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HomeMy WebLinkAbout002-1049-95-000 (2)Wisconsin Department of Commerce Safety and Buifraing Divisdgn PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. Permit Holder's Name: City Villaye X Township Simmelink, Earl Baldwin, Town of CST BM Elev: Insp. BM Elev: ~ BM Descripti~o9 ~ ~~ r' l ~ . ~ ~ ~U ~ J v ~ TANK INFORMATION TYPE MANUFACTURER , ,r~. y i CAPACITY Septic ~..^. Dosing w~s >~~,~ Z g/,O v Fl e ~ ~ / Holding TANK SETBACK INFORMATION TANK TO ~ P/~ ~ 0 WELL BLDG. Vent to Air Intake ROAD Septic yb ~ ~~y ~~ ~ Jg / -- Dosing R~ / _f ~~'-~ `g J ~~ ___, Aeration Holding PUMP/SIP190N INFORMATION _ ~ Manufacturer )) vC S Demand GPM Model Number G 1 ~ 2 TDH Li~ ~ Friction Loss System H~a~~ TDB ~Ft Forcemain Length ~ Dia. I J z- Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 506397 0 State Plan ID No: Parcel Tax No: 002-1049-95-000 SectionlTown/Range/Map No: 21.29.16.3096 STATION BS 7• o`d HI /d1. FS ELEV. /od Benchmark / a , /~ ~ (J /~ ~ ~3 ~ j~~ 3 ~,~A a Alt. B t .~ t~a~G~ S 33 /d/. 75 B dg. Sewer look t~1~ 4.~ y~. d$ St/Ht Inlet /G ~ Z9 9L ~ 7 ~„~ SUHt Outlet /~ ~ 7 Z 7 ~,~ . ~t v Dt Inlet r0.5 `~, . S S Dt Bottom 13, 79 4 3. 2 `j Header/Man. ~,~j /6Z ~ ?J Dist. Pipe 5, b 3 ~Q Z ~ ~~ Bot. System S. ~.7 /a/, 5// Final Grade ~' ~~ /6 ~ • ~ G st co~jjpp~~.. Te~~ GO S• 33 l o ~~ S ,Q'3 <46, v BEDITRENCH Width Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ 5 ~ ~e `~ ~1 \ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: Type O ~s~ ~ Z3 ~~/ / ~~ ~ /~ UNIT Model Number ~ DISTRIBUTION SYSTEM C.etZk.,,lo lZeLt.. ld /~ Header/Manif Distribution // x Hole Size x Hole Spacing Ve to Air take _ I ~ ,~ ~,~j L Pipe(s) S / 5 ~ ~ i i ~ ~ ~~ 3 1 'J ""_/pt~-~~..y1 Length_ Dia___ Length D a Spac ng.____ 1 ~ r,a SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Y~ ur.~... Depth Over Bed/Trench Center l Depth Over Bed/Trench Ed es xx Depth of To soil ~ . xx Seeded/Sodded r xx Mulched /~ ~p 't' g ~ p ` ~ -i ~.~(es (_] No ~ Yes C No ~a~. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~/~/ Inspection #2: / / Location: 891 230th Street Baldwin, WI 54002 (NW 1/4 NW 1/4 21 T28N R16vU~1 metes & bounds Lot ~ Par I No: /21.29.16.3096 1.) Alt BM Description = ~ / L /~ /~ 2.) Bldg sewer length = Z a ~ f„^si~ ~/tl.~yb ~,11~{ n °~~j 4~0~1G. ~ CSLi /CI ~ ~~ -amount of cover = t ~ J (~`(.t)~ 3 a~- ~e~sc. ~-L~,~,v.. 5 ~ ~.~k. Tr ~'',~U,~G~;~t ~~, (~o~,.~ c~ Plan revision Required i"_ ;Yes No " / ~~u /I /b ti7 (o / 7 Use other side for additional information. SBD-6710 (R.3/97) Date ~ Insepcto Signat //~ JD~ Cert. No. Buildings Division County % ~ / ~ ~ ~ " 201 W. Washington Ave., P.O. Box 7162 r - ( ~~s n Madison, WI 53707 - 7162 (608) 266-3151 Sanitary Permit Number (to be filled n by Co.) /7 Department of Comm rce ~ ST. CR I anit y Permit Application Stag Plan LD. Number / 'Ct'if'~9V1 .21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(I)(m) Project Address (if d ifferent than mailing ad dress) e z f ~ I A lication Information -Please Print All Information T h ~ ~ ~ ~ 3p . pp Property Owner's Name - ~ 3 ~ Parcel # Lot # Block # ~ m ~' ~ay~_ ~ti-~ Property Owner's Mailing Address ~ Property Loc a tipon ~ ~ Section ~ ~ City, State Zip Code Phone Number . a /~ ~U~ o per/ ~~~'~ ICS r' TZ_( ~ (circle o ) /~, N; R~~p~ c~ II. Type of Building (check all that apply) l or 2 Family Dwelling -Number of Bedrooms ~ t S ~\ G~ Subdivis ame S mbcr ~ ~~ `~ ^ PublidCommercial-Describe Use ^ State Owned -Describe Use Q~ nn ^City_^Villagc~txTownship oC ~1~-+C [II. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S tem ys Re lacement S s[em p y ^ Trcatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Rrnewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / - / / IV. T e of POWTS S stem: Check sll that a 1 `)rt//~ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ ConstrUCtcd Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Linc ^ Gravel-less Pipe ^ Other (explain) ~ ~• ~ V. Dis ersaVTreatment Area Information: Design Flow (gpd) Design oil Applicati Rate(gpds ~. S' Dispersal Arca Required ( Dispersal Arca Proposed (f) System Elevation ' ~ ~5~ ~, z.N i o ~ ~~3s,y ~ 1~~~ ~~y vo• ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Stccl Fiber Plastic Gallons Gallons of Units Concrete Constructed Glazs New Existing Tanks Tanks Septic or Holding Tank Lw.~n ~i(a/ .C..~ ~ Aerobic Treatment Unit /n- _ /7 ~` vZ. Dosing Chamber ,r~l IJCJ / La/ i VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) Plumber's Signature ,~ MP/MPRS Number Business Phone Number ~~ / ~~ wti ....~- `~2 2 u 7l~ - 7Zz ' ~2~ Plumber's ddress (Street, City, State, Zip Cadc) ~ am" 2 20 ?~ (,~ ' tS l ~~ 27 VIII oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fc (includes Groundwater Surcharge Fec~j Dat~y Issued ~ Isstimg Agent 'gnaturc (No r)tps) / ^ ~O ~ ~/ ~ O _ ~' / ~ Owner Given Reason for Denial (. y ?~ /h ' IX. Conditions of ApprovaUReasons for Disapproval ~ ~~~ ~ ~~ G fr _ " " yr'Y(~ TU' ~ S STEM OWNER: Y~.~ ~- 71~~ ~~~ ~~~ Septic tank, effluent filter and - ~ Lt;~ dispersal cell must all be serviced /maintained ~~~~ ~~~~ ~~~,fy er management plan provided by plumber. ~ s ~ p a 2. A11 setback requirements must be maintained ~~ /~- licable code/ordinances. - Attach complete plans (to the County only) for the system on pape~/~oYli as than gIR s 11 inches j(hsiu T U D->ti t j ~~ SBD-6398 (R. 01/03) i ~ _ ._ _~ ~`l Z 2,30'' S~~ OoZ- ~ o~-a5•cac?c7 K~~ \~~ ~~/ ~~ ~.~~ _ YSK ~ t r~,o~ L. ~oz) lr---3 ~ 1 ----~ r 'yam w~ ~~0~/ C~ (~~~~ k S ~ v oc~l~ ~-~ n~ l ~,~f~1 ~~s- ~ S~a~ .c..cX-~ kv L' o ~-y t pro, a ~ . / c.~.~owr • ~ _ LL~ , A ` c~.o%,, C~Q~ ~5 ~~ I /1r--~`-~j L1i'}l.Z2Z ~a SS ~ ~C.~~ ~~1.1C~ wn~ Q, ~~K Z5 [h7 r (.J ~`~ ~~ ~. ~ - ~.:., N~ ~~ z~~~a~~ ~~la~ 'L,, ~ `U T"om"' ~~ L s ~ l c~V ~ ~ o tl , yo B~-c 2 ~s' a~ i u-uza 4 ~ ~ ~~ ~ ~,. w~~t~.S 5~.~:.. ~l ¢. ,39 l~ M ~t ~ , a~ ~~ (n~ r` Q w e V~ I , ~;\~=.~ l Q ~ e-C ~lp~. ~t (~ `'1 ~0 4, 1~w_ ~1w-21-~~_ibw o~~,, ~3~.t ~.~.~ -V ~, S ea~e_ ~ ` ~O 3 a~ ~ ' commerce.wi.gov i ^ 1~~~~~'~ Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 15, 2007 CUST ID No. 226524 ROGER L TIMM TIMM EXCAVATING 3128 20TH AVE WILSON WI 54027 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2009 SITE: Earl Simmelink 892 230TH St Village of Baldwin St Croix County NW1/4, NW1/4, 521, T29N, R16W Identification Numbers Transaction ID No. 1431692 Site ID No. 729151 Please. refer toboth identification numbers, above, in all. corres ondence with the a enc . FOR: Description: Three Bedroom Mound System /Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1147470 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: ~ This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank. explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Comm 83.22(71 - A copv of the approved plans. specifications and this letter shall be on-site durin construction and open to inspection by authorized representatives of the Department which may include local inspectors. P ~.~.T.~. C~ndit~onadly UEP~RTMF-JT nc rn111111~conr ROGER L TIMM Owner Responsibilities: Page 2 805(2007 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm ferry. swim@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. Henry F Grote ,Certified Soil Testing ,,ry.., .,.~,,., M .,.. ~,..>,~ .M. ~....~,,..,.~.,~.., . .°` ^c ,'~.~..~ Earl Simmelink -Mound ~~'' C r y ~ e ~ Z~O~ ~~ Construction Materials and Techniques ~~~//`/~s All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Pressure Distribution, SBD-10706-P (01 /01) Mound, SBD-10691-P (01 /01) Location: NW '/4, NW '/4, Sec. 21, T 29 N, R 16 W Town: Baldwin County: St. Croix Date: August 15, 2007 Owner: Earl Simmelink Address: 886 230th St. Baldwin, WI 54002 Plumber: Roger Timm Signature: License: 2265 4 Attachments: SBD-10577 -Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management _- DIVIS-U SAFETY AND BUILDINGS SEE CORRES ONDENCE page 1 of 8 Design Criteria ~`'S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L ~ Bedrooms x 100 gal/bedroom/day x 1.5 ~ gallons/day hydraulic load Design Calc ulations In situ designed loading rate D.z-~ gallons/sq. ft, per day Depth to estimated high ground water ? Z ° in. Depth to bedrock ~ f'~O in. Cross slope at system ~ ~' ~ % `'~ ~-" Force main length S S ft. of Z in. ~~9 ~ Manifold/header1ength 4'o ft. of ~'I z in. ~ ~`~ ~ Drain-back q-3 ~ gallons Lateral length Z @ ~ ~+- ° ft. of ~ ~~ z in. Lateral elevation ~ ~ ~ ~ `1 ft. @ bottom of lateral Lateral hole size ~l~b in. @ ~ ~ ~ in. ( 3, n ft.) Spacing ~ `~ holes/lateral ~ ~ holes total Lateral volume Q • `~ ~ ~ gallons Total lateral discharge rate zS' ° g gallons/minute @ 2~S ft. head Network pressure compensation losses i ~' ~-S ~ ft Elevation difference ~ . , ft. ~-' Friction loss ~ ~ ~ ~ i ft. @ ~S gallons/minute S S Total dynamic head ~ 3 ~ 4 ~ ft. Pump/si~on 3b gpm @ -~-- 1 ~ ft. of head Manufacturer ~ ° K` ~-s ~ ~ ~ I Model # ~ ~~ ~ ~-- Dose volume ~b.~ b gallons Liftlsip~on tank ~ ~~-`<< ~ ~-o ~~ gallons Septic tank ~ -e-Q-~~ ~ ~~ ~ ~'~ gallons Effluent filter ~ ~~. (~ - ~ ~ ~~ o ~-~. s ~.~-~2 c.~j~vov°b' Measurement pump on and off ~ ~ ~ in. Q ~ Height alarm from tank bottom ~ ~ ' ~ in. Reserve capacity ~k$~ gallons specs.calcs.res X Page Z- of g 'v ~ _ _ . _ ,~ ~_ Plod 1"(a~ a~~ S ; ,,... ~a~•,~. ©02- lo4'~'t-QS•cwo ~~~ ~ ~ ~ ~~~ k S"~- ~ c ~o~, ~~~ ~ ,~, ~ ~ ~ ~ 1 ~~~ ~~`~ `\OOrJ~ ...•. ~ ~t , ~aT~"i 1] 'l~-1 ~ C (ev,o~ ~w .,~ ~30~~ C~ w~s~ ~S ~~ I ~'1i'?4ZtZ i ~ `~ ~w^~eQ w. w. H ~~~~Q¢~~~~ ~3 c>o b ~~ ~~~ X ~~ ~ S LL~ ~«e >,-~ C ~~ 4 ,,. N~ ~~ s¢.~ba-~~ ~,abla~ ( ~ ~~t-t (~~,.o~ ~ra1Ce Q ~we C~ ~-E.a.,. ~-l ~ s ~ 10,; 6 2 0 ~ , s,-~ ~\ o ~ ~ ~ ~ ~ S~..a~t s ~ ~. ~~e.. ~ ~~ ~- F SJt.~ ~ Ati. S; ~ ~~F.V (~ o< ~1 ~- S - ~, s ~ U -t-t~-~~ ~ b ~ o ~..5 l uro, o ~^'.~ow- ~a G.,LL~ ~.~a~ 7.o a, 1~w- 1~~w-Z1-Z~-Ib~ ~~ S cafe- ~ ~ ~O ~3as~ bU,: v : l cY\7b V S [/~ z ~ ~~ .~ _ (~ 1 3 \ (~ a rs ~ l t /~ 1r at~ ~a t-2~i '~'h ~a.~ ~ ~s' Ds~ o ~.., r Z ~~ ~~~' ~ CC9~tiZ~ ata.v~) ~ ova /..~.a...S~ c......, ~ `~ O t7 z ~ , ~ '2 ~ ~ x.13 ~ '~ ~`~ N I (o i`+bCo%1 '-~~j 1 ~~ ~l o ,,,., \ 2, o t7~ 1 S o.v ~w~ l c9-c~ , o l ~~~ w v 'y o~~~, r ec~ ~~ ay k~~.~l ~0,~ = O. +~ 3~ ` J ~ . C . t f ~~~ V 0.h ~ . 4 v.,., ~~ ~1 0 Z~ol ~!-o' 2.0' I~ ~ 1 ~I ~~ ~,II -~(- ~ ~~t,3 ~ 2.4,Z ~ ~L \3,~~ S~,o I X3,0' ~3~0' o '. 4 ~ lY ~ ? u C 1 ~ ~ .,/f~~~yy` x, ~ o~ l e.r v . ~ ••. ._... `l ti V ~ ~.S ~ ~ ~ ~ b • zT' o ... ~ ~ . ~~ b ~ E.; O ~ t-Mr.. `YLrr.lwti. T~O~- O. • i. ~~C.YL `of ~~ I~ L 1 'p- PCB ~ z c..`, \4o r,.1„'~-. G. LQI 4. p '1 1'Y O ` ~. T p.~r ~` 1' `A ~ IIX ~\ L/l.~L~.~` I ~`iZ"P~~ S~ ~ r ~~ ,~ I 3,01 ~ ~,~.,' ~ . o' ~! ~~ ~,,\K Lag ~~'b~ \ l`y `1}~\, ,, ~ '•'~ 1 ~ { A.X Q~/.~~ ~J. ~ C 1 1 Q ~ `1 •~ ~ ~ ~ ~,O A I~;~ f ~J I \. ~"` > _ Slog ,,, ~-o~- .,1 ~nS cl~v~ ~ 2.S' ~. a~ ~ ~.~ s ~~ ~ QVL SC..^ 'T~7 '}O~tC hA~~h `^ ~ C • :~.. I. VElJT CAP . 'i'~C.Z. VENT PIPE WEATHER PROOF ~ 25' FROM DOOR, JUIJCTIOIJ BOX WINCOW OR FRESH ~Z1 ~~ ,. ~ ~ 1( ~r~. t o b ~ ~~ ~ APPROVED LOCK10.1G MAIJHOLE COVE F, ~/ WARN\N is AIR UJTAKE I ~`AQ~>_ GRADE I I _ COFJpU1T ~-- K~' ~ \~~~ \ ~~ f `, 11~ •j~ PROVIDE I =___= I'~ r ~ J, AIRTIGHT SEAL I III 'f L, k ~ ~- ~ 1r1, o ~.,,, v~ `T~~ ~ ~ (r t~LS , ~'~S L 2•V tT ~,Z• O `I I III c `_ f I I I APPROVED JOiA;7S ~'~!ow, w-~-21~ I I III W/ PIPE ~p y I ~ I Al-ARM EXTEIJDIUG 3' C~ VII "1'~ ~ klv. w.,~ i ~~l I i I 01JT0 SOLID SOIL .d-~<< U U ~o ~~. ~ I oti . ~-, ~~,o~ ~ I PUMP -~, - - ~ OFF Q-~ Q-~+. ~ Z . ~! .. ~ l~ __._. - .. DLOGK i ~~ _ .. L ~ 1' _~ ~_~ • i `._, , ~o., 3~~~ ~~ i ~' ,I ~ i, '1 I , i ~ (~ g ,. ~.. ~ ; '~ I 1 ~, ~ '~ i i i ~S ITT PERFORMANCE RATINGS Total Head (ft of water) Gallons Per Minute . _ EP04 EP05 5 53 - 10 46 62 15 36 55 20 21 46 25 0 33 30 - 11 METERS 10 9 8 o ~ w = 6 _v Q 5 z } 0 Q 4 O ~ 3 2 1 FEET 0' GOULDS PUMPS Wastewater COMPONENTS Item No. Description 1 Impeller 2 Base 3 Pump Casing 4 Mechanical Seal 5 Ball Bearings 6 0•Rings 7 Power Cord 8 Oil Filled Mator 9 Motor Housing/ Stator Assembly 10 Motor Cover 3 ~(~: ~\ ~. 6- 9 ---~_ ~ S __ ~ ~ ~_ T .`- 6 o~ g v iv tv w w ~~ ~rrvi 0 2 4 6 8 10 12 m'/h CAPACITY ~~~~~ IL V ATION REPORT ' Department of Commerce i h Comm s5, wis. Adm. Code Division of Safety and Buildings ~~,„r,.,rr Attach com lete site Ian on a er not less County p p p p /: x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. R sewed Personal information you provide may be use or se ~ygb~raiacy La , s. 15.04 (1) (m)). Property Owner V LJ P perty Location #2549 Page 1 of 3 Certified Soil Testing, LLC St. Croix ~-1049-95-000 Date /,!r'Ylti ~ ~i Simmelink, Earl G vt. Lot NW1/4, NW1/4, S21, T29N, R16W Property Owner's Mailing Address L # Block # Subd. Name or CSM# 886 230th St. 2rJ ~~y,~ ,~,,, ~ /~ 7 City State Zi Code hone Number City ' _~~ Village ~ Town Barest Roa Baldwin WI 5 15-684-2160 Baldwin 230Th St. New Construction Use: ~ Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement a Public or commercial -Describe: Parent material loess over till ~~-~ Flood plain elevation, if applicable NA ft General comments install 8' x 57' rock cell mound ~n 100.0 contour as upsl a edge of rock w/ 1.4' sand fi!I @ 0.4 gpd/sq ft and recommendations: basal loading ~ . S- Boring 1 Boring # -- IX Pit Ground surface elev. 98.5 ft. Depth to limiting factor 20 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft= in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-7 7.5YR 3/2 - sil 2 m gr mvfr gs lm .6 ' .8 2 -12 , 7.5YR 3/2 - sil 1 f sbk mvfr cs im ~ -- .4 .6 3 1 12-20 lOYR 4/3 - sl 1 m sbk mvfr cs im .4 .7 4 20-25 lOYR 4/3 flf 7.5YR 4/6 sl 1 m sbk mvfr gs 1m .4 j .7 5 25-40 7.5YR 4/4 c2d 5YR 4/6 scl 0 m mvfr - - 0 0 side seeps below 33" Boring Z Boring # ~, Pit Ground surface elev. 101.3 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPDlft' in. Pvtunsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ett#1 'Etfs2 1 ' 0-8 7.5YR 3/2 - sil 2 m gr mvfr gs lm ~ .6 .8 2 8-1 7.5YR 3/2 - sil 1 f sbk mvfr cs lm ~ .4 ~ .6 3 12-21 lOYR 4/3 - sl 1 m sbk mvfr cs 1m .4 7 4 21-22 lOYR 4/3 flf 7.5YR 4/6 sl 1 m sbk mvfr gs 1m .4 .7 5 ~ 22-38 7.5YR 4/4 fed 5YR 4/6 7.5YR 5/3 scl 0 m mvfr - - ~ 0 ~ 0 _ I ~ ---- no side seeps; occasional gr/cob/st ' Effluent #1 = BODS> 30 < 220 mg/L and TS >30 < 150 mg/L ' Effluen>r#2 = OD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si a re: CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 4/24/2007 715-233-0398 $BD-8330 (R OL001 Property Owner Simmelink, Earl Parcel ID # 002-1049-95-000 Page ? of 3 , 3 _ ;Boring Boring # pit Ground surface elev. 97.6 ft. Depth to°tirr-dir-g..fac~or 20 in. ~~ Soil Application Rat Horizon Depth Dominant Color Redox Description Texture r~--:~. 'stence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Colas Gr. Sz. Sh. 'Eff#1 ~ -Ertaz 1 0-6 7.5YR 3/2 - sil 2 m gr mvfr gs 1m .6 .8 2 ~I 6-12 7.5YR 3/2 - sil 1 f sbk mvfr cs 1m i .4 .6 3I 12-20 ~ lOYR 4/3 - sl 1 m sbk mvfr cs lm .4 .7 _. 4 20-27 lOYR 4/3 f1f 7.5YR 4/6 sl 1 m sbk mvfr gs 1m i i .4 .7 5 27-36 ~ 7.5YR 4/4 c2d 5YR 4/6 scl 0 m mvfr - ~ - 0 'T 0 ----- - side seeps below 31" * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access sen~ices or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. St3 U-3;3(i (R 07/OO) Certified Soil Testing, lLC • ~ `~ ~~0~ S~o O~Z- ! or-~~'t°CtS•cac~ca w~~ 0 Cl O~`~ (~ ~ <. \~, o~ '3-3~ ~~ ~~ ~~'z~ C~ru,o~ ~~ °Z~ r r ~ ~Z RJ ~-1 1}~ ~ w ~l o-e,p~ ,~ ~ t 2. aQl o ~U~dtl2~ ~~q~ a~~. ~3~1 ~.~. ~~ 1 JO c o..l e, O 15 ~~ L1'~ 2 z Z ~ ~ + q~ C t oz."b~ `\\ ~_ 1 ~~ _f _ - ~~ O K~t~ ~~'" 92 C ti.(n~~ b(J~.: v s ~ ~~ pr R., No ~~ s¢.~b0.~~ ,.y~,ol~~a~..a ~p l~K ~~~.o~ ~aC2 C~ bwe `U ~k-~- L( ,,~ t ~ l o-v' ~ 2 o v , (,e ss-c a\ d °~ ~ r1G a~C .¢~ ~ o ~~ <l ~ S.S~ ~~ a.~ ~ ~o o.- c o t ~ 3 a~ ;x ' System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Roger Timm, 715-772-3214, or the St. Croix County Zoning Department, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic systetn," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Z. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. ~. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 5. No paper products other than tissue should go into the system. 7, No chemicals should go into the system. B. Avoid surge flows of water; try to spread laundry throughout the week. a. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance I . The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. ~. if this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system ailo~~ s reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the s~ stem area. I I . Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing. and!or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 Owner: Simmelink, Earl Computer #: 002-1049-95-000 Address: Parcel #: 21.29.16.3096 Unknown Municipality: Baldwin, Town of Address: 886 230th Street Baldwin, W 154002 04/05/2007 Simmelink, Earl Ryan Yarrington Failing septic is discharging to the surface. Sanitary permit must be obtained and replacement system put in by August 1, 2007. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~(i~. r ~ ~ ~ 1n N'- ~ , I h Mailing Address ~~ ~ O~~ ~~ Property Address t~~ ~ O~~d `y~ (Verification required from Planning & Zoning Department for new construction.) City/State ~~.1~~,,r,,,," ~ d_ Parcel Identification Number ~z,- ~O~- `i>~- Gov (.~~-8) LEGAL DESCRIPTION Property Location 1 `~ u' '/4 , '/4 ,Sec. ~ , T ~9 N R~W, Town of ,.- Subdivision ~ ~- ~..Q' ~~-~~i1~ ,Lot # Certified Survey Map # {''~ `l ~1~-~' ,Volume ,Page # C~V~f anty Deed # ~ 7 (~ ~~'~ ,Volume age # Spec house yes no 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 years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb r of bedro s ,~`~ ' ~~ SIGNATURE OF APPLICANT(S) . ~/ ~Z/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Parcel•#: 002-1049-95-000 os/o7/2007 02:18 PM PAGE 1 OF 1 Alt. Parcel #: 21.29.16.3096 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 -SIMMELINK, EARL J TR EARL J TR SIMMELINK 886 230TH ST BALDWIN WI 54002 Districts: SC =School SP =Special Property Addres s): ' =Primary Type Dist # Description ' 886 230TH ST ~/ ~ I SC 0231 BALDWIN-WOODVILLE AREA ~ D SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 21 T29N R16W W 1/2 NW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40114 1601/4) 21-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 10/13/2004 776885 2674/547 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 5.630 1,000 0 1,000 NO 00 UNDEVELOPED G5 13.370 16,800 0 16,800 NO OTHER G7 1.000 5,000 43,600 48,600 NO Totals for 2007: General Property 20.000 22,800 43,600 66,400 Woodland 0.000 0 0 Totals for 2006: General Property 20.000 22,700 43,600 66,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 y ,~ U. 267y P 5y 7 STATE BAR OF WISCONSIN i'ORM 3 - 20(10 Document Number QUIT CLAIM DEED This Deed, made between Earl Simmelink a/IJa Earl J. Simmelink, a single person -- - ------- - - -- - - - Grantor. and The Earl J. Simmelink Revocable Trust dated February 8, 1990, Earl J. Simmelink, Trustee, with full power to convey, Daniel Sims and Linda Jolicoeur, successor Trustee Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix Couniti'. State of Wisconsin (if more 1. West Half of Northwest Quarter of Northwest Quarter (W 1/2 of NW 1/4 of NW 1/4) of Section Twenty-one (21). _,~~ 2. South Half of Northeast Quarter of Southeast Quarter (S 1/2 of NE 1/4 of SE 1/4) of Section Seventeen (1'~. 3. East Hal f of Northeast Quarter of Northeast Quarter (E 1/2 of NE 1/4 of NE 1/4), Southeast QuaRer of Northeast Quarter (SE 1/4 of NE 1/4) and North Half of Northeast Quarter of Southeast Quarter (N 1/2 of NE 1/4 of SE i/4), in Section Twenty (20) All in Township Twenty-nine (29} North, Range Sixteen (lti) West. 776885 KATHLfiEH H. MALSH REGISTER OF DEEDS ST. CROIX CO. ~ liI RECEIVED FOR RECORD 10/13/2004 10:00AM QUIT CLAIM DEED EXEMIPT t 16 REC FEE: 11.00 TRARS FEE: COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Rehlm Addres Thomas A. McCormack 102010th Avenue Baldwin, WI54002 002-10_x9-95, 002-1038-95, 002-1045-10, 002-1045-50 Parcel Identification Nwtllre:r (P1N) , This _ is homestead property . (is) (~icuat) Together n•ith all appurtenant rights. title and interests. Dated this _ ~" da}• of ~~ ~;~ _ , 2004 3~ -- --- -- "~ - X * * Earl Simmelink * AUTHENTICATION Signature(s) authurticatcxl this day of * ACIdVOWLEDGD~NT STATE OF WISCONSIN ) ss. St. Croix _ Counri ) Personalh came baforc me Lris ,~~ day e: ,__ ~,~~~ ---- --- - _ , 2004 the above nanied __~ __ _ _ _- ___ -__ -.__ _.___ _ - .__ __ __ __ .- _ -_ _ __ Ea Simmelink a/k/a Earl J. Simmelink * ,. _ ----__~-~_^- - - -- -J._ ._ - ------ - - -- --;r--~-- -- -~ -- - - - -- - - TITLE: MEMBER STATE BAR OF WISCONSIN _ (If not, toto me laio«~~ to be the pe authorized by § 706 O6, Wis. Stats.) - - -- -- -- - _- - instrument anc ckrrowle THIS I?~ISTRi"SENT R'AS DRAFTED SY' * ~~~~5 Thomas A. McCormack _ _ _ _ _ _ _ _ Notary Public, State of Baldwin, W I 54002 _ _ _ _ _ _ __ - _ _ __ - My Conuttission is penal (Signahues may bz authenticated or aclatowiedged. Roth are not necessary.) * Names of persons signing in auv capacity must be typzd or printed below their signature. STATE BAR OF ~~'ISCONSIN QUIT CLAIM DEED FOR1i No. 3 - 2000 ~~_c~ted the toregoing --- - }' '~` - - -- --- N r;~:---~~~--- ------ ,, ~t~lron date: INFO-PRO (800)655-2021 wwuv.infoproforms.com t~