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002-1018-80-000
~Nisconsin Department of Commerce ~2fety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. permit Holder's Name: City Village X Township Belz, Scott W. Baldwin, Town of SST BM Elev: Insp. BM Elev: BM Description: ~~ ~M I ~s TANK INFORMATION ~ TYPE MANUFACTURER ~',~,~ CAPACITY .~ Septic ~ ~ v ~-' •i ~ ~zSrJ Dosing ,gyp ~dYN d ~- / $ ~ .7GO X77 Fi I n ~Piw liO / d'V~'t> ~ Holding TANK SETBACK INFORMATION TANK TO P/L ; ~ L BLDG. Vent to Air Intake ROAD Septic ,~~ 7 J!~ / 5 Z Dosing 7$ i ' SU ~ /~ ~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ ~'~ DPMand ti_ aw Model Number ~~ ~~ TDH Li~ ?• ~~ / Friction Loss System e~~ TDH Ft Forcemain Le th / Dia. 2 ~l Dist. to Well > SO / SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 514994 0 State Plan ID No: Parcel Tax No: 002-1018-80-000 SectionlTown/Range/Map No: 09.29.16.126 STATION BS HI FS ELEV. Benchmark ~• i ~~ 3 .-t ~n c> Alt. BM ~~ ~ CoJ 3. 2- goo , Z Bldg. Sewer II• a pl / SUHt Inlet ~~• ~ / ` ~ SUHt Outlet ~_ Dt Inlet ~ Dt Bottom r !~• ~7 ~ Header/Man. 3.a `' ice. Dist. Pipe Bot. System 3• ~` Gq , 75 Final Grade ~ • Q ~D/I St Coverer / ~';~~ God ,3. Z ~ JU • Z ,, , r 5.v5 yam. r BED/TRENCH Width / Length ~ No. O renc PIT DIMENSIONS No. Of Pits Inside Dia. Liquidid De\ DIMENSIONS ~ 9~ ~ ~,_ ~ SETBACK N SYSl'EM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: `~ INFORMATIO Type f ystem: Z ` ~ / y~ , UNIT Model Number: 1~ o J O DISTRIBUTION SYSTEM I1 s~4~/ Header/Manifold y 'r Distribution z / ~ /~ / x Hole Size x Hole Spacing V o Air Intake 11 ~' Z ~ Pipe(s). ~~ `J ~ ~~ 3 ~ t Di i S LL 0~ ~J ~ ~. S'7~ CNq / Dia Length a pac ng Leng h S[)I(_ CnVER Y Druem~rc c.,~4om~ nni.. YY Mnund Or Of-Grade SvstPms ~nlv Depth Over Bed/Trench Center / / L Depth Over Bed/Trench Edges ` i xx Depth of Topsoil , ~ xx Seeded/Sodded (~es L] No xx Mulched ~es ~ No ` 7 i` '~o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: i - /~/ ^~^~-' Inspection #2: / / Location: 1063 230th Street Baldwinr WI 54002 (SW 1/4 NW 1/4 9 T29N R16W) 40 acres Lot ~'_.. ! ~~°',.~.~-. ~ ~ Parcel No: 09.29.16.126 C 1.) Alt BM Description = '• ~ ~ I..OJ~~ 01 ~ ~~,~ ~ ~ .- r/ .~ ~~ ~' ~J r j' ~ ~' . . 2.) Bldg sewer length = _~! I ~' - amount of cover = , Z ~ U `i°~a~ ~ ' ~ ., oe~~s 0o r_ Plan revision Re uired. Yes No Use other side for additional information. ____ ~ _. _- __. -~ - --- - __ Date Insepctor's ignatur Cert. No. SBD-6710 (R.3/97) ,.r ~,a~ ~~ ,~ s~rq ~. t:ommerce.wi.gov Safety and Buildings Division County r. 201 W. Washington Ave., P.O. Box 7162 ~-~ ~` /',~jc i sco ns ~ n Madison, WI 5 -71 Sanitary Permit Nupmber (to be filled in by Co.) Department of Commerce 5 ~ [ 9 Sanitary Permit Application eta js~ ~ y7°mbe` In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you purposes in accordance with the Privacy Law, s. 1fiQ4(1 xm), State. I. A licatiou Information - Please Pri Al nformation Property Owner's Name / Go % / L Z- Property Owner's Mailing Address lDly 3 Z~a~ s r City, State Zip Code C~~vW! ~ 1,1/t 5~oz II. Type of Building (check all that apply) / ~ ~l or 2 Family Dwelling - Number of Bedrooms T rovidep>~ ~be~t r~con SEP 2 4 '1008 ST. Cft01X COUNTY ZONING OFFICE Phone Number ?(S b85 Lot # .~ /4~3 z3~ u- Sdf~ Parcel # ooz -loll 8n-aao Property Location / Govt. Lot l ~~'/., ~l~ %, Section (circle on T o~ ~ N; R ~rio __ E ~~L Subdivision Name r ~~.,,•t..~. Public/Commercial -Describe Use ^ City of ^ State Owned -Describe Use / CSM Number ^ Village of t~i'j~ ~ Town of ~ /rf~L C~ W t v~ ((~ Otl III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~' ^ New S stem Re lacement S stem y ~ p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) List Previous Permit NumbeAand Date Issued B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Before Expiration Owner ~ 1 IV. T e of POWTS S tem/Com ooent/Device: Check all that a I L c~ L . ~.7 ^ Non-Pressurized In-Ground ^Pressurized In-Ground ^ At~irade ~Mound> 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) /f V. DispersaUTreatment Area Information: d r Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required (s Dispersal Area Proposed f) System Elevation DD ,S' 0 , (.p /aov 377 ~ 1 `~• 7 VI Tauk Info apacity in Total # of Manufacturer Gallons Gallons Units a ~ o b„ ~ New Tanks Existing Tanks ~ / /~/ /' w ~ V ~' e, d " ~' Septic or an ~S~ _,_ Z~ ~ /~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum esponsibil' r tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ~ afore MP/MPRS Number Business Phone Number TODD L . SINZ ~~ 139462 715-235-2644 Plumber's Address (Street, City, State, Zip Code) E5609 708TH AVE MENOMONIE, WI 54751 VIII. Use Permit Fee Date Is ued Issuing t Signature Approved ^ ~sapprove $ / /~/) p / ^ iven Reaso Denial fO"~' ' ~~ !~Z S/~~ IX. Condi~;pReasons for Disapproval 3~ C_ _ f)~~,~µ/~ ~ ti 5 ~ ~ a,f~ 1. Septic tank, effluent filter and , ~r' .' dtpersal cell must all be services/maintained 1 ~- ~ ~~' t~l ~"1~ ~fM,.,, ~"' i as per management plan provided by plumber. 2. All seCbackrequirements must be maintained ~ as ~ apple coda ~ 4~ +SIaQ. 5 6a e.~ ~a ~o~e.. a~~ Attach to complete pleas for the system and submit to the County oa on paper not less than 8 in x 11 inches in size GO /~ . , i .~ w ~o~ ~5 K u .i Sw ~I~ tiJ w ~~~ o~~ ~ ~~ ~0~3 a3o mss- ~`~ yo ~ ~J9.73 ~3 ~,, - ~{ f~tcr~ ewe loiM+MyE ~~. o~. StorN~ ToP or ~M er~ct~ !~ ~4 t1 o S Lr4S3 ~~, ~~~ -' Deg uE'w~ - ,..~..._._._~....___._.... _ -...- Titstltvi q0 X G ~4? L'o~!` ~Ea c13,92~ lit~.2S OJ~~I ,~ ~ Nn Co ns i s TiM.r ~~ro~Sti S~ST~r.,~ ~/~ ~- S 9 T~.`~ =il t,J t h B~,~w~ n ~i r~ .?~L~ t~aLw S7' ~pt~ t°~ ~~. . { 1 zSo~~st~ Gti-~C; b Trtntc: k+~/~ OrtK~ea ~Tq$Z7rt4~s~ ~ ~ yG ~,b ~tS ri SK ST~w, 5 Q, ra ~j« ~,~ ~~ ion 1'ov~ o~c. S IoP E -~2C~4 . ~]CC!!~Y ~w~,'o-~. ~ve, ~ ~ ~ ~ ~ `~`- . ~ ~/P '. _ ~~o lT (~c~Tz 1~1~'T" ~7aL~ SW ~I~. til~J ~l~ S9 7'_z~ ~1Lw i ~~ ~~ i 103 a3o `"~S'r' 8~lZ~wih` ~ ~,e-r`~i~c t° a, . - f l zso f -t So Goy t3 a Trh+tc. W ~r~ ~,~-h-~kFih sE«{p Pump , ~9~73 ~,~ prtN eo Frq ~z~-=t4R~ l ~ ya ~ Fr' ! ~~~ =""'~' 4~ ~~~ .... ..___._. .~ Q t-----~--~ r,~ _ ~,~ 4 f3~r~ ~2tM la+t~+fgE ~~. . Q3 ~~-100' ~3ott+•~ ~ o~ . S ia~N~ M.r g'~ - ?8.8~' ToP or ~°M er~ct~ ~~4rln SLr¢Q , ~lS T k S~ STrw~ .`..~" D~iuEw~ ...~.._._..__.~...__...... ...~ ~-'~s t7~,a ~~ X Ir X47 Zo~~ T, Ea r '~` Nt~ Ca ~t5 i s TiM,T ~o~ Tnu~ o~. S !c~ C ~ 7`l~~v~Sl~ S~ST~.~ ~,eE~4. i Q/P i commerce.wi.gov ~ ^ iscons~n Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary September 03, 2008 CUST ID No. 139462 TODD L SINZ T L SINZ PLUMBING INC E5609 708TH AVE MENOMONIE WI 54751-5520 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/03/2010 Identification Numbers Transaction ID No. 1584974 SITE: Site ID No. 741959 Scott Beiz Please refer to both identification numbers, 1063 230TH Street above, in all corres ondence with the a enc.. Town of Baldwin St Croix County SWl/4, NWl/4, S9, T29N, R16W FOR: Description: Mound /Four Bedroom /Level Site Object Type: POWTS Component Manual Regulated Object ID No.: 1198509 Maintenance required; Replacement system; 600 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; System: 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); 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 durng construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 10 feet around the slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and L'01tG dispersal are prohibited. !'~; • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. _,y,~s.~E~ ~D • A Sanitary Permit must be obtained from the county where this project is located in accordance with the~,_2~~ requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CunRl • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat TODD L SINZ Page 2 9/3/2008 • Comm 83.22(7) A copy of the approved In ans specifications and this letter shall be orrsite during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes oradditions 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, ~~~~ ~~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~ ~ RE~ErvED AUK 2 g 2®~$ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN SAFEnr& BUILDr INDEX AND TITLE PAGE NG~ Project Name: Scott Belz Sewer Owner's Name: Scott Belz Owner's Address: 1063 230th st Baldwin Wi 54002 715-684-4452 Legal Description: SW1/4 NW1/4 S9 T29N R16W Township: Baldwin County: St Croix Subdivision Name: Lot Number. Block Number. Parcel I.D. Number. 002-1018-80-000 ID~9.29.16.126 Plan Transaction No.: 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 specifications Page 8 Plot Plan ., Designer: Todd Si License Number. MP139462 Date: 08/26/ Phone Number. 715-235-2644 ~~A!jl Signature: ~ ~~^°* x, ~. v s ~ Designed Pursuant to the 'r ~, ~,,,,y~§~.~c~ Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and both ~ A~ CCI;yGS SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and ~ Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) SpDNDEII/C Version 5.1 (R. 06/06) Page 1 of 8 Mound and Pressure Distribution Component Design Site Info_nmation F::'. ~ -~- 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) 0.00 Sde Slope (%) ~-__._ __ ~--- 98.15" Contour Line Elevation (ft) 17 00~ Depth to Limiting Factor (in) ~0.60F In-situ Soil Application Rate (gpd/ftz) Note: Sand fiN (D) calculations assume a Table 83-44-3 in-sRu sod tteatrr~ent for fecal coliform of <= 36 inches. Distribution Cell Information ~~OOf Dispersal Cell Length Along Contour (ft) = 6.67 Cell Width (ft) t 1.~f Dispersal Cell Design Loading Rate (gpd/ft2) - Ti Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure DisribuRion Information network? M ~ ~ ~F.,_ Y or E, Center or End Manifold r 3.34 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. ~-_~ ___.~___ ~--- 0.156 Orifice Diameter (in) F 3.50k _ 'Orifice Spacing (ft) = 11.54 ft2/orifice 2.09 ForY:emain Diameter (in) j.___ 75.00'k" Forcemain Length (ft) Does the forcemain drain back? ~-~ ~~ 90.OOf Pump Tank Elevation (ft) ~,~n=r '~ clr F~J 4.55 System Head (ft) x 1.3 12.23 Forcemain Drainback (gal) 9.23 Vertical Lift (ft) 81.20 Sx Void Volume (gal) 1.28 Friction Loss (ft) 93.44 Minimum Dose Volume (gal) ~ In-line Filter Loss (ft) 28.00 System Demand (gpm} 15.06 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o ions choice -- 0.75 _________ ___~-~~ 1.00 1.25 1.50 x ' x ~ 2.00 x _ 3.00 x Manifold Diameter Selection in. dia. o 'ons choice 1.25 x 1.50 _ x ~_x ~ 2.00 _ _~ ~ __--~ G__a_llons/Inch Calculator , :,; Treatment Tank Information ~ ___ _ "Total Tank Capacity (gal) 1250.00 _Se~ic Tank Capacity (gan ~~ V J ~ Total Working Laluid Depth (in) Huffcutt Concrete j Manufacturer ~~ gaUin (enter result in cell 649) Dose tank Information Effl_uent_Filter Information i 768.~~ Dose Tank Capacity (gad Orenco Filter Manufacturer i ~ _. __ _ ____.__--__~_._.~ 17~10~Dose Tank Volume (gaUn) LFT0822-14ba _ _ 4 f Fitter Model Number Huffcutt Concrete _.I Manufacturer Project: Scots Belz Sewer Page 2 of 8 Mound Plan and Cross Section Views 1_ ~ ~ L Mound Component Dimensions A 6.67 ft B 90.00 ft D 19.00 in E 19.00 in F 9.50 in G 0.50 ft -T -~ _~ -1 H 1.OOft K 10.13ft z 8.63 ft L 110.25 ft J 8.63 ft W 23.92 ft 600.30 (ft2) Dispersal Cell Area 6.67 (gpd/ft) Linear Loading Rate 2152.80 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.53 (ft) IF 99.73 {ft)-- Dispersal Cell ">~ Elevation E Shading Key 1[] 0 Topsoil Cap Q Subsoil Cap T d ""~'~„l'= © M C33 San AS ® ~ Tilled Layer 05 ~ Aggregate 1 H 100.23 (ft) Lateral Invert 0.0 % Site Slope ~ a 0 1 5 ft ~ _ j _ . T ~ a 0 0.5 ft ~-- Dispersal Cell 1 F Typical L~er~al a~ ~ A -~ 15 (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 (AxB). Project: Scott Belz Sewer Page 3 of 8 End Connection Lateral Layout Diagram Later centered over thi P • =Turn-u p w~ ba I I vahre or cl ae n out pl u g All laterals are Mderuicaf IE- X--~~ Hiles dried on the babtom of the lateral ~ ~~ r Foroe min Cl]Ir'RC[10f11l1atee of C(OSS [d t1WtliFdd ~ 2nd point. Laterals t: foroe main of PVC Sch 40 (per COMM Tabk 84.30-5] Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Dose Tank Ilnfonnafion Electrical as per NEC 300 and -- Comm 1628 WAC D~rv>Ied Tank component is properly vented Huffcutt Concrete Ca acit 768.00 Volume 17.10 Manufacturer Gallons gal~nch Dimension Inches Gallons A 25.45 435.16 B 2.00 34.20 C 5.46 93.44 D ~~ ~~ 12.00 205.20 Total 44.91 768.00 Orifice Diameter Orifice Spaang (~ Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity ~- A B C D tank. 3" Bedding ._. _ _ Alarm Manuafaclurer SJE Rhombus _ Alarm Model Number Tank Alert 1 _-_._.___._._~.l Pump Manufacturer Franklin _ _ _ Pump Model Number SE 40 H ~ ~~ Pump Must Deliver 28.00 gpm at 15.06 ft TDH I 0.1561 11.54 ft` 3.34 ft 1.50 in t cover with warning label and locking device and sled watertight i 4 in. min. E- Atierr~e outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device Pun off elevation (ft) 91.00 ~ar* elevation ttt) 90.00 Project: Scott Belz Sewer Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name ____ T L Sinz Plumbing Inc. T____ Phone 715-235-2644 POWTS Regulator's Name ~~ St Croix County Zoning ~ Phone 715-386-4680 Svstem Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Partide Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.3 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cful100 mL Service Fr~eguency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound E'i1h~r Ins d and/or service once eve 3 ears Should inspect and dean at least once eve 3 ears Test once eve 3 ears Shoukf test month) laterals should be flushed and re tested eve 1.5 ears 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)(), 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 arrd 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 Sprinkler Valve Box Distribution Lateral ............... Threaded Cleanout Plug or Ball Valve Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Scott Belz Sewer Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, tKs. Adm. Code General This system shall be operated in accardartce writh Comm 82-84 W~_ Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (0181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01 )] and local or state nrles pertaining to system maitkenance and maintenance reporting. No one should ever ender a septic or pump tank since dangerous gases Wray be present that carld pose death. Septic and pump tank abandonnr~t shah be in accordance with Cornet 83.33. Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank mantwle risers, access users and covers strould be inspected for water tightrtess and soundness. Access openings used for service and assessment shah be sealed watertight upon the completion ~ service. Any opening deemed unsarnd, defective, or subject to failure must be repk~ced. F~OSed access openings greater than S~nches in diameter shall be secured by an effective locking device to prevent accidental or unaufhor¢ed entry into a tardc or component. Septic Tank The septic tank st~l be rrrred by ~ erd'nridual certified to service septic tank under s. 281.48. Stets. The contents ~ the septic tank shall be disposed of ~ accordance with NR 113, Wis. Adm. Code. The operating carrdtiorr of the septic tank and outlet tier strati be assessed at least once every 3 years by inspection. The outlet filter shah be cleaned as nece~ary to ensure proper operation. The filter prtridge shook! not be removed unless provisions are made to retain solids in the tank that rr~y slougtr off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the finer shall be serviced if the alarm is activated continuousy. Intermittent filter alarms Wray indicate surge flows or an impending continuous alarm. The septic tank shad t~ve its oonterrts removed when the vokmne of skrdge and scxun ~ the tank exceeds 1/31he liquid volume of the ink. If the contents of the tank are not removed at the time of a triennial asse~rrnent, rrnaintenance personnel sfna~ advise the owner of when the next service needs to be performed to maintaii less than maoarwxn sam and sM~dge accumr>tation in the tank The addition of biological or ctterr>icaf adddives to enhance septic tank perfomnance is generally not required. However. if such products aue used they shall be approved for septic tank use by the Departrrnent ~ Corrnrrnerce. Pump Tank The pump (dosing) tank stead be inspected at least once every 3 yrs. All swilctnes, alarms, and pumps shah be tes#ed to verify proper operation. If an effluent tier is instated within the tank fi shad be inspected aril serviced as necessary. Mamd and Pressure Distribution svgEem No trees or shnrbs should be planted on ftte maand. Plantings Wray be made around the mownd's perimeter. and the mound shall be seeded and mulched ass necessary to prevent erosion and to provide same fxotectioa from frost penetration. Traffic (other than for vegetative maintenance) on the mound is hat recommended since soli compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather iutallations (October-February) dk~ate that the marnd be f~vily mulched as protection from freeang. Influent quadty into the maxrd system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mgtL FOG for septic tank efflveM or 30 mg/L GODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cful100 mL for highly treated effluent. Influent flow may not exceed maoQrrrm design flow speclfied in the permit fa this instaNation. The pressure distrrbution system is provided wdtn a tlustning point at tine end ~ each lateral. and it is recorrnrrnernded that each lateral be flushed of accumulated soils at I~ once every 18 rrnonths. When a pressure test is performed rt should be compared to the initial test when the system was installed to determine A orifice clogging teas ocarrred and if orifice cleaning is required to maintain equal distribution within the dispersal ced. Observation pipes within the dispersal cad shah be ctteclced far ettkx~ ponding. Pond~g levels shad be reported to the owner, and any levels above 6 inches considered as an imper>~ng hydrauic facture requiring additior>al, more frequent mondoring. Continoencvt~ If the septic tank or any of its corriporner>ts become defective the tank or component shad be repaired ar 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 fatls to accept virastevvater or begins tD dnsct~arge ~ to the ground surface. # wid be repaired or replaced in its' present location by increasing basal arm if tce lealrage occcrs or by removing biobgically absorption and drspersal mech. aril related piping, and replacing said components as deemed necessary to bring Ure system into proper operating corrdiian_ See Page 5 of this plan far the naune and telephone ntunber of your local POWTS regulator and service provider. Pretreatrrnerrt Units The information and sctnedule of mau~rnagement and trreirnternance for ~ devices such as aerobic treatrrient units or disinfection units are attactned as separate doarnrerrts and are considered part of the overall management plan for this system. b'~ r, `~ ~: / s , ~.: •, t f +.'iC ~ E~ i' rt 3 ' UpperVOlute Seal: Vellumoid gasket i ~ ,. ;. • .. . P wer C d• 16 AWG 3-conduct r coppet &tranded ~. Frankli'n' Electric Su~merslblQ Effluent Pumps a're tteslQried fior Cooling: The motor.. housing contains, a•cooling use in t~P[mal.s~mp.anct.general.e9Watar(ragap~lic&tlpns:where• oll Io,Prgy(dg cogi<iPg,(pr the motor and higtaer pressure. is rsquired. Thy •pump is desiened• fog pumping tq !(~~rl~te be~rinl~s end awls, The„se non•eXplosive, non-corrosive liquids with up to 3%4~ spherical pumps areb;~p+ai~l~ ar gper~ting with. solids: •Do not use for raw sewage. the mo~pr holjJSlr?g ~a~aUy, @,xposed Automatic operation can be achieved with the use of the RF3. for extended periodgof timq, providing , sufficient motor cpolinq and ~eanng : . Remote Float, Switch, Other ao~~so~ies such as basins, check. s + + lubrication. hpw~irer~ + F~e.tllest cooling valves and covers are,also ayaliabla. ° r ~ w and Igngest ipotor7l~f~ ~~~ti~ devil All models have a, ,1.1/2 NPT dispharge. Do not over-tighten being pumped.shoi~~d~p'amt~I~y~bQ above discharge pipe into pump voiute'discharge. theaQp of the cast iron motor housing. UNPACKINQ: ~ SAFitTY GUI4ELINES: Franklin Electric pumps are carefully packaged, inspected. and ` ` "' ``'` ` tested to ensure safe operation and deJiyery. VVhen•you receive • your pump, examine it carefully to determine. ihat~there..are no broken or damaged parts that,may have occurred,during Risk~of electrical shock,,This pump Is supplied with a,grounding shipment: If damage has occurred, make. notatiprt and;notity the conductor and/or grpundirig-type attaphmentpl~~=~To•.reduce firm from which. you purchased the pump and they w111 assist the risk of electric shook, be cQrtain th t.ii is :conn~eted?to.a you in replacement or repajr; ff requiredc properly..grounded, prqundirtg Sype receptacle ~ .,>~~; SPECIFICATIONS.: ' t- Read all its~ructipns and safgty gyide~(nes thoXQu~ly Failure to Discharge: 1=1/2"NPT vertical ' follow the guideijnes and ~hed~strgctions Could result in serious . bodily ln)ury and/or property'dar~aj~e.t •: Handling Capabilities: 3/4" screened. opening Your effl, ent um ., is equi with a 3- ron electrJcal,plug. 4 p. P PP~~• P 9 Housing: Cast Iron The third, p{gng ~~, to ground. the pu..mp.tQ.;preyenlr,possitile: Volute; ABS plastic electrical ~h44k hazard. Do.not re~oYS the third pang from the fm eller: Closed deaf n with stainless steel wea'r' Plug A, separate: branch circuit is. recommendpd`fL1o{not use,an P 9 ektehsion cord ~:,,~ ~, ,; ring 1Nlien a pump is in a basin, etc., do nat~touch motor;>gjpps -• Motor. Sirfgle phase, induction 1750 RRM, or water until unit (s. unplugged or shut off. If„your installation. with automatic reset thermal overload has wate(,QI,,~olSture present, do not touch wet area until all Protek'lic~. •• Hardware: 34Q Series stainless-steel FIGURE 2. ~ • " FLOW - LITERS/MINUTE Bearing: Ball. ~ ' Radial Bearing: Sleeve --Permanent lubrication ~ ~~ ~ ~•. 300 . .. ;Shaft Seal: MaGh~rt~c~l, sprltip loaded, stationary. ,o carbon with rotating, ceramic seat ~ + ' Impeller Seal: U-cup, Nitrite ~. ~ ~~ Volute Seal: O•ring, formed NltrUe ~, _; ~ ~ •+•-~ ' - w Motor Housing/.... ,~ ~ :.:.. :.. .. .:. e w • u~ ~ FIGURE 1. x ,. _ . ¢ . 2 ,. • ~; ~e u o ~.,,,, FLpW • GALLONS/MINUTE• b . t~ .. Wisconsin Deparbnent of Commerce Division of Safety and Buildings C u ~~1 SOIL EVALUATfON REPORT in ~rrrnl~nr~ urith C`.rmrn A5 VV~c 4~im ('.tY'1P~ 1454 page 1 of 3 AC.E. Sat & Site Evaluations Attach c:ont a site anon trot less than B'h x 11 ind~es in size. Plan must t~ 1~ t~ Cou ~ St. Croix inducts, but not lanited to: vertical and trorizontal reference point (BM), direction and Parcel I D percent slope, scale ar dmemsions, no •ation and distance to nearest road. . . 002-1018-80-000, ID;~ 9.29.16.126 Please ,~i a ~ R Personal iMomrauon you ~ (P Law, s. 15.04 (1) (m)). used rot se~ary ~ 7 2 b a property Owner ~`/~ '~ ,: _~ Property Location Rick & Shine Borowicz "" ~• Lot SW 1!4 NW 1/4 S 9 T29 N R 16 W owner's Mailing 160 230th Street ~ 2 ~ 2001 ~"' Lot # Bock # Subd. tVa/rrre~/C ~ 3p . ! ,! ST ' 1 ~O Y-'" ~CYYl~pone N e Za city Vdlage r Town Nearest Road Baldwin ~ z +~+IIIIVUZZ 5 89 Baldwin 230Th Street ~, Use: ~ ~ 4 Code derived design flov+r rate 600 GPD Replacx~trlen Pub i 'al -Describe: coal Tiil _ Flood plain elevation, if applicable na General corrvr~errts ~~ ~(%h, and recorrxnendations: Mound system elev. = 99.74' at 19" above 98.15' contour. x~~~ ~,,,~,~, ~~ ~ q, 6i3 • Ze~D ~~ # ~~ 1'"11 r Pit Ground Surface elev. 97.47 ft. pepth to limiting factor ~„ ~__in. Sal AppGc~ior- Rate Horizon Depth Daninant Odor Redox Description Texture Structure Consetence Boundary Roots GP D/ft= 'Eff#1 • 1 0-8 10yr4/2 none sil 2fsbk ds as 2fm,1c 0.5 0.8 2 8-12 10yr5/3 none sit 2msbk ds cs 1fc,2m 0.5 0.8 3 12-17 10yr4/6 none sl 2msbk dsh gw lfmc 0.5 0.9 4 17-30 7.5yr4l6 f2f 7.5yr5/8 si 2msbk dh gw 1fm 0.5 0.9 5 3041 7.5yr4l4 f2d 7.5yr5l8 sl lcsbk dh - - 0.4 0.6 Bori Z Boring # ~, Pit ~ Grourxl Surface elev. 97.7$ R pepth to Inrriting factor 19" m• Soil Application Rate Horizon Depth Dominant Colar Redox Description Texture Structure Consistence Boundary Roots ~' •EftYE1 1 0-7 10yr4/2 none sil 2fsbk ds as 2fm,1c 0.5 0.8 2 7-12 10yr5/2 none sil 2msbk ds cs 1fc,2m 0.5 0.8 3 12-19 10yr5/3 none sd Zmsbk ds gw lfmc 0.5 0.9 4 1 -26 10yr5/3 f2f~ 7.5/8 sil 2msbk ds gw 1 fm 0.5 0.9 5 26-35 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk dh gw - 0.5 0.9 6 35-48 5yr4/4 f2d 7.5yr5l8 sl lcsbk_ dh - - 0.4 0.6 "Effluent #1 = BOD ~ 30 <_ 220 mglL and TSS > < 150 mglL ' E = BOD <30 mglL and TSS <~0 mgJL CST Name (Please Print} S' CST Number James K. Thompson 5.~ 3602 address AC.E. Soil & Site Evaluations Date valuation Conducted Telephone Number 340 Paulson Lake Lane, Osc~da, WI 8/22/01 715-248-7767 ,. .gyp . ~P . (P .c~ •4 . (~ prq~ty pyK~ Rk~c & Shirley t3orewirs Parcet ID # 002-1018-80-000, ID# 9.29.16.126 Page 2 d 3 ~~ # / P~~ Ground Surface eksv. 98.17 ft. Depth to limiting factor _ ZT in. Sad Application Rate Horizai Depth Dominant Cola Redox Description Texture Structure Carsistence Boundary Roots 'Eff#1 "Eff#2 1 0-9 10yr4/2 none sit 2fsbk ds as 2im,1c 0.5 0.8 2 9-12 10ytt312 none si4 2isbk ds cs 1fc,2m 0.5 0.8 3 12-17 10yr5/3 none s1 2msbk ds gw 1 fmc 0.5 0.8 4 17-20 10yr4/6 none sl 2msbk ds gw 1 Bn 0.5 0.9 5 20-28 7.5yr4/6 f2d 7.5 8 sl 2msbk dh gw - 0.5 0.9 6 28-40 5yr4i6 t2d 7'SyrS/8 ~ fld 10/2 _ sl 1 csbk dh - - 0.4 0.6 . ~( .4 ~4 .~ ~- ~~ # / P~-~9 Ground Sutfaoe elev. 91A ft. Depth to limiting factor ~ in. ~ A Rai Haizon Depth Daninmrt Cola Redox Description Texture Structure Consistence Boundary Roots *Eff#t1 *Eff#2 1 0-9 10yr4/2 none sit 2fsbk ds as 2fm 0.5 0.8 2 9-18 10yr4/6 m1p7.5 5/8 sit lfsbk ds cs 2fm 0.2 0.3 3 18-30 10yr4/6 n'~dtp 6/2 sit lmsbk ds cw 1f 0.2 0.3 o ~ng# ~~ Pit Ground Surface elev. ft. Depth to limiting facts in, ~ ~ Ike Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 • Effluent #1= BOD ~ 30 < 220 mglL and TSS >30 < 150 mglt. • Effluent #2 = BODs <_30 mgll and TSS <~0 mglL The Depa~en# of Comme[ne is an equal opportunity service provider and empbyer. If you recd a~isrance to access services or need nna~iat is an a~emarte famiat vlease cositact the derma atb08-266-3 tSt orTFY 6t18-2b4-8'Yf7.. ~! •. .: ,,. 'i z3o ~` s~~~t o"- ~~ ~' iys~ ^ 50;1 e/a~ua~an P•~ Ereva~;o~ ^ 8~ PaS~ur~ {~ ~ 5 ca/e.: ~ . yo. 3is" I ~i .~';liul ~a.~~„a anea l~f G~1 t~~ ~OC~-0n'1O~Sid;nq. dC'%4~~rU,Y.~oUt~/~Im~ ~ SS u.~ru, ~l a V` . loo. w : V ec~3~ S ,fE.~-n- tt~. ~ 91.80' ~~~}~~ ,be ab~da ed as p~~ ~ade• 63 ^ 98.07' 99.90' ^ e.X;sE:n~ ~ Qn,rw9e res~d~«~e i U ~a dre~eway ~~ ~.W GV b~"'~;. ~o.~ Cf,. B.M.: ~jo oFConc~r.'~ ~lla~o 5/a6. E~~cv~~~~98.810~ Gd t'Q tle~( d~ i Je ~ ~~R.inq ~` ~o co•~s:sf~~ Con~c~or S/opt trywel( 54~ C d~'sc.~,~e ., ~`, j~a~h yart( / fh~ouJ~C Sysfe.,, a~e.Q. (A1~ ~ ~~ ~ ~~-~ r ~ ~ ,Q.a-,,~..~~~~ .~,~t.e1 ..~~,.~-~.~~~ ''~~-- , ~~..~,~G- ~ - ~-~ ~/ -~,~ w~ ~ ~- . -~a~ ..fir-~., v~~- a ~ ,~- ctpp, dx. /oca~fi c~ SepEi t~+- September 19, 2007 Scott & Marie Belz 1063 230th Street Baldwin, WI 54002 ~.~ ~~ Re: Your failing sanitary system at 1063 230th Street, further described as being Code Administration located in the SW/NW quarter in Section 9 T29N R16W in the Town of Baldwin, 715-386-4680 PIN# 9.29.16.126. Computer # 002-1018-80-000. Land Information tr Planning Dear Mr. & Mrs. Belz: 715-386-4674 On September 11, 2007, I received a soil evaluation report from James Thompson, Real Property Certified Soil Tester (License #3602). Mr. Thompson performed a soil boring next to 715-336-4677 the existing drywell on September 5, 2007. The boring shows redoximorphic features (mottles), which indicate high ground water conditions at 13". Therefore, Recycling this verifies the current sanitary system is failing and must be replaced. I have 715-386-4675 enclosed a copy of the soil boring information for your review. If you have any further questions or concerns, please feel free to call me at (715) 386-4683 (8:00 A.M. to 5:00 P.M. weekdays). Respectfully, ~. Carrie Stoltz Zoning Technician /cs Cc: Town of Baldwin James Thompson, CST File Enclosure: 9/5/07 soil evaluation PZ@CO. SA/NTC'RO1X. Wl. US ST. CRO/X COUNTY GOVERNMENT CENTER 1 101 CARM/CHAFE ROAD, HUDSON, Wl 54016 71 X386-4686 F.ax WWW.CO.SAINTLROIX.WI.US ~~ ~~. i k ~ ~.; i ~~~ }rv CERTIFIED MAIL/RETURN RECEIPT REQUESTED August 28, 2007 ~., Scott & Marie Belz ~' 1063 230th Street Baldwin, WI 54002 Re: Your failing sanitary system at 1063 230th Street, further described as being Code Administration located in the SW/NW quarter in Secfion 9 T29N R16W in the Town of Baldwin 715-3s6-46so , PIN# 9.29.16.126. Computer # 002-1018-80-000. Land Information ~ Planning Dear Mr. & Mrs. Belz: 715-386-4674 I have sent you numerous letters regarding your sanitary system with no response. Real Property On August 14, 2007, I received a cafl from James Thompson, Certified Soil Tester 715=386-4677 ~ (License #3602). Mr. Thompson did the original soil evaluation for your property on ~ Recycling August 22, 2001. He told me he was called because you stated to the plumber he 7'15-386-4675 works with, you would like another area tested and seemed confused about what was needed to abate your complaint. Mr. Thompson told me the only site suitable for a sanitary system is the area he tested in 2001. The rest of the property has either fill or limitations such as high ground water. Mr. Thompson stated that when he did the original soil evaluation, he did witness surface discharge coming from the existing drywell, which indicates the existing septic system is a Category 1 failing system pursuant to Wisconsin Administrative Code Comm. 81.01 (92) and Section 145.24(4) Wis. Stats. Category 1 systems are those which fail by discharging sewage to surface water, ground water, drain tiles, bedrock or zones of seasonally saturate soils. These are considered the most serious types of failure, and are given the highest priority for ° grant assistance. The existing system is also considered a human health hazard as -- defined in Wisconsin Administrative Code COMM 81.01(128) and Section 254.01(2) '" Wisconsin Statutes. A failing system can harm the environment by discharging sewage to the surface, to a lake or stream, or to groundwater. oof:e ~ r< °~~•~~ Pursuant to the St. Croix County Code of Ordinance, Chapter 12, St. Croix County ~~ ~~ Private Onsite Waste Water Treatment Systems Ordinance, subchapter 12.1(F)(4)(d) when a failing POWTS is identified it shall be brought into compliance i M£ with Wisconsin Statutes and Wisconsin Administrative Code. ~d18~ ~~ _ St. Croix County participates in the Wisconsin Fund Grant Program, which is a ~~~-e, financial assistance program that assists property owners in replacing or ,~,~ rehabilitating failing private sewage systems. All work, however, must be completed ''~`~ prior to our submitting the application to the Department of Commerce to qualify sent t ., ;,ertfi ~ . .~~, _:: .sue, ~~~,.~.,,. sail. .r.~~_~, wA,...,.~.~, . BII im ST.CRO/X COUNTY GOVERNMENT CENTER 11181i~ 1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-4686 FAX Z@CO.SA/NTC'RO/X W7 US WWW.CO.SAfNTCROIX.WI.US 'for this grant. If you are successful in receiving a grant through this progi`am, x`'$125:00 Administrative fee is due and payable to this office at the time you receive your grant award check. A brochure outlining the general program is enclosed, along with information on a few other programs. If you feel you may qualify, specifics of the .program can be discussed further with you. This failure has technically been ongoing since 2001, but I will give you up to (1) one year for replacement. Therefore, 1 hereby order the existing sanitary system be replaced with a code complying system no later than August 28, 2008. Failure to comply with this order and with the provisions of the St. Croix County Code of Ordinances, Chapter 12, St. Croix County Private Onsite Wastewater Treatment Systems Ordinance, or any order issued in accordance with this ordinance shall be subject to a penalty as provided in Section 12.8 (B) (2) (a). Penalties include forfeitures of not less than $10 per violation nor more than $1000 per violation as/or be subject to injunctive relief. Each day a violation exists is a separate violation. Pursuant to Section 12.8(B)(3)(b), St. Croix County Private Onsite Wastewater Treatment System Ordinance, "Any person, company, partnership, corporation or government unit aggrieved by a written administrative decision made by the Zoning Administrator, or his/her designee, or the Committee may appeal the decision to the Board of Adjustment. An appeal of a decision shall be in writing and shall be made on a form provided by the Planning and Zoning Department and shall be filed with the Planning and Zoning Department within 30 days of the date of that administrative action. Other substantiating evidence will be accepted." Please call me at (715) 386-4683 (8:00 A.M. to 5:00 P.M. weekdays). Respectfully, ~~~~\~ Carrie Stoltz Zoning Technician /cs Cc: Town of Baldwin File Enclosures: WI fund and other grant program brochures ST. CROIX COUNTY GOVERNMENT CENTER 1 1 O 1 CARM/CHAFE ROAD, HUDSON, W/ 54016 715386.4686 FAX PZ@CO. SAINT-CROIX. I~VL US WWW.CO.SAINTCROIX WI US -- - - s Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8%= x 11 inches in size. Plan must County include, tart not limited to: vertical and horizontal reference point (8M), direction and percent scope, sale or dimerrrsioru, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. gg,,~~~~ R/~p~+ revved ~ Personal iMam>rtion you Provide may used for~~ C'1~~ ~~ s 15.04 (1) (m)). I t(~t A l ~ Properly Owner Properly Location 2090 Page 1 of A.C.E. Soil & SRe Evaluations St. Croix 002-1015-80-000 Scott W. & Marie T. Belz 1 2007 Govt. Lot SW 1/4 NW 1/4 S 9 T 29 N R 16 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1063 230th Street ST. CROIX COUNTY Na City State ip Code Phone Number City ~ Village !/~ Town Nearest Road Baldwin ~ WI 54002 (715) 684-4452 Baldwin 230Th Street _f New Construction Use: ~ Residential /Number of bedrooms Code derived design flow rate /_f Replacement ~ Public or commercial -Describe: Parent material Glacial Till Ftood plain elevation, if applicable General comments and recommendations: Evaluation completed to determine suitabliity of soil for continued use of existing drywall. GPD Na a Boring # J Boring Pit Ground Surface elev. 93.75 ff . Depth to limiting factor ~ ~ 3„ in. Sotl AppAcatiorr Rate Horaon Depih Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots P D in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. "Eff#1 `E 2 1 0-13 10yr3/2 none sil 2fsbk mvfr as 2fm,1 c 0.6 0.8 2 13-26 10yr4/4 f1d 7.5yr5/8 sil 2fsbk mvfr cs 1fc,2m 0.6 0.8 3 26-45 7.5yr4/6 f1f7.5yr5/8 Ifs 1msbk dsh gw lfmc 0.5 1.0 4 45-54 5yr4/4 f2f 7.5yr5/8 fsl Om dh gw 1fm 0.2 0.5 5 54-74 5yr4/6 f2d 7.5yr5/8 sl Om mfr - - 0.2 0.6 ' Effluent #1 = BODS> 30 < 220 mg/L nd TSS >3 < 150 mg/L ' Effluent #2 = BOD <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' stare: CST Number James K. Thompson -----~ 3602 Address A.C.E. Soil & Site Evaluatio Date Evaluation Conducted Telephone Number 340 Paulson Lake lane, Osceola, WI 54020 9!5/2007 715-248-7767 _ _ ~ ~~ ` I ~ Soil Q/Q(uaLan P,"~ • Ele/a~on . 8y Pa5 ~u!'~ 5 ca/e.: / . yo' 3~5" z 30 ~` s~« t e~ ~~ L3o~Om O•FSid~nq, (/ .3 ~ 97.80 " ^ ~ aPP.oz /oca~iv~ drY~ell Q.X : SEinq ~ QG.ra9t eXI;7~i i~ t ~cs;d{ltnce ~ (J $¢~Fjc~,.~ S4i~ac2.._.tl A ds c.~ ~~e 9807" w~.~~d d•i~e~aY ~ ^ M (~a~n . y amt! I 9.90' ~~ ,..~~II E cv` = 9g. 810 ~ r'Q Je,( drive ~ ~Rinq ~ ~o co r~ ,S; s ~~ ~ Co n ~pc~ or S /op~2 fh~ou~~( SySfern a.~e.Q. p~. ? ~ z ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM -, "r OwnerBuyer __ JC ~~ ~ ~ Igf.,~Z (3r.vt_c~ ~r - ~ ~. C ~z Mailing Address ) D b ~ a 3 c, ~"' S-t . fJ C~. j~ u: ~ .-~ (,c.71 5`-f o n ~ Property Address ) 0 l0 3 a3 0 ~` 5-fi. (Verification required from Planning & Zoning Department for new construction.) City/State ~ ~~ry'i ~ (A.~ 1 Parcel Identification Number LEGAL DESCRIPTION Property Location ~ '/4 , ~ W '/4 ,Sec. ~ , T a~N R~~W, Town of .~1,(x~ ~~ Subdivision ,Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ~~~~' - 5n~ ,Volume -~~~~-, Page # ~~,~. Spec house yes Lot lines identifiable es no SYSTEM MAINTENANCTJ 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 or 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 .:> SIGNA OF APPLICANT(S) ~7 /1 (0 / Moog 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) 235;? 116 STATE BAR OF WISCONSIN FORM 2- 2000 Number I WARRANTY DEED THIS DEED, made between Ricky J. Borowicz and Shirley L. Borowicz, husband and wife, Grantor, and Scott W. Belz and Marie T. Belz, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Name and Retu Address: Edina Real itle, Inc. 400 S. St. -Suite 1 l 5 Hud n, WI 54016 40 54 ~,~7 ~~ ~~~ ~ Metro Legal Services EDIRET 400254 a _886ti7 t~D :]5648 Dated this 22nd day of July, 2003. * Ric J. Boro AUTHENTICATION Signature(s) authenticated this 22n d~ly~]Ed~2~RRON Notary Public TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) PHIS INSTRUMENT WAS DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both aze not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature 2-1017-50 2-1018-80 Parcel Identification Number (PIN) This is homestead property. C.N Shirle L. rowicz ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this July 22, 2003 the above named Ricky J. Borowicz and Shirley L. Borowicz, husband and wife to me known to be the person(s) who executed the foregoing instrument and a~cjknowledged the same. *Diand M. Barron "" '~ Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 11 / 19/2006 ) 734 1 69 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 08/06/2003 03:30PIf MARRAHTY DEED EXEMPT # REC FEE: 13.00 TRANS FEE: 1500.00 COPY FEE: CC FEE: PAGES: 2 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 '~J 2351P 11? EXHIBIT A NE 1!4 of SE 1/4 of Section 8-29-16. SW 1/4 of NW 1/4 and North 39 1/2 acres of NE 1/4 of SW 1/9 and that part of NW 1/9 of SW 1/4 described as follows: Commencing at the NE corner of said NW 1/4 of SW 1/4; thence West 33 feet; thence SE to a point on the East line of said NW 1/4 of SW 1/9, 33 feet South of the point of beginning; thence North 33 feet to the point of beginning, ALL in Section 9-29-16. ~~ ~ ~, ' ~ ~ C~arcel #~ 002-1018-80-000 Category Alt. Parcel #: 09.29.16.126 002 -TOWN OF BALDWIN Current X 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 Co-Owner O -BELZ, SCOTT W & MARIE T SCOTT W & MARIE T BELZ 1063 230TH ST BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 1063 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 9 T29N R16W SW NW TOWN BALDWIN Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-29N-16W Notes: Parcel History: Date Doc # VollPage Type 08/06/2003 734169 2351/116 WD 3 WD 744/164 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 5,400 0 5,400 NO 00 UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 3.000 12,000 176,700 188,700 NO Totals for 2007: General Property 40.000 17,500 176,700 194,200 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 17,100 176,700 193,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code 04/20/2007 03:40 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00