Loading...
HomeMy WebLinkAbout002-1009-75-000Wisconsin Department is Commerce PRIVATE SEWAGE SYSTEM Safety and Building ding Di Diviswn INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, 6.15.04 (1 Hm)l Nik & Kelsey Newgard v r TOWN OF BALDWIN TANK INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Ak Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION SOII ELEVATION DATA Inlet Bottom HI BEOITRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO I P/L BLDG WELL LAKE/STREAM LEACHING Manufactures Type Of System: CHAMBER OR UNIT Model Number. niQTDIDI ITIAu awaT=sI Header/Manifold Distr tion Pipes) x Hde Size x Hole Spacing Vent to Air Intake Length Dia Length Dia Spacing :1 S(]II CAVED _ _— Depth Over - Depth Over ........,.. v..uv.evo oyarema Wnry Bedrrrenth Center Badfrrench E Edges xx Depth of To pal xx Seeded/Sodded m Mulched 0 Yes 0 No tmautte code discrepancies, persons present, etc.) Location: 2221 CTY RD DD 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑Q Yes [*No Use other side for additional information. SBD-6710 (R.3/97) Date Inspection #1: InsepctOes Signature Inspection #2: Ill Cart. No. :54,l-7v7,3-607 t,,,.� AI �Savices » 4922 Ma&m Yards way Madioa4WI53705 r 6%0 / SwaltayPamd ilinubw(tobeMWinbyCo.) �� 0 Mndiem, W1 P.O. Boa' 7162 2 q 8' g 0 2- Sanitary Permit Application SM Nmber Inaceadi a xt aim MI3a321M, alter Ade4 C;eaK anb.�oa at" 6nm to in appopeiar �o etamaaw t k — O 2 0 DO 7 —G Pmjail Ad&= (tfdaum+a mini ft addrs) is tcgwred pderb dta MM a aaiq emit Boaz Appiewhe bsa in ambcwood POWTS m aahmird to the Daprhu"Ge ad PaaNnlead Savior Fttreoad iaimaliea _ mry be taaad br aeooadaq -P 2 221 PAPOMIUMMIAM Law a.13 a"n w L Property ownees 1%m 2 3 Place! a /K s EC sc! 6ucRaLA1t t 002 - Properly Owner's 11 IN Addrm Ptoprty T'Mm i 040. Qox //9 cleat.w City, srr zip coda Nmber T Syoa ti/u * Vw sk seeti� s T e? 9 B M II. Type of Sd0t0aS (eberh all tint apply) La a �S ©1or2FamFly Dwelling - Number ofBedtooms y D"iGICurnmercial - DearxbeUm Block* of owned - Describe Un or CSN Nto6ar q/- d918 waaat !3A[Du/J oG� ZS M. Type of POTYPS Ptamlb Cke* ell6er "New" or "Rapim mmla' and other anOaaiie en lim A. (leek one boxer Mm B. Complete line C if • Gable A' ew warmDwacemena System ❑Other ModiBtation to Existing SyMm (aplai) DMIdifianal Preurannent Una (explain) B ❑Holdiaa Tank �ta-0roead ( �4tl,rade X Mound G Z , / t t T Wividaal Sig DaaiP Othus Tree (� C. Ramwal Barone ❑R"IelmEzpkdm f Plumber to New ListReviom Pe'mk Nmber wul Dar Iaaood l r/ TV. DkpwnVrmM=eut Am and Tank 0 0 Design Flow (ad) Dt=ig• SoU AMAizlm DLpand Aran Rtgttirtd (af) Diapaal Ana paaPoaed pQ Syaaa Hnalim / D O GOO 4675 /00./5 ad 99.8 C•.lr..r Tads lufocandm Capacity's t7alloo Total Dalian fof Oaas ,�/ g ■q Now asla �ara� �+ ao — ,tea I �J EJEt �orc c. r Da"MClamber Qt7 8GG l Ld.Y.dd V. RmpsoslblWy State- Leo aira�ad, aae�a tie' POW1 S Wawa en tie Mcbed pica. Plumber's Name (Print) a MP/iMS Number Butsiora Ptime Number ' <'E'Nr /7/0A! .7dY/ 99 7/5- 9s2- Y/SS Plunim a Addtm (Shoot, City. Stage, Tip Cam) too /fox o WXs9no VL Use Only Tj(Ad l't ❑ Aa/mtlQFm� eDya�t/7�—_t A/sa 8(prre =(QOJ� 1;!41 ` ❑ iw Decrial (G�Z3 Condid S wNFR drHlwppre..l 3) e�s� Ple�� Di s�v� tank, effluent filter and dispersal cell ``� 5 `'e— °u dR e� is at,tu,e, t must be serviced maintained as per �P (S agement plan provided by plumber. W4 _ a— e- setback requirements must be maintained f Z p1�arlM MY - ' a1" a4 sB»�18O'S�Ij� (�7�z3 JAN 31 2023 St. Croix County S ' XSit Community Development 10 Co. /J: u so OD eE..AniEA 10VIK /I/t4UI9AAA- Le. 4. 004 WWI NW, S 24 N1 /d w D: of /3�tow/y, Sr. L.taix La. ' FZ Pc+ o ao` ya A'IJ G7' /ir.1, 15.87 .4eAF tar ,Ita S/s in. v .,WraFcxr 'War JI(Lo 0 we�c Y-dA. NsE 0/ "yc SsN. yo tJlrstR ' gas lava/saa CowAo rwK re c I4�.l� FaRtc,�A�r�/so� ` y S x 135Aoc.< «tt .??.! fc /SS.1I 'YnWlI Pears Svs..G. - /do.!S o4 L.4r, I IV. Ej. - P9. ��. K•/- /do.d' ra/ aF 'c�N `LAL� /'i/F (�A/rrl4 C.cEEr, Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI53707 January 12, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2025-1-12 Plan Review: PWTS-012300067-C Kent Hoke 200 Bremer Ave, Ste D Colfax, WI SITE: Newgard County Road D Town of Baldwin St Croix County NW Y. NW Y4 S5-T29N-R16W FOR: DescriptionA bedroom-600 GPD mound-20" to limiting factor- Effluent Filter - Maintenance required. Phone:609-266-2112 Web: hlty:5d5W.w1coc Email: dios(dwisconsin cos Tony Evers, Governor Data Hereth, Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.1, SBD- 10691-P (5/22-5/27) Pressure Distribution Component Manual — Ver. 2.1 (May 2022-2027) Verify proper dose is achieved and system is not being over dosed. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 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. 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. • 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 • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained 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 Industry Services 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, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)634-5124 Joshua. rowleypwisconsin.gov Page 1 of 9 Private Onsite Wastewater Treatment System Index and Title Page Project Name: /ii/K /YE4)L.4,CO - _ y- �,c. /'%...).4 Aadrs C .1Ear Owner's Name: Owner's Address: pa hex �/9 APPROVED DEPT. OF9*FEFV�PRQFIi+S14NAL ,t SERVICES /✓�LOl�/.1� (.% I SyGO.i DIVISION OF INDUSTRY SERVICES 9ii�ri �isf Legal Description: /V U f N rJ, a y W. it 4d SEE CORRESPONDENCE Municipality. To_wn, Village, Cry of !r✓g a w �� County: Sr. C.AdtK Lot Number: /I- Block Number. CSM Number. 3 / 9[ a Subdivision Name: Ce . Qe . 00 Parcel LD. Number - Pap 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Name of Designer: Signature: Index and Title Page Plot Plan Cross -Section & Plan View Pipe Lateral Layout Septic Tank / Pump Chamber Cross -Section & Specifications Pump Perfo®ance Information POWTS Owner's Manual & Management Plan POWTS Owner's 1 & Management Plan Filter License #: /`10 - 07.7 y! 9 9 "Mound Conl6onent Manual for POWTS" VesComponent-1 (May 2022 2027) "Pressure bunion Component Manual for POWTS" Version 2.1 (May 2022 2027) Anscem.e,r son Rv Imdcn Uspan rr7Jr7 Cllr/r�� 7/1/ 'r7r7 h�f >� /�! I G'oG/ - 'N'v \\ / 1 s-'•oo/ - 7-7 rr/ 1r7 7•,.ar°7 BB6 rvo S/'o0/ - •73 .r4s SJnod fr„a/,i , s1Y/ r �6r �F'?6 l ` ' °f N-15 �rrrd a'Sb oh '/+'S 70/, f' .3rH 'rq-1, 77Jfh p3rodov / ® J ob ° 77/1 I 1,yw;2 r01" r fh'FSf S/S' 71y -to7 fv7r jerl, rj (njy oh or O f �d 'a� x,vr/ �ss �r/np7y� jo ry 00 'OjJ '°)-"v7fvy y N/A/ o7sad oral D = / 35 ft Z _ .S8 ft r = 4 ft a = S -ft g=�ft A _ Y5 ft 13 = /35' ft _ _ 1B ft J = 7.3 ft TZ = ko,,l ft L S.fg ft N = ?9.8 ft 4' seh. 40 PVC observation pipe 1.5ft 0.6 ft GEOTEXTILE FABRIC COVERMIO AS M C-33 SAND FILL _ _51 TOP SOIL 1 CROS"ECTION OF -MOUND Page 3 of 'T PTURN® LATERAL a ACCESS BOX _5 TOP SOB. OBSERVATION PIPE A WATERTWNT CAP \ (i/ DIWRIBUTION LATERAL (-LI!Y In. $ch. 40 PVC D2W Lateral Im ert O.= /2o. tS ft System EI.= _04 iS ft 1�, ii ii/�� /are�����• Contour o.= _ ft NPLOWED SURFACE .. S % SLOPE T FORCE MAIN (20 soh. 40 PVC D2865) DISTRIBUTION CELL = S! S ft x /3S ft = L47. Sje (W-2W ) Min.Roq*W- 4do + /.o ■ido fe PLAN VIEW OF MOUND r— 2• Faroe Main Obsembon pipe /35 J dw *e /aY' B I —+h— n I 1 I Marftw I' 12.5 ft (EZ Row 12M (mnin. DWAha 1 ' soh. 40 PVC Pipe (1Yff In. g?A S ft S! S ) • D2Ba5) WL40 PVC OX= Uptumed LaWrel WM Aaxse Box Prohibit dbUabance and vaMde tra15c vWddn 15 ft of dooneiope toe. L I 9eeal Area = ft. as7..tfe Min. Required = ao + =Soon try HOLE DIAMETER = 3116 in. — LATERAL DIA. in. PVC MANIFOLD DIA. _ in. (sch pipeeD2662865) FORCE MAIN DIA.= ,7 in. P 414.15 ft. S = .725, ft. x = 5..3 ft. Y - 53 ft. PIPE LATERAL LAYOUT OF MOUND (Center Manifold with Aggregate) Xw A Access Box A Page I/ of ? �0 HOLES LOCATED EVENLY ON BOTTOM OF PIPE. Minimum Number of Holes = Ld 7. S rye + 12 = 51 Holes 1-3_ Holes/Lateral x y Laterals = S.? (3/16") Holes x 0.66 gpm / (3/160) Hole = 3 S! 3,2 GPM = SYSTEM FLOW RATE PIPE VOLUME _ .?L s ft. Laterals (total) x . QL / galfft. = 14.94 x 5 = 49 V 8 GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = /OC.G.S ft. INAL GRADEMANHOLE RISERS COVER 1pmf>7i� Iovvaae.•�umw mr aaraa.+m.a..+•• KEON� NNW 1 xmId•illmmn•er••ry) E ECTRICA1-. BUILDING SEWER t ML aL t• PVC T••t VW 1•ar•11^ebmami•••ra1- JUNCTTONBM r cvr Ws 3@LxMp •eo•• PA000 Rmd Pha••n f n* Wa6•1• T� 11 11 11 dnrvte r A,t rw, -tee er•rw• " � �'+a' a •••+r ru•rralo�..r A Page S of 9 t- blik Stlt 40 PVC Tot Vmr roo•1•d 12- above •1•d• W3C aboveR V' ' Flood B•••fo• I FORCE _ /PTIONS �MPIIN rr`` � —`moo I�I wNaNM OF r OF SUITABLE Bono BENEATH TANK & MTMM outr GWrN CF Or Anandrgalwilt r/b•r•wr parePele111AtQN1oD Tank Manufacturer. 61/6364 6MQCA9-rE Daily Wasto irFlow (DWF): 446 Gpp Septic/Pump Size: /,?Oa /so* gallons Number of daily doses: S. 3 Alarm Manufacturer. S6/rtwwcs volume: SD 1tx . /L3 �Y S Model Number- /•r'J-TI Force main _—gat Switch Type: xya- rAwe4d. Actual dose volumes 13 7. 9 gal _ 1 t±S gM 1/3, Al gal (toted dose volume -vd mms off ros min) Effluent Pump Manufacturer. Li rrtr 6,wvY DOSE TANK CAPACITIES; Model Number. 9 EC Reserve above alarm / 9. 8 In = qf'4, Y gal (D) Minimum Discharge Rate: 3 q 32 GPM Alarm float above on float_ 2 in = *9 Y gal (C) On/Off float measurement L. 2 in = / J 7 Q gal (B) Vertical lift (pump off to lateral invert) ............ /?• 7 ft Off above tank bottom 8 In = 1779 gal (A) System head (distal pressure 17. s x 1.3 ft): 3.3 ft /SO ft Force main x L5 /100 friction fader 3-P ft pOSE TANK DIMENSIONS: FilDerfridbn loss ................. It Length /dy in Wdth 94 in To l ny.... Jc 1- w CMH)_ ft ouuer neigrn j6 In Gallons/Inc- 2117 9EC SERIES - 4PO HP iff-0A-0 1 1 1 1 9K-m a o a m a Sa W A M cum-9N ® Freetldfn !1•aerb Hdwx m7•]a I ...loa rtmo 9EFUA-IF -- '04. la< 9 EFFLUENT PUMPS Eama-Coftd CW . cast iron larltil daft cast Iran McEar9idl stew ►�.rwmRsw. Ninipibalmaoerarllk:_ ball bwjft v m Cod slrw -slrow -runs -a■zga sraea-M.r• s DOD OUO a �8 } fiLNo � A O 0ao 0000 x x w ?age _$ 0f drinking water supply. Maintain a regular steady Flow by spreading laundry washing diroughout the week_ Avoid vehicle traffic over all system components. Compaction a fatow over the dispersal unit may cause it to frt:czc up. INSPECTIONS dt. MAINTENANCE: Inspection shall be made by an individual tarrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in arry tank exceeds one-third (113) or more of the tank volume, the entire contents of the tank shall be retnoved by a St PMV Stxv104 Operator and disposed of in accordance with Ch. NR 113, Wisconsin Admin. Code. Specific servicing mechanics must be provided iff anvertical i3>15 feet or if horizontal is> 150 feet and instruction to be provided below. "Rue outlet filters) shall be inspected and cleaned to remove any accumulated solids according to manuficturcesspecifncations. Solids washed from the filter shall be retained in the tank Filter cleaning may be necessary at more l}ettucnt intervals than stated in the maintenance schedule to keep thesystem operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safety abandoned in compliance with Ch. SPS 393.33, Wisconsin Admin. Code: All piping to tanks and pits shall be &%carmected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel, or other inert solid material. CONTINGENCY PLAN: if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soiabsorption system. The replacement area should be protected &am disturbance and compaction and should not be infii ed upon required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement O A suitable replacement area is not available due to setback and/or soil limitations Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. M The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area_ If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ® Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions ofsuchs ACITIsmustcomplyWith the rules ineffea.atthattime. WARNL1VGrl!1 SEPTIC PUMP. AND OTHER TREATMENT TANKS MAY COIA NTN LETHAL GASSES AND/OR 1NSlJFFIGIENI OXYGEK Do NOT RERCUEOFAPERSONFROM THEiNTERIOROFATTAANKKMAYSEDIMCULTO IMPOSSIBLE ENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAYRESULT ADDITIONAL COMMENTS_ POWTS INSTALLER Name: o Phone: SEPTAGfi SERVICING OPERATOR (Pumper) Natrte: Phone: P,0WI S MAINTAINYR Name: Phone: LOCAL REGULATORY AUTHORITY Name: 5r. C,w� �oifw.+.rr itrlt. Phone- 7/S 38�- y�do � 14. 9 a? Maintenance Instructions Biotube Effluent Flter Now to Clean Your Effluent Filter To ensure your effluent filter is functioning property, it should be inspected every year. Under normal conditions, your effluent filter wrli function for several years before cleaning is necessary The filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tent At a minimum, the fitter should be cleaned whenever the tank is pumped Most people preferta have a septic tank service provider take care of filtermaintanance and cleaning. You can find a septic tank service provider in the yeaow Pages, under 'Septic Tanks & Sj starW Or you can contactyour county health departmentfor a Est If you wish to inspect and/or clean your efauentfilteryourself, be sure to dress propedy. Weer full-length pants and shire, shoes, gloves, and goggles or glasses. Then follow these instructions: 1. Remove the access lid to your septic tank by unscrew- ing the stainless steel lid bolts with hex head wrench Provided. If your lid is above ground, itwal be easy to find. If it is buried below ground, find the markerthat indicates its location- 2 Remove the filter cart idge by grasping the tee handle and IiRing k out of its housing (see photo i). 3. Spray the cartridge tubes with a hose to remove any material stilddng to them /see phoW 2). Ensure the three orifices in the optional flow modulation plate inside the filter are clear of arty debris. Make sure the rinse water runs back into the tank, but do not allow solids material to fag into the open fdW housing. 4_ Firmly place the cartridge back into the housing. 5. Some eftluentfiicars come with an alarm that active= When the filter needs cleaning. If you have an alarm, check to make sure it is working by lifting the float with a stick An audible hom should sound. The alarm panel is nornalty mounted on the side aftho house or in the garage. Note: If your effluent%r doesn't have an alarm system and you would Eke one, call your local sepbc system installer. 6. Record the data that you inspected and/or cleaned yourf lter on the form thatfoaows. If you checked the alarm or made arry other observations aboutthe tank or system, include that information under'Nams' T. Attach access Ed by placing iton the riser, snatching the openings in the lid with the hnk catchew, Irwert Rd bolts Into catches and tighten with hex head wretrch provided Photo 1. Remove the filter cartridge by lifting it our of ha housing. Phoa► Z SPINY roe I i b a6tt ttth a hate, rrt+s>t aaaassw FW1414 Of. wa Dept d end PtoCesaiortal s,s SOIL EVALUATION REPORT Page —L or 3 D ywort of Sd* end Bu1dYg1 n acoordatre wilh SPS 3M. Vft Adm. Coda p uch coff%*b site pWt an pepr not Im Bun 8112 x 11 Willis In Sm PWrl RIW end FPavWLD.indude. but not 6nilsd to tnricel aid hodmnt8l tdeserstls pa11t (�parent slope. scale ordYnenslota. north arrow. sort!lr.-? t end t ltnn t0 raalest road.ptaase print all inforroatlon. wd by Psn=W t /shim a paa WWN mr be MM a samrdnr psipom rrkvW Lm. a. ILM M (tap. PMp" Owner rpopurb L mmm a r _ -_ pilot Lot 1M 11/u% /4 S 5 T 2y N R ( (r a (or',® propwy Oaauls IAeMrg Addrtr Lets 9bdts $rbtl Name «CSMs ad,aen Itor IS'feC2 it?!`l l( -2lrJT Ssl44amI CTm uu Codedrtreddesf�lowuea foe GPo gJ NwCmWttlon thmig RaaW=WlrierbWGftlnbemre — T_ _ D ❑ Ptd16imlaim-- - Parant rrrwrid a 4c,T �-1 ^ gilt Flood Plitt airA*m It mM*abb Gatural o«rrneta WW recornrrsrtdatiorr: © ❑ 8«Yp Ground etahca ebv. �•8% R p * ® Pfl DW6 b kWM f� �— in• g� 1111111111 Dsplt DwmkwnCobr Redox Dexrlptiat Tma n Sbuch n Roots s Hurt= tt $Ansel Qu. Sz Cont. Cot« Gr. Si. Sh 21MAK at r es e- o e Jt m f 1y sL 2n.s:K rK r d 2 e- o Sc 0YX /A Whx /kf✓ s o.o o.o A D Jet& 7 ti � -ii O� /�� T O. O O. O 5 -3l4 lsyt 5/6 -7 5YK -Phi D r C.S /. o 0.0 - Bor" * C onry Ground frrfaos abv. � 7 - it.Depth to WMV NOW_1O in. Sal F FloAzwt Dep1r Dontirtmi CtAor R0dox DasCfaBon TratYre t3sta<1ua Root C'�� n. lAursal Ou. Sz Coal. Cdi r C.n. Sc bh w L 3 �!b /e!F •/ 3 4-t� loY� So v lot S O - 0 l- S 7.591=ft -P/of S' - 2 /enA-'/le •srR-s Rol WILL • EMuW tsl • eoo > W s 220 nqlL.d TSS 40 41 CST Nmn C'baavA*to . yvYs �,��r�/w.m►stor.�.-u,�,sjvoi� iAgzg ik r d S 2 , Z . 3 r n, e- O.O and TSS 7I4•'l1 a%Y//S I Property Owner T• w A c &g parcel ID r papa --L of 3 ❑ ev+v pp Ground alaleoe eim. .o? n. Depth to one factor 2.0 In. Soil APPkMbn Rate hldrltArl DWM h Dote, i Odor Mood Reft Daa%n Da. Sz cam Cdor Tomre Strvctus or. Sz She ROM GPDM ' / 2 0_9 a YX 0 9t1 sil Zses6K 2A MA4 le Ar✓14" i++ r C S CS 2,P . �3 /S-to o R-yI4 SL 2wt K M r 1 2 3 -28 c iti yIG S R'I d s c 2m sbx Mfr q5— . 2 3 p- v s c sld L /x S o.v 0.0 Ya-YG roncs 3 O s ►x f'r CS — , 5 /. o ■ Enhtenl an = BOD , > 30 1220 ffWL and T55130 c 150 mglL - E1Alrent 02 - ODD . c 3D mg& and TSS 130 rnWL The Dept of Safety and Professional Services is an equal opportunity service provider and employer. if you need assisnnce to access services or need maurial in an alternate format, can= the department st 60E-26&3I5I or TN thrauah Relay. 20"DoM11 III M s ccd e r': yb. I � \ rld 94.5r' TOM KAw4en I RLIJamin Twsp i "/47Yq-A(&*ss-Tz9Arit w as j3Nr/ - ioe s' - 761, File #: ST UNTY SANITARY SYSTEM office use Oniy "" "`110 OWNERSHIP/ADDRESS FORM Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addn City/State/ZiF Phone Number (required) 1- l.x 09- G?9(-p - 0 % Q) Email Address (required) Parcel Identification Number d ix� - -7J -v00 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NVV t/4 , LLV�- t/4 , Sec. 5. T N RjC W, Town of bWd1AJ n S Subdivision Plat: Lot # L. certified Survey Map # (3 $ Volume 31. Page Warranty Deed # [ [ S"q (before 2006)Volume . Page # Number of bedrooms Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 no New Property Address Aa (staff Initials) 61R= Un ONLY 2zi 2- (Verification of new address required from Community Development Department for new construction.) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form 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. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245 4250 Fax cddPsccwi aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.sov � me fN.fM ® FAT-M qRI�. fI1LT I10011 aONIO 0 -I 0 .-i�T ® IUD YASiI INTERIOR ROOM LAYOUT PLAN W.� �.. � �....... 0 i PLAN NORTH State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number I Document Name THIS DEED, made between Thomas M. Kanten, as Trustee of the Thomas M. Kanten and Melody A. Kanten Revocable Living Trust dated October 22, 2019 and any amendments thereto ("Grantor," whether one or more), and Kelsey M. Newgard and Nikolas K. Newgard, married to each other as suvivorship marital property ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, 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 addendum): SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF 1159779 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/ 10/ 2022 02:28 PM EXEMPT#: REC FEE 30.00 TRANS FEE 810.00 PAGES: 3 "The above recording information verifies that this document has RecodeeMfOlectronically recorded Namrfi rAAq: the submitter TitleSmart. Inc. 4810 White Bear Parkway, Suite 100 White Bear lake, MN 55110 002-1009-75-000 Parcel Identification Number (PIN) (Signatures may be avM0rrtc0ted or aclonoMdedged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S p eDIoE�ED �� 7 ® 200f{3 STATE BAR OF WISCONSIN FORM NO. 7-2003 TYPO 5Ve(11"A%1T lflty 11Tit779 gnc11�6 65 Dated: August 19, 2022 Thomas M. Kanten, as Trustee of the Thomas M. Kanten and Melody A. Kanten Revocable Living Trust dated October 22, 2019 Thomas M. Kante Trustee AUTHENTICATION Signature(s): Thomas M. Kanten, as Trustee of the Thomas M. Kanten and Melody A. Kanten Revocable Living Trust dated October 22, 2019 and any amendments thereto authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: TitleSmart, Inc. 4810 White Bear Parkway, Suite 100 White Bear Lake, MN 55110 ACKNOWLEDGMENT STATE OF MINNESOTA ) WASHINGTON COUNTY ss.) Personally came before me on this the 19th day of August, 2022, the above named Thomas M. Kanten as Trustee of the Thomas M. Kanten and Melody A. Kanten Revocable Living Trust dated October 22, 2019 to me known to be the person(s) who executed the for eirt 'nstrument and acknowledged the same. akk Notary Public, of Minnesota My Commission (is permanent) (expires: 01/31/2025) AMY BAKKE i° NOTARY PUBLIC MWNESOTA M' Cam�ucn FUN Ja 31.203 (Slgnatuns may he authentieatW or aduoowAedged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN FORM NO.7-2003 ' Type ft-" 'Jt�Sift3Plty 1159779 Page 2 of 3 EXHIBIT "A" Lot Fifteen (15) of Certified Survey Map recorded in Volume 31 of Certified Survey Maps on page 6968 as Document No. 1131828, located in the North Half of the Northwest Quarter (N'/2 NWY,) of Section Five (5), Township Twenty-nine (29) North, Range Sixteen (16) West, Town of Baldwin, St. Croix County, Wisconsin. (Signatures may be authenticated or acknowledged. Bah are not nwA"ary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED, TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN ryp85TGe"*g0b0hty 1159779 Page 3 of 3 FORM NO.7-2003 ViMccc4< F W W M W M m 0 III O IK a W >p F. 1`4 d w! m b O N O 0 G O D w N Z W W W =yrz10 bm M V! W G r\�' i (L U 0 F d' WQY1Ow ;YN1�o6 cc Q O Oi0 WH�WyNn1, mom iOm V SCALE: 1 INCH = 400 FEET 400 200 D iiiiiiig 400 PREPARED FOR: TON KANTEN 11117 220TH STREET DA CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER AND PART OF THE NORTHEAST QUARTER OF THE NORTHWEST OF SECTION 5, TOWNSHIP 29 NORTH, RANGE 16 WEST, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. LEGEND LOT 16 AREA © FOUND ALUMINUM COUNTY SECTION CORNER MONUMENT TOTAL E7f0001NG RIGHT OF j t2O a87SQ.236ACRES 19.329 ACRES UNPLATTED 1� LAND NORTHWEST CORNER- S ECTI N5 SURVEY MAID SURVEYOR: -, DOUG ZAHLER S & N LAND SURVEYING LDWIN, W164002 2920 ENLOE ST. SUITE 101 HUDSON, W154026 The property depicted by this map Qenfelns areas that are subject to the Shorelend Overlay District. Additional resWctions apply. Contact Community Development for furtherinformadon. Lots 14, 25 and 16 are zoned R-1, Residential Dlsb*E, Which allows 1 Principal dwelling per 10 acres. Two additional residential units are avollable for Lot la and 2 residential units arc ovagalbe far Lot 1S while toned as R-1. This note Is intended to assign residential units and does not amunt for required /at design standardk such as suitable sags for private on -site wastewater b eabnent systems, access standards, etc Please contact the Community Development Department for more information. 61 V 2021 S00'38'58"E gI tI of WI m I ao zI Ol m NI8 Z T 4 LO C.S.M. VOL. Z3,, PG.5573 WESTTLO.W.- ZZM ST. I • FOUND 1 INCH OUTSIDE DIAMETER IRON PIPE FIELDWORK COMPLETED: Z/26/21 O SET 1 INCH OUTSIDE DIAMETER BY 1R IN LOT 1 I UNPLATTED LAND c-LK_. I VOL.9 COUNTY "DD" PG_2669 ROAD — I -NORTHUNE 1$ I NW2/4 r-NORMERN: coWFR mA 617.46' r-t S86'S6'D2"E Z n -WEST LINE ► NW114-NWP'4 �� `-FXI3T7nG OA/VE 6 LOT 16 ❑OUTBUILDINGS e r�.HWSf 1-75'O.H.WJII. n CZHOUSE SETBACK 2-EXISTING pBVE..., SHED / IJ10 I tj��V 66' N87'OZ'14'W : z CH LONG IRON PIPE, WEIGHING 2.13 LELS. PER LINEAR FOOT ' _ _ _ _ _ APPROXIMATE WETLAND LIMFTS DERIVED FROM AERIAL AND UDAR DATA o I UNPLATTED LAND I V UNPLATTED -------- °tea° LAND I UNPLATTED SMALL I i -SOUTHR.O.W. I LAND ' COUNTY RD. 'DO" TRACT m i -NORTH QUARTER 'E 2628.85'- - — — I m CORNER SEC77ON S SURVEY MARK NAIL -��-�L- O2 1, Fr. 25.871 ACRES FENCE LOT 14 N LOW BUILDING OPENING 1,119,433 SO. FT. Z �Itia.a . 2S.699ACRES , LOW BUILDING OPENING - I35a.0 ik2 �91.. sz7 03• a -- au.zs• 2619,9S' _ UNPLATTED LAND SOUTH UNEN212-NWV4- UNPLATTED LAND Each Pamel shown on this map Is subject to State, County aid Township laws, rules end;I ulatlons (La., wetlands, minimum lot else, access to Parcel, etc) Before Purchasing or developing any parcel contact the St. Crobc County Community Development Department and the Town of Baldwin for advice. Z207H ST. i — �-83.3a' SOD'ls'SO"E(Lvv b 3 001 a n Cl) i O GI�I a >I � 3.r e, 0 LOT 13,O VOL. 31� PG_6918 N 1,6 9. G3�(�C� M CST-aou — /a Wrs. C spi of Safety and P fession IA Z0Z' S IL Et✓AI Division of Safety and Build, gs I IATION RFpOj��; L•Z (/+ m ASqqM&tt* with S S 3R5 Wi. n Page L of 3 / I Boring # ❑ Boring Pit Ground surface elev. 98 89 R. Depth to limiting factor�o in. Horizon Depth in. Dominant Color Redox Description Texture Munsell Structure onsistence unda ry Roots Soil lication Ra PD/ft Qu. Sz. Cont. Color Gr. Sz. Sh. 0 -/0 o iR 3/2. 2*..r6K rak r $ ff#t ffff2 Se' 'ln`gbK I �OYx �f° rYf r CAS / , Z 30 o iK vI/b Sc 7 5 /ntigbK ikfr S 5 0' fe s 7.SyR5/P-'Id O n1 ►x�; $ ¢ v. v o. v to 3 OS r �S 5 /• v Iij Boring # ❑ Boring Pit Ground surface elev. 7.75 ft ' Effluent 4l a RM > -in , inn Depth to limitino facinr _ 90 w Property Owner v1%- K&4 , _-re Boring # Parcel ID # ❑ Boring Pit Ground surface ebv. • D % ft. Depth to limiting factor Z D in. Horizon Depth Dominant Color Redox Description Texture Structure onsistence ounda in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. re 3/ S'/ 2*1-V6/< /+f✓ C S 2 - o K,/ S 2 &SL Ae �►1 f r t' S t3 /S 2U p V14 SL 2m K /h r— C' - 28 0 iK. V/G 5 y/e 5/S /d arts G 2•H SbtK M �'r S IV. Uri S tr S/,_ 7 yG-5 51;e.5/G ❑ Boring # ❑ Borng ❑ Pit Ground surface elev. fL Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundar in. Mansell Qu. Sz. Cant Color ElBoring # ❑ Boring ❑ Pit Ground surface elev. ft. Deoth to linitinn fAmnr Page 2 of 3 Roots I GPDM !mlm Soil Roots I GPrW 7 Horizon Depth in. Dominant Color Munsell Redox De Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Soil lication Rate oundary Roots GPD/ft 7 ff#1 ff#2 Effluent #1 = BOD . > 30 1220 mg& and TSS >30 < 150 mg/L ' Effluent #2 = BOD , < 30 mg/L and TSS 130 mg/L The Dept. of Safery and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format. contact the department at 608-266-3151 or TrY through Relay. s1113-e110nu yr q crF bD \ q�� `Y7.75 " \ 07• 94.si. 3tldwin Twgp n(wY4Attvyi*S5T2914-Ri& w c.. f # //p a1= nn" 82 . 97.75- 63 = 97 °7 SAt#/ = /00.0' = -rap, ev s/1%yt/v. P�p�,l��wko�pri�es, $M6+Y Z -- /o/. 9* ' =Ti io of VY �q/✓•��p� i %�r�rt fK%9ieei— scale M A,P/C t 2G ?r85 1'9 � � -COUNTY STAT SANIT, r, l 2zz I rn ae PLUMBER AND/OR PERMIT EXPIRES NO. 648402 k Y PERMIT D� PREVIOUS SUBDIVISION NO. 145.135 (2) WISCONSIN STATUTES (a) The purpose of the maftary permit is to allow installation of the private sewage system described in the permit (b) The approval of the unitary permit in based on regulations in force on the date of approval. (c) The unitary permit Is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of a unitary permit. (e) Renewal of the unitary permit wW be based on regulations in force at the time renewal Is sought' and that changed regulations may Impede renewal. (1) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permI4 or transfer ownership of the permit, please contact the county authority. ZING OFFICER - DATE 71P 3 UNLESS RENEWED BEFORE THAT POST IN PLAIN VIEW DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)