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HomeMy WebLinkAbout032-2144-50-000 (3) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552334 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: Nordstrand, Scott Somerset, Town of 032-2144-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 07.30.19.1260 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer rolding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia 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 Bedrrrench Edges Topsoil Q Yes ® No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1618 40th Street Somerset, WI 54025 (SE 1/4 SE 1/4 7 T30N R19W) St. Croix National Estates North Lot 05 Parcel No: 07.30.19.1260 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes 0 No se other side for additional information. Date Insepctor's Signature Cert. No. -6710 (R.3/97) i aomM fety and Buildings Divisi C n AO \1 Wol W. ashington Ave., P.O. BBx 162 1. dison, WI 53707-7162 Permit Number (to be filled in b Co.) SCO s~ 2 ~Q~N~'' _ 553 rtt Of ammo 8 _ _ State Transaction Number Sa ita pplication ? 3 o c, submission of this form to the appropriate governmental t l) In accordance with s. Conan. 83.2((2 A~gtpt' POWTS are roject Address (if different than mailing address required Prior to obtain►n a~ itaty permit. Note: Application forms for state-owned unit is ) l erce. Personal information you provide m used for seconda of submitted to the Department o ` with the Privacy Law, s. 15.04 1 )(m), Stats. Gj , J d u oses in accordance -S / ~ 1. Application Information - Please Print All Information Parcel # Property Owner's Name / (l r 4 ~ 0 ) 2 - c 7 y - ~ "~VC~~ v c 5 PropertyOwner's Mailing Address Property Location & l/ Govt. Lot '/e, Section-7_ City, Stat Zip Code Phone Number - - ircle otys)~ Lot YI. Type of Building (check all that apply Subdivision N me or 2 Family Dwelling - Number of Bedroo ~r~ / Block # - ❑ Public/Commercial - Describe Use - e ~ - ❑ city :CSM Number [I Village of ❑ State Owned Describe Use -J. own of X - - - 1,7L III. Type of Permit: (Check only one box on hne A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued / B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber 11 Permit Transfer to New Owner Before Expiration - IV. T e of POWTS System/ComponentlDevice• Check all that a IyZ - ❑ Non-Pressurized In-Ground [I Pressurized In-Ground t-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretreatment Device (explai _ ❑ Holding Tank 11 Other Dispersal Component (ex lain) - - V. Dis ersaVTreat ent Area Information: Dis ersal Area Propose (sf) System Elevation/ / Desr Flow (gpd) Design Soil Application Rat (gpdsf) Dis ersal Area Require (so v/ VI. Tank Info Capacity in Total # of Manufacturer E ° Gallons Gallons Units T vy w 0 w New Tanks Existing Tanks Septic ar Holding Tank - Dosing Chamber _ 6on the attached plans VII. Responsibility Statement- I, the undersigned, assume nsibllity for installation of the POWTSMPlMPRS Nu'mb',:r Bus ness Phoonne(NNu/mber Plumber's Name (Print) Plumber's S' re G 1-7)j- S G'~cac...c. _ l ~ J umber's / PlAddress (Street, City, State, Zip Code) V Count /De artment Use Only - Approved EPermit Fee pate I sued Issuing t Signature / 0,Z5 rven anon for Denial $ ( I rovaUReasons for Disapproval /o r '~ti 5~-~ (`pJlea!!• DFCiL, G ~,,J pP'~`•we' 1 Septic tank, effluent filter and 3) 4A 9 iA C, dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained per app (cable wt empommmmup -the system and submit to he County only on paper not less than s 112 x t t inches in size SBD-6398 (R. 01/07) Valid the 01/09~i K PLOT PLAN PROJECT Scott Norstrand ADDRESS P.O. Box 1000 Hudson Wi 54016 SE 1/4 SE 1/4S 7 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 95.7' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEST GF10-8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 97' 95' 93' Property Line B. B-1 scale = 1 /4" =10' 3 X AC 15% Slope Grading is to be done to divert B-3 Area 15' below run-off away system is to remain undisturbed from system Well is to meet all WDNR Setbacks B-2 95.7 Tank is to be properly Huffcutt Combo Tank bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House 458' Property Line I IF 40th ST. 4tipARTE~l Safety and Buildings. 0 3824 N CREEKSIDE LA D HOLMEN WI 54636 3 S K Contact Through Relay 9 `1 P S www.commerce.wi.gov/sb/ www.wisconsin.gov ADO 'sSION Scott Walker, Governor Dave Ross, Secretary April 11, 2012 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/11/2014 SITE: Identification Numbers Scott Nordstrand Transaction ID No. 2072130 40TH Street Site ED No. 778191 Town of Somerset Please refer to both identification numbers, ' St Croix County above, in all correspondence with the agency. SE1/4, SETA, S7, T30N, R19W Lot: 5, Subdivision: St Croix National Estates FOR: Description: Three Bedroom At-grade System / 15% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1366335 Maintenance required; 450 GPD Flow rate; 42 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent 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 constructe'~FkIVATE SEW 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 and 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. i N% P The following conditions shall be met during construction or installation and prior to occupancy or use: DIvIsION OF Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with d7t~ 'cE CORS requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system 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 state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. SHAUN R BMD Page 2 4/11/2012 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. SPS 383.54(1). • 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. • 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swirn@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. SHAUN R BIRD Page 2 4/11/2012 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. SPS 383.54(1). • 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. • 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 j erry. swim@wiconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. RECEIVED Cover Page APR - 4 2012 SAFETY & BU!! D"Jrr Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 3/31/12 Owner: Scott Norstrand Location:SEJ/4 SE1/4 S7 T30 N,R19W Lot 5 St. Croix National Somerset System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# 1. Cover Page kGE SY~~ s 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 3VE AND BUldt~ 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications Shaun Bird Signature License numbe 6900 PLOT PLAN 'PROJECT Scott Norstrand ADDRESS P.O. Box 1000 Hudson Wi 54016 SE 1/4 SE 1/4S 7 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 95.7' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none Ilk BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEST GF10-8 ❑ BOREHOLE WELL *H.R.P. Same as Benchmark 97' 95' 93' Property Line B-1 scale = 1/4 " =10' 3 -0 A-C. ~g1eG2t~ 15% Slope Grading is to be done to divert B-3 Area 15' below run-off away system is to remain from system undisturbed Well is to meet all WDNR Setbacks B-2 95.7' Tank is to be properly Huffcutt Combo Tank bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House 458' Property Line 40th ST. At-grade System Sloping Site Cross Section and Plan View - - - - - - - - - - - - - - - - - - - - - E Dimension Fe 1 'L''. 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Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a `/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe.. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/051gj Page of Pressure Lateral Layout One Lateral - End Manifold l - Threaded Cleanout Lateral Turn-up - - No Plug Force Main X L Long Sweep 90 Bend Pressure System Construction Distribution Network S ecifications Lateral Diameter Z In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 51 2- In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter 2- In, cleariout plug and are enclosed in a 6-8 inch Force Main Length Ft, diameter lawn sprinkler valve box accessible Tvt'PrL No. of OR c FICeS: t{g from finished grade. Grade :Q: • 6-8 Inch Lawn Sprinkler Valve Box I 03/0519j Page of septic-Dose `rank Cross Section And PUMP perfc►r'mance Specifications _ _ - s PumP Manufacturer L 7 - 1'futk Manufi►cturar Pump Model umber Tank Model_Numb r Alarm Mai►~~' Q_ Total Tank Capacity. - . Alarm B Srwttvh Type - Total D narnic Head crDB.) Feet ~ - Filter Manufrtettrrer - - Elevation Head Filter Model t~',trmiser % - Distal pressure Netwar 'erformaace Required Porce Minimtii~ ' Pwnp Ft TT?1 C "!'Dial outlet 1lnanhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Looking LkNtce. Inl6t Manhole Seemly Mounted With Docking Device 6" }3elaw Grade Sealed Water'tiaht Weather-proof Junction Box Finished Grade +r rrK rr IYS IOU No mW r 1 rr vent Min. 12°' Disconnect Above Grade Means ` with vent CAP rr ,~.,.,.cr r l s r r r a r r•. MIN r r rp r • / r . f r r ra :ra.; : ,a,+ 1,[ r • . r,+r~i Iir`i e`r~`~ i r;+aa . Y aYaY Y Y•Y Y•IaY ~rrY I•r`Y Y 1 Y 1 t Fa;Y; > r, , utlet Filter ai ~tdet Bade ; Inlet ria ,•+rr r • : Y t3' a1 witch i 0tt tlgs and Reserve Cal~r Weep y1; r'! -_-r - - - ` 'rank Volum GPI dole a B V'Olwtue Gat. Dimension Inches - ' (reserrre) A o? S '6 /:Y 1 r (warm) $ 2 Off Elevation t. r ell /~afp- ©t Bottom " (close) r ✓ / ,i, . . ac G • 7~ J r,aa ra' Elevation. Total - c-Y-i'/-P a 1 •`r Ir a, a.,a, l•'r'a`r'aii f i c rrs ri'c s rs ;c~ti rs~rs ~Y T r' ''r , a r a i t c,+ to+, i•+ ~ ;~.~a;al raa r r r /I• r t r r r r r r [ r• r l i l r 1`Ir[ I r[ r 1•+`r 1 r.r r r r r r a+ a+ a : r i/ r r r r• r r r • a, r•1 r r r r Y Yrr'i •;r Yr Y r l r irr r r a~r`I•r n• r,a~a;r~F~ •ra a a a i i I I I l a i r/ i i~r a ay of . a r`l, • / Is Nis' 'AdLLA`'ION: The septic/dose tank is bedded and back filled in accordance with the GENERAL I the manufacturer may not of bmy as s ii'led by th depth manutactimes product approval ificatronsr Maximum clap be exceeded without ptiar Approval- Manhole covers exposed to grade have an effective looking device (padlock) to the tan with installed. Piping at the inlet and Outlet is of aPP Ov8d rn rain co at~ved with 5' l' `w PVC to ridgein the ,and laid on stable soil to prevent settling or aaggtug . The r (Mavatiou and the alcove is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28, 02/05 LI Page of 4R LaserJet 3100; 1 715 002 Wiel nlay-o-Vu e-.Uure+, t k, J J 9EM SERIES SUMP/EFFLUENT PUMP 11.65 r 8.95 0 ~ 0 Sipocfficntione 99IINF rsc man am 9are616N6 ut =No ~ ier~~wwx Ma. K hills NP 991ii 1N.W 1MP1v" 9 it IV 7l, Mtl Itlf #bl Illalsq W0 m 5093x0 WAA 410 115 314 13.0 1009 70 54 55 41 32 13.0 N 24 9.11 t11.61x9.9a 991-0 509m WMA 41'0 230 314 6.5 1000 70 64 55 4i 32 131 20+ 24 9.11111.6119.94 0-04,M 59M ROA 440 115 34 13.0 1000 70 94 55 41 32 13.9 29 27 9.11 111.&116.91 Idg - m l9A' 1+ 4-0 W V 4000 74 54 55 J1 a2 13.8 20 27 9.11 {11.6119.94 Ca:tlaroustlutY~l-~1911esirRNlaaaiwolerPUmPaust~socoaGiwausdulf~ubaYUlMY+rennwltlm!►t0ifoliMiedt~InOafarRiaa oW~a FLOW- LIT[RSIHGA Constnwtion 0 Iona 2000 3000 Motor Housing Boxy Coated Cast Turn Impeller Material Poly Carbonate 10 impeller Type Closed Vane 30 Volute ADS s W Power Cord _ SfrW-A z0 " Mechanical Shall. Seal Nitrile with carbon and ceramic faces -5 m Fasteners Stainless Steel 10 Shaft Sta'1nicss Steel_ - es Upper Sleeve and Lower Bearing I Ball Bearings 0 20' 40 6o b0 FLOW- cd1LLIN+iSr.+tnurE LittiC Giant ftm Co. PUMP PERFORMANCE CURVE 115V 60"2 j PO Boa 12010. omakese City, OK 73157 P6oue: 4rB.'t47.2511 + Fad: 405 221{.1980 E mil ceslooarserrk~lBUadnt eoo Www Lltt1CG1antftMP.cnm c 2 iotm 995235-07103 EMENT PLAN. 9K~TEM BP~TNDt+IB -aa x~+trFt7rEsrutA`noN s a R 0NA ❑ kA E111dard FWW NIN.MbgkNW A25 1:7 13 NA now P"ANW-M 1 qIIA gMuwtFM@r*AkdO ONA. Own* v o Na *UAW at Q=I*Vw Urift [3 NA _SW MWWhWW r 0 NA mom, ate L7 NA Sam APPINSW Rate MA h~ W smWev ~ p Pelt Filter fi1A tSo~rerrdoM OXWw nerxrww {BC W Am MOIL ©M n ❑ +fsr_ -tumor 41WIM. try ciao nw& tireh+rasbed a»rent E WNY D in-gmwid sR+KY) II JsVWnd (Prm~ eTodtaa'rrbl +bara 413 taaaard At-grsde 0 Maaund Tare) Stem ffisOde (T slti 530 ` arandg/l. f'iaDO T r. e D t]tlter f-arced C:e~toerr~ ' tn~ar'ldtetx+let+sr • Vilr~s4rf~~'dMtrMY~G1r,a ~r momnum Efplrl* P Stye Serwtaars pr"raaara W - 9errkae E+rr+nt inspect condidan of tank(s) At 1iCiUlE 90ce every D months ac) EMsxlmum 3 yrs.) When aambined !sludge and scum Squab orrafdrd G) Of tank volume Pump cwt onntonts or tank(*) ~nspaat dbpara~d aMU(s) At least once every 5 C3 months r(e) (Ma dmum 3 yrs.) At kwo once iveiy , D n ninths . s) ~ ~:;leeut adQWerrtttiirer' e) ❑ 11[f4. .n ooatlc& & am= At iciest once anerry D maeNlfs spact pump tem►P s) D NA Mush ietrrab aid p ie s we UO At WW on= every ~ ~ ~ At least once every D maAft 13 Y"O) 0 NA At least onms emery D rr e"ItIs 0 yvags) o NA .4AAH WMANCE NOMCTI M of the t law ~r i oarunim acct araparsat caips, hmi tale ~s by an Tndia kkM ate Pa~V4T~ al~leaarrrr Plrunbrr: aMerrber plurebK 1:~ ateewasar, PoMV i'IB trrgr: go ans: MUM Wude a vWld kop"M Ur VW taaaic(i) to tiles ft ery rnreat g or brokon nwdwmrw kiwd r mw aeeoiei or laths. mmure the vahmm of oombined @kid#* OW MUM read m clear- for awry beck asap ,-,U. pondly of @ML*xu oar theimund - The dbpwvW txdKe) staaad be vwwny kwpembed a deaok d» @Muw* levab n the observadw Pon and bo tier any pendlttg Of eMLO t an ft grOWW gWrfmo' The pQ1dkV of rlKurnt an the rend re PAW the Immadhte mOMIM of flee WO rsguW$WY a'd'Oft MW h+alioslw s or tngrr ofthe W* vduawe, am faftig a~llhet! ft WmWW sgaarra~ aAl>a aatrdrort of Axop aid a m In y tank sgtrefs oete-t#+6rd of Tn wAh c NR ~t)rae ~M11t ~ 1tM 1N11CltairY l1r fofittlVMt ~ am ~ ~ 13, Wbt7tRW 00.0 Codw womot aprnpOR", slid MY or u POWtlS componwK P l b be m*ft ? of adMlCtAlf~ of-12 of l(tS0 SW be PriscMa>ltd by e `,t}1ag rt>Ntrtap mno or aaoorawtv St 1"t . raarpW wo-to pry to 9w Twf mpbbary sutfto* whin 10 +dttylt of a~mp1 of gent "Aff UP AND OPERA770M c,~ Or =Ix new eta prior 00 curs of to POW r$ C bVA&JW t buggS). thr the Pf4SWM are :h6mioaatls tt st mercy I if* 4 o am move"" Pow" O"Wor It - it * dts d ow w~ have tto cc irm M of Vw.wOKe1 raeaawvW by a s alsrA*V apw*W prior to us 1 Sy36ejrn start up shalt not occ urwtion sor"l'conditions are frozen at the infiltrative sum.. Durir:tl power outages pump tanks fTW fig above noanal highwater ieyets, When pawner is (8SMf yd the excess was6m+wle twill be dls+d=Mod to the dW&VM Mit(s) in one large dose, overtoadng the MU(s) and maY result in the tw*yp or surbwe disdsarge tDf ett MIt To avoid this sibtatiort have the content:*. ofthe prunp fm* removed by a i Sopewaw Seer vichv Opendar Wior.116 reallolft 'Pow W the effluemt pump or contact a Plurribm or POWTS Maintainer as assist in nuffum iyapetla the ptMP cxurhV" tO MStorO normal levels within the pump tank. Do wo: grit or pwk vWx*mom bake and dtsp$gl O*- Do not dfive Or park aver, or ~*fte distil or compact the ail-to wi6dn 15 *0 down slope of any mound or at-grade son absbrpljon area Reduction or alaninatiot of the (blowk$ (torn ftte wastewater sham may improve the performance and prolong :tits We of Cttt POWTS-, andbio§* •ba W*poK- butts; condoms; cotton swabs; degreasers; dental $Oss; diapers; disirdi darts. t8t;' focffkl fat drain (sWM pump) waster, fi111 and vegetable peelings; gasp&ne, gtMW herbtc ft, meat W: mauls: Ot ldfi l9 ptndUGW pe tides; sanitary napkins: tarrtptxts: and wafer soften brine. ABAMEPONMNENT When the POMS falls arKVor is p arManerdly.taken out of service the fonowing steps shaff tae taken to Insure that the systeun is property and safely abandoned In compliance with ch- Comm 83..33, Wisconsin Adminkftefivie Code= ' All p4ft to tanks and pits shag be disconnected and ttie abandoned pipe openings sealed- The eeorrtsrrls of elf tanks and pits shag be removed and properly disposed of bya Septage•Senrifcing Operator- ' Attrer putsrping. all tanks trod pits shag be excavated and removed or their covers rarnoverFand the void spate tilled wtih soli. gravel or another inert solid matedal- CON'T I13ENCY PLAM if the 1"OWTS fads and cannot be repaired the fallowing measures have been, or trust be taken, to provide a code compb;ant rephiewent system 0 A suitable teplacement`aren has been evaluated and may be utilized for the location of a replacement soil absorption system- The repiumment area should be protected from disturbance and compaction and should not be infringed upon by requh-ed setbacks tram eadsting and proposed structure, lot tines and wells. Failure to protect the replacement atonal will result in the need for a new soil and site %evaluation to establish a suitable replacement area- Reptaoament systems must Comply with the rules in effect at that time- 13 A suitable nspiacement ar. is not available due to setback and/or soil limitations- Barring advances in POWCS tedwoiogy a holding tardL may be installed as a last resort to replace the failed POiNrS- a site has not been evefust od to identify a suitable replacement area- Upon fat7ure of the POWTS a sord.and site evaluation must be pen%wr'rt ad to locate a' suitable replay ement area, If no replacement area is available a 'iokfing tank may be installed es a last resort to replace the tailed PDWT's. Mound and avara de :Solt atbsotptton :systems may be reconstructed in place following removal of the biomat at the orrI ttrative surface, Reconstructions of such systems must comply with the rules in effL41 at that Erne. <<WARh`IN1S>> SEPTIC:. PUMP AND OTHER TREAT MIMIT TANKS MAY GoNTAIN LETHAL GASSES AMMOR INSUFFICIENT OXYGEN- oo Nur ENTER A ssPwnc, PUMP OR oTH R. TRi4ATMENT TANK UNDER AM' CIRCUMSTANCES. DEATH MAY RESULT- RESCUE OF A PERSON FROM 'TIME INTERIOR OF A. TANK MAY BE DIFFICULT OR IMPOSSIBLE_ ADDITIONAL COMMEtM[ POWTS INSTALLER POWTS AMINTAINER Marne S cL L1 Name c~ _~l r phone I.i - 02 c - ~o Phonej SEPTAGE Iit;RYiCINQ QPEMA►TOR AffFE LOCAL REGULATORY AUTHORITY Nam Agency- f r7/ C1/l c. Zk- Phone J f ~i'hone S 96' ;Kjg rtes darlmKt rrt was dk~pyr vw soft of ea [hear tarns, A4wquet8e art! Waushwa County Zoning and Sanlatim s - 11* t10c[h'Ml muses me,x it MU1r-,VqU*MQM"0 ar ctn. COMM 43-. tlZlir: IM&(f) and (3), Wiisconsin AW.*&Uwive Cade ilsio of d* domrifflt d'aes rwr guarantee tine palormartne of the Pawrs. Grtwrz01) - 6 6 UO- U _ a 0 a ~sa Y- . -T-- M- it ~ le-11 6-YL Wisconsin Department of Commerce SOIL EVALUATION REPORT Page f of 3__ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code t~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Oro 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. ~ 2 Please print all information. Review Y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).~ Property Owner Property Location j`. U ~r Govt. Lot r 1 /4 SF 1/4 S T 3(~ N R E r 1w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest oad l~ s') - o mew- & le 4 New Construction UseZRResidential / Number of bedrooms __S Code derived design flow rate J~ GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable /VZ j ft. General comments vtke- ZQCD and recanurendations: System Type System Elevation 2 I Boring # ❑ Boring ~f ❑ pit Ground surface elev<_45_L ft. Depth to limiting factor A~Q in. gRootsGP Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary D/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 7-Z I/- l;91 4Z~ ZZZf .5~ - ln4' P. Ali f° # I❑ Boring Boring a 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 r y s ,v , y • Effluent #1 = SOD > 30 1220 mg& and TSS >30 < 150 mg/L • Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of F3-1 Boring ,V j pit Boring 0 Ground surface elev. ~3 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 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 Boring El Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 'lepth 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 = BODS > 30 < 220 mglL and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 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. SOD-8330 (8.6/00) Property Owner Parcel ID # Page of ~l Boring # Q Boring Op 2 F3_1 `I pit Ground surface elev. ft. Depth to limiting factor 4l) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 J E Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ~Eplication 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 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil iption Rate Horizon 1epth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Eff#2 Effluent #1 = BODS > 30 1220 mg/L and TSS >30 < 150 mg/_ ` Effluent #2 = BOD, 130 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 (FLWW) Soil Test Plot Plan Project Name Scott Norstrand Sha ird Address P.O. Box 1000 Hudson Wi 54016 M #226900 Lot 5 Subdivision St. Croix National Date 3/31 /12 SE 1/4 SE 1/4S7 T30 N/R19 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron 97' 95' 93 *HRPSameasBenchmark i B. Property Line 17 -10 . B ? scal = 1 /4" =10' S,ys-kM oydy nor I 15% Slope B-3 II B-2 ' 95.7' U, , r n r 458' Property Line 40th ST. 2b 9 7 r + i NAO~,.. 2. ~ - I * 1 2~ , I i 4r t Ir ' 3 ~ f tip ~ ~ , I r ~ t I ~ ?~?yf ! J C j d 1 F` I F_--AyREA=3.00,` AC AREA 3.00"i4 r I %f x II I N ,aj f r / r N j co co, Ul co, I 9a --=AREA t I ^ a `1 f tea... _ Isar . J - t ~'-FEZ- - '_t '`,.-r'-• r _i L- - - - - - - 1(Iy w_ ` _ 5+ DRIVEXIVA 098' t' wt w~ a S00'42'00" S00,42'000E L £l - - ' 244.80' 253 7U ` ` 8.07 33.00 DEDICAMN „ I 0 4J-HE PUBLIC 0, 0 r Y r T Y 4 ~r { 5f;,. 'e i.,,•^.s~„-•. ~..-:~yr• i t •:!,S iffy",. r v~ „ - r` SE 1 4 COR. OF E 1 OF SEC. 7 T30N R19 E 7 AG/RESIDENTIAL ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIPCERTIFICATION FORM / Owner/Buyer -3C~A iQ ? [d _%4--f to C, L A o ' 0 /J Mailing Address 'I c'~S C~ I ~.,-~~cSCJ.t~ . ►c_ C, Property Address (Verification required from Planning & Zoning Department for new construction.) Parcel Identification Number - y City/State T 3 LEGAL DESCRIPTION Property Location SI_ Y,, Sec. , T N Ri Town of 58 ~.Gu2_ r Lot # Subdivision Certified Survey Map # Volume , Page # , ~ ge# Warranty Deed # 1 Volume Pa Spec house yes co 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. 83.52(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.(I) 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. I/we, 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 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. I/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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNA URE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 0$/05) SAINT CROIX NATIONAL GOLF COURSE i I o I W I 0g 1 I ~ I Q I I 1 I i ~ ~g11 j I i ;Wp ~ ' `1O1sE EOe E 6 s 3 - 5 Z o m b SOCP 42'00"E 286.09' s 140TH STREET o z! E wn N Z!9 ~ fP Z 'g 01 m 0 I IIll l IIIlIlII! State Bar of Wisconsin Form 2-2003 8 0 5 4 7 0 9 WARRANTY DEED Tx:4040718 954787 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 04/19/2012 2:41 PM THIS DEED, made between Daniel C. Nustvold, a married person EXEMPT#- NA ("Grantor," whether one or more), REC FEE: 30.00 and Scott J. Nordstrand, a sinele person, and Claire M. Sobon, a sinele nerson as TRANS FEE: 279.00 ioint tenants with rights of survivorship PAGES: 1 ("Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum : Lot5, Plat of Saint Croix National Estates North-in theTown of Somerset, St. Croix County, Wisconsin. 032-2144-50-000 Parcel Identirication Number (PIN) This is not homestead property. (is) (is not) Exceptionsto warranties: Easements, restrictions and rights-of-way of record, if any. Dated 7t9l r Zf Od I / (SEAL) (SEAL) * *Daniel C. Nustvold (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Daniel C. Nustvold authenticated on 'Y STATE OF ) ) ss. COUNTY ) *Kristina O gland TITLE: MEMBER STAT BAR OF WISCONSIN Personally came before me on (If not, the above-named authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Ogland Hudson WI54016 Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY b10DIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * l•ype name below signatures. INFO-PROT" Legal Forms 800-055-2021 www.infoprofbrms.com 1 Of 1 ~t N 10~ Q Z r- e Eon o~ LEE o~ ®l 0 0 0 Opp a a ~ rr Q" ~ 6 Y 0 0 u~ ® Z 8 e o d a~ I 4 N Ua 11A11111111 ,arc r,i Y 7 E OPP n ~ Z '1 qJ F } l a y ~ F 4 ~ o sit 'd { ! 0 o § Q d z +Yb ~p ~ a4 • ro ~ I,1 fl I .Q .q yd d 0 a+" a~ Rp ~n ~ yY d ddd i, y ~ I S v I ,P,fl e „o- A + o-d 9 i M -------------------Nfl .o-.r r n E WSJ >g m:a iu 3 ~1 c o 9 ~ ~ 6 •o.a .a,a 3 ° , a 11 'r f ~y g 1 o ~ a ❑oo❑ ~a ,t,M N ~ a 0 ~a r o .m • P i • Q L fl ;li ~ ~ ~ ~ a x i ~ ',I i rat- u~~a ! y raaaa y~ a~ : f t ~ _ 3 - fl' i e z ~i : 0 : ; i a .