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Home My WebLink About002-1070-60-000`epartment of Commerce ~ Building Division PRIVATE SEWAGE SYSTEM y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Personal information yot~ provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hielkema, Harve Baldwin Townshi SST BM Elev: Insp. BM Elev: BM Description: /~ ~~G , cxs C5 r' ~ /GP g~t~ 1~ r'rP'.v TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~hn,,` c} .~ i ~~•--~ / r t~UCG t~5 Dosing Aeration Holdi TANK SETBAGIti INFORMATION ELEVATION DATA county: St. Croix sanitary Permit No: 463094 0 State Ptan ID No: Parcel Tax No: 002-1070-60-000 Section/Town/Range/Map No: 28.29.16.424 STATION BS HI FS ELEV. Benchmark Z /~- Alt. BM ~. S !OG .7 Bldg. Sewer SUHt Inlet ~? ~~; 1'S SUHt Outlet ~ Dt Inlet Dt Bottom Jrj 7 qy ,`I S Header{Man. ~, ~ 103.E Dist. Pipe ~ ~ E' (a .~o to3 ,~ Bot. System ,7 I ,5 ~ o3,~g Final Grade St Cove 3~_ ~4~~ G~~y S Ia3.~S c:v~-,-,got,, /' c~3.~ !o/. 3 TANK TO P(L WELL BLDG. Vent to Air Intake ROAD Septic _f ""~ 7"~ ~ /CPU '"7 ®~ ,~. Aeration ~_.~ ..,_. _ . TAT Holding - ~ __.r PUMP/SIPHON INFORMATION Manufacturer Demand / r ;,1s~.~C G GPM Model Number //~~''~~ rs ~~ `3 t /~ TDH Lift ' Frictio Los ~ System Head G ~ TDH Ft ~ S J .a.z ,od .~3 , - l .cy~ 1 Forcemain ~ eng n _ ~ ia. rt ~ Dist. to v~Lell 1 C 7' 1 7 q _ , , , S ~ . SOIL ABSZ?RP-1"-tAt~t--S~STEM BED/TRENCH Width. Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ 7 5 ~ SETBACK SYSTEM TO P!L BLDG WELL LAKE/STREAM LEACH nufacturer: INFORMATION CHA R OR TYp~~ ~ t~ •~ + ~ ~ - '* ,~ ~jy ~~~ ~ / ~ UNIT Model Numbe . DISTRIBUTION SYSTEM HeadedManifold +E r,r t Distribution Pi es ~ t ~ x Hole Size r~ ' x Hole Spacing 3 ~ Vent to Air Intake ~ Length_~ Dia_ { /2. Length 70~ ~Z. Spacing ~ ~/'L Dia ~ oB --~ ~ ..G /~ '-' ~nl'L ~.DVER v Oraccnra Cvc4arnc Aniv YY Mnnnrl nr At.C:rada Systems Only Depth Over t Depth Over xx Depth of xx SeededJSodded xx Mulched Bed french Center ~ ~ BedlTrench Edges ---_. Topsoil ,~ ', I Yes :: ; No j Yes i ;~ No ._ r ~-.......~. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /(; !~ ! C!'~ CJ~ Inspection #2: « 1~1 ~ K1s p-v~ ate- ~r ~~ ~w •,-bio/^ ~i~J/ Location: 2340 Hwy 12 Baldwin, Wf 54002 (SE 1/4 SW 114 28 T29N R16W) 8~acres Lot f / - Parcel No: 28.29.16.424 1.) Alt BM Description = ~~ "r °~ S ~ Su.~ 3~ ~t ~ S ~S ?i ~ 7- ~ }~ v/~~r' i~~lt/r ~~•~ 2.} Bldg sewer length = ~ ~' ` ` `~ '-~~ Qlcw `' ~ G'~ -amount of cover = ?~;pr '~~ ~c ,, +t- ~~...,~~c~-~ w • ) ~ ~Z ~-p ~(~-~°~"'~-, ~- - - _.. - -- _ __ _ - -. __ ._~ -_-r. Plan revision Required? Lj Yes ~~_y? No i ~~, ' ~ ~ i j ~~C~ Use other side for additional information. __^ _!__- l _l Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ST. CROIX COUNTIT "~~ ~~"'~~`~---,~ WISCONSIN ~, ~' '~-, __ .~'~.~ PLANNING & ZONING DEPARTMENT ^~ ~~ ~~ { f N f M N ~ • ^ rn~r ST. CROIX COUNTY GOVERNMENT CENTER ~` - 1101 Carmichael Road -~ ___._~~ Hudson, WI 54016-7710 '" ~ ^•"'' ~ Phone: (715) 386-4680 Fax (715) 386-4686 ~- _~~~'` November 30, 2004 Harvey Hielkema 540 Summit Circle Baldwin, WI 54002 RE: POWTs Installation Inspection for 2340 Hwy. 12, Sanitary Permit #463094 Location of Property: St. Croix County, Wisconsin Municipality: Baldwin Township Subdivision or Plat: 80-acre parcel, part in SE1/4 of SW 1/4 Certified Survey Map: Section 28, T29N, R16W Lot Number: N/A Address: 2340 St. Hwy 12 Dear Applicant: A septic inspection of the above referenced property was conducted on October 28, 2004. This property is located in the SE1l4 of SW '/A of Section 28, T29N, R16W, and is part of an 80 acre parcel. At the time of the installation inspection, this replacement Private On-site Wastewater Treatment System (POWYS) was found to be code compliant for a three (3) bedroom home. The existing septic tank and drainfield were abandoned per requirements in Comm 83.33. An effluent filter has been included to improve wastewater quality discharged into the new mound system.. The inspection report and related documentation of this POWYS is on file at the Zoning Department. If you have any question regarding this system, please contact our office at 715.386.4680. incerely, amela Quinn Zoning Specialist Cc: Joe Stang, Master PlumberlPOWTS Installer file .,~.M•_. ST. CROiX COUNTY WISCONSIN zoNa~cc~ o~aRnuca~r sr. cROa ootmTY c~oveNr c~rtt~ ttot t~umittZoad Hudson,vuf scats-rrto Pi,oae: ~rts~s.ssso ~cCrtspss~sss -~~ Ta ~ ~ ~ I - 2 ~ ~~` r --~ pagex ~ ~ C~a~J Piwne: ~D 5' I~ - Cv 2 g -' _ ~(o d ~ oafe~ ~ ~ 13 D 1 ~ `f c~ D Ucgeert I~For ReYte~nr Cl Please ComcnenE t] Please Repti- L7 Please Recycle ~~P~~ ~ ~'S~/2~~~ a~ /~y~ C°~" ~ ~~ _.~--` . ~ ~. Safety and Buildings Division Cot'"S'~. ~', ~ G 1` 201 W. Washington Ave., P.O. Box 71b2 , ` «~~~~~ Madison, Wl 53707 - 7162 Sanitary Permit ttrr~ (to Q filled in by Co.) (608}2bb•3151 De artment of Commerce state planl:D. umber Sanitary Permit Application ~U ~ ~~ ~- ~ In accord with Comm 83.21, Wis. Adm. Code, pfgpppypp saoanrovide ..... Ptiv Law, ,~ t p~ ~r~ '-~ Project Addn~s (if different than mailing address) maybe used for secondary purposes 4~` t,~ 1 [. Application Information -Please Print AlhInforaaa a ~ ,3 Cl Ci' ~--( w ~ Z ~~ - Property Owner's Name _ ~ Parcel # Lot # Bock # ---~ OD Z - /D 7Q - 'Q Property Owner's ailing Address n / L~' ' ti's t~r~(1=; ,, property Location ~.~ a ~Q-7(~ ~ . S- ~U ~' ~ y„ m , ~ (.. ~' 2 L ! e.... ' '~ ' /~ S E y, ~~i., Section 2 City, State Zip Code Phone Number o ,`~,~ II. Type of Bailding (check aN that apply) ~ ~ Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms ~.~, / ~ ~~ ^ publiclCommercial - Destxibe Use ~ w ~ ^City Village j^7'owrtship of ^ State Owned -Describe Use 1(I. Type of Permit: (Check onl one box on line A. Complete line B if applicable A' ^ New System t System ^ Troatment/Holding Tank Replacement Only ^ Other Modification [o Existing System, List Previous Permit Number end Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner ~. N. T of POWTS S stem: Chee aq that a ^ Non-Pressurised In-Ground ound >_ 24 in. of suimble soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Cartstructad Wetland ^ Pressurised In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fitter ^ Recirculating Synthetic Media Filter ^ Leacbi Chamber ^ Drip Line ^ Grav -less Pi ^ Other ( lain} / V. Dis rsal/i'reatmeat Area Information: ~~ ` f Desi Flow (gpd) Desi Soil Application te(gpdst) Dispersal Area Requ' (sf) Dtspersal Area P {sf) ystart ~-- ` VI. Tank Info Capacity in ~ Total Number anufacturer b Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed G~ New E~dsting Tanker Tanks Septic or Holding T~k 1(i (>CI ~ l • C S ~ `<~ Aerobic Treatment Unh posing Chamber ~ ~ C U ~ ~ VII. Rapor~ibility $tatemeait- G tke a amtrme >hr tasttdlaHon of the POWTS shown oa the attacked tts. Plumber's Name (Feint) Plum Signadtre -~+fP1MPRS Number' B~i~ ~0~ Nm"~ / / Plumber's Address (Strxt, City, S > Zip ) ~ ' VIII oan /De rtment Use Oa s} Approved ^ Disapproved Sanitary Permit Free (includes Groundwater Date sued I mg Ag Si (N ` Surcharge Fee}$/ ?~O~ ~ ~11~~ DU ^ Owner Given Reason for Denial cJ / `/1j1 ,~ IX. Conditioner of ApprovaUReasoas for Disappry~l ~ ~ ` 1 Septic tank, effluent fll~t1e aAd"~L iY>p. ~ ~'~ ~~ / /j'~c~ r dispersal cell must all be serviced !maintained ~%t~ / ~.,` /'. ~,~. as per management plan provided by plumber. ~~~GCO"?'~- ,~~s-~ `~~' 2. All setb8ck requirements must be mafintained r~2 q~GoGtryt~yt~~'~~~~~d' 3 3 as per applicable code/ordinances. (,~;Tylitir,cl cT 7s - ~ wetaee ewaplete p4ru (to tee comfy oaar) fo. tee m~ as tom' oot lea ~ eta :11 ipdea ~ she SBD-6398 (R. 01/03) ~' ~ c e ~Cc~ vna._. .~ ~~ t 0. 0 ~: . N ~ ' C ~~ ~~ ~y ~ Est" Ta•- k ~-o~~-~ ~ w~~~ ,~~ Cx~sF~~g 3 ~~~ Sh~~t .~~~ ~- r' `__~ / ~h ~ ~~- ~ - 7 ~ .s~pf, ~/ Pu~yo ' , ~ Q slo g e-~ Lh~ -,~ bpr- \ \ \ r~~ \ ~~~ ~~~ Q~ 1~or~" ~ A ~ s~"c~r 10 \ \ Ar« ~ ~~ ~gg.3S 13.n~ ~~~`.©~ TAP o 4 `Puy P,4pe 8a `,~.1 v,3 .3 S' JO/.3S ------• C~tto,~. o~ Hour` S+c4+~.~ ~ ~ U-)o'y ~~-~ ~~ ~ Pis ~3yU -- ~~-- - ~i N~ ~ ~ --T:-- ,. ~commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 30, 2004 CUST ID No.223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/30/2006 Identification Numbers Transaction ID No. 1064351 SITE: Site ID No. 689983 Harvey Hielkema Please refer to both identification numbers, 540 Summit Circle above,, in all comes ondence .with the a enc . Town of Baldwin St Croix County SE1/4, SW1/4, S28, T29N, R16W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 982794 Maintenance required; Replacement system; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD-10572-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD-10572-P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems". • The pressure network is to be constructed in accordance with publications SBD-10573-P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135.and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the pe artment. which may include local ins ecp tors. -5~' Cc~~a~~i~t~t~~~l~,~ ~~~~~~ DEi'ARTMENT OF CJfr~fJIERGE JOE STANG Page 2 9!30/2004 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the. POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (808)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 INDEX SHEET PROPERTY OWNER: PROJECT NAME: HARVEY HIELKEMA 540 SUMMIT CIR BALDWIN, WI 54002 HARVEY HIELKEMA PROJECT LOCATION: SE 114, SW 114 , S 28, T 29 N, R 16W MUNICIPALITY: TOWN OF BALDWIN COUNTY: ST. CROLY DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6199) CONTENTS: Page 1: Page 2: Page 3: Page 4 RECEIVED Page 5 SEP 2 0 2004 Page 6 SAFETY & BLDGS DIV~I~age 7 Page 8 Name: Joe Stang Address: PO Box 263 Woodville, WI 54028 Credential Number: 223475 Plot Plan Cross Section and Plan View of Mound Distribution Pipe Layout Septic Tank Pump Chamber Cross Section & Specifications WLP1000/600-MR Zable Tank Specifications Pump Specifications POWTS Owner's Manual & Management Plan - Pg. 1 POWTS Owner's Manual & Management Plan - Pg. 2 Signed Date: September 13, 2004 DtVls!uiu ~ 'kFE- ~Y ~,t~tU tiUiLU11YG5 -_----- S~E GUI~~ SPONDE-VCE Pl~f ~~~~ .~t,~~t ~ r- a~ t~~rU~ ke' vr1a., Pa ~- ~~ ! ,~ _ ~~ , S ~l ~ c~ ~ P ~_ ~~ ~. ~ ~' - ~ Q~ ~ fig-- ~ ~. 3 ~ ~- z ~~ t a ~~ w l a '`~-, ~- ----~- ~, ~ ~ 1,Jr~_~~, F~~l ~ ~ ~~ ~ ~ ~ ~. -' ~ ~-,, ''~ ` \ ~I d , \ W ALL ~f~~~~ -~ ~ ~. --- 'C /C~~bse ~L '7 `'0 5~'~~rL~r(LA1~0 \ sio p ~ Ghc~ .,,~ bQr- C" ~ ~ \ ~\ p ~ sfi~r b ~ \ /~ r« ~ ~~ \ '~~19.35 1.3.r1. ~v. ~ ~ T~~ a 4--'` P u L Pap e ~ 8~ \F. I v~3 .3 s` (OI,.3S Qo ~ I O rti o ~Y- f -1 o ca,s t- 5 ~ c.~1 i ~ of ~ ~ ~a~/ a34v __ ~_~~ _ _ _ _ ____ _.__. ~ Nu'~ - a ~(,~% ~ P r` ' f 'V ttx'v' ~ T~1 t ~~ k. ~YVt_ cam.. Synthetic Covering AS~M C 3 Medium Sand -~ _ +,,~ CIeV. CC~3. D5 Topsoil 3 ~ ~E Page ~- Of Distribution Pipe F c f~ 0 / ~ -Ec3vr~a Elegy, /Ot~~ Force Moin From Pump `~ % Slope ,~ l.~.Of 2~- 2 i Aggregate '"' Cross Section Of A Mound Signed: License Number: Date: a `~ F"o rc e. M ~. ~ ~, F--©w. R,- ~~.~ q ~n Ft. B 7~~ Ft. K ~ .~ Ft. ~ 97.E Ft. ~} ~ F t . ~i3.2 Ft. $ Ft Plowed:, Loyer". ~r~ Zo. 0 ~~ Ft. E ~•~a Ft. F.$a2Ft. G ~ Ft . H l- Ft. (~°°""` ~o w ~~, Observation Pipe J ---•--- . --~`-- K a ~ A ~ -- -~ -----------------------------~ r_ ~ .J w ~~ ~ _ l __._ _._.._,._....._ ____ ..._. _.._ ..._ __._ _.... ~Ristribution 6)C~t_ Of 2M- 2'2' Pipe A99re9ate ~ f7 / Observation Pipe ~a5`L~ ~r~ca '~ I~YD Plan View Of Mound ,- ~. ~eQv~O~-`ter ~G `CSC f~I~ I C. I E ttv` O'-+-~ Perloroled Plp. Oeroli End Vlew P.rlora~ao ~ ;. t 1 ~~ 3 ©F~ ~~ Holes Located on Bottom are Equally Spaced 'c~ rC - N '.[~ r ~i ~~~kf -~e ~ctvi io(~tX _ ~ ~~~~ app. Signed: Discribuciy?Pe Layout License Number: Dace: 1" P 7~ ~ 5a- R 3' s 1 ~~ x ~~a ,, Y ~3 a Hole Diameter ~ Inch Lateral ,~ Incn (es) Manifold ~~_ Inches force Main " ~ Inches NoIE~sIl``~Pe-- I-a~"~~~~i 3 ~ ~a ~Gc I ~-lal~ -= 7 ~o j1 ~'' ~ I k ~ rn a v Page~Of .~ .~ 1 v~ ~ r , . ~ c~~ SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 " .RUC. V ENT PIPE 12 " MIN . ABOVE GRADE E WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER c~} C - ~Iz~' W/ PAD LOCK 8 rou-.~ ~ • WARNING LABEL C ~, 3 - Q / C _.,}_._ y " MIN . 2y" 18" IN . ~ S•D• ~ a ~~1 t8 MlN• INLET " ' WATER TIGHT SEALS .. T 1 . ~ ~ GAS- , ,~ T /APPROYEO FI4TER A ~ ' SEAL ~ JOINTS KITH APPROVED ~~ $E~ ~-~ ~'~' -~- ' ~ ALM APPROYEO PIPE P t P E 3 ' (a "x ~ 6'' B "F-' ~ ' ~ ON 3' ONTO SOLID SOIL ONTO SOLID C 1 1 SOIL PUMP OFF ELEV . S FT. 9~ -t- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: ~eSe.C- ~ 3'3 `l X s. ~ ~'l°` 7 ~'~;'• TANK SIZES: SEPTIC iDCC~ GAL. DOSE VOLUME INCLUDING DOSE („~-,~-, GAL. ~^.S~ G~I~~FLOWBACK: 7.3.~~ GAL. ALARM MANUFACTURER: 5., ~ v° S 5~-e,,,,~APACITIES: A = 'LS • INCHES = 0~6~ GAL. MODEL NUMBER: SWITGH TYPE: Mt~YCU.v'ti_ cx~~ B = 2 INCHES =~3t-~-~ GAL. PUMP MANUFACTURER: ..~,~ , C = ~ INCHES = /L~~S~ GAL. MODEL NUMBER : 3571 E ~ Ii F SWITCH TYPE: - ~~ D = /D INCHES = ~67_,,~r~-L. REQUIRED DISCHARGE RATE ~J~/!o GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICA L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIFE ~O~ FEET MINIMUM NETWORK SUPPLY PRESSURE f,~.S' FEET _~ FEET FORCEMAIN X ~•~ FT/100 FT. FRICTION FACTOR 1~.~-FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID b~P'Y`H-_~ " • S IGNED: LICENSE NUMBER: DATE: 1/88 /1 c-~_v ' 150' ~,r,,~i ~ `. ~{I i TOP VIEW SCALE: 1 /4` = 1' 9 VLfV 1 J n/I. ri .> OUTLET INLE7 iD '~ ~ ~ ~ N ~ ~ M 3" s n SIDE VIEW scALE: 1 /a` ~ 1' 5 ~ s- WLP1000/600-MR ZABLE TANK SPECIFICATIONS DIMENSIONS: WALL: 3` BOTTOM: 3" COVER: 5" MANHOt_E: 24" I.D. HQGHT: 56" O.D. LENGTH: 150' O.D. WIDTH: 84` 0.0. BELOW INLET: 42' O.D. LIQUID LEVEL: 36' WEIGHT: 14.795 LBS. fNLET ANO OUTLET: 4` BORE WITH STOP FOR QUIK-T1TE, FERNCO GASKET, CAST-A-SEAL HOOT OR EQUAL INLET AND OUTLET BAFFLES: YASCONSiN, SEE DETAIL X10 (OTHER STATES SEE CHART} LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC) 16.76 GAL/IN (PUMP) LOADING DESIGN: 7' 0" UNSATURATED SOIL ~~~Q C~OaC~Q~~C~ warn us nwr Io, MaoEw Rock, ~ s+~so 800-325-8456 MODEL W1P1000/600-MR ZAHLE SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON } JANUARY, 2000 n~ r. µ~ ~~nn.• <.~•r _,~r Submers b Effluent Purnp METERS FEET 8 7 0 6 U g 5 a Z ~' 4 Q O 3 F- 2 1 0 25 1 10 5 . MQDEL:3871 DS SIZE. 3/4 SOL! . RPM:1550 . H P: 0.4 00 10 20 30 40 50 urm 2 4 6 8 10 12 m'/h 0 CAPACITY ~GOULDS PUMP: se~u,~us ~w Euoarr• oaobu, i gee SPECiFlCA710NS AAE SUBJECT TO CHANGE yy(fHOUT NOTICE PRAfTEO ~ V.$~~ ~1~GE~~ ~' ~°` 1501 ~ ~ OIL'!EYALUATION REPORT Page 1 of 3 Wisconsin Department of Com ` ce t. -5 ~_(111~ Division of Safety and Buildings SE In accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. t i ~ i 'Pl J` ~~4 ~1 County an mus Attach compleke s ~ te plan on r notes~ t > n s~. l St. t.ir01X include, but not limited to: verb I and t~r ~~ttilfe 6M), dinction and ' Parcel I D percent slope, scale or dimems n location and distance to nearest road. . . Q ~ ~ f o.7~ ~ ~ ~~, Please print al! information. - Dat i v e Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (mil• 0 t0 f7 Property Owner Property Location Hielkema, Harvey Govt. Lot na SE 1 /4 SW 1!4 S 28 T 29 N R 16 W Properly Owners Mailing Address Lot # Block # Subd. Name or CS 540 Summit Cir, na na 80 Acres City State Zip Code Phone Number City Village V; Town Nea Baldwin ~ Wt 54002 715-684-2850 Baldwin Hwy 12 New Construction Use: yi Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD /; Replacement Public or commercial - Describe:na Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable na General comments and recommendations: Mound Design, system elevation 102.44ft based on contour fine elevafon 7~ ~ ~ ~ r ~~• ~ ~~u ^ Boring # Boring Pit Ground Surface elev. 102.00 ft. Depth to limiting factor 20 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10yr3/1 none sil 2msbk dfr cs 1f .6 .8 2 13-20 yr4/4 none sic! 2msbk dfr gw na .4 .6 3 20-48 5yr4/4 c2d 7.5yr516 scl/sl 2msbk mfr na na .0 .0 Boring # Boring Pit Ground Surface elev. 102.00 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/1 none sil 2msbk dfr cs 1f .6 .8 2 7-18 10yr4/4 none sic! 2msbk dfr cs na .4 .6 3 18-26 5yr4/4 none scl 2msbk mfr gw na .4 .6 4 26-48 5yr4/4 c2d 7.5yr516 scl om mfr na na .0 .0 'Effluent #1 = $ODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TSS < 30 mglt_ CST Name {Please Print) Signature CST Number David J. Steel 248956 i Address Steel's Soil Servi nc._ Date Evaluation Conducted Telephone Number it 994 200th St., Baldwin, WI 54002 9/3!2004 715-684-5680 i Property owner Hielkema, Harvey Parcel ID # Page 2 of 3 Boring # Boring / Pit Ground Surtace elev. 100.10 ft. Depth to limiting factor 22 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/1 none sit 2msbk mfr cs 1f .6 .8 2 11-22 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 22-48 5yr4l4 c2d 7.5yr5l6 scllsl om mfr na na .0 .0 ^Boring # "Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # 'Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Snit application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David 3. Steel CST-POWYS Lic. #248956 Harvey Hielkema SE1/4,SW 1/4,S28,T29N,R16W Town of Baldwin, St Croix Co. 994 200th St Baldwin, WI 54002 Bus.(715) 684- 5680 Fax (715) 684-3449 Legend 1" = 40' • =Benchmark Ele. 100.00ft Top of 3/4"PVC Pipe • =Alt Benchmark Ele. 100.45ft Top of 3/4" PVCPipe ^ =Borings Boring Elevations B 1 = 102.OOft B2 = 102.OOft B3 = 100.1Oft B4 = OO.OOft ~, . el/ S~ ~~ -s ~ 1~~~-y ~z .e~ 'Z..' '73.~ +~,~ ~`...~~~ ~~~t.'~`~'~~`,l ~~'~.-~~``~ ~`i..~t~ Cry. e.. . 'rr'tztz~tiia~:z r~:~uireci s' _. 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'.:., ` ~ • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _~ of _~ FILE INFORMATION Owner I-IARVEY IzIELKEIj1A Permit # ~~ ~ O nrc~P!1~1 DAQAMCTCQC Number of Bedrooms 3 ^ NA Number of Public Facility Units CX NA Estimated flow (average) 300 gal/day Design flow Ipeak), (Estimated x 1.51 450 gal/day Soli Application Rate (~, al/day/ft2 Standard Influent/Effluent Quality vlo ly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (RODS) 5220 mg/L ~t Total Suspended Solids lTSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~ NA Fecal Coliform (geometric mean) _<10' c 100rn1 Maximum Effluent Particle Size Y~ in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. ovorcnx cuGr•rcrr•eTrnNc Septic Tank Capacity 1000 al O NA Septic Tarrk Manufacturer WIESER CONCRETE ^ NA Effluent Filter ManufacturerZA$EL ^ NA Effluent Filter Model A-100 12rr x 20rr O NA Pump Tank Capacity 6U0 al ^ NA Pump Tank Manufacturer WIESER CONCRETE ^ NA Pump Manufacturer GOULDS PU1v1PS INC ^ NA Pump Model 3871 EP0411F ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ®NA Dispersal Ce(lls) ^ NA ^ In-Ground (gravity) ^ I - and (pressurizeN 1 ^ At-Grade C~Mound ~ Z~ ^ Drip-Lint; ~ 5 ` Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency ever : 2 ^ monthls) {Maximum 3 years) ^ NA Inspect condition of tank(s) y At least once ® ear(s1 Pump out contents of tank(s) When combined sludg e and scum equals one-third (Y3) of tank volume ^ NA er : 2 ^ month(s) (Maximum 3 years) ^ NA Inspect dispersal cell(s) y At least once ev p years) ® monthls) ^ NA Clean eff{uent filter At least once every: 13 ^ year{s) ® month(s) ^ NA Inspect pump, pump controls & alarm At least once every: 13 ^ year(s) ^ month(s) ^ NA Flush laterals and pressure test At least once every: 3 Q year(s) ^ month(s) ^ NA Other: At least once every: ^ year{s) 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 tanks) 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 cell{s) 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 IY3) 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 limited 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. GMW (4/01) Yit+1NER t i-IAYVEY HIELKEAiA Pape ~ of,~ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process andlor 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) in one.large dose, overloadlrtg the Cell(s) end may resultln the backup or surface discharge of effluent To avower to the effluents ump o ncontad a Plumber' of P0111?S Meln~lrter to Septage Servicing Operator prior to restoring po P assist in manually operating the pump conVols to restore normal levers within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb ~ romped, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elfmInation of the following from the wastewater stream may Impro a 9e~o aan~ ~ ~~~ of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; asolNe, greases, herbk~dea; meat disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; g scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brute. ABANDONKlVIENT 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 stately abandoned In compliance with ch. Comm 83:33, tNisCOnsln'AdrttlniSVatlVe Code: • All piping to tanks and pits shall be disconnected and the ab er1 ~ sdosed of b a Se to a Servicing Operator • The contents of all tanks and pits shall be removed and prop y P y P g After pumping, all tanks and pits shall be excavated and removed or their covers removed and the vokl space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN it the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a e compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location Of a replacement SoU absorption system. The replacement area should be protected from disturbance and compactlon,and should not lot tines rind wells. FaUura to be infringed upon by required setbacks from existing and proposed structure, protect the replacement area will result in the need for a new soil and site evaluation to estabUsh 8sttltabie replacement area. Replacement systems must comply with the rules in effect at that time. p 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 felled POV1fTS. The site not been e d to identify a suitable replacement; area Upon faDure of the POWI'S a soU and site v uati mu a perform d to to s ' ble re men If nor cement area IS evaUable e ho! g tank may be installed as a s resort to replace the failed PO the infiltrativets rface.oReco sWctionstof su hasystems must comply wlith the N es In effect at that t(rTte~. tat :<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIORINSUFF1ClENTOXYO DO NOT ENTERUESOF Al PERSON FROM THE 1NTERIORNOF A TANK MAY BE D F,FlCULT OR MPOS 1Bl.L. MAY RESULT. RESC aDDITIONAt COMMENTS ~O`NTS INSTALLER Name STAND YLIIhIBING & ELECTKI Phone 715/684-5166 POWTS MAINTAINER Name •Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORYAUTHORI7'Y Name ABC SEPTIC SERVICE - i'iENOi`i0i~1IE A9encY ST CROIX C a Phone ~ _ Phone 715/235-1666 1 7nis document ~s drafted by the starts of the Green Lake, Marquette and Waushara County Zonlnp and SanKaUort ip~~ 1T>It dOCWt~~rlt rn00fi the minimum reQUirsments of ch. Comm 83.22(2)(b)(i}(d)3(t) and 83.54(1), (2) 8 (3}, yyLsconsanAdmlt><stratlva Coda. Use Of tilt doetunsntd0a A0~ guarantee the periorrnancs of the POV/'fS. Gr~AVN~ti U. 2612 P 610 1 STATE 8AR OF WISCONSIN FORM 2 - 2000 Document Number WARRANTY DEED This Deed, made between Francis G. Dees and Ruby W. Dees, husband and wife, as joint tenants ____ Grantor, and Karvey N. Hieikema and Suzanna H. Hie(kema, husband and wife 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:) Southeast Quarter of Southwest Quarter (SE 1/4 of SW 1J4) of Section Twenty-eight (28), Township Twenty-nine (29) North, Range Sixteen (16) West. SUBJECT TO an easement for ingress and egress over the West bb feet thereof, in favor of the holder of record title, their heirs, successors, and assigns, of the Northeast Quarter of the Southwest Quarter (NE 1J4 of SW 2J4) of Section Twenty-eight (28), Township Twenty-nine (29}North, Range Sixteen (Ib) West, and provided, however, that said easement shall become effective only upon default and foreclosure of a Land Contract of even date between the parties conveying said Northeast Quarter of Southwest Quarter (iVE t/4 of SW 1/4). Said easement shall be of no effect upon ful! satisfaction of said Land Contract. -7Ea8~~7 KATHLEEN H. IiALSH REGISTER OF OEED5 ST. CROIK CO., wI RECEIVED FOR REC~RO 07/0912004 10:30AM l(ARRANTY DEED EXf19pT it REG FEE: 11.00 TRANS FEE: 465.0@ CDPY FEE: CG FEE: PAGES: 1 Recording Area Thomas A. McCormack Attorney at Law PCJ BOX 2120 Baldwin, WI 54002 402-1074-60 Parcel Identification Number {PIN) This is ~ homestead property. (is) ~istmcri(i Exceptions to warranties: Easements sad restrictions of record. Dated this ___- ~~~ _^__ day of _ ~,~_ , 20Q4 ' ~ ~ ~ ____ ~~-~ /. / . res-~1 * Francis G. Dees ._ _._~ _ _ D O_.~ ®,~ * Ruby W. D AiJTHENTICATtON ACKN©WLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. St. Croix __,____ County } authenticated this day of y ~,~ Personall came before me this day of .___._._____.________._.________.____.._..___.__ ~ _ __ , 2004 _ the above named T" Francis ees and Ruby W. Dees _ _ T1TLE: MEMBER STATE BAR OF WISCONSM .____._ _ ___.___ __._.__ _ '~ ~ th ~T b h k c ~ ~ `.._'_•~~_. '? (If not e e pe to me nown m n(s) o exe aang , authorized 7(16.06, Wis~5tats. instrument and acknow dged sat~~t~.•'' -~ ~'~"f, '~. THIS MSTRt1MENT WAS DRAFTED BY * _-~'~__ .,._ _ _ • ~ ~ ~-~: ~ "' Thomas A. McCormack _ _- . State of WISCON31N+ ' O.;_~ ;~ Notary Public .,. ~`'"~ Baldwin, W t 540 02 , Ivly Commission is permanent. (If no~ta i(iri c~te:-~ . _ __ _ __ ___ tSignaiwes may be authenticated ar acknowledged 6ot}t are not necessary.) ~___._._.___._._._._.____...____..~_.._.:_,,~~~ ~ ~ `~ ~) * Names ofpersvns signing in any capacity must Be typed or printed beivw their signature. ''~'^~...,~: ~ STATE BAR OF WISCONSIN ~w WARRANT2' DEED FORM No. 2 - 2400 INFO-PRO (800)655-2o2t www.intoproforms.com Parcel #: U~2-~ ~7~-s~-200 01/31/2006 11:26 AM PAGE 1 OF 1 Alt. Parcel #: 28.29.16.4278 002 -TOWN OF BALDWIN Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11 /23/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -WILKINS, HAROLD F HAROLD F WILKINS C -GJEVRE, BRYAN P BRYAN P GJEVRE 2340 HWY 12 BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 2340 HWY 12 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres; 5.001 Plat: 4883-CSM 19-4883 002-04 SEC 28 T 29N R16W SE SW EZ-U-1182/179 Block/Condo Bldg: LOT 0 1 CSM 19-4883 LOT 1 (5.001 AC ) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-16W SE SW Notes: Parcel History: Date Doc # Vol/Page Type 12/09/2004 782027 2711/345 WD 11/23/2004 780790 1914883 CSM 07/09/2004 768297 2612/610 WD ~nn~ c~ ~nnnneQV Bill #: Fair Market Value: Assessed with: 87199 159,600 Valuations: Description Class Acres Land RESIDENTIAL G1 5.001 12,400 Totals for 2005: General Property 5.001 12,400 Woodland 0.000 0 Last Changed: 05/19/2005 Improve Total State Reason 90,100 102,500 NO 90,100 102,500 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code 010-GARBAGE Category SPECIAL ASSESSMENT Amount 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 Parcel #: 002-1070-95-000 02/01/2006 08:47 AM PAGE 1 OF 1 Alt. Parcel #: 28.29.16.430A 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 CaOwner ROBIN T,&BONNIE A RINGER BURMEISTER O -BURMEISTER, ROBIN T,&BONNIE A RINGER 2354 HWY 12 BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 28 T29N R16W SW SE EXG W 300 FT OF S Block/Condo Bldg: 721 FT & EXC THEE 1/5 OF THE SW SE Tract(s): (Sec-Twn-Rng 40114 1601!4) 28-29N-16W Notes: Parcel History: Date Doc # VoUPage Type 07/23/1997 1099/495 WD 07/23/1997 1098!222 LC 07/23/1997 967/180 07/23!1997 898149 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 87204 Use Value Assessment Valuations: Last Changed: 06128!2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 26.000 3,100 0 3,100 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 27.000 3,200 0 3,200 Woodland 0.000 0 0 Totals for 2004: General Property 27.000 3,200 0 3,200 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 St. Croix County Zoning Tuesday, November 30, 2004 at 8:01:26 AM Detail Sanitary Information Page 1 oft Computer #: 002-1070-60-000 SublPlat: 80 acres Section: 28 Parcel #: 28.29.16.424 Lot: TN/RNG: T29N R16W Municipality: Baldwin Township CSM: 1/4 114: SE 1/4 SW 1/4 Owner: Dejong, Dave 2340 Hwy 12 Baldwin, WI 54002 State Permit: 112677 Issued: 06!22/1988 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 08/0311988 POWTS Detail: Bed (seepage) Bedrooms: 3 WI Fund: yes POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Reauirements Additional Notes Money Owed Tom Nelson NA Hudson, Dale $0.00 Signed Off; Yes /~ IJ~~ „ „ t ~,.-~~A/ ~/ Owner: Hielkema, Harvey 2340 Hwy 12 Baldwin, WI 54002 State Permit: 463094 Issued: 10/06/2004 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 10/28!2004 POWTS Detail: Bed (seepage) Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Mark Iverson (contr NA Stang, Joe $0.00 Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 10/28/2007 DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7969 MADISO~1 WI 53707 SW~,SE4,528,T29N-R16W Town of Baldwin HiQhwav 12 INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS CONVENTIONAL ^ALTERNATIVE ^ Holding Tank ^ In-Ground Pressure ^ Mound SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING State Plan I.O. Number: III assigned) NAME OF PERMIT HOLDER: Dave DeJong ADDRESS OF PERMIT HOLDER: Route 1, Baldwin, WI 54002 INSPECTION DATE ~' ~° ~$ 1 _ 3~ BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale E, Hudson 6629 St, Croix 112677 MANUFACTURER: / (/ LIQUID CAPACITY: TANK INLET ELEV.-. TANK OUTLET ELEV.: WARNING LABEL PROVIDED: ^YES ^NO LOCKING COVER PROVIDED. ^YES ^NO / BEDOtNG-. VENT DIA.-. VENT MATL.: ~ HIGH ER NUMBER OF ROAD: PROPERTY WELL: BUILDING. jVENT TO FRESH AIR INLET FEET FROM LINE: ^YES ^NO Y S ^NO NEAREST DOSING CHAMBER: V I MANUFACTURER BEDDING LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFA TIIRER WARNING LABEL PROVIDED: LOCKING COVER PROVIDED: YE ^ / ~d f{ 3,~gs / ( YES ^NO YES ^NO S NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: ,T NUMBER OF PROPERTY LINE WELL BUILDING VENT TOFHESH AIR INLET WEEN ~ D I OM f `~ 7 S~' 7 ~ .f 3 MP ON AND OFF P U YES ^NO NEAREST " ` 0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing construction shall cease until (lf soil can be rolled into a wire or excavation FORCE LENGT ~~ DIAME rER MATERIAL AND MAR L/ J KwG , . MAIN ~ T the soil is dry enough to continue.) nnwt\ecwrTlllwrwl cV CTCwA. v V WIDTH: LENGTH. DISTR. PIPE SPACING IN':IUE DIA aPrtS L70UID BED{TRENCH TRENCHES. MATERIAL: PIT DEPTR DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ARUVE COVER. ELEV. INLET ELEV. END'. PIPES FEET FROM LINE AIR INLf.T NEAREST- --- Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ES ^NO SOIL COVER TEXTURE PERMANENT MAHKf RS YES ^NO OBSEH VA TION WELLS ES ^NO DEPTH OVER TRENCH/BED CENTER DEPTH OVER TRENCH/BED EDGES. /• ~ DEPTH OE TOPS ~ SODDED ^YES NO SEEDED YES ^NO MULCHED YES ^NO 'RESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACI BED/TRENCH D Q iJ , / ~ 7 TRENCHES: ~ IMENSIONS r MANIFOLD PUMP MANIFOLD DISTR. PIPE ELEVATION AND ELE V. ELEV.: DIA.: ^ ) ELEV.: DISTRIBUTION ,..C INFORMATION HOLE SIZE HO LE SPACING GRILLED CORRECTLY ~~`~ L al ~ S~ YES ^n .OMMENTS: PERMANENT MARKERS: OB: YES ^NO I / /~ l LLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATE HIAL & MARKING 7 v Fs ~ DIA.: / U COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS O ^ YES NO DN W ELL&. NUMBER OF PROPERTY WELL: BUILDING ~'/~- 1Yvcc l~ntn FEET FROM IUF ARFST uN~3 ~ SOS /2Q Sketch System on Reta' in county file for audit. Reverse Side. SIGNATURE. TI LE. DILHR seD s7fo IR. ov62) _ ~~ Zoning Administrator {~, ~-°°~ SANITARY PERMIT APPLICATION ~ILHR COUNTY j~D f ~ LI Code Adm Wis 05 In accord with {LHR 83 ~ / ' . . . , .~...a ~......,.,....,o,. STATE SANITARY PERMIT # ~i a~ `~ ~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'h x 11 inches in size. g $ _ ~~ a / -See reverse side for instructions for completing this application. PETITION ((~~ ^ 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. YES LL~J NO FOR VARIANCE PROPER OWNER Ave. ~e, ON PROPERTY LOCATION .Sw'/4S'E'/4,S ~~ T~9;N,R/~ E(or)~' PROP TY O,~NE('S MAILING AD RESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME j - (~~(F- CIT ATE W ZIP CODE ~ PHONE NUMB~jE ~ ' S CITY NEAREST OAD, LAKE OR LANDMARK VILLAGE : ~RL ~W/i 7 /-L /A l Z S g cAJ /.J p0 Z d 7f . c c o fl. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family - ~ OR ^ Public (Specify): III. PURPOSE OF APPLICATION: {Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. ^ New b. ~ Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an System System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previously issued. Permit # Date Issued 3. ^ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ^ The System is shared by more than one ownerlbuilding. Attach Common Ownership Agreement to County Copy. n #1 and only one in #2) i IV. TYPE OF SYSTEM: (Check only one ~~ yy 1. a. ^ Conventional b. V`J Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ~ Mound f. ^ IGP In-Fill Tank P TION SYSTEM INFORMATION: (Check one) V. ABSOR v f 1. a. Ic! See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: per inch): (Minut es REQUIRED (Square Feet): PROPOSED Square Feet): ~ ~~ JJ -7' ~ ~ 7 tP ~ ~ ~~~ 7.~ Feet Private ^ Joint ^ Public VI. TANK CAPACITY in allons Total # of f ' N M t Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks ame ac urer s anu Concrete glass App Tanks Tanks structed Se tic Tank or Holdin Tank ?'~~ DOD j ee S Lift Pum Tank/Si hon Chamber )( r,d~0 (~(>6 ~= $ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for. installation of the private sewage system shown on the attached plans. Plumber's Name (Print): a ~ ( ' Plumber's Signature: (No Sta ps) MPJMPRSW No.: ' t ~ ' ~ Business Phone Number: ~ d ~ , f ~,~ t, ~ ~ o ~a y ~.~.~-~.... trJ P IJa~. . . ~ ~ -33 ~~' Nam f Designer: mber's Address (Street, City, State, Zip e): Plu 11 d 0 ~ D ~ f4 ~ +'J ~~ ~ t~/ ~ C.aJ 1 S ~~O O Z. G VIII. SOIL TEST INFORMATION q ~.. c ~ So sU Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: ~5' d 'hl~ i L /Q ,~~ ds d.v, c,J,'S S'~o ~.~ i S ~~6 - ~/ 8 s+ IX. COUNTY/DEPARTMENT USE ONLY Approved Disapproved ^ Owner Given Initial Sanitary Permit Fee ~1 !, ~ ~ Groundwater charge Fee ate `~ p~ l Iss ing Agent Signature (No Stamps) u'~ ~ ~ ,, " ~ ~~o ~'` ~ Adverse Determination • `- L - X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb-67) (R. 03!86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2: Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code wilt be applicable; 3. AtJ!'revisions to this permit must be approved by the permit issuing authority. A new perri~t may be needed if there is a change in your building plans, system Location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399). to be submitted to the county prior to installation; 5. Private sewage systems must be properly-maintafned:.The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; I1. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check al! appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; Vl. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, liftlsiphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g: . MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if appiicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C} complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E} soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more ~_ ~~ commonly known as the groundwater protection law. This change in statutes was the ~ result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Water -~~--~ included the creation of surcharges (fees) for a number of regulated practices which WiSCOrt~in's can effect groundwater. The surcharge took effect on July 1, 19$4. All of the water that buried reasure ~ ~ ~ is used in your building is returned to the groundwater through your soi! absorption ~ o ~~ system or the disposal site used by your holding tank pumper. L The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC- 100 This application form 1a to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance.' Should this development be intended for resale by owner/contractgr,("spec house"), then a second form should be rer.air.ed and ccmpleted when the property is sold and•aubmitted to this office with the appropriate deed recording. Owner of Property ~-Q c~ ~'~ ~n CL ~ff f r ~~° ~Q~4 • ~---- Location of Property ~~ •~~ fit, Section ~. , T ~ N - R ~~ W Townahip~ / W:, ~ ~ S ~ ~ D ?Sailing Address ~ ~x 53 ~ ~ ~ ~~, -~ 4~f~, S`%00 Subdivision Nama ` N/~" Lot Number /(/~ ' Previous Owner of Property ~v r? c~ ~~~ !V ~ ~s~/? Total Size of Parcel .~ ~~ ,~~~~' Date Parcel was Created • Are all corners and lot lines identifiable? ~_„ Yea No Is this property being developed for resale (spec house) ? Yea ~ No Volume ~ ~~ , ' _ and Page Number .__rP_~ ._ as recorded with the Register of Deeds • INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty•Deed 2. -Land Contract • 3.• Other r.eeordinga filed with the Register of Deeds Office In addition, a certified survey, if available would be helpful so se to avoid delays of the reviewing.procese. If the deed description references to a Certified Survey Nap. the the Certified Survey Map shall also be required. , .y PROPERTY OLUNER CERTIFICATION i (G!e) eenti.6y Mutt a.CL d~atemente on ~h,t.6 6onm cute cue ~o •the 6es.t o~ my (oun) , hnowPedge; ~ha.t 1 (we) am (cute) the ownen(b) 06 .the pnopenty deae~ri.bed .in •thib ~.n6onmation ~onm, 6y v.clitue o6 a wanh.a.n~y deed neconded .~n the 066~,ce o6 the .,County Reg.t.a•teh o6 ~eed~a as Doeument No. •Z~ Q and ghat 1 (we) pneaen~Cy own .the pn.oposed a,cte fan ,the sewage poaa~ays.tem (an T (we) have ob~,i,ned an eaaer~ent, ~o .nun with. the above desen.i.bed pnopen,ty, bon the . conaxicccetc.on o6 bai.d ayb~em, and the same has been du.Cy neconded .~n .the D~d.~ee • ~~ 5 .the Cocui.ty Reg•i,6.teJr. o ~ Heeds , ab Do eume-tit No . J . L -~ :SIGNATURE OF OWNE SIGN URE OF -OWN (IF APPLICABLE) DACE SIGNED ~ DATE SIGNF.'~ APPLICATION FOR SANITARY PERMIT . STC- 100 This. application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit. iasuance.~ Should this development be intended for resale by owner/contractgr,("spec house")~, then a second form should be retained and completed .when the property is sold and•aubmitCed to this office with the appra;:riate deed reco~dinE. Otmer of Property ~~ bona v~~ cane ~~ .~ Location of Property ~rlt ~_lt, Section ~. , T ~ N - R ~~ W Township ~ ~C~; ~ ~/' S ~ ~ ~ ____~ -- Mailing Address ~ ~ 532 .D4,~,%~ ~~,~ S~IOOZ Subdivision Name /V~ Lot Number ~~ -- Previous Owner of Property .tea rl t,~ ~ra' /V~ /.5~~/7 _ _ Total Side of Parcel ~ ~C -~~,~ Date Parcel was Created • .. ~. .Are all corners and lot lines identifiable? ~ Yes No Is this property being developed for resale (spec house) ? Yes _~ No Volume '~'~~ wand Page Number ~~c~.,_,_ se recorded with the Register of Deeds INCLUDE WITEE THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty~Deed L 2.Land Contract .. , 3.• Other r.eeordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the raviawing,procese. If the deed description references to a Certified Survey Map;•Che the Certified'Survey Map Shall also be required. ~}. PROPERTY OtUNER CERTIFTCAT70N i (GIe1 eenti.sy ~.h.at a.Q,P, a~cxtemente on ~hi,a 6onm ane .tJuce .to .the. 6e.~~t o~ my (oun) , • hnow~.e.dge; ~ha.t T (wel am (cvicel ~h.e owneh(G J a6 .the pnopenty debeh,i.bed .in .th,ib .i,n~onmat<,on ~onm, by v.vctue o6 a wa~.a.,tity deed neconded .bn .the Cd6~.ce o~ .the .,County Reg.i,a~e~c o~ ~eeda as Document Na. •~~" q ;and .that T ~(wel pneaen~y own .the pnopoaed d.ite ion ate sewage pod bya#em (on T (wel have • o6xai,ned an easement, #o .nun with the above dese~c.i.bed pnapenty, bon the cort.b#h.uett.on od eai.d.aya.tem, and .the dame ha.s been du,fy neeohcfed .in the 066.~ce • o ~ the County Reg.i,a.telc o 6 Deeds, as Document No , 1, SIGNATURE OF OWNS SIGN URE OF -OWN (IF APPLICABLE) ~~22- $~ .DATE SIGNED, BATE SIGN~'1 rl'~115 D@@Cj., made between ..DOI1ald G,t_-•N~1S-q}~___~/__S/..~... .._.. ..DQx~~~•.~._Ns~son,.. a.. single..person ....................................... ...............:......_.:......_.:...._.....---..:_.....---•---•----------.._....-------•---....., Grantor and...I~aV 7.5~._L.._..l~C:sTOriq_..1Tld...'~CC x~....Tr.....A@s70i1~~ -.-• .............. .hia,s.b~ns~...and.. ~ta.~s.~._:Sure.i.~rnrship..Marital..Propezty :: ....................................................:..:....................:.............----.., Grantee, W1tI1@SS6tli'1, That the said Grantor, for a valuable consideration...... conveys to Grantee the following described real estate in ...__~:~.r...CY:~.?.==........ County, State of Wisconsin: W 300 feet of S 721, feet of SW~ of SE4 of Section 28-29-16. 7HI8 SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE ~. ST. CROIX CO., WiS. ' ReC'd. for Record this. 19th f doy of MaY A. D. 19 s ~ ~, ~_ . 8:30 A~ ~ -. James O'Connell ~. !w I /w' rr~QDq~~ Q~ ~ '; ~~ WQX~eputy i. RETURN TO .. Tao Parcel No :................................... ~ ~ This .:.:..•._.1.5 .............. homestead property. (is) (is not) Together-with all and singular the hereditaments and appurtenances thereunto belonging; And.._:._.~~.1=s~..Z1:~Q~ ...............................•-• - - - ....._..---.._......................---..............._..... warrants that the. title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. AUTHENTICATION Signature(s) ...........................................................• e authenticated this .._.._..day of ........................... 19__._._ TITLE: MEMBER STATE BAR OF WISCONSIN (If not Dated this ....:------------------15-t h---- ...... MAY................................., 19. $ 7... .._......... day of -•-• ............... ---.....(SEAL) ......_ ~~t~......~-.c.~.....(SEAL) * :...: .........................••-----..............--•-••-----••-- * --AQn.~7.d..G,...Nei..~on_.......:.....---........ ............................._....................................... (SEAL) .._..............._....._........................................... (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ~ ss. ;,St . CrOlX -,_._-__,-..County. Personally came before me this ....1 5 t h____day of .....................~'Is3.y.:...._•---._., 19.3.7... the above named ._Dana.1.d.-G-•---~.elson--•-•--------------------------•----•-- authorized by § 706.06, Wis. Stats.) to me known to be the person ...._......_ w31o execut~dzthe foregoing m ument and ac~no~_ ge t e ;f-e. ~ ~ c.. i;~ THIS INSTRUMENT WAS DRAFTED BY ~/ (J /~J~ f ., i ~ ~•~ ~• ~ '~ _ ~`_-~ ......John..~.:...Nes.~~q~.~1~....A:f~t~t ................... ,~._. .Brent W__ernlund ........ ~~ .•......J~ . .. ,I L lrv~~t - Baldwin,. Wisconsin-__5!~.QQ-~__„____-_._-,_- ~.lotary Public .. ....5~....~xo.7,x ~t'~int~4 ,is. ' (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state eicpiratlon ~~ are not necessary.) March 19 8 9 ' date : ....................................~..........._......_, 19.........) ~ ~~ *2lamee of persona aiEntn9; in any capacity should be typed or printed below their ai¢natures. ': i _..__.~_...__....~.~._,.~,__ .. .. 1' H.C.MIIIarCompeny~ Y.1•.u W 1. STATE BAR OF WISCONSIN FORM No. I - 1982 Stock No. 13001 This Deed, made between ..Donald-- G.:-- N~~~-QD....~./..5~.~.-. ..DQx~~ld_.Nelson,.. a._single--person........---••-•---• .................... .. ----••----•-•------•--••---•--------•---••---•-•---••--------------••--•----...---•---•-•----.., Grantor, and---.Dava.sl..b.....DeJon~ --~x~d...'~e~X'~....~I.,...AeJori~, ..----•----•------ .hla.s-b~n~l.'-a.n.d-.Utz:fe.~--.Sure.i~rs~.rshig--Mari.tal-.Erape~ty ...--•-•-•---•----..__..--•---------•-•---------------••----•--•-•----•-•-•-•--...---....------..., Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... .-----•----------------------------------------•----;..-----•-------••-------••----~-:-:---Croix conveys to Grantee the following described real estate in ...._ _t--..•-----------------•-. ~ County, State of Wisconsin: W 300 feet of S 721 feet of SW~ of SEa of Section 28-29-16. _. __ THIS BPACE RESERVED FOR RECOROINO DATA REGISTERS OFFICE ST. CR01X CO., WIS. '' ReC'd. far Rewrd this_ 19th l doy of May A. D. 19 s 7 ~ ~ 8:30 A ~ -~,.-__ James O' Connell j ~ la ~1 Os i ~~1 ~~Deputy `' '~ i RETURN TO Tax Parcel No: _.....__._ .............•-..._...... $~~ This ....._.._~.5 .............. homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And......GI`~~..I~~4.~.-•---...------•---••-•-•-•-•----- - - -...._ .................•---•--••---••------ --••--•-•-••---•---••-•--•--........ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this ....-...--_•-.-•--..-..15_th --...... day of -• ...................•-.. .~'Iay...-...........--•--•-•--......., 19.87-.. ----•--••---(SEAL) .---...- G~t..../`r~...-...-~.J .~..e.~._._..... (SEAL) I '~ ------------ * ._J?Q~?_?~dd-.~,...Ne~,,son ......................... ....................................••---.......------.(SEAL) -•-- -----...-..---•--..._.-...--.......(SEAL) AUTHENTICATION ACKNOWLEDGMENT i i Signature(s) ---•• ...............................•----•------.........-.- STATE OF WISCONSIN !~ 2 ss. ...............................................................................• ..St. Croix ..................................County. I authenticated this __..._..day of ........................... 19_..__. Personally came before me this .--15th._..day of ;~ ..............•---...~'Ss3.y..._•---.---_-, 19.8.7... the above named * ._Donal.d...G..._.N~].son----------------------•------:•-•---•-- :.. I TITLE: MEMBER STATE BAR OF WISCONSIN (If not, .__....... ----'- 4 2. authorized by § 706.06, Wis. Stats.) to me known to be the person ..._..._.___ w3io execut~d~'the ~i ~,- • ' i foregoing in ument and a novel ge t . >Ilie. ~ ~ ~= i i THIS INSTRUMENT WAS DRAFTED BY ~ ~ • ~ • ~ !! .~f)~ 6.~ ~ ~ `. ... Jahn Nes ..........................•---.........f ....~,:. -•---. ...----- -•-••---•--• * Brent Wernlund -- ; ... Baldwin,--Wisconsin_._~~.QQ-~---------------- Notary Public ...---.....~~.---~xs~.~,x_........~i3elint#,T~is. •----- --------------- (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state eiz:piration ;; are not necessary.) date: M3rCh 19-,.•••------__•----__~ 19-89.-,) •Nnmea o! persons signing in any capacity should be typed or Drinted below their signatures. _--- ------ __~--_-.--._ ..__..__._.~.__..~..v._-~ .___.._._._~ H.C.MillerCompanyiM' STATFOAM No. WI1982NSIN Mn...au. WlacanN. I~~Si7i Stock No, i 3001 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~Iv~ (~, ~co~rDY) 4 ROUTE/BOX NUMBER PJp~ S ~ Z Fire Number Z3S`f CITY/STATE ,gq ~(1~.1,',a~ ~~ ZIP ~L1ooZ PROPERTY LOCATION:.~~~ ~, S~ ~, Section Z~ T ~~ N, R lfO W, Town of , ~~~/~~/ rJ St . Croix County, Subdivision /(~~ Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_.~ be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new stems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H t/~ H r r 9 H H O z d 9 H three year expiration. yo E I/WE, the undersigned, have read the above requirements and agree ~ to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Fv ment of Natural Resources. Certification form must be completed and returned to Che St. Croix County Zoning Office within 30 days of the three year expiration date. A l S I G N E D ~J 1~~~ DATE 02 O a St. Croix County Zoning Office P.O. BOX 9$~ Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER L...~Qui a, pQ~~OY} 4 ROUTE/BOX NUMBER _ ~p~. S 3 ~ Fire Number 235`1 CITY/STATE_~q ~(~; ~_~ ~~ ZIP ~ZJOOZ, PROPERTY LOCATION:.~~ ~, ..5~ ~, Section Z~ T 29 N, R f~ W, Town of , ~~~~(~~I !'1 St . Croix County, Subdivision /y~ Lot number~_. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- .. ment stage in the-waste dispo-sal system. St. Croix.County residents m_Y a maximum of 60% of the cost of which was in operation prior.to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly 2 v r r 9 r c z C y The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal s}rstem is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. c s I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with a the standards set forth, herein, as set by the Wisconsin Depart- h menC of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. ' S I G N E D ~ ~~~~ DATE a2 O d~ St. Croix County Zoning Office P.O. Box 98- Hammond,. WI 54015" 715-796-2239 or 715-425-8363 Sign, date and return to above address. '~ ~ . DEPARTMENT OF INDUSTRY,. LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) • (H63.0911) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, W1 53707 5~ ~~ ~/ 1 fT1~N/R/GElor-W TOWNSHIPp1A~A1+6~FP~ALI~Y: ~.gl~wiN LOT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY: ~t•t;t,Or X. OWN R'S B R'S AME: h,Q-~!/Its•~.•9v~ ~.c,ToaG- MA LIN ADDRESS: ~-t • 1 Hwy. -Z. (3~tL04>/~ Ct>/S SYooZ l1SE N0.6 DR . COMM R A DES RIPTIO ; Residence ~ N.~-, ^New ~Repface via r ea voxnvra ~ ~an~a n~nvc //,~~ `` S: ~P I r~~~ ~ r C '/ _/ _ DN Si7`~" w -1;~rE,~eaa~:7a =.~o'`',-.~u ~-- , -6~¢~~~ TING: S~ Site suitable for system U~ Site unsuitable for system ~ ~~~yµ' ~ ~0~ STa~ . M~ ~. ~~ , IN-Ga ~ a ~a ~ -I~~ L~H ®~Ga~ •IR'AO U/V v D SYS~T ;M:(optionaq I If Percolation Tests are NOT required j DESIGN RATE: If any portion of the tested area is in the 7D ~~.ST O~ under s.H63.091511b1, indicate: C~~~~~ ~ Floodplain, indicate Floodplain elevation: ~,~p1,,~/,Q ~"NO PROFILE DESCRIPTIONS /N ~E'C. FT'" BORING TOTAL P H T GR UN DWATER•INCHES CHARACTER OF SAIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH lN, ELEVATION OBSERVED E HET TO BEDROCK IF OBSERVED (S E ABBRV. ON BACK.1 B- ~' 3, p 95.7 ~ 1~ icy" (t•33) /~o'..~,~/~N~ ~t,~,~y s;i ~l.¢.ts~), .G7' ~~-ON •gn~y (31ac~Y s~~ w;~c, ~.~•f. a~. .,~~s ~ ~3~' ~~'. x.33 . ~- 12,~P-f3a~ 5~ u' L~.~DisT'. DR`G-Y 1't0'tS . i r B-~ ~,0. 95,0 ~~ ,~ ~'4 C~y~~) G ova,, . +y fR.~a , . ja sr -,~,, pL~l•~ s;~ .G7 'c~• Q~ - ~hr S~/ w SM. ~~~.c. '~iST. R Mots 1,33' .4~QS/ &3 3.0. 93•~~, 1VnDlED ~,- ~~O r ~ s,~p ltd 75, o~aN. yy. s,y, .~s, 3U-9Y ~;~, -S • Y3.u- S~ W 'AiS7%ytT ORS B- MO'P'S hT' ~~ 5~ , ~,Q j2~t7 S~ CS~ITVR~4T~0' s~~~~. E/~!/,gTi4,c~S o~ PE~'~S PERCOLATION TESTS EST DEPTH. WATER IN HOLE TEST TIME DR P IN WATER L V L-IN HES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p I t p PER INCH P. .?A Yy Gi' D ~ / 2 / Z P- P. O . GO d P-. - ~ P_ .7 D * -3 I~- P. ~r - fa 'D e,~ s~ ~hr s r t. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~ j~ l,~ 1~ ~ r r , /~N~ i G~ ~~ SYSTEM ELEVATION [~V T 7 I ' ~ --- -..1 _._._ _.._-t --- -- ---;-.._.. __ ~' __ .' ^ 5A -- ~~ ~ ti~ ..--~ -- --- -fL_ _-~~ '--_ b r . ~ ss ~ ~ ~ i - ~~ ~... ' . r ...__ Q _. ~..~ ~ ~! __ __~ ____ _1 ~~ _~_ 1Y..:_ 1w__ ~_-_... I _ ., ~ _ ... _ _ ~ ~ _ _ _. .. ,__. .. - . _~_ ._.a .. I _ _ , .. ._ ~__' _ ..... _, _ ~... f .~._ ...._ _ . , _ . .. .. . .. , _ ._. _ ..:_._._ ... ~'t~._ .. . SYVgW' M',~ ~`f J Q~~t~;'~Si'o~ A-~-D vvL.7._. ..~._ .._.... t ~N _ ~.~ c.. ....: ; This test site•id~T ~a~~ROVED-__! ..~ . for a conC;wentionar~l~y~~e}, fic s s#em; 1, the undersigned, hereby certify that the soi{ tests reported on this form were made by me in accord wit'h'~~~~~6fglfel:M~t nr ds specified in the Wisrnnsin .Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : HOMESITE SEPTIC PLUMBING CO. TESTS WERE C MPLET ED ~N ~ 855 O'NEIL RD., HUDSON, WIS. 54016 ~ ~ , Z ADDRESS: ROBERT ULBRI CERTIF CA TI ON NUMBER: PHO E NUM ER(optional-: WIS. MA8TER PLUMBER LIC. N0.3307 M.P.R.S. ~ ~ . ~ ~ 6 ,3~~ '~/~s • CST SIGNATURE: ~~ ~~ ~/ DISTRIBUTION: Original and one copy to Local Authority, Proprrty Ownrr anri Sail Trster. Q " O b Q ~ ~ ~t J W1, W _ V Y' _ v- Q . . ~ ~ 1~ ~ ~ 3~ t a 0 -, 0. ~ ~ 0~.. . ..1 4 W~~ ~~ti N ~ o M :~ :, ~ ~ \ ~ a ~ .. ~, N e o ~~'° ~ F-~-- h ~ m ~~ ~ ~ H . ~~ ~ ~ v `°~_~$ ~ ~ ~~ ~ ~ g~~:~ J a ~ ~ ~~~~ ~~ ~~ 11 ~1 ~ x ~ ~~ A a~ a. ~ ~i~ °" Q ~ / _ o ~- `" g ~ / ffl / ~~ ~ ~' - ~ `~ \ ~~ o~ ~ ~~ . ~ ~ ~S ~, ~\ ~ ~ ~`` ~ \ Q p ` 1 o ~ •~- Q e° z ~~~ e .~ ~Q V H w a J ,/ ~ ~ 9 ~ ~ p\ ~ N ~ ` ~ ~ ~, ~ ~ ~ ~~ ~ o ~ ~.i ~~ p `` '~ ~ ~` ~`~ j~ . ~ " `~ a ~ ~. Q '. ~ ~~ o _ _a~ ~ ~ ~ -~ o ;~ ~ ~n ~'~ ~ a~ ~ .~ ~~ '~? p to raL ~) ~i ~ ~ ~> ~ ~ ~ CJ "r 4%.. ~ t ~ 1V ~.: . fir) ~ . 'Ti. ~' t~' ~ ~ .y a ~ ~ -~^' \ `'~ ,3 ~` ~. ~ X ,~1~---.- ~o' _~ r a 0 Sh e c~ 'e 1-~ -----~ o $ Mounol ~ 7y• j z ' gyp' 37~ 1 0 f~ ~• z-/DOV 901. Tan~jS ~~• 5~0 ~ . \ ExisfiAq L go L; to ~Q,. e .~~ ~ °"9 Rf, 1 9 13alo~rvin~ ~i~~ 5~0o L i ~3 0 0 > II v ~x,'Sf,'n9 Poje !~ Bs^'1. - D~nofes ~enG-1 Mpr11 ~a uS~: Ele /. ioo,d V / / , Be»e~i /~'~ar"~ is Goff°ri' o~ Sfee~ s:al,'n9~ of S,E', Come ;~ o~ sh eor. f3 l~~' s«. zs T No. 51 fe ~ ; ~ N- ~ylZ (~ ~~9 N 1~/6LcJ / ~~_ ~O ~ Sca~e i~ 4 ~ No, r ~~ 0 Q 1 • V W~ii V I / , ~-~6G~9 CST 3y13 fi`iwa'l /L State o~ Wisconsin \ Department of Industry, Labor and Human Relations SAFETY 8 BUILDINGS DIVISION June ~, 1 ~dC i~~dve Le JoncJ F;aute 1 E;al dye i n, ~' i 54(lCc 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 ion t~ia. Si~B-rJl X21-P near i~ir. tie Jong: iZE? : Lave L'e Jang -Residence ~`~, ~L~__\ .: Private Searage Syster~ S~d,E,2~,2's',1 CIS' Ta4~r7 of Eald~:in, St. Croix County, YsI Section 15.24 (1 ), i~iscansin ~t«tutes, arcs s. ILtit< ~;~.Ug (~) (u), -~isconsin ~rr~inistrative Code, a71o~~ tt;e aw~ner to petition the de~partraent far a variance to ttie ins%altatiorl for a private seti;acE sysi;e;r, to replace an existing private seo,~age syster.~ at a si to 4¢t;i ct- i s not i n ful 1 corlpl i anee ~~i th the si ti ny standards i n tale ~adr:~i rli strati vE rule. T ire syste+:; uesi gr~ propased 5r;ou1 d protect ttie eaters of tt;e state frarz cont~;n+i nation. If this system lrecar~tes a failir,;; syste+x+ or corltarfiriates fire waters ai- t{;e state, this variance strap be resci;~sded. T1-e t?€~tition far a variance requested tc~ s. ILt~~t t's3.2:3 (1) (d) of tt+e hiis. i`'atlt~. Code gas co+~sidereu orl iiay 2G, t~Lta. ~-tit petition tias teen canclitionally approvt1cl. 7tie conc;i ti an t~ei ny th8t i r~ the event c€ fai 1 ure, the rrounci systen+ stial i Le re=l;~l ~~ceJ ~~i tti anal Ji tl, tank or oi:tler oi~f-1 of systcr,;. The rule rec~ui res tt;at a rnounit syster,+ l7avc~ a r~ti nis~;ur~ of 24 inches of sui tabl e natural soil. Til~> variance requested -,=as tG install « replacement r.~ound syster,r on a site a~i tf2 12 i nci:es at suitable natur«1 soil . r~l l of ti;e ~+ata and stzter~ents subrri tted on t;ehal f of tt+c petitioner »r~re car;sidcre(i. This variance is specific ~:o tise subject petition anti canr;ot be usec fat ar:~~ ~;c3~,itional riuctificatorts. :sincerely, ~ j :' ~ ,~ ~, ~ ~ , ~ . ~~ tich~~tea<# te~+c-t~, ~;rchitc~et Director, Gffice of isivisian Cedes anC4 %japl i Ceti pri CCCts) 2E~ts-3C&C: I:rl:;~5:UL1tai cc: Lerey Jans~;y, Private SeE~age Consultant -District e~, Clrippewa Falls Thor;las irel sore, Toning Hal,,i ni stratar - St. Croix C;aunty 6e1 pit's Pl ur=C~i ng ~ Fieati n~ SBD-8928 (R. 10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION i~t~IUi~1TE. ~E°WItCE" i'l.t}~t {~Af'fd{}~tftl. t i{~ ` i r-c. . # i i 1. , ~ ,: i.,.:• a ~+1.'_ii S3-i7:~ ~1}:i{~~ i t .,l M:'1_;)j's ' R'~.)1 ~ `"~3 ~~.,;.:)~lillia~i,lf 1`i4%e lli.l? ,, f .gin I'..,, ~.'C7i7r ? 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'.~ i.:'Si~„ .... _. _. I l: `.r'? 1,%ii€ll,'i Y1'~,c? ~_ ~' ~. :i.('I,~fl SBD-6423 IR.101871 ..-. •, ~'/'oP e rf ~I ~ h ~ J O ~ ~ ~. - . ~- - V~ h ~ri/e y~ Z ,~~ ,a ~ '~ ~~~~ N ~ ~ L' ~J ro 0 K, ~~ ~ b W ~~ lyA'`-O V ,~ ~ „ ~ ~ w 3 ~.q ~ O ~ o ~ ~a y ~ _~ ~b ~ \ a ~` ° ~ o~ ~. v \~ ~ o, K o ~o h • a_° ~ .DS ~ (r1 ~ 1a ~ 1 ~ a ~ -.._ ~- r , ~j ~ A d ,~ ,, "~ ~ ~ ~~ tai ~ ~<>, Q~~,~ ~,~'~~ `a~sy ~, °-~ ~y S (~ `~ t7 ,~ ~ ,, • , .j ~ o ~ c, ~~ ~ ~. soo <U;,~ ~°~ ,o~ tieF ~' ~ Prop~YtY ~,'ne ~- 3 V ~ y~ w ~, ~ w ~' `~ ~ ~~ .. o C;~ a ~w ~~ z~ m~ ~~ 11 J Q ~ hJ, l _~ ~s- , s ., ~~ F, ~, ~.-::. fl ~ ~ A ~ o `~~ ~ `~' s ~' ~ ~o :~ - .;,. Straw, h9arsh Hay, Or Synthetic Covering` Medium Sand ~~ ~~,~x" ~- Topsoil. -~ ~ E 3 Slope Bed Of zN- 2'2 Aggregate "' Page / Of `~ Distribution Pipe J ---~~-- ~ ~D ~; Force Main From Pump Cross Section Of A Mound System Using A Bed For The Absorption Area Signed : ~/ ~ ~_-' ,~/~ ~f.~-~-~.-- License Number: iylP~l"Z~ Date: ~" - ~ -;~~ Alternate Position of .Force Main L G Plowed Layer i n ~-v , ~ Z~~'8 F •%5" ~ G -D B ~ ~ Ft. i~.~,~ Ft. J ~~ Ft. L ~_ Ft. w Ft. .~.~. z ~ ~ ~ Observation Pipe- . ~-------- 6 1< . r------ -------..r ._ _ -_ _ _-_ _ _ -- _ ~ - A ~~ __ - ___------___-- -- -_ ~ __--- -- _-- ,, Force Main ° From Pump r. "O~tSt'FI; 3E~dt1~46 ~EAA-- ~ _.... _.._ ~Distrib ~~~~~'~,;~~,r,~,~ Bed Of 2~~- 2 %2~ ! ~~~,~ ~~ ~- ~-~gggregate t, ~~~ 0bserv ;z ~ ens ~~'~ DEPAR NiEN3 CAF fJDl.ip ii`i', k.tc~G~l ~ti~i~ `P;~'~',,~~~I~~Di~arkers IVISION ~ SNi=E1'Y A~1L7 ctUILQi1iGS E CORRESPONDENCE Plan View Of Mound sing A Bed Far The Absorption Areo ' , .1 A Perforated Pipe Deta{I En ESPONDENCE s Located On Bottom, 'e Equally Spaced Last Ne "" ""r Uistnbuilon Pipe Layout Signed.: ~~ ~ CYu~~ -- -License`Number: ~~~~~ Date : ~' -- 3 -~rS' Hate Position Of Mal From Pump .$ aw i P 23 •n R _5"-33 ~ S ZY.~'7 X ~'~J Hole Diameter ~ Inch Lateral 1 Inch(es) Manifold Z Inches Force Main " ..~ Inches 1 ~5 = 3.75- ~ . 2 S = b~ 7S"- /l. ?S- x.3.75 /~.~ S- /8.75"- .?/..2 ', L.~. Page 2 Of ~ ONSITE SEVNA~E SYSTEM •; ~~~ ., ~~~ ` f ~'~ ~ ~ ~ ~ f f ~~+t i. ~ ~}~,~ ~'a ~, Ltz ~, ~~ f.,:. rF i~v>:< ,?;;Y• ~ ~~- , ~_ ~,,~,~ RELATIOiVS ir~~~CJi'i fi .i ~'tl.l,.: , ViSt D.~ 5,~,~~,yY 0 t1ILDituGS ~~ir.,s .4 ~1 '~ . i . ti .~ PAGE OF -PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 'i~C.I. VENT PIPE ~ 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE is"MIIU. I IU L 1= T APPRO`JET) JOINT W~C.I. PIPE EXTENDING 3' Q1.1T0 SOLID SG{L. „~,~---VENT CAP WEATHER PROOF _ JUNCTION BOX I2°MIll. I GRADE I ' I CONDUIT ~-- APPROVED LOCKING MAIJHOLE COVER t,JgRwt~ ,[~ ~~Q~~ V ~'~~ \\~; PROVIDE I OyS1TE SEWAGEI~-~r~~.~~EAL A l:~~~~'~,G~f%f~ I {~!'~T ra ~~ t -~ I 13 ~.~ CC~ of ~y k ~~ Iq~ Cm ,;i i1y'~ ~ ~tl . 'ai 4' ~j ~~ C: DEPARTMPPIT G- ;tiD , irY, l(~EGR ANU N4?~~(~IJ RCLAT10t~S fVISi4 OF SAF/E~iY Attit~ UfLDIIVGS I l~l. P -_J y. E CORRESPONDENCE T- COAICRETE 6LOCK 4'~ Mlhl. I ~ ~ IB"MIA1. I'I III I'I I I (I ALARM II I ON I APPROVED ,l011J i W/C.=. PIPE EXTEUDIUG 3` onlTO soup soli OFF RISER EXIT PERMIIT'ED ONLY IF TAIJK MANUFACTURER HAS SUC4i APPROVAL SPECIFICATIOt~IS '~ 6EPT{G AND DOSE TANKS MAAIUF'ACTURER: ~~C°- -S ~IUM6ER OF DOSES: PER DAy TAt`JK :.SIZE;: /ODO GALLONS DOSE VOLUME: ~3~~ GALLOt~15 ALARM MAftiIUFACTURER: _ _ - -~ C~ ~~E~ ~r'Q CAPACITIES: A= •3~'S II~ICHES OR O O ~ GALLO~.IS MOUEL AIUMBER: ~ ~ . ~ -- - ~~ g B= z {NCHES OR 37'72GAlLOfJS .SWfTCH 'TYPE: /~IL~~C/.I/"t) C= ~' INCHES OR ' GALLO-.!S s-3 f'UMf' MANUFACTURER: ' ' ~~`.3 tT~S ~ D=_._L~_IfJLHES OR 2~ GALL01J5 MODEL AIUM6ER: ~ CD.3 L NOTE: PUMP AND ALARM ARE TO BE SWfTCH TYPE: __ ~Y ! i~/e/'GLtr1/ INSTALLED OU SEPARATE CIRCUITS 'PUMP DISCHARGE RATE 'IO,T GPM C~ ~ VERTICAL. D1FFtREP1CE BETW EEN PUMP OFF Ag1D DISTRIBUTIOhI PIPE... ` FEET 2 -I- ML~1~/IUI~~jMUM NETWORK S T UPPLY PRES5URE . 2.5 FEET F -1- _ / FEET OF FORCE MAIN X '~ FRICTIOU FACTOR ~ ' ~~ FE T o~r. .. - E "" TOTAL OyA1AMIC. HEAD = ~~ FEET INTERNAL DIMENSfoNS O ~,"3', F TA-JK: LENGTH ~ ;WIDTH LIQUID DEP ; TH SIGNED: ~"~' ~~ ,j ~[-<<~~~-y~-= LICENSE NUMBER: ~~`' ~-~ ~~ ~ ~''c7J DATE: -~ , .wave ~ c ~ ~~ -. =- performance Curves METERS FEET 90 WE15H 70 x 20 WE10H 60 1~. WE07H- 15 ~ WE05H 40 10 ~ WE03M_ ~ WE03L 5 I 10 0 Submersible Effluent Pumps MODEL 3$85 SIZE 3/~' Soli ~C ~ ~y u 1u ZO 30 40 50 60 70 80 90 100 110 120 GPM t ~ ~ ~ ' 0 10 20 30 tn'fi CAPACITY ~; GOULDS PUMPS.INC. ~- ~ -~,~ sae METERS FEET ~ 120 henna ~QQc ~5 11C ~ 1oa sa 2s ~ 70 x 20 0 15 ~ 40 10 ~ 20 " 5 10 0 0 - -- "" "' ,"' ov iu tw 9u t00 110 120 GPM ~ ~ i ~ 0 t0 ~ 30 m'fi CAPACITY ~.., •1985 Qoulds Pumps, Inc, ~ ~ ~:~ ~ ~ '~ E1MChveJuly, t9i5 I - ^ ~ I O ~'" 1.~ 1''~. CTS 7 ( 3 E- ~ K ~ V E {K.3 ~ ~ + v `" J p ,` ENT OF ~•' t REPORT ON SOtL BORINGS AND oR AND. PERCOLATION TESTS. (115) HUNtAN-REL.A710NS (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O, BOX 7969 MADISON, WI 53707 ~~ ~~ ~/ 1 jTZy N/R /~E lorlW 70WNSHIPN6+RA.4I~Y: sA I~wfN OT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY: -1-.~: x OWN R'S 'S NAME: ,~,~-.yes. ~~.~ ~.~ To~~ . MA LIN ADDR SS: ~~ ~ - ~ wy- -2- f3~t~D w/~ tv~S sYoo z USE NO. BE ': CO R A DES IPTION: lace ~ Re ^ N DATES OBSERVATIONS MADE I ,R, STS: ~ ~~ P~ ~ ~ /~ / f ' Residence p ew ~ ~. ~- , / / ~!/ RATING: S` Site suitable for system U' Site unsuitable for system ONVE TI AL: MOUND: IN-GROUN : S S EM-W-FILL HOLDING TANK: RECOMMENDED SYSTEMaoptional) ^s ou ^s au ~ ~os a_u as au ®s-au ,~ol.,~ v - W•~-tc.. ~-~-~~~ ~~ ____.._..._.~__._.__ o R /~col~ - ~ I' cam--t o~J If Percolation Tests are NOT required s DESIGN RATE: ~` If any portion of the tested area is in the 7D ~~ST ~~ under s,H63.0915)lb), indicate: C~A~''~ '~"' Floodplain, indicate Floodplain elevation: ~~pw/,Q 'A`ND PROFILE DESCRIPTIONS !N SEC. F T" 80RiNG TOTAL P H R UN DWATER-INCHES CHARACTER OF SAIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN• ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (S E ABBRV, ON BACK.) B- ~• 3,D 9571!, ~ ~o „ r Its (~.33~ t. o' .v,~~N~ ~~~><y s;/ ~tw,s~), .G ~' c~.ON • gno-y !3)acKY ~,•/ Wrt~,-f.-~.-F. oQ. .r+o~s~ ~3,~'~~'~ 1,33. r2,~t -a a . s ~ w ~~, ~~ . ~ I•s r.. o a -~-y ~•c o ~s . B. , r Z ~ D S ~o S ~ ~'d Cis ~ ' B- . . ! . a ~ ~L,f~ Sit •G7 ~~• Qa - I.ht Si w SM, ~~N-~ 'D-'ST. R Mots --a3' -4r~Qsj &~ 3 0 G / ~ 3 ~ I~voDIED AT ~ ~ ~~ S ~ I .15 ~ O/~Qti1. !fir si~~ .7s ' (~~1 `97 cs/lf . S i ~ ' . t / • p ~.,p , ~ AiS~ivcT Oi2 13.u- 51 w Mots ~r (, 5' ~ 1, 0 2i:u 51 ~5+1TVR~4'T'f 0~ B- sp~~~~ ~/~tigTia.~s ~~ f~E.~°~jr PERCOLATION TESTS '~ "~' ~ "` ~~- ~'--a 3` DEPTH, WATER IN HOLE TEST TIME DRO IN WATER LEV L-IN HES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p ~ t P D PER INCH p. YYGZ' D ~ % 2 / L P- p_ O L6 . GD d P-. ~ p_ . 7 D ~ 1,3 11. p- ~f r /~J ~Erv SE LhT $ i l PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. {ndicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and sfiow their Location on the plot plan. Show the. surface elevation at all borings and the direction and percent of land slope. ~~ 1 /~,~/- ~ j-r. S~N~ G / ~~ / (.t/ , i~'~ / (0 SYSTEM ELEVATION _ __y_ - _ ~' ~ m ~;. ~ ~ ~ ~~ ~ ~~ ~~o~ ;~ to _„_ 'fib ~' ! ~ --- - - b- ~h t ~ c.? G--'.: Q a a ~_ Q ~ ~ J ~ W {_ V `~' W T ~ ~ v" - ~ 0 \ ~ ~ 3~ o 0 p a A ~ `3- 4 O •~ 4 w fl° ~ ~~~ f ~" o ~ C~ h ~ o M 2 1 ~ ~ ~~ a ~ ., W ~ N ~ J VO (, ~ - __~ Qo 4 ~ ~ ~ ~~ 4 ~ ~` $ ~ ~ ~ ~~ ~~ v ~, ~ m~~~ ~ ~ ~~~ ~~~:~ ~J~°~ W ~ ~ .~ n ~i ~ .. ~ .x ~ ~? 1 Q a~ ~ IU~Wy~ ~ ~ o ~ ~~ / ~~ ~g .~-,. / ~ / (fl ~\~ ~ '\ , ~~ ,. ~ ,~ `~ /. ~~ ~ o °s ~ ` "9 ~ ~ ~ ~ /~~r ~ ~ ~\ ~ N / ~ ~ ~ f ~ ~ ~~ p ~~ ~ ~~ ~ ~ fi ~~ - ~ ~ ~ /~ ~ ~. f ~ ~ ~ ///` / , ~ Q' ~~_ ~1 ~ ~. i A ~ ~ ~ . P -'. 2 ~-' ~ o _ -Q~.. ~ ~. ~ ~ ~, - ~ o i~ ~~ G~ ~ p 1K ~ I 1~ ~ •~ld tee. ~~ ~~~`' ~.. ~i c'~ CJ 'rC'_ di ~Q 1V h w cn ,. i ~~ ~ 1 ~ ~ O '+C + .~ fir. ~ ~ ~ - o-r, ~ 0 ~1 0 O ~ ~~ ~ ~ 3 M .~ ~` i ..a Q 3 O ~~ ~I a z ~~' ®~ .. ~, `~ ~ M ~' 3 ~' Q ~ M ~ ~ ~ ~ a~-r ,~ ~ado~d ~ Q ~ v ____a~_____.~. _~.~____._ __.~..__._._._.~~___._ ~,.._...~.~ ~ ~ a ~ -r c ~ q ° ~ ~ „~ o ~ 4i ~i i- ~ CS ~ ,~ ~ ~ G ~p v c .~ ~ ` ~ ~ ~ ~ i ~ 4' a ~ ~ ~ `~ \ -c --~- ,r rv~ ~ ~ C1 ~ .~ 0 '-~-" --~ ~ a- Q PO v1 p c • o ~' h o °o ~ ,o o i~ o ~ ~ °°° ~ ~. o ~~ ~~______ ~ ~~'~ .o :~ ~ ~" ~ E-----'~ ,a ~u-~ k~ v E' z ~i Nazi ~ 41C ~ ~ v ~~ a^~ ~~ ,~ /(,~-~ a do,,~d -~-- -~- N .~ w May 9, 1988 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: ST. CROIX COUNTY WISCONSIN ZONING OFFICE 798-2239 (HAMMOND) 425-8383 (RIVER FALLS) HAMMOND, WI 54015 An on site investigation for the Dave DeJong property located in the SW 1/4 of the SE 1/4 of Section 28, T29N-R16W, Town of Baldwin, revealed suitable soils at a degth of 1 foot, below which high groundwater was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, ~h~a+-~4U ~ . t"l~.t-~3t~~1,rG Thomas C. Nelson Zoning Administrator rc DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7969 MADf$ON, WL (53707 SW~,SE14jS28,T29N-R16W Town of Baldwin INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS ^ CONVENTIONAL Id.AALTERNATIVE Holding Tank ^ In-Ground Pressure found SAFETY & BUILDING\ DIVISION BUREAU OF PLUMBING Stale Plan I.D. Number: (lf ass$7b3984 NAME OF PERMIT HOLDER: David DeJong ADDRESS OF PERMIT HOLDER: Route 1, Baldwin, WY 54002 INSPECTION DATE: ," ~~ - ~ )_ 8 7 BENC (MARK (Permanent reference po/nt) DESCRIBE IF DIFFEREN T FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: ~i i ~j .) ~ ~1 ~ r1/ jl ~" Name Plumber: t MP/MPRSW No.: County Sartitary Permit Number: Dale E. Hudson ~~ 6629 St. Croix 99052 SEPTIC TANK/HOLDING TANK MANUF ACTORER. LIQUID CAPgCITV. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER t ~~~~~ (,~- ~ DO ~ ' ~ ''. PROVIDED: ^YES ^NO PROVIDED: ^YES ^NO BEDDING: VENT DIA.: VENT MATL: HIGH WATER UMBER OF ROAD: PROPERTY WELL. BUILDING: VENT TO FRESH ALARM. FEET FROM LINE: AIR INLET: ^YES ^NO ^YES ^NO NEAREST DOSING CHAMBER : MANUF ACTOR ER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTROLS OPERATION AL NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE. AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I Fr~c;Tr, DIAMETER. MATERIAL ANO MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONALSYSTEMe WIDTH: LE NGTH. NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA.: LIQUID #PITS BED/TRENCH TRENCHES. MATERIAL: PIT . DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END: I PIPES: FEET FROM LINE: / AIR INLET: NEAREST- s Mfl11ND SVCTFM• Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERS SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH!BED CENTER DEPTH OVER TRENCH/BED EDGES: DEPTH OF TOPSOIL: SODDED SEEDED. MULCHED. ^YES ^NO ^YES ^NO ^YES ^NO PRESSl1RIZED OISTRIRIITION SVCTFM~ WIDTH. LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV.: DIA.: ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ^YES ^NO ^YES ^NO NEAREST ~~~~~ Sketch System on Reverse Side. DILHR SBD 6710 IR.01/82) ~; 11 ,t' l ~ 1 ~ , j`/ ; ' ~ ~ '~ ,r ~:' ~t { M . , 1, ~r --~~ ~ ~ r Retain in county file for audit. GNATUR E: TITLE: Zoning Administrator SANITARY PERMIT APPLICATION ~ DILH COUNTY ' Y F~ Adm Code Wis In accord with ILHR 83 05 ~" // . , . . ~a°~~~- ANITARY PERMIT # STAT : t ~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'/z x 11 inches in size. 8`~~Si~7 -See reverse side for instructions for completing this application. PETITION ~ ^ I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. YES No FoR VARIANCE PROPERTY OWNER ' ' ~ ~ PROPERTY LOCATION R ` ~ (or W Ll~'/ 5~ 'l N S T~9 C~~~ e p . l~ .. a, , , PROPERTY OWNER'S MAILING ADDRES LOT NUMBER /~~ BLOCK NUMBER SUBDIVISION NAM /v~ CITY, STATE ~ ZIP CODE--77 ' ~~d PHONE NUMBER 3~~ r CITY NEAREST ROAD, LAKE OR LANDMARK O VILLAGE. `~A1~~j~ / Z !1 LUl VGi _ 3 .v II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ~ OR ^ Public (Specify): ~~ III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. ^ New b.~ Replacement c. ^ Replacement of d. ^ Reconnection of ~.-e. ^ Repair of an System System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previously issued. Permit # Date Issued 3. ^ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ^ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ^ Conventional b. Alternative c. ^ Experimental 2. a. ^ System- b. ~ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ^ See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (S uare Feet): `/ ~ bli i t ^ P i ^ J /1/ Feet c u Pr vate o n VI. TANK CAPACITY in allons Total # of ' M f t N Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks urer ame anu s ac Concrete structed glass App Tanks Tanks Se tic Tank or Holdin Tank d®~ ~"' Z~ 1 lr- ~° ^ ^ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): ~ ~ ' Plumber's Signature: (No Stamps) MP/MPRSW No.: ~ Business Phone Number: ~ ~/~ ~a/e ~ : / a.~ ~~~ G8~ 3 Name of Designer: Plumber's Address (Street, City, State, Zi Code): ~~ ~ /, /~ O / ~i'7 ~ ~ L~C/~ i S`7` QC/ VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: ~`~ .fix / ! .~ ~A/ , ~ ~ ~i G y-:~~o6 IX. COUNTYIDEPARTMENT USE ONLY A d ^ Disapproved ^ O Gi I l i San''tary Permit Fee J '~, Groundwater h rge Fee ate Issuing Agent Signature (No Stam s) pprove wner ven nit a ( '~ ~~ ~ t Adverse Determination . 1 X. COMMENTS/REASONS FOR DISAPPROV~~ SBD-6398 (formerly Plb-67) (R. 03!86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed , if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.}, depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or twa family dwelling; III. Purpose of application: Check only one in ##1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z X 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Grou included the creation of surcharges (tees) for a number of regulated practices which WISC~ can effect groundwater. The surcharge took effect on July i, 1984. All of the water that burie is used in your building is returned tc the groundwater through your soil absorption system or~ the disposal site used by your holding tank pumper. The monies colle:;ted throug^ these surc's~arges are credited to the groundwater fund adminis- tered by the !department of Natural Resources. These funcs are used for monitoring ground- ~w•ater, groundwater contamination in~~estigations and est=~b(ishmect of standards. Groundwate i''s worth protecting. `?8D-?.398 (R.G3lU61 s ~ . APPLICATION FOR SANITARY PERMIT STC- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequaQies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractpT,("spec house"), then a second form should be retained and completed when the property is sold and-submitted to this office with the appropriate deed recording. Owner of Property ~GtViO~ -~1e Location of Property ,~>.~ ~ ~~, Section ~_, T ~9 N - R ~ W - Township p ~l~' ~ a'n - Mailing Address ~,~~ Subdivision Nama /~~ Lot Number /j~j~9 Previous Owner of Property ~0~'1 /lOe~SOIi - ,~. Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? ~_ Yes No Is this property being developed for resale (spec house) ? Yes ~_ No Volume '~ ~~ and Page Number ~2 as recorded with the Regieter of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty --Deed 2. Land Contract , • 3. Other recordings filed with the Regieter of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. • ~. PROPERTY OGINER CERTIFICATION I (wet een~,i,dy ghat a.?f. 6#a-temen~a on Shia 6onm ane ~ie.ue .to .the beet o~ my (oun) , hnowPedge; xhat 1 (we) am (ane) .the ownen(6) 06 .the pnopenty deaehi.bed .gin •th.i.a ~,ndonmcLti,on dorm, 6y v.ih,tcce o6 a wa~vcanty deed neconded ~.n the 066~.ce o~ the Cour„ty Reg.~.atiet od IIe2do as 4ocorre:Lt r~o. ~~'~~~ ~i,a~, anu .ihax I iwei pneeen~Cy own .the pn.opoaed d•cte don the sewage po6 a ys.tem (on T (we) have o6•ta.i.ned an eaeemerLt, ~o ..nun with the above deaeni.bed pnopen.ty, don .the cona.thucti,on od bai,d ays.tem, and .the same hab been du.Py neconded .~n .the Odd.ice od the County Reg-is.ten od Deedb, as Uoeument No. ) . ~, SIGNATURE OF OWNER SIGNATU OF CO-OWNE (IF APPLICABLE) DATE SIGNED DATE SIGNED - r '~.~~, %-~~ ~ t~a. ; srASS~s~t,car ~vc~tx ~t ><-->~ ,, ~., .~;r ~ 479'7_ ~ ~, ,. 'T?'~~-- ~~ ~~ Z'lz~ia Deed. •aaa i~ .A~~:. ~...:Dl~ifl~,. al.~t/.,~. ~ fw''. ........... .... ...... ............ ...: ............................ ~ _ ~ M. - - . ~. ,'. ... .. ...... ...... ...... .., .........q 1R~\~1 ~ , ~. .ad.a~avid:.L....DeJ~~i~.:~d_.Terz~,..L...Asd~ng,. .......... ..... ...ea.,. huaband..and..w3fe, ..S~IZViYnrahfp..Msrital..Pxap~=t..y , ~. F. ~ ',^ h ~° w~L11~~1, Tlut the acid Geantor, for a vairabla ~...... ~- eQareya~to Grastae the fol ~~ ~°` y bwnns dsseribed seal satllte 1L .....S.t. e...Cr.~.4~~........ ~ * ' County. State of W iaooiuin : ~ r:: .. ._ W 300 feet of S 721 feet of Sid of SE~.of Section 28-29-16. ~ rasa.t x.:.:...:_.........;. ,~ - ~~ ; ..,~~ ,~' ~; :, ~ ~° ~~ _ ~ ,. }~, \~. _ ~ . ~~~` _ - _- ~ ~ -r. / ~~..~ F ~•'~_ :~. '~~• - -~~ ~~~~ q ~k ~ ~ .~ • ,~.~ ~~ i t r, , Thia . - .. - -- :.~,8 .... _ .... .. homaatead peoperty. ~:' <;~ ~~ ~~~ Tosethsr sritb aU sod aiey~ular tM Mreditameats and appurteaaaesa tbeeeaato baba~int; s - Ana . ...G>k A.x1L0>:..... _ _ .. ,~;, . ~.: warrsats that the title is caod. indefeasible in fec siatpk and free and eleas of eacawbran~aa a:eept '~w r` and will warrant and defend the name. Dated this 1 5th day of . ... .(SEAL) ._ .... _.. _(SEAL) AfJT81iNTICATIOAI authenticated this ........day of_:......_ . _---......, lt)...... • TITLE: 1rIEMBER STATE BAR OF WtSCONS[N ,. Uf not, ......... .. authorised by ff ?06.06, Wia. Stata.) ~~ ~ F~~ vw .~ _. l9ay .. ......... ....... .... ls..l~.. • -. ~2~~. ~~ .. ~.,.,t..~-~.:'~.... ~.~.~.:...~a+~tr~ :tom 3 ~ ~ ... ,~' - -~ '4 :~- _ ~ ~#~ STATE OF WI3CQNSIN ,.,„ ~;:, ~~ . . ,; ~s. ..St. CrOiX .............Coaaty. -, ~, Personally came before me Thia ._. ~ S t h ..,d,p~, et ~~ . ................•---•May_.--•---....... 1f.$.7.:. the abwlii:~ -.D~nnald..G~..Nelaoa...._........... v. ,; -~ :. to me known to be the person . ,..:.... who e~iri-ti. _ toregoinR in~ument andraoknorHedze the •~ , . ~ v - TMfa,tNS2RUMENTM~~R4FTE0 BY ~r ~ ~ ~ '. • ..... 6rent Wez=nlund '~ .Baldwin : Wisc n in•.. _.. ::: ~~ .......,.........4. $.. ~4QQ.2 ............. Nots-v Public _:.... St..: ~zfli,x;. (S1RnaUtres may be autheAticated or ack»owledged. Both. N~' Commiasiosi is perreunent.(if uot, s3a4~tlt~jr~ ;~, } are riot necessary.) ~ NlarCh 14 - •N~o~s or ar~t~. sNniwt to aer uwchr !d De tyy..l ur prinW MMw tA-ir sWrwsea. e ata~'twt Of 11~fWf ~!.'..1, '~ i'rpit ~-+-;. - ~ - _s~., ,~;~-* ST C'-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~q~,~'(~ -.-J~~y?~ ROUTE/BOX NUMBER ~~~ Fire Number CITY/STATE 3~~~v~~, ~~, `I..IP ~~Oc~Z PROPERTY LOCATION:.S~ ~, ~~, Section, T ~~ N, R~W, . Town of ~GI~G~'cyi~i~I , St. Croix County, Subdivision /~/~j Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank dumper. What you put into the system can affect the function of tP-e septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m-L a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County 7.oning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County toning Office within 30 days of the three year expiration date. S I G N E D 1 ~YI i~2 ~' ~~ -oPY~Q DATE m St. Croix County Zoning Office P.O. Box 98~ Hammond, WI 54015 715-796-2239 or 715-425-8363 H G N ~-3 a r r a H H 0 z d a H m H 0 z x H b Sign, date and return to above address. s DEP MENT' OF {NDIIGTRY, iA~BOR*AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOC/AT]I 1•S S TON:T fp TOW.!NKS~HIP/MUNICIPALITY: LOTN BLK.NO.: SUBDIVISIO.Ny~lNAME: COUNTY: OWNER'S BUY R'S NAME: MAILING ADDRESS: 1SE ~ NO.BEDRMS.: COMMER IALDESCRIPTION: Residence ~ ~ //~ ^New Replace QAT1111 /~. C® Citn e.atsl.ln inr. evetnm 11~ Cim ..e.~..itsf.ln fnr evctnm 'DATES OBSERVATIONS MADE LPRDF- E C PTI NS: A TESTS: ..S -~O-g'7 _il'~ ONVENT(IO~NAL: ^S ~U MOUND:. ^S U IN-GROUND-PRESSURE: ^S ~U SYSTEM-IN-FILL ^S ®U HOLDING TANK: ®S ^U RECOMMENDEDY~ EM~ional) 1 j O N ] ~ If Percolation Tests~re NOT required DESIGN RATE: I If any portion of the tested area is in the ~~ under s.H63.09(5)(b), indicate: ~~ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B-~ ~.o' 9~.Z2' ~~ P ~ ., ~~,~S,il- ,,8~ ~~% ,, c s- ,~ `~/,p '' gl/-l~~ o~~ ~ of Pt '' ~ ~ , ~f "~/s.'f- /c~'Bns - ,~ " n ' C B- B- PERCOLATION TESTS ° ~ ~ Q TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-IN CHES T MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 P PER INCH P- P- P- P-... P- P- PLOT PLAN:. Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sca{e or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of lai ' SY TN 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. M print : TESTS WERE COMPLETED ON: r ~ = ,ZO '7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CS T SIG N ATURE: . ~ ~ /~ DISTRIBUTION: Origlnel and One Copy to Local Authority. Property Owner and Soil Tester. DILHR-SBD-6395 (R.02l82) -OVER - ;. 1 ~ _ ,.. r r . -• INSTRUCTIONS FOR CC~M PLETiNG FORM 115 - SBD - 6395 '~T,u~be a corhplete ~nrj~accurate soil tE~st, ~,~r,r r; ;~r~~°t ~n~~st irxaude: ~' ~., ,• - :a 7. Complete legal description; •~ 2. The: use section mush clearly indicate why ~ ~ ~ *'~~is is ~ residt~nce or commercial project; ~~ ~ ~ ~,- .; ., -, ~ ' _ ... 3.,;MAX(MUM number of bedrooms or c e ,ase. x>lanr2ed; 4: is:this a'nevv or replacement syster7r; _--. _ '' _ `~'~_~ 5. Complete the`siaitabiFity rating boxes. A SlT! 1: ";.!lT"o~E3LE FOR A HOLDING TANK ONLY lF ALL OTHER SYSTEMS ARE RULEQ OI.IT E F~~ "i'.")lL Ct2NC)ITIONS; 6. PLEASE use the abbreviations showy he; a '.; : ,,, ,:>rofite descriptions and competing the plot ptan;~ , . ._ _. 7; MACE-A L'•EGIBLE diagram accurately I~x . >ur test locations. Drawing to scale is preferred. A `;sep~r•ate sheet may be used if desired; _. _ , _ _ _ $. Make sure your benchmark and vertir,<~rl r `c" . ~ r ~~rK.nc~ point are clearly shown, and are-permanent; 9. Complete alt appropriate boxes as to dates, w ::' z.s, r:adclr asses, flood plain data, percolation test exemp-' tioh, i~ appropriate; `' ` 10. ff the information (such as flood plain, e;ic~vat ion) d~cs not apply, place N.A. in the appropriate bax; z:;1-1 :. Sign the form and place your current zaddrr~ ~~ ar,d yc~rn~ certification number;: 12. Make egple copies end distribm~ ~,.~ __ .. i -r~. r~i_L ~C71L TESTS MUST BE- FlLEt7 vVITH THE LOCAL AUTHORITY WITHIN 30 D,~ h "i Gtr){~rlF't_1=T1(lN. ,,' . .,, ~ ,.. ,, t ABBREVIATlt~~,!`"' r~` ,. ' °"~:~.i; ~l=~IF~I~ SOIL TESTERS ~ ~ . ,- Soil Separates and Textures C7ther Symbols st -Stone lover 10"} t3R -- Bedrock cob -Cobble {3 - 10") SS -Sandstone .__ _ ....._ _ ._ _.__-._ - gr -Gravel (under 3") ~ LS -- Limestone _ . _ . ..., ~~ • ~ - *s -Sand ~,.~ Ni~t?~1 - High Groundwater . _ _; _ cs ~-- Coarse Sand _ , 'r'.:=rr; -- Percolation Rate med s -Medium Sand r,~~ -- VU'eN fs -- Fine-Sand ~3tci<t -Building is -Loamy Sanc{ ~~ -- Greater Than _ _ __ _ _.. *sl -- Sandy Loam ;~ -- Less Than ;. _ .__._ ~I -Loam ;a -- Eirown __ _ _ ~>4s -_ slit LL7ai1"i - ~l~C.!: si -Silt: i, t ,, -- Gray . . "cl -Clay Loam Yellow scl -Sandy Clay La~rrr~ - Red_ , sicl -Silty Ciay Lo;~m s~r~~at .- Mottles' ._ ~ r ~ . sc -Sandy Clay ~:rr` - with sic -Silty Ciay ~Ft ---- few, Fine, faint *c -- Clay <;c - common, coarse pt -Peat rr;r~7 --~ Many, medium _ m -Muck ri -distinct ~.°~'~• ~ .,`-, _ t~ -- prominent i~~itrt~#_ -- High watr~;r level, '` Six general soil texturcu surface water for liquid waste ciisposat French Mark -- Vt~rticai Reference Point TO THE QWNER: This soil test report is the first step in ~ :- . s~inr .. , ,~:.; „~:_, The county or the Department~may request verification of this soil test in tt~e fi A completea set of plans for the private sewage system and a permit applic< ~: appropriate coca! authority in order to obfaira permit;.The saniiary t3errr;iY :~„ :arior to the start of any. construction. ~~ ~' , ~, _ .. ~, ,~ , Owner,. ~enc~i /~ R J 17DCi v~ ".a~ 1~eT ,,~~ ~ ~-Q o1e Q f ~i f• ~ Coi-~e r ~ ~ col olw;r~~ Gc~~ . 5y46 Z ,LI 8•M ~ - ~e»ofes Bend ~Qr~ BZ ~ 97-ZZ ~ ~ ,~ 83 -- 9G,/~~ ~ -7 D~ n ~ J G (;, ~ L. a ~ s. e . I I N~~ay 12 Sl.~~ SEA ~9N R~GW ~o. 0 o` ~- /~ s~ I ~ 1, ~e ~._. Poe ~ J _ ___~_.____ l ~X i'S~ i n O I ~~ u~use ~ 9g'/ 7w'o /DOO J a ~, ,~; ~o/r.~;~9 /Qrl1~S MB~NG i p~U O ,l~~~ONS 0 NO S p ~ ~ 0 No a~,,.o,NG P SCR j Nt OF ., ~~ 4~ S~j ~ . N'~a Y ~z -~~ 0 4 -~~~ ~ ~ ~roWn y ~--~- ~ ~ , Nub-~Y~' ~~ ~~Z ~ ~sT 3~i3 -~ 133 r ~~ .. a Owner; ~enc1, / c .17ci v;'ol .1~e Jo~,~ ~fQde At n t~ l co,-h ~ r ~ ~ ~aldwin~ Gr~~. 5y0a Z ,d 8-M ~ - .~~nofes Bend ~A~~ i .3~1~7. _/DO,~~ tee-/e v, Bz ~ 97-ZZ ~ ~ ~~~ I B3 - ~G -1~ ~ ~i ,~~ - 93.98 ~ ~~ - ~o c,~ 2~ N.way ~2 Sw y sF~ ~9NRl~W z ~ ~~' L 0 ns ~ ~ /~ 5~~ r ~ ~ ~, f~ I I ° ~ I ~ ~ ° I' ~ 98'/ /-.t o us Z. ~ . 3 .~ V ,- NG 4EQ P~-uM~l a ~ ~~IONS ~T~ ~'~ ~ ~ AN RE s. D NDM g o~ ~~ V , ~ D ND 6~I~DING ° NZ DF . ~ ~D OFD S~1 T `~, . _ 0. _ ~ `~v L'' 5 ~rawn ~y: O ~... 1 ~ m~~GZ~ , CSC 3.~~.3 133 ~~ ~ ~ ~ ~- ..~c~ v. ~ 1~~ ~o n~J LoGKtNG 'DEVIS:E AIJD IVARNIUG LA9EL AT COVER ~~ RADC ~ ~ ~ - _~; MAIJHOI.~E - Mt tJ . 2 y" 2. D. ~R o 11 ~ d c C,as f' - ~,e o N P, p.a• SArrl c. +g.5 / N /e t ~~Rtc s ~ F Tw o HIGH 1VAT6R tVARAIlFJG DEVIGE OAt ~ ~ ~S. !9':`POLE O.R St~1jON 61-DG. St:RVED , /~ ____ . . , . oN s~°cawe/ ~N/~. fancy M1A1. 2" CAST IROiJ VE1JT -MIIJ. Z5~ FROM DOOR,IVIIJDOtV, OR FRESH A1A tA,1LET G~JtJ,Di11T • rte ; - _ ..._.-. r~i W. rt" A150~i::- t3RRDE .. ----~. TDIJGE At~iO GROOVE OR SNIPLAP JOIIJT ` A1rQ1~IREU pROVIDI<. CAST IRON FROM INLET ' TO 3' aC~0/.1D EDGE OF U1.IOISTURDED bOtL -- - F om f~ SSG Re~'ui ~ertcw ~s- _~ 1VATERTIGFIT ..~ JO1 NT b EXGAVAT10iV L1t1ES p a Q ~o ~- ~ ,~o~ ~j~s*E D~-p~R~~EN D~ 4N D et IO E1~`j~DNS NUMP SR ~ ~~ ~~. ~. , Signed: ~/~~ ~ ~~;~;~%/~s.y.,,. _ License t3umber: ~/0~~ Z~ Date : ~ ~ J'O "LEAD JOItJT DEPART I'IEN'T ~t~PPROVEU JOit-~TS S.~~TLON 1NRLt ~H01~01NG TAAfK SSG --~1: i~ GRA~I~A1T OF SEINER ~~~ ~ i DEPTH OF SEWER~FRQl+1 ~'©'~ FINISI}ED G0.AOE ~; gglS. r. TA13K GAPAC 1 T r,' - TA11K MRIJUFACTURER P"S- QAJGR-e'f' ~ Ajy E~ IF 5f'{'E CONSTRUETED - PROVIDE K[yrHAy WITH 1VATER .STOP AND RIt<NFORCEM~IJT ' pEQARTMENT APPROVED ~IVALL TIES ALLOIVEO r7 ~~ . ~.. ~'' _ O f~ _ - _ ~. - - _ ~av, U' -~ec~"o x'19 ~_ HIGH \YATER -VARNIt~1G _ DEVICE OAJ " 8' POLE OR Its!/Dhl Bt_OG SERVED LOCKI1Jb~ DEVI~,E AT covER GRADE _ MAi~1HOLE - EXCAVATiOf~! t_ t u~ s ________y e,NG ' ~ 1 ;~ o P ~ `~e~ P ,~o ~~~~Eta~ o~f ON of ~ t.~~ CpR SIGA1 A l.A . ~,,; e ~~~~~ II~~ z9 /~// CO(O --~~-5'7 ~o MpN .- '~ ., • - { ~ 2" VEt~JT -- 25' FROM DOOR, 1VIIJDO-V ~~ ~ OR FRESN AIR IAIt_ET ~, Iz" Mli~y. ABOVE GRADE ~, ~- i """""mow TOi~1Glf E ~ GROpV[ GR SHlPI..AP JOIIJT RF'.QUIRE.D PROVlOE CAST IROfJ F"iZOr,A IIJLET TO 3' BEyO-.1D EDGE OF r--~ UA.IDISTUR~ED SOIL ~, _ ! I LEAD JOI A]T3 PITCH '-) e E .. ~pE .,,.~,;...-, /K- V~~ 5EGT101~1 THRl1 HOLDfAiG TANK 1.10 SGALE GRAOIEt~]T OF SE\VER ~ ~ r ' DEPTH OF SE-VER FROM 3 D~~ FII~IISHED GRADE TAiJK CAPACITY ~Q©© TANK MAAIUFACTURER ~u°~° f~.~ NOTES iF SITE COIJSTRUCTED PROVIDE KEYWAY WITH Qty -VATER STnP- '" ~~ ilO \\/ALL TIES ALLr~-VED ~~ ~~° . .~ 1~ ~~ ST. CROI X COUNTY WI SCO NSI N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W 154015 May 28, 1987 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sirc An onsite investigation of the soils was conducted on the David DeJong property located in the SW ~ of the SE ~ of Section 28, T29N-R16W, Town of Baldwin, St. Croix County. The inspection verified that the soils were suitable to a depth of seven inches. This site should be suitable for a holding tank. Should you have any questions, please feel free to contact this office. Sincerely, ~ _. ~ .._ `. Thomas C. Nelson Zoning Administrator TCN:rmc WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.0. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of st. Croix Location SW 1/4, SE 1j4, Sec. 28 T 29 N, R 16 ~~ W Town or ~$ Baldwin Street Address Route 1, Baldwin, WI 54002 Lot No. N/A Block N/A Subdivision N/A Landowner's Name: navid neJong The application for this site is for: ^ new construction use. ® replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ^ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numTers sued to-you. ) ~1 one of the applications needing a quota .number. The quota number assigned to .this application is - - ^ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary permit was issued but was later .ruled unsuitable due to new or changed soil criteria established by the department. ^ for an application on file prior to February 1, 1980. ^ for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: [~ a failing conventional, soil absorption system. ^ a holding tank that was installed and in use prior to February 1, 1980. ^ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. [~ I certify that the above information is true and accurate to the best f my knowledge . ----~" _ _ _-----~ - ,.t.G~- Name Thomas C. Nelson Signature ~ " County Official Title St. Croix County Zoning Administrator SI28/87 Date DILHR-SBD-6158 (R 12j82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, D{VISION HUMAN REDATIONS PERCOLATION TESTS (115) MADISON W 53707 (H63.09(1) & Chapter 145.045} LOCATION:S ,~ , S CTION: p a /~ ~ TOWNSHIP/MUNICIPALITY: ~ OT N ~~.. BLK. NO.: SUBDIVISION NAME: SGtJ ~ ~ r / R c ~ / Q/ f COUNTY: OWNER'S BUY R'S NAME: MAILING ADDRESS: Sf. Coo ' .~~~c~~c~ {~'t. l / ~~,' ' ~ : `_j , ~ DATES OBSERVATIONS MADE {PR FI E RIPT NS: A ON TESTS: ^New Replace It ~ _ZO~O~ RATING: S= Site suitable for system U=Site unsuitable for system CO NVENTI NAL: os~u MOUND:. asr~u IN-GROUND-PRESSURE: as®u SYSTEM-IN-FILL ^s®u HOLDING TANK: ®s au RECOMMENDED SYSTEM:(o Tonal) ~~ ~~ ~ ~ ~~ o , ,~~ , If Percolation TestsBre NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: ~~ Floodplain, indicate Floodplain elevation:. ~j~ PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR; TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~. l7. 9~`~8~ ~ ~'(Ior1G ~~ P ~ " G"g/s. ~ /~'' ras • 35'' ~~ B-~ .~.o' x,22' ~ tP >P ., ,~~,~S,l- `ate - ~~ "' -~ B- ,3 ~j/.o' 9~,ffo~ o~ °~,. of ~ ~ ,, ~ ~~/s~'1• /l7'Bns/' .Z~.~ n ,~ C B-'~ - ~ .~• ~ ~d~~ min ~ >~?„ %g '~ ~ ~L~r ~~ • '' .2 •~ 1~'sc ~ B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD ~ PERIOO 2 P R PER INCH P- P- P- P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal acid vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~~ ~~ SYSTEM .ELEVATION ~/o „~9 ~r~ S ____ ' -- _ _ „~ .. _ _ _ ;;. ~,t _,an,~i~ _a~, ;~. •uollon~~SUUa Aur; }o xa€~Xs at{~ of ~c7!.~cl • icu 1rua,laci rt~el.!u~s atl~ •:j!LUaad e,~le~~o~ ~__ _ ... o~ aapao u! ht!.lotline ieaol ra.te!.tdaad<iEk <~ l; - uc.,!leal{dde lluteed a p4ae wals/~e e6ennaB a7enud ayt ao} sueld }0 1as alalduao,7 ~ ~r,:,c~~.~.- ~ ~,i , ~,fl.,d !>~ri!} stir. u! ,isel I!s~s s!~t ~© u©lteo!;!aen lsal~baa deua-luau».,pdaQ ac~t..c<~ h~uno~ at{_L ,,cza:, ~ > {~~iEar~;~r~s ui d::~:asts.cl)ay~ s!~t:aodaa ~saa. I!os s!y~ !.. t fnir~ ~~13NM0 3Hl Ol "" WSTRUCTIONS FOR CaMPLETING FORM 115 - SBD - 6395 ' _ __ ,; ,• ~T~@ be a cort~ple~e-~nii ac~wrate soil test, _ yf.~E, ~.>z~s~rt must include: t: a.. 7. Complete legal description; _ 2. The:,use sectitln must clearly indicate wh _ r r silence or commercial project; ~ - , __ ~ , -. ' _.__ __ _ 3.:;IVIAXIMUM number of bedrooms or u;,ss _ ~... ~ ~ planned; _ . -.. , . ;-- 4 ` Isithis'a'nevv or replacement system; ..._ _. _ -' ``~~ 5. Complete the suitabi{ity rating boxes. ~, __.. . - _. `"a(i f.~ iS 5t,it"i,~E31_F FOR A NOLDtNG TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT ~F1~Ei7 ON St~lL CONDlTlONS; 6. PLEASE use the abbreviations sha~~,rn t~f> ,, ~~~r ~°~~ri*incr ;,~r{Mile descriptip-ns and completingthe: plot plan; - 7;, M,4,KE A'LEGIBLE diagram accuratr~ly ic;c;atir}q your tc;st locations, Drawing to scale is preferred. A "'sepaCafe she~t,m8y'be used if desired; ~ - 8. Make sure your benchmark and vertical elevation Yeferrnc;~ point are clearly shown, and are permanent; 9. Ctpmplete all appropriate boxes as to dates, n<3rrr~ s, addresses, flgod~plain data, percolation tesf ezemp-" tiah, i`f appropriate; ;, , 10. If the information (such as flood plain, e i~vatic>n) does nrat apply, place N.A. in the appropriate box; -:: , 1 ~~,~; Si n,the form and lace our curren,~ arld+'r ;s aru) r}rrr rr~rtr rcatrnn num er; ` 9 P Y Y - _„-,~__ 12., Mak~~legblectlpies end distribute r~s rer;luired, 1~l_L 501E TESTSMUST BE F~ILED'iNITH_7HE LOCAL AUTHORITY WITHIN 30 C~~'fS Cat' CQMPL_LTi('?N. ~~' ~~" ~ ~ - .• _ .. .. ., _ • .: .. ;._ _ ~. ~_. _,_ .... ,_ 4 4 ~ ~ ` ~ " , ___..___ __ ._ .. ABBREVIATIO!~!S F r7' ' '"=:~T!~=1EE~ SOIL TESTERS --, ~•, ' t ~ _. Soil Separates and Textures C}ther Symbols ' st -Stone (over TO") F3R -Bedrock cab -Cobble {3 - 10") SS -- Sandstone ,._. _ _ ~ _.._ _ __gr -Grave! (under 3") 5 -Limestone r % , , . i' ; ~`s- _, Sanci , .~ .. -- 1-1iyh Groundwater cs -Coarse Send ~+ ~- Percolation Rate _ . _ ._____M-_....~ .. med s -Medium Sand --- Well fs -- Fine Sand - Building Is -Loamy Sand ~ -- Greater Than _._ r. #s(-Sandy Loam ~ -- Less Than ' *i - Loam t ..._ SYOwn . _........----`_.__.. __._.. *sil -Silt Loarrr .. -- Blank " si -Silt f:Ty -Gray *cl - Glay Loam Y -Yellow scl -Sandy Clay Loam R - Red- ,.:; . ~ sicl -Silty Ciay Loam - mot _. Mottles'. _ ~- ~ " '~ .'' *'° : , sc -Sandy Clay ~:a! -- with sic -Silty Clay :ff ..._ few, fine, faint ~`c -Clay cr: -- common, coarse pt -Peat rv~~-,, -Many, medium _ m -Murk ci --- distinct `` ~~ ~ .-'~_~~,'• _- ~ ~~ -- prominent 1i'`~"w'~ -- Nrgh water level, Six general soil textr3rfas surface water for liquid waste disposal ~ E3ench Mark ' "'~ Vr=rtical Ref~rr~ncc Point Owner-; ~encl, /~1G 17 av~"c~ 17eJoh~ ~fQde of p 11 f~ l coi~~~r o~ ~Qldwlr~~ ~%. 5~/Od Z ,L1 13.M • -1~enofes Benc~ /rl4-^>~ .~~1~• -/DP ~D~ E/ev. BZ 9?-ZZ ~ . ~ ~ B3 - 9~ -/~' ~i ~~ - 93.9' ~ ~ ~~ ~~ JG6~ c.o r-- i • - SG1%S~~ ~9NRl~~ ~a. 0 a~: 133 ~~ ~ Poe ~ ~/ ~ o , Ex."st ~ n9 ~ ~ ~ 98'/ /,louse ~3 V ,/ ~ l~Nl~ /~%'wa y /2 ~; 0 o`_ ~~awtl ~y I II ~- ~ . ~1~A-~^- I I ~pGGZ9 1 ~ CSC .34/3 NOTE: This document is to be recorded in the Tract Index at the office of the Register of Deeds in the county indicated below. CANCELLATION OF A HOLDING TANK AGREEMENT As the sanitary permit issuing agent in the county stated below, I hereby certify that the following described property is now served by either a public sewer or a septic tank - soil absorption system that complies with ILHR 83 , Wis. Adm. Code. In addition, I understand that execution and recording of this document cancels a holding tank agreement between the . ~ ~. ~~ , , and ~0. y i ca 1) P ~CN14 that was recorded on the ~ day of ~,,~~ 19~ in volume 7$3 , page ~~o as document number S~? 7~? 7/ . Witness my hand and seal this ` day of ~"lf/~i~i~k~ 19~,. County of S"~ • ~~f'~t ~( by ~( C P_.S~~~nG75oy~ (include title) ~S i S-~{~.,,-t.. ~,~,~nq ,1~w~~ rL. STATE OF WISCONSIN cJ Personally came before me this ~ day of %~/ ~ 19.,L3• -~. the above to me known to be the person who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: NOTARY PUBLIC MY COMMISSION EXPIRES: S't. Croix County Planning and Zoning Tuesday, January 31, 2006 at 11:40:10 AM Detail Sanitary Information Page 1 oj1 Computer #: 002-1070-60-200 Sub/Plat: NA Section: 28 Parcel #: 28.29.16.427B Lot: 1 TNIRNG: T29N R16W Municipality: Baldwin, Town of CSM: Vol. 19 Pg. 4883 1!41/4: SE 1/4 SW 114 Owner: Dejong, Dave 2340 Hwy 12 Baldwin, WI 54002 State Permit: 112677 Issued: 06/22/1988 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 08/03!1988 POWTS Detail: NA Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA Notes issuer/lns~ector Built Plumber Other Requirements Additional Notes Monev Owed Not determined NA Hudson, Dale $0.00 Tom Nelson Signed Off: Yes Owner: Hielkema, Harvey 2340 Hwy 12 Baldwin, W 154002 State Permit: 463094 Issued: 10/06/2004 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 10128!2004 POWTS Detail: Bed -Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Reouirements Additional Notes Monev Owed L~ _ ~{~ p Sterna. Joe Paperwork from 1988 mound has been moved to $0.00 ~~'. t~`~/ , ~~ ., f/,,) "~j current file with 2004 replacement paperwork. DAVE SW4j SE%, Section 28 own o a .win n 2nd Notification 3rd Notification _wi. ~~002 _ _ H~.ghwaX.. 12 ~f site:__ ~~ ?~(~ _ /7 /~ _ _ _ ~ 28 if Baldwin ~. I12677 ~ 6=Z2=88 Dale E: Hudson :placement _ ~ef~°~ r T~~'1.~E' _ ~:_ i /i WISCONSIN FUND