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020-1437-13-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provede tnay be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Voi t, Tim Hudson, Town of CST BM Elev: Insp. BM Elev: BM Descriptio /oo IC1Drv ~, t G5T TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 3, 5 P ~ ~zs Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7~JC~ ~ 7Z ~ ~ / , i' 1 ~ - Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dist. to wen SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: ~ ~ 487981 ~~I State Plan ID No: Parcel Tax No: 020-1437-13-000 Section/Town/Range/Map No: 22.29.19.2718 STATION BS HI FS ELEV. Benchmark !a/. V`d 1. b~ /tom ^ AWB~~ S;-` LL ~ .~5 9~. 53 Bldg. Sewer ~.$7 53. s/ SUHt Inlet ~.~ y3~ 3z SvHt Outlet ~ , ~~ 9 3 Dt Inlet Dt Bottom ~ Header/Man. q . 75 9 ~ ~ g 3 Dist. Pipe Bot. System /D.co`t~ 9 Final Grade 5. a 9~, l~8 St Cover 3 ,~ ~ 9 ~ , SZ BED/TRENCH Width Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ 3 ~~t-g~j Z ~C•,~.v~ ~- ~' SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer.. L~ ~ ~ ON CHAMBER OR ~ ~ ~ ~ 7 a INFORMATI Type Of System: ~ ~ UNIT Model Number. r11STRIR11TInN SYSTEM )h z~1 t- zz . ~ ~, d'bd ~C Header/Manifold ,~ ~ Length ~• 5 Dia 7 Distribution Pipe(s) Length ~ Dia ~" Spacing ~ x Hole Size \ ` x Hole Spacing ~ Ve~nt~ fir Inta~e~ ~1,. F- `° SOIL COVER x Praccnra Rvstams Anly YY Mnund Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ t0 g BedlTrench Edges ` Topsoil ~ -. Yes ,l No Yes ~ ,; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 683 Heritage Way Hudson, WI 5 016 (SE 1/4 SE 1/4 22 T29N R19W) Kelly Estates Lot 13 1.) Alt BM Description = ~"' L. W;...~oL.~, S~ (~ E Z Co ~e fg 2.) Bldg sewer length = / $ ~ - amount of cover = ~ y Plan revision Required? I ]Yes , No Z~ z I~ / Use other side for additional information. l_ ~o i Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 22.29.19.2718 ~--,i Cert. No. ~ ,~ s ,~'- Safety and County ` m m 201 W. Washin on Ave., P.O. Box 716 ~ ,~~~~~~~ Madison, Sanitary Permit Number (to be filled in by CoJ De artment of Commerce (fig) ~{ ~ 7 9$~ Sanitary Permit Applicati n State lan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal informati you pr may be used for secondary purposes Privacy Law, s15.04( xm) IV 1.111 ~ ;l ~ ~ n Proj Address (if different than mailing address) I. Application Information-PleasePrintAllInformation CROIX000N ST . Property Owner's Name ~ / Lot _ ock # Mailing Address ~ Property Owner s Property Location ~ ~ ,~~ ~~/~ ~~ ~ City, S I Zip Code Phone Number - ' ' \ circle o ) / r 27 fti J ~~ N; R~E o~ (~ O (check all that apply) e of Buildin IL T cLp Dk " g yp , ~ 1 or 2 Family Dwelling -Number of Bedrooms !'" i r 5~ berv~slo a €S~imnber ibe Use (a i D blidC l ^ ommerc escr a - Pu ^ State Owned -Describe Use 2 ~ 2 t G f5 .~/ ^City Vii a jp1"ownship of III. T ype of Permit: (Check only one box oa line A. Complete Gne B if applicable) A' ^ New Syste~rn ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Otha Modification to Existing System B. ^ Permit Renewal Permit Revision ^ Chan ge of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~~ 7 ~ l TV. T of POWTS S stem: Check all that a Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ -Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ n Constructed Wetland ^ Pressurized I ~ J Recirculating Synthetic Media Filter ,!J Leachin Drip Lie ^ Gra el-less Pipo ^ Other (explain) V. lDis rsal/I'reatmentAtea Information: Design Flow (gpd) n Rat Design Soii Applicatio a Required (s/f) Dispersal Area Proposed (sf)/ System Eleevation / / / / / / ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gathms Gallons of Urritr Concrete Consr)rrcte~ Glass New Exisatting w Po Ial 5Z Tanks Tanks z ldin Tank S ti H g ep c or o Aerobic Tn:atment Unit using Chamber VII. Respo tbility Statement' I, the undersigned, ulna responsibility for installation of the POR'T'S shown on the attached plans. Plum 's me Prir->1 Plumber' Si MPIMPRS Number Business Phone Number ~ Plumber's Address (Street, Ity, tate, Zip Code ® ~ ~ S' VIII. Coun /De artment Use Onl Approved ^ ~ pro Sanitary Permit Fee (includes Groundwater Da Issued issuin gent Si o S Surcharge Fee) ~ ~ ~ ~~ ~ ~ ~~ ^ er Giv Reaso ial , l0 IX. Conditions of ApprovaUReasons for Disapproval ? D nn ~ ~ ~ /~ Jew 3 ~ P2f1v~~ ~' I<e.J , ~ t o ~- , " SYSTEM OWNER: Se tic tank effluent filter and ~ }- Q ~re~ 1 p , e~ ~ . dispersal cell must all be-,ervices /maintained as per management plan provided by pklrrtber. 2. All setback requ'lrements must be maintained aK per applaable Code / ordirnnCes. Attach Complete plans (to the COanry onry) rot me system on pspcr uu..~,...w.. o.,.. ~ .. cun_~z~Q riz ni m~~ ~' ~~ ~ ~~ ~ 1~ ~ ~ ~ ~ M 0 ~C ~ ~ ~ ~~ 4 --~ P `~) h ~~ ~~ fl ,~ a _~ M - ~ G' n,,~ \1\ 1 ~~ ~j ` `~`~ ~~. ~ ~~ ~ ~ ~~~ ~k ~~ M ~` ~o `L ~ ~ ~ ~ ~ _ ~ ~. ~ ~~~~~ ~~ ~ ~~ ~ ~ ~ ,n ~ _~ 1n C~ ~ ~Z'R ~ ~~ .~ ~_\ 1 ' ~/.c~. a ~~ `\ r `~.Y r ~, _~~i 1 ~, ` • d~ ~~~ ~ ~ ~ M ~ ~ ~` ~ ~ _~ ~~ __ _ - _ ~ M ~ ~ ~ ~ ~ ~ - ~~ ~ ~ 8 ~--ti ~ ~ \g ~~ v ~ ~~ ~ ~C w ~~ -v ~ ~~ ~ _~ ~n ~~~ _ ~ M~ -a /~. ~~ ~ *~ ~y ,~ ~ `~ \\\ \I '> ~~~, ~_ ~~ WisconsinDeparfmentofCommerce SOIL E ALI.~i~~~~~T~; Page,~of Division of Safety and Buildings in accordance with Comm 8 Wis. Adm. Code 4h~ n Attach complete site plan on paper not less than 81/2 x 11 inches in ize. PI st ~ ~ 7 include, but not limited to: vertical and horizontal reference point (BM) direction and Pernel I. , percent slope, scale or dimensions, north arrow, and location and dis nce t31~~~FR~U _ Please print all information. ZONING OFFI Devi Date Persona! informatlon you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). II ~ ~ b 5 Properly Owner Property Location Govt. Lot 1/4~ - 1/4 N R (or) W Property Owner's M ,fling Address ~ Lot # Blo # Subd. N or 6SM#- 7 Ciiy ~ State Zap Code Phone Number ^ City Q Village own Nearest Road New Construction Use: ® Residential / Number of bedrooms ~ Gode derived design flow rate ~~ GPD ^ Replacement ^ Public or commeraal -Describe: Parent material ~~i~Shl Flood Plain elevation if applicable ft. General comments and recommendations: ~ y~~ ~1e,~ ~~~ q - , o a Boring # ~ Boring ~ pit Ground surface elev. ,9s ~~_ ft. Depth to limiting factor ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Sthacture Consistence Boundary Roots GP DffP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eif#2 ~, ~ -6 ~ e ~ -~ ~ / _ q R !I rr Boring # ~ Boring ~ pi( Ground surface elev. ~ 7, ..~ ft. Depth to limiting factor ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 / D -i 9 ~ e ~ ~ s ~ .~ , ~ 4 _ ~'' s _ _ `~ 4 r~ tr ~ ~~~ ' E nt #1 = BOD > 30 < 220 mg/L and TS5 >30 < 150 mg/L ent #2 = BOD < 30 mglL and T55 < 30 mgrL CST Na lease ri Signature ~ ~ CST Nurr>ber Address ' Date Evaluation Conducted elephone Number Sl? ~~ ,.~ ~ ~ - _ - ~ -~ ..,,., ~,~„ m,,.,x.,,, Property Owner ~ ~ -" Parcel ID # ~~_~ 3 7 -~fZi'? /Page ~- of ~„ ~ .~ Boring # ^ Boring ,/ ~ pit Ground surface elev. ~ ft. Depth to limiting factor ~ 1~~ in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D1fF in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 S J R 4 s' - - `t 9 ~~ ~r 3~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Descripfion Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. 5h. *Eft#1 *Eft#2 ^ Boring # ~ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sol lication Rate Horizon .Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f>? 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 mg/L 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 (R.O7/00) s. ;., . a ,., Property Owner _~~ ~ Parcel ID # /~~^.~ ~~ f~'? /Page . ~ of _ ~_ ^ .Boring # ^ Boring - / pg Ground surface elev. ~,_ft. Depth to limiting factor ~~ in. Sofl flcetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Murisell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 '"EfF#2 3 e s ~ ~ ~ _ , _ _ a 4 r n • ~r 3. ^ 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 D/ft' in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eif#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sort ication Rata Horizon .Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl? in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODe > 30 < 220 mglL. and TSS >30 < 150 mglL * Effluent #2 =BODE < 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 deparhnent at 608-266-3151 or TTY 608-264-8777. SBD-6330 (809/00) `te'a ~? i w ~~ 0 h w ~ c `~ '~ ~ ~ ~ ~ ~ .~ ~ ~ ~~ -~~ ~ ~ ~~ ~~ ~ ~ ~~ _~r° ~ ~ ~__ ~-~l~ ~~ r ~ / ~ ~ m _._1 ~ ~ ~~ ~~ 0 ~~ ~ ~ ~ ~~ a `~ ~ 0 ~ ~ ~~~,~~ ~~~~ ~ ~ .~' -- ~ ~ ~ Q ~ -,~,~~ . ~ ~ ~, ~__ }~-_ Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ~ ' ~~~~~~~ Madison, WI 53707 - 7162 Sanitary Permit Ntunber (to a filled in by Co.) De artment of Commerce (608) 266-3151 Sanitary Permit App ' t Sta Plan I.D. tml~ ,t~// In accord with Comm 83.21, Wis. Adm. Code, form n you p / be used for seconda ur oses Privac Law ma s ~ ° 4 9 ZQ~ Proj t Address (if different than mailin a~ress) ry p p y y , ~ g I. Application Information -Please Print All Information 7 CROIX CODN S IC Property Owner's Name / Parcel # LoE Block # ~' ~ ' 7- ` Property Owner's Mailing dress ~ Property L©ca 'on .~ ~~4„ ~y ~~~, ~e~itttbt ~ City, Sta Zip Code Phone Number _ d p (ci e~ /~ Z7~ O N; R or (check all that a ) ~ e of Buildin II b p g . yp Q. ~' ~ or 2 Family Dwelling -Number of Bedroo Subdivision a 6SA4-Atamber- , / ' / ' se V ~r ~" e l-Describe U i ^ P blidC omrnerc u a nn ~-~y ^ State Owned -Describe Use ~J, ~ 'I' t) J'~.~ t~~4 '~~ ^City V'1 e ~ hip of III. T ype of Permit: (Check only one box on line A ,Complete Gne B if applicable) A' ~-New System ...~--- ^ Replacement System ^ tmentlHolding Tank,Iteplacemtatt Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Chan of Q Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber y ,Owner , IV T of POW"TS S stem: Check a8 that a ~ Non -Pressurized in-Ground ^ Mound > 24 in. of suitable soil ~}'~ < 24 in of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Ground ^ Holding Tank ,+*{^ Peat 'Iter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ n - nstructed Wetland ^ Pressurized I r , ~ Recirculating Synthetic Media Filter yy Leaching Chamber ^ ~' Line vd-less Pipe ^ Other (explain) V. Dis rsaUl'reatment Area Informat'.orr--~ Design Flow (gpd) Design Soil Application Rate(gpds~ ispetsal Area Requi s Dispersal Area Propo~ (sf) m Elevation Syste / Q VI. Tank Info Capacity in Gallcros Total Gallons tuber f Ueits Manufacture Prefab Concrete Site Cwrstnrcted Steel Fiber Glass Plastic r~ ~g Jam.' G/ ~ l D ldin T lc ti H S g c or o a ep _ Aerobic Treatna:at Unit Dosing Chamber VII. RespO sibility Statement- I, the ersigned, arue responsibility for installation of the POWTS show n the attached plans. Plum 's ame {Print) um 's Si ~ MP/MPRS Number Business Phone Number ~- Plu is Address (Street, City, te, p CotJ~ ~~ L(/`J VIII. Coun /De artment Use Onl Approved ^ proved Sanitary Permit Fee (includes Groundwater Date issuin Si re Stam Surcharge Fee) ~ 3~a ' ~ ~ L, `l ~ ^ thvrter Given Reason Denial IX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: 1. 'Septic ta~~c, eflkr~tt titer and diapers-+ cell musC iM b~-services /maintained as per n ~anagemant plan provided b1- pkrtrtber. 2 AN setback rt3quirems~ts must be maintailtsd is Pm 3PPNCable Ct'1d• / OfdiflitlCls. wttacd compterc pram tro me a.vunry oo.yt wr .uc ,ya.~....... p.pc, .«.. ,~A ...~.. -..- - ............... _... J CRTI_ti~QR fR nl m~~ ~ ~ ~ / \ ~ ~ .~ ~ ~ ~ b / >c ~~ ^~ h ~. ~~ ~~ ~ ~? ~~~ ~ ~ ,~ ~ ~ ~. ~~ ~ ,~ h ~. w ~ vt ; ~a ~ '~ ~~ , ,,~ ~~ - ~~ o ~ ~ ~ ~ ~i t~ k N~ ~ ~ ~~ ~_~ \ /' v~ ~ ~ ~ ~ ~- v m ~ ~ ~~ i ~~~~ `'~ m ~~~~ ~~ --~ y ~ ~ ~, '~ ,~, ~ _~ , ~~ ~ "~ /moo _~~Liti~ ~ ~_ '~ ~ ~~ // \ ~ / \ ~ ~ 3 ~ ~ ~ / ~ \~ ~ _`'~ S ~ ~ ~~ ~a~ ~~ ~ -~ ~ ~ ~~~ ~~ ~ ~, ~ ~~ ,, ~ ~ ~ \ ~.~._. ~ ~` ~ ~o ~ ~ ~~ b ~~,~~ ~ ^~ ~ ~~ 'b - i '1 `~~ ~ ~~~~ r~ - -.__ ~~~~~ ~ -_ ~ `. r ~~ ,~ -~ _~ ~mc~ ~~ y ~~ `~'~%~ -~ ~ ~~ _ ~'~~,y~ ~' Z •-- ~ 1219 SOIL EVALUATION REPOR Wisxnsin Department of Commerce e ``~' "`' ° ~ ~~ ~ P 1 of 3 Division of'Safety and Buildings in acc~dance with Comm 85, Wis. Adm. Code Steel Soil Service C my ? ,; '`b. ~ ~ Aitach complete site plan on paper not less than $%: x 11 inches in size. Plan must St~ ~~ include, but not limited to: vertical and horizontal reference point (BM), direction and Pa cel I [A r percent slope, scale or dimemsiorts, north arrow, and location and distance to nearest road. ' ~ ~~ OZ.~ , / ~f 3 7 /3_ ~ Please print ail intomtati'on. ~ ~ ~ ~ ~"F i- g Reviewed B ,~g Date Perronel infarrr~ation you provide may be used for secondary purposes (Privacy !_£ft1r, s. 15.04 (t) (m)). /~ Property Owner Property Location Reliant Developers LTD Govt. Lot SE 1/4 SE 114 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9900 Valle~y//C~reek Rd. Suite 135 13 na Kelly Estates City i~DCx~~k(f y 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 Public or commercial -Describe: Parent material ou twash plains and stream terraces Flood plain elevation, 'tf applicable na General comments and recommendations: System elevation 93_ 6~trenches spaced and depth to code 5.50~f below grade Boring # " Boring 105 V Pit Ground Surface elev. 99.10 ft. in. Depth to limiting factor Sol( Ap~icaGon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-10 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 10-19 10yr4/6 none sicl 2msbk mfr cs 1vf .4 .6 3 19-26 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 26-105 7.5yr4/4 I none Is osg mvfr na na .7 1.2 y3, ~ rr ~r ~ ~ ~c~ ~ Boring # . _' Boring / / / Pit Ground Surface elev. 99.10 ft. pith to lim iting factor 105 ^r in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0-12 10yr313 none sil 2msbk mfr cs 2f .5 .8 2 12-21 10yr4/6 none sicl 2msbk mfr cs 1f .4 .6 3 21-54 7.5yr4/4 none s~ls 2msbk mfr gw na .5 .9 4 54-105 7.5yr4/6 none Is osg mvfr na na .7 1.2 y~3~~ r - r- 2 ~`~ (~l.a tnwem ~~ = a~u 5> :iv < ZZU mg/L antl l 55 >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SST Name (Please Print) Signatu~ CST Number David J. Steel ~-=%~~~G~___ , / /'y~~ 248956 4ddress Steel Soil Semce ~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 15401 10/22/2002 715-246-5085 i 'Eff#1 'Eff#2 1 0-18 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 18-20 10yr4/6 none sicl 2msbk mfr cs 1 vF .4 -6 3 20-28 5yr4/4 none sl 2msbk mfr cs na -5 .9 4 28-44 7.5yr4/4 none Is osg mvFr cs na .7 1.2 5 44-54 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 6 54-105 7-5yr4/6 l~ n e ms osg ml na na .7 1.2 Property owner Reliant Developers LTD Parcel ID # Pending ~ Page 2 of 3 goring # _! Boring . 1!"" Pit ~ Ground Surface elev. 98.10 ft- Depth to limiting factor 105 in. Sod Application Rate Horizon Depth Dominant C~or Redox Description Texture 5tnicture Consistence Boundary Roots GPD/itz I I Boring # !Boring "Effluent #1 = BOD ~ 30 < 220 mg/L and TSS = 3fl < 150 mglL 'Effluent #2 = 80D5 _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 scrvic~ s car Borins~ # _ 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 SE1/4,SE1/4,S 2o,T29,R19w (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 Kelly Estates lot 13 This soil evaluation was conducted to satisfy a zoning requirement, it mayor 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 Top of '/2"pvc pipe • =Alt Benchmark E1.100.60Ft ~~ ~~` Top of/z" pvc pipe J ~~ ~` ~~ 3~ ~- - ~o-~ ,,--~ State Bar of Wisconsin Form 2-2003 • WARRANTY DEED Document Number Document Name l ( THIS DEED, made between LaCasse Development Inc a Wisconsin Corporation ("Grantor," whether one or more), and Timothy J. Voiet and Laurie J Voigt husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, :fixtures and other appurtenant interests, uI St. Croix County, State of Wisconsin ("Property")' (if more space is needed, please attach addendum): Lot 13, Plat of Kelly Estates in the Town of Hudson, St, Croix County, Wisconsin. ~lU~ Ct3F'lj O~ Tt-ice C.~l`t1GIN~L 1Vlr.f3 1:~~LL~Y ~B~3`F~lt~O-(• & -1-l~~LFr `~. __ Cioser Recording Area Name and Return Address 020-1437-13-000 -`='` 't- Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated September 29, 2005 * (SEAL) ~ AL) *LaCasse Development, Inc. * ($EAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT ..Signature(s) authenticated on STATE OF Wisconsin ) ss. ' * St. Croix COUNTY ) TITLE: MEMBER STATE-BAR OF WISC(?NSIN ~ Personally came before me on_ September 29, 2005 (If not, ``~ttt-1,t ttttt4~ the above-named LaCasse Development, Inc. Wisconsin authorized by Wis. Stat. `~~ ) , , , , S`~ ~ Cor ora 'on r ~~ ~ • ' -~ AA ' ..Oyu,,, -, to me n to be the person(s) who executed a foregoing THIS INSTRUMENT DRAFTE~~1~~=O }` • .~ w instn a and acknowledged the same. ~C - Attorne Kristina O .land = ~ ' C~ • ? Hudson WI 5401.6 '~ cf~.' . ~? c`` ` * Connie M. Gullixson ,9 ~~~~ii~F OF -W"~G~*?•, Notary Public, State of Wisconsin My Commission (is permanent) (expires: _ (Signatures may be authenticated or acknowledged. Both are not necessary.) .NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. , WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM N0.2-2003 * Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoproforms.com ST CROIX COUNTY OwnerBuyer SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 01- Mailing Address ~ 7 ~ ~ l ~ X1'1' y ~~ ~J ~ ~--1~tiltC~jl1~ Properly Address (Verification required from Planning Department for new construction) ' f~'t- City/State ~~~i~r1 ~ ( Parcel Identification Number oo~ !~ ~ ~ 3 ~l ~. ~ ~(~ 71 LEGAL DESCRIPTION ~,z~l~~ Property Location ~ '/,, .~_ '/,, Sec. o~oZ , T~_N-R~W, Town of '~" Subdivision Certified Survey Map # Lot # ~ ~Z. Volume ,Page # Warranty Deed # ~~~~ 7S- . Volume~~~~r-' 9' .Page # ~-~~ Spec house ^ yes I~ no Lot lines identifiable] yes ^ 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. The property owner agrees to submit to St. Croix 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 wastewaterdisposal 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 standards set forth, herein, as set by the Department of Commerce and tine 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 Office within 30 days a year expiration date. l ~~ o < <d ,~3 i, o s- SIGNATURE Or PPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property des ribed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF PLICANT DATE ****** Any information that is mis-represented may result in tl~e sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2899P 62y II State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number 11 Document Name THIS DEED, made between LaCasse Development. Inc., a Wisconsin Corporation ("Grantor," whether one or more), and Timothy J. Yoigt and Laurie J. Voigt, husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 13, Plat of Kelly Estates in the Town of Hudson, St. Croix County, Wisconsin. atz~atz~~s KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 04/30/2005 10:30AK WARRANTY DEED EXEWPT ~ REC FEE: 11.00 TRANS FEE: 299.70 COPY FEE: CC FEE: PAGES: 1 Recording Area ~! Name and Retum Address 020-1437-13-000 Parcel identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated September 29, 2005. 2 *LaCasse Development, (SEAL) (SEAL) AUTHENTICATION Signature(s) authenticated on ACKNOWLEDGMENT STATE OF Wisconsin ) ss. St. Croix COUNTY ) TITLE: MEMBER STATE BAR OF WISCigFTSIN (lf not, ``>>ttt t ttptt~ authorized by Wis. Stet. ~~ ~ .. , si ~, THIS INSTRUMENT DRAFTE$~1i~~4 .k .U. Attorne Kristine O land ='~ '. V • ? Hudson WI 54016 % d' ' . 2 ~~i,,~~tOF rtW~S .• Personally came before me on Spptember 29, 2005 the above-named LaCasse Develo meat Inc. Wisconsin Corporation to me awn to be the person(s) who executed~~te foregoing in a and aclcnQwledged the same. Notary Public, State of Wisconsin My Commission (is permanent) (expires: - ) (Signatures may be authenticated or acknowledged. Both are not accessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 " Type name below signatures. INFO-PROTM Legal Fonns 800.055-2021 www.infoprotwms.com ~. ~ ~ ~a.-- ~ , I r ` ` ~v~ ~'. ~ i I7 ~ ~' ~ 1 CO ~ , ~ ~ i i 1 y~ i ,~ 1 t ~ , - '~ -- ~. ~ 1 .... 0 >, ~ ^ ~~ '``.. ~ X12 Zs ~ _ _ ~ ~ :y r 1 a• 0~ . --. -~- ~. ~ ' °a,d i yy ~1 m w ~ ` `~ ~ e ~ ~1 > /~ 1/`" ~ ~ ;\ ~ ~ rn~-D 1.1 ~ SC11'05'08"E 147.83' ''• ` \ ` ~~ ~~; ~' a - 2t2:ty' o` ~ 1 + ,~~~/ PONDING EASEA~ENT ~~'~ i ~ ~.--~5 + ~°'~'~ J ~ ~ ~ ~ .+ 342.49 .- Z ~ `. s'gs-w) ~~ ~~~..18' -°~ ~4.t4• ~ l l 1o3.0s° j 23s.4o° -',.~6~®~°' ~, ~ ~ ,fit ~ Al ~y°. ~; ~ ~ rn n ~ WEST UNE OF LOT ~'~ ~~; ~ o ~ ~ g~g ~ -' PG: 3226 ~,~' ~ p N ~~' • ~ ~ ~ (~ tG t!1 CA Pr as ryi. 1 , W •N ~ r~~-+ ~ C -~- v ~ v \l, w N ~ ~ ~ - CS ~ ~ O! _ C) -~ i O I~ ~ ~ '~ ~ to ~ ` a~i` ~ . 1 w r f ,.~ iD r~ ~ ~ saw _ ~ ~ P J ' ~ N ~ ~~u~~~ _~ o ' ~' ~ o o f'~~~r pF ~,,~ lib~i z ~ - ~,yr ^~ ~ NOl'05'08°Y~i 2il.03' ~' ~, ~: N01`OS'a8°w sz4.~0• _ . _ .,._ --- -. -- ---~-= , - - 'EAST LINE OF THE S9lJTHEAST Ql1ARTER SEC. ?2. T. 2S N., 'R. 19 W.__~• w 1i~L,~,,`I~ ~~~~ ~~~ t ~ ~ l A/ 1' ~ T 1/ t r 111 A fi f'\ 1 T 1 i"i R 1 V ~.. i, .; r a C.. .: 1 a 1 1;.: a s n V V 1 1 1 tJ 1 v ' .., .. : POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION = / 3 Owner ~ - ' Permit # DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~ NA Estimated flow (average) 1 gal/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate 7 gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) _<30 mg/L Biochemical Oxygen Demand (GODS) _<220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality __ __ Monthly average Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) <_30 mg/L l~NA Fecal Coliform (geometric mean) <_10" cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Page ~ of Septic Tank Capacity gal ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model 7 ^ NA Pump Tank Capacity al C"~MA Pump Tank Manufacturer ~ NA Pump Manufacturer ~ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: A Dispersal Cell(sl_ ~ In-Ground (gravity) ^ At-Grade ^ Drip-Line _ __ _ ^ NA ^ In-Ground (pressurized) D Mound ^ Other: Other: ^ Nq Other: ^ NA Other: ^ Nq Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ ^ yea~(sj(s) (Maximum 3 years) ^ NA Pump out contents of tank{s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ monthlsl (Maximum 3 years) yearls) ^ NA Clean effluent filter At least once every: ^ month(s) J~ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ year( ,(s) ~ NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ~A Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE SCHEDULE MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the 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. 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 POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting. products or c4her chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are deteC#ed have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore. normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade 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 and/or is permanently taken out of service the following steps shall be taken to insure that the system is property 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 seated. • 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 shat! be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS anWTS INSTALLER / Name ~ ~ ~' Phone ~ , -~ _ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ~ ` Phone Phone ~~5- ; ~~ ~ This document was drafted in compliance with chapter Comm 83.22(2)(bl(11(dl&If) and 83.54(1), (2) & (3), Wisconsin Administrative Code.