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020-1342-10-130
W+a Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix $a+�ty and Building Division INSPECTION REPORT Sanitary Permit No: a 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Cook Revocable Trust Hudson, Town of 020 - 1342 -10 -130 CST BM Elev: Insp. B BM Description: / Section/Town /Range /Map No: (vi d V v (� � "'�-�I'1Xs_ 32.29.19.1829 TANK INFORMATION ELEVATION TA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 'Rr " • q _ oo. 6 Dosing ��� / Alt. BM 7—P ltiY1 Aeration �{ Bldg. Sewer 3a �► 3.1 l a l. Holding St/Ht Inlet °X, 3 75 /ol TANK SETBACK SUHt Outlet INFORMATION 3 �� 0 D j� TANK TO W/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / y / Dt Bottom Dosing Hea an. NJ Aeration 1L Dist. Pipe / Holding ` Bot. S m C Final Grade PUMP /SIPHON INFORMATION 6 11'7 Manufacturer Demand St Cover ( 2s GPM / C4 CIU Vl {� LS I0 3 Model Number TDH Lift Friction Loss m Head I TDH Ft T A Forcemain Length in, Dist. to Wel SOIL ABSORPTION SYSTEM BED /TRENCH Width f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 SETBACK SYSTEM TO P/L 5 BLDG WELL LAKE /STREAM LEACHING Manufact / r INFORMATION CHAMBER OR n�7 r Ty Of System: g _ f/ \ J r / UNIT Model Numb T IBUTION SYST J /I� Header Id ion / I x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length Dia Spacing SOIL COVER x Pressure Sy stems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center r Bed/Trench Edges Topsoil l El Yes El No [I Yes El No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_Ia/_2�41 Inspection #2: Location: 486 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R19W) NA LLott/ 1 Parcel No: 32 29.19.1829 1.) Alt BM Description = ��✓ �"' "' �� ',,( �� 2.) Bldg sewer length = ( �,Q/I�f Gt,'� 7' 2,LQ•Q�iC� �° - amount of cover = \ p �y(eQ (� alw,. (O Plan revision Required? Yes VNo O Use other side for additional information. SBD - 6710 (R,3/97) Date Insepctor's Signature Cert. No. cb/1111110 Safety and Buildings Division comity 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) P 1064 Deparbnent d Cciitittt►roe 5 Sanitary Permit Applieatio State TransactionNum1 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for ect Address (if different than wailing address) submitted to the Department of Commerce. Personal information you provide may be used for u es in accordance with the Privacy Law, s. I S. 04(i m Stars. !� .Y 6 !� L A lication Information - Please Print Informatio .5' 4 �✓ Property Owner's Name / Partxl # / , nc c ow Od PtWrty Owner's Mailing Address Lr C C n Property Location / ' g4 � � I L .0 J 1 Govt. Lot l • / �Z �J City, state zip code S '/, ,it1W Y+, section /��� �� G/D ZONING OF ICE �� (am* on" II. Type of (check all that apply) lI Lot# T b divis z% i O R j !� [3F. W k,6 , Subion Name I or 2 Family Dwelling - Number of Bedrooms 01 ❑ Public/Commerciat - Describe Use City of ❑ 3M , Owned - Describe Use 2-5-1 w CSM Number ❑ Village of li N 'a? ") 2 54- C.-�� 9 Town of ,mad , d III. Type of Permit: (Cheek on one box on line A. Complete line B if applicable) A. New System Replacement TmatmeM/Holding Tank Replacement Only Other Modification to Existing System (eorplain) System B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plu mber New Owner iratiom I IV, a of POWTS S Cote oneat/Deviec: Cheek all that Non - Pressurized In- Ground Pressurized In- Ground Al -Grade Mound? 24 in, of suitable soil Mound <24 in. ofsuiWMe soil ❑ Holding Tank - [T - oth er Dispersal Component (explain) ❑Prehestment Device (explain) V. Dispt nalIT rea t Area Infotzttation: Dispersal Area af) System Elevation Design Flow (gpd) Design Soil Ap llons l Area Required I'd eel VI. Tank Info Total # of Manufacturer Material allons Units New Tan /// ks / S eptic or IfioldingTank J �� j„7p� �/ r� D e y , ewe Se-*- Dosing Chamber L ew) e go 1 I ` � C 4s'- 3e e= a-'+ VII. the aitacbtd pbes. R onsibility Statement- I, the anderaigned, assume responsibility for installation of the POWTS ahovrn wt Plumber's Name (Print) Plumber's Signature Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. Coun /De t Use Onl Loved isappm Permit Fee Date I Issui art Signs rven R Denial S 4 29l 1X. Cnnditf+easons for Disapproval 3 .� / r S -37 1. Septic tank, effluent finer and t . dispersal cell must all be servtces / maintained as per management plan provided by plumber. IX All setacltrequit"t1ettts must be maintained as Attoeh to eompkte pl for the system and aahmit to the CouMq ody on paper not tw lb--- g t!i x � iaehs is dze f a SBD -6398 (R. 01/07) Valid thru 01/09 1toe!, rCc 'P' cr o� yiv " lad / ' a\ 0 n v,. a � _ t °h O� Ij G/j i LJ a a N a I� 4' t I Wisconsin Department of Commerce SOIL EV L N EPORT p age 1 o f 4 Division of Safety and Buildings in accordance w' Attach complete site plan on paper not less than 8 x 1 f f size. Plan must unty St. Croix include, but not limited to: vertical and horizontal rence point (BM), direction and parcel I.D. 020 -1342 - 10-130 percent slope, scale or dimensions, north arrow, an location, distand� *arest oad. Please print all * • n. iV r . Y Rev7 by Date Personal information you provide may be used for seoonda purpcig" tWtit l`aQ,�. D4 (t) Property Owner rty Location Cook Revocable Trust (William Cook) Govt. Lot NW 1/4 NW 1/4 S 32 T 29 N R 19 E (or)W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# /, 699 Eddie Lane 13 '/( C'n d Q,et� City State Zip Code Phone Number OCRy []Village own Nearest Road Hudson Wisc. 1 54016 1 ( 715 386 - 1667 Carriage Lane E] New Construction Use❑ Residential / Number of bedrooms 3/4 Code derived design flow rate 450 /600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Glacial Till and Limestone Residuum Flood Plain elevation if applicable N.4 ft. Ge re raaceients Conventional System 30" below grade —�5� POW t Boring # a Boring Q pit Ground surface elev. 95.10 ft. Depth to limiting factor 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-14 10YR3 /2 --- sil 2tbk mfr cs 2f 0.6 0.8 2 14-30 10YR3 /6 -- sl 2mbk mfr cs lvf 0.6 1.0 3 30 -50 7.5YR3/3 - -- s Omgr ml cw — 0.7 1.6 4 50 -68 10YR3/6 -- s Omgr ml cw -- 0.7 1.6 5 68 -80 7.5YR4/3 --- s ()mgr mfr cw — 0.7 1.6 . �D 495.0 F 2 Borin Boring # 96 pit Ground surface elev. ft. th to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10YR2 /2 --- sil 2tbk mfr cs 2f 0.6 0.8 2 12 -26 10YR3 /6 --- sl 2mbk mfr cs lvf 0.6 0.8 3 26-54 7.5YR3/4 — s Omgr ml cw __ 0.7 1.6 4 54 -72 7.5YR3/2 -- s Oingr m l cw — 0.7 1.6 5 72 -96 7.5YR4/6 -- f s Omgr mfi• cw __ 0.7 1.6 ' Effluent #1 = BOD > 30 220 mg/L and TSS A30 < 150 mg/L Efflue r)t #2 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur$ CST Number Thomas W. Gedatus fJ'Y� K! ci 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 11/6/2007 1- 715 -684 -5166 - -1. /11IVf/M\ Property Owner Willia Cook Parcel ID # 020 -1342 - 10-130 Page 2 of 4 F Boring # Boring 97.4 68 El Pit Ground surface elev. _ T R Depth to limiting facto Soil fication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDh1z in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 1 Efr #1 `Effff2 1 0-14 10YR2 /2 -- sit 2tbk mfr es 2f 0.6 0.8 2 14 -24 10YR3/6 sl 2mbk mfr cs Ivf 0.6 0.8 3 24-14 7,SYR3 /4 - -- s omgr ml cvv 0.7 1.6 4 4468 7.SYR3 /2 -- s omgr mt cw -- 0.7 1.6 5 68 -80 7.5YR4/6 f2d5YR5/6 spots s 0 M9r mfr CW — 0.7 1.6 L± Boring # 9 Boring Pit Ground surface eiev. ft. Depth to limiting factor in_ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stmcture ConsWence Boundary Roots GPDRF in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "E1101 - Eff#2 E I Boring 0 Boring J Pit Ground surface elev. _ft. Depth to limiting factor In_ Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Root. GPD/f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh• 'Eff#1 '0102 - Effluent 81 s SOD, > 30 220 mot and TSS >30 < 150 mg& ' Effluent Art = W0 S 30 mg/l. and TSS < 30 mg/L The Department of Cotnrnerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please wats I the depaRment at 608266 -3151 or TTY 608- 264-8777. S6p-.8330T40 (ILUMU) Tod =QI 9Z:OT 80 -SZ -TO 8 6 CQY'r a AgG 1.. �n °L IA c, w:sc. snot 0 w V 5 32 T 9 N R i b %"1 � C 4 Q 2Q # 020 - t34Z r % \ sov N �.�� }s .Cot 13 4 NE r � 01 41 - Z CS T 2 60 q3,1 95. qb•3 R yo A SM = on 0 1 1 -is .s / g- ,��oPe✓ 8- z g s.o Cl L4 r l C� 1 6 -Z % B B NA IL TN \ iz ASH s� 0 -t P 3 °6 '� Sep. 09 08 09:28a p,11 YLiMP C.lIAMBLFI CIIUSS SMTIO A SPECIFICATlt1L�� vcu"r CAP C.Y_ VENT PIPt I APPROVED LOr-KMSG 1./I:ATHE1lYRfld !"1AA11lQt>+ C,01/ER JUI1iCTlaN 1S OX FROM DOOR, Z 3 12 "I'llti. ILbaOw an PREs" A. )P, IhJT'r1KE � � ! GRADE y" AlttiF, GOIrlDL1lT — - -.-- 1 AAA � IAILET FmovI DE f � AIRTIriHT SEAL i I ( i � kf A ALMA rAPPROVED 1 1 Qu JOINT VIT14 LM FT, � APPLE PIPE �, "_1 y OFF p SOLID SOIL C"CoWre BLOCK KisEK £JUT rEKAIWm 0MUJ Ur ThUK MMX.'FAcTURF,-R "As W-w-m APrROVAU SEPTIC t SPEGI LGATip�lS Dost TAU AS 5 C x Mua%w^ Or w5cs: PER a" Tw11t15 MllullillCYL1StRR: TAM SRC : ! Z o`�,8 G O . ��. KALL01N5 DOSC VaLLIME 5 � E. - x,0••.10 s MtLLMILlf. S ACKFL 1 . MAUUFACTIIRER: - -. i MCD 6L. UU^bRR: �9..� k /4 L &!:h F�►PAC r►. WCUS OR GAEL .'= S PU" Ir1ALIMAGTURCR: ��1 �w S __ / L: �•a N3LtilEi, Olt 6ALL Y5 i N►gR1CL IJLIMIIIER' E. OS J p= IMMIES OR f.Att 1 i SWl7'GN T}IPES c• • PUAP AIM ALA&M /t" TO DE MINI.l um Dlat"Alt4m AAT[�Gvn 110TALLCID GM SEPARATE CIRCUITS ! YEIRYICKL DWFERt#tis: CBTWILCM PUMP OPP AM 4+ 306UT'IOQ FiM- / � f1tT + ^tLjIAIUM METWM K Si1PP1.S PRCs6URE .... . ...... 2.5 MET {. 5 0 Fc E r or PoRcr. MMM x �_ jL FtuTwu ffiocn R. ?� � FCT i TOTAL OyWlrKK. HEAD as p, FEYT III tltblA#_ OIMCLlt10NQ Of TAUK: LEU&TR ;WIDTH � ILIQUJEI G tP'T H $ S 'J161�tEOi ���� �,.�.. LICE1.ISr[ I�lllr'1DER: 2 �� DA`rC: ll Sep. 09 08 09:29a p• POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pageot FILE IN OOMATION SYSTEM SPECIFICAMONS ° /Z lr v ev Septic Tank Capacity P 2 gal ❑ NI Perms # Septic Tank Manufacturer (, 0 N DEM PARANIMMS Effluent Filter Manufacturer 0 N Burn of Bedrooms C, DNA Effluent Filter Model - 7 U ❑ N Nuqnt door of Public Facility Units O NA Pump Wank Capacity gat O N Estim sted flow leverage) el/da Pump Tank Manufacturer N Dazig tlnw (peak), lEsxirnated x 1.5) L Z' # Pump Manufacturer 4 Q N Sol Applicotion Rata k a1 /da !?t Pump Model O N Stan lnfluentlEtFluent Quality !Monthly average` Pretreatment Unit � Fats, da & Grease (FOG) 530 mg/L ❑ Sand/Gravel Fi ter 0 Peat Filter Bi Wlerhicat Oxygen Demand IBOD 5220 mgfL DNA C1 Mechanical Aeration •O Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection D Otter: Nebo ated Effluent Quality Monthly average Dispersal Coll (s) D N Bi ch ,, +amicai Oxygen Demand (13001 —<30 mg /L 1>pfn•Ground (gravity! [3 In Ground IPressurizedl Total tkapended Solids ITSSI S;iQ rng/L ❑ NA 0 At -Grade ❑ Mound Fecal CoNform Igeomettic mean) f-I& ctuf100ml Ej DrWLba 0 Other: Maxi Inum Effluent Particle Size Y. in dia. 13 NA Other: ❑ A Otlwr q NA Other: ❑ JA "V as tv&el for damns& westewsm end septic tank offluftnt. Other: ❑ MAKV4ANCE SCHEDULE situioe Event service Froquency fj in ct condition of 120(c) At least once every: '� reont ) sl iMaalkrurrtt 3 Yews) d IN equals one-eird I F of Lank volume ❑ A combined shed o and scum ev 0 �, Pum out contents of tanks) When 9 1 dispersal call(s) At least once every: month) tM.dmum 3 years! O A saris} At least once + month(s) p A CI eftFuettt filter e`Y' { 110 ve arle) At least once ev 0 moathts) ' q A Is tic alarm R err. Ins pump, um contra ar s R A. p p if:f ye ( ) Iaterrals and pressure test At least once every; 4 0 ~WS) O A O At least once every. 0 y (s) q Ot O M" CE MTRUCI<IONS Insp Ions of tanks and dispersal calls shell be made by an intliVOual Carrying one of the following fitzenses or certi mi w ns: Ma or Plumber: Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintairm. Septage Servicing Operator. 7 k ins 'ono must include a visual Inspection of the tankla) to identify any missing or broken hardware, identify arty cracks or lei ks, ure the volume of combined sludge and scum and to check for any back up ar ponding of effluent on the ground surf e. The ispersal callis) $hall be visually Inspectad to check the effluare level$ M the obcvtvatlon pipes and to check for tray ponc ing of cent on theground ourface. The poodiirq of effluent on *So groundsudwe may in inns, a failing condition and requires zhe hnm late notification of the local regirWory authority. Wh the cambinexi acoumutatlan of sludge and actrnl in any tank equals tare -third 1YJ or rltore of file renit volume, Ute eon a of the tank shall be removed by a Septage Servicing Operator and dlepoaed of In accordance with chapter lift 113, ntitn Administrative Code. AN . senrioes, including but nor %mited to the servicing of effluent filters, mechanical or preasurlted compaprints, prelrearn ant Unkl, and any servicing at intervals of S02 months, shall he performed by a certified POWTS Maintainer. A as vl ooe report chaff be provided to the local regulatory authority within 10 days of Completion of Any service event. GMW 44M t I Page of START UP AND OPERATION For new construction, prior to use of the aPO dam a the dispersal cell(s).orlf the presenc of high c oncentrations t + a a detected have he contents that may impede the treatment process g of the tank(s) removed by a septage servicing operacor prior to use. System start up shall not occur when soil conditicns are frozen at the infiltrative surface. toted the excess wastewater will be pow er is res tored wet outages pump tanks may fill above normal highwatet levels. When pow result in the backup or surface discharge of Duri o g P d ma y Dur p cell (s) an Y g the ce ( 1 in one large dose, overloading vicin O erator prior to restoring dis i•sal cellls) to a Servicing P discharged to the p'e tank removed by a Sep 9 Is to contents of the pump um controls effluent. To avoid this, situation have the Conte ratin the pump p ower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually ope 9 restore normal levels within the pump tank. ark vehicles over tanks and dispersal cells. Do not drive or par ab so r ption k over, or otherwise disturb or compact, the area Do not drive or ,p area. or within 15 feet down slope of any mound or at -grade soil P Reduction or elimination of the following from b e was tewater I nts; fat; condoms; co tton swabs; degreasers; diapers; disinfecta rove the asers; denta perfo rm ance loss; and prolong the I oft e POWTS: antibiotics; baby wipes; cigarette bu tts; foundation drain (sump pump) water, fruit and g b l and e water • softener brine. gre ase; herbicides; meat scraps; medications; oil; ve painting products; pesticides; sanitary nap tampons ABANDONMENT When the POWTS fails and/or is permanently taken out of mm 83.33ollowings steps s b taken to insure that the system {s properly and safely abandoned in compliance with chapter • 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 Sep tage 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. LAN t b CON P o r ,must e taken, to provide a code compliant CON P m easures have been, tber repaired the following he P OWTS fails and canno P fft replacement system: ❑ A suitable replacement area has been evaluated and may be utilized and compaction and should replacement no be infringed upon by disturbance t tu . The replacement area should be protected from Failure to protect the replacement area will system P re lot lines and wells backs from existing and proposed structure, replacement area. Replacement systems must required set h a suitable result in the need for a new sail. and site evaluation to establis es in effect at that time. POWTS ❑ A suitable replacement area is not available due to comply with the rules es in setback and /or soil limitations. Barring advanc technology a holding tank maV be installed as a last resort to replace the failed POWTS• d site tank A 11A ❑ Tbg site has ' e E3 Mound and at -grade soil absorption system may be re comply wd place re constructe d f oll o wing wing at that t a biomat at the remov infiltrative surface. Reconstructions of such sy < <WARNING> > DU NOT SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CON ER ANYTCIRCUMSTANCES. DEA H R SULT. RESCUE OF A ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICCULUL T OR IMPOSSIB ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name �'`!l "'u ��, ,,.�lf Phone Phone / _ — 3 . SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ Name _ Phone Phone This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code. 08/27/07 RON 15:28 FAX 715 380 4888 0001 �wf gay► Stfaly and Dml&w Diwioa CMILY 20I a. Waterlog A,•e. PA Barr 7If2 St C R e, i y �at� tdetr, WI 162 Ssaasy ItNamTrsc{m 6e 80ed it byCo ) vm� 5/ 4!0 Sanitary Permit App&atio A m • ..ter: � 8U1M wa. Aim. c� s„bral iaa or** anit is rogsirad prior M obakft a su&w punit- Non. ApplicW= fauns for ase Projacdt +ns(waftlentolm medire*"=) =wb� a the Depa�mt d CWWOO,. PC==M ia�enu" you provide mar w for ` elce2 Lam/ U t& -%ft 0 W L - Pbwe PrirtAN Paopeny owsees Pasta! f N Property a"r / «'' ` Poopaty Location b ? �, e. Irl h �. NTY ra,LLot r �SZ9 City, Sense ONI y � / �! _ s� jc, A seaioo 3 f q lase) n- Type af( clre;yralltSnt ) / O �# 'k A _l, t'arw 2C�t*DaaWM— Nwsbaofltia 1 S �vi�OATJ }A Block # W r o fz i 4-' $ ❑ PoblicleCosnnMCW— Dowiteuse e. ❑ Cby of OSWeO med— DesrxibeUse �❑ vwild �� i� Z 5 + 2r, ar [osm d k S o h UL rppe of Pe� (tbelt oolly amins ats 1Gre A C9=p1MLrqj rB if"pBeabie) A. E$ Netr$rslem ❑ R Sy.OM ❑ Taak o* ❑ Othvr eafima Exjxft Sysw=(aPla*r) IL ❑ ft. titaWF d 0 Pes w ReOww ❑ awflab. Pamir Tumdbrio Nrw Litt Psavxws ftMNusber and Dme (sstrod Betore expin don rv, r nw ofrowrs A davit 19W m4hets u rin d rn-cl ron►d Cl Pressrtrixnd WOOM6 0 Momd< bL afttgoftwil ❑ QiogTaak 00dwD*=dCaatnane.tt r G iJerioa(arplait V. Divemurewsliewt Agra fu6irmatbw > tsO SOMM c D 0. �7 c UU 9 3.3 3, 9 Vl. Tmk Irk Cspaeity in Toot , # of Cdfmrs Witt tra,.TN" iia Q Sepiaorliotdr�Tat / 2 G (� 1 2 C V [ t+ 5 e. E v U UU l VII. Mdeme t` 1.dbe hwbd rtimdd*F4DV 1Sslratrsaotite Pl usbcc s Mauve (Riotl sS mire B Pfane I Haaber J e- St A-h 23Y? S"- L �Y - S'IG PiwAWs Addy waft9M GW ) _ R 0 /30 Y 4 5J 4-�&!0 U. �.� S NCO 2� YII i7ae Pm Dente imaers s�oaae 36 L !X. C tTsr Sros1 rb �Z n c 1. Septic tank, effluent finer and 3) /'r'T' dispersal cell must alt services'/ maiMairted L �' 'as per management plan provided by plumber. o n 22. #AltWtbackragttiamtrnts mwt be i�.d�ttt■ c ..�4�r••v�••rr.�s .n.., .,;;34f L 81/07) VWd ftu Oil09 $; !t� n ^^ : ,� •fa�.�.y oa N,._ (`S L 1 88-27 -87 17:85 TO: FROX:71,5 .3$5 *? =r 4 9 Nw liSa�� LVtSc. ,sy � r �► w '/y N w 5 3Z T as N R 1 '--J C KQ =p #� OZO — 1342. — eo — 1 .4 w'..,c� so kt-.� �} Zoe 13 LO T Lt 50 Gks& 60 2 - 95 •3 �tu A 6 f e- 5.0 o -Z 9 t ..,,-PF, isr z TN AsH N��Son LVtsc. S�IOi w V T a N R 1 to `^� C a W q N y S 32 _ 94 - w'.n l�. i►� po 1 j ��urc 1� o wt 41 60 . G 1" ql� S oe �s- Z qs.o 9 7 .� 1 tio' .3 t i Asw 3' Property Owner William Cook Parcel ID # 020 - 1342 -10 -130 Page of 4 3 Bonn # Boring Boring El Pit Ground surface elev. 97'4 ft. Depth to limiting factor 68 n. Solt App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f1' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i *Eff#1 *Eft#2 1 0 -14 10YR2 /2 - -- sil 21bk mfr cs 2f 0.6 0.8 2 14 -24 10YR3 /6 - -- sl 2mbk mfr cs lvf 0.6 0.8 3 24-44 7.5YR3/4 - -- s 0m9r ml cw _ 0.7 1.6 4 44-68 7.5YR3/2 d5yr5 /6 s 0m9r mfr cw -- 0.7 1.6 �- 1b 1 t( a Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Appfii cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDhf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 - BOD > 30:5 220 mglL and TSS >30 < 150 mg/L Effluent #2 - BOD < 30 mg/L and TSS < 30 rrglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266-3151 or TTY 608- 264 -8777. SBD- 9330Ten (x.07/00) St. Croix County Land Information Online Page 1 of 1 -AP Parcel Computer Number. N/A Primary Owner. N/A County Home Search Tax Record Documents Map Search Results Tools.. 0 ®,P =, Tools... k Search Results -1 Matching Property ro N Return To Search Methods N 1917 FOj20-1342-10-130 te Mailin Labels Grid TOWN OF HUDSON BLE TRUST LN, 329.4 1 830A- 10 7 18 to TN HUDSORI OL2 ' 3.' 1 820 ry N o`L�' ! N iIto , !� v I 28E Scale :l - = �- ft. Cun+ent Tool: � '�-- http:/n2.21.230.178/website/LRPortal/main.asp 10/812007 FAX COVER SHEET Stang Plumbing & Electric I.O. Box 263 Woodville, Wh 54025 Phone Number 17136845166 Fax number 171568"255 Send to: St. Croix County Zoning From- Torre Giedatus Attention: Ryan e: 1/25/2008 f Office location: Hudson Office location: Baldwin Fax number. 17153g"M Phone number 17151;5451.66 Urg Re 1 ASAP Please comment Please review For your Information I� R y ❑ I I� Total pages, including cover: 2 Comments: Z0d =QI 9Z:0T SO -SZ -TO Parcel #: 020- 1342 -10 -130 04/11/2007 04:38 PM PAGE 1 OF 1 Alt. Parcel #: 32.29.19.1829 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): O = Current Owner, C = Current Co -Owner O - KINGSBROUGH HOMES LLC KINGSBROUGH HOMES LLC 8750 90TH ST STE 201 COTTAGE GROVE MN 55016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 486 CARRIAGE LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.595 Plat: 2636- WINDSOR HEIGHTS LTS 1/27 '98 SEC 32 T29N R19W PT SE NW WINDSOR Block/Condo Bldg: LOT 13 HEIGHTS LOT 13 1.595AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 32- 29N -19W SE NW Notes: Parcel History: Date Doc # Vol /Page Type 02/28/2001 639409 1593/167 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.595 59,500 0 59,500 NO Totals for 2007: General Property 1.595 59,500 0 59,500 Woodland 0.000 0 0 Totals for 2006: General Property 1.595 59,500 0 59,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ' — - - - - -- 1.465 ACRES ,•�' M 63.794 SQ. FT. \ ao 0 0 ; N 33 p 1 -- - - - - - r a0 i O' C ./ / �� \— tI) N �at + • — — — � . ' ' � 1.304 ACRES N • 56,818 SO. FT. FALL 3 I \ 34 3 93 �� o J, o to ACT - QLI ; z 0 11 ; I N 7 8" . 2 9 E ' N 1.214 ACRES ' O �• �i3' 9 52879 SQ. FT. • . ` 1.237 A CRES o \. 53,903 SQ. FT. 'r L . . .-- . . —N 85'44'59" E— • . _•. . `c 'ALL 0.5' +\- — 329-40 ' _ •` WELL ACT — ••� \ sa y 1.237 ACRES 79'S — — — — — — — — —� 53,896 SQ. FT. / ' 262 w BALL LL- �,�� \ \; • \, ACT I /.� � \ .• ., 1.595 ACRES • .� \ w / / • ,�s 69,476 S FT. V C� '7 w Z ►- I o / s• m tK 14 1.072 ACRES N h / F- 33' 33' 46,708 SQ. FT. `'� "� 15 / 0 04 �°` 1.090 ACRES LOT 1 X I / / �/ �' 47.482 SQ. FT. N � ; 00 C. S. M 584.30' w --- - - - - -- 7 • + \ L_ ----- - - - - -- 4 5 3 I S 88'46 25" W 650.30 - I 3, PG. 883 I TO BE CONSTRUCTED IF ROAD ' I ----------- - - - - -- I IS TO BE EXTENDED I p M LOT _2 o� ------- - - - - z UNPLATTED N WOULD PUMP CHAMBER CROSS SECT IOW AAlO SPECIFICATION V C U CAP ' 4 %. 1. vENi P {PC 1 WEATHERPROOF APPROVED LOCKMG — ZS` FROM ODOR, JUAlCTIOU BOX MANHOLE COVER WIMDOw OR FRESH AIR INTAKE t GRADE ( l _ COAli3UlIT t8 "JKIAt. ` - - -- - -- I ` 1 IKJLE T PROVIDE AIRTIGHT SEAL */ A ALARIA a � I *APPROVED 1 old c JOINTS WITH ELEV. FT. APPROVED PIPE i 3. ONTO PUMP -� ( OFF 0 SOLID SOIL COUICKETLE BLOCK - RISER EXIT PEKAI - WED OASL4 IF TAUK MANuFACTURCR HAS SUCH APPROVAL SEPT E SPEGIFIGATIOKIS DOSE W' e s c sc TAUM MAWFACTUOLER: LIUMDER OF DOSES: PER D" TAWK 52E : 1 ' 20 c ) / 8 O O GALLORIS _DOSE VDL.UME ALARM P%AUU FACT U PLC R S IOUCLUDIIJG EACKFLOW: I t S GALLONS MODEL WM6ER: A ^I k A\ er' i CAPACITIES= A = �'0 IIJCHESOR � / �� GALLOY5 SWITCH TNPE: — R r C t' �� 8 = 3 IAICMES OR S GALLONS PUMP MAUUFAGTUR[R: - _ C t7 K C S C. - k i t l� � 104LHES OR 1 Ro WIILOUS i MODEL UUhIDER: 3 8 �7 E tJ D- 1 1 - -� INCHES OR 55 GALLONS i SWITCH TypE; ( G Iti IJOTE: PUMP AND ALARM ARE TO BE ' MIUil4U M DISCHARGE RATE INSTALLED OU SEPARATE CIRCUITS GPM VERTICAL DIFFEREUCE SETWEEAI PUMP OFF AMD 013TIttbur1oU PIPE- If � FEET I + MIIIIMUM METWORK SUPPLY PRESSURE ... . . .. . . .. 2 . 5 FEET + 5 IFFY OF FORCE MA1k! X • 5 ooM FRtCTtOU FACTOR..? y � FEET a 1 -- TOTAL O'SWAMIC BEAD a S+ FEET i a i !IilTERtUAL. OtME1LlStOIIIS Of TAUK: LEiJ>rsTH- _..._.r;L.iQUID DEPTH s� SIGWED: LICEUSE LIUMSER: DATE:..._._. -- ITT GOULDS PUMPS Wastewater F. RAffum Total dead Quom Per of wat l ((t er z ` EPO4 EPOS 1 0 46 62 2 Base l6 3 G1*9 8 15 36 55 4 Medm" Seal 20 21 46 5 839 Bembigs 7 25 0 33 6 6 046ngs 9 - - 30 — 11 7 Power fad 5 8 Oi Filed Motor 4 ' Motor Housing/ 3 = 0 110utorCover 2 METERS FEET - s 10 t 9 30, 57H ? ' i } $ f -- -- — — — 2 5 Fr s 20' t } f 4 EPO+ f O 3 10. 2 7 EPO4 ! 1 , 1 r N _ GPM L 0 2 4 6 8 10 12 sN CAPA- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ of FILE INFORMATION SYSTEM SPECIFICATIONS O gal Owner Septic Tank Capacity 2 (.' ❑ NA Permit # Septic Tank Manufacturer L") c.S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer J? P_ S C ❑ NA Number of Bedrooms 1 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity ( c gal ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer � � b, ; 'C S(�, Z❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA Soil Application Rate s Pump Model ' 1 gal /day /ft p � / ❑ NA Standard Influent /Effluent Quality Monthly average Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) _ <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 104n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA 5 year(s) y 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 every: Q month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once ever // f ❑ month(s) y ' I l P year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ® year(s) Flush laterals and pressure test At least once every: ❑ month(s) (') ` � ❑ yeyear(s) ❑ NA Other: At least once every: ❑ month(s) ❑ NA Other: ❑ year(s) ❑ 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 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. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or dam Y P / damage the e dis ersal cell(s). If high concentrations ar 9 P 9 e 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. ❑ 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 POWTS MAINTAINER Name S L �} h ,r' Name S Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name . CID Co Ze ni Phone Phone 7/5 . 3g( _ 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. ST. CROIX COUNTY ` SEPTIC TANK MAINTENANCE AGREEMENT AND / / OWNERSHIP CERTIFICATION FORM t� Owner /Buyer I i l' I 1 Mailing Address &IN Property Address (Verification required from PUnning & Zoning Department for new construction.) City/State Y ��� , (�� Parcel Identification Number T LEGAL DESCRIPTION Property Location My '4 , (V �� y 4 , Sec. T �°� N R W, Town of Subdivision Plat: �l /�G��SCei� � �'�j , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # PJ �g� (before 2007)Volume , Page # Spec house yes no Lot lines identifiable yes 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 ( I ) 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 Planning & Zoning Department within 30 days of the three year expiration date. [/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu f dro in SIGNATURE APP ICANT(S) 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. (REV. 08/05) 05/27/08 TUE 09:32 FAX 715 386 4686 1001 ST. CRO]EX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ovvner48uyer �,t/ l (l e o v (4 Mailing Address (� L C' Property Address 4 n (Verification required from Planning & 7ATJ Department for new construction.) City /State s '° ti �� ^ Parcel Identification Number LEGAL DESCRIPTIQN Property Location 4 , (� 'l, . Sec. T N R W, Town of 4A Subdivision Plat: r 44 e S , Lot # 13 . Certified Survey Map # , Volume , Page # Warranty Deed # ( � c l e (before 2007)Volume , Page # Spec house! yes.. no Lot lines identifiable 11 yes ;0 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 a#fect the function of the septic tank as a treatment stage m the waste disposal system Owner mamtetance responsibilities are specified in §Conan. 83.52(1) and is 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 (t) 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 113 full of sludge. ! /we, the undersigned have read the above requirements and ague to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Comex and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of mylour knowledge. 11we 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 SIGNATURE OF APPLICANT(S) 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 ..Terence is made in the warranty deed. (REV. 08/0s -52 - - FROM:715 385 4685 Pal ..7 08 11'40 TO: I lllill IIIII !1111 Ilill lull lull llll !Illll Ill! llll X 8 4 8 9 9 8 1 State Bar of Wisconsin Form 1 -2003 848998 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 04/23/2007 12:50PM THIS DEED made between WARRANTY DEED Kingsborough Homes, LLC, a Minnesota Limited Liability Company EXEMPT aka Kingsbrough Homes, LLC ("Grantor," whether one or more) REC FEE: 11 .00 and TRANS FEE: 330.00 Cook Revocable Trust created by trust instrument dated June 6, 2006 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property (if more space is Name and Return Address needed, please attach addendum): Wisconsin Assured Title, LLC Lot 13, Windsor Heights, Town of Hudson, St. Croix 1810 Crest View Drive, #1B Hudson, W1 54016 County, Wisconsin. 020- Parcel Identification Number (PIN) This IS NOT homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, Restrictions, and Rights of Way of Record Dated APril 6 2007 (SEAL) (SEAL) * * Steven J. Morse, Chief Manager Kingsborough Homes LLC (SEAL) (SEAL) AU sCy ACKNOWLEDGMENT Signature(s) NOTAl2), N STATE OF WISCONSIN ) ) ss. authenticated on '� Vo. a �.o. St. Croix COUNTY ) PUBLIC * 5 Personally came before me on _ April 6, 2007 TITLE: MEMBER S SIN the above -named (If not, Steven J. Morse as Chimf Mwager Kingsborough Homes authorized by Wis. Stat. § 706.06) to me k wn to b e person ) who executed the foregoing inst t an knowledge he same. THIS INSTRUMENT DRAFTED BY: __ * Richard K.Y. Lau - Redmon Law Chartered Notary Public, fate of Wisconsin 2217 Vine St., Ste. 204 Hudson, WI 54016 My Commission . s permanent) (expires: ) (Signatures maybe authenticated or acknowledged. Both are n ecessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 • Type name below signatures. 1 of 1 vviscu 'DepMment of commerce SOIL AND SITE EVALUATION Divi f Safety and Buildings Page ! 70f BQ u of Integrated Services in accordal s. IL , 3.09, Wis. Adm. CodeL� Attach complete site plan on paper not less than 81/2 x 1 i[ area in .+an must County include, but not limited to: vertical and horizontal refer print (BM�i�uid :tip percent slope, scale or dimensions, north arrow, and 00 and distance to nearest roa��3 Parcel I.D. # DEC ► ? -- 020- /3 VZ - /o - X30 4 APPLICANT INFORMATION - Please print �I�form*Tolf>ROIx ,� Reviewed by Data �( Personal information you pro ' y be used for secondary pu - *riva. Props Owner �; �r 4Pr �/ 1/4 �� 114,S2 N,R E (or)dC ProKrty Owners Mailing Address of # Block# Su bd. ame or CSM# City State Zip Code Phone Number ❑ City Village Town Nearest R New Construction Use: 1 Residential / Number of bedrooms / Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 gpd Recommended design loading rate bed, gpd/fl_ ,,,Y trench, gpd* Absorption area required RR bed, ft trench, ft Maximum design loading rate gP ue�. gIcd/t Recommended infiltration surface elevations) ft (a refe ad to s e plan yw Additional design/site considerations Parent material .J if aDolicable.. ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S U ❑ S ❑ U ©S ❑ u 0 s❑ u ❑ s [A u O s O u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 13 in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ' / Ground a elev. 22-- ft. — — Depth to limiting factor Remarks: Boring # s 3 Ground elev. Q4`�ft. Depth to limiting factor >� in. Remarks: CST Name (Pleas rint) Signature Telephone No. da Address Date CST Num r 1 SOIL DESCRIPTION REPORT PROPERTY OWNER 'T < < Page PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench � Ground r elev. S — � � — — Ili , of " Depth to limiting factor �in, Remarks: Boring # �2 - n N Ground z. elev. , Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Con . Color Gr. Sz. Sh. Bed , Trench Boring # _ 17 7 ,,5 - s Ground - — elev..� ft _ Depth to limiting factor �' Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) a le y/ e lY b / le PLOT PLAIT Paoe 3 of 3 Scale 1' 3 0' ?DDZQ `l_Y$Z GPnZ1Z G� L'Pr�!� y I ' - ,D I `- � wI\ - ti 4 J p I \ 35 q {a wG 33 i c J S -7 G 3 I / // 131"Z tt ; a �l .p o►J_.al _' �- 3ty'! �y C aw -30 _ 0 3 _ 715 425 01G5 220254 03 QO CST Signature Date Telephone No. CST No. Job NO. r '.,;iii Delfartment of Commerce PRIVATE SEWAGE SYSTEM County: Safe and Buildings Division INSPECTION REPORT •P� RAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: I fx Personal info you provice may be used for secondary purposes [Privacy Law, s.15.04 1 m l 344523 Permit Holder's Name: ❑ City ❑ Village aTown of: State Plan ID No.: WEST LAKE BUILDERS HUDSON --_ CST BM Elev. Insp. BM Elev.: TBM Description: Parcel Tax No.: pa / 020- 1342 - 10-120 TANK INFORMATION ; (- _ ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic OU Benchmark G O Aerati Bldg. Sewer olding Ht Inlet q Z 5 TANK SETBACK INFORMATION St Ht Outlet TANK TO P/L WELL BLDG. Ventto ROAD Air Intake Septic - / NA NA Header/ Man. Aeration NA Dist. Pipe t°" Z Hol Bot. System y /�� 3.3 3 PUMP/ SIPHON INFORMATION Final Grade b'�• 9 � Manu r I Demand Model Num :� Kpm TDH ift I Friction stem TDH t oss Forcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM BED/ EN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 40 - 2- IM N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM L Manufacturer: INFORMATION Type \ , HAMBER Mo a er: System: em J �� ± �? y(/� — - OR UNIT DISTRIBUTION SYSTEM r r ( h/ tt OT f7*9-ES U56'D Header / Manifold r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 11! Dia. / Length I Dia. 7 � Spacing _W -7 Z 9 1 Z_ - ;l Z aP 7 d SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) dP �� 's SS� 3 l F- e.� LOCATION: HUDSON 32. .19 , NW , NW 4 8 2 CA�2RIAG LN W / WINbSOR H / • 2 • `/ �� !ej e t! �/ tee✓ = 11 Ke aa��iu' L vT 3 - EAJA of -rl E_ 7 1y - — r,�.q,e� ;-loft _ nnaC�r� 4V a�� �U - ° Plan revision required? ❑ Yes ❑ No Use other side for additional information. fE SBD -6710 (R.3197) Date Inspector's Signature Cert. No. s'32 7;2 9 j 6! /flJ X ,,i7 /a7 tJ ' ✓rl e � �Y.1.t �. oe� o s .'spartment of commerce SOIL VALUATION of .3 liUMM of Integrated Services in tits. LHY 7 ^ mss. Adm. Code �. p AttaCh Complete site plan on paper not less than 8112 x 11 in sizel.�Nr County Include, tart not limited to: vertical and horizontal (BM). dKer.don ? percent slope, scale or dimensions, north arrow. and di tes rw�ere mod. Parcel I.D. rt 75 IL2ea X/ ST CROIX APPLICANT INFORMATION - Pisses prints// ' uwTY by Data Personal intonation you provide may be toed for seoondary purposes tawNs" Property Y,-Z" 1/4 1/4.S T .N.R E (w& Owner's Mating Address tot fi Subd. or CSMif I City Zip Code Phone Number ❑ qt M ®Town Road Qt] New Construction Use: Residential / Number of bedrooms Addition tD existing building ❑ Replacement ❑ Public or commemw - Describe: Code derived daily flow 4 � / 6 7 0 gpd Recommended design loaV'ing rate , bed. gpd* bench. gpd* Absorption area required 2 bed, ft ft Maximum design W&g rate �� bed. WWF ___,ta__ #e . 9Pd* Recommended infiltration surface skmation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation. if applicable ft S = Suitable for system Conventional Mound "round Pressure AT -Grade System In FE Holdkng Tank U= Unsuitable for system s❑ u 1Y1 s❑ u ® s ❑ u J U p s ®U ❑ S ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture structure Consistence Boundary Roots GPDfiP in. Munseti Ou. Sz. Cant Color Gr. Sz. Sh. Bed , Trench � t� Ground _ ft Dept,, to 3.3 factor Remarks: Boring # Lj f/ Ground Depth to Nrniting factor &-Z—jn. Re CST Name �Pd Telephone No. Address I Data CST N :. Pei . . .:. i Dominant Color • Mottles • • . ® Gr. • .: ' .. ti .. MRS i A Dominant Color Mottles :f � 70S J� 71 JT�1�SOn� . .. ...... . . .......... . f or! ° C 1 .3 o j Of