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HomeMy WebLinkAbout020-1439-16-000Wisconsin Department rT Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Rosam'i LLC Hudson, Town of ;ST BM Elev: Insp. BM Elev: BM Description: /dam 3M ~ S~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 3 ~- ~S111p G;\ G O Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic a Z ~~ ~ ~ ~ ~~ Dosing / Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Hea TDH Ft Forcemaih Length Dia. Dist. to well SAIL ABSORPTION SYSTEM i~ ~ c°°nty: St. Croix Sanitary Permit No: .463458 0 State Plan ID No: Parcel Tax No: 020-1439-16-000 Section/Town/Range/Map No: 25.29.19.2742 ELEVATION DATA STATION BS Z ~~ HI idZ FS ELEV. ~oG Benchmark 1i.9 z.~ r Qb AIt.BM~~~ y d~ ,i,~~ ~J aQ•~~ v Bldg. Sewer ~ 6•q7 a .9~ SUHt Inlet ~- g.y Ia~•51 St/Ht Outlet * •59 1~~, 3 S Dt Inlet ^~ Dt Bottom ~~ "~ Header/Man. /6 (~~ ~,,~ • ~ Dist. Pipe ID`9 q/` ~ j_ / `P Bot. System ~ IZ'~ ~~ '~ Final Grade ) `Z 1 .7 l St Cover,~w,?~ ~•~.,,7 ap ~ BED/TRENCH Width 1 Length . No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ g 7 . S V ~ r ~ ~- ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: MATIO CHAMBER OR INFOR N TypeefSyste~~' n 11 ~~! 11` _I 7 ~/~ , J~ N UNIT Model Number: ~~ rte, ~ X + DISTRIBUTION SYSTEM /4 ZGC.I,._ ZFS d--d~A Header/Manifold ~~ / Distribution Pi ~ x Hole ze ~ x Hole Spacing Vent to Ai Inti~ 3 ('~ e ^~ ~ f _ ~ pe(s) \ ~ S i h Di ` Length Dia pac ng Lengt a SAIL OVER v Procenrn Cvctamc C1nly YY Mnund Or At-Grade SvStemS Only Depth Over ~ Bed/Trench Center ~ Depth Over BedlTrench Edges ` xx Depth of Topsoil \ xx Seeded/S dded N Y xx Mulc ed Yes No . ~ o es COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 872 Prairie Meadow Drive dson, WI 54016 (NE 1/4 NE 1/4 25 T29N R19W) Indigo Pon~ds''Lot 16 Parcel No: 25.29.19.2742 1.) Alt BM Description = ~J ~~ ~ r' o.~CsS ~ ~ ~ t' ~~ ~ ~, ~,.j ~, 2. Bld sewer len th = L C ^ ' - amount of cover = > I Z !/ r 1 -- - - - -- - - -- Plan revision Re wired . Yes ~ No q ~ c~~ ~ ~ aS Use other side for additional information. _ ____ -.__ __ _ _ ___ _- __ ___ __ _ _ _-- ~- Date Insepctor's Sig ture Cert. No. SBD-6710 (R.3/97) ~a~ ,..nf ~ I~n ~.a-1 -- In-F~.~Vfi~~,.w .~ 1I/ _ ~ ~~f0 ,•nt~l-~_.~1.:~,.1~/~ ~°Vrl(/a v V VC..i~ a ~"- .v im.-.- - ... - IV •w •VVJ"i r~ .._._ -- -- County Safety and Buildings Division P.O. Washington Ave. 201 W ~~~ C rd`s , . «~~~I~ /~ Madison, ~~ ~~ ! Sani Permit Number (to be filled in by Co.) ¢ - 1] D 8) 2 31 U Department of Commerce ~ ~ 200 S~ plan I.D. Number Sanitary Permit Ap o MAY A / adon ou provide fort ! i / ~ v n n In accord with Cotton 83.21, Wis. Adm. Code, persona 1 GR~iXL~UN 4 x'01 ~~ (if different than mailing address) ( ) ) g~. may be used for secondary purposes Privacy Law, s15.t> NWG OFFIC 9 ~. /..zax-~z~E /~1~.o.a~~... ~2z/t I. Application Information -Please Print All Information d 6 Gtlo•~v Parcel aY Lot 8 Block >Y Property Owner's Na the I 3 - ~~~ , z ~~ n Property Owner's M Address Property Location ~~ (,~ - //~' 14, iV,t u,Section __¢s~~ City, State Zip Code Phone Number _ r, l ~l/l/ (circle ) ~ N; R~ E ot~ T l _ _ II. Type of BtWding (check all that app y) t / _ ~Y ~ Q,,(~ ~ Subdivision Name CSM Number , ~ y;,[ir~ ®1 or 2 Family Dwelling -Number of Bedrooms / I 4~_ ~ n/ GO d ^ Public/Commercial -Describe Use ^ State Owtted -Describe Use ~ ~~ `~ d- - ^City_^Village ®'fownship of /~~~,,,,/ III. Type of Permit: (Check ody one box on line A. Complete line B if applicable) Q - / A' ~ New System ~~ ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Petroit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: (Check all that a 1) I d t ~. ~ ® Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filur ank ^ Peat Falter ^ Aerobic Treatment Unit ^ Recirculating Sartd Filter ^ Cotuwcted wetland ^ Pressurized in tdir ~ ^ Recirculating Synthetic Media Fit r ®Leaching Chamber Drip Line ^ Gravel-less Pipe ^ Other (explain) _ __ _ ___ V. Dis rsal/Treatment Area Infor t-J 7~G~/ =~v T Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~, VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steet Fiber Plastic Gallotss Gallons of Units Concrete Coastructed Glass New Existing Tanks Tanks Septic or Holding Tank _p Aerobic Treattrem Unit Dosing Chamber VII. Responsibility Statement- I, We undersigned, assume responsibility for installation of the POWTS shown on We attached plans. Plumber's Na me (Print) Plumber's i gnature MP/MFRS Number Business Phone Number G,~ ~ ~, ~ ~ ~ /s - ~s ~ Plumbe Adore ss (Street, ity, State, Zip Cod C / / ''~ T V /ELI .(- - ~ b VIII oust /De ent Use Onl Approved ^ D' ~ Sanitary Permit Fee (includes Groundwater Date sued Issuing ignatur ) ^ ~~~ - ~~ Surcharge Fee) M `-C.J C /b O J IX. Conditions of ApprovaUReasons for Disapproval ~„ s~ ~ ~ o~.l~ ~'d~ ~~ 3~ Q~~t~t:.r rv~~s~-- S~o~l y~. aw ~ SYSTEM ER: a.lfo,.x off- a ~ ~~~~„ v~, ~, U ~] ~ ~~ ,. Septic tank, efllttent filter and c~na,,,..(Pef~ ~ p ~-~°-- dispersal cell must all be services /maintained / L / ~ O~''vC.O ~ ~~ . as per management plan provided by plumber. 2. AA setback requirements must be maintained ~ ~~. as aer appNcabie code / ordinsnces. ~ 5~5'~"'~~-- S.~~c.. t~n-~ '~~ ' ~`~-' ,nrs ~ dry. C C c ar __-_" ^~r^ r+o aw .... warp ,...y~ .w ..R o~aw.. w rte, w..wa wru w,r r as uaa.uw av s,cc .. . , d2opC2ry ~ - .. ' /~N~ a 0 0 E G ~, ~i~'~ ~~~~ ©~ D R~~~~1~- 'L•~Sb(,~ 43rE~t?S ~~~~ ~~ \ ! ~'' . ~~rT /~.~ SRrctr~w O~pf ~~ 3a Lr-0+~~od~~~END f~' ~~ ~ ~a ~. ~ ~~ ~~/~~ QDN~ ~ P~~pRo~ u~ Rey, ~ ~ ~- .• 'PLOT ~c CROi~ iECT10N PLA 7,APPA 6igi. EKCAYATW~ ~ . p~1y~M~ UMT PRO~CT Rog~~ t u.c ~o err od ~~~ ~UQ~ yF w,4.Y ~AAf~~~~, ~ /~T ~~ N COPY .. w s ~ 1 ~6~ 1/~ Ew - D~ a~ P~ P~ ©~S~Q~/rkr~o~l 02 VEN r 44p i2` A~ ~~K~ loeaa~_.._ /~Mt~~naMt ~1G~/46eJf The S ~~a~ ~µ~o PEE Chamber ~~~~ uc~se: ~ ~!'7 5'`7 W1TE: ~ - ~ w ~~ _ :sa1~.i~sr: - . - ~ T~c,K Bo~••n ~~v.~~, ~~ SoVc~Es ~~ ~r o ~~ o Ev ~ ~•~~ I S~O~ V rEw I --I r-- ,• overt ac ~accn~na b a 0 0 D ~_ G ~, ,~r~~ $~ ~~~~ ©~D 0~ R~~~~~! .... ... ~e a • •P~OT It CROSS SECTION PIJ1 xAPPA ~. EXCAVATING u P~U)~MlP~ INrT ~~ ~ ~~~~ 49rES~?Sq~tic " PRO.JrE-CT ~~~s.~ g~criao D„of i~l 3 R Le~roB~ t~sc ~tct~ E~ ~ =~µ~~ S~''",c7 ~'"~ J-NU~~.o tpoN ~ i~ ~ N ~ sPR . `~ CoQ.t•N~ ~vuF ~~%~ Q~Nf . P~op~m w~ ~or~noa i ~"`T ~e .~~~ ~ ~ ©6S,~+JI~~no~J o2 VEN r ~ ~2` ~~ fi~Kµ ~t~-~` _ c.,~•-~r,~e --1 (-- '~°,~~ -~--r-~ ~;N~s~G N'Ai~ ~~ ~o P~ • 22 ~!'7 5'7______ _ ;sa~TESsv: . ~~~5' ~o,~Bsd ,. e_ _ ~ _ _.r~ v ~/ -,.-------.. - _-~.~ „ ~ SOIL EVALUATIOII! REPORT 1909 ~ ~ ~ 3 A.C.E. Soi 8 Stie Evakrations St Cron l.D. Rosatttji, L.l_C. Govt. Lot NE 1P1 NE 111 S ~ 25 T 29 ~ R i9 W Property Owners Mas~g Address LaR # Biocdc ~ Subd. f~arne a CSfl~ 2141 Co_ HwY. C 16 Plod Of ltutigo Ponds City Stal3e Zp Code Phone idttrnber _J CAy if v~age vJ Tanm tvearest Road New Fbdpnond { W! 54017 715-24&7071 Hudson 872 Pr~ie Me~+v ik_ iV' 1~ar Cecs~n ~= Y" ~ 1 t~rr~a d be~uorns 4 _:_I ~t _. f Public or oarttr>~ - t)esa~e: Parent rt~er>ei {dal txrhrv~h General cotrxtrerrts and t~rcarnrrrns: cottverttion~ POWTS using iwo trenches with com - ~ Pro ,,~.~`o Ccxie desired tbw ride ~ GPD Flood pialn elevation, ~ na bined EJ.SA =857.16 sq. ft. at elevation ~ ~ ~-- P7t G surface elev. 9s.D7 >z ~ to rrrrr~ >, 3s" ~. saa Rye l t Caior Redox re,r stnx~re ~ B«~n- Ram ~ ~,. l a,. SY. Card. Caor c~. sz. sn. -Etfl~, •Er~2 1 0-54 10y>3tL none ~ 1il na na aw na na na 2 54.54 7.5yr416 Hotta is & gr ' Osg ml t~nr 2#m 0.7 1.6 3 64-80 10yt516 trove s ~ ~ Osg trd gw lftn O7 1.6 4 8tT-936 ' 10yt6/4 rrone s 8~ ~ Osg trd - 1 m 0.7 1.6 i Z 18artrg ~ -~ 9 L_J Y~ ~t ctd sutace elev. 94.57 ft. ~, ~ ,g ter > 129" in. sai l~pq~on Rye Ftorrzon Damirc~rd Color Rsriaoc Tenure Stnrcfise Cotatislet+ce Bavrd~}r Roots C ~. k4nsel (]u. Sz. Card. fialor Gr. Sz. 5h. `Et>l(ki 'Ef~Z 1 0-65 1{)yr3/2 none slAs NI ' na na aw tra na na 2 65-82 10yt5i5 none s Osg ml car 2(m 0.7 i .6 3 82-129 90yt6J4 none s 8~ gr Osg ml - 1fm 0.7 1.6 * Eft 41 = 80D y> 3D < 2~D nglL TSS >3t) < ffirertt #2 = 80D <3o trg1L artd TSS <3o ngyL CST ~~ Prlr~) CST Ntsrdter James K Thompson ~_ 3602 Adctiess A.C.E. Soi & Site E Dale Evan Cared Telephone Nurtrber 3e~ p ial~ ~., Seq~p Sr2~1005 715-248-7767 ,,. Property ~, L.LC. Paroel !D # 020-1439-16-000 Page 2 of 3 ~ # 1+ Grorxrd Seuface eleor. 98.18 R. Dept to 9 ft~ > 168" in. ~q q R~ Hor¢on Depth Dominant Cobr Redox Desaip#ion Texture Struchse Canoe Rails a~. takttrse8 flu. Sz. Cont. t'.at~ lit. Sz. Sh. 'Efif#1 `Eff#2 1 0$ 10yt'3l3 none s1 2fsbk mvFr cs 3fmc 0.6 1.0 2 6-'18 10yr4/4 none s! 2Dsbk mvfr cvn 2fmc 0.6 1.0 3 180 10yr5J6 none 1s1;<gr Osg ml cw 1fm 0.7 1.6 4 30-63 30yr516 none s 8 gr Osg m1 gw 1fm 0.7 1.8 5 63-368 10yr6/4 none s 8~ ~ Osg dl - 1 m 0.7 1.6 # ~ ~9 Pd Ground Sta'tace e9ev. ft- ~ ~ 9 fatdor ~. Sod Application Rai Ftoraon Depth Dominant Cobr Redox Desaption Texture Structure C~stenoe t3oundaty Roots in. Mrmsep flu. Sz. Cont. Cobr Gr_ Sz. Sh. 'EtT#1 'Et~2 Boreag # ~ ~9 Pit Ground Surface eaev. ft• fl~ ~ ha. Sol P~ppticatiar Rate i-iorizon Depth Domir~arrt Color Redox Descriptiwr Texture 5iructure face Roots ~. to t]u. Sz. Cont. Color Gr. Sz. Sh. *EtT#'I 't_ff#2 ' E#tluerit #1 = t30D ~' 30 < 220 etiglL acrd TSS >3p < 150 rng1L ' Etlkrent #2 = 8005a 30 ng/L and TSS < 30 mg/L s The Department of Commerce is atr equal o~ortrurity service provider sled employer. If you raced assi~ance to access services or ~ need material in an altercuste fort, please cmrtad the departrrtent at 608-26Cr3151 ~ TTY 608-264-8T77. .- Prat ~; t ~ t4.do ~ (1 r; vt 0 9~' of . q~. . ~~ ~~. b:m. ~ Top o{h;y~,~yo ~r'cG f~ssumt.~ slur. _ /Oa.CO. ~ D~Q , i~ 00. ~ ~ • E,r,:s E;~ ~ racle a fie'!' -~ r~i ~ec.~on ~ F °~Ci36'~~ (~, ~ S loP~- 1n~I ~ e~/„~, n /Ce~'j0f /90y /of./G, ~0l~50~~ ~.. C~;X Cv., chi. l~ q / i '~, ~~ ~ • y ~ ~,, ~ ~~ 8z . 38 l ~ \ ~, ~ Y4c% u.7i'~;n ~~ `\ Ci'ou~n off' ~~a//aE Q-l may 1 ~~~~~~~ ~ bC Cu.~ ~ /'crnovc.d~Or,'o~ ~ ,'3%v`~~ a~, ~ 8i Sys~.r, ctmstrae~•or-, z~ ~ h `.. `. .~ p' --- 0g" `~ y P.3~3 Wisconsin Department of Commerce Division of Safety and Buildinos SOIL EVALUATION REPORT ,n .~•.nnrrhn•w ..d4h (`nmm Ari Wic Arlm C:(ldP 1308 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8'/2 x 11 inches in s¢e. Plan must St. Croix include, but not limited to: vertical and hor¢ontal reference point (BM), direction and Parcel LD percent slope, scale or dimensions, north ur ~^~! !^~~tion and distance to nearest road. . pending Please print a 1 infoiE ~ vE' Q Date eviewe Personal information you provide maybe us for secondary purposes (Privacy Law, s. 15. (1) (m)). C~t/~v ~- // (~ Pro a Owner p m' 3 2003 Pr perty Location ~ ROSAMJI, L.L.C . Lot G na NW 1/4 NE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address T ~'~~~IX CUUN-i i L t # Block # Subd. Name or CSM# 2141 Cty Rd. C wNING OFFICE 16 na Indigo Ponds City State Zip Code Phone Number J City J Village ~ Town Nearest Road New Richmond ~ WI 54017 715-248-7071 Hudson Highlander Trail ll~ New Construction Use: y_f Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _J Replacement ~ Public or commercial - Describe:na Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevation 98.30 ft, trenches spaced and depth to code 3.75 ft, below grade ~ ~~'S ~o<c~.~+-~ Boring # J Boring 1~ Pit Ground Surface elev. 102.05 ft . Depth to limiting factor 100 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP "Eff#1 D/fl' 'Eff#2 1 0-8 10yr2/1 none sil 2msbk mfr gw 2c .5 .8 2 8-18 10yr4/4 none sicl 2msbk mfr gw 2c .4 .6 3 18-32 7.5yr4/4 none scl 2msbk mfr cs na .4 .6 4 32-70 7.5yr4/6 none cos osg mvfr cs na .7 1.6 5 70-100 7.5yr4/6 none ms osg ml na na .7 1.2 i /, Boring # ~ Boring ~ Pit Ground Surface elev. 102.05 fl. Depth to limiting factor 130 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 DIft= *Eff#2 1 0-6 10yr3l2 none sil 2msbk mfr gw 1 c .5 .8 2 6-30 10yr4/4 none scl 2msbk mfr gw 1 f .4 .6 3 30-65 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 4 65-130 7.5yr4/6 none cos osg mvfr cs na .7 1.6 ~~ / ~~ "Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 = BODS < 3u mgiL ana l ~~ < ~u mg~u CST Name (Please Print) Signatur CST Number David J. Steel ~~ ~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/29/2003 715-246-5085 Property Owner ROSAM]I, L.L.C Parcel ID # pending Page 2 of 3 Boring # J Boring Pit Ground Surface elev. 95.75 ft. Depth to limiting factor 130 in• Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots "Eff#1 P 'Eff#2 1 0-6 10yr3/2 none sl 2msbk mfr gw 1 c .5 .8 2 6-29 10yr4/4 none sil 2msbk mfr gw 1f .5 .8 3 29-32 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6 4 32-65 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 5 65-130 7.5yr4/4 none Is osg mvfr na na .7 1.2 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots "Eff#1 PD •Eff#Z ^ Boring # J Boring _f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots P "Eff#1 'Eff#2 "Effluent #1 = BOD 5> 30 < 220 mg/L and 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 NW1/4,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 16 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. 100.20Ft Top of 1/2" pvc pipe =Borings Boring Elevations -- ---.OSFt .OSFt ~SFt )OFt 1, c% d ~ - _ r Pv ! /~ S •~ ~ ~ 77 r 4S 4p. ~ ; ~ ~ ~ 'S . i• ~ tt - .4,~• - r , .• i ./ ftj 8712 _!' ~ - ~,~ , ' , ~ (2.000 { ~ ~ ' ~ ,(1.152 AC: • = ~ ~ -- ~; , ~ • ~~~ • - , yo_ , h' ; 9~,P ~~. 9x39 ~ ' ~ ; ~ 197744 S,F. :- 8 S.F.. , ~ ~ 1 (2.244 AC.) ~- ; "` ~~ - ~ V- ° , ~ ~." > . ~ ; , (2.075 AC.)' } ~1 ~ -~ (1.000 AC. N.B.P.A.) .- i • ~ . .,, j , (f.058 AC. N.B.P.A.y ~ ~ '~so ~ ~ -- ..~, ~ ~ ~S` • 1 r ~ ~ ~ .~ _ ~ ' ' ' ~ ~ ~ 9489'1 S.F. ~ i r ` , j - •. ~~ ~a _ ' X2178 AC.) ~ `~ _ `, -- o_ `ro^i -~-~ (`.000 AC. N.B.P.A.) ! ~~~,.• ~~- ~. ~., ~ ~ ~` o _-- - - `~P R. ;, /' ~~~' ~ ~, N ~a . ~ ~15~ ~ 1088 ~ k (3 071 AC. ~ r' i J ~`~ \ ~. ' • `'t~-' '~ ' ~ ` ` ` '• - \\ - -, \ ~--~ ~ ~ ---- ~' l ~ ' ' , 91875 S.F. ?p r f, ~ ~// : ~ ~ ~ ~ !(2.109 AC.)-- °o `r ~- .J ~ ~ .~- , ~ ~ /. .~ .044 AC. N.B.P.A.) /'~. - ~ 120'J48 ~.F ~'-- ~ ~~ r .f " ~ '(2.772 A -- ,-104457 S. ~~. 48 ~ . , ' - ~~ C.) : ~ x_(2.398 AC.)~,~~ ~ ~ •'~ '~~- ~ ` 1 75 S.F. ~•_ '" ;' - _ gg •' ' 1.141 AC. N.B.P.A.) 1.308 AC. N B.P.A.) ' ~a `(2.109 AC.) ~ - ~ - - _ 'F y+ ~~_ -- f _(1.147 AC. N.B.P.A~}~ ~- ~ ',Sam i ~ ~' A ~ f' +,S~Y . ~~$W ~~ a fT~l ~ +'~_ ..~ N ` • .~ ~ I ; 1 `• f / ><+56~ 9ZrZ30+0 0 'i _ d \ p ~ a O ~r~~g~ `~~r0`s ~- ~~ O~ <V L 5C SS \ ~~~ \ 40 \~ ~ ~ l~ $. ~< + w \ oWZ w u ~ _ I ~~: ` X1,9 ap$ I / < pp _ ~ ~~~ .. s. 6 ~ ,n u 4 ' of s L ~ ,. 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I ~ City/State `v ~~'v W ~- Pazce! Identification. Number ~~ - ~~J~ `~ - ~~ ~' ~ LEGAL DESCRIPTION Property Location IV % %,, ~(C %,, Sec. ~ , T Z~ N-R~W, Town of ~U ~N Subdivision o l~tn Lot # Certified Survey Ma`p7 # .Volume ,Page # Warranty Deed # ! ~ 1,~~~ ,Volume ~ Page # 3 ~ 6 Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTEM. MAINTENANCE ~/4.~" ~ 7Z~ ~ ~9 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 3t. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, 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 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, f the three year expiration date. IGNATURE 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 operty described above, y virtue of a warranty deed recorded in Register of Deeds Office. 7 ~ 21. o SIGNATURE 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 ' ~ Page ~ of .START UP AND OPERATION ~ ucts a other chemicals For new construction. prior to use of ~/~ a ~kthe dispertsatl cellist ~ 1' huh c~+~^~~ detected have the contents that may impede the treatment Process . of the tanklsl removed by a septage servicing operator Prior to use. System start up shalt 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 wNl be discharged to the dispersal ce81s1 in one Isrge dose, overloading the ceNlsl and may resuR in the backup or surMce discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septags Servicing~OP ~e pum coot olos o power to the effluent pump or contact a Plumber or POWYS Maintainer to assist in manuaNy open g restore normal levels within the pump tank. Do not drive or park v~ictes over tanks and dispersal cells. Do not drive or park over. or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soN absorption area. ve the performance and Pr~n9 ~a life of the Reduction or elimination of the folbwing from the wastewater stream may lnpro POWYS: antibiotics; baby wipes; cigarette butts; condoms; cotton ~linea gresse~heerbicides~mest iscp ps amedi ations; oil; foundation drain !sump pump) water; fruit and vegetsble peelin~s;s9tener brine. painting products; Pe8ik'~~% sanit~Y napkins; tampon , ABANDONMENT When the POWYS fails and/or is perrnanenNy taken out of service the following steps shall be taken to insure that the system ~s Properly ~d safety abandoned in compliance with chapter Comm 83.33, Wisconsin AdmMistrative Code: • All piping to tanks and pits shall be disconnected and the abandoned p'~pe openings sealed. • The contents of alt tanks and pits shall be removed and properly disposed of by s Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fiNed with soil, gravel a another inert solid material. CONTINGENCY PLAN ode a code compCant If the POWYS fails and cannot be repaired the following measures have been, or must be taken' to prow replacement system: ~ A suitable replacement area has been evaluated and may be util'aed for the location of a replacement soil absorption system. The replacement area should be Protected from disturbance and cornP~~ and should not be infringed upon by required setbacks from ~w soil and site ev~ scion to estabNsh a suit ble replacement area Replacre~ment systems must result in the need for a ne comphr with the rules in effect at that time. _ O A suitable replacement area be ~ allediasta last r resort to reply edthe failed POWTS.s. 6~9 advances in POWYS technology a holding tank may ^ The site has not been evacuated bc~ ~~ hable~ ePllacemena ~f no replacement aces s available a holding tank evaluation must be performed may be installed as a last rosort to replace the failed POWYS. ^ Mound and at-grade soil absorpons o such systems must o pN with thelrulesfin e'(fect at~th~atane. the biomat at the infiltrative surface Reconstruct < <WARNING> > SEPTIC. PUMP AND OTHER TREATM,~ TMENT TANK UNDER AN~CIRC MSTANCESDroDEATH MAY RESUL~ RESCUE OF A ENTER A SEPTIC. PUMP dR OTHER PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFlCULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWT'S MAINTAINER POWYS INSTALLER Name Name oth ) ri ount Ben Mor an Phone 715-386-2130 Phone 715-386-2850 LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PUMPER) Name St. Croix County Zoning OffQ e Name Tri County (Ben Morgan) Phone 715-386-4680 Phone 715-386-2130. This document was drafted in compliance with cMP~ Comm 83.22f21fblftlfdl8iffl and 83.54111. f2) S f31. Wisconsin Am° Code• . . ~ POWTS OWNER'S MANUAL & MANAQEMENT PLAN Page ~ of `~ ne~u eeReu~reg ~.~.. Nwrrber of Bedrooms 4 O ~ Number of Public Faagty Unix CIA Estimated fbw Iwersgel 400 Oesign fbw Ipeakl, lEstitnsted x 1.51 600 Soil Application Rste . 7 /it= Standard InfNaent/Effhrant OuaYty MontMY ~~ ~ Fsts, Oil 6 Greaw IFOGI S30 ~ti Biochemical Oxygen Danand 180Ds1 ~~ ~ O ~ Total Suspended Solids 17'SS1 5150 mgll Prsvested Effluent OuaGty MonthN wsrage Biochemical Oxygen Demand IBOGiI S30 ~• Total Suspended Sogde ITSSI S30 ~ O NA Fecai CoGform Igeomstric meant 510 cfu/100mt1 MaxNrarrn Effkrent ParticN Size Xs h ilia. O NA Deters ~ D~IA •VaMNS typical for dorrssdc wastewsesr end septic talc ettlusret. •Septic Tank Capacity 12 5 0 O ~ Septic Tank Marwfacttrer Wieser O NA Effirrsmt Filter Manufacturer Zabie O ~ EfNua~t Filar Model A-1800 O NA Pump Tsnk Capacihl DNA Pump Tank Manufsctwer DNA p~ Manufsottrrer ~ DNA P~ Model DNA f~rassatrnent Mink O SandKdKiravN Filter O Mechanical Aeretbn O Oietnfection O feat Filar O Wetland O Other: DNA DNpersal CeNlsl O Im-Cxamd Igrsvityl O At.~~e p pdp.Iys O NA O In-Gro~u~d Ipreawrissd) O Mound O Other: Otlrsr: ®NA Otlrsr: ~ NA Oehsr. ®NA 1AAINTENANCE SCNED!!~E Serviw Evsrtt 8«vMe y inspect condition of tanklsl ~ Nsa one every: 2 0 s 3 yearel O NA Pump out contents of tanklsl When combined skrdge and scum squab orte-third USI of tank vokars O NA Inspect dispersal ceNlsl At Nast once wary: 2 W rreonthlsl g 1~1 s1 O NA Clean effkeent fgter At least once suety: 1 ~ ( morrd'lsl O NA Inspect PAP. OAP oontrob ~ alerts At Nast once every: O monthlsl ~ M NA Flush laterals and preaurs test At Nast ones every: O mo GIs! ®NA Otters At Nest oroe wary: O non ~1s1 ~ NA odwer: ~ NA INgMITpiIANCE INSTRUCTIONS Inspections of tanks and dispersal calls shah be made by an individual carrying one of tM foNowing lioaeses a ceRificstions: Master Plumber; Master Plurrrber Resvicted Sewer, P0IA/TS Inspector POWTS Maintainer; Septage Servicitq Operator. Tank inspections must inckrde s visual inspection of tM tankisl to identify >nY 0 ar broken hardware, ideretiill any exardts ~ measure the vokrms of comebined skrdge and sown and to rdack foc any back up a ponding of effluent on the ground suuface. The dispersal ceNlsl shag be viwaMy inspected to check the sffkrent Nveb in tM observation pipes end to check for any pondln9 of effluent on the ground surface. The ponding of eHkreM on the ground surface may indicate s fabing condition and requires the immediate notificstion of the krcal regulatory audrority. ~ When the combined accumulation of skaigs and scum in arty tank squab onethiM 1X11 or more of the tank vokrrts, N entire contents of the tank shah bs romowd by a Septage Servicitng Operator and dhposed of in aooordanw with oltapter Wise:onsin Adminisustiw Cods. Aa other services. inckrding but not limited to the ssrvicireg of effluent filters, meechanicel of ptgewized compotterets, pretreaanent atria, end any servicing at intervab of S12 months. ahsM be performed'by a oartifred irOWTS Maintsinsr. A service report shop be provided m ties krcM regulatory authority within 10 dsys of oomeplstion of any service event. GMW 14I~Ot1 J 2223f' 306 • STATE BAR OF WISCONSIN FORM S - 2000 PERSONAL REPRESENTATIVE'S Dc~:ument Number DEED Judi iViccum.asPersonalRepresentativeoftheestateofFlorenceK.Polen ("Decedent"}, for valuable consideration conveys, without warranty. to Rosamil. LLC Graatee, the following described real estate in St. Croix County, State of Wisconsin (the "Property) (if more space is needed, please attach addendum): . Please see the attached legal description. ~ , . 7 1 93t7J9 KATHLEEN H. WALSH . REGISTER OF DEEDS 5T. CROIX CQ: , NI RECEIVED FOR RECORD 04/2/2003 03:00PK PERSOHAL.REPRESENTATIY . tXEI~+T #: .. REC. FEE: 13:00 ' TRANS FEE: 3448:80 ' COPY FEE: CC FEE: . ~PAGES:~• 2 , Recording Arca ~). N' • - :. • ,.. ` ~ ~ . ~. ~ Name and Return.Address . ... Edina Realty'f'itle ' : ~ . . ~ ~ . • 400 S. 2nd St., #1'I$ .~: ~• • : .• . - . Hudson, W154016~. r"~ Personal Representative by this deed does convey to Grantee all ofthe estate and • ~ ~QC . interest in the Property which the Decedent had immediately prior to Decedent's death, Parcel Identification Number (PtN) • and all of the estate and interest in the Property which the Personal Representative has This Is not ~'• homestead property. • since acquired. ~ ~ • . ..: ., .(is•not) •: Dated this 28th day of___ Aorll ~ ~ ,•2003 ~ .~ •~ ~ - • .. .. ~.; ~ Q .. ~ , .. • Judy . Niecum .. . . Personal Representative ~ ~ ~ •. Personal Representative , AUTHENTICATION ' • ~ .' •.~ ACKNOWLEDGMENT . • • Signature(s) Judy . ,Niecum ~ • • ~ . ~,-. ~ STATE OF WISCONSIN ) ... ; . ) ss. . . ST. CROIX County ) authenticated this 28'" day of April ~ 2003 ~ ~ , ' - Personally came before me this 28'" day of ' • April 2003 the above. named ~117-f.d~/ ~:. g1Cj `Judy. ' Niecum TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, .. ~ ~ ~ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) _ ~ . instrument end acknowledged the same. :. : . Z'H[S INSTRUMENT WAS DRAFTED BY ' Heywood, Cari & Anderson,S.C., 1200 Hosford St. Suite 106 • , P,O. Box 125, Hudson, WI 54016 ~ Notary Public, State of WISCONSIN ` My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary,) ~ ) ' Names of persons signing in any capacity must be typed.or printed below their signature. PERSONAL REPRESENTATIVE'S DEED STATE BAR OF WISCONSIN FORhI No. 5 - 2000 • ' INFO•PRO (BrNJ)653.2021 www.infopmform~.com `1 2223f' 30? Parcel A.: That parcel located in part of the Northwest Quarter of the Southeast Quarter, the Northeast Quarter of the Southeast Quarter, the Southwest Quarter of • the Southeast Qtbarter, and • the Southeast • Quarter of the Southeast Quarter, all in Section 24, Town 29 North, Range 19 West, and the Northwest Quarter of the Northeast Quarter, the Northeast Quarter of the Northeast• Quarter, and ~ the Southwest Quarter of the Northeast Quarter, and the Southeast Quarter of the Northeast Quarter, all in Section 25, Town 29 North, Range 19 West, Town of Ht+dsoa, County of St. Croix, State ~of Wisconsin; further • doscn'bed as follows: Beginning at the south quarter corner of said Section 24; thence North 00 degrees 31 minutes OS seconds Wost,.(for the. purposes of this description the south tme of said Southeast Quartcr.assutned'ba boar North 89 degrees 53 minutes OS seconds West) along the North-South Quarter line of said Section 24, a distance of 158.37 feet; thence North 89 degrees 56 minutes 47 seconds East a distance of 794;98 feet to the point of beginning of a line hereinafter described as "Line A"; thenco North 00 degrees 16 mimrtes 57 seconds East, along said "Line A", a disttance of 1049.18 feet to the point of tenninatiom of said "Line A"; thence North 47 degrees 03 minutes 07 seconds West a distance of 118:06 feet; thence Noah 27 degrees 46 minutes 10 seconds West a distance of 196.02 feet to the center line of Badlands Road; thence North 67 degrees 30 minutes l3 seconds East, along said center ling a distance of 708.39 foet-, thence North 67 degr+oes S6 minutes 31 seconds East, continuing along said cents line, a distance of 674.75 feet to rho westerly line of BOUNDARY RIDGE, according bo the recorded plat ther+eol; dunce South 00 degrees 25 minutes 17 seconds West; along said westerly line, a distance of 1826.90 feet to the southwest corner of Lot 7, said BOUNDARY R1GE; thence North 89 degrees 43 nuautes 38 seconds West a distance of 66.00 feet to a poitrt 66.00 feet westerly of and perpendicular to said westerly lino and hereinafter described as "Point A"; thence South 89 degrees 56 minutes 47 seconds West a distance of 961.84 feet to a point 66.00 feet easterly of and perpendicular to said "Line A"; thence North 00 degrees 16 minutes 57 seconds Bast, parallel with said "Line A", a distance of 1036.45 feet; thence North 89 degrees 25 minutes 43 seconds East a distance of 82.43 feet; thence North 77 degrees 28 minutes 43 seconds E,.ast a distance of 343.87 feet; thence North 83 degrees 18 minutes 47 seconds East a distance of 201:86 feet;'thence Norih'S$ degrees 53 minutes 32 seconds East a distance of 263.23 feet;. thence North 54 degrees .19 .minntes 28 seconds East a distance of 112.69 feet; thence North 42 degrees ] 3 minutes 44 seconds East a distance of 46.55 feet to a point 66.00 feet westerly of and perpendicular to said westerly line of BOUNDARY RIDGE; thence South 00 degrees 25 minutes 17 seconds West; parallel with said wcstorly line of BOUNDARY RIDGE, a distance of 1370.64 feet W said `Toint. A"; thence South 89 degrees 43 minutes 38 seconds East a distance .of .66/00 feet to said southwest comer of Lot 7; thence South 00 degrees 25 minutes 17 seconds West along said westerly 1me of~ BOUNDARY RIDGE, a distance of 163.55 feet to the North line of said .Northeast Quarter of Section 25; thence South 89 degrees 53 minutes OS seconds East, along the north line of said~Northcast Quarter and the south line of BC)IJNbARY.RII7tGE,. adistance of 760.75 feet to the nordteast corner. of saidNortheast Quarter, thence SoutH 00 ~de:grees 29 minutes 03 seconds West; along the east line of said Northeast.Quartu, a~distance of 2616.18 feet to the southeast corner of said Northeast Quarter; thence South 89 degrees 25 minutes 58 seconds West, along the south line of said Northeast Quarter, ~ di?stance of 2606.35 feet to the southwest corner of said Northeast Quarter; thence North 00 degrees 24 minutes 10 seconds West, along the west line of said Northeast Quarter, a distance of 2647.29 foet to the point of beginning, St. Croix County, Wisconsin, except that part described as follows: AI! of the Southwest '/. of the Northeast'/. and"also the West SSO Feet of the Southeast '/. of the Northeast'/. and Also the Souti1250 feet of the Southeast'/, of the Northeast'/., except the West 550 Feet; all in Section 25; Township 29 North, Range 19, Town of Hudson, St. Croix County, Wisconsin. ~r~/~ ~~ ~ 101,0 - ~~ GIUO ~o- ~~~ ~ -~o-~~, ~o - la~c~ - a~ ~~- ~o~ ~ ao, l0~ Q- 3v ^~~~~ aa~fo~9- yo~0~o a~ `c1~9,-~a-ate ~~~~ ~o- ~ Dom. r~ r Parcel #: 020-1439-16-000 05/10/2005 02:28 PM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2742 020 -TOWN OF HUDSON Current ',X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * ROSAMJI LLC ROSAMJI LLC 250 W 2ND ST NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 872 PRAIRIE MEADOW DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.178 Plat: 2128-INDIGO PONDS LOTS 1/57 020/03 SEC 25 T29N R19W PT NW NE INDIGO PONDS Block/Condo Bldg: LOT 16 LOT 16 (2.178AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-19W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 07/10/2003 729699 9/71 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.178 41,400 0 41,400 NO Totals for 2005: General Property 2.178 41,400 0 41,400 Woodland 0.000 0 0 Totals for 2004: General Property 2.178 41,400 0 41,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00