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HomeMy WebLinkAbout034-1032-30-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479367 0 GENERAL INFORMA710N (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Scobe , Darcee I Springfield, Town of 034 - 1032 -30 -200 CST BM Eiev: Insp. BM Elev: BM Description: ,1 ^n Sectionrrown /Range/Map No: J d� 6 ° 1 I II, CST 15.29.15.226C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �, © 0-:54 h3,54 Dosing Alt. BM 50 t, 1 , 1 3 Z. kn � (\ Bldg. Sewer 67 yg Holding St/Ht Inlet 13,toq C f`T • 9 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i r Z 255 1 Dt Bottom 1 Zez, %. Z9 - Dosing / ! Header /Man. Aeration Dist. Pipe 111 -76 lot •ss� Holding Bot. System PUMP /SIPHON INFORMATION 6 _ 1 1 Final Grade /0.16 162 •1 Manufacturer Demand St C r $ vd /b q GPM Model Number TD H Lift r Friction Loss System He 6d TD� �,Et rf '] Forcemain Len Dia. rl I Dist. to Well - . j 50 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of ench PIT DIMENSIONS No. Of Pits Inside Dia. I Liquid Depth DIMENSIONS <O � — �^-- SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type stem: '��J A) UNIT Model Number: 46J I DISTRIBUTION SYSTEM Z Si' Header /Manifold f e to Ai take Distribution Ct, 1 / J I ` x Hole Si x Hole Spacing V Z Pipes) ` J Z' ?� ` f �` , 73 r/ Length Dia Length Dia Spacing V SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S ded xx Mulc ed Bed/Trench Center / Bed/Trench Edges Topsoil c Yes No es i =j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: O ` / 3 1 / Inspection #2: Location: 3069 100th Avenue Ion, WI 54027 (NW 1/4 NE 1/4 15 T29N R15W) NA Lot 1 �-+ .-s�. rcel No: 15.29.15.226C 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = z g 15iJ f 5' �,.. ('J o I � Plan revision Required? Yes No b i Use other side for additional na information. — _ -- — Date Insepctor's Si nature Cert. No. SBD -6710 (R.3197) P X, A z �o 04/11/05 1ff1N 14:40 FAX 715 273 8884„ —P,C, L AND M GMT, Q 001 _..._ . Srtfety and jluildingg Division County +fit W . Wuhingtou Ave,, P.O, Box 7162 Swjtary permit Number (to be filled In by Co.) lsconsln d 637151 7162 3ra q 09 srtment of Commerce S a Plan LD• lumber Permit App ion!�Fr � II S oso = (e -AA,S. in trd with Cwom 83.21, Wiz. Aden. Crxie. pets tl ardor fduft you provide T Pr t Address (if difiereat thin mailing addtr st) accr may be used for eeoondarY Purposrs Privacy I1v+. sl 13 x R g - Ii I. Appllcatloft Inforuaation - I'lydse I'rint Ail Infotwatitm Ty Lit tf I Block N ' zpNING OFFICE I p Property Owner's Name Properly Locadw Pre Owner's Us cling Addreara= � zip CtttMs Plfono Numtur ���� City State t� L is s w Cf 10 S y ' CSM Numtxr 11. TYrA of Building tcluck aU that apply) `i °" S -- ffiQ 1 or Psniily Dwelling - Number of Dcdrtsonts [.l publielUxttmercial - Describe Use DCi❑yUS =e hip of i l State Owttacl - Ducrihe Use _ nA. Comp Iicable) UST- c -2�� Zz 6C IIL TYPO of Pt rmlt: (Check only one box an 13e latc line B if app ❑ odw Modification to rxistins Sym- A cw 5 stem n Repinceusent syaum ❑ t rrauucrw'Yfoldittg Tuilc Rdplaccmeot O dy N y sus] — 'i ( Chi o f r.I Permit Ttarl;W W New Li%t Previoull Permit Number and Date is U Penn ic Rmlawal I IIII D permit Revision B I Plumber Owner Wore Expiration I ..L ..�--- '• -- '^ —. IV. T x of PUyyT 5 t �9 E m s (Ch 211 that a )t �_ At c3radc D Stnsle ,w p S:u+�i I -Ater rai Non - Preasdrtrrti IA- Grourd ,� Mnfntti ? 24 in, of sWi2btc 61 L) Mrnud [ 24 id. of Alitabte soil l7 nt (] CeMttructtd Wodand M Proatirlm I,anlund v Hnlding Tank f Peat Filter U Aemhic T rtr 4 nw Other e xit aus l..� Rcc lrCLiatittF gaud rotor etie Media Fil i1 Leachin mbet r:J D Line ❑ avcl•less !'t -- -- f}-- ❑ Rnci rcutatin�_ , "D = I .ob / ! •oa__ 1 Area Iafortttation: : Sya�em R tevatbn V. Di i/Trentment I n So lt A lic n ItatoWds Dispersal Aroa Required it) Alspersat Aren d (� prsiatf Flo 1) t)eaiY PP ,. � •� O � Prebb Site Steel ether Phtttc L7 v Ceps -- us Trml Number — Manufitcuuer Glasx� VI. Tank In r _ fcfi Concrete Constructed Gal iotu Cal of Ual C ,rl t Aa & I ttcu� t+atisdrtg / T —— Tat Tatres i -_—.1- Septic rx Holdi Tfnk Aerobic t'rcaumatt Itnit I I pcstrytC•lnrrtber T� - _ i Ilation the II'0� 5W*13 ea the attacLed +ens• Responsibility Statem 1, LW* und eratga�d, acntn tesPtsfseihilil for I PPS Number / Boainars Phrxte Number VIII. plumiser'a Nimt; (Prat t) Plum w Signs re /�.�. � P 's Addtas (Strc:.t , try, State, ' Code) VM. Count Me artmnt US* On Isnti N Permit Fee includes timundwater Date Isetted ! ABem 5i (o Sutmilsi 5tutitary . ( Approved F3 simove •d Surcharge Pee) t 2S ❑ tvon Reason or Denial I IIX. Cantu of pprov Val SYSTEM OWNER; 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained I as per management plan provided by plumber. 2. All setback requirements must be maintained ----- -- ---I aS ❑Pr lir tllu nnrin /n� on pryer flocIcss thaPt!1112 k11lncbm -i W we Aa ttc6 e ornPt�d. anti lt tlo Go+sty tidy! for tde s7ri SBD -6398 (R. 01/03) v' 9b D _ 914 V � h N 0 M coq p M C1 3 Ln a a A W `� 7 r a N -Z r W j3� Q D/ Safety and Buildings 141 NW BARSTOW ST FL 4TH commerce .Wl.gov WAUKESHA WI 53188 -3789 4 TDD #: (608) 264 -8777 i ,.�mmerce. n/ www.wisconsin.sin.gov ov epartment of Commerce Jim Doyle, Governor Mary P. Burke, Secretary July 25, 2005 CUST ID No.224617 ATTN.• POWTS Inspector LYLE J MYERS ZONING OFFICE NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA E1556 STATE ROAD 64 1101 CARMICHAEL RD BOYCEVILLE WI 54725 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/25/2007 Identification Numbers Transaction ID No. 1159050 SITE: Site ID No. 702008 Darcee Scobey Please refer to both identification numbers, 100TH Avenue above, in all correspondence with the agency. Town of Springfield, 54013 St Croix County NW1 /4, NE1/4, S15, T29N, R15W Lot: 1, Block: 19 FOR: Description: Mound, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1030208 Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706-P (N.01 /01). In the event this soil absorption system or any of its component parts malfunctions so as to creatW$galth hazard, the property owner must follow the contingency plan as described in the approved plans. In add�tfbn,.,ttie I must comply with the operation, maintenance and monitoring duties as described in section VIIf the mo d c6rup lent manual. A copy of this information must be given to the owner upon completion of thei�,olct OFFF`�,T . All holding/treatment tanks are to comply with Comm. 84.25(7)(a). S QFf f yF Maintenance information must be given to the owner of the tank explaining that periodic c f the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval con lions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. LYLE J MYERS Page 2 7/25/2005 Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Julia A Lewis - Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 548 -8638, Fax: (262) 548 -8614 jlewis@commerce.state.wi.us Mound System Cover Page pg 1 of 6 W Project Name: Scobey -Mound Owner's Name Darcee Scobey Owners Address 500 Wisconsin St. N Apt. 219 Hudson, WI 54016 Legal Description ' /4, NE %, Sec 15 T 29 N R 15 W Township Springfield County Saint Croix Subdivision N/A Lot# 1 RECEIVED ParcelID# 034 - 1032 -30 -000 JUL 18 2005 Table of Contents SAFETY & BUILDINGS pg- 1 Coverpage 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Lyle J. Myers MP /License #: I. D.# 224617 Date: 7/15/05 Ph. #: 7156432520 Signature: 44 Mound System Design Methods Used `L , mss per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" y (Version 2.0)SBD- 10691 -P (N.01/01) U per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N 01/01) �CF Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715- 643 -6068 email: 3ba @3badvisement.com Mound System Page 2 of 6 Mound Sizing Calculations Project Name: Scobey -Mound Site Conditions Design of Entire Fill Project Type: 1 or 2 Family D welling • Cell depth at upslope edge (D): 14.0 in. % Slope: P % Cell depth at downslope edge (E): 23.4 in. # of Bedrooms: Distribution cell depth (F): 9.5 in. Depth to limiting factor: in. Cover thickness over edge (G): 6 in. Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in. Absorbtion rate of in -situ soil: 0.6 gal /ft /day End slope width (K): 10.1 ft. Effluent quality Eff #1 . Fill length (L): 95.2 ft. Max BOD effluent value: 220 mg /I Upslope width (J): 5.4 ft. Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 16.0 ft. Fill Width (W): 27.4 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal /day Basal area required: 750 ft Distribution cell width (A): 6.00 ft Basal area available: 1650 ft Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft Observation Pipes Contour Elevation of Mound: 100.00 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 101.17 ft Final Grade of Mound: 102.96 ft Mound Plan View Observation Pipes z� K B k—K I Tilled Area/Fill Material Mound Cross Section Final Grade p Observation Pipe Synthetic Fabric �g G Distribution Cell }q System Elevation y b is . .atlr Cover Material Fill Material „Invert Tilled Area Slope _—Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(g) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page 3 of s Pressure Distribution Calculations Project Name: Scobey -Mound Lateral Layout Lateral /Manifold Design Lateral elevation: 101.7 ft Lateral diameter: i is In. Rows of Laterals: z Lateral spacing (S): L — ft Manifold type: =Center 7J Lateral to cell edge: 1.5 ft Orifice diameter: Laizs • In. Lateral discharge rate: 9.47 gpm # of Laterals: 4 System discharge rate: 37.90 gpm Distal Pressure: 5 ft Manifold diameter: 2� In. Lateral Length: Manifold 37 ft length: 3 ft Orifice Spacing /Distribution Forcemain Friction Loss Orifice spacing (X): 19.73 Inches Forcemain length: 80 ft Orifices per lateral: 23 Forcemain diameter: 2 . I Avg. ft /Orifice: 4.89 ft Friction loss in forcemain: 2.390 ft Lateral Side View Lateral Length — Turn -up w /ball valve or cleanout plug 0 0 T S n o � Orifices on bottom of lateral equally spaced PVC laterals and Forcemain to comply with specifications per Comm 84.30(2)(e) Forcemain connection via tee or cross to manifold at any point Lateral Plan View Manifold Lateral Lateral x x x x x x x x x i x x x 2 2 Lateral Length Lateral Length Clean Out Detail Observation Pipes Clean -out plug Final Grade or ball valve Water tight cap or plug Lawn Sprinkler Box Slot Note: Closet Collar 6" Minimum may be used in Long Sweep 90 place of 3/8" bar ortwo 45's 3/8" Bar Lateral Mound System Page 4 of 6 Septic, Pump and Dose Tank Project: Scobey -Mound Tank Information Dosage Volume Pump tank manufacturer: Wies Con crete Forcemain drains back to tank? OQ Yes O No Pump tank size /model: Wi000 / 650 -MR Lateral void volume: 15.6 gal Pump tank gal /inch: 17 Dosage to absorbtion Cell: 78.2 gal Actual Pump Tank Volume: 646 gal Forcemain volume: 13.9 gal Tank bottom elevation (inside): 91.5 ft Total dosage: 92.2 gal Septic tank size /model: W1000 /650 -M Pump and Filter Total Dynamic Head Pump Manufacturer: Little Giant Are laterals highest point? y Pump Model: 9EH if not, enter highest elevation: 0 ft Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft Vertical Lift ( "D" to lateral) 9.50 ft Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Friction loss In forcemain: 2.39 ft Pressure loss from filter: �p ft Total dynamic head (TDH): 18.39 ft Pump Tank Diagram Dose Tank Levels Watertight Locking Cover In. Gal 4 Inch ' With Warning Label Minimum Finished A Reserve 22.6 383.8 Grade B Pump off to Alarm 2.0 34.0 7 Alternate C Total Dosage 5.4 92.2 Outlet Location Elect. per Comm D Effluent depth for pump 8.0 136.0 F r 16.28 and Total Capacity: 38.0 46.0 NEC 300 Weep Hole '°' or Anti - Siphon B Device FLOW- LITERS /HOUR C 0 1000 2000 3000 D 30 10 j y YJ W 20 7.5 W 5 a Ld Pump must be capable of: 37.9 GPM 10 e.s and head pressure of: /„ 1 e � o 0 a 20 40 60 8o Little Giant FLOW- GALLONS /MINUTE 9EH PUMP PERFORMANCE CURVE 115V 60HZ Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 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 surface 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. Pump /Dose Tank If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump /dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system 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. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. 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, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. I i D 0 v ' � h ° t O o N P� l� 3 Ul 04 a CA W cc J U u. % rORIGIMAL� 2083 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing County M, Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must 1. St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel 1.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest roa 034- 1032 -30 -000 Please print all information. � R ie � Date/ Personal information vi 0 on you pro de y be us nvacy s. 15.04 (1) (m)). Property Owner Property Location Nelson, Eugene & Donna Govt. Lot NW 1/4 NE 1/4 S 1 T 9 N R 15 W Property Owner's Mailing Address Lot #� Block # Subd e or SM# 3051 100th Ave. 1I f jj City S to Zip 8 er JA City jg Village. jN T n Nearest Road Glenwood City W - - Springfield 100Th Ave. New Construction User Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement In Public or commercial - Describe Parent material loess over sandstone Flood plain elevation, if applicable NA General comments and recommendations: install 4' x 112.5' rock cell mound on 100.0 contour as upslope edge of rock w/ 1.25' sand fill Boring # Boring J Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 1 0 -5 10YR 3/2 - sil 3 m gr ds gs 1 f/m .6 .8 2 5 -12 10YR 3/2 - sil 2 f sbk ds cs if .6 .8 3 12 -18 10YR 4/4 - sil 2 m sbk mvfr gs if .6 .8 4 18 -23 7.5YR 4/4 - sil 2 f -m sbk mvfr cs if .6 .8 5 23 -36 7.5YR 4/4 f2p 7.5YR 5/8,5/3 sl 1 m sbk mfr cs if 4 .7 6 36 -44 SSBR occasional gy si coats on peds in horizon 4; common gy si coats on peds in horizon 3; SSBR by general resistance to penetration w/ > 50% SS fra s 1—Y] Boring # Boring 6 Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 *Eff #2 1 0 -6 10YR 3/2 - sil 3 m gr ds gs 1f /m .6 .8 2 6 -9 10YR 3/2 - sil 2 f sbk ds cs 1m .6 .8 3 9 -22 10YR 4/4 - sil 2 m sbk mvfr cs if .6 .8 4 22 -26 7.5YR 4/4 f2p 7.5YR 5/8,5/3 sl 1 m sbk mfr gs if .4 .7 5 26 -50 7.5YR 3/4 - sl 0 m mfr gw - .2 ..6 6 50+ SSBR horizon 5 has pockets 10YR 7/4 s & Is ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 50 mg! ent #2 = BOD < 30 mg /L and TSS < 30 mgt CST Name (Please Print) Signature. CST Number Henry F. Grote — �tt�t 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 7/26/2004 715 - 233 -0398 I ii • : i Property Owner Nelson, Eugene & Donna Parcel ID # 034 - 1032 -30 -000 Page of 3' �[ F Bori ] ng # Boring Vj Pit Ground Surface elev. 97.4 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -4 10YR 3/2 - sil 3 m gr ds gs 1f /m .6 .8 2 4 -9 10YR 3/2 - sil 2 f sbk dsh cs 1 m .6 .8 3 9 -21 10YR 4/4 - sil 2 m sbk mvfr gs 1M .6 .8 4 21 -32 7.5YR 4/4 s I 1 m sbk mfr cs if .4 .7 5 32 -60 7.5YR 3/4,4/4 c3p 7.5YR 5/8 sl /scl 0 m mfr gw 0 0 l OYR 6/3 6 60+ SSBR horizon 5 has pockets 10YR 7/4 s below 38" Boring # Boring i F-1 De th to limiting Pit Ground Surface elev. ft. P 9 factor in. Soil Application Rate jj Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfV in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ! 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 GPDKO in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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. SBD -8330 (R.07 100) Certified Soil Testing � , r µ . x .�. 1 4 < t rj rA Ll <- _ v i a s LA { 9 C� O � N rJ J fl _ J v ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C'_RTIFICA T ION FORM Owner/Buyer t�j�2 C L �C,9 t✓ Mailing Address s s / P� Property Address 1 C) 0 (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION C 1 Property Location N ' /4, NC ' /., Sec. T �/ a N -R �W Town of SPr2/ �V�i Lz� .� Subdivision Lot # Certified Survey Map # 77 5 (040 Volume 1 . Page # 4 1 g Warranty Deed # 77-(0 ------ , Volume 2( 2 . Page # 2-7 Spec house ❑ yes 64-no Lot lines identifiable f yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance 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 in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating Mthe eptic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days oyear a ira ' dat SIGNAtNLE OF APPLICANT DATE OWNER CERTMC A ON we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro zky described above, by v'rtue of a warr deed recorded in Register of Deeds Office. p -� �' 7 v Q l �il �/ ,s SIGNATURE OF APPLIC DATE * * * * ** Any information is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' � SIII� t.]e • . w he Lalzevl e w Model Home On Display A r Our Lakeview model has been designed to take advantage of the view. There is a great view from every room of the house. 18' of glass in the great room provides light all the way back to the fireplace.Vaulted ceilings over the living and dining, open up your favorite gathering places. 30e angles add privacy to the large deck on the view side of the home. Bedrooms on opposing sides with separate baths give you the solidarity you need inside the home. Separate Whirlpool tub and shower in the master bath, large kitchen with a snack bar, large utility room, plenty of storage, all complement a home designed to maximize quality comfort and privacy when needed. "What a view," will be the comment of every guest! MAIN LEVEL 1820 50. FT. 2Y-0• BEDROOM K2 0¢ 3'Et iaS ea � MASTER BEDROOM � 4 DINING ROOM ULL BATH WIC U VI NG ROOM W— 2— HALL M5T. % BATH e•BITa ' BEDROOM 43 i ecv ms KITCHEN 0 UTTuTY ROOM MERICKEL L MBER 3TiY �,WM P.O. Box 471 Wadena, Minnesota • 218 - 631 -3570 G Located 1/4 Mile West on Hwy. 10 The Lakeview 1820 Sq. Ft. Lakeview shell materials ............ $38,400.00 SHELL OPTIONS STANDARD FEATURES To Change To: 9 1/2" I- Joists floor system w/3/4" Primed James Hardie Lap Siding .add $1,800.00 T & G Plywood floor Treated deck .................add 2,925.00 2 x 6 walls Cedar deck .... ...........add 3,550.00 Certainteed Monogram Vinyl Siding Timbertech, like model .........add 6,100.00 Marvin Clad Low E Argon insulated windows Marvin Clad Low E Argon insulated patio doors Stone front, like model .........add 2,800.00 Rollex Aluminum soffit & fascia Nailite shakes, like model .... .add 525.00 Prestique Elk 30 yr. laminate shingles Clad entry door frames 2 x 8 Treated wood basement with stainless steel nails ........add 6,100.00 Material to finish interior ............ 6,350.00 6" Wall insulation FINISH INTERIOR OPTIONS R -44 Ceiling Insulation Cellulose Flush oak doors and trim To Change To: 1/4" Pro -lay M/R underlay at vinyl 6 panel oak doors like model ....add 2,400.00 Sheetrock walls and ceiling Prefinished doors & trim .......add 1,600.00 P.F. white closet shelving Fireplace with stone surround ...add 2,400.00 Aristokraft Westbu ry Wheat Oak: Wire shelving ................add 475.00 kitchen cabinets w/laminated tops ... 7,430.00 master bath cabinets w /marble top ... 1,150.00 Blueprints per set $700.00 main bath cabinets w /marble top .... 950.00 purchase Will be refunded with the of � P ase home laundry cabinets w/laminated tops ... 870.00 Total for above materials ........... $55,150.00 Modifications to plan $100.00 (non - refundable) 400 miles free delivery PRICES SUBJECT TO CHANGE WITHOUT NOTICE Above Prices Are Materials Only Let us recommend professional licensed contractors to build your home on your site. a 0 e Z MERICKEL L MBER g 7 YWm & -6 P.O. Box 471 Wadena, Minnesota 56482 -0471 Phone: 218- 631 -3570 • Toll -Free Phone: 800 - 225 -3570 • Fax: 218- 631 -3572 Website: www.merickellumber.com 2/05 s� ' - -_� PR n(�-L. W 1.( �� a i s �• h !v C 1 a �0 �, •0 u r U; 2 6 7 2 P 2 7 3 - 7-76SJZ KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CA.. WI This Deed, made between Eugene S. Nelson and Donna R. Nelson, RECEIVED FOR RECORD husband and wife 10/08/2004 10:15AN — _ -- WARRANT D EED Y 11 Grantor, and Darcee A. Scobey, a single person REC FEE: 11.00 _ TRANS FEE: 186 COPY FEE: CC FEE: — - -- PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Part of the Southwest Quarter of the Northeast Quarter (SW 1/4 of NE 1/4), and part of the Northwest Quarter of the Northeast Quarter (NW Recording Area 1/4 of NE 114) of Section Fifteen (15), Township Twenty-nine (29) North, Name and Return Address Range Fifteen (15) West, Town of Springfield, St. Croix County, p 0.r f , ( r Wisconsin, more particularly described as follows: .t7 ! q-tu of One ) of Certified Survey Map filed September 29, 2004, in e 19 of Certified Survey Maps, at Page 4844, as Document No. 775662, office of the Register of Deeds for St. Croix County, Wisconsin. 034 -1032- 30,034 -1032- 40,0341032 -60 Parcel Identification Number (PIN) This is not homestead property. 0%) (is not) Exceptions to warranties: Easements and restrictions of record. Dated this day of 'C" 2004 �O C * ; Eugene S. Nelson f * Donna R. Nelson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St. Croix ` County ) authenticated this day of , Personally came before me this day of 2004 the above named Eugene S. Nelson and Donna R. Nelson TITLE: MEMBER STATE BAR OF WISCONSIN N N 7 _ (If not, to me ]cndtv(;no'6e the pe yvho executed the foregoing authorized by § 706.06, Wis. Stats.) instrunie THIS INSTRUMENT WAS DRAFTED BY * _ Thomas A. McCormack Notary l u ; -$tate o 11�SI 4011 N Baldwin, WI 52 My Co J. ot, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ���''�.., F W i • ,.�'r�c2� — Q 7 ) * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO -PRO FORM No. 2 - 2000 (800)655 2021 www.inioproforttfa.com I FORM NO 985 -A IINR.ItlLTiu Stock No. 26273 VOL 19 PAGE 4844 KATHLEEN N. WALM REGISTER OF DEEDS RECEIVED FOR�RECORD 09/29/2004 03:15PH CERTIFIED SURVEY MAP NO. CERTIFIED SU RVEY HAP - ITEC-7ZET 13 . VOLUME 19 PAGE 4844 COPYY FEE: 3.00 PART OF THE SOUTHWEST QUARTER OF THE NORTHEAST QUARTER, AND PART OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER. SECTION 15, TOWNSHIP 29 NORTH, RANGE 15 WEST, TOWN OF SPRINGFIELD, ST_CROIX COUNTY, WISCONSIN N 1/4 CORNER 2615.50' Section 15 -29 -15 U_NP Found Alum. Mon. 1307.75' 1307.75' LANDS 589'48'06 "E c� N89'48'06 "W Y NE CORNER DETAIL 1ooE� 9 v sED , , p O� Section m ?Mon. 35.18' S s9= 3 `�))• ��� see detail - - -'�� J - LOT UN PLATTED zo S LANDS ss9�.e °• 2 901,642 sq ft � 'eF o w 20.70 acres j w 0 o cl. In r -o -w �a OWNER /PREPARED FOR: o w DoT Mr Eugene Nelson sor re5c 0s 3051 100th Avenue c"o °1 °OOD w1 Glenwood City, WI 54013 - 878 sq.f t. ! at 20.17 acres SUR`1E �f DRAFTED BY: not Incl. r -o -w JS SURVEYING LLC h yr A .. $ l 9 U_N_P _ TTE UNPLATTED S89'58'43 "W 660.00' LANDS LANDS - - -- i0_i 1 0 L O_' 11 �.5.M_ OL_'V PG, 45`3 PG. 4513 CURVE DATA TABLE CURVE RADIUS ARC CHORD CHORD CENTRAL TANGENT IN TANGENT OU N0. LENGTH LENGTH BEARING ANGLE BEARING BEARING 1- 2 410.90' 372.17' 359.58' S85'08'41 "E 51 °53'44" S59'11'48'"E N68 ° 54'28 "E 2-3 443.90' 402.06 388.46 S85'08'41"E 51 °53'44" S59 °11'48 "E N68 1 54'28 "E N Note: Each parcel on this map is subject to State and County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office for advice. LEGEND ....._...Government Corner (as noted) SCALE: 1" = 300' North Is referenced to the o .......... Set 3/4" x 18" iron rebar weighing North line of the Northeast 1.502 lbs. /lineal ft. Quarter of Section 15- 29 -15, o... .._ .... Set 1.25" x 18" Iron rebar 0 300' 600' which bears N89 °48'06 "W 0 .......... Found 3/4" x 24" iron rebar (St. Croix County Grid System) & Set "PK" nail Page 1 of 2 Vol 19 Page 4844