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020-1402-04-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563818 0 GENERAL INFORMATION 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: Delta Construction, Inc. Hudson, Town of 020-1402-04-000 CST BM Elev: Insp. BM Elev: BM Description. 2 Section/Town/Range/Map No: Z. ~5 ( 11.29.19.2515 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER +~95 CAPACITY STATION BS HI FS ELEV. Septic Benchmark 66 I0096ng Alt. BM n /,3 /Q 2_ Aeration Bldg. Sewer, ,Z Holding St/Ht Inlet 4, TANK SETBACK INFORMATION St/Ht Outlet, TANK TO p ~/L 1 WELL BLDG. ent Air Intake ROAD Dt Inlet Septic ! - Dt Bottom 1~6 AJ 4- 2) -716.0 - Dosing may? Header/Man. cI duo J~p•g Aeration Dist. Pipe , s 4f, 7• 95 Holding Bot. System $ . I 75-3 17 PUMP/SIPHON INFORMATION Final Grade 3.5 9 7-'S' Manufacturer Demand St Coved C / 3 GPM / z Model N er J2. t 86.1 s T'9TD Lift Friction Loss System Head TDH Ft Forcemain Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z t SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION a Type Of System: CHAMBER OR 7- .,3 / G10~^Vi'~~ " ~ / b~ /J,4- UNIT Model Number:,.,` ~ ~U r, , v ' DISTRIBUTION SYSTEM /4 3Z S Header/Manifol~ Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) :5`4,j 0 , C- Length (0 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over "",/~~I~~ Depth Over xx Depth of xx Seeded/S dded xx Mul hed 15r , Bed/Trench Center / ' Bed/Trench Edges \ Topsoil es No s 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 789 Starlite Ave rHHudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) risty View Lot 4 Parcel No: 11.29.19.2515 1.) Alt BM Description = r.- jL Ga ` - G lil wv~w- vG k 2.) Bldg sewer length =Z 7 - amount of cover = Plan revision Required? ❑ YesJ No / ~ I ~ ~ ~ 13 L4 Use other side for additional information. 24,- ~ lp SBD-6710 (R.3/97) Date Insepctor's ignat Cert. No. J PLOT PLAN PROJECT Delta Construction ADDRESS 400 S. Second St. #135 Hudson Wi 54016 SE 1/4 SE 1/4S 11 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/25/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of lath ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' E AT N _ 94.8/94.0 5' below grade of tank, piping shall be Schedule 40. Vent .M. 72' Property >6'9 i Sta dar Well is to meet all Line of Cover achin Ch r A setbacks required by o ea .6ft^2/pair caps` WDNR 30' 4' Long 12" ade Elevation 50' 34" is -2 7b 0' ents X 66' cells wi p 1ng Scale is 1" = 40' unless otherwise noted 20 Pro 3 Bedroom B-3 House 0' 30' 7% Slope 15' ST 50 B-1 i 99' I 100' 98' 321' Property Line - - County n t. mo''`t i EC EiVED Industry Services Division . ' 1400 E Washington Ave Sanitary Permit Number (to be filled in by CoJ , 4 D S . , 1-1 P.O. Box 7162 I S 4; JUN 2 7 , 2013 Madison, WI 53707-7162 State Transaction Number 9affil uMmit Application A) in accordance with SPS 383.21 (2), Wis. Adm. Code, submission of this form to the appropriate governmental unit - is required prior to obtaining a sanitary permit, Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary / purposes in accordance with the Privacy Law, s. 15,04(I)(m), Slats. lnformatioa -Please Print All Information - Parcel #7? ~7 1. Application f~ Property Owner's Natne , _ ©02 D ~ O a2 ~J r C4-- a Property Owner's Mailing Addr::ss Property Location S7 Govt. Lot / City, State Zip Code Phone Number SE Section CA,) J y C. T / N; R /?ircleo 1 V - rW 11. Type of Building (checlt all that apply Lot fr 2 Family Dwelling - Numbertif [3edroo s ubdivision Narne S D , ) Block N ~DdS~. ❑ or ❑ Public/Commercial - Describe Use city • P CSM Numher illage of State Owned -Describe Use L1 - Town of 111, Type of Permit: (Check only on box on line A. Complete line B il'applicable) - A. New System I.7 Replacement System ❑ Treatment/1-lolding'1'ariR Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Issued ~L Date B. El Permit Renewal 17 Permit Revision ❑ Change of Plumber El Pemrii Transfer to New Expiration owner - - _ - IV. T e of YOWTS S ste!!! mponent/Device, (Checli all that apply)__ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil P ❑ Holding Tank ❑ Other Dispersal Component Pretreannent Device (explain)__ ~-~tfw~~ V. Dis ersal/Trea ent A!•ea Inforination: DesignrFrloow (gpd) Desigr Soil Application Rate( dst) Dispersal Area Required (st-- Dispe-sall Arrea 1'Lt)po d (st) System E1ev tin 1 Total # of MJanufacturer 1. Tank Info Capacity in v Gallons Gallons Units 9 w c H n New Tanks Existing Tanks u° U ii. t5 a. l_, RQ v I~ ~J-G/-ay'~.. ~ • w cif Septic or Holding Tank ah Dosing Chamber - Vii. Responsibility Staternent- 1, the undersigned, assum onsibility for installation of the PUNTS shown on the attached plans. Plum is ame (Print) Plumber' dturc MP/MPRS Nutnber Business Phone Number Plumber's Address (street, City, State,, Lip Code) Will ount /De )artment Use Only-(/ - - Permit Fee Date Is ued Issu,rig A Signature pproved ❑ en Reason Denial ~T Y ✓ - - - n IX, Conditi easons for Disapproval 3, lu v 1, pti ' tankef8tlferit fi ter grid G/Glo ,,dispersed cttill must all ~e ~ervtces l maintalruild as {few management plan provided by'plumb er. [A00.1k o,-A ~ 2. ipll1lk [agttlletnerlttl must be t:laintainbd 1 n ~ro r'a"~'1 PK ~ code t or~ar~s. _ ' Attach to complete plans for the system and submit to the County only oil paper not less than S 112 x t 1 inches in size SBD-6398 (RO313) . Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/25/13 Owner: Delta Construction Location: SE1/4 SE1/4 S11 T29 N,R19W 789 Starlight Ave Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan i 7. Filter Specificati heet Signature License nu 4;r #226900 i PLOT PLAN PROJECT Delta Construction ADDRESS 400 S. Second St. #135 Hudson Wi 54016 SE 1/4 SE 1/4S 11 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/25/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of lath ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 94.8/94.0 5' below qrade of tank, piping shall be Schedule 40. Vent .M.* 72' Property >6" Quick4 Standard Well is to meet all Line of Cover Leaching Chamber setbacks required by with 20.0 ft2 of Area WDNR 5.6ft^2/pair of end caps 30' Long 12" 3 4" Grade at System Elevation 50' -2 0, Vents 3' X 66' cells with >3' spacing Scale is 1 = 40~ unless otherwise noted 20' Pro 3 Bedroom B-3 House 0' 30' 7% Slope 15' ST 4111- 50 00.0 B-1 99' 100 98' 321' Property Line i Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99.8' Len Grade Vent 3' Septic Tank 5' L5' S' Long 1 Grade at System Elevation 3 6Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A-94.8' B 94.0' ST. CROIX COUNTY SEPTIC.; TANK MAINTENANCE AGIMEMENT AND OWNERSHIP CERTIFICKrION FORM Owner/Buyer Mailing Address --!?Z~__S Property Address (Verification required frarn Plant~rng & ~oniazg 1:)epartnie:nl for new constrvctiun_) City/State Parcel ldentiilcatiotz :l`fiurliwr. ojo_.'/... /_.Q U`.--_ / rOV C7 LEGAL UESCIItYp''.I':CUN Property Location C % , r/4 ,Sec. 2-?N- X w Towel of Hof # Subc~ivisiori Certified Survey M44) it - - - -r Vt>l x~ne ~ Y Page 9 Warranty Deets # l~ ~ 1 Vohllne Spec house 0Y., no Lot lure:• dentii:iabl yes no SYSTEM MAIN TE k'i(ANCE AND OWNER CEW11FICATIOIVN improper Vase and rlhainttaiance o€ your septic system could result in its premature failure to handle wastes. Proper maintouance, consists of pt: roping out the septic tame every three years ur sooner, ifaceded, by a licensed ptanper. What you put into the system can affect the firnction of the septic tank as a treatment stage in the waste disposal system. Owner rruritrtenartce responsibilities are speciiivol in §Cotrntt. 83.52(1) and in Chapter 12 - St. Croix. CoUrVY Sanitary Ordinance. The property owner algees to sabinit to St. Croix County Planning & .Zorii iF; Department it ccrtiliCatior► forru, signet[ by the owner and by a master plumber, journeyman piurnber, restricted plumber or it licetrted putrtper verifying that (1) tht on-site. wastewater disposal systora is in proper operating condition anal/or (2) after inslrectian and prunping (if necessary), the septic tank is less than 1/3 full of sludge. 1/we, the wrclersit;uud have read the above requirerrrents and agree to mammin the private srwabe disperse[ systerrr with the standards set forth, ]lerei", as set l7y the ):)ePd trnerrt of Colrrrrrerce acrd the DepartmurLt of Natural Resources, State of Wisconsin. Certification stating that :y:ittt SeptiC system has beery rrrttintained must be completed and returned to the tit. Croix County Planning & Zoning Deparlrnent wlthirl 30 clays of the three year expiration date, I/we certify that s-11 staternents on this forrrt are true to the best of my/our k 3 3wledge. l/wC arrJtue the owner(s) of the property described above, loy -virtue of a warranty deed recorded in Register of Deeut Office. Number 0 bed'0011 le ~ GIN TURtE OF APPLIC.ANUS) DA'T.l? Any infbrrriatiox1. that is Misrepresented may result in the sanitary perrrrit being revoked by flee plattmng & Zoning Department. Include with this applical.ion a recorded warranty deed from the Register of Deeds Office and a copy of tine certified survey rrrap if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN page _ of__ FILE INFORMATION SYSTEM SPHICIFICATIONS Owner ~ p , Septic Tank Capacity ❑ NA Permit # Septic Tank Manufacturer I I NA DESIGN PARAMETERS~..~~ Effluent Filter Manufacturer, U NA Number of Bedrooms _ ❑ NA Effluent Filter Model -1c1~ 4NA _Number of Public Facility Units NA Pump Tank rapacity - Estimated flow (average) gal/day pump Tani; !Manufacturer i Design flaw (peak), (Estimate=.d x 1.5) l~ ~ gal/day pump Manufacturer Soil Apptlcation Rate gallday/ftZ Pump Model Standard tnfiuent/Effluent OL"ality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L 0 NA E3 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 6150 mg/1_ CJ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) _ ❑ NA Biochemical Oxygen Demand (13006) 530 mg/L ><,n-Ground (gravity) ❑ In-Ground (pressurized) 1-0 0 Total Suspended Solids (TSS) 530 mg/L NA 0 At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/10om1 0 Drip-Line ❑ Other: iMaximum Effluent Particle Size ~ in dia. ❑ NA doter' ❑ NA (Other: NA Other _ ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: O NA II~IAINTENANCE SCHEDULE Service Event Service Frequency ]inspect condition of tank(s) At least once every: moat s) ear s (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume 0 NA - month(s) Ilnspect dispersal c ell(s) At least once every: (Maximum 3 years) ❑ NA 0 month(s) (:;lean effluent filter At least once every: ear(s) ❑ NA Inspect pump, pump controls & alarm At least once every; _ 0 year(s) ❑ NA I::iush laterals and pressure tast At least once every: ❑ month(s) ❑ NA ❑ year(s) _ ether: At least once every: T ❑ month(s) - - 0 NA ❑ yearns) ❑ 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 inspectlons 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 zombined 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 fcrr 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 Iegulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (t) or more of the tank volume, the entire contents of I:he tank shall be removec 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, land any servicing at Intervalo of 512 months, shall be performed by a certified POWTS 11laintainor. A service report shall be provided to the local regulatory authority within 10 days of corn oletion of any service event, START UP AND OPERANON Page - of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of panting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high --oncentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall nol. occur when soil conditions are frozen at the infiltrative surlace. During power outages oump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and mey result in the Itackup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septatte 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 vel' icles over tanks and dispersal cells. Do not drive or park ever, or otherwise disturb or compact, the area within 15 feet down slope of ary 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; der tal floss; diapors; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicidesi; meat scrap: ; medications-, oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following stems 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 rif by a Septagf: 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: °W_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 compa,tion 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in plaa;e following romoval 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 OWTS INSTALLER POWTS MAINMINER Name Name e Phone Phone v a-rrly J-~7 SEPTAGE SERVICING OPERATOR PUMPER • LOCAL REGULATORY AUTHORITY Name Phone NamEe Phonjj-_ This document was drafted in co'npliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383,54 1 , O & (3), Wiscoi isin Administrative Code. FiLTER :crap x MY lit the xWel' cage .1k4a tm WW at'thr uutlttt t*W to ,,Sure it ix tehtured U"4111- ti" im=w,s c""nhvg. If not, V-m WiNr Inw-t two itloo iii*o the tank Nrrouyh Ittww au4A ,}r stAveet vaAd (ghm) ddditiu,ral pilm Attu the uurlet plus. iiymp a whyit tin owe eta dry MW on the cutlet plea, tanpr"W" tbu itutom of etit~iadk Will ~ rrwird t4iibmru the i1wer- to the to* ahd "a it utwIng the aptiorrai Y:Upa Mr~al r* suprtrurt, If >Irkia mumurt rnathad is tart utiff ed, prut7rttd to 40 Iota} s F.t• .3 For M""*" trtfl ""V the uptiaAi~gl s,du sluNpurt: soius+d Maid 4104 %-arch pe axtto the truer cam- 0 Gilt srippurt method is tart utlltaed, trt•oc*id 'ko 1eu foot: Solvtilht tiY* lit4'ilttei cage J*ft tip tHJillirt pitre. "art tite hitee carbidge ,eta he rce, I>(weslnri darer, ula}A tilig fiibtr lodcs irrtu the b tw % the c~sa. ut~r+txi ui' ,'•.'•;T' t..;r.. If b b its sY clwktrtlst: goa'~ MSittdt tlis utflrrttd_ 66*** arty torte Miss, and trrctd by turning Mal~rrte~rllali~iice t. lire aflltierdl Nttae sl.oY,td br 3urvio0d. rteatvad every tl,(kt tits a:aptlc tank iy 2. gpen the utotlat MCICesS areataurp to i J (5urrtip W.u eGalpat: tank ,7sttact the ~tNIC acrd ryiker, tawr pJQl:6jy, Makitlh sUrtj to r r ley- v» the b4ta"' 'f th+s C,irrit and oat just tits etrttdUe the siuddu ' Q. Utece rota erritrwtt:levwet hay L•Imetr torMtTrerd ~ gu,Rrt avid eliluolli, ,nutlet pipe, firmly pub up ua tPra 19Jtrtr hrsndie w th$ itlVetrt r,, tit,) M clrrttW" kro+,f fit* rte, dlcludftla IA 5. s11de thr flirt 'r rartrhlyet t+b Ind a,rt: ut'tlva s:lraut iFrJ►' ' ,r' t t;, JJ a VAS swfteh Uahiv*lrtr,d tr „ deaglrry. should tta rw,ricivatl by turwinl rcty rprirt is Ottlae"t With water reply t u tardm*w1spi 4tTw'e SWUM GtrYd ,~tsfllir3d While huldlny the r.~rrbi y down) over iiw +~f3 r5it iii itlt(g 4ccur (lame dart ani rr,- g t,n opurilr p urf~te~ercirtp auto all c ti' Yr akih ~r ift ~rl Cry11;r1d rt ' atrJriveyrn ruratmtlal is tl tvtirit wtrtftY u tJ !J' VlW bivitch is utNirxd tlrrsad Uack Intr, tlt+i I fwp)W tt b twat. twos h,g dack"ise tJn~. y Ii rlrtll,{ti fabJ Jlltur arrd /4, ' J, Ytwtfrt the filter c:at•tri° b i the ,lira, luck y: uck Into lh e` . it*u the Lrittucrr of thur a Cate, lireicyiq~ datWrt't!►uVl ip. Ftnlrlaerj Old secure tIJH case. y. u 't4 1rC { IfX7r8i tJlJEliilii ot, the t ' Yo q hwY t.E::ro. ~~''f1C,~$'i'illrllJ~t~>~iid.k:[►ri7. ~'r~1 ~p~~,~~ M"Al 4 1 04 FLOOR OMM CW T3 - airr s t ` r i. .00 L" 4 t s wri 4a so Pr ~t I iY HWL ' aim Ac"m 7 IO Pr STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED 6 9 1 4 7 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between RICHARDL 0. STOUT and jANET P FT-GU 05-16-2002 8:30 AN - hucba-Ad-and- w±fa, WARRANTY DEED p-~-~-~--..---- Grantor, EXEMPT # and ETA -C QNSTRTTC'PTQN, TNr REC FEE: 11.00 - TRANS FEE: 179.70 COPY FEE: Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee the following PAC's' 1 described real estate in Gt -Crte] w County, State of Wisconsin: Lot 4, Plat of Misty View, Town of Hudson, St. Croix County, Wisconsin. Name and Return Address Ft LL 020-1013-30-000 420-1014-10-000 Parcel Identification Number (PIN) This- _inn} homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 1 S Y h day of May ~ 2002 / (SEAL) `L/~L~iL 9 (SEAL) Richard O. Stout Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, 1 )l( ss. St. Croix County. authenticated this day of Personally came before me this 1 5 _ day of May 2002 , the above named Richard 0--Stout-and Janet _P- Stout TITLE: MEMBER STATE BAR OF WISCONSIN NC)TARY PUBLIC _ to (If not, me known to WiSQQN%%t~d the foregoing authorized by §706.06, Wis. Stats.) Instrument and ackRgRNC ~aI{ieBAST THIS INSTRUMENT WAS DRAFTED BY , Janet P. Stout 1353 A_w_atukee Tr. HudSOn, WI 5401 6 Notar Public. State of Wis nsin My ommissi4 is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not '1`t/jrr~/i~'3 ) necessary.) - ' Names of persons signing in any capacity must be typed or printed below their stgnature. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., inc. FORM No. 2 - 1998 Milwaukee, Wis. Jun 26 13 06:59a p.1 I u•w. I ~ i r'- ' I I I , I 1 \ I =3LJLJ h r r 1 ~t D I z ' I 7, I I v,n I' Fm i~ .r Z r ; r: I' I'~ I' I D m .1 z z El I~ ~ III - r , ~ Imo, i i e~ aGm ` rrrl ~ I _L1J_LJ r I ~ 1 ' ( I'I I ~ I 1 , ~ \ ~ v I ~ ~ & ~ ~ I 1] 0 F 6 D r 1 _ ,_•I 8 o 1 I'- 4. ~ ? $`$'1~-•~ =se s t~ a p~ ~e DELTA CONSTRUCTION i ~ a ~ a I o of = g£.~x~~ !,Hl ON & MARY BERGERON ° g [NJ r A .04, 1 Sli~9A ~ al HUDSON: WISCONSIN y qb w I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Jun 27 13 08:44a p.1 Jua.27. 2013 7:44AM ARROW BUILDING CENTER No.2642 P. 2 - - V -e .ill. a.v 4 CI w - I i aS S. a ~Y S i Ik ~ 5 a.v j' t 11 i I~ ~ s 0 11 I r- y 5q u I t ~ a y g - - to 0.M 0.V .MM 1 ,a:atz&;c ~^~Iy ~z$ ig 1S c p r~3 41 ~3d E X - F4 In ltt P i N 4 § ; l F`Y=~is 7'ii9f =i'~~}~• , DELTA OWSTRUCTION 2 E ! 1 ! ! ' ' BRANDON & MARY BERGERON Nis! 11 €:01. , $ti~ecs~: HUDSON, WISCONSIN "~T4_ Jun 26 13 07:00a p•3 I r ,1•~• I ,BSL.i(A I _ I I - 4 ~ I _ ~s r i 1P-r I i > I c z ,OOC :fep ' r• ! firi T-no iJ> i ,j'`O q.J,'y~'•~~'\r q I g Yq> R~ s 'is .1 o.owN~ cbalr .~~V J~ e I a Y °7 y .3 ~ 1i11 ~ k ~ y I 4~q Ails ~i ]i•~ ~ RS J; kT oz _ I 4 ~ z n ~ t~ I - ~ I §Z r .B I v i r ra n,nr 1'C b Hi C. _ I 4 hp I Q' I V-DI f xf:-'IIr ~ FY ry §.a NON O>7NER ^e ~ - S G Rm 4 L '-r o-r .c.,a- I I . K- S6rIZ ~ r..'altl~L_q~`it7~jE168E5®rr _ 1 A'~A r ~ I cIM ~ ~ 1 I d I .i N Vu. iEQ I EgIE.,umENT h I S I erxu• ~ I iu9gIbvEn ° , 3! 6 5g~ ~Z Y 9'ni- 4Y ' 10.1• h J b, I 4 _ r' 9 4 I I 1 A 19- m°~ r~ a s i :x, q ~I' i, R h I azl 3a - - OQ,Y nRi w m,a ',J O jl3 w 'II H I 'S ~ Izs' '~4 lea• I I Z _ II v I DP.E98Eq ° IOiC 8 'O i~! I r•r I nr I I it oil as ~.%:DARa +$~_E8 a m g f _*°Gyp~,3k5$Ir. r• 5i$ DELTA a ➢ i m ' x• CONSTRUCTION ~r m R~ g V -$19 $ i yr a f z9„zlR3~.~y1 BRANDON & MARY BERGERO a, m '~t.~'- 3;3 es ag~x=4' HUDSON. WISCONSIN 4 d m I - - - - - - - - - - - - pct 101 is /o) #zi l a Weconsin Deparlinent of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County incude, j4ut not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. n Z , v , OUf~ ,orcent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ `0 I!Zo Please print all information. evie by Dat/e~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))• ` G d v Property Owner Property Locator GovL Lot S L 1/4 S~ 1/4 S T zq N R ( 17 E (or)~j Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 1153 A e TrG 4 H!5+\/ City State Zip Code Phone Number ❑ City ❑ village ® own Nearest Road SM N01 151401W 14 J's r) ~4 qrLk ~Audr [ig New Construction Use: Residential i Number of bedrooms 3 - L Code derived design GPD ❑ Replacement ❑ Public or commercial - Describe: ' Parent material 00 C. S K Flood Plain elevation if a~ip icable K a'-1C `x General comments $ -S~e w, t ( t ✓ G U and recommendations: 1~'L L u/ . + Q 3. ro 40 ov t C7 0 $T CRt]6X 0UNTY Z(JNINGOFFICE / a,~ Boring Bonin # O 51 Pit Ground surface elev. 9 ft. Depth to limiting factor ) 4~ 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 6-l if 10 r3~-L S;l 2mab rr r' G I V-r 5 8 z ry s3 to l~ ; I k r .5 .8 3 -rd /D r`~ m S s m - - I- Z 1 ~ loo ~ ~ # BOn FTI Bonng ® Pit Ground surface elev. W ' 0 ft. Depth to limiting factor in. Soil lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Z ~D-ZI i lm CS - .7 ~.2. - ZI -lw lU~ ref w - m s L~ ry) ,r ' Effluent #1 = BOD > 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) Signature CAST Number h G Addy Date Evaluation Conducted Telephone Number 2\ t 5ya C~~~~24j-4W g Property Owner DTI C 1(lt Parcel ID # Page Z of J ~ Boring # Boring Fs-1 ® pit Ground surface elev. 17:7- qa ft Depth to limiting factor 11 in. Soil Applicatio Rate pHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eft#2 1 v-~` 8 0-13 i) 3 ~ S i l Z r C-5 yL m r c-S - 1 D f I tom 6 -7 2 Boring # ❑ Boring ❑ ❑ pit Ground surface elev. ft. Depth to {Baiting factor in. Sal Applicabon 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 i I F-1 Boring # ❑ ❑ pit Boring 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 = BODS > 30:5 220 mg/L and TSS >30:5 150 mg/L ` Effluent #2 = BODS < 30 mgfL 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-8330 (R.07/00) Property Owner ~TT{1[ 1 Parcel ID # Page Z of 3 Boring # ❑ Boring Fs- ® Pit Ground surface elev. :7- qd ft Depth to Igniting factor in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Stiudure Consistence Boundary Roots GPDHf in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. `EMM `EW 0-~3 C~ 31 s~~ Z ryfr- c5 I -41 8 Z y f ryI L MACA (n r cs - Z m D rn ( - .-7 (.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/if' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2 T 7-1 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to i'mtiturg factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •E1142 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 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. SB"330 (R.07/00) PAGE 3 OF NAMES y T OT# LEGAL DESCRIPTIONSE YSE 14 ,S /I T Z J ,N,R, I l EloKW y0 SCALE: I"= BM 1 ELEVATION /6o • U BM 1 DESCRIPTION lop o J, 1- Z" 14,1 4, BM 2 ELEVATION 9dr / BM 2 DESCRIPTION p o ~0. q - s P C SYSTEM ELEVATION 9 y y U ALTERNATE ELEVATION JbP `l3• $D G-w;~ Y 3 00 _ _ C TOUR ELEVATION a~ _yo , Q $a qq np x U 3 'I /NYC N o a S/ 7 g-1 2c 3,L~ ~ ~ Sit -a ,j A S °v oc O SIGNA ! DATE /G L 3 _ o/ Parcel 020-1402-04-000 09/27/2005 11:27 AM PAGE 1 OF 1 Alt. Parcel M 11.29.19.2515 020 - TOWN OF HUDSON Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - DELTA CONSTRUCTION INC DELTA CONSTRUCTION INC 206 2ND ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 789 STARLIGHT AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.001 Plat: 2185-MISTY VIEW 1/17 020/02 SEC 11 T29N R19W PT SE SE MISTY VIEW LOT Block/Condo Bldg: LOT 04 4 2.001 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 05/16/2002 679147 1891/636 WD 04/09/2002 675857 8/100 PLAT 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Chan ed: 06/06/2003 Description Class Acres Land Improve Tot I State Reason RESIDENTIAL G1 2.001 44,000 0 44,0 0 NO 6T_4_L1 Totals for 2005: General Property 2.001 44,000 0 44,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.001 44,000 0 44,000 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 Safety and Buildings Division Cry 201 W. Washington Ave., P.O. Box 7162 f~S Onsin Madison, WI 53707 - 7162 Sanitary Permit Nmnber (to be filled Einby Co.) Department of Commerce (6011) 2663151 q53/51 Sanitary Permit Application State Plan I.D. Number in accord with Comm 83-21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1xm) Project Address (if different than mailing address) 1. Application Information - Please Print All Information S 9 t 0*1/. IN Property- Owner's Na me Parcel # Lot 8 Block # OZO - /'(02 - 0*-Ow(- TiSt ,NS' Property Owner's M ailing Address Property Location d .2 Ae City, State , J zip Code Phone Number , -A• f1- 90 j - g/•- (circle o C1 f~/`' L,tf 1 I r"" / IL Type of Bull (check all that apply) T .Z 9 N; RZEE or flKor 2 Family Dwelling - Number of Bedrooms 04 ger Subdivision Nani /(SM Number ❑ Public/Commercial - Describe Use K/ ❑ State Owned - Describe Use ❑City ❑Village Ql ownship of O III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. iE'New system ❑ Replacement System ❑ Treatme,ulHolding Tank Replacement Only ❑ Other Modification to Existing System B. [I Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner - IV. llm~ of POWTS System: (Check all that apply) Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑,Rec' ating Sat ii ❑ Recirculating Synthetic Media Filter Leaching Chamber POP Line ❑ Gravel-less Pipe ❑ Other (giplaw) `r' V. Dis rcatment Area Information: G £A~ .S K, In ° S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dhpersal Area Required (sf) Dispersal Area Propo*d (sf) System Elevation - / }p?.7r/ . t4a -7 7. 1P e-2 . VI. Tank Info Capacity in Toni Number Manufacturer Prefab Site Steel Fiber Plastic Gallo Gallons of Units Concrete Constructed Glass New Exisft Tanks Tanks e- Aerobic Treatment Unit Dosing Chamber - VII. Responsibility Statement- 1, the undersigned, assume - y for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) s Si MP/MPRS Number Business Phone Number 7~ X 1 -z-Z!/~U 7~} = "f--644,9 Plumber's Addre as (Street, City, S , Zip Code) Fogerty Plumbing & Perk T"Ung s - o -47? 7 VIII. C Approv el~~j Sanitary Pent Fee Cipcludes Gro ndwatw ate Lqsurna Agent Si (N Stamps) t Surcharge Fee) <S D~~ ❑ Owner Given Reason for Denial 2°/ D IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER; 1 Septic tank, effluent filter- and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach aomPtae plans (Io the Comity ody) for the system on paper not less than U12 x 11 bmim in sae J Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~ ~k~rit fmrs~ ~ Asa , l N - x yv $'3 AcT 3~~ 4 ~ Bay, ry •f Gam/ /~sxH ~octo Al" A04 XTff~ f~0 7 ,SV ~jto.K ~.vvl - r ylw~, O ~F sysr~- s ~udv L®f lni4r/s "v/ ~ " ~ pz 8' ,coot sysr6.a . c-( 3x F,t S " C_y 3X G yyo - FP•Y J Fogerty Plumbing , #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 535-9609 ~ ~GI/t tm~r~ ti ~X ' f"-f \ l 7t ~ +f L ~ t c~, ~ _ yd I 4z r h540 A ~ Q~L = ASCr- ~ Jp~ iF s /f«~iy N ~ of sysrw.* - t ' i y~g' ,coos sysreyow . c-I -3x l~.5' 3x Fxs 9ya - F P• y PC( PotzS to 1 #Z.l l 2-q 6 Wsconsirl Deparlment of Commerce SOIL EVALUATION REPORT : page of 3 Division of.Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County f Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must C-00 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~nn f Z , v , QUC~ .,percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. evie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). `te U Property Owner Property Locatkni GovL Lot S 1/4 S~ 1/4 S T Oct N R / E (or)e Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 4 H1 7 135 e Trc;t City State Zit Code Phone Number ❑ City ❑ Village ® own Nearest Road ~Akvckson UJl U ('115) 4 - /->l o n ~n,c New Construction Use: C3 Residential / Number of bedrooms Code derived design GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material O U +LAJ C- 5 L-N Flood Plain elevation ' p cable 1G =x ft. General comments ~l'~ 'c (t V Q C-1 U and recommendations: G tv . q 3. ?sue 40 ou-ef- 73. a 0 $T Club( 00UNTY i ZOM14GOFFICE /Q ❑ Boring _ © Boring# q~s upl Pit Ground surface elev. ft. Depth to limiting factor - Soil Applica Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EMM 'Eff#2 6-11f ow-3/2- - 5r'/ 2rl~b WA- G I v-C 5 $ z iq53 lu lq ; l Zrnahk- r 5 8 3 -IO lU r`t rn S s rn ( - - I - 2 t ~oo ~ vk ` p. s r F11 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor 1 /6 in. ® Soil Lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Eff#2 0-16 l , 2 st / 2m c -s a .-,5 . Z 14-ZI i hn GS - .7 /.2 I _ z ZHID IUD r`f to - ms U ry, ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature / CAST Number G~- 2 5 9 Address Date Evaluation Conducted Telephone Number 211 $0'' Sy0 ~~-d ~~(5)24~-y~8 Property Owner} Parcel ID # Page Z of Boring # ❑ Boring F-sl ®pit Ground surface elev. 9'0 ft Depth to limiting factor 1 1 (o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Slruchue Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 'Eff#2 -!3 C, 31 SO 2wrbk, r CS Iv-~' 8 Z- Z -31-A I!J (-yl L 1m r ~S - Z. 3 rl'1 D rn ( - -7 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/fft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑ F-1 Boring # Boring ❑ Pit Ground surface elev. ft Depth to Iirnfing 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 *042 Effluent #1 = GODS > 30:5 220 mg1L and TSS >30:5 150 mg1L * 01uent #2 = BODS a 30 mg/L and TSS < 30 mg1L 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-8330 (k07/00) Property Owner Tf ~C 1 Parcel ID #1 Page Z of a Boring # ❑ Boring ® Pit Ground surface elev. :7- 70 ft. Depth to limiting factor in. Sal Application Rai Horizon Depth Dominant Coto Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-13 C~ 3) SO z r c5 1 8 Z( y I r y 1 z m r c5 - Z 3 - )D r~tl~ m Q rn ( - _ .-7 t. 2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Sal Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Efr#1 `Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surfaoeelev. ft. Depth to limiting factor in. Soil Application Rat( Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `01#2 ` Effluent #1 = BODS > 30 < 220 RxlOt and TSS >30 < 150 mg/L ` Effluent 42 = BODS < 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. SBD4330 (R.07100) PAGE 3 OF NAME A- TOT# ~ LEGAL DESCRIPTION -SE Y.S E 14 ,S /I T 2 J ,N, R, 11 E(oKW SCALE: I"= ya BM 1 ELEVATION /0c). d BM 1 DESCRIPTION 1e a,4 1 c. 141k BM 2 ELEVATION 9I• / BM 2 DESCRIPTION ~ P o 4 /0. Z'` ~ q S P C SYSTEM ELEVATION 00 ALTERNATE ELEVATION do P Y3-'f cl L- w~ q 3 a o _ 4- C OUR ELEVATION 4-1 .yo , Q y. 8o , I g. 15D k v 1 a S • •a L 3 /gyp O ov oc o SIGNA / DATE /G L - G~ g o~ OQ O ~m ~ C ~ ! cQv O II 'zi r- t s _ w ~uF ~ u ham„ • _ ~ O _ (IQ a~ t ` t i in t-4 CAP a N- !-,cam ca CD o II 171 NN O n II mom 94 L+- ap A V p, it cn N ~3 ODC • `F chODN 03 Cr ODW V ~ 2- 6 M A L ~ POWTS OWNER'S MANUAL & MANAUt:Mt1111 PLAN Page ' of FILE INFORMATION SYSTEM SPECIFICATIONS Owner CT7~-- &AJ Septic Tank Capacity p5o al O NA Permit # ' Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms ❑ NA Effluent Filter Model l gyp O NA Number of Public Facility Units NA Pump Tank Capacity al pj1A Estimated flow (average) al/da Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer A Soil Application Rate 0 - al/da /ft' Pump Model ~NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit PNA Fats, Oil & Grease (FOG) 530 mg/L O Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BODE) 530 mg/L ~At- -Gro und (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100m1 ❑ Drip-Line ❑ Other Maximum Effluent Particle Size Ya in dia. ❑ NA Other. O NA Other E3 NA Other: E3 NA Other: O NA `Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ eat (s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y9) of tank volume O NA Inspect dispersal cell(s) At least once every: O year((ss) (Maximum 3 years) O NA Clean effluent filter At least once every: .2 ❑ eat j(s) O NA ❑ month(s) q Inspect pump, pump controls & alarm At least once every: ❑ ear(s) ❑ month(s) NA Flush laterals and pressure test At least once every: O year(s) ❑ month(s) MA Other' At least once every: ❑ year(s) Other: 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 (Y,) 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. AN 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 4?i 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 cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During fill above normal highwater levels. When power is restored the excess wastewater will be P power outages pump tanks may discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the 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 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. The-site t0l alua ' a o ing ttank nP- CONS7R(1Cg101V b e a '>QRD4418 I7FA ❑ 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 `t P(_l(!~v(~/~U l Af Name Phone Q I Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY EP: e Name S C 2Q1~(1 (Vudnz e Phone/S- 3glo- fo C7 This document was drafted in compliance with chapter Comm 83.22(21(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. _ , ; R ST CROIX COUNTY SEPTIC TALK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerA3nyer 2)e!~'Zr ¢ 7-, Mailing Address a'T. w~ yob Property Address Z9 r v (Verification required from Planning Department for new construction) City/State ~ Parcel Identification Number /oi 3- 30 -Ot LEGAL DESCRIPTION Property Location -15-d6_ _CLs== Sec. TAN-R_ Z W, Town of &,ef &Sy41 Subdivision Lot # Certified Survey Map # Volume . Page # - Warranty Deed # 4,7f / V 7 Volume / S"'?l . Page # "W/ Spec house O yes-0 no Lot lines identifiable O yes O no SYSTEM MAINTENANCE 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. Tie property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber,imneymanplumber, restrictedplumber of a Iicensedpomper verifying that (1) the on-site wastewaterdisposal system it proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/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 Commerce and the Department of Natural Resources, State of Wisconsin CerdMi tion sta ' that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days me expiration te. SIGNA APPLICANT DATE OWNER CERTIFICATION I (we certi that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p rty d n n a1■Iborve, byJ/((virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE- Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ll 1£391 P 6 3 6 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED 7 9 1 4 KATHLEEN H. MALSH REGISTER OF DEEDS Document Number ST. CROIX CO., III This Deed, made between RECEIVED FOR RECORD DT~reLrss-s-TrsDcQ S'i:OUT and dAI! E; T- 05-16-2002 8:30 AN husband and iio fi f e r - WARRANTY DEED Grantor, EXEMPT # and DF.T.TA _r-0NR1rRur-1rTf7N . TNT REC FEE: 11.00 - - TRANS FEE: 179.70 - - COPY FEE : Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee the following PAGES: 1 describe estate in -qt _C rn i x County, State of Wisconsin: Lot , Plat of Misty View, Town of Hudson, St. Croix County, Wisconsin. Name and Return Address LL 020-1013-30-000 020-1014-10-000 Parcel Identification Number (PIN) This J -c: not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 1 5 t- h dayof May 2002 (SEAL) _ (SEAL) Richard O. Stout * Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix County. authenticated this day of Personally came before me this 1 5th day of May 2002 the above named _ Richard O--Stout aid Janet _P--- Stout TITLE: MEMBER STATE BAR OF WISCONSIN NOTARY f~U T~ to (If not, me known to er R WISGIO d the foregoing authorized by §706.06, Wis. Stats.) instrument and ackl~ RPJ®AadzeBAST THIS INSTRUMENT WAS DRAFTED BY . " Janet P. Stout 1353 A_w_atukee Tr. Hudson, WI 5401 6 Notar Public, State or Wis nsin My ommisslo~n~_IS ermanent. (If not, state expiration date: (Signalures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin t_e9ai 6iank Co., inc. FORM No. 2 - 1998 Milwaukee, Wis. ~ r a 14~111i. ,~F,1,00 ECEVAMONR LOT 17 N of 913.00 LOT 16 • j 2.008 ACRES 2:008 ACRES °87,433 SQ FT 87,450 80 FT ; q►~~.`` o ./A a3 - - -a-.- 312.34 6' 0 281.89' a '~p0 • / / , / MIN. FLO 689024'37"1K 594.55 @• < ELEVATIC STARLIGHT - - 914.30 N89°24'37"E 595.44' 315.49' Q 279.95' \ \ \ ----0-- _.._.._.._.i _ C+ M IN. FLO OF MIN. FLOOR ELEVAT 898.00 Z ELEVATION OF 900.00 LOT 2 a LOT 3 w 2.50o ACRES W Z g0 2.500 ACRES ~ 108,892 SQ FTN 108,905 SQ FT A 1 \ 8 m 10 i i 8'98.00 'Ile .001 i' i 76.52' ' Ak 1 set 0p 1 320.12' 1 SSW24-03-W 596.64' 87,143 SQ FT 1 g 1 p a (N89°01'27-E 646.65 r L-25 w 1 b _ 1' 92 50 p~ ~ jLl" LOT I L-21 903.00 LOT 5 9.120 ACRES 2.536 ACRES 397 257 SO FT ' 110,489 SO FT FENCE f ` rat 8 ~ot?JoLIUJo l/~ISn m MIN. FLOOR ELEVATION C no. ` . 903.00 HWL. _