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Home My WebLink About020-1395-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Colle e Cit Homes, Inc Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: `f7.~C ~~~-~ ~~ ~7 ~ :r-~ sr~-~c SDK f ANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration ~ Holding ._.._. ~. }• Lam. _ ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing --- -~.. Aeration Holding __. _ _ _ PUMP/SIP..HON INFORMATION Manufacturer -----'----- _ Demand GPM Model Number ~ ~~ TDH Lift Friction Loss tam Head TDH Ft Force ain Length Dia. Dist. to Well SOh.. ABSORPTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: 453248 0 State Plan ID No: Parcel Tax No: 020-1395-40-000 Section/Town/Range/Map No: 25.29.19.2434 STATION BS HI FS ELEV. Benchmark Alt. BM ~ Bldg. Sewer ~ V ~~110.- SUHt Inlet c~ 3 I 0 9 . ~ SUHt Outlet 5.~ /oa:3 Dt Inlet \ Dt Bottom Header/Man. \ Dist. Pipe ~ Bot. System C~~Y 1~ ~ ~ -y. ~ ~:? • :~ 9o2-v Final Grade St Cover ih' -~-' I I ~ . r BED/T NCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS •? y ~ `~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR '_.-,~ ~ f ~->-r.~v ~' Type Of System: ~~n ~~~~~~-~ ~--~ ~~~ ~ /G~ ~ Z~,c. ,~ (~1 t1NIT ModelN~mber: ~. r.- ~ ~ DISTRIBUTION. SYSTEM ~{ ~„~ } ~ ~ ~„!~ . w:~ s~ 2 3 cE.. Header/Manifold istribution x Hole Size x Hole Spacing Vent to Air Intake ~ Lr~igth 1 5 ~ Dia ~ ~--' Pipe(s) Length Dia Spacing ~. ~_ ~ ~ C~ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Bed/Trench Center ~ ~idi~ Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched bU`/~~,~ n Yes ~ No ~ Yes [] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~ /1`Z /~ Inspection #2: / .MLA i Location: 809 Highlander Trail Hudson, WI 54016 (NW 1/4 SW 1/4 25 T29N R18W) Scenic Hills Lot 40 Parcel No: 25.29.19. 34 1.) Alt BM Description = qty r c. ~~,~ ~-i-~ 't'`; C-n /U~~;r, 2.) Bldg sewer length = ~~~% -amount of cover = ~,c, ' (r -- Plan revision Required? ~ Yes [~ No , ~ ~ _ i I Use other side for additional information. I ~ / 7 < ~~ ~ ~~/ ~ _ __-,J I~ "~ __ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division Washington Ave., P.O. Box 7162 201 W COtOtY S~ (i1G(/1 . ` ~ ~ Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) isconsln •(608) 266-3151 S3 Department of Commerce State PIanLD.Ntrmber Sanitary Permit Application ~ ~ ri nmvide In accord witb Cotnm 83.21, Wis. Adm. Code, i maybe used for secondary ptapoaes Pn i nn Py eafo~^° u LaS'~/~ ~ - Protect if ~9'ezmt t}ran mailing address) X09 ~ fr~C.l..rwo,v~. T ~~ 1. Application Information -Please Pr1nt Al! inform tion ~ O A'!'! L n ~ t` ~ Bltxk n ~ l.ol a C I k P ~~~ CCC Property ()wiler'S Name L ~ ~ ' ~{ QQQt ~~~_ p''' ~( ~t ~ Yom' ~O !^ . LY~UI~~ ~ ~ ~ ' L NING OFFICE Property Owtx1's Mailing Address 79 2O P~nY location I i Ll/~ '/., 7~/ r~~, section ~2 S ~ City, State ~f~ili Ni~ ~~" Zip Code ~a 7 Phone~iumber_~ ~- ~ ~~ 7 ~~'jj . ~ q n / ,(circle ot~e) T ~( N; R E or v I1. Type of Bu lding (check all that apply) oy (~ S Su 'vision Name CSM Number S. ~1 or 2 Family Dwelling - Number oC Bedrooms ~ ` n n _ ~ .• Y t ~ ^ Public/Commercial - Describe Use T ^~ ~~~ ~Z `rZ.3 sT D ge~Township of a Vil l City_^ ~ . ^ State Owned- Describe Use 2 3 at1D . .- ill. Type of Perntlt: (Check only one boi on line A. Complete line B if applicable) D,2.p - i3RS-- A' ~ f~ New System ^ Replacement System ^ TYratmenUHolding Tank Replacement Only ^ Other Modification to Existing System n ------ ~ list P[eviotu Permit Number and Datc issued B. ^ PermitR®ewal ^ PetmitRtvision - ^ Changeof' ^PermitTtaasfertoNew Before Expiration Pltnnber Owner 1V. T e of POWTS S stem: Check all that a 1 ^ Noa -Pressurized ln-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Saud Filter Constricted Wetland ^ Presstnizod ln•Ground ^ Holding Tank ^ Peat Filter ^ Aerobic 1Y'eatatent Unit ^ Rxirotilating Sand Filter ^ ~ .~.^ Recirculatirt S tbefic Modia Filter Dd line v 1-less Pi ^ Oti~er lain) V. Dis ersal(l'reatment Area In ormatlon. u' s Dis rsal Area Proposed (sQ System; anon Design Flow (gpd) Design Soil Application si} ispersal Ar eq Pe / 9 a / app .7 S7 8y~ i ib er Plast c t in Total Number Manufacttrrer Prefab Site Steel F V1, Tank info ~P~ ry Concrete Constructed Glass it f U a s Gallons Gallons o Ncw Exirtiny TsrJca Tardcs ~ Septic u u,.i.r~c--T" _.T•.,,t d ~ ~`V /~. ~~~~ r Aerobic T~eatmeru Unit ~ DuainK Chamber I ~_ V11. Res nsibtll Statement- 1, the under ed, ass W for tnstalWtlon of the POWTS shown on the attached tans. MP/MPRS Number Business Phone Number Plumber's ame (Print) PI s Si v L s~2 I~ /39 ~ ~/5=2.3s= 2~ ~ , Plumber's Address (Street, City, State p C ,~Sd o 9 ~v 8 ~ •~~ ~°~ ~li~ w~ ,s~~r/ ~ VI11. ount /De artment Use On) ure (N s) at S ign ge od !s g A Sanitary Permit Fee (includes Ground Date~tr ~ Approved ^ Disapproved Surcharge Feej [~ ' , ~ ~ ~ ~ ~ _- ` _ '~ 0 ~!,~irtl<x-~- _ `'' S ' __- -~ ^ Owner Given Reason for Denial ~~ ~, IX. Cond(tions of ApprovaUReasons or Disapproval ~ ~ ~, ~~-~ `r6^/~ ~~~G~ ~, 011~~~2~,~.-- ~STEM OWNER: /y~' _ ~r~, r,C--~'rz' ~I~~-'~' L, (, ~ ?„ ~~''~{~ / 1 1 Septic tank, effluent filter and c~ ~~ /v 1~7 ' ~t~"`"• ~M ~~°`~ l-~ dispersal cell must ail be serviced /maintained r r / ~ ~~ ~~ - ~ as per management plan provided by plumb ~ (J~~~,y,..~~;~ir/ °%' ~~,X ,i.~C~'~f =- ~a 2. All setback requirements must be maintainea ~"! .~~!~-~~. '~~/~ ~'`~ as per applicable codelordinances. JJ / i ~IIA /"./n /. __.. Attach complete plane (to the N~ ~ ' ~~. ~ ~n~t~ ~ ~ ~~ ~ S~-6398 (R. 01/03) - ` a 7r° ~ m~~ ~~ ~?s~~y /~/~~ 05!25/2004 12:08 FA% 7152352592 T L SINZ PLUMBING INC f~003 T.~. 5inz Plumbing Inc. E3609 708th Ave. Phone: ('715) 285-2644 Menomonie, WI 54?51 Fax: (715) 235-2392 _,_ ,_, _ _ / ww~~v.tlsinzplumbing.com ~vuJ % ~ rcl %y~ S ZS T 2 9 iP/ 9 dJ ~~ T 5lv ScE.~f~ ~//s Sd~; ST G'~o rx Crv- g~ l F2 S~ts~ o~ ~wr ~/ lav ~•r~ '~~ 97F~ ~~. ,~ ~~ a L~p. ~''~~. S T.~. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 11 rr www.tlsinzplumbing.com 4 t-~'~ C'~E C t~F ~-1' oM~'S ~~- T/uJ % wJ % .S Z~ j 2 9 ~l 9 ~ ~a T ~a SCE~~~ t~~//s S'v8, S~ G,L'D rX C?v. 3~r ~ ~-~ Brrs~ o~ /, ~~ ~1 loo 6~ '~Z 97,8 „~1~' /I I~'. o~~ ~~ Wes- -~- 1-y~ '~~ 4~~ ~ ~~ 2 ~iti1ST~ hhl~etliT' 6w1 I ~o S~e~T~ ~r g~, ~ gam' ~'" w- ~ z~c.~ ,~-,~~ ~, ~~ ST.~~ a _ z ~x ~ ~,~ ~<~~.~E.~ ~~ri~•rc ~ Cr~.~~~,~s ti ~`~ s r s rf~vr ~-L~~ 92 ~ O ~s f D~r2312004 15:~3 F~ 715235292 _•• ,... T L SINZ,PLL°DIBI~iG INC „~... ., , r~. ''~! ~1 ; a~ ~fl111S1~' ~4tt~!"dSS , PropoRy Address ST CR07X COUi~tTY SEPTIC TANK IviA7NTENAI~tC1~:1~C~RBEMSN'P AI+1D _ n'~vnfRRSFIIP C"RRTn~rraTlO~ FORM .~ i°. ~ ~i 001 ~ f ~~1, :_ ;U~+~ i ~! ~ f -~.. } s ~ ~- l (Vcri(icatioa rc~uired ftOm P an:Ccg Department for ucw conspvcCioa) City/State 1 ~~;~.1~ ..~i __ ~,~s parcel Identifieatiofl Number r ~^ ~ t. ~..EOAT~, 1~ESCRiYT~O~T erty t,oc3tion ~ ~ 1/~, N ~11~ y<, Pro cc. a~ . S T ~~ N-R..~. Town of ~ ~~ ~" p ~ ' ` f ' :,,~ : , , V Subcitt vY5I0II y,t ~ i ! L Cert{f ed Srtrvey Map if _- , ~°olunae ,Page # ~.. ° f '.-~: ~ ~ _ ~ 1 ' F ~!T` ~ ~•' Warnsnty Deed # '~ , ~ Volurle Pagc # Spec hol!se D yes ~I no Z,at Itnes identifiable ~ yes C ao S g~ T'EM h'IA.tZti'TENA.NCE Lmproper tse and t.~ainteaanecof your septic aystzm could result i+s its pmmatnne failtite to Izznd!c wastas. Proper ioainttrance coasisCS of pttrrping otzL the septic taAk every farce years or soouzr. if needed by s ]icdosed pamper, What Yoe put into the systeet can affcc: the fuitczion of the septic iaalc as a ttaatment stsgc itt the w25te disposal system, • The Property owns ugrrss to submit to St Croix Zeairtg Depas',~Rent a ccrtifieatioA ferrtL signed by the vwoer sad by s ~terplumbor, jotsiacymanplu.~abar,tasxictcdpitunberoralieeasedpt~rvtsiCyi'°S~(1) tE~og-cite wastevrstetdisposal systcat is in propCr operating condition and/or (2) oiler inspsetiou ind Pump~g (i.° aecessuy}. the 6eptie tank is less than 1/3 foil of stodge. L/~, the andertagacd have trod the above it%q~srmeaet and agrte to taaiataiss chc pavate sewage disposal system with the steads;ds see Eorth, neteia, as sot by the Dcpsrtuxat of ConrmccCe amd tho Depamacat of Natural Resatures, State of R'itaonsiu. Cc-~Er~~ion cuE`uuA that your septic system hsr been nnalntaiaed tru3t be completed slid ~Cttuntd to the St.-C'~to1X COY Zrnnins OI°Ftca within ?0 d3ys~ ~ year cxpL•x • a date. ~~ \ .i J~ -=~~ SIGNATURE OF /1PI=L CANT D``~T~ 1(wc) catif'~ that a!1 5tatcutents oa this fornl arc trot to the best of ray (our) 1~aov/ledgc. 1 (we) am (arc} the o'wucz(s) of Esc property dcSGttood above, by virtue of a watrsnry deed recorded ;n Register of Deeds Ogee. ~~ SIGNATVRE OF .lI'PI.It:.'~it~T DATi? •••••• At3y info.~maiion that is tnis•reprs:sentedraay result sn the sanitary Permit berg Tevoked by cite Zactaq Dcparta-ca- ••f~•• "" Int:Cade vr(th thEs apglicettion: n stamped vearrnacy decd fraru the Regster of Deeds ofif'~ca n copy of the ccmtled stsvcy tl~P if tcfereuce is u~de 1SL tine wsrnaty deed ZOOltiDO --_._._.___.__... __ Xk~ LZ ~ ST AIOAI ~DDZli~ZlSO Safety and Buildings Division County ~ ~ ~ f~ /.~ t t/ ` ~ 201 W. Washington Ave., P.O. Box 7162 --- ' Jl ~~0~~,~i~ Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 „~~, I Department of Commerce state PIanLD.Number Sanitary Permit A p ~~`° In accord with Comm 83.21, Wis. Adm. Code, information you provide 1D ~~ Address (ifdiSerent than mailing address) maybe used for secondary purposes Pn Law~l,~~t(1~(n~ ~ p O (~. f 1. Application information -Please Print All Informs oo ((~~~T ~~~ ~'`,~~~ ~v~~ ~'-1 ' ~ ~"' t=;''1 ~ tC~, ~ ~ ' ~ ,lv I ~, Property wr~er's Name Z~ i " ~ - Parcel # Lot # Block n Prgxrty Location Properly Owua's Mailing Address `~ ~ (~1~~ VI t_t_t ~wG~ ~~., ~1~, section ~ Cite ^ ~ ,, `` l \ Zip Coder ~ PhGo~ne Number/ p / ~ i, }`~VIU.~ 1~~ ~V C~ ~ /~~~f.L'~_('C~~~ ~ \(1~(circleo~) T N; R E o 11. Type of Building (check all that apply) ~ Subd(i'1vis~ion\Narne ~ ~G1,CSM Number ~1 or 2 Family Dwelling - Number of Bedrooms ~`~J` 1~ 1C ~lll.J ^ P~.:blic'Cotruner'ial -Describe Usc - ------ ~ ' ^City_L:~Village ownstlip ^ State Owned -Describe Use ~,. `' !~ - B~ /~ 111. Type of Permit: (Check only one boi on Ilne A. Complete line B if applicable) S . 4. 1 ~ r A' New System ^ Replacement Sysum ^ 7h;atmmt/Holding Tank Replacemmt Only ^ Other ModiLcation to Existing System list Previous Permit Numbs and Date issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Pltmtber Owne lY, T e of POWTS S stem: Check all that a 1 ^ ~1Joa -Pressurized ln-Ground ^ Mound ? 24 in. of suitable soil ^ Mound <24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurizod In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treattt>ent Unit ^ Recirculating Sand Filter ^ ^ Leac ' tlrnmber ^ Dd Line ^ Gnavel-less Pi ^ Othe lain) Recirculatur S thetic Media Filter V. Dts ersalll'reatment Area information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation i ~/Q~ Dn . 7 S7 d`7 / Z.• Z~ 0 i in Total Nuntber Mattufacturer Yrefab Site Steal Fiber Plastic V1. Tank info ~p~ ry Concrete Constructed Gtass dallmts Gallons of Units Now Eziytin~{ TarJts Taf1~Y _ ~ Scnric or Huldins Tank .1~.~/t /~ ( u~rV(~C, l ~ Aerobic Tsarmcru Unit aW`~ D~uinK Chamber V11. Responslblll Statement- 1, the ttn ned, stun s ns1bW for Instatlatlon of the POW'I'S shown on the attached fans. PI 's MPRvlPRS Numlr_r Business Phone Number Piu is Name ( ~~ ~ ~ `~^ ~~~~1 _t~~ J~ `~ ` {O 11 Plumber's Address (Street, City, State, Zip C „ 11 ~~~~ ~~JC~c~ -7~C~ U ~' I~l~'I~ON~O-J1~ Vv V111. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Approved ^ Disapproved Surcharge Fee) ^ Owns' Givm Reason for Denial 1X Canditioos of ApprovaUReasons for Disapproval Attach tompkle piano (to the County only) tor.-the ~ystcm oo paper not ~u than S1R s 11 lnehn In size SBD-6398 (R. 01/03) 05/25/2004 12:06 FA% 7152352592 T L SINZ PLUMBING INC f~ 002 Safety end 13uildiags Drvisiea Canty ~' ~ ~ f~ ~ ` ' ~ ~ 201 W. Washington Avc., P,O• Bo:7162 w a Madison, yyl 537D7 - 7162 Sanitary Permit Number (to be filled is by Co.) t~S~O~S~~ , (608) 266-3 I S 1 Department of Commefce g~ planLD.Num~ Sanitary Permit Application ~ In e~rd with Camm 83.x1, Wis. Arita. Cade, ptssaoal ittformatioa you p Idc may he used f4t smoadaty p.apars Pavacy I~w, s I S.OtI((1 xm) ~ ~~ ~ Prges.4 AddressG(if ditfemt theses auiliing address) I. Appl(catloatnlormatloa-PleascPYl tAlllt~E `I~~-? V SO 1 F',,I~~~~~ i Rap^ny umer's Name Patt:el M Lvr N 81oek a o z~ ~ C TY 1N~. o L Pttrperty Lerstion prapcrry Owntr's Mailing Address (.~-IacKE (~ l-L~3~. Cf,~~ ~VLI v.. ~~: se:cei® o~ City, State Phoot umber T N; ~~E o ,,11. Type of Building (c6cck all that >apply) Suh~divisi~oa~Nacre ~ ~C~CSM Nuarber XI l or 2 Family DwClliag - Numbtr or Badroowrt+ dVS.r~ fv 1C ~~~y. J C^` PubGdComm:rcinJ - D~tsihe Use v' s oWosbi of ^City^^ dlag ~ P Q State Owpcd - Dtscribe Use 111. Type of Permll: (Check only one boY on rice A. Complete Ilse B If appllcablo) A' New System ^ Replacement 5ysttw ^ 'ltsistmmVHoldiag Task. Replaasmpat f)aly ^ Otber ModiBatiop eo Existi0g System • list previntts ppbsit NuvtbQ apd Date issued H. ^ Pcratit Renewal ^ Permit Rcvisim ^ Cb:+nge of ^ Permit Tesasfi3 ro New Before Espirdrion Pltrmber Owner __- IV, i ~' 0 YU YY LA J Slc[n: `uc~w wn .~~• ~ ^ ~Noo -Pressurized la-t~otmd ^ Mwr1d > 24 is o(auitable sell ^ Motrad < 2d in. oCsuitable soil ^ At-{3rade 0 Sipgle Pass Saari filtc Consmraed Wetland ^ Pressurized )n-Crtound ^ }loldmg Teak ^ Peat Filter ^ Aaobie 7Yaatmmt Unit ^ Resltsulatiag Ssmd Fiher ^ Retucularing Synthetic Media Fi1tQ ^ leacbia8 ~~ -_~ l~ Q cnvtl-rsa r- D orL~ laic) V. Dls erFa1/freatmcnt Arca lafor'IDatloa: ~ s tear EJe~atioo _ _. .. ., n_:_ e-::..,.,:t....t.... 2.r.,/nnd:A Dispersal Area Reautrt~ (sl) Dispersal Area Ptopos (J) Yes ~„ ---''-DO ~• . .. 7 S7 ~ C G-• U Mutufacturer prefab Site Steel Fiber V1. Tank info Capacity ~ ToW Number Concrete Constructed Glass Gallons Gallaas ofUaita ur HuWinrt Tardc Tanta stic p•eoinK CMT6er VII. Rcapoaslblll Slaletnent- 1, the tlv aed, aslblll tar InstaWldon of tEe POWYS shown on the athchod tatr:r p{u 's Name ( PI '+ MPMLPR$ Number 8usirsess pboae Nrrmber ~~`~~ oo 1 ~ rnP c a, -z ~~~ ~- Plumber's Address (Barrel, Ciry, Slate, 2~p C Ylll Couo /De Rrtment Use On) Sanitary Permit Fee (includes Orotmdwater Ds.tn issued Lssuing Agtnt Si~anrre (Nc Stamps) ^ Approved ^ Disapproved $utcDarge Fes) ^ 0~ dived Beacon for Aeaial IX Ccadltioas of ApprovaUReasot-s (ot' DlaapproVal~ ~ ~` L ` ,~G~ • ~,, ~ s/~'~/6 (te tae Couaq solyt taet6e gatces as paper net 1pa tLaa alrl s I t lao6o la 1~ SBD-6398 (R. ~l/03) i T..L` . Sinz Flumbing Inc. E5609 708th Ave. Phone: (715) 285-2644 Menomonie, WI 54751 Fax: (715) 235-2592 www.dsinzplumbing.com ~la~iV a- ~if~P$i~ ~i`q9 ~S ,~ ~v T yea SGf~~~ r~~//s Sd~B, ST ~~ ix ~. $I~l 1 ~' ~. 8rts~ o F ~~9e,~ ST~eL Sf~E^5. ~~ ~f 10O B~ ~~ 97,g v . P'e1N' . ,~.., ~~~ 4" ~° o ;_ ~. t > ~ ,r. j~ ~ ~ ~~~ :~ ~ , ~ir~ ~ ~~~ t~rfw~r- I zoo . ,s~ Tic. ~~ ~ ~1- 8~I g 7 T~'' K w~ f-~ y~~ - j p p ~° ~ r 70 Rl ~;; :~ .~,~; ~ C • ~., .~, A~5 ' ~' p ~ S y sT~ ' ~i1.,E~/,~ ~l2 ~ 0 .. , . ~~ s~~s Pi~~~~z. 05/25/2004 12:05 FA% 7152352592 T L SINZ PLUb4BING INC ~~, _ ~ __.~J001 T.L. Sinz Plumbing Inc. E5609 708th Aveztue Phone: (T ~ S) 235-2644 Meaomor~ie, WI 54751 ,Fax: (? 15) 235-2592 ~A~C 1'RANSNIIITAL Date: 7~'0: ~1.=.~2.0~ x 1. T' Attr,-: No, of Pages: (including Covet) From: l' L ~."[Z_ l Subject: Message: - -- Signature: a r~R~~~~, Wisconsin Department of Commerce SOIL EVALUA_T~\ REPORT Division of Safety and Buildings in arrnrdancP with Cnmrl.&b_ Wic Adm [3ixie 2023 Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inche i~ze. Plan must ' ' County St. Croix include, but not limited to: vertical and horizontal reference t (BM), direction and percent slope scale or dimensions north arrow and loc on and distance to nearest road. '~ Parcel I.D. , , , , Please print all info ation. iewed By ~ Da / ~ Personal information you provide may be used for second purposes (Privacy l.aw, s. 15.04 (1) (m)). Z!(O Property Owner Property Locati Tigges, Brian & Barbara Govt. Lot NW 1/4 SW 1/4 g 25 T 29 N R 19 W Property Owner's Mailing Address Lot # lock # Subd. Name or CSM# 2397 Eagle Trace Lane 4 Scenic Hills City State Zip Code Phone Numbe City ~ Village Town Nearest Road a~Jdb1J/ n(>l~ ~ 55129 651-998-0 Hudson 809 Highlander Trail / New Construction Use: /, Residential /Number of bedrooms 4 Code derived design flow rate 600 ._ Replacement _; Public or commercial -Describe: Parent material some disturbed fill over sandy/loamy outwash Flood plain elevation, if applicable NA General comments and recommendations: install in-ground trench system relatively deep @ system elevations 6.0' below surface contours as trench center lines w/ 0.7 gpd/sq ft loading GPD Boring # ~ Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-5 7.5YR 3/1 - sl 2 f sbk mvfr cs 1f/m .6 1.0 2 5-16 7.5YR 3/1 - sl 1 m sbk mvfr gs 1 m .4 .7 3 16-28 7.5YR 3/4 - sl 1 m sbk mfr gs 1 m .4 .7 4 28-33 7.5YR 3/4 - Is 1 m sbk mvfr cs - .7 1.6 5 33-130 7.5YR 4/6 - s 0 sg ml - - .7 1.6 occasional gy & cob below 33"; horizon 5 grades to 7.5YR 5/4 s @ 130" ^ Boring # Boring / Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 132 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2 1 0-18 7.5YR 3/1,3/2 - sl fill mvfr cs 1 f/m 0 0 2 18-37 10YR 4/4,3/4 - Is/s fill 0 sg ml 1m .7 1.6 3 .37-45 5Y 5/2,4/2 f2p 7.5YR 5/8,5/3 sl 0 m fill r-- mfr cs - 0 0 4 45-55 10YR 4/4 - sil 0 m fill mvfr cs - 0 0 5 55-63 7.5YR 414 ~~,, ~'Z ' Is ml cs - .7 1.6 6 63-132 7.5YR 4/6 s 0 sg ml - - .7 1.2 horizon 5 has inclusions of sl, no red features, possible fill or disturbed; horizon 4 is clean of rdox features tttiuent rx1 = tsUns> 30 < 220 mg/L and TSS >30 < 1 0 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mgt. CST Name (Please Print) Signature: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/7/2004 715-233-0398 Property Owner Tigges, Brian & Barbara Parcel ID # Page 2 of 3 ^ Boring # -- Boring /f Pit Ground Surface elev. 97.8 ft. depth to limiting factor > 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxxture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-29 7.5YR 3/1,3/2 - sl fill mvfr cs 1f/m 0 0 2 22-49 7.5YR 3/4 - sl 1 m sb ,fill mvfr cs 1 m 0 0 3 49-60 7.5YR 4/6 - s 0 sg dl gs - .7 1.6 4 60-130 7.5YR 5/4 - s 0 sg ml - - .7 1.6 Boring # Boring /' Pit Ground Surtace elev. 97.8 ft. Depth to limiting factor > 130 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 1 0-21 7.5YR 3/1,3/2 - sl fill ~- mvfr cs 1f/m 0 0 2 21-51 7.5YR 3/3 - sil 2 f sbk mfr gs 1f .6 ~ .8 3 51-58 10YR 4/4 - sil 2 m sbk mvfr cs 1f .6 .8 4 58-60 7.5YR 3/4 - s 1 m sbk mfr cs - .4 .7 5 60-130 7.5YR 4/6 - s 0 sg ml - - .7 1.6 i~ occasional gr & cob below 60"; horizon 3 is gritty w/ s, almost sl 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 I I I '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. SBD-8310 (R.07/00) Certified Soil,Tes6n9 A ,"{ _. f .> r ~ ~ ¢~ _ a p 1 1 C1W+V' ~ y' W~ t _ ~q . N ~" ~~-S~ -LS"- Z~-1RW °-1 D ~-- ti, ~. \~ 4 So M ~ ~~ ~ ~~. ~. ~Q s 1~3~ _~ s~oo • ~K = 4~,g C ~. !wi4 4t, { ~ •~. ~.~QL.' so:~S QQ.~', 5 ~ bt'~ ~ ~.w~.~ 5..;~5 ti~ \ ~ tq ~ ~ \ ~3 Mti~~ , o S ~l- tz ~_4. _-- i ~ ~3 O~- ~'~-~ ~+ Z~17 G .~ C1R.. a~J~ cti i •~ ~~ 1~ w~ a ( ~ ~ ~`~ 3.85 ~ k 4 y: ts~ 4~t2.~ ~' S ~~.t~ ~~~ ~ 4~` O Z,p (~,~ ~~ ,( f -J-~~ + ~ E ~ ~-o `r two \ / ' S ~' /~ CGt.iz...,.-~, \ s: G~ s 4-,.~ ~ j ~~~~ ~' `/7~ Oil M ~~ S ~ ,, ~-,e~-y &~~- U ~""~ - / Joao. s' 3 2 6~- ~ ° ~ ~ Vlfisrx~nsinDepartmentofCommeroe - SOIL EVALUATION REPORT Page I of~ Division of Safely and Buildings m aocoraanoe wrm ~orrnn ~, vvis. gyn. ~.oae st Pl 11 i i ¢ 81/2 ~'`r 5 -~-. C ro ~' Attach complete site plan on paper not less than an mu n s e. x indude, but not limited to: vertical and horimntal percent slope, scale or dimensions, north arrow dirediort and ' '" `andkl b neared road. Parcel I.D. . 0 2 ~ ~" ! 3 ~:~ J ~ ~ ~ Please print a atm. ~~~ ` ~ ~' Data . . Personal inrortnation you provide may be used dary ~~r~i~~ja~~r~acy Law,ls., 04 (1) (m)).. Property Owner r~ Loca ~j~. ~~~~~ ~ ~ ~~Q1 -_ 'Lot kl 1/4Sc~11/4SZ~S"TZR' N R ~4' E(or)® Property Owners Mailing Address S ~ e ~ 'ot Bbdc # Subd. Name or CSMf/ pFFtGE ~ CO ~ Z Q S-~ i ~ ~ WC~. , ~~ (~ S G _ ~ ' City State 25p Code ~ umber ~ .City ^ Ydtage I~ Town Nearest Road .,__ _. .. ®New Construction Use: ® Residential / Number of bedrooms 3 _ `/r Code derived design flow rate ~SSO ~(o O O GPD ^ Replacement ^ Public or axnmercial -Describe: Parerd material OU fcaJ0.$ ~ Flood Plain elevation if appficeble y/ ~ ft. General comments S~ S~ ,~ ~ L G J 0. f~ b /~ - ¢0 9 7 ov Go w ~¢..-, ~ and recommendations: ~ ~ ~ 2.. 12. ~ 0. {..: O ~ _ ~~, - 1~ ~,.r -s- 43- sU " I Boring # r~~i ~g i:pi Pit Ground surface elev. 9 S 7ott. Depth to Innifing factor l 1 y in. Sal ' n Rate Horizon De th Dominant Cobr Redox Description Texture Structure Consistienoe Bourxlary Roots GP D/fC~ p . in. Munsep Qlt. Sz. Cont Cobr Gr. Sz Sh. 'F~f#1 'EfT//2 ~ O_lv fp ~ SL m LS ~v~' -S .~ 2 (~-Itp ~ `- m t - - ~ l . 2 ~-~ ~ ~ . ~ ~ Q l o ~ ~~# ^ Boring w/.~v~i~z-6h.S Slit-~w~~-=~*o-•'"a~',-~~~-~-/ ® Pit Ground surface env. ~S 7Q ft Depth to laniting factor ~ ~ 7 in. Sod Rate Horizon Depth Dominant Cobr Redox Descr~tion Texture SWdure Consistence Boundary Roots GP D/l~ in. MunseU Qu. Sz. Cont. Cobr Gr. Sz. Sh. _ 'Efi/F1 'Eti#2 1 a- ~0 3Iy ~ . 5~ ~. m-~r ~5 ~ ~~ - 9 Z ~ ~ d - p 4~ --~ rt"~ S p -~ - ~ (. Z 2 ~, (d Z ~~ • Effluent #1 = ~D_ > 30 < 220 ma/l_ and TSS >30 < 1 50 mo/L ' Effluent #2 = 80Da < 30 mglL and TSS < 30 mglL CST Name {Please Prat) S' n re CST Number ~.r 253 09 Addn~s Datae Evaluation Conducted Telephone Number 2//3 ~Sb?~ S-~. somers~ ACS/ oZS- ~ '~-v1 7~ - zY7-Yom' Property Owner C' k~ ~ L Parcel ID # Page z of_ 3 Boring # U Boring Q ~ ,~ q ® Pit Ground surface elev. S9 ~ ft. Depth to limiting farxor' ~.1` in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfEz in. Mansell Qu. Sz. Cont Cobs Gr. Sz. Sh: "Eff#1 'Eff#2 2 _- y ..._ S ~ _ ~ Z . . a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ication ~~ H ri th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff zon o p in. Mansell _ Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 "Eff#2 a Bonng # ^ Bonng ^ Pit Ground surface elev. ft .Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cob Redox Desaiptwn Texture .Structure Consistence Boundary Roots GP D/fg in, Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#'1 "Eff#2 "Effluent #1 =- BODs > 30 < 220 mglL and TSS >30 <_ 150 mglL * Effluent #2 = BODS < 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 608-264-8777. SBp-8330 (RD7/00) PAGE J~ OF~ NAME 14 Y` ~-e-~ I LOT# ~~ LEGAL DESCRIPTIONNw I/a5~/a SZ,STZ~ ,N R Iq E (or)C~ ~~ (~ y , CONTOURELEVATIO -S ~/ . S~ SCALE: 1 - BM 1 ELEVATION (DU • o BM 1 DESCRIPTION -fop o.~ ~ ~ v ~ $•'P-e BM 2 ELEVATION q F • U~ BM 2 DESCRIPTION {-U~ a~ ~~ p v L ~.' p ~- SYSTEM ELEVATION •Ivo ~/ 7. o o Lo w-e ~ 9C~• ov ALTERNATE ELEVATION~~Gy•So Law ~r'43.5~ N Q5 ~ ~ s'G 9y ~N ~~ 2 / ~~ ~,~ ~, ~ t. , ~~~`` o ~~ i~ ~ Q 4Y ~ ~ ~~,., ~ '-~ n''~ ;' r. ~, (' I ~V L ~, ., ~~~ ~, ~~ `~~ ~`~ ~w `Yj V'~ `'^.~ aq. S~ ko l o~l I ~'~~ t a . "~ -=----_ d~• ~~ ~ •~ ~~ ~~{ , ~- Q_~ Say - __ _- l2 U~ --.. ___ _..____. ~ ~~~-v~ ~~r: ~ \ ~e Pr 00~~"~ ~Lok 1~ATF. /o - ~ - G/ ~, ~~ - ~, ~~~~ ~ o ~, , ~ ~, ~ ! 1r ,, ' ~4 ~ ~ \~ v \ ~ 1 ~ ~~ ~ ` ,\ ~ I- -0 0 L . ~ ~ -' _ ~r icj~--f~4 1-V~J~ ,. ~ 49 . >~ ~ ~~ ". <971. 1 1 . ~n~ i i x'~ ~,. `` ,, ~~ ,. ; '~ , , ~ i' ~ , ~ ~ ; ~ _~., o i -s I ~ ' 1 ~ ~ ~ l 048.1 •~ .' 104. ~~ < ~ ~ z , oho A ~ x ~ ,~ ~~ ~ ~ ~ ~ IC~,O `~ AL~`~ ,~ ; ~ 'dL ~, s-k. ~ hi -` ~ .~ .~:, ,,,, ~ ~ ,~ .~, / i ~ .-' ~ '~ ~~ /,~ ~ / - \ ~0 ~~ ~ , ~ ~• ~~. i •~ x ~ \\% ~ ~ ~.~ X i ~_ v-- ~ ~~ .2~C x ~~ ~ •, f /• .3 5.1 X X X X ~1 L X 103 .8 103$.9 ~ ~ ~ Q'4~.5 ~ 05/25/2004 12:08 FAX 7152x52592 T L SINZ PLUMBING INC f~004 fl~/23/20fl4 15' ~3 fid?C 7~a235Ya9~ ~f: _ r ~„ j ~ Mailistg Adtlr~s , Pioparry Address City/5-~tc Parcel Idete.tificaeoa Number F Q, ~ ~~~% _ "~~` ~~• V' LEGA.~T~-S„C~LP,Tt~Q~_T ~ q~Z~ 3 cation ~y~ ~/~, N~JI~ 5~~, Sec. ~~ . T ~~ N R_L! 53a-'. Tows of }~~•~~~ tcd ~nrve Ma if ~'oltun$ ~ Page # -. _~ Cettt~ 3' P 4 .~- WaTra~,tY Dt~d f! t, ~~1' ~ ^~ Valu~.e %-' Page r* J~'~ . Spec Lat'+se C Y~ ~ no Lot Imes idu~ufiablt: ~ yes C ao SySTEI~i 1'rl~rn"7-'~,~A-"1 ~ ,~.t,~'.,.~~ ~repeS tSe ~d Ca]tlteoauGCOf ~t~ s~CC i75t6tR could resa~C+a its paema~ur~ ~tlre [O ~1C wastes. Ptvper consists of ptc~pizsS out the stsQek tspY every ttisee ywxS et expect, if paedrdby s 'licea5ed puttspas, Whnl' YQC put ltsso tb,e syst~m caa. ^Bcr tba flsaetion orthe aepeft: ttalc as a uaao~uts~ge iu. the wtSSa disposal *~nettai. _ ~e plopesty owner agrees to svbmiL [o SL G~ix ~~g Depa3Smen! a restiiicnaoo. farm. sig:tud by tba owner sad by s ~s~rpl~r. J~ci~'a~'~~+ sasa~ctzdplRtalxs Csa l,;pmsedp~•x~swS ati_ ~ 1~) floc ot}~tlm wasEewratasdispasaa syatcm is in prvva oPm'+~ oOadicoa aoc+Jar (a) a€ter ~aspectiou sad ptmmp~g (~.f ~Y)~ ~ G taalcLi less Ihaa 1/3 fuII of sladga. C~wc, rho aq~derFigssod tsaYe trod t11e abova rcquiseaseats std tgsee io r~sian3a the y~iYdtlC SCa+aga diapesal cns+am wig the sta~cZsrd, set Fettle, aet[ria, sS ~,et b~ tFsa btpara:uai of Copse apd ttxa De~moc~ of NattvtaX Resota~, 3tstc of Wtsraamla, C~-48c+dan eut~g shat yau_' septic syszCm hs4 iaeea mnlneainod IiRS.~SI bo aoruPlcted tad setusrrd to cbe St •Ciaiz Comfy ZaaioS OL~ftoo a.ithla. 30 days et Ghe tbs~-1 yetrs~' a}:pi'n • d daft. ~ SICr21A'CZ7~ OF APp CANT DATA d'W!rZT,R ~R CATZON cl;c ewit~si o: I (we) acrsil~ e6as all av,resMats oo this Cat::'t a[e save co sba best atrny (out L:aowle4sa. 1 (wa) im ~~S ;.be propGr:7 dcsueoed above, 'cnta e+[ a waaaary deed sacotded is Register of Reeds CLTice. ~i7--~ 5IGt1A'IZ11tE OF .~pPLI DAT" ~.-~.a.. • • ~•-• Ant lnfo.•xstia[Lea tbzl is It~s•tsycssaat~d may tsmtLt sn tba sanitary peraut berg saraietd by the Zottlag DepasQt-aat- • • Iatlads wtcn this appticatiea: a stamped vrsrtsary decd 5'om t2c Rc~s oT bcedr of~i'.ce s ctsQgr of tht cc»tled stsvey tR~B ~ reEetm~ Ls tttttdc to lhtw wasaatY deed T L sIN~_pL17~IN6 INC ST ~ iCROTK COTJ3~Y't'Y SEpT`LC TANK ~~~ ~ A13D _ ntVNRR~^sAIP r'.RR~rrcrrrATZON FORM ~ oo~ ~~ ~ • tLtjy~i~ aoo~aoa~~ . . X~'3 [z - cI Ht)M pndz/iZ/SO POWTS OWNER'S MANLiAL 8T MANAGEMENT PLAN Page ~ of L FILE INFORMATION Owner '~~ ~ ~ ~~ m ~$ Permit #,` " - - - ~r3 ~~~ DESIGN PARAMETERS Number of Bedrooms ^ NA. Number of Commercial Units ,f~'NA Estimated flow (average) OD gal/day Design flow (peak), (Estimated x 1.5) ~~ gal/day Soil Application Rate 7 gal/day/ft2 ~ Influent/Effluent Quality Monthly average* Fats, Oil r~ Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solid (TSS) <_150 mg/L Pretreated Effluent Quality NA Monthly average** Biochemical Oxygen Demand (BODs) X30 mg/L Total Suspended Solids (TSS) <_30 mg/L Fecal Coliform (geometric mean) sl0' cfu/100m1 Maximum Effluent Particle Size ~ inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity ~~7pD gal ^ NA Septic Tank Manufacturer ~~~ ^ NA Effluent Filter Manufacturer ~pg~,~c ^ NA Effluent Filter Model ~-~~~ ^ NA Pump Tank Capacity gal .8'NA Pump Tank Manufacturer 8'NA Pump Manufacturer .0'NA Pump Model ,.0-NA Pretreatment Unit sT1A ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~In-ground (gravity) ^ In-ground (pressurized) At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. * * Values typical for preveated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every /! ~ ^ months year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume Inspect dispersal cell(s) At least once every ~,~ ^ months ,l]~'year(s) (Maximum 3 yrs.) Clean effluent filter At Least once every /, ^ months J~'Year(s)~~ ~ A't' Inspect pump, pump controls 8t;alarm ~ At least once every ^ months ^ year(s) C~dA Flush laterals and pressure test At least once every ^ months ^ year(s) C~.Ad'~ other: At least once every ^ months ^ year(s) ^ NA other: At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Maste Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks} 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 (~3) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical. that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents System start up shall not occur when soil conditions are frozen at the infiltrative surface. Page ~ of 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; disinfectanu; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; paintine groducu; pesticides: sanitary napkins; tampons; and water softener brine. ABANDONEMENT 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 ch. 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: ~7 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 fines 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 lace the failed POWTS. s t as not en evaluate o identify a tabl replaceme area. Upon failure th OWTS a an 'te alu io m b perfo d to ocate a table re ceme area. If n repla ent area le a holding to y b installe alas res to repla a failed POWT . ^ 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 IMP(1C.CIRI.F. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ ~/ itJL Phone ?/S' ~ ~ ~ SEPTAGE SERVICING OPERATOR (PUMPER) Name POWTS MAINTAINER Name (~ s/Nz L136- /NL Phone ~ LOCAL REGULATORY AUTHORITY Agency T L~/DI ~ G!~l/it/ Phone 7/S- 386- 5680 04/23.'2004 1~:4a.,~'~1rTC 715352592 _ • ST SEPTIC TA3VK O~rv*aerBuyer •.1Ji It li %.~~ Mailing Address ,; _ ',_ ,~" ; Proporty address •` 1 ~~ ~,i~ (Vcrificatioo rcgit~ .. i~~~L~ : `;~_ Cary/Brace 2 L SINZ. PLITal$ING I\C .~' 1~0U1 ~RO COLTP~I'~"!' ENATICB AC}RBEIv~N'I' AND CgRTg'TCA7'ION FORM ,~ / : • ~: i 1 ~ ~ ~t. ,':"?__ ~ / 1r' ~' ~~ ;'t ~4 v "t fTOn, p .g Dep~rnetsr for new coastrttetioa C ., ~-1 /..,~-~ r i~ Parcel entification Number j.> ~ I,EG~r DESCRIPcT~1ON ~ Property Location 1~-~/, 5W t/•, Sec. ~ T~,.,N-R_]_!_~+ Town of }~~____ll~~~ ~ ``~=f tt ~~~'; ~ ~'~ `, ! lii''~ i ^- Lot # /~.s~ Subdivision ~, i ~ ~ `~~ t 11 ~ ~ ~ ;` ~ Certtf ed Snrvey Map # _ , ~lolurma ~,~,_ Page ~ ~ -- a.~ ~'„ ~ 'Volturle ~~~'~} } Page # r' ~ .~~ 'l~ama3ty peed ~____'{,;~~,,' . Spec l:otzse D yes l~ no I,ot lines identifiably ~, Xes O ao SYS'I`~Nj ~~~~'c~ANG~ ~,nproper rice attd trainteaaneeof your sepae system could result ~ its prttnattu+e failuzti to handle ws.Stes, PtoPcr naiaterance coasira of pumping ottt the septic teak every t:~e years of 6oones, if aeedod by a lteetued pumper, What yat: put into the ryst~o can aPlcct the funecoa at the aapde tastk as a trostxua~ut stage to etse wtste disposal s7ratcui. 'Ihc ropcrry owner ogrccs to submit to St. Croix Zonla~ Department a ccrtifieadoa frotm. signed by ttte anvacr end by a p that 1 the o~sito wastewatadisposal aystctn mn drrpltmtbar,lo+~oy~'m Pl~b~~n~mddPitaabtt otalic~nsedpumpe=vctltY~S ~~ Icss than 113 full of alu c is as proper opctadug condidoo and/or (2) a.ftcr i.oSpe+etion lad pumpsng (if tuc~cssary), ~ aeptie tank is ~ . I/wo, the nndrrrignod Itavo read the above r~quir'cmeut^t and sgtoe to maiatiia the pavste sawsge disposal :ysura vnth the standsrds set Earth, hatzia, as sat ~ tfse Dcpartutens of Commerce sad tho~Dep~rtmcpt of Natural Resources, Stave of'R'iscv oP~iu .~ ~0 rutitiq that your septic stem has been utaintllncd mut be oo letcdtlndttttueed to the St. Croix Comity 7-0ains drys o! the throe year cxplrnri n date. ~~ ; cY/ SI=GNSA•1LlR.E OF tiPF'~ CA24"1' O W*F.LR CER CATIOI`I 1 (we) ccxtit'y that all sratca-ents oa this torni ate t:tuc to the best o[ my (o~) ~owledgc. t (wc) am (a.rc) tt3e o'w'scr(s) ai e5c property det:cnoed:bove, b ~Yirtue of a watrtt.~ry decd recorded in Register of Deeds t~~Ce. Qom.,-~' y ~`~ ` , ~OF AppL1~~ DATE S[GNANRL' .. • ... • -• • • • q,ny infetmatioa thzt is tais•repttsentad msy result in the sanitary permit bciag cevokcd by the Zoa:.ng Acpzrizricat_ •• Lnelade ~Sttt thli Applittttioa: a cep¢y3 off the ccrritied urveY ~psfetcfereane~tnado iu the warranty deed S00/Z00 YFd 6E ~ ZT Q~~tt l~OOZ/Zi/50 ,"CRY-1 l -OG TUE OS ~ 39 R~1 land T i t I ~+ 1 nc, FRX N0. E51 697 6181 ?, Q2 U 2 5 S$ P 6 3 7 -7~0e~s RA7HLEE>k H. YALSH REGISTER OF DEEDS _ 57. CROIY CO.. YI l)acurnenc STATF, BAR OF WISCONSIN FORM 1 •2000 WARiLINTY DLF,D '1'ht15 OGi;U, rrndt uetwcen Carriage Homes XX), )nc., a Minncwtn Ca'poratioii. Grtntnr, and Cutlagc Ciry Homes, lnc., a Minnesota ('~~rpolt+!ton_ t3ran!G„r ~ '~"' C3rantur, for t+ ~nluabie eon.itierati~n, conveys to Grant`u the following described real estate in St. Croix County, Sts1e of Wisconsin (the "t'ropcrty"): R£C&IYED FDR RECORD ®~ 12812tif8~1 89 t 3SAM YhRRAH7Y DEED Ei(JIPT I REC FEES 13.00 Tii,11i5 FEEL 218.78 COPY FEE: GC FEE: PAGES: 2 iteCOrtfin~ Area N.rme and Return .4ddress: t,attd Yitk lnc. 1900 Silver Lake Aoid, if200 New t3tighten, TvLN S51 It Y 'T'ubether wi!L •sR appurtenant rigl;ts, ti[!c and interests, 20-1395-40-000 dated I~cniificatiun Number (+?iNl ~~.--... This ~Ll homtstead rrtspcrty. Grv!;tur w,urants thAt the title to the !'ropetty is good, ind,fcasible in fix simple and free and clear of encumbrances except Uated this t4th day of April, 2004. Carrie .Homes XXI, Ins. _-Itellei St~M~rtntLVicerPresidcn: _ * - Siernturv(s) SnI?. ATTACHED EXHIBIT' A AL1'FIEN1't!CA1~10N -ouih:aticattd this IAth day of Aprii, 2004 Y ACKtrOWGEDG~9EtV1' STATr OF Minnesota ) WASHINGTON COUNTY. ) ss. Personally came before me this t4tlt day of April, 2004 :ltc abav,: named Kctlci St. Martin, Vicc President of Can-iabe ~~ ~`+~"-"`y-+-' I lornes XX'1, lnc., ~ Minnesots Corporation, to me known iu be f!'1'l.i?' ME1v1t3i;Ft ST/t"1'fs HA1t OF WISCQTfSIN the person{sj who executed the foregoing instrument and (I1'nut, acknowle ed the same. authorize:! Uy S 70b.Ofi, Wis. S43ts.) ~~ !'FtIS 1Nl I RU~dENr tY,~S GRAFTED BY ` Annette D. Theis _ __ Notxry Public, State of Minnesota ~ ^~ ~^• My eotnmission is pertnsnen-. (f f not, stntc expiration date -C;rcgory A: 1?ontf~, /1tty,i900 Silver Lake load it200, Ncw I j31,12~]~~ ) fjri.ehton VIN SS t I? _`~ '-~ _ '~ ~ t5ignsaur~e5 m+ry l~ hu+heracnred or acknowledEeC Dolh ore na nccusury.) c .. ANh1~TTE D. TI-1E-, • Narns ot'p:rsnr.: si~mns +n any eaTaciry must bt ry~rd or printeJ below their siarature *. MCTARY PUBIIC - 4!IHFIESOTa -dy Comm. t:><drot Jan. 3r. 2006 WArtK.~Nll' t)t:tU 5'TA'ft: &AROF WtSCANtiIN FORM',Vu. Id004 1+ XYd 6£ ~ ZT Q~11 i~00Z/ZT/SO I1AY-? 1-04 TUE 08:39 AK Land Title, Inc, FAX N0, 651 &97 6181 P. 03 . ~ U., 2558P 638 EXHIBIT A I,at 40, n A{at of Scenir. Hilts, located u~ the Town of }(udson, St. CYOIZ County, Wisconsin. ---~ sooi~ooi~j~ Xvd-.._fie..aT Q$,N 3;oozizTiSo i, Douglas J. Zahler, Registered Wisconsin Land Surveyor, hereby certify that this Stoke-aut Plan was prepared under my direct supervision and is correct to the best of my knowledge and belief. ~~ 0 ~~~~''' ~~o °o. w+ a ~ ~ ~~ _~~ ~ ~ a o ~ ~ LOT 40 OFFSET STAKES ARE 15' x OEN07ES WO00 LATH SET e DENOTES WOOD HU8 SET • • • • • • SETBACK ~~ r~~ ~~ fl l~ .~ ~ ,~ ~~~~~~ R ~~~ 2 cY ~~ x yi ~ ~ A_ 3 $.~ ~, a ~~ ~ 7~ ~ O V O w g O ~~ ~ J U --~ W = C.~ U W -- OU g U c/1 ° ar~¢r wo. 1 Z Q CL !-- 0 w Y Q F- S00/SUO _....._......_.... Ydd 06~ZT Q~•N 600Z/ZI/SU ~` ~. ` ~" ~ ~t ~„g:s Q~4 i_ ~ ~ ~ ~ ~- ~~ ~ ~ ~ (may ~ ~ , , ~ C} \ ~ 2„ ~ ~~y '~°~`~~ ~~ ~°~' 27 t~f'i ~` 412 T ~} ,~ ~~ ~y ~ a- -,~ t» ~~, x„ ~ w ~ ~ ~, ~,~ ~ sti ~~ et- ~ ~ ~' .~ w ~ ~ r ,!~ ~ ~~ ~ ~a ~~ , ~~ ~.~ ! ~ _.. cn _; ~ ~ ... C , ~ ~`~ ~ ~ ~`, ~ 3 ~'~, w "~~~ v r ,.,,,.... 1... ._ ~ . ~