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HomeMy WebLinkAbout002-1018-30-100>1lVisconsln Department of Commerce PRIVATE SEWAGE SYSTEM Safety anii 8tfildir~,Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. 'ermit Holder's Name: City Village X Township Mar elofsk ,Eric & Abb Baldwin, Town of :ST BM Elev: Insp. BM Elev: BM Description: ~/~ g cs ~ SANK INFORMATION /1 TYPE MANUFACTURER ~~ CAPACITY Septic ~~ j '~r~. 3 W 1, ' l ~.+ Dosing u~ N ~ ~~ F ~ !a(c 5z5 Holding TANK SETBACK INFORMATION TANK TO P/L~ WELL BLDG. Vent to Air Intake ROAD Septic u~u , t A _ /` ~ / ~/ `o Dosing ~~ ~ ~/1 _ / /`o/ ~~ / I ~ o _ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer vL ~ ~ Demand GPM Model Number ~ ~ x 3~ •7.J TDH Lit ' ~ Frictio~ oss System Head T 1H ~ t Z Forcemain Len~c / Dia. // Dist. to well Sell ARSnRPTIJON SYSTEM 1 county: St. Croix Sanitary Permit No: 515079 0 State Plan ID No: Parcel Tax No: 002-1018-30-100 Section/Town/Range/Map No: 09.29.16.122A ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~, ~~ a!, ~ /ate Alt. BM F,' l ~..~,.. u ',~ ~ ~ ~ . 9 7 Bldg. Sewer /D.tb 9~ . ~ 8 SUHt Inlet II, 87 $~! . g I SUHt Outlet ~ Dt Inlet ` ~ Dt Bottom I` ~ ~ 7 ~~ . ~~ Header/Man. /~ • I ~ l ~ ~ ~~ Dist. Pipe .1 ~~•(o~ Bot. System rD, I ~ ` b' Final Grade , r,~ /Z Co,r~,,r 1l. Z `10 . S BED/TRENCH Width ! Length ` ~ Trenc s No. PIT DII1iLENSIONS No. its Inside Di3~ Liquid D DIMENSIONS ~ Sfo. Z5 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f System: /~` ~ / ~ Q 7 ~~ ~~ UNIT Model Number: au IIICTRIRI ITIf1Nl CYSTFM !_ .L.L Header/Manifold Length Dia ~' ~ Diserisution ~ ~ ~ ~ / Length/ Dia •Z5 Spacing_y~ x Hole Size / ~~ x Hole Spacing ~/ ~~ V to Air Intake v 10.5( 1~ SnIL COVER r Pracsura SvstPms C)nly xx Mound Or At-Grade Systems OnIV /1 Depth Over t C Depth Over - Bed/Trench Ed es xx Depth of To soil ~ xx Seeded/Sodded Mulched en Bed/Trench er ~ G3 ~ g p ~ , ..~ ? Yes ~~~ No M Yes ~ No r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~~ / ~ 7 ~ Innspection #2: / / Location: 1070 240th Street B Idwin, WI 54002 (SW 1/4 NE 1/4 1 T29N R16W) NA Lot 1 P/a kJ ~~ ~ Parcel No: 0 9.16.122A 1.) Alt BM Description = ` ',~ ~ ~~ ~'{-'~- ~~`~ ~~dW 2.) Bldg sewer length = Z / / - amount of cover = ~ >5 Plan revision Required? ~ Yes No Q ~ ~ ~ Q / 3 Use other side for additional informati n. v I ~!/ --, Date Cert. No. SBD-6710 (R.3/97) commerce.wi.goV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 c,'g' C~OjX i sc o n s i n Madison, WI 53707-7 Sanitary Permit Number (to be filled in by Co.) Department of Commerce Sanitary Permit Application state Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u ores in accordance with the Privac Law, s. 15.04 1 m , Stats. ~~ j~ /~O~ I. A lication Information -Please Print I orma ' ~ ~~ ~ V _ / Property Owner's Name / Parcel # EPIC ~: ABBY Iv1AFcGELOFSKY tJ ~ F) ZOOS 002+ /O/~ -+ ,3d -' /dD Property Owner's Mailing Address Property Location ~' c/o CIIRISTY GREGG 2307 80th A st cROlxcouNrv (~ /Z2 , f1CE Govt. Lot ~_ City, State Zip Code Phone Number ~,~ y,, N F, %<, Section ~!-1LDWIN, WI 54002 715-684-2079 (circle one N; R ~ E o~ T ~ II. Type of Building (check all that apply) Lot # _ - f7rl Subdivision Name ~ 1 or 2 Family Dwelling - Number of Bedrooms 3 1 Sc~pw,, • ~ Bloc Vol 14 P 3957 ^ Public/Commercial -Describe Use lCa,~~ ^ City of /~ ^ State Owned-Describe Use ~ CSM Number ^ Village of ~ ~ ~ 51 l SS ~c~ 2 3 BALDtiIN ~ Town of l x 0 . Ge. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 ~ , ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ~' Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) / V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Applicati ate ((gpdsf) Dispersal Area Requir (s~? Dispersal Area Pr os d fj System Elevation 450 ~ ~ 1 D • "[ 450 ~ I ZJ 450 + 2~ 91.00 •~ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ o '~ ~ New Tanks Existin Tanks ' ~ c Y " ~ _ g II ~ W ~O !D~ C't ~ w U v~ ~ Y v~ is, c7 a Septic or Holding Tank 1000 1000 1 Wieser Concrete x Dosing Chamber 600 600 1 Wieser Concrete x VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ignature MP/MPRS Number Business Phone Number BENNIE HELGESON `~ - 220292 715/772-3278 Plumber's Address (Street, City, State, Zip Code) LJ 1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII. Coun /De artment Use Onl Approved ^Dis Permrit~ Fee~j ~ ~ ~ $ Date I ued ~ /~ Issui gent Sign ure ^ O en Reas for Denial 1f~ ./ IX. Conditi8~l~~p{~,~3easons for Disapproval / 5 e, s~.ai, 3 L ~~~ ~ ~ ~~5 t'~ 1. Septic tank, effluent filter and 1 MM ~~ dispersal cell must all be servkes /maintained f ~ ~r1'G e.E' ~I ~ ~'~'~" aspen management plan provided by plumber. Z AN setbacksequirements must be maintained ~ ~ ~ ~ ~- ~ ~ 9Q.1 ec a~ ~ ~~ tea. ~ ~, ( ~.1~c~ dl ~ ~~~ Attach to complete plans for the system and submit to the County only on a er not less thaX8 vz x 11 inches in size ^ / ' ,A /f'~OIL°.. ~-~,tn, ~~ DOS fXla.Q„ (t'C-,(_~.L ,7!_J~_.I ~. S~eC c~A1L. ~~`i~~V~ 2(~,~~ ItS '~r`~Q~ SBD-6398 (R. 02/09) Valid thru 02/11 ~ sr. CRor K C~c~~~T `f ~~f ~„ ^ 4~~ ~ ~ u r q~..~~ ~~. ~; ICI '~ ~ a: '~ r~ ! ,I.°. ,~ // !~ti ~, ,~---~~ f '~0 bs a.c~ i~~]COPY JUM,-04-89 01:28 PM 'I~~ O 1 ~ ~ 4. bti ~r: CRat ~~ C~~~IT ~ ~~ I~,va~~ ~a~~sti;p s~~~, ~~ ~ ~~~. ~ ra 1N ~:~c~ ~( J ~.XC~e'p~ f`l`,~ S~1d~r1. f ~~~a.~ r P. 02 9 ~ ~s ,a v? uga f ~ ~~,.a~ .~,. ~ ~ ~1 ~ + I ~. I,~ t ~~ 1 r! ~~ ~~ rf r ,,~.~' / „~. t_~ i~ cod .SPp~ 4~"' ~~~ti~r commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay www.com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary June 04, 2009 CUST ID No. 220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItE5: 06/04/2011 SITE: Eric & Abby Margelofsky 240TH Street Town of Baldwin St Croix County SW1/4, NE1/4, S9, T29N, R16W Lot: 1, Subdivision: Vol 14 P 3957 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1672801 Site ID No. 748623 Please refer-to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1228727 Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor. from original grade; System: Mound Component Manual, SBD-10572-P (8.6/99), 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank; and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Condi ~~~~ DEPARTNlEMI ~~/~~~~ SEE CORRI • Inspection of the POWTS 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. Stat BENNIE W HELGESON Page 2 6/4!2009 • Comm 83.22(7) A copv 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. Owner Responsibilities: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 designerof the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be 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, ~~~~~ ~J Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin. gov Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 ~~'iSl~l\RT code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ; J.f? ~ ZC+9 ~,:_ _ v ~~a~~ ' ~l~~s INDEX SHEET PROPERTY OWNER: ERIC & ABBY MARGELOFSKY C/0 CHRISTY GREGG 2307 80TH AVENUE BALDWIN, WI 54002 PROJECT NAME: ERIC & ABBY MARGELOFSKY PROJECT LOCATION: SW 1/4, NE 1/4, S 9 T 29 N, R 16 W MUNICIPALITY: TOWNSHIP OF BALDWIN COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP1000/600- Mr Zable Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Sign d Date: May 28, 2009 ;angry t~V~'p OF CQ~~ L=Y ~ ~PONDEN =~~ Er;~r, ~- Synthetic Covering AS7'M C 33 Medium Sand ~ Topsoifi .J i 3 Page ~,. Of~ Distribution Pipe G F ~ ~ ~l ~~ ~y D _r,y„ ~ ~a.s ~~~ % Slope C%~~.Of Z~- 2 %2 Force Main Plowed Aggregate From Pump Layer D a ~ Ft. E 1~~~. Ft. Cross Section Of A Mound . F , ~a Ft . G , ~l~ Ft . A ~.Ft. H / Ft. Signed: g ~ Ft. License Number: K ~~~~~~ Ft. L 7 ~. vs~Ft . Date: ~ ~ Ft. T .S ; Ft . W~Ft. Observation Pipe ~ ~ - - ~ - - - ---~ -- - - - -- - ._._ . ~ K j ---------------------------------------- --- A I ~ a ~ rc~ w ,.----- -------- ~Distribution ~~t-t~--0f i~~- 2'2~ ' Pipe Aggregate Observation Pipe . Plan View Of Mound JUN--~04-09 01 :29 PM wt<r~~ ~ ..~~ ~, i r ~ K~ ~'/ E~dFvi~w P,rloroi~a l Pv~ P~v~ ~,,,~ I~l~..y, 4~Ic~ P. 03 ~~~ ~1 -- Holes Located an BoxGOm sr8 Nqua7~ly Spaced ~ '.~•r rip, P.,fo,nled r'rA~, pe~o~r Di_ s~eribu~_ion t't >e La ore Signed: License Number; Once; P ~./ ~ , rr R X ~ ~ rr " Y dole Di~amete~ „~, Ynch ~SCQr81 " ~ YACn (09~ Man~Fold '~ , . Inche9 1'arca Md~rs " ~,.~ ~nchas N41=s P~,~ ~r~~ro. j = ~ ~,^i c ~ ICI ~,~? Page,~Of~ • SEPTIC TANK 6 PU CHAMBER CROSS SECTION AND SPECIFICATIONS '~ 4 " .PU~C„ V ENT PIPE 12 " MIN . ABOVE GRADE E 41EATNERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX FRESH AIR INTAKE c--WITH CONDUIT AP.PROV ED MANHOLE. COVER W/ PADLOCK £ WARNING LABEL :,._._. 4 " MIN . ty" 18" IN. ~ S. D. u ., f~ 18 MI N• INLET ~ ~, WATER TIGHT SEALS GAS- ~ ~~ • T TIGHT ~ ~ ~/APPR4~IE0 F1l.7ER. --~- A SEAL ~ JOINT$ WITH APPROVED ~o~~`o~ -}- ~ ; ALM APPROVED PIPS PIPE 3' S= '~ -~- ~ ~ 3' ONT© ONTO SOLID C i ON SOLID SOIL SOIL PUMP OFF ELEV . ~/.S~FT. -~-- ~ OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE ~~""~~. TANK MANUFACTURER : l.~'~5~~'' TANK SIZES: SEPTIC ~C~~ GAL. DOSE _(~OO GAL. ALARM MANUFACTURER: ~.~~, ~Iec~c~ •MODEL NUMBER: Ib~ (-{~ SWITCH TYPE: ~~~- PUMP MANUFACTURER: o ~S MODEL NUMBER : 0 ~/ SWITCH TYPE: Oa~ DOSE VOLUME INCLUDING c(. Y9 (sal. --'~ F LOWBAC K : ~~ . CAPACITIES: A = Ig INCHES B = ? INCHES C = ~, INCHES D = ~C7 INCHES ~.7c~t 1 . GAL . = 30,6$ GAL. .~~. = 33,2 GAL. = /~~GAL~ = 1~7~ ~ GAL. REQUIRED DISCHARGE RATE ,~o.7~GPM PUMP ~ ALARM WIRING AS PER IL.HR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~„_,- FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + ~ FEET FORCEMAIN Xa ~~_FT/100~FT.~FRICTION FACTOR . ~-FEET TOTAL DYNAMIC HEAD = 1~FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID 6~P'Y`Fr 3~0,_' SIGNED: LICENSE NUMBER: DATE: _„_,,,_ 1/88 ~S O U Z Q W J '/A~ I.t. _ /dry V ! 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Motor • Rugged glass-filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion Single phase: 115V resistance. Materials of Construction 'Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resis#ant threaded stainless steel shaft. 'Available for automatic and manual operation. •CSA listed models available. !ion and feature stainless steel hardware. K ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of _~ Fu F IN~r1RM~T1ON Owner Eric u Abby. i4ia,rgelofsky Permit // nee~r_w~ onennnGT~RS Number of Bedrooms 3 ^ NA Number of Public Facility Units ~ NA Estimated flow (average) 300 al/da Design flow (peakl, (Estimated x 1.51 45U gal/day Soil Application Rate 0.5 al/day/ft2 Standard Influent/Effluent Quality 1~/lonthly average"' Fats, Oil & Grease IFOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD5) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L 1~ NA Fecal Coliform (geometric mean) <_10" cfu/100m1 Maximum Effluent Particle Size Ya in dia. O NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. ever~nn eDGrre~CeTIn1UC Septic Tank Capacity 1(xO0 al ^ NA Septic Tank ManufacturerWieser Concrete ^-NA Effluent Filter Manufacturer polylok ^ NA Effluent Filter Model PL-525 ~ NA Pump Tank Capacity 60U al ^ NA Pump Tank Manufacturer iti',eser ~oncrete_ ^ NA Pump Manufacturer Goulds Pump Inc . ^ NA Pump Mode(i871 EP04 ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: :~:NA Dispersal Cellls) ^ NA ^ In-Ground Fgravity) ^ In-Ground (pressurized) ^ At-Grade ~] Mound ^ Drip-Line ^ Other: other. ^ NA Other: ^ NA Other. ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls- At least once every: 2 ^ monthls) (Maximum 3 years) ear(s) ^ NA Pump out contents of tankls) When combined sludg e and scum equals one-third (Y31 of tank volume DNA Inspect dispersal cell(s) At least once every: 2 ^monthls) {Maximum 3 years) 6i3 yearls- ^ NA 6d monthls) ^ NA Clean effluent filter At least once every: 13 ^yearls) Inspect pump, pump controls & alarm At least once every: 13 ®monthls- ^ year(s) ^ NA ver : A l 3 ^ monthls) ^ NA Flush laterals and pressure test y east once e t ®yearls) Other: At least once every: ^ monthls- ^yearls) ^ NA 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 tank(s) 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 (Y~1 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. OWNERS: -ERIC & ABBY MARGELOFSKY Page 8 of 8 3'TART UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative 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, overloading the ceI11s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; .medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN ff the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ® Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO N07 ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS onU~TC I~ICT4t 1 FR POWTS MAINTAINER Name Hel a 'x Phone 715-77L-3278 Name Phone .:_. 715-273-5811 SEPTAGE SERVICING OPERATOR (PUMPER- LOCAL REGULATORY AUTHORITY Name Johnson Sanitation Phone 715-273-5811 Name Phone 715-386-4b8U This document was drafted in compliance with chapter Comm 83.22121(b)1111d1&If1 and 83.54(11, 121 & (31, Wisconsin Administrative Code. ~~scon~in Department of Commerce Division of Safety and Buildings "°'V SOIL EVAL TION REPORT in acxordance m 85, Wis. Adm. Code ~~ Page 1 of 3 Northland Plumbing, Inc. County Attach complete site plan on paper not less than 8% x 11 inches in si Ian St. Croix include, but not limited to: vertical and horizontal reference point (BM), dir n an percent slope, scale or dimensions, north arrow, and location and distance to rest Parcel D. Z / v/ r/ ~ ~v , ~,1 ~ Q' v CJ Please p nt a//~l~~rri~'~~ p Da / ie Personal information you provide may be used for secondary purposes (Pri Law, s. 15.04 (1) (m)). ~ , ~ r Property Owner ~ U 2008 Property Location Christy Gregg JUL Govt. Lot SW1/4, NE1/4, S9, T29N, R16W Property Owners Mailing Address N209 MclCa 23 7 T. CROIX COUNTY Lot # ~ Block # Subd. Name or CSM# / VOI ~/ -~4 ~0 I-l 0 y l=icE . . City n State ~ e one um r ^ City ^ ~Ilage ®Town Nearest Road Spring Valley va~ WI 54 6~2 Baldwin 240Th St ®New Construction Use: ®Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ^ Replacement ^ Public or commercial -Describe: ft. Parent material Glacial Till Flood plain elevation, if applicable ~~p General comments Mound site using 89.67 contour. ~~ ' U ~ 9///~Q ~J - ..SGt%/!~2- and recommendations: ~ /~ py //~y ~ _ ^ S'~ _, _ „ J , ~ I 8 1 ^ Boring Boring # ®P't Ground surface elev. 91.28 ft. De th to limitin factor 49 in. App P 9 Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eti#r1 'Eti#t2 i 0-9 10YR 3/2 sil 3sbk mvfr cs 3f .6 .8 2 9-18 10YR 6/4 sil 2sbk mvfr cs if .6 .8 3 18-25 10YR4/6 Is 2sbk mv(r cs .7 1.6 4 259 10YR4/6 s Osg ml gs .7 1.6 5 49-54 7.5YR5/6 7.5YR5/8fifspots sd 2sbk mfi a .4 .6 2 ^ Boring Boring # ®Pit Ground surface elev. 87.75 fl. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP Dlfl' in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. *EfF#r1 *Etts2 1 0-12 10YR3/2 sit 3sbk mvfr cs 3f .6 .8 2 12-18 10YR6/4 sil 2sbk mvfr cs if .6 .8 3 18-27 10YR4/6 Is 2sbk mvfr cs .7 1.6 4 27-32 7.5YR5/6 7.5YR5/8fifspots sd 2sbk mfi a .4 .6 5 32-50 10YR4/6 s Osg ml cs .7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Michael J. Myers 267985 Address Northland Plumbing, Inc. Date Evaluation Conducted Telephone Number 2943130th Ave Glenwood City, WI 54013 7/29/08 715-265-4115 SBD-8330 (R.07Po0) 2/ Property Owner ~r+~Y Gregg Parcel ID # 2 ~of 3 Boring # ~ 64ring ®Pit Ground surface elev. 91.28 ft. Depth to limiting factor 39 in. Soil ic~tion Rate Horizon Depth Dominant Color Redox Description =: Textu`e' Structure Consistence Boundary Rood GPD/ft~ in. Munsell Qu. Sz. Cont. Color ,.~ Gr. Sz. Sh. *Etf~H *Etrae2 1 0-11 10YR3/2 it 3sbk mvfr cs 3f .6 .8 2 11-23 10YR6/4 sil 2sbk mvfr cs if .6 .8 3 23-29 7.5YR5/8 cos Osg ml a .7 1.6 4 29-39 7.5YR5/8 fs Osg ml gs .5 1.0 5 39-52 7.5YR5/8 7.5YR5/6fifstreaks fs Osg ml gs .5 1.0 * Effluent #1 = BODS> 30 <220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ,.......,,- ~. -..,~-. .,_.~.~... ti.._W.....-_ Horizon Depth Dominant Color Redox Description - ' Texturrr ~ ~ctcttue Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color " ,'fir. Sz. Sh. `Efhlil •Etf#2 1 0-11 10YR3/2 ,;sit'~~ 3sbk mvfr cs 3f .6 .8 2 11-23 10YR6/4 sil 2shk mvfr a if .6 .8 3 23-29 7.5YR5/8 cos Osg ml a .7 1:6 4 29-39 7.5YR5/8 fs Osg mt gs .5 1.0 5 39-52 7.5YR5/8 7.5YR5/6fifstreaks fs Osg ml gs .5 1.0 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD$ < 30 mg/L and TSS <30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ...,......~ m __,~~. .,..r..~_-. ~...-~.._ .~. I W ~7 w 1 ~ 1v ~v `~ J \\ ~V ~~ .~ !' `~\~ \.. Z Q H ~ ~ 0 -~„ V `Q W v' ~ i rr^^ ~ I \' t I ~" v W '~ 3 J Q- w a'- ~ ~ ~ ~, s cb 1, ~ ~ ~ ~ -~ _ . -- _ _ ~. y.~,r- , ~~ -Q - ~ .o c~-~ ~~ z '~ _ ~~„ ~ a ,,,ro +'J coq ~_ ~- ~. --~~ i po O~ h ~~ ~~ '~ M - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer C G'~ _ G ~,L rTd/~I Mailing Address ~~(~ 7 BI~~'v Property Address 70 ~ y~ ~-- (Verification required from Planning & Zoning Department for new construction.) 1~' City/State ~~~~ [/l/`I l~, ~~ Parcel Identification Number b b ~ -col ~ - ~o ~-0~1 ,, Zia /~~g ~a - a,~ LEGAL DESCRIPTION Property Location,~~ '/a ,,dam'/ ,Sec. ~, T ~N R ~ ~ W, Town of Subdivision .ll~f~- Lot # ~. Certified Survey Map # ~~ / ~ S 3 ,Volume ~ 3 ,Page # ~ S~ :S-: Warranty Deed # ~ ~ 3 ~~~ ,Volume ,Page # Spec house e yes O no Lot lines identifiable D yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. - I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the :standards -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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms .~ GNATUR OF APP CANT(S) Iv Jul 2(7U°I 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) ~~~~z~1~a~ 11:2 ~~~h~i~~~~~ b~~i~aHr~:.ty~ ~~~ ~~~i'k~5 ~~.1 li' l~~ i7~~~ ~~~ Chresty ~[. Gregg Located in the Sauthwe~t 1; 4 of the Northeast 1 f4 of Seeti~n 9, '~ Z~ AT, ~ ~6 W, Town afl3aldwin, St. Cmix C+~unty, Viaisc~nsin. ~.E3CRiPTiON: ~'hxt certain pat~el of land located in rho 5autliwesst 1/4 of the l+iartheast l.I~ of 5cn .9~'i' 24.~T. R...16 9V. ?av~m of l3addwin; St: Croix Cvi~ty, 'UVissm, mare fully d~scrbod as foiluwsw Com~aaet~witzg at the Nt-ttheast c+aznrer of said Seats©n 9; ihenoe S Dl°07'55" B (assumed beating on the East line of the Northeast %, of said Section 7, recrnded as S t}1'07`S7" F,~, a distance of 1~43.E1' to the Northeast trotnex oi: the South y of said ~Tordteaet'1,; thence, aloaig the Natth Line of said South ; of the Noriheast.'/.,.l~T 8T° 13 `Sf" W, 1 ~99.~8'; thencew S 03° 15'47" W. ~?J.QO' to the Pazttt of 13egirtttirt~ Qf the parcel to be herein described; thence ~ $7°l3`51S" l;, 3G3.15 ; thence S 03°15`47" W, 479.83', tlavitera h` 87°13°56" W, 363.15'; thaatcc N 03°15'47'" 1;, 479.$3' to the Point of Begirming, ccmtaining 1.7d,243 square feet or 4.900 acres, subject to easements, covonants and restrictions of accord. This parcel includes tlsg tmne~t of a variable width ease~anettt #'or 9ngrass end egress, as retarded in Dc~cwaaeztt Nuruat~ex $`~' j ~ ~r„I , as shown on this map. State of Wis~o~si7a) County of l?iarce} Y, Laurence W. Murphy, Registered Laird Sttrvayur, do hereby certify that by direction. ofF the Qwcier, Christy M. G~gg, t have aurveyed xrrd divided tlse lands slaawn hereon sat accordance with o~clal neaprds, Chapter 23b_34 of Wascc~ztsis- Statutes and the ~rdinancas of St. Croix County and that this snap and deacriptian are a true and corrGCt representation thereof. i7atsd : lN.ay 2$, 2UQ$ Tbas inxtrument l~ra#teal by Mark W. Peavey ~~NERAL NUTIC~ STATEMENT: Nate: Each parcel shown on this map is subject to State, GatR~aty and'f'cswnai~its laws, rufes ar~rs a~eg~~latians (i.e. weti~.r?d:s, rttiairxtum lot sire, access to parcel, ertrrcc.). ~£a1Ce purchasing or dcvclQping auy parool contact the St. Croi.Y Courxty lon ink ~.?fflce anal the Town of Baldwin. { A T~h Y11~+ n~11.TC~17~T APP~tov~~ ~ TrOflill~ 1 .~iTr'i.L ,L` Vl' W~~Wi~I S7D1~~ ~•~~Y ~~~. ~.-~~~rie~~r~~•~~JS cc~+ pp I, Cheryl Slind, being the duly elected, giaali~ied amd actira8 treascu'er ©f the cauz~ty of St. Craw, do he±rcby certify that the - if not ne°rdad 30 daY~ °~ records ire any office skzc~w ne unredeemed ta.~ sales anal nc~ twpaxd ,~ ~t ani-atd ~~ ~ taxes nr special assessaae~ars as of~;~~r 3t _-- -'~~ afiiectirag the 1aa~de included in this Certitsec( SurvEy lulap. A U Y r~ S~ ~~ w 0 ~~ •~ ~~ ~~ a ~~ ~~ ~ = ~~d 00'~ ~~3~ AdQ~ cw~st ~~~~ ~~a ~a~ ~ ~~~~ ~ ~ ion ddN A3A~l1S Q3I~Ild3~ ~d~Q-~o aoa~tstP6D r~ao~~a ~q~ Q3AI3~~~ IM ` ' LJ~ XIOM'~ ' 1S sa~~a ~p a~isz~a HSI~~f ' H N331N1~V~ ~~~~~~ ~ ~~ n >;~ ~ a ~ ~~~ ~ ~ ~~ ~i . ~" ~ g ~ ~' ~ ~ ~ ~ ~A~~i~wur~~u~~i~.~~~~~i '~~~ , '~ ~S£ ~ ~~ti+ 04 ~ ~ ~~ ~~ at 1 ~~ I i ~ i E ~~ ~ ~~ ! a~ ,~; ~ ~~ .~ ~ ~~ ~~ ;~ ~~ ~, z= ~~ ~~ ~ ~. .~ 'E ~_~ ~° , ~ ~ ~~ s ~ ~z ~ ~ ., ; -- ~~ ~~ I. ~, ,£~~ ~, I F I 1 Q~ r -J i ~'~ ~ r~ ~} ,~ ' ~~ ~~ 8 Q~ .~ *,... e ~• Q, ~' ~ ~~ *~ ~' P + ~ ~~` ^ ,~~ ~z,~ ~ ~~ ~ .~~,~.~ x '~"tili ~~ r ~i .~i~±;~~-L4 .:~rl`id S'~.7;~f_LHriY~~3 f~~tti9TG19L99 9Z:ZL 600[,1'TT.,%9~" FJ6,•ILIZN~J3 11:25 6~15E~15b~~ BF'IGNTIE'~c` I~+d jV~ ~ T'~t ~~ `~~ %'~ ~~ l ~f: `~ f y ! i ~ ~'~ ~ ~ .• ~ 1f, hf ~rn-~ l,~nm,e~t ~~d ~x w. Poavey }~-' .~ ,L'~y_ -- Vdl. 23 Page 5 ~b5 ~' ~ D. ~Q 1 A `~'~~ y i ~q- $ ~° y 1 ~ _ ~ t • ' y ~, Z ~ ~~ f Y y i ' Ps=,GE 0~~`~i5 SHEET 1()~' 2 State Bar of Wisconsin Fonm 3-2003 QUIT CLAIM DEED Document Number Document Name THIS DEED, made between Christy M. Gregg, a single person - - ("Grantor," whether one or more), and Eric S. Margelofsky and Abby L. Margelofsky, husband wife, bolding as survivorship marital property ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum) Pari of the Southwest izuarier of the IVor[heasf tZuarter (SW l4 of the NE 1/a) of Se}:tion Nine (9}, Township Twenty-nine (29} Nurth, Range Sixfeen (I6) West, Town of Baldwin, more particularty described as follows: 1. Lot One (1) of Certified Survey Map filed September 19, 2008 as Document lvo. if2flb~.3, utnce oz me xegtsier of assns ror at. ~,rotx i.ouniy, wiscvnsin. TOGETHER WITH, AND SUBJECT TO, the terms and conditions of that certain Joint Driveway Easement Agreement recorded September 19, 2008, as Document No. 881654. Dated ~ D- i '-~> (SEAL) -- ~_..~ _. ~.__3gg... ~ __ 9 _ . 9 _ 1 0~~~~ KATHLEEN H. ~AISH REGISTER OF DEEDS ST . CRDIX co . ~ WI RECEIVED FOR RECORD 10/29/2008 11:30Ah1 QUIT CLAIP9 DEED EXEBPT # 8 REC FEE: 11.00 PAGES: 1 Area Name and Return Address ',fhuttts A McC;OrinaCi: _:~ _.. . 102010th Avenue >. ,,. FO Box 2120 ~"'~ Baldwin, WI 54002 .002-1018-30-000,002-101&SO-000 Parcel Identification Number (PIN) This is not homestead property. (as) (is not) ~~~- .~~~':tr?~~.o (SEAL) * Christy M. rte egg (SEAL) _ ~, Signature(s) authenticated on AUTHENTICATION TITLE: MEMBER STATE BAR OF WIS (If not, authorized by Wis. Stet. § 706.06 ) THIS INSTRUMENT DRAFTED BY: Thomas A. McCormack Baldwin. WI 54002 (Signatures may NOTE: TATS IS A STANDARD FORM. QUTf CLAIM DEED •Type name below signatures. ACKNOWLEDGMENT STATE OF Wisconsin ) ss. St. Croix COUNTY ) (SEAL) Personally came before me on ~ 1J - ~ - y g > the above-named Christy M. Gregg ~~~~tc~l'~o.- °~_ to ~~e lrnown to be the person(s) who executed the foregoing ~~' truiEngnt and ackn wledg the ~ ' ~y Public, State of Wisconsin _ e+~~~,~II11r115SlOn (~~) XXXXXXXXXXXXXXXXXX } bL~tp~ ewledged. Both are not necessary.) ANY~YIDDI ~1"~P1N TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. ®2003 STATE BAR OF WISCONSIN FORM NO.3-2003 INFp-PRO"' Lepai Forms • (800)655-2021 • inFop~ofortns•can i' ..~ '~ f lscansin Depatfinent of Commerce Division of Safehr and Buildings SOIL EVALUATION PORT in acx:ordance with Comm 85, dm. Code #43 Page 1 of 3 Northland Plumbing, Inc. Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan mu County St. Croix inGude, but not limited to: vertical and horizontal reference point (BM), diredion an arcel I D percent slope, scale or dimensions, north arrow, and Nation and distance to nearest ad. . . ~~ _ / / p ~~v~ 4 Please print all inf rmaf~l![(1C~C ~/ ~ ~ Date Re By n wdc s. 15. Pen;onat information you provide maybe used for dary purposes (1) (m)). ~? ~'7 Property Owner ~i " _ S E P I i Z 0 operty option Terry Gregg C- ~ ovt. I_o W1/4, 1/4, S9, T29N, R16W Property Owner's Mailing Add ' ST. CROIX COU TY # Block # Subd. Name or CSNgF~~~~ i N209 McKay L City State Zip Code ^ Village ®Town Nearest Road Spring Valley WI Baldwin 240Th Street ® New Construdion Use: ®Residentia! / Number of bedrooms 3 Code derived design flow rate 450 GPD ^ Replacement ^ Public orcommercial -Describe: Parent material Glacial Till Flood plain elevation, if applipble ~• General comments This site is an At-Grade or Mound site. and recommendations: 1, ^ Boring J Boring # ® Pit Ground surface elev. 92.81 it. Depth to limiting fador 44 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consisten Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. "EiFi1 'Eif#2 1 0-10 10YR3/2 sil 3sbk mvfr cs 3f .6 .8 2 10-20 10YR6/4 sil 2sbk mvfr cs if .6 .8 3 20-37 10YR4/6 Is 2sbk mfr gs if .7 1.6 4 37-44 10YR4/6 s Osg ml gs .7 1.6 5 44-65 7.5YR5/6 7.5YR5/8fif spots scl 2sbk mvfi cs .4 .6 --~. 2 ^ Boring Boring # ® Pit Ground surface elev. 93.26 ft. Depth to limiting fador 45 in. Soil Appltcation Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consisten Boundary Roots GP D/It= in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Etf#tt *EtT#2 1 0-9 10YR3/2 sil 3sbk mvfr a 3f .6 .8 2 9-16 10YR6/4 sil 2sbk mvfr a 2f .6 .8 3 16-32 10YR4/6 Is 2sbk mfr cs if .7 1.6 4 32-45 7.SYR5/8 s Osg ml gs 1f .7 1.6 5 45-67 7.5YR5/6 7.5YR5/8f1f spots fs Osg ml gs if .5 1.0 * Effluent #1 = BODS> 30 < 220 m and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mglt. and TSS <_30 mg/l_ CST Name (Please Print) Si ature: CST Number Michael J. Myers 267985 Address Northland Plumbing, Inc. Date Evaluation Conduded Telephone Number E 1556 State Rd 64 Boyceville, WI 54725 7/27/07 ,S ~ •ZSZd SB 3H (R.o7f00) /2Z Property Owner Tent G-'e99 Parcel ID # ~ Pa`ge 2 of 3 , 3 Boring # ^ Boring ,~ Pit Ground surface elev. w;~r'' LL89.77 ~• Depth to limiting factor 46 in. ® Soil Application Rate Horizon Depth Dominant Color Redox T re Structure Consistence Boundary Roots GPDlft= in. Mansell Qu. Sz. nt. 3or +~ Gr. Sz. Sh. 'Efrakt *Etf#1 1 0-12 10YR3/2 -' " ~~~°` sil 35bk mvfr cs 3f .6 .8 L 12-21 10YR6/4 f;~'`~ sil 25bk mvfr a 2f .6 .8 3 21-31 10YR4/6 Is 2sbk mfr cs if .7 1.6 4 31-44 7.5YR5/8 s Osg ml gs .7 1.6 5 44-46 7.5YR5/8 fs Osg ml gs .5 1.0 6 46-68 7.5YR5/8 7.5YR6/8fif spots fs Osg ml gs .5 1.0 * 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. ~, ~~ 3 ~_ N li- N ~'' ~- 2 ~ '~ v r d' 3 ~ ~ Q ~ ~` N ,,-,. a ~. ~~ ~ .~°-s fl~~ 0 n- r m 4 Q ~ ~ ~ r d L b v C^ ~1 `v ~ J (~ ~ ~? ~ ~ ~~ ~~ ~ , - ~ 11 M ~ ~ ~ ` ~ . w `2 J / M g / m o ~ ~ ~ ~~ ~ ~ o ~~~~ / ry' ^~~~ ° Parcel #: 002-1018-30-000 osio5/loos 02:25 PM PAGE 1 OF 1 Alt. Parcel #: 09.29.16.122 002 -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 -GREGG, CHRISTY M CHRISTY M GREGG 2307 80TH AVE 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: 40.000 Plat: N/A-NOT AVAILABLE SEC 9 T29N R16W SW NE TOWN BALDWIN Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/16/2007 855621 COAF 07/16/2007 855620 COAF 06/11/2007 852516 TI 09/02/2005 805332 2881 /068 (~C mor .. 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/11/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 21.740 4,200 0 4,200 NO 00 UNDEVELOPED G5 12.260 17,200 0 17,200 NO AGRICULTURAL FOREST G5M 6.000 10,200 0 10,200 NO Totals for 2008: General Property 40.000 31,600 0 31,600 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 31,200 0 31,200 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