls,WI 54022 09-10- 13 715-426-1755 1 Property Owner BEST/PAYNE Parcel ID# 042-1086-20-020 Page 2 of 3 3 Bonn # CI Boring Boring ® Pit Ground surface elev. 99.00 ft. Depth to limiting factor 92 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR2/2 -- 1 3fgr&abk ds cs 3vf-m 0.6 0.8 2 12-30 10YR3/4 -- sl 2fabk dsh cs 2vf-m 0.6 1.0 3 30-92 7.5YR4/6 -- s Osg dl -- 1vf- 0.7 1.6 some gr. Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon 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. SBD-8330Test(R.07/00) , Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner TMm-n+y b, 4, ' ' KIKwERLy M. 15T i" = 40 ft Legal Description 1-or-4, csM lg-147q swV4 (except where noted) rFg y w/ c,. 31, Jr24ra, Res w, -r4,1 a j J vatlioReN, sr, c1ZolX cowM t, !wlt sconss'n) - -c-ie North : . It o 3 i �� A RE '►b t3E CREpt, Doti �O �iNocrr� P1'-y OO,aZ Tab'," CDruDGtc�TF.1� �n� Z E 1� IU o 0 1 'Mw� =P. iAU's2i viov I.Sp' 1p 2 ogo 0 raw L3) 3X b8' ,ce' 'POST M.6v �►'� I. Leek-'s tn ce L r 4 a W o 3 . • Yi Site Location: "" 'jam x px ND iii. LA 3i 5E-' e.7; ti� • 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must (14._` Y O include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 0 a)_ //)p '#1 _020 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. /VQ/ Please print all Information. Reviewed / Date/ . Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ,. 1/41/640(o/b4Q ' Property Owner Property Location / / RI chard N-0 • Govt.Lot ,gJ 1/44//,/ 1/4 S • Lel N R /6 E(or)0 Property Owners Mailing Address Lo Block# Subd.Name • CSM# \353 A -Address , c • /IVY 791 i City State Zip Code Phone Number ❑City ❑Village Q Town est Road 85On ,d1 , S�ICI (1(5)5yq_(07a1_ 0 c pied.. �!1v4Gt, la. New Construction Use:c Residential/Number of bedrooms _? Code derived design flow rate_ '/S0/ 2 ___...._GPD ❑Replacement ❑ Public or commercial-Describe: _ — – — -------- Parent material 6 04-c,u-et S K ------- I=lood Rhry eievrgitlt f able ,—___ 44L---_--ft. General comments f--C I'� e--12 , e e/ ' ` ,� i'"'-'` 'lam and recommendations: d S tip'"'� , ' ---+‘ i. ?, 2, 71:10L f r " (i/yv (-lit lam)V!.;{.t,n``) ❑ Boring q� i-___ ,..., Boring# Ground surface elev.L d 6 ft. Depth to limiting factor_�/Q _in. ® Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munseii Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 1 6-I0 16 yr3/,/Z 50 1 Zip,<b I� rrl-Cr C S (v-�' . �j . 8' Z. to-`f I yr (/ 3 c f 2ni±i m-WC c — . 1 . Co . 3 'limn t o yr`% -- S 035 m 1 _ . 7 /. 2- i Boring ✓ IL 9 P Boring# ❑ Pit Ground surface elev.�U –ft. Depth to limiting factor # in. I Soo Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munseil Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I •Eff#2 I 0-I - /6■ r3/3 S// 2 yr-L5tk mfr C 5 I v-P • 5 .2 2 (2-33 /b yr`t/3 1 i c 2r-i K wi-Cr c S ( i-C . `t - _3 33-7/ /0 y r 34 S L 3m5b k m-c c v\/ — . 5 .9 U -/ I-1113" l©yrylo 3 C.)si m I — - ' 1. - •Effluent#1=BOO,>30<220 mg/L and TSS>30<150 rng/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) •nature CST Number Address / Date Evaluation Conducted Telephone umber Z Il ga ' ` £n>�KL--( c..) . S�/Ue s S - g- o 74s _ 76 o '027. ■ M a Parcel ID# Page __ _ of_ Property Owner___± -_ / 3 ❑ Boring i 2.4, J Boring# ft, Depifi to limiting factor tn. 1 Soil Application Rate g Pit Ground surface elev. Horizon Depth Dominant Color Redox Description Texture Gr. cture Consistence Boundary Roots e GPD/ft2EffIF2 in. Munsell Qu.S___ Color C 5 ' 1 d H 2 to r3/2- 'Si I 2n-,sbk I�n-r, („� , 5 2 (2-26, 1O y r q/3 5 i c/ _ Zn-,S.I)l< t�-y) c S I v.� . y 54 3.,-,sh/< ' t cw 5 .9 3 Zee-7Z (o y r�/�, --- — ' "7 I. Z 4 5 D nn( ❑ Boring Boring# ft. Depth to limiting factor__ _in. ❑ pit Ground surface elev. ___ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture j Structure Consistence Boundary Roots GPD/ft2Eff#2 in. 'Munsett Cu.Sz. Cont Color I Gr.Sz.Sh. I [ ❑ Boring Boring# Ground surface elev. _ ft. Depth to limiting factor__ __in. El Pit Soil Application Rate Horizon l Depth Dominant Color Redox Des;ription Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 1 'Eff#2 + 'Eft# I 1 I 1 1 ' Effluent#1 =BOD5>30<220 mg1L and TSS>30<150 mg/L *Effluent#2=BCD,<33 mg/'_and TSS<30 mgIL The Department of Commerce is an equal opportunity service provider and employer. I f you need assistance to access sery ices or need material in an alternate format, please contact the department at 603-266-3151 or TTY 603-264-8777. sao-s»o(R.m/oa) • 1 .-. PAGEOF , NAME: 510 Li 4- LOTtl Co LEGAL DESCRIPTION: 1/,111/4,S3( TZLN,R,/5 E(or(§1) r SCALE: ,y ( ELEVATION 100 - 0 N i BM 1 DESCRIPTION: 44 0--C r tpc,te PrPe — --i- — BM 2 ELEVATION: BM 2 DESCRIPTION: -iq c,--i- I fe SYSTEM ELEVATION: ys sc, SYSTEM TYPE: (Gn u e A-c so e\ick ' L- . 3 0 r • -c, ti .N. 7 0■. ..) (&C;; I \ s-) \l, \ ki - .J 1 N : Wr.. •r`i 14-i) \ '\. . .. / N SIGNAT ',E: ...;• ._, — DATE: :.-- - - & ._ . )