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HomeMy WebLinkAbout020-1439-50-000Wisconsin±iepartmentof Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division 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 Mar uette & Lee Builders Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: { Db ~~ 1 LS 1 TANK INFORMATION n, TYPE MANUFACTURER CAPACITY Septic ~ ' J 3 ~~ tc /~~~ ~ F; ~ ~.eQ.~ ! Aeration Holding TANK SETBACK INFORMATION TANK TO E P~ WELL BLDG. Vent to Air Intake ROAD Septic Z~' / /37 ~ Z I ~ ~5 ~ ` Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number r. TDH Lift Friction Loss System Head ~ TDH Ft Forcemain Length --- Dist. to well Coil aR5f1RPTInN SYSTEM county: St. Croix Sanitary Permit No. 488242 0 State Plan ID No: Parcel Tax No: 020-1439-50-000 SectionlTown/Range/Map No: 25.29.19.2776 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Z. ~1 ~az.'7 /~ Alt. BM y 1~~- C.a,.u.~. 3.9~ 9~' .~c, Bldg. Sewer y. ~S . SUHt Inlet 7 ~~ ~~ St/Ht Outlet $, I Z ~/~, ~j Dt Inlet ~ ~ Dt Bottom ~ Header/Man. ~ ~•9 9 ~ Dist. Pipe // ' b S/~ 7 ~ . O cr Z . -7 Bot. System G ~Q.' I~ Final Grade 7 ~ g St Coved ..--rvte,~-- Ca 3 5~ ~~ 7~, i /z. b 9~ • 7 BED/TRENCH DIMENSIONS Width i Length ~ -qZ No. Of Trenches Z f PIT DIMENSIONS ~-- No Of Pits ~- Inside DI-a~_ I_~anir! Depth ~ ~ I 3 ~ } 2,~.G~J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~~,~~~ CHAMBER OR ~- ~~ i INFORMATION T ~ Of Systema n ~ ZS ~ ~q ~ / /~ ~ ~ /1 _ UNIT Model Number Q J; `/ r11CT~IC11T1~1A1 CVCTGM F ~ 7~ f GG = ~5 Header/Manifold I I Distribution x Hole Size x Hole Spacing Vent to AI,r Intake ~ ~ pipe(s) \ \ S i ~ Di ~` ~. 3 feJ~ a+~e~ o C Length_~_ Dia ng pac a Length r ' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Vnl~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodde 3ed/Trench Center ~I + ~ Bed/Trench Edges ` Topsoil \ ~ :OMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / tcation: 881 Highlander Trail Hudson, WI 54016 (NW 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 50 Alt BM Description = -y'A' lad CaJ e..`. E z- C..o v 2~ Bldg sewer length = 40 ~ -amount of cover = 3 , 5 , revision Required? ,i Yes ~i No I ~ ~' I DI ether side for additional information. _ `Q Date 710 (R.3/97) xx Mulchgd '~ No Yes No inspection #2:__/ /_ Parcel No: 25.29.19.2776 ~~ 3~ ~ S Cert. No ~~ Wisconsin~DepartmentofCommerce PRIVATE SEWAGE $Y$TEM Safety and Building Division ` ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township ,Mar uette & Lee Builders Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well 0111 ARC(1R17T1(lAI CVSTFM ELEVATION DATA county: St. Croix Sanitary Permit No: 488242 0 State Plan ID No' Parcel Tax No: 020-1439-50-000 Section/Town/Range/Map No: 25.29.19.2776 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHWG O Manufacturer. INFORMATION CHAMBER R Type Of System: UNIT Model Number: rIICTGIR11T1~1A1 CVCTGM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing S(lll ('_(1VFR ., o.e~~~~re c..~tn.nc l1n1., vv Mnnnrl (lr ~t.RradP SVSf2m3 Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil 'Yes ~' No Yes <' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: / / Location: 881 Highlander Trail Hudson, WI 54016 (NW 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 50 Parcel No: 25.29.19.2776 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = __ __. _ _ _ _ __ _ --- - I- --- No ~ i ~ ~ I Plan revision Required? ° fj Yes ~ ~ Use other side for additional information. ~ ...__ ! 1___~ L _ _ _____ ~ ~ - Date fnsepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Divisio C ty C ,rte d 1'~ Q ~- ` 201 W. Washington Ave., P.O. B /Q`/~O~~I~ Madison, WI 53707 - 7162 Sanitary nit Number (to be filled in by Co.) (608)266-3151 ~ /gp 2L.~Z Department of Commerce Sanitary Permit Ap ~prENED State Plan LD. Number ~~ Itt accord with Comm 83.21, Wis. Adm. Code, person information you provide ~ may be used for secondary purposes Privacy w, s15.04(1)(m) 2006 Project Address (if different than mailing address) I. Application Information-PleasePrintAlllnformation ~~ /~~ ~7L~~~'~~~ t TT ~'( UNTY Property Owner's Name Parcel # Lot # Block # ~L~-Ct .t-- L. ~~ ~ L L- C- ~V o Z.a - - ~ ~o Property O wner's Mailing Address Property Location q~ (~ /Or~ C~ ~~'>z <.*-~ per ~ ~I' ~ ~ [J ~ ,(Jj,(f Section Z s ~ ~f' ~~ Cit St t Zi C d Ph N b ~ `_,°-- '' y, (a~ e/y~ /"vJ ~ D fl~ W ( p o e / ~~QIS~ one er um 7lS-~g~ S3~ G T ~ (N; ~Ecor~ ) II. Type of Building (check all that apply) ~.1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number / Pa ~ o s ~ ~ ^ Public/Commercial -Describe Use ~ f o ^ State Owned -Describe Use ^City_^Village ~fownship of ~ ~Pca.-7 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ~ New S stem y ^ Replacement System ^ TreatmentfHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Permit Revision ~~~ ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner ~ // ~~ `/~/~` " ' ( IV. T e of POWTS S stem: Check all that a I ~lon -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravei-less Pipe Other (expl ~n) V. Dis ersallTreatmentArea Information: Deli n Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis sal Area Prop ed (st) System Elevation S ~ Nk~f 9 . r V .Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank "J [~ Aerobic Treatment Unit Dosing Chamber VIi. Responsibility Statement- I, the undersigned, assume respon ibility for installation of the POWTS shown on the attached plans. Plumb 's Name (Print) Plumber' ignature MP/h~RB-Number Business Phone Number z2b ~q ~~~' z 2'3 ~ Plu ber' ddress (Street, City, State, Zip Cod G~i-~ dam- C ~-c.J 1 S VI[l. Count JDe artment Use Onl Approved ^ Di ~ Sanitary Permit Fee ~ eludes Groundwater S Date Issued Issuing nt Signature ( Stamps) ~ ^ O Reason for Denial urcharge Fee) ,~1 ./' ,2r ~ IX. Conditions Approva 3` ~- - - I Jw"~l J t . SYSTEM OWNER: effluent filter and ~~- 1 Septic tank Q ' , t, ,~ ~,,/ a~ a.~ ., „ er t all b dis al cell mu vi d / i t i d ""'C"~~` `'* ~} ^~ p s s c~ e s~r ma n a ne ~as per management plan provided b lumber d s ~ ~ ~ ~ G 7~ y p . , . , Q,a . ~ S 2. All setback requirements must be maintained . as per applicable code/ordinances. .,..ten wn,p,c,c p,am t,u me a,ounry omy) for me system on paper not teas than allL x 11 inches in siu . 2~; SBD-6398 (R. 01/03) W .. ~~o ~ ~~~.~ _ i .Z2t~ 7 ~GL W f 1~ ~~ ~P"' w e g~ ~~ ~ ~ ~ T N '' ~~~ UGC ~~0~ ~ti~ f~1 ,~~ ~~ ~ ~h v ~ ,- ~~~ ti,,v 2 k 1ti~ ~~ Z,, 2 ~~p '~ C. G ~,.D ~~~ ~-26d ~~ 6z +}+CK 4 ~ .Z 24~ 7 ~~~ W~ 15a ~''~ ~ ~~ ~~ ~, rl r N '' ~~~~ -~ ~~, ` ~~o~ (~-~ A.() ¢~ 13Z ~~~/~'~ i26d y~ l ~ ~wrCK pR~GII~AL Wisconsin Department of Comme IL EVALUATION REPORT Division of Safety and Buildings - ~~~ .-~ ~ ~. Page 1 of 3 m auxrwarnz vnu~ wnnn oo, vws. rwrn. was ~'r'h' ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size Plan must . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel i.p. 020 - 1439 - 50 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. a by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (7) (m)). . 2 Z ~ Property Owner Property Location L~ • ~ ^ MARQUETTE & LEE BUILDERS LLC ~~, Lot ---- SW 1f4 NE 1/4 S 25 T 29 N R l9 E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1810 Crestview Drive 50 -- Indigo Ponds 1/57 020/03 City State Zip Code Phone Number ffY ~ Village Town Nearest Road Hudson, WI 54016 ( ) Highlander Trail New Construction Replacement Parent material General corrwrrent and recomrr>enda of bedrooms 4 Code derived design flow rate 600 GPD - Describe: outwash Flood Plain elevation if applicable ~ ft. AU G 1 6 1006 New test required to relocate system area. ST. CROIX C~p~l}{pyrtion In-ground trenches -- 0.71oading rate -- to be designed by Roger Nelson. ~~ # ^ Boring a pit Ground surtace elev. 95.05 ft. Depth to limiting factor 90 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-14 10YR2/1 -- is if-msbk ds as 3vf-co 0.7 1.6 2 14-32 10YR4/6 - s Osg dl as 2vf-co 0.7 1.6 3 32-90 10YR4/4 -- s Osg dl -- lvf-m 0.7 1.6 ` HOI'1ZOris 2& 3 have 10-IS%gr; some cobs. gZ.oe 9l db .fp 2. ~'1O 2 ^ Boring # ~ Q ~~ 86.07 87 pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10YR2/1 -- is lf--msbk ds as 3vf-co 0.7 1.6 2 13-34 10YR4/6 -- s Osg dl as 2vf-co 0.7 1.6 3 34-87 10YR5/4 -- s Osg dl -- 2vf-co 0.7 1.6 OriZOriS 2&3 have 5-10% gr; some cobs. Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mg/l and TSS < 30 nxyL CST Name (Please Print) ~ f ignature CST Number Ma Jo Hollister 224832 Address Da Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 08 - 11 - 06 (715) 426 - 1775 Property Owner Marquette & Lee Blders. LLC Parcel ID # 020 - 1439 - 50 - 000 2 3 Page of _ 3 ~„~ Boring Boring # ~ Pit Ground surface elev. 94.75 ft. Depth to limiting factor 96 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10YR2/1 -- is 3fsbk ds cb 3vf-co 0.7 1.6 2 5-9 10YR2/1 -- is 2fsbk ds cs 2vf-co 0.7 1.6 3 9-17 7.SYR2.5/2 -- Is lfsbk ml cs 2vf-co 0.7 1.6 4 17-35 IOYR4/6 -- s Osg ml gs 2vf-co 0.7 1.6 g 35-96 10YR4/4 __ s Osg dl -- -- 0.7 1.6 orizons 2&3 have 10-15% gr; Z,ep ,6~"'9i1 orizons 4&5 have 1-5% gr; few cobs & stones 33 ~ S Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eft#2 Boring # Bonng pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Mansell Qu. Sz. Cont. Caor Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg/L "Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330res[ (8.07/00) Y Plot Plsn far Site and Soil Evaluation Py'Operty Owner IV~{{RQuE~ ~ ~ ~,ttt.DE~S uC, Legal .Description L.o t Sfl, =~toiGo t~0-~s, - JVvJ`~~4~ Sw~~4 oF-~~ N'E~I~~bEC. as,'tz4~J~ Riau1- -to~n~ O!F t-tN.t~sl~J .sT• c ROUX ~OUA1't,Y~ WtScONS~N • _i~ 1ST ~~~ 0 iz~ ~ a, gw- . n~~ P'~ ~ ~~ 93 p0 r ~ ~ B2 '/ . ~ Q~ : ~ ~,~ ~ -~~. S Sltt I~1CQtlOls: Page 3 of 3 1 " = 40, f~ (fit where muted) ~ = BDe fit Z.~72 f~c~s North T SO ~ts~-,~ DW ~LU~`XOI W f gyp, flG~ i~ x~l -Top p~cc~:=~~i~ ~-~ /~SSLt~A~U f 8~•«jf ~.tl ~-. ~ ~Z.-toP of sP-KB ~a BR-ou-~ . ---~~.. ~`s~ q0 ~ E~ 5.05 C ~, ~. 40~~ ~R~ X ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/lr ,~ (~ (S~. (.f . ~ -~ ~ ~ ~ ~ ~ ~CA./~ rl~~I2,~ ~ C- Mailing Address G2~f ~~~~ ~ ~ Property Address ~ ~ ~ ~ ~~ `14-~~' Cam-- T(~'-~~ ~., ' (Verification required fro Tanning & Zoning Department for new construction.) City/State ~~ ~ Parcel Identification Number ~ Z d - J~3 ~ ~ ~a ~-- d a~ LEGAL DESCRIPTION ~.~ ~ ~ Property Location~~'/4 , Jy ~~ ,Sec. ~~T ~N R~W, Town of >fl~~ Subdivision j N bj ~(~ lO0 ~ ~ .5 ,Lot # jJ~ . Certified Survey Map # Volume ,Page # Warranty Deed # ~ 2 ~ Z ?j ~ ,Volume ,Page # Spec house es no Lot lutes identifiable ~ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic taiilc as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plaruting & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Ihve, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zo~ung Department within 30 days of the three year expiration date. Ihve certify that all statements on this form are true to the best of my/our knowledge. I/we arn/are the owner(s) of the property described above, by vi ty dee~~~ reco~ in Regis~Dee~c~~~t~7/~ ~ ~ ~ ~ Number of bedrooms C~%d',,~ -s ~ 724~~ ~ (~~ ~ _ -;L~~ ~-~~~ . 6 ,~,~ SIGNATU O APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Plamung & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) WisconsinDepartmentof~ommerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Mar uette & Lee Builders Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA c°unty: St. Croix Sanitary Permit No: 4$8242 0 State Plan ID No: Parcel Tax No: 020-1439-50-000 Section/Town/Range/Map No: 25.29.19.2776 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer StlHt inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM 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 Bed(rrench Center Bed/Trench Edges Topsoil Yes 0 No ~ Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 881 Highlander Trail Hudson, WI 54016 (NW 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 50 Parcel No: 25.29.19.2776 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD~710 (R.3l97) Date Insepctor's Signature Cert. No. t~~ Safety and Buildings Division County ~pp ~ C ~ ~ 1~ ` ~ 201 W. Washington Ave., P.O. Box 71b2 (/c.c ,SCO~~,~ Madison, WI 53707 - 7162 (608) 2b6-3151 Sanitary Pen it er to fille y Co.) e 'ta Permit Application State Plan I. , timber -- Inaccord with Comm 83. 1, Wis. Adm. Code, personal information you provide ~- J y ~m~sed for econdary purposes Privacy Law, s15.04(I)(m) Project Address (if di ent than mailing address) L Applicati Information - Plea C IX COUNTY ST a Print All Inform 4Qf ~ 9 . ~~ ~ or Pr ert Owner's me Parcel # of # Block # ~ Property Owner's Mailin ddr ess Pro Location ' ~~~ nn ~/ ~ " ~ ~~ ( [ y L.'/ '/. Section City, to Zip Code Phone Number , ., WY/ fl'~ ~ j ~~0~~ 7 ~`~3~~ 573 2~' trcleo e) T N; R~E or~ II. ype of Building (check all t apply) // Q 7 /f ®; l or 2 Family Dwelling - Number of rooms Subdivision Name CSM Number ^ Public/Commercial -Describe Use lM ®N~ ^ State Owned -Describe Use ~ ~ ^City_^Viliage ~'ownship of fQ7rt`y III. Type of Permit: (Check only one box on a A. Complete lin B if pp t a e) ~ A. .New System ^ Replacement System ^ TreatmendHolding Tank lacement ily ther odification to Existing System • B• ^ Permit Renewal ^ Permit Revision ^ ange of nnit Transfer o t Previous Permit Number and Dat s Before Expiration Plum ter IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound > 24 ~ . of suitable soil ound <24 in. of suitable soil ^ rade ^ S~ le nd Filter ^ Constructed Wetland ^ Pressurized In-Gro d ^ Holding Tank P Filter ^ Aerobic Trea ent Unit ^ R r 'n and Filter Recirculating Synthetic Media Filter Ching Chamber Line G -less Pipe ex m V. Dis etsallTreatmentRrea Information: Design Flow (gpd) ~ Design Soil App ' aU n te(gpdsf) spersal Area Rem (sf) ~ ~ Dispersal A yttem Eleva ' t 5 ~s Q~ ~ r-. ~s a VI. Tank Info Capacity otal nber Manufact r Prefa Site S Fiber Plas[ic Gallons Gallons Units Concrete Constru Glass New Existing Tanks Tanks Septic or Holding Tuck ~ "_ Aerobic Treatment Uni[ Dosing Chamber ~ ~~ / r T VII. Responsibility Statement- I, the dersigned, assume responsibility for installation of the POWT own on the attached plans. Plum is Name (Print) umber's Signature D ~~~-f~~ MP/Mi~FSNumber ~Zb ~' Business Phone Number ~ z 73 ~~~ Ptmr76er's ddress (Stre et, Cit y, Stat ip Co d e) ' / ~ ~ J / ~ ~ / l/ ~/ ~ v `~ ~'~' 4f W C ~~~ VIII. ,ount ~/De artment a Onl pproved ^ Disappr ed Sanitary Permit Fee includes Groundwater Surcharge Fee) ~ ~ Date Issued ~ s cnt Sig cure ( amps) ~ O en Reason for Denial ~~ ~ / ~~ i I~~~I~ovVUNE oval/Rea ns for Disappr ~ ~~~u~ t~'1(,(/~~~2C~ 1 Se tic t ~ k ffl ' p an , e uent rand / / dis ers stall be serviced /maintained ~~~ry~~~ as per management plan provided by plumbe~ ~67~1~ ~/d~~,n~e ~t/s~ aft. S 2. All setback requirements must be maintained ~ "~ `/ as per applicable codelordinances. ~ ~ .3Ua ~ n ~ ~ ~ ~~ 'V _ _ Goa ' `~ o.p,o.c pans tin me ~.ounry onryl for W/e system on pa~tr not rus than lillL x It ~tfches in siu V S -6398 (R. 01/03) -~~~~~ ~2,~yL ~ U ~ ti ~o+ P~n~7 ~1~1 l Ll ~ [t ~ , . ~ .,,,,. •t ~ '" ~ ',~ ~., ~~ .~ a ~~ ~.~` ~ 4~~~~ ~~ ~~ ~ . ~: ~- ~ ~:, r ~~ COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, must e~dend to a point no greater than 6" Below Finished Grade Cover vdth ~CA'M Loekin~ Device ~ X (tgptcalj ~VI LUl~l~ ~.~. a~V~/~1Z O ~- 1 /~lSUL~ Min. 23" Access Opening PIS Ou1et Effluent Filter ~ Inlet Baffle ~S9x Access Opening, not top of eouer, must e>dend at least 4" Above Finished ~Gj ade . j ~PPrZe CA i~ jFinished Grade 1 /ZN/~'~!/~r~/h um I .r Min. 23" Access Opening i ~Z "P>VG ~,~ c~rnRi~l Wig if"O/c S!~ .~ .Union ~,2~YE~ ~iPE 3 F'r _Jl~P1,M- ON`1 d .SOS-/D S'O~G_ ~~~~ 3 ",Sand ar q ra ~ TANK MFR: 1 ~ ~ ~~ TANK SIZE: SEPTIC ~ GAL. DOSE ~ GAL. ALARM MFR: ~-~v~~ MODEL # ~~~ ,,,~~~' Switch type: l~ aJ~~ PUMP MFR: ~ ~~~ MODEL #: 1~{`- SWITCH TYPE: ^~ B = 2_INCHES =_ t~Z. GAL. C = INCHES = GAL. D = CINCHES = ! Z~~6GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) i VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = O FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + O FT. ~rd FT. OF FORCEMAIN x ~~FT./100 FT. FRICTION FACTOR ...... _ + 7.~ 9 [ FT. TOTAL DYNAMIC HEAD (TDH) = Z 2~ ~ FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH th~gUhal~ r , W 1 ~ ~eh~r 2 v /auer rah pd~es ComparFment SepticlPumpTank ~~ ~ ~~~} on offside GUaIIS) SPECIFICATIONS DOSES PER DAY: DOSE VOLUME: ~ Z GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = Z3~ OINCHES = ~Z-L-~--GAL. MP/MPRS SIGNATURE: ~ ~ LICENSE NUMBER: /~~ Z Z`6 ~ ~ 7 -~, ~ ~l~"v.~ 2 7~ Quick4 Standard Chamber 12" . ~~-,~ f . ~s° uicrk4TM STANDARD CHAMBER 34"- SECTION VIEW MultiPort End Cap SIDE VIEW TOP VIEW FRONT VIEW ~~ ` v - ' =~ ~Qulck~~ ,~~~~ ~~lia rya ~ r s, .2 ~~!,t ~ ~ s -be~.JN~1r11`al~Spe~Ificatloos ~ w ,~ " ~ ,M~uIIIPort~End Cap'.Nomina S.~eclf~C at~gh F T a ~t Q'-r n ~ . 1;' ~I~t; ICJ n n'r~l ~ M''k`,_.Yr ra~° y?~r1'r Fr -Rai .h '~ ~~ P 52 X 12 Sfz~ (V^J r' L x Hl , s '° _k t .- "" °~ A r .d "~a~+ 12 Effectl~ e Length „~~~~, ,~8_ , ~ ~Ilivert Ht;ight ,~,,~,,~,~, - ,, ~.~~ 25 .: ~ G.- lniertHelght ~ ''~ * 8~, ~~~ ^ ';= :, _. 1 l R ,c _ ~+ v .. ~ r 1 J lT J ^} h^Y INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY (a) The structural htegrfry of each Gtarnber, end prate, wedge artd other accessory manufactured by InNlretor ("Unitsq, when installed and operated h a leachfiald of an onstte septh system in aocordartce with hfittretor's ins[ntctions, 8 wartented W the orlgAtal Purchaser ('Hddef') against defective materials and workmanship for one year hom the date that the septic permtt is Issued for the septic system contakwtg the Units; provided, txrwevec that if a septic permit is not required by applicable law, the warranty period will begin upon ttte date that installatbn of the septic system commences. To exerdse its warranty dghts, Holder must notify hNtrator h writhg at Ira Corporate HeadquarteB h Old Saybrook, Connecticut within fiReen (15) days of the aAa9ed defect. Infdtretor wiq suppN replacement Units for Unfts determined by Infiltrate to be covered by Nis Limned Warranty. Infiltrator's Nabdiry speGfically excludes the cost of removal arxYOr Installatbn of the Uruts. (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRPPH (a) PRE IXGLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNRS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILfTY OR FITNESS FOR A PARTICULAR PURPOSE. (c) This Umtted Warranty shall ba void R am/ part of the chamber system h marwfacturetl by anyone other than Infiltrate. The Limited Warranty ~ not extend to incidental, consequential, special or Indirect damages. InfAtretor shaA not be liable fa penalties or Aquidated damages, Including bss of production and Profits, labor end materials, overhead costs, a other bsses or expenses hcurred by the Holder a any third pedy. SpecifiraAy exckxied from Limtted Warranty coverage ere daRiege to the Unlts'due to orrYnary wear and tear, alteration, accldenL misuse, abuse or r>aglect of the Units; the Units being suh)ected b vehlcta traffic or other corxiitbns wMdi are not permitted by IFre hslallatbn Atetructbns; failure to maintain the mnimum ground covers set forth h the hslaAatbn hstructbne; the placement of improper materials Into the system contahhg the Units; failure of the Units or the septh system due to improper sitktg or Improper sizlrtg, excessive water usage, Improper grease disposal, or Improper operatbn; a any other event not caused by Infiltrator. 'I1tIs Umiled Warranty shell be void if the Holder fai4s to comply with eA of the terms set forth h this Limited Warranty. Further, h no event shah Inflltretor De responsible for arty bss a damage to the Holder, the llntts, a any Nlyd parry restating from hstaAation or ship- ment. or from anY Wotluct AabiGty clalme of Holder or arty third parry. Fa this tlrntted Warrenry io appN the lMks must be InataAed h accedence with aA stte cnntlitlorts requred by state and local Codas; aA other applicable laws; end Infiltretor's hstaAation hstroctbns. (d) No representative of InAltretor has the authority to rtttange w extend this Umited Warranty, No wanarriy applies to arty parry other than the odgl- nal Holder. The above represents the Standard Chafed Warranty oRered by hfiltrator" A Amited number of states and counties have diRerent warranty require- ments. Arty purchaser of Units ahoutd contact InNtrator's Corporate Headquarters In Old Saybrook, Comecticut, prbr to such purchase, to obtain a copy of the applicable warranty, and sftouW carefully read that warranty prior to the purchase of Units. ~ / • ~ SYSTEMS INC Environmental Onsife Wastewater Solutions'" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • F/aX 860-577-7001 800-221-4436 U.S. Patents: 4,759,661; 5,017,041; 5,156,486; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2.004,564 Other patents pending. Infiltrator, Equalizer and Sidewinder are registered trademarks of InFlltrator Systems Inc. Infiltrator bl a registered trademark to France. Infiltrator Systems Inc. is a registered trademark In Mexico, Contour, Contour Swivel Connection, MicroLeaching, PoyTuff, SnapLock, ChamberSpacer, PosiLOCk, QuickCut, QuickPlay RECYCGEDPAPER and Quick4 are trademarks of InfilVator Systems Inc. ®2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP-0 APR-12~-2005 16 28 ~~ GOULD5 ^.a: ' ::. . FERGUSON ENT HUDSON PUMPS 715 386 6144 P.01 Submersible REffluent Pump .. PE SPECIFICATIONS ~~~.... APPLICanpNs Spepally designed for the following uses: • Mound Systems • E~FfluentJDosing Systems • low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump/ Dewatering METERS FEET I 40 Pump -General; • Discharge:l'/~" NPT • Temperature: 104°F (40°t) maximum, continuous when fully submerged. • Solids handling:'h" maximum sphere. • Automatic models include a float switch. • Manual models available. • Pumping range: see performance chart or curve, PE31 Pump: • Maximum capacity: 53 GPM • Maximum head: 25' TDH PE41 Pump: • Maximum capacity: 61 GPM • Maximum head: Z9' TDH PE51 Pump: • Maximum tapadty: 70 GPM • Maximum head: 37' TDH MOTOR General: • Singe phase • 60 Hertz • 115 and 230 volts ^ Buih-in thermal overloadpro- tecdon with automatic reset. • Class B insulation. • Oil-filled design. • High strength carbon steel shaft, PE37 Motor. • .33 HP, 3000 RPM • 115 voles • Shaded pole design PE41 Motor. • .40 HP, 3400 RPM • 115 and 230 volts • PSC design PE51 Motor: • .50 HP, 3400 RPM • i 15 and 230 volts • PSt design -f ,T PE5i1 .~ ~ r- ---,~ ~ I I j I _ I I I - i .,. -..M. I MODELS: PE31, Pfa1, PE51 I I I I ' . '~ ' HR .33, .ao, .so ..pE4. i f i 1 ' '.I_.. ' , ~ i 2 GPM 1 FT I' 111 ~ ; • I I F..i . I .~....'.~. ppI G~pI I . ; I I , I , I• I I ~ r ' ~ ' I ~ • ~ • I • I ' ' i ~ I ' ~ ~ ' I I I I. I' I I~ I ' ; I I j ' ~i I I . ~ I I I- ' I f i I~ 'I . ~" I- I ~ ; -I i l l ~~ ' I •- ~ 1 ~ ., ~ - I~ I II ~ ~I II - I ,I ~,, , II,I. I I ~ ~~ ~, ' i ' I' , Ili Ijl I ; ,. • 1 ,•; •i'j ~ I ~ I "I I ^i~~ ;~ I , I I -I.i;- ~~~ i; ,. I • 1U ZO 30 40 50 6D 7n ro~~ un 35 10 30 Q s Z5 U Q 20 D 0 15 10 5 ~ - o .. oa 0 5 t 0 15 m3/h CAPACITY ® 200a nT Water Technology, Int. Effective June, 2004 i9PE37/41 FEATURES ^ Corrosion resistant construction. ^ Cast iron body, ^ Thermoplastic impeller and cover, ^ Upper sleeve and lower heavy duty ball bearing construction. ^ Motor is pemtanently lubricated for extended service life. ^ Powered for continuous operation. ^ All ratings are within the working Ilmits of the motor. ^ Quick disconnect power cord, 20' standard Length, heavy duty 16/3 SJTW with i 15 or 230 volt grounding plug. ^ Complete unit is heavy duty, portable and wmpact. ^ Mechanical seal is carbon, ceramic, BUNA and stainless steel. ^ Stainless steel fasteners. AGENCY LISTINGS ~~O C US Tested m UL 7~8 and CSA 222108 Standards 8y tanacr~ Standards Assodation ~le+on~asaa Goulds Pumps is ISO 9001 RegisOercd, Goulds Pumps 4~ 1TT Industries ;` r.~ Qf` ~, O i. j v % ~ _ ~\_ r ' / ~ , ya 'N ' ~ a. 1 - ( ! ` i ~~ `, ~ ~~ F' (3.071 AC~ 1 f l ~ ~ ~ , _ -- - ~ 1.442 AC. N.B.P.A.) ~ j ~~ r ~ ~~ ~ 87839 `S. .....~- ...--- ~. f .= ' ~ -y~ -....._/-.%Z ~ ,/// r' 1 ~ ~ (2.016 AC.)__•- .--__ ` , ,- ~ ~ ~ , .384 AC..,N.B.P.A.) - '` 'f ~,~ .; / ~ ~ '. -~ _ ~ f 1~ ;g$i'_ ~ ~~ ~ . '~~ ~ r 1 ' 315 ..~ i` ~ ~ w /- ~ ~ ..~., ELq'1h~ .ZZ , w • 95.83 .~- - ! j' .. j/ .- Oct' ~ , a ~ i '° ~! -' t ~' '~` ~ ~ ~ `~ , ~~ ~"~~ ;,` ~ ~ ~ ~.-, ,~'~ X50 ~ ~ %~ `~ ,;'' -"49'~ '~ .,' ~ `` a :w - ~ 120'l48 ~ F.. _ ~-104457 S~ ~ ._ _ ~ 4. _ ~' `sue ' `~ \ (2.772 AC) , ~ ~~ _(2.398 AC.)~ . ~'.` ~ - 51 _~ ,' t ! 1.141 AC. N.B.P.A. 1.308 AC.+N.B.P.A.) z, ~..~ ~ i ~ ~,,-- ~ ~ 157194 S.F. ~ . ,,~ ~ - ~ ' _ ~. ~ - _ :~t'_ ; .' 3.609 AC.~J - ''j ; ~ ~ ~ -_. ,r } ~~_--' -- •- ~ ' ~ 1.022 AC. N.B.P_.A. ,i~~'`f " . '~ , ., %"'• - - v r ~ ~~ ' O - s r -r. ~.' ` _.. ~ / r . ` e } . - tf. Vii/ ~ - , ~, ~ ~ r ` ~ ' ` r ~r ~ ~Y~ ` ~ 79 .;~ .. `-~ ,142. r _ .. ~ '\~ _ _ r _ ~ '~ . 1 - _ - ~~ ~ ~ . _...- -. ... ,. i ~ ~ - _ _ - ~~ ~ f~ ^! .`.1 ~ ~~ Vim. )/~/ ~ ~~~' ~ ~/ .,~~ "`~ ~ ,- .- ~ i ; i, ~. • . Wisconsin Department of Commerce nivicinn of Safafv and Buildings SOIL EVALUATION REPORT .,..4.,....e ...:4h !`nmm as wic Aram Cade oSl ~>J ~ ~~ ~fZ~f~e' Page 1 of 3 Steel Soil Service - ... _--- -- -- - - County ---- Attach complete site plan on paper not less than 8'/= x 11 inches in s¢e. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. ~- O~ QZd _ Please print all information. Reviewed By Date Personal information You provide Law, s.15.04 tt) tm))• Propefij Owner Property Location ROSAMJI, L.L.C Govt. Lot na NW 1/4 NE 1/4 S 25 T 29 N R 19 W Property Owner's MailingAddres ~`11~'~( j 3 2~~~ Lot# Btodc# Subd.NameorCSM# 2141 Cty Rd. C 50 na Indigo Ponds City ate Z~O~i~?AhtirS~liFii~Friber J City ~f Village N Town Nearest Road New Richmond ~ 'y~' Hudson Highlander Trail New Construction Use: rI Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ~,;f Public orcommercial -Describe: Parent material Sream terraces and pitted ouiwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevations 95.65 tt, trenches spaced and depth to code 3.75 tt below grade Boring # ~ Boring Pit Ground Surface elev. 99.40 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots *Eff#1 PD~Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 10yr3/2 none sit 2msbk mfr cs 2c .5 .8 2 6-16 10yr4/4 none sl 2msbk mfr cs 1 c .5 .9 3 16-120 7.5yr4/4 none cos osg ml na na .7 1.6 S- COS <35% coarse fragments = 36" & >35% <60% = 60" b l - e ow system Boring # J Boring ~K Pit Ground Surface elev. 99.40 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "Eff#1 PD/ft*Eff#2 in. Murrsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 10yr2/1 none sit 2msbk mfr cs 2c .5 .8 2 6-17 10yr4/4 none sicl 2msbk mfr gw 1c .4 .6 3 17-25 7.5yr4/4 none scl 2msbk mfr gw 1f .4 .6 4 25-38 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 5 8-120 7.5yr4/6 none cos osg ml na na .7 1.6 "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) ~ Sig~ratLr : CST Number David J. Steel ~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/25/2003 715-246-5085 Property Owner ROSAMJI, L.LC Parcel ID # Pending Page 2 of 3 Boring # J Boring M Pit Ground Surface elev. 96.80 ft. Depth to limiting factor 120 in. ~~ Application Rate re t St Consistence Boundary Roots P Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture ruc u Gr. Sz. Sh. *Eff#2 *Eff#1 1 0-8 10yr2/1 none sil 2msbk mfr cs 1c .5 .8 2 8-16 10yr4/4 none sicl 2msbk mfr cs 2f .4 .6 3 16-32 7.5yr4/4 none scl 2msbk mfr gw na .4 .ti 4 32-120 7.5yr4/4 none Is osg mvfr na na .7 1.2 ^ Boring # J Boring _J Pit Ground Surface elev. ff. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. ~ Application Rate Horizon Depth Dominant Color Redox Description Texture Stnucture Cor~istence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land 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, alease 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-POWTSM ROSAMJI, L.L.C. New Richmond,WI 54017 Lic. #248956 NWll4,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 50 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' • =Benchmark Ele. 100.00Ft Top of 1 /2" pKC pipe • =Alt Benchmark Ele. 99.SSFt Top of 112" pvc pipe ^ =Borings Boring Elevations B 1 = 99.40Ft B2 = 99.40Ft ~, ~5,~f- B3 = 96.80Ft B4 = OO.OOFt 7` E' ~}~~ -~~ 7 ~o~f' ~ 3d ~"- ~ r, ~~ ~~ ~35~ ~ 6 ~~~~ _. _ n y«-°, r,~ ,~~~~, ST. CROIX COUNTY r,>~-,,,..;~4.:~-=~=-~,. --~,\ WISCONSIN ZONING OFFICE NNN//NNNN - ~.... ST. CROIX COUNTY GOVERNMENT CENTER `_ ~~.,_... __.- 1101 Carmichael Road ~~._ ~ -~' Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 November 25, 2003 James Rusch James R Hill, Inc 2500 W County Road 42, Suite 120 Burnsville, MN 55337 RE: Shoreland Zoning District /Indigo Ponds Subdivision Dear Mr. Rusch: Certain lots of Indigo Ponds may require a County Special Exception Permit for filling and grading due to their location in the Shoreland Zoning District. The lots include: 36, 37, 38, 39, 40, 41, 45, 46, 47, 49, 50, 51, 52 and 53. Lot 53 is currently under review for further subdividing. If the building site is located within 300' of the Ordinary High Water Mark (OHWM), has direct surface water drainage to the ponds and exceeds the grading limit that is allowed by ordinance in the Shoreland area, a Special Exception permit will be required prior to commencement of construction. Affected lots whose building site is beyond 300' from the OHWM of the ponds will not be required to obtain a Special Exception permit. Please note that on these lots an erosion control plan must be reviewed and approved by the Zoning Office before the issuance of a sanitary permit for the particular lot. It is preferred that the erosion control plan and the sanitary application be submitted to the Zoning Office at the same time to better coordinate our review. If you have questions or concerns, please feel free to contact this office. Si rely, //~~t~"~ V S Rod Eslinger Zoning Specialist RErh CC: Town of Hudson, Brian Wert file ~~"_` POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of Z FILE INFORMATION Owner l2tt~i~r? .~~~ /G ~. Permit # ~~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) al/da Design flow (peak), (Estimated x 1.5) ~D al/da Soil Application Rate al/da !ft~ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODb) 530 mg/L Total Suspended Solids (TSS) S30 mg/L ^ NA Fecal Goliform (geometric mean) 5104 cfu/100mi Maximum Effluent Particle Size Yin dia. ^ NA Other: ^ NA * Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer ~~~ ^ NA Effluent Filter Manufacturer ~ ~ ^ NA Effluent Filter Model ~(~ v ^ NA Pump Tank Capacity jf'D al ^ NA Pump Tank Manufacturer ~/~~ ^ NA Pump Manufacturer ©j,(jL~ ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) ~I'rl-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: 3 ^ month(s) (Maximum 3 years) 9 earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cellls) At least once every: 3 ^ month(s) (Maximum 3 years) ®year(s) ^ NA Clean effluent filter At least once every: ^ month(s) ®year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ?~ ^ month(s) 8 year(s) ^ NA Flush laterals and pressure test At least once every: ~ .® yea~js)(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the 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 (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components,.pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW 14/01) y ^r ' Page ~ of 'START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent: To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall lie taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaceme ystem: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and- proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ Q ~ (~ ~L SON Phone S- z 7 3 _ 7 T POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name Gl~l GD jf~-./~'y Phone 1jl .j' 6 6 This document was drafted in compliance with chapter Comm 83.2212)Ib)I1)jd)&(f) and 83.5411). (21 & 13), Wisconsin Administrative Code. State Bar of Wisconsin Eorm 2-2003 WARRANTY DEED Document Number Document Name THIS DEED, made between Rosamii LLC __ ("Grantor," whether one or more), and Marquette & Lee Builders LLC ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 50, Plat of Indigo Ponds in the Town of Hudson, St. Croix County, Wisconsin. STATE 020-1439-50.000 Parcel ldentitication Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated * ~*Rosamji, LLC (SEAL) (SEAL) * * Signature(s) _ authenticated on * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ~' authorized by Wis. Stat. § 706.06) ~,,.~ r-. THIS INSTRUMENT DRAFTED BY: . Attorney Kristina Ogland 6c~23t~ - KATHLEEN N. WALSH REGISTER OF' DEEDS ST. CROIX CO. , WI REGEIYED FOR RECORD 03/08J2006 10:15AM WARRANTY DEED EXEigt=~' ~ REC FEE: 11.00 TRANS FEE: 488.70 COPY FEE: CC FEE: PAGES: 1 Recording Arca Name and Return Address ss. COUNTY ) Personally came before me on ~Ff L~~ ~// ~C 1~ Jl; the above-named Rosamii LLCT- ~- me known to be the person who executed the foregoing trhm~aS1 and acknowle~i"ae th ame, ~, Hudson WI 54016 _ _ * ~ Notary Public, St e o ' My Commission (is permanent) (expires: ) (Signatures may be authenticated nr acknowledged. Both are nut necessary.) NOTE; 1'IIIS IS A STANDARD FORD1. ANY MODIFICATIONS TO TtIIS FORM SHOULD BE CLEARLI' IDENTIFIED. We1RRAN'l'Y DEED ~ 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 AUTHENTICATION ACKNOWLEDGMENT * type name tx:k>w signatures. INFO-PROTM' Legal Forms 800-655-2021 www.infoproforms.com .~Fyb. 28. 20b6~S12;41PM~-The GEHRKE Group-Hudson i ---. ~~ ~ ~-~ ~~• r 2 ~~ 1 ~: ,.moo ~ ~ LC „'- (2016 71C.j~ r~ ~~--T°° .~ ~ N.9.P.~, ~ j ' ~~C ~ ~..% ` / ~' ~ ,lw i ~ ~ ~~ ~~ ~ ~,. ~ ~ ~ i~ . i 1'-~ ~ ~.~ _.` i ~. . .~ ~. .; ,f ~. ~ /. , ~i ;i.~---~ ~ ,~, , , ~: 1~ r ,,r ~~~ ~ ~' ~ r~ s.~ .~. asos ~c.~l ~~ f -~ ~ ~ ~ ~; ' 1 ~ i ~ ~~ ~ : ,' r ~ . r ~~ \ V I r .ti ~ ~ / y~ ~ ' ,~ 7 fy-' ,%' , wl T s j ~.. ~.~ , /~ ~ ' ~ f , r ~- f ~ r ~ r ~ ~ .~~ rl ~~ 1 141 I~ N.B.PJ-. 1.306 ~~N.B.P.A `~~ ~° _ f '~ ~e . -~ _ '~`~ ` ~ •'' i--- .~ ~ _ • / -1 +~ -_r , ~~ .• ~ _ - ~:, _ ~f T'' - - ~~l / ~ ~~__ I ~i ,r r y~ ~ ~ / f / .' ~~ ~ ~_. r /: _ / r ..~_ ~^ ..-i ~ , i i\ ~ •/ '~, { ~` ~J ~ ~( .,~'/ ~.~ / ~ ~ II i h ~~ ~ ~~~ - ~ ~ ,~~ •ti N .~ v •~ O r.N r a '~ N a o N ~ O C N 4 ti C n O N M tl '~ O W C~ .~ '~ A ~ W Z ~ g z N FN- Z C C7 O Z r to 3 r N V C O a O C ~ R a to J V 0 0 ~o ~ N (h ~ O M y N -O 7 O N 2 #E a ~ m v ~ c ciao 'a C 7 LL 3 3 `~ O Z y O a m C O` N L C V 9 Y N U 7 N a o Z ~ z O ~ ~ y E ~ - 41 O ~ 4f ~ w O O a ~ a a a a~ `° `~ °o ~ N N = N M O -o m Yom) 1'~IJ c J O ~' t6 s} O r ~ a a ~ c :: c O N V O O o° N c N O ` '~ O O O N U C O_ cLi~u~3$ _o v°, C O.L..- Vw w E ~ ~ N 61 w ~w y E ;~'~ ~~a~oov"g V ~~ f6~ f0 OL - E c o.-°v °c~~ d m'~. ~ a a~i~ m vi ~ O o.~ c~ ~~ 3 ~o.Y C~ 3 wg ~ N~ O N d d y L 5 a a~ o a ~"m~ rnca Z N~~ "~ .5 y O N L 0 '= N C V~ C N f0 ~ 'O N y ~C O N y Q~ U N~ ~ U~ O U w c N N 7 a~ r O ` ~ ~ E u~i v°i a z z Z } ~ ~ 7 LY1 ~ Q Q ~ Z in 0 0 ~ ~ so c ,n ~_ ~ m 'E C O +O-' ~ } m a~ a c c ~ ca Z ' Z Y ~ C O N U 0 Z '~ M c 0 0 Z C N 0 0 Z y N O O o O C ~ O ` '~ O O O O C S C C w O ~ to ~ ~ ~ m « cri~ani3L~ N c0 ouo~ . 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N f0 ~ N O .G ',Ev ~ o- E o _ -o c ~$ ~ c c ~ •- ~ - C y U y N O N .~ O. c cc a L o Z ` ° o o d ~ m m~i t6 G1 v N S y fq C ~ O1 N ~ O t6 N L_ L ~ O :- C ~- O O O 'C N C V~ C U 'O ~ O O ~ CN y C yy O (0 ~ N ~ Q , F- U N .C LVl U O `U c N E N ._ a~ r O ` 0' ~ a E vo uoi i a z z O Z N ~ E ~ 3 d m ~ c Z 0 Q In E ~ o -~ v a °o ~ tC0 ~ N y c S C ~ m M c C ~ 7 C7 ~N, N d v ~ in z° y a z° y } V c a~ Z N 0 7 ~ ~~ m ~ } c c Y ~ I I I I I I I I _O Z b M , c I o I m w I Z I N C o I o I Z ~ I I E I a' I °' I E rn V Q. ~ c c °~ ~ I d 7 M ~ ~ o I I I I raRni sc o so PROPOSED NEW LOT LINE PROPOSED LAND TO BE ADDED TO LOT 50 1,596 SQUARE FEET 0 0 ~~ m m ~o~~~ .~ .~ ~~ ~~ ~ ~_~ ~~ v ~~~ ~~~ ~ a e ~ ~ ~ & as ~'o ~~3 ~ -_ ~ $~~ ~~ s z i7~ ~ ~ U ~ t- W ~ i Y ~~ v ~ ~? a ~z ~ ~~ I ~ ~~ _ ~ ~ ~ QO o g ~ J ~- SHED/PLAYHOUSE 0 _ _-~R:~FZp`~~ N ~v~ ~ ab~' ~~~ ~ ~~ ~ ~~ ~y ~~~~ l y~r ~.. ti's ~o v \ ~ `-~ ~~ ~~ ~~ ~l RECEIVED SEP 2 6 2007 A C N = U A n 0 /r?~~ S00°24'08"E 5278.7"1' 134'9/9-0-'I1 0 m v °a Z1 a 0 ~D 1T1 a V v ST. CROIX GOUMY 8URVEYOR'S RECORD NORTH-SOUTH 1/4 LINE ~ 77s.7o' j j ~ ~ $~. =w $ f~} r ~, ~a m v Z ~~ ~`~ I m N ~n NN ~ ~ ° p~ N A m~ A 1 T p O D d ~ ~j~0 1 `~ y ' i P i0O o i~ 16 I c+~a ~ I IP 0aD~60 (?~~10~ i f~ -T t,9~~ 3zso~ s~ • ,80 ' .~ igmi~iu ';uiiNUiuryuumigNgmi Sfi0541 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09Ii4/2007 01:30PM CERTIFIED SURVEY MAP VOL; 22 PAGE: 5456 REC FEE: 13.00 PAGES: 2 /n z m '!b/fll///,~/ N1~3 C~'b~ ~ • ~ ~ ~r~ ~ cAi ~ ~ • a~ O s O ,~/` MY/ry~ptLR` ~ ~ nO i ~ ~nm 1 r G <mo ' ~ ~ z `m ~I o ~~ ~ ~ ~ ~ ~ O ~ rn rn ~ ~ . ~ - Sr~TiC tP -p z - rF~ to . -- T y ~ C v ~~ ~ 5 3.64.0~•~OS - L6'OS £4'6 s~i~ s ~ ~ IQ I~ IQ I~ ~ I IIr I to to I~ I 1 Ig ;~ 1~ I oa•~ o ~ ~~ ~ ~ ~~ c m y ~ m~ c t ic ~ ~o v v ~v • ~ ~c ~ .r~ 2y 'A p ~C Cm') ~m c me ~ O ZZ _ ~ o ~ o ~~ ~ ' ~ > ~~ ~~~ ~ z °: z ~ ~p z n~ ~ c i v z lm2 $~ c» -+ z v m r m c~ m z BEARINGS ARE REFERENCED TO THE NORTH-SOUTH 1!4 LINE OF SECTION 25, WHICH BEARS SOO°24'08"E (ST. CROIX COUNTY COORDINATE SYSTEM) 1~ ~ I ~`~ ~ ~~ `~o ~; r ~v _ ~ ~O '. ~° '~P ~ ' ~O i~ ~! ~~ ~~ ff ~O ' r ~ i~ ~~y~ ~y _ ~ A9' >,Z~ / ~ ~~~~~ ~ ~ ~ i i ~ ~ ~~~ -~ . ,~ ~ / / ~ ~ / ~ i i ~ i ~ ~ Na ~ ~~~ \ ~~ (] U ~ ' ~ ia. ~w IV i ~N G~ ~p rfn~ rxfi ~ ~y~~ w _~~ ~~ ~~ ~ °m -; ~ ~ to ® / 1/1-x£ SA , ~ N sysT~c ~ 9 M+y~~ e- sl 5 v Z ~~~ 5zy~°' ~ °~ ltd ~~ O ~ T ~ m~=~ Z ~ m m >7 Z cn v ~ ~ ~ Z Can=~ D v~o~ --~ o Z m OT O ~ m m _ mn~. ~ ~ O ~ ~1..~.1.( l1J X A m 0 -+c~ ozo= o ~ Z t" F~~ cNn m f,7 ~ _ O y ~ ? oo~~ ~ ZNZ° ~ ~ \ }~ ` J ZcoD ~ . ~~ . ~ ~ ~ ~~ L ~ \ 1~ ~ 1 \~~ 9 ``I. ~ 9 ~. ~~\ ~~ i \ \ ` \ \ \/ N \` D~~Tn ~QCrnZ C~O~p Y n ~ . mmn~ zo~r ~ ~m > ZTO~y~ ccontOi~~N t{~m2~~ c~~ 0 =m =w°Dy CO =~ "U %~ „ ~ p ~Om~ ?O?Q~ O ~ ~ n Zi v i 2~ ~ m ~ OOy~ O m~ai~~ p c ~maim~ a~ to ~~~>a°~SZ ~ m~~~ y~gom m~ ~ ~ o~z 5"~T S ~ ~~ 2 f11 .~A Z m -1~ Cf -i~ A °~~~ v' O SHEET 1 OF• 2 ~ ~ ~ /~ ~Ii1 Vol. 22 Pane 5456 ~ ~ ~ C 7 ~ 3 (D ~ C2 N < C ~ O N ~ > > O to N '~ ~ ~ Q ~ O N ~ ~ p C C n S co ~ O ~ ~~ A N ~p <z~ ~ -~ c ~ ~ 07 ~.. o c ~ ~ o ~ i o { " c m n Z "~ ~ c N O Q ~ N o c O ~ ~ O a ~ o • ~ O ~ fD fD G ~ ~ - o w m ~ 'n ~ m CD ~ ~ ~ ~ N 7O7 O 2 a fD ~. 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W a '' ~ ~ ~ C i < ~ `a ~ Z A N ~ o N ^' Z Z II m ~ ~ CD i p A ~ I C T C a d ~' a~ °1 '~ d "S O y A `h ~o o- A 4 ~d ~V N O O Op ''T.. b°p N yC !~ !~ Cu r ~ ~,, a .; n ~ m o CJ N u, 7 ~ c ~ :3 N Q t9 ( p ~ p ~ ~ ~ ~ N O- ~ d ~ ~ ~' O y ~ ro ~ f° ~ ~ ~ ~ o ~ cn Z D m ~~ D ~' -p ~ W 3 ~ (D i CD N n ('D S c ~. Q M O L O s T D 10 o ~ ~ ~ ~ ~ o ~ ~ c m ~ ~ fD 3 N v 0 s rn C DcQ? m ~~ ~. D ~- w D~~ n ~~ ~ j: ~ o . . 7 C~ -~ 7 O d n `G y y N f N Z A~ cOn3 R°~ 3 m ~N ~ ~ O N O rL N C f/3 .,.. 7 v a ~ _. O N O Cn Q O N A ~ j"O O N ~ O O ~ t0 (~ N ~ 'O CO N N A N N O O~•. A O ~ • ~ N ~ ". N ~.< w _~. A O C n ~ o ~~ °-D~ m °° ~ ~ o w~ ma>>o !/1 ~2 ~ {y v' O N j 7 a O 7 ro r~ O o ~ O i ~u~ol c .°: ~ ~ ~ ~ .~ ~ ~ ~ I 3 ~ ~ N O ~ I m ~ v nl y C A y ~ t0 ~ o.a~I 7 0 N _~ 'O I N ~ O I, y ~ ~ p N a o ~ ~ ~ ~ i N N N ~ ~ v q ~ 1 ~ r- hD ~ A A ~ O 3 d N I N 7 ;-. 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IIIlI''~~~''Ill 1111! 111111111111!111111 !III * a s o s a l 2 '' 8fi0541 ~ KATHLEEN H. WAESH ' REGISTER OF DEEDS ST. CROIX CO., WI ~~ ~ ° RECEIVED FOR RECORD = 09114/2007 01:30PM J CERTIFIED SURVEY MAP A a VOL: 22 PAGE: 5456 ~.~~j,~S,00°24'08"E 5278.71' NORTH-SOUTH 'I /4 SINE REC FEE : 13.00 "~ y - - ~ 77s.7o• J ~ PAGES : 2 ~Z 3499.01' .`•~~uwmurugq. ~ A %/~ N ---I o, m iZ w° v. N T ff f~)1 IV i0 I Ip i~ I~ 1~ m m D~~~ d c > > " n C o 0 0_ m> j a a d m g ~~. r m r- O3~~j~ ~ m p c q ~ ~ g D z p 0 ~ ~io(;iN o m ~ O _ W N N . p <'~ w T t p 2 iP i~ 1~ ~ o~r~aco pgMD~s ; T 1.91'909 3"Z£.0:.~oSUOs ~~ ~ ~ Cn = \ h. ~ •~ ....••..` .~ ~ ~ ~t`J 2 : • ~ ' BEARINGS ARE REFERENCED TO ~ _- v vy p = ~ ~ ~ THE NORTH-SOUTH 1!4 LINE OF s u ~ ~ SECTION 25, WHICH BEARS ~. x a ~ ?6 : h S00°24'08"E (ST. CROIX COUNTY COORDINATE SYSTEM) "'~inrrr~tem"- 1 A_ D S G" <~m I ~ m m G < m X m ~ rr ~ g = O s ~ ~ w r P ; .` r $ oo rn ~ ~ ~ SFQ _ C ~ ® ~ ~ -- SyST _ F x '~ O m _ T vI ~ ~ O OS ~ 16~09S3,.6dA1°L £q'6 m~ . g1'9ZL ~'j \ 1 M....~~ M~~ lH- ~ V V U !, ~ r- -n O -I W O = Z ~ m m z cnO L~ ; ~ °_~~ ~ 3 t ~ ~ b ~ ~ v t/) ~ `~~p p ~m 0 rn 1 ~ ~ ~ ~ Z S ~~ I~ `O ~~ ~ --I m m = n ;~ Z ~, ~ \s0 ~~~ v p 0 1`~' A ~ \i~j ~c~ ~nmp O O n ~' ~ -n C ~ '~ S ~~ o ~ O m :L \`~\ \y O `a ~ C7 cfl 3~ ,09' lZb £L~991 / , ~ p ~ \~Q~ ~ ~ ~ ~ ~ -v ve ~~~ ~ \ y ~ z Z~ ~ ~ \ ~~,~ o ~ ~. --f ~ ~ r ~ ~ i / ~ w ~ ~~ J ~ '..~ .--1 ~ n ~ ~ P tea ~ ~ ~ o i0 o ~ , - . i \ \ I lO ~ N D ~ / ~ / ~ \ ~~ I I`~ ~c7` ~ O wv~i N w ~ ~ ~ ~ y G \ 99 ~ a ~ C+~Ji m p ~~ ` ~ ~ Z i --1 ~ ~ ~ d ~ i ~ ~ / O O ® / ~ OO£ \ N -i Y ~ \ sFa p SysT~C _~ .LN ~`~ ~ S~ \ ~ ~ r Z Z o v v cn N ~ rn~ D~, c m ~ lA O -i ~ 2 to m cZi m° o -' ° ~ o ~~ m '- m D cvi~ m v ~~ ~' ~ ~ D r m ~' Z ~+ o 25 ~ Z T G1 loft OA O Z r m ~ ~ rn ~ O O m O G7 I-I-I c c nc p v v pv Z C \ zv~oz~ vvm-fr' D cnc~z v~ C~O -' A .o`. A O~ \ nr<mC~ Din0~0 m D2 C'>DT~m O ZZ c+ ~~ mDmcmz amA~o mz-<m~ ~mD°y cN~ ~~ ~~~ ~~~'~ ZJ ~ Zcmi~~ O z ~~ m ~= 'l' v o0 ZC ~ TA~~ -- m r ~ Spr- p m? ? ZD p ~ O ~ tn? ?S m =4° I I ~p m =~ m~ "'mvoumi D ~o~~D ~mv GVi.,m~ Cn 2 g~mw~~m ~ Z -r°-mi -zi -O~rvrZA mma?'^' m `~a'ic m 0 v~ ~ vz ITi m Dm mD2() ~ m ~j~zor ii °mG m ~ :~ ~z a, rn o~'f m o nZl ~A o z G) -~Z ~~ ~ ~x ~ 0 2 v zi m m .. G7 Z O m SHEET 1 OF 2 ~ ~ Vol. 22 Page 545b f CERTIFIED SURVEY MAP _ , 5 , LOCATED tN PART OF THE NW1/4 OF THE NE1/4 AND PART pF THE SW1/4 OF THE NE1/4 OF SECTION 25, T29N, R19W, -~ TOWN OF HUDSON, ST. CR01X COUNTY WISCONSIN. BEING LOTS 47-50 OF THE PLAT OF INDIGO PONDS. SURVEYORS CERTIFICATE 1, Ty R. Dodge, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Michael & Sherri Nelson and Jennifer and Steven Knuth, I have surveyed and mapped part of NW1/4 of the NE1/4 and part of the SW1/4 of the NE1/4 of Section 25, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin, described as follows: Lots 47-50 of the plat of Indigo Ponds. Containing 9.39 Acres (409,281 Sq. Ft.). Subject to all easements, restrictions and covenants of record. f also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin statutes and the land subdivision ordinance of St. Croix County and the Town of Hudson in surveying and mapping the same. ,;;; ,. - - , . ..--- ._ _.. ~ - 4 ~ -0'1 .+ +~ R. Do ge RLS #2484 Date ,, ,, S & nd Surveying , . - 2920 Enloe St. Suite i01 _.•: -..;:r_ ` Hudson, WI 54016 :~ _ . .~~ Lot 1 Property Owner acquired the original property with document #840186 and is adding property from an adjoining land owner with document #Q(ao _j9. This map shows the result of those conveyances. No additional lots are created by this map. therefore it is exempt from subdivision review per 13.1(8)(3). Lot 2 Property Ow er ai~ the original property with document #785909 and is adding property from an adjoining land owner with document # This map shows the result of those conveyances. No additional lots are created by this map, therefore it is exempt from subdivision review per 13.1(8)(3). APPROVED ONy~'~'~~O~BY ~!~ L)(4c`(F~-(/'YI ,ZONING DEPARTMENT. DRAFTED BY: WES ANDERSON PROJECT# 6749-01 DATE: 8/6/07 REVISED: 2 °f 2 SHEET 2 OF 2 Vol. 22 Page 5456 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Iaocumeht Number " Document Name THIS DEED, made between an undivided 100/1 ("Grantor," whether one or more), . int tenants as to R. Nelson and Sherri L. and wife, as _lomt tenants, as to an undiv~3tl6~"'mterest, "Gran ee ~TS~ U Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 49, Plat of Indigo Ponds in the Town of Hudson, St. Croix County, Wisconsin. ACKNOWLEDGMENT File #2694813 020-1439-49-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of--way of record, if any. i Dated July`~~ , 2007 * ~osam' i, LLC • (SEAL) (SEAL) (SEAL) * AUTHENT~IjCATION Signature(s) ra authenticated on n eft ~~~r, f~ ~~r~' ~!/~~, _ f/~+ * t1S+1~- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ~~ ~~~~ ~y~~l Recording Area Name and Return Address River Valley Abstract & Title, Inc 1200 Hosford Street, Suite 201 Hudson, WI 54016 STATE OF WISCONSIN ss. St. Croix CO~UN~TY ) Personally came before me on Jul , 2007 , the above-named c,"r~, r known to be * ^~ -cr Attorney Doug Berg Not Public, 1200 Hosford Street Suite 201 Hudson WI 54016 My ommissi~ s) who executed the foregoing of Wisconsin permanent) (expires: `Z"Z ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED t9 2003 STATE BAR OF WISCONSIN FORM NO.1-2003 * Type name below signatures. RIVER VALLEY ABSTRACT & TITLE 1200 Hosford Street, Suite 201 Hudson, WI 54016 (71386-7772 Fax (715)386-7664 File Number; 2694813 Agent File Number: 002694813 Property Address: 883 Highlander Trail, Hudson, Wisconsin 54016 Borrower(s): Steve Knuth and Jennifer Knuth, and Mike Nelson and Sherry Nelson. Seller(s): Rosamji, LLC Lender: COMPLIANCE AGREEMENT, LIMITED POWER OF ATTORNEY AND DISCLOSURE The undersigned hereby agree to cooperate with any representatives of the Lender or River Valley Abstract & Title regarding any reasonable requests made subsequent to closing to correct errors made concerning this transaction or provide any and all additional documentation deemed necessary by the Lender or River Valley Abstract & Title to effect this transaction and make the loan marketable or insurable. River Valley Abstract & Title may receive ancillary benefits from the deposit or the closing funds. The undersigned further agree that "to cooperate" as used in this agreement includes but is not limited to, the agreement by the undersigned to execute or re-execute any documents which the Lender or River Valley Abstract & Title, in the ordinary course of business, deem necessary or desirable to complete this transaction, market loan, and insure the title to the real property. However, the parties hereby understand that the Seller(s) listed below, if any, are not responsible for performing any duties or obligations of the Buyer(s) /Borrower(s) in this transaction and the Buyer(s) /Borrower(s) are not responsible for performing any such duties or obligations of the Seller(sj, if any. The undersigned hereby appoints River Valley Abstract & Title to act as his /her /its attorney-in-fact to correct typographical or clerical errors discovered in any of the closing documentation executed by the undersigned at settlement. THIS LIMITED POWER OF ATTORNEY MAY NOT BE USED TO INCREASE THE INTEREST RATE THE UNDERSIGNED IS PAYING, INCREASE THE TERM OF THE UNDERSIGNED'S LOAN, INCREASE THE UNDERSIGNED'S OUTSTANDING PRINCIPAL BALANCE OR INCREASE THE UNDERSIGNED'S MONTHLY PRINCIPAL AND INTEREST PAYMENTS. In the event this limited power of attorney is exercised, the undersigned will receive a copy of the document corrected, executed or initialed on his /her /its behalf. The undersigned and River Valley Abstract & Title hereby further agree that in the event that this agreement is enforced or attempted to be enforced, by judicial process, the prevailing party or parties is or are entitled to all reasonable costs, disbursements and attorneys' fees incidental thereto, from the non-prevailing party or parties. YOU ARE INFORMED A CLOSING FEE WILL BE CHARGED IN THE AMOUNT OF $260.00 RIVER VALLEY ABSTRACT & TITLE, OR ITS AGENT, ACTING AS REAL ESTATE CLOSING AGENT IN THE ABOVE TRANSACTION, HAS NOT AND MAY NOT EXPRESS OPINIONS REGARDING THE LEGAL EFFECT OF THE CLOSING DOCUMENTS OR OFTHE CLOSING ITSELF. Purchasers choose to share the ownership of this property as: Please Initial One Marital Property with Survivorship Rights OMB No. 2502-0265 Paoe 1 A• CHICAGO TITLE INSURANCE COMPANY B. TYPE OF LOAN CHICAGO TITLE AND TRUST COMPANY t, FHA 2. p FmHA 3. p CONY. UNINS. CLOSER : Tracy L . Turner 4. p VA 5. p CONV. INS. 6. File Number: 2 6 9 4 813 DATE OF PRINTING: 06j28/07 002694813-001 TLT RV ` TIME OF PRINTING: 14:18 ,r 7, Loan Number SETTLEMENT STATEMENT 8. Mortgage Insurance Case Number U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPME C. NOTE: This form is furnished to give you a statement of actual settlement costs, Amounts paid to and by t e settlement agent are shown, ems marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not Included in the totals. D. NAME OF BORROWER: Steve Knuth and Jennifer Knuth, SEE ATTACHED ADDRESS: E. NAME OF SELLER: Rosamj i, LLC ADDRESS: F. NAME OF LENDER: ADDRESS: G. PROPERTY LOCATION: 883 Highlander Trail Hudson Wisconsin 54016 H. SETTLEMENT AGENT: River Valley Abstract & Title, Inc. ADDRESS: 1200 Hosford Street, Suite 201 Hudson Wisconsin 54016 PLACE OF SETTLEMENT: 1200 Hosford Street, Suite 201 ADDRESS: Hudson Wisconsin 54016 1. S ~ LEMENTDATE: July 02, 2007 09:30 DISBURSEMENT DATE: Jul 02, 2007 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract sales price 17 0 0 0 0 0 401. Contract sales price 17 0 0 0 0. 0 0 102. Personal Property 402. Personal Pro e eft e e c S l m nt har es o 0 t b rro e 103, w r li e n 14 00 9 6 6 .0 0 3<>':>:>::::>::>:>:'•>:'•~:•:'••>:'•:>#>:':'>'.:>::>:»::z:::#>:#:.::€:'•:::::::'.:'::~::»?£~t#<::<: ::::::::::::::.:::..::::::::::. ~:;::>:::;:; : 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106, City/town taxes to 406. Ci town taxes to 107, County taxes to 407. Coun taxes to 108, Assessments ~ to 408. Assessments to 109. 409. 110, 410. 111. 411. 112. 412. 120. GROSS AMT DUE FROM BORROWER 17 0 6 9 6 . 0 0 420. GROSS AMT DUE TO SELLER 17 0 0 0 0 .0 0 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500, REDUCTIONS W AMOUNT DUE TO SELLE R: 2p1, Deposit or earnest money 501. Excess de osit see instructions 202. Princi al amount of new loan s) 502, Settlement charges to seller (line 1400) 673 .00 203. Existing loan (s) taken subject to 503. Existing loans} taken subject to 504. Payoff of first mortgage loan 204. Firat National Community Bank of N.R. 127, 501) . 00 205, 505. Payoff of second mortgage loan 206, 506. 207. 507. 208. 508. 209. 509. Adjustments for ftems unpaid by seller Adjustments for items unpaid by seller 210. City/town taxes to 510. City/town taxes to 211. County taxes of/01/07 to 07/01/07 720.12 51L County taxes o of 07 to 07 0l 07 72 1 212. Assessments to 512, Assessments to 213, TAX BASE $1452,17 513. TA7{ BASE 1452.17 214, 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY FOR BORROWER 720.12 520. TOTAL REDUCTIONS AMT DUE SELLER 128 893.12 300. CASH AT SETTLEMENT FROM O BORROWER 600. CASH AT SETTLEMENT TO FROM SELLER 301. Gross amt due from borrower (line 120) 601. Gross amt due to seller (line 420) 7 0 302. Less amts paid by/for borrower (line 220) 720.12) 602. Less reductions in amt due seller (line 520) ~ 12 s, 693.12 ) F-2857-01 4/80 Page 2 OMB No. 2502-0265 ORD/ABS# 2694813 L. SETTLEMENT CHARGES TUNE OF PRINTING: 14:18 ESC 002694813 TLT RV DATE OF PRINTING: 700. TOTAL SALES/BROKER'S COMMISSION based on price PAID FROM PAID FROM Division of Commission (line 700) as follows: BORROWER'S SELLER'S 701, LB: $ to FUNDS AT FUNDS AT 702. sB: g to SETTLEMENT SETTLEMENT 703. Commission paid at Settlement (Money retained by broker applied to commission $ ) 704. Other sales agent charges: 705. Additional commission: $ to soo. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee 802. Loan Discount % 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mortgage Insurance Application Fee#o 807. Assumption Fee to 808. 809. 810. 811. 812. ~• ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from to @$ /day Or o days gp2. Mortgage Insurance Premium for o. oo months to 903. Hazard Insurance Premium for o. oo years to 904. 905. 1~• RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance o . oo month @$ per month 1002. Mortgage insurance o. oo month @$ per month 1003. City property taxes o . oo month @$ per month 1004. County property taxes o . oo month @$ per month 1005. Annual assessments o . oo month @$ per month i~• o. oo month @$ per month 1007, o. oo month @$ per month 1008. A e ate Accountin Ad'uatment 0 , 00 0 , 00 1100• TITLE HARG 1101 • Settlement or Closin Fee to River valley Abstract & Title 15 0. 0 0 15 0.0 0 1102. Abstract or title search to 1103. Title examination to 1104. Title insurance binder to 1105. Document re aration to 1106. Notary fees to 1107. Attorney's fee to 1108. Title insurance t0 River Valley Abstract & Title 425.00 inciu es abov ite d e ms b num ers: 1109. Lender's co era e v $0 0 9 o $ 2s o 4 0 Owner's covers e 1110. $1 ~0 000 0 9 0 $ _.. . . __ . _. 1111. Prepare Power of Attorney for Nelson to Locomen Abdo 7 5 . 0 0 1112. 1113. i2oo. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deed $ ll.oo ;Mortgage $ ;Release $ ia.oo 11.00 13.00 1202. City/county tax/stamps: Deed $ ;Mortgage $ 1203. State tax/stamps: peed $ slo.oo ;Mortgage $ 510.00 1204. Record Real Property Control Agreement to St. Croix County 35.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest inspection to 1303. 1304. 1305. 1306. 1307. OMB No. 2502-0265 Page 3 /ABS# 002694813 TLT RV SUPPLEMENTAL PAGE DATE OF PRINTING: 06/28/07 . NAME OF BORROWER: Steve Knuth and Jennifer Knuth NAME OF BORROWER: Mike Nelson and Sherry Nelson . NAME OF SELLER: Rosamji, LLC PAYOFF OF FIRST MORTGAGE LOAN CHARGE AMOUNT 504.001 Loan Payoff to First National Community Bank of N.R. $ 127,500.00 "' TOTAL PAYOFF OF FIRST MORTGAGE LOAN (LINE 504) $ 127,500.00 -------------- -------------- Ihave carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by mein this transaction, I further certify that I have received a copy of the HUD-1 Settlement Statement. ~i~ ve Knuth Roaamji, J fifer Kn , Mike Nel on Nelson Sh~r~i To e o my no ledg a HU -1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and ha a w' a di bur th un ersi d as part of the settlement of this transa ' Sett meet A Date WARNING: h is a cri to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can Include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. UTILITIES The undersigned Seller(s) do hereby state that I/we will make arrangements with the City Water/Utilities Departments to have final readings made on water/utility charges and will have the final bills sent to me/us at our forwarding address; Seller(s) wilt pay the final utility bills immediately upon receipt so that the final utility bills do not, at a future dare, become a lien on the above described property. It is the Sellers' responsibility to deal directly with the City to reach a settlement amount and pay the final bill. The undersigned Setter(s) and Purchaser(sj do hereby individually and jointly agree to fully protect, defend and hold harmless Chicago Title Insurance Company from any loss, costs, damages, attorneys' fees and expenses of every kind and nature which it may suffer, expend or incur under or by reason of this utilities certification. The undersigned further acknowledges that an Owners Policy of Title Insurance issued in conjunction with the current transaction, will not afford protection for unpaid utility bills not yet a lien on the real property. PENDING ASSESSMENT NOTICE The undersigned Seller(s) certify that they HAVE HAVE NOT received a notice of any pending special assessments or a notice of hearing for a new improvement project from any assessing authority, the costs of which may be assessed against the property, that have not been disclosed to Purchaser(s) in writing by the Seller(s). PROPERTY TAX DISCLOSURE In the event the current year's property taxes are not yet available from the County Treasurer, the undersigned Seller(s) and Purchaser(s) understand and agree to base the tax proration on last year's actual property tax amount or on the tax estimate received from the County. This is a full and final settlement of the tax proration. The undersigned Purchaser(s) understand and take responsibility for homesteading the property immediately after closing and upon occupying the property. The undersigned Purchaser(s) are responsible for all future taxes due on the above referenced property. In the event Purchaser(s) are not required to escrow for taxes and have elected to pay taxes directly to the County Treasurer, the Purchaser(s) are responsible to contact the County .Treasurer for the next payment date. The Purchaser(s) are responsible to contact and obtain a duplicate property tax statement from the County Treasurer. MORTGAGE LIABILITY AGREEMENT As a requirement of closing, Chicago Title Insurance Company is being requested to payoff lien(s) and/or mortgage(s). The Lien Holder/Mortgage Company's acceptance of the payoff figure as shown on the Settlement Statement is NOT guaranteed by Chicago Title Insurance Company. The Owners/Sellers and or Borrowers agree to immediately pay to the Lien Holders/Mortgage Company any additional funds necessary to satisfy the liens/mortgages, including but not limited to: additional interest, escrow account shortages, late fees, foreclosure fees, legal fees or accounting errors. If the Owners/Sellers and or Borrowers dispute the accuracy of any additional funds needed to payoff and or release the liens/mortgages, the Owners/Sellers and or Borrowers agree to pay~xhe additional funds to the Lien Holder/Mortgage Company immediately and settle the dispute between the appropriate parties after the lien/mortgage has been paid and released. Dated: July 2, 2007 /~ Owner Phone Owner Phone Owner Phone ~~s" ~~G - ~os~ Buyer ~ Phone ~/5' =3f3lv-d c~ ~ Byer Phone Buyer Phone