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HomeMy WebLinkAbout020-1437-21-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building 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: Insp. BM Elev: BM Description/:' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 4 ~ ~~ <. ~~~7~ G `~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~/ ~ J /V /~ i ~ ~ ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Model Nu er TDH Lift Friction Loss Syst ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: 463222 0 State Plan ID No: Parcel Tax No: 020-1437-21-000 Section/Town/Range/Map No: 22.29.19.2726 STATION BS HI FS ELEV. Benchmark 5 .~4 ~cs.~ ~C~ Alt. BM G \~,... Cc.s~.. z . cl ~ id Z . 7 ~ Bldg. Sewer SUHt Inlet 7.78 y~, y~~ SUHt Outlet ~ ,Z~j, ~t7~ ~I Dt Inlet ~ ~ Dt Bottom Header/Man. i ~ ~ Z ~ °I . ~lJ ~ ~ 4 r ~.. Dist. Pipe °I•'Z-$ ~~. Sic Cif..`f~ ~ L Bot. System G - ~C c ~i I ~ Final Grade (- S.Sy !ao ~ I-~ St Cover Z •~~ i6z_ ~~ ~~,1,,~ ~.e5 ~~ . ~ I ~Z ~a'S rl~ • / ~ c~ BED/TRENCH Width ~ Length ~ No. Of Trenches ~ i PIT DIMENSIONS No. Of Pits Inside Dia. Liquidh DIMENSIONS ~ ~ Z Z -T~e~, l., ~ /~ ~~ V~ ~~---- "" ~~ ~~ SETBACK SYSTEM TO P/L BLDG LL W E LAKE/STREAM LEACHING Manufacturer: //++~ r , TION CHAMBER OR .Lv~t't INFORMA Type Of System: ~~ j C ~ f ~ ~ ~ A 1,/\ _ UNIT Model Number: ^ ', J DISTRIBUTION SYSTEM Z~ v ra r 1,. 4lc i a~.~ Header/Manifold ~ ~ ~ y L D Distribution Pipe(s) i ~ S th~ Di \ x Hale Size x Hole Spacing \ Vent to Air Intake Length ia pac Leng _ a ng Still COVER v Ornccnrn Cvc4nm~ Only vv Mnnnrl nr Af-(:Yalta SVA}P_mS OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded ~ xx Mulched Bed/Trench Center ~ ~ ~ Bed/Trench Edges \ Topsoil Yes ! No "Yes `' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /, Location: 801 Ross Road Hudson, WI /54016 (SE 1/4 SE 1/4 22 T29N R19W) Kelly Estaates Lot 21 Parcel No: 22.29.19.2726 1.)AItBMDescription= ~iJ'd'r,t., l._.E;~1~.,L_ ~-~~.~~ ~- t--ae~GS ~~ 2.) Bldg sewer length = I ~ ~ ~ ~ ~U~ti n - amount of cover = ~~ ~~t:~de~ ~2 ~v~,,~~.ti jo ~ • ~ //t~~ C? r lp Plan revision Required? ;Yes o Use other side for additional information. I L '" d ~~~~ L Date Inse tors nature Cert. No. SBD-6710 (R.3/97) ' Safety and Buildings Division C°°nty s-~.. ~ ~ O 1~ ~- 201 W. Washington Ave., P.O. Box 7162 /~~~~~'~',~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 ~ ~ 3ZZ2 ca~l[ ~ ~ `® ° ~' ~~- .~ ~ Sanit a 't App s~ Plan LD. Numbe< In accord with Comm 1, information you provide may be used for seco ~ y w, s15.04(1,)(rnt) ~~ 1111 ~~ Proj (if~ ~ mailing addr ~ ~ O.SS ~ I. Application Information -Please Print All Informatio , Property Owner's Na me - / "-'----•.~ :-.-,., ' - ~ ( .._..~ ~ Parcel y Lot Ai ~lock3w n.~ L ~ S ~ ~~ (7fl~l l1 r Owner's M ailing Add ess Property Property Location n ,~i ~/ / ~ S / 3 C T y l~'v ' / - Se<;tion Z 2~ ~~ l<i s~ l4 City, Stat e Zip Code r Phone Numbe , , ~/ /~ (/ ~~~ ~ ~~ • / _ s ~ ~ ~ ~ p ~/ ~t'S ' 3<3 l '`S / Q ~'!~ / (circle T / N; R ~ E Type of Building (check all that apply) ~ v~ II ~ . d N i i 1 or 2 Family Dwelling -Number of Bedrooms er ame Subdiv s on v ~~~ ~T'4'~ 5 ^ PubliclCornmercial -Describe Use .. / ^ State Owned -Describe Use ~- ^Village >~Township of ^City _ t uD III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ,Zp - i 3~ - 2 r bU~ • 2 2 `~' I~New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Ltst Prevwus Permit Number and Date Issued Before Expiration Plumber Owner lv. of POWTS stem: (Check all that a I ) (~•Non -Pressurized hrGround ^ Mound > 24 in. of suitable soil ^ Moues < 24 in. of suitable soil ^ At-Grade ^ Single Pass r ^ Corutructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating S Fi r5 ~7j ^ Recirculating Synthetic Media Filter ^ Leaching Chamber rip Line ^ Grave(-less P' ^ Other (expl ' ) V. Dis rsal/Treatment Area Information: S ~ S Z Resign Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area aired (sf) Dispersal Area Pro (s s m Elevation t ~ a t S ' '~ lv a ~ . 7 gS~ fl . z .s ~ ~ 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S Plastic Gallor-s G~lons Gallons of Units of Units Concrete Concrete ns Glass New 1=acisting ~ Tanks Tanks ~ Septic or Holding Tank ~ 2 p ~ Z .s D ~ ~ ~t~s~ Aerobic Treatment Unit ~~ , Hosing Chamber VII. Responsibility Statement- I, the undersigned, assttme responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me nt) PI bet's Si tore MPRS Number Business Phone Ntunber Plumber's Addre ss (Sitar, City, State, Zip Code) Zg~ z /0 d~ ~}-U.e.. SOiei ~IJG-~ ~>9' l~ Gv/. ~S ~f 7 le ~ VIII. Coun /De artment Use O pproved ^ D' Sanitary Petmit Fa includes Groundwater Date Issued Issu' Agent Signatttre (No Stamps) ^ Ow 'ven Reason r Denial Surcharge Fee) I 2 ~ '- / V J~ ~ ~ IX. Conditions Appro 3) ~ ~ t -~ SYSTEM 1 Septic tank, effluent filter and ~" '~'""` `~ "° _-._ s'-~ d ~ ~ dispersal cell must all be serviced /maintained ; ~ o •~~-(~~~- ('f"z ~~ im,. t„e.,~-.e.~o4o ~,~Q v as per management plan provided by plumber. w ;}-f:,,,,, o(Ip,~~~ ~,[5 ~ ~~.~1 2, All setback requirements must be maintained` ~ ~~~ ~ ~ ~ ~ ~~ de/ordinances bl c li . ca e o as per app Bt Attach complete plans (to the County ody) for tLe system on paper not less thsin 8112 x 11 incbrs do size ~~~ SBD-6398 (R. O1/03) .~ ` b ~~ "V A 0 t ~ ~ ~ O _ .~ 40 Q 'M ,~ ~a ~ M 0 ., 'q bi O ~ i~ ~~ x k1 ~~ i~. C~ ~ ~ ~ I 1 ' ~ ~ ~ ~ o0 r po y ~o~ c~ i o- i~ ~1~ ,-,~ 7 ,,,. .~ ~ ~~ v ~ ~ ~ .v ~~ ~~ ~~ o ~ ~. ~~ J J 2~m v ~~~ g w ~ ~~a w O ~aa ', ~~Qw '. a o a'a ~~ ~ ~ W~W ~ U ~ J ~ Z ~ LL k ~; s 0 L ~- ~~ o°c 4 :~ e ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers otEngineerrg systems 715-772-3442 Private Sewage Consultants PROJECT INDEX PLAN I D # DATE ~~ U ' ~'~ ' O y OWNER G~ CstSS~ ~-2U.eI~ . ~ PHONE 7/.S' JQ/~ -S~~.S ADDRESS .S7j G~j /~~. ~- ~ ~UDSD~ W 1 S • S ~{ ~ 1 CQ LEGAL DESCRIPTION ~p J-- -~'~/, ~~~~/ ~5T¢7`~S s~ s~, s~~~. z Z, rz y~ ,e ~~ w . S~• loo: ~ TOWN OF ,y~OSD~ COUNTY CSTM .S ?~ Ibe~~~G.7-~ a'Sy~3~ LOCAL AUTHORITY/ SUPERVISION ST C/~/ ~ 2D~~ ~~ ~~ PROJECT DESCRIPTION: ~~GU ~~S TiE'U cT i o ilJ - y~0/p ~- Pi~~~o S~'v .----___ Ui'G`C ~ ~ N~~ 7~,4~-rte ,e Cells . ~~~I~~ THIS POWT INCORPORATE 83.44(2)C A FILTER MODEL # SYSTEM SHALL PER COMf~t. PRdOPER ZABEL /1- ` /D~ 'y;•>>'eht ~ Associates I~~ ivate Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 /~'~P~'S ~ Z z ~3 ~ S r1ti6~ • 2 ~ ~bo ~~~~~ Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. r G n C C R c R A U1 3 Q Q n' ~ ~ ~ _ ~~ "' ~7: ~~ i u ,tti~ ~ i , ~y,, m ~ .._ ~ ,a, I m ~ ro g ~ ~~- ~ ~ ~ ~ :~ ~ Z ,`p ~ ~ j e ~! S , ~ ~ 1 ", ~ ` i ~, ~ , ~~ ~ _ _ :. ~~ ._~ ~_, ____ ~ . -_'~-~~ .r r; a z O Rs a ~ +i ~. ~ ~ 1 ~ ~_ ~ \\, ~, b ~ ~ ~ ~ -1 .~ ~. ~` l+ o ~ ~ `~1 ~ ~4 ~)\\ ~~ o ~' 1 '~ ~~ ~ ~' W W ~ ~ ~ ~ N ~ N . '~ ~ _ ti~ i ~y o~ ~ G~ ~~~i, ~~ y ., ~Q N~ O 1 V 1 \~ ~ 1C b ~a~ ~ ~~ ~ { ~~ ~ I~h~ ~~W ~ p_ '~ ~ +~t' iii °~l~ ~~ ~ o~ ;{ ;~N- .---~. _~'~ `~ ~ p {t ~i~ -N W ~i ~{ ~ ~~- - \ ~~ ~,i~ ~~ -ii ;i ~ ~ ~ { { ~y O ~°~ b, ~ L ~ ~ ~ ~' ~ ~ ~ ~` ~° Q t~ !~ ~w---t \ C -'-i~~~ ~ N v "~ A O•Q O 1 m D lrn ~ '~ ~ ~ ~ I~ ~m~ c~ ~ m ~ ~ ~` n Q W~~ ~ h ~~~ n' ~~ V P oa N c O P a N ~. 'Z O W ~ ~ y o ,` y i~~ #. ~~1~~~~ ~Ns~~~ ~~~ ~ ~ vim. 1 r// 1 __ 3U `~~T. - p~5r~-NCB ~ ~~~ r~ ~~' " .~ ~9f'f'~o~i~p t/~.v 7- c,4~' U,v ~.~sp~C T/d,,~ P1/"`~- 1/1/ A/'r'x~E" 1` 1 .. ~z ,. /aJ~~7~1T-4!~ sc~l, , qo -~--Pl1c 9R~f>c-- TiP~.tJ c~ N ~~ S ysT~~ . r G'h'o SS Sic Tio~ o~ T~p~"~uG~': ~j // ys~ S'- ~ s ~ ',~'f'~clrl 1. s~-i ~ .ems c~,o~ ~- -~-~- . 1 ,fir t vv iNS~I~c-T/®,v j~/,~Q- ,~~/ ~~ ~ _, scii . 90 3a ,aP~x~~ %v~eiXfiro~E'., -,~Pac -/ - ~ - - 11z ~ ~- 9~~f~~" T~~~ ~~ ., ~ .~ ~. ,~ . , .. OWNER'S MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner} is reponsible for proper operation and maintenance of this system. Regular periodic inspections and 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 controlling ,authorities.. SPECIFIC CONTACT AGENTS y * Governmental authors t `s~~ ~ ~ f X' c ~/ Y/ inspectors: __ * Licensed installer, responsible for maintenance."Users^ manuaie Providing an operation/ ~a ~~ T`" ~~,(312 ~ ~ cG~ 7- M {CIE' S ~ Zz~ ~ S * Licensed servmce / inspection agent other than installer: T1P/ ~ GT~ 5~4~~'7`~~9-TiOV ~U~-l~?r~U ~ ~p . *. Electrician, for pump, electric controls, wiring units:- /v/ / IMPORTANT OWNER MAINTENANCE RE UIREMENTS • 1. Winter traffic (sleddin g, shove ring, 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. (a vacaction trip, resuiting'in no water use) can also lead to freeze ups.' 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This svs~em was designed for a maximum wastewater flow of ~~ -gals. daily. --_ ~. 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 o~itage 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 (leakage). 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 erosion preventive) can lead to fai].uree1Compactioulor heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'PEM!! Effluent in the„~ystem beneath IS NOT sufficient alone t0 maintai;z a -~ L ~covgr . 6• Periodic inspections by the owner, or his a necessary. Insuec~i-;.,., .,: ___ _ _ gents, is a....~.~.....__ . _ ~ECE~VE ors~a cake ~ f `;,, i-° c; ~~>'<~- ~UATION REPORT ~L~ 3 ~ soooroance wph nom. c:oae _- ~ . t~ae. a,c nd limited ao: vertical t~ Peroentsbpe, scab orrcr, rwrth arrow, and tocaUon to Paroei t.o OZ O ~ l 0 5 q • 9 D • QO D Please print aN irrfonmaGion. by Da>g ~.o~wr~wr~a~~n,u.~eato~~.rw.n~c~r~.«r.~.+so~t+~c~~. , 3a y, ~- A C A S 5~ b E VL bPNI fin/ T IN C Propertyloca6on Govt. Lot S~ 1/4 S E7/4 S S T ~ N R lq E (or1® Pn~pertyownersadd~ess - L,ot# t3lodc~ N s~,ed. Name arm ~ s7A~ S ~~ GTY R.l~ ~ a ~ l~ ~ ~~- ~ State Code Phone tJ~inber ^ fey ^ vNiage ®Town Nearest Read N (vD50n~ WI 5-40/6 ~ 7l5 38~•5~'05 ~o ~2bs5RD ' ~n Nsw cons~xtion tJs~) R / Number of treedroon~s `t code derived design ~- raoe ~ O O 4 P~ GPD O Replaoernerrc O Public or aoner~ - oesai~e: Pan3nt material C~ UT WA 5H _-- Food gain elev~ion SappRcabie !y/Fl s- and reoomrrrerrdai~n8: S ~N h RUUn1 +~L NON RPR~E5a2~~-12~,D,US tyST~M . ,y '_f~NDS ,~ p loo. 3 ~ ! ~ ®Plt Ground sutaoe elev. _ R oeplh m factor G8 -I h Sal Rele Horfaon Depth itf. Oadr>arrt ti#rerseM tiadox Desaipdon Qa. Sz CarR. Color Tex4re Sine Gar. Sz Sh Caads~oe Baxday Roots '~'I '~ a It~'i'12 9/ - siCl a-~sb~ ryi-Fl' w 3-~ .-9- . ~ 3 -40 Iu~'R~l~ - S d m l w av~ ,~ I- (v ® ~" 0 ~ X03. ~'9 qg.~ ® Pit Ground srefaCe elev. R Depth b tintilirg factor irs ._~ Sbit Role tloriaon Depth i-. Oorninent iYNxaaw Redax Description t]u. Sz Cant Color Texture SUtrcKse Gr. Sz ~. Car+oe 8orarderr Roots C '~~ '~ l 0- 15 I d'i~R a/~ - .~ K I~r -F ~ to 2 5 3a - u YR ~+~ i C 1 m-F ~ S ~ ti- ' lv -4od7d IDir' S/ • Etl~nt 01= BOD > 30 < 220 rnglL and TSS >30 _< 1 50 mgll. ' EflMrent fl2 = _ 3t) and TSS = 30 mgil CbT Name tPleaee Prinq Slgr>aa.e ~ ~,~~ Y u ~ ~, ~;~7 - i ~ 3 /4dd~ess Oats Telephone ~ Sf1~ 1n?!~n,~~ ~~QiN~-i ~IJiFt-L~Y.,n/I ()/2--11U'y- '7~5-X70?-3'4`i~a ~:Si~Mieht & Associates f~rivate Sewage Consultants 2812 1 Qtf~ Ave. Spring Valley, WI 54767 ~~ ~'~"r r,~a- a _.. r :~' t/`., r ~-A ('ASSN 1~vLOP. ~~ ~1~ ~ 2 ~~ l tl Tepee StrtrClure Carrs~erroe Baufdery Raols a' te` Hortmn OepO~ ln. Dornirrer~ ftArxrse~ Redact Desa p on Qri. Sz Cant. Color Gr. Sz. Sh. '~1 '~ a 3 -i 5 )5 - - qb ~ o Yr2 a 1~~{24/9- ~ v ~~ si8 - . -- _ 1 / s ,-a , 3~'sbx C K- . 0 s - -~"F>' i m ~ C S Q W - 3 "~ 3 ~/'f~ a ~-f ' (o i ~' ~'7 ' B • ~O ~ ~ (o ^ ~ ~ ~ a,~ ~~,. R b ~ ~ ,~ i don D d R Texiue Silrraue Carmietenoe Roots GP Df~ Morison Oeper ir. Donirarf; t orc esa p e (au. Sz Carts. Color Gr. Si Sh. '~'1 ^ Barirg># ~ Ground, surfaoedev. tt b irri~g factor ~ Soi Reie GPWI~ Harimn Doper i~. Damirarrt Mtnser Redact Oetaiplion. tUr. Sz Cont. Color T ~ SYtrCttre Gr. Sz Sh. Conroe BotttKlery Raols '~'1 '~ 8adtg # ~ ~ Grarsrd sr~faoe R Dept b emi'rr8 factor ir. Haiaott p~ Dorrirrarrt p~p~n. Tmdus Sire Ca~erroe Boundary Rods kr. Sz •Corit. Color Gt: Sz Sh d ,~~-v~ CvP/"r~~T l~l c L~ C~355~ wT 2a~ , hi. P Rop~f~"T ti' t~~rv c ~ I 1 ~ n !e0- ~O ~ JO~Z ~~"' 35 ~ 5 % 5 ~.oPE ` 5 ~' 83 _ Go!J "TOV (Z ~ 03 43' 12! ~ ~ 2a' ~ ~~ gyp? ` bc~ . +5' • M+ ry W ~_ - J prvpasPCl ~ house la~a.-fion ~ ~ ~ a © ~- ~ ~ ,. ~ L~Vf1 T)p ~v s ~3 ~ = 100.3 1 ~ 100 - C7 p Ma Ip ~ 1 =_ ~_ d Gs.U 7~OU,P S • BE~GH M~9RK LISM~ TbP D,F P//DES ~ = l3 b R ~n- ~, C f3 ~ ~ ~'~ = ~p~ SGT/~ G DT' 21 •5'I' CRUIX CUUN'CY SEp7'IC "I'AN:K [i~[AINTENANCE AGREEMENT AND .,... ' OWNERSIIIp CERTII=ICATION RORM ()wtter/)3uyer ~.. ~4 C~ S 3-!r C).a ~ ~_,,Ga~ ~ 'Z9 ) d~ Mailing Address ~ r ~ SAC y ~~ ~q , property Address ~©l ~~ e 1 ~ R ~ a ~- (Vertiicahon regtttted from Ptatming Department for new constriction}_ ~ City/Stag _ ~~~_ parcel Idetiti ftcation Number o 20 - I ~{ 3 ~- -- Z 1- c~c1O LEGAL UESCIt1P"I'IUIV C Z~Zto> property Location 5~_ '/<, _ S ~- Y,, Sec. ''Z. Z, 'I' 2.~. N-R~~W, Town of ~~k~ S.^... Subdivision ~{,p L 1_t~ f-~~s~ L,oi # "T~~ Cettlfled Sttt-vey Mttr # ~- ~Yrtrrt:nty Deed # 7S 7 ~ 3 Volume ~ page # '~_ . Volwne Z ~ 3 s ,page # Y~-S. Spec house ^ yes ~ tto Lot lines identifiable yes D rto SltS~rEM MAINTENArIC~ lntpmper use and maintenance o[ your septic system could result in its prematwe failure !o handle wastes. Proper mainten consists of pumping alt the septic tank every three years or sooner, if needed by a licensed pumper, What yoi put into the sy~ can affect the fimctson of the septic tank as a treatment stage in the waste disposal system. Tile property owner agrees to submit to St. Croix Zoning Deparfrrn;nt a certification form, signed by the owner and 1 mastetpiumber, journeyman pttmtber, residcled phrmberor a iicensedpumper verifying that (I) the on-site wastewaterdisposat sys is in proper operating condition and/or (2j after itts~ctian and pumping (it' mcessaty), the septic tank is less than 1/3 fill of stud ii~vc, the trnctcrsigned have -ead the above requirements and agree to maintain the private sewage disposal system with the stand: set forth, herein, asset 6y the Departntcnt of Commerce and the Department of Nattrrai Resources, State of Wisconsin. Gextiftca~ stating that your septic system has been maintained mus! 6e completed and returned to the St. Croix CoaMy Zoning t3lfice within clays of the tttrec ye expiration date. C,/ SI Al RE t7C APpt.tCANC DATE OWNEtt CEIiTITICATtt?N . [ (we) certify that alt statements on this fonn ate true to ttte best o[ my (ottr) knowledge. I (we)~am (are) the ownet(s the pro ere described above, by virtue of a warranty deed recorded in Register of Deeds UiTice. S GNATUR ~ plr ~ ~ II /ls~ Q ~/ DATE ****~* Any information that is mis-represettled may resttit in the sanitary permit being revoked 6y the Zoning Department. ''+*° '~+ tnctrrde with lhts apttileaOon: a stamped warranty deed from the Register of Duds otfice a copy of the certified san+ey map _it reference. is made in-the warranty deed Wisconsin Department of Commerce OIL EVALUATION RE Division of Satety and Buildings in accordance with Comm 85, Wes. Adm. Code Attach complete site plan on paper ~ less than 834 x 11 inches in size. Plan mist include, but not lirrrled to, vertical and horizontal refererx:e paint (BM), daection and percent slope, scale ar drcnemsK3ts, north arrau, and Eacatian and d"stance to nearest road. Please print all iirformatian. Persons information yaa provide may be used far secondary purposes (Privacy Law, s. 15.04 (1) (m)}. Property Owner Properly Location ~:~ .~ 1226 1 of 3 Steel Sat Service s G .~.__ _ ....... Parcel I.D. Pending ~' ,...Q _ _n. Dale o~ 3 Rellaret Devebpers LTD Govt. Lot SW 1/4 SE 1/4 S 22 T 29 N R 19 W Properly Owners Mailing Address La # Block # Subd. Name ~ CSM# 9900 Va~ey Creek Rd. Suite 135 21 na KeRy Estates City ~~°~~~ State Zip Code Phone Number m City Village ~ Tam Nearest Road MN 55125 651-731-3174 Hudson Ross Rd. /"; New Constructi~ Use: iV Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public acommercial - Descxibe: Parent malarial ou twash plains and stream terraces Flood plain elevation, if applicable na General comments and recornmendations : System elevation 98.44ft trenches spaced and depth to code5.41 beksw grade / ~~ # Boring 105 Pit Ground Surtace elev. 100.45 ft. pepth to in. limiting factor ~ Ap~n Rate ttosizon Depth D~;r^ant Color Redox ~ Tezt~~re Strrxdure Carsste ae Bous~y Roots GPD;It= `Eff#1 'Effi'R2 1 0-12 S Oyr3/2 none sil 2msbk mfr gw 1 f .5 .8 2 12-24 10yr4/6 none sicl 2msbk mfr gw 1vf .4 .6 3 240 10yr4/6 none scl 2msbk mfr gw na .4 .6 4 40-53 10yr4/4 none sl 2msbk mfr gw na .5 .9 5 53-105 7.5yr4l6 none ms osg ml na na .7 1.2 t L f Boring # .~ Boring u / Pit Hor¢on Depth t?omusrd C~ 1 0-13 10yr32 2 13-18 10yr4/6 C,~ u 1 f 3 18-32 10yr4/6 4 32-53 10yr4/4 5 53-105 7.5yr4/6 Ground Surface elev. 100.45 ft. pep}h ~ lirrfiting f~ta 105 in. Redox Description Texture Stnrcture Cors~tetx~ Boundary Roots none s8 2msbk mfr cs 1f none sicl 2msbk mfr gw na c2d 7.5yr45/6 scl 2msbk mfr gw na none sl 2msbk mfr cs na none ms osg ml na na Sod Application Rate GPD~t= 'Eff#1 ~ "Eff#2 .5 .8 .4 .6 .4 .6 .5 .9 .7 12 - trrruenr ~~ = tsuu ~ :w < cuu mgi~ ono r 55 >30 < ~ 50 mg/L `Effluent #2 =GODS < 30 mg/L and TSS <30 mg/L --- -- _ CST Name (Please Print) - 5igru#ud? __ _ _-- -__-__ _- _ -- -___ .._ CST Nurrsber David J. Steel w~Q~ ~ ~ _ 248956 Address St¢a Sal Service ~"`"~-~ Date Evaluation Conducted Teleptrarre Number 1564 CR GG, New Richmond, WI 54017 10/23/2002 715-246-5085 S property owner Reliant Developers LTD Parcel ID # ~~ # Boring / Pit Ground Surface elev. 103.85 Pending ft. Depth to limiting factor 105 in. Page 2 of 3 Sol Application Rate Hrxizon Depth Dominant Cobr Redox Description Texture Stnrdure Cor~btenee Boundary Roots G!'Dfft2 'Eff#1 "Eft#2 1 0-15 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 15-29 10yr4/6 none scl 2msbk mfr gw 1 of .4 .6 3 29~t8 7.5yr4l4 none sUls 2msbk mfr gw na .5 .9 4 48-105 7.5yr4/6 none ms osg ml na na .7 12 1 ~ i L~J ~~ # -; 8onng ~j Pit Graind Surtace elev. 103.85 ft. Depth to limiting factor 105 in. ~ qp~ Rate Hor¢~ Depth Dominant Odor Redox Description Texture Stnx:ture Consisterace Boundary Rods (~D~ "E'f(#1 *Eff#2 1 0-8 10yr'3/3 none sil 2msbk mfr cs 1f .5 .8 2 8-22 10yr4/4 none scl 2msbk mfr gw 1 c .4 .6 3 22-33 7.5yr4/4 none sl 2msbk mfr gw 1vf .5 .9 4 33-52 7.5yr4/4 none sUls 2msbk mfr cs na .5 .9 5 52-105 7.5yr4/6 none ms osg ml na na .7 1.2 ^ Big ~ Bortng Pit Ground Surface elev. ft. Depth to limiting fade fa Sod ~ Hrxizon Depth Dorninent Cdar Redox Description Texture Stnretrxe Corrsstence Bax~y Roots (~D/ft~ 'Eti#1 'Eff~2 ' EfFluent #1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mglL ' Efflu~rt #2 = BOD$ <3D mg/L and TSS <30 mg/L The Department cf Commerce is arr. equal oppcrrtnnity service provider and emplo~~r. If you nc~d assistance tQ aortic s~-rvices or STEEL'S SOIL SERVICE Page 3 of 3 David J. Steel 1564 Cty Rd GG CST-POWTSM Reliant Developers LTD New Richmond, WI 54017 Lic. # 248956 SWl/4,SE1J4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (?15) 246-5085 Kelly Estates lot 21 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' ~ N ./ ~ Benchmark El. loot Top of 'h"pvc pipe Alt Benchmark E1.9r 5Ft ? op of/2" pvc pipe ~„ ~ ~ o =Borings `~D'-" - ~o (~''~ ~ .^ Boring Elevations a ~~ ~,u~^" `~ ~ ,~ B1 =100.45Ft ~f~~o ~ Q~" ~ B2 =100.45Ft B3 =103.85Ft ~~~, i w• B4 =103.85F qb' ~b~s ~~~ Z;~o ~s~ ~~~ o ~~ ,, ~-~, f ~~ ~~ y ~~~ ~ ~~ ~Z ~5~~~ ~ ~,~ ~~' ~~o S~o~~ =~ ~ 23' ° Z ~-~ ~ 0 7 ' ~. ~~~ s b n~ ~- ti„~ o ~ ~ .. n,.zf ~ ~( 1 ~ to I i .. "~..,a.` \ ~ s g, O6' _ _ ' Yt I_ v . ~) \ .~y~.. s' I I I{ i-.~ i --8 ~• to'~a i. cc' c 1. ,.a~~1 I i d. ! 8~ I fl\ S 1 ~~ rt,y 1. 1. 8 +' ~ f7-Z i,l .. . M 1 - - ~\ r• / ./ ~ is _ ~ '~~'pJ" '~~ \ ~,~~i~gri% ~/ YFi~~Y~^~- l':'7 .1, I , `w.at . P 1 ~ I~' w~~51 ~ ~ `n y 3 / d / 1 ~ ~ f ~.~ ~ I111IJ F - .. . .. 1 • 1 . ~- 1 ~ ~ f ~ F 1 r ~u~» M/ X11'` ~ 1 `~~';j~' ~ p iypri "r~ ~ ~ I I; ~~ ,~ `emu ~~' ;• ~ ~~ , ~ ~ ~ _ ~ •,s~ ~c11F ~t~i(d I~ IV ~ \`~ `~~=r'~i r /, ~~wi I ! / ~ .\ \`'\ i..'J • ~D~ -"y: ~ L ~ ~ I M ~ ~ `• \ _ ~ ~' a ~p ,` /' ,: ~i ,: to III ?' • ~ , '~ ~. ~ n . ~ . - ~ "!i / l .' / ~ ~r ~ r `ri I ~. ~`tl I \ ' •~~'1 1~Cro~ ~~1~t $ ~ ~ ~ `_ ~ ,\, `f L f 1yi ~!. } ~) III 1 ! i ,~ ~ _ 1 ~ ~g?n ~ ~ ~`_' ~k ~ y ~ i ' . I@C k' nit ` ~ ~ . w ~ ~ I t: .\ •~ yr` ~~ \ \~ ~ j , t i .. _ , Z ~ ! 1 '~ ./ f //' . ` \ 111...•. ~. ! , l :.7~s\1 ; -.:: i~: ~~ '~^ r 329.18 N03 .7 7. E, Wz ~,:. ~ ~, ""' Pf,'>flblNC £AS£MENi$~ ~~. '~ .I ; ..,.., , ~ ++ ~ 416. 3 N01°0508y ~ 1'`' I O n 1 ~. .~ `~~ ~N~ a` ~ yy ~ 1 . i M _' ~ I S~ i r i m ~ :3~~I ,~~. `` ~ ...k ~~~ ~ ~ ~;~ ' {1cs, f~ for ~~?J•~ ~ ~ i ~ ! \ ~~ ~ x ` ! ~ , ~ .~~'\•~ I v I fit. ~ ~~.. ~~ , .,~ _63 ~ ~~ '' c.s..`~ iiierV~ j ! ~ t .1 \;.,~4`\ P r1 m I ~~~ I ~~ ~'.~~: ~m I ~~ ~R k 1 ~s~ PI • ... ,' t ~ i, ` ~ r ~I ; F ~' i~ ~s c 1 / f ~C7 to I ~6 ~ j i~ r~ i GN FnsQ F~ ~~ ~. « ~ ~~ l ~ ~ (' y~~ ! ~_ v .. 1C ~_~lF3 _ _. ._ • .I GEGK ~~.__.._T~. t _ a~rt_~~l ;~ ~ --_a I NJ~K `-1- ....,.~M. i I.NGRY t GRE.4 F Rt;QM - j f-r I ~~ KITCHEN MUD RM. -- t ~ ~ ~ ~ PANTRY i~ , i '~. 51'UGY FrJYER ~~ irJING GARa"v'E ~~ n i ~ t i r° I i i ~_ ~! , BEDROOM 2 / BEDROOM 3 / GIOSET ____ ___ BATH ~_., OWNERS SUS'i'E ~ ~ I i ,t , 6 ~ _ l ~ ~ ~`~`~ I I i GWNER$ _` ,-- BATH I ~ ,~ i r i F(?YER ~ ,~ ~ €~ ..-_ ~ V 841~IS L(?Fi BEDROOM 4 r _~.,.___ t --- --- _____' i I i i I r I ~ I ~ i I ~ ~ ~ I 4 ~ I [ I I I C k A t __ .._ _.t I I i I i ( i (___.,.... ______a i t__________________________~ Document IJ 2535 P ~i 9 5 STATE BAR OF WISCONSIN FORM 2- 2000 ber WARRANTY DEED made between Reliant Developers, LLC, Grantor, and aCasse Develo men c., 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 an 1, Plat of Kelly Estate Croix County, Wisconsin. `-' Recording Area ~s~g~~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED F'OR RECORD 03!29!2004 09:10AK WARRANTY DEED EXEhIRT # REC FEE : 1.2.00 TRANS FEE: 4074.00 COPY FEE: CC 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"d St. -Suite 115 Hudson, WI 54016 423495 020-1060-30-050,020-1059-90-0 d0 Parcel Identification Number (PII~ This is not homestead property. Dated this 26th day of March, 2004. Reli eveloper 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 INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature * * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this March 26, 2004 the above named Rick_ oston, Chief Manager, Reliant Developers, LLC xo~'ine~ known to b the person(s) who executed the foregoing instrument and ackn !edged the same. ,~ Notary Public, State,bf Wiscons' My commission is p~ M'3 ate: 11i4i2oo7 f JUDY LARRIEU ) State of WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 ~~~ s ~ 1 1 u• ~ O O , {50' { {r°i 1 1~ ~{ { {+ 1 ~~ 7 { ~ { ~ { 6 ' { 3 106631 S.F. r 10 { { ~ '{ ~ (2?580 AC) 1 1.'~'~ (2.448 AC.) 1 1;- - - - -- ~ -- J `{ { IM t 1 A { ~~ , ~ .{~. 5~3 ~• R { { S yak ~ ~.-~ 1 r{ s ~ ~ ~ ~. _- { ~ { i 1 ~~~~ _ ~ ~ N79n6•3~wE ~3Y r 1. -- '" -- -----'~'"HF.R~TA ..- r ~" 33' ~ 7` ... '' 9 ..~ ... ~ Q .•- - ~ c ~ ... A16 ~i ~ ~, 6 7 S.F { ~ ~ ... ~%' . w N`s8'S~8 3~Qry~,''_!wN (0.373 AC.) 1 ~ ~ ~' 264.62 4~~"''~~9~'~1r tic ~ I ~ 1 r~ ~ • ~ ~ 1 Fq v~TI: 0~-1 0-1 ~ 0 1~ ,~ 9 .o ~.>,~ d~ ~a ~ ~+' 1~ 108434 S.F. \~' 76.73• ^ !" `"' y ~ { ~ N ,~ (2.489- AC.) N89'19'31'E W W i ~ 1 ~ 1`~' No owEL.uNG ~- .-- -~ In v~ { ~ ! ~ ~~ Ba.ow ~" ~ ~ ~ r '~ EL.EVATION 923.8' ~ a d { d cv .- {•- 461.58' - - -- ~ ~ r ` `•" - " -" L _ _ N$9'19'31'E 411.77 _ _ _ _ _ ~ 3 ~~ ii ._~.~---- ~, ~ ~ .~- - ----------- ----- g ~I,.y1 .+~~, ~a ~' ~1 ~ ==a TOP S--= ~ ~ ~~ ~. { . ~ . 1 ~ 91498 S.F. /f. 47.53' ~~ A ~ 1 ~ ~ ~ {. (2.100 AC.) ~ ~ .~/ R G 1' ~' { • ~ NO-DWELUNG os• ~ \ 132441 S.F. ~ ~ { EXTERIOR ''or, ~~„ ~. (3.040 AC.) {, { i OPENING BELOW ~N ~ ~ ~ ~- w\\ {. - { ELEVATION 919.7' w ~/ ~ ~ ~ 'r-~ i ~ N89'19'31'E 381.42 _ _ { _, _ ~' i`~g g1 ~ ---- -- ~ _ t'YY 495.96' _ _ ~; { .~~ '_ ~~~ ._ ._ ~ ~ _ .~ { ~ N •p -.-.---------- --~. ~ ~; ~r3 ~ $$ . :3> o !@ .. ~.r 7s { ~ ~,.__.___t t~ t g { . ; _ 105538 S.F. ~ { 4 z ~~.. ~- ~ , t ' `~ 1 -- No DWELLING EXTERIOR ~ im _ ` ~ , I ~ ~~ '~ ;y OPENMG BELOW r n ` 1 1 ~ 4 '., ELEVATION 919.7 0 l `'' ~ ~ ~ Z{ :29751 S.F. 50' { •- ~~--' 2979 AC.) { ~ --~ i 1~ 0 ~°~ \ 1 F MONUMENT AND { 8 1+ 1 S i N01~lhtENT ANO g ~~ - ` ~ {~-.~- L.ANOSCAPE ~ ~ a 1 ~' ~ eWnCf_epF~r_-'~"{ '~ {_ ~ 1 { _J__...•' ra~rue~.T _. ~!>> 1+r,R' R'