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HomeMy WebLinkAbout020-1439-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579080 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 Township Parcel Tax No: Corey Johnson TOWN OF HUDSON 020-1439-01-000 C CST BM Elev: Insp. BM Elev: BM Description: I L ` Section/Town/Range/Map No: Q 7 7 25.29.19.2727 TANK INFORMATION ELEVATION DATA j TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ~ S Septic f Benchmark , 0 /off l /oa Dosing ~v f Alt.M 7 97 Sif 9G '7-V ~o r co $DD ~l' Bldg. Sewer 16,% 34.4,1T EHold St/Ht Inlet 11.105 v5 • Bq TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ i WELL BLDG. Ven o Air Intake ROAD Dt Inlet ` Septic 7 50 / Dt Bottom f 5.~ ez -I Z_ Dosing 7 56 / ./n z I Header/Man. $ /Uri Aeration ~►oJS. a~ Dist. Pipe 14,x7 gg z3 Holding Bot. System g7, rah ~ Final Grad PUMP/SIPHON INFORMATION (Y1; lI "y '7Z • 4(' Manufacturer /n/ Demand St Cover Us GPM , g2.~ Model Number 7 Sa DH Lift&I /I Frictiono ' qZ_ System Fjela TDH S t /1/ Forcemain 1 Length / Dia. / Dist. to Well 30 Z SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth LINFORA ? 14V ~ J,,~ SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Type Of Syste / CHAMBER OR 14 sdL+ /~J1 0 n~.sG ~j~ 27 x,~_ N~ UNIT Model Number: II DISTRIBUTION SYSTEM 30 d~ 16 e, Header/Man Poll? If Distributio Ix Hole Size x Hole Spacing Vent to Air Intake Length Z Dia 1- L ngth Dia Spacing Sd v e r~ 5 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only D 6 ~G Depth Over Depth Over xx Depth of xx Seeded/S dded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes R No F Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Tel ~~nInspection #2: Location: 878 HIGHLANDER TRL .IL L . ®Je ,SQ1.) Alt BM Description = 1'~ 64_ _ L~,lr.s a,•~ 2. Bldg sewer length - amount of cover = > C. / n n a h a,yLX., Plan revision Required? ❑ Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. County Safety and B i ST_ CROIX 201 W. WaShingtOrV Sanitary Permit Number (to be filled in by Co.) T.~ S ~t Madison, WI 53707-7162 OWED SEP D 8 2015 5 Sanitary Permit ApplicatiolsT CROix COUNTY State Transaction Number accordance with SPS 383.21(2), Wis. Adm. Code, submission of this fomt'tlM aY ~RME / A is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) Department of Safety and Professional Servies. Personal information you provide may be used for seconda 878 HIGHLANDER TRAIL u ses in accordance with the Privacy Law, s. 15.04 1 m , Stats. HUDSON, WI 54016 I. Application Informati - Please Print All Information operty Owner's Name / Parcel # GREY JOHNSON / 020-1439-01-000 operty Owner's Mailing Address Property Location , 2:72- 726 GREEN BRIER ROAD Govt. Lot 1 City, State Zip Code Phone Number NW v., NE y, Section 25 HUDSON, WI 54016 N/A (circleonelL T 29 N; R 19 Eor II. Type of Building (check all that apply) Lot # EXI or 2 Family Dwelling - Number of Bedrooms A "l Subdivision Name /Ik Block # ^^••LL--+ INDIGO PONDS ❑ Public/Commercial - Describe Use % N/A ❑ City of /La CSM Number ❑ Village of ❑ State Owned -Describe Use 3 aF /b ~L N/A N Town of HUDSON III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) In AAS Ton-Pressurized In-Ground Pre nd ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation 600 -4 1 .500 1,500 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a o New Tanks Existing Tanks 1 L w u v `u ti bb IUD- WIRL, n. U C~ V) ir= U a. Septic or Holding Tank Dosing Chamber 800 0 800 1 WIESER X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si re MP/MPRS Number Business Phone Number PAUL KOEHLER 2254.10 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND WI 54017 VII County/Department Use Only Approved Permit `~Fee Date Issue S Issuing ent Signature 66 en Reason for enial $ / By, IX. Condi T IRReasons for Disapproval 3 1I tank, effitmffi ter and Aispemal cetl`:must all be SerVlC s / malntairted J per manapMent plan provided by: plumber. ' ~ ".1~►"~renta musf qe rrelintaflt _ r r n PK+PP Dods / ordWaMon. 4~ ts+?,uw ~et r ovt W 1 v: PQ. 6b.' 65 d a Attach to complete plans for the system and submit to the unty only ft paper not less thj° S u2 x I1 inches in sizeL) wo, ID C~ SBD-6398 (R. I I/ 11) PeA) J,l G~ I b L",_ P `dw-, 5~ pk,_ " vf✓r, ~a 1, ~c~are. i P ~b2 I f " LUI P/aPfs~ G~~-~ _ti Ga,r~~ Ci 90 4 V-1 9wh r~SDil a is L Com 7S Sid stir-k A3 1 ~G11c0 i i I t i pill P~aps.~P G~~-~ o rL 35 SE Fz ~yGs 01, w G v , rYsdrl PUc ~ a~ l r; ~ S i r ',lti Q t d G Q1 ~ ~ 2 l g~rv CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: COREY JOHNSON Owner's Name: COREY JOHNSON Owner's Address: 878 HIGHLANDER TRAIL HUDSON, WI 54016 Legal Description: NW 1/4 NE 1/4 SEC 25 T 29 N R 19 W Township: HUDSON County: ST. CROIX Subdivision Name: INDIGO PONDS Lot Number: 1 Parcel ID Number: 020-1439-01-000 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing &.Cross-Section r 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: PAUL KOEHLER License Number. 225410. Date: 9/8/15 Phone Number 715-246-2660 Signature Designed pursuant tothe In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page_of Project Name: 3 No. of Cells Per Cell ft Cell Width Total No of (D ft Cell Length 5 sq ft EISA Per Cell it Cell Spacing 5 b~ sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator E71203H-5ft 5.0' 25.0 EZ12031-1-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: 2 b w Gravelless Leaching Unit Model: 6 S Typical Cross Section Finished Grade" ft Observation Pipe with approved cap or vent Soil Backfill 'n Geotextile Fabric ■ ft Infiltrative Surface 12 in Q I I a `IV ft Limiting Factor min Slotted and Anchored Vent/ _ _ _ _ _ _ _ _ _ - . Observation Pipe with Cap ■ \ f ■ f ■ • Plumber/Designer Signature: License Date: Je ~pf~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner COREY JOHNSON Septic Tank Capacity 1,280 gal ❑ N' Permit # Septic Tank Manufacturer WIESER Ia No DESIGN PARAMETERS Effluent Filter Manufacturer d N4 POLYLQIK Number of Bedrooms 4 QQ NA [Effluent Filter Model 525 ❑ W Number of Public Facility Units ❑ NA Pump Tank Capacity son gal ❑ N r Estimated flow (average) gal/day Pump Tank Manufacturer ❑ N.a WTFqFR Design flow (peak), (Estimated x 1-51 gal/day Pump Manufacturer GOULDS ❑ N.4 Soil Application Rate al/da /W Pump Model EP-05 ❑ Na Y Standard Influent/Effluent Qualitq(8800D5,)j nthly average• Pretreatment Unit Q NA Fats, Oil & Greasmg/L El Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand 0 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solid0 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Q uality th{y average Dispersal Cell(s) d N,~ Biochemical Oxygen Demand mg/L l! In-Ground Igravityl ❑ In-Ground (pressurized) Total Suspended Solidmg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' ofu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other ❑ N,% 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: 3 ❑ month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and sour equals one-third (Ys► of tank volume ❑ NA Inspect dispersal cell(s) At least once every. ❑ month(sl (Maximum 3 years) ❑ Nit 3 ® year(s) Clean effluent filter At least once every: 1 ❑ month(s) Q Nit I ear(s) Inspect pump, pump controls & alarm At least once every: ❑ Ye rl 'ls! 11 N<, Flush laterals and pressure test At least once every: O month(s) 13 W. ❑ year(s) Other: At least once every: ❑ month(s) ❑ NF, ❑ year(s) other: ❑ NF, MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or ce"Itieations: 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 surfaos. 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 (Ys) 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 11:3, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmerrt units, and any servicing at intervals of S12 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. _ START UP AND OPERATION Pago ?,of For new construction, prior to use of the POWT$ check treatment tank(s) for the presence of painting products or other chern that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the coot 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 wi discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharg effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing operator prior to resto power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump control: 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 i within i 5 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 POW7S_ antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; 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 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. 1 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 wi 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 eomplia replacement system: 11 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptk systern. The replacement area should' be protected from disturbance and compaction and should not be infringed upon 1 required setbacks from existing and proposed structure, lot limes and wells- Failure to protect the replacement area K result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mu: comply with the rules in effect at that time. El A suitable replacement area is not available due to setback and/or soil limitations. barring advances in POWT technology a holding tank may be installed as a last resort to replace the failed POWTS. !v t alua. e a tZDI-s l8 YTM~ , N>a✓ Cans `772 n r O Mound and at-grade sod absorption systems may be reconstructed in place following removal of the biomat at tfn infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMFNT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NCI 15NTIER A SEPTIC, PUMP OR OTHER TRF-ATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF I PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR iMPOSS(SL.E. ADDITIONAL COMMENTS f POWTS Ii11STALLER POWTS MAWA1NER Name COUNTRYSIDE PLUMBING & HEATING, INC Nerve AUL KOEHLER Phone 715-246-2660 Phone I715-246-2660 SEPTAGE SERVICING OPERATOR (PWUPER) LOCAL REGULATORY AUTHORITY Name lf RELS SEPTIC SERVICE Name Ste. Cp,, (~1 Phone 15-4 25-1025 Phone --/S--U~y (p (7 This document was drafted in compliance with chapter Comm 83.22(21fb)11!(d)&(f) and 83.54(11. (21 & (3). wisconsin Administrative Code. I P, e w. e, SCc11TKC 1Y } 3 s--- 7, < i U )OIJ ~/YJ1rs'Ai_ ~~w^e~e3 f~rC'~nr i } ~ C - ~ G o~ ll . GOULDS PUMPS Submersible Effluent Pump MODEL 3871 EP04 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- Canadian Standards Association File # LR38549 • Heavy duty sump matic models include resistance. %Ipo' • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is 1509001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3/4' maximum. ■ EP04 Impeller: Thermoplas- N Power Cable: Severe duty • Capacities: up to 60 GPM. tic semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1112" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. METERS FEET 10- e Fasteners: 300 series + - - - + I stainless steel. I 9 30'-° - 5 GPM • Capable of running i ` dry damage to i - - rY 8 ( ! ! 2.s ff components. 25` I ! ! ! i 0 7 a - - - - Motor: _ • EP04 Single phase: 0.4 HP, v 6 20+ c - 115 or 230 V, 60 Hz, 1550 a - - I ! - = - -1 RPM, built in overload with } 5 I i " ! ! automatic reset. ° 4 15 - - • EP05 Single phase: 0.5 HP, - - - - ! - - + - t EP05 ! 115 V or 230V, 60 Hz, 1550 ! 3 10z RPM, built in overload with - 1 - J - - ------t- EP04 - " - - s' automatic reset. 2 • Power cord: 10 foot 5; standard length, 16/3 1 z i l - , S1TW with three prong i grounding plug. Optional 20 ° 0° 10 20 30 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug ' (standard on EP05). 0 2 4 6 8 10 12 m3/h CAPACITY Goulds Pumps © 2003 Goulds Pumps Effective July, 2003 ITT Industries B3871 'M000-Mld7A :3113 95-V8-5Z~-008 0 \ O9L4S IM 'N008 N301VW OL AMH Sn 9LL£M Z 21f10d-1SOd A3a 0-70-0700 'CVO 313801!00 -ivnNbW OLLd3S w LLJ =8nod-38d .o-,L=.4 l =31V0S dOM :A8 NMV80 m lOJ 008/08ZldlM N w W ' -3 W z0 FF-q w J m O D O z < v V) 0 0 F v~ a o fL d w w Q ~ c) < D m m C ~ Q o O w U < O a qkQ Z w 0- m 1<- Z~ M ~ O LL W o I-- z <-,c~ < F L`J o H O o o Z 00 W i q o a < N o< U LL > ~U ap o vi m Jww o D Lab z vN V) Q v O W of C? Mom a -oN 't~ e = v z d w o 00 D_ J~oo.rro0 w mw~ rio o <cia -1k < a CL N (n NIinOF-JO H I~ - < MN CID W0_ zz Y~ ~L.a W W < W P fn WU OZ Z~ 0- W Y Min'n-~Z~~ ~NV) z o4Za wN <0 Oc, z ..OF= J ON 0Zir U MF: 00 Hy oW 30 < Ow a w CL x oo Q zJ Z~0F- 05~ 0V 0m~ Q ZW d ~x NU F- ooo<wWOw? aIt <~O U 0 vv,o ~ go w9mUm<=JHmJ 0 Z 0!Y Oti < J J Or N ? ? J OJ Q U U I a H- V) U d ~ w Z H W~~ j O 12 iI II. I I ' a0' I : w ll ~ II. W II II D I •~I II: I_ w0 ,1 I I w I f 11 II II ( N Lij I in II II a I I I' in it Ir i ° LLI I J 0 J I I. u8~ 1. U jl w w< II I f W I.- M o I I < 11 II ws .s4 £ w ~ U I I II l A~ IE I I t W cr U L~ 0 H ih Z J < 0038 < cn sV z < - SES Controls Page 1 of 2 Home Careers Contact maw. v:. ti ,•:ri:, e. I Y.. M K. tidy g c ;v Search SJE-Rhombus SES Controls Build-A-Panels 4 Go Back to Ai! BAP Product Info l Featu-. • Mode, 114 . • Mode€ 115 Specs • Mode; 112 Downloads Model 122 • Mode; 3t2 • Mode 372 PS Patrol® • Mode! 22S • Model SGS • Model 113 • e1 1 t 2 ~ 3 Mode; Post Alarm With Receptacle for Plug-In Pump . Mode; 124 Control • Model 314 • Mode, 32 • Intnnsically Safe Post Alarm Provides Convenient Wiring Connection and System Retro Monitoring for Pump Station Applications • Model TD • Model DTD The PS Patrol® post alarm system features a built-in high • Model PS water alarm and provides a convenient location to connect all • IFS Drip wiring required for a pumping station application. • Model DP • Mode: RP • JB Plogger The PS Patrol® system employs a receptacle to accept either • Ultra Nator' a 120V or 230V pump and/or piggy-back pump switch. Vent • PS Patroliw holes on each side of the post help prevent moisture • Maffei 126 condensation inside the post. Available in 120V, 230V and 9 • Starter Boxes VDC models. • C-Level Starter - Boxes • SJE Oil Spotter- • SJE Ci' Spotter, Auto PS Patrol® Features: • Pedestal rated for outdoor use • Receptacle for 120V or 230V pump and/or piggy-back pump switch • Pull out assembly for easy wiring • Control switch provides alarm activation • Test/normal/silence switch mounted externally for easy operation • Separate 120V alarm and pump circuits • Red alarm beacon • No external cords • U.S. Patent No. 7,218,511 Options: • 120V, 230V and 9 VDC models • Factory-installed circuit breaker/terminal block • Factory-installed elapsed time meter (ETM) to log pump http://www.sjerhombus.com/ses-controls-build-a-panels-details.php?ID=33 5/7/2014 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address c,A_j V"--t> o Property Address At-I (Verification required from Planning & Zoning Department for new constructio . Cit)/State Parcel Identification Number LEGAL DESCRIPTION Property Location 14[4 '/q , Ri 'fa , Sec. , T Z-9 N R tot w, Town of 14 yi Subdivision _ 1, w6 ) i la Q Lot # Certified Survey Map; # , Volume , Page # Warranty Deed # 6'01 Volume , Page Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. what you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinancc. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your 'septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this force are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by v' warranty d recorded in Register of Deeds Office. Number of bedrooms SIG URIC OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) I I Will ~_~y i ~ Y rA 1 % 9940V Ai.ItIOZOOON N do y r•t t .oo " r ,6Z `LiP9Z MmO L, *ZeOON ~M 99 " R d~!$ _ 1XIER5 i L S \r T ° f, Qo <s q C 3 ~s! a~ 9g 'n II ~M F N c N - i-. 111 LAW 11 } et s a 6 -ti • =H j! PH I I i I Oo i M1 . Wisconsin Department of Commerce CAL Division of Safety and Buildings SOIL EVALUATION REPORT in accordance w' 1258 Attach complete site plan on with Comm 85, Wis. Adm. Code Page 1 of 3 inciude, butnot li PaPer not less than 8y x 11 inches in size. Plan must mited to: vertical and horizontal reference Steel Soil Service Percent slope, sale or di point BM , di Count memsions, north arrow, and location an(13M), distance o n and /'/ease Print all information. nearest road. Parcel I.D. O St. Croix Personal intormation you Provide ay Revi 0- Property Owner s. 15.04 (1) (m)), ewe y ROSAWI, L.L.C - Date Property Location Property Owner's Mailing Addres Govt. Lot 2141 Cty Rd. C na 2003 Lot NW 114 NE 1/4 S 25 City ate # Block # 1 Subd. Name or CSM# T 29 N R 19 New Richmond ' ~~-~1iTn11ber na - W KING 0 F J City J Village Indigo Ponds ')7~'7 1 Town Nearest Road New Construction Use: Hudson _ J Replacement Residential/ Number of Highlander Trail J Public or co bedrooms 4 Code derived design rate Parent material Sream commercial - Describe: flow terraces and pitted outwash plains 600 General comments GPD and recommendations: system elevations 89.80 Flood plain elevation, if applicable na Cafe - 60 s cad and depth to code 4.25 ft below grade _ El Boring # Boring - &0 % S ~OCcc,~' ~z pit Ground Surtace Horizon Depth elev. 94.0 ft. in. Dominant Color Redox D Depth to limiting fact Munseli escription Texture or Qu. Sz. Cont. Color Stti~re ----144 in. 1 0-12 10yr3/2 Consistence Bounda PPttcation Rate Gr. Sz. Sh. rY Roots Soil A 2 none sit i PD/lt= 12-39 10yr4/4 none 2msbk mfr cs 2c *Eff# *Eff#2 3 39-72 sicl 2msbk mfr •8 7.5yr4/4 none ~ sl 9w 1c .5 .6 4 72-144 7.5yr4/6 2msbk .4 none mfr 9w na .5 .9 All < Cos osg ml na na .7 1.6 s ~ Z Boring # J Boring h e Pit Ground Surface elev. Horizon Depth 94.05 ft. in Dominant Color Redox Description Depth to limiting factor 140 in. Munseil Texture Qu. Sz. Cont. Color Structure --Boundary ~ in. 1 0-12 10yr2/1 Gr. Sz. re Consistence Bound Application Rat Sh. none ~ Roots Soil PD/ft= 2 12-36 srl 2msbk 10yr4/4 mfr 3 none cs 2c *Eff#1 'Eff# 36-68 7.5yr4/4 sicl 2msbk none mfr CS .5 .8 2c .4 4 68-140 7.5yr4/6 sl 2msbk mfr .6 none cos gw na .5 c osg mvfr na na .7 1 ll "Effluent #1 = BO- > 30 < CST Name e _ 220 mg/L and TSS > (Please Print) 30 `-150 m9/L David J. Steel Sizyn`at ' Effluent #2 = Bpp ~ 30 mg/L and TSS < 30 mg/L 5130 Address Steel Soil Service 1564 CR GG, New Richmond, CST Number Wl 54017 Date Evaluation Conducted 248956 4/28/2003 Telephone Number 715-246-5085 Property Owner ROSAM3I, L.L.C Parcel ID pending IE Boring # Boring Page 2 of 3 il✓ Pit Ground Surface elev. 90.35 ft. Depth to limiting factor Horizon Depth Dominant Color 120 in. Soil Application Rate Redox Description Texture Structure in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots Gr. Sz. Sh. P , 1 0-6 10yr2/1 *Eff#1 *Eff#2 none sil 2msbk 2 6-39 mfr gw 2c .5 10yr4/4 •8 none sicl 2msbk mfr gw 1 c .4 .6 3 39-55 7.5yr4/4 none sl 2msbk mfr 4 55-120 cs na •5 .9 7.5yr4/6 none cos osg ml na na .7 1.6 ❑ Boring # -j Boring :J Pit Ground Surface elev. Horizon Depth - ff. Depth to limiting factor Dominant Color Redox Description Texture in. Soil Application Rate in., Mansell Qu. Sz. Cont. Color Structure Consistence Boundary Gr. Sz. Sh. Roots P 'Eff#1 *Eff#2 ❑ Boring # :J Boring -j Pit Ground Surface elev. Horizon De th ft. Depth to limiting factor P Dominant Color Redox Description Texture in' Soil Application Rate in. Mansell Qu. Sz. Cont. Color Structure Consistence Gr. Sz. Sh. Boundary Roots P /ftz *Eff#1 *Eff#2 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < The _ 150 mg/L _ Department of Commerce * Effluent #2 = BOD < is an equal opportunity service provider and employer. If you need 30 assistance to acces sservces or need material in an alternate format please contact the department at 608-266-3151 or g TTY 608-264-8777. STEEL'S SOIL SERVICE IN C. 3 of3 David J. Steel C~ CST-POWTSM 1564 Cty Rd GG 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 i 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. I00.00Ft Top of 1/2" pvc pipe • = Alt Benchmark Ele. 100.35Ft Top of 1/2" pvc pipe ❑ = Borings A 1 Boring Elevations BI = 94.05Ft Gl~ B2 = 94.05Ft B3 = 90.35Ft B4 = OO.OOFt G f*a 5 c 3 /r o y s 27--Zy7 " _ 135.03 , 6 r sw 4' 97744 S,F• 5. (2.244 AC.) ' 92458 (1.058 AC. N.B.P.A,) ' 8$27 .S~.F f h (2.123 AC.) 2.0265 AC.), X' (1.578 AC. N.B.P.Af) { 1J217 AC. N.B,P.A.}, { J; ; .ass / ` - ~V r ~t 071 AC. 1 1.442 AC, N.B.P A. -00 f 91811 87839 S.F. ~9 t (2.108 (2. 16 AC. lo 1 (1.090 AC. N,B.P.A.~ AC. N.B.P.A.) d' "jt,1 - \6'~ ~r dam' - ~ _ ~ / t`: ~ r ~ ``315.6_6 w j~. -157 s2' ` f / s~ t' 157194 SY . 157.92' ``(3.609 AC.) 1.022 AC. N.B.P.A. r , r 116.13' 1.79 s8L -52 s' --__96690 .F,-' ' t ! (2.220_AC r (1.114 AC. N.B.P A.~J J f ~y r f r f . 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 pet nor special exception permit are required if you decide to build on the lot inrthe 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: Jennifer 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 F From: Jennifer Shillcox Sent: Tuesday, April 17, 2007 10:31 AM To: 'dan.baumann@dnr.state.wi.us' Cc: Ryan Yarrington; Kevin Grabau; Steve Olson Subject: Lots 1 and 6, Indigo Ponds Subdivision Hey Dan, Thanks for getting back to me so quickly. As I mentioned over the phone, we met with a builder who will be constructing houses on Lots 1 and 6 in the Indigo Ponds Subdivision in the Town of Hudson. According to the builder, Lot 1 has a large pond which shows up as a drainage easement on the preliminary plat. I am guessing this is a man-made storm water retention area and that shoreland regs do not apply. On Lot 6, there is a small pond/wetland that shows up on the preliminary plat as having an OHW elevation of 919.6 with a 75-foot setback platted. The builder also submitted a copy of survey that shows the wetland having an OHW elevation of 923.86 per the final plat. I have attached a copy of the preliminary plat and the survey for your review. I need verification on whether or not this is a navigable pond. Let me know what you determine after you've seen the site on Monday. I appreciate your help! Thanks again, Jenny Shilicox Land Use Specialist St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, WI 54016 Phone: 715-386-4682 Fax: 715-386-4686 Lennifers a(~co.saint-croix.wi.us Lot 6 Certificate of Lots 1 and 6 - Survey.jp... Indigo Ponds Su... . . , k h e 1 Page 1 of 1 Pam Quinn From: Pam Quinn Sent: Wednesday, September 14, 20114:58 PM To: 'steve west; 'Mark Erickson' Cc: Kevin Grabau; 'Wenholz, Michael D - DNR; 'Pericak, David M - DNR; Steve Olson; David Fodroczi Subject: Sarrack Lot 4 Indigo Ponds and Shoreland zoning Attachments: Indigo Ponds wetland delineation.pdf Hi All, After extensive review of documents contained in the Indigo Ponds subdivision development folders, it does not appear that lots in the northerly portion of the subdivision were intended to be subject to Shoreland zoning requirements. The attached 2003 wetland delineation identified the area on Lot 6, labeled "wetland" on the plat, as a depressional area, not a navigable water body. Mark Erickson has taken time to research the navigability issue and provided support for a finding that the area on lot 6 is non-navigable and should not be subject to the filling and grading permits required under county Shoreland Zoning. The "depressional area" on lot 6 is within a recorded 75' setback and drainage easement, which will provide a buffer against land disturbance occurring on adjacent lots. Permanent stabilization of disturbed areas is required in Item 7.3 and erosion control during construction is required in Item 7.9 of the recorded Declaration of Protective Covenants (Document 770482). A hand-written note by a county staff member was attached to a copy of the preliminary plat, which specified the following lots within 300' of the year-round Indigo Ponds as being subject to Shoreland zoning: 36, 37, 38, 39, 40, 41, 45, 46, 57, 49, 50, 51, 52, and 53. The Town of Hudson zoning ordinances are applicable for lot 4, but not the county Shoreland overlay district. I have issued the sanitary permit for Lot 4 and recommend that the special exception and land use permit applications be withdrawn. The application fees paid for the special exception and land use permit will be refunded. The Sarracks may now obtain a building permit from Brian Wert and proceed with the construction of their house, driveway and septic system subject to town ordinances and recorded subdivision covenants. Pamela .2uinn4 Zoning Specialist (POW13) St. Croix County Planning & Zoning Dept. nol CarmichaeCRoad Hudson, "WI 54016 715-386-4680 ,2amg(a,co.saint-croix wi us 9/14/2011