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HomeMy WebLinkAbout020-1395-23-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION t (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(mN. Permit Holder's Name: City Village X Township Lifest le Homes Hudson Townshi CST BM Elev:~ ~~ Q In~p~M Elev~ ~ ~ BM Descrip io~ ~a~~ 1/J ~~~ ?~~ 1 o ~~y 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic a s~ Dosing ~ ~ Aeration /! ~"~ ~-- Holding ~--- TANK SETBACK INFORMATION TANK TO /L WELL BLDG. Vfent to Air Intake ROAD Septic / ~ ,~-~ 6 / ~ / / j }~` Dosing _ -_ _ Aeration `„ , „o° ' " "`" Holding PUMP/SIPHON INFORMATION Manufacturer Demand Model Number TDH Lift Friction Loss stem Head DH Ft Forcemain Le Dia. Dist. to Well SOIL ABSORPTION SYSTEM J y C~~ b-~iV~ / (',0 .~~ cOUn~r St. Croix Sanitary Permit No: 430246 0 State Plan ID No: Parcel Tax No: 020-1395-23-000 SectionlTown/Range/Map No: 25.29.19.2417 ELEVATION DATA3 ~ //7~-/~/ih-e, ) STATION BS HI FS ELEV. Benchmark n~ /L. 2~ `~, /D~`D Alt. BM S~ ~~ dU~ / Bldg. S s ul ~ (~,~o ~ 00. ~O SUHt Inlet - J .~ ~ r~ SUHt Outlet / D m ~Jr~ ~0 ~~ c_„~-_ Hea, der/Man. ~ • Dist. Pipe~~ o s 7i •'~ Bot. System I~ r , ~ 9' Z. Final Grade D. ~1 ~'S 'St Cow ~ ~"fS S q 40 Dom. f BED/TRENCH DIMENSIONS Width ~ / ~ Length / 1~5Y-~~li No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WE LAKE/STR M LEACHING CHAMBER OR anufacturer: ~~ "l Typ f System: / /~~ ~ odel Number: DISTRIBUTION SYSTEM 1 Gl~,ra•,,,~y- Head anifold Distribution}} r J x Hole Size ~ x Hole Spacin Vent to Air Intak Length_~ Dia Length U Dia__ Spacing ~ !~ SOIL COVER Pressure Systems Only xx Mound Or At-Grade Systems Only ~~~ Depth Over / ` Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~" ~3 ' j :J Bed/Trench Edges Topsoil ~ ,. ' ~l Yes No ~ °:! Yes No (~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~ /~ / ~~ inspection #2: / / Location: 868 Highlander Trail/H.udso~nrz.Wl 54016 (NE 1/4 NW 1 2 T29N R1J9W~)~Scenic Hills Lo~S~ Parcel No: 25.29.19.2417 1 J AIt BM Description = S~ W ~G`r ~QAi(.~ !N'~ .~~ -S~ G~G~-- 2.) Bldg sewer length =p ~ l~,f -amount of cover - { ~ ~~' ~ ~ ,,,._ /: ~~ ~~C.~ i . ~ ~ c~5 Use otherisrde foruadditiona es :'i No Q ' _.__ _ _ information. L__ D I~~~--- ~ ~. ,' _ - _ _ -L~~!d~l!r-- ---~~! ~_ ~- ~ Date f~~~ Insepctor's Signature ~r /~/~ Cert. No. SBD-6710 (R.3/97) /I~/~w(~A'i'U Q"~(~-~~ ~~G~7~~' " ' ~~ ~{~~G~/uG~.~~~ ~ iQ ...,,, - ~7 ~hS ~ ~ • . ~J~~~ s4~ ~~ l ~~+ ~~~~P.-~ r ' f -~---_ ~,~ ~ ,.s~ ~~ ~~ . ---_ i I I I i s w y ~ a ~ >c ~ 3 m iO~y ~ ~• ~ N fl. w 7 O O ~ W O ~ I 3 I o w C/) Z D m ~n` D y .D c ~ n c O i m N I o T -0 i =' ~ y s c 3 ~ m ~ a ~ I ~ ~ ~ N ~ -{ a Z a a 0 Ow. _0 . O 7 ? ~ N C ~ W fl. 3 Z ~ ~ I o ~ N ~ ~ I i i I a mr~u~~a,~a _ y~ fD m o °-' ~ a • am °-c °1 ~ I w no ro p j ~ w y. 'a0_ N O j O Z O LD . y j = ? = Q S f ti~°7sv i . o m W < s ~ mm ~ v ~~ ~ oo N ~ ~ ~ F m N -' ~ t/i O O~ ~ y ~ Z w3 f a~ m A ~ ~ o a w n ~cfDi'om' ~ , coo d ~~ a ~ c. o o a o N ~ ~ i p o~ O I 3 °i o C ~ ~ ~ c o ~ 9 ~ A ~ 'o ~ ~ , ~ A v c ~ :: ~~ 3 9 '~ ~ a <1 0 o r_ O a ~ o ~ !!V,• O N Y~1 c l i ~~ ~ ~ ~ ~~ ~ o ~ CJ1 N „! ~ O N S O ~ O ~~+. ~ c y~ o a o ~ i c a o - a a ~a i w N ODD ~ i N n i O OD ~ i N N O '~ 0 0 c~rcn = ;I 3 o c~ N~ a ~ ~ 0 ! 0 0 ~ °: ~ g gg g N N~ ~ w n m v ov ~l ~. , ~ ~ S _ ~ K y y 3 °-' ~ ~ I .'.' i C W Z ! ~ O ~ ~ ~ O ~ N ~ C i N J n v ~ ~ A Z <D O A a ~ ~ ~ z N W '~ !~ m m A a ~ ! '' A ~ :: ~'~. ~ 'l Z _a y Z ~ A A , I ~ ~ T c 7 a ~ y~ C a, ' ~ a y 0 N I o '° a 0'0 as w ti --- _ Safety and Buildings Division C:ourtty 2Q1 W. Washington Ave., P.U. Iktx 7(I$2 ST. CROIX _ _ iscon~in Malciiun,, Wi 537t?7 - 7(182 Sari - ra he t'illea in h `Ca.} Department of Commerce (608)261-t,54G 430246 Sanitary Permit Application i s ~ ,~~ A pertionai ittf;xntat;ao ynt, provide ~, acatra with co-rtttt 8321, w~. Haan caae, _ - may tx usea fix>eatttdary purposes Privacy Law, s15.04(I xm} Projtxt Address di~erarithan mailing addnessj 868 HIGHLANDER TRAIL ]r App ' t' Informatitu - P~ t ft-rm - Z 3 -~~ / ~ - 3 -- Property )wrnr's Nance P • I # Lot # 23 131ock # JOHN RKEL (LIFESTYLE HOMES _ __ iRopc~ty [)wnts's Mailing Adc6rss ~ <<~: Rapat}+t.ocaracm 67_2.0 STILLWATER BLVD. ~~ __ t-' ~ NE tr, NW v, Sedicxt 25 City, State: T.ap Ccx1c ~ a Phone Nttmbcr ._ , , _" - -- STI LLWATER, MN 55082 ~ 651-~73-5"05'3 `~ T 29 N, R19W r ~ w ~ _ -- IL Type of Baildiag (check al! that apply) ~1`Ior2FnmilyIhvelling--Nnmheroi'Bedrooms.4 PER SUBMITTED HOUSE PLAN _ Suha;visianName CSht:~tmlber U Pueli~~i:omrocrcial-t>e~t;tet;~ SCENIC HILLS -- -- CHAMBERS (28) ~ ~ ~ ^stag ow.,~ Dc2cri6c [rte o City_L(Vi11a~e (~T<trmrltip of HUDSON _ _____- _ _ ~__ __-- _ - ___....~__._---. ]li. T ype oTPermit: (Check only une boaw on litre A. Complete line B if appll '~ k~Q New System ~~ Re{dac~nesn System ^ Troaunetu/tluldittg Tank Replacerrwzt! ta,tly ~~ Outer Mudificatian to Cxisting System 8 • ^ Permit Renewal ~ryy~ i!r Pemtil Revision -_._.._._. ^ Change or ^ Pctntil Trast~'er to New lad Prtw,ws PermiE lvtetltber and Date lssttcd tleivrc Expiration ~= Phunt~r owner 430246 ~ Z -__ -_ IV. T of POW"fS S tem: Check all that a f ~ ~ t.y.jYcm -Pressurized ln-Cirrnutd Lj ~'(auna= 24 is of'swra6le soil ~ Mound < 29 is oFsuitabte soil ^ AL-Grade ^ Siaplc Pass Sand ~Itc~r ^ ^ I Ccxo4uuCted Wcrlatxr ^ Ptessttrizeti ln-tiround ^ ttutding'i'antc ^ Peal Fifttx I I Aercttric'iYealreterttl7nit ^ Racimwlulir, - Filler ' ~-~ ~ ( 7~ xecircuiating synthetic 1vSedia Filter ~ [.e~hirtg Chas»tter ^ Drip t irte ^ Gravel-less Pipt: ^ Oltu~ (explain) ~ 1 ~ JJ l ~/~~''~ Y. Dis rsai/Tt't'att~entAtea forms#Fon: 87.5' LONG 14 CHAMBERS EA. ZABEL FILTER A-100 .. ~._.. x .. ty7t _ evatron ~ m t:3esitgt Flow (bpd) FhStign Soil Application, S2ate(gpdef) Dxper4al Area Reepiireti (c _ .. 870.8 93.65 ~. 2 600 .7 857.14 .. _ VI. Tanis Info Capacity in Tata1 Nurrf+cr __ AlattufacKUmr Prefatt i1e feel Fiber ~' 11SI1C ~ fialtotss _ (;slktnc oftir,it5 t;ona~e L'rn~lnui«i Ciiass Phew Ex,sttnA Tanks Tanlts '~`°'~~'°rci,agr~ YE 1250 1 ___ WIESER ~'-'~~ YES fiti~b;c Tn~atmen4 LTn;! rMsire~ l~hwnrx;r VII. Resprmsibility Staterm:nt- ], tJte uniersigaaai, aaso.e respom,ibBity for ~ of the POlV7'S aito++w ev /bc tf~ed platta,• Pluntlser's Name (Print} PI 1'tMP1LS Number 1~rninaaa tYuxte Nttmher TODD FEATHERSTONE 242514 _-__._-. 715-381-1704 P9utnher's Address (Sveel, ['ify, Sra1c, Zip t'udcl P.O. BOX 467 HUDSON, WI 54016 DATE: 7/29/2004 j VI o®ut !I)e artment Use Onl .'tpprovcYi U Disaptxuved San;tary Perm;t Fee eludes C.rourtdwater Date Issued ring ent S attire (No , Stn,a,atKcr•~1 //ll Sv ` ~ ~ ~ 3~0 ^ Otmnr Given Reason for Dania! IX. Conditions of ApprovaVRessorls for Disapproval ` L~ ~ Q~ - ~'~ %~-e- ~~~2/ ~ ,~ I/~+--f d I/YI. 7~r.P.l~sa~t~ ~/~G~ z~ i~ ' Da'"'L~ ~ Gi%'-` Gta ~ " 2 ~6~ ~ ~ , ~-~r'~' ~ a~---~/ 2/~ d 3 >~ -~4/~SRi1~t.~ ~ o~:z~~c / ~~ .~ ~/ ~, ; ,tttscb cawtplrls pb,ro /t+~ Ceuatly aah) ~l"` sj~sl,am e0 gaper twA taaa 16im BltL z !1 intlaes ~ sf®e U J ~, t~ ~ ' S Bi - ~'~ . - ~G.~ Bgt - EG . 9~ ~'J~D B/>>..~ Ems. . moo, o T~~' Apv- B~ o /no, /O Ta,P oF' M a ~~~t~~ /JP~ ~ - -- - LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020-1395-23-000 Parcel Number 25.29.19.2417 OWNER NAME: First CHARLES C & TERESA W Last RANSOM PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 868 HIGHLANDER TRL SECTION 25 TOWN 29N RANGE 19W '/<160 NW '/<40 NE Line Description Line Description TOTAL ACREAGE 2.019 PLAT SCENIC HILLS LTS 1/72 020/01 LOT023 BLK 01 SEC 25 T29N R19W PT NE NW 15 02 & PT SE SW SCENIC HILLS 16 03 LOT 23 2.019AC 17 04 18 05 _ 19 /.'~ -~~~ cJ~O 06 20 W 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit Z Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in acrnrrlanra with rnmm R5 Wis Ar1m Cnda 1398 Page 1 of 3 Steel Soil Service County Altach complete site plan on pa n size. an must ' St. Croix include, but not limited to: verb and her M), di on and percent slope, scale or dimemsi s, nortAA ~ an ovation and distan to nearest road. Parcel I.D. 020-1395-23-000 Please rint a ll i n^form~tiQq~3 Review d By Date _ ( n C Personal information you provide m y be usdd~C~con~a~r~ppu LLrposUUes (Privacy , s.15.04 (1) (m)). / , ~ ~ ~ Cj~ Property Owner ST. CROiX CUUNTI' Property Location Arkell, John ZONING OFFICE Govt. Lot na SE 1/4 NW1 /4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 6720 Stillwater Blvd 23 na Scenic Hills City State Zip Code Phone Number ~ City _ ' Village _yi Town Nearest Road Stillwater ~ MN 55082 681-439-2414 Hudson Highlander Trail i+ New Construction D~~ r~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD W J Replacement _ J Public orcommercia~ - Describena Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 97.40ft. Trench es spaced and depth to code 3.OOft below grade. S~ ~ ' ~ l(~ c~ ~ r ~ / ~, Boring # ~ Boring 96 /I Pit Ground Surface elev. 96.4 ft. Depth to in. limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DlRz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/1 none sil 2msbk mfr cs 1f .5 .8 2 8-17 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 17-24 7.5yr4/4 none sl 2msbk dfr gw na .5 .9 4 24-96 7.5yr4/6 none ms osg ml na na .7 1.2 C ~~ ~l ~~ ` ~ ~ _ ~ rf i ~ 7 2 ~~ ~ Z ~'1 Borin V Boring # g /J Pit Ground Surface elev. 96.40 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/1 none sit 2msbk mfr cs 1f .5 .8 2 8-22 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 22-29 7.5yr4/4 none sl 2msbk dfr gw na .5 .9 4 29-96 7.5yr4/6 none ms osg ml na na .7 1.2 •~ * Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TS5 < 30 mg/L CST Name {Please Pr nt) Signature' _ CST Number David J. Steel ~ ~ ~~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 12/19/2003 715-246-5085 Property Owner Arkell, John Parcel ID # 020-1395-23-000 Page 2 of 3 Boring # J Boring r~ Pit Ground Surface elev. 100.40 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots P p in. Mur>sell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/1 none sil fill na cs 1f .0 .0 2 9-96 7.5yr4/6 none ms asg ml na na .7 1.2 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWYS John Arkell New Richmond,WI 54017 Lic. #248956 SE1/4,SW1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Oak Hudson, St. Croix Co. Fax (715) 246-9372 Scenic Hill, Lot 23 Legend 1" = 40' • _=Benchmark Ele. 100.00ft Top of 1/2" PVC Pipe • =Alt Benchmark Ele. 100. loft Top of 112" PVC Pipe ~ =Borings ~~ SIQ~~' Boring Elevations ~, B 1 = 96.40ft ~~~tf~~- B2 = 96.40ft N ~ ~ ~, ~a ~~- B3 = 100.40ft rt' B4 = OO.OOft ~. yo~~ boo. .~ I~°~/~ ~ ~~ Z-~Z' ly" /Z' 7~~ ~ q` 1, /5~ _~~'~~ /z - ~5-c 3 ~~ a5` ~a~ ti~~~ ~~~~, ~ SAfety tpld BAi1d1t1~S 1~VlSlOn C%~Y C ~~ ~~ 201 W. Washin6toa Ave., P.O_ I3ox 7082 /~ ~ ~ ~~~~~~~ Madisrm, WI 53707 - 7082 >x filled in by Co.) Sanitary c6as)261-~sas 30 ~ 3 Department 01 Commerce Sanitary Permit Application ~~' I.D. Number In aooord with Crstrm 83.21, Wis. Adm. Code. P~~ ~~~ Y'~ proms may be usert for sooootlary purposes Pnvacy Law, st ~_ttA(t xm j (it than mailing adttess) Y[goa ~s fl~ifil7 ~~ / cation lrformatioa- Iefatmatiott rrr O y {~•& Name Parocl # t #~~ Blo c # ~~ i'coperty Otr~ner's ARailsae Add Property i~oration C Zirp Code Phaae Number / a ~~ e of Baildiog (check ail that apply} °~ n T 7 yp ~ S Subdiv;sion Name C5M Number ~1 or 2 Farrrly Dwailing - ot'Bedroans ial - I) :C s ab U P bii ',~-~C L c a ~ ea e u ^ Sta6e Uwnod- Dcacn~6c CTsc ^City_^Vii Towrohlp III. Type of I>ermit: (Check only one ilue A. Conapletr lice B sppliceble) V 2..~ ~"{ •• A' ~Novr Syetatn ^ Rapb~aemsaa Syst®n ^ T aek ~ Only ^ d'dicatien to Ea ' ing ~ r B. ^ yet Kettewal ^ 1'ennit ltcvisian ^ of ^ Detroit Transfer tr- iVew L ~ Iiefore Expiration P Owns IV. of POWTS rem: Check all that i on -1'reasurized Ia-Ground ^ Manrat > 24 in. ot'suitsble soil Ai 24 in. at'suiRablc soil ^ Ai ^ Slagle Pass Seed Fi1sGr ^ Canshucled Wttland ^ Pncaaoripod In-Grawrd LI Holding T ^ Pad Fi Il Aaobic Treetmert 1Jnit ^ Rewradate~g Sa}~d Filter ^ Rnrirnrlatiag SytltlrMic Medic Fiber n [ eschirrg Clterrd~er n ira: n t3ra Pipe ^ O16er (expbsi) Y. llds Vi'reatmeat Ater infot~artian: ~Dr'i ~' i7U rea Requi red (s0 Flow (gp~ Design Soil Appiicatiai R,ote(Bpdst) Diapassl A Desigp em ev~ivn // ' / ~ j ' (OQ~ ~ 7 O ,s~ ~7 •~ ~ GCS YL Tank Lifo y in Total ~ Prefer site Steel Fiber Plastic Gallons f~elknia of t Inits Gonads (:aoatttrcted Glass Talcs T~s Sgctcc ~ T Aadric TnaUneni Unil TA~cnm (:lurrdKa VII. Responsibility Statement- I, ~arsl~..e..ve reapod6ilky tar beAwretlew of ale I~OWI'St drown as /he at/rcbei p1.*a- ~'s Name (Print) P Ol~l~ Pl~mrber' ~ lu/ m' b MI'lMi'RS Number Haxineaa Plrnne y G ~ r J - / ~ ~ ~~ ~ ' " f~~ r~V~~/ d Plumbex'a Aridness (Street, City, Zip Codc) ~T~ vm, cons !Dc :r~ewt Use tDn ~:~plxaved ^ Disappntved ysoitary Permit Foe (iadtrdes CmoarrdwtUer F Date AgpO Si o Staoops) ^ Ovmar Giver Reason for Deeial ~ a) ~D -~` ~2 0 IX. CO~OI Appiq~a!/IZCatROLf rtOC ~S=(7QrlYYal ,~,,~ `~- ~ t ~ . r Oita - - I\gac<r cwaplNe plum (le the Cwety adz) fir iLe syrisss ar paper aid 1a-16ae tall:ll iac-ea in alma .~~'~ ~~,r ~~ ~~ ~~~ r ~+ .~r~~f ~ . ~ ~~ frf~ f /' /, r / ~ rte' / ~r ~ ~~, ~1,' ,~~~~~', ,~ f ~, ; ~ r~ ~ t ~~ 1 ~ -`~ ~ ~~ f,, J, i ~. f~, ~ ~~ t `~ r ~ 1~` ~ ~~ ~. `~`'~,ti ~'t~ 1~ I ti r ,~ i ~ ~~ ~ r ~ r ! ~ ,1 r a i ~~ t ~"'~ ~ ~_ _ .~ _`- ~ ~~ / .i' ..--_--~ ~ /i f•• r ,' I i i y ~. ~ ~~i~ 1= ~ S ~~~ a-`~ ,~ 1Q s o~~ ~~ ~^ EMI ~{ aw z . ~ ~~'- 4 ,~ ,~ Ci l - ~_ \\\ , •V \_ 1 1 ,~ ~ ti _,~ \_ fv. ~' ~_ ~ ~ \\ ~~^ • ~ ~ Aim ~ ~., ~1~ ~ - '~ ~- - - r ,~'` ,~ 1 /~ s f v /f ~' ~ ,f R -~' r ~ j~~/~ J '• ~ `~ ,.~ t~~_ ` _-~ it - ..,~- ..." SYSTEM CROSS SECTION /1'l /} ~v~-lo ~~ ~/ Sys r~~ ~` ~` ~~ oil! ~~~ O PID # " ~ ~ss'~~/~~0~/a,S ~~T~„ N,R~~''~ LOT' BL = /SU,B"~`~'~ /l--L• .S CO VCd ~~'='~ I ~~G' "D~/ _ . 242514 r _ f f ,•~,.-x~ X~ f, r~ f .. ~~ ,r ~',y ~ f~ ~r,~~ ~ ~ t ~t ~ ~ jilt _.. fr r~`~ ji1 ~ ~ I~ / .~ ~, ; d r . ~' J ,` ~~ .' r ' ~ ~ rr r` r'' +' ~„~~ r V ~' ,~ r" ~ -- 7 1 ~ ~r r ! ~ /~ ~;~ r~ / A ~ r f ~~' ~ t~ ~ ~ f / ~ 'e A ~ ~ / / .~ ~ ~' ~~~~ 1 ~ ~ ~ r~ ~ 1 ,~. < ~~ ,, t /` ~ ~ 1 - ~ 'ca ~ 1 ~ e Y ` ~ ~ 4 '~~ r~ ~~ ~ 1 ~ ~ ~ ~ ~~ ~~~ ~ ~ ~ ~f f ~~ ~ ~ ~~ ~ ~~~'"~ i ~~ i ? - ~ ~~ .~ '• ..~ ` ~ i r~ ~-. t t 1 •.fr" -2. ~ ~ ' ~• -y"'~. ~, ~t ^ ~~-/rte -~.-.. ~~ ~ ti.. ~ ~ ~~ ~~ ~ _ f~ `.Y' ~_ ~',. ti "r _ ~L .,` ~.. r _r" ,. wsconsin Department of commerce _ SOIL EVALUATION REPORT Page I of Division of Saiety and Buildings an accoraance wrm wmm ~, vv~. cram. was ~'' S-f- ~ st Pl i i 8 1 i h . C o ~ an mu 112 x nc es n s ze. 1 Attach complete side plan on paper not less than indude, but not limited to: vertical and horizontal referonoe point (BM), diredicxr and Panel I.D. Oro-' l 3 t S ~ ~ 3 - c~ a to nearest road. percentslope, scale ordfinensiorrs, norttr arrow, a ` Please print all -~_! .l 7; ~ by Date . Personal iMormatlon you provide may be used ~o¢llery rpoe~(Prlvacy ~~~ 5.04 (1) (m)).. ~ei~ ~ !a ~0 Q Property Owner ~..J ~-:.~.'~ ; iP Location • ._, ..,: Lot fU!% 1/4 ~ 1!4 S 2ST Z°I N R I ~ E (or)b ,. PropeRy Owrtet's Mairerg Address , L`Ot Biodc # Subd. Name ~ CSNt# City State Tp Code . -Phcxre i C~FFiGE . ;; ' .City ^ Vtlage (,~ Town Neared Road ~S"I% I l wa.~r Vh v` , f'SQ ~Z (. , ~ ~ Y 4 -.~ 'y ~ s ~~ ®New Construction Use: ® Residential / Number of ~ : . ~ _~_ Code derived design flaw rate DSO ~~ O O GPD ^ Replacement ^ PubNc or aommerdal - Descnbe: Parent material U taJ (~ Plain elevation if applicable N /-~ ft General comments 5 s ~ rr~ e, (~ V 0.f .b /~ q ~ . So ~ ~ Cv `~ '~L ~,~ ~//~ ~" and recommendations: ~ (~ ~ 2 l 2,J 0. : d ri d vtti Sit Gc~/ ur~ D ,7 u~P~~ ~ pSf4 a:(? j i3oring # ~^i ~9 i:pi Pit Ground surface elev. G~-}. ~ R Depth to limiting tailor /~ 8 in. Sod ication Rate Horizon Depth Dominant Cobr Redox Description Texture Strudure Consistence Boundary Roots GP D/!>? , in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. 'E~ 'E~ ~ ~- I )~ r- l z -- L S I m rr> t,r c I v .~ .1 ). z .` , ~ Boring # ~ ~~ Z- ®Pit Ground surface elev. q 5.2o R i~eptli to iiimiiting factor 1 1 3 in. ~ Rabe Horizon Depth Dominant Colo Redox DesaipVon Texture Strucbun: Cmnsistence Boundary Roots GPD/fl? in. Mansell Qu. Sz. Cont. dolor Gr. Sz. Sh. - 'Eff#9 *Eft#2 I 6--z IO~r31~ --~ ~5i1 2 ,hk ~ c Ivy , 5 2 i2 - ~ _ _ I ~ ,- ~-tly -- ~f l 2 m~ h m ~~ L 5 - , S ~ _~ -- ~ Dyr ti I lp - m S Os rrm ~ ~ ~ 1._ 2 ..~ !~ -~ Effluent #1 = BOD_ > 30 < 220 mo1L and TSS >30 < 1 50 ma/L ' Effluent #2 = BOD. < 30 mgfl. and TSS < 30 mglL CST Name (Please Print) - Sig, a~ CST Number ~G vV` ~ 25330 Address Date Evaluation Conducted Telephone Number 211? gdT-i`~. S~rr~e~~Qi, (~~ S~-IdZS ~~~-o/ C7~s~2~17-~10~~ Property Owner /~.r k~ ~ Parcel ID # Page z of 3 - Bonng # ^ Hornig ® Pit Ground surface slay: . ~O ft Depth to limiting factor 1 ~~~ in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPD/fg in. Munsell Qu. Sz. Cont Cobs Gr. Sz. Sh: "Eff#1 *Eff#2 ~ o `~ ICS I Z s; l 2 ~ c 5 __ ) V~ . 8 z ~ -2 - y ly ---, s, Z bk ~,' c ~ 3 5-I~ ~ ~ tilc~ mS ~ _c m I ~ - . 1 I. 2 ~~' ~ C l ~~ t•O J~ ^ Boring # ^ Boring - _ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil. ic~tion Rate on H i th De Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GP Dflt? or z p in. Munsell Qu. Sz. Cont Cobr Gr. Sz Sh. "Eff#1 "Eff#2 Boring # ^ ~~ ^ Pit Ground surface elev. ft Depth m limiting factor in. Soil licatbn Rate Horizon Depth Dominant Cob ~ Redox Dasaiptbn -Texture Structure Consistence Boundary Roots GPDlfi? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 "Eff#2 " Effluenrt #1 =. BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =BOOS < 30 mglL and TSS _< ~ mg/l The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (807/00) PAGE ~ OF~_ NAME 14 r k.e. ! ~ LOT#Z 3 LEGAL DESCRIPTION u ~ '/4,u~'/< SZSTZ9 ,N,R ~ `~ E (or)b »_~(.~ CONTOUR _9~i: a a ~ 9' • a \ / ~4 i~ SCALE: 1 - BM I ELEVATION D~ • v BM 1 DESCRIPTION V1a,'L ~ i. ~ '• ~o~p e ( - ATION v ct , q r~ 0 ~ ~~ u~~ BM 2 ELEV 0 BM 2 DESCRIPTION -1a ~ ~ ,'~ r~ P a pP~ SYSTEM ELEVATION ~ ~• S° ALTERNATE ELEVATION ~ Z • ~~ ELEVATION ,S`~ Q •~~ N ti ' .\ `y oQ y~ 95, B \ R~ • ,,~ r (J~ o ° d~1-'' ~- ~ ~- ~-O, 1~ kl' ~~ G`y X 3.0 ~ ~ ~ I ' ~ ! i ~ ;! u X 7.~ ~ ~ ~1 ; ; ~~ ~ Z . 3 ~~~ A 1,0 , _ ~ . 9~ b~ R, ' ~~ 99 .~ 99 . 1.7 6 1, S ACj J4 - ~ ~ ~ ,1 :` 1 . \ i ~._. ~~~ t rc ~~~~ 9 ~.9 i X ,o,~; ,- - s ~, x POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 f FILE INFORMATION Owner JOHN ARKELI. Permit # ~ Zf,~,~ DESIt3N PARAMETERS Number of Bedrooms 4 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) 6 al/da Design flow Ipeakl, (Estimated x 1.51 al/da Soil Application Rate .7 al/da lft~ Starat~td Influent/Effluent Quality Monthly average ` Fats, Oil & Grease (FOG1 S30 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ^ NA Total Suspended Solids ITSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) <_30 mg/L Total Suspended Solids iTSS1 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA other: ANA "Values typical for domast~ wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer B ^ NA Effluent Filter Model A ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Cell(s) O In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground Ipressurized- ^ Mound ^ Other: Other: ~~q Other: $~ NA Other: ~ NA iuerur~rue~ur_c cr~uFnrn F Service Event Service Frequency Inspect condition of tanklsl At least once every: ^ monthls- (Maximum 3 years) ,~ f~ ear(s) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal celllsl At least once every: ^ Y an`s,ls) (Maximum 3 years- ^ NA Clean effluent filter At least once every: ^ month(s- ®yrearlsi ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ year(s) ^ NA Flush laterals and ressure test P At least once every: ^ month(s) ^ year(s) ^ NA Other: At least once every: ^monthls) ^ year(s) ~,NA Other: ¢i(.N A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall 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 ;nspections must include a visual inspection of the tank(s) 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 IY31 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 <_72 months, shall be performed by a certified POWTS Maintainer. A service report steal! be provided- to the local regulatory authority within 10 days of completion of any service event. GMW 14/01) '~, Page 2 of 2 START UP AND OPERATION , For new construction, prior to use of the POWTS check treatment tanks! for the presence of painting products or other chemicals ` that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shaft not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fist above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) 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 dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feat 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 property disposed of by a Septage Servicing Operator. • After pumping, elf 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 faits 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 been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade 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 AND 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. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~( Phone ~~ ~ ~d-(~ onu-rc IuelNretNFR Name FEATH RST Phone 715-381-1704 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name pINKY'S Phone 651-436-5788 Name ST. CROI CO Phone 715- This document was drafted in compliance witfi chapter Comm 83.221211b11111d1&If) and 83.54111, 121 & 131, Wisconsin Administrative Code. APR-16-2002 07 05 Gwae~uyor o a ~.atvaw w.ar •••, ~ ~ s~rrc r~ ~ xc~~~T owr~sHIe c~rzFtc~r~.ox ~o~ L P.02/05 ~~ ~~ 7.x'0 5~ art /c.~w.~,. ~ ~ !i/v ~~iltt:cr~ v~r~ S~'a~. ~~ ~8 t~CUt~-u~v R. (v~ituatioa ~ ~ Pisnoaing ~ ------ - ~~ /tI [ s d_ parvel Ide~ti~cation Numbar ~,., n zo - (3RD- 23- ~ ` Z~~~i I,~AI~1~_ BC~1"IQ1~I .~ ,~. ~a L,t ,~-/ v.v n~1~ s~ ~ 7 Propt~ly I,,ocatiQn ,~'/•~ ~~ ~. Sec.. ZS~', T 2°1' N ~.,.,~~, raven of ~ $ybdi~risian S ~ E' ~ l /S Lot # ~-3 - , 'Vott~me ~' # -' Cc+rtifiied StYrv~p 14iap # x-23 ~`~ . val~,~ Z2s~ .~ # d arar~anty n~ea # ~ ~' . Spx hau~e C~ yes ~ no dot lines ideatifiable ~ yt~ ©no ~useand~ainteast~ofS'a~ ~ptu~ystemc~aaidtesuitia its ptetnat~ fsliuet4 i~earast+~ Ptoperms of S ~t ~ e task evesY three yew or anaiuet. if sided. br a iiceased P W'~at you put into tlbe ay:te~ can affoct the ~ ~ c t~ as ~ t~aent is the arasto disposal xystgsa. Zya ~peety eaner a~ 10 ~btcit to St. t~aia ?.a~g ~~ ~ cesdfic~tion ~°°r by ~'a"'~ snd 6y a mxis]os~Y~Pors lics:used~~S(I~ the a~a-a~etadisposal ' ~ is pcoptc t;pcaratia~ ~~- mac (~ ~' °~'~ Pig ~~ y)• ~ ~` is k:: tlwn i/3 fott ai'aLa~- ~ tue ~ have r~adl rise shave ~ ~ sa t of ~. ~ s+st ia~, ~ ax 1~y ~ of Cam aad De~e~ . ~gt~at yaar,eeptic ~ bxntnaintainedmust ba ~pietod sadreduucd to use St. G~+ou~ Uaunty 7opi~ng Of&awitbia 38 ~ ~ y~ i ate, ' °~~ ~,~e~c~rrr n~~ra ~ GE~t'il'~TICA. 4N lasoariedg~. I (are) am (ate) >he owner(s) of (~~ ccttifjr starts on this foam arc tnse to the txat of suy (out ~ PrO by virba~c of a vv~aty did rocvtded m Yte~st+ar oI' Uceds Qf~ce. T` ~'~ _ Q UA"Y"g A OF APPLICANT . reyolasd tl~ ~ooivg pcpasttnev~'*"~`~ *sr+»* psi ~e~mtiast tlsat is mist+eiyt+escastedanay seseit is the saaitAry pest f>ch~ by . t• Is=cludo arilh tilts application; u sts~od ara~rsnty deed from tl~e Regastor of Deeds office . a copy of tb,e czatifiad aanrey map if reference is sissde in rho watt~ly deed . - ''J 2258P Oy6 ~j 723746 I STATE BAR OF WISCONSIN FORM 1- 1998 Document Number ~'lr~Tl' DEED 020.1393-23-00 Parcel Idemificatioa Number (PIN) THIS DEED, made between Carriage Homes X3Q, Inc., a Minnesota corporation, Grantor, and Lifestyle Homes, Inc., Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real ostate in St. Croix County, State of Wisconsin (t}re "Property"): SEE ATTACHED EXHIBTT A .This jg homestead property. Together with all appurtenant rights, title aad interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 4th day of April, 2003. Carnage aka XXI, INC. / +Kellei St. Martin, Vice President (SEAT.) + AUTIIENTICATION Signature(s) authenticated this 4th day of April, 2003 TITLE: MEMBER STATE BAR OF WISCONSIN (If sot, authorized by § 706.06, Wis. Stara.) THIS INSTRUMENT WAS DRAFTED BY Greg Booth Attorney 1900 Silver I,atce Road New Brighton MN 55112 (Sigoanura may be authenticated or aclmowledged Both are not necessary.) •Namea of peraoer sigaiog is airy capacity must be typed or printed bebw their sigmtwe. Raordiug Area KATHLEEN H. IfALSH REGISTER OF DEEDS ST. CROIX CO. , YI RECEIVED FOR RECORD 05/30/2003 09:30AK MARRANTY DEED E%EIDT t RfiC Ffifi: 13.00 TRARS Ffifi: 28.70 COPY FfiE: CC FEE: PAGES: 2 - Name and Return Address: Land Title Inc. 1900 Silver Iake Road Suite 200 New Brighton MN 55112 #219318 (SEAL) • (SEAT.) ACKNOWLEDGMENT STATE OF MINNESOTA }SS. WASHINGTON COUNTY. Kellei St. Martin, vice president of Carriages Homa X311, Inc, a Corporation under the laws of Minnesota on behalf of tho Corporadon, personally came befom me this 4th day of April, 2003. + Natty J. IQrttz Notary Public, State of Mimesota My commission is petmaneai (If not, state expiration date: Jan. 31. 2(X75 NANCY J. LENT2 • NOTARY PUBLIC-MINNESOTA tAy Comm. 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