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Home My WebLink About002-1037-20-000,nsin Department of Commerce PRIVATE SEWAGE SYSTEM .~ety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 !1)[mj]. permit Holder's Name: City Village X Township Mortel, John Baldwin, Town of SST BM Elev. Insp. BM Elev: BM Descriptio t r+ivr~ nvrvr~mH ~ iv~~ TYPE MANUFACTURER CAPACITY Septic ~~~ j O DD (~ d 6 Dos r / ~ <SU Aeration Holding TANK SE`t-BACK INFORMATION TANK TO ~ WELL 1 BLDG. vent to Air Intake ROAD Septic ~ ~~' ~ / Dosing , ~ ~~ ~ ~ , ~, ~ Aeration Holding PUMPlSIPHON INFORMATION Manufacturer ~ Demand GPM Model Number ~~ t> / / ~ ~~ TDH Lift '~ FrictiAn•Loss ((~{{ Syst ~ ~H ad TDh~ Q ~t J i Forcemain Length Dia. ~~ 5J Z Dist. to Well ~ ~ fob SOIL ABSORPTION SYSTEM GLC V/'1! IVIY VF11 h Gounty: St. CroiX Sanitary Permit No: 506388 0 Slate Pian ID No Parcel Tax No: 002-1037-20-000 SectionlTownlRange/Map No: 17.29.16.248 B STATION ~-BS J. HI /D~~ FS ELEV. /DO~d Benchmark ~~ ~~~i V Alt. BM ,.r Bldg. Se er SUHt Inlet y ~'- s-s' 9~• StlHt Outlet 4~• 16 - (o Dt Inlet Slp .~ y5 prY Q Dt Bottom ,~ , ~2 . t5 Hea~dar~. .C Dis~e •• Q / Bot. Syste>~a ~ Z w~ S ~~ ~/ ~J Final Grade ~/ q , ~ ,rte ~~d ~ ` 9~ ~ ~ ~~~ • 7 BED/TRENCH Width ~ ~ Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3.~ ~/ ~] SETBACK SYSTEM TO P/L BLDG WE LA /ST EAM L NG Manufacturer: INFORMATION CHAM OR Type f System. _/ ~ ~ ~~~ ~~~ I Mode ber: Spr.M " I DtSTRiB_I.tTi0N5Y5TEM .~y/n ~1'1~0~,( ,~sw .~.('Q.~,. / L.-,, PVe~L~u ~~aw - fi~ Header anifo Length Dia ~ Z~ Distribution t~ pO Le gth ~ J' ~ Dia ~• 2 Spacing ~ x Hote Size /~ h x Hole Spacing ~ /r ~/ ~~T~ Vent to Air Intake ~ r ~ l~ SOIL COVER x Pressure Systems Onlv r!xx Mound~r At-Grade Systems Only 4;J (J,~Q., Depth Over Depth Over xx Seeded~Sodded ~~ xx Mulched BedtTrench Center Bedrfrench Edges Topsoil ~ . ~ 1S~tir'L ~K ~ ~~ ~~ Yes ~ No ~ '~~ Yes jJ No ~ s COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~ `~' !~ Inspection #2:~/~/ U ~ /fin .-- Location: 994 230th Street aldwin, WI 54002 (NE 1/4 NE 114 17 T29N R16W) met & bout oC `` Parcel No: 17.29.16.248 B "1 ~J Vim; ~-~~ 3 c:Q~ >,v~~~i ~ era--a,~uw 1.) Alt BM Description = U . f ~,~/u Q ~C~2 ~.7' ~.l~~ L~~ S!-calr~-i~ ~ ~~t,o 2.) Bldg sewer length = n ~~ ~ 1,r ,~~~uG,~ f~, k? a ~~ft, - amount of cover = r L(•'G~"-~GLL "'VVV!!! ~J -- ) ,/ ~ ~. Use otherl~ide for additional information No ~ Da~ ~/ ` _ lnsepct~o,.-'s Sign ur~ - _ ~ !r' S 0'~ y SBD-6710 (R.3/97; No. _/ GOU LDS PUMPS ~, ~3 a ~` i •• .. ` ~"°.~r y .,~. ~~ Submersible Effluent Pump WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/4' maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeder available as an option. ^ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge. ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant, stainless steel. Threaded design. Locknut on all models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to components. ^ Designed for continuous operation when fully submerged. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation on '/s-1'/z HP models. ^ Class F insulation on 2 HP models. METERS FEET 40 130 _._ t WEtSWH 120 ~- - ~ ---~- 35 110iw~2kH ^ 30 100; -- 90 _ t-~tstt - w 25 80~ WEiOH a 20 70.~vE07H Z 60 ~\ ~ wEOs a 15 50 Eo5H ~ 40 10 30 i~EO~M i . _ s 10, ~ I 0 00 t 10 20 30 ~_ 1 I_ 0 5 Goulds Pumps © 2003 Goulds Pumps Effective July, 2003 Single phase (60 Hz): • Capacitor start motors for maximum starting torque. • Built-in overload with automatic reset • STTOW or STOW severe duty oil and water resistant power cords. •'/sand'/z HP models have NEMA three prong grounding plugs. •'/a HP and larger units have bare lead cord ends. Three phase (60 Hz): • Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturers recommended working limits, can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier incase of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS S ~ ® Tested to UL 778 and CSA 22.2108 Starxlards By Canadian Standards Association C US File#LR38549 Goulds Pumps is ISO 9001 Registered. I_ _._,_, _ _ __~ 50 60 70 ~ 80~ 90 100 110 120 130 140 150 160 GPM 10 15 20 25 30 35 m3/hr CAPACITY vvvdw.goulds.com 4~`Y ITT Industries Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 St. Croix ,~~0~~,~ Madison, WI 53707 - ,,: Sanitary Permit Number (to be filled in by Co.) department of Commerce (608) 266-315 Sanitary Permit Application State Plan I.D. Number ~~~~ / J In accord with Comm 83.21, Wis. Adm. Code, personal information you provide address) scent than mailing oject Address (if dill may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information -Please Print All Information RECEIVED 994 230x' Street Property Owner's Name ~ ,-^ 3 N O V 0 6 2 0 0 7 Parcel # Lot # Block # 002-1037-20-000 NA John & Michelle Mortel Property Owner's Mailing Address ST. CROIX COUNTY PropettY Locaiton r Z u' section 17 NE'/ NE's G v't tot 994 230 Street .. o . +. City, State Zip Code Phone Number (circle one) Baldwin, WI 54002 715 684-2344 T 2~,_ N; R 16 E or W II. Type of Building (check all that apply} 1 or 2 Family Dwelling -Number of Bedroo :~ ~ (~' S'n ~~(~- ~~/~-~. S1uAbdivision Name C SAM Number J r` Y 2~ ~ ~f~ Public/Commercial -Describe Use: „ ` ^ State Owned -Describe Use: City OVillage~Township of Baldwin IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ~R~lacement 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 an~ Date Issued ~ '~ 3 (~ "7 - J~j'C 7 Before Expiration Plumber Owner 3s33s~ - a-~~ IV. T of POWTS S stem: Check all that a 1 - ~ ~ ~ ~~"~` ^ Non -Pressurized In-Ground Mound ? 24 in. of suitable soil Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter (( ^ Constructed Wetland ^ Pressurized [n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filtet~ru ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~. 7 ~ S~yrG( V. Dis ersaUTreatment Area Information: t Design Flow (gpd) Design Soil Appl ic ation R (gpdsf) Dispersal Area Req iced (sfl bispersal Area Proposed (sf) System Elevation ~~ L ~ -t'~ ~ ~ ° ~~~ ~~ ~ ~ ~ 5~ C tl 9~ 8 z 450 d 1 % . 0 ~~ VI. Tank Info Capacity in Total Number Manufacturer efab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank X00 ' - ~~ ~-~ 1 Wieser Concrete X Aerobic Treatment IInit ,/_ ~~ cj eosins chamber 750 750 1 Wie r Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) s Sign tore MP/MPRS Number Business Phone Number Dale Hudson ~ ~ #220853 715) b84-3378 Plumber's Address (Street, City, State, ip Code) ' 820 Main Street, Baldwin, WI 54002 VIII, oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit ee i c des Groundwater ' Issued ,.Issuing Age t Signature Stamps) Surcharge $ee) ~ ~ / / ~ ~ ' ' , " ^ Owner Given Reason for Denial L...-~ Q ~ ~ zt4 i i~( ~- L~.(/V/1 ^~ ~j IX. Conditions of AppravaUReasons for Disapprove n ~ /C ^ ' " ~ ~~ ~ ~ ~ rZ ~G~~~ q/ ~ '''' ~ h ~,/~'~ t, ~ 1 Septic tank, effluent filter and / `~Y„~~ "' f ~`~-=~'~ ~~~~'~' ll, di l ll t i i ~ ~'~~ ~' S spersa ce mus elf be serviced /ma nta ned ,I,t ~i ~ S, t l id b d b l ~~~ ~~`~ ~'1 G / ~~ ~ as per managemen p an prov e um y p er. /, ~' ST ~ .T ~ arn~~ . ~'~'~ d~ ~~~ ~? ~ ~- Afl setback re 2 uirements must be maintains y /" ~ . q ~. ~,~r ..-t~l G . as per ap licable code/ordinances ~ ~~'" p S . r ~ "Yt.4 fin (8'~~ '~. / f ~~ nn nn ~~ ~~ ~~ j~A,ttael- complete plans (te the~C, ~oun~ty,,Jonly) for the syyste~m on pa r njot~ than 81/2 Viz` 11 in/ches 36 dfie ~ S/ -f i7,~~ 7 /~~ G"~.?iC/X G~r"~~itJ ~7f U //'~/7 ~ ~~'Zi( ~~7 ' ~O ~~C/!N ~ `f-G~-IG~~ /~ 1 SBD-6398 (R. 01!03) ~ ~` L~' ~.a- C~~r~-~~.~~~(,ovt GG~,- _J,t ,,h~l {~~~l,h~Cl G~i~'Wm~""'~ . ~. {~wy C " <,ss sz~ ~ So~% cda/ua~a-~~o~ t~ ~ Exls~i~ 8rade e~e~ -~- EX.s~~ 6~b~a/~t~P fence G4/~:C/ ~~ lo' ~ p 99st 230' ~. ~E~'yaEfs~, SLR. i7, ~ U T29?.~ ~ /G u~., T, off' ~/o%v.:,, S~. C~o:~e C~~ cJ! ~ c.1. # av,~ -/o.37-zo -cod b~: ~q 8.28 a comes. c% I i E,l'i Ski"n g ~i 5 hcd (/ ~~~~ I d~~vewaY ~o b t k ~l~.n o~o7l..d. P~oPo Sed aJ; est.(' Cor,c . ~ GPJd 8 a0. 5.T~--- ~/ Po/y/o.f'P,c -sue S ems'/u ~.,t ~' ~ ; a, - 2 °s ~. y~0 /~y C'. ,- ~~.~-' ~~rcema, n i~j ~ ~'!I YT `, ~ ]1 ~ ~ 7'r2~ S/oBe "~ -t"/c ra a~~ 5 ys te.~ ~~ e4 ~2 f, U ~ C 1 r ~ ~ v `c i ~~ I t r~ t e i j ~~ t ,~ ,. r ~~ ~~_`~' EX~s~n~ dtcX ~ L _. aQ - 3b cd~oe~, u o . - ,~. / I ~ ,\• ., i ~1 ~4cS.t:M. 3031 ?~joj'oce.~~ ~Oi~Ot. s ~ ~~avt/cc/ /`G~+:~trq ~e~.// Sbef ~ P~~iseQ/c.v; tsci Ca,.crt~be 750 ~..o. P,,.,,.,pc_ta.Kb~'. ~~ ~f ~?o~-: Or, : na,~ .d.ii1. c/tS ti'oyeo~ ~ J9.cc,a~i rrr ~-~a,6/,s,/i,~o! /Ylet~.~n d %Ca.~'o,~ ~yt e4 .~.tastsre.,r,h,'LS ' ~l'o•n house ~~~ %de~~iF''~c/ o•, Sa%. 8~ ~~G_~/la;/%~ .duce posh ~~ i ~' ,Z 30~ Strcc ~ commerce.wi.gov i ^ ~scans~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. corn merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 13, 2007 CUST ID No. 220853 DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. 820 MAIN ST PO BOX 78 BALDWIN WI 54002 ATTN.- POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/13/2009 Identification Numbers Transaction ID No. 1464183 SITE: Site ID No. 16912 John & Michelle Mortel Please refer to both identification numbers, 944 230TH Street above, in all comes ondence with the a enc Town of Baldwin, 54002 St Croix County NE1/4, NE1/4, 517, T29N, R16W FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1151944 Maintenance required; Replacement system; 450 GPD Flow rate; 16 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 during 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. Cta~r~it • Per manual cited above, limited activities are allowed. in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and ~° dispersal are prohibited. Ct=FAR7ttr~iZ • The existing POWTS must be properly abandoned-per Comm 83.33 Wisc.Adm. Code.. ~ of G • A Sanitary Permit must be obtained from the county where this project is located in accordance with the SEE CGi~E~~ 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. Stat DALE E HUDSON Page 2 9/13/2007 • Comm 83 22(7) A cogy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized r~resentatives of the Department, which maYinclude 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 or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall .relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, /,~ ~,~~~~~ 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. ~- 9~~Fi s SFp 1 CFO John B. & Michelle C. Mortel qFF~ 2?00~ 3 Bedroom Residential Replacement Mound Design ~eU~ based on ~A' MOUND COMPONENET MANUAL SBD-10691-P (N.Ol/Ol) & /'V~s PRESSURE DISTRIBUTION COMPONENET MANUAL SBD-10706-P (N.Ol/Ol) NE'/4NE'/., Sec. 17, T.29N., R 16W., Tn of Baldwin, St. Croix County, WI, Pcl.# 002-1037-20-000 John B. & Michelle C. Mortel 994 230th Street Baldwin, Wi 54002 PAGE 1 OF 9 ..... TITLE SHEET PAGE 2 OF 9 ..... WORKSHEET PAGE 3 OF 9 ..... WORK SHEET (pg. 2) PAGE 4 OF 9 ..... SITE PLAN PAGE 5 OF 9 ..... MOUND CROSS SECTION & DISTRIBUTION LATERAL DETAIL PAGE 6 OF 9 ..... PUMP CHAMBER CROSS SECTION PAGE 7 OF 9 ..... PUMP SPECIFICATIONS PAGE 9 OF 9 ..... SYSTEM MANAGEMENT PLAN PAGE 9 OF 9 ..... ATTACHED SOIL EVALUATION REPORT PREPARED BY: Dale Hudson 820 Main Street Baldwin, WI 54002 (715168, 4-~37R SIGNA DATE: ~ `~` . ~® ~F COhFMEF2CE EYAN UI 3 ~_ v~0lVDENGE MOUND WORKSHEET John Martell 3 bedroom replacement residential mound ABSORPTION AREA SIZING 1. Design wastewater load: 450.00 GPD 2. Depth to limiting factor: 16" 3. Land slope: 7.5% 4. Infiltrative capacity of soil at system elev.: 1.0 gpd/sq.ft. ASTM C33 med. Sand, infiltrative capacity of native soil = 0.4 gpd/sq.ft. as per table 83.44-2 5. Dispersal cell area required: 450.00 sq. ft. Dispersal cell area proposed: 4 .00 sq• ft. Width cell #1 (A) .50' Width cell #2 (A) .50' Length cell # 1 (B) 65.00' Length cell #2 (B) 65.00' MOUND DESIGN -CELL #1 1. Mound Height: Fill depth (D) 1.67' 20" Downslope fill depth (E) 1.94' (23.28") 1.67' + (3.50' X 7.5%) Depth of aggegate (F) 0.80' Cap depth (G) 0_5' Topsoil depth (H) 0~5' 2. Mound dimensions: MOUND DESIGN -CELL #2 1. Mound Height: Fill depth (D) 2.38' (28.56") Downslope fill depth (E) 2.65' (31.80") 2.38' + (3.50' X 7.5%) Depth of aggregate (F) 0.80' Cap depth (G) 0_5' Topsoil depth (1-n 0_5' End slope (K) 13.50' ((2.52' + 2.79')/2 + .80'+ 1.00') 3= 13.37' Total length (L) 92.00' (65.00'}+ (2 X 13.50') = 92.00' Upslope width (~ 9.00' (1.67' +. 80' + l.00')(3)(o.ss) = 8.8s' Downslope width (I) 17.00' (2.65' + .80' + 1.00')(3)(1.22) = 16.29 Total width (W) ~$.~0' 9.00' + 3.50' + 6.00' + 3.50' + 17.00' 39.00'-'' ~...: SYSTEM ELEVATIONS Cell #1 Cell #2 Installation Contour elevation: 97.15' 96.48' Dispersal Cell elevation: 98.82' 98.82' Highest Dist. Network elev.: 100.17' 100.17' Pump Chamber elevation: 90.00' 90.00' Pump off elevation: 91.00' 91.00' Lift: 8.32' 8.32' BASAL AREA & LINEAR LOADING RATE Basal area required: 1,125.00 sq. ft. 450.00 gpd./0.4 gal./sq.ft./day =1,125.00 Basal area provided: 1,950.00 sq. ft. (65.0')(3.5' + 6.0' + 3.5' + 17.0') = 1,950.0 Linear loading rate: 3.47 gal. /linear foot 450.00 gal./130.0' = 3.47 /~~ Dl{$F>t{It$AL CEkL SPACING CALCULATIONS 450 gpd/2 ceiLS = 22S_00 gpd per cell,. infiltrative opacity of native soil = 0.4 gpd/sq.ft. as per table 83.44-2. Basal area required per cell = 225.00 gpdJ0.4 gaL/sq.ftJday ~ 562.50 sq. ft. 562.50 sq. ftJ65.40' cell length = $.66' total width required 8.66' total width -- 3.50' cell width = 5.66' minimum separation required between cells FRESSURIE; DIST1R1f8U1fION NETWORK I. Uistdbution pipe sizing: Laterals: (2 ner_ceA_x_2 ceiis} Lateral length: 31^;,,,,68' Cetera! size _11.' Lateral spacing Na Sidewall separation 21" Orifice size 1/8" Orifice spacing 1.81'(1 st hole at .905' front manifold) C1rifiGes per lateral: ~$ 2. Distributipn network discharge rate:. 29.52 . /minute (4 Iaterals)(18 orificesJlateral)(0.41 gaUorifice) = 29.52 gpm 3. Manifpld sizing: Location Center Length 9„x,,,5' Diameter 1 ~/." 4. Force Main: Diameter "~:' Length „~Q Flow rate 30.0(}t Ida /t11i1t. Friction lass 1~$1' (?0')(1.94ft./100ft.) ~ 1.36 ft. S. Total dynamic head: I6.63' Mitt. supply pressure 6.50' Vertical lift 8.32.' '7 Friction loss (Forcemain) i.$l' Total dynamic head = ' 6. Iyump selection: Manufacturer:. Goulds Model ntunber: I'E41 Pump will discharge app x.43.0 gpm (a 16.6 ' TDH 7. Dose chamber: 'Wieser 750 - - 7 I inch 7 .50 .actual A) One day balding ca 9.04" ~ 385,32 gal, B) Alarm settipg: 2.00" r 40.56 dal. C) Dose votucn~ -~ flow back: ,4.50". °. ~~.2G ggt_ (454ga1.)(ZO% Design flow) ~+ (.164x70') u 1 OI.48 gal. max. dose volume (.064)(4 x 31.68'x5) = 40.55 gal. min. dose volume ©) Reserve. storage; i 2A0" -= 243.36 ga[. TOTAL 37.5" ~ 760.50 gaL E00~ "IdA~ ~,LIS '9' 'II05 ~ ~ V i~9LL 8~Z 5TL Xt~3 ZS~i~T Lt ----~ . C.o. ~c.vy, L " (o$S, SZ' ~ Soi/ ~c/Q~uaULCY~/di • Exis~~~ Bra-dce~ev -~(- EX.'s~i~q 6~r6Le/t,~%rP {ence l/ -~"'~JS~ S~i~ q G~aodtn FcnG.C ~ p 99s~ 230 ~. r1E}'Y~Eys~, SLR. i7, V T z9~1., cn. /G cJ. , T. off' ~/o%,:,, 8 O S~. C~o;,r ~'n., cJ! ~G/, # Od,2-/0,3~ 20-c00 bc:~q r% 8..28 acres, E,Yi s~i'n_q !/ S hc.~ Q~~~ d rldGwa y E"Xi'Sfa'/~/j 3cp~.'c Lean ~- t ~ dAo~' S. ~/. E/e%': ~~ ----- ~'S-• o ee a 2fMO DiJ~ Proposed ~;~~ co„~. ,~oSRo. s. ~' ' ~"~ E,rsd'~~ dew /li ~„ f rp' ~' ~/ Po/y/a,f'F~,C -S~~ ems a4 ~~ " 36 tdroeM z'~s~. s~o/'y c. ~, ~ ,~' ~ " - ~' ~s~ducc oar--Gvc I ~} ,.,, ~ .. ~ ., ~ `~ ' r ~ h ~/ ~ ~f ~~ TM. 303/ 01 F : f ~ ~ ~ p~ ~ ~ . ~ ~0 ~.te.~ I ~/'QVC/C.oI /'C~:ni~ 4.k~I S><P~S ' e a " Tri ~ s/oBe ,' ~ ~ ' Pro~isco/c,v;csciCo,~cr~& 75o~.,p.P,,,.,,.,pc..la..~b_a.~'. , ' ~' ~ ~ ~ ~~ , ~ ~ 1 ~ ~ ~Y~~ ~r~. nom .B. 1 nT. c%s tfoyeod 1 i i 1 t/LYe[c~li i , 1 "~ ~ 1 1~.C.l..a />7 ?$-r<a.6~3~.~C~d. /1?et.~-/! d ~OCA~iOv'~ ~s ~ - 1 s s~~ - 4 t ~ ~ ¢ ~ i ,~, .~~de Sys«/.~~QSu~~~ 1 d~. ~ r .Sa / ~Pe arL~ f!'om h o e l ~ i den~'F•'~ o -~ ~° . c. , ~ , x, 0 us 8 ~ i o ; ° k r l , ~. , ~' ,rt'ssurn t-d ale ~!` = /p0.Od ' ~ + ~~ ~ ~ ~ ~ ~ I - ~ t I f ,2 30'~ S~1c~~ Scutt/~~;~~/ ~q.~o~ 9 Center Connection Lateral Layout Daigram ~ no Scale 9s, .68~_ ~"~- j- ~ "sc~(. pop/.e. ~eMa~n Four Cyr/%~45a~i. SldRdC., /a~u.~saE.3/.68.~ Or: ~ ce Spa c; : /, 8/; / £~ ho% a~ O. yos'f'~'emi /1'~an.'~/e ld i ~'i~~'Ce 5i ~8 > • r ~~ , IY/a~,~e c/~.s~"Sc.~,.4~0 P .G', a't 1.S' ~qfe ~cfr ~ 6z,hS~,!lrrda s~rcade. 3.S ~.o' 3.5 ~~ ~"/.S' \ 0 -------'~ _~..____ `~ 0.80' ~ ~_G.O, ,2. ~' ~~ . ~a~~ I° Crown ~v p df'nmaa~d {o d%Y4*~ .sur,ro-ce ~at.~o~'~.~or.~.nd. Co~u'~%' ~P So;/ a S~Ou Code. o `~ i .r 98.8' i 6~' 1%190 5`e ~. Sod 9 ~- LSO ~ dC$@ ~~Rk ~Rir01'R78t10R Locking coverw!!h waming latsei and Ioclcing device and -~ 9@81@d watertight f:leCtfiCai 89 pet NBC 300 and ---~ Comm 18.28 WAG ~ 4 in, min. di9cOrineCt ~i' Tank component is properly vented E------ Akemate outlet location . Foraemain diameter Wieser Concrete Ca acl 760.50 Volume 20,28 IV4anufacturer ~ 2 in. Gallons gaUinch A Wee hole or antl- Dimension inches Gallons A 19.00 385.29 B 2.00 40.58 G 4.50 ~ 91.29 C 12.00 243.38 Total 37.5p 760.50 P B s;pnon device C P,~ um~elevation R 91.00 D Dose ,tank elevation ft 3" Bedding un et tank. 90.00 Alarm Menuef~cturer SJ Rhombus Tank Alert' r Alerrr! Model Number SJH 1041421 Pump Manufacturer Goulds ____.__ Rump Model Number P~41 ~_~_ AM'ound plan 3-~ ~ - r so' ~ ~ ~~ ~-~ cr> :~ ~ " 30~ ~S` ~ i~~~ a 6api~j "IYA3 3,LIS '8 'TIQS ~ Q ~ ~9LL 8fiZ 9TL X'd,3 ZSaVT LOOZ/1:T/B4 ~GOULDS PUMPS Submersible Effluent Pump PE ~~ C T Q z } 0 ~1~.~ o APPLICATIONS Specially designed for the following uses: • Mound Systems • Effluent/Dosing Systems. • Low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump/ Dewatering ^r~ETERS FEET 40 _ ____ -.__ PE51 i 35... ....._ ;. _.. 10 30 PE41.......{. 25 SPECIFICATIONS MOTOR Pump -General: General: • Discharge: 1'/:" NPT • Single phase • Temperature: 104°F (40°C) • 60 Hertz maximum, continuous when 115 volts fully submerged. • Built-in thermal overload pro- • Solids handling: '/~" tedion with automatic reset. maximum sphere. • Class B insulation. • Automatic models include a Oil-filled design. float switch. • High strength carbon steel • Manual models available. shaft. • Pumping range: see PE31 Motor: performance chart or curve. • .33 HP, 3000 RPM PE31 Pump: 12.0 Maximum amps • Maximum capacity: 50 GPM • Shaded pole design • Maximum head: 25' TDH PE41 Motor: PE41 Pump: • .40 HP, 3400 RPM • Maximum capacity: 60 GPM 7.5 Maximum amps • Maximum head: 29' TDH •PSC design PE51 Pump: PE51 Motor; • Maximum capacity: 70 GPM .50 HP, 3400 RPM • Maximum head: 37' TDH 9.5 Maximum amps • PSC design iMODEIS: PE31, PE41, PE51, HP: 33, .40, 50 _ .. __ ; ~ 2GPM ~ i -- 1 FT ~ .. i 5 _ . ~ _ _._.I-- ...._......-----f.. - I 0 0 0 10 20 30 40 SO 60 7 0 GPM 80 0 S 1 ~~ ~ ~ ~/~ 15 m 3/h 33.8Ygf~ m. m~i~i/+X.tM c!i'a P ITV ~ - / 1 2002 Goulds Pumps J~2 ~ QG1- ~p~~S~A4rtL ~-a•Clp Effe<[ive November, 2002 7V q. /r/. Lct J 9PE3t/41 O FEATURES ^ Corrosion resistant construction. ^ Cast iron body. ^ Thermoplastic impeller and cover. ^ Upper sleeve and lower heavy duty ball bearing construction. ^ Motor is permanently lubricated for extended service life. ^ Powered for continuous operation. ^ All ratings are within the working limits of the motor. ^ Quick disconnect power cord, 20' standard length, heavy duty 16/3 SJTW with NEMA 5-15P, three prong, 115 volt grounding plug. ^ Complete unit is heavy duty, portable and compact. ^ Mechanical seal is carbon, ceramic, BUNA and stainless steel. ^ Stainless steel fasteners. AGENCY LISTINGS S~~ C US Tested to UL 778 and CSA 22.2 108 Standards By Canadian Standards Association File #1R38549 Goulds Pumps is ISO 900t Registered G,Co~u,,lds Pumps . ~o f'9 ,L1,. ITT Industries Mound System Management Plan ' Pursuant to Comm 83.54, Wis. Adm. Code General The mound septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10691-P (N.O1/O1). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank aze not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall he cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless 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 alarm, the filter shall be serviced if the alarm is activated. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Puma Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an efrluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System Trees or shrubs should not be planted directly on the mound. Plantings may be made around the mound's perimeter. The mound shall be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) on the mound is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the mound and will promote frost penetration during cold weather months. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. The pressure distribution system is provided with a flushing point at the end of each lateral. Each lateral should be flushed of accumulated solids at least once every 18 months. A pressure test should be performed with the results compared to the initial test taken at the time of system installation to determine if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contineencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring become defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location. Toe leakage will be eliminated by increasing the basal area of the system. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber or your county zoning or health inspector. Pg. 8 Of 9 4.. ~ Wisconsin Departmentof Industry, SOIL DESCRIPTION .REPORT Safety & Buildings Division Labor and Human Relations P.O. Box 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, WI 53707 Pit No. ~ Elevation ~l$.O Soil Survey Page No. C~Z Mapped as S~TlPtGO S ~ ~ Page ~ of Customer Name ~o~{N ~l~lp~~,l.. of Eva nation Date 3- t°!-°12, Current Lan Use or Vegetative Cover ~~sZvCt-L. Parent Materials s~1,T~ S'~t~.~T ova ALL CustomerA ress aa~ z3o`~ sT. ~~`-~w ~N w ~ s4ooz Estimate S a owestGroun water zq " Floo Pain Elevation , ti~ . R , County sT• ~~~~x Tax Parce No. System Loa ing Rate in Ga ons Per Sq. Ft. Per Day °••zz. lot Lega Description IJ OF /~ LD>~ 1 N FS: of I.l~ t / -1.~ t: 1 Sic c . `1 , ~ Z q iJ ~ ~ 16 iv System Geometry an Oept r~i~., . ~.~'~ s ~Q l~-t ~ux~~ w` z ~~iC~k~S ~ x ~ 3 S ope an Aspect 6 f o Horizon Depth . In. pominant Color Munsell Mottles u. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Boundar Remarks: clayskins ores Hand other Loading GPD/ft.2 1 ~ -9 ~ O`i.l~- 313 - s 1 I Z •Fs btic m ~ti. a. S ~ . ~ Z ~-zq S~~Z 31 - s ~ Zmsd~ ~^',v`F^ eg o, 6 ~ Zq-3~ 5 ~l 2 31 y ~. z -F ~•Syizs/~ R>vo ~oyLti s~ z s ( Z ~- sew m ~ ~~ ~ 9 s~~~~ RT 3-3.~ ~.,. ~. ,3u1-b0 5-12 3Jy ~~ S ~ ~ m ~'(-~~.. 1V•!~ Additional Remarks: ~,~LPC~C~ g~,t~T ~~5~°-rsq _ 3Zj~2,h-~ Z~S1l~~l~ - ~ SO ~~~ -~ >L do . Z !v ~.. MU T °1' `~. 9 ~- S;~ ~. c~. • Other Site Features: ~~_ t~Gw >~T z9'r C~ ~ 3-Z--q2 ('~)S) ~IZS-o16s 57C~ Limiting Factors/Depth: CST Signature Date Signed Telephone No. CST # ~Z- L-y ~ cnn a»n,.~ ~.,nm • Wisconsin Department ofIndustry, SOIL DESCRIPTION .REPORT P o t~ & 7969 ings Division Labor and Hurnan Relations ox (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, WI 53707 Ma ed as St'ovTll'rGC~ S ~ ` Page Z of Fit No. 3 Elevation qS.3 Soil Survey Page No. (~Z pp ustomer Name of Eva nation Date ~oKN `Nll~~~,1., 3_ ~`'i-dl~- Customer A ress a~ ~- z3o`TM sT. ~~~.~w ~ ~v w ~ s ~ ooz Current Lan Use or Vegetative Cover Co~s~'v~L. Estimate 5 a owest Groun water 16 `~ Parent materials s~1.T~ S~tat~~' o~~R. ~LL F oo P ain E evation '~' _ R County Tax Parce No. System loa ing Rate in Ga ons Per Sq. Ft. Per Day Lot Lega Oescnption -J pF' h~.Dw ! JV p'T'• u~ rl~ 1 / -1~i ~ ~ s~ c . ~`l . ~ Z R ti ~ ~ 16 w System Geometry an Oept r1~~ , t.~' S 11-.~A V--~ °u,vD w` z T2. ~vc~k~s 3 ;c `3' ope an Aspect 6 °l o ~ ~51'L~2 C. fir' Horizon Depth . In. pominant Color Munsell Mottles u. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Boundar Remarks: clayskins ores Hand other Loading GPD/ft.Z l O-1 ~,O`i.(Z 313 - St~ l~p~ ~~ cZS o.3 3 ~6-Zb J~12 3/ C'Z- 7.SYQ SLR ,Pr~,.a ~ o Y tt s ~ z. S ~ ~ `F S bh ~ ~ ~~, e- S 1V-I~~ Z6.3g 5 k 2 3/~ ' ~ g ~ Oyh lM, '~.~ s ~ PtGE ~~T z.C~ ~~ tV-~ • _.. Additional Remarks: ' i :; - Other Site=Features. '~ i L~5 1 • ttC~1 PiT ) ~ ~r L~~ at - 3 - Z! - ~1 Z (~ 1 S) ~ ZS - O) /o S S 7~0 Limiting Factors/Depth: ~ CST Signature Date Signed Telephone No. CST # ~Z_ u~ - cnn q~~n 7~~ n•~qM ... _ _ ~~. s Wisconsin De artmentof Industry, SOIL DESCRIPTION .REPORT Safety & Buildings Division labor and Hurnan Relations P.O. Box 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, WI 53707 __. _ tt - Page 3 of Fit No. .~ Elevation ~1`i• 3 Soil Survey Page No. (~Z, Mapped as Swo~Z'tRGC) S l I Customer Name of Eva nation pate ~o~N ~lO~~l.. 3- l°!-~'Z Customer A ress °tq.~ z3o`T'F sT. ~~~-~w~ti w~ s~oo~z Current Lan Use or Vegetative Cover ~-'~s1tiR-c= Estimate 5 a owest Groun water 3~'~ Parent Materials s~1,T~ S~U1-~.~~' o~~R 1'1~-t_ F oo P ain E evation , ~~''~ County s~-. ~~~ ~x Tax Parce No. System Loa ing Rate in Ga ons Per Sq. Ft. Per Day o. z-z.. Lot Lega Description IJ pF' J<~-~w 11V jam': p~rJ~l/ -?..1~ 1 S+CC. tit ~~L~i iJ ~ ~ 16~v System Geometry an Dept ~r~i~ . ~.~' s ~-ao V--tou~v~ w`Z'C~C~Cb4~S ~~cr.3~ ope an Aspect (~~l o ~U1ZTb{ WL~ST~C-Ef , Horizon .Depth . In. pominant!Color . Munsell'! Mottles u. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Boundar Remarks; dayskins ores Hand other Loading GPD/ft,z ~ b - $ L O `{~- '~ 13 _ S 1 ~ ~ 'F 5~~rt Yn `F~. ~S b, 3 Z $- \S it 1o'-t2 3/~ _ s ~ ~ ~.'~sl~k m f~, ~S O•~o 3 ZS _3D ~-S`lR ~1~ - S~ ~Cg~12 1'-~U'F'-~ C_S 4, S ~ 3p_u$ ~-S Y2 31 ~r C-"Z~ '~•SYR 3!8 P~.o lOY2 s~z s 1 1 ~-sbk ~~~ '~''~~ Additional Remarks: .Others+te Features: I! ~~. `G~GW R'[' 30~` ~~% ~ 3-Zt-`tZ ("1!S) ~lzS-o16S S7(~ Limiting Factors/Depth: CST Signature Date Signed Telephone No. CST # ~z- ~i~ cnn a»n!~i n•~!1m PLOT PLAN S c-it L~ t `~ = L~ O ~ VAT PIPS 3 802v~ 'oR~v~,wh~( R~51~~ ~~~ sere P•4 X ~i' Z- w Page '~ of ~. r-ZS -- i ~ ~ ~ ~ ~ i ~ rt ~I b~ ~uT ~ Pk~T ~ o~ O 1 STv¢ ~3 ~ _ i 6% I I I - v u ~ ~ 0 I~ '~ 11 1 P.Z 1 1 11 ~L~ 8 ~.i~ {iuoT P'R~PLsR_l'/ ~.f~ts~ LL9S ~----- 1 - ~~ 41r S, ~~(R~Z- Lur l.vuL ~-- BYI _ ~,. lOl~•O ON NfriL 6~~ ~~U6°e GR1J•~y~t'p of IO P~~ CJt~e~SL ~ ~ tiN NW S i pE OF -) "Dt f~ . W04~ PU SZ'. ~~ . CST Signature Date Signe Telephone No. CST # ' 4' Z _y~ 1 " J _. . . ~ (-- ~~ ~I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~~~~~~ ~~~~' Property Address --~q"~ (/Verification re uired from Planning & Zoning Department for new construction.) City/State ~~~Ul icy f` ~~ Parcel Identification Number ~ ~ - ~~~~ " ~ d ` ODO LEGAL DESCRIP>TION Property Location/1i~ 1/4 ,/~~ '/4 ,Sec. ~, T .Z ~ N R~W, Town of ,~Q~~L.t~/!'~ Subdivision JV~ ,Lot # ~. Certified Survey Map # N~ ,Volume , ,Page # Warranty Deed # ~~ ~~ ~ ,Volume Page # ~~ Spec house yes n~a Lot lines identifiable es 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 yeazs 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 I2 - 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 aze true to the best of my/our knowledge. Uwe amaze the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. /~/~//off DATE 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) 1~~~3~~~.~ Q.~ c~cat~t cf Ndw - ,rX.i7. ~t~83 s; 2:30 ,P' :.'r1. a ~~:. . alts=wed lrte. i[Tlla 40 t c `_.~'4 ~ ~~'~--g. ~.at:i:.. T-ai- ilds~..~r'1 !~Y d tit trial PirG. far sad u otlASideral5oo t v y;, .. t - 1 rite t+ttta aL ,~.LCs1F_:.y~_ 't'ho"+s~i Af~_~ti#5~.~.Ql1'J!. u E3 E S 6 i , ii 6O ) ~ ~~•r~: - .. _ r , t~ri'i luraP ~.~__..~. _ _ f tlfrfa~ 1 ._. to ti fir! by rte ttsitd pauit...1.8.5d tht second tgri. the :nrapt 'r6sreof s heieby .tt.a . ~ ~+, . ~:•bd, old. +~ad. nrlearl(ed, at3aled, oeoveped sad ~~ y theses pseaents il~ ~. t[~. ~x ~ ~. t~~ta t+~. mot, ~*.l~y ~a ~oe~~ tr~uo ester ~a rtav.t~ a ~ .~ cti,~ «~a ¢.rc. ~t~ >~ ~t..~ t~ try .~~ rata tax ~.oa~d :,< rise +_ro®ty of ~ t _ o ~ x and Seale d w.aoatss~, ~-~: Ft parcel of 3.and locater3 in the E•SE;s of NE's of Sectic3n 1~--2'9-15, Town of t3aldwin, being futrtttez described as follows a Beginn,inq at tt;e NrE co:rn~es Hof said 5ectian 17; thence S along the E 3.iane o¢ the 1!iE'~ of NE3r[ a distance of 534..+10 leer; thence L388 34'00^W 668.OS Peet; thertcs Nl°23'00^E 576.00 fee to the N 2.in+e of ~.he t~iE1a of NE'ls; thence S85 40'00^E ";,°_,.,•.r_-,~ 655.52 fc•~et co the point of beginnin5r. _.. ~, Q ~~ t. ___._ (,ta Pt(a~v, oor~+us Dsecal.QZ4or+ ~ Rac~t+se Sma) '><'o/eT$c+ar +riib ~ aed sia~•tt7u the hertditamtfrls Arad a}tpattt:nanccs thm~aeto belonging ar ie on}• arise i,ppsrtainittq;esnd 611 the estate aiglt=, tiifr, ie[~st, c1a~ or dsmay a'L~tsort~s let ebr t~ FanE of chrt first pat•t. cathtr in !sw ar equity, eit>;er in pwnestion or rxpectaeeY +o[, Fa said to the c#ao~r tllt~aiesd prt°micsos, sad then irc'a•dit3~ota attd appvrteaancev. To R~ae•o a.erm To bFoli! ril>c s>sid ps•+ee-isss os altars dswcmy[+tt sith ehe t ereslitnmee!» and appur!snancea, vato the said pasc•],45of at= atytimd parr. and ~ttae~r •..htzr, and ,~~ FOREirER. ~,~ ~ wnae~...~.3..r„s~ii....A~a~,.o~aa~l ,8_a~:ra.IS:.~..~_~a ~sr_iJa..... _..--- .._.w......_•_.-..-••..... .~,_~._......_ -•••••..~ ~ tsutg d tht• fo+l tutrt, Yur .t-.•Il Jit+l (tw .v...-,,,.~r•., +ka.-, r~orettsot, Rtltnt. bargain and agrce to and with the said .sart?~ES.-of the +actond ~trt,,.-~_ .• fr Ft a. i-*` .Y.Psein and o~aigtts, that. at +Ihr titae 4l the rtnstalia$ and 4eliV'Cry O[ thrse presents it is waif s,ei;ed of the ln'Dmiistir abox.F tl~eesr+"btri, a~ st a good. wre. ~tfoca, ahsclat+s and ieddeaufrie estaee of in6cri;ar..x in the ~cr. in fee simp}e, ostd these the same sates Ssse attd clear testa s9E +att:tmt .that!ser...~..~.__.,.•...•._.-~-..-. _ •----•--..~_•--.~.-.._._.• ~...~........._....._........._._... s~ the tLs aburtt tfaasaiaexi psrtnim iu tiro qutti aed ptarrat~la pm+esaitrn of the acid parf2.P S...of the second pvzrt,._..•~..•hetrs and assigns. sgaitae a,U sell t~erz persoa yr prn».e:s lasftti;y rlaimiltg the eahoie t:r any pan t:leztl[, it will torrvcr zYARRAN9` Alvij' DEFEfVC. is wltota. s~*harear, thr •~id Fi rs C Nation•a 1 Bank o£ Raldw.i.rn- ,;:..:a'"",-'°`->> ~ y' ; ••i7.1C~° parl}° aR t((r Ord Fyn, ta.e+r-•u:•..1 th.-.a- Ix.-..•tti: iv le- ._yna.l 1•• J011 ~. tMe t7_Zlk ~ ^ S ~ ,Vii ['"ra~iialant• and ~nt~-~n~.a t.} Bt}e3.da Thomgsrtn . ~t,~~t~z~ ~,~'. Sald~w}1'l~_ 43~-c~eottsin..aa.l .tom aurryr•at.• ..-..} t., le..~ 1..-r.•utttv:tffia..l• tb.• ~`` .5..}- of ~O~ie1~X. i~ .(t~`. i'1~ 1~3. -'. SdGc`d'ED i(~iL3 SEALED L.l ?R£SEfVCE OF „`` s ~(_- _ _ _~_____ ___. --- // 1 mil/ 11 ='1/ ' KaG'IST.fYl t!F-~ cn t~ r iii i _. j, on - ~ Mentin , ice era-„Jena -a - +. l C-uC;NTl3iC7i1GiV f3U: _ ly~~` _ ._ `~ IJ _~,-/~ ~ ~_ -'~~ie`~c`l~a T ompso~t, Cas~iier ~ ~~ 3TAC~£ OF WISCONSl1Y, l } ~. .1 Personally came before me, altiL----° --- ---_day ol..._...NS2Y.£S[Lb.~X--.-•--• A. D.. I9..~.~ .............~ZQ~...M.......~£'.TA:G.7,Tl.~S.r.......---°--... 1 -. ~l1C0 1'n-.iJ.nt• an.l Shelda Tizomps.on.,.. Cashier • s•~a[~xot (ha•:(buvo ~'~ namcel forpaa-.ttiur.. to me {mown to be the parsons who exetute+d the foregoing instrumenr• and to ma• knc).vn u> ur such.. ..V1CN Pn•sidc,~t •~ it and_. Cs'l~T$lY1@L. S~CIflCtlij'7f~f sJiei Corpura[ie.n. Jn<1 acknuwlevg.d lhal (h,~y a•seeulaal lho fura•I;uin~ instru men( Je each aslTu'cre J3 lha~ dreg! of said Crx}xt;J(wn• L\• 11~ au(hnrily. r.~y / r t ; !' •\ 1 - ~ ttOTARY t . ='....... ~ ~ ~ ...:...........hlin.--~-----Linstin,en............ ,, ;~ - •. - l stt~t~ ti .t.• ~ •--. ' '• a Thin instrument dra;te~l by `•, / 'U ~ r2iYeta JPublir~~ta.te.._qf-..Wsc.-.---....t~t?fX,~pfi~.. ~~.. _,John...G~..-_Nis-ting2n-r----At-tc~xne}..-------- ~ Z• • ~~ ~rliir~:•,s'srxr ~~f~ c(s)---~'e.x'max~~n.'~.., ............. malt:win, Wisccznsin^54002_ `_~' _ ,• ~,~ .~__- ..______ ._ (4K[lata [H31 (!i of tha VGLOOOa1n Rutvr Drortdr ehst all Iru[rumants 'to its rocafrda4 atrsll lures Dlatotf Drlatad or tTpawrlttsa [barson tfia - namr of tLa {rantua, gcsacsr. wttnsrr and nntar,). R7hitIiANTV GEED-•5TwTE r~F JVISCOtiSt N. FORAf NO. t .. c ..,.a ,o ...,,.,,... _ _ , .,-~ wi~E~ierY ~~F~-fir o~.a~. `~I`i.T1E Oil it 1~(QCZitLS/TF_-k`OtID[ 3 ts, afiR t~ 11! 1~R, t}iLTk ~ ~ '( r~ o Wisconsin Department of Industry, SOIl~ DESCRIPTION .REPORT Safety & Building; Division ~ Labor and Human Relations _ P.O. Box 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, wi 53707 Pit No. 1 Elevation q.$.o Soil Survey Page No. ~ Mapped as SPw'n-~rc,0 s • 1 Page t of +~ Customtr~Jame - _ ~o !-~ N `N101~T~ ioi va uat on ate 3 - t 9 -- 9 Z urrent la Use or Ve9etatwe over P r~~ lvR-C arent arena s s ttT~ Te~v~.,-r o~ttt Ti u. ustom~r refs q9~ z.3oT'' sT. ~3~k`. ttis w ~ s~oo~ Estimate a owest roun water Z9 " Pan evation tv • P, . ounty ST. CRIB UC ystem L in9 ate in a ons er Q. t. er ay o.Z"2. • lot eqa p On FC• qF IJ~ f / -1.~~ 1 LD+~J t N ~'Y Z=! t•J 16 ~v Ystem eometry an dept n+.a , t.~' 7 MrD M ou~p w/ Z ~9uCtktS ~ x ~ 3" pe an f~ °f e w ~ ~it~-~f 4 Horizon Depth . In. Dominant for Munstll Mottles Cont. Color Texture Structure Gr. Sz. Sh. Consistente Roots Bounder Remarks: <iayskins ores Hand outer Loadi GPD . 1 ~ ~-9 ~o~ltL 13 _ s l 1 2.~sbtic w,~y, a.s .. o. '' Z oi-ZQ 5`i>~ '~1 - s ~ Zwt S ~ v'F^ ag o, bj .3 ~9-3y S `~ 2 'sl C 2 7.SYR5/$ n~.,o w~ta sr t S ~ ~ ~ SLR b`'' U'~,. C 9 ~ A~- 33" U. ~. ~ y-bo 5 ~ ti. 31 L~ s- i o Y•, m~'i.. ~v • ~ . Addiiionai Rerttarks: R~QL~C(r ~L~,f-. sYST~I _ ~ 1~~Ct~ `~~s~ t~~,c.~ _ y 59o GPD ~t r +~o Z. C:U~~J'tPCt +~.~ L~ M VT'R...~ 9 E~ Y 9' ` `. _ ~ ~.. ~~ M tf) [~ GL , +n rn o . w ~- ,Other Site Features; ~ ~. N` o. ,`~ EST. MGW Pr'r Z9 rr -• Limiting actors/0ept ; o•• . ;,~_ 1 Li~GI~w ~ 3 -- Z l - °I 2 ,.,~'",} 7 S) ~l Z:S- O 16 S S 7b+ CST Signature Date Signe Telephone No. CSC 9~ Z - ~! .~ D 3 08/28/07 TliE 09:45 FAX 715 386 4f 3 ~ s _ ~ ,o N T ~ ~-- b ~ O d r~ 1 ~ '~ a .. `. . - o' ' d _S m~~W. N ~~~ A N ~~ J ~/ -i O N 3 • O Q r N N t D ~. h.. 0 b A 7~N' "C W N N ~ ~ ^~ ~ ^p 3 ~ 3 a "~` r. x. ~ A ~ ~ ^ Z ~ N ~ ~ '~ ~' G o ~ ' ~ 0` ~ 6` ~ ~'' ~ ' X ~ N to c~ V- O 3 1 tr ~ D ''~ S „[ ~ ~ '' ?O ~ a ~ ~ r __._ .._ ~_ •~.. / ~ ~~ ` ` w ~N - y Z ~ ~- J ~ ~ ~ - ; ~ r ~ a ~ ' ~ .o ° -- . r i ~^ o ~ N r ~ c -. Z ,~ o Q' ~ ~ ~ ~ b ---- A ~ ~ ~d N~ O ~ • fi, _ ~) ~ LL ~ A t0 V T~ N n w ~ C r ~ A f1 w .~ A n w 4 n M ~ 3 ~ ~ ~ ~ ~ ; ~3 N~ ^A ~~ ~w y ~ N A Q Y ~ O !! ~ ~ ,(.( r f t t7 7 777 ~ h r (, A ~.,,~ ~ M g ~ C ~o 4 N c ~ r~ 7 A ~ O ~ r G N r ~ ~ ~ '" ~ ~ .. A r ~{ L ~ A ~ O N ~' D o (~ 17 ~ ~ ly J ~.: ~ ~ ~ oai x ~ r ~ wn A * r .i r ~ s b ~ ~r• ~ M r« l ~ ~, ~ (~ L 6 ~..- -i ., ' _ t= ~ ~'~ L ~ ~` _ ~ ~. ~ . X002 W ~~ Q N rr ° o Z aN 0 ~ ~. C.3 2 0 1 ~~ '~ V~ b ~3 r ~ A~ v f~D ~ '' o ~_. ~: y N a ~=- ~ r. O M \f N ~ q ~ (,~7 .- ''~ w ,o T ~~ ~ ~ c ~' c~ ~ r n tJ1 ro ~ ~ °„ ~' o ~ z ~ ~ ~ ~ n I3`~ ~ M _ O ~_ ~ d O ~~ ~ D ~ r /^) ~ ~ V' /"1 to i~ o `~ a N ~ S A . fD v Q~~ 1 ~~~ ~c ~ ~x~ m - ~, w n ~~c w ~ -- N w v .~ G ~" V _ .. ~ . -~ ~. ~~ rr-~ ~ ~ (,~ 1 Wisconsin bepartment of Industry, SOIL DESCRIP710N .f~EPQR7 ~- Safety & Buildings oivisio~ Labor and Human Relations P.O. Sox 7969 (Attach Soil Profile Lotatson Map - To Scale - On A Separate, Signed Sheet) Msdison, wI 53707 Pit No. .~ Elevation q`7. 3 Soil Survey Page No . ~ Mapped as Srw~'11~tr~0 s 1 Page 3 of {~ ustomer eme ~ol~N Y~10~1L of va uat on ate ~ - L°i - 9 Z urrent Lan se or Vegetatwe over P -~s'tvRC Perant Materials "" s <.1T~ s~iw-19~T au~ ~t..~. ustomer refs Estimate a owsst roun caster oo a n ever n o~nty o. System Loa In9 ate in sons er q. t. er sy . of eqa scr pt n ~T~ OF 1.1~! / -1.~~ ! LD~I 1 N "'~ ?.4 -..1 ! b w System merry an apt ruu . t.~• s 11Np lti tiuxlp +~~ z.1~t9uCtitRS '~ is L~ • pe an ~ U °t o 'f`~-~ WI~Td~R Horizon D~pih . In. DominaM Ot M nul Mottles ont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Bounds Remarks: claysktns ~ ores Nand tl7e t o - ~ 1 Oy~t. !3 ` s t > >'F soh. wti 'F~ ~S ~.. ~'' ~ ~•, ~' Z $- \S to `i2 I6 - s ~ ~ Z ~~ek mfr. ~s ., ,: o- 6- . _ .. ., . t{ 3c-~a8 ~-S'~ 3 to s~z, ' S ~ 1 ~-sbk w-~-F,.~. H .1y. Additional Remarks: r ~ ~ ;~ Other~Siterfeetures: o j Cv ~~ . ~~+~~ AT 3p v ~ o ,, j Llmrt ng Factors/Dept C i ~ 3--z.l-gZ CST SrgT nature Oate Srgne i ~ 1 ~ ' 'fit S ~I ZS- 01 i. s ' S .. , e e one No. 9~ L -' 08/28/07 TIDE 09:46 FAX 715 386 4686 • . M r ? 1 ~:__ .. ~~~Q. ~., Q8°_ ~ ~3 N ' r [~ ~ ~~" " zg ~ ~- "z ~z J r r J ~ _~ ~ ~~ ~ [ a` d ~ , J Q` -~ r ~p~ 4 0~ ~~~ R ., . A ... _ . __ _ -- ..- -- . ~ . N' v~; q0~ ~~ ~N x ~ tiA ~ _ r% O C C ~_ V _ ~ Z-3y ~ S~'. - - ~ °. 1 m ~~ le ti-e Q-.'t. ~~ q ~ v X004 i~ ~-, ~~ i~ 0 r d y ro r ~~ b b p 4 I~ 0 y ,St. Croix County Planning and Zonin Thursday, September Ol, 2005 at 9:08:45 AM Detail Sanitary Information Page 1 oj'1 Computer #: 002-1037-20-000 Sub/Plat: NA Section: 17 Parcel #: 17.29.16.2488 Lot: TNIRNG: T29N R16W Municipality: Baldwin, Town of CSM: 1141/4: NE 1/4 NE 114 Owner: Mortel, Jon 994 230th Street Baldwin, WI 54002 State Permit: 289367 Issued; 06/1211997 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 0 WI Fund: No POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Not determined NA Hudson, Dale Filed with 00 permit. $0.00 Signed Off: No Owner: Mortel, John 994 230th Street Baldwin, WI 54002 State Permit: 353351 Issued: 03/27/2000 POWTS Dispersal: Mound County Permit: 0 Installed: POWTS Detail: NA POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Not determined NA Hudson, Dale Signed Off: No Permit: Replacement Bedrooms: 0 WI Fund: No Additional Notes Monev Owed Inspection report never filled out. GCS shows $0.00 improvements to property. 8/31/05 ~~ I~ ~-- ~~)~ _~~ ~:~ u ~ ~,,~+~ --- ~u ~~ Parcel #: • 002-1037-20-000 09/01 /2005 09:40 AM PAGE 1 OF 1 Alt. Parcel #: 17.29.16.2488 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 - MORTEL, JOHN B & MICHELLE C JOHN B & MICHELLE C MORTEL 994 230TH ST BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 994 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 8.280 Plat: N/A-NOT AVAILABLE SEC 17 T29N R16W iN NE NE COM NE COR SEC BlocklCondo Bidg: 17, TH S 534.4 FT, TH N 88 DEG W 668.05 FT, N 1 DEG E 556 FT TH S 86 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 655.52 FT TO POB, TOWN BALDWIN 17-29N-16W Notes: Parcel History: Date Doc # VollPage Type ~nn~ ci innnneQV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.280 9,400 169,400 178,800 NO AGRICULTURAL G4 6.000 600 0 600 NO Totals for 2005: General Property Woodland Totals for 2004: General Property Woodland 8.280 10,000 169,400 179,400 0.000 0 0 8.280 10,000 169,400 179,400 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wis~onsin'bepartment of Commerce PRIVATE SEWAGE SYSTEM Safety and BuBdings Division INSPECTION REPORT GENERAL INFORMATION (ATTA~I~-~O PERMIT) Personal information you provice may be used for secondary ~s~ [Privacy Law, s.15.04 (11lmtt Permit Holder's Name: ortel, John ~ p .- ~r r ~ ~ ^ City ^ Vill e ^ wn of• Ba~~wm ownship CST BMElev.:- .. BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA Coun~rt CrO1X Sanitary~grEn,it No.: State..33PIJJanJJIDJJ 1No.: Parcel.T,~c Nq,~7-20-000 STATION BS HI FS ELEV. Benchmark -Alt. BM Bldg. Sewer St/Ht Inlet St / Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade St cover BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIM N 1 N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Num er: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / mspect7on ~~: i / Location: 994 230th Street, Baldwin, WI 54002 (NE 1/4 NE 1/4 17 T29N R16W) - 17.29.16.248B 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No Safety and Buildings Division ,- - SANITARY PERMIT APPLICATION 201 W. Washington Avenue `~~~~SI n In accord with ILHR 83.05 Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper ~ unty -' ~~' C " ' ._~ . than 8 1/2 x 11 inches in size. 1.__ , ~ - y p/ ~ • See reverse side for instructions for completing this application R~ state Sa;; ary Permit Number _ ~ ~ 3s~ 3 n~F Personal information you provide may be used for secondary purposes ~ ~`d,/ ~ , heck ~if re ion to previous lic C [Privacy Law, s. 15.04 (1) (m)). ~~~ State Pla ~ Numbe /br~Gt . I. APPLI ATI N INFORMATION -PLEA E PRINT ALL INF ATI ~ t ~ ~ ~~~ `~ Property Owner Name '-~' ~ V4~ f1• / " ! GY' e. rope L ~` -_ 1V , S ~ ,#' I - N- R /~ ~ (O W Property Owner's Mailing dress ~~ O~ ~ 1~ ber Block Numbe City tate '~~ , ' ' Zi~dg ~a ~ Phone Number Subdl ~ a cg S ber ~~ -.~ tom v~ / ~ ~ (7i5) $ ° I1. PE B I G: (check one) ^ State Owned -2 J ^ !t~ ~) ~i ~? ~ " ~ own o Nearest Road Z3 ~ ~ s~; Public 1 or 2 Famil Dwellin - No. of bedrooms C1G I ~ f III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~O~ ~, 1~3~1 ! 20 ~~~ ~®~ -~~ ~ ~.~ Z~ [ ~ ~ °~'~' g 1 ^ ApartmentJCondo - 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ^ New 2. replacement 3, ^ Replacement of 4_ ^ Reconnection of 5, ^ Repair of an ______S~stem ________System_____________TankOnly______________ Existing System ________ Exlstln~S~stem B) ~A Sanitary Permit was previously issued. Permit Number 2~93G r~ Date Issued ~ /Z 9~ V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressur"zed Distribution Experimental Other 11 ^ Seepage Bed 21 ~ound 30 ^ Specify Type 41 ^ Holding TanlC ~ 42 ^ Pit Privy 12 ^ Seepage Trench 22 ^ In-Ground Pressure G P i l ~ • fl r vy ~ 43 ^ Vau t 13 ^ Seepage Pit r ~ 14 ^ System-In-Fill 6~ ~~ VI. ABSORPTION M INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (s ft.) Proposed (sq. ftJ (Gals/day/sq. ft.) (Min./inch) ~ Elevation ~ ~~ " ~~ ~ b ~~ ~ ~ eet Feet ® ~ . - ~ v ji Z~ /1. ~ ~ VII' TANK INFORMATION Ca aut in allons g TOtal ll # Of k Manufacturer s Name Prefab. Site COn- Steel Fiber- l Plastic Exper. A - - i Ga ons Tan s concrete g ass pp New Exist n strutted Tanks Tanks Septic Tank or Holding Tank /pOG~ ~-" ~~~ ~ C G/•~~~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber 7~~ -"""' 5n f l ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) ~ rr l e ~ . ~c~//c~sorti Plum is Signature: (No Stamps) ~.~ ~ ~~~ MP/MPRSW No.: ZZ~ ~ ~~ Business Phone Number: 7/.5 - «y -~~3~ 7 ~ Plumber's Address (Street, City, State, Zip Code): / -) ~_' IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved anitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) rOVed '~4pp ^ Owner Given Initial Surcharge Fee) ~~ ~ 3 _~~ ~ Adverse Determination ` X. CONDITIONS OFAPPROVAL /REASONS FOR DISAP .~.Q ~, t,: ,~ P(`R~~VA~L?: ,~ ~,~Q ~ ~ ~ , ~~ ~~_ s,y,J„_.,.,~i~ p ` C`} ,',_„ C . ~i7nBI1T1(iN~~O,~rigina o Coun Oyy~ ~e~byiTO: Safttyl& euflefn DI sl n ~e r,. lur~Der INSTRUCTIONS Y. 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county priorto installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental~product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishmentof standards. ~ r '~. ~, isconsin Department of Commerce Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603-1905 Tommy G. Thompson, Governor wtliam J. McCoshen, Secretary August 31, 1998 CUST ID No.6306 ATT7N.• POW7S INSPECTOR BOLDTS PLUMBING AND HEATMG INC 820 MAIN ST PO BOX 87 BA~,DWIN WI 54002 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/31/2000 SITE: Site ID: 16912 St. Croix County, Town of Baldwin NEI/4, NE1/4, S17, T29N, R16W John Mortel _. _ FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 37546 Identification; Numbers _ _. Transaction ID No. 121519 Site ID No. 16912 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. • 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. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. • The existing septic system must be properly abandoned. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. BOLDTS PLUMBING AND HEATING INC Page 2 8/31/98 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~. RARD M SWIM , POWTS PLAN REVIEWER Integrated Services (608)785-9348 , MON - FRI, '7:15 AM - 4:00 PM JS WIM@COMMERCE. STATE. WI.US DATE RECEIVED 08/28/1998 FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 BALANCE DUE $ 0.00 . '.. ,~ BOLDT ~ S RECEIVED 17VLJJ i xla~,,tss.~ ~ ~ AUG 2 8 1998 PIUMBiNG a NEATIN6 INC. sAFEry & B~ nr~ ~. "Serving You For 40 Years" 820 Main Street Baldwin, W154002 (715) 684-3378 Fax (715) 684-3144 page ~ of Mound System For A -~ Bedroom Residence Located in thel~l/4 of the~~l /4 of Section LL, T.Z`1~I, R[~W; Town of r~ cz l cl ~.;.~~' ~ ~ , Y T • ~_ Y~r:'X County, Wisconsin. Index Page I of 8 Page 2 of 8 Page 3 of 8 Page 4 of 8 Page 5 of 8 Page 6 of 8 Page ? of 8 Page 8 of 8 Title Sheet Plan View Cross Section Distribution Pipe layout Pt>imp Chamber Pump Performance Curve Soil Evaluation Report Site Plot Plan Mound System Plot Plan Prepared For: ~'®.~`~•T•S. E~t<,~, ~r ` C~a~t~itiotially ~~ / _) r ~ f -- DEPARTh9E~JT OF COMMERCE ~~ ! (~f ty % n ~~i ~ J`~'`!'~l ~1 _..,,ctint~]E SAF~7Y AND~LDINC,S }SEE GUr<K Prepared B, -: ~/ Dale Hudson Certified Soil Tester /Master Plumber #220863 ~~ .' '.. ,, ~ r Page?- Of ~SrM ~ 3`3 Medium Sand Topsoil Straw, Marsh Hay, Or Synthetic Covering g i ~ ~E fd % Slope Undisturbed Soil Trench Of Z~~- 2 ~2 Aggregate -' Distribution Pipe Force Main From Pump G Plowed Layer D Ft. t•b~7 r Cross Section Of A Mound System Using F r Ft, 2 Trenches For The Absorption Area G ~P Ft. A ~ Ft. H /.$ Ft. B ~ Ft. Signed : fit- ~ ~~.~~Zp,--~ c ./Z Ft. License Number: ~zog53 K /.~ Ft. Date: ~- ~~-~~ L ~ Ft. J _~ Ft. Alternate Position of Force Main I ~ Ft . -~., W~[t~Ft. L ~- J~ _-_-----t3 t -_-_-_- - _K , ~ C - _ - r . _ ' _ _ _ _ -_-t Force - - Main W ~ 0 servatio~ Permanent Pipes Markers Distribution Trench Of 2 M- 2 2 u t Pipe Aggregate . ~ Mound Using ~ Trenches For Absorption Area .~ .. _ End Cap Distribution Pipe Oetaii For A Four Lateral Network Alternate Position Force Main PVC Distribution Pipe w~ S Page.3 Of 8 PVC Force Main Holes Equally Spaced On Bottom * Last Hole Should Be Next To End Cap ~ -~ Signed : ~ G`~ . 1 ~rY`-~ License Number: ZZ~B/~ Date: ~ ~~l~ t PVC Manifold Pipe P 3~ Ft. S /,~, Ft. X 3~ Inches Y~1 aches C~~" s Hole Diameter ~ Inch i Lateral Diameter /~~ Inch(es) Manifold Diameter L inches Force Main Oiaraeter 7/ Inches 1 Holes Per Pipe ~/ invert Elevation Of Laterals -pQ.l'1 Ft. ~ ~ 1 . S' I~nr.1 _.L_ ,~1- .. 9, s ' PUdfiP. CHAME,e.R CROSS SE!"IDsJ AWG SPEClf`ICtiTIGAl; VENT CAP Y~C.I. ~~EUT PIPE WEATHERPROOF aps<ROVEO LOC:!~h11.. JUA1CT101J 80X MA~JHOIt: COVET ~ 25' zROM GOOK, WIWOOW OR FRESH IL"Mill. AIR IAITAKE 1 1 GRAOE 1 ' Y" MIIJ. ~~ ~ •• Is•d~clu. • C0IJDUIT ~-- -____-__ ~\ - IB"M11J. ----- --- -- 11~ _____ lA1LET PROVIDE ( ----- AIRTIGHT SE/~.L I I i I V I I APPROVED JOIIJT A I (!I APPROVED JO~~ I II( , -. ( (I ALARM EXTEUDIIJG OI~lTO SOLID SC ~ _ b I iI _ ~ ( OIJ C ( I I ELEV.~L~Z FT. PUKP ~ --~ • ~ .dFF`. 0 f GOAICRETE BLOCK ~ ~' RISER EXIT PERK17fE0 OIJLy IF TAIJK MAUUFACTURER HAS SUCH APPROVAL sE~~c E ssP.~c~Ficai ot~s oostE . ~ei'~ ,r5 Tw'lJKS MAfJUFACTURER: I~IUM6ER OF DOSES: PER DAB TAlJK S1Z£ : 75~ ~ C,1AI_t_01.15 DOSE VOLUME /3O t 96 r 7,LARM MAIJUFACTUR>ER' ~ CI ~ ~G/ r0 IWCLU01~1G 6AGKFEOW: 7 GAUON~ MODEL 1JUM6£R: r~ ~ _9 CAPACITIES: A=zy`~~lpJCAES OR,~7~~ C+AlLOUS SWITCH T9PE: //~'~ /P rGUY'Y g = 4 IIJCNES OR -3S'7~ GALLOIJ~ PUMP MAAIUFALTUR[A' v p~ /~ C = 7'33 IAICHES ORf3p~ ~ GALLOIJ~ MODEL IJUM6ER: ~~~ 3~~ L 0 ~ ~ 111CHES OR ~~ '~z GALL01.1 SWITCH TJPE: PY' G~~y lJOTE: PUMP AUDALARM ARE TO bE MIt,11MUM DISCHARGE RATE ~~'~~ GPM INISTALLEO OU SEPARATE CIRCUITS VERTICAt_ OIFFEREWC£ 6ETW><6A! PUMP OFF AUO OISTRI6UTtOU PIPE.. ~_ FEET ' -t- MLI1/.lI?MUM NETWORK SUPPLY PRESSURTTE/~.. .. 2-~ FEET ~- _~ FEET OF FORCE MAIN X '~F/pp ~FRttTWf,1 FACTOR_ '~ 7 FEET TOTAL O`.it.1AMIC HERO = iz ~ ~ ~ FEET ~1 ~~, y .~ 11.1TERAIAL. OIMEIJSIOUt OF TAIJK: LEkiCsTH $"T" ;WIDT!-1 gy .;LIQUID DEPTH y2 SIGfJEC~Q~- ~~ ~~1~~rn~ LICENSE I.lUMOER: ZZ ©8~~ OAT E: ~ ~~ .. .. .~;.r,.u.-~. crx...: 0 ~~ V 4 ~~ ~v "' N L ', !n O ~ 3 ~ ~m no` y~ oA~ ~I~V~ ~3 ,~ ~ r' Z n l J .~ ~~ OI O \ K~ _ ~G3i' O~ TOTAL DYNAMIC HEAD 0 0 ~- ~L C 3 N -~ u 0 `~ ~~ ~ "f d ~/~ Wisconsin Department of Industry, SOIL. DESCRIPTION .REPORT Safetyy & Building; Division Labor and Human Relations P.O.Box 7969 (Attach Soil Profile Locat~ort Map - To Scale - On A Separate, Signed Sheet) Madison, wl s37o7 Pit No. 1 Elevation ~I.S.O Soil Survey Page No. 6~ Mapped as S~uT11'tC~p s ~ ` Page ~ of ustomer ams ~o H N ~1 O~T~ o~ va uat on Dace 3 - ~ 9 -- q Z urrent Lan Use or Veyetatrve over P Pc5 ~,,R.~, arent arena s s ~1Ty, s~u1~,,T ouEA 1~ LL ustomer ress q9~ z3o`r''` sT. Bah`. ~~, w ~ s4ooz Estimate a owest roun water Z9 " oo P sin evati0n tv • ~ . ounty ST• c-Rv~K • o. ystem loa ny ate in a ons er q. t, er ay o.z'z.. Lot Le9a es<npt on ps~uFlJ~1/ -1J~~ Lam) ~ N :' .~Lq-J ~ 16~u ystem eometry an ept -~-rN . ~.~' s f1~sD -`-~oun,~wJ~.`~.~cek~s ~;c~~' qpe an Aspect 6°1o w~Y+~~~f t Horizon D¢pth . In. pominant . for Munsell Mottles u. Ss. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Bounder Remarks: clayskins ores Hand other l.osdl GPD ~ 0-9 ~o`-tcz t3 -" s l l 2.~sb~c m~ti. a.s o• 4 ,. Z ~-zq s~~x. ~! - S 1 Z~sbk mv~ ~9 0. b~ 3 Z9-3y s ~ tz 3~ C 2 'I.SYRS/~ ~o ~oKQ s.: s ( Z ~- sen ~'- ~ ~ ~ 9 s ' rtc~ Pt'f' ~3" N• ~.--- Additional Remarks: ~t~p L JCL ~Ls~Y- 3`!S~)''1 - 3 ~ ~`?J~ Z.~S l L~ ~C.E - y S O ~ P ~ ~L T tJO , Z C.o+ti.?Z~P~1-v L~ J~V?1't.~ A T 9, r r , Other Site Features: ~ Limiting Factors/Dept : CST Signature Date Signe Te ephone No. C T ~ Z - U . Wisconsin Department of Industry, SOIL DESCRIPTION .REPORT Safetyy & euildin~!s oivislc labor and Hurnan Relations P.0.8ox 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, wl 537~~7 Pit No. 3 Elevation X15.3_ Soil Survey Page No. 6~ Mapped as St~`R1'r6O g 1 ~ Page Z of ustomer amt ~o H N ~1 ~R~ of va nation Date 3 - ~ °i - 9 Z Current Lsn Use or Ve9etatrve over C~ ~ s ~v R L. Psrent Materials -" s ~1T•t s ~UtWt~ T o~'aR ~ --~.. ustomer rest q g ~ z3o`t'ti s~-. ~3~`. w ~ N w ~ s ~ oo z Estimate a owest roun water 16 `' oo Pan suet on » ~ ~ • ounty I 1rN o. ystem Loa m~ ate m a ons Per q. t. er ay ' lot e9a estnpt on Ft• uF t~~ t ~ - ~~ t L~)1 N ~ . L q iJ I b w stem eometr an ept rtiw .1.~' s Mso Y Y -~-r o~,~ w~ z -~~~~ers ~ x ~~ ~ ope an s ct ,;. 6 °!o i . ~ ` ~y Horizon D¢pth . In. pominant, ~[r Mu a r ~ '" Mottles s. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Bounder Remarks: daysk rik ~ ' ~ ores Han oth r ~,Z.. `t- 1(o S ~tR ~ J - S1 1 ~,~~c h1 V'Cw. cs i+ o.y ,~ 3 1_ 2 6 S y R ~/ rt+..o o r= s i~ S ~ ~~ S ~lz ~-~+ v ~'~, c g iV - t~;', ;t, " ,.~ , ~ Additional Remarks: ' _"r Other 5ite~Features: h+ ~ ~:::~ ~ T. 1tGW PrT 16" _/~~, ~ 3 - z, t - 4 Z (~? 1 S ~! 7:.S - 016 s 5 Llmlting Factors/Dept ~ CST S gnature Date Slgne Te ep one No. ~Y Z - = (~ ~ ~ ~-~ `, Wisconsin Department of Industry, .SOIL DESCRIPTION .REPQRT pap tBox 7969ings Division Labor and Human Relations Madison, WI 53707 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Pit No. .~ Elevation q_7~ 3 Soil Survey Page No. ~ Mapped as S+PO~Tl1'rG0 g L Page '3 of ustomer ame of va uat on Oate ~o !~ N ~-il OCZ~ 3 - ~ °l - °f Z ustomer ress urrent Lsn Use or Veyetativs Cover ~ ~ s Zv R-G Estimate a owest roun water Parent Matenais `P s ~lTy. T~U1W.t~W T o~'eSt. T~ ~.~. oo Pan evat On ounty ST• cR~ ~X o. System loa infl ate in a ons Per q. Ft. er ay 1, a, zz. Lot eqa escr pt on SJf~ uF W~ 1 ~ -1.~ ~ 1 L~)1 N L q N 16 w ystem eometry an ept nw . t.~'~ s t~nsa -~-~ o~np w/ Z'c~.9vcr1~S ~ x ~ ~' pe an pe ~ b of 0 1JCy1e-~} We~STt~R . Horizon Depth . In. pominant ~ q~P M n e Mottles ont. Color Texture Structure Gr. Sz. Sh. Consistence Roots Bounder ~ Remarks: claysklns ores H and otMe L G d-8 ~O`~R /3 - sib ~'~s~~ w,~~. ~s ~ ~~ ~• '' Z ~ ~$' - \S 10 `1 R / 6 - s ~ ~ ~. ~ s~ k W- '~r• c-S ,. o • 6i 3 - ~S_~ -s'•S~ta lyr sl \c~ek mv~fa ~S ~ a• y 3~-4$ 7.S Ye 31 G'Z ~-JYR 3! 8 h,,,o ~o s~~ S 1 C-.$~k 1 ~ V ~- r~,~. Additional Remarks: ~o r O~her~Site!Features; ~sT . `c{Gw ~ 30" ` Limiting Factors/Dept ~~ .. ~~ ~~~C%LXc~Ci ~ 3-?I-gL CST Signature Date Signe ('~~lS X17:5'-o~6s Tee one No. ., i 5'. .~ cf L ~ ~~ ~ i r ~. I PLOT PLAN Sch ~.~ ~" _ ~I O ~ v~T PiPk Page 5I of ~ 3 80Rw1 ast.~v~~u -t`i R.~t~ ~ FL 913 m~ sNVn~ `~ l'f0~ p•4 ~ x ~ -. _ tip' ~ Z' w~ zs r I ! _ 1 ` I f ~- b~~ -~iT ~ PhtT ~ I oR OI sTi+¢i~ ~ ~nt, a Ra.~, --~ I ~ ~ ~ ~ 6 ~u i I v I ~~ a ~ I , I~ ~..( ~ ; i P.Z P-3 ~~l,~o - ~/~L {-aOT I~RoPl110.'ry l.l~uti, ~ I,L9S~ ++ .. ~ - ~I ~' S' r i Nor L.uZ- ~~ • o F -. . ------ 2 g~ _ ~,. ~uu.o or.~ rvA~cL 6'' ~ou4 G.w~•~y,D l0 Pty ~l~ l~h1e-¢(~L a -N NW S - ~E pF -~ "D! tj , wo0'~ Pu Sl'. I : , _ ~. ~ 3-, ZI - °t Z S ~ 1 S) ~( ~ S-01 b 5 5-~- I . a ~ w ~ a ~ a 3 .o ~1 ~ v1 0-00 ' ~ O 4 O ~ ~ ~ Q ~~ °` o .z y ~ OQ ~ ' "~! Q i +~ V ~ I~ ~. i ~. F N W O I` r ~~ ~ri /G !NQ/ T w ^, 0 n ..o C" i7 ~s C ~1 a ~ ~` c~ Q ~ 1~ S ~\ T - ..~ J ~> ~ G! ~ r0 ~ ~ 0 ~ ~ ~ ~ ~ ~ -_ ~~ N ° ~ ~ ~, I ~ ~ ,'^ v, ~ a -,_ ~~ - j ~° ~-~ N Z O <.J ~ I°o y ~ ~ N ~ `~o d ~ ~ ~ .. w ST CROIX COUNTY SEPTIC TANK MAIN~ANCE AC3R£EMENT OWNERSHIP' CERTIFICA'CION FORM OwnerBuyer C1' n ~ ~o y; Mailing Address 9`~ ~ ~ ~ ~~ Property Address ~ ~~f~~ / ~ ~^~ (Verification required from ' ~ ~`< Departsneat for new City/State ~~ ~~~j'y.. !it/,' Parcel Identification Number ~~~ /L~.3'7-- Z ~ IJEGAL DESCRIPTION Property Location ~ %, /~~~~ y,, Sec. ~ ;~ . T ~~ N-R~W, Town of G7 v~i'r~-~ Subdivision /~' ~ Lot # /1I/g. Certified Sacvey Map # / ~~~ Volume f P e # ~ ~ Warranty Deed # -~~~~ ~~ ~~~ Volume ~ 7 ~ .Page # -~ Spot house D yes [i~"no Lot lines identifiable. (l~' es ^ no y SYSTE1ti'I ~~IAINTENANCE - use and ~izztcnanaof your septic systemoasld result is its fm7cue to handle wastes. Propermainbeaaaoe ooas<sts of p oat Sce septic tank every Ssnoe years oc sonnet, if nocdodby s ffaased pumper. What yon pat into the system eaa affect-the tsm~ctioa of the septic taak-as. a stage is Ilse vraste fii-spo-sal-, - T~ PmP~Y- o~ to :fit to St. (~Onc 7.uaiag Depactssxmt a .oatification form, signed by the owner and ~r a ~~p-l~y~Pluml~ restuctodplumbora~r i iioeasodpamperv~-iag that (1) ~x on-site wastewaterdisposal syrOem is is pmpar operating condition and/or (2) after won and pscmping (if aec~acy), $~ tep~-tank is less than I/3 dull of shsdge. - ~ ~ nmdezsignod have Head the above rognit and agree to maintain tibe private sewage disposal system wills tl~e standards .set facto, herein. as set by the Department of Commecoe and the Depactiment of Natural Resocsrxs;State of Wisooosm.. (acetification ~~g roar a~ septic system has boea maiataiaod mart be oomplttod and rctmnod to the St. t~oix. days of the ihrx year expiration date. ~Y ~~ Oiicx within 30 ~ OF I.I T ~ iZDi DATE OWNER- CERTII~CATION I (we) certify that all statements on this foam are true to the best of my (our) knowledge I (wc) am (are) the owner(s) of the pmpecty d~escn'bod above by virtue of a warranty flood recorded in ~tegistcr of Deeds Office. SIG OF PI;It.,ANT ~ ~~ / b0 ATE «««««« Any information that is mis-repr~eseatod may exult in the sanitary permit being n;vokod by the Zoning Departmoat. «««««« «« Iacludc with this application: a stamped wasmnty flood fiom the Regisicr of Doods ofYice a copy of the certified survey map if reference is shade in the warranty deed Wisconsin Department of Industry, Labor and Human Relations Safetyan$ Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village Town o ~lORTEL, JOHN BALDWIN CST BM Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INF~QRMATION TANK TO P/L WE BLDG. vent to Airlntake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer a and Model Number GPM TDH Lift Lriction System TDH t Forcemain Length Dia. I-f ist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA County: ST. CROIX Sanitary Permit No.: 289367 State Plan ID No.: Parcel Tax No.: 002-1037-20-000 ao~nniun STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/ Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header an. Di .Pipe Bot. System Final Gra ~/ ;/ ~ BED /TRENCH Width ngth No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N DI N I SYSTE O P/L BLDG WELL LAKE TREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mo el Number: cyst OR UNIT nItTRIRl1TIAN R'`YSTE M ~ Header /Manifold Distribution Pipe(s) x Hole e x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL CO~/ER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth ver Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: BALDWIN 17. 29.16.248B,NE,NE 994 230TH STREET Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ~~i~'^•i SANITARY PERMIT APPLICATION safety andl3uadingsDivision Bureau of Building Water System: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county c ~ ~ than 8 v2 x 11 inches in size. oo i ~ • See reverse side for instructions for completing this application state sanitary P9ermit Number ~~ ~~ The information ou rovide ma be used b other overnment a enc ro rams y p y y g g y p g ^ Check if evision o previous application lPrivacy Law, s. 15.04 (1) (m)]. State Plan I,D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S ~- 5Z 5 Property Owner Name // ] J t Property Location (Or W /~ t /a ~t /4 ~ S ~ 7 T Z~ N R /~ / c, o h r- ,~- , , / - - - L Property Owner's Mailing Address ~ Q~'r7~ ~Q~ Jam'/ Lot Number /v~ Block Number ' / n ///1 City; St/a]te Zip Co~~d//e //Phone Number rte[ Subdivision Name or CSM Number~~ IL TYPE F 6 ILDING: (check one) ^ State Owned 3 ~ !ty t ~ Towan ~~ Nearest Road ~~ ~ ~ Public 1 or 2 Famil Dwellin - No. of bedrooms - Lt~~+ -^' OF +va . ~ III. BUILDING USE: (If building type is public, cheek all that apply) Parcel Tax Number(s) ~~A 0o z ~~`~ ~ r ~~ ~~~ vl ~ ~ ~ '~ 1 ^ Apartment/Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash S ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ^ New 2.~Replacement 3. ^ Replacement of q- ^ Reconnection of S. ^ Repair of an -_____System _____.___ System __ Tank Only______________ Existing System ________ Exlstrng System B) ^ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution .Pressurized Distribution Experimental Other 11 ^ Seepage-Bed 21~Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure 42 ^Pit Privy 13 ^ Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 7. Gallons Per. Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate. 6. System Elev.. 7. Final Grade Elevation Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q T ~© ' j ~, ~ ~ /I~i'9 7 7 Feet Q.S~I Feet VII. TANK INFORMATION Ca aclt in all0 5 Total ll # Of Manufacturer's Name Prefab. Site ste l .Fiber- Plastic Exper: N E i i ons Ga Tanks Concrete e glass App ew x st n strutted Tanks Tanks Septic Tank or Holding Tank [ -"' /O(ab ~ , '(Y ~ t~ •Gy ^ ^ ^ ^ ^ Lift Pump Tank /Siphon Chamber ?~Q -- O r ~ ~ ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber"s Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): ~ ~' 't ~~l~DZ~ s l~ ~ ~o i ... , ~ ~ ,.... a IX. COUNTY /DEPARTMENT USE ONLY (Approved ^ Disapproved ^ Owner Given Initial Sanitary Permit Fee (includesGroundwa[er Surcharge Fee) 6 ate SSUe Issuing Agent Signature (NO Stamps) ~ Adverse Determination / ' X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & RuilJings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be appPicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the 'system is to be installed_ II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce June 5, 1997 2226 Rose Street La Grosse WI 54603 BOLDTS PLUMBING 820 MAIN ST BALDWIN WI 54002 RE: PLAN 597-40525 FEE RECEIVED: 180.00 MORTEL, JOHN NE,NE,17,29,16W TOWN OF BALDWIN COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall. keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections. can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, ~~~~ Ge and M. S an Reviewer Section of Private Sewage (608) 785-9348 SBD-7997 (R.11/96) - BOLDT's - MqY , ~~o ~uv u i SAFEJ.y~ 9199] P 1 61NC. ~(UGS ~~ "Serving You For 40 Years" 820 Mafn Street Bafdwfn, W154002 (7i5) 684-3378 Fax (715) 684-3144 Mound System For A Bedroom Residence Page ~ of g Date: -S'~' ~ 7 Located in the ~~ 1 /4 of the N~ 1 /4 of Se tion ~7 , T~, Rj~W; Town of /3 a lc/~,u ~ ~, , ~f . h 0 / Gounty, Wisconsin. Index Page 1 of 8 Page 2 of 8 ~.`~~' Page 3 of 8 ,~~.~ `Page 4 of 8 E~~ ~~~ Pa e 5 of 8 ~w "'~ ~ 4~~~ ,§,~ ge 6 of 8 ,; ~'=W ~" ~ ,~~~~,~age 7 8 ~-- ~ ` ~ ~ _g~~~~~P of 8 ~.e - ~ ~ ~~ O o ti o`~ ~`~~~~~ ~Q~y~ ~' Title Sheet Plan View Cross Section Distribution Pipe Layout Pump Chamber Pump Performance Curve Soil Evaluation Report Site Plot Plan Mound System Plot Plan Prepared For: Prepared By: Dale Hudson Certified Soil Tester /Master Plumber #2208b3 t Straw, Marsh Hoy, Or Synthetic Covering ~ ~ ' .~sTn-c c.~ Medium Sand ~ _ 6" Topsoil '~' y. Slope Page ~ Of Distribution Pipe F D Bed Of 2~- 2 %2 Force Main Aggregate (6" t3elow Pipe) Cross Section Of A Mound .System Using A Bed For The Absorption Area Signed : i~a~- ~. f ~r~~o-r~ License Number: ZZOf~S~ Date: S-'7- 9'7 Alternate Position of Force Main L_ A ~ Ft. B 4y Ft. !< /p Ft . L !/y Ft. J'7~55 Ft. I 9.5 Ft. W Z Z Ft. G Plowed ;L7~ D /-O Ft. E %5 F . • $ Ft. G /O Ft. K !.5 Ft . ~ ~ Observation Pipe-~ 8 K A I - - ~ - W ~------~--------------- -- ( Force Main o --,----------------- Distribution Bed Of 2~- 2 %2~ Pipe A99regate .1 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area ~n n ~for~~ ~ ~fAn ~ S ~' f -- yOSZ ~ P1i CAF 3 of 8 01Strtbutlon P1pe Oeta11 For Twp lateral ttettirorK ti01 eS loCdtrd On (#Ott0111 Are Equally Spa~ted PYC Force -'lain Cnd Cap ~ . X x PYC Distribution Pipe P P X '" last Hoie Shou14 Se Next To End Cap ~ P ,~ fit, Hole Diameter ~~ Inch ~ X ~~ Inches Lateral Qiameter ~ Inth(es) Y ~~ Inches Force Main Diameter ~ Incnes ~ ~f ~Hol as/Pipe Invert Elevation Of Laterals •O! Ft. S i fined : G~y license Number: ~~C ~j,~ /~f'' G's~ Date: .J ~ ~'"9 `~ PUf'iP CHA.f^.B~R CfGS5 SEC'IOIJ Af<1G SPECIE"Il:lT10~!5 VEA1T CAP y~ C.I. VE'~!T PIPE APFROVED LOCKfN(- WEATNE RPROOF JUA1CT101J BOX MAt`1HOLE COVE F. ~ 25~ ~ ROM GCOR, WIIJDOW OR FRESH 12"MIU. AIR IAITAKE I I GRADE ~ I 4~~ MIIJ. ~ .~ IB" rrlu. G0IJDUIT ~-- -----_--- IB"MIN. ~ \ --------- . ~ lh ____ PROVIDE I -- - 11~ILET ~ AIRTIGHT SEAL I I i' V ~ ( APPROVEfl JOtAIT A i i i ~ APPROVED JOIfJTS I I ~ ( ALARM EXTENOIUG 3' I 1 ~ OIJTO;SOLID SOIL b I I I OIJ C I I ELEV_ ~r~'©~FT. I PUMP--~ __~ ~. ,r~fF o ~ ~ CONCRETE bLOGK ~ RISER EXIT PERMITTED OiJLy IF TA-JK MANUFAGTURE.R HAS SUCH APPROVAL f ~ sEl'Tlc E SPEGIFI~CAT`IOI~1S OOSE• f ~ TAi.IKS MANUFACTURER: l~t/L° I Sc.° ~^S I~IUMBER OF DOSES: PER DAy TAIJK SIZE: ~~~ fGALLOIJS DOSE VOLUME /37~ , f~ ALARM MANUFACTURER: S ~. ~/~G~fD INCLUDING bACKFLOW: "T GAEtO-JS MODEL -.IUM~ER: ~y~~ - ( CAPACITIES: A= ~~ alucaES oR3t2•S6 GAILOUS SWITCH TyP[: /jj''f P Y'G U.Y ~/ - g cr-~~ tIJCNES OR 3~'7Z GALLOAIS PUMP MANUFACTURER: vPu t ~ C = '~~ IIJCHES OR~-37 y~ GALLO-JS MoaEL NUMBER: ~~ ~ 3 ~~ ~ D = _L~-r 111CHES oRz1 ~~3ZGALLONS SWITCH TYPE: /~'~~y'Gur~/ IJOTE: PUMtiP AND ALARM ARE TO 6E MINIMUM DISCHARGE RATE 30' z ~ GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETW1<EN PUMP OFF ANO DISTRIBUTION PIPE.. ~~ FEET •~- MIlU1MUM NETWORK SUPPLE PRESSURE//. ... 2.5 FEET + ~O FEET OF FORCE MAIN X ~~65 F/oo rxFRICTIOU FACrOR..~ FEET TOTAL D`.~AIAMIC HEAD = ~'s' ~5 FEET N ~z., IIJTERA]AL DIMEIJSIOIJf OF TAIJK: LE!-JGTH ~~ ;WIDTH ~` ;LIQUID DEPTH SIGNED'=~~~ ~' ~'D LICENSE 1.1UM0ER: ~Z~~~~ OATE:S~/"'! . .. Performance Curves 4 0 zo J F f O t- 15 R ` e 10 `e 5 1 OL Submersible Effluent Pumps ~o~~ ~or~e i s~-~ ~ 0 MODEL 3885 o SIZE 3/a" Solids wE1st+ 0 wE1oH 0 -WE07H 0 WEOSH 0 0 WE03M WE03L - D D 0 0 t0 20 40 50 60 70 80 90 100 110 120 GPM I I 1 i 0 10 20 30 m'/h CAPACITY ~GOULDS PUMPS.INC. 5>~ Maus ~ ~ aae METERS FEET 120 35 110 100 30 90 ~ 80 ~ 70 = 20 J H 0 H 15 ~ 10 ~ 20 S 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 I I ~ 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. L ~ 0 1 ~ ~ / EHecGve July, 1985 /L/G~- ~~ / Y 1.60c~67-- ~~ t~ gs3 ~ ~ - q ~ C3885 __ _ _ _ __ ,, ~ DII.HR ... ,. , Attach complota situ plan on PaPef not la+ not limited to ve+ikal and Iwrizontal refer dimensioned, north arrow, and location a+ APPLICANTiNFaAMAT10N-PLEASI t s in t ( action a :e to near~st ~p~ ~~L I~~~1t~~JA~~~+T J COUNTY ..~f', Cro ~' ~ PARCELL0.1 REVIEWED BY GATE PROPERTYOWNEIfi ~, ZQ~~1C'E e7 ~ -^. / '" /ar~~ ROPERTYLOCATION ' t~OVT. LOT if/~"" t/l ,i(~~/t,S l7' T ~ ,N.a /6 t ( W PROPER OWNER'S MAILING AD ESS ~ / LO~~ BI,pC SUBO. NAME OR CSM x qTY, STATE SpIP CODE Pi~NE NUM9ER QCITY QVILI.AGE~~fOWN NEAREST ROAD (J New Construction Use,(aCj Residential / Number of t>e~ooms ~ Reptaoement l J Public or oDrnmeraal describe . Code derived daffy flow ~5~© gpd ~ Recortxnertded desifln foad'ing rats ! ~ bed, gpd/tt2 - 3 trench. gpd/f!Z , _ Absorption area required ~ 7S''~bed, tt2 37~ ~ bench, fl2 Maximum design loading rate • 5 bed. gpd/ft2 - ~ trench. gpd/ftZ Reoonunended Inftttration surface elevation(s) it (as referred to site plan benchmark) Add'l+.orlat des.~rt ! site ca as ~afiortc ' , ~ Paten! material Ste! 7`v gno>' Sao,,,, v s-~ial: ,•r~e,r? ~°' Flood plain elevatbn, if appt'~cable /V~ (t S =Suitable for SySlern U =Unsuitable fors rem oONVENTIONAL ^ S ~ U td0UN0 l~ S^ U INGROIlr10Pt~SSURE D S ,®U AT~RADE ,~ S O U SYSTt3d iN FlLL ^ S .®U HOLDNIG TANK ^ S :~ U SOtL DESCRIPTION REPORT Boring ~ l Ground elev. 96-~ n. raniting ..„ :°.arfr:g x , elev. 95.72 tt. fimi6rg 39 ~~ Horizo Depth Dominant Color Mottles Texture Structure ~~~ ~~ Roots GPO/ft in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. g~ Tom' 3 /~-c 7 ~s . ~ ~,~ .z ~ ~ ~ ~v r ~ ~ . 5 ~ ~ 5 3~-~ 5y ~ e. ~ ~ ~,s % se / ~~ s.~~ mfr- . y • 5 ~ Remart~ : I ~ # ~ S I ~ ~ ~' ~-g /o y~ 4 /lion G s.,' ~'~.. /~?1/ a5 ~-~ ~ • ~ ~ - 3 ~- g-1 ? .io1~ $/,3 ~o c'~ s~%/~ ~ Ss~ r.~t~ r c r~ Z~ ~ Z • 3 ~-y s ~e 4 cZ~ 7.~ ~~ ~~ 1 ~.,~., ~ - c.~ • ~~ I -.~ J I Remarks; CST Name:-Please Pmt .:....__ ____.~Al~ ~ ~~ SipnaU+re: ~~., ~~. .~ ~ ~ Gate: CST Numbe+: HLUN 1 IVfV HtNUH I ~ 05, Wis. Adm. Code _. si j must include. but nd o_ pe, scale or Boring # ~~ eGi ~G'-off ft. Depth to smiting (~,~ Boring # Ground elev. ft. Depth to limiting factor Boring # . :~:::: Ground elev. R smiitimg (actor Boring ~! :~:. . ~. a:x~..r Ground elev. Depth l0 limiting factor Horizo Depth 1n. Dominant Color Munsell Mottles qu, ~ Cont. Corr Texture Structure Gr. Sz. Sh. ~~~~ ~~ Roots GPa 'Bed Tiend Z /~ ~8 f®% ~3 one s-`~ s l'7~/ r C ~.J ~`~' '~ ' ~ 3 s y 37.5 SyI~' ~ ~Oyf >'i ~ / ~" c .'jyl~' Clt~ '•`>' r(i Remark' s: _ _ Remark s: Remark' s: 1 nemancs: dwhCr ; John M~~~~ 99y z3o~ st, I~al~lw: - ~, CJ, . syo~ z 7is -~gy- z3 vy ~,(~'~ ~ ¢~ .. f p0~p~ ~M, ~L _ ~o/,6Z Q t - 9s.~z' ~3~ 96'oZ fl Q2 3°Jo '~ ~~ ~ a~M. #I ~p °fp p Wh~'~c CO/'/1C. r foS~ 4~ a3 1~0. -~ ~rQwn ~y ~ ~~ ~, ~, cty E ~1~csr zza853 s-7.97 L1+sJ_._J ~'3~~~ i NE% Nay' se.~,l~ [3aldw;•. Twn ShP• Garagt~ I ~Qrn 5~ X9/1 lot l,'~es are, "' sysfcm. SGG ~t / ry rV / Z5a tl, St• Owner; C~o~ n /'(or~~ 99y 230 st, 1~Q~a<w1nJ G~(~ SS~aoL 7rs-6gy-Z3~f ~ BM ~ : oo.o~- ~ ,~ ~ BM I 1 / p w~: ~e Cori e r des /- i 1 ~ ~M#Z=IOI.6L -L~ar~,v„ ..~' JJ, r ,20 Sid~h, ff SF Caf~tr e~ f~ouft„ BI Br- 46-~7 ~ /05 Bt- q~.7Lr j33 - 9G. o z' x---93 B Z- 3 °l 0 ~a No. --~ No. z3°~ NEy' NE% Sec.l7 ~ol~wi+'~ lwn5~'• Fxis~~.~`q -SeP1 ~C fion~ ~a DGI Y`Gvno/C~, ~~'06l$ei ~bQfa~6 ~ pM F-- ~~ ~ ii w c L .: zr $3 ~~9' ljArAgC ~ BQrY.. 51 --~ .,Jrow ri ~~r ; MP~CsT 2Zo853 s_7 _9~ a1~. l "'- yon 2 30"~ sr. ' ~ ~ ;~' D I L H R in accord with It.HR A3.05. Wis. Adm. Code - ~. . Attach:compieta silo plan on paper not lass than 8 1/2 x t 1 inches in sire. Plan must indude, but . not limited to vertical and horizontal relerence point (BAS, drecfion and x of sbpe, scale or dimensioned, north arrow, and location and distance to nearest road APPLlCANTZNFORMATION-PLEASE PRINT AL! INFORMATION E` °-~ ~ PAACEI 1.0. 8Y PROPERTY OWNER: ,,,/~ PROPERTYIOCATION ' c~ ~ ~-~. / ~ /o r~e OOYT. I.OT ~(/~ 1/4 /~~/4,S j 7 T ~ ,N.R ~r, E ( W PROPERT~OWNER:'S MAILING AO ESS LOT I B SU80. NAME OR CSM e qTY, STATE ~iP COOS PHONE NUMBER ^CITY ^VII.LAGE~iOWN NEAREST ROAO lOrev:' L.c.~'. Sy~nZ (~i,~~ `~-Zs'S/'-ir ~~/l~cv,'~-~-- ~34~ 5~" (J New Cortstrur~ion Use.(~CJ ReskfenGad / Number of bedrooms 3 Replacement (J Ptrbl'K: or commercial describe . Code derived dat~y flow `~50 gpd ~ Reoomrnended desiflrt big rate ~_bed, gpd/ft2 •3 trench, gpd/tt2 Absorptan area required ~ ~~ bed, tt2 37~ ~ trerx;h, ft2 Maximum design loadutg rate • 5 bed, 9Pdlft~ ° ~ trer>ch, 9pd/(t2 Recommended infiltration surface elevation(s) ~ ft (as referred to site plan benchmark) Addi6onai design /site considerations Parent material _ S'~•~fv an ~a~ m~ sc-,a/,-~ E ~ ~" Flood plain elevation, i( applicable NUJ tl S C Suitable for system (~OAIVE!•lTIONAL MOUNO INGHOlXdOPRESSURE AT~AADE SYSTl3d N FlLL FIOLDYJG TANK U =Unsuitable for system ^ S ~1 U ~ S ^ U ^ S .®U .~(S ^ U ^ S .B! U ^ S :® U SOIL. DESCRIPTION REPORT Boring # /~ Ground elev. 9r'•~ n. Oepthlo Fiinibng ~., Boring # .. a •'. Ground ~~ n. firt>ifing ~„ Horizo Depth Dominant Color Mott{es Texture Structure ~~~ ~~ Foots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trt~ l ~=~ Hoye y~ .~~ s- ~ /~'.~6 m/ a ~ i f' •2 ~3 3 /8 ~7 ~~ . ~ ~~~ .z -~ ~ ~ ~ ~ rev r r, ~ , 5 , ~ y 27~' Sys ~ ~' ~- S~ ~m ~ /~?~,r G t,c~ ~ 5~ • (, Remar~ : i i i ~ _ ~ ~- ~'-1 `7 .10y~' '/3 to c'~ si ~ ~ s /~1~/ r c ~ Z-~ ~ L • 3 .~-y ~ y~e ~ ~ Z~ ~,~- $~ s~ I ~ .,, ~ ~ ~ ~ ~~ I -.~ 5 ~~ s s y~ y ~ z~ ~.s y ~ s~ l ~ ~ ~ .~ ~ - y ~ ~ . , . I Retnartcs: CST Name:-Please PtiM _~p /~ ~ j u~~o ~` p -.=-J j~ // Phone: '7/ ~ ~g~ ~.~.~ r /-'d Address. ~~ O ~QI n. S~ LSIa' ~(~'~.v, ;~., , Cam, ` ~yd~ Sgnature. Oate: CST Number: ~~ ~~ s_~ 6 ~-~' '4 Boring q 3•. Ground elev, ~~.~h. Deptl~ to smiting f ~y ., Boring N :y~. Ground elev. ft. Depth to limiting lactor Boring # 'v. ~p x Ground elev. n. Depth t0 limiting tacta Boring t! ~~.''•~ Ground elev. ~. Depth to smiting factor Horizo Depth ~ Dominant Color Mansell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh• Consistence 8cuxfary . Roots ~~ ~ ~ 1 ~PD~I(_ Bed enn 3 ~ 37 ~- ~ `~ ~l/a n s ~ ?.mss /~? r Cu.) / •,5 • ~: y 3-~ , ~ y~e ~ l~ ~o ~ 5' t' _~ SC ~ ~,~ f ~ i Remark's: Remark s: Remark s: nemancs: Owner; M t~oh n / "l o-^~e 99y 2.30' 51'`. 1~. a'~wi Its G~; , SyadZ 7rs-~gy-Z34~ BM ~J : /oo.o~- p o~ wd.~e comer e~ BM ~I + p ~ ~ ~M#Z=1d1~6L -~A~levh o7 S~'o~~,~, D Z~, zo SE CO`"h tY a7 ~touf ~ BI B~- 46-~7 ~ /05 BZ- 95.7Z 133 - 9G~oz' B Z. 3°10 3 ~a ~, B3 -. T No. z;~~ NEy' NE! see: r~ ~a~A'wi ~ wnSilr Exi:l ~~g SeP~;C ~ah~ ~o AC ~"emo/COf. ?~'ou$t, BM ~ 12 W E L L G'gra~t GArp9C I UQf... ~/9' ~. ~..-;~y 230"-' St. „Drawn ~y ; v~- ~~ fUuo~o-ti- MP/csr ZZo853 s_ ~ . 9~ Sca~e. lp- N0~ dwhCr : 99y z3o~' st, ~a 1 ~w; r`, w' • sya~ z pis-6gy- z3yy No. --~ F ~rC-wY1 ~y i ,~~ ~, ~- l''1~csr zzo853 5-7.97 2.3~i~ ~3 M, ~L _ Ial-6L B!- 9~•5~~ BL - y5.7Z~ B3' 96•aZ 0 Q2 3°]0 ~~ ~i3 pl All lof J~'neS Qre, •/Op ~ ~C~'-~ T r o m Sy5'f~m ,* SGGIL ~~~ /Q~ -- 2 S o tl, a~M. #~ `gip °f pp p Wh~'~c Co~nc, r ToS~ .~ ~„~ NEB N~ H s~~, !~ [3Aldw;~ ~wn ShP• Gard'~~ ~Qf v1 5! .. S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property VO~r'J /~c~r~c / Location of property /!/.~ 1/4~ 1/4, Section ~~, T~ 9 N-R~W Township 1~_c~/~O~wi-~, +Mailing address 99 `/ Z..3C~~' ~/~ . ~~ ~C~l Gtr ! Y~ G~(J r~ ~ J -7~~ ~ Address of site __ SG?,~'JP Subdivision name /~~-~' Lot no. /V~ Other homes on property? Yes~No/ ,/~ / Previous owner of property t;r~~ /Plg~,'o,~.A / ~'g~`'1~. o ~ l~Q/~f~v Total size of property ~~G1c,r~ S Total size of parcel sa c c--ef~ Date parcel was created // Are all corners and lot limes identifiable? Yes No Is this property being developed for (spec house)? Yes x No Volume ~a 77 and Page Number 38~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. .S'8'9 g ~ and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. C~// ~ (~ Signature of Applicant -Applicant Date of Signature Cfj .- ~~ .. C~ Date of Signature ,~ STC-105 SEPTIC TANK MA[NTENANCE AGREEMENT St. Croix County OWNER/BUYER U~/`i ~ ! ~ !D Y' ! t'J l MAILING ADDRESS q 9 '`~ ~-~,~~~ Jc~ ~ ct l p([~ i ~ r- ~ ~t/i ~ -~`t ~~~ PROPERTY ADDRESS ~~,~»~ j~(location of septic system) Please obtain from tl~c Planning Dept. CITY/STATE L ~ ~ ~(yl e,c~ ~ y... , C~i ~ ~ ~~~~~ PROPERTY LOCATION J~~ 1/4, /y~ 1/4, Section ~~ T Z-~ N-R fE~ W TOWN OF ~~ ~pf c:y ! rte- ST. CROIX COUNTY, WI SUBDIVISION /V~ LOT NUMBER CERTIFIEDSURVEYMRP ,VOLUME ,PAGE ,LOT NUMBER: 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 licensed septic tank pumper. What you put into the system can affect tl~e function of the septic tank as a treatment stage in the waste disposal system- St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement-that owners of all new systems agree to keep their system properly maintained. ' The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (t) tl~e on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum- I/~'~re, the undersigned have read tine above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisc~on~si~n D~NR- Certification stating that your septic has been maintained must be completed an returned to thY^' ~~'~ oix County Zoning Officer within 30 days of the three year expiration date. SIGNED: ` __--- St Croix County Zoning Office Government Center 1101 Cannichacl (load I Judson. \\'I S40 t (, i l/9? . » rllll~urtr ~ua-~, ~.Mreew F ~ ~~; 1~ V~ ~ • i PAcE~V STATIi OY WIl~[7DNSIN-YOLM 7 38~3~ ~ ,at vAts MMRt1Y !N aotilno DAtA ~.~ ~: .:. -11tt;te lift,. L dey af_._.....~IQYe~~ r _.._ 40if ;.,olaal_9anJc_.cr >s«~~w+~ ..»_..... _..._..a Corporation ~ eAtaieertaa! eadltilM ttaslee and -ryr vwtYe d tie awn d the state d Wisransia, located ,,,, 1~Zdwin : _Wieemsin, party at tie feet pert and REGl~i~~tS ©FFKE 3T. GROq( CEO., w4f. Roe'd. ics t::~cord Ifih 28th der of Ncv AD.:983 m 2:30 P _. M+ _ ,~;.;~f~. as ~41II~.Le7tilt8 a- ___~___. ..»» !elie« .~ a . tie eeeeratf rrt. .».......... ._ »_ T!!! tE - . , r f {! ~ t!! t t ~. Tin! ~ raid qtly a( tie 6rrt pert. far and is omridt ntioa ' • '.` ? '- ~ ~ a t t efMtlwtiet gi,~~ a!~ ThflllA3ilt~..i3l~d_kO,~lII.Q.»..~,~.6Z.aQA.Q.) AI'TOPIv . eo it paid by tie aid part.. ie9d tie set:ond part, tie raaipt wiereof Y hsertby eetttMed and adtaawtedled, fats pwe, !ranted, barsained, eoW, remised. rdased, aliened. conveyed and coa y tier prwab doss atrl~ !tact, berpu. sdt, r«niee, refeerq alien, twuvey sad ooafirtn Yato tis~avid partt£3.at of sacottd ~ and aailaa lfatoreR lie faYOrY[t dssar~ed reef pteLe aituatnd ra tie Coeaty Of_....»....,$~.i.a....sr~.~,X..._..and State of wiscomia. to-wit: E A parcel of land located in the NE)x of NE~f of Section 17-29-16, Town of Baldwin, being further described as follows: Beginning at the NE corner of said Section 17; thence S along the E line of the NE~ of NEB a distance of 534.40 feet; thence N88 34'00"W 668.05 feet; thence N1~23'00"E 556.00 fee to the N line of the NEB of NEB; thence S86 40' 00"E 'j'<,° ';,_ ~ ~; 655.52 feet to the .point of beginning.. :h ~et>_ (I- NsceaswrRY. ~olvruws Desci:rntrnt art Rsessss ADS) ToMthes wits aU and singular tie hercditam.nts and appurtenances thereunto bebn`inQ a in any wise appertainittp; aad all tie estate ei~t, title, interest, tain- or demand whatsoever, of the said party of tF.e fiat part, either in aw or equity, either in possession or aspectancy ol. is and to tis above barlsined premises, and their hereditaments and appurtenances. To tdaea To 1>told the aid premises as above described wits the hereditaments and appurtenances, unto the said part..l@„~o( the tpcoed part, atd to."helr.. heirosnd aseiypte FOREVER. Aai c6e tit...,~:...Z~.~..:~`Id~~.Q11.a~.....~.d.I~~C...Q.~...~~:1.~W].D .................. .....:.......•--....... »_._..__...»....................: party afthe first pert, (w it..•If .md ity wca-a•.aur., ilax•~ covenant, grant, bargain-and agree to and with the said partl.E'.S.:of tie ~~ attend puR.-.~.»...~1Blr.:.:.-.....heirs and assiQru, that at the time of the ensealin` and delivery of these preKnts it is well seised of tie pnwias above ~taeribed, as of a load, wee, perfect, absolute and indefeasible estate of inheritance in the law, in fee eimpk, and fist tie -arse are free and dee- from aU incumbrantxa whatever ...::..........•-°_......----•--..._ _ °------..................._......................_.:...............:............._.............:....._ ttad fiat the shove barlaiaed ptemua to the gwet and peaceable possession of the said partlleS...of the second p ~~~ieira and assilas, apiiset sU asd every person ar persons lawfully claiming the whole or any part thereof, it wiU forever WAR~~T ANQ' DEFEND. twWlt~esewlleteol.thesaid First. National -bank. of. Baldwin ~`'` , `' ~~~-~ - party of the bra part. has r;auew~l Ihc~a• pn•x•nts W Ih• si~;ncal Icy Jon M.. Meg~j~~ !ilk _. . Iii ~ ~ ~ « tit~l'n•,.i,h•nl, :~nir eottntersiKwa.tby .Shelda Thompson , it.rR'p[Qlea~ ~. ~ 3alc~w~n~, ~+:.ranris, and its a'urpur:da• seal to Lc hereunto aR'ixa,i, ~ hi. ~/ day of. - NOVeI~~r i~ .(~ 19,i 1~ 3. `. SIGNED /1N3 SEALED ItV PRESENCE OF • • 1 e ~ RT 111ATTnNAT. RANY i1F RA7 SPIN f SE rh j ~ NV11 7./ 1'1G 11 {. i11A, YlVG "-'-' CUUNTE II:NEUi ~ ~ ~ . ~e ~ -,~ , S['ATI< OI WI8CON81N. Persoaatly taax before me, thia__.............day of...:....NQY.~.IAbe~......, A. D., 19._$.~ .............~1:QA...~...:-.I'!~~t.],L1~.R....--:°----... .............:..........._._...........__ .._......_.... ...Vice.., ('n•aiJcnt, anal .Shelda.. Thompson,... Cashier , xxx~>~c~r the .,l,uvv '' named Corporation, to tee known to ba the perpns who esecnted the foreloinl instrument, anal to me known to Ix• ~urh.. . V1Ce I'n•sialuat ''~ alsd... Cashier...-..__~Itn>b>!iol,r acid Corporation, and acknowh~Jgcal that they e•recuttrl the faxa•soinR inytrwnent .~. such url'accn as the ' deed of said Corporation, Dy it:: authority. A ~/ D '' - .1 ,~ NOTAItt ,~ ~........- • :.:...........-IfJ.h21...~__NeSt1I1 lAa...._.._.. ~ ftAL ~ ,~ ) ~'•, e~ ' Tile instrutneat drafted by ~„ 7fi;fa ~PuWid..~~tll~~....9.~.._W~asg.Cr..r_......~1~~ Q ~ ..Zoha.:.G..._Nestiagea.,....Attarne~r..--.----- ~ Z• . nMy t1 d:..uee ~>a#Iketq (le) oe man~tit~.._.___ $aldwin~, _Wi cs onsin ,54002 _ ° '' '• - •- -r•• ~-~-:~ r ___-- -- tttssdsY trr.fl (U d tM wlsswa asesiss »ro~yss that W t.Keum.aa Yo M rsot'rdsd saeU tr•• etddf Metd x enewdttea tbresa tM ~ aamss M tt+e asessers, srsaesss, wltssrse es1 s~etarfl. ~ w/letttAlfTY DLiD•-~bTATi O! WISCONSIN, FOAH NO. l +. c. run+« co . n.ouu.