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'ermit Holder's Name: city Village X Township Parotti, John Hudson Townshi ;ST BM Elev: / Insp. BM Elev: BM Description G1? • D c o . Q ' CST R rw TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 6-L seyn - L Dosing — qz I D1 Aeration Force -in- 7 th Holding 0 3110 G4 .o, to) TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic — qz I D1 TDH Ft Force -in- 7 th Dosing 0 3110 G4 .o, to) �-� Aeration c� St/Ht Inlet III WELL 1 0 , 12. Holding St/Ht Outlet INFORMATION CHAMBER OR 'A 3 X1 r PUMP /SIPHON INFORMATION Manufacturer BS Demand GPM Model Nu ber ELEV. TDH Lift riction Loss System Head TDH Ft Force -in- 7 th l SOIL ABSORPTION SYSTEM A r\ , 0_ _ L__ /4vwP ,A County: St. Croix Sanitary Permit No: 408201 0 State Plan ID No: Parcel Tax No: 020 - 1414 -13 -000 ELEVATION DATA STATION BS HI FS ELEV. Benchmark 3.5'a c3•so Liquid Depth ou. Alt. BM l Bldg. Sewer SETBACK c� St/Ht Inlet III WELL 1 0 , 12. 13.3y St/Ht Outlet INFORMATION CHAMBER OR 'A 3 X1 r Dt Inlet 1 � �� Model Number. / Z. Dt Bottom Header /Man. Dist. Pipe lo. }3 c1Z- ctZ • TT ' B System Final Grade n 6.0 96 S'O gi • o St Cover 5.30 r 98 . 20 /TRENC Width r Length No. Of Trenches -. Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM NS l SETBACK SYSTEM TO P/L III WELL LAKE /STREAM LEACHING Man fa�,u e htl " INFORMATION CHAMBER OR Type Of System: r �+ 1 � �� Model Number. / Z. UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Length Dia Pipe( Length Dia Spacing Topsoil I Yes _'i No _ Yes A No SOIL COVER x Preccurp SvGtBms Onlv xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I Yes _'i No _ Yes A No COMMENTS: (IncI�Q„cP 'screpencies, persons present, etc.) Inspection #1: (0 /�� / — Inspection #2: Z� A t - Location: 741 Glenna Drive Hudson, W 1 54016 (NE 114 SW 1/4 29 T29N III Walden Woods Lot 13 Parcel No: 29.29.19.2545 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = y I'D',� 7 -- Plan revision Required? Yes No ' -� / � / v OIL (� ! .� I' C 11- Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. r- r NQe� d� 1� � l va��c _..` Safety and Buildings Division Cuvnty L 201 W. WashittiltOn Ave_ P.0• Box 7161. Site ' W1 3707. tent of commerce -d3 - � sanitary permit Number � *I s Consln Sanitary Permit Application S 20 In watord with Comm 53.21, Wit. Adm. CodtPs I� WOr you provide [I Chwk if Revision for $stns Plan I.D. Number I. Applketion Lit n -Fleets P&W AN IdDrumtlon parcel Number property **=Is Nam pmparty Ownies UsUm AtldrM r y + l4 Sat TaW N,R a ! y4t 1 ST - Nttmbm / BrockNumbet City State zip Cow Subdivitioa Name CSM Number II Type of xwwtug (do& an that apply) s �w - Number of Bedrooms DU or 2 Ftn>ilq Dwe111ai bpi a pttAdComtaarCW - Describe Use NetuettAotd o sto Owned IB. fiype Permits (Check ottiy one box on liras A (ntmsbat trbenu for internal ism). Complete line B if applicAble} A. 1 New 2 0 Rpm s'mm 3 ❑ Replacement of 6 © Addition to For Coestb' rue Tanis 01 1 zxh B. Q Cbeck if Sudtaq pew previously lsaned Permit Number Date Issued 3 �#t (Cbecit all that apply)(numbering ncbesne � for internal sue) � A — IV. Typed Pes Mou 21� Ad 47 D $tand Filter 510 © Constructed wetland �, \ 44 ,Non - Pret�ited ist- (3totmd Si D Drag Lice 22 ❑ ln 4111 Holdia5 Tank 48 ❑ Slagle Pans 43 Q At -Qtyde 46 ❑ Actable TtaaMOL Unit 49 D RecL d%' 30 D Odser V. Area Inlos'ste rat Soil App DWPOrW lioaeioo percolation stain syta ev Final Qrade DKIP Flow ���77 Frop Rate(t�ale./Days�S4.Fc3 (Mlo.Mcti) Q �^ /, Fkvation f v ` Steel Fiber Plastic Eb � Total Number Manufacturer Prefab VL info claltoat Gailoan of Tttaks Cottcrooe Coasttucmd Cilasa New Exbedal Sq& at'HoWIN Taft f fos of *6 i+OW" sbews on tlu attaclud ltuu. VII. Spttenteat- L the curds + aatuma sew Number Buainese Ph= Number Pluatbar'a Name Mft) Phtttiber': SiSatatte 713- 3 —3lzl w'�'fl,'a rn s U,er � ,t' bEes AfteM (UM. Ciry. Sfax. Zip COdt) VIII. artment Use Oral pate Issued lssu Agaat Sigatnnue (No Stamps) Sanitary permit Fes (iucludat 8 :autdwuer �Appmved ❑ Diag prove Sum use Fee) i _ (,I Owner Given law Adverse 2 2 5 Deterntiotdoa UL Conditiooa of ArPrwftyReasm for Diappr OY &I � - cx -b ° I atLh4atiti . + 4 . Adwh (to du CON* edy) for the systaa oa paper net leis shat lift t ii In dre sBD -6398 M ' 05/0 '" r ✓ sGa��e � `�yD' 1te- e qrA I MV • mA IM 1 tro 1geo: , 41 , th !6 -✓do JI,S o aJit/ �lc�5 Adz `19.73 M &L5 -e- S % 're o-4-J 'v 1477 * Wisconsin Deparfinent of Commerce SOIL EVALUATION REPORT page 1 d 4 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 must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel lI p percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 020 - 1083- 30 -000, ID #29.29.19.3340 Please print all Inforrmllion. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Midwest Const. & Development Of Hudson„ INC. Govt. Lot — N E 1 SW 114 S 29 T 29 N R 19 W Property Owner's Mailing Address La # Block # Subd. Name or CSM# P.O. Box 932 13 1 Plat Of Walden Woods City State Zip Code Phone Number �' Ilage j6 Town Nearest Road Hudson WI 54016 715 - 760 -114 \ - s Glenna Drive New Construction Use: 0 Residential / Number of Code design flow rate 600 GPD Replacement � Public or corrxnercial - e: Parent material Glacial outwash Flood i elevation, if applicable na r General comments and recommendations: Install 2 trenches using 29 high ca c infiltrator �y elev. = 93.50'. F-1 Boring # Baring >97" in. Sal Application Rate nth Pit Ground Surface etev. 97.66 ft. - to ftinq factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0 -28 1Oyr3/2 n Is 1fsbk ds as 2f,1mc 0.7 1.2 2 2yr4 /3 none Is 1 ds cs 2f,1mc 0.7 1.2 3 2740 yr5 /4 none s 0 sg dl cs 1fm 0.7 1.2 4 40-68 yr6 /4 none s Osg dl - - 0.7 1.2 5 68 -95 1 Oyr6 /4 _ none s Osg dl - - 0.7 1.2 z l • T�� 'A Horizon #3 contains approximately 40% gravel & cobbles. y�• 5Z�8S •9 Z � 1 im Boring # J Boring Pit Ground Surface elev. 97.52 Deoth to limiting factor >95° in. Sal Appkcafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 I *Eff#2 1 0 -10 1Oyr3/3 none Ifs 1fsbk ds cs 2fm,lc 0.4 0.6 2 10 -27 1 none grlfs 1 msbk ds cs 2f,1m 0.4 0.6 3 2740 1Oyr5/6 none grs 0 s dl cs if 0.7 1.2 4 40-68 1Oyr6/6 none s Osg dl gs - 0.7 1.2 5 68 -95 1 Oyr6 /4 _ none s Osg dl - - 0.7 1.2 `{ 2-1 s� 'I 'A Horizon #3 contains approximately 40% gravel & cobbles. * Effluent #1 = BOD ? 30 < 220 mg/L. and TSS 1 <150 mg/L Effluent – BOD 30 mg/L and TSS < mg/L CST Name (P Print) Sig re: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations D Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/15/01 715- 248 -7767 property Owner Midwest Const. & Development Parcel ID # 020 - 1083 -30 -000, ID# Page 2 of 4 3 ] Boring # Id Boring Id Pit Ground Surface elev. 96.02 fl. Depth to limiting factor >96 " _ in. So4 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GMM *Eff#1 *Eff#2 1 0 -19 1 Oyr3 12 none Ifs 1 fsbk ds cs 2fm,1 c 0.4 0.6 2 19-8 1Oyr4 /2 n one Ifs 0 sg ds cs 2f,1m 0. CV14 '1 3 38-80 1Oyr5 /6 none grs 0 sg dl cs if 0.7 1.2 4 80 -96 1Oyr6 /6 none s Osg dl - - 0.7 1.2 5 48 -90 1Oyr6/4 none s Osg dl - - 0.7 1.2 Horizon #3 contains approximately 5% gravel & cobbles. n T 4 ] F Boring # Bonng Pit Ground Surface elev. 94.86 ft. Depth to limiting factor >90" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Eff#2 1 0 -9 1 Oyr3 /2 none fsl 2fsbk ds cs T2f, ,1 c 0.5 0.9 2 9 -17 1Oyr3/4 none grlfs 0 S ds cs 1m 0. CV14 '1 3 17 -31 1Oyr5 /6 none grs 0 sg dl cs if 0.7 1.2 4 31-48 1Oyr6 /6 none s Osg dl gs - 0.7 1.2 5 48 -90 1Oyr6/4 none s Osg dl - - 0.7 1.2 Horizon #2 contains approximately 30% gravel. Horizons #2, 3, & 5 contain approximately 20% gravel & cobbles. Boring 5 Boring # Pit Ground Surface elev. 9 _ ft. Depth to limiting factor >92" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNt' *Eff#1 *Eff#2 1 0 -23 1Oyr3 /2 none Is 1f ds as 1.2 2 23 -37 1 Oyr3 /4 none gr Is 1 msbk ds cs 72f,1=0.7 1.2 3 37 -77 1Oyr5/4 none s 0 sg dl cs 1.2 4 77 -92 1Oyr6 /4 none s Osg d l - - 0.7 1.2 Horizon #2 contains approximately 30% gravel. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L. * Effluent #2 = BOD < 30 mg/L and TSS <30 mg& 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 devartment at 608 - 266 -3151 or TTY 608- 264 -8777. SOIL AND SITE EVALUATION 1477 Page ( of 4 PROPERTY OWNER: Midwest Const. & Developme Of Hudson„ INC. PARCEL I.D.# 020 - 1083- 30 -000, ID#29.29.19.33 A.C.E. Soil &Site Evaluations REPORT MEMO Soil evaluation completed for plat review purposes and prior to clearing of lot hionumentation. Results indicate that the soils at this location are suitable for a conventional septic system. Additlal soil evaluation and clarification of system location /design may be required prior to POWTS design and sanitary rmit acquisition. (�Ie nQ D ( ✓c 0 d L a ■ 97.0 ■ -s� g Q CE ■ rl.; I in k pine �t¢ • ;1441, - 104. Co ' 73; .Gz , ■ Sol e ✓a /u & wi /a of 56 .CfoIxCo 99.0 'co.?",60"r- Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Coda each Private Onsite Wastewater Treatment system (POWTS) shall include Information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions far system ab b e o file at the department, agent, or governmental unit. The approved p permits zoning or health department. Table 3: and/or service once every s gears once a year and clean at least once once every 3 y ears The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servlcing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic nk and outlet filter shall be assessed at least once every 3 years by inspection. The utiet tilt s hall be cleaned as necessary to ensure p fggrptio The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsits Wastewater Treatment Systems SBD- 10567-P (R.6/99). Management Plan for a Septic Tank and Sol Adsorption Component filter is equipped with an alum, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indloate surge flows or an Impending oontinuous alarm:, The septle tank shall have Its contents removed when the volume of scum and sludge In the tank excw is 4/3 the llquld volume of the tank If the contents of the tank are not removed at the time of an aeeaarnent, r sftnance p ersonne l shall advise the owner of when the next soMes needs to be performed to maintsin less then maximum scum and &judge accumulation in the tank. Manhole deers, access risers and covers should be Inspected for water tightness and soundness. AEI*$ openings used for service and assessment $hall be sealed watert cht upon the completion of seNce. Any opening deemed unsound, defecOve, Or subledt to failure must be replaced. , Exposed access openings greater than 8- Inches In diameter shall be secured by an efTeollve look nq devioe to prevent accidental or unauthorised entry Into the tank. No one ah" entw a septic a 0VW bubnent or h olding tank flog any room wlthoW be ft In Hull coenplftmos with 08M ,sbndw* for eJf'�arlA� � COR�Md ipRdie. Thlt �tfiai�� t+vlthlR the ie�tlC o/' Other "tbMt of boon# tuck may aonUln lethal paws and Maus of e p rw ift lntular of the tank imy be d#ftN or IMPS"WIC Tank abandonment $hail be in aoccrdance with Comm 33.33, No. Adm., Code when the tank is no ionger used as a POWYS component, The soil absorption component asm1mg this structure Is deeignad tO eaaept domesto wastewator from a msidentlal faculty. The limits of operation of this component are shown in Tape g. The longevity of a +loll absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliabia operation, Good water conservation practices by all occupants and the i n s tallatio n of water =$10rwing plumbing fixtures are key fac Lora In extending the useful life of this component. The soil absorption component`& operation must be assessed by In spection at Ieast once every three years. The Inspection shall include recording fled gals of pondirg, If any, in the observation pipe*, and a vis Inspection for any evidence of surtace seepage or discharge from the component. On steeply sloping sltes+ areas of erosion should bs Identified and reported to the owner for repair. The surface discharge of dwnsmlo wststewater or sewage from the system Is prohibited and considered a human health hazard. Traffic around or aver the soli absorption component should be avoided pa during winter months, The compaction or removal of snow cover over the oflmponent may 100d to hydraulic fallen by freezing. This type of failure Is usually temporary, but Is dlfHcult or impossible to re pair until weather oondlgons improve. In general, 9011 aompecuon over this camponertt will reduce d0volon of oxygen into the soil and dispersal 0411, rich may lead to more intense, and earner, organic cloong of the fall. 2 ManaBsment Plan for a Septic Tank and $oil Abwrption Component pisntop of deap400tsd Vass and shrubs dirfatly over of within tan feet of the componsrft should be avoided since root Intrusion into the Component may obstruct Wastewater flow. Contingency Plan In the *vent of system failure, a new system could be Installed in an alternate area. With t he installation of a diverter valve, the existing system could also be reused after a period of three to bur years. It is the property ownemt rIspor»ibility to maintain the alternate area tfee ftm any Planting of treat, shrubs, etC. in can of fsrlun of the original s y stem, the alternate area will be need. If any tress, shrub*, eta. Nwe been planted on the siternste area, they will have to be removed at prowtY oestrus "Pon". if altemste area Is destroyed, there w* other altemsti systems that can be used, in which, oould nwit in added ocipow to the pV*rty owner, Any tank sbsndavment shall be done in acconfatnce with Wift Cods 83.33, Any q ueetlont r*parding this code, please contact your local Zoning Office or contact the insftelling plumber. o.0 ► r� 'D +ce. �'� 5' ).3 8 1. -� L4 to 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jd 4 .r/ Mailing Address Property Address City/State LEGAL DESCRIPTION Parcel Identification Number Property Location /,, 5-4) %., S 1 ___ , T 4 N-R W, Town of 4`114,14'a . Subdivision Lot # e. Certified Survey Map # , Volume . Page # Warranty Deed # 4 � ' � 9.2 '-�- , Volume / 91-3 , Page # l9�':Z Spec house ❑ yes 9 no Lot lines identifiable' yes ❑ no SYSTEM MAINTENANCE 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. 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 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 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 Zoning Office within 30 da of ee year ex ' lion date. S GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. )GNATLM prop described above, by v' a of a warranty deed recorded in Register of Deeds Office. t OF APPLICANT « «« « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. " * * * * I (we) am (are) the owner(s) of t0 / (A G DATE «« 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 (Verification required from Planning Department for new constructio STATE BAR 0F4ISC A14FU 1 - 1Lc 2 Document Number I WARRANTY DEED This Deed, made between Renton, Inc., a Wisconsin corporation Grantor, and John D. Parotti and Nancy Parotti husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): L .:ot , Plat of Walden Woods i n the Town of Hudson, St. Croix County, Wisconsin Recording Area 682 1 28 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., MI RECEIVED FOR RECORD 06 -19 -2002 10:55 AN WARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 261.00 COPY FEE: CERT COPY FEE: PAGES: 1 Name and Return Address , ,-,VA-Kc(1 -r J o A L womp� k N 5 51 ,�-5 Together with all appurtenant rights, title and interests. 020 - 1083 -10 & 020- 1083 -50 Parcel Identification Number (PIN) This is 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, restrictions and reservations, if any, of record. Dated this / day of hC-- 2002 Renton, Inc.. B : AUTHENTICATION Signature(s) Rent Inc., a Wiscons c orporation by authenticated this day of ,2002 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY _Kr istina Ogland, Estreen & Ogland 30 4 Locust Street, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ss. ST. CROIX County Personally came before me this ay of �t� -�• , 2002 the above named Renton, Inc., a Wisconsin corporation by - 3 e: to me known to be the person(s) who exec [foregoing instrument and acknowledged the same. i C) 1 A /; Y sPU B LA Notary Public, State of (� 5 Lo:. t r ' 4 T ° "•""•'•• p My Commission is permanent. (If not, state expt6`F WtSL " Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 1 -1999 D RI\ NORTH LINE OF THE SW1 /4 7 39.25' ,5 52.88 267.21' 151.98' J T 1 )E E ASEM .14 TOR tr SERv v h CENTER OF /j o� TEMPORARY C Al ° CUL- DE-SAC o, 34 LOT 7 ' . J ° 3.200 ACRES I �/ WELL (139,386 SO. FT.) j /' 1 4 9 9 HOUSE & -- - - - - -- GARAGE s S S j 8 80' RADIUS TEMPORAR` CUL -DE -SAC EASEMEN• VENTS g v REMOVED UPON RO . EXTENSION. I i . 4 '( i N"► aq � pSEM E N ,oNS ISO 10NENj fop RES / •. SEE gEPA 'A/ rya i LOT 2 2.026 ACRES (88,240 SO. FT.) I LOT 13 2.520 ACRES S89"1 6'52'E 348.59 20.89' I ( (109,777 SO. FT.) w 33' 33' O4 s r I J ! m LOT 3 I � Z � ao 2.416 ACRES (105,250 SO. FT.) — — - 7' 215.78_ J jj N ,AGE EASEMENT, EACH SIDE OF CENTER LINE. • I S89 222.62' J S89 &52"E 410.85' ,CK PINE DRIVE °° �. t srt� s��„ �nty R "lgster of [?R N89"1 6'52"W 410.41' , m d0 --