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020-1439-41-025
Wisconsin Depa,~tment of 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)]. Permit Holder's Name: City Village X Township Weber, Jose h Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: _ / L~ ~j 11r'~ ~ ~^`~ ~ TANK INFORMATION TYPE MANUFACTURER ' CAPACITY Septic , ~ 1 '` n. W 4Y~ f YYI I!~/~ P:r r ~ G~ ~ V Aeration Holding r TANK SETBACK INFORMATION TANK TO ~" P/L SJJ J ~*~- WELL BLDG. Vent to Air Intake ROAD Septic > 5~, " ~ /~ /V i~ e Z.. t .~ ...@-~ Dosing ~.rc.,,...~_ __ Aeration Holding __~~°_ PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number , "'°`~=• 3 TDH Lift riction Loss System -._, TDH Ft Forcemain Length Dia _ Dist. to well ELEVATION DATA County: St. Croix Sanitary Permit No 506352 0 State Plan ID No: Parcel Tax No: 020-1439-41-025 Section/Town/Range/Map No: 25.29.19.2767A STATION BS HI FS ELEV. Benchmark Z .y--~ ~01.~7 ~ oa Alt M ~~ • ~-1 Bldg. Sewer ?' ~ 5 ~~ 3Z. St/Ht Inlet 5• Z7 97• Z SUHt Outlet rj .7~ y` , '7 3 Dt Inlet ~ Dt Bottom ~, ~ Header/Man. g,•'~ 9 yY 3 Dist. Pipe 4.1 9Y 33 `~ 4 Bot. System ~ 44 roY~( 7 ? • `{ `~ 9Z•~~ Final Grade 5~ ~+$ '(~ • `7 `~ St Cove F;'~1.~,, God 2 • `~ /00.67 ,~ SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length i No. Of Trenches PIT DIMENSIONS ~ ~V ~ ~ jc r. ~~ SETBACK SYSTEM TO P/L BLDG WELL LAI INFORMATION Type Of System: • ~~ ~ ~ r ~~~, Ga~Jf'ri'~'~o t nICTDIRI ITIf1Al CVSTFM Ai. fi~_ ~`, IMENSIONS No. Of Pits Inside Dia. Liquid Depth ./STREAM LEACHING Manufacturer: CHAMBER OR ~~" a~~d L..J ~~ 1 UNIT Model Number: ~~~ Header/Manifol ` Length ~ ~ Dia 1 Distribution Pipe(s) \ ~ \ Length \ Dia Spacing x Hole Size ~`....._ x Hole Spacing `'°-___ Ver}t.to Air Intake L _ ,J j ' ~-.+o SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx ra9aiched Bed/Trench Center.t,. '{ ~?` BedlTrench Edges „®` Topsoil ~ -._,,,_y4Y No ~`~,.ves No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 905 Highlander Trai Hudson, W//I 54016 (SE 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 41 Parcel No: 25.29.19.2767A 1.) Alt BM Description = , 1 Bldg sewer length = Z - amount of cover = 3 t / L.0 ~ ~._ `sion Required? ~_ ;Yes No ~Z 0~ side for additional information. - Date Cert. No 3/97) I ~,,~ ffl~' Safety and Buildings Division Co-mty t S ` 201 W. Washington Ave., P.U. Box 7162 1 ,, / 1 jVla~, WI 53707 7162 {m be filled in by Co.) tN Saa ~ ~ ~ Sanitary Permit Application State T u~act>.n twn Number N~%~j ubmission of this formate govenuneafal d Ad C o e. s m. In accordance with s. Comm. 83.21(2}, Wis. unit is requires} prior m obtaining. a sanitary pexmtt. Note: Appiitxtion forms far state-owo~'i'B~i~ aEC Projod Address (If dift'exent slum maiWag address) submitted m the Department of Commerce. Ptttsoaal information you provide may be used for secandary ` sn accordance with the Pr`r Law s. t5. i m Stets. ~ ~ {~ - I ' ~ t / 1 ns I. A Ldormat~-n -Please Print All Property Owoer's # Property t)w~'s Ming Address T.ocaao / 27 `p~ l J ~~~ S ~ ST. CROIX COUNTY . l/ ~C ~ C' ,State ('„ode r - l Number y., ~~ Y,, Section _J ctrck T~N, R~EakW ) II. Type of i3nihling (chet3t all that apply) Off, ap Lot# ~~ Subdivision Name t or23=amity-Dwelling-NumberofBedmor-v4 : b l3tock# :_L d h s~ ~ ~ ~ ^ Pubiic/Cotmrterciat - ikseribe Use ^ City of ~1 1 Ir~6JS~t-~ CSMNumber ^ ~llageof state Owned- Destxibe use (~ N I'r- Town of O e ` Ores ~ ~ III. Type of Permit: {Cltet:k only a on Ilse A. Complete lane pplieable) A' New System ^ Replatxmutt System ^ Treatmetn/Hoklmg Tank Replacement Only 0 Other Modi~fua<ttiurn m Exiniag Systan (expiam) B. ^ Petmtt Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer m New List Previous Putt»t Number and Date Issued Before Ezprtation Owner IV. of POWTS rem! ntnttlDevtce; Check sit that a ~tJon-Pressurized In-Ocound ^ Pressurized In-Gcotmd ^ At-Grade ^ Mound> 24 in. of suitable so7 ~ Marnd <24 in. of suitable soil ^` Holding Tank ~~her Dispersal Component {explain) ^ Prett~m>ent Device (wcPfain)- V. his reatment Area IafortnaNon: AreaRegnired (st) Dispersal Area Ptd (s~ Sys"temETtva<an /I Design Fbw tt;Pa} ign Soil Application ~ ntspersal ~/ 3 ~ ~ V j ~ Vi. Tank Info Capacity in ll ns G Total Gallons # of Units Mtm m o a NcwTanks ExistingTmiks ~ U m ~ ~ w ~ P~~. 'c Ho~iagTank ~t -- - - -- - -- - VII. ReapOHat Statement I, the nadetsigned, assaaie or iosWlattaa of the POVV7'S the attached pons. N b B i Ph P s Name P s Si lure one um er °s ness P s Address ttce ,City, State, Zip Code) c ~ N.~t~~~ ~ ~- ~ Q~r VIII. Coup /De t Use Unt Pemtit Fee Bete Issued Issuing t Signattue Approved isapprovo 5 D • °° ~Q 3 a 7 - van Reason for I1C. Condtt~teasoiss for Disapproval ~` La ~i ~~~~ % ~ ~' d~F~ ~ \ ~ f~,~ ,~-~ pe(`~-~Y 1. Septic tanlc,_effluent filter and J dispersal cell must all gg servkes I maintained f / as per management plan provided by plumber. t 2. AA` aetbatsk eegttaemtertts must be maintained rj 5~~ rvl,~- ~, Sd awe d M1. --~-~ of Im t4pu 8 rR Y 1 r [oe6es in sixt system sad sa4 to the C my only sa t ~ ^ /~Q 'i ~O SBD-6398 (R- 01/07) Valid thtu 01/09 1 I +~,~ ecSf2rc- ~~ 'i~, r. I~'~. ~~ ~„v« 573t~+,'Vrr M~1'tY2 R4::t~t,+'!s~`p Y 9DOa 9i~~~!IgQb i9C~ 66 ILJ~ 4 QV~ s~y~N~ s~s~a~ti~~~~ ~.~--r l ~ i z7 C~ n ~ S ~SJ~~ ~ / Uo n ~57~ C ra ~X ~ o a ~ 9 ~~ ~ ~~ ~ S~ ~~orss ~ ~~\ sew; ~,~_ ~~ ~ ~ .~ ~ .~r~--~ ~ Eaq~~~ ~~ ., ~ E~q2 ~ y ~~ l ~ \`~ ~~ `~ ~~~. i ~ ~` -/_ ~. ,~~ _ ~~r\ ~~ ,f ~.~ :~~ ` /Cl ~' .~ '~ ,7'~ \.l ~ ~ ~~~ ~~ ~~,` ~~~ ~ /~~ 7 y ,~/`-, ~-~ ~~~ ~Jos~~~ ~: w~b~e~ s~ y~ N ~ S~sTa~ ti X21 q c,v ~~ ~ ~ ~ mo n v c~~-~~-o ~J' U©n ~7 Cry ~~r /lU~ ~ ° ~ 3 ~ ~ © o a 9 ~ ~S ~~ ~~G~~;~ecs~iQa/ laks~ ~ 5` `~ i~.h LcPn ~ r ~c~ ~ l o'~ S~ ` `~ovLS ~ Z~~o ".~ ~~a ; ~ --a4 -~~' sew ~ ~ ,~_ ~~ ~ ~~~fi~ ~ ~ ~ `7 ~m, £~/~ ~~> z plc ~'~'~"- .o ga9l~~ ~~q1 ~ ~. ~\ `~ ~~ ~~ ~ ~~~ ~ -, ~ ~ f -. 4 ~O ~ '~ `~~ 3~~~-~/ ~u \ Q~ ~~ Q?9y ,, .~ ~i~~ `' Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arrnrdance with Comm 85_ Wis_ Adm. Code l/~?~~~~ Co rU~'OL Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8%: x 11 inches in sae. Plan must 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. ~Z p - / - / -~~ ~~ _ ~ ~ ndin Please p Date R i Personal information you provide ma be used~~~ ~vacy , s.15.04 (1) (m)). ev ew y ~ b Property Owner ~ Properly Location ROSAMJI, L.L.C Govt. Lot na SE 1/4 E 1!4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or M# 2141 Cty Rd. C ST. CROIX CC?UP~1T'v 41 na Indigo Ponds City Stat Zi CI~~~FF ~ ~ City ~ Village td Town Nearest Road New Richmond ~ WI 54017 715-248-7071 Hudson Highlander Trail 1/ New Construction Use: yJ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial -Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: system elevation 93.65 tt, trenches spaced and depth to code 4.00 ft below grade D •~ ~ t7~ ~'"~ Boring # ~ Boring iI Pit Ground Surface elev. 97.65 ft. Depth to limiting factor 120 in• Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr2/1 none sit 2msbk mfr cs 2c .5 .8 2 8-24 10yr3/4 none sl 2msbk mfr gw 1 c .5 .9 3 24-39 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 39-46 7.5yr4/4 none sl/cos 2msbk mfr cs na .5 .9 5 46-120 7.5yr4/6 none cos cos ml na na .7 1.6 Zdd if Co cen---~ ~ 1 COS <35% coarse fragments = 36" & ~~ c°i _ ~~n°~ = F(1" below svstem ~/ Boring # J Bonng ~ I Pit Ground Surface elev. 97.65 fl. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft2 in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yrL/1 none sit 2msbk mfr cs 1 c .5 .8 2 5-46 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6 3 46-84 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 4 84-120 7.5yr4/6 none ms osg ml na na .7 1.2 ~1 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) -~' Signatuje: CST Number David J. Steel 1/ ' v 248956 ,: Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/30/2003 715-246-5085 Property Owner ROSAMJI, L.L.C Parcel ID # Pending Page 2 of 3 Boring # Boring ~rj Ph Ground Surface elev. 92.65 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Textun: Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr2/1 none sil 2msbk mfr cs 2f .5 .8 2 10-14 10yr4/4 none sl 2msbk mfr cs na .5 .9 3 14-33 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 4 33-96 7.5yr4/6 none ms osg ml na na .7 1.2 ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # J Boring J Pit Ground Surface elev. ff. Depth to limiting factor in. Sod 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 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODS < 30 mg/Land 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 SEl/4,NE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 41 This soil evaluation was conducted to satisfy a caning 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' • = Benchmazk Ele. I OO.OOFt ~ ) Top of 1/2" pvc pipe N . =Alt Benchmark Ele. 99.80Ft Top of 1/2" pvc pipe ^ =Borings Boring Elevations ~ ' B 1 = 97.65Ft ~ ~ B2 = 97.65Ft ~ ~/~A~ B4 = OO.OOFt ~y~~4 ~~ ~,~, ~z,~s-~ ~- ~ ~~ s~ ~a~ 1 ~~~51 i ~` ~o~ 3~ ~~ ~o Z ~ 7S"F~ ~J r , I J ~~~~ ~~ -,~~ ' INDIGO PONDS y laded'n tlr Natlrwd QaNr d M SruNron OnM1r, n Na Nar~M°d Camr d Ma sadNan arar,'n IM •suM.ss4 mm4r d Ma N SaNad Qloir, and n Mr Sa0add Orolr d 0a Salhe°n Qwrlr, d n Rclkn 11, fan i9 Np1N, Rrgn It Mal, ad n Nn NrN.al Oair d Mr XrNral Curly, H Md NaV+al Carly al Ra NpMera C°oir. a nn SeuardN Oialr nl Ma NoUaml 0uata, rd ~ ~ r S c Ya SdNaod Cwl r d Na Nrlharl O+rlr, d n $rnlWi 77 lan 19 N°rtq Roar 19 Mnrl, (an °I N,dra, 51. G°ir Cooly Mamm. u® ~~a°r Q uuarrl aurr srtm Sara ~~" 2 adumlr aw SC~d~tl ~ rsaammmm pi F.up 9E 9Nti 1 a< t d r.[ as ar 3 un~ as 1 ~ aae nm m b~~^ Imau, ~ j/ is"/Aa/ 0 waeMaalamaa,n Z•~ ~, J..~..~'' / / ids ' fd"' ad, ~ us am at da arm mam 7C3dd +S/ ~ !r t as f M aM alb m rmaaM tnumadtm . 2 ~' ~ J / ~ 0rMa'd sal rmwu aaam as t d~>r nu u. _~-""" Ys J - _ _ _ L aat w / >~ q ~ ~,~ • . -Ma- aara aM ~ ' ~ I,ANDER ~tAll - G 46 omlaM dVaaRa m uxss laa rn ~ N ~t r rda"isa / j ~ - ~IIGN / ~~ 47 ~' dua sr, rm r mr m a rom ac m ~~ nmu. 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I '~ Im1! 7,11 ,~; ',, ~~ ssraMds~Mnauu u wx wn ds o x alxst .~ ~ni;)i rr*rn i nin;• Il-aauuarasaxa\ \ r// S89'1S'SB'W 2806,35 v~•_lcl_~.ti_wl~e,< Nx OWNED BY U.S, flSH AND IMtD UFE / __ .......,m,,a..__.... .~ M OWM Oa11Al u a•+ray w a K R na l aM am ' a, s a a, a m JNIVIGa7 ~~~ ~, aram a r[ naMra imf 10I/ •aawl((, I.aM.aNM 1, ,, ~~" ~ ~..i`"' ___ _ ..---' ..-- ` ~.',,. ~ ; / e f J \/ / ~ +~ ~ ~~ \ ~ ~ -~-~- t ~ ---- __~ -°'-'- .~' ' ------ _.(2.004 AC.) ~`'d i i __._. ~ ~ `~, _ 02~~ ~ ,,. -~_- ,.`(1.581- AC. N.B.P.A.) f; ~ 1 1 f ^--~ ,~: `' \ _ .~-- - , . '• .~..~ ..- ..-. ,•i ~r ~ - .-~ +' - _ ~ \ ~'\. ~.... ....~ t ALT / -/'' ~ ~ ~ ....+~ ".,.,,.. '~~ ~ ~ ~ : ~D'~ ~`'~ __ ---"~ -= " -_,(2.09 Ac.)`~_ .._ - - ~r. - ., '-(1.621 AC. N B P.A.)`_ ` ~ r~ .- _ "_ ----- ~ . - _ ,, __ - ... - _ ~. _ sus ..` ~. ~Q _; _ ~ ~..._ ,~~ ". . ., - a _. _ ,,,,,~ . _ _- _ .~ _~ ~ ~50 ._ ,- .$ _ - ._- _. - _ . __ _ ...`,yo--~''- ;: _ -_ - _: ~~ .. _42r - ---~~ /~ ~, -. _. _ . ._ _ " . ` ~o . ~,~ _ 87~ S.F. ~o :~ . . ~_ V_ ._46 - ___. ._ _ _ . _ _ - _ - ---- 91875 S.F - ~'_,' -__ _ i-. (2.109 AG)f ~~ _ - -- - _ ~ ~ ~ ~j(1.063 AC. N.B.P.A.) ~ f _ - ,,/ ~, . 1. ~ ~'' , ~ . f_.. - ~ ~ .~~ i -mil _ ~' --..., ~ ~" ,/ ,/- r .~ ~ \ :.~ ~ .` / ~_.- J J 0 ~ i __ ~ % 11 O _/ , , '~ ~. _ { ' ~ . ' cV f -~ ~ ~! _ 1 _ . _. - 9 ~~ a i, } ~ ~, ^, % ' '. ~ V~W~ SI.F. ,t ~ _~- `` • ~. ~;:" #' i - .` ~ l ` ., f .. ~ 1~ _.. -.~ r Ci. ' ;- ~ ~ 'i ,521 A ~'` '.. ~ ~, r '~ ,~ ~. -~r-- - -~._.-. •~ (1.473 ~AC. N.B.P.A.~ ' ~ . X42- ~ ~ . ~ "' . .. . _ ._ _ _. _ _ . ~ .- - _- . ..~ ~ -- _. J -~ - .. _ _.. _ _ _ - j _ _ .. ._ ~ ~ ,. .- 1 ~~ _ .. N - _ ..~. ~: _ _ _. ... Y' . ~ ~~ _ . ~ \. ,~ ~~~ 8. -~ ~! t , ,~ ~. ~~ ~ -_ .~~ ~~, .~ ``' ~, ~ ~ X64 •, ,75' ~` ~ ~~ ~ ,--- S t i i h ~`, 1` ° X33' , , N ~ j1.001 . ~ 9y ~' '~ `~, ~ ~`~ ~"''`~ ~ ~ ~ ~i~S7 ~ `1 ~• 40 ,~. ~/ :~-.. ~,~ ~-_:405 F~' ~..__ , " ! r` Rq~~ .~~~ .o - - - ` ~ 8717 ~ ` ~; !~ ~1~ ._ 1.095 AC. N.B.P,A.-}' ~ + ; ' cwr' fs ~. .~ - - . , _ ~ r- } l - ~ 1 4 5~ \ iti ~ ,` ti ~ f ~ 1~ - 'y ,1 ~ , /f ~ 35.23'\ ~` ~ ~ ~' 1 ~~ ! y~• `gam _..i -~ ~-- ~ f~` f~ ~ ~ ',,~ 1 .. ~ 1 ~. 0 ~ ~1 ~6 ~.- .. ./ __ - ~+ ` ~, ~,~, ~'`l~, \ rrrrrrr~i -- .:... ~~.... November 25, 2003 James Rusch James R Hill, Inc 2500 W County Road 42, Suite 120 Burnsville, MN 55337 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, Wf 54016-7710 (715) 386-4680 • Fax (715) 386-4686 RE: Shoreland Zoning District /Indigo Ponds Subdivision Dear Mr. Rusch: Certain lots of Indigo Ponds may require a County Special Exception Permit for filling and grading due to their location in the Shoreland Zoning District. The lots include: 36, 37, 38, 39, 40, 41, 45, 46, 47, 49, 50, 51, 52 and 53. Lot 53 is currently under review for further subdividing. If the building site is located within 300' of the Ordinary High Water Mark (OHWM), has direct surface water drainage to the ponds and exceeds the grading limit that is allowed by ordinance in the Shoreland area, a Special Exception permit will be required prior to commencement of construction. Affected lots whose building site is beyond 300' from the OHWM of the ponds will not be required to obtain a Special Exception permit. Please note that on these tots an erosion control plan must be reviewed and approved by the Zoning Office before the issuance of a sanitary permit for the particular lot. It is preferred that the erosion control plan and the sanitary application be submitted to the Zoning Office at the same time to better coordinate our review. if you have questions or concerns, please feel free to contact this office. Si rely, Rod Eslinger Zoning Specialist RE/jh CC: Town of Hudson, Brian Wert file ' ST. CROIX COUNTY ` SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIl' CERTIFICATION FORM OwnerB uyer _ `~ ~ ~ ~ ~/1t{E ~;c"1L Mailing Address ~,tnS ~ ~t~(A-T~'2-S ~e ~~'' ~`2-, ~~-w ~t c~N M-c~ ~~D Property Address ~ ©~ ~l 1~r.4} t.~Q-~.r i~,~1, ~ 2A i `. (Verification~r"eq`uired from Planning & Zoning Department for new construction.) City/State ~~ S~ fix! 1~ ~ Parcel Identification Nunnber b "~ Q -- L 43 g °- ~. 1- C5 ZS LEGAL DESCRIPTION Property Location ~ '/a , ~'/4 ,Sec. ~S , T ~ `~ N R i °1 W, Town of _ ~ ~ S ~ of 5ubdivisioti _ ~, ~.-fl1.~ ~ ~ N-~ ~ ,Lot # ~ ~ Certified Survey Map # Warranty Deed # ~~~ ~ ~ Spec house yes no Volume ,Page # Volume ,Page # I,ot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists ofpumping 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary ordinance. . The property owner agrees to submit to St. Croix County Planning & Zoning Departrnent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that ali statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number o ooms ' ' 9 ~_ ~ -/ S ATURE O APPLICANT(S) ~ ~A'I'E i ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department:°*~`* Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. _~ ~ ~~o -~~ ~~~ ~ EZ12~3H 24,t I/2 Circ. =18.84" a ~-- 1~-~./Zt` Dom. {~?.~ Void Volume Void Coefficiatt in Aggregate given at 57.4'iG. O_D. of 4" pipe = 4.625 inches z.ltu;a Void votlune per liner fL = 1.14 • ~ ~ • iR = 0.1 t 7 ft' t2ia /ft O.D. of eerttertytinder a T2.5 inches Vaid volume in aggregate of center cytinder = l.ta • 6'u~ l.ta • 3.1t25isl } ~E2inrft, ~ 12inlft J !`•57a=..422 ft' O.D. of outside cylinders= 12 inches Void volume in outside cylinders = 2.3.1 q~ 6II1 • .57a = .g01 ft' `l2in r ftJ Void volume a[ bottom between cyiirtders = ~1 Ia`° 6"` ~_~3,t4~ 6ai 1_~~ = 0,2.15 tt' [2hilft 12inJft I3inrft Yoid volumt at outside bottom corners { i 2 of void volume between cylinders) 021 S ! 2 =.0.108 tt' Totat void volume = 4. S t 7 + 0.422 + 0.901 + 0115 + 0.108 ~ 1.763 cubic ft ! ft 3allons per ft = l.763 X 7.48 = 131 ealfons aer linear R. Sal Interface ~ Side:wall(2 Sidawails) BOttOtn I~ss~ ~Fi 2 a 18.$4in = 3.1 a 12tH 1R 2.00 Total Solt laterface Ares Projected'freacb Area Sidewatt Htaight = 1Z in. "2 = 2.04 Sq.Ft. Bottom ~ 3b in. = 3.00 Sq.Ft. Projected T~tach Area ~ 5.44' Sq.Ft. ~~!! O( EPA Aggregate Trench System EZ12Q3H Rin j~lndustrial Group 65 jndustrio! Park Rd. Oak(und, ll~f 38060 srru.e ~ rum eztza~+-„>> S.14 EZ~,~`ZO~ ~.,,.,~~ sir. t or t t ~-z~-ot POWTS OWNER'S MANUAL & MANAGEMENT PLAN FlLE INFORMATION Owner Permit # DE5IQN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ WA Estimated flow (averagey QO al/da Design flow (peak), (Estimated x 1.5) Q al/da Soli Application Rate ~ at/day/ft2 Standard, Influent/Effluent Quality Monthly average'' Fats, Oil & Grease {FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS} 5150 mg/L .PreSreated_E#fiuenLQualiiir-----_-_.. _. b4~av~ra9e Biochemical Oxygen demand iBODB) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510" cfu/100mi Maximum Effluent Particle Size Ys in dia. ^ NA Other. ^ NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page ~ of Septic Tank Capacity ai DNA Septic Tank Manufacturer ~ S ^ NA Effluent Filter Manufacturer 'o ^ NA Effluent Filter Model ^ NA Pump Tank Capacity a~ ^ NA Pump Tank Manufacturer ^ NA Pump. Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Caravel Filter ^ Peat Fker ^ Mechanical Aeration ^ Wetland Disinfection O Other: s~ersal-Geillsl---- _ _: _ _ _ __--- ---.~-1d-A - In-Ground (gravityl ^ In-Cuound tpressurized) At-Grade ^ Mound ^ Drip-Une ^ Other. Other: ^ NA Other: ^ NA Other. ^ NA Service Event Service Frequency inspect condition of tank(s) At Isast once every: O month{s} (Maximum 3 years} earls} ^ NA Pump out contents. of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA inspect dispersal cell{s} At feast once every: ^ monthts) (Maximum 3 yeas} year(s1,. ^ NA Clean effluent filter At least once every: month(§} years} ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ y®ar(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s} D yearfs} ^ NA ~~ At least once every: _ ^ month(sy ^ yeartsy ^ NA Other:- ^ NA MAINTENANCE INSTRUCTIONS tnspect)ons 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 tank(s) 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 celi(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 (Y3} 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 ocher services, including but not limited to the- servicing of effluent fihers, mechanical or pressurized components, pretrea~nent units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shad be provided to the local regulatory authortty within 10 days of completion. of any service event. START UP AND OPERATION Ps~ge ~of For new construction, prior to use of the POWTS check treatment tank(s- for the presence of ,painting products or other chenticats 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 an; frozen at the infiltrative surface. During power outages pump tanks'may fill above normal highwater levels. Wh~- power is restored the excess wastewater wiN be discharged to the dispersal cell(s) in one large dose, overload'mg the cell(s- and may result in the backup or surface d'~scharge 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 dnve or park vehicles over tanks and dispersal cells. Da not drive or park over, or otherwise disturb or compact, the area within 15 feet dawn slope of any mound- or at-grade soil sorption area. Reduction or elimination of the fogowing from the wastewater .stream may improve the performance and Probn9 the fife 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; ~d water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the folbwing 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, atl tanks and pits shall be excavated and removed or their covers removed and the void space filled with sail, 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 compiiattt replacement system: A surtabie replacement area has been evaluated and may be util"tied 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 wilt result in the need for a new soil and site evaluation to establish a suitable replacement area. Repl~ement systems must comply with the rules in effect at that time. D A suitable replacement area is not available due to setback and/or soil limitations. Barring advances ~ POWTS technology a :holding tank may be installed as a last resort to replace the failed POWTS. ~ D 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 tocate Sa suitable replacement area. ff no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ~ Mound and at-grade sail. absorption systems may be reconstructed irr place following removal of the biomat at the infiltrative surface. Reccnsuuctior-s ofsuch syscems;must.comply witi~t the rules in effect at that time. < <WARNING> > SEPTIC, ptJNip AND OTHER TREATMENT TANKS MAY CONTAIN L.E~HAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO NOT 811TER A SEP17C, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. f4ESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR .IMPOSSIBLE.. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ Phone `r C CJ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~ ~ y~ Phone S' " ~j This document was drafted in compliance with chapter Comm 83.22t2)Ib)tt )Id)&If) and 83.5M1), 12) & (3), Wisconsin Administrative Code. Page ~of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank{si for the presence of .painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). !f high concentrations are detected have the contents of the tankts) removed by a septage-servicing operator prior to use. System start up shall not occur when soil conditions- are frozen at the infiltrative surtace. During power outages pump tanks may fill above norma( highwater levels. When power is restored the excess wastewater wilt be discharged to the dispersal cell{s- m one large dose, overloading. the cell{sl and may result in the backup or surface d'~scharge of effluent. To avoid this situation have thecontents of thepump tank removed by a 5eptage 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 ~'ea_ Reduction or el'unination of the following from the wastewater .stream may improve the performance and prolong the fife 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 t1~e system is property and safety abandoned in compliance with d~apter 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 shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert sol'~d material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the foNowing measures have been, ar must be taken, to provide a code compliant ..replacement system: l~ 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 mfringed 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 sukable 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 snit 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 ra suitable replacement area. ff no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ' ^ Mound and at-grade soi! absorption systems may be reconstructed in place following removal of the biomat at the infikrat)ve surtace. Reconstntctions of such systems rrwst•compty witty the rotes in effect.at that time. . < <WARNiNG> > _ _ _ - - - - - - - SEPTIC, -PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT 811TER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. i3ESCUE OF A PERSON FROM THE tNTER10R OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.. ADDITIONAL COMMENTS POWTS INSTALLER Nine ` ~ Phone `~ (' SEPTAGE SERVICING OPERATOR iPUMPER) Name Phone POWTS MAINTAINER Name bone LOCAL REGULATORY AUTHORITY Name ~ ~ Yl Phone S ~q This documerrt was drafted in compliance with chapter Comm 83.22{2)Ib){1)Id)&{f) and 83.b4{1), !2) & {3), Wisconsin Administrative Code. 07/05/2007 THU 1a: 00 FAX 715 986 a687 ST CROix CO REG OF DEED6 ~J0o1/001 State Bar ofWisconsin Form.l-20D3 WARRANTY DEED T)ocumdncN~nber N t?ocnmeraiVamc THrVS DEED, mado betvvea1 A,maicam Clara-iC Humest L1,C ("tia~~tor," whc~th~ one or more), and Joseah J. Weber,. a~. mAtri~~~ ~pe~son ("Grantee,,, whether ane oar more)., Grantor, for a valaable GonsidrraUion, conveys to Grantee the following described real estatC, together with the.reuts, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wi.4eonsiu ("~Propat}~') (lf more spacers ncaied, phase attach addcadtun); Lot 41, Plnt of Indigo Ponds iu the Town of Hudson, St, Croix County, Wisconsin Lxeelat Lot Z of Certified Survey Map in Vo1.19, Page 4407, Doc. No. 784370. ~mgnir~~qui~ain~~iepiq~i 847978 KATHLEEN H. 4lALSH REGISTER DF DEEDS ST. CROD( GO., ~lI REC~IVEA FOA RECORO 04/09/Z007 09:55AM wARRkNTY DEED a~z a REC FEE: 11.00 TRANS FEE: 556.20 RAGES: 1 .Recurdirig Aron Name River Vstley Absltacc S Title, Inc 12i)D I'tosford S1rc~,~Sn1u 201 Tindcon, Wi 54016 Flo ~f: Part of Lot 40, Plat of Indigo Ponds in the Tows oi'Huclson, 5t. Croix Crnmty, o20-t434~1' 025 WiSrorisial described as follows: Z.ot 1 of Certified Survey Map in Vol. 19, page Identifi~4un Number (1~M 4907, Doc. No. 784370. 'this ie mt ; hpm¢atmd p~opc~iy. (is) f e not) Grantor Warrants that the title to the Property id good, indefeasible in fee simple and &ee and clear of enCtiu~.branees except ~aecmefita, [CStYctlerna spd reghta-of--way of rewrd, if any, Dated Apri16,_204'1 Homes, LL.C (SEAL) ~ (SEAL) 4' M AUTg1:NTICATlON r Siguatute(s) 'j:!'(~~` '' ~ 1C authenticated on ~0 ~ ~tR . ~t~t~ 0 TITLE; MEMBER STATE BAR Ole WISCONSIN' (If not, authorized by Wis. Star. § 706.06) THIS INSTRUMENT DRAFTED BY: ACKNOWZI~DGMI~NT STATE OF WISCONSIN ) ss. St. Croix _ ~ COUNTY ) Personally came be a me on A 6 2007 the abovo-named L~,~ totme ~t~owa to be thetpejson(s) who executed the foregoialg ~ r Attorney Doug Berg - No Public, Staten ~isconsia 1200 Iiosforcl Sn: Suite 201 Huctso aV 51n~4016 . -• , My Commissiou (is perman.eut) (eacpires:: ~~Z ~ ) (SlgRxtarea maybe akthantkafad or sc]ma~vladgeQ. I~th are put ucccs~asry.) NOTE: TIlrs IS n STANDA2tD T'O1iM. ANY MUDII+7CATTONS TQ TX[LSirORM SIIO~ BF Ci.>iAkLY IDF,1V7'INJEg. WAR13AlNTYDEEA d920D3 ETATL BAR OF'WISCON$rN FORMNp,1-7A03 • Type nomo yolvw tagmoiace, ~ . This extraordinary development>r~s only five. minutes from I-94, 20 minutes from downtown ~< ~.