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Home My WebLink About020-1439-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM c ounty: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538779 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal,lnformation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. City Village X Township Parcel Tax No: Permit Holder Name: 020 - 1439 -13 -000 Oeverin Homes LLC, c/o Kenneth J. Oeverin Hudson, Town of Section /Town /Range /Map No: CST BM Elev: Insp. BM Elev: BM Description: i��Js�i r 25.29.19.2739 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. .1► S Septic Benchmark Alt. BM Bldg. Sewer Aeration Z , Q 7 • 7 Holding St/Ht Inlet 3 9 - 7 ? St/Ht Outlet 9-7 1 TANK SETBACK INFORMATION �` TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic J ` Dt Bottom Dosing Header /Man. gt Aeration Dist. Pipe 6 Holding Bot. System Final Grade j C t PUMP /SIPHON INFORMATION (V Manufacturer Demand St Cover f� GPM Model Model mber """ `] 3 c73 TDH Lift , Loss Syst ad TDH Ft `7_ Z Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM evi �b � Length No. Of Tr enche s PIT DIMENSIONS No. Of Pits Inside Dia BED /TRENCH Width . ' Liquid De_ p` DIMENSIONS 3 G(� 3 LAKE /STREAM SETBACK SYSTEM TO P/L BLDG WELL LEACHING Manufacturer: CHAMBER OR y✓� r �� +��' INFORMATION Type Of System: // UNIT Model mber: a �z �s �' ,�, G i 14 +-li I�-� = A DISTRIBUTION SYSTEM a A * T. l ' x Hole Size x Hole Spacing Vent to Air Intake Header /Manifold i Distribution \\ (! Pipes) � Length �' Dia q Length Dia Spacing SOIL COVE ft.� x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over =Depth xx Seeded /Sodded lched p Bed/Trench Ed es\ ^Yes No Yes ]N, Bed/Trench Center � , 3 g COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: ! / Location: 800 Sumac Trail Hudson, WI 54016 (SW 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Parcel No: 25.29.19.2739 ds Lot 13 1.) Alt BM Description = � 2.) Bldg sewer length = - amount of cover = Z e Plan revision Required? 7 Yes No Use other side for additional information. Ce Date Insepctor's S' atur nt Nc SBD -6710 (R.3/97) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 538779 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: Oeverin Homes LL C, c/o Kenneth J. Oeverin Hudson, Town of 020- 1439 -13 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 25.29.19.2739 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht 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 Length Dia. 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: uB 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 Topsoil Yes 7] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 800 Sumac Trail Hudson, WI 54016 (SW 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 13 Parcel No: 25.29.19.2739 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 0 Yes 1] No Use other side for additional information. Date Insepctor's Signature Cpl No SBD -6710 (R.3/97) RECEIVED W� �v, Safety and Buildings Division County v L 0 201 W. Washington Ave., P.O. Box 7162 S 11 1/NTY Madison, WI 53707 -7162 anitary permit Number (to be filled in by Co.) OFFI E D _ to Transaction Number Sanitary Permit Application 4 ��. In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the apiat ernmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u o ies i n accordance with the Privacy Law s 15 04(1)(m), Stats. �v I. A,p lieation Information - Please Print All Informati Parcel # Property Owner's Name 07b _ / At, 21 7_ 13 �Qb Property Location J Property Owner's Mailing Address (.. 3 3 C,er' Govt. Lot / City State Zip Code one Number ,f( y, %4, Section 6� II 'Hype of Building (check all that apply) Lot# Subdivision Name I or2 Family Dwelling - Number ofBedroom Block # � ❑ I'ublic /Commercial - Describe Use (" - ^ ❑ City of CSM Number ❑ Village of ❑ ,it ate Owned- Describe Use own of III 'Type of Permit: (Check only o box on line A. Complete line B if applicable) A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) _ List Previous Permit Number and Date Issued B. ❑ Permit Renewal it Revision ❑Change of Plumber ❑ Permit Transfer to New Before Expiration Owner '�..L -t�- ry IV.. Type of POWTS SystemlComponentlDevice: (Check all that apply) ,,, Pion- Pressurized In- Ground El Pressurized In- Ground 11 At-Grade El Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil Cy �AJI ❑ I [ olding Tank ❑ Other Dispersal Component (explain)__ _ El Pretreatment Device (explain) r ` ro sed (� Syste levati� V. Dis ersailTreat ent Area Information: De sign Flow (gpd) Design Soil Application Rate( st) Dispersal Area Required (sf) Dispersal Area P 41K , _7 A Y .(^ VII. Tank Info Capacity in Total # of anufacturer U Gall Gallons Units U u New Tanks Existing Tanks �'I Go w a Sepiic or Holding Tank Rasing Chamber V IC i. Responsibility Statement- I, the undersigned, asaum onsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ature MP/MPRS Number Business Phone Number � fi k PI umber's Address (Street, City , StaCode) � 1 . INV II oun I e nrtment Use Onl Permit Fee Date sued issuing ent Signature Approved ❑ pisara N El O tven Reason tahpenial O / L.;K . Conditions of A rovallReasons for Disapproval n 111" 1 /►Cy,,> OYSTS Ww� � r�r ` u I 7. .$eptic tank. efAuenhfllter and .: dispersal cell must all be sery / maintained I as per management plan provided by plumber. 2. A1'+ dck TaIll. `erttertts must ba.►naintained _ Jij system and submit to the County only on paper not less than 8 In x 11 inches In size S.13D -6398 (R. 01/07) Valid thru 01/09 Soil Tes d System PLOT PLAN PROJECT Oeverino Homes LLC ADD 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1 /4S 25 /T 29 N/R 1' W TOWN hudson COUNTY ST. CROIX 7/10/11 MPRS Shaun Bird 226900 DATE BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRE E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 12 allons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 857.4 # of chambers 42 BENCHMARK V.R.P. Top of basement foundation ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 92.3/92.1/1.9 5' below qrade @ B -2 Well is to meet all setbacks required by WDNR Plans Designed Using Conventional Powts Vents Manual Version 2.0 B -2 2% Slope Pro 4 Sumac trail B -3 Bedroom 0 , House 3 -3' X 58' cells with >3' spacing 20, B.M.* 10' 10' 5' 20' ST B- 5 , 25' 40' Property Line Vent o>6" Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 4' Long 1211 3431 Grade at System Elevation Soil Tes d System PLOT PLAN PROJECT Oeverina Homes LLC ADD 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 25 /T 29 N/R W TOWN hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/10/11 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRE E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 12 0 allons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 857.4 # of chambers 42 BENCHMARK V.R.P. Top of basement foundation ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.3/92.1/1.9 5' below qrade @ B -2 Well is to meet all setbacks required by WDNR Plans Designed Using Conventional Powts Vents Manual Version 2.0 B -2 2 %Slope Pro 4 Sumac trail B -3 Bedroom 3 -3' X 58' 0' House cells with >3' spacing 20, B.M.* 10' 10' 5' 20' ST B- 5' 25' 40' Property Line Vent > 699 Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8ft^2 /pair of end caps 'Long 12" Grade at System Elevation 34" Property Owner _ Parcel ID # Page of ®Boring # Boring r J� pit Ground surface elev. ft. Depth to limiting factor �n Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 O's 10 z ' ` -01 �j - r r 3 - r O 1 - r L� it Ong # ❑ 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 E] Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. 11 pit Soil ication Rate Horizon Iepth Dominant Cola Redox Description. Texture Structure Consistence Boundary Roots GPDIfF 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. SBD4330 QW00> _ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CrOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538779 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)]. Parcel Tax No: Permit Holder's Name: City village X Township 020- 1439 -13 -000 Clevering Homes LLC, c/o Kenneth J. Oeverin Hudson, Town of Section/Town/Range/Map No CST BM Elev: Insp. BM Elev: BM Description: 25.29.19.2739 TANK INFORMATION ELEVATION DATA �ypE MANUFACTURER CAPACITY STATION BS HI FS ELEV. mark Septic Bench Alt. BM Dosing Aeration Bldg. Sewer SUHt Inlet Holding St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Header /Man. Dosing Aeration Dist. Pipe Holding I. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Deptn DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LE ACH I NG R OR Manufacturer. INFORMATION Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM vent to Air Intake Header /Manifold Distribution x Hole Size x Hole Spacing Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only T ulched Depth Over xx Depth odded Depth Over To soil Yes No BedlTrench Center Bed/Trench Edges P Yes r� N COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 800 Sumac Trail Hudson, WI 54016 (SW 1/4 NE 1/4 25 T29N R1 9W) Indigo Ponds Lot 13 Parcel No: 25.29.19.2739 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes gd No Use other side for additional information. Cen No Date Insepctor's Signature SBD -6710 (R.3/97) -- . _.- . - County Buildings Dtvtaion _____ I _> - - - dlMl ttirll Washi n .Ave„ PA BOX 7162 - -- '' W 1 53']07 -71 fit Sanitary Permit Number (t° be i ilia in by l o.) Number - .------ - -_ -_. `' .� StatcTrat�eacti -- SAW tar I Application In a;i; , vttlt s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the sppro is ental Project AddmsB (if different thaw t mailing a'idrnsa) unit as requital prior to obtaining a sanitary permit, Note; Appiication forms for m submitted to t ic Department of Commerce. Personal info you provide to or dHty utj!n t in act ordanee with the Privacy Law, a.15.tt4 { m , 1. j!q! i�ieatk in [nt� ermatiu2 _ p� print An lntormation Parcel # Prop arty Owns is 1Jatiie _ � - S � AdLii ( 6- - Ls � - _ - -- Property Location a Z -1 rty Owne r a Mailing -- -- -1 - -- - -- Zip Code Phone Number A i 'L %, State an firers o City. , � Let i1 11. 'Itype of Hdldinft (Check all that apply) C Subd!yluonNom f or 2 Famil y Dwelling -- Number of Bedrooms - - -- QkP _ 11 city of _ - - -- - - - - - -- - -- -- .. ❑ i bliclCom riercial- Ilescribe Ilse _._.__- __.___ _ 0 age of _ ..— ....._...__..._ -_ -. __ C.� ;i t;nc Ownci 1-Describe Usl, ,____._.. _.r- __. - -- -- - .- - -- own o -- -- -- -- ---- - - -_.- -- lIL,1C ype f Permit: (Check oni one box on line A C litre B i f app![esbl _ Other Modification to Patiati fig System ("It's"") ) — A - - -- -- [� Replacement system reatment( em Q T'klolding Tank Roplacement Only atom - - - - - -- -- --" -- - List Previous Permit Number al id Date Issued ❑Chan a of Plumber U Perrnit'Tranafer to TJnw Il. ❑ Permit Renewal C1 Permit Revision S owner _ Before Expiration of 1!OWTS 3�abeitelCom on Check t1H that et Mou 7 24 in of suitable soli ❑Mound < 24 in. of suitable 'oil Press ized In- Ground C� Pressurized In- Ground El At-Grade - -- __ ❑ Pretreatment Device (exQlatn )_ -- _ -T - - - - - -- J- ❑ liuiding'['ank ❑ Other Dispersal C:omponcnt(explam) -- _ V. la!�L*!aali Tr ' ent t Area I_ - __ wf rMation - - -- - m Stev trio d Uia treat ArArco Requites( N Dispersal Area posed (sf) Deli ,n Flow (EPd) Design Soil Applicatio ate(gp af) P - _ -- Manufacturer ` P y rani _ n - -_ . -- - - -- -- Ca sett m V11. Tank Into Gallo (Iellons Units � U M'; ' silks SepN c or I18141nt Tank —__ l-•-C —C/ - —. — - - -- -- Vr t.. Reaptmt lhility Stnte tatent ^ 1, the undersigned, mama dbWty for inrHUrtbn of the P OWYS shown on the Number Business Phone N fiber _ MP RS NumIMPber Plum' r'. Nan a (Print) - -- Plumbs +c C l ime -• Code ) , Piurnber's Addmas (Street, Ci ,State, Z'p ) A / - ent Uee Unl - -- -- - Issuing nt Signature - -- t F Date is ned V'Ill. nunt�lDe n rtm _- _.�--- - - - - -- Permit Approved Q 1 � /� ___ - - - -- Own -- R_ usaon for t � - - - -_ _ -- -- - - - - ns for Disapproval 1 (� 1;'i. t'ondl ��aO J ��. �-�.. � � �y -, 6 tank, effluent flfter and dispersal cell must all be serv ! maintain r t as per management plan provided by plumber 2F M' joback regUif is Must.be maintained ' 'T - will on Pp r nwa lee* b s I/a w ° / fnc�n In d:a At W n enmP� P was r tOw sy„awm ails sobMU a1R cwrMy Y sHD -6398 (R. 01/09) Valid thrill 01109 PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1 /4S 25 /T 29 N/R 19 W TOWN hudson COUNTY ST. CROIX 5/25/11 3 BEDROOM MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 88.0/87.0 5' below qrade 463' Prop erty Line Well is to meet all ; 41 setbacks required by B M * WDNR 37' .` 5' Plans Designed Using Pro 3 82' Conventional PowtS Bedroom B -2 Manual Version 2.0 House B -1 7' 13' Vent 20 ST Quick4 Standard -W 2 -3' X 66' cells with >3' spacing >6„ Leaching Chamber 20' Stu ac Try Of Cover with 20.0 ft2 of Area Vents 5.8ft ^2 /pair of end caps 4' Long 1211 80' Grade at System Elevation B -3 34 11 11% Slope Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 5/25/11 Owner: Oevering Homes LLC Location: SW1 /4 NE1 /4 S25 T29 N,R19W Lot 13 Indigo Ponds Hudson System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contin cy Plan 6. Filter Specifications S e Signature License number 6900 PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 25 /T 29 N/R 19 W TOWN hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/25/11 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 IL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100° Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 88.0/87.0 5' below qrade 463' Property Line Well is to meet all setbacks required by 44' WDNR B.M.* 37' Plans Designed Using Pro 3 82' 5' Conventional Powts Bedroom B -2 Manual Version 2.0 House 13' B -1 7 20' ST tL_ Quick4 Standard -W 2 -3' X 66' cells with >3' spacing Of Leaching Chamber 20 ' 5Egu ac Tr, with 20.0 ft2 of Area Vents 5.8ft ^2 /pair ,of end caps � 80' Grade at Sys tem Elevation 34B -3 11% Slope Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard -W Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 94.0' Vent Grade Vent 4 4 4 X30/34 Septic Tank 4' Long 1 5' 4' Long 191 3 4" Grade at System Elevation 3491 Grade at System Elevation r Spacing 5' 2 -3' x 66' Cells Observation tubeNent Same on other end Located at ends of Cell A B 16 chambers per cell System elevations: A__88.0 B 87.0 Maintenance and contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 5stet ested y Plan system fails, determine cause of failure, use alternate area and install new replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biorvat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SUMC TANK MAIlUBN.ANCE A(�RF.�3MBN'T AND OWNS SER CBP.TPICATION FORM O ne r'suym Oe- o 2 PwpertyAdcl.ves &"D (Vaiftatim required f4mPlowing dt 7aft Deparimsmot trmew aaw*aad m.) Car /.;raft_. Pwod1d, L&G OLL 1vpesu1y Loc itio V. , N %4 ,Sec. 2 S T 2 7 N R�W, Town o Subdtrl im . 110t# 1 Certltlged Sttrvey* Map # . Volume , Page Wurrenty I I eed # , Volume , Page # Spec Louse no Lot tiaee idenftftWa no W 1wp i per sae sad a of yw septic systom aoidd resatt in ita ps limp f flare to hurdle wssi t. Psoper medndrm�anoe a i a�sdlM of p�moop3og tmt tLe soptia tank every U>dttea yeeeas oar soames, ifneedar] by a %oamssd V rte*ar. V1W you Put into lire sy,doma csa, armed the fimatioan of fire septic taak as a treatoaot sags in flu watt disposal swumv. C WAW mdaeemmee resporwiWitie i we speaffied is $Cown 83.52(1) and in Chapter 12 - St. C MIX Caamty Ssmitsry Ozdi ww& Tire I I nqpsrty caner egress t D sub= to SC Cm= Coumty Pl mfg * Depaspma a outfiestion famk x*od by tip o.vnar aed by I L mas6ee pbpmbse; j6umrjjm phmnber, settrtetsd pbnobw or a liaeosed pumoper vsrIfgbeg dw (1)1Le oar -site waswfwaft di i posal syslemm bin pot*w opsre ft cxmdition =&or (2) agar iespect km and P16 (if y). the septic tsak is less C`tan 1/3 f ; j1 caf slaw Vwe, the mod have seed in above raqukemoeutb sad agrse'to naaistt da. the private sewegm dispcsel with the saanaowds sac j wft. b a& as cat by the Depart memt of Cone M=* and the Depatamo ofNa and Rstoomaey Stets of WisoomehL Ccriilication i Md42 dust yosa sop& system bss bean maiat gnW mist be comp iftd sod xeo and to tlrs SL CMM Cotmoly P1siamma9 dt Z,mw: g Dqm meant wl&n 30 days of fire Have year an*sedm date. fl oe Net'ify that alt .our this Sm= are trine to fire best of my/ow lmaale p. LAwe sw(mve the owtrea,(s) of dw Propva:ty dw tbed above, by vftaw of a weave y deed reoor&d in Rmghd r of DaKU Office. Nuaber of bedt+ Ons— c S 1d2�'l i I IGNATOn OF CANTS) DATE *• *A ay milx ateif ooQ errt s mderqueyaeoett shay result in dw smmtery pa* berg revolted by ft Pbndpg & Zattimg - * "' Include with f Me sppliestfom a nowded warranty deed from ttu Register of Deede Office a ud a copy of tiro certified 9Vxfty map if redienmoo is m ado in the wo deed. 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Zm ' i ( W ZOW O 7 0 � L � t � Q o _ 'jl'X Z Z z ,ZL'S£Z M„41,94°LON � ti's O w 8ti' W 3 o OS � �� amp � b,f Z M.S 0°60S��n N O :4D Li U ..Q) 3 " �� ,� i" Q. v F_ N o * rn ' i 1 c' a 2 r- U c o O �t � pi Lo Z m � � ^ Q 1 Cn -i °c N �o_ d o II w b pN Z F W ^O cn W w 3ci z� p oWZ 00 04 0_T via °.r W O�� OXdJ N COQ O ON Z Z d �(� Z wow o M > ° O� Vf(C) OM N J 00v ( ZF D O NOD W Q CY) " 1 o z > Li !• �g °2°r',J W A ; ` z o W Z 2 �O M lI )� =o a z N�1 035.55 "W lL ) Orn W ,LO'Z6l ,4F'8ll %,) ,S£'OlF M "Ol,4Zo0ON cJlQao 0 2� I 0 LIJ /ri o� °� I `` N W U ° \/ w II /h Q Od C I V J ° " N "cn no , /e° X 0) 14 �° L1_1 Q �O O N JO F J �``f 0 y v Z > LLjl W �Zp 1 z0�i 6 ui iw °w c 6L 3 "0l,4Ze00S `` o _ _3 N ^O I�a 0i 0 E r� L i wN0 z aw ' k' .. oz pof _�I W n � w3ca NQ °,9/ rn e n� �`��I a z zW N �o r .�� 6�\ o W Z �wz ° " >I o F � F rnN I �'\.� =N bi`,�b�'� N Im 00 'M 6L 'b ''N 6Z '1 - '4Z M ° w w r N\� z 03S 3NI1 23318vn0 Htnos -H1aoN � �` Z o W I °�� i /� ( cn 7.1,_ LnN) (3 „50,24° LON) 8029107 Tx:4020423 STATE BAR OF WISCONSIN FORM 1 - 2000 936930 WARRANTY DEED Document Number BETH PABST REGISTER OF DEEDS THIS DEED, made between Rosamji, LLC, a Wisconsin Limited Liability ST. CROIX CO., WI Company, Grantor, and Oevering Homes, LLC, a Wisconsin Limited 06/01/2011 08:49 AM EXEMPT #• N/A Liability Company, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 30.00 described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 120.00 "Property "): PAGES: 1 Lot 13, Plat of Indigo Ponds, Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title, Inc. 2200 W. County Road C, Suite #2205 Roseville, MN 55113 Together with all appurtenant rights, title and interests. 020 - 1439 -13 -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 27th day of May, 2011. R amji, LLC �— * Sandra M. Gehrke, President * - * AUTHENTICATION ACKNO W LF,DGNI ENT Signature(s) STATE- OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 27th day of May, 2011 , N Personally came before me this 27th day of May, 2011 the �••'•" '•�''V above named Sandra M. Gelirke, the President of LLC. * a Wisconsin Limited Liability Company, to me known to be the TITLE: MEMBER STATE BAR OF WI UNM person(s) who executed t • regoing instrument and (If not, --- acknowledged th ame authorized by § 706.06, Wis. Stars.) N�_.AvB`�G — — THIS INSTRUMENT WAS DRAFTE •'OF.'SGO� * Kell J. Nelson - - -- Notary Public, State of Wi onsin Richard K.Y. Lau - Attorney At Law My commission is pernlan it. (If no[. late expiration date: 4/13/2014 (Signatures may be authenticated or acknowledged. Both are not necessary.) - - - -- — — *Names of persons signing in any capacity must be typed or printed below their signature 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN NORM No. 1 -2000 y 1303 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 plan on paper not less than 8 %x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. 2 (}— _/ Pleas Print�l � Re ewe Date Personal information you provide ay be used forums (Privacy s. 15.04 ( (m)). / r6 Property Owner MAY Property Location ROSAMJI, L.L.0 2003 Govt. Lot na SW 1/4 SE 19 S 25 T 29 NR 19 W Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# ST. C;RUi;� CUUNTY 2141 Cty Rd. C zorJi � ,, 13 na Indigo Ponds City State Zip ode J City J Village a Town Nearest Road New Richmond I WI 54017 1 715 - 248 -7071 Hudson I Sumac Trail 1/ New Construction Use: t/J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement Public or commercial - Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevation 93.45 ft, trenches spaced and depth to cod 5.00 ft elow grade M e Boring # I Boring Pit Ground Surface elev. 98.45 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr2/1 none sit 2msbk mfr gw 1c .5 .8 2 9 -32 10yr4/4 none sicl 2msbk mfr gw 1f .4 .6 3 32-48 7.5yr4/4 none Sc l 2msbk mfr cs na .4 .6 4 48 -120 7.5yr4/6 none cos osg ml na na .7 1.6 COS <35% coarse fragments = 36" & >35% - <60% = 60" below system F il Boring # J Boring 1/ Pit Ground Surface elev. 98.45 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr2/1 none sit 2msbk mfr gw 1c .5 .8 2 6 -19 10yr4/4 none sit 2msbk mfr gw 1f .4 .6 3 19-48 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 4 48 -120 7.5yr4/6 none cos osg ml na na .7 1.6 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) ignature: CST Number David J. Steel' 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 ROSAMR, L.L.0 Parcel ID # Pending Page 2 of 3 3] i Boring # J Boring Sol Pit Ground Surface elev. 91.95 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr2/1 none SO 2msbk mfr cs 2c 5 8 2 12-48 7.5yr4/4 none scl 2msbk mfr gw 1 c .4 .6 3 48 -120 7.5yr4/6 none cos osg ml na na .7 1.6 r� F-1 Boring # Boring J _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 D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F -1 Boring # Boring _f 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 7S 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 SW1 /4,SE1/4,S25,T29N,R19W Bus.(715) 246 -6200 Town of Hudson, St. Croix Co. Fax.(715) 246 -9372 Indigo Ponds Lot 13 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. 100.0OFt Top of 1/2" pvc pipe • = Alt Benchmark Ele. 100.25Ft l� Top of 1/2" pvc pipe ❑ = Borings Boring Elevations B 1 = 98.45Ft B2 = 98.4517t B3 = 91.95Ft B4 = OO.00Ft Ncr,r4 �-o� �7 z Fti.9i S,TF� 6` i3 Ao� Ij I x N IRON F&LIND'2.81 F F EAST AND 7.71 FEET NORTH OF PROPOSED �OT CqR?jER. FOUND &41 FEET e 1 4 A A -N r 'NORTH OF PROPOSED E L T ORNER . %,J L 79 3s 9 3.22 N89 L A.b 0 56'47* 8 45 180 -00V X -177.00' - 426. O B RA / - 1 0 OR I A 33 "EA NT B NN U; NT IN OF NE A' I s. _7 0 87417 AQ),, 01 \ (2.007 AC.) c4 % (1.346 AC. N.B.P.A.) 524. 273.2 S.F. lkk 99982 of (2.295 AC.) /of (1.568 AC. - N.B.P.A.) - 88400 S.F. (2.029 AC.) (1.682 AC. N. B.P.A.Z f 978 S.F. (2.246 AC.) 1.002 AC. N.B.P.A.) 3 -7 (A NIRIE - MEADOWS - 649 4 MRIV 0., Op 6 1�93.7 r. 3 06' DRAINAGE EASEMENT Sk _j 121132 S.F. (2.786 AC.) 1.000 AC. N.8 P.A. 83. 2q A co CV 4" O.H.1N 135,03', 919.6 97744 S.F (2.2414 AZ 5! N.B.P.A. `� , 1 \ ' ' 92458 (1.058 AC. .e8z�� x.41 , . � � ,;�'. ', (2.123 At.) )(1.578 AC. N.B.P.k)