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HomeMy WebLinkAbout020-1080-50-050 (3)a O n N m 10 CD cn z D to CD a O z O v ` O 3 CD m CD W s m c m 3 (D 7 cn avcna_ m w N C SP. C n �QCD- y 3 vni 3 a o 6a�mc`n� CD 0 n N K Z co D ad o ai O p G N =r '3< c CL c (D m ; o m 3 v °- p N Dj II K fQ r a co 7 � � c C G1 a CD N p a O c O 0 3 0 O CD CD 49 O O O L O c � W � O . O N � B N O _ N n a a Q K O O O 7. W N CD CL 0 00 O C cn o co y c o T v v rr d .► N 3 ° �o 7 z r z D m o au :? 0 � m ti n � s c 3 m v a m � C6 a C 7 CL e T a O !� z CD A c a 3 m o to CD C t N CL IV O O co � O O N O �Wo 0 0 g a'• c m 2 D v A M N A ? A J � M A z Q M z z I1 m _ co R C O d �1 O O 0 a A S A ti W N O w ti O dQ V A W av Op ti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAC 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 Dravelin , Leo I Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: (3r( t GS i TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W, / Zc� Dosing / J TDH JUS Friction Loss System ead Holding 3. 0 TANK SETBACK INFORMATION TANK TO - f /L /IJ �Z, WELL BLDG. Vent to Air Intake ROAD Septic / J TDH JUS Friction Loss System ead Dosing 3. 0 l Aeration Length i D Dist. to Well WELL r' •� Holding Z !1 INFORMATION PUMP /SIPHON INFORMATION Manufacturer - Demand FS � GPM - 3 7 Model Number / J TDH JUS Friction Loss System ead TD 3. 0 l Forcemain Length i D Dist. to Well WELL r' •� � . 5 Z !1 INFORMATION SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 479222 0 State Plan ID No: Inside Dia. Parcel Tax No: DIMENSIONS Alt. BM 020 - 1080 -50 -050 Section/Town /Range /Map No: 3. 29.29.19.3298 STATION BS HI FS ELEV. Benchmark No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Alt. BM �!� 3. Bldg. Sewer ,i �y St/Ht Inlet BLDG WELL r' •� � . 5 St/Ht Outlet 6 aSL, INFORMATION Dt Inlet CHAMBER OR UNIT 'l+�`+� T�- Type �► Dt Bottom 3 � I �/� I� 1 ,i 5 q4.c 3 Header /Man. o �Je 1 AL CC Dist. Pipe -c f� %,�) /6 !. 35 Bot. System C , 115 Final Grade St Qgv 1 19 37 /11 • 1 BEDITRENCH Width I Length / No. Of Trenches Vent to Air Inta e �� PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �!� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: r ' ���► INFORMATION CHAMBER OR UNIT 'l+�`+� T�- Type �► I 3 � I �/� I� Model Number:. Q V ` o �Je DISTRIBUTION SYSTEM A lrl l 4 L10t t c) f- 6 Ileo = 25 U Header /Manifold ./ I �t Distribution Pipe(s \ x Hole Size x Hole Spacing Vent to Air Inta e �� Length Z Dia T Length Dia Spacing \ Yes F] No ] Yes ] No SOII COVFR v Droc — S-4nma nnly vv Mnnnrt Or At -Grade Svstems Only - t � Depth Over ! Bed/Trench Center 4t Depth Over Bed/Trench Edges \ xx Depth Topsoil ded xx Seeded/So d Mulc ed \ Yes F] No ] Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 Location: 700 Crosby Drive Hudson, WI 54016 (SE 1/4 NE 4 29 T29N R19W) JNAL,ot .11 1.) Alt BM Description = t' j V -� ��l av\- � O" CS 2.) Bldg sewer length = (0 j > - amount of cover = q / I Plan revision Required? Yes o 1 Use other side for additional informa ' n. [, - Date SBD -6710 (R.3/97) Inspection #2: / /_ Parcel No: 29.29.19.3298 Cert. No. r �J e+ Lu comprere plans (to me county only) for the system on paper not less than 81/2 x 11 inches in size 5 l SBD -6398 (R. 01103) Safety and Buildings Division County • 2?1 W. Washington Ave., P.O. Box 7162 ConS,Vn M Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 31 q Z i 6- Sanitary Perms A atiQ>r� { ',f p � l State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, pe ormati n you provide r' may be used for secondary purposes Privacy to) Project Address (if different than mail' n address) I. Application Information — Please Print All Information :4-. L;c ` CO/ 1A Property Owner's Name " FF Parcel # Lot # Block # f at -O r a lj �, l ' r � B �''v ---• Property Owner's Mailing Address Property Location 4 P J (,)11 ,�/F _ '/4, '/4, Section City, State Zip Code ( Phone Number —,6,p 'f q� 14 �. 4 CS t S G Z � (circlj T N; RLV_E & W II. Type of Building (check all that apply) �� CSM Number / 1 or 2 Family Dwelling — Number of Bedrooms © ( ❑ Public /Commercial —Describe Use CS • y Z �� 9, 3 ❑ State Owned — Describe Use 3 (r ❑City ❑Village�Township of V So H III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 20 _ G .�� A. New System Y ❑ Replacement System p y ❑ Treatment/Holding 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. Type of POWTS System: Chec all tha appl %Non — 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 Leachin C am er ❑Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Trent ent Area In ormation: Sl- s 7 9 — Design Flow (gpd) 00 Design Soil Application Rate( sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 6. f— (Oa.So VI. Tank Info Capacity i Gallons Total Gallons Number of Units Manufacturer m4001, P1 sz� Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Existing Tanks Tanks �;/to r Septic or Holding Tank Aerobic Treatment Unit LA ZD�� Dosing Chamber VIL Responsibility Statement— I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip e) 107.0 rte ` - X4,5 VIII. Coun fDe artment Use Onl X Approved ❑ Disa Sanitary Permit Fee (inc des Groundwater Date Issued Is uing gent Signature o Stam ❑ Owner iven Reason for Denial Surcharge Fee) 3C-- -- , IX. Conditions p r a al 3 \ DCC > � SYSTEM OWNER: 1 Septic tank, effluent filter and � dispersal cell must all be serviced i maintained ( J as per management plan provided by plumber. c� n 2. All setback requirements must be maintained `) �` �` (�Qrt Lnn.c•• as /ordinances. J l per applicable code C / , r �J e+ Lu comprere plans (to me county only) for the system on paper not less than 81/2 x 11 inches in size 5 l SBD -6398 (R. 01103) s of 7 2 t13 2-z r N �c O T N &o 1 1 C� L v� i m 0 r S� oak T HouSG 1} -13 ED N Loon #" 5 � a 4f �� 3 - ?QE Nc yES 19 C4„b•,s 2 a DW-Lavi -7-+ c 4x 0 13 Z P. Q qv T3 641- •p .� �/i PVC ��PE 100.0.0 W 1 - Z 6 "ISO CD 6" vt 6 o TA N lk- w��olYLo% F'/L764- w COP H P i n ,� .. o D �-. e I,' ►1 Lm7� / C s of 7 21! 1-9 3 7a o Ceo slb A r ; od r N v NAZ i N A 6o t � w 1 , 0 1•o sva '71 TGta ti C $6 w- bax T/ ?� S� Bf fl pv _f WE)5ER /19 oco 6" "t 6 ,0 TA N K- w��o! y�oK FiLT6r� w cf t u I r 1510 Wisconsin Depotnent of Cmmeroe UATION REPORT Page 1 of 3 Dwision of Sdsty and Buildings in damce with Code A.C.E. Sod & Site Evakati" Attach complete site plan on paper not less 8'/2 x 14fet in St Croix mdude, but not hrnded to vertical and refer point (l A percent slope, scale or dmemsions, north t Parcel I.D. � 020- 1080 - 50-000 Please print al/ i Q C ;) y R By Daje Pwomel iribrma6on You piumb may be used for secandaiy purposes s. 15.04 ) (m)). Property Owner Location Leo Draveling Govt. Lot SE 19 NE 19 S Z9 T 29 N R 19 W Property Ownse Marling Address Lot # Bbdc # Subd. Name or CSM# 868 Kelly Road, Unit A 1 I I CSM Vol. 17, Pg. 4532 City State Zip Code Phone Number City J Village a Town Nearest Road Hudson ! WI 1 54016 1 715 - 351 - 0714 Hudson 1 700 Crosby Drive 1m New Capon Use: t/ Residential / Number of bedrooms 4 Code der(ved design flow rye 600 GPD Replaoernent _) Public or commercial - Describe: Parent material Glacial outwash d Flood r a General r 4 = and : Install conventional POWTS using four trenches with combined E.I .S = 1500 sq. ft at elev. 100.50 Recommend dosing to increase system efficiency & prolong useful life. Bo rkV I Boring SM Pit 1 in, 0-16 kinsell 10y2/1 2 16-24 1 Oyr4/3 3 24-36 1Oyr5 /4 4 36-57 1Oyr413 5 57 -63 1Oyr4/4 6 63-114 7.5yr4/6 lmsbk mil- Iso S° Baft a #� 0 Pit Ground Surface elev. 106.85 ft. Depth to limiting factor >114" in. Redox Description Texture Structure Consistence Boundary Roots Qu, Sz. Cont. Color Gr. Sz. Sh. none ! 2fsbk mvfr gw 3fmc Depth in. none sit 2fsbk mvfr cvtr 2fm,1c Roots none sl 2msbk mvfr gw 2fm I none IS lmsbk mvfr aw 1vff 2 none Ivfs Om mfi aw 1vf,f cW none Ws 1csbk dsh - 1vf na Sod Application Rate 0.6 0.8 0.6 0.8 0.6 1.0 0.5 1.0 0.4 0.6 0.4 0.6 Ground Surface elev. 102.87 ft. Depth to limiting factor >88" in. ( eWnRate� HorL= Depth in. Dominant Color Mansell Redox Description Qu, Sz. Cont. Color Texhue Structure Gr, Sz. Sh. Consistence Boundary Roots GPD/fP 'Eff#1 'Eff#2 1 0-14 10yr2/1 none I 2fsbk mvfr gw 3fmc 0.6 0.8 2 14-25 10yr4/3 none sil 2fsbk mvfr cW 2fm,1 c 0.6 0.8 3 2 5-32 101614 none sl 2msbk mvfr gw 2fm 0.6 1.0 4 32-60 7.5yr4/6 none Ifs 1msbk mvfr aw 1vf 0.5 1.0 5 60-88 7.5yr4/6 none Ivfs Om mfi - lvf,f 0.4 0.6 E81uert #1 = BOD? 30 < 220 mg& and SS >30 < 150 ' E #2 = BOD < 30 mg/L and TSS <_0 mg/L SST Name (Please Print) CST Number James K Thompson �— 3602 mew A.C.E. Sol & Site Evakations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, 5/32005 715- 248 -7767 Property Owner Leb Drayeling Parcel ID # 020 - 1080 -50-0 Page 2 of 3 3] Bmng # � OM Pit Ground Surface elev. 104.93 ft. Depth to limiting factor >90" in. Sod AWfication Rate Horizon Depth in. Dominant Color Mansell Redox Descrption Qu. Sz. Cont. Color Texture Strocture Gr. Sz. Sh. Consistence Boundary Roots I *Eff#1 *Eff#2 *Eff#1 *Eff#2 1 0-13 10yr2/1 none I 2fsbk mvfr gw 3fmc 0.6 0.8 2 13-27 10yr4/4 none sit 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 27 -53 7.5yr4/6 none Ifs 1 msbk mvfr gw 2fm 0.5 .0 4 53-90 7.5yr4/6 none WS 1msbk mvfr - 1vf, 0.4 0.6 .IL F—I B # I Boring Pit Ground Surface elev. ft. Depth to knifing factor in. Sod Application Rate Horgan Depth lo. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistenm Boundary Roots *Eff#1 *Eff#2 F-I Berg # �9 J PR Ground Surface elev. ft. Depth to limiting factor in. Sod gppliplion Rate Horan D Depth D Dominant Color R Redox Description T Texture S Structure C Consistence B Boundary R Roots *Eff#1 'Eff#2 Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =130D <30 mg/L and TSS < mg& The Department of Commence 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. c4/ teoOra ' /ot/ C-' S n1 171 S 6J�y/I rt'Y, Se e. ,4M. 6At)ckr Wk: /It:/ in 3 Sf�•n�xcd 00- 1(6'ee. Ebel" = / /z.ss' i (IlAr' -S p.ei of 5t - 5 taKLd � gZ &r,-k Assu.r i i n P�. of3 DEC P. L a. d ��a►...ial.:..� � j , 7 is o E � Je � � r -- Doss Tank lnfomwmon Elechlgl ae per NEC 300 errd ► Cm" 18.E WAC - �. Dleoogrrect Tank oompom le properly vented wrier Concrete Manufacturer Ca 773.78 Gallons Volume 18.12 gal/inch Dimension A Inches 25.48 gallone 428.84 B 2.00 32.24 C 7.52 121.14 D 12,00 193.44 L. Totail 48.00 773.7t3 A :f B C D Alarm Manuefacturer ILevelArM " Alarm Model Number pLy Pump Manufacturer Zoeiler PUMP Model Number 153 Lmidnp Wi$r with WO 1h p MW and loo" dsvloe end 4 in. min. 4— An 1 wu bmatlon Foraniein diameter T 2 in, Weep holy or anl- "*M devioa radon M 88.20 , Uft mWallmn 87.20 Pump Must Deliver gpm at r"�"�q' "� TDH Pmjeot: Miller Construction - Residential Dose Conventional: — Page 4 of 9 PUMP PERFORMANCE CURVE 53" 96" 41" w ° m 3" 6" m0 '-' r r D N I D m r 0 r Q n6 a m a I� 44" 1I Z 0 N D 39" M Z X z M D Z C C7 > C D N C7 � Z7 M DN 0 zo —1 Z 0 O ➢Z Z p m M Z � Z Armor =�nW�N --1 �� O N D O 0 fNrlZ AsZ Z .o�o TT C7 ' Z m 0 n0 2p�� -1 7:3: N C (n =j CO N D D O NO -1 ��O•• �w � 0 N c z D� ��oomrr*I�rnWm�w �V M K 0 m M r m D � � r -� a,_ ry O N L °° N w N ;u o o O D 0 C7 D 0 N4 O co D �����00- _ V) N s T C7 O N -1:1 - Ti r 00 N �S Z Z-u Z G)D m O OO C) O D r- O D O N C Z 0 O NW mO X X T J c cn r C M r .O N z M 0 ;o N C> X D V J _: O �� r M O r M M Z n M z M V) M N WLP1200 /800 -MR SCALE: 1/4"=11 REV N0. DATE: ° m WIESER CIICIETE m DRAWN BY:SWT z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, N7 54750 DATE: JANUARY 2001 V ° REV. JAN. 2005 800- 325 -8456 FILE: WLP1200 /800 -MR LIUv �) AM vm , Filters PL -525 EFFLUENT FILTER ( .: Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD (gallons per day) making it one of the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL -122, the new Polylok PL-525 has an automatic shut off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that claim! PL -525 Maintenance: The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL -525 out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace septic tank cover. Alarm /' -- Accepts PVC accessibility extension handle i 525 linear feet of 1/16" filtration slots Rated for over 10,000 GPD Accepts 4" & 6" vR SCHD. 40 Pipe1R J \ . Gas deflector Automatic shut off 1' I — ball when filter is removed U.S. Patent No# 6,015,488 I" 5,871,640 PL -525 Installation: Ideal for residential and com- mercial waste flows up to 10,000 Gallons Per Day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary, 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace the septic tank cover. zchhical Specifications % -525 EFFLUENT FILTER (COMMERCIAL) 617 BALL CHECK _ EXCEPTS 6 SHG 40 f FOR INLET MENTION 11.57 14.35 OUTLET BUSHING EXCEPTS - -7 j 4 "SCH 4086'SCH 40 8.10 i 10.68 -- _ l i i 5.23 i _- 33.02 I PL -525 FILTER HOUSING - - -� . 1 &34 - - - -- PART NO. - 30142 -525` I MATERIAL: HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5 BALL • HDPE Polylok PL -525 Support Stand 'Should you feel it necessary to add additional support to the PL -525 filter, use a six -inch Schedule 40 or SDR 35 pipe to extend from the base of the filter to the bottom of the tank. The extotion pipe needs to be anchored to the filter housing with one or two #10 X 112" SS screws. Anchor 1 -2 Stainless steel screws through housing and into pipe. Use #10X112" 6" Schedule 40 Pipe Pipe rests on bottom of tank 700 r,- as 6 flr,✓� POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner' -- C.�f�` Permit # Z2-Z DESIGN PAPAMF:rGRc Number of Bedrooms Z 5 d al ❑ NA Number of Public Facility Units Inspect condition of tank(s) ❑ NA Estimated flow (average) Effluent Filter Model �(,SL �' Pump Tank Capacity al g al/da y Design flow (peak), (Estimated x 1.5) ( ®© g al/da y Soil Application Rate �!� ❑ NA Pump Model gal/day/ft' Standard Influent /Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg /L ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA Total Suspended Solids (TSS) 5150 mg /L ❑ Other: Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD 530 mg /L Y In- Ground (gravity) Total Suspended Solids (TSS) 530 mg /L ❑ NA Fecal Coliform (geometric mean) 510 cfu /100mi ❑ Drip -Line Maximum Effluent Particle Size Y in dia, ❑ NA Other: ❑ N :.. Other: ❑ NA ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATH)NA Page I of Z Septic Tank Capacity Z 5 d al ❑ NA Septic Tank Manufacturer Inspect condition of tank(s) ❑ NA Effluent Filter Manufacturer ��4�yt -,k❑ NA Effluent Filter Model �(,SL �' ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer ❑ month(s) -- ❑ year(g) (Maximum 3 years) ❑ NA Pump Manufacturer At least once every: ❑ NA Pump Model ❑ NA Pretreatment Unit ❑ NA ❑ Sand /Gravel Filter ❑ Peat Filter El NA ❑ Mechanical Aeration ❑ Wetland tIn ye ars► ❑ Disinfection ❑ Other: At least once every: Dispersal Cell(s) ❑ NA ❑ NA Y In- Ground (gravity) ❑ In- Ground (pressurized) ❑ At -Grade ❑ Mound ❑ month(s) ❑ year(s) ❑ Drip -Line ❑ Other: Other: ❑ N :.. Other: ❑ NA Other: ❑ N A Service Event Service Frequency Inspect condition of tank(s) At least once -eve once-every: ❑ month(s) 3 ear(sl (Maximum 3 years) E] NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once eve every: ❑ month(s) -- ❑ year(g) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: I - ❑ months) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: month(s) 3 ❑ El NA tIn ye ars► Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) 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. Tangy . inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or ieaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pond ng 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 dispo$ed 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. Page 2 of 2 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 cell(s). 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 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. J T alua ' g a o in ank be ' e ai a RD41'B TiS� �D� A/6 CaN 5T7ecicai n ❑ 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 IMc �pu C—L, L Phone G 12 � S� ) qZ �— POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S'T. G l bUN 20� Phone '7 / 3e This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION Owner Permit # DESIGN PARAMETERS Number of Bedrooms ; a l ❑ NA ❑ NA Number of Public Facility Units ❑ NA Effluent Filter Manufacturer ❑ NA Estimated flow (av rage) Effluent Filter Model ❑ NA al /day Design flow (peak), I stimated x 1.5) g al/da y gal ❑ NA Soil Application Rate At east once every: al /day /ft Standard Influent / Effluen Quality Inspect pump, pump controls & alarm Monthly average* Pump Model Fats, Oil & ease (FOG) 530 mg /L ❑ Peat Filter ❑ Wetland ❑ Other: Biochemical Oxygen Dem d (BOD :5220 mg /L ❑ NA Total Suspended Solis (TSS) 5150 mg /L Pretreated Effluent Quality Other: Monthly average ❑ NA Biochemical Oxygen Demand (B D S ) 530 mg /L Total Suspended Solids IT 1 530 mg /L ❑ NA Fecal Coliform (geometric mean) 510 cfu /100ml Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tan (fluent. RfiA1&1rCRu AR1^C 4M1%YCr%"1 C SYSTEM SPECIFICATIONS Septic Tank Capacity ; a l ❑ NA Septic Tank Manufacturer Inspect condition of tank(s) ❑ NA Effluent Filter Manufacturer ❑ NA ❑ NA Effluent Filter Model ❑ NA ❑ NA Pump Tank Capacity p month (Maximum 3 years) gal ❑ NA Pump Tank Manufacturer At east once every: ❑ NA Pump Manufacturer Inspect pump, pump controls & alarm ❑ NA Pump Model El NA ❑ NA Pretreatment Unit ❑ Sand /Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: ❑ NA Dispersal Cell(s) ❑ In- Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In- Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ NA ❑ NA Other: ; ❑ NA Other: ❑ NA Service Event ; Service Frequency Inspect condition of tank(s) At least once ery: month p earls► s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When co ined dge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At lea once every: p month (Maximum 3 years) ❑ NA Clean effluent filter At east once every: ❑ month(s) ❑ yearls) ❑ NA Inspect pump, pump controls & alarm A t least once every: ❑ year(s) Y El NA Flush laterals and pressure test At least once every: onthls) ❑ y r(s) ❑ NA Other: At least once every: ❑ mon s) ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and ' persal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master lumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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. w ST CROI!K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Addre: yc" Property Address ZCO C'I1D592 DIWIZ ? (Verification required from Planning Department for new construction) City /State Parcel Identification Number - p.. LEGAL DESCRIPTION �'` Property Location '/,, , ' /,, Sec. Z9 , T 2_9' N -R,6W, Town of _ Subdivision S "-7 Lot # Certified Survey Map # 72Z/ 3 Volume , Page # y _3 Warranty Deed # 1 7-3 5_2 Z , Volume z- 3 ( 7 , Page # /(-, 7 Spec house ❑ yes f no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic could result in its premature failure to handle wastes. Proper mainter zcc consists of pumping out the septic tank every 4hree years or sooner, if needed by a licensed pumper. What you put into the s;�ste�: can affect the function of the septic tank as a tr�'� stage in the waste disposal system. The property owner agrees to submit to St. Croix 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 systerr: is in proper operating condition and/or (2) after inspection and p=ping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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. Certificare-, . stating throe t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of e expiration te. /Z / o SIGNATURE OF APPLICANT U DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncn;s) of the prop des cd above, by vi e a warranty deed recorded in Register of Deeds Office. l /Z SIGNATURE OF APPLICANT DATE "'•" Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. " "" " Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1616 .. wksconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan u - • --- County `°� -_- S . Croix include, but not limited to: vertical and horizontal reference point (BM), directr and a� ' percent slope, scale or dimemsions, north arrow, and location and distance t ear est roams / k �e 020- 1080 -50 -000 Please print all information. t - Reviewed Date Personal information you provide may be used for secondary purposes (Privacy s. 15.04(1) .� Z Z Property Owner Pr rty Wx,;�tton School District Of Hudson "'- SE 1/4, NE 114 S 29 T 29 NR 19 W Property Owner's Mailing Address t # Su . Name or CSM# 1401 Vine Street 0a1*q p�ised CSM �1 3 City State Zip Code Phone Number City _J village ! own Nearest Road Hudson WI 1 54016 1 715 386 - 4908 Hudson Crosby Drive 0 New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _I Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. = 89.00' using 39 leaching chambers. 'B#4 evaluated 523/03 to expand .,_system area to accomodate required road easement 0,5 ON d 2 Put& ❑ Boring # I Boring �. 16 Pit Ground Surface elev. 94.66 ft. Depth to limiting factor >114" in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10y132 none sl 2fcr mvfr cs 2fmc 0.5 0.9 2 8 -20 10yr4/4 none fsl 2msbk mfr cs 2fm,1c 0.5 0.9 3 20 -31 10yr5/4 none Ifs 1 msbk mvfr cw 2f,1 me 0.4 0.6 4 31 -53 7.5yr4/6 none gr Is 0 sg dl cw 1fmc 0.7 1.2 5 53 -81 7.5yr4/6 none Ifs 2msbk ds aw 1fm 0.5 0.9 6 81 -1 4 1 10yr6/4 none is 2msbk ds - - 0.5 0.9 Boring # Boring Pit Ground Surface elev. 94.51 ft. > 112 in. Soil tion Rate Y� Depth to limiting factor App lica Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 04 10yr32 none sl 2fcr mvfr cs 2fmc 0.5 0.9 2 4 -18 10yr5/4 none sil 2fsbk mvfr cs 2fm,1c 0.5 0.8 3 18 -36 10yr4/6 none fsl 2fsbk mvfr cw 2f,1 me 0.5 0.9 4 36 -50 10yr4/4 none gr Is 1 msbk ds cw 2fm,1 c 0.7 1.2 5 50-69 7.5yr4/6 none Is 1 msbk ds aw if 0.7 1.2 6 69 -112 10yr5/6 none s 0 sg ds - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L aid TSS >30 < 150 g/L Effluent #2 = BOD S mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson - 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, ill 54020 2/192003 715 - 248 -7767 ` Property Owner School District Of Hudson Parcel ID # 020 - 1080 -50 -000 Page 2 of 3 3] �I Pit Boring # Boring Ground Surface elev. 94.02 ft. Depth to limiting factor > 109" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 'Eff#2 1 0-7 10yr3)2 none sl 2fcr mvfr cs 2fm,1 c 0.5 0.9 2 7 -16 10yr4/4 none fsl 2fsbk mfr cs 2fmc 0.5 0.9 3 16 -32 10yr5/4 none Ifs 1 msbk mvfr cw 2fm 0.4 0.6 4 32 -50 7.5yr4/6 none Ifs 1msbk dl cw 1fm 0.4 0.6 5 50-68 7.5yr4/6 none Is 0 sg dl cw 1fm 0.7 1.2 6 68 -109 10yr5/6 none s 0 sg dl - - 0.7 1.2 i Borina Boring ff - 94.81 ft. D to limiting factor > 123" in. i� Pit Ground Surface elev. � g Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots QPDff *Eff#1 *Eff#2 1 0 -7 10yr3/2 none sl 2fcr mvfr 7 as 2fmc 0.5 0.9 2 7 -17 10yr3/3 none sil 2fsbk mvfr cs 2fm,1c 0.5 0.8 3 17 -31 10yr5/4 none fsl 1 msbk mvfr cw 2fm,1 c 0.5 0.9 4 31-44 7.5yr4/6 none Is 1msbk mvfr gw 1fm 0.7 1.2 5 44 -71 10yr4/6 none s 0 sg ml gs 1fm 0.7 1.2 6 71 -123 10yr5/6 none s 0 sg ml - - 0.7 1.2 F—I Boring # I Boring 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 P *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 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. Ap � So e ✓a /ua�'CJn ♦ • /oca - (e d P Sta�e Ele,✓: _ _ v a flee . ►1 I I Ic" QaKfree. 3.2 o At Coos b y 0��� ue CSI - -mac.. 1616 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 65, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 020- 1080 -50 -000 Please print all information. Reviewed By Date Personal information you provide may be used for se Privacy Law, s. 15.04 (1) (m)). Property Owner @operty ocation School District Of Hudson Govt. Lot SE 1/4 NE 19 S 29 T 29 N R 19 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 1401 Vine Street FEFB 2 6 2033 �_ ._RQpowd CSM L/s 3 City State Zip Cod PhoWNq n I , J ity J Village y Town Nearest Road Hudson WI 5401 Hudson Crosby Drive ✓J New Construction Use: r Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement Public or commercial - Describe: Parent material Glacial outwash i Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. = 89.00' using 39 leaching chambers. Boring # J Boring Pit Ground Surface elev. 94.66 ft. �' ��'' Depth to limiting factor > 1 4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' /ft' *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sl 2fcr mvfr cs 2fmc 0.5 0.9 2 8 -20 10yr4/4 none fsl 2msbk mfr cs 2fm,1c 0.5 0.9 3 20 -31 10yr5/4 none Ifs 1 msbk mvfr cw 2f,1 me 0.4 0.6 4 31 -53 7.5yr4/6 none gr Is 0 sg dl cw 1fmc 0.7 1.2 5 53-81 7.5yr4/6 none Ifs 2msbk ds aw 1fm 0.5 0.9 6 81 -114 10yr6/4 none fs 2msbk ds - - 0.5 0.9 Boring # Boring Pit Ground Surface elev. 94.51 ft. Depth to limiting factor >1 12" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0-4 10yr3/2 none sl 2fcr mvfr cs 2fmc 0.5 0.9 2 4 -18 10yr5/4 none sil 2fsb mvfr cs 2fm,1c 0.5 0.8 3 18 -36 10yr4 /6 none fsl 2fsbk mvfr cw 2f,1mc 0.5 0.9 4 36 -50 10yr4/4 none grIs 1msbk ds cw 2fm,1c 0.7 1.2 5 50 -69 7.5yr4 /6 none is 1msbk ds aw 1f 0.7 1.2 6 69 -112 10yr5 /6 none s 0 sg ds - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS 4< 150 * #2 = BOD5 -E mg/L and TSS <�30 mg/L CST Name (Please Print) Sign re: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 2/19/03 715- 248 -7767 Property o w ner, School District Of Huds Parcel ID # 020- 1080 -50 - 000 Page 2 of 3 3] Boring # Boring 0 Pit Ground Surface elev. 94.02 ft. Depth to limiting factor > 109 01 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' *Eff#1 *Eff#2 1 0 -7 10yr3/2 none sl 2fcr mvfr cs 2fm,lc 0.5 0.9 2 7 -16 10yr4/4 none fsl 2fsbk mfr cs 2fmc 0.5 0.9 3 16 -32 10yr5/4 none Ifs 1 msbk mvfr cw 2fm 0.4 0.6 4 32 -50 7.5yr4/6 none Ifs lmsbk dl cw 1fm 0.4 0.6 5 50 -68 7.5yr4/6 none Is 0 Sg dl cw 1 f 0.7 1.2 6 68 -109 10yr5/6 none S 0 Sg dl - - 0.7 1.2 F—I Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' *Eff#1 *Eff#2 — – – - -- - -- - - - -- - - F—I Boring # – I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' *Eff#1 *Eff#2 — – – - -- - -- - - - -- - - * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <_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. :i PPS X - 1 (VI u L ± enchM, tja,'l in 20 "C4eery Assn reed efed: = i00, 60; B2 E !e✓: _ 3"2 o 't Crosby Or"iUe mac. 5+ / e vR1ua 0 ♦ E /eva �,'on � /OCA"�eol�rO�• �,3Cl Parcel. #: 020 - 1080 -50 -025. 02/02/2005 08:28 AM PAGE 1 OF 1 Alt. Parcel #: 29.29.19.329A 020 - TOWN OF HUDSON Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * SCHOOL DISTRICT - HUDSON SCHOOL DISTRICT - HUDSON 1401 VINE ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 29 T29N R19W PT SE NE EXC PT TO CSM Block/Condo Bldg: 17 -4532 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 11/05/2001 661182 1755/165 WD 06/05/2001 647394 1653/312 WD 11/27/2000 634210 1562/124 PR 07/23/1997 1090/319 TI gnnA CI IRANIADV Bill M Fair Market alue: Assessed with: e Valuations: Description Class Acres OTHER X4 0.000 Totals for 2004: General Property 0.000 Woodland 0.000 Last Changed: 03/31/2004 Land Improve Total State Reason 0 0 0 NO 0 0 0 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 020 - 1080 -50 -050 02/02/2005 08:28 AM PAGE 1OF1 Alt. Parcel #: 29.29.19.329B 020 - TOWN OF HUDSON Current . X'' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * DRAVELING, LEO A LEO A DRAVELING 868 KELLY RD A HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 700 CROSBY DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.500 Plat: 1713 -CSM 17 -4532 020 -03 SEC 29 T29N R19W PT SE NE CSM 17 -4532 Block/Condo Bldg: LOT 01 LOT 1 (5.5 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 08/15/2003 735922 2367/167 WD 08/15/2003 735921 2367/166 WD 06/04/2003 724393 17/4532 CSM 11/05/2001 661182 1755/165 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 48272 69,300 Valuations: Description Class Acres Land RESIDENTIAL G1 5.500 53,600 Totals for 2004: General Property 5.500 53,600 Woodland 0.000 0 Last Changed: 07/21/2004 Improve Total State Reason 0 53,600 NO 0 53,600 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel` #: 020 - 1080 -50 -0W 02/02/2005 08:29 AM PAGE 1 OF 1 Alt. Parcel #: 29.29.19.329 020 - TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 3 Tax Address: Owner(s): * = Current Owner General Property 0.000 * SCHOOL DISTRICT - HUDSON, RETIRED 0 0 RETIRED SCHOOL DISTRICT - HUDSON 0.000 0 0 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 0.000 0 0 0 SC 2611 SCH D OF HUDSON 0.000 0 0 SP 1700 WITC 0 Certification Date: Batch M Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 29 T29N R19W SE NE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 11/05/2001 661182 1755/165 WD 06/05/2001 647394 1653/312 WD 11/27/2000 634210 1562/124 PR 07/23/1997 1090/319 TI 2004 SUMMARY j&\ This parcel will not get taxed. It exists soley Assessed with: ,+ for parcel history tracking purposes. Valuations: Last Changed: 03/31/2004 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 APR ' I j' 7243St3 m VOL 17 PAGE 4532 - KATHLEEN H. VIE911 ST. ERs` REGISTER OF DEEDS SURVEY�3l2'S I;:.:: ,`? ST. CROIX CO. WI RECEIVED FOR WORD CERTIFIED SURVEY MAP 06/04/2003 09:30AM CERTIFIED SURVEY NAP Located in part of the Southeast 1/4 of the Northeast 1/4 of Section 29, REC FEE: 13.00 Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin COPY FEE: 3. PAGES: 2 Prepared for and at the request of: Sam Miller A special exception use permit is required for the disturbance of slopes P.O. Box 151 20% or greater not identified on the approved plat or CSM. This permit Hudson, WI 54016 is applied for through the zoning office and is reviewed through a public OWNER• School District of Hudson hearing process by the St. Croix County Board of Adjustment. Drafted - by: Michael H. Lynakey : LEGM Northeost Comer, a 0 � 02 � o `Section 29 -29 -19 X - Section Comer Monument ° _ •• of R ecor d (Found Mvsonry C) �� • Set V x 18' Iron Pipe weigking p . Nail) " m 1.13 pounds per linear foot N O _ .°• O Found 1 -1 /4" O.D. Iron Pipe W (3 I r IMP I O o o co 1 c u 0 - -- Found 2 -3/8" O.D. Iron Pipe N to a W o ..... Building Setback Line S' 0 (50' From right of way) I un S ,o a � *� rrR. _> _ DODGE NP�ATTED = _ z s E = S -248 c _ 4 — ' o' ' 3 CLEAR LAKE, �j o I r o z '' +�(� O 1 9 ' a °ry, N � sus'4 ,����`� X169 l / Q N 1 1 M rt Q rlrlr prpJlIIHIIIIt 1 � riP �� O, o n in I L.0! I ~- m c i z TOTAL AREA: �' O f I n 239, 606 ft. o cc� cn 3 rt 1 � iv 5.50 o N =� Ir IO 003o ID �'- LL � a N� 1 IX 0 0 3 1 -4 O _ KO ass tat m i I 1 1 Tl 1 R. 1 M '- '_Town Road I 1 a. N a v CD \� Right -of -way co I - o a I r - - nj -- East 114 Comer, -N D fV Section 29 -29 -19 p I m " i 0\ ,N (Aluminum County I r I CID Monument) 10 East/West 114 line N89'27'28 "E A j = of Section 29 J 100 4784.58' 6 .3 449.92' 6 6' S89'27'28"W 516.25' --- _ Le m o r 80' - N89'27'28 "E 5300.83'- �. �� R E r✓ _ Cd/ _de l Right –of –way LOT 29 l 1 Eosement I 1 / S CRO ES Icn i� LOT 42 �i \ SECOND ADD_IT 1 16 jo fx COUNTY \ I D I x - - - I \ Plannine 7oninm and Parks Commit{P�e I West 114 Corner Centerline \ \ 1 I M IN) Section 29 -29 -19 \ \ J UN 0 4 2003 1 i U) 1 00 (Aluminum County 1T not recordea within 30 days of I O I D Monument approval date approval shelf be l z I f CURVE TABLE IU) CURVE RADIUS I DELTA I ARC I CHORD CHURD BEARING I TANGENT BEARINGS Cl 317.00 5 32.60' 1 32.58' NO2 I N05 I N00.09122'W f 2814P 005 St. Croix County Occupancy Afffdavff Name — (Owner) Typed or printed being duly sworn , states, under oath, that: l/ a 3&7 P .1"' T I. He/she is the owner/pan owner of the following parcel of land located in St. Croix Coca , Wisconsin, recorded in Volume 1 7 _ Page S 3z Document Number Z�t. Croix County Register of Deeds Office: 73 5' 9d'• A parcel of land located in the i Y. of the /./Z /. of Section Z � T _Zff N - R /- W, Town of �1�,f . St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): P7. o/r 79r=535 KATHLEEN H. VALSH REGISTER OF DEEDS ST. CROIX CO., VI RECEIVED FOR RECORD 86/02/2005 03 :25PH AFFIDAVIT EXEMPT t REC FEE: 11.08 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 I _ � L/iCr �/uOS.�•.i w t S_Yotb As owner of the above described property I acknowledge that the septic system serving this residence is sized for a bedroom home, or a design flow of Gov gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently occupants living in this residence; &, occupants are pemnitted based on the design flow. Therefore the septic system swing this residence is code compliant. However./ understand that N there are intentions to exceed the number of permitted occupants, the system will need to be modified to acoomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. j Zoos Dated this Z � � day of 1i e AUTHENTiCATK)N me(s) authe tided ft s day of TITLE: MEMBER STATE BAR OF WISCONSIN (if not, autwized.by § 706.06, Wis. Stats.) THIS MSTRUMENT WAS DRAFTED BY ACKNOWLEDGMENT STATE OF WISCONSIN ) 1w• St. Crolx County. Penionaalllyacbaomee ob�ef�om n% ft ZI day the 'fee 1Y �CJi2a.c•C ��rt.�- So me known to be the persons) who executed the foregoing instrument and adawAedge the same. Notary Public. State of Wisconsin (Signatures may be audmUcated or admowledged. Both are not My Commission Is perm um If not, 1 r4o"aary) Date: // - y — D 7 M, `THIS PAGE tS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" am OF This NMbrmWon must be corrokted submX101- dommed nW* A r ft11I M'rWssa. and fZ 0fMqui►" Offarhlbnr00 such es fhe Arai ft daun& lased dssa0don. ela may placed on tlrls " pipe of ft dootowd ormay be plaosd on oddWwdAdQ0# &the doownw t. dft On o(06 cow page adds a*~ to y w docmnad and 12.00 to the rsoordina use. WFseonshi SfakaNW 59.517. J 2367P 167 T31-5 �322! STATE BAR OF WISCONSIN FORM`I - 2000 KATHLEEN H. WALSH WARRANTY DEED Doc cni N ber REGISTER OF DEEDS ST. CROIX CO., MI is D ' d, made between Sam E. Miller, a single person , Grantor, RECEIVED FOR RECORD and Leo . Dra elin , Grantee. 08/ 15/2003 03:05PH G tor, ra valuable consideration, conveys and warrants to Grantee the followtr� _ cribed real estate in St. Croix County, State of Wisconsin (the WARRANTY DEtJsl , . EJ(W "Property") (if more space is needed, please attach addendum); .. ' REC FEE: 11.00 Part of the SE 1/4 of the NE 1/4 of Section 29, Township 29 North, Ran a w " TRANS FEE: 206.40 COPY FEE: 19 West, Town of Hudson, St. Croix County, Wisconsin, described a of CC FEE: 5f Certified Survey Map filed in the Office of Register of Deeds for St. PAGES: 1 Croix County, in Volume 1 7 of CSM's page 4532, as Document No. 724393. �-- �--�— Recording Area Name and Return Address Heywood, Carl & Anderson, S.C. 1200 Hosford St., Suite 106 P.O. Box 125 Hudson, W1 54016 Together with all appurtenant rights, title and interests. ? c is O Zo - I en13Q 10 -000 Parcel Identification Number (PIN) This i s not homestead property (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record. Dated this o� day of ' `y 2003 " Sam E. Miller AUTHENTICATION Signature(s) Sam E. Miller authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Heywood, Cari & Anderson, S.C., 1200 Hosford St., Suite 106 P.O. Box 125, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) STATE OF ST. CROIX ACKNOWLEDGMENT WISCONSIN ) ss. County ) 2003 Personally came before me this "2, 19 day of Z 4 IX , 2003 the above named Sam E. M1116 to me known to be the persons) ylt13yeeted t' Ibihiig instrume t and acknowledged tlfeftine. CC CL , ,�Q t j i s Notary Pu lic, State of Wiscon§4 1 .........••.. . My Commission is permanent. (If not,.upte exp i p•date: Names of persons signing in any capacity must be typed or printed belowwtheir signature. INFO -PRO (800)655 www.infoproforrm.com www.infoprofos.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. I - 2000 7n- ( r- 72 4393 VOL 17 PAGE 4532 KATfiEM H. VWUSA — " -- REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR hECORD p� /�� q 06/04/2003 04:30AH CERTIFIED SURVEY ��iP CERTIFIED SURVEY HAP Located in part of the Southeast 1/4 of the Northeast 1/4 of Section 29, REC FEE: 13.00 Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin COPY FEE: 3. +80 PAGES: 2 Prepared for and of the request of Sam Miller A special exception use permit is. required for the disturboce of slopes P.O. Box 151 20X or greater not identified ori' the approved plat or CSM. This permit Hudson, WI 54016 is applied for through the zoning office and is reviewed through o public OWNER: School District of Hudson hearing process by the St Croix County Board of Adjustment. Omft.d by 1Nch°.1 H. Lyn k y LEGEND; �`No✓•theost Comer, n -- � z 1 Section 29 -29 -19 v ° Section Comer Monument of Record (Found Masonry a Q D 31 • Set 1" x 18" Iron Pipe wcigiring r" 0 Nail) 1.13 pounds p er linear foo p 7 o a O Found 1 -1/4' O.D. Iran Pipe 0 I �� O Found 2 -3/8" O.D. Iron Pipe 0 N 10 as N ° . _ _ _ . • _ . Building Setback Una (50' From right of way) 1 V1r 5 a �p TY a° 5 DODGE S ; VA — _ ��o �� 0 1 r— 5 3 CLEAR LAKE, t . O I O WI >< NO SU R�EHO� o N 69•og Q (/j N �� 1 C—I aeon LOT1 o� n,� a i C 7DTAL AREA: a O� 10 ° ° o Z 2.79 606 sq. ft. o ` �? c� S in I N V 50 acres o N. 10 0 o s 1 r- ^' AREA EX�I30.W.: T f`'-p '10 Ix ° ID z rn �a``23bas sq. °i �_ I tTI - 3o I� o o s; f j W o Town Rood S� o Ip v C3 f = CF) Right -of I 1 D— - a I ( v N East 114 Comer, 1 a I> Q N r.11 Section 29 -29 -19 O ° I Z (Aluminum County - r n Mon urn en t) 10 Ecstlftst 114 line - I N 89'27'28 'E I of Section 29 ) 0o 4784.58' n 66 449.92' 6' S$9'27'28 516.25` — i — /em� ro ory_BO N89'27'28 "E 5300.83'- _' J ,erynr -ate —y LOT 2 9 C ' a rl _S F ATES OT 42 f � SECOND AODIT ROVE\ 1' 10 101 J \ _ _ _ OIX COUNTY \ "Plannlnn 7on�n aid Parks Commie i Q I x I — 1 ` West 1/4 Corner Centerline JUN 0 4 2003 1 I � i CO Section 29 -29 -19 ` ` I _-I I --i (Aluminum County O D II not rocur000 wanln 30 days of I Z 1 -! Monument) approval dale approval shall be I IM r! null rind Vold - I (f) CURVE TABLE CURVE RADIUS I DELTA ARC I CHORD CHORD BEARING I TANGENT BEARINGS C1 317.00 5`53'30' 32.60' 32St3' NO2'47'23'E - N05'44'UB'E N00 22'V C2 383.00 38 260.34' 255.36' 1414'49'20.5'V N04' 9' N34 '4 'V JOB / WO57SLI108 Prepar by 1a./t�' Caui&VGroup, rnr- V 150 o 150 Phone No. (715) 246 -4319 GRAPHIC SCALE Fox No. (715) 248 -3630 SCAM IN =T: 1 Inch = 150 feet P.O. Box 325 NO TH BEARINGS ARE REFERENCED TO THE EAST LINE OF THE Now Rlchmond, M 54017 NE 1/4 OF SECTION 29, TONNSH!P 29 N., RANGE 19 W. Sheat 1 of 2 WHICH IS ASSUMED TO BEAR N00'09'22`W. Vol. 17 Page 11532 l oo CERTIFIED SURVEY MAP Located In port of the Southeast 1/4 of the Northeast 1/4 of Section 25; Township 29 North, Range 19 West, Town of Hudson, St Croix County, Wisconsin SURVEYOR'S CERTIFICATE: 1, Ty R. Dodge, a Registered Wisconsin Land Surveyor, do hereby certify that by the direction of Sam Miller, I have surveyed, divided and mapped a parcel of land located in part of the Soutfieast Quarter of the Northeast Quarter of Section 29, Township 29 North, Range 19 West, -` Town of Hudson, St. Croix County, Wisconsin, described as follows: Beginning at the east Quarter comer of said Section 29; thence, on an assumed bearing along the east -west Quarter line of said Section 29, South 89 degrees 27 minutes 28 seconds West a distance of 516.25 feet; thence, along the arc of a curve,,cpAcave to ttte porthwest, a distance of 32.60 feet, said curve having a radius of'g- 11-.00 feet and a chA that` bears North 02 degrees 47 minutes 23 seconds East a distance of 32.58 feet; thence North 00 degrees 09 minutes 22 seconds West a distance of - 337.70 feet; thence North 69 degrees 09 minutes 47 seconds East a distance of 550.01 feet to the east line of the Southeast Quarter of the Northeast Quarter of said Section 29, being the northwest comer of Lot 6 of St. Croix Estates; thence, along said easf 16 of the Southeast Quarter of the Northeast Quarter, South 00 degrees 69 minutes 22 seconds East a distance of 561.00 feet to the point of beginning. Containing 239,606 square feet (5,50 acres). Subject to all easements, restrictions, and covenants of record, I also certify that this map is a correct representation to scale of the exterior boundaries surveyed and described and that I have complied with the provisions of Chapter 236.34 of the Wisconsin State Statutes and the subdivision ordinance of the Town of Hudson. > {Z 6. S -1 R Dodge— Registered Wisconsin Land Surveyor No. 2484 Date JEO Consulting Group, Inc. P.O. Box 325 New Richmond, W1 54017 Sheet 2 of 2 Vo1.17 Page 4532