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HomeMy WebLinkAbout020-1437-19-000 I Wisconsin Depa ommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Build, Sanitary Permit No: INSPECTION REPORT 479266 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: LaCasse Development I Hudson, Town of 020 - 1437 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 7 7.7-5 1 r6 r�\ /.- G - S - F 22.29.19.2724 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P� K:, Zsf� Benchmark Dosing �[�;('#- Alt. BM Bldg. Sewer °I3 •a3 Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet 13 A'3Z O Septic 17' 756 j IL' 1 Z ► _ Dt Bottom 11�. Dosing Q 7 I _7 5 6' Z I 1 _ Header /Man. , V I - 7. c5 c r$ a Aeration Dist. Pipe 9 Z • BS 7 7 q -•7 Holding Bot. System G O q Final Grade I f I PUMP /SIPHON INFORMATION • $ 166 . 3Z Manufacturer t Demand St Cover Zoe.l e,— GPM F.' ��►- d3 98 .O e- 1 Model Number 9 9 55 TDH Lif� 55 Friction Loss System Head TDji� Ft e , / .5 Forcemain Length Dia. t I Dist.toWell '7 Z SOIL ABSORPTION SYSTEM BEDITRENCH Width ► Length I No. Of Tre nches PIT DIMENSIONS No. O f Pits Inside Dia. Liquid Depth DIMENSIONS 3 �jQ �J 1 G � A SETBACK SYSTEM TO D O P/L <✓ BLD 1f Q W LAKE /STREAM LEACHING Manufacturer: 7; INFORMATION CHA Type Of System: , f� IT OR Model Number t DISTRIBUTION SYSTEM � © , ZZ4"Z = L / Header /Manifold h Distribution x Hole Size x Hole acing Vent to Air Intake I / Pipe(s) N ", Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth xx Seeded /Sodded xx Mulc Bed/Trench Center Bed/Trench Edges Topsoil Yes No es [Tj No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 809 Ross Road Hudson, WI 54016 (SW 1/4 SE 1/4 22 T29N R19W) Kelly Estates Lot 19 Parcel No: 22.29.19.2724 1.) Alt BM Description= �' A , 2.) Bldg sewer length = 'Z , - amount of cover = Plan revision Required? L] Yes o Use other side for additional information. `— Date insepctor's Si ature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County 2:��u C o , (/ 201 W. Washington Ave., P:O. Box 7162 /`- isconsin Madison, WI 53707 - 7162 Sanitary (to be filled in by Co Department of Commerce (608)266-3 Sanitary Permit Application q Smote Plan I.D. N umber _V/ In accord with Comm 83.21, Wis. Adm. Code, personal information you provt 0 may be used for secondary purposes Privacy Law, x15.04(1 Project Address (if different than mailing address) I. Application Information - Please Print All Information O Property Owner's Name GAF • C�FSSE J7�VE5 Ca > f- is zn • 13 • !t • Bloc Property Owner's Mailing Address Property Location S G� . ST. CROIX COUNTY c/, City, State V 1 Zip Code ZO OFFICE S4 y, �� y, Section - `� / • l / lS • 31/• 5,30 2 - I ((circle Z / 4 II. Type of Building (check all that a I T N; R E q�(W / l ap �/ -.0, 5v "i•� `� t 1§4 or 2 Family Dwelling - Number of Bedrooms ` 7 f S bdivisio�n/Name am CSM Number 11 Public/Commercial - Describe Use ' �` t '� al 957 4"f S ❑ State Owned - Describe Use Z IN, ion) ❑City ❑Village *0 wnsh1 of O III. Type of Permit: (Check only one box on A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treat ment/Holdin Tank Replacement Treatment/Holding ep 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 -------- Plumes Owner X79 z Cp IV. Type of POWTS S stem: Check all that appl XNon - Pressurized h t- Ground ❑ Mound > 24 in. of suitable soil 11 Mound < 24 in, of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑ Constructed Weiland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter Leachin Chamber ❑ Dr Line ❑ Gravel -less g P Pipe El other (explain) '9 V. Dis ersanreatment Area Information: Design ow (gpd� Design Soi! Application Rate(gpdst) D s�rs� Required (sf) Dispers� Pr (sF) System Elevation ^ � 1 VI. Tank Info jC�:�;, in Total Number / Manufacturer QQ • Prefab Site Steel Fiber Plastic Gallons of Units C( Concrete Constructed Glass Septic or Holding Tank 1 ' Aerobic Treatment Unit DosingCha�mber v VII. Responsibility Statement - 4 the undersigned, assame responsibility for installation of the POWYS shown on the attached plans. Plumber's Nance (Print) PI ber's Signature #P/MPRS Number Business Phone Number 1 ? /S' -7�� • 3�ti' Plumber's Address (Street, City, State, Zip Code) /f U-e 4)1. S C7 C.0 VIII oun /De artment Use On Approved Disapurov Sanitary Permit Ft includes Groundwater is Issuing t Signature (N Surcharge Fee) Ct Iven Reason for IX. Conditions of ApprovaURessons for Disapproval , I SYSTEM OWNER: 3 1. Septic tank, effluent filter and dispersal cell must all ba services - 1 msilllaillsd �Oi.� VC_ . as per management plats provided by pktmW. 2. AN sdback lVW*emants rollers bs msi ***d 41 'psr appWmw cow/ nr llmt rs Attach complete plans (to the County only) for die system on paper not Ins than EIl2 x I l inches in size SBD -6398 (R. 01/03) _�fttLJSt; Y0 t39b L` - ik s +th � •.t k - t.:'f' •' . .'F; O*rO&kmm 9d tft rf otFii ngliuv 9 GA S slOf INby01 ftoi tkW -qo *q as " �3u 1 11—AVe16 t AE7R/r'lZee - �7��i�'o,J AS u.e. [o� . 0,� Tv o,e� Te r o r o• p q- t o c�N o 2D & T o yl oconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings Comm i v in accordance with m 85. s. Adm. Code Coup -,!�T• e - , p Or Attach complete site plan on paper not Less than 8112 x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference Point (BM), direction and Parcel I.D. -7 percent slope, scale or dimensions. north arrow. and location and distance to nearest road. d • ! I ' / a R Please print all Information. Re by Dat Personal irdorm km you Provide may be used for secondary Poes p (PrWaw law. a. 15.04 (1) (m )). Property Owner Property Location ((''�i g Govt. La lJ 114J v 1 S ��' T�' N R E (or W Property owners Mailing Lot # Block # Subd Name or CSMfi 5 c7 Y. P. 9 aly State zip Code Phone Number ❑ City ❑ Viilalp RrTown Nearest Road b D� �/ Syo /�v (7/1) 3J/• 54105* , � /'o-r's �D . New Construction Use: C Q Residential / Number of bedrooms — Code derived design flow rate o -- 0 0 GPD Replacement ❑ Pubic or commercial - Descrlbe: Parent material Flood Plain elevation if applicable ft General comments s '4 'Uo y and recommendations: �— ❑ qQ > Bofft # Pit Ground surface Nev. f f ' °. it. Depth to fim&V factor soy Rate ' Harmon Depth Dominant Color Redox Description Texblae structure Boundary Roots GPDNF In. Munsefi Qu. Sz. Cord. Color Gr. Sz Sh. TOM *01#2 o- �oy� /- aTJ A" cs 3 • I& ''y z o oe sw sL . / O 3 S /p c 7 S O /. F te# ° Borim ❑ Pit Ground surface elev. % Depth to &nbV factor in. Rate Hoot= Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA! lr. Mtunsel Qu. Sz Cont. Odor Gr. Sz. Sh. *M1 TOM • Effluent #1 = BOD > 30 1 220 mglL and TSS >30 150 ffq& Effluent #2 - BOD 130 mgA. and C5�`T CST Name (Please Prinq ' • C Sig^ ZZ�/ ,� r 5 Address 7- Date EvahMM CaWuctW Telephone Number Ulbrichl ssocia es Private Sewage Consultants 2812 1 Oth Ave. SDrina Valley WI 54787 Property Owne6 Parcel ID # Page of 1 BorkV# ° ❑ Pit Ground surface elev. ft. Depth to Unftg factor in Soo Palo Horizon Depth D=lnantCdor Redox Description Texture Stuck" Consistence Boundary Roots GPDNE Munsell Qu. Sz. Can t. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I F-1 Borg # ❑ ❑ Pit mound surface elev. ft. Depth to WnM9 factor in. Sob ApplicAlon Rate HA:on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM In. Munsell Ou. Cont Color Gr. Sz: Sh., 'Eff#1 'Ef #2 h . F-1 Boring; # ❑n9 ❑ Pit Ground surface elev. ft. Depth to irrrting factor in. Soil Application Rate Horizon Depth Donut Color Redox Description. Texture Structure Consislance Boundary Roofs GPD/ir: In. Munsell Qu. Sz. Cont. Color t.7. Sz. Sh. - EM • Ef mart #1 = WD, 21 220 mg& and TSS >30 1 150 nV& E.ftluent #2 = 130D 130 mgll. and TSS 1 30 nV& 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 &Twat, pleat contact the department at 608- 266 -3151 or TTY 608- 264 -8777. seaa►3etr�sae i t j Cl) go l;D f rC CD m A 0- 10m w z N s i Ilk N a w �n y i I f j t W N 1 J, �► A tj ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants PE/ NIA• 7 PROJECT INDEX PLAN ID # 4 t 7 2 C& CO DATE ` _ `y a 5 OWNER PHONE ADDRESS - -- S7 3 qy LEGAL DESCRIPTION GO f" # �� 61� G'S7 S pito bz /q37• l� .aVV 5 Lo. S :E, S�.zz h'rS� TOWN OF zf (>pSO/t) COUNTY S C � CSTM LOCAL AUTHORITY/ SUPERVISION PROJECT DESCRIPTION: zz 13 0 T" 77� /3 y pe - 7 - - J it1/ G ,PS W o b G.1� p � ) ov 7 X* s �6 �- 17PZ T�'T 74 a Pg.l INFILTRATOR SIZING WORKSHEET P3.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Per 4 11 11 } J f ONTO CG j W CP * . m Cj O` CD E — -4 C w /7- LA t r3 O Rt 0 = y tt m P0� ! it IL 90 O� O m O O D �Dm CO 1 ► p 'a a c 11 t� 4 mMm t ! V O W ` N D• C � 7 -FIN V1 F s ' ref / cv c�r�v i PiPd04 �5p �aa ;AY i vv �N SpE� Tiov p,�, l t� AIA/. 2 _ 1 Itr 1 - c y P s y �7ZFm , a SEc Tiox) 7 7 G w,A 1q sQ T, fiia��ot g c, �fcfr S � T�'o� _. c,9-&n y sE,� - .e& -d elms - �.� i , vv �NSp�cT /ov p � Aw z .. Iff 50 ,� T� uc# PUMP CHAMBER CROSS SECTIOU ARID SPECIFICATIONS pA147 of y" 5� •�8 3 > /D ' fo Gvi vt�CJ, aao a ;�.:P i v r� .rt wG _ VElJT CAP I P� PE • VENT PIPE WEATHER PROOF APPROVED LOCKIMG JUNCTIOW BOX MANHOLE COVER w1 lvftiC,oIiol! ,I GRADE - I ' y" MIND. .MPG COlJDUIT L ` — ---- - - - - -- PROVIDE I - --- -y INLET AIRTIGHT SEAL I I I I I { I APPROVED JOINT A Opp - i i i � APPROV PE OINT W PIPE �a n µ { i i LXTENDINIG 3' �O 1 ( I ( ALARM EXTENDING S ONTO SOLID � IL �� 0 ONTO SOLID SOii P G ON g� � c I { ELEV. FT. I PUMP --� OFF ZISE 3 d, D ! y �IOiPE eF � �g�DO G • $ S�tv� BLOCK 40 tort f%0 A) GY�i v C RISER EXIT PERMITTED OWL4 IF TAIJK MANIUFACTURER HAS SUCH APPROVAL .fr, SEPTIC E SPEC.IFI'CATIOKIS DOSE 0 1 '� S4 W 4 �) {JU���R OF DOSES: PER DA-4 UR TAIJKS MAMUFACTER. �-1 Q TAMK SIZE: / � GALLOMS DOSE VOLUME ALARM MAUUFACTURER: t j �/ �� M INCLUDI BACKFLOW: GALLONS MODEL HUMBER: ! � V �-- CAPACITIES: A= � WKS OR � GALLONS SWITCH TYPE: D �' B= � INCHES OR ✓ GALLOIJS PUMP MAMUf=ACTURER: �` C =� ( f 4 -7 INCHES OR / GALLOIJ5 MODEL HUMBER: � ` ( wp D =1' L— INICHES OR ' GALLONS SWITCH TYPE: v- , k` MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE ZQ GPM I ^N�S ON SEPAR CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTION PIPE.. FEET + MIAIIMUM NETWORK SUPPLY PRESSUR . . . . .. . . . . � FEET �AGG�. + _ FEET OF FORCE MA X F % FL FRICTIOU FACTOR. ' 7 6 FEET "oA 1 — TOTAL DytJAMIC FEET F 3q INT.ERAIAL DIMEWSIONS OF TANIK: LENIGTH ;WIDTH ;LIQUID DEPTH ' / r To P I'ST f a x - l i THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # A ZOELLER EFFLUENT PUMP MODEL.'98 H EAD CAPACITY 6unv = MODEL rage•. 3 Jp i IA -.FF ts- asp la �. + IN S t - le t �o to 50 so ft0 248 ' FLOW PER M*Mc- ' p nvnn ewe at to q y t lsll $ 4ml l IM 3 !1 ns zo st to ! r S >e s s�odtYrsro - .. a 3 /li CONSULT FACTORY FOR SPECIAL *ft + "*Cb cw "s"Wtars, l N duplex eysjwM, Me gtv3W a and %*W r an NWI e W csxY am;wwm are avaw* to c� en d Me "" dws. d ex aYalema, Me evebble %ft a e ayNama. Pb91►beck mercury Wmkhea ere BvWkbk for vartsWe Nvo"cycM comak Standard +N nrode - WeipM 3o Ibe - N p, a1110"M oum, !` Intpr s.*epw"*dtPotf y IlAodd y trot s�he�oe = ry aow w40h of dwAb 14 mil►. II + i pj 1 of 3 McA-r e� a1a074 Z�0 a ' M"* fMOFSE for oanld morirtof 2" ono lfon d serial aup t!! g0 = s°'"'d So'" r k i l t ._ !a Z i a .. p Ff wit hPN':tPA» p Adian fKN� oo ���bwawbdbr�m ' r'no pl heN Jf'd► ; dot w � 1pipl t�%,t Mf�irw t�11tt fb-*d M f C W'ro Al PAUMX slnit l•A� pj ,fy.�Cersd Ir.d , '�, _IrH.» .et * M.1 M.rw be a. a... _. _.. 06/16/2005 02:37 7153819771 WELCOME HOME GMAC RE PAGE 12 Page 3 of 3 ST'EEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST Powmm Rcliard Develapers LTD New Richwnd, wi 54ov Lic. # 248956 S'WX /4,%1 /4 ,S 20,x29,M -9W (715) 2.46 -6200 TOM ofHadsm St C ok Cm (715) 246-5085 Kdly ire lot 19 This sob evaluation m* S4adselcd to a swin I equil it 00 or my gat be saibble he Yw ale. The bmdn of dw kd stay or spy sat be au tt ms ss Wnmm tot Ht wm no t estabsoed at tie dm the we teat was eogdn"ed. � I" ad 40• A = Boubmark Et lo0.00Ft Top of %"Vve ate o= Alt Bak EL99.95 t Tap of W M pipe Bafa 0evadom BI =101.751rt 8� B2 =101.75H 133'W9995p ,�,2 I f if c w'ma l j, c 4 i1� ti ' / � rl i f i I No It I o� 1 a � i s L t i f , ti' +• AN Sig o r' % ` A � , t •, 4 '� -,_' ' _ " �•, ; �. 1 i �� � �'� •,,.. , rat � ; ` ! � { r.. ' � I . ` 1 � � r lot E1 3E)Vd 3d OIM 3WOH 3WOO 1LL618E91L LE:ZO 898Z /91/98 l uildings Division County S4 . G R O +• Visconsin 201, W l�fadt f�$��VE D rtw ary Permit Number (m be filled in by Co.) F _ Department of Commerce (60 3151 Sanitary Permit Applica on J U N 2 1 2005 Plan I.D. Number In accord with Comm 8121, Wis. Adm. Code, personal info lion�C��iQ may be used for secondary purposes Privacy Law, sl 04(1)!z� L�UI�C COON ONING OFFICE TY jest Address (if differettt than trailing address) ZZ l I. Application Information - Please Print All Information A 9 0 Property Owner's Na me Parcel # Lot # - Bleak•# G/} 0>4SSE" Er✓D�J�t�T� Ca ozd • /y37. 1 1-0 0 0 Property Owner's M ailing Address S7 3 n �` . RD. A Property Location el City, State C' Code Phone Number 'A• s� [A.Section Z Z V L2So AJ (mot/ Lv - 7 1 S ' 3P ' S - q 2. ! 1 (circle one H. Type of Building (check all that apply) T N; R E o �1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name c - rirtetber� ❑ Public/Commercial - Describe Use ���`� V c ❑ State Owned - Describe Use ❑City_ ❑Village &ownship of ITV 0/J III. Type of Permit: (Check only one box on line A. Complete ' if applicable) A. I KNew System ❑ Replacement system ❑ Treatment/ ding Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ C of ❑ Pe Transfer to New List Previous Permit Number and Date Issued Before Expiration Plu r Owner IV. Type of POWTS System: (Check all that ap Non - Pressurized In- Ground ❑ Mound > /in. suitable soil ❑ Mound < 24 in. of ' ble soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wedand ❑ Pressurized In -Gro Holding Tank ❑ Peat Filter 01 Aer is Treatment Unit ❑ Recirculating Sand Filter C1 Recirculatin Synthetic Media Filter Lea mber 11 Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Informatio 5 ,,t i Z , S Design Flow (gpd) Design Soil Ap licado t f) Dispersal Area Required (sf) Dispersal Area \pwed 40 System Elevation ( S5? $•7 VI. Tank Info Capacity in F Total Number Manufacturer Prefab Site Steel -Fiber Plastic Gallons Gallons of Units /, �` Concrete cted Glass New Existi Ci.� C t I7 rtr) onstru Tanks T Septic or Holding Tank �p Aerobic Treatment Unit & �i C d Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's S' gnature P /MPRS Number Business Phone Number R. 741- 'g2iC[47 - IS . 7.7.a • 3yq Plumber's Addre ss (Street, City, State, Zip Code) VIII. Count /De artment Use Onl A pprov es app ved Sanitary Permit Fee includes Groundwater Date Issued uing ent Signature (No Stamps) Surcharge Fee) I 11 en for Denial ,3 — 2 3 Zcf�S IX. Conditions pprov 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. w w . 6 X7 5 T Gd T �. 4 - n 00 CO lu a f; N C � a � 0� � N �Cn v v nO U >* ° D m @m cs m. W v =3 m o m �' CJ m n _ m r.> i r C3 ;3a/ r, '! D e 41 to �. , - ULBRICHT & ASSOCIATES CO. 2612 110th Ave. - Siring Valley, WI 54767 Reg• Desows of � sv 715- 772 -3442 Pdvaft PROJECT INDEX PLAN ID # DATE Z'- OWNER /-A 44SSE b e UG Co - PHONE � I s • 3 ,?/ - - 9 9 ' D ADDRESS s1 3 C4 • �D_ A q V DSfl�s (4 1. S g & I Cy LEGAL DESCRIPTION LOT # I k"ff //y L�s7";i-rJ6S Fria oZo -tK . igaoa 5o Se S',L-c. ii. , T Tz 4 w TOWN OF 409Sfl.J S `f• • C P-0 () COUNTY CSTM P rLltl 51 jrEt, zo: Z �g�S LOCAL AUTHORITY/ SUPERVISION .s'�`. CPO 1 ( G�\ f Zox�k ( M( PROJECT DESCRIPTION: • New C6,3 srt 12 V c-T f0N -- F OR - A �• � s�� -�la w � � o a � s . GU N U k u T i o N)• L J qt;4 y• t4 • 1 2.7,�,ot3 �k� 7' J IS POWT SYSTEM SHALL Ulbricht & Associates INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL Private Sewage Consultants FILTER MODEL # 2812 10th Ave. 4 Iba Spring Valley, Wl 54767 ID A � za MPRS # Pg.l INFILTRATOR SIZING WORKSHEET P9•2 SYSTEM PLOT PLAN P g.3 CROSS SECTION TION OF SYSTEM, WITH ELEVATIONS. Pg. n to If If Q kA CL {� oo °0 >S m �u �r N 1�n V% % o' _ rn �7 9 z tm Q, • �. N r RO SS . w — c�J 6 W-Z r La r �. - Ti CO A Q CO m�0� M —L< ^- m^ a — O O < to go v v 7 D G m -r (D r' 1 �GC Dm W , N to i 5D (D m 0 OMB l� P cu m Z1 CD O z r � N cs� - N N Z cn ei JA oe ow tv s�lcT�ov �r fog q2 mira . 7,V7 r Cho SS SCcTIO .5 7 1A)6— ,Nr L ?if'i9- ?'o'S ys w,� J � . J SQ. ��: rfi��•�ov� ��1'si �fr�.�f/ � SSG T `rD'v -- s- go' ov A1'Al lff /001 Or (� K �1 v • OWNEK's MAINTAIIVCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and a servicing is necessary for the safe healthy operation of ; this system. The owner is required by code to submit all necessary' maintenance /inspection reports to the control ling,authorities.. SPECIFIC CONTACT AGENTS *. Governmental authority/ inspectors: 3 % y��a * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: - 7 - 7A • 3 qy L� t�-� `c -(— M PP s 2-ZCe 3 � * Licensed service / inspection agent other than installer: TiPi G 7Y. - 5,4,,x,• r o,v * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic'(sledding, shoveling, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter vacaction trip, resulting in no water.use) can also lead to freeze ups. 2. Water conservation- needs be exercised! system can be hydrolicAlly overloaded and destroyed. This sysjem was designed for a maximum wastewater flow of gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage. disposal unit, or any other unnatural sources of waste Any introduction of such waste materials will overload and destroy this system. 4. if a power outage-occurs, or a pump fails, it may # result in a temporary overload of effluent being pumped into the- cell, which may adversely impact the cell (leaka'ge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative"cover (the cells insulation & erosion preventive) can lead to failure. traffic also Compaction or heavy can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the Aystem beneath IS NOT sufficient alone tO maintain a yi �covar. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on rho ,...,,,_„a __ . - 1224 4 Wisconsin Department ofCornrrrerce SOIL EVALUATION REPORT p 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Sall Service Attach complete site plan on paper not less than 8Y: x 11 inches in sue_ Plan must Cou C include, but not limited to: vertical and horizontal reference pant (BM), direction and percent slope, scale or dimemsons, north amxa, and location and distance to nearest road. Parcel I.D. Pending Please print all inforrm ion_ R By Date Personal mformstion you provide may be used for secondary purposes (Privacy Lahr, s. 15,04 (1) (m)). O . Property Owner Property Location Reliant Developers LTD Govt. Lot SW 114 SE 19 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or GSM# 9900 Valley Creek Rd. Suite 135 19 na Ke#y Estates City 60o 6urj State Zip Code Phone Number C' Village loge Tovm Nearest Road MN 55125 651 731 - 3174 Hudson Ross Rd_ 1� New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ;.:; Public or commercial - Describe: Parent material outwash plains and stream terraces Flood plain elevattion, if applicable na General comments and recommendations: System elevabon 96.75ft, trenches spaced and depth to code 5.00ft below grade Boring # Boring im Pit Ground Surface elev. 101.75 ft. Depth to limiting factor 96 in- Soil Application Rate Horizon Depth Domes Color Redox description Texture Structure C wham Bourg Roots GPD/4f° *Eff#1 I •Eff#2 1 0-8 10yr3/3 none sd 2msbk mfr a 1f .5 .8 2 8-20 10yr4/4 none Sid 2msbk mfr gw na .4 .6 3 20 -26 10yr4/4 none sl 1 csbk mvfr cs na .4 .6 4 26-96 7.5yr4/4 none Is osg mvfr na na .7 1.2 Fil Boring # '~ Ong Pit Ground Surface elev. 101.75 ft. Depth to Ming factor 96 in. Sot Ap*.a�bm Rate Horizon Depth Dominant Color Redox Dior Texture Structure Consistence Boundary Roots GPD/W "Eff#1 I `Eff#2 1 0 -11 10yr3/3 none srt 2msbk mfr Cs if _5 .8 2 11 -24 10yr4/6 none sicl 2msbk mfr cs 1 of .4 .6 3 24-46 10yr4/4 none sl 1 csbk mvfr gw na .4 .6 4 46-96 7.5yr4/6 none ms osg mvfr na na .7 1.2 Effkie nt #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent 02 = BOD � 30 mg& and TSS <30 mg/L CST Name (Please Print) S' nature: CST Number David J. Steel 248956 Address Steel Soil Service u '" / Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 10/24/2002 715 -246 -5085 I propertyOwn fZeliant: Developers ,LTD Parcel ID # Pending Page 2 of 3 F 3 Big # Boring 40 Pit Ground Surface elev. 99.95 ft. Depth to limiting factor 96 in. Horizon Depth Dominant Color Redox Description Texture Structure Corisisterice Boundary Roots GPD/fF 'Efl#I *Eff#2 1 0-10 1 Oyr3/3 none sil 2msbk rnfr CS I c .5 .8 2 10-24 1 Oyr4/4 none scl 2msbk mfr di 1c .4 .6 ( 1) 3 24-46 1 Oyr4/6 c2d 7.5yr5/6 sicl 2msbk Mfr di if .4 -6 4 46-96 7.5yr4ro none MS osg MI na na -7 1.2 6 Boring # Boring Pit Ground Surface elev. fL Depth to limiting factor in- F� — AWce" Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Mmdary Roots GPD/fF 'Eff#I 'Eff#2 ❑B # Lj Boring oring g pit Ground Surface elev. ft- Depth to limiting factor in. F �Aphcabm Rate Horizon Depth Dorriffiant Color Redox DescrqYhon Texture Structure Conssterice Boundary Roots GPDtft *Eff#I *Ef fO2 Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD -S..30 mg/L and TSS -,� 30 mg/L The Department of Commerce is an equal opportunity service provider and eruplo3w If you need assistance to access services or Page 3 of 3 STEEL'S SOIL SERVICE David I Steel 1564 Cty Rd GG CST - POWTSM Reliant Developers LTD New Richmond, WI 54017 Lic. # 248956 SW1 /4,SE1 /4,S 20,T29,R19W (715) 246 -6200 Town of Hudson, St. Croix Co. (715) 246 -5085 Kelly Estates lot 19 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' ✓ i Benchmark El. 1 oipp of '' /2 "pvc pipe Alt Benchmark EL'_95Ft ✓ op of /2" pvc pipe ❑ = Borings Boring Elevations B1 = 101.75Ft B2 = 101.75Ft B3 = 99.95Ft B4 = 00.00Ft 0 �2 7. 3 LO Lod �'� /o /•7s�� v�� �- k FA ( �� E'°"t n'C)N sy� 1Jf C' SL_UI_1� _L._LL_L_1_l�J.L____L._CL1Y_iJ_ set ;.a • u�✓ -ia'i , Q Z 1+ ' �. namxw ZONED AG—RES { • i • • IEQn t 1Te.A "01'04 _- s , . N o f �\ �' `�' - -� =- 1282.44 S01 ':':.. �, �, • P, � p�c -'`� {{pp �• rp l a x .J} pi IR ' �• X1,1 Z rn m, 10 ~�9�• -33 ` I �. 69 Lt� q� g plZ I f� • I so .. ....: 'r •'_y` \ .. ..i ' / /. p - t / �g�p1t I t0 •� •,'+•• ,`` 't •�\` �\ • ,r v p •� , Pahl 4331 :•6 �'••� t 111 �� i `'��i /w/ y � f •� \�,\ y t 1 ry �& 1 i �QQ7dd� \ \•••'' —JJJ 213 . ; ' ,, . ( /.jam , f •, a � ` \ / ' � V f �•` .} "Ji• � �C );i:1 ' ra •. � ` ` ° yrR,4O1 + �;;; ! � J � , 1 �• ` 370.47 •'. CD w \ Fn 1 I % -7060 RLNOVm- I 3 0 An $• �� 14•I I•. + r !•N ! t ' r "1 �a ` P I K • 4 ,.�- J N/ N ag - a _ \� • \'+' ` `• `'\ 1 \ �� -• 6• ` S: -i 329.18 NO3 ' T 1'E Z— ! ' i , -� 4° V I �' G �``'\ �-NOZ° \ 416.CL3 "0,°0508•�t ° I ? G ,lrcl ` F •� 7.07 • .I' • ^! . tltrs7u"r � I 1 ,� ,, .' IZ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 5 t/ p & -j� u pS o o 4 01 Ce Property Address k os S A. 4 * A 9= (Verification required from Planning Department for new construction) City/State Parcel Identification Number O 2 b Y 3 7 I I LEGAL DESCRIEPTION 2 Property Location 5LAJ V4. L�1 I R VPS o ' %, Sec. . T N -R W . Town of Subdivision L< c S Lot # t / Certified Survey Map # �— Volume - -- , .Page # � C Warranty Deed # 3 . Volume Z S3 5 , Page # q q J Spec house kyes ❑ no Lot lines identifiable yes ❑ no SYSTEM AL4U TENANCE Improper use and maintenanceof 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 mastorplumber, lotnneymanplumbc4 rest rictedplumber or a licensedpumper verifying that (1) the on -site waammterdisposal system is in proper operating condition and/or (2" 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 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 Office within 30 days of the three year expiration date. SI TUBE JW PLICANT 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 dewn:r above, virtue of a warranty deed recorded in Register of Deeds Office. %J SIGNATURE OF APPLICANT DATE ssssss Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ss 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 ORIG iNAIL U 2 5 3 5 P 4 9 5 ?57836 l i • KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., NI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD DocmnentNumber WARRANTY DEED 03/29/2004 09:10AK f WARRANTY DEED THIS DEED, trade between Reliant Developers, LLC, Grantor, and EXQpT t LaCasse Development, Inc., Grantee, REC FEE • 11.80 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 4874.00 the following described real estate in St. Croix County, State of Wisconsin: COPY FEE: ,�. CC FEE: Lots 2, 3, 4, 5, 7, 8, 9, 11, 13, 14,- i5�'16, 17 i9 20 and 21, Plat of Kelly PAGES: 1 Estat t. Croix County, Wiscons - X37 -15-j"=o Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2' St. — Suite 115 Exceptions to Hudson, WI 54016 Easements, re if any. 423495 020 pQ Parcel Identification Number (PIN) This is not homestead property. Dated this 26th day of March, 2004.' Reim Topers LC B 6 -f ' Vick Toston, Chief Manager, Reliant Developers, LLC • AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 26th day of March, 2004 Personally came before me this March 26, 2004 the above * named_ Ri ston, Chief Manager, Reliant Developers, LLC ja- own to the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN fiie kn instrument and actin ledged the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY r `Tu-d Cam eo Notary Public, State f Wiscons Peterson, Frain &Bergman — Steven H. Brims My commission is ate: 50 East Fifth Street, St Paul, MN 55101 11/4/2007 DY LAFiRI U ) (Signatures may be autheticated or admowtedgcd. Both are not necessary.) Notary U IC J *Names of persons signing in any capacity must be typed or printed below their signature State of Wisconsin WARRANTY DEED ? ;S1-1 STATE BAR OF WISCONSIN FORM Na2-2000 cls� S� Ate -i I --------- ------- - - - - -' SOL I J L ' 31 563.37 21 M %79'2 6 30 r, 4A ' r 56 3-3 7 ' _ I ' 128 7c I SJL_ — (� 7 _ 5 N 6 J W '0169 g �i ov OT 1' � o �— — ' o • •� 6' 67 S•F• c'=O. -�4A 373 AC. 0. 434.58 w $�5 u o ( - -- - - �" NOTE: OUTLC I ( ,°n�, \ ~CF IppEN gP/► -- AND STI pRIV/►tE 13 •61 \ ; ; BENC:HM `- 1 TOP STEEI Io N ` 5 \ o �t�1,� it 5l9�6 3 \ \ ELEVATION t (2.48 AC.) \ `N89'19'31' W W \ Ss0 NO DWELLING — 1/1 V) \ �. EXTERIOR I I \ \ OPENING BELOW c0 ^ ELEVATION 923.8' 'r ob I� N89 *31'E 411.77 — — — _ — — ;� 3 w - t- - - - - - - eNCHMARK 3S 3S 17 ok 2 - a�u` T ELEVATION ^ Ii ��� 103018 S.F. ^ ,� ! •' 20 930.92' (2.3 AC.) 1 50 91498 S.F. / :. 47.53 1 NO DWELLING AC.) r EXTERIOR OPENING BELOW NO DWELLING A- x °, EXTERIOR g �� to - ELEVATION 919.7 OPENING BELOW i� •� / o' '� •r w\ ELEVATION 919.7' ^'/ ,;� i° WL SID — — — N89'19'31'E 381.42' — — — I _ — ' .+- �• \r'� �--- - - - - - -- J, — ------ - - ---- 67.78' 3 \w r I ob 16 ... XON 'O I i I 21 + I t - O q tr \a 1 2 ?589 AC. I I 105538 S.F. N I i 2G� • w- - NO DWELLIN( (� I (2.423 AC.) 3 \ EXTERIOR i 1 I NO DWELLING EXTERIOR I I to � \ OPENING BEl I I I OPENING BELOW N I \ ELEVATION 9 ELEVATION 919.7' 60 I z I Z� i SOL see--- --- I -�• T 3 I I MONUMENT AND $ � o.�\ �• I ��_- I~r'� SEMENTE 374.07' — — 156.03' 272.77 —y 116.74'— - .45 N 8 (N89 6 3 5 4? � 1067 a - - • "" - •+.••.. , TN HT OF WAY LINE BADLANDS ROAD - - — 42"E N89 *24'47 2603.1 - + Y I 7 — rujivoo, I - � I t :