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HomeMy WebLinkAbout030-2005-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563832 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: Nygaard, Ter L. & Debra St. Joseph, Town of 030-2005-60-000 CST BM Elev: 11 Insp. BM Elev: BM Description: ,ten Section/Town/Range/Map No: / Z5 Gs 33.30.19.369C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic Benchmark en 6 - d. 0" -A_ 3 / 3zA Alt. BM,` Dosing bit e64 Oka - a Aeration Q 7 Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet /G .Q9 S7, TANK TO P/L WELL BLDG. ent Air Intake ROAD DHrrlst+ 7 St Sep /600 tic !,a / W ~0 3 Doing ~b Header/Man. /1,77 `6 Aeration 7 Dist. Pipe /1-77 '77 ` 101, Holding Bot. System 12'.7 1 L •S% I-- 114 473.(7 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover (0-13 q3. SZ GPM tai 4I Model Number 40,15 g9 • 67 TDH Lift Friction Loss System Hea TDH Fa., S i6 . Forcemain Length Dist. to Well J'~~~ Q~ SOIL ABSORPTION SYSTEM CJ BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / 7- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR A i a► Go w0 / ,d 7• & 'Z g~ UNIT Model Number: Gy~11"~ ' DISTRIBUTION SYSTEM At% //0 ' G = 3 Z. k - Header/Manifold /l Distributio \ x Hole Size x Hole Spacing Ver~t~o;ir_Iptake ipw ' ~Up e S Length~_ Dia Length Dia N_.1. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded xx Iched Bed/Trench Center / / Bed/Trench Edges Topsoil 7 Z Yes No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 565 Cty Rd E HOs n, WI 54 16 (NW 1/4 1/4P3 T30N R19W NA Lot 1 r Parcel No: 33.30.19.369C 1.) Alt BM Description = t-,. It (CJI Mail; A ( Z"_ Ind 111 / / a e_k 2.) Bldg sewer length ~t', 67"/ r0 Q, eM b ' r.! - amount of cover = Plan revision Required? Fs~ Yes N q No 5 3 Use other side for additional inform ion. SBD-6710 (R.3/97) Date Insepctoe ignatur Cert. No. Sa'( e da rua ~'or: P' EkiS~'~ ~~e el~.t! s(0~ Terry 1~eb~a rcyq ce and SCoS CF,. ~cl. E 0 Q ,pct/ Cs,n do% ~ i2s /lam%>t SEr~; Sew 33. T3o? s f . ~-I o i JC lD.; cc~l. ~a 030-.2~- 6o -cam I r--- ~ara9c ~neve( drrvewQj po~cl - Ex•~~6'n5 ~ ~,raL►~ wek ~b oPA-1 !a„on 3 bedr w Qasid~e ~r}~ t ea v" U) ood-I 1 do~tumo~S:ol;n~. /o~L;~rs y/ca' 1 A.SStAIn e d ¢ LU` _ /Od. CJb Fri SxS64-7 1 ,act. Q , EXi36 ~a/, (c~iPSe/~rje. ~Z~~o slope ~(~o SyS~emarrA ~o; / e u 5 4,c1 SIT a-6 ou,&l ct = Y~oY' (oropasect dispusalCe~/. Two(z~ c~~~.s 0.f 3'xbT'S,oGC~ dad ~ 5uira cc e/c~` 6~ 87~• Gin en acvn , 'tn /tTct ~ C. 5uiAce a(cv, = 86 35'f. ~9 ? oq- /i o~"aTy County Safety and Buildings Division St. Croix s 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P S Madison, WI 53707-7162 -5 3 8 3 Sanitary Permit Application C State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate go+ental unit Agkl~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are s bjlpgd to PiKed Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be AM for secbijd~aG purposes in accordance with the Privacy Law, s. 15.04 1 m Statsarft c'9 Same 1. Application Information - Please Print All Inf ' . Property Owner's Name IV Parcel # Te & Debra Nygaard 030-2005-60-000 Property Owner's Mailing Address Property Location 565 Co. Rd. E Govt. Lot City, State Zip Code Phone Number NW Section 33 (circle one) Hudson, WI 54016 715) 549-6312 T 30 N; R 19 E or W II. Type of Building (check all that apply) Lot # 1 Subdivision Name I.td '1 or 2 Family Dwelling -Number of Bedrooms 3 Block # CSM ❑ Public/Commercial - Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of CSM Vol. 1, Pg, 125 RI'own of St. Joseph III. Type of Permit: (Check one box-"e Complete line B if applicable) A. ❑ New System eplacemcm System ❑ Tmatrnent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ber B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit ~ LV 'um / and Date Issued Before Expiration Owner V/ve/t/OIV. Type of POWTS System/Component(Device: (Check all that apply) on-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. Dispersal/Treatment Area Information: 32 Infiltrator "Q-4 Plus" Standard chambers & 4 endca s, Pol Lok PL-525 effluent filter- Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 Gpd 0.7 Gpd/Sq. Ft. ✓ 642.86 sq. ft. 660.40 Sq. Ft. ✓ 87.00 0/( VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units .gg S o New Tanks Existing Tanks v °.3 a`U FT B ~ wL7 CL Septic or Holding Tank 1,000 1,000 1 Unknown X Filter canister 1 Wieser Conc. X Dosing Chamber VII. Responsibility Statement- I, the ua ersigaed, assu a responsibility for in on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 P son Lake Lane, Osceola, WI 54020 VIII.tounty/Department Use Only Approved ❑ Disapproved Permit Fee Date Issued Is g Agent atu ❑ Owner Given Reason for Denial % J / n IX. Conditions of ApprovaUReasoosfor Disapproval 3 vi l/Yl~ C~Ylit~ r1 d Gt SYSTEM OWNER: 9. Septic tank, effluent filter andl dispersal cell must be serviced / maintained 0 as per management plan provided by plumber. 2. All setback requirements as per applicable cActk MWp&ftMaes for system and submit to the County only on paper not less than 8 t/z x 11 inches in size SBD-6398 (R- 11/11) Conventional POWTS Index & Tilte Sheet Project Name: Nygaard 3 bedroom Replacement Conventional POWTS Owners Name: Terry & Debra Nygaard Owner's adress: 565 Co. Rd. E, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 1, CSM Vol. 1, Pg. 125 Legal Description: NWl/4 SE1/4, Sec. 33, T.30N., R. 19W., Tn. of St. Joseph, St. Croix Co., WI. Parcel ID 030-2005-60-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Septic/Filter Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Evaluaiton Report Mater PI ber Restn ted Service: James K. Thom son, DSPS Credentia 14 Signature: Date: r Page 1 Of 11 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) Sa'"! a✓a/ua.F.'onlo,~ axnzl-may yude elty Terrr~ l~.e6ra Yty~ Qard 5105 Co. ~Qcl. E /4'otso"' u74 .S' I(0 ~ot/ CS,rI r/o1. / /2S ~ /I~Yt!SEr~ Sec 33.77.3o4. St. d o.X e C,Jl roc/ ly 030-.2~s-4 0 -CtO 9?aCres, r--- ~°~9` ~ru~e! dr~vewQy 6u G,, r Screw _ ^ Rd. E porcl ~x.~-b'n~ E,tN~trW welt ~b 3 bedt•'✓ oPr`n lawn if a~ 6riAs t " : c3,~-tom o{ 5: ol:,~g /o6 L:Ar3 >/L0 ' t V ~ ylssumcd ~ t~ = /od, da' ,F~o,.,,l sxyt~.+-, ' EXiS fincj ~ce~ u);e5e/ el. Sofa Sloop Wol SY,yte ov, areR 94.0 4o be 14 o lo~d• a~ out/cf = May ~ propasc~l d;s~Q,/~~/. T~,o(zl br~clu.saf 3'xb7'S~cc dad ~ ur CxGC ~~rG~ E eor, uia~~ Clio*.~bcrse Gy-~nbe 97--v)' L~ ~r~ ac v.0. Zh ~'/tJ~t ~~✓C Ski ce elcv, _ ~g 3s"t. 2 d~' i NYGAARD DISPERSAL CELL SIZING CALCULATIONS 1. (3bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 G design flow 2. Infiltrative capacity of native soil = 0.7 gpd/sq_ft. 3. Absorption area required: 642.$6 sa. ft. 4. Absorption area as proposed: 660.40 sue, ft. (32chambers total) Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft. EISA 642.86 sq. ft. - (4 endcapsx5.10) = 622.46 sq. ft. 622.46 sq, ft./20.00 = 31.13 chambers required Number of trenches: 2 (a), 16 chambers per trencl Trench width: 2.83' Trench length: 67.00' Trench spacing: 9.00' on center Total system area w/ 9' center spacing. 12.00'x 67.00' Pg. 3 of 11 Operation and Maintenance of Dose-Conventional Septic Systems Septic systems have two primary functions - to clean domestic wastewater and to dispose of it. A properly designed and installed system should provide many years of use, but like anything, septic systems have limitations. Even the best system will fail over time and will fail prematurely if used improperly. Septic systems are biological systems that depend on beneficial bacteria to breakdown and digest waste materials while removing harmful bacteria and viruses. Only bio-degradable wastes should enter the system - it is not designed nor intended to be a dumping station for the things that you do not know what else to do with! Do not put synthetic materials into the system! As soap, grease, oil, food waste, fecal matter and other solid wastes are flushed down the drain, they enter the septic tank and are retained there. The liquid effluent passes through to the pump chamber and is then pumped (dosed) into a drainfield where it is purified as it filters through the underlying soil. Over time, solids that are carried through the tank, dead bacteria and slime-mold clog the soil under the drainfield and limit its permeability. Eventually this clogging becomes so thick that the system will no longer drain properly, resulting in a discharge of sewage effluent to the ground surface or a backup into the house. Careful use and periodic maintenance can help insure a longer system life. To help prolong the systems fife, keeQ these think in mind System Use • Minimize the amount of wastewater that enters the system. Practice water conservation - i.e. turn off the faucet while brushing your teeth. Repair or replace leaking fixtures with water conserving fixtures, reduce shower times, wash dishes only when there is a full load, etc. Do not allow water softener, air conditioner, dehumidifier or high efficiency furnace discharges to enter the system. ■ Spread out water use. Do a few loads of laundry a day rather than doing many loads in one day. Use a front-loading washing machine or one with a suds-saver feature. Use liquid laundry soaps. • Limit the amount of household cleaners, degreasers, disinfectants, etc. that enter the system. Do not use automatic toilet bowl cleaners or drain cleaners. ■ Do not allow solvents, thinners, pesticides, poisons, acids, paints, etc. to enter the system. • Do not put synthetic materials into the system, i.e. paper toweling, feminine hygiene products, disposable baby wipes, diapers, cigarette butts, condoms, etc. • Do not use a garbage disposal. Do not put food waste, coffee grounds, grease or oil down the drain. • Biological or chemical septic tank additives should not be used - they can actually harm the system. ■ Trees or shrubs should not be planted directly on the drainfield. ■ Traffic over the system (other than mowing) from automobiles, motorcycles, snowmobiles, etc. should be avoided. Soil compaction above the system will hinder aeration within the system and limit evaporation out of it. Traffic areas also increase frost penetration and can lead to freeze-ups. System Maintenance • The operating condition of the septic tank and pump tank should be assessed every two years (code requires a 3 year maximum maintenance cycle) by a certified sanitary waste hauler. The contents of the septic tank and pump chamber should be pumped out and disposed of at that time. • Septic and pump tank openings should be inspected for water tightness and soundness. Any opening deemed unsound, defective, or subject to failure should be replaced. Exposed openings need to be secured by a locking device to prevent accidental or unauthorized entry into the tanks. No one should ever enter a septic tank or pump tank without proper breathing apparatus, as dangerous gases may be present that can cause death. • The filter at the outlet of the septic tank should be cleaned yearly or as necessary to ensure proper operation. • All switches, alarms, and pumps should be tested to verify proper operation. ■ Observation pipes within the drainfield should be checked for effluent ponding. Ponding levels above 6 inches indicate an impending hydraulic failure and require more frequent monitoring. If the septic tank, pump tank, or any of their components become defective they should be repaired or replaced. Defective pumps, pump controls, alarms or related wiring should be immediately repaired or replaced with a component of equal performance. If the system fails to accept wastewater or begins to discharge wastewater to the surface, the drainfield should be replaced. Questions on the installation, operation or maintenance of the septic system should be directed to A.C.E. Soil &c Site Evaluations (System installer) at (715) 248-7767. b • • Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility $ Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16° removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4° & 6" SCHD. 40 Pipe +f~ PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs a i servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed C septic tank. 5,871 MO 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. ~q 0,fll 1 Soil Absorption Svstem Cross Section 5? .0'- 96.o ft 4" Schedule 40 Final Grade PVC Vent Pipe S-0 ft With Vent Cap 7_~_ Leaching Chamber $7 O0 ft System Elevation A. 0 ft Sp.~.ft Soil Absorption System Plan View ft .4,Y3 ft -MIIIIIIIIIIiIIIIIII Vent Or Observation Pie Leaching Trench 1 Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model ,~'~tl r✓ aQ-c6dIU5 5&-"0f I-d EISA Rating .2.0.0 sq ft per chamber Soil Application Rate 0.7 gpd/sq ft 11870-0 gpd Design Flow 0.7 Soil Application Rate 20, 0 EISA = 1, /3 Chambers 2 rows of chambers each. Page of l/ I i 432 n L nn ma 0 O m1n0 O x_ mF~ 0 Z D n D n DA in~Z n r Z rr~iD On rn A r ~ n 371„ hl y 6° 2 n m w Z m I '>7 r i A D S r 4.~ O Z t 8" MIN. ~ F: C < Fri D O - I _ 37" I n Z 22" x \ n41 D ' o N n f Z cn I~ !I An rld m u ice, I i I , zI ~ I rn ~ L > r C m D rr-, _ i r T / Irl:D F / I+ > Y 'i_ I D D Z ill I L I FILTER CANISTER DETAIL SCALE: 3;4 RED' No T UlIESERCURCHETH DRAWN BY SWT - - { Z SEPTIC MANUAL W}716 US HWYIO. MAIDEN ROCK, W 54750 DATE, JANUARY 2008 REV. JAN. 2008 300-325-8456 FILE:SHEET 13 ~,7~~~ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 565 Co. Rd. E, Hudson, wl located at: NW '/4, SE '/4, Section 33 , Town 30 N, Range 19 W, Town of St Joseph , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service June 24, 2013 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,000 gallon Construction: Prefab Concrete X Steel Other ufacturer (if known): Unknown Age of (if known): Unknown Permit nu~nber (if known) Unknown L_ James K. Thompson icensed Plumber Signature ) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS July 1, 2013 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Terry & Debra Nygaard Mailing Address 565 Co. Rd. E, Hudson, WI 54016 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 040-2005-60-000 (,3(OqC) LEGAL DESCRIPTION Property Location NW NW /a SE , , Sec. 33,T 30 N R 19 W, Town of St. Joseph Subdivision Plat: Na , Lot # 1 Certified Survey Map # 3 S , Volume 1 , Page # 125 Warranty Deed # 951408 (before 2007)Volume ? 1 , Page # 52 Spec house ❑yesOno Lot lines identifiable (Byes[] no SYSTEM PENANCE AND OWNER CERTIFICAT_ ION 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 §SPS. 383.52(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. 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 Safety And Professional Services 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. Numbe of b po 3 S4tNAV_W,6F APPLIC T(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. 04/12) 0271,59 CERTIFIED SURVEY MAP a 9 n 10 FILED MAY 221975 aApxs O' CONNELL Qepi.hw of Deeds 64 Croix county, wisconsiiJn G Cr \R5 R 9 Cc, O ~ . ~ 22 6 =lV 4 5~ 3p' 0 N Gam. `pi ~9. Lf) _ A r CV °Ib\ D q(\~1 ••~O p O ~.S° p o d6b S 89°03'43" E 7.40.35` Z c%j O v \ °621 fA CO- 52396 2r\ ° 22 W ~ D z \ $39 g6 0 11.987 ACRES \ M \ Q 173°4847 ° _ O iT 'Uo Z 9\Z O ~ ~ 00 X004 S 89°12'42" W 1125.88 SCALE 1" = 200' co R1 ■ V • - FOUN D [RON PIPE O - I" X 24" IRON PIPE WEIGHING M 1.13 LBS./LINEAL FOOT C> O- 2" X 30" IRON PIPE WEIGHING O 3.65 LBS./LINEAL FOOT Z COUNTY SURVEYORS MONUMENT S .1/4 CORNER SECTION 33 - 30 - 19 Volume 1 Papre 125 (SEE OTHER SIDE) ~9 . Talc II 11111111 IIIIIIIIIIIIIII III 805-0151 Tx:4037049 State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED 951408 BETH PABST Document Number Document Name REGISTER OF DEEDS ST, CROIX CO., WI THIS DEED, made between David T. Smith, as trustee of the Thomas H. Smith 02/27/2012 2:16 PM Revocable Living Trust dated May 3, 2000, and as an individual, EXEMPT#: 3 ("Grantor," whether one or more), REC FEE: 30.00 and Terry L. Nygaard and Debra J. Nygaard, husband and wife, as PAGES: 1 survivorship marital property, ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Recording Area addendum): Name and Return Address ' A parcel of land located in the Northwest. Quarter of the Southeast Quarter (NW '/4 of Reah . on taw Offices, LiC hw SE '/4) of Section Thirty-three (33), Township Thirty (30) North, Range Nineteen 126 S. Knowles Avenue (19) West as described in the Certified Survey map on file and on record in the office New Richmond, WI 54017 of the Register of Deeds for St. Croix County, Wisconsin, in Volume 1 of Certified Survey Maps, page 125, Document No. 327159. _=_93e-2ee5-ae-eeo-- 030-2005-60-000 Parcel Identification Number (PM This deed is given to correct that quit claim deed recorded June 28, 2011 in the This is not homestead property. Office of the Register of Deeds for St. Croix County, Wisconsin, as Document No. (is) (is not) 938165. Dated February 13, 2012 (SEAL) a?u - 7 (SEAL) * *-David T. Smith, trustee (SEAL) (SEAL) * * avid T. Smith AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. ST. CROIX COUNTY ' ) * Personally came before me on February 13, 2012 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named David T. Smith, trustee of the Thomas H. Smith (If not, Revocable Living. Trust dated May 3, 2000, and as, individual, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. se``,`~Y` E ~So Leah E. Boeve, Remington Law Offices, LLC * Leah E. Boeve _ ? • Q T 126 S. Knowles Ave., New Richmond, WI 54017 Notary Public, State of Wisconsin My Commission is permanent. .off , * (Signatures may be authenticated or acknowledged. Both are not necessary.) e l ,G NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARL1 FIED.- • CN ~ 1t tilr CLAIM DEED © 2003 STATE BAR OF WISCONSIN , Ao3 Type name below signatures. it I ` 2331 Wisconsin Department of Com SOIL EVALUATION REPORT page 1 of 3 Division of Safety and di I in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil 8 Site Evaluations Attach not less than 8% x 11 inches in size. Plan must County Include, . r0cal and horizontal reference point (BM), direction and ' ` 4- St. Croix percent scale or dhernsions, north arrow, and boation and distance to nearest road. Ile d' 030-2005.60-000 Please print all Information. L/UN 2 O ev By 724 Personal inforrnabon you provide may be used for secondary purposes (Privacy Law, e. 15.04 (1) (m)). 13 Property Owner Property c POWW /4 SE 1/4 S 33 T 30 N R 19 W Terry L. Debra J Nygaard Govt. Lot Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 565 Co. Rd. E 1 Na CSM Vol. 1, Pg. 125 City State Zip Code Phone Number J City J Village 1_6 J Town Nearest Road Hudson WI 54016 715-549-6312 St.Joseph Co. Rd. E J N opstruction Use: ✓J Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD I t J Public or commercial - Describe: rent material . Glacial Outwash tL " /Flood plain a evation, if aP~licable Na General comments ' T~t TO and recommendations: Site suitable for convention 1l POWTS dispersal cell with 0.7 gpd/sq.ft./day loading rate. Proposed infittrative surface elevation to be 86.50' ,V Boring # Boring ❑ ✓_J Pit Ground Surface elev. 92.10 ft. Depth to limiting factor >1 15in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Shicture Consistence Boundary Roots G in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 1 0-7 10yr312 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 7-22 10yr4/4 none sit 2msbk mvfr a 2fmc 0.6 0.8 3 22-37 1Oyr4/4 none 81 2msbk mvfr cw 2f,1mc 0.6 1.0 4 37- 7.5yr4/6 none Is Osg ml 9w 1vf,f 0.7 1.6 5 50-115 1Oyr4/6 none s Osg ml - - 0.7 1.6 t 1 t Boring # J Boring L ._J e Pit Ground Surface elev. 91.85 ft. Depth to limiting factor >105° in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 1 0-9 10yr3/2 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 9-23 1Oyr4/4 none sl 2msbk mvfr cw 2fmc 0.6 1.0 3 23-50 7.5yr4/6 none Is 2msbk ml cw 2f,1 me 0.7 1.6 4 50-10 1Oyr4/6 none s Osg ml - - 0.7 1.6 * Effluent #1 = SOD? 30 < 220 mg/L a TSS ?30 < 1 mg/L * Effluent #2 = BOD < 30 mg/L and TSS S30 mg/L CST Name (Please Print) ignature: CS Number James K. Thompson Y 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 6/8/2013 715-248-7767 i Property Owner Terry L. & Debra 3 Nygaard Parcel ID # 030-2005-60-000 Page 2 of 3 U Boring # Boring Pit Ground Surface elev. 93.61 ft. Depth to limiting factor > 124" in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texture shicture Consistence Boundary Roots GPOF in. Munsell Qu. Sz. Cart. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-8 1Oyr3/2 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 8-15 1Oyr4/4 none SO 2msbk mvfr cs 2fmc 0.6 0.8 3 15-34 7.50yr4/4 none sicl 2msbk mfr cw 2f,1 me 0.4 0.6 4 34-46 7.5yr4/6 none Is Osg ml gw 1 vf,f 0.7 1.6 5 46-124 1Oyr4/6 none s Osg ml - - 0.7 1.6 Boring # Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. SON Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Ef1#1 'Eff#2 f Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#f1 'Eff#2 • Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/1L • Effluent #2 = BODS 1.30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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