The URL can be used to link to this page

Home My WebLink About020-1439-17-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ` INSPECTION REPORT GENERAL {NFORMATION (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 Lunak, Gre Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: a ~ ` -"_ TANK INFORMATION TYPE MANUFACTURER ~`',~,,~ CAPACITY Septic r°°. ~ - / ~ ~~ , Bosing _ Aeration ,~~ Holding _.-.-_- -_ ~~_ TANK SETBACK INFORMATION TANK TO P/L ~< . $. WELL BLDG. Vent to Air Intake ROAD Septic •fi ~. ~~. ~~Z.' - ~ t.. T , ~` (., h 1 r. Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~ " ` - - •- TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well Coll ~RSnRPTI(~N SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 499278 0 State Plan ID No: Parcel Tax No: 020-1439-17-000 Section/Town/Range/Map No: 25.29.19.2743 STATION BS HI FS ELEV. Benchmark Alt. BM _ _._ Bldg. Sewer y ~+~ + , c: ~ ~ ~' SUHt Inlet i yc~ `i5~ . ~ ~ SUHt Outlet Dt Inlet ` ,~ Dt Bottom •~ ~ Header/Man. ~ ~~ f' ~~~ ~~ Dist. Pipe ~ 7~ • lG` Bot. System ,~ y ' C/ ~ J~. Final Grade ~ st Cover h.t I ~ ~~ <j ~• BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS , `-,+ r • ~~"~.` ! I t; ~ v_ `'_ •: ~ - ` i \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturerr,.~ ER OR CHA -~-/~.1` ~ ~~+''`~~ INFORMATION Type Of System: ~ r , e ,y iCt' - { uN Model Number: rIICTRIRIITI(1N RVCTFM f -_{ . `•~. Header/Manifold ~ Distribution x Hole Size x Hole Spacing Vent to Air Ike . ' `l - a' V Pipe(s) ~ ~. \ ~ ~ ; _ ; . Y , . ~ . Dia Length i Length '+ Dia ~ Spacing ~ ~ > - : Coll (:(1VFR „ o.e o c.,~+em~ n., i., YY Mnnnrl nr At_GradP Systems Onlv Depth Over > Depth Over I xx Depth of '" xx Seeded/Sodded xx Mulched Bed/Trench Center ,= I` t Bed/Trench Edges .. Topsoil ~. ~ No \ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:_ i / Location: 890 Highlander Trail Hudson, WI 54016 (NE 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 17 Parcel No: 25.29.19.2743 .... 1.) Alt BM Description = , 2.) Bldg sewer length = ~ a` ~ l•_' : ~-1~~ ~ ~) •t~•~ ~ ~~~~ - amount of cover = ,) ,` j g t ~ ~, ~ r ~( --- ~ , -- - -- - , - -- - --- - f Plan revision Required? ~, Yes ,%' No 6 ~ Use other side for additional information. _ _ ' Date ~ Insepctor's Signature Cert. No. SBD-6710 (R.3/97) /( COmmet'ce.uvl.gOV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 _ ~ i seo n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Dtspartmartt of Commsroe y g cJ 2 7 Sanitary Permit Application onNumber cti StateTransa ~ ] ~ submission of this form to the appropriate governmental Code 21(2) Wis Adm ccordance with s Comm 83 In /~ . , . , . . . a unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal inform ~ ~ ~~iney~~e-used-{eF-Secondary u oses in accordance with the Privac Law, s. 15.04(1) m , Stat . 1 f~ 1. A lication Information -Please t All Informs n t7 yd ~' ~• "~ Property Owner's Name ~ 1 ~ A ~ Parcel # /7 _ . j ,l~.. ~`~ 1. ~ ~_ ~ i ~ n _ ~ ~ Property Owner's Mailing Address ~ roperty Location ~l ~ '' r~ ,,,, °'' ~• ~ ~~ _ ~ I Govt. Lot City, State Zip Code `-- one tun ` T'~~---` ~e _ y., Nor y., Section ~S ~ t , i ~~ ~,/ -; ~~ ' ~/S _~ - ///I (circle one 2~~ T ~ N; R _~~ E o W Type of But ding (check all that apply) II Lot # , ~ . ~-t or 2 Family Dweifing - umberof Bedrooms ,(o ~ n -. Subdivision Name ~o.Yx a..... • Ada ~~ per. 6ab~r+:k~e ( Eiii -~pe.. ~ Block# cr Ei ~~ pp ~~ n ~ ~,/ ^ Public/Commercial -Describe Use (7¢bN'ai~b ~ ~ IJ~'x ; ^ Ciry of ^ State Owned -Describe Use CSM Number ^ Village of ~ /~~,~ G~R !/' Z ll ; ®Town of^/S/A~rc~~~ Ill. pe of Permit: (Check only one box online A. Complete line B if applicable) A' ®New System -~---- p y ^ Re lacement S stem ^ Treatment/Eloldin Tank Re lacement Onl g p Y ^ Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and ate Issued Before Expiration Owner IV. T e of POW'TS S stemlCom onenUDevice: Check all that a 1 ~ Ta Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersalfi'reatment Area Information: Design Flow (gpd) plication Rate(gpdsf) Design Soil Ap~ rsal Area Required (st) Dispe al Area Proposed (sf) Dispers System Elevation / j r/ r • Vl. Tank Info Capacity in Total # of Manufacturer ~ c ~ Gallons Gallons Units ~ ~ U U m r •_ New Tanks Existing Tanks ~ c :: ~ ~ 'b' ~ ~ a U yr u. C5 a 1 Septic or Holding Tank ,, .f.J J C7 r Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si azure MP/MPRS Number Business Phone Number ~ Plum is Address (Street, City, State, Zip Code) ; ~+ /. /cS~ ~ V i . ~/. :i ~1.~?~ S 3 V11I. Count /De artment Use Onl ' Approved ^ prov Petmit Fee Date ssue Issuing A t Signature ^ O tven Reason ial $ `7~.51~•°0 ~ i` a7 IX. Conditions of Approval/Reasons for Disapprova SYSTEM OWNER t S+~ptrc ?asik effluent. tlltet anri ~1~.,r,rr,s ,.:,{~ r~~,,,st aN be ma~:ntain9d as tier ma' 3~<: M~: P~a~ < _ r~~.F.e~ 2. AIr >e'^ack !equ~~rernenis rn„_` to ~ ~~a~ntai~ted 3:~• her dppaaeDler6ottleptoetylatt:~tba3he sasrem and submit to the County only on paper not less than g 1r2 x t t mcnes m size SBD-6398 (R. 01/07) Valid thru 01/09 T - ~ElT //2a~ERn' I3NE .I O/ER /d'0 PTO No/UN ~/1oPE~A'Y LINE ~w ~. ~ ygiO,Qoo~ ~ u' ~ ~ ~p~vGE ~C,q/yJGE 1 ~ ~nO, ~ 0 ~ ° ,~ ~- - YS ~I ~~ f----- /YO Ta EAS'7 ~js., ~ flo~~\ F i~ ~y~ xo ~~ ... u PLOT M CAS ~CTWN P~~1~N YAi'f'A •ROl. ExCAYA11Nii piC I,~ill~llio VNT .. , ~w .. PAO~CT _~ ~T. ~/torx _~OU/rY _' - !` ~~~e S~~c yo .C~ioG ~wPi¢ /ot'sv ~L ~F.rsS'~t V.Pi~c T NK t,~s7,v Z.oat'L A-~?oo F.~cr.C~c ~v.HO J.xoR.T ivs~+.¢i~ 5' ~~iovc ~i~FLVPM' ~T.uE LI~1/EWi4y .Q/~7~ Tom of ~a /°~t ~.o~' ~ .ELf/=/vo, oo .9~z .Qi7 rcP /F ~/i°/YG ~+~P~ E<k = 9~ os ios' / I /~r~ruwvnF/.t T~.vr~ Oss+~ed kT, 0~1 vENr ~~P ~~ ~~ ~~~ /!~/k~~ w~a•K ~1 fig Iab4J~ GrM~.ilst~ ate ~ -•-) ~~-- ~' ~ ~r 0 ~' OveAep at t.aechinp N W E ~~ _S C11L/ ,..,... °~ ucewe: ~~ 3~3 -----~ ~NrsM~~( - - ~~~ .T a~ _ ~~ ~!.: ~ -~ S+OE 1~![W ;~ coP~ T/~ ' ~- ~FlT /lLO~L1ERTY LTNF ovEa /ru 'ro No/tTrr %~a.P~r LrvE ~/~?a.ParFO l/EtL ~w f` ~ y~D,Qos~ ~ ~• ~ ~ ~QEStDiN~ ~(„p~bE ~~b 1 ~g. O ~ ~ 3s F- /yo Ta EASr B3 ~ ~ /s), ~,5., ° `rlaA`c` E 'E/off{ ~Y* I~~o , LzivE ~.o~ ~ cnoa aic~r~oH Pw~ YMPA ~NO~. EKCAYATM~ INC I.~IN~ WiT .. , .. Pi1Q~Cf a. /~ y-~ 1 ~1T_ L/larx L~O~s..rr~ - ~'` ~iol~ .J'cy6c 5'0 ~o~ ~-w6R ~oYS`O C~i+Ot LiL£'F-PX~! VE/oTlG /INK l.tS9N T~O[{tCL A-/?00 F.lGT,&it ~ir10 cli~lAR7 AN.4/~1 y "iDYG ~'f'~,Gf/6NT ~zuB d~@vEwAy i9t7. B/'7 TnP oc ~~ YC /a...LoP/ ELr/. = 9~ OS ~ I /oS ~ // /~rn'L~waf/.t T.aivsc. .~ - _. _. ", R .. Y --~~ 1~_ h 1, ._~ l~it~sE~hlr~rlt~ ,/~k~~ ~a•n J~i• l~d.Jr G~~~~ r Otieryp et 7!~ ~" Elik~iw- tonplh s~~kT~o~J VfN~ G~i OQ ~191~! ....--~ u~~e: ~ p,An; o 0 -- FNr~G~t~ .r-- ®2 lr ~ E ,.~ GALS ~~ a. . _....~--- _- -~^-~-~~" ~.~ K~S~~4EV~~ P~SO'c'~• .: l Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in ar-rnrdance with Comm 85. Wis. Adm. Code 1286 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 dimensions, north arrow, and location and distance to nearest road. . . pending Please print all information, sewed ~ Date Personal information you provi a may nv y Law, s. 15.04 (1) (m)). G,~~,~ Ls 6 Property Owner Property Location 19 W 29 ROSAMJI, LLC ~ N R Govt. Lot na NE 1/4 NE 1/4 S 25 T Property Owner's Mailing Address ' ~ i' Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C _ 17 na Indigo Ponds City State ~; `~ti` ~ Umbe ~ City ~ Village ~ Town Nearest Road New Richmond ~ - - 71 Hudson Highlander Trail i/ New Construction Use: y_J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD `f Replacement ~ Public or commercial -Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments d depth to code 4.75 ft below grade and recommendations: system elevation 93.75 ft, trenches spaced an / C~~ ~ ~ ~ - % Ce a~t~..e- ~ 3~ loo ~~ vtecd lod ~ ~~s~ Boring # ~ Boring ~ Pit Ground Surface elev. 98.50 ft. Depth to limiting factor 120 in. Soil Application Rate T cture St Consistence Boundary Roots P D~* Horizon Depth Dominant Color Redox Description exture ru ~Eff#1 Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 10yr2/1 none I 2msbk mfr cs 1c .5 .8 2 6-21 10yr3/4 none sic! 2msbk mfr gw 1 c .4 .6 3 21-45 10yr4/4 none sic! 2msbk mfr gw na .4 .6 4 45-80 7.5yr4/4 none os osg mvfr cs na .7 1.6 5 80-120 7.5yr4/6 none cos osg ml na na .7 1.6 ,, ,~ 3„ b~i(7 ~-, Boring # ~ Boring ~ Pit Ground Surface elev. 98.50 ft. Depth to limiting factor 120 in. Soil Application Rate ture St Consistence Boundary Roots P DIft~ Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture ruc Gr. Sz. Sh. •Eff#1 Eff#2 1 0-7 10yr2/1 none I 2msbk mfr gw 1 c .5 .8 2 7-26 10yr3/4 none sl 2msbk mfr gw 1f .5 .9 3 26-48 10yr4/4 none sl 2msbk mfr gw na .5 .9 4 48-120 7.5yr4/4 none cos osg mfr na na .4 1.6 e/ 5 ~ ~ "Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS <30 mg/L and i Ss <su mg~~ CST Name (Please Print) ignature: _ 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 ROSAMJI, L.L.C Parcel ID # Pending Page 2 of 3 Boring # J Boring ~ Pit Ground Surface elev. 94.40 ft. Depth to limiting factor 120 in• Soil Application Rate l ri ti R d D xtun: T Structure Consistence Boundary Roots GPD Horizon Depth in. or Dominant Co Munsell p on e ox esc Qu. Sz. Cont. Color e Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr2/1 none sil 2msbk mfr gw 1 c .5 .8 2 12-28 10yr3/4 none scl 2msbk mfr gw 1f .4 .6 3 284 7.5yr4/4 none cos osg mvfr cs na .7 1.6 4 44-120 7.5yr4/6 none ms osg ml na na .7 1.2 p ' ~~ O~ ^ Boring # ~ Boring _j 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 PD 2 *Eff#1 *Eff#2 ^ Boring # --~ Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color tion Redox Descri Texture Structure Consistence Boundary Roots PD p in. Munsell p 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 NE114,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715} 246-9372 • Indigo Ponds Lot 17 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend i"=40' • =Benchmark Ele. 100.00Ft ~ Top of 1/2" pvc pipe nj~ ~ „~ • =Alt Benchmark Ele. 99.OSFt ~ ~ ~ ' ~- v ~' Top of 1/2" pvc pipe n ^ =Borings Boring Elevations B1 = 98.SOFt B2 = 98.SOFt i~ %~ B3 = 94.40Ft B4 = OO.OOFt _ ~ ~. ' - _~ ; ~12ti \ ~ N L ..91.05-~ ,. , ~'~~ 87123 S.F'. ~ °' o ~~ _ ~ r _ o 0 --(2.000 AC.) \ _ .,.;~. J ~ ~ ~___ ,~ J (1.406 AC. N.B.P.A.) ~ °: o R,,k - -~ ` f ~~ ~~ ,~ , =s•~ - 'fir' , ~ " r ~ ~~ _ , `' _ , .__. ~ ~ ! ,r~ i - 1~--- I ~ 1 ~ ,~ ~ ~. ~• °~ ~- ~ ~ / ~ - ,~ 6 - v- ,_ _ x. d~~`~ ~~ f ~ ~~ _ - . _ ..- ;, ~ / ~ ,fie f ,: ~ _ ~" ~ ~~ X '~ / y w . , ' ~` .~ ,. ~ l ~,,,~ mss. . ~- . q ,. ' ~,'I ~ ,, ~% 1 (2.000 AC.)( `~i - ~'~ ~~„ _ ' - __ ` ~ 1:;(1.152 AC. N.B.P.A.) <~ ~~x. .,. _ ~ .38~.,,t\;. I t ' •, j /, ~ 87121 - ,~2 ~2 '`~' ~ ~ ` ~~~ ~ 7(2.000 ~ e' `~ ~ ` ~ ' / ~' .- ~ ` , ti~q, ~ j '(1.581 AC ~~ '~`?~~ ~- ~~v ~ ~. 90398' S f.. ~ .~ ~/ ~. n ~ `~ `~- {2.075 AC.)4 ~ r ~ ~ ,~ ~ ~ ~~ s _ '' N `~~-' . ~ ~ ~ (1.000 AC. N.B.P.A.) ~ '. ~r , f ` .1 / -.. _ ~~ __._ % ~~ '34891 S.f. j 6 '/ , r• '~~, - = (2.178 AC.) `~ ~ '.... --- - _ ~_~ i `roi .~- (`.000 AC. N.B.P.A) ~ ~ ~ - ' `~~/ / . .\ ', , ` 1 ~~~ _ _. \ r % ,- ~ `. X23. _- 8 ~ ~ ~ , ~~~ v~ -~ X25 ~ Sc~ i , ~ ~~` ~ _ ~' . ~' ~t~ ,- ~ - ' ~-_ ;, -`_ .- O o o , ~ ~ 'fig i.. _ - Cp,` ~ ~'__ - ..._--- -_-__ - ~ ,/ ; / .~ . I _ .--_ . __ ~," _. __ ~ -~ ~ _ ~ .- ~ - -- - ~- _ ~ ~~1`~ ~. _ _ -` '`, \` - ---_ .~'" ~~,~~. 91875 S.F. ,/~ _ -.(2.109 AC.) %~ ~~ ~/ ®19' ~ _ ~'~ ~ :~ _.- cr `{1.621 AC. N.B.F l -46 f , ~~ ~ > 47 ~; 9187$ s.F.~ ---. ~. '~ , ~~~ j/~ 81875 ~ S.F. ~ (2.109 AC.) ~ ~ - - ' % J / ' ~ ~ / / t{2.109 AC.)-.- ~ r OIL ! i .725 AC. N R. P e 1 / f -- - -- >, a v •r, ff'i u ox lo(wro--, Cn `."~ Q' -"~i<7 fir" .8l'919Z M.t0.6Z.00S (aum uwnol a.m.ts..x ~ •~Yi_= ~ ~ _ fR ~Yp I wfK w +• ~a nswno ' sriuroi ' I ~y ~t\ ~y II ~'ss~ d i# i~:runai su ~o ~ yyC~~a~f~~ +' ~ I `r z "` a.~wn mmssr ~~ g 4Ji ad , ;'Qq C ~~ 3 ~ A.7t..,-» ~~F~ Q~ ~XS~ r~a []i ~'i k aR4pq ~' NaY ~ ~~" ~ ay 9 I /~/~~i g L' ~ ~Ry ~ N`II NE~ S N~~P~~~ N~~ ~~~~ g I ~~ ~ V/~ E~ ~ ~ a^ e o ~ ~ ~: "~_„~_ 14~5~ ~ aY y .o r _ ~_ ' i°'t7 C~~l; VCS :-1 ~yy'n .q, ~4. R ` ` / ' ~'j^' ~ ~~ V it d S~ I N.M txr y~'waw ~~s yK / "` ~ ~ / /i . ~ Q ~~ ~ R~5 itl In \ // ~_ / ~ ~ ~ - ~ _t -~~ ! ~i~~h~~~~~;~~~n c~~ ~ ~Ei \i, sue/ // / ~ \ ~ a~~_ A-- € ~ aY .O6'9Z9t M Lt SZ.OOS -•. "! ss•rei- 'I_.« a ~~ .a~..~ ,, A.'tU •11.iL.f t4' N=~ v~~ ~\ \ ^~il .>saGz`-1 .t~.st.oos -~, •:, ~ ~~.~ ~ i f +\ ~_ H~6~ 51 "~' ,~ ~ ~ a I c I ~qa§ i~w ~~ a ~y :n I ~ 2 I . F € 4 o~L \ \ \ T ~ gg ,~~iq°$ k. .f !a 11//,I,..::.- A~ ~:`Ii~ i'~~ty~, ~' o`~ ~d$ `Y •~~' ~'i~ __^i~ -_ \ __-__ -j--__ I' it ~Y ~ 4t, ''~.' ` ~r`""w i~ i II Tidal ~vwns,; I ~ ~f ..~~~, ~~..+~ ~~ r ~ ~ ~ `\ ~ ~ day • T' _ _ P~~~ ~ ~ \ Q a~_ ~~~% 2 ~~g I°f/ "* /s-Y'"-" .'aa.c~ie¢s__-~ ¢ . ~~ ~ *,,1• n~s~j~q~`•~r~ ro. ~\ I a a[a ~z~~~.c_R# /I/ ~ /o.'/ ~ .~-.'Y-.. ~\ \ ,4\ ~.n i~_^ q ..'~N ~\ \\ ^ Ig~~ e8i~ Zia F~e~~= _ ~ ~, / /^a~~ ~ •,~ o \ ,,~~ ~ / ~/~ \~, ~ g ~ ~ \~ ~ °~~~~-4°~a ~~ /j~ I /~I P8~ 'n"~,bcicf,~ ~ \ ~ ~ / /~yp5y ~ \ \ a~ Od'~~.~-fidt 1CCA4aowhl ~ % ( t..r ~ ~~~ //5~/~/`\ F! \ 1~ 1 I ~+~~ X53 S .csro[oL,•• }~c;` P / I ~ ,~ / / 1 ( ~ ''JJ lid B .,~.. x"~ I ~ P~~d ~ ~ E ~~ I o v %~agsYFds .4y'rCar~~h~'. I k '°° ~v ~ r .a,~i k S11 p I I I p~ ~ f ~Ybl ~ ~(II i nl~ I<. ay o~ ~ I II ~. I ~ I n~l g555 ~ 3 s ~a I \ g~~ ~~~~#~'yJ8 I ~~ o $aYg ~g^i ~ IO I ~i'~ $~ ~ i ul y. ly ~~ iam O c sffi~ • ay ~ ,f...~_.~.~ ~~~~8 t /aba.~Aan ~M ~g w I•~`»«i,• ~"` ~ ~ ~ i ~ ~ Nay ;~i (~ 'g8 La" ' „PapY °L" w ryay I~ ~ ay ~ ~-~~ '' ~ ~~;y~~8ya?y9Yp ~~ ~• +\ \ nl~~ b u~ e :~~ I Y~d I r i ~ R .aeeri .>'i~ ~> .., ar~o. ~\`•,,,\I~ ~! i p~~ '1JI hy. ee o Laos # I 11 bR --'~I ~ w.o. 11 I '• I R :: . ~a ~ „ .~'~" I I I ~ YI ~ ~~ ay Irr R = ~ ,, ay ,~"~, i~ 1- SE>r i@ §_,~_ _I# gaA ~ I ~r\ as ~''.b ~ ~ I affil QL! ~~L? YQ >E~t'° ~' ~ "~ y S~ w~l v'v fi Y~ie ~ €E~ r ~\~ i(a I ~I~ ,eer~n d ~d Q° t4~ ~ ~ - lA ~ a >> ~m~w~, ,p~~T (xmz..w» ffi ~ $ai ., ( .r'cn . C ui '°f m .. - - ~ ~ a 3 ;12J:. -mnw - ~ '•~-~'_T-i7 ,•~-iF•. ,-rte'. -`r _•~ ~ .6Z'Lti9Z M OL tiZ.00N v.~ - _...T M.Cf1_L •(K1N "--Yf ~ is w>-.--. _ J . _, . 4uuoooxl 1'~' . ~'=i . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION Owner ~^ ~ C.~ N Permit # DESIGN PARAMETERS Number of Bedrooms / ^ NA Number of Public Facility Units ~ NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.51 al/day Soil Application Rate al/daylft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD5) <_220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD51 530 mg/L Total Suspended Solids (TSS) 530 mg/L ®NA Fecal Coliform (geometric meant 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ®NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS •Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer _ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model O ^ NA Pump Tank Capacity al ®NA Pump Tank Manufacturer ®NA Pump Manufacturer ®NA Pump Model ®NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ®NA Dispersal Cell(s) ® In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound D Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed'by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/011 Page ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanklsl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone POWTS MAINTAINER Name Phone ^~~ ' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name r Phone Phone _ ~~Q This document was drafted in compliance with chapter Comm 83.2212)Ib-1111d1&If) and 83.5411), (21 & (31, Wisconsin Administrative Code. Page ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s1. If high concentrations are detected have the contents of the tanklsl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. ` Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN ' If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon fai)ure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name - Phone ~ _ Phone ~~- _„ ' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name -~" Phone ~ - Name r Phone ~ _ ~~~ This document was drafted in compliance with chapter Comm 83.2212)Ib-11-Id)&(f) and 83.54(1), 12) & (3), Wisconsin Administrative Code. 834681 ~~ State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number 1 Doannent Name THI5 DEED, made between Landsted, LLC, a Wisconsin Limited Liability Company ("Grantor,,, whether one ar more), and Gregory D. Ltmak and Kara Bolton-Lunak, husband and wife ("Grantee," whether one ar more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtwes and other appurienant interests, in St. Croix County, State of Wisconsin ("Property') (if more space is needed, please attach addendum): Lot 17, Plat of Indigo Ponds in the Town of Hudson, St. Croix County, Wisconsin KATHLEEN N. MALSH REGISTER OF DfiBDS ST. CROIX CO. , 1t1 RECEIVED FOR BfiCORD 09/18/2006 10:00AM MARRANTY DEED E7lE~PT # REC FEE: 11.00 TRANS FEE: 387.90 COPY F'EE: CC FEE: PAGES: 1 Roeordine Ares and Return River Valley Abstnut dt Title, Gw. 1200 Hosfotd Street, Suite 20 t Hudson, WI 54016 File p; 2691251A 020-1439-17.000 Parod Identification Number (PiN) Thia is not lamepead property. (ie) (is not) Grantor warrants that the title to the Property is good, indefeasible in fce simple and free and clear of encumbrances except: Eaaementa, reatrictioas aad righb-of--way of record, if soy, Dated September 15, 2006 Landsttlt, LLC, a Wisconsin Limited Liability Company (SEAL) (SEAL) (SEAL) s AUTHENTICATION L Turner signature(s) Tracy authenticated on ~~~~ 1 ACKNOWLEDGMENT STATE OF WISCONSIN ) • ) ss. St. Croix COUNTY ) * Personally came before me on September 15, 2006 , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Mark Erickson, President of (If not, ~ ~ y Company authorized by Wis. Slat. § ?06.06) to e n sons who executed the foregoing i s d e e a same. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg of 'c, State f co m 1200 Hosford Street, Suite 201 Hudson, WI 54016 My Co ~ ion (is permanent) (expires: - ) (Sisaatnres may be adientfesbsd of sei~ow~lsdged. Itot6 are not secessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM BHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®1003 STATE BAR OF R'ISCONSIN FORM NO.1-2063 • Type name below signatures. tofl OwnerBuyer Mailing Address ~~ Property Address ST C120IX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~~ ~~~ (Verification required from 1>~a uting Department for new construction} ~ U Ci /State U ~d N ` ty ~_r_`/y -~-- Parcel Identification. Number _ b2- ~ ` (~ 3 ~ - ~ r] ~ ~ ~ LEGAL DESCRIPTION _ / Property Location ~ '/,, r %, Sec. 2..5 , T 2~1 N-R I ~W, Town of ~N Subdivision -~ Lot # ~ / . Certified Survey Map # ~ .Volume ,Page # Warranty Deed # V. 3 ('E7 (~ ~ 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 St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or alicensed pumper verifying 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 W isconsin. 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. ,.~ l / ~' o SIGNA O APPLICANT DATE ~ OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI F A I I (we) am (are) the owner(s) of l~l /~l D~ DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include tivith 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