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HomeMy WebLinkAbout002-1013-50-200Wisconsin,'~epartrpent of Commerce PRIVATE SEWAGE SYSTEM Safety end 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)]. Permit Holder's Name: City Village X Township Anderson, Joe Baldwin, Town of CST BM Efev: Insp. BM Elev: BM Description: ad Nl ~ 1 G5~ TANK INFORMATION TYPE MANUFACTURER ,i,SS CAPACITY Septic W~e~ 5 i~ Dosing ~ ~vc~ Holding TANK SETBACK INFORMATION TANK TO P/L ~~~'"". WELL BLDG. Vent to Air Intake ROAD septic ~ 3 ~~ 3 3' 33 ~ "' Dosing 3~ ~ N~ 33 , 3~ , Aeration Holding PUMP/SIPHON INFORMATION /1I~ Manufacturer ~ ~ Demand ~ per, GPM Model Number E `Pa Z~• 7 TDH Lift ~. 75 Friction Loss 0.8 System Head (, . Sb TDH Ft i~.os Forcemain Lengt~i Q / Dia. ~r Dist. to Well ~~ Z SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No : 499238 0 State Plan ID No: Parcel Tax No: bdti - 13 - 5D ~ ZOd Section/Town/Range/Map No: 06.29.16. ~~ STATION BS ~D ~ `IZ HI /ID , y FS ELEV. /t5~ Benchmark T• ~7 1t~'17 _ ~o Alt. BM ~: ~ ~. Gad ate, ~ . o /~ ~a, ~! z Bldg. Sewer ~, 5~ ~ •~ St/Ht Inlet I' ` .~ ,~ 9$ , ~ ~ St/Ht Outlet ~r ~ Dt Inlet `. •.. Dt Bottom /~a, z5 5'S , r Header/Man. ~ , 5 ~Da,.9 Z Dist. Pipe S' S io'~,9 Bot. System (o • Z /b ~/ , Z ~ Final Grade St Cover F• -~, ,, (', ~ ,/by. +/L BED/TRENCH Width ~ Length / No. Of enche ~ PIT DIMENSIONS 1 No. Of Pits Insid Dig a. Liquid\ DIMENSIONS ~a / O 1 (O ~ JJJ ~~K SETBACK SYSTEM TO P/L B LDG WELL LAKE/STREAM LEACHING Manufacturer: RMATION IN CHAMBER OR ~ FO Type System: 5 7 / 3d ~ ~~ ~ T / v UNIT r Model Number: OJ IIICTRIR11T1f1N SVSTFM W t'Jd~ Header/Manifold ~ b ' y ~ Distribution ~~ ~ Pipe(s) 2q ~~ tJ~t x Hole Size ~r ~/ ~ x Hole Sp7acing / g Ve to Air Intake ~/~ ~0 + 5 Length Dia I • Length Dia I 7 Spacing 3' 3 Z. U ~ J ~ a Snil COVER v Pruo~~~rc Svc4emc only YY Mnunrl C]r At.Grade Systems Only Depth Over i ed/Trench Center Depth Over Bed/Trench Edges ~ xx Depth of Topsoil ~ xx Seeded/Sodded xx Mulched N ~ L ~ Yes No o Yes /•~f COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ / ZI / ~11~' Inspection #2:____/T_/_i Location: 1144 220th Street Baldwin, WI 54002 (NE 1/4 SE 1/4 6 T29N R16W) NA Lot 1 GIn,iS~ T lo.~ Parcel No: 06.29.16. 1.) Alt BM Description = ` ', ~ ~'`~" Go `~'~~ G~,.a,,; ,,`,5 ~ ~~ P~ U ~a ~~~ 2.) Bldg sewer length = 3 (o - amount of cover = / / / ~^ v S O w_ ~7 ~ -- -- - -- _ .. ___ _ _ _ _ _ ~. __-r.__ Plan revision Required? l Yes ~ No ~ ZZ. t7~o ~~J~~ 7~ Use other side for additional information. _ - ~ -I - ---' -_ _.. Date Cert. No. 3D-6710 (8.3/97) SOU LDS PUMPS ~~~ ~~_g~ t - ; • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. .~.. APPLICATIONS Specifically designed for the Blowing uses: • Effluent systems • Homes • Farms - • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/a'~ maximum. • Capaaties: up to ti0 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/i" NPT. • Mechanical seat: carbon- rotarykeramic stagnary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (Ei0°C) intermittent • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EP04 Single phase: 0.4 HP, 115 or 230 V, fi0 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, } } 5 V or 230V. 50 Hz, 1550 RPM, built in overload with automatic reset. • POWer Cord: 1 U f00t standard length, } fi/3 S1TW with three prong grounding plug. Optional 20 foot length, 1613 S1TW with three prong grounding plug tstandard on EP05). Available for automatic and manual operation. Auto- matic models include IWechanicai Host Switch assembled and preset at the factory. FEATURES ^ EP041mpeller. Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. nu~ss ~r to~- 9 s a ~ x v 6 z 5 0 a 4 0 ~ _ 2 0 Submersible Effluent Pump EP04 & EP05 Series ^ EP051mpeller: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effioent treat transfer, strength, and duratHlity. ^ Motor Cover. Thermoplastic rover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. 0 2 4 6 8 cartiaanr ^ Bearings: Upper and lower heavy duty ball bearing constnKtion. AGENCY LISTING C , SP` ~ ~ us3a~ cows Pumps is rio Soot Re~tered. 10 12 m3/h Goulds Pumps a Safety and Buildings Division County ~ 5 `' ( ` ~ ~ 201 W. Washington Ave., P.O. Box 7162 .. 7 , C~,v-- .~r" /SCO~~,~ Madison, WI 53707 - 7162 Sanitary Perrnit Number be filled in byCo.) Department of Commerce (608) 266-3151 q23 Sanitary Permit Applica ' n In accord with Comm 83.21, Wis. Adm. Code, personal infon~~t~ State Plan I.D. Numbe ~ '„S ~ `'] / / ~ ~St'tar /~.'~ may be used for secondary purposes Privacy Law, s15.04(I xm) roject Address (ifdifferent than mailing address) L Application Information -Please Print Atl Information ~~~ y y a ao ~ ~~... Prope~Owner's Name ~C arce Lot # Bloc # Propert y Owner's Mailing Address QC~ 3 Property Location ~j / 0 ~ / ~ ~ ` Y ~~ Y. ~~ '/. Section ~ City, State Zip Code -~'h~~l , , , _ ~~~ ~ ,e~/ V _ (circle ne) T ~N; R~E 1~ II. Type of Building (check all that apply) . ~ 5 or 2 Family Dwelling -Number of Bedrooms ubdivision Name CS umber '~ v. a PS 7 ~ ~~~ ^ Public/Commercial -Describe Use o ^ S[ate Owned -Describe Use ^City Vil e ship of IiI. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New S stem y ^ Replacement System ^ 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 ~ ~ t( ~ f `~ IV. T e of POWTS S stem: Check all that a 1 ~ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil Moon < 24 in. of suitable soil ^ 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-less Pipe ^ Other (explain) I V. Dis ersal/TreatmentRrea Information: Desi n Flow (gpd) ~ o Design Soil Applicatio ate( ' Dispersal Area Required (sf) Dispersal Area Pro osed (sf) ~ System Elevation o /.p ~,o~,cc~1 ~QO G o /b 3 , X33 VI. Tank Info Capacity in Gallons Total Gallons umber of Units Manufacturer (,dr~ 14^'J~^ Prefab ~oncrete Site Constructed Steel Fiber Glass Plastic New Existing i ,(`_~;' Tanks Tanks Sepric or Holdine Tank )7~ /a w-~ «OO Aerobic Treatment Unit Dosing Chamber ~ ,~ OO ~/~ - _ . ~d VII. Responsibility Statement- I, the undersigned, assume responsibility for loin tallation of the POWTS shown on the attached plans. Plu is Name (Print) Plumb Signatur /MPRS Number Business Phone Number ~ u7~i~ aao~~-7 ~~s- ~6 ~~ ~s ~-- Plum 's Address (Street, Ciry, State, Zip Code) ~© ~ , ~c l / G~ ~ ~~~ VI I. Count '/De artment Use Onl Approved ^ Di Sanitary Permit Fee (m des Groundwater Date Issued Issuing gent Signatu ( St mps) ^ Surcharge Fee) ~~+f~` O~ iJ O en Reasot Denial ,, ,J IX. Conditions al ~L ~\ 1 /I ~ ,Q., ,,~-„ ^..}.-~ ~ __ ~,`` • "`"'~ 3~'~l _ SYSTEM OWNER: (ll (`~~ f 1 Septic tank, effluent filter and ~ .p' ~~ M ~ C~.~, Qo ~ t~ 1 1 U dispersal cell must all be serviced /maintained /~ as per management plan provided by plumber. g3• ~3 " ~ ~~l' ~R r-~o ~ 2. All setback requirements must be maintained ~-~"~-~nn' 1 NFL as per applicable code/ordinances. ~~jtrlJC., 4~- 323 ~3~ K . lam. ~~ Attach complete plans (to the County only) foTlhe systep;per ns than 8112 x 11 inche size SBD-6398 (R. 01/03) U R.orri.~w i _,~ •:~ . i ~liZ _ _ `ova - ~~~ti~ ~o~ .~ ti~ ~ © ~ /~ ~ 1 .. OO ~ //~~ pQ ~. _ ay ~ _ : . ~~ ~ ~ ~~~ i ~ ~ ~ ~~ t ' 2 ~ ' ~ ,~ j ~~f.~ .9 X __ - ~. .- '~ o ~ Q~r ~iZ - -IbQ dF SP- ~ 1+~1 IWD it Q~ f}AgD 6cr~w~ t~ 1 P-C.~S v f commerce.wi.gov i ^ ~scons~n Department of Commerce October 19, 2006 CUST ID No. 224832 MARY JO HOLLISTER HOLLISTERS SOIL TESTING W9875 690TH AVE RIVER FALLS WI 54022-4011 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/19/2008 SITE: RECEIVED OCT 2 3 2006 ST. CROIX COUNTY ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Safety and Buildings 4003 N KINNEY COULEE RD t.A CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary Identification Numbers Transaction ID No. 1335326 Site ID No. 719586 Joseph & Kathy Anderson Please refer to both identification numbers, 220th Street above;. in all corres ondence .with the a enc . Town of Baldwin St Croix County NE1/4;:SE1/4, S6, T29N, R16W - - FOR: Description: Three Bedroom Mound System /New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1103100 Maintenance required; 600 GPD Flow rate; 20 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/O1) 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 located and constructed in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 tank/filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. G'c~rt~~ ~EE~~ral~~, ~~.. DEPA~~iN1Elv~i of a7r~rrr~~ct MARY JO HOLLISTER Owner Responsibilities: Page 2 10/19/2006 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating [o proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual andlor owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -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 maybe 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, erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry, swim@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 ., Wisconsin Department of Com,~~ SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings t;omm a5, vans. ream. wce County ST. CROIX ust Pl i 1 i h i an m nc es n s ze. Attach complete site plan on paper not less than 81/2 x 1 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. (Pending) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please prima I/~~~E,® R ~ ~ by ~ Date ~ ~~ Personal information you provide may be u for secondary purposes (Privacy Law, s 15.04 (1) (m)). b Property Owner pf T 2 g 2006 opertyLocation ^ 29 16 6 ^ W SE ~ ~ CORNEALNS TeGROOTENH[JIS ( uyers. oeseph Anderson) (or) 1/4 g E N R T 1/4 vt. Lot ----- Property Owner's Mailing Address ST. CROIX COUNT L t # Block # Subd. Name or CSM# 1138 220th Str t -- -- CSM Pending City State Zip Code one Number ity ~ Village Town Nearest Road Baldwin, WI 54002 ( 715) 684 - 3485 220th Street New Construction Use; Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ~ Public or commercial -Describe: Parent material outwash Flood Plain elevation if applipble l~A ft• General comments Mound System -- 1.34 ft. sand fill -- 0.61oading rate and recommendations: Additional baring required to move system area out of O.H.W.M setback. ~~ a Boris # U Boring 0 pit Ground surface elev. 97.86 ft. Depth to liming factor 25 in• Soil A lication Rate i D th i ant C lor D tion Redox Descri Texture Structure Consistence Boundary Roots GP D/fP Hor zon ep in. om n o Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 7.SYR4/3 -- sl 2fsbk mfr cs 3vf-co 0.6 1.0 2 4-12 7.SYR4/3 -- sl 2fsbk mfr cs 2vf-co 0.6 1.0 3 12-25 7.SYR4/4 -- sl 2fsbk mfr as 2vf-m 0.6 1.0 4 25_32 7.SYR4/4 f2f7.5YR4/6 sl 2fsbk mfr __ lvf-m 0.6 1.0 Some gr in alt horizons. a Boring # ~ Boring 102.06 23 ^ Ground surface elev. ft. Depth to limiting factor in• Soil A ligtion Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft° p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 7.SYR4/3 -- sl 2fsbk mfr cs 3vf-co 0.6 1.0 2 4-10 7.SYR4/3 -- sl 2fsbk mfr cs 2vf-co 0.6 1.0 3 10-23 7.SYR4/4 -- sl 2fsbk mfr as 2vf-m 0.6 1.0 4 23-30 7.SYR4/4 t2f7.5YR4/6 sl 2fsbk mfr -- lvf-m 0.6 1.0 Some gr in all horizons. * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L - tmuent rf~ = tsvu5 ~ ~~ ., yr~ anu ~ J~ _ w ~ ~ ~ CST Name (Please Print) ignature CST Number Ma Jo Hollister 224832 Address ate Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 06 - 22 - OS (Revised: 10-10-06) (715) 426 - 1775 Property Owner TeGrootenhuis (Buyers: Anderson) parcel ID # (Pending) Page 2 of 3 3 ~„~ Boring Boring # ^ Pit Ground surface elev. ~' 16 ft. Depth to limiting factor 20 in• Soil A lication Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f1T p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR2/2 -- 1 3fabk mvfr as 3vf-co 0.6 0.8 2 10-20 10YR3/4 -- sil 3fabk mfr cs 2vf-m 0.6 0.8 3 20-24 10YR3/4 -- sil 2fabk mfr -- lvf-m 0.6 0.8 Some cobbles. a Boring # ~ BOOB 103.36 35 Pit Ground surface elev. ft. Depth to Limiting factor in. Soil A lication Rate rizon H De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0_g 10YR2/2 -- 1 3fsbk mvfr as 3vf-m 0.6 0.8 2 8-14 2 1 Zfsbk mvfr as 2vf-m 0.6 0.8 3 14-18 10YR4/4 -- sil Zfsbk mfr as 2vf-m 0.6 0.8 4 18-35 7.SYR4/4 -- sl Zfsbk mvfr -- lvf-m p,6 1.0 Some gr. Boring Bonng # Grour~ surface elev. ft. Depth to limiting factor in. Pit Soil ligtion Rate i H D th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff or zon ep in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Tes[ (R.07/00) pwr ~. v j _ ~ ~~~ r 1 _ ~ 1 ~~ f}A~ 6 a~uu~ ~1~,. I~' 1 piC,~S V~lrG~ ~~ p~~ piv~w~l~ w ~a ~~ v ((DD~~ _ G F ~ p ~q. LCL,e.~fr5r+ ~ ~,. a ,~ti p ~ it 1 oo ~ i~; fl0 ~ r ~~/ /~. i~~~ ~ *' '~ ~t~CP 7i•''~ . ~. _.. _ ... Wiscoru~ Department of Carraneroe SOIL EVALUATION RE RT 1 d 3 Division d Safety and Builydirgs -- __- in accordance with Comm 85, Wis. Adm. Code RO Attach oorrrplebe sith plan on paper not less than 812 x 11 inches in s¢e. Plan must inctude, but not limited to: vertical aril horizontal reference point (BM), direction and ISLi -- - ~endi g) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please prli-f all infivrntation. Personal'udonnationycu provide may be used for seoondarY purposes (Privacy Law, s. 15.04 (1) (m)). Q Ply Owner Property Location ^ C012NEALNS TeGROOTENHUIS (Buyers: Joeseph Anderson) Govt tot ----- NE 1/4 SE 1l4 S 6 T 29 N R 16 E (or) W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 1138 220th Street -- - CSM Pending State Zp Code Phone Number ity village own Nearest Road Baldwin, WI 54002 ( 715) 684 - 3485 220th Street a New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ~ Pudic or commercial -Describe: Parent material outwash Flood Plain elevation ff applicable ~A ft• General oomrrerits Mound System -- 1.34 ft sand fill -- 0.61oading rate and recommendations: Additional boring required to move system area out of O.H. W.M setback. i p 0 a Pit Ground surface elev. 97.86 ft. Depth to lirrrifirrg tailor _ 2rG ar. ~ ~pn Rate # ~ ~~ i i re T t Structure Consistence Boundary Raots GP D/fr= Horizon Depth in. Dominant Cobr MunseN on pt Redox Descr Qu. Sz. Cont. Color ex u Gr. Sz. Sh. 'Eff#1 'Efl#2 1 0-4 7.SYR4/3 - sl 2fsbk mfr cs 3vf-co 0.6 1.0 2 4-12 7.SYR4/3 - sl 2fsbk mfr cs 2vf-co 0.6 1.0 3 12-25 7.SYR4/4 - sl 2fsbk mfr as 2vf-m 0.6 1.0 4 25_32 7.SYR4/4 tzf~.5YR4/6 sl 2fsbk rnfr __ lvf-m 0.6 1.0 Some gr in all ~O°S• 2 LJ Boring 23 ~9 # Ground surface elev. 102.06 ft. ~ to 9 factor, in. 0 Pit Sod ication Rate i C b Descri tion cto R Textun: Stnxture Consistence Boundary Roots GPD/fP Horizon Depth in. r nant o Dom Munsell p r e Qu. Sz. Copt Coles Gr. Sz. Sh. 'Eff#1 'EfF#2 1 0-4 7.SYR4/3 - sl 2fsbk mfr cs 3vf-co 0.6 1.0 2 410 7,SYR4/3 ~ sl 2fsbk m& cs 2vf-co 0.6 1.0 3 10-23 7.SYR4/4 - sl 2fsbk mfr as 2vf-m 0.6 1.0 4 23-30 7.SYR4/4 t2f7.5YR4/6 sl 2fsbk mfr - lvf-m 0.6 1.0 c3oiil€ ~¢ iu gll hnri~ons. ' Eft1ueM #1 = BOD > 30 < 220 nglt and l u5 >30 < 15U mg/L - ranutsa +rc = ows _ .n, . gyn. a,.. , _ ...y= CST Name (Please Print) Y J Signature 7VG~~iliJ ~ CST Number Marv Jo Hollister f ~1 ( U 224832 ~~ Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 06 - 22 - OS (Revised: 10-10-06) (715) 426 - 1775 Property Owner TeGrootenhuis (Buyers: Anderson) paroe! ID !>` (Pending) ~ ~ ~..~ ~n9 3 goring # Ground surface elev. 99.16 ft. to 1'arating factor ~. Q Pit Soil ication Rate Horizon Depth Dominant Redox Description Texture Stnxx~uure Consistenxe Boundary Roots GPD/ff? i... !',~u~e!! (h. Lz. Gotn: C•e!o!' G Sz. Sh. 'Eff#1 `Eff#2 1 0-10 l0Ylt2/2 -- 1 3 bk mvfr as 3vf-co 0.6 0.8 2 10-20 10Y123/4 -- sil abk mfr cs 2vf-m 0.6 0.8 3 20-24 10YR3/4 - sil 2fabk mfr -- Ivf-m 0.6 0.8 Some cobbles. ~9 ~ ^ Boring Pit Ground surface elev. 103.36 ft. ~ to leg tailor 3$ in. Soil ication Rate Horizon Depth Dominant Color Redox Desrxiptiorr Texture Structure Consistence Boundary Roots GPDlff in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 ag 10YR2/2 -- 1 sbk mvfr as 3vf-m 0.6 0.8 2 8-14 1 2fsbk mvfr as 2vf-m 0.6 0.8 3 1418 t0YR4/4 - sil 2fsbk mfr as 2vf-m 0.6 0.8 4 18-35 7.SYR4/4 -- sl 2fsbk mvfr -- lvf-n- 0.6 1.0 Some gr. ^ Borirg ~ ~ Boring Pit Ground surface elev. R Depth to grating factor in. Sal ication t2ate Horizon Depth Dominant Coi Redox Description Texture Structure Consi~ertce Boundary Roots GPDlf>a in. Munseti Qu. Sz CoM. Color Gr. Sz. Sh. `Etf#1 'Eff#2 * Effluent #1 =GODS > 30 < 2211 rrgll and TSS >30 < 150 mgll ' Eflluera a`2 = 80D5 <_ 30 riK,jlL and TSS <- ~ mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sBn-sssar~a tx.mroo~ ~.ora u~S ~ ~ ~ `11~.~Mr._ ~G NpR-~fit plt,. 0 ('A~~' : I ~~~ t~ J C.7ci1. D~ .n9 x h ~Z 9b• ~ ~/ n i_ ~-_ a .9~ f1 r ~au.~~^!k UIMCfl 100. c~ it2 - 'tb~ OF SPI l~ N 6 IWD t Q ~ }tAN~D 6 o'~1/a'o I$'.1 ACAS RECEIVEQ OCT 1 3 2006 SAFETY & BUILDINGS MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: JOSEPH ~ KATHY ANDERSON Owner's Name: same Owner's Address: 907160th Street Hammond, WI 54015 Legal Description: NE1/4 of the SE1/4, S 6, T29N, R16W Township: Baldwin County: St Croix Subdivision Name: Lot Number. Parcel I.D. Number. Plan Transaction No.: o • ~ o ~5 ~' ~ N `S ~ ~ / ~'' • • ~ :' MARY ~O `.{pt_LISTER 1859 RIVER FA--LS, ~. ~ W~ Q. ~0®0.,. ~~S'C,~N~~~~~ •~~~~~~ii~*~~ Block Number. NA Pending) Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specfications Page 8 Plot Plan Designer. Mary Jo Hollister L'~cense Number. 1859-007 Date: 10/11/06 ~ ®®~~~ Phone Number. (715) 426 -1775 Signature: (Il.Gts Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01!01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.0 (R. 04/03) :y,~„,,, ,,, ,,, .. _ Page 1 of 8 .~~ SEE CGi~RPSPO, t=tvCE Mound and Pressure Distribution Component Design Site Information 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) 12.00 Site Slope (%) 102.50 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft~) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/fl2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information c Center ar End Manifok! 3.33 Lateral Spacing (ft) 6 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 15.00 Forcemain Length (ft) 97.00 Pump Tank Elevation (ft) Z. '~ /~ 6.50 System Head (ft) x 1.3 6.33 Vertical Lift (ft) ~~J ~ 0.20 Friction Loss (ft) 13.04 Total Dynamic Head (ft) Note: Sand fdl (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal c~liform of <= 36 inches. 10.00 Cell Width (ft) Are the laterals the highest point in the distribution Y network? If N above, enter the elevation (ft) of the highest point. 10.00 ftz/orifice Does the forcemain drain back? 2.45 Forcemain Drainback (gal) 55.93 5x Void Volume (gal) 58.38 Minimum Dose Volume (gal) 24.72 System Demand (gpm) Lateral Diameter Selection Manifold Diameter in. dia. o tions choice in. dia. o tions 0.75 x 1.25 x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x _ 3.00 2.00 x 3.00 x Treatment Tank Information 1200.00 Septic Tank Capacity (gal) Wieser Manufacturer Dose Tank Information 800.00 Dose Tank Capacity (gal) 22.22 Dose Tank Volume (gal/in) Wieser Manufacturer x Y GallonsJlnch Calculator Total Tank Capacity (gal) Total Working Liquid Depth (in) ~~ gaUn (enter result in cell t349) Effluent Fitter Information Zabel Filter Manufacturer A100 Filter Model Number Project: JOSEPH 8~ KATHY ANDERSON Page 2 of 8 Mound Plan View 1- 1_ ... ....... :-:-1110 B ~:~:~:=:~:~:~:=:~:~:~:~:=:~:~:~:=:~:~:~::::::-:-:~:-:-:-:-:-:-:-:-:-:-.. : s ::-:::. .... ...... Observatron Pipe -:-- ~- .. . K: O D ~:E: - - :I::~-.~.-.-. B ~~ -f -~ -~ -1 L Mound Component Dimensions A 10.00 ft B 60.00 ft D 16.00 in 1669.92 (ft2) Basal Area Available 6.00 (ft)1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.60 (ft) --- ...................- G I -...................... 2 .................:..... I F Dispersal Cell 103.83 (ft)-- _= ~ ~ ..:::::::::::::::: Dispersal Cell :.:.~. E Elevation ~~~~~ D Q •= . . .....- a. 12.0 % Site Slope Shading Key 1~ ~~ Topsoil Cap © ~~ ~;;~„ Subsoil Cap ~-~::: ASTM C33 Sand Tilled Layer Q5 ~-] Aggregate 'v $, ~- Dispersal Cell ~ o. 1.5 ft wa ~ a o~ a o w 0.5 ft Typical Lateral :~ o ~ _ ~ ~--~- A E 30.40 in F 9.25 in G 0.50 ft H 1.00 ft z 17.83 ft J 5.74 ft K 11.11 ft L 82.23 ft W 33.58 ft 600.00 (ft2) Dispersal Cell Area 10.00 (gpd/ft) Linear Loading Rate H 104.33 (ft) Lateral Invert 102.50 (ft) Contour Elevation /'~ Geotextile Fabric Cover ,/ See lateral details on Page 4 for number, size, and spacing of laterals. F Laterals are equally I spaced from the distribution cell's centerline in the ' distribution cell (AxB). Project: JOSEPH & KATHY ANDERSON Page 3 of 8 Center Connection Lateral Layout Daigram Face min corriection via tee or cross to mara'Fold at an9 point. P •=Turn-uprdbsllashrear IFX-~~€'~ ~2~I cleanoutplug Holes driNed on the bottom aF the lateral. L~erafs are ider-tic al Laterals ~ force mae- of PVC Sch +FO per l~]MhA Table $x.30-5 'F- S a t S y Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 6 Orifice Diameter 1.25 in Orifice Spacing (X) 29.26 ft Orifices per Lateral 3.33 ft Orifice Density 4.12 gpm Manifold Length 24.72 gpm Manifold Diameter 13.04 ft Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and -~ Comm 16.28 WAC Tank component is properly vented Wieser Ca aci 800.00 Volume 22.22 Dimension Inches Gallons A 19.38 430.54 B 2.p0 44.44 C D Total 2.63 12.00 36.00 58.38 266.64 800.00 Manufacturer ~_ Gallons galrnch A B C D Disconnect tank. Alarm Manuafacturer Tank Alert Alarm Model Number HW101 Pump Manufacturer Gould Pump Model Number PE 41 Pump Must Deliver 24.72 gpm at 13.04 ft TDH Project: JOSEPH & KATHY ANDERSON 0.125 in 3.08 ft 10 10.00 ftz/orii 6.67 ft 1.251 in 2.521 ft/sec Locking cover with warning label and locking device and sealed watertight 4 in. min. ~- Attemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~um~off elevation (ft) 98.00 D` ose tank elevation (ft) 97.00 Page 4 of 8 Mound System Mainfienance and Oueration Specifications Service Provider's Name Darrell Septic Phone (715) 425-1025 POWTS Regulator's Name St. Croix County Zoning 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 m9n- Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 flz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure Systemr Laterals should be flushed and pressure tested every 1.5 Mound Inspect for ponding and seepage once every 3 years 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 Turn-up Detail 6-8 Diam Cteanout Sprinkler II Valve Distribution Lateral Finished .............•• ............... Grade v1 eter Lawn - ~ ~ ~ ~ ~ ~ ~ ~:~ Threaded --~ ~----------------:-.-. Plug or f3a Valve Box Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JOSEPH 8~ KATHY ANDERSON Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shah tre operated in akx:ordance with Comm 82-84 Wis. Adm. Code, and shall maintained in akxrordance wNlr 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 acxordance 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 corers should be inspected for water tightness and soundness. Access openings used for service and assessrrrent shall be sealed watertight upon the completion of service- Any opening deemed unsound, defective, or subject to failure must be replaced. F~osed access openings greater than 8-inures in diameter shall be secun~l by an effective locking device to prevent aociderrfal or unauthorized entry into a tank or cornponent. Septic Tank The septic tank shall tre 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 akx;ordance with NR 113, Wis. Adm. Code. The operatir~ condition of the septic tank and outlet filter shah be assessed at least once every 3 years by inspection. The outlet filter shall be Deaned as necessary to ensure proper operation. The filter prtrid9e shoukt not be removed uninss provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an aaarm, the filter shall be serviced if the alarm is ac#ivated confinuorrsty. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its content": 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 tmre of a triennial assessrrrent, 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 ctrerrrical 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. Puma Tank The pump (dosing) tank shall tre inspected at least once every 3 years. All svritches, alarms, ar-d pumps shall be tested to verify proper operation. ff an effluent filter is installed within the tank it shall be inspected and serviced ~ necessary. Mound and Pressure Distribution Svstem No trees or shrubs shoukt be planted on the mound. Plarrtings may be made around the mound's perinieter, and the mound shall 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 reoorvmrended since soil canpac6or- 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 muinhed as protection from 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 BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mt_ for highly treated effluent Influent fkrw may not exceed maximum design flow specified in the permit for this installation. The pressure d'~stribution system is provided with a flushing point at the end of each lateral, and it ~ recommended that each lateral be flushed of akx;rrmulated solids at least once every 18 months. When a pressure test ~ performed it should be compared to the initial test when the system was installed to dethrmine if orifice Dogging has occurred and if orifice leaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the d~persal cell shall be d>edked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an mpending hydraulic failure requiring additional, more frequent monitoring. Corrtinc~ency Plan If the septic tank or any of its comporrerrts treoome defective the tank or component shah be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring bekxxnes defective the defective cxxnponerrt(s) shall be inrmediatey 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, ft will be repaired or replaced in its' present krcatan by increasing basal area if tce inakage occurs or by removing bioiogicaNy logged absorption acrd dispersal media, and related Piping, and replaing 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: JOSEPH ~ KATHY ANDERSON Page 6 of 8 . ~GOULDS PUMPS Submersible Effluent Pump PE SPEOfI 'ilOMS APPLICATltNIS S~cialll- designed for the fotbwing uses: • Mound Systems • Effluerrt/Dosing Systems • tnw Pressure Pipe Systems • Basement Draining • Heavy Duty Sumps Dewatering METERS FEET' i 40 r 35 30 t"PE4t y 25 ~._ , -~. e 20 ~~ j 0 0 15 ~--; r ? tt --r': Pump -General: • Disd~rge: l %' NPi • 7emparattne:104•F (40°Q maupmum, continuous when ~uWlly s~~bmertp'd. • SO!!dS handling.'/!" maximum sphere. • Automatic modeh irTdude a float swvitch. • Manual models available. • Pmnping range: see Perfamanae chart or curve. PE31 Pump: • Ma>amum capedry: 53 GPM • Maxinwm head: ZS' TDH PE41 Pump: • Maximum opacity. 61 GPM • Maximum head: 29' TDH PE51 Pump; • MaTdmum capacity: 70 GPM • Maximum (read: 37' TDH 2 GPM 1 FT General; • Sntgle Phase • 60 Hertz • 115 and 230 vas • Butt-in dtenrra! overload pro- tediart with autom~c reset • Vass B insulartion. • pg-.flea design, High strertgtit carbon steel shalt. PE31 Motor: • 33 HP, 3000 RPM • 115 votes • Shaded pole desi~r PE41 Motor: • .40 HP, 3400 RPAA • 115 and 230 volts • PSC design PE51 Motor: • .50 HP, 3400 RPM • 115 and 230 volt • PSC design Des: PE3r. vfs4t, 3~..+o .so ._~.. .r.. ..r _ :~_ 0 --% 20 30 40 50 60 o sa~Q 1o rs ~-1 ~ 1FBATIIRES ^ Corrosion resistant tonstnrcuorT. ^ Cad ion body. ^ Thermoplastic impeller and onver. ^ t-ppEr sleeve and IOWer heavy duty bal! bearing conswction. ^ Motor is permanently lubricated for extended service life. ^ flowered for continuous operation. ^ All ratings are vvid>;<rr the working (units of the moto-. ^ t~,idc dlsconrrect pov-rer cord, 20' standard length, heavy duty 1643 S1T1Al with 115 Or 230 volt groundit»g plug. ^ CohnpteM unit g heavy duty, portable and oompa~t ^ Mechanical seal is carbon. ceramic, BUNA and stainless Steel. ^ Stainless steel fasteners. s~- c us Tested to i1L 778 and CSA 22.Z 108 ~ Canadian 9ra~ AuodiEinn Cli a #~trO854s Gerdds-~rnpc~lS090Dt , .~ _~ P~Ni~-~~: =i_~ ~t2Q3~CT+3tast:Ptt ~ KflT~ 1 GPM 80 ~~~ _ ~ C,~ m3,r, Goulds Pumns a V~~G~ ~~ p~~ Q~~,~Y . , _ _ tia M ~~ ~~ V ~ C ~ "Y ~ /~ ~ ~ .. °~ ,~ r.,' po a °{~ ~I I ~\ ? i~~I J ~ ~ ~ . ~~ r 1= ~ X a ~ ~ n _ q3 ....r ..c ~ UL IN_ ° e~- 2 - .-- -- tOZ.b ,,.i~~rw wia~r~t Q.~~g~~ ~S 1 Acmes .~ ~ dv`~ ~•- ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~e-2 Mailing Address ~0 ~ ~ /, D ~ ,~?; ~ ~-L ~ Property Address ~l y a p2d ~ S T -° (Verification required from Planning & Zoning Department for new construction.) , i City/State f~(~,Gt~; W~ Parcel Identification Number Z-- (Q~"j~'S~- ~,d'j~ LEGAL DESCRIPTION / ~' ~ ~~ ~\ Property Location ~Ng'/4 , 5~ '/4 ,Sec. ~ , T o7Gl N R~IJ W, Town of ) ~,3 ; Subdivision Certified Survey Map # Lot # Volume o~ 02 ,Page # sail Warranty Deed # ~ 3~ y g O ,Volume ,Page # Spec house yes Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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. 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 returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~ ~ SIGNATURE OF APPLICANT(S) ~/~/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 8374gtmt II STATE BAR OF WISCONSIN FORM 3 - 1998 ~ KATHLEEN H. MAI.SH QUIT CLAIM DEED DEE DI R" ~ ICROI C ~I ! I I S . [ X D Document Number ~ ~ RECEIVED FOR RECORD -- -_ - - - ~ ~ 10/26/2006 11: 15AN Thils eed, made between ~.1 ~ 1L~~ ~ l ['7.Y1~ ~~1C e_ ~ Ted ~-~~.t(l~ . t~ - _ (IUIT C A I L M DEED l 111 E E T ~ ~ _ ''+~ ~ _ _ _ Grantor, REC FEE: 11.00 [ and 1 ('~-~P ~ QI<lC ~Q t- ~ TRANS FEE: 150. 00 T T COPY FEE: -- - -- - - __ - CC FEE - - - PAGES: 1 _ .. Grantee. Grantor puit claims to Grantee the following described real estate in j '7Y . ~ '(~(~t X. County. State of Wisconsin: 1 P 5Z91o _ Lots / ~'2~Crr 1. iC.~e~ F _ --- ,_- _ _ -- Add __ - _ - ~ 2.2 age. ~~ ~ ~3 7 3 v~.~ ~ oco,~-E-d ~r~ (cos 4 of ~ ~ '!~1 0~ fie. NE '1~{ { and ~.c~- of i-tie 1JE 1144 of ~t SE'lti o~ Sec - to , T 2°l N , R- 1 ion . TOuJr~ o ~- ~.~d ~+'n, cJ~ - Cco~ X COt~Y~ ~ , lam, I I; f Together with all appurtenant rights, title and interests. Dated this °~~ day of ~'.~- _ ao0~ ~~-r-r~ o L~E.~I.~./~~~rr (SEAL) Signature(s) AUTHENTICATION ACKNOWL State of Wisconsin, ` ~'~,;_ 31N ss. authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY_^,^ ~~ln e r ~ ~~ ~~C1c~,P f~ rl (Signatures may be authenticated or acknowledged. Both are not necessary.) Name and etum Tess ~ose_.p4n ~-Ko~~hec~~t~e ArrdefS~r~ °-~-~ ~ ~o+in s~ . l~owv~tm tsYx.~l , W ~ 5'io l L --- __-_--_-_-., O~ ~c~Z1a-3~0050_ ~_ Parcel Identification Nrmber IPIN) This l °J homestead property. (is) (ls not) -~`+~ '•t Z ` sA'~ V~ (SEAL) S`j~re; ~ coun~ Personally came before me this ~ ~i day of OC-'tO~x°Y . the above named S'~~ yi~.I r~..s ~ T~ roo'1 ~H h~,~~ f~l~~~~---r_ -T ~ ,r, o-i-~t~ ~,t` __ to me known to be the person ~_ who executed the foregoing instrument and acknowledge the same. e~~ ~ ~ • ~o~lee,1 t~- ~ alsh Notary Public. State of Wisconsin My commis ion is permanent. (If not, state expiration date: ,~ e Nam s of persons signing in any capacity muu be typed or printed below ihetr signature. t1~11T CLAIM DEED STA FORM No. 3 I jggg SIN Wisconsin L.egei ~aukee~.W CERTI Fi ED SURVEY MAP LOCATED IN PART OF THE SEA /4 OF THE NEB /4 AND PART OF THE NE'1/4 OF THE SE1/4 OF SECTION 6, T29N, R~6W, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. OWNER NEIL TEGROOTENHUIS 1138 220TH STREET BALDWIN, WI 54002 SURVEYOR'S CERTIFICATE PREPARED FOR KATHY ANDERSON 907 160TH STREET HAMMOND, WI 54015 SURVEYOR EDWIN C FLANUM NORTHLAND SURVEYING. INC. P.O. BOX 14 ROBERTS. WI 54023 1, Edwin C. Flamm, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Kathy Anderson, f have surveyed, mapped and described the parcel of land which is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as follows: A parcel of land located in part of the SE1/4 of the NE1/4 and part of the NE1/4 of the SE1/4 of Section 6, T29N, R16W, Town of Baldwin, St. Croix County, Wisconsin; described as follows: Commencing at the East 1/4 Corner of said Section 6; thence S00°02'45"E, along the east line of the SE1/4 of said section, 79.44 feet to the south line of Lot 1 of Certified Survey Map recorded in Volume 15, Page 4052 at the St. Croix County Register of Deeds office, being the point of beginning; thence continuing S00°02'45"E, along said east line, 1232.16 feet to the south line of said NE1/4 of the SE1/4; thence N87°38'43"W, along said south line, 1328.92 feet to the west line of said NE1/4 of the SE1/4; thence N00°08'10"W, along said west line, 1309.16 feet to the east -west 1/4 line; thence NOO°26'16"W, along the west line of said SE1/4 of the NE1/4, 167.98 feet to the south line of Lot 3 of Certified Survey Map recorded in Volume 14, Page 3794 at said office; thence S87°52'29"E, along said south line, 894.01 feet to the west line of said Lot 1; thence S00°30'13"E, along said west line, 250.26 feet to said south line of Lot 1; thence S87°52'29"E, along said south, 435.91 feet to the point of beginning. Described parcel contains 42.64 acres (1,857,211 Sq. Ft.). Parcel is subject to town road (220th Street) right-of-way and all other easements, restrictions, and covenants of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of the County of St. Croix, and the Town of Baldwin Subdivision Ordinance in surveying and mapping same. APPROVED sT creouc coulrrr Sao ~ z«~ OCT 2 S 2006 ff 1'IOt fa00r<,lad Wllllltll 30 tliyi Ot alppoval ~ fpprONal (hall be COUNTY TREASURER'S CERTIFICATE STATE OF WISCONSIN)SS COUNTY OF ST. CROIX) ,,,~ ScoNS,~~ EDWIN C. FLMIUM 5-2487 AMERY .. ;' :~ V1r18 c ~~ ~~ ts' Qi l.J s e ~ o' I, Cheryl Slind, being the duly elected, qualified and acting Treasurer of St. Croix County, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of lo'L 3i /O~ ffecting the land included in this Certified Survey Map. 1©Ja~-~c~-,co Che 1 lind, Date Cou Treasurer Each parcel shown on this map (plat) is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Baldwin. SHEET 2 OF 2 SHEETS 2ot2 Vol 22 Page 5296 ~3 6 3 7 3 2 3 CERTIFIED S V RVEY MAP LOCATED IN PART OF THE SE'1 /4 OF THE NE1 /4 AND PART OF THE NE7/4 OF THE SE'1/4 OF SECTION 6, T29N, R16W, TOWN OF BAL~WIN, ST. CROIX COUNTY, WISCONSIN. OWNER NEIL TEGROOTENHUIS 1138 220TH STREET BALDWIN. WI 54002 !~ ~,~ GIO ~IM 1 _I~ O ' ~: I r ~~c I ~~~° ~i0 ~'z I LOO 4 ~3 C~a~oGut]o OMn C~IOL~o 9 ~}~ (pia ~3DJ4 0 ~ m ----- ------------- 1 °' 400.00' '-' -'- -- -- - z w I zo ~_ N ~, I ~ t z° ~ ~ QOQ~ ~jq~ ~ Et/4 CORNER ~ aL__ WM ` ` u ~ N ~~~ ~ R - S89°40'09'W ON 6 115iTH • i S~1°.~2'29wE E)fIST •~ AVE. LEST 7 43s.at' ,,,~ _ ~(r 15.62 ACFiESINC F ~ • - ~ '~ 680,479 SO. FT. . - ~0~. VOL 22 PAGE 5296 KATACEElt H. REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 10/25/2006 09:30Al1 CERTIFIED SURVEY KAP REC FEE: 13.00 COPY FEE: PAGES: 2 PREPARED FOR SURVEYOR KATHY ANDERSON EDWIN C FLANUM 907 160TH STREET NORTHLAND SURVEYING. INC. NE CORNER HAMMOND. WI 54015 P.O. BOX 14 SECTION 6 ~ (R = S89°40'09"W) ROBERTS, WI 54023 poi ~~-te"E 94.01' 150.00' 344.07' ~ ~ i ~ w 75' SETBACK FROM N. r- F-- v z ORDINARY HIGH WATER m wpw= MARK ~ • J_ I :` ~5 ~ ~I CK FROM ORDINARY HIGH WATER ~L t~,~ . ~. MARK ~,.`L`1' o \ 15.45 ACRES EXC. RNV ~ ~ 672,884 SO. FT. ' ~ PROPOSED DRIVE ' N87°52'29"W 712.02' _ - ~- 75' SETBA • • • • • 678 99' EUNICE POST FROM THE DEPARTMENT OF NATURAL RESOURCES VERIFIED THE ORDINARY HIGH WATER MARK ON MAY 2, 2006. e w v~ w O v w \ ` 1g11i1p11!J/4~ I z gGO/yV ~ O ~ EDWIN C. Z £ FI/MJUM " ~ z~ : 52487 +- _ _ ANIERY G WIS ~~ "L /o LOT 2 27.01 ACRES INC RNV 1,176, 732 SO. FT. 26.26 ACRES EXC. R/W 1,143,669 SO. FT. SOUTH LINE OF SHE NE7/4 OF THE SE ~ N 0 v i w~ zz w w O ~ W V 'w- X ~ 2 i w°~ i ¢Q U ~ ~ ~ z _zwo m O O ¢~o THIS INSTRUMENT DRAFTED BY SAM ADAMS .106 NO. OS-29 DATE 6-27-05 BARN ° = 1 QSHEDS SHED: a ~~ EXISTING DRIVE HOUSE ~ ~ Fv SHED ~ ; -w :~ ~o I w: ~S I Z, .- ~: I uJ• c3• g z- w O; ~ ~; W I m, ~= o ~I : w .~ .o .~ c•J QI ~~ ~' ~I c'74 I L~~I I •I) I NI I(~N I I I I i Ni ~J1 1 ~I I ~p ~ N N p- ~N~ • N er w NI~o O iv ~ JS rvai-~8"4S"N1/ 1328.92' I MMt~L~C14 u°f~D ~C1_rM._D~ LEC~EN~ ~1 Q 1"STEEL SURVEY MARKER FOUND I • 1" O.D. IRON PIPE FOUND 1 p 3/4" X 18" IRON REBAR SET WEIGHING SE CORNER 1.50 LBS. PER LINEAR FOOT SECTION 6 ~ X X EXISTING FENCELINE (R = XXXXX) PREVIOUSLY RECORDED DATA SCALE !N FEET 1" = 200' SHEET 1 OF 2 SHEETS 200 0 200 1of2 Vol 22 Page 5296