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HomeMy WebLinkAbout020-1437-15-000Wisconsin De~artrrient of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildirtg Divisior, , INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township LaCasse Develo ment Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: / ~~ • ~ jv 1. ~ ~h ~- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing I f v Aeration D ~ ~ / , Q Holding I I TANK SETBACK INFORMATION TANK TO ~ P/L WELL BLDG. Ven~ it Intake ROAD Septic ~ f~, I ~ ~ I ~)r ,.(- > ~ ~ / Dosing ~7r ~ J 0~1 Aeration Holding PUMP/SIPHON INFORMATION ~ 1 Manufacturer Demand GPM Model Number ~~ 3b TDH Lift 3 O~ Fri ion L s System H d TDH Ft Forcemain Le ~ f Dia. ~ y Di . to,ell ~.`~ ELEVATION DATA County: St. Croix Sanitary Permit No: 463380 0 State Plan ID No: Parcel Tax No: 020-1437-15-000 Section/Town/Range/Map No: 22.29.19.2720 STATION BS HI FS ELEV. Benchmark n ~~„-_'~ /d 0 ~"' Alt. B ~ ~ , Bldg , //• y6 . 03 St/ t Inle /Z~ p 3/ S t Outlet is . ~6 . v In x°1.70 ~ '7 -! Dt Bottom ~ ~~ g Z • ~ a n H . _ l~ e T Z Dist. Pipe Z ct L ` Bot. System l ~ • 1 a.7 Fi I Grade ~ t S Cover ~ 3~ h v t g• r ~d 8 Z•S~ ~sq ~ v SOIL ABSORPTION SYSTEM /0 -L SCI -L- / 9 - e l BED/TRENCH Width Leng~ No. Of Trenches PIT DIMENSI S No. Of Pits nside Dia. Liquid Depth DIMENSIONS ~ 72 9- ! 7 / (O SETBACK F MA N SYSTEM TO P/L BLDG WW~ LAKE/STREAM LEACHIN CHAMBER OR M nu reF: IN OR TIO Type f System: , ~~ ~~ -f /, ~ ~ ~ UNIT odel Number: ~ ~ t)ISTRIRtt4'InN SYSTEM i Heade anifo6 Z fi Distribution ~/j / ss 44 ~ l ~~ L x Hole Size x Hole Spacing f_ Vent to Air Intak Leng / Dia Spacing_ ! ~_.y ength Di a ~ S(~II CnVER v Arcccllrn Cva#amc flnhi YY Mnllnrl [)r Dt-firadP SVSt2mS OnIV oC.h ~ r%/~tt TAU ri~~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BediTrench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Location: 805 Heritage Court Hudson, WI 54/016 (SW 1/4 SE 1/4 22 T29N R19W) Kelly Estates Lot 15 1.) Alt BM Description = ~' ~Z ~r~B-~ 2.) Bldg sewer length = 2~ ~ -amount of cover = ~~ ~ ~~~W'v/,~~- - - - - __ -- Plan revision Required? ,Yes No ~ ~ L~ ~~~~ h~~' Use other side for additional information. V ~ _ Date Insepct gnature SBD-6710 (R.3/97) Inspectior, #2: / /_ Parcel No: 22.29.19.2720 ~~~vJ7 Cert. No. Safety and Buildings Division unty ~ ~ ~•~ o ! v C Jam. Lam ?Al W. Washington Ave., P ~ ~ - ,~~On Madison 2 D 'tary Permit Numbei (oo be filled in by Co.) 3 ~ ~' f ( ) {-~ 3, Commerce Department o Sanitary Permit Applicat n ApR 0 6 20 Ste pl~r` 1 Wis. Adm. Code, personal informs on you provide ~N1Y In accord wilt Comm 83.21 ,X ~D , may be used for secondary purposes Privacy Law, s15. 1}(m}S.i GR N pFFtC~ Pr Address (if different than mailing address) G I. Application Information -Please Print A!1 Information (1:. r-. ~ s Property Owner's Na ttte L~' C.1~'sS~ ~~ O Parcel x t ~ Block y O- /~3 7 • l S• 00~ . 220) Property Owner's M ailing Address Property Location ~' ~" ~ ~~ K,Section / if . City, State I . ' ~YJ~ /~ w I Zip Cod//e~~ / //,~, S -L V / tl/ Phone Number L~ ~ ~ ~ ' ~ / ~ ~ T ~'~ N, R ~ ~ ~ E Ie~y' e of Bttildm (check all that aPP1Y) ~ 5 II T g . yp 1 or Z Family Dwelling -Number of Bedrooms ^ Public/Commercial -Describe Use Subdivision Name CSM Number c ~~~~ ~S ~~~~ _ ^ State Owrted -Describe Use ^City_^Village Q1'ownship of a v III, Type of Permit: (Check only one box on line A. Complete line B if applicable) `~' New System ^ Replacement System ^ TreattnendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New L>st Previous Permit Nttmber a~ Date Isstted Before Expiration Plumber Owner IV, of POWTS S stem: (Check all that a 1 ) ~NOn Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Cot><structed 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 rsaU1'reatm t Area Information: ~ Design Flow (gpd) Design S/o~il Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) ~ Sys Elevation c e ~~-AJ S S . / ~ ~ ? L /o , VI. ank Info Capacity in Total Number Manufacturer Prefab Site S 1 •Fiber Plas[ic Gallons Gallons of Units Cortcrete Constr6cted Glass New Tanks Existing Tanks ~ ,' - Septic or Holding Tack ~ ~ / ~'• • J ~ ~ef~ r[~ V Aerobic Treatment EJnit Dosing Chamber ~~ ~ 2 ~-~~ J VII. Responsibility Statement- I, the undersigned, assume responsibility for " WTS shown on the attached plans. Pltumber's Na me (Preint) P is S' cure M R umber Business Phone Number 2~~~tbR ~~~,T" ~~s ' • ~ y~ Plumber's Addre ss (Street, City, State, Zip ode) ,z~~z /o~ ~~-r~.e • ~~R%v ~I~41/ Zvi s~7~ VIII. Cotm /De ent Use O Approved ^ Disa Sanitary Permit Fee (dncludes Groundwater Date Issued Issuing gent 5igoature o Stamps) ^ Owner Given R n for Denial Surcharge Fee} 3o0-- 7 f3T 2e~ ~^ IX. Conditions Approv SYSTEM OWNER: 1 Septic tank, efFluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete pleas (to the Cohuty Daly) for the system oa paper ~t lew than e1rz x tt t~hes m stxe g~ . 5BD-6398 (R. 01/03) CU ~- ~~-- s,~ c ~f~;T ~ 7~ ~~~ ~~ -•..`_ ~... ScgC~ ; ~ "_ y6 ~ ..- ~G~~ pars ~a T /5' -- ~~ i'r-iES POWT .SYSTEM SHAL ~" ti~ ~' INCORPORATE PER L 83.44(2) A PROPER COMM. FILTER MODEL # ZABEL d ~'/~ ~ ~a ~X ao ~ ~~~~- ~ ~ l~s~ ~ovC~t~~ lS~ 5 ~ • S,T, .., ~ ~~~~ ~~ - ~- ~,uleS~2 ~~0° P/~ n ,~ ~~,~ - s y s r~M GeGe ~ ~-° ~ 3' x 7a ' ~ • i ~~ i s ysr, C~e.~2~ -l3 ~~_ ~_ ~ ~M ~ C 5 ~I~-~ ~v J '~a~ o~ ~ O p' l~ ~ 1 /a -~ ^ 3 8 a ..g, , ~ I~~ t ga1~ ~g~,G~~sv,`~ ~O~~Pvg. ,~~6 IJ s ~~ IW ~q9. ~e -'(K ( 5~5 ~~ ~07~~ of ,. ~~c ~~ ka~ /- ULBRI~HT .& ASSOCIATES CO. 281210th Ave. • Spring Valley, WI 54767 Reg. t~signers o~Engrneering Systems Private Sewage Consultants 715-772-3442 PLAN ID # OWNER ~j~ C/4sSE ADDRESS ~ 73 PROJECT INDEX y ~f~. ~- _ _ LEGAL DESCRIPTION L6 f 1 ~/ ` ~~ ai ~ d a0 - !~ 3~ --15' - o 0 o s ~~ S~'r 2 ~y'~ TOWN OF ~{'I~~.SD/l) `s~~ ~~~ ~, COUNTY CSTM ~~V~ J ~ ,~ Zy b ~J J 8 LOCAL AUTHORITY/ SUPERVISION cST ' "~O I ~G ~~ ~'C)1 ~ ~~'~~- PROJECT DESCRIPTION: /V~IU ~.vS~i Uc-~io'u .- ~oi2 ~' /d/QQ/doS~ S -,,, ,~~~ T3~i~M . ~~ . D~ S/~ fiv ~rTi~~ r~ Cflo/~iQµT,O.v,~ G ~S iql S~.uD~ f~a ~-e S Ulhricht & Associates Rrivate Sewage Consultants 28.12 1 Qth Ave. Spring Valley, WI 54767 Mp,~s t~- 2~ 3~ s ~- ~ o s ~' Pg-1 INFILTRATOR SIZING WORKSHEET Pg•2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. ~"~ s DATE ~ ~ s ' PHONE v~Sa~1 /U/S. s obi ~ ,. a z, rZ~ i n t °m 5 D c N t~ m fl. ~• . ~ a _~ a ~~ ~~ .; ~ ~1 ~ G ~~ ~ ~~ ~ ~ ~~ W ~ .. ~ `~: w ~ ~ ~ r 1~1 ~- x ~ ~, d '~ ~ ~ ~ ` 1 .. ` ' I_1 ~I ~~ ~ ~ y 0 0 of ~~ Z~ ~a /~ ~~i T ~6r~" ~o~~ ~~~r, ... Scglc : /~= y~ . _ ~~~~ ~,,.rs L.o T /s' ros~° ~Rti~ ~i i"~-iiS POWT .SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER zAgEL (~ FILTER MODEL # ~ _`~ ~ o ~,~ , ~ ~~ ~~~ ~~~ ~ 5 S,T, ~ IS ~J ~~'°° P/~ ,~ ~ r s ysr. cam. 1~ 1~.~ . ,~M~ ~ a~o~~'o~ ~ ~ oj~. ~~~ ~~__-_-- ~~D~_ 2 ~ ~Et goy ~~, ~ ~ gg~,GO~s~~'~ n~ ~ ~a9g g1 'te Se Pig, `~~ 2 ~~~~gy,~ d a I ~W I ~~9 ~~ f iti 7~ ~o7~}G of ,- ~ yep ~iAl ~, r-_.~ ,~ ~ ~- s~ ka.y A J ~ f. ~,. ~ - rv.S,/~~ci,~~~,v ~,~'}~ °~' ~~~~4' ~' ~~ ~l~ ~~~ ~~ ~ r '~~ --, .,,~. ~~'p~~~I~' U~~ r c.~jd U,r~ i~JS~1~~T/t,v ~~ ~~ir ~~~~ _. is x ., (Q A/.'~~ /,~{iG71~'rt Tai' ~~ ~~ ~~~ ~~~~~ ~r~~~ ,~>' .~~~ 7~~ ~ ~i,~v, q~ , y4 ~/~4' SS' SAC % /0~.1 ~~ T t' L~iUG~~S" \ l~ ~~ ~ f ~'~,. ~~J,,~c. ~~` Lrl / / ~ . ~ .~Q ~~," ~!"/ .~~,j17 tL'~/'~GeJ'~`` -~,I 5~~ ~f r~ ~Er~ _. ~` ~ .S r"_~... ,, . sue, ~~ P~~~~ ~.,~. D ct ~ ~ ~~ ~ . ~~ ~ !~ ,, .~ ~f Cho SS S~C~/O,~c.~ O~ . T~~"ti~~S" _ , G- l /V ~i G 7~'~ 7-o~'S ~ ~_ l `~'~, ~ ~ - ~ ~~' ~~= ~~~,~vL~ Gr~~G~~ S~'~ Ti's _. s'. ~ s ~ ilk t it~i "2_...~ ,F~N~S~ED 3l~- A~.~~ iv~~~~To~' ~ -~-~--~~c ~, jy ~ S. C Tk'~.v ~~ ., .~ :~ G . ~i~v, ~ f . ~ .. OVER: See Reverse Side for Vent/ (3bservation Pipe Details. PUMP CHAMBER CROSS SECTION AND SPECtF1CAT10NS `i"C.I. VENT PdPE ?' Z5~ FROM DOOR, ~ win1DOLJ OR FRESH AIR t1JTAKE p ~i11~tDrr ~r/~ ~,~tTio,v ~ ' (f Djf lE UAtr' t ~v ~~ j IAILET APPROVED JOIAIT lJf C.I. PIPE ~XTEA}DIR)G 3' ~JAlTO SOLID 501E f ~~. ~~ t~ vet f ~ S,flE A ~N ~~~ ~o~ ,do'C B ~~ b E. iS v tt 3~ COA)DUIT I `-- V PROVIDE AIRTIGHT SEAL 3 "~ a~` x -~() ~ ~ PllMP ~ ~f gQ 1 ~~ BLDCx-- ~~" ~ aF t APPROVED LOCKIAIG MAWHOLE COVER w~ w,16tN~,~Cr- ~,9/3E/ I 1 ~, ~, ~ ~ ~ t ~ I ~~ .' t --~ y" MIA]. f8"MfiJ. -- -~-~ (' ~~ i~ APPROVED JOIA f' Wf C.I. PIPE ~_~' ALARM EXTEAiDIA1G 3' it OAITO SOLID SC o~ oF1- ?,rSE 3.. .yo~~ sr S~tv~ ~c~-.v y- .r RISER EXIT PERMITTED OA1Ly fF TAIJK MAAIUFACTURER HAS SUGH APPROVAL SEPTIC E SPEC.1PtGATtOl~!$ ~,(~ ~. TAAlKS , MArLtUP'ACTURER: "'" ~~~ ~.~~~C. ~ jJl1MBER OF DOSES: ~ PER DAy TAl~ift 512E : ~~~ GAt_LOA1S DOSE VOLUME ts~ / ' ` ~ ~~. `ALARM MAAluFAGTURER: ~~-~"/t~ ~~iE~J ifiJCLUDtUIf~ BACKFLOW: GAC~aN ta~~- MODEL IJUMpSER_p'''j ~f ~' ~'" CAPACITIES: A=!~_IfJCNES OR ""~ GAILOA- SW17CH TAPE:. Tl C~~"T $ = 2' IAICHES OR _ GALLOIJ PUMP MAAIUFACTURER: _l~/' (~~,,1~1 C = ~ C~~ IiJCHES pR ~ GALL01~1 MODEL AIUMt3ER: [G,is/ ~/~,~- ~ °~-°'- D=~._._(AFCNES OR ~.- GALLOf~ 9WITC H T`.lPE: P t ~~/ r~L~`` ~lA~" f WOTE: PUMP AtJQ ALARM AttE TO BE MINIMUM DISCHARGE •RArE . ~~ GPM INSTALLED OAI SEPARLATE CIRCUITS VERTICAL DIFFEREAICE BETWEEIJ PUMP OFF At~O OfSTRiBUTtOA! PIPE„ ~"~ FEET ~~NF S~1Efrs~ ' -I- MruIMUM >vETWORK SUPPLY PREQ55 RTTE//, .. lf~J~ FEET L~4LG~, t~ o .y~ + FEET OF FORCE MAIM K ~ ' + F/pp ~FRICT1ou PACTOR..~ FEET ~~Ur ~ S 3 - TOTAt_ DyifAMtC HEAP = t!.3L.._ FEET' =. IA3TERAfAL bIMEtJSiC+NS OF TAAJK: LENGTH ~" ~ {++• ;WIDTH °~ - ~ LIQUID DEPTH p jw ~.---- V!: fJT CAP WEATHER PROOF ~uucTroN Boxi 12"MIU. •• GRAD£ Y ~ ~ I ~ . ~~Y ., ~, ~' ~~ • ! D~ / ZOLLER EFFLUENT PUMP MODEL 98 FLbW pt`et MlfflftE TOTItt DYMIUtq MtAgr-lOW Kai th.nttf It-tutkt u~a otw.ttwNa 11lA! iAtACttr . VNti•1M~M IRtf Mt1tPt QAttA~ ltit• 1./2 to poi I! ~n •t x~t t/ LaT ~ t10 ,e too ?S AS LockYak• ~~• ~~ CONSULT FACTORY FUR SPECIAL APPLICATIONS • Elsctrlcar eiterrtalory, tvr duplex systems, an avattabie and •aQpRed with as{ alarm. k • Met cury float swNches are evaAable for contro~lrtg sht le d f leclrerrk:ai aiternetae, I~t ctlrpiex EYEhms errs ovailabte with i g an three phase systems. a w thout Norm hvitt:he*. e Ooubie piggyback mercrrry (coat EwAchea ere evatiabie for varlaWs level long cycle cornrots. 9tenderd ett models -Weight 39 ibE - ~tf,. N.P. N E~rt~• EELECTIOM atHDE t. rnNprd !lost op•ttlsd 4 pd• tMeA~ntw1 wvtleh, t-O oxtatrur oantrot tt t EM uk i [ d Control S~bcUat Rlod~t Y h1-Ph 61od• Am • Elm i~x . p p ~ P • . 00Y}~~~ ~ fewy t~ •y„~h a do~t~ ~ ~wdeh n.rt ro Ft~ITT. A70ttbaek tn•reuty, poal t~ t t ! ub " 0.6 P_____ .- Du t~R ~~ - ~. At~eh•nicd dt•tnalor 10.0074 a 10-OATS, ' E 0 -- ODO 440 ? of t~.!_, . r Hula 1• . to f tdOT it, la oottet nwtt•I M e:ratt~„t Ak•ntelot, ^E-Puk' : E- Mltewy wrnor itvet •wtlch t0-0Q2S tnid y a ooMtd t tot 1 L T _ -- f9i 4]0 r ~ 1 s 4 x - l 4 / t . rct vatot ~P~x (~ d (,) Rot! frsltrm. 'P~Wr f Rt't:Ni 1i4M "1P~k' : tw-edori t>a ~ f . _ of E .. . < or tO11"•ctwn a w4•d-h sim- ~" °' d"PMY aWt+~t to conQ . T. rwa tZ) AeN'J•P~k :rot wMwdptti eoM.~__..+t tpKot- 0• t,~.,,t„+e..wr„r iti.•tt /~.~„t. t.t« u w.>IOo ~ cemt~,~.eo„ ~« r ~'ti'T Iibftf; EbchkN M~~natot f t~t1; 1Nrr P~ ~+~: N~chu i v A I ~ • At tnslsRaEos w tA+tt CAUiIOp t r Ir- il , c N . if; lt~m,ta, tJ•t!L ~ E'~"~0~ Eu4u, fRbMt; tuw Aie.pi.~ C«+sd ~ e . p te oa {.ifo.~ anA w4fry ,Qs~W -~ rhJ~ ~n~ ~lwlttol~n. AR d~a,tla+t ~n1 ~ar.tr end...-_.a.. _~~ ~ ~ ~M' - ~ ti ', ~ :/~ ~ t/~ ~ s!e ., ~ ' - ~ ,~,, o + + e t pit. 1 1!2-tt t/i NPii `„" ~ .,. • OWNERfs I"!AINTAINCE OF.. ,.. _ - SEPTIC SYSTEM _ . POWTS (landowner) ig maintenance of reponsible for proper operation and serviefn this system. Regular periodic inspections and g is necessary for.-the syst~e~. The owner is required bsafe healthy operation of, this y code to submit all necessary maintenance/inspection reports to the controllin g.authorities, SPECIFIC CONTACT AGENTS !~, G~~tr G~~ * Governmental authority/ ins ectors: p ~,u ®.t~(r- 3~~ ' ~~~~ * Licensed i~stalier maintenance !~ responsible for providin Users manual: g an operation/ l ~~ ~3 ~ * Licensed `servorce / inspection agent other t " ~ han installer: T~'~ - c7" 1' ~~.t1f T"rg-7-io ~ ~(~ ~/3 0 ' * EZectric~a&~ f°~~pumP, electric controls - '~ wiring .units: . ~ ~/-~c~ -~ IMPORTA OWNER MAINTENANCE RE UIREMENT '' 1. Winter- S traffic {si.edding area shall shove9ting, etc. the cQll not be,permitted, or frost ~ across the freezing u Y canjwill penetrate into winter. P the s stem. Discontinuos {a vacaction trip, resulting'in no wateruse in the lead to~ .freeze .ups •' usel can also 2• Water conservat.ian needs h d •° to Y roil be catty overloaded exercised! Or system can be designed"for and destroyed. This sv a maximum .wastewater flow of ~stem was 3- POWT'S 7~_ gals. daily, are not designed to accomodate disposal unit wa . ar ste a s Any introduction nY other unnatural from a garbage:.:- _ of such waste' sources of waste. destroy this system. materials will _ overload and 4. If a power veita in a temporar ge occurs. or a pump fails, it ma cell Y overload of effluent bein Y result . which may adversel g Pumped into the recommended that a Y impact the cell allowin licensed pumper em t (leakage~• It is Consultg the pump to return to p Y the lasing tank, Your installer dosing the correct amounts. immediately for advice. ~• Neglect of the ve erosion getative cover (the cells traff' preventjve) can lead to failure. insulation & ~REGULARLYIso can destroy t he s Compaction or heavy ystem. It IS NECESSARY TO the WATER THE VEGETATTpiv AVER A SYSTEM!! -~,Ystem beneath IS NOT sufficient alone t0 -yt "°~covwr. Effluent zn maintai~~ a ~• Periodic inspect' io neee ns b ssary. Inspection Y the owner, or his a 3.ntc ~-~,~ _-- - pio~~ ,.,a _ gents. 3Q • ~ - C ... nth ..... _ ,-.. ,ice ~ • • 1221 Wis~rrsin Departrnentbf Commerce SOlL EVALUATlQN REP~R ~, , , P ~ ~` `~ t of 3 Division of Safety and Buildings in accordance with Gomm 85, Wis. Adm. Code ' ' ! r'n ~ Steel Soil Service Attach c~npl~e she plan an paper r~ t~ than $Y: x t 1 inches ¢~ see. Plan must C mY r ;. ,- ; ~ include, but rat limited to: vertx~ and horizontal reference porritt (BM}, dbectmn and P _ _ ~~ Bent slope, scale or dirnernspns, rarth arrmar, and location and distarxe tct nearest roed_ . Pending Freese print aft infonnat7oa_ R 65, ~ Personal eMarr!~brt yw! p!Ft4de may ~ for secondary Pam (PrvauY thy, s 15 Q4 (f } (m}}, _ - 1 Property Owner Property Lo cation F~eNarrt 9ev~fopers LTt~ Govt_ t_nt SE 1 J4 SE 1 ~ S ~ T• 29 N R 19 V1f Property flwrner"s Mailing Address Lot # BIoGc # Sutxl . Name or CSfyt# 994f1 Vaaey Creek Rd. Suite 135 15 na Keay Estates City (moo°c~fu ~y State Zip Code Phone Number ~<( City Village Town Nearest Road MN 55125 651T731-317d Hudson Heritage Ct C r1 0 M' New Ccxtstruction Use: ~ Residential / Number ~ bedrooms 4 Code derived design fknnr rate 600 GPD Replacesrrent _.~ Public or corrrmercial -Describe: Parent material autwash plates and stream terraces Fkad ~;,, ele~ion, ;~ applicable na General canmert~ and recammendatians: System elevation 91.60ft, trenches spaced and depth to code 6.75ft bekmr grade ~~ # ~~ 118 ~ Pit Ground Surtace elev. 98.35 ft. in. Depth to limiting factor Sod Application Rate FtoriZOn Depth Qorrtirrarrt Cb4or Redax Descr~tion Texture Stnrcture Cerrce 8our~y Roots GPt11FE' *€ff#1 "Eff#2 1 0-14 10yr3J2 RORe SII 2msbk mfr CS 1f .5 .8 2 1424 10yr4J4 none sic! 2msbk mfr gw 1vf .4 .6 3 24-34 10yr4J6 c2d 7.5yr516 sic! 2msbk mfr gw na .4 .6 4 34-58 7.5yr4J4 none sl 2msbk mfr r~ na _5 _9 5 ~~-'~ 18 7.5yr4J6 none is osg mvfr na na .7 1.2 ~ ~- H2- ~[ t ~~~ ~ Q 8orrng # _.: 118 / Pit Ground Surface elev. 98.35 ft. pepfh ~ (~~g fxtor in. Sa(( Apn (~ Hor¢on Depth Domis>isrrt C~or Redox Descript~n Texture Structure Cor>SSi~tence Boundary Rays GPDtIt= `Eff#1 `Eff#2 1 Q-9 10yr3J2 none sd 2msbk mfr cs 1f .5 _8 2 9-16 10yr4J4 none sic! 2msbk mfr gw 1vf .4 _6 3 16-58 7.5yr4J4 none sUls 2msbk mfr gw na 4 ~ ~ 4 58-118 7.5yr4J6 none ms ~ osg ml na na .7 1.2 c~" ~Z .~ ~~ ~~T' 1 ' ~ttt~nt #1 = k~11 T 30 < 220 m9/~ and TES >30 < 150 m9~ * Effluent #2 = 641 <_~ mg/~ and TSS <~0 mgJl _CST Name (Please Print} -- _ - - - -- Signature: - _ __ ____._. __ _ _ __ ___ _ __-_-- CST Number David J. Steel 248956 Address Steel Soil Service L~ Die Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 154017 10/23!2(102 715-2+.t6-•5085 S Prey Ow~r Reliant Devel9pers LTD Parcel ID # Pending Page 2 of 3 $ Boring # Bing r' Pit Ground Surface elev. 96.75 ft. Depth to limiting factor II8 in. ~~ ion Rate Applrcat r Horizon De~h Dominarrt Galor Redax Descri~iors Texture SLn.~cture Gorsstence Bxxrdary Roots C-QD/ft~ 1 0-11 10yr3l2 none s~ 2 11-24 10yr4/4 none sicl 3 24-35 10yr4l4 none scl 4 35-50 7.5yr4l4 none sl 5 50-118 7.5yr4i6 none ms 'Eti#'I "EfF#2 2msbk mfr cs 1f .5 .8 2msbk mfr gw na .4 .6 2msbk mfr gw na .4 .6 2msbk mfr rs na .5 .9 osg ml na na .7 12 Boring# _.i Boring " Eftlu~tt #1 = BOD s' 3t! ;220 mg1L and TSS X30 < 150 mg/L ' Effluent #2 =BODE <30 mg/L and T5S <30 mg/L The Deparirnent of Cnwmeree is an equal opportaoity serviee pmvir3er anci emg~k~yer. If y{>u need a.~.si~t tc~ mss ~etvir;es c>r • Baring Borrnsa # Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Reliant Developers LTD New Ricltnnond, WI 54017 Lic. # 248956 SEI/4,SE1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 Kelly Estates lot 15 This soi! evah~ation was conducted to sat~fy a zoning requirement, it may or may aot be suitable for your use. The location of the test may or may not be ss shown as permanent lot lines were aot established at the time the soil test was conducted. Lege»1 C ~~ 1" = 40' ....~ • Benchmark El, 100,00Ft 3 of %Z" c i ~ ~Z • Alt Benchmark EI.IOI.SOFt ~,J / c~ ~ op of'h" pvc pipe ~ ~- Boring Elevatia~ns Bl ~8.35Ft B2 =98.35Ft B3 ~6.?SFt B4 ~O.OOFt 7.33 bus ~,z ~~ f~y~~ ~~ PI~~~- ~~~ a~ l ~~ ~ ~, ~' • / , ° ` ~ ~.•- 1 -, r ~ -F t S ..?77. . 1 ( ~ 2]1.96 • , ~ -~ ,. ~ .'~ ~ ' ~ ~ sT cttv~z evv~rr~~ • ~ s~rTtc •rArri~ t~AtNT~N~NCE AGREEMENT aNn . aWNi;RSI~itP CERTit<IGATIQN ~rORA~ Uwtt~et/)3tlyer _ ~.. A C.o S 3 IVt2tilrttg Address _„ ~ - ~ ~ ~' Property hddress ~Q S `~`' ~' "r• ~ ~ ` ,/ , r vl2.~ .S 4.+s j (Verification repaired from Planning Department for sew ate). - city~stat~ ~.~ 1 .~ ; l ,~- a© . 1 ~_ Parcel Idetrtificatian Number p 2a ~ I ~ f 3'~- L~GA~- ur~sc~uer>lc~~t ~ . ~ - - . Praperfy Larcatiatt 54,i '/... Ste.'/+, Sec. ~ x; T ~~ N-R~_W, Tmam of ,~~~~ s....,.. Subdivision T -p t L ~ - f- 4,~. Q ~ _ ~ # ~ J~'' Cettfttled Sarvey ;trap # `~- .------ Vviutne .Page # --~._ . Warrrtntp heed # Vaitritte ~ ~ 3 S Page # / ~~. Spec house C7 yes ~{ no Lot tines idettfif:able yes CT no SY51LrN~ ~tAttit'>t'ENANCt1 tmpraper use and maintenance of poor septic system eontd resin! in its premature toilette to lias:dlc wastes. Propermainiei consists of pumping out tht septic tank every three years of sooner, if needed by a licensed can affect the runetion of the septic tank as a treatment stage in the waste l ~~ What l~ ~ i~ ~ s3 dispvsa system. Tht lnopetty framer agrees to sabtnit to St. t:,tolar Zoairrg Department a rxrtificatiori . maetet~-tutnber,3ontneym9tnpitrtnber,testrictedptumberorslicensed ~' scgaec~ ~ ~ ° and is in proper operating eondilion and/or Z after' ~~$thet(lj ~aa-sltewasttwatcrdispoasi sy () ntspection and pumping (if necessarq), the septic tank is less Qutn t/3 full of alts time, the undersigned have t-ead ttic above rcgttiremerrts and agree to nrainta~ ttre - ~- set Forth, herein, asset by the DepaKmcni o[ Commerce and the De~rarUneat of l`latttral R,~ State of Wiscous~m. ~~„~ !tEating ttrat y~ 4~ic system hat ~~ maiata#reed must bt: completed and retunred to tha St. Croix Coin ~~ °~ ttse ~~ expiration date. ~- Y Office witlti t S! A~ RE ol: APPLtCAN'[' ____ ~ 11~~/ DATE ~. _ t)~I~R C'EjtTL~rrA~rnN f [wcj certify that all statements atr this fimn art ime to fife bast of mY ~') lrnowlcdge. the pr described above, ey virtue of a warranty deed recorded in Register of Deeds O[l;ce. S (3NA7~JR Or L _ ~##~-~. I (we).~ {ace) the o(: DATE Arty information that fs mis-reptcsertted tray resttit in the sanitary permit bei»g revoked try tlm 7.ort' ~~. ~•• *• intlndt• wtfh this appttcatfon: a stamped warranty deed from the Registerot t3eeds office a copy. of the certified sarvaq map it retctence is made irr t~ warranty deed . - U 2S35P 'i95 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED CIS DEED, made between Reliant Developers, LLC, Grantor, and LaCass Development, Inc., Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lots 2, 3, 4, 5, 7, 8, 9, 11, 13, 14 15 16, 17, 19, 20 and 21, Plat of Kelly Estates, St. Croix County, Wiscons D,~v -x,37- ~5 czx~ Recording Area 757836 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIK CO. , MI RECEIVED FOR RECORD 03!29!20$4 09:10AIS NARRANTY DEED EXQIPT # REC FEE: 11.00 TRANS FEE: 4674.60 COPY FfiE CC FEE: PAGES: 1 Exceptions to Easements, re Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 115 Hudson, W15401i5 if any. 423495 _020-1060-30-050,020-1059-90-0 QO Parcel Identification Number (P~ This is not homestead property. Dated this 26th day of March, 2004. Reli evelopers LC B * ick 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 RJSTRUMENT WAS DRAFTED BY Peterson, Frain & 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 prittted below their signature Notary Public, State My commission is 11 /4/2007 State of WARRANTY DEED STATE BAR OF WISCONSIN FORM Nat-2000 Go f 15 * * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this March 26, 2004 the above named ston, Chief Manager, Reliant Developers, LLC te~fie known to b the person(s) who executed the foregoing instrument and ackn !edged the same. 1 ` ,- ,~ ~ ~ ~ir7~~~F ~ ~ 4„ t ;~ .ors£a st•tt£ i ,~ .so-~ot ~ , .tt•t[ '~..i ., ,:~:~ ~ ~~ 1N3W3SV3 9NIONOd /~~~'~, / ~ ~ ~ ~ ..• ~ I '% .£8'Lt t 3.80,Bp. tOS~ gkrO ~ .L l'Zlt ~ • -' + ,~ ~ ~ ~ a ~ ~~_~ / a ~ 3 0o CSI rya ~ / W ~ / ~ laJ yV 2 t j Off ~-~ F-I // y M •~///~ • ~ ~ ~- NN 3OZ ~ ~C ~~ pjI ~ $ ~ ^ ~//// I ~~i zW0 W .~ / / ~~ p$~A // I r~~ .OS gyp/ / ~ ^ ~ ^j ~/ / I I ~~ ~ ~ ~~ / I 1 y// ~~~'~// I / / ~~ / 8t. - , ~ ~ ~ / / I ~s / ~~` 3 t ,~ ~\0` \ / / to v .OOI I ~ ''" v ~ ~ '~ ~ < I ,~ ~ ~ ~ ; ~ \ ~' \ ~ $~ ~ C ] I ~, I N I ~ ~ \ ~ ~ I 8# ~ ~ i ~ ~~~' \O L ~"i , tia~< ~ W~ I (. )N W ~ nC ~ ~ .~ ~ / \ ~ ~ N, I e~l I J V) ~ ~.N,. 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