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HomeMy WebLinkAbout020-1439-55-000Wisconsin oepanment 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)I. Permit Holder's Name: City Village X Township Larson, Daniel and Beth Hudson, Town of CST BM Elev: ~ Insp. BM nElev: / ~ U BM Description: 1/ e ~~ ~ ~ ~ © V ~C/Yld Y TANK INFORMATION ~' ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic t ~ /! u2~ ~ 2 s~ Dosing ~/ ~ /~ 1~ -h / Aeration Holding TANK SETBACK INFORMATION TANK TO P/L W~ BLDG. Vent to Air Intake ROAD N Septic ` ~ - ! ~ (, ' j Dosing ~-- Aeration i~s~, / Holding PUMP/SIPHON INFORMATION ~A Manufacturer Demand GwM Model Number TDH Lift Friction Loss ystem Hea TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM Z ~ ~ 7.~ ~ar,.•G(p/Lo County St. Croix Sanitary Permit No: 506318 0 State Plan ID No: Parcel Tax No: 020-1439-55-000 Section/Town/Range/Map No: 25.29.19.2781 STATION BS HI FS ELEV. Benchmark //0 y a~ $ /o~, a Alt. BM ' '~ ~ /'Wan Bldg. Sewer Sc K ~tt,I~ 4 ~.~. 9 R. ~ ~ S Ht (plef fi,~ `' p` 8 s ~ _ 2 s SUHt Outlet g, 10 r S,G~-( ~ a3 Dt Inlet ~ ~' ~p 3 S,~IZ / ~ Dt Bottom / ~~ Heade Man , ' `" io ' 2 ° to. ~ 7 9~. 6 ~ Dist. Pipe / y BB,Qt SvstEm S ~ Z- /~• ' Final e s ~ /O D • ~ St Cover ~- 2 nt~. 3~ 3 is f Z ~ ~2 /~ f-r ~A' a DEDE (TRENCH DIMENSIONS Width ~ ~ Length q2f No. Of Trenches PIT DIMENSIONS / No. Of Pits Inside Dia. Liquid Depth ~ ~ ~ SETBACK INFORMATION SYSTEM TO P/ BLDG WEL LAKE/STREAM LEACHING CHAMBER O Manufastarer: Type Of System: 2` /~, ~0 /~ ~ ~ UNIT Model Nu er: Z ~ ~~i / ~ / DISTRIBUTION SYSTEM ~e~ .A/lA, /111 ~wlr, /2`'.A.~n~n1 ~Z2'if0 -~D9 o~~GBi ~l y~/Lai Bader ~ni~ Id i Distributi~~(~ ~,L, ~ ~ Pipe(s) TT x Hole Size x Hole Spacing Vent to Air Intake Length D a Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over ~' Depth Over xx Depth of xx Seeded/Sodded xx Mulched /~, Bed/Trench Center / Bedlrrench Edges Topsoil ~~ Yes ~ No ~ Yes [I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~O /~ZZ/~~ / Inspection #2: / /_ Location: 871 Badlands Road Hudson, WI 5e40116.(NW 1/4 SE 1/4 25 T29N R19W) Indigo Ponds Lot 55' Parcel No: 25.29.19.2781 1.) Alt BM Description ~t~0'~ YI't~~p(.2 t'" Z 2.) Bldg sewer length = ~ ~ ~ SCN ~ a - amount of cover = y ,'~ Plan revision Required ~1 Yes ~.: No /, '~ J , ~~ ~Jb13"7 r Use other side for adddlonal information. [ v_ ~ 2 ~ 'v ~ (,~.~_ ~~~%~''~- , -' "~ Y __~ -_ _ _- SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No. commerce.wl.gov Safety and Buildings Ih 'ion county ~ ~ 201 W. Washington Ave., P x 7162 O ~ ~ i sco n s i n Madison, wl 53707- 2 Sanitary Permit Number (to be filled in by Co.) i'~parttttertt ~ ~„~~ 5 Sanitary Permit Application State Transaction Number N,4 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate g ernm unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO are Project Address (if different than tnail~S addry~s~ ~ ( ~ ( ~ submitted to the Department of Commerce. Personal information you provide may be used for sec y~. ~~ ~ ~,+,Q / 4~~ + ~+ ores in accordance with the Privac Law, s. 15. 1 m , Stats. L A lication Information -Please Print Al ormation property Owner's Name ~/ v a. Btu Lf~RSat~ D P 1 # oZo -/~35 - 55 • i~oo , Property Owner's Mailing Address Pro y Location ~ Z •~ , ~ a bZ Cl'Tp ll,,e Greek ST. CROIX COUNi'Y Ga Lot Z S City, S t ate Zip Code Pho Number ' ~ 1/,, s ~ '/,, Section ' l I~V Wi D~ W ~ . S4 C l Ip `) I S 3 a S$ ~ T Z`1 N; R ~_ E~o~ t l ) ll th k h pk ~ Lot # ~ app y a a ec II. Type of Building (c Subdivision Name or 2 Family Dwelling -Number of Bedrooms 5 ~~ W~ Jr.Q Block # y~ i C ^ public/Commercial-Describe Use \ ^ City of ^ State Owned -Describe Use CSM Number ^ Village of p ~O Vl ~1'own of ~~ ll Z Q,b~-C.P.~.IS c,~ ZZ k Z3 C, N-o~er~ ~ , f III. Type of Permit: (Che only one bog on line A. Complete line B if applicable) A" (New System ^ Replacemexrt System ^ Treatrrtetrt/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued $. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New ~~ Before Expiration ~'n~ 1.. r 1 V. a of POWTS stem/Com onent/Device: Check all that a 1 /~ ion-Press ed In-Ground ^Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil Marnd < 24 in of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Prdreatme~ Device (explain) V. Drs rsal/Treatment Area Information: '~" Z ~sf) r Design Flow (gpd) Design Soil Application Rale(gpdsf) Dispersal Area Required (sf) / D~sPersal / " _ SystemQ t? ZS • gs 5 ' 2 ~ ~ 7 / g57. I CPo~ . . / J. VL Tank Info Capacity in Gallons Total Gallons # of Units Manufactures ,~ ~ c ~ U New Tanks Existing Tanks ~ ~ ~ /~ c ~ U ~ ~~„ v~ w ~ v~ a ~ iw C5 a Septic or Holding Tarilc l ~ tJ p ~ z5~ ~ ~ i e Sej Dosing Chamber ~" VII. Responsibility Statement- I, the nnderaigrred, assume responsibility for instanation of the PowT ..n on Hue attached plans. Plumber's Name (Print) Plumber's Signature MP PRS Number Business Phone Number B~~R, B~ ~ ~ u Err ~ ~~ t ~,o b 5i 43~ .S'i ~ 1 Plumber's Address (Street, City, State, Zip Code) ~ . 3 31 /! COvkt R , t^i l W VIIL Coun /De artment se Onl Approved move ^ Permit Fee Date I ed Issuing Signature $ ~~ . ~ ~ ~ 0 ^ Own teen Reason for ~al ]X. Condi~rBReasonsforlAsapproval 31 pltl ~ (/~~ ~ l ~O>~-- ,1•~ 1. t3aptk: tank,. effluent flker and dispersal cell must all ~servtcee / mairtained/ maintained prior t~ 5~~i ~~~ `~' 4 ~~ ° I/ as per management plan provided by plumber. --~ ~b 5 ~~ '~"'^'S ~ ~ 5e'i~'~'~ ~~ 2. •AN s~Rback tequiremants must be maintained p per spplicabie code ~ ordina~ea. _ ., ,.....~.:.a.. at[sca i0 Compa:ce p.anE IOr [ne Sysaem auu sYU...n w .« ..w...] ..... r-r-' ___ _ __.... --__ _ _ _ _ _ _ __ _ ~~4: I GdA.a.. .* ... 3 ¢' ~ ~ c N IL 0 ~ ~ ? > ~ ~ } = Q 7z ,~ U ~ Q ~ N ~~ o ~ u ~ ~~ W F 8 ~ J ~~ _ ~ ~ ~ ~ ~ ~ O J ~~ ~N N m~ Q (n W W m > ~ M $ N ~~ II 11 N ` ~ `r m' IZ c n N m m a ~ CS ' ~O ' a- I od a3 ~ O U . o nom. ~ d m ~ 'v ~ al ~~ QN m ~ c~i> ~ I o ~ c°~ d ~ o N o o Q ~ v ~ 1 a fl-m N N(N ~~ L °m3°' L I av2n Qtn rn c v I W Q O J O ~ ~ I. c c~ ,- 1 _ ~ N -' O _--~ ~ ~ I ~u~ m r .~ .W+ ------ O O N d m ~ -'-~/''' I' N _ __ ~'- I ono;t,~ A•~OL ----------------------------------- ---- - J M ~1 N ~ ' ? ~ m m ,-k" ao _ ---""--~' ~I m ago _ _------ '~luo~,8• _ - _ _ ___--------------_~ -------- `~ --', O~ = Pg4of4 Y ~ ~ @_ z ~ ~ ~ O .a .Q > > Q Q ~ ~ ' ~ (!~ = - - ~ ~ s ~ U N ~~ s~ W w to °- b o~ $ ~ w ~~ c ~ c~ ~~~ ~ ' ' ' ' 1 w w M $~ ~~ cn u -i i- ~ ° ° z ~~ ~ .- N m m N ' NO a_ I om a`~ i `o oa ~ M c N d N ~ ~ ' C ` I J n ~ ~'~ o n`.o ~ ~ Qc"n ~~ Ma n $. o m o N o o 'Q ~~ ~ l a O.0 w N m r2 O~ ~p ' L O- N O .00. a- ff1 I- t . v I O `p J ' O ~~ I. W c ~ 1 O -~ ~ O ~ I (~ m r -------------------------------- --~--~ H O I. N O to _ _ !~ I ono;u~,0'OOL ---- -- --"- ~ ~ ~I m m ~k co __--''~~~~' I __. ------------ -- - _ ---------- ---~ au!l~(1-iado~d -~~ Pg4of4 1296 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 size. Plan must St. Croix include, but not limfted to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. " Parcel ~ p nding Please p nt al~-~3f ~ Rev' ed By Date Personal information you provide may used for secondary purposes (Privacy s. 15.04 (1) (m)). 6 O Pro a Owner p ~ rd~~~Y 1 s 2003 Pro a Location p ~ ROSAMJI, L.L.C Govt. Lot na NW 1 S 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address 5T. CROiX COUNTY Lot # Block # Subd. Name or CSM# 2141 Cty Rd. C zONiiJG OFFICE 55 na Indigo Ponds City State Zip Code Phone Number J City J Village ~/ Town Nearest Road New Richmond ( WI 54017 715-248-7071 Hudson Sumac Trail 1I' New Construction Use: t/ Residential / Number of bedrooms 4 Code derived design flow rate J Replacement J Public or commercial - Describena Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable General comments and recommendations: system elevation 98.55 ft, trenches spaced and depth to code ~ft below grade Sr 600 GPD na Boring # J Boring t/ Pit Ground Surface elev. 103.30 ft. Depth to limiting factor 96 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. YEff#1 *Eff#2 1 0-12 10yr2/1 none sil 2msbk mfr cs 2c .5 .8 2 12-24 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6 3 24-54 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 4 54-96 7.5yr5/6 none ms osg ml na na .7 1.2 N , ~ Boring # J Boring -~ Pit Ground Surface elev. 100.00 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 0-10 10yr2/1 none sil 2msbk mfr cs 2c .5 .8 2 10-30 10yr4/4 none scl 2msbk mfr gw 1 c .4 .6 3 0-96 7.5yr4/6 none Is osg ml na na .7 1.2 rt * 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) 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 ROSAMJI, L.L.C Parcel ID # Pending Page 2 of 3 Boring # J Boring 1I Pit Ground Surface elev. 89.8U ft. Depth to limiting factor 96 in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Stnicture Consistence Boundary Roots PD p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-6 10yr2/1 none I 2msbk mfr gw 2c .5 .8 2 6-36 10yr3/2 none sl 2msbk mfr gw 2c .5 .9 3 6-9 7.5yr4/6 none Is osg mt na na .7 1.2 ^ 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 P 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 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTSM ROSAMJI, L.L.C. New Richmond,WI 54017 Lic. #248956 NW1/4,SE1/4,S25,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax.(715) 246-9372 Indigo Ponds Lot 55 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. 99.80Ft Top of 1/2" pvc pipe ^ =Borings Boring Elevations B1 = 103.30Ft c tN-P5 ~~ Ar ~i 4 ~~ 1 • C` ~ J• ~ ' ,_~ / ~ ./ -- ~ T- ~ ~ ~ 7t :--; -'mil ~ .' O~ - T~ f ~ ~ : - icy, ~~ ----- -- __. -~ .J ~ , ~ ~ ~ ~ i ~ ~ ~ /. ,-,•c , ~ `_ ~ -~ ~~. 4<}ti. ~ ~ gyp,: ~ •-.. - ~. _~ ,-\-1- ~ r \ ~O I ~ ~ c ~2AINAGE EASE ~;-. ~~ OY ~ i NB~~~'' Ti/~ h`OS X31- ~2 ..,- TER LINE ~- --. .? o `~ 1~/ P, ` ~ ~ ~~ BADLANDS ROAD _201. 9 ,'` 058 y r , ..~ ~ ~ 1 w ~, ,.,. ~ ~ pp l , ~ 3 - " v w / L J . ~~ ~ - ~ ..- `~ ~; r~9N~ ..~-OF WAY LINE ~ o_ y` ~--. ~~. "~ ~- ~` , ~`~ BADLAND OAD ~ „~ / j ~ r` ~ ~~ i, i ~ ~~~~, ` ; 8714Ei S.F.--~ t~ Icy' $7123~S.F.-_ 2.1G5I O ~ ~~ ~ y ~ ~ (2.000 AC ),I r ~ri ,~ ' (2.000 AC.) ~ ~ (1.002 AG N `, ::. /' ~ ~~~ ' '~ (1.086 AC. N.B.P.A. ^ 1.344 AC N.B.P.A.) • ~ ~~" ,~ ~p s y o ~ ``.~~ ~. J 24.88' ~, r '; : ; '106.85 ~ O i " ' ~ ~p~ ~ w\ ~ ~ v -, ` t 84.09 J` ,~ ~ . ,37,03 - -~ - - '~` ~~, '_~ ~:'~ ._ ~ ~ •54.33' ~,~ ~/ - - : ~ , \.,! ~~Oa pG, -- - • l` •_~`, 86 .. r •, ,_ - 68 9~ ~- ~34 . - ;sue,. srj'~~c~ '~ ~ , « r - s : ~~3•$~~ N83~ 2 .s~~ sue. • p - m - ~ ,.~ ~ ~ ~ , ~, ~ •' ~ (NSZ'~ •. '~ ~: -t1 7°0. O _... ~ - MMATION= ~~ ~g O B~ ~ ; r, ~ti= ~`~ ~. _ _ Y~~• ~" • s. /~ , Y • - f.. s. _ ..~-.. r' ' ,1 ... j' 1 . % ~ t .. •.~ ~, ~ , . ~ 1 ;~ 010 E ,--_. ~" ,- ~~ rV ~ E IRON FOND ` ~ ~., ~ ,ti ~ ..,~~ _. i I-~ \ 7 L_ ~ ~.l _ i ~J /~/~ - ~~ ~/ /" /' _ . - - ~~ . - ,- - `1-; ~. € ~. ,- D.59 FEET EAST Q ~ \ ~ `~~.-~.. . • ~ ~ `\. ` Y ` ~1 OF PROPOSED ~ _ '- _ -- - _:, / -• ,.~ __ .. _ 1'" ~ '"• r 1- ~ s`'~'r ~~ ~~ ` ~ '~ Page 1 of 4 Leaching .Chamber Design Spreadsheet Project Name: Lot 55 Conventional System Owner's Name Q~h +~- ~e~4-h ~.arSah Owners Address ' 6 771 K e C -~1u ems. 1.~2'. 54e/~p Legal Description -~n+y ~ '/., se ~ '/. Sec 25 T 29 N, R 19 w ~ Township Hudson County Sairrt Croix ~ Subdivision Indigo Ponds Lot# 55 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 "IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSffE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD-10705-P (8.6/99) Calculations and Drawings Page 2 of 4 Site Conditions Infiltration Elevations Site Type Private ~ Trench #1 Trench #2 Trench #3 %Slope 20 # of Bedrooms 4 Depth to limfing factor 96 inches Soil Application Rate: 0.7 gal/it^2/day 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: Manufacturer: Wieser Volume Chosen: 1250-MR Effluent Filter Selected: Zabel A100 Note: Access opening of sulricient size to be provided to allow removal of finer. Opening to terminate at or above grade. Cross Section of Septic Tank 100.00 98.00 0.00 95.25 93.25 0.00 Ft Ft 92.00 90.00 N/R 3.25 3.25 N/A 0 0 N/A In 100.00 98.00 N/A Distribution Cell Choose chamber type: Infiltrator Quick 4 Standard U # of trenches: 2 ~ 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 Combined Length of Cells: 184.0 Ft 12" Min Grade Cross Section of Cell 18" Min Cover Material Gbservation Pipe ~ ~ (if required)~~ _ _ -Final Grade All joints to be water tight ~ D3034 or Ground Effluent Sch40 Contour Filter Pipe Leaching System Chamber Elevation 3" Bedding Under Tank fNt 1C~~~ ~r 5ch qC~ ~ PVC plus 1~enq ~: ~ ~I-I ~L ~ f~' Lf 6~ ~ ~~ ttif~.l,tw L7byrr wa fi~l ~'il?r f7l~~~rvatJ~O-t !'ire Page 3 of 4 In-Ground System Management Plan pursuant to comet 83.64 W. E-. 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 and/or 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 sludge/scum. 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 flee 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. Performance Monitoring: Performance 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, aggregate/leaching 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 D°~ 'X96 ~9 IND1G0 POND5 J y -' ~~~ laald'n tln Xryueq Qalr M W Saanw QaAr, 4 M NrYnoal Wna' el M SaAMfd Wrk, 4 IM Swmxal Qir4r el the 59' ~ RauRp4rS SaMrw OurYr, M 4 tln SaNmsl Darlr sl In Smpmd Q4N, d M Swim N, laa 19 Mrtlt Rmp 19 Met ad'n tlw NrN.ol Q,~''I" ,' ~ ~`^ pf I~~\ I D,Mr el se ArYrml Owlr~ h w MrMeml Qatr d ar zrzsmt Gntr. 4 or tarmwA G~rzr el me srshemr arw, aw 4 ysl'~ ,~ a ~ a me SMMmI Oirlr of We Nrprad Oialr, d'n Sectlm !5, ifri M Nrtlt Amle N INes lam d Wprr Ss Oah Cam1A I ' ~` ~ "~)~ ~' , X ,;?, znanrarz raa , / p , a~ last uxz n s[a A ts6 ~ ~ i "J, ~ ~p / 57 .,I I GS 1 mn sr. ~ I r I r• ryfaael~ ~ Sr ~~+eC I d~i'~~y~~F~jY'G / ~~ 1 11 a ~' ~ "Sn ~: A~ ~6 p swsMniaummmroea S yle Ya~~~~ ~~ ,yyl'"~ ,- / G ~~a~ I ~ `I dz~ . ~ ~~ \ / rr amnsroua ~ ~~P° ~ "s;~~" F ~~ ~ ~~a~p ,~ e>,ir~~ I ~ ~ n ~i~~ t o s aaarluAnsrmsra r <tl~3e: ~~ ,iD~F~,`~~''j'!~ 0~ a w '_i'~ ~k7 ux ourua~Una~am d~ `Ir °44 ~yti ~~%~'rA'~eE1~' R,, "` ~ I I.rK I ~ ~ , ra rn'zusormsnosmo,c :~ d us m raps m SGt[ M RR Cy ~~~ :%", ~.t01y ~ JA' r I ~~ un sr ~ ~ I y I ,t( J 1 ' ~ ,J9 '~. 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I '~ ~ ~~ ~ °#~ •A I I ~ I etl ~ i I I I ` 1 ~~ I I~~- rms r l I SfE 9 r~rrlr (ET f Ye.r ~ llbA Ml/ 09/04/07 TUE 12:02 FA% 715 388 4686 ST CIZ7L CO ZONING ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ a,~ Gar;d h Mailing Address "~~` a ~5~~~ ~C,~'~"~ 7`~~ ~S v n ~~S' ;, S`'Sio~,!' Property Address $7/ ~~[.9„r.~s ~- ~ ~ ~a~,-i ,~~, (Verification required from Planning & Zoning Department £or new City/State ~~,~, !•-~i~r'~ Parcel IdentificationNtunber LEGAL DE~CRIP'I'ION Property Location ~'/. , ~~ 1/0 ,Sec. ~~, T ~N R `cl ,Town of ~~~e T Subdivision Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ,Volume ,Page # Spec house yes ~ ~ Lot lines identifiabk~. no SYSTEM MAINTENANCE AND OWNE>~t CERTIFICATION Improper use and maintenance of your septic system could result is its premature failure to handle wastes. Proper maintenance consists of pumping out the septic talc every three years or sooner, if needed, by a licensed pumper. What you put imo the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Ovmer rnaiatenamce responsrbilities are specified in §Comm. 83.52(1) and in Chapter l2 - St_ Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman Plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and Pumping (if necessary), the septic teak is less than l/3 frill of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sec forth, herein, as set by the Department of Commence nerd floe Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained mast be completed and returned to the St. Croix County Planning 8c Zoning Department within 30 days of the three yeaz expiration date. I/we certify that all statements on this form are trae to the best of my/our Imuowlodge. Uwe am/are the owner(s) of the property descnbed above, by virdre of a warranty deed recorded in Register of Deeds Office. Nu er of bedr erns ~, SIGNATURE OF APPLICANT(S) 9 / S / o~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Phuuung & Zoning Department. *** lrrchu~le with this application a recorded warranty deed from the Register of Deeds OflYCC and a copy of the ceartitSed survey map if reference is made in the warranty deed. (xl~v. osros) State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number A Document Name THIS DEED, made between Rosamji LLC, a Wisconsin Limited Liability Company ("Grantor," whether one or more), and Daniel R Larson and Elizabeth A. Larson, husband 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 55, Plat of Indigo Ponds in the Town of Hudson, St. Croix County, Wisconsin 111111 IIIII IIIII IIIII VIII VIII IIII II{III Illl 111 * 8 5 6 8 1 1 77 1* ~~~~ { f KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/02/2007 10:40AM WARRANTY DEED EXEMPI t REC FEE: 11.00 TRANS FEE: 256.50 PAGES: 1 Recording Area I Name and Return Address River Valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 File H 2695302 020-1439-55-000 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, if any. Dated lulu ` ^ n? ~`F007 Tracy ~, Tl~irno; (SEAL),~~/(~ %// ~~/ut-'~.- {SEAL) State of Wisconsin (SEAL) (SEAL) * » AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. St. Croix COUNTY ) * Personally came bef a me n Jul 007 , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named ~ (If not, to me known to be the rson(s who executed the foregoing authorized by Wis. Stat. § 706.06) n t e e to sa THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg ~ N Publ c, ate of Wisconsin l ~ ~`(,~ 1200 Hosford Street, Suite 201 Hudson, WI 54016 My Commis i (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are oot necessary.) NOTE: THIS [S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. I-2003 • Type name below signatures. toft