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020-1395-08-010
` ~ I ~ 1 a~ O ,~ ~" ~ ~ I N ~ y O a' ~ ~ ~ I O O y ' ~ N ~~ o r N m 'y ~ c ~ •- •c E ~ o ~ ~ I ~ O y D. O N ~ • ,a tA «. fp ~C • m > N > f0 ~' otS ~' E I ~~ ~ L ~ ~ ~ C -T N l0 ~ d m yam I ' . . ~ ~ ° 3 0 i a ~ 2 i ~ i a?c~ C N ' ~ i { - go'oE`° 3 ~y~~ I ~~3v+•- i v~~~,v Q O C fp to I N r ~ ~ j Z y ~ I O Z a =" 8 I v ~ v z N z ~ a m I N - - I i o I O Z a C U_ ~ ~ ~ Z ' p ~ Q ~ I a i ~ N H ~ ~ R~ a~ Z '6 f0 ~ t7 ~ ~ N " _ ~ ~ c f=/1 N I N E ~ y C C C Y a v O O ~ ° ~ E z I c d f0 c I R N N _ y ~ ~ G .. R ~ 'e ~ c c a i in oo t t t 0 5 S ~ °- ~ o ` Y ~ O O O ,~ =a,da y a • w ` o ~ fn J V ~ 0 0 } O O N N ~ ~ N N ~ I N 'moo _ • v E ~ ~a:o~ ~ s' ¢Zin a' :? I !~ ~ ~ ~ ~ ~ m , p. O L I M W Y! ~ O N C ~ ~ o v 3 ~ ' a d o r N ~ C'ON V s. ` " ~ ~ of ~ ~ n ~ `° y ~ I '" " ~ P E c o w y ~ «% v ~ }~ O N= J~ O N Z c Y d{' fA O U .n a ~ ~ =€ I ~~ a '~ ~ ~` v t ~ ° O ~1 A a v ic v Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Divisir~n INSPECTION REPORT ~~ e GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Landmark, Inc. Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Description: ~ 5 ` t I(l~ C,~n.K~ 'ANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY Septic ~E~ 5~2. (ZAt7 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Ma facturer Model Nu er TDH Lift riction Loss System Head Forc in Length Dia. ist. to SOIL RPTION SYSTEM ~ RENCN DIM idth ~~ Leng ___1 ~.~^ ' - No. C SETBacK INFORMATION SYSTEM TO Type Of Syst_ em: P ! L ~ ~ DISTRIBUT ION SYSTEM Demand County: $t. CroiX Sanitary Permit No: 404967 0 State Plan ID No: Parcel Tax No: 020-1395-08-010 STATION BS HI FS ELEV. Benchmark /~~' ~ Ti'.~ D,3. `OO. c'7 Alt. BM Bldg. Sewer ~ ~ 2,'2„ ' St/Ht Inlet -a J I-p •01 SUHtOutlet ~Lf(~ ++ b~YS~ Dt Inlet Dt Bottom Header/Man. $.3~' r S•~ Dist. Pipe p: 3 ~ ~~, ~~.~ Bot. System .'~ A ~ t'S r / T Final Grade ~~ ~ `3 ~ ~ ~~ S,. ~ r St Cover ,/lO ~~r CHAMBER OR ~~- UNIT Dia. Header/Manifol Distribution x Hole Size x Hole Spacing Vent to Air Intake d 4 S Pipe s) , ~D J Length Dia Len Dia cing Still rnVFR ,, o~e~~~~.e c..~+ema n.,w YY Mrn~nrl nr 4f_Grade Systems OnIV Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ~;:~_.~ Yes Imo:; No ~ ~ Yes [] No ~. COrMENTS: (Incl de co discrepencie~ persons Are tit, et .) Inspe tion # : / /~~ Inspection #2: Location: 838 Prairie Meadows Dr Hudson, WI 54016 (NW 114 NW 1l4 25 T29N R19 ) Genic i s Lot 8 Parcel No: 25.29.19.2402 t • ~.~,Q ,a. -goo tom'. ~l ~ e.,.. 1.) Alt BM Description = >+~~~ ~~~"~.""''`r ~+~~' ~) ~~ ~*'~ ~` 2.) Bldg sewer length = ~r -amount of cover = /~ .~.~ -}~ ~ ~R.~ Ce~S ! i C~~3a~~~ __ _ -- Plan revision Required? ~..-i Yes I No ~~~ ~ ~~ ~ J Use other side for additional information. _ ,_ _ 11 -- - -~ - - - Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) iTrenches 3~ t. 1. ~ ~~ ~ ~ ~q i ~~ ~~~ ~'`~ -" ~ ~'~~ ~ Safety and Haildings L'jivision ~ 201 Y~1. ~Jashington Ava,, P.4. Sox 7l b2 ~~~~~~~~ ~ Madisoa, WI 53707 - 7162 Department of Commerce ~ Sanitary Perinft ~~ippliication In accord with Comm E3.21, Wis..Adm. Code parfoAal tniorswriaa you provide _ mar ba for aecarodaty auma~PrEvacy Law tIS.pA(1~(m` -- I. Apml4eatlon ~ ~ - Ple~e Prlat AI! ltsforeaation /rfeU~'S ECE1'1AE® Zt Code Pba Slue P ~~ ,~.OIX COUn; i v ~OPJIh~G OFFICE ~_ moo -139,f'-0P-odd xadan o? Y4 ~ /~u~s2~ra9N.R/mil r ~. 83ock Nuusber -- II. Type of Htswldla~ {e~aclt sq than tpP1Y) ~Ciry ~1 or 2 Family Y - Ns~mber of Bedroama ~~ - ~Yl>}a~e Q I~ub}iclCopmteroiai -Describe tlu ~d .~'.~ Q sate owed !~~ mil, lfw+eet Rout tII. Type of peraltt {C1t~ Daly oae box oa liae A inumberh>~ schea^~e ivr fnternAl tee). Corpplete line B if atipplieabk) A' i New 2 Q Repleoemeac Sysoazn 3 Q Replacemonc of 6 ^ Addition to For Couat7 t#ie E S sent Petndt Number Data Issued 8. ~Cbeck if 3anttary Pwrtnit Previously Issued ~ Mw ~ZvOZ I'ir. Typo os Petmlt: (C`b~1s sll that wpply)Gsun+berin~ achotae le for Internal tue) -~ !~'-tpO 44Noa -Preawited L~Gr~+nd 2! G~ Mound 47 0 Sand Piioer 50 ^ Coa~uaed Worland 11"2 ^ :i!'rrasnrirr+ad ~ 41 ^ Holdit~ 'Task 48 ~ Slagle Pays Si ~ Drip Lana M __ ii G6~ or VII'. B~ 8h~mbsr's ~f%f, a ..____. ~~ the uadeM~aad~ ausums r:ipatutbW for Plumber's 5ignauee j of tba Pd Number a~z<d~~ ~,,,~ ~~ ~}aYaRQp 9~'f `!!1 (#lass 1s~3&rG -3i (,Approved ~ Dvad o..~...., «.................... _.__._..---- _~~ Surcharya Fee} Q Ciwaer t3lvea initial AdvatAe rn , p0 -'i' 1X. Candttio» ~ hppra~'nURewwas for Diettpprove! ~~ ~ ~ ~5~ ~~ apers~Aira _ Ratgdnd - L~apertul PropoRed 933 ~37~ ~•~" lr~Capeaity is ~~To~at~~Nu~bar t3ellms i CraUons I of Tacks Stati(aa18.1DsysISQ.I$.) (Mt4.RAC10 ~ ~~ r~tlrn a6 lMpll' AOt lesl tbatl M Y County 5iW Addressp ~etiecic it Revision y04/9G 7 9y~ a Prefab Site Coacrote Corsrrucrd SSD-6398 (R. 0Sl~1) I ~ ~.yc~ jY,~rf( ,pia: /D~,B ~'^~ a~~G ~ ~ ~ S ~ ~~s Yi r1t ~ ~~S' 'TO•F/.~U o f ~~So. a `~ S~~ ~ Y d a,,~.~1~.1,' .v J ~~ U<' Sao .cJ ~~~ `'4~' y ~~ h ~ ~~ U d ~~ `~ 2 ~~ ~ o ~ ~ ti~ ''~ f,Gdd w ~~\ a~ lJ .~,~ ~~ ~~9~ ~(oas~ s; ~ t-~ ~`~( r- L, ayc~ jy+D~rf( ,~j~c: /p~~E t~..3 ,~~/~ ~b ? D S G ~~/ ~G ~ ` ~~S `~O~/..U B f ~~meSa' mar/ ?~ ~ ~-.YD~ ~t°v~rS.~,o ~ d y ~~ Y u ~~ ~ ~ ti ~ ~~ ~oS ti f~ ~ 6 d ./~~t. ~~ ~l~Sy S.'1~-~i ~ `lf ~i\ a' Q .. Wisconsin Department of Commercie Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of 3 in ~rrnrrlnnro with (`nmm AS VVic A.ir.. r`.vln _- - - -- County l C I'Y~l Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must .- K 7 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date • Personal information you provide may be used for secondary purposes (Privacy Law, s. 75.1M (1) (m)). Property Owner ~ ~Oh~ f L ~ ' Property Location GL - l ~kIMZS ~/G Govt. Lot~l~ 1/4~j~ 1/4 S?~ T„2~ N R ~Q E (o Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# :3 2 ~ a ~ ~ ~ a-.,u.~ g ~~~~ L ~ ~ 5 City State Zip Code Phone Number ~ City ~ Village Town Nearest Road [~ New Construction Use: ® Residential / Number of bedrooms ~ - y Code derived design flow rate _Y,~ - Replacement ,LLJ, Putilic or commercial -Describe: Parent material ~ U a Floo f~i~l~' fi~pplica le ~(/ / ~- Genera! comments s~(S~t ~n _ /t tJ ~ ~f /- p U and recommendations: (~/ ~'~°~ 2 5 2002 ~U _GPD ft. Boring # ^ Boring * f UP $DI ~ ~i 5 bC~ ~'c° © pit Ground surface elev. 9~' ~~ ft. 1 - Depih to limiting factor / Z b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ( d-~o l0 r3/~f SL ~rr,s mv~'r c 5 -- .lP /~ 9y.v~ ~goring# 1^~ Boring ~- tOP Sail hc:~~ l~a~G-, remvvcd I~ Pit Ground surface elev.", ft. Depth to limiting factor ~ ~ U in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a ,12D (U y lv m 5 ~ 5 ~ ~ ---- -- . 7 /. Z- G11UCI11 81 = DVIJS ~ sv ~ GCV mgrs ana i as Hsu _~ -rou mgn_ tnluent rFZ = t3VUs < 3U mgrL and T55 < 30 mg/L CST Name (Please Print) Signature CST Number ~~c~cul-~ Schu -~:-'~ 15330 Address II Date Evaluation-Conducted Telephone Number 3 ~Q ~~ ~. ~r'Yl~(' CT ; E 5~/jJ~ ~ -- - ~ -~ G~ ~Z ~~( 5~2~ ~- ~"lUU ~. SBD-8330 (R07/00) Property Owner 4 ~-~ arcel ID # y, . ; . Page Z' of 3 Boring # U Boring ~, ~b~ 5p ~ ~ ~S\b n 1 .rrY tpvccr ®, pit Grounds rface elev. D ft. Depth to limiting factor Z~ in. Soil Application Rate Horizon Depth Dominant Color Redox De cri Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ O - l 2 ~p r Y~ro '.n 5 Q 5 h'l ( - ~ . '~ /. 2 ~. - °r 6 3v ~, ~ ~.8 0 ~ ^ Boring ^ Boring # q~ y~ ^ pit Ground surface elev. ~.! = ft• Depth to limiting factor in. Soil Appliption Ra! Horizon Depth Dominant Color Redox Description Texture Structure Consistence E~oundary Roots GPD/ft2 in. Munsell Qu Sz Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor . _, in. ^ Pit _ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell ~ Qu Sz Cont. Cotor Gr. Sz. Sh. Rate I 'Eff#1 I 'Eff#2 'Effluent #1 = BODS > 3t~ < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = Bt' DS < 30 mg/L and TSS < 30 mg/L The Department of Commerc : is an equal opportunity service prov: der and employer. If yo ~ need assistance to access services or need material in a ~ alternate format, please contact the r':epartment at 608-266-3151 or TTY 608-264-8777. sao-as3o (R.o~roo> I . ~~ ~ i ~ , PAGE~OF NAMF ~ =~"~ma rIC '~n•! -~ T OT# ~ T EGA_L DESCRIPTION ~ 14 ,S T N R E(or)W SCALE:1"= ~ ~~~ BM 1 ELEVATION /0(J • C~ BM 1 DESCRIPTION ~pd~ ~awlc~a~ b/~ Ci t' BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION Y9-U ~ ALTERNATE ELEVATION CONTOUR ELEVATION ~G - ~ U '~~'~'- ~ ~- .S~ -Q a'' ~ ~~ ~ a ~~ c q~.5° l ~ ~ ~~t ( M~ _ h SIGNATURE i/ -~ ~ _ -_ __._ _ _ _ __ DATE ~ - / f - ~ Z t Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ~~~o~~~~ Madisoa, Wl 53707 - 7142 be artment of Commerce 3 a ~- o (Zy Sanitary Permit p 'cation In accord with Conan 83.21. R-is. Adm. Code, persoaal information you provide tnav be used for aecosadaty rnutases PtivacY Law s15.04(l~m) _.,.___._.. Application ~f'tytamtiaa - Ple~os Prlat Ail Information -_ .cn cw t r a ~` d e Property owwer'a Mailing Address N1 Q G~uN~Y 7.32 ~4Yf~.$ LcY ~4.r/-G City. State zip Cod Zp 11~ County a# s38 P~w~ vU~ "Sanitary permit Number ~`~~'6 ~ ^ Cluck if Revtston ~~ parcel Nnmber~S .2R . 19 . ozo -. 13g~- o8-eta Proporty location S~ T , Block ~e a-LlG !%'~/~`rd ~~ 3"SO y ~v:S"/-Yd J- yQ9S e .r~,' L /r %l s' II. Type of suildin~ (check au that apply) ws ~ s w~`• °'''lt• pcity ~i or Z Family Dwelling -Number of Bedrooms []Vlllage Q pnbiiclComtaercial - Describe Use owttahip SD.N Nearest Rom ^ State tlwned r« r~.~e ,e dc•~s ,Qv ~. TYl>e err permit: (Check Daly one box on line A (attmberiag sxhe.me [or hxteraai rue). Complete lino B if appIkable) For County use A. 1 ~' Nan 2 ^ Replacement 31'stem 3 0 Repiacemcnt of 6 ©Additian w Tank Onl ~ Fads ' S at3m Date issued stem Fermit Number B. ^ Chsclt iP Sanitary Penmit Previously Issued ~ scheme is for internal nse) ~ ~ IV. Type oP Permit: {Check all that apl~Y)(a~~ag ~S p~, ~ 44,~Non -Presstuiied IY--Grauad 210 MouAd 47 ®Satxi Filter 50 ^ Constructed Wetland~Q"",.+T v~ 41 ^ Holding Task a8 0 single Pass 51 ~ Drip Line 22 ^ Presturited In-Gmund 30 Cif Other ~ •-S G. ~' 45 ^ At-Grade 44 0 Aerobic'Matment Uarit 49 ^ Recircula' y, eat Atnea Iaformatloa: Percolation Rats sY Final Grade Design Flow {gpdJ ~~ Arai Dispersal Ares soil Application %/' D ,} j'~ y d proposed Rate(Gals./DsysiSq.Ft.) (Min./lnch) U S S ~aD ~.~~ ~S 7 ` 7 ~l 2~~~ .Ja- ~. od 7s, a ~ i. Tank Info ~~u' ~ C~tlans of Tanks or Holding 7antc I n/ I - I ~~ f~'0 VII. R oasfbllit3' Stateateat- b the ttadestdgned, tmswme rcapoaudbillty for of the POWYS shown oa the atxaehed pGtmber'a Sigrature RS Number $usiaess Pl Plumber's Name {Prod) /~f/iG'~'s~iN- SGh/s.fi~ y/Ye1' Ptumber'a Address (Street, City. State. Z~ Code) Number l VIII. Coast /De t Use Sanitary Permit Pee (includes Grotusdwattr Date Issued issuing Agent Signature {Na Stamp Approved ^ Diaapp Surchar8e Fee) ~ 0 Owner Given trutial Adverse ,~ ~ 2S• ~ M o~.ZSI?~° IX. Condi ons APPr,M~'~--m for iaap ~ ~ 1~(~ ~ ~o~Q,Q c,~ ro~oQ`~o~ceS , -~ ~/++ ~ l~ ~n~tu ~. ~ -~+->~ ~i`~ °4 p'°,` t gr.tu~+2 e~'T~S . ~~ ~ ~- Attach complete plane (to the County Dab) for the e7stena oa Paper net less than 3112 t[ 11 lttt'hp !n slat 1 Fiber Plastic Glass Prefab Site Concrete Constructed sera-~~gs t~. osroa) ~-a.v~ ijl~r,~ u ~/~ ~'',~~ .Z~ 7` ~' Sc ~,v~ ~ ,~'l2S _ T w~ .~ ~' ~~ ~l~o..J ~~~~ { /~/r1,2-~ ,~ ,~~ a~/ ~l,~.f<. s ,~ t-~- ~~~s~b~~ ~1~0 W,~~k ~ ~`~~/il ~ v a ' q ..~ A/ `~ :~1 sue' ~~ g7o ~W~ r ~ ~ \. 5'~ y a~ ~ ~ a ~ X ~ + C4 ~ M ~~ mr . i , // ,/,•~ , ~~ .~~74 ~ ~ 3/02 a /o ~ J~ a~/ usL s ,~ A'-~ .ago s~bh ~ G~~~o ~~~~ ~~~ ~~ ~~ g7d m~ ~ h 5,'t y ~3' v y ?t -~ ~ ~1 - tNisoor?sin DepaMaent of Commerce SOIL EVALUATION REPORT Page I of ~, Division of Safety and Buildings , m aocoroance vrmr a~orrrrn aso, rvis. t+arra. t.oae n m st 8112 11 i i i Pl h i t l Couniy 5-f-. C ro ~~ te plan on paper no ess than Attach complete s nc es n s ze. a u x inducts, but not lenited to: vertical and hori¢ontat dinedion and p~1 1.0. . percent slope, scale or dimensions, north arrow, { _i<!~'~r`a~@ to neared road. Please print a ~, atio~ ~ ~, ~` R by Date , ` cy law: s:1 04 (1) (m)).. Pe-sonal inronnation You provide may be used ,;~iadery ~ z ZOD ` ~ property Owner _ P Location ~. .~;Ua ? ~ 7~~~ Govt of ~ 1/4/Vw 114 S ZS T Z~' N R /~f E(or Property Owners Mai~ng Address •` .; =~ ~ 5T '- ~~t Block # Subd. Name or CSMI~ C~ ~ Z o S~ i I I W ~, "FFICE `~. S G City State ZP Cade ,, ~!!1, i`~ .City ^ Y dlege (~ Town Nearest Road ® New Construction Use: ® Residential / Number of bedrooms 3 _ `J~ Code dern+ed design flow rate ~S~ ~~ O O GPD ^ Replacement ^ Public or eanmerdat - Descnbe: Parent material DU faaJQ..>; ~ _ Flood Plain elevation if applicable f 3 q , U ft. General comments S ~ S ~{ rVt t t c J0. f•b /~ - ~P ~/- o ~ l.,o w ~-r go•oo and recommendations: ~, Uf~ e? I •e..~ 0.{-,b r~ -fop b'9: so ~ow-e r g£s•Sa I I Bonne # a ~9 , L l LZSI Pit Ground surraoe elev. 7~ • ~ v n uepm m axmm~g Tacror i i ~ ~ m. Sal n Rate Hor¢on Depth Domir~ntCdor RedoxDasa~tion Texture Structure Consistence Bourxlary Roots GP Dffg . in. MunseU Qu. Sz. Cott Color Gr. Sz. Sh. •Eff#1 •Eff#2 a- Z t -- s' 2r~ m ~ (~ ~ - 5 •8 2- IZ-1 l ~ ~4`~ Si 4 2 -~ c5 - . 5 •8 3 I -~ l r4~ mS b ml - -~ I.Z ~~ # ®p~~ Ground surface elev. 9'S : U 4 R Depth tD limiting factor~_ in. Sod Rabe Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP DlIr? in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 *Eff#2 1 0- ~ 3 t 0 -=- ~ S i I 2-,-~,b nr~~t- c. 5 (v ~ • 5 •. 3 ~y-- l0 I `- ms ~ - ~.2 * Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 mayL ' Efliuent #2 = BOD- < 30 mglL and TSS < 30 mglL CST Name (Please ..Print) Sic bore CST Number ~G vv` ~~-1~.~ wok e.r ~~ Z533c~`~ Address Date Evaluation Carducted Telephone Number 2 t i 3 ~0~' Si-. S~me~~e~ ~ ~1 ~yo~ G ~i -~/ ~~s~Zy7-~l~ ,t.. Property Owner r ~~ ~ ~, Parcel ID # Page z of 3 aring # ^ Boring 2 S ^ Pit Ground suntaoa elev. 9 ~ ft. Depth to limiting factor _„L~ in. Sofl icatiort Rate Horizon Depth Dominant Color Redox Description Texture Structure Consis6ence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cunt Colo[ Gr. Sz. Sh: *Eff#1 "EtT#2 ~-12 ~ - S~ ~ bk Gs_ ~v~ _• ~ 8 2 I Z-2~ i ~ ~-- ~ i k ~r ~ 5 - 8 t o.o 3~ ^ Boring # ~ Boring ^ pit Ground surface elev. ft. Depth 1p limiting factor in. ~~ ication ~~ Horizon Depth Dominant Color Redox Description Texture Struchxe Consistence Boundary Roots GPD/fi? in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 "Eff#2 ~~ # ^ Boring . ^ Pit Ground surfaoa elev. eft .Depth to limiting factor in. Soit &:ation Rafie Horizon De th Dominant Cob Redox Description Texture .Structure Consistenae Boundary Roots GP D/fi? p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Effli2 " Eflluerit #1 =BODE > 30 _< 220 rix3IL and TSS >30 _< 150 mgll. ' Effluent #2 =GODS < 30 mglL and. TSS _< 30 mglL 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 60&266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) '+ PAGE ~ OF~_ NAME -4 r K ~-- ~ I LOT# ~ LEGAL DESCRIPTION,(/E '/e1~,c,Ua S 2sT~f N R(~( E (or)~ SCALE: 1"= yU M 1 LEVATION /dd. d BM 1 DESCRIPTION ~ c~ -~' Z ~~ ~o~ P, j~e BM LEVATION o/ 9 `/C~ rte' BM 2 DESCRIPTION %~, o .~ Z ~uL ~„oTe SYSTEM ELEVATION ~a0 9/OO Gyw-er 90~ao ALTERNATE ELEVATION ~c, ~ S' Y Sb 6owi r A A. sd CONTOUR ELE NATION gt , so , q ~, so r 9S. So ix -~- - sic. z S SIGNATURE ,~ ~-~-~~-----~ DATE ~ -S-al __ ~AG~ --~ OF '~ ~M. i~ ~r r ~p g~ } a ~~ ~' ~ ~ o fg ~ ~_ Y ~ti ~ N tll a $ ~ ~o .~ ~O ei r _ i p ~+ 4 ~i qy 4W! tt~o N ~~ • ~ ~ ~~ ~'~ ~ ~ M ~i =~ ~ ~ ® ~ ~~ . s~ S ~' ~ ~ ~ '~ k it ~ ~~ ~~ ~~ f~ ~~ S 3 w T I"w x ~ r ~ '~ x _ ~n N ~~ ~a ~~ ~ ..a H t~ Ch + : ~ ~~ ~ .~ ~ Ct1 X (!~ ~ ~ ~ ~ ~ • TJ ~~ o~ c co' c c O n ~ 3 ~ ~ ~ r ~. a. ~ ~ $- ~ ~ ~, ~ g c m sn ~ ° zC ~~~~~ m ~ao~ ~~ Q ~ . A ~ ~ ~ n ~' ..~ ~ ~ 3a ~~~ ~~ N ~ ~ ~ tQ ~ ~~~~ 4 i ~~ ~ m ~ n ~ ~ ~ ~~~ ~ ~~~ . ~ n ~ a ~i trim ~~ ~~ "'~t~+ InvQ~i i 1'---}~ b . , i ~ o ~i .~ `~. .. • w ,~% Private t~nsite Wastewater Treatment System Managemen# Plan Septic Tank And Gravity in-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Cade each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits tar system are on file at the county zoning or health department. This management plan complies with Comm $3.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onslte Wastewater Treatment Systems SBD- Table 9: System Deston Specifications Sanlta Permit Number (o ~- Number of Bedrooms Desi n Flow -Peak pd as Estimated Ftow -Average ( pd) v'D Se tic Tank Capaci (al) Salt Abso lion Component Size ftz) 2 - ,~,,,, Ty a of Wastewater Do estic Table 2: Soli Absorption Component • Limits of Reliable Operation Septic Tank Component Soli Abso tion Com onent Desi n Ftow -Peak d) . as iy, Maximum Influent Particle Size (in 1/$ Maximum f30D iL} 220 Maximum TSS m /L) 150 Table 3: Maintenance Schedule Septic Tank inspect and/or service once eve 3 years Outlet Filter Inspec# once a year and clean at feast once eve 3 years Soil Abso lion Com onent inspect once every 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic to nd outlet filter shall be assessed at least once every 3 years by inspection. The outset filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~~ Management Plan for a Septic Tank and Soi; Absarptton Component filter Is equipped with an alarm, the filter obeli be serviced if the alarm is activated continuously. intermittent filter alarms may Irtdlgtte surge flows or an impending continuous alarm. The septic tank shell have its contents removed when the volume of scum end sludge Jn the tank exc;eeda 1/3 t#~e liquid vc~fume of the tank. K the oonterrts of the tank sro nct romaved at the time of an assessment, maintenance personnel shall advise the owner of when the rt®xt services needs to be ps+#onned to mafitain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers ehauld be inspected fcr water tightness and ooundneaa. ACOess openlrtgs used for sarvioe and assassrr~nt sha~Ii be sealed watertight upon the compietlort of aenrioe. Any opening deemed unsound, defective, or aub)ect to failure must be repiaarsd. , Exposed aa:eas openings groater than 8-inoh~ in diameter shall be tBCUred by an elfectlw locking device to prevent acciden#al or unauthorized entry Inca the tank. Na orte should enter a septic a other treatnNnt or hofdtng bnk ~ .ny r..son w~ belrt~ In full coer»pthnc~ wlfJ~ osxa stcendands iRar enhrlt~ • eonn,>zcwt space. Thi rtrrtosphen wldtln the septic a otlrer tr+s+atti~t of lroldl»~ tc~tt ~.y oQnbin ~aN ~,ais, end ruacw of a pe~tan ~ t~» tntwtor of tits arRk may br dlf~tcult or lmpaeslbh. Tank abandonrr~t shall be in accordance with Comm 83.33, Wis. Adm. Cade when the tank is no iangsr used as a POWYS component, The soli absorption component serving this structuro is desl~ned to accept domestic wastewat®r from a residential facility. The limits of operation of this component are shown in Tabu 2. "The longevity of a soH absorption c~mpanent depends greatly an proper and timely maintenance, and system use within or below the limits of reliable operation, Oaod water cartservatlon praatioes by sil eacupants and the instsiJatlan of water cronserving plumbing fixtures are key factors In extending the useful life of ibis cornpon®nt. The Bali obsorptlon oamponent`a operation must ~ aaeessed ay Inspection at least once awry three years. The inspection shad include rac:ording the levels of pending, if any, in the observsibn pipes, and a visual lr~spectlort for any evidence of aurfac;e seepage or discharge from the oampanent. On steeply sloping altos, areas of erosion should be Identified and repotted to the owner far repair. The surface discharge of domestic wastewater ar sews fla from the system is prohibited -and rcnsidered a human health hazard. Traffic around or aver the soil absorption component should be avoided particularly during winter menthe, The compaction or removal of snow cover over the component may lead to hydraulic failure by fr$ezing. This type of failuro is usually temporary. but is difficult ar impossible to repair until weather conditlcna improve. !n general, soil carnpackion over this component will reduce difi'uslon of oxygen into the soil and dispersal coil, which may lead to mare intense, and earlier, or~gsnic clogging of the soN. Z ..r Management Pian for a Septic Tank and Soii Absorption Component Pisntinga of deep-rooted trees and shrubs directly Ova{ Of within ten feet of the Component should be avoided since coat intrusion into the component may obstnact wastewater flaw. Contingency Plan in the avant of system #ailuro, a naw system could tie inata!!ed in an alternate area. With the inatalfatlan a# a divarter vacua, the existfnp syatam could also b• roused agar a period of throe to four year. k is the property owners rosponsibility to maintain the aitemate area free from any piantinp of trees, shrubs, etc. In case of failuro of the original system, the aitemats area wifi be needed. If any trees, shrubs, etc. have bean planted on the alternate area, they will have to be removed at property owners e~ertse. I# alternate area is destroyed, there ant other alternative systems that Dan be used, in which, could result in added exper»e to the property owner, Any tank abandonment shall be done in accordance with Wisc. Code 83,33. Any questions regarding this Dods, please contact your loceti Zon3r,Q t}!'fice or contsct the inataHina plumber. ~c.~ ~,.r~ a..~,t.,~, ~ ~ v~, eY, 6 >, N~ t Z t S~ 3 ~ b , 3 ! ~ t ST CROfX COUNTY Owncr/Buyer Mailing Address Property Address (Verification required from Punning Department for new construction) ~ ~ t~ty/State ~~"^'~arcel Identification Ntunbex ~,EGAL l?ESGRIP'1i'>(ON ozo- 1345-08- v~ ~~Z Property Location ~ %.,,,1/~_ t/., Sec. ~ . T~_N-R1~W, Town of ,,~/Q~So.,J . ~ Subdivision ,~,QL%~_ ~ //~ .Lot # ,_~ Certified Sarvey Map # .Volume ~ .Page # ~~ Warranty Dtxd # Gn~lrf ~O~ ~ , Voltune ~~ ~ ~ .Page # 2~ Spec hotise,.~' yes O no SEPTIC TANK MAINTENANCE AGP.EEMENT AND OWNI?RSH[P CERTIFICATION FORM I.ot lines identsf~able ~ yes ^ no S`YS~M ~iAIl~I'I'ENANCE Ia~zaper use sad asainteaaaoc of yoar acptic rystem could ~sult im iss I*remabm~efailurc to harrdlc wasLcs. Proper axamieaaacc of pawing our the septic teal; every @uu years or sooner, if aeodod by a liooensccI pnnsper. Whit you put into rho tysttm . can affcd the function of the septic tank acs a trzatmeat sage in II~c see drspc~sal system. The propcYty owner agrees to submit to St. C3noix Zoning Ducat: xrtificxtioaform, signed by the o~encr. an+d by a msstaptumber, joameytnAaphmrber; testridcdptuuiba or s liocnsedputupcrvaifying thai (1) the oa-site wastewaterdispoulsysum is is pmpa operating condition andJor (2) after iaspoctioa And pampiag (if accessary). the scpt~a tank is less than 113 full of sludge. Ifwc, the mmd~ed have rud the above tnq~riremeats and agret bo maintain the private sewage disposal system wide dre standards set forth, herein, ss ter by the Departimeat of Commerce and the Degaztmeat of Natural Resources, State of Wisconsin. Cectifcatioa stating that yoar septic system hzs boea maintained must be coraplcted and returned to fire St Croix County Zoning Office wisbin 30 days of three year expiration date. Si TORE O P CANT DATE OWNER CERTII~ ICAT'XON I (we) certify staicmcats on taus form are tnre to the best of my (our) knowledge. I (we) am (aru) the ownG{s) of the ~esaibed ve, by virtuo of a wattanty deed recorded in itcgister of Dxds Office, SI 'TUBE OF APPGIt.,ANT DATE s.s.ss ~, iaforaution that is uric-relxYxcatcdmay result in the sanitary 't being rcvoiced by tlro Zoning Department. s••a.. .s Include with this application: a stamped warranty decd from dre Reg' of Deeds office a copy of the certified survey sup if reference is made in the vrarrs.nty decd w. ~ ~ '~` 117-M-COC-pOrdUon Minnesota Uniform Conve~ancin Blanks (1978). Miller/Davis Co. ° St. Paul, MN 651-642.1988 8 _.. ---_ ------- .---------- -- ___ STATE OF MINNESOTA ss. Affidavit Regarding Corporation ~, COUNTY OF ___ _ _ _ - _._ - - _ _- and ---_ ___.---- being first duly sworn, on oath says(s) that: 1. ("They are) (. he is) the __ and the _- _ __ _ ___-- -_---- - -- -- - -_ __ respectively, of _ ___-- _-_ _. -- Carnage_.HomesXXl,_Inc_ _-- --_--~-_-- _- _ a _1~innesota _ _ ______-_-__ .__..__ corporation, the corporation -- -- ------ _ -- - --- -- in the document dated --- ,and filed for record __ -_ ---- ------- -- as Document No. _ - (or in Book - ------- ----- of -- -- - - ------- - - -----_-. __.._ - - - __ - Page _-___ .-___.- __ _ __-_-.-------.) in the Office of the (County Recorder) (IGE~kOt~ct~~ _ -- - - -- - St. Croix-- -- -- _ - County, tnnesota. of _ _ _ __. 2. Said corporation's principal place of business is at - and said corporation's previous principal place(s) of business during the past ten years (has) (have) been at: 3. There have been no: a. Bankruptcy or dissolution proceedings involving said corporation during the time said corporation has had any interest in the premises described in the above document ("Premises"); b. Unsatisfied judgments of record against said corporation nor any actions pending in any courts which affect the Premises; c. Tax liens filed against said corporation; except as herein stated: 4. Any bankruptcy or dissolution proceedings of record against corporations with the same or similar names, during the time period in which the above named corporation had any interest in the Premises, are not against the above named corporation. 5. Any judgments or tax liens of record against corporations with the same or similar names are not against the above named corporation. 6. There has been no labor or materials furnished to the Premises for which payment has not been made. 7. There are no unrecorded contracts, leases, easements or other agreements or interests relating to the Premises except as stated herein: i '~ 8. There are no persons in possession of any portion of the Premises other than pursuant to a recorded document except as stated herein: 9. There are no encroachments or boundary line questions affecting the Premises for which Affiant(s) (has) (have) knowledge. Affiant(s) know(s) the matters herein stated are true and make(s) this Affidavit for the purpose of inducing the passing of title to the Premises. Carriage.Hon:es, ~hc.. .~~ ---- ... _ _ _ _ _ _ _._. i ~yy{ ._~.. ~. , _..... - .._ . ~.. Subscri d sworn to before me this ... __ .._ ._ _ - ~° r~av of ~-_~-- -. - .2001... ,s r ^.• . ,: i I~ THIS IND Made by.RICHARD N. PEARSON and JEAN M. I~ .~i PEARSON, husband and Wife, grantor. S.. of....st :.. Croix------ ---•• ..............................••----.-......Countyy, Wisconsin CARRIAGE HOMES XXI, INC. a h~teb conveys and warrants to........._.........._ .....................................•---.__..._ Minn~sota corporation, ' --._. ---- -._.._.._ ........................................................Y;..~i g{~rantee....---. of WaS~ing~on ...............Count 1~i~~i2~ ~or the sum of prl~_Qollar_-.and,- no1100._-.(~ 1, 00) _-.and.. other.._good._and-- va luable_.. CQI19~Sl~JG~~ 7aS2n ...............••--------.......-----................-----............ ---...... -----------•-----.._.......... WAI11iANTY DICIDD B7A7E OP WISCONSIN-FORM 9 TNI• •PACL RLYLRV[D POR RLCORDINO DATA RETURN TO the following tract of land in-...~St.:-.-CI:Qix ...................._.........-...............County, Wisconsin: .A~.1...4-~_.kh~...N9~.t.~'.~e~.~..Quart<e.r_..(~Jyti';;,.-~nd...(~orth_-Half {N'~) of the Southwest Quarter (SW;) of Section 'Twenty-Five (25) 'lbwnship 'Iwenty~Nine (29) North, Range Nineteen (19) West, St. Croix County, Wis%onsin, except IAt One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as' Document No. 518444. In Witness Whereof the said grantor. S.. haVe...... hereunto set:......_theit•--•.-_-..• hand 5... and seals.... this ....-•---... day of--- ~aY .......................••-•---........., A. D., ~~C..2Q0~ ............................................................ (SEAL BION>IID AND AIDALED iN PR3I:8RNCI. OF ....(SEAL) .~~~~~C,'Ll S~GZ.. ......... (SEAL ) M:' ~~OIV ............................................................................................Y (SEAL) Ma.nn~ssata :N ~~• , 41~~ 16G2P~~289 II Warr-wti~ ~ce~ .. ) . 648604 Y.ATHLEEN H. WALSH hEGISTER OF DEEDS Si. CROIX CQ., WI RECEIVED FOR RECOkD 06-18-2001 12:f5 PM iJARkAHTY DEED EXEMPT M CERT COPY FEE: COPY FEE: TRANSFEk FEE: 9900.60 RECOkDING FEE: 1.00 PAGES: 3 Aewediat Area Name and F:etaia Address l,a,.l T;-F le, 1rc . J9oo S'ilvor (.eke j~ No,.~ ar7~~n , MN SS/!Z C7Z0 - 1069 - 70 - oo c~ Pa¢d IdenBfication Nmaher (PIM C~ZG-ln6Y-~p-vC~p' O 2' o - I O6q _ ~d _ vav b 20 - 1070 ' coo - C7r~p 020 - l070 ~ rv -nvp U20 - )0'76 -zo -~ "THIS PAGE IS PAST OF THIS LEGAL DOCp!@iT - DO NOT Ri•?IOVE^ 7Lk iofgmedaa mu4 be aocpjafed pj• q$~~, deannou aGle. mm~e k rcnun adCn+r a,d N ar +he trto~dnt efmuee, ktd 4rertp~, erG ~^~' ~-~~ oe thse P-E- ~/ rc4'~~l• Odor Jrsfoie~aoon ivrJ, docianrnc ~° i Use of dilr Darer a addr ~r Pale 4/~ Qaaanav aI w y 6r ylaefd on ad~daw! cr tRe -at owe pate re your ~ner~t and 32. w dw rerar~.. ~ . 1'at ~ ~ ~ iPircowln Swnee~, J-.S17. WRD,( ]~y6 r. ' DOCUMEKT NO. I+ c. __ WAHMNTY DEli1D t 1662 STATE OF W)gCON81N-FORM 9 TNI~ ~FAC[ RLLERVLO FOR RLCOROINO OATA THIS INDENTURE, Made b .RICHARD N. .PEARSON and JEAN M. PEARSON °""' _,,,••_____________•-• usband. and _ ife, grantor. s.. of..._St:.. Croix ..................•----.................................County, Wisconsin,: hpteby conveys and warFants to..._CAf?RIAGE -HOMES XXI, INC. , a ,~ MLnn2sota corporation, ..............................•... , tvasfi'ingtori.._.._......--- ................................................... t rautee........ of ......._ :........................._---•---................................ y 1RdfXd6li~ for the sum of;: Count , Qn~_pollar.„~nd_ no1100----(~1; 00)._ and-_other..good -and- valualile_--I~RLTt,RN „ L,~ti,~t t ~~f /t C4?D.8 id~zatLOrl .. ...---- ....... ......... lSfraif/~/.3 /41cc S, Iv<-~ L<•rf(e i~e.~. Sf1vC .......... .._ ..... ......... ........._.........-.............-.........----...............---.......................... , ~ r i J Ito.,., ~/t~ the following tract of land in....-$t.,,..C[ol ~t F ``•' ....lF.---• ...........................................County, ~ s'// t Wisconsin: .A~~,..4~-.khe,-plod-1rhw~~.~..Quarter-_.LNy~;~..and_.~IOr~h-.Half (N~) of the Southwest Quarter (SfV~) of Section Twenty-Five (25), Township Twenty-Nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin, except Lot One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. See Attached Exhibit A Parce~ Identification Number This is not homestead property In Witness Whereof the said grantors-_ ha~~...... hereunto set......... their hands... and seals.... this .........- day of... !~aY ........................................ A. D., Y~C.2Q0]. _.....-•---• the above named .....-- ............._..... (SEAL) ,,,,,... .................... (SEAL) ~. ~) :'..:'~.......... (SEAL ) _.-......-- ... ...........(SEAL) ...-----.., A. D., i~..29,01 to me known to be the persons..., who executed the fozegoing instrument and acknowledged the same. /---~ s..--t =-~ TFIIg INSTRUMENT Aa DRAFTED CY ` ~RX-MOUNTAIN Richard J. Ga~rLel, #32864 880 Sibley Memorial Hwy., 8114 Noaa~AL: Notary Public, . ~~' „N,OTARYPUBLIC-MINNESOTA County, Nis. ' My Comm. Ezplres Jgn. 31, 2005 ado..a.~.~ ~ cr.+; r, 1, t• ~ cc~.~i D-1736 o r Diy rorrlmission (ek ..................°°..._.....-.......-.:......................... (Section 3941 (1) of the Wiuoroin Shmtu provides That all instmmenU to he recorded shall have plainly printed or typearittrn thereon the name of Ne `canton, grantees, vitneases and notuy. Section fy.Slj similarly requires tha! the name of the puson cvho, r govern- menW agencT ~h¢h, drafted such imrmmenq shall IK printed, typewn!ten, stamped or vritteR thercoa in a legible manner.) WARRANTY DEED STATE OF WISCONSIN wboonam r.oLal Blank comn-ny I'ORlli No. f Milwaukee, Wle, (lob 39R 11 ) ~ ~ Vn!..~U62aAGE 291 _~, EXHIBIT A Parcel Identification Numbers 020-1069-70-000 020-1069-80-000 020-1069-90-000 020-1070-00-000 020-1070-10-000 020-1070-20-000 o~ ~~~. ,~~~~/~ of . c~o~x co~'N~~ ~s ~~yN .p~' ~UDSO~, ST. N,.R19~,T ~ ~ .... . C,~ ~ 1 .... _. _..---- y `~ I .. ~'' K,Wl.• ~4.C (~(~t t~D~Qt#t~ ~0~~ ......- N ~ ~ ~ ~ _8 ~ ~,~ ~ ~ 93,532 SC? FT ~ 2.196 A~C~ $ .2.147 A~~ ~^l 1N.r r ~°' ..~ . ~J 1 ~ , - -- • -- N~~ ~~ prairie ~SOrs;Tw _.._-• ._.. •-- .... .. . Kwi~ ....... +.. ., . cctA.o ;