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HomeMy WebLinkAbout020-1439-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561086 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: Hartman Homes, Inc. Hudson, Town of 020-1439-03-000 CST BM Elev: Insp. BM Elev: BM Description ~W Sectionrrown/Range/Map No: 161,7 IJ 2- 4L) '13 r) 25.29.19.2729 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE ~h S CAPACITY STATION BS HI FS ELEV. I~ Septic ; e~ Z I OO Benchmark /I Z 5 /~q•a /6 / . 7 Dosing r b J / 106 Alt. BM~t f Ca JJ t /(p' ,j }teratiotr o , Bldg. Sewer ''•q 7/.:5 1 Holding St/Ht Inlet -q 7 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. en o Air Intake ROAD Dt Inlet o Septic Z5 7 _ Dt Bottom / g8 Dosing 7 ZS / 7 Zy Header/Man. C.3 c77-7z: Aeration Dist. Pipe fJ J 97. 7 Holding Bot. System -74 r 7 PUMP/SIPHON INFORMATION Final Grade ( .9 Manufacturer Demand St Cover~ - 7 26 ej GPM C'~ tl... Co • [ -3 Model Number \ ! 7 ZIA TDH Lift 4.L Friction o~~ System Hepd~ TDH - I f Al f Forcemain Len~O / Dia. Z Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / No. Of Trenches ( ^ PIT DIMENSIONS No. Of P ty s - Inside Dia. Liquid Depth DIMENSIONS 4v 5v 3 Ve SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer, INFORMATION CHAMBER OR y ~•t Type Of System: ~7 17 /Z3 UNIT Mo50a.~beeL //U Co ri. ✓4w1• 17 I DISTRIBUTIONS TEM /5 :<jk~ / /1l Header/Manifo)d Distribution x Hole Size x Hole Spacing Vent to Air Intake .5,~ r Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only J5 Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mulched Bed/Trench Center 3 . Bedrrrench Edges Topsoil Yes 0 No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 882 Highlander Trail Hudson, WI 54016 (NW 1/4 NE 1/4 25 T29N R1 9W) Indigo Ponds Lo~ 3 Parcel No: 25.29.19.2729 1.) Alt BM Description = Ga ✓i'„ C(,~a; h1 ^O u t-5 Q v~ 2.) Bldg sewer length = - amount of cover Plan revision Required? Q Yes No 12- Use other side for additional information. U f SBD-6710 (R.3/97) Date Insepctor"s Si ature Cert. No. I O_ - ~ I D 1 a~ ~c t VI ` ~J J l . AL 1. Coody DkidOn 2411 w. W~ ~ P: Box71S2 1aa- p~N+~(~ flWfiL yCO-) L%WkMW wW 7582 ~~O I 6 49 (J Sanitary Permit Application A)Pr W=dMw No ses 333.21M d coft safes*M m~ an io f¢a 9MMUTUS Iu rro gxMfw 1 ~ ol) ' N), O 0zp-i`I.3 .3000 p sb&dTbgAddM sT CRo 4013 ~ 2729 R UPC) 6C_%secrim _Z_5 II. Type of (do* an tlaatxppw Lot's ~ 1 (r2FM* DwdW9-)hnbm OfBeftm end ~ 92 4 ~t}Yt;~~i Olt ~ la. - D p ' -Dwzbc C]coyaf csM ~ D v eof Towso# 1(15oN D&dcoecd-Dwc9WVWUm w 21 r 2. Z. III. Type erfPermi 4 oidy ambox os rwo A. COmpk rise B if sgp1 ) A. rsvMM D D T TeelcR 0* D Oderr mE sSsa'm E a ©s►ea D Z+amAtBaveaoa D Owow Its ufpOW1S mice: Clseefcalt ~t - 13 ww~~Uomwd Q p Dade D Mo®d?24 at of a sW D <2'4 h. of sA D{MffDwcEMAc ( tlevim - V. JAM AM Ts~tk 7xib cep. 'm R~ ! t d i .rte 1 adim v~ ra e a 8 1 m c v G w ~ZS ~Twk I 1 ~ ~ paws ~e~ Pt~oocl a _ vM Sbftmeut- 16 fte NUM0,64 'S -7115 -756-2,y !o 7!S• 337- ISf cQcc h~srl-o-^- fox 5 S V13L Use OW,,,, Date 0-0 g 3o i 3 IX. Con ftrpmnd 31 1., wtl o~'' PP J: Act o' .&C 1: taMc atllt~eM f'~tmr` ia~' to de sal cetl-must an ~rvloea / maiMal I,J g*m M plan prowdedby plumber., ` 2 of j0 CmTl13=llftsfw : _JIG. ~ivn A18eE=aB~fir~~~ esTMfl 113 SBA" (P. ~ 'I CONVENTIONAL COMPONENT DESIGN Residen#iai AppCca#ion INDEX AND TITLE PAGE Project Name: N\ owners Name: - - y y Q~ AV3 D(Z So tTc- 6 L Owners Ad&ew. t "v u~u Uj - Legal Dsscri on ~.;inJ Icy Ne I/ 5 25 T 2q 1J l2 I rt r✓ Township: H u osz (y County: - 1`r -Ca a Subdivision Name: 16C) Lot Number. Parcel ID NuRdW. Page 1 index and tiffs Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Fib Specs Page 6 Maintenance Information Page 6 Management Plan Page 7 St Croix Cty Septic Tank Maintenance Fomt Page 8 Warranty Deed Page g GSM or Plat Attachffwft Sol Test & House Plans Designer/Plumber Ucense Number. M~ 1~.5 y Z Date. Phone Number 7JS- Sig r 0990 ed puwmt W Sol Cowonw t Msrod for POWTS vwswa 20 SOD-IWIMP (H.01X" Plus 1 z vi 2 ~ r G ~FAZ o ~T ~ s p Soil Absorption Svstem Cross Section 161 ft Final Grade 4" Schedule 40 PVC Vent Pipe ,-'7=~ ft With Vent Cap Leaching Chamber 40 ft System Elevation ft b ft Soil Absorption System Plan View 8g ft _ ft III I III ~_ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model --r -OFI(U I~1'C(N~ Ql)cc EISA Rating _0 sq ft per chamber Soil Application Rate ~-7 gpd/sq ft gpd Design Flow = .-7 Soil Application Rate _ 76 EISA = Chambers 2 rows of 21.4 Ziambers each. Page of ST. CROIX COUNTY SEPTIC TANK MAINTANNANCE AGREEMENT AND OWNERSHIP CERTIFICATE FORM OwnerBuyer M kG~, Mailing Address Property Address 13 (Verificatim rfm. PlanaingDep on) City/State i k h Parcel Identification Number ~~I,3 3 0 0 0 LEGAL DESCRIPTION 1 Property Location 'W Y, j~ F_ '/a Sec. ;,!';'T~N-R~W, Town of `TV sOY~ Subdivision 4 A PO h J6 Lot# 14 Certified Survey Map# 7 q , Volume C1Page Warranty Deed# qS 6:5-6 L/ Volume Page Spec house yes _X_no Lot lines identifiable ___X yes no SYSTEM MAINTENANCE Improper use and-maintenance of your. septic system could result 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. Whatyomput.into. the.systemcan affect the fimction 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on site wastewater disposalsyStem isinpwper.operating condition and/or (2) after inspection and pumping (ifnecessary), the septic tank is less than 1/3 full of sludge.' I/we, the undersigned havaread the above sequiremeats and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by th Department of Commerce and use the Department of Natural Resources, State of Wisconsin.Ce fizatiAnstating that your.septic system has been maintained must be completed and returned to the St. Croix County Zoning ce within 10 days of the three year expiration date. SIGNATURE OF LICANT DA #of proposed bedrooms 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE Any mfo:matim that is misepreemted may rewh m the smniary pa vi being revoked by the Zmamg Depattment****" Include with this applicatim a stamped wwranty deed finm the Register of Deeds office a oopy of the oetdW convey map if reference is made iathe warranty deed I~tSTALLATION INSTRUCTIONS r ~°'a a~xaM PL-5251PL-625 FILTER P_-5251PL-625 FEATURES & 8ENEFITS .r f Features & Benefits: : Rated for 10,000 GPD o PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 9Accepts 4" and 6" SCHD. 40 pipe s Built in Gas Deflector The PL-525/625 Effluent Filter should operate efficiently for several years under normal conditions before aAutomatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the aAccepts PVC Extension Handle filter needs servicing- Servicing should be done by a rtified septic tank pumper or installer. RECOMMENDED PRODUCTS - - - Polylok PVC Filter o- 1 Extension Handle f 1 1 i 'ew:' - - t- Ira - e F Riser Safety Screens Fitter Alarm Panel and Risers & Riser Covers Extend & Lok~°' SmartFiKer~ Control Polylok risers bring your Polylok Extend & LokTm Polylok safety screens Switch septic tank cover to grade. is a simple, easy to use prevent tragic accidents This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets failing into open a and switchs d audible provi notification visual nd time saving by elimi- make filter and/or baffle septic tank entrances. bating digging to find tank installation a snap. impending fitter and tank servicing. entrance. Fits 3" and 4" pipe. For a full list of Polylok products please visit our web site at: www.polylok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 7560 gal ❑ NA Permit # Septic Tank Manufacturer W t~R. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Lo K ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model S 2 S ❑ NA Number of Public Facility Units 04NA Pump Tank Capacity gal NA Estimated flow (average) H~ gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ) -NA Soil Application Rate I gal/day/ft2 Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <_30 mg/L 1XIn-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510^ cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) 11 NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: S year(s) Clean effluent filter At least once every: month(s) ❑ NA year(s) ) NA Inspect pump, pump controls & alarm At least once every: ❑ ❑ month( yeaarr(s) (s) ) A Flush laterals and pressure test At least once every: ❑ ❑ month( yeaarr((s) s) Other: At least once every: ❑ month(s) NA ❑ year(s) Other: ❑ 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 (Y3) 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 <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) ' S'T'ART•UP AND OPERATION Page of 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 pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ZM Name Phone 5- _7 . 7-4 1,of Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name -t CQU ("r-1 Phone Phon-7 S. L 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. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or 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 pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone S- °'7 ~56 - Z4 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name `C e f Phone Phone -715 - - L 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. RECEI VED L #1057 SOIL EVALUATION REPORT O G ! N A $CpDepartment of C!fj 2 $ 2012 in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Keith E. Stoner ST~~~rtt~vz~ N NG OFFI(,E ~~~iii... Attach complete site pkd blililo4 r~% less than 8%x 11 inches in size. 4an VIA. ~ n~ S} , C p^0 I x include, but not limited to: vertical and horizontal reference point (BM), d on a`i3n percent slope, scale or dimensions, north arrow, and location and distance to peamstmad.. Parcel I.D. 020-1439-03-000 Please print all information. tvie y Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 & /2l/ Property Owner Property Location Hartman Homes Govt. Lot NW1/4, NE1/4, S25, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 744 Ryan Dr. Suite 102 3 Indigo Ponds City State Zip Code Phone Number City ❑ Villager Town Nearest Road Hudson WI 54016 715-377-1555 Fkk 1d50t1 Highlander Trail Z New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement U Public or commercial - Describe: Parent material Glacial Drift Flood plain elevation, if applicable NA ft. General comments Tested area approx. 20x90' located on side slope of narrow ridge. This allows for 2 cells 90' long using the 101.50 and 100.00' and recommendations: contours w/a 8' separation or 3 cells approx. Musing the 101.50 and 99.00' contours w/ 3' of separation. System elev. to be sef ba5zd on hon,c eleva4,'on. S-e-e.0)'te/z/ ZDe ? S ~Gi~ ❑ Boring # Boring w Pit Ground surface elev. 101.75 ft. Depth to limiting factor >113 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 0-6 7.5YR2.5/1 - sl 2mgr mvfr a 3f-co 0.6 1.0 2 6-16 7.5YR3/4 - sl 2msbk mvfr gs 3f-co 0.6 1.0 3 16-30 7.5YR4/4 - r Is Osg ml gs 2f-co 0.7 1.6 4 30-113 7.5YR4/4+5/4 - s Osg ml - 1f-co 0.7 1.6 t~ 2] Boring # Boring Pit Ground surface elev. 97.20 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 0-5 7.5YR2.5/1 - sl 2mgr mvfr cs 3f-co 0.6 1.0 2 5-11 7.5YR3/4 - sl 2msbk mvfr gs 3f-co 0.6 1.0 3 11-24 7.5YR4/4 - SI 2msbk mvfr gs 3f-co 0.6 1.0 4 24-96 7.5YR4/4+5/4 - s Osg ml - 2f-co 0.7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * ffluent #2 = BOD5 s30 mg/L and TSS S30 mg/L CST Name (Please Print) Signature: CST Number Keith E. Stoner 224059 Address Keith E. Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 5/17/2012 715-653-2324 SBD-8330 (R.07/00) Property Owner Hartman Homes Parcel ID # 020-1439-03-000 Page 2 of 3 ❑ Boring F3 Boring # Pit Ground surface elev. 100.50 ft. Depth to limiting factor >107 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 0-4 7.5YR2.5/1 - I lmsbk mvfr cs 3f-co 0.4 0.6 2 4-24 7.5YR3/4 - I 2msbk mvfr gs 3f-M 0.6 0.8 3 24-28 .5YR4/4 - SI 2fsbk mvfr gs 3f-m 0.6 1.0 4 28-107 7.5YR4/4+5/4 - s Osg ml - 2f-m 0.7 1.6 q . F-1 ❑ Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 `Eff#2 ❑ Boring F-1 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#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 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Keith E. Stoner M a M 0.o F a O d x a ~ y C v~ Q •C N 0 0_ n a z ~ o a O ~ I S \ I ti N i l 0 o° en n ~ h owo o i h ~ ~ o V li OM ~ O I N O V d h~ o 0 0 I Q 00 o i Q C ~ m h Q ~ y O r ~ w ~ h Q ~ N a F $ as ~cto „ U Q ~ p~NO ~ i. yn - n $ c > N M i 4k ZM 4t a ]A a9 W h .780 AC) • 919.ji 97744 S,F. 1 cJ. (2.244 AC.) - d• `1+cwx N~ r 92458 S~.F. ` (1.058 AC. N.B,P.A.y a' ( 2123 AC.). (1.578 AC. N..P..) r (3.071 AC~ + 1 rf = ; 1 rf r i 1.442 AC. N.B.P.A.) i r r ! SOP r 87839 S.F. / (2.016 AC.)_ ~~,r(1.384 AC. N.B.P.A.)- j ,,g(,` • ~ ~ . - _ • As 315. fs ~ ¢ ~5 • ; ti , 85.83• " ' ~ • I~~ / i• . ~SBL 49'< 'L " ` 120'!48_ F. .A04457 S,.F S , - ~ (2.772 AC.) _ ~..-(2.398- AG.. , 51 1.141 AC. N.B.P.A.)' 1.308 AC. N.B. 157194 S.F. - Y z 3.609 AC.~//~' 1.022 AC. N ;B.P.A. ` e 4C) / B.P.A.. s,. S~ V.1/.t],•✓w'- ~i/ . :.W ~.-I y✓ fit`\K rT.✓ `ra Ki6v' -A 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: 3ennifer 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 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 OHVrd'ff~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 nr not this is a navigable pond. Let me know what you determine after you've seen the site on Monday. I appreciate your help! 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 iennifersco.saint-croix.wi.us 11 Lot 6 Certificate of Lots 1 and 6 - Survey.jp... Indigo Ponds Su... Page 1 of 1 Pam Quinn From: Pam Quinn Sent: Wednesday, September 14,20114:58 PM To: 'steve west; 'Mark Erickson' Cc: Kevin Grabau; 'Wenhoiz, 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 (POW93) St. Croix County Planning & Zoning Dept. not Carmichael Road Hudson, 1W1 54o16 715-386-4680 pamg(a,co. saint-croix. wi. us 9/14/2011 t r{ N A E .l` ~ ~ cu fir: ~ i • ~ t ~ 3 1 gig V5 41 ra ins sx 3S.~ 0 04 I zd►• XMION S .p ri 'fir "'raa r ~ ~ ,g Z i -}ab~'~5c i e. .4s *Ot At.l 1 oz.OON 21 ~ '1 m t A ^N p off M WA ~1y9Q% C. 101099 y s ~ ~t ooa '3'E~< a . .QOTIt s t6* ~+szzl 'a .oo .a ti- t t r - kT AVL*9Z M.0 L.*Z.00N R--~-A•; Ty1'~•fi .]W.vr „i T' i State Bar of Wisconsin Form 6-2003 956564 SPECIAL WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 11 05/17/2012 08:18 AM THIS DEED, made between Associated Bank, National Association EXEMPT # NA REC FEE: 30.00 TRANS FEE: 131.40 ("Grantor," whether one or more), and Hartman Homes, Inc., a Wisconsin PAGES: 1 corporation **The above recording information verifies that this document has ("Grantee," been electronically recorded whether one or more). & returned to the submitter Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): Hartman Homes, Inc. Lot 3, Plat of Indigo Ponds, in the Town of Hudson, St. Croix County, Wisconsin. 740V ,P Qr.~ ADZ For Informational Purposes Only: t1t[G~ler>~, /n// 5 Ol(~ Property Addresss - 873 Prairie Meadow Dr, Hudson, WI 020-1439-03-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances arising by, through, or under Grantor, except: municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utiNty and municipal services, recorded building and use restrictions and covenants, and general taxes levied in the year of closing and will warrant and defend the same. Dated May 15, 2012 Associat nk tional Association (SEAL) (SEAL) * *By: Michael Waltz, Vice President (SEAL) (SEAL) s * AUTHENT11 U ACKNOWLEDGMENT Signature(s) P e~/ STATE OF Wisconsin ) ) ss. authenticated on ELIZABETH * 'IS-_ Milwaukee COUNTY) Personally came before me on May'y , 2012 * 5 the above-named Michael Waltz TITLE: MEMBER STATE F 1N (If not, ~1Nra►~~~to me known to be the person(s) who executed the foregoing d a same. authorized by Wis. Stat. § 706.06 } instrument and ackn Z e THIS INSTRUMENT DRAFTED BY: Elizab R. ScrivnerKnight Barry Title Inc. / KBT #X617663 Notary Public, State of Wisconsin By: Elizabeth Scrivner My commission (is-perntartent) (expires: April 3, 2016 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED flc2003 STATE BAR OF WISCONSIN FORM NO. 6-2003 'Type name below signatures. INFO-PRO"- Legal Forms • (800)855.2021 • intoproforms.com 1 of 1 Ii /VO r sue , d 1271 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 dimensions, north arrow, and location and distance to nearest road. Parcel I.D. G ZG Please Tint RMED Revi ed y Date Personed information you provide r ay be used for secondary purposes (Privacy , s.15.04 (1) (m)). Property Owner MAY 13 2003 Property Location ROSAMJI, L.L.C Govt. Lot na NW 1/4 NE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Addres ST. CROIX COUNTY Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C ZONING OFFICE 3 na Indigo Ponds / City State Zip Code Phone Number City I Village a Town Nearest Road New Richmond WI 54017 715-248-7071 Hudson Highlander Trail Of New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Public or commercial - Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments S and recommendations: system elevation 96.10 ft, trenches spaced and depth to code 5.00 ft below grade - D, 0~- Boring # I Boring e Pit Ground Surface elev. 101.10 ft. Depth to limiting factor 120 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 0-6 10yr3/2 none sil 2msbk mfr gw 1 c .5 .8 2 6-32 10yr4/4 none sicl 2msbk mfr gw 2f .4 .6 3 32-120 7.5yr4/4 none sl 2msbk mfr na na .5 .9 COS <35% coarse fragments = 36" & >35% - <60% = 60" below system Boring # I Boring sJ Pit Ground Surface elev. 101.10 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 "Eff#2 1 0-8 1 Oyr3/2 none sit 2msbk mfr gw 1 c .5 .8 2 8-32 10yr4/4 none sicl 2msbk mfr gw 1 c .4 .6 3 32-48 10yr6/4 c2d7.5yr5/6 sici 2msbk mfr gw na .4 .6 4 48-65 7.5yr4/6 V none sl 2msbk mfr gw na .5 .9 5 65-120 7.5yr4/6 none cos osg mvfr na na .7 1.6 ~o y Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si e: CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/28/2003 715-246-5085 Propeity Owner ROSAMM, L.L.C Parcel ID # pending Page 2 of 3 3] Boring # J Boring J Pit Ground Surface elev. 93.10 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none sil 2msbk mfr cs 1c .5 .8 2 4-19 10yr4/2 none sicl 2msbk mfr gw 1 c .4 .6 3 19-40 7.5yr4/4 none scl 2msbk mfr cs na .4 .6 4 40-120 7.5yr4/4 none cos osg ml na na .7 1.6 F-1 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft! in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # - Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 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 NWl/4,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St:. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 3 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 q / • • = Alt Benchmark Ele. 100.60Ft 93 /v~+- Top of 1/2" pvc pipe F g r ❑ = Borings g 7, Boring Elevations BI = 101.1OFt B2 = I O 1. l OFt ^ ` B3 = 93.IOR / 00- /d'Gr B4 = OO.OOFt ~ I ~o 4- k: KEITH E22 ~dD DBB~I EK~STONER SIREN WI 54872 Phone (715) 653-2324 J~~ G~ ~1oN\NG OEF~G Q~NN~NG To Whom It May Concern: Enclosed is (are) soil test(s) completed in County. Please review and file at your convenience. Please feel free to contact me if you should have any further questions. Thank you, Keith E. Stoner Debbie E. Stoner