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002-1005-70-050
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Lee, Nathan Baldwin, Town of ;ST BM Elev: Insp. BM Elev: BM Description: (~ ,~/~ / "~ 1 11 1 ~ l~~ 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~, ~j ~J, i't~~ ~,~,,~ S / Z « c Dosing ~c`%r'~ ~~~ ~C~,i c ~' Y ~~~~ • V /_ V Holding TANK SETBACK INFORMATION TANK TO P/L )`'~~ WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~~ Z I P z l/ Dosing 7 ~ I73 A ~ ,(~''~ ~~' ~ ( Aeration Holding _ ..... PUMP/SIPHON INFORMATION „ , , Manufacturer r `,,. Demand l"~ c~ •~ ~- S GPM Model Number nG ~ i -- Ze (F,~J TDH Lift ~ Friction Lo~ F~ System H d ~ TD ~ Z ` ~ ~ 7 ~ ~ Forcemain Length i Dia. : ~ Dist. to weu O ~ r S[111 ~RSC)RPTInN SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 487928 0 State Plan ID No: Parcel Tax No: 002-1005-70-050 SectionlTown/Range/Map No: 03.29.16.46A20 STATION BS , HI ryct ,W FS ELEV. ff~ Benchmark Z ~ /O ~ 7 lJ~ AITt. BMC L. J ~s ~ r-7 BI g. Sewer I -j ~ {I( ~ _w ' f/y SUHt Inlet ~~'~ SUHt Outlet ~ ~ Dt Inlet _` ~ Dt Bottom I ~ ~ ~,' Header/Man. , ' ~ 1 9 Dist. Pipe ~~~lT~ ~~ t7.~~ Bot. System ~ 35 ~ 7 Z S Final Grade t~ ~~~ St Cover ,` i ~~ . Vim, 7_ ~ 7 ~~ ~ W 2 J ~ d ~~o ~ r-- (~ , 0 9 (9 - o BED/TRENCH DIMENSIONS Width ~ ,/ Length J -7 ~ 1 No. Of Trenche ~ ~- PIT DIMENSIONS ~-~. No. Of Pits ~''-' Inside Dia. ~. Liquid Depth ~. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~ Type Of S stem: IY~ v . ~~ r Z 7 ~ ~'1' NA-' ~1.~~- UNIT Model Number: ~~ IIISTRIR11TInN SYSTEM t~l~eSF- Header/Manifold ' Length~~ Dia ( Distribution ('Z. ~~ ; Pipe(s) ~ ACli~~f,'S., Length ~'~ ` ~ Dia ~ Spacing e~i~4t~QV x Hole Size ~~ ~ ~ x Hole Spacing ~ '~ ' ~' V~]t to Air Intake i ~~: i !~ zS ~~. SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over t B dlT h C Depth Over Bed/Trench Ed es xx Depth of Topsoil ~ xx Seeded/So ded xx Mulched ' " e renc en er ~ 7 ~ g \ ( Yes i t,)~ No No _, Yes ~ . COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: nn/b / /~ / ~ 5 Inspection #2: / /_ Location: 1135 245th Street Baldwin, WI 54002 (NW 1/4 SE 1/4 3 T29N R16W) NA Lot 1 K-~ Parcel No: 03.29.16.46A20 1.) Alt BM Description = l•:~n 4s? t.°~ ~ ~c~c~.~-I ~, ,ice. G O 2.) Bldg sewer length = ~~ ~ 3 t-° ~~ ~~ ~ ~ti"~ P ~ T r _ - amount of cover = 7 •ision Required? I J Yes o I ~ ~ <~ II side for additional information. ;._._i 1~__ ~ L-~ Date 2.3197) Cert. No. '~ ' ~ and Buildings Division Coun .~ 1 W. Was ~ gton ~`vt;.;'P:O:~Bo~ 716 ~ . ~,. '' t", St. Croix iscons~n ~dtson, wI X707 - 71f~i2 Sanitary ermit N to le ' r by CoJ ~ (608) 266-3151 Department of Commerce ti l_ Sanitary Permit Application i to Pl LD. Number ~ 'Z 3-p Z ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ., ti ~' ~'~ ~ ~ ~ b d f d P i L 5 04 l m - h d ili ma e use or secon s u y ry p rposes r vacy . ( x aw, s1 ) ress (if di ent t an ma ng ess) oleo A ~_, r1iNG C1Fri ~ _ I. Application Information -Please Print All Information 245th Street ~l 3 j j Property Owner's Name Pazcel # Lot # Block # Nathan Lee / 3 ©®Z --~ 6 0 ~ - 7 t1- d Property Owner's Mailing dress Property Location P. O. Box 413 NW SE ' y~0~" Section 3 'y '/ City, State Zip Code Phone Number °, ., Baldwin, WI 54002 29 ~ c(circte one) T N; R V r II. Type of Building (check all that apply) , / 4 ~ ~~ /~ ~, a 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number Public/Commercial -Describe Use 17, 44$$ ^ State Owned -Describe Use ^City_[]Village ~'fownship of Baldwin III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `4 0 New S stem y ^ Re lacement S stem p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / i i IV. T of POWTS S stem: Check all that a ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ~ Mound < 24 in. of suitable oil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel- Pipe ^ Other (explain) t ~ V. Dis rsal/I'reatmentAreo Information: t'J7~ (N Design Flow (gpd) Design Soil pplication Rate(gpdsf) Dispers 1 Area Required sf) Dispers Area Proposed (sf) System Elevation 600 0.4 ~, p ~j' (( 600 / ~~ 600 ~ S73 97.17' !/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steei Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1200 1200 1 Wieser x Aerobic Treatment Unit , ~ / - N DosingCbamber $00 800 1 Ser WI X VII. Responsibility Statement- I, the undersigned, assume ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's Signs MP/MPRS Number Business Phone Number Roger Nelson MP226497 715-273-4444 Plumber's Address (Street, City, State, Zip 122 East S mmit Avenue Ellsworth, WI 54011 VIII. n /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (ij~~dudes Groundw~r Surchazge Fee) .~! '1 ~!'~ Dat Issu ~0 I uing A nt Si tore S p~ ^ Owner Given Reason for Denial ~ ~~ff" of 7 Q~ ~~'~~OVaUReasonsforDisapproval 3 Q~ ~~s v~/~~,f , ~ 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained ~ ~t:~~ ~ G~'~i'~;~iiticc.-~• ' Dumber. / _ yt~ /~ t~U/}.t; ~ ~~ l ' a All setback requirements must be maintained ~ ~~~Zp?~ ~ 2 . ~ ~ ~ . , ~ as per applicable code/ordinances ~ ~ ~~6,~=~i~-u- - ~ ~~ ~ 8m ~ ~ ~O C sT-` ~' w ~~~v - CSm s~~ ~) /S~ ~r ~61,Ff~ Attach complete plans (to the County only) for t~ system on paper sot less than 81/2 a I l inches in siu ~ `_ ~ / / l.Jl ~ ,,y~~,.Sao /~~ ~Nu~ c~~- - ~~~Ce~'(~l,~~t~~~=- SBD-6398 R. 01/03 ~u~~~ ., 1~ Gue~a~a~ ~~ ~° Nathan Lee P. O. Box 413 Baldwin, WI 54002 ` NW %,SE%, S3, T29N,R16 R' Baldwin Township S~ Croix County Scale 1 " = 40' Weiser 1200/800 tank BM #1=100..00' top of nail in box elder tree BM #Z =101.00'top of nail in box elder tree N ~yo'of Z" force main ~~/ // CS ti~ 2 ~~~ ~~ ~~ ~•~. srdpc ~~ n~ Q2 ~ ~, ~~ U~ a~ i a~-,y ~N q ?" `~~ ~~ M~ o13i-T z ~. t M v ~ ~v a r~O~Y ~~SV~~~ k 3 ~,~ ~° ,~ ~- ~- ~~ ~ l ~~s .~~ '~~ ~ .~ f Page 8 of 8 LL ~~ Q ~ ~ ~ ~ u ~ 71503 I~IP-R 2 2 200' ~ ~ ' VOL 17 PAGE 4488 ~° - KATALEEA H. REGISTER OF DEEDS ST. CRGIX COUi~TY ST. CROI}I CO.L MI SURVEYGR'S RECGRD RECEIVED FOR KECORD 03/28/2003 11:20AM CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP PAGES~:~~2 ~' LOCATED IN THE NW1/4 OF THE SE1/4 OF SECTION 3, T29N, R16W, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. GRAPHIC SCALE 1 "=200' OWNERS / SUBDIVIDERS LEE & PATRICIA DORWIN 1430 PLEASANT AVENUE BALDWIN, WI. 54002 0 200 400 600 BEARINGS REFERENCED TO THE NORTH-SOUTH 1/4 SECTION LINE OF THE FRACTIONAL SECTION 3, ASSUMED TO BEAR N00°29'15"W. NOTE: The lot shown hereon is sut~ject to that conservation easement as described in Vdume 2139 . Page 581 . Document No. 709393 in the St. Crdx County Register of Deeds. LEGEND ~- - INDICATES SECTION CORNER MONUMENT (AS NOTED ). -~ - INDICATES 1" X 24" (OUTSIDE DIAMETER ) IRON PIPE WEIGHING 1.13 LBS. / LINEAR FOOT SET. - ~ - INDICATES FENCE. w J I z o I H U 1. [n I ~ I ~+ I ~ I~ ~ I ~ I o I z I ,T~,~ - INDICATES WETLAND BOUNDARY ® - INDICATES NET PROJECT AREA I OF 5.4© ACRES. GENERAL NOTICE STATEMENT ~I I ~ THE PARCEL SHOWN ON THIS MAP ~ ( IS SUBJECT TO STATE, COUNTY AND ~I ~ ~ TOWNSHIP LAWS, RULES AND I c I REGULATIONS (i.e., WETLANDS, ~ 1 MINIMUM LOT SIZE, ACCESS TO 0 ~ ~ ~ 3 i PARCEL, ETC . ) BEFORE PURCHA~i[~ rr rr ~(~ I t OR DEVELOPING ANY PARCEL D IQ CONTACT THE ST. CROX CO~NTY ST. ChO1X CO ~ fY I ~ I ZONING OFFICE AND THE i$I?(llnn Inn{nn and p3~kc ""' f` ~ g I APPROPRIATE TOWN BOARD FOR ADVICE ~ c I ~ . BAR `~ ~ 2 I tf not recorded witiun 30 ~> ~l I I I y approval data approvals • it be null and void ,~rjC'~ S7 I I / ~ • J0~ .PH 4 ~ • • ~ I CiRi ;v8[RG • ( 5-223'.1 I E. Pd~N R1CtfMOPJU s I W1 ~ I I lJ g ®-INDICATES THAT PORTItON OF THE NET PROJECT AREA THAT MAYBE USED TO BUILD STRUCTURES (i.e., DWELLING, GARAGES, SHEDS, ETC. ). THIS PORTION OF THE NET PROJECT AREA EQUALS 1.9 ACRES. ' PREPARED BY: bt?ANBERc5 SUR~~YIN6 1239 C.T.H. "E" NEW RICHMOND, WI. 54017 PHONE (715 ) 246-7529 JOB N0. 02-04B 3_ ~n m~ ° 0 Z Ni/4 CORNER, FRACTIONAL SECTION 3 ( 1" (OUTSIDE DIAMETER STEEL SURVEY MARKER NAIL FOUND ) NOTE: THE ORDINARY HIGHWATER MARK WAS VERIFIED BY THE ST. CROIX COUNTY ZONING OFFICE ON 02105!03. m UIVPLAI~ED LANDS N DESCRIBED TIN VOLUME 1306, PAGE 551. , - - - - - - 3~ S87°45'54"E 539.07' ~ ~ Y /. TE L' ., 0 r ~ a •~ .~ •_ o •~ ~i~ =10 ~ al, °I //~-~ .,IN~ ;lo ~, olz W ml l iz 3 ~~ N ~ °O ati vu .v ~ I ~ Y I , ~ ~ r, ~, ~~ ;_ ~ ~ J /iQ V, ~~~ ~ ~~ t~`~ 506.02 ' ;~ 47 '57 "W 53q . ~'~- ~ Q ~~ - ~o: ~Q. , Q 3 ~ ~ x ~` ~} ~, ~~ 'z .o ,~ O ~~ ~O ~~ ~~ ' ~w ~ ~Oo~~ ~l 583,791 SQUARE FEET - ( 13.402 ACRES ) NCLUDING RIGHT-OF-WAY 47,9 SQUARE FEET ~80 ACRES ) xCLUDING RIGHT-OF-WAY ~ u~ cn m 0 w ~ ~ ~~ rn ~I 0 c°n Z ~I $.5' SOUTH LINE OF THE NW1/4 OF THE SE1/4 UNPLAITED LANDS S1/4 CORNER, FRACTIONAL SECTION 3 ( 1 1/4" (OUTSIDE DIAMETER ) IRON PIPE FOUND. SHEET i OF 2 r u Vo1.77 Page 4488 commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.g ov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 04, 2005 CUST ID No. 226497 ROGER D NELSON NELSON PLUMBING 122 E SUMMIT AVE ELLSWORTH WI 54011 ATTN: POW7'S Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/04/2007 SITE: Nathan Lee 245th Street Town of Baldwin St Croix County NWl/4, SE1/4, S3, T29N, R16W Identification Numbers Transaction ID No. 1200299 Site ID No. 705409 Pleasexefer to both identificationnumbers, above, in all comes ondence with the a''enc'-. FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1042759 Maintenance required; 600 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • 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 Comm 84 product approval conditions. • Comm 83.22(7) - A cony of the approved plans specifications and this letter shall be on-site during construction and o en to ins ection b r' sentatives of the De artment which ma include local inspectors. ~ ' Conditionally ~ ~~-Qw~ ~ ROGER D NELSON Owner Responsibilities: Page 2 10/4/2005 • 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. • Comm 83.52(1)(x) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART'code: 7633 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Nathan Lee 4 bedroom Mound system Owner's Name: Nathan Lee Owners Address: P. O. Box 413 Baldwin, WI 54002 Job address: 245th Street Legal Description: NW 1/4, SE 1/4, S 3, T 29 N R 16 W Township: Baldwin County: St. Croix Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank ,~~rF1~lED Page 5 Page 6 System maintenance specifications Management and contingency plan 2005 ~ Page 7 Page 8 Pump curve and specifications Plot Plan . SEP 2 SA~~r ~ ~ SD~I.DINGS Designer: Roger Nelson License Number: MP 226497 Date: 09!23/05 Phone Number: 715-273444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDEt-10691-P (N. 01/01), and SSVVMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.0 (R. 04!03) Page 1 of 8 •~ r M Y a ,~..,,~, ~. .,,~ ., .. DEPARTMENT OF COMMERCE IVi510N ~F FETY AN BUILDINGS SEE CORRESPO DENCE Mound and Pressure Distribution Component Design Design Worksheet .~ ,,~ '?~ ~- n;.~~, ~' Site Inform ation (r or c) R Residential or Commercial Design 400.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 9.00 Site Slope (%) 96.00 Contour Line Elevation (ft) 22.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ftZ) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c ore) a Center or End Manifold 4.00 Lateral Spacing (ft) 2 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 240.00 Forcemain Length (ft) 80.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 16.83 Vertical Lift (ft) 2.32 Friction Loss (ft) 25.65 Total Dynamic Head (ft) ~} Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 x x 1.50 x 2.00 x 3.00 x Treatment Tank Information 1200.00 Se tic Tank Capacity (gal) Weiser 800-325-8456 Manufacturer Dose Tank Information 800.00 Dose Tank Capacity (gal) 22.24 Dose Tank Volume (gal/in) Weiser Manufacturer Project: Nathan Lee 4 bedroom Mound system Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 8.00 Cell Width (ft) Are the laterals the highest oint in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 12.00 ftz/orifice Does the forcemain drain back? Y Enter Y or N 39.15 Forcemain Drainback (gal) 46.79 5x Void Volume (gal) 85.94 Minimum Dose Volume (gal) 20.60 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x x 1.50 2.00 3.00 Gallons/Inch Calculator (optional) Total Tank Capacity (gal) Total Working Liquid Depth (in) gal/in (enter result in cell B49) Effluent Filter Information Zabel 1-800-221-5742 Filter Manufacturer A100 Filter Model Number Page 2 of 8 Mound Plan View 1- I_ . 1/1 10 B Observation Pipe ~' r.,r. j.•.. ,.. j: f.1..r, f~ r,r, 1,, f, f;1,•1,•~,,~ ,•f;~'.,:, f, f, j, f; r~ f. ' :..~.r. r• j• j•~.: •:•r•:. j•r, r.r•r• j•r• f•r•~• f.:..'.~. •'~:r:.•. L•L•L L••.••.•S.•L•'.• . L• 5 •L•L•L•ti.•t•'.••. L•L••. L•L•L• f.•jL~.~•~~~~ j.~~~l.~fL~L~L~.~:~:~. f:~. f: j:~: f:~.~: j. jti~tir. f:~.. f:~• .~. ~i• ~B ~. !t J _+ TA I I ~- L Mound Component Dimensions A 8.00 ft E 22.64 in H 1.00 ft K 9.89 ft B 75.00 ft F 9.25 in z 12.98 ft L 94.79 ft D 14.00 in G 0.50 ft J 5.76 ft W 26.73 ft 600.00 (ft2) Dispersal Cell Area 1573.20 (ft2) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.94 (ft) . FFJf/J F 97.17 (ft) -- - Dispersal Cell ~ ~ :::::::: Elevation --- r:r:r:rr 2 frr:rrrr.~,. r:rrrr{{ rr::rrrr::r{~rr._, ........................ . . Dispersal Cell 97.67 (ft) Lateral Invert :D ~ ~ Shading Key 1~ ~ Topsoil Cap © {'~'~f Subsoil Cap ©~ ASTM C33 Sand ®Tilled Layer ^5 r:f:r~ Aggregate 9.0 % Site Slope '~ a ~ .Q 1.5 ft m O 0.5 ft 0 ~ ~ :•:.f.:. r.~~:. rtij.~ •: .•, •y.ti,. L~L.L. ::}:, Typical Lateral r;r;; L•L•ti•ti•ti•ti•"•. ti.1 •~•• :•:•:•:•:•:•:•: •: •r•: ~ A -* 00 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (Ax6). Project: Nathan Lee 4 bedroom Mound system Page 3 of 8 End Connection Lateral Layout Diagram Laterals centered o++er the A & B dimension +=Turn-up wrbetl valve or aleanoutplug p _ .I AN laterals are identioal IE ~--~I Holes drilled on the bottom of the lateral ~ equaNy spaced J. Forae main aonneation pia tee or arose to maniFold at .my point. Laterals & force main of PvC sch 4D [per COMM Table 84.3D-'s'~ Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Orifice Diameter Orifice Spacing (K) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and -- Comm 16.28 WAC Disconnect ~i Tank component is properly vented Weiser 800-325-8456 Ca aci 800.00 Volume 22.24 Manufacturer Gallons gal/inch Dimension Inches Gallons A 20.11 447.18 B 2.00 44.48 C 3.86 85.94 D 10.00 222.40 Total 35.97 800.00 ~- A B C D 1251in 25 12.00 fig/orii 4.00 ft 1.25 in 2.10 ft/sec Locking cover with warning label and locking device and sealed watertight i 4 in. min. ----~_ ~ Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P, umg off elevation (ft) ~--~ 80.83 D~tank elevation (tt) 80.00 Alarm Manuafacturer S. J. Electro S stems Alarm Model Number 101 HW Pump Manufacturer Goulds Pump Model Number PE 51 Pump Must Deliver 20.60 gpm at 25.65 ft TDH Project: Nathan Lee 4 bedroom Mound system Page 4 of 8 Mound System Maintenance and Oaeration Saecifications Service Provider's Name Installed b Nelson Plumbin Phone 715-273-4444 POWTS Regulator's Name St. Croix Coun Zonin Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ndin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished • ............. ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral / ~J Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Nathan Lee 4 bedroom Mound system Page 5 of 8 Mound System~Management Plan Pursuant to Comm 83.54, Wis. Adm. Code e ral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. F_xposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be Leaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may sough off the fitter when removed from its enGosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. PUmD Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shalt be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection ftom freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODSr 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and tt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically Dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Nathan Lee 4 bedroom Mound system Page 6 of 8 LGOULDS PUMPS Pump - GetteraL• • Discharge: 1'h" NPT • Temperature: 104°F (4th maxir»wn, cantlnuous when fully submerged • Solids handling: '~" maximum sphere. • Autmnatit models indude a float switch. • Manual models available. • Pumping range: see performance chart or ame. PF31 Pump: • Maximum capadry: St) GPM • Maximum head: 25' TDH PEA1 Pump: • Maximum capacity: 60 GPM • Maximum head; 29' TDH PES1 Pump: • Maxnnum capadty: 70 GPM • Maximum head: 37' TDH .S\~ SPECJFIGTIONS APPLICATIONS Specially designed for the fdkowing uses: • Mound Systems Effluent/Dosing Systems • Low Pressure ~e Systems • Basement Draining . H~~. p~ Sump,/ Dewateri»g METERS I L `~~ ~~ 30 pH z 20 0 15 N 10 5 0 ~ ~~-- Submersible Effluent Pump PE MOTOR General: • Single phase • 60 Hertz • 115 volts • i3vih-in thermal overload pro- teuion wAh aubnr~ic reset. • Class B insulation. • Oil-filled design. • High strength carbon steel shaft. PE3t Motor. • .33 HP, 3000 RPM • 12.0 Maximum amps • Shaded pole design PE41 Motor: • .40 HP. 3400 RPM • 7.5 Maximum amps • PSC design PESt Motor: • .50 HP, 3400 RPM • 9.5 Maximum amps • PSC design f~6'li--' . ~ t . .f.~ • t i.. " ~ 1 MODELS: -f31, iE4'. Pf51 ... , t_.. , ..;.. ,. ~ .. . ._:. .....l...r.. ~ I .:......_:_ .. ..... I ...1...7_ .....r.. _. 1..~i - ...i... .. 1 ., . ; , y ... . ........... ... _.. .. y..r...... t... i . .. j..4 ~ M - } ~ t .. _ - - ......... . ... YY . . r }r' ..._ t t - I - ... L ~ . I- - i . _ .. . . .. - ...r...l... ~. .... r..4.. _. .d. * 1 .. t .. Y ... ••-.. ..t..... .. ••- !~- _ -y . .. ...' .. ::~..., .. .. : .... .. , ._i..` .. ..~.._.... ... 1...l...' -1---,.... . _. ... ~_. ._.L.: _ ~. -k ,y -.. ~•, ~V ov : ,u GPM 80 ~ 10 15 ao-~a caaatlTr E+ 2002 Goulds Pumps ~^= Pm Effettf~+e lvooembsr. ZQ02 V BPE31/4'• FEATURES ^ Corrosio» resistant construction. ^ Cast iron body. ^ Thermoplastic impeller and rover. ^ Upper sleeve and lower heavy duty ba;l bearing construction. ^ Motor is permanently lubric~ed for extended service life. ^ Powered for wr*<irwc+us ~~. ^ AN ratings are within the working limits of the rrlator. ^ Quick disconnect power card, 20' standard length, heavy duty 1613 SJTW wfth NEMA 5.15P, tixee prong, 115 vdt gr+ourrdmg plug. ^ Comple0e unh is heavy duty, portable and compact. ^ Mechanical seal is carbon. ceramic, BUNA and stainless steak. ^ Stainless steel fasteners. AGENCY US7INGS s~~ t US Tested b UL 7T8 and csA u.t Boa sbnaards By hnsditn StsrlAuds AOe F16 ~tRi~9 COUIdr -UOIpS IS ISD 9001 Rtyirlend, pQy~ ~0~8 Goulds Plm~pa ITT Industries r Nathan Lee P. O. Box 413 Baldwin, WI 54002 NW %,SE%, S3,T29N,RI6W Baldwin Township Sz Croix County Scale 1 " = 40' Weiser 1200/800 tank BM #1= IOO.OD' top of nail in box elder tree BM #2 =101. DO' top of nail in box elder tree ~yo'of 2"force main q~ 9y' .. _. a,_ N v Y U c~ vl ,'` og! qN Page 8 of 8 p cJE~ L ,. - jiUiscoi~ln Department of Commerce SOIL EVALt.~ATION REPORT Page ~ of,~ Division of Safety and Buildings in accordance with Comm 85, W(s. Adm. Code Attach com fete site ian on County P p paper not less than 8112 x 1 i inches in size. Pian must include, but not limited to: vertical and horizontal reference point (BM}; irectlon and Parcel I.D. percent slope, scale or dimensions, north arrow, a~d"location;~rid_dlst~ nearest road. ~ti /` 1/ , -. Please print aii i~iFp~rnat/o `~ Ravi wed by Date ~5. 4 I Personal intarmation you provide may be used for ecb'r?Hary p Law. ~ Property Owner _ Pr(pj5e Location ~` ~ ~ ~ ~ G t-- t A/ l.J 114 ~ 1 /4 S Tp79 N d E (or Property Owner's Mailing Address i/ L Stock # Sub~Name or,~~+1# Gf! ^~ ~ t /1LCAy Dom -~Do s~7~-o City State Zip Code .one , mbar ~ 7TC o ~l ~. Cfry ^ Village ~7own Nearest Road ~ " ~` ~~~ ~~- `~ off ~~ ~ New Construction Use;,~Residentlal /Number of bedrooms Code derived design flow rate d GPD ^ Replacement ^ PubNc a onmm i -Describe: Parent material ~ FiQgd Plain elevation if applicable ~_ f ft, General comments ~ ,/~ -(• 02 ~~ ~ / ~ ~~~ ~~ and r°oommendations: ~~ fr /yt p ~~,~/ ~ , ~ ~_ 002- t~S-~o-oSUC~~A-2o „v,.~v` . soN.oQ '~'/ ~ 9l . zao r Boring #~-BO~'g U Pit Ground surtace elev. ~ ~ ft, Depth to limiting factor'1CK7~~ "~ Soil AppUcaUon Rata Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. MunseU Qu. Sz. Cont. Color Gr. Sz. Sh. +EfP#1 'Eff#2 Boring # Boring ® ~ Pit Ground surface eiev` ' ~ ft. Depth to Eimiting factor ~_ in. Soil Appticadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. +Eff#f 'Eff#2 s ,- ~ .~ S /~? , - trnuenr ~-~ = tsc.rua > so < zzu mgn_ antl T5S >30 < 150 mg/L "Effluent #2 =SODS < 30 mg/L and TSS _< 30 mp/L CST~~~nle~/Print) „ gnatu CST Numb~elr Address ~/ ~ / /~~' ~ D e Evaluation Conducted Telephone Number SDD-8330 (R07/00? S. ,~ - `f .~f .--_ .~ . ~{" ,~ 'f `~ ,` ~. ... ~ ~. . I .. ~ _ 1 .. y. ,~¢' - ~- ~ ,~1. ... ~a e ,~ -`. - _____- 1 i .. (, t~ -- ~ ~. _ , .. .~ ~ _. ic< `, ' I i 1 L Property Ovrr+sr Parcel ID # Page of Boring Boring # ~ i Pit Ground surface elev, ft. Depth to limiting factor_~~ v~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz In. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 302 .~ 3 S ~' s 3 ,s~.y.~ ~~~s, y ~ ~,-~~ w~ ~ 3 . 13oring # [] Boring ^ Pit Ground surtace elev. ft. depth to limiting factor in. Soil Ap Iicadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft~ in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 ^ Boring # ^ Btxing ^ Plt Ground surface elev. ft. Depth to limiting factor in. Solt Ap llcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fN in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 "Effluent #t n BODY > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =BODY < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. Tf you need assistance to access services or need material in an altornato format, please contact the department at G08-266-3151 or TTY 608-264-8'777. .~ .•`f SBD-8370 (R07K10) ~~i~ Test Plot Pl Ad~~"iS P.O. Box 413 Baldwin Wi 54002 Lot Subdivision ------- Date ATM #226900 9/9/01 N W 1 /4 S E 1 /4S 3 T 29 N/R 16 W Township Baldwin Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. =Top of Nail in Box Elder Tree~~ System Elevation 97.6 *HRPSame as Benchmark A t. BM =Top of Nail in Box Elder Tree @ 101.0' • . 4 a 7 1 5 0 3 7 ' V OL 7 7 PAGE 4488 xAT1RL:EEA H. REGISTER OF DEEDS ST. CROI7I CO. MI RECEIVED FOR RECORD 03/28/2003 1I:20AM :.axiirinu auxvnr nwr nrn at+t+ _ ..~ .~.. CERTIFIED SURVEY MAP PAGi6Szhh2 LOCATED IN THE NW1/4 OF THE SE1/4 OF SECTION 3, T29N, R16W, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. GRAPHIC SCALE i"=200 ~ OWNERS / SUBDIVIDERS LEE S PATRICIA DORWIN 1430 PLEASANT AVENUE BALDWIN, WI. 54002 O 200 400 600 BEARINGS REFERENCED TO THE NORTH-SOUTH 1/4 SECTION LINE OF THE FRACTIONAL SECTION 3, ASSUMED TO BEAR NOO°29'15"W. NOTE: The lot shown hereon is subject to that conservation easement as described in Vdume 2139 p~ 581 .Document No. 709393 in the St Croix County Register of Deeds. LEGEND - INDICATES SECTION CORNER MONUMENT ( AS NOTED ). -~- - INDICATES 1" X 24" ( OUTSIDE DIAMETER ) IRON PIPE WEIGHING 1.13 LBS. / LINEAR FOOT SET. K - INDICATES FENCE. ~,,,~ - INDICATES WETLAND BOUNDARY ® - INDICATES NET PROJECT AREA OF 8.40 ACRES. GENERAL NOTICE STATEMENT THE PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS. RULES AND REGULATIONS ( i.e., WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC . ) BEFORE PURCHA~p OR DEVELOPING ANY PARCEL ^~ Ra CONTACT THE ST . CROX COl~IVTY ST. CROIX C ZONING OFFICE AND THE r~annino 7nninn and c APPROPRIATE TOWN BOARD FOR AovlcE. MAR 2 8 ~gC O ~ aw ~7~~0~~ s u ~I ~I If not recorded within 3U a_ Pproval date approval a null end void ®-INDICATES THAT PORTION OF THE NET PROJECT AREA THAT MAYBE USED TO BUILD STRUCTURES (i.e., DWELLING, QARAGES, SHEDS, ETC. ). THIS PORTION OF THE NET PROJECT AREA EQUALS 1.9 ACRES. PREPARED BY: 6RANBER6 SURV~YINrlS 1239 C.T.H. "E" NEW RICHMOND, WI. 54017 PHONE ( 715 ) 246-7529 JOB NO. 02-048 J 0 F I v I ~ I I 1 ~ I' ~ 1 I I I ~I I ~ ~~ i c ~I 13 I~ ~ la In ~~e I ~ I '~'I I ~ ~ I :gf "I I I be~ V I I I I I I) Ni/4 CORNER, FRACTIONAL SECTION 3 - ( i" ( OUTSIDE DIAMETER STEEL SURVEY MARKER NAIL FOUND ) NOTE: THE ORDINARY HIGHWATER MARK WAS 3 _ VERIFIED BY THE ST. CROIX COUNTY ZONING OFFICE ~~ ON 02/05/03. o~ UNPLATYED LA~9D$ ~ DESCRIBED IN I VOD_UME 1306, PAGE 55_1.3 S87°45'54_E 539.07' -~-~ ~ Y33.04 `: -- - : ~ /~ • a ~~ V .~ k'-' Y i a '" e~SOIL = I TEST± ~ ~ ~ , .a ` 3 Z • i .a ra ~ ~ O •H ~~ •x '~ ~~ o Q I ~ / ~ 1L®~ ' II ~lo~ 583.791 SQUARE FEET JI ~ ( 13.402 ACRES ) ~ NCLUDING RIGHT-OF-WAY al;~ 47,985 SQUARE FEET WIC ~ v ( 12.580 ACRES ) Jib /~// ~ E CLUDING RIGHT-OF-I WAY W I/ / / / / ., ,~ L`T / T v U i ~Q v ,\ ill i Iy . Oml, m o ~~ N o g ~I II SOUTH LINE OF THE NWi/4 OF TCH$E SEi/4 ~_ UNPL_ATT~D I.~-ND$ N .-, _ Si/4 CORNER. FRACTIONAL SECTION 3 ( 1 i/4" ( OUTSIDE DIAMETER ) IRON PIPE FOUND. SHEET 1 OF 2 ~~ Vol . 7 7 Page 4488 ST CROIX COUNTY SEPTIC TANK MAINTII~IANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~!~ Tf/~Ll/d" ~~~,~~ ~~ Mailing Address /Q ~1~1 , ~/f-~~i~ ~,~,~Gf/~il/ /~l/I ~~~0~ Property Address Z ~~± ~ (Verification required from Planning Deparhnent for new construction) City/State Parcel Identification Number ~ !~ ~ /'04~ ~7C7 ~ D.~ LEGAL DESCRIPTION Property Location ''/4, ~ ~ '/a, Sec. ~, T~N- ~W, Town of .~~L ~ W V~ . Subdivision ~~ Lot # ~„~. Certified Survey Map # ~,~ ~~ ~~ , Volume ~ ,Page # `7` ~ g~ Warranty Deed # _ ~ Z~ ~~~ ,Volume 2 30y ,Page # Zl Spec house ^ yes ~ no Lot lines identifiable yes ^ do SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterptumber, journeyman plumber, restrictedptumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the 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 retunted to the St. Croix County Zoning Office within 30 days of the thr ~ ~ riate. __ _ . io l ~'l may' SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that alI statements on this form are true to tlac best of my (our) knowledge. I {we) am (are) the owner(s) of the property d scri above, by virtue of a warranty deed recorded in Register~of Deeds Office. S NATURE OF A LICANT ~D l IOJr DATE *'**** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****. ** Include with this application: a stamped warranty deed from the Register oFDeeds office a copy of the certified survey map if reference is made in the warranty deed Parcel #: 002-1005-70-050 10/06/2005 04:56 PM PAGE 1 OF 1 Alt. Parcel #: 03.29.16.46A-20 002 -TOWN OF BALDWIN Current !,Xj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current CaOwner O -LEE, NATHAN A NATHAN A LEE 1090 7TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(esj: ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 13.402 Plat: 4488-CSM 17-4488 002-03 SEC 3 T29N R16W PT NW SE CSM 17-4488 LOT 1 13 402 AC BlocklCondo Bidg: LOT 0 1 ( . ) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-29N-16W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 07/03/2003 728648 2300/210 WD 07/03/2003 728647 2300/209 TD 03/28/2003 715037 17/4488 CSM 03/05/2003 712116 2162/83 C~ reF 9f1(1~ SI IMM~RY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class UNDEVELOPED G5 PRODUCTIVE FORST LANC G6 Last Changed: 06/25/2004 Acres Land Improve Total State Reason 5.402 2,200 0 2,200 NO 8.000 7,200 0 7,200 NO Totals for 2005: General Property 13.402 9,400 0 9,400 Woodland 0.000 0 0 Totals for 2004: General Property 13.402 9,400 0 9,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04!17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 2300:'= 210 STATE BAR OF WISCONSIN FORM 2 - 2000 Document Number WARRANTY DEED This Deed, made between Michael L. Dorwin and Kay D. Dorwin, husband and wife Grantor, and Nathan A. Lee, a single person Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Part of the Northwest Quarter of the Southeast Quarter (NW 1/4 of SE 1/4) of Section Three (3), Township Twenty-nine (29) North, Range Sixteen (16) West, Town of Baldwin, St. Croix County, Wisconsin, more particularly described as follows: Lot One (1) of Certified Survey Map filed March 28, 2003, in Volume 17 of Certified Survey Maps, at Page 4488, as Document No. 715037, St. Croix County, Wisconsin. 728648 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 07/03/2003 09:10AK WARRANTY DEED EXEMPT t REC FEE : i i . 80 TRANS FEE: 80.40 COPY FEE: CC FEE: PAGES: 1 Area Name and Return Address Thomas A. McCormack 102010th Avenue Baldwin, WI 54002 002-1005-70 Parcel Identification Number (PIN) This is not homestead property. (~ (is not) Exceptions to warranties: easements and restrictions of record. Dated this 3 Q day of , 2003 AUTHENTICATION * M'chsel L. Dorwin t.--~ * Ksy .Dorwin Signature(s) ACKNOWLEDGMENT STATE OF WISCONSI St. Croix N ) ss. County ) authenticated this day of Personally came before me this ~~ day of ~ _ 2003 the above named Mich 1 L. Dorwin and ICay D. Dorwin, husband and wife TITLE: MEMBER STATE BAR OF WISCONSM,. •'' >f~' ~ lrts ~, (If not, ~' '~...~~ •" •.ti~ a known to be the person(s) who executed the foregoing ~*`~ • '• t ac a ed the same. authorized by § ?06.06, Wis. Stats.) ~-~ ~ J THIS INSTRUMENT WAS DRAFTE r ~ ~ «' a R. Jens Thomas A. McCormack , ~ NoQry Public, State o ISCONSIN Baldwin, WI 54002 ' 4 Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are n e••• sary7"~ ~ `p~o~ -07-201)7 , _ ') * Names of persons signing in any capacity must be typed or p tttod.below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO (800)655-2021 www.inf FORM No. 2 - 2000 oprof°rms'com 0?/0/2005 00:44 7153810236 MARQUTTE LEE PAGE 05 ~-- .. , - '7 1x037 VQL 17 ..PAGE t~488 R6GISTSR OF ASbDS ST. CROI]t MI ts3%28/Z003 11 ~cQ~r~~rTre StfitV131E' HAP CER7I~IED SURVEY MA.P PA[3ss:~ TOWN? OF 6ALDWI ST 4 CROIXF COUNTY ~ W2SC~SIN N 3, T29N. Fi 16Mt. G1r1APHIC SCALE 1 ~ =2Ofl o BOO aoo 600 BEARINGS 1aEFEFiEMGk"D TD THE N01:7T}i-SOIITFi 1/4 ~CT~ ~ 70 BEAR NOO°29 15I~~ ~GTIflN 3, -(~- ~jQj~ The lot ehovm hereon is s<b)ec1 w that oonoelvadon essertlelri as daect(bed in Vd~+e 2139 .Page 5a I . DootNtlent Na. 7'09393 _ In the St. Croix CowtY 1 Register of Deeds. ~ 1 L!`GEMD INDICATES SECTION COFINEW MONUMENT ( AS NOTED )• -~- - INpzCATES i" X 24" ( OUTSIDE ~ 13 L~9.4R. / ~ /W FOO7I~ ---.+.- - INOiGATES FENCE - ~,~ - ~NDICaTES wET~AND 90UNDARY ~/ INDICA'T'ES NET PROJECT AREA fI[~1~ OF 'S.4t1 ACRES. ~~ KoT>IC~ sT~-T PREPAfaED BY: ~~/~YINcr~ 1239 C.TJi. "E" ~ I ~ I i 1 ~. I I I I ~( V ' i i _ Is 3`~~I~ ~ t(1a~ I u ~ j4 I ( I i~ I tr noc raw-nod wrr+,rn 3u Ye~l 1 aa°r°rer °'~e •oo~vvar e~U ceI I ~ nu11 and vok! 1 ( I i I I 1EF~6-~P~ RI~G~ AD SIN Bp,LOMfIN. MI_ 54D02 N1/4 CORNER. FwACTIONAL SECTION 3 MARKF.Ia NATL~FOIJ~o ) TER STEEL y^tiJayEY ~iIQTE: TI-E ORDINA,R~' HIGHWATER MAR)C WAS ~ . VERIFIED 8Y TIf ST. CROIX COUNTY ZONING OFFICE ~~i ON Q~/p5103. ~ N UNPIA'TTED LANi~ ~~ pE9CRiBED IN i VOLUME 1 SO6~ PAGE 55_1. ~ ~ SB7°45'54'E 539 A7' .~'~fi1 i ~~ .~ ~i~~~ ~~~ ~fi~~~° ~ ~~ ~'e / ~~/"// ---- :_ :x .~ r~ • ~a ~..~~ ~ 791 SCiUAi>E I • :~ :: Si ~i ~ ~l w r ~A gl Y ~ ~~ ~I j T-`J M97J47 37'~l ~- - i SOUTH LINE OF TI-1~ NWS/4 OF THE Sff i/4 ~ ~ ~1NPl.ATT~D L~-ND$ ~~ 33 ,., Si/4 CORNEA. FRACTIONAL CTSON 3 PIP1E FOltNO , OUTSIDE OIAMET~R ) IRON sr~T i of a ~7 VoI. T 7 Page 4488 ~- uVDICATES ?NAT PORTION OF ?FIE NET PROJECT AREA THAT MAY BE USED TO BUILD STRUCitNiES (t.e., owfftuNO, cswr~ACaEs, sl-ADS. eTC.11. TI-as PormoN OF TMIE NET PROJECT AREA EQUAI-9 1.9 ACRES.