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HomeMy WebLinkAbout020-1439-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538755 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal it :formation 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: Mitchell, Steve I Hudson, Town of 020 - 1439 -14 -000 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: 6 I BM /� 25.29.19.2740 TANK INFORMATION A z ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I Benchmark / /dam t' �, t 1 1 Dosing Alt. BM�A r ' . P6 /Ly ,� ` , 11 4a poi, i7 Aeration j Bldg. Sewer Holding St/Ht Inlet 1 ` 7 7q. Zl TANK SETBACK INFORMATION St/Ht Outlet �S 13 5- 0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z6 J Dt Bottom Dosing Header /Man. 73 C Aeration Dist. Pipe 7Z 3'f Holding Bot. System X 9z 9 ° t /L 4 Z C? /• 2 Final Grade 17 Z 9b - o� PUMP /SIPHON INFORMATION Manufacturer Demand St Cover/ 1 �/ / 7 GPM t (P • / Model Number 1 1-63. TDH Friction Loss System Hea Ft Forcemain Le D' Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length 2, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 71, �_ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR m UNIT td Type f System. Model Number.� or�e DISTRIBUTION SYSTEM Header /Manifold i/ Distribution x Hole Size x Hole Spacing Vent to Ai nta Pipes) %,._ i- ' * 3Ir , t Length / Dia T Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only tt' Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center s / Bed/Trench Edges Topsoil �, �� , Yes 0 No es No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 797 Sumac Trail Hudson WI 54016 (SW 1/4 SE 1/4 25 T29N R1 9W) Indigo Ponds Lot 14 Parcel No: 25.29.19.2740 1.) Alt BM Description = `' ( 4 C' 2.) Bldg sewer length = .20 - amount of cove r = ,> -3 L �ision Required? 0 Yes *No No — a for additional information. ,.3/97) Date Insepctor's ignature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 538755 0 GENERAL INFORMATION 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: Mitchell, Steve I Hudson, Town of 020 - 1439 -14 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 25.29.19.2740 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain L Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 i Topsoil g 0 Yes 0 No 0 Yes aq�l No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 797 Sumac Trail Hudson, WI 54016 (SW 1/4 SE 1/4 25 T29N R1 9W) Indigo Ponds Lot 14 Parcel No: 25.29.19.2740 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes❑ No —� — Use other side for additional information. J Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) B�T1feo /,C p1AT i� CiiO�S 6 SECT1oN PLANS -. - y�ppA Bpps,. EXG►Y INC PLWme"+ Umff Olr —�� /000 &.(L . w,E4 Ito - npo j � w SA 16 Pe- Imie Po�yL ®� k'e��e2 Apt CI OC)P w e.4e#U , )GI.ZCI< OWIM r �iC�1E/t ✓/9Tla✓. B „ uc�NSe: OQSE/t✓Arlonf /l1Enr J7AcA. To 7E� 1U7jt A AdWC DAs. hivsts+ G 4,o y'�PyG J'NEL yo / of M4y- r1j 9� COYER 5r 44r "& TESTING Y: (EFFECTIVE LENGTH" t r� ^g ��► JivYERT - ' 6 ! �'� • ca • /DER S VtE T/1ENC/d fiCooR ,E(�crATlviv � lli 70P VIEW Sam r4fsr MuldPort End Cap iorrr v�+ni T } a r f , I I ,.ZNFSLTi�ToR .rxsTFi�il .LVC- 4 cornnlercevl►I.yov Safety and Buildings Division County 201 W. Washington Ave., P.O. Bmt 7162 isconsin tri P m ?v ..- Madison, WI 53707 -7162 Sanitary Permit ��� filled in by Co,) 4 u r mbe Sanitary Permit Appli t cati� ���-- -- -- In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a State Transaction N governmental /��/J/ unit is required prior to obtaining a sanitary permit. Note: Application forms for state WTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information for secondary u. in accordance with the Privacy Law s. 15. 1 mI n V I. A licatioa Informative - . Print AN Informa Property Owner's Name Parcel # �- 1 201 i Property Oamer's Ma' mgAdtfreas UNTy Pmpem Location sT. G & Z ` L N G OFFICE Govt. Lot City, State Zip Code umber �L — y y., Section (circle one T R ? E .I, 'Type of Building (check all that apply Lot # I Subdivision Name 9 1 or 2 Family Dwelling — Number of ! 131oc1E Public /Cmtnnercial — Describe Use till ❑ City of E A CSM Number ❑ Village of ❑ State Owned — Describe lUse Q p Tow. of roev M. Type of Permit: (Check only Ant box on tine A. Complete tine B if applicable) A. i ❑Other Modification to Existing System (explain) , N ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only fi B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber C1 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner f 'r s IV. TypC of POWTS S C t/Device: Check aQ that r Non- Pressurize In- G round ® Prt actin -Gramd D AWrade ❑ Mwnl24 in. of etitil soil ❑ Motmd <Z4 in. of suitable soil ; 1-1oldir Tark ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) - -D - -- 1 Design Flow (gpd) Design Soil Application 7 bdsi Dispersal Area Required ( Dispersal Area Proposed System Elevation V1. Tank info Capacity in Total # of Millnufacturer Gallons Gallons Units Q ti q x I New Tal Existing Tmka ! cr'rFLVr'erT .0EYLMA 40 rn CO) 1-.6 R. i Septic or Holding Tank , ^ J Dosing Chambee V11 . Responsibility Statement- I, the undersigned, assume revposasiibilNy for itastallatioa of the POWTS shgwa o, the attached pleas E Plumber's Name (Print) Plumber's igosture MPMIPRS Number Business Phone Number Pluni Address (Street, City, State, Zip Code) t^ VIII. Coon /IDc p aruse3itusi ow --- Approved isapprov Permit Foe Date Issuing Signatina ❑ iven Reason €or $ �� Zl // j IX. ConditiP>fS iQki( ssods for Disapproval J / ItY vat 1 1. Se tic tank, effluent filter and 3 ,� PC dispersal cell must all be services / maintained ' as per management plan provided by plumber. i 2. All eetback requirements mul maintained as per appl izo6e code / oidirarli . Attach b k puss for the syalei and mbmit to the Consty only m POW am I m tits S in 111 iind" is Mile SBD -6398 (R. 02/09) Valid thru 02111 t NON - RESIDENTIAL CONVENTIONAL POWTS DESIGN INDEX AND► TIME SHEET Project: Steve Mitchell 3 Bedroom Conventional POWTS Contact: Steve Mitchell Address: 797 Sumac Trail, Hudson, WI 5016 Legal Description: SW' /., SE 1/4, See. 25, T29 Nit 19W Township: Hudson County: St, Croix Subdivision Name: Indizo Ponds Lot No.: 14 Parcel ID Number: 020 - 1439 -1 Plan Transaction Number: Index and Title Sheet Page 1 Site Plan Page 2 System Design Calculations Page 3 System Cross Section Page 4 Filter Specifieations Page 5 System Management Plan Page 6 Treatment Tank Plan View arc Cross Section Page 7 Parcel Map Page S Septic Tank Maintenance Agreement Page 9 Warranty Reed Page 10 Attachments: Solt Evaluation Report Resigner; Gary Zappa License Number: 222373 Signature: Phone No: (715) 38&2 Rate: Page i of 10 � aLOT & cposS aECnoN Plows — - zoom mm. E "V,*Tm INC. PLU) UW to A l l /000 &"(L . w IE3 02 � � rJ Q 5-u AL /w N P ov + All S No S cou azCK y�JTiAN0.9/10 L. /+�/- /1- �l3,SE a✓. ��` O,G�Sf/1 ✓i0TI0/��Y TO 7 �tt - �or f ��� �o✓E GiZvoE . Fxnacs�► G2vOt DATE• /4 A xz� uN7 96 COLER �i' J'yEL yv /a1'PE 5Z' 4' SOIL 7M . ft- (EFFECnVE CBS MI z vv�Rr - a E� � f� FIR g f/. asp sm vm rl4wc V Fs�oo� A24 0-9=0" AE/ MuldPort End Cap ,,; . v Sam TErr a �x ts' DISPERSAL CELL SIZING CALCULATIONS 1. (3 bedrooms )(100 gallons estimated flow )(l .5 design factor) =450.00 p design flaw 2. Infiltrative capacity of native soil = 0.4 gpd/sq.ft 3. Absorption area required: 1125 sq.ft. 4. Absorption area as proposed: 1 20sq.ft. 6 chambers total) Infiltrator "Quick 4 "=20.00 sq.ft. EISA per chamfer, Infiltrator "Quick 4" end cap (pair) = 5.80 sqA EISA 17.40 sq.fi. _ (3 pair endcaps)(5.80) = 625.46 sq.ft. 1137.4 sq.ft/20.00 = 31.28 chambers required Number of trenches: 2 Q19 chambers per trench I (a- 1 S chambers per trench Trench 'Width: 183' Trench Length: 79.00' Trench Spacing: 7.00' on center Total system w /5' trench spacing 16,50' 79.00' Pne 3 ©f 10 Soil Absorption Cross Section 97:ma ft 9`lr� 00— r, 4° Sdodule 40 Final Grade PVC Vent Pipe R3 With Vent Cap g /S o Leaching ♦ B 9 '�'! Chamber n 4- : 7 ~ Syst vat on � •$3 ft Oft Oft Soil Absorotion System Plan Wow ft �p Leaching Trench Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Suecifications 0 J. Manufacturer And Model / /L •�`f�,v2 ' _5TIw iD Aftd EISA Rating 0t 0 sq ft per chamber Soil Application Rate 0. 4/ gpd /sq ft _yW gpd Design Flow O• Soil Application Rate • O EISA = sus_. -2S Chambers rows of — Z 9 chambers each. iw Page 3_ of /o EFFLUENT FILTERS PORI "The PL -525 has 525 linear feet of 1/16" slots. It has an automatic shut off ball. When the filter is removed for cleaning ball will Alarm g f aceesxlbility Accepts PVC e.I eosin handle float up and temporarily shut off the system so the effluent won't leave the tank. No other 525 firma, feet filter on the market can make that claim!" o11116". Ilttralloll slots — Rated for over 10.000 GPO r Accopra <" & 6" SCHO 40 Pipe . a J V Gas dellector Automatic shut } —~ ball when lilts, Is removed "The PL -122 has over 122 linear feet of 1/16" slots. Rated for 1500 gallons per day, and A : ca ;x 112' PVC can be manifolded together with other PL- H ndl a_ switch 122's to double or triple the GPD. It has an 122 Linear h. automatic shut off ball that stops flow when - -e11116inch the filter cartridge is removed for cleaning. Fil[a Slots Comes complete with it's own housing, no -, Filter Housing gluing of tee or pipe and no extra parts to with Y& a Plpe Adapter buy. R i Gas Duflector Automatic Shut -OH �f� —• Ball When Filter is Removetl From Tnnk Order # Model # Descri tion List Pri PK -525 PL -525 Effluent Filter System 20350 PK -122 PL -122 Effluent Filter System 6250 6 -10 P 9 s o(/O conventle"l swat "m Manhunt Pbn Pursuant to Comm 83.54, Wis. Adm. Cade GemM The conventional septic system shalt be operated in accordance with Comm 82=84 Wis. Adm. Code, and shad be maintained in accordaiwe with went manual SBD 147(15 -P (N.i}lffil� All local andior state rules Pa"i ring to system maintenance and maintenance reporting shall be compiled with. Se e-* Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 154' of service pad, with bottom of tank to be :� 15' below service pad elevation. The operating condition of the septic tank shall be assessed at least once every two years by inspection: The septic tang contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tactic. Th contents of the septic tank slall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. if the contents of the tank are not removed at the time of assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 11'3 scum and sludge accumulation in the tank. The operating condition of the outlet filter shall be assessed every six months for the first two years of system operation and once every two years or as needed after that The outlet filter shall be cleaned as new to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shalt be seated water tight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is ,generally not required. If such products are used they shalt be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Sell Abler gko Ceti Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October February) dictate that the system be heavily mulched for fiost protection. Influent quality into the system may not exceed 224mg/L BOD5, 154 MG/L TSS, and 34 mg/L FUG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring- C946ut[tusy Pike If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Gary Zappa at (715) 385 -2854, or the St. Croix County Zoning Department. Page 6 of 10 04/21/2011 08:29 7156475181 WIE5ER CONCRETE PAGE 03/03 x N g1" 86" 8 H 9 I I l � �i 3" 36" 4" UP 36" t ' 4" CAS N V ! 'O C z S 39" o g � � a O In a pct f■ 6Q 1 � A g e .. � s N cb P p ■ gyp �. �i � 1 cw _ V 0 r'SI O � NDmT'+ ii� '*1 I ET Q Sao so� �� �o� O ■o o $ � v MA.P�ODO ��� 1111NETE P SCk 1 4 '=1'- RE -P R: SEPTIC MANUAL JANUARY W374 US ++wr +o MA!OEM ROCK vn a4rso REVISED JAN, 20 800- 325 -6456 wv!aeoa!e ' rt 1 t4. � � � � �1 � ;�1 -`� : .�.. ��. '" �• , �t t (F). y '/ / Tr i� � ° y a M 1 ' C o o 0.11 — k:4j S. r ss �8j �•� I Q�. � � � .•���, r :,�. \ ' `• �r6� 'd �l _ ... :�, � J` � :tX C ' ". • ; ��: � — P "� $'4\ � L .S��I�: �y � i ��`t,'"C��"�� ' �� ' / tom `7 r K.: ' f. `!' � �- • � v l y I S 8 i .. c'a �, 10 `, 's, '� �� " 6 f ti� w � t �y ci `. �� a� si; ,� ACNEO A Ti pe r - y�� �•� ► er g ��, � � r .. i �� _, '° 8 .: , � s S^ ' ,s+� y { ; S s - s-•�� ;< ^�.it,.,�icy. N00 f 6 57.. ^ Ir ?=, _ a'T.- '` $ : Y ; _ . `? -: - 100'16.57 "E 1036.45•. �`jc • x a • 4 �X`!, cMOO•oarbot ,an s+7 7' .,.< r • 1 �r � � 1 y. , , ., i• ;' ! • Jib �[ �•• ----�_ = ��= �. � ,�C • •• ik 0 4 rp � ,. \(;, �� , ,e� ` y ` �: AN i �y • >u � • �X , , �. �t=- ', � .- 16 1.e , ^ 'C �1� ` \� tC w ' r . .x <�'�• �' �,` ';X . r tes '!�. - / ,•��•.� �,� � v' ;� ��- '1>tt� >. ra r' �� •,;G; �Y VV �`C . 1 1,� .'.,� %r:�;?�r ell � -.•( � J.' -/ . `�-- ,�•`, 's"� EE X f ` . �` , �� �• \ a't r 1� ���e� ♦ .rQ� _ • P `�.. =� :y ' •! . \. ,,�� �C.q e N � -. -" � �, 1l4E %CST \ � g � .. ` a I .: .•__�yy �' 1. �i� .. .� � ,� . .�... dg1�11p� 109:1.! i i �� � �,w 7� i , ° e+' ' '� f f�O • � • ..• t .� 7K� � . ` p v •' !!� i ' ,' QU�O� t x`rt p /'S +, w.N',% � II .c x,'r �;`� •Sy ;6. '_� �� ..w�'' -.. ' ,t • S.T!'X M.. , Y ,, 1' � ` 'L•Q �" .t,/y �/•' � �O.OY '� x aaY X` ,� �G}-- /•�c�4.� Y� '� � • �• ` pq �'� ��(;• s C • Gj' 1 �,�._� MiESi ��-.M ; —• v r / 1 V �„r: r (f II IIII � 1 IIII IIIIIII � I III 8024583 Tx:4017911 STATE BAR OF WISCONSIN FORM 1 - 2000 934672 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Rosamji, LLC, a Wisconsin Limited Liability ST. CROIX CO., WI 04/07/2011 11.47 AM Company, Grantor, and Steve Mitchell, single and Susan Baustian, single, as joint tenants with right of survivorship EXEMPT #: :4 - Grantee. N/A REC FEE: Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: -0 00 described real estate in St. Croix County, State of Wisconsin (the PAGES• 1 "Property"): Lot 14, Plat of Indigo Ponds, Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title, Inc. 1900 Silver Lake Road, Suite 200 New Brighton, MN 55112 3570'lq Together with all appurtenant rights, title and interests. 020 - 1439 -14 -000 Parcel Identification Number (PIN) This is not homestead property. 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 this 24`" day of March, 2011. R amji, LLC M� * Sandra M. Gehrke, President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this Personally came before me this 24th day of March, 2011 the above named Sandra M. Gehrke, President of Rosamji, LLC , a * Wisconsin Limited Liability Company, to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and (If not, acknowledged the same authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * Kelly J. Nelson Notary Public, State of Wisco , in ,.•••'••••.,,,� Richard K.Y. Lau, Attorney At Law My commission is permanent. (If not, tate a 'radon d�tQ� 4012 Street, #200, Hudson, WI 54016 Aril 13, 2014 y; (Signatures may be authenticated or acknowledged. Both are not necessary.) • ;Q 'Names of persons signing in any capacity must be typed or printed below their signature O , • C ` 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -200 N .4 c.,-- /D ©FJD ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -� p_ 1t e e Mailing Address %573�,� /ci�!',�; Property Address - 79 - 7 Sq 111A 1L T✓'It h 1VYMX / ��� 5�' �� �• (Verification required from Planning & Zoning Department for new construction.) City /State N �� Parcel Identification Number 0 Z LEGAL DESCRIPTION Property Location S In) '/a , S '/a , Sec. 15 , T 2 N R 1 9 W, Town of yGtsd 'V Subdivision Plat: - 1/��1� �4� S , Lot #. Certified Survey Map # , Volume , Page # Warranty Deed # q ( 02, (before 2007)Volume , Page # Spec house ❑ yes Xno Lot lines identifiable X 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 (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number o bedrooms IGNATURE 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 reference is made in the warranty deed. (REV. 09/07) 1304 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site Ian on County p p paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 19 Please pd t all 'RM" V E ® Revi d By f Date / Personal information you provide may be used for secondary purposes (Privacy Law, s 15.04 (1) (m)). l/ D Property Owner MAY 1 3 2003 Property Location ROSAW, L.LL Govt. Lot na SW 1/4 SE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address SF C;ROIXCOIJNTY Lot# Block# Subd. Name or CSM# 2141 Cty Rd. C ZONING OFFICE 14 na Indigo Ponds City State Zip Code Phone Number J City _]Village Town Nearest Road New Richmond WI 1 54017 1 715 - 248 - 7071 Hudson I Sumac Trail 0 New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement —J Public or commercial - Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevation 92.10 ft, trenches spaced and depth to code 4.25 ft below grade o'cl lbadt-- . Boring # J Boring 1m Pit Ground Surface elev. 96.35 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 1 Oyr3 /2 none I 2msbk mfr gw 1 c .5 .8 2 6 -18 10yr4/4 none scl 2msbk mfr gw 1 c .4 .6 3 18 -39 7.5yr4/4 none sl 2msbk mfr gw 1f . .9 4 39-96 7.5yr4/4 none sl 1 csbk mvfr na na .4 .6 Z It rr � 1 r7/2 silt lens 1 -2" in diameter at 40" Boring # I Boring II Pit Ground Surface elev. 96.35 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr2/1 none sit 2msbk mfr cs 1 c .5 .8 2 7 -96 7.5yr4/4 none sl 1csbk mvfr na 1f .4 .6 1 9Z t Q !0 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 — 30 mg /L and TSS < 30 mg /L < — CST Name (Please Print) ignature: CST Number David J. Steel Le� 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 5/8/2003 715 -246 -5085 Property Owner ROSAMM, L.L.0 Parcel ID # pending Page 2 of 3 3] Boring # J Boring V1 Pit Ground Surface elev. 90.15 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr2/1 none I 2msbk mfr cs 1 c .5 .8 2 6 -19 10yr3/2 none sl 2msbk mfr gw 1 c .5 .9 3 19 -96 7.5yr4/4 none sl 1 csbk mvfr gw 1 c .4 .6 10yr7/2 silt lens 1 -2" in diameter at 30 inches F-1 Boring # I 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 PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *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 Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST - POWTSM ROSAMJI, L.L.C. New Richmond,WI 54017 Lic. #248956 Swl /4,SE1 /4,S25,T29N,R19w Bus.(715) 246 -6200 Town of Hudson, St. Croix Co. Fax.(715) 246 -9372 Indigo Ponds Lot 14 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1 " =40' ♦ =Benchmark Ele. 100.00Ft Top of 1/2" pvc pipe • = Alt Benchmark Ele. 99.75Ft Top of 1/2" pvc pipe ❑ = Borings Boring Elevations B 1 = 96.35Ft B2 = 96.35Ft B3 = 90.15Ft B4 = 00.0017t ti, R6 2 2� 3h 53' � . 36 5 � tlaMIMAL INDIGO PONDS Laa wr ' o} I ms.l Loakd It Na MrN.ea arw of Ne Scuuwl arl «, n ar MAL UfIUTY EASEMENT DEN p, 3 Iv I 0 �"p roala wo" _ NaNrl aaAr el tiv SwNFeI aata, N as Salhne ;, Q � ms• wnlmrt Fu1 Utter If N/ UAW arlr, and In Ne Saaesa aria a ;1 , w tdf tlUn M 8 � 1 f it Irm M FM tM SwN.a arty, a n Sacl'm 24, rte. 21 North, Rope 19;; " ; u 14M y Y " Y " P f " Rll rd'n arolr NI Ne NrNr.t aoir a Ne V'*'* We n ( 1" ens' 0.e 1 Ir sotto Irm M ' 4! NI Na/aelt a NaNrt aria, n the SwSd ^, V '�, fsR N a ^ wl ,. 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