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HomeMy WebLinkAbout036-1071-40-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix �afPty and Building Division INSPECTION REPORT Sanitary Permit No: 515161 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Sko fund, Karl I Stanton, Town of 036- 1071 -40 -200 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range/Map No: 1 *6111ft r 13 Z GsT 30.31.17.454820 TANK INFORMATION ELEVATION DATA OQ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a Benchmark Lie, Ve F`�1.6 , 11C 3, �s Io3,'�isd 99 . gowng Alt. BM Aeration Bldg. Sewer 6. 9q b4 Holding St/Ht Inlet (o . 35 5- 7. 13 TANK SETBACK INFORMATION St/Ht Outlet 0. �7 'S TANK TO P/L WELL : D G. Vent to Air Intake ROAD Dt Inlet Septic (0 3 5 I Z 7 50 Dt Bottom Dosing Header /Man. q 6-7 T 1/ +� / Aeratio Dist. Pipe 91.0-7 1 �/ Holding Bot. System �` Z 93, Z% Final rade PUM /SIPHON INFORMATION e l i, �• B Manufacturer Demand St Cove��- S GPM fi-•; 1 3 • !' Model Number s • ` g TDH Lift Friction Loss Syste ead TDH Ft Forcemain ia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches I PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 (p rle4 JA�_ �- 13 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: 1 CHAMBER a T OR Model Number ~ DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing ] Vej to Air take Pipe(s) .� Length_ Dia Length \ Dia Spacing �� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 7 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center q Bed/Trench Edges\ -1 Topsoil No Yes [] No Yes E] COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / Inspection #2: Location: 1985 145th Street New Richmond, WI 54017 (NW 1/4 NE 1/4 30 T31 R1 7W) NA Lot 2 Parcel No: 30.31.17.454820 1.) Alt BM Description 2.) Bldg sewer length = �� - amount of cover � aIS6 d'e b.e.. $'A..50 (47il(j Plan revision Required? Yes )(N o �� �� Use other side for additional information. 0� Date Insepctor's Sig ature Cent. No. SBD -6710 (R.3/97) commerceml Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ' i sco n s i n Madison, WI 537 7 anitary ermit Number (to be filled in by Co.) Department of Commerce 5 I Sanitary Permit Application S tate Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 7 6 � 75/ unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ^� / . p urposes in accordance with the Privacy Law, s. 15.04 1 m Stats. 7 I. Applicatioji Information — Please P ' A orm ion RECEIVED Property is ame / Parcel # 03 .1671- a zoo - to � Prope Owner's Mailing r Property Location OFFICE Govt. Lot City, ate i' Zip Code one Number d1 c,A y,, 1 1 y, Section / f- � (circle on T R Type o Building (check all that apply) Lot # ❑ I or 2 Family Dwelling — Number of Bedrooms Subdivision Name Bloc t C.bt, /Commercial — Describe Use C?1✓ ❑ City of CSM Number ❑ Village of El State �Owned — Describe Use ^ X � GM 'O 4 2. � 00 r + : 15 Town of { n� .- III. Type of P mit: (Check only one box on line A. Complete line B if applica e) A. % New System y ❑Replacement System ❑ TreatmenUHolding Tank Replacement Only ❑Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. El Permit Renewal ❑Permit Revision ❑Change of Plumber 11 Permit Transfer to New _ ���� Q � t � Before Expiration Owner ., fjj U , IV. Type of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) / Design Soil Applicatio ate(gpdsf) Dispersal Area Re iured (sf) Dispersal Area Proposed ( System Elevation J �3 V . Tank Info Capacity in Total If of Manufacturer Gallons Gallons Units a o New Tanks Existing Tanks y ,� y o y R k_ a. U Septic or Holding Tank — � J Dosing Chamber t/ VII. Respon5ibility, Stateme t- I, the undersigned, assume res i!Uy for installation the POWTS shown on the attached plans. Plumbe 's me (P ' t) Plumber', Si a MP/MPRS Number Business Phone Number CZ� - 46 J z Plum er's A dress (Street, Ci , State, ip Code) ' - c s VIII oun /De artment Vse Onl Approved ved Per�miit Fee Date Is tied Issuing Ag ignature 0 tven Rea , Denial $ / �� a IX. Conditions of v eass or Disapproval t SY$T € A nn r on f +l 1, Septic tank, e' of filter No 1 A dispersal cell - tl1111 i as p <r rnanay , drl P byPh=bW. Z. All setback re ; r- :nts rnyttt lv ttac to complete p ans or t e system and submi to the County only on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 l pc obi y.�: --S� e- 30 - y�3ir� /7c✓ 1/.m' NA I ' i �! , 96:7 weir —� c i hh i i r : / I i � .� �.� /JJ,�� mil- �� . � ,✓��'/ � s��� -.0 r Y � -3 i i o COPY ' l — ' v c -�;o �J `� - .i/�:� - see �30 - y'.3ir✓- �iycJ 5 X-a �.t /mss ' � r Zi . to i '1 f % A it � j .� �,c;xif/ /l1,yc'�r �• �g,o . � �r✓1� >� s�r,r;� - ,L:1 %5; � -�' j Safety and Buildings 10541N RANCH ROAD commerce.Wl.gov HAYWARD WI 54843 Contact Through Relay iscO n s' n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary September 24, 2009 CUST ID No. 224263 .4 77N.- POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/24/2011 Identification Numbers Transaction ID No. 1707515 SITE: Site ID No. 751534 w Karl Skoglund Office Please refer to both identification numberP. • 1J 145TH St above, in all correspondence with the A m, i Town of Stanton St Croix County p t ` NWl /4, NEIA, S30, T3 IN, R17W FOR: Description: Non pressurized in ground, office, 6 employees, 2 floor drains Object Type: POWTS Component Manual Regulated Object ID No.: 1241003 Maintenance required; 192 GPD Flow rate; 120 in Soil minimum depth to limiting factor from original ade; Si "t v System(s): In- ground POWTS Component Manual, SBD- 10705 -P (N.01 /01); Commercial System, E went Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: Key item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in the "In- Ground Soil Absorption Manual System" are complied with. A copy of this information must be given to the owner upon completion of the project. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • Comm 83.02. This approval covers only the domestic wastewater directed into the POWTS. The Department of Natural Resources must be contacted regarding the treatment and disposal of non - domestic wastewater, including those mixed with domestic wastewater. Please refer to the following website for more information: h=: /Iwww.dnr. state .wi.us /org/caer /cea/c=liance /auto /wastewater.htm #septic • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and COMM 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. i KIM A O CONNELL Page 2 9/24/2009 t • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Access to the filter for cleaning must be provided per ss. Comm 84.25 (7) and (8),Wis. Adm. Code product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. The outlet filter shall be installed per product approval stipulations. Reminder • Materials shall conform to the requirements of COMM 84. • Surface water drainage shall be diverted away from the system area. • Maintain well and waterline set backs per COMM 83.43(8)(i). 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. 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. Beginning October 1', 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. 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 tenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pat.shandorf@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or• offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.gov/SB/SB-BuildingContractorProum.httnl KIM A O CONNELL Page 2 9/24/2009 • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Access to the filter for cleaning must be provided per ss. Comm 84.25 (7) and (8),Wis. Adm. Code product approval conditions. Maintenance information must be iven to the owner of the tank explaining g p g that periodic cleaning of the filter is required. The outlet filter shall be installed per product approval stipulations. Reminder • Materials shall conform to the requirements of COMM 84. • Surface water drainage shall be diverted away from the system area. • Maintain well and waterline a lme set backs per COMM 83.43(8)(1). 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. 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. Beginning October 1'`, 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. 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 oraamtenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pat.shandorf @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.gov/SB/SB-BuildingContractorProgram.htrnl t J � / G ' � f�' - /���� AID, �iJ , �/tloi�i� l�L� � - �'YL� %7 ►5 vi /--7 3w 4v, /9 7 �RDSS S� GTID r.1 b� A TYPICAL S YS T�. M USING A LEA Gl�ttt�tG G4f A Ml3 €R. i APPRovEb CaP V> ut /ta5ERVATIDA PIPE 12+MiN F It1RL GRADE y� p ,61 t8 �oc k�� ll SYSTEM �� LEALH�tJb �. ELE\(ATiOtd FT. LNRM3ER TOP OF LEAGH Ck+ftnn6GA TD IBC A LEA 5'r 8 i-Lo \A 0 P,1 G 10 R L 2PrD E. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _,� - of FILE iNFORMA fON SYSTEM 'SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit L Septic Tank Manufacturer -- ❑ NA Effluent Filter Manufacturer DESIGN PARAMETERS ❑ NA Number of Bedrooms JO NA Effluent Filter Model ` / ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity ga l IN NA Estimated flow (average) gal /day Pump Tank Manufacturer U NA Design flow (peak), (Estimated x 1.5) p gal /day Pump Manufacturer fP NA Soil Application Rate 7 galld ay /ftz Pump Model NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ONA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) .❑ NA Biochemical Oxygen Demand (BODd 530 mg /L W In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ik NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 530 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA other: ❑ NA Other: ❑ NA Other ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: y ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA inspect dispersal cell(s) At least once every: 0 year( j(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA _ IR(year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) 19 NA ❑ year(s) Flu =F: la'e-als and pressure test At least once every: ❑ month(s) O NA ❑ year(s) Ovrar�: At least once every: ❑ month(s) ❑ NA ❑ year(s) MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined .accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance w)th chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :912 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION rage _lcz For n'ew` construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. - ONTINGENCY PLAN If the 'POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil (imitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. C <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. WDITIONAL COMMENTS UWTS INSTALLER POWTS MAINTAINER Name Name Phone j s _ Phone EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone _ his document was drat et '- - -- - - F ence with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. - If) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County , Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0.3f'o " 1071.. yd ' Z� Please print all information. Rev d by Date / q Personal information you provide may be used for seconalra" w 9R.W, s. 15.04 (1) (m)). Property T Property Location OC 1 O 6 ZOOS Govt. Lot 114 1/4 T 1 N R E (or Property er's M ' ing Add re r' I Bid # Sutxt. Name or CSM# J 144 - KING &ZONING O ly to Zip Code Phone Number ❑ City Village 10 Town Nearest Roa f (� New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: Parent material _ 0 "7 1 11A SW Flood Plain elevation if applicable ft. General comments and recommendations: M Boring # r 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 GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 t� n Boring # E] Boring Pit Ground surface elev. l ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l/a Q Cr 11 * Effl rtt #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L tfluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Na se Signature CST Number Address J/ Date Evaluation Conducted Telephone Number S t Property Owner Parcel ID # Page of Boring # j ❑ Boring pit Ground surface elev. && Depth to limiting factor ,� 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 NJ Q 4 F-1 Boring # E] 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Efr#2 ❑ 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 GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#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 (8.07100) Property Owner Parcel ID # Page _ of 5 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 GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Zl .10 44 7U — Q F 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 GPD/fF 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 GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mglL and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS i 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. 3RD- 8330OL07/00) 30 3 X , el7'c✓ Nk- w A � S wAll ►` d�iJc,Jrr� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND r OWNERSHIP CERTIFICATION FORM OwnerBuyer v( "Lj Mailing Address C Property Address l r m� � (Verification required from Planning & Zoning Department for new construction.) City /State ' ft Parcel Identification Number LEGAL DESCRIPTION / Property Location,4L i /4 , i/4 , Sec. Se , T�__N RZ_W, Town of Subdivision _ _ __ , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes J. Lot lines identifiable ; yes no . SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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. Owner maintenance responsibilities are specified in §Comm. $3.52(1) and in Chapter 12 - 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 (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the srzadards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uvv-e 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 'A�1 '� / 9 / SIGNAT#E OF APPLICANT(S) DATE * * *Anv information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * ** _-. lode �ztIa this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -.:�-ence is made in the warranty deed. =,EV10R, n5) Y - I I!!II! Illll IIII! IIIII IIIII IIIII IIlI 111111 IIII IIII * 9 0 2 9 1 2 1 902912 STATE BAR OF WISCONSIN FORM 3 - 2000 BETH PABST REGISTER OF DEEDS QUIT CLAIM DEED Doeument Nurttber ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Vernell Skoglund, 08/31/2009 08:00AM Grantor, and Karl QUIT CLAIM DEED Skoglund and Stephen Skoglund, as tenants in common, Grantees. E%ENPT 1 8 Grantor quit claims to Grantees the following described real estate in St. Croix County, State of Wisconsin (the "Property l: REC FEE: 11.00 PAGES: 1 Lot 2 of Certified Survey Map filed March 29, 2001, in Vol. 15 of C.S.M., pg. 4057, as Doc. No. 641580, located in part of the NW' /. of the NE'V% of Section 30, Township 31 North, Range 17 West, Town of Stanton, St. Croix County, Wisconsin. Recording Area lY Name and Return Address: Karl Skoglund dt Stephen Skoglund 575 N. Knowles Avenue, Suite D C New Richmond, WI 54017 Together with all appurtenant rights, title and interests. 036- 107140 -200 Parcel Identification Number (PIN) This is not homestead property. Dated this day of S 2009. • Vernell Skoglund AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signatures) COUNTY OF ST. CROIX )33. authenticated this jally e fore me this O T day of the above named Vernell Skown to be the petson(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN fore and acknowledged . (If not, authorized by 1 706.06, Wis. Stab.) VAR THIS INSTRUMENT WAS DRAFTED BY N ic, State Of Wisconsin Robert L Loberg My chwAission is t. Knot, to expiration date: Loberg Law Office sw/ SFA6852 " Z.-I ) (Signature may be auata dcmd orw1novActiged Both are not accessary.) *Nantes of puma signing in any capacity must be typed or prirmo below their signature ��w tt�E M O, �O' A 'ql - Az - QUIT CLAIM DEED STATE RAR OF w1SC4,451N • #0 B�\G . FORM No. 3.2900 �F tW1aG,`x� 1 of 1 , R 2 9 2001 Daces Ot xrat , Von FIL '0 MQ Coil Gq^ .� -�.p.. DER SURVEY MAP Located in part of the Northwest Quarter of the Northeast Quarter of Section 30, Township 31 North, Range 17 West, Town of Stanton, St. Croix County, Wisconsin. Prepared for and at the request of: Karl Skoglund 149 High Street New Richmond, WI 54017 OWNER: New Richmond Farmers Union Cooperative Drafted by. Ty R. Dodge NORTHEAST CORNER NORTH 114 CORNER ,SECTION 30- -31 -17 SECTION 30 -31 -17 UNPLATTED_ LANDS NORTH LINE OF THE (FOUND ALUM/NUM (ESTABLISHED FROM 77£S) NE 114 COUNTY MONUMENT) -- - - -S89'59'40 "E 2633.63' �: __ ZiOIDT NSWE - - - - -- --, - - - - - -- ---=- ----- - - - --- ----- - - - - -- a S89 "E 1051.27' 731.25'_ - - - -- - - - -- — -- — � 287.02' R`�� �y _ 697.37 r � - - - -�� I' r-6 6 i w B § ii-N89 984.39' -- ; �' •,�CQ' / 1« to Z I 1 I ........... `" .................. ............................... ' oP .. g ,�..... LOT 1 N LTEST,� c �'� I� N l w ' w w TYPICAL yl• ' �° ° z 1 40 rn / I CA I Lp TANK "' LOT 2 , o 1 01 I tlNTR71Ay cn F�� �Ql• _ w Iq IZ I mN TAN KS f ° 1 33.00 �J 06 C I e 287.02' IN J , I Z ;� ; 1 N89'59'40 "W 320.02' / ! n o o Z 0 Ch `D O If I� rn ' U coo Ln fTl 1J I 0 a : n O lk —0 _ i -------------- - - - - -- �+ee i o' 1 I� m ' r K c�i a�i o �y�� pY n D I 1Nt I� I �' J7 NOTE: THIS PARCEL CONTAINS LANDS a m E cn 1 FORMERLY USED FOR RAILROAD ,'c v1 ; I ' �ti RIGHT —OF —WAY. LAND OWNERS TO THE 0 0 o s /�o SOUTHEAST MAY HAVE RIGHTS UP TO a THE FORMER CENTERLINE OF SAID REGARDING P OF OTHERS ° ?C +4 �/ IN SAID FORMER RIGHT —OF —WAY. a W. M '3 2I 5 a k C e� m 1 i = � O r y I LOT 1 " A o v t g I I NOTE: FOUND 1" IRON PIPE TOTAL AREA: o o C T i I IS 5 45'20'38 "W 2-09' FROM 136,123 SO. FT. f :3 I SET 1" IRON PIPE 3.12 ACRES `< 3 0 i a► AREA EXC. R — O — W: o 112,614 SO. FT. a m ( 2.58 ACRES i SOUTH 114 CORNER o 0 o c SEC 7100V 30 -31 -17 LOT 2 a — (FOUND ALUMINUM TOTAL AREA: a n W — COUNTYMANUMEA6PPr1UIItV 402,384 SQ. FT. �'� LEGEND ST. CROIX COUNTY 9.24 ACRES f0 s o ' Pfanninq Zonino and P;-kr ror rnittee AREA EXC. R —O —W: `° n o Section Corner Monument 359,553 SO. FT. rt 0 of Record MAR 2 9 2 00 8.25 ACRES y • Set 1" x 24" Iron Pipe weighing 1.13 pounds per linear foot O Found 1" Iron Pipe If not recordeu wiviin 30 days of approval date approval shall be .................. •Building Setback Line (100' from right- 061fatiWoid NOTE: THIS PARCEL IS ZONED INDUSTRIAL JOB # A00141 200 0 200 NO ZTH Prepared by. A & E GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 inch = 200 feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE 109 East Third Street, P.O. Box 325 NE 1/4 OF SECTION 30, TOWNSHIP 31 N., RANGE 17 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S89'59'40 "E. Sh eet 1 of 2 Volume 15 Page 4057 d G I i ,�$�9,cei9�6E "� y/ I _ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D 3/^ /o � � 2� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 1v / Please print all Information. Re ' Date Personal inionnetion you provide may be used for ary purpoa s (Priv Law. s. 15.04 (1) (m)). p Nlarne4t Property Location Govt. Lot ! 114 : 1/4 T / N R (or� Property Owners ling Add Lot # BI # Subd. Name or — Q%M. 7 45 City S Zip Code Phone Number ❑ City Vg age 0 Town Nearest _ A ta a ( ) jo New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement I Public or commercial - Describe: Parent material lac}/ Flood Plain elevation if applicable / 1N General comments � and recommendations- Sys'`r' q� 1 — �G' 5 . �B�Jx o ,Z�S rs°i�� — ,�ES� /Ji1 — s F/I f ❑D1I Boring Boring # 1� Pit Ground surface elev. , � P Z — ft. Depth to limiting factor >yG in. r ! Soil,8Wkatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots, • Gob/fir in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 C P Boring # ❑ Boring Zit. Depth to limiting factor >�_ in. pi( Ground surface elev. n9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz or Gr. Sz. Sh. 'Efl#1 *Eff#2 4 s • Mar# #1 = SOD > 30 1 220 nVL and TSS >30 1 150 mglL PMye #2 = SOD 1 30 mg& and TSS < 30 nVIL CST Name Signature CST Number Address tote Evaluation CorKrCW Telepta m Nwitiff f I r' Property Owner !� Parcel ID # Page E Bori # I ❑ Boring --e, f l Pit Ground surface elev. , �,� ft. Depth to larriting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz t. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 3 - 3 , F Boring ° Boring El pit Ground surface elev. ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •042 F-1 Boring # Bo ° nes ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fti In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efr#2 • Effluent #1 = BOO > 30 IM mglL and TSS >30 1150 mg/L ' Effluent #2 = BOD 130 nV& and TSS _< 30 nV& 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. seo43" QtA=) G9y3r' 0,87,38 vo M Parcel #: 036 - 1071 -40 -200 06/21/2007 08:38 AM PAGE 1 OF 1 Alt. Parcel #: 30.31.17.454B -20 036 - TOWN OF STANTON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - SKOGLUND, VERNELL & KARL & STEPHEN VERNELL & KARL & STEPHEN SKOGLUND 149 HIGH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1985 145TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 9.240 Plat: 4057 -CSM 15/4057 036/01 SEC 30 T31 R1 7W PT NW NE BEING CSM Block/Condo Bldg: LOT 02 15/4057 LOT 2 9.240AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 31N -17W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 04/24/2002 677077 1877/483 WD 04/24/2002 677076 1877/482 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/17/2007 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 9.240 34,000 25,000 59,000 NO Totals for 2007: General Property 9.240 34,000 25,000 59,000 Woodland 0.000 0 0 Totals for 2006: General Property 9.240 30,000 25,000 55,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 P,0 AL F. lGf o JOHNSON AME_f:Y. Y M % 'q l � 00 ' A �% FI V E p, 0" N0 gas j c Township 31 North, ° eoq nogiQ T I F E D t quorter of Section 30, Bgpf4 art of n 01 Northwes tn, St. CroixfCounty,o�sconsin. Locat In Range 17 West. Town Rang ared for and at the request O Prep Korl Skag lund NpRn{E'AST C OIW AW 149 High Street 017 S£CTidd ,10 -J1 -17 New Richmond, WI 5,1 U Caop erative ( ?' ALUMINUA/ New Richmond Farmers OWNER: N ar'nj LINE OF n�E C01/1VTY A/QNUA/ENT) Drafted by. Ty 9. OadOe N£ f/4 NORTH 1 14 coRNER UNPLATI — LANDS - E 2633.63" (EST av HE-D FROM nes) - -- 589'59 40 (fsrAausr+EO , 200 _ _ — -- — — -- .-, �•-- — -' _._. � � SB9'56 E 731.25 �.. •... �. 7 3 ,°'.'�p�itY 697.37 • " 28TOT a -- N89'59'40"W 984.39 / /�� M mot^ ........ .. .......................... �. � I I LOT 1 N / �� LOT 2 / c?�% off. $Q% 't I Lb FANK I I 1 �, r ly t _� O/ too p f>r/ Gv 2 I L rayKS� �, , '� ' •, / b- o 0 I 33.00s ?287.02'V'41 �� / • / �` J / X• v r•� I •C I Z 1 'N N89'59'W "W 20.02' /, i�� a 1 '0 A I / Y THIS PARCEL CONTAINS LANDS �' i �� / a cD� 1 z, 1 N I F10RMERLY USED FOR RAILROAD I l Z N' I� �{ / ti� RIGHT -OF -WAY. OWN UP TO a' 1 f I 1 / �� / SOUTHEAST MAY o " I N v w 1 /' C�'�i' THE FORMER CENTERLINE 0 ' SAID ` = / �` �P.' RAILR0A0. CONTACT AN ATTORNE F O c Ps'a ' h REGARDING POSSIBLE RIGHTS OF OTHERS 'or n a 5r IN SAID FORMER RIGHT—OF—WAY. o ., � cl ZI rw' '0 $ I -► -'o LOT 1 wo ' I a TOTAL AREA: o o p w NOTE: FOUND 1' IRON PIPE 136,123 SO. FT. = '< 3 0 Z I I IS S 45'2(WY W 2.09' FROM 3.12 ACRES m"O 5. I I I t' IRON PIPE AREA EXC. R -O-W: ag 0 c 1 r 112,614 S0. FT. d Q 3 0 a 2.58 ACR ES o o p n SOUTH 114 GARNER LOT 2 A 0 rt s£cnav .10 - 17 TOTAL AREA: 5. (FOUND A LUMINUM 402,384 SO. FT. COUNTY AIGIVf/MENT) 9.24 ACRES P 0 Q t F AREA EXC. R -O-W: n 0 Section Corner Monument 358,553 SO. FT. � y of Record 8.25 ACRES • Set 1" x 24" Iron Pipe weighing 1.13 pounds per linear foot O Found 1" Iron Pipe • • • • • .. • • auilding Setback Line (100' from right -of -way) NOTE: THIS PARCEL IS ZONED INDUSTRIAL 200 200 NO). TH JOB # A00141 Prepared by. ■cam A & E SCALE IN FEET: 1 nch LE 700 feet LAND SURVEYING & CIVIL ENGINEERIN G BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE Phone No. (715) 246 -4319 Ric hmond, WI 54017 NE 1/4 OF SECTION 30, TOWNSHIP 31 N., RANGE 17 W. New Ric 109 h Third Street, P .O. Box 325 MICH IS ASSUMED TO BEAR S89'59'40 "E. Sheet i of 2 CERTIFIED SURVEY MAP Located in part of the Northwest Quarter of the Northeast Quarter of Sectlon 30, Township 31 North, Range 17 West, Town of Stanton, St. Croix County, Wisconsin. SURVEYOR'S CERTIFICATE: I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, do hereby certify that by thy: direction of Karl Skoglund, I have surveyed, divided and mapped a parcel of land located in part of the Northwest Quarter of the Northeast Quarter of Section 30, Township 31 North, Range 17 West, Town of Stanton, St. Croix County, Wisconsin, described as follows: Beginning at the North Quarter comer of said Section 30; thence, on an assumed bearing along the north line of the Northeast Quarter of said Section 30, South 89 degrees 59 minutes 40 seconds East a distance of 1051.27 feet to the northeast corner of that property described in a Quit Claim Deed recorded in Volume 847 Page 111 in the Register of Deeds Office for said County, thence, along the southeasterly line of last deed, South 45 degrees 24 minutes 24 seconds West a distance of 806.11 feet; thence, continuing along last said southeasterly line, South 45 degrees 20 minutes 38 seconds West a distance of 653.04 feet to the north -south Quarter line of said Section 30; thence, along last said north -south Quarter line, North 00 degrees 42 minutes 36 seconds West a distance of 1025.12 feet to the point of beginning. Containing 538,507 square feet (12.36 acres). Subject to 200 Avenue (A Town Road) along the most northerly line and 145 Street (A Town Road) along the most westerly line of the above described property. Also subject to all easements, restrictions, and covenants of record. I also certify that this map is a correct representation to scale of the exterior boundaries surveyed and described, that I have complied with the provisions of Chapter 236.34 of the Wisconsin State Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Stanton in surveying and mapper the same. / zoo Ronfild F. Jo Registered Wisconsin Land Surveyor No. 1186 date A & E Land Surveying and Civil Engineering P.O. Box 325 New Richmond, WI 54017 v RONALD F. JOHNSON s -11 P6 ANIF wIS, s m �`� y sow•'' -l ��° N p S U � Sheet 2 of 2