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020-1474-03-000
Wjs~onsin 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 Environmental Holdin Com an LLC Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~ ~ tNt i TANK INFORMATION TYPE MANUFACTURER ; ,ACS ,J_ CAPACITY Septic ~ L~~~S ~5 ~ iz~c~ ba Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ~uJ WELL BLDG. Vent to Air Intake ROAD Septic ~. ~ / _ //L v'T Z~ / C~ / J Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufactur Demand GPM Model umber TDH 'ft Friction Loss Sys ead TD Ft Forcemain Le ia. Dist. to Well C(lll ARR(IRPTI[1N RYSTFM ELEVATION DATA County: St. Croix Sanitary Permit No: 499294 0 State Plan ID No: Parcel Tax No: 020-1474-03-000 Section/Town/Range/Map No: 13.29.19.3000 STATION BS HI FS ELEV. Benchmark S . I / ~ 5. i /oZj Alt. BM/+ /•'-b' f31~~ :-we-~• 5 22 Q Bldg. Sewer %c . 3Z ~,~ ~ 7g SUHt Inlet ~~ 2 ~ 3• ~~ SUHt Outlet 11.51 93.5 9 Dt Inlet ~ Dt Bottom s ~! Header/Man. It•o5 ~~ ~5 Dist. Pipe ~z ~$ ~3 b~ Bot. System l3 • I y Z Final Grade ~ , -7 ~ 7 , St Cover $.~ y~ 3 Q.J`I /-~S.Iq `ISM BED/TRENCH DIMENSIONS Width ~ 3 Length ~ ' Z.C7 No. Of Trenches ~ ~1 Q~-G PIT DIMENSIONS ~ No. Of Pits ~_ Inside Dia. ~'~ Liquid Depth ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~ _ /~~/) ~~~cr~ /~ ~l INFORMATION T e Of S stem: YP Y G ~ ~~ V / ~~ / ~~ w /~ J V' , 1~ J'\J UNIT Model Number: Q ~ f U ~ C/L, t DISTRIBUTION SYSTEM ~4:...~ ~~ ~a~t 3b = (n0 c/,~..b...0 Header/Manifold // / Distributi ` Pipe(s) ~ ~ \ x Hole Size x Hole Spacing Vent to r In p .~'~~ ~fdl~1 Length ~ Dia ~ Length Dia Spacing ~~- Cull !`!1\/GQ , n_.,.,......,, o..,..,....~ n..1.. .... 1111...,...1 /1r er_r_r~~lo Svefame only Depth Over / Depth Over -~ xx Depth of xx Seeded/Sodded xx Mulc ed Bed/Trench Center ~ ~ Bed/Trench Edges \ Topsoil Yes ! No °'. Yes ~1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 875 Yellowstone Trail Hud on~4016 (SW 1/4 SE 1/4 13 T29N R19W) Yellowstone Valley Lot 3 Parcel No: 13.29.19.3000 1.) Alt BM Description = ~- ~~ ~i ~. ~ O ~", SL rp ~~e ~~ 2.) Bldg sewer length = ~j / e: ~, ~ CpMtY1@fCQ.W1.Q~y Safety and Buildings Divisio County 201 W. Washington Av ., P. ox ~~~ ~ ~ „ ! Madison 1 5 7- r (to be filled in by CoJ Sanitary Permit Numbe Department of Commerce g / / Z / Sanitary Permit Applieati State Transaction Number In accordance with s. Comm. 83.21(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 Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information ou condary u oses in accordance with the Privac Law, s. 15.04(1)(m , Sta I. A lication Informati n - lease Print All I r at n Property O n s Name ~ ~ Parcel # ~~~' FEB 2 ~ 2007 ~`~ o2a ~ /~7~ - a - oab Property Owner's Mailing Address Property Location ST. CROIX COUNTY ~ Govt. Lot City, Sta Zip Code Y< ~ / _~6t~ ~S~ /a, Section ~,~ C (circle one Sao / 9 E ~ ~ ~ N; R T ~ ~ _ II. Type of Building (check all that apply) Lot # ~ 6~ Subdivision Name ~1 or 2 Family Dwelling -Number of Bedrooms ' ~ ~ z' ~0.2A.- lec~C Block # ^ Public/Commercial -Describe Use ew ^ City of ^ State O wned -Describe Use CSM Number ^ Village of Town of n 7 f' j Z - U t'Sd'-' G•J 2~ f.' ~7 GInG III. T ype of Permit: (Check only o e box on line A. Complete line B if applicable) A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~,~-~ IV. T of POWTS S stem/Com onent/Device: Check all that a I Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding 07 Iher Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersalll'reatmentAree Information: Design Flow (gpd) / Design Soil Application Rate(gpdst) Dispersal Area Re~ired (s Dispersal Areaposed (fit) ~ System Elevation / / / '~ / DD ' / Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ o ~ ° New Tanks Existing Tanks ~ D ID~ ~~~ ~ c a v ~, ~ in to .. ~ ~ R is. C7 R a Septic or Holding Tank _~ Dosing Chamber VII. Respon ibility Statement- 1, the undersigned, assume res nsibility for installation of the POWTS shown on the attached plans. Plum is me ( riot ~ Plumber' Sig ure ,~ MP/MPRS Number Business Phone Number V l ~ ~ G3 S~ - ~ u ber's ddress (Street, City, State, Zip Code) ~~ l V11L ount /De artment Use OnI Approved Permit Fee Date 1 sued Issuing A t Signature ' $ y5 D . ob z~~ a 7 Own en Reason for Den IX. Conditi~~~~easons for Disapproval 3~ 11 J~`~ ~ Q~ ~,e oJ: i7 ~~ 1. Septic tank, effluent filter and q, t~~ dispersal cell muse all ~ services !maintained b...w~- w,.c-~,_ °. as per management plan provided by plumber. ~~ l/~..o~e.,c .,.~~~ 2. All setback requirements fitJSt be maintained ~ 1 " b t ~ ~ Attach to complete plans for the system and submit to the ounty only on aper not less than 8 ~/i x inches in size ~~~~~ SBD-6398 (R. 01/07) V lid thru 101/09 /~ (Ql 0/~,./wl.~. ( Icl /~,~ ~ 1Q3 ~/,/5 i 5 tx._. ~' t ~/cu (`J~ $, ~(,.~~ ~'6 /er t (act.; ~„` o ~.~ 5~1.~d- Lort~-.~. ~c; ~ ~ „~~~~. tl ~- '~~ r ~ ~I 1 .~M ~' ~ \ ~' \\ ,~\,~ ~ h ;, ~ '~ ~ ~ ~ ~ ~ w ~~ ~, Q \ ~ ~ ~ m ~ ~ ~~ \ / ~~ i\ .;y1 i ~ ~ ,~a• ~ b ." ~` ` ~ \ ~ `~ \ Y! ~.. y °J ~'~ n `O ~~ ` .i \~ v ~~ C9 ~ 1,/) ~r~ ~~ ~~ - ~.~ ~~ ~, // \~~.. . \\ h ti ~, ~: ~''.. el a` ice, n Z ~~ V V ~~ :'~ ~ ~~ 4 vQO9 ~QQ ~\ 6\ ~\ C~ ~ C\~ \\. ~> ~ 1 ~~ ~ \ ~~~ ~ ~ ~ \ ,r v C l ~ ~ ~ ~ ~l ~ ,. N \~ `J ~ ~ i (~ ~2 V \~i _ ~ i ~y M ~ ~ \' ~ ~ ~ ~ ~ '~~ ~ w ~ ~~ ~ ~° (~ `~ ~ ~ ~~ -~ ~ ° ~ ~ m - ~° _~ /~ ~ - ~ . ~o / ~~ w i ~, ~-- ~ ~ ~~ / \ p ~ ~~'j ' ~ ~ / ,~~ ` ~,, ~\ / T ~ ~ \ ~ 0 \ ~~ ~E O Y 1 .1 ~ ® ~ ~_ ~~ ~ \~ '~ ``' - ~ \ .3 ~ ~~ .~, ~ ~ ~ ~' ~~ ~~ `~ ~ ~~ ~: ,fi ~` ~ ~ ~ ~~,pp~ ~i w ~.9 r ~ ~ y ~ o ~~~ ~~~ ~~ ~~ ? ~ \ ~° 1 OWNER: HUDSON HOLDINGS, LIC. 703 PINE STREET N. HUDSON, WI 5401fi (>1s) 3n-zolD PREPARED BY: AUTH CONSULTING/AGSOCIATES 2920 ENLOE STREET HUDSON, W3 54016 (]15) 361-5277 PREPARED BY: T OF NTY YELLOWSTONE VALLEY 5&N LAND SURVEYING : PLA COU 2920 ENLOE STREET nuosoN, Yn saols LOCATED IN PART OF THE SE 1/4 OF THE SW 1/4 & PART OF THE 5W 1/4 OF THE SE 1/4 F olL pls) 3es-zo07 OF SECTION 13 AND PART OF THE NW 1/4 OF THE NE i/4 & PART OF THE NE 1/4 OF THE ~ NW t/4 OF SECTION 24, ALL IN T29N, R19W, BEING LOT 7 OF CERTIFIED SURVEY MAP IN ~~ VOLUME 9, PAGE 2513, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. LOCATION SKETCH ~g5 CURV E DATA TABLE (NL u]IGMS ME BI FEET) EASEMENT TABLE •U° 7Y)IFN DF NUDSON ~ 70 #835 937 Itrcls'rra•s orrice Si-. C tO1X CO WIS. yth~ ~~R«oN ZYIAbLll1~CD.~~ '~ `~ Wee.. c.e1%W a>e m0.e A,e o,9.x e.•+P,r~ nw/ Lel Le,9u AAp. q.dna L,nBa LW19u rm9.x M B.,t al n 303 BB se•4aJS• XasoD•sas•E ziafiJ 2JB 94 x]]srofi'E nznBZJ•w 30J.00 2 x2330'58.5"E tp11> 1 s,'De'E x13R0'S)'E ~ 2N 00 lOSJ'39' NO]05385'W 150]5 15238 NIR]e'S1'E 83Yi8Y 3 x&100 WaB 39' x1056'b S'W 2159 2J.60 1T32'40'W N919']TW C3 SJJ 00 t0.1J,1' N83'aJ'015'W J]t 48 ])9.43 H3]l9'2TW De'3B'W SJJ.OO 313]18' NN'10'x 5'W 20301 2b.z> N1]'I9'3TW HISI Sfi'W 5 53300 10VB'42' N34VIVYW )43) 1)515 x45'I058'W ]B'W G 38].00 38Y9'3S' ST!']t'18.5"E )8300 28542 NBBTM'OTE 584TM'30'E .8).00 4N4>'II' SAtY]'025'E J3340 ]32N 58490'JB'E SxJI 2TE CS 21200 SB'40']3' SOSDa50.3'W x08.01 211.85 52J1WSTE 53T] W ,1 i I EASEMENT TABLE'V' \. SECTI r I ON t3 z ucwWD Ev (` nniNV2s*ERx `~ ~~~ .\~ +'~ SECTI N 24 ~~~ a~~ ~~~ T29N, R79W \ \ _ SCALE IN FEET ~,\ \ \ ] Im ° "' ]')~ " 100 0 l00 200 ` ~ \ ~ \ ~`\ \ ___. \ \ \ \ \ ~ \ \ sDe fi>~ \ \ \ DD,~ ~ \ a2oZ„c znl gfi. '~, ,~ \ \ .: eee .~ ~' ~ \ \ \ .~ N F•D3. ~ .., J6. ~ \ \ \ ~ \ uCJ i ~, ' ~ LOT 6 ~~'°. ~~ ~ \ .. \ R _ n.AO '- 0]89 50 Er7 _. \ \ '\.~ \ 9 - ~ - O 6 ti a ~~sec ~ l 'b, Cy'C4C0 ~ \ \ \ \ ... S ~ ~.........,. EA ~EWi - TO BE b \ Opp ~ , \ \ EN 4WD UPW `~ \he]~P '~~ ` ROAD ENTBtaat h'ry ' oOT 5 a, \ ~NOgTy \ \ `~ \ \ 'wart-aF-IYFN`Ar FAB1faR ' M10 ." N ?it \ \ \ \ _ ' '. NNPo: ROAD ~]~ 00 i ~, ~ ~ . I ~ tNp,Q ~ \ \ \ \ :.. AuauEXr a+naXS ~a '-- - _ ; ~+ n s~ ~ ,~ 1 Se~ra~> ~ ~ \ \ ~ \ ~r1.. ~ . ~ e ),rt 'S" \ DAB o B ~ \ ~ L0T 7~ s9 ~'D' \~' e~ L0T4 / ~ \\ -,NpFA \ a9n AtliE3 ~ i Bu'eoi sO~n. / ~., s .. \\ \ \ R~4Q\ Ba28850. fi \~i W :-;/ -j1V \ \ \ ~ ~ \~ \ '\ L00=99R0 a 0p3 APAES'., .~ 1•. - ~ a]35230 R \\ ~:;I L16 ,~" ` .Q \ Bw NWE=9960 ~n~ l•\ \ j 1L yam' ~\ \ .~\ Lo Ace a ~ ~ -a .9nel / - •\ \~ 119,]5)SO.ER. ~N'99 Wc]Zt b> ' ~ \ O s \ 53 f 93 iWND uWUUatr rs ~~ n,., rS 1 \ ~] \ NJO~ 5603~6'S~'W~0•«' iA~-~~ . +~O V~vm . NB3300.4 W 5q \ ~ 3 J N. ~' ~ ._..\ ?4.Ba- ~ LOT 2 I N ~N '~ I' I._ .1 ~~ LBD~BSB.o ~ I •~ j r~ ]OZ Aaas I j I ~ I i I 187,]8) Sa R, ; I ~ ~ I ~~~~ I.:_ N~.9 8.0 ~ i t ~ O I I ~~~~ - ~O (s~ ~ '/ / seB•axE.eaSN T~ I ~~~ SHEDS 7 HWEE:"~ ^/ /I / ~`~' I ~~ ~ / ~/ LOT t L95~ l IT£,w~v.~ ~: ~~~~/'7 /' of eii ~n. p5o43 qCi ,~ / ~ •b sours I~4 /~7 ~ 7 :. / ~ M Asr rN N% xrn ~ YCnON 13 ~ / ( 4 / / ~/ )V`~ / JB'E 2850.00' I__SECndt 1J _ Ig~nal 1] I J I ^ ' _ 7 ~ W ~~7/ ~. / `~ V - x39..5 -_ / 'S5 i~ q ~ M / / ti / ~ aES xE~~w LEGEND / / 2y. / / ~ O fWxO KUWHUx CWNTY SECnW CaBKR wONUwFNi / / ~ '(4I ~ ~T '- ~ 11` • FWNO 1" WTSIDE aAME)EW IWW RPE ~ / ' ry / O SEi 1-,/.' DUMEIER BY 18 W WfltlOMC wl)J G IRat B ~~ . LON 185, PfA UNCM FOOT ~y e•' "' ' - HL OTNEA LOT CgWEnS T90E ' 'L SPp` TCNm AREA WpG)ES WL-OE-SAC PoMT-OF-WAY. TFMµ WOADWAY H S W G MpNYENTFD wM 3 W ~AUEIEP BY 10• LOxO Wtlt PIPE tlXXC L,] LBS Pfw IINEAR FOOT WECOROm BEAgWG AMO/M a3T)NCE / B ~OY i ~ )HI RENOMD fApl _ .._.._.._ ONNNAOE EASEWQIT W .( /~ jJ GG%~ .. - ............. _ _ _ - BaUNNO SE18AM (50' inbl RIWT-OP-WAh ' WOE UnUtt CASaIExT + 4•l j / ' NOIL W RRprt ZONN)ON3E Is AO-RE5DlNnAI Fat GCH LDT IS Y2 ~ ~. / I TS i!E IHi[NDED ZOWNGNSE (SWaE iAY1lY HWESJ. ME AC-RESOQ1nN _^ E>a8nH4 f[NOE I DRAINAGE EASEMEN NO OWNEA OR RE90EHT 91µL DO NeYMING . REW WED YMINW LOT 91E n 20 ACRES (25AC 1200' gApU3 fAtl% uWRaOMAh / I CH WdILD WTfRfERE WM OR tlUNGE ME I rN111 OF ME LSD OOwPRQ1EM9L£ - AVFRAa:) PER )HE TOwt OF NUDSON. - - NfMEST PtlNT aF aNER LANO)YL OT AVERAGE f w1ER DRAWAGE AHO SaL EROSION PLAN FOR ]NIB INCWOES BUT 15 NOT LWxFD Tom IDDIG uPW. ossmuOa+c. u.muxc. ~ MI5 PROPFRtt IS LOCAnD WMIN A NefpAL OEtP GSWG NPE C[PM REWlealatT AAE'A. ui WElI cwsmuc ~ Wu aca.WE x f- xf - Ble.Bn ~ OPOSm OPoVFWAY ww wATfX ELEVAnw Fa+ Lm Exoww ABLE I OR E%CAVAONG. OP PIANatO Ix ANY PatD OR DRNNACB EA3]tENR. WAIFq R CE APPfiWAI FRW vV,E~11.5 wntlN OEN)IE1F0 t3WSF~T ZONE ~ i T BwDWC aPENIXC - ME zloe Ac 4s. Ac iar z-4 1 ~ ¢ a~s, w TER XWAYS. wAnn ~ xA m rnA sfmlxcs. WLLwTS L m AnomaXN. gEOARCNENTS DE suaEC OO 916.Oo iowESr w,mow DR DODR EIBVAnW. . Lor 3-x)49 Ac OT h . ~ Ga PMCEL ~~ Ox P5 O V/W APoABIL WOM Ruiz T-tY-wAv N 2011 AC DT S' ~ E ieFN OF NUOSOX IS aux3EO A NbI-E%CW9L£ EASE3IENT TO PROwDE Wx5NI i SUB.ECi TO STAIE. CWNtt AxD natS aES ut0 gE WLA ,E x BExCH uARN - lOP K FK F1EVAnW C OT 8.2.003 AC u <nW, uuNTptutrE, UR RFPNRS TO ME O W ~wS W AiCE .55 RutDS Wxluuu L 3E. O r non KO LOT 0 3.027 c 3.005 AC WCULL2A~ PONDS atuNA¢ WAK^ ANO T8 WMW ME SU•aVSTOx S REWUiFD. CEL ETC.) w9WE PUgCHA9N0 OP NY PMCFL Ca1TACT ME ST NC E ELEVAnW S ARE R(SFAfNCED LOT 8.4]03 AC . A O L40PI tl)a% Ca1Ntt 3tleNC ORl[E ANO ME )Olwt TD ME HORN u,FAICAN NARCN. TOTµ~1J.>I5 AC AVERAE~2fi]5 AC a" HUO3tl1 FOR AONCE. OATW OF IBB B. Tws wsmuuEXT mArnD Dv ' x51A]t xwtE ]Da Na aseA-m oA¢ Da/SDfxme REwsD DBNt/xooe SHEET 1 OF 2 ~ ~: Wisconsin Department of Commerce E~I~,UUlj-Tdo~~~E Division of Safety and Buildings lVl H ~ u ~"ttraect>r~ce with C m 85, Wis. Adm. Code ~,~` ~ n Attach complete site plan on paper not less than 8 1/2 x 71 inc es in Si~e.~1a711~uC~~UNTY inducts, but not limited to: vertical and horizontal reference poi BM direction and _ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print a!! information. Persorwl irrformaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~ RT ; ~~ ~"1 ~ " P ge ~ °f ~ ~ unty ,~ . n.,'1 1 Y LD. '~ /ed by i _ Date I ~~ ~~ ~ • ~ ~ ~ Govt. Lot ~~ 1/4 ~~1/4 S ~~ T ~ N R E (or W Props rs Mailing Address Lot # Block # Subd. Name or CSM# / City State Zip Code Phone Number ~ City ^ Vil ge own Nearest Ro ew Construction Use: esidential ! Number of bedrooms3 Code derived design flow rate ~ GPD ^ Replacement ^ Public cornmeraal -Describe: _._..__--___ __ _~ Parent material ~~G[/C`~~ f~ Flood Plain elevation if applicable ,~// ft. General oonxnents 7 • $', 3 e_ L otc/ 4 ~`t~/ and recorrrrrrendations: / 9 System Type ~Drt/1J~r`.-~/r,~/l.~~ System Elevation (~ q ~• ~- Boring # Bonng pit Ground surface elev. f ~ - J ft. Depth to limiting factor _~~-L/ I /- in. Soit ipliori Rate hiorizort Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 •Eff#2 t L ~ ,- 3/z., --.. r ~ ~~' ~ ~ ~ /, 9 11 GG J ~~ # ~ BOnng /' it Ground surface elev ~ • 17 ft. Depth to limiting factor ! ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eft#1 'Etf#2 p-1 Z ~0 3f S i r Z t z~~Z ~~ Sl ~ i ~ ~ -// ~ 4/ 1 ~ n Ct. ~`~ • Effluent #1 = BOD > 30 < 220 mg/L and TS5 >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST I~larfte (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evalu tion Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 ~-^~ ~--~ ~ 715-246-4516 J Properly Owner Parcel ID # Page *~ Boring # ^ Boring (~ //~~ ,~ Pit Ground surface elev. ~ ft. Depth to limiting factor T= in• Soil ication 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 2 ~- `~ / !~ S ~- ~ ~ ~-`~ l--l a.u;.,.. ~ ^ Boring L~ ~ ^ Pit Ground surface elev. ft. Depth to limiting tactor m• Soil lication Rate th D t Cdor i D Redox Description Texture Structure Consistence Boundary Roots GP D/ff Horizon ep in. om nan Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Bonng ~~ # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Sofl ication Rate Horizon . 'depth Dominant Co{ Redox Desrxiption. Texture Structure C~sisterrce. Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =BODE > 30 < 220 rtxtll. and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mglL and TSS < 30 rrglL 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. seaaa3o (r<.brool `~ ~ Soil Test Plot P1. Project Name Hudson Holdings LLC S Address 703 Pine St. N. ,/"~ Hudson Wi 54016 Lot 3 Subdivision Yellowstone Valley p ~'TM #226900 4/26/06 S W 1/4 SE 1/4S 13 T 29 N/R19 W Township Hudson Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 95.5/95.2 *HRpSameasBenchmark Alternate Benchmark __Top of ii2'° pipe @ 100.2° ne -„ ~ ~ ~,~~ ~. ~ '~ .. .~ ~ ~ ^~. ,~. `~' '~ \ --c' ~. Q _... '~ :. _ ~`'. . `. ` ~ ~ ~ `. V ~` ~````' 1, C ~\ v - , \ ~, `,, ~ ~. . ` ~ r Fy ~=~.;~ ~ ~ H1dVE=994.0 -'` ; ~ i ~' / . ~; •',; - ~ 'D,•'1 ~ ~~ r , % ~, ~ ~ j .., ~~-_.' ~~ ~ ~, LB®=996.01 ~ f t r ~ ~ '.. •`. ~,' ~' / ~~~., ~ ,-.~,,,, ~ i . ~~ 1 ~, .t ;' ,' ~A' ; <- r~'tt 4.4.5 AC R ES~ ® ,. ._ ~~~ _ ~~ ~ 3 ~. ._ .~~,. - _ ,~ ,. . .. .. r l~! ;; f' Lea=99s.o .., ~ ! ,, ;/ ,~•' - .. . ..., i >. `~ ~ . i` / 1 ._. _ ~~ti r ~ ,`\ ,~~ ~ ~_ ._ . ~ ~ ~ ~ . ~.. -. - . ~. ~~ ! o~ of J `O : ~ ~ ar e~~~~°o~~~N" C`Cy, ~g~` r f i/ State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ~~ Document Name THIS DF~ED, made between Hudson Holdings, LLC ("Grantor," whether one or more), and Environmental Holding Company, LLC ("Grantee," whether one or more). Grantor,'for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lots 1-8, Inclusive, Yellowstone Valley in the Town of Hudson, St. Croix County, W iscunsirr. ~~~~;i~8 KATHLEEN H. WALSH REC;TSTEfi C1F DEEDS ST• CRC3I}i CO. , WI fi'ECEIVED FQR h'ECQRD J ~1&4/;~0Qt6 1 ~ : 35PM WARRANTY DEED EAEt~r'T # f CS 1?EC FEE: f 1. 0~ TftAR1S FEE: CCIi'Y T'EE: pCL" i EE: Recording Are9 '~~ES' ~ Name and Retum Address Title One Premier Group #10718 020-I018-40-100 Pazcel Identification Number (PIN) This homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements and Restrictions of Record. Dated October 2, 2006 *Jeffre`v W. Member * (SEAL) (SEAL) * * AUTHENTICATION Signature(s) authenticated on * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706. THIS INSTRUMENT DRAFTED B~: IVotur,~ 1°'oblic ~tnte ct VUisconsi Michael H. Forecki, Attorney °~"""°""""""'~"'"~" Eau Claire, WI ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix COUNTY ) Personally came befo e me on October 2°d, 2006 the above-named ,.., ~ ~.~-, (p,aC.~yt'r'c-~.. to me known to be the person(s) who executed the foregoing instrument and acknowledeed the same. * 1/velyn M! Saeger Notary Public, State of Wisconsin My Commission (is permanent) (expires: l0/12/08 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. I-2003 * Type name below signatures. ~~' ~~~ Page ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal 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 will be 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 soi( absorption area. Reduction or elimination of the fopowing 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 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 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 INSTALLE ' Name ~ _ / Phone .._ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ' Name =5ene Name ~ ,, Phone _ -- . ~: _.:-ent was d~a`'e_ - __-Vance with chapter Comm 83.22(2}{bif? id}&(f) and 83.5411), (2) & f31, Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of .~ FILE INFORMA Owner i Permit # ~nv:( DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units J~NA Estimated flow (average) Q gal/da Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate ~~' gal/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average . Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) <_30 mg/L 1~ NA Fecal Coliform (geometric mean) 5104 cfu/1O0m1 Maximum Effluent Particle Size Y$ in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity gal J~NA Septic Tank Manufacturer ^ NA Effluent Filter Manu#acturer ^ NA Effluent Filter Model - ^ NA Pump Tank Capacity al .l'f IVA Pump Tank Manufacturer 1~NA Pump Manufacturer ~ NA Pump Model ~ NA Pretreatment Unit ~ NA ^ Sand/Grave{ Fitter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA 1~In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ry' ^ month(s) ~ ear(s) (Maximum 3 years) ^ NA ?ump out contents of tank(s1 When combined sludge and scum equals one-third (Y3) of tank volume ^ NA inspect dis ersal cell(s) p At least once eve ry' ^ month(s) year(s) (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ month(s- 3 year(s) ^ NA 'nspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ~ NA =.ys~ laterals and pressure test At least once every: ^ month(s) ^ year(s) JziG NA `~ At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the 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 immedi=_-e net'rfication of the local regulatory authority. G'.'~s- '-~ .,: -rb~ned accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire cc~:'~-'s ~ t~= tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, ~,','s~~-~ - -dr-~ istrative Code. r.! ~ .- _- _e .:-es. including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment .. .~ ~ ~ a-. s=_^: icing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. -- _= ~ ~ ~_ _ . ~~aii be provided to the local regulatory authority within 10 days of completion of any service event. ST. CROIX COUNTY SEPTIC TANK MAINTEATA~T~E=AGREEMENT AND L~ OWNERSHIP CERTIFICATION FORM --:---,=x ~1~J; fonn~ OwnerBuyer ~~t,-~,. 1~ o t,~ . k z L L c~ Mailing Address 70 ~ ~. ~•.~ Property Address g '7 ~/•z,GGc~w~ ~_ S'U --- (Verificaton required~from Planning & Zoning Department for new City/State ~,~~ 5~,,~ T u `~ ~- Parcel Identification Number LEGAL DESCRIPTION Property Location.StJ '/4 , ,~_ 1/4 ,Sec. ! ~ , T a R N R ~' q W, Town of ~dr~s~-•-~ Subdivision ~/Q L G, ~~~Q ~~ LLcv _, Lot # 3 Certified Survey Map # Volume ,Page # Warranty Deed # ~,3`~"g~,~' ,Volume ,Page # Spec house ~ no 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 l2 - St; Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plamiing & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that. (1) the on-site wastewater disposal system is in proper operating condition and/or (2} after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge., 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. Uwe certify that all statements on this. form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er of bedrooms / cN~l , IGNATURE OF APPLICANT(S) ~I71 /~ 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} EROSION & SEDIMENT CONTROL PLAN Site location: 875 Yellowstone Trail, Lot 3 Plat of Yellowstone Valley, Town of Hudson Owner(s): Environmental Holding Company, LLC Parcel ID #13.29.19.3000 Code Administration 715-386-4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." In Land Information ~ addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and/or landowner to follow erosion control procedures and maintain them until 715-386-4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on-line at: www.commerce.state.wi.us/SB/SB-DivCodesListing.html) Real Property 715-386-4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling following activities will be required in order to maintain compliance with the plan: 715-386-4675 Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. Surface drainage is northwest, with construction planned >50 feet from the drainage easement mapped on lot 3 of the Plat of Yellowstone Valley. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow diverted runoff to be directed onto neighboring property or into surface water conveyances. Contain runoff by installing temporary diversions graded ALONG CONTOUR between construction areas and any potential receiving waters (includes drainage ditches and retention basins). Temporary Diversions specification sheet is available from county. 4. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products (straw wattles, silt fence, and/or erosion control matting) will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. ST CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARMICHAEL ROAD, HUDSON, Wi 54016 715-386-4686 Fax ~~r,,-„ ~~,~,T,~~,,,,, ~.,, „~- ,.,,,,..,,-„ ~„~,.~T,-~.,~.,,.,~ ~ ~~ Page Two -ESC Plan Acknowledgement Form 5. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site. When late- season weather conditions will not permit seed germination, a heavy straw mulch cover will prevent erosion until vegetation can be established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with state and county code requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erosion & sediment control product installation. PLAN PREPARED BY: RYAN YARRINGTON, POWTS INSPECTOR #683475 Owner acknowledgement of ESC Plan requirements: _J_/2007 (Please sign and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and maintenance agreement, which is given to the plumber at time of permit issuance.) Copies provided for excavation contractor, plumber, and town building inspector ST. CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-4686 FAX ~~n.-,~ ~,,,,,,,-,-~>.,~~ ~~„ , ~.- ~.,,.,.~~.-.. ~~~~~T.-r,..~.. ~~,~ , ~~- ~~~ ~~,~~~ ~ ~o~~~ ~tECEIVED FEB 2 3 2007 ST. CROIX COUNTY EROSION & SEDIMENT CONTROL PLAN Site location: 875 Yellowstone Trail, Lot 3 Plat of Yellowstone Valley, Town of Hudson Owner(s): Environmental Holding Company, LLC Parcel ID #13.29.19.3000 Code Administration 715-386-4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." In Land Information ~ addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and/or landowner to follow erosion control procedures and maintain them until 715-386-4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on-line at: wwev.commerce.state.wi.us/SB/SB-DivCodesListing.html) Real Property 715-386-4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling following activities will be required in order to maintain compliance with the plan: 715-386-4675 Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. Surface drainage is northwest, with construction planned >50 feet from the drainage easement mapped on lot 3 of the Plat of Yellowstone Valley. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow diverted runoff to be directed onto neighboring property or into surface water conveyances. Contain runoff by installing temporary diversions graded ALONG CONTOUR between construction areas and any potential receiving waters (includes drainage ditches and retention basins). Temporary Diversions specification sheet is available from county. 4. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products (straw wattles, silt fence, and/or erosion control matting) will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. ST. CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARM/CHAFE ROAD. HUDSON, Wl 54016 715-386-4686 FAx ( 4' a ~ Page Two -ESC Plan Acknowledgement Form 5. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site. When late- season weather conditions will not permit seed germination, a heavy straw mulch cover will prevent erosion until vegetation can be established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with state and county code requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erosion & sediment control product installation. PLAN PREPARED BY: RYAN YARRINGTON, POWTS INSPECTOR #683475 Owner acknowled ement of ESC Plan re uirements: _ ~/1 /2007 (Please sign and return original ESC form to Planning & Zoning D t. A copy is attached to the owner's permit and maintenance agreement, which is given to the plumber at time of permit issuance.) Copies provided for excavation contractor, plumber, and town building inspector ST CROIX COUNTY GOVERNMENT CENTER 1 l O 1 CARM/CHAFE ROAD. HUDSON, Wl 54016 715-386-4686 FAX