Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1445-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sa~ety ii~nd Building Division INSPECTION REPORT GENERAL INFORMATION (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 Filla, Mike Hudson, Town of ;ST BM Elev: Insp. BM Elev: BM Description: i :- i ~.. ., k _. p. _ ~ s Hrvn nvrvrcm~-i i~rv TYPE ,' MANUFA!CrTUf~ER ',,, . s , ..~,~, CAPACITY Septic ~ ` ~ ~y. Dosing Aeration Holding - ~-- ___ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~. .~.. .. Zf: 'Y ,~ j ' ,. Dosing Aeration Holding _.. _ PUMP/SIPHON INFORMATION Manufacturer Demand ' GPM Model Num r TDH Lift Friction Loss System Head TDH Ft Forcemain Length - -- - - Dlst: to Well Cnll AQC/IQQTI/1h1 CVCTCM ;'".~.~. "~2_ ~' ._ r`' i..-__ o _...:#e1.,'~C BEDITRENCH Width Length "' No. Of Trenches- PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .r ' _ R SETBACK SYSTEM TO P/L _ BLDG WELL LAKE/STREAM LEACHING CHAMBER OR ManufacturQr; . _ ' i 'fzi ~~ INFORMATION ~ ... _ . Type Of System: r r UNIT Model N~mb it ~ f\ICTCIQI ITIAIU CVCTCIIA eade7/AAerrifold Distribution - -- °- -... x Hole Size x Hole Spacing Vent to Air Intake _r_ - Length `c z':.s`... Dia Length Dia Spacing C /111 !~A\/CD n_~.. ., se......d !\r Ak~rnAu Svctcme (]nlv .~,: .~ ~,+w, ~„y... Depth Over Depth Over xx Depth of il T xx Seeded/Sodded ~r,• xx Mu)c~d0, I Bed/Trench Center Bed/Trench Edges opso "! Yes I _ No i~~~i Yes ~'~'NO ~: COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ~-+ %. r'-11'-+'~ ~ Irt~sq~ction #2: ---t"" / Location: 1068 LaBarge Road Hudson, WI 54016 (NW 1/4 SE 114 11 T29N R19VV1 Sunset Hills Lot 16 'J , Parcel No: 11.29.19.2831 ~,,; 1.) AIt BM Description = ~>hs~.°~~ -' t .. ~"~'_'".' ak:;`_ 'C.'°""~,,.`, .;_ 2.) Bldg sewer length - "~! ` { ^ ~ ,,,,,~ odrrt'~Sf cover w 't~. y~.,.~` k `~ Yt:w~,, ~-± ,y ee ~ ~. w _ + Plan revision Required? i~~~ Yes jNo ~ ~ ~ j Use other side for additional information. ", ~~ ' ` ' " ro,t ` '~~' ~ ~ ~ ' ~` ~ ~ ~~- - ' Date ~ Insepctor's Signature Cert. No. SBD-6710 (R.3/97) +'~ , ~ - urn' .'fir <~. ~ '~.~...~ r ~ i u-1 ~f~ ~C _ i-i(~~' . a CLCVAlIV1Y vA1F\ County: St. Croix Sanitary Permit No: 506278 0 State Plan ID No: Parcel Tax No: 020-1445-10-000 Section/Town/Range/Map No: 11.29.19.2831 STATION BS HI FS ELEV. Benchmark ,1 `j (I3~~.~2 Alt. BM Bldg. Sewer , " SUHt Inlet ~.~ ~~ ~ I•.J~ St/Ht Outlet ~ •i .L f ' '~ ~5 Dt Inlet ° Dt Bottom deader/Man. r~.. `~"~' ' ~'~ . Dist. Pipe rM , { ~-•.~~,' ' ~:1 ` Bot. Systertt ~ I ~- ~ : { ~ • 3~ r Final GradB ' ~ ? i .; ~ ~' v,R.Y ~ t}. tI ~~ ~ • St Cover - ~ ~ • ~ I G I +~. 2.s,"~,'.. c4~ r~~~..aVa F...sd.~., f~'[`'~ ..,~d-i~..~'~i~JYy ~.~.•j'~'~!`ti6,(.$~t. ':V Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division • 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: City Village X Township Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing S[lll rnVFR ., ore«.~~e c..~•e...~ n.,i.. .... 11An~~nr1 nr et_r;rarla Svstamc C)nly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~~ Yes ?, ~ No ~ ]Yes ~ j No ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover county: St. Croix Sanitary Permit No: ~ 4S ~5 State Plan ID No: IO~Z'-~ Parcel Tax No: 020-1445-10-000 Section/Town/Range/Map No: 11.29.19.2831 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! ! Inspection #2: ! /_ Location: 1068 LaBarge Road Hudson, WI 54016 (NW 1/4 SE 1/4 11 T29N R19W) Sunset Hills Lot 10 Parcel No: 11.29.19.2831 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = ` Plan revision Required? ~~~_j Yes ~ No L ~' h Use other side for additional information. _____ I _____1______ Date SBD-6710 (R.3/97) Insepctors Signature I ~~- Cert. No. at~er~ Sao . - /~'ia~2 ~~_.__ catrtmerrcr3.vvi.gov Safety anil 3uildiags Divi tan ~ zcI w, Wasnittgtatt,Ave., P.O. Flax 7162 County ~ C 5"" ~GYb r _ i s co ns i n ~ NCadison, V4'l 53707-71G2 Sanitary Pam~t Number (to be filled in by Ca.) ~ gepartment of t'.omrneroe ____ ~~ ~~~~ Z.~ ~ Sanitary Permit Ap .lie In accordance with s. Cumin, 83.21(2), Wis. Adm. Code, s Sian isran to ti opriate governtnerttai ` ' StateTransactiani\t~mber / V_ ////~~~~ -- _~ ~ unit is required prior to attaining a sanitary permit. No tcation I or stataow~ted POW fS are ProjectAddress(ifdifferentthanrttai)ingatldress) submitted to [hc liepattmunt of Canmerce. Persona! int rmation rovide may be cased for secutxtary nt poses in accordance with the Privacy Law, s. ! 5.04(1 i rn}, $t ~~ ~ #' /a / Q IOUV I. ,~nniication lnfarutation -Please Pr tntorn~atio f'rapeny Uwner's Nrnte - - - ~~~ 1 Parcel N `---~^ ' ~T Property(hvn~r s/Mailing Address JUL `L 7 ~ut)1 ~C ~~2' 'Property Location ~ • J / ~BQ ~~G/ ~y % ~U ~ Govt. Lot _ City, State Zi Code _ p ~~ i~. t3Q~1JVTY / t'~Lef '/., S~ '/.. St:ctian ~ ~~f ~ ` rclc orx) ~ I. Type of t3uildiug (check aft that apply) 6 K wp ~ ~ Last ~ 1~ ~ __ Subdivision Namc ~__~ Or 2 f antiiy Dwelling Number of Hedranms „ ..~-._ ~ ~~_ ~. ~.] Public/Commercial -Describe t-ice ~ , ^ Ctty o( __ . _ _ ^ State t)wned - Describe t!se ~ CSM Numlxr ~T.- ,___, __ _ { O Village of r----- I _ ~~~ ~ ti - Towr, of Ii ~ ~ Itl. Type of Permit: {Check 6n1y one box on line A. t:amplttt: libr. ~ c k3 if applicable) ! A. __..._.... _.___._r._.... .~._w.~._ -- ., New System ^ Replacement System ~ Q `CceatmentfHolding Taok Replacement ?nly _ i~ Other Modification to Existing System (explatn) ~ y f ~~ Perntit Renewal G Permit Revision Change of Plumber Permit Transfer to New List Previous Permit Number and Da Iss __ Sei'ore Ex^ pt~ ~ ~~'~Q 77'' j Owrte~ ~ p ~Z ~ 5 ~l ~ ~ 1 1 _ ___ . t I V. Type of POWTS S~stem'ComponentlDevice: (Check alt that ap)alv~~ __ ~ ~~Non-Pressurized ln•Ground ~ Pressurized in-Ground ~ At•Grade ^ Mowtd ? 24 in, ofsuitable soil ~i Mound ~ 24 m. of suitable soi3 II I `) Holding Tank Uthcr Dispersal Componenr (c;:plain)___ ___ ___ _ ea Went Dovice (explain) ~ ~ ^~~ ..~ ~'. Dis ersallfreatment Area Information: ~ GC.s'~ `f ___ j Destgn Flow (gpd} Destgn Soil Application to{gpdsf) pispe`/rsa!/A,rea Reuuir J (st) petsal//Area P~ro3posed/(sO -System Elevation F t'I. Tank Info Capacity to `Coral j f of Mat~uE'acturer f ~ I f _ ~ Gatfons Gallons !;nits a ~ ~ u ~ f j NewTaaks t:xiatatbl`anks ~ ~ ~ ~ ~ ~' ~ a 's rig H w ti, C7 .-. ~ '~/ ~ ~ ~~ ' a f , / o _ ~_...~~ _.. _~ - - ~ aephc or Holdu,g Tank j DObllltt ~{lilntft( ~ I `- ~j, !~ r i ~, $ Y ~ 1 __ ~. - Vii. Responsibility Statement- t, the uaderslgacd, assume responsibttity for instailattoa oflhe P01v'['3 sh n oa the att,-ched plans. ~ ' r s'lumber s Name {Print) ` Plumhes's Signature / PRS Number Business Pirone Number ~ i ~, ~ l ~ rz 7~ S~ fy ~t-yn~e ~~G- 3 f ~ y °2~~Y~D 7r 5 = _ , ".-'1 ._._._ ~... ._ __ {'lumber's Address (Street, City, State, Zip Co de) / /~ / / f ~fI V111. Count /qe arttnent Use Onl _ pprovt:d isappro _ Permit Fee $ Date sued ` _ ~ Issuing tx Signatu e . _ ~ ~ er Given Rea for Denial $$, oo 7 ~ Z7 b ta. Condlt,~~~.eaaons for pisop),roval ,(I ~ ~ ~ ,~ 3~ /V v ~ p S~(5 ~ ! 1. 8splic taMt, effluent filter and dispersal earl must alt be sentices J maintained ~^ 1 { ~ ~"' ~'~' ~' ~'"' C u~-~"-~"e ~ . as par management plan provided by phunber . 2..Ap arlbat:k 1'ayuifements mr~t be mairrtainbti ~'" ~ ~TtT3c7i to cotuyilele plans u.•' hr system and botbtnit fu [be County only tin pupa trot Less than 8 In x 1 i inches io size SF3D-G398 (R. 41167) Valid thtu 4),49 N ~~ a~Y ~ s ~~ v~ y~,a ~h ~~ .~~ ~ ~~ ~~ ~ ' ~` ~~ ~~ o ~ ~~ t~i r.~~ ~~~ s:~~-~ ~~~ ~~ ~c ~-e~ / ~~ ~o " I.~i~z.jP; d_ io.~ ~ ~~~ ' ~~ ~~~ ~ ~9'9D ~~~zs~o7 I - - --- - N (~M ~ 8 • ~ ~" ~ ~ ~~ ~~,a ~h ~~ ~~~ • ~~3 ~~ ~~ ~``~ ~ . s ~~a~'e` ~, 7, ~/a~-s ~- S;"~'~ ~~~ -.SC a.L. -~ / !f ~a l /3i~1 1. d ~~? ~.¢- /O~ ,~/~2-%i~ /0~ ~ R~C~~V~Q • Wrsoonein Department of IL VALUATION REPORT ~ ~ of 3 Division of saf~y ~d &~dn~ .JAN 0 9 2 004 ~- ~, tom ss, was. a~ cotta ~ s f G~oi )C Attach complete site plan on not -r 0 ~ inches size. Plan must include, but not limited to. - diredion and Paroel I.D. 0 2 O • /0/,3 • SD • o~i7 percerrt slope. scale ordur~nsiorts, north arrow, and location and distance to nearest road. Phase prlet all information R ~ Date Z~ ~~/ ~o~.r+r~+acw~-rou~~~.r~~earors.yest~a~ruw.~.75.o~t~)tm)?. Iz- ~ ~S l~i4(!i/~ ? 7I~itI /1'I DrV 7"~3Rif~~tlp Progeny tra ~ tta s l T'2! tv !z `~ 1~ ~o~ w 5 ~~ to ~ s s des ~~ ~lS ~ State Zip Code Phone t~xnber ~ ^ ~ Town Road ~}voso~ l.~/. s yoiGv i 7~5, 3~6 •.~yoz tf-v0so.v 7,tt~.v~`~' ~ • 1~- tyeww Con~trction use: ~ Residential ~ Number of bedrooms 3 " code derirred design Aow rate y5b - Goo ((pD ©~rt ^ Pu6fic a cormreraal -- Oesc~e: Parent nraterla! _ 5 A'itlQ Y DUT GtJi} ~. Rood t elevation a app!>cable / ' ~ fl. General carrnrer><s ana ' ~/P~i4~ T~ST~"O ! S _ SUiT~4'~L~ ~oiQ rtv ~~ /itJ(r~2 O(J.VD Cd.I~U~~CI T. ! ~.tJ~4 L ~. t~ . W . ~ S , t / t~ ~ ~04.7U ~> /!~ f {~ • {d t+tt VO(R6A7 D{9fi7{~17 tlgiY. il. iJHINI W 7rtfWY~ 1A41iJ1 t+ NI. SD~ R8~ Honaon Oeplh DO[flfiatR Redwc Desarpdarl TBxttre Strudue Coroe t3olmdary Rooms !n. j4ttML9eN Qv. SZ Ci01~. ~.`OIOr Q?. SZ. Stt. ~~ o • ao ~o yk 3 --- zf shy s e s 3 f- . s . ~ y /oy s'~~ zfsh cs . s 3 •5 /6 Ce Gi MO7~ L D, nti GQ.~ Q. S b v n # o ~o3.z5 > ~~ ICJ yal Pn erev. n. _. yepu- ~ mcwr - ~- Sol - Race ttorixon Domirren! :e>d~D sa„~,re Corucistenoe 6oundtxl, t2apfs c ~ &r. NAunsetl Qu. sz. Cont. caor tx Sz. S'h. -~,! 'E>T~2 l o• 5 /o ~ L /,w, ~sl~i~ w 3 ~ • 5` • `Co z s •L . s c. ~ s - o ~ o , ~. • Etlr,ern 1t't = tiOD_ > ~ < 220 mo1L and TS'S >30 < 1 5d rrtmL - #2 = t30D_ < 30 mdl. and TSS < ~ mnlL esr ~ ~ T ZIG,~,ei GGi7- ,1~ Z 3 Address Date Evahiatian Conducted Taleplane Number ~.P-c • ~-- Zoo 3 ~tS • ~ 7a • 3 4/S/Z. Ulbricht & Associates Private Sewage Consultants 28 ~ 2 10th Ave. Spring Valley, WI 54767 ~/~POOttrom or.~n «~L~a ...~ /"t CITI_ __1_~ S vusE-~ }fills 1"7. /~?ON T~~P%ifiV f> o ~ O • /d/3 • So • ozra 3 ~ ~ A Page a ~~ ~~ o`~ t3e~- ~. Ua! i Redox ~ £~. 5z. tJord. Cabr Texhxcs 5trc~cdse tsY Sz Sh. Carss€stierxae t3t7tutdar~r ttoois C '~Ft 'Etf#2 ~ ~ • ~ io yR yl L /}she- ~ /2 c~v 3 ~ • Y • 4, s ~ ,SQL ~ ~h ~ c S .~- . 2 ~. L /o ~ cz Hco ~/GL / ~ S~ji~ .~ ._ Z ~ 3 o S ~,s ~~~ f. ~~ ~ Q t'rt Gmcx~dsurfaoe~+r. _ ft. E3eptFe ~ -vs. t~(1pX f Tom. a '~ bi1C~S ~ $p(~tY wriw t Rs~G ~• ~ QIL .~iZ. ~i0lit. . t s ~ Q. a~•1.'. a~t. ' V+iRK i i t Qe.eCer..~ ~+ rfY11 tl1f~Ctt~AGtOU $ C2~SlR6~ L. ~ ~Ci~OX tOiS_ ~EX~12 .'~§UCttfiE ~ ~ ':n. Mead tlo. Si. toed. t~okx ~ Sx. Sft. ; ~ j ..~ P p '+~ ~' ~ t~: ca~~e~. ~. ~ tam ~. soy t~ eioeezare va~aert tic s s^,~ ~ e ~ ~ sz. cont. ~ ~. sn. ~ ~ ~T~RR'{i 7(~ x ~AJS y W ~ +GFd ~.. ~ [+7~7 ~J~i ~ 1~ •+~y+- - - w GflluGll[ fiC ~ DVIi¢'~ JQ ~. ~ i W f .~'f~~. ~ vus~j 1~i1/S ~. N1oN T~3~PiA-~VI~ o ~ o ~ io~3 • so - ozra ~ 3 ~~- ~~~~ ~ f # ~o Z r ~~ Rage n: .~ I ` Rit sc~face,etev _1_ ~ 5 ~ 7UR_ ~ max, ~ 9~ ~ --- -- ~~ ~~ o~ ~~ ~ ~~ ~ ~ ~ ~ • ~ io yR ~ L /fsh,~ ~ /2 ccv 3 ~ • Y • ~ s - ~iL / ~h ~ c S -~ . z - o s ~ , s ~.~ ~ f• ~ - Pii ~staiace~ev. tt E3e~eto~Pac~___- ue_ tbtFzon s Uor Ftecfax ~ 3"exi~e. Stye C~ Boundary Roots au~ x G aaort rcaie ~- ~ Qv. Sz. C,oni. t;,~vr Gt. Sz- Sig. ~ '~ '~ i ~E RCt~OX ~B$q'~[i_ ~8xh3F~2 .~§iJC~+3FE ~ ~ RaO~LS ~ itt_ ~1[f8 QU. $L t„ +p(it. {`iO}CtC ~• `~ .~i. '~1 ` .,v R ~ ~ ~ ~ eiav. ft. to fat~Or irt. ~,,' ~~~•~~d~ ~ ~ pa~ajduxoa a~ann s~sa~ itos auk .~ag~ ~o~Canzns ~ .zadotanap ~iq panouz a~ann sauii poi auxos s~ `a~~.~naa~ aq aou ~C~uz u~id void s,ZS~ uo pa~ou s~uawa.~ns>;ay~ Lc~T~ /0 y~ ` ~ ,~ a~ ~ T0~ ~i~- ~,~-~ '. /~3' S~ ~ 01, 0 a 0 io' ___~--, SG~9~~ = / ~~ .. 30 . m ~ ~~,g~~~ p,~ T ~ ~ ~o ~ ~~ x t ,d3 e ~ i~' 3~ ~, Id0 o ~D3,0 Ct~ J ~J 0 0 ._-- ~~ o~ ~~ ~fee~~-- p~ /~ ~oo•o~ -~` Wes T Go r~ ~-%N-~-- r f~ ~a For issuance of permits and designing Gontact: Ulbricht & Associates lumbers Registered prNate wastewater consultant and p 2g12 10th Ave. gpringValley, WI 54767 7i5 772 3442 a ~ o{, ,d COUNTY PLAT OF: SVNSET HILLS LOCATED IN PART OF THE NWi/4 OF THE SE1/4 AND IN PART OF THE NE1/4 OF THE SE1 OF SECTION 11, T29N, R19W, TOWN OF HUDSON, ST. CF~'OIX COUNTY, WISCONSIN; INCLUDING PART OF LOT- 5 OF THE PLAT OF JOSHUA HILLS. Nt/4 CORNER SECTION 11 °~I I TEMPORARY CUL-DE-SAC DETAIL ®\ / \ / 1 I \ 1 \\ ~ ' LOT 7 LOT 6\` ~ o \ 1 ~e 11 88 RADIUS lEM CUI-0E-SAC EASEMENT TO BE CURVE DATA TABLE CURVE MINDER LOT MINDER RADIUS CENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT IN ~TAMB:NT 0117 CI 233,00 79.42'49' N49'36'14.3'V 298.63' 324,16' N89'27'39'V MI9•M'S0'V 3 233.00 37.36'27' N70.29'23.3'V i3L49' 13429' N89.27'39'V N31.31'12'V LOT 1 233.00 16.17'04' N43'22'40'V 66.00' 6622' N31'31'12'V N35.14'OB'V 4 233A0 23.29'10' N22.29'29'V 102.80' 103b3' N33.14' ' : N04•M'30'V C2 167.00 80'00'06' N49.44'S3'V 211.70' 23318' M19.44'30'V N89.44'S6'V C3 233A0 33Y7'15' S27.38'27.5'E 14318' 143.33' S13.32'OS'E S09•M'S0'E C4 167.00 79'42'49' S49.36'U.S'E 214AS' 232.34' S09.44'S0'E ~ S89'2J'39'E NJM4?6G~4~D 6G1MD~3 I _- \ ORANV CUL DE SAC 1 \' S '\ ~t ~ ' N89°13' 28'W 484.41' - - 80 RADIU TEMP EASEMENT SEf OETAR ABOVE 1~ \ \ ~` \ \ ~~\ 1 ` \\ \ \ M"'~ LOT7 217. : - ~ ~ ~ 0 El 1S: . ~ 141' LOT 6 `~ ~~ 1 I z.a AcRES ~' ~ . . 2.17 ACRES I 1 110.72750. Ff. HJI>' . 94711 SO. FT. " 1 ~` ' 1 1 Lb • ~lLN' . ~ ~~ ~ ~ LOT S SA : 1 1 : ~ ' 1 ~ 2.90 ACRES 121.733 SO. fT. .. . . ~.f1' 1 ~ ~~ ~ ~~ ' 1 1 1 1 .: ... $ 558°,i9'29'W 364.16 ~ 1 1 . 1 O SA :: ~ :: ~: s l ~ :. . _ _ _ 1 o c . R~ $~ I y; i ~1 ~= 11 m S-A ~ .. ~~ I 1 ~' 1 ~gm 1 ... ~ 2 ~^ LOT10i~ I ~ II S A ~~ c{5 1 ~ .. .. g ~ ~ i I Z I ~ ~ LOT 5 ; ~ 1 i' ~ 1 1 '. .. :: :: .. k`~ O ~ lloslis~o FTj ~ ~ ~~ ~~ v~ z.lsncRES i 1 1 : :: ~ LOT 8 ~ ~ ` I 4 I II 93.ezo so. Fr. - 1 1 1 • a:Nu .. ~ 2.55 ACRES I ~ ' I .. \ - .. 111.12950. Ff. I I a_ m ' ~ t . - .\~; .. .. L10 ~ YII,M' , \ `\ \ ~ ~ I ~ "A~~ ' / \ \ .. \ I I 1 to I Q R C \44H ~ . \ . \ ...... .. .......... ............. .. ......... i .... ........ ... . .... ...... [ ~ F 4 \ 1y L.-._ - f y L DPRDVOE ' ROF LO75 &1D / __- ~~ LOT 4 `~ z.sz ADREs ~~,' I 108.]47 SO. f-T. ~ ~ . . O y . ~ ~ < , ~ ~ O o0~. ~ ' _ ~ LOT 3 ACRES '~i SA .. . ^ .. 2.71 119.413 SO. Ff. • .. .. .. uo • aLle ~{ ~~ ~*~ _ y _ .:Ai 66' ~ H i S~ ~r ~~~ ~ $ , pI S-A a ' I Z ~' NB9°55"^N 181.52- -~ ---- ---- 6 ~ - $ _ P E TURKEY TRAIL - ® k LOT 2 ~ 3 J°- 2.OO ACRES 87,321 SO. Ff. yY LBO ~ ~~ ,~ SEPTIC VEItT ® ~tOC LOT 1 t5 ~ 9.00 ACRES WELL 130,880 SO. Ff. I I I~ I ~ i i 1 I I I ~ I ----~ 1 I I 1 ~ ~ I 1 1 m ~~ ~ 1 ~ I€ O I ~ I~ b ! I~ 0 i ~o ~ i II i I I 1 I j IS89°2T39'E ~ 89.14' 1 m~ l'~ gl ~(o]l~ it I wCM~~l~l ZII j0'~ I (0 I I~ I ZI ~'~ j ~ -~-_- 505 I $89°86'80'E 1283.47 SOVTH lBJE OF THE NWI/40F 111E SE1/40F ~ECTpN/1 BENCHMAPI( I " TOP OF 1• IRON PIPE I ELEVATIDN - 918.32 I I ~ M I G801PG3[I_Mn_~ C~~4L14C~~ I w p~ ~ I - ---- I 9a ~ ~ a~ ~~ ~ 90 ~ I ( ~ d~~~ ~ I ~I alai ~ _~-- ---~ i ~ L-- ~ ~_ --- _ ---- ~ ~4Qa_~~ -------------- DaC__ S1/4 CORNER ~ ~ ~- ~I SECTpN 11 / ~ SHlET 1 OF Y SHBETS • ~ z o ~ z F z z ~ c7 U ~ ~ fl Z ~ ~ F W w j 1W- U tWi!° a t `n W~ O a LL iO ~ LL O Y W = O Z W o Z~ o ~ a¢ ZZ z¢ Qz Qa~ WZ U ~'~. W ~ Iz ~ Qd' U _ O ° a . Q ~ ~ 0 ¢ J ~D J 3 = W V W ~ q V Z z a ` x Z o ~ r fr o ~ W ~ W ~ a f' ~ W ~ ~ a ra x a ~ ~a ~W o~ o w ~ ~ ° o~ z z ~ ~ ~ m x~ C7 ~ ~ o y z F- W 3 ° ° ~ l7 t0 V ~ ~W o ~ ~ 3 J 4~ ~ ~~ NM Mr- ~° d W ~ d QQ ~ I • 0 0 0 I ~ x I I ~ ~ ~ ~ B i o I I 3 a b I _ __ ~ W ~ = -~ r n~ N Z I ~_ .ss•zrs 3,~,~ooN - - - - - - ~_ 3C18f)d 3H1 Ol Q3LV'JIa3O - V r_ __ .~. - ~6l'£09 39~SEd00W --- --- ---------L--- --- I i ~~ s ~ ~' O W ~o 1 '- I p r U W O~ I 4•-~ I 0 ~~ ~~ -__.~yi CVO i ~ i J .60'90£ I .00'991 I .60" L LS MZL~9~00$ SE"LOB = NOLLVA3'13 i I N 3dld d0 d01 ~!lVWHON38 I Z! o -----~ o Z ~O I W .. < Qa .. ~ °O S W LL =~pzzF U_aga: ~~4.Oi W ~ ~ ~ Z = ~ 0 1 2F'OJ! ~~w~l ~OJ~: ~~°~t ~~~ ~OW~( ~ W ~ ~ <?< Z D ~ 2 ~ O N 2 !- Q = W ~ t ¢U`~`[` ¢O~OF ~~~U: °3zZc Z ¢ W ~ IWL ¢ ~ CC' d.~ F OF~Ogi Z.UaC ~' J g ~NV~ ~N _ IYUIi "IiVA _3NN'Ri3l.N' ~/L3S3Hl~Of/LNW3H1~0 ~~~~°G1G10~4C7E .L9'LL~ 3.S s I I ( - i 3S/lOH I ~~~ I - __ I I ~I i i F ® r a 0 i `n J I I i _ _ __ _. ._ ~ILE INFORMATION Owns Permit_ ± ~~~+t DESIGN PARAMETpRs Number of Bedrooms ~' ^ NA Number of Public Facility Units p NA Estimated flow {average) ~fS"4 ` al/da Design #low {peak), (Estimated x 1.5) ,~'(~ a!/da Soil Application Rate elide /ft~ Standard InfluentlEffluent Quality Monthiy average* Fats, Qil & Grease {FOC) 530 mg/L Biochemical Oxygen Demand {t3OD6) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthiy average Biochemical Oxygen Oemsnd {BODE) 530 mg/L Total Suspended Solids {TSS) 530 mg/L ^ NA Feca) Colifcrm {geometric mean) 510" cfuJ100m1 Maximum Effluent Particle Size Y8 in die. ^ NA ether: !.~ NA "Values typical for domestic wastewater and septic Lank effluent. MAINTENANCE SCHEDULE POWTS ©YUNER'S MANUAL & IUTANADEMENT PLAN Page of Septic Tarek Capacity ~'~~} gal p NA Septic Tank Manufacturer ~rC~~ ~ ^ NA Effluent Filter Manufacturer (~~ ~ O NA Effluent Fitter Model ~ ~~ ^ NA Pump Tank Capacity d gat ^ NA Pump Tsnk Manufacturer Sey O NA Pump Manufacturer ~~y~ ~ O NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter L7 Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Oispersa! Cellts} ^ In-Ground (gravity) Q At-Grade ^ ()rip-Line ^ NA O In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA athe-; ^ NA SYSTlEM SPECIF)CA'1'tONS ~- Service Event Service Frequency inspect conditiwn of tanks) At least once eve ry' ~ manthts) tMaximuni 3 ears) earls) y ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third {Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: pp__monthta) (Maximum 3 years) .~ !3 serfs) ^ NA Clean effluent fitter Ai least once every: month(s) ~, ~ ~yearls) ^ NA Inspect um p p, pump controls & alarm _ At least once every: ^ month{s) .•----~ ^ year{s) ^ NA Flush laterals and pressure teat At least once every: ' ^ month{sl r~-- ^ year{a) ^ NA Other: At least once every: D month(s) ^ e~{s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shelf be made by an individual carrying one of the fallowing 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 aced scum and to check for any back up ar pending of effluent on the ground surface. The dispersal celtts) shal{ be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent nn the Around surface. The pending of effluent on the ground surface may indicate a failing condition and requires th® immediate notification of the Local regulatory authority. When the combined accumulation of sludge and scum in any tank. equals one-third tY3) or mots 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. Ali other services, including but not limited to the servicing of effluent fitters, mechanics! or pressurized pomponents, pretreatment units, and any servicing at intervals of 512 months. shelf be performed by a certified POWTS Maintainer. A service report shall be provided to the lacal regulatory authority within 10 days of completion of any service event. Faye _~ 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 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wilt be discharged to the dispersal ceilts} 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 Aperator 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 n©t 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 tt~e 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 Gods: • 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, aN 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. CONTIN©ENCY PLAN If the POWTS faits and cannot be repaired the fallowing 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, tot lines and wails, 1=allure to protect the replacement area will result in the need for a new sail and site evaluation to establish a suitable repiacernent area. Replacement systems must comply with the rules in effect at that time. D A suitable replacement area is not available due to setback and/or sail limitations. Barring advances in POWTS technology a holding tank mey ba installed as a last resort to replace the failed POWTS. D T sit d site ~~~ e tank ~ Mound and at-grade sot! 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. < <WARNINfi> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. Gti 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 6E DIFFICULT OR IMPOSSIBLE, ADDITIONAL COMMENTS POWTS INSTALLER lame ~_ `1r. ~ .s., ~ 4~~ Phone ~ ~. - _ ~ ~ .5' :z POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR {PUMPER) LOCAL REGULATORY AUTHORITY .Name _~ Phone Name 5d-. C.l'o jil o ... z +.,~ .n Phone -7~ - 3~to - `f (a ~ This document was drafted in compliance with chapter Comm 83.22i21(bift ltdldiffi and 83.54(1?. {21 & l3), Wlsconsin Administrative Cade. page Qf START UP AND OPERATION --' _- For new construction, prior to use of the POWTS check treat;~aent tankisl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellis}. It high concentrations are detected have the consents of the tank(s) remoued 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 norma6 highwatar levels. When power is restored the excess wastewater will be discharged to the dispersal celltsl in one large dose, overloading the ce11is3 and may result in the backup or surface discharge o! 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 manuaNy operating the pump controls to restore normal levels within the pump tank. Oo not drive or park vehicles over tanks and dispersal cells. Do net drive or park over, or otherwise disturb or compact, the area within t 5 facet 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 #{oss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; nil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANC~ONMENT 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 Comn', 83.3, Wisconsin Administrative Code: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The consents of all tanks and pits shalt be removed and properly disposed of by a Septage Servicing Operator. • After pumping, ail tanks and pies shalt 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 #oHawing 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 sines and webs. !=a}lure to protect the replacement area wit! result in the need for a new sail 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 andlor sail limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~~ ^ T sit d site ~ e ~ tank Mound and at-grade sail absorption systems may be reconstructed in place following removal of the biomar at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNINt3> > SEPTIC, PUMP ANO OTHER TREATMENT TANK; MAV CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. UV NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAX RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWT$ INSTALLER Name ~~ ~~~. ~ ac ,~~-~ rr• 4~~ 1~ Phone ~ ,r - _ ? -- S' :z POWTS MAINTAINER Name Phone SEPTAQE SERVICING OPERATOR (PUMPER} LOCAL REtiULATORY AUTHORRY Name Phone Name 5d: Gfo ~aC o .., Zve~.n. Phone 7~$ - 38'to - `ef (o F>' Thi.4 document was drafted in compliance with chapter Comm 83.22t21tbltl}td}doff} eras 83.5411), {2) & 13), Wisconsin Administrative Gads. ~' J _ ' • SEPTIC TANK ~ PUMP CHAMBER CROSS_SECTIUN AND SPECIFir_ATiONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE ~ WEATHERPROOF JUNCTION BOX APPROVED >_ 25' FROM DOOR, WINDOW OR INTAKE WITH CONDUIT MANHOLE CCVER FRESH AIR W / PADLOCK ~ ---- ----WARNING LABEL FINISHED. GRADE f 4" CI RISER ;~_4" MIN. ~ ~t 1$" IN. 6„ MAX. ~; ~ ,~ INLET ` ~, ~ WATER TIGHT SEALS , GAS- ~ ` TI T APPROVEO A ~ ~ AL SE , JOINTS WITH ~. ; ALM APPROVED PIPE PPROVED ~ B ~ ON 3' ONTO IPE 3' ~ ~` ~ SOLID SOIL riiTO SAL I D OIL PUMP OFF ELEV . FT. C -~- ~ ~ OFF ~''' RISER' EXIT PERMITTED ONLY D LF TANK MANUFACTURER HAS' APPROVAL 3" APPROVED, BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: ~~,'~.Se~ NUMBER DOSES PER DAY: ~,,,_ TANK S__IZES: SEPTIC ,lpolj' GAL. DOSE ~ S6 GAL. ALARM MANUFACTURER: _,l - ~ U ~~av~ss-- MODEL NUMBER: ~ s. v SWITCH TYPE: ~i~r~ PUMP MANUFACTURER : ~ocS?~~ MODEL NUMBER : fp a SWITCH TYPE: /~~~~ REQUIRED DISCHARGE RATE ~,{~ GPM DOS£ VOLUME INC LUDING F LOWBAC K : ~______ GAL . CAPACITIES: A = ~ INCHES = .3~ GAL. . B = 2 INCHES = .~~ GAL. C = $ INCHES =GAL. D ~ INCHES = _ y~ -GAL. PUMP E ALARM WIRING AS PER I LHR 16.23' WAC VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE ------- FEET + ~~ FEET FORCEMAIN X ~.Gd FT/1Q0 FT.OTALIDYNAMICAHEAD ~=• _/ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WTDTH ___; DIAMETER LIQUID !`A^ ~ 4 "- ~~' ,,~ /~.a ,~ ,~ f SIGNED: ~,~:~~c--~c-~~~~.~~ LICENSE NUMBER: ,?~?9~ICJ DATE: 3. ~-~ 1/88 ~GOULDS PUMPS Submersible Effluent Pump 3871 E~5 APPLICATit3N5 5pedfically designed for the fallowing uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • bewatering SPEC1FtCATIONS • Solids handling capability: 3/," maxsmum. • Capadties: up to 60 GPM. • Total heads up to 31 feet. • Discharge size: 1'!:" NPT, • Mechanical seal: carbon- rotarylceramic-stationary, BUNA-N eiastomen. • Temperature: 104°F {40°C) continuous 140°F {60`C) intermittent. • fasteners: 300 series stainless steel. • Capable of running dry without damage to components. • Fully submerged in high grade turbine oil for tubrlcation and efficient heat transfer. Available for automatic and manual operation. Auto- matk models Include Medtanica! float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^ EPOS Impeller: Therrnoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. IR Motar Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Gn>tdian Standards Assoaafion (CSA listed model numbers end in "F" ar "C".) Goulds Pumps is ISO 9001 Registered. Motar: • I:P04 Single phase: O.Q HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0,5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length,16l3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 S1TW with three prang grounding plug {standard on 1:P05). ®zooo Goulds Pumps Effective February, 29~ 9381 0 2 4 6 8 10 t 2 m~Jh CAPAp1Y Goulds Pumps ITT Industries 842~~E, STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Croix Custom Homes Inc., Grantor, and Michael P. Filla, a single person, and Catherine Jo Koehler, a single person, as joint tenants, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 10, Plat of Sunset Hills in the Town of Hudson, St. Croix County, Wisconsin. Recording Area KATHLEEN H. 19ALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 01/17!2007 02:00Pt1 IiARRANTY DEED EXEI~'T if REC FEE: 11.00 TRANS FEE: 297.00 COPY FEE: CC FEE: PAGES: 1 Name and Return Address: Edina Realty Title, Inc. 400 S. 2"~ St. - Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restricrions and rights-of--way of record, if any. 515092 020-1445-10-000 Parcel Identification Number (PIN) This is not homestead property. Dated this loth day of January, 2007. Croix Cu om Homes Inc. B * W att .Erickson, Secre * .t(~ AUTHENTICATIOI~e,~~P~Q~~\~ ~ .\,~ Signature(s) ~ ~n r~J 5 ~~ authenticated this 10th day of January, ~~}~Z TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN SS l0l (Signatures maybe authenticated or acknowledged. Both are not necessary.) "Names of persons signing in any capacity must be typed or printed below their signature ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this Janu~ry 10, 2007 the above named Wyatt M. Erickson, Secretary, St. Croix Custom Homes, Inc. to me known to be the person(s) who executed the foregoing instrument aid acknowledged the same. *Treasurer /I l_ 9 *Cheri Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) WARRANTY DEED STATE BAR OF WISCONSIN 1of1 FORM No.2-2000 v 7"' ~ ,Z ~ LO r ''WA V+ .~ .~ ~' 'g ~ N !`~nl O A C U VV O O w° o 3 w w in ~ u°~ °i ~r v ~ ~ V N e ~ ~ ~ a0 0 oD Z vi to 3 w w o in o to o ~ V N st v ch <r m In o v o Z (n ~ 00 M `t (`~ (h U tLJ (U ~ N J ¢~ ¢ Ors ~~'~~~ ~ x~ 1 ~ ~ ~ ^ ~ i 0 Vu ~ ~~ ~I QI ~I I nn~~ U ~I a~ ~I a~ ~' ~I - - - - - - - - ~86'Zbs 3.9E~SE,OON - - - -- - $ - -. - - - OilB(ld 3H1 Ol a31b~J1034 .- ~ ~6l'E65 3.9E~5s;,00N I`. iI Q ~ t a 1 1 r T N. ~ O W ~~ r I ~ m a °D ,~ O ~~ n ---lr 3 -' "~ ° ~ J ; N ~'~ I ~ ~00'98l ~ ~ X90' l GS /V~Z 1~9f OOS A ~ ~ ~S£'L06 = NOIlV/1313 J Z ~~ 3dld d0 d01 ~tIVWHON39 C GU I ~ ~ Q ~ ~ O ~~ II I _~ ."~ O a ~ N ~ ~ nj r P~ ST. CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND ~ // OWNERSHIP CERTIFICATION FORM ~~r Owner/Buyer ~/r,K ~? /"~ ~~/,~ Mailing Address ~~ ~ /~~~-~~ ~/ ,r~.~,~U ~ Property Address (Verification required from Planning & Zoning Department for new construction.) ~~ City/State v' ~"o ~~ ~C~~~ Parcel Identification Number LEGAL DESCRIPTION Property Location/~'t/ '/4 ,~~~ '/a ,Sec. ~, T.~N R~W, Town of ~~,. ~.~,~ Subdivision ~v ~S e ]~ ~'~~~ ,Lot # ~~ Certiitied Survey Map # Warranty Deed # Spec house yes o~ Volume ,Page # Volume ,Page # Lot lines identifiable ~ es ' no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposai system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. . 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. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this foam are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number~~of bedroomsD_,~__ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 71ti2 St. CrO1X ,~~O~~~i~ Math 5 707 - 7162 S~~it' llun~ber to be filled in by Co.) 2 151 ~ J Department of Commerce _7 Sanitary Permit Applic N Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inf 'on Yo~~el~ /C® `1 Y C jest Address (if different than mailing address) may be used for secondary purposes Privacy Law, s 1 S. I xm) L Application Information -Please Print All Information D~C ®~ Z 068 LaBarge Road ;' Property Owrtea's Name / ,3 ST. CROIX COUNTY Lot # Block # arcel #: - ~ o2o-144sao Clot lo~ Na Croix Homes, Inc. ~" Property Owner's Mailing Address Property'' ~~ i 707 Grandview Drive ~li., sE v., section 111 City, State Zip Code Phone Number "'~ Z ~3 T 29 N; R 19 W Hudson, WI 54016 (715) 381-9896 '~'~ ~ IL Type of Building (c k all that apply) ~ OlC t.1, (]e"- O~'~` S"~D`~. Subdivision Name CSMNumber ^XI or 2 Family Dwelling - Nter of Bedrooms ( 4~ fro ~5e. 1 - ^ Public/Commercial -Describe U~ .. ~ Sunset Hills ^ State Owned -Describe Use ~7 1 1 ~ ~ t~L~ t! (S ~/ 1,3 ~ Z 3 C~a ^City_^ Village ^XTownship of Hudson III. Type of Permit: (Check only one bo ' n line A. Complete line B if appl' ` ble) A' ^X New System ^ Replacement System`~„ ^ Treatmettt/Holding Tank Replacement Only ^ Other Modification to Existing System t B. ^ Pemut Renewal ^ Permit Revision ,~:ltange of 'emvt Transfer to New Iasi Previous Pemrtt Number and Date Issued Before Expiration PI ~wner IV, of POWTS stem: Check all that a 1 Trvo tre hes 3' X 92' w/ 23 " ' ck 4" Infiltrator chambers er trench ^ XNoa -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ^ At-Crtade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank Firter ^ Aerobic Treatment Unit ^ Recirculating Sand Fitter ^ Recirculating Synthetic Media Filter Chamber ^ p Line Gravel-less Pipe ^ Other (explain) V. Drs rsal/Treatment Area Information: Fo sig 46 'ck 4" ch hers 19.1 s .ft. EISA/chamber + 2 r. end ca s = 890.20 EISA Design Flow (gpd) / Design Soil Application Rate(gpdsf) Area Requ' f) Dispersal Area Proposed (sf) System Elevation 50' t h 102 600 gpd 0.7 gpd sq. ft. 857.15 sq ft 890.20 sq ft EISA upper renc . "~ 101.50' lower trench VL Tank Info Capacity in Total N Manufachuer Prefab Site Steel Fiber Plastic Gallons Gallons of Concrete Constructed Glass New Tanks Existing Tanks fit! Pd IO ~ `~~ septic orxotdingTank 1,250 _ 1,250 1 W' serCo reteWLP1250-MR X Aerobic Treatment Unit Dosing Chamber VIL Responsibility Stateme t- I, the ed revpo on of the POWTS shown on the ed plsos. Plumber's Name (Prurt) bar's tgn MP/MPRS Num Business Phone Number James K. Thompson ~~ MPRS #30021 (715) 248-7767 Plumber's Address (Street, City, tp Code) 340 Paulson Lake Lane, sc~la, WI 54020 oun /De a t Use Onl ved Disapproved Sanitary Permit Fee (includes Date Issued Issu' Si o Groundwater Surcharge Fee) 12I 9 b 5 tt Reason for Deniat 3 cep IX. Conditions of Approval/Reasons for Disapproval p Or,~ M4.~'tn~-~,,,~~ ~-' S~ ) 3) ~ ~ M ~ ~ L S Q 8Y8TEM OWNER: , 1. Septic tank, et'fluertt tMer and a~ tf~ ~~ t~~~. . dispersal CNI must all ~~/ maintafnad as per ma ~ ment plan provided by plumber. \ ~~ ~ / J~_ S~ Co[^.,.a~. ~ l.o~ 1 uirements must be maintained \ ~c k AA tb 2 ~ ,~, ac r se . J a per applicable Code /ordinances. (~ rv1 R t S ~ 3 Z ~ Sea" ~ fc~i nc~r)!t- bo ~ ~ ~' S ~$ . Attach complete plans (to the County only) for the system on paper not tesa than ti11Z 111 niches in size O 0 I 11_-- v) o. ~ (,J,/Yl Elty` = SIB, o i~+8 or.~ o{t~.,r fhoPo std y6tdran.» ~LSr'o~sncG ~ ~. 8°~49e A w -, r 1 \ b 0 1~ ~. -~ Elcv` = '03.80. .' ~'~ i ~ ~ ~ /~ I~ 0 ' 82 ~~,' ,' ~~ r/as: 97' ~~~ ~ , ~ ~. t~~ i~ ~'~ /~i o~ i , . ` ~; ~ ~ 0/r i 81 i~ ~i , ~:'' ~ / y ' : ~' ,~_'~ Pr o a ~ ~~ 4 ,: \ h~ >r ~ S 8/` t` P~oPas~r ~,~~~ c~ f~++at~ w/ Fbly/eKP,[ [F'~'/u~w ~ ~': /L~/ cbfi O~/av~ . zn zs' ~, earl ~P~ ~ Se,/ evYi/ua.~o., ror•E by GcCG~r'c~ ~ EX%s~n~ 9r,~de e/ev- d • /_o ~t ~D/'~• Clt7ixCuJ{3~~I7 ~stcJ ~nC. ~.at /o SuASL~ f~`~/s SGG- //~ T . off' /'~w~^. . ~ ~s--- ~~~i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/~tye~ C/'Di X C.~-S~n-~ ~~25 Mailing Address Property Address U t,~/• O/~ (Verification required from Planning Department for new construction.) City/Mate ~, ~~~ Parcel Identification Number O>-D - ~ S~~S- /C~ -~ LEGAL DESCRIPTION Property Location n'~ ~ '/a , s E '/a ,Sec. ~~, T ~-~/ N Subdivision Certified Survey Map # - Warranty Deed # Spec house ~es ^ no W, Town of t~~", Lot # ~. Volume `~ ,Page ~ Volume ,Page # ~® lines identifiable B' yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result ~ its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years ors ner, 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 a waste disposal system. The property owner agrees to submit to St. Croix County Zoning ent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed umper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and porn ' g (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree standards set forth, herein, as set by the Department of Commerce and the I Certification stating that your septic system has been maintained must be cc Department within 30 days of the three year expiration date. SIGNATURE OF APPLICANT OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of property escribed above, by virtue f a warranty deed recorded in Register _.~. SIGNATURE OF APPLICANT ****** Any information that is misrepresented may result in the sanitary Include with this application a stamped warranty deed from the Register of 1 reference is made in the warranty deed. maintain the private sewage disposal system with the ~artment of Natural Resources, State of Wisconsin. pleted and returned to the St. Croix County Zoning /~~//O~ DATE wr knowledge. Uwe am/are the owner(s) of the Deeds Office. /a /O/ /~ DATE being revoked by the Zoning Department. ****** Office and a copy of the certified survey map if Document Number U: 2749P 076 State Bar of Wisconsin Form 200: WARRANTY DEED Document Name THIS DEED, made between ("Grantor," whether one or more), and Croix Custom Homes, Inc., ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee tl described real estate, together with the rents, profits, fixtures and other interests, in St. Croix County, State of Wisconsin ("Property") (if m needed, please attach addendum): Lots 9 and 10, Plat of Sunset Hills in the Town of Hudson, St. Cr. Wisconsin. 76 I r+t+• 1 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIK CO.. WI RECEIVED FOR RECORD 02/ 14/2805 01:00PIi WARRANTY DEED Ei;E~F'? 1 REC FEE: 11.00 TRANS FEE: 570.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Addn:ss following ~purtenant a space is County, 020-1013-50-000 Parcel Identification Number (PRV) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way Dated ~ I Signature(s) ___. authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Attorney Kristina O>tlan if any. P. G ~ ~~~ _ _ ~ (SEAL) 17ontbriand (SEAL) ACKNOWLEDGMENT STATE OF ~-~ ~C ~ ) ss. ~( X COUNTY ) Personally c me before me on ~/ L-/~~ 5 , the above-n ed Daniel P. Montbriand, to me kno~ instrument Hudson. WI 5401ti Notary Pub My Comm (Signatures may be authenticated or acknowled NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO WARRANTY DEED ®2003 STATE BAR OF WI AUTHENTICATION to be the person(s) who executed the foregoing d acknowledged the same. :, State of LA~I ~Ccr~n~ ~ ion (is permanent) (expires:- ~ J~1~? ) d. Both are not necessary.) [IS FORM SHOtiLD BE CLEARLY IDENTIFIED. ONSIN FORM N0.2-2003 • Type name below signatures. ~ INFO-PROTM legal Forms 800-855-2021 www.infoprofonns.COm ~ ;, l _~ ~_ I -_ ~, _ ] P ~,.I ~ C~ >t~ 00~ ~C.~~ z ~ " ~ ~ N ` v V v c .. ~ ` j^~~. Z' ~ o s I D zz / T D r. A -- ~ ti 7 ~ i _ D ~ ~ ~ pG ~ C ~n ~~ ~~ D C r -o O m z D n -~ 0 z e ~, V A ~~r ~=0 v ~ f'1 A C n ~. D z 0 D 0 n D m Conventional Septic System Management Plan Pursuant to Comm 83.54, W' .Adm. Code General The conventional septic system shall be operated in accordance with omm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.Ol/O1). All and/or state Hiles pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Se bottom of tank to be <_ 15' below service pad elevation. The operatin€ assessed at least once every two years by inspection. The septic tank ~ the tank exceed 1/3 the liquid volume of the tank. The contents of the 113, Wis. Adm. Code, by an individual certified to service septic tank not removed at the time of a biannual assessment, maintenance person needed to maintain less than 1/3 scum and sludge accumulation in thi ensure proper operation. The filter cartridge should not be removed t that may slough off the filter when removed from its enclosure. ff the serviced if the alarm is activated. Septic tank manholes risers, access tightness and soundness. Access openings used for service and assess service. Any opening deemed unsound, defective, or subject to failurf than 8 inches in diameter shall be secured by an effective locking dev No individual should ever enter the septic tank as dangerous gases m abandonment shall be in accordance with Comm83.33, Wis. Adm. G component. The addition of biological or chemical additives to enhan such products are used they shall be approved for septic tank use by tl Division. itic tank to be located within 150' of service pad, with condition of the septic tank and outlet filter shall be ontents shall be removed when the sludge and scum in septic tank shall be disposed of in accordance with NR under s. 281.48, Stats. If the contents of the tank are nel shall advise the owner of when service will be tank. The outlet filter shall be cleaned as necessary to Mess provisions are made to retain solids in the tank filter is equipped with an alarm, the filter shall be risers, and covers should be inspected for water Went shall be sealed watertight upon the completion of must be replaced. Exposed access openings greater ~ to prevent accidental or unauthorized entry into the tank. y be present that could cause death. Septic tank de when the tank is no longer used as a POWTS ;e septic tank performance is generally not required. If e Department of Commerce, Safety and Buildings Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption stem. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide a degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compa 'on may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration durin cold weather months. Cold weather installations (October-February) dictate that the system be heavily mulched for fro protection. Influent quality into the system may not exceed 220mg/L BODS, 150 exceed maximum design flow specified in the permit for the installati TSS, and 30 mg/L FOG. Influent flow may not Observation pipes within the dispersal cell shall be checked for owner. Levels above 4 inches indicate an impending hydraulic Effluent flow shall be alternated between dispersal cells on a two switched diverting effiuent from dispersal cell currently in use to inspection and maintenance. t ponding. Ponding levels shall be reported to the requiring additional, more frequent monitoring. hedule by use of a diversion valve. Valve to be cell on a two-year cycle coinciding with septic tank Contingency Plan If the septic tank or any of its components become defective the tank r component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the 'spersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be dir~ted to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-46$0. sa'sas nh,a~sE.oog (~. ~~ ur - 0 ~ < H ~ ~, m di ~ .. . ~.. 0 Q ~ ~ w a ~ ~. J ~ ~ ~ = i ~~ ~ J __ . i:~ E PUBLIC _ _-.-~' _ if _.--- ~ - " _~ 17.x•- -' ' -~ _ i ^~;~ S s,~ I i r ' 1 ~s /~~\ ,/ ~ $ ~ ~ ~ ~ .~ !~ ~ ~, ~!. O Q c~ 11 ~ ./. J nN C? ~' N ~ ., .. '_' J j.. . ~. ~}...:'~ •' .~ . Yom,; l