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HomeMy WebLinkAbout020-1437-03-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION r (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township A letree Builders Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Description: ~A411! IhICA~11AAT1AA1 CI C\/ATIA LI r1ATA TYPE MANUFACTURER CAPACITY Septic ~ ~ ~L Z Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ 5/ ~ / \ `.~J / Dosing Aeration ,,, --~ Holding PUMPP%SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift ctio oss System Head T H Ft Forcemain ength Dia. Dist. to Well SOIL ABSORPTION SYSTEM 7_ 3 ~ r L ,,,,. _ ~. ~ ~ county: St. Croix Sanitary Permit No 463101 0 State Plan ID No: Parcel Tax No: 020-1437-03-000 Section/Town/Range/Map No: 22.29.19.2708 STATION BS HI FS ELEV. Benchmark ~, f / Qty- D Alt. BM Bldg. Sewer ~~ ~ ~ ~ r SUHt inlet 9 • s3 q `f . 96' SUHt Outlet ~ ~ G 3, / Dt Inlet Dt Bottom Header/Man. ~ p , ~ i 93 •~'`I Dist. Pipe 0 • . s 9 3 , qs~ Bot. System / /. 9 Z • 6Y ~r z9 Final Grade /],,,,, ~ " - ~3 Z ~~,~ ~~ ! ~ `` St Cover ~ D ~ z/ S-y R • ~s r RENC Width / Lengt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 f ~) Q1!• SETBACK SYSTEM TO P L BLDG WELL LAKE/STREAM LEACHING Matuygr:/ ] /~ INFORMATION CHAMBER OR v~, 17~.Y/ Type Of System: ~ / S L ~ `.~-- UNIT Model Nu r: U• ~ DISTRIBUTION SYSTEM / la At„~f%L )- Header/Manifold Distribution / x Hole Size x Hole Spacing Vent to Air Intake ~ Pipe(s)/ `~- ___~ r ..... Length D Length Dia pacing----__ ~ O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ / `/ (~ Bed/'1'rench Edges Topsoil [] Yes ~ ] No U Yes ~ No CO ME~S~: (fie co a d' ~repencies, persons present, etc.) Inspection #1: 6V,~~~ ~ Inspection #2: `T-7a L ation: 808 Ross Road Hudson, WI 54016 (SW 1/4 SE 1/4 22 T29N R18W) Kell Estates Lot 3 Parcel No: 22.29.19.2708 1. Alt BM Descri tion = S'T~ ~O"`~e ~e C~f~ ~) W ~~~,r~~~ 2.) Bidg sewer length = 2 ~ t DK ~ /~ 0 '~ ° ~l $ 2 ~t~j~ 1~c1~ / Yh - amolunt, off cover = ~ ~ ~--'~ 3 ~"~^~ ~~ ~~`~ Plan revision Required? ~~ Yes No If ~ O ` ~ sD Use other side for additional informa ion. SBD-6710 (R.3/97) Date Insepct rs Signature Cert. o. ion: County C ~. to gton Av P 7082 S ~ ~Q/~ ~~~j~~sn tson, WI 5~~0 2 Sanitary 't Number (to be fil De artment of Commerce ) 3lDI Sanitary Perini Ap c '~N-~~ State Plan LD. Number to accord with t..omm 83.21, Wis. Adm. ~ E /{I d' may be used for secondary purposes ~,e~ m) Projoct Address (if dirferatt thao i I. Appligtton Information -Please Print Art Info !Finn ~~. ~ l~.l Owner's Na ~ Z • ~ // ~~ ~/ fd~ Parcel # Lot # Brock # .ti[ /3 t~~~~e~es ~ 3 OwQjner's Mailing 13 ~ ~D~~~L~i/~1„Q~ ~/~ `~' 2 0 S ~O/P~"~t~' aq n city, state `s~ %, ~~ y., Section Z Z • a TAP Code Phone Number Caoo j~/,~p/2 /~I~v . SS/ Zs G~,2 • ~'aS • 3~6 Z ~ /~j (t:iroe one) II. Type of Bttitding (c6txk alt that apply) ~ T N; R' { for W ~ar 2 Family Dwelling - Number of Bedrooms ~~ Subdivision Naau CSM Number ^ Pttblic/eonmr«eial -Describe use It ~/~ EsT~'F'T~S ^ state Owned -Describe use ST ~ Z ^City ^Village (~fownship of G~f D~ III. Type of Permit: (Check only one box online A. Complete line B if appligble) " A. New System ^ Rephtcertrent System ^ TroatmendHokGog Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Reaewal ^ Permit Revision Before Expiration ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Lssued Plumber Owner ~O° -Pressurized ~-~ound ^ Mound > 24 ia. of suitable soil ^ Mound < 24 in. of suitable sat? ^ At-Grade ^ Single Pass Saari Filter ^ C°°stnrcted Wetland ^ Pressurizod In-Ground ^ Hokting Tank ^ Peat Filter ^ Aerobic Treatment unit ^ Recirculating Sand Fiha ^ Recirouhuing Synthetic Media Fiher ping ber V. D reatment Area Informatio . ~ ~"~ ~ ^ Pk1O) Ir (gPd) Design Soil Application te(~dsf) ispersal Area R wired (sf) Dispersal (s System Ek r ' '~ ~s~ ~~a /~ 9y. sv VI. Tank Info Capacity in Total Number Manufacturer prefab Site Steel Fiber Plastic Gallons Galtorts of Uaits Concrete Cot-stnrcted New Existi~ Glass Turks 'ranks Septic err Holding Tank /~ t~ ~) /I1'1 / /.n i'~.(` ~~s , i _ ~ ~ . ri~~ VII. ResponsibItity Statement- I, the naderxigned, assume respo stbility for installation of the POWTS showy on the at4tched pleas. Phmibern's,Name (Pent) umber's Signature MP/MPRS Number R . (~ Lit3 R I •C / ~ Bnsirtess Phone Number ~,/ Plumber's Address {Strew, City, State, Zip Code, ~ Z G ~ ~ ~ ~~ S ~ 7 1 • ~ ~ / vrrr .......,.,t.e....r_--... -- t~Approved ^ Diywpprov~ Sanitary Permit Fee (inchaies Groundwater Da Lssued ing • ^ Owaer Given Reasmt for Denial Surcharge Fee) ~oI J CJ's ~ ~D ~ 17{. Conditions of Approval ns forpisapproval, I ~ YSTEM OWNER: ~~ I~Z~'4~ v~~ is an ~, a went filter and j~ ~,: dispersal cell must all be serviced / niaintatned ~ U a_s per manaaemartt elan orovided b him~i~ 2. All setback regwrements must be maintained -- as per applicable code/ordinances. Attach eampkte ptaas eta the cwaty awry} ter tie system as paper sot las than 81n : i t taehet:a sla SBD-6398 (R. 08/02) ~~ L O ,~ y~ N C 'a ~ ~ CT ~N~ln < o ~ '~° ~~~~ ~D~~ ~~`~~o 0 ~~ v c~,a ~ 0 ?~O 0 ~~ ~ D • ~~ {1 ~. ~ ~ y ~~ ~ `, 4~ NN~ O ~~_~ ~w~= ~~~~~ N ~ ~~ o~ ~o ~o bmDm~ b ~ ~ o~°~ m mom ~ ~ nom' m~~ r-~r ~- W b n ., ~, d 0, o~ ~~ / -Z o Ri ~~ ~ a '`A C1 N ~ ~ ~ o '!~~ ''~ w i~ ~- ~'_~~ ~~ ~ o -h ~ ~_ ~ ~~ {~ ~. ~ ~ o ~ ° / .. --{ ~I ~ ~ r ,~ ° ~ • {7 ti ii 1O1 0. ~ ..._..i ~ ...L, II i o0 J 1 I ! I ~' d ~..~ i{ 11 i it W ~i{ { ~ ~ 11 1{ ~- ~`r Iiw 1{w Ilx 11% IAN {F~ i 1 !, ~10~ 1 L~-----La cp • o~ _ O . ~ ----. y ~o n~ ULBRICHT & ASSOCfATES CO. 287 2 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems • 715-772-3442 Private sewage Consultants PROJECT INDEX (. PLAN ID # DATE D~~ / 1 ~~ OWNER ~~ /r JL~~.Id~t1 ~ ~/ PHONE ADDRESS -~ j~ ~7 tt~ooyG~,v~ ~,~, c~ao~ ,~-v • ss~Z. s LEGAL DESCRIPTION GO f ~ 3. ~-~~~ .~`$r,~~S'- ---- ~l~v o ~ • I obD • j`~0 -dam • ~SZv, ~ ~, yec- , z Z ~ T1f. ~ /lr~~ TOWN OF __ f~~.S•Z?~ ,. ~T" ' `mil }L. COUNTY CSTM j fi/~jG~~? ~ ZZCE 3 ~ ,S LOCAL AUTHORITY] SUPERVISION _ ST ~/~/J~C 'G~c/ ~p,v t•~~p-~ PROJECT DESCRIPTION; • ~,~!'~u ~o Q ~tT Zt !~6 ~ r• c~ ~ ~~t~ic.~;t c~ Associates Private Sewage Consuitants ?~12 1(3th Ave, ~;t3rir2G 1~atley, VVi 547fi7 j~ t Pg.l INFILTRATOR SIZING WORKSHEET Pg-2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATI~Nfi Pg . 4 ~~ .. v C C v m 0 A !li ~. n fU .._ ~~ ~ 7 ` ~~ I ~ E_ ~ ~~ ~ y ~ ~~ ~ ~, ~ ~ d ~ ~ G ~ ~ ~ O ~ ~ C y ~y ~ ~~ ~~ ~ ~o r p N a ~ * o ~ ~ a ~ N b ~ ~ ~ ~~ G p `~~ r ~ ~ z~ m W 1 ~ R , ` ` O ~ `) Q ~ N ^ - \7CVl 1 ~ • _t N w N ~ tl ,~=~"` ,~9/~t/> ~ 2 ,. ml~ ~ ,~ ~ K 3~ ~~.~~ ~,~>~~~~Td~E' ,~ ~ti _ __ L n r a. v ~ -- , -- .,..- ~ l~ ' '~~. ~ /~ C~ ~ . U~, ~,vs"fJ1~c Tie~,~ ~,~- ~ I,~t/ "Z_ ~ f lei S fi~`D ~~~c T~'~~J ~ ~ , ~ - r! ~f ~ _ _~__ a~ ~i~v, ~j~f. SO it ~ // ' l ~/~ ~ ~ ,, ~~~~ ~,~~~7Td~' ~rl~ s~ . ~o ~-~-,p~c -~.. Fiiu~Sfi~~'"D .~-=--- ~~'~~ ~~ N {~ ~l d~ y ~~ fnN'UC ~ <~ . N N ~ °~s~ ~A~~ ~`D~ ° ~ ~_ ~, n ~, 0 ~ N~ v c~,.s ~ i 0 ~~ ~ t~ ~, I~ ~~ Ii ~ ~ v ~' a ~' rl1 ~~ ?c. , O ~,~-~ ~~~z ~~^ ~ ~ i ~ o° o0 OmD~~ ~~ -o ~ o ~` m mom ~ ~ n ~ D r~r ~. f N W a ~ . , i~ ~ ~ ~, O ~, ~ ~ .. 4 ~ (~ ~ ~ o ° _~, ~ o / -t o ~ ~ ~ t ~ ,`7 li li IQ -. i i o • ~°I 1> 1 ~ •.--.•i ~ ~ 1 ~ ! '~ ~ "~ 1 i ,r' 1 I 1 ly ~!` 1 t i 1 - '"` I II W ~ ii ~ i ~` ~i l 1 1 Q- ,~-~'`~ 1 1 w I I w ilx' Ilx IAN Is•°~c> it li -~~Id 1 LI------L~ ,6~ d _ 'Z M ~- D. 1 ~~ ~ ,~ ~ c1 ~ ~, ~ ~ ~ 4 y c y T (o ~~ OWNER' s ~, Y , MAINTAIIVCE - OF.... SEPTIC SYSTEhr POWTS (1•ando~rner maintenance of.thiS~srePonsible for servicin Ystem. Regular Proper operation and 9 is necessar Periodic inspections and cyst°em. The owner is Y for the safe healthy-operation of. this maintenance reQuired,by code to submit all necessary.. /irtspectioti reports to the controiling,authorities.'.- SPECIFIC CONTACT.~AGENTS _ * Governmental authority] inspectors: ~~ ~CJ(, C~ ~~V% Y ~ ~--- * Licensed installer - maintenance *< ,.responsible for providin - Users manual: 3 an operation/ * Licensed servarce p / inspection agent other . ~/[ I - ,GT'~ ..~,~,~t ~ than installer: *. Electrician, for , _ Pump,,electric controls, wiring units. / - IMPOkTANT QWNER MAINTENANCE RE UIREMENT 1 . ~~inter .traffic, S area. shall (sledding, shovelrir~ not`be permitted g• etc.) across the the cell, freezin or frost can/will ..winter. g uP the system. Discontinuos useetrate into (~ vacaction trip: resulting in no Ovate- in the Iead to,freeze ups. - r use) can ~aLso :~. Water conservation needs hydrolicall to be exercised! desi Y overloaded and destro ed. Or system can be fined for a maximum wastewater Y This svs~em was flow of ~~ ~• P©W'I'S are ____--.~` gals. daily. not designed to accomodate wastes from a disposal unit, or an .Any introduction Y other unnatural sources of garbage.. ~., destr of such waste materials will averload.and . oY this system. - , `~- If a power outage occurs in a temporary overload or a Pump fails, it ma cell( which ma of effluent bein Y result '..recommended Y adversely impact the g Pumped Into~the allowin that a licensed cell (Ieak~ge). It is 9 the pump to return Pumper empty the dosin Consult your installer dosing the cox'rect amounts . • immediately for advice. ~• Neglect of the erosion vegetative cover {the cells traffic preventive) can Iead to failure. insulation ~ also can destroy t he Campactiou REGULARLY WATER THE V system. It or heavy EGETATION IS NECESSARY T© the Ystem beneath ©vER A SYS2"EM~! Effluent in ?'~ cover, IS NOT sufficient alone tQ lila22'ita~il a `~ 6. Periodic ins necessar Pect~.vns by :the c'xner into Y• Inspection or his agents, is the system: p~moundnbasat ~a,.have been poraf:P~a inspectia on the incur n tJ2ne~Q t _. ST CRUIX COUN't'X _. ~~ SEPTIC TANK MAINTENANCE AGREIIMENT .,~..~..-_ AND _- ~' _ ~.- ' OWNERSi3iP CERTIF#CATi4N CORM Uwtterll3uyer F~- ~/ ~ ~ ~/~ • ~ ?3S • ,~S G woo ti y A~Iail#ng ltddress /~~7 ~~OD /~t, ~jt°, ~ 20 S ~yv. SS ~ 2.S i'ropetty t«dress ~©~ ~ ,. (Verii'tcation required from Fiseming Department [~ rrew constmcEioni UN ._ . 2~0~ Pro ert Locati©n 5 w ~/, '` Z ~vo~sp~ p Y s~ /+, Sec. ZZ , T N-R /~ W, Town of CitylStat~ ~ ,~^ pZ~ . tv i nri'n . ~~ ~(~_ Panel Idetrtircativ[t Number _ atav-= _ LEGAL UESCRIQ'~'I Subdivision l~~`l ~_ ,~ ~ 3 Ceti#iied Sat~vey i~Ap # me Pegs # ~Vrrrrrtrtty teed # 7 ~ 3 ~3 Z- 2 ~ 7 d ~S ~ ~ Votwne Page # Spec house Oyes d no Lot Titles idetttifiabie~ yes D no SYS'i'EM MA.iiitTENANCR lmpre~per nse and maintenance of your septic system could resat[ m its premattue failure to handle wastes. Pry ntaini consists of pumping out the septic tattle every three years ur soorter, if needed by a licensed Wfiat y~r ~ into the can affect the turrction of cite septic tank as a treatrricnt stage in fire waste disposal sya[em. The propertp otivner agrees to sabrrrit to St. Goix Zorrirtg Departmcttt a cettifica#iorr tvcttr, aigued by Elue owner an master phtmber,,journepman pttnr+ber, testrictedrhtm6exor a tice~dpt moping that(i) the oa-siie was[ewat+etdi is in proper operating comlitionand/or Z aitet in sposal () spection and pmnping (if r~nssary?,1he s~t[c tank ~ less iitsn tl3 fn2L of s Iltive, the unckrsigned have read the above requirements and agrce.t[i maintaie fire private sewage diaposai system witty [he Sts set forth, he #n• as se#. t:y the Departrrrcrrt of Commerce and the Department of Natural Resmrrces, S[atc of Wain. Certil Mating that our septic 4ystem s been male:twined mast be completed ar-d returtuxl to the St. Cmix dag3 of [irree year ~p#~~ rtat~~ .. CvrtMy Zama$ (~I'rce wil // ~- i i 1 ~~URE 9 ~~ ~~ a~'iv~R c~T'~'1tCATioi~i t (we) certify tha[ all slate is on this Form are trae to the best of my (otrr) knowledge. 2 {wej ~am (are) the owne the protiert scribed abo by rue of a anty deed recorded ir: ttegister of Iheds tJitie:e. ~ T~URE df ~ AN'F .. !2 /4~ DATE ~"'«'`'`• Any infottttation that is ntis-te . presented may result in tits sardtary permit being tevvked by the 7.anntg Dep$rttrtent. *!' tnslrrde whit this at-t+tteatiun: a stan~e<! warranty decd from the Register of Deeds ati'rce a cagy of the certified survey map iC reference is made in the wamMy deed r ; werr Detsar4rrent of cortrrrrene ~ -'I SOIL ~(~..UA ION REPORT gage ~ ~ 3 t~visicn of safety and Bt~Ndkgs Aitad'r oorr te0a ells lan «~ a er riot le s than a ,rz x i, ~~~ p ~ p p s irrdude, bid not to vertical ~d hortaordad mfe~rce Par+oei !.D_ . ~Q - Q'ff'jj ~ ~., p . /O lvO percent slope, scale a danerrsiorrs. rrortlr amow• and to Please pnitrt al/ itrfa n. Die PasoruY 4korreation Y~ P~~ ~Y bs used tot Purposes ~. s.15.04 (1) tm)). ~Q ~' ~~ ~~/L~~s ~ f,~~~' p Q GrnR.l.at s~ 1/4 51/4 S ZZT Z / N R ~7 ~~yy PrQpetiy s /CvGt~o®~~~ ~iQ - sv~~.e 2oS Lot # 3 t~dc # Subd Name or CSAai /~t~ y ~sr.4-r-~ s State Code Phone Number coooD~vR ~tJ ~5 /Z s to/z ~ 8os • 35 ~ l ^ ~ [~ VUtage ®7own Nearest Road fjU S v./ Ross ~D New Cortstructiort use~ J~. Residerdtal t N<rrrber of bedraorrrs Code derived design Clow rye GPD ~ Replaoerrrent ^ Pubt~ or carwrreroial - Desabe: _ Par+erd rrrateriai /oE5 S oU,l,:, S,4-.c9i~ y ~a ~, ele'v~u«, gale ti ~. c ova-GcJ~F~• ana • ry-R~,¢ - T~s ~ s~ ~ >'s~a~.E' die •¢.rJ /•(i/c~20 v,vv ~• ~~ C.v `i- S Q ~ ~ ~ p Ground elev. ~ ~• ~ ` R Oaptl~ tv 1~9 r >~ ~ Soi, Rasa Nartx3orr Depth Dcrdnard tZedox Dasaip6on Te~dune SgucEure t~a>sist~roe Botxrdary Roots tn. tl tltr. Sz Cont. Color Gr. Sz. Sh. 'E,1~F, 'EfffR2 /0 /e ~' .S/L /1F U ~ S / ~ '~ G 3 io s -. siG ,~ c G 7•S L 0 S CS • 7 D • io ~ - D ~0-t q .CI Pit Ground surface elev. ! ' ~ >t Depttr m factor >~~ in.. „ soil Rate t~iotiaort Depth Dorr~&rard t?edooc Description Texture Strucdae Come 8orardary Roots GI B in. t~lr,xsell t1u. Sz Card. Color tx Sz Sh. 't~k, /o S/L 2 S ~~/p W 3 .4 .g Z ~•2 /O 1L S /f ''~ S• SL / 5~ ~. © - 5 i O - /. • Etli~,erd ~, = eou > 30 < sac rraN. and, ss >30 <, 5a rr~rt. • nerd ~2 = eou < ~o nay. ana Tss < 3a Rr~a. f~f Noma ~f? ~ ~L/31E' /•G L1 ~ ~~-2 ~ Address Date Evalu~on Cotrducted Teleplrorre Number Private Sewage Consultants 2812 1 gth Ave. Spring Valley, WI 54767 turner ~1,~ ~v~~2s Proaenr ~-~~ /-~~-3 Par~et to ~ G ZO • /aG0 f D . ~ a a ~. > iiaimn Depth Dons Redoac oescrip~on Terre Structure Cow sour,dar,~ Roods cP OUaF ~,. Mur~L ~. ~. ~. ~. ~. ~. -~, 'F~2 / o • / /o y SiG ~ ZfS fR w 3 • ~ • ~ -~--- S [. /f ~ C - ^ ~ ~ ': ^ Pit Cat~dsurfaoee~ev. R Oepth to 6rrd6ng fadar in. Solf Rabe tiai¢on Depth Dort~ant Redone Desaiption Texture Structue Core~stence 8ot~aty Runts in. MtnseR tom. Sz Coat. Color tom. Sz Sh. ~ 'E7~'t o ~ s,~eete,,. ~. a~# Sol Rate tiorimr- Depth Dortfiant Redone D~tion• Textrxe ~ structr~e Car>sistanoe e«,ndarr Roots in. Qu. Sz. c«,t. Color Gr. sL sh. -Eif#'t ~ ^ o ~ teete,,. ~. Deplhtofrr~itingiactor ~,. # ° > sa Rye ' Hormorr is. Domnar>t Mix~eM Rsdorc Desa~Gon. Qu. Sz (font.. Color Textrse Strudue Gc Sz Sh. Corte Sotrttdary Roots f P 'Etfit'1 OAE 'Et~l2 E4Ruet~ #'i = gpp, ~ 30 < 220 rtgR. and TSS >30 <_ 150 mgA. ' t #2 = BODE <_ 30 rrrgR. and TSS < 30 mgfL. -~ y K ~ N w b r~~ y~ N '~ ~~~ G ~ ~ C3 ~~~~ ~~m~ °~C D' ~ N C~~ ~ <' ~ n ~ ~~ O `~ ~~ n D ~ ~ ~~ ~ . , i 1! ~ ~+ '~ ~ ~ w ~ ~ O -~ W ~ ~ ~ ~ ~ ~ o .. ~~ ~ - ~ °~ ~ ~ ~ N M ~ p ~!. O 4 .1 ~ • r ~,,- .~J ~ 1 V r` ^a W . ~ -o ~j_ ,~ +` V O A Q ~J N ~ ~ ~ _ ~~ r U 26~8P 1S8 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WAtRRANTY DEED This Deed, made between LaCasse Development, Inc.. Grantor, and Appletree Buitders Inc.. Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 3, Plat of Kelly Estates in the Town of Hudson, St. Croix County, Wisconsin. ?73232 xA?II,~ESH », NALSH REGISTER t3F DEEDS ST. CROIX CO. , itI RECfiIYED FOR RECORD 09!02/2089 89:30A1i IiARRAN?Y DEED EXElpT i REC FEE: 11.00 TRANS FEE: 251.70 CEIPY FEE: CC FEE: PAGES: i Recording Area Name and Return Address o y ~~~~~, a~-~~3~-6~^ Parcel Identification Number (PIN) 't'his is not homestead property (is} (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. `,' Dated this rl day of September , 2004 * AUTHENTICATION Signature(s) authenticated this - ~r [~_ RAttn~, _ No#ary Public _ ~~- ~sconsin TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ ____ authorized by § T06.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED $Y Attorney Kristine Upland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary) '~ Names of pessons signing in aoy capacity must W ARRANTY DBEt) * LaCasse DeveIoptntnnt, Inc. _ ~f~C~ GTi - ~~' ACKN,;~fO~~W~ ~bEDGMENT STATE OF ~~G~~rr~"-lc__--__..._ ) SS. t~ , County ) Personally came before me this ~.~f ^ day of September , 2064 the above named La arse Develo went, Inc. to me known to he the person(s) who executed the foregoing instrumen d ac 6w ed the same. -* ~ - ---- --- -- ------------------------------------------------ No Public, State of My ' si is pet. (If not, state expi tio~n~e: G~~~T_ ') or printed below their signature. STATE BAR OF WISCONSIN FORM No. 2 • I99F Information Professionals Co., Fond du Lac, W l 800.655-2021 l` i ,. ~.. , .,, fir; (NOO.4s'ss'w) U N_P L A T T E D_ _L A _N D S01 °02'17"E 1282.44' 230.00. ~ ~ [~i.c~ I I 275.01' I I I II II it II I II ~I ~~ II I I1 ~I 'I Iii a I ~ I Is II III IIN I I~ _ I I~ ..,~ I I , No I I$ No I I~ 1 li o~ W I I~ ~w .p I I'w° I I~ I I I ~`^ I l w ON I I~ I IJ I o~ N - I I~ 1 1 I I - ` ~~, II 11 II ~, I ~ I 1 ,es ~- J I I 1 1 ~ J-~'~ I~ 1I J L - I J L - ~ _--•-------------- _- p5Z 'J _ ~ ,. ' ~1 3 1 -I r-- 1I ,~s-~~ i t 1 ,es--~- I I 5°~ ~1 1 1 ~ '°',,1 1 II -. II II ~ 1 1 II IIz .- 1 1 __ _._- _ ~ r ~ I I z '^ $ x o N ~ i I s ~ 11 ~ ~ ` - -- - _ - No2.39'39" so U- o+ I I I ~. I I ~! N P c~ ~~, ~~ a w i,w ; i IN $ I I m~ ~~w~a 1 J ~ 1 ~ ~, E~~~r~ ~' • ~ ~:,., a ~. ~. 1210 ' ~ SOIL EVALUATION REP T ~, r r- :.~ Wisconsin Department of Commerce ,,.~ ~ ; ~~ @~ ~ ~ (~ ~ Page 1 of 3 ~.~4 .. Division of Safety and Buildings in accordance with Cornm 85, Wis. Adm. Code Steel Soil Service ~r ~O x (lei ~p,i', ~l Attach complete site plan on paper not less than 8'/z x 11 inches in s¢e. Plan must cen C i :~! < < ~ i , ~= Cro~ include, but not limited to: vertical and horizontal reference point (BM), direction and °°° ~-° percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. G"j~ ~ - g Please print at! ireformattion. R iewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Property Owner Property Location Reliant Developers LTD Govt. Lot SW 1/4 SE 114 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9900 Valley Creek Rd. Suite 135 3 na Kelly Estates City Ltlo~bkr~ State Zip Code Phone Number City Village Town Nearest Road MN 55125 651-731-3174 Hudson Ross Rd. CS'~ / New Construction Use: ~i Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD _ Replacement Public or commercial -Describe: Parent material outwash plains and Stream terraces Flood plain elevation, if applicable na General comments and recommendations: System elevation 104.20ft, trenches spaced and depth to code 4.OOft below grade Boring # Boring 96 Pit Ground Surtace elev. 108.20 ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-14 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 14-24 10yr4/4 none sic/ 2msbk mfr gw na .4 .6 3 24-29 10yr4/6 f1f 7.5yr5l6 scl 2msbk mfr gw na .4 .6 4 29-36 10yr4/4 none sl 2msbk mfr cs na .5 .9 5 36-63 7.5yr4/4 none Is osg mvfr cs na .7 1.2 6 63-96 7.5yr4/6 none ms osg ml na na .7 12 Boring # _ Boring /' Pit Ground Surtace elev. 108.20 ft. Horizon Depth Dominant Color Redox Description Texture 1 0-13 10yr'3/2 none sil 2 13-22 10yr4/4 none sic/ C ~ rr, 3 22-36 10yr4/6 f1 f 7.5yr5/6 scl 4 36-72 7.5yr4/4 n Is 5 72-96 7.5yr4/6 none ms Depth to limiting factor 96 in. Sat Application Rate Structure Consistence Boundary Roots GPD/ttz *Eff#1 ~ *Eff#2 2msbk mfr cs 1f .5 .8 2msbk mfr gw 1vf .4 .6 2msbk mfr cs na .4 .6 osg mvfr gw na .7 1.2 osg ml na na .7 1.2 tttluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Pl~se Print) Signature: GST Number David J. Steel ~ 248956 Address Steel Soil Service ~R,_~i,~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 10/20/2002 715-246-5085 erty Owner Reliant Developers LTD Pro Parcel ID # Pending Page 2 of 9 p f 3 i Boring # Boring 106 90 Depth to ft limiting facts 96 i {~ __________ii . 1/ Pit Ground 5urtane elev. . n. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP *Eff#1 'Eff#2 1 0-10 10yr3l2 none sil 2msbk mfr cs 1f .5 .8 2 10-24 10yr4/6 none sicl 2msbk mfr gw na .4 .6 3 24-96 7.5yr4/6 none ms osg ml na na .7 12 R~,r,,,, x 'Boring Effluent #1 = BOD s> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Boring # Boring _ __ _._ _ Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Reliant Developers LTD New Richmond, WI 54017 Lic. # 248956 SWl/4,SE1/4,S 2o,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 Kelly Estates lot 3 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. 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