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Home My WebLink About020-1395-54-000' ! t Safety anal 1311ildings Division County _ 201 W. Washittgtott Ave., P.O. Ikrx 70 ROIX CO. _ __ ~~~~~~~~ ikfadi. ( E1V E 1 ~ { Sarni Permit Number {to he filled in by Ca.) s~E fi08) DQpartment of Cammt3rce ~ 6 2~ Sanitary Permit App~icatia PI I.D. Nuroher ~N In accord with Comm 83.21, Wis. Aden Code., personal ittfortnalion pro may he art fix searndaty ptu~ex Privacy law, sl S.U4(t}( ) QIX COU ~ ~1'~ ass E if di8~eran than mailing address) _ T. ~ E7 GAL RIDGE L Appiicativn InformatitK - Picttse PrlnE Ali Infarmation ZC ~-{ P,o~lty owner's Nance L~ Qm G ~ ~ ~ ~S P~r~- ~ lAt a 54 ~k ' - ~ PENDING lkoperty Owt>er's Mailing Adaknss -_.-_. Property ~,~, ~~Z bb ST/LL(~~~ ' ~"' ~ SE ~~~ NW v<. Sediae 25 ar v~ 7 City, State Trp Code Phone Nutz>bcr '7 ~ 3 - `J6 ~ LAKE ELMO, MN __ _ 55042 , 681-d39- cxrcia one) T 29 N; R19Wi=~;~ II. Type of Building (check all that appl Q (~ 1 or 2 Family Dwelling - Nnmherof' PER SUBMITTED HOUSE PLAN Subdivision Name Csht rium[wd Pub1iG'L:onuucrciat -tkxcrihct)se SCENIC HILLS n ' '' I ^ state Ownwl Dcecci6o CTsc _ J~_.1_S~" . ~'~ u-_S w __ /a f" ~0~' ~" // --- Caty_~.lvitlaYe D4T'ownrltip of HUDSON IIL Type of Permit: (Check only one boz on lire A. Complete litre B if applicable) -~- - _ a. i7Kxaw system --- ^ Replac~ncm system ~ Troa4rxanflltdding Tank. tteplacerr~ Only 1_} outer Modificatiat to l;xisting system ~• ~ Pe+rtnit Renewal 1 _l Pettnit R.evi4iun ^ Change oS' ~_) Pc~uit Trar~erto New t~"t ~~"s PermiE Number and Date Isstud 13zfore E~q~irati~ Plumber fawner' _. __. IY. T of POWTS S rein: Check all that a 1 C1 Non -1'r~sutized ln-(irouncl U ,Lfiwnd_ 24 in ofsaitable scsil ~ Mound < 29 in ofsuitable soil ^ At-Grade Cl Single PasF Ss~ ~ItL'r 1_l 'C~Ci Peal Pittrr I I Aaatric'iYealte~tUnil ~ Rec:isi~.lnling Sacul Fdl~ d C I H ol oun CotLSttuc[eA Wedatxt ~ 1'tes~rfieA Itt-Ci''a _ (( ~( ~j ~ ~ J ~~ Recirwlating Synthetic Media Fiber [.F,Sch"~Chambrs iJ Ihip l,inie ^ Grdvel-lras Pipe ^ Olfse,+ (exPtmn) ~ ~ ~ Y. Dis rsailTt~etttmentArraLtfot~ttatiolrt: (3} trenches-(2} 68.75/w-11 BioDefuser Chambers (1) 75'12 chain ers-tote chamb .__ _ __ - t)esi~pu F7uw Esr~~ LkviRn suit aptt;~atior, Rar,,~e,~ / bispelsal Area Re+cp~ ~. Eat) ~ t A syRterr, Flevac; e I lter-~ 750 .7 1072 .-_ ~ ~~~ a. 3.95 b.92.36 YL Taplc Info Y ~ Tote! NumtMT _ _ Manufac4ttrcr Site Steel ~ Galiotls C:altutts nfiiniss twmaete Co~tntcied Ciiass ~ Mew Exastugt Tar~hs Ta~l[s __ sgt~crtt°~"'~~~ X 1565 1 WIESER ~ X Aerobic Tn Ylni! t7f!itI1~Y I~ILt171t%;r VII. Rettptmsibilily Staterm~nt- I, tLe mmdersiattad, althe tOwFS sitaa.^ en ric atlacbcd pious. Plmnber's Nanre(Print} Plum ' MPtLS Number Mmn~vv INmneThrmfror ', TODD FEATHERSTONE 242514 ____.-- 715-381-1704 Plumt~er'stlddress(5`Ineel,City,Sta~ '.ode, P.O BOX 467 HUDSON, WI 54016 V Dent {De arlment Use On ,'~prrnred CI Disapproved Sanitary Permit Fee Einc)ttdes Gromndwater s~,~aur~r•~~ ~`~~ ~ Date 7ss'ued ~ /~ ~ 'ng Agent (No ) ^ (~vcwr Givat ltcxuxt for Ueniat J ---- _- V. / _ .~ _ iX. Conditions of ApprovwllReatons fo~ prov~ ~ ~~ 1' ~ ~~ - SYSTEM O NNFR ~~LG' ~ l . 1 Septic tank, effluen Ilter and /~~ r J ~' dispersal cell must all be serviced / maintained LQV~~YkI . ~'3 sv ~~~~ ~ as r t l id d b l ~ pe managemen p an prov e y p umber.. G(~~ / 3S 2. mus a maintained v as per applicable code/ordinances. e6Yyt~yy! o 3. ~~~~ ~~ ors 00 't..i C~l~-i . 3 Head ~ Ct.~tL~ee,,e/uatr fir) ar ttte sr~, .fl t~Pa' ~ ~+ (tea eut i 11 wrcio ie s(~~ ~ G~~ ,~ V':;sconsin Departnx>nt of Commerc.~ PRIVATE SEWAGE SYSTEM Safety i4S~d Building Diws-on _. INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Lifest le Homes Hudson Townshi CST BM Elev: ~ Insp. BM Elev: BM Description: ~ - OO.O 00.0 B~ ST TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W E:(S~R. ~os Dosing ~a~R! Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing ~ S+ ~) ~ 3Z I Aeration - Holding PUMP/SIPHON INFORMATION Demand GPM Forcemain Length SOIL,.~~SORPTION SYSTEM Well _ ~z~ ~-s Ft r=LEVATION DATA county: St. Croix Sanitary Permit No: 430642 0 State Plan ID No: Parcel Tax No: 020-1395-54-000 Section/Town/Range/Map No: 25.29.19.2448 STATION BS HI FS ELEV. Bench ~rkl~ ~ ~~! ~~ a ~0 3 s•b (~ dt Alt. Brt~} ,, ~ l~~ '~pj~ ~ , / `~ . ~"- Bldg. Sewer ~ ~ ~ ~ ~ '}, 9 ~' 9 ~'. ~"~ i SUHt Inlet i n SUHt Outlet ~ ,sl/y Cr~..(~ t 4~ • /~ I Dt Inlet Dt Bottom Header/Man. ~ Dist. Pipe Bot. System `~ ~ Final Grade r ~ ~ ~~or ~~~ I ~s•~- ;t Cover ~ , r RENCH Width ~ Length No. Of Trenches P DIMENSIO No. Of Pits I side Dia. Liquid Depth DIM 3 . 3 SETBACK SYSTEM TO P/L BLDG WELL LAKElSTREAM LEACHING Manu cturerl~ INFORMATION CHAMBER OR ~dGC ~ Type Of System: ,~ ~~ / ~ ~1 UNIT Model Number: ' fit/ v ~ ( DISTRIBUTION SYSTEM HeaderlManifold ~~ Distribution x Hole Size x Hole Spacing V Air In ake ~ h i ~ Pipe(s) C / Lengt D a Length Dia Spacing SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [_; ~ Yes I, _ij No '=~a_I Yes ~ } No COry[M~NTS: (I code dis~genci on resen etc.) Inspection #1: ZS Inspection #2: T--7-- -s~.db~IC A. -100 E-j~~ .~~ t~'~u' ~i~,~~ ~`~ Location: ~7 galQRidgp~ H~uldson, WI 54016 (SE 1/4 NW 1 25 T29N R19W) Scenic Hill Lot 54 1.) Alt BM Des~'ption"- " n(~'~~D~~ ~ L ~ ~~ 2.) Bldg sewer length = ~ (I mac., ~~'~•3 ~ " ~ Z ~ Z -amount of cover ~l 1 ~~-~~ ~ th5~ll,'.C7t'>•b+^ ~ Z~ $'' ~ ~ ' 3 rt 3) Ste. / ~ ~ cs•.~s ~ 3 ~__ a~l~~ _- -- -- -, ---_. __ --- ----_- - -- Plan revision Required? Yes No ~ ~` Use other side for additional information. ___ I / ~(~J ~__ _ _ ___.__. _ ____ ~SBD-6710 (R.3/97) ~ _ _ (~ ~ Insepctor's Signature ~^ ~- ,, __ _;- - 5) s'~~ .~ y 4 ~fi/`l ~~ ~~ ;- ~ o y Z, ~~~~~ _ ~- ,~;~~ .~7 ~~ ~~i z ~~ ~ Z~, • z~ _ j~s ,z t ~z ~~ = ~j z ~ 1 s.~~~'' sc~ 1 . t ~! S a, _~ Job ~. d~° ~ ~-~~~ ~ a,~ o D = BsretN6r5 gj _ EG • 9?. 7a ~a_,~<.q~~o ~~_ ,~~ gy~oo ey,.t - ~oo.v~ to ro s/y " arc ~°..~ Ti° ~y "~vc ~i. W~ T- Z C a, Sy; Job ~. d~ ~ ~-~~s ,. , ~ e,~ o D = B~fv~s 4i - ~~ . 9T, 7a ga _ ,~< . q~ ~o s~_ ,~~. 900 Q/rl~( ~ /OO,mG ro v ~/y " arc ~ia~ 3/~7 • - imo • 70 Ti° ~y ""~vc ~°i. I , SYSTEM CROSS SECTION CARRIAGE HOMES -LOT 54 -SCENIC HILLS MAN HOLE GRADE 97.70 INSPECTION PIPE { { E- ZABEL FILTER 1565 GAL. }-.i 2 @ 68.75' AND 1 @ 75' SYSTEM ELEV. , a.9_3.95 b.92.36 c_90.16 oZ Bio .?~E'~'r~SE1et - cam ers ea. 11 BIO DEFUSER CHAM E S ~ ~ O ~~ 1 @ 75' - 12 chambers O 12 810 DEFUSER CHAMBERS PID # SE '1s NW '/s,S 25 T 29 I~I,R 19 j~ LOT 54 g~~ ~g SCENIC HILLS ca v^ ~~ ~Q^' 242514 From: To: KEVIN Date: 7/26/2004 Time: 2:22:22 PM Page 2 of 2 ;' ~ Ticket Number ~ 4 9 4 ~ ~0~~~~~ Our Job Numbe$ ` W 3716 U.S. HWY 10 MAIDEN ROCK; WI 54750 Customer Number ~ (715) 647-2311 SOO-325-8456 FAX: (715) 647-5181 ~~~ f rvninu~ow-ouv.w - --- Sold To: Oats of Delivery a- Driver - u Address - ~ 0 Dispatcher Inspected By Deliver To: ~ ~ ~ Time Departed Beg. Mileage Address Time Returned End Mileage Address r .. - Set HOUfs # of Loads Quantity Description Weight Amount :. i :+. i __,.=,-_ .. • Delivery Terms 01 Sale: Cash on delivery unless other anangements have an h i th hi ~ Sales Tax c s o per mon , W been made. A linance charge of up to 1 h° annual rate of up to 18°o will be added to accounts 30 days past due. Tofal Materials Recd - Comments ~ From: 1 lv). Hoot ~ menomrnnc ] Spooner ] Portage gy Date - I Other I Fond du Lac TRUCKER'S COPY . ~ ~---~ Z5.2°/. /~ • ate/ From: To: KEVIN FACSIMILE COVER PAGE To : KEVIN From Sent : 7/26/2004 at 2:22:20 PM Pages : 2 (including Cover) Subject HERE IS THE DELIVERY SLIP FROM WIESER FOR THE 1565 TANK FOR LIFESTYLE HOMES PERMIT #430642. I"LL KEEP PICKIN AWAY AT THE THINGS I CAN TAKE CARE OF. THANKS, SHERYL RECEIVED ti ' S IL EVALUATION REPORT Wisconsin DepartmentofC merce)AN d 7 20Q~ Division Of Safety and Buildi S in accordance wi Comm 85, Wis. Adm. Code 1399 Page 1 of 3 Steel Soil Service 5T. CROIX COUNTI' County Attach complete site pl on papPr~l~ ~ x131 inches n size. Plan must St. Croix include, but not limited BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. OZD ' ~.3~5 P ding Please print all infonttation. Re ewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ 9 O Property Owner Property Location Arkell, John Govt. Lot na SE 1/4 NW 1!4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# d ~Cf~ 6720 Stillwater Blvd 54 na Scenic Hills City State Zip Code Phone Number ~ City ~ Village ~ Town Nearest Road Stillwater ~ MN 55082 681-439-2414 Hudson Highlander Trail New Construction Use: ~ Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement ~ Public or commercial -Describe: Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 93.86ft. Trenches spaced and depth to code 3.833ft below grade. ~i Boring # J Boring f~ Pit Ground Surface elev. 97.70 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cons~tence Boundary Roots GP DI(t' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. YEff#1 *Eff#2 1 0-8 10yr3/1 none sil 2msbk mfr cs 2c .5 .8 2 8-28 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6 3 28-36 5yr4l4 none sl 2msbk dfr gw na .5 .9 4 36-100 7.5yr4/6 none ms osg ml na na .7 1.2 ~ 3 °I '. ~~<~ ~ h 9 Z- 3 i (p tf rl / l Boring # J Boring /~ Pit Ground Surface elev. 97.70 ff. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DHt' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs 2c .5 .8 2 12-24 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6 3 24-36 7.5yr4/4 none sl 2msbk dfr gw na .5 .9 4 36-100 7.5yr4/6 none ms osg ml na na .7 1.2 "Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ~~ Signature: CST Number David J. Steel ~;~ - 248956 ~ Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 12/30/2003 715-246-5085 Property Owner Arkell, John Parcel ID # Pend Page 2 of 3 Boring # ~ Boring 1~ Pit Ground Surface elev. 94.00 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk mfr cs 2c .5 .8 2 10-18 10yr4/4 none sicl 2msbk mfr gw 1c .4 .ti 3 18-37 r4/4 none sl 2msbk mfr gw na .5 .9 4 37-100 7.5yr4/6 none ms osg ml na na .7 1.2 Q.~ it g ^ Boring # ~ Boring _{ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ':1 Boring J Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWYS John Arkell New Richmond,WI 54017 Lic. #248956 SE1/4,NW1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax (715) 246-9372 Lot, 54 Legend 1" = 40' • =Benchmark Ele. 100.00ft Top of 3/4" PVC Pipe • =Alt Benchmark Ele. 100.70ft Top of 3/4" PVC Pipe =Borings Boring Elevations B 1 = 97.70ft ~'i, B2 = 97.70ft hI ' B3 = 94.OOft i ~ I ~h ~r ~ B4 = OO.OOft ~f ~ ~~ ~Z,o~~r ~ ~ ~~ g~~ ~z _ jo -0 3 20~ 2 ~-~~ ~ ~~ ~,~ ~ G~ ~ 0~~~ gad ~~ ~1 ~J , l- ~ ~~~Iz. ~3 ~~ ~~ g-3 /3 ~2 ~ Z ` ~~ 28'' 3~' ~3 $ ~~~, ~o~ ~. /y!~ ~' ~ ~ ~ b s ~. i. .. r t ~, s ,. . ~ ~~ ~ ~ ~ ~ ~ _-_- ~ss~~ ~ ` i y, ~ jcl 1 ~ . 1~oZI.~ ~ f t ~fl~ i , . f f .~ t A~ \` ~ Y3 ` .., ~_ .. `, - _ -~. +t Y. -. ^.-.....~ .- -- ~ ~"` .. s- __~ ~'~.,_--~-~ ~` - ~ _.~ - , t 7 ~ A C ° 7 ! ~ J' f -~`~_-_ „~`~.,`-~-.~---~:~?.- :fit ` 3++t /~ ,. , r _ ,. _ i t ;• E ,t f' ~` ~ ;~ 1 tl, r ~ ,! ,~,... it t ~ i fr / ~'^ "--- ,.. ~ ~ d i ~ ~ q{ sy~r/;~~ ~ ~ 1 1L~i, ~ / ~ ~ ""~`,~~'~ ~~ 1 ,,~~~ ~ l ~~ ~ ' ~ ~~ iii'' 1 '~ ' ~ x g '~ ~~~ 1 X95.9 d~f~li~ p.'~ /'" ~ ~ Nil..' . ' 2X ~ ~ a ~~~ ' ~ r ; i r~ t~~ ~~_ ~~ ~''~ ~' ~ t f~ % ~ ~~z t _ ,,~ ~~ ~ ',, _ ' // 'l'it ~ ~'4 Jh.`. /!. 1 ~ f f , '~~r / f' ~' /~" ~~'` ~~. ~ ,: 1 ' ~ 1 f f it j '~ i; ~~1 ~~'~~rF{~ 1.1 t ,r ~t„t~f~i/j•~>~ l~ ~i / l 1 ~{r ~~ 1,f r # ~ [ ~~t Y ~}yIj/''~!"t/~'~{l~',c`r,c f,~ f ~' y~ f - 7 r'~ ~ 5 R /f ~ ~ fi,~9.~~? Y.~a~i ~f 0~9fit~~~~%~ fa~ ~ ~iNswnsin Department of Commerce . . Divisidn of Safe'~i and Bui~ings SOIL EVALUATION REPORT Page I ot~ m aocoroarwe wmr ~orrnn aa, vva:. ream. t.vae ~'' S -{- t i i Pl 11 i h 81/2 . C o l an mus ze. es n s x nc Attach complete site plan on paper not less than indude, but not lanited to: vertical and horiQOntat reference ditedion and percentslope, scale or dimensions, north arrow, and nearest road. p~ l,p. - ~ 2 0 - / 3 y's - S -Q'~~ Please print all i ~~ n. `~ ~, by Dam ~ law. s.15.o~(1) (m)). , Personal intorrnation you provide may be used ti»' ~l Pu G2y.y (. 1i(m 4 r Property Ouvner ~ t~ ! . ~ .~(t e~ ,~ .- Prope Locebon Govt L ~ 5 { 114~/tti/114 S ,~" T Z q N R / `j E (or) ~' Property Owner's Malting Address ~ 4-, ~, ST CRCt~ ~ Lot # ~ t Bbdc # Subd. Name or CSMIf Co ~ Z O S~ ~ ~ I wa~-e~ r-''~. vnrTv ~`7!l S e ; City State 23p Cade .Number ~~E _ , []' ^ Ydlage (~ Town Nearest Road sti. I l ~-{-cr !11 v` , f'So ~Z { b'~.. l,;~ 4 ~.~-Y~Y ~..., - v 5 ,ti, n +~ ~f ® New Construction Use: ® Residerit~l / Number of bedrooms 3 _ `{ Cade derived design flaw race DSO l (o O O GPD ^ Replaoemer-t ^ Public or commercial -Describe: Parent material OU fc~1A-s (~ Flood Plain elevation iF applicable ~~ i z . O ft General canments S S ~ rYL G I G V0.f.b /~ _ (, . ° o Csiru.(d ~ -~ ~ "'/ ~ i ~` ~~~ .• t r G~d~-~' and recommendations: ~ ~ ~ .e,U al, : d r1 - .9'y- O a -- Boring # ~~~II ~g l~v Pit Ground surface elev. J'QD'G flt Depth tD limiting tailor l/S in. Sod ' n Rate Horznon Depth Dominanf Co Redox Description Texture Stnx~ure Consistence Boundary Roots GP DH~ . in. MunseU Qtl. SZ. CoM. Cobr Gr. SZ. Sh. 'Etf#1 'Eft#2 I Q -8 /Q r 3/ Z -Sr Z rhu~ h1 ~r- C r~ ~ ~ Fl Z $-z y ~6 r ~`~ ~ S.' ( Z~'-,Sb~ NYC-~r' ~ S -- , ~ 3 Zyi~s , _ G ~~ _ _ ~ r• h ~h ®Pit Ground surface elev. 9~ ~o d tt. Depth to limiting tailor ~,~_ in. ~ ~ ~~ # ^ ~~ Horizon Depth Dominant Cob Redox Description Texuun: Structure Consistence Boundary Roots GP DIfP in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. - 'EtT#1 'Ett#2 Q-~N JO ~ z -- "S,' Z~na.~~,E. rYt~'~ ~S ~v~ ..5~ , g Z Jy-`1~ io ry/ 5.. Z,v15.5,~ yyt r' C' S - . S . ff S- `' ~~ ~~ ~ 9' 6' ~ 3 Z o~s C sf * EfNuBnt #1 =130 > 30 < 220 mall and TSS >30 < 1 50 mall ' FJflueM #2 = BOD. < niclll. and TSS < 30 mgll CST Name {Please Print) ignature p CST Number Addmss Date Evaluation Condur~ed Telephone Number ~ Ji3 tSo ~ S~ ~s~.se ~, w/ SYGZ r' G - i - a/ ~~s- zy7- ~a~ Property Owner la.. r ~~ ~ ~ Parcel ID # `. ,. , _ _ Page z of _~ Boring # ^ BOA 3 ~ Pit Ground surface elevg9 ~ d ft. Depth to limiting factor //y in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr? 'Eff#1 *Etf#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh: r ' _ . / _, 3 (~ ~ h ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth bo limiting factor in. ~ ication ~~ n i H th De Dominant Color Redox Descxiptbn Texture Structure Consistence Boundary Roofs GP D/if zo or p in. Munsell _ ~ Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'EfF#2 Boring # ^ ~~ ^ Pit Ground surface elev. ft. Depth M limiting factor in. Soil lication Rate Horizon th De Dominant Cob Redox Description Teldure Structure Consistence Boundary Roots GP D/fr? p in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 "Effluent #1 = BODg > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mglL and. TSS _< ~ mg/L The Departrnent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) • • I` • - ~ ' PAGE ~ OF~_ NAME 14 ~!` K •e- ~ ~ LOT# S `{ LEGAL DESCRIPTIONS ~ `~4 Nw'/4,S LsT zq ,N,R Iq E (or) ~ _ _ SCALE: 1"= yU l BM 1 ELEVATION /00.0 BM 1 DES (CRIPTION {~, ~ o ~ Z "oJ~ QI D -e - + ~` BM 2 ELEVATION 9 `T• O U I ~ cC, Z S BM 2 DESCRIPTION {~~ o L' Z ~~ PU L ~~~ SYSTEM ELEVATION q (~ • O O ALTERNATE ELEVATION 9 y- U U CONTOUR ELE NATION 9 S •~f 9. o ~- ~cx~•o 0 r ~ ~~,i I {v c~5~ _ k 0 a~ ~o I o aq ~~-~~ ,~ ~~° `~', ~~~ s~k~ ~' ``~ ~~~ ~ g-~ W ~~ 0 ~ ~ ~ r i tiL: ~ ~Db _ _ . __ ~_ -3 ~ • ~~ ~ ~~ ~ ,~ _ ,_ 5"I' CJiC)IK CUUti°I'1' SEPT'iC TAT1K .ti1Aii~ITi:NA.~ICE AGP,EEItifEN7' I~ND OW;v`E::SN(P CERTiriCATiON FC32.~ Ow~ncrii3uycr 1.__ f FE S ~ ~ 2. CEO S~ t,c~ q-i~ v • ~ Mailing Address ~ ~ 2 ~' ~ ~-~ ~~a~er ~a~ Property Address L- ~ T' ~ ~ ell L.-L.~S (Vc.:fication required from Planning Dcpartrncnt for new coas~uction~. CitylState Wisconsin Parrzl Identification Ntunber -~'4-~e-`i'" OZa - (39S- ~ ~ ~,EGAL ~IFSCRIPTI(3N - See Attached Legal on Deed 0 25~5~~ Property Location SE %, /~~;~t, Scc. ~~ T~N-R ~ Wr Town of ~~GcoSOnl Subdtyision Scenic Hills . Lot ~ ~. ____ __ CertZtied_Sarvey Map #~ _ _ _ ____ __ L`olt;me .Page # Barran Deed # ~7`-~~ l~ t 0 . v~~t~t: Z `{3 ~ , Page # Z2~ Obi, ~y, 2~3 ri Spec house O yes ~ na I.ot Lines idcuiifiable ~ yes O no SYS3'EIVL MAL~I'I'Ei~IAHCE • Tti]iX'QpCr ifSC:nd rn~ n+~"++~r+Ge O f your SG}7~C YyS{CIIl could SrSttit is its p*r~tumfailaze to l3audlC wasias. Proper tII~trn ~ nor caasitts of pomgiag oat tiZ,c septic tsal; every tie years or eoonrr, if aeed~ by a iio~ased ptmzper. What you put into the system can affect the fimetion of tlu septic tack st a ireataz~ ttage is flye x~ssie d'upoarsl system. The pmpcrty awncr agn~ to tuhmit to St t~oiz Zoning Dcgartmcnt: certificatioafaun. sued by the owner and ~y a tras~cpltaal~er, joumeytnan plamlxr; restzided p i ar = licezu-d p~ verifying tlsat (1) L~,c on-site ~zstcwaicr disposal system is in ptnper operating condition and/or (2} aFter iaspoctioa and prn~iug (if neussary), tae septic tank is less than 113 full of sludlc. I/w~ tt-e h:vc read the shove roquiretueats and agree to sauitain the private sewage disposal system ~ '~ the standards ect fazib, hueia, u set by ia,e Dot of C.ommetcc tad the Department of;~Tatutal Resoutres, State of Wisconsin. Cerii{carioa stating that yoer septic sysiefu has been tnaiataiaed tazist be cacaplctcd sad returne$ to the St. Cmiz County Zoning Officx within 30 days of the Lion dafe. /~1~~63 TURE dF APPLICANT DATE OWi~TER CER'IT~C.aT7ON I (we) cert. that all statemcn~ an this form atr_ trio to the best of my (our} L'-iowirdgc. l (w~} am {r~) tie o~,•nG;s) of the property descn at~ove, by virtue of a aar,-anty decd rxordcd in register of 33ccds af~u. /"_ SI OF APPI:iCAIvT DATE s•s.ss ~, information that is mis-rn^rs~t:c~ir.•zy tcrt?t in tsc saaita.-y permit bci~ rcvoEtd 6y tae Taring I?cpa.~ent. `r•`• •• lneluttt with tizis sppti;xtiart: n ssrtped wa.^~anf}' d•-cd from the Register of Dcecs of:ice a c:,py of lire ccrtife~d r~.-vty mzp if rrfcrence is made in tsc vraztbrcy dcrf POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ? of ? FILE INFORMATION SYSTEM SPECIFICATIONS Owner C FES Permit !f DESIGN PARAMETERS Number of Bedrooms 5 ^ NA Number of Public Facility Units ^ NA Estimated flow lavera9el ,~3~ allday Design flow (peak), (Estimated x 1.51 _,~~ gallda Soil Application Rate .7 al/da lft~ Stated influent/Effluent Quality Monthly average` Fats, Oil ~ Grease IFOGi Biochemical Oxygen Demand (BODbI Total Suspended Solids (TSS) 530 mg/L 5220 mg/L 5150 mg/L ^ NA Pretreated Effluent Quality Biochemical Oxygen Demand IBODS} Total Suspended Solids (TSS{ Fecal Coiiform (geometric mean} Monthly average 530 mg/L \/ 530 mglL t8; NA 510° cfu/100m1 Maximum Effluent Particle Size Ye in die. ^ NA Other: ANA "Yakies typical for domestic wastowater and septic tank sfflupnt. MAINTENANCE SCHEDULE Septic Tank Capacity 1565 al ^ NA Septic Tank Manufacturer WIESER ^ NA Effluent Filter Manufacturer Z B ^ NA Effluent Filter Model _1 ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Fiher ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~,(JA Dispersal Cell(s) [~ 1~ nd (aravi~) ^ At- cede ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other. ,~A Other. ~ NA Other: ~ NA Service Event Service Frequency Inspect condition of tanklsi At least once every: ~ month(s) (Maximum 3 years- ,~ ~ earls( ^ NA Pump out contents of tankls} When combined sludge and scum equals one-third (Y,I of tank volume ^ NA Inspect dispersal cellls) At least once every: ^ Y art 'Isl (Maximum 3 years) ^ NA ^ month(s) ^ NA Clean effluent filter At least once every: _ ~ear(sl ^ month(s) ^ NA Ins ect pum um controls & alarm P P. P P At least once eve ry~ ^ year(s) Flush laterals and pressure test At toast once every: ~ e8~(sitsi Y ^ NA Other: At least once every: ^ month(s) ^ year(s) ~NA Other. ~[JJA 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 tankls- to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/011 Page 2 of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellts). tf high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wiN be discharged to the dispersal celtlsl in one large dose, overloading the cell(s1 and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andlor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, alt 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 rtte POWTS fails and cannot be repaired the foNowing 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. /~ r T ite not b evaluat to ide ify a suit le replac en area U on failure of the TS oil and site ~' V e do m st pe orm to cat a suitable ep{a t area. no rep ent availa le a h n m y e ' stalls as a last rt to r ace the f ' POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~ Phone -7 _ . ?o.- y POWTS MAINTAINER Name FEATHERSTO Phone 715-381-1704 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. CROIX C Phone Phone 715-386-46 This document was drafted in compliance wrth chapter Comm 83.2212i1b11111d)&If) and 83.5411), (21 & 131, Wisconsin Administrative Code. J 2H3SP 228 I STATE BAR OF WISCONSIN FORM 1 - 1998 Document Number WTl' DEED Parcel aentifwation Number tp1N) THIS DEED, made betweenCarrfagu Homes g Mimesota corporation, Grantor, , Grantee, Lifestyle Homes Grantor, for a vahrable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin {the "Propert}~: SEE ATTACHED EXHIBIT A This is not hottustead property. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple aad free and clear of etrcumbraaces except none Dated this 10th day of October, 2003. Carriage omea XXI, Inc. ~/~l.C ~ r~~ (SEAL) • Kellei St Martin, Vice President (SEAL) AUTHENTICATION Signature(s) authenticated this 10th day of October, 2003 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 70fr.Oti, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Kellei St Martin, 12415 55th St N, Lake Elmo, MN 55042 (Signatures maybe authenticated or aclrnowledged. Both are not necessary.) •Names of persons signing is any capacity must be typed or primed bebw that Bigtlatnre. Recording Area 743610 KATHLEEN H. 11ALSH REGISTER OF DEEDS ST, CROIX CO., MI RECEIVED FOR RECORD 10/14/2803 09:45AK MARRANTY DEED EXElDT t REC FEE: 13.00 TRAMS FEE: 269.78 COPY FEE: CC FEE: PAGES: 2 It2 IJl1 OZO-1'~`~i l~7 (SEAL) (SEAL) • ACKNOWLEDGMENT STATE OF fiAltt~tSt~"k.. ~SS. Y,1AN~-1ny}otl. COUNTY. Personally came before me this ~I day of Of,~'Dq~W 200 ~S • the above named Kellei St. Martin vice president of Carriage Homes J{7i;II, Inc„ a Mimnesota corporation to me lowwn to be the person(a) who executed the foregoing instrumeat and aclmowledge the same. • Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: +'""•. CHRfS;INEM.LENTSCN rgTM" PU&1C ABTA • • bAY Cf1wAR11S6t(3~ @XPIFlES ,ti JIWUAFiM31.2005 GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF HUDSON COMPUTER NUMBER 020 - 1395-54-000 Parcel Number 25.29.19.2448 Claimed Date Re-certified / / Relate Number: SCENIC H OWNER NAME: First Last LIFESTYLE HOMES CO-OWNER Mailing Address 11200 STILLWATER RD City LAKE ELMO State MN Zip 55042 - Type Vol Page Doc # Rec.Dat Vol Page Doc # Rec.Date HISTORY WD 2435/ 228 743610 10/14/2003 LAT 8/ 76 658318 10/04/2001 PROPERTY ADDRESS: Hse # 1/2 PD --Street Name- Type SD Apartment Post Office 761 REGAL RIDGE School District: 2611 - SCH D OF HUDSON Special District: (1) 1700 - (2) - (3) - WITC Plat Code: Last Changed on: 11/10/2003 Book Number: 1 SECTION 25 TOWN 29N RANGE 19W '/.160 NW Y.40 SE Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers F4-Prev, F5-Next, F6-Legal, F7-Value, F8-History, F10-Exit, F12-More ~ . DOCUMENT NQ. / , ~~ / _O ' (l (IQ ~. $ ~. ; n I ~ I. I -:~~___-- - -_ THIS INDENTURE, Madc b .RICHARD N. PEARSON and JEAN M. PEAR,SON, husband and ife, grantor. S.. of....St _ Croix ........................................................County, Wisconsin, CARRIAGE HOMES XXI, INC., a h~reb convoys and wactants to........._..... .........................................._.._...------•---------• Minn~sota corporation, . _. _._ . _._.__.-- .................................................... g~ rautee...-... of ~ ~fas5ing~on .....County, ~B~ii or the sum of pr~~_~Ql~ar:_-and-_ no1100.-. (~ 1.00).-.and.- othe r---~aod,. and. va luable-.- CQT1~~S~~~s~~~SZ~1 ............................................................................................................. WAIt1i.ANTY DI~IDD BTATC OF WISCONSIN-FORM e TNIi iPACL RLiLRVLO FOR RLCORD5N0 DATA RETURN TO ----- thc following tract of land in....~~.....~~Qg ................................................County, Wisconsin: .A~.~...9~-..thy...N4~.thh!~S.k..S~~~?.Ater...(.N~1':~)~,..ana...North_,~ialf (N~) of the Southwest Quarter (SVJ~a) of Section 7taenty-Five (25) , `T`ownship 'P,venty~Nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin, except IAt One of Certified Survey Map filed ,Tune 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. CV Y ` I Ir~ , iV - 1 - c~ J 7" I .. "'~,.,.~+"0'- 117-M-Co ration _ i STATE OF MINNESOTA COUNTY OF -- - _- Minnesota Uniform Conveyancing 43lanks ~ 1978) MiAerlDavis Co. u St. Paul, MN 651-642.1988 Ss. Affidavit Regarding Corporation and being first duly sworn, on oath says(s) that: 1. (They are) (- _he is) the - _. and the - - -- ._ _------ - ------------ ---- - __ respectively, of _ - - - -- - -- Carriage-.HomesXXl,_Inc.---- - ----- ----------- ----- a ----_--_1~inne ota_ ------__--- --- --- -- corporation, the corporation -- - named as _ -__ --- _. _- . ----_-_--. --- ~.__.._._.______ _ .. ___- in the document dated _ - - - -- - , and filed for record ~-_ --. - ---- as Document No. __-.- (or in Book ___-___ of ____.______~_.__._ ____ ___..___.__ _ - - __ _ Page _--- -_ __- ---_ _- __.---- ___---) in the Office of the (County Recorder) (~x3cvcac>jcx~x~ -- ---- - of -. St. Croix._ ._ -- -.-- County, Minnesota. ,, 2. Said corporation's principal place of business is at - _._ _ _ -.. and said corporation's previous principal place(s) of business during the past ten years (has) (have) been at: 3. There have been no: a. Bankruptcy or dissolution proceedings involving said corporation during the time said corporation has had any interest in the premises described in the above document ("Premises"); b. Unsatisfied judgments of record against said corporation nor any actions pending in any courts which affect the Premises; c. Tax liens filed against said corporation; except as herein stated: 4. Any bankruptcy or dissolution proceedings of record against corporations with the same or similar names, during the time period in which the above named c~rpuration had any interest in the Premises, are not against the above named corporation. . 5. Any judgments or tax liens of record against corporations with the same or similar names are not against the above named corporation. L TL.--..- L.. .. M,..,...... ~.,ti,~- ~~ m~*~r»~~ f'~miehar) +.. rho Prr~micvc fnr tzihinh navmenr has not been made_ ~:\ 3 A ~~ tOP2. .l 3~ 1. 3LA / -- 1 1 .0 . ~ ~~ L» ~ 12X ~ ~ V ~X 10 2.5 Iy 1 X ~ 971. y~``~:~r`CiC' ' ~ 01.9 - x .7 AC ~ C1,0.~) 995.9 r .. ~'~~'-/ 156.2 l' ~l X7. ~ ~05 6 ~` ~--~ -~ ;~ 1054.2 X/ ~ i ~,~- Parcel #: 020-1395-54-000 os/os/2oo8 04:27 PM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2448 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 C Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -VANDENBARK, SCOTT T & ERIN SCOT T-S~-.ERIN VANDENBARK ~ , 859 HIGHLANDER TRL ~ HUDSON WI 54016 ~ Districts:r"m"~`-y SC =School SP =Special Type Dist # Description Property Address(es): Primary " 76'k~~,o. ~ SC 2611 HUDSON --"'---- lam` SP 1700 WITC Legal Description: Acres: 2.055 Plat: 08-076-SCENIC HILLS 1/72 020-01 SEC 25 T29N R19W PT SE NW SCENIC HILLS BlocklCondo Bldg: LOT 054 LOT 54 2.055AC Tract(s): (Sec-Twn-Rng 40 1 /4 160 1 /4) 25-29N-19W SE NW Notes: Parcel History: Date Doc # Vol/Page Type 04/02/2004 758481 2540/179 WD 10/14/2003 743610 2435/228 WD 10/04/2001 658318 8/76 PLAT 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.055 100,200 301,100 401,300 NO Totals for 2008: General Property 2.055 100,200 301,100 401,300 Woodland 0.000 0 0 Totals for 2007: General Property 2.055 100,200 301,100 401,300 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 i I ~ ~. ~ ~ ~ N N Q ~ O ~ ~ ~ ~ I I "o I ~ I K I o i ~: i a. 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