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HomeMy WebLinkAbout018-2005-05-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Div4tsion ~' ^- INSPECTION REPORT GENERAL INFORMATION r (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Miller Homes of Hudson, LLC Hammond, Town of :ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~{ Dosing ~~O f to F,'1 Pb ~ a~-K, Holding TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. Vent to Air Intake ROAD Septic ~ / ~ ~ ~ ~ l ~, Dosing j 15 ! /~ ~ Aeration Holding PUMP/SIPHON INFORMATION at ~ i Manufacturer « Demand eJ~- Z62, GPM Model Number n ~ ~ ~ 2 ~~ (~~ ~ TDH Lift ~ 7 Friction Loss System Head ~F TDy I d c / rd ~ ~ Forcemain Len ~ Dia a ~ Dist. to Well ~ SOII ABSORPTION SYSTEM county. St. Croix Sanitary Permit No: 479303 0 State Plan ID No: Parcel Tax No: 018-2005-05-000 Section/Town/Range/Map No: 31.29.17.931 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM H~9 _ ~ ILA ~~~G. t~W~~ YY ,~ V~ /OZ~~s Bldg. Sewer 'D `,,~ ,~~ . SUHt Inlet 13<5S `IO.(o3 st/Ht outlet ~ ~, g 5 ~ O ` ~~ Dt Inlet ~ Dt Bottom '.T, l ~ ¢7. O~ V Header/Man. S.~' 96.! Dist. Pipe CJ . 9 5 9(~ Bot. syst9 t~ t:sp ~,b5 ~ Final Grade ,t +r.~~ `t ~ 7 I St Cover ~~ 7.9`1 9 (o . F1 ,.,,~-- q,~~ 9~. BED/TRENCH DIMENSIONS Width / ~ Length ~ No. Of/~ren~ s ~ ~ PIT DIMENSIONS ~ No. Of Pits Inside Dia. - Liquid Depth ~ L G _ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHA OR _ Type Of System: n ~~OaJ ~¢ ~/ o ` (/ (~P ~ ~~ UN T Model Number: .~ DISTRIBUTION SYSTEM Header/Manifold l t4 rJ' 1 1~z ~ Distribution Cz i t ~7 / P~pe(s>~ ~y ~ ~/Z~ L •~ ~ x Hole Size ~t 1 ~ x Hole Spacixng ( 7 ~ U ` Ve t to Air Intake //'' ~V . Length Dia ~ Dia Spacing Length SOIL COVER v Praem~ra Rvcfamc Only Yr Mnund Or At-Grade SVStemS OnIV Depth Over 1 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ , ' Bed/Trench Edges Topsoil ~ ~~f es `-~ No s ~~~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~ 1 / a~ Inspection #2: / /_ Location: 1524 66th Av--en~ue Hammond, WI 54015 (SW 114 NW 1i4 31 T29N R1}7~W) Highl d Ranc~Lot~5 ,T p Parcel No: 31.29.17.931 1.) Alt BM Description = r t °`'~5~1 "~~' C~ q ~ w,~ ~" ~-o ~S ~T'/~"' ~-C~ S; J`' 2.) Bldg sewer length = ,~ ~ ~'6 Z - amount of cover - / - ~ ~ 1 fir, ~jt'~ ~O ~ ~ 6 8 ti~a Plan revision Required? ~ ~ Yes °' No ~~ ~ , ~ ~'' I ' ~ ~~ S'I Use other side for additional information. J Date Insepcto Signatur Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County ~, ~ 201 W. Washington Ave., P.O. Box 7162 sfi. ~//O 1 }~ ~scnn~~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ) Department of Commerce (608) 266-3151 ,- Sanitary Permit Application ~ State Plan 1.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide I may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Informat R~Fri~~.~~~~' / SL y ~~ra A/~ ,~Q n M oh ~ w ~ l Property Owner's Name / 3 Parcel # Lot # Block # ~E~ /-~~~ s .MUD. o s zoos ~m~.~ ~ - Property Owner's Mailing Address Property Location X~ok~t /S~ S i . CROIX COUPJT?` ~ /`r ~' ' 3 / City, State Zip Code /., .~~c! /., Section ~ Li QSO K [iti ~ .Syt~~G 7iS 3$"G-Z7foy Q Z-/ ~ circle ) T N R ~ E W~ II. Type of Building (check all that apply) ; o ~ ~1 or 2 Family Dwelling -Number of Bedrooms ~ c~ Nb m rt~ f ~o vs fi / Subdivision Name CSM Number _ e v[ c ^ Public/Commercial -Describe Use v ~ /~ ,/~ I ~'~' ~- (a N a /~GC IIG l~ ^ State Owned -Describe Use ~c-~/ S ~~C ~IO~ o i1TDa ~ y y~ ~ ^City ^Village~I'ownship of .~ n, µ. ~~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p ~ N !t A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I ^ Non -Pressurized In-Ground Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Consbucted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recircu]a in and Filter. ^ , A ~ Recirculating Synthetic Media Filter ^ Leaching Chamber ' . ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) tf-'f~, V. Dis ersal/Treatment Area Information: rr'7•t.v r , ~/O Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) D' rs~ Area roposed (sf) System Elevation s~ /-~ F dr p. y /izs yrh '~~~ y~ ~v,9o' VI. Tank Info Capacity in Total Number Man facturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks E~asting Tanks ~ m ~ ~ r q Septic or Holding Tank oba r, Wes; s ~ Aerobic Trestrnen[ Unit O ~ Le /C ~i• / t(r` / Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for iastallatioa of the POWTS shows on the attached plans. Plumber's Name (Print) ~ ' Plumber's Signature ~ MP/MPRS Number Business Phone Number k,~- ~a~-I/ Zzs o~~ pit-~ s = i~z Plumber's~Address (Street, City, State, Zip Code) /d 7p ~~,~~/ r ~~G Sow W/ SYD~~ VIII. oun /De artmeot Use Onl Approved ^ Sanitary Permit Fee (includes Groundwater Date ss lssui gent Sign e ^ er Give eason enial Surcharge Fee) ~~ ~ 7 ~~ d5 IX. Conditions of Approval/Reasons for Disa vaI ~~ ~ J.LdL.A--~_. SYSTEM OWNER: ~~~, ~ ~~ ! ~ ~~~` 1. `Septic t5nk, effluent finer and dispersal cell must all be services /maintained as per management plan provided by plumber. ~ ~ / ~ i ~~ v ~~ ~ ~ ~~ a[~CaJ~ I ~ o 2. AU setback requirements must be maintained C~ ~ f I as per applicable code !ordinances. w...p•cw puus tw we wun[y umy) ror [ne syan:m on paper no[ te98 man ar/l I 11 iaC6ee in size ~~ ~C SBD-6398 (R. 01/03) M M M ,. ~ `JOi/Qlb~uQ~iOn /DBE ~ E,t'~'Sfi~ ~rizdt elegy' ~ Eki's ~`'~ ferrcc/it ~ A ~ Sca/e: / ~= o' I~PIc~{.'~/YS~3.~otS P/a.fo{' ~~/i/and ~Paix-!t, T ^. of ~anmand, SSE,. 'Utlix ~. I`t'-d~~N~oumd G~ /B 30 ,t' /OS 38- ~-}'s'.i' yo'disosrsa/~i. C7`~ CzJ distli"bu.~an/a.~1r'w..faa.~ /%X8B.y4'' ~~ w e9c h~ `~~ ~~ ~° ias.~ - - _ It . 8 , : ToP of i /'on 7yt ~, f Sy~O~ (~M p p~~ t.J fe 5~~ Ccritrc~ ~I,`~Z. GSf `u. S. (1. S. eie~,% ~, ~.•~[. !I~ ,GeaD/Coso-mQ Com6i~a~vr~ -- _ ~^oh - \ ~ ' ~ S.T/,o, c..a/ ~x6~/A-,rvtFF/a end ~ - `~ ~- ` 9:~ bu:lollz Scu>~r ~ ~~ _ _ O- --' ~`~ ~ - .o' Propo3td `--~ ~~ ~ ~., _ , `~~ ~~Y ~~Si~°rrC2 I e 9.3 0 ,Pvt~ /o cafi ~ b ~o-~ ,` 81 `~~ b .` \' 9S. o' con'~Dw 3e ru.1. r o.rK ~ T~ o.~ Job S~~('Q. SSw.nt 2~QU, = /Lb.Cb /cYJ/.d5`Gc.5.6.3. ele~~ / ~~Q~~. i~ a h p~. say 9 xi .. y m m h M JOiI QKu~.cQ~iOn P~ ~ E,t'~'sti~ ~/~zde e%~' -iE- Eke s ~ n9 Ferrcc/,n e Sca/e: /': o' ~~k/and ~Pa.wk, T, of f'I"'oPostsf ~o~nd u ~ /9.30 X /O S, 38'' ~.}'s;r yo'Q;'sosrsa/Ci//. CTS C~ d;sty)"bu,~'on/~1rnfa.e.~ /~Z;Y88.s/4'' ~~` ~~. ~~~, ~~~ y~-l c~ ~~ boy l8s•o . _ _ _ - - _ _ . It . B : 7-0(' of ~ ion 9/.s~ ~O; pe. El¢d.' = 9119' ire ~ f s~~,r ~~o p~~~ ~; e 5~~ ~U~ C9u. ~y'u. s. a. S. ¢~eNJ i,.>L IA ,(j0o~loso-atQ Com6i~n~rn-+ g2 `` ' - d~J~ / Esc/, • f! 9aia~R. ~.47 ~ ~ _ ~ -. 3 b.~d~uD~ i '~ n `• ~~~ 'CGSr ortc2 I `~\e ~ Fa~c¢ ~ o ~ P~o~s.ed~J ' ~~ ~ '~ ~ s ~ ~ ~ _- 93 s/o, o~ bid '~ ~~ ~~ ssw.n e eU, _ /~. cb /GYI/.,~5'Lt.S.6.5. tl¢t~~ / ~~Q~~. C~ a M a h ~~ Sad' 9 e Site Inforn (r or c) R~, 300.001 1.501, 450.00 7.50 94.40 29.00 0.40 Mound and Pressure Distribution Component Design Design Worksheet nation Residential or Commercial Design Estimated Wastewater Flow (gpd) Peaking Factor (e.g. 1.5 = 15096) ~i Design Flow (gpd) , Site Slope (°k) Contour Line Elevation (ft) Depth to Limiting Factor (in) In-situ Soil Application Rate (gpd/ft2) '~ Note: Sand fill (D) rakx~lations assume a Table 83-443 in-situ soil treatment for fecal cdffonn of <= 36 inches. Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution ~-~ Pressure Disribution Information network? Enter Y or N (c ore) a Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. ~-~ _ 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spaang (ft) = 5.00 ftz/orifice ~ 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 86.75 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft)~ x 1.3 7,73 Vertical Lift (ft) 2.29 Friction Loss (ft) 16.53 Tota! Dynamic Head (ft) Lateral Diameter S4lection in, dia. o ions choice 0.75 1.00 1.25 1.50 2.00 3.00 ~_~~ Treatmerrt Tank Dose Tank Irrtormati,.,--~~ ~+ 648.00 Dose Tank 17.00 Dose Tank Wieser Concrete Ma .~.- - " 13.05 Forcemain Drainback (gad 81.15 5x Void Volume (gad 94.20 Minimum Dose Volume (gal) 37.07 System Demand (gpm) M= vneter tions z Project: Miller Homes of Hudson - S ^.-= choice x or (optional) ~1Aanufadurer .aodel Number .-^,apacity (gal) g Liquid Depth (in) - - ~suft in cell B49) ,.,~~d Page 2 of 9 commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ vuww.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 01, 2005 CUST ID No.225036 MICHAEL P MC DONELL MILLER HOMES OF HUDSON, LLC 1070 HUNTER RIDGE RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/01/2007 ATTN.' POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1150547 SITE: Site ID No. 700784 Miller Homes of Hudson Please refer to both identification numbers, 1524 66th Avenue above, in all corres ondence with the a enc. . Town of Hammond St Croix County SW1/4, NW114, S31, T29N, R18W Lot: 5, Subdivision: Plat of Highland Ranch FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1025878 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. ; `, VF ~ ~ ~~ r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application ~'~~~/ INDEX AND TITLE PAGE ~~~ ~~'~ Project Name: Miller Homes of Hudson - 3 bedroom residential mound Owners Name: Miller Homes of Hudson. LLC Owners Addn~s: 868 Kelly Rd. Hudson, WI. 54016 Parcel Address: 1524 66th Av. Legal Description: SW1/4 NW1J4, Sec. 31, T.29N., R. 18 W. Township: Hammond County: St.Croix Subdivision Name: Highland Ranch Lot Number: 5 Block Number. Pace! I.D. Number. 018-2005-05-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report 0 ~~~~.~~ , Moos ~~~ ~~,~; ~~~ ,~~ K Designer. Mike McDonell License Number. 225036 Date: 06/29/05 Phone Number. (612) 865-1927 ~1, ~ Signature: Designed Pursuarrt to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01!01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) ur,~ ~, D v tan~ir vz ~ ~ F+" ""• ~ Version 4.01 (R. 09/04) ~/' `~ Page 1 of 9 ;~I k; C;uitrt~SP ``PJCL Mound Plan View I i 1_ _ - --ii . 1/10_ B • 'Observation Pipe ~L1 ~ . ~• '. L~J. .'. '. -T -~+ -I -1 L Mound Component Dimensions r/ c~ , i~ A 5.OOft E 11.50 in H 1.OOft K 7.69ft ~~^ O`~~~ B 90.00 F 9.50 in z 8.71 ft L 105.38 ft ~ G, ,- D .00 in G 0.50 ft J 4.59 ft W 18.30 ft h~3~ °~ 450.00 (ft2) Dispersal Celt Area 1233.87 (ft2) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement ac~ Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.78 (ft) 94.98 (ft)---~ F Dispersal Cell ;~ Elevation Shading Key 10 Topsoil Cap Q ~~~~~ Subsaii Cap ©~ ASTM C33 Sand =]'-;`5~ Tilled Layer 0 Aggregate ~I H Dispersal Cell - 95.48 (ft) Lateral Invert ~p ~ ~ _ _ .~ ~ ~~. 7.5 % Site Siope ~$ ~. I c °• 1.5 ft . c 00 0 a 0.5 ft 0 ~ ~ (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Miller Homes of Hudson - 3 bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Latrals centred orrvr th P • =Turn-up vfball valve or cleanoutplug Ad laterals are 4dentical ~ X-~I Holes driNed on the bottom of the lateral 3 e4~~ sP~d ,(, Force main Comet~lon pia tee or Dross to mardfokl at any point. Laterals & f«ce rrwirt of F'VC Sch 40 (pr COh~1 Table 84.30-5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing pC) 2.01 ft Lateral Length (P) 88.44 ft Orifices per Lateral 45 Lateral Spacing (S) 2.50 ft Orifice Density 5.00 ft2/orifice Lateral Flow Rate 18.54 gpm Manifold Length 2.50 ft System Flow Rate 37.07 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.5,3 ft Forcemain Velocity 3.79 ft/sec Dose Tank In~rc-mation Lib cover with warning ng label and klcldng device and sealed watertight Electrical as per NEC 300 and --~ Comm 16.28 WAC Disconne~ ~ 4 in. min. \ y ~_ Tank component is property vented E- Attemate artlet -ocation Wieser Concrete Ca acit 646.00 Volume 17.00 Manufacturer Gallons gal/inch Dimension Inches Gallons A 18.46 313.80 B 2.00 34.00 C D Total 5.54 12.00'. 38.00 94.20 204.00 646.00 3" Bedding A B C D __ _. Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller ~I Pump Model Number,BN98 Pump Must Deliver 37.07 gpm at 16.53 ft TDH Forcemain diameter ~ 2 in. Weep hole «anti- siphon device P~ ump off elevatton (ft) 87.75 D~k elevation (ft) 86.75 Project: Miller Homes of Hudson - 3 bedroom residential mound Page 4 of 9 f r ~ ~ Mound System Maintenance and Operation Specifications _ . __ __ -- Service Provider's Name Mike McDonell Phone 612-865-1927 -- POWTS Regulator's Name St. Croix County Zoning ', Phone 715-386-4680 1 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Partite Size 1/8 in Estimated Flow -Average 300 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ct and/or service once eve 3 ears Should ins d and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold boarci or chisel plow. 5. The mound structure and other disturt~ed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • ............. ............... Grade \ , ~8" Diameter Lawn ~/_ ~ ~ . . . ~ . ~ Threaded Cleanout Sprinkler Valve Box ~ Plug or Ball Valve Distribution Lateral ~~ Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Miller Homes of Hudson - 3 bedroom residential mound Page 5 of 9 ~~ Mound System Management Plan a - Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01 /01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. Atl switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank R shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mgiL GODS, 30 mg/L TSS, 10 mg/L FOG, and 10' cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed R should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Miller Homes of Hudson - 3 bedroom residential mound Page 6 of 9 Wisconsin Department of Commerce nivision of Safetv and Buildings SOIL EVALUATION REPORT .-, ec ~nr~ n.a... r".,~c 1853 Page 1 of _ 3 A.C.E. Soil 8 Site Evaluations County Ariach complete site plan on paper not less than 8'h x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . 018-2005-05-000 Please print all information. Reviewed ey Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NW 1/4 S 31 T 29 N R t~ W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 5 Plat Of Highland Ranch City State Zip Code Phone Number _f City ~ Village J Town Nearest Road Hudson I WI 154016 ~ (715) 386-2769 Hammond 1524 66Th Ave. /~ New Construction Use: ~ Residential /Number of bedrooms 3 Code derived design Flow rate 45U ~ru Replacement ~) Public or commercial -Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 94.90' at 6" above 94.40' contour. Boring # ~ Boring Pit Ground Surface elev. 94.40 ft. Depth to limiting factor 38° in. Soil Application Rate D i t C l D ri tion D R d Texture Structure Consistence Boundary Roots GP D/ft' Horizon I epth I in om nan o or Munsell p ox esc e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 I 0-7 I 10yr3/3 none sl 2fsbk mfr as 2f,1m 0.6 I 1.0 2 ', 7-17 10yr5/4 none sicl 2fsbk mfr cs 1fm 0.4 0.6 3 i 17-25 j 7.5yr4/6 none Is 0 sg ml gs 1vf 0.7 ', 1.6 4 j 25-38 10yr5/6 none gr s 0 sg dl gi - 07 ~ 1.6 5 i 38-60 i 10yr5/6 t'2f 7.5yr5/8 Is/sl 0 sg/ 1 msbk dUdsh ai - 0.4 i 0.7 6 ~' 60+ II 10yr82 none L.S.B.R. na na - - na na Hor¢on #5 consists of an irregular, discontinuous mixture of soils indicated. Sand is cemented in place, parting to Osg when disturbed. H#6 contains >50% limestone fragements. Faagements are 4" - 8" X 1"thick with Is/sl mix between fragements. a Boring # ~ Boring J Pit Ground Surface elev. 94.38 ft. Depth to limiting factor 29° in. Soil Application Rate i l th D t C H i D i tion dox Descri R Texture Structure Consistence Boundary Roots GP Dlft' nan or ep om o or zon ~ in. Munsell p e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 ', 0-7 i 10yr3/3 none sl 2fsbk mfr as 2f,1m 0.6 1.0 i 2 7-13 10yr4/6 none sicl 2fsbk mfr cs 1fm 0.4 0.6 3 113-29 7.5yr4/6 none gr Is 0 sg dl gs 1vf 0.7 1.6 4 29-45 ~I 7.5yr4/6 ------ -~ 5 45-56 10yr7/8 f2f 7.5yr5/8 f2d 7.5yr5/8 gr Is L.S.B.R. 0 sg na dl na gi - - - 07 na j 1.6 na - ~ Horizon #5 contains >50% li stone frage ants. Fragements are 4" - 8" X 1"thick with sllsicl mix between fragements. ' Effluent #t = BOD ~ 30 < 220 mglL an TSS >30 < 1 mg/L (fluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature~ CST Number James K. Thompson 5 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 154020 10/122004 715-248-7767 . ~ i~~ . h M ~~~~ y~~ ~c~ ~~~ yr ~~ ~° '__ 9/S~• ~'/,z ~ ~S/oo~. __ _ ~ YYYo' ` ` ~ ~ Q3 9~~~ ~ ~ rn - -- --_ _ ~.~ ~``'' 9f~3Y ~.\ - _ _ ~ - 92.0' m ~~ i ~ ~~ ~4 \ ~ ~ ~~ \ \\ ~ \ ~ "F \ ~ ~ y° - ~ , `~ 93 0 9+! s'~ ~ , • ~~ ~ ~ _~ 93,x, ~1 ,` 9S.o'C.on~Eoµ% ~ nc~ ~ arK; 7~ o.~' Job S~a~Q. /cYJi3S~u.S.~.3. e/ee~1 ~(o~~/P. ^ soil ¢-~/ua~;o~ ,o, E • E~'i'sti'~ ~/izd~ elect -~F Eke s ~ ~ P~cc%a e ~~/~/and ~a.rwlt T • of It. B. 'T~oNoP;ion /O,Pe. El¢v.' = 9119' (92t. ~y'u. s. a. s. eic~J a M h ~~ 3a~'3 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT n errnrei~nrw wikh Rnmm RS WiS Adn7 ~:O[te 1853 Page 1 of 3 A.C.E. Soil & Site Evaluations - ~ County an must Attach complete site plan on paper not less than 8'~ x 11 inches i St. Croix ~ include, but not limited to: vertical and horizontal reference point ( and location and north arrow scale or dimemsions ercent slo e ~ lion and tg purest road- _ Parcel I.D. , , p , p ` ~ ~ 018-2005-05 00 Please print alt information. ~ , O Reviewed By Date Perswial irdormation you provide may used ~- Law, s.15.04 )). ~ ~s Property Owner ~ Prope ion Sam Miller Govt. Lot SW 1/4 NW 1/4 S 31 T 29 N R 17 W Property Owner's Matting Address Lot # Block # Subd. Name or CSM# P.O. Box 151 _ 5 Plat Of Highland Ranch City State Zip o~ ~ ~J City pJ Village ~ Town Nearest Road Hudson ~ WI -(TT5j3=5=1 7C'~ Hammond 1524 66Th Ave. /J New Construction use: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement ~ Public or commercial -Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 94.90' at 6" above 94.40' contour. Boring # ~ Boring 38° i R t i Pit Ground Surtace elev. 94.40 ft. n. Depth to limiting factor on a e Soil Applicat H i th D lor D i t C tion Redox Descri Texture Structure Consistence Boundary Roots GP D/ft= or zon ep om nan o p *Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-7 10yr3/3 none sl 2fsbk mfr as 2f,1m 0.6 1.0 2 7-17 10yr5/4 none sicl 2fsbk mfr a 1fm 0.4 0.6 3 17-25 7.5yr4/6 none is 0 sg ml gs 1vf 0.7 1.6 4 25-38 10yr5/6 none gr s 0 sg dl gi - 07 1.6 5 38-60 10yr5/6 f2f 7.5vr5/8 Is/sl 0 sg/ 1 msbk dUdsh ai - 0.4 0.7 6 60+ 10yr82 none L.S. B.R. na na - - na na Horizon #5 consists of an irregular, discontinuous mixture of soils indicated. Sand is cemented in place, parting to Osg when disturbed. H#6 contains >50% limestone fragements. Fragements are 4" - 8" X 1 "thick with Is/sl mix between fragements. a Boring # Boring 1~ Pit Ground Surface elev. 94.38 ft. Depth to limiting factor 29" in. Soil Application Rate H ri n De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' o zo p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 none sl 2(sbk mfr as 2f,1m 0.6 1.0 2 7-13 10yr4/6 none sicl 2fsbk mfr cs 1fm 0.4 0.6 3 13-29 7.5yr4/6 none gr Is 0 sg dl gs 1vf 0.7 1.6 4 29-45 7.5yr4/6 f2f 7.5yr5/8 gr Is 0 sg dl gi - 07 1.6 5 45-56 10yr7/8 f2d 7.5yr5/8 L.S.B.R. na na - - na na Horizon #5 contains >50% li stone frage ants. Fragements are 4" - 8" X 1" thick with sl/sicl mix between fragements. * Effluent #1 = BOD ~ 30 < 220 mg/L a TSS >30 < 1 mg/L * ffluent #2 = BOD < 30 mg/L and TSS <30 mglL CST Name (Please Print) ignature~ CST Number S 3602 James K. Thompson Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola, 154020 10/122004 715-248-7767 P01®NTS OWNER~'yS MANUAL ,(MgTIQN ~~- j~ ;IGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units A Estimated flow (average) ~j~~ al/da Design flow (peak), (Estimated x 1.5) L~1s0 al/da Soil Application Rate ~ al/da /ft~ Standard Influent/Effluent Quality Monthly ave rage• Fats, Oil & Grease (FOG( 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BODE) Total Suspended Solids (TSS) 530 mg/L 530 mg/L ~NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. r,enir.irc~in~~rc crucnlllc & MANAGEMENT PLAN Page ~ of 2 SYSTEM SPECIFICATIONS Septic Tank Capacity /po ~~ ai ^ NA Septic Tank Manufacturer Wm,; S ~v' ^ NA Effluent Filter Manufacturer ~6~, ~ ^ NA Effluent Filter Model ~ ~d ^ NA Pump Tank Capacity '~ j0 al ^ NA Pump Tank Manufacturer Wo.; S ~./ ^ NA Pump Manufacturer Zo ~ 1~, ^ NA Pump Model ~ ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: O NA Dispersal Cell(s) ^ NA ^ In-Ground (gravity) ^ in-Ground (pressurized) ^ At-Grade ~ Mound ^ Drip-Line ^ Oth~ Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ~~ ~ ea (s~(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y1 of tank volume ^ NA Inspect dispersal celllsl At least once every: ~ ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent fitter At least once every: /, / ^ month(s) ear(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ ear(s1(s) Y ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other ^ 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 tanklsl 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 (Y,I or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo$ed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 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. ID OPERATION Page ~' of ~/ ~n~tru~,tion, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chem~ca's impede the treatment process and/or damage the dispersal celllsl, If high concentrations are detected have the contents enkisl removed by a Septage servicing operator prior to use. start up shall not occur when soil conditions are frozen at the infiltrative surface. ~9 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be ,charged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of ~`Ivent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring cower 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, Dc nct drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area ~~. tr. o ~ 5 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 PCINTS, antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat: `oundation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications: oil. aainting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT `~/hen the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the svstem. ~s 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 vita soil, gravel or another inert solid material. CONTINGENCY PLAN It 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, t~i 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• ~~ b e e a s e ~~ 8 1?~~ -3Vattat7T~a holding tank • ~NI ~ ~~ •~G•~ CONS77ZClG~l D~ 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. <VVARNING> > 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. ''+DDITIONAL COMMENTS OWTS INSTALLER Name j ~~ Phone 1z~ OlD .7 1 q Z a` EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ` Phone ,.s document was drafted in c I' POWTS MAINTAINER Name .. Phone Name ~ C ~ b 20r~(~ Phone "'rl S"-- 34 (p- omp lance with Chapter Comm 83.22(211b1(111d1&(fl and 83.64(11, 12) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORIvf OwnerBuyer ~/LL,Er2 ~©/l'I~S Mailing Address /~oh~is~ Property Address /SL ~ ~t~ ~~ (Verification required from Planning Department for new constructio Ciry/State /-~ama+onAc (.t/ I Parcel Identification Number LEGAL DESCRIPTION D ! ~f - ZcY~S - aS - Z5o0 Property Location Sw '/~, l`1 w '/,, Sec. ~~ T 29 N-R l W, own of f~a.~,M e a ~ Subdivision (-~ ~ S ~ ~4K~, ~Q µ c,(,~ ,Lot # S Certified Survey Map # 7 ~ y~ ~ ~ ,Volume ~ Page # ~_`6 Warranty Deed # ~~ y ~ `' 9 ,Volume Z S8' ~ .Page # ~ Z `f Spec house yes ^ no Lot lines identifiable] yes ^ no SYSTEM h'iAAINTENANCE ~~ Improper use and maintenanceof your septic-sy&tem could result in its premature failure to handle wastes. Proper ma: to ~~: e consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the sys:e:~. can afI'cct the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and 'o ., master plumber, journeyman plumber, rostricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal s ystc a: is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is Icss than 113 full of sludge. Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the st~~da: i set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Ccrtif•ca^.o^ stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office ~~~~: 3G days of the three year expiration date. _ 1/1~S NA OF APPLICANT DATE OWNER CERTIFICATION I (wc) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the o~~':-~^..~ the propcrry described above, by virtue of a warranty decd recorded in Register of Deeds Office. ~ ~ / ~ / a SI NATURE OF APPLICANT DATE • • • • • • Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Deparment. "' ` " •` Include with th(s applieatlon; a stamped warranty decd from the Register of Deeds office a copy of the cectificd stuvcy map if reference is made in the watzanty decd ., Document Number J_.2587P STATE BAR OF WIS(:ONSIN FORM 2.2000 WARRANTY DEED Bii/~; This Deed, made between Bruce J. Moll and Thomas S. Aaby Grantor, and Sam E. Miller, a single person Grantee. i Grantor, for a valuable consideration, conveys and warrants to i Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Lots 4, 5, 6, 7, 8, 9, and 10, Plat of Highland Ranch in the Town of Hammond, St. Croix County, Wisconsin. Exceptions to warranties: Easements and restrictions of record. Dated this '='~" day of , 2004 * AUTHENTICATION Signature(s) authenticated this _ day of , * TITLE: MEMBER STATE BAR OF WISCBTI( (If not, =_-~ , authorized by § 706.06, Wis. Stats.~,Q ,: THIS INSTRUMENT WAS DI~EJ Thomas A. McCormack ,~~ Baldwin, WI 54002 ~~i (Signatures may be authenticated or acknowledged. Bot 4Ii * Names of persons signing in any capacity must be ty WARRANTY DEED sz~ 7'64699 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD 06/03/2004 10:30AK NARRANTY DEED EXE?PT # REC FEE : 11.08 TRAAS FEE: 792.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address F r= c t3 018-1069-00-400 Parcel Identification Number (PIN) This is not homestead property. 6i>~ (is not) * Bruce J. * Thomas S. Aaby `ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) i'j C~ rsonally came before me this ~` day of 2004 _ the above named Br J. Moll and Thomas S. Aaby ~~- - to m~'(cnoy/t jt3 be the person(s) ut roil r { ,uiuw ~ ~ Notary Public, State of My Commission is pen ing att. ([f not, state expiration date: a-- _,~•) or printed below t!ieir signature. STATE BAR OF 4~'1SCONSIN FORM No. 2 - 2000 INFO-PRO (800)655-2021 www.infoproforms.corn ~t TION 3i, TOWN~HI~ ~9 NORTH, Aiv~ 17 WEST, TOWN ~.~I ~TIFIED `=SURVEY MAP RECORDED IN VOLUME 15, PAGE ~+!~)~}8. ,, . ,,, ~ I • .~ _ _ Y OTHERS ~~ I ___~~ --- ~ ,. _ ZONING: AG-RESIZJEPIZIAL ~M~ ~~ THE NW1%4 ------ '~ ~ , 289.13' 1 ~ /~~ ~~ / 1 ~~ ~ ~' _ ~/ T Ji~ "~ ~,~yi~ ~, , ,. i .Y~ ~ ~i ,, ~~~ 't~ ~ ~~ /~ ~ ~~~ ~ T i ~ >~ ~ -~/ ~% ~ ' ~ ~ ~ ,~,; ~ ~` ~, ~ ~• 5 .F ,~~'~ ~ -r ~ ~ ( ~~ '~ \ ~ ~ ^~ ~ -~~ \ ~ ~ ~ ~~ ~ ~ ~ ~S 89'~r8' 2~ 5 ~ E Q~ -T_ _~, 1~- ~ / S 89'48'2`" ~ 292.0 I' ,. ~ \ ~ I ~ ~iIC ' ~ , ~, ~~ ~ ~ :~, . , i y~ 1. // .'~ ~,~ X85 9~ cll I j~ ,I ~ I t ';i ~ I z ^i B. ~E064 ~.F ( 3 ' s ~ . _ j N.B. ,1.10 A ~ ICI ~- _BO ~- 9.9.00 ~ ~J~/ ,~ ;~~,~ ~ \~~ ~. ` 'yov/ / / /, ~/ 9 ~ / ~,~ ' / ~, ~ ~ . /, ~~ ,.., -~~ ,~ ,, ,; ~'~ ~~~ L/ / , ~/ I '' ~ / /I ~~` r-~ ~ IN O (Z I~ ~~ _i~_---, 0 ~~ _-- ~ --- r -- \ ~ ~ ~ / m .~ _ I~ ~ Ir _~- ~.., ~ ,~~~S 89'4$'25" E 24.'50' - o rn , ~~o _ L)- m r ~~ ~,/ i ~ ~ D - f I ~ --~ ~~ ~ ~ I '' , ~ // i 4 ~ ~. ,,. , ~ ,n . . ,. ~. _. !_ -' ~ ~~ c0 ~ ~ QJ ~~ '~ l N.6. 53922 5,1=. o /' '~1 -< ~ N.d. 1.24 AC. i M ~ ~ ( O \ ~ ~ Q ~ t~WE = 1000.0'' z ml .t. ~a.r Lam..... -~ !~-- . 4'~. ,~ ~o __ ..._ ~~ )I` ^, ~~. ,..,, ._;: i P~;r~l #: 0~8-205-~5-~~~ 07/08/2005 04:35 PM PAGE 1 OF 1 Alt. Parcel #: 31.29:17.931 018 -TOWN OF HAMMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * MILLER HOMES OF HUDSON LLC MILLER HOMES OF HUDSON LLC 868 KELLY RD UNIT A HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1524 66TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.290 Plat: 2089-HIGHLAND RANCH LTS 1/13 018/03 SEC 31 T29N R17W PT SW NW HIGHLAND RANCH Block/Condo Bidg: LOT 05 LOT 5 (3.290AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-17W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 11/29/2004 781153 2704/531 OC 06/03/2004 764699 2587/624 WD 08/22/2003 737073 9/82 PLAT ~nn~ cl IMMeQV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 0 Valuations' Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.290 29,900 0 29,900 NO Totals for 2005: General Property 3.290 29,900 0 29,900 Woodland 0.000 0 0 Totals for 2004: General Property 3.290 29,900 0 29,900 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 . w~~ oepe~t ~ canrnerce SOIL EVALUATION REPORT Division of Safety and Buidings ~ ~~~ witir Comm f35MWis. Adm. Code ,~ _, .,_ Athddl wmplete site plan on paper not less than 8112 x 1 ~ in sr~ i~ y inducts. but not IkriHed to: vertical and horimrrtal reFerence (BM) dtrec~ion~ Patoal ID. percent sbpe, scale or dimensions, north arrow, and Iocation a distance to nearest road. 2 O (~ ,5 Riviewed tiY Please print all inibnnaf~on. .S i.; ~'i ~ ,-~ Persoad teformation you provide may bs used rar secandsy PwP~ X01' Law. s. 15.Q4 (1) (m)?• PropertyOwner ~ _ Propeftyfocatbn Property Owner's MaiNng Add Loth Biodc # Subd. Name or O ~ J ~ cny State Zip Code Phone Number ~ City ^ Vi~ge owr ~i] New Construction Use: I~ Residential / Number of bedrooms ~~~ Cade derived design flow ram _ [] Replacement Public or r~mmerdal -Describe: Parent material ._ 6 `~ ~i~.sc~.s~ ~- Fbod Plain elevation ti applicable _ General oonmierttss S S-~ e rr~ •e.1 e ~/' . Q's ; 0 O and recommendations: / ^ Bortrig Bonng # [~ Pit Ground surface elev. ~ i Z o ft Depth to limiting factor _~ in• Horizon Depth in. Dominant Cobr MunseU o- 3/Z Z ZZ -~~ ~ Redox Descriptron Texture Structure Consistence Boundary Roots ... 'Eftlll • v 'Eff#2 tlu. Sz Cont Cobr Gr. Sz. Sh. ~,,~ / c ei_ ~ ~,~ m~~ ~ - ~ Boring op~~ Baring # ®Ptt Ground surface elev. // 7~ ft. Depth tD Nmifmg factor in. Soi iron Rate t T StrucWre Consistence Boundary Roots GPDlftz Horizon Depth Dominant Coles Redox D~tion ure ex 'Eff#1 'E ff#2 in. Mansell Qu. Sz. Cast Cobr Gr. Sz. Sh. (' O Z 1 /~ ~ Sin . ~~ ~W rjCF / • Effuent f!1= BODs > 30 < 220 mg/L and TSS >30 <_ 150 Name (Please Print) _ Sa ' Effluent fi2.= Page ~ ~ Date T z q N R ~ ~- E (or~ ~ ~a nch Nearest Road /~/ ~ GPD ft. TSS <_ 30 Address '~~- ~~ O -OZ 7ZO VN C -2 M'l~ l ~ Parcel ID # ~~~'~ ~ Page ~._ oi~ Property Owner ^ BOMg ~ ~~ in. a eorarg # ~ Pit Gnwnd surface elev. ~~ Od ft. Deed' to 4rrtirnrg far~or Horizon Depth Oom~tt Color Reflex DessQiption Texture Structure Consistence Boundary Roots in. MunseN Qu. Sz. Cent Cobr Gr. Sz Sh. -~v -uS 'Eff#1 'Eff#2 ~~ ~~ .~ l,_~ ^ Boring # ^ eonng Ground~surface elev. ft. Depth to liniflng factor in. Sob lion Rate ^ Pit Horton Depth Redox Oest~tion Texture 5trudure Consistence Boundary Roots GPDIig Dominant Color 'EtT#1 'Eff#2 in. MunseH Qu. Sz Cont Cobr Gr. Sz Sh. Boring ^ Boring # Ground surface elev. ft. Depth to ~rtitireg factor in. ^ Pit Soi tion Rate Horizar Depth Dom~rt Color Redox Descriptiar Texhae Structure Consistence Bourwiary Roots GPDIfF in. Mtmseil tlu. Sz Cont Color Gr. Sz Sh. 'Eti#1 'Eifff2 • Ef6uent #'t =GODS > 30 <_ 220 mg1L arxi TSS >30 <_ 150 mglL ' Effluent tl2 = BODS < 30 mglt and TSS <_ 30 mgll. The Department of Commerce is an equal oppotttmity service provider and employer. If you need assistancc to access services or need ~~~ ~ an ~~~ format, Phase contact the department at 608-266-3151 or 7TY 608-264-8777. PAGE ~ OF 3 ~TA_1~:E ~~ ~ I LOT# ~ LEGAL DESCRIPTION ~~ ~~``'~~ S 31 T z `~ N.R. ~ ~ ElorY~