Loading...
HomeMy WebLinkAbout020-1074-30-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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 Hamann, Terrence Hudson, Town of CST BM Elev: / ll~ ~ ~ Insp. BM Elev: /U~ : a BM Description: C ~1L .11~t~t d 'h~a ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ` ' ~ ~(./ /~ Dosing Aeration g' „_ Holding TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Septic d t i ~ i .3 8 ~ ,~.~ ~ ~ Dosing Aeration Holding - PUMP/SIPHON INFORMATION ( ~i~,t,~~j Manufacturer Demand GPM Model Number TDH Lift Friction Loss System He TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM v ELEVATION DATA County: St. Croix Sanitary Permit No: 506321 0 State Plan ID No: Parcel Tax No: 020-1074-30-000 SectioniTown/RangelMap No: 27.29.19.14296 STATION BS HI FS ELEV. QD Benchmark ~ ~ ``~ ~ /O I ' Alt. BM Bldg. Se r tti ~ ~S ~ p ' b 0 Ht Inlet ~ ~ f ~ f N ~~ ~~ ~,~ t Outlet b7 ~ 7 0~ Dt Inlet _ t Bottom _~ Head :vtan. `"T- " ~ , ~ ~~ 3 7 Dist.~P'pe ~ ~y/ 3. S Bot. Sy tem z .aw' Z ~ -ZS ~-z. s Final rade /J ~ ~, O St Cover 2 i t-~~ ,~ Q- ~~ ~ ~?~ ~ P. (ll'L C'TJLCO~c.- ~ ~Z-~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ^ o` ~ / 1 _ ~ ~ W SETBACK TO SYSTEM P/ 3LDG WELL ~ LAKE/STREAM ACH G Manufact ORMATION HAMBEfi< h INF Ty Of System: ~ -~J ~" ~~ UNI Model Number: ~~{y - DISTRIBUTION SYSTEM .~.r,.~Ona, _~,,,,., 1,.~~.a. eader/ anifo d Distribution ~ _ ./- x Hale Size - x Hole Spacing ent t Air Intake ~ ~ Pipe(s) f i' In'vLf/it ` ~ r i L h Di S ~ .--~ th Dia_ ng engt a pac SOIL COVER Y Pressure Systems l~nly YY Mnund nr At-Grade Systems Only ~ (A~ ~~ .L.n n i Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges ~~ Topsoil -- ~- GI Yes [ ~ No ! ~ Yes ~ No 6lL ~ ~i a~ lAJ r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ I / ~ ~ Inspection #2: / / Location: 678 Red Maple Lane Hudson, /W, 154016 (NW 1/4 NE 1/4 27 T29N R19W) NA/Lot 2 //~~ ~ Parcel No: 27.2/9,.19.14296 1.) Alt BM Description = Up~ ~~`~- "" ~Z ~ ~~'';~-~~ r!E~ 7` r ~:~11~J ~~-~ ~ "=K~: _ L /_ 2.) Bldg sewer length = ~~y ~; /~ ~t ~``,SVS ,, /~~ pj~~~ /~/~Q./Q'.Q~ IcrQ/~7/Vl - amount of cover = ` 2 n ~ L lU~ J'A'G b.-~2c,-~ ~~-/-~ ~OI,~(/~/ ~C~.e~r-LOd ~C1/b ~" SL~Xi(}-Q~ ~t11 /, ~.. Plan revision Required? I ~ Yes ~ ~ o S U~ Use other side for additional information. _~ _ - l ~ v ~__' - _ _--- -- - - ~'~~~'v`'~-_ __ Date Insepctor's Signature Cert. Nc , SBD-6710 (R.3/97) C4Mtl18t'~t'.wi,~tlV Safety and Buildings Division 201 W hi W County 1 ~ ( S _ ,~ . as ngton Ave., P.O. Box 7162 ~ (~ • ~ "1 ~~~ n ~ Madison, W 07 62 Sanitary Permit Number (to be filled in by Co.) De#~trtment ~ commerce 5ocp 3Z l Sanitary Permit ApplicatiU~i~«~. State Transaction Number .,w,, In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove"r~lffflll~I unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Commerce. Personal information you pro ' Project Address (if different than mailing address) u ses in accordance with the Privac Law, s. ] 5.04 1 m , Stars. ,/I/I I A lication I f ti Pl P i 7 8 ~~ ~ -" t Gp ~ ~G I~ . n orma on - ease r nt All formation Property Owner's Name ( ~e ve>nce ~q,~~,nln SEP i ~ ~~t~~ arcel # o-lo7y-3~-o0~ Property Owner's Mailing Ad{dress 8 ~"'f- 1 (~ ~t/1M ~.(~ - ST, CROIX CCa.3t~'31' operty Location I ~~~~ (~ v vt. Lot City`, State ~ Zip Code ` ~~f y, N~ yo, Section ~~ - U ~ $ c) ~ ~ ~- 1- ~ I O ~ ~ ~ ~ 5 ' 3 8 ~ -sy~ p (circle one ~ T ~ ~ II. Type of Building (check all that apply) Lot # N; R . ( E ot I or 2 Family Dwelling- Number ofBedrooms ~ ~' Subdivision Name ~'.` ~~ ^ Block # Public/Commercial -Describe Use cJ~ ~ 2 ^ City of ^ S ~~_, O`g~„ tate Owned-Describe Use 's~ CSM Number - ^ Village of ll \\ II-- CJIS"I~ CQIS W ((0 +' ~~ Lr'1aN16<fS L ,~ q ~~~ (~ 1 1~~ ~Townof ~U1~Sn1~ -~~ III. Type of Permit: (Check only one box on line A. Complete line B ifapplicable) A. ~ New S stem Y ^ Re lacement S stem p y ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S stem/Coin onent/Device: Check all that a 1 Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound _> 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ~1LC..C~t,,,,: retreatment Device ( xplai ) V. Dis ersal/TreatmentArxc Information: Design Flow (gpd) / ~lSo Design Soil Application Rat gpdsf) ~ Dispersal Area Re uired (st) ~ / Disp rsal Area Proposed (sf) ~ System Elevation ~~ t G + ~ ~- (o y 3 s l0 9 (s y. o 6~ o w ~oK ov VI. Tank info Capacity in Total # of Manufacturer Gallons Gallons Units ~ ° 0 ~ New Tanks Existing Tanks w/Par r/z z5 O ~ w ~ ~o ~ ~ ~ rn y ~ y "' ~~ w in j a. v ~ C7 ts, Septic or Holding Tank J ^ O n U lJ ~ e (S Q /. Dosing Chamber VII. Responsibility Statement- t, the undersigned, assume responsibility for installation of the POW wn on the attached plans. Plumber's Name (Print) o m ~ Plumber's ign ure PRS Number Business Phone Number ~ t,~~ ( ~3~a~3 7/~-3~6-~~SZ Plumber's Address (Street, City, State, Zip Code) ~ 3/ ~ s ~ ~ `71~~ 01210~~ LGVtQ ~~/JS~ ~~ V111. Count /De artment Use Onl pproved isapprove Permit Fee Date I sued Issuing ent Signatu er Given Reason fo nial ysv . oa q ,! ~7 IX. Condit~~~easons for Disapproval 3, RS ~o~~~'/rt147 w~ t ~ ~. /gyp Ir~~r,,~,q 1 Septic tank eftlueM filter and ,J !~ P`~'+ . , , nn ~ s~~a~ / dispersal cell must all tae servtces /maintained $~(~,~ ,~ 101¢.. Sw~ °~~ as per management plan provided by plumber. 2. AH se'[back requirements must be maiMainad y S ' ~ ' ~ ~ rt,~ e~ ,~, w ~ l . -••••-•• •~ -v+•r+~•~ v~•+~ +~• •••~ ~~>.~n. a..u aumnn w . r ~.ounry omy o per no[ Bess [nan a u~i t t inches m stze SBD-6398 (R. Ol/07) Valid thru 01/09 1 ~~ (~ ,~ ~~}~ ~ Gays ~~,•v r ~,. <; ~.~ ;,`..... ,..:: . ,;. . .,~;~ _ T-~ (' ~~ ~ fie- -~-- ~ ~Y v~ -~-- Gu ~ ~o ~-- ~ ~, ~~v~ -b~n~h ~~~ ., \ _ ~ ~. _. ~ ,, 6 ~~~ --_`_ i ~ ~~~ i , "' ~~~ r i - ~ ~ ~~ ~ o ~ - ~ ~' ~ ~ ~Q '~ - _ _ - ,~ ~a,.l ,, 1 ~~ ~~~ , r ~ ! ~~. ~~ ~ ` ,ti ,~„~ ~ ~~"t`n~~-S ~ . _ __ _ __ (~ is ~ ~ ~ ____. ~'a~fi'Yt a . ~Q,S C,;,~ ~~~ \~ ~~ ~ '~ F~ ~~ \ ... ti ~ \ \ ~ ~ \ 1 al ~ Z ~ m a ~ ~~ ~~~~ N v ~~~• -~W~~h ~'P ~~id ~ ., -, - - , ,_ .. ~~ ~. `~ ~ .~~a(e f ~, _ yG r E < °Sf r ~ ', ~~ ~ ~, ~ ~ , i 1~~ ~ ~, t' ~ ~ ~ ~ 1 ~Q~~~- . _~ l ~~ ®d~~ ~ ~ ~~ ie 2_ 3~C~ ~ \ ~ e ~ ~~ ~ ~ ~ ~ ~ ~~ .\ Irl ? T Wisconsin`bepartment ofCommerce Division of Safety and Buildings SOIL EVALUATION REPORT in nnnnrrl~nnc wiFh f`nmm AF Wie Gtim ~'.fV'IP 1795 Page 1 of 3 A.C.E. Sal 8 Site Evaluations County Attach com lete site Ian on a r not less than 8'l x 11 inches in size. Plan must P P P Pe St. Croix include, but not limited to: vertical and trorizontal reference point (BM), direction and Parcel l D percent slope, scale or dimemsions, north arcow, and locafwn and distance to nearest road. . . 020-1074-30-025 Please print all information. ~ Dat Personal informatiai you prcwide# mey be ,~ (Priv Law, s. 15.04 (t} (m)). /~~y~, ~U 2 D ~ (~ l/ Property Owner Property Location Terrence & Cathryn Hamma Govt. Lot NW 1/4 NE 1/4 S 27 T 29 N 19 Property Owner's Mailing Addres lock # Subd. Name or CSfih# ~p 778 Hill Farm Road ~„ , ,~ •: Outjot 1 CSM Vol. 17, Pg. 4490 City tate Z~p~~t~tcimber ~ _f Village 1+ Town N~rest Road ~ujyyt~~ Hudson ~ WI 54016 715-381-5459 Hudson Hill Farm Road New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Fkxxi plain elevation, if appf'-cable General comments ~ `~ and recommendations: Install two trenches at elevation = 93.75' using 28 leaching chambers. 600 GPD na e ~-~ ~~ ~ Boring # Boring !/ Pit Ground Surtace elev. 96.42 ft . Depth to limiting factor ~~ >94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3l3 none sil 2fsbk mvfr cs 2f,1m 0.6 0.8 2 11-21 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.6 0.8 3 21-30 7.5yr4/6 none gr Is 0 sg ml cs 1vf 0.7 1.6 4 30-66 10yr5/6 none s 0 sg ml gs - 0.7 1.6 5 66-94 10yr6/6 none s 0 sg ml - - 0.7 1.6 Boring # Boring ~~ N Pit Ground Surtace elev. 98.25 ft. Depth to limiting factor ~ in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/3 none sil 2fsbk mvfr cs 2f,1m 0.6 0.8 2 11-29 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.6 0.8 3 29-39 7.5yr4/6 none gr Is 0 sg ml cs 1vf 0.7 1.6 4 39-72 10yr5/6 none s 0 sg ml gs - 0.7 1.6 5 72-98 10yr6/6 none s / 0 sg ml - - 0.7 1.6 /~ it '~ * Effluent #1 = BOD 5> 30 < 220 mg/L and SS >30 < 150 L ~~ ~ ffluent #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Please Print) ature: ~ CST Number James K. Thompson `~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 154020 5/112004 715-248-7767 Property Owner Terrence & Cathryn Hamman parcel ID # 020-1074-30-025 Page 2 of 3 Boring # ~ Boring Pit Ground Surtace elev. 98.11 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 *Eff#2 1 0-10 10yr3/3 none sit 2fsbk mvfr cs 2f,1m 0.6 0.8 2 10-15 10yr5l4 none sit Zfsbk mvfr cw 2vf,f 0.6 0.8 3 15-21 7.5yr4/6 none gr Is 0 sg ml cs 1vf,f 0.7 1.6 4 21-62 10yr5/6 none s 0 sg ml gs - 0.7 1.6 5 62-96 10yr616 none I s 0 sg ml - - 0.7 1.6 ,L r ~~ ^ Boring # ~ Boring df Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Gont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots `Eff#1 'Eff#2 ^ Boring # I Boring _ J pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 `Eff#2 `Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS ~ 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Q f • E/e /a Rio ~ ~ So,'/ed4/ua~'on /J.~ ~ggµµ~ 'f9 r'es`'uir('rrlOw~c e:/=5/0 of /, CSM / 7~5~5/90, '`1ES.Z? T. o N~s~, 5-~ .cio;,~ ~.~ . ~o~ 2 ~~ ~, .~ lot ~~ ~~~~ b ~~ ~~~ t3c.nah wiar ~ T,,o of /''p.d.c. P,/-~. 9 .D' - a3 i~ ^-7 97._0 '_._ 'I °-_~.-~-~ / ~ i i ~~ i ~i i ~~ i i ~// / i 6 ~ ,' ~ ~~~ ~` i I ~' 5`r' Q~E /off ('y~ner Elev :9,2.36 ~~.30~~ ? 6 6 6 5 6 Line of Southwest Quorter of the Northeost Quorter YOL 19 PAGE 4924 KATHLEER H. N7IL~5H-"-'"-` REGISTER OF DEEDS CRUIR CO., MI R ~EIYED FOR RECORD 0 /03/2005 04:00Pl1 I 1-1~4" O D. UNPLATTED LANDS C TIFIED SURVEY KAP Iron Pipe - - _ . - .- , ._._ R FEE: 13.00 West Line of Northwest Quorter of the Northeost Quorter C ' PAGES: 2 unn~nn+n-s++e- .. .+ !D( r- ~ (n o ~ i~ iW r o -'~ ~Q i0 ~~ y ~ ~I Q W ~- ~ W ~ `' i ~ C ~ a D .-+ 1 ~ ~ 1 r Z m \ ~ ~ ~~~ -P CO I N .. I-S~` I-~ ;]fie. o a I I~ . io ~~ IO ~ Z o~ b ItD i~ 13 I Ij b ~ ~`° I~ I~ 12 I~ IN ~~ 66' ~~ .Q ~~ I° Ic i~ I d' I V la 1~~ vv ~~ ~ 1 c,. to °c I~ ~ C I r ~ ~•~ 4 I o~ ~ I ~~ o~• o O i I I O Ira I ~ I "~' ~ ~ p 4 0 l~ ~~ir / . 359.93' (N00'<JO'27"E 359.94, w~i-A N°m ~p~D r- ~~ o W ~N IC Icy ip . I~ I~ I° I V I r -~ °~° o w4 v r ~: ~, "'~ Q ~' N ~o ,~ O 0 N~ '~ b ~ ~ . 1 Eost Line of Outiot 1 ~ ` S00'00'S2"E 201.22' / ~, `~' NW Cor. Lot 6 ~ ~~ ~ ~ ~ ~ I~ ~ ~ -'~~ ~ ~ I~ ~b I~ o 5, o ~°: IQ I t I4 t r o ~ 0 0, I ~ o ., I $~ _ NND ~ -. ~ ~ ~ ' SO ~~ gy ITI I D . p 100' ~ ,o O • -~ w ni ~~ ~ w m -~ ~+ ~ r-- ~ ~ - Found 3" 0. D. o '~ O~ c° ~= Jron Pipe I "' ~~\ rn w0~~ \ ~~__-~ ~~W Storm Woter Retention Area '~~ U~iw Joint Orivewoy Esmt.~~, ~~ 160.47' C1 ~ ~ _. ~ g ~ ~ ~ i ,- ,a ~ j C ~Ci ~~ 0 0 --~ S00'00'27"W 950.22 ~ ~ ~ A~~ - m o v, a p p ~ ~ a' rv a Z C V ~ v ~ I ~ Z 3 ~ o ~ ? .~ w ~~ y ~. p ~v w f*1 o ° ~ to ~~ ` `° co ~ ~ i~ Icy {r ~ ~ N i ~ W I~ I'A I I~ ~ N o m ~ v to l~ ~ ~ ~ 2 41 ~ e Found Northeast Corner ~ s p~ o ~ ~ Sec. 27-29-19 ,~ °, W ~ 0 4 o Aluminum Monument -f , 1 ~ ~ o ~, ~ . ~ o ~ p..,. ~ ~ ° n Zr o Ov m Q ~ 59' ~ z ~ C 7p y~ ~ Na ... S00'00'S2"E ~ ° ~ ~' o n p ~p~ o _ . 4D C ~. ~ ~°°? `~' -'~ m ~ CW ~ ~ ~ I ~ ~ ~ 0 ~ 0 Q I^" , ~ I° r*i I t I I o- I Cn I O o o m ~ ~ m ~ ~ '~ ~ n r. 7 , ~ N I~ o o a ~ a ~ ' ` ~ ~ OD I W ~ o ~ o ~ -• o C O 3 '0 V ~ a m A `° x 3 1~ I N ~ ~~ w ~ ' + o. ~ o ~ X20 ~ o e . , c a ~ f NE Cor, tot 6 u~i 1 ~n Qa~ - RCS ~~ rJ Lot 15 Plat of Humbird Hrlls~ .~ 1.~ A~~:'d I ° ~~ ~ ~ ~ Z a-• 0 0 ~ 3 ~~ OCOCp O ~ ='* '"' fi~~A n r-N~ O. rn , ~ ~O J~ °~'oo ~ . ~ ~~ ; ~ rn n ~ ~NZ D _o~o fi ~. n. o o o C!3 + ~ _?~' C c ~Q'aQ C ~~~ rn Q a~~ -~ T V ~ -~ Q _~ ~y~a 3 ao ~? co D ~ o 0 ~ . °, 7 ~" GO Q '~` O ~ C [~"'~~ CERTIFIED SURVEY MAP Located in the Northwest Quarter of the Northeast Quorter and the Southwest Quarter of the Northeost Quarter of Section 27, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin; including Lot 6 of the Plat of Humbird Hills, port of Lot 30 of the Plat of Badlands Prairie and also Outlot 1 of the Certified Survey Map recorded in Volume 17, Page 4490 Central Arc Chord Chord Curve No. .4r.gle Radiuc Langth Bearing Length Tanyent in Tangent Uut 1 20'29'39" 233.00' 83.34' S10'15'41,5"E 82.90' S00'00'S2"E 520'30'31"E 1 (Record) 2031'02" 23.3 00' 83 44' 510'15'17"E 82.99' 2 13'01'50" 303.00' 68.91' 583'33'54"W 68.76' N89'55'11 "W S77'02'S9"W 3 89'54'19" 50.00' 78.46' S44'58'01.5"E 70.65' S89'S5'11 "E S00'00'S2"E Located in the Northwest Quarter of the Northeast Quarter and the Southwest Quarter of the Northeast Quorter of Section 27, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin; including Lot 6 of the Plat of Humbird Hllis, part of Lot 30 of the Plat of Badlands Prairie and also Outlot 1 of the Certified Survey Map recorded in Volume 17, Page 4490, described as follows: Commencing at the North Quarter corner of said Section 27; Thence South 00 degrees 00 minutes 27 seconds West, along the west line of the Northwest Quarter of the Northeast Quorter of said Section 27, a distance of 950.22 feet to the northwest corner of Outlot 1 of the Certified Survey Mop in Volume 17, page 4490 recorded in the Register of Oeeds Office, this being the POINT OF BEGINNING of the parcel to be described, Thence South 89 degrees 54 minutes 04 seconds Eost, along the north fine of said Outlot 1, o distance of 363.11 feet to the northeast corner of said Outlot 1, Thence South 00 degrees 00 minutes 52 seconds East, along the east line of said Outiot 1, o distance of 92.59 feet to the northwest corner of Lot 6 of the Plat of Humbird Hills recorded in the Register of Deeds office; Thence South 89 degrees 46 minutes 16 seconds East, along the north line of said Lot 6, a distance of 442.18 feet to the northeast corner of said lot 6; Thence South 00 degrees 00 minutes 52 seconds East, along the westerly right of way of Hill Farm Rood, 160.47 feet to a point of curvature; Thence continue along the westerly right of way of Hill Form Road, 83.34 feet along the arc of a curve concave to the east, with a central angle of 20 degrees 29 minutes 39 seconds, a radius of 233.00 feet, a chord bearing of South 10 degrees 15 minutes 41.5 seconds East and a chord length of 82.90 feet to a point on the westerly right of way of Hill Farm Rood; Thence South 62 degrees 04 minutes 49 seconds West, along the northerly right of way of Red Maple Lone, 51.23 feet; Thence continue along the northerly right of way of Red Maple Lane, North 89 degrees 55 minutes 11 seconds West 311.14 feet to a point of curvature; Thence continue along the northerly right of way of Red Maple Lane, 68.91 feet along the arc of a curve concave to the south, with a central angle of 13 degrees 01 minutes 50 seconds, a radius of 303.00 feet, a chord bearing of South 83 degrees 33 minutes 54 seconds West and a chord length of 68.76 feet to a point on the northerly right of way line of Red Maple Lane; Thence South 89 degrees 19 minutes 33 seconds West 395.46 feet to a point on the west line of the Southwest Quarter of the Northeost Quarter of sold Section 27; Thence North 00 degrees 00 minutes 27 seconds East 372.94 feet to the P01NT OF BEGINNING and there terminating. Subject to all easements, restrictions and covenants of record. The total area of the above described parcel is 253,100 square feet - 5.810 acres. SURVEYOR'S CERTIFICATE t, Clarence E. Schultz, Registered Wisconsin Land Surveyor, hereby certify. That in full compliance with the provisions of Chapter 236.34 of the wsconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Terry and Kathy Hamann, 778 Hilf Farm Road, Hudson, Wisconsin, 54016, I have surveyed, divided and mapped the above described parcel and that such mop is o true and correct representation thereof. Note: Each parcel shown on this map is subject to state, county, and township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Groix County Zoning Office and the Town of Hudson. ,,,,,t~CO~S,i,,, i- i "7 1 53~~ APR - ~ 2004 VOL ~ ~ PAGE 4490 KATf{LEEA N. w7CCSA-'~" REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR ~2ECORD 03/31/2003 10:45AN CERTIFIED SU_RV_EY NAP - • v w CERTIFIED SURVEY MAP PAGES~EE2 3.00 A. David Kelly, Jr. Located in part of the Northwest % of the Northeast 1/. of Section 27, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. LOT 1, _CERT/FIED SURVEY M VOLEIME 10, PAGE 2871 _ _ KELLY_ESTATES UNPLATTED~ ~ I (~1NPLATTED LANDS ,LANDS 1_ NORTH 1/4 CORNER (R = 22 RODS OR 363 SECTION 27, 729 N, R 19 W ~RR = 89.57 E) (R = S 89.44'13'E 2603.021 p°OppSI7TIO~~N pF--FI~~E~~~ J (R = ~JN6~ 8' 44'E -~~ - S~89'44-'13'E 2603.1 f - 1111Y~G~ ~~,~ S89° 44'13"E 3Gi.i19' ~ -,._L[SCCl~! _ _~o _ S 89'44ti3'E .~~ 2240A2' N 00°00'27" E 47.00' .z~ - Y N FOUND 1'TIEPIPE 'OCY S 00' E, 27.3' FENCE '- 1't WEST .., n~ ~' f; ~ ~ ~., ~ ~ .~' c~ ~,. cv (~ n c~ ,. ~.. ~ ~- j3„ U u C1. ~N~ d ~- tv ~~ Z ~; ~' p~ Qw' gN~ .o o ~ ~. ° ~. ~ o Li y Z 71 ' n L? 44.=. ~, `° cu g ~~` W ~ ~ r ~, ~~ (R = N 89'2644'E) O JOINT DR/VEWAIA ~ . Yti ~? ~ iU ,~ ~ ~ ~~ ~ ^ w R ~ , LOT Z _ " ~ ~ 147,925 SQ. FT. OR 3.398 AC. z ~ ,~ ss~ ~ JFO ; \ ~ ~l S 89°26'42' W Q 7.09' 0 -' e N ~ LOT 1 i 780 SQ. FT. ~~ 180, OR 4.150 AC. S 89°53'36" E N OUTLOT 7 130,889 SQ. FT. OR 3.000 AC. (TO BE ADDED TO LOT 8, HUMBlRD HILLS OR ~ nr" rn TIJL •IAOTIJI -- -- - ~ NORTHEAST CORNER ~RK~HT DFWi0.Y-~ SECTTION 27., 729 N, R .19 W ~'S LINEBADLANDSROAD ~ALUMMIUMM(M+NIMENT) ~~ ~~! 4j~~ N --- BEAR8V6S ARE REFERENCED ro THE NoRTNLWE DFTHE - NDRTHEasrv4DFSECTIDNn, T 2a N, R 19 W, ASSUMED AS S 88'4/'IJ' E. 2 SCALE NU FEET 1' ~ I00' J~ '' 100 0 100 200 3 c~ _' ~~~'$14DDRRES$ ~ 4410 KENWOOD PARKWAY '' ST. PAUL, MN 55105 ~~ C1 ~ ~' ~ o ~ a ~ LEGEND ~ ~ 3;; /NDICATES f-1/4"O.D. X 18"IRON 0 PIPE SET (MIN. WT. - i.13 LB./L.F.) ~ • INDICATES 1"IRON PIPE FOUND ~ ~ INDICATES 2"IRON PIPE FOUND °' c ~ SOIL BORINGS (PROPOSED SEPTIC SYSTEM) J SECTION CORNER MONUMENT (AS NOTED) -.- INDICATES FENCEUNE DATED: o ~ DECEMBER 31, 2002 ~`SGONg~~ .•..... ~ ~ LAURENCE •• FD(/NDYLP. .' W. i 7Z6h a8gd 6i TEA O 3r£L.~6i~.6BS JDaq O} paWI186D v ~ o ~ ~ ,,~~~1N~~~tl~~,~ ~~ MBLil 'NBZ 1 LZ uol}Dag ;o Je~Dnq }soey}JON ~$ U ~ ~- ~~ ~' b~ ~~j, ~ ey; ;o Bull y}JOU ay; o} paouaJO;aJ aJD sBulJOaq ayy g v cn v ~ 7• ~ '~rO/. d ~ '~ ~ ~~ aa~ ~ s o E ~~~ ~Q`~~ 'PPts Est \o,~ j ~ yy;~ o c °' o ~ o ~ -~Q` ~ .S11./H P~~q+,unH ~o ~~Id Q~ ° .,ss,/ .~ _ _ ~ I ~ 3 J c Sl X07 O b o a ~ ~ ~ °` ~ g ;07 •JO0 3N 3„ZSAo.00S ~ v ,~~~ ....I ~I or' `~ ~ ~ o ,L'b'09L ~~~ ^~f ~I ~ ~ = p n ~ ~ ~ L `*I (,6Y"091 3„ti,DO.OOS~ -~~~ N of 111 `' ~ ~ ~, a ` z o .OZ~ ~~./ws3 .foMan/~p 7u~or ~3,~ ~I v o ~ ~ ~ -~ M ~d 3 a.l ~ ~ ~ ~ ~ ~ o N°' '~., oa~y uo//ua/a~/ ~a/oM woo;S cV :~ N ~ ~ ~ I ~, .=per v ~ `~- _ cD ..., ++ ~ o .. m ~ o~ add uoul cn ~. y o o rn 00 ~ r 1-------' M `. 0 ~ r1 y ~'' o, ~ -c c3 rn H I .99 Z ~~V ~ t v o c m g ZI -~ rn ~ ° ~ ~ ° ~ :. of =1 w "~ °~Yia 1"--'.ooL ,~ ~~ ~I ~I wl O I _ Q U CJ 0 C v ~ pl ~ ~"'„' ~~~ I 'j ~~ ZCI ~I v ....o O O • ~ 3 ~ i QI N ° -~ ~ ~$ c, CiI <L~ !-I Ali ~ N C O ~ ~ I '` COI OI bl I ~~~ L~ ~1 X21 OI ~I _ _ I -+1 Cil 'C c •....v W a ~ O~ O ` ~ I .~v ~ ~ o ~ Z vI 4~ ~~ ~1 ~ G~ U ~~~~ ~ ~ ~ `o v ~ 0 21 ,,~ o~ ~ \ ~ ~ \ c v~ rn a u 9 io7 'JOD MN 1 °' a ~.. ~ a. o ~ 3,.ZS,oo.oOS r ,zz•LOZ 3rz5 oo.oos , 33 ~ N D ~+ N z l 1o//np /o aui7 ;so3 ~ ~ c ~ _ ~"~ 4 ed/d ~JaJ/ \ 1 ~+( C 2 Z ~ 4 p ~ b •~ 4` -~ ~ \ CJ Z ~, g c~ a~~ o e~ ~ '~I "' ~ a l ~ ° ~ ~^~ ;uawnuo{~y wnuiwn/y ~ ~ ' ^ o ~ o -~ oaS 2 ~ 61-6?, -LZ /soay;ao~/ puno~ ~ ~awo ,..~ M ~ S 0 ~ J 1 z w o b W o ~ ~ ~I ~I I ~I ~ v ~ ~ of vil ~I o1 ~ ~ ~ :n ^ o N r vI UI ~I O~- a ~.- ~ \rn~ ~I 4 .1 N ~~~ ~' wig ~~a I Z °N~ ~ g~~ ~ p N .c Z m 3 c ~~ 1 () ~ O 1 1 ~ Y 0 c 0 ~i LL ' N o,~ CV °~a O~ ~ ~ W ~ M .~ 3 0 < M ~ c '«~ i+~ n - O I ~ ~I ~i ~i a Cil of ~I ~I O~ a l A i CC ~ O l ~ o ~ 4 c B ~ I I ~ o ~ o ~ ~ `. :~, I M ~'"°G Q tl O~ ° I ~ \ I ao ab' ;ao i ao N O `_ '"~ ~ iQl o a " ~ I ~ ~ I ~ "' ~ ~~ ~ o o M_ ~ f I to w o Q POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner ~el`r~ 9m~n~ Permit # DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units - ^ Nq Estimated flow (average) ~ ~ gal/day Design flow (peakl, (Estimated x 1.5) ~ gal/day Soil Application Rate 1 ~ gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODS) _<30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ Nq Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page _ of Septic Tank Capacity I ~0 (~ gal ^ NA Septic Tank Manufacturer ~ 1 ~2 f- ^ NA Effluent Filter Manufacturer Td~ ~ ~ ~ ^ NA Effluent filter Model ~2 ~ ^ NA Pump Tank Capacity .~ gal ^ NA Pump Tank Manufacturer -- ^ NA Pump Manufacturer ~- ^ NA Pump Modef ,~ ^ NA Pretreatment Unit ~ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cellls) ^ NA '~[,In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: d Other: .~0 l`t fG~'d f ' / V f C k `7 ~ ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ~' earls)(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) ~ S When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^monthls) (Maximum 3 years) 3 15C yearlsl ^ NA Clean effluent filter At least once every: ^ month(s) r ~ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: .~ ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: - ^monthls) ^yearlsl ^ NA Other: At least once every: ^monthls) ^yearlsl ^ 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 IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls- for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl• If high concentrations are detected have the contents of the tankls) 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 cellls) in one large dose, overloading the celNs) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. ~ The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name m~'~ .Ovn~n Phone ~) J ' ~ C~ ~- d~0 SEPTAGE SERVICING OPERATOR (PUMPER) Name ~p~ S~we f ~~( Phone POWTS MAINTAINER Name vim` 5 we/ SQ/~1/i Phone LOCAL REGULATORY AUTHORITY Name ~ ' _ C II O ~ X zc~ ~ t'~ 1 Phone 3 This document was drafted in compliance with chapter Comm 83.2212-1b-(11(d)&(f) and 83.54(1), (2) & (31, Wisconsin Administrative Code. ~l 2195P 569 STATE BAR OF WISCONSIN FORM 1 - 2000 Number ~ WAItRAIYTY DEED THIS DEED, made between A. David Keily, Jr., and Elizabeth KHHelly, husband~~~a~nd wife, Grantor and Terr nce Ciran~Ornforna Va~i,ableyconHs~c)ne anion, conveys to Grantee tile' following ~ described real estate in St. Croix County, State of Wisconsin (the "Property"): See attached Legal __ _ Informational Notes: The real estate property ID or Plat and Parcel Number is 20-1074-30-000. XX Badlands Road, Hudson WI Together wit11 all appurtenant rights, title and interests. * Grantor warrants that the title to the Property is good, indefeasible ui fee supple and free and clear of encumbrances except Easements, restrictions and rights-of-way of record, if any. ' Dated this. ~ L'.~~ ~~©-~ * avid A. Kelly Jr. ~- ~_.. * Elizabeth Kelly `~ * AUTHENTICATION Signahue(s} authenticated this bane . otary ?ub~s~rn----- * r..~ae, of '111)t~CO TITLE: MEMBER 51~~'~AR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY A. David Kelly, Jr. (Signatures Wray be ant renticatec! Or acknorvled~ed. Both are not necessary.) "'Names of Persons signing in any capacity must be typed or printed below their signature Recording Area KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FQR RECORD QJ4/04/2f803 01:28PP! WARRANTY DEED EXERT ~ REC FEE: 13.00 TRANS FEE: 135.0@ COPY FEE: CC FEE:. PAGES: 2 Name and Return Address:, T ygp ~ o-l~ ~~c ~7'V- 3~3S1S ao-- l~ ~ - 3~ - moo Parcel Identification Number' {PIN) T11is is not 1lomestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) CO[JNTY. - ~-- G`f) c ~" ) ss. Personally came before me this ~i`~ day of ~lr~ ~ , 020 the above named A. David Kelly, Jr. and Elizabeth Relly, husband and wife to me known to be the .persons who executed the foregoing instrument and acknowledged the same. * Nora y Public, State of Wisconsui My conullission is penllanent. (If not, state expiration date: t 1, l~ ~~ ~ ) WARRANTY DEED STATE UAIt OF 11'ISCUNSIN FOILDI Nu. 1-2000 cly5~' 570 EXHIBIT A Outlot 1 of Certified Survey Map filed March 31, 2003 in Volume 17 of Certified Survey Maps, Page 4490 as Document No. 715302 located in the NW '/a of the NE '/ of Section 27, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. Informational Notes: The real estate properly ID or Plat and Parcel Number is 20-1074-30-000. XX Badlands Road, Hudson WI File No.: 373515 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ 2 r l ~ ~ c Q ~ ~fV~ ~ V~ ~ Mailing Address ~ ~ ~ ~ 1 ~ ~ ~q r v-1 12 C1 q J Property Address 7 ~ 1 ~.QrJ 1~ A ~R ~ "~.t (Verification required from Planning & Zoning Department for new construction.) City/State .~-~J d Sc1 h ~ W ~ Parcel Identification Number a ~ r 10 7 y~ 3 ~ ` d 0 0 LEGAL DESCRIPTION Property Location ~~ IAA '/4 , ~_'/4 ,Sec. ~, T ~_N R~W, Town of ~y r0 S ~ rl Subdivision '~ Lot # Certified Survey Map # ~d l U ~~ ~ ~ A • W ~ `~ D ,Volume ~~ ,Page # ~ ~ ~ d Warranty Deed # U a ~ °l 5r P S (p 5 Spec house yes no Volume -- ,Page # Lot lines identifiable es 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 tank 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 Planning & 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. I/we, 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 Deparhnent 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 & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~ ATURE OF APPLICANT(S) JlU / U7 DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & 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. G (REV. 08/05)