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HomeMy WebLinkAbout020-1437-08-000r 2000 Oxford Avenue Eau Claire, WI 54703 /.! (715) 552-8888 Fax (715) 552-8827 1-888-844-1980 ~^ ~,~~.~ ~~ f ., ~~~ ~ ~~ `~ PREfERREO d ~~ ~ " ...~ ~ ~ ~. ~J ~_ ~ ~' 1. i~ ;, i 1 I i n d O ..A a ~_ ~~ N a 7 ~ ~ I ~ I I ~ ~ ~ ~ ~ I I ~. \ I o I o. i ,~~ a Z I o j. ~ d ~ p. I ~ ~ W d Z ~ ~ i o. 7 I I ~~^, I II i I / f, I~ I I I nano! ~d c o ~ ~ c c .. i ~ ~ `D I ~ 'o :' ~, n 3 ° m c . ego ~ j °-' ~ ~ :` :~ I ~~ Z ~ O I p~ N I = N N ~ j ~ C7 N O a ~ J ~ N N f O 0 N v 0 Q O v J C I N ~ ~''~ p 7 H ~ ~. O ~ ~ cn ZI D W a ~ b N a rn ~ a ~ - rn p ~ O J S ~ v N o Z O H O ~ ' ~ ~ O C ~ ~ ~ ~ 3 :~ c ' a .. v ~ OOO °~ c O ~ c a ~ N ~ aD ~ ~ (7 fA N fn ? - ~~ ~~ , v 3 d J ~ o `~ 3 N o D ~, n m ~ ~ °: -o I N fd O O y ~ i y f~ C p N x a _ ~ A ('~D 3 ~ d ~ O ~ 2 ID A y ~ ~ Q c ~ C1 ~ ~ f -='N G1 ~ I m N N ~ ~ a ~ t0 Z ~ ° ~ ~ v o " ~ B ~ m 0 U! ~ ~ N ~ F ? ~ ~ a~ ~ N N N x N• ~a ~ ~ `_ O ~ ~ F F p tO/i O R d O CD ono O 0 o° i T C 7 a d '° H, a:. ~ A~ ~ ~ A~ Q ~• o~ "'ti ~ O 0 M~ t~ ~• O ~• a A a A N ~O H "~ 1 C.v R A 1 ~. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safely anrJ Bui~img 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 LaCasse Develo ment Hudson Townshi CST BM Elev: t Insp. BM Elev: BM Description: (~~ ~ ~~ ~ a+O . l7 . t7 2. S t S• i`~Lf S W'S TANK INFORMATION v ELEVATIO~.DAT~ TYPE MANUFACTURER CAPACITY Septic ~z~o Dosing Aeration r. Holding j TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ JAI \ ~ / ~~ Dosing Aeration Holding ~,r' PUMP/SIPHON INFORMATION Manufa turer Demand Model Nu er ~~ ~,~ TDH Lift io oss System Head TDH Ft Forcemain Length Dia. Dist. to Well county: St. Croix Sanitary Permit No: 463215 0 State Plan ID No: Parcel Tax No: 020-1437-08-000 Section/Town/Range/Map No: 22.29.19.2713 STATION ( t g kA.. . BS HI FS ELEV. Benchmark Bldg. Sewer ~,(D f rjS~o St/Ht Inlet q• car 9`~ ~~ ' SUHt Outlet Q ~ , 3? r Dt Inletnlet Dt Bottom Header/Man. )p,cf~ r ~3-~ Dist. Pipe / l7. ~ d r °~3• TZ Bot. System ~ , S-1 2 . ~O Final Grade ~~,,// N wT ~^ < S ~ r ~`~. Zo St Cover , / '7 JO I ~ ' 0 SOIL_ABSORPTION SYSTE Z3~ ~~,~ ~ . lTRENC DI ONS W idth ~ ~ Len / No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ Z- Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma~ufacty~re . INFORMATION CHAMBER OR ~ Type Of Sys ~ ~O r ~y^ r \ ~ ~._.,_ UNIT - Model Numb _ n ~ fdKM 1 ZIL DISTRIBUTION SYSTEM ~ ~ Lst {„ raa~ Header/M~anQipfo~ld if Length Dia ~- ~ Distribution Pipe( Length Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake ~ ~~ r 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 BedlTrench Edges Topsoil I~ Ves [~ No [] Yes L No COM,~ENTS' (Include cod di crepencies, per~Qns present, etc.) Inspection #1~\ ' 2~~ ~~~ W ~ of ~y~ns-~ off- i~rg¢n c~'o.~. Location: 676 Heritage Road Hudson~, Wfj~I 54016 (SE 1/4 SE 1/4 22 T29N R19W) Kelly Estates Lot 8 1.) Alt BM Description = S ~ 1 • wnG-v~LtiiKf2 ~-B"'~s 2.) Bldg sewer length = -~ 3 S ~ -amount of cover = ~ ~-2 "r~,a,~Q Cdr . Inspection #2:~k-'--~~r-""`' Parcel N . 22.29.19.271-3(~ ~ ~ ~ ,~ ~,~"~ b.,,., ~ 0. ~T- ~-- Plan revision Required? Ye ~ No .fir- ~ f L,, ~ ~ ~ ~.~ Z Use other side for addition ma' I~!-~~~r~-t , -- - ___ - ~ _ --- Date Insepc s Signature Cert. No. SBD-6710 (R.3/97) ~(Sf ~ ~~ ~~, o°° '~ ~•~~~ ~~ ~p~' .` ` i Safety and Buildings Division County ` m m 201 W. Washington Ave., P.O. Box 7162 1~~~0~~,~ Madison, WI 53707 - 7162 Sanitary Permit Num er (to be fil ed in by Co.) De artment of Commerce (608) 266-3151 ~{p 3 Z ~ S Sanitary Permit Application State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal in€ n y prow de may. be used for secondary purposes Privacy Law,l ~ Project Address (if different than mailing address) I. Application Information -Please Print All Informs on ~ ~ ~ ~ ~ i P ~ ~ A Property Owner' ame Pazcel # Lot # g B}oek #-- / Property Owner's Mailing ddress Pro erty Location s ~ ..; ~ ~ ~~> c '~El ED ~ ~ ~ ~~~ city, Stat Zi cos P - - •, section ~- = , '3 `5 APR 0 7 2006 (C~leq~ N R ~ E II. Type of Building (check all that apply) ; or .t';I I or 2 Family Dwelling- Number of Bedrooms ST. CROIX COUNTY Su ivisi n e -GS~Jm~ser- ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ^City V' age~Trownship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) `~' ^ New S stem y ^ R lacement S stem ep y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal Before Expiration Permit Revision ^ Change of Plumber ^ Permit Transfer to New r O Li vio~us~e t Number and Date Issued ~i~z"'7' " ~ -~ wne ,s ~~ ,~ ~ IS IV. T of POWTS S stem: Check all that a z S Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound <24 in. of suitable soil ^ At-Grade ^ Singte 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 Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Informatron: --"--' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required~sf j Dispersal Area Proposed (sf) System Elevation i ~' `~ 7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ _ ~` Aerobic Treatmem Unit Dosing Chamber VII. Resp nsibility Statement- I, the aodersigned, a me responsibility for installation of the POWTS shown on the attached plans. Plum r' ame Print) Plumbe's Si ~ MP/MPRS Number Busir>ess Phone Number ~ S r; ~ ~~ Plumber's Address (Street, City, Stat Zip Code) ~ ~~ ~ ~ i VIII. Coun {De artment Use Onl ,Approved ^ Disa v Sanitary Permit Fee 'dudes Groundwater Date Issued Issui Agent Signs (No Stamps) ^ Surcharge Fee) y ~--~_ " ' D ~ . en Reason for Denial j ] IX. Conditions pprov 1 '>~" ~ ~~ ~~ t S t o ~J I ~ ~~"~k~ s~Srts~-~ .~-,,. ~,. S ec~,,,~ ~ -~o~ ova , ~.. w,.groac p.sm isu we wnory onry~ ror me sys[em on paper no[ aw man alit : r r mcaes m atze SBD-6398 (R. 41103) .x'73, ~~~. 1 ~,/ ~~ ~~/~, -s,~~-s~~~a- ~a9~/-~'~~~~ ~pSD~ ~~~ {~GSI,~ l lU~i~paJ s'~~,~,sJx~,~ /pX" - ~..~~Gd, D / 1- / ~/ . ~ ~ 5-c,~-/,c ~~ ` (~ ~ ~~ A '~ I ~ 1 L~ I n~ ~~r/~ -~ ~X~ , ~ y S ~~-~ ~Oicsc ~~G~JS~ i 13ni l ~ ;. - Zc ~~ ~~ „Lr 8 ~~ ~= /~ /~~ .~ ~~ 7 Wisconsin Department of Commerce SOIL EVALUATION RE RT Page,~of _~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz .Plan /~~CEf ' include, but not limited to: vertigl and horizontal reference point (BM), di coon 9rTd- parcel LD. percent slope, scale or dimensions, north arrow, and location and distan to nearest road. Please print all information. APR 0 7 b Date Pen~onaf information you provide may be used for secondary purposes (Privacy L s. 15.oA (1) (m))_ . _ , ~~ ut ~~ f(.~ ~ , /~ p J t7, ~.G / S -. rt3dvt'.-C~-- 1/4s 1/4 Sv7 T ~ N R ,E (o Property Owner's Mailing Add ss Lot # Bio Subd. Na r 6SMIJ<-- City State 7rp Code Phone Number ^ City [Village own Nearest Road ~i New Construction lase: Residential / Number of bedrooms Code derived design flow rate _~~n GPD ^ Replacement ^ Public or cmmmerclal -Describe: Parent material r~Yr~ ~,g-s~ Flood Plain elevation if applicable ,Ii ~ _ ft. General commerrts and recommendations: ~ s• ,~ Boring # ~ Boring 3Cy ~ Pit Ground surface elev. ,~~.~-ft• Depth to limiting facto~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F : /I 'f' ~q 4 ~ 9 82.6`3 ~-g.l~ 2 ^ Boring # ~ Boring pi( Ground surface elev. ~~ft. Depth to limiting factor ~ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f(~ in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. *Eff#1 "Etf#2 ~~ /S ~ a 4 a 4 3. 3z o .32- uent #1 = BOD > 30 < 720 mg/L and T55 >30 < 150 mg/L * Effluent #Z = B U < 3U mglL and I ~ < 3U mgrL CST N (Please ? Signature CST Nurr>ber / / _ _ .~ Address Da a Evaluatio onducted Telephone Number ~~8 ~~ ~ -~ PropertyOwner~ Paroel ID#~/~~~ /1~~~1~ Page ~ of Boring # ^ Borir~ pit Ground surface elev. _ ft. Depth to limiting factor ~ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Shucture Consistence Boundary Roots GP D/fi? in. MunseN Qu. Sz. Cont. Color Gr. Sz. S h. "'Eff#1 "Eff#2 / C ~5 a . ~ a q 4 ~ vz.69 X3.32 0 • 3 ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DHt? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 * Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL 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. SBD-8330 (R07/OD) 3~~ " ~~~~ ~Jx/~o~~E„~~ ~jJL .~~ / sue' - s~~?~ -T~,t/ -~'/9~~~ S"7,3 ~~1 ~~ ,~ ~~s~ ~,aset~ Lv.~ s~/~iG ~~~,~c-~ /~f ~,~- 1~~~~~ ~; l~ ~~~o, a " / ~G- ~s ,D '~ GST~ ~~~~ ,K '~ i i `i ~ ~ o ~ a~ l !., ~ ~~ ~ ~~ `~~ ~ s~' R~ ~ .. z I ~~ ~ i °° -_ ~i 3 /r ~! ~ SL ~3 Y~` .~ /f ~;J25 - ~ - /7,G'7Q• ~jt('~ OI ~~ S . Safety and Buildings Division County ` m ~ 201 W. Washington Ave., P.O. Box 7162 ' ~scons~in ~ Madison, WI 53707 - 71 62 ~ 608) 266-3151 Sanitary Permit Number (to be filled in by Co.) /1/ '1 c De artment of Commerce ~ Lr=,~ _ ~ ~ ~ ' o~ Sanitary er ~ ~ E~+~~~~[~ State Plan I.D. N rimber In accord with Comm 83.21, Wis. Adm. Code, personal info ation ou provide /~ may be used for secondary purposes Privacy Law, sl .04(Ixm) ,~ ~ ~ oject Address (ifd' Brent than mailing address) ~~ I. Application Information -Please Print All Information h~UIN(. Property wn is Name ZQNING 0 r cel # ~ Block # 1 ~ /~' roperty Owner's Mailing dress property Locati aZ~l 7 ~~ ~~ % - % S ~~ City, S ~ Zip Code Phone Number < ., ection s~~ (circle o ) T ~ N R~E ~ II. Type of Bnilding (check aII that a ly) . . ; or ~ ~. ~1 or 2 Family Dwelling -Number of Bedr s bdivis~ n ame r - ~ ^ Public/Commercial -Describe Use . ~ i= ,~'- 1 ^ State Owned -Describe Us ~1 S L' s W Z ^City Village ownship of III. T ype of Permit: (Check only one box on line .Complete line B if applicable) A. ~ New S stem y ..fir ^ Replacement System reatment/Holding Tank Replace t Only Other Modification to~xi em B• ^ Permit Renewal ^ Permit Revision ^ Chan of ^ Permit ransf to Ne vious it be d Date Iss Before Expiration Plumber ` Owner IV. T of POWTS S stem: Check all that a J~NOn -Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mo 24 in. of suitable soil -G Ingle Pass S d Filter l~ ^ ~ Constructed Wetland Pressurized In-Ground ^ Holding Tank ^ P i ^ Aerobic Trea it irculating S Filter ~ ^ Recirculating Synthetic Media Filter Leachine Chamber ^ Drip Line ^ G -less Pipe ^ Other ai V. Dis rsaUl'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispers ea Required (sf) Dispersal o os em Elevati ~,~,^ C~ '/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit , ' / ~ /D ,1 W (J Dosing Chamber VII. Respo sibility Statement- I, the uodersigne ume responsibility for installation of the POWTS shown on attached pleas. Plumb 's ame 'nt t Plum is , MP/MPRS Number usiness Phone Number Plumber's Address (Street, City, State, Zip ode VIII. un /De artment Use On pproved ^ Disapproved Sanitary Permit Fee ncludes Groundwater p`V Suroharge Fee) . ~ Date slued / sluing A~ Stamps) ^ Owner Given R n for Denial !~ ~ S V ~ / °' a' ~ ( ~ IX. Conditions of Appr aURe ns-for Disapproval / ® G~ i,/ /Z~ ~ STEM OWNER: pZ ~t.i/l~l s Septic an fffient filter d ~ ~/G,/ ~~i~~ ~~ ~ dispersal cell must all be erviced /maintained '~ ~3 ~ e as permanagement pl rovided b lumber. 3 Qr ~ yy~c.~~ se ac regwreme a malntalne ~J J ~~ o as per applicable co /ordinances; !i ~Lf;rn G~~°~ ~-~'~ ~ ~- ~ 6 _, S ~. nrnco compneupwns lro me a.ounty onry) for me system on ryperaot Tess than sirz ~: 11 inches insize ~~ ~ ~~ Q~ SBD-6398 (R. 01/03) .a J ¢, fi ~Y ~~ a ~~ F~ t. ~. .~ F~ ~~.~ a ~ ~~° : 1 ~ ri ~ t f n i ,` 7~ i ,+ } M .` .~ Y .,~~;ass,~ ~,~J,~~~,~,~.~ -~ ~ s 3 ~~ I~~~ ua~ Ut1T s~/!~ f~d.s~ ~,I ~~ /'=~ .~ S,~~,~ ~; t ~~~~~~ jl~i 1,, s try ~ G~~r \, ~~.. .~ tS`~ ~, `~~ f /~~S ~.Co,R~sz!) i+~,t 11 O - - Is ~ -_ .._._ ~ ~ `~.1 • ~ 1214 tNisgnsinDepartmentofCommerce SOIL EVALUATION REPORT p~ t of 3 :~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ~ ~ y ~ ~ ' ~~~r S Soil Service Coun ,, Attach complete site plan on paper not less than 8%: x 11 inches in s¢e- Plan must fit` ~'f~ntfi , include, but not limited to: vertical a:.d hor9zontal reference point (BMj, direction and ~=w_~ r~;: percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel ~ ---- - Pending Please print aU information. By Date Personal information you prove may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ t7 3 Property Owner Property Location Reliant Developers LTD Govt. Lot SE 1/4 SE 1/4 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9900 Valle /C'reek Rd. Suite 135 8 na Kelly Estates City t,~`~Db~r'.~ State Zip Code Phone Number City Village Town Nearest Road MN 55125 651-731-3174 Hudson Heritage Way /; New Construction Use: ~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Fublic or commercial -Describe: Parent material outwash plains and stream terraces Flood plain elevation, if applicable na General comments ~ and recommendations: System elevation 92.25ft, trenches spaced and depth to code 5.OOft be~w grade Boring # ..__'! Boring 96 Ill Pit Ground Surface elev. 97.25 ft. pepth to in. timittng factor Sod Applicator Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ *Eff#1 *Eff#2 1 0-20 10yt'3/2 none sii 2msbk mfr gw 1vf .5 .8 2 20-36 10yr4l4 none sic! 2msbk mfr gw na .4 .6 3 36-43 10yr414 none scl 2msbk mfr gw na .4 .6 4 43-50 7.5yr4/4 none sl 2msbk mfr gw na .5 5 50-96 7.5yr4l6 none __+ ms osg m! na na .7 1.2 Z trLr ~ ~ '"( ' 4~~ Boring # Boring / Pit Ground Surface elev. 97.25 ft. Depth to limiting factor 96 in- Soil Application Rate Hodzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-11 10yr3f2 none sii 2msbk mfr cs 1f .5 .8 2 11-21 10yr4l4 none sic! 2msbk mfr gw 1vt .4 .6 3 21-30 10yr4/4 none scl 2msbk mfr cs na .4 .6 4 30-36 5yr4/4 none Is osg mvFr cs na .7 1.2 5 36-96 7.5yr4/6 none ms osg m! na na .7 1.2 / ~ ~ tntuem ~z = t3VU ~• Jv < zZa mg/L and TSS -30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS <30 mglL SST Name (Please Prinf} Signature: CST Number David J_ Steel ~g~~ ~ 248956 4ddress Steel Sol! Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 10/21/2002 715-246-5085 " ' property t7wner Reitant Deweiopers LTD Parcel ID # ~2nding Page 2 of 3 Boring # - _f Boring 95 96 Depth to ft limiting factor 96 in ~! Pit Ground Surtace elev. . . . ~ Application Rate Horizon Deoth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft2 *Eff#1 *Eff#2 1 0-18 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 18-36 10yr414 none sic! 2msbk mfr gw 1vf .4 .6 3 36-50 5yr4l4 none sl 2msbk mfr gw na .5 .9 ~~ 4 50-96 7.5yr4/6 none Is osg ml na na .7 1.2 ~/~ ~ ~0~~ ~ ~ 9Z2~' a~. ~ ~ ~~~ Rnrinn # 8onng * Effluent #1 = BOD s' 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluc-nt #2 = BODS <30 mg/L and TSS <30 mg/L Tl:e Department of Cornmeree is an equal opportunity service pravider and employer. ff you need assistance to access services or 1 i Borina # Boring _ ._ STEEL'S SOIL SERVICE Page 3 of 3 David J. Steel 1564 Cty Rd GG CST-POWTSM Reliant Developers LTD New Richmond, WI 54017 L1C. # 248956 SE1/4,SE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (? 15) 246-5085 Kelly Estates lot 8 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' • Benchmark El. 100.00Ft op of 'h"pvc pipe -~ • Alt Benchmark E1.99.85Ft op of 1/2" pvc pipe ^ =Borings ~:c~7,~~ ~~ ~G- Boring Elevations q7. Z~f B1 =97.25Ft B2 =97.25Ft ~ 6 `~~~,~ B3 =96.95Ft B4 =OO.OOFt r,-~ ~- 5~.~ i ~~.~~ ~S~ .~ ~ ~ ~~ ~~ ~~ ~~~. ~~ ? ~ ~Io -'~ s.06 x ~ ~> '} `~ •• _ t it ~~ t _ g. l .c i ~ 1 e l "~ ~ ~ IK, ' I ~ 2 / !~ k "'~ ~ I 1- % ~ i ,. IAA) ~ ( i~ ~ ~'' \ i. -'~ ~ s - .- S .~ S •- ..~ . • _ 7'. ,• t g' `~.. ~ 11~'11~ I ~ ~ : ~.. -'~i ~rt:e ~ 1 ~ ~ - L . >S I . ~.aa~ hi k 3 IC7w, ~ ~i J, ,s $ ' I ~~ z c~z ~ fs _,_..~.~------~~--f ~ 8 +~ri i N- Ot a-~o ~ /• / ~' I' ' I Fri- ~ ! /'y f 4 as/ N- ~li S -i - {jp~ .1 6dC)~.t~ ~ 1' N .\~ `~.` +s•~, vL~~ps~'" ( ~I,Pe=,rii ~ i J J ~ t l ' 1 • ( -i ..<. .t t r.~ K t_ ~ `° '0 ` ' _ B t0 ~ • 1 IC 7 I': ~, -~' `~ ~` Ty - is '' p~ fC~ 1; i ~!~ Y'• fah ' p 1 a` ~ u!• ~y ~ K~ /~ I i + a r r. ~ ~ % R I ~ ..~ t --r.~ i ` . \ .~r'~ ' ..A ANN ' vNN~ ` ~`,', ' " i't I > `r1 `' 329.18 NO 7' 1'E °i 's i• • ~ ~ + "z n PgnbtNG EASEUENT 4~ `~ ~ ~ ~ / ~ . n . - ~ ~ ' ~ i , ., i ~ i z .l^~ ' e;' F~ .~` aZO ~ 416.fj\3 N01'05OS 1~ -~ '' ~ ~ J I t;' I 1- ~ ,.,, ~ ~~>< I '~ • ~, k a-~ ~ ~S 1' •r~ _ ~I~CSS `urc br fir' `~~' ~ ~ t ' ~ ~ l ~ " I ~ ~ z't ~ ~`' -i ~ :a ups V rt i ~ ~ ~s I fifi ~ V~ / ( it p Ol f ~e 1 1 ~ ~ ~ 1 IR I ~ r ~ ~ ~~~~:~ ~ ~a ~F ~Q ~uS'`4 ! JA s(C f ~,r il~ • ~ ,~! T/ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ~ /,~/~ OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~~y,~~sS e, fleJ.~G 1-r~...."~"' Mailing Address s ~ ~ G ~y ~ ~ ,r~~.~;s ~ ~ iii ~ Property Address ~ (Verification required from Planning Departr~nt for new construction.) City/State ~,,~ 3 ate.. C~ Parcel Identification Number ~~r~i-~ ~Z 0 ~ / ~ 37-~ ©~.~t~ LEGAL DESCRIPTION . ~~ ~'3 Property Location b E '/. , S ~ %4 ,Sec. z 2 , T Z- cl N R~~W, Town of Subdivision } -~~ L ~ y ~f~ld ~ ,r ,Lot # _~. Certified Survey Map # Warranty Deed # 7s 7 ~3 (o ,Volume a s 3S ,Page # Volume ,Page # Spec house ye no Lot lines identifiab ye no ~~ SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Depaztment 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 Zoning Department within 30 days of the three yeaz expiration date. GNATURE OF APPLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form aze true to the best of my/our knowledge. Uwe amaze the owner(s) of the pro escribed a , b virtue of a warranty deed recorded in Register of Deeds Office ~./-tea' a SIG A OF APPLICANT DATE ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ****** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. . ,• ~ , FILL: INFORMA Owner -~ Permit.---- ..rn,nr~ nwnwaecTC~c pOWTS OWNER'S NUAL & MANAGEMENT PLAN,,;.. vrv.v....~.......~ ..-,.~ Number of Bedrooms ^ NA Number of Public Facility Units ANA Estimated flow (average) al/da Design flow Ipeak-, (Estimated x 1.51 ,, al/da Soil pp(ioation- 7 al/da /ft~ Standard Influent/Effluent Quality Monthly ave rage' OGi 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS} 530 mg/L ~ NA Fecal Coliform (geometric mean} S ° ml Maximum Effluent Particle Size Yd in die. ^ NA Other: ^ NA *VaVues typical for domestic wastewater and septic tank effluent. Page _,~._ 0 f SYSTEM SPtt:Irlt,:A i was Septic Tank Capacity ~ ' al ^ Ni~~, Septic Tank Manufaaturer .4. ~ " O N~ Effluent Fllter~Manufacturer ` `` ' ~ a`' ~ ~ O N<< !, Effluent Filter Modal ~ O N!; Pump Tank Capacity al f~ NA ',, Pump Tank Manufacturer ~'N~_ Pump Manufacturer 17`fJA. Pump Model ~ NN. Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection O Peat Filter ^ Wetland ^ Other: ~ Nk Dispersal Cell(s) ,~In-Ground (gravity O At•Grade ^ Drip•Lina ^ N~' ^ In-Ground (pressurized) ^ Mound ~I Other; Other: O Nf~ Other: ^ NA Other. ^ NE. MAINTENANGE SGNEDULt 7 Service Event Service Frequency Inspect condition of tanks} At least once every: ^ month(s) (Maximum 3 years) ~ ear(s) .~ ^ NA pump out contents of tank(s) When combined sludge and scum equals one-third (Ys1 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ D month(s)" ` (Mautimum 8 years) ~ year(s) DNA I --{ C{ean effluent filter ~S ~~'~ least once every: ^ month(s) ~ ~ yearls? ^ Nr~,^ ^ month(s} ~Nf~ Inspect pump, pump controls & alarm At least once every: ^ ear(s) r ~ ^ month(s) r, ~ j,7dJh Flush laterals and pressure test At feast once every: O ear(s) . Other: At (east once every: O manthlsl ^ ear(s- .~-NA Other: C7 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, `i'he dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondin;~ of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thc: immediate notification of the loos) regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,} 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 Cod®. " '~ All 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 POWT5 Maintainer, A service report shall be provided to the local regulatory authority wlthln 14 days of complatlan of any servlae event.. aMW (AIO t . 9 3--_ Page 01 START UP AND OPERATION - For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting producFS or othec,chemica~ . that may impede the treatment process and/or damage the dispersal ceII1s1. If high concantratfons are detected have the contents of the tanklal removed by a septage servicing operator prior to use. System start up shaft 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 rastore4i the excea; wastewater will by discharged to the dispersal califs) in one large dose, overloading the aolt(ai and may result In~tFN backup or surfaw dtscharQe o1 effluent. To avoid- this situation have the oontenta of the pump tank removed by a Septage Servioinq Operator prfot;to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually°operating the pump' controls co 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 ari; 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; gasoNne; grease; herbicide$;;;imeat-scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWT5 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 compliancy with chapter Comm 83.33, Wisconsin Administrative Code: • Alt piping to tanks and pits shall be disconnected and the abandoned pips openings se~lpdi.r, • The contents of all tanks and pits shall by removed and .properly disposed of by a Septage ,Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers ramgygd and the void space filled with soil, gravel or another inert solid material. CONTINC3f=NCY PLAN If the POWTS fails and cannot be repaired the following measures have bean, or must by taken, ;to provide. a codq compliant replace ant system: ,,:,,.~ ., :~,,, ,~, ~A suitable replacement area has been evaluated and may be utilized for the location of a replacement sell absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from yxisting and proposed structure, lot linos 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.' Repiaeement systems must comply with the rules in affect at that time. © A suitably replacement area is noc available due to setback and/or soi( limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS.-~~~-_°~- ~ ~ K~ D 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. .. . .. :. .... . . ., _ _ t~ Mound and at-grads 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 a; that lima. < < 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 pF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS ... iw~.1~,,, r,, POWTS INSTA E POWTS MAINTAINER Name Name k r Phony _ Phony SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Noma ,~ . r ;, Phone ,,~ -E ~ ~ ...;- ..,. ~ - ,his aocumenc was drafted in compliance with chapter Comm 63.22i21(b)(t)Idl&(f) and 89.6411), (2) & (31, Wisconsin Adminlatrative Code. U 2535P ~i95 Document Number STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Reliant Developers, LLC, Grantor, and LaCasse Development, Inc., Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following desc ' ed real estate in St. Croix County, State of Wisconsin: Lots 2, 3, 4, 5, , 8, , 11, 13, 14, 15, 16, 17, 19, 20 and 21, Plat of Kelly Estates, St. Croix unty, Wisconsin. Recording Area ~s~~3~ KATHLEEN H. t1ALSH REGISTER OF QEEt7S ST. CROIlt CO. , WI REGEIVETI FOR RECORCe 03/2912004 09:10A14 NiARRANTY DEEQ EXEi4PT # REC FEE: 11.00 TRANS FEE: 40?4.00 CCiPY FEE : CG FEE: PAGES: 1 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Name and Return Address: Edina Realty Title, Inc. 400 S. 2°a St. -Suite 115 Hudson, WI 54016 423495 020-1060-30-050,020-1059-90-0 d(~ Parcel Identification Number (PII~ This is not homestead property. Dated this 26th day of March, 2004. Reli eveloper Br * 'ck Toston, Chief Manager, Reliant Developers, LLC * AUTHENTICATION Signature(s) authenticated this 26th day of March, 2004 * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 * * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this March 26, 2004 the above named Ric stop, Chief Manager, Reliant Developers, LLC .to•'lrie~ known to b the person(s) who executed the foregoing instrument and ackn ledged the same. .~ *Tiid""'Larrieu Notary Public, Statf Wiscons My commission is 'P'ritn"S ate: 11/4/2007 ~ JUDY LARRI U ) (Signatures may be authenticated or acknowledged. Both aze not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature State of WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-20(!0 • • '~ V ' , ~ T AT E Lo Toted in the Southeost Quarter of the Southeast Quorfer in the ~ Souf eost Quarter, ol! in Section 22, Town 23 North, Range 19, West, County,~Wisconsin; including port of Lot .3 of Certified Survey Map record ~+ uNE OF THE sOUTHWESr tTER OF THE SOUTHEAST i n-~- ~ 1TER SEC. 22. T. 28 N., R. t9 YY. .L.LG ~- -~- A 1`11^- i "T' 1 r1 A I 11 II I~ I II it I I~ III I l .r I~ I Imo' I IN I Iz I I II iI II 7 1oss31 s.r'. (2.448 AC.) (N89'24'S2`) 589°12'38"W 2297.51' '1 ~~~ ~ i ''~ 1~ 1 1 ~, ~i ~iA 1 1° o~+, 11 1 31 ., t, ~~ ~~ ~~~, ~ r1'r 4 L.u.i_ ~ I ~ I I ~ nY~~ I I I I I I ( i In I I~ 1 1 3 I I~ I IN l i$ __ I I 323.49' 1806.05' 9 112329 S.F. (2.579 AC.) ..-.s~-.---- I I '~'~ ~ ~ ~I __ ----~ ~------.. 503 .~ - - -.. J °° --' ~ _ ~ ~; .r"' ~,..-gam-- "'" ~ v~ -,ze.7 ~____---~.----~. sue. I I `, 3~~=,:,,.•~ ~~ r ~~ ~~ ...- --I ----'.---HE~~ G ,6.31 ~ _ _, .... ~-~ ~~ N~__=-- ~ ..... '' g6~ ? v ?: ~..- _„ .-$79 a N ~ ' A~69. = .~ ~ 6267 S.F. wog ;4.s2' ~'~565 8,~3y~g~. ~o (0.3 3 Ac.) -+- ,~ NOTE: OUjL.OT 1 WILL BE 4.58 ~.~~'~ ~ ~ / '~ 9 ~ yC '~~' , ------USEQ FOR PICNIC TABLES =_ ~ ~ ~ ~ ~ ~ gpAC AND PLAY STRUCTURES. ~ see ~" '~ PR1VA~ OP -~ ~;~ ~ sF,f,~~ . S~g•26 3t".!H \ ~ ,~ --TOP@~PIPE t N \ \ ELEVATION ~ 924.68 ~ S ~ 1 9 ~ ~r : r ~ \ d. \ \ ~ 104728' S.F. ~ ~ i 108434 S.F. ~~; 76.73'.^ ~- ~- \ \~s (2.404 AC.) z (2.489 AC.) \ \S F~(~ TIyy ~ NO OWELUNG `N89'19'31 E cW SW \ ~Qi. EXISTING_, ~A~AG~-` 50• ~ EXTERIOR ~ \ \~. HOUSE + ~ OPENING BELOW ~ . I i \ \.T~, l__J ~ ELEVATION 923.8' `w° rn ~ (~ \ ~ \,, I ~ I ~ ~ 33' ~r 9'1'9'3=`E~~11.?7` _ _ ;~ us ~ \ \ /~~/~ TOP STEEL PIPE-~"; '? ~~Ak~' 103018 S.F; ~ 18 •~• ~~ ~~ ~ ~~~ ~t ~- 7 i ~, ~ ~~~