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020-1395-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567281 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bell, Brian & Lucia Hudson, Town of 020-1395-10-000 CST BM Elev: Insp.BM Elev. BM Descr' lion: Section/Town/Range/Map No: / (9 D.. �) /00 ' 1( ( o 4 S/r � 25.29.19.2404 TANK INFORMATION ELEV2TION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Y Septic Benchmark ieaS71 WI /Z )-- —, z g va ?..) /CO. / Dosing Alt. BM 1-072 o f �'Ztaf-k=YhCualtc edval Aeration Bldg. Sewer Holding St/Ht Inlet ARit l Outlet TT�fT � zil TANK SETBA INFORMATION ->� �' '""" TANK TO P/L WELL BLDG. Vent to Ai ntake ROAD DtJ t VQL __Vie,- � q 41. g 3 tt �" p�� /� ti-1A ��,' � Septic __-_ f t?T f /I �" Dosing Header/ nl V'Sq (a „,... Aeration �� Dist.Pipe i �- Sv 5. Holding Boystem / I J2 .53 Wy Final Grade "(t a� / ..5? 7. PUMP/SIPHON INFORMATIOP(1�17y g',3 9z,/� Manufacturer �� Demand S17c2,1 / _ GPM f G 4 2. 5 9 .I� Model Number - '1 lm C ZA Q/t/ TDH 'Lift Friction Loss System --:• TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM— 47L ring CeZ(J vf(vo,(J,� 4o � r,,Qy_ 17/� j BED/TRENCH Width 3 / Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Dep DIMENSIONS 3 / O 3 ,-- INFORMATION SETBACK SYSTEM TO V P/LW/ BLDG WELL LAKE/STREAM(I---EACH O Man tur it-hr a� T Of System: f ( UNIT Model Number: RIBUTION SYSTEM 71-0 1141444--, SD ,yA i t2� /r, _J ' /N)�r�ifold t Distribution / v✓ d S x Hole Size;— x Hole Spacing u ijo Air Intake v"`� //!!AA` ��'p/ Pipe(s) /,, . �� l Length Dia Length"'ti Dia Spacing >/Ofl uaxi.._ 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 Bed/Trench Center 9 / Bed/Trench Edges Topsoil E Yes M No 0 Yes 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: (2-i. ( 7/ /3 Inspection#2: / / Location: 25.29.19.2404 848 Prairie Meadows Drive Hudson,WI 54016(NW 1/4 NW 1/4 25 T29N R18W) Scenic Hills Lot 10 Parcel No: 25.29.19./240 1.)Alt BM Description= s' aQ al-Sri(V a. f• CtQ..•rt� 2.)Bldg sewer length= 51-a- p`_ 0 0' J ti 4(( a.�- -amount of cover= �"l l/ Plan revision Required? Yes No � ,-�] Use other side for additional information. a I �, v SBD-6710(R.3/97) Date Insepctor's Si nature Cert.No. . .9o.co' r • 50,/e✓a/aa-6-e„,,,,,- by ScA0eitta ci •..,i/eda/ua4;or,p, by-TJ ci i 5e- ♦EX,S�r�9rude elet/a-4z,-) 92.0' 4ca/. /= A z.i.5C 9... 0' Ji fil=3 c i N Brai fie' �d// (t ` 8516 4-41.-,e f(ea«/, L..)s ■ r \ t Sp p pj Q AA-dS0n, f 94 1 /id, /J/ . ,"56-€416- N//s iii-lf 1/4,11. ? \ i , 9yu ' \ ■9(0' , o 06")ypcvy✓, 5cc..2 5;T :9/, g./yw'., Tn.�f/K�SGY7� t , , ` 3 .e ro4 co., u.�l, t i PC/. 41 G26-X395-/0-occ C.t'•3&13cl-5Pc`s�. \ t w� t /�ci�g.2.68SacreS 8y ■ ■ t ■ t tt 81 Pea�S¢ddeiscrs.,), wleen. �trcc(3� ..s-..0--- L., SV-4, ■t -fic6�S 7/�W'/7 T., /fir ,I 1 t yQQ t , �r>�'/�a-�✓c .Su,rl¢eC e/ev��mr,3�� ti 05 aeI t d(v,.,)n 4.71_1,-de atBQo;86.0•' q(B6 t d v6-' vIdC. elCzAwre/•'n 6X,.5.47n 4.2-5v9../ 1,t2ieSer 64-tecl4-e t .. 5 e,..)/ ,,be..1 X-/a)e,ef/c nt` (3artcfttvtailC 1 �` Le✓a-tov-E IL.. vu 14A ef.=9S.2V: .Qof cvn off' ► t I /taw pi S.-ding. ,l % 9ar4ye`., , + id : ColrGr eF/oWer/eve/ CsnGe,&Pc�io,Elet!a 91.6,5.' 'EXisti, Nik kesidlnee ,- Exist t,Je61 U 337.35' > Pra;rye fe eadowu Dr: _ J..zW9 County Safety and Buildings Division St.Croix 0$ 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) ��\ Madison,WI 53707-7162 5,-1 2Y( Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit Na is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(lXm),Stats. ("'ra Same I. Application Information-Please Print All Inform 's C Property Owner's Name . . Parcel 4 I Brian&Lucia Bell ,Y>. �4%20-1395-10-000 r '2•4710 / Property Owner's Mailing Address r'n C,7, Property Location To, Li 848 Prairie Dr. ,v �.Qo/, Govt.Lot City,State Zip Code Phone Number %- NE '/, NW '/, Section (circle one) Hudso ,WI 54016 (651)755-5068 T 29 N; R 19 E or W II.T pe of Building(check all that apply) Lot 4 or 2 Family Dwelling-Number of Bedroom? 10 Subdivision Name p(( 51 Block# Plat of Scenic Hills ❑Public/Commercial-Describe Use Na 0 City of ❑State Owned-Describe Use CSM Number 0 Village of Na Down of Hudson III.Type of Permit: (Check o 1 _ = - - ., line-A—Complete line B if applicable) A. stem �- Replacement System Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Pr �evious Permit Number and Date Issued Before Expiration Owner - 3 1 1 (i P I—'- r2/&/2 00 IV.Ty of POWT . , Component/Device: (Check all that apply) on-Pressurized In-Gro + ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component ex. ;:. 2 • . .,. ' • . explain) {7 at-Inn e4.CA V.Dispersal/Treatment Area Informatio.•51 Infiltrator"2-4 Plus"Standard chambers&6 endca•s i W 01 i S fe.4r4J GPX.t o Design Flow(gpd) Design Soil Application Rate( .. Dispersal Area'equi • r 1 pers. ea ' +..sed(sf) System Elevation / 600 Gpd 0.60 Gpd/Sq.Ft. 1,000.00 sq.ft. 1,050.60 Sq.Ft. 87.0',88.0&89.0' ✓ VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units ..igt4 Al New Tanks Existing Tanks ,EU iT� ! wC7 a Septic or Holding Tank 1,250 1,250 , 1 Wieser C Concrete r 1 X �j� Dosing Chamber &X/577/111i" £i i3 4 A�oo - /7'e` VII.Responsibility Statement- I,the enders' red,assu a responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's ignature MP/MPRS Number Business Phone Number James K.Thompson afr1154 MPRS 30021 (715)248-7767 Plumber's Address(Street,City,State,Zip Code) 340 Pa lson Lake Lane,Osceola,WI 54020 VIII. ounty/Department Use Only pproved 0 Disapproved Permit Fee Date ued I: uing Agent Si ❑Owner Given Reason for Denial $ y 7 s.`f% I l 0.-7 13 , dpr■)ux_vt4...__, IX.Conditions of Approval/Reasons for Disapprcn 5 5�r'„_ t/ 'r d 61-i. L�(/r-.i i Je r 1/dS SYSTEM OWNER: v� 'T"r"J y 9`2/� ZOf� �Q 1.Septic tank,effluent filter and It iZt03^xK (.L�i� / , � f2— aJtt jt- �, !I dispersal cell must be serviced/maintained >! I'� as per management plan provided by plumber. ` / �' H✓ 2.All .. . -. 5 4- '•-' '"--,., 1 r''' -±r-T4 um ands 't tot Conn ty only on pa�not than 8 in x 11 inches in size as per applicable`::- or.'ui.nces. / (i • SBD-6398(R. 11/11) "' (/ Replacement Conventional POWTS Index & Tilte Sheet Project Name: Bell 4 bedroom Replacement Conventional POWTS Owners Name: Brian&Lucia Bell Owner's adress: 848Prairie Dr,Hudson,WI 54016 Site address: Same Project Location: Subdivision: Lot 10,Plat of Scenic Hills Legal Description: EE1/4 NW1/4,Sec.25,T.29N.,R. 19W.,Tn.of Hudson,St.Croix Co.,WI. Parcel ID#: 020-1395-10-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Parcel map Page 7 Septic Tank Maintenance Agreement Page 8 Certification for Utilization of existing septic tank Page 9 Waranty Deed Attachments: Soil Evaluation Report by Schumaker Soil Evaluation Report by Thompson Mater PI .-r Restrt ted Service: James K.Thompson,Dept.of Comm.Credential#30021 Signature: e O s--- Date: r/I,c'. 2 .20/3 Page 1 Of 9 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.O1/01) 290.co' • S0,7e✓a/tca-6onlo/c. by S5%4 ervta.,44i •Soil eta/Geer;or,p•'' by Tf orr►/osc,-, •CXiS.6iT,rude eie i/cv4r n 92.E ■ 4Ca/e_/_t_,Ai!`1 3.5G `' I' N R N Br a,7 pe4G,6 i 4 ?c// 61 , I 85/46 g"air,'e/�eaa/e w S • I 90 0• 0 Atelson, ,-,i/ 5`�°/w ■∎ 11 9/0I 061vot)144 5cc..2's 7.-:z974 9yv, 13.3\ ' , d p./yw., T,,.o1,44 c/seY7 4.eel* eo. mil, ell-34,i �� , I /k/. a C �(39s-/U-o� e . E I Y v,�get —�' ■` �‘ ,\ \ It I% 6,/72.6 5 acres ' I �, BI propavdd;5 es-r5c (ce//. iru(3) ` 'oncL,S et 3;r 7/%44//7 T.,,/aro- ,- 1 I . am 1'{ V-ii*d (�3 7j(4---6-y..,44. + ■ I ', t =714 f ki.✓a.�i✓e sa.4ce e/ev, ar,,S 4 i I I I I #5444440 dow,-,4." 'e a-t8�'BAO: 4141 E, - • " . I I ): ¢81 a. C1 // 9GB0��~ ' Propos • 5�',1S7/n3o3y 1 _ dtrv57on vle .. e(7/a"r2/.'nt 6X,,5.0,79/,2sv9 l? /t)i est,-�Cncrde ■ Sciatic_ -,e,...y e./,4-Ia)e6f/la41 8tnck ■ a`l Etc-01.- o,1-E 11-i. owt-14A, el,- 911y, t#am o.F' /awn 5:dir,9. \\\\ E'IN!=GG/04 8/1 t 4� %, 9a d,e`,, ,, • /! : Co44croF/cover/eve/ �i C ncrat 1 d-io,Elev z 91.4.6, ' v 414 kesidmee EP:5, ►y uJe4/ 337.3O' y /°rairje 4e4 de415 Dr BELL DISPERSAL CELL SIZING CALCULATIONS 1. (4 bedrooms)(100 gallons estimated flow)(l.5 design factor)=600.00 Gpd design flow 2. Infiltrative capacity of native soil=0.6gpd/sq.ft. 3. Absorption area required: 1,0°0,00 sq.ft. 4. Absorption area as proposed: 1,050.60 sq.ft,(5lchambers total) Infiltrator"Quick 4 Plus"=20.00 sq.ft.EISA per chamber,Infiltrator"Quick 4 Plus"end cap=5.10 sq.ft.EISA 1,000.00 sq.ft.—(6 endcapsx5.10)=969.40 sq.ft. 969.40 sq.ft./20.00=48.47 chambers required Number of trenches: 3(ai 17 chambers per trench Trench width: 2.83' Trench length: 71' Trench spacing: 9'on center Total system area w/9'center spacing: 21'x 71' Pg.3 of 9 Soil Absorption System Cross Section NI =A-- IN 9/,0i— I I 93.73 ft 4"Schedule 40 atop/ Final Grade PVC Vent Pipe BT 0'5 I With Vent Cap 'q•O , ft n (Th (Th / Leaching 87.Oi Chamber e9.6'' ft System Elevation -2,S3 ft _Co ft (oft Soil Absorption System Plan View 7 / ft Z.e3 ft { 0 11111 I # 1C� (p ft Leaching _I Trench 1 Chambers --_, 10 , I I 0I _ t C \ 4" Dia Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model 4' a... .- 'Q- 5i.4/us .% ._doted EISA Rating 20.0 sq ft per chamber Soil Application Rate O.C. gpd/sq ft Co dZ) gpd Design Flow;. 0.6 Soil Application Rate x 7-o EISA= SC Chambers 3 rows of /7 chambers each. Page 4/ of 9 Conventional Septic System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall be maintained in accordance with component manual SBD-10705-P(N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber,Jim Thompson at(715)248-7767 or the St.Croix County Zoning Department at (715)386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1Xe). Septic tank to be located within 150' of service pad,with bottom of tank to be 5 15'below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code,by an individual certified to service septic tanks under s.281.48,Stats. If the contents of the tank are not removed at the time of a biannual assessment,maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank.The outlet 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 filter is equipped with an alarm,the filter shall be serviced if the alarm is activated. Septic tank manholes risers,access risers,and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33,Wis.Adm.Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce,Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic(other than for vegetative maintenance)over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March)dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS,and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional,more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old Drainfield at 3 year anniversary of new system installation. Old drainfield to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Continuencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg.5 of 9 ! Al;!VtlUdfli.1,l ? 1 ,es Z.1.£ . . rr C.) c‘j / § 4 i l • r 0 „..- I 0 � I / z vim g 1 • • '1,e'941E M,t t t( ' • * �1 6- (a(9 ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Brian & Lucia Bell Mailing Address 848 Prairie Meadow Dr., Hudson, WI. 54016 Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State Hudson, WI., 54016 Parcel Identification Number 020-1395-10-000 LEGAL DESCRIPTION Property Location NE I/., NW IA, Sec. 25 ,T 29 N R 19 W,Town of Hudson Subdivision Plat: Plat of Scenic Hills Lot# 10 Certified Survey Map# Na ,Volume Na ,Page# Na Warranty Deed# (before 2007)Volume ,Page# Spec house Oyesl lio Lot lines identifiable S yesIno SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&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 wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 /ii / I3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) 70/'9 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address)848 Prairie Meadow Dr.Hudson,WI 54016 located at: NE 1/4, NW 'A, Section 25 , Town 29 N, Range 19 W, ' Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it(they) appear(s)to be functioning properly. Most recent date of inspection or service October 25,2013 , 1 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,250 gallon Construction: Prefab Concrete X Steel Other Manufacturer(if known): Wieser Concrete CA •+ ank(if known): 11 years,installed 5/09/02 ermit mber(if known) 399614 b , - C .-.)..—s..— James K.Thompson icensed Plumber Sign.iture) (Print Name) MPRS MPRS#30021 (Title) (License Number) MP/MPRS November 20,2013 (Date) Form to be completed by licensed plumber(Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 P5• 8o( IflIllI 0111 IIII � 8114196 State Bar of Wisconsin Form 3-2003 Tx:4091045 1583174.1-sMN QUIT CLAIM DEED 969318 Document Number Document Name BETH PABST, REGISTER OF DEEDS • ST. CROIX CO., WI THIS DEED,made between Brian P.Bell and Lucia L. Bell,husband and wife 12/12/2012 12:52 PM EXEMPT#: 16 ("Grantor,"whether one or more), REC FEE: 30.00 and •Brian P.Bell and Lucia L. Bell,as Trustees,or their successors in trust under PAGES' 1 the Bell Joint Revocable Trust under agreement dated October 7,2011 ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate, together with the Recording Area rents,profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): Brian P.and Lucia L.Bell 848 Prairie Meadow Drive Hudson,WI 54016-7975 • Lot 10,Plat of Scenic Hills in the Town of Hudson, St.Croix County,Wisconsin Parcel Identification Number(PIN) This is homestead property. (is)(is not) Dated I CQ,rAttA I ,2012 • (SEAL)/ (SEAL) * * :rtaann P. Bell 86-ee (SEAL) � �1.�.�t� (SEAL) ---- *. -- —, * Lucia L. Bell AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN authenticated on CM I. COUNTY )ss. s Personally came before me on LQ-(!,p/m.bi,1 I ,2012 , TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Brian P. Bell and Lucia L. Bell,husbandT (If not and wife -., � authorized by Wis. Stat. §706.06) to me known to be the person(s)who exectit ekte.fc -/rcgoiag', .X;i instrument and acknowledged the same. „.Cis , i, THIS INSTRUMENT DRAFTED BY: \ Scott M.Nelson,Mackall,Crounse&Moore,PLC,901 jt Marquette Ave.,#1400, Minneapolis,MN 55402 Notary Pu ic, State of Wisconsin My Commission(is permanent)(expires: 43142,12 .,-). • (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.' QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO.3-2003 *tRkliame below signatures. P5 OC? 2356 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations Attach complete to site County indude,but not limited to:on vertical and horizontal reference point(BM),direction and St. Croix percent slope,scale or dimemsions,north arrow,and location and distance to nearest road. Parcel I.D. 020-1395-10-000 Please print all information. \Re iewed� Cozcile r Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(t)(m)). j// �(,,°i' �.Proper ty Owner Property Location V� v° w ZT w Brian&Lucia Bell Govt.Lot NE 1/4 NW 1/4 S 25 T 29 N R 1 Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 848 Prairie Meadow Dr. 10 Scenic Hills City State Zip Code Phone Number _J City J Village s/ Town Nearest Road Hudson 1 WI I 54016 1 (651)755-5068 Hudson i Prairie Meadows Dr. J New Construction Use A Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD A Replacement J Public or commercial-Describe: Parent material Glacial Outwash Flood plain elevation,if applicable 926.50 General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.6 gal./sq.ft./day loading rate. Recommended infiltrative surface elev. =87.0',88.0'&89.0'. - 1 Boring# J Boring , ✓J Pit Ground Surface elev. 90.83 ft. Depth to limiting factor >107" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1t2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10yr3/2 none sil 2fgr mvfr cs 2fm,1c 0.6 0.8 2 12-20 10yr4/2 none sil 2msbk mfr cw lfmc 0.6 0.8 1 3 20-34 10yr4/4 none gr sl 2msbk dsh gw 2vflfm 1.0 4 34-50) 0.6 10yr4/6 none gr Is Osg dl cw 1 vf,f\ _/ 1.6 5 50-107 10yr5/4 none s Osg dl - - 0.7 1.6 'C ''') -:- /t&y 2 Boring# I Boring Pit Ground Surface elev. 93.46 ft. Depth to limiting factor >116" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-5 10yr3/2 none sil 2fgr mvfr cs 2fm,1c 0.6 0.8 2 5-26 10yr4/2 none sicl lmsbk mfr cw lfmc 0.2 0.3 3 26-38 10yr5/3 none sil 2fsbk mvfr gw 2vflfm 0.6 0.8 4 38-51 10yr4/4 none gr sl 2msbk dsh cw lvf,f 0.6 \ 1.0 ( 5 -60 10yr4/4 V -� none gr Is Osg di - - 0.7 1.6 r 6 60-116 10yr5/4 6-5.C. 5• none s Osg dl - - 0.7 1.6 — tonguing to 68"at NE corner of soil pit. Effluent#1=BOD 5>30<220 mg/L and S>30<15, mg/L Effluent#2=BOD5 30 mg/L and TSS<30 mg/t. CST Name(Please Print) ignatur. V CST Number James K.Thompson 3602 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 54020 11/20/2013 715-248-7767 ' a - \ il.• .56i/e tca�rGr to I- . �" by so/✓a/bcota,E4.-- III,�7i/eda/.d.-6c4.,p, Ex• s'E% uc/e e/e✓a- Zn ea/e:/=to �p 9s c' ! �■.i�i# 4 ,4 • j0f .SZ 9�o' ' ', i N Brill.)$e144&,-4 & // �,2 + �, 0 898 g"ail,'e/ t eacdo w s 1Z o.o' /4 dson, '-i 5"Y°/� /� +t i 9 1 /d, ,o/4.-e 0-,e1 17ic h,`//s t9(ol:k■ + t t i 3 .eroFX Po., �/ ` + I pc./. a -i39S-/a-oc6 Z1/5 14/g3 c4-s puso.1 ■ t t + /,ri X.48 5-acres + t I ' t t.* kil\yS,o-- ► tt i �l I 1 ( 1 t 1 , t I 1 I 1 I . I I I 1 ■ d � 9G.D0��� 1 6)06V2/,:2-57 9a,P GJitSer cede t stialle e,,.)/ ,Ee.l,4-/e o f/ua,-f ��tnc�r 1 (`lE_eiato,.+-E I•. omtl4A el,=96.25!, 8otar,oP lawn 9arcye. t• + , • Co.aer ec/owe,-/eve/ , • N4 kesidsnee tn- aci _ ead : ~rtmentofCommerce PRIVATE SEWAGE SYSTEM ~g Division INSPECTION REPORT ,.A1. INFORMATION (ATTACH TO PERMIT) ~i information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. .nit Holder's Name: City Village x Township Carria a Homes Inc. Hudson Townshi CS'' °"" G1-••~ Insp. BM Elev: BM Description: /~ ~' ~' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~ ~ ~---., -~ `~ Dosing - i Aeration % r Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ - ~ ~ ,; Dosing Aeration Holding PUMP/SIPHON INFORMATION Head Forcemain Lertgth Dia. `"~--~ SOIL ABSORPTION SYSTEM ~~ • ~ ; ^ ' ,,~: > Yv . , ; ~ t BED/TRENCH Width , -~ ~ Length^ ~ - No. Of Trenches DIMENSIONS ~j / ~, ~ _, SETBACK SYSTEM TO P/L k~ BLDG WEL INFORMATION _ Type 0(System: p -• , ! ~' '~/ -~ ° I" DISTRIBUTION SYSTEI47 county: St. Croix sanitary Permit No: 399614 (? State Plan ID No: Parcel Tax No: 61x0-~~f,~ /D-pp STATION BS HI FS ELEV. Benchmark ~ ,, _ Alt. BM ~~ ; ~ ;~` r 1»,r,~, ;,c„ y-• (air<< ~:~ .~~ ~I~~c~~ Bldg. Sewer ~ ~ 1 f1Hf Inlet St/ t Outlet ~ t ~;. E/•tiil _ / %~' • Z~1 DtlnleY ~~ // Header/ an. Dist. Pip i'~~ ~ - -~- _ ;; ~ /_ ' ' ~> ~•~~ ~ (~ ~~ c= Bot. Sy ' - i- I ~ ~ ~ ,~.dS `f~ Final Grade St (over ,• ~ I` i. /-~' i,.: i 1_L- r DIMENSIONS No. Of Pits Inside Dia Liquid Depth _- ~. 1KE/STREAM LEACHING ~ Manufac ur r: / f CHAMBER OR ~~.l.~G°~~~ l/ ~~~ 1-`~ `--' ~~ ` ' UNIT Model Number. ~~ i/ H ~ifoid „' t , Leagtn J~ Dia `'~' Distribution - ~ - i Pipe(s) , ~ ' ~ length ' -' ` ~ Dia ~ i ~ Spacing ~: / x Hole Size =~~ x Hole Spacing ~ Vent to Air Intake L-~ ~ ~ t ~ ~~ ~i SOIL COVER Y Pressures Systems Only YY Meund Or At-Grade Systems OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges „~-~ Topsoil ~,- [j Yes [] No ~] Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ' /~/ i. `~ Inspection #2: / / Location: 848 Prairie Me doves Dr Hudson, WI 54016 (NW 1/4 NW 1/4 25 T29N R18W) Scenic Hills Parcel No: 1.)Alt BM Description = , ~a`,~;, ~"(~~ '~~+ ~~'~ ~,~~~~i:~r--, ~:'~ ~ i~ ~l~-rr' 2.) Bldg sewer length = . -~ r ° ) , ~ ,.~ . ~ ~ _ ,,(_ / ~ /~ ~ %i ~ iis;.. -{ s r~i ~.,,,.<~i,,. - amount of cover = ~ -~ , ~ ~~ / _ Plan revision Required? ^ Yes No i -~ ~ •~j ~~ ' ~ ~ ~ ~- % ~ - ,-~,._ ~- I Use other side for additional information. ~_~~ ~'~ ~' ~'_ ~ ~~'~~~ ~ ~~=T- ~~ ~~' ~~ ~" ' ~ -' - Date Insepctor's Signature Cert. No. ,~, ~1, 1, '\/ ~• l i~ ,- ~ .~;~ , ~` 1y 1 `1',/ ~._ ~ r~~ ~4 ~~ i y ~ L~ ~ ACS _t ~~v. ~~ s .~1 ~~ i --- --- ,, , ,; ,1 ____ r~ :~ %i ,~_ ~ ~ 'S~ ~ S~ Q~ t4.t 21 l= 1M~-06tt.1 s ~1R • Sanitary Permit Application Safety & 13uiklings Division In accord with Comm 83.21, Wis. Adm. Code 20l W. Washington Ave. PO Box 7302 `~seonsln See reverse side for instructions for completing this application WI 53747-7342 Madison Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)] , (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County ~• L /' State 99 ~ ir~t Number Check if revision to previous application State Plat-1. D. Number ~~ ( O Information -Please Print all formation I. Application Location: Property Owner Name ~~ ~~~ ~ ~ ~ ~C • _. ~ Property LocaLon ~q ' ~ r ~ ~' . ~ ~ n ~ 7~ 1;N, R EE lor ~,~ 4, 9 1 Property ~s Mailing Address S~ ~r~~ /~~~~ ~ l.ot Num er o um r r a qty, Gtie // //~ ~~p e one c ? u rvrsron ame or CSM Number iI. Type of uilding: (check one) os ~ ~, s I or 2 Family Dwelling - No. of Bedrooms :~ REeEivE~ ~!~;"; ^ Cih' ^ Village ' , _ ^ Public/Commercial (describe use):_ ~~ ~- ~ ~3 own of~,. l ' NQV 2 '~ 2001 ^ Statt-0wned s~ 2%~ ° ST CROI Neeaest Road ` /ti/ ~n N ~ 2'ONl ppFFiGE s.~e ax um r s O U• l39 S• ~d -00 1[I. Type of Permit: (Check only one box on line A. Check box o i lic S. • ~ ~ 4~d A) I. ew 2. Replacement 3. Replacement of L S. 6. Additi n to System 5~stem Tank Only Existing System B) ermit Number Llate issue ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) (~fon-pressurized [n-ground d Mound ^ Sand Filter ^ Constructed Wetland O Pressurized In-ground D Holding Tank ^ Single Paes ^ Drip Line © At-grade ~ ^ Aerobic "Treat ent t Init ^ Recirculating ^ Other: - ,~`~ 62 a'~ -~-ra ~ ~ G ~ ~ • w. c1 3 ~c S G~ S t cc V. Dispersal/Trestment Area Information: 3 ~i-t v 5--~ '( I. Desrgn Flow (gpd} 2. Dispersal Area Required 3. Dispersal Area Proposed 4. Soi! Application Rate (Gals.lday/sq. ft.) 5. Percolation Rate (MinJinch) 6.,Sys f; evation ~/ m ade Elevation Vll. Tank Capacity in `Coral # of anufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons ranks Con- Con- glass New Existing Crete structad Tanks Tanks ~ (~U tke Y ~ ~' ^ ^ ^ ^ t; ;~ j - < D ^ ^ ^ ^ Vlil. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's ame (print) um is rgnaturc (no stamps}: MP PR No. 13usmess hone um r umber's Address (Streit, City, State, ,ip Co ) 1X. County/Department Use Only Disapproved Sanitary Permit I~ee (includes Groundwater Dete Issued sui g Agent Signature (No start-ps) Approved O Owner Given Initial Adverse Surch a Fee) ap S '~ ~ Z /DG - Detetmination ZZ 0/ X. Conditions of Approval /Reasons for Disapproval: •S.r~C~e.w.,. +`~a-C.b.~~" 5 i ~ ~ ~.s't?e- ' X71. ~"°~ i t-- l.r.~ . ~,.. ~~ n _ ~~` -! ` J`eCeu~.Intilta~i'9+1 S . ~7/00) ~' 'Q ~Qi Qn 1tL.t R 1 R Inl~~-~6(.t] S 11Q Sanitary Permit Application Safety ~ Buildings Division In accord with Comm 83.21, W is. Adm. Code 201 W Washington Ave. Po Bax 7302 ®~SCOIfSI/l Sec reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes Iuiadison,lvl 53707-7302 Department of Commerce (privacy Law, s. 15.04(lxm)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy on y) or the system, on paper not less than 8 -1/2 x 11 ut es in size. County ~~ /'~~ ~.J ` S`~`3 99 ~ i~ Number p Check if revision to pn:vious spptication Stae Plan I. D. Numt~er O ~-- r6 ~U -~ I. Application information -Please Print sl nformation Location: Property er N e Property auon Property rs Mailuig Address S~f ~~~~ ~1~~ ~ l.ol Num r u r a rh,, talc `gyp c orK j u rv~ on nine or um II. Type of wilding: (check one) ~'` ~ ' / ^. 1 or 2 Family Dwelling - No. of Bedrooms :_~S REe~ivE "~ ~ ~ ~'ty O village ~Tawn of O PubHc/Commercial (describe use): o .-- ' 2 °~s~ ~~V 2 ~ 2~~~ I ^ State-0wned i~ ST CROI Newest Road ~'~~ 6' COUNN ~tINOO~FftC;E a ax um s I[i. Type olPermit: (Check only one box on line A. Check box o 1 tic A) I. ew 2. Replacement 3. Rep acement of L S. 6. Addition to System Systan Tank Only Existing System B) ermu um r Date slue ^ A Sanitary Permit was previously issued IV. Type of PO\YT System: (Check all that apply) (~+lon-pressurized In•ground ^ Mound ^ Sand Filter ^ Constructed Wttland O Pressuriud ]n-ground ^ Elolding Tank ~ Single Pass ^ Drip Line O At-grade ~ ^ Aembic Treat ant t tnit ^ Recirculalin(t O Other: 62 ti ~ ~ ~- G ~ L~ ~ '~ u. .5 ~a~.. - . c S ~ ~ 3 x V. Dispersal/Treatment Area Information: 3 ., b ~I 1. Iks~gn Flow (gpd) 2. Dispersal Arcs 3. I)ispers Area 4. Soi! Application Required Proposed Rate (Gels./daylsq. ftJ 5. t'ercotalion Rate 6. L• evatio m a e (MinJ"mch) Elevation ~' o'G ~-,,~ SUS - ~. ~ g 3. l o ~.~~ VII. Tank Capacity in 't'otal # of anufacturer Prefab C Site C Steel fiber- lass Plastic Information Gallons Gallons Tanks on- on- g N t E i crcte ~~~ ew s ing x Tanks Tanks ~- ^ ^ ^ ^ / , ^ ^ ^ ^ ^ V[ll. Responsibility Statement 1, the undersigned, assume responsibility for installation of the PQWTS shown on the attached plans. Plumber's nine print} um tgnature (no stamps): -~~ MP PR No. -~`/.~s~ usmcss one um r ~i 3s/ ~xs- umber's Address (Street, rty, .rate, .ip ) IX. County/Department Usc Only Disapproved Sanitary Permit Fee (includes Gmundwater Date Issued u' g Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surch a Fee} pp ZS ~ ~ Z /D4 0 - Detetmination Z / X. Conditions of Approval /Reasons for Disapproval: ~ ~ p (~ ~(,~ ~ ~,, f~ /~ ~+~ a~.nn~ v.+wa~ ~a.~ ~ir.oQ Kt-C" u~ncg.~`'°c'"""~'~ t"`~' ta-+uxt. ~ (~-~~A.ua~-~ 9t't~ -kS ( _ L lj~~ +~-t`C.t~~M~c ~ ~ 07~ ~ ~ - W . ~,.. Cs.n~~ 5'2e- ~ ' . l~ o~ ~ P ~ l~ ~~ S ~ ~~~ ` trece`~tiwr~.~dtwO~s . ` SBD-6398 (R. 09/00) S~ ~Yu-, LOTi# l D I.>?i(3A1. DESGRIpT~ON .,c `/ ' ,y' c' L 9 .R 1 q E (a scALE: i'~_ `~~ BM 1 ELEVATION 100 • o - BM 1 DESCRIPTION -4o P c~ Z" a uc. Q t per., BM 2 ELEVATION ~ 4 i• / S BM 2 DESCRYP'I'iON " SYSTEM ELEVATION 43 • d ALTERNATE ELEVATION 43 • `{ a CONTOUR ELEVATION fG•~'~ 4700 , 4~. o ~ i Sfl ~' ~ `~Z/ ~~ ~~~ - ~`~"'l~ 5~ dYu-, LOT# D LEGAL DESCRIPTION % S/ S E a SCALE: 1'~ y 0 , - BM l ELEVATION IOC> • 0 BM 1 DESCRIPTION -~oP c~ 2 " ~JC A; oc __ -- BM 2 ELEVATION i. 1 S BM 2 DESCRIPTION ~.p .~ ~ Z " ~1 SYSTEM ELEVATION 43 • `! d ALTERNATE ELEVATION Y 3 • `~ p CONTOUR ELEVATION Y6•~'~ ~ ~ , Qg. o 0 i SD ~ `~~~Z~ ~~ ~~%" _ ~~l ~/ WisconsinDepartrnentofCommerce SOIL EVALUATION REPORT Page I of~ Division of Sateiy and Bui~ings m ao»oraanoe vum~ ~.omm oa, vns. r+om. woe qty ' t Pl 11 s croi Attach complete s0e plan on paper not less than 81/2 x an mus ~. inducts, but not limited to: vertical and hor¢ontat t and Parcel I.D.. . percent slope, scale or dimensions, north arrow, and ~ rat road. P/erase print al! I n. .E~ ! ... R by Date Personal information you provide mey be used Kx dally ~ ~~~~. s.15.0A'(1 )).. '`~~ ~0(p O t Pr~rtY Owner _.r ~ t1 i v ~ P~ 1 c a> . 1!4 ~/~Il4 S ZS` T Z N R / ~j E (or~ Property Ow er's Mailing Address ~ - n ~ ~ Lot # ,~ # Subd Name ~ CSM~ / - tv ~ Z. ~ s'~ i ~ ~ WG'I"e r'' ~ ~G pFfFl E~ S e ~ i City State Zip Code . ^ Vtilage (~ Tawn Nearest Road ~ , _ _ ~Srt i l l w«.~•cr -'Vt ~.. f'Sa ~z c ~'~} _ ~ ~ ~ f ;_ ,,. ~ ,~ _~ s ,'~ ® New Construction lJse: ® Residential / Number aF bedrooms 3 _ ~{ Code derived design tTow rate ~Sd ~lo O O GPD ^ Replacement Q Public or oommerdal -. Describe: Parent material Ov fc~.ra.81•. Food Plate elevation if applicable ~3G ~ 9Z G • S o ft. General comments S ~ S ~ r11 e. l G ~a f•b n - q 3• Y U and recommendations: ~, L,~ 2. l ~,~ a- •4-.`0 >r\ - Q3. yd l.pl Pit Ground surface elev. 9~-ft. Depth to limiting factor I Zd in. Soli ' n Rate Horzon Depth Dominant Cobr Redox Description Texture Stricture Consistence Boundary Roots GP D/fP . in. MunseU Qu. Sz. Coat Cobr Gr. Sz. Sh. •Efi#'1 •Eft#2 I -U IU Z -- Si l 2 k rr~' ~S lv~ . ~j - ~ Z l I -4b (~ 413 - Si ~ Zr~b k -~-r c S -' . 5 ~ 3 4p-124 1 ti ~(o _ -r5 Ds m - _ l • `7 /' Z 43.10 S~'• ~ 43 L Bonrig # ^ ~~ .. ®Pit Ground surface elev. ~ 7. / O tt_ Depth to limiting factor ~ I in.. Soli Rabe Horizon Depth Dominant Cobr Redox Description Texture Stnxdure Consistence Boundary Roots GP Dlfft in. Munsell Qu. Sz. Coot Gobr Gr. Sz. Sh. - 'Eff#'1 'Eff#2 t ~ -l~- I Z ~- Zfn~.bk c t v~ . 5 •~ Z iy _~. r.. ~ .. gi t 2 b _ G _ J . $ 310 -~ I$ 10 ~ m S Os 1 -- - --~ ~ . 2 r---- ~F~~B * Eftluerrt #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 malt. ' Effluent #2 = BOD. _< 30 rnNL and TSS < 30 mglL CST Name (tease Print) - Signature CST Nuriber r~;l ~ ~~ 1~.~ w~ e.r' ~- ~---- ZS 3 30~ Addmss Date Evaluation Conducted Telephone Number 211 3 ~~3 S~. SOrner-~e-~~ r4(I 5/02,5- ~'~ GJ 7/5-247--`1oy~' Property Owner ~. r kG ~ ~ Parcel ID # . Page z of _ 3 , Boring # ^ ~~ ®Pit Ground surface elev. ~~o ~ y~ fk Depth to 1~~9 ~~' ~~ in. Soil lication Rate Horazan Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfI? in. Mur>seil Qu. Sz. Cont Cob[ Gr. Sz Sh: "Eff#1 'Eff#2 i ~~2 io z s. ~ ~- cs ~ ~~ ~ ~' • 8 3 3p--I~ ( rrS ~ ,! . - .-1 J . Z ~•6 ~~ # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon th De Dominant Cobr Redox Description Texture Struchare Consistence Boundary Roots GP D/lf p in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eif#1 'Eff#2 Boring # ^ Boring - ^ Pit Ground surface elev. tt. .Depth to limiting factor in. Sal lication Rate Horizon th De Donrnant Cob Redox Description Texture Strudauie Consistence Boundary Roots GP D/fl? p in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eif#2 • Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = GODS < 30 mglL and TSS < ~ 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 deparlmerrt at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.07/00) PAGE ~ OF_~ NAME -4. Y` K -e- ~ ~ LOT# (d LEGAL DESCRIPTION tiF `~<Nw `~<,S z5T2 9 N R (~[ E (or) SCALE: 1"= yU BM 1 ELEVATION /0O • ~ BM 1 DESCRIITION -k~ p o ~ z " ~ Jc Q: Pe BM 2 ELEVATION /0 I• / S BM 2 DESCRIPTION -Its ~ U ~ Z " ~l G _~ ~'D~ SYSTEM ELEVATION 43.Y6 ALTERNATE ELEVATION 93. `(~ CONTOUR ELEVATION 96•~~ 9.00 , 98. ao 4?~OO ~ a-3 q~•oo _, 1 ~ e. 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Ln l(J In Q ~ 'O ~ N N N r` L7 N 'Q r tD tO M ~ r V~ iN ai w ) a ~ ~n N c~) ~t c0 aD O ~ ~ m Z ~ ~ ~ ~ 'Q ~ uy a N t ' cp oC oo •- to v cflw~ U u rev ~ L ~ V ~ o- w~ c ~ ~ E ~ ~ r< O O M ~ (V ~ ~ m cr -r ~ co 0 b N 'G ~ c,.~ c„ I c~ o cv ~ ~ O c+7 (n •t Q o0 7 47 M [+) r O N ~~ N M M O~ ~ N d O O ~' r r N 07 C w ~.t N Q1 O~ ti cA .I (,~ ~ ~- c , •-- 0 0 0 O G ~ w 10 0 ~ ~ a C7 vs o ~ C ~ ,~ ~ ti jptlJ~MN ~ ~~ o 0 0 0 o c a m ~~ Private Onsite Wastewater Treatment System Management Plan .Septic Tank And Gravity In-Ground Soll Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and pnx~dures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, of governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the En-Gnaund Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanita Permit Number Number of Bedrooms Desi n Flow -Peak ( pd) Qo' Estimated Flow - Avers a pd) 4~o'Yi Septic Tank Capaci { al) Soil Abso tion Component Size ( ) d Type of Wastewater Do~~ Taber 2: Soil Absorotlon Component • !.{mite of Reliable Operatlon Se Tank onent Soii Abso tion Com ent Des' nFlow -Peak iz ~-~'~'' Maximum Influent t'ardde Size {in « 118 Maximum BODa /L 220 Maximum TSS m L 150 Table 3: Maintenance Schedule Septic Tank Ins ct and/or service once eve 3 ears Ouflet Filter ins ct once a year and clean at least once eve 3 ears Soi! Absor tion Com onent inspect once every 3 years Septic Tank The septic tank shalt 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 tank and outlet filter shall be assessed at least once every 3 years by inspection. Th t t felt sha+l~,e deaned as neeessa to ensure props` aeration. The filter cartridges of be remo un ss provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Managemen# Pian for a Septic Tank and Soil Absorption Component filter Is equipped with an alarm, the filter shelf be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. if the con#ents of the tank are not removed at the time of an assessment, maintenance personnel shah advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers. acxess risers and covers should be inspected for water tightness and soundness. Aooess openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. Na one should enter a septic or other beatment or holding tank t~or any reason without bang In ful! compliance with OSHA standards tier entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and riescue of a person from the interior of the tank maybe di!I1fIcWt or impossible Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POVVTS component. Soil A,6sorntion Gomponent The soil absorption oon•~onent serving this structure fs designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. C3ood water conservation practices by alt occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspedion at least once every three years. The inspection shah indude recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or d~charge from the component. On steeply sbping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around ar over the soli absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary. but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soli and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ,' . ~ Management Plan for a Septic Tank and Soii Absorptlon Component I Plant 8 of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided sirx:e root intrusion into the component may obstnxt wastewater flow. 3 CONTINGENCY PLAN !f the POWTS iatis and cannot be rey~aired the loliowinr measures have been, or must be liken, W provide a code compliant replxement system: A sultabk replacerrxrst area has been evaluated and may be utJll:td for the tocadon o!a replaoemerrt soil absorption system. The replxemcnt area should be prow from dlswrbance and compaction an8 sinoulb rdt be inS11r>eed upo~+ by required setbacks Irom exbtJng and proposed strvctun, lot Imes and wells. Failure to protect tM npiacement area will result in the need for a new soli and sett evaluadon to esabllsh a suitable replacement area. Replacement systems rnwc comply with the rules In effect at that t1rne. Q A wttable replacement area is not available due to setback and/or soli Utnlptlons. SarrtrtE advaswes in POWTS tecittwto~ a holden` tank may be (rotalled as a last resort to rephoe the tatted POWT'S. D The site has not been evaluated to Iderrtly a svEWxe replacement arcs. upon failure of the ~~ a loll and site evaluation must be p+rriormed to locau a sufubte replacement arta~. it no nplacerrrent area Is ava}lablt a hotdinE tank may be lnsulled as • tact resort w replace the faded POWTS. O Mound and at•t;rade soli absorption sysurru tt-ay tx retonstnscted In place fapowin` removal of the biomat at the lnflitraclve surface. Reconswatons of each rystems must comply with the rvks Mt sKea at dus date. < <WARNING> > SEr't'IC, PUMP AND OTIiER TREATMENT TANKS MAY CONTAI1dl LET'HA14 GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A Sl<PTIG, PUMP OR OTH~ T'REATMlEN7 TANK t1ND1ER Ai~iY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM Ti1R INTiR1VR OF A TANK MAY EL DIFFICULT OR s~nnccrres r. ADDITIONAL COMMENTS ... POWTS INSTALLER Narnt Phone his-- ~/- y SfPTAGE SERVICING OPEIUTOR PUMPER Nama tPOMRi MAlNTA1NER .Name .Phone 60CAL REGULATORY AUTMORiTY ~i5'- - ST CROIX CUUNTY SEPTIC TANK MAINTENANCE AGP,EEMENT AivD OWNERSH[I' CERTIFICATION FORM Owncr/E3uycr r~dh.~t ~/'1[ P,..~~ Mailing Address _ ~ ~~~ Property Address (Vcrificalioa required from Planning Department for new construction) ~.Pl ~ ~~ City/State ~~S 5~,~ _ Parcct Identification Number G ~~ ~ ~' ~ ~ ~~- ~0` Goa ~,FGAL IIFSCRIP'~ON Property ]:,oration ~G" %,/f~w ~/., Scc. ~~, T a''1 N-RAW, Town of ~~~"o'•-^ Subdivision ~~ ~' /~/ ~~ .Lot # ,_.~,~. Certified Sarvey Map # ,Volume ~ .Page # l~ Warranty Decd # ~~~~ . Volume l Cv ~'-.~- , Pagc # `~~ Spot horse ~ ya O no L.ot tines identifiable ~'a ^ no STEM MAIl~I'£Ei~IArICE ImFu~oper use sad tnanaGeaanaof yota septic system could result is its pr~atanfailure to hurdle wastes. Proper ta~ieaaacx of pvatpiag ottt the septic tank every three y~ or sooner. if needed by s Iioenscd pumper. W'6at you put into the eysGem . can sffeet ffie fiructiaa of the septic faak ss s treatasr~t sage is rise ~vasx d"~OSaI tysGem. The prapetty ovPna egtzes to tmhmh to St t~ Zaatiag Dcpartatcnt : oatificntioa foam, sign+od by t6o oatatc tad by s nssskxplumber, joameytnaaPWmber, restrictodptumber or a liocasodpua~erve=ifying that (1) the oa-site wastewatcrdisposalsystcm is is proper operating condition and/or (2) altar inspection and pompiag.(tf necessary), the scptictaak is less than If3 full of badge. vim. tb,e love read the above r+ogvirrm~ents and agree bo maint:ia the privsetc sewage disposal systeaz wig the ~~'~ set foctb, hatia, as set 6y t!u Depsrtrnea~t of Commcr+ee and tfbe Department of Natural Resources; State of Wisconsin. txrCif cation stating that your septic has been unaiataincd aunt be cocnpldu! and rct~.ed to the St. Croix County Zoning Office within 30 dayx of the ~ iratioa date. ll~l~~ SI TURE F APPLICANT DATE OWNER CE~tT1<FIGAT'XON I (we) certify statements on this form arti true to the best of my (our) lmowledgc. I (we) am (are) the ownet{s) of the pt+oputy dtux~ ve, by virtue of a warranty decd recorded in iZegister of Deeds Oft'ice, v // ~ ! ~4i f SI 'iURE OF APPLICAANT DATE asa~s •s ~, iaformatioa that is nzis ledrnay result is the sanitary permit being nevoiced by the Zoning Department. ""`" •• IaciuQe rrtth this spptieation: a eta warranty decd from the Register of Deeds otter a copy of the certified survey sup if reference is madesn the warranty deed ~ ~ . y,:, . s Zfi62P~~289 64$604 Do~vmaa Number KATHLEEN H. WR15H Docvmmt Ue REGISTER OF' DEEDS War ~~~ ~cc~ 5T. CROIX CC!., WI RECEIVED FOR RECORD _• 06-iB-2001 12:45 PM t WNkkAMTY DEED - EXEMPT N CERT COPY FEE: COPY FEE: TkkNSFER FEE: 9900. D0 RECOkDIMG FEE: 14. D0 ' PAGES: 3 '. Raordint Area Name aed Redtta Address l..a.d T.-Fle, Ins. ,goo S'ilv~r L~k< Zo~.d Ncw Dr1p^•ton ~ MN SS/!~ Ozo- tDbq-7o -oov Pared Idmtifr~eon Number 0?II~ C7ZO -- ! d6Y - gp •- dG p - OZ o - I v6y -`?O - o~v O Zc~ - 1070 ' coo - ~p0 oao - 1070 - ~v -oUo U 2 c~ •- ) o ~7b - z o - t:~ °THIS PAGB IS PAST OF THIS L$GAL DOCOME1Tf - DO NOT REMOVE" 7LL io[o~matioa rauu be comPiand 6y a+brrGtter: docwwou flde~ ar tht prmidnt ataarsa, ktal dacr! ~^< & rcrurn addror aid ~ (j/K9~~J. Odisr~ylaAOdon ~ Peon, er4 m°)' be P~~ on th4 JLst Pets the doaanav w Pat ~ L° i eJ Pot adds ane e m ur Qf bs laced on addtdonal er do docvaiw~t. Utr rhL awrr a P'et Yo dxranent and Q7 to d4~ rrrro ~' P >? ~'.C.~j 1Pucavin Sramei, SP,Sl7. W.?DA I~Rf ' ~ DOCUMENT NO, I. ~ ~ -_ WARMNTY PEED ~(; {/~j1}~]~//,~~~ STATE OF W)gCON91N-FORM 8 y, •, V r YQ! 1f62~f{~I:J~J ~ 1MrL .FAC[ RL.[I1V[D FOR pLG01101N0 DATA THIS INDENTURE, Made b .RICHARD N. P1;ARSON and JEAN M. PEARSON h ............................................. .................a. usband and ife ....--.....-----.......... grantor.§.. of.-..St-r..Croix ......................................................Countyy Wisconsin,. h4reb conveys and wacFants to..._~~?IAGE HOMES XXI INC:. , a M1nn~sota corporation. .............._.-.......!.....--........................ , Waslington n~yy~~e~gg~~ rautee-....... of - County, or the sum of; Qn~-•_pollar;_and..no/100 (1.00), and._other•_good_and_valua6le__.GRETURN.DL.,ti•<a T;~t/t C4n$~d@x~ta.orl • .............................. !rsfil 9tL3 /~!C'c s, I u<-~ L<'r!(c i2c~. .........., sf lc,~ the following tract of land in.....St....-Croi,lc.,__...__•..._. rVE •..` ~r + J It~-o A.i N)~~ .................................County, ~ S'// t Wisconsin: -A~.].-.Q>;...the-.hlp~•,R(lw~$,~__Q~arter-„jNyV~,~ _and._,(Vor~h-_Elalf (N~) of the Southwest Quarter (SW's) of Section Twenty-Five (25), Township Twenty-Nine (24) North, Range Nineteen (19) west, st. Croix County, Wisconsin, except Ipt One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No, 518944. See Attached Exhibit A Parcel Identification Number This is not homestead property Ia Witness Whereof the said grantor. 5.. have-..-.. hereunto set......--.their hand S..- and seals.... this ............ ..............._....-....._ day of...... aY....-------..._....-...........----...., A. D., Y#C..Z00~ BIONED AND SEALED IN PRESENCE OP ..._ ................................................................................................ "- •-- • ~••~ r~ .......................(SEAL) ................................................. ~-~.~ ~,~ . ~ =fin .................................................... M. ~1SON ........~-1./L. Y..D'.-.';--~..........(SeAL) / ...........................................................................................'--(SEAL) St~ta of ,~Ogt;spta ..... _.-..-....... p ,- Washingt`on~_., eb~h,~unty, {Personally came before me, this.7~:.`~:.. day of.. ~.`..~....... . the above named ..RICHARD N._..._EARSp19 and JEAN M. PEARSON husband and wife ~~~~~' A• D" C.,.~QOl ...... .... to me known to be the persons..., who executed the foregoing instrument and acknowledged the same. ........................................... . .a n~ - _ ...................... TNIB INSTRUMENT A~ DRAFTED Y Richard J. Ga~rLel, #3264 ~~-MOUNTAIN NOTARY Notar Public,. ~ NOTARY PUBLIC-MINNESOTA 880 Sibley Memorial Hwy., #114 REAL Y sl~~e..• ..................................... County, Wis. ' My Comm. Explras Jen. 31, 2005 i~leflE391ra $ieights, pzi+7--~~3~.@ 1736 My mrnmission (ex ' [ (Section 79.71 (i) of the Wiscomin Statutes provides lhrt all Instruments to be recorded shall have plainly printed or typevwrihrn thereon ment 1 aaeney~mh~ichntdra(teda suc~ls~ insr,umenti shill tl ey~ SMtion 79.S1j similarly requires that the name of the person bo, or govern WARRANTY DEED pr~rNed. trneadrten, tamped or wnttcn thereon in a I<xihk manna.) STATE OF WISCONSIN wlaconaln Lca[t stank Cama-Dy 1`ORaI No. [ Mllmaukae, wla, (Job aSfi 11 ) . ynl. l.U~~PAfE 2c7~ EXHIBIT A Parcel Identification Numbers 020-1069-70-000 020-1069-80-000 020-1069-90-000 020-1070-00-000 020-1070-]0-000 020-1070-20-000 UNPLE AWNED '~~ / - ~ ~` sc 1 ~ ~~~ ~ ~ ~ 1 s~~ ~~ . ~` ~~ 0 ~~~~ ~ N ~ N ~ 1 _ ~' ~~ ~ ~ ~a~ I ~ ~ ~ ~~ ~Rp~ ~ .~ i ~~. _.,~ /. ~ J N IR r~ ~ 8 / ~ ~ w o -o ~ i ~s~ .` ~ N /. ~ ~~~ ~a ~ ~ ~ 1 1 ~. ~ ~ a Psi pp - ~ _ ~ ~ __ ' ~ ~ • ; -~~ ~ ~ ~ . . ~ ~s~aY ~1 ~ = ~. ~ ~ ~ .. .'L. . ~. ~ , Q ~ :a ~ ~ 1 r~------ ~ _ ~- -.- _." . - •- ~` • ~~ ., Q ~ _ _ ~ ~ ` ?' ~ R~~ / W W N ~~,g / C ~ _ u r 333 / . ~~ ~ ' e ~ ~ ~'( ~,~ ~ i i i i i i i i I i. I I I I i I I I I I I I 1 I I I NOISN31X3 OdOd NOdn 03AOW3d 1~11d011`dWOlnd 39 O11N3W3Sb~3 Ot1S'30'ln0 ~dddodw3l srna~ Aa L' ~ ----- i "~e u ~ J 8 ~.~ ~~ i dso ~ ~, ~ v' C N u r i '~--- (~] ~ ~~ f7j U `~. ~ ,~ Q ~ ~ ~ c~v ac ~ r N T