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HomeMy WebLinkAbout040-1303-00-017 Wisconsin kparhhent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION hEPORT Sanitary Permit No: 453227 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: B'erstedt, Todd I Troy Township 040 - 1303 -00 -017 CST BM Elev: Insp. BM Elev: BM Description: Section ( rown /Range /Map No: D d . D I lob - d o She,[ � 22.28.19.1752 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS EIV. .2h d _ fa6 • Septic Ben 2 b i3 Dosing S� Alt. BM Aeration B Holding St/Ht In et r 1 0` . TO TANK SETBACK INFORMATION S /Ht u tlet /0 r S �b //-7.0 TANK TO PP /� WELL BLDG. Vent to Air Intake ROAD Dt Inle ZZ r oe S 7 � J Septic I / i Dt Bottom � q t � Z �- Dosing , Header /M XV1 Y Aeration _— 1 Dist. Pipe y 17 Holding -_ Bot. System Final Grad PUMP /SIPHON INFORMATION Manufacturer Demand St Cove GPM DT fr h 6 /O Model Number 15z Z`� - 3.7 io TDH Lift Friction L ss Syste TD Ft S °Ir1 1�1. 1 7 ►tir ��t l� Forcemain LepQth Dia. 7 t Dist. to Well L M � t / SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /LS BLDG IWELL LAKE /STREAM CHIN Manufacturer: INFORMATION CHA OR Type f S stem: � � UNt� Model Number: _4 DISTRIBUTION SYSTEM ;-e 61 e k4,., t; c Header /Manifold Distribution �� " /� x Hole Size x Hole Spacing Vent to Air Intake ., Pipe(s) c ' v �C- a S ") 7 � 7i 'I ,, -p � Length Dia Length Dia r Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center > ( Bed/Trench Edges Topsoil C l C x Yes No No Yes COMMENTS: (Include co iscrepencies, persons present, etc.) Inspection #1 J // � inspection #2: J / 1 �� Location: 227 South Glover River Falls, WI 54022 (SW 1/4 SE 1/4 22 T28N R19W) Wal utrf Hib Farm LoM7 �G rcel No: 22.28.1 .1 1.) Alt BM Description = ST Q '� C &v 2.) Bldg sewer length= O t tICAWn�Xk 6" ; ''W I � a f - amount of cover = Q��'t V� �,(.Q� Z a�' �I�rE'u -4�•� i Plan revision Required? L Yes {' o Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's ature Cert. No. i� 1 4 Couch` ` I �f� and Buildings Division 7082 — J i to s 2Q1 W. by CO.) { Wasbingtoa AvC., P.O. Box SaaiulYPssmitNumba be filled i ?i Madison. 53747 – 7082 S (608) 261.6506 State Nu � Plan LD. �3 0 partment of Comme rce aQj] . i, pQZ Per ' ""r ` �C u li eddress) star on you p s procet Address (i than gnat i S an v p 83.21. Wis• Adm• Coda )?�0°Law, info i accord with Cornet I E�11`C/ v �� YW � 1 � J es prtvacy tnay be used for secoy P 2 2 �UIr.�U)I� Tot #i Blocky Patccl # No_ /I I, Applicatfoa Information – Pleaso Print All Informatlon O� $Name /` 7 S� Property ptoperZ7l�cauon Section i ProperTY Owaa s Ma's g Ad 3 Y Phone A't:znber i cJrcl e i 2 _ p Code .�� E o W c ityI state I I - esrcN�ba - Suead+��Jvisioa NamLe J,,�/ IL Type of Buil3ing ( all that aPP1Y) l or 2 FamilY t)" "ns- N "ber of Hod—mo O Cirr �•ily ownship of IF ❑ puhlirlCoramRCial - Dactibe Usc r ❑ State Owned- Da=u Use if a llcable) Com fete line B PP rIL Type Of permit: (Cheek o ly 0120 boz T on 1i12e A. P Taa>i ASP m ont only ❑ Orber 1 �odifVAhQA to Existing ystern n¢JeadHoldiag A. [] New $yal6rfl 1iGetneaT System List previous Pq�tit Number and Data tssued 1] Permit TrIz5fer to New [] Change of Owner � j] Permit Recision Plumb y , P Renewal _ O Before Expiration Single Pass Sand Filter 1 ound <24 in. ofsuitable soil A,. Snd F ` Of PODS 8 stem: Check all that a ❑ gairculatiog ailter TV. T e > 14 in. of syirable soil lJ Aerobic 7 ent Unit V1 in -Ground ❑ Mound _ O Part Filter a lain) Q Non -Presf { l Heldiag Ten" other (xP / ❑ pressuritod inl'irouad Lint Gravel -]ess Pipe Coamucted Welland . Chamber ❑ D^ Ater propos sf) Sy:ten'+�evanoa l 0 tha6c Media Filter © a pis per�i V. I l er ST den wired CsC V. Dis er*nM' ;;tot Aret1n P Site Doi Stxi Fib Plastic gn Flow DrslSp / Prefab ass h S (1 lvt�aauptactqurer Cgact,cte Cons Gt�i oral uatb� VL Tank Info OallorJS of Units W Gallons New fiaiuias 7anits T&nks J Scpde or Koldiaa Tza i Aerobic Tnatamot Unit tent r[on Gf the POwrS sba�+n oa she attached "Phone // l r onsibility stalls 7� Easiness P Doaiaa assume reap MP1M�1�,}'ru�bGj VII. IRS Statement 1. the under$ p>Yib $nature erne (Pri+�r) _ plum 6 j s Address {Stsae4 CiT?'.� z e) o rate (No Su nps) Plumber' }O/ !/ !seeing AB�t Sign Ground"'ater Datc Issued I artrne12t Use 0121 gaairary permit Foe (includes �/ Z 0 Gun Surchar Fat) J �' % / L /;, ' Q Disapproved Q owner Cri ven Reason " Denim rovai . Conditions of Apprpvam"son�s,.for Die j SYSTEM OWNER: 7l`'`� �_ tic tank, effluent 1 er and Sep ! dispersal cell must all be serviced I mailtlmber. as per management plan provided by p L ,J 2. Ali setback requirements must be maintained (/v` / =l / s per applicable code /ordinances. of s ttisa slR : u lames to sixc s ��^p tUtl' 3 — / u oalr) rot t0 /Oz, 0 / 16 Zr� �twh complete pl► �>an_�zoQ ('R. 08102] PLOT PLAN PROJECT Todd Bierstedt ADDRESS 392 Omaha Ct. Hudson Wi 54016 SW 1/4 SE 1/45 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/10/04 BEDROOM 4 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 847 HOLDING TANK SIZE LOAD RATE •6 ABSORPTION AREA 1000 # of chambers none kk BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H, R, P. same as benchmark SYSTEM ELEVATION 120.0' Existing 3 bedroo V ldSy stem WW Sl,U6d�'Visr(s� d house to be is on a diffent par I converted to 4 now, owned by a different p b om house they have been notified f existing tank and know A new well drilled and 100' �,.sv a�. zo' � setbacks shall meet those found in Comm. 83 ST T� Tanks are to be � properly bedded and ( S� provided with o i lockdown covers with 22 ,I*01 approved warning 1 is to be labels DT T done to divert run- off away from , system 103 102' B -2 101' 8% B- Slope Area 15' below system is to remain I ndisturbed v� S. Glover Rd Scale = 1/4" = 10' B.M. Alt. B.m. Top of Survey 411' Property Line 311' Property Line Iron @ 96.8' • ` Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wl.gov , LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 � s c o n s � n www.commerce.state.w;.uslsb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary May 18, 2004 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/18/2006 Identification Numbers Transaction ID No. 1002038 SITE: Site ID No. 683680 Todd Bjerstedt Please refer to both identification numbers, S Glover Road above, in all correspondence with the agency. Town of Troy St Croix County SWIA, SETA, S22, T28N, R19W Lot: 17, Subdivision: Walnut Hill Farm FOR: Description: Three Bedroom At -grade System Object Type: POWTS Component Manual Regulated Object ID No.: 958624 Maintenance required; Replacement system; 600 GPD Flow rate System: At -grade Component Manual, SBD- 10570 -P (R.6/99), the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (0 1/8 1) Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter 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, Condit stats. APP The following conditions shall be met during construction or installation and prior to occupancy or use: Ulk, FT C General Approval Requirements: N TE • This system is to be constructed and located in accordance with the approved plans, with publication SBD - SEE CORRE.S 10570 -P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater System, with publication SBD- 10573- P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and with publication SBD- 10573- P(R.6/99) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • The changes made to this plan on 5/18/04 by this reviewer were acknowledged and approved by the system designer. • Per manual cited above limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c SHAUN R BIRD Page 2 5/18/04 • 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. • 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. Stat • Comm 83.22(7) 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. 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. 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. 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 ,l 1 Charles L Bratz POWTS Reviewer I1, Integrated Services WiSMART code: 7633 ' (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G 3ansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 05/10/04 Owner:Todd Bjerstedt Location:SW 1/4SE1/4 S22 T28 N,R19W Lot 17 S. Glover Rd. Troy System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 91,41 y 4. Pipe Cross Section /Pipe Layout Y 5. Pump Chamber Cross Section �o jWERCE 6. Pump Curve CD1 7 -8. Maintance and Co igency plan PoNOEN 9 -11. Soil test Shaun Bird Signature License number 6900 PLOT PLAN PROJECT Todd Bierstedt ADDRESS 392 Omaha Ct. Hudson Wi 54016 SW 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/10/04 BEDROOM 4 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 847 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. same as benchmark SYSTEM ELEVATION 120.0' Existing 3 bedroom V ldSy st /`f.P,Gc�,Salvlvisl(s house to be em is on a diffent parcel converted to 4 now, owned by a different party, b oom house they have been notified of the existing tank and know to have it A new well will be drilled and pumped and buried I eonW . 2 3 100' setbacks shall meet those found in Comm. 83 ST Tanks are to be properly bedded and 120' provided with lockdown covers with approved warning Grading is to be labels IDT done to divert run- off away from system 103' 102' B -2 ❑ B -1 101' 8% B -3 Slope Area 15' below system is to remain undisturbed S. Glover Rd Scale = 1/4" = 10' B. B m. Top of Survey 411' Property Line 311' Property Line Iron @ 96.8' L 2:5 B '— 5• fie-- PvG �oAG„E.MAiN �, 5' 2 "T U PO4 U P S" k-• pISrrli6UTiCW L.ATE.RAL W A 1 SMBILIZED o8t-ERNAS+604 WELL O > 5� 1/�6B i /6B !/2 B A 'I n L = R CELL of '?- - ZZZ AbGQEGarE. PtOffLb\iEb S Yu71AEnL. Fabric Distribution Lateral .STAES Observation ---- ---,,,._ L, , -Soil Cover rS , Well 12 , YVWVI Ns,( i 6 PReWEa A 2 >5 Y. 5LOPE Plan View and Cross Section of Wisconsin At -grade Uric with a Single Absorption Area on a Sloping Site S�GnJ4"s'uKE : L1c,E+sSE#�= Distribution Pipe Detail For Two Lateral network AGC E 55 50X 41 TuRN -UP (CLERrlouT) Holes Located On Bottom. Are Equally Spaced PVC Force Main * X PVC Distribution Pipe Y P P X * Last Hole Should Be Next To T up P Ft. Hole Diameter 5 13), Inch X Inches Lateral Diameter Inch (es) Y Inches Force Main Diameter 72, Inches # Of Holes /Pipe Invert Elevation Of Latera s / a , � Ft. Signed: License Number: Date: +r+►� •At�l6cit estc�aa stc-raM as►#c� srC+� F:r_ar #��� YCWT CA? t.:. rte! MSC "�r �--; .sastovca �ocresu� snow %kAbjw0f.c cCvC1t f s�ai�"sOia lox Mk IV i GR.►nc dL f ^vtTf*m r MAI . i � a s A ; ' � t � a►s.wtN s 3 JOtln'S iilt>y t # T A t?vED PIPE f . 3 4 ONTO j d *e p S( LID SOIL GOatCRCTi aL0C14 #t#fcA CU ACstwfrq 01.11.!! If TA" AWANSFACTii"S NAIR atG# A *r "i• aoa j ruwill�isClYRl� Qum" t Of DOliil: �t 1t 9" "a.* $FOR b1tLi.Qer#t 910:9 VO6"C = • ...,�.,�,,........�., CAPACM=t A . MUCI OR f1wiy" TOM � -� cA, S � ##Am= OR UWAW � l4Mliii /1167�i1RSOi ,,,,�.. C a �it�efi' M � ��l•�fW ^0"6 W0469W. Z D • l�IC•+fi 4R �'� bA«fR1t SWITCH 9'i"T : pump AUG A."m ARi TO lK A1y #l�tYlri OiSCKAfif �R 4►� �}T�it� f}ATt Qe {� '�'*i YtRTtiAi si►nRRiwl� P atr+ #i Pump*" + AIWAWA UC SUMV co , . . .. ,, PELT 'c� reSTOWFOAGgpAl : lVrwt OVWA^lt 149AD 6TF'XLlA6 B;I*C JAWWt Of TAIWKS U&Q*Ts+ TOTAL DYPP�k` M v HEAD CAPACITY CURVE EFFLUENT AND DEINATERING MODEL 152/15 MODEL I 152 153 W Feet Meters Gci. Liters Gel. Liters g 50 1.5 1 69 1 261 77 291 J 153 I 10 3.1 1 61 1 231 70 i 265 15 4.6 53 201 61 231 12 40 152 20 61 I 44 167 52 197 25 I 7.6 34 129 1 42 ?59 U 30 30 9.1 23 1 87 33 i 125 ' Z 8 ' 2 - 1 0 . 7 - 22 85 70 40 12.2 + _ _ 11 42 a 0 1 i ock Volve: 38.0 Ft. ( 1.6m)�44.0 F ( 1 3 .4m)I 4 10 1 0 20 40 60 B0 100 GALLONS LITERS S0 160 240 320 - 3 27/32 �1 4 5 /s 0 — FLOW PER MINUTE ; 227/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ a i 332 • Timed dosing panels available. •Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. 7 - • Double piggyback varable 18ve1 float switches are available for variable level long and short cycle controls• • Sealed Owik -Box available for outdoor installations. See FM1420. I • Over 130 ° F (54 °C.) special quotation required. i 2 1/8 1521153 Series' I �+ 152H E on ol8da n Model i Yons•Pn Nod m r �n e A Sim tex Q I� 5 1 2 or 3 sKZaw N752 115 1 2or3 BN152 115 1 Auto 8.5 lnduded 1 BN1 _ 23D1 No 4.3 1 2 or 3 8E152 ' 2301 Auto 4.3 Induded 2 or 3 10.5 1 2 or 3 SELECTION GUIDE Nt 115 1 N back variable level float 8N13 115 ± =2=. Auld 5 2 or 3 1. Single piggyback variable level float switch Or double piggy 10.5 intruded 2 or 3 E153 230 Non 53 1 5.3 HE153 230 1 Auto Included 3 switch. Rater t0 FM0477. o cnurtoN 2. See FM0712 for correct model of Eieetrical Alternator 6Pak 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) All Installation of controle, protection devices and wiring should be done by a qualified or (4) float system. r Nation electrician. ectric Code (NEC) and the safety followed including o safety and meilth Act 05KA),, RESERVE POWERED DESIGN r Zoeller For unusual conditions a reserve safety factor is engineered into the design of eve P um p . MAIL To P.O. BOX 16347 Louisville, KY 40256.0347 Manufacurersof.. s (dP is v il le, X Y 40211 -1961 Cane Ran Road QvauryY&VIV Sly f S. � Q o Louisvle. K P.4 � (507J 778- 2731 .1(80 92B PUMP � FAX (502) 774 - - 3624 http,lAvww.zoeller.com ® Copyright 2000 Zoeller Co. All rights reserved. . p 0V i �i�4 i ,� Wisconsin Department of Commerce SQ��. EVA UATION REPORT Page Of Division of Safety and Buildings Lia coor(�(t�1� ' . Adm. Code Coun�'�( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. � v - 13o3— W - I - Please print all information. eviewed Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). () Q Property Owner Property Locatio U e Govt. Lots L,r,�1 /46 14 s2 7—T N R E (0 w Props Owners Mailing Ad ress Lot # IBlock# Subd. Name CSM# a State Zip Code Phone Number p City El Village Town Nearest Road e��L 6�i NPN Construction Use Residential / Number of bedrooms Code derive design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material 4��1,o�ovt�J.S�. �r�ood Plain elevation if applicable - , .y�l� ft. General comments �' and recommendations: �� 4? 4 -10 -no Boring / sl dh 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 GPD/ff in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 c IJA Z r� ez !/ s � /!� /�/ /►�/ ® Boring # ❑ Boring -) Apit 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 o tl a "J z ---- ol KI Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa 0 CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address D to Evaluation Conduct d Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ >/,—D 715 - 246 -4516 i Property Owner _ Parcel ID # Page of F3 _1 Boring LoVi Boring # pit Ground surface eiev. Depth to limiting factor in. g*Eff#1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RootD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E V#2 F-1 Bori ng # ❑ Boring ❑ Pit Ground surface eiev. 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 # E] 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. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD < 30 mg/_ 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 -9330 (8.6100) Soil Test Plot Plan Project Name Todd Bjerstedt Shaun B' Address 392 Omaha Ct. Hudson Wi 54016 CSof #226900 Lot 17 Subdivision ---- --- Date 4/12/04 S W 1/4 SE 1/4S 22 T 28 N /1119 W Township Troy ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation At -Grade *HRPSameasBenchmark Alternate Benchmark Top of Survey Iron @ 96.8' Existing 3 Bedroom House AL Scale is 1" = 40' unless otherwise Site does not have a noted well but a old cistern >50' above system 300' and >500' away! 103' B -2 75' 50' B -1 S.Glover Rd 25' 101' 8% k B -3 Slope 90' B.M. Alt. 411' Property Line B.M. 3 11' Property Line ST CROIX COUNTY SEPTIC MAVEN CE AOREEMEN'I'` AND O SHIP CERTIFICATION FORM owner/Buyer I S C Mailing Address _ 2 - Tel 3 617-6 lC�if/ Address a�� i r Property for new constructio (Verification required from Planning DeP artme Parcel Identification Numbe City /State EGAL DESC RI PT ION �� N- a / j7 L �� W, Town of Property Location /•� _. 1 /'� Sec. ; rrA t # �tlAr(. f�(SUSE I,o Subdivision tom' Volume , Page # Certified Survey Map # d 2 q Volume j�° , Page # eed # Lot lines identifiable yes O no Spec house es ❑ no � e, S YS� �M of our septic system could result in its premature failure to handle wastes. Proper maintenance improper use and mainten y a licensed pumper. what You put into the system consists of pumping out the septic tank every three years or sooner, if needed osal s stem. can affect the function of the septic tank as a treatment Stage in the waste lisp Y Croix Zoning it to St b ed by the owner and by a owner agrees to sum. Department a certification form, sign The property er verifying that (1h) the on -site wa stewater disposal system masterplumber, journeyman Plumber, restrictedplumber or a licensed pump the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) a ft er inspection and pumping (if necessary), sal system with the standards ed have read the above requirements and agree to maintain the private sewage dim of Wisconsin. Certification Uwe, the undersign t of Commerce and the Department of Natural Resources, Office within 30 set forth, herein, as set by the D epartmen leted and retuned to the St. Croix County Zoning stating that your septic system has been m aintained must be comp days of &r a year expiration date. / n DATE iGNA I OF APPLICANT OWNER CERTIFICA TION our' knowledge. I (we) am (are) the owner(s) of arc I (we) cer tify that all statements on this form deedteco ded in Register of Deeds Office. the property described above, by virtue of a warranty , � DATE SIGNA OF APPLICANT' An ted may r in the sanitary permit being revoked by the Zoning Department. * * * « «* y information that is mis- represen stamped warranty deed from the Register of Deeds office a copy ** Include with this application a copy o f the certified survey map if reference is made in the warranty deed LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1303 -00 -017 Parcel Number 22.28.19.1752 OWNER NAME: First Last GLOVER LAND COMPANY LLC PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD A artment 278 TRIBUTE PKWY acGe Sg .�-e� SECTION 2 8N RA 9W '/4160 SE'1 <40 NW Line Description Line Description TOTAL ACREAGE 12.040 PLAT WALNUT HILL FARM 1/75 040/03 LOT017 BLK 01 SEC 22 T28N R19W PT SW 1/4 15 02 & PT SE 1/4 WALNUT HILL FARM 16 03 LOT 17 (12.040AC) 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, 177- Valuations, 178- History, F10 -Exit Pa ge .J„_ of 2 • T PLAN — ER'S MAIIUAL 8, MANAGEME GAT NS QOV1dTS O�fN SYSTEM SPECIF at p NA $ Tank CapacttY DNA Fit E INFORMATIO $ Tank Man�otUter der (3 NA if Effluent F�ter Manufacturer p NA Perm Effluent Filter Model f DESIGN P� ❑ NA at Pump Tank Capac 0 NA Number of Bedrooms NA NA c Units aild p Tank Manufacturer Number of Comm a NA Estimated flow (�) � at/d Pump Manutgcr �Jd S� D NA Design flow (P ), (mated X 1 aUda tft= Pump Model _ p Unit p Peat Fitter Sos APP�°n Rafe Monthly average 0 -, Filter p Welland tntiuetttlEnluent Quality S30 mgA- ❑ Mec�anicat Aeration 13 Other F Oil 4 Grease (�G) :5220 mgtL ❑ Disinfection Demand (BODO BiodheTOW S O Solids (TS 5150 Manufacturer Monthly average" Dispersal CeU(s) ❑ in -ground (pressurized) pretneatsd Effluent ° w' p 1 - ground (gravity) �L3m 13005) 30 mg/L -grade en Demand ( 530 mg/L her. B'tochernical Oxy9 tided Solids CT ❑ pri ins rda y rra0, and Feeat CoCfo Total Suspe an 510' cfut100m1 domestic (1 ^ n tm (geometric, me values trp ieW for inch diameter sepw tilt effluent. wastewater. Maximum Effluent Particle Size values typimt for preirsaw SCHEDULE Service Frequency 3 rs. MAiNTENANCE SCHE ar(s) (Maximum Y ) Service Event ` y p months At least once every of tank volume Ins pect conditi of tan on ks) and scum equals on third (K) Ins When combined sludge ears) (Maximum 3 yrs.) contents of tank(s) 13 month Pump out At least once every ❑ mon years) ped dispersal cells) At least once every p NA ins t filter ce every ❑months s) n on ue east O NA taffl I s Clean At ear( ) I controls 8. alarm [3 months tnsped pump. P P At least once every p NA and Press test p months D y ear ( s) Flush IaW At least once every ❑mon ths f3 yea r(s) [3 NA oe : At least Once every ott licenses or MAI�ANCE INSTRUCTIONS a n carrying one r, the following e ppVlri'S Inspector POW't� Maintainer, Septag Of tanks and dispersal Cetis shalt be m ad e id Sew any or broken inspe011" tanks plumber. Master Plumber on of the tanks) to �� y for any back UP oerti�... ns must include a visual tnspedi slu and scum and to check t levels SeNfd 19 operator. Tank in l specxio measure the voume of combined dg to check the effluen hardware, idenr �Y cracks or leaks, The dispersal cell(s) shall be visually Inspected tiding of e ffluent on the round surface- tiding of effluent on the ground surface• The Po ulatory authorrtY or po ndbV of effluent on the g for any Po in the obaervatiort pipe:' and to c h ec k for and requires the immediate notification of the local leg round surface may indicate a failing k equals one- tt►ird (X� or more of the tank v with ch NR 9 e and scum in any tan orator and disposed of in accordance ""n' When the combined accumulation of move b a Septage Servicing OP entire contents of the tank shall be removes Y com and any sin Administrative Code. components. Pretreattment co pO S Maintainer. 113, Wlscort n ip! or pressurized POWTS comp ed by a ceRifled POYYT mega l be ffo� al � nrto+n9 of effluent filters, is � 12 months or Less shall • n of a service event The t intema corn letlo nY other maintenance or mon'rto to the local regulatory authority within 10 days of P A set>� report shall be provided pro d u cts or other treatm tanks) for �1e presence °f painting START UP AND OPERATION ent t� a If�e dispersal ceil(s). if high concentrations are F or new ponst Udion. pnor to use of the p0 �s and/o dam g col prior to use. F e the treatment p e servicing opera P chernWis that MY I t removed by a septag detected have the contents of the tank(51 _..._ Page pr fr ozen a t the infiltrative surface. -1- conditions are fro y en power i restored the excess s g start up Watt not occurs IM above normal tiighwater levels. the cefl(s) and may result in the �; pump tanks c ell(s) in one large dose, overloading um tank removed by a putv+Q po'K dau+ged to ttha To avoi situation have the contents of the this P P 'wastWW.W'' des�e of t"'ent et to the effluent PUMP or contact a Plumber or POYYTS Maintainer to badWP or surface O p erator F �,t - 'restasIng P normal levels within - hin the pimp se� Serve CUfltr rtiarttraay operabnfl the PUMP .. drive not drive or park over, tsr otherwise disturb or compact, Do not drive or pack vehicles Over and dispersal und of Of an mo at -grade =1 absorption area - the area within 15 feat down slaPS ter stream may i mprov e the petforrnance and prolong the fif Lion of the ;taiawic►g �' the wastewater d rea denial floss: diaPeM Reduction or-eilmina d9arette butts: condoms; cotton swabs; e9 hwbiades; meat baby VAP and vegetable peerbgs. gaw&w; 9reaSe: of the POWTS: anti draht (surnp purnP) water fruit and wer softener brine. disk�fectanffi: fat; fou acts; pesticides: sand8� napkins: tampons: scraps: mans; o4 Qainting pr+ad - s shall t * taken to insure that the ABANOW*MEM taw and/or is Permanently taken out of servi mm 83.33. ce the following isconsin Administrativ8 Code_ When the POTS In compliance Witt' ch. C° is proPe ly and sealed. system safel h be di eded and the abandoned pipe openings e Serviang Operator. ta and p rf removed and properly disposed of by a SePta9 All cons to and the void space .. Th. contents of an tanks end pits she . After pumping. all tanks and pits shall be excavated and removed or their covers rem flied Y i Soil. gravel or an0ft Inert solid material. CounNGENCY PLAN epaired Lh$ folfowfng measures have been, or must be taken, to Provide a code If the POWTS falls an cannot be u� ent system: compliant nepla t.BCea has been evaluated and may be utilized for the location of a replaceme should not p A sultsbi ne lhas t area should be protected from disturbance and compactio e reply rten absorption system. The P from e)dsting and proposed structure. tot lines tnes and wells. Failure blish a suitable be infringed upon b fequired setbacks for a new soil and site • evaluation to es— protect the replacement area en result in the need replacement area_ Repta�'1enL systems muse comply with the roles in effect at that time. suitable replacement area is not available s a last resort to place the failed POVV S ng advances in PO d O A be Installed a failure of the POVVTS a sod an ogy a holding tank may $ site has not been evacuated to identify a suitable replacement area. Upo n to locate a suitable replacement area. If no replacement area is available a evaluation must be petforrn� removal of the btomat at holding tank MW be installed la ystems may re reconstructed in p ce following ound and at -grade soil absorption with the rules in e s of such systems must comply effect at that time. the fitpative sud�ace. Reconstr+ n «vVARN1N4> O TANKS MAY CONTAIN LETHAL GE C RCUMsTANCESF DEATH MAY SEPTIC PUMP AND OTHER TREATMENT 00 NOT ENTER A SEF'TiC, PUMP OR OTHER TREATMENT TANK UNDER ANY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK NAY BE DtFFICUL -7' R IMPOSS113LE. ADDITIONAL COMMENTS POWTS mAINTAINER POWTS I- STALLER Name � Name cz lti J✓ i . ,_, >�Z �� Phone Phoned�� LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPER A9en�Y Name .�2 Ptiorte Phone i�v-- J Th>s dxument mew TIVS dowmerif was drifted try Cie ataiiss of the then t ake, Wrpuette and W2 County Zoning tttid Sanitation agencies. the minimum toquirertents of dL Comm 83. xtl(00 and 83.54 {1), (2} S (3), Wisamsin Aarritntstr�>n+ Code. Use of this d does no G1utW (1101) guarantee the perfamanoe of the POWTS. ' U, 2496P 024 ll 752342 KATHLEEN H. WALSH Document Number - QUIT CLAIM DEED REGISTER OF DEEDS ST. CROI Co., WI GLOVER LAND COMPANY, LLC, a Minnesota limited liability RECEIVED FOR RECORD company, Grantor, quit claims to TODD A. BJERSTEDT, 0122/2004 09::30AK Grantee, QUIT CLAIK DEED EXEMPT # 155 the following described real estate in St. Croix County, State of REC FEE 11. Wisconsin: TRANS FEE: COPY FEE: CC FEE: Lot 17, Plat of Walnut Hill Farm. PAGES: i This is not homestead property. Return to: D. Peter Seguin Mudge, Porter, Lundeen & Seguin, S.C. Dated this I ° +� day of 'j":Jn0ary , 2004. 110 Second Street, PO Box 469 Hudson, WI 54016 Tax ID # part of 040- 1086 -60 -000 GLOVER LAND COMPANY LLC, A Minnesot ility company r (SEAL) d A. B- r e Its: Chie anag AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Todd A. Bjerstedt as Chief Manager of Glover STATE OF WISCONSIN ) Land Company, LLC authenticated this day of )ss 1 2004. COUNTY OF ST. CROIX ) Personally came before me this J 6� day of TITLE: MEMBER STATE BAR OF WISCONSIN yload , 2004, the above named Todd If not, authorized by §706.06, Wis. Stats. A. Bjerstedt as Chief Manager of Glover Land Company, LLC, to me know to be the persons who executed the THIS INSTRUMENT DRAFTED BY: foregoing instrument, having full authority to do so and D. Peter Seguin, Attorney acknowledged the same. Mudge, Porter, Lundeen & Seguin, S.C. 110 Second Street, PO Box 469 Hudson, WI 54016 Notary Public, Y&te 8f Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) My COmmissl n (expires): I o - 9. OS 4 OK .. -Names of persons signing in any capacity should be typed or printed below their signatures. QUIT CLAIM DEED .c'�+' fp�� .aaaap�a!r gr N 3AWN ,t sTOu R`- • .:. L V m y y Ui , —1 —� ,. m -i r f W P r f T I C z _ c 0 0DDDD r O � v� \ = G) Z Cn V D 0 0. 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