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Home My WebLink About002-1061-60-011Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information"i you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Nelson, Ronald & Jan Baldwin, Town of CST BM Elev: Insp. BM Elev: BM Description: ~6~ ~-~ ~ ~-S~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ N v ~F~~~ ~aoo Dosing tt Co ~v..~D a ~ ~ F~ ~ ~te~n~o g-~dv Holding TANK SETBACK INFORMATION TANK TO ~ d P/L ~ ( WELL BLDG. ~ Vent to Air Intake ROAD Septic ~ O i ~o 7 ~~~ ~S I ~ 5 / _ Dosing ~~~ ~ /~~ 1rJ i / C / J _ Aeration Holding ~~_ PUMP/SIPHON INFORMATION f~ Manufacturer / t_ ~` ~ «~ L- (,Q, ' Demand GPM Model Number ~ ~ ~ ~~ TDH L~ ' Friction Loss ~3 System ead '~ TDH Ft ~. 93 Forcemain Lengfh Q, (o Dia. ~ - Z Dist. to well 7 ~ , 1 C(111 ARCARPTI[)N SVSTFM i~\ ELEVATION DATA County: $t. CrOIX Sanitary Permit No: 479409 0 State Plan ID No: Parcel Tax No: 002-1061-60-000 Section/Town/Range/Map No: 25.29.16.3796 STATION BS HI FS ELEV. Benchmark / , Q (p C, ,b , Q O J Alt. BM n ' ~ ~ ~JJ.wb~~a 2 . ~ /6J • c15 Bld Sewer rz. rs 9y, ~s St/Ht Inlet Iz.75 ~5!al SUHt Outlet -~ Dt Inlet ,~ Dt Bottom ~ b ~ ~ 9 `j Header/Man. ~~$ Dist. Pipe ~. ~ -7 Bot. System ) ~ $ 9~ Final Grade I_ ` G I D /d St Cover I A A I BED/TRENCH DIMENSIONS Width ~ l.J Length ~ v (~ ~ No. Of Trenches 3 (Ce ~ ~~ PIT DIMENSIONS No. Of Pits Inside Dia. ~' Liquid Depth ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ,~... tt ! '(' L <- INFORMATION CHAMBER OR 7 /l f cc> . Type Of System: Ga,n,,~e~-; o ~ / ~ ~~ j ~ /4 d ~~ UNIT Model Number. I~ICTRIRI ITIf1N CVCTFM iU .L~ 1 Header/Manifold ,~ ~ Distribution e(s) ~ ~ pi x Hole Size x Hole Spacing \ Vent to Air Inta ~1I~- ~P,Q~t ~. ~ 5 ~ p cin th Di S ~ I Length Dia_ g a pa Leng Cnll Ci;~VFR Y Drncm~rn c..~+oma n.,w YY Mni~ntl nr At_Grade Systems Only Depth Over ~ Depth Over I xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ Bed/Trench Edges ~ Topsoil Yes ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /, Location: 2628 70th Avenue Baldwin, WI 54002 (SE 1/4 SW 1/4 25 T29N R16W) NA Lot 1.) Alt BM Description = ~~ ~~ ~`~'~~~~~ ova 2.) Bldg sewer length = ZG~ / - amount of cover = , Plan revision Required? ~ ~, Yes ~f~` No G ~~ll ~ Use other side for additional information. ___`~ V5 Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 25.29.16.3796 3 ~ J~ Cert. No. Safety and Buildings Division Ol W. Washington Avc., P.O. Box 7162 Cotn~ u , ~" ® 7162 I 33707 d be filled is b CoJ b t it Nu P i ~~~OA~~~ - Ma ison, W y m er ( o erm San tary ' ~ ~ (608) 266-3151 ~~ D~ artment of Commerce Sanitary Permit A .: ~ ~° ~° l.D. Number peisaoal m you prrn'i Code Adm In axord with Comm 83 Wb 21 , . . . , may be uaod fat:eoenaary purposes Privacy La slS.o4( ~.. 2a~5 Pmject Address (ifdifferent than mailing address) ` ~ j T ' ~ ~~ I. Appllcsdon information -Please Print All Information ~T. CROOX COQ a tp a d /~ 's Name ~~~ ~ k Parcel N ~ ~ ' ~ I^ Property Owner's Mailing Address Psnpetty I.ocatim 3 7- r ~ ~ ~ ~ ~ ~/~~ '/~, SexKim /' Ci Ste ri~ Zip Code Phone Number h ll th t ildi k f B T ) 1 2 ng (c ec a u a ype o . aPP Y / ~ ~ ,(j/ Subdlvlsim Name CSM Number or 2 Family Dwelling - Number of Bedrooms ~ ~Ct ~ ~ / ~~ Q~~~ ~ / ^ PublicJCamnoercial - Describe Use ^ State Owned -Describe Uae ~ {'lu ~ ^City_^Village ownahip of Ill. T ype of Permit: (Check only one boz on line A. Complete line B If appUcable) A' New System ----~ ^ Replacement System ^ Treatnunt/Holdiag Tank Replaexmetrt Only ^ Other Modificadm to Existing System B. ^ Pe®it Renewal ^ Permit Revislm ^ Change of ^ Permit Tramfar to New list Previous Permit Number and Date issued Before Expiratim Plumber Owner IV. of POWTS s tem: Check all that a 1 S T, ~1on -Pressurised hr(3rotmd ^ Matmd >_ 24 ln. of suitable soil ^ Mound < 24 ia. of suitable soil ^ At-C3rade ^ Single Pasa Sam Filter ^ Constructed Wetland Preawdzed ln-0mund ^ Jdoldlag Tank ^ Peat Fllter ^ Aeroble 1Yratmant Unit ^ Recirculating Sand Filter ^ Recircula ' S thetic Media Fil Chambei ^ Drl 1.1ae ^-0tavel- 1 ^ Other V. Dis nal/IlreatmentAras o .~ Y ~~' 0 Design Flow (gpd) Design SoU Appticadm Itate(gpdsfj Dispersal Area Required (sfj Dispersal Arm Pm ystem Elevatim ~~ ~,~ o~ ~f40 ~i3~f 2 ~L.D Vl. Tank Info Capacity in Total Number Mantafacdrrer Prefab Site Steel Fiber Plastic Oallona Cfallaos of Units Concrete Cmatructed Olass New Bxikiag Tanks Teaks Septic or~~r.--r4 K/V ~~ r Mrobic Tn.aament Link ~V / ~ 1(i Doling Ctsembcr I?'~ d Vll. Res mibW Statement- 1, the on sibUl for installation .the POWT3 shown on the attached Pl Name (Priat) Plumber' MP/MPRS Ntm~bar Busiaett Phone Number d~ L ~n~Z P t3g~6 Z 7tS- 2 ef= 2~ ~S~' lumber's Address (sweet, City, State, u i / t,S~ d D~' - , c° d kl GJ .z ~SSf7s'l VllL onn / De nt Use . Approved ^ Disapproved Sanitary Permit Fee (includes t3roundwatar Surcharge Fee) y~ 2 ,, ~,, U~ ~ Jssued Agm Signature ( ) ^ Owns Olvmt Reatm for Denial ~ "' .>(~ . `~ 2 6~ R.~ IX. Condittom of ApprovaUReasons for Dbapproval SY~.M OW~~ Septic tank, effluen filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Amen ewmproa puss lW sat eroarry ouy) rer cat rysmm ea ptpor roc sass uaa .,~. s ., i.e~w ~. w,c SBD-6398 (R. 01/03) T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 www.tlsinzplumbing.com ~3_' ~ ~~j19~6v ___._._ ~ , ~/ ~~ ~~sf~ .~ - a7~~~ o~,~~~ ~ ~ ~~s ~.8u-c ~ rov ~vtf'~ 0 t FitE~9 c-P ~'t-PcL ~`i`.a-rat 70 ~',dvE T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: ('715) 235-2592 www.tlsinzplumb-ing.c/om ~,~1~ L ~~ ~ ~J ~/ / V L~C-~ 6/V ~~ d ~ ~L ~f~IJ ~~ ~~ ~~ ~`~ ~ ~ ~ T it ~ ~ ~ ~ l.~ ~-£t,~ . I'',3o' ~~I g9~6v 1~rirGc~~ /ov~~~~ _ ~.~r~o ____ ~~ f,~/ ..~ - a7~~~ o~,G~~ ~ ~~s yi, Su-(~ (UU 1~v~~ 0 t' ~(t~E-~y 9 r..~P ~'t ~c L. ~`J',ay~ - - ... ,..~•a••.-. ..,. ..,. ... ., .. .~ ., ........ .. ...... `, .~.~ M P1 i N W a: ATJi ~ ftPRC01= LOCKINC3 Cpn/~R 3LHC,t-o-+ ~rivttn+~ ~.d8k'.C . BGOt ~~ ~ ~~ Y~ ~..4 , J7ti~i/7 .r P1 P1a 3' tv NDISTUaE.EA .. - SoIL 24'' ~.U. it dk 4° MA-iu0.t~ .~. ~, ., ~ ~ Yfs~dT l.1Ri r a r.cc.o A .. rso~.C ~"~Q~~ c W ~tav~.R 4 a (.ET ,~ba~fra ~~ ~Fi..ES ~I.A~ 3' ono N E G.T i O i-LS ~^ '""`~ '1~ K b .r~, ~l ~t~1v"'~ ~ 0~~1 " (~ ~r?u D C~GF pll?'~ b ~ ~, _QV, ---~--~~~~ ~~ ~ ~ T ~ t4toCK ~ t SCPTIC E SP~GI~IL Ar?C~A1 ~ _ - OOSt ~~~~~.~, 5 TAA.I..S MA-JUFACT~30.~R: ~JLbM6CR a!< DOSE$:~ pLK p,~~ • T^IJK SizC; l lTty't9 - (rC't"~ yALLOA75 S d ls'~ ti~-v AL ARI.1 ~tA- ~ •.DOSC VOL4fME / AA ~V IA~CL-tBil e . ,iu ~CruRcla; .J~j Sa1GKFLOW: ~` GA~tO~JS /'~OOC L 1.lU,j~ytk; - ~ ° ~ ~ `'`~ CAPAGITlES: A s ~WCHfs ox gy w ~o ~ ~;s ~~.g Z' $ _~ - I-JGxES DR _ GALLp1.:9 ~uMP M~,AlU>:ACTISRCR: ~~ 9/~Jyf -~~-•--~ i C~~ I uL H C 6 p R~ G~ 0 ~ ; 5 ' MPDCL 1UUMDLR: 1. ~ . ~R ~ JW1TC1{ Tbpt~ V"~a''V"~v~"~~ Q s ~~ I-34NES OR GAILGi.I; I,JOpE; P(JMP A1JD ALI.RM ARC TJ 8C !"tIA11MfJM DISCKA1l(-C RAT _.,~~~GP}~ rNSTAt,LEO pN SEPAaATC CtKCU~r; ' /ERTIGAL QtFf[RCAJt£ 6ETW[tIJ Pt1MP ps>l qyp plSl'Rl~lTlOA3 PIpE., (~f_ ~ FEC1' + rtiu~ uM +~CTWORK SUPP4,y rREtruR~ .. .. ~ ~ ^I=ECT .. '~ .~, . F~ E7 OF PORGC M/-{N X .L.:~.(.~,f~'t00ILiRiCT101.1 rhCT01t...~ FC T `-' 0 TOTAL O~UAMtr; NCAD ~ ~~"- f><ET ~rcR-.IA~, G,MEU41olJt ~or TA1.1K; LEA~6TH ,~ ~7. ~~ ~• 2 .. 'WIDTH `~ -.-..~.,,; ~,IQutD OCPT H ~A~l ~ ro 1~ zd WdZ0:60 S00Z ~Z 'FpW 860 ~~Z SZZ 'ON Xd.~ ~JNIlSSl BIOS Q8IdI1~180 W02~d ' ~ ~ ~ ~ ~ 1 i~ ~ 9EH ~ER1ES SUMP/EFFLUENT PUMP 8.8b S~ec~ficst~on~ 3 ~ SOLIOS SAE R{1NNNiG PtAfORMANCE 1~ ® ~ti~ SHUTOFF RS I PWR, C}Ib, 4/ElOHT 01YENS10N MODEL CAT. tIE11ND HP 40LT3 {Dist. In.) AMPtJWITT3 5' 17 1b' !U Iry,l ' ' {Ft.l {Uu.) IN z l Y wl N0. N0. 13 8 20~ 27 tt xtt.6ar,B94 9 uucSA ahrl 115 ~a ts.o 1000 11 88 60 a9 sz . . 4EH-CaM 509330 a 5 1000 8 T1 EBB 60 a9 32 t3.tl 20' 21 9 ti Y 11.64 Y b.04 4EH-CIM 509340 UllC5A 4(10 290 3I . 11 68 60 40 32 13,8 20' 27 9.11 x 11.64 x 8.94 9EH•CIA-RFS 509350 UUGSA 4,'10 1tA yi 13.0 1000 49 32 1'+ S 20' 21 9. I I zit _64 z 8,94 9 H IA AFS 60938V Ul,`CSA a h0 230 :~a 6 5 1000 11 88 60 JO t.. ~o ]U 0 ZO t0 bo ~t+ F~pw_ GAL. L,i.INS/mINUTE PUMP PFRFf1.RMANCE CURVE 11SV 60HZ to ~,s S ' g 2.5 ~ it Construction. ~ ~7~tnr IJousing lmncllcr Material Irn cllcr'J~re Volulc Pc~wor Cord _ _,,_ MechanictTl Sha:1R Seal 1~'a steneTs __ ... Sh~f~ _._....... 8eurings ~~ ~v ISO 90010C~pTIFIED Finoxy~('rxiteci C~~,ii Iron Paly Carbonate ._ Closed ~~ane - . SJTW-A " Nitrila wid>; cAtbcin xt~cl ~crrarnic faces __ ,. 5tkt1II~0`JS SLCeI ._~ SCil1IIl08`J S~V1:'1 _ 1 . Upper 5lea; vc ar-d Lower Bail Hearings Little C~i.~t Pump Ca-. P() Sox 12010 Phunc: 405.94.2511 Okte, cjty, l)K '~31 C7 ` Fdx: 405.951. Sb7a www. LlttileC~antPump.com ~+ Forrn 9952J:5 - 01/OU l/t abed •`INdLZ~E z0-9Z-noN .` LZ88 Z~~ 9GL E `•OOIE ~a~,aasE~ aH :~.g lua FLOW- LITERS/I~IUIIK n roo0 X000 3000 ~~~~'~~~~ ~~~~SO~IL~EVALUATION REPORT Department of Commerc~ in accordance with. Comm 8 dm. Code Division of Safety and Bui ~~ ~ `r~~ Attach complete site plan on paper not le~th ray 1 incSlze,Plan must County include, but not limited to: vertical and horizon~rj~ re ce point (BM), directibn percent slope, scale or dimensions, north arrow, a d to ation and I ta~c~dto'~~r st roa .Parcel I.D. Please print all informatio ~~~ ~r~~~ ~td'~ ~~ Reviewed By Personal information you provide may be used for secondary pur ses (~ipa(~ $'arv~'~r~~~) (m)). Property Owner y Location Nelson, Ronald & Jan Govt. Lot SE1/4, SW1/ , S25, T29N, R16W Property Owner's Mailing Address Lot ~ Block # Subd. Name or CSM# 2609 CTHW D ~ ~,-J City State Zip Code Phone Number City ^ Village ®Town Nearest Road Woodville WI 54028 715-698-2351 Baldwin 70Th Ave. New Construction Use: ®Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement ^ Public or commercial -Describe: ?j Pj~~Ca Gt Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments install "conventional" in-ground trench system @ system elevation of 96.0 w/~pd/sq ft loading and recommendations: -' b,~ . Boring # ,-, Boring !~, Pit Ground surface elev. 100.0 ft. Depth to limiting factor > 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz.Sh. •Eff#~ •Eft#2 1 0-12 7.5YR 3/2 - sil 2 f sbk mvfr ~ cs if/m .6 .8 2 12-32 7.5YR 4/3 - sil 2 m sbk mvfr cs lm .6 .8 3 32-45 7.5YR 4/4 - Is 1 m sbk mvfr cs im .7 1.6 4 45-69 7.5YR 4/4 - s 0 sg ml cs - .7 1.6 5 69-96 lOYR 4/4 - s 0 sg ml - - .7 1.6 rt ~~ Z f ,Boring Boring # ''-- ~' pit Ground surface elev. 99.0 ft. Depth to limiting factor > 98 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-13 7.SYR 3/2 - sil 2 f-m sbk mvfr cs 1m .6 .8 2 13-24 10YR 4/3 - sil 1 m sbk mvfr cw lm .4 .6 3 24-98 lOYR 4/4,4/6 - s 0 sg ml cs lm .7 1.6 I 3 stratified lOYR 3/4 Is bands: 45-47, 57-58, & 71-73" Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 /L " EfFlue~t # = OD and TSS < 30 mg/L CST Name (Please Print) Sig to e: CST Number 4enry F. Grote ~ 222774 4ddress Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 6/14/2005 715-233-0398 #2261 Page 1 of 3 Certified Soii Testing, LLC St. Croix 002-1061-60-00 Date fv ?~ d anv-a»v ~n v nw, Property Owner N@ISOn, Ronald & Jan Parcel ID # 002-1061-60-000 Page 2 of 3 3 _~ Boring ~ . Boring # ~ pit Ground surface elev. 100.3 ft. Depth to limiting factor > 105 ln. SOiI Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary. Roots GPD/ft2 in. Munsell Qu. Sz: Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 7.5YR 3/2 - sil 2 m gr mvfr cs lm .6 .8 2 8-42 10YR 4/4 - Is 0 sg ml gs lm .7 1.6 3 42-105 10YR 4/4 - s 0 s9 ml cs lm .7 1.6 1 I stratified lOYR 3/4 sl bands: 1/2" @ 32 & 41 + 37-39"; H3 has occasional stratified lOYR 3/4 mcos bands 1-4" thick, irregular & discontinuous Boring Boring # _ ~ pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rat Horizon Depth Dominant Color Redox Description ' Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. CoIQ Gr. Sz. Sh. 'E$#1 'Eff#2 j i Use 0.5 gpd/sq ft loading due to some textural variations observed @ depth in sand & loamy sand ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing, LLC • ~O~g~rX"~' ~J c~~, ~~~~SV~n,- ~~o~ 1~w,,~ ~F-~~o_:LS -Zit-llow ~_ `v n2-l Jtol -(~o - OoC~ w~~ ~,~ \~ ~.,~~ ~~ ~ ~~ S~-~(~~ C~ ~, o~ ~ ~, _; v ~^ ~ ~~ ~ ~~~ -~ 5 zy ~ag~ ~ ~~ \ ~ ~~~ . -, c~ 15 ~ ~~ ow.~ ~ l o~~ ~~ fib, 1` ~ YSC,-t ~ ~ L~~YO,t7~ ~ ` ~ 1 Cq ~ - eI //'~~ \ ~17r"% ~ w a 1ti ~ d. L L M~.d L~„" ~' ~" ~ HOC ~V 8'„'~ ' `" ~X.-ZV k~ 3 0 ~ 3 C' 0 r tJG~b7~1bb5 bB:56 7152352592 T L SINZ PLUMBING y6: !i~~ ri;, FRi; 10: •71 F~1 i15 aSS 4s68 ST CRx CO ZONING OwuerBuyer tviailir,s Adams Property Address PAGE 03/03 ~i O ll Z sr cRarx coYr~t-rY SEI'~'1;C TANK MAINTENANCE AC~RBEMBNT AND OWNERSF~P CERTL~CATZON FO1ZM ona.l cC ~~;dr clu,vie~- ~~~~ a.~ 09 ~c a ~a ~- ~o ~ ~'~~ v~' ~ Z ~bZB ~~~ (Ycrificatiata requited from Planning Department for new construczlon) _ CIty/Stale Farcel Xdentification Number Da- -f~ d ~,,EGAL DESCRIpTZON Property Location °~ ~ . y<, °~ w %t, Sce. O` ~. T a-~ N-R l~ W, Town, of ~ ~~~iCl ~/'l Subdivision 3 ~G~2JlA~ ,~2•l~i~~ 1 ~ ~ ~ .Lot # t^~rti~e Snr~ey Map/~J# . Volurue ~/ ~ Page # ~~~~y eed # ! 0 ~ O ~ ~ Volume ~ - I ~ Fagc # ~ ° ~ _, S ec house O es no L,ot lines identifiable yes ~ uo P Y SYSTEII'.i ~'~NANCE Improper use and Lnaint'^ a~~~ of yauC xptic system; could rcwlt ~ its prem.shlre Eailtt[e t4 bw,dle Was[t:s. Proper mai^tenaacc caaslsta of pumping oat tho septic LanY every thr'ca yca:a ac sooner. if Deeded by a licensed pumper. Whet you put fate the system can affect the fuac~on of the acpcic tank tts at treatment stage fra the waste disposal system, 1'hc proporty owner agrees to submit to St Croix Zot,,iag Department a Gerd~Cation £ottm, signed by the owns and by a mastprplumbor, journcymatnplusabtz, testziettdplumbec or a licenscdpumper rcflfying that (1) tba on-~ito wastiewnterdisposal system is is propex operating condition and/or (2) attu tnspeclion and pumping (if ncccasxry), the septic taaY is less tlsaa i/3 full of sludge. Uwc, the n.odetrigued Dave read the above rzquiroments aAd agree to tnaiatnin the primate sewage disposal aystera with the statrda~rds set forth, hetaia, as act by the Depaztmrsu of Conivieroe and the bcparrtrucnt of Natural Resourect, State of Wiscadsla G,tti$cation stating that your sepkic~systcm has been me lntaiaed must be completed and zctumed to the St. Ct:oix Coutsry Zoning OftTcc within 30 days o e thst;c ye explxnriolt~~iatF~=:- \ l~~%~.~t:~L! ~; ~ t• (~ SI A'I'C1R.E OF AI?pLICANT PATE 0~4'NER t'~'Ii~Z+'1rCATION I (we) certify that alI statements ore this fotnt ace true td LLc best of,ny (out) ~owledge. I (wa) aw (a.re) tl]c owner(s) of t1,e petty des ~b/'ed a~bo~t, by irtue of a wxrtanry decd recorde in Rt ister of Deeds O(tice. ~ ~~ f`J~ .~i~(.C/ ~(,~ I l S GrIATURI O~ A.PpLICANT DAT'S •+'•~+ Any itiformat(pta tyat is utis-rcpx~sentcdmay result ih the sandtaryperttut being revoked by the Zocli.tsg Department. `""~~ '' Include with this stpplicatiots: a stamped q>$rs>anry {iced from the Rcgivter of Dccds a~fice a copy of the ccttified surrey trap if rcftrence is utade in the wamnty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of `f/ FILE INFORMAT N Owner ~ ~ ~~~ ~ ^,1 Permit # nFSIGN PAReMFTFRS Number of Bedrooms ~ ^ NA Number of Public Facility Units ~B'RA Estimated flow (average) ~a al/day Design flow (peak), (Estimated x 1.5) ~ al/day Soil Application Rate ' al/day/ftZ Standard Influent/Effluent Quality Monthly ave rage` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 <_220 mg/L ^ NA Total Suspended Solids ITSS) <_150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand IBOD51 530 mg/L ,/ Total Suspended Solids ITSS) 530 mg/L O(NA /`` Fecal Coliform (geometric mean) 510° /100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. eveTClu coc~•ICIr_eTInNS Septic Tank Capacity DQ 0 al ^ NA Septic Tank Manufacturer ~" O NA Effluent Filter Manufacturer ~/~(~~ ^ NA Effluent Filter Model rQ ~~~ ~~ ^ NA Pump Tank Capacity GO gal ^ NA Pump Tank Manufacturer ~~/ ^ NA Pump Manufacturer ~~ f ~~ / ^ NA Pump Model ~~!'t' ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: LQ"NA Dispersal Cellls) ^ NA n-Ground ravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA NINIIY 1 CIV NIYVC JVf1 C1.JN LC Service Event Service Frequency Inspect condition of tankls) At least once every: ~, 3 month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cellls) At least once ever y~ ~ ~ ^ ear(s) s) (Maximu ears NA :.. ~' ~ ~'h" E . _ a onthls) A Clean efflUe`nt f#t~r ~ once earls) onthls) ^ A Inspect pump, pump controls & alarm At least once every: $.yearlsl ~ ^ monthls) A Flush laterals and pressure test At least once every: ^ yearls) Other: At least once every: ^monthls) ^ yearlsl A Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls- shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of'sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services,; including but not Ilmited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page y_ of v START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up~shall not occur when soil conditions are frozen at the infiltrative surtace. During power outages- pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the .dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To''avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet .down slope of any mound or at-grade soil absorption area. ` Reduction or elimination of :the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by 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 another 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, 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. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS tec 1 gy a holding tank may be installed as a last resort to replace the failed POWTS. T his not been eval ed identify a suitab ent area. the POWTS a soil and site a st be perform to a suitabl acemen eplacement o ding tank ma tailed as a last res to r ce the d POWTS. Mound and at-grade soil absorptions ms 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 GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~/ l~(fli ~~, /~~i Phone ~,..Z ~~ POWTS MAINTAINER Name Phone ~' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name 5' ~ /fG Cj Phone ~ ~,~,(, ~ a This document was drafted in compliance with chapter Comm 83.221211b)It11dl&If) and 83.54111, 121 & (3-, Wisconsin Administrative Code. Parcel #: 002-1061-60-000 08/22/2005 03:04 PM PAGE 1 OF 1 Alt. Parcel #: 25.29.16.3798 002 -TOWN OF BALDWIN Current '~X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner LYN O WALTER W & CAROLYN NELSON -NELSON, RONALD & JANET RONALD & JANET NELSON WOODY LLE WI 54028 L ~ ~o `~G~ !/H S~/.~~ ~~ Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 33.000 Plat: N/A-NOT AVAILABLE SEC 25 T29N R16W SE SW EXC S 31 RDS OF W Block/Condo Bidg: 36 RDS Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-16W Notes: Parcel History: Date Doc # Vol/Page G OC 0 a ~~ ~~ 7/23/1997 457/437 (/~ 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 32.000 2,500 0 2,500 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 33.000 2,600 0 2,600 Woodland 0.000 0 0 Totals for 2004: General Property 33.000 2,600 0 2,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 002-1061-50-000 08/22/2005 03:04 PM PAGE10F1 Alt. Parcel #: 25.29.16.379A 002 -TOWN OF BALDWIN CurPent ~X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner O -NELSON, WALTER W & CAROLYN WALTER W & CAROLYN NELSON C -NELSON, RONALD & JANET RONALD & JANET NELSON 2609 CTY RD D WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 2081 60TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 7.000 Plat: N/A-NOT AVAILABLE SEC 25 T29N R16W S 31 RDS OF W 36 RDS OF ~ Block/Condo Bldg: SE SW p /~ ~~ ~. A ~/ ~i/Y G.f~/~ ~'C Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-16W Notes: Parcel History: q ~ S ~~~~ o~ ~ ~ ~ ~(S ~S Date Doc # Vol/Page Type 784822 2 30/1 QC 1 l r(~/ 3~ ~ 4 07/23/1997 / ~° 1 s s 3 ~ 5~ 9AA~ CI IMMARV Bill #: Fair Market Value: Assessed with: Valuations: Description Class RESIDENTIAL G1 AGRICULTURAL G4 Totals for 2005: General Property Woodland Totals for 2004: General Property Woodland Use Value Assessment - Last Changed: 06/04/2003 Acres Land Improve Total State Reason 2.000 9,000 29,600 38,600 NO 5.000 200 0 200 NO 7.000 9,200 29,600 38,800 0.000 0 0 7.000 9,200 29,600 38,800 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 .U; C?30P 159 . ' II State Bar of Wisconsin Form 3-2003 ' QUIT CLAIM DEED Document Number ~ ~ Document Name THIS DEED, made between Walter W. Nelson and Carolyn Nelson, husband and wife ("Grantor," whether one or more), and Ronald Nelson and Janet Nelson, husband and wife ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croiz County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): A 50% interest in: Southeast Quarter of Southwest Quarter (SE 1/4 of SW 1/4), Section Twenty-five (25), Township Twenty-nine North (T29N), Range Sizteen West (R16W). Dated December 31, 2004 (SEAL) * * W ter'n'. Nelson (SEAL) ~~f+~~2 KATHLEEN H. NALSH REGISTER i7i: dEEdS ST. CROIIC CO. , Mf I REGEIVED Fl1R RECORd 01!12!2005 1@:ISAl4 SUIT CLAEIt dEEd EIEhIF~T # 8 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Retum Address Thomas A McCormack PO Boz 2120 Baldwin WI 54002 002-1061-50-000,002-1061-60-000 Parcel Identification Number (PIN) This is not homestead property. (is not) (SEAL) (SEAL) AUTHENTICATION `~" ~ ~ ~ ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) .. )ss.;'; . authenticated on ST. CROIX COUl'Y) , Personally came before me on December 3I.20 ~:, -~ , * the above-named Walter W. Nelson and CarQ'~n Nelson, `' TITLE: MEMBER STATE BAR OF WISCONSIN t-y " ~ ~ Q`T_ ~~. J'¢c (If not, _ to me lrnown to be the pe n w q~, a ~cnt th~ foregbi~ authorized by Wis. Stat. § 706.06) instrument and acknowled d the am ~ t'~ ~ O ~' `~ , sn ~f • 2 's THIS INSTRUMENT DRAFTED BY: * Thomas A. McCormack '~, ~ ~ ' ~ •''~ p Thomas A. McCormack Notary Public, State of WISCONSIN ~ ~- Baldwin WI 54002 My commission (is permanent) (u~txxxxxxxxxxxxxxxxxx ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QIIIT CLAIM DEED STATE BAR OF WISCONSIN FORM NO.3-2003 *Type name below signatures. ®State Bar of Wisconsin 2003 INFO-PROTM Legal Forms • (800552021 • infoprofortns.com ~a