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Home My WebLink About020-1439-20-000 r - Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building.Division 1 9 � i1 INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430330 0 GENERAL INFORMATION State Plan ID No: Personal information you pr ' e ma b fo secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hudson Township CST BM Elev: Insp. BM Elev: B Description: �J nw, ctiori/Town /Range /Map No: 1 62 3 • ! U 3 'U j 25.29.19. TANK INFORMATIO ELEVATION DATA H='�,t- a ,- . BZ TYPE MANUF APACITY ST TI HI FS ELEV. jog • 3 1�i • �f � Septic Bench ark 7 s g 0 /"c � ,Iv ation /_ c J Bldg. Sewer , /� I h �G 4 Z 6 Cp Holding t/Ht Inlet ns tn- 1.10 /t2, TANK SETBACK INFORMATION St/Ht outl� b0, S� TANK TO �/L EL V L LDG _ ent to Air Intake ROAD t Inl - o ,/ Z l Septic ZU� > ' �V 2 b l Dt �� 9�. Dosing Z r , ✓ Head r/M Aeration Dist. Pipe Holding Bot. S yst �4_ PUMP /SIPHON INFORMATION Final Grade fw a� Z a Manufacturer and t Cover GPM / I' - &V ` �(Z i / D 3 • (v Model Number I TDH Li action Lgss System ihi ad TDH Ft C (� r Forcem n Length Dia. Di t. to well 0 ( l s � SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 '� SETBACK SYSTEM TO PW BLDG WELL /M AKE /STREAM LEACHING M c�ture INFORMATION CHAMBER OR D t Ty Of System; , r 00 UNIT Model Number: 1 DISTRIBUTIONS EM , a/ r� Header /Ma fol Distribution x Hole Size x Hole Spacing Vent to it Intake y Pipe(s) / f Leng Dia Length 0 / Dia Space �- � SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over s Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench C er Bed/Trench Ed es To soil g p Yes L, No JI Yes No CO M ENTS: (Include code discrepencies persons present, etc.) Inspection #1: / Inspection #2: 1.2- -7 1 05 Location: 924 Highlander Trail H son, WI 54016 (NE 1/4 NE 1/4 25 T29N 19W) Indigo Ponds L' t 20 Parcel No: 25.29.19. - 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = � � ` �� o�.s� /n s - � 5. _' _ Plan revision Required? No Yes � I � O Lf 4oty Use other side for additions ' r on � SBD -6710 (R.3/97) Date Insepctor's Si nature Cert. No. s Safety and Buildings Division Cormty 201 W. Washington, P.O. Box 7082 ST. CROIX CO � C�� Madisrns W 5375 ? - �(I82 Saeritwy Permit Numb (to be filled in by CO.) (608) '261- t 430330 Departme of Commerce �• ti r . ; State Plan I.D. Number Sanitary Permit Appile4tion , ; In anemd with Ccmnn 83.21. Wis. Aden Code, personal . 16f tion y ner pirovida; maybe imadfixsecuuclary purposes Privacylaw 41-i.04(lXp) ICiI1LH1VUt AIL 'lilia Q L Application Information — Please Print Ali Infor ,/ mative 7 , � �) Pr(lierty Owner's Name Par Lot e?d Block # AMERICAN CLASSIC HOMES 4 Property Oviri x's Mailing Address -- Property Location C ity BOX 4143 zip Code Pl,oiteNui /%-e ,, HASTINGS MN 55033 T N, R[f -- - - IL Type of Building (check all that apply) 141 Famil Dwelling - Nun*wr o1' Bedra+mcs . 6 PER SUBMITTED H O U S B PLAN SuNtivision Name CSNt Number U 1'ublic'Comnrercial - i)excrilx Use ❑ state o„, i D it, (r. trenches w/14 chambers each = 4 ❑(;ity_LIvillage. t Townsi* vr�sv Iii. Type of Permit: (Check only one box on line A. Complete line R if applicable) • A. 13 New System ❑ Replacement System TreatmenMoldi%Tank Replacement Only t} Other Modification to l suing System list Previous Permit Number and Date Issued B. ❑ Permit Renewal M Permit Revision ❑ Change of H Permit. Tran4er to New tkfurc Expiration Phunher owner 430330 Sept. 12, 2003 IV. Type of POWTS System: Check all that appW I Nero - Pressurized lu- Ground U Ltound 24 in of suitable sail ❑ Mound 1 24 in rsuitable soil U iu -orade U Single Pass Sand Filter C(xrsTr ww waiand ❑ Prc'ssurizod In-C ..d U t-lomdim °rants H Peat Filter I I Aerolric newmentUnii ❑ Rrxartxdawog Send Filrer U R ceirculating Synthetic Media Filter ❑ Izach' ber IJ Drip line ❑ Gra el -less Yip ❑ (XI. (explain) V. Dispersal/Treatment Area Informst - 1 e user 8m ers - L a bel Al Ul) f Z oe ller pump lkesiga Flow (gpd) I Ikviga Soil Application Ra Reyerirnt (et) cperx+eI A MA Pnrlfreced (xi) System Elevation 900 .7 Tk 1285 1291.5 98.0 VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber PiaStw GrAkm f;s►tons ofIi'Vits Concrete Constructed (:class New f Fxrstugt T:urlu Tanks Septicnrtleldmglank X 1 1 WIESER YES Av-jbic Tn,ftncn4 Uoi! SJ � 3 ` fimmnp `'" l r X 1000 1 1 WIESER YES VII. Responsibility Statenvoent- 1, the uncle rr apwevibilStp for ieadseHrMioa of the PO scion. m the :.ached phone. Plurn$rer's Name (Print) MPIMPRLS Numb= Mnuaxa 1'lwxte Nlunher TODD FEATHERSTON PI s 242514 715 - 381 .1704 Plumber's Address (Street, City, Star p Codc) _. PO BOX 467 HUDSON, WI 54016 VIII oust /De artment Use Onl Anorcxed IJ Uisamiroved Sanitary Permit Fee includes GTOnndwater Dace Issued sstring �o ) ❑ Owner Giver Remxm for Ur --trial ) T� `�'- !f 3 U �p YL IX- Conditions of Approval/Reasons for Disapproval f act Attach ease clam (b the County ems) tw thr synen,o poor twttea, term sin i tl:rrciea � size - ....�� 12i09iO3 TUE 15:03 M 715 388 4688 ST CRI NG •r Pli CHAMBER CROSS SEC TIOIJ AAJ0 SPECIFJCATIpIUS V ELJ T CAP 4'C.I. VIZUT PIPE WEATHERPROOF APFRQ LOCKIW- - Z_5' FROM DOOR. _ JUAICTIDAI BOX MAIJHOLE COVER WIM004 OR FRCSH 1Z MIN. AIR WTAKE GRAOC ' MIS. o 18 "PIILI. v — — INLET PRGVIDE I - `7' AIRTIGHT TEAL I •/ # A ALAR P► 6 11 1 C *APPROVED Du JOINTS WITH t�EV FY APPROVED PIPE �_ 3' ONTO PUMP _ OFF 0 SOLID SOU t — CONCRETE bLOCK RISER EXIT pEKArwrD OUL IF TANK MANUFACTUR>~R HAS SUCH APPROVAL. SEPVC E �� PEGI�rGAT10 DOSE TA I,IKS MAMU ACTLIRER: wM6ER OF OOStS: P ER C" 5� TALIK SIZE : .. d d c - AL-Lo .15 DOSE VOLUM)~ ALARM MAMUFACTUlk0t: � 1�,�� l INCLUDIWU OACKFI.OW. GALLON! M40rL LjUM6EP(: wL / CAPACITIES: Am 2 - ?° 2 NJClRE5 OR CALLOUS SWITCH Turc ry��s =!�� $+ .� 9 (INCHES OR GALLOLIS PUMP MARJUFACTURYR: �/e C= f LXNES OR rALtOLJf S MODEL (NUMBER: O ilUGHEA OR GALLOLJE j SWITf_ N Ty'[: AIOTJL: PUKP AND ALARM ARE TO at KIMIMUM DISCHARGE RAT /S7a !7d GPM ��I(NjjST//ALLEO OW SE PARATE CIRCUITS VERTICAL DIFFERCU DETwEtllj Pu FIB Arun DI ISUTIOM PIPt.. 1 [l am FEET p v � � ' 11 n �Q L � dK �. MIWIHUM AIETWORK SUMS PKE�S ! I + Z � FEET or FORGE MAIM x = L F Yp rEFRICTIOIJ FACT"- FEC7 'TOTAL. oumikMIG. MEAD -m FEET IUTEOLMAL. DIME WS%oki 1, OF TALJK: L N ;WIDTH ;LIQUID DEPTH j 91GItiSEQ: LICEMSE UUMOLOt: % HAT :�7 SYSTEM CROSS SECTION MAN HOLE INSPECTION PIPE GRADE �fJ30 • E- ZABEL FILTER 1665 - - 87.5' SYSTEM ELEV. , 98.0 14 BIO DEFUSER CHAMBERS o 010000 o 14 BIO DEFUSER CHAM 14 BIO DEFUSER CHAMBERS PID # 20-1064-50 _ NE +h NE '/4.S 25 T 29 KR 119WE L�20 BL„_, SUB INDIGO PONDS C T HU ON . za2s1a MPRSW 242514 HEAD CAPACITY CURVE MODELS 53 -55 -57 -59 Model "53/55/57/59" 25 Ft. Meters Gal. Ltrs. • 6 20 5 1.52 43 163 10 3.05 34 129 15 15 4.57 19 72 r 4 Lock Valve: 19.25 ft. (5.9m) O 10 O r- z 6 5/32 2 5 ! 4 5/8 L — 1 119 —1i 1/2 NFT 0 3 X5/16 ALLONS U.S. G 10 �i 20 30 40 50 LITERS 0 ( 80 60 a ` / 4 1/'6 FLOW PER MINUTE 009697 CONSULT FACTORY FOR SPECIAL APPLICATIONS i •Variable level Float Switches available. • Variable level long cycle systems available. • • Available with special cord lengths of 15', 25', 35' and 50'. • Alarm systems available. '° l /ls } • Duplex systems available. 1 1 3 3/32 5KM SELECTION GUIDE Single sal Cor"Selection 1. Integral float operated mechanical switch, no external control required. Model vdWh Mode Amps Simplex I Duplex CSA UL 2. piggyback variable level float switch or double piggyback variable level M53155 & M57159 115 1 Auto 6.6 1 or 1 & 7 ' — Y Y 1Wat 901M. Raw to FM0477. N53/55&N57159 115 1 on 8.0 2 or 2 & 6 3 or 4 & 5 Y Y 3 • Mechanical akemator'M- Pak! 10-0072 or 10-0075. BN53 115 1 Auto 8.0 Y Y 4. See FM0712 for correct model of Electrical Alternator. BN57 115 1 Auto 8.0 -- N Y 5. Variable level control switch 10-0225 used as a control activator, with Electrical BE53157 230 1 Auto 4.0 Y - Y Alternator (3) or (4) float system. D53l55 & 057159 230 1 Auto 4.0 1 or 1 & 7 Y Y 6. Four (4) hole J- Pak, junction box, for watertight connection or wired -in simplex or F33i55 & E57159 2 30 1 Non 4.0 2 or 2 &6 3 or 4 & 5 Y Y 2 pump operation, PIN 10.0002. Single piggyback switch included. 7. Two (2) hole J- Pak, junction box for watertight connection or splice, PIN 10 -0003. A CAUTION ForinformationonadditionalZoeller products refertocatelogan Piggyback variable Level Root Switdles, FM0477; All instanation of controls, protection devices and wiring should be done by a qualified Electric• lANemabr, FM0496 ;MacharkalAlremator,FMC495; SumpJ Sewap Basins, FU04E7; and Single Phase ncensedelectriclan Allelectricalandsafetycode sshouldbefollowedincludingthemost Simplex Pump Cdntrd iAlarm Systems, Fh10732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. F)L-7 70: P.O. BOX 16347 • sville, 4g 4025 02 Rung MenufacfureBOf.. 3649 C— RunRoad x ® .Ae, v 4oz11•f961 /939• 1 z731.1(600J 829 PUMP P �� zler•� FAX ( 774 3824 0 Copyright 1998 Zoeller Co. All rights reserved. ff bk YC Jessie Nye Subject: Featherstone /Indigo Ponds Lot 20/430330 Location: Hudson Start: Wed 12/17/2003 10:0 End: Wed 12/17/2003..A:00 2 Recurrence: (none) 924 Highlander Trail 25.29.19. 20 Parcel #: 020 - 1439 -20 -000 09/30/2004 04:50 PM PAGE 1 OF 1 Alt. Parcel #: 020 - TOWN OF HUDSON Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * AMERICAN CLASSIC HOMES AMERICAN CLASSIC HOMES %MARY R RUSCH %MARY R RUSCH 250 W 2ND ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): - ary Type Dist # Description * 896 HIGHLANDER TRL SC 2611 SCH D OF HUDSON , / SP 1700 W ITC C �� vl (� P-2,C Legal Description: Acres: 2.019 Plat: 2128 - INDIGO PONDS LOTS 1/57 020/03 SEC 25 T29N R19W PT NE NE INDIGO PONDS Block/Condo Bldg: LOT 20 LOT 20 (2.019AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 25- 29N -19W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 10/21/2003 744365 2440/325 WD 07/10/2003 729699 9/71 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 29,200 Valuations Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.019 54,000 98,700 152,700 NO Totals for 2004: General Property 2.019 54,000 98,700 152,700 Woodland 0.000 0 0 All 2.019 54,000 98,700 152,700 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges P p g q 9 Total 0.00 0.00 0.00 Safety and 13nildings Division county IF 201 W. Washington Ave_ P,O. Box 7082 ST. CROIX visconsin Madison, Wl 53747 - 7092 Sanitary Pen Number (to be filled in by Co.) r3epartment of GOITIMerce (608 ) 261 6546 3 Sanitary Permit Application - Slate Plan I.D.Numper� In accord with Comer 83.21. Wis. Admn Code, personal information you provide / -------- --- - -- may be USW for setwrnlary purposes Pnvacy taw, st N.U4(1 )(m) "ed A� than ma� (it fferent iiing address) / L Application Information - Piie Print All Information - - " - RE +' HIGHLANDER TRAIL ase J 1. Property (boner's N a Wed. # t 20 -- -- Hock # - - I AU "G 2 0 4 203 20- 1064 - 50,000,20 -0o su_ � Property Owner's Mailing Adr6as toperty Sinn w U P.O. BOX 4143 _ ��, _ C_ NE NE ;., seCtic>4m 25 City, State: Zip Code Phone Number rmrrte me) HA STIN G S, M N 55 T 29 N. R 191f WWV IL Type of Building (check all that apply) t� e�tn, I or 2 Family Dwelling Number oi" $e�rooums 6 Subttivlsion Name C514i Itiumtmea I� i'ubUuCounnacial - Dc =ibe Use INDIGO PONDS ❑ State ournecf - Ik Bribe I lsc 3__ 7" - - -__- 'ity_ lviltage & ownship of HUDSON III. Type of Permit: (Check only cure tmi ott line A. Complete line B if ap plicwble) A. New 5 ystetm� ❑ Roacernemd Syslan ❑ Treatmer vHoldmg Tank Replacement only ❑ other Modification to Existirmg System $. ❑ Pert Renewal ❑ Perm icevision ❑ cxange of I � I'cnnit Trangfcr to New mast Previous Permd Number and Date Issucyl mm Refine Expiration Plumber Owner IV. T e of POWTS Sys tem: Check all that i i u Non -Pmss•vrized Iu� ❑ Nfcmund > 24 in. ofsuitable soil n Mound 124 in. ofsuitable soil ❑ A#-Gradc 1.1 Single Pass Sam Filter ❑ c>rvttruow wetland ❑ Pm uri;Zed In-ki nd Ll n kin g •rank C7 P,& F,,tc, n Aerobic Trcat,ne A Unit ❑ Recirculzling Sail 1•ilter ❑ Resirnmlating Synthetic Media Fihnr n t,.cbing ber H Drip Ire 11 c. - tens pipe a V. Dis rsalfrreatment Ares Information: 4X, 11" IO DEFUSER CHAMBERS ZABEL FILTER __.... - Design Flow (gpd) Design Soil Apphcabon R Dispersal Area, RcWired (it) System EIC"t' ` !,� ((�a 0) 900 .7 1285 1 291.5 8.50 b' VL Tank Info Capacity in Total Number Manmffaeturer Prefab site Fiber cmilons G;alkim of I inits Concrete Condructed Glass 23emv Exmsttmsg Tanks T Septic ra.t:iotdingTank X 1665MR 1 WIESER 1 Aerobic Treaunsamt Unit rTr.cine Chamher VII. Responsibility Statement- I, the for iaahe�dloe of tyre POw'rS shows ew time •tkaehed Pharr. Plumnticr's Name (Print) P s S' I MI /MPRS Number tkninem trlmnee Numb" TODD FEATHERSTONE 242514 7 15 - 381 -1704 Number's Addrm (Street, City, Sia C:ndc) P.O BOX 467 HUDSON', WI 54016 V OUR artrnent Use Only_ �pprov� ❑Disapproved S anit ry Fee) F ee (includes Uroundwae� Date Issued — I ing Agent (No S Sanitary Pernut 11 Ownm Given treason for Denial L IX. Conditions of Apptrovalllteasons for Ifisapprova! 3 \ Nn a`� �o � � ell OWNER; J yam( 1 Septic tank, effluent Inter and Ce _ dispersal cell must all be serviced / maintained < �► S k all per management plan provided by plumber. � O a 4 O'� 2. All setback I' ►' vt�►, as per a plicable code /ordinances. ��St�d� Q }� P� � � ��, D / ✓� lttaeA (to the t7 for tl an paper rube$ than i ia 7'Gl� i Q _f� 1 -- - ass a - r -- V - - -- - 3 i i C y 4 �lJ v a ��L g 5 �o ` e SYSTEM CROSS SECTION E--ZA8E L ..._..r.t 0 85 ' - -- Sys rew �L. 98.50 D4".c4f st7 o 0 1! io �E �vsE� o PID - - - - NE a NE ' /,,S 25 T 22- N,R n.ZE LOT BL_.. SUB INDIGO PONDS T SON �' koniSW 2425 1254 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. pending Please prr evi y �Datg Personal informabon you provide may used for tfo2cy law, .15.04 (1) (m)), l i Property Owner Property Location / ROSAMJI, L.LL MAY 1 3 2003 Govt. Lot na NE 1/4 NE 19 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C S CR0!X COUN71' 20 na Indigo Ponds City State J City _j Village Id Town Nearest Road New Richmond WI 54017 715 - 248 - 7071 Hudson 9 .gy Highlander Trail 0 New Construction Use: 0 Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD I 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 98.50 ft, trenches spaced and depth to code 4.50 ft below grade Bori tom. O. 2 S r� Boring # Am g Y' Pit Ground Surface elev. 103.00 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr2/1 none I 2msbk mfr cs 2c .5 .8 2 4-10 10yr3/4 none sil 2msbk mfr cs 1 c .5 .8 3 10 -24 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6 4 24 -48 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 5 48 -120 7.5yr4/6 none cost osg mvfr na na .7 1.6 y /Z a Boring # I Boring NJ Pit Ground Surface elev. 103.00 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0-6 10yr2/1 none sl 2msbk mfr cs 1c .5 .8 2 6 -13 10yr4/4 none sil 2msbk mfr cs 1f .5 .8 3 13-29 10yr4/4 none sicl 2msbk mfr gw na .4 .6 4 29 -54 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 5 120 7.5yr4/6 none co osg mvfr na na 7 1.6 ItY 17— ±L , LL * Effluent #1 = BOD 30 _ 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L CST Name (Please Print) Sign ure: 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 1 Property Owner ROSAMJI, L.L.0 Parcel ID # pending Page 2 of 3 3] Boring # Boring yj Pit Ground Surface elev. 99.80 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr2/1 none I 2msbk mfr cs 2c .5 .8 2 4 -10 10yr3/2 none sil 2msbk mfr cs 1 c .5 .8 3 10 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6 4 24-44 7.5yr4/4 none sl msbk mfr cs na .5 .9 5 44 -120 7.5yr4/6 none cos osg mvfr na na .7 1.6 C F-1 Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # -) Boring J 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 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD L30 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. i Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST - POWTSM ROSAMR, L.L.C. New Richmond,WI 54017 Lic. #248956 NE1 /4,NE1/4,S25,T29N,R19W Bus .(715) 246 -6200 Town of Hudson, St. Croix Co. Fax.(715) 246 -9372 Indigo Ponds Lot 20 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 ♦ Benchmark Ele. 100.0017t To of 1/2 " pvc pipe = Alt Benchmark Ele. 100.2017t Top of 1/2" pvc pipe ❑ = Borings Boring Elevations B 1 = 103.0017t i B2 = 103.00Ft B3 = 99.80Ft B4 = OO.00Ft W .RS �r kl— F FA NIA f♦ ♦fir;♦ ' 4� ► 0 A �1 �,� i ♦ �► �► � , A k4 MWA MA OMMA IWA mo t► �,�� / _ rI • ♦ '� ♦1;�,`��!y�� %y�' � ♦� �!�►�! ` ♦ t a i ' , ST CROI COUNTY SEPTIC TANK MAINT NANCE AGREEMENT OWNERSHIP CER IFICATION FORM OwnerMuyer _ . y, - f s F s �05f1 /�?Ti L I Mailing Address Property Address �� i� /mil C� 4 r ✓! ' . �G� �'6t��f�z (Verification required from Planning Dcparl went for new construction) City/State rt !G=v�✓ ,,. �s sc' , Parcel Identification Numba G C�YY�rL►a�►. LEGAL DESCRIPTION Property Location %., NG y, see. -R--2W, To of Subdivision 1 /`� _ ° �aU S Lot # Cerfified Survey Man # Volume Page # JACKmi C 1 v olume . Page # 3 Spec house 40 yes O no Lot Bees identifiable yes ❑. no SYSTEM MAINTRNANCE laqxaperwe sndmaiateasaceofyourscpticsyst= vesaftbosp ucetohand1cw&sh=ft*pcimawx8a= condm of pampiag out the septic tank every three yeas at if needed by a iioeosed pumper. What you put iam do systaa can affect the f=cdon of dw septic tanlcas a treat nad waft diVocal.system. TIM property owner agrees to cabmit.to St. Croix - g Depattzoed a caffmlion tonne. signed by the osvuaa* and by a P 7 y�Phmimwresuictcdphzmheraca ' pouq=vcdfying*9(I)tlroon- itewssiewaterdispawdsystem is m proper operating condition andler(2) after iaspectimand .(fnecessW).the septictanb less than 113 &U-of sludge. Uwe, the uade 4pwd have read the above requirements and agar to asiotsin the private sewage disposal system with the standards set fork herein, as set b}r the Depactmeatof Cam snerce and +fie D qm macut of Nsdttal Resources; Sate of Wasccasin- C brdficad i on stating 64 yaw septic ridenthas been maiatainodmest be comooted and r Wmcd to the St. Croix mty Zoning OSoe: within 30 A ie th oe year date. 4 OF P CANT DATE OWNER- CER CATI TIFI ON I (we) certify that all statements on this foam are true to the best of my (omr) knowledge. I (we) am (are) the ownet(s) of the property descriioed above. by virtue of a warranty deed is Register of Deeds Off m SIG9AME OF APPLkGkM DAVE Any information that is mis- representodmay remit is the sanitary petu k being revoked by the Zoning Department. •' Include with this application: a stamped warranty deed fiam, the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MAN AL & MANAGEMENT PLAN Page I of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner ( Septic Tank Capacity a l ❑ NA Permit # 30 3 3 0 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Z 1 0 ❑ NA Number of Public Facility Units Pump Tank Capacity al A Estimated flow (average) v gal /da Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer A Soil Application Rate Q . al /day /ft Pump Model NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit �< NA i rease (FOG) 73 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODd 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L 13 At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100 N ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size =india. ❑ NA Other: ❑ NA Other: ❑ N Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) (Maximum 3 years) ❑ NA s) At least once every: 2.-3 ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA 3 Inspect dispersal cell(s) At least once every: 2 — ❑ ear(s) (s) (Maximum 3 years) ❑ NA -,P-month(s) ❑ NA Clean effluent filter least once every: ❑ year(s) Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and ressure test At least once every: ' ❑ month(s) ❑ NA P ry ❑ year(s) Other: At least once every: ❑ y ear(s) (s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an i dividual 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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to the k 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 (Y 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 512 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. Page _ of y 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 tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater 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 re ace nt 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. T alua ' g a o in ank b e ai a � Of-l! B T!I✓1� fb R- A16W af1J5 M IC:n 0 ❑ 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 INSTALLE POWTS MAINTAINER Name f/E,�STj��/-� Name Phone S'— 3 �� _ d Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name st, ( GUN ZOAII�J Phone Phone - 71S — 3W 1 4 - 4y (� (� This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. J 2223P 3 6 STATE BAR OF WISCONSIN FORI 15 - 2000 7 1 9 - 3 ' 90 9 f I PERSONAL REPRESENTi LTIVEIS KATHLEEN H. WALSH Dc•cument Number DEED REGISTER OF DEEDS ST. CROIX CO-. MI Judi_ Ni ccu as Personal Representative of the estate of Fiore ice K. Polen RECEIVED FOR RECORD G ne ee en , r valuable consideration conveys, without rranty, to 04/29/2003 03:00PH ii. TJ rantee, the following described real estate St. State of iaconsin (the "Property) (if more space is n eded, please PERSONAL REPRESENTATIV a addendum): EXEMPT i Please see the attached legal description. REC FEE: 13.00 TRANS FEE: 3448:80 COPY FEE: CC FEE: PAGES:. 2 Recording Ara Name and Return Edina Realty Title. 400 S. 2nd St., #116 Hudson, WI 54016�'/„ Personal Representative by this deed does convey to Grantee all of the estate and V interest in the Property which the Decedent had immediately prior to Decedent's death, Parcel Identification Number (PIN) 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 April ` • Judy . Niccum Personal Representative Personal Representative AUTHENTICATION ACKNOWLEDGMENT Signatures) Judy .Niccum STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this 28' day of April 2003 Personally carne before the this 28 day of April 2003 the above, named �f�adf/ �jKj Judy,' Niccum TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the persons) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Heywood, Carl & Anderson,S.C.,1200 Hosford St. S uite 106 • P.O. Box 125, Hudson, W1 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 thei signature. INFO -PRO (800)655.2021 www.infopmfomv.corn STATE BAR OF WISCONSIN PERSONAL REPRESENTATIVE'S DEED FORI 1 No. 5 - 2000 n Q 719310 STATEIIAR & ZAaS& FO A19 -'2000 KATHLEEN H. WALSH PERSONAL REPRESENTATIVE'S REGISTER OF DEEDS Document Number DEED ST. CROIX CO., WI RECEIVED FOR RECORD ` j ug Niccum. as Personal Representative of the estate of 1 r ce K. Polen @4/29/2083 03:08P1i valuable consideration conveys, without warranty, to osamji LLC ntee, the following described real estate ' St. Croix PERSONAL REPRESENTATIV . o Wisconsin (the "Property) (if more space is needed, please EXEMPT i attach addendum): REC FEE: 11.00 TRANS, FEE: 4342.00 All of the Southwest 1/4 of the Northeast 1/4 and the West 5 0 Feet of COPY FEE- the Southeast 1/4 of the NE 114 and also the South 250 Feet o the CC ..FEE: Southeast 1/4 of the Northeast 1/4, except the West 550 feet, li in RAGES: 1 Section 25, Township 29 North, Range 19, Town of Hudson, I. Croix County, Wisconsin Recording Area Name and RWtrn Address ' "M p4alty z M" 400 S. 2W SL. #115 Hudson, WI 54018. Odr/ bz- z ao - /Olo Personal Representative by this deed does convey to Grantee all o the estate and 9 : 1 - b interest in the Property which the Decedent had immediately prior to Decedent's death, Parcel Wentifiation mber �j- /(�¢6� and all of the estate and interest in the Property which the Personal Representative has This Is not homestead property. since acq uired. (is not) A 104q �p4ZaD0 Dated this 28 day of April 003 • Judy Z.Nlccum Personal Representative Personal Representative AUTHENTICATION ACKNOWLEDGMENT Signature(s) Judy , Niccum STATE OF,. WISCONSIN ) ) SS. ST. CROIX County ) authenticated this 2 ° day of April ', 2003 Personally came before me this 2e day of April 2003 the above named Judy . Niccum TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by 1 706.06, Wis. Stats instrument and acknowledged the sane. . THIS INSTRUMENT WAS DRAFTED BY Hepvood, Carl & Anderson, S.C., 1200 Hosford St., Suite 106 • P.O. Box 125, Hudson, WI 54016 NotaryPublic, State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures may be authcnticatcd or acknowledged. Both arc not necessary. , • Names of persons signing in any capacity must be typed or printed below their signature. VG O -PRO. (800)635 -2021 www.bikptofomu.com STATE BAR F WISCONSIN PERSONAL REPRE$ENTATIVE'S DEED . FORM N S - 2000 1 2223P 307 parcel A: That parcel located in part of the Northwest Qu uter of the Southeast Quarter, the Northeast Quarter of the Southeast Quarter, the Southwest Quarter - the Southeast Quarter, and-the Soaftast- 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 O f 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 Hudson, County of St. Croix, State of Wisconsin; further described as follows: Beginning at the south quarter corner of said Section 24; th rice North 00 degrees 31 minutes 05 seconds West, (for the purposes of this description the south line of aid Sou*eatt Quarter .assumed to bear North 89 degrees 53 minutes 05 seconds West) along the No -South Quarter line of said Section 24, a distance of 158.37 feet; thence North 89 degrees 56 minut 47 seconds East a distance of 794.98 feet to the point of beginning of a line hereinafter described as "L' a A "; thence North 00 degrees 16 minutes 57 seconds East, along said "Line A ", a� distance of 1049.18 eat to the point of termination of said "Line A "; thence North 47 degrees 03 minutes 07 seconds W a distance of 118.06 feet; thence North 27 degrees 46 minutes 10 seconds West a distance of 1%.02 f t to the centea line of Badlands Road; thence North 67 degrees 30 minutes 13 seconds East, along said center line, a distance of 708.39 feet; thence North 67 degrees 56 minutes 31 seconds East, continuing g said center line, a distance of 674.75 feet to the westerly line of BOUNDARY RIDGE, according the recorded plat thereof, thence South 00 degrees 25 minutes 17 seconds West, along said westerly lime, a distance of 1826.90 feet to the southwest corner of Lot 7, said BOUNDARY RIDGE; thence No 89 degrees 43 mmueas 38 seconds West a distance of 66.00 feet to a point 66.00 feat westerly of and perpendicular to said westerly line and hereinafter described as "Point A "; thence South 89 de 56 minutes 47 seconds West a distance of 961.84 feet to a point 66.00 feet easterly of and perpendi ar to said "Line A "; thence North 00 degrees 16 minutes 57 seconds East, 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 act; thence North 77 degrees 28 minutes 43 seconds East a distance of 343.87 feet; thence North 83 de 18 minutes 47 seconds Bast a distance of 201:86 foot; thence North 58 degrees 53 minutes 32 East a distance of 263:23 feet;. that= North 54 degrees .19 minutes 28 seconds Ea a distance of 112.6 feet; thence North 42 degrees 13 minutes 44 seconds East a distance of 46.55 feet to a point 66.00 feat esterly of and perpendicular to said westerly line of BOUNDARY RIDGE; thence South 00 degrees 2 minutes 17 seconds West„ parallel with said westerly line of BOUNDARY RIDGE, a distance of 137 0.64 feet to said "Point A "; thence South 89 degrees 43 minutes 38 seconds East a distance of 66100 to said southwest corner of Lot 7; thence South 00 degrees 2S minutes 17 seconds West along 'd westerly line of BOUNDARY RIDGE, a distance of 163.55 feet to the North line of said -No Quarter of Section 25; thence South 89 degrees 53 minutes OS seconds East, along the north line f said Northeast Quarter and the south line of BOUNDARY. RIDGE, . a distance of 760.75 feet to the no east corner of said Northeast Quarter, thence South 00 degrees 29 miauies 03 seconds West; along the east line of said Nort heast Quarter, a distance of 2616.18 feet to the southeast comer of said Northeast ; thence South 89 degrees 25 minutes 58 seconds West, along the south line of said Northeast Quarto distance of 2606.3S feet to the southwest corner of said Northeast Quartet; thence North 00 degrees 2 minutes 10 seconds West, along the west line of said Northeast Quarter, a distance of 2647.29 feat tc the point of beginning, St. Croix County, Wisconsin, except that part described as follows: All of thi Southwest % of the Northeast'/. and also the West 550 Feet of the Southeast % of the Northeast'/.. and Also the South 250 feet of the Southeast % of the Northeast %, except the West 550 Feet, all in Section 5, Township 29 North, Range 19, Town of Hudson, St. Croix County, W 011� 1 l] - /067 , C / /I IVO, , D- l��g-ly -� 9 lalc� -y��v 6 a- sot �vro Q - 3v �000, ao- 1or�9- yo�o�o a it),rq -go-0a a�)- /ate ♦ d�� K ,�� ♦' ��i �� • ��' fi .... � � ®� o � , ��L�� r'��h� � o ��1 s •air - `y�. � �. .� —v� , PA MA `o • :r ♦� • ;. ,♦ ��e ,�Q�l I MA MA C :: f C 0 O 3 m 3 A 3 '* m ry (D 'C A+ T -4 n 2) 7 0 ° W p C N �I • =r (y ' 4f. co O a m 3 m y w N N F— CP N m d 7 —{ N ■'S 0 0 0 0 0 c m rn A� co V CT 3 7 VI (M ? 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