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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division r .~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes !Privacy Law, 5.15.04 (1)(m)(. Permit Holder's Name: City Village X Township Werden, Pete Baldwin Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~, /~ / ~ ~ l Dosing ~ ~ /~/~ Aeration -.. ~ Holding TANK SETBACK INFORMATION TANK TO E~ /L , WELL BLDG. Vent to Air Intake ROAD Septic ~ 3 I ~ ~ ~` ~ ~~ C Dosing `~ Q ~ , ( r ~ ~, Qr Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ n Demand D-/ ~-~C k/~ GPM Model Number ~~ ~,p TDH Lift 7 Friction Loss System e ~ ~ TDH Ft .~ ~ i.v i ~ Forcemain Leng~,~/~ Dia. /t 2 ~ Dist. to Well ~ ai ~~ Jv - 7 t County: St. CI"OIX Sanitary Permit No: 453041 0 State Plan ID No: Parcel Tax No: /n- /~ Section/Town/Range/Map No: 25.29.16.37 STATION BS HI FS ELEV. B nchmark (~ ,~ 2.2- ~ D -Z ~ (Z ~~ 6 - 6 A. ST • C. Bldg. Sewer ~ S o ~s~1 ~`•3 1 >. St/Ht Inlet ~~ ~ G ~ l~ 7 SUHt Outlet (e • to ~ ~ , Dt~lr let I(o-~ gam, z Dt Bottom , Y PSP~VS ~` ~ ` ! I ~ ' ~ ~ I eader/Man. ~7 ~ C, r Dist. i e~,~~ t ~~ • U ~ ~~ Z Bot. System I Z ~ ~ •~ Final Grade Z ~ a r ~ ~ t W St Cover .3/Gg U-~ f/ (-~.:~'Z Z. 3 ~ tv 3 4~ t~ 1 1 ~~ ( ~• ~. C~rlk~v 1 9 ~ ' b ~ q~~7 53.E SOIL ABSORPTION SYSTEM '1n' Old~'~ %~(~ r.Lrn~ /. e ~_ _ BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~ ~ / a-~" SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING Manufacturer: INFORMATION CHAMBER OR Ty e Of System: ` ~~ ~~/ r \~~ UNIT Model Number: DISTRIBUTION SYSTEM ~5( ~~G(.~ u/"LU~lGv~14- d\f,~. f~ ~_ A ~' Header/ anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Q _ '~~ J Length Dia Length Dia Spacing ~- SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv I~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed(Trench Center BedfTrench Edges Topsoil ~ Yes ' No Yes I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /1 /~ 0 / D~ Inspection #2•, / / S / ~ 7 'T~~ ~ I Location: 2643 County Rd. "D"^~B,~aldw~in~, WTI 54002 (NE 1/4 NW 1/4 25 T29N R16W~)" NA Lot 1 ~~ Parcel No: 25.29.16. ~~~ 1.) Alt BM Description = ~ C'r"''''" _ .~. 3 ~ 8l (~ 2 = '~'tv ~ ~~ ~ `_~~' 1~~~~ ~~ K~ -~'-~ 2.) Bldg sewer length - !{~ o R (o , ~ er i0 . (~ ~~ . ~ !J -amount of cover = ~ ~~ - ~ y 2 '~ ~ ~ ' S ~ T - _ 'r 'Ian revision Required? `"Yes ~" o ~ ~~ i ~ 10 I ~ J / l~~jp e other side for additional information. `- ~ `Date 1 ~~ G~?~ _ - J `__ __ . _ _. _~`_ ~" ' --- - 6710 (R.3/97) Insepctor gnature Cert. No. i . _,, :. } oft„ ~ -~- -- ~a~ ~~ ~ / ~ °" ~/ s' ~^~1/ `d'~f "~ '~ n- ~ E (~~_ _ V s ~ Safety and Buildings Division COt'a~' ~ , ) 201 w. Washington P.O. Box 7082 ~ ~ ~~ ~`' (~ " Madison, WI 3707g~g~pg~ Sanitary Permit Number (to be Stied ~in`by Co.) ,~ ru° °, , Department of Commerce : z,;° Plan LD. Number Sanitary Permit Applicati n ~v f ~, ~ ~ In accord with Comm 83.21, wis. Adm. Code, personal infottr[at n you pr~~ldtr ,~ ~ ,~ ~ Pro' ct Address (t different than mailing oddness) tray be used far secondary purposes Pnvacy Law, s 1 S. (1)(trt~, ~ Q ~ I ~ /p ! / ~ C~/ . ~ D \ ~ ` I. Appiicalioa Iafortnatioa -Please Print Ail Information ~••~~ „, > 1 °~-«, erccl # Lor ~ Hlodt N Property Owner's Name ~JQ Z ~ ~ ~~ ~ ~ ~ ~O~ ~~~ Property Location '' °, Property Owner's Mailing Address ~ r- City, State Zip Code Phone Number l /~ ~ "~ ~ ~~ /~ircle n Type of Building (check all that apply) e ~, ~~~: Subdivisio Name CSM Num 1 or 2 Family Dwclliag - Number of Bodrooms ~ / J publidCammetcial-Describe Use !]Ci ^Village sbip of State Owned - Daenbe Use ,~1 ST C~ ~ u/ ~ ~ - . llity~t/i~~ IIL Type of Permit: (Check only one bos on line A. Comp ere line B if a plicable) A ^ Other Madifieation to Existing System ~vew Systao ^ Rrplacetneat System ^ Treatment/Holdiag Tanlt Replacement Only ~-•'-"- L' Previous Permit N ben and Dale Issued B. ^ Permit Renewal Pettnit Revision ^ Change of ^ Perttti[ Transfer to New ~~ ~ O ~/ 3 ~~ Before Expiration Plumber Owner /~'+4-?~" IV. T e otPOW!'S S stern: Check all that a 1 Noa -Pressurized in.Gmund ^ Mound >_ 24 ia. of suitable soi] ^ Mound < 24 in. of suitable soil ^ At-Crrade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressutizsd in round ~] Hakling Tank CJ Peat Filter ^ Aerobic Treatstenc Uni[ ^~Affx~ircu acing Sand Filler Jn•~ ^ Other (explains) l.i~ Raircuhtiag Synthetic Media Filter his Chamber ^ Drip Line ^ Gravel-less Pipe ~ ~ V. Dis eraalrl'reatmentArea I formation: l ,run Required {sf) Dis zeal Area ProPos°d ~ System Elevad n I7esi ow ) Design Soil Applicazion Rate{gpdsf) ~P~ / ~ ,y"\ I ~ r'1 ~ (~ ~~ ~ ~ /l,~ Manufaenuer Prefab Si[e v S Fiyberl Plastic -YI. Teak Info Capawty m Total Number ~/ Concrete Consauctat Glass Gallons Galloru of Units /,~L~'~~~' ~C~ ~! Ncw Existing v~ Tanks Tanks Scptic a Holding Tank L, Aeroble Tttetmen[ unit 330 Dosing Chamber ~- VII. ReeponslbAlty Statement- I, the underslgne ume respcns{biliry for iastallarioa of the pOWTS shown oa the Eu~s nh~dPhorte ~~ Plumber's re MPiMPRS Number ~ " Plumber's N e (Print) ~ ~,J ~ (~ ~ / ~~., Plumber's Address (Street, City, State, Zip e} d ~ /l \ f . Coua /D artmeat Use Oa! Sanitary Permit Fee {inc]udea Groundwaccr Dat 2 ~ L in8 Agent ign tune ps) ` Approved ^ Disapproved Surchazge Fce) ~ ~.y~y ~ t7~ ^ Owner Given Reason for Denial J V - IY. Conditions of Appror• wsoas fo~rova/~~ ~~ ,~/~ ~ ~,~~ /h~~%~'~'~!ed ' JG~~ ~ ~ eSr-i ~~ ~~~ to ~d ' -~ ~ U~'' 1 ~~a~'`'~" - ~ 330 0`~• ~~~e2J ~ ~°`' ~'O ,~u~.~~- ~~~ ~ ~>~~ Attach compk pleas (t!o Le Coua[y only) for tpe ay+tcm en paper not kst than gIR : lI tochec In size SBD-b398 (R. O8f02) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accoraance wnn ~.ornm aa, vns. ram. ~.oue C~n~ ~*~ ~(_ Plan must Attach complete site plan on paper not less than 8 1/2 x 11 inches in size r . indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~Dh, ~~/~„`r~r Cs~ ~y~~ ~ _~ ~ ~''z ` ~" ~ ` _ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~J -fT / < Please print all information. D to viewed Personal information you provide may be used for aecondary purposes (Privacy Law, s. 15.04 (1) (m)). ~/ L^~ / ?/ Property CM~~ Property Location /~.~ ~ T~ N R E 5 W ~~4 ~ or) ~ ~, 1/4 Govt. Lot Proper~,y Own s Mailing Address Lot Block # Subd. Name or CSM# 'J'am.. "~ ~~ 7 2 ~ / ~ Cily State Code Phone umber ^ City Villa a Town Neare Road ~e -~ O ~ - ew Construction Us~"B.Residential /Number of bedrooms ~_ Code derived design flow rate T J !7 GPD ^ Replacement // ~^ Public commerdal -Describe: ~_ _____ __-_,__________ __- Parent material ~G~.C/C~~ Flood Plain/~elev 'on if applicable _~ f ~ ft. General oorrunents ~'~ ~ / ~ ~ ~~l/ L%//~-'C./~~"" ~~° "'' ! ~ "" S~[.c~ and recommendations: J ~ gyring ~.~ Boring # spit Ground surface elev. ~_ ft. Depth to limiting factor in. i Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 < n ~~ Z ~ ~ ~' ~ ~ ,~ ~ s c ~ ~/' / ~ ~ C~ sr h ~~ # ^ Boring 0( pit Ground surface elev. ! ~ - ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i.~ ~--'-- ~.SC ~~ 1 .S lr Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mg/L and T55 < 3Q mg/L CST Narrts {Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Condu d Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~° ~~ --~ ~ 715-246-4516 Property Owner _ Parcel ID # ~ Page ^ Boring Boring # 3 ~ pit Ground surface elev. Depth to limiting factor 1 ~ ~ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/H? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff# `Eff#2 ^ Bonng # ^ Bonng ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 ^ firing # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP DIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 `Eff#2 `Effluent #1 = BODE > 30 < 720 mg/L and TSS >30 < 150 mglL `Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sso-e33o rn.woo> oil Test and System PLOT PLAN PROJECT Peter Werden ADDRESS 2637 Ctv Rd D Woodville Wi 54028 NE 1/4 NW 1/4S 25 /T N/R 16 W TOWN Baldwin COUNTY ST.CROIX 3/30/04 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL IN-G ND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 805 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chamber 30 ,BENCHMARK V.R.P. Top of Garage footing ASSUME ELEVATION 100' Filter' Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 90.6/90.0 6' below grade Plans Designed Using Conventional Powts Manual Version 2.0 Property Line Well 15' ,.. _15'_ 10' 3 0' Cty Rd D 110' i '~; r 3 X 94' C 1 1 10' >3' S a -2 a~.~ 10' ~ 45' 0, Y Vents B-3G~P•i~ Vent >6" of Cover 6' Long11 l " Standard Biodiffuser Leaching Chamber" with 31.1 ft2 of Area Grade at System Elevation 14' Pro 3 Bedroom House 30' 70' ~ ~{0 I ~~~ ~~' `~ 60' i~ ~~ G.:. rte! .NMrt i4 ~~a "- pRCt. ~~o+w4n rlee~~ •sA Lt'•'A11 ~ Q~R4t~! ~t t ~~ ~-rataliOvtD 1.pGltsUb '.+n,-uls~Ott tCVtR ~f' M1ii. ~~ M'!1}A1. tLrwP CiyAPhd£R GtOS~ 5£G~sQM ~-sj StCG1~:GAT~ # 5 -- /"'~s„~...•~VCI~T LAS ''* t wtwTktlt~ROOr i ~ .:ria~G~sCr.J •os< i is"~•~. tRQV+~'; ~ wttlt~+r't !~-L t 1 ~~~ f ~~~ /-;.ARM i * R~ROv~ .~QIlI~'3 KITn 1E0 PIPE 3' OKT4 SOLID SOIL. + ! OAi t ! i ~ or• toalalt~Ti iitOt+t RI f!!t lAfT *CRAi'1!'R~ 1~Ali.l1 rr 'TAlrNt ~1nYWJ~CTtrRtR tt/ii~ SiiCM Ait~,q~~l. ~ ~~~~• ~(J (~ { ~ ~~~ O~@~tRltLT ~ , t~~.t~ ~ P . SeWit ta+~w~el~~-C*uRt +~•,dc~- o~ ooat:: ass ~ TAYtt wit t bAL.i.QI~l~ 003i w0l.WMi ~ l4i~8NS ~NtR/16!'1iR=It; F_'_(~~ a .~- t ~~..~,..,.""„'"""" Msti~Mt it~ltL+/0lAf4 iwt ~ ~_ ~ xOOti. wYMKRs .f~. ~~, c~-*ACrTc~s w.~~: ~ptti olt ~~`++~~~+~ Mu.Oir~ ~~ ~ ~tlTE,M 1'~i `''L' / f-aJ''~ ,,,,,,,. ±± ss Sr,,,.Z...~,.,Nr14tKi OR `~~i *~ AIWifIlt!'YRtRt ,,.•.,,.. C. ~ts.!>t~ 04 ~ Mwwl ~"~oOtl. #1YMlsR: /s.J ,~~ D~...~.~.tt,IC•+iROR ~~~.~..OA1,~ORt awsTCM TyPis ~ ~ n rn.~'~.... ~~ tYM- A1lD ,1~.asltM~ 1iR! T1 K i'-+*i1l~YN1 OtiC1~~~ ~ '~ O•T; ~ ~l~~C 01~i DlMf~ATS 6iR~i11Ti vjR~'ltAL alMDRiAiLt at'!'+~/iiY ~NPM Oft Mld OtlTRli~iT:OW i~~i•• r.: " '.. ~:fr'r' ~~~~ ~, I k% K~yl~tit~t MCSiddRK tilPti.y ~'RttSiiRt ...... ......~. iCtT (~ ~ •G.~:.~ ttt? OR TORCi MAi#1 ft ~; e~r Ttau ~ ~ t[!• ~tt ~ P~ ,r t ,. sR - ..~... ... ~ '~TAL g'~IAMiC'7 MtI-D a~ ~^7 `~ ~'se! 7 ,,.~ ~ ~ 4'~'R1ti~1. t!l/rEtiJttO~i Qi '!"Jl41K: tRAi6Tti .,,1,,.,.,......,, .,W;pTK ~,. • E I • " t ~~t 0 4~~ w r...,._._ TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DE'NATERING °¢ U_ a z 0 r 0 F-- 0 MODEL I 152 153 Feet i Meters Gol. Liters Gol. Liters 5 I 1.5 69 I 261 77 291 10 3.1 61 , 23? 70 265 15 4.6 53 201 61 ~ 231 20 •~ 6.1 44 167 52 ? 97 25 7.6 34 129 42 159 30 9.1 23 i 87 i 33 i 125 ~i 35 10.7 -_ ___ ~ ~ I 2L 85 40 12,2 -- ~ -- 11 42 I L--- Lock Voive 33.0 =i. (1? Em) 44.0 Ft. ( 13.4m)- 3 27 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. `" • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long antl short cycle controls. • Sealed Owik-Box available foroutdoor installations. See FM1420, • Over 130°F. (54°C.) special quotation required. 1521153 Series 1521153 MODELS Control Selection Model Ph Volts • Mode Am~s_ Siim lex _ Du lex N152 ,_ „ 115 1 Non 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2 or 3 Et52 230 1 Non 4.3 1 2or3 BE152 230 1 Auto 4.3 Inclined 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 t Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 0< 3 BE153 230 1 Auto 5.3 Included 2 or 3 D CAUTION Att installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National ElecUic Code (NEC) and the Occupational Safety and Health Act (OSHA). -.-. ,I' I 12 1 j8 I ~__ SELECTION GUIDE sK2osa 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3, Variable level conVol switch 10-0225 used as a control activator, specify duplex (3) or (4J float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. _,~..~a,,, MAIL T0: P.O. BOX 16347 ~^'~=; Louisville, KY 40256-0347 Manufacturersof.. ~- ~' - ~ SNIP T0: 3649 Cane Run Road , Zp ~ ~~~ ~- ® Louisville, KY 40211.1961 Q!/r1L/TY~UMPS SNCE ~9,.~9' .,, /'T (502) 778-2731.1(800) 928-PUMP http://www.zoe/ler. corn ~ PUMP LO. FAX (502} 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. 32 32 LIILI~-.+ D 80 1bU ~ffU JLV GENERAL ST. CROIX COUNTY, WISCONSIN NEW TXSCR01 REAL ESTATE TOWN OF BALDWIN COMPUTER NUMBER 002 - 1060-50-125 Parcel Number 25.29.16.372B Claimed Date Re-certified 04/17/2001 Relate Number: OWNER NAME: First PETER M & JENNIFER M Last WERDAN CO-OWNER Mailing Address 2637 CTY RD D City WOODVILLE State WI Zip 54028 - Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY EZ-U 2433/ 360 743324 10/10/2003 WD 2350/ 177 734062 08/06/2003 PROPERTY ADDRESS: Hse # 1/2 PD --Street Name- Type SD Apartment Post Office 2643 CTY RD D School District: 231 - BALDWIN-WOODVILLE AREA Special District: (1) 1700 - (2) - (3) - WITC Plat Code: Last Changed on: 03/25/2004 Book Number: 1 SECTION 25 TOWN 29N RANGE 16W '/<160 NW '/<40 NE Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers : Delete? F4-Prev, F5-Next, F6-Legal, F7-Value, F8-History, F10-Exit, F12-More St. Croix County Zoning Detail Sanitary Information Tuesday, March 30, 2004 at 2:30:02 PM Page I of I Computer #: Sub/Plat: NA Section: 25 Parcel #: 25.29.16. Lot: 1 TN/RNG: T29N R16W Municipality: Baldwin Township CSM: Vol. 17 Pg. 4573 1/4 1l4: NE 1/4 NW 1/4 Owner: Werden, Pete 2643 County Rd. "D" Baldwin, WI 54002 State Permit: 453041 Issued: 03/26/2004 POWTS Dispersal: Non-Pressurized In-ground Permit: Transfer County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Pam Quinn NA Bird, Shaun Change of Plumber $0.00 Signed Off: No 3/30/04 -tanks installed and Shaun did a new soil report for revised system location on west side of driveway. Will submit another revision before installation of dispersal cells. Owner: _ Werden, Pete 2643 County Rd. "D" Baldwin, WI 54002 State Permit: 430231 Issued: 08/18/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Standard (Infiltrator} Bedrooms: 3 WI Fund: no POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Frazer, Darrell Field verification of soils at this site -must Signed Off: No have chambers in sands as described or must increase size of system accordingly. Shaun Bird stands behind his original soil report of sandy loams with bands of sand @ 0.4 loading rate. Additional Notes Monev Owed Well was drilled <50 ft. from septic area. 2004 $0.00 Revision submitted for change in system sizing due to new soil report with sands at influent elevation. Will issue revision, but this conflicts with original soil report of sandy loam @ 0.4 gpd/ft2, so will require field verification of soils on permit conditions. Look for bands of sandy loam and sands that will reduce loading rates. Safety and Buildings Division COU°~~ ~~ L j _____,_, "" , + 201 W. Washingtot: Ave., P.O. Box 7082 s Madison, WI 53707 - 7082 ~ Saairary Parmit Numbs (to be filled in b Co.~/ ~~ ~5C~1 ~Slr nt of Comme Sta[c Plan D. Numbtr ~ Departme PPlieation Sanitary Permit de -'"--- addta ilin nalinfottrt~4ionyoup~'t in accord with Comm 83.21, Wis. Adm. S. (~1f e e~ *'~Y ' g project Address (if different than ma s s P° [naY be used for secondary P~ Y ase Print Alt Infor [ions LO Pl ~ ~ ~ ~~ e I, Application Information - NG OFFICE NI parcel # t # Blur # Name / ~ properly ~ s J ~ Location rt -..~. Property Owner's Mailing Address rope y ,~ J ~Y., %, Section ~_~ City, State Zip Code ~ /~~ " Phone Number ~ rrcle ~ ~ ~ ~ ~ 5 N; R Eot ~ ~ G II~, ype of Builriing (cheek all that apply) _ ~/. ~ ,/ _ _t l ~ ,( ,,~ ~ ~ Dwelling -Numbtr of 8edroorns _... ~ ~ L ~~''~yn G~ ~i~ ~%' ~/ ^"' ' -- il 2 F ~ Subdivision i~~ CSM N y am l.or ~ ^PubliclCortunercial-Describe Use ^City Willa Townshipo ^ State Owasd -Describe Use _ rmit: (Check only one box on line A. Complete line l3 if applicable} f P IIL e Type ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System A' New System ^ RcplaCement System List Previous Permit Nutnbex sad Date lssued ^ Permit Revisio Change of Permit Transfer to New ~ B. ^ Permit Renewal 1 ~- ~~ /~ Before Fxpisation IV. a of PO~'-rt5 S s tem: Check all that a ^ Mound < 24 in. of suitable soil i ^ At-Grade ^ Single Pass Sand Filtu Q l n -Presstuized In-Ground ^ Mound >_ 24 in. of suitable so en[ Unit ^ Recircularing Sand Filler ^ Pest Filter ^ Aerobic ?ream Consnyeted yy~ciartd ^ Pressurized Im{'irouad ^ Holding Tank Line ^ Gravel-less Pipe ^ Other (explain ~ Drip Recirculatin Synthetic Media Filter (] L.eaehing Chamber V. Dis ersalrCreatmeat Area Information: Di-.,_.~,i ,e,rea pr ed (sf) ",'~ Required (sf) " ation Rate(gpdsf) I?isPersal li l A stem Elevation Design Flow (gpd) c pp Desi Soi ~ ~ ~ 8 , ~ D J'z~ i Capacity in Total VL Tank Info Number f Units Manufacturer G~ C Prefah Crete Site Constructed Fiber Glass P Gallons - - Gallons o ~~~ Gi,~~%'~~" " ar wsms..o.a,~, ~ - - - VII. Responsibility State I, the undersigned, a responsibility for installation of Ilse pOWTS shown on the attache pans. MP/MPRS Num~ ~ E usit'~s Phone Numb Plumber's Si e ~ /r- ~ / ~ ~ Plumber's Name (Print) ~f (/ f / ~ - S l~..ir~- ~/ _ P umber's Address/(Street, City, State, Zi ~/ J /'" ~ ~~// oua /D as-tment Use Onl Sanitary Permit Fee4(includes Groundwater Dat Issued 1 wing Agcn Signs a (N Approved ^ Disapproved Surcharge Fee) ~/ ~ ~ ~ ~f,,~ b - ^ Owner Given Ranson for Denial 7't -^ IX. Conditions of Approva!!R ~ ns for Disapproval ~~~~.~ AivZ~~~~ ~'~(J c.utc..cQ ~.~~~~ ~ s~ of ~A ~~-~ ~pu/~ (~S Na ~ P1aas (to the County only) for the system oa paper not less thsa 6112 s 11 Inches la sve 7 SBD-b398 ~R, 08102 `~- Pam Quinn Subject: #430231 - Werden/S. Bird Location: 2642 Cty. Rd. D, Sec. 25, Baldwin Twp. Start: Tue 3/30/2004 11:30 AM End: Tue 3/30/2004 1:00 PM Recurrence: (none) Shaun is to submit change of plumber and get new card; will install tanks and do a determination for system area. May have to revise the dispersal configuration yet again. St. Croix County Zoning ~~T ~~~-~~~ Monday, March 01, 2004 at 3:47: SS PM Detail Sanitary Information Page 1011 Computer #: Sub/Plat: NA Section: 25 Parcel #: 25.29.16. Lot: 1 TNJRNG: T29N R16W Municipality: Baldwin Township CSM: Vol. 17 Pg. 4573 1/4 1/4: NE 1/4 NW 1/4 Owner: Werden, Pete 2643 County Rd. "D" Baldwin, WI 54002 State Permit: 430231 Issued: 08/18/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New O iK County Permit: 0 installed: POWTS Detail: Standard (Infiltrator) Bedrooms: ~ WI Fund: no POWTS Pretreatment: Unknown Notes - - - ~ _ Inspector As Built Plumber Other Requirements ~~ Additional Notes Monev Owed Pam Quinn NA Frazer, Dane Field verification of soils at this site -must ` ~ Well was drilled <50 ft. from septic area. 2004 $0.00 Signed Off: No have chambers in sands as described or mi a or c ange m ys em sizing must increase size of system accordingly. doe to new soil report with sands at influent (~ Shaun Bird stands behind his original soil el vation. Will issue revision, but this conflicts report of san y oams wi an s o sand @ w~h original soil report of sandy Loam @ 0.4 oa ing rate. gpd/ft2, so will require field verification of soils on . 1 ~ ~~~~. / _ /permit conditions. Look for bands of sandy loam IVU I -,t (~~s7~ r-~., and sands that will reduce loading rates. ~~ro ~\ Y~. ~.~~ .~ 5t. Croix County Zoning Wednesday, February 25, 2004 at 3:33:17 PM Detail Sanitary Information Page 1 ofl Computer #: Sub/Plat: NA Section: 25 Parcel #: 25.29.16. Lot: 1 TNlRNG: T29N R16W Municipa{ity: Baldwin Township CSM: Vol. 17 Pg. 4573 1141/4: NE 1/4 NW 1/4 Owner: Werden, Pete 2643 County Rd. "D" Baldwin, WI 54002 State Permit: 430231 Issued: 08/18/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Standard (Infiltrator) Bedrooms: 3 WI Fund: no POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Frazer, Darrell Field verification of soils at this site -must Signed Off: No have chambers in sands as described or must increase size of system accordingly. F3oa3~ ~w~ ~~ .- ~~~~. ~,~. ~"~ ;' ~ ~1, __.-- ~' t~! -~~' ~ v~ Additional Notes Monev Owed Revision submitted for change in system sizing $0.00 due to new soil report with sands at influent elevation. Will allow, but this conflicts with original soil report of sandy loam @ 0.4 gpd/ft2, so will require field verification of soils on permit conditions. Look for bands of sandy loam and sands that will reduce loading rates. 'isconsin Department of Commerce PRIVATE SEWAGE SYSTEM safety 3:ist Building Division - ,, - • 1 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Werden City Village X Township Baldwin Townshi CST BM Elev: Insp. BM Elev: 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 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well ELEVATION DATA County: St. Croix Sanitary Permit N 430231 0 State Plan ID No: ~--r // / Parcel Tax No: ~j V `J ~/ Section/Town/Range ap No: 25.29.1 . SOIL ABSORPTION SYSTEM ~KOP~S~I..~ ~ I /'l-~.~Yvr~ STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Df Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM ~ Fnr.Wiu Manufa r: ~ INFORMATION CHAMB F,BDR ~ Type Of System: J UNIT Mo N ber: DISTRIBUTION SYSTEM Header/Manifold Length Dia Distribution Length Dia 6~ Spacing x Hole Size x Hole Spacing Vent to Air Intake SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Oniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~-, Yes i;} No - ~ Yes No _ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (~/~/ ~ /(~3 Inspection #2: / / Location: Unknown (NE 1/4 NW 1/4 25 T29N R16W) NA Lot 1 I~N/ J ~ ~~ryt~~No: 5 916. 1.) Alt BM Description = ~ ~~~j~_ ~(~,_$T f'/~~ ~/.ER ~ F~/ Jr~~J~' 2.) Bldg sewer length = ~ ~- 0 .TJ ~! L ~.p, fZ~-T~- -amount of cover = Use otherls de foruadditional information. No ___ ____ I _~ ~ __ ~ _ __ _ __ _ _ i _ ~_ 1__~II SBD-6710 (R.3J97) Date Insepctor's Signature Cert. No. St• Croix County Zoning Monday, February 02, 2004 a<10:24:56AM Detail Sanitary Information Page 1 oj1 Computer #: Sub/Plat: NA Section: 25 Parcel #: 25.29.16. Lot: 1 TNlRNG: T29N R16W Municipality: Baldwin Township CSM: Vol. 17 Pg. 4573 1/4 114: NE 1/4 NW 1l4 Owner: Werden, Pete 2643 County Rd. "D" Baldwin, WI 54002 State Permit: 430231 Issued: 08/18/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Standard (Infiltrator) Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Reouirements Additional Notes Monev Owed Pam Quinn NA Frazer, Darrell ~ Field verification of soils at this site -must Revision submitted for change in system sizing $0.00 Signed Off: No have chambers in sands as described or due to new soil report with sands at influent must increase size o system accordingly. elevation. Will allow, but this conflicts with original soil report of sandy loam @ 0.4 gpd/ft2, so will require field verification of soils on permit conditions. r~ Satety and $uildings Division County ` 201 W. Washington Ave., P.O. Box 7162 S'I'. (:ROIX /L+/t~~~~~ Madison, WI 5 - CE~V antt Permit Number,(to bafilled in by Co.) (608) 266 15t 31)23 Department of Commerce Sanitary Permit Application state P I.D. Number ~ JAN 2 6 2 04 ~ In accord with Comm 83.21, Wis. Adm. Code, personal information yo provi e may be used for secondary purposes Privacy Law, s 15.04(])( CROIX COU ST ~sro~ect ddress (if different than mailing address) . E TY R AD D I. Application Information -Please Print All Information 2 ~ ~~ n ` ~~, Property Owner's ame Block # Parcel # Lot # WERDEN ~~ NA Property Own s Mailing A ~.. e r adc~Fe ~ N -' ~e1 ~ b Property Location ' ' a ~a 2637 COUNTY ROAD D /; S 25, T 29 N, R 16 W NE /4, NW City, State Zip Co Phon Number ,/ ~ _~~ ~_ WOODVILLE, WI 54028 715-698-415.5 ~""""~^ II. Type of Building (check all that apply) h~• q ,,, ~ , ~ i i M N b / 1 or 2 Family Dwelling -Number of Bedrooms 3~ on Name CS umber Su div s NA ~ ~ ~ ~/~ ' L' ~ i ! o Public/Commercial -Descr be Use ~I f BALDWIN l~ 7 r~G~Vy ~' ~6~C~`-' '7 !%~'? O City O V Ilage T o wnship o ~. . o State Owned -Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if app icable) A. / New System o Replacement o Treatment/Holding Tank Replacement Only o Other Modification to Existing System SYSteI11 B o Permit Permit Revision ~ o Change of l b o Permit Transfer to N O List Previous Permit Number and Date Issued Renewal Before um P er wner ew ~ ~ ~~~' p I ~Q I~ D (! Expiration IV. T e of POWTS S stem: (Check all that a 1 Non -Pressurized In-Ground O Mound > 24 in. of suitable soil O Mound < 24 in. of suitable soil O At-Grade O Single Pass Sand Filter O Constructed Wetland O Pressurized In-G d O Holding Tank O Peat Filter O Aerobic Treatment Unit O Recirculating Sand Filter O Recirculating Synthetic Media Filter 1~ Leaching Chambe O Drip Line o Gravel-less Pipe O Other (explain) V. Dis ersal/Treatment Area Information: ~ -~o/. Design Flow (gpd) Desi~> ' ail A cation Rate{gpdst) Dispersal Area Required (s~ Dispersal Area roposed (sf) System Elevation 4_50 0.7 ~ 642.9 653.1 ~ 93.0-95.0' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Nevi Ecisting Tanis Tanks Septic or Holding Tank 11100 1000 1 HUFFCUTT X Aerobic Treatment Unit Dosing chamber 600 600 1 HUFFCUTT X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number DARRELL FRAZER ~, 221071 715-288-6225 OR CELL 715-828-5734 Plumber's Address (Street. City. State. Zip Code) l 6317 160TH - B LOO IdT E R, W 1 54724 VIII. C nt /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Age t Signatu ( tamps) Surcharge Fee) ,~( 5-~ ~U ` ' oZ ^ Owner Given Reason for Denial I l ' ~ Qy 1 Conditions of Approval/Reasons for Disapproval ~~~~ ~Q ~ nI „ / ~ ~ ,,, e 1 S ~ C'S'f~ /~ dicnPrsal cP11 must all be serviced ! maintaigg~ . ~Q_ J1 ~~[/ z- ~ ~ ~Z s nt ian rovided by plumber. ~~• U~i4i Q'~ a l/v 2. All setback requirements must be m 1n a er applicable code/ordinances. ~3 3- ~ ~ ~ ; e (~. YI?-ic* 50- (s Con~,Y as , . . p .S e..~- (~~1111~/ ~ n>7,u~ ,lo-~: ttach complete plans (to the C o _ for the system on paper not less than 81%L x 1 [ inches in size ~~6~ ~Y,, f~~~ ~~ ~rr~ >f~ rr~i`C~~d~'~ =z.. - ~Si7~` ~a ~~ ~ ;t ~'~. WERDEN SITE PLAN -----------~- - - --(CTY ROAD D) NE-NW-25-29-16W BALDWIN TOWNSHIP ST. CROIX COUNTY, WI (3) NON-PRESSURIZED DISTRIBUTION CELLS EACH CELL USES (7) LEACHING CHAMBERS (MODEL - INFILTRATOR SYSTEMS "STANDARD") EISA RATING = 31.1 PER CHAMBER 150' - 2" SCH 40 PVC FORCEMAIN (must droin bock to pump tonk) BUILDING SEWER MUST COMPLY ~W1TH COMM 82.35 WAC (tt)(C) I (LOCATION OF WELL MUST COMPLY( WITH WDNR CHS_NR-811 &-81~ I "~ (SCALE) 0 15 30 (UNLESS SHOWN OTHERwtSE) wLLIAM J. BERGH WISCONSIN CERTIFIED SOIL TESTER DESIGNER OF ENCJNEERwO SrSTENS CUSTOMER IDN 227819 LEGEND BENCHMARK ELEVATION = 100.0 (top of well cop) ~ LOCATION OF SOIL BORING(S) LOCATION OF SOIL PIT(S) ~C NO APPARENT COMM 83.43 SETBACKS PARCEL DESCRIBED AS ____ ACRES HUFFCUTT MODEL 600 PUMP TANK ELEV = 88.0' X55' - 4" ASTM PVC ^-10' - 4" ASTM PVC BUILDING SEWER LINE HUFFCUTT MODEL 7000 SEPTIC TANK PAGE 2 OF 8 p, r Cover Sheet WERDEN 2637 CTY ROAD D NON-PRESSURIZED IN-GROUND SOIL ABSORPTION COMPONENT Reference SBD-10567-P (.6/99) `Yn-ground Absorption Component Manua!" Location: COUNTY ROAD D NE'/4, NW '/4, Sec. 25, T 29 N, R 16 W Town: Baldwin County: St. Croix Designer's name and license #: William J. Bergh (License No. 1577-007) I the undersigned state that these plans we igned and submitted under my autho iry. Designer's signature: Designer's address: Designer's phone number: Contents Page 1-cover sheet Page 2- site plan V "" 1- I 2667 113th S •eet Chippewa F Il 154729 715-723-5555 voice 715-723-7535 fax 715-577-6838 cellular Page 3- leaching chamber x-section Page 4- leaching chamber manufacturer specifications Page 5- septic/pump chamber x-section Page 6- pump curve Page 7- management and contingency plan Page 8- management and contingency plan •*''" SON ''••. ;'WILLIAM J: ~u ~ BERGH ::Q :.`: 'bt ~~NAL od~~°~ Ry~6l~~:^4W! Page 1 of 8 ' r WERDEN SITE PLAN ---~------ --(CTY ROAD D) (97.5) _~~ #1.~ ~~ ,. ~~ y ~ (95.5) ~#~, ,fir ~~ WELL 150' - 2" SCH 40 PVC FORCEMAIN (must droin bock to pump tonk) BUILDING SEWER MUST COMPLY I WITH COMM 82.35 WAC (11)(C) I (LOCATION OF WELL MUST COMPLY( WITH WDNR CHS_NR_811 &-812 J I '~ (SCALE) 0 15 30 (UNLESS SHOWN OTHERWISE) WILLIAM J. BERGH YNSCONSIN CERTIFIED SOIL TESTER DESIGNER OE ENGINEERING SvSTEMS CUSTOMER ID/ 227819 LEGEND BENCHMARK ELEVATION = 100.0 (top of well cop) o LOCATION OF SOIL BORING(S) i LOCATION OF SOIL PIT(S) NO APPARENT COMM 83.43 SETBACKS ;k PARCEL DESCRIBED AS ____ ACRES NE-NW-25-29-16W BALDWIN TOWNSHIP ST. CROIX COUNTY, WI (3) NON-PRESSURIZED DISTRIBUTION CELLS EACH CELL USES (7) LEACHING CHAMBERS (MODEL - INFILTRATOR SYSTEMS "STANDARD") EISA RATING = 31.1 PER CHAMBER I , y, 3.._. .. L ._. f..., __ .,,,. ,,,_ ~_ ~ i ( I t 3 €" PROPOSED 3-BR~ BUILDING SITE HUFFCUTT MODEL 600 PUMP TANK ELEV = 88.0' ^-55' - 4" ASTM PVC X10' - 4" ASTM PVC BUILDING SEWER LINE HUFFCUTT MODEL 1000 SEPTIC TANK PAGE 2 OF 8 GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical) (installations may vary & require additional cells (not shown)- drowing not to scale) observation pipe (where required) growth 7 NUMBER OF LEACHING CHAMBERS (per cell) ~ TOTAL NUMBER OF CELLS 21 TOTAL NUMBER OF LEACHING CHAMBERS (all cells) A MINIMUM OF 12" OF SUITABLE FILL MATERIAL IS REQUIRED OVER THE CHAMBERS. INFILTRATOR STANDARD CHAMBER - OPEN BOTTOM AREA = 15.5 SQFT. INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING = 31.1 FT2 All moteriol and piping specificotions as per the Conventionol Soil Absorption Component Monuol. PAGE 3 OF 8 SYSTEM ELEVATION = 93.0-95.0' ~ r SEPTIC/PUMP TANK CROSS SECTION (DRAWING NOT TO SCALE) Final grade (slope ground away from risers for drainage) Actual depth may increase see COMM 82.30 (11 ), (c) and (d). tank vent Access riser with locking cover (cover must be properly marked with on approved warning label) OF power & alarm Coble (must use seperote power & alarm circuits) \ externally mounted J-box 4" min. . force main access riser 18" min. inlet bottom of inlet invert water level 3• 4" inlet / tee or baffle approved effluent filter required on tank outlet reserve filtered effluent alarm ',, on off Minimum of 3" of suitable bedding beneath tanks pump pod EFFLUENT FILTER ZABEL (A-100) (or equivalent) Septic tank manufacturer/model Pump tank monufocturer/model Alarm monufocturer HUFFCUTT 1000 DWF (doily wastewater flow) 450 HUFFCUTT 600 Number of doses ^~ 5.6 (DWF /actual dose volume) S.J. ELECTRO Forcemoin volume 24.5 Alarm model number Type of float switch Effluent pump monufocturer Effluent pump model number LITTLE GIANT 9EH Minimum pump discharge rote (gpm) NA Vertical lift (pump off to lateral elevation) 12.0' System head (distal pressure x 1.3 ft.) 3.25 Friction loss in the force main <2,0' Total Dynamic Heod (TDH) <14.0 HW 101 MERCURY Actual dose volume (gal) (total dose vol. - forcemain vol.) $0.11 CAPACITIES reserve above alarm 23.5 inches = 307.15 gallons alarm above pump on 2 inches = 26.14 gallons on/off measurement 8 inches = 104,56 gallons off to tank bottom 14 inches = 1$2,9$ gallons TOTAL 47.5 inches = 620.83 gallons PUMP TANK DIMENSIONS length 3t" width 3t" liquid depth a7.5" gallons/ inch 13.07 page 5 of 8 . 9EH SERIES SUMPIEF'FLUENT PUMP Specifications MODEL CAL SDLIDS SIZE RUNNING PERFORMANCE (OPM @ HEAD) SHUTOFF PWR. CRD. WEIONi DIMENSIONS N0. N0. USTINS HP VOtiS (Dia.ln.) AMPSIWATLS 5' 10' 15' 20' IFtI P.S.I. ffi- (Lhs.) (N K L a W) 9EH-CIM 509330 UUCSA 4/10 115 3/4 13.0 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 x 6.94 9EH-CIM 509340 UUCSA 4/10 230 3/4 6.5 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 z 8.94 9EH-CIA-RFS 509350 UUCSA 4110 115 3/4 13.0 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIA-RFS 509360 UUCSA 4/10 230 3/4 6.5 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 z 8.94 Construction 30 W zo Q a w to la ~.s ~ w f s 0 a z.s Motor Housing Epoxy Coated Cast Iron Impeller Material Poly Carbonate Im eller T pe Closed Vane Volute ABS Power Cord SJTW-A Mechanical Shaft Seal Nitrile with carbon and ceramic faces Fasteners Stainless Steel Shaft Stainless Steel Bearings Upper Sleeve and Lower Ball Bearings 0 20 40 60 80 FLCIW- GALLONS/MINUTE PUMP PERFORMANCE CURVE 115V 60HZ ~~ 3`~ '; `~~Rh Little Giant Pump Co. ~ PO Box 12010 `Phone: 405.947.2511 ~~, Okla. City, OK 73157 Fax: 405.951.5674 ,s` ISO 9001 CERTIFIED `~"` ~ ~ `C~m Form 99~ 5 - Ol /00 FLOW- LITERS/HOUR 0 1000 2000 3000 The Standard Infiltrator® Chamber The Standard Infiltrator Chamber 1" Overh_Ip at Latching Mechanism ,- T IK---~ _ _ Chamber End View 1 0 0 ~ '"~" ~" ~ O O ~O C ~~~ ~O ~ o INFILTRATOR SYSTEMS INC,_STANDARD LIMITED WARRANTY INFI~iRF rOR ~+ ~EM~ IN' I flrrarc~ " "iDARD LIMITEL7 VJARRANTV r-OR SEPTIC. Fk'C)UC?~ .: r 11~'^"`rr.~ ~r=i~ _ . ~ r... . In~'Irrr~or f~nlle~r.~av ro ~. r~~1, nstall~rr ..-e r~ratrc: n m+ yr rn a ~ ... I '. : i rr - ~ - -r ~ pr, "i I. i 4 a ern:, r~.,f: ~- i... I I.. i.i~ I:i ..l _y_.~. ~. [h.J I,,HovdeU. ~ o ^ nr nzy l ..U-up t late that .,y.{p 3(I f~~v ~ ~~, ~ ' wff l~ rat t rfpi.l~.iP hP8(1i IartnrS In Aff'tnt~ ] K, Irldr^f n r y fr ~ Oi - ~ i-•.. f Hrator r:A,upply Ir... mc~~rU YS l~r rhae i~..lo[drrn[ned b)I ~'ilvatorro r,i .. ~ l:,~.....if :ally (`%f.L'dP_ti the (.05 0(I(:iY 0J.13, d. J( ntta' ..,.~ (lf r71e Unlrs. Ib) I111 -~ i ~ ?I I (al P.F_E EHQUSIVE ~'r{ERE ARE NO OTHER WARRAN IIES WI fH RFSRECT TO r I " IE L r ,I i :NTACiILCCV OR FITPIESS FOR H PARTI(-ULAF: '?URPO'.~E. Ir) -t F ~ ~ I ' ~dircrt e~ nn9es I "rlrraror shell nor 6F liable for prnalr s o Iq i'da?e!1 .f., n. ~ I ~. " ' - -.. • osrs or o'rw losses or caPr nss 'nrurrsd by the Hnl 'er or n J •nird r i ~. s duo cu o drr ary u~ar and t..ar alt rra(a a, -U~n4 r ,t _ ..Iw~r. or : , u n~glr~~ oI r. I .~c Un~r= whirh:-. or pumlttelb~ ni-',[Ila'or'.Ir6td:crion..~'al~rc[Jrnaln- -a rh m ~)m~.-7 - ~ ,nr ~tf it zpmlm mo,orials inro the systo n. t i ning rY U Ts: f~ILud n rr i; rn ' I - ~ )a. nprop Urea,,, d~spo. I r r'n proper operaCo) or any ~ a >brr. ~_ r~ not , s. 6y I nl .., ~ vcr i r ~ Wiry •- ,~V n~ il ' 11~IJC ': ork to _ompfy v: rr, all o t7ro mlms ~ , orJ 7. ~~ L rn [~c. Juarrt,rey. r Fr rtf ~er, 'n no rvc rt shall Infln ~ aqc rd the I lelder rho Lr'c or any [hied parry result rd tom ir. ;raAanon or shipment, l ~r ~rOT 9n} pr00 JCt I'lbTty C o l,, y Fdr ;~'i; 1.IIn (?d rNarrn[,.y tt~ ApF=y [nP. .l 1Ts rt1LSt be instAM n aCCOldc _O Nrh ell SIfP, r I~~rd .,~ndT'ons rF.gri red by cram a~rd i 111 ~r appllc.~hlr. I-rw' and I. flttv i~s:ell t i;r-vnictionr,. I ~) No rcpres~ raivr. o- Infilrmor by rde this U'mitu' +.ar'arry 'n dry nra*~nrr wr arson. vEt or :r exrr n.f ;his L.n ed Nary„„Wry. N -rrranry a I ~ o any (; - ~1 I folder. h . eLOVe net or= v ..r r ,G and by IrAlrramr. A I'n'~c~l n_mbr' of -~ )!es aid or Hies heda ,ifur.~ t m r arty rear iremorrs. N (> h~ 0 ~ c f 11 art: ' r 01 f >.IL x>k Corn e`: c.d, prior to surf r.arc.l as, ro [ t:ra'.r a ropy oI the I,f I..abl, .~:) ty ,n ~ n ~ F r r .o -,.pit r) ,, dr Urns. I nc '0(5;-.c. n. 1 f-5 f101r -CCI pl' CnIC'1[. Chemb_rs mu t I r ~ stalled ~ ns. Eailrr ro r ;r311 accord'r, ~. nznr fact ,rus instn ,[: ~_ ,'1f ~o~cr wznantJ. I nttannr Sysre r-.canmtrr ~. r,rd 13nnc1ry flro . nth all pr,s [ s^ptlc systems. Sy tc i sizing -.f t nnorl a .,,,, r - ~.. >~ ~~ _.~ Size(WxLxH)......34"x75"x12" Storage Capacity ....78 gal./10.4 ft' Weight ..................................26 lbs. Louvered Sidewall Height............6" • SYSTEMS I NC Environmental Onsite Wastewater Solutions" 6 Business Park Road P.O. Box 768 Old Saybrook, CT 06475 800-221-4436 860-577-7000 FAX 860-577-7001 www.infiltratorsystems.com 1-800-221-4436 For technical assistance, instal{ation instructions or customer service, call Infiltrator Systems at 1-800-221-4436. Posi~ock ° End Pfate U.S. Patents: 4,759,661; 5.017,041; 5.156.456: 5,336.017; 5,401,11& 5,401,459: 5.511,903, 5,716.163; 5,588,778, 5,839,844 m Canadian Patent,; 1,329,359; 2,004.564 Gtlter patents pending. [~i~.7) Infiltrator, Equaliu)r and SiddJVlndnr arc regisn,red tradcrnarks of Infiltrator Systerru In::. Infiltrator 15 a registCmd trademark In France. nFCVaEOnwea Infdtra[or Systems Inc, is a rcgr tcn;d trade mark In Moxlco. Contour, MlcroLeaching PolyTuff nap Lork Chamber.Spacer, PosiLOCk, and QuickPlay are trademarks of Infiltrator Systems Inc, ~ 2001 fnfihrator Systems Inc. Printed in U.S.A. C700401 FNL-3 -~ --- 75" ------- Effective Length ' ~ ..-- RECEIVED Wisconsin Department of C mmerce ' Division of Safety and Buildi gs JAN 3irbac~Qr~l~nce Attach complete site pl on paper not less than 8%Z x~UJ11 incl include, but not limited :vertical and horizon I ggr''ee~~c~e pc percent slope, scale or imems~Tis,Ca~~fr_~tNtbdatior IL EVALUATION REPORT Comm 85, Wis. Adm. Code County size. Plan must IM), direction and distance to nearest road. Parcel I.D. 1576 Page t of 3 Geo Tech Soil & Site Evaluation St. Croix Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ /L /~ Property Owner Property Location V WERDEN ~ Govt. Lot NA NE 1/4 NW /4 S 25 T 29 N R 16 W __ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2637 CTY ROAD D NA NA --- ___ City State Zip Code Phone Number City ?Village ~/ Town Nearest Road Woodville ~ WI 54028 715-698-4155 Baldwin CTY ROAD D / New Construction Use: /' Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ' Public or commercial -Describe: Parent material LOAMY STRATIFIED GLACIAL OUTWASH Flood plain elevation, if applicable NA General comments and recommendations: Site suitable for a conventional septic system. Recommended system elevation = 95.0'. Recommend system elevation = 0.7. Boring # ' ' Boring '95 ~ Pit Ground Surface elev. 97.5 ft. Depth to in. limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-6 10YR 3/2 none loam 2 m gr mfr cs 2f-m 0.5 0.8 2 6-20 10YR 4-5/4 none sl 2 m sbk mfr gw 2f-m 0.5 0.9 3 20-30 7.5YR 4/6 none m-cos 0 sg dl gs 2f 0.7 1.4 4 30-40 - 10YR 5/6 none s 0 sg ds cs -- 0.7 1.2 5 , 40-46 II 10YR 4/6 none s 0 sg dl as -- 0.7 1.2 - - _ - 6 46-95 ~ 10YR 5/8 none f-ms 1-0 c sbk mvfr -- -- 0.4 0.6 , ~ ~ Horizon n o.2 with 10 -15% pebbley mat rix. ^ Boring # Boring ~ /! Pit Ground Surface elev. 98.4 ft. Depth to limiting factor >100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-6 10YR 3/2 none loam 2 m gr mfr cs 2f-m 0.5 0.8 2 6-20 10YR 4-5/4 none sl 2 m sbk mfr gw 2f-m 0.5 0.9 3 20-30 7.5YR 4/6 E - none m cos ~`~ 0 sg dl gs 2f 0.7 1.4 4 30-54 -.. - - 10YR 4/6 none s 0 sg ml-vfr cs -- 0.7 1.2 5 54-78 7.5YR 4/6 none m- os N 0 sg ,~ ml as -- 0.7 1.2 t; 78-100 10YR 5/4 ~ none fs 1 m-c sbk mvfr -- -- 0.4 0.6 _ _ - - -- i nn i 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ffluent #2 = OD5 < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number William J. Bergh ~ 227819 Address Geo Tech Soil & Site Evaluation ate nation Conducted Telephone Number 2667 113th Street, Chippewa Falls. WI 54729 1/13/2003 715-723-5555 ' Property Owner ~ WERD~N Parcel ID # Page 2 of 3 Boring # Boring Pit Ground Surface elev. 95.5 ft. Depth to limiting factor >88 in. Soil Application Rate Horizon Depth Dominant Color ~ Redox Description Texture Structure Consistence Boundary Roots PD/ft2 in. ~ Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. *Eff#1 *Eff#2 1 10YR 3/2 0-10 none loam 2 m gr mfr cs 2f-m 0.5 0.8 2 10-24 j 10YR 4/4 none sl 2 m sbk mfr gw 2f-m 0.5 0.9 3 24-36 i 7.5YR 4/6 none s 0 sg dl gs 2f 0.7 1.4 4 3 - 3 ~~, 10YR 4/6 none s 0 sg ds cs -- 0.7 1.2 5 53-88 ~ 10YR 5/6-8 none f-ms 0 sg mvfr -- -- 0.4 0.6 i __ I - ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - - - - - t I_ _~ t -- _~_ -- ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. ~ Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 _~. } _ __ ,_ ~~i * Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department ofZ'ommerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBA-ssso (R o~/oe~ Geo Tech Soil & Site Evaluatlon ,~ . WERDEN PLOT PLAN NE-NW-25-29-16W BALDWIN TOWNSHIP ST. CROIX COUNTY, WI --------~--- ------(CTY ROAD D) - WELL N (SCALE) 0 15 30 (UNLESS SHOWN OTFIERWeSE) WILLIAM J. BERGH WnSCONSw CERTIFlEO SOR TESTER DESIGNER OF ENGINEERING SvSTEMS CUSTOMER ID// 227819 LEGEND BENCHMARK ELEVATION = 100.G (top of well cop) o LOCATION OF SOIL BORING(S) 1 LOCATION OF SOIL PIT(S) ~C NO APPARENT COMM 83.43 SETBACKS 7IC PARCEL DESCRIBED AS ____ ACRES PAGE 3 OF 3 AUG. 14.2003 8~34AM .87!14!2883 84:29 ~. ~q~er SKYLINE DISPLAYS 4142581127 TN DFSIBNS INC aT CROlX ~OXTNTY A~ O~VN CBR1'IIwICA~'tON FORD i~~T ~~~~~~~D .A~°~; 1 3 2003 ST. CI?OIX COUNTY ZONING OFFICE Mld1lSg Addreoe ,..~~.37 ~T'!~ r~ d ~r.......r-- ~r.~ Co U r~7~/ f20 /-1-z? ~~ ~ ~, (v~.tios mqu4ad tr~om PLnaieS Dapetmsmt toF11Rw eee~neebnl d~y/Sttue ." ~,,, Ptut;el Idecl NNallwr Loa~kias~ ~ % a/'!a Sic. 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I ~ DATS omit C' ,r~~i7~TON Z (w~e~ Gall~r thtt all aea~d aa. thla ~bprr ass true m tbs bnt of ~ GvyF) s: t (,rte) am (~~ the oMnat(t) w~E file dersq'll~ed by vit~le o[ a wnaaaaly flood ieoorded ~ Raai+tor of i?eadw O@ke. ~ ~ I~B~ ~~'-1~Nf x'1"8 . '•• Aqy ioramvydAt- that b ~~r:ewit'la t~ waaita7-F~R bps r~-o~d by s~ Zae~aa D~.tt~ r.gsw ~ soelada w~[et< ~ aPF~elan: a stan~od •~rargel- load tram ors (!.`tape e! Daa~b ems s amt of t6a aatgped w>rvplr map lt're6arwraa b meda ~ >fre wam"aa(y dwad ~~ N0.324 P.2i2 PAGE 01 RACE 111' RCVD AT811~Z0031:Z3:?4 plVl (CeNI~Ipay~ghtTime~"SVR;pAXS~AV0110tDWS;9101 tCSIp:4~42S811ZT'QURATION (AMMlhsss(;D1~1 POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: ~~~~ ~ I - Owner/Agent: POWTS Maintainer: Local Regulatory Authority: POWTS Installer: Septage Servicing Operator WERDEN Geo Tech Soil & Site Evaluation -Chippewa Falls, WI 715-723-5555 St. Croix County Zoning Department -Hudson WI 715-386-4680 Darrell Frazer -Frazer Excavating -Bloomer, WI 715-288-6225 DESIGN PARAMETERS Influent/Effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150 mglL Soil Loading Rate (SLR) = 0.7 gpd/ft~. SYSTEM SPECIFICATIONS The components of this septic system are intended to serve athree-bedroom (450-GPD) single-family residence. The components include a Huffcutt model 1000 septic tank, a Huffcutt model 600 pump tank with Little Giant pump alarm and controls, an approved outlet filter and (3) non-pressurized distribution cells using graveless leaching chambers. A total of 21 Infiltrator standard leaching chambers are required when applying an EISA rating of 31.1 as specified by DCOMM. All parts of the components must comply with WI Adm. Code COMM 84 and be installed per manufacturer specifications and approval letters. DESIGN CRITERIA o "Design of conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and Design Manual - Onsite Waste~~~ater Treatment and Disposal Systems:. EPA 625/1-80-012 October 1980 / SBD - 1067-P (R.6/99) "In ground Absorption component Manual" o SBD - 1070-P (N.01/Ol) "In ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one-third (1/3) the tank volume. The effluent filter should be inspected annually to ensure maximum performance. START UP For new construction prior to use of the POWTS check treatment tank(s) for presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage-servicing operator prior to use. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water-saving appliances and tixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products. paint, disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. / Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved unti I any problems with the system are corrected to prevent back-up of sewage into the dwelling or surface. Page 7 of 8 INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule) / Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) filters shall be ins ect o remove an accumulated solids according to manufa specs Ica ions. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at Zrrat~'fPeque7it intervals than stated in the maintenance schedule to keep the system operating properly. / Pump ChamberJTreatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. / In-Growid Gravity Component dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. o Divertor Valve The divertor valve shall be switched to serve the opposing distribution component every three years (when the septic tank is due for it regular maintenance). However, if ponding is observed in the observation/vent pipe of any cell, the divertor valve shall be switch to the opposing component. Furthermore, ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned incompliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. - The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. / A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure(s), lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o The sit as not b valuated i tify a s ~ ble replace area. Upon failure of the POW and site /~ eva ion ust perfo me locate a s ale repl area. [f n e lac t area is available a holding tank may be i stalled last resort to replace the failed POWTS. o Mound and At-Grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. Page 8 of 8 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF BALDWIN COMPUTER NUMBER 002-1060-50-000 Parcel Number 25.29.16.372 OWNER NAME: First CRAIG E & GLORIA J Last RASMUSSEN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTION 25 TOWN 29N RANGE 16W '/<160 NW '/440 NE Line Description Line Description TOTAL ACREAGE 35.090 PLAT LOT BLK 01 SEC 25 T29N R16W PT NE NW 15 02 EXC N 300FT OF E 30FT &EXC 16 03 CSM 13/3662 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit i~ 9 > ~ . ? 3 2 1 1 ? CERTIFIED SVRVEY MAP LOCATED IN PART OF THE NE1/4 OF THE NW1/4 OF SECTION 25, T29N, R16W, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. Z z 0 0 g~ 3 Z ~ T I~ ' s ~~7 ,~ I ~~> ~ J ~' ~i~ '°z ~igc~~ ~jCS~ ~'°w ~~ i iQ ~~ 1 f i~ ~~ ~o ~~~ 'o ~~ ~~ ~~ ~~ ~nT' o l ~ I ~'ml owl p~ r m z g ~ u MM[PLL~GI4~CD (SG1fP:]DD ~ I ---------------------- i O~[r~L~D f3~ O4C11C~G3~ wESTUNEOFTHE NOO°08'45"E 831.77 sr. cROlx couNTv ng 2auna and Packs CanmiHaa ~u~ 2 5 2ooa o O A a IF aoltsCOfdedviYSan3Qdaysof appaal dsls apvro+y ~ ~° nue "na votn ~ ~ VOL 77 PAGE 4573 KATHLEEt[ H. M7~LBR-' REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 07/25/2003 01:45PM CERTIFIED SURVEY tlAP REC FEE: 13.00 COPY FEE: PAGES: 2 --------------------- Z 0~0 '~ I ~ 6 ~- ~o .\ ~ O ~ ~~~~~ ~ ~ ~i~l m ~ ~ .~~ ~~ ~O ~ ~\ ~`o "I~ V ~~~ I ,p (S00°00'1TWj' ~~ N NOO°08'45"E 491.13' I ~ ,~ 458.10' / o ~ ~ ~ ~.~~-~ ~ I ~ ~ _ yo _ N ~,' C-`~ ~' ~1 - ~n ' ~ Pi ~ ~, i~ V ~Q>s~~~`~~ ~t ~~~c ~. ~~ N ~ _~ ~ ,~ ~iq~c 1 ~ Naa°oa33w : .4a III ~ ~ ~ ~.~ ~ m c, ' -° . N O ~ so.4'_0_0~~~ ; N e41 ~ ~ 0 i ~.ax ~' ®' ©~ 50' `~ ~ ~ 17c~ ..~... nm• in iquivc ow.v+ VV-a~u ~7 ~ ~"-' SOO 0033E 1025.11 ~„~ ~ ~ e ~ a ~ S00300~ E 3300333' -'I~~ z NJIv]PdlQ44C~D ~Q(~1D~i !~ + i~ ~ Om_n7_[~L~D Cirl_O4G{1C~Gi~ ;°D ~~~~~ ~ ~%~ a in1 N N o.o I ~i~n ~~ V m ~ ~ ~ ~ ~ ~~ ~yY !III D Z C ~ ~~ ~ ~ g ~ ~~ ~g Z ~ BEARINGS ARE REFERENCED TO THE SHEET 1 EFTS sT. cROlx COUNTY COORDINATE SYSTEM Vo1.77 Page 4573 St. Croix County Zoning - Wednesday, December 03, 2003 at 1:26:11 PM,~, Detail Sanitary Information Page 1 ojl Computer #: Sub/Plat: NA Section: 25 Parcel #: 25.29.16. Lot: 1 TN/RNG: T29N R16W - Municipality: Baldwin Township CSM: Vol. 17 Pg. 4573 1/4 1/4: NE 1/4 NW 1/4 Owner: Werden Unknown _ State Permit: 430231 Issued: 08/18/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Leaching Chamber Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Insaector As Built Not determined NA Signed Off: No Plumber Other Requirements Fraser, Darrell Additional Notes Monev Owed $0.00 I ~~a.~~U ! I~a~ 1`~l T ~~cs~-, Vt~Q~Q.~ -' 1~ ~~,esy U~ ~ "" "-, hsu~-e, s~ ~ ~ ~ ~ ~ ~ ~ ra ~e f~/ I ~1L.~, ~~v~9--- d,~ --~ ~~~~ ~~• sJ tls ~~ ~ ° ~"' ~ ~'~ ~~~~~e ~\\r ~ \~ ~ ,- `~ ~~ Safety and }3uilding`s Division County 201 W. Washington Ave., P.O. Box 7162 S'i' (:ROIX ~~~~~~~~ Madison, WI 53707 - 7162 Sanitary ermit Number (to be filled in by Co.) (608) 266-3151 2J0 Department of Commerce Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Informatio a ~ ~ st"'' .. ,.s c i ~~ ~ -7' ~ ~,,. Property Owner's Name ~ P I # Lot # Block # WERDEN ~+}°~_ `a 1 iva Property Owner's Mailing Address ~ - roperty Location 2637 CTH D NE '/4, NW '/4; S 25, T 29 N, R 16 W City, State Zip Cod P~or-e uipblrr W OOD V I L L E, W I 54028 Y7i~"698=t#i5.5.,~,~ II. Type of Building (check all that apply) / 1 or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name CSM Number ~~ ~3~ NA z/'~ o Public/Commercial -Describe Use O City O Village ~ Township of BALDWIN o State Owned -Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if appli ble) A. / New System o Replacement o Treatment/Holding T Replacement Only o Other Modification to Existi stem System B o Permit o Permit Revision o ange of Permit Transfer to List ev us Permi ued Renewal PI ber New Owner Before Expiration IV. T e of POWTS S s tem: Check all that a I Non -Pressurized In-Ground o Mound > 24 in. of suitable soil O ound < 24 in. of suitable soil o At-Grad Ingle Pass Sand Filter O Constructed Wetland o Pressurized ln-Ground O Holding Tank Peat Filter '~ Aerobic Treatment Unit Recirculating Sand Filter O Recirculating Synthetic Media Filter Leaching Chambe O rip e O Gravel-less Pipe O Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) sign oil Application Rate(gpdsf) D ersal Are equired (sfl Dispersal Area Proposed (sf) System Elevation 450 0.4 25 1150.7 87.0' VI. Tank Info Capacity in Total Nu er anufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of nits Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 HUFFCUTT X Aerobic Treatment Unit Dosing Chamber 600 600 l HUFFCUTT X VII. Responsibility Statement- 1, the unders' ned, assume responsibility for installati of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb 's Signature MP/MPR umber Business Phone Number DARRELL FRAZER !' 221071 715-288-b225 OR `~ CELL 715-828-5734 Plumber's Address (Street, City, State, Zip ode) 16317 160T1t _ BLOOMER, W _4724 VILL Count /De artment se I Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued sui g Agent Signature (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) //,, 2~v r ~}- ~ p '~,3 IX. Conditions of Approval/Reasons for Dis pprov 1 ~~' ~~~' ~ ~` r n ~~! v, ~~~t`,' z ~ s po~~wt4, ~~eC ~S. , Sc,/S~ r~ ~ ~~ , JJi ,~T~'r'~t~ j ll ~ 1 ~ 19~ I~,_''~~2b1 ~ ~___- ~ I Attach complet plans to the County only) for a ystem on per no less th~n S1/2 x 11 inches in size ~~~~ ~ ~ ~. ~~ ~RT~-(39R (R. (ll /~31 WERDEN SITE PLAN . ,~~ ~.. - NE-NW-25-29-t BALDWIN TOWNSHIP ST. CROIX COUNTY,° WI 60'-2~~CH 40 PVC FORCEMAIN {droin bock to pump chomber) v m N O~ HUFFCUTT 1000/600 J SEPTIC/PUMP TANK ~ r PRIMARY BM (w/APaaovEO ouAET FILT NAIL = 100.0' O ~~ PROPOSED ,' ~~~~~~~ 3-BR HOUSE /~..li Q~ ^! ~ /` _ -,, `~~ X60'-4" 034 PVC d ~v BUILDING E R C. ALTERNATE BM ~},~(~~ R ELE V 103_^0' (3j NON-PRESSURIZ DISTRIBUTION CELLS EACH CELL USES (12/ )LEACHING CHAMBERS (MODEL -INFILTRATOR YSTEMS "STANDARD°) EISA RATING = 31.1 PER CHAMBER ,1 . , 3 0 '-E-a -~/c. (SCALE) I LEG N Q "~ 5 30 BUILDING SEWER MUST COMPLY E ~ _ WITH COMM 82.30 W.A.C. (tt)(c) ~ (na Cm tee/topVofl~encepo00 p 103') (UNLESS SHOwN OTHERx15E) o LOCATION OF SOIL BORING(S) NIILIAM J. BERGH LOCATION OF WELL MUST COMPLY ~- `MSCON9N CERTIFIED Shc TASTER WITH WDNR CHS. NR 811 & 812(b) ~ ~' LOCATION OF SOIL PIT(S) DESIGNER OF ENGINEERING SvSTEMS %IG NO APPARENT COMM 83.43 SETBACKS CUSTOMER 101/ 227819 ~C PARCEL DESCRIBED AS ____ ACRES • Covey Sheet WERDEN 2637 CTH D -Woodville, Wi 54028 NON-PRESSURIZED IN-GROUND SOIL ABSORPTION COMPONENT Reference SBD-10567-P (.6/99) "In-ground Absorption Component Manual" Location: NE '/a, NW '/a, Sec. 25, T 29 N, R 16 W Town: Baldwin County: St. Croix Designer's name and license #: William J. Bergh (License No. 1577-007) I the undersigned state that these plans were designed and submitted under my autl~^ity. Designer's signature: Designer"s address: Designer's phone number: Contents 2667 l 1 `h Chippev~Falls, WI 54729 715-723-5555 voice 715-723-7535 fax 715-577-6838 cellular Page 1-cover sheet Page 2-site plan Page 3- leaching chamber x-section Page 4- leaching=chamber manufacturer specifications Page 5- septic pump chamber x-section Page 6-pump curve Page 7- management and contingency plan Page 8- management and contingency plan `~•~'"~gCO~-3j~• '; ~, , v ~ ~~ ~ ;WILLIAM J:: ct ®` BERGH `~' ='p ~•s~ ~'••., • ' ~ ~ o~~`"S~~4DVA1~- ~~y~'' Page 1 of 8 ~ . cD d } ~ N Z N30 ~ O c~ r x 1 Z p ~~~ Z p U I ~ W Q F- Z CO to Q ('~ ll /~ V ' W 0 W S U I ~Z4 \ Q ~ O~ W o o~~ ~o ~~,~' U V o ~'- i- a ~_ W Q ~v O w.. ~' U~ O= d O.~ ~ m ,. ,a I. M as V n O ~ a~ ~ Z O J 1D ~ ~~ ~ '~ w o J ~ Q ~ Q O V V r O ~ ~ ~ Z w a V' J } U O i7 N ~ ~ w o N o a N_ v Q ~ ~ M 7~nr vii vwi LL u ~ _ ? (.~ d J Z ~ W I ~ O V '~ ~ ~ a Z=S w ~ w Z W C.~ W J N M Y (n o U w a m O~ m Q w o oin N I ~- _ M I II a~O~v I VZNrrj I °~ma~ a Q O J J~ Q ~ 0 0 ~ OU m wow w Z V ~ ~ O O ~ W Q-.ZZ Q ~ ~ ooa J x ~ ~= ~= a w U_ Q Q Q U w~ p 0 0 4 m~J J z a 4 ' ~ "~ ra rv aN i a ~ 0 00 Ov Uayj ~"" U~j N~ H Q ~ 0.~ ~ ~ ~ ~ ~ 0 J Z ~ M W U ~ ~ W U INS °a ZO O3P U ~ ~= U= m3 ~~ (~ N W W I~ _~yy yl W } ~ N O~ .-, K W 2JV~ (~ ~ az w _ O ~ N mpWN J Ln ~~?o U ~ o a~W~ Q ~ W W J fJ W O \J N Z ~ w Za W ~ Cj~U O ~ N O O g O~ m m O w O ~ •- ~ •- ~ Q a n z u ~_ _J w w ~' Q J J a z a ,,, t~ Z y ~ ~ J U ~ O ~ ~ > Q a o o -~ ~ y U N ~ N ~ 1 C ~ O c~0 .fir PAGE 2 OF 8 GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical) (installations may vary & require additional cells (not shown)- drawing not to scale) observation pipe (where required) growth ~~;'' S NUMBER OF LEACHING CHAMBERS (per cell) 3 TOTAL NUMBER OF CELLS ,/ 3r TOTAL NUMBER OF LEACHING CHAMBERS (all cells) A MIN{MUM OF 12" OF SUITABLE FILL MATERIAL IS REQUIRED OVER THE CHAMBERS. INFILTRATOR STANDARD CHAMBER - OPEN BOTTOM AREA = 15.5 SQFT. INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING = 31.1 FT2 All material and piping specifications os per the Conventional Soil Absorption Component Monuol. PAGE 3 OF 8 SYSTEM ELEVATION = 87.0' •. , , ~ . ~ ~ ~ 5Gw R ,f.~'~ ~ Yom. ~j'~ ~'~yyyy~~ 3 The Standard Infiltrat rJ Chamber Chamber End View ,_ .. _ _ 1 ;~ " i2 1 ,. -.• __ ; . PosiLock'" End Plate ~. ~ ~ ~ ~ ~. `~ >~ O ~ `~ ~ Size(WxLxH)......34"x75"x12" Storage Capacity ....78 ga1.110.4 ft' Weight ..................................26 lbs. Louvered Sidewall Height............6" - ~ ~ ~ ~Y~T~ M ~ I N C Environmental Onsite Wastewater Solutions" 6 Busines=. Park Road P.O. f3ox 768 Old Saytxook, L1 06475 800-221-4436 860-577-7000 FAX 860-577-7001 V/v~n:v.infiltratorsystems.com 1-800-221-443fi For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1-800-221-4436. U.`~ ~ ,.i . , - -- .. ,~ .. r., [ iC ,.~01 ~ . .~1 1.97~. 5 1',i 1F .SSS] ~ 5" 9.44 (flfi ~ .or, "! ~ - ~ ~.Si-- ~~ Ifs!'.. of Y ,1 _f =~ !i f (~ I f'c1 ?f.. d . ~.Il Fffl'C~ RECYCLED PAPER ~UYII ,L ~ ( f. Fri ,.n ~;lfl ,lKr. iGtfn~l k~(,. if ~. ~~.I'~~ 'nG'~i Iii _, .~I!1~ F :Cl if. if„a_ '.~%ni-:iFU~-~ ' ~ .. . , S~PTI~/PUMP CHAMBER CROSS SECTION (DRAWING NOT TO SCALE) Final grade (slope ground away from risers for drainage) Actual depth may increase see COMM 82.30 (11), (c) and (d). I tank vent AcceSS riser with locking cover (cover must be properly marked with on approved warning label) OF power & alarm cable (must use seperote power and alarm circuits) \ (externally mounted) 1 junction box 4" min, ,force mair access riser bottom of inlet invert 3" 1-' -'- ~ filtered f ~ water level } I__ effluent inlet I I ~ 1 Minimum of 3" of suitable bedding beneath tank EFFLUENT FILTER ZABEL (A-~00) (or approved equivalent) reserve alarm on off ~~ --- -+ ~ 72.0' UOG w\pump Pod Tank monufocturer HUFFCUTT DWF (doily wastewater flow} 450 ~ septic/pump chamber capacities 1000/600 GALLON Number of dooly doses 5.6 (DWF / actual dose volume) S.J. ELECTRO (or equivalent) Alarm monufocturer Forcemoin volume g,$ Alarm model number HW 101 (or equivalent) _ Actual dose volume (gal) l i t R (total dose vol. - forcemoin vol.) 79.78 n va Y (or equ MERCU Type of float switch CAPACITIES Effluent pump monufocturer ITTLE GIANT reserve above alarm 21 inches = 313.53 gallons 9EH alarm above pump on 2 inches = 29.86 gallons Effluent pump model number on Toff measurement 6 inches = 89.58 gallons Minimum pump discharge rote (gpm) NA off to tank bottom 13 inches = 194.09 gallons TOTAL 42 inches = 627.06 gallons Vertical lift (pump off to lateral elevation) 15.0' PUMP CHAMBER DIMENSIONS System head (distal pressure x 1.3 ft.) NA length 49" width 70.0~~ Friction loss in the force main <1 ~ liquid depth 42" gallons/ inch 14.93 Total Dynamic Heod (TDH) <16.0 Page 5 of 8 9EH SERIES SUMP/EFFLUENT PUMP ~ ~~ :~ :. r_~ W s „ ~~ ~.. _...~ v~ _ _~ „- ~i Specifications MODEI CAT. SOLIDS SIZE RUNNING PERFORMANCE (DPM @ HEAD) SHUTOFF PWR. CRD. WEIGHT DIMENSIONS N0. N0. LISTING HP VOLTS (Dia.ln.) AMPSIWATTS P.S.I. 5' 1D' 15' 20' IR.1 Ik.l (L6s.) (HxLxW) 9EH-CIM 509330 11L~`CSA G'10 11 ~ 3/4 13.0 1000 71 n8 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIN 509340 UL'CSA 4.10 230 3l4 6.5 1000 71 66 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIA-RFS 509350 UL'CSA 4.10 115 3/4 13.0 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIA-RFS 509360 UL'CSA C-10 230 3l4 6.5 100D 71 68 60 49 32 13.6 20' 27 9.11 x 11.64 z 8.94 BLOW- L ITERS/HOUR Construction n ,nnn annn znnn --- --- -- - 30 zo Q W to 0 la ti 7s~ 5 ' a zs Motor Housing Epoxy Coated Cast Iron Impeller Material _ __ Poly Carbonate Impeller Type Closed Vane __ -__. __ VOIUte ABS Power Cord SJTW-A I ---_ Mechanical Shaft Seal -- ---- ---1 Nitrile with carbon and ceramic faces Fasteners Shaft. Bearings 0 20 40 60 80 FLAW- GALLONS/MINUTE PUMP FERF~RMANCE cuRVE SSPMA ~•"~~ah. __ .,. ]15~' 60HZ ;~~ ~ ~ - -.~ t~ ISO 9001 CERTIFIED Stainless Steel Stainless Steel _ -- ---- - ~~~ Upper Sleeve and Lower ~'I Ball Bearings Little C>I<iant Pump Co. PO Box 12010 `Phone: 405.947.2511 Okla. City, OK 73157 Fax: 405.951.5674 ~~.; ~C =s Form 995235 - Ol /00 POWTS OWNER'S M.-ANUAL 1vIANAGEMENT PLAN PERMIT NUMBER: (~~ ~ 1 Owner/Agent: WERDEN POWTS Maintainer: Geo Tech Soil & Site Evaluation -Chippewa Falls, W[ 715-723-555 Local Regulatory .authority: St Croix County Zoning Department-Hudson, WI 71 ~-386-4680 POWTS Installer: Darrell Frazer- Frazer Excavating -Bloomer. WI 715-288-622 Septage Servicing Operator _ DESIGN PAR.A~IETE:RS Influent/Gftluent quality (values typical for domestic anon-commercial wastewater and septic tank effluent) Fats. Oil and grease, (F(Ki) <30 mg/l~. Biochemical Oxygen~Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150 mglt, Soit Loading Rate {SLR) = 0.4 gpd(ft'`. SYSTEM SPECIFICATIONS The components of this septic system are intended to serve athree-bedroom (4~0-GPD) single-family residence. The components include a IJut1-cult 1000/600 gallon septic/pump tank with Little Giant pump alarm and controls, a Zabel A-100 effluent tiller and (~) non-pressurized distribution cells using graveless leaching chambers. ~ total of 37 Intiltrator standard IeachinQ chambers are required when applying an EISA rating of 31.1 as specified by DCOMM. All parts of the components must comply sti~ith ~1~1 \dm. Code COMM 84 and be installed per manufacturer spacilieations and approval letters. DESIGN CRITERIA o ''Design of cimverrtional Soil Absorption Trenches and Beds`. R.J. Otis - ASAE Publications ~-77 and Design Manual - Onsite Wasre~~~atcr Treatment and Disposal Systems:. EPA 625/1-80-012 October 1980 / SBD- 10~h7-P (F;.6;99) "ln ground Absorption component Manual'' o SBD - 1070-P (N.O 1101) "tn ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & nIANAGEMENT Inspect the condition u( the treatment Yank(s) and dispersal cell(s) a minimum of ever}~ three years. The septic tank contents must be removed in accordance with Chapter NR 1 13. WI Adm. Code when the combined sludge and scum equals one-third (I/3) the tank volume. The eflluent fiilter should be inspected annually to ensure maximum performance. START UP For new construction prior to use of the POWTS check treatment tank(s) for presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed h} a septage-sen~icing operator prior to use. OPERATION The propeirty o~a~ner i> responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of ~~~astewater will affect the performance and longevit}~ of your pOWTS. The installation of water-saving appliances and lixnn~es along with prompt repair of leaks reduces the wastewater volume. Also. the brine or waste from water softeners, iron removal units. and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste. showers. dishwater, etc. The system is designai to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit pack and seeds. bones. and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the onh~ paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins. condoms. cigarette butts, dental floss. and cotton swabs should not enter the system. Chemicals such as petroleum products. paint. disinfectants, pesticides. antibiotics (medications). solvents, etc., should not be flushed into the system as they can serioush damage your POWTS and contaminate your drinking water supply. Maintain regular steady tlow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. / Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions. however water should be conserved until and problems with the system are corrected to prevent back-up of sewage into the dwelling or surface. Page 7 of 8 s SOIL EVALUATION REPORT Page of Wig: rosin pepartrnent of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. AdmpCode ~ f r Attach complete ske plan on paper not less than 81l2 x 11 inches in size. lan np~tE C E inducts, but not limited to: vertical and horizontal reference point (BM), dir lion and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distan to nearest road. Date Please print all information. d E ~ ~ ~~ b - . O6 pp 3 Personal information you Provide may be used for secondary PurPos~ t~rv~Y . s. 15.04 (1) (m)). property Owner Props Govt Lot BFFICE S /~s T~ N R Gi E ~- r Q ~ ~ ~ ~ ~~~'~ Lot # Block # Subd. Name CS Owner's Mailing e ._.- `~J-~ Nearest Road State p Code Phone Number ^ City ^ ~Ilage o ~i~ i,~.~~, /l~~ I L1/~ ~ S yob (/~ i ~' 3' ~ ` 7 l/VIJC U611~av v..v..J....~-- ---- - New Construction Use: Residential ! Number o rooms ^ Replacement ^ Publ' or t;ommeraal - D~ejscnb ----- -'~ ft. parent materia is u `O,~ ~ • i~ i Plain elevatio~n~~if a~~p~~plicable`~ General corrvnents ~~~ ~e y~;~i~'~ arld reCOmmendatltNlS~ ~~ ~' ~ /~ ~ ` ~ G ft. Depth to limiting factors=-y- in. Soil icat9on Rate # ~ ~"~ g 1 ~ ~. Pit Ground surface elev. Texture Stricture Consistence Bourxiary Roots GPDlfP Horizon Depth Dominant Color Redox Desaiption •Etf#1 'E in. Mansell Qu. Sz. Cont. Cdor Gr. Sz. Sh. .~ 3/i - - S ~~ o ~~ Boring # ~, pit Ground surface elev~ ' ~ ~• Depth to limiting factor ~~_ ~• c ~f1 mnA_ and TSS < 30 m9IL Grantor, and Peter M. Werdan and Jennifer M. Werdan, husband and wile Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Part of the Northeast Quarter of the Northwest Quarter (NE 1/4 of the NW l/4) of Section Twenty-five (25), Township Twenty-nine (29) North, Range Sixteen (l6} West, Town of Baldwin, St. Croix County, Wisconsin, more particularly described as: ~f Certified Survey Map filed July 25, 2003, in Volume 17, as Document No. 732117. 734062 KATHLEEN H. wALSH REGISTER OF DEEDS 5T. CROIX CO. , MI RECEIVED FOR RECORD 08/06/2003 09:30AK WARRANTY DEED EXEMPT # S REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Area THOMAS A. McCORMACK ATTORNEY AT LAW PO BOX 2120 BALOWIN, WI 54002 002-IU60-50-000 Parcel Identification Number (PIN) This is not homestead property. (~ (is not) .,,~ ~.. VI. ~350j~ [P, t7g7~7 U v STATE BAR'OF WI~~S~ FOR4v12 - 20D~ 1 document Number WARRANTY DEED This Deed, made between Craig E. Rasmussen and Gloria J. Rasmussen, husband and wife, holding as survivorship marital property Exceptions to warranties: easements and restrictions of record. Dated this ~,j'~ day of , 2003 * AUTHENTICATION Signature(s) authenticated this day of _____ , same _,~y `~ ' ~ ~~ vim' ~;`--- / a .; ~. - TH[S INSTRUMENT WAS DRAFTED BY * hl /i-~y~5vr1 cr : T ' ~ .. Thomas A. McCormack Notary Public, State of WISCONSIN ;~ a • ~ Baldwin, W! 54002 My Commission is perDtapent. (If not, state p(ti;i" * Gloria ~' ACKNOWLEDGMENT i STATE OF WISCONSIN ) ss. St. Croix County) Pe nally came before me this Isf day of 2003 the above named ~ Craig E. Ra ssen and Gloria J. Rasmussen, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, to known to be authorized by § 706.06, Wis. Stats.) ~ stty ent (Signatures may be authenticated or acknowledged. Both are not necessary.) _ * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 !~~ •. w.. .. .,•... INFO-PRO (800)655-2021 www.infoprofonns.com