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020-1437-07-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division t 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 LaCasse Develo ment Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: i~ (3JVll Gs7- TANK INFORMATION TYPE ~ ~U i~ U~F~` n~~ ~1 CAPACITY Septic ~ «`,~~., Z. Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L W ea (-- WELL BLDG. Vent to Air Intake ROAD septic ~~ 9 3 ~ s ~ ____-~ - Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufact er Demand GPM Model Numbe TDH Lift 'on Loss System Head TDH Ft Forcemai Length Dia. Dist. to well 0111 ARC~IRPT1(1N CVCTFM ELEVATION DATA county: St. Croix Sanitary Permit No: 488020 0 State Plan ID No: Parcel Tax No: 020-1437-07-000 Section/Town/Range/Map No: 22.29.19.2712 STATION BS HI FS ELEV. Benchmark ~. 9 a ~o~ .9 raa Alt. BM F:t~. Go~.e~ `J.53 /D2.37 Bldg. Sewer s- 8~ 9 ~ D q 7~ b~ 1 SUHt Inlet (6~ , ~. ~ 0 9 5 .c~ ~ SUHtOutlet 'A~ ~2. 3Z ~~~• cJJ! 'S$ Dt Inlet -~, Dt Bottom 1 ~ Header/Man. 13 a 31 q y . s `7 Dist. Pipe J3 X31 9~{.S~ Bot. System Q ~( 7 1 ! ~ ~\\ ~~ ~ ~.+.~ CA J e,~. . 5 53 /oz,3-1 s Sa f ~ s~ 9, aCP y5f • ~~ ~ j ~ /y. yZ 9 s , yg 9 . 41 Z 1s.aa ~fZ~$Z 3 ~s.~g 9 Z . `}z- 1 .~ .I _A ~~llt 2.7yX~ flY.(~Co BED/TRENCH Width ~ Length , No. Of Trenches PIT DIMENSIONS No. Of Pits side Dia. Liquid Depth DIMENSIONS ? 1+~ +, ~ rC~. ~ \ ~ \ ~~ SYSTEM TO P/L BLDG WELL LAKE/STREAM I Manufacturer.~ !1 ~ f 1 „ ~ d- ^ INFORMATION CHAMBE R OR ~ ' a ~ ~ ! Type Of System: ~ ~- / 1$ ~~ ~ ~ ~ ~ ~ ~ UNIT Model Number: ~ J / fG t D o,n,Je_,, ' ~ IIISTRIRIITInN SYSTEM , te~l~ Header/Manifol~ ~1 Z ~ Distribution Pipe(s) \ ` x Hole ^Si~ze \ x Hole Spacing \ VenAt to Air Intake ltt-I ~ Voyl'~'.S . Length Dia Length Dia_ Spacing ` Z~cil C('111 r_f1VFR .. o.e~~...e c.,~~nmc A.. L, w 1111nnnrl rlr A4_(:rarlo Svwts±mc Anly Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / ~ ~ Z Bed/Trench Edges \ Topsoil \ ~ Yes ,', i,j No s ~ ;! No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1' ~~~ yr~~ Inspection #2: 7' / ~ 9 / ~~ Location: 672 Heritage Way Hudson, WI 54016 (SW 1/4 SE 1/4 22 T29N R17W) Kelly E tes Lot 7 J ~~ Parcel No: 1.) Alt BM Description = ~~ ~' ~'" ~ ~ ~`' G ~•a,i A5 ~"' ~.p~,k,~j ~ ~ (`e- ~ ~ ~ •t~•~Z 2.) Bldg sewer length =$/r ~ ~" ~ ~~ -amount of cover = ~' ~ y;/ te„yKr; ~,~P~-~.ry ,~ ~-~,~ ~~-- ~~v q ~ I _ I__ _ _ _ - _ -, ,-~/ Plan revision Re cared. Yes No G~ i I 1 ~~~~~ Use other side for additional information. / ~%De ~ ~ -- -- -- --- --, `-p- - - L-_.---' Insepct s Sig re Cert. No. SBD-6710 (R.3/97) Safety uildin Division County ~ 201 W. Wash Av ., P.O. Box 7162 D .STS ~ F~ / x- SCQi~S~~ Department of Commerce ~adts°n, S 26 151 ~~:~~~~4 it Number to be filled in by CoJ ~ ~jbOZ~ o QQ Sanitary Permit App ' io ~, state Pl I.D. N'r"'ber N ,¢ In accord with Comm 83.21, Wis. Adm. Code, personal info atio y provide' l- d 9'` ~' ! n may be used for secondary purposes Privacy 5.04 x ) Project A r e ss (if d ifl"erent than mailing address) L Application Information -Please Print All Information i 1 p T~.1 /7 ~/~ ~ r~'6"L~' ~~~• °r~ ~ ~ e~ ~ SE" /l~ ~/D~ ~ G f// Z- Parcel # Lot # Block # .. oz0•/y3 .o~• 000 .a~ Property Owner's Mailing Address r I/ 5~3 ~~ ~D ~ Property Location S~ ' Z a ~~~ City, St/a~te ) / f / Zip Code Phone Number ~'~ Section ~'~ ~ , i'I !/,~~4/ `^~ s 7 ~~ ~ g/ . S y C7 s ,ene'"~ Z ~ , ~ (circl ~ T N R E II. Type of Building (check alt that apply) , / ~ ~ pq~ s ,µ,' ; o ! 1 Subdivision Name ~68~i b • ~ or 2 Family Dwelling - Number of Bedrooms s . ern er ~/~I/ ~S T ' ]~~S G ^ Public/Commercial -Describe Use ! ~ ^ State Owned-Describe Use ^City ^Village f~I'ownship o ~ v~ III. Type of Permit: (Check only one box on fine A. Campfete line B if applicable) `~' ~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. ofsuitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ RecirculaCng Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drib"Line ^ Gravel-less Pipe ^ Other (explain) V. 1)is ersal/Treatment Area Information: '-' Design Flow (gpd) Design Soii Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed{sf)' System Elevatio/ ' VI. Tank Info Capac in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Units I-~ / ~ ~ ~~ oncrete Constmcted Glass New Tanks Existing Tanks ~ (ddb ~"~" Septic or Holding Tank ~ /~ ~ / ~ (` K/ 1, Aerobic Treatment Unit ~ _ A A (~ iC Dosing Chamber VII. Responsibility Statement- I, the nndersigned, assume responsibility orinstallation of the POWTS shown on the attached plans. Plumber's Name (Print) ~ ~~~Tr Plumber's S" nature -IvfPIMPRS Number aZ4375 Business Phone Number is•77a~3yyZ. Plumber's Address (Street, City, State, Zip-Code) VIII. Coun /De artment Use On{ Approved ^ Di Sanitary Penmiti Fee includes Groundwater Date Issued Issuin Agent Si atu (No Stamps) ^ O tv Reason Denial Surcharge Fee) 2~ /"" ` . ~~ ~0 IX. Conditions Appro 1 SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. Ali setback requirements must be maintained as per applicable code/ordinances: nttacn comptete ptams,tto me e:ounty only) tar the system on paper not teas than 81rz x 11 inches in siu (Z, -~ ~.~ SBD-6398 (R. O1l03) ~, ' `~ s ~~~~ I ~ ~~ "~- ;'. -~ -c ~-~ ~~~ . ~, ~°~ N ~~ ~ ~ r ~ ~ '~ o '~ ~tl t~ ~ ~ ~ \l'1 ~ ~ ~-.. "r t'D rn d a ~ p~ o o a V ~~ ~, `'T"'1 ~ G>,G~~ ~\'cr ~ ~5 7` L~ T °~•. `` ~~~~ °~' i, ~ N s 1 ~~ 1 ~~ ~ ~~ ~, . } t~ ~i p ~• ~1 tl ~~~~ o. 'loop W I~ '~~ ~~ 1' ~I ~ 1 ~~ ~~ ~I w N i -_ ~l ~ ~~~~ + i~I ~~ ~~ ~~ 1+ ~ ~~ a _ ~~ o t~ ~~ RG ~. a ~. (AN"OC '~pjp<~- ': O @ "''' S1i~~~ ~~~W ~ tQ ~ ~~ ®n ~ ~ w yy3 " O `_ ~~17~ I m~AO~ ~? N ~ O~ d0 rm-Dm-~i ~~ o-~~ m mom O ~ ~ ~~ ~~~ r~r 1 ~', N! o ~lLBRICHT & ASSOCIATES CO. 28i 2 10th Ave. ~ Spring Valley, VI/I 54767 Rte. ~ orE~~~ sy 7i 5-772-3442 Privare seww~ge consonants PROJECT INDEX PLAN I1D # DATE ~ ~ • ~ _ ~~ OWNER (j/I" (. /g-S,SE -l~~C U~ 1 D~ ~iU G PNONE 3 d ~• ~S~!~O S ADDRESS 5'7 ~ li?<< - !G'D. ~` ~~ f~1.D.jOa w / ' S ~t ~ f LEGAL DESCRIPTION Go T' ~ 7 ~~'~~~ 7 ~/s ~~~~~ pi ~ ~~ • ItI37. d7• DDO SctJ, S~ , mac. ,ZZ, ~"~-~! TOWN OF /7VO.r'D~t,~ ~~~J COUNTY _ CSTM ~~~~ D S~'.Qx~C._ Z~ ~ j~S X14 ~ s ?-• C leo~• k LOCAL AUTHORITY) SUPERVISION .S 7`"• Gd~D> x, Z~~ t*JU ~,r-- PROJECT DESCRIPTION: ~ . ' ~U.~cv ~D,v S ~2 U G~-rD ~ ~~-S~ Ala ~ {~~pos~: a., p/2~f~os~v i~- .. Q ~ t ~ !c ~- ~ .~~ ~t`~~'te. ~~ ~ cam. s . ThiIS PO''VT SYSTEM SMALL ^ECORPORATE PER COMM. ~3 4~(2)c A PROPER ZABEL ILTER MODEL # ~ ~ l~ ja7' r ~ ~ ~~ ~/ ~ • 21~t3 ~ ~'c ~.`7` Ulbricht & Associates Private Sewage Consultan#: . 2812 10th Ave. Spring Valley, WI 54767 tit P /~-S ~ zz~ 3 Pg.l INFILTRATOR SIZING WORKSHEET Pg•2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 ~~ ~~ ~~ ~~ n.,. c .,--~--- - - ~~ n y fl m ^4 A^ •/ R d e. n m a Z ~1 a ~,~~~~ ~ ~ ~ ~ ~ ~ ~ d "'1 ~ ~ ~ O ..d ~' ~ ~ ~ ~ ~ ~ a ~. ~ ~ ~~ ~ ~ ~ ~ o ~ _ `h ~ ~ ]j`\ ~ I e - 1 V ocr ~ ~ ~~ ~ ~ ~' ~ O ~ ~C ~ ~ ~ ~ `~ c .~ + ~ ~ ~ ~ ~ ~ R~ ~ ~ ~ ~ ~ ~ ~ ~ -~ °0 :~ i `~ ~, v 1 fi N ~ n ~~ In y ^~ G ~~ 00 `n J ~~ 0 ~- t~ ~ . o cN ~. ?~ ~^' {'~ °C ~ ~ ~ N ~' h I~ 0 d .i~ ~ ~~ ~ ~ ~, ~ ,, ~ ~ ~~~ ~. ~ ~~ 1 2 L ~ ~ ~ ~' ~ ~~ ~ ~, r, tl ~ • ~ ~~~~ w 1 rn i _~ ~ ~ ~ ~ ~~ ~; ~~ o ~ ~ `y ~~ N ~ ,i ~~ ~+ ~ Y V a` Pi 0 0 ~~ ~I w ~~ ~~ .i~ ~ ~ ~ ~ ~_ ,~'y, ~ J 1...+ V~ ~~ _~ ~ ~~ ~i I~~~ -~ to c ~~ U}N~C zs coo =. - j ~ S iQ~ '-+ '°'~ ~ QO ~DN~ tQ ~~~A ~ ~ ~ ~? ~ ~ _ O ~ s p1, T N O w ~~ ~:A.~~~ m~0~ ~ N ~ O~ 00 Q ~ rDm~ -~ ~~-~~ Om m~~ O ~ ~ ~ ~~~ m ~ ,- r. r h ~~,pp~~ ~ ~,v_.sp~~~~~.~ .gip .~._ day ,~ i> 1 1/~ ~liv. ~ ~ ,, x ,, t'~(CV Gam'' ~ i 5-tr~~vc ~ ~' ~(!1 ~. ~~~~ ~9P~~~~1~ ~~,~ T- cep U~ ~NS~~cT~~,v f71~ /d p • ^~_ ~fi~/rSffE"D sue. go 9~~-,~c-_ ~.. p~c Ti~~~ c~ - - - _ ., ., ~- ~. ~ sysr~-~ ~i~v, 1(p .,8l~. .~--- ~,~'~ SS Sic j /off ©~ T%"ti~~s' ,~ ~' l~ i ~ 7p~9~- To ~ > ` ~ i ~ ~~ wl~„ ~c1~~ ~~ Ky I 1„ '~~ 1~I1~[f . ~ 2 .. 1/( [ ~~ J ~- ~~~ ~~~ ~~ 19r°f'~U~~ U~.v T cep 11/t ,. -~ scd , qo AP~'x,~ ~,v~r~ztTa,C' --,--Pv~ ~- 9R~f~~ ~©~. d ~! ,~ r - . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pala . /of Z FILE N~lFORMATtON Owner L,9, ~` SSA' .PU,C a iV C Permit # OESItiN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units NA Estimated flow (average) ~ aUda Design fbw {peak}, (Estimated x i .5) ~ 1 (Q V v af/day Soil Application Rate ~ da Standard- lnfluentlEffluent Quality (y avarage" Fats, Oil & Grease (FOG 530 mg/L Biochemical Oxygen Demand (B $) 5220 mg/L NA Total Suspended Sotiids ( ) 5150 m / Pretreated Effluent Quality onthfy average Biochemical Oxygen. Demand (BOOS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Colifonn (geometric mean) 100m1 Maximum Efftuent Particle Size Ye in dia. ^ NA Other. ^ NA "Values typical for domestic wastewater and septic tank effl(tent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity Q ~ ^ NA ' Septic Tank Manufacturer jv f~S•~~ ^ NA . Effluent Filter Manufacturer Z ~ L ^ NA Effluern Filter Model ~ ~ ' ~Q () ^ NA Pump Tank Capacity ~ ^ NA Pump lank Manufacturer ^ NA Pump. Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit NA ^ Sand/Gravel Fitter ^ Peat Flier ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other. Dispersal Cell(s) DNA ~In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Otf~r: ^ NA Other. ~ NA Service Evem Service Frequency inspect condition of tank(s) At least once every; ~ month(s) sorts) (Maximum 3 ears) ^ NA y Pump out cornents of tank(s) When combined sludge and scum equals one-third (y3) of tank volume ^ NA Inspect dispersal cell(s) A# feast once every: p month(s) ysarts) (Ma~dnnutn 3 years) ^ NA Clean effluent filter At least once every• month(s) ^ year(s) - ^ NA inspect pump, pump controls & alarm At (east once every: ~ month(s) ~ NA D year(s) - Flush laterals and pressure test At (east once every: -~~~` ^ month(s) _ ~NA ^ Year(s) der' At feast once every: ^ month(s) ~NA - ^ year(s) - Qther.` ^ NA MAINTENANCE IIVSTRUC710NS inspections of tanks and dispersal cells shag be made by an individual carrying one of the following liceisses or certifycations: 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 teaks, 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 pond'mg of effluent on the ground surface may indicate a failing condition and requires the fmmedtate notification of the focal regulatory authority. When the combined accumulation of stodge and scum in any tank equals one-third (y31 or more of the tank volume, the entire contents of the tank shah be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. AI! other services, including but not limited to the servicing of effluent filters, mechanicaf ar pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certitied POWTS Maintainer. A service report shat[ be provided to the focal regulatory authority within 10 days of completion of any service event. Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ., ~, . _ ~ [~ U~ 2 START UP AND OPERATION Page ~ of Par new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting. products or othei:chemicat: that may impede the treatment process and/or damage the dispersal cell(s). tfi high concentrations are detected have the content: 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 br discharged to the dispersal ceU(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 tc restore normal levels within the pump tank. t?o 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 6fe of the POWTSs 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 shalt be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrafive Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents at all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.° • After pumping, all tanks and pits shah 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 fogowing 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 shouhi not be infringed upon by 9 P posed structure, required setbacks from existin and ro lot lines and wells.. Failure to protect the replacement area will resu#t in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rotes in effect at that time. ~ A suitable replacement area is not available due to setback and/or soil limitations. @arring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. D The site has not been evaluated to identify a suitable replacement area. ,, U' evaluation muss be performed to locate a suitable replacement area. If riv `repplacement area s oval b e a hold gdtank may be installed as a last resort to replace the failed POWTS. Q 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 Ulbricht & Associates rlva a ewage ~ onsu ants POWTS INSTALLER POWTS MAINTAINER Name Spring V~Iley; Wt 54767 Name Phone ~ ~ s . '7 7vZ 3 y y ~ Phone SEPTAGE SERVICING OPERATOR {PUMPER) LOCAL REGULATORY AUTHORITY Name Eit~ /I~~ ~~'f'/?J Name ~7"". C2 d /~ ~. z~ ~ /~Al Phone ~ ~ S_ .. - 8 ~ 2 ~ 3 v phone 7 s' S ~ 3 ~6 ~ 7 G This document was drafted in compliance with chapter Comm 83.2212)(b)(~)(d)&(fl and 83.54(1), (2l & (3), Wisconsin Admir-istrative Cade. ~' ~ .~ 1213 lNisconsinDepa~finentofCommerce SOIL EVALUATION REPOR~ ~~~, ~ ~ /~~~ P 1 of 3 Division of Safely and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sal Service Attach complete site plan on paper rwt less than $%2 z 11 inches in s¢e- Plan must ~~:: ~roiX include, but not limited to: vertical and horizontal reference point (BM), direction and ~ -••-•--- -•• ---r-----°-~ percent slope, scale or dimemsior>s, north arrow, and location and distance to nearest road. Parcel I.D. pending Please print all information. evi ~ Dat Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Property Owner Property Location Reliant Developers LTD Gout- Lot SW 1/4 SE 1/4 S 22 T 24 N R 14 W Property Owner's Mailing Address Lot # Block # Sutxl. Name or CSM# 9900 Valley Creek Rd_ Suite 135 7 na Kelly Estates City (,U b o ~ ~(,t P ~J State Zip Code Phone Number ~ ?" City Village ~ Town Nearest Road MN 55125 651-731-3174 Hudson Ross Rd. ~ New Construction Use: ~_ Residential /Number of bedrooms 4 Code derived design flaw rate 600 GPD Replacement Public w commercial -Describe: Parent material outwash plains and stream ten'aces Flood plain elevation, if applicable na General comments and recommendations: System elevation 96.30ft, trenches spaced and depth to code 5AOft below grade Boring # Boring ~ /e Pit Ground Surface elev. 101.30 ft. Depth to limiting factor in• Sod Applicat~n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ *Eff#1 *Eff#2 1 0-5 10yt3f4 none sci 2msbk mfr cs 1 of .4 .6 2 5-32 10yr4l4 none sUls 2msbk mfr gw na .5 .9 3 32-96 7.5yr4/6 none ms osg ml na na .7 12 ~ R6 . ~ l S`I 90 Boring # Boring ' 96 y' Pit Ground Surface elev. 101.30 ft. Depth to limiting factor in• Sod Application Rate Horizon Depth Dominant Color Redox Descripton Texture Structure Cor~s~tence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-9 10yr3f3 none sil 2msbk mfr cs 1vf .4 .6 2 0-18 5yr4/4 none sl 2msbk mfr gw na .5 .9 3 18-48 7.5yr4/4 none Is osg mvfr gw na .7 1.2 4 48-96 7.5yr4f6 none ms osg ml na na .7 1.2 ~' ~(o ~ / /y'D trrlUent yF": = tSUU ~ :3t; < 11U mg/L ansf ! SS ~3U < 150 mg/~ * Effluent #2 = BODS< 30 mg.'L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ~ 248956 Address Stee! Sal Service G~--~/ %,~' Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W t 54017 10/21 /2002 715-246-5085 Property Owner Reliant Developers LTD Parcel ID # Pending Page 2 of 3 Boring # - Bortng 90 98 De th to ft limiting factor 96 i Pit Ground Surtace elev. . p . n. Sod Application Rate Hohzon Depth Dominant Color Redox Description Texture 5tnicture Consistesxe Boundary Roots GPDlftz *Eff#1 *Etf#2 1 0-16 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 16-27 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6 C I f!' /J 3 27-38 10yr4/4 c2d 7.5yr5r6 sicl 2msbk mfr di na .4 .6 4 38-56 7.5yr4/4 none s~ls 2msbk mfr di na .5 .9 5 56-96 7.5yr4/4 none ms osg ml na na .7 1.2 8orina # Boring - -- - - - . * Effluent #1 = BOD 5> 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 1 1 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 SW1/4,SE1/4,S 2o,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 Kelly Estates lot 7 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was conducted. Legend ~ 1" = 40' N / ~ Benchmark El. 100.00Ft op of %2"pvc pipe Alt Benchmark E1.99.SOFt op of/z" pvc pipe -~ o =Borings Boring Elevations B1 =101.30Ft B2 =101.30Ft B3 =98.90Ft B4 =OO.OOFt r 3~ 3 ,5 ~ Gv ~ 5 ~ yo-~ ~-i r~-2 l ~' ~ s~- A~~~ 57' g~, ~~~--.~ ~ 1~~2 -off ~ ~3~/Z` ~~-~ , io~,3~~~ i oo~ ~o ~~ ~'~. S~,s a~+- ~~~~~ ~6~ ~~-~- i ~~3 r '~ 1.0! V ~ ! 27!.01 , ~ • .•\ +w.,.. 3.- j n ••.-.\ ,\ ~.. -" 1 V_ 1 1. a ' 7 r } N~ .... 1 ~.~ / r ~f O Y' ~{ ~<~ t.. l IW may,,,,. .~_ __. _!_. ,•~- .r'"' ~ / ! ~'- '~. • _ -• m .~ v 1 m I C~f11 ; ._ -- ,, .$~~L••c• d 1 ~ rrscY ~ I .• 7r•.D~ ' r. Fr ` =J \ ~ ¢~~a -s ~ g ~fl I JY~11 .t~ •_.•... s ~ / ~. 1 ~ (~-r.Q~I .i• t\ `~ ` i , f r '-' i :_ ` '~~ • ^ ` ~ r'te' ~ •j w j $$ ~ ~ r- ~ :r ~ '`IS \ ~C ~/ fir/ C~~ is ~ ~ .u.~t - I~ is • . pn. 211.96 , 1 , ~ r. ~-. 4 , / ~ t~ •~ ~sl~. r/ /, ! r I !1 > ` r 8 ~: 111 ~~ ;~ ---~-__- -. ~~ ~ ~; r ~ - ~- ~ - ~ •'_~ . ~C~its (I' N '\, \•~', •4' ` }"clot r `t'ti'.=Yi'ii ~ J J J l t ~ ^r --..<.r: J r a• . r7 ~ I 1 ~ 1 \ Q .270. _n:r ` f ~ 8 ' '^' ,tv ~• I vII ~ ~ •~ --ioececwvEn= ~..~' ~ • ~ ~• ! fig' ,~~~''.~-~ t . ~ n. '` ~` ~ / -~ +. !. K ~ : ~ ~ - r ,a 1 r Srrr~ +~ f •~ ` ~ ~ Ott / ~~ti ~ ' _`a~ $\~: .8• s 1` j,~r i7{w. 1 1• V k is \g ~ yce/' ` ~' .\ \ \ j i:~'X ~ a'{ .'{ ~ ~ k. _ ~ >: 1 it ' 11 it ('. ~ ! ~ //" = - i~ia - ~ ~ .` ~ , J.t. '; .;s !\.. ,t, ~ r •~ ~' 329.18, N0 ,j' I ~ 1 t" `• ~~.'\`, ~~ / '~`~~;~.?~l•;~'.~. 1 ~ - it 1•E ~ ~ S7i ~ I t 7r Mf~ VG!'ibtNG EASEMENT'i~ `~cF` ` ~ _ i ~ ~ ' ~ i s I No ''~'1 ~ ~ ~~ .`` ~NaZO 416 3 N01.O508. ;' ~ ~ ~~, ~ ' i t ~''' 1 r*1 II ~iF I ` `' \~r~ _~ ~' ,~ •~'~ _~1tsTUU'a-~ol J,X I ~ I .~ 1 . ~~ it vc. u2d V ! r~- ,, ~ I I II I k ~ ~~ ~ ( ~• ~F ~~ ~`Z as M 1 ~ 1 I tR 1 . r ~ ~ ~~~ ~ ~ ~ 4a ~=`a ~iS V 1A S& (...~~~- I ( I !~i f ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~,.~} C:.•~ s_S~t t~ ~ ~ , ay c . Mailing Address ~ ~ _G ~ %t ~~ ~ ~~~~~ Property Address (~~ ~- ~~ ~,.. a ~u ~ ~.. (,J {Verification required from Planning & Zoning Department construction.) CitytState ~~~, ~ t-L.,, Parcel Identification Number 4 20 • / ~,3 7. O 7. Oo O . 2~(2~ LEGAL DESCRIPTION Property Location ~~'/4 , ~~ 1/a ,Sec. `~ T '~ ' N R~~W, Town of C~~.~~-- - Subdivision ~ L [ ~_~~ ~~~~ ,Lot # ~. Certified Survey Map # Warranty Deed # ~ s 7 g 3 CO Spec boos yes no Volume ,Page # Volume 2•S 3 S ,Page # Lot lines identifiable ye no SYSTEM 11~IAINTENANCE AND OWNER CERTIFICATION ~~ s Improper use and maintenance of your septic sy,~tem 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 §Camm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zonit-g Department a certification fomo, signed by the owner and by a master plumber, journeyman plumber, restricted phzmber 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 1t3 full of sludge. Uwe, 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. Cerpfication stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Deparhnent 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 lmowledge. Uwe axn/are ttie owner(s) of the property descnbed above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ____~_ ZOO ,$ t_/_ IQNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the. Flanning & 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. Q8/t15) i U 2S3SP '195 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Reliant Developers, LLC, Grantor, and LaCasse Development, Inc., Grantee. Grantor, or a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lots 2, 3, 4, S,Q7 8, 9, 11, 13, 14, I5, 16, 17, 19, 20 and 21, Plat of Kelly Estates, St. Croix County, Wisconsin. -r~ -i3-tJOU Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Recording Area ?57836 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIY6D FOR RECORD 03/29/2004 09:10AlI MARRANTY DEED EllE1~T 1 REG FEE: 11.00 TRANS FEE: 4074.00 COPY FEE: CC FEE: PAGES: i Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 115 Hudson, WI 54016 423495 020-1060-30-050,020-1059-90-0 QO Parcel Identification Number (PII~ This is not homestead property. Dated this 26th day of March, 2004. Reii evelopers LC B * ick Toston, Chief Manager, Reliant Developers, LLC ~~ ~a * * AUTHENTICATION Signature(s) authenticated this 26th day of Mazch, 2004 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, 1 authorized by § 706.06, Wis. Stats.) `. THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (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 March 26, 2004 the above named Ri ston, Chief Manager, Reliant Developers, LLC to-tfie known to the person(s) who executed the foregoing instrument and ackn ledged the same. Notary Public, State My commission is 11/4/2007 $tSt@ of WARRANTY DEED STATE BAR OF WISCONSIN FORM Nat-2000 ~./ ~ c ~ N J°~° ^N. ~~~ . ~. ~ a LU y y R~3 -°° o .~ a ~C ~ zM ~ o°~ ~'~~ rn ''" j .y. ,C O c 'OyV~ c n°, 3 ~ ; ~ s,-1 ~y~ c ~~ v J C SI -~ ~~. . a ~~ ,_>~ ~.' 3 ~ ~ W Z H N y W ~ F' W N T N ~~W W y Z ~ K ~ ~~~ ~<a z~v ~~. 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CROIIX COUNTY ZON~iG DEPARTMENT AS BUILT SANITARY REPORT . pRc~JE~-7 A~aDQeSS Owner L q C A 55~ D l; v' ~t•.o p• 1 N ~- ":dtlc~.s 5-7 3 G'C Y 2D ac ~?2 fit= tZ~7~4~ Wr}Y, 1~}-v DSpN ~ w ~ Cit3~.~tate _ N ~ p Sa rJ , w ~ 5~ i Lo ~ ' i..egal Description: I of ~ Block - SubdiviisiotJCSM # KB~~-t~'' ~STH 'rFS '/. S w '!A S E , Sec_2.2 , TAN-RAW, Town of H vps~ PIN # ~-f f ' ~lOZD SEP'T`IC Tt~NK --- DOSE CHA1ViB.ER HOLDING TANK INFORMATION: Tank marmfactnter W r ESEt2. Size $T/PC ~~ - Setback from; House ~ We11 ?5o'p/f,)5~ Pmnp manufacturer ,.t t-~ 11t[ode! `-' - Alarm location {itOLDt!-iG 1'A1+iiC5 ONLY) N f D~ Setbacks: Service toad Vent to fresh sic intake Water Line Meter location Atarm Ioc~tion SOIL AB O.RT~ITON SY EM: ~3~ t t c-ay,gM~~rzs L~'> d ut ~-K- [f+5 c%yA~H3~ (,I~ i Z ~H +~ M P~~t2S('-i• f! ~ ~ ~ -r re nc h al . Type of system: Coavl~a,~ea,4~ Width 3~~• Length '~' Setback from: House 3 S' Well R 3' P/L 3 c' Vent to frESh air i take o 5 0~~ ELEVATIONS: Description- of benchmark Tv P co F F- t,.TeR N1 A ~ F4oLE Co~~R Elevation /oo • nc Description of alternate benchmark BoTTo~vt op itovSE ,S~,a~,v~e Elevation I d 3.3,~ Building Sewer ~~''71f STlIiT Inlet ~ 3•~> `~ $T Outlet 93.25' PC Wet N A- PC Bottom IJ_ P~ ___`__ l~ea;~ei-~~ifold ~2 ' 2-~ Top of ST/PC Manhole Cover ! l~ y . v p Distribution Lines {) () ~~ • .Bottom of System {a) 9 / • v ? (b) r1 ~ • D 9 ` ~". {c) el U ~ 3 Z r d) 9'O • l Z _ Final Grade () . ~ 5 • ! Z.. {) ~ ) ~f ~g °~ a Date of installation 1 9/bfOpermit namber State plan somber N /A~ Plumber's slgnaiQre License number ZZ~137 S Date 1 / Inspector ~'VA 11J 7 ~ ~ . ~SCJ k >~ Wv Ulbrieht & Associates Private Sewage Consultants 2812 10t~~ Ave. Spring Vaiiey, 1~VI 54767 J~U~, lU SYS?~M D~'"pTN ~ Shc~.. TEST ' ~ ~ G12~~}S~D FROM Ci (v " -ro To h-t ~ ~~'t'A- tN MPc l~i/c~ 3 b ~~ wisoor~rt Deparartent of Commerce SOtL EVALUATION REPORT Page ~ of r Divkiort of Safety and Buildings m acooroanoe wan t.omm no, vv~. ram. was Plan must t l 11 i iz Att l t it th 8112 t i h l ~ S i G1~,o ~G ra comp e s an on paper no ess an x tes n s e. ac e e p , but not Hmited to: vertical anti horizontal reference point (BM), direction and Parcel I.D. ~-7 " ~ 7 " ~ ~ " ~ perr~nt slope, scale or dimensions, north arrow, std location and distance to nearest road. / Please prfnt all information. Re~"avued Date Personal bNorrrraliorr you provide may qa used for seoorrdary purtwses (Privacy Law. s. 15.04 {1) (m)). ~ ~!J Properly Owner Property location ^ L C r'T'js~ [/~ ~~. ~~ • 1 /~ G Govt Lot 5 W 114 S E 114 S Z T Z.q N R~ l E (or) W Property ONrtters MaOhtg Addn3ss ~ ' 5 Lot # Block # - Stbd. Name or C.SAA# ~ ~s - ' ' ~r~ ~3 c.~ -Z s 1<ELU r t~ E ~y stye ~ Pnor>c r~rrnber ^ Cily ^ v~age ~ Town .Nearest Roar- t~ vDSoN w i ~+UI G 1~5 > 3 / -~~ uDSoIJ r=R~T~~ C.ortstruc~iort Use~Residertti~ / Number of be~ooms ~' Code derived design Aawv rate i G b© GPD ^ Replaoenterd ^ Pubic ~ oartrrterciai - i'anertt marterial ~, wash %7 `~ Flood Ptairt elevati~ort ~appficable t'1 a tt General ALr ~a- and o # o ~. ~~ ~ ... Pit Ground staharse elev. ! Q f. OOfL De~h b Gn~rg factor in. Sol Rate Horizon Depot Dorrtinartt Rsdwc Desrx~ttiort Texttme Strtx~txe Consistence Bormtdary RAds GP in. Murtse9 Qu. Sz. Cont. Color Gr. Sz Sh. 'Efgf1 'E1fAl2 1 p -/p i u 4'rt 3/z - S i I rn K 1'hfi-• C S dF- . 5 •~ ~- !O- 1 ~uYie`~'y- - S i G1 2 ~ b -{y- W ~v~• . ~• • ~ 31-53 ~ •5 '~/~+ -- 1 s D s wt l w -- .-7 l • t~ 4- 53' x-7.5 s/~- - 5 p s d l - - - I•~ ^ ^ Pit Ground staters elev. ft Depot to factor in. ~ Rate # ~ Hor#zon D~1h Dorriatartt Redox Desa~dan Texttse Strur~ure Corts~tertce Boundary Res GP DAtr in. Mansell Qu. Sz. CoM. Cobr Gr. Sz. Sh. 'Efft11 'Eft#2 t tF1 = BOD > 30 < 220 mkt, and TSS >30 < 150 n~tgA. ' Etlluent if2 = BOD _< < 30 mglL CST Name (Please Print) _ Sigrtahrre ~2 Number i/R 1zt' Address Date Evahr~rt Telephone IC ASSnCiRtae rrlvate Sewage Consultants 2812. 10th Ave. Spring Valley, WI 54767 Pan~IID ~ Pane er a~~ °~ __ ^ PO t~rotxrd surface stew. ft t~tlr b taclor irr. Sol Rafe ttoriton Deplh Darimant Redorc Oesaiftion Testae Structure Correislenoe Botrttdary Roots ~ in. MunseN Qu. Sz Cont. Color Gr. Sz Sh 'Eff~t 'Eflf2 ~ ^ ~8 ^ Pit tatora-d surface slaw. ft Oeplh m 9 factor ir. Soi Rate. ftoriaon ~ OorNnart Redox Oeaaip6on Texfrre Strucprre Cor~rce Boundary Roots t~lfg ir. fltrrrsel ter. Sz. cart. color _ _ __ (fir. Sz Sh. - `~f 1 ^ ~~ ° ear: (] ~ c3ror.rrler.faoeele,-. ft oepdr m rr~rg faaor aR sol Rate ttortnort t)aplit Doninant Redarc DesorlpGon. Texture Strrrct<rre Conroe Borrbery Roots _ t3POVlE in. MurtsN llu. Sz Cont. Color to1r. Sz Sfr. 'B-t?1 ~ 'Ettif2 a ~8 ~ ^ Borst ^ ~ Grorxrd surface elev. R t)epth to ~r9 facbr in. Sol Rabe Horizon Oeptlt Dominant Redox Oesdiptian. textue S~rdure Cansistenoe Boundary Rods t1PQHF h Hansel tlu. SZ Cora. Color tar. Sz Sh '8~'i ~ 'Et112 E111uert #1 ffi Bt)D~ > 30 ~ 220 mglt. and TSS >30 <_ 150 mgll tR2 = BOD, <30 rrglL and TSS < 30 tnglt.