HomeMy WebLinkAbout020-1439-57-000Wisconsin DepartrrLant of Commerce
Safety and Buildin~Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
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
Ulrich, Karl Hudson, Town of
CST BM Elev:
ltd 0 ~ ~ Insp. BM Elev:
~D ~ BM Description:
~..~ ~. ~ oa.p. ~._
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic A ~ `
L~~v-tom /
Dosin
Aeration _ ~ ~~ ~ ~~
Holding /ti~
TANK SETBACK INFORMATION
TANK TO P/L WELL
~~ BLDG.
~^ Vent to Air Intake
~' ROAD
Septic ~ ~ / ! f ' ~ ~
Dosing y (V
Aeration
Holding
PUMP/SIPHON INFORMATION ~~1~~ -Y'~(AlJ
Manufacturer Demand
GPM
Model Number
TDH Lift Friction Loss ystem TDH Ft
Forcemain Length Dia. Dist. to Well
Cf111 ARC(1RPTICIN CVSTFM 7f\ ~ . ~ .,4- / 1 ~ ~ti . A'
K
`/
~~ ~ _ w~" ~
BED/TRENCH
DIMENSIONS Width / Length ~ No. Of renches
'~~ fj ~ I ~
11 PIT DIMEN NS No. Of Pits Inside Dia. Liquid De"pth~ ~ ' "
~a.v-U 1N~-
SETBACK
INFORMATION SYSTEM TO P/L BLDG WEL LAKE/STREAM LEACHING
HAMB T Manufactured- 'L _ L V,
.-~~i'- -] 1~C~J
Typ Of System: ,~,, n ~
(~V ' ~""r ~)
~ J `~/ p~ r
~ J ~ / .~ Model Number ,~ •i
111S.T-RIRI ITI()N SYSTEM O) µ^''' ~ l~ / ~f7" ~•~•i 'i"rf Lvt -~f'VA~.. D~-~f
Heade anifold (~r{
Distribution
)) r x Hole Siz~ x Hole Sp cing
'~`- Vent to Air Intake
'
i y
~ ~
Pipe(s)
h I ~~ Di
S
i ~0~
Length Dia ng
a
pac
Lengt
Cnll (_ FR ., o.e«.,.e c..~~e..,~ n..i.. .... Mnnnrl Clr Af_f~rarla Systems Only
Depth Over 1 Depth Over - xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~ Bed/Trench Edges Topsoil ~ yes ~ j No i ]Yes (.~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/ ~a~ nn Inspection #2: / /
Location: 877 Badlands Road Hudson, WI 54016 (NE 1/4 SE 1/4 24 T29N R19W) Indig~i Pon s Lot 57 ~y_ / Parcel No: 27. 4.29.19.2j8~~ `nom
1.) Alt BM Description = ~ `~ ~ ~ ~ ~ U '~(,(jy~- `/'O~~r-6~-~~ ~[~-
2.)Bldg sewer length - ~ ~ '~` ~',
-amount of cover =~ 21, t~
___ (~~ s
Plan revision Required? ~`] Yes !. No i ~ ~ l/
Use other side for additional information. ~ ~__ ~ .! ~O __ ~ ~
Date Insepctor's Sig ature Cert. No.
ELEVATION DATA
County: St. CrOIX
Sanitary Permit No:
479288 0
State Plan ID No:
Parcel Tax No:
020-1439-57-000
Section/Town/Range/Map No:
24.29.19.2783
STATION BS HI FS ELEV.
Benchmark ~~, r7 ,~ /~~~~
Alt. BM
'h~' ti ~lrra
o• 3
/~ y yS
B ~. Sewer Q~Ih Z, ~ /D 2 • u
SUHtlaletL~ ~ f ~r yf S 3 ~,g'
St/Ht Outlet D~ ~ ~Z ~, 2.. 3
Dt Inlet ~
i
Dt Bottom ~ ~
Header/Man. O. 3 Gj ~,
Dis Pt ipe /p. 2~
Bot. System 4 •S''
~'
r
~ fir, L~
~3
~ ~
Final r de w ~ ,, A ,,
St Cover ~ ~ _ ~ r ~ 3 3 L[
7 ~ ~ ~ . (L ~
7
~ljrr
Safety and Buildings Division
Washington Ave x 7162
L~1 V1F County ,Q ~
~T. C /~
~
.
IO ~ ~` M~~ `"~ 53 - ~
~A er (oo filled in by Co.)
mb
Permit Nu
r
. ,SCOOS
(608) 266- 151 `" , -
7
~ '
De artment of Commerce
Sanitary Permit Application ' ~u~ ( ~ ;, State PI I.D. Number
vide
r
formation u
l i
d
o
p
n
e, persona
[n accord with Cotnm 83.21. Wis. Adm. Ca
may be used for secotdary purposes Privacy Law, s15.t)4(1) ) Zp
N lX ~~''"~ Projec Address (i different than mailing address)
NI
I. Application Information -Please Print All Information
Property Owner's Na me
/ ~ Parcel aY LotC lock X
/'~
T' [/!
~
' u
Property Location Q 3~- S 7._.
s M ailing Address
property Owner
L~ _ C ~
.[~ULtA lf,y~_u.Section __~
try, State Zip Code P
~ / (circle t-e)
T ~ ~ N; R,~~E or~
l
h
' ~
at app
y)
Iding (check all t
II. Type of B
3
Subdivision Name CSM Number
~
~ r
0 1 or 2 Family Dwelling -Number of Bedrooms ~ ou etQ-
ib "~
e Use
^ Public/Commercial -Descr
^ State Owtted - 'be U , / -
y ^City ^ViUage ®'Township of ~uaro
III. Type of Permit: ( eck only one box on line A. Complete line B if aPP
A' ®Ne~V System
`.-~~ ^ Replacement Sysum ^ Treaiment/Holding Tank Replacement Only ^ Other Modification to Existing System
B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber Owner
][V. of POWTS S stem: (Check all that a 1 )
Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Sit-gle Pass Saud Filter
^ Conswcted WetlaM ^ Pressurized In-Gro iag Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter
^ Recirculating Synthetic Media Filter ®Leachin Cham ^ Drip Line ^ Gravel-less Pipe ^ Other (explain)
V. Dis rsal/Treatment Area Ltfor ` o -
ign Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
;.~
,~. yQ
lj 'U o . s ia.~~ ~a,~. 9 .
o
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Cotutructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank ~,
V -
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's ' gnature RS Number
MP/
M
P Business Phone Number
AA
''
`
Plumbe ' Addre ss (Street, City, Stan, Zip Code)
.Z'"
Count /De artment Use Onl
Approved ^ Disapproved Sanitary Permit Fce chides Groundwater
Surcharge Fee)
~ Date Issued
~
f uing~r a Stamp)
^ Owner Given Reason for Denial 3d ~. ...
, Jr 0
.7
](X. Conditions of ppprovaUReasons Por Disapproval
YSTEM OWNER: _ 3 ,,,;~~ !~ ~ G~llt~r~~~ ~_~~
1 Septic tank, effluent filter and /~ ~~~~ ~Q( !00- -
~~/ ~/'~
ll must all be serviced /maintain ~~~
l
i
~
_
ce
spersa
d
as per management plan provided by plumber. ~ ~e~'`v t, uu,Q~ d 2. /'~.0-u~Gat-1~.
~t~y CST. .~y~l•~'~l
d
~
2. All setback requirements must be maintaine
lits per applicable code/ordinances. ~v ~~t,~-~ti„ die y~ -P-~~ ~ avita~~2a~mmt~
0 ~- ~ ~- ,d~rx.~d ~ ~- G~~ '~ ~
(/ - •••,••••• .wwnpwo P+~ tw roa wuuq ~r71 ivr ~ Sysr® oa parper' rq[ rCbS roan 81/L x 11 1M:nlS ID Stx!
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Chamber
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'PLOT It CROii SECTION PI
IJIPPA 6ROi. EXGIYATIN6
. P~IyrMIMl6 UNIT
" PiW`~CT
uc~E: ~2 ~ `7 S'`I
DATE: ~ •~~• a~
SOIL?Ea BY:
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T~„tcN 8a,+~., ~~vATrex, 0~ Sack
A = 9~•~S
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Sro~ V iEw
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IAPPA 6ROi. EXGIYATING
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The Stands
~r _
- y•a~ ~~~ PEE
Chamber
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uc~: U12 ~ ~'`7
Or1T@. ~ ~ ~~~ U ~
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P. 3 ~.3
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Vlfiscorrsirr Deparfinerd of Cornrnerce S L E~Q,I~~ ~PO ~'~ ~ ~ 1 of 3
Division of Setiely acrd B :. ~ ,.,a~. ......,, ~ w~ e.a„ r~ ~:. A.C.E. Sod 8 Site Ev~tions
U ~ ~ OU`?
t
' s¢e.
Attach oorr~lete site plan on paper rat less than 8'r4 x 11 ir>ches St Croix
indude, but rat kmited to: vertical and trarizardal refiererrce point ,direction and ~
~
~ t r~41
ce11
D
fidet
„
percent slope. state or dNnemsiars, rarth arrow. ~d bcation and fq t1~it~
ZONINGOFt- '-.,
+~E .
.
020-1439-54-0
please printaNy-/omta~fon. R
Plersorral idarrr~ion yorr provide mey be used tar seoordaY WV~ (~~Y law. s.15.04 (1) (m)). ~ ~ ~
Property Owner
Rosamji, LLC. Property Loc ation
1!4 SE 1/4 S 24 T 29 N R 19 W
Property owner's g Address Ld # s, Subd. Name or CSN~
2141 Co. Hwy. C g Plat Of Indigo Ponds
Cdy State Zip Cade Phone Number dY ~ Yrdage +~, Town Nearest Road
New Richmond ~ WI 54017 715-248-7071 Hudson Sumac Trai
--_
ti~ New Construction ~~ Residerdial ! Number of bedrooms 4 Code derived desi~r flow rate 600 GPD
;~ f Replaoernent Public or oonxrNm~ - Descrdire:
Parent material Glaaal outwash Food plain elevatlort, if atppficable na
Gerd oomrrrer><s
and recorrMrrendatiorrs: Inst~ conventional POWTS using two trenches with combined E.I.S.A =1,200 sq. ft at elev. 92.75 8
91.50'.
o~~
/~ Pit Ground Surface elev. 97.38 ft. pepm ~ Ong factor >116" pir. Sol Application Rate
Fbrizon Depth Dominant Color Redox Description Texture Structure Corrsistenoe Boundary Roots GP D/IF
in. tlturtseN Qu. Sz. Cord. Color Qr. Sz. Sh_ 'Eft*1 'Eff~2
1 0-113 10yr'3/3 none 1 2fcr mv(r c4 3fm,2c 0.6 0.8
2 113-34 10yr4/4 none sd 2fsbk mvfr cwr 2fm,1 c 0.6 0.8
3 34-45 10yr5/4 none si 2fsbk mvfr cw 2f,1 m 0.6 0.8
4 45-63 10yr416 none sl 1 msbk dsh aw 1 vff 0.4 .07
5 838 7.5yr4A6 none Is 0 sg dl aw 1vf 0.7 1.6
6 68-96 10yr518 none s & Is 0 sg dl cvv 1vf 0.5 1.0
7 96-116 10yr4/4 none Icon 0 sg ml - - 0.7 1.6
Z /. ~- '7G
Boring ~ ~ Ground Surface elev. 99.02 ft. peplf, to ~rrdUlg factor > 128" m. Sod Apphca6on Rate
Horizon Depth Domirmrt Color Redox Desaiption Texdre Sinatiue Consistence Bourdary Roots GP D/flz
~. luhm,~eq Cu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 'Eff#l2
1 0-24 10yr3l3 none 1 2fcr mvfr cq 3fm,2c 0.6 0.8
2 24-34 10yr4/4 none ~ 2isbk mvfr cw 2fm,1c 0.6 0.8
3 34-44 10yr5l4 none std 2lsbk mvlr ctnr 2f,1 m 0.4 0.6
4 4l6 none 1 msbk dsh aw 1 vff 0.4 .07
5 54-7 7.5yr416 ~` non ~. Is 0 sg dl aw - 0.7 1.6
6 10yr5/6 n
l~6 of ~ Osg ~ s 8 y Oyr4i4 t)sg gr I
,;~ reduced y of hor sg - - 1.0
s too numerous to differerdiate. Loading rate of hormon adjusted to
izon due to texhaal changes.
` Effluent s1 = BOD ~ 30 <_ 220 mglL TSS >30 < 1
CST Name (Please Print) Side
James K Thompson
Address A_C.E. Sad 8 Site Evakratiorrs
340 Paulson Lake Lane. Osceola. 54020
' Efftifent s2 = BOD <30 mgll. and TSS <~0 mgll
CST Number
_ s 3so2
Evaluation Telephone Number
624/2005 715-248-7767
®~y~
126.E S~
ply orrr~ Rosamji, LLC. p~ Ip g 020-1439-54-000 Page 2 of 3
~9 ~ ~ Ground Surface elev. 97.56 tt. Deplh to Nrniting factor > 118" in. ~ gppp~ Rai
Horizon Depth
in. Dama~nt Cola
AMxrseA Redox Desaip4on
Qu. Sz. Cont. Color Tee Stnrchxe
Gr. Sz. Sh. Carrsistenoe Boundary Roots
`Eti~1 'EYFi2
1 0-16 10yr3/3 none ~ 2fcr mutt cq 3fm,2c 0.6 0.8
2 16-28 10yr4/4 none si 2fsbk mutt cw 2fm,1c 0.6 0.8
3 28-38 10yr5/4 none aid 2h3bk mvfr cw 2f,1m 0.4 0.6
4 38-54 10yr4/6 none sl - 1msbk dsh aw 1vf,f 0.4 .07
5 54-59 7.5yr4/6 none Is 0 sg d aw - 0.7 1.6
6 59-118 10yr51G none s Is 0 sg ~ - - 0.5 1.0
H~16 oorMains several straFified layers of t Oyr Osg ~ s 810yr4/4 Osg gr is too ntxrterous to ~fferen~be. t.aadutg rate of horiaon adjusted to retied
.~ / ~~- ,~~educed per of hormon due to tee d,anges.
~ ~.:1
,J Pit Ground Surface elev. tt. ~ ~ 8 fader ~. ~ gpp~oalpn Rate
Hor¢on Depth Dominant Cobr Redox DesaQfion Texture Stnx~rxe Cans's~noe Boundary Roots
in. MunseN Qu. Sz Cont. Color Gr. Sz Sh. 'Eff~1 'E8#2
• Etfbent ~1 = BOO ~ 30 < 220 mglL aid TSS >~ < 150 mgJt. * Eft ~2 = BODS <~ mgll and TSS <30 mgJL
The Department of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY608-264-8777.
f-l o...~.... ~ Bores
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// tgad ids 35V.~ ^So,/ a/a/ua~;on~o;~
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\ Asset r+sed ¢!¢a: _ !L8 AD;
03.s0~
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P. 3 ~.~
Wisconsin Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
in accordance with Comm 85, Wis. Adm. Code
1294
Page 1 of 3
Steel Soil Service
County
Attach complete site plan on paper not less than 8% x 11 inches in s¢e. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
Parcel I
D
percent slope, scale or dimemsior>s, harrow, and Location and distance to nearest road. .
.
pending
Please pr tall ~~~~ R iewed Date
Personal iMormation you provide may used for secondary purposes (Pnvacy t.aw, .15.04 (1) (m)).
t !! 6
Property Owner ~7A~ 1 3 Zd~~ Property Location
ROSAMJI, LL.C Govt. Lot na NE 1l4 SE 1/4 g 25 T 29 N R 19 W
Property Owner's Mailing Address ST. Cf~01X CO~r~ i y, Lot # Block # Subd. Name or CSM#
2141 Cty Rd. C ZuN;,vG C~FFI ~~ 57 na Indigo Ponds
City State Zip Code Phone um J City _( Village ~ Town Nearest Road
New Richmond ~ WI 54017 715-248-7071 Hudson Sumac Trail
1/ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement _J Public or commercial - Describe:na
Parent material Sream tettaces and pitted outwash plains Flood plain elevation, if applicable na
General comments
and recommendations: system elevation 92.85 ft, trenches spaced and depth to code 6.00 below grade
Ste.- Z oo ~ Co -~ ~ CoS - 3s~ < p ~o /lee.~' leo " ~ 3Sr'?o ~~ 3 6 "
Boring # -:~ Boring
120
/~ Pit Ground Surface elev. 98.85 fl in.
. Depth to limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-4 10yr2/1 none I 2msbk mfr cs 1 c .5 .8
2 4-12 10yr4/4 none sicl 2msbk mfr gw 1f .5 .8
3 12-24 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6
4 24-39- 7.5yr4/4 none sl 2msbk mfr di na .5 .9
5 39-120 7.5yr4/6 none cos osg mvfr na na .7 1.6
72" b -- !off s 3 ~ - d `' l~-~LJ -~~
~Z ~(o o = /32 ,
Boring # ~ Boring
J/ Pit Ground Surface elev. 98.$5 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIflz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr2/1 none I 2msbk mfr cs 1c .5 .8
2 12-20 10yr4/4 none sicl 2msbk mfr gw 1 c .5 .8
3 20-39 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6
4 39-60 7.5yr4/4 none scl 2msbk mfr di na .4 .6
5 60-120 7.5yr4/6 none ms osg ml na na .7 1.2
* Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 3o mgit_
CST Name (Please Printj natu~ CST Number
David J. Steel _ 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 5/7/2003 715-246-5085
Property Owner ROSAM]I, L.L.C Parcel ID # Pending Page 2 of 3
Boring # J Boring
~/ Pit Ground Surface elev. 89.80 ft. Depth to limiting factor 135 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rests PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-14 10yr2/1 none sl 2msbk mfr gw 1 c .5 .8
2 14-45 10yr4/4 none sicl 2msbk mfr cs 1f .4 .6
3 45-64 7.5yr4/4 none scl 2msbk mfr cs na .4 .6
4 64-135 , ~ 7.5yr4/6 none cos osg mvfr na na .7 1.6
_ ~.M
ZooZ f Gv~-
COS <35% coarse fragments = 36" &
>35% - <60% = 60" below system
Boring # ~ Boring
f/ Pit Ground Surface elev. 88.10 ft. Depth to limiting factor 120 in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr2/1 none I 2msbk mfr gw 1c .5 .8
2 12-31 10yr4/4 none sicl 2msbk mfr cs na .4 .6
3 31-52 7.5yr4/4 none scl 2msbk mfr gw na .4 .6
4 52-120 7.5yr4/6 none cos osg mvfr na na .7 1.6
t'O d it Y~!-~Q.s-e
^ Boring # J Boring
_f Pit Ground Surtace elev. ft. Depth to limiting factor 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
* Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
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 NE1/4,SE1/4,S25,T29N,R19W Bus.(715) 246-6200
Town of Hudson, St. Croix Co. Fax.(715) 246-9372
Indigo Ponds Lot 57
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
the time the soil test was conducted. Legend
1" = 40'
• =Benchmark Ele. 100.00Ft
Top of 1/2" pvc pipe
• =Alt Benchmark Ele. 100.40Ft
Top of 1/2" pvc pipe
^ =Borings
Boring Elevations
B 1 = 98.98Ft
B2 = 98.85Ft
B3 = 89.80Ft
ua = uR ~ nFr
t
_~
,6~.-y .,gyp ~. . ~-: •:r GJ x ~;f `,
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~ ~~ _ // r- __`66.. _o:/ _ ~~ ,~ ~ ~ ~ ~ of
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~ iii ~ „~ u , g2, ,~ `-~ ~~\ ~ k , ~' oNO ~~ '~,°.
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4i .g0 /., c3`o: ~ C ' DRAINAGE EASEMENT to ~ ~ ~ ~ / ti
NTER LINE " ~ - ' ~/ ~y ~ ~.-) ~~
/~/ BADLANDS ROAD . ~ .~, 201. 9 - /,.~"~- .~- ~~)
..
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OwnerBuyer Y 1
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
~-
~ VI l P t L
1
Mailing Address //~~ -- II
Property Address ~ ~ ~ 1~(~ ~ ~ ds ~ ~ ~
(Verification required from Planning Department for new constru ion)
~ X20 ~ 1 ~~5'- ~ 7
City/State ~~ V Sc) I/1 W ~. Parcel Identification Number
LEGAL DESCRIPTION o a,~g 3~ rJ 1
Property Location ~ '/,, S~ %4, Sec., i Z~ N-R~W, Town of I" l VGt.s~
Subdivision T^~,-~„ ®n,,,~ s Lot # ~.
Certified Survey Map # .Volume ,Page #
Warranty Deed # 7 ~ ~] ~ CJ ~ Volume ~ o~ ~ ,Page # L d ~
rya. S~~P y$t
Spec house ^ yes Q no Lot lines identifiable @ yes ^ no -
-- ~ ~ U
SYSTEM MAINTENANCE
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 yeazs 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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, 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 Zoning Office within 30
days of the three ear expiration date.
/ /O
SI F APPLICANT DATE
OWNER CERTIFICATION
I (we) ce 'fy 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 desc bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
7/- l05'
SI NATURE OF APPLICANT DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
. . ' ~ POWT8 OWHER'S MANUAL & MANAQEMENT PLAN
eEgIGM PARAMETERS
Number of Bedrooms 4 O NA
Number of Public Fat~'ity Unia ~ddA
Estimated fk-w Iawragel 400
Design fbw IP••kl, (Estimated x 1.Si 600 d
Soil Application Rste /fti
and Infiusnt/Effiuant O~uaaty
Fats, Oa b I
Biochemical Oxygen Demand (BODeI
Total Suspended Sofds !'rS31 Monthly average.
S30 ~ti
5220 nglL O NA
6150 mg/t.
Pretreated Effluent Ou•aY
Biochsnrtical Oxygen Danand IBODe!
Total Suspended Soads fTSSI
Facsl Conform Igeontetric meanl Monthh/ eversge
S30 ~-
S90 ~ ~
s1 1
Maxinwm Efikrent ParticN Site Ye in dia. O NA
Oeher. D~IA
'Vak~es typkst for don~esdc wastewater and septic tank etflwnt.
swgresa ~clacntloN:
P+w~~~,.
.Septic Tank Capattytty 12 5 0 O NA
Septic Tank Manufacturor Wieser O NA
Effktent Filar Manufsctttrer Zable O ~
Effluont Ater Modal A-1800 O NA
pump Tank Capacity DNA
Pump Tank Manufscturer DNA
purrs Manufaattrrer DNA
~ DNA
Pretreatment Unit
O Sartd/GravN Filar
O Medtanioal Aeration
O DWrtfection
O Past Filter
O Wetland
O Odrsr: DNA
Cealsl
k~-Ground IOravil'YI
O Drip-Line
k~•Gnound Ipro:
O Mound
O Other. O NA
~ed1
Other: ®NA
Otlrr: ~ NA
Other. ®NA
f1AAaNTENANCE SCHfEDYLE
Service Event
Servke
FtequarwY
Mspect condition of tank(s) At Nest once every: 2 0
( (~1dlniMn 3 ysarsl
O NA
n ewrttbined sktdge
Wh and scum equMs °M't~d IXeI of tank vokrrrte O NA
Pump out contents of tanklsl e
Inspect dispersal cealsi At Neat once every: 2
~ frtonthle! g r••r•1
sl O NA
~ ~ ~1~ O NA
Clean effkrent filter At Nest once ~~
monthlsl ®NA
Inspect PAP. PAP oontro~ & alarm At Nast once every: O
mo ~Isl Q~ NA
Flush ktersls and presaue test At kart once every: O
mon =1si ~ ~
Oo+er: At Nest once awry: O
~. Q~ NA
MANITENANCE INSTRUCTIONS or grtfications:
Inspections of tanks and ditpersN cells shsa be made by an individual carrying one of the folbwirq NOMINe
Master Pkunbar: Master Plumber Restricted 8swer POWTS Inspector POWTS Mahtainer, Septage Servicing OPK•~• Tank
inspections must include a visual inspection of the tanklsl to identify arW missing or broken hardware. identify any cracks or Nska,
messure the vokrrrw of combined sludge and atxun and to check foc any back up of ponding of eHkrent on tM ground surface.
Tire dispersal csalsl shsa be visuasy inspected to check the effktsrtt NveN in the observation Pips and to check ~ anY
of efNuent on the ground surface. Ths ponding of effluent on the ground surfaos may indkste s faiang tmndition and requires
knmediate notificstion of the local regulatory authority. ~
When the f ~bme k shwa romowd by • Ssptage Servicing Perator and dNposed of accor~danos chapter NR~e
contents
Wisconsin Administrative Code.
Aq other services, inckKling but not arrdted to the servicing of etfluent filters, msdtt+nicsl of pro:svrNed oornpo~~. Pfetr••~t
w-its, and any servicing at intervab of St2 n-onths. dtsa be P~a~'bY s ~~ ~W~ Maintainer.
A service report shad be provided to the bcal regulatory audrority within 10 days of oompledon of any eervioe event.
GUAV1l µ/p1)
. - Ps~e ~,,~of
sTART UP ANO OPEIRATION
for new construction. Prior to use of the POWYS check treatment tanklsl for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cenlsl. If high concenvations are detected have the contents
of the tanklsl removed by a septage servicing operator Prior to use.
System start up ahs0 not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fin above normal highwater levels. When Power is restored. the excess wastewater will be
discharged to the dispersal cents) in one large dose, overloading the cellls) and may resuR m the backup or surface discharge of
effluent. To avoid this situati~n contact a Pk~mber or POWYS Ma tsin~to~assist i~ m~anuaNy oPeratM9~the pump tc ^e~sta rmtgo
power to the effluent pump
restore normal levels within the pump tar-k•
Oo not drive t down slo is of any mound or at-gradeasoil albsorptiontarsa. ~ p~ ~~ ~ otherwise disturb or compact, the area
within 15 fee Pa
Reduction or elimination of the folbwing from the wastewater stream may improve the performance and prolong the life of the
P01NTS~ antibiotics; tiaby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; fat;
foundat'wn drain (sump~pumPs~ ~•~ Pkina~ tampons;land water softener brine. e; herbicides; meat scraps: medications; oil;
painting products: pest
ABANDONMENT ~ taken out of service the following steps span tie taken to insure that the system is
When the POWYS fails and/or is permanen Y
proPedy and safety abandoned in compnance with chapter Comm 83.33, WisconsM Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
d sed of by a Septage Servicing Operator.
• The contents of all tanks and pits shall be removed and property ispo
• After pumping, all tanks and pits shall be excavated and removed or they covers removed and the void space fined with
soil, gravel or another inert solid material.
CONTINQENCY PLAN
If the POWYS fails and cannot be repannrod the fonowing measures have been. or moat be taken, to Provide a code tom ant
roplacement system:
~ A suitable replacement area has been evalu ~ from disturbance and compaction andofsl oukl note bye 'Mfringed upon by
system. The replacement area should be prof the replacement area will
required setbacks from existing end proposed structure, lot lines end wens. Failure to protect
resole in the need for a new soil and site evaluation to establish s suitabb replacement area. Replacement systems must
compN with the rules in effect st that tune.
p A suitable replacement area is not available due to setback and/or soil limitations. Bsmng advances m POWYS
technology a holding tank may be instaned ss a last resort to replace the failed POWYS.
^ The site has not been orated to locate a suitabk,repllacemena ~ no replacement ares~ ova able a holding tank
evaluation must be pert
may be installed ss a last rosort to replace the failed POWYS.
O Mound and at-grade son absorption systems may be reconstru with the Iru esfin effect at that time. ~e biomat at the
infiltrative surface. Reconstructions of such systems must con-PN
< <WAIININQ> >
SEPTIC. PUMP AND OTHER T ~~~ENT TANK NDER ANLY CIRCt1MSTANCESDroDEATHS~CI ~ u ~ t~SCUE OF A
ENTER A SEPTIC, PUMP OR O
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POW'TS MAINTAINER
POWYS INSTALLER Name Count Ben Mor an
Name of ~
Phone 715-386-2130
Phone 715-386-2850
LOCAL REGULATORY AUTHORITY
SEp7'AGE SERVICING OPERATOR IpUMPERI
Name St. Croix County Zoning Offc~ e
Name Tri County (Ben Morgan) ~~ 715-386-4680
Phone 715 - 3 86- 213 0 . ~~ ~~ Code
This document was drafted h+ compliance with chalxw Comm g3.22121(b11111d161fl and 83.54111, (216131.
` ~\
' i1 2 8 ?_ 5 P y 8 1 797997
KATHLEEN H. MALSH
State Bar of Wisconsin Form 2-2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO. , MI
RECEIVED FOR RECORD
Document Number Document Name
06/20/2005 10:30A?I
MARRAt1TY DEED
EJfElPT #
THIS DEED, made between ROSAMJI, LLC REC FEE: 11.00
("Grantor," whether one or more), COPYSFEEE ~ 330.00
and Karl P. Ulrich and Stephanie S. Ulrich, husband and wife CC FEE:
PAGES: 1
("Grantee," whether one or more).
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address
interests, in St. Croix County, State of Wisconsin ("Property") (if more space is The First National Bank
please attach addendum): PO Box 89
Lot 57, lat of Indigo Ponds in the Town of Hudson, St. Croix County, Wisconsin. New Richmond, WI 54017
020.1439-57-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated
/l OD n ~
Traci:' !_ Turner
' Stc~- is ,~
Wisconsin
AUTHENTICATION
Signature(s)
authenticated on
TITLE: MEMBER STATE BAR OF WISCONSIN
(lf not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Attorney Kristine Oeland
Hudson. WI 54016
LLc
,~
1ACKNOWLEDGMENT
STATE OF ~i- )
~ ) ss.
COUNTY )
Personally came before me on ~~~/~(/~P~1LJ~
above-named ROSH L C
to me known to be the person(s) who executed the foregoing
instr~llnAnt and acknaQiddeed the same.
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003
• Type name below signatures. INFO-PROT'" Legal Fortes 800-655-2021 www.infoprofortns.com
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