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HomeMy WebLinkAbout002-1060-20-000w'~Of~" °~`~"~`" °~ CO`"""ef~ PRIVATE SEWAGE SYSTEM ~~ and ~ D~sbn INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal infomlation you provke may be used for secondary purposes [Privacy I..aw, s.t5.04 (lxm)J. H Permit Ho der s Name: ^ City Vi lagli ^ Town o genson, Darcy Baldwin Township CST BM Elev.: ' Insp. BM E ev.: BM Des ~(i~~: / ~ r~ L , I ~ ~ • ~ D (- 3~ C s-c 2- C ~'f PJ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W ~~ S ~2. ZooIBtiD Dosing ~~ - rr Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake RO.'~O Septic -~ 0-}• f --- NA Dosing cr ~ ~. ~ ~ NA Aeration NA Holding St. Croix 384278 ~3~8 =~"r~s. ID.~ ELEVATION DAT A STATION BS HI FS ELEV. Benchmark Z ~.~p rJ ~, ~,. t. BM Bldg. Sewer ~ ~ ~p •s'S~ St/Ht Inlet (~",O5- 89.~~ St/ Ht Outlet Dt Inlet Dt Bottom l~8•$ g6.o ~ Header/Man. 3•~~ ~0(-5`f I Dist. Pipe •32- )u 1. v I o I. So Bot. System 1•gS~ I ~ •4s o .oo' Final Grad '9 ; l( l,,e,~- IZf ~2 Cover ~, qs ~ 9 . !~' ~ PUM~HON INFORMATION .. Manufacturer Demand ~.,{ Model Number ~bp~t~' }~~ GPM 1S ,~S DH Liftl~,~~ FridionZ,~ System~,y~ TDH23,~DFt / Fii rr Forcemain Lengths ls~ Dia. 2 Oist. To Well All eR~ARPTI[tN SYSTEM rYrl~~_ «~ 3n )+ C la. S ~ E Width Le~g~ r o. Of s PIT No.Of P~ Inside Dia. Liq id Depth EN I N DIM 1 N adurer: SYSTEM TO P / L BLDG WELL LAKE /STREAM LEA G SETBACK r- INFORMATION Type O a ys ~ v 1 OR UNIT um System: DISTRIBUTION SYSTEM S' "~-~*~'''~``--'' Header / Mani old n u Distribution Pipe(s) c 3`F S~~ ~ ~ x Hole Size ( u x Hole Spacing v 3( Vent To Air Intake Length ~_ Dia. ~ ' i . ~ Length Spacing o SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded i Sodded xx Mulched Bed /Trench Center Bed /Trench Edges ~ Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons presentJpt~jection ~#1: O~jr2.9/Q( Inspection #2: Location: 2671 County Road D, Woodville, WI 54028 (NW 1/4 NE 1/4 25 T29N R16W) - 25291636~9~- -Lot 1 ~ 1 7~~ 1.) Alt BM Description = ST ~•~- 3 ~s 2.) Bldg sewer length = (~ . o q -amount of cover = > Sp" ~ _ io.~,5~' } + ~e 3.) contour = ~~, 5.0 (yGt,afi ~ 5`3e ""!' / + Z. Plan revision required? ^ Yes ~ No ~ ~ ~ Use other side for additional information. o $ 29 0 ~ ~~~ Date Inspector s Signature Cert No S8D-6710 (R.3/97) ~~ ag3047 Safety arsd Bu;ldsags Division i ~ -~~' _A_ _ E ~ 202 W.'Plashingloa Ave.. P.C. Box 7262 ; 7262 dse WI S37t}7 ~ '' " j M ~„ ~~~_CYn ~' K ~ 5ite Address I - a on, ~ ~~~~ ~ ~ r ~ 1 u?! !7e artmsnt of commerce ~ ~'~;~ ~ ~ ~ ~~ ~ ,~ _,~.~ 3auit~y Per~ait App ~,:a:.?-._~ '~ ~ St-nitauY Pttiait lqumber 3~'/Z ~- In aoaord wilt Came 83.11. VVu. Adm. Cede. pare Into at~rrovida ~ ~ ' Q Check if Aevieion be !br Prly e !. ~ I, Applkatltea Ie+tdi'ertmatlto • Plettw P'eiot AA Ltf 14~ ' fRhete Plan I.D. Number r"`" Pralrariy owns': Ntstno Patest Number ; Sl' GROIX I -P e ~ti w ~ t. ~ ~ courorv --- , prapp,tgr Owaer' Marlins Addrtra tt,E Phoperty LaebtioA ~ ~ City, Stoat Zip Cod® "tia~N ~ Nwubar Slack Nutnbar linbdivuiaa Natno CSM Nu.~bei~ II. Typs o!' SuildinP telmck ali that apply) ~ DCity l or 2 Plssnlly Dwallit~ -Number of 8edraorne -_ ~ o-k ~ ~.- ~ ~iFL.K~ Ql-Waga PublielCon>:necrGti - Describe 1Jsa ~~ ,~ I ^ State tlwnsd Natrat Adtd / ' ~Q ~r! ~~ III. Type ox 1'eranitt (Check oarly aae boz eat Itt:s A (attatsberftn~ scheme for #nter>zal etas). Ca nplste litre 8 i! aplrUcsble) A' Y~'`New 2 D l;apiacsmaat Syuste 3 ~ Bsplauttunt of 6 ^ Addison to ~ p'a' County use (% ~j a. - ~ O ~ 00 i s~ ?trait oct Fxiseits s stem S . 1(0.3 to f f} 8. Q CiLaClt if Stttsittuy Pot~aft Previauely iraued Petlrsfs Number bate Issaed IV. Tyre M Parmitt {pieck all that t;prly){nutubertng scheme is for intetzsal tree) ~4 Q t3at- -Pcasuriaad Ia•Qmuad 2~.Ad0und ~9 ~X (r ~ ~) 47 ^ Sand Filter 50 ^ Constnt:ted Wetland 1Z G' Prastur3sed Itt-Clrauad ~i 'u iioldtny Taalc 48 ^ Stugim Pane Sl ~ Drip Ltrre 45 ~ At-Gratis 46 ^ Aerobia Treatment utsit 49 ~ Recircula 3Q ~ Outer V'. Die t At~ea Intotm~atl aat = ~i' - S' S '3 Daslaa plow {:pdi Diepeesat Aces Diaparatet Mee Sofa Appikation Parcolat}on Rata Sy9anm Elevadan Final Grade ; ~ Regctirni Prapostd Raw(Gt1s.lDayslSq.Ft.) ~ E:esvation (bZin.llnchy ~ ~a~ /. ~ 6~~J ~ ~~D ~ ' ~ Y (l, o / i .vim ' i~a, ~ / ~ ~a'~. ? ~. Ttatalc j~p Capacity in ?aaI # Ntttaber Osilaut thsiTatu i oi?ttalca Manui3cturer . Prohb Sits Steal 'Fiber Plastic Caaarsut Canetcuetad ~ Qiase ~ Nwv III ~ ~ i epde ar 4ads ~ ~D -.e Y A' ~' ~ thetas (~ ~ d!/i ~ u° c: / # ~. $ ~' i, this - aallnaie ~~' Ioa et! the POWTS ehawq ~ t$e attached Pltnrlber'a Nt~e ~etntJ P!>rmbar's $ismuttq M it3 Ntnnbsr 8ntsiusea Phone Nutn'aer ~'l(~'~ ~ Sal ~~a.t'ay ,~-=- ,~~ 7 !~ D /S -3 G -- 3i ~ ? Plumbnr'a Addte,e t frost. City, Sttta, Zfp Cadet S' c a ~. ~.~ ~.s'a,~ ~1,. ` ~' arttauot Ap~,r~ Q ,~,~ taty Permit Fee ( Qcoutdwamr Rate Ta basing ASent Sigttature (; 10 5tatnpt? Snrehtsega pas) ~ G7 owaer Ginn taitfei Advacee . ~ 3aS o ~" 3 0 + , o ~- IS. Candltla >sr e~ t'Approva~tuuam fib Diwpprovat ~ ( ` ( 1 N' ~~~er 'FO be ik.S~a,~~Ne~~Ser~iGtd per /-~ahi..~i~.e~-ur~rS f~~Gowimec..c~Rr'Y[ohS_ J! i __- - -- ~ J (te tlr. t, l !ae gem on papa nol ~ ibis 4113 s 33 iedsa sa des ,''a£',?>,":~7Ai/~3a7~ tip.' W1V~~ , __\ ~~ ~ ~scons~n Department of Commerce ~~ -.~ ,~. ~.~... ~~ ~ r ` , *~<S: ~L" Sa~t~4 ;. r May 04, 2001 CUST ID No.691727 ARTHUR L WEGERER 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/04/2003 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary ATTN.• POWTS Inspector ZONING OFFICE ST CRO1X COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: SITE ID: 628470, Darcy Hagenson St. Croix County, Town of Baldwin NW1/4, NEI/4, 525, T29N, R16W FOR: Description: Four Bedroom Mound System Object Type: POWTS System Regulated Object No.: 788267 Identification Numbers Transaction ID No. G37358 Site ID No. 628470 Please refer to both identification numbers, above, in all comes ondence with thew enc. 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of this information must be given to the owner upon completion of the project. • 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 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. 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 Departrnent, 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. ARTHUR L WEGERER Page 2 5/4/01 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. Sincerely, ~~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services 608-789-7892 Mon -Fri 7:15 AM to 4:30 PM jswim@commerce.state.wi.us DATE RECEIVED 04/10/2001 irEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code:'-7633 TITLE SHEET FOUND SYSTEM FOR A ~ BEDROOr1 RESIDENCE This plan has been Manual SBD-10691-P (N.01/O1) LOCATED IA1 THE ~~~'`~ TOWi1 OF ~3 ~~~ Page ) of ~ prepared in accordance rlith the Mound Component and the Pressure Distribution Manual SBD-10706-P (N.O1/O1) 1 /4 OF THE !JE 1 /4 OF SECTION ~S, T Z ~ N, R J ~ W, ~w~1~-1 ~T'- e-l?~l X COUNTY, WISCOPdSIN, INDEX . PAGE 1 of 7 PAGE 2 Of 7 PAGE 3 of 7 PAGE 4 of 7 PAGE 5 of 7 PAGE 6 of 7 PAGE 7 of 7 TITLE SHEET SYSTEi:i I•I:~~dAGEi•1.;LZT PLAiv PLOT PLAN ~n~ PLAN VIEGI-CROSS SECTION DISTRIBUTION PIPE LAYOUT PUI•IPING CHAPIBER CROSS SECTION- ~ ~`'U1 PUMP PERFO RIIANCE C., ~`~ ~w~ .~ „~ ~ q a PREPARED FOR "•~" .; _ ~ °l = t=it-0 Rw C~ ST. _ _ PREPARED BY WEGE~ER SQ I L . TEST S iVG acvD . . DES ~ G~i S~RV S CE P.O. Box 74 421 N.riain St. River Falls, GTI 54022 Phone 715-425-0165 Fax 715-425-6864 vs:~•satil~ Qndtiti°~ ~o ''~`C-~~E ~QGO~M~U~~p~t-~ ~QQ~A~~~ 0 ~O f :,4Qp~ s S~~~A ~ IN/.rl ~ ~i, ~~~~~~~~ ~~~~/~7 ~ :j ~t ~ • ARTra)n L i ~ WE•ERER i L".CIS C s 6LLSYloflTM, ~ ~~ ..b _~ ~ 1 ~ ~ ~~ ~~~_ ~.SIG.ti ~1~-~-01 JOB N0. OD 337 Mound System Management Plan Page Z of -j Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be 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 continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank= If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S tem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October:February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General - This system shall be operated in accordance with Comm 82-84 Wis. Adm. "Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] arid local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. F~cposed 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. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump,. pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at ~ ~,l$-- 3~"6- LI (~®O ST'• CLZ-t~ UC The system installer at 1. 1.S - ~$-(~- ~lZ.~ - Se.~JN~1,A~rc.L~ The tank manufacturer at $yt) ~ 3ZS- $~L.S6 wt~~R The effluent filter manufacturer at `doU, ZZ[- 572 Zf~;13~ The pump manufacturer at - - -- PLOT PLAN Scale 1 "_ ~l ~' ~. ao `~+ RV E .- ZR 6 ' - Page ~ of 7 o- zs m; ~ Zoo `n+ sr. 3r1}~l- ~'Z:_l~0 ~O`d~v `)`'1~t61~F, 31~`DtA. t?v C PIiP~ w1~-77f -. S v 66 ~~n ~o~~ ~r X ~ ab ~~ ~h~ 3 h~ ~I P G PCbZ av f ~~ !"~-- 2 9 , / 1S• ~o woT ec~~P~-T / I oR ~?IgTU~z~ ~ . 'T"~i't S ~~ ~ .P~l h I ~ j ~ I / ~w ~ / ~ ~ I ~~ ~ ~~ /~r~ -~s, ~, zoo c~ / i-~I,~PUC /~ 2q, ,-~o °~ ,F,wt- ,~P~c Z C0~.11'uv~ ~,c-4'.S' $o~M of ~~ ~.t~0.9 0 7 J 1` 3 ~- 2 m a~-~- 0 0 8M #-z -~ _ - NOTES • ~ _ ..._. 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required).. 3. Septic tank to be lZ-'dol~o~ gallon capacity manufactured by w ~~`~ ~ eoti eQ~ ~-zvflv~ w l ~ -~B oc~ z -°~~z- ~t ~rC-sz 4. $ench marker •, g~ Pr~pVr` 5. Divert surface water around system Ito prevent ponding at the uphill side. ~~y'r~P PE1Z-F02~~yCE CU1ZyE i~~ -1 ~r- -1 uouias ~~~~3~~~~3~~ ~ ~ '~ 3885 APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS ~ ~ ~~;~ ` Pump • Solids handling capabilities: 3/"maximum. • Discharge size: 2"NPT. • Capacities: up to 128 GPM. • Total heads: up to 123 feet ," TDH. • Overload protection must be provided in starter unit. • Shaft: threaded, 400 series stainless steel. • Bearings: ball bearings upper and lower. • Power cord: 20 foot standard length (optional lengths available). Single phase: •'/3 and Yz HP -16/3 SJTO ' with 115 V or 230 V three prong plug. • 3/4-1'/z HP -14/3 STO with bare leads. Three phase: • %z-1 Yz HP -14/4 STO with bare leads. On CSA listed models - 20 foot length SJTW and STW are standard., • Mechanical seal: silicon carbide-rotary seat/silicon FEATURES carbide-stationary seat, 300 series stainless steel metal parts, BUNA-N elastomers. • Temperature: 104°F (40°C} continuous 140°F (60°C) intermittent. • Fasteners: 300 series ^ Impeller: Cast iron, semi- open, non-clog with pump- outvanes for mechanical seal protection. Balanced for METERS FEET 90 stainless steel. • Capable of running dry 25 so without damage to components. ~o Motor Single phase: •'/ HP,115 V, 200 V, 230 V , 60 Hz 1750 RPM;:%2 HP Z , , 115 V, 60 Hz; 3500 RPM; `- 'c %z HP=IYzHP, 230 V, F 60 Hz, 3500 RPM. o • Built-in overload with automatic reset. `~ :• Class B insulation. ~ ~J Three phase: •'/z HP -1'/z HP 200/230/ .460 V, 60 Hz, 3500, RPM. , , . •,-Class B insulation ~, ,'°~>°. _ 20 so 15 50 40 10 30 5I 20 --> 10 smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency: 2" NPT discharge adaptable for slide rail systems.. ^ Mechanical Seal: SILICON CARBIDE VS. StLiCON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ^ Motor: Fully submerged in high-grade turbine oil for lubrication and efficient heat transfer. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits; --~5 GPM 5 Fi can be operated continuously without damage. ^ 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 in case of outer jacket damage and to prevent oil wicking. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS SP Canadian Standards Association ~~ Underwriters Laboratories SERIES: 3885 SIZE: 3/'SOLIDS RPM: VARIOUS TD~'Y`." OL Ot--`-i i 1 ( I! i! I I 1 I I I I~ l I I I I 0 10 20 30 40 50 60 70 80 90 100 110 120 130GPM ,: ., ~:. 0 10 20 3o m3m 1995 Goulds Pumos. Inc. caaacirr Effective Mav.1995 W>r~tbn 1n Department of Commerce ~. . ,,, Ivision~f'Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code Page ~ of 3 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must county S C Z-U l k I T- 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. Q~IDZ t`1 C~ Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)j. Rev' ed b Date M Property Owner ~j ~,~.~ LO,~n~ty Qv` LLB =~ P~'RL`.~t' 1~}•Pc-6 ~ SO N Property Location Gout.-Eot 1~1 UJ 1/4~~ 1/4 S Z S T Z 9 N R l b E (or W Property Owner's Mailing Address ~-°t - ~U Z-~1 '~ ST. Lot # ~ Block # - Subd. Name or CSM# ~ ~ Qo Sd~ ~S M City State Zip Code Phone Number ~~~~wt-v wt S~loo~ (~lS) Ue~f- ~t68y ^ City ^ Village ®Town Nearest Road Z3t~~~ity 8U `n+ r}v~ ~ New Construction Use: ® Residential / Number of bedrooms ~ Code derived design flow rate ~ 00 GPD ^ Replacement ^ Public or commercial -Describe: Parent material GLF~E.(~L. T1 L.L. Flood Plain elevation if applipbie _. ~ ft, General comments "" and recommendations: '-~OUrvy~ L~JI 4 rK 6~' ~LS7-r`LBV~T'lUh1 C-~L . ~ ;"' ~/'• ~- . ~l,v)~ul~ 1~ `` of S~nj ~-t~~_ '~~;} ~ `~' ' ~~~^~ _- r~_ .: , ~.d.t_ rte ~` ,,. `~ _ a Boring # . ^ Boring ... _.. _,. _ ~ ~~ ~; r ~ r'? . ~~t7 - . . ~ .y Q Pit Ground surface elev. ~ 9 ~ 0 ft. Depth to limiting factor= ~ Z O ~,..iu ~GMx , _ __ ~...- ~ v,,,~~q ~~oi4tAppilcaUon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consis ice eoun Kt$oots<. ~ GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~.,~ ; .__~ ~.-~;"~f~ 'Eff#1 'Eff#2 _. `o - q 16 `'tiVz-31 .. .. _ S j 1 z`~ b k .:_, ~t`~- _. . ' . 5 . ,. g _~ Z q _ Zn i` opt ~Z ~l - si ~ 2-~bk m~- cg - . s . ~ ~! 3 ZD- ~ ~.Sy12-31y 'Fl~1.S`J2Stg L p yv~'~L _ .3 ~5~ Boring # ^ Boring ... _. ®pit 'Ground surface elev. L 110.0 ft. Depth to limiting factor ' Z Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 • •Eff#2 1 D=S' 1C~~-I231Z - Std z-F.~~~ m`~~- cS _ -s ~~~ ~_ ~ g u ~ ~-1.y.ZS/!c - S i ~ z'Fsb~ h'l~ . CS - , 5 ~ -.~ ~ ZZ_4 l:S 7e3Ly -Ft~ ~.SyQ S/`u L.. , Ov,,, . v-'1'F!- - , 3 •5 -/ ' EfllUen t #1 = BOD_ > 30 < 220 ma/L and TSS >3n < 1 5n mn/1 + GHIi mnf iM . ann ~ ~n ..,.,n .,..a Tcc ~ ~n ..,..n CST Name (Please Print) _, .. ,Sign re .. -_ - CST Number . . .: ... ©0=337 .:~ . Arthur L` ~~Wegerer 220254 Address W e g e r e r Soil Testing & Design S e r v i c e Date Evaluation conducted Telephone Number 421 IJ. i~iain St. River Falls, WI 54022 ~(,~g:pp 715-425-0165 '1Y , . ~ V 4 8~t ~ Property Gamer Parcel ID # ~~Iv IN G pa.,p Z .,. 3' ' Boring # ^ Borln ®Pit Horizon Depth Domina in. Mun - - Ground surface elev. ~ R • S ft. Depth to limiting factor" Z Z in. Soll Appligtlon Rate t Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz ell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 - 0-9 lo~~ 31Z. - si ( z~-sb~ mph e s -- . s . . ~ Z . - z Z t~~ 4~Cy - sii I 3 `~Sbk D~.s h CS - . 5 . $ , 3 • zz_y1; -t-s ~ ~1~. ~.sHa s~~ L ow, mil- _ . 3 .5 • ^ Boring # ^ Borin ^ Pit Horizon Depth Domina in. Muns Ground surface elev. ft. Depth to limiting factor In. • Soil Applicatlon Rate t Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ II Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 j Boring # ^ Boring ^ Pit Horizon Depth Dominan in. Muns Ground surface elev. ft. Depth to Iimitlng factor in. Sal Appligtfon Rate- Color Redox Description Texture Structure Consistence Boundary Roots. GPD/ft2 I Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 . . 'Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 =BODE < 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 services or - need material in an alternate fonmat, please contact the department at 608-266-3151 or TTY 608-264-8777. ssn.s~so tx.uroo> 1 ~"~ ~ . + Y- PLOT PLAPd ~ Page 3 of 3 ,. Scale 1 `= yp ' ~ ao `~ RV E . o-ZSri~i ~ f Z~ 0 `rte- sr. ~ *i - L'T-. L ~0 : 0 ` d~v '7 ``\~ 161, 31 ~' D iA , ~ v e PCP ~..wl~-j7~} .. ~ v ' ~- LI ~J /''-E- ~ • / IS 24 Do NAT eo~P~-T' / / o o Z ~~gTv~z~ / 'Tti~ S i''cttsi`A ~-~ I / ~ °~o / ~ m / / I J ~ f Zq. / a / Q' I 0 Couhjv~ ~.~i4.S' ao~M of ~L ~t.lDp.g f.~.~'Si~~w, 1~ 1 _ t 8 -0 0 CST Signature Date 715-425-0165 220254 O~ -33~ Telephone Ido . CST Alo . ~ Job Pd0. sT cROtx covNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER'TlFICATIUN FORM OwnerBuyer ~ t~C~ :gin 1Nailing Add~~esa~-~ `F 1©~ ~nc,e ~~ ~ l e1 c-J ~ n ~.,~ ~ 54-Dt~ ply Addrtus ~ ~~ ~ Coun~ Il~`~ - ~ l1Jo~U~+ l ~~. (Varificstioa:egteind tia(m Ptaaom~ Deprbaeat to mw coaNtattio~ 1~ CitYlState V~-0~ ~Vi ~~~ ~~ ~ Parod Identification Nuutber Prope~tty Location ~ '/.. ~ ~ '/.. 5a. ~ 5 . T as N-R ~ b W. Town of ~~ ldw o.. Sttbtlivitsfon .Lot #~ ~,^. CerdAed Sel~t-~- Mnp N G ~ 3 ~ 1 ~ ~ . Yotttmo - . Psge ~! Wat~ty Deed ~ ~ ~ ~ ~f~ ~' ~,,,~, Volume: ~~„-C~_,_, p~ ~ Spec hatue O yex m no Lot tines idatti5abte t~ yex ©no Impeaga etc and maioie~tmoootya~r septic system atuld eaait is i4~ ptemgstefaihtre b beadle tvattea. Prager ceeaittt o! puaopia~ om the septic tsot erery thtet yens or soaam, if aided by s lioeasod pumper. Wit you put irtb the system cu aiXect the lbactioo of is septic tndt r a ttwmttaY tpl~a b the wsds dispad system. TLe propeety owner apices b aubm~ b St. (3aa Zoaitu Depatameat a caddudat foam, dyad by the Darner and by a ~0'. ymaaptnmber, ntfticledphmeber a a titxaaedpamper vatilyiap tbat (!) the os-rite waatew-aterQitpotal aydem is a pt+opar opeuatlAt caaditiaa aod/ex (2) athtr ittepeetion and P~P+t-t Gf' Y}. ~ ~ tads a [aa tbaa 1/3 dal! of sh~dpe. Uwe. the aa~destisaed haw read the abort tequieeeoeats sad spec to maiataia tbs priwte sewage ditpaal system wiW the ttaadards ser forth, ~ as ~ ~ ~ ~` Cammecce and the Dtparo~neat of Natural Rasances, SWe of Wiscaatip. Cettiileatioe ~mti that your septic system has been maiataised mast be computed ssd tetueaed b the St. CYoix Canty Zoait-d OSitx withla 30 dr aE the three year etq~iragoa data. ^, ~- s n>RE DATE OWNgR CRR'TttRr~7~~ I (we) certify that at! tbtantsats as this farm ate tuts m the belt o! my (oar) lotowledae. I (wej am (are) the owaet(t) of the prepttty described ~ by virtue of a wattsaty deed eeeaeded >r Register of Deeds Ollice. ~,~~,~ GNA OF CANT DATE ...... Any iafotasttioa that is nit-eepresateed ta•y [Frail is the sattitaty permit beiop revoktd 6y the Zoaiag Departrneat. ~~••~• •• ladude rMth tttb apptkatNa: a st.~ed wanaaty deed from the R,aisoer of Deeds offset a espy of tits esrdtied tsrvey map if refeeeaoe is made b the wansnty deed FROM Thomas A. McCormack FAX tom. 17156842393 -lj, l J l3F t~~',>~ O Rolland J. Lorentson and Veterta H. Lorentson; husband and yvlfe, quit' claims to Darcy E. Hagenson, a single person, the following described real estate in St. Croix County, State of Wisconsin: olland.L.Lore Es6n "Verona H. on ACKNOWt£DGppENT Parcel t The North 300 feet of the East 30 feet of the Northeast Quarter of the Northwest(Qe~er (NE %. of NW '/.) in Section Twenty-five {25}, Township Twenty-nine (29) North; Range Sixteen ('I ) Parcel 2 The West Half of the Northeast Quarter (W '~ of NE %) of Section Twenty-five (ZSj; Township Twenty-nine (29) North, Range Sixteen {76} West. RESERVING, HOWEVER, to Grantors, or t0 the survivor of them, the right to occupy tMe residence with attached garage, pole shed, and barn presently located on the Northwest Quarter of the 1~lotthe~asF Quarter (NW '/. of NE Y.), said right to terminate upon-the earlier of the-deettw~the survivvF of-Grantors-oEwhen nefther Grantors shaO have resided in said residence-as-.his or her principal residence for a continuous period~f six (6j months. This is homestead propertp. BMed this ~ day-of;~~~ ~~ , 2000. i AUTHENTICATION Signatures} authenticated this _ day of , t9_ signaWre type or print name TITLE: MEMBER STATE BAR OP WISCONSIN (If not, authorized by § 706.08, Wis. Stets.) THIS 1NS7RUMENT WAS DRAFTED 9Y Thomas A. McCormack Baldwin, WI 54002 STATE OF WISCONSIN "ST. CRO1R COUNTY l?ersonaUy . Carne befotE me ihi3 ~ day of ~.P , 2000 a above na Rolland J. Lorentson an Vd BBna H. t~nt _ ~YA'd3hd~drife, to me known to be-the perton(s a the f instrument anrlackrwwfed sa~y~ ~ ~ signature Jun. ~ 2001 01:28PM P2 (,3'7'516 Y.A'iFILEEhI H. WALSH REGISTER OF DEEDS Si'. CSilIX CO., WI RECFIUED FOR RECORD 01-2?-001 8:00 M 0[)E~TGt.MIM DEEM A CERT COPY FEE. CORY FEE: ivR.MSFER FEE: RE~RDT_tDi FEE: 10.00 Pfi6ER:.- 1 Thomas A. McCormack 1020 10'" Avenut PO Box 2t20 Baldwin, wt 540021 002-160-20:-30;•50 (Pearl IdentHleation Number) tl ~ : F Notary public st Croix Co~, Wis n3igrf k l ,. ,~~ •` My commission is permanent (If not, te'expuation date: 19 .) 'Names of p9rsons s'~gning in any Fapacily shouttl De typed Of printed bebui their sgnatures. ' ItAmnalgn PrordlaWrwK (,omparW FOM Ou 60e. W6fLMA 80D.ft5S ~~ C C a GC GD N CERTIFIED SVRVEY MAP LOCATED IN PART OF THE NWi/4 OF THE NEi/4 OF SECTION 25, T29N, R16W, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. ° N w M_Gv_ll?fsG144C~_DD__ 6QG:!]_DD_ W ~ ~ ®M7G~1C~D C3~7 04C~C~G33_ ------------ - -------------- - ~~~ w O ~ IIDII ~_~ C.T.H. ~ _ ~ Nl/4 CORNER r- ~ ---- ---- ----- --- C~' ~ w SECTION 25 ~ EXISTING NORTH LINE OF THE NE1/4 Z °z ~ se7°o4'17•E °' ~CENTERLEME S87°04'17'E 295.86' ~ sECTIONZs m i- ~ Mt/4 CORNER 1049.x' "c.i S87°2 COMPUTED FROM WETNESS 25.50' $00 ~~ EXISTNJG FIELD ,~ - jr--- -^ MONUMENTS OF RECORD) _ DRNE ,a 1344.91' `_ a N S87°27'O6'E 270 2T OWNER DARCY HAGENSON 29 FLORENCE STREET BALDWIN, WI 54002 SURVEYOR EDWIN C FUWUM NORTFNAND SURVEYING, INC. P.O BOX 290 HUDSON, WI 54018 °~ } o ~i n ~-~ ~i L51 ri W ~ ~ LEGEND ~, • 11 i Cf111 ~ ........................ ' a ' a; w ...................................... N ~ ~ ~~~ `` ~~ ~ i 0 $ .. ~ o Q O ~ ^ RAILROAD SPIKE FOUND ~ o W ,n ~~ ® 1 ~ ~~ ~~ ~ p ~' LOT 7 w° , ~ ~ M9~ ~'~ p r X 2a• tRON PIPE SET WEIGHING o .~ a Q ~ o w ~ oo ~ 1.13 LBS. PER LINEAR FOOT 8o S ~.. ~ ~`~ d. ~ ~ ~ 2.28 ACRES NJC. RNY ~Z rn O LL ` ° ' ............. 10d ROADWAY SETBACK Q ~~` Z 99457 SO. FT. 2 J a 0 z ~' ~; f ~' O ~ 2.00 ACRES EXC. R/W ~ O ~ a' ~'' o EXISTING FENCEUNE 87,298 SO. FT. ~ ~ ~~ ~'~ o ~ a? Oi APPROVED N ST. CROIX COUNTY Planning Zoning and Parks Cornniitlee 2.4'+/- APR 2 5 2001 N87°27'06"W 295.77' ~J~IPL Q'u~C p dpa~g I If not recorded within 30 days of -------------------- approval date approvalshatlbe OU9G~JGD Drl pdp`~~p I null and vad THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON SCALE IN FEET 1 ° = 100' 100 O 100 200 Wisconsin Department of Commerce SOIL EVALUATION REPORT soon of Safety and Buildings ~"`~~ ,~ in accordance with Comm 85, Wis. Adm. Code County Ct~pCmpiete site plait on paper not less than 8 1/2 x 11 inches in size. Plan must ~; but notrtimited to:`:.vertical and horizontal reference point (BM), direction and ,p`~cent sloQ~, scale or dimensions, north an-ow, and location and distance to nearest road. Parcel LD. ti Pease print all information. ~ Reviewed by ~~ ~~ `pe~¢a l ~ n you prorride may be used for. secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Rc~ L.p~~ L~l ti-ti./TS~-V Prooertv Location E3u~t~. ~ ~ZC4' ~}~p'c6 ~ SD IV Property Owner's - --- -r ........ . Hunt ~`1 u111UC1 ~~~~wt,y ~w~ ~ su~a~i (its) bey{-~IbBy Page ~ of 3 S`}-. C~Z.U l K Q~titi ~ Date ravk•-hot 1~1 ~ 1/4~~ 1/4 S Z S T Z 9 N R i` b E (or W lot # Block # Subd. Name or CSM# 1 - ~P-UP~S~ es+~ City .: ~ Village ®Town Nearest Road ~ ~ ~-flw l N ~ 8U `~l-F fg-V ®, New Construction Use: ® Residential / Number of bedrooms ~~ Code derived design flow rate b 0 p ^ Replacement GPD ^ Public or commercial -Describe: Parent aia'terial GL.P~/ fl-L 'n LC Flood Plain elevation if appligble ~ ~} General comments ~ and recommendations: MOVtr\.,r,~ W f 4 rK 6~ ° t71S1-~-r-LB~~on1 Qt?ZL , .. Y~ i nJ 1 Wt U~ 1 l~ `' o C= S ~svj~i LL a Boring # . ^ Boring .. __ .. _.. _. ... . ... - . _ _ ... ... pit .Ground surface elev. ~ 9- 0 ft. Depth to limiting factor ~ O in. . . , Horizon Depth Dominant Color Redox Description - Texture Structure Consistence Boundary Sail Application Rate Roots GPD/ftZ _. .- in. Munsell ~ ' ~ t1u. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 •Eff#2 _ . 0=-9 - 10`1'~jl _-- -- - _ _ - .. si 1 z~bk ~n`F- .~S : _ ~ s~: ;.$.. -_ -. Z 9 - Zti Lost R fly s i ti Z~bt~ m~- cS ~ - . s . ~ 3 20-y~O ~.Sy~3ly ~l~1 S`91LStS L p-- yy~-~'j- - -3 . ~ 5 a Boring # I^~~ Boring .. .. .. - t~ pit 'Ground surface elev. (V0~ 0 ft_ no.,rr, r„ rm.+~,,,, ~..~,,. Z 7 Horizon Depth Domin t C l ~~~~ Soil Application Rate In an o or M ll - Redox Description Texture Structure Consistence Boundary Roots GPD/ftz • unse Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 - 'Eff#2 1 D=S ~ 11d-~231z .. .. - .. si.~ 2.~~~~- m`~- cS .. _ 5.. ,..~... 3 ~ ii_~ Z:S 7e3Ly -Flpc ~.S`iR S/~ L... p,r,,~ -. m'~1- . - . 3 ,5 - _. 'Effluen t #1 = BOD_ > 3n a ~n ,,,,,n ~.,a ice .en , , ~ ., __~ - _ _... - ..._ _ __ CST Name (Please Print) ~........, ._ - . ~, Sigri re .. .CST Number . ~ +, ,, ..,.:. 7 ~~ 220254 Arthur-"L Wej~erer -- ' ' _ ~ .. ~ ._. , ._.••.~t90=3'3 .. ~ ~ - Address W e g e r e r S o i l Testing & D e s i g n S e r v i c e Date Evaluation Conducted Telephone Number 421 ~;J. Bain St. River Falls, W7I 54022 j(_.~ jj ~~© 715-425-0165 ~~