HomeMy WebLinkAbout020-1439-54-000Wisconsin,Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
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
Johnson, Tro and Jennifer Hudson, Town of
ST BM Elev: ~ Insp. BM Elev: BM Descripti~ ~ / _ ~ ~~ ~~
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TANK INFORMATION
TANK TO P/L W ~L~ BLDG. V``o Air Intake ROAD
Septic y ~~ / ~ / ~ / C~~
Dosing ' W / ~,`;
Aeration
Holding
PUMPISIPHON INFORMATION 1 ~nA.~t~
~Nlanufacturer errand
GPM
Model Number
TDH Lift Friction ss tem Head TDH Ft
Forcemain Leng Dia. Dist. to
SOIL ABSORPTION SYSTEM 2 2+ /_3 G~ra~,. /~~~J
ELEVATION DATA
County. St. CrOIX
Sanitary Permit No:
506319 0
State Plan ID No:
Parcel Tax No:
020-1439-54-000
Section/Town/Range/Map No:
25.29.19.2780
STATION BS HI FS ELEV.
Benchmark
-----
~ 3.3
~ l 3.3
/oo- a
Alt. BM ~~ ~Z ~ ~d~ ~S
Bldg. Sewer j C ~ y P/G • 2 /~ 7, /
t/ t Inlet 22°
2
/p6- /
Ht Outlet
~. (~S
~O J~- ~
Dt Inlet
Dt Bottom
Header/Man. ~Z ~ / b ~ ~ P`~
Dist. Pipe / •5 j / p a ; ~~
Bot. System
Z
Final Grade
N~~ ~sl'
~~
& 3 ~
io.~
U-
Cox Gl.~t ~ ~
BED/TRENCH Width ~ Lengthf No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 ~
~JgL C(2
} 7
SETBACK SYSTEM TO P/L C BLDG W LAKE/STREAM LEACHIDUG Manufacturer:
-^
INFORMATION CHAMBER OR v1/
Type System:
^
~ > 3D~ ,` UNIT
Model Numb
~ ~~ f N
DISTRIBUTION SYSTEM ~~ ,~ _ ~,/ ,/ (~0 w1 ~,~li,,
eader/ ~nifolc~ ism ution x Hole Size x Hole Spacing Vent to Air Intake
Length Dia Length Dia Spacing l!/ ~ 7 J
SOIL COVER
x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over /
"f Depth Over xx Depth of xx Seeded/Sodded xx (~,,~
BediTrench Center 5 Bed/Trench Edges Topsoil
Yes ~] No
~ Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~Z/~~ Inspection #2: / /
Location: 867 Badlands Road Huydson, WI 54016 (NW 1/4 SE 1!4 25 T29N R1 W) Indigo Ponds Lot 54 P/arcel No: 25.29.19.2780
1.) Alt BM Description = Tb~ U"} V~~~ ~ Z mil ~ ~..Q ~ ~ s~1~Le ~ (J~-c' /./~ /~~C~l~~ ~~
2.) Bldg sewer length =' 2 r ~ ~i~ C(~q ~~ i~-~~K~1 ~ e CI~U
-amount of cover = ~ ZL~II~ ~ ~ /) _ _ „ ~ ~f~ ~~ ~~~ UUU
Plan revision Required? ~ ] Yes ~o Z ~ / _ -- - /~_~1-~~ _--
Use other side for additional information. ~ U ~ ~ ~ l'1 ~.(~fiyliy~,~ ~ j
2 U 7 ____
SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No.
D
~~
Ic d
TANK SETBACK INFORMATION
cornmerce.wl.gov Safety and Buildings Division C~~y
~'
ZO1 W. Washington Ave., P.O. Box 7162 ~
i sco n s i n Madison, wl 53'707-7162 Sanitary Permit Number (to be filled;n by Co.)
i~epartmerrt of commerce ~j p (p 3
Sanitary Permit Application see T'°~' Number
/ V
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate etntn
unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned PO are
submitted to the Department of Commerce. Personal information you provide may be used for se Address (if differelrt thaamailing ad///dress)
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/
~
oses in accordance with the Privet Law, s. 1 S. 1 m , Stets. ,
/
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L A lication Information -Please Print formation
Property Owner's Name P #
Tro d 3t~w~ ~c~ S6~S D Zb - ~~ ~ ,S~j/- ~O
Property Owner's Mailing Address Location ~Q
Z / v~
~
~~ , STUNS C ~E ST. CROI Go Lot
~
City, State Zip Code Pho Number y~
~~y 5 E ys, Sectio» fs
~!V(,I,SOK ~~• 54ot/o ~lS 3 ''{`57 q
T 2 t N; R) (circle~e)
~
E or®
II. Type of Building (check all that apply) d k ~
A Lot # _
.
~1 or 2 Family Dwelling -Number of Bedrooms 5't Subdivision N1ame
~
/~ Bt ~
~
I - I n d
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5
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Public/Commercial -Describe Use ^ City of
p 4~~
.
^ State Owned -Describe Use
CSM Number
Village of
Town of ~ ~ Sot^
lIL Type of Permit: (Check only one box on live A. Complete line B if applicab
A' New S stem
i Y ~ ^ R laceme~ S stem
eP y ^ Treatment/Holdin Tank R laoemerl Onl
g eP y ^ Other Modification to Exi S e lain
~8 Y~- ( xP )
B • ^ Pemut Renewal ^ Pemrit Revision ^ Change of Plumber ^ Permit Transfer to New ~~ Previous Permit Number and Date Issued
Before Expiration Owner ~ '~~. +.
IV. a of POWTS stem/Com onent/Device: Check all that a 1
Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Cnade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in of suitable soil
^ Holding Tank ^ Other Disperse! Component (explain) ^ Prdreatment Device (explain)
V. Dis rsal/Treatment Area Information:
Design Flow (gpd)
~ Design Soil Application dsf) Dispersal Area Required (s
'~ Dispersal Area Proposal f)
~ S vati
9g
5"
~
low .7 57, I 87 ~ • I •
8.5
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ~ U
NeW Tanks Existi Tanks
~ ~ ~ (//-
W C+4~PL~ ~~~ `~-~ c
~ U a~
v~ ~ sd
~n 0/ `a~
w C7 ~
P.
septic or Holding Tank - Z 5 0 ! Z $~ 1 ~ e S t:-~'
Dosing Chamber A ~ ~ ~ .-
VII. Responsibility Statement- I, the nndersi~ned, assume respalsiblllty for illstaDation of fhe POWTS ~ on the attached plans.
Plumber's Name (Print) Plumber's Signature PRS Number Business Phone Number
Ba~R~y ex~~Foutrt~ ~ aalbZa l051-43~O-S'?bl
Plumber's Address (Street, City, State, Zip Code)
N-?D53 Col.kry R~~ ~S~31 ~Ia^t' VaG(,e , ~~ ~ 5476°7
VIIL Coun /De artment Use Onl
~pproved ^
~PPr Permit Fee Date I sued Lcsuing Si
^
50 ~ Oo
$ ~ 9 7 ~~
er en Reason `
IX. Condi~~-/,Reasons for Disapproval 3~ ~' J 1
1. Septic tank,- effluent filter and M•
1~.•
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5 r ~ OC"
,
1
ersal cell must all be services /maintained
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as per tnanagemeM plan provided by phtmber.
2. ~AN 1li~Cl(tequirements inter tie rnalrThirled ~~,~,e..~.-~ ~ '~ . '7 Sa.~~~ ,
erode!
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Wisconsin DepartmentofC merce S IL E~EPORT Page of
Division of Safety and Buildi s A U G ~ Q ~~ 7
i a ~e with mm 85, Wis. Adm. Code
County ~ ~
Attach complete site plan n pap@rinpt~#1a~~j~~C 11 in hes in size. Plan must
indude, but not limited to: ertica an onzon re erence nt (BM), direction and Parcel I.D.
percent slope, scale or di nd distance to nearest road.
Please print all information. Revi by Date
Personal iMormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) im)). ~ ~
PropeAy Owner Property Location
b O Govt. Lot ~~ 1 /4 ,'T/4 S ST ~ N R E (or W
Property Owner's Maili ress lot # Block # Subd. Name or CSM#
City State lap Code Phone Number ^ City ^ Village To Nearest R d
i ~SYo! c ~~~ ~~'~ 3~ ~ ~
$~ New Construction Use:~Residential / Number of bedrooms Code derived design flow rate 6111) GPD
^ Replacement ^ Public or co erdal -Describe: __._____ _~_ ___
Parent material dL[~"'t~~.l/i-~ Flood Plain elevation if applicable i~~~ ft.
General oorrvnerrts L //~~ ~ Q I _ r
and recommendations: ~~~Lac2~,e {~ N' S ~`~' `~ ~O`..~-e- w~; r~ r` +~ ~. ~- d'^t~
System Type ~ 1?i (J System Elevation
l
1 Boring # ~^71 Boring ,/
~ pit Ground surface elev. n 3r ft. pepth to limiting factor ~~ in.
Soil lication Rate
Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 - i~ a , ~ ~----- ~S O s ~ /,~ ~,~ 7 f ~
~ ~ -(
ll
Boring # ^ Boring J ~-
~. Pit Ground surface elev. ~ ft. Depth to limiting factor ~/ J in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. M
unsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#
1 'Eff#
2
//
~~ /1 / /
7
2 s- ~ I ---~- ~ d ~v/
1
t
` tl
' Eltluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 ~--02-x.. ~ ~ 715-246-4516
~~
P~rope~rty Owner _ Parcel tD #
17 I Boring # ^ Boring ~~~ ~~
Page
1~~:~
of
L~J ~ Pit c~rouna surrace elev. - n. uepui w umiung mucnT ~ ~~ ~. ~I lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP OIft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t •Eff#2
l d-13 ,-31z o?rn h'1 ~' ~ ~ -!~
1 / ~ S OS ,~'~ ~t~ /
Boring # ^ Boring
!_~ U Pit Vrounasunaceeiev. n. vapui ro nnuw~y ieuvi ~~~.
Soil lica6on Rate
Horizon Depth Dominant Color Redox Description Texture Structure ~ Consistence Boundary Roots GP D/fl'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
^ Bonng
Bonng # Ground surface elev. ft. Depth to limiting factor in.
^ Pit Soil icatron Rate
Horizon 7epth Dominant Color Redox Descxiptron- Texture Structure Consistence Boundary Roots GP D/ff
in. Munsell Qu. Sz. Cont. Cotes Gr. Sz. Sh. 'Eff#1 'Eff#2
'Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg1L 'Effluent #2 =GODS < 30 mglL and TSS < 30 mglL
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.
sBas~w (n.woo~
Property Owner
Parcel ID #
Page
Boring # ^ Boring ~ /~ /_ /
®Pit Ground surface elev. ~~ ( SS~oft. Depth to limiting factor / / V in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence BOUndary Roots GP D/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2
!i --- 5 os ~ ~~ r . ~
^ Boring # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure 'Consistence Boundary Roots GP D/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2
^ Ong # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in.
Sal ication Rate
Horizon 7epth Dominant Color Redox Description. Texture Stnrcture Consistence Boundary Roots GP D/fP
in. Mansell Qu. Sz. CoM. Cotor Gr. Sz. Sh. 'Eft#1 `Eff#2
` Effluent #1 = 8OD5 > 30 < 220 mgfL and TSS >30 < 150 mgiL 'Effluent #2 =GODS < 30 mgft. and TSS _< 30 mglL
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.
580.8330 (R.NUO)
a,
Soil Test Plot Plan
Project Name Troy Johnson Shaun Bir
Address 1831 Stone Creek ~J
Hudson Wi 54016 CSTM ~ 26900
Lot 54 Subdivision Hudson Date 8/22/
N W 1/4 SE 1/4S 25 T 29 N/R19 W Township Hudson
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe
System Elevation TB~ *HRPSame as Benchmark
D°~ 'X96 ~y INDIGO PONDS ~ -
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Page 1 of 4
Leaching Chamber Design Spreadsheet
Project Name: Lot 54 Conventional System
Owner's Name "T"roy ~ S'eh-.; ter ~kwSo-~
--~
Owners Address \'83 i ~ fok Crc k
Legal Description ~/ • '/., ~ • '/ Sec 25 T 29 N, R 19 w •
Township Hudson
County saint Croix •
Subdivision Indigo Ponds
Lot# 54
ParcellD# pending
Table of Contents
Pg•
1 Cover page
2 Calculations and Drawings
3 Management and Contingency Plan
4 Plot Map
total # of pages: 4
Designer Name:
License #:
Date:
Ph. #:
Signature:
9/4/07
Design Methods Used
'9N-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD-107(Xi-P (8.8/98)
Calculations and Drawings Page 2 of 4
Site Conditions Infiltration Elevations
Site Type: Private ~
~~
%Slope 10
# of Bedrooms 4
Depth to limiting factor 115 inches
Soil Application Rate: 0.7 gal/ft^2
Effluent Quality Eff #1 •
Design Flow: 600 gal/day
Max BOD 220 mg/I
Max TSS 150 mg/I
Septic Tank
Contour Elev:
Infiltration Elev:
Limiting Factor Elev:
Treatment and Dispersal Zone:
Cover Material Required:
Finished Grade Over Cell:
Trench #1 Trench #2 Trench #3
103.50 102.50 0.00
99.50 98.50 0.00
Ft
Ft
93.92 92.92 N/A
.5.58 5.58 N/A
0 0 N/A In
103.50 102.50 N/A
Distribution Cell
Choose chamber type:
Infiltrator Quick 4 Standard U
# of trenches: Z ~
Chamber Length: 4.00 Ft
Chamber EISA: 19.1 Ft2
Endcap EISA: 5.8 Ft2
Required Infiltrative Area: 857.1 Ft2
Actual Infiltrative Area: 871.1 Ft2
Total # of Chambers: 45
Total # of Endcaps: 4
Manufacturer: Wieser
Volume Chosen: 1250-MR
Effluent Filter Selected: Zabel A100
Note: Access opening of sufficient size to be provided to allow removal of fitter.
Opening to terminate at or above grade.
Cross Section of Septic Tank
12" Min Gre
All joi nts to
be vwater tight
Effluent
Filter
3" Bedding Under Tank
~ 4/ ~_ ~
,~
A~fht ~~'~11~ ~~~rrvaEa~l
x 5ch ~C~ ~,, ~'lr~
~'1/C p l~s
Combined Length of Cells: 184.0 Ft
Cross Section of Cell
18" Min Cover Material Observation Pipe
(if required) - - Final Grade
-- _
13034 or Ground
Sch40 Contour
Pipe ~ Leaching
System
Chamber ~,,,,,,,.;,,~
! enrj 1,
~~I./6
~~
~ wl~l~
1M~~rva?aa-~
f'~pr
Page 3 of 4
ln-Ground System Management Plan p„rs„an<to ~omn ss.s4 w. a c.
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The
county, department or POWTS service contractor may make periodic inspections of the
components, checking for surtace discharge, treated effluent levels, etc. The owner or owner's
agent is required to submit necessary maintenance reports to the appropriate jurisdiction andlor
the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals
when necessary in accordance with their approvals. The use of chemical/biological "treatments"
is not required or recommended. If such additives are used, make sure they are approved by
Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned
as necessary, with provisions to keep solids from passing the septic during removal. No more
than 1/3 of the usable tank volume may be occupied by sludgelscum. 3 year inspection: If tank
has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in
accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the
inspector does not recommend pumping of the septic tank, then the owner must be notified of
when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be
routinely inspected to be watertight and of good repair.
Absorbtion Cell
The absorbtion component must remain free of ponded surface water prior to pump operation. If
4 inches or more water level is detected in the observation pipes, the owner must be notified of
possible problems/failure. The designed daily flow capabilities of the component should never be
exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to
grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive
walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion
capabilities and/or possibly cause it to freeze in winter conditions.
Pertormance Monitoring:
Pertormance monitoring must be done at least once every three years following the installation or
at the time of a problem, complaint, or failure.
Contingency Plan:
If the septic tank or other components therein (including floats, alarms, etc) become defective,
the defective tank or component must be replaced immediately to ensure that the system can
operate as designed. If the absorbtion component cannot accept wastewater or ponds
wastewater to the surtace, the component must be repaired or replaced in it's current location by
removing the clogged bacterial mat, aggregatelleaching chamber cell, and distribution piping
within the cell and replacing failing components in order to return system to proper working order
as required. If repair is not feasible, a new system is to be constructed in a designated
replacement area
?1S 386 4686 ST CRa CO ZONING
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIl' CERTIFICATION FORM
OwnerBuyer ~~y ,O. J O~~~a~
Mailing Address ~~ ,3 ~ S TQrv ~ C/`p~°,~ ~i %~ds ~:~ ~~ ~ yo%6
Property Address
(Verification required from Planning & Zoning Department for new constntction.)
City/State ~y ~.SO~v c~ Parcel Identification Number
LEGAL DESCRIPTION
Property Location ~Ci '/. , ~_'/. ,Sec. as , T _~a°~N R~_N~ Town of }~ ut~ St~v~
Subdivision
Certified Survey Map #
Warranty Deed #
Spec house yes
Lot # ~.
Volume ,Page #
Volume ,Page #
Lot lines identifiable ~. no
SYS~'EM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to beadle wastes. Proper
maintertaace consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put irno
the system can affect the function of the septic tank as a treatment stage in fire waste disposal system. Owner trmintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix Courtly Sanitary Ordinance.
The property owner agrees to submit to St. Croix Coumy Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, jour~yman phnnber, restricted phunber 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 u~ersigned have read the above requirements and agree bo maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce artd the D~roorrent of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been ~iatained mast be completed and returned to Ste St. Crone County Planning 8t
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all 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 of bedrooms ~_
SI ATUI OF APPLICANT(S)
DATE
***Any information that is rrtisrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ***
include with this application a recorded warranty deed fxom the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed
(REV. 08/05)
~~
State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number ~ Documerrt Name
THIS DEED, made between Rosamji LLC a Wisconsin Limited Liability
Company
("Grantor," whether one or more},
and Trov D. Johnson and Jennifer L. Johnsonzhusband and wife
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ("Property") (if more space is
needed, please attach addendum):
Lot 54, Plat of Indigo Ponds in the Town of Nudson, St. Croix County, Wisconsin
845364
KATHLEEA H. MALSH
REGISTER OF DEEDS
ST. CROIX CO.. MI
RECEIVED FOR RECORD
02/26/2807 10:00A?!
MARRANTY DEED
EXERT #
REC FEE: 11.00
TRANS FEE: 248.70
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Name and Return Address
River Valley Abstract ~ Title, Inc.
1200 Hosford Street, Suite 201
Hudson, WI 54016
File !t: 2693201
020-1439-54-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Easements, restrictions and rights-of--way of record, it any.
Dated Febnlary 26, 2007
LLC
(SEAL) (SEAL)
:~
AUTHENTICATION
Signature(s) rrer
TzaC ~, ,Y,I~C
authenticated on ~'~aCy ~~ n~1C~
1
crate ~{~~~
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Attorney Doug Berg
1200 Hosford Street, Suiie 201 Hudson, WI 54016
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
St. Croix COUNTY )
Personally came before me on February 26, 2007 ,
the above-named
to a known to be the per (s) who executed the foregoing
in ent an ac n e ed? the sa
* ~ t /1/1 i , ,~ inn /1
Notary Public S ate of Wisconsin
My Commissi (is permanent) (expires: ~2 - ~ - d 1
(Signaturea may be suthenttcated or acla-owledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
Type name below signatures.
t_
Wisconsin Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
in accordance with Comm 85. Wis. Adm. Code
1295
Page 1 of 3
Steel Soil Service
County
Attach complete site plan on paper not less than 8'/= x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
and location and distance to nearest road
north arrow
ercent slope
scale or dimemsions _
Parcel LD. p Z b' 3 $ ~ ~
.
,
,
p
, pndig
Please int a~fjj
'
a viewe Date
r secondary pu ~ivacy , s. 15.04 (1) (m)).
fo
Personal information you provide m be used _ ~ ~~, O
Property Owner ~~~Y ~
~ ZQ Property Location
~~
ROSAMJI, L.L.C Govt. Lot na NW 1/4 SE 1/4 S 25 T 29 N R 19 W
Property Owner's Mailing Address
S
~"R
~LX C Lot # Block # Subd. Name or CSM#
~.
~
OUNTY
_
2141 Cty Rd. C
54
na
Indigo Ponds
City State Zip o ~ City J Village ~/ Town Nearest Road
New Richmond ~ WI 54017 715-248-7071 Hudson Sumac Trail
/~ New Construction Use: t/ Residential / Number of bedrooms 4 Code derived design flow rate
J Replacement J Public or commercial - Describe:na
Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable
General comments
and recommendations: system elevation 93.10 ft, trenches spaced and depth to code 5.00 ft below grade 600 GPD
na
Boring # J Boring
1/ Pit Ground Surface elev. 98.10 ft. Depth to limiting factor 120 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-16 10yr3/2 none sil 2msbk mfr cs 2c .5 .8
2 16-32 10yr4/4 none scl 2msbk mfr gw 1 c .4 .6
3 32-53 7.5yr4/4 none sl 2msbk mfr cs na .5 .9
4 53-120 7.5yr4/6 none cos osg ml na na .7 1.6
ZbU~ C~Q~ C~6 F~~~ S-~r,
COS <35% coarse fragments = 36" &
"
>35% - <60% = 60
below system
--.--~-
Boring # J Boring
Pit Ground Surface elev. 95.30 ft. Depth to limiting factor 96 in. Soil 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 10yr3/2 none sil 2msbk mfr cs 2c .5 .8
2 8-48 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6
3 48-96 7.5yr4/4 none Is osg mvfr na na .7 1.2
(l0 ~/ nl
* Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and T55 < 30 mg/L
CST Name (Please Print) Signature,. CST Number
David J. Steel 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 5/7/2003 715-246-5085
Property Owner ROSAM)I, L.L.C Parcel ID # Pending Page 2 of 3
Boring # J Boring
r/ Pit Ground Surtace elev. 89.90 ft. Depth to limiting factor 96 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
1 0-18 10yr3/2 none sil 2msbk mfr gw 2c .5 .8
2 18-36 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6
3 36-46 7.5yr4/4 none sl 2msbk mfr cs na .5 .9
4 46-96 7.5yr4l6 none Is osg mvfr na na .7 1.2
tv~u ti
^ Boring # ~ Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Conuistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
^ 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 PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 5> 30 < 220 mg/Land 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 NW1/4,SE1/4,S25,T29N,R19W Bus.(715) 246-6200
Town of Hudson, St. Croix Co. Fax.(715) 246-9372
Indigo Ponds Lot 54
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
the time the soil test was conducted. Legend
1" = 40'
• =Benchmark Ele. 100.00Ft
Top of 1/2" pvc pipe
• =Alt Benchmark Ele. 99.SOFt
Top of 1/2" pvc pipe
=Borings
Boring Elevations
B 1 = 98. l OFt
B2 = 95.30Ft
B3 = 89.90Ft
B4 = OO.OOFt
N
e
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it j, ~ ` ;' ~ ~ t ~ ~ ~~ ~j ~ .~1 ~ ... -'C.. ",9y 9 __
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MINATION- ~.,~ 8290 8?~ j _ ~ / ~ \,; `. "`
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