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HomeMy WebLinkAbout020-1371-25-000~E ItUo -~.s~t ~ ~~ °'~ ~~it ~0 3 - No caA.2. Wiscongin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildirig 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)j. Permit Holder's Name: City Village X Township Michels, Jeff Hudson Townshi CST BM Elev: Insp. BM Eley: BM Description: ~ ~ e~ ~ I p (j TANK INFORMATION ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic UJ ~ -i Dosing Aeration Holding TALK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ i ~ 32 f ~~ Dosing Aeration Holding PUMP/SIPHON INFORMATION PM to SOIL AcBSORPTION SYSTEM ~,,,~,,, ~ BED/TRENCH Width Length No. Of Trenches DIMENSIONS 3 / S~,~f Gac~ Z SETBACK SYSTEM TO P/L BLDG WELL INFORMATION Type Of System: / ~. v > ~a r ~ lam' DISTRIBUTION ,SYSTEM county: St. Croix Sanitary Permit No: 429935 0 State Plan ID No: Parcel Tax No: 020-1371-25-000 Section/Town/Range/Map No: 23.29.19.2217 STATION BS Ht FS ELEV. Benchmark 9 . So t tit) . o Alt. BM Bldg. Sewer `E• Z ~b S • n' t SUHt Inlet SUHt Outlet t Ct Inlet Dt Bottom Header/Man. ~~ ~ t .M Dist. Pipe . ~ f '- ~b 02. t Bot. System . S-S- . 15 I D • Z t Dl•v Final Grade ~ ~- ` St Cover ~ ~. n t ~ 010.0$ --[ CHAMBER OR ~ ~F-i T- ~~, I UNIT Model Numbed ~i Depth Header/ManifolcL Distribution x Hole Size x Hole Spacing Vent to Air Intake tJ~. Pip 1 ~ 1 Length Dia Length Dia Spacing 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 BedlTrench Edges Topsoil ^ Yes [~ No ~] Yes ~ No COMMENTS: ~( lu de discrep cie ,persons present, etc.) Inspection #1~~~/~ Inspection #2: 'TT' Location: 745 Nicholas Drive Huds Ln, 154016 (NE 1/4 SW 1/4 23 T29N R19W) Evergreen Estates III Lot 25 Parcel No: 23.29.19.2217 1.) Alt BM Description = yGt~p,~%1 , 2.) Bldg sewer length = 37. ~,,(~ - amount of cover = ~ 1 _ ~~,4~, ak ~"`~et~~dn . "w~n -- t --- - -- __- ----~ Plan revision Required Yes No y,... ; vS. ~ .~~ ~ .r.~,,.,,,,E. Use other side for additional information. __ _ ._ ~ ~ I __. __ __ __. ~ J~ SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. r~ Safety and Buildings Division C~tY ~ ` m m ' 201 W. Washington Ave., P.O. Box 7082 S (~ ,s CO~SI~ Madi (608) 26l-6546 7082 Sanitary Qermtt N~ ber (to~led in by Co.) G L~ De artment of Commerce ( 9 Sanitary Permit Application State Plsn I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary Purposes Privacy Law, s15.04(Ixm) Projcet Address (ifdiffercnt tdrm mailing address) I. Application Information -Please Print Ali Intormati ._~_-_-_ ..._ ` Property Owner's N me f # Lot # Block # T\ / 37 I _ t7a Property siting Address ~ Property Loca tio n ~ ~ ` ' ''. , S i ~~ ' Ci State ty ~ ' ect on % ~ ~%a , Zip Code ~ I (iopp ]~gtnbgr;;_ t ~` ~ / Q _ J (OCr cucle one) T ~ N W ~ ~ ~ f 'j R ~E II. Type of Bulltling (check all that apply) ` ; , , or fl a 2 Family Dwelling - Number of Bedtnoms ~ ~ s a Subdivision Name CSM Number ^ PublidCommercial -Describe Use ~- ^State Owned -Describe Use ^City ^Vil a wnship of -III. Type of Permit: (Check only one box on line A. Complete Une B if applicable) A. New System ^ Replacement System ^ Treataknt/Holding Tank Replacement Only ^ Other Modification to Existing System B • ^ Permit Reaewai ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IIV. of POWTS S rem: Check all that a 1 ~ O Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Siogle Psss Sand Filter ^ Ctmstntcted Wetland ^ Ptnssurizad In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treattr-ent Unit ^ Rxirculatiog Sand Filter ^ Recitculatin S thetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-kss Pipe ^ Other (explain) V. Dis rsaUTreatmeat Area Information: Design Flow (gpd) Dexigrr Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Ekvation O~ S ~ r O . 1 -/ _ / i ank Info Capacity in Total Number Manufacturer Prefab Site Steel Frber Plastic Gallons Gallons of Units Concrete Corutructed Glass Wew Facistirrg tads TaNcs Septic or Holding Talc - , J Q ~' .~Q / ~'~'\_ Aerobic Trcuarent Unit l~siag Chamber VII. Responsibility Statement- i, t6e nadersigned, aunme reaponsibitlty for fastaltatioo of the POWTS s6owa oa the attached ph-oa. Plumber's Name (Print) Plum 's S' PRS Number Business Phone Number ur~~~ as a 3s ~ ~~s - a~ ~ - ~ ~ Plumber 's Address (Street, City, State, Zip ) n /v v t~~~ ~~~ C7 VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Gr water Date Issued Issuing (gent Signature (N Stamps) ^ Owner Given Reason for Denial Surcharge Fce) 1 A ~ ~~ ~ V, 0 ~ C~di~io'~ns o~ pprovaUReastRts for Disap~~ p~~ ~ r t~ ~~ J~~~ k ~n ^~ j (/ ~ t b ~1 J ~ ~ ~---- .____s- d~ ~ l ~ 1 Attach colnpkte plans (to the Co +w ohly) rot the system oa paper sot las than ill2 :11 lathes la ~ Arl.~ 5,~.~'b~k-S ~ ~~ o..~ ~. a~ln~c~ c.ee~ ~Q-c.c~!~v~o^^-ce S . SBD-6398 (R. 08/02) ` N= ~• N~ laso ~."^- ~._ ~pD T- ~ ~~ d~ i ~° ,~ ~ a °~° ~~ ~ /~~ aab3s ? i 1 / ~! (,/~ ~~~ S ~" N~ rasa u~^- ~}._ boo 'r- ~ ~~. ~-, ~r,p ~ >oo~T °~~ /U t ~~ i ~° ,~ ~ _a _ ~ ~' ~~ v V /~i~? adb3S ~ i 1 /` /~ = ~~ ~~~ 8 ~ Wiscor"sin Department of Industry, SOIL AND SITE E V A L UiA-~ p"iN R E P;D R T Labof and Human Relations Divison of Safety & 8uildinas __~ .--:.~ n ~ .r, .,., .,,r'"''v.r.,_ w.~..., n,...~.: ~ Page 1 of 3 - - - 111 QVNV~4 ..~l~l ~~~ ~~ 1 V~/f.P~., •.~J• ~•p~~~~. y aav ,(~oU NTY er not less than 8 1/2 x 11 inches m s ~' lalan must mclUtl~~ 6Lt lan on a Attach com lete site ~ '~ St. CROix p p p p -- # - not limited to vertical and horizontal reference point (BM), direction an~l,% of sl~e~ scale Qr PPIRCEL LD. , dimensioned, north arrow, and location and distance to nearest road ~ "" - -~ '..-,.p~ '; ! 020-1062-70-000 ''" APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATJ4N , K`_; R VI ED BY DATE ;,,. , :-;,d, , PROPERTY OWNER: '°•. . PROPERTY LO •ON .Richard LaCasse "GOVT. LOT NE Ira , : 5W vas 23 T 29 ,N,R 19 }E~or) w PROPERTY OWNER':S MAILING ADDRESS LOTS ~~- _13LOCK # $UBD. NAME OR SM # 521 McCutcheon Rd . -4' na ~anka~ dS- CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE ®fOWN NEAREST AD Hudson, WI. 54016 ~ Hudson Waldroff Fh1. Rd. [xj New Construction Use [xj Residential I Number of tledrooms 4 [ J Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpolft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.50 ft (as referred to site plan benchmark) Additional design I site considerations trenches 4.00' below grade spaced to code Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for s stem CAS ^ U ~7 S ^ U CAS ^ U CAS ^ U C~5 ^ U ^ S ® U SOIL DESCRIPTION REPORT Boring # .................. .................. ................. 1 Ground elev. 105.1 ft. Depth to limiting factor +90" Boring # 2 ................. Ground elev. 105.5 ft. Depth to limiting factor +90" Depth Dominant Color Mottles Texture Structure Consistence Ba MxJar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y . Bed Trench 1 0-9 10yr3/3 none 1 2msbk mfr yw 2c .5 ~ .6 2 9-20 10yr4/4 none sil 2msbk mfr yw lm .5 .6 3 20-9 7.5yr4/6 none co Osy ml na na .7 .8 cI nq sf-nX1v. Remarks: 1 0-10 10yr4/3 none sl 2mgr mvfr gw 2c .5 .6 2 10-2 10yr4/4 none sl 2msbk mvfr yw if .5 .6 3 20-9 7.5yr4/6 none ms Osg ml na na .7 .8 Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th ve. New Richm d WI 5401 Signature: (~ Date: 11-1$_99 CST Number: m02298 v'c PROPERTY OWNER Richard LaCasse PARCEL I.D. ~ 020-1062-70-000 SOIL DESCRIPTION REPORT Pagez_of 3 " i Horizon Depth Dominant Color Mottles Texture Structure Consistence Bandary Roots GPD/ft - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-10 10yr4/3 none sl 2mgr mvfr yw 2m .5 .6~" 2 10-90 7.5yr4/6 none cos Osg ml na if .7 .8 Remarks: 1 0-13 10yr4/3 none sI 2msbk mfr grw lc .5 .6 2 13-21 10yr4/4 none sl 2msbk mfr gw lm .5 .6 3 21-30 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 4 30-90 7.5yr4/6 none cos Osg ml na na .7 .8 Remarks: 1 0-8 10yr4/3 none sl 2mgr mvfr gw 2c .5 .6 2 8-20 10yr4/4 none sl 2mgr mvfr gw 2m .5 .6 3 20-90 7.5yr4/6 none cos Osg ml na na .7 .8 Remarks: Remarks: SBD-8330(8.05/92) -~ STEEL'S SOIL SERVICE Gary L. Steel Richard LaCasse 1554 200th Ave. CSTM2298 NE4SW4 s23-T29N-R19w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #4- 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 test was conducted. N 1"=40' BM.= top of 1" pvc pipe C e Alt. BNi.= top of 1" pvc pip ~' ~~ CD Gary L. Steel 11-18-99 Flpr 23 03 03:08p David Steel 715-246-5085 G p.l ,sin Departmentollndustry, SOIL AND SITE EVALUA,~J~ON F;EPOR~~Sa ~0 ~^6~,,]J1~of 3 and HOtnan Relations ~ ' 1~C U j SQ(y on of Safety R Buildings in accord with ILHR 63.A~,'W+s~ Adm.~ode ~;_,. COUNTY Attach complete site plan on paper not less than 8 1/2 x ~'~F~Ih m inc(~6e; twt PARCEL LD. >K no± limited to vertical and horizontal reference point ( t9~..% of sbpei ale.flr ~ 020-1062-70-000 dimensioned, north arrow, and location and distance nea eslroad. ~ -- y ~ '' `^~ - 2~t p.;: REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT L INFiII~-?T~:f~~' ... ~-~ ~~~~`•-y ~~ `• L::til~:. PROPERTY OWNER; ~ _. PER L {tTION -~ Richard LaCasse `~,' ~ NE t/4 : SW t/as 23 T 29 ,N,R 19 ~D(a) w PROPERTY OWNER':S MAILING ADDRESS LOTI< ' -BLOCK it SUED. NAME OR Sas 521 McCutcheon Rd. .~ na ]]nlra~s CITY, STATE ZIP CODE PHONE NUMBER CITY VILLAGE ®fOWN NEAREST AD Hudsonr WI. 54016 (715 38 - Hudson Waldroff Fitt. Rd. ~) New Construction Use [~ Residential / Number of bedrooms 4 [ ] Additiort to existing building j ]Replacement [ ] Public or oommeraal describe Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 858 bed, ftz 750 trench, ftz Maximum design bading rate . 7 bed, gpd/ft2 .8 trench, gpd/tt2 Rewmmended infiltration surface elevation(s) 101.50 ft (as referred to site plan benchmark) Additional design I site considerations trenches 4 00' below ctrade spaced to code Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for s stem L~ S O U ~7 S^ U C~ S^ U CAS D U CAS D U O S ® U cnu n,FSCRIVTtoN REPORT Boring # :>~::;:>:n:. <~ 1 Ground elev. 105.1 tt. Depth to limiting factor +9 " Boring # ~~ 2 Ground elev. 105.5 ft. Depth to limiting factor +90" th D Dominant Color Mottles Structure i C xtda B Roots GPD/ft Horizon ep in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence ons ry a Bed Tterxtl 1 0-9 10yr3/3 none 1 2msbk mfr yw 2c .5 ~ .6 2 9-20 10yr4/4 none sil 2msbk mfr yw lm .5 ~ .6 3 20-9 7.5yr4/6 none cos Osg ml na na .7 I .8 ~.O L]nm~r4c• 1 0-10 10yr4/3 none sl 2mgr mvfr yw 2c .5 .6 2 10-2 10yr4/4 none sl 2msbk mvfr yw if .5 .6 3 20-9 7.5yr4/6 none ms Osg ml na na _7 .8 I j t7 I • S'~ ~~ Remarks: CST Name:--Please Print G L. Steel Phone: 715-246-6200 Andress: 1554 200t ve. New Richm d WI 5401 Date: 11-1 CST Number: m02298 Signature: ~`w ~ n $-99 Rpr 23 03 03:09p David Steel 715-246-5085 p.2 { STEEL'S SOIL SERVICE Gary l,. Steel Richard LaCasse -1554 200th Ave CSTM2298 NE4sw4 S23-T291v-R19w New Richmond, WI 5401 i MPRSW-3254 town of Hudson (715) 246-620C lot #~ 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 test was conducted. N 1 "~0' BM.= top of 1" pvc pipe ~ E Alt. BM.= top of 1" pvc pit ~' °T Gary L. Steel 11-18-99 Flpr 23 03 03:09p David Steel 715-246-5085 p.3 . ~ PROPERTYOWNt_R Richard LaCasse SOIL DESCRIPTION REPORT Pa ?. 9e_ot 3 PARCEL I.D. # 020-1062-70-000 Boring # ~:~ Ground elev. 103.8h. Depth to limiting factor +90„ Boring # fit.... Ground elev. f t. Depth to Nmi6ng factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ~~~~ ~~ Roots GPD/ft Bed rends 1 0-10 10yr4/3 none sl 2mgr mvfr yw 2m .S .6 2 10-90 7.Syr4/6 none cos Osg ml na if .7 .8 Remarks; 1 0-13 10yr4/3 none sl 2msbk mfr qw lc .5 i.6 2 13-21 10yr4/4 none sl 2msbK mfr gw lm .5 .6 3 21-30 7.Syr4/4 none scl 2msbk mfr yw if .4 ~.5 4 30-90 7.5yr4/6 none cos Osy ml na na .7 .8 Remarks: 1 0-8 10yr4/3 none sl 2mgr mvfr yw 2c .5 .6 2 8-20 10yr4/4 none sl 2mgr mvfr gw 2m .5 .6 3 20-90 7.5yr4/6 none cos Osg ml na na .7 .8 Remarks: Remarks: S8 D-8330(R.05/92) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION Owner Permit # DESIGN PARAMETERS Number of Bedrooms ~~ ^ NA Number of Public Facility Units ~NA Estimated flow (average) ~ ~ al/day Design flow (peak), (Estimated x 1.5) ~ al/day Soil Application Rate ~ 7 al/da lft~ Standard Influent/Effluent Quality Monthly average" Fats, Oit & Grease iFOG) 530 mgJL Biochemical Oxygen Demand (RODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) _<150 mg/L Pretreated Effluent Ouality Monthly average Biochemical Oxygen Demand (GODS) s30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Yg in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity 5"d al ^ NA Septic Tank Manufacturer (~,Q~ ^ NA Effluent Filter Manufacturer Q,,,C~ ^ NA Effluent Filter Model ~ - ~ Q ^ NA Pump Tank Capacity al '~A Pump Tank Manufacturer ANA Pump Manufacturer ANA Pump Model ~ I~PNA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~ NA Dispersal Ce111s) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Evert Service Frequency Inspect condition of tankls) At least once every: ^monthls) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: a ^ monthls) (Maximum 3 years) year(s) ^ NA ^monthls) ^ NA Clean effluent fitter At least once every: ,, yearlsl ^ monthls- ^ NA Inspect pump, pump controls & alarm At least once every: ^yearlsl ' ^monthls) ^ NA Flush laterals and pressure test At least once every: ^yearlsl Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shaif be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls- to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal ceII1s) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersa! cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ ^ The site has not_ ~-°__ _~... _., . - aa=..«:~.. _ ., .:«..~.:.. .,,..~ ------ - -----•--- - :1•~.e_nf the POWTS a soil and sit8 ev~ln tin • ~- -s- •~`~ ~- ^~^~^ hromant area If nn ronl 1 ~~ iuidln4l tank ^ Mound and at-grads soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP ANO OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. enmm~Nel CAMMFNTS POWTS INSTALLER ~ rr.~ ~(~ ~ ` ~ ~-e POWTS MAINTAINER Name e,,,~ Name Phone ~ b Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ~pIU1N Name Name ~ T Phone Phone l~"' _ 3 $ G - !!~ g This document was drafted in compliance with chapter Comm 83.22(21(bl(11(d)&(f) and 83.54(t-, (21 & l3-, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuyer Mailing Addrt Property Address (Verification required from Planning Department for new City/State LEGAL DESCRIPTION Pazeel Identification Number ~ a, b -- 1 ~ 7 j - eZ S Property Location ~ %., s !.(, y4, Sec. ~ T~N-R~W, Town of _ Subdivision Certified Survey Map # Lot # o~ ~ . Volume .Page # Warranty Deed # 7d ~ (o c1 ~ Volume Page # ~ ~{ Spec house ~ yes ~ no Lot lines identifiable yes ~ no ,ss~~ SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property-owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner aad by a masterplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds 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 Couaty Zoning Office within 30 days°rof the three y~ar expirado date. ~; F ~. ,SIGN, OF APPLICANT 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 roperty described above, virtue of a warranty deed recorded in Register of Deeds Office. ~.~{~~ `; TUBE OF APPLICANT DATE «.««s« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **"**" ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed OWNERSHIP CERTIFICATION FORM 706699 2 1 ~. 7 P 3~~ I{ATHLEEIi H. 1fALSH STATE BAR OF WISCONSIN FORM 2 - 1999 STGICROIX COD~MI Document Number WARRANTY DEED RECEIVED FOR RECQRD This Deed, made between LaCasse Custom Homes, Inc., a 01 /22/2003 1l :30AM Wisconsin Corporation EXEMPT ll REC FEE: 11.0@ Grantor, and Jeff P. Michels and Suzann Michels, husband and wife COPYSFEEE ~ 248.70 CERT COPY FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of W isconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lot 25 Plat of Evergreen Estates III in the Town of Hudson, St. Croix ounty, Wisconsin. 020-1371-25 Part;et Identification Number (PIN) This is not homestead property. (}I) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any, Dated this ~ day of January ----- ~, 2003 AUTHENTICATION Signature(s) authenticated this day of , • TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated yr acknowledged. Both are not necessary.) LaCasse Custom Homes, Inc. ACKNOWLEDGMENT STATE OF WISCONSIN ~ ~q )ss. ~ V lQU County ) Personally came before me this ~~?~~~ day of January , 2003 the above named LaCasse Custom Homes, Inc., a Wisconsin Corporation by its to me n to be the person ho executed the foregoing inst a acknowle a same., l'~c c G'6'C~1~1 t..~-- Notary Public, ate of Wisconsin My Commission is pe~rm7an-~ent. (If not, state expiration date: of persons signing in any capacity must be typed or printed below their signature. ~Mannatlon Profosaanais comPenr, Fong au Lac, wi STATE BAR OF WISCONSIN Tracy L. Turner ~s~-ZOZ' WARRANTY DEED FORMNo.2- 1999 Notary Public State oI Wiscons' .. ., s / 8 ' o '~r~y O~ ~~ ~ s s.~, F 2.054 ARCES 89,471 SD. ~• Op~V 5 CJ \ LOT 27 2.713 ARCES 118,181 SD. Ff. N85°11'51 "W 47.30' ~~ ,,~~ © / ~`~ .,~~ / ~ No ~' ~ ti ,\O' b~ 100 ` ~ ,(1 r iRc C. ELEV. LOT ssr° ~` 4.179 ARCS 70 ~2Q LoT z5 ~~ ,0495 . ~. ss~~-~ 4 ~ 2.42 _ RCES ~° • ,568 SQ. ~! . ~ ~c ~ • ~ ~~ ~ 4`~ ~ A ~" ~0yo ~ 6 ~ ~ / Job ~~ h • Q t / ~~e~i ~~ ~, o ~ z ~~ypTER 11~ ~6 / ~ 92oJ~ ~,ddy' ~OO HRH ~yp,'SER ff :: ~Z,l°~ ~ O~~ i ~ ~ 5 ~ ~o . ~ ~ off, i ~, ~~ D ~ / A o ~`~'~ 205.55' ~ ~ ~ / ~'~ 112.75' ~ / V83°58'13"W 488.35' Me3°2r43w~ ~D dQ~r_~ ~~a~~ o ~ O4~ o COUNT7~ TREASURER'S CERTIFICATE _____ CSG~~3 _ ~ - - - State of 1Pisconain) SS County of St. Croiz ) I, Mary Jean Livermore, being the duly elected, TANGENT TANGENT qualified and acting Treasurer o! St. Croix County, ~ do hereby certify that the records in my office NTH show no unredeemed taa sales and no unpaid 3.07 N00 13 oy t N05°43'45'E ~.1a S87°1aa5~E S38°13'1a'E taxes or special assessments as °~ affecting the ~ ~ ~. ~' ~,~`~ ~ ~ ~, vy~ ~ o~,llri o r or mauerry, biU 16 q N U =111 t t V A L tl A I I V I'1 1'i t N V M t rq~ ±~ ~ .t,. r aid rm Relatlons ' avNloe of 8rfaty 1~ Odldrga In accord with ILHPI 83.Og, WI'. Adm. Code .....,. . , St. CRoiac ~ttaoh oomplstr eltd' plan on p8per not lase thin t11/2 x 11 inohaa in M:a. Plan must include, bui PAR . clot Ilrtlited ~ wrHoel and horizontd ~refsnnor point (BM-, dlreotlan and'/r of elope, eoale cr 020-1062-70- a d dtmen~ionad, norlh:arrow, and Ioostjon and dietanato nean8l road. VIEW OATS APPLICANT IN~ORMATt -PEE-ASE PRINT ALL INfORYATION ERTY F1. PF~?PEATY LOCATION Richard LtCeame ~ v~ ®OVT. LoT NE vs t3W v4s 23 9 .N,R 19 N4(a1 W ~p 4 AOOR~ss BLOCK r 8UB0, NAME C9M N ~ 5 na uNrnown X121 t~utcheon Rd. I , STA 1l C00 PHON UMBER ILI.AOE OWN NEARE6T Hur]slor- t _ Hudson WaidrO!! ibt. Rd. ~~ New ConeUuctlon Uee (~ Re614enHal t Nun~er Ot bedrooms 4 (] AddNbn to exietinp buNdinp ~~ i ! Repl8oem4nt ((P~Ik of carrunerd~l deecnbe Cade dertued dept' fbw ,,,~QQ.., gpd Recommended deefgn badN-g rate ~„_7 bed, gOdl<t2_.fl--t-er>rh> 9Pdrtt~ Absorpllon area required ~~ bed,.tt2 ~Q._ trench, ft2 Mexlmum design loading rate _ •? -bed, gpolM2_~.~._vendl• gPdnt2 Reaortlrnended NAItraHon eurfece elevallon(e) k (as referred to alts plan ~nd~mark) AddlHonai deetgn / ells coneldefaUone ~ hr 4,QQ' below arar9e •~ed to code Patent mateNeV oubWarh Flood Plain ele~atlon, It applicable na R 8 . ultable for 8 slam C V~tTiONAI NO M40ROU 0 PRE66UAE At•ORAOE SYSTEM IN FILL aoLaNO TANK Unaulteible a $tem t~ S ^ U ~S ^ U LAS ~ u Obi O u ~S C] u C~ S ® u 901E DLx'8CAIPTION IiBPORT Depth DomUant Color > Mottles Texture Structure ~ g~gry Roots t3PD /fi ®oring P HorizOn h Mansell 41i.3z.Cari.Odor far. Sz. Sh. B 1 0-9 10yr3/3 n©ns 1 2mabk mEr yw Zc .5 .6 1 2 9-20 10yr4/4 nCS-a ail Ztnsbt~ mfr y~r lm .5 .6 3 ZO-4 7.3yr4/6 none eo a Oey ml na rue .7 .8 Ground lOS!„^~l tt Oepth to u tlng ; terror B.Q.- Noflnp f1 a 4bund eiev, iQ~a,"~ tt. pepth to IImIHng . Remarw 1 : 0~ 10 10yr4/3 ruane eli 2agr tnvlr gw 2c .5 ' .6 Z 10-2 1,Oyr4/~4 norza si 2msbk mvfr . ~ lE .S ' .6 3 20-9 7.5yr4/b nt'rnra me Owq ml na na .7 ~ . e E~J ~ d LLG6- Z8E-9iL ~ l31 I,1~H3?! S3WOH 3SSC~ti1 ~ Q I GT ~ 60 Q3M 8002-5Z-ZitiW PROP~RT1-OwNrEll Richard LnCaes® BGIL DESCRIPTION REPORT PARCLLLD,f . 020-1062-70-000 eorinp M Ground ~, 1Q~„~it. Oeptlr to b~~A ~. n ! . 8oring M 4 Qtolltd etov, 10'1.911. D~~pptlr b nmldnp +y~0". ~O/InQ ~ ~G{{ryyovvund 10,1.111. Do R b ~P~r,a '« Boring # Qround tdlW. ft ~ro Intitlnp tear Papr2 `~ ?~ '~ Hortaon C78plh In. Dominant Color MunsAll Mogtee Ou, 8a. CON: Color 7extu~e Structure Gr. 3s.'Sh. ConslsESnos Root GPp!-t Bid 1 0-10 10 r4 3 non! si. r mvfr w ~ .5. .6 2 10-90 7.5yr4/6 nano co • 0®q ml nn ~ l f . 7 .8 i Remarks; 2 0-13 i0yr4/3 none s1 2mabk mtr yw 1C .5 ..6 ' 2 13-21 .10yr4/9 n~o~ns ei 2mablc mfx grr lat . S ~ .6 3 21-30 7 . Syr/q nor-r scl 2p-eb3e n~i.r yw 11' . Q _ .' . 5 4 90-90 7.5yr4/6 nono co a 0®g ral na ns .? '.@' 1 0-8 10yr4/3 norw el 2agr nivfr yw 2c .5 ~ .6 2 8-20 10yr4/4 Wont ai 2t~r tnvfr gw 2cn .5 i .6 3 20-90 7.5yr4/6 nano cos Oeg ml na rta .7 ''.8 Rsmaeks: b0~d iLL6-C86-SIL~131 .11~ti3M S~WOH 35Sti~fl~~Ql 6i X60 Q3M 6002-9Z-ZitiW ,. STEEL'S SOIL SERVICE G,csry 1.. Srsel Richard LaGasa 1554 200th Ave. C8TM2298 N~csw~ s23-T29x-R19W Nsw Richmond, WI 54017 MPRSW-3254 t dean (715j 246-6200 lot #W4- Thin so31 evaluartion xae cdnductod to satiety a zoning requirauisnt, it may or may tyat h4 suitable !or your use. The laaAtion of thr tut. shy ar may not by as eha~rrt u pumensnt tat iinme sere not wtahiished at the time the fast KRS.c~oaducted. N 1 "~0' sHt. • top o! 1 ~~ pvc pips ~ ai . 100.40' Alt. BM.~ top of 1" pvc pipe 1. s1. 100.20' '~~ ~'2r ~~ a 1'~` ~-' b ~ ~ ~~;~ . ~~, , ~~ ~r ~ ~~~ ~,e.,,~ ~~~ ~. wary L. 8t~e1 11-1'8-99 S0%d iGL6-Z8E-SiL%131 ~11ti3LI 53WOH 3SSl7~tl1%QI 8t %60 Q3M E00Z-9Z-LltlW Parcel #: 020-1062-70-200 01/25/2005 09:30 AM PAGE 1 OF 1 Alt. Parcel #: 23.29.19.2380 020 -TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current LX Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * LACASSE CUSTOM HOMES INC LACASSE CUSTOM HO 573 CTY RD A HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Le escription. Acres: 0.000 Plat: 0926-CSM 1313726/EVERGREEN ESTATES3 C 23 T29N R19W PT NW SW & PT NE SW Block/Condo Bldg: LOT 2 BEING LOT 2 CSM 13/3726 18.736AC EXC PT ERGREEN ESTATES III Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-29N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 03/15/2000 619686 1495/593 QC 09/30/1999 611239 1460/021 WD 09/30/1999 611238 1460/019 WD 07/23/1997 823/526 more... ~nn~ c~ ~nnnnet~v Bill #: Fair Market Value: Assessed with: 0 Valuations: ~ Last Changed: 05/19/2000 Description Class Acres Land ~ Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 110 Specials: User Special Code Category Amount 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . lblU~ ,~~~0l~ ' ',~,,. F~ N "' Z m d~3 A ? ~ O= f'l ~ N .N d ~7 ~ r D *1 I c o '" ~ ~~y ~a•, o ~~o/ A fU Z V ~ ~ o ~' D z r m .O ;~ ~ , ~~ ' ~~ ~~ ' '~ 'O ' ~ i ~ , i ~ i , ,, 1 1~ ' ~~a Fl~~~ g~;F~ 2 3 1999 Kp'(N1.~EN H.WALSN Aep~stes of Oeeds ~t.CcoGcCo•~m oao - roe a - ?o - aao a38c E~:~.U909 ~~ a es~, c3/372{~ j \ w- 1 I __+~'_ I BEARINGS ARE REFERENCED TO THE ~ jEAST -WEST I/4 LINE DF SECTI^N ~ ~ j X23, AASSUMED TO BEAR S89'46'06'E ~ A ~ 1 '~~,/~ ~ ~ rr Z ~ W . r `F~'. `. ! ~Z .~ • \ I ~ .~ .a '~ ~. _ _ `'~ \ ~~ FAR)d ~ N00'02'29"W 885,00` ~`- WEST LINE DF THE NEI/4 OF THE SWI/4 oNOI ~~ 1 ~j ~ I o o; i 'p ~ I I ~ I of • ~ I ~' ~ ;~ 1 m ~ I i I 1 ;~ .x ; N 1po~o `~ ,' / ~ ~• la ' f ;~ ; A ' ~ ; o0 N C'1 D r m z ~, rnl II N O O D D ~ ~` m H I ~ a ~ v' ~ a ~ ~ ' ~~++ y n ° rv ~ w r ~' ^+ :-~ v rr ~ ~ oo ~ a ~ ~ ~ ~m ~ y co b n a ~ ~ N ~ "' ~ °v•oc o r awr O ~ ~ ~ i ~ b ~ ~, snDZ tiDZ ~ a ti cn m 'C7 t~ ~ c.c~ ~-c'C onc' ~n~ N GG ~ ~ -u ~yym+ytDi~ ~ 3 Z ~ ;~ a.3~a rjr ~~ ' ~, \~9s ~y9~F b~ ~~? 0 •~ oa °s a z r*i ~ y ~ b 'y \ ~ ~ ~ urn i - N ~ y ~ ~~ ~ ~. ___.._~ ~O !~ ~ I~1 I ~ I ~ ° A ~ b I ~ o y ~ ~ ~N\ ~s~ ~ ' SEA O~ ~2N ~!/1 j '~ p~j ~ ps •y N~ ® e {~ . 1 .Z1 ~ ~ 1~1 g I M a D ACC '~ ~N 1 ~ ~ '~,~ X09 ~ ~i ®~~ ~ ,+ - iro ; I ~ b ~ ,~ m / w 'SraS / , ~ ~ a y •a'~~~~ 1 y9 ~ y ~ ' ~ i s s ~ ly ~l~ . ` ~ ~ 0`13 8/~' v °l ~ - I a '~ ~ ___~~--E'~%ST LINE OF THE NEI/4 DF Ti-~E SWl/4 `__ _ _ I 'mil tray O I- WEST LINE ^F THE NWl/4 DF THE SEl/4 m _ i ~ ~ y i c r'~1 39.37' c ~ I •t. ~ C3 ~ \ ~ o j O O ~ 3 ~ ! ;'~ 379,63' ~ ,~, ;~ °~A ~ ~ ~ f V ® ® x ~ ~ i 0 f*1 x ~ ~~ ~z W G D • ri m N N~ ~ °' ~i d ~~o-D+ - r 0~ w Z Z D ~ N ~ ~ ~ ~ m m D ~ m o w r~ f.ll y V N ~ D tD f*7 ~ ~ \ pNp o a w ~ ~ \ Z ©~ ~ z ''' ~ ~ ~ ~ o~ I • rim z z ey~ i- ~ ~( ~ (A Z f7 ° 0 ro , Z i ~ ~ " ~ y odd Zw ~ ~~ ~ W~11 ~N~ N~ r, ~ ~ czi v r-+ ~ W ~ w O~ 2 ~ ~ ~~ r ~ s ~ a ~ v r+ ~ ~ ~O o : ~ . w ~~ ` 7 _ N ~ 0 _ ~ p~ D Q? J ~ O n V N v r \~ ~~ ~ x x x ~ .! o~ ~ N Vl VJ A \ ~ X H G1 GZ-1 GZ'1 ~ ~ ~ A '~ ~ r~'I furl ~ D f!'1 p ~~ DaQ -- !D(p ~ -- ~D lod ~~