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HomeMy WebLinkAbout020-1342-10-150Wisconsin Department of Commerce j PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATyjACHMO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ��Ul� City Village X' Township sb es h[ Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: 1 01) (n k TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 5 6 Dosing 1 01) (n Aeration 1 _ Holding Friction �� t TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic i 75 ' 1 _ Dosing Friction �� t 24 Aeration 9S Z7 5 or main LAKE /STREAM �3 Holding I All 0 rql:; Job 72 el Z Dt Inlet PUMP /SIPHON INFORMATION ACJ -4 Sid' -kjyt Manufacturer BS Demand FS ELEV. GPM Mod umber O � Liquid Depth /(/ IC) Alt. BM ate`; . GoJ�- T H Lift Friction Syste ead TQH Ft Lo l 9S Z7 5 or main LAKE /STREAM �3 Dist. to Well I All 0 rql:; Job County: St. Croix Sanitary Permit No: 453032 0 tate Plan I No: Parc Tax o: 020 - 1342 -10 -150 Section/Town /Range /Map No: 32.29.19.1831 ELEVATION DATA STATION BS HI FS ELEV. Benchmark �S 3� /b3 3 5 Liquid Depth /(/ IC) Alt. BM ate`; . GoJ�- �� 9 . 'k(4 '73 SI Bldg. Sewer 8 -d 9S Z7 St/Ht Inlet WELL LAKE /STREAM �3 93.7Z St/Ht Outlet c03 72 el Z Dt Inlet � � � 9 17 9 � . 3 Dt Bottom lf✓ll0 p� � Header /Man. ►/ Dist. Pipe plow 38 f q 2. Bot. System ZS r, 7 Final Grade St Cover Z T 4 9 3 1' r! VOI ABSORPTION SYSTEM t I t C14 —k4v_, 11 17 I; 1 B /TRENCH DIMENSIONS Width ` Length o. N Of Trench Vept to it Int e , PIT DIMENSIO S No. Of Pits Inside Dia. Liquid Depth � �� `o SETBACK SYSTEM TO L ) JBLDG WELL LAKE /STREAM LEACHING Manufacturer. - INFORMATION CHAMBER O � � � Type Of Systerrf: 1 n lf✓ll0 p� � Model Number. DISTRIBUTION SYSTEM _0_j k , 00 _ _ 1 ,. 4 f C / Header / Manifold Distributio Pipe(s) \ � x Hole Size ` x Hole Spacing Vept to it Int e , Length Dia Length Dia Sp \ �- cin `o SOIL C DVZP—, -_ x Pressure Svstems Only "�x Mound Or At -Grade Svstems Onlv De Over B d/Trench Center '�'` epth Over B /Trench Edges xx Dep f Topsoil xx Seede Sodded Yes M No xx ulched Yes �� No a,J r OMMENTS: (Includ dediscrepencies, persons present, etc.) Inspection #1: 1 CA Inspection #2: Location: 494 Carri ge Lane ud WI 54016 (NW 1/4 NW 4 2 T29N R 9W) Windsor H fights L ` o: 32.29.49.1831 1. Alt BM Description 2.) Bldg sewer length = f a t L / • ^ n (� �—� aT�'� - amount of cover t7b�� Plan revision Required? :, Yes o � /� I O � � � Use other side for additional info mate Datp In toes attune Cert. No. SBD -6710 (R.3/97) _ / 1 PA AID 07-5-1gW . R2 201 W. Wash4ton Ave., P.O. Dox 7082 ST. CROIX Madi%4- Wl 53707 -7092 s N Number (to be fi]W�v by Co.) Department of Commerce . ation Sanitary Permit Appkel In Comm 83.21. Wis. Adm. Co&, infor�" aocordAith personal rwavide may he w;ed fir %w"Awy purposes Pfivacy law, sl 5.04(lxW); Prqitxt Addras (if different Um mailing address) 494 CARRIAGE LANE L Application Information - Please Print All Information EE ATTACHED WARRANTY DEED Property Oww's Mailing Address 'Property Localicm 29 W or IL Type of Building (chitick all that apply) A 09-611/ mRion Name CSM Number I or 2 Family Dwalfi Numkw(W 5 B,!DR�M� rER SUSKTTED HOUSE PLANS rublieComlmull - Describe U. WINDSOR HEIGHTS 111. Type of Permit: (Check only one box on line A. Complete line 8 if applicall1c) list Previous Perntif Number and Dale hxued Before Expiration e- Plumixt 453032 MARCH 22, 2004 IV. Tyw of POWTS %ystem: (Check all that apply) Media Fiber 'Al HDripune flia Eloa.(expiaul) 0 81.21'(13 chambers T 750 5 1500 1524 94.15 V1 Tank Info Cvadly in Tocal Number Site Steel Fiber Plastic Ae�3c'.rrcaftnem ;nit VIL Responsibility Statement- 1, the uvulersigned, asslalac relipmoillaky Aw hatalladea orthe PON"s shown M the attached phlu". Name(print III~ Number TODD FEATHERSTONE 242514 715-381-1704 P.O./130X 67 HUDSON, WI 54016 Karutary Permit Pee (includes Groundwaier Dole haw I Aing Agent SIAM El o,. -Givon Rom for Dolw IX. Conditions of Approval/Ressons for Disapproval -71pl m j e ada-W dv(-� 0029-/ anta AID 07-5-1gW . R2 I I I I 0 0) N 0 0 d A N y 0 C v C t" p 7 -C CD N m � C 3 A 7 �a N 3. c. O r N 3. c. 4 °o -0 O -0 O 3 3 fnZ Cn ZD CnZ W ZD CD co D c8 D W CD ca" D n D cn 3 a a IW 3 a a co O O O O CL C. N N O N O N I Z Z CD CD c CD c n m CD CD N 7 CD 5; m @ N 7 CD N CD m O O O O I ,C D C C CL Z a a a a o Z a a a a o_ o_ I 0 O 0 O O N O (� C A C c w n N 3 W a lD 3 o m o CD I 0 in .• � yr j I I I I I r0 CD 0. 3 � 7 W a, cn o n =• m a0� s f � W 7 o m ai (A ° a CD C L N : 5. in xN _. CL -0 O A w c• N O C1 C2 CD Oc 7 — N CD C CL :5 C y �N _. a•.0 O j 0 U) c N a Cl CD - c O ac-vo o �A T.c� 3 d o o �<-,. a cs o �A T.m m o o y. 3 Q D CD C :3 CD cD CD = Z o N � C CD a �- o a 0 a CD ( O Z < Wy_ a�c�' m C D N�Na� Wy_ a m 77 6 CD G.. A' M 7 O 0 <' A * o 3 N A � -' d �. ?. ( ' ° <' A o' B y o cn� a o m ' w m o a L c- _ o cnc CD CD A y oD m o a oti 3 c n 3 Cl CD CO o �o ��� c m Aam CD o CD -°, a N o �� 3 Na) •°, 3a cn w to g, cn CD w CD N _ ¢� ¢ C1 A O N A W 6 C L O CD A O ? f =.N N- CD O :nO CD y ? O c Q =.N N-0 0 CD CD O TO C 00 O C1 N N f<D CA CS CD A CD A • c 7 3 ( d N N N N C1 0 N 0 A A . (D O 3 C1 0. a < 0 CD C1 cn O. COD A N d L1 < n ' CD O• N C, A N C C 7 Q O a g P. N CA C A c 0 N A O' O tp fD < N �< d a 0 Cp 3< N CA , tea K 6 d y �0. a� CDX a(D O `2 =ova CD X �o�= U �G A. CA .y cn d � Op• ,. cn C/) a O O CD CD fA O O O O i 0 O CZ n CA p ° c 3 A CD I T V 3 CD c-n W � 0 0 N g C CD N 0 o c y a � a o a o °w ° 0D N N" (0 O O A A A N O A C50 o SS o a N CA N j - 0 v _v C w 0 A �. � O M A C OD Z x o 0 c A' CD N c N -� Cl) CL �(6 D a co M a � 0 !�! Z CD Cn f c 0 6 3 A o = w o CA c N O a O -' A W Q J =r o v' 0 Co C') c rr CT sz cn O CD (0 s rn -4 CO) A 2 ID M z0 N Z A ;o I d D � O P p z i A O, O O h �V o a U; 2491 P 43y STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed, made between Kinasborouah Homes. LLC aka Kinasbrouah Homes. LLC. a Corporation Grantor, and Kent A Brunner and Kimberly S Brunner husband and wife , Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property "): - s � m; -e t5 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 01I14 ,4 ,, : H sxF�ipr � REC FEE: 11.00 TRANS FEE: 265.20 COPY FEE: CC FEE: PAGES: 1 Area \k rvame auto mecurn Maaress Iienf O Rr,.M er �Ll me 7�}�e rr age one Oto m u �543J I 020 1342 10 150 Parcel Identification Number (PIN) This V5 MW homestead property. (is) (is not) Lot 15, Windsor Heights, Town of Hudson, St. Croix County, Wisconsin. Together with all appurtenant rights, title and Interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 26 day of November 2003 (SEAL) (SEAL) Steven J. Morse as Chief Manager for Kingsborough Homes, LLC aka Kingsbrough Homes, LLC (SEAL) (SEAL) AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) ACKNOWLEDGMENT F a mSty 4 ) SS. Personally came before me this 26th day of November 2 the above named i Steven J. Morse as Chief Manaaer for Kinasborouah Homes LLC aka Kingsbrough Homes LLC to me known to be the person who executed the foregolnc0hstrument and ack=wleda.etbe:.same.r.�. --. -- ll.//''/ ,. // A THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet "' 7350 80th St. South' �' ~ -'• Y LINDA K R A Er�/t■I,�,'/_ )��� Cotta Grove, Cottage a o, M N 55016 3-62510 Fi l.tC- M7[ "'��S pTg �/ NOTARY F! W ` �!.:' My c.- E,.pi -e J: -,2006 (Signatures may be authentiid or Both are not necessary.) " Names of persons signing in any capacity must be typed or printed below the STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 1 - 1998 LlNrI ,A KR.AEVIER NOl"AR1' ' 1s?11C • M. P'" "�SOTA dy Co - p 2006 State oftaBres' "'?0� rrwent. (If•nota tion date: NC - .. °� JSL1C- 6•!i "°SOTA 2006 Wisconsin Legal Blank Co, Inc. Milwaukee, Wis. From: To: KINGSBOROUGH HO S, I C Date: 3/3/2004 Time: 3:37:02 PM 27P r7 756706 KATHLEEK H. WALSH .................. ........ REGISTER OF DEEDS 10 /07;113 TUE .. [18 FAI 716 186 1686 ST CRI CO ZONI11 ST. CROIX CO., W1 FO CORD 03/16/2004 09 30AM AFFID DOCUIPMA Nurra XQPT # ast. Croix Count/ REC FEE: 11.00 TRANS FEE: Oc cupancy Affidavit CCCCPFEE: : 2.00 PAGES: 1 KINGSBOROUGH HOMES, LLC Name - (Owrlec) Typed or printed Wng duty swam . OW". ceder oath, that: 1. jact$bo is the oaset/patt owner of the fall of Isad IocatW is Se. C mh t 4VW, w L%=msta. w9vided in v otmne p>oe 167 poal[[leot rAxd er 6394M St. Croix Comq Reba of Deeds OMM Nn+re md Addre" A col oFlaad in the MM E. of the L of soc°tion 3 __2 Kin 5 "m' T N —R 19W W,f;;�Of HUDSON ska°� '�`i �jCEhSt ►� 2Ol dul desaa as Sottowr (mobs& tat no. and tJota. Wis0000in. beia� Y sUb&V1doon1M or &tiw wo kw ip6mII SEE BELOW a ao- I3�t � - t o� t i - O _ ---� s e Oft rlesidanoe � Eor a tle�tt the septic ystem seMnp owner of ttwe above descirlAd ' of !��' " design flow ie ceia�gW by � 1S8 Wd fw 2 be IndNidurab par droom SYIWM O v" *" rssk "e o is Dods ootT �- t ioM�ewr. I based are 1tw d esipt flow• heed ��, the System V'* need bo be wW=tand that If there are li tw Lions to WCOW the r UM r of t dler kwt bads. 1 also ackrowled9e that I wil make motlitted W aovoceodgft wy kxxessed war Aowr rlirt ttis Pro e w, 1 �tts leform fion avawi m my AMR* p inter mm in wdw*Q quTHEM1CATM ' T ' STA tM OF W ISCONN not iron wrs ems) �7 Graa+7n �a os wtis nay eYl G ad IC '• �; • Mft nay be Wjitlenlil"d a U*'0*ted9W' 8M an not 1)•Is: CA Moms" - " I M PAKr or VMS L F.r3Ar.0 r fbbldiw- o a ft PW dooms. !� !h� d � oo�pry�ps � �+ Pp� b yvurebou�rK �n0 oF+- �. and R°'r°�gre�pNrrodon �P�lN� - -- ee. IARioonstn S�aR q o r 0� - �cAto3y\ u w v H 00 1 ,- 12:09.03 TUE 1S.03 FAX 715 386 4686 ST CRX CO ZONI�fG PAr.r Lr PUMP C KA.MEU CROSS SECT AMD SPEP.IFI ATIOkiS E VEWT CAP Y VEAIT PIpE WEATHERPROOF APPROVED LO(Aikl& Z5' FROM DOOR. JLIUCTIOAI 8aX MAWNOLE COVER WiA1DOW OR FRESH IZ�MIIl. AIR IAlTAKE i GRADE /h1A1. 1 `• I B' MIN. MIAMI, ♦ - -- -- IIULET FROVIDE I / AIRTIGHT SEAL r w A I I I i ALARM io ou «APPROVED JOINTS WITH 1 GLEv. FT APPROVED PIPE __� 3' ONTO IO MID — �, O rr p SOLID SOIL GOUCKETE bLOCII KISER EXIT PEKAIWCC OULU IF TAWK ^WUFACTURESt HAS SUCH APPROVAL SEPTIC E h g� f SP�IGAT A E /.c�s�c.Q TA►1KS M>'►�IUFACTUREiL: - IJUMDER OF DOSES PILR DA`J TAIJK SIZE: O49>G GALLoAIs DOSE VOLMAC ALA KM MALIUFACTURCI[: — LG�,�(�f L- INGLUDING BACKF1 ow. z�4we— GALLON' MOO£L NUMBER: _� �� CAPACITIES: 11a ° 5 7 s2 NCRE5 OR CALLOUS SWITCH TIIPC: '' 5 = — ' 2 1 NG1 IiSS OR CALLOUS Pu P MAUUFACTURCIt. — �-� 77J r t o„ IAILMES OR GALLOWS MODEL AIUReER: s�� L S D = OR ____� 6ALLDAIS 5WITCH Twpr - . MOTE: PUPtP Awo ALARM ARE TO At M.L WIMUM DISCHALtGC INSTALLEO OW 5EPARATL CIRCUITS 4 1 VERTICAL DIFFEILEUCF BtTvJEEAI PUMP OFF AUD DI3TmEubu roc At Pim 1�.J._ FEE;T �� +- MILlIKLJM KIETWORK SUPPI H PKESSUILE , , _ . , , - 0 - . z.+ / z FEET ' ' ` VA �' + � FEET OF FORCE MAtW Y, '` 7 F jjo o rt Fitt GTlom FAL.TOR - a 7 FEE X •1 7 ro*rAl- DYNAMIC "CAD s FEET � • 9 11JTERw1AI DIME, 1 o AWK: L.ENCPT ;WIOTM ; LIQUID DEPTH 5IG1 LICEUSE moms k �� � DATE: T TOTAL DYNAMIC HEAD U O O O U U U n U O O O i N A � v 8 U O N O U U O FEET W N CSe = m W �o - m D Z m 0 �� 0 my c N N N < z m c� n n a V W V N O 40 00 o$ U N w o w Mc r °O ic n 0 x v n D D C7 n C m 00 a 0 l BG980098 . 009 lo00� 98999900680 @0098a� � 000999cDDaG698o� 99869�0680089988g N licall000 .. B9B99 Ocoee 98090�96GB @8B0 B�M i N A � v 8 U O N O U U O FEET W N CSe = m W �o - m D Z m 0 �� 0 my c N N N < z m c� n n a V W V N O 40 00 o$ U N w o w Mc r °O ic n 0 x v n D D C7 n C m From: To: PAM QUINN Date: 7/23/2004 FACSIMILE COVER PAGE To: PAM QUINN From Sent : 7/23/2004 at 1:15:12 PM Pages : 2 (including Cover) Subject: 464 CARRIAGE LANE INFO. I THOUGHT WE HAD A CHECK WHEN WE RESUBMITTED FOR THIS HOME. CHECKED MY RECORDS AND GUESS WHAT? WA -LAH. HAVE A WONDERFUL WEEKEND. SHERYL FEATHERSTONE EXCAVATING, INC. From: To: PAM QUINN Date: 7/23/2004 Time: 1:15:14 PM Page 2 of 2 0 N O lI 3 m o d g I e . �►. #� I O N O Z7 Z Z O C N N '! • n N 7 a y O- u CO Q a N N N N 0 �. O Cl m m n O o I fD N O 7 7 a ;I 0 't cj O O c c Uf 2 Z fn Z C!1 o> D m D i► m a A rr n a m I 0 o 0 0 ► N I O Z O O y ^. Q_ tftd• _ Cl /y I 000 a ' < •' 1�/q i y d CD Flo �oo�lr �, rn m co a m 8 II co eo I I H I n n ?L o a�.a �N c3 1 R1 C Qn Q , n n 3 n c o m _ O m > > a Z I N z 0 n M 1 , c. C A Z o o -° e o c ° f O o o ? 3 I. ( N 3 1 N J (D J Z yx n i A ;7 ° ? Z CO o 3 h I A C O S w 0 ? CL 5. c n n 0 C a Z a CL 0 N N N a^ 0it 3 I o _ca 2 9 � _w co a 4 CD CL �d 2 a� C. c O cr K A ZL D b 4n w '° 0 0 0 C I` Q b I o o n � Cl CL I' �,,, 3 � s 01 u O AaaeY txuuuykte plc (t. the Ceaay aaty) tin the t Auks s) Vt hoc ( wi \ 40 �� `�° vo o t a t>� _ Safety turd Buildings vision County visconsin 201 W. Washington Ave., P.U. Box 7082 ST. CROIX Madi scm, W 1 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)161 -6546 453032 Sanitary Permit Application scare Plan I.D. Number In accord with Cam 83.21. Wis. Aden Code, personid inflomuttion you provide may be used for secondary purposes Privacy Law, st c'EIVE Address (if dilietera than mailing address) 494 CARRIAGE LANE , L Application Information — Please Print All Information c s ame ¢: # Lot 15 15 Block # KINGSBOROUGH HOMES, LLC ;; ; , E ATTACH NTY DEED Owner's Madtng Address _i Y, d :� OF=F C _ Proaty Location 8750 - 90TH STREET NW y, NW ,/ seaiadr 32 City, State Zap Code Phone Number COTT GROVE MN 55016 651 -480 - 1881 T 29 N; R 19 P ,�W ) IL Type of Building (check all that apply) "''aO"N'mo Csidtivumtwa t or2 Family Dwelhng NumberarBedmw 5 BDR MS PER SUBMIT H P LAN p Puw fC .._ U. WINDSOR HEIGHTS ❑city ❑vinam IXTownsbipof HUDSON ❑ Ste. 0--d D- -ih.U— _ -- - 3 , /c _- – IIL Type of Permit: (Check only one boz oa line A. Complete tine B if applicable) 020 - 1342 -10- 150( 1_831) X New System IJ Replacemad System ❑ Treatanni Holding Talc Repiaarrterd Only ❑ Other Modification to E dstimg System B. 11 Permit Renewal Q1 Permit Revision 11 C9fa W of ❑ Permit Traw er to New List Previous Permit Number and Date Lsued Before Expiration Plum1w owner 453032 MARCH 22 2004 of POWTS System: Check all that appl I 1XNor - Pressurized Im{hoxmd ❑ Mound > 24 in. ofsuetable soil ❑ Mo < 24 in. of suable soil ❑ 41 -Grade U Single No Sand Filter ❑ Coed Wetland ❑ Pressurized Im-Groarrd ❑ Hu6d W T=* ❑Pet Finer l A roMc'IYea meniUmt 111% waswhow S=d Fituer � �a Recirculating Synthetic Media Fixer ❑ I-� ❑ Drip I,hw ❑ Gmvet-less Pipe ❑ ^ /.,P C/ V. Dispe rsalfrreatmient AreaInformation: 4 I - DEFUSER CHAMBE -ZABEL A -10 D,-Sp Floc (gpd) Design Soil f ppik l at i on Rsrte( nespersa stem 750 1 1 .5 1500 1 1524 _ . , Vt Tack Info capadw Total Number Manufactewer Prefab Sae Gailwa Galkwo ofPknits Concrete Constructed Cruses New Exwtm TMks Tacks sephcorllolftTank X 1565 1 WIESER 1 Aaubic Treatment Unil - ---------------- VII. Responsibility Statement- b the uunitersP neC d®sd®e rtaaloddlky Bur PmdtdrNaa of Or loVYTS she e. tide PIML Plumber's Name (Print) A Number ttt>Ainesa t'Mxle Numdrer TODD FEATHERSTON 242514 715 - 381 -1704 Plumber's Address (Sweet, City, 3tatc, ) P.O. BOX 467 HUDSON, WI 54016 6 -15 - 2004 VIII. Coos !De arliseet use Only T._. - - - - -- �� U -- 't Sanitary Permit F (includes Groartdwate� ate lssued 7 Agent Signature a Stamps) f0 SurcLargc Pcc) (�h 11�� U, I / ?,sa.`C IX. Conditions App easoas for Disapproval 3} �r¢ t� $ � p SYSTEM OWNER: w Q r ,tQQ At u wt 41.111 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. d.j u, StiC 5rL-4 I oa." S 2. All setback requirements must be maintained o� ,0 0 _ odd J O� 2 / as per applicable code /ordinances. � s 01 u O AaaeY txuuuykte plc (t. the Ceaay aaty) tin the t Auks s) Vt hoc ( wi \ 40 �� `�° vo o t a t>� RMCMMARK i EL, VU.20 i / EKlS't1N4 HOUSE 1 " O N wl 49 7 e .- o0- IVq ",0 s 6/ _ 97.0 ; B 97.4zp co p �' 9.3. To OA O MW CMMARK T CIS PIPS a do s 0 , r , L�www.�•.. .�..... rr�w �.� r�+ww�� ��.ir N *952 A o.49 ToP m yA��� , • AA.- - 80" �• rop- of !Yt t g/ - �97. ¢IG 8-7 - 9 7.44,0 ' DJ BW- 93.3o , `RECEIVED 1395 Wisconsin Department of Comi i erce DEC 18 2003SOI EVALUATION REPORT Page 1 of 3 Division of Safety and Building in accordance with omm 85, Wis. Adm. Code Steel Soil Service ST. CROIX COUNTY County Attach complete site plan paper ng(prl��nches ainize. Plan must St. Croix include, but not limited to: ), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. pending Please print all information. eviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location West Lake Builders Govt. Lot na NW 1/4 NW 19 S 32 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 703 15 na Winsor Heights City State Zip Code Phone Number J City J Village a Town Nearest Road Hudson I WI 1 54016 1 715- 386 -9878 Hudson I Carriage Lane IJ/ New Construction Use: Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement J Public or commercial - Describe: Parent material Ridges and till plains of ground moraine. Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 95.70ft . Trenches spaced and depth to code 2.33ft below grade. Boring # i Boring 101 Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 66 in. I Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' *Eff#1 I *Eff#2 1 0 -9 10yr3/2 none sil 2msbk mfr cs 2c .5 .8 2 9 - 28 10yr4/4 none sicl ? 2msbk mfr cs 1C .4 .6 3 28 -37 7.5yr4/4 none sl 2msbk dfr cs na .5 .9 4 37 -66 5yr4/4 none sl om dfi cs na ,2 .5 5 66 10yr6/2 none fractured limestone na na na .0 .0 [ Boring # I Boring V1 Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 73 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' *Eff#1 *01#2 1 0 -12 1Oyr3/2 none sil 2msbk mfr cs 1c .5 .8 2 12 -24 10yr4/4 none * 2msbk mfr cs 1 c .4 .6 3 24 -53 7.5yr4/4 none sl 2msbk dfr gw na .5 .9 4 53 -73 5yr4/4 none sl om dfi gw na ,2 5 5 73 10yr6/2 none racturecl limestone na na na .0 .0 Effluent #1 = BOD 30 < 220 mg /L a n d TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS < 30 mg /L CST Name (Please Print) ,.Signature: CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 12/15/2003 715 - 246 -5085 Property Owner West Lake Builders Parcel ID # pending Page 2 of 3 [ ] Boring # I Boring e Pit Ground Surface elev. 93.30 ft. Depth to limiting factor 66 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 1 *Eff#2 1 0 -12 10yr3/2 none sil 2msbk mfr gw 1c - (0 .8 2 12 -27 10yr4/4 none sicl 2msbk mfr gw 1 c .4 .6 3 27 -46 7.5yr4/4 none sl 2msbk dfr gw 1f .9 4 46 -66 5yr4/4 none sl om dfi gw na .5 5 66 10yr6/2 none fractured limestone na na na .0 AA .0 F-1 Boring # I Boring Pit Ground Surface elev. fl. 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 GP *Eff#1 *Eff#2 F-1 Boring # I Boring J Pit Ground Surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD s.30 mg /L and TSS <30 mg /L - I 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel CST - POWTSM Lic. #248956 West Lake builders NW 1 /4,NW 1/4,S32,T29N,R19W Town of Hudson, St. Croix Co. Windsor Heights, Lot 15 &r I q� `e 1564 Cty Rd GG New Richmond,WI 54017 Bus.(715) 246 -6200 Fax (715) 246 -9372 Legend 1" = 40' ♦ =Benchmark Ele. 100.00ft Top of 'h" PVC Pipe • = Alt Benchmark Ele. 98.80ft Top of %" PVC Pipe n = Rnrings. SYSTEM CROSS SECTION KINGSBOROUGH - WINDSOR HEIGHTS - LOT 15 1565 gals. { j 3 @ 75' AND 1 @ 81.25' 12 O 0 12 B10 DEFUSE CHAMBE b 13 BIO DEFUSER CHAMBERS -TRENCH 81.25' PID # 30,020- 1342 -10- 040,02 _. U W' /, NW' / 4 ,S 32 T 29 N,R 12101E LOT 15 BL_ SUB WINDSOR HEIGHTS C O _.VWT_. HUDSON ,1342 -10 -070 242514 Wisconsin Department of Commerce s PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Kin sborou h Homes City Village X Township I Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Friction Loss System Head TDH Ft Forcemain Length Dosing Dist. to Well 32.29.19.1831 Aeration SYSTEM TO P/L JBLDG IWELL LAKE /STREAM Holding Manufacturer: INFORMATION PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Number Vent to Air Intake TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: No. Of Trenches Vent to Air Intake 453032 0 State Plan ID No: Inside Dia. Parcel Tax No: DIMENSIONS Length Dia 020 - 1342 -10 -150 Section/Town /Range /Map No: 32.29.19.1831 STATION BS HI I FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom meager /man. Dist. Pipe Bot. Svstem St Cover BED /TRENCH Width Length No. Of Trenches Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Length Dia Length Dia Spacing SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Bed/Trench Center Pipe(s) Topsoil Yes No Yes No Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only 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 Yes No Yes No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 494 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R19W) Windsor Heights Lot 15 Parcel No: 32.29.19.1831 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required. Yes No � I Use other side for additional information. -- SBD -6710 (R.3197) Date Insepctor's Signature Cert. No. it t or 0 W ta. 4 16ti Alttacb cempkie plum (it the Cwaty a*) for the system ea paper and lw IMn 81n t 1 irKires is � ( t S S Safety and Buildings DivisiM (;aunty N visconsin 201 W. WasltimgtonAv E2 ST. CR Sanitary Pennit Number (to be filled.in by Co.) Madiun ? t;pg >� 0 3 2- De rtment of Commerce Sanitary Permit App�ie do R 1 S e Plan I.D. Number - 3 fxr �gI In accord with Comet 83.21. Wis. Adni. Code. persona] iitfbrri ticxt )N �� GO Address (if differetxithan merit erg address) \x may he u sxt }ie �Y purpose }'rivacy law, s15. 4(l)(m) G O� OF FV(, - 494 CARRIAGE LANE _ L Application Informative - Please Print Ail Inhwalatioa Pnlxdy Ow wr's Name P 4 _fi Lot ti 15 Ad9ek # KINGSBOROUGH HOMES, LLC SEE ATTACHED W ARRA N TY DEED Property Owna's Matting Ad&css Property Locati 87 50 - 90TH STREET N W1 NW v<, smiai 32 City, State 7.,ip Code Phone Nrutlbcr C arclaate) COTTAGE GROVE,_ 55016 651 - 480 -1881 29 N; R IL Type of Building (check all that app 1?4 1 or 2 Family Dwelling Nurnher ol'f3e�rmoira bdrms per submitted house plan Stt[xlivisiat Name esht tiumt+er U Publiecommercial- I7escribeUa. WINDSOR HEIGHTS ❑Village YTTrrwnsliipof HUDSON ❑ Type f Permit (Check only tote boz on lin A. plcte line B if a tcabie) ' / ,r Oz 0— (o A. 3 New System U Replacement System U Pennit Revision ❑Tree ddiiig' Replaixe mit Only U Change of IJ Pmnk Trarpqer to New �� time W f xisting Suslarr I rs# � � , B. U Permit Renewal 13elixe EN)tration Plumber Owner' IV. Type of POWTS 5 tem: Check all that appl LX Nom - Premrized la- Ground U Morrnd> 24 in. 4 le soil . U Moxmd < 2 - ofsuitabie soil U At -Grade U Single Puss Sand Filter constructed Wetland U Pressi nLw ht- cinwnd U Holding' U Peat Fiber Aerotric `rYeatxnentllnit � Rmirwlaling SwA Filler U i Recircuts ing synthetic Media Filter P9 GexhingChamber nip u 101 Gr rvej -1 pe 11 Othet (explaw) 3 trenches 3'x100' - 1 amber V. Die rsaU Treatmeut Area Informatia : USI �10- DEFUSER CHA ERS AND 13EL A -100 FILTER .. - -- - Design Flaw (gpd) Fhytiga soil Application ante( llisPernal Area Rrgnire=! (c t Orr» Pn,(>rtaerl (rte) 4yxr gra 750 .5 1500 523.90 VL Tank Info C Capacity in T Numtior - -- - - Manufacturer Prefab Site tee Fibei Gabon C of I jibes Concrete Constructed Gl ass Nr w Ex t suag - Tanks Tads, "ethi m ilolda* - lank . X 15 65 1 WIESER AcTVbic Tnretmern LTni! — - . _ __..- _ ... DM ire Chamhcr VII. Responsibility State t - 1, the mrderMww4 , as rea of lfre 1"UV1T5 airown an pi nnx. Plumber's Name (Print) Plumber' Si MPtMPRS Number nntr n Phone Number TODD FEATHERST NE 242514 715- 3 81 -1704 Plumber's Address (Slreel, ity stat K'0&) P.O. BOX 4 HUDSON WI 54016 VIII. Count fl)e artment Use On Annmved llisaptrroved Sanitary Permit Fee (includes Grtmndwater Date Issued low Agent Sigriatrue (No Slamps) �m Fm) 2 S� 22 200 ❑ (hFrrer Given Rriastxe For Utmia! IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: J �t I , �7 1 Septic ''" 1 tank, effluent filter and dispersal cell must all be serviced / maintained SMr-e_ 6 u as per management plan provided by plumber.Q� —^ 2. All setback requirements must be maintained as per applicable code /ordinances. or 0 W ta. 4 16ti Alttacb cempkie plum (it the Cwaty a*) for the system ea paper and lw IMn 81n t 1 irKires is � ( t S S 00 .40 000 0.E 000 o N • 962.8 12 X5.4 CY �` { to f r � el r { { 12 3 ( 6c. �3• t b. IY w �vV ,S 290.49 N88 °48'28 "E 7TONS PER CO PI PID # '/4 _ _ T _ N,R _ E LOT_ BL_ SUB CO VO TO MPRSW 242514 / �- 90I Pi 0 AW _,ems /- 9� -3 ,e,3 - 9�• 2 N 4i7 �� 0 ~Q r / 1 ��q r 1 �♦ N OJ c III ^ "' , Igloo O / ���� : 'O6�•00 `�` TC r �•.` �iad1.9 �.` 12 t ' I I f r 1 I I I AN aw W.. - --I& A-- — - - - - - -- Igm 0 G /0o.6 r 7c10 o AV 1 *, S're Et 15041 N 290* 49 N88 °46 ? 25"E n0IS PER PID # _'/4 _t/4,S _T _N,R _E LOT_ BL_ SUB CO V❑ TO MPRSW 242514 Do / �3 30� A -l.31� EG • lbo .o P //°c jw _,S /- 9� -3 �� -93 •S 9t. N B� Q Az: ea. s / ���� : 'O6�•00 `�` TC r �•.` �iad1.9 �.` 12 t ' I I f r 1 I I I AN aw W.. - --I& A-- — - - - - - -- Igm 0 G /0o.6 r 7c10 o AV 1 *, S're Et 15041 N 290* 49 N88 °46 ? 25"E n0IS PER PID # _'/4 _t/4,S _T _N,R _E LOT_ BL_ SUB CO V❑ TO MPRSW 242514 Do / �3 30� A -l.31� EG • lbo .o P //°c jw _,S /- 9� -3 �� -93 •S 9t. N Vrj�mnsir Department of Commerce Division of Safety and Buildings Bureau of Integrated Services in ac Attach complete site plan on paper not less than 8 1/2 x include, but not limited to: vertical and horizontal ref percent slope, scale or dimensions, north arrow, and APPLICANT INFORMATION - Please pd, Personal information you provide may be used for secondary Prooedv Owner Mailing city SOIL AND SITE EVALUATION ordanim with~ : dI�HR 83.09, Wis. Adm. Code `baires in si Plan must. County %point ( and on and 1 earest toeuil. P . # P E L 2 .� :_ ry�g IH_ e . 1/1 o ST Nbx Re Vs (P""acydej .fTWo ( (0r ocation C'/ �- AvX) t //V i 1/4 /�, 1/4,S Zip Code Phone Number 44 l 1' vtl # I Block# I Subd. Name or C 1 s' I 0', aWe , ❑ City , �❑ Village ,® Town Page _/_ of Z Date T�9 ,N,R Nearest Road ,, New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4 :�r gpd Recommended design loading rate gi bed, gpdift gpd* Absorption area required "C bed, ft Zl1D0 trench, ft Maximum design loading rate - — gpd/f1 —,,,— trench. gpd P Recommended infiltration surface elevation(s) /5 ft (as referred to site plan benchmark) Additional design/site considerations Parent �� Parent material G Flood plain elevation, if applicable It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 1 f21S ❑ u [As El U Os E] u I 1Z s u I ❑ S I Cl S® u SOIL DESCRIPTION REPORT Boring # 13 Ground elev. ,2LLft. Depth to limiting factor Boring # L 1 1 Ground elev. Depth to limiting Remarks: Dominant Color M lm� Structure .. .. WAM Remarks: SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# /S Boring # Ground elev. ft. Depth to limiting fa or Min. Boring # ri, Ground elev. �ft. Depth to limiting factor : 2? in. Boring # F, . Ground elevA Depth to limiting factor Boring # [3 Ground elev. ft. Page �2-- of Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 Bed , Trench -� ,s s Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ft2 Bed , Trench Remarks: Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 97 "' oy 30 �l S SYSTEM CROSS SECTION KINGSBOROUGH - WINDSOR HEIGHTS - LOT 15 M A NH ©t.E fns P, f'iPE 1565 gals. Z T eir) CL 93.5, 92.25.90.9 16 lglo ,U��[/SL�/e O 0 .._..._.�....�.._ jo v rr o 1 16 BIO DEFUSER CHAMBERS I -221111 PID # 30,020- 1342 -10- 040.02 NWy NW' /4,S 32 T 2 N,R IWE LOT 15 EL_ SUB WINDSOR HEIGHTS � � HID C - 1342 -10 -070 MPRSW 2 4 2 514 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION Owner KINGSBOROUGH HOMES LLC Permit # 5� © 3Z DESIGN PARAMETERS Number of Bedrooms 5 ❑ NA Number of Public Facility Units Service Event ❑ NA Estimated flow (average) 75 g al/da y Design flow (peak), (Estimated x 1.5) ❑ NA gal/da Soil Application Rate . 5 al /da /ft Stand Influent /Effluent Quality Monthly average* Fats, Oil & Grease (FOG) S30 mg /L ❑ NA Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA Total Suspended Solids (TSS) 5150 mg /L X3,4A Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD 530 mg /L W.NA Total Suspended Solids (TSS) 530 mg /L ❑ NA Fecal Coliform (geometric mean) 510" cfu /100m1 Maximum Effluent Particle Size Y. in dia. ❑ NA Other: At least once every: RNA * Values typical for domestic wastewater and septic tank effluent. AU1TC\IA &II+C &1%UCr1111 C SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer Service Event ❑ NA Effluent Filter ManufacturerZABEL ❑ NA Effluent Filter Model -1 ❑ NA Pump Tank Capacity Pump out contents of tank(s) a l ❑ NA Pump Tank Manufacturer WIESEg ❑ NA Pump Manufacturer ❑ NA ❑ NA Pump Model ❑ month(s) ❑ NA Pretreatment Unit ❑ Sand /Gravel Filter • Mechanical Aeration • Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: X3,4A Dispersal Cells) M In- Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In- Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ month(s) W.NA Other: At least once every: 4 NA Other: Flush laterals and pressure test A�r NA miam 1 cl�r.wvc vv..r.vv �� Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) y ear(s) ❑ 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 every: ❑ Yeast 1(s) (Maximum 3 years) ❑ NA ❑ month(s) ❑ NA Clean effluent filter At least once every: I! years) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ❑ NA Other: At least once every: ❑ month(s) ❑ year(s) WNA Other: CR 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. I A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 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 pumps 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. 0 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 FEATHER Phone 715 - 381 -170 Name FEATHER Phone 715 - 381 -170 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name PINKY'S Name ST CROIX COUN Phone 651- 436 -5788 Phone 715 -3 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 Owner/Buyer �II��b6YDL�L O-rues LU 4TJ X l /1N /oY Mailing Address 2)7 ;y Property Address g04 6�rf -e 4 el l. I C b ��Gt U� L rNt, YM 5Sal - Ors r - r I ct 6 r- L.0 -vizo (Verification required from Planning Department for new City /State uL� � 2 -� ) i Parcel Identification Number o 20 - 13 2 z -1 O -1 s o �• 1 8 31) LEGAL DESCRIPTION Property Location N VO %4, N W %4, Sec. 3 . T Lq N R 1 W, Town of 4U SDI Subdivision W I nd r Lot # Certified Survey Map # . Volume . .Page # Warranty Deed # L' � 9 . Volume ) 5y 3 . Page # R Spec house ❑ yes Wno 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 throe 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, journeymanplamlrer, restrictedplumber 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. Vwe, 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. Ceitificatiion stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the throe y xpiration date. 77 SIGMA O APPLICANT 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 owners) of the pro erty descr above, by virtue of a warranty deed recorded in Register of Deeds Office. 2/ s� co* 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 N 1593na167 STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED Docameat Number This Deed, made between West Lake Builders, Inc., a Wisconsin Corp2ration Grantor, and Kingsbrough Homes, LLC Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described teal estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area ,; j a 639409 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CRDIX CO., WI RECEIVED FOR RECORD 02- 28-2001 11:45 AN VARR NTY DEED EXEIPT I CERT COPY FEE: COPY FEE: TRIVISFER FEE: 1438.20 RECORDING FEE: 10.00 PACES: 1 Name and Rewm Address Lots 3, 4, 7, ►3,14 an I S, indsor Heights in the Town of Hudson, St. EAGLE VALLEY BANK, N.A. Croix County, Wiscon 1301 Coulee Rd Unit 2 Together With the right of access over Outlot 2, Plat of Windsor Heights in l"lUdSOn, Wl 540 the Town of Hudson for the benefit of Lot 14 of said Plat. 020 - 1324-10- 130,020.1342 - [3 -1342 - 10.140 Pmeel Identification Number (PIN) This is not homestead ProPedy 00 (is not) Exceptions to warranties: Easements, restrictions and tights- of-way of record if arty. ° da of Feb Dated this / Y 2001 • 3Yest Leke Rglders,Inc. • AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. U i K County ) authenticated this day of tersonally came before me this f 4t 16 tiny of 2001 the above named 1 Fe�rxenY West ' e Builders, Ine., a Wisconsia Cor anion b • A eJoi! ' (, ge it's tiESr pt'N T TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (if not, i ent and acknowledged the same. authorized by § 706.06, Wis. StatcJ t 9 C, (. at Ft( r'1 THIS INSTRUMENT WAS DRAFTED BY • /1ZQ r' 6e n`e L % r'1►� Attorney Kristine land Notary Public, State of Wisconsin My Commission is permanent. (if not, state expiration date: ndson, 3 /t fSlaoo l (Signatures may be authenticated or acknowledged Bola are not necessary.) ) d DIP" below their sigaahtre. °t �' PfOi1oi ea°°° r Fond Names of persons signing A any capacity must be type nted STATE 6AR OF W LSCONSIN WARRANTY DEED FORM No. 2 - 1999 �c, * * PIONEOR * eng neer * * * LAND PLANNERS - Certifica of Sur trey' for: .KINGS.BORO UGH 1Z QJ .PiS -�� House Address: 494 Carriage Lane do t , NO N th fj •� so HOUSE DETAIL -AM i" a 30' TOP Ole PIP! - EL - 959.20 14 EIOSTIN4 HOUSE 953.2 *4 / 9'53.4 .r1rA r �ry (V / i / f r VV I L.V t R� 95x4 � A0. .N. ti �e 4 2.0 �ars Rft N O TEApENCE` ': �► : FOTHEIVIDA(MEl1 l S-2J GOLUM81A HEIGN .`,p �► MN 0 - 1 o ty�C LAN a���q lo 1 j 80 rM a shown are assumed % 2422 Enterprise Drive Mendota Heights, MN 55120 ENGINEERS • (t3S1) 681 -1914 FAX :881 -9488 E ARCHITECTS 625 Highway 10 N.E. Blain$. MN 55434 (763) 783 --1080 FAX: 783 -1863 c [10 /' ?,� 959,8 2.6 <0 � ssz.t v� 962.8 To I 982.8 I tz / 1 I / - $ 5 r r 959.2 d � 93:,6 9 67 X 969.4 X 939.0 A 96! ` 82.8 X 263.1 15 x 963.8 � X955.0 ------------------- M ---------------- f ------ *952 NMI- I. HOUSE PLACEMENT PER OWNER. 2. FIELD ADJUST BUILDING ELEVA flONS PER SOILS AND DRAINAGE 290.49 N88a46 "E 964,8 :4 j x °�� U X I n� '$Q 9ee,2 i � n 96s,e I fl0 p I V O I z 1 12 TOP OF PIPE EL - 965.05 4.: 5 e I ' 000.0 Denotes Emergency Overflow X 000.0 Denotes Existing Elevation PROPgm BCI7LzVG s.T.art MAM 1 <33 @ Z > Denotes Proposed Elevation Lowest Poor Elevation; 9�2 Denotes Drainage Flaw Direction Top of Foundation Elevation 3%+.4 Denotes Drainage do Utility Easement Garogta Slab Elevation: ,g{q fat door) --4- Denotes Monument NOTE: Proposed buGding alto grading Is in coeerdonae with the —+- Denotes Offset Iron grading pions approved by the city engineer. NOTC: Centreetcr mutt verify ell dimenehms & drlvewoy design. LO _15 TN��1�DSo.R - 1EG.�- L ST CROIX COUNTY, WISCONSIN We hereby certify to 1 ING-BOROU 8 i9 that this survey, plan or report was prepared by me or under my direct supervielon and that I arts G duly licensed Loved Surveyor under the laws of the State of Wisconsin. Octed this 8th A.D.. 2003• .,�_ day of _ August _ REVISE AND RESTAKE (new house) 1/30/04 Signed: PIONEER ENGINEERING, P.A. .j%1 1 5 BY L c 1 k 945 200493.04 JFW Terrence E. Rothenbdcher. L.S. Req. No. S - 2340 ZO 39Vd 9NI833NIDN3 833NOId EBBTEBLE9L ZZ :ET b00Z /E0 /Z0 b x' �`_ t r � r� a r x ��'� � ., � i ° � r