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HomeMy WebLinkAbout020-1450-07-000Wisconsin Department of Commerce Safety andt3uilding Dtiision PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Grand Pro erties L.P. I~udson Townshi CST BM Elev: Insp. BM Elev: BM Description: ' ' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing -----_.. Aeratio ~~~ \ 0 Holding `~.~b.,,.: ~ /~ - ~~ ~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ GC- ~ _ _ -.. Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numbe TDH Lif Fricti oss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 453455 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 22.29.19. STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ~/.ro3 9ta.3~ SUHt Inlet ~ . ~7S ~ cl V .'L'~ SUHt Outlet Dt Inlet Dt Bottom i Header/Man. ~ . ` gti.s Dist. Pipe \ Bot. System ~,,; zed- zw ., ~•~- ~~ • 2 • Sc> Final Grade St Cover 9 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~, ~ -. ~ ,,~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ~ ` ~w, Z~ r ~, .,7 A/ ~ ~ UNIT Model Number: L L I . ~ ~ Lt-i n y 2~'~ G ~.- L-- L I `.~ DISTRIBUTION SYSTEM ~- l-IS' ~~..>~~ Header/Manifold Distribution x Hole Size x Hote Spacing Vent to Air Intake r d 8 Di ~ pipe(s) th Di L S i ~~~ Length a ng eng a pac SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil n Yes [] No ~za [] Yes [] No COMMENTS: (Include code discrepencies, persons present., etc.) Inspection #1: /2 I Z / C? `~ Inspection #2: / / ~~~ Location: pending new road name Hudson, WI 54016 (SE 1/4 SW 1/4 22 T29N R19W) Hudson Est~a(tes Lot 7 Parcel~No~:~22L.29.19. ~/,~, 1.) Alt BM Description = j.< ~. Gid"`"L ~2 G(Att'0 R rt G~YACtNt4~2. t~-8+ S~x 2.) Bldg sewer length = ~~-!' W(~,(~p,~'~ i9,0Y-F'l. ~ GLPP~/, , j3 ~Q~~tn O !'y"'l -amount of cover = 5v., (Q'~ ll~hs- ~ ~ 110Y-~'k a1~ g/, ~~,-~i~L f~N~„f'~-QI~+~Q _ fit. ova-s~'d ~ rLra,c'I~.q~e. - e QSe vw~,~__ - ~e...._. Plan revision Required? '_ Yes [°s~~ No ~ ~~ ~ J `~. I~ -- - , i-- _ ----------- ~ ------ - - -- - J Use other side for additio i rmation. ~__ _- L- -~ SBD-6710 (R.3/97) / Date Inse~cto~r'saSignature n~ q C/e(~Jrt~~/NJO. ti'v r ~/ ~~t: ~q~C;..~`~ ~f1.2. ~ ~ W~y, ~ '~~~~ ~ ~W~l• ~ ~V~ ~~iG / N ai O 3 ° ~ ~ ~ N C• ° 7 7 ~ A (y a o W O o ,r L O c. a a c m ~ ~ c c 3 ~ ~ N N d 3 O s (D C (D fD N ~m °v m -„ ~ ~~ D m o 0 0 °c ° CD °m °- CD ~~ ~ a~•~ mD n 3m°m~~~$p~ ~ Z > j x2 ~ a~ ~ a o O~~ O S N y. c0 y ~ ~ D_ ~'+ CD > N ~ CO ~. N y•o~mymNV? (D N N ~ 7 ~ CD ~ ~. v o 3 0 o m d m? a~ c m 3 m ao ~f° m m w va aam ° 3 c °~° d m f m f ar ~ N fD ~ d .~•. D. ~ C7 ° m 3 Sao c'u 0 0~ N•coi~y ~o CD N m ~~ ~~~~ ~ a '~ ~ 0 m f» O O °o ~ c ~ f ~ ~ ~ ~ 3 :* O A ~ n ° I N N ~ r - a ~ a °° ~ O _3 N ~_ O A d m O O O c 0 N N ° ~ O D ~ A ~ ~ ~ A ': ~ o ~ m rn ° 3 M ~ ~ o ~ - ~ ~ ~ o m ~ N N C ~ ? Q N ~ O C ~ a W ~ a °o 3 !~ Z A m c 3 a 3 ~ c ~, n 3 ~ ~ ~ d c N d N o CO J N S .0 3 ~ _ c n O 7 m d N ~ ~ ~ A Z ~ ~ ~ ~ A ~Z ~ mNN. ~ Z i~ ~ ~ ~ i A d :: i•-i O ~yO Ir 0 d • O 0 ~y.,~ • `~ tii ~p1 ;va O 0 a Y N ti °o A A as a m +a ~v q ~° b 1 Cpl r- ' ~ Safety and Buildings Divisiot~ ounty j ~ ~ s 201 W. Washington Av P.O. Box 716 / ~ -scons-n Madison, WI 5 707 - e it Number (to be filled in by Co.} Department of Commerce (~8) 2 3151 ,EG'~ Sanitary Permit Appiicatio v igu Ian I.D. Nu{nber ~ J In accord with Comm 83.21, Wis. Adm. Code, persona[ informatio you pro tle .~ ty' ~~ / " / t _ ~ _ may be used for secondary purposes Privacy Law, s1S.04 1)(m}sr ~ Proj ct Address tf different than mailing address) , __~~ ~~ ~^ ~ ~/ + gD~ ~r+~~ I. Application Information -Please Print All Information G OFF/CE Pro rty Owner's Na me ~ pe rcel N L Block N Q ~ Property Owner's ailing Address roperry Location • i~G~l~.Y ~i~.r ~ ~! y C'~~S4 Section ~ ~ ~ Ciry, State ode Zip C Phone Number , . , _ - .~Q' ' t~ ~~ ~ ~ / / ~'Y r~~~ ~° ~~GrCf (circle o ,) ~ ~E R ~ N 'C ~ ~~ ~,~ , II. Type of Building (check all that apply) S-~ _ . . ; ~ G 1~1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ____ ^ Public/Commercial -Describe Use ~~' ~4~ ~3 __ _ _ I ____ f ^ State Owned -Describe Use ~~ ~s~ C~~S GtJ~ZZ ~3 l~Village~I'ownship of /'TU~~r' ^City _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ( ^ Replacement System ^ Treatmentll{olding Tank Replacement. Only - ^ Other Modification to Existing System ~ B. ~ ^ Permit Renewal iration Before Ex Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Data Issued ~ 1 ~J C~t ~ p , , - t..J .J --~J ~! t IV. Type of POW'I'S System: (Check all that ap ply) _ _~_ 'on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Singh Pass Sand Filter { ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Pea[ Filter ^ Aerobic Treatment L'nit ^ Recirculatmg Sand Filter i ^ Recirculating Synthetic Media Filter ~'X.eaehing Chamber ^ Drip Line Ci Gravel-less Pipe er (explain) V. Dis rsal/Treatment Area Information: / S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sft spec Area Proposed (st m Elevation a VI. Tank Info Capacity in Gallons Total Cations Number of Units Manufacturer Prefab Concrete Site ~ Constructed Steci Fiber Glass plastic ~ New Existing I ~ Tanks Tanks ~ _ Septic or Holding Tank J C°ds ~ ~~ _ t~ ' ' ~ Aerobic Treatmem Unit { ~ , ! ~ %il~ !lllJJ W _ Dosing Chamber ~0~ / ~S~Y _ • ' ' ' ~ VIL Responslbillty Statement- I, the tutderslgned, assume resporrsibllity for ' aUation of the POWT$ shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature P MPKS Number Business Phone Number Plumber's Addre ss (Street, C°i~ty~S~tate, Zip Code} ~j p VIII. oust /De ailment Llse Onl _ pproved ^ Disapproved ^ Owner Given Reason fttr Denial Sattitary Permit Fee (includes Groundwater Surchir a Fee) J~ ~V g _~ ~_v ' ~ _ ~ ~ ~ Date Issued 1 ing A nt Sign cur (. Scamps) j G x /~ 27 ~ ~ ~ ~ p-yt IX. Conditions of Approval~Reaso~r Disapprov s '~ ~ ~,~ ~~ 9 y~ay ~~~- ~,~ ~~ ~~~ Sys, '~ ~, ~~ 3 `~°s~ ~ S .fir-t a.,~ 93. o a~i > S v oy e ~ ~~ "r ~,. ~~ G~~eS~ 6f g~Bz .,~ rdvic(G prty-~ar~I POUr~t'.~, C~ f'1'l ~ e~ofr~-e s~..r~-e.~. a~e~ n.a r~ ar ~~.~-c..s" C~ ,-'2 ~ s ~~s'u~~ e~ ~~~, ~~,. a~ .,~ ~~ ~~~ ! ,, ya, ~ ~'- ~~ ~J6~ sal r~~~ °_ /U6~~ /a~ l,'N e. ~. ,fl. 31' __ o ' ~~ ~~ p.~~ ~~~ ~ e~~ ~!~r~ a~ S~u~i ~~" ~ ~ e~ ~ ~ ~~ s ~ 8~ . ~ g~, ~~ ~` s ~- ~ ~~ /o%~ Yom- r~ ol!,~'~` ~'~~~- ~` t -~=~C~.cf~~ •.~;c~" ~ ~.~~ s~rll ~~ .sys . t 0. ...,....._ ~ ~ 3° ---. .: f? ~ ~~ g ~~ !! __ ~__ ~ (~9 ~ 1'k hl' ~~OWY~ (o ~ G f TLt~ ~ ~Z Io~-~e sd~ ~~ .-~~ ~~~~~s ,~'~~ ~ C t~ ~ Y PAGE~OF 3 TZ~' N R cif E (oil BM 2 DESCRIPTION SYSTEM ELEVATION 9 3' ~ ~ G ALTERNATE ELEVATION ~ 3- ~ CONTOUR ELEVATION ~'- ~~ ~ ~ 4 2 ~~ ~ G d ~___, Z3U i d~~Y C' /~ 'k~ G~~ . ~ ~~~ ~; ~Y ~7 fTl f Z D -{ ~D -~ '- D < o v o n o ° z N a m o ~ ~ m ~ "'~ r ~ n ~ ~ H ~- 0 ~-~- °'~• ~~~ o~~ o Z a a 0 0 ~...~yN }'~~ t :~ ~: .. a .~,-~ ~ ._.......~ .......~~,. -~~ / " LOT 4 ~ 2.548 ACRES 0 _ r^ ~r?. 0~ ~ • ~°' 110,897 SQ. FZ'. ~ ~i~ / 0 L.B.O. = 905.10 0~~ y y Wis. ~ N ? y 0' ~ vo 3~ ~3W p~1 6 077 ~ 0~ o w v tv ` HWL = sos.5o LOT 5 o bRAINAGE v 2.004 ACRES cs\EASEMENT ~' ~1~ 87,278 SQ. FT. ~~A ~ L.B.O. = 905.50 ' ~~ ' 321.71' S84'25'11 N89°48'23"E BENCHMARK: TOP OF 31.25' IRON PIPE=915.4 O E88 2 ~ ~ I i 101 o ~ w I ~' I ~° C v o Idles ion ~ F~9 LOT 6 2.004 ACRES . 87,296 SQ. FT. \~ L.B.O. = 905.60 0 vs u.• ~j1 ~ .~ ~.~ „• S~ ~ ~,S89'2 f^ . ' ~'~ ~ o+ . • / ~ a~ . ~ V~ ~~ • / ~ '~/ N89': Q 11' ~/ ~ \~ / ./ •/ _~ ./ I ~~ LOT 2 . 2.003 ACRES • 87,243 SQ. FT. w ' ~o w 2 W • N ~ ~ • • ~ N ' O ~ ~ ' 240.68' • ~ n, ~ ~ N89'29'09"E . ~ rn ~ ~ . rn ~ ,~ m o, .• ~ ~ Z w •. ~• ~ tZ LOT • ~ 2.004 ACF "~ 87,282 SC I ~' I ~ I ~ ~ N 1 ~ 124.27' I~lo _ ~~~~~ \ 377.99' I~I~ I~I~ r-' mm o Idlo ~ ~ o~ ~W I ICI =Wti N O N w . i I I ~ E97 .~~~ LOT 7 s~ --.-r.~ • , WL =903.60 ' ~ 2,004 A RES ~ ~-- ; ry . 87,273 . jrT 50' I z 50' . EASEMENT W I L•B.O. = 05. I ~ ~ o °o 1 .E ~ _ o W W o 9y . ~,Ey',4. ~ SEIy ~ ~ I ~ _ c ~l ~ Q ~ ~ y ~ ~ ~\/ `96 t-~'o~Q~~Am7LTt!-Y 'Q7S~- ~ ~ 33 133 '""~Dn6~Tc~n.: ~ BAD LANDS ROAD N89°51'27"E 649.27' BADLAND MW1~~44C~D ~QI~D~ ~,~,2,e l " 'Ya' P ~ w /Qm ~'6'' sll %6~'~ ~"11V \V" ~ -,~'' ~ y~ ~ ~ c ~ f (', ~~ e, ~o ^, ~ ~- ~ ~`" ~S ~y~ ~,~ ~~. ~ t ~"~~.~ _. oal~ .v f I (~ ~ /~/~ t o~ ~ ;~„~ ~`j I ~~ ~ ~~ _ T ~ ~ ~' ~~~ ~ ~~ ~~ ~ ~~ ~ ' I I ~ ~ _ ,, ~, 1 ( i .I~. L i IY 1 `~ ~ -~~ + E ~, Zo ~t;. ~i~ ~. ~'.e,2~ ! '• = Yd r ~i 7 ~~1 ~~ v 0 Qr~'/~~- ~~~ i .~~ ~ ;~ ~cl .'v ~,2Q6 ~'~ ~'~ r:'~ G-: fh Z~ ~ ~ ie-~ Wisconsin Department of Commerce Division of Safety and Buildings 0 SOIL I N REPORT Page ~ of m accoroancx wnn ~.omm o~, vv~ . my Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz Plan mus - indude, but not limited to: vertical and horizontal reference point (BM), . rediory ~ d ~ I,p, , percent slope, scale or dimensions, north arrow, and location and dis ce to n$I ISt rgad. ' Please print all information. ;i ST nReviewed; Date ,'l /~ ~ Personal information ou ide ma be used for seconds Y Prow Y ry Purposes (Privacy ~ AA~ ~ ~ )) ~~ Prop ertyOwner Prop // ~~"1~2~~ ~~~~ SG r1 ~~ irat/ls~l '~ Govt. Lot ~- ,~14~r~1/4 S~ Z.T ZC( N R E (o W~ Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 2 ~ ,a - ~, ~` t O-O ~ ~ ~ ~. O ily Code Phone Number State Zip ^ City ^ Village ®Town Nearest Road C _ ~/ -X.)rvV- ~} f-t/~ "/f1Z (~ ) ~_ -n C.ov~ ~Qo~ ~ct /lcY S ~ New Construction Use: ® Residential /Number of bedrooms 3 - `L Code derived design flow rate y ~J /~o ~ ~ GPD ^ Replacement ~ '' (( ^ P'_ublic or commeraal -Describe: __ _ ___ Parent material ~t;~-r iw`~` Flood Plain elevation ff applicable ,~ _ ft. General comments ~ C~ ~ ~{, U ` ~ ~ ~ ~ v / ~ f Z~s /~ ~ G~~ ~p S/ and recommendations: Y ~ /-^ 1 i V /oc~,~ s 6~ d ~~-s-, G~/lavria - ~Z ~s ~~~ G~ ~ Boring ~- ~ ~~~'W~~ uu~!'vrv~~'~,ry ~ - Boring # 6 !/ L ® Pit 'Ground surface elev.~~ ft. Depth to limiting factor i I in. Soil 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 I ~' t ~ ~ L Z„~sylC ,fir c'...s ~ v~ a s ! ~ r ~ ./ / Z, Bori # ~ Boring ~~/J'1^ a- pit Ground surface elev. • 20 ft. Depth to limiting factor 1 Z ~ in. Soil lication Rate orizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I Q ~ iG~(r31Z ~ ~ ~ zrrs4/~ w~~-r C. s j~~ :S .d L ~- N ~. N - ~c..I ~ l~ ~s' - ,~ ,~ 3 y~ I ZU ~ ~ 1 I - r L',~ .. lam' ._ ~ ~' 7 ~• L+ 3- d ~ `~ 9 • Etfltrent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mgA. • Effluent #2 = BODS < 30 rng/L and TSS < 30 mglL CST Name (Please Print) _ _ CST Number .~= ~ S ~ Tess Date Evaluation Conducted Telephone Number ~ ~ i3 ~U ~ s,< ~iti._e ~-~, ln1' / ~ ~"1z'GZs /d - Z r/ - o `/ 7/S - 7Go oZ ~p /~ ~ Property Owner lam. nG~- ~tiP. Parcel ID # lr ~ 7 Page L- of _~ ~ ^ Boring `~ ~ Boring # ~ ~ • Q pit Ground surface elev. ft. Depth to limiting factor ~ ~ t%' in. Sal licetion Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 N~ ' f !fir 0 ~ / l(,' - ~ ` ~ c tn~ 1 - `_ r ~ 2 v D ii /~~ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ^ Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit - Sal icaGon Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh. 'Eff#1 `Eff#2 • Effluent #1 = BODa > 30 _< 220 rrglL and TSS >30 < 150 mglL ` Effluent #2 = BODS < 30 mglL and TSS < 30 mg/L 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. sso.e~w ntdoor SCALE: 1"=_ ~~ / BM l ELEVATION ~~~ BM I DESCRIPTION ~- 0 U-~ Dar ~ ~' ~~ r S~~ ~~ BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION q 3' y ~ ALTERNATE ELEVATION ~ 3- ~ rnNTCx IR ELEVATION PAGE~OF / (~~ ~- Safety and Buildings pivisiun i County i 201 W. Washington Ave., P.O. Bax 71b~ -`~~~?!'ct ~ ~C _ll ~SC+O-~'1Sitt Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce ~, (fie) ~'~~-'1S1 S3 S~ . . i State Plan l~ N mbar Sanitary Perm>tt Application ~ In accord with Comm 83.21, Wls. Adm. Codt, personal iafotmitiort you provide may bt used for secondary purposes Privac3r.t.;w; a1i3~94Ft){m) , ; - Proj Add s (if different than maiimg address) t 1 ` I, Applica Information - Please Print All Infor tion ~ ~rnA~ a~ PropertyGwru:r`s me ~ . ~ - ~' ~ ~' Farcei;V Lo Htockk ~ ,vt:/''ciJ(/c~ t~ Z:°1/ice: C-.l /~ ~r T//~ Proptrry Qwaer's M sills,? rtes ~ _ _ Pr~ty Location__ ~ ~ ,,,r~~c~l 2 ~~`U~-s~c~ l'~ S"c~6`~-e- t~'d City, Stan Zip Code Phone Number '~~ '~'~~ ;4,Section ~?~ Sah~ e-vy .~ ~ ,` j ~ ~~,;~~" ~ i/~. ~11~ (circle o ) ~ T ~ N; l2 /~ 8 or~ II. Type of BttildinQ (check all that a ly) ~ g w~ ~ Subdivision Name CSM Number i ar 2 Famfiy Dwelling - Ntanber of Hodr ~ ~S. ~ PublicJCommerrial -Describe Uae c'c ~~D,~ ~` ~~.~ ' " ~ State Owned -Describe Use of ~' Gt./~ 2 Z 'f" ~_ 'Ciry~l~V illage,~'`I'ownship of sc ~$'c:ti~ ____ 1 III. Type of Permitr (Check only one box on line Complete line B applicable) A' r 'New 5 stem . y ~ Replacement System '~ atmenuHoldl ank Replacement Only ~ Modification to 8xistia System __ B ~ ~ Pacmit Renews! ~ Permit Rtvision ^ Change G Permit Transfer to New L~ Pr loos Pe t r D to issued 9efore Expiration ~ ~ Plumber Owner 'i i_ _ IV. Ty of PC)WTS stem; {Check all that a 1) - - l ,"~' Non -Prasaurizsd [n-Cirouttd ~l Mound > 24 in. of suiutbie sail ~ nil < 24 in. ox suitable soil ^ At-Grade ^ SitlSle Pass Sand Filter I © Constructed ViJetland C Pressurized In-Ground ^ Holding T ^ Pe titer ^ Aerobic Traatmeni Unir u Recirculating Sand Filter ~~ ttecirculatin S athetic Media Filter eachin Ch r Dri Lane ravel-less P' a er ex lain V. Dls reaU'Iti'eattueittt Area lnl'o n: -~ ~ -- S _ `_ - i JJ Design Flow (gpd) Design Soil Applioatior tgpdsf) A ersal Area Required (sf) Dispersal Ar ro I Systern Blevetion G moo- ,~ ~ 3 ~ ~S ? , ~ . ; e~; s o K ~ I V[. Tank Info j Capacity in Total hum r Marufactuter Prefab Site Steil i Fiber Plastic Gallons Gallons ~ of L' is ; I Concrete Conantected ;Glass ~ I New Existlrtg~ . ~ ~ Tanks Txnkt ~ ' ! ~ ~ Septic or Holding Txnk ~ ~ ~ Aerobic Treantttnt Unit I { oairsE t~tarnber ~'4 J VII. Reapotuibll#t Statensent- I, cite tmdersi ed, assetate its anslhllit for saltation of the POWTS shown the attached lane. ~ Plutrixr's N: me "-' (Print) Plumber' Si gnaturt ihiPRS Number Business Phone Number ; Pl,tmber'a Atldre ss (Street. City, State, Zip t) _. I i /4 7~ Ste. ~: ~~ •` ~'L/G~ ~~ I ~~VT ount /De artment Use Ortl Approvgd ~1 1?isapproved Sanitary Permit Fee (inches Groundwater D to °.ss ed suing Ag Signature mps) ~ Surcharge Feel dv ~ d ~ G~ I~~ ^ Uwtter Given Resaon for Denial ~ ~ 2 ~, / 1 u C 1 cx ~P Ap~,yt p,~a~al/F~easons Por Disapproval ~ ) ~/ ~Ol~'~ /~~ q~', l>rn ~'~-~ l~2ati~ ~~ ~o--rn~t1t 1-~itJ SYSTEM R: Q ~~~.~ Septic tank, effluent filter and // dispersal cell must all be serviced /maintained ~ ,,S~Pjy,~ ~~ ~ ~~~ ~~~~%~k, g/, ~ Z ~,~ 7 as per management plan provided by plumber. ~L~a- ~ ~~;~ ,S-`2~d ~Q,1G7`u 2~ 2. All setback requirements must be maintained ~ ordinances. rZe.d,dll ~'_Gc,I~IU.QoI `-~ec~ ~ ~-e ~ ~~ ~' ~ ~S ~P~ ~ fto Co y only) for tbt, yaN n pa teat is llwa Si/~ x 21 ineleras in sine SAS-t439R rR. m m~~ 1 ~ (~~Jc. ~ja~ ~7-~i~`y~~C~"~- (JAO~'/L SU~3lY v'I S~~`~ ~~er~~ ~ I 'J q~ '\ I ._,_._ I ~j' v.~' ~iiGr~e ,+"~', .c :' .l /~ l" yo ,~C 5 °c%~ ~~~ ~ ~ C~! ~ ~S6-y ~ ~'?`~ ~~ a~S~~l/ ~ " .J ~pp ~G ~~ ~~ d(~zc .v,LS ,~c.~ _ ,~~ .'_ ~,~~~ .~_ STANDARD CHAMRFR Quick4 Standard Chamber MuitiPort End Cap ------_~'_. r - ~ __- ~ . r~ - ~~) -~~,~ ~~ ;J ---F i ~- r SIDE VIEW sloe vlEw 70P VIEW FAQiVT VIEW r ,•~ ~*~,, '?: i :.•-~,_ r ~ `,. ,~nl ~` f#a raw .Quick4 Sta:idard Chamber' Pyomina! Specif~cati~cls : . Size (VIl x i_ x H) 34' x 52" x 12' Effective Length qg• Invert Height g^ Site 4V x L'x H~ a 34' x 16` x 12" Invert Height 8' or 1.25` INFILYRATOR SVSTEM$. INC. $TANDAf-•Q~I~NTiED WARRANTY Wi The T ^_lursl hlsgnty- of each chamber, erd Pgte, ,n~dq-} ,r'Id ,rll',yl ar reSSOry n+a. ar!aG4rn~ci Gy InlJlralor { ", q':19") witnr ~nslalled alld nperalgd in 91F3CI1.IPid d fln 0!>,SitP, SF.ptIG System +n ec: xxdancp wrth In(i![alr,' S it CCU 17 „ ice; warrante.(i IO Ihp pnglnal pUlChas91 ('iip.dw'( agalnS} Uelacliya ItlatE•YYalti and Workfttiri.Vlip tOr tvta yaar (rOln Ilx? tla20 iltal tllp sepSic pert 11 I„ ..SU(xi wl' lha spplie SyetP.m P?nlalnal9 11B Ur1As; pr0>•ttied, hOWgVeU Ihal a sepiir permA is rxr! reyuved bV appGratYlp law, Jhe ar flrdY peripd va0 txrgin upp, • t17t? tlata that InsialMilpn of Iha Septlr: sYsrern C%A'tV, iBf1C&4. TD l ..:B its Wartanty ng)I5. Hplder must notify !f%17lydifl' m 14tiA?p ai ryS =AriN%+afe FirtiukhrpYners in tn'cr Srtyprppl(. ,^,(IrnefGCtd NnttYm !1(taen f f 5) days of Ifr9 all9ged rkitx4, infihralpr will supply rOUlaCpn><*rrl Units +pr tl s delry mula(1 ny InlittralUr !U be pc Brad by Ihs LvniltYl yYartanly, +niiitraicv4 r4ltlilliy speC.ifi(a1Fy axOlUd~+ the CgCit OI ranlpVal arkl/Ur irti!anylial Ot rh9 i1n,15. !I:~S TF'E '_IANTCn WARRANTt AN~' REMtI?.C - N SUHPARAr -RAr:H iuJ AHF LXGLl1SIV 11 •-: AH NfJ UTH~H WARAANT'IFC WITH RCSHECT , l NE JNrfs, IN(;LUf;ING rJO iMVLIED WAHiWNTiE~ bF ME:fiC:HANTA81Llfl' cn F TN .~,i .i)ii A PAHirt:IJIAH PURPOSE. ±, } n Llrnnaa v, r N snail Cal pia A any part ~f rre .:hamup aY,lort'+ ~ matulactl Nnri nv anvonp pile-ir a'r Infllirator T!te + ut Ica] V umnly dues A 1E-x11G ^k tlenra rrN+SPJOe +Idl, SiAiL'Iw Or ndirCY,l dd na;)BS. IntlAlatur sY+al ru•I bR faille?ur jx "Ylr'.s G, IgUidalep dal'tayes 1rr- irkj ':~56 0l urcriurl nn and p nt _!wr end materials, overfY9ad posts or plher Iossps a oxlwrrsos'auuned dY I o Holder o' any third par'y. ('(x;16; ally r~t,l c+ed 6prtl L,rnl e(1 VJarran[y wvorpge are damage to tha Iri ;: duE: io tvdinary wear and taal allaratiu , a;:cidan. misuse. atvw pr nayloci of ;he l1nd.: thn Ur. f wirg gupi9pled to vehicle :rahw a Gilts coMy:bcns wfticb are not pormi11a7 by tha installation InsYUpfiuiYS; !adurp ip ma6dain the minimum ground severs bBl forth in the ,(161a11atiD"~. instn/ptipRS; the Wapentanl of imprppty rnalyrals into the System crxttain;ng the Units; tallure pf the Units Ur the Septic sysl9m dua Iv improper ailing or improper sizing, ex,:usshre wafer usaga. ImPloper gmase disposal. a Imprapyr operatipn; a any ptfror 9vart nc' caused dY MfiNralpr. This i.+r7Ni9d Warranty shah ba vpW iF the Hddsr !ai!s !p rrympllr wdh aG' M iha [errris Set Nrfh m this limited Warrarxg Fl.llher, !n no event snail M~fillratUr ba rr>,cppnsibfe ipr any IrfS or damage to R19 HGfdOr, the Unds, or arty Utirtl pdny msufWq Iron A1SlaliatiOrl pr C.hip- ment, or iron any product IiatalitV claims pf h Iddar pr arty R•aty paY,y. Ern' tnis UmAed Wavanty :o appN, ipe Units must be inslaAaly ;n a;;cordance with all ,Ile condYtorls reduved Yry scalp antl 5ps1 codes; all ptheY app;cabl9 m-ws; and 'rn!illratw~s insfal7atiai insiracU9ns. :kill HrJ~lPweSenldlv9 d IlYliltralor hats the aU1h,m1Y to ciwnyo cr nA`rsrc ihie LInnW N(;lrrrdv, Nn v.•nn;,n:y ajgH:ps to arYti Party O1hU It1Un the pry)I~ Tnu a1rUVp reple;.a ds the tandad +. united Wa ranty pllertxi by Int,6relur A l niltx: rlumG9 <d Stnles en;f r»Unlgs lww cdfu.e,•d warmlrry recila6e- ' to Is A ry pLrr;fta.,0! Of 11rU1 shpufd ponlacl "tfnraioY'S rprt:Wa19 H9adGUallprS In Old rSaytvpUY, Cwirinf`.CtiCUi, nrar SC SUCK purchase, irJ oblaill a copy of Ih9 applicabre warranty, and shou67 carafUPy read flat waRaniy prior to Ih9 ptacnase of Urits. I 1 .C Parnnic~ d 7y0 RCi >; nt'f n • SYSTL=10/IS I NC Environmental Onsite Wastewater Sofurfons°" ~ Business ('ark Road • RO. Sox 768 pfd Saybrook, CT 06475 X560-577-7000 • FAX 860-577-7001 800-221-4436 , ..,, .,.-.., . ,~„~, .,,~ ,raw o, r r o, r w, u,:>co, r /d; O,dSN,tyaa Canadian Patents: t,52fl,959; 2,004,564 Othr:r patents pending. Infiltrator, Equalizer and 6;deWinder are reAlstered trademarks of Infiltrator Systerns Inr,. ?nfutrator is a registeraci 4ad;amark in France. Infiltrator Systems inc. is a retyistered trademark in fvtexk;o. G.Jntour, Contour SwkA;' Gxsriection, tvACrolsaCh',ng, PolyTUtf, SnaGLock, C!tamber$pacor, PlasiL(xk. QuickCut, Quk;kPlay nECraEnvA/i[x and GuiCh4 are trademarks of tntiliraror Systems fnc. 19 200."t Inftratol Systerns inc. Printed in O.S.A. ,,,,, ,.,,,.,, ,~. „ JtGIIUN VI6:W ~''° CI ~ENi ~SPE 13" MIN. ASDVE G:7ADE £~ 25' FRO1~,DflUR~ W~~Q~i--pR F~`tESH a~R yNTAKE -~- FyNZSHEw GRAZE r. V ~ ~ t"d i .a a , ........r j r + r"IAX . :6h'LZT ~' r c ~; '~{ y -,..~...~,.W.,.., ~~x- +J +....~ ~' AT~R Ti~iil SEALS ~` ;p~ROV~~ >ip~ ~, ''~'0 S,'~t, ~ D ~; }dli. ,~ ~ ~ ~T 8 ~~ PIMP Q;"~' ELEV . ~„~'T. ~ C `~ ~{ D ~ ~• ~ ~-FAi`~!~~DROQF JLNC~"YCN SC~x '~x:~~ C~NDU7': ~, r ~ ~ ~S ~ i ' : ' GA 5~ TSGHT ~ `; ~ ~ SEAL ~ ~~ ~ ' } r r~--ALM E i0N ~ i ~, ~ ~ j ~DFr ( c :1 ~ " APFR vl~ EIS SEDD: NG J A'FSER TANK ~?'PTSC r DOgE ~ ANK MAN7J~'ACTURER r;ylVK ~iz~S: SEP~'IC D05 E ~~Eez~'~carycti's .~.r~r~ .,L~ '~,~] ,,,.~,,. (yG~, A1L . ~"~ ~~Y W ~L.~icH MANUFACTURER: ~ ~, ~ra.y- ~ ~"~ MODEL Nt1M~ERs ......,'~--~"'`~'~„_~ SWITCi~ TYPE ~ -~-~Cr., ~,~ MAuv~ACTVR~Rr MODEL NuM9ER : ~r~-.~.. SWITCH TYPE: xQu iRED Di SCliARGE RAT~~ ~gw ,~.~..~rras,~ c~~J ~~ W ~ PAb LOC K 8 WARNIl~G i.ABEI rrrr ~ 't ~ : ~Y . an 30INTS ~llTi~ ~'PI~VED FtP~ ~' ~CTO SOLID, SQIL ~a RISER EXIT pERME z TED ONLY IF SA?JK ~tANUFACraRER NAS APPROVA? ~ON~RETE PAD r~~MaE~. i~oSES ~~~ SAY: •r.QSw VCi~U;~E yNC~D~NG F~ow$ACx; c~,~, . CAi~ACZ TIES: A +' I;vC3~dE8 a ,,,,,,~ ,,,,~~A1... C ~ INC~ILS = .GAL. / puMP E A:,,AnM wZRIN6 AS ER ZLSiR ?b.23' wA~ ~RT:CAL DI~'~'ERE:SCE BE~'W,E~~'~.~'tH~ Ci ~` A.~L~ ISTF,ZSUTIaN FiPE , MTNI:~UM NETWQRK SUPPLY PRE5SURIE ~~ FEE;' ~4.»,,, FEET ~`ORCEMAiN ?~ ~, .. ~ , - ~ ~ . PFET ,.--~t~ r T/ ~ ~ 4 F„ F'R. w T. c~N F'ACZ'CiR , +~C":~L DYNAMIC KEAL ~'irT ''~"'E.~NAL DIME~t'a:t?N`S LF FGIK~ ':'A~SX: ~E~~^ v t . ~ ~: LE:~G T,y L.. . ~'Tf1'1 i WIDTH ---- i jj c~'ER .---'-' °/ • 4 ~~.~~ ~GOULDS PUMPS • Fully submerged in high grade turbine oil for lubriratian and efficient heat transfer. 3871 EP05 APPLICATIANS 5pedfically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPEtIfItATit)NS • Solids handling capability: '/+" maximum. • Capacities: up to 50 GPM. • ToWI heads: up to 31 feet. • Discharge size: 1'!:" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BJNA-N elastomers, • Temperature: 104°F (4040) continuous 140°F (604C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatk reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 15/3 StTOW with three prong grounding plug. Optional 20 foot length,16l3 SlTW with three prong grounding plug (standard on EP05). ®2000 Goulds Pumps Effective February, 2000 8387Y Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. fEATURES ^ EP04 fmpeiler: Thermoplas- tic Semi-open design with pump out vanes for mechan'scal seal protection. Submersible Effluent Pump f1 ^EP05 Impeller. Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor lover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power gable: Severe duty rated oil and water resistant. METERS FEET __, _ , ... .. ,... ... .., .. .. to ', 8 30~~'~ ........_ _._._ .... _ s _.. z a 0 7~ 2s~~ _ ~ _.. .. ; _ er 20 . .. 5 ^ Bearings: Upper and lower heavy duty ball beating construction. AGENCY LISTING ~' Can>xlian StarMla~ Association ~CSA listed model numbers end in "F" or "C".) Goulds Pumps a I50 9001 Rogistered. i _. -- 5 GPM ......,-, 2,s Fr 0 2 4 6 8 7 0 12 m~/h r~-raclrr Goulds Pumps ITT Industries - Wisconsin Department of Corrxnerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Aitach complete site plan on paper not less than 8%: x 11 inches in s¢e. Plan must C~~ SSMC-roix~ include, but not limited to: vertical and horizontal reference point (BM), directron and Parcel I.D. (yin G~ti•,, percent slope, scale or dimemsions, norttr arrow, and location and distance to nearest road. Please print all infoRnation. eviewed Personal infomration you provide maybe used fa secondary purposes (Privacy Law, s. 15.04 (1) (m)). - l.lliYt~- ___ Property Owner Property n 1203 page 1 of 3 Tom Schmitt ~J Grand Properties, LP Govt. Lot SE 1/4 SW 1a4 S 22 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name w CSM# 712 Rivard Streeet, Suite 300 7 Hudson Estates City State Zip Code Phone Number ~ City _J village ~ Town Nearest Road Somerset ~ Wt 54025 715-247-5900 Hudson Badlands Road /~ New Construction Use: ~ Residential /Number of bedrooms Replacement ~ Public or commercial -Describe: Parent material Outwash Plain General comments and recxmnmendations: Area is suitable for a conventional system. trench) 86.7. Slope is 10°h. 3 Code derived design flaw rate 4JV uru Flood plain elevation, if applicable na Possible system elevation for Area 1 is (high trench) 88.7' (low ~ ~ Boring # Boring ~f Pit Ground Surface elev. 92.47 ft. Depth to limiting factor 96+ in. Soil Application Rate i ti ture Te Structure Consistence Boundary Roats GP D/ft~ Horizon Depih Dominant Color p on Redox Descr x ;E~1 E~ 1 0-8 10yr312 none I 2fsbk mvfr as 2f .6 .8 2 8-18 10yr4/4 none sl 2fsbk mvft gw 3f .6 1.0 3 18-25 10yr5/4 none Is Osg ml gw 1f .7 1.6 4 25-96 10yr5/6 none s Osg ml - --- .7 1.6 Boring # Boring ~J PR Ground Surface elev. 92.95 ft. Depth to limiting factor 97+ in. Soil Application Rate t T Structure Consistence Boundary Rood P D~" Horizon Depth Dominant Color Redox Description ure ex •Eff#1 Eff#2 1 0-7 10yr3/2 none I 2mgr mvfr as 2f .6 .8 2 7-17 10yr3/4 none sil Zfsbk mvfr gw 1f .6 .8 3 17-36 10yr4/4 none sil 2fsbk mft gw .6 .8 4 36-9 10yr5/6 none s Osg ml - .7 1.6 ~I ~.~ ~r Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS<_30 mg/L ana r ss ~ su ~~ CST Name (Please Print) Signature: CST Number Thomas J_ Schmitt ~~,, 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 8/3/04 715-247-2941 - -a- - -- ',' Conducted by: Conducted for. Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, WI 54025 New Richmond, WI 54017 Pho e: 715.247. 4 ~ Subd. Name Hudson Estates ~.~,.~ , ~~~ Lot No. ~ _ ~~' 1/4,~1/4,S:22,T29N,R19W ~ ~ Township of: Hudson BM El. 00.00' ~~ o ~ "T /e,~/4~r~ P ~~~%s ~ / ~ ~'6~.? 6~ Alternate BM El. ~/.t~U ~ ~~ o ~ '~ ~~ P~ ~~ Slope = L_% Contour Line EL //!~ Sc e: 1" = 40' ~ q0 ~.~ g~ i ~ ~ ~ ~ ~z ~' r ` ~~ ~ ~P } ' ^fi i ~a' ~ r ~~~wLtuln f + 331 ~ , 9~~ ~~~ I a ~ ~~''+ i _~ ~ 90` ~~ ~ ~,~ ~ 4~" ~r l~.df ~o~~ __ ___ ____ __ __ This soil report was done to fulfill a Zoning requirement. It may or may not be in a location that is suitable for your use. No permanent lot markers were in place when the test was conducted... Wiscortstn Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arrnrci~nro wi4h (_nmm RF Wic Orlm f'rvlsa 1203 Page 1 of 3 Tom Schmitt Attach complete site plan on paper not less than 8%Z x 11 inches in size. Plan must i l t li it d t rt d t ti l d t i l ~ COUnty St CfODC nc no m u e, a e o: ver ca an xx zoMa referenc, e pant (BM), directiar and percent slope, scale or dimensions, rarth arrow, and location and d"stance to nearest nom . Parcel I.D. Please print all information. Personal irrformatan you provide may be used ~~~ s. 15.04 (1) (m)). Reviewed By Date Property Owner Property Location Grand Properties, LP ~ Govt. Lot SE 1/4 SW 1/4 S 22 T 29 N R 19 W Property Owner's Mailing Address " ~- Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 ,,,.~,. ,,~, ..,, , _ ,_, , ,_ 7 Hudson Estates City S Zip' L ~i~ ~ City ~ Vllage ~ Town Nearest Road Somerset ~ WI 54 - Hudson Badlands Road ~' New Corteruction Use: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ~ Public or commercial -Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system. Possible system elevation for Area 1 is (high trench) 88.7' (low trench) 87.5 Slope is 10%. ~ i ~ ~ /~~? ~i~ Boring # ~ Baing ~+ Pit Ground Surtace elev. 92.47 ft. Depth to limiting factor in. Shc Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisience Boundary Roots GP D/ft= 'Eff#1 *Eff#2 1 0-8 10yr32 none I 2fsbk mvir as Zf .6 .8 2 8-18 10yr4/4 Wane sl Zfsbk mvfr gw 3f .6 1.0 3 18-25 10yr5/4 none Is Osg ml gw 1f .7 1.6 4 25-96 10yr5/6 none s Osg ml - - .7 1.6 r--- ~/ ¢S. 2 ~g{r .2 Boring # ~ Boring Pit Ground Surtace elev. 92.95 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth 'Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ *Eff#1 *EtT#2 1 0-7 10yr32 none I 2mgr mvfr as 2f .6 .$ 2 7-17 10yr3/4 none sil 2fsbk mvfr gw 1f .6 .8 3 17-36 10yr4/4 none sil 2fsbk mfr gw - .6 .8 4 36-97 10yr5/6 none s Osg mf - - .7 1.6 ~'~/ 1 >~'"~ ' Effluent #1 = BOD ~ 30 < ~p mglL and T55 >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and T55 <~p mg/L CST Narr>e (Please Print) Signa~re: `' CST Number Thomas J. Schmitt ,...,,~,r/ 227429 Address Tan Schrnitt Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond WI 54017 4/12104 715-247-2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 Q ~~ # ~ Bonng Pit Ground Surface elev. 89.55 ft. Depth to limiting factor 106+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 *Eff#2 1 0-13 10yr3/1 none I 2mgr mvfr as 2f,2m .6 .8 2 13-21 10yr3/3 none I 2fsbk mfr gw 1f,1 m .6 .8 3 21-39 10yr5/4 none I 2msbk mfr gw 1 m .6 .8 4 3`~, 10yr5/3 c2d 7.5yr6/8 7.5 /2 ~ 2msbk mfr cs --- .6 1.0 5 62-106 10yr516 none s Osg ml - .7 1.6 ^ Boring # = Bonrrg ~ Pft Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 "Eff#2 Boring # ~ Bonng ft. Depth to IimRi factor J Pit Ground Surtace elev. n9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 *Eff#2 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <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 services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. t~ +~ Conducted by: Schmitt Soil & Site Evaluations Thomas J. Schmitt, CST 227429 1595 72nd St. New Richmond, WI 54017 Pho :715.247. 4 ~n.ao ~ BM El. 100.00' Alternate BM El. l ~ Sc e: 1" = 40' Page 3 of 3 Conducted for: Name: Grand Properties, LP Address: 712 Rivard St. Suite 100 City, State, Zip: Somerset, WI 54025 Subd. Name Hudson Estates Lot No. ,~ 1/4, ,~C„/ 1/4, S: 22 , T 29 N, R 19 W Town//s~~hip of Hudson / .-~ a f°.od~c ~ ` ~ ~fo ~ b 'P1d ~ °Tqv o~ ~'~ PG Slope = LO % Contour Line El. ~~~ ~~ I° ' ~~ ~-- ~- ~~~ f~ ~ I I 0 ~F I(~1 I i ~~ ~~~ P `~ os~ (~~~~ ~~~~~~ ~~ 31 3 /~~ 4-`'" This soil report was done to fulfill a Zoning requirement. It may or may not be in a location that is suitable for your use. No permanent lot markers were in place when the test was conducted... ~ ~l Z ~'~ ~ ~z g ST' CROTX COUNTY SLPTlC "TANK i\4AINTENANCE AGR.EEMCNT AND OWNE(~Si-[If' CERTIFICATION FORM Owner/IIuyer ~('A~-1~ ~rc>~_)~__ L Mailing Address 7~'a• R1V'ARD i'f2., ~m~~~' ~"' I Property Address ~-er`~ - i 1/ C(, Qilti~ (Verification required from Planning Department for new construction) { City/State ~(~ d1.~~ (/~~ Parcel Identification Number LEGAL DESCRIPTION ~ n~~/~~~~~t~~~~' Properly Location ~ '/,,~fl-~ '/,, Sec. ?~ , Tv2~ N-R ~` W, Town of /~d-~s'-~ Su6d;viston ~~' ~-~~~ ~,~'T~S kof-~~ Certified Survey R'Iap # ~ Vo ume ,Page # ~CJZ11- ~ was-}- t~ -t` Warranty D ed # ~S~ 5~.3"/ ,Volume ~~'~ ,Page # //~ Spec house J~yes ^ no Lot lines identifiable jd~ yes ^ no SYSTEM .MA.INTENANCE Iritpcoperuse-and maintcnanceof your septic system could result in its premature failureio handle wastes. Proper maintenance consists of pumping out the septic tank every tl~rec years or sooner, if needed by a licensed pumper. What you put into the syster can affect the function of the septic tank as a treatmcat 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 systern is in proper operating condition and/or (2) after inspection aad pumping (if necessary), the septic tank is less than I(3 full of aludgt. Uwc, the undersigned !rave read the above requirements and agree to maintaiq the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and tl~c 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 Zot:utg Office within 30 days of the three year expiration date. ~/~7/4 SI A OF APPLICANT DATIi OWNER CERTIFICATION I (we) certify that all statements nn tlii~ farm arc true to the best of my (our) knowledge. the property described above, by virtue of a ~~•arranty deed recorded in Register of Deeds OfGcc. ~ -- SIG TUBE F APPLICANT . I (we) ant (are) the owner(s) of /~~/ DATE '""''` Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. •""+ " Include ~vitt~ this application: a stamped warranty decd Crom the Register of Deeds office a copy o[ tl~c certified survey map iC reference is made in the warranty decd • ~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN P.$e ~ at F~.E IHROI~au-TioN Owner ~ P Pemnit ~ ,~-.~ i7Eiti~iN PARAME'IPRS; Number of 8edroorns y" DNA Number of Public Facility Units q Estimated flow iaveragei y V G itiJda Design flow (peak), (Estimated x 1.5} ~ Q ~ elide Sod Applieatbn Rate ~ . ~ at/da lft~ Standard lnNuentlEffluent 5luality Monthly aversge° Fats, Oil ~ tiroase {FOG) 530 mglL l3iochemicat Oxygen Demand {BODr) 5220 mgiL ^ NA Iota! Suapsnded taoNds {TSS} 5160 mg/L Pretr®ated Effluent f~uaiity Monthly averapa l3iochamical Oxygen Osrnand i600~) 530 mg/L Total Suspended Solids tTSS) 5353 molt C~. °e, / Feaa1 Coliform fgeomatNc mean) 7 510° cful100m1 Maximum Effluent P`artiole Size Ye in dis. DNA Ckt~sr: DNA "Values typleaf ~' dotneatic wastewater and Nptic tank effk~ent. SYSTBN! 8PEClFICATiONB Septic Tank Capaolty ,? ~ al O NA Septic Tank Manufacturer O NA Effluent Filter Manufacturer ~ .~ DNA Effluent Filter Model ~0' ^ NA Pump Tsnk Capacity al DNA Pump Tank Manufaoturer ids. ~ DNA Pump Manufacturer ~r•41s. / Q NA Pump Model ~ DNA Pretreatment Unit O Sand/Gravel Flltsr D Machanioai Aeration i7 Dieinfection O Peat Fliter d Wetland D other: O NA Dispersal CeEt(s) ~ !n-Ground tgravityi D At-Grade D Drip-4ine DNA D in-Ground (prassurizedi ~ Mound I7 Other: Oar DNA Other: DNA Other: ^ NA MAINTE~IIANCE SCl~oul.tr ~~ service Event service Frequency inspect condition of tank(s) At least once every: ,3 a! s {lUlaxlnwm S ysara) ^ NA Pump out contents of tank{s) When combined sludge and scum equals ane-third {YS) of tank volume L7 NA inspect disp~aa# cell(s) At (east once every 3 ~~+_) tilAayrimum 3 years) O NA Clean sfflusM filter At least once every: ( monk{s! ,'id" aria) DNA Inspect pump pump controls & alarm At least once suety: ~--~- ~~Is) Q ear{s} Q NA Flush Isterab and pressure test At (east Once every: ---- ~1 {s) D aria! DNA Other: At least once every: .,_- ©r1'10rf~(s( -.., ^ NA Other: Q NA MAINTENANCE lNBTRUCTlONs inspections of tanks and dlapersal cells snail be made by an individual carrying one of the folbwing licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; PaWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections Must include a visual inspection of the tank(s) to identify any rnissIng 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 Around surface. The dispersal cell{e) shall be visually 3nspectod to check the affluent isvsis M the observation pipes and to Cheek far any ponding of sffiuena on the ground surface. The ponding of affluent on the ground turfaCS may indicate a failing condhion and requires the immediate notfflcatlon of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals ons-third {Ys) or mare 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 Nfi 113, Wiaoonain Administrative Code. Ali o#tter services, inciudinQ but not limited to the senescing of effluent filters, mechanical or pressurized Components, pretreatment waits, and any servick-g at intervals of 512 months, shalt be psrfarmscf by a certified POWTS Maintainer. A service repots shat! be provided to the loeai regulatory authority within 10 days of completion of any seroiae event. •apo~ anlzeiislWwPV utsuo~sl~ 'fE1 R (ZI 'il}45'£B Pus t;1~tP)(t?tg11Z1~t'E8 u+waJ ,aiaeya yilm aauelldsuaa ut psi;sap ssM wwunaoR a!y1 Q2 ~ Q ~~ ~S ewaN aunrN IuaaoHinv Ar~folv-fno~a ~aao-t la3dwnd2 aolvaaao oNl~fna3s avv.cd3s auoyd aw4N ~l3NIYlNtVW 81MOd ,~~ry,,H ~.., ~a.'l~",'~'? eweN d8'1'Id1SNt 81MOd SiN3WWOO '1VNOti1CG1f 'fi81S80dW1 l1011nJlddiG 8g AVW SNVI b d0 aO1l131N! 3H1 WOt~ NOS!!gd d 30 ~t1OS9!! 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SavadQe. Ctrantor, and Grand Properties. Y.P _ _ Crrantee. Grantor, for a valuable consideration, conveys anal warrauts to Graxltee the following described real estate in St, Croix County, State of Wisconsin (if more space is needed, please attach addendtttzt): See Attached Exht-bit "A". ~~~~~~ KATHLEEN !{. kALSI{ REG~31"t~R OF DEEDS srt. cRO~x co, . ~> RECE;yED FOR RECORD 0L/e7/2004 11:15A1'l MARRAN~'Y DEED ~i~r ~ REG Fl"sl:: 13.0(D TRA1+1S FEE: 340.00 Gt'PY FHfi: CC FEE: 1~AGE^a : 2 Recording Area Name and Return Address . 020.1058-SU-OW uzaios9-oo-ooot aza-loss-io.ano, o2o-i s-9aoop, Parcel Idcntifirarlon Nu~absr (PIN) This js ~(liC7'e homestead property ps) (ts not) Exceptions to warranties:''Easements, restrictions and rights-off way of record, it any. Dated this _~ day of. r ~'~ ~ ~ - c~ . '~ ~ Willis D. 8avadg~ AL)'Y'I~NTICATION 5ignaturc(s) authenticated this ~, 4ay of t ~ CKNOWLIaDG]~ENP STATE GF `'~/~ ) ss. ~~ County ) Personally came before me this day of the above flamed tt,~rr~~ W11IgS p. SBVad e, _. _ _ ... ..._. TI'TI..'E: MEMBER STATE BAR OF' WISCOTISIN ~~~ ~, (If not, = ~ .~ ~'' to ';,~cttown to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stets.) ~~: ,~ r~ 1e1tt and acknowledged a same. TEIIS INSTRUMENT WAS DitA.k"1'GD $?~ ~ ~~~Jn ~.' .. , Attorne Kristlna_ _ sx~d -%'~d'' • ' '" Yiudsoa, WI34016 ~ 'ri,~1VSlN ~~ txty Public, State of /~//f~ ~.,. ttt~t~~ My Co fission is permanent. (If not, state expiration date: (Signanues may be authcn4~ted or aoimowledged. Both are not nr~ssary.) , ~ ~ ~ .) ~ ooz ~~ * Neches of persons SigttiIlg in arty capaClry must be typed or primed below their Signature. lnfotma6on Protesslonnts Ca., Fend du Cac, W1 s-rATE upta OF wlsCaNStrt iWQ-655-2011 WARRANTY DEED FORM IYo. 2 -1999 N ~ N ~ D~ ( NORTH 1/4 N fn ~ ( T29NSR19W ~ 144CD 6G~~]D~ MMPdG m~ . _ - o I ~ ~ ' Na9.3T66'E 5208.23' ' ( ~ W r 2602.19 ' ~ Z ~ wesT va coR. ~ -~- N89°37'56"E 1301.09 ~ ~ EA s c4 ~• o ~ - ~ C ' ' 2804.04' T29N, R19W R19W 29N T 1301.09 EAST-WEST 1/4 LINE m I IXISTING FENCE I~ 00's EAS~OF E 5'x SOUTH OF ' ' ~ LINE r1 j~ Z a~ PROPERTY LINE FROPER I~ ~ m Z I~ I N ~~ I~ t I~ W ~ I ~ A~ Z I~ j ~ ~ ~ i ~ I ~ e ~ ~ l ~ I~° ~ ~ 9 S j ~ 1 ~ , ROBERTS LANE ' ~ ~ - ~ N89°41'03"E 31.25 ~ ; w 0 I ~ J ( oo y+ y~, ~ I - r -J ( 60.00 ACRES I ~° PROPOSED PROPERTY DESCRIPTION: j That pert of the Southwest Quarter of SecBon 22, Township ( I o I ~ 28 North, Range 19 West, Town of Hudson, St. Croix Counh ~3 Wlsconstn, described as follows: I ~ i ~; ~ Commenctng at the southwest comer of said Southwest I q ( SOUTH LINE OF THE IXISTING FENCE ~ Quarter of 5ec8on 22; thence North 89 degrees 51 minutes I 4'x NE OF NE 1/4 OF THE SW 1/4 CORNER 1 I~ ~ 4 27 eeconds Eeat, assumed bearing, along the sOUth line of ( . I ° O PROPEFlTY CORNER I ° ~ said southwest quarter, a distance oT 1298.51 feet to the poi _ _ _ w ~ ~ ~ of beginning, being the southeast comer of that certain _ j~ - - ' - ~ - • ~ o r n r w IXISTiNG P N ORNE S89 44 41 W 649.90 ~ CerBfled Survey Map recorded In Volume 15, Page 4192, or I~ I F~ ( 14'x SOUGH A 1'x W T ( file in the Register of Deeds Office, St. Crobc County, I OF PROPS coRN ~j r ~" ~ ~~ r ( WlsconsM; thence North 00 degrees 32 minutes 31 second: West, abng the east line of said CeNfled Surrey Map, belns o~,r g ( ~ " the east line of the Southwest Quarter of said Southwest rt di t f 493 73 f t t th f th t Qo i I ~ ~i .( er, a s ance o . ea o e nor comer o Qua eas ~ ~y I n said Certified Survey Mep; thence Sauth 89 degrees 48 o ( ~/ o ( minutes 23 secontls West, along the north line of said i (?i Certfled Survey Map, a distance of 31.25 teat; thence Nora r C~Q, ( 00 degrees 32 minutes 31 seconds West, a distance of th N rth 89 d re i 1447 58 f t 41 t 03 ( ~ ~ ~i ( ence eg m nu . ee ; o es es ~ seconds East, a distance of 31.25 feet to the east line of the ~ $ Northwest Quarter of said Southwest Quarter of Section 22; °, r w ( thence North 00 degrees 32 minutes 31 seconds West, alor ( , m , ~ A ~ `~ ~ ~~' said west Ifne, a distance of 880.94 feet to It's intersection with the east-west quarter line of saitl Sector 22; thence _ ( ~ $ ~ ~ ~ mo ., '~ North 89 degrees 37 minutes 58 seconds East, along said m ~ ~ m I ,,, east-west quarter line a distance of 1301.09 feet to ICs i ~, ~ I Intersection with the north-south quarter Ifne of said Section v S89°48'23'_W 31.25' ~ ~ g zz; thence South oo degrees 29 minutes 07 seconds, along S ~ $ ( said north-south quarter Ifne, a distance of 1318.77 Teet to U c southeast comer of said Northeast Quarter of the Southwes q r i ~ ~ ( Quarter, thence South 89 degrees 44 minutes 41 seconds West, along said south line, a distance of 649.90 feet to ICs r N ~~ ~ intereectlon with the west Ifne of the East HaH of the ~ ~ r~ q i w Southeast Quarter of said Southwest Quarter of Sector 22; ~ir °~% ~= ` ' ( thence South 00 degrees 30 minutes 51 seconds East, alon Ew NG FENCE ~ ~i c ~,' ~ ~ said west 11ne, a distance of 1317.44 feet to said south Ilne c ~r rr 'p ~. PRO ERN LINE I the Southwest Quarter of Becton 22; thence South 89 w W - ~ N ( degrees 51 minutes 27 seconds West, along said south Ifne SOUTH LINE OF J "~ 398'352e'E ~ a distance of 849,27 feet t0 the point of beginning. THE SW 1/4 ~ W rvn S89'56'19'E 429 r5' 220.OT w eae.2s' Containing 60.00 acres, more or less. ~_.,-F- - ~ ~.-._._._.~.-. 1299 "1 . -- __ sw coR. sEC. zz BADLANDS ROAD souTH 1/a Subject to a public road easement over, under and across R79W T29N coR. sec. 22 that rt taken b Badlands Road and all other easements , ° 1 '~ ~ S89 5127 W 649.27 T29N, R19W bound pk r,am end resMctlons of record, if any. Sa9°51'27'W 2597.03' I, Thomas M. Heat', Registered Wisconsin Land Surveyor, hereby certify that the above described end mapped properly was surveyed ny me or under my direct supervision and that this map is a correct representation to scale of the boundaries to the best Slj; of my knowledge and belief. y~N LEGEND ` , S' ~ ~ I ,~ I ~ FOUNO ALUMINUM COUNTY^ m ~f 08/11/04 FRI 07:43 FAX 715 388 4887 REGISTER OF DEEDS ~ 003 ~ ~ ~~~U 2y87P 114 EgSIBIT 4 hat part artf the ~SW . of Section Z2, Township 28 North, Range 'l9 West, Town of Hudson, S~. Croix minty, risin ~ y scribed as tcvs:~-Commeracing at the SW comer of said SW ~/{ of Section 22; thence N ~ °51'2 ,assumed bearing, along the South line of said SW '/., a distance of 1298.51 feet to the point of beginning, being the SE corner of that certain Certified Survey Map recorded in Vol. 15, Page 4192; thence N00°32'31"W, along the East line of said Certified Survey Map, being the East line of the SW '!~ of said SW '/, a distance of 493.73 feet to the NI` corner of said Certified Survey Map; thence S89°48'23"W, along the North line ~. of said Certified Survey Map, a distance of 31.25 feet; thence N00°32'31"W, a distance of 1447.58 feet; thence N89°41'03"E, a. distance of 31.25 feet to the East line of the NW '/ of said SW %, of Section 22; thence N00°32'31'W, along said West line, a distance of 690.94 feet to its intersection with the East-West quarter line of said Section ~22; thence N89°37'56'E, along said East-West quarter line a distance of 1301.09 feet to its intersection with the North-South quarter line of said Section 22; thence S00°29'07"E, along said North-Sou#h quarter line, a distance of 1318.71 feet to the SE corner of said NE % of SW '/<; thence S89°44'a1'W, along said South iir?e, a distance of fi49.90 feet to its intersect"ron with the West line of the E "/a of the SE '/. of said SW % of Section 22; thence SOt7°30'S1'E, along said West line, a distance of 1317.44 feet to said South line the SW % of Section 22; thence S88°51'27"W, along said South line, a distance of 649.27 feet to the,,~i~it of beginning. ~~_ o ~~ r i i~ (((({ ~ ,. „~. _. /~~_ ~~ ~ ~~ '~ `/ ONOi 3~ o Cy I ~ ~ ~ I ~ ~ 3 ~° h ~ ~ ~ v ~ ~' . • ~ ~ d ~ 3 ^' ~ ~ ~ \ 1 ~ ;.. ~ 0 ~ 3 ' v w _ ~ ~ Z °c~'n ~ c N `~ f ~' • ° a i o i ~ + O ° v ~ ° ~ 3 N ~D ~ N ~"~ y c 1 fD O N 7 (D H O p Q ep+ N N N p 0 U1 d ~ p ~ ~i3 O N p O N N 0 ~~ N d ~ ~ CO O 1 \ . = NO O~ N O O p O O O C ~ O p O ~ ~ ~ My A7 O 3 ~ ~ N p ~ ~ ( A 7 .0 w cn z cn v D ' ' m cn z v? v A '" o a 00 e~ m ~S D c o ~ N w ro D ro~ a ° C ~ I a lao o o~ v a W a ° ~• ~ O ~ . ~ c N C N L N c i N N N p p I O . 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O O ~- N ~~' Jessie Nye Subject: 453455 Schumaker -Grand Properties Location: Hudson, Lot 7, Hudson Estates Start: Thu 12/2/2004 12:30 PM End: Thu 12/2/2004 1:30 PM Recurrence: (none) 22.29.19 804 Germain Lane .. / l' ~~ i