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HomeMy WebLinkAbout020-1395-27-000 '50" -Qarn mb f 11 111 $ Tx:4 85878 4 Document Number Document Title 995393 St. Croix Count BETH PABST y REGISTER OF DEEDS OCCII/JanCj/Affidavit I RECEIVED FOR RECORD J` h � •� 04/30/2014 2:08 PM EXEMPT #: Name— (O er)Typed or printed REC FEE: 30.00 being duly sworn,states, under oath,that: PAGES: 1 1. He/she is the owner/part owner of the following arcel of land located in St. Croix County,Wisconsin,recorded in Volume ay41 Page -:Yk t Document Number'1223'11 St.Croix County Register of Deeds Office: Recording Area Name and Return Address A parcel of land located in the %,of the 1!9/.of Section a s � �j�-L, — --�—• T_;qft-_N—R lot_W,Town of AAdJ&oV-% ,St.Croix County,Wisconsin,being duly described as follows(include lot no.and 6 tM subdivision/CSM or detailed legal description): ^^ cao - t ©0d) 'SCV--4 L '�M`1,. % �— d; Parcel Identification Number(PIN) As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a I bedroom home,or a design flow of-6W gpd. The design now is calculated by assuming 150 gpd for 2 Individuals per bedroom. There are currently__C occupants living in this residence; .occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants,the system wilt need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. D this � day of >r` AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated this day of St.Croix County. 1`7 C �- -ln Personally came before me this ✓ day of the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Instrument me known to be the person(s)who executed the foregoing authorized by§706.06,Wis.Slats.) Instrument and acknowledge the same. IS INSTRUMENT WAS DRAFTED BY J\ (� + Notary Publicq31619 of WI i:brislr ... (Signatures may be authenticated or acknowledged. Both are not My Commission. rmanpq If not xpiration date: necessary) Date: -3 ( - -- "THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO WET 1EMOVE° This Inkimation must be oo Wkfed by submltter: document title.0,,M 6 retie address.and p&td'-,iqu1r*W.`othariMormatlon such as the gran ft douses,leagal descdpt ion,eta may be placed on this first page of Me document or nay be placed on additional Pages Of the document Note: Use of this cover page adds one page to your document and$ZOO to Mme na fee. Wisconsin Statutes.59.517. St. Croix County 995393 Page 1 of 1 I Wisconsin Department of Commerce, PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: 408265 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Carriage Homes Inc. I Hudson Township 020 - 1395 -27 -000 CST BM Elev: Insp. BM Elev: BM Description : - / 00 n- /D . b �, % `' PVC �! ®1-' rm e TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I �� � �� Benchmark n _ _ ,� t ! 21v �p�'`'/ Dosing AVBM ST / n. / Aeration I Bldg wer Holding St/ t Inlet U7 l07. O TANK SETBACK INFORMATION SvHt Outlet Cove . TANK TO P-/L WELL BLDG. Vent t it Intake ROAD Dt Inlet Septic / Si p• Dt Bottom t v �� / I Dosing H der/ Aeration Dist. Pipe op a (' $ C/9 /0 /• �'� 2Z6 Holding / Bot. System I , // 100. l PUMP /SIPHON INFORMATION Final Grade S ID 3 J1 Manuf cturer and St Cover 7: 7 r GP� UIUAa..' 5'�U� n- 113� 5 �- 3S_ 6) 9 q I Model Num r 44 Ft �y�[ O 5 le-0— TDH Lift on Loss System Head TDH / J 13- Forcemain Length Dia. Dist. to Well b io SOIL ABSORPTION SYSTEM BEDITRENCH Width Len th No. Of Trencbe� No. Of Pits Inside Dia. Liquid Depth DIMENSIONS o SETBACK SYSTEM TO P/LL, JBLDG JWEL LAKE/STREA LEACHING Ma cturer , INFORMATION CHAMBER O F6 �' Type f System: Model Number: DISTRIBUTION SYSTEM r hba"T 0-e Header /Manifold Distribution F � I x Hole Size x Hole Spacing Vent t Air Intake (9vt „ / Pipe(s) n l" / fry Length Dia Length r Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only o 72,47e ' 4 - Depth Over / Depth Over xx Depth of r/Sodded - Mulched Bed/Trench Center ! I Sedrrrench Edges ,/ Topsoil Yes No ❑Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 2 1 Inspection #2: Location: 850 Highlander Trail Hudson, WI 54016 ( E NW 1/,4.�2_5T29N R19W) Scenic Hills Lot 2277 Parcel No: 25.28.19.2421 n 1.) Alt BM Description = ST ' LD1f � 6T� � kk'5C eOQ-e -a 2.) Bldg sewer length = 2 �0� V�f�i ka _ 11 rbAJI - amount of cover = > I $ ii iS 6Y Sa) / Cn Q �'�I�(9 -�'Yw 1. h(M^162rS riC�" �Yb'ha S- /�Cl P.h ! i pe y I' N _40kd .45 - evision Required? 4,zI Yes VNo - `� -- oZ /n er side for additional information. Date Insepctor's ignature x.3/97) r - Zo l W w athingtou Ave., P .O. Box 7162 NVIsconsin Madison, WI 53707 - 7162 Sire Addmu Department of Commerce env' !7; fr - o� Sanitary Permit Application �" P et (�g � 0 � 7o accord with Comm 83.21. Wrs. Adm. Code, persto d information you Provide Check if Revision be used Ea L Application Wwwa lon - Please Prlat All Inf � State Pkn I.D. Number - r's Name Pued Number . 7 -tZ1 S -_ - -- 0.20 - Pnmpo Owner's Maiiiq Addrea load /on / City. State Zip Code Phone Number umber Boc Numb Subdivision Name CSM Number ( (/ w�c It. Type of Buis (&0* an that apply) DOW 2 Family Dwc ft - Number of Bedrooms � rr^^ rt9 V � ❑ ftbUt CommexCial - Describe Use E. 1, UOZ _ Or ❑ Stmt Owned 3 �x8� -Sa - ucY� S r ST. CROIXCOUNTY" Nearest NING OFFICE 2 t III. 'Type of Permit: (C beck only one box on Hue A (n or hstaaal use). Complete One If V applicable) A. 1(IrNew 2 ❑ Re$wen= System 3 ❑ Rephioemeot of 6 ❑ Addition to For County we 1'anlc s• if Suftory Permit Previously Usmod P«rak NWqb O 2�'� Dam spa of , Zoez IV. 'type of permit: (Check all that apply)(msmberhrg scheme k for internal use) 44 0! Ion - Pressmiva b Ga ad 210 M wd 47 ❑ Sand FUW so ❑ C,onsUmtod WdWmd 22 [J Pressurized In -Ground 41 ❑ Holding Teak 48 ❑ Single Pass Sl ❑ Drip Ida 45 ❑ At -Gmsde 46 ❑ udt m9 30 ❑ O&a V. Area bdbnoadon: e. Design Row (gpd) Dispersal Area Application Percolation Rate Elevation Final Grade Required PeopoagQ, g -F, R*WGsU./DaydSq.Pt.) (Min./hxW Blevadon j�� `1' . � VI. Tank Lnfo Capacity in Totd Number ldandwWrer Prefab Site Steel FUM Plastic Gallons Galktoe of Taub Concrete C.onmacoed Ghiaa New Ex>NiE Tanks Taub Sepde or Holft Task Daft Chnomber VEL Statement- I, the moderalgaed, assasoe responoldlity for hlstaWttmm of the POWTS ahown oa the ausc)ad "umber's Name ( Print) Plumber S' iv1Pn�RS Nuwber Busioes: Phone Number Phomber's Addma (Suet C sate. Code V13L cum Use Approved ❑ DbWwv Sawnry Permit Fee (inclnda Groundwater Tate Issued Unft at ftesna+e (No Stamps) "e Fee) ❑ own" Given Initial Adverse � � I� D L 11 9 Daermiimdoa 13L Conditions of Ap for Disapproval QL— v 1 S,arf ,„ • J A k_�d anQ_C`_ Wl �` � CSC � �� -�Ct' 1`►1. Anfer awspide View On Ire Coq cab) for the symom am der no Meo bins S14 z 11 bebes it do SB"398 (R. 05101) Sol §� N N *W.-- - ■■! M ■■E■! ■■I id HERNE) I OMEN MEF- SEENWAA ■E■MMENNES MMEMN ■ENME ■ ■NSW■ ■■ ■■ ■ ■ ■!!�■ ■ ■� ■y■i�! ■ ■ ■■ ■ ■■ ■ENNE■ ON ®■ ■Mid ■ ■ ■ ■ ■�''�M�� ■ ■ ■ ■■ �!'>�� mono■■■ Mw - ON memo L� fEm mom No NEW �s �i � _14 , I so ■■ ■Mme■ ■■ .��W ; � � .�: END No SEEMS cal -M SEEM OMEN ■ENNE■ MENEM ■■ ■■■■ ■SCI ■mr ■ SJO! ■E ■otjn� ■■■■■■ ME MMMSMMEEMMM BE EMWAMMEMEMMOM ■■■!E■E■ENI ■E11%2I■E N MANIIm ■EM!1■E ■■■ ■ ■ ■M■EN■E ■■o■■� m■ MMMMMEMMMMMMMMMM 0 04A ME II ■SSE■ ■■ ■■■E■ENEE■LME_ .WHE ■■■ SEEN ■o ■ ■ ■ ■! ■ ■ ■�� - Mai ■l�ONES! ■ ■, SEMEN■ mgq MENEM ME Ems ■ ■M ■■■■■ IME■ ■MM ■ MEN ■ ■■ NONE S■E■E■mwmJ■S / / ■ ■ ■ ■■ ■SEEN ■OMEN■ FIA V�A' ENE M MRMM ■■■■ENE / mom■ ■■ �Ii- ■ ■■ mom F%ENMM■■ - ■�,.,.,,,. - ■ NOMMEMEM MEMPHE M MEMENIMMEEMEN ME ■ ■NE■■■■■E■■■■■■E■E! NONE ■■■■son NNE ■ ■omme»ELM MMM■ // MMOMMEMEME 0 EMN MEMNON ■■ MIMIMMIMMMMIF mmrmm�� SEEMS mS mmmmm®Smmr�'����mmmm■ ^ill, 021010 ■,M MMM somm■ i gMMMMM MIN MINE 0 IN a E. Q__ LC MM MIEWPUji w s7'. - Emm 0, 0 ME! MMMMMEMFZNNN IN MM■ MMMIDMib� rr /mom! IN MEN w call M �:- \ soon ■ ■EESE isEms * MMM MEMn■ O L!EEM NI MOMMEM 00 MMMMMEIMMMMMMBM ■MMMMMMMM11MM1 x%z1MM' MERMINAME /!'MME ■mmoommosommsmmom m■rfrim � IN ■■ MMIMMEMMMMMMMMME ME MEEMMEMEMEMMIN MMMMMMMMMMMMMMMMIMWNMM ■O� ■t��� iii 11011-11EMME NNE IN smommom 0 ■■ ■t1ME1\01■ MENEM smommism ■MOMEME»M■ ■MEME■ NESS s / /MMMMMMMMMM mmon � NONE S;■ -- Hm ■ORENO 0 - �.� - Imo■ MEMO NONE W-g- _ SEEM NONE Ml NOME MEMMEM ■s ■ lr ��! ., ���-- IN ME ME MOM MEMEMEMMEME MENIMMEMM»E ON No MEM»MOMME■ ■ ■' ■ ■■ ■ ■ - ■ ■■ ■ ■ a n � ■■■■■■■■ ■■ e ■■■ ®■■ ■■ - ■■■ ■ ice% /•L.:� .L�_.�(� ■■ ■ ■■ ■ ■ Z ' 1231 Wisconsin Department of Commerce SOIL EVALUATION REPORT Pag 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest mad. Parcel I. D. 020 - 1395 -27 Please prin# all information. R By Date Personal informatm you provide may be used forsecond s. 15.04 (1) (m)). pr{'OZ_ Property Owner R Property Location Carrage Homes Inc. Govt. Lot SE 1/4 NW 1/4 S 25 T 29 NR 19 W Property Owner's Mailing Address O 2 202 Lot # Block # Subd. Name or CSM# 6750 Stillwater Blvd i��C 27 na Scenic Hills City State ip Code �Y City Village Town Nearest Road Stillwater MN 5502ZONiN Hudson Highlander Trail New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: System elevation 100.34ft, trenches spaced and depth to code 5.16ft below grade Boring # A Boring it Pit Ground Surface elev. 105.50 ft. Depth to limiting factor 108 in. Sov Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Itz *Eff#1 I *Et'f#2 1 0 -33 10yr3/3 none sM11 na mfr cs 1vf .0 .0 2 33 -37 10yr4/4 none sicl 2msbk mfr gw na _4 .6 3 37 -50 10yr4/4 cld 7.5yr5/6 sicl 2msbk mfr gw na .4 .6 4 50 -108 7.5yr4/4 none Is osg mvfr na na .7 1.2 q Z 2 Boring # • Boring im Pit Ground Surface elev. 105.50 ft. Depth to limiting factor 108 in- Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD1W *Eff#1 I "Eff#2 1 0-8 10yr4/4 c1d7.5yr5/6 sicl 2msbk mfr cs na .4 .6 2 8 -108 7.5yr4/6 none ms osg ml na na .7 1.2 Cetr•R Effluent #1 = BOD ? 30 < 220 mg /L and TSS X30 < 150 mg /L Effluent #2 = BOD < 30 mg/L and TSS <JO mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel Soil Service r Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 11/29/2002 715- 246 -5085 Proptrty Owner Carrage Homes Inc. Parcel ID # 020 - 1395 -27 Page 2 of 3 ❑ $ Boring # Boring Pit Ground Surface elev. 102.20 ft. Depth to limiting factor 108 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sicl 2msbk mfr gw na .4 .6 2 9 -20 10yr4/4 cl d 7.5yr5/6 sicl 2msbk mfr gw na .4 .6 3 20 -108 7.5yr4/6 none ms osg ml na na .7 1.2 r�V � F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. FSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 i i I Boring # Boring Pit Ground Surface elev. ft, Depth to limiting factor in. 50l Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 I I i * Effluent #1 = BOD ? 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD <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 Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST- POWTSM Carrage Homes Inc New Richmond, WI 54017 Lie. # 248956 SE1 /4,NW1 /4,S 25,T29,R19W (715) 246 -6200 Town of Hudson, St. Croix Co. (715) 246 -5085 Scenic Hills Lot 27 Legend 1" = 40' ♦ = Benchmark El. 100.00Ft N Top of 'h "pvc pipe • = Alt Benchmark E l.1 0 0.20Ft "op of V2" pvc pipe /d 0. IF ` n = Borings Boring Elevations B1 = 105.50Ft B2 = 105.5OFt B3 = 102.20Ft o zd B4 = 00.001 b� , o' / 30 �2 us � w` pq Safety and Buildings Division ` 'rsconsin 201 W. Washington Ave.. P.O. Box 7162 WI 53907 - 7162 Sift Address Department of Commerce ro 3 5`5 - 1 54 Sanitary Permit Applica" Nr(o S In aee«d with Comm 83.21, Win. Adm. Code, penaoal info r, ❑ Cha& � wa w be ed for Pri Law sm I. Application Inibrmallon - Please Print All Information Plan I.D. Number Property Owner's Name Nmaber /7i'- ST. CROIX �a�.r�� —�7 DtXi Property OwoeesMailing Address ING OFFICE 1 ' O � O A City. Sate Zip Code Phone Number Lot Number Block Number .?7 If Subdivis e / CSM Number �7'! ll�C�✓�' I�'� '� '� v � Z ' � /'l [ t� 1 ,7111 II. of B check all that l r 'Type B ( a pp ly ) or 2 Family jug - Number of Bedrooms P. a �vtp[ c`lro�,S ❑ Public/Commercial - rib: Use o ❑ State Owned Nearest Road AI. 'Type of Ptrrmlt: (Check oftone box on line A (numbering sdemse for internal Complete line B if appli le) A. 1 PN 2 ❑ ReplaceineAe. 1 3 ❑ Replacement of 6 ❑ Addition to °r Canty use seem Tank Only I Existing System B. ❑ Check if Sanitary Permit Pwvim* N Permit Number mm lived IV. 'type of Permit: (Check all that ap*Xa Scheme is for ' use) 4alloa - Press�uized I�Groimd 210 intoned a7 ❑ ter SO ❑ e A 22 ❑ Pamrized b-Ground 41 ❑ Hoidtog T 48 ;Cculating e Pass 51 ❑ Dripiiae 45 0 At-Grade 46 ❑ Aerob' 49 30 ❑ Omer r V. Area Informaxton: L ne•• Design Flow Qpd) Dispersal Area Diapetsai Area Rate a Final Grade Required Y�9 -Ft) Elevation VI. Tank Info Capacity in Total Number r Steel Fiber Plastic Galloes Gallcas of rote Ghm New Bsisda: r�...L Taub Twins Septic or Holding Teak Y _ y 5 A Dm ft comer VII. Responsib Statement 1, the sai me mw=AJMW of the on the atx d d plans. Phtmber's Name (Print) Plumber' lure Business Phone Number Plumber's Address (Street, City, Scree. Zip Vm. cam me rot USe Gnl Approved ❑Disapproved Sanitary Permit Fee (includes wafer Date Issu rts ed Lssuin8 Ag S*nan (No Stamps) Surcharge Fee) ❑ owner Given Adverse ��� I %. Defermitmtiao i � tons of Ap B a for Disapproval S i � � � � 11 �r t�.o.N�[,e. � ��• _ IGt'dLYt?O ►a ,ti4t�:., C�- ejCs S D -6398 (R. 05101) ■■l iil■ iii�l`:if�fii\1lil■illili >iiil ■il■i!!!!!!!!c.__________'fi Vii �iiiil illlii�iiiiiiii�i i!!!!lil�ii!■■, ■ /ii!■■!I !!!!llililllillllll ��� ill ■ / /lillil ■■!! ■■■■■■!!■lil■ /FTi!!!N' /!!i!!!1 !■!!!!!!■!!!!l i MwMMMMM !■!!!!l ■!!!■!!■®■!llim y;!■■!■!!l ill! llll lonMR��zlo! // ■ !!■!!!!1 MMMMMMMMMMMlMwmmm ■!■■!!!!!>►R `ll�i��llli►'�!1 ■ �llilllil ■!■!■!■■mMMnv�±s Illi / /!!!!■ �. \t�iiil iil!l i�i�il•�'��L'ir��w�•?�l /,ii!!!! l ■i�i"iil ill!■ !!■!lM'AliwZ%!�' %1!MMMmKMMMM=■l !■!!!!■1� ���fiilii�'i►11!!!!! !!■!!■Ml ME ■illliilii�i�i�llli /ilk �Sil■l!!■!!!!l ■ii! liilii�l..iiii /il�i►�i■ t�iiiiiil ■!■!!!!!!!!■■■! /Iil1/ll ►�■ �iiii/�iil ■ iiilllliill■�IliiC�liil■!!■ ■i■!1 !!!■■! liilll /�iliifililli!■1111a�i■il ■llili■■■!!! /llli!�llllii!!a■���iil ■ !■ ■!!llliil'Il���iil�illll!/�'R �l�iiiiil !■■!!!■lli,�ilii�iii■I!#� !■!!!!■MMFAl!!!i!!! /� Mill!!!!! %i�■!�!!!!' �!"�il� 1 /■il■!!!ll OMEN !Mi ■ill!!MW/�'rEN !!!!i ■! Mill!! ■ ► //!lull ■!M!!.�'��!!�i� M����11i1 ■! ■ ■!!!�Ji�ii� /!!!!!!!!! 1�!�1,�!!1!1!!� ►>���"!� ■i lit ■ ■ ■!!! ■!!■ ■ill ■!! ■lu�iiii�ti�l�i �ri� lull! ■!!!llilillllllliiiliiilil ■ ■■ ■■ MEN �a� ME on ME ME J ■■■N ME 11 INW, JITE I I _ ■ lErg ■ ■ �- Wo mwin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safely and Buildings � • in accordance with Comm 85, V& Adm. Code c ro Attach complete site plan on pa not less than 8112 x 11 inches in size. Plan must s +. per i' include, but not limited to: vertical and horizontal reference direction► and Parcel I.D. percent slope, scale or dimensions. north arrow, and . *1 nearest road. ^ ^� - Dale Please Prlfndt all f won. Personal information you provide may be used for Law s Property Owner P Location U t 1l4 114 S ZS--T Z- N R E (or _ Sf Property Owner's Mailing Address T � C1 X 1-0 1 # 7- Blo& # Subd. Name or CSM# CO —� Z 0 Si City State Tip Code � ❑ wage (� Town Nearest Road s7i: I L w« r VN rl . "0 4s'Z ( U . s 14 ® New Construction Use: ® Residential I Number of bedroorn --%_ Code derived design flow rate DSO "6 O O GPD ❑ Replacement ❑ Public or commercial -. Describe. Parent material 00 +LA ••S �1 Flood Plain elevation N applicable t / ft. General comments S y S k yy`, F`I • Da Z aww . vv and recommendations: e,J 0. 4, r` — . P $$, 06 "vtl -er g? .00 © Boring # t❑ Boring i A Pit Ground surface elev. G l ft. Depth to limiting factor I I b in. Sod Application Rate Horizon Depth Dominant Color Redox Desciipbon Texture Structure tore Consistence Boundary Roots GPDIfP in. Munsell Qti. Sz. Cont. Color Gr. Sz. Sh. 'Eff#f •Eff#2 M.5 (D�c O S°tra, Bari # ❑ Boring ® Pit Ground surface elev. q . f n ft. Depth to Igniting factor 1 I in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. '81#1 'EfW2 o - ►D �3 fit✓ 2rn s I v 5 1 3 2(v -I►s IO 9 )�p _ rY�S G� m I J — 7 1. 2 ' Effluent #1 = BOD a 30 _< 220 mglL and TSS >30 < 150 mg1L ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg1L CST Name (Please Print) S' re CST Nunber Q f� 2 Address Dale Evaluation Conducted Telephone Number C3 I Property Owner Parcel ID # Page Z Of a Boring # ❑ Boring ❑ Pit Ground surface elev. q Z- I U ft Depth to limiting factor' 1 , C in. soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 I , c- m I.2 t-d . Z i_ F—I Boring # El E] ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Efr#1 *Eff#2 I I E] El Boring # Ground surface elev. _ fL Depth to limiting factor in. F El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 MIN ' Effluent #1 =- BOD > 30:5 220 mg/L and TSS >30 <_ 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 2648777. SBV -8330 (R07/00) I K _ w PAGE OF_3 NAME 14 LOT# Z 7- LEGAL DESCRIPTION S F ` /4MW4,Szs ,N R. 1 (or) 10 SCALE: 1 "= yU , ELEVATION /off c� BM 1 DESCRIPTION ✓la,• I ; .i I Z w0 .1 „ -� 1-r-ft s — K O M ELEVATION BM 2 DESCRIPTION -kj "woo al FP n cA- P os f SYSTEM ELEVATION j- 8 9.0 0 G 0,.0 2 r 8% 0 6 ALTERNATE ELEVATION }t, p 8 Sl . o 0 G- w e r$ 7. o CONTOUR ELEVATION 6' ■ n 9 1 V g -3 ■ ■ a'� q . o 0 C - 4?- —x X 4- ✓A -� (�- � • IoZ a SIGNATURE DATE pro p K i *� {� 1111"i MIII m Moll r; 4 Will ogpl `vim. ; �� w,� -��:;� � � �� �,;� ter► �-�- i ■a • • • ors■ • � I • J i ! 1 r t -- : I � 1 ? I 1 1 i i I � 1 • 1. i - � I S�. i_� L. 1 1 �.._ ._ •.L.�:.�- ._9_ .�.1_ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity <Z�d a l ❑ NA Permit # Q " Septic Tank Manufacturer C--e ❑ NA DESIGN PARAMETERS U Effluent Filter Manufacturer ❑ NA Number of Bedrooms Y ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units — 4NA Pump Tank Capacity a l ❑ NA Estimated flow (average) ��/ al /day Pump Tank Manufacturer Z 4A Design flow (peak), (Estimated x 1.5) 467 al /day Pump Manufacturer Aff I N' A Soil Application Rate • 7 al /day /ft2 Pump Model .0 Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 5tf`NA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 1 p"n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ANA Other: ❑ NA Other: ANA "Values typical for domestic wastewater and septic tank effluent. Other: 13 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At (east once every: ❑ month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y1 of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 Kyear(s) _� ❑ month(s) ❑ NA Clean effluent filter At least once every: ! year(s) Inspect pump, um controls & alarm At least once every: L3 month(s) J' NA P P. P P ❑ yearls) h(s) Flush laterals and pressure test At least once every: ❑ ❑ mont mont l Pi�-NA Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA 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 inspections 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 cell(s) 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 (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal 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 shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal 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 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not 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 POWTS MAINTAINER Name' t Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name _15_J_, CIO f Phone Phone 91r. ' $ 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. fc-z APR -16 -2002 07:05 ' P.02/05 0 L v ilViif �sV ��� � • SSMC TAM , `N CCU AND OWNMtSW MTMCATION FORM k' K -T / N OWWMU �• '� Wmg A,ddrCss 6 7 5 - 0 5 �l /ww v V A/ p Vhi 1 1 c P',- S- . (vori�catiea .qW, d foam P DW$rM= Ever saw oonststtctioa) C W s G. Parcel IdeFtiiication Number s,, n citi�t proms Lotationj� y, J � / V w y., T N -p Town of Subdivision d IS , </S Lot # CerMcd Sur veY Map # volume � - , p� # wamilty D-d # _,Sc..� ®r . Volume Page # w4�' -' Spec hausc 0 yes no Lot lines identifiable ycs © no tin its hire fa.�um to bandla Pmpw� az� . . t�sesndnabeasnc +cafS►aareeglLCSS'm'ceflI gi � bw dreq� �oaasista of . cut am. t tc tack Ovary gM yam or saa=. if ueoded by .. . can afyoca the limatiatt of gn sop& bak as a uwbx= MP in the wasw disposal m- no pt�opedy eaoner &Zwa wbattt to fit. Ckok 7.a bg Dg a tip stpod restticoed ace lkcoxd 6 tbmt(i) meoa -sitie ma rpinatba� f P � f2) � and P�'g O �), the septic ants is tie:: oa 10 f;9 Ott i� izs p�+opar � . slave and tt� tc Ewa. the andetsignod have head tit~ � a f Rte. stem of Wf�a�Io. � set foal?, asset by ft of Com =ac and the Dcputm.4 tic has bow mainulud must be complctcd audraduucd to the $t CroDC C=* 7�ooit 011loawi k 3O tang fhat. ym � d-: y Neprtc�►rrc nATR 1 d U tmowigdgL I (we) sm (ua) the aovaa(s) of �ms I (WC) C w* stat on this form a= ttuo to the best of my (our) the PXG by vM= of a wamnty deed vmtded in Raga w of Dceds Office. OF APPLICANT DA'f'B A txforncmtion that is Oafs- eeproseated.m:y rmIt is the sanitmrY Pc=ti tevokad by liar rmkt s****' *• Inctado with this application: a stwVed wagmuty flood frogs the RegbW of Derds office . a copy of dw eo dfwA survey map if eafammce is myth in rho wa *wV deed APR -16 -2002 0'P :05 P.05/05 KATHLEEN H. WALSH t REGISTER OF DEEDS ST. CROIX CO. y WI �ar C*4-"- 1 RECEIVED Fdt RECORD 06 -18 -2001 12145 PM WARRANTY DEED EXEMPT 1 ,► '�� CERT COPY FEE: COPY FEE: TRANSFER FEE. 9900.00 RECORDING FEE: 14.00' jteeoet 4 Ara Name ad Rehm AdhM • !goo a'�l�e.< f._o.ks �oa�a f�Zt� t 461 - - 70 0o a karea idea9sr3iaq Nor M - ri ao pZo - I d6ry 'el - c:) (), Zo 0'70 00 - Opp 020~ 1 -10 0 2 0 — 1 0 -70 7. - cang r "TRIS PACE IS PART OF TiMS LM& DOCMMNT - DO NOT MMVE" This k6 mvian m aU wc&W by mbmk= dm ; Mk,� # m w & raign addAW- Mi ILK flMO&W4 Oa LVb� MA 4w &c pmft &Wow rrSul AmaWa . ear. mV be rlaead on ddipu psis 4 f &f A m v wr or moy be rkma an aisU Nd~ 4I Ae deamm m fi�ja Use q'dJs wwr~adds ow pqp ay~ docomms ad SXW to &Jnm nr tae. Wbamuin fir. P.M. UMM 21M TOTAL P.05 APR -16 -2002 07 :05• P'.03i05 DTATlt or wimoNsm —Foam 9 1 ' VO 1f62 ' • ' , i� THIS a1'At; RCiCRVSD FOR MCOMINO DAYA ''HIS I1vA ,Mad 13.- RICIIARD N. PEARSON .......... •and JEAN M. PEARSON, hus nd an( wi ... ........................... , ........ ........_.._....._.......... - -- .... »._ ..._...................................... .- ... ....... ................ ............... grmtor_§_ of . St, Croix - ---.-- __.. _ . ......-._ . _ . = • - - .Count , Wisconsin, h reb convoys and w r ants to:....°'� HON1E5 XXI , IN M1 Y ................................... .............................; nnesota corporation, ...•._...�I Was5ing .._. .._ w .... _. ........... .. ...... .. .... ..........�ii(dbH �f rautee......._ of!] or th um od noLQO (1.00) and other good, a --- and valuable �IJtETURN To Ty�'�� n, @� LLI,I ICGP. ------------•---------••------.._ ... .. ...........-•-----.._. ......_...._..._..... IV the following tract of land in..., ,...Q 47, ?�........... __--- ....._ .. .. .........Count wiscoasin: . ls+ .l._Qa~.. h .. -2 ..s is ._Nggt . b[ lf ( N) of the southwest Quarter (SWy) of Section Twenty -Fiva (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 Parcel Identification Number I ; i • �i i t I This is not homestead property I Ia Wlawn Whemo the said grzntor.jS baVe hcreunto set ........ thei - hand.§_.. a seal-_ this .- _......_............ day of.__-». X ..... .. .. __- _.._ ............ , A. A,, XIC -201 510?4 .D AND SDALED IN PBXJMNOZ OP .. yy� ------------- ••.........................••.. M. klatrlCDtJ1V .... . ....... . . .. . . . . ...... . .. . . . .............. . ...... . . .. ta saft Of ashin ........ A. D., _. County. Personally came before me, this.:7�� day of the above named .ANjM. PEARSON,*husband and wife .............................. .. ....................... ............. . . .......... .... ... .... . .......... . ................................ . ............ . ................. ...................... ............ * ......... tome known to be the persong .... who executed the foregoing instrument and acknowledged the 3&lnt:. I.A Eam"OUNTAIN 18 INSTRIJMKN TH _T WA; DRAFTED y Richard .j. Gabri. 964 jR . � , T ! M - E A County, Wis. NOTARY Notary Public. �y jj;;Wm. Expires Jw% BEAL. 9, 880 Sibley Memoria Hwy., #114 d jigpAck -ky�jghtra, MR-451"-1736 My comn-dssion (Nz y _Iq (Section !19.51 (1) o f th WISCONin Statutes PrDVidCS that a ll i m t runma t s t be rc ea r dod shsil have plainly printed or type-citt0d them= Rnsnm of the 4mrktw% SrLntwi witaGUCS and notary. 5 ir jWv )qjj� similarly re Tres that the name of the Person Who. *to- qui menul agency Which, dcafttd such InstntraW. shall Ie printed, typewratteek. stamped of Written thtreft 11ft a le manner.) WARRANTY DEED STATE OF WISCONSIN Wiacquain Ural 31sak ComVemY FORM NO. 0 MIlWaLukoe. Win. 0442SR11 APR -16 -2002 07:05. P.04i05 CTJ c w� u v l - 00 Oti C .-• N!! O d O b b p ' 000c�� W x LL 0 ' 0 ------------------- b �Gdlf99 Co�UI_R U3 341 VA wnos LLMON 8 y15 u M.LOWA M R / I ' 3 51 8 Ngm b �Y 1 b N 0 me yy +y��aa► w fd � vJ mN rL Q QQ a r rL 3 �+ �♦ ; ,ems - r._ . .. 1 1 �Ne No to 1 1 ti gi t s r n � N 8 a'� 1 1 •• .Sd � � r �i s� C23 N 1 .,4 x 1 a r I 9 JO I JHHHS 99S