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D n° m m o m m m ~v 5i ~~ ~' Qn~ ~ asm m ~~ o ~ ny'< a<• °' O O. O. O N Q O y W 7 Q Q 7 3 y Q~~ 3 O O N W '. N p m ° yfD ~~ o ~' a° m ~~ ~ 3 ~ am ~ c~i~rv~•'aa~ N m o. v N ~ o~ co n ~c n ~ ~' .•: m p 3 w ~c y•o m`~ m ~~ n~i m m ~ ay o ° m Wm ~.m ~ O O 'O CT ~ O- C S C fD =! 7 •P 7 0 ro ~ 0 S N CD S C ~•y>°~'~ms3~~ oo m3°'~m ~mon3ia %m o ~~ o -•~ ~o•o ~ m ~ ~~ v ay ~-~ ~~~aaFW~m° ~ p°-°o3 ~yv~~ ao m>°c ~ N. m ~~ ~ m m ° ~ v v3, ~~ y ~ ycFic°i~~~c°_•mN (~~ omm Wm ~~~•~c~u o~y°o~ov°= a yooo? a~N~o_ O p O1 7 7~ O. a f~ 7 3 y ~ n ,(Q~ 7 (~D O..•n ~ y O fD ai ~ ~ fD ~ IO N O O C~71 I~ o° °o °o Ia 3 y c ~' m ~ m ~ o .~ ?k o C -+ ~N~•••~~ ~ ~ T o ~ o ° co .~ N N o w ~, ~ o ? °o v fA :'!' 6 M w ~ N `G co ~ 1 N A ? ~ ..a ~] .~ A 2 O •• ~ 7 fn ~ '•' m N ~ CO Z ? ~ W m ~ A ~ ~/ G A'+ Nf R O O~ d :T ~• ~• A O O~ 0 w b°o A A ti N b ~, a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Div~ion - w . INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: n City Village X Township McCabe Homes Inc. (fix ~' ~• Hudson Townshi CST BM Elev: ~ Insp. Mp,Elev: BM esc ipti TANK INFOR TION ELEVATION DAT TYPE MANUFACTURER CAPACITY Septic ~~~ tZSb Dosing A-ss~ ~ r Aeration Holding TANK SETBACK INFORMATION TANK TO PiL s-~- WELL ~~ BLDG. vent to Air Intake ROAD Septic ~ Q~ 0 > ~O ~ ~ i „` ~" Dosing I Aeration Holding PUMP/SIPHON INFORMATION __~___-_ Manufacturer Dem d GPM Model Number TDH Lift Fri Loss System Head Ft Forcemain Le Dia. ist. fo Well / iBenchmark County: St. CrOiX Sanitary Permit No: 420699 0 State Plan ID No: Parcel Tax No: 020-1402-03-000 Section/Town/Range/Map No: 11.29.19.2514 BS HI FS ~-~ s 11 I alk 9.6~ erg t o~ : o B~g`Se evy r 's ~ .~~U.o - [ i ~'T ~ ,7 Z ~"] . I l SUHt Inlet SUHt Outlet ry[,aiyt, .Q~ S• fs ~ 5- Dt InTef Dt Bottom ~ Dy'• ~ D.l~pe Final Grade ' ~w.-I~ ~ z3 s~v-~' - SOIL A ORPTION SYSTEM ~Jp~. ~y,J~(~ ~,~, ~ 30 d ~ ~ BED/TR CH Width , ~ Length No. Of Trenches PlT DIMF DIMENSIONS 2 -~ r SETBACK SYSTEM TO P/L BLDG WELL LAKE/S INFORMATION Type Of System: ~~ F SS , ' '~~ ~ ~ DISTRIBUTION SYSTEM ((.F ,r,~q~,,,, L.an„ J4 ¢~J ~0 ~ CHAMBER UNIY 1~i0~ FMS S~ del Number: Header/Manifold 4 C d//~` i~r Distribution Pipe(s) ~ / ( x Hole Size __~ - x Hole Spacing Vent to Air Intake .• ( ~ ~ 1J ~ f ~ Length O Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only pZ/K( G~llil'n.l~.PJl/~'pYn Depth Over r Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ Bed/Trench Edges Topsoil Yes ~ No ~ ~l Yes L~ No MMENTS: (Incl e~ a discrepencies, persons present, etc.) Inspection #1:~/~O ~ Inspection #2:~/~~~ ~~~ ~~ (666 Location: 779 Starlight Ave Hudson, WIn5401-6 (S /4 SE 1/4 11 T29N R19W) Misty View Lot 3 Parcel No: 11.29.19.2514 1.) Alt BM Description = la~`^'~" d(!~ 5~~ ~ ~/~ CN l~Yl/t ~ U~~l.~ ~ , a%P~(,~J-Q.1(fl., (<tlLC~J 2.) Bldg sewer length = ~ Co2.~ ~ (~l,c~.c~'~'1~~f ~t-~ ~~/ --~'~,~-~~,,,(s -~irr~ .e /~ /~ ~/ - amount of cover - ~ r ll ,~ ~.~ ~/Pi-/ S S-~?irr• ~f - A~f/ vv i" 8 y Plan revision Required? Y s n No ~ ~ ~~ ~ , f i /~ ~ S Use other side for additiona formation. l.~ SBD-6710 (R.3/97) ~~ ~`•' ~-- ~D~at.e. ~~w' ~ , (~ ~ Ins Actor's Sign ure Cert. 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A a r W C TJ ~ N ~ COO N ~ I O ~ 7 -+i N Q N C 7 N~ N O N c 7 41 O O N '1 O (^\ ° ' 7 = i O N ~ r~ o ~~ v o c0 ro ~ 3 i w ~ a o ~ O 0~ O 3 ~ y N~ ? p Vl Vl j ~ R ~ I m cn v cn Z D N ~ u to v cn Z D N C O ~ a ~ • ~ co ? to D c cn ~ co D a ~ C I ~ `-° °- ~ ~ °~° a W °°`~ N I ~ ~.~ ~~.~ L ~+.~ ~ ~ O O S O . .. O ~. O O ~. O ~ ~~ fA ,O„ 6 N• a ~ a ~ ~ '0 °' °' Z `° Z `° 000 `~ y' o C C Z7 ° C C~ ~~~ C w ~ N N ~ ~ d d ~ W y N G I o a n~ o a a~ v v G, ", 7 cA o0 7 ao 00 ~ m v o ~ -, ~ o. a ~ a a d ~ °~ ~ ~ ~ ~ ~ 3 m iV I N .. a, a O Z .. O 7 O ~i °= m O ~ a o ~ °= m O ~ o o p o ~ ~ I • c o a ~' • - c o a ~ I 7 n O~ N~ _ ~ Q N N~ ~ 7 N N O 7 a O. .TI j ~ -p ~ fD 7 O. O. 17 7 p~ ~ ~ N fD N ~ N I n 0 0~ ~ C n 0 0 ~~ ~ O Q I _ 7 fl N Z I ° . .D 7 Z ~ 7 7 O- ~ N f0 A Z N ~ N o < N N ~ ~ N o < N N ' D c 7 ~~ A n v ~ N r' ..- ~ o o n m y r; > .~ ~ o g~ °. Z O p~ I ~ 7 3 o' ~ 7 ~ I ~ a o c ~ o c ~ .~ o~ m o~ m W 'v m ^~ N O N O ~~ a ~ Z a 7 ~ ° ~ ~ I °,. ~ ~ o m I ~° c~ 3 V! Z ~ N 7 41 7 ~ `G `2 `G ~ ,~, 7 d 0~ fD N C O O O N O N d .77 Oo < tD N ( 7 d 0~ N~~ CAD ~~~ O N Q O ~1 Oo < fD N ~ a 3 N (D N O N p~j a >' ~ 1 ~ a S~ CD N O N p~j n: ~' ~ . C C N fD j ' 7 N ~ ~~ D ~~ 'O 7~ 6 ~ 7 N Q ~ C 0~ O N 7 ~• c t 0~ ~n. Z ~ N o I CD. ~ a~~~ ~ cam' Z °~7 ~c ~3 N oo-•m o c ~ ~ 'o7p' C~' Q7 N ~• ~3 N oo-~m o . I b o o a'fD ~m Q ~~ 7 a o N 1 ~ ~ ~ o m Q`D m~ ~v l a m a ~ O a ~ N ' 7 ~ `a ~ ~ ~ ~ ~ (7 7 ~ ~ m ,~ m m 3 ~ ~ a 'y ~ ~ ~ N .~-.' 07 ~' ~ N 7 C ~ l 77C 7C ~ ~p .~T ~ .~-.' N ~' ~ V ~ I sv a n 0 3 -Qm m~ o_o cl 0 3 -tTm y ~~ o ~ ~ ~ ~• ~ ~ ~Q ~~ o ~ m ~ ~• ~ ~ ~~ o ;e I _ ~ f c a° °~ a m _ ao m a A ~ o 3m F to sm c b O a ate' o~ N c e i~° N p N am ~~ N c m~° • ~ `~ "O N ~ ~ _ T ~° m~ °'~ T m o 7 m~ °'~ ~ m D ~ ~ `~ ~ N m m ~ ~ O ~ ce ~ 7 O N (D f C O ~ ~~~ O BCD O n O W N O ~ <.< n jS 'N"~ I w O. N N. 7 N?~ a d N N d .~ 7 N _S 3 a 7 0 7 7 7 f7D N 7 O 7 O 7 7 N ~ O O S N n~. O (O 7 J N Nom. A O ~ t il 7 ~ O O N A 7 ~ -A. ~ ~ b w oo N ° ° = ° ° ~ o o o o . ti `~ Sanitary Permit Application saict~ ;>s; ;~,.~„-,, In accord with Comm 83.21. Wis. Adm. Code 201 ~'` ~s ssh.r seonsin See reverse side for instructions for completing this application ?~~ Gepar imenr or Commerce Personal information you provide may be used for secondary purposes 'slad,s~n '~'~ : ~_ (Privacy Law, s. I5.04(I)(m)~ (Submit completes (omi ~,v ,„ Attach com late tans (to the count co onl )for the s stem, on a er not less than 8-I/2 x I I inches in size Counr~~n .State ~t~ Per it umber ^ C ec i ~r' l~Cr7 1 n Stale Plan 1 D N~, ~er 1. A lication Information -Please Print all Information ope ,Owner N'am~ Location: '77~j S-f+grli' ~ ~~~- FEB 2 0 2003 Progeny Location _ ~en~ Gwner's Mailing Address LIl4 114. S T ~ , I - , j T. CROIX COUNTY Loi Number \\/~~ ZONING OFFICE ~ ''"~ ~~;~ State i Code ~ j~ Phone Number Subdivision Name or CSr`1 !~umoc~ l 11 Type o Building; (check one) ~~ ~ ~ ' ~~ ~ I or 2 Family Dwelling - No. of Bedrooms:-____~ .~/~ ~ Ctty ~ Publ~dCommercial (describe use): O village ~ State-owned _ ~ Town of !!I Type of Permit: (Check only one box on line A. Check box on line B ifapplicable} Ne'esi Roatl A) New System 2 ^ Replacement 3. ^ Replacement of 4. O Addition to Parcel Tax Numberl,; S stem Tank Onl B) ! Existin S stem Q A Sanita Permit was reviousl issued Permit Number Date Issuca 1 ~~ Type of PO WT System; (Check all that apply) ~ Ti~E~/C/-~f:~ ~ ~'~on-pressurized In•ground / °~~ g~0 '` ~u,al1/~ b~0 -~ L~tb Z.• 03 Of Pressurized ln-ground ^ Mound rwtlLrn~~YS ^ Sand Filler ^ Constructed ti1'etland -~~.~graue ^ Holding Tank ^ Single Pass ^ Drip Line ~.~~ ^ Aerobic Treatment Unit ^ Recirculatin ~~` 2~` !9' ' r g O Other: V Dis ersal/Treatment Area Information: .:esig,^, Fluw (gpol 2 D~spersalArea 3 Dispersal Area 4. Soil A lication ~ equired Proposed FP 5 Percolation Rate .System Elegy ion ~~ ~ ~~ ~ S~I-~. Rate (Gals /daylsq.~ (Mtn./inch) _ ~_ ' ,_ ~ ~na' "`3~ i.~ ~ ~ ~~ ~:13;~J~,. ~'1 Tank l ii1DT Capacity rn Total b of Manufacturer Prefab ,l~ Information Gallons Gallons Tanks Ex ,._0 New Existing Con- Con- els;s T ( Tanks Tanks crate structed I'll Responsibility Statement ~ .~ I !, the undersi ned, assume res onsibilit for installation of the POWTS shown on the anached tans. `~~_~moers .Fame (print) Plu is nature ( s 2 ~,( ~' MPlMPRS No. V ~ ~~ ~ Business Phone Numpcr ~:m.oers Address (Sue t, y, State, Zip C de) ~'~~ ~ ~/ t- 1. ~'lll C only/Department Use Onl/ ` 1/ ,L~~ ~ - ~J Y O Disapproved Sanitary Permit F e (Includes Groundwater ^~PPro~co O Owner Given Initial Adverse Surchar c Fee Date Issued Issuing gent S~ Hato ~,\;; -~ B ) ~~-~ ~ g ,amps Determination oZ-/~O Conditions of Approval /Reasons for Disapproval: j ~ ~ ~~~. ~ sys,~-, P.let~,~,-, nzus~ 6~ /eu~~- ~~ Cs'~-ham n~.~ an BZ. ~Sa~cYo s/~ ~~d ~ y ~a~nle.~ -reee~ -yb L.e of da. ~`.e2~(~0 ~;. ~~~:.~'~ vn-u-~ d.~ ~farz.e.~u~nn~c/ GJ~~'~ ~~Q.~.`'f~( r~~r~rs/Ltl ~~d~~.,, l~t~lt-yam 13. s , b , ~ ~~ l/~r ~~~-/~ ~ ~.e C'~P~1d aQ- y,_¢.ede~/.~~ ~~e,~-~.y 3 yres. ,?tam . Faso w~`-v ~..~ ~" ~!J" I ~~ ~ ~ S T-l- ~ 3 $o~ -- U (~ ~ ~-~u- Ce-,.,G~c ~'i`Shs - so17 t-e ~Y~ L-Pi/i"P,~ sR~o~ l_~''' ~y b ~'".c~~. ~ r,a = 9~. ~ p ~- ~ . ,:, , A- _ f~~ ~ --- t ~-a 1 ~ ~ ~ x B"3 ~ i~ ,,, ~a G- N•u`t~ ~p,Uaaoss> Department: ~Commeroe of Safety and Bui&linrts ~GS Ib,2>~o 1 SOIL EVALUATION REPORT '~ZI,Z~j0 : Page ~ of in aocoraance wlm c;omm cs5, vols. ream. t~ooe - . County `~ Pl t i i J ~ ~ an mus ze. n s Attach complete site plan on paper not less than 81/2 x 11 inches include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. U 2 D- / ~0 Z ' d 3 -CEO C~ seals or dimensions, north arrow, and location and distance to nearest road. percent slope , Please print ail information. Date b e ' ~ Personal information you provide may be used for secondary purposes (Privacy law. s. 15.04 (1) irn))• ~ /1~~~ / ,~ // // ~~~//'/rte,^- ~~~~ V v ^ ` 6 ~~ p~dy O~~ Property Location ~~ ~ Govt lot 5 F 1146 L 1 /4 S // T 7i / N R / 9 E (or) ~ Property Owners Mailing Address Lot # Block # Subd. Name or CSM# ! 35 Pt e Trc,-t 3 M i -~ ~I iew City State Zip Code Phone Number ~ City ^ Village ®Town Nearest Road C, UJl EU ('115) 4 - ~ c .,. {ant lG ® New Constructior- Use: (~ Residential I Number of bedrooms 3 ' `l~ Code derived des' ttow rate ~ ~d 0 Q GPD ^ Replacement Q Public or txxnmercial - Describe: '~ "y". Parent material G V -t~t~~ a. 5 ~ Flood Plain a d~applica ~ tt. ' General comments S ~ $~~ ~l t /LV • 93. $ O La w t-~-- 9 0 "' {, and recommendations: L 21td'• 9/• yo rti ~r e / y p. L v , .. : ;- ~,~ ~ .' ~ n a(1~1 i ~ ,( r C'~ ~ bd~wr:.4 ~=E?EII~~~Lfhc~i C~ ~titZ~ ~a arC'~D~a~o'~..~ ~ Si viit?~ ~ ,t /~/ //, ~'. D,.~,~CCee--v~~E ,. An~~,.....:~,,...A :_ ~ .- Q b y-~ 'YNe~ _ ~ ic./AU DA/ /'~ ~/~l1'If ~H/'~i L~Offitfl..~~ ~G Zvi rN .~ \ / ^ Bonng ~ - ~''~ ` Boring # ~t ` Ipl Pit Groundsurfaceelev. 9~'•G o ft, Depga to ~~g factor~'rtly~ ~~ lication Rate rizon H t De Dominant Cobr Redox Desrxiption Texture Structure Consistence Boundary Roots GP D/ft' o p in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ~ D~~g 1 1~3/Z 5L lm.~b ~S ~ v~ . 5 . 9 i ~- ~ 3.8' - r' °13. ~ r~ Boring # ~ BO"ng p ®Pit Ground surface elev. 4 ~• G 0 ft. Depth to larlidng factor ~ /o in. cal tion Rate Horizon Depth Dominant Cobr Redox Descrry~tion Texture Structure Consistence Boundary Roots GP D/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 3 5y-/~ U r ~t/~ -- m S 0 rn I ~ - .~ ~_ z 2 . ~' 5*'J. 6 ti ' -~ . 1~r' D. f S o " ' Effluent #1 = BODS > 30 < ~0 mg/L and TSS >30 < 150 mg/L ` Effluent #2 =GODS < 30 mglL and TSS < 30 mglL _ - _ - -_. CST Name (Please Print) Sgnature CST Number Adari, ~c hut,~ker ~~ - ~~-~ ~--~~~ 25 ~~9 A~~ Dam Evaluation Conducted Telephone Number 21t~ ~'~ `~ Sr~r,r,~~~, ~~I 5y0Z~S /G-ice-- o / t~15~24~-yov8 property Oamer ~~~ ~ _ Parcel ID # ,.,,~ Page ~ of Boring # U Boring 3 ®Pit Ground surface elev. ~Ld ft DeP~ ~ ~~g factor ~ Z g in. Sal ication Rate Horizon Depth Dominant Colo Redox Description Texture Stnr<ture Consistence Boundary Roots GPDlfF in. Mansell Qu. Sz Coat Color Gr. Sz Sh. *Eff#1 'Eff#2 ~ - io lb ~ ~3 Z Si / ZmG.h k c I v-~ . 5 2 p Ip ~ - Sid 2 ~ _ 3 ~ -12 y~ - ms DS ~I _ .-7 .Z U /'b1 I,/ivh ./~-Qi2,0/ l/N •Yy, D d d ctiv(. wy ~~ # ~ Bonng v --- • - - - - - ^ Pit Ground surface elev. ft Depth to laniting factor in. Soil tication Rate Horizon De th Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/ff p in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 'Eff#2 ^ Pit Ground surface elev. it. Depth to Irtnituig factor in. Bor(ng # ^ ~~ Soil lication Rate Horizon Depth Dominant Color Redox Descxiption Texture Structure Consistence Boundary Roots GP D/ft' in. Mansell Qu. Sz Cont Color Gr. Sz. Sh. 'Eff#1 "Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 -rxyL aril TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. tf you need assistance to access services or need material in an alternate format, please contact the department at 608-26fi-3151 or Tl'Y 608-2G4-8777. SBI)-8330 (R.07l00) Property Owner ~`rf'(~(~ ~ Parcel ID # Pege Z ~ 3 ~~ # ^ e«ms Ground surfsoe elev. ~ d ft. Depth to rniring factor ~ Z O in. ® Pit ~ Soil Rate Horizon Depth Dominant Redox Descriptbn Texture Stnx~ure Cor~Gance Boundary Roots GPDIPE in. Munseil Qu. Sz Cont Cobr Gr. Sz Sh. 'Eff#1 •Eff#2 - - L Ib r3 Z Si ~ Zm~.b k c I v~' . 5 2 ~0 4 - Sid 2 c _ 3 ~ _,Z fp ~J - m.~ ps 1 - _ _ ~ ~. z Banng # ^ ~~ ^ Pit ~~ surface elev. ft. Depth to limiting factor in. Soil n Rate Horizon Depth Dominant Cobr Redox Description Texture Strucdtue Consistence Boundary Rools GP DIit? in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Etf#1 `Etf#2 ^ Boraig # ^ ~~ ^ Pit Found surface elev. ft Depth to I'6miting factor in. Soil lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/tf° in. Munseli Qu. Sz Cont. Cobr Gr. Sz Sh. `Eff#1 "Eff#2 'Effluent #1 = BODS > 30 < 220 ntglL and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 30 mglL and TSS _< 30 mglL 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 608-26G-3151 or TIY 608-264-8777. SBU-6330 (R.07/00) PAGE~OF~ 'NAME S~oJ~ LOT# 3 LEGAT DESCRIPTION.SF ~SE i4 ,S /r T5E ,N,R,S~ E(~~ SCALE: 1"= ~~~ , BM 1 ELEVATION !oo . o BM 1 DESCRIPTION to p o-~ 1~~' ~ Z " l~~~ ~ BM 2 ELEVATION 9~ . /o BM 2 DESCRIPTION ~ P a -~ ~ c,f'11 Z" t-E•'o~ J,,_ SYSTEM ELEVATION d*rP q 3, ~y Lr~t.rc r R(2. YU ALTERNATE ELEVATION 4adr q' f .2 U Lo.,,cr `ly zy CONTOUR ELEVATION9'S • ~a "' `I ~•,S~ 0 ~~~ b~`~ ~D ~a x B- `~ ~~~~ ~yav~ ~3d, ~, -~ s-~ ~ ~ 6~ ~ ern Z i Sec.. ( f fi _i n / ' ~~ ~, ~,~. ~~" k ~ ' t ~'~, ~ ti~ ~/G g-3 ~, ~~ o"~ (°~` q ~~. ~~s.., ~.w O r~ `~`°''!~`' M, SIGNATURE r7~~ ~'/- DATE /G - Z 3 - °/ lP~ oos; can sw~sesav S1/4 CORNEF SECTION 11 N R ~~~ o.~G~ ALUI~NU41 DouNrv secnaN i 00li~1E1 Mp4AAB~lf FOUND RIOIN/ WAT91 RElB~l110N ARPA 'v FOUND Y PIDN PiE . ~ NWOwwr enaADUW&gwNp ~ 80L BDI*JCiB _ -'-'- /2WDE lRI!lV 6~BB.IEMf ~ moRRND race P~on NDI@ L~vr. PLaon e.evwnon M n~ ~a+ure o~ ~~ FMBF®FInOR 6~NATION OR 7M! IDVYEaf ~,~ ODNT~OUN LNC MBEMBJfWMCOINgi DOOIIRkYA710N K!t{N! BPOfBPVA7DN II.W.L Hfi1 WA7®ILNE NOIE NOOVA~Eq ORPBCBff NYLLL DO ANYrIND WNDM WOIRO NiiMi~ 1AR1l1 OR (1.fACllp) NlTIUN.MlL6APIlA OMNJO[TROPN~TIONOPiM~APPIpV® OOI~M}IHIENN7 WA701 pMN11D[ AND X01. PDII [LOP! OR OR6L'1®1 BgB10N FLAN FON 1PN PLAT. TN MK1UOi88Uf q NDTLMJiD7OYU~OPq t1f-7D1LilOPE lF'OI~OB6TINlDiND. AL7®r'14 RWOOR Df.AVAINQ OII Pl/Vi1ND N ANY PO-O fABB~iIl, NVNYI DMNM~ OR'DFE~, t r.. r... =0'WIO[dMNW[PAIDABJf 011~d~Nt~~yR10~~OUWpR~.~NIt 6 Do1raY d 2dW, MobNr~d WbeePNlu WW ~uV~ybP, Mr'~Y ~Y that UM droV~ dMpIMO Ord PPNIpMd p10pK 1M~~ M~11~y~d by wM a urly Pld dY~et wpPrlMan end tlr tlJ~ nryP It ~ oanot P~pPNQIhtlOPP tY ~Ow dyN- bOUrdQI b ~ bMt W nqr bgwwd~ end bNN. ~, ST CROIX COUNTY SBPTIC TANK MAINTBNANCB ACRE AND OWNBRSHIP CBRTIFICATION FORM Oa-ner/Buyer C dj!!ES ~G . Mailing Address ~ property Address il~• (Verification roquir+ed from Planning Deparmaent ~ new Parcel Identification Nutnbes aaD 'f ~~~ _~g~-O d0 City/State SAL DESC$IP'I,ON. Location ~~ %s, 5 ~- %,, Sec. l ~ . T~N ~~ w, Town of Pml~y Lot # 3 -- Subdivision /yl~~S~'l !/l~/ Certifiied Survey Map # _ ~ Volume ..Page # Warranty Deed # 7D ~/ 3 ~C ~ .Volume .~.~ Page # `~ Spec house yes [7 no Lot lines identifiable~es D ao S~YST'EM ENAl~CE lure failure to handle wastos. Proper maiatenaruce use and rnaiatenan+xof your septic system could result in its prema ~ ~ system consists of pumping out the septic tank every three years or sooner, if needed by a Iioensed Pumper ~t 3'OU P~ txa affect the function of the septic tank as a treatment stage is the wasto disposal system. The properly owner agrees to submit to St. Croix Zoning Departrneat a certification form, signed by the owns and by a masbCrPlumberloutneymaaPl r,~ctedplumberor a licensedpumper verifying that (1) the on-site arastawaterdisposal system is is proper operating condition and/or (Z) after inapa~ion and pumping (if necessarl-). ~e septic tank >s less than 1/3 full of sludge. ~ the umdersigned have read the above regnir+emonts and agree to maintain the Private sewage disposal sy~m with the standards of Natural Resources, State of Wisconsin. Certification sot forth. herein, as set by the Department of Commerce and the Department to the St. Croix County Zoning Office ~` 30 stating that your septic system has been maintained must be completed and returned days of the year oxpira ' date. Zia io3 DATE SI(IIJATURE OF APPT.IGANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr 'bed about virtue of a warranty deed recorded in Register of Deeds Office. 1.3 ! d DATE SIGNATURB OF APPLICANT t being revoked by the Zoning Department **«"`«« «««««« Any information that is mis-ropreseatod may rca;ult is the sanitary Perini «« Iadude with this application: a stamped vvartaaty deed: from the Register of Deeds office a copy of the certified survey map if mfer~enco is made in the watraaty deed ~~,,POWTS OWNE'RJ'S MANU.A/L~& MANAGEMENT PLAN Page~of ~ FILE INFORIiAAT10N ~ ~w~~~~ ~ ~ ~c~~~~iv"SYSTEM SPECIFICATIONS Owner ~ ~~~ ~ f Permit # ~f 2. o DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) oo al/da Design flow Ipeakl, (Estimated x 1.5) (OQ© al/da Soil Application Rate ~ al/day/ft2 Standard Influent/EffluentIlualit~ Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD5) 5220 mg/L ^ NA Total Suspended Solids ITSS) 5150 mg/L Pretreated Effluent Qual'tty Monthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids ITSS) 530 mg/L ID~NA Fecal Coliform (geometric mean) <_1 ° fu/100m1 Maximum Effluent Particle Size Ye in dia ^ N Other. A 'Values typical for domestic wasKewater and septic tank effluent. ^^ n~urcw~ ew~ne erucn~ u e Septic Tank Capacity ` ot,~~ al ^ NA Septic Tank Manufacturer j~~~ ^ NA Effluent Fllter Manufacturer ~ a~~ ~ ^ NA Effluent Filter Model ~ -1Q CJ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ N Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: A Dispe al Cell(s) oZ ~r~~s'~`~(~G' ^ NA n-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other. ^ NA 1\1/111\~G~\M1\VL VV~~L.YV~.V Service Everrt Service Frequency Inspect condition of tankis) At least once every: ~ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tankfs) When combined sludge and scum equals one-third (Y,1 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ monthls) (Maximum 3 years) yearls) ^ NA Clean effluent filter At least once every: ^ monthls) year(s) ^ NA ^ monthls) p NA Inspect pump, pump controls & alarm At least once every: ^ year(s) ' O monthls) ^ NA Flush laterals and pressure test At least once every: ^yearls) fir' At least once every: ^monthls) ^ 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 tankis) 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 IY31 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 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. Page ~ of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other cherrlicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) 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 Isump 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 shah 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 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. ~~ ^ T-e site has not b°°^ av In tari +.+ ' ~ s•• •~~^~1.. .,.^I^-- - - -~..il•,.° .+f the P~WTS a coil and Site ~~ ,___ ..61.. nlnn°mnnt araa If nn r°nl•-_ -~ 1 1i1~ ~ h^!~!nS! tank evlu-t~nn . ~... ^ 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 n n Name Phone ~ ~ - ~ ~ ~ j POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~ (~'~ Phone l - 3 ~ - ~ Q This document was drafted in compliance with chapter Comm 83.221211blltlldl&lf) and 83.54111, 121 & 131, Wisconsin Administrative Code. U 2139P 'i51 ` ~ STATE BAR OF W ISCONSIN FORM 1 - 1998' WARRANTY DEED Document Number This Deed, made between Kristv M. Smith ,Grantor, and McCabe Homes. Inc., a Minnesota COfDOration Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): ACKNOWLEDGMENT Area Name antl Return AtltlreSS McCabe Homes, Inc., a Minnesota Corporation Lot 3 Starlight Avenue Hudson, WI 54016 020 1013 30 000 Parcel Identification Number (PIN) This is not homestead property. (IS) (fs not) Lot 3, Plat of Misty View, Town of Hudson, St. Croix County, Wisc sin. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 12 day of February, 2003. EAL) Kristy M. mi (SEAL) AUTHENTICATION WENDY SWATZINA signature(s) NOTARY PUBLIC STATE ol= wl authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 3-21518 (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in anv caoaciN must be Noed WARRANTY DEED 7t~9361 REGISTER OF DEEDS ST. CROI% CO. , MI RECEIVED FOR RECORD 02/12/2003 12:45PI[ EJIt7~T # TRARSEFi6E: 225.00 COPY FEE; CERT COPY FEE: PAGES: 1 State of Wisconsin, (SEAL) (SEAL) ) ss. SL Croix County Personally carne before me this 12 day of F ~ 52003 the~boyq~amed y}~ ~T to me known to be the perso ~ who executed the foregoing Instrument and ckno edge the same. . ~-e n c-cx' ~' Notary Public, Stat of Wisconsin My commission is permanent. (If not, state expiration date: ~~5ih~ ., STATE BAR OF WISCONSIN FORM No. 1 -1998 Wisconsin Legal Blank Co, Inc. Milwaukee, Wis. I ~N Q ~ ~ O 70 ~,OS N ~ ~ OS ~ ~ N - ~I I I A_ . ~. •. mw I I V o w I i ,s9'ZbE N1„EZ,yEo00N m a ~~ I i ~ A i .10,49'47"V1- ,~ ~ ~' ~ / Om"s I ter. ti II __ _~ ~ I I I ~ I '/ ~a~ '~~ I ~~-- r ~ ~ t0 ~ ~ ~ p r m= ~ I ~ m= i ~ororZ I ~ w ~ I I~ ~o O i>" r •~ o r ~ N a "~ o -~ r ~ ~ ~A p ..a ou I I ~~\ ou ~ Q~~ ~O ~ I I I ~~ ~y p~ .`_,~ ~ N 0 ~ I I ` b.0081 £L-1 \~ \ ~ ~ I ~~~ LOON \ I I , I I \~`. I ~~ N b ., '4 ,os _ ~3 ~ e -~ -• 1, ~: •~ ~ ~ ~ aoN N y~ r- m Z O N°o r ~ O o ~ ~ ~ :~~~ og0 m oa ~ N ,, yn ~ I _ ;~ a-1 ~ ~p w O70 ~ _ ~ ` p .~ , 01 ~ ~ `. ~ ~ m ~' ~ ~ `~ ~ `~ ~ a V e I I ~ ~~ ~ ~~ 1349.37 ~~ u; Q - ' 238. Or r ~ 246.67' 239.83' 1 .73 C m NOO°2gp2o°7a~ba~M '5.20' 1' ~ Z _ _T-.~.~ ~ ~- r.-,r~ra n~Il/1M~n o C`7 r' ran-Il~~~ a 7270 1 1 'J 2285P 39S STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between McCabe Homes, Inc., A Minnesota Corporation, Grantor, and John D. Saranzak and Helen C. Saranzak, husband and wife, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 3, Plat of Misty View, Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties:' Easement's, ~resntrictions and rights-of--way of record, if any, ~~~ Gt'l? !/h r Cow ~wj^ _ sys,/.~,` .1 Dated this 20th day of June, 2003. mr: cA~~ r~mEs, A snvrtt» rr~,~,nari:,s AUTHENTICATION Signature(s) authenticated this 20 ~ia ~~.~A~iRON Notary Public TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WA5 DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street # I 1 S, Hudson, WI 54016 (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 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 06/23/2003 02:45PK iIARRANTY DEED EIIEMP''f # REC FEE: 11.00 TRANS FEE: 974.70 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2'~ St. -Suite 1 l5 Hudson, WI 54016 396789 020-1402-03.000 Parcel Identification Number (PM) This is not homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. P ovally came before me this June 20, 2003 the above namedcCabe Homes, Inc., A Minnesota Corporation to me known to be the person(s) who executed the foregoing instrument rZd acknowledged the same. ~ ~tplYt0.S ~'TC ~ ~~ CZ7 ~ . '"Dian . Ban~on ` Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 11/19/2006 ) WARRANTY DEED STATE BAR OF WISCONSIN FOIiAt No.2-2000 ti N i~ a o I ' M ~ i i a C ti ~ ~ I ~' a O N O v i C '~ d 3 i ~ ', , 'o c 3 i 3 ~ ~ rn W o Z y ~ `~ ~ ~ ~ r O '' ~ ~ ' Z ~ ~ ~. a m oZai !~ ~ ~ ~ t ~ Z ~ ~ O Q I ' y . ; c ~ N ... C! 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