Loading...
HomeMy WebLinkAbout020-1439-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552320 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Karls, Kathleen L. Hudson, Town of 020-1439-05-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / IV\ 1 SZ' 25.29.19. 1 TANK INFORMATION ELEVATION DATA 7.731 TYPE MANUFACTURE • CAPACITY STATION BS HI FS ELEV. Septic Benchmark W ~ ems. /5 5 3.05 A03-05 0=> ln"e l0 5zS Alt. BM Z. /a1.01 97 Z C Aeration Bldg. Sewer 5.'31 Holding St/Ht Inlet 7 TANK SETBACK INFORMATION St/Ht Outlet • 96. MI5 TANK TO P/L WELL BLDG Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic 33 5 C IM Dosing Header/Man. I 47dl. _ , Aeration Dist. Pipe pr ( O•~l77 Holding Bot. System 7.41 '73 41 PUMP/SIPHON INFORMATION Final Grade q.3 -76 Manufacturer Demand St Cover /a t ' D GPM ~i~4G~- CA Z. b Model Number TDH Lift Friction Loss System 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 3 DIMENSIONS 74 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type/0f System: CHAMBER OR 4 6.ti.J~ y -~UNIT Model Number: /V <k. 4..~0 DISTRIBUTION SYSTEM j-/ 8= ` Header/Manifoll) Distribution x Hole Size x Hole Spacing Pento Tntake Pipe(s) Length Dia Length Dia Spaciny_~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only OJ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M Bed/Trench Center 5 • I ' Bedrrrench Edges Topsoil ched Yes ❑ No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 863 Prairie Meado'w~ ~Drivve,Hudson, WI 54016 (NW 1/4 NE 114 25 T29N R19W) Indigo Ponds Lot 5 Parcel No: 25.29.19.2371 ad 1.) Alt BM Description = J Le 16 e 2.) Bldg sewer length - amount of cover = V Plan revision Required? FE Yes X Use other side for additional information. SBD-6710 (R.3/97) Date Inse is Sign a Cert. No. G I11e VI ov Safety and Buildings Divis'on ntY C, I 201 W. Washington Ave., P.O. Box Qo Iti / epae invent! + co U ' 1GE Madison, W 1 6nitary Permit Number (to be filled in by Co.) 1 ,4G ~y c C/ r anitary Permit Application State Transaction/Num er In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appr )nmental /A unit is required prim to obtaining a sanitary permit. Note: Application forms for d POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide used for ondary - purposes in accordance with the Privacy Law, s. 15.04 I (m), Stats. QI e 94 - 1. Application Information - Please Print All Information U Yv/ 7 rGL ' y G~ Property Owner's Name 0-- Parcel # OX-IV-37 - 05 -00 0 Properly Owner's Mailing Address Property Location C 1 y B fftr t, Lot f City, State Zip Code Phone Number ~ N l►,Y Section 11 S R4 1) sot) ~J J 5 (a l Ili o (circle one) 11. Type of Building (check all that apply) np i Lot # T a N; e 1 E or W X1 or 2 Family welling- Nrtmber of Bedrooms Subdivision Name tnT'~ C~ L'cf vt1 (h 7ti1 Block # d )90 To W n ❑ Public/Commercial - Describe Use L✓ C'.✓os'e,I-S I V ❑ City of - - ❑ State Owned -Describe Use CSM Number El Village of 144 pSON MTown of 111. Type it: (Check only one box on line A. Complete line B if applicable) A. ew 5yst ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) e;7 ~ber and Date Issued 6. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber El Permit Transfer to New List Previous P/_„Iit Before Expiration Owner IV. Type of POWTS S stem/Coo onent/Device: Check all that a 1 .y .girt C_ 'o IHZ~Non- In-Gropod ❑ Pressurized In-Ground ❑ At-Grade ❑ M/pund >/24 in. ofsuitable soil ❑ Mound J#24 in. of suitable soil ❑ Holding Tank LFbtlier Dispersal Component (explain) ~ g L'f'i-fl._/n UYI~ Pretreatment Device (explain) y _J7 , V. Dis ersalfrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation c~ .'7 11" 1 07a ✓ logo 9 ee ` VI. Tank Info Capacity in _'total # of Manufacturer y ,o Gallons Gallons l)nits l y p o New Tanks Existing Tanks e d 0 2 a U 'rn H el w U n. Septic or Holding Tank Dosing Chamber him - VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. MP/MPRS Number Business Phone Number Plumber's Name (Print) P m is Si TC7~,-~ umR e~ 1aaA10 15~3$(1-10)Plumber's Address (Street, City, State, Zip Code) o S upsoN USA S Viii ount /De artme se Onl pproved ❑ Disapproved Permit Fee vf~ Date Issued Issuing Agent ignature ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval ~r SYSTEM OWNER: 40 siWI- a-yLl~ d-'w)v 1 Septic tank, effluent filter and ) y~. dispersal cell must all be serviced / maintained) SPA! /~C1~~~~ L G' r~ -1L -Q -as per em nt plan rovided b lumber. lJ S C~~JP y +"c cy~_• S 2. All setback requireNf8ftP fPrCl VbOaftinftil n and submit to the County only on paper not less h, 8 vi s I 1 inches ilLsize I as per applicable code/ordinances SBD-6398 (R. 01/07) Valid thnr 01/09 LLL~~~ 00op Maio A4me Joe u ieesia r 40mijoj) :7:Na 5 o PONDS iG \N 3 -Trp ~j c s 4v l ~30, z i 1 ~ ; AS16 74, 0 rp = ` i ~S~oS yP~ iC. f t~~ po~ (lot 5 S j ~OKJG,p1 6 s ~ ~ ewe 1,' 'err ~e r 5' _ 0o, 649.40' PRAIRIE MEADOWS--.. DRIVE:..: w ?SO: 493.7 24Sr 1 3 pp' v I' - ~ r" , t ' x.63' , - p . DRAINAGE EASEMENT 6'" • ' ~c co 1 .x920121132 S.F. ~~t: ` ` rn _ _ (2.780 AC.) - • _ 1.000 AC. N.B.P.A 135.03', { 919\.~ 97744 SF. = f- , v i' f f ! t r (2.244 AC.) J S~.F. (1.058 AC. H.B.P.A.). ` t / f s BZ , . 8$27 .S~.F. (2.1 AC.) ' 2.0265 AC.)~ )(1.578 AC. N.B.P.A.) 1.217 AC. N.B.P.A.). ` At, =f i 1.442 AC. N.B.P.0.) , t 91811 5.~, .3 'E 87839 SyF. 'A'pp ~J ~r (2.108 AC.), (2.016 AC.).._.- f (1.090 AC. N.B.P.A.) - ,`(1.364 AC. N.B.P.A.) 375.66' If, SOL SOL i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: a.r. Owner's Name: Owner's Address: 97.3 A6C1~ Legal Description: (JJ ~ T a~ R IT Township: ~(aaSan~ County: S i 1,R0 R Subdivision Name: Trv 4,)g 0 po w oS Lot Number: Parcel ID Number: Qac) o 04o page 1 Index and title Page 2 Plat Plan Page 3 System Sizing & Cross-SEm io-n--- / Page 4 A P'., Filter' Specs 3( Pa-4,J, Page 5 Maintenance Information Page 6`~-_ Maem'ent Plan Z ✓ ~ja Page 7 St. Croix Cty Septic Tank Maintenance Form V Page 8 Warranty Deed _ Page P CSM or Plat Att'achM6hts: Soil Test & House Plans Designer/Plumber: (~4License Number: Date: 7. _ Phone Number Signature Designed pursuant to the In- 'round Soil Absorption Component Manual for PoUV s Version 2.0 S8D-1070'5-P (N.01/D1). G I 000,P/0 Zo OC& j©n IN r~ i' 0 Po N D S ~ 4u N 3 -rQtic~ s 3x7a -1 hrm6ki (QufLk 14 --fh ~t l dgj pc~ T6 C,~ s3 r /0' aQ d ys 3s 00 , Is(o S'gpl S4;(- po~~ (,off- S S Owe)/ ® &Na mpa k rI~v 100.U °r (A ~l~ P,Ie • (3e4 MU V- F-IeV,!- 100.15 pvc o;- 40 r S \ ~~KP~RIe DA-moULoS DQ-lwe i Soil Absorption System Cross Section t~d•VSft 9T ~ 5 A" Schedule 40 Final Grade PVC Vent Pipe c~ With Vent Cap ~~•L J ft Leaching Chamber ft ' System Elevation . ft ft 3 ft Soil Absorption System Plan View - _ ft { M {t Leaching Trench 1 Chambers ` Mm f, I 1111111111111IME 4' Dia. Trench 2` Header Vent Or Observation Pipe C Trench 3 Leaching ChaMber S ep c fications - Manufacturer And Model _ Q41 c.K y N~1 kkn~01L - EiSA Rating., cl V sq ft per chamber Soil Application Ratea T'- gpd/sq ft gpd Design Flow Soil Application Rate - 101 OA EISA = _5 y Chambers 3 rows of chambers each. Page of ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C G ✓ Mailing Address 113 h [kK3er vc JV1 L4/1 '510L& Property Address 963 Lrq'f re- M e.:*J a U/S Air ! J~ -2-fl., (z__ (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 006 - O '0cx) - 14,59 LEGAL DESCRIPTION j Property Location 1/4 , I/4 , Sec. A , T A 9 N R_L~W, Town of H N ~ S Subdivision Plat: ILA-1:1V I d Vk Lot # S_ Certified Survey Map # , Volume , Page # Warranty Deed # /S '34-(before 2007)Volume A , Page # Spec house ❑ yes A no Lot lines identifiable V 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 of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) v0v-11-;?U1U 10:45 AM St. Croix County Plan/Zoning 715-386-4686 1/2 POWTS OWNER'S MA1WUAL, & MANAGEMENT PLAN Page ~ of ~ FILE INFORMATION SYSTEM 4PECIFICATIONS Owner , ~1L S Septic Tank Capacity al Ci NA Permit # 2 O Septic Tank Manufacturer 1 k>2 C3 NA DESIGN PARAMETERS Effluent Filter Manufacturer Vol Lo C7 NA Number of Bedrooms ~ 0 NA Effluent Filter Model p A NA Number of Public Facility Units '5NA Pump Tank Capacity gal NA Estimated flow (average) 5 00 al/da Pump Tank Manufacturer NA Design flow {peak), (Estimated x 1.5) 7 S 0 aUda Pump Manufacturer NA Soil Appllcatlon Flats aUdayPltx Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit C3 NA Pats, Oil & Grosse (FOG) 530 mg/L 0 Send/Gravel Filter 13 Peat Filter Siochemioel Oxygen Demand (SODS) 5220 ms/I. 0 NA C] Mechanical Aeration Q Wetland Total Suspended 5ollds (TS$) 5150 mg/L Q Disinfection 0 lather, Pretreated Effluent Quality Monthly average Dispersal Cell(s) C3 NA Biochemical Oxygen Demand (BODa) 530 mg/l_ ?kin-Ground (gravity) Q In•OroLmd (pressurized) Total Suspended Solids (TSS) 530 mg/L /NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100m1 (3 Drip-Line (O Other: Maximum Effluent Particle S(ze YS in dla, Q NA Other: ❑ NA Other: 13 NA Dther, CI NA "Values typical for dommlo wastewater and septic tank effluent, Other: E3 NA MAINTENANCE Spi EDULE Service Event Service Frequency inspect condition of tank(s) At least once every, mentFl(m) !Maximum 3 years) Q NA a. ear(s) Pump out contents of tank(s) When combined sludge and scum equals one»thlyd (Yj) of tank volume 0 NA Inspect dispersal cell(s) At least once every; month(s) (Maximum 3 years) Q NA CA ® ear s Clean effluent filter S At least once every: f ae~l h(s) 0 NA Inspect pump, pump controls & alarm At least once every: 13 month(a) A yeer(s NA Flush laterals and pressure teat At least once every: rnonthlsl NA Other. d year(e) At least once every,, ❑ month(s) NA Other; C] ear s) DNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or cardfloatlons: 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 teaks, measure the volume of combined sludge and scam and to check for any back up or ponding of effluent on the ground surface, The dispersal oell(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 loco( regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third NO) or more of the tank volume, the entire contents of tha tank shall be removed by a Septage Servicing Operator and disposed of in accord Wisconsin Administrative Code. ante with chapter Nh1 713, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, retre e un(ts, and any servicing at intervals of 512 mo p 8tm nt nths, shall b be performed by a certified POWTB Maintainer. A service report shat! be provided to the local regulatory authority within 10 days of completion of any service event, GMW lVol) Nov-11-2010 10.45 Art St. Croix County Plar,'Zonlnq 715-386-4686 2/2 pegs of START UP AND OPERATION products or Other chemicals For new construction, prior to rise of the IaOWT:~ check xreat►nent tank(s) for the presence of painting P that may impede the treatment process a dog cpa attire t crdispersal C1` MM, if high concantratlona are detacted have the contents of the tank(s) removed by a Sept 9c to use. system start up shall not occur when sail conditions are frozen a, the Infiltrative surface. !wring power Outages pump tanks may fill above normal htghwator levals. When power Is restared the exaass wastewater will be overloading the discharged to the dispersal call(s) eve theacontents of the pump tankGrefmoveddby aySept9asresult peratorf pace rior toprestcating effluent. To avoid this his situation h power to the effluent pump or contact a Plumber or PL}WTa Mafntainar to assist in manually operating the pump controls to restore normal levels within the pump tank, Do net drive or park vehicles over tanks and dispersal calls, 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, the Elfe of the Reduction or elimination of the fallowing from the wastewater stream may improve the performance and prolong POWTS: antibiotics; baby wipas; cigarette butts; condoms; cotton swabs; dagreas8ra; dental floss; diapers; dlslnfasctants; fat; foundation drain (sump pump) water fruit and vegetable peelings; gasoline; 91`0888; hafbicldes; ma8,t scraps; medlcaticne; cEl; painting products; pesticides; sanitary napkins; tampons,, and water softener urine, ABANDONMENT When the FOWTS fells and/or Is permanently taken out of service the following stops ahail lee taken to insure, that the system Is properly and safely abandoned In compliance with chapter Comm 83.32, Wisconsin Administrative Code, • All piping to tanks and pits shall be disocnnaotad and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and properly disposed of by a 0isptage Servicing Operator, • After pumping, all ranks and pits shall be excavated and removed or their covers removed and the void space filled with sail, gravel or another inert solid material. CONTINGENCY PLAN If the POWT& fails and cannot be repaired the fallowing measures have been, or must be taken, to provide a code damp ant replacement system: L A suitable replacement area has been evaluated and may he utilised for the location of a replacement sail absorption system. The replacement area should be protected from disturbance and compaatlon and should not ba Infringed upon by required setbacks from existing and proposed structure, lot lines and walls, Failure to protect the replace mant area will result in the need for a now sail and sits ovaluation to establish a suitable replacement area, sopiacoment systems must comply with the rules In offant at that time. A suitable replacement area is last resort to replace the filed 11 POWT~s. Earring advances in PgWTI' technology a holding tank may be installed as Q The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POVVTS a gall and alto evaluation must bs performed to Ipcata a sultabls replacement area. If no replacement area Is available a holding tank may be Installed as a last resort to replace the f'allad POWTS, 0 Mound and at-grade sail absorption systems may be racanstruoted In place fOllOwin!g removal of the Wont at the Infiitratias surface. RGOO119truatinns of such aystams must aom}+ly with the rules in affect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TFIRATfV ENT TANKS MAY CQNTAItrt LETHAL GASSES AND/OR II WIaFII: t [+IT Et WI I. NOT ER TREATMENT TA74K UNDER ANY CIRCUMSTANOSS. >SNTER A SEPTIC, PUMP OR KiTI# DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A. TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL CQMME TSS POWS IN TALLER EPh 4 Name Phone SEPTAQFe S&RWFCING OPERAT R ( pER i or3,a~ R t WLA'PO u d, a'y L:93 Name S C R b l Zd hill N S -y S- v S Phone S 3 This document was drafted to compliance with chapter COMM 83,22(2)(b)(1)(d)&(f) and 8344(1), 0 (a), yillsccris)n Administrative Cbdo, ~'LT52S lEff llent Filter— Effluent Filters Pol. lok, Inc, pee 1 of t ikl:aziei;in t e '1J-S,A:':i i i Polyltalt inc. Fairfield Blvct atlin koi f ' 9 ll . will Top kF're g d. , i" 0602 e: M-76 ' 5-8J5r55 linnali: palartatC.com You are Mere, a +Proow't Details , ~Friu, EFFLUENT FILTER Raising the bar in filter tochnolo PL-625 Effluent Filter Description Ej fflu ent Filter's Polylok, Inc is pleased fo add Its new commercial filter to it. existing IRne of gf,fality effil,,pnt ' M4-nd & L okT" filters. The PL-525 is rated for over 90,000 PD (Gallons Per Day) making it %)rio of the I°",° largest mmmercial filters in its class. It has 525 linear feet of 9/;6' Cfikration slots. Like the f Risers & Ricer Covers Polylok PIA 22, the new Polylok PL-625 has art automatic shut off ball intralied with every L filter, When tile filter is removed for cleaning, the bail will float tip and temporarily shut off Distribution Boxes ant h i the system so the effluent won'i leave the tank. No other filter on the market can make that Accessories claim! Pumps, Begins, P'uYnp r lorfng Inform-,)i:iori Request a Quote Related i and p Systems ...,.....~W ...+.,..u...,,,......._. ea PI'QGI.ICt'~ ~ i Soak / Gaskets I ! Baffles, Senltory Tees, Rated for 10,000 WID (Gallons Per Day) Deflectors _ M 5266 linear reef of 1116" filtration Eniarge for details • Accepts 4" and 6" SC ND. 40 piF~e Reber Sege * Built in Gala Deflector Handles send Recfet~ra • flutomAtic shutroft ball when filter is minoved a Alarm accessiblllty ! Accepts PVC extension handle I Signs I Lan jecape I Drainage The PL^625 Effluent Filter should Operato efficiently for several years linear normal conditions laefore requiring cleaning. it is recommended that the fjltel' be cleaned every I Forms & Clamps time the tank is pumped or at least every three veers. if the installed filter contains an optJonal alarm, the owner will t e a notified by an alarm whoa the filter { Wtyi Seeiatlt 8 Se c , n 5 5e ir~i NI inch should be done by a certified see#rr. tank pump~ar or instal)er. ~ ng, Concrete Accassori'es Maintenance Instructions, Pressum Fitters 9. Locate the outlet of the septic, tank. der Crantrol Product -2, Ramove 3. Do not We plurnhing whpump ilr iank s remu necessary ~ RebarMG,+ak and C1HiU 4. Pull PL-525 out of the housing. IM~6G1Yt4'19 5. Hose off filter over the septic. tank. Make :cure all solids fall 480k into septic tank. µRetaar Safety and ID C; 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and CCmplet,~ly irl,ertesJ. 7. }replace septic tank cover. PL,525 Installation: IdaRl for residential and ccmmerclal 0eOePative Landscape waste flows up to 90,000 GOOlls Par Day (GAD). Techtrioal SPi'waEiol instailetion Instru(.,fjo ls: Related Prodv4rts 1. Local's the nutlat of tha sept!p flank. POMP Fllfer and ftrl 2. Remave tank cover and Puillp 3. Glue the filter housing to hca "tor 6'f 1eCessary, i 24" x 12" Riser Filter the access opening 4isc a Polylok Ext~~td i~pLpGal~c. If t}1e filter is not centered under ! sme FilltaM C nltrot 4- Insert the RI_,525 filter info its housing. or pip-(,,e of pipe to cknter filter. f httn'//auiartarr~ ~nic r990~ '°Nl„r-r.r r1r.,tsrvlc ~,cn~~rnrl„r.? TT"'p-'1 II WV[ l :6 W7 '~l °n vw i4 2010 9:12AM No. 3066 P. 2 29 TF IF 7C* ~ ~ f l ay cn r- C1? ~ T ~7 C7 P -M, O ~t to ~ rn iv rz C-) c~ U9 rQ o Ln P +r 4f] s~ 1~ w LU CL LU w Lol l C7 ~l ~r~, ~ P► Wui M Y Cam, d 990E 'ON az1:6 ow,, b~ 1300 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and _ percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 0 e Please p r eviewe Date Personal information you provide may used r n(leri4acy taw s. 15.04 (1) (m)). Property Owner Property Location ROSAMJI, L.L.C MAY 13 2003 Govt. Lot na NW 1/4 NE 19 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C ST_ CFRO~x CUUN7 Y" 5 na Indigo Ponds 7 City Sta City _f Village bol Town Nearest Road New Richmond WI 54017 715-248-7071 Hudson Prairie Meadows Drive V New Construction Use: y~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I 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 93.65 ft, trenches spaced and depth to code 6.00 ft belo rade K~ Boring # I Boring 1e Pit Ground Surface elev. 99.65 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 0-8 10yr2/1 none I 2msbk mfr cs 2c .5 .8 2 8-24 10yr6/4 none scl 2msbk mfr gw 1 c .4 .6 3 24-48 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6 4 48-120 7.5yr4/6 none Is osg mvfr na na .7 1.2 Fil Boring # I Boring ✓l Pit Ground Surface elev. 99.65 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr2/1 none I 2msbk mfr cs 2c .5 .8 2 9-20 10yr6/4 none scl 2msbk mfr gw 1 c .4 .6 3 20-38 7. yr4/4 none sicl 2msbk mfr gw na .4 .6 4 38-96 7.5yr4/6 none Is osg mvfr na na .7 1.2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signatur - CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 5/9/2003 715-246-5085 Property Owner ROSAMM, L.L.C Parcel ID # pending Page 2 of 3 3] Boring # J Boring Pit Ground Surface elev. 99.55 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDjft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr2/1 none I 2msbk mfr cs 2c .5 .8 2 8-24 10yr6/4 none scl 2msbk mfr gw 1 c .5 .8 3 24-48 7.5yr4/4 none sl 2msbk mfr gw na .5 .8 4 48-60 10yr6/4 c2d7.5yr5/6 sicl 2msbk mfr cs na .4 .6 5 60-110 7.5yr4/6 none Is osg mvfr na na .7 1.2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # J 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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 NW1/4,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 5 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' n1 ♦ =Benchmark Ele. 100.00Ft ]V Top of 1/2" pvc pipe • = Alt Benchmark Ele. 100.1517t Top of 1/2" pvc pipe ❑ = Borings Boring Elevations B 1 = 99.65Ft B2 = 99.65Ft B3 = 99.55Ft B4 = 00.0017t r?6r 961, 6 (DUI 101,2o ~c4102.26 ~~/a3•~ r 23' r t33 Z y ~3 From: Jennifer Shillcox FW Indigo ponds Lot #6.txt Sent: Thursday, may 03, 2007 10:00 AM To: 'williamjpeterson@comcast.net' Cc: Ryan Yarrington; Kevin Grabau Subject: FW: Indigo ponds Lot #6 Bill, The DNR has determined that the pond on Lot #6 of Indigo Ponds is non-navigable; therefore, county shoreland regulations do not apply and neither a land use permit nor special exception permit are required if you decide to build on the lot in the future. jenny Shillcox Land use specialist -----Original Message----- From: Baumann, Dan G - DNR [mailto:Dan.Baumann@Wisconsin.gov] Sent: Wednesday, may 02, 2007 4:15 PM To: 7ennifer Shillcox Cc: Baumann, Dan G - DNR subject: Indigo ponds Lot #6 jenny, we've determined that the pond/wet area on Lot #6 that you asked me about is non-navigable. Daniel G. Baumann, P.E. Regional water Leader West Central Region (715) 839-3722 Dan.Baumann@dnr.state.wi.us Page 1 Page 1 of 1 Pam Quinn From: Pam Quinn Sent: Wednesday, September 14, 2011 4:58 PM To: 'steve west; 'Mark Erickson' Cc: Kevin Grabau; 'Wenholz, Michael D - DNR'; 'Pericak, David M - DNR'; Steve Olson; David Fodroczi Subject: Sarrack Lot 4 Indigo Ponds and Shoreland zoning Attachments: Indigo Ponds wetland delineation.pdf Hi All, After extensive review of documents contained in the Indigo Ponds subdivision development folders, it does not appear that lots in the northerly portion of the subdivision were intended to be subject to Shoreland zoning requirements. The attached 2003 wetland delineation identified the area on Lot 6, labeled "wetland" on the plat, as a depressional area, not a navigable water body. Mark Erickson has taken time to research the navigability issue and provided support for a finding that the area on lot 6 is non-navigable and should not be subject to the filling and grading permits required under county Shoreland Zoning. The "depressional area" on lot 6 is within a recorded 75' setback and drainage easement, which will provide a buffer against land disturbance occurring on adjacent lots. Permanent stabilization of disturbed areas is required in Item 7.3 and erosion control during construction is required in Item 7.9 of the recorded Declaration of Protective Covenants (Document 770482). A hand-written note by a county staff member was attached to a copy of the preliminary plat, which specified the following lots within 300' of the year-round Indigo Ponds as being subject to Shoreland zoning: 36, 37, 38, 39, 40, 41, 45, 46, 57, 49, 50, 51, 52, and 53. The Town of Hudson zoning ordinances are applicable for lot 4, but not the county Shoreland overlay district. I have issued the sanitary permit for Lot 4 and recommend that the special exception and land use permit applications be withdrawn. The application fees paid for the special exception and land use permit will be refunded. The Sarracks may now obtain a building permit from Brian Wert and proceed with the construction of their house, driveway and septic system subject to town ordinances and recorded subdivision covenants. Pamela Quinn, Zoning Specialist (PO"W7S) St. Croix County Planning & Zoning Dept. not Carmichael Road Hudson, 1WI 54o16 715-386-468o pamagco. saint-Croix. wi. us 9/14/2011 From: Jennifer Shillcox Sent: Tuesday, April 17, 2007 10:31 AM To: 'dan.baumann@dnr.state.wi.us' Cc: Ryan Yarrington; Kevin Grabau; Steve Olson Subject: Lots 1 and 6, Indigo Ponds Subdivision Hey Dan, Thanks for getting back to me so quickly. As I mentioned over the phone, we met with a builder who will be constructing houses on Lots 1 and 6 in the Indigo Ponds Subdivision in the Town of Hudson. According to the builder, Lot 1 has a large pond which shows up as a drainage easement on the preliminary plat. I am guessing this is a man-made storm water retention area and that shoreland regs do not apply. On Lot 6, there is a small pond/wetland that shows up on the preliminary plat as having an OHW elevation of 919.6 with a 75-foot setback platted. The builder also submitted a copy of survey that shows the wetland having an OHW elevation of 923.86 per the final plat. I have attached a copy of the preliminary plat and the survey for your review. I need verification on whether or not this is a navigable pond. Let me know what you determine after you've seen the site on Monday. I appreciate your help! s Thanks again, Jenny Shillcox Land Use Specialist - St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, WI 54016 Phone: 715-386-4682 Fax: 715-386-4686 iennifers co.saint-croix.wi.us ;i_1 -~_l Lot 6 Certificate of Lots 1 and 6 - Survey.jp... Indigo Ponds Su... 11111111111i111f1{111111111 8052744 Tx:4039303 STATE BAR OF WISCONSIN FORM 1 - 2000 953348 BETH PABST Document Number WARRANTY DEED REGISTER OF DEEDS ` ST. CROIX CO., WI THIS DEED, made between Rosamji, LLC, a Wisconsin Limited Liability 03/28/2012 1:46 PM Company, Grantor, and Kathleen L. Karls*Grantee. EXEMPT#: NA *a single woman REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 195.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 5, Plat of Indigo Ponds, Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title, Inc. 2200 West County Road C, Suite 2205 ' Roseville, MN 551 13 LTI # 371838 Together with all appurtenant rights, title and interests. 020-1439-05-000 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, Reservations and Rights Of Way of record. Dated this 2 l st day of March, 2012. Ro mji, LLC * Sandra M. Gehrke, President AUTHENTICATION .~OTA~~.. ACKNOWLEDGINIENT i Signature(s) STATE OF WISCONSIN ) N~, A ST. CROIX COUNTY. ) ss. authenticated this 21 st day of March, 2012 '9~~;. •a5~ Personally came before me this 21st day of March, 2012 the ~F VNI$G~ above named Sandra M. Gehrke, the President of Rosamji, LLC * a Wisconsin Limited Liability Company, to me known to be TITLE: MEMBER S"I'A"1'E BAR OF WISCONSIN the person(s) who exec °d the foregoing instrument and not. acknowledged the Sam (If . % ~ authorized by § 706.06. Wis. Stats.) ` THIS INSTRUMENT WAS DRAFTED BY *Kelly J. Nelson Notary Public, State of NViseonsin Larry S. Mountain - Attorney At Law flly commission is permane tt. (If not; state expiration date: 4 ) 4/13/201 (Signature; may be authenticated or acknowledged. Both are not necessary.) "Names of persons signing in any capacity must he typed or printed below their sienauue 1 of 1 I WARRANTY DEED STATE BAR O WISCONSIN FOR.Al .No. 1-2000 d = < - O CO) 6~cf' z n~v z m Z ~ rn m ic 0 m 70 m Cl) 41b X m 01'.. =q '~1 Z O "a --q -1 > Z -I 0 m N _ CA Mi m C~ m o X C/) z c O ~v d t0-1 m z D C-, c L- X Z Cl) 4 0 ~ -n N = rn X o o O z N O Z 1 IT c v ~n~ r' Z z - C~ co r C G) m r cn c Cl) z v N -o m 0 < N m N o rn z O n Cl) -q Z F) o fl m m Z o ;a c w _ to -n Z-V > 0 G) X -q ° o 9 ~o ° m o a o m 0 so c. X11 ° 1 °~3 140 1 IT All. W ° o o = - CIL C m mo m N n o rN~ CL a ° o LrL m JJ a o~ : s m~ H = v ~m r Fg M z 7 3