HomeMy WebLinkAbout020-1439-15-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
563836 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:
Maack, Chad • Hudson, Town of 020-1439-15-000
CST BM Elev: Insp.BM Elev: BM Description: /� Section/Town/Ran Map o:
/4/ '5 ►U I 4410.64-- ,0 -is 9.19.2741
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV.
Septic %„ ; �' 7 /a 7 -
o
.b/ Benchmark
Lit.-)t v5.e.c _ �'l 1-•-.. z /ZSd 2.-3 -/_A5 ' 3 /0-3
' Alt. BM -3 . �1S �. `�
F,14-....... G e.a, r t L._ (✓,'1 L<..- CO ,
Aeration Bldg.Sewer
Z.`l LI, I /oZ.
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L I WELL BLDG. Vent to yir`JInttaake ROAD Dt Inlet \
Septic I ■ Dt Bottom ilir
'7 5o �l[4- 33 � 754
Dosing Header/Man.
Aeration Dist.Pipe
/o . l (0 9r y,1(
Holding Bot.System '� / ? $
/z. I 1. ( crL.7>
Final Grade ^
PUMP/SIPHON INFORMATION j4 ,k/._ 6���-.2, 7.bs 97, g5
Manufacturer Demand St Cover
Model Number
TDH 'Lift Friction Loss System .,.-. TDH Ft
C----- --._____,
Forcemain L- • - 'ia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. 'Liquid Depth
DIMENSIONS
3 )LL 1 'Cie �_ �_ \
SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM CHAMBER LEACHING Manufacturer— ,p,,. � I
INFORMATION OR -L�r J rte_
Type Of System: �t,e (] 7516 5 1 / �� UNIT Model NumbRf: I // 1 /�
CO K ti ..a�111" (y cl Cam' �t SP7� .Ji
DISTRIBUTION SYSTEM 361-36 — (o 6 4-O4--c -- 'L
Header/Manifoi II Distribution x Hole Size x Hole Spacing Vent to Air In_take e� /1 S
cl Pipe(s) — �_ o!j-L c-'
Length 7 Dia F Length �-- Dia Spacing
SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center , 6 S Bed/Trench Edges Topsoil "*----......., Yes No Y. Ei No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 791 Sumac Trail Hudson,WI 54016(SW 1/4 SE 1/4 24 T29N R19W) Indigo Ponds Lot 15 Parcel No: 24.29.19.2741
1.)Alt BM Description= / �� �� Ck Q,pw, /04..h� d v\
2.)Bldg sewer length=3 6
-amount of cover= I
2_ ..4-- Loo yL /f a -- 4--
Plan revision Required? M Yes No jJ e, 13 Al,' ` to g 34 '7�j
Use other side for additional information. 1 /
SBD-6710(R.3/97) Date Instctor's Si•Nature Cert.No.-
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,necaxx�at TO County 1 ' ST- C r c
c '" Safety and Buildings Division
p ° ;, y 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.)
� .. Madison,WI 53707-7162
ru 4 � 563 3 (.0
Sanitary Permit Application State Transaction Number
In accordance with '•• 83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit V 4—
is required prior .b , /ng a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Departm-• o .'-ty.•, Professional Servies. Personal information you provide may be used for secondary
purposes ii a4:' : ce the Privacy Law,s. 15.04(1)(m),Stats. 41'1 9 ( sr V 1 � �RAtL
I. Ap i ! t'. I i rmation—Please Print All oration
Propev, ■ er' I ame r lA .A. • Parcel#
M k /ii „ 62O- 143G -, )5 -666
Property Owner's Mailing Address {,f ��/ O Property Location
L0 Lc ''71 N 5T JO 04 Govt.Lot
(. 27zfl)L'
City,State Zip Code Phone t t 'A, 414 2S
q� 1,� 19� �J /� SvU /a, (�/ Section
J tso 0 I 5L`V I / T
+1 CRO/x T Z L 16(circle o
II.Type of Building(check all that apply) Lot# Ty N; R E��
Of°1 or 2 Family Dwelling—Number of Bedroom. 15 Subdivision Name
��ii 'f- I- 1NOILO f oNOS
❑Public/Commercial—Describe Use OI< 1/lo05e,
/ ❑City of
❑State Owned—Describe Use CSM Number ❑Village of
2 13;s�- Ce,US L.J 36 4-36 C . ..r� ' `Town of U t�SD IJ
III.Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. tut System�.N y ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain)
B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV.Type of POWTS System/Component/Device: (Check all that apply)
❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil
❑Holding Tank ❑Other Dispersal Component(explain) •Fret eatment Device(explain)
V.Dispersal/Trea ent Area Information: 6Q 0 U t etc_ Ai DK km CZ C 12_S
7
Design Flow(gpd) Design Soil Application Rate(gpd Dispersal Area Require 1 I ispersal Area Proposed(s System Elevation
606 1 5 atb 1260 13 is-_ 73
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units o c,
New Tanks Existing Tanks o U C y
g ❑ a�
Pi CA,`� iL. a U ..,H0
rn w t7 i~
Septic or Holding Tank 14:0 j 1 I Iz- /`
Dosing Chamber
VII.Responsibility Statement- I,the undersigned,assume responsibility for insta lation of the POWTS show. •. the attached plans.
Plumber's Name(Print) Plumber's Sign ture '/MPRS cumber Business Phone Number
ZEVI-= t'ah G Y' / 2.7.-32,q Z. 1f 5-"15S-2y Col
Plumber's Address(Street,City,State,Zip Code)
PO. REX EL b?Z -'St{2 'V1 S`-IDD g
VIII.County/Department Use Only
Approved Permit Fee Date I ued Issuing A Signature
❑ iven Reason r Denial 4/5. co 7 12/13
IX.Condi>9 easons for Disapproval / � ,
W dt(R 3) ,t)o , i? . • o 6' d
1. Septic tank,effluent filter and � 1/L
dispersal cell must all be services I maintained I-1
es per management plan provided by plumber. dra,. i%e 6115e41 -
2. Ail selack regtWements mug bslnainsq d
s per cede/or sra ,
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398(R. 11/11)
CONVEN11ONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: C.�{ 1`f1 N tct K '
s- 202S �7V1 10 s�'
owner's Address: t�SQ rJ 1�/
Legal D�ascnpt�on: S W
lly s (A-i 5 29 N J R t 1a/
►ownsiip: U OSo IJ
County S-r C(�/'.
Subdi+ to Name: �'N01 VD �p S
Lot Number: IS .
Parcel ID Number: OZO ~14.361 1 c5-L1DL`
Page 1 index and title
Page 2 Plot Plan
Page 3 System Sizes&C:oss-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St.Croix CtY Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments:Soil Test&House Plans
Designer/Plumber: jet- F I-Q 1C License Number: M?RS 223Z`/Z
Date: 1 1 )3 Phone Number `i (• —?ra5-Z y 6
Sig ir---"d"
it U
Designed pmt to the k-Growrd Solt Absorption
Corripor+ent for POWTS Version 2A 800-toR1SP(NAIAD 1}
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Soil Absorption System Cross Section
98 ft
4'Schedule 40
Final Grade
PVC Vent Pipe ♦- // 5Sft
With Vent Cap
Leaching _÷C �-- q3`5
Chamber
System Elevation
ft __G_ft
Soil Absorption System Plan View
1-'0 ft
3 ft
- 11!111 IIIIIIIIIIIIIIIIIIIIIII1111IIIfll11 11111111111111101111 III
ft Vent Or Observation Pipe Ir Leaching Trench 1 Chambers ---p
IIIIIII II I IIIIIIIIJlIIIIIIIIIIIIIIIIIIIII I IIIIIIIIIIIIIIII4IIIIIIII1I I I�IIIIII�—\il,.Dia.
Trench 2 Header
Leachina Chamber Specifications
Manufacturer And Model I N t1CrizA[O(�
EISA Rating 7-0 sq ft per chamber Soil Application Rate .5 gpd/sq ft
( EX) gpd Design Flow: . J Soil Application Rate = 20 EISA= 0 Chambers
2 rows of 30 chambers each.
Page of
itLoi t` '• .Y ��a CA INSTRUCTIONS
FILTER RI I
8 :TM.,....
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..1p,_
Installation 7 �'_-. . k°
tartt ~, r1 '.
STEP 1 Dry fit the filter cas c^tn the end of the outlet pipe to ensure it is 14» •d '''
centered under the access opening if not, then either insert more pipe into the . ,',1;;'''',',41,'>,•--
d
tank through the outlet or solvent weld (glue) additional pipe onto the outlet A ' •• e'tA.0
Pipe —
`,
t ' � Ir ;i
I, I. .
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length %, t,.'
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the ,{,t,'r ,q`,4
optional supplemental side support If tide support method is not utilized, ,1 Ii '" i
proceed to step four 1'+y,�,v\�'°'r ,
STEP 3 For installations utii 71,1C1 the opteor ii supplemental sihe support' X 1 4 1',� ;`fi'`:"t
solvent weld the 3/.-Inch pip oite tNm filter ase If side support method is not 1"t"bs ,I 1 °,�' •.
y� X
otilized, proceed to step four ,,, ''
D R p 0..1,-,e....,
STEP 4 Solvent weld the filter case onto the outlet pipe insert the filter ; y
cartridge into the case, pressing down until the filter locks into the bottom of " � 1 "t
a'
the case. ,,� „,
�+•�
STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning '��;�s',i,,: ,» �.
TT�s 1
clockwise 90° 1 '•�� 1,1 R'
Maintenance
1 The effluent filter should be ;leaned every time the septic tank is
serviced. ,'' '4, 1 !.t..., +tin. .`. 7:''''z
2. Open the outlet access opening to inspect the tank and filter '2x "• �; .
3. Pump the septic tank compietely, ^raking sure to remove the sludge ,
layer on the bottom of the tank and not 'Just the scum and effluent l` E. •$,' ,p . .' s• ;l
4. Once the effluent level has been lowered below the invert of the I`'i9�` ti�,�.'
outlet pipe, firmly pull up on the filter handle tc dislodge the E`t1 ,
I
5
cartridge from the case i;i;'lii':pr.r., * r I*
the cartridge up arid out of the ruse for cleaning ti'h , �e I pug
� { lflf"a It
6 If a VRS switch connected to an ai,3rrn Is present, the swiCL:h „ htr,'"'r OP
should be removed by turning co_,nterc ckwise 't0° and cleaned j.�is
with water only. ,,',,411''''I � w k . ` • •
7 While holding the cartridge on its side (laee flat surface facing i �alr « " • ,� �0R'�'<
down) over the access opening, rinse off the cartridge with water a iQl" ' s "* r`
only, making sure all septage material is rinsed hack into the tank Qr ,. •=.v ►� :•�
8. If VRS switch is utilized, replace by inserting into filter and 4r°3 ,' 'jfI 'I t' t► ' ,f
turning clockwise 90° �' ,illif°n R `•
9. Insert the filter cartridge back into the case, pressing down until 4l m + •
the filter locks into the bottom of the case. ��if�� �� ` ; d
10.Replace and secure the access opening on the tank ,i �• ti
"+w'e� 1, ,ir Ct.
M' i. I ..4'` 9 till,
0
Materials: ' .•. .. « * ,
,. +t,if
Model Numbers:
BEAR ONSCTE FILTER CARTRIDGE ruvu YEAR ro r'ii WARRANTY .
BEAR ONSrtc"Filter Case lr!et■me I,m,ted W.,.anl,
. .. •\
r
'('. clip; •�`t, r-ir`'r, .
..0" I;31,.
• POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner C m) - r
/(�R � Septic •
Tank Capacity . 1' ''gal ❑ NA
Permit# 5? 3 & Septic Tank IVlamufacturer �W( ❑ NA
DESIGN PARAMETERS 11��// 1% Effluent Filter Manufacturer BEAR ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA
Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer Q NA
Soil Application Rate gal/day/ft2 Pump Model 0.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 (BOD8) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L gin-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y8 in dia. ❑ NA Ot1ef: ❑ 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) ❑ NA
a year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cells) At least once every: � yea�th(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ' ❑ month(s) ❑ NA
. �. Ayear(s)
❑ month(s) ❑ NA
Inspect pump, pump controls& alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
P ❑year(s)
Other: At least once every: ❑ month(s) 0 NA
�Y ❑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 512 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.
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Page of y
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:
• 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
replace ent 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 Ft= Name
Phone its_ `Z 5 5 2 �( Phone
SEPTAGE.SERVICiNG OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name $4 Gc-O;, - G
Phone Phone "',15 . 5/6- #6-so
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.
1305
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 riot 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, earest road. Parcel I.D. O 2(�—' fr_/ Y ,�,
Please pri t all krr�►1!E D Date
eviewe
Personal information you provide may used for secondary purposes(Privacy Law,s+15.04(1)(m)). 61A'V`✓— I °Z//i°-/
Property Owner MAY 1 3 ZOT1J Property Location T
ROSAMJI, L.L.0 Govt.Lot na SE 1/4 SE 1/4 S / 2 T 29 N R 19 W
Property Owner's Mailing Address 5 t�OIX Coq Lot# Block# Subd.Name or CS C#
ZONING OFFICE
2141 Cty Rd. C
15 na Indigo Ponds
City State Zip Code Phone Number J City _f Village tre Town Nearest Road
New Richmond 1 WI 1 540171 715-248-7071 Hudson I Sumac Trail
(f New Construction Use: yJ Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD
J Replacement J Public or commercial-Describe:na
Parent material Sream terraces and pitted outwash plains Flood plain elevation,if applicable
`d s na
General comments
and recommendations: system elevatio 93.50 ft, nches spaced and depth to code 4.50 ft below grade 3,'O j�p W,,.
ad- .t3/- 132-c d`d1.'—
a Boring# J Boring
N Pit Ground Surface elev. 98.00 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 10yr3/2 none I 2msbk mfr cs 2c .5 .8
2 5-30 10yr4/4 none Is osg mvfr gw 1c .7 1.2
3 30-96 7.5yr4/6 none sl/Is 2msbk mfr na na .5 .9 i
/
6
11 qa
2 Boring#
... Boring
f/ Pit Ground Surface elev. 98.00 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 0-4 10yr3/2 none I 2msbk mfr cs 2c .5 .8
2 4-24 10yr4/4 none sI 2msbk mfr gw 1c .7 .6
3 24-96 7.5yr4/4 none sl/Is 2msbk mfr na na .5 .9
Mil
MM...
=EMI
*Effluent#1 =BOD5>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) ature: CST Number rj/: –
David J. Steel / % 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG,New Richmond,WI 54017 5/8/2003 715-246-5085
f
• Property Owner ROSAMJI, L.L.0 Parcel ID# Pending Page 2 of 3
3 Boring# I Boring
1I Pit Ground Surface elev. 93.55 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 0-4 10yr3/2 none I 2msbk mfr gw lc .5 .8
2 4-24 10yr4/4 none sl 2msbk mfr gw if .4 .6
3 24 IN 7.5yr4/4 none sl 1 csbk mvfr gw na .4 .6
-
4 44-96 7.5yr4/4 none si/Is 2msbk mfr na na .5 .9
Boring# I Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
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 GPO/ft2
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 SE1/4,SE1/4,S25,T29N,R19W Bus.(715)246-6200
Town of Hudson,St.Croix Co. Fax.(715)246-9372
Indigo Ponds Lot 15
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
I"=40'
• =Benchmark Ele. 100.00Ft N
Top of 1/2"pvc pipe
•=Alt Benchmark Ele.99.85Ft
Top of 1/2"pvc pipe
❑=Borings
Boring Elevations
BI =98.00Ft
B2=98.00Ft
B3=93.55Ft
B4=OO.00Ft
l ;Aft-
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ST.CROIX COUNTY
SEPTIC TANK MAINTENNANCE AGREEMENT
AND
n t_ 1OWNERSHIP CERTIFICATE FORM
Owner/Buyer VlAA A `G
Mailing Address ZO15 7 1 CST• (J
Property Address 7C1 1 J l ac. Tr&i (
I (Verification required from Planning Department for new construction)
City/State TV v J APY∎ t l), • Parcel Identification Number 0G.20 114 31 -1S-CVO
LEGAL DESCRIPTION
I Z�
Property Location 5A/f,, J'�''/a Sec. T 2M N R t t W,Town of ALA-44.6.0
Subdivision dlgt) PM-1(1,5 Low 16--
Certified Survey Map /I� "(q ,Volume Page
Warranty Deed# 3O')io off- ,.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. Whatyoaput.into.the.system..can affect the function 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 disposal systPm is.in proper operating condition and/or(2)after inspection and pumping Of necessary),
the septic tank is less than 1/3 full of sludge:
I/we,the undersignedltave.read_theabove•requirements 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.Cethficationstatingthat your.septic system has been maintained must be completed and returned to
the St. Croix County Zoning Office within 10 days of a three year expiration date,
C Lv 5--2.0 -20
SIGNATURE OF APPLICANT DATE
#of proposed bedrooms if
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:
0/14 i‘44.117 5-Zo
SIGNATURE OF APPLICANT
DATE
****** Any information that is misrepresented may reauk in the sanitary permit being revoked by the Zaaing Department'm"
" Inducts with this application a stamped warranty deed from the Register o'Deeds office
a copy of the certified survey map if reference is made in.the warranty deed.
I, _
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DOCUMENT N0. I I Li11Jt
STATE BAR OF WISCONSIN FORIvi 1-2003
• WARRANTY DEED Tx:4132173
980362
THIS DEED,made between James Phillips and Julie Phillips husband and BETH PABST
•
wife("Grantor"whether one or more)conveys and warrants to Chad D.Maack REGISTER OF DEEDS
and Angeline J.Maack,husband and wife("Grantee",whether one or more), ST. CROIX CO.,WI
the following described real estate in ST CROIX County,State of Wisconsin: / 06/12/2013 12:55 PM
EXEMPT#: N/A
Lot 15,Plat of Indigo Ponds in the Town of Hudson,St.Croix County, REC FEE: 3b.0O
Wisconsin.
TRANS FEE: 269.70
• PAGES: 1 •
RETURN TO
First National Community Bank
PO Sox 89 •
New Richmond, WI 54017
•
Tax Parcel No: 020-1439-15-op0
This is not homestead property
Exception to warranties: Municipal and zoning ordinances and agreements entered under them,recorded easements for the
distribution of utility and municipal services,recorded building and use restrictions and covenants,and further except 2013
real estate taxes.
Dated this 11th day of June,2013.
•
• jg •
am Phiw;s
-
Julie Phil!'
AUTHENTICATION ACKNOWLEDGMENT •
Signatures authenticated this day of , STATE OF WISCONSIN
20
ss.
COUNTY OF ST CROIX
TITLE:MEMBER STATE BAR OF WISCONSIN
(If not, Personally came before me this 11th day of June,2013,the above
named.James Phillips and Julie Phillips,husband and wife to me
authorized by§706.06,Wis. Stets.) known to be the person(s)who executed the foregoing p O regoing instrument•
and a owledge the same.�
•
THIS INSTRUMENT WAS DRAFTED BY at
V
Robert L.Loberg/Loberg Law Office * Amy L.Monson . a« t t
Notary Public St.Croix County,Wis. ,
1314681/alm 1 .a
My Commission is permanent. (If not,state •i _'hontTatti
(Signatures may be authenticated or acknowledged. Both are ) 3-9-2014 " rf .,i 1B
not necessary.) r
milff ATV DEED • .�-`a.��`d;o.r-2003