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HomeMy WebLinkAbout020-1439-02-000Wisconsin Depar'rrent of Commerce Safety and Building 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 Landsted Homes Inc. Hudson Townshi CST BM Elev: O D Insp. BM Elev: BM Description: ~ t O ~ ov-o ,jet TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic C.P C1..Q~?~ ~ 2_~~ Dosing ~ 62i / _ I ~/~/~ ~ / _ i Aeration ~ rnrn ~/~ Holding TANK SETBACK INFORMATION TANK TO P/L /~ WELL '~- BLDG. Vent to Air Intake ROAD Septic IN 0~ r , ~~ / Dosing yH'S Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss m Head TDH Ft Forcemain Le Dia. Dist. to welt SOIL ABSORPTION SYSTEM /_ 5 /rn ///) ELEVATION DATA county: St. Croix Sanitary Permit No: 463225 0 State Plan ID No: Parcet Tax No: 020-1439-02-000 Section/Town/Range/Map No: 25.29.19.2728 STATION BS HI FS ELEV. Benchmark ' ~ • ~ 1 ~ 3 ~ ~ D~ ` ~ Alt. BM r^~ ~ ~^~d"1E7 /. _ - L `Kdl~f " .2 1 / a,7 Bldg; Sewer SUHt Inlet ~U/ ,p /Dy~ SUHt Outlet ~ b ~ , ~. 2 /b A `/ 7 Dt Inlet '. ~_ Dt Bottom / ~' Header/Man. ~ ~ ys "I~' t ~~ 1 , ~ ~ ~. Dist. Pipe , ~ ~ . ' Bot. System ~.. B,R~' Fin e ~~ c.... S. Z, I -p2 St Cover / r M ~ ,~~ Z /`T( ~S~ Gf~h ftJ ~i ~ a-vr ~ • - ~ -G BEDITRENCH DIMENSIONS Width Len th ~ ~ 2 111 No. Of Trenches ~ PIT DIMENSIONS ~J No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WE LAKE/STREAM EACHING HAMBER O Manus er: ,~ _ T f S stem: Yp Y ~~ ~ ~~- ~~ / / UNIT Model Number: DISTRIBUTION SYSTEM V Head anifold ~ f Distribution ~iy,~,~ '~ / L th ~ i Pipe(s) ,~ `' ~, th Di S i L eng _ D a pac ng eng a SOIL COVER r Praccure Svstams Cinly x Hole Size x Hole Spacing Vent to Air Inta a ~~ xx Mound Or At-Grade Systems Onlv ~ w Depth Over ~ r Bed/ Center 'S Depth Over Bedlrrench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched , ~ ~ ~ ~ ~ Yes ': No ]Yes _ I, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:___~__/~/~ Inspection #2: / / Location: 880 Highlander Trail Hudson, W 154016 (NW 1/4 NE 1/4 25 T29IN_R19W) Indigo Ponds Lot 2~ ~p,~,,P,,arcel No: 25.29.1(9~~272~8 1.) Alt BM Description =ST eav~~. ~~ -~`V1 lS r~~~-CW~' ~ ~s„Q,~S "' ' " ' "~/~~f .~., .,+-I ~G~l""" "- 2.) Bldg sewer length = ~~~ / / /,~~~ j~ o ~ ~// -amount of cover = Y "~(/ hr+'~` .~ll~~ L 'T~~ Plan revision Required? ~ ]Yes i ° o ~ ~ • ~ ~ ,f-t~ ~ ~ Gi 1~~t~ ~ ~~ S ).~~~ Use other side for additional information. _-- ~ t/-~ ~_ _ -_~ ----~G-- ~~--><~_ Date Insepctor's Signatu a Cert. No. SBD-6710 (R.3/97) ~~ /~ea.1 Safety and Bui n \ County S` ' ~ ' ~ ~ 201 W. Washington Ave., ~' F i~ O !?( I SCO~SI ~ Madison, WI 53707 - ~ ~ !~ Sanitary Permit Number (to be filled in by Co.) r . Department of Commerce (~8) 266-3 '°"'°° ~.--, ~ 3 2 2 S- ' " ~° ~ ~~ ~° ~~ Sanitary Permit Application -~. ~ Plan I.D~Number ' ~ In accord with Comm 83.21, Wis. Adm. Code, personal information )u provide ,` may be used for secondary purposes Privacy Law, s15.04(1)~ni) klddress (if different than mailing address) Project ' ~ , ~80 ~I6il4o ,,iCIE/~ T/~z4~ ~irl~.ro../ I. Application Information -Please Print All Information ~ ~ -°'-' ~ w ... Property Owner's Na me - _' ! arc)il /f Lot # Block I/ Property Owner's M ailing Address Property Location ~~ / a~~'t-''~ ~7-, ~` ~I ~ ~k ~ ~ '.G Section , City, State Z i p Co de Phone Number Ff-Ll+f~~ t<?/i~ G'~ ! , ~ -7 ~ =~-T Df (ro ~'~' ~~ ~ !t ~~ lio e R~E ~ 1 N II. Type of Building (check all that apply) ~ ~ 5 „~. r o ; -~ ~1 or 2 Family Dwelling -Number of Bedrooms c~(~( S_ Subdivision Name CSM Number ~ ~ ~~~~ ^ Public/Commercial -Describe Use ' ~ 1~ ~ ^ State Owned -Describe Use - ^City_^Village i Township of 1y~sJ,c,~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ©Z.p _ 2 - ~ , 2 ~2 A' New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Otily ^ 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 1(V. Type of POWTS S stem: (Check all that apply) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leachin Chamber ^ Dri ine ^ Gravel-less Pipe ^ Othe (exp ain) V. Dis rsal/Treatment Area Information: g =~ Design Flow (gpd) Design Soil Application Rate(gpdsf) r Dispersal Area Required (sf) ispersal Area Pro sed (st) r System Elevati " ~ ~ ~ ~ ~S ~. /~~~.~ . 7C~ ~ . ~ s~ a..r-, ~~.oJ , Cx~ ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tattks Septic or Holding Tank ~~~~ `%~~, o5_ ~ ~,c.s ~ ~ S i ~ ,,~^ v~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi a assume res onsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plum S' grta MP/MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) ~i~' !~ ~~ 5'~ tel. 1-~v~a~ ~vrJ ~-v' ~ S4~©l ~ VIII. Count /De artment Use Onl Approved ^ ved Sanitary Permit F (includes Groundwater Date Issued I sui Agent Signa a (No Stamps) ~ en n for Denial Surcharge Fee) ~~rtyy--~~ 2'JV . ~~ IX. Conditions of pprov SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. n~wcu wmprete plans tto me t:ounty only) ror me system on paper not teas than toll x 11 [aches in size SBD-6398 (R. 01/031 /vo2rt~F ~Q~~trt~4' l,~n)E 5~ ~ /~~ ~~c~' g~~c~rr-n,kkr To f o~ N/t~r~ sE'r ~~vTt~ ~~J. = loo, oo' ~s~EC'fl'oN/Ybnl'~ N~1 3'~~G~6~ ~,a,n E~t~ ENd ,~.~ ~ o . ~a ~ N _A. c~ ~~ 0 ~~ J d D` t ~ ~ ,-- ~, q3 as" L~~S'( ~o~~~ ~~~~IE ~~~ li' p(/L L~~N~L~ Dew Box 2~~~ ~s' ~. d e~ pow ~ ~ R~`'' pE~ 0 '°gc~L V ~O~oSE9 l.J~[G. Ca2t vEwhy PLOT ~t CROaS 8ECTION PLAN =APPA aROa. EXCAYATINO 1N P~1Jl~N6 UtiT . . .. PiiOrE:CT ~~~ LLG .,~yL1rG~ ~ r a C N i~o SC~A~ Ew E J.~c~o.~ , P~ ~.~ v - ©,~ ©,~5~2~/ i4'rl owl 0 2 vEN r c..,,~p ~~~~ Gem -~~.~,~~»t ~•~t~J~ N`A/~ SAN{oP~E ~at~~e The Standa d In it for Chamber - - 1' Overlap ac ~atcning I~~ uc~NSa: ~~°7S`'1 GATE: i~ •a`i • ~ ,,saL~at~la4sr: J~zs 1l~'7, ~~ . ~ ~EwkH Bo7ra., ~~V~'~- 0~ Sac~c~+ ~. m~ ~~ _~ ~ 9q oo, y ~~~ - srGE V,f«+ aig.~' 75' Effective Length ..,,~ Z ~ Ste. ~' ~ `f`~ris Porce~Q/~ a Wisconsin Department of Commerce SOIL EVALUATION RE ~ ~ L Division of Safely and Buildings in armnianr.~ with (:nmm 1~5~'flrr~lrlw~Gtrla 1866 Page 1 of 3 A.C.E. Soil 8 Site Evaluations t ~~~ Attach complete site plan on paper not less than 8'/ x 11 inches in size. an mus ~! ~~ ~ St. CfOD( include, but not limited to: vertical and horizontal reference point (BM), dir lion and percent slope, scale or dimemsions, north arrow, and location and distan to nearest road. ~ Parcel I 020-1439-02-000 Please print all information. ~ ~ ~ e • gy Date Personal information you provide may be used for secondary W l~~Y , s. L~Q4 tt):G!r)~; i ~ ~ ~..• Property Owner 'L~afiOrti;; Landsted, L.L.C. Govt. Lot NE 1/4 S 25 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 431 2nd Street 2 Plat Of Indigo Ponds City State Zip Code Phone Number J City ~ Village 1~ Town Nearest Road Hudson ~ WI 54016 715-386-1111 Hudson 880 Highlander Trail %u/~ ~~,~ O ~, (fa/jl°(~ f/ New Construction D~~ i~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD _V f Replacement ~ Public or commercial -Describe: Parent material Glacial outWash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at 72" below existing grade within tested area (98.0' & 99.0' suggested) using 28 leaching chambers. Boring # J BO""g >138" in. /J Pit Ground Surtace elev. 105.89 ft. Depth to limiting factor Application Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr32 none sl 2fsbk ds cs 3fmc 0.6 1.0 2 5-14 10yr4/4 none sl 2fsbk mfr gw 2fmc 0.6 1.0 3 14-36 7.5yr4/6 none scl 2fsbk dl gw 2f.1 me 0.4 0.6 4 36-46 7.5yr4/6 none Ifs 1csbk dl gs 1fm 0.5 1.0 5 46-62 10yr5/6 none s & gr. 0 sg dl gs 1fm 0.7 1.6 6 62-138 10yr6/4 none s & gr. 0 sg sl - - 0.7 1.6 H#5 contains approx. 20% gravel & cobbles. Hi'16 contains approx. 10% gravel & cobbles. Boring # --y Boring i/ Pit Ground Surtace elev. 105.93 ft. Depth to limiting factor >142" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr32 none sl 2fsbk ds cs 3fmc 0.6 1.0 2 6-19 10yr4/4 none sl 2fsbk mfr gw 2fmc 0.6 1.0 ~ 3 19-44 7.5yr4/6 none scl 2fsbk dl gw 2f.1 me 0.4 0.6 4 44-68 10yr5/6 none Ifs 1csbk dl gs 1fm 0.5 1.0 5 68-142 10yr6/4 none s & gr. 0 sg dl gs 1fm 0.7 1.6 H#4 contains 1 /4" - " discontino bands of 7.5yr4/6 Ifs. H#5 contains approx. 20% gravel & cobbles. * Effluent #1 = BOD ~ 30 <_ 220 mg/L a d TSS >30 < 1 mg/L fflu 2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name {Please Print) Signatur . CST Number James K. Thompson 3602 Address A,C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. O . WI 54020 11!182004 715-248-7767 Property Owner Landsted, LL.C. Parcel ID # 020-1439-02-000 Page 2 of 3 Boring # ~ Boring Pit Ground Surface elev. 104.13 ft. Depth to limiting factor > 133" 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 0-5 10yr3/2 none sl 2fsbk ds cs 3fmc 0.6 1.0 2 5-20 10yr4/4 none sl 2fsbk mfr gw 2fmc 0.6 1.0 3 20-37 7.5yr4/6 none scl 2fsbk dl gw 2f.1 me 0.4 0.6 4 37-60 7.5yr4/6 none Ifs 1csbk dl gs 1fm 0.5 1.0 5 60-133 10yr6/4 none s & gr. 0 sg dl gs 1fm 0.7 1.6 H#5 contains approx. 10% gravel & cobbles. ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Efftst2 ^ Boring # ~ Borng Pit Ground Surtace elev. ft. Depth to limiting factor 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 ' Efnuent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS<30 mg/L and TSS <30 mg/1_ 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. .4 /f . ,B. ~rl. ~ Te po{ Sc.~rvey staX~. ~g$ `~~ C~(ew = 95/•1ld~~ o~ c{ ~Qi / SG ~ ~ir(o ~/'aund aS Sw~veY c~m~(~b~nf-• ~ ~ _ ~ ` itla.o~COr+~ur~ •' ~ ' -. ~, ~i ~~ i ~ i ~ -- ~ i ~ .S/p~ ~ ~ C ` 1 ° ~~ _, az ~ ~ ., 81 ~ A-oposcd .' y 6 tdroom i~3.36~ ~Q~~~ ^ Soi/ e /Q /u ado., P,'t • ,o~ope/~ys~ Sc4le : / = s/0' /C Q~ ~ /~~olp ~u,.~dS~~d,L.L.C', flro~oQn~~~ ~n rd//in~ graolt a~, buy Id~n~ S;tC = //lo.Gt~~~ w o \ ~ `~\ ~" S cc b d, v, ~~, ~ cya/orova.P ~ 6 e j u 5 ~-d ~,r- ~' ey0 /a c.a.~ en f d~ :S~Sa.O 6.r ~cc, d cd i .F' ~e,,a k~ c amen `~ C~/y /s ~0%~.~iled ~~ ll/'Cf~ O~~Ori~~ 5 ys E ~~c. Q ~O/ac~m~E SYs~~~^ iE~cc. /~~~'~+ ~no~er / Tra,% . 3 0{.3 . . ~ POWTB OWNER'S MANUAL & MANAQEMENT PLAN wge ~ of FILE wFORMATION Owner ~r'~~i''T~~ ~~ ~-~ , ~'., P.nnit ~ y-~ 3 22S eE~111 PARAYETdlS Nurribsr of Bedrooms 4 O NA Number of Public Facility Units ~lA Estimated fbw Isversge! 4 0 0 Oesign fbw lpeakl, IEstirrtated x 1.51 600 aUd Soil Application Rate • 7 aUd 1ft= Standard InfluentlEffkuret owilty Monthly averags • Fsts, Oil ~ Gresse IFOOI S30 mgA. 8iod~ernical Oxygen Demand 1800:) SZ20 ~ O NA ?Drat suapena.a solids tTSSI S1 so mg/L Pretreated Effkrent Quaihy Monthly Biochemicsl Oxygen Oemared 1800a1 S30 ~ Total Suspended Soilds tTSS1 S30 maL. O NA Fecal CoGfonn (geometric meant stO' cfu/looml Maxarwm Effluent Particle Size Xa in die. O NA Other: ~ DMWA •Wiws typicN for don~ssdc wsstewaar and septic tank effk+iru. sYSTEM SP[CIpCAT10NS •Septic Tank Capacity 12 5 0 DNA Sspdc Tank Manufacuwr Wieser O NA Effkaa+t FiMsr Manufscgarar Zable O NA Effluent That Model A-1800 O NA Pump Tank Capacihl DNA Pump Tank Manufsctunr DNA Pip Manufaoturet ~ DNA P~1ep Model DNA P~ Urdt O SandK3ravN Filosr O Ma;hanical Aeration D Disinfection D Pest Fbter D Wetland O ocher: DNA Dispersal CeNts1 O IrnGround Igavityl O At-Guide O pdp.~ O NA D hMGrowed Ipreawrisedl O Mound D Other: other. ®NA Other: ~ NA Other. ®NA MAINTENANCE SCNEDUrLE Service Event Service fKequerecll Inspect condition of tanklsl At Itaet once avwy: 2 0 s ~ S yarel O NA Pomp out contents of tanklsl When emrnbirted sludge and wart egtfals orte-Udrd 1>SI of tank voNane O NA Inspect dispersal caplet At lest once every: 2 ~ ~ ~1~ ~p 3111 O NA Clean affkwret fiber At least once every: 1 ~ mon ~Is1 O NA Inspect pump, pump controls & alarm At least once every: O momhlsl ~ s ®NA Flush laterals and prossurs test At least once every: O ~d jl~ ®NA Other. At least once every: O mont~lal ~ NA Ocher ~ NA MAINTENANCE INSTRUCTIONS liwnses or certif~cstjons: Inspections of tanks and dbpersal cells shah be made by an individual carrying one of the following Master Plumber: Master Plumber Resaicted Sewer POWTS inspector: POWTS Maintainer: Ssptage 'n0 Operator Tank inspections must include s viswl inspection of tM tanklsl to identity any missing or broken hardware. identify any ~xscks or leaks, n~eawre the volume of combined skedgs and scum and to check foc any back up or pending of effluent on the ground surface. The dispersal ceitlsl shop be vauaMy inspected to check the effkesrtt levels in the observation pipes and to check far any i~i^9 of effluent on tM ground surface. The pending of effiueM on the ground surface msy indicste s faiilng condhion end requires immediate notdicstion of the local regulatory authorieY• ~ When the combined accunwlatiort of sledge end scum in any tank equak onethird 1)~1 or more Of the tank vokane. N entire contents of the tank ahaa bs romowd by a Septags Servicing Operator and disposed of in aooordance with chapter Wisconsin Adminatrative Code. Aa other servkxs, including but not limited to the servicing of eHiuent , mechanical or prasu~ed ts• i~ units, and any servicing st itebrvals of S12 months. shall be performed'by a cerWisd POWTS MaiMSirter. A service report shah be provided to the bcal rogulatory authorhy within 10 dsys of cortiplstion of afw service event. t3MW 14/011 ' _ Page ~ of o' • START UP AND OPERATION 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 caMlsl. If high concentrations sro detected have the contents of the tanklsl removed by a septage servicMg operator prior to use. System start up shall not occwr when soil conditions are frozen at the infihrative surface. During power outages pump tanks may fill above normal highwater kvela. When power is restored.the excess wastewater wiu be discharged to the dispersal ceNtsl in one large dose, o~ad~ng ~ ceillsl and may resuR ~ 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 POWYS Maintainer to assist in manuaNy operating the pump conuds to restore normal levels withM the pump tank. Oo not drive or park vehicles over tanks and~.igs~ s~ ~s~~~ ~ or Park over, or otherwise disturb or compact, the xea within 15 feet down slope of any mound Reduction or elimination of the bNowMg from the wastewater stream may improve the performance and probng the life of the pOWTS• antibiotics; baby wipes: cigarette butts; condoms: cotton sw~i~degg~ •'erdb~~~ ~%at gaps em~i ationa; oil; foundation drain (sump pump) water: fn,kMa! tamponsb endp water softener brine. painting products; pesticides: sanitary nap ABANDONMENT ~,~,~y taken out of service the following steps shall tie taken to insure that the system is When the POWYS fails and/or is perm properly and safely abandoned in compflance with chapter Comm 83.33, Wisconsin AdmMiatrative Code: • All piping to tanks and Pits shall be disconnected and the abandoned p'~pe openings sealed. d sad of by a Septage Servicing Operator. • The contents of all tanks and Pits shall be removed and properly ispo • ARer pumping, all tanks and Pits shall bs excavated and removed or their covers removed and the wid space faNed with soil, gravel or another inert solid material. CONTINGENCY PLAN have ~~ or moat be taken, to provide a code compCaM If the POWYS fails and cannot be repaired the foNowing measures replacement system: ~ A suitable repl Iacen+en yea ~ ~be protects i~st rb~ ~d compaction ana sha~id inota~ bye tinfrin9ry ed u by system. The rep ~ ~~~ structuro, lot ~ ~ ~qs, Failuro to protect the replacement area will required setbacks from existing resuh in the need for a new soil and site evaluation to establish s suhabk replacement aroa. Replacement systems must comply with the rules in effect at that time. p A suitable replacement ma i~ ~ aNed!asla last resort to replace the fs~ t'kd POWYS s. Barring advances in POWYS technology a holding tan aY p The site has not been orined to ~~ a au•Rab e~repiacemens ff no roplacement area is ava able a hokf gd tank evaluation must be pert may be installed as a Isst resort to replace the failed POWYS. O Mound and at-grade soy absorption sYsten"s may be reconstru ~i ~plros ~f~loe~ st thatatime. ~e biomat at the infiltrative surface. Reconstructions of such systems must comPN < <WARNING> > SEPTIC. PUMP AND OTHER TREA~TR~EATMENT TANK UNDER ANY CIRCUMSTANCESDroDEATN MAY RESUI.~ RESCUE OF A ENTER A SEPTIC, PUMP dR OTHER PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOS816LE. ADDITIONAL COMMENTS POW'TS MAINTAINER POWYS INSTALLER Nine ri Count Ben Mor an Name of n Phone 715-386-2130 Phone 715-386-2850 LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PUMPERI Name St. Croix County Zoning Offs e Name Tri County (Ben Morgan) Phi 715-386-4680 Phone 715 - 3 8 6- 213 0 . ~ q~iah~me Code. This document was drafted in eompliance with chapter Comm 83.221211b11111d181fl and 83.54111. 121 ~-131, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuyer Mailing Address Property Address construction) I - City/State h ~_ Parcel Identification, Number LEGAL DESCRIPTION 6 X16 ~2c~ - 1 ~ 3~ oz ~ flr~a Property Location ~ '/,, /~/~ %,, Sec. ~.S" , T o~9 N-RAW, Town of ~ ~ IJ Subdivision ~ ~ Lot # ~. M Certified Survey Map # = .Volume ,Page # Warranty Deed # yt 268 3 ~ ~ ~ ~ .Volume ~ ,Page # Spec house ~ yes ^ no Lot lines identifiable ~] yes ^ no 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 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. The property owner agrees to submit to 3t. Croix Zoning Department a ceriification form, signed by the owner and by a masterplumber, journeymanplumber, restricted.plumber 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 septiCtank 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 year expiration date. SIG ATURE OF APPLICANT DATE 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. N 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 OWNERSHIP CERTIFICATION FORM ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 4„ ~ q N C~`I„~,L~ L.L (i Mailing Address ~ ~ ~~ ~Q V ~ 1 ~O ~~~ .' ~ ,~ ~ di6 Property Address ~ (Verification requi d from Planning Department for ew construction) v~ City/State Parcel Identification. Ntunber a Z~ ~ 4 3~ ~ Z ~ ~~ D LEGAL DESCRIPTION Properly Location /~~ %,, /Vt %,, Sec. ~S" . T o~9 N-RAW, Town of Subdivision ~ ~ Lot # ~. Certified Survey Map # Volume ,Page # Warranty Deed # U 2 bB 3 P ~ ~ ~ ,Volume ~ .Page # Spec house ~l yes ^ no Lot lines identifiable ~1 yes ^ no SYSTEM MAIN7ENANCE Improper use and maiatenanceof 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 is the waste disposal system. The property owner agrees to submit to 3t. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumberor 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 tha 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 year expiratioon date. SIGNATURE OF APPLICANT DATE 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. J~ Lt- c l a 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 Wisconsin Department of Commerce SOIL EVALUATION REPORT rlivfcinn of Cafafv and Ruildinns __-~__,.,....:.M ~....,.., Qa ~nr.~ nrlm rtnrlo 1257 Page 1 of 3 Steel Soil Service ~-~ ---- -- -- - County Attach complete site plan on paper not less than 8'/: x 11 indres in size. Plan must St. Croix indude, but not limited to: vertical and horizontal refererx;e point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. pending Please print all information. R revved B Date Personal iMormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). ~~yv / f () Property Owner Property Location ROSAMJI, L.L.C VE~ Govt. Lot na NW 1/4 NE 1/4 g 25 T 29 N R 19 W Property Owner's Mailing A dress Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C 2 na Indigo Ponds City St p Num r ~ City _f Village ~ Town Nearest Road New Richmond ~ V1(4 7- ~ ~-24 7071 Hudson Highlander Trail ~) New Construction um er o bedrooms 4 Code derived design flow rate 600 GPD J Replacement ~ Public or commercial -Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevation 90.40 tt, trenches spaced and depth to code 4.75 below grade ~ a Boring # J Boring Pit 1 in. 0-4 Munsell 10yr3/2 2 4-24 10yr4/4 3 24-38 7.5yr4/4 4 8-120 7.5yr4/6 Ground Surface elev. 95.15 ft. Depth to limiting factor 120 in. Redox Description Texture Stnx:ture Consistence Boundary Roots Qu. Sz. Cont. Color none sil Gr. Sz. Sh. 2msbk mfr gw 1c none sic! 2msbk mfr cs 1 c none scl 2msbk mfr cs na none cos osg mvfr na na ./ r;~fYJ~-~ s~ -~ ~~ ~/ ~ l Sod Application Rate GP D/ft= *Eff#1 *Eff#2 .5 .8 .4 .6 .4 .6 .7 1.6 COS <35% coarse fragments = 36" & >35% - <60% = 60"below system Boring # J Boring iir Pit Ground Surface elev. 95.15 ft. Depth to limiting factor 120 in. Soil Application Rate ti R D ri T r t Structure Consistence Boundary Roots GP D/ft Horizon Depth in. Dominant Color Munsell on edox esc p Qu. Sz. Cont. Color ex u e Gr. Sz. Sh. *EtY# E 1 0-8 10yr2/1 none scl 2msbk mfr cs 2c .5 .8 2 8-35 10yr4/4 none sic! 2msbk mfr gw 1c .4 .6 3 35-45 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 45- 7.5yr4/6 none cos/ms osg mvfr na na .7 1.2 ~o ~ ,~ * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 <_ 150 mg/L * Effluent #2 = BODS < 3u mg/L and 1 s5 < su mgrs CST Name (Please Print) '" Signatu -~ CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4!28/2003 715-246-5085 Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTSM ROSAMJI, L.L.C. New Richmond,WI 54017 Lic. #248956 NWl/4,NE1/4,S25,T29N,R19W BuS.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 2 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. 100.60Ft Top of 1/2" pvc pipe p I-I = Rnrinoc r ,~~:•~ ~~nii~iL.__ IvIGhVVYYJ ~ ~tVC'CI Vt~,r _..r;.~"~,-'~~~zs ... __ .. _ 493 77 _. ~ ~ - 9.63_ ' ?4S>~~ ~~' f DRAINAGE EASEMEN7C) ~ ~~ ;• , "~ ,~~ ~ oo ~,~gZa---- -~ 12f132 S.F. ~, ~ 1~ •~ ,'~~ ~ ~~~~ ~ 'sue ' ~p ~~ . ~' _.-- _._._.... ._. ~ (2.780 AC.) ~e '~ r ~ .. ~ tN .~_.. --~ : an'~~_ _-(1.000 AC N.B.P.A.)~~s' ~ ~~~ ~-, \ i - ~ 135.03'... \ ~ ~ 9 9 6 ~ryry~' f ,J ~ , ~ f ~ ~~ '~ ~' 4- ' ~~ . ~ ~~. r --- ~ ~ ,! f r ;' 1 ,, "~ f ,~ 97744 S,F. - ,~ . -• ~, ' i ~ ~ (2.244 AC.) E ~ `~~ ~ `, ~ `~, 9245$ S.F. / ;' (1.058 AC. N.B.P.A.j. ~' 8$27 S,.F. ~ l ai ,S (2.123 AC.j ~ _ - __ - 2.0265 AC.~, ~•,~~`~~~ •. ` ~ ~ ,,~ ~l / (1.578 AC. N.B.P.A.) ~~ r ~- __-- ~ • .•- 'S -- ~ ~ ( is t~ t , f f ~ , ., 7 --. -- _ ~ ~ ~ - _-~ y _ r ~ ~ ~r .. .. 1 7r • - r _. r .~ \ ~ - _, ~ ., _~ y ~- -y'_ - i a _ --- r ~. ` ~ ~' ~. ' :3.071 ac.) ~ / ~ ! f s~ w• n = _ `~, ' ~-.~. ~~ ` '~,._ .- ' " ~ 1.442 AC. N.B.P.A.) ,~ 91811 S.~, '^^ ~~ ~ 8839 S~ . ~--' _..- m~ ~ ! ., ` J: ! ~ (2.108 AG.) , `'` ~ ,~~"~ X2.016 AC.)._.~ - .~'• '' , ~; (i 0'90 AC. N.B.P.A. ~ ~` -.- `~ ~ ~ ' - ,(1.384 AC. JN.B.P.A.).. ~' f,. 'J' ~~ ; ;~~ f ~ ' ~%~ ~ ~~ ~ ~ ~ . /`° ~... _._.._. i _! ~$`'/ ;t`~ . `c~.~ r `315.66 y ~ w ,~~ ^ t ~' 1 S? , ,y ~ ~ ~,~ ~ 1~1 • 9 .83 ~f -> -~~' ~ _ % `L~ ~~~ - f ~ ~ ~~ r ~' i i o ~~ VVV ~o ' gyp,;. ~ 5 ; ~ __ r 120~~ 1.57.92' •5:~ _ ~ _ ~ ~ '' S1 ~~ ` ~r~i4i ac `- _` - _ ~-~! _.r- ~~ 157194 S.F. ' ~ ~`~ 157.92' `` ~ ~ ,~ ~ -..` 3.609 AC r• r `" \ \a~ ~% ~ -_- _ ~ ' ~ ~ 1.022 AC. N.B.P.AI i ~„ 1 - 1 , t 1 ~ r ~!~ ' ~ ~..~r- ~~ ti ~ , A ~ 3 8.13'x, 1.79'_i_. ..•' ~~~ ,,. _ ~-. _ ' ~ ~ . - ~ S # i r,' -96690 S.F.-' ~` ~,~. ! . t 1 _. ~ C-/• : _~ ii : 1 3.-d.1 : L d "• t• . t ° .7 i~i r. ni e ° n c . U. 2683P '~3~r STATE BAR OP WlSCONSIh FDRM 2 - 1999 t~o«rment Nwmher WARRANTY DEED This Deed, trade between Rocaatii, l[.1[.C Grantor, Ciraatee. Grantor, for a valuable consideration, conveys end wartaats to Grtuatce the following described real estate in St• Crofx County, Sate of Wisconsin (if more space ib needed. Please atta:.h atidcndutn): ~~Phtt of indigo Ponds io the Tot+.n of Hudson, St. Croix Coauuty, Wisconsin. . _ _t3 c, 06' rc ~ ~ ~ ?7g x 63 KATNLL$11 N. YA[S8 REGLS7(rYt OF DEEDS sr. csotx ca , rr W~EII~BD F'~R RE~CORp 1®I27/~4 09; 3it1K Mt11RRAiITY DF~D ~t CO~P'Y81~ s !~ le tiecotdipgArea ~ ~Z ____ PAi~s• 1 Name and ReA~rn Addrees ~l ~nfi~_ ~~ -a~r . ,~,439.OZ•OW E7roe1 ]demificatiaut Numbs ~iM This Jg ttoc hatnestead properly (is) (~ ~) Exceptions to warranties: Fssetnents, restrictions and rights-of-way of record, if nay. Dated tk~EC~'~~ ` day of Ucto6er_ . 1A04 . `~7~~P~~_ r ~ ~ ' R~wq(i, I.LC AUTfIENTICA7'ION Wl. f-MENT G"~ ) ss. --..-__--..--_. _^~~ ~' ,~,,, ~1,-~--- - - _ County ) authenticated this day of ~•.r ~ r J ~~(': Y1S1(~ pertauaelly came before the _ y of 4 f~cf10 _ r ~, , appq _ the above named -------- _.`...___ ~._-....r._..-......---- 1ITLE: MEMBER STATE BAR OF WTSCONSIN ....__._ ...................................___...... ¢f not, __ _ _ „ to known ro be t>te person(a) who extxarted d-e forgtoing authorized by ~ ?06.06, Wis. Slats.) .~.- iastnt and aeknowle~Qgrdt~pi~tpite.~ . •• THI5 INSTRliMBNT WAS DRAFTED BY ---•-- Attcraey 1Krfstiao O~land_. _ .._._ ~..- .......... ..r ..._ ....-~------...-----~---- Hw_ fson. WI SOOIb _._ ._., Nato ic. f _. -._ Y_ T My Cornet~n ertna t. (If twt, state aspiration date: tSiytmmres msU+ Ne authenticated ar at:imowled~ed. Both att trot necessary.) Y~, ( r ~ ~ --, .) • Names of persotu tigaing is airy capacity mist be typed or printed Oe[ow their aig,u-ture. --t 4iannaiua Probesscan:ts Cu.. Poed au tie, nl1 srarrt ruQ qF WISCONSIN 800-tiSS2tIIl w~,wrr tr~u result no.: - t~ `, OCT-1.3-04 08:43 AM GRE 7152469974 P. 01 ~xi. ~~h~~~~L~ IViGHUVvVJ ~ VKI V ~ ~'~;, • ~i.,,.:e...;,~~'~~??so, '~: ""- .:~:- -M--• a..,. .:.~ 493 ---r~ .4 `'~o f ~ ' ( DRAINAGE EASEMENT G ~~ .. '`i7~ ~ ~. ' ` ~ ~-92Q"' J_ ., 121132 S.F, ~ ` ` ~ ~ ~. ~ ~ ; ~ 1~ '.- " .,1~ ' . _ 1.000 AC. N.B.P.A.)~~• 1 \~ •'~. ~ ,^~. ~ \ \ ~ ~ ~ j ! ; / 9245 ~g. ;'! /i~ (1.058 A~ N.Q,P•A~1 7~ f ` ~ ~ 212 AC, ~ ,• ~ ~ ,, / ~ . ~\ .-~ ! / / ~ •~ • ~ f ' r !! - ~' ~ ~, ` ; • ~., -~ ~. ~ - .oil i-c) t ~ f / ' ~. ~ ., ~. 1 i ~ ~ ~o- ~ (2.108 AG.) . ~' ~ - ~ ~/ ~ (2.016 ACS.) _.~ ~- ~ .~•' - ~ -~(1 090 AC. N 8:~ ` _ x'(1.384 AC.~N.B.p.A.), • '~, ~~ I r' , -,..1^A~`~ / .rte r ~.-~ ~~. ''~• '~ ~ ~ '~ !r "'t •`~ ' // ~f~ ~/ f.~. M~~~ rte- f , ~ ~ n / ~ , ~ ~ , ~. „~. { ~ , / f r I r Q •I i i - ~ ~~ I ~ 792` •~. r ~ ,~. I ~ ~ '~~ • ~•' ~ 1.141 ;AG 167, 92 _ .,. ~ 3.600 AC. ~ ~ , 1.022 AC. N.QP.A, ~ __ - _ _ - ~ . ~~ ' ~~ i .1~ ~ ~ rI ~ - - - i. ~1 ~ 4 e s 4 ~--~-------~ n~ :~l ~ ..._ _........._ rl.;.~ _._. _......,._ i3~.~os- - ~ H~•3s~so ~w. ~ ~PRAi !E .~ ~,~. MEADOW'S DF~~VE ~~ ~~ 4Q~T7',~,~ b j R ~a ~ t ~~ .. QRANAGE EASQAEII'f S ~ b ~ ~~~~ !~ _ ~ t2tt32 SUF. _ ~ ~ ~ h 471 E,1~ ~ Q~,. ~ ~ w ~~ ~r -r-E DM-EWNG ~ er ^ ~ ~ C Ba.OM- . of ~ ^i CSI vA9'S0"E ~ s• ~ ~'~ ~ ~ ~ r 7 ~ ~ ~'-- ~! * '~ 91~'Sa S.F. ~I ` ~ 27'3 S.f. ~ ~ ~ ~ (2.123 AC.} K ~~ tl~ PPE"" J ~ ~ 2 EIEvAl101! 93Q~C' ?~ 6!` 4' ~~ ~ ~ ~t,EVA1~t - ~aata~ya.~~ ~~ '~` ' ~ ~- s1m -E ~ ~'. i~'31 222.44• `L-. ~~.~ w N O~PENNC EOw~~ +' IIE ~7g.2' ~ * 2 ~~ r''~ ~ ~ IEt~ SF. ~ (2. 6 ~) ~ '~ ~~ C + .~ ws Ac.~ C118 ~ /~ ; -~ ~y ""' ~- ..~ o.K1\ ..- 1id3v ~ ..-- "' ~"e ~~ ~ ~ ~ _ ~~ ~ f _. .... ...s. f .~.~ g ' ~~~