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Home My WebLink About002-1073-95-000`Iv°isconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT ~' ~ (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Mundt, Tony & Melissa Baldwin, Town of CST BM Elev: Insp. BM Elev: BM Description: /~0 . U /Od`~ S~~' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ p~ b Dosing ~i0~ Aeration ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WE BLDG. Vent to Air Intake OAD Septic ~~ ~~, 2 Dosing ~ ~,~ i..~ - 2~/ ~ Aeration Holding PUMPISIPHON INFORMATION tAanufacturer Demand GPM Model Number ~ j~, TDH Li Friction Lossr ~Syste ad TDH Ft ~ . ~ v ~ ~ gyn. Forcemain Length / Dia~~~ Uist. to Well SOIL ABSORPTION SYSTEM 1 t/., '~ f7 ~ - LLEVATION~bATA County: St. Cf OIX Saniti;try Permit No: 506338 State Plan ID No: Parcel Tax No: 002-1073-95-000 Section/Town/Range/Map No: 29.29.16.441 STATION BS HI FS ELEV. Benchmark p S, Z os'Z i~ • a Alt. BM Bldg. Sewer --- ~X is ~ ~ /6 S' 9g; 6 St/Ht Inlet /v' ~ ~ , SUHt Outlet ~, Dt Inlet ~ Dt Bottom -~ 9 -3 Header/Man. `~ J ~ ~~ ~O~ •~ Dis~t_Pipe ~~ °~ '~`` / y ~f.7~ . 9 7p b" .3 Bot. System 3 $~(o !/cf ~ Q 3 Final Grade ' / -7 St Cover / ! S ~ v 0 4q • / /~ , 6. SD 9 ~I • 9 yb~ r ~, o...~ BEDITRENCH Width ~ Length , ~ No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 ~~ SETBACK INFORMATION SYSTEM TO P/L BLD W LAKE/STREAM ACHING C AMBER O Manufact ~ Typ Of System: ~~ , - , U _ Mod umber: J ~~ ~ OD DISTRIBUTION SYSTEM„5.:,,1'e, ~ e~. ~ /~ .e~~ ~ ~~~.,~~- !./,.~~ man O.l.../ X -tpw,c9f k-leader/Manifol Distribution ~y ~ x Hole Size x Hole Spacing Vent to Air Intake ~ th i i S Length Leng pac ng D a SOIL COVER Y Prpscuro Svs}emc only YY Mnund nr At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 2 ~/i J Bed/Trench Edges Topsoil ~ Yes 0 No [] Yes ~~i; No CO!'i/1MENTS: (I is cepencies, persons present etc.) Inspection #1:_~/~/~~ Location: ~.~~'w _ a dwln, WI 54002 (SE 1!4 SW 1/4 29 T29N R16W) metes & bounds Lot 1.) Alt BM Description = /`~~ ~ ~~ 2..) Bldg sewer length = C d - amount of cover = Q,~/5 l~ J e __ _ Plan revision Required? ^ Yes No ~/ ~~~ ~ ~h-~-~:~.~. ~'7`~~ Use other side for additional information. ____ - - -- _ __ Date Insepctor's Sign lure SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 29.29.16.441 ,_ Cert. No. ,~ J Parcel #: 002-1073-$0-000 11/15/2007 03:58 PM PAGE t OF 1 Alt. Parcel #: 29.29.16.441 1/26 002 -TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -DAIRYLAND POWER CO-OP DAIRYLAND POWER CO-OP 2615 EAST AVE S BOX LA CROSSE WI 54601-0003 Districts: SC =School SP =Special ` = Prim roperty Addre (es): Type Dist # Description ~ 11 ' 2234 HWY 12 ~vl.L SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC ~ j ~~ ~~ / /~ C L . Legal Description: Acres: 3.140 Plat: N/A-NOT AVAILABLE SEC 29 T29N R16W PT SE SW COM ON S LN SW Block/Condo Bldg: 1/41171.4FTEOFSWCOR,THN344.6 FT, W 200 FT, N 569.3 FT TO S LN RR, ELY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ALG R/W 546.5 FT TO POB; CONT ALG R/W 29-29N-16W 273.5 FT TO CL OF DRIVEWAY, TH S 6 DEG W ALG CL 404.4 FT, W 337.5 FT, TH N 6 DEG more... Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/04/1992 Description Class Acres Land Improve Total State Reason OTHER X4 3.140 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 hA, Parcel #: 002-1074-10-000 11/15/2007 03:58 PM PAGE10F1 Alt. Parcel #: 29.29.16.441 D 002 -TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -MUNDT, TONY & MELISSA TONY & MELISSA MUNDT 2236 HWY 12 E 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: 9.840 Plat: N/A-NOT AVAILABLE SEC 29 T29N R16W S 344.6 FT SW SW LYING Block/Condo Bldg: E OF DAIRYLAND CO-OP RD EZ-U-1248/149 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 8091618 07/23/1997 732/20 07/23/1997 723/520 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 9.840 33,500 0 33,500 NO Totals for 2007: General Property 9.840 33,500 0 33,500 Woodland 0.000 0 0 Totals for 2006: General Property 9.840 33,500 0 33,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04117/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Safety and Buildings Division 2 County ` ` ~ ~ n ~ r, Tf /C ~ 01 W. Washington we P.O. Box 7152 ~~ CO/~S~n Madison, WI 53 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (508)26 1 S~ Sd~p'33 - Sanitary Permit Application I Statfe~Plan I.D(~Number Q , i ~ ' ~ ~ n accord with Comm 83.21, Wis. Adm. Code, personal information you pro / d / may be used far secondary purposes Privacy Law, sl i.tl4(1 xm) Project Address (if different than mailing address) I. Application Information -Please Print Ali Information E ~ ~ 2 Z 3;p ~'~' ' Z- E Property Owner's Name N O V O 9 2 O O 7 ~v ~vti~ p P~ ® Lot # Block # ~ - /a7 4 . S~ o00 3. Property Owner's Mailing Address ZZ ~~ ~ j `, ^( ~ ~ ~~5 ~ ST. CROIX COUNTY /~ Property Location SB ~'~ 1/ / / 2 C t w Section ? ~ ~~ ~~' ~~' C i S ta te Zi C d Ph N . ~ ty,^ / ~ ~ ,1 ~ _ / 2 1 J/T I D ~~/t/ W ~. p o e s~ o ~ one um ~ -7 - ~CY`~ / Z/ / ~(circt~ ) T N; R E W II. Type of Building (check all that apply) ~ ' Subdivision Name CSM Number 1 or 2 Family Dwelling -Number of Bedrooms ^ PublidCommercial -Describe Use ^StateOwned-Describe Use ^City ^Village Township of III. T ype of Permit: (Check only one 6oz on line A. Complete line B if applicable) A' ^ New S stem y eplacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewat Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ~__ Plumber Owner S~ / 2 ~ Q Gj ~C ~ "') V (D J U / L/ IV. T of POWTS S em: Check all that a t Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound <24 in. of suitable soil ^ At Grade ^ Single Pass Sat-d Filter ^ a nd Fi l ter ^ Constructed Wetland Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating S .. ~ - j ` Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) J-~.~'r ~ o.~ V. Dis rsaUTreatment Area Information: Design Flow (gpd) ign Soil Applit~ti n Rate(gpdsf) ~ Dispersal Area Required (s ~ Disperse[ Area Proposed (sf) System Elevation ~5 -y o ~ ~ ll~ / .3 ~ . . VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Taudcs Fatisting Tacks ~, ~ S ~ ~/ 4 I ~ t. Septic or Holding Tank ~ ©6D /r r ~-/(J Aerobic Treatment unit t7osing Chamber D w•lr\ VII. Responsibility Statement- I, the andersigrted, a~ume responsibility for installation of the PO shown on the attached plans. Plumber's Name (Print) Plumper' ignature MP/MPRS Number Business Phone Number R. vt~13~2iGG~ f- zZ~ 3 ~ -I d7 , Plumber's Address (Street, City, State, Zip Code) z.g/~ p -tu U,2 ~ Sp~i~ ~ U~/l ~j S~/ 7~ VIII. Coun !De artment Use Onl ~pproved -sapproved Sanitary Permit Fee (incl es Gro dwater S h F '^ Date Issued Issuin ent Signer tamps ' urc arge 7 ee) /~ ~ Z ~~ / ~C ven Reason Denial . J IX. Conditions of ApprovaUReasons for Disapproval ~ 1 Q ~~. ~ ~b 3~ tS(~Q s ~ SYSTEM OWNER: 1. Septic tank, effluent fltter;and a~ ^ , _ ~,o ~ << °~ dispersal cetl must all ~g s~ryj~; j,m~ tan fined r as per management plan provided by plumbe-. ~. •AN setback requirements must be maintained at per appNcable code /ordinances. Attach complete plaag (to We County only) for the system an paper not less than 81lZ x 11 iac6ea in sift .~-- ~~ ~.~ l5 SBD-6398 (R. Ol/03) :~~.,~,ssaciates :-,~waga Consult~nfis '~ AuE. ;~ey ~'~1 ~~-~?o~ ., a 5_ ~°?, _~ i i ~~ Q1~ ~~RoE B3 , t~ ~~ S~sT"eu"' R;g~ s/awl ~ ' ~---_. -p~'~ SID ~ 3 ~ ,8 ~ a A~~~~~ ~-~~' ` ~~ ~~ _., .. ~'~~~ ,0' o M ~~~io% :3,~D~"'~ QJ~ ' ~~ of S ~ ~ ;r~ i~ aM ~ >~ 30, Y J ~~,' ~o --- 1 ~0~13 ~ ~R~ e,~s T ! ~~ r ~~~~ 5.T J- ©U ~ ~ ~P ~y 'i ~~-~ ~~~ t o ,~ ,O ~ ~O~G -- yg.o'` ad ~A~KS ALL NON-GONFORMiNG TREATMENT TANKS SHALL BE ABANDONED PROPERLY PBR COMM. 83,33, -_-,, r ~ `Q I 1 ,`~ ~~i,gp BZ • ~ c ~0 ~~~ 10~ ~(0~ s~-ST~M ~~~,j~~j~~D. jbr ~~ '" ~ l J ~. -- te`''a ~~ o' --~ ,gM #",~= Top of oiv ~5~yr~e T ~.~,v~O/.e <OU.P,i, ~~, I~ ~- D? ! „I :.~G~ :ies E ?~ t~ = u (`715 4`7 P.~lCZtl Jerk.>:~3~, „+~ ~,~sri~l~ 28~? ~ ~ ~ ..,,4 S~~i~G °` ' '! ~'~ ~~7~7 .5~~1.~e- ~' / ~~' LD _ ~~C~~ ~i T'S ~ = CONTOdk Gib S~~~t~'~f'' r ,_ s,,. ~Lssoc~ates ,~~~Q Co~sultGnt~ '! AVE. '~Gy, ~°d'E ~-?rat" ~~I I D,o, o M ~~~~ S.~~Jb _'0~ ~~QEyT ~~ S~sr~ ~/QV. . RrB~' s/e~~ ~' S ~ / ,d ~3 -~` i~ f~N ~- ~ 30, J ~~~~~ '~ - ._r___---- ~o -- r R~~ ~~~ 11 PR~~'~ST ~~. r~~ ' ~~ ~v~ 5.T ~ P,C . (~ pU ~aQ f 1~ ~Q~ y,b '+ "~ r ~ ~8 ~ ~ ~ ` ~ ~ r • ,,,,. V r "- f • ,, r ~ , ~ `a----max ~~ " ~a ~ o~, So 1 S~ - -.. -~ B ~ ~ ~ ` r O~ .. 3' . Q ,, ~ x ~~, ., ~ ~ Y,. • a ~ ~ • 1 ~~ ~ •~ 4 o~D n3~u~~~ n ~!v /~ S~ST~i~ ~r(7.yr v~o. ` ~Y -----" _ y~,o` .~ o ---- _, ~~~~~' ~(bwi~,(~ od ~Ar~Ky ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. a ioo.3D , ~r ~rsT~,sr ~~v - ~7 ~ , .y ----,~ _ --__ BM#"~= Top of ~~v 5~yri~ T M~a~Ole Court,, 92. -1. (~!~~fii:lii, iv v-~-OCi~tOS P+~ivata SeG~~;~~~ Cnnsult~,nts 2812. i;~ki;'~ti,rv. I\ SC~4/-~ ~' / ~~' LD CONTOdk Lim S/~~~~f'~ R~1"~51- - N~'W A•R+~~ o~u ~RO~Ary • ~2y,Y~ - sT ~Roix Zo~~NU- ~~P~ wln of Convnerce SOIL EVALUATION REPORT ~ 1 of 3 t~ivisJOn of and suiidhgs Altaclft oom~sle she plan on paper rwt less ttlan 8112 x 11 Indies ~ Sze Plan must ~ f . . ~ nat t~: r aid itotlao[dad rafen3noe voint tem. d ana t stops, scale or moons. nom arrow. ana Location acid doe to newest road. p Paroet ,.~: ~~ ~ . --~ ~ p 73. 9, Jc . ood Please print all information. tneo~tanyara+owad~arneueeesorssoo.wM-vwvo~stararae~rV...s.~aottl3t~t)- ~' Date /1 /Z O won ~ M.Q. ~- ~' A~ JAI ~ E I V E Govt. 1a S W 1!4 S ~• T Z/ N R ~~ E( W Pn~pertyOwnet+s Address Z~3 wy~. /Z ~q TOV,O 9' 200 Lot# 8lock# Silvd. Name a~CSMk P,gRT or y~~,gG~s ~w~~ w~ s~yyoZ t ~ is ^ ~ ^Wtage ,®To+nm ~ow~.~ NearastRoad h~wy / ~-- ^ New gorrs$ur~ort Use~R / Number ot`bedroortrs Cods defi+ec, ttow Late Q ~ can ^ Pub6c a -besaibe: ~ Parark mateti~ /oFSS a v~;g~. oY Ti/lS r~iood hla~rt eleva6ort if ap~hte ' "f=1 a :G~srtera! rx~rtirttertts Si Z E' SYST 13i4s~0 oN MosT- ~P~sr7~icTifl~. ~4P~I ~~Ar~oQ~u tP,~~ Area ~ Spot Tested suitable for O~ ' ¢ t1' ~~~~' e convengonal inground system (P.O.W.T.S.) 8a~p e 0 • Ground surfaos stay ~ 0 ~ R oepih to tacbr 7 ~U in. . Salt Rate Hodaort Daptl~ Dotttirta~tt Redooc Desatptian Texttxe Strudue Cottsis~noe Barxtdary Raots in. IIIGatcel Cu. Sz Cont. Color Gr. Sz. 3h. '6f#t ' • 1 i /a R' 3 SL 2 SbKf iw- ~ ~ 3 . to / o 7• S Y SG Zf b nM~ CS -F . !o - ~ O 7 S ----- SL z sbX d • Go ~~MO T ~4 9R ~ivv ~2 / o !-s, a O~ ~ ~Plt ~, ~~-~~ ~. ~~~... ~ ~ R~ fldiaon Qepth Oardnart Redax Desalption TexlJUre Structure Cora~enoe Borat~t Roots GPOIIr: tn. ~1u. Sz. Cont. Color Gr. Sz. Sh. 'Eft#i '£I~R2 o•// % 3 -- 5~ afsbr; /lrluf2 w f . la / a .s ~ --- ~ fsb ~~R c f . ~ • L ~2s h C s • 7 s yR ----- sz ~ ~~~K ~ ~ • G `E1fII1JefTt #1= BOD > 3lT <2z4 mM. and TSS >3Q < 1 5t) mall ' fRuent ll2 = BOD 4 30 moll. and TSS < 30 rttdl L - - - csr Name R O~T3 E~'1"' ?~ !b l2 ~ G(~T-- 'i' ~ ~ -~ ~ ~ 7 /,r~2 r ~~ ~~ 2 ~ 3 7$ Add1°'~ Ulhricht ~ Associates Private Sevua~e Eonsultants 4 Spring l~slleu, ~rJl 54767 oU. S-'p7 W i~ sT ~,~~~~ ~ ~y zm,~,~~~.- ~' Ry~-N> vE.e~~yi~G- ~s~1 ~t c~or~ra sum ~,-. a t~Ilr ~ facer n Rata Hortaorr OepBr Dominant Descripliarr Tefdure Struchrre- Car~ence. Y Roots; Gl' DiIIE irr. Hartsell Qu. Sz Card. Color Csr. Sz Sh. `E1~R1 '~ / o. a R3 --- sL~ ~fsb ~' w . ~ ~_o e«„s~ ~ e~ ~ Pit Grotrr'rd al~-. ft ~ m fac6or h sa Fiarizon Depth Dominant Radom Descx~on Tezbure SUuctu~e C Botrrdary Roots irr. 11At~ tlu. Sz Carle. Color Gr. Sz Sh - •~ 'L'~'l ^ ~r9 Borlt~g ~ ^ Ph Ground strfata; slay R b tiniUrg factbr in. Sat Raba Morlxan Depw Domirant iZadoorO~tion. T S67x~rra Corrsishenoe Boundary Roots in. AMa>se~ 17u. Sz. Cant Color (~: Sz Sh. •!~ '~ ^ ~8 # ~ ~ Graard surface elev. R Oep~ b tirniBrrg factor trr. Sot Rate FforLaon Depth Ooiairraert Rerlort Tsxhrra S6rrclua Cansistenoe Borrrxlary moots GPDdIE h 1iAvae~ flu. Sz Color Gr. Sz Sit. ~ 'C~1 'E1~2 ~; ~. • ~ = Bpp` > 3Q <?20 ~- T5S >3l1 _a 15C~ mgA. • Efiuerlt fR2 = BODs < 30 rrrglL and TSS _< 30 rrglt. The Department of Commerce is an equal opportunity service provider and employer. If you need assistamx to erase sexvices or • need material in as alternate format, place contact the depardnerrt at 608-266-31St a TTY 608-2648779. aeu-avotr~os . ~ ~ ~. ,~ ^ ^ Pn tselav. R Depp, tIO facbr Hodxhaon Depth Dotrir-ant Redox Des~don Texture StrucUae Consl Irt Mrxxtalt Ctu. Bt Lbtrt. Color L~: Sz. Sh. .. e ~ .. ., a „ . a .. t=loritort ~r l~orric~nt pesaiptian Tare `Struc~xe.` Boundary Raols; in. MuneeM ~ Au. Sz. Conk Color Csr. Sz. Sh. 'EN#i 'E~#2 •ao S ~----> 5~G a. s ~ n~ ~F R cS 2 • G~ 7 S~ ~ SL Z sbk 5 . 4 /. a ~_ ~,. _ ~Yt ~ t .. - ^ •""•~~ ^ PI< Clralnd eurfaoe elev. R b fa~ior in. Q SoN Rata Hodson ~r Dominant RedoxDesatplion. T StrtxUue Uonsisfenoe Boundary Roois k (1Auri~ Qu. Sz Cant Color (~ Sz Sh. 'E7~1 'E1~Z a ~8 ~ ^ t3tound arrteoe slay tt Oe¢ti~ m taclor in. Sai Rate tlorlxon Depth ' Domlrtant Redooc TeotWrr3 Shttcture C.ora~tenoa Boraxlary Moats it. iMra»eM (~. 3z Dolor Gr: Ss. Vii. ~ "~#1 '~ a:- r • #'1 = Bt]I?s > 30 5 2Z0 mgfL •!SS >30 < 150,mrgA. • Etlkterrt alb = BfaD~ < 30 mrgA. and TSS _< 30 mgll The Deparhnen! of Commerce is an equal opportunity service provider and employer. If yon need assistance to access services or nerd material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. aer}wacR,wool Z 1 ~~~. ;=~ssac;ates :-.-,wage Consuit~nts `~ Ave. '~ey,1"~1 ~:~707 w~~~ 0 l~? Y J C ~~~~{ f 3° ~ ~M.a~'~ ~" or Sf~~ aM - p-9~,0- '~~` o A -~ y~e .,-- 1 ----- ~0 - 5g _~ ~~ ~~r ~ ~~~~ Top ~F oiv '~ r ,5~Q11G Thy r/~l~J~}~1 ~0% T ti r oU.e,L„ ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. ~b 5-~ "'-~_ ____ 'J~(~~ ~3 ,b o .~~ ~-d Ioy I°~'g~ a BZ 9~ O1D ~ ~~~°~ A3 ~~~ • -a ' le 1,5~ 1Q l d ioo.3O -N~ P±'iV:<ta ~~4'u~C;B r(l~?sUlt";niS 2812 ''~?1,~~~U. Spring "I,,,;,_,,, ~,°,,I ~.7~7 SC~4/-~ ~ ~ ~~' Z-~ = ~A~~~ ,~~~Ts A = CONTO17k. Gib 5~~~~'~t`~ ~~ UL' BRIGHT & ASSOCIATES CO. ' 2$12 10th Ave. • Spring Valley, WI 54767 715-772-3442 P~- ~' ~~..~ ® Reg. Designers of Engineering Systems E~ Private Sewage Consultants PROJECT INDEX PLAN ID # DATE ~Vd ~ 4 ~ Q ~/ ~ ~ OWNER ~N I ~ /~ j .Z ~ S~~' ~U/V ~~~ PHONE Y~y~ S~ ADDRESS ZZ~ZJ C Q LT7~ ~/ ~ Z ~-~T'~7` "` ~J~`IDLU/~C1 LEGAL DESCRIPTION ~~~ ~ oZ- ~~~~ _ CC~~~ !~/~ 7~ ,1~~ ~d~~.,Z ~ sw ,y s~ . z y T Z~~, 2~~ w TOWN OF /,~ ~~~~A~ COUNTY ~'~`d~ ~C , _ CSTM ~ • ~~~J! ~ l G~?~ ~ ~` ~~~ 7~ LOCAL AUTHORITY/ SUPERVISION ,j j'~• ~/~ ~J`Y ~.(>/'~~ PROJECT DESCRIPTION: ~ ~ ` ~t,i~2,. ~4 CD,vp-ewv,~~ ~~ftG.i~U~ S~pfiG sys,~- M, ~ D S%5 f-. ~ ~o ra Vie.- /r~v~_e . ,~ ~,~ . , . ~~ ~µ Si+Q ~d~ . 5 ~ ~.~~ 7 ~ ~ for' ~ C~~/. Z~,~~ ~G- ~v~u?~~,.`5 s ~ ~ fn~~-~ ~- s Y 5~~,~~ ~~-N~- sysf~- ~ysf~,^ w ~~ ~~~ ~~~ ~/~ti ~-~v soI ~~~ ~~~ ~ ~;,L~• l~e~~es . ,~~ ~,~ ~~ ~i-i '~i~'ou~u~ o~.~-e_. ~.: M,Q I2.5~ ~e3~7~ U;~iri h~ ~: Associates Private Sewage Consultants 2812 ~ qtr Ave. Sprin ~/~Iley, ~~J~If5~4767 Pg.l INFILTRATOR SIZING WORKSHEET r`~~"~l~t~ Pg.2 SYSTEM PLOT PLAN ~/~ Q i ~ Pg. 3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. / "UU ° V i ~ 7 Pg . 4 " ~~ „ „ ~~ Pg.S OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg-6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 {OPTIONAL) PUMP PERFORMANCE SPECS. .~ The attached plans and specifications are based on "In-Ground Absorption Component Manual For Private Onsite Wastewater Traatmani- SvGi-am4 _ ~~ (VF+rci ~n ~ _ n 1 SRI-1 (175-P f Nn1 /n1 . ~'a i ~G, ~Q ~ ~T ~- ~i~~~.'a ~ ~ l I ~S 3 X50 de ~/~ ~ ~~~,~s To i~~ f ~Ko/~oS~D ~ 3 7~~.~~ 5 ~,. ' 7 ~ ~ oR ~ ~ SIBS GD~(r ,~,±d~ 3 x ~""~- 5 c~P S ~'~ ~~i,~~~ ~ ~ g sl~lS x ~ %.~ s¢.-F~. - Ilo7.~ S~ ~~~ ~ j~~US S 5~.~~ . sirs o ~ ~. ~~PS ~ S.~ SQ.~~ ~, ; ~ ~~ ~ 3 ~,p~~-v ~__._ ___Q ~- urck4 STANDARD CHAMBER PEEP sort Tcs; So r ~ L 4i4DI ~~. r i /5' • GPI/.~,Z SIDE VIEW ow i ~..,.. ~_.. Quick4 Standard Chamber ~1~P~'av.~ off' /NSj~~~~~~~ ~~"I~ ---- ~, z9~ ,a ~/~ ,, M "2_... ~~iV ~SIf~ED ~~~ , ~ yR•4f~c Ti~~~ ~~ ,, •~ «~~L ,P~4,~~D ~ s y~r~M - .`CROSS S~cTio.~J of ~TiP~"ti~fs C Gju~ c ~ ys~ Z~S/N G- IN~iL7rPi4T~~5 ~.~ ~~~A<<~Ty cv/~il, f ~ . I .~`~ 1=T. rt/d/.~~~ +C~j ~fC,~?~f ~ S~'G T~'~ /t~ Cyq-~~cl l ~~ ~ S ~`~ ~ .P~-L~ C~i~ T'r i, ~~+ ., ~. K 2 ~~ ~2 ~.. -- ~ ~ / ~~~ ,.~ ~9Pf ~~~1~ U~~' 7w ~~9~ vv /~/.S~1~cT/ov ~/~„ ~~ 5c~ 40 ~~„ ~9Pf'~rr~l> U~.v 7- cam{ jo ~,r9 /NSp~cT/ov f~/~ ~~~/ sc~.y~o .~--~~c ~. ~~N/SI~ED 9,~~-~~ ~a~' S~ T~~~ ~~ ,, ,, ~ s ysT~.M ~i,~v, y $. 5 C7 o S Sic ion © TiP~'~uc~~s C~ S T ~ ~ ?~.S G-- 1N~i G 7~~ T ~S ~ ~~~~, ~~p~~ ~~ ~y . wig, f G . / ~ ~ ~T, /fia~~''uv~ C~,~f c~~y' ~,GL Sic T/'o ~ t S~~ ~ .?.wLC. C~fiOs s- ~ --• SQ ~ TT C~4-®ilCl T / ~ 9R~~~ T~~~ off ,, ,, C ~~ OVER: See Reverse Side for Vent/ Observation Pipe Details. i SEPTIC TANK >; PUMP CiiAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE i; ' FROM DOOR, WINDOW OR FRESH AIR INTAKE ~~.~ FINISH~'D GRADE 4" CI RISER .-r-+ ~--- 6 " M 1 N . ABOVE G ADE ~~. 6" MAX. INLET ~ ~ ~~~ ~~ ~~ WATER TIGHT SEALS 4" I CI PIPE 3' ONTO SOLID SOIL APPROVED MANHOLE COVER W / PADLOCK s; WARNING LABEL 4" MIN. ~t ~c A v APPROV ED ALM JOINTS WI CI ON PIPE 3' ONTO SOLID SOIL OFF '~~ RISER EXIT PERMITTED ONLY' IF TANK MANUFACTURER HAS APPROVAL ' ~3eti'"®M of ~N~ BAFFLE X0.15 ~,~5 q PUMP OFF ELEV . FT. - ~~~Di,.~ ~/ ~ Uh T- i D.v ~ WEATHER PROOF JUNCTION BOX WITH CONDUIT -r~~ .. ~~ ~ ~ ~~ i~ I' GAS- ~ 1' TIGHT ~ ~, A I SEAL ~ ~_~ ~ B ; ' i ~- ', 3.~-S .~ c ; I D~ ~~ 3" APPROVED BEDDING UNDER TANK SEPTIC / DOSE Gl~lF..5E2 Ylita(~,~~1L- 'TANK MANUFACTURER : C.Q NUMBF,R DOSES PER DAY ~~ TANK SIZE5: SEPTIC 1~0~ GAL. DOSE VOLUME INCLUDING DOSE ,~~QQ_ G/AL. /z'y~}~$'r- FLOWBA~CJK: ALARM MANUFACTURER: G~U~ /~I'"(~/QM CAPACITIES: A = ~~' MODEL NUMBER: L SWITCH TYPE: ~~OA.-T" PUMP MANUFACTURER : ~~1~~ ~ ' MODEL NUMBER : ~C Q ~/y. N.Q SWITCH TYPE: ~"'- fQ~-~ /D Z GAL . INCHES = ~~~ GA'.. INCHES = .3l CAL. INCHES = I02-- GAL. D = ~~ INCHES = Z7 ~ GAL. REQUIRED DISCHARGE RATE .Z(~ GPM PUMP ~ ALARM WIRING AS PER ILHR 16.23 WAC N Q Z5 IPE VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTIO " ~ FEET + MINIMUM NE'T'WORK SUPPLY PRESSURE ~~.~. FEET + ~~ FEET FORCEMAIN X.~FT/100 FT. FRICTION FACTOR ,~~ FEET _ TOTAL DYNAMIC HEAD Q ~ FEET ~I INTERNAL DIMENSIONS OF PUMP TANK: ~ ' ~, uvi0 Vd/Uti1 E r~R of o2 70 ,Fi~i2C~ M~9-/~v s ~ ~- ~i4-~S THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # ~- f00 ~~- ~ ~ ~C L D ~, LENGTH ~~ ; WIDTH ~7 ; DIAMETER 3 9 ,, LIOUID DEPTH C3.z5~ ~ -~ i NL ~r To ~~'s~2~ ~ v r~ v,~ /3o sC i~~; ~~~~ GI ~ If septic tank is fitted EACH 1" OF TANK DEPTH with a Zabel filter, there EQUALS '~'( GALS. shall be an approved above ground locking manhole cover for year-round servicing access. g = 2 C _ t'0 •~P CONCRETE PAD SPECIFICATIONS ~- l ~ ®~ 1 a, ~, ., f • ~ ~ ~~ ~ 1 • ZOELLER EFFLUENT PUMP MbDEL.'98 torx orwwo r~-tow rtll uann/ trnarn ~„s erw~lrwrb . 1~ t•rAenr tlIN/4MrN rur IrtnM eau lln• • • Lq » :» q l10 •t x~l • 11 ~.•f ~! Ire ~• l10 ~ •• ,'. 'li CONSULT FACTORY FOR SPECIAL APPLICATIONS• • ENtali~ ehall/afort, to dupleli syatemsr tfe ev~pable tnd • Menuy pot! fwhchs~ ae tvtNabie br f~rNrolNng tklgte tnd NiPpptd wllh to atefm. ~ lhres phase ey~elne. 1 Mtdpntkti tllemetort, duplex Welems, els avepeble wNh or • Ootlbie . aU1dA ~Yrfa hlrRCheE. Pb9Ybecic meaxffy pow ewdchee tre evtihble tot valsbN MvN fonQ cycb conhde. 6hndttd tN fnodels - WNQII! 3Q Ibe - yS I~,p, eEf.ECTwN ouN>fl • . f. 1nfpN eo~t ~ppy ! poM "'KI""lal swlleb, eo bA~nW eorNrd ggdrd N t„Mo - Cohkket SNKgos ' !. Igrgia Pioord•d: nNrwry tort a tp~ ~ gyp. ~! ' lAodo) Y ~-ph lAode el ox ~wMdr. IMIa b f1AO1i1. f . t. ~ , du x i M~dNnial dh-ntler IboO>Z or 10001 +. eN fY01 i>~ for aagcl MoiMl d EM~eN . "E-Pdc". ~ 1 ~ t o- / fa ~ -- l ~ (~1 eo~rl trsni~ :~ e! a ~Mrd aellvyor .p~~ fM !~0 f floe ~ f ! ! i l ._ i er 1 t i .. ~ fF1'rfh ~ "J•f dt". wneMaibat for ~fil~pplMoor~cllal or .. •~ a ~x ~~ teooooz wlnd•M ~ - i. we pf haN "J.f dl ; for wit eonn..~-.. a ~. h f~M~ y ~w ~~ •~M arM b w'b1 on Canbbwllorl 0urbr, Fhbb/ CAefION ~'~'1 ~ 1rbllij EYcMerl MNn~ar, rl~; VochuJul IWr ~ ~ iw~rl~t~~Jl~M ~ ~ ~ Mo~M -o ~eM ~ ~ ~. . ~~~ M1'! f~p~11>; .,.•. w.wy fIN>wr;.r,e try cen.a •M ..LqI eee...hrrAt -. MIIowN . • r - N ~M AA p•Np N~ Ebatrlrr C~ t~f ~ 0w C d ~ ~ . RESEpVE POWEpED DESIGN • For'unt,fsual conditions a reserve safely lacta 14 ' ... .. ~ineeed inlo the design of o,iery Zoeper ptmrp MAIL 14r.U. BOX f6311 E ~~ ~~ ~~ larl~vrr~ Kr brss o3er MtnulaGturprr •!. , , :v ~ ~ fr F ,;W ~,..,. ",..,. .. , h ,It ' FLOW pEp MINUTE 1 f/Z-il 1/t NPf i f •OWNER's MAINTAINCE~~OF SEPTLC SYSTEM - I. POWTS (landowner) is reponsible for proper operation and maintenance of. this systeat. Regular periodic inspections and •- servicing is necessary for the safe healthy operation of; this syste~t. 'Fhe owner is requi red by code to submi t all necessary maintenance/inspection reports to the controlling,authorities.. SPECIFIC CONTACT AGENTS S7- C~~Jx C j'f/ *. Governmental authority/ inspectors : 2 D,V/N fj- ~~~ . . 7~s • 3~G • y~ ~o * Licensed-installer, responsible for providing an operation/ ., maintenance "Users" manual: zZ~3~S =* Licensed servmce / inspection-agent other than installer: * Electrician: foic pump, electric controls, wiring units. IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic~~(sledding, shove ring, etc.) across the area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos use in the . winter_(a vacact.ion.trip, resulting `in no water .use) can also lead to freeze ups... . 2. Water conservat-ion •needs~ to lie -exercised ! ~ Or system can be hydrolically overloaded and destroyed. This svs~em was ••. designed for a maximum wastewater flow of ~v gals. daily. 3. POWTS are not desi~+gned to accomodate wastes from a garbage • disposal unit, or any other unnatural sources of waste. :~ Any introduction of such waste materials will overload and destroy this system. . 4. If a power o~ztage~ occurs, or a pump fails, it mays resu3t in a temporary overload of effluent being pumped into the. cell, which may adversely impact the cell (].eak~'ge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer~iinmediately for advice. 5. Neglect of the vegetative"cover (the cells insulation S. erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the.~ystem beneath is NOT sufficient alone tQ mafntain a ~~ `~~cov~arr. . 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports-have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized • laterals, at each tip - for flushing and cleaning the Laterals out. The filter-system in the tanks (via a locked abotre tX2"~t.IT"Ys~ x''_C33}'e~~" f~`±~l~s~.3 r~'; {t ~' -; ~' Safety and Buildings Division 2 C°"n~' S'T' C O l ` , m ' 01 W. Washington ":ve., P.O. Box 7162 J~~ ~D~S,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co J De artment of Commerce (608)266-3151 ~~~ Sanitary Permit Application State Plan LD. Namber ~~~5" . , In accord whh Comm 83.21, Wis. Adm. Code, personal information you provide ~ ~ 2 ~ Z (' may be used for secx,ndary purposes Privacy Law, s15.114(i xm) Project Address (if different than mailing address} I. App[ieation Information -Please Print All I ati S(,~iyrjL, Property Owner's Name O N ~ ~-L~ ~~ ss~q /~ v,U D 7`- arcel # Lot # Block # o o a~~ 0 73 ~ g S' v a o Property Owner's Mailing Address ZZ3 /~ ~yw. ~2 ~~T- Property Location w ~ 9 y~ s ~Z s S i ~ ~ Cirzrzry, State '~ ," g~ ~ Zip Code Phone N /umber t ec on , • . /Ji'4 /Q~~tIJ tt/ 5y ~ ( /,, ~ / ' SCE 5 ~ ` ~ ~ T ~ ~ R (~(E oe n T l~' . ype of Building (c k all that apply) ~ 3 RECEIVED SIIty aiet+I+lame 6S~M3iamber ~1 or 2 Family Dwelling - ter of Bedrooms R T OF ~ S Q 't' d ~1 ~ ^ PublidCommercial -Describe , / / ^ Sta[e Owntx!-Describe iJse ~7 ^Ciry ^Village~Township of fi3AL..DWI III. Type of Permit: (Check Daly one on line A. Comp! to lined, ~f~l)NT A. ^ New System Replacement S m ^ Treatm a On ^ Other Mod cation to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Perm' ' ransfer to New List Previous Permit Number and Date Issued Before Expiration ter Owne 3 ~ ~ (J ~l ~ ~ ~, y ~ G} d / / IV. T e of POWTS S s tem: Check all that a , i G~?r~t ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soi Mo < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructai Wetland ^ Pressurized In-Ground ^ Holding Tank Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Fitter ^ Leaching Chamber ^ Drip L' ^ vet-less P~ ^ Other (explain) ~ /~ V. I)is rsal/I'reatmentAr~a Information: GZ Desi Flow (gpd) ~Sv Desi Soil Ap lice ~ n te(gpdst) ~ ~ Dis 1 Ar aired {sf) Dispersal Area roposed (sf) System Elevation Sao ~o • /~o l o ~ , ySo ,S ~~ . VI. Tank info Capacity in Tote! Num Manu rer Prefab Site Steel Fiber Plastic Gallons Gallons of U Concrete Constructed Glass New Tanks F~dsting Tanks /-~' ~`~p W ri-~ /~ Septic or t{ok6ag Tank O fj ~ ~ ~ oU ~.D~ Aerobic Treatment 1Jnk Dosing Chamber ~/ (~ ~~ .' rQ -.S r ; ~ _ 9j r lG VII. Responsibility Statement- L the ande ed, assame responsibility for installation of th e POWT'S sho on the attached plans. Plumber's Name (Print) Pium Signature ~rIP/MPRS Number Business Phone Number - RaB~l~f 21~6Ri ~(~ zZCP3-7S 7IS • 772.3`~~{Z Plumber's Address (Street, City, State, Zip ) ` 2 8i z /o ~ lfv.~e... S~it'i~ir l/~ l~-e ~ ~ S y /~ L/j VIII. Dan /De artment Use Onl .rte proved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ ~ ~, y~ 4'~' J Date stied ~ ~ ~ }.suing A ent S Stamps) ^ Owner Given Reason for Denial _ C•t/ IX. Conditions f A rovaUReasons for Disapprav , Gy, YSTEM OWNER: ~ ~~~ `,(/~ ~~~`~~~~~`~ vent filter and '~~~^ dispersal cell must all be serviced /maintained C~~~~. G>,~~ -~-~I ~ UU~~z~ as per management plan provided by plumber. -,~ ~ "~_~ ~ All setback requirements must be maint ' ~Z~Yh/~ as per applicable code/ord' SBD-6398 (R. 01!03) mantes. ~ ~ ~ S Sys /~ Attach compkk us ( Comty Doty) for the sys (dpaper not les~fhan 81/2 x l 1 i~hes in siu ~~ ~ /J~- -~ _ ~ .` ...... _..__ _._ .. _... _ . ~~.IO~~~ i a = G~.v fo v,C' ~--- Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valleyz WI 54767 ALL NON-CONFO G TREATMENT TANKS SHA BE ABANDONED PROPERLY PER COMM. 83.33. ~" l~ v~Tio~s ~( a ~ ~y~ ~~ 3 `~ 4 i~~ ~~ R~5 , 5 I~ ~~ ,~~ ~~~ N a~ pR~ ti NEw w/FSe'R ~- ~ ~,,,cf o 0 0 ~'~o-Q Z ~ R~~S7" s~ r~ Tz~~6MM~ '" o sys T. ~/~U~FTro.u ~/D.v y q~ 5y'~l?.Gr' ~~a ~~!! p p. b ' w ~ ~~ w~ 7 ~'~- ~-- ~. P ` ~~~ Z ~b ~ t~~ ~ ~D /5~~- y' }"~ P' ~l 5~~ K a~ ~~~ rJ~ ~$Rp. ~ o~ ~;~"~ o/ 1 ` ~ ~ ~' ~~Sf ~ lei !~' ~~~ p~+f~t ~b Obis t a,, ~~ u~% _____~ ~s ---~-- • ~z_ ~q,5y _y8.~5 ~3 P~-~' BEM ~ M E~ ~ ~ s'~ QEQ~~ ~,0 ~~5 P~~p~(P QUA. ~ 1 ~ a 8' , sir ~~~~ -~^ ~~ /oo•~ ~ '~~'~ h ~~ a y~ ~s ~' commerce.wi.gov isconsin Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www. coin merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 16, 2007 OUST ID No. 226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 2812 10TH AVE SPRING VALLEY WI 54767 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/16/2009 Identification Numbers Transaction ID No. 1428209 SITE: Site ID No. 728989 Tony Mundt -Dwelling Please refer to both identification numbers, 2236 Hwy 12 W above, in all corres ondence with the a enc . Town of Baldwin, 54002 St Croix County S1/2, SW1/4, 529, T29N, R16W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1146653 Maintenance required; Replacement system; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. Tlus system is to be constructed and located in accordance wththe enclosed approved plans and with the component manual(s) refexenced above. 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: • On page 4, the specified dose tank is no longer approved. As discussed with you on the telephone earlier today, the following tank will be substituted with these pump switch settings: Tank manufacturer: Wieser Concrete Products, Inc. Model number: WLP 750-MR Liquid. level = 37.5 inches Vertical capacity = 20.28 gat/in A = 15 inches, or 304 gallons B = 2 inches, or 41 gallons C = 4 inches, or 81 gallons D = 16.5 inches, or 335 gallons 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 Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. P.~ Can, ~~ DEP DIYJSI SEE CORR ROBERT W ULBRICHT Page 2 8/16/2007 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. Sincerel eter E Page ~' Private Sewage Pla viewer ,Integrated Services (608)266-2889 , M - , 0630 - 1500 Hrs pete.pagel@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~~li/^ aY Y^ ^~ M I ~~~®Y~Y A! is~~ it M 2812 10th Ave. ~ Spring Valley, WI 54767 715-772-3442 PROJECT INDEX Plan I,D. # _~ Owner 7oN y ' MF/'.~s,~} /VJyy~ 7" _ 5,1~ Address ZZ3 ~o ~4~y / Z- ~i4S7", ,B~/DU>i.J Gl~/S . S yaoZ, ~ Legal Description Pi4~r of ~~~sf /~/N oOZ- /073. 9s'O~o ~OU~+. ~z, D~ !W %~ ,SE'C- 2 y TZ ~/V. ~ ~` !Co Wks T-- Town of ~~9G~w/,J , County St . cR0 f~ C.S.T. IQ. ~~~R~ (,~-~ ~ 2ZCa3-1 S~_.._ ....._. Installer Rn$ERT ?,t, I bRjC tiT Local Authority/ Supervision s~, Gk~l ~ cTy. 2ON ~ ~G.. ~E~T• PROJECT DESCRIPTION o ff,~,~lily RE ply ~~~~ r M o vN o ~ ys~-~ M Fo ~ ~- 1~~4-; ~; ,u G--- F•o R ~ CbN~~M~~D c~'ss.~oa~. /.~~yW~ll sysr~~ 3 13~e'~ - ~foM~ . P R-o P osE~ ~ ~ 2lS~~G- /y" sst~vv ~i!/. ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. COwU~:v J'io~i9- L !`1 o U N D s y5 T RECEIVED AUG 0 9 2007 SAFETY & BUILDINGS Reg. Designers of Engineering Systems Private Sewage Consultants Date /4 U~ • 7 r Z o0 -7 - Phone 7/s • ~od~y S~.S~ ~~~ ~,,~ PR s ~ zz 43-7 5 Rat~~7' ZtLB R i G !n"1" Ulbricht & Associates Private Sewage Consultants 281 ? 10th Ave. Sprinct galley, WI 54767 f~~ ~ - ~o~ ~ ~! T. ~ifi S ~h~ly To~ ~VF~ Pg.l PLOT PLAN VIEWS pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE IDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN. OUTS) U g. DOSING CHAMBER CROSS SECTION & SPECS. ~. ~.5 PUMP PERFORMANCE SPECS (REVERSMENTSE(REVERSEUSIDEESHOWS) w Pg. 6.OPERATION, MAINTENANCE REQUIRE Z SITE ~ SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO ~ ~ LOCALE AND GOVERNMENTAL UNIT AREA) v ,~ ~ V O W The attached plans and specifications are based on the following U rim approved manuals:. "Mound Component Manual For Private Onsite Wastewater Treatment Systems (Version 2.0 SBD-10691-P(N.O1/O1) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD-10706-P(NO1/O1). .. e = ~^ Q 13.~c~~-e ~~' TS GD.v fo v,C Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. R~l6MM~~~~ ~i~v~-r~o,~ ~4~ovy ~-~~l ~oa•7e ~~.~o~~~ ~Lc Uyl-TiauS NEw u,i~s ~• G,,cf~- ~ 0 0 0 ~.d¢ . P R~~s7" S • ~~ 4 3~ IW~. s ysT y q~ Sy ~ ~'' ~~a~ ~ sV C.~. N~ 0 Ce P~~ ~ ~E~ Z ~ ~ y6 ~ z q ~,~ Z ,~ / Q ~--• I r /~, 5f~- y,~ y,! ~I ~~ ~~% ~~'' ,~~ ,5 ~~`` ~N t~ ~`~ R'~ ~ ~l ~d ~ ~ ,~ . r d f ~' ... ~b ~Ob~s `r ~. .~ . . . .. r . .. ... . ~.. • i ~~' ~ - yy,s~' ~ M SoMM. RRI ~ _ ~ ~,5 7 ~ 5~ Q~ ~ C'',P-~EV I/ ~ S pO~~E Qp,OpE ~ ~ ~N~s PQORP P ~ ~ I „ 3 ~N3 x`21 ~pOE~'~ ~ Z ~ 1~ ~ F~L~~~ ~ti /y~ i a ~ y~ ~s ALL NON-CONFORMIN TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. a Zy 3 ~~ ,e~5 ~5 ll' ~R~li~ h 1, 5~~ K ~~ ~~~ 1~ ~t~Rp . a c~s~~l y Of '~ a,- ~' ~ , SET •.,_, 0 ~~~ /40'~ t ~1 ~~ h ~~ '/~ Ct~o55 SEc•rtd~ of l~oc»D -- w. rrt Tien Py zefl~- Vu~ FoRM TQE• Dev of ~" ro ~ a~` A9g~r5nTE s ysr~M E It: V,4 T'ioa oo. 70 ' ~E • MEt7. 1 9 . • O ~ L ~~/ //~~ i~//plowt£a Tops i~ 3 % SIopE F'oR~E 1"I/F+~ ~ E /3~ ,~ t=r.~~) ~ • B~ FT• /,~NI C ~ • .~ Fr. ~ ~ C~ FT. /// ~,h uu~ FoRM E ~ t=Vnroa uu ~R ~ y~ s~ ~: -- ELEVhT~o~ 5 . ;' ~~ ~ • Top o f R o c~ l ~~• ~~ , ~„ . -~-o o F V 2 P ~_ ~ATERA~S ~ ~• .~7 I PLAN VIEW c~~ Mo~~~ -- wf rte T3~D f SIR r ~'~ ~/ avtt, cell •Di 5t Ri(3oT~ o,~,~ ~3'~ TNtGI:~]ES9 PIPI1J~s• °F T°p s o i l w~ TE~i41iU~ C~ p'S 'l L _ ~v(?cE MAiN i i ~ ~ f3ED of ~2'~ ~ Puc cAppEp To 1i" paygR!`6-~°;T~ dl3SeRVhr~oa ~ Pipes /ocA-T%avs : 7 ~N 7~ieDi''1 ~'upS~ of C'~ // PEQM/WE~uT MhRKERS t Td~s Bf G/L'A~ ~?~% ~w~E]~S l REG2t)iRED (3ASl\t, l~RE~' ~ v~rt_y whSTEF'low ~/ ~ S n t L r,~-f: t TRn~nd E ~O ~p~~; Ty Pi~oposEb 4~ts~( ARe~ = ~~,~~~ ~. -~ -- ,Q ~ F r• 4 75 Fr k ~~ Fr l~ 9S F r ~ 9 Fr T ~~ F r W - ~,~ Q '~ -- --------_ --__ •---j ~ 1 -~1 1 ~° W Y M y. a ~ (A +r~ 75x/~+tS ( 1 '~so s~. Fr. ~5~5 5,~1~ ~T. Observation pipe ~ ~--Dist~ibtrtiort ceH 6" FiH material (~tSTbt C33, fine aggregate) _,.- Cover material Tilled area ~•----Slope ~-Force main Figure 6. Cross-section of a Mound System Vttater tight cap 4° min. dia. Sloi 6° 6" min. min. d Infiltratiae surface ~ ' lilfater Closet Collar Bar (3 yin. dia.j Figure 8 -Observation couplings ~ ~~ ~ o ~~ ~ c~. ~~M ~~~~ ~~ , ~ /tail. ~~~.~~ ,, ~ << ~~ ~~~~~~~~ . ~ / ?.._ •~ isTQ~ QUT10~ 'pr ~' L~4~ ot~ C~~T1: ~4L.~ ~ M~.~ i ~o cm. ~ . ~ ~ _ P . ~ • ~o~E ~ `` X ~- F%~s ~ x ~ /2- - -, ,~ - ---;~ ~ p 3 ~ F r ~ ~ .~. . R Z ~r ~~~~ x 3 ~ ~Er~TR~L... F o RcE M Ai ~ ----._ INcN ?j(~ Fr. of ~ . puc y l s -~-~-., Iuc}~ . ~~R~•h(3lE . ToTA~ VdID Ub~t~)-1 E ~ GAlS • 'DiST~ac~ 3 70 7r~.~ l~11~"~U.y~- H oi~ v~~ME . ~4 T~ R ~ ANC N ~S ~~ /~,T~ ~E~urRhl M~utFc~~d 2, ~5 ~~,~ ~ _ tN c ~ ~s ~c~~2tE MAIN Z - It~G1~E5 •~'. of tf~~Es~~t P~ ~3 I.IUVERT Et,~V~TiOK o f L ATE ~QI! t 5 SEE (~~UE ~S E S ~ f~E .F'a ~ ~-- ~~~ Z D ~ ~R~tiNAL c~D ~LTT)4fL ~ 17. E i ~t i (._ • P i QE' ~?iPi~i ~'~'- PE R Fa R ~4TE D ~ o~s;Ty ~ R~MovE- ~4t1 Rill (3URR5 ~ ` Y ~. ~ , - Nei~S ~ocATsa o,J f3oTT'oM E~V~tIY S AC ~.. ~ ~ E ~ . 0 W-s ~iSrRigcsrtoN ~~SchAR(~E RATE ~a PAR ~tE S .G~ ~ l3 = R t=Rch ~ArERq L ~•5~ .Gq~ /Mi~1. ,N ~'oTf! ~ S~ i S TRI gu Tt o ~1 ~t S c k~RR ~E ~ RATE ~t~(Z ~ ~ -VEr woR K 3~/ 3 -L G~~~1H~~N. ~ a•5' M ~•Nr MU M r~ ~D~T~ t L o ~= LA-T~ R/~ L ~~p /~iPF,s ova- ~ i c`-~ ~ ~.v~ of ~-~-~~ ~;v~sft~ ~Iovup yiP,4D~ ____ _~ L~9w,v S~iPiv,~~ ~~ Gu ~ d~i ~ ~C~E"S s 7`~O ° .S'GvE~~ 0 2 ~~~ yy_ , ~E,V ~..~ tH~'E~~~ ~~•~~~ ~9~~/~rE~ --~ PUMP CHAMBER CROSS SEC CI .'~ P~~E `f oF~ `f„C.Z. VEA1T PIPE ? 25' FROM ODOR, T WIAIDOW OR FRESH r AIP, INTAKE ~1/'~DE G~IE D'~T/OM IO Z •D ~..--., -...~~ ~~ 5.0 , ~IEUATi lv ~ l.~~l ~~ INLET v ~~ P r APPROVED LOCKING MAWHOIE COVER u'f w~i(N/~l~ ~~/gE~ Y" MIA(. IB"MIN. __ _ ROVI D E I ~L ~ AIRTIGHT SEAL I II' -__ APPROVED JOINT A ~51 ~G~l I I ' \ /' VJ~C.I. PfPE ~ b f~ ~~// EXTENDIAIG 3' ~~..r(nM ~ i I ~ APPROVED JOIA JI,ITO SOf_ib SOIL ~O ~ I I ~ I w~C•I. PIPE -t 8 (~ 3 ~ ~ ii 3 • ~-~ I I ALARM EXTENOIAIG 3' oF~ -~ q 5 • ~ S ~ / 3 q ,, ( I I ~ oAITo soup sc ~' c~ ~ I oN ELEV. FT O C ~ I 1 ------ / I ,J ~ O 1 1,, t - PUMP --~ ~ ~ OFF Z~.SE 3 a k ~~ DD( 1 ~ _ ~~(~ u>rt f i6~J" '=~ ~ ISLOCK ~1oiPE` of Si1.v~ ~~~ ~- RISER EXIT PERMITTED OIJLy IF TANK MAAI - ~~'~~ UFACTURER HAS SUCH APPROVAL SEPTIC E S PE C I F I~CATI C)A1 S 005E _ -/- TAAIKS MAAIUFACTURER: W~~S~~ YJ/tXl.~~.L C() N. l TAAfK SIZE ; 7SO fvUMSER OF DOSES: PER DAa ALARM MAAIUFACTURER: L.GuL~ GALL.OAfS DOSE VOLUME p~ 1S I A-~M IRlCLUDIAIG BACK GAt.LpN! MODEL NUM6ER: ~. V' L - 5 ! ' swITCH TyPE• F~~/4l- CAPACITIES A_ 7 INCHES oR 2 Eou pUMp 7 AEI/~~ B = INCHES OR J GAl IJ MAAIUFACTURER: -~_-_7 L1 t-~ MODEL. AlUMBER: _ ~.3 [ Z N• r . C SWITCH TYPE; ~1Gl~'y,t3A~LK ~~Q~¢T-- MOTE: PUMP MIAlIMUM DISCHARGE RATE __ ~5 Gp~,,, INSTALLED i VERTICAL DIFFEREAICE 9ETWEEAI PUMP OFF AIJO D15TRIgUT10N PIPE.. ~~ O MEET -F- MINIMUM NETWORK SUPPLY PRE URE . , , , ~ ~ . _ .3.;~ ~j 2~ r~ FEET -~ J" FEET OF FORCE MAItJ x Z' iS F7,,/~ /pp ~FRICTIOAI FACTOR. ' ~ F _.l-ICHES OR GAL OIJ .INCHES OR ~ ALLOA RM ARE TO CAI SEPARATE CIRCUITS 1"AA9~ S~fGS L~/~IC j ~"~vr I S 7~~~ c _.__ TOTAL Dy1~fAMiC. HEAP = 1 ~ • FEET jZoUND a IAITERAIAL biME1J510NS OF TANK: LEIJGTH~~WIDTN (LIQUID DEPTH THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # Q • ~D b ..-----VENT CAP WEATHER PROOF JUIUCTION BOX-` 12"MIU. I .1 GRADE I I COAIDUIT ~-- ORR`~~~`0 Q~~~~~C C ~CQ~R'~S S~ CAPACITY o HEAD/ ~ ~ ~ ~ „5 ~~, 50~~ LLONS 10 20 30 40 50 60 70 80 90 10G 110 110 195 - 1 95 95 . .I ~ • ~ 75 ' MOD EL _ MODEL 189 16 5 70 65- 69 55 ~ ~ MO DEL 1 83 MODEL 189 ~~- MODEL M ODEL ~ 137, 139 185 25 20- 15 MODEL MODEL 181 97 10 MODEL 5 53, 55, 57, 59 CUR Ve ~ W W W W Y. I ~ 24 75 22 70 20 _ SEWAGE and DEWATER/NG 30 28 EFFLUENT 24 D DEWATERING U 20 Q ~ 18 O Q 18 O 1- 14 12 10 8 6 4 2 0 GA LITERS 0 80 160 240 320 400 FLOW PER WIINUTE E_ ~< "137" Cast -ron Series "139" Bronae Series • Automatic or Nor:-Automatic. • '/z H.P., 1 Ph., 115V, 200-208V or 230V. • '/~ H.P., 3 Ph., 200-208V or 230V. •Non-clogging vortex impeller design. h HEAD CAPACITY UNITS/MIN Feet Meters Gal. Ltrs. 5 1.52 104 394 10 3.04 79 300 15 4.57 64 242 20 6.10 36 136 25 7.62 8 30 Lock Valve: 28' • Passes 5/e inch solids (sp ere). • 1Yz" NPT discharge. • Float operated, submersible (NEMA 6) 2 pole mechanical switch. • Automatic reset thermal overload protection. ~C/ / `~ ~. • Stainless steel screws; bolts, guard, handle and ~-LL arm and seal assembly. 'Bronze motor and pump housing, switch 3280 Old Mllla/3 Lane case, base and impeller. RO. BOX 16347 Mercury /loaf switches are available /ornon-automatic models. LO+~v1Ms, Kentucky 4Q216 FLOW PER MINUTE . •~ . ' ~~ ~ ~ Mound System Management Plan ~_ ... 'P~. •.~ of.~ ~~ Pursuant to Comm 83.54, Wis. Adm. Code, ~' • Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The conten{s of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be deaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain'solids in the tank that may slough off the titter when removed from its encbsure. If the biter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously, Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic lank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the lime of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of bfotogical or chemical additives to enhance septic tank performance is generally not required. However, if such products are used. they shall be approved for septic tank use by the Department of Commerce, Safely and Buildings Division. ~ ' Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms. and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shaft be seeded and mulched as necessary to prevent erosbn and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penet~tion. Cold weather instatiations (October-February) dictate that the mound be heavily mulched for frost protection. ' influent quality into the mound system may not exceed 220 mglL 8005, 150 mg/L TSS, and 30 mglL FOG. Influent flow may not exceed maximum design flow spedfled in the permit for this installation. - The pressure distribution system is provided with a Bushing point at the end of each lateral, and it is recommended that each lateral be Bushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the Mitiai test when the system was installed to determine if orifice dogging ha's occurred and H orflke deanMg is required to maintain equa{ distributbn within the dispersal cell. Observation pipes within the dispersal cefl shall be.checked,for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more foequent monitoring. General , This system shag be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572=P (R. 13199)[ and local or state rules pertaining to system maintenance and maisrtenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shalt be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no bnger used as ~~ POWTS components. ` Septic br pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective. or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shag be secured by an effective locking device to prevent accidental or unauthorized entry into a lank or component. Contlnaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or repirced to keep the " ~~ system in proper operating condition. if the dosing tank. pump, pump controls, alarm or related wiring. becomes defective the defective component shag tie immediately repaired or replaced with a component of the same or eauai performance. it the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface. it wifl be repaired or replaced fn its' present location by Increasing basal area if toe leakage occurs or by removing biologically clogged adsorpflon and dispersal media, and related piping, and repladng saki components as deemed necessary to bring the system krto proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspedor. SEF REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TU 'ffitS SITE, DESIGN, AND COMPONENTS .-. la[3.LlYIKj(Yf.~i ur 5EF`i'iC SYSTEl; POWT5 (landowner} is reponsible for proper operation and ~~ maintenance of. this system. Regular periodic inspections and • servicing is necessary for the safe healthy operation of, this system. The owner is required. by code to submit all necessary maintenance/inspection reports to the controlling ,authorities.. SPECIFIC CQNTACT AGENTS ST C,c~o1X C~`~ ZdNr'aG- * Governmental authority/ inspectors: ~~p T ~/S 3~~ . y~~C~ * Licensed-installer, responsible for providing an operation/ maintenance "Users" manual : ~• ~/~2 ~'~, ~~,._, 7/,s • 77,~ •3 yy ~ s ~ R /~v lr U~//-e y ~v/. S ~/7G7 ~* Licensed servarce / inspection-agent other than installer: ?mil/,~K i IG T ~ /f sr oc„tr-t-s ~o . SE~n c i~U•yP; ~G- 7/s•77~ •3y~Z. * Electricians for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE RE UII2EMENTS 1. Winter traffic~~(sledding, shove ring, etc.} across the area shall not be permitted, or frost can/will penetrate into• the cell, freezing up the system. Discontinuos use in the . winter_(a vacact.ion.trip, resulting in no water use) can also lead to freeze ups. ~ ~ .. 2. Water conservation•needs to be exercised! Or system can be hydrolically overloaded and destroyed. This svs~em was ••. designed for a maximum wastewater flow of ~~O gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste~~materials will overload and destroy this system. - 4. If a power oittage~ occurs, or a pump fails, it mays result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (].eak~'ge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer ~iiumediateiy for advice. 5. Neglect of the vegetative"cover (the cells insulation S erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the,tsystem beneath 1S !iIOT sufficient alone t0 maintain a ~L `~=~covsr. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressuri2ed • laterals, at each tip - far flushing and cleaning the laterals out. The filter system in the tanks (via a lucked above • ground cover/manhole). Only a licensed properly qualifiied person should be performing this work which involves health ~ severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. w ~ _l . ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ S ~ TR'' Mailing Address Property Address z z 3~ ~~wy ~z ~.~5~-- , ~~-,~w,~ ~~. s S S/,~o Z (Verification required from Planning & Zoning Department for new construction.) CitylState w~1~'~~~ri1J ~ ~' Parcel Identification Number d ~~' ~ D 73 ' 9•S' 00 ~ LEGAL DESCRIPTION q Property Location !J~ '/4 ,~~ '/a ,Sec. ~' g , T.2 ( N R ~~ W, Town of ~/'~'~Orc~r'y Subdiv~ ~' u ~'~~/~ / O ~ ~-" f ~'~ s ~ Lot # _ Certified Sarvey Map # ~~~--` ,Volume ,Page # Warren Deed # J ~y 3 ~ ~ ~ Volume - ~~~ ~ ,Page # Spec house yes no Lot•lines identifiable yes no ~, SYSTEM MAINTENANCE AND OWNER CERTIFICATION .. Sr Z. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52(1}and in Chapter 12 - St. Croix County Sanitary Ordinance. - The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary),. the septic tank is less than 1/3 full of sludge. ~.. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with tie standazds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County P,1luming & Zoning Department within 30 days of the three year expiration date. 9 Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. • Namber'of bedrooms ~ ~ ~/ ~ /07 IGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed (REV. 08/05) Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 OOGU MENT NO WARRANTY pE~p r.•.s t.:Yw•:E aCSCfiV Eb FOR RE<aluU•,=G Gw,w J ~~ '' STATE BAR OF W15GONSIN FOR!-1 't' - S08'~ ~ •~ i~l low. i L. s .r 4/• 1 ~. ay, ~•~ Bruce J". Moll, a single person `~'~-CFsDLX~&~_.V~! P.~a'd t_r f?__~rd - ..._... ......__. .-- - _.. .... . .... .. ...... MAR 1 8 1994 12:15 P.~a ............. ! ~.a; ...-:.;. _~ ..TpnY .-Mundt -arlFd-- MP~.3>ss~ MuFiS3.t f ~ - ~ . ~ husband. aAd wife - _ ... ..- --- - -------------- - -- . tl~~0oi*6 tf i s Rev v: s '-' ._ _- - - ~ S t. C, r o i~ r -r ~-.....- ~. us., s ~~ ~ .sue t i,n fl.11.•w in;• drweri6ell real estate in ... -. ,... -.. i- --------- ------- -.--.Gou nty! -. ~- Stttt.• <.f ~Vina.~n.'VI: South I3a2f o: ~+oiithw~>iyi: ¢uarte~r (S'g Qf SW'g) EXCEPT' that part Northerly of the Raiiro~d R/W and EXCEPT that part to Dairylarid Power Cooperative in Volume "281", page 264 artd EXCEPT that part ..ying Faest of the last described ex_eption; Southwest !~„~~...~ ~~.~ vF ~.::».~•..i`~ ~t ,<uur ~• \ vri q • ai ~ / us' a-a>~ t.. i .. Northerly of the ~Raf lroad~R/W; r r y ~ rin Section Twenty-Nine (29) , Township Twonty-Nine Norfih (T29N), Rangs: Sixteen West (R15W). This deed is given in fulfillment of a certain land contraot between the above parties dated MaY 2 1988, and recordQd in the office of the register of Deeds for St. Croix County, Wisconsin, on May 4 1988, in Volume 809 of Records, at Page 618 , as Documer:t No. 436984 _'~ .i-.. 1'~ L. L- 1 U J ~1 c~ ~ ~ ~ ii ~! ~ ~- This _.-S. -. i71Ut••-.. homc9tead propert}•. (is) (is not) Is~cl}tints to .vnrrantiea: Easements and restrictions of record, and e~ccept any liens or encumbrances created or suffered to be created by the acts and defaults of the grant~rees, their heirs, successors or assigns. l~nled this ... .. ._...1~..~`. ~.... _. dn~! of ....- ... lltie-~~'~~w~~7~... .... _.... ... .~. /. .-.., I9.g~ .- Bruce J . Md1.1 .-. ._- .. - -- ..-- -- •-"---- -(SEAL) ...- - - .._ .151::AL! AUTliE11ITICATION ACI£NOWLI;I~GMENT Signature(s) STATE OI• WISCONSIN sa. •--------------•----------------•---•---•-----••----.._..----•-----•--•-----•--- S t. C r o i X Count~•. authenticated the .--__---day of.--___-•-------- ------•„ I9_•--._ I'crsonally carte before me 9}~s ~~ ~("`.da~• of - yln a re ~-•--- -----. 29-..---- Lhe sboa•c named TITLE: 1~IE1bIIIER STATE BAR OF SVISCONSiN - ' •---------.--•--•---- ---••-•--••--- -.. .-__. .---.----_._ ... ... - (II not. -•------------------- ----------- ------•.------•• -- - - ..--. .. ...- ---•---••---- --- -- .- • - -. . authorized be ~ 7(3ti,OCt, tiVis. Stats.3 to me kno~cn to be the person - ---........ ~c!to ececuted Lhe •••~,~ _ infi instrument and acf:nowicdge the sane. .• 1 TNiS INSTRUMENT WAS DRAFTER BY ~ !. ~~Y~. Thomas A. McCormack E.~:• "': - - - - - •-- .•- Baldwin. WI 54001 ~ : t- t .•. rc .. `- ~ ~sza.ti~~\a-- - - - ---_- ~ 3'~--a---. . ... ..--•- - ....--.--•--------•-•-----------f-<1-:- ~~--,-......_..___- ~ : IVotan' Public ...- .._ 5t. Croix... Coun(.y, rc;Q. i .y •r 1 ' - - 9T}• Cr.lnmis~ion is pl+rmannnt. `1 i not, state .~~piratinn (Signatures rr=ay he authenticated or atk~sotolCcrged. Both' - ~ are not necessary-) '. ~' t :_' datr• _~.~3 1!)r} :9~~ -S -Nnmaa •+[ n~r,nce e:c„nc in onY ~nnnr as eh.•ei : Lr ts', ri . r ..r Ynlyd 1.. ... r. •,=-~.r =iF nn r•rc::. ,.~'A RRA NTF DCED STATF. 1t Att OF N[StONSiTi lM o~pns•n laoAl f3llnk Ca Inr, F DtZ Ai N:O. -- - 1'•+_ 0.i.lw•ry•,krr W•SCO'=5••` r ,iMsba~ahr trr~erd of Carrne~ ~ i ~,SflIL EVALUATION REPORT t)ivislOrr of Safeyr and 8rgs ~ ~~ 3 +~ acooraarroe w~ a.anrn ~. ~. aaoe attach aornpl~e ei0e qan on paper rat ass ttran a arz x a a courtly 5 T ' ~~ a ~• ~ m ara Pew l.o. c~02- /OZ 3 • '~S• o©d ~~~ ~~ J U L 2 0 00 ~ Paswwrrron~onrouaavw:+~rawaawra.o- > > 7 23 d7 ~pertyamer a TQiV ~(J/V ~ ~ ~ /I'l~f SSA ProperlyLa~6'iorr Gavt. La d • ,/Z, S 1M ass 2 `j T ~ 9 N R !~ E ( W Propertys - Zz3Ce !f~ /Z ~~57' Lot # Block # ti Subd. Narrre a CStdld` 1~t~2T o~ y6+ ~~eS State Phone ^ (~y ^ vie Q Town t Road l3r410tv/w Gv1. c ?15~ GoQ •SIvS/ p w . !z ^ NBW CoflalliM~On (,180: (~ ReSlderdl8i / l~ttRrltleraf (7edfO01r14 Code derived desi~r ttoW rate ~,~d GPD i~Repiaoerner~ ^ Pubes Or oormren3~ - Describe: Parent nr~ermt _/o ES S ~ GE2i ~~ iULt' ~'r'Il S Food Ptak, elevation its N tt c3errerat oannrertis ~~ / 9(a 9 aM l~fea X Spot Tested suitabl~e~f,/or a~~ mound (P.O.W.T.S.) system using ._.~.:~.~. ~~ . sand fill. ' ~ ~~~ ^~ ~ SS.~S. Pit C~rotxrd srrfaos elev. ~ , R Deplh m tirr~irg factor ~ Z" ~• ~ Sol ftala Hariaon Oeph Darrrirrarrt liedoor Oescriplion Texwre Sducgre Cor~tenoe 8axrdary Roots in. i Qu. &z Cflrrt. Cdor Or. ~. Sh. 'fi~Rl4 `~ ©'!d /o YR 3 S~- 2.-~Sh 5 ccv 3 ~ ~ o 2 !e•/~ !o L 2fsbK ~ e5 ~ -1 0 S/L ~-•1fR CS f f Cv 2 • o Me CL '~'I~ Z 5 ~ 5 2 ~~ ~ B«in~ 2.Z s s.S . Pit c~und Neiv. at. o~ a r ~• -• sa Ra1s flairon Depth Oanrinunt Redox Damon Teucture Stnrckae Corui~enoe Boundary Roots C~P Oit(! ir. IlArxrseN (~. Sz. Cord. Cabr Cx Sz Sh `lBlfl'i 'f: ~-~ /o YR 3 ~ ~ 2 ,r,„ sbK s C ~u 3 l O 2 /o ---- ~ z fs h c ~ .~ S• z ! 5 --- L cS ~ s s ~ t~IBnt ~ _ ~ > 3Q < ~ rr10~. arld TSS >30 i a 50 rrr0lt_ ~ hard ~ = BQQ < 3Q Ii1M. and TSS < .~ rlrelt. . CST t+lame (Please P~~~T ~ I t~0 ~ ~ rr~t ~" ~~ ~Nu~m6~~•~ l< Addrea~s ~Ji6r'i'~'h~'& ~i ate s Date c-ve~uon cond~aaa Televtane l~.n~r Private Sewage.. Consultants ~.tt 5 - (~ 7 ~ !S ~ ?~~ . 3 yyz. n o ~ ~ '#~'I"1~b"E''. spring vaaiey, WI 54767 7'~e~-r~i~,~T 7'~•,v~s C3) .9~~~ .va ~- ~`f'/P ~ ~ ti S~.t'Sov.~llt~ S~~`~ic.t-7~ So •lS . ORIGINAL ~,~ Ir'ss ~ M ~tif~-c~ (~1~a ~# ^ ~ p pri t3taud tae ele~-. tt Depth ~ tatdor Flortzott Depot Dotrtinant Redatt Desaipdott Texlua 5~ttttuns Corral in. lAtnseM tau. Sz. Corr. (bloc Q: St Sh. .1 F~, ~ a r. _ ~.~ ~~ dda . /D73 • gS• °° 2d ~ Z s-s-s . ^ `~ ! !N ~ V,VpIp SY IafA ORiY. ia. VC~A! W IR^W~ 1~A ~ ^M 1'IOffootl Depth DOlllineft Ratloot Oeetalpion Te~ue SbNt~Xe Comae BOtaldaf~/ Roots i in. Munseti tau. Sz CotR Color Gr. Sz Sh. 'E10F1 '~ / D ` 3 --- SL ~ ~~, S h ~ S cw 3 ~ / a D t ---- L z~ h c s /L ~ ~F C /0 ~ ~ CL MO's C 2 S l'J n-a. ~r~ . Z S L ~ F ~ R o X• f ,4 I, ~`L i~ (r C S o~ L -' 1~~ ~L ~-. Borirg # ^ ~9 ~ gaud su~ae elev. a Deptli ib factor in. Rals Hotttan Depth Dom's~ert tZedott DesoipGon_ Texhris Car~fatios Bottrdary IZooFa itr. ~Aterser utt. Sz. Cont. Color . Sz Sh. 'E>~'t 'F.>~2 a ~~ ~ a 8orinp ; ~ Gtotstd sufaoe elev. R Oep~ b ire factor in. Sot Refs Horizon Qt Oa Dominant fledoot Desaip6on. Tt~se Struc4s+e Cort~atetroe Bowtdaty .hoots (3P 00! p h Murroe~ tau. Sz. Cott. Color (x Sz Sh. 't~'l '~ , E-11Ntert #1= BODs > 90 < 220 rtglt. ant! `15S >~ <_ 15t melt ' Etlluent tl2 = BOD, <_ 30 mglL and TSS = 30 tttelt. . The Department of Conunerce is an egnai oppordmity:xrvice pmvidet and employer. If yon nts:d assistance to a~xss services or need material in as alternate fomrat, please contact the t at 608-266-3151 or TTY 608-Z64-ti77I. ssws~op~.aoa~ ,~} ~ . I s cA ~~ ; ~ ,,. ~a a = ____ a T3.~~~C~-e ~~' 7'-S GD.~ ~ v,e? ~ ~~U~-TiauS Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. R~G6MM~.vD~D i`IavNO sYST ~l~U~-rio.v f4/ov y 4~ 5y ~ i~a~ '~ D ~v~~ou ~ ~,~N~ w ~~ ly s~N ~~'~~ ~oo•7e " ~~' ~ ~ !V ~ 15 ^ /~/ 3y ~~r~, 3 t~ ~~` ~~ 3~ ~~ ,e~+5 to ly ~--. 0 1` 'y1 _ ~~,~;'' y ~, 5r~~ ~~ ~~~K1~ ~t~Rp. ~a ~ ~~. (S (a ~ ~ ~~ ~~b (5)b~y FA,jI ~~ ooh C~S~(~y Dl~y ~. (o I _ .~ ~` b ~ , ~z / - g, , ~r ~.~( ~~ ~ is a ~~y id s ~ ,` 5~ ~ ~, 3 6 ~ /o°~~. t ~ ~~' ~3 3~0 ~ ~s si6~ y~ z ~ " ~ Q'S y ' _y~~~s ~3 ~ lye l Wiscoru+n Department of -ndustry, $ OI L AND SITE EVALUATION REPORT Labor and Human Relations Il:.eeinn of Cafnty R Rulr~irvLe ue_ w J_' ~_J_ -~~ -Depth Dominant Color Mottles Texture Structure Consistence Botxxla Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ry Bed tench 1 a-1.b ~.b~-L~-31z - SL) 2.~Sb12 ~^'t-~~. ~.S - o.s e.~ Z 16 -Z7 ~O `'L lZ- ~L ~C~ ~At l l~ `-L IZ b [S / S L C., O ~'"1 1M.~1- ~- - S 2.Z. `' SOIL DESCRIPTION REPORT Remarks: Boring # ,: `~° 1 :< - %d Grotxld elev. . ~ Depth to Nmiting facto lb" Boring # ~` .~ Z ~~ ~~~~1 Ground elev. ~~ Depth to smiting fa~ ,, u-l1" Lu~~ 3 L Z. sL ~ Z'~~bk wL~~. ~S - o. S ~ o- b Z ll - ] °~ l l7 t-( lZ ~l ~ 6 ~ ! ~ ~c tz (~! 3`S 5 ~ C.~ ~~ V~L~1- - - _ v S 1 S ~' Remarks: TName:-Please Print Arthur L. W e e r e r Phone. 715 -4 2 5 -016 5 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 _ - - - - Date•,_ _CST Alumher~ - Srgnatura: - ~. of-S-.t~~j ~'"Ulv~ -l~ ],~`~~~~ ~' "" M0057b" :__ Page ~ of 3 ' a - ~~~ 4VVV~\I .. ~~.. .vr ... vv.v , .,v..,v.... vvvv 1~ /~ \~/ VQUIY 1 1 Plan must include but er not less than 81/2 x 11 inches in size lan on a lete site m Att h Ste. ~~~' , . p p p p ac co not limited to vertical and horizontal reference point (BM), direction and 9~0 of sbpe, scale or PARCEL I.D. # ~mensioned, north arrow, and location and distance to nearest road. 00 Z - 1 0-13 - 9 S APPLICANT INFORMATION-PLEASE PRINT A!! INFORMA710N REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ~p'tl`'( ~ V1v'~T` ~9V~-t6~- S e' 1/4 S-v 114,S Z°1T Z °J ,N,R ~ 6 E {a~W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED- NAME OR CSM # .~ Z ~. 3 ~ ~~ tZ - CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE ®fOWN NEAREST ROAD Z3>F`C~-'Qk~11~, W S uo+e2. (l1S) 68y, 31SZ B~~-DWi N ~• S- ~1 • \Z [ ]New Construction Use [X]. Residential / Number of bedrooms ~ [ ] Add'aiQe to existing building (yCj Replacement [ ] Public or commeraal desaibe Code derived daily flow 6 0~ gpd Recommended design looming rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required ~ bed, ft2 ~ trench, ft2 tula~dmum design loading rate bed, gpd/ft2 - trench, gpolft2 Recommended infiltration surface elevation(s) - - ft (as referred to site plan benchmark) Additional design /site considerations ~OL~I-~lt; ~~~ `Z~~ ~ - ~~--4-"11'~l ~JD 3U00 G1rt. ~wk Parent material SLO `~^-t~U~'" ~ v ~Z G ~ 'R ~~ Flood plain elevation, if applicable ~ - A - tt S = Suitable for system U =Unsuitable for s stem CONVFMIONAL ^ S ®U MOUND ^ S (~ U IN-GROUND PRESSURE ^ S [~ U AT-GRADE ^ S ®U SYSTEM IN FlLL ^ S ®U HOLDING TANK ~ S ^ U ti ~ ~~- PFi~PERTYOWNER ~-'1y~~ T SOIL DESCRIPTION REPORT Page L of ~ PARCEL LD. # OO ~ - 1 l~'1 ~ , °t S Boring # ~~i:L:Ri:'ri '?` •~ ~$ ~t ~` £:< Ground elev. -"' ft. Depth to limiting factor , '~Z' Boring # i:':i: .` ?ra ..; ~: 4 ~~ ~~:~.:~'rrv`i Ground elev. --, ft, Depth to limiting fac` 1 ~, Boring # ~<,~~ ~:< ~'€ ~ :< ~~~~ 5 ~,t::: Ground elev. `1 ft. ,pepth to limiting j=2ctor ~, a .Boring # {..4 t .. ui: n:,$,: t4 '•` ':'::r Ground elev. ft, Depth to limiting factor Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Sed Trends u-~Z ~,~`'t~-~ L~. ~ s t°1 Z~sUk v~.~~ ~.S -- o. S u.~. Z ~Z-~ 1.O'11Z~~ ~:,1 -~.S~caSJg SLC, O>~ Wt'~~- - Remarks: ~ v-~I W`11Z 3 i.Z ~ st.\ 2`F~bk t"'1`F~ ~..5 ~ o.s o.L Z ll-l9 ~ to`'t.t~-~!/t~ C1. ~,S`~itzSll3 Sic.j ~~-, -~'L`~1~ - ~i Remarks: o _~o ~,b`1 ~Z Z~z - s ~ \ Z~~b~c wt`f ~ ~, g - v. S o. ~ G w ~~ i Remarks: ~. -R.. ~. 8 Sk ~ - S u t. t_ S , 1-'~ Y~ 1 S o>v L 1~- L l' U' !~ R S L ~ Remarks: L. ~ ~ PLOT PLAN Page 3 of 3 SCALE 1"= 60 ~~~ f ~~'~v U ~ ~ $•~l /1, 'd'.3 ~ N _}..i D~ ~ 1 ~~ d I ~ ~ i _ ~z _ `. Q g•1 ~, I ~~ r i _ ----~ ~=~ C ! ~, x ~.~ 7J ~-, - J ~! 8D~ 2 ~.~s. x .KM,k -- --- r V~*TT"' ~' ~ _ _ 1 roost y. S r1 tt..o . ( d ~~ 1 x S tom; S ~ ~~ 1 CST Signature Date Signed Telephone No. CST Sr: CRIB I C couN-nr ~~, ``'! ,' _~ -~ s ~~ THIS PERMIT EXPIRES 1. UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW OWNER D~U~/ ~UI~A 7` CHAPTER 145. (2)tMISCONSIN STATUTES STATE SANITARY PERMIT R~'cACEm£n/r ^TRA R/RENEWAL PREVIOUS NO. 3S 8'1 - /AG 1 22 PLUMBE S~ TOWN 0 ~EC 2 AND/OR VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R.8/00) l.~C.# 2263 S SUBDIVISION 3 S2• NGV.f ~ NO. 506338 (a) The purpoa of Ub sacdtary pennkk to agow hata8atlon of Yu yrivaY sewage sysbm ~crfY~ N Yre prmk. NI The approval of the sanffary pamk b based an regulatlone M fora on the date of approval. (c) The sankary permk R valid and may be renewed fa a speciNed perbd. (d) Charged regulations will not impab the va8dky of a sankary permk. (e) Renewal of Ure sankary permk wik be based on regulatlone in force at the time nnewel y souglq, and that changed regulatbns may Impede renewal. (n The sankary permk k tranaferebk. Hktory: 1971 c.188;1979 c. 34,711;1981 c. 314 Note: k you wbh ~ renewthe permk, or transfer ovmereh~ of the permk, pkese contact the county authodly. AUTHORIZED ISSUING OFFICER -DATE 2 ~ D LOT BLOCK S't. Croix County Planning and Zoning Detail Sanitary Information Tuesday, September 2 i, 2007 at / 0: 06: 57 AM Page 1 of 1 Computer #: 002-1073-95-000 Sub/Plat: metes & bounds Section: 29 Parcel #: 29.29.16.441 Lot: TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: 1/4 1/4: SE 1/4 SW 1/4 Owner: Mundt, Tony & Melissa 22 36 Hwy 12 E Baldwin, WI 54002 State Permit: 506338 Issued: 09/25/2007 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Issuer/Inspector As Built Plumber Other Requirements Pam Quinn NA Ulbricht, Robert Not determined No Owner: Rhone, Virgil 2236 Hwy 12 E Baldwin, W 154002 State Permit: 35989 Issued: 12/04/1969 POWTS Dispersal: Non-Pressurized In-ground County Permit: 0 Installed: 01/09/1970 POWTS Detail: Seepage Pit POWTS Pretreatment: NA Issuer/Inspector As Buiit Harold Barber No Not determined No we Scheduled Puma Date Pumped 6/1/1983 6/ 1 /2006 1 /9/1973 Additional Notes Mangy Owed soil tested area is outside that previously $0.00 documented in Art Wegerer's 1995 soil evaluation that indicated a holding tank was necessary. Permit: New Bedrooms: 3 WI Fund: Plumber Other Requirements Additional Notes 141oney Owed Boldt, Everett soil report still in active files fora 4 BR holding $0.00 tank, evaluated by Art Wegerer 6/1/95. Found copy of permit application, which proposed a 1000 gal. septic tank to service 7 persons. Former address #2234 Hwy 12. Will file with replacement soil report. No replacement permit has been submitted by current owner since 1995 soil report completed. Found 1995 state plan approval issued to Tony Mundt -again apparently not installed. 1st Notification 2nd Notification 3rd Notification St. Croix County Planning and Zoning tYfonday, July 23, 2007 at 11:09: 53 AM Detail Sanitary Information Page 1 of 1 Computer #: 002-1073-95-000 Sub/Plat: metes & bounds Section: 29 Parcel #: 29.29.16.441 Lot: TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: 1/4 1/4: SE 1/4 SW 114 Owner: Rhone, Virgil 2236 Hwy 12 E Baldwin, WI 54002 State Permit: 35989 Issued: 12/04/1969 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 01/09/1970 POWTS Detail: Seepage Pit Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Issuer/Inspector As Built Plumber Other Reouirements Additional Notes Money Owed Harold Barber No Boldt, Everett soil report still in active files fora 4 BR holding $0.00 Not determined Siar~~d Citf No tank, evaluated by Art Wegerer 6/1/95. Found '" copy of permit application, which proposed a 1000 gal, septic tank to service 7 persons. Will file with replacement soil report. No replacement permit has been submitted by current owner since 1995 soil report completed. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 6/1/1983 6/1/2006 1/9/1973 ~, : ~ SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Ind tr ,Labor and Human Relations ~~ .~_ June 22, 1995 ~~ ~ F n^~ ~~,~, s ~, r' '~ " ` J ~A~ ~ ` `'s'y . •',:.~. .... ~~£~ 1 ;`t y~:` .; 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 ~z~ ~ ~~.~ RE: PLAN S95-40676 ,L MUNDT , TONY ~+' Z2 3 ~ FEE RECEIVED: 60.00 SE,SW,29,29,16W (,{~ TOWN OF BALDWIN QU Z~~(~13 ~~ COUNTY OF ST CROIX HOLDING TANK ~j ~ ~~d--~ 3 _(~G-dI~L~ /~ ~I ~/~ /~2 8 The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan ~~~.tbml.ttal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR $2 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, GL~~~~ t Dennis Sorenson Plan Reviewer Section of Private Sewage (608) 785-9336 ~m~ BBUA•798T lH.1WW1 ~~ HOLDING TANK Page ~ of 3 r For A y Bedroom residence S ~ ~ ~. s LGCATED IA1 THE S~ 4 OF THESw ~. OF SECTIGid Z°t ,T Z9 N, R 16 ~h, TGWN CF ~ pt~~w1 N , ST, ~-L~-ULX COUNTY, WISCGIvSIN. INDEX PAGE 1 of 3 TITLE SHEET PAGE 2 cf 3 PLOT PLAN PAGE 3 of 3 HOLDING TANK SECTIGN PREPARED FGR T~ Nit r~ ujv~r _._ Z ~- 3 ~{ t~w`i 1. Z Q-~~.~wttv,~.v~ SUooz PREPARED BY L'~lEC-~Ei~EFr ~Q I L TEST I tVC-~ AND D- E S I G4't! S>E lE*: ~! I C E F.U. BOT 74 421 N. iSAIN ST. RIVER FALLS. IiI 54022 715-425-0165 ~• ~°4 i^ t ARTHUR 1. ° ° WECERER = t_ asps r _ ~SIG~~ , =5~. 1~ 1~q 5 JOB NO. q. 5-10 _ ._ .. - _ __ PLOT P Lt~-y Page Z of 3 n SCALE 1"= 60 ' ~ ~ e5 L~ ~ ~ 7' G' ~zs~S v~~ c N I I ~ IQ i B.Z 8•.3 8.Y g.~ ~:,. , r r. " f `; %?:~.,~ ~~ O~Wi-fem..-u~ ~ . x ~` f . ~ .. u N ~NS'mt1,, 3000 6 R-~ . --~~~w~sl~Rrv LI BD~ (--4-~ a ~ ~~ ~ ~~ST', i ~v c, tto~o iw ~ ~~ - Q.~ S . H •T. -~ ~ sync ~,~ c,~1Uy~ S ~~~~-~~ x ~,k - x v~.rT- k3• S ~u"tt : LX~S'l~v G 'c'M"~ 1 O Q~ ~'tae~~DU1~A ~~S P~ CuDN . N --~_~ ~~ L _ _ ~~~ ~ ~~ ~ 002 ~ ~.o . ( d ~~ xs __ ~~~E ~ b~ 3 ~~ ~~ ~(~ HOLDING TANK CROSS-SECTION Approved Weather Proof Vent Cap ~ Junction Box Approved Locking Manhole Cover 4 ~~ C • I • -'--- ~ With Warning Label Attached Vent Pipe Minimum 12" Final Grade 4" Minimum Water Tight-" Seal Blind C.I. Plug Approved Joint High Water ' Alarm Switch ~ SPECIFICATIONS - - - _ - - - ~ TANK New '~ Existing Manufacturer : 'M. ~p w~~2tJ ~C~`~~", 1~ ~, Tank Size:. 3oop Gallons ALARM Manufacturer: S.S'. ~~~~ S~-i,S`~l.s Model Number: ~,p ~ ~~t~ Switch Type 1~~..cy~Z,Y NUMBER OF BEDROOPiS:~_ GALLONS PER DAY: 6 00 18" Minimum Approved Joint w/ C.I. Pipe Extending 3" Onto Solid Soi (oR S"~ C P f PEA HDLQING TAt~1~C S-ERVICING GO~I~~ACT Co~Date - - - - This contract is made between the- Holding Tank Owner(s) Name(s) and I Pumper's Name L.IV,/~~C~7S I V ff~~11YYC~7 Tony Piundt I ~~~~~, ~87~230t $>~~~~ I We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) As recorded in Volume 1069, page 512, document no. 5143.06, St.Croix County, Wisconsin. See attached description. 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of St.Croix 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract. the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) I Tony Mundt I Subscribed and sworn to before me on this dot I ~~~~y ~_ ,~ ~~,,,, Pumper's Name (Print) I Pumper's SigSignature Notary Publi r r ( ~'~~1~-~-~lLp ;~-~ J My commission expires: Pumner's Registration Number ,D/V~ 7 ~~ SBD-7574 (R 09/88) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations South Half of Southwest Quarter (S~ of SW~) EXCEPT that part Northerly of the Railroad R/W and EXCEPT that part to Dairyland Powe- Cooperative in Volume "281", page~264 and EXCEPT that part ~ying West of the last described exception; Southwest Quarter of Southeast Quarter (SW~ of SEA) EXCEPT that part Northerly of the Railroad R/W; All in Section Twenty-Nine (29), Township Twenty-Nine North (T29N), Range Sixteen West (R16W). ` V1t+scansn~Depar-tm~ntoflndustry. -'-_-F1~~LD1. _~T~INK-~GIR~E-EM~~f~ -=:_saf~y;ufd_a~ain~s-n~v.;;;~n `== .. y__ _ ' Labor and Human Relations ~~~~ Bureau of Buildings and Water Systems Bf1()K. PAGE ~2 Document No. / PlanYdentification No. ' This space reserved for recording data This agreement is made between the governmental unit and holding tank ,greement Date Owner(s) ~I,H, ~ i o, / 9 9 .~ County or Local Governmental Unit I Holding Tank Town of Baldwin ~ Tony Mundt We acknowledge that.application is being made for the installation of (a) holding tank(s) on the following. property: (Provide legal land description) As recorded in Volume 1069, page 512, document no. 514306, St.Croix County, Wisconsin. See attached description. Return To /o(• "" Gve~z.d.U ~ ~r _ _ ~ - u or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch_ tt_HR 83, Wis. Adm. Code, or Ch. 145, Stats. As an inducement to the County of St.Croix to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described in s. 254.59, Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax biI! as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats. 2. The owner agrees, pursuant to s. ILHR 83.78 {70), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by the County and State. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the municipality to enter the above described property on a regular basis to read and/or inspect the water meter. .,. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided bylaw. 4. The owner, except as provided by s. 7 46.20 (3) (d}, Stats., agrees to contras with a person who is licensed under Ch. NR t 7 3, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contras or the owner's registration with the municipality. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contras, with the municipality within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 746.20 (3) (d), Stats., the owner shall submit the report to the municipality. The municipality may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may inditate that the holding tank is not being properly maintained. 6. This agreement will remain in effes only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. IIHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) -Print ~Notrized Owner(s) Signature(s) - Tony Mundt subscri nand sw on this date: r~~:a-k~ rnicipal Official Name -Print I Offical Signature ~~~ ~ h ~ ~' I 1//~' -/ ~Y~ 'f ~'~``~''/ My commiszwn eiy Municipal Official T/it\fe - Print K /1 ~d~t+ ~~~`' / ~~ - The information you provide maybe used by other go4einmerit agency programs (Privacy Law, s. 15.04 (txm)) ~, ~;~l.... T,. ~.: C. L.~...:~. _ . JUN ~ 3 1995 ld .` OD 14 . _:3 9.`r.._W r ~ ' -~ ~~ Cf'';a 1 K ~~ -- .. ,{ ~, ~~~k~.~1~6~~~~ 93 South Half of Southwest Quarter (S~ of SW's) EXCEPT that part Northerly of the Railroad R/W and EXCEPT that part to Dairyland Powe- Cooperative in Volume "281", page •264 and EXCEPT that part ~.yinq West of the last described exception; Southwest Quarter of Southeast Quarter (SW's of SE's) EXCEPT that part Northerly of the Railroad R/W; All in Section Twenty-Nine (29), Township Twenty-Nine North (T29N), Range Sixteen West (R16W). Wiscor2sin Department of Industry, Libor-and Human Relations Division of Safety 8 Btmldings SOIL AND SITE EVALUATION REPORT a uc_ w~- ~_~_ Page ~ of 3 ui aaa.a. ~n~~ .v ~ .w. ....~~~. v...... ,~ ~ +~ U NTY er not less t lete site lan on a om Attach but x 11 inches in must include Ste. ~~1.X. p p p p c , ~ not limited to vertical and horizontal refere (BM), i~and ,scale or ~ PARCEL I.D. # dimensioned, north arrow, and location a is nce pe 00 Z - ~ b ~ 3 - q S APPLICANT INFORMATION-PLEAS INT AL`~~I~tFOR TIO REVI DATE PROPERTY OWNER: ~D'IJ`'~ ~ utv'C~~"' °~ ~:'i-, ~ , '~"~ ~^ ~'~rr (~~;'' ~ PERTY LOCATION , StT 1/4 SW 1/4,S Z°tT Z9 ,N,R ~6 E(o~W PROPEATY OWNER':S MAILING ADDRESS T # BLOCK # SUED. NAME OR CSM # .1 Z 4 3 ~ ~~`-'L 1Z -' _ CITY, STATE ZIP CODE P NIA ^CITY ^1IILLAGE ®fOWN NEAREST ROAD BIPCLpwi>J,LV s~t~oL (~lS) S~Z g~~-DWIN ~•S.h. ~Z [ ]New Construction Use [~ Residential !Number of bedrooms ~ [ ] Addition to existing building pt] Replacement [ ] Public or commeraal desaibe Code derived dairy flow ~ 00 gpd Recommended desu~n boding rate _ bed, gpd/ft2 "- trench, gpd/ft~ Absorption area required ~ _ bed, ft2 trench, ft2 Ma~amum design loading rate bed, gpd/ft2_ - trench, gpolft~ Recommended infiltration surface elevation{s) ~ ft (as referred to site plan t~enchmark) Additional design /site considerations ~pl..~11-~~ ~"~C~-~~rc ~ZG~C4. ~ - ~~-~-"t -"1 X10 3~iJ0 G1f-C_ 11'fh/IT Parent material 5 ~ lwt~Z' G v ~Z G ~ ~ ~L Flood plain elevation, if applicable 1~ - R - ft S =Suitable for system U =Unsuitable for s stem CONVENTIONAL ^ S ~ U MOUND ^ S (~ U IN•GROUND PRESSURE ^ S L~ U AT-GRADE ^ S ®U SYSTEM IN FlLL ^ S ®u HOLDING TANK ~ S ^ U SOIL DESCRIPTION REPORT Boring # -:.:i-i:L-<: <~ 1 :-:< <~ .~<:~. Ground elev. . ~ Depth to limiting facto lb" Boring # ~~ Z ":a ,r.. Ground elev. _~ Depth to limiting factlor1 ,, -Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ry Bed Trends 1 a _ ~b ~, opt ~- ~ 1 i - s % 1 Z ~- 5 b tz v~-~.~C t~ ~, S - o. s o. ~ S 2.Z. ti Remarks: u-1,1 tio~.~ 3 L Z. - ~L ~ Z'~~blc wt~t_ ~S - t~- S o. b Z 11,1°1 lug (z. ~c16 ~ t u~r,r~ 6!3 S~c~ _ _ v S 1 S ~i Remarks: CSTName._PleasePrint Arthur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: _ Date• CST Number. _ <. _ °lS-t©~j ~ulv~ ~.t'l9.`l~~"'-- ~:M00576" PROPERTY OWNER ~ U rum T PARCEL 1.D. # 0 ~ ~ ^ 1 ~ ~ 3 - °r S Boring # 2, <:.. 3 `~ ~ti.~ \:i~:titi.~::{:i~:t~ GfoUnd elev. -' ft. Depth to limiting factor , `Z Boring # '~~~f~: x~ }. 4'>i Ground elev. ~'^ ft, Depth to limiting fac~ l ~, Boring # ~`~~.:: Depth to `•imiting factor ti ~, SOIL DESCRIPTION REPORT Page?" of y3' Depth Dominant Color Mottles Texture Structure Consistence Bour~ary Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer~ v - lZ ~. 0`1 CZ- ~ L Z -~ s t 1 Z $ s bh. w,..~ ~• ~.s -- 4 • S o. 6 , Z ~Z - la l u ~ tZ ~1l ~' ~ -~• s~rti2 sla s t c, ~'~ w~. ~~. - Rernarks: ~ v-~I wKtZ 3 Li -~ siti Z~-~b>z ~"~'~~ ~,S ~ o.s o.C Z- l l - l9 l o `11Z- ~ /~! el ~ , s `7 R s1g S i c.l O w, -~-~ `FL- - -I ' Remarks: o_~ o ~,o~t CZ Z t z - s i ti Z`~~U k -~`F~ ~. s ~ ~. S o. ~ Z 1u-?A ~.0`1R. illy C1~.s`t2stg Sic. bwt ~~~ - - - G w ~~ ^ KL C Q:•i: ~Y{ J fy ~ 4 !y. Ground elev. ~ ft. goring # ~.:., z.. .. Ground elev. ft. Depth to limiting factor Remarks: tJO`~ ~ t~ ~ Z~~. e-0 ~ lZ. S ~r B l 1U ~ ~, -"2 C 8 S S~-~i e- - S u p S, l SL Remarks: ` PLOT PLAN Page 3 of 3 SCALE 1"= 6O ' ~C~s'~ S o~~j ~ ~ ~.Y /1. ` B•.3 ,I ' ~ "I - I~ B.~- B'~ C~ _` ~! ~ ~ ~ S~~ ,~ ~.~ ~, 2~~~ .-.-- ~I B~~ -` 2 Qrs. 1~~, _, .. /Q',~ sync. ~-~.,e Crr~'n111~ S 1~5'sC_.~I n ~,„k -------- ~. ' '``, k U~- ~ ~ L g~ ~ I ~~~~. ~ ~~ ooo~ ~~ xs i ~~ ~~~wv of Yt~~'h-'c._ ~'utv ~- ~ y L~L~I S (715 ) 4 2.5 = (1 t h 5 I~QO 5 7 6 CST Signature Date Signed Telephone No. CST # ' \ Form P1~ • 6 • k~L~_- C t'~~/t.~in~ -- ~o~ d ~ ~' /~ ~ L~a~u~ . 7 Wisconsin State Board • APPLICATION FOR PERMIT of Health for PURCHASE OR INSTALLATION OF A SEPTIC TANK (Sec. ].t.~4.03, Wis. Stats. ) A. OWNER OF PROPERTY -Type or use BLACK ink Name Address Street, City, Zip Code B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED Check 1. City Mail address ~ ~ ~ ~y ,~ SC~+ ~ ~ ~„~ ~ ~ County one : 2 . 3 . Village ~ Town ~ ~ ~ ,~ ,~ ~ G~ ~ ~~ A L c~ w , „~ G~ ~ s n R o ~ n ~~ , ~, ~ . ~. Give license number held: C. INSTALLER Wisconsin Restricted -- Licensed ,,// ~ Sewer Plumber ~7 ~ Services Nam. Addre s s~-~ D. SPECIFICATIONS OF SEPTIC TANK Site in gallons: Check one 1. 50o gal. 4. l,50o gal. 2. 75o g~• 5. - 2,00o gal. 3..~ 1,000 gal. 6. _ 3,000 gal. 7 . !~, o0o gal . 8. 5,00o gal 9. Imo`-over 5,000 gal, give .capacity Materials: 1. 7f Prefab concrete 2. Poured concrete 3. Steel E . TYPE OF OCC~TPANCY 1. 7~ Single family residence 2. Multiple family residence 3. uommercia.l esLaolisnment It. Industrial establishment F. APPROXIMATE NIJ~~IBER OF PEttsoNS SERVED DAILY G. PERCOLATION TEST MADE By whom ~~~,~ P_ ~ ~ 1. X Yes 2. No Date d ~. l~ (To be completed by County Clerk) Date application is filed and fee aid _ _ /~~ Permit issued (date) ~-- 6~ _ <. P//ermit Number ~a~~ ~~~ ~~ County ~,~ it fi .~~i Clerk /c., .~ ~.~ ~ ~ ,°---7 ,fire Note: The application cannot be consider for filin~~til all of the above questions are answered and the fee paid. County Clerk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the~State Board of Health. Checks and money orders should be made payable to the Wis. State Board of Health. e~ ~~~ 1 , V' l , ~ie~Q/d ~i//¢~d Tph ooiCi- \ ~ ~ C ~ ~ 0~. C 1~ o ~Chai-p' Koae~•t vr: t - - W C- ~Yos:/~ va~s-.F~i/ !'l/e~n ere CS `C J C E ~ V ~ 1 ~ Fein Power- V,V ~ . ~, ~ . ~ A A . ~ "~ o • _ ~ C • •N¢ro%~ •~y` `0 ~ ~ ~ C~ .C ~e~ V Jerome C ~\ ~ 0 C ~ h 'Q~S C~ p~ l~'lote /37s C~ ~ ` ~ ~j 0 ° 4 / ~. ~" eo ~e~/r \ p 0 \` ~ ~C a °. ; ~ ~ !,y . ~~ ~ ~ `~ R//~E~q C C l~ ~ 1~ ear,, ~ o~ %~S ~ ~ v Edw~~ 6 ~ ~~ Q o 0 ~o . Bo ~ ~~ 'V ~ v " ~ do ~w ~ Fi-offices V ~ V~~7 v e/ei %~k GB 0 V mm ~re~B~d4~, \ ~ 2io ~ ~, 4.o by 9/ e •• ~/%~/s • . 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