HomeMy WebLinkAbout020-1439-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 563886
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Scott, Landon &Janel Hudson, Town of 020-1439-07-000
CST BM Elev: Insp.BM Elev: BM Description: / Section/Town/Range/Map No:
/as-d /OO a TOE u r7.7.44z4-1.: 25.29.19.2733
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic F2" / -- /Z.�� Benchmark
S. y /d3 i
Dosing 1.?"--,4,�,4, (/N.- 4--(/ —t/7-/- Alt. BM
Aeration �,_____ Bldg.Sewer 7\ y 77
3�3 � s 6'. o
Holding /gih�f}�Ist—_ 5 cif d
Cv,�.'� 7. 3 9 6, �
TANK SETBACK INFORMATION s_#_,Q cA-di- 7 6, 9(p.?/
TANK TO P/ W�gFF�LL� B Vent to Air Intake ROAD Dt Inlet IA /4-i1 Gr�2
Sa�lee� S/& L4Ia._", '7t lc.— _._—.
Septic 1 3.l y / �—F/ Dt Bottom 5-ji_,,m,.4__ji. itealm,, ------
Dosing ,i I 1 p °1/ ,u y� I 7 ` • ! vs t 9 7 " 9
Aeration Dist. Pipe ' u 7
Holding Bot` Systern 0 _
I.
_j , Final Grade
�
PUMP/SIPHON INFORMATION a v i Z 7,-‘
Manufacturer GPM 2 and St Cover / rvS S o/ 9' 99-3--
:3 7
Model Number J C.' e �1 �e4
TDH 'Lift Friction Lo - System Head TDH Ft Vy G' c//U-z ��
Forcemain Length Dia. ID o Well /
SOIL ABSO• •TION SYSTEM ��J} \22 C% 'frt L os.Jl et-C-4__
BED/TRENCH Width / Lengths 4No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLD WELL, LAKE/S AM ( LEACHING Manyyff�ttuurer / 6
INFORMATION y _ �4L'∎-CHAMBER OR _L� l �C��
Type Of System: \S�// 7 I 1-1 UNIT
C%O, t / �G� /� / .nng.. Model Number:
DISTRIBUTION SYSTEM > t w ��� �\ �7.tt� '
Bader anifold Distribution x Hole Size x Hole Sp - Vent to A Intake
/ Pipe(s) V! �/0 / / �--
Length Dia Length a / Dia Spacing c '
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 �C r )k Bed/Trench Edges Topsoil Yes No a Yes El No
El COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: I I/ 2 a/ /3 474 Inspection#2: / /
Location: 853 Prairie Meadows Drive Hudson,WI 540116,(NW 1/4 NE 1/4 25 T29N R1 9W) Indigo Ponds
Lot
t 7 Parcel No: 25".29..19.2733
1.)Alt BM Description=17;p b, %/ r-o 4.41-e �Z6 ` t. k 4621 1 2.)Bldg sewer length= $ / G / U
-amount of cover= > y/d 4 /J-e /1 �,,, „�p �, i '/v L ciut44L
Plan revision Required? Yes 'No /I 25-0 1 / (/ 6 71 Use other side for additional information. �(Q (/SBD-6710(R.3/97) Date Insepctor's Cert.N6.
Soil Test and System y PLOT PLAN
PROJECT Landon Scott 7 ADDRESS 1415 Broadway St.#29 Hammond Wi 54015
NW 1/4 NE I14S 25 /T .;7 N/R 19 W TOWN Hudson COUNTY ST.CROIX
MPRS Shaun Bird 226900 ��� DATE 9/22113 BEDROOM 4
CONVENTIONAL XXX IN-GROU/D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LYFT TANK SIZE DOSE TANK SIZE
r
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
,, .BENCHMARK V.R Top of walkout foudati I ASSUME ELEVATION 100' Filter BEAR ;liter
I I BOREHOLE 0 WELL *H.R.p. Same as Benchmark
Praire Drive
A SYSTEM ELEVATION 95.0/95.1 ' 4' below grade
Sale is 1" = 40'
unless otherwise All piping shall be SDR 30/34, within 1( '
noted of tank,piping shall be Schedule 40.
221' rnQ9I
ki 66' 135'
H I/
[l i I'`• 255' Property Line
.t41)')t‘ ‘2VI 1 Y.
/ S
,fk
is 1 r
0' B s
35'
ail Irl
Pro 4 60' L.
3
ee
0' Bedroom
99 i D� E
House
B
Nsilk
.M.
60' /, 2% Slo e
P Vent
o
15' ••a*� >6„ Quick4 Standard
13-3 _ Leaching hamber
of Cover ' g
�!� �G' with 20.0 ft2 of Are a
40' Ar //' 5.6ft^2/pair of end aps
4' )✓ong�
Grade at System Elevation
Vents 1111111111■111 34"
B 2 11' ..
90' �—in
B-1
2-3' X 88' cells
with>3'spacing
466' Property Line 101
lit
V 100' CP
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code t
County +
Attach complete site plan on paper not less -dsk 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and o rence point (BM), dirediiQVrid Parcel I.D. O l r,
percent slope, scale or dimensio o a an ocation and distance to nearest road. CJ V ~j~
Pi t a formation. 00- F Reviewed by Date
Personal information you prov y be d for secondary purposes (Privacy Law, s. iyl5(tij
Property Owner Property L ion
,TVA
L
u t~ tS[~ 1/4 N /4 S Z~ N R E (o W
Property Owner's Mailing Address Lot # rock # ,ubd. Name or CSM#. n
State , Zip Code P Me Number ❑ City ❑ V lage Wl own Nearest Road
p i
ew Construction Use~pfResidential /Number of bedrooms Code derived design flow rate GPD
❑ Replacement [j Publi-c ~f commercial - Describe:
Parent material C.w.;&,u ~t/f Flood Plain elevati n if applicable 4.1
General comments ~e 5>!P Q / Gc,
and recommendations!:
System Type System Elevation
1 Boring # Boring 9
Pit Ground surface elev. K! - 0 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.
'7 40-&70
bl
Boring # ❑ Boring
IY2 in.
® Pit Ground surface elev. ` ft. Depth to limiting factor
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
I(
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ture CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 7 715-246-4516
Property Owner _ Parcel ID # Page of
❑
Boring # Boring "
1 ` pit Ground surface elev. 1, -S ft. Depth to limiting factor /D 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. p*Efff#l 'Eff#2
6 Al 1
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit 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, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/_ 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.
SBD68330 (8.6(00)
Soil Test and System PLOT PLAN
PROJECT Landon Scott a ADDRESS 1415 Broadwav St. #29 Hammond Wi 54015
NW 1/4 NE 1/4S 25 /T N/R 19 W TOWN Hudson COUNTY ST. CROIX
W~j~rr) 9/22113 4
MPRS Shaun Bird 226900 DATE BEDROOM _
CONVENTIONAL XXX IN-GROU D PRESSURE CONVENTIONAL. LIFT' HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING 'T'ANK SIZE LOAD RATE .7 ABSORP'T'ION AREA, 891 # of chambers 44
BENCHMARK V.R.Y. Top of walkout foudation ASSUME ELEVATION 100' Filter BEAR filter
❑ BOREHOLE WELL *H.R.P. Same as Benchmark
Praire Drive
SYSTEM ELEVA'T'ION 95.0/95,1 ' 4' below tirade
Scale 15 1" r 40'
unless otherwise All piping shall be sDR 30/34, within 1( '
doted of tank, piping shall be Schedule 40.
21'
66' 135'
255' Property Line
5'
35' 10' ST
Pro 4 60'
30' Bedroom 99,
House
B.M.*
60' 2% Slope
Vent
15' W? Quick4 Standard
B`3 of Cover Leaching Chamber
with 20.0 ft2 of Are a
40' Area has been cut i 12" 5.MA2/pair of end ;aps
4' Long( I 411 r
Grade at System Elevation
Vents 3 q.„
B-2 90' B-1
2-3' X 88' cells
with >3'spacing
1466' Property Line 101,
100'
- - County
Industry Services Division
s
1400 E Washington Ave Sanitary Per~ct)i Ntnnber (to be filled m/by Cu.}
P ri l'.O. Box 7162 I ~~C sir, I `-~IU
S I Madison, WI 53707-7162 F
_+aasra st
Se' + ti A1utr ber
tat
nitary Permit Application 0,ry
in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this tbrtu to the appropriate governmental unit ST _~~1_----_-- -
is required prior to obtaining a sanitary permit, Note Application forms for state-owned POWTS are stibmltte(l to Project Ac Q~.f f different than mailing address) -
the Department of Safety and Pror'essional Servies. Personal information you provide may be used Por secondary ~ouN
Purposes in accordance with the Privacy Law, s. I5.04(l)(m), Stats. _ - n:;70 1. Aplication Information - Please Print AEI Information Property Owner's Name
Par
d,
d,76- 6 -7
Prnpery Location
,70 7
1 7: Property Owner's Mailing Address
- - - ! Govt. Lot ----r
City Suite Zip Code eNurnber - Section
yV c Ie one
II. ype of Building (check all that apply) Lot
' Subdivision acne
or 2 Family Dwell ng - Number of Bedrooms
Block #
escribe Use-___-_-
❑ Public/Commercial D 61C
City of
• C5M Nurnt,t; Village of
❑ State Owned -Describe Use Towrl of
Z--- w~ZZZ, kk- Z2 ~ a! 5 - - -
ill. Tip e ' Permit: (Checks only on/f: eox on line A. Complete line B if applicable
A' ew System- ❑ Replacement Systern D Treatment/Holding Tank R c Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date issued B. ❑ Permit Renewal Permit Revision t Chan • ot'Plumber I mit Transfer to New _
Betbre Expiration Owner
IV. Type of POWT S System/Com anent/Device: {CI Ic t t
' -
on-Pressurised In-Ground [I i'ressuri~ed In-Ground I_ ,r ❑ Mound % 24 in. ul'suia+blc soil Mound <24 in of suitable' it
iolding'l an]( LI Other Dispersal Component (ex lain Pretreatment Device (expiam)__-__--___
V. Dis rersal/Treatm nt Area lnforntation: -
De n Flow (gpd) Design SoiL~pplicatiorl Ra[e(g dsf) Dispersal Area Required (sf 1]isper>al Area Proposed (sl) jsy to I;levatio
Y
- -total # of Manufacturer a, G
Vl.'I'anlc info . Capacity in
.0 i15
Gallons Gallons Units /r v b
C
New Tanks Existing Tanks
/J 1 p U n v i 0
Septic or Holding 'rank
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assn onsibitity for installation of the POWT show on the attached plaits,
Phone Number
Plu is Name (Prutt) Plumbe'' S' tore
~
PlumbcAddrestreet, City, State, Zip Code) /
Vill. ount /De artment Use Only - -
_Per/mTit`F7ee Dilate _Issued____ Issui ng nt Signature
Approved Disappro+ !
iven Reason for Denial
-
Condilrg'*Measons for - Disapproval
1. Septic tank; effltfenfftttar and.
dispersal cell must all be servk es I rviakita .
as per martaoement plan provided by'pIUOOf.
2. A4 4p(*_, k requirements r t*, be is d
as ~ ram. - - - -
--Attach to cumplele plaits for the system and submit to the County only oil paper aot less than 8 112 x 11 inches iu size
SBD-6398 (12031:)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/22/13
Owner:Landon Scott
Location: NW1/4 NE1/4 S25 T29 N,R19W 853 Prairie Meadows Dr. 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
4-6. Maintanance and Conti gency Plan
7. Filter Specifications S
8.-10. Soil Test
Signature
License numbe 26900
PLOT PLAN
PROJECT Landon Scott ADDRESS 1415 Broadwav St. #29 Hammond Wi 54015
NW 1/4 NE 1/4S 25 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/22/13 BEDROOM 4
CONVENTIONAL )OOC IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Praire Drive
SYSTEM ELEVATION 93.9/92.7' 6' below qrade
All piping shall be SDR 30/34, within 10'
Pro 4 of tank, piping shall be Schedule 40.
Bedroom
House
21' 7' Scale is 1" = 40'
ST unless otherwise
noted
10'
84' B-
7' B.M. *
54' 61' B-3
46' 13% Slope
Please note:
Soil borings will be
65' dug deeper if cos is
B-2 found to be
>35%coarse
ent
100' Vent
98' 96'
>6" Quick4 Standard
172' 94' of Cover Leaching Chamber
Area
with
t^20.02/pair ft2 of of end caps
5.
2-3' X 88' Cells with >3' spacing 4' Long 12"
34" Grade at System Elevation
222' Property Line
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
/ Finish grade elevation
Typical Installation 99.9'
Vent ACI Grade Vent
3' 4" 3!
X30/34 Septic Tank
5' Long 5' S' Long 119
Grade at System Elevation
3 6' Grade at System Elevation
Spacing 5'
2-3' X 88' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
System elevations:
A 93.9'
B 92.7'
POWTS OWNER'S MANUAL & MAN.A GIEMIENI PLAN Varje...----- -.of
i-it-F INrokmAimi SYSTEM S'ECIFICATIONS
owner Septic Par kCapacity NA
)a
Permit # `peptic Tar k Manufactur ei Vi NA
1-1 NA
DESIGN rrts ~ c.h~rcr
Numbe51GNr of PARAMETERS
teY' Illfadel--- ..__~7
- ❑ NA t.~fth1F'n't ~ il ter a
~
11A
Number of Public F=acility unify NA Punip Tank Capacity I NA
_
Estimated flow (average) al/da Purnp't ank Manufactur..-n l NA
Design flow (peak), (Estimated x 1.5) t!/ ,Or al/da Purrlp Mar ufactrn.er -I NA
Soil Application Dare al/da !W Purnp Mot el 1.:7 NA
Standard Influent/Effluent (q)uality Monthly average" Pretreatmt rnt Unit F I NA
Fats, Oil tf Crease (FOG) 5 30 mg/L. H Sand/G -avel Filter U Peat Filter
Biochemical Oxygen Demand (BOCK;) sz20 rng/f.. 0 NA l 1 MecharicaI Aeration L 1 Wetland
"t"otal Suspendrrd Solids (T SS) - 160 mg/L. Fl I)isirrfe(liorr 1.1 Other:
Pretreated Effluent Quality Monthly average Dispersal t;elt(s) L-1 NA
Biochemical Oxygen Derriand (BOD5) 530 mg/L_ rr-Grou rd (gravity) LI In--Ground (pressurized)
Total Suspended Solids (I'SS) 530 rng/L. ~NA 1-I At.- Grao, 1-1 Mound
Fecal Cotiform {geometric mean) 5104 cftr/100rn1 I'] I )r'ip-Lir} 3 l l Other
Maximum Effluent Particle Size r c)tf7Er: l IVA
~ in cira. Cl NA
Other:
IJ NA Other LJ NA
"Values typical for domestir; wastewater and septic tank effluent. Other A NA
MAINTENANCE SCHEDULE
_ Service (Event Silirvice Frequency
Inspect condition of tank(s) At least mice ever month s)
y' ear si (INlaxrnium 3 years) 1-1 NA
Pump out contents of tank(s) When combined sludge and SCUM irquals one-third (V3) of tank volume BI NA
Inspect dispersal cr.ll(s) At (east once every s) (Maximum 3 years) 1-1 NA
- - -years
Cleary effluent fitter - - At least once every: D niantfus)
iear(s; 1-1 NN
Inspect pump, pump controls & alarm At least once every: J monthi s) 1 NA
D year(s;
Flush laterals and pressure test At least once every. U month{,) -1 NA
C l year(s)
Othr.r _ _
At least once every: Lt monthls) I 1 NA
E1 year(s)
I: NA
MAINTENANCE INS'rRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Pturnbei; Master Plumber Restricted Sewer; POWTS Inspector; POWs Maintainer; r-eptage Serviring Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any missing or broken hardware, iJentity any ci Ycks or leaks, measure the voh.nne of
combined sludge and SCUM and to check for any back up or pondincd of effiuent or the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to checl: for any pondirrrf of effluent on the ground surface.
The ponding of effluent art the ground surface may indicate a failing condition and requires tha immediate notification of the local
regulatory authority.
When the combined accurnulatioii of sludge anti scum in any tank equals orie-•third or more of the tank vuluiue, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordanc y with chapter NR '113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, rnechari4;al or pr'essurzed components, pretreatment units,
and any servicing at intervals of 5'12 rnonths, shall be perforated by a certified POW77 Maintainer.
A service report shall be provided to the local regulatory authority within 11) clays of c(,ripletion of ani, service event.
START UP AND OPERATION
For new construction, prior to use of the F'Oiltf-I G check treatment tank(s) for the p resence of painting products or other chernic:als that
may l impede the treatment process and/or' darra9a the dispersal cell(s). It high cancentrations are detested have the contents of the
tank(s) removed by a septage servicing operator prior to use.
Systefn start up shall not occur when soil conditions are fro7.en at the infiltrative surftice..
During power outages pump tanks may fill ab•-)ve normal highwater levels. When power is restored the excess wastewater will he
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup o-r surface discharge of effluent.
To avoid this situation have the contents of th ~i pump tank removed by a Septage Servicing Ooerator 1orior to restoring power to the
effluent pump or contact a Piurnber or POINT!; h4aintainer to assist in manually c perating the Trump controls to restore normal levels
within the pump tank.
Uo not drive or park vehicles over tanks and dispersal cells. Do not drive or park ever, or otherwise disturb or compact, the area within
t G feet dawn slope of any rrround or at-grade soil absorption area.
Reductiorl or elimination of the following from the wastewater strearrr may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette bunts; condoins; cotton swabs; degreasers; denial floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides meat scrape; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and watt+r softener brine.
ABANDONMENT
When the i'OWT'S flails and/or is permanently taken or.rt of servico the following stets shall he takrtn to ir*Ure that the systern is properly
sand safely abandoned in compliance with chaptor Comm 8:3,33, Wisconsin Administrative Code:
" All piping to tanks acrd pits shall be disconnected and the abandoned pipe openings sealet.
'rhe cc-intents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
After pumping, all tanks arid pits shall be excavated and removed or their covers removed arid the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POW TS fails and cannot be repaired the following measures have been, or must tie taken, to provide a code compliant
replacement System-
A suitable replacement area has been evaluated and may be utilized for the location of :a replac:erneni soil absorption system.
The replacement area should be prolected frorn disturbance and compac:#ion and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure fa protect the r::placernent area will result in the need
fora new soil and site evaluation to establish a suitable replacement area.. Replacement systems must comply with the rules in
effect at that time.
l,l A suitable replacement area is not avoallable due; to setback and/or soil lira tations. Barring advances in POW I'S technology a
holding tank may be installed as a last resort to replace the failed I10WIFS.
El The site has not been Pvaluated to ,dontif'y a suitable replacement area. Upon failure of the POWT S a soil and site evaluation
roust be performed to locate a suitable replacement area. If no replacemen: area is available a holding tank may be installed as
a last resort to replace; the failed POWi-S.
11 Mound and at-grade soil absorption systerris may be reconstructed in plar:e following nrmoval of the hicrmat at the infiltrative
surface. Reconstructions of such systirrns must comply with the rules in effect at that time
<<WARNiNG>>
SEE PTIG, PUMP AND OTHER TREATMEN'I''I"ANKS MAY CONTAIN LETHAL. GAESFS AND1011, INSUFFICIENT OXYGEN. DO NOT
ENTER A SE-PT IC, PUMP OR OTHER TREA'nWE T TANtc UNDER ANY CIRGUMa;TANGES. W:.ATH MAY RESULT. FESCUE= OF A
PERSON FROM THE INTERIOR OF A TANK 1/1AY BE DIFFICULT OR IMPOSSIBLE,
ADDITIONAL. COMMENTS
FIOWTS INSTALlL ° VOWTS MAIN rA1NER
Narr' Name
_.m_..l'hore
. !?hone
SE IP I`A(yk: SERVICING C)pF"RATt)I2 f'tJ (_I2 LOCAL REGU LATORY AU '.HORfll'Y
Name tUarne t-
PhonP.w«,Y~~ ihonP.
I hi,,; document was drafted in compliance with chapter SPS 383.22(2)(tr)(1)(d)&(#) and 383.54(1), & (3), vlfisconsin 10,ninistrative Cade.
CARTRIDGE INSTRUCTIONS
~as>~s[ral~ioa ,
sr ep t Cary fit tine umv. eaarm onto the end of thr olltitt pipe to ensure it is
Centered wider the rat co" up*"Ing. If nut, tire" rather 1"Gart toole pled litho tiro
tank through the outlet or suip.nt weld (fidue) additlunaf pipe beta the uutlet
pipe.
C:i7rr- a Whfie tiro ca>xe is Will :Iry fftt it oil the outlet ph-to, rnmasure tits lemgtt,
of 46-inch Woo receded to bmt* the niter to the tank tmd wall if UtliF.firlg the
aptional supplemental etide support. If side support ntat-hud is nut utUt ed,
proceed to stop four
s•rO6 t Fur knatallatiatrs utilizing the uptignal riUppleltit,irta! side suppnrt-
saluea t weld the % -ihci, pipe ors u the filter Cabot. If ride support Method is not
ul iled, preweed'tu snap foul. j1
Solvent weld the filtei ease auto the nubat pipe, fr,t:ert the Vital
cartridge into the rase, ressiol tc
d+ i down Until the filter laic ku iota the battrrr:', Of .
the Casa.
If a Vas switch is utlii:tead: irre;ert irrta tins si1t
clockwise er rand suck try turning t;!r'
~'al~rten~latc~
1. The efnUerrt niter should be Cioaned livery time tine ouptic tank t„
serviced.
z, open the outlet access epanorg to inspect than tank arid titter,
M. Isunip tiea septic tank uonoplettly, making stare to rernulls the sdudyle
dayw- uu the bottom of the ti'vik and not Juat tine sa;um and effluent, ru
4. once tl're utnuent level has t,ve/t lowered below the invent of thu
outlet pipe, firmly pull up are the filter handle to disludge the
Cirrtridge (roan th,r c"e, r
5. Slide the rartrldge up and mar of the caaso: fiW cleaniiry, dpi
u, it a VAS switch Gunn-too to an alarm is present, the switch "
sh'outd he removed by turnthq courearduekwisw 9tlw tend cleaned
with water only.
7, While holdkrg the Cartridge Cllr its tacit, (large flat surfbce tarbry
down) ever the aaVess aliening, rin6e off the caltridge with wirkne
only, nnakirrg cure all septago: atratedal is rinsed hack into the tatrk_
` fi. if VR5 awitth is utilized, replikoe by Nrserting intu lifter and
turning ciaekwise ma". t.y
h~i Yti l~'1 +•w
9. insert tha inter cartridge bark hate the G"to iire"Jug down, art it
tine niter lackrs into tiro bottoun'it the case.
~ Vr11 IVf' 4 . 'Y '
lo.ftepiate and secure the acctesd utranillg an the unit,
r.rl:••Ye ;"°wl~•'°r; r9Mi Yit~aro{r{{ •t,yi. '•t lt,. iSrFt41~:.V:+Saf6x ~7"'.
lfarwrir~ da~l~t7<wlllrtas .iertiiltitt 6017-P&p."I,a'i`MS (653-4583)
12
v ° 8 ~O ~664j\ tASE'NfNT~~ -s UPENING ELEVATION EL 945.2'c'
M 99804 S.F. a 55" %
_
0 0 (2.291 AC.) C~ £ '38 334,00"E1 3 5j9~,2
O.- Z - 42.90' 87417 S.F.
C) C) Z N N80°32'35 E (2.007 AC.)
273.27' 589°56'
w~3 \p
r N s, 9 3 BENCMARK
N 99982 S F ° v TOP STEEL PIPE -
a'N~ O.H.W. (2.295 AC.) N ELEVATION = 940.49'
~ 924.37 p- o °o 10
Z C3
4v' > N Z
ow
88400 S.F.
(2.029 AC.)
NO DWELLING EXTERIOR
aQP °4v/ OPENING BELOW Z NO DWELLING EXTERIOR
ELEVATION 942.0' OPENING BELOW
wry/ ELEVATION 942.0'
04
-~I
v, L
U~~ ~ ~I W ~ N
ON
IJ~I a ~-WL SBL 58L SBL wL SBL-
u_IpoNi O
O -
? -188.13` - 223.22'- - Ln- 238.05-
\ N89°35'50"E 649.40'
o _
1- o - -
0 W)P R A I R I E S89°35.50"W 649.40' MEADOWS DRIVE
(i )I 8 193.96'- 9.63
f 6.00 493.77 aW
o o
I 'n ;n~ 'n
~I sBL o DRAINAGE EASEMENT 6 L SBl n581
00 121132 S. F. 2
(2.781 AC.)
N8447'11"E 183.90' s\2~~
-rI o*.NO DWELLING
EXTERIOR
N OPENING BELOW a ooI r I ao1
ELEVATION 925.9; °o'- °z m coo ~ry
C J~ N89°59'50"E `n 5' I _ z •3
135.04' N w3 0 C4 / C -hco
J
~'-4 5
92458 S.F.
7
-J~ ~ _'~o tcu Nry (2.123 AC.)
\ A 88273 S.F. I S~ `o, v Co
(2.026 AC.) 9.
a-, sr. 573°493
BENCMARK O 10 (9TOP STEEL PIPE- E` 8 2
-7 , ELEVATION = 930.90' \ 2SSS~, 61;
BENCMARK
TOP STEEL PIPE - - ; -
ELEVATION = 938.18' R~ >
BENCMARK X88
TOP STEEL PIPE
/ ELEVATION = 957.30 N65
G I N89°31'32"E 222.44' `rte=
181.40
~ ae
O NO DWELLING EXTERIOR
N OPENING BELOW
ST. CROIX COUNTY
SEPTIC TANK MAIlVTBrrANCE A(~REffiV9aBN'r
AND
OWNERSHIP CERTEnCATION FORM
c Z~ s
Owner/BuYer a
Mailing Add S
c
lk"I
Propefty Addrew ~s
(V ona regaited frown Planning & Zo=g Depatimant far n6woff-)
City/Stat+e - Parcel Identification Number 6:2 01 D 7 39' 07 mU v
Pro party R-aW, Town of
/ %4 x/; , Sac. Z T
Pte'' Location , .
r Lot
Subdivision T l 7 a
Certified fintvey Msp # _ ~Volume page #
'Page
Warranty Dead ,Volume #
Spec house Lot Yiraos idaaoClitsbla'
YCFG~
O
uld result at its pr'im'e failnto m bwA wastes. Ps+oper
Itsgssopmr =wand wWs~e of ] co if=wded. by s Ucwwd pamper. What ym pW into
MawbMance 0=sisls ofp outdo tank ever9 tlaee You oz sooner,
the system can affect *0 faction of the sap* tank as a treatment atW im the waste disposal Owner
use gwMed in #Cotnas 83.52(1) and in Cbaptw 12 - St. Ckoix Coumly 8snbuy Oulmce-
DVabmwA a
,rjw property owner agoees to subu d to St Cm= Caw * MUMS d, ~8 ° *A ~1) *0 ma by the
owner and by a. saast w p per' sesuic Md plumber or a lica®sad (if WCOMMY). *0 septic fink's
wastcwstrar dbpmd sysbeem is is prap°i' opa00S ewdifion and/or (2) aft fi speotim
kss thaw 15 fuIl of studga:
Natausl s wrtb the
I/ws, &e. undu*p ed be" send tine above req=GnxmJS and agme do this
of Commerce and the Deperm~mt ReaoulvM State of Wisoonsia,
has been maiatsmed mot be owVleted and tebnwd to the St. Croix ComstY Plaman8
eandar& set 'fawfb~, huVE0, as act by the DePertzmt o ~tia~ee
CZoning~ a~~tmg within *A 3►M 30 sdaysepO of y ors daft
to the best of s+aylout' hto'wled 1/w 0 am/are tb~e ownea(e) of the
i/aro cacaiy that sli statGamaats.om~ tbds faqm are tray recorded in RagisW of Deeds Offioe-
properlp dascsibed above, by vide a wana~3►
Numb f bedrooDATE
Al: :OF AppLICANT(S)
ssrl ay ! is mistapxesem~bed may result is the sanitary pmmit being ra%'olaed by the Planning &Z08 Depermmt
h,,,rle with this app s reCMW wmady deed fim the Register of Deeds Offuce and a copy of the owtified survey mat► if
is steLde iQS the west~emty deed.
reft"M
(tEv.
osros~
8 Tx:5 2 2 5 4038949 8
STATE BAR OF WISCONSIN FORM I - 2000 952977
BETH PABST
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between Rosamji, LLC, a Wisconsin Limited Liability 03/22/2012 2:32 PM
Company, Grantor, and Landon C. Scott and Janel L. Scott, husband and EXEMPT#: NA
wife as survivorship marital property, Grantee.- - REC FEE: 30.00
Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 180.00
described real estate in St. Croix County, State of Wisconsin (the PAGES: 1
"Property"):
Lot 7, 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, #2205
Roseville, MN 55113
LTI # 370128
Together with all appurtenant rights, title and interests. 020-1439-07-000
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 28th day of February, 2012.
R amji, LLC
/ .
* Sandra M. Gehrke, President
* Dto,
AUTHENTICATI ACKNOWLEDGMEN
T
Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY ss.
authenticated this 28th day of February, Personally came before me this 28th day of February, 2012
the above named Sandra M. Gehrke , the President of Rosamji,
eic VA
* LLC, a Wisconsin Limited Liability Company, to me known to
TITLE: MEMBER STATE BAR OF WISCONSIN be the person(s) w o e foregoing instrument and
(If not, acknowledged the sa e.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY *Kelly J. Nelson
Notary Public, State of Wis 6(ifnot, Larry S. Mountain - Attorney At Law My commission is pennane it. te expira tion date:
4/ 13/20 l4 )
(Signatures maybe authenticated or acknowle(lged. Both are not necessarv.)
*Names of persons signing in any capacity must be t. ped or primed bclox\ their signature
1 of 1
WARRANT", DEED S'EATE; BAR OF WISCONSIN FORM .No. I-2000
1301
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
County
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 0 2o-
Please nt all information. vie Date
Personal information you provide =uRe jrLar7jT- acy s.15.04 (1) (m)).
Property Owner Property Location
ROSAMJI, L.L..C MAY Govt. Lot na NW 1/4 NE 1/4 S 25 T 29 N R 19 W
l
Property Owner's Mailing Addres Lot # Block # Subd. Name or CSM# / I -)-733
2141 Cty Rd. C 1 7 na Indigo Ponds J
City tale Zi Otald~CRt tuber J City _j Village a Town Nearest Road
New Richmond WI 54017 715-24 - 1 Hudson Prairie Meadows Drive
0 New Construction Use: t Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describema
Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na
General comments
and recommendations: system elevation 93.85 ft, trenches spaced and depth to code 6.00 ft below grade.,&Qkit rKt"'`
Boring # J Boring
J/ Pit Ground Surface elev. 99.85 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 10yr2/1 none sicl 2msbk mfr cs 2c .5 .8
2 9-16 10yr4/4 none sicl 2msbk mfr gw 1 c .4 .6
3 16-53 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6
4 53-120 7.5yr4/6 none cos osg ml na na 7 1.6
CFO L4 xe,
it
COS <35% coarse fragments = 36" &
>35% - <60% = 60" below system
Boring # J Boring
0 Pit Ground Surface elev. 99.85 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 0-5 10yr2/1 none sit 2msbk mfr cs 2c .5 .8
2 5-15 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6
3 15-42 7.5yr4/4 none sicl 2msbk mfr cs na 4 .6
4 42-120 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 = BOD5 S30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
David J. Steel 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 5/9/2003 715-246-5085
Property Owner ROSAM]I, L.L.C Parcel ID # pending Page 2 of 3
F3] Boring # I Boring
N Pit Ground Surface elev. 94.05 ft. Depth to limiting factor 120 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
1 0-8 10yr2/1 none I 2msbk mfr gw 2c .5 .8
2 8-21 10yr3/2 none sil 2msbk mfr cs 1 c .5 .8
3 21-48 10yr6/4 none sicl 2msbk mfr cs na .4 .6
4 48-55 7.5yr4/4 none sl 2msbk mfr gw na .5 .9
5 55-60 7.5yr4/6 c2d7.5yr5/6 Is osg mvfr gw na .7 1.2
6 60-120 7.5yr4/6 none Is osg mvfr na na .7 1.2
2+' I Dr) Horizon 5 has noncontigous mottling spots
F-1 Boring # I Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # I Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D
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.
64 C ty Rd GG
15
David J. Steel New Richmond,Wl 54017
CST-POWTSM ROSAMR, L.L.C.
Lic. #248956 NW1/4,NE1/4,825,T29N,Rl9W Bus.(715) 246-6200 • Town of Hudson, St. Croix Co. Fax.(715) 246-9372
Indigo Ponds Lot 7
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
Legend
the time the soil test was conducted I„ = 40'
RECEIVED A = Benchmark Ele. I00.00Ft
Top of 1/2" pvc pipe
MAY ` • = Alt Benchmark Ele. 100.05Ft
N 2003 Top of 1/2" pvc pipe
ST, cf~oi.x C~(;rv rv ❑ =Borings
ZONi NG Boring Elevations
OFFICE
BI =99.85Ft
B2 = 99.85Ft
B3 = 94.05Ft
B4 = 00.OOFt
O
Z 90;74
1057F,
'Sp
g94.5-54+
qq
vac1 1-o V iA,,-
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 7
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.OOFt
Top of 1/2" pvc pipe
rJ • = Alt Benchmark Ele. 100.05Ft
Top of 1/2" pvc pipe
❑ = Borings
Boring Elevations
B1 =99.85Ft
B2 = 99.85Ft
B3 = 94.05Ft
B4 = OO.OOFt
i
271
qd
y , slate
3z
~ y oSF«-
z . 4q
i L r r •
„238.05'rI~- ~ - '
tP, •~'/K✓✓ 7} /
649.40'
w PRAIRIE MEADOWS ~ L~
"42
.89 493.77
66.00 .4
DRAINAGE EASEMENT 6 ssL set
121132 S.F. L
_ 1 ~ 92
(2.780 AC.)
OD'
vto-
f"O.H.w. =ti f~/' ,gym 4 f
/ _ 135.03' 919.6, 97744 S, F.
(2.244 AC.)
(
924558 8 S`.F. (1.058 AC. N.B,P,i
f ~ a cz+ t / _ . J • -
' - <vf (2,123 AC,)
r' (2.0265 AC.~ (1.578 AC. 'N.B.P,A.)
i .t J
z x(1.21/7 AC. N.B.P.A.
= _ (erg
2 4
- (3.071 AC~✓
1\ 1.442 AC. N.B.P.A.)
91811 S.!'. 87839 S.F. ✓ , _
(2.108 AC.), % (2.016 AC.)
' (1.090 AC. N.B.P,A.} - - (1.384 AC. N.B.P.A.)
"r-' . ~js, / ~dam' - - - - _ ~ - - ~ ` 4
' . ; `315.66'
(AL
S4- , 7 - N D7 cr
:tip '•'~~C ~ - ~ ~g - ~ f I~. !
' 57.42' rj1 ~$c
From: 7ennifer 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