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020-1395-45-000
Wisconsin Department of Commerce Sa2ety'and Building Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Nersonal information you prove may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: ~~C~L/ I City Village X Township - ,,"WUVu vJ Hudson, Town of CST BM Elev: ~ Insp. BM Elev: BM Description: IF117R IIrrVR1Y1M 11V1Y TYPE MANUFACTURER CAPACITY Septic a oo ~~ Dosing Aeratio I~ Holding TANK SETBACK INFORMATION TANK TO P~ E-~ WE BLDG. ..~ Vent to Air Intake ROAD Se_p~ ~ ~ ~~' I ~ ~ 4{~ Dosing O / Aeration Holding PUMP/SIPHON INFORMATION ~Ob m~1 ~c"t' r1 ~~ Manufacturer ~ ~ Q ~A ~~~V L/tx-t!~:1._ . Demand GPM Model Number ~Q 1 (,~ "~V TDH Lift Frictjor~oss tl System H a TD Ft ~. Forcemain Len h , Dia r~ Dis . to Well CLCVAIIVIY UAIA County: $t. CrDIX Sanitary Permit N 463338 0 State Plan ID No: Parcel Tax No: 020-1395-45-000 Section/Town/Range/Map No: 25.29.19.2439 STATION BS HI FS ELEV. Benchmark p n ®L / bs, ~ ~, Alt. BM ~ ~-~ ~~ ~3n Bldg. Sewer ~~ qs ~( ~ ~(. ~ SUHt Inlet ~ O~~ I 2~ 7 • D ~~• ( SUHt Outlet ~- Dt Inlet ~ ~~ / / Dt Bottom / ~ , (,t -f- (~ , ~ _- ~ S' 1 ~ol.. l Header/Man. O) - ~ t Dist. Pipe O' . g• b - Bot. System .~ Fin rade ~ ~ ~~ ~G , t S~over / z..~ 2. ~ N~~'J ~7 / ~ G I JCr I SOIL ABSORPTION SYSTEM I I "v -" ` T / L (off 7 ~ = (~-(- ( l BED/TRENCH Width ~ Length No. Of Trenches PIT M S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~1 V SETBACK SYSTEM TO P/L B WEL ~ KE/STREAM LEACHING Mapufa~tarer: ) INFORMATION CHAMBER O ~V ~{ Tye f System: / ~ \ ~ t Model Number: D1~TRIBUTION SYSTEM 77 / r,FLUY.l.YCS,~~ A'VI (.Gt2,(f «dt._ !rx v~.A~S~II .?~Jd Head /Mar)ifold Lengt Dia ~ Distribution Pi e s Length ~ ~~ ~ ~Dia~ Spacing t ~ ~ x Hole Size ~ ~ ~ U~ x Hole Spacing Vent to Air Intake / 7 ~(~ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv U~~w' ~i~J ~~ ~Y°t ~~n Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded M ched Bed/Trench Center ) ~/ Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ Plo COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / / Location: 733 Regal Ridge Hudson, WI 54016 (NE 1/4 SW 1/4 25 T29N R19W) Scenic Hills Lot 45 Parcel No/: ~5~~.2/9.19.2439 1.) Alt BM Description -~~~1 ~..~ /?~" dY~ ~~ .~,5 ~"('~ _ ~/ o(hc 2. Bld sewer len th = t ~ ,.,~ Q<~~~%~~'~.~. 9 9 ~~ - Z ,~ ~1 ~ "~ ' ~ m c d~ Cam` -amount of cover = ~ I ~ ~.. ~ ` ~~~~Q ~~ ~ Plan revision Re uired~ Yes No ~ i ~ ~. Use other side for additional information. ' ~ ~~ LL'n'/Yri~.. _ ~ ~ '~ ~~! SBD-6710 R.3/97 to _ Insepctor's S1t~i~ture Cert. No -- __ _.~. Safety and Build' _ 'on County .,v , P'Z « S ~ ~ ` :t}1 W, Washingtan A e., P ~ D 1 - < . WI 707 2 " ~- ~~ Ivl di ita Per Number (to be filled in by Co.) a -s~ons~n De artment of Commerce :. a so _3ISl , ,: n 3 33 ~ _ Sanitary Permit Appiie ~ „state Ian LD. Number [n accord with Comm 83.21, Wis. Adm. Code, personal infortnatiotj ~' ' ~~> l~ i-~ Z, ,) f. ~ _ may be used for secondary purposes Privacy Law, s15.(>4((( FG GF`t`1~'~ i Proj t Addtess (if different than mailing address) - pad - ~.3 ~.j'- 4~'3--aa'd I. Application informatiarr -Please Print All Information 7~~ ~6~w / ~l~d~,~~ Property Owner's Na me ~ L~ ~~C~l/ ""' " ~ Parcel h` Got ~. Block /!~~ Property Owner's ailing Address 3 Z ~ ~- Property Location )~ t City, State Zip Code Phone Number ~- I} Z t'L/~? T ~h~zi1~~;, 1 ~~D' ~- 4.--_ --- (circle a T .~~ N; R~E or~ } II. Type of Building (check all that apply) _ / or 2 Family Dwelling -Number of Bedrooms ~ ~~ Gta/ ~ ~JS~ _- Subdivision Name CSM Number t 'G Public/Commercial -Describe Use _ __ ______ _ ~~~ ~iUftG~ ~ l (/~ ^ Stan Owned -Describe Use _~~,_~_______ ~ GCity~^Viilage ®'I'ownship of~~ 1 J~ `~ III, Type of Permit; (Check only one box on line A. Complete Ilne B if applicable) ~ A` ~ New System ^ Replacement System ^ TreatmenUliolding Tank Replacement Ottiy ^ Other Modification to Existing System B. [] Permit Renewal Permit Revision ~~- ^ Change of i Permit Transfer to New List Previous Parmit Number and Dale ]sued Before Expiration Plumber Owner IV. Type of POWTSSstem: (Check all that a 1) ST• _.~~ _ _~~Z_~ `_ ~. Non -Pressurized In-Ground ^ Mound > 24 in. of suitable sail L Mound < 2~ in. of suitable soil ^ At-Grade Q Single Pass Sand fiilter ^ Constructed Wetland ^ Fressurized in-Ground ~ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ~_Leaching Cham ^ Dn Line ^ Gravel-less Pipe ^ Other (explain) ~_ V. Dis ersal/Treatment Area Information: • - i ~c ~ /-. Y" ~L -. ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis Area Reyuired (sf) .., Dispersal Area Proposed (s~ I System Elevation ~~ ~ G G~ ' ~ ~ ~S 7 ~?~ I 5 • ~ ~ VI. Tank Info Capacity in Total Number _ Manufacturer ' _ Prefab Site Steel Fib fastic Gallons Gallons of Units ~ Concrete Constructed I` Glass i 'i New Existing ~ t Tanks Tanks _ i Septic or Holding Tank i ,~Q'C3 ~,. ! t~ ~~,,, ~ _ 4 Aerobic Trea[ment Unit .T Dosing Chamber r- t~ I L ~ ~• ~ ~,~e ~ i -. _ -_ __ .___-___~.__-__ VIL Responsibility Statement- i, the undersigr-ed, asstune responsibility for ' anon of the PC7WT5 shown on the attached plans. _ _ __._ Plumber's Na me (Print} Plumber's Si gnature ~ ~ ~ 4Pf FRS Number Business Phone Number ~ Plumber's Addre ss (Street, City, State, Zip Code) ~~ ~ ~ ,~G ~'~ 1~,~ ~~?~Ul ~ _ Y _ e~G~- ~,5'~ ~1_ _ ~ VIII oust iDe artment tise Ont Approved Sanitary Permit Fee (includes Groundwater ^ Disapproved (fU Surchar e Fee) Dat Issued ' wing Age t Sig tore o tamps) ~ < _ _'~~ -_ g /~ ~ _^ Owner Given Reason for Denial _ _ ~V ~ ~ 7 ~~6~ G~i2~L~~ _ _ IX. Conditions of Approval/Reasons for Disapproval ..~ a~ ~d ~- j~ ~ ~~a~/ate. Cc's- o~ a :~ -~ ~ ~'a.~'~- ~~ ~-~~rt~~h~~=~-- ~t ~ ~ l/h -Sam - rys-{~-- / ~ ~~ ~ ~ ~i . Attach66mplete plans (to thdCounty vnlyyl6r tKa System on paper not less than 81/2 x 11 inches irr size i CRi~-fi~AR (R will /~~l :J ~~ ~. ,cr `~ _ , ~i~" Q~' ~ `~ ~ ~n rc~a%'.~ i ~ ~ ~r5 1 V" ~ ~ ~ J ~a `~, ~~ ' w ~j ~~ t S~'~:.C~l "cam , ~i~ ~Ya~~,c7~~sli ~, ~,~y ~/ 3 .~~ ~ fTp~~~. ~`~ ~~ ~~/I G.~ rc~~.-~- 6~~ ~~"~~, ~~~ ~~ ' ~~ ~~ ~~ ~ t Wisconsin Department of Commerce SOIL EVALUATION REPORT Page j of 3 Division of Safety and Buildings m aczaruance wnn ~.omm aa, vns. rwm. t,we County ~ ~ ` Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must ` Va ~ . include, but not limited to: vertical and horizontal reference point (BM}, direction and per( I,p, G ~~ ~~ S~Q 1 ~~ ? percent slope, scale or dimensions, north arrow, and location and distance to nearest road. t ~ i j l Please print all information, viewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ 4 Property Owner Property Location I_ - Govt. Lot ~ 1 /4 j,(J 1 /4 S T ~ ~' N R E (ot Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 5n L ~ r .~ ~ ~. ~~ ,•t(s City State Zip Code one Number ^ City ^ Vliage ®Town Nearest Road e ~ ( c~ tY1 s ( ) d ~~ v ~ So /L i/ (~ New Construction Use: ~ Residential / Number of bedrooms 3" y Code derived design flow rate ~ S~ /G O ~ GPD ^ Replacement ^ Public or commerdal -Describe: ~~ __ ~__.____ Parent material ~ u ~-wr~..5 h Flood Plain elevation if applicable A~ J L~ ft. General oorrtrner~ts y e ivy Q. ~ ~ 9 and recommendations: S s r V. ~, o a ~~ # ~ Boring Gl [~ pit Ground surface elev. ` ft. Depth to limiting factor ! Z 3 in. Soli icatiort Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z - 5.~/ ~~ c - L -iZ i ~ `" ~ ~ 1 ~-- -- %-~ o ~ 2 " ® Pit Ground surface ele . ft. [?epth to limiting factor I ~ d in. Soil ication Rate Horizon Depth Dominant Color Redox Texture Structure Consistence Boundary Roots GP DIfg in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 O-~~{ ~ '" ~+ ` Zen ~- m~~ C ' S ~ ~ ~z ~ylY ~~~1 Z~ shy m r (1~~ ~ / y --~ fl .~ S.o , ~ ' E}fluent #1 = BODE > 30 < 220 rrglL and TSS >30 < 150 mglL • Efl1ueM #2 = BOD, < 30 mg1L and TSS < 30 mglL CST ~ (Please Prurt} Sig CST Ntmtber s~ - ~-- ~~ Date Evacuation Conducted Telephone Number j(, ~~ ~S`l' ~'S~ ~~~,~,r~~,n~~r~(. r,~ /, Sys/~- co-zy~Os pis =7/~O oZ ~9 Property Owner (~css2~Wlar~ ParcellD# ~U'f' 7~ Page ~ of _ ~~ # ®~n~ Q Pit Ground surtace elev. ~Q ft. Depth to limiting factor /~C/. (p~n, Soll ication Rate Horizon Depth Dominant Color Redox Destxipdon Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 •Eff#2 ll ff'' C /n- 1~ lv~ ~ - L r C - -~ `. ~' ~S Vh ( ~ ~' r ~~ # ^ BOnng ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. R. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Col Redox Description. Texture Stricture Consistence Boundary Roots GP DJff in. Munsetl 12u. Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 'Eff#2 ' Efliuent #1 = BODa > 30 <_ 220 tngll. and TSS >30 < 150 mglL ` EAIueM #2 = BODS < 30 rngA. and TSS < 30 ntg/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. seoa~w tR.b+ooi ,-- Scw.(~ ~ f'`'~c' Sy~~evr~ e.(e ~'~G~ s J~~ ~ ~Y ~,, ~- ~_ i~' I '~ ~ ~~ ~ Su ~~v • Si=PTTC :"A.1K £ PLI1~1P Ci~ATiH£R CROSS S£'CTIC~N A;v?7 Si'£CIF~Ct^.TIO:y'S 4" CI VENT PIPE 12" MIN. ABOVE GZe,DE ~ ? 25' FRgM DOOR, WINDQW OR FRESH AIR INTAKE FINISHED GRADE 4 " C I RISER -----~ 19" IN. 6" MAX. r ~i L+E `I' 1 ~ .~' ..._..__.._.M~ WATER TIGHT 5EAL5 APPROVED 'TPE 3' 1NTQ St?L I D 'p11" PUMP OFF Ei.EV . ~F'I . W~ATH~RPROOF ~JUNCTIdN $OX AFPRflV ED WITH CONDUIT MANHO~.E GCVEr~ 'rJ/ PADLOCK ~ ---WARNING LABEL ~ _ .~1._. ~ t~ ~f MIN . .• .~ i ~ E ~iA S' ~ 1t TIGHT ~ i, \/APPROVED A SEAL { JOINTS WITH ---}- ~ ALM APPROVED PIPE ~" ' SON SOLOTDrSOIl C i ~ ~"` OFF '~'~ RISER EXIT D PERMITTED QNLY IF TAiv'K M.NUFACTURER HAS APPROVAL 3" APPR3VED B£DIIING UNDE~2 TANK CONCRETE PAD SEPTIC / DOSE wPECIFiCATIONS WANK MANUFACTURER : ~ `~„~~.~ TANK SIZES: SEPTIC I`~. CAL. ._._...._ DdSE GAL. Ai..,Ar2M MAN'JFACTUR£R: Le~r~~~S~M ~`~' MODEL NUMBER: _ ,~ 4.,,.V SWITCH TYPE: ~ M~+e..~,~ PUMP MANUFACTURER: ~~~w MODEL NUMBER : : ~~ ""'~`~ aWITCH TYPE: t~ne~C P,EQli IRED DI 5CP:ARGE RATE ~ ~ GPM NUN:BER DOSES PER DAY : T bCSE VOLUME IIuCLUI7ING F LCWBAC K : ~ ~ ~ GAL . CAPACITIES: A = ~~ INCHES =GAL. B = 2 INCHES = ~~ GAL. C = ~ INCHES = ~~ GAL. D = ~ INCHES = 01 ~j GAL. PUMP ~ ALARM WIRING AS PER I;.HR 16.23 WAC '~IERTICAL DIFFERENCE BETWEEN PUMP CFF AND DISTRIBUTION PIPE ~a2. FEET } MINIMUM NETWdRIC SUPPLY PRESSURE . 2,5 FEET + ,~~ FEET F QRCEMAIN X ~~{oOFT/IOa ~'T. FRICTXON FACTOR . ~"W FEET T.C~TAL DYNAMIC HEAP _ ;~~~F£ET w~ITuEitJAL DIMENSrCNS OF PUMP TANK: LENGTH ,,,~ WIDTH •-~"' DIAMETER -- ~I~UrD ~'~' ~ K ~ ~ G•,~C Pe2 !" ;IGN D: _~'° ~„~"~ _ _ LIGEN54 NL1M8ER: - ~-~-~.~ LATE: 1/88 ~GOULDS PUMPS Subnnerstbte Effluent Pump ~~ 3 V ~ ( EP05 APPLICATIONS Specifically designed for the fiallowing uses: • Effluent systems • Homes • Fauns • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 'li' maximum. • Capadties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge sire: l'/:• NPT. • Mechanical seat: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: t04°F (40~ continuous t40°F (ti0~ intermittent • Fasteners: 300 series stainless steel. • Capable of running dry without damage to wmponents. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, t 15 V, 60 Hz,1550 RPM, built in overload with automatie reset. • Power cord: t 0 foot standard length, t b/3 SJTOW with three prong grounding plug. Optional ZO foot length, t 613 SJTUV with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- maticmodels include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EPOd Impeller: Thermoplas- tic 5erni-open design with pump out vanes for mechanical seal protection. ~ EP05 Impeller: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic desfgn provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable; Severe duty rated oil and water resistant. METERS FEET _. , ..._ to~- _. . 7 x _v 6 s a 4 c ~ 3 z 14 ,,. 0 09 y0 20 30 40 50 GPM 0 2 4 5 8 10 12 m3/h CAPACITY Goulds Pumps ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~° cannNan suwidatds llssodation (CSA listed model numbers end in "F" ar "C".) Goulds Pumps fs ISO 9001 Registered. ~92000GouldsPumps ~ ITTIr7dustries Effective February, 2000 83871 Quick4 Standard Chamber ~~vrrViV YICYY !UluttiPort End Cap SIaE vrew FRONT VIEW Cluick4 Standard Chamber.Nominal S~esiS,caiians Size -N x L x H) 34' x 52" x 12" ' Effective Length 48• Invert Height $• INFILT AT R~Y~STEM,`7, iN~~T~ryppRD Li ITED WAF~(~aryTy (,2r The elruclural inte4l'ity G each rl+amtbr, era] Plato, wulyn and olhor accFet$ory mar s~l;,~,turcxf hY InlNtrabr ('Units'), whorl rnGlalletl arW oparaterl ..) 1 N',ar.:h(reki M an ons;la sept4; SYaterrt n aecnrdanue with h5rl,lrator's irsrRZ,iials. L'. wd Tant1\j .0 Ina original purchaser f 1i^,fdBr') against tlerectiva Hinter als and wurknren4hP fnr ona Year lrom thn dale that tl a sc Ptr[; r~r 1 [ s issurx! Fx h<, suptz: s slrxr, e;rintaininl] Ihn Units; provided, h'swauar, drat 7 a WNiC Oerrl r r5 of regrrr¢tl ~Y apprrtahia i iw, the a t pHrNa) w7 kxtgi~~ upon ttw data drat nsrailatiorr o1 Nta septic ay5lP.rn r~rnrm6nces. TO e"Pn Isa :15 w rmly nth!:. F}plYOr rlwet notNy I tCNraca Ong at itg t.c.pdrale liead.hartn s 'n ad Suytxtxx, GnnnBOrrGU! wulnn fiHean bd) daYS 's t le all~ad rlr `e t tnfrltratw wNl suPVIY raWacamertl Un td fa Urals orternnnen tr,. IMrltrator to de cnvarya o1' Ihls Umiletl'.^rarranry- hrfN7 at rk tidbit<ty s,x)ciNealN excludes the cQfit of ramwa; arvd/or rngtallahon Of lhE Units. {bi ?Nt-: LiMITf;!) WARIiAN71' qPH) gEM[pIE51N SUBPARAGRAY}T {af ANE fXCLU;iIVE, TItERF ARE VO U1~HER WgRRAN71Eg 44'(TF! RESf'[~.7 O Tt1T UNI r5- iIJCLUDING NO IMPi1ED WgRRgNTIES Ot MEfi:,NANTADILITV pR S I NES Frig A PARTIl1JLAMi PURfKl56 !~1 Thl Lirttilud Warr mty sh~N he rxd it anY Dart M the eJ'arnher system' m nukr.huatl f y do/tine fl r than Inn!vata. The Limyad W,rr ,n;y rietrs noI oxtcnU f0 indldenldl crns,,q.~er t ai, Flx)r:ial r'mdrecl rknmages- Iq(Ntralor shah ncl b.' ab~ fur pn la t n~ v Cquw,ialed damage's, rne!udeg loss of pirxwelron arrd pre6ts ratrcr and matariala, rrv5rhead CdsLC ru other lOSSas w oxreneos vrr:rxred by tt>6. I-i.OVrtyr tlr any !hiM party. $ptClfmgliY exch. dud iron Lirrrtexi v;drranty ;:overage are tlamage to aia Units due; lu oMinvy wear a a teac. atera;~.oe, acCklenl, rcrisuse, abuse, nr nrglecl of Ih» L its; iris Un is tieing sutijzrtetl tq vtn'BGIa 1reHir, or other r;bnt~tkms which arc not uarmRlnrr uy the mstaltefarr instructions; fature to rnaintah) rrye mlr n - n grountl GrWerB sat forth in the instarrelion instruGtigns: thn pia06ma1t of Improper maltr~ah in:c~ the sy6ler*i cgntalnmg tt~,e UnNs: Iatlure o' fife Units (x iha SepilC system daa tO lmprn[Ier 3lting o` Improper :,iZii}a, er.cassN'A wd!e" s-ge iinpr;Aiar grpa6e CNEtYOSaI, q 1mprGpar Operatgn', LK any Ottler eJant net oau62d by Infillraldr TYus lJmll2[1 Warranty pTrall 60 1'oid it the NYddG Jail to GOn>F)iy witty aN d 1tR talm3 aBt forth lrl tMS tJn4ifi;1 YYananly Funher, In rn went shall infliUalor be responslt•le i(yr env lass w dart,aga ro the Hv:dar, lire Unas, or any third pawl raSUlUng from U,etada!lon or ship nxr,V, nr frnrp anY WUiuq pabl'NY Gaims W Fkrklar w any ttHrti pgdy For Mis lirnltad tMmranry in aPP18 tits Urin9 mr.31 be insfaNad in a0cnrdance with aN Hite rXxldirgnS ragWrer4 Cy slate and logal Co('lee; all outer appgcaNe laws, an(; InINlra{or's hrStallalHxr instrurlions, (dJ tJ0 re;x_rsentalrva o' inhHralnr has Ifm authority b chango or extaryl this ! ,irited yYarranly. No warranty appNas to any party Whn; fryan Ura or'r~6 'r31 Rdldar. Tllu ahova repressnls !ha Standard l.irrntad Wananly nHarrsd by Infiltrator,. A Iin,NoU numhar nl slates antl Wiinlies Iw•x+ r,~,rHexenl warranty require. nrants, Any purchaser nr tJnits srrousd cur,raua Inrrryrator's Corpgrale fiaadrluarlurs in CNU SaYprouk, Conrmceaul, prior to su0h purehem, I6 rbt2rn a copy of the apgl;cabW warranty, a;ui Sh0u0 ctrtae4ty read ;hat wa!ranty prior to H>8 purJ~ase of UniU. sloe view TOP VIEW `~ a ~, '.' 3 ~. ,d 1 ,ust`~c-~'r f rf~ ~ it . ., ter ,~ ,Niuit~Port ~nd'Cap:Nominai~Specifisations .~ ~~ - ~ ~= " Size ~W x L'x Hy 34' x 16° x.12" invert Height 8" or 1.25' +~ ~ ~ a SYSTEM , I I~ C ~ Envtror-menta! Ofz&ite WiRStowater SolufJons~" 6 Busil-fess E'ark Roast • RO. Box 768 C~Ict Saybrook, :;T 06475 860-577-7000 • FAX 860-577.7001 8Q0-2~1-4436 .i S. Patent31 4,7;iy,661; 5,p17,041; 5,1;16.488; 5,336,017; 5,401,116; 5,4u1,459; 5,571,903; 5,71$,163; 5.58F3,77A; 5,839,844 Canadian Patents: 1.'29,959: 2,004,564 Uther pate.:as pending. intiitretor EquaHZer arld Sidewinder are registered trademarks pt Intittrator Systertrs inc. Inidtrator is a reylstered [raiemiirk in France, inGhrator 5ystesns Inc. is a ragistared tradernark in Me><!w. Contour, Contour Swivel Gonneciia-, MicroLaaching, PolyTuN, Snapr,ock, CrtamioerSpacer, PosiLtxk; Quick^..ul. QuiCkPlay eecrcceaPAPew and Cuick4 are trademarks of Ir,illtratcr Systems Inc. ~ 21)03 !nf>Iirata Systems Irlc. Printed n U.S.A. ~•~~ uick4~ STANDARD CHAMBER a -~ ~7. 2, 7 ~4-E C1. C X1.9 I .~ '955. X ` 957. 4 ~, , RD ~ ~, // ~~~ ,- 967.4 ~ ` ~ i X ,1 ~ ~ ,\ X , 4 A \ 960 4 1 i/ X 963.4 96 .6 ~~~ 1 \~~C~L 0 X ~ 963.5 ~,~5 4n~~~ Ti _~~ 41~ i ~~ ~, ~ < .4 A ~ 1,24) °' 2, V _ ~ 9 2.5 I~ ~ ~ ~X 7 ` __--~ ~ ~ ~ __-~' i ~~~ ~ ~ 6 t . 7 ~ ~~ ~V ~ C~ ~ -V ri Z \ \`~, ~`\`_`` , ~ ~ ~ ( ,- 990.2 ,~ l ~ ~ 0 ~ / ~ ~ 65. 1 ~ ~~ ~; ,, ~.~~ _ ~ ~ ~ ~ ~ A ~~ 964.3 9 /'~~ /~ ~ ) J i ~ X ~ 9~~ ~ x x ( xr X / ~_~ ~ /%~ ~ 987.8./ 91.9 ''~ ~ ,' ,, ~ ~~ ',, r , , ~, ~ ~ . , ~,- ' .~ r,.~,,~'~-- ~. . t~WNER'S MANUAL & MANA~EMEN7 PiAN P„e4 ~ ,, ?~ SYSTt3M $PECtFICATIeI~It DESKaiN PARAMET~S Number ci Bedracma *{ q NA ~~ Number of Public Facility Unha DNA Estimated flow 4avsrtsgal sUda OeaDpn flow lpeak}, tf;stimated x 1, S} ~~ d aUds Soli Applioatior! Rata a: 7 ~ Standard Intfwnt/Effiuent Quality allda ht Monthly aversga~ Fats, Oii & areasv (FOG} 530 mgfL Bioohembel Oxygen Demand t80Ds} SZ20 mall DNA Total 5uspandsd SoNde {TSSi 5184 mg/l Pretreated Effluent (3uaiitY Monthly average Biachemioal t?xygen Demand iBODs) 53fl mgll Total Suspended Solids {TSSI 53O mgJL NA Feca! Coliforrr~ tgeornetria mear+} 510 1 OOm Maximutat Efflusrit Particle Sixe xr in die. D lVA Other: DNA ' Veiues typical far domestic wasieweter and septic tank tfliusnt. Septic Tank Capaalty Z d al D N~ Septic Tank Manufsaurer DNA Effluent Filter Manufacturer ~ ~ ~ p NA Effluent. Filter Model ~~ DNA Pu~rp Tarrk Cape~olty al DNA Pump Tank Manufacturer ~ , , 0 NA ~ s ~ Pump Menufscturer ~,R,~,,~ ~ DNA Pump Model ~~ DNA Pestreatment Unit NA O 8eufd/C3ravsl Piiter ^ peat f'lher a Mechanical Aeration D Wetland D pDsinfectlon ^ Other: D~~ efr al~Ceiils) DNA - lD Ground tSravityD D trrGraund {Pressurized} D At-4rads Q Mwmd D Drip•Line D Other: Other. DNA DNA Other: DNA MAIN!'~lAlglrE t3CF1EDtI1.iE 8erviee Evert t3ervioe Frequenoy inspect condition of tanktsi ,alt least once every: 3 afar s e {Maxlrrwrrt 3 years) DNA Punk cut contents of tankta} When Combined sludge and scum equals one•third lYs} of tank voktme ©NA Inspect dispersal collie} At Least once every: 3 manl~tel {gym 3 years} DNA Clean effluent fiher ~~ t Deast once every: ~ ~ tttctt t°} arle} O NA 4nspsct pump, pump controls d~ alarm At least once wsry: .-.- tttorth{e! L3 {sl O NA !"lush IaterNs and pressure test At (east once every: r--- tr~on {s} Q ea+~a} DNA other. At least ont;e every: mot-this) ....r t7 s) t7 NA Qtlwr: D NA MAINTENANCE iN8TF1UCTlONS lnspectiona of tanks artd dispersal cells shah be made by ast individual carrying ono of the following licenses or aeMflcatians: Master Pkrmber; Master Plumber Restricted Sewer POWTS (nspsctor; POWTS Maintainer; Septage ServlcMg Qperator. Tank inspections moat Dntlude a visusi inspection of the tank(s) to identify any anissing or broken hardware, identify any Cracks or leaks, measure the volume of combined sludge artd scum and to check for any back up or pending of effluent an the ground surface. The dispersal collie} shat! be visually inspsatvd to chuck the effluent levels ~ the observation pipes and to cheok for any pondIng of effluent on the ground surface. The ponding of eiflueni an the ground surface may indicrte s falDDng condition and requires the immediate notDficatlan of the local regulstory wthority. When the combined accumuiatitut of sludge and scum in any tank equate one-third {Ysi or er+ore of the tank volume, the entire oontarets of the tank .shalt be removed by a Septage Servicing aperstor and disposed of in accordsnae with chapter NR t 23, Wiecanain Administrative Cods. Atl other services, inoluding Dot net limited tb the servicing of effluent filters, mechanical or pressurized Campanents, pretreatment units, end any servicing at atYervals of 512 menthe, shall be performed by a certified POiAITS Maintainer, A service report sha!i be provided to the heal regulatory authority withM f 0 days of raor-rpletion of ~1y service event. •apo~ 8n!ieliSlu!wpy u!suoaslM '!E3 R (Z) '!1149'68 Pus t}l~8lPitll(gilZ1ZZ'E8 ulwo~ 183dHyo yilM aauslpuroa ul pei}slp ~M iuauxloop sly, Q~1 ~ ~.~ -~ auoyd _ ouoyd -~~ ~ ~ '-L~ aweN au,1tN Alll3QH1f1d Aa01K'If103>;! 11dQ01 l!l3dW[ldl ~OlV2l8d0 QNIalA1~3 3P1I.Cd3S auoyd ~N l13N1YJ.NIVW 81MOd ,?"mod` , ,G ~ / G auoild ,.f X7f~ ~ ,, •~ Ya • ~ ~ • I/, a~N »S171I1SN1 SJ.1V-Od S1N~ W W 00 ItINOU,IGQV '3"1818SOdWl !!Q LlflQli~lp ~8 AVW 31NVJ. V 30 iiOM'J1N13H.t WOieii ND~~d 17 d0 311QS813 'i1ttS3a AVW H111~C '83QN1IJ.SWf10a1~ ANSI d3QNt1 XN71 1NdW11IStll !i'iHl.O tic? dWfld 'QIId~S d ifii1N3 lON Oa 'N3D1~Xr;3 l.FJ3t~1~~118N1 >d01Qi4d $88SKQ 1VN191 N1KINOQ JIbW S>IN~11 1N~W1.1I3a1 tlaNlo QNb dwnd 'QI.1.d8s < <DNINlJVM> > •owli iayi ie iaa}}e ul seln~ ayi yilM didwao isnw sulaishs vans ~o suo};ar~aisuoaaa •aae}xns an}iexii!-ul ayi ie iewolq ayi }a lsnowox bu!nnopo} easld u! poianxisuoaox aq Aew suxa3sAs uolidlasq~a iloa aps16-is pus punoyy (~ S1Mfld ul saauenpe bulx~ 'S1MOd polio} oyi aasidax of ixosol isel a se popleisus eq tiew 3}uai bulploy s Aisolouyooi •suolieilulli I!os lo/pue ~}aegias o1 anp algellsne iou sl sore iuauloasld8.t alga~ns ~ ~ •awli leyi 1e iaA~}9 u! seln3 oyi yi(nn Aldwoo lsnw swais~s iueulaaa{ds~ •eAlg iuowoae{dax a{geilns a ysl{geiss o; uolivn{sno ells pus p{os neeu s xo} paeu syi w i{nsax 1!!M esxe iuauxeaspdex ayi iaaioxd of axniled •s!!oM pus sau!p io{ 'alnionlis posadoxd pus Bulislxs ulox} s~a~egiss pallnbex ~cq uodn pe8ulx;us eq iou plnoys pus uoliaedwoo pus soueglnislp ulox} peioolad aq plnoys sole luoutaoeldel e41 •u18;sAs uolidlosge {{os iuawsasldex a ;o ualisaol oyi xo} Pazlllin oq stew pus poisnlene usaq ssy gaze iuoulaas{dox elgailns :wets iuatuaoeldsl iuelldwoo opoa a aplnold of 'ua~lsi oq isnw la 'uasq aney salnseaul bwMOpo} syi palledax eq iouuea pus sfltt>l S1MOd oyi )! N1>r1d A~N~JNIlNQ~ 'lltf193aW pi108 haul xoylauQ xa lOl1~JB '!-oa yl!^^ Pell!1 eaeds pion ayi pus penoursx sxonoa llayi xo parowal pus paleneaxa aq !lays alld pus s~lusi pe `6uldwnd xauy s loieledQ 8ula-nleg ebeidog s ~tq }a pesodslp ~l{ledad pus psnoulax sq !lays sild pus s~}uei !le ;a siuaiuoa e41 • pa{aas sBu}usda ad}d pauopuege syi pus psiaouuoas!p eq !lays sild pus s~luel of bwdld bd s :opo~ enrie.uslululpy u}suoas}~ 'gS•gg wwo~ ~aidsya yilnn aauepduloo ul pauapuegs A{a;es pus >tlladold sl uiais~ts ayi iey; exnsw ai us~{ei oq !{eys sdais buimollo} syi aalnlsa }o ino ua~}sl ~Iiuauswxad sl xojpue s{le} g,l,Mpd syi uoyM 1N8WNDaN~1181I •aulxq xaueiios xalenn pus :suoduxtei :su!~deu tieuues :sap!a!lead :slonpold Suliu!ad :{lo :suoliealpaw :sdalos ;seal :sopla!gxay :asealb :aullase9 :sBulpaod algeiabsn pus i!nl} :xaisnn (dwnd duuns) ulelp uolispunal :ie} :siuaiaa}u(slp ;sladelp :ssol} {aiuap :slesQelbep :sgenns uoaioa :sulapuoo :sunq auelebla :sadpnn ~lgeq :saliolq!lue :SiMC?d ayi ;o a}!! ayi Bualold pus oauewla}lad ayi onoxdull ~eul tussles leiennaisem oyi uaol; 9wnno((o~ ayi ;o uo}iewwlla to ualio~pa}l •ea;s uo}idlosge {los bpell}-iB to punaw Aue ~o adols uMOp iao} 5l u{yllN- eaxe eye '3osdwoa xo gxnislp oslnnxsyia xo 'xeno ~lx8d xo onlxp iou as •sllea ~asladslp pug s~{uei xono selalyan filed to anl~p iou og •~pusl dwnd syi upytsnn slanoi pewxou exoisax of spaluoa duxnd syi Buliexada A,ilsnuaux ul islssse of xaupeiuleW S.LMOd xo xagwnpd a laeluoa xo dulnd luenl};a ayi of laMOd Bu!xolsex of xo!.d joi$xadp Sula!nxeg aBsidag a Aq panowBx ~pue1 dulnd syi }o siuaiuoa syi aney uolieni!s sly; plans off, 'lusnl}{o }o ableyastp sae}lns to dn~loeq syi ul 1{nsaj I(aw pus (s){{aa syi Dulpeo{xano 'osop able! auo ul lsi{lea {esladslp ayi of pobleyas!p aq {{{nn laia~naisenn ssoaxa ayi paxolsax sl xaH+od uay/N •s{enal xaieN+ybly leullou anoge !{[3 Aeul s~lusl duxnd sabslno 1sN+od bulxnQ •sas}xne an{3exill;u! ayi is uazol; ale suol3lpuoa llos uaynn lrtaao iou !}eye do-Eels wels~g •esn of land loielado Bulalnlos s8sidas a ~lq ponaulal (sl~lua3 syi }o siu93uoa ayi aney pelaaisp axe suorieliueauoa y8-y }l •(s1t{ea lesladslp syi abeusep la/pus ssaaad iuawisexi syi spedwl ~teux ieyi s!eolwaya xayio xo sianpold Bu!iuled ;o aouesaxd ayi xo} ls}~ueY xuaulieen ~poaya g,~/NOd_eyl ;o esn of xol~d 'uolialUlsuoa Mau xod NOI1VN3df3 ON~- df1 1llt/'1S 2 -0 2 ~a~d a v~r Parcel #: 020-1395-45-000 07/12/2005 08:50 AM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2439 020 -TOWN OF HUDSON Current ' X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner PAUL R & STACY M TURNER * TURNER, PAUL R &STACY M N9656 CTY RD M CAMP DOUGLAS WI 54618 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 733 REGAL RIDGE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.459 Plat: 2438-SCENIC HILLS LTS 1/72 020/01 SEC 25 T29N R19W PT NE SW SCENIC HILLS Block/Condo Bldg: LOT 045 LOT 45 2.459AC Tract(s): (Sec-Twn-Rng 401/4 1601/4} 25-29N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 03/22/2005 790092 2768/319 WD 12/27/2004 783357 2720/535 WD 10/04/2001 658318 8/76 PLAT 911A~ CI IMMARV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class RESIDENTIAL G1 Acres 2.459 Last Changed: 04/29/2002 Land Improve Total State Reason 34,600 0 34,600 NO Totals for 2005: General Property Woodland Totals for 2004: General Property Woodland 2.459 0.000 2.459 0.000 34,600 0 34,600 0 0 0 34,600 0 34,600 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n v, 0' gds ~~~ ~~, ~ A 3 ~ ~: M I Z~ Z O A (~ 'D ~ Z I O vi O W fl1 '~~ N m O m ~ N A a~ p n y m o C° m E. ~ p a N N 4 1 C ~ y^ O Z ~ ~ ~ o- w c~ Z ~ D W co D a W O A a W . O ~ ~1° ° ~ O . ~ - N Z1 I ~ O p f~ I O A fD 2' c I 0 ~ 0 0 g , g ~ y ~ ~ ~ m ~ m o ~ ~ O ~ 7 y H O ~ m 3 ~ ~ o a ~ ~~ M a , ~ z w z D O O ~ v ~ O s ~ ~ c m ~ ~ N i c I (D ro c ' , ~ c . ~ - a ~ 3 =p ~ ~ ~ N ~ ~ D ~ u, ~ a I ~ ~ , a 3 0 rt 3 ~! Z I ~ n 0 Q ~ S O n 7~ S Q a o' a~ m o Do m a o ~v ~ Aa~3 ~ n~ N O. ° Z m d ~~~~ 0 0 0 a n~ ~p 7 pZ ~ N c o'er p f m N A'O ~ ~ a 7 O N N~ ~ N i d ~ N• p ~ ?. -o m O fD 7 O ~O ~. N ~ a oa ~ ~'~Qpc 3 ~ > 3 m> ~. ~g om ~co 3 0 0. cm om p- _ ~ ~ 3 d a ~ c o m ~ a ~ ~ ro ~ -, Q r 1 Q ~ ~ ~ C ~ N j a a p .,. ~ O O N CAD o O O O o f I o o ro a. ~~no 3vv d d~ ~ ~ -~ ~ ~ ~ ~' `~ ~ ^' i ~ ~ ~ ~. ~ _ M w ^ O O C ~ O ~ • W 7 W O- y ~ j ~ ~~, ~ ~ o ?~ ~ -i N ,~~ n 7 n O A ~ ~ W 7 CO ~ R O 7 N W ~ O O C W C7 O ~ a a n r d W n N 2 ~ ~ » C = 3 .. a '~ ~ y o ~ ~ ~vv,~ _. v ~, N - ? - w ~ A ~ N !\ (~ N D m ~ o ~ . N N ~ p c c ~• N a S ~p -~ -I fn 3 ° .p Z cAi ~ c m a .~ ~ .. A z ~ O Z -I N ~ ~ m ~ cn z c ~ ~' ~ 0 w ~ y ~ ~ N A ~ y (~D a °7 I ~ ~ c a o j O A A x c v N 0 A I b w DO ~ ?o ti ti Parcel #: 020-1395-45-000 05/11/2005 02:31 PM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2439 020 -TOWN OF HUDSON Current I X ~, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * LANDMARK INC LANDMARK INC 4732 LARKSPUR LN LAKE ELMO MN 55042 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 733 REGAL RIDGE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.459 Plat: 2438-SCENIC HILLS LTS 1/72 020/01 SEC 25 T29N R19W PT NE SW SCENIC HILLS Block/Condo Bldg: LOT 045 LOT 45 2 459AC . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-19W NW SW Notes: Parcel History: Date Doc # VoUPage Type 12/27/2004 783357 2720/535 WD 10/04/2001 658318 8/76 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/29/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.459 34,600 0 34,600 NO Totals for 2005: General Property 2.459 34,600 0 34,600 Woodland 0.000 0 0 Totals for 2004: General Property 2.459 34,600 0 34,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ ~ Safety and Buildirigs Dfvi 201 W. Washington Ave., F. '7162 c~~ntr .~~ ~ ~~ ~sconsln ~ Madison, WI 53707 - d' Sanitary Per Number {ta be filled in by Co.} Department of Commerce ~ ~~$~ 2G6'3151 .~.. ~ ~ 3 ~ .__._ ~l Sanitary Permit ApF~~+catio .-v b er ~~ LD. Num ~ y ~ ~ In accord we Comm $3..21, Wis. Adm. Code, personal ittfprtnation u provide r `~' may sed for secondary purposes Privacy Lztw,s!$•0~1(1}( ) ~ ,, ~ tii a, f i~~j ~~ ~~t ddress (if differ:nt than mailing address) f ~ ~ 3 3 ~ ~ .~-L ' ` i' ~' I. Application Information - e Print All Wormation ~'~ ~ `'.1J~i~ ~,Ji~{ J ~ Property Owner's Na me / f~ ~ ! arcel # at # luck # i ' _ ~!~ Property Owner's ailing Address GQ~ /l5 ~ ~f' j~ n ~ ~~ ~ ~ Property Location S i `~ ` ~ St t Ci r ect on ' . ' •--_ ~~ s'~ a ty, e ~!/ .n,~ 7_ip C e Phpne Numbe p~- ~ (circle a l9 - II T f B il i T~N; R Eor ype o . u d ng (check all that apply) ~ (~f ar 2 Family Dwelling -Number of Bedrooms _ ^ PubliclCommercial -Describe Use _ '" -_ ~ Subdivision Name CSM Number GjGi'G- ~ ~~~ ~ ~ ~~ t~ State Owned -Describe Use ~ ~}/ST C~ZG<S -[N/ ~~ - -~ - ^City`^Villa e,r Township of ~~ III. Ty pe of Permit: (Check only one box an line A. Co lake line l3 app lcable) ,g A' ~ sq New System ^ Replacemer:t System 1^ Treatment/Holding an eplacement Oniy ^ 0th to g I B. ^ Permit Renewal Permit Revision ~ hanpt; df Permit nsfer to New List Pre us Permi rand Date Issued Before Expiration Plurn ~ `~ ~ owner ~---~ / ~ ~ ~ (~U ~•~ l / I ( or r IV. 'T of PUWTS System: {Check a1! that ap ples- _ _-_ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil L~ Mound ~ 2A in. of s ble sail ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding , ttk ^ Peat Filter ^ Aer is Treatment Unit ^ Recirculatiug Sand Fitter ^ Recirculating Synthetic Media Filter 'Leaching Chamber Dr p L ipe~' Gravel-less Pipe ~i Orhzr _ ~ ~ V. Dis rsalJTreatment Area Informations ~n ~~Z'= ~(' s ~ --~- -- - ~Design Ftow (gpd) sign Soil Applicari~Rate(gpdst} spersal Area Requtred (sf} rDispersal Ar Pr sed -stem Elevation ' 3 ~0~ ~ ~ ~u~7 71 • 9~i ~6 VI T ~ j . ank Itifu Capari[y in Total Nu r~ Manufaetuet Pre Site Steel Fiber plastic !I Gallons Gallons of nits i Concre ( Constructed ~ Glass New Existing ~ Tanks Tanks j 'Septic or Holding Tank ~ ~~ l ~+ / ~ f~ ~`GS'C Y ~ f Aerobic Treatntetu Unit ~ ~ ~ ~ ~ ~ ~--- -"-- iii (~f -- ~e v ~ - Dosing Chamber ^ ~D~ ~ / ,~• VII.-Responsibility Statement- I, thB undersi ed, assume responsihiUty for irls gatlott of the POWTS shown on the: attache tans. i ~ i Plumber's Na me (Print) Plumber'. Si gnature MPRS ]\umber Business Phon umber ~ Plumber's Addre ss (Stree ty t Ci State, Zip C ) _, ~ 2 ~ VIII. `stmt /De artment Use Onl - Approved _ Sanitary Permit Pee (includes GrUUndwatcr Dace Issued ^ Disapproved Surcharge Fee) ~ ~~ ~~ ~ ~ ~ D ^ Owner Given Reason ar Denial _ _ ~ Iss ~ ge Sin re ( m s g p ~ ~ IX. Conditions of ApprovallReason for isapprovat ~y~ , e A ~ ~ ~d?,~, ,SYSTEM OWNER: ~/~'' A ~ A U Septic tank, effluent filter and ~/ ~ ~.~~ /V( 1L' ~~~ f~l~yj G~ 'fjyylo ed /maintained `J `"`'~ rvi ll b t ~ e se c a , tspersal cel- mus 5 d- ~ s~ ~~ C~ • as er mono ement plan provided by plumber. ~~~~jj '' ~' r~ ,~0 7~.Ut~2 C~ ~~ 2. All setback regwremenfs musfse m'arn ~ S~,{J-->d /1~~ ~ "~ as per applicable code/ordinances. ~ ~~~ Glis'l~~~ ~'"'~`~ •~~u~t , ~ AttaCR complete plans tto toe County trtnyl rOr tde systew t,n paper nqt less rhea Sl/z x 11 inches in size" ' ~ `~L J~~~~~ (/ ~ 0 I ~~ i y V ~y/ ~.~ D l~ ~~ /~'~ Q/r <0 ~~~/ ,e ~'~ ~~ ~~ ~ `~' ~{,~ Q~, ~/r ~s ~~ Bl ~. LD ~ 5'~v S ~ 1r a'r. ` `~ ~ sy wC w/ ~ ~~- ~ soy -~ s~~r w ~ tr ~bk a~~a~ ~~ ~.~~~~c.u~~ ~'o ~67~J l1YL 561 ~ 12Q~01~ ~t~e ~'~h U ~~~~. ~~ ~r~Sc 5; T~ S'C L' :,v. 6~ ~'~r; ~ ~, ~~ ~ ~_.~ x q2 Tr~~~.s ~3 ~~ `~ ~ 'l~~- ~a,1s-a~ ~~~ ~~~ ~ '~~ rD l v~soo sin Department orcommerce - SOIL EVALUATION REPORT . oaf safety and Buildings Page I ate t M aoooraance wrm wmm esa, ~. ,~,...~ ~y ' 81/2 t m s c ro ~ us x ~ n~. Attach complete site plan on paper not less than indude, but not gir-i~d to: vertical and twdzflntat percentslope, scale ordimensions, north arrow, a t p , t (SM), d' and ' ' and distarroe to rfesrest road. Parcel I.D.. . ` U2 U - 3 ~ S _ ~~ Please print ail i aBOQt~~+ ~ , ~'~, l • Y Date ~, Persorud ~tormation you provide may be used tar `1~r~vaaY . s.15.04T4~ (m)).. Puficaes GG~YI~-:~ l °~ ~ d Pam' C"'n~ ~_ c~-~ s ,~ ~,~ I~ 2 ~ '~,~ Qroperty 4ocation . ~ ~/~ , T CRUX,., Go~R. L-otE /l/F 1/4 SGv 1/4 SZ,S' T Z ~/' N R /c/ E (or~N . S Property owners Maim, Addrdss j ~, ~oui~ l_ot ~; Block # Subd. Name ~ CSMir: Co ~ Z.O S-~ ~ ~ ~ wa-E-e r~ •~ . ~. 4NGO~Fi, y~~~ s e t ' State Zip Code Ph -.._,_ _,--: ~'~ s• _,, ity ~ Y~lage (,~ Town Nean3st Road sr ilw«. ,~~.~ / ® New Construction Use: ® Residential / Number of bedrooms _3 - ~f Code derived design flow ra6e DSO ~~ O O GPD ^ Replacement p Public or commeraal - Describe: Parent material OU {-c.,~.rCt,$ (,~ Flood Plain elevation if appCK:able Q'G • ~ R General comments 5 ~ S ~ rr1, e_ (e Jc~.f,b n - f o 4' 9 Z~ so G o~" -¢r 9~ GO' 1 t~ ! 4` ~3 and recommendations: ~ ~ ~, 0. .b r~ - ¢o~ Q' /. J' O G'° ``' `. `~ ,1 ~t.'~ I S V~o~-~-e- ,,Q YYI Z ~ffi~ i.....J.n. n.! ~ oA , n Boring ~ - .,.,,,, • ~ - lf' ~ (~ Boring # i:pr Pit Ground surface elev. ~~' ~ ~ ft Depth b limiting factor ~ 1 ~ in. Sal ' n Rafe Horizon De th Dominant Color Redox Description Texture Strudcrre Consistence Boundary Roots GP D/fP p , in. Mansell clu. Sz. Cunt Color Gr. Sz. Sh. •E~ •C'~ ~ U-1`F l 3 3 --. Sit k >r~r^ LS I v .~ . 5 •$ !vl CST Name {Please Pri{it) ignature CST Nurr>ber e.r 2 pdd~ Date Evaluation Conducted Telephone Number 2113 ~~'-' ~ • ~m r ~ e-~ ~. ~ 1 ~ ~02~ ~ l `- ~/ `lid - 2 y 7- yDD ®Pit Ground surfaoa elev. q_~R Depth to Igniting factor l l5 in. Sol ' n Rats Horizon Depth Dominant Cobr Redox Description Texuun: Stnu~ire Consistence Boundary Roots GP D/fl? in. Mansell Qu. Sz. Coot rotor Gr. Sz. Sh. - 'Eff#'I •EB#2 1 0-1 I 3 ~-- 2 r c 5 (v~ . 5 • .8 2 1 -yp ~-- Sit 2ma~k r c - ,8 i g~f~' 1~- S ~ ~, * EfN~rrt #1 =SOD > 30 < 220 ma/L and TSS >30 < 1 50 mdL ' FJpuent #2 = BOD< < 30 mg/L and TSS < 30 mglL + r a , r Properly Owner I~.r ~~ l Parcel l~ # OZC3-.l 3 ~f .~ ~ ~{S=(~ U page Z of ~_ a Bonng # ~ ~~ ® Pit Ground surface elev. ~~ft Depth to !'muting iacfia' ~ 1 ~n in• Soil lication Rate Horizon Depth Dominant Color Redox Desaiptbn Texture Structure Consistence Boundary Roots GPDIif! in. Mansell t2u. Sz. Cunt Color Gr. Sz. Sh: "EIf#'I "Eff#2 .. 2- -I D mS s m1 ~ ~ .~ / 2 p. _ 7 .2 `' .. o Z' _ _ _ ~~ # (J Boring ^ pit Ground surface elev. ft. Depth bo limiting facxor in. ~~ it~tion Rate Horizon Depth Dominant Cobr Redox Description . Texture Slructrxe Consistence Boundary Roots GPD/fr? in. Mansell ~ Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~~ # ^ Bonng ^ Pit Ground surface elev. ft .Depth tQ limiting factor in. Soil lication Rate Horizon Depth Dominant Cob ~ Redox Desaiptbn Texture Strudure Consistence Boundary Roots GP D/f~ in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 "E1T#2 " EfBuerrt #1 -- RODS > 30 ~ 220 mg/! and TSS >30 _< i50 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. SBD-5330 (ROT/00) t• ~. PAGE ~ OF~_ NAME f~ r K.e, ~ ~ LOT# ySLEGAL DESCRIPTION,u G ~~4SW'~4~5 zs-T ~ N R~Q E (or)~ SCALE: 1"= ~U 1 - - BM I ELEVATION ~(>O_ d BM 1 DESCRII'TION ~a ~ o -~ ~~ D u L P~ P '~ BM 2 ELEVATION 9 ~r ~/ CJ BM 2 DESCRIPTION n .L~PV'r ~.'Pt 5YSTEMELEVATION ~P yZ•S°Go,..rer R~•ao ALTERNATE ELEVATION +op 9h Sy G,ows Y90-~ CONTOUR ELEVATION ~'h'•!o a 9G 'Ca ~ l X ~" ~ ~ ",'.~l ~~ 1~.1Y~ ~b~. o N ec.. zS ~o ~ ~~~ "ti~~~r ~(..la 6 ~-~aJ Q~ O~~ pi°P I~ / ~ i0. ~rtoQG J' g.2 ~ ~f. ~~' '~~ ~e, ,~~ ~MaK -6~-- - ~' S"T CROIX COUNTY SEP'T'IC 'TANK MAINTENANCE AGP.EEIviENT AND OWNERSHIP CERTIFICATION FORM Owner/IIuyer Mailing Address L~~}AJ~~'YI~i2 S`~ ~ l~ 7a~Q rtru.~'t 13~i1 ~ ~i..:T~ STItE13'~ ~I~F~'1~, LAKE ELMO, MN 55042 Property Address ~ 3 3 ~~~ L ~i1~G~ ~,~ (Verification rcquirrd from Planning Dcpartrncnt for acw construction) ~ CityJState WISCONSIN Parczl Identification Number -~ l~~y-/39~~~ I<,FGAL ~ESCRIPTIQN t (.z~39~ Property Locatiaa ~_ 1+, ~ /A, Scc. 2~. T~td-R ~~ W, Town of ~~°~~.sd Stibdivisian SCENIC HILLS , I,ot # __.G.~ Cerfrfied Sarvey Map # .Volume .Page # ~- X33 ~`7 Z 53~ . ~Z~a~~°~ Wz<rraxiy )~ ~ . Va1~e ~ ~ „> lags # Spec hanse ^ yes I~ na I.ot Imes ideniifiablc ~ yes ^ no S`~S~M ~AII~II'~'ENAI~ICE . 1mlx~Oprsuse sad ttramtcaancx of your septic system could x+csult is its gtzasatmiGfailure to handle wasLcs. Pnopcr>s~tcaaacx consists of peaking out the septic taa>; every time years or sooner, if needed by a Iiceased pumper. What you put into the systean. sera tzffoet the function of thG septic tnalc s$ si treatment mge is Syc,vute d'LSPasa1 system. Tha pnopecty avcnca[ tgtzes to cahmit to St. Ckou Zoning Departmtut i cezttificntiaa foam, sigacd Esy the asenrr. and by z ~upltnntier, lattmcymaa phrmber; resoricbod plumber or:licensed pumper verifying that (1) the on-site wastcwatcrdisposal system is is Pte' operating eonditiou and/or (2) a_+4er inspoctioa and pnmpuzg.(if accessary), the ttrptictanlt is less than 1/3 full of sludge. I/w~e,, five tarddtsigned hive read the above rtagviremeats sad agrx to maintain the private sewage disposal system wi`tlz the staadanis act fottb, hcxsia, asset 6y the Departrneat of Commcne and tiu Ikpartnneat of Natural Rrsouxras; State of Wiscansin_ Certification stating that your septic system has boen maintained must be compldcd and returned to the St Cmiz County Zoning Office within. 30 days o ~he throe year do date. ~' ~~/ ~J 1 IGAIA CANT DATE OWNER CE1rtTTFICATIiUN I (we) ctitify that all statements an this form are true to the best of my {our) Ioaowledge. 1 (we) am {arti) the owa~(s) of the property descrx hove, by virtue of a wartauty decd rocorded in itegistcr of Dcads Office. SI TUR.E APPL:TC.ANT DATE ss«.as ~, information that is mis-rtpreseatcdtnny result in the sanitary pctrnit being revolted by fire Zoning Dcpaztnseat. ss.... " Include wlth tlsls apptirxtion: a atattipcd warranty decd from the Register of Dods offict' a aspy of the certified survey map if rtfercnce is tzrade in the warn.nty deed tl, 2720P 535 STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number I wARItANTY DEED THIS DEED, made between Carriage Homes XXI, lnc., a Minnesota Corporation Grantor, and Landmark, Inc., a Minnesota Corporation Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A 783357 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 12/27!2004 09:i5AM WARRANTY DEED l:i(t~iRT ~ REC FEE : 13.0@ TRANS FEE: 251.7@ COPY FE£: CC FEE: PAGES: 2 Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 .tti 2~16~.2R Together with all appurtenant rights, title and interests. 020-1395-45-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 16th day~of December 2004. Carriag omes XG~G/• c. * Kellei St. Marlin, Vice President AUTHENTICATION Signature(s) authenticated this 1 6th day of December, 2004 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Larry Mountain Attorney 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 {Signatures may be authenticated or acknowledged. Both are not necessary) *Names of persons signing in any capacity must be typed or printed below their signature ACKNOWLEDGMENT STATE OF Minnesota ) WASHINGTON COUNTY. ) ss. Personally came before me this 16th day of December, 2004 the above named Kellei St. Martin, Vice President of Carriage Homes XXI, Inc. a Minnesota Corporation to me known to be the person(s) who executed the foregoing instrumentl~d ~acgkn/'owle ed the ame. Y I'IVYI(NI r ~~ --- *Nanc J. ntz Notary Public, State o Minn sota My commissson is germane t. (If not, state expiration date: WARRANTY DEED STATE BAR OF WISCONSIN • MnM~v~nrr~n.w'.nv/.rvnr.~.~nnMV~nrm,~• ~;ANG~' .I. LENTZ ~-. ?,^?AR1' Ptl3! ii,'-MItdN~SOTA ~'~ My Comm c:~ mre~. Jan 31, 2005 1~ 4~ .~, 2~2oP sss EXHIBIT A Lot 45, Scenic Hills, St. Croix County, Wisconsin. A ~'~ f • t. - ~ t ~ .` •~r / • • ' ... • , .~ ~ ~ ~•'~ ~ .• ~ • / :. . . f .• ~LV ' ~~~ ., ~ ~ ~ ~+ B /1~~' • ' p, ~"" o~ ~+ I j PR _~~ ~, ~~ - J - . ~. .., _ ~ ~ ~ ;~ ~ - ~ ~- • ~' Lam' ~ ., . - 1 ~O~ ~ r \J ~ ~~ f%9Piz3f ?w~ ~' ~"r C s y .. • S. ~~^ ~G.~6 _`~ t _^~,, ~ ~~ ~ ~' L ~ ~ ~ ~ ~~- ~~ ~. ~ ~ . d ~ ~ r'"~ ~ 4 ~ i ~. ~ 1 ~ •- ,~ --' ~ ti ~ '. ~~ r ~ 1 ~~ A `.. ~ ~ ~ 1 ` ' . ~\ ~ ~ ~ ~_ ~~,~.,~; _~~ , ,-- . .` ~~~ ~` ' , ~ 7 r \` x '. i ~ `~ ~ ~ ~ ~ ~ ~ ~ ~ ' '~, ~ ~ ~ !~ ~. ~ ~~ a ~ ~ i ~ ~ m .. . ~ ~ ~~ ~ ~ Y. ` , ~ r i 3 ..... ~ ~;' . L, = Ut3rc~s-,~ Enka .wror ,oa ...r~~ _ _; ~.._ i '~ Ca `. .., `~ `'` ~ ~ ..._ . _~_ ~ ~a. nsir Department of s~ommrs-ce PRIVATE SEWAGE SYSTEM Safety end Building Divisidn INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Ho{der's Name: City Village X Township Carria a Homes Inc. Hudson Towns CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMA' TYPE MA UFACTURER CAPACITY Septic Dosing Aeration Holding ~ r TANK S ETBACK IN FORMATI ON TANK TO P/L WELL BLDG. Vent t it I ake ROAD Septic Dosirtg Aeration Holding 'ATION DATA STATION BS H{ FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. /~ PUMP/SIPHON INFORMATION Manufacturer Dema GPM. ITDH Lift (Friction Loss IS~stem Head ITDH Ft Forcemain Length Dim Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P1L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of Syste UNIT Model Number: DISTRIBUTION SYy9'TEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER / x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes ~ No ~ Ves ~ No COMMENT (Include code discrepencies, persons present, etc.) Inspection #1: / /_ Location: 7 .gal Ridge Hudson, WI 54016 (NE 1/4 SW 1/4 25 T29N R19W) Scenic Hills Lot 45 1.) Alt BM D ription = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ~ ~~ Yes ~ No ~ Use other side for additional information. I_.__ i __ __ i ~ . _ .__ _ _ ____ __ -- __ - SBD-6710 (R.3/97) Date Insepctor's Signature Inspection #2: i ! Parcel No: 25.29.19.2439 ~~ _l Cert. No. (,tom C Sai'ety and Buildings Division County 201 W. Washington Ave., P.U. Box 7(182 ST. CROIX ,~~o~~l~ Rrfadiutil, W 153707 - 7{}82 Sanitary Permit Number {to be filled in by Co.) ~608)261~54ti ll~ Department of Dommerce - Sanitary Pelrm>it lipplicatl®>r~ i State Plan I.D. Number ,/ In aoand with Comm R3.2I, Wis. Adm Cock, tr4-rsarral iaifcxntatiom, you provide r may he uS~ett fitr ~'!' Plvposrs Privacy Law, s 15.04(1 }(my Project Address.ttf diH~eret~t than mailing address) --- 73~'REGAL RIDGE L Application Information- Picttsc P t AlI Infir'rma ' „-,, -- -~. .,.~ Pnapc~riy ttwaa~r's Nana: Parwl ~ Lot # 45 Brock # CARRIAGE HOMES, INC. D f y u d ' Z -- / - ____ l ti ~ s Mailing Adikesx s i'topc~rty tJtrixx Property oca on ' Z~~~ 6720 STILLWATER BLVD. - ~ ~ NE ~,~ SW ,,<, se~;~~~ 25 __ Csty, State Zip C 7~ ~ -, - STILLWATER MN 5508 _ 651-439-2414 29 19~~~1 e of 8ailding (check al! that apply) ' II Ty . p 5 PER,SUB . ITTED HOUSE PLAN ill or2F.vnilyDw~lling Nuol'I SutxlivisionNattme CSlkt.rnmt+er . ISGc«nn~r~i~l _ r~rilx r:,~ t iJ t~ SCENIC HILLS , „ J~cS~• ~u~ ~~~~ r ^ CDvitlai!e (~)v-,~~~ HUDSON sx~ow„~+ r;~t ~__ III. T ype of Permit: (Check only one boa ott litre A. Complete li B if ap¢licabk~~ ---- -- -- - - '~. ~~yy Nr,+~ c„~e.., LA ~_ - ~ R.eplac^~nent Sysl~n ~/ ^ TrnahttettUttuldittt,'Cank Replacaartent CA+ty ~~ Modifieatiort to Exi • ~. l~ P~rtnit Renewal BKturc Etgriratino ^ Permit Revision ^ CAange of Phur~r ~~j c[rnit Tran!ffer to New t~ ~ tt a - IY. T of POWTS S ten: Check all that a __ i b ` { tJ`Ncm -Pressurized In-Cirvuted U ,Lfaind_ 24 is ol'suitahle srnil I~ owtd < 2~1 irL o itable soil ^ At-Grade I~ Single Pass Sam Filnx f ... ~ wJ'a~rt~; S:+x:u1 Filter CctnSlRkCiilt WCtlan(t ^ Pres~rizcxi Itl-Ciramd LI Huldir~ Tank l~ F'cat Pii6a l._I A , ce}rie TkeatrewaNtlnii 3 R eciratlating Sytttl-FAic Medsa Ether [~ l.eachiug Chamber ~J Dri ~I ine _ ^ Gt-avel-lase 1i - ^ Chtu9' (expt } f l n - Y. I}is rsal/Tesettineat Arra infnrmstiotr . - ----- Design Flow {gpd} Ihytign Suil Applicatiau, Rnte{gpdefl 1 Area R~,ired {ct) '.. 1 AmaPn,t,rroeect {xi) .' 0 ILTER 92 . 750 .7 1071 ld ~ __ __-- .____ _ - Prefab e S Filter 1?lttstlc VI. Tank Info Capacity in Tout Np(trt+cr Matiitfae4urer ` ~ \ Gonad Ca~lnrcl«i C~iass i CraBons _ (;atkms ~tinies ~ ~ New EIIlsi111Q ° , Tanks Tacdcs _ 'e~mii°'`''~~$"~ X 1565i` 1 WIESER ~ YES ~ ,4erssbic']Yualmenl tint! ~ ~ i2~ ~~N"'~`- ~ ~ ~~ , ~'""^Y~' X ~ 000 1 IESER YES VII. ResponSlbiillly Stattemlrot^ I, the emldersegned, use®ec respwfailuYAy for dlsnla of Wa FQWf \ shanva mn tkc attached phaax. - Flut,elner's Name (Print} Pliyfmber' atu - - ~IMPitS Nu cz \ ~t~+i~~a I'~c ~~+~*~~ ~ TODD FEATHERSTON ,~ 242514 _ ----- 715-381-1704 Ptuentter's Elddress (Street, City, State, 'Lip udcl \ PO OX 467 HUD~ON, WI 54016 VI aunt 1De artment iTse Onl .~r~~~ ~ llisapproved ~rta~ Feat ~ee~a~ `~~ 3w~l,mgc. Fcc) .. ~ ~ ' `~'~ ` __ ^ Owner Given Reasnte for Iktnia! _. _ __-. _ - --- -- - _ ~~ Conditio s of Ap~-rovtallReaspns for Aisattp~wewtl 3 ~ ~~ SyS,~jy' y I~ GT~}~jyj ~ ~~ ~ GZ~Cc_ - l~/-P~-~ -~ YSTEM OW NEF2: _ ~ r. , Septic tank, effluen fit er and- ~~ ~~~'G~t'~ Gl~-~ ~J~ 3 dispersal cell must all be serviced maintained ~I ~~ ~ Pt/G~~ as per lumber. h~~,UQ_ ~{~f~Yt~v / ~ ...~ setback requirements must be maintained ~,/~~~ ~ ~~~ `~~,u~ L ~ C.U -- as per applicable code/ordinances L~ ~ ~ /~ - / :-ttach aa~,, "te ~rf/~eu (u dK c/.u.tr ~l~t~!lte system .® t~ ~}JJ i >< aAes m star ~ I (~(.l'.C liYtG%Y>7t.~.t.0~2~ ~IG~Gt~ '~ ~.2 ~(Y"~ ~/Y' GC_X// (.i°I~.!_1`/ ~ijt ~ fJ - 1 L-d~~~4/ SAS-~P~-i .~~~~Z-o~.., --~' ~0 ~ 9 ~ ,r~Z~9s' c~,~~ v~ ~/ ~, ~`~ © ~- ~~k ,~ _____. ''~- 1~ t. :'. t i ~ ._ t, i t ~ _ • ~~• I - ' ,~ • s~ •+ ~ • ~ 1 y • t ~ i. ~ • ~ , ~ _ ' ~ . ~ • ~ ~ ~ ~ - ~ ~''`~~ r ~ . ' ~R ~,~s~ _~~ . _ ~ ~~ $~ ., z ~_~ _- - .,~, ,~ ._ e~ ~ e ~~ - ,, ~ - - Lol' - ~ N ~ ~,,I ~ ~ - . 1 o .~ _ro•,' _ i / w ~ -- G~? fd /~ ~'/e /off t~ _ fo D. 9?y ,~'c.- d.~ ~ ,~ . /~ P~ !° ~.~.~ / _ ~- - I . .~ ~ ~ - • ^~~ SYSTEM CROSS SECTION LIFESTYLE HOMES -LOT 45 MAN HOLE ~, GRADE 96.60 INSPECTION PIPE E- ZABEL FILTER 1565 GALS 112.50 & 106.25 SYSTEM LEV. 92.0 ,// s (c ~~~ U~ ~',e.~2:~--~ S' 18 BIO DEFUSER CRAM ER ~ 112.50&106.25_ __ o ~' 1000GALS o P1I3 ~ NE '/. SW +/4,S 25 T 29 -+-,~ 19V E ~T45 g~,~ ~gSCENIC HILLS Ci ^ ~ nwovi~ - ter, _i / ~~ ~S'iiii i+i2514 ~~~~12!09-%03 TLTE f5:03 FAQ 715 388 4686 ~ ~ ~ ~ ST CR% p'p ZONING f~J001 rAr..t -~ GI" F~N~P CHAMBER CROSS ~EC7lOrJ ANG SPECtFICpTftMJS vet~T cAP H'~C.T. vLAJT PIpC ~_ ~ wCarHSRPROO~ n-rrcovEa LaLK!h:C. } ~ JllGlCTf03~1 BOX MAIJHQt-F' CpVEC` Zg' FRor1 DOOR, ! W~NtiOW pR FRESN !2"Mlu. AIR IIJTAKE 1 GRADE ' 1 Y~ MIAI, I ~__ # to°nlu. co,~nws~T SE°Mrr~_ ~ ___-----' - -- ~- ~~~ -- - ~ ~ tIJLET PRC>~+DE ~ 1 ~_ _~._ ~`~' 1~lRTIGH'T' `s£A~ t ,`~ f ! * ,r A ~ ~ ~ ~ ~ ! ~ A!_ARM ~ I D ~ 0 *APPROYED ~ ~ ou JOINTS N1TN t 1 ELEV. F7. ~"'~` flPPROY£0 PIPE t 3' ONTO PUMP --._,. - _ l ,~ " OFF o sO~ID san caucRCrE atocK RS$ER EXST PCRMI'iPEA OIJ4y IF TAAJf( MANUFAGTL?F~ER HAS SUGH APPROVAL ` SEPTIC E ~PEG1~tGA1'tOt~lS TAGIt{S MAIJUFACTLIRERJ: ~`~~~~" ) ~JIlMBER OF DoSSS: PER OAy TAS.tK SIZE; 9~ G;1~-•1~ C~ALl..0A15 D05F VOLUME A!-AltN1 M1tA3UFACTURCR: -~~- 11UCLUDI/JG SAGKFI.OW: °'~ ~ 4A3_~otJ! Mt~QEL -JUN1f5CR: ~~~ CAPACITIES: A=~_WCHL58R C.A41.01J5 SWITCH TyP[: Gds b- °~ Ik{GN£SOk _ GAILOtJS ITU!'hP KASSk1FgtTLIR£k: f~ ~,~ C~WLHfS OR fiAL~O-Jf 1 MOdEL -JUMOER: r,~.,~,a p a _,•_~S/SC4iES OR GAlLDA1E i SWITCH TypE: AIOTL: PLiMrP ANA ALARM ARE TO 6L ' !"UAIIMUM DISGMARGE BATE - C5 GPM iNSTACLSp Oi~J SEPAAAT>< CIRCUITS ! t{EitTICAL D1FFE1LEi.1£F bET W4CS1 P111RP OFF 'CI01.1 QlP6., ~ FEET / - `6~ ~1~ -1- MI//Ai1MUM RIETWbRK SUPPt.y PREdS RE , ~ ~ ~ ~ z•5 FE.ET~ 2((/ r /-'v/~Y3 r'OSS ,} 6S ~ FEET Of= FOR4E I'MttJ X ,~ 7 F/16DFC;K1GT64-i fACT'OR- F£E'Y I Z dddh~~~~ T~1~~~ Q,~~~YI- -- Y A!. tJAMIC HEAD = FEET n ~j bcj ~n~ i ~{ Q ,~ ~~ ,~ I/JTER~.fAs, DIME}.ISSb-J4 OF TANK: 1.EAIGTH ~V ;WIDTH ~~'~..._~.jtrlQUtO L~CPY41~-~ ~~~~ j St6lJEO: L1CEtJ5S A1UM8ER. PATE: ~O -vy i PUMP PERFORMANCE CURVE ~s r- ~ ~ PUMEFFLUENM ODELSURVE 3/8",1/2" 8 3/4" SOLID PASSING CAPACITY PUMP PERFORMANCE CURVE SUMP /EFFLUENT I " " " 42 3/8 & 314 ,112 SOLIDS PASSING CAPACIT q 1 191 MODEL Feet Meters 48 Gal. Liters 53!55 57159 Gal. Liters 72 Gal. Liters 76 Gal. Liters 98 Gal, Lters 1371139 Gel. LHers 140/4140 Gai. Liters 151 Gat. Liters t2 5 1.5 29 110 43 163 38 144 50 189 72 273 93 352 86 326 50 189 10 3.1 22 83 34 129 30 114 40 151 61 231 79 299 80 303 45 170 t 15 4.6 10 38 19 72 14 53 30 114 45 170 64 242 73 276 38 144 t86 20 6.1 - - - - - 17 64 25 95 36 136 86 250 29 110 11 4186 25 7.6 - - - - - - - - - - 8 30 59 223 16 61 30 9.1 - - - - - - - - 49 185 - 1 t 40 12.2 - - - - - - - - - - - - 28 106 - - 50 15. - - - - - - - 1 60 18.3 - - - - - - - - - - - - - _ - - 70 21.3 - - - - - - - , 60 2a.a - - - - - - - - - _ - - - - - - 9o zl.a - - - - - - - - - - - - - - 100 30.5 - - - - - - - - - - - - - - 110 33.5 - - - - - - - - - _ - 120 36.6 - - - - - - - - - - - _ - - 130 39.6 _ Sh uto ft H ead: 18 ft. 5.5 m 19.2 5 ft . 5 .9m 18 ft. 5.5m 25 ft. 7 .6m 23 ft. .Om 26 ft. .9m 50 ft. 1 5.2m 30 ft. 9.1 m 2 7 165 4165 22 7 ~83 163 16114161 16314163 16514165 18514185 18614186 18814186 Gal. Liters Gel. Liters Gal. Liters Gal. Liters Gal. Liters Gal Liters 100 379 61 231 61 23t - 58 220 . 145 549 1 93 352 61 231 6t 231 - - 56 220 140 530 1 1 4661 4189 85 322 60 227 61 231 - - 58 220 134 507 1 79 299 59 223 60 227 58 220 128 484 1 1 140 70 265 57 216 59 223 - - 58 220 122 462 1 62 235 55 206 58 220 85 322 58 220 116 439 1 188 45 170 46 172 55 ZO6 _ 70 285 58 220 104 394 1 I 4 4188 20 76 33 125 50 189 51 193 58 220 90 341 ! 15 57 39 148 32 121 58 220 71 269 I - - - 23 87 9 34 52 197 51 193 ! I 152 - - - 10 38 - - 45 170 26 106 153 31 117 2 8 I - - - - - - - - 18 80 - - 151 - - 4 15 - - 1&5 - - - - - - - - - - - 2 4185 - - - - - - - - - - - - 56 ft. 17.1m 66 ft. 20.1 m) 89 R. 26.4m 73 ft 22.3m 114 R. 34.7m 91 ft.( 27.7m 98 1 0099228 4 1 2 A CAUTION Model 185/4185 should not be subject( u s ' 3,55 ~~~ 76 137 13s to less than 30 feet TDH. NOTE: For Pump Pertormance on Model 112, Industrial c< ~ ~ to 2 0 3 0 4o s o 6 0 7o eo 90 1 11 0 1 1 14 0 15 o umn ex losion roof um ,see FM0219. ~~ 0 BO 180 240 320 400 460 580 FLOW PER MINUTE 0099~p W , U ~ SEWAGE AND MODEL 2 11 2 64 2 66 267 268 270f4270 282f 4282 284f 4264 292/ 4292 293 Feet Meters Cal. Uten Col. Liters Gal. Uten Gal. Uten Gol. Utah Gal. titers Col. Ulan Gol. Litan Cal. Liters Gol. 5 1.S 82 JIO 9o J41 ,28 484 128 484 128 ,a, I}T 500 127 481 179 976 110 530 - D EWATE R I N G 10 3.0 53 201 60 227 89 J}7 89 337 89 JJ7 101 J82 98 }BJ 157 594 124 469 = BD 15 4.8 JT 1T1 23 B5 50 189 50 189 50 189 77 291 64 242 1JJ 503 108 409 118 20 8.1 -- -- -- -- 10 JB 10 b f 0 JB 58 212 N 129 106 401 91 344 IOB 25 7.6 -- -- -- -- -- -- -- -- -- -- 2D 110 6 T3 7J T78 75 284 96 75 30 9.1 __ __ __ __ __ __ __ __ __ __ __ __ __ __ 42 159 56 112 82 35 19.7 -- -- -- -- -- -- -- -- -- -- -- -- - - 33 125 85 40 12.2 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 10 3B 4B 7D 50 15.2 __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ 60 18.3 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 70 TI.J __ __ __ __ __ 55 Shut-oH bead: 19.5 N . 5.9m 18 ft. 5.5m 2,.5 f t B.tSm T1.S K. B.Bm 21.5 fl. B.t1m z9 f1. B.Bm 26 a. 7.9m JS K. 10.7m 12 a. ,2.8m 5o Il }0 i5 From: To: PAM QUINN Date: 5!612004 Time: 2:25:04 PM Paye 2 of 3 ~. r - ~~ R. ^ ~'~ ~ ~ • ~ • ~ ~ •_ ++ . VVffrr • , ~ 1 ~~ -- ~ ~ ~ ~ ~ • ~ .. ~ l t, . • f .,~ ~ _ .. _ . t, ® e6 ~ ~~' . 1 ~,,~ ~ . ~ ~ ~- PRo . - ,~~ ~ /~ • _ ~ ,, . f ~ ~ ,. ~ ~ ~:~ , . ! 3° _ _ ~. . . 9G~ o ~ _ ~"~ . B-~ '~ ~ ~ ~ ~ `~ =moo ~ ~ .. -~~- - I y N~j~ ~~ v Ti~P osl ~ ~G ~ . i Y, • ` Y .... - .,~oa.'. From: To: PAM QUINN Date: 5/6/2004 Time: 2:25:04 PM Page 3 of 3 .. . _ - . _: ~ ~ _ . ,~ t ~• '~ 1. _. ::~ ~ .. • ' . z 1 ~ f .~•~ ` .. . _ ` -• _•. ~ ~~ use ~ ~ _~ ~o _ ~ .-.. ~-a .a ~ . _ .~' .. - .. / . ~ .,~ ~,-r- . ~~ . _ ~~ ~' :, ; .. , Gam. ~-' p " ~~~ ~ ~~ o .,~~ ~ • 9 1 ~~ ., ~, y _ r _~ _ ~ ~ _,~ 'f''. ds ~ V N _ ~D _' ~ ~ ~ ~~ ~ r i Ti/ ~/fit ~ ~ ; - ~ ~~ .~ ,- _ ,. ~' . ., . S. ~~ w+_--~~ / r~ ' APR-r6-2002 07 05 - •~ P'J~i05 p l 4t\V ~~ V V v~'a a• `~ SBP"TCC 'LANK ~KA.Ad'T~IANC~ AaBP.~Mf~'I' AND ' QWN~RSI~' C~tTIFIC~A't`ION FARM Qp~~3uycQ - ~~ !~ 7S'o 5 ~r~ s ~,. ~"5'v'a~. ~~~ 733 REGAL RIDGE (y~ificatioa rc4talt+od ~ Plauaiag ~ ~ saav oaortfuctloa)~ _ C~tylSt~ta ~~ $ c' Parcel Idelttifsc~tion Numbs U 2 ©` ~~v ~s,~T~ n~srrxi~tar~ ~,~ ,q„~~.~ c,~,,~-i ~,~ n ~~~. ,~. y3 ~ NE ~/ SW y, Sec, 25 , T 29 N R ~.9_.W, Tuwu of HUDSON PiY jpcauori ,.,._.,,,.. ~ rybdivision SCE` C~rtificd Survey Map # ,~~-.{-/~ - '4i~arrautY Deed # „~c ~ g ~ ° r Spx house ~4 yes no Volume . ~~ # -- ' Volume ~ ~ ~ Z p~.ge # I.ot tines ideati.f~able ~ yes ©no riIC~ tt~ facluie to hatadle Raton. Proper main tse sad oaf S"o~ ~P~ ~m caald result in iks ~~ticraaed Qu7upar. W~ ym+ P~ i°fO ~ ay:x:s cearsista of p~~S oat the septic task erety tierce years or mover' if needed b! can affoct rays ~ ~ ° tam as a aeauncnt stsgc is ~a pasta disposal aysteac. ,~ , a~vna ages to sabtait to Sc. Crohc Zo~B ~ a eerdficsciaa tcsom, sigmt b~- ~ w'~'oee s~ 6y a plaat~ta.]°P~'~Odplt~mbaora ficrosedpm~v~ecifys~~(I~ dio ~~tes~sotal i~ fn ap~~ ca~ttiou s~ ~ ~ °a attd po~+~ttg C~ neoessaty~ ~ taalc is tas tl~aa lI3 sntl crf Uwe, tlao vndeetlgned har+e read du above nrq a~ sbroe to a+smtsin the Ixira~ ° svttb ~ ~t set forth I~CIx-. ~ mtby ~C t of Camanaot sad the Dep~~ of Natal R,esour~oes. ~ of Wisaaasla. Casa ~„g~,t yam ~~ ~~ ul~a.~c ~ ~ yea ~ rbe ~t. ~ ~ ~~a3o ~~ ~ ~ ~ iratioa dato. 04/14/Zp04 . AA'rII - - ~ APPLICANT' 4~{ CL~t'fT'f~TCA.'~.'ION ~ imavrIedge. I (we} am (xre) the oweea(s) of t (~~ ~~, atatas~ts as this form are true tp the beat of my (~? the I'iO by vim of t wtaanty decd roeacded in ItagicGer 4f Ueeds QEfix. ~--° 04/14/2004 '" - pA'f'8 A OF APPLICANT •«.«~. •+•••~ qQ,y irtornmtieat flat is mis.s~etseestntrdmay result in We ranit7iry pcunlt btdn$ nypkCd by th0 ?OttIQ$ ~' •• Iaciude with this apnliCation: t- 6bampod svartanty doed fxom the Register Qf Uescsedi office . s copy of the cectifiad sarvey map if refeieaoe is ttsxde in rho "aransaty deod ,'~ _. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of ? FItE INFORMATION OwnerCARRIAGE HOMES INC Permit # DESIQ~N PARAMETERS Number of Bedrooms 4 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) 750 al(da Design flow (peak), (Estimated x 1.5) 1125 gal/da Soil Application Rate .7 al/day/ft~ Stated Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS! 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) <_30 mglL Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric meant 510" cfuJ100m1 Maximum Effluent Particle Size Ys in die. ^ NA Other: j~NA "Values typical for domestic wastewater and septic tank afffusriR. SYSTEM SPECIFICATIONS Septic Tank Capacity 1565 al ^ NA Septic Tank Manufacturer WIESER ^ NA Effluent Filter Manufactur~~B ^ NA Effluent Filter Mode! Al 0 ^ NA Pump Tank Capacity /Q o o al ^ NA Pump Tank Manufacturer LvjF~-,E~ ^ NA Pump Manufacturer 2®~ LLB ^ NA Pump Model ~ ~ ^ NA Pretreatment Unit ^ Sand/Gravel Fiher ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~~A Dispersal Cell(s) ''LXIn-Ground {gravity} ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ~A Other: ~ NA Other: ~ NA NANCE SCHEDULE MAINTE Service Event Service Frequency Inspect condition of tankis) At least once every: 3 ~ month(s) ~ earls} ^ NA Pump out contents of tank(si When combined sludge and scum equals one-third (Y31 of tank volume O NA Inspect dispersal cattle) At least once every: 3 ~ ea~(s}(s) Y ^ NA ^ month(s) ~ NA Clean effluent filter At least once ever Y= 1 - 2 IS~yearls} Inspect pum um controls & alarm P. P P At lease once eve ry~ ^ month(s) ^ yearls} ~ N~q Flush laterals and pressure test At (east once every: ^ ear(s!(sl Y ^ NA Other: At least once every: ^ month(s) ^ ear(s) NA Other: c~(1dA 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{sl 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 {Y31 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 i 13, Wisconsin Administrative Code. All other services, includ"ing 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 14/011 ':a. Page 2 of 2 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 andlor damage the disperse) cell(s). If high concentrations are detected have the contents of the tankts- removed by a septage servicing operator prior to use. System start up shall not occur when sot! conditions are frozen at the infiltrative surface. During power outages pump tanks may fifl above normal highwater levels. When power is restored the excess wastewater wi)i be discharged to the dispersal cell(si in one large dose, overloading the cellos) 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; dente{ 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 faits 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 shalt be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shat) 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 availab)e a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and at-grade sot) 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 ~ r- 7~ (~/ POWTS MAINTAINER Name FEATH ST Phone 715-381-170 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name PINKY'S Name ST. CROIX COUNTY Phone 651-436-5788 Phone 715-386-468 This document was drafted in compliance with chapter Comm 83.2212)Ib)1l )Id)&(f) and 83.5411), (2} & 13}, Wisconsin Administrative Code. sT Cttc~~x couN'rv _ SEPTIC TANK MAINTENANCE AGi~.EEMENT AND OWNERSHIP CERTiPiCATiON i;OIZIvI Owner/Buyer CARRIAGE HOMES XXI Mailing Address Property Address 12415 55TH STt~EET NORTH, LAKE. ELMO,]_55042 (Verification required from Planning Department for new ~CityJState WISCONSIN ~JFcaL nESCI~rTroiv Property Location %, Parcel Identification N her 6 4 8 6 0 4 ~/.~, Sec. . T -R W, Tawas of _ $U~dIt~ISiati SCENIC HILLS jot ~ _ Ct;rtiGed Sarvey Map # Voittme .Page # 'PVarranty Deed # 6 4 8 6 0 4 Volamc . Page # Spce hoase O yes i~ no I.ot iiaaes ideniifiablo ®yes ^ no ~S" ~'M ~4iAIl'~'I'Ei~iA1+ZLE . Ia~xoper use and nramttnaaa of your file could result is its gccasatttsefailntn to Izaaadle wastes. Proper ~aace consists of paazpiag oat the septic fault every yrars or , if aeaded by a lid pwaper.. What you put into the system . can affect the fimetion of the septic tank as a tmeat stage fire w:stz daslxasal system. Zhe piopezty owns tgzues to to St Ck~oiX tut'a oertificxtioa fotza, sited by flu owner. and lay a a>as6eephtml~er, joaraeymaa pWmbe~ renri ptu:nber or = li,ctased vesifyiag that (1) tl~e on-site wastcwatcrdisposai system is is ptnpcx operating condition and/or (2) ¢Eer inspoction and puciapist. of acccssaty), the scgtictank is less Than 1/3 fail of sludge. u~, the aadezsigraed Invc rtcad the abo requiranents an+d agree m maintain the private acwage disposal system witty ttre staadarLts cet fottb, basin, ss set by the of Coazmcrec and the Department of I~tatural Rcsout+ces, Stata of Wiscoassia. Certification stating that yoar septic sysLe:u has maintained must be croraplded and rctuaa to the St. Cmix County Zoning Office within. 30 days of tlte'thc+¢e year expiration date 'TUBE OF APPI,I DATE I (we) ctttify that all statements on taus form air true to the best of nay {our) {aiowledge. I (eve) am (are) the ov~Ta~{s) of the property descry hove, by virtue of a waitauty deed rocorded in izcgister of l3cecis Office. .1 Z; /7/l~ SI 'TUBE APPI:iCA2~1'T DATE ssssss ~, iaformatioa that is mis-represcatcdmay t~csult in iLc saaltary pctmit being revoicod by the Zoning Dcpastmcnt. """ •• Include with this application: a aiampcd warranty deal from tht Register of Deeds office a copy of L'ae certified survey map if rtferenee is made in the earaxre.nty deed vi'! PAC` Dxumenr Number Docetmmt'IetSe ck r r-c~r~~' ~cc~ f... ^_ . ~; . ~486~4 i%:~T~!! eEN H. Wi~LSH F:~~~3.~~;~t~'~; ©F' E~E~~h s~. crui:~t ,:c., wz h;ELEi+3tD FCR RECORD ~i~RfiaAaT'( DEED ~ EkE~9F~? ~ CEZT CORY FE;:: COPY FEE: T,NNSFE~; FEE: 3?v4.0~a RECtikU?NG ,SEE: 14.44 F'~GEE: ~ x~ata~g :~ Name and Aetara Address 1 qoo ~'~tv ~ r L.~.k < ~~~ J'~.?~~ 1~~~~~n 1 MN sS(!z C~ZO - 1 ~~~ - "70 -- ©~ y ~~ zaeat~aaa x~aber ern) c~ZO- ld~~-~~-~c~o C Z: o - ! t7~`f - ~f D - v a C~ zv _ 1 ~7D - coo ~- ~~ 0 2 0 - 107 O " ~ v ~- c~ a~ L 2v - j e 7~ - zo -~ "TSIS PAGE IS PART OF THIS LEGAL DOCUAiF.NT - DO NOT REMOVE" 'I'hit infotasarioa mutibe tompletod 6y submitter: docxnnou Qrle, rtmrec & rcxrrx addrur, and PfN (ejrtquired). Oafecr ircfarrnation rush ar nc~ jtmuin j Hausa, k;a! dcrcripdon, ete. may be placed an thin fast pane of the daesaneru oror may be placed on additional page of the doeYanatL ore: Urt of thir oo++cr page odds ant pa;e to your doesonatt acrd ~. ()p to the reeoreti,rr fee. Wireonrvi Srancv, 39.517. WiYU.{ 2/5~ ~''~~' I ~ DOCUMENT NO. i. v ". f ____~~_:: _. .~__: ___ THIS INDENTURE Made by RICHARD N. PEARSON and JEAN M. ._ _....__._ ._......_..__..-•-• ......................................County, '~i~i:G2f~~or lthe sum of Wasfiingl=on png_~ollar:- and.. no1100-.-•(~ 1:00}...and., other.-.good.•and-valuable.-.' --------- --------- --------- -•------- -------.. ......... ---.._........I PFrAR.SON, husband and ife, ' grantor. S.. of....St: Craix ........................................................County, Wisconsin, hpreb conveys and warFants to_...CARRIAGE HOMES XXI , INC. , a _ Minn~sota corporation.~ ...................................................................._..~........._-- WARIi.ANTY DIGIDD STATE OF W13CONSIN-FORM 9 TNIB BPAC[ RHeHRVHD iOR RLCOROING DAYA RETURN YO the following tract of land in.__..$ir.:...C~4?:x ................................................County, Wisconsin: -Al.a,..of...iih~..Nor.t:.~w~~,~..Q~artr~.r..,(,~lv~~„)~,..and.._North _lIalf (N~) of the Southwest Quarter (SW 4) of Section 2~aenty-Five (25), Township Twenty~Nine (29) .North, Range Nineteen (19) West, St.-Croix County, Wisconsin, except Lot One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. Ia Witness Whereof the said grantor. S.. haVe..._.. hereunto s~et:......_their-_-,•..-__, hand 5... and seals.... this .................. day of... ~aX.......................------........., A. D., Y~L..2.ROJ- \ ~ ...................... ............................................................(SEAL) BION'~D AND AIDALED fN I'REBiCNCI. OP' - ---..... ...... _ ........................................ ............ ~ ..~~ .....................(SEAL) i M:'~t501V ............................................................................................Y (SEAL ) • ~JJ ' c ~"1 ~ N / ' ~ '~ 1 / ~ `~ z ~, o c~i ~ . cn ~ w ~~ v U t.. cc3 a O O O p 0 0 0 0 0 0 0 0 ~ o00 ~ O O O O •--~ N ~ ~ ~ O O O ~ ~ ~ ~ ~ ~ 0 0 0 0 0 0 O O O 0 0 0 0 0 0 0 0 0 r X -~. , ~ .. Dxument ~lum5et ~a r r~~-~ ~cc~ ~' yi:! .~U~~PAGt~~c7 l4AT~!! EE:N H. WALSH ~:~ ~ ~;;=~ r~~ of ~~~Us s r. c~:~z:~ cG. , WI kEt;E~t~tD FGk kECGk~ wH~fiaM; Y nE~n EXE;~~~T # ~ CEKT CGFY FE: CGF'Y FEE: ?fiMSFER FEE: 99v4.Q4 kEC~l6;-?N FEE; 14. G0 F'~si:ES: 3 Rxacding Area Mane and Reenrn Addrrss i~l -7' ~ -f 1~ ~ ~ n c, . A t goo 5'~(vcr L.~.k< ~~d l~..Ic~..~ !~:-~5~~ ~ MN SSIlz, C?zr1 - 1469 - -70 -- Oo v Putcl Ideatiticaiiorr Nmber G'YN? C~ZO- Id6~f-'~G..v00 d Z o - I v~C`J -~/D - voc, C~ Zv _ ! X70 - c7o - ~~ 020 - 1070 "~v °vvv L 2v - ) o ~7f~ - zo -~ "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DU NOT REMOVE" 'Rut intotmatioa murtbe eompletoQ by ~ubcaitta-; daeumeN ar(~. rye & rctrirn addrus, and PfN (jrrgedred). Od~cr utforn~arrars such ar the jnmcns elausu, 4jaf dvcription, ere. map be pfacc4 on durlfrst pa;r of the docuasast oror may be pfaeed a++ addiriw~al pa;es of dot doctancnt. orc: Use of this court page adds one pale to your doetanent and S2.L10 to tkc recor~)tr fee_ WircoRrin S•-^~-*, 39.517, WAD,{ Z/A~ ~'' ~ ~ DOCUMENT NO. %_ ~~ `f' ~ ~~~ Z( n v (, THIS INDENTURE, Made b RICHARD N. PEARSON and JEAN M . PEARSON, husband and c~ife~ ............................................................... raptor. s .---....... St . -Croix -__ --•- '--.~....... g ... of.... .......................................County, Wisconsin, hpreb conveys and warrants to....CARRIAGE HOMES XXI, INC., a Minn~sota corporation.~..........--•-• ....................................................._~~....... ~.. . _..,__._ _ ..__._.._ ............................................................. ~p rautee-----... of ~ ~V'asfiinghon ~,~i<i2i~~or the sum of~ ......_ .:...................................................................County Qn~_~o~1ar:: and,.nof 100,--($1.00)._.and.-other good-.and, valuable ~ry,~77Q 7 Q a }}.. /-gyp ....... ................... .Y.XlAK~F~?t~HSS~.`l.:i ..... ......... ......... ......... ...................... ......... ............................ II WAItIiANTY DICIDD STATE OF WISCONSIN-FORM 9 TNIB iPACt REiERV[D -OR RECORDING DAYA RETURN TO the following -tract- of land in.....5~.,...C~:Q?:~ ......................................................... .~;_. .County, Wisconsin: .A~,I...QI~...~h~..N9ii.kkiW~S.~..S2u~?.i:~~.r....~N~in~,. and_,.(vgrth.,,~ia1f (N~) of the Southwest Quarter (5W~a) of Section ~venty-Five (25) , `T'ownship Twenty~Nine (29} .North, Range Nineteen (19) West, St. Croix County, Wisconsin, except Ipt One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as' Document No. 518444. . In Wetness Whereof the said ran or. S.. haVe...... hereunto set ........their.,..... ,_ hand 5... and seals.... this ......._ ................... day of... ~aY............g.....t..............., A. D., Y~..2~Q0~. ...................... ..................................................... ....... (SEAL) BIaNIflD AND BIDALED IN PREBRNCI. OP' ..._ ....................................._.......................................................... ....~ .....................(SEAL) ~. , . ~ _ Yh I 0 0 0 0 0 0 N N N tJ CJ tJ O O O O O O i i i i i~ ~. ... ,_„ 0 0 0 0 0 0 ~J J J ~ Ol ~ O O p ~D ~ ~ ~ ~ ~ ~ ~ i 0 0 0 0 0 E 0 0 0 O O O 0 0 0 0 0 0 0 0 0 0 0 0 b W h n ti GL C ~. ~ ~ f""y' ~ ,A r C:JS w . ~ I`~ ro :~ '~ 1~ ~ ti ti t 4 ~`. ~. DOCt7MENT NQ. f Q ~ ~+ O o .; ~• ._- __ i ~,.__~_...-_ ._ ~~ llVDEATI'CTR,E, Made b RICHARD N_ . p91AR.SON and SEAN M. -_._., pFARSoN,--husband -and Ir~ife,. _..~ ~....,-.._ .................................._._~-_.__. ' gplatar»s.. of». St:..~oix...,~_._.._--------------------------------------------County, Wisconsin, CARRIAGE HOMES XXI, TN(;., a hGreb tonveps and warrants to.-.-._..._......_..-------- ----------. ................_..-.....,.......~... ltii;nn~sota oor~orativn, _,_,,,_ ..........................-.-.----_---- WA1tM*P1'1' D6BD ~ sr~n or wrscoxs(N-rvwrt • nua wsa taasssv~o +on irw.vw «~*. ~as~]inghori'--.___._ ........................................County,YI43{i4k~,151ti~~~ot the sum of~! , pn~_(~Qll~r---and-.noj200-.-.01.00)--anu'- other- ~~-?.:?.,and-ya~u~?b1e...RE,~w~ To _- __ _ __ - ................... ... - ...__.:._...._.__.._.. --i~- the following tract of land in---..~~.t-..~fQ~~.--~- .- . --- - - --~ ------•-•--....'COUn~ of the Souttw~est - Wisconsin: .F.ill_9f ..thy...N-9.zth~S.t..4Uarte.r....ifs:r2,--a:`14~...[~.~r'.rth._Ha f tN~) j~ Quarter (b'W;l of Section 'Iirenty-Five (25I , '!bwnsnip 'Iwenty-Nine (29) North, Range ' Nineteen (19) West, 5t. Croix County, Wisconsin, exee278Z tSO1eCL01 eC,cxtntydRegisQer Map filed 3une 29, 1994, recorded in Volume 10, Pag ~„~ of Deeds, as ppcument No. 518444. • their __,,.,, haads._ and seals.... this Ia Witness Whueo~ the said grantor. S_- baVe..._. hereunto att.-._.._.--.•_--.-•-•-• (S~-L) »' .._ -dap of..__. aY ............................».._....., A. D., X~C..2QQJ. " BiON3W AND ItimAldt:17 iN PRa~RNCtL OF ••- _~_ , " „~ (SEAL) . _.__.._...._._...__..._ ..... ........:.............._-.....-.:.._.. 1:1-: I ...___.-_...._..__...._._...._ ........................».........................T (SEAL) ~,,tt to l _ Sta~tC of ~~i~ -._..-._WdshingtOn _..-- --.County. ~Fersonally tame brfore mc, this-.~~:::~, day of...~.°..~......._._--., A. D., ~~..-.~.~01 Y the above named Kip-ri~'''~ '~. "~-~-"N: a~ ~--AN M PFAR50N, husband-.and wife, .....»........ --z__._.._......._ .......................-..._..._..-.._.. , .....»._....»..»..---V -..---------~ __~.._.» ..............................»»....._. to ane latowa to be the persorrS.... who executed the forcgoing'instrumcnt and ackaowiedged the same. -s,..-,, ____---~ , , _ - Tl~IY INt<rRUMEN7 w~vA, nP A/TC BY xl7tARY ~, ` ` Ni013NTA1N Richard J. Ctabrlel, #~Z86¢ brery Public, - 'Y~F ' yy.i~PY PUBL{C_--/,lNNESO~A-- (.Aunty, 'wi5. _ 880 Sibley Mempr is 1 Hwy . , 11114 s$,.t. My Comm. Expires Jan. 31, zoos • -1736 b1y cornmrssian (e't ' _ ......................................................»........... J (Section S9•It St) of Ne u~ac«u~n Sur.rtn prorldn that atl in>trc:ncmi tv be recorded shalt bare phialy printed or tlperritteon totaon the n-rnn ~ the j,anlon, ~unrttc, .nnnsce anA nWin Sru .~.,:. `5 `t i tr:ndatiy rcgw ra [b,t the nflnc u( Oar xnan .rho, S mental a~enq •rhrch- drattrJ wch murumrnt, sbaU Lc nrTntea, ~, 'wi~•ten, stainpptcJ m w~r.ucn thacon 6r s legible manner-J n• r oo . Urv nvr n S~f~A'1'T2 nt't iV f SCONSIN _ W rwrondn I,orat mnm< Cornns*7 • L ~ ".~ • - «