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020-1439-45-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township Landsted Homes Inc. Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Description: ~- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ` ' ~$~ Dosing C ~ n ZC.~S~ 1~ 1 ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ + / ~1 l0 ~~ , ~ ~~ ' Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GP Model umber TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County; St. CrOiX Sanitary Permit No: 453414 0 State Plan ID No: Parcel Tax No: 020-1439-45-000 Section/Town/Range/Map No: 2529.192771 STATION BS HI FS ELEV. Benchmark Alt. BM / 5• ;~ CeJ / '~ • (off ,/t(p , d'Z Bldg. Sewer ~:zZ 9s.~ SUHt Inlet C11 ~p• tl ~7.74a SUHt Outlet 7~~~ C ~' )~ Dt Inlet ~ ,~ Dt Bottom \ Header/Man. 9'z ~ r8 Dist. Pipe i ~Z- 12 . ~°1 ~ 3 Z • 1~ Bot. System t 2 • Z 1 3 . ~ ~ ~ L • ` 3.`18 ~ .'-1 Z "/ Final Grade 7 ~~5 ~`(~ • ~z St Cover y,C+~, /e0.~ i BED/TRENCH DIMENSIONS Width Len th 9 ( ~ No. Of Trenches - ' PIT IMENSIONS No. Of P' ~ Inside Dia. Li ui ~Depth Q ~ ~~ ~ + T ~~~`~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. , I r ~ INFORMATION CHAMBER OR ~ ~ + ~ ~`a Type f System: ~ ~ /~ ~ ~ ~ 7 , L \ UNIT Model Number: ,~J c J . \~ a, DISTRIBUTION SYSTEM ~""" 111. p~ _l ~rp~.l_ _ 7.~ ied-x.51 Header/Manifold Length Dia ~~ /J '-r Distribution Pipe(s) ~ Length Dia_ Spacing \ x Hole Size ~~ x Hole Spacing Vent to 3 ~' it Inta e G .ac....~ w SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over ! Bed/Trench Center ~ ~ ~ Depth Over Bed/Trench Edges xx Depth Qf Topsoil ~ xx SeededlSodded xx M ched , , ~_ ~ Yes ] No i~:,. es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) lnspection #1: ( / Location: 915 Highlander Trail Hudson, WI 54016 (NE 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 45 1.) Alt BM Description = 5~.(~d" ~ ~- J ~~- 2.) Bldg sewer length = Z~ ~ - amount of cover = ry ~ .J -~-----r---~ Plan revision Required? ]Yes , : No II ~ ~ .Z~ i a Use other side for additional informati n. L_ ___ ~__ ~ __J Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 25.29.19.2771 c,~, Cert. No. ~ rp O A `~ S. o 7 7 to z D cn D y o. ~ O Z 0 nNi 'n c ~ ~ v Q m d m _p N s . ~ 7 .Z1 n ~ ~ c o ~ ~ ~ m ~ 7 y O 2 a N N a m'O m D ?o~~ a a c ~ ~ ~, gyp. ~ co ,-. ~ _ w y O Z 73 ~ O_ ~ ~ N O O ~ < ~ ~ ~ o a '~ ~ o m ~ f0_D N ~ ~ ~ aa~ ~, ~ ~ ~y a ~ ~ o N G1 ~ ~ ~ n O N O ~ O ~- n to O °c °: ~ ', ~ ~ ~ ,~ ,v :*. ~ '~ 3 o a ~ I wo N I A 3, I ~ I n 7 VI ~ bi ~ = _ a ~ I a m ,~~ ~. , N - o I °w c al 0 O ~ `zO? ~ ~ N N O vvv,~ ~'o :: H °' °_'• m i °: 3 d ~ ~~ I r r ~ ~ I 'o ? ~ i (D y 3 ~ n ~ ~ N n. I ~ I O C a I I W ~ I a 3 y Z ~ ~ Cfl i m c a I I I I I O N O ~ ~ `r~ ~ ~ fD a fn Z iD is D o. W O Z 0 m ~ c ~ 3 v ~ v O s c~ f~D m m Ul yyc~u a ti ~ < d mommy ~. ~~ ~ o ~~ ~aN.~ m 00 ~ N, 7 z A O ~ ~ O p O N y O ~ N S O O p ~ W ~ m o 6 C fop CyD f~ a~ n ~' 4~i m'o~ N d D. O _ ~ O N fR O O F O ~- nwp 3~n t~ C o ~ ~ e ~ O `i1 1 ~ j ~• ~ ,o ~ ~ . ~~ w ~~ /~ ~ 3 '' ~ ~ ~ `, ~ ~ w ~ o ~ r U1 N = N o C CJt N ~ N~ ~' a i a N ° F""i ~ m I ~ p ~ A ' ~ "3 C a m p N ~ ~ 1 O II y ~ b ~ J ~ 7 N u0i 9 O O ~ C O C _ a a `~ O O = ° N ~~ o N O o ~ n r to ~ -i ~ ~ ~ 3 ? H • m i ~ ~ d /yy~ tz a', 7 ~ to to Vi ~ ; ~' a ~ ~ ~ ~ I ~ ,. ~ ~ v ~ ~ I ° 3 y o i m y rn I ;~• C f1) Z ~ ~ ~ n y I ~ ~ q i N• m a 1 o ~ i ~ ; ~ ~ N A Z n o c ~ A ~ O a A ~ ~ z ~ N m ~ cn W ~ z ~ ~ Q O "' Z ~ ~ m ~ ~ N ~ A A y fD i T c d I y ' A fi N v 0 ~A A w d0 N fp ~ ~' V Safety and Buildings Division County n _ 0 1 G ~~" C tK 201 W. Washington Ave., P.O. Box 7162 - SCOOS~O Madison, WI .53707 -• 7I62 266-3151 608 Sanitary PLrmi`Number (to. a filled in by Co.) j C, / r Department of Commerce ) ( > , l 1 Sanitary Permit Application ou provide ersonal information Code 21 Wi Ad 83 i h C State Plan I.D. Number y , p s. m. omm . , t In accord w may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Addres (if different than mailing address) I. Application Information -Please Print All Information ... v Property Owner's Na me ~ Parcel N Lot ~~~~ Block!! f iO,~r ~ r - Property Owner's M ailing Address ,; ~ ~ Z,) k ~.~),~(~1 ~ ` Property Location ~ 7~ / J / c ta te City, S Zip Code Phone Number csyv/6 _ / (circle one) ~N; R,~Eor~ T k ll l h h ~ ~ { _ at app y) - ~ a t ec II. Type of Bui Bing (c ~ Subdivision Name CSM Number 1 or 2 Family Dwelling -Number of Bedrooms D ibe U ^ escr se PubliclCommercial - ~,--~ ~ ~ ~ ~ / ' / ^ State Owned -Describe Use ~ p) ~T ~s~C~t~J (N~ ~ Y" C ®/1~,^ ^City_^V illage ®Township of~yL III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ~ Permit Revision ^ Change of Permit Transfer to New List Previous Permit Number and Date Issued /! Before Expiration r-^----~ lumber caner ~ ~ ~ ~- 2 ~ 6 3 IV. T e of POWTS System: (Check all that a ly) ~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching C r ^ Drip Line ^ Gravel-less P' 0th r (explain) V. Dis rsal/Treatment Area Infor atron: Design Flow (gpd) esign Soil Application Rate(gpdsf) ispersal Area Required (sf) Dis rea Proposed (sf) System Elevation ,~ .fl. 9a-~s r S . 7 ~P~s`1 ~ ~ oP'o- ~~ ljUV . atx VI. Tank Info Capacity in Total Number Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass plastic Gallons Gallons of Units New Existing TaNcs Tanks Septic or Holding Tank Aerobic Treatment Unit w _ Dosing Chamber VII. Responsibility Statement- I, the tmdersigned, asstune responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature ~4PlMPRS Number Business Phone Number Plum s Addre ss (Sweet, City, State, Zip Cod ~cS`" N /Z/. .,i VIYI. nt /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater ` Date Issued suing Agent atur ~ o tamps) Surcharge Fee~ ~ ~ ,, ^ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval _ `~ ~~ ~e~ ~ ^ ~S - y ~ ~ o'c,(., ~ s ~~~"~-'c ~~v~" ~~E~'~vc/~e- ~aGct'fZ.e'z'" I6 j ~ f , / ' ~ ~ ~.P.~ /lad ( Uh ~'tQ,~. ~-l~~it~.e ~ l~a~~ Ta ~ ~i -~iy1 3 j s ,s r, I ~6 L ~ car ttach com~ptet^c plan~s /(t~o~ the~ouuty outy) r~~em Qn pa~an~+l o+~•/~~ / „~~ ,~ ( „ ~. v.., /r,AA /T Al / \ -~ v I/~ ,/[/`~w' "~J~/ (/"~tL 0 ~O °~° ~ . _ L9 6 ~ ~ ~P~OT ~ CROSS SECTION PI t IMPA EROS. EXCI1rAT1NG {~c+~ ~ . • PWIa~NG UNiT _~~ ,~ ~-- ~o a~ 6~k~~ , RE`' ~E'~c~ ~~'S~ ~~~~ C~• ~~ 0 a~' o~ FN-s ~ ~e EL EJ_ 1 vo_ cee `I ~ Sc~~~ SEwLp L...vE /a5o Ghi. WeESEQ Seif~c y,~C 4J--rq -Z~tBte~ ,q. t8oo ~t~' y •- Pd c ~ 4..~~ ~8~ ~.k ~~ 87- ,Oeov 3a~c _ w~ ~~w ~r n ~~~w~cTJov ~"-~ ~~ ~eQ ~ ~~ Eltcf~ E,vp PRO~ECt m ~ 1/~ Ew -- D~E~~l•~a~ ~, P~ ©ss,~e~fkT~~~ a2 dEN r 44P '~ ~,.-~k»~ R~' f4~~~ Glee The Stand: - 1' Overlap at Latct-ing ucENSE: ~,,~' QATE: ~• ~~ • n ~ - N`A+~ ~w {o ~,pE .sol~TES~u~a sr: Chamber ~~~~ S~oE ~/Ea -~- 75' ' Effective length . ~ •~ ~~ Rpom Q ~cr: fp/~oQkte~ ~ E4~GE ~~ . 5~ ~~' 0 ...PL.O~ ~. ~ 'PLOT A CROSS SECTION PL Z 2APPA EROS. EXGWATINti twu~all~ uNIT .. Pi1Q~CT r~ENcffr/IQ~PK - To® OF ~NrSrF ~'Lo~oQ EL Ed _ loo. cm `~A `x~F~ S~w~ ~/.vE ~~ /~SO ~,tc- ~iESE4 S~itrc ~'t~C ~~~ ~~tc~ ~ t8oo ~tflQ' Y •- Pd c ~~u c uerr 4i,~,E ;,e. ~-.~ ~~ ~ 83 ,Deoo 3a~c ~ s ~,srEb3urio~J /~£bl-ofR ~~r~~.usAccn-ocl ~,pE ~Itc/I ENp 0 N S,C ©~S'S~`R'1I ii4T~ G<J O 2 VENC ~p ~N~srtG `~~Nc~,v~a~.t ~~f~6oJf c~l~e The S - - r Ove~lep et ~atchino ~/`Alc ~w {o PEE Chambeir ucE,r~: ~?~Z ,saLT~ssr: ~=!/'~l~l,~ ~; `~ TEi,JcH BoTr..n ~~Vr4Trex- PEq SacT _ m~ __ ~ EJ.. B ~ ,2~. S~Of V ~fw ~~ 75' Effective Length ~p eSdD G.iiL -,~~..., ~, . ~++ ..\ ~~T` NNNn~N~~^ .__ n.u ,,,. f M ~.. ' III EROSION & SEDIMENT CONTROL PLAN ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 Parcel # 25.29.19.2771 Site: Lot 45 Indigo Ponds, Hudson Two. Owner(s) Landsted Homes LLC Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Wisconsin Admin. Code Comm. 21.125 requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The Owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan (ESC Plan) is in effect and the following activities will be required in order to maintain compliance with the plan: The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization has been completed. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. Surface drainage is southerly toward wetlands/pond, with a buffer of approx. 200 ft. from proposed construction activities. Contaminated runoff must be contained above the 50' OHWM setback from navigable waters. 2. Route contaminated runoff into stabilized vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (includes drainage ditches). Do not allow diverted runoff to be directed onto slopes adjacent to the wetland. (See specification sheet for Temporary Diversions provided by Zoning Dept.) If excavating contractor grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence may not be necessary. However, silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with diversions and vegetative buffers. The POWTS or Building Inspector may evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass/vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment control installation. Prepared by: Pam Quinn, Soil Erosion Inspector #665054 Owner acknowledgement of ESC Plan requirements: _ , / /2004 Wisconsin Department of Commerce Division of Safely and Buildings SOIL EVALUATION REPORT in accordance with Comm t35, Wis. Adm. Code 1798 Page 1 of 3 A.C.E. Sal & Site Evaluations Attach com late site Ian on r not less than 8'r4 x 11 inches in size. Plan must P P ~ i l d b li i l County St. Croix nc u e, ut not m ted to: vertical and horizonta reference point (BM}, direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 020-1439-45-000 Please print all information. evi Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.(14 (1) (m)). ,/ ,, ,, ~ ~ , ~~/~ V ~~. ~~ Property Owner ~ ~ ~ F ~~ ~ ~ Property Location Landsted, L.L.C. Govt. lot NE 1/4 NE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# 431 2nd Street , ~ ;, '~. ° ~ ~ L 0 ~ ~ 45 Plat Of Indigo Ponds City fate Z-p Code Phone Number - ~ City ~ Viitage ~i Town Nit Road -~ ,~,~ ,, ,, ,,:-~ ~ LL,, Hudson (WI ' '" " 3$6-11 1 Hudson 915 Highlander Trail New Construction use: N" Residential / Number of bedrooms Code derived design flow rate 600 GPD Replacement J Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General commerrts and recommendations: Install two trenches at elevation =92.75' & 91.25' (5.5' below existing grade) using 28 Teaching chambers. a Boring # J Boring Pit Ground Surface elev. 98.35 fl. > 132° in. /..~ Depth to limiting factor Soil licatron Rate App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 1 0-8 10y2l1 none sl 2fsbk mvfr as Zf,1 me 0.6 1.0 2 8-30 7.5yr4/6 none sl 2fsbk mvfr gs 1fmc 0.6 1.0 3 30-51 7.5yr4/4 none Ifs lmsbk mvfr gw 1f 0.5 1.0 4 5 - 10yr516 none stmt. s 0 sg ml cwr 1f 0.7 1.6 5 80-132 10yr6/6 none stmt. s 0 sg ml - - 0.7 1.6 r-~'2. S ~ .= Z Boring # ~ Boring Pit Ground Surface elev. 93.13 ft. Depth to limiting factor > 126" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots t,,P D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr2/1 none sl 2fsbk mvfr as 3fmc 0.6 1.0 2 B-38 7.5yr4/6 none sl 2fsbk mvfr gs 3fmc 0.6 1.0 3 38-55 7.5yr4/4 none Ifs 1msbk mvfr gw 1fm 0.5 1.0 4 55-92 10yr5/6 none stmt. s 0 sg ml cw 1f 0.7 1.6 5 92-126 10yr616 none stmt. s 0 sg ml - - 0.7 1.6 Z s 1 ~~~2t~t.~' ' Effluent #1 = BOp ~ 30 <_ ZZp mglL and SS >30 < 150 g/L uent #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Please Print} Signature CST Number James K. Thompson s'~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceol . 154020 5/18!2004 715-248-7767 Property Owner Landsted, L.L.C. Parcel ID # 020-1439-45-000 Page 2 of 3 a Boring # ~ Boring . Pit Ground Surface elev. 95.21 ft. Depth to limiting factor > 129" in. Soil Application Rate Horizon Depth bominant Color Redox Description Texture Structure Consistence Bourxiary Roots in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr2/1 none sl 2fsbk mvfr as 3fmc 0.6 1.0 2 4-12 10yr4/3 none sl 2fsbk mvfr gs 3fmc 0.6 1.0 3 12-26 7.5yr4l6 none sl 2fsbk mvfr gw 1fm 0.6 1.0 4 26-36 7,5yr4/6 none Is 0 sg ml cw 1f 0.7 1.6 5 36-42 10yr5/6 none stmt. s 0 sg ml cw - 0 1.6 6 42-129 10yr6/6 none stmt. s 0 sg ml - - 0.7 1.6 ^ eorins# ~ ~°~"~ J Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Gont. Color Gr. Sz. Sh. *Eff#1 *Eff#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. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS X30 < 150 mg/L * Effluent #2 = BODS < 30 mgtL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY b08-264-8777. T d 3 d '~ ,$- 50.E ¢~a/u4~~b~;~,'c • ~le r/a ~, o. ~ n '~ c~/e: / = s~0 ,Q~ ~ i 79B ~p t !f 5 =n c~~'~i D ~S, ~f C 2 S Tn. ~~ {~dSo~,, St • C~%X ~c.,c.' ,C1c.,clS'ta.c{ hb'rrie5`Jra/J. ~e ~ c 1, Yylo.r~_, Tod off' ,~;-~ ~,s h e ~lc~r; fl5sa.n~d e lQV.` = /x cz -- ~,. ' ~ 8 ~ _ Y~ u~ ~ ~ ~ ' .T1i ~ / / r ' / / / ~p , - , .- -' i i ~ ~ ~ ~ i i 9g~' ~ ~ ~ ~~ ~~ ~.- ,, .- ,~~o~~ ~, 4~~"~ q~°-'p e.~-' y~°lo s~t~ /' fe ~ 99.0' 15% C~ 3 0 ~'~ ST CROIX COUNTY SBFTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~G~~~ cC~ ~ ~. Mailing Address~~ 2 ~~ ~'~f,Pe~ ~~ U~tS,3~ W ~ ~`IV( Property Address (Verification requiry(d faom Planning Department for City/State 1~'I t l .~~ ~ -~- Parcel Identification Number ~~~ --/~~,~ -moo-- c~ o~ L GAL DESCRIPTION `I Property Location N E %,, ~~', '/,, Sec. Z,~, T~_N-R ~~,W, Town of ~,~GS~_. Subdivision Lot # ~aC..~..._• Certified Survey Map # . Voltune ,Page # Warranty Deed # ~~ 1 ~~ l ,, Volume ZZZ~, Page # ~~~ Spec house D yes ^ no Lot lines identif able ~l yes ^ no SYSTEM MAINTENANCE lmpmper use and maintoaanee 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 ir; the waste disposal system. The property owner agrees to ~bmit to St. Croix Zoning Department a certification form, signed by the owner and by a tnasterplumber, joutneyntanplumber, restncted:piumber or a licensedpumperverifying that (1) the on-site wastewatesdisposal system is in proper operating condition and/or (2} after inspection and pumping (if necessary), the septic tank is less than !/3 full of sludge. Uwe, the uaderaigned have read the about requirements and agree to nraintain 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. Certifcatiou stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Oflice within 30 days f the three year expiration date. ~ L~~ ~ 6,10 SI NA OF APPLICANT DATE OVYNER CERTIFICATION I (we) certify that all statements on this foam arc true tv the best of my (our) knowledge. i (we) am (are) the o•,amer(s) of the p petty described above, by virtue of a warranty deed recorded in Register of heeds Office. ~.a std GL~ ~ , ~ y SIGNATURE OF APPLICANT DATE ***""' Any information that is mis-sepresentcd may result in the sanitary permit being revoked by the Zoning Department. ****"" ~`* Include wikh this application; a stamped w°arraniy deed from the Register of Deeds office a copy of the certifeed survey map if reference is made in the warranty decd . . ~ Pow~rs ovinr~~s qua. ~ -a~s~rr ~ ~..,L.~.~. . ~.~ f~LE ~ Owner ~p ~ L ~• Permit d ..~a.wu waswue*e~~ Number of 8etkootns 4 ~ ~ Number of Public Fac~itY lktits ~A Estimated fk-w laverapel 400 Design Uow Ipeakl. IEstirnated x 1.51 600 Sal APP~~ Rete • 7 /ft= l3w~dard Mfkient/Eff1uaM OuaitY MomMr arars ge' Fats. Oil d~ ~ireaae IFOGI S~ ~- eiochetnical oxy~n Danartd 1800s1 s2Z0 mp/~ , a NA Total Suspended Solids RSSI 5150 mg/~ Preveaad EHiuent Duality MOnthh avera oe Biochemical OxYpen Wntand 180x1 830 ~- Total Suspended SoEde 1T~3S! 890 ~ NA Focal ~~ I manl O st t Maxitmwn Eftktent Particle Sias ~ N die. O NA thMr: ~ Z7WA '8ed~ Tank Capacity 1250 O NA Tank M~f~tunr Wieser O NA Effluwrt Filter Matwfscttxar Zable C ~ Eiflwnt Iffier Model A-1800 ~ ~- Pump Tsnk Capacity DNA Pump Tank Maftufaoptrer EI NA Pump Marwfst ~ DNA ~ DNA ~~ DNA D Sattdlrirawl Filar O Pwt Filar O Medical Aeration a Welland D Dieirtfection o Other: ~~ O NA p(~,i_ O ItrGrottnd IPr~ O At~Grade a Mound O Orip~l.ins ~ Other: Other: ®NA Other. ~ NA Opp; ®NA MAINTENANCE MIST1tNCT10NS Mspactions of tonics and ~peratl cage shall bs made by an individual careyinp one of the foNowinO 5oenas or certification:: Master Plumber. Master PMafrtber Reaarifad Sewer POWTS Inapoctor; POWTS Maintainer: Septaoe Savuctrq Tank inspectiora mwt irwdude s vawd inspwtion of the tanklsl m identity ~Y a broker hardware. iderttih any cracks or Isaks, meswre tM vok~me of combined slud5e and stunt and to check fat any bads ~ or Pcnd~O ~ sfflwnt on tM grattnd ~~. The dispersal ceNlsl shag be viwaNy inspected to check the effktutt iswb~n ~ may indicate fabinY corw and nquina the of effluent on the groued surface. TM ponditw of effluent on the Around , imreadiate not'+Eicsttion of the local regulatory audtoritY• When tits combined act~.urrtulatiolt of sludge and egtrn n any Ora ~~ ~ disposed or more of the tank voKtttte.entire oonana of tits tank shall be r!artowd by a Septage 9 of in aooordartoe with chapter Wisconsin Administrative Cods. AM other services. indtrdirtg but not ~irrtited to tfte eervtcing of effltartt fdtere, rttechanicai or pre:eurited ea~wMe• P unite. and any servicing at inanrais of SiZ ntortgte. shell bs perfortned'by a certified POWTS Maintainer. A service report shah be Provided so the ball regulatory audtoritY within 10 dare of oontpletion of airy eetvice event. 6UAVr Illptl •y~p typical for domgtic Mrastewaoa end septic tank sfNuart. ~~.~+~. BART UP AND OPERATION ~ use of the POWTS check treatment tankisl for the presence of painting ixoducts or other ~^~ For new construction. P~ and/or damage the dispNSal ceElsl• If high eoncentratans are detected have the contents that may irnpsde the treatir+ent ~ ~~~ p~ ~ use. ' of the tanklsl removed by a septage System start up shah not occur when soil conditions are frozen et the infilKaave ~~°• at . the excess wastewater wiN bs ~+~9 Pow ~~ P~ tanks may ~ above normal hrghwater levels. When Power . ce5tsl in one large dose, overloading the ceNlsl and may result in the backup or surface discharge of discharged to the dispersal tank rertwved by a Septage Serv~cmg Operator prbr to restoring effleent. To avoid this situation have the eaiter>ts « POWT MS sintainer to assist in manuaNy operating the pump «mntrois to power to the effluent pump or collect a Plumber restore normal levels within the PAP ~k• vehicles over tanks and d'apersz~ drive or park over. or othetwias disturb or compact, the area Oo not drive a park ~ ~~ ~ m9~ area. within 15 feet down slope sell ~ ~ of the Reduction or alirninstion of the folbwing from the wastewater stream may i<nprow the dental '~ id smfsctarns: fart: butts: condoms: cotton swabs; degreasers; ' pOWTS: ar+tibiotics: baby w~: ~aratte asoGne; grease; herbicides: mast scraps: medications; off; foundation drain IsumR pun~P) w~% fruit and wgstab ~ softener brine• painting products; Pe~% sanitary napkins; tampons. Af3AN~NMENT taken out of service the following steps shah be taken to lesure that the system is roperly~ar dOsafely ~andoee~d ~ ~P~ 5~~ ~ ~~~ Comm 83.33.1K~sconsin Admin'~strstive Code • AU Piping to tanks and P~ shah bs disconnected and the abandoned pM~ ~^'^~ ~~• • The contents of all tanks and prts shah be rertwved and W°PwN disposed ~ ~ a Septa9e Setwcu+g Operator. shah bs excavated and removed or their covets remaved and the void space fiNed w+th • After pump&c9. ~ tanks end P~ soil. gravel or another inert so5d ~. CONTINGENCY PLAN ~ fotbwleg measures hew been. or must be tafcen. to provide a code comP~ If the pOWTS fails and eanrwt be repmred ~~e^1ent ~ be utd'aed fot the locadon of a replacement sol ~( A ~irtable replacement eras has been wakiatedfrom distwbance and colr~atdar and should not be infringed upon by system. The replacement area should bs P~~ the replacement area will required setbacks from exiaan9 and P structure. lot fines end wells. Far~ue to ~Iacement systems rtwst result in the need for that time. ~~ to ~~~ a suitable ~t comely with the rules advances in POWTS t7 A suitable rePlacxrraw+t web ~ ~~~ last r~rtreplace the felled ~ s. tee;hnology a holding tank maY area. Upon fai~xe ~ the pOWTS s soil and arts p The site has not been evalwted to identity s suitable repl ~t N ~ ~t ~ le svaNabb a holding tank evaluation must be P~~ to kfcate s suitable tepla may bs installed ~ a Iast resort to replace ~° faged pOWTS. systems may be rl~c,onatruated in P~ fopo+~ removal ~ the tiiomat at the (] Mound and at-grade soil amp ~ ~ ~~ ~ comPN with the rules in effect at that lane. lef~erative surface. < <WARNING> > TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICMNT O~~• DO NOT SEPTIC. PUMP AND OTHER TAEA Yt~1-TMENT TANK t1NDER ANY CIRCUMSTANCES. DEATH MAY RESULT. iMSCUE OF A ~p A SEPTIC. PUMP dR O~ AA TANK MAY BE pgpCULT OR IMPOSS1ti1LE• PERS~ fFROM Ti!IE INTERIOR POWTS MARITAINER pOWTS DISTALLER ) Name o t Ben Mor an Name oth phone 715-386-2130 Phone 715-386-2850 TOR IPUIIAPER) LOCAL REGULATORY AUTHORITY gEPTAGE gERVICWG OPERA Name St . Croix County Zoning Of f ~ e Name Tr i County (Ben Morgan ) phone 715-386-4680 phone 715-386-2130. ,A~Coee. T1as ~ument was dratted in compNsncs vriM chapter CortMn 83.221211b1(tlldlglfl sad 89.54111.1218131. .. ,-,, f.~ ~ f•w'r"'r'~"'. ~ ~~~ ~~ 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, WI 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 bu within 300' of the j~FI~NM}, has direct surface water ramage o t e 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 rosion control Ian must be reviewed and approved by the Zoning Office before the issuance of a sane or 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 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division t 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 Hoider's Name: City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 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 SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 0 State Pla No: ~ Parcel Tax No: 020-~~3~-f~r-moo Section/Town/Range/Map No: 25.29.19. ~ -~- STATION Bldg. Sewer Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAM E OR Type Of System: N T Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Oniv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedJTrench Center BediTrench Edges Topsoil Yes [] No - '~, Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 915 Highlander Trail Hudson, WI 54016 (NE 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 45 Parcel No: 25.29.19. -~,\ 1.) Alt BM Description = ~~~os/ ~ /v ~!J /~~ y F !/ L- ~ ~~Wm ~~ G ~ 2J Bldg sewer length = ~ ~ ~ C'f~GZI~'~ - amount of cover = q `~ Yes No ~ ~ ~ i ------ -- - ---1 I -- I - } i Use otherls de foruadd tionai information. ~~` ~ i I~___- J 1_ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County f 201 W. Washington Ave., P.O. Box 7162 T. ~ ~ I SCO/I SIII Madison, W.I 53707 - 7162 it Number (to be fitted in by Co.) ~~8)266-31 r ~D ~30S'~"~ Department of Commerce Sanitary Permit Application State Plan I "Number personal information you pr vide ~~jy `~ Code Wis Adm rd with Comm 83 21 c I 2aa3 , . . . , n a co ) dd ili h may be used for secondary purposes Privacy Law, s15.04(1)(m) ress n a an ma Project Addr s (if different t ' 'Q /YS ' /r4~01°/j T/? I. Application Information -Please Print All Information ~ fjNING FFIC ~ ~ //!irons h/.~- ~' %/3//> Property Owner's Na me reel # t Block ay .~ . C - .,,~ ~ . Owtter's M ailing Address Propert y Property Location GG ~~ oCIS ,~ '" - '~ , //E _ ~ti ,Section ~S /~~' Ciry, State Zip Code Phone Number _ {circle e) ll h l k t ihli h a app ng (c ec a IY. Type of Bu y) ,; Swb•,,,~,, Subdivision Name CSM Number ~ 1 or 2 Family Dwelling -Number of Bedrooms e i ib U lC i D bl ^ p r - escr e se ommerc a ic u ~.c-- ^ State Owned -Describe Use 3 1 0 ~ ^Ciry_^Village Township of~~~rw~~ III. Type of Permit: (Check only one box on ' e A. Complete line if applicable) A' ~ New System ^ Replacement System Treatment/Hold g Tank Replacement Only ^ er M ification t ~ ng Sy B. ^ Permit Renewal ^ Permit Revision ^ C nge of ^ Permit Transfer to New List us r t u a D sued - Before Expiration Plumbe Owner IV. Ty of POWTS System: (Check all that a ly) .~ l4 ` ®Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soi Mound < 24 in. of suitable soil ^ At-Grade Ingle Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding ank ~ Peat Filter ^ Aerobic Treatment Unit Recirculating Sand Filter > ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line'^°,, ^ Gravel-less Pipe ^ Other (explain) V. Dis rsal/Treatment Area Information: ' Design Fiow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Requireb;(sf) Dispersal Area Proposed (sf) Sy rem n ~~ VI. Tank Info Capacity in Total Nu r Manufacturer Prefab S Ste Fiber Plastic Gallons Gallons of nits Concrete Constructed Glass New Existing Tanks Tanks N Septic or Holding Tank .5 6 - - ~- Aerobic Treatment Uni[ ~ Dosing Chamber ~O - III. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's i gnature MP/MPRS Number Business Phone Number ~d~ /s ~6 - a Plumbe ' Addre ss (Street, City, State, Zip Code - ~- s 1 'VIII. County/De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I sui Ag`nt Signature o Stamps) ^ Owner Given Reason for Denial Surcharge Fee) {~ _____ ~~''" ~ IX. Conditions of A~ pprovaUReasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/Z x 11 inches to size 5~D-6398 (R. 01/03) /~~~ / ~ ~~ / ~~ .a~~ G~/ 6~.~,f ~ ,~ ~ ~ ~ e o a' - ®~ ° ~ 3~ ~jbVDA+e~To~'~LtQMo'P /QS' l'Kp,Po5F1~ :'~ ,Wt1C . ,~ ~~ ~' , Poec K ~ ~e~~dsEQ ~ ~ . /~/JQooeh ~ ~j ~s ~OE.v<£ I i P~cH 5, ~ ao~~ ~" ~IlJ1 T`( gQt/{K~otn1Y F~~4~, rf-Q.Sb: , ~r ~2c~ A?,4,•J lct~ yo ~~ a3d ~/,~uto d• r ~h~s'f ~ ~ 'PLOT 1t CR06~ iECT10N PNW ZAPPA 9ROi. EXCAYATWii IN ~?~D~r ~ ~ ~~~~ "' PROJECT ~oS~r/IJ l~G / ~T ~ O t ~e~ GN ~Ctt=7~.d L~wvt£~7~o~..~~~ / a~ sys~E~ /S(S !>he.. 5 r<<T~K wr~ .Z~48Le ~ /ga Ou'6'~ET ~C'fL~ i2" A~~ f,~ts«t /I~~k+c~ngaut 71G~~QoJf ~~b~e The 5 I- S~Q~/rkTi o^J o 2 VAN r ~ ~N~srtL N`~Ilc Sea ~o P~~ Chamber ~jSo <.p-~. L~ ~ T~o4 FC1E~= N ... ~ E ~o ~ scu ~~~~~~ OATS: // • /9' • c''.~ ,swLtesTa~gar: ~ . ....a~g ~G . . ~" Tt,,~ca 8ofa., ~~v~- P~ Sac~Er ~. ~~ SrOE V ~Ew 75' Ertective l e~pth ~~ dQ~ ~ ~~ ~ ~ ~~ ~ ~ ~a ~ ~ ~ ~~' o 0 3~ ~ivD~~ ~i ~®L~MMr~ / ~~ ~~v~ fig/ -t 0 G~~£ ~ /45. J ~~~ms~n /~~ ~~~ . ~ \ ~~ , P~ec ~ ~~~Qoo~, ~} ~s ~OE.vc~ SeREE..i P~ct+ ~, ~a~ ~~~ w~-~-N~'^ .. .' . a' f-a~~cE ryf.~~ ~cr~ i~o P~~ X30 "/,o.~{o ..•PUi bT• ~-- ~,4,T' 'PLOT ~ CR08S SECTION PtA~ ZAPPA 6ROf. EXCAYATWG IN ~~n®~'( PWliA01NG UMT ... ~/a!E .. PROJECT D5.4 r/1 d~ ~: ~ ar- 4~S ~ ~(~e C®a O'oNd ~j~ ~ ot~t ~oc~_ ~w~ o~ .~~ ,~7~=`7~".~ Lo..~v~~~lo,~~4~., / ~~ Sy~s~~ ~+ Ou~3'~E"~ ~iC'f1E2 • ®~'` A~~ ~~~s~ ~~-,r,~,,-, 51G°~so~f: GN+M~t~@ The S c~iSS~~/rkT~o^i art VENT Gip ~N~~~ ~`ac. ~~+~o P.PF In~iltdator Chamber ~So ~~1. L~ r-a t~ne~ Tmoq FI.EJ= N Vit' • ~ E ~o S scu uc~NSe: ~~ ~f~lS'`7 ,801~TE8~11~ SY: D,~~ ~ ~ J ~~-c~ ~- I--- ~~ SrOE ~liEa 75' Effective Length 1267 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 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 dimemsions, north arrow, and location and d ~stance to nearest road. ' . . pending Please rinf all i f a 'wed By Date Personal information you provide ~~~~~ ay be u Privacy , s. 15.04 (1) (mjl. ~ NB/ Property Owner Property Location ROSAMJI, L.L.C a ~ t '~ Govt. Lot na NE 1M NE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C 5 ,,,~~ ,.t .;i~i ~ ~ 45 na Indigo Ponds City S to Zi ~Pi'e!~F'~rb?i~,I~#nber ,~ ~ City ~ Village V_J Town Ne arest Road New Richmond ~ WI 54017 715-248-7071 Hudson Highlander Trail !~ New Gonstruction Use: 1/ Residential /Number of bedrooms 4 Code derived design flow rate j Replacement J Public or commercial -Describe: Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable General comments and recommendations: system elevation 99.80 ft, trenches spaced and depth to code 3.50 ft below grade 600 GPD na Boring # :J Boring 1/ Pit Ground Surface elev. 103.30 ft. 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. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/2 none sil 2msbk mfr cs 1 c .5 .8 2 6-32 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6 3 32-120 7.5yr4/6 none cos osg ml na na .7 1.6 _ yw.~. (( Boring # J Boring i~ Pit Ground Surface elev. 103.30 ft. Depth to limiting factor 120 in. Soil Applicatan Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP O/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 0-3 10yr312 none 1 2msbk mfr cs 1 c .5 .8 2 3-19 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 19-120 7.5yr4/6 none cos osg ml na na .7 1.6 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land TSS < 30 mg/L CST Name (Please Print) S' ature: _ CST Number David J. Steel ~z,-----_~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/26/2003 715-246-5085 Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTSM ROSAMJI, L.L.C. New Richmond,WI 54017 Lic. #248956 NEt/4,NE1/4,S25,T29N,R19W Bus.(715} 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 45 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' Benchmark Ele. 100.00Ft Top of If2" pvc pipe ~~ Alt Benchmark Ele. 100.20Ft op of 112" pvc pipe R d =Borings Boring Elevations BI = 103.30Ft BZ =103.30Ft B3 = 99.90Ft B4 = OO.OOFt N .~ ~d~~ r^. i ~~~ J ,~ ~ ~ ` ~~ ;'t~ ~ , j ~ '(1.581 AC. N.B.P.A.) ~ ~- ~ 9_~,. - X017, ,, r ~ - --~ ~~ / .~: ~ J _ '~. 90398 ~ S, F. r ~ . ' r ~. ~ ~/1 ~. `o. ~4 g5~ / ~r18 13 ~ ,s "~ ~' (2.075 AC.) ~ ~ '~ / /! ~ .' ~ (1.000 AC. N.S.P.A.) ' ~ 1~ ~~ ..~ ~ / - ~~ ; % / r "1 .. j r~ _ _. ~' / / _ /"- ,i ~ r s % ~"!! _ .. ~ W4: 1,1.x./ ~ i o. . ~ ~ `see .- - '`~ - 0~ • c~. Ac~- . %" 3 ~ _ y~,. . 6• • 'I" ` I r-- t. ? `~ - _ OA ` _ _ ./~ : f / (2.261 / ' / .'~ _ `` /115' - ~,. _ ~ _--... _.~ .~ -- _ (1.635 AC. ` ~~ C I ~ ~~ 1,,...' ` V o~ -~ •~~ .~ . r 1 ., ~ Q ~ 9• - 0 ` ` `~-.. ~, ~3. ..^,~ ~, --~ - r A`~ _____ I _ _ ; I ,V t,, •%~ - '~-.\ `...~_ ~ 02t}-""! r-._ --~ ---- .____ (2.004 AC.) ~~~ ~ ~, l.- _..-`- ~ x(1.581 AC. N.6.P.A.) ~ ~- - fl `r..-- _~ f_ .. ., ,„r. - - l - i ~. 5 ~~ - l ~ ~ " / _ ~- `r' "'- ~ ,~ ~ .___ ~ - 91875 S.F. ~ ---' - ~ ~ '- (2.109 AC.) ~ __ .% i -- - -,~+ ~ ;; i ~-~ y'~-. .._ Jv-•t(1.621 AC. N.B.P.A.)~ . _ ,rte ~ - - ~ -~ ,~ ,- _ -. . ,. ~__ .,`~_ ~_ _ ____ ~.. i ~__ -... ~ ~ f ~ ~..~ 46 . . ti " `` ~~ .. _ _. _ _ i ~ v_....~. _.-~..._ -._ _. _. .., ... -- ... -" ~ ~ ~ 47 ,," ~ 91875 S.F. -~'""' - ~o :l,. r r ,;' / ° , 51875 ~ S.F. `'cA (2.109 AC.),~ r -- - ~ - -- h~ . . 2.109 AC.)--- 1( _ ~; (1.725 AC. N.B.P.A.) ~ ~ - - - _ ~ /f1 - ,~~' / , ~ - ' 1.044 AC. N.B.P.A.} \ / ; ~ J ~. ~ ' . / , - - f / f i ~/' ~. 4 I . J _ f f~ ! f ~ I'.~i '/.''~ rte` r ./ ,, -. / .; , _- - ~., -~ ; ~_ _ ~.:~ ,F'. . 31 X75 S.F. _/ •~ 2.109 AC. ~ '~' >Yy;V `-, f~ ~ ~~. '1 .~ `~ ,`~ ' i , )t - 0~ ~\ _ `~ J !.4 \ . ~ _ v ~-.~ .... . -_ - -. - - ~ 9 -. i ~ 1 - _ e 5 _ ~` 1/ f ti - - / _~ _ " / Sj , _ a ... •. ._ • -- - ~- - _ ~~ \ ~` a~\ ~ x,4,1_ _ '''~ ~~ , ~ ~ ti1~098001 S.F. .` - _ _ ~~. - - J` ~ J~ - ~ `(2.521 AC.) .4 3 AC. N.B.P.A. ~~ - ;N 0 - ( .T - -,,,."'' 154 !y` _~• ti - - _ _ ~ ~ - ~ _ , I ! ~ i - - __ __ . - - , i - ~ ., _. _ ..- _ _ _ _ ~, . - - ., _ ._ ~ . . ~ , ~• _ - _ .. , -~ r .; ~. ,. . _. " g .. - .,. , , ~ i • f ~ ., _. .. . , ~ r _. - ~ ~ i _ _ ...~. ~. ..... _. -- - -. .. _ / r! ~ S .--- J ~ ~ ~.~'~." =- ~,~\ ' ~ ~ ` ~y ! of j , ~; .,/ ~cA ~ ~ ~ ~ t ~ _ i .t t ~O~O ~oJ~'GY PAGE OF PLiMP CHAMBER CR055 SECTIDIJ ANU SPECIFICATIONS ~`>, d VEIJT CAP '1" VENT PIPC ,APPROVED ~OCY;ING WEATHER PROOF JUNCTION WOK MANHOLE !:OVER ~ ~ 23~ FROM DOOR, WINDOW OR FRESH IZ"Mlu. I i AIR INTAKE ( " GRADE I `I" MIN. ~~. I ~ I a"MIAs. COAIDUIT ~-- --------- ~ ~ \ IAII..E'1. PROVIDE ( ---- - AIRTIGHT SEAL I III r ~ ~ I III APPROVEp JOINT A I I (I APPROVED JOIA W/C.'I. PIP£ I III w/C.I. PIPE / CXTk.NDiA;G 3' I II ALARM EXTENDING 3' QWTO SOLID SC.:. B ` ;1 ONTO SOLID SC I I ) oN C .I 1 I r PUMP-~ '--~ OFF ..~ L• p ' ~ CONCRETE DLOGK I ~ RISER EXIT PERMI'R'EO OIJLy IF TAAJK MANUFACTURCR ,HAS SUCH APPROVAL r , SPECIFIGATIOAdS ~QS~,~"TAAJKS MAr,IUFACTURER: ~ r•r '« -•~'r'' ~ AIUMBER OF DOSES: y PER OA`J TANK LIZE : ~c1 ~ GALL0IJS DOSC VODUME ~ ! yOr ~6 GALLON RM M FA T ' ~w~~ 7 INCLUDING 6AGKPLOW ~~ LA A*IU UR.CR C ~ - ,~ MODEL AIUMBER: d~Li CAPACITIES: A= ~ INCHES OR S~ooGAllO1J; SWITCI•I TyPC; /~'7~~cs 35. ~ GALIOAJ' vsv TY/J 6 n ~ INCHES OR . ' PUMP MAWUFAGTURCR: GbL/t X h C !~~in/s-r ~i~,. C ^ ~ HJCNES OAL~~ 6ALLOAI MODEL AIUM4CR: - ?~~~t oS/~i5~ D ~ .~-INCHES oR _ ~ ' `~ GALLON SWITCH TYPE: ~ic~.~1A .,irc~s,~ J'Le.o~. NOTE: PUMP AA1D ALARM AAC TO 4E INSTALLED ON SEPARATC CIRCUITS ~ PUMP DISCHARC~C RATE GpM VERTICAL DiFFEREWCC 4>~'t'WCCy PUMP OFF ANO DISTRIBUTION PIPE.. `33~oFEET -~ MIIUIMUM AIETWORK SUPPLY PRESSUR .... :.... .. ~•' FEET E -1- ~~ FEET OF FORGE MAIIJ X TT ~ ~~D F/ooPCFRICTIOAI FACTOR.. ~S-~ FEET TOTAL DyAIAMIC. HEAD = ~3 FEET s~.~,. • ,, .. yam„ IUTERUJAL DIMEIJSIOIJG OF TAAJK: LEAIfaTH ;WIDTH .-.--~;LIGIUID DEPTH -._.~.- 9161JE 0: LICEIJSE AJUMBER: °2~°??73 DATE::! G.vir r9~A -111- . ., _... .. " _ Page ~ of g 8TART UP AND OPERATION .' , Fcr new conspuction. prior to use of the POWYS check treatment tanklsl for the presence of painting products ar other chernics4 that may impede the treatment process and/a damage the dispersal ceglsl. M high cancentratrons aro defeated have the cantenc of the tanklsl removed by a septage servldng operator prior to use. System start up shall not occur when soil conditions are frozen m the infdtretive surface. , , During power outages Pump tanks may fill shave normal hi~water levels. When power le restored.the excess wastewater wiN b~ discharged to the dispersal ceUls) in one large dose, overloading the oeglsl and may result in the backup or >~ ~° to restgorlil effluent. To avoid this smratwn have the contents of the pump tank removed by a Septags Servicing Op~at p~ controls t~ power to the effluent pump or contact a Plumber or POWYS Maintainer to assist in manuaay operating restore normal levels within the f~P tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over. or otherwise disturb or compact. the are. within 15 feet down sbpe of any mound ar aR-grado soil absorption area. deduction ar elimination of the folbwurg from the wastewater stream may improve the perfonnulce and probng the life of ~ POWYS: antibiotics; baby wipes: cigarette butts; condoms: cotton swabs; degreasers: dental fktss; diapers; disinfectants; tat herbicides: mast scraps: medications; od foundation drain (sump P~PI water: fruit and vegetable pesings; gasol'ins; grease: painting products; pesticides: sanitary napkins; tamP~s: ate water sohener brine. ABANOONMENr When the POWYS fails and/or is pennartently taken out of service the folbwing steps shoo tie taken to insure that the system i properly and safely abandoned in compliance with chapter Comm 83.33. Wisconsin Admkristxative Code: • All piping to tanks and P~ shall be disconnected and the abandoned pipe openings sealed. • The contents of aN tanks and pits shall be removed and properly d'~sposed of by a Septage Servicing Operator • After pumping. aU tanks and pits shah be excavated and removed a their covers removed and the void space filled witl soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWYS fails and caruwt be repaired the folbwing measures have beNl, of must be taken. to provide a code compRan replacement system: ^ A suitable replacement area has been evaluated and may be utiidzzed for the locatbn of a replacerrlent soil absotptia system. The replacerrrsrtt area should be protected from disturbance and f:ompacYron and should not be infinged upon b required setbacks from existing and 1xoPosed structure. ~ lines ~ weNs. FaSure to protect Efts replacement area wi result in the need far s new soil and sNe evaluation to establish a suitable replacement area. Replacement systems mur comely with the rules le effect at that tune. .' ~ A suitable replacerflent area is not available due to setback aftd/or soil lirftitations. Barring advances in POWT technobgy a holding tank may bs installed as a last resort to replace the failed POWYS. D The site has not been evaluated to identify a suitable replacement area. Upon faikrre df the POWYS a soy and sit evaluation must be performed to bcate a suitable replacement area. If no rePiacentertt arse le available a holdir~ ten may be installed as a last resort to replace the failed POWYS. D Mound and at-grade soil absorption systems may be ntconsuucted ir-- place foNowing removal of the biomst at th infihxative surface. of such systems must comply with the toles in effect e< that time. < < WARNING > > SEPTIC. PUMP AND OTHt71 TREATMENT TANKS MAY CONTAIN LETHAL. GASSER AND/OR prISiJFHCtEN7' OXYGEN. DO NO SON PROM THE IMNTERfOR OF AA TANK MAYY BETO~FICULT~OR IMPOSSIBLE. ~~. BATH MAY INSULT. RESCUE OF PERS ADDffIONAI COMMENTS pOW7'S INSTALLER POWYS MAINTAINMI - Hams ~.r2L •,~ Name ~ T Phone X7/3 ~6 - ~~ Phone /.s ~6 SEPTAGE SERVICMdG OPERATOR IPUMPERI LOCAL REGULATORY AUTHORITY Name ST C.2 ~ ? Name _ .,c /~l2 ~r0..~ Phone ~ Phone - ~'"6 '` 6 F TMs document was drafted in cornpRarrce with chapter Comm 83.221211blltildlatf! and 85.54111.121.134. Wad Adminisaativ Cods. _ ~1-i3--C~3; n,~"wf.~t:f a~,d~ted 11 mss r:c. ~ -'~c -_t;g co ~ xk - .....- , a..,.:-PO77 hY Y. bl ~t-t2~b37 L:32PIL1;LOndated NOmIB !r~~- sT CROZx cov]~rx SEP'I'YC TANK MAINTENANCE AOREEM]3NT AND ' pWNERSHIP CERTIFICATION FORM Ownar/Buyer ~ 0 ~°~ ~ 1 j ~-- ' - ;,- L .~Yvi 7 Mailing Address X25 0 ~ ~T e~tJ L?,-, -S~` _~, NP 1~ ~ '' ~/ P Property Address ~ ~ k -~tr1 ~15 Vt ~ ~61e ~Cd,-~ ~~' {Voriflcation required flrota Planning Depasttrsect for ow aonetructtoa) City/State ~~ ~~ Ibt"1tn~.~n ilrn ~A/LParcei identification Number ~ - d - - 4o O ~~~~~ L~ At. DE t i . ~ ~ ~ W Tawn of + Ir~~ ~Q~-- Propo:ty 1,ocatian ~ t,, ~ /., Sec. ?,~., T ~l N-~ ~- ~ ~ n t _ Subdivision Cectlfled. 3utrvey Map # ter.. ..Volume ~ _ , Pagt ~~_ WttrriRnty Died # ~ ~ ~ Dq ____~^_:. Yoluma ..,~.~...=~ Page # ~~ ~. spat: >~uea o yes ®n~ Lot ]inea identifiable ®yes D no Itapmpar usv asd erna{t3tepeaceoL your sepLiC system could rasult in its premature failtus to handle wastes. propeznsairrtesrsaas con!eitts of puttspiag out tine septic tunic curry thzee yearp os sooner, if aaoded by a Itoanred ptunpec, What you put Into the eyotom aaa st$ct file firactlon of thr septic talc to a troatmeat etagr Li the waste diepoaal system. The prapatty aavaer egress to submit fo 9t. Croix Zoning Departatont s cestitioation ibnn, signed by the oantez and by s masterpluaabez, jOtlraO}ids?1pt111~Ot,1'EStriCtC~p(11II1bOSOf puCIGSCdp~[VCt1f~l~tbat~Z) tlltlau~ditCW~AtOWit0rd14pO8t~ BpBtRtr is in proper aperaHag epadltioa ead/or {2) slier ipsifeotion and pumping (li aerxesarl'), the septic lank ie lase thin 113 roil of alndae. 17wa, the aadersigaod have read the ebove requirenteub and a8ree to maintain lira private sewage dlapo:{ai ryatem ~uity, the rtandarda set foztb. herein„ as set by the Dapartmcat of Commerce tmd rho DepatenentoiNatucat Rcsotitces, State of Wircensia. Certifieatfaa stating drat your sopt'uC ayatoat has bona matrttsiaed must be osmpktcd sari rstttroed to Chc St, Croix Courtly Zoning GtTce witiria 30 of the tluee year ex " a date. • ~r~ o.~ {iNA OF PI~CANT DATE 9VirN .R F,~TIFICATI~ I (we] certify trot ail rtrtemeAtr an this form ere true to the bast of my (a+r) Jutowtedge. 1 (we) sm (are) ti+e owrtar(a) of rho prvperiy deser e, by virtue of a warranty deed recorded to Register oi' Daeds 4fttca, -~~-~ ~' 3 aNATURP Olt APF ICAhR ~~ DATS Any ia£otmation that is mie~repse9satedrtay resort in tha aenitery pa-init being revoked by tha Zoning Aopattroet-t,'+•"` ..:.~• r« intctude w]tA this sppllesttloo: a c Py of w~ ctrl Ord aucvcy m p ifcrtthranceD m tit: in the warrat-ty daed 1 ~-1~4-~'v t`~~:'•, ~r~i Lei `t C~3 CPS HC(fiC.`; ~.. ~ ~-, "~. F+ 6'L~l_` ~ _i- l~ ~• ~ 22234' 306 ~ 1~ ' STATE BAR OF WISCONSIN FORM S - 2000 7 1 9 3 ~ 9 PER90NAL REPRESENTATIVE'S KATHLEEN H. WALSH . ~ ~ br+:umcnt Number DEED REGISI'E13 OF DEEAS + - sr. cROZx co: , rrz Judy iYlccum,asPersonalltcpresentativeoftheestateofp'lorenceK.Polen RECEIVED FOR RECORD ("DCCLtSCAt°°}, for valuable cottsideratiou conveys, without wratranty, to X4/2912803 03: LPN Rosatnll. LLC t3rantee, the following described real estatc in St. Croix County. State of Wisconsin (thc "Property) {if mnrc space is needed, please pERSOHAL REPRESEHTATIY attach adde:tdum): . f:x~T #: - Please see the attached Iegal description. ~ REC. FEB: 13:00 ' 7BANS FEE: 3448:80 • EOPY FEB: • CC BEE: • :PAGES:'. 2 . According Ana . . ~ ' ' . ~ .: Narno one Rclusn,Address ~. ' ~ '. 400 S. 2nd St., #ita11j~:,G4 ... ~ .. , ~ Hudson, wl ~oi8 J I ~~~5 Personal Rcprescntativtbythisdeeddaescoavcytoflrantecallufthecstateand `T7f~(i ' interest in the Property whfch the Decedent had immediately prior to Decedent's deotli, Pareet Identification Number (PINT and atl of the estate and interest In the Property which the Persona! Representative bas This Is not " homestead pnpedy. since required. ~ .. . ~ {is•not) . Dasedthis -28th day of Ayrll ',2003 , • ,' , ~ - • ' `-_ /~.(.L~'(~f/ ` r t ~ ~ .. • SYdy .IVtCC{trg / Personal Representative ~ Personal Representative AUTH)rNTICATIOIV ~ ~ ACKNOWLEDGMENT Signature{s) Judy ,Nfccum ~ - `; STATE OF WISCONSIN } ;. )ss.- - ST. CROIX County - ~ ) authenticated this 28'" day of A rll 2003 ' ' , Personally came before me this 28'" day of, APrfl , 2003 theabovanatttcd ' ~ A1J~yf qIL% ' Jam. Pllceuro TITLE: MEMBER STATE BAR OF WISCONSIN ~ ' . {Ilnot, ~~ ~ to me known to be theperson{s) who executed the foregoing authorized by § 706.06, Wis. Stnts.) instrument and aclatowledged the same. T1iiS INSTRUMENT WAS DRAFTED BY IIeyyrood, Carl do Andersott, S.C., 1100 liastbrd SL, Sut[e 10fi ~ " _ P.O. Box 125, Hudson, WI 54016 ~ Notary Public, State oC W15COPtSLN My Corrtttissian is permanent, (if not, state °xpttadon date: (5igeatures msy be aulbenticated or acknowledged, Hots are not nacesaary.) ) • Names of persons signing in any capacity must ba typed or printed below their signature. ~ TNFO•PRO (800)633.2021 wwH.inropraromy.com STATESAROYWISCONSiN PERSONAL REPRFSENTATLVE'S tIEED FOttlvt Nv 3.2000 ..