Loading...
HomeMy WebLinkAbout020-1447-25-000Wisconsin 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 sewndary purposes [Privacy Law, s.15.04 (1 )(m Permit Holder's Nami=: City Village X Township Bast, Kernon Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: 9 8• Z- (~ tM, Z Gs T TANK INFORMATION TYPE MANUFACTURER ~ ~gS CAPACITY Septic 1 _ (_S 1~ S ~- W~~Q tG `Z (pQ F'b r s ~-' ~J ~~aJ~, e Aeration Holding TANK SETBACK INFORMATION TANK TO P/~. WELL BLDG. Vent to Air Intake ROAD Septic ~ 7 ~ /J~• ~Z ~ '7 ~/ 4 ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH L' Friction Loss Sys ead TDH Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 488194 0 State Plan ID No: Parcel Tax No: 020-1447-25-000 SectionfTownlRangelMap No: 15.29.19.2856 STATION BS HI FS ELEV. Benchmark G . z~ roy. ~ 9~. z Alt. BM ~Jalk. ~~ s. i. 9~, z$ Bldg. Sewer c/5 • D~ SUHt Inlet ~D' ~~ 9 StIHt Outlet /~ .,~ ` 93 x,7.7 Dt Inlet ~ ~ Dt Bottom 1 `! Header/Man. ~~•'~ ~Z•sg Dist. Pipe //. 7 2. N 97. S qz. ct, Bot. System /L . 9 9~ Final Grade S. 5 X5.9 4 St Cover `~ ~~ I, ~ , 37 BED/TRENCH DIMENSIONS Width i Length, ~ t No. Of Trenches ( w PIT DIMENSIONS No. Of Pits `"'\ Inside Dia. Liquid Depth `\ 3 g~ ¢- j 2. _ Z `Jew-G/'vs~ ` • SETBACK SYSTEM TO P/L SLDG WELL LAKE/STREAM LEACHING Manufacturer: - ~ ~ INFORMATION CHAMBER OR ~1? ~ ~ Type Of System: / UNIT Model Number: DISTRIBUTION SYSTEM ~s~ Z3 t.Js~d-- Z7_ ~~ta~-- Header/Manifold ~ f Distribution Pipe(s) ~ ~ ~ x Hole Size \ x Hole Spacing Vent to Air I takq~ f,0 Z Dia th~ Len acin Len th Dia S P ~ S _ g g g p _.• - SOIL COVER x Pressure Systems Only xx Meund Or At-Grade Systems On{v Depth Over I Bed/Trench Center ~wL! Depth Over Bed/Trench Edges xx Depth Qf Topsoil \ xx Seeded/Sodded xx Mulched I _~ p ~ \ ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: i Location: 931 Coyote Ln Hudson WI 54016 (NE 1/4 SE 1/4 15 T29N R19W) Coyote Ridge Lot 25 1.) Alt BM Description = ~ jt a~ 2.) Bldg sewer length = rj 7 •l -amount of cover =~`u 3[' ,~ ; r/~ (~L~~i t Plan revision Required Yes o ~ `-y ~~ j Use other side for additional information. D / "l_pl SBD-6710 (R.3/97) Date Inspection #2: / / Parcel No: 15.29.19.2856 ~J eJ~D ~, 3 ~7 S~ ---~ Cert. No. Safety and uildings Division P.O, Box 7162 Washi Ave. 201 W county 5 j ~ ~ o l n •~-~ , . • ~, Ma •son, I 7 - 71 i 'tar Permit Number (to be fine itl by Co.) ECE' ~eon~~n 08) -3~ 51 D ~ $8 De artment of Commerce State Pla LD. Number Sanitary Permit Applicat n AY I g 2 l informatio o p n r d C ~ so a e; pe o In accord with Gomm 83.21, Wis. Adm. may be used for secondary purposes Privacy Law, s15.04(1) r. CROIX CO u Project ddress (if different than mailing address) rY I. Application Information -Please Print All Information C ~ ~ ~ L Property Owner's Na me / Parcel q Lot N 'ZS lock N ~~~ ~~ ~J ~4- 5-~- ~.o - i~~~ z s-- a o a . ddress Property Owner's M ailing A P}•operry Location / ~ City, fate (~ 0 ~ ~ , i j 1 1/~ Vt/ t Zip Code ~~d/ r_ t'/ Phone Number // ~ •-~ (circle ona) / Z g s/ T G ~ N; R~E or~ / ' ~ J T k all that a l ) h ildi ( f B 1 ~ ~ ` . pp y ec ng c u ype o ow. II. t:,S ~ $v O k Subdivision Name CSM Number ~ ~ lLo~ 1'~~au `1. ~I or• 2 Family Dwelling - Nwnber of Bedrooms _- T ^ Public/Commercial -Describe Use C 0 YO •><-~ j~ ~ //~~ ~1 . ^ State Owned -Describe Use ~. IJi~•~ G?.~~ ~~.G-. ~ Z~ (.~~ ^City_^Village Township of 6t S'-p~/ III. Type of Permit: (Check only olle box on line A. Complete line B if applicable) A' ~ New S slam y ----- ^ Replacement Systwn ^ TreatmetidI•Iolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^Pertnit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV• 1'Ype of POW'1'S 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 ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Lint: ^ Gravel-less Pipe ^ Other (explain) ~ V. Dis ersal/Treatment Area Information: b en Design'~FI~(gpd) Design Soil Application Rat~(gpdsf) Dispersal Ar~ equired (/sf) tspets Area Proposed (st) System Elevation ~ VI. Tatlk Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New 6xist(ng ~ /~ /L 1t~ Tartks Tanks ~/ Za tot~C~ /~ ~ ~ F ~ ~ ~-, - Septic or Holding Tartk Aerobic Treatment Unit 2~ VII. Responsibility Statelnent- I, the underslgtied, assume Plumber's Na me (Print) Plumber' Si gnature 0 ~ N~LSo ,~ Plumber's Addre ss (Street, City, Stale, Zip ode) VIII, County/Department Use Onlv for hutallatlon of the POWTS shown on the attached plans. MP/D,4lP+R3 Nlnnber Business Phone Number Z ~ ~ ~ ?mss 27~ ~'~~ ~ l/ i Approved ^ D' proved Sanitary Permit Fee (includes Groulydwatel• Date Issu d Issui Agent Si a Surcharge Fee) ^ caner G' Reason fo enial ~~~ . ~ Je / 9 ~~ IX. Corlclitiorls of Approval/Reasons for Disapproval srs~lt tR: 3 J Q.~ ~ 1~..`. rw,~ d~ ~J re t~ : ~. e.~.~ a ~,.~e 1. Septic hnk, effluent filter and dispersal cell must all be services /maintained ~ ~ ~ ~~ v ~1.~ vim. ~ • as per management plan provided by plumber. ' 2 AN sslbaek requirements must be maintained as per appNable code / ordinances. r+nacn completo plans (to the County only) for the system on paper not less than 81/2 x 11 inches iu size SBD-6398 (R. 01/03) c ~0 -~ ~I.AN :~ ~, ~~Z, ti~~~ P ~,~ ~. . , I v '-~,~~ ~C 2 5 2~~3 Sc~i[. Division of SateRy and ;~~ ~ru miry ... ~ EVALUATION REPORT /~ 3 J ZONING 0~ F~I~`.,... •p., a.• .~.a..,........,..a county S T. CiQ O/ ~ Attach oompleoa site i~ rnatl9S~ n x 11 indles in s¢e Plan must . ir~de. twt not Grrrited ta: v and horiaord~ rete~rooe Point (Btu, direction anti ParCei LQ. Jl~~- peroentsiape, sc~eadNnens[oas. north amow.arid localfonand d~nce~ n~rest naad_ Please prn,t all Iraformatfon. Reviewed b,, Moss , 9 ~'°~wro"~°"ya"°'°"a°"~'aue°°ror'°°°"°°'rv~r~"•s.'s.°'tt'~t'"tt~ N o £ SEtT• l /~ /tE'/E3tl0~(J ~f}$ ~ PropeRyio~on Gaut. Got IVW 1/4`'s~ 1!4 ~S-/'7 T "~~ W R ~~ 4~(0~ w Pn~periy Owner's 1ufaA"n8 address fY L~ • ~rtR G..~ ~~ ' Lot # z5 # Scbd. tVame or CSAA# E,V !N "G~o y'o rte- ~jpFr~' ', Sfabe h~UDSo ~ w/• s yollo ?t 5 3 8h •~?5 [] c,~, ^ visage ®7rnm tic tZoaa /f vOSo•~ 13~1~~ ~~ - ¢t~ ~ use:l81 ~ r I~ksnner of bedraor:~s 3 '- Cade derma desi~ Aaw rage YSD -- o'i7 GPo ^ ~ ^ Pubcc a oonxnerdai - u~ee: Parent _ SA-iyl7 y O UT4JA-~S' LI Flood ~ etev~ion ~ N ~ ' ~~ Tom' TEV sv i r-r9•,E3/.•C. {~/~' •tv .;v~ ~Pvv.~~ ~ cd,v v~.vTr v~vrL s ys r,e-~ . C~ o. W • TS•~ ~s ,~~c~~ r 1 / 1 ~~ ~ G~.~17 • ~ ~~ ~ t~ ~t Wa~RY Si1,1aNV glir. • ? ~L iJ14A, R ifN~ IY{.~, ~ ML ~ - t ~ iww,~ p~. ~ W1AROy pay ~W{1fi1 .'~,,,,..,,~~,,~~`` t~Nwgplf /~,/y~~ VOY. ~ ~ VMM /y ~y ~A• X74. ~ ~p~., ~NR' / o•~ 0 3/ L z fshK~ ~sG, w 3 . s • ~ z 8• /o s SSG s h ~. s / . i • 3 3 .s ---- ~ ~.s ~.>~, ,e e -- . ~ [. .~-- p ~ r. i ~ ~ 0 ~°'`,~~ ~ ~ Qr~oundsurtaoeete+r. ~~•s~n ~;b~ 89 ~ . ~, ~ torte ttorixon i]eptly Uominent tiedoac Description Tune ire Coradstenoe Boundary boots Gi ~R in. Mtxrse! Clu. Sz. Cont. Color C~ SL Sh. '~F1 'E>F#2 / o• /oyie ~/ L L h Sti c~ ~ •~ , s . ~ ~ /0 •/ 7• S /Q GS /.wl ~ ~ (• to tit s~ ~ ,,.~.~~ , S 4 , dQ C - t .t ~~ • lent #1= t3oo > 30 < 220 re~1G and,SS >30 < 1 50 mdl. • t~,enc ~ = Bt3D _< 3o mA+G and Tss t 30 mgfG . B ~~- ~ttb~~cGi r Zzc~3zs Address Oats Evaktaion Conducted Telephone Wunber ~vov• ~ ~oo~____ ?t5•?7a•3~1~2- rnvate Sewage Consultants 2812 10th Ave. ~/~ S ~~ Spring Valley, Wl 54767 ~ p . !o ~7 ZD • /01,7 . z.o • io.2'~ , Tor,~G of 80 ~ Z o ~ o~ 30 - Q•a'a' yo • ~ ~l +/ Ca yo Tom- ~~1~G-~ KERtio~ T3~-5 ~" Par~cellD # L o T Z S z ,~ 3 q 3.7a > 9D . ~ _ n ~, ~ r Pit cro~,d surer ~,,. Soi Rye ttotiton OePlt- Dominant Redooc Des~on Texture Structure Cons~noe 8ota~dary Roots t3PD/tP ~. MunseN Qu. Sz Cord. Color Gr. Sz Sh. 'Eff#1 •Ef[#2 d •iz io R y L Zf 5fk s~ w 3 f . s • ,~ ~- o L l h~ c . z. .3 .3 8• s ~i ~ I -Fsh~ ~ v ~ c - • ~. • 3 ~•sr~ s ~---. G s lit d cf -- , ~ i• Z 5 ~0 7 S D, ~. •? ~, Z .2 r( a ~~ ^ ~ o Pit t~rormdsurfaceew. ~. b ~,. Rate Ftorizan Depth Donw~ant Redauc Desvip6on Texture Structure Consistence Bourxlary Roots toPDl[P in. Mansell t2u. Sz Cold. Color Gr. Sz Sh. 'E1~1 ~~ # O ~9 ^ Pit Cxamd sursace elev. >t Depth to in. Rate Horiaort Depilr Dominard Redox Desaiptlon. Teuchrre Structrrre Ca~Uenoe Boundary Roots GP OVfit in. Munsei Qu. Sz Cont. Color ~ Gr. Sz Sh. 'E1~1 'Etfif2 t~fltterrt ~1= BODE ~ 30 < 220 rt-g1L and TSS >30 <_ 150 mplL ' E•fthrerd ~ = BODs < 30 mgA, and TSS < ~ mg1L The Dtpa~rtrnent of Commerce is as equal opportunity scrvice provider and employer. If you nced assistance to access services or iiced material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ,~cayoTE ~;o~+, ~~Rtia~ T~~4-s T' . ~~ Parcel fo # L o T z s Pane z~ 3 ©~~# ^ Pit Ground surface elev. ~~ • ~a 8. Depth to ArNNng tacbor ' ! D in. SoY Rate Horimn Depth DominaM Redox Desaiptiort Texture Strtrchxe Consistence Boundary Rooffi OP DM' in. MunseN Ou. Sz Cunt Cdor Gr. Sz Sh. •ER#1 •Efi#2 l d •~Z io R ~ - L ~f shk sti w 3 f . s • ~ -~ • o ~ c sh ~ c . -z . 7.5 /Z S ----, G S /~ ~ C f - ~ 1. 2.... ~o S D, r2 . ? c. Z. ,r °~ ~~ ~ ...~+ u rll -. ......... .....ww vw +~+cYu. av m.wary ~aww - r~. a7YN Rate Horizon .Depth Dorrdnant Redox Description Texlwe Struclwe Consistence Boundary Roots GP DIfF in. Mtmsed Qu. Sz Cont. Color Gr. Sz Sh. 'E18k4 'E1ii~ # ^ Pi8 t~ Gramd srafaoe elev. ft. Depth to I'aniting tac~or in. Soil Rabe Horizon Depth OorNnara Redox Oesaiptlort. Texture Structure Cot~ter~oe Botmdary Roots GP OVPF in. MunseN Qu. Sz Coat. Color Gr. Sz. Sh. 'dC#1 'Eff1t2 ` Efikamt #1 = t30D, > 30 <_ 220 mgil. and TSS >30 ~ 150 mgll. ' Eftiuent #2 = BaD, <_ 30 mgfl, and TSB: 30 mglL Tht Department of Commerce is an equal opportunity service provider and employer. Ff you need assistance w access services or need material in as alternate format, please contact the department at 608-266-3151 or TTY 608-264-8'777. sac-tuotR.eoa> ~~ g yo aj i/ = ~ • - ~AG~~ ~%TS ____ ,~ Gov ~~~ ~~ S For issuance of permits arx! designing Contact: Ulbricht & Associates Registered private wastewater consultant and plum 2812 10th Ave. Spring Va11ey, W154767 715-772-3442 .~ r ~ To ~° a~ ~ ~ M ~ ~~ y~ q~, ~ ~ ~ ~,,d ~ a9 ~ r~, 0 ~d .Z. S v s H w 58 - --- --= S 5 ~ ~ ; Tod °~ 6 .O r [^OT \ L¢ go May 15 06 05:17p Team Speer Bast 715386866 p,l ~~ . teaa 11p:4r! ,17.:~ r~u.ao .,._,.~-- - _,,,.,..._,~. _,._ _ ST CROIX GOti11YTY Sl~l'T]C 'TANK MAINTCNpNCE AGREEMENT AND pwNERSHiP CERTIFICATEON FORM QwnerBuyer /J .~ ~ g,~sr i4lailing Address ~~ ~ 8~~ f?DI~~O Pxaperty Address ~~J CO~t?'~ LN. - Nua~- wrsct~si~ (Verifiearion rege:hed from planning DepattnttRt Wr new construction) City/$tate /-~yaSati.) Parcef idcntificatitan Number ~~ ~ ! 4y 7-a5-«yp ~ECtAI_ DE. SCRi~jOt+t Property Lta!catian '~~ '/,, 's~ '!., Sec. _JS , T a9 N-R_L~,..w, Town of f~uOS~ Suhtiivisiarr Ca YOi ~ 211K~~- , I.ot q ~ s , Certified Survey Map q , Volt:me / ,Page # WsarrAnty Dced # (~ () ~~~ , Yolumc ~~ ~. Page q ~ Z U SPCC house C3 ys+s ~ no Lot lines identifiable ~ yes O no SYSTEM MAINTI~I~iANCF, improper use and rnaitttena»ceof your septic spstcm could result in +~ premature farlure to hattdie wastes. Draper matntcnan.c consists of puttrprng out rht septic rank ry cry thrte years or soontr, if rut!de0 by a beenstd pumper What you puc intro the system can alItcc the (uneripn of tins scptcc tan3: 0s a treatment sage in tM waste disposal syatnrtt. ThC property Ownlr 9~',[CCS 10 strbttr+l t0 SC Ctala ZORStiY DCpamtrcnr a ccrrrflCation form, sr`rttd by tht oarrrer and b~ a nrasrci ptamt+er, jou tstcyman plurrrbcr, tcscricrrd ptv+rrircr or a )iccnscd pumper rOrifying that (1) the oa-snit wosrewater disposal systc rr. w in rropEr aptratinfi candnion antLor i z) after rrtxpectron and pumping (if necessary), the stptic tank is tens than 113 full of stooge. lfwe, the unders: ned have read the above requiremtttcs and agree to rnainrain the pri~ste sewage disposal system with she standards se[ fonh, h s se[ by the I}epanment of Commtret and the Departrne»t of Natural Reseaq+ces, State of wisconsrn Cen,ficaann strttrtt; t ya r se s~ctcm has been nwinravi.•.t »utsr be complNed and rctvmcd to rht St. f'roi~t Gounty 2onirtg Off:cc within 3Q t(a of lire art tratiNn dote. APF'LiCANT Si /S /a~o ~~r~ alt statcntents un this fornt arc snrc to the best of my (our) knowledge I (we) am (alt) the owner(s) of Ic, §X .•rauc of .r ~~ arran:y deed recorded in Register oC Deeds Office. CANT' S i~-sroict~6 DATE "" Any inCorrnuion that is m+s-rcprescmcd Wray result m the sanrtary pertn+t being revakeG by the Zoning Dcpanrrtcnt. """ " include with this apptieauon: a stao+pcQ •~ansnty decal from the Regixar of Deeds office a copy of the ctt7rfied survey map if rcitrence is madt in the wartantr decd ~~d Z66G9BESTG uosuyo~ uoseC d'CT=tp EO 8~ ~~p uick4 .,- , ., ,~ STANDARD CHAMBER - ~ ,~ Quick4 Standard Chamber ~,s p~~ ~ SECTION VIEW { / ~'I 34"- MultiPort End Cap SIDE VIEW TOP-VIEW FRONT VIEW ~Quic °.fi Size Effsc ' ~ fl'/A I ~.~~ -;~. :~ '7 q'~ ., ,.F..: ' ,4,E INFILTRATOR SYSTEMS ING STANDARD LIMITED WARRANTY (a) The structural integrity of each Gtember, end plate, wedge and other accessory manufaduretl by Infittretw ('Units, when installed end operated in a IeaGTLeld of an wutte septa system n accordance with Mfittretw's lutrucibns, Is warranted to the orighel purchaser ("Holdar'~ against defedWe materials and workmanship for one year from the date that the septic permit ds Issued far the septic system contatwg Ne Units; Provided, fawever, that lt a septk: penal is rot required by eppflcable law, the warranty period wW begin upon the date that installaton of the septic system canrnences. To exercise its wananry fights, Helder must ratty InNtretw in welting at Its Corporate Heatlquarters h Old Saybrook, Corvtecticut within fifteen (15) days of the alleged dated. Infittretw wfll supply replecertrent Untts iw Units determined by Infittretor to ba coveretl b1' ihfs UrrAted Warranty. Infittretw'& IiabiGry spedfaely excNtdes the cost of removal and/or Instaualbn of the Units. (b) THE UMfTED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE IXCLUSIVE. THERE ARE NO OTHFA WARRANTIES WfTH RESPECT TO THE UNITS, INCLUDING NO IMPUFII WARRANTIES OF MFACHANTABILfTI' OR FfTNESS FOR A PARTICULAR PURPOSE (c) This limttetl Warranty shall be void tt any pert Of the chamber system is marwfactured by anyone other than Infittretw. The Clotted Werrenry does rat extend to incWental, consequential, special w kWlecl damages. Infittretw shall rat be liable for penalties w flquidated damages, FaWdlg loss of production and profits, labor and materials, ovarheed costs, w otfter bsses or expenses incurred by the Helder w any tlJrtl party Specifaaly excluded from United Warrenry coverage are damage a the Urttts due to orcdnary wear and tear, attaraticn, axident, misuse, abuse w neglect of the Uruts: the Units being subjected to vehirJe treKa w othar conditions whk:h are rot pertnttted by the installatbn Insiructbns; failure to maintain the mhimurtt ground covers set forth in the Installa[on lrstructlons; the placement of impropar materials Imo the system contaltltg the Unks; faiure of the Units w the septa system due to improper sttirtg w lnpropar sizing, excessNe water usage, improper grease tlisposal, w lnpropar operetbn; w any other event rat caused by InfJtratw This Lirtrled Warranty shall be void it the Holder fails to comply with ell d the terms set forth n this United Warranty. Further, in no event shay Inflltretor be responsible for any bss w damage to [he Holder, the Unks, w arty third party resulting from Installation or ship- ment, wfrom any product uablliry Gains of Holder or arty ttilrtl party Fw this United Warranty to appy, the Untts must be Installed h accordance with all site conditions required by state and bcal codes; ell other applicable laws; and Inffltretw's instaAation hstructbns. (d) No representative of Infittretw has the auttadry to change w extend tltLs Lknited Warranty. No warranty applies to arty party other than the origF nal Holder. The above represents the Startdard LYnited Werrenty offered by Infittretw A Iimtted number of states and counties have tlllferent warranty require- ments. Any purchaser d Units should contact Infiltrator's Corporate Flaedquarters in Old Saybrodc, Comecticut, prior to stah purchase, to obtain a copy of the applicable warranty, and should cerefuly read that wamanry prior to the purchase of units. ~ ~ ' • ~ O SYSTEMS I NC Environmental Onsite Wastewater Solutions'" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 800-221-4436 U.S. Patents: 4,759,667; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,407,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and SldeWinder ere registered trademarks of Infiltrator Systems Inc. Infiltrator Is a registered trademark in France. Infiltretor Systems Inc. is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeaching, PoyTufl, SnaplACk, ChamberSpacer, PosiLock, QuickCut, puickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc. ®2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP-0 j .._ LB.v. = so1.60 .. -~ '~1 L37 ~ ~ ~-i` ~ , ~ ~ j W 1 ~ .~ 34 L J i j ~ ~i~ _ L L35 _ _ _ _ _ _._._. .......1. ..1 ............. ............ ................... ... . .~........ ...............................- °° ~ ® _ . ~ ~ j ~~ I 101 _ __ -- / ~ 1 L14 '14' 10.54 /~ / ~ ~' i i ~ • /" % N 86°08'i4"E 310.54' l., , , . ~ ~' ~ ~ ~~ g ~~ ~~ ~ • l j ~~ ~ , ' ~ / / ~ , i ~` " " % i ~ ~ s ,,.. LC ~ ~ r' ~ . ~ ,~ % ~ ® ~ ' l : ~ ' o LOT 25 ~' a ~'~ ~ ~ 2.03 ACRES ~ H ~ ~ `. ~ LOT 24 m 88279 Sq. FT. m ~ I ~ ~ 2.03 ACRES ~ ® z ~ ~~.\ 88486 SQ. FT. S ~i ~1 ~! ' ~ ~ A ~ ~ ~ ! ~. ' RAD TEMPI N j ---~N rri ~ 4:UL-DE-SAC ~ i ~ ~ ~ ~ F ~ ~ ~ , , ' I .~ 4 i ~ ss oa. 282.03' 3io. is o ~ u 388 58 1 W ~ 287 5 82 SOUTH LINE OF THE NORTH 1/2 OF THE SE1/4 x X x , x x . k x x M[r~p~4~r'C~D ~D~ O~ nMC~D o ~7 a0`~1C~G13~ DRAINAGE EASEMENT UNE TABLE NUMBER DIRECTION DISTANCE NUMBER DIRECTION DISTAh Li N44°OS'25"W 239.21' L31 N86°29'45"E 65.85' ~ S45°5 i'35"W 360.65' L32 S01 °51'46"E 136.83' ~ S45°51'35"W 20.Oa L33 S86°29'45'1N 167.8G L4 S45°51'35"W 228.36' L34 S86°29'45'W 123.09' ~` S45°51'35"W 112.29' L35 S86°29'45'1N 44.77' ~I L6 589°21'18"W „ ~...,.,._,.._,~ 93.52' L36 N01°51'46"W 47.79' VZ~B~ ~P. IZo STATE BAR OF WISCONSIN FORM 2- 2000 Document Number ~ WARRANTY DEED THIS DEED, made between Kernon J. Bast, a married person, Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area 75m9f+G3 KATHLEEN H. 41ALSH REGISTER OF DEEDS 5T. CROIX CO. , MI RECEIVED FOR RECORD 01/07/2004 12:35PI1 MARRANTY DEED EXEMPT # 8M REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Name and Retum Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 412540 20-1027-40-000 & 30-000 &20-00 Parcel Identificazion Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. * ernon J. Bast AUTHENTICATI r0~1C1 Signature(s) _ G~gC1 ~ a~1C o ~- . ~-ns~=~- authenticated this 6th day of Japing ' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) •Names of persons signing in any capacity must be typed or printed below their signature ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this January 6, 2004 the above named Keeton J. Bast, a married person to me Irnown to be the person(s) who executed the foregoing instrument and aclcnowled the same. -~/~~ *Cheri Brown ,c Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) ~3 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 u 2ys7P 1Z~ EXHIBIT A The NE '/. of the SE '/• and the N W '/. of the SE '/., all in Section 15, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E'/, corner of said Section 15; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE'/. of said Section, 407.27 feet; thence South 89 degrees 08 minutes 15 seconds West 535.46 feet; thence South 14 degrees 10 minutes 34 seconds West 93.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures 25 degrees 34 minutes 33 seconds, whose chord bears North 54 degrees 32 minutes 33.5 seconds West and measures 35.41 feet; thence northwesterly along the arc of said curve, 35.71 feet; thence North 14 degrees 10 minutes 34 seconds East 76.12 feet; thence North O 1 degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume i, page 217 at the St. Croix County Register of Deeds Office; thence North 88 degrees SI minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. > ~ ~ ,•~\ POWTS OWNER'S MANUAL & MANAGEMENT PLANPage ~ of Z FILE INFORMATION Owner N~ Permit # DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units -- ^ NA Estimated flow (average) ~ al/da Design flow Ipeakl, (Estimated x 1.5) Qjj al/da Soil Application Rate ~ at/da /ft~ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD$) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODb) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Yin dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity Z Q al ^ NA Septic Tank Manufacturer (~f ~ ^ NA Effluent Filter Manufacturer ~ ~ (~ EL ^ NA Effluent Filter Model ~ (~~ ^ NA Pump Tank Capacity r---- al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ~- ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection O Aeat Filter ^ Wetland ^ Other: ^ NA Dispersal Celi(sl ® In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In•Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency ins ect condition of tank(s) p At least once eve ry~ ~ ^monthls) 9 earfs- (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA inspect dispersal cell(s) At least once every: 3 ^monthls) (Maximum 3 years) ®year(s) ^ NA Clean effluent filter At least once every: ^ monthls) ®year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ?~ ^ month(s) ®year(s) ^ NA Flush laterals and pressure test At least once every: ~ ^ month(s) '® year(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardvyare, 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 tha immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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. Alt 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. GMW (4/01) • Page ~ of Z START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemical: that may impede the treatment process and/or damage the dispersal cell(s!. If high concentrations are detected have the content: of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) 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 Saptage Servicing Operator prior to restorint power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc 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 andlor is permanently taken out of service the following steps- shall tie 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. D Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <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 Name ~' p ~ 2 ~ L 50~ Phone c, _ Z 7 ~ _ l2,((f POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name zD N~i/ C ~ 0 ! Phone ,, / ~ (o ~ T~ 8 jS This document was drafted in compliance with chapter Comm 83.22(21(b1111(d1&(f) and 83.54(11, (2) & 131, Wisconsin Administrative Code. Parcel #: 020-1447-25-000 Category Alt. Parcel #: 15.29.19.2856 020 -TOWN OF HUDSON Current ~ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/27/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -BAST, KERNON J & DONALDA SPEER KERNON J & DONALDA SPEER BAST 948 LABARGE RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 931 COYOTE LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.030 Plat: 10/17-COYOTE RIDGE 020/04 LOTS 1129 SEC 15 T29N R19W PT NE SE BEING COYOTE Block/Condo Bldg: LOT 25 RIDGE '04 LOT 2 2 ( ) .03AC) 5 ( - Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-29N-19W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 10/06!2004 776378 2671/157 VRNC 07/27/2004 769938 10/17 PLAT 01/07/2004 750940 2487/120 WD 01/07/2004 750939 2487/118 WD mo-e... 7f1(1F CI IMMARV Bill #: Fair Market Vatue: Assessed with: -- - - - - ------- -- - - 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.030 77,400 0 77,400 NO Totals for 2006: General Property 2.030 77,400 0 77,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.030 77,400 0 77,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code 05/19/2006 11:12 AM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00