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Parcel #: 028 - 1046 -40 -000 25 P
PAGE 1 1
Alt. Parcel #: 36.28.17.290 028 - TOWN OF RUSH RIVER
Current X', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Per Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
MICHAEL S & LINDA M WAGNER * WAGNER, MICHAEL S & LINDA M
10 HWY 63
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 10 HWY 63
SC 0231 BALDWIN - WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 4.000 Plat: N/A -NOT AVAILABLE
SEC 36 T28N R17W PRT SE SE DESC AS BEG Block/Condo Bldg:
ON W R/O/W HWY 63,451.5'N OF CENTER OF
HARMONY RD AKA PIERCE- SR CROIX CTY LN Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
RD, TH N 417042', TH W = CENTER SD RD 36- 28N -17W
417.42', TH S = WITH HWY 63 417.42', TH
S 417.42' TO POB
Notes: Parcel History:
Date Doc # Vol /Page Type
01122/2001 637189 1577/533 WD
01/22/2001 637188 1577/532 TD
07/23/1997 1091/550 QC
09/01/1994 520961 1093/619 LC
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
7221 154,300
Valuations: Last Changed: 10/21/1998
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.000 15,700 76,500 92,200 NO
Totals for 2004:
General Property 4.000 15,700 76,500 92,200
Woodland 0.000 0 0
Totals for 2003:
General Property 4.000 15,700 76,500 92,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 118
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1313
4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 4
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations
Attach complete site Ian on County
p p paper not less than 8'/ x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and parcel LD
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 1046- 40 -000, ID #36.28.17.290
Please print all informatio R • y Date
Personal information you provide ma t r�QPrivacy s. 15.04 (1) (m)).
Property Owner Property Location
Ernie & Diane Waite Govt. Lot SE 1/4 SE 1/4 S 36 T 28 N R 17 W
Property Owner's Mailing Address �? .J .V La # Block # Subd. Name or CSM#
10 Hwy. 63 aura "
City Stat Zip ( City village( Town Nearest Road
Baldwin ( W I Z 715 -684 -3615 'P�ltatts y R U h Hwy. 63
New QQagitaigtion Use: jo Residential ! Number of bedroorris 3 Code derived design flow rate 450 GPD
Replacement] Public or commercial - Describe:
P Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: System location between B -5, 6, & 7. System elev. to be 97.00' at 6" above 96.50' contour.
Boring # -=j Boling
Ie Pit Ground Surface elev. 86.91 ft. Depth to limiting factor 36 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
*Eff#1 *Eff#2
1 0 - 1Oyr4/3 none sit 2fsbk ds as 2f,1m 0.5 0.8
2 7 -12 1Oyr5/4 none sit 2m ds cs 2d 0.5 0.8
3 12 -36 1 Oyr4 /4 none sil 1 msbk ds cw 2f 0.2 0.3
4 36-60 7.5yr4/4 f2d7.5yr5/8 lfs Om dsh - - 0.4 0.6
Boring # Boring
Pit Ground Surface elev. 8 4.77 ft. Depth to limiting factor 38° in• Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
*Eff#1 *Eff#2
1 0 -5 1Oyr4 /3 none sit 2fsbk ds as 2f,1m 0.5 0.8
2 5 -17 1Oyr5 /4 none sil 2msbk ds cs 2d 0.5 0.8
3 17 -38 1 Oyr4 /4 none sit 1 msbk ds cw 2f 0.2 0.3
4 38 -62 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD <30 mg1L and TSS < 30 mg/L.
CST Name (Please Print) Sig ure: - CST Number
Ja mes K. Thompson J z 3602
Address A.C.E. Soil & Site Evaluations D e Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 20 9/20/00 715- 248 -7767
property Owner Ernie & Diane Waite Parcel ID # 0 28-1046 -40 -000, ID #36.28.17. Page _ Z _of _4
a Bering # Boring
Id Pit Ground Surface elev. 112.96 ft. Depth to limiting factor 30" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-4 1Oyr4/3 none sil 2fsbk ds as 2f,1m 0.5 0.8
2 4 -15 1Oyr5/4 none SO 2msbk ds cs 2d 0.5 0.8
3 15 -30 1Oyr4/4 none sl 2msbk ds cw 2f 0.5 0.9
4 30 -57 7.5yr4/4 f2d7.5yr gr.sl Om dh - - 0.3 0.5
i
F4 Boring # Boring
18 Pit Ground Surface elev. 97.67 ft. Depth to limiting factor 16" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-4 1Oyr4/3 none sit 2fsbk ds as 2f,1m 0.5 0.8
2 4 -16 1Oyr5/4 none sil 2msbk ds cs 2d 0.5 0.8
3 16-41 10yr4/4 m2d7.5yr5/8 & sil 1 msbk ds cw 2f 0.2 0.3
10yr6/2
F 5-1 Boring # Boring It Pit Ground Surface elev. 93.10 ft. Depth to limiting factor 32" in. Sat Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
*Eff#1 *Eff#2
i
1 0-6 1Oyr4/2 none sil 2%bk ds as 2f,1m 0.5 0.8
2 6 -24 1Oyr5/4 none sil 2msbk dsh cs 2d 0.5 0.8
3 24 -32 1Oyr4/4 none sl 2msbk dh cw 2f 0.5 0.9
4 32-45 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
i
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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.
I _
p O wner Ernie & Diane Waite _ parcel ID # 028-1 -40 -000, iD #36.28.17.290 Page 3 of 4
a Boring
6 Boring #
Pit Ground Surface elev. 97.84 ft Depth to limiting factor 30" in. Soil Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0 -5 1Oyr4 /3 none sit 2fsbk ds as 2f,1m 0.5 0.8
2 5 - 18 1Oyr5/4 none sit 2msbk ds cs 2d 0.5 0.8
3 18 -30 1Oyr4/4 none sl 2msbk dh cw 2f 0.5 0.9
4 30-49 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
7] Ong # Y�� Boring
t Pit Ground Surface elev. 93.21 ft. Depth to limiting factor 42" in. Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots —
*Eff#1 "Eff#2
1 0 -5 1 Oyr4 /3 none sit 2fsbk ds as 2f,1 m 0.5 0.8
2 5 -15 1Oyr5/4 none sit 2msbk ds cs 2d 0.5 0.8
3 15 -23 1 Oyr4 /4 none sit 1 msbk dsh cw 2f 0.2 0.3
4 23-42 7.5yr4/4 non its Om dsh aw - 0.4 0.6
5 42-62 7.5yr4/4 f2d7.5yr5/8 strat.Is Om dsh - - 0.4 0.6
F-1 # Boring
vr� goring
,,_`,� Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMe
*EfP#1 *Eff#2
* Effluent #1 = SOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 30 mg1L and TSS <30 mg1L
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.
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Wisconsin Departmgnt of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
'
Safety and`Bu +IdingDivision
INSPECTION REPORT Sanitary Permit No: 420777 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. d 21 G ?�
Permit Holder's Name: City Village X Township Parcel Tax No:
Wagner, Michael & Linda I Rush River Township 028 - 1046 -40 -000
CST BM Ele Insp. SM Elev: BM D sc ption: Section/Town /Range /Map No:
oL Q d Q yL ' 36.28.17.290
TANK INFORMATION EL9VATION DATA
TYPE MANUFACTURER CAPACITY STATIO BS, HI FS ELEV.
a o • Q oD- RP 16V 0
Septic Ud d BenchP3ark 2. 3 Iv Io 2.3 60 d
Dosing � Alt. BM ^2�,„ Stns • (Oa
Aeration Bldg. ewer
--- 61n � 3 3
Holding St/Ht Inlet
5'cy o � y dap �►� �2. 9
TANK SETBACK INFORMATION St/Ht Out
TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet
Septic , I \► ! p,�o t . Dt Bottom � p�
Pg
P
Dosing U `J � � / H er a �O�D
Aeration P p Dist. Pip�1 o L A 7.GS
9 ' r
Holding Bot. System 3.Q 9G
Final Grade -i �t?n� ( / 6
PUMP /SIPHON INFORMATION I �s'f ':?Y, J
Manufacturer Demand St Cover !� � /lL
GPM L, . T
Model Number
TDH Li� M Friction Loss System Head TDH Ft I
Forcemain Le th ! l Dia. 2 ,, Dist. SOIL ABSO I N SYST 7
BED/TRENCH Width / F No. Of Tre ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS '
SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM C G Manufacturer:
INFORMATION TypdOf,6ystem: LOt II
CHA ROR
I ,„ _ I �� 45V Model Number: A J7OD—
t"(v W
DISTRIBUTION SYSTEM
Header /Manifold Distribution / x Hole Si J xHoleSpacing Vent to Air Intake
Pipe(s) j
Length 3 Dia Length / Dia 1 - 5 Spacin 3 7 2 - 5
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center BedlTrench Edges Topsoil E,,-_]
[] Yes No Yes Eg] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: – 7 / 0 - 3 Inspection #2:71 103
Location: 10 Hwy 63 Baldwin, WI 54002 (SE 11/4 SE 114 36 T28N R17W) NA Lot O/ -fa Parcel No: 36.2 .1.90
1.) Alt BM Description = 1� ri.
rTVhj of kA AAA, fJ'd j Lt�
2.) Bldg sewer length = u d l' d a � �,Q� Q — A' 7
- amount of cover
Plan revision Required? j Yes v
- - --
I
Use other side for additional Information. 1 Q1 _-------- .------ _. —_. - -- ��/t• —� T -4
SBD -6710 (R.3/97) Date Insepctor's Signatur Cert. No.
S Y�b�•
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 ST CROIX
N Visconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 ZO
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal inforn a tion ', r�D 852162 ^- r L .`�
may be used for secondary purposes Privacy Law, sl 04(1)( IV ED Address (if different than mailing-address)
I. Application Information - Please Print All Information l
APR d 3 2003 icy
Property Owner's Na me arcel # Lot # Block #
8T. CROIX COUNTY
MICHAEL & LINDA WAGNER ZONING OFFICE 028- 1046 -40 -000 �
Property Owner's M ailing Address Property Location
10 HWY 63
City, State Zip Code Phone Number SE %, SE 1k,Section 36
BALDWIN WI 54002 715/684 -7689 T 28 N; R ( circl of W Z�O
II. Type of Building (check all that apply)
Q 1 or 2 Family Dwelling - Number of edrooms 3 I Subdivision Nam rcM Num
❑ Public /Commercial -Describe Use C q 1W eS�} N/A 5 w�lae `
❑ State Owned - Describe Use n ❑City []Village Township of RUSH RIV
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System y � Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑Permit Renewal El Permit Revision ❑Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
1V. Type of POWTS System: (Check all that apply)
❑ Non - Pressurized In- Ground [X Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain)
V. Dispersal/Treatment Area Information: 7►fc 10D
Design Flow (gpd) sign Soil Application Rate( gpdsf) ispersal Area Required (sf) ispersal Area roposed (sf) System Elevation
450 � 450 450 1. 97.00
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank. 1000 1000 WIESER CONCRETE 3 X
mi� ` 600 600 WIESER CONCRETE X
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Z "__1__( 1 's Si gnature MP /MPRS Number Business Phone Number
BENNIE HELGESON 0292 715/772 -3278
Plumber's Addre ss (Street, City, State, Zip Code)
W1229 770TH AVENUE, SPRING VALLEY WI 54767
VIII. Count Department Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued lssuing gent Signatur To Stamps)
Surcharge Fee) �•
❑ Owner Given Reason for Denial
3z
oq 2eb
IX. Conditions of Approval /Reasons for Disapproval
*
mss 15 a- f + ot� c> Jx"Kre eo,- S .w+ `L `�: one t �(
�-�.,,
7 DX -
Ski { —
J ? Atta l tt the C y or the system on paper not less than x 1 inches
SBD -6398 (R. 01/03) .J p ,�} = ?D vb- C
C �
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2 as
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer n)a m ;/X e
Mailing Address lU j j `3uc� �^ l.Jl SG� Z
Property Address CL� t-�u, A 5 e: I wr"
(Verification required from Planning Department for new construction)
City /State 13o � "1101b - j Parcel Identification Number
LEGAL DESCRIPTION
Property Location SE ` / <, S1✓ ` /4, Sec. ,T N- R Town of
Subdivision - e1"ce -- -
Lot #
1
Certified Survey Map # , Volume , Page #
Warranty Deed # ��/ L 9 , Volume 57 ,Page # S-
Spec house O yes CID no Lot lines identifiable yes O no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix 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
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the s tandards
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 Zoning Office within 30
days of a three year expiration date.
3 1 1$16
SIGNATURE OF AlYP DATE
OWNER CERTIFICATION
I (we) 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 pro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
JUL t 3 //
SIGNATURE OF PPLICANT DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
I
i
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
'\
Visconsin www.commerc .wis ons
Department of Commerce www•wisconsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
March 27, 2003
CUST ID No.220292 ATTN: POWTS Inspector
BENNIE W HELGESON ZONING OFFICE
HELGESON EXCAVATING ST CROIX COUNTY SPIA
W1229 770TH AVE 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/27/2005 Identification Numbers
Transaction ID No. 852162
SITE: Site ID No. 657058
Michael & Linda Wagner Please refer to both identification numbers,
10 Hwy 63 above, in all correspondence with the agency.
Town of Rush River
St Croix County
SETA, SE1 /4, S36, T28N, R17W
FOR:
Description: Three Bedroom Replacement Mound System
Object Type: POWT System Regulated Object ID No.: 896609
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Conditions:
• This system is to be constructed and located in accordance with the enclosed approved plans.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during
construction and open to inspection by authorized representatives of the Department, which may include local
inspectors.
Owner Responsibilities:
• Comm 1 83.52 - The owner of a POWTS shall be responsible for ensuring that the operation and
()(a ) P g p
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
P, O. V T. S.
C 0 l Z d l 1` `it` '1 I I CST e a
ev"Rk MME
BENNIE W HELGESON Page 2 3/27/03
Owner Responsibilities Continued:
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to
the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence 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,
Fee Required $ 175.00
&40G-� Fee Received $ 175.00
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633
jswim @commerce.state.wi.us
cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544
r
INDEX SHEET
FC
Fjy
$44
PROPERTY OWNER: MICHAEL & LINDA WAGNER �C
10 HWY 63 A
BALDWIN, WI 54002 V !k
PROJECT NAME: ,MICHAEL & LINDA WAGNER
PROJECT LOCATION: SE 1/4, SE 1/4, S 36, T 28 N, R 17 W
MUNICIPALITY: TOWN OF RUSH RIVER
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 & 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 Signed
Address: W1229 770th Avenue
Spring Valley, WI 54767
Credential Number: 220292 Date: March 25, 2002
UtNkRTMEN] 0f COMMERCE
Di IS!CtN ETY ND SU1LDitSGS
.SEE CORRESPO DENCE
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Synthetic Covering •
Distribution Pipe
AS7 C 33 t ,, . 9�• Y/
Medium Sand
H G
Topsoil
- =r = = =— ��= F i u 9 7.00
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u
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/8 % Slope• Plowed
CELiLOf ? 2 %2 Force Main
Aggregate
From Pump Layer
D , S Ft.
E r-9 Ft.
Cross Section Of A Mound F Ft.
D J s Ft.
A �_ Ft. H / Ft.
Signed: g 7s" Ft.
License Number:
K LS .
.:L Ft.
Date: j _�K_ Ft.
T / (0 Ft.
W a1. Ft.
Observation Pipe K
r F ------------------------------ - - - - --
a r _ ------------------- - - - - -- j
Distribution
C�Lt- Of 2 ;12 .
Pipe Aggregate
Observation Pipe
Plan View Of Mound
- i cl:� e. l G.� ndc. l�1 cLl, ne�Y Page 3 Of g
SEPTIC TANK ✓; PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" QVC „VENT PIPE 12” MIN. ABOVE GRADE E WEATHERPROOF JUNCTION BOX APPROVED
> 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER
FRESH AIR INTAKE - 0n W/ PADLOCK E
61- 6(Av%o{ WARNING LABEL
FINISHED GRADE 9y 61 4_ _4" MIN.
2y�
y "PUL 06SERW►tIonl , s. D. „
.. IN, ` �
18 � t8 rniN.
PIPE
INLET r J I
GAS -
WATER TIGHT SEALS T TIGHT i � /APPROVED
A SEAL JOINTS WITH
FILTER _ I ALM APPROVED PIPE
APPROVED 2A ZVI- B ON 3' ONTO
PIPE 3' 1`' x�& _T_ ON SOIL
ONTO SOLID C I '
SOIL PUMP OFF ELEV . FT • - D OFF
D
3" APPROVED BEDDING UNDER TANK CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE ') r - (5�
w I '
TANK MANUFACTURER: Iese
TANK SIZES: SEPTIC /DDC> GAL. DOSE VOLUME INCLUDING GAL.
DOSE —
GAL . �, '7, 7 � 6j, � LOWBAC K :
CAPACITIES: A =
�
I8 INCHES = 6 .6S GAL.
ALARM MANUFACTURER: �, rlttf► Sy1>'�,
MODEL NUMBER: Joa� B = 2 INCHES = 33 .5 GAL.
SWITCH TYPE: GAL.
C = _� INCHES = /Ott S
PUMP MANUFACTURER: Z�� / "� D = INCHES = I�� GA
MODEL NUMBER: L'
'�
SWITCH TYPE:
16.23 WAC
REQUIRED DISCHARGE RATE �(, /G GPM PUMP & ALARM WIRING AS PER ILHR
FEET
VERTICAL DIFFERENCE BETWEEN PUMP OFF FT. •DISTRIBUTION PIPE • `8�� FEET
* MINIMUM NETWORK SUPPLY PRESSURE FEET
+ f� 7 O FEET FORCEMAIN X 2,� FT/ 10 F TOTAL I DYNAMIC AHEAD •� _ _FEET
WIDTH ; DIAMETER
INTERNAL DIMENSIONS OF PUMPTAN - : / LEN GTH UID 6` 't c L
-
(O i / (p 6-- A, F-N Cof 1 QS�' JAG n s,O? t J PSI
LICENSE NUMBER: DATE:
SIGNED:
1/88
PerforoleA Pipe pelcll
Cave 011) �.
End Vlew
Perloroled ( 44 t
PVC Pipe Ene� ToI�
o``Ob` CLe
�.J� \0
` CC Holes Located on Bottom
are Equally Spaced
P`5 -
�I�sT
PIP.
Distri bution Pipe Lay
P 7. S e�
R
S 3
X a '3
Y
y
Hole Diameter Inch ,�_
Signed:
Lateral Ad Inch (es)
License Number:
Manifold
Inches
Dace:
Force Main Inc
te0. 97. s
h Pe, ka ►4-I = 3 8
X Two 4.. r r�(s = 7 6 14.44
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it TOTAL DYNAMIC HEAD /CAPACITY
w HEAD CAPACITY CURVE PER MINUTE 3 7/8 6 1/4 '
MODELS "140/4140 EFFLUENT AND DEWATERING �4 5/6
Ft. Meters Gol. Ltrs.
5 1.52 91 144 3 1 7 1 /8
14
10 3.05 84 318 +
0
15 4.57 76 288
12 40 1 1/2 - 11 1/2 NP1
140,4140 20 6.10 68 257
25 7.62 59 223
35
10 30 9.14 49 185
30 35 10.67 38 144
40 12.19 21 79
8
25 45 13.72 5 19 12 5/6
0
lock VeWe: 46'
= 6
4 SJIB
U
Q SK1524A
> 15
0
a
J
Q
0 10
Doub S e a Desi
2 57f8�6If4 Wei l
5 4 5/e
0 0 3 7/8
U.S. GALLONS 10 20 30 40 50 80 70 80 90 100 110 +
LITERS 80 160 240 320 400
0 FLOW PER MINUTE 010904
11/2 - 11 I/2 NPT
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and supplied with 6 FL & — an alarm.
Mechanical alternators, for duplex systems, are available with or without --T
alarms. 4 5/16
• Control alarm systems are available for 1 phase pumps used in simplex L SK1524B
system. See FM0732.
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable SELECTION GUIDE
level long cycle controls.
• Sealed Qwik -Box available for outdoor installations. See FM1420. 1. Single piggyback variable level float switch or double piggyback variable level float
• Over 1307. (54 °C.) special quotation required. switch. Refer to FM0477.
• Refer to FM0806 for 200 F. applications. 2. Mechanical alternator M -Pak 100072 or 10-0075.
3. See FM0712 for correct model of Electrical Altemator E -Pak.
4. Variable level control switch 10 -0225 used as a control activator, specify duplex (3)
140 Series - 53 lbs. 4140 Series - 73 lbs. or (4) float system.
14014140"• MODELS Control Selection
Model Model Volts-Ph Mode Amps Simplex Duplex
N140 N4140 115 1 Non 15.0 1 or 1 &5 2 or 3 & 4
E140 E4140 230 1 Non 7.5 1 or 1 &5
- -- For 3 & 4 O CAUTION
BN140 BN4140 115 1 Non 15.5 1 or 1 & 5 2 or 3 & 4 All installation of controls, protection devices and wiring should be done by a quaUfied
SE140 SE4140 230 1 Non 7.5 1 or 1 - &5 2 or 3 & 4 licensed electrician. All electrical and safety codes should be followed including the most
recent National Electric Code (NEC) and the occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
Louisville, KY 40256.0347 Manu/ecturers of. .
SHIP T0: 3649 Cane Run Road q
® Loulsville, KY 40211.1961 kIrrAA/PB SYCE /a/s!c/
(501) 778.2731.1(800) 928 -PUMP
httpYAvww.zooller com �L/ /Yll �0 FAX (502) 774 -3624
0 Copyright 2001 Zoeller Co. All rights reserved.
• 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8
FILE INFORMATION SYSTEM SPECIFICATIONS
EPermit MICHAEL & LINDA WAGNER Septic Tank Capacity al ❑ NA
$20 —
Septic Tank Manufacturer WIESER CONCRETE ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Mo A -100 12" 16 x NA _j
Number of Commercial Units [a NA Pump Tank Capacity 600 gal ❑ NA
Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER CONCRETE❑ NA
Design flow (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer IZOELLER PUP1P COO NA
Soil Application Rate /ft�
al/da Pump Model 140 ❑ NA
Monthl e' Pretreatment Unit El NA
Influent/Effluent Quality y avers 9 ❑ Sand/Gravel Filter ❑Peat Filter
Fats, Oil &Grease (FOG) 530 mg /L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection ❑ Other.
Total Suspended Solids (TSS) 5150 m /L Manufacturer {
Pretreated Effluent Quality ® NA Monthly average" Dispersal Cell(s)
Biochemical Oxygen Demand (GOD 530 mg /L ❑ In- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) 530 mg1L ❑ At -grade 0 Mound
❑ Drip-line ❑Other.
Fecal Coliform (geometric mean) s10 cfu /100m1 '
Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non- commerclao wastewater and
septic tank effluent.
•• Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every 2 ❑months &7 year(s) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume
Inspect dispersal cell(s) At least once every 2 ❑ months Q year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every 1 ❑ months . 9 year(s)
Inspect pump, pump controls & alarm At least once every 1 ❑ months Q year(s) ❑ NA
Flush laterals and pressure test At least once every 3 ❑ months Q year(s) ❑ NA
Other At least once every ❑ months ❑ year(s) ❑ NA
other. At least once every ❑ months ❑ year(s) ❑ 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,) 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 ch. NR
113, Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any
other maintenance or monitoring at intervals of 12 months or less 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.
START UP AND OPERATION.
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
,
.OWN`ER: NICKEL & LINDA WAGNER Page 8 of 8
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
I
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 cell(s) and may result In the
u
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.
A13ANDONOMENT
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 ch. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code
compliant replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil
absorption system. The replacement area should be protected from disturbance and compaction.and should not
be infringed upon by required setbacks from existing and proposed stricture, 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 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
I
POWTS INSTALLER POWTS MAINTAINER
i_
Name HELGESON EXCAVATION INC Name
Phone 715/772 -3278 Phone 715/273 -5811
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name JOHNSON SANITATION Agency ST CROIX COUNTY ZONING OFFICE
Phone 715/273 -5811 Phone 715/386 -4680
Fhis document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets
,r,e minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(O and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not
Guarantee the performance of the POWTS. GMW (2101)
1313
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference BM) direction and
percent slope, scale or dimemsions, north arrow, and location an tance to nearest road. Parcel I.D.
028 - 1046 -40 -000 ID #36.28.17.290
Please print all information. ewed gy ate
Personal information you provide maybe used for second2?ypu'pes�s (PrivacXle4v, 15.04 (1) (m)). � dg
Property Owner roperty Location
Ernie & Diane Waite : z �s� ovt. Lot SE 1/4 SE 1/4 S 36 T 28 N R 17 W
Property Owner's Mailing Address of # Block # Subd. Name or CSM#
10 Hwy. 63 I
TY
City State Zip Code ; PttlJjNfi J City vllag go Town Nearest Road
Baldwin WI 54002 715 , 5'f" QIJNZ H 63
New Construction Use: td Resit riitMUiuriaber bedrooms 3 Code derived design flow rate 450 GPD
Id Replacement Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: System location between B -5, 6, & 7. System elev. to be 97.00' at 6" above 96.50' contour.
Boring # j Boring
Pit Ground Surface elev. 86.91 ft. Depth to limiting factor � in' Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD /ft
1 0 -7 10yr4/3 none sil 2fsbk ds as 2f,1m 0.5 0.8
2 7 -12 10yr5/4 none sil 2msbk ds cs 2d 0.5 0.8
3 12 -36 10yr4/4 none A lmsbk ds cw 21' 0.2 0.3
4 36 -60 7.5yr4/4 f2d7.5yr5/8 Ifs Om dsh - - 0.4 0.6
a Boring # '' Boring
Pit Ground Surface elev. 84.7 ft. Depth to limiting factor 38" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
1 0 -5 10yr4 /3 none sil 2fsbk ds as 2f,lm 0.5 0.8
2 5 -17 10yr5 /4 none sil 2msbk ds cs 2d 0.5 Q
3 17 -38 10yr4 /4 none sil lmsbk ds cw 2f 0.2 0.3
4 38 -62 7.5yr4/4 Q0.5yr5/8 gr.sl Om dh - - 0.3 0.5
-------------- * Effluent #1 = BOD s> 30 < 220 mg/L and S >30 < 150 L t #2 = BOD <30 mg/L and TSS <�30 mg/L
CST Name (Please Print) I Signature: CST Number
James K. Thompson ` 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
Osceola, WI 54020 9/20/00 715- 248 -7767
property owner Ernie & Diane Waite Parcel ID # 028- 1046 -40 -000, ID #36.28.17.290 Page 2 of 3
3] Bonng # J Boring -
Ad Pit Ground Surface elev. __ 112.96 ft. Depth to limiting factor 30" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
*Eff#1 *Eff#2
1 0 -4 10yr4 /3 none sil 2fsbk ds as 2f,im 0.5 0.8
2 4 -15 10yr5 /4 none A 2msbk ds Cs 2d 0.5 0.8
3 15 -30 10yr4 /4 none sl 2msbk ds Cw 2f 0.5 0.9
4 30 -57 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
F 4] Ong # W f Bering
lib Pit Ground Surface elev. 97.67 ft. Depth to limiting factor 16: in. Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots SPD1ft
*Eff#1 *Eff#2
1 0-4 10yr4 /3 non ,A sil 2fsbk ds as 2f,lm 0.5 0.8
2 4 -16 10yr5/4 one 2msbk ds Cs 2d 0.5 0.8
3 16-41 10yr4 /4 m2d7.5yr5/8 & 10yr6/2 A imsbk ds Cw 21F 0.2 0.3
F-5 1 Bering # 0 Boring
Pit Ground Surface elev. - 93.10 ft. Depth to limiting factor 32" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft
*Eff#1 *Eff#2
1 0 -6 10yr4 none sil 2fsbk ds as 2f,im 0.5 0.8
2 6 -24 10yr5 /4 none A 2msbk dsh Cs 2d 0.5 0.8
3 24 -32 10yr4 /4 none sl 2msbk dh Cw 2f 0.5 0.9
4 32-45 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
* Effluent #1 = BOD ? 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 formal, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777.
r property Owner Ernie & Diane Waite Parcel ID # 028 - 1046 -40 -000, ID #36.28.17.290 Page 3 of 3
Boring
]Boring # Sal Application Rate
Pit Ground Surface elev. 97.84 ft. Depth to limiting factor 30" in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 Eff#2
1 0 -5 10yr4/3 none sil 2fs ds as 2f,im 0.5 0.8
2 5 -18 10yr5 /4 none A 2msb ds Cs 2d 0.5 0.8
- - -- -- - - --
3 18 -30 10yr4 /4 none sl 2msbk dh Cw 2f 0.5 0.9
4 30-49 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
F71 Boring # jj Boring
*M Pit Ground Surface elev. 93.21 ft. Depth to limiting factor 42 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture ,
Consistence Boundary Roots "Eff#1 PD/ft Eff#2
1 0 -5 10yr4/3 none A A 2fsbk ds as 2f,1m 0.5 0.8
P"'
2 5 -15 10yr5/4 none 5 o ( 2msbk ds Cs 2d 0.5 0.8
3 15 -23 10yr4 /4 none sil imsbk dsh Cw 2f 0.2 0.3
4 23-42 7.5yr4/4 none Ifs Om dsh aw - 0.4 0.6
5 42 -62 7 f2d7.5yr5/8 - strat. Is Om d sh _- — - _ ---- - -- - 0.4 - — 0.6 --
Boring # j Boring
Pit Ground Surface elev. — __ ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GRDM _2
*Ef1#1 *Eff#2
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <_�O 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
c Y
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OCT -22 -2002 03:27 PM R.C.E. Soil & Site Eual. 715 248 7764 o � P.02
. _ r c� 1 4.1
w 'OIL EVALUATION REPORT` 1313
leaonain Departmentof Commerce , t _ d 4
Division of Safety and Buildings P age
soco drtee with Comm $5, WIa Adm. Cods A.C.E. Soil 8 Sits EralueAone
Add winplob eft pion on paper not last then 8%.11 drehoe In ebe. Pin must Cot *
W**, but not Amsted to; wrtkal and hftMW I alerellEe peW (8M), dl U#m and _ St. Croix
proem elope, oasis or dllnemsion, nw% snow, and 1 end dMarm to nea vet reed. Peresl I.D.
Pi"A's Pdnt all lrrl MINdon. 028 - 10 IDt
P*50 inlbrmatbn bou odd• mw d wee for acond Rwi;wad By Dots
ry Pe�R IPtiriorla�r, s, 15d (7)
Property Owner Plopty t xdk)h
Ernie & Dian Wa BOA Lof SE 114 SE 1M S 36 T 29 N R 17 W
Property yawners Meting Address Lot all ' sF3ubd. Name or C! NN
10 Hwy. 03
city Stab Yip Cods Phony Number city io M fte own New&# Road
Baldwin I WI i 54002 i 713.684 -3615 Pleasa PAO H .63
New eonstnxxlon Use, ROSMO / Number d bedroorne _ 3 _ Code dw red design flow tie 450 GPD
Replacement Public or cam rmclal - DescrAba _
Parent material Glacial Till Flavd pldn sleAban, if appi k" — na
General om"laMe
and rommyoncl Mons: System location between B-5,6, &7. System elev. to be 97.00' at 6" above 96.50' contour.
Pit ground Surface dev. 96.91 . ft. Depth to ftnAng famor _36 In. Solt AppkMm Rate
Horizon NO I Derninant Color Radon Descdp&m Torture Swolure ConslsEr nos Boundary Roofs
-OW . p
1 0 -7 1Oyr4/3 none sit 2fsbk ds as 2f 1m 0.5 0.6
2 7-12 -- 10yr5 / 4 none ail 2mabk ds cs 2d 0.5 0.8
3 12 -36 10yr4 /4 none - - �� - ail ` lmsbk I ds cw 2f 0.2 0.3
4 36 -80 7. 2d7.5yr5/8 N6 Om dsh - - 0.4 0.6
soft 0 0 Boring
�- ---r 0 Pk Ground Surface dow. 84.77 R Depth to llmrinD few 3 8 ° ....in. Sol Ap*aik n Rate
Horizon Depth , Dominant Color Redox Texture Ruch re C onswerive Boundary Roots
"Ef 1 OF.RS2
1 0 -5 10yr4/3 n one sal 2M* da as 2f,1m 0.5 0.0 �
2 5 -17 I 10yr5 /4 none su 2msbk ds 2d I 0.5 4 0.8
3 17 -38 10yr4/4 none so lmsbk ds crt► Zf 0.2 0.3
4 1 38-82 7.5 f2 Val Om d - - 0.3 0.5
" Effluent #1 = SOD d s 30 < 220 wg1L and *30 < IdO mWL � '• � BOD < 30
- mQlt, and TSS -c 30 mlyL
CST Nana (Please P" C Number
J ames K Thomp _ _ -_�� 36
Address A.C.E. Soil & Site E'Wudlans � a p�e 6vduetion Cand called Tdapha Number 340 Paulson Lake Lane ClecaoK %M 920100 715- 248 -7787
OCT -22 -2002 03:28 PM A.C.E. Soil & Size Eval. 715 248 7764 P.03
Prop * Ernle & Dime Wame � .._ __. Paroel ICi ..028 3046 �0�OO,.I D #36 .Z .17,290 Peps _Z of ..4
F3 Be" 3 16orirp M
I . - I
Pk 61ound Surfaceelsv. R Dsptlt to liming factor - 3 In.
Harbors Daplh OomNnaM Color Raft Ducriplio Texture strucluts t.anelewm p ' -
1 0-4 10fR4/3 none of 2febk do as 2f,1m 0.5 0.8
2 415 10yrs / 4 none ail 2msb cs 2d 0.5 0.8
3 15-301 10yr4/4 I none sI 2msbk da cw 2f 0.5 0.9
4 30-57 7. 6yr4/ 4 I f2d7.5 /8 gr.sl Om dh - - 0.3 0.5
F F4 7 7BWn a
M Pk Ground Surfer o1w 97.67 R. Depth to Ihtft factor 16" in.
Sal /1ppYcatian Rate
Horizon Depth Dominant Color Redmr 0eseriptian Te:krr0 ShKkn Boundary Roob
TIM
1 0-4 1Oyr4/3 1 none all 2fsbk do as 2f,1m 0.5 0.8
2 4 - 18 1Oyr5/4 no ne 91 2msbk ds cs 2d 0.5 0.8
m2d7_SyrS/8 !tc
3 181 10yr4l4 Ip /2 all I sbk do CVV 2f 0.2 0.3
no
i
1
i
� Pk Ground Surface eiev 93.10 ft. Depth to IhNtlnp factor 32" -In. Soil ApOcoft Rate
Horizon Depth Dominant Calar Raft Darj;Rm Texture i Wnw;t es Camistence &wWary Raab GPD/R°...
'Filial 'Eff2
1 0.6 1Oyr4/2 no ne sil 2fabk do as 20m 0.5 0.8
i
2 6 -24 10yr5 /4 none so 2msbk dsh ca 2d 0.5 0.8
3 24 -32 1Oyr4/4 n o n e sl 2msbk dh 1 ew 2f 0.5 0.9
4 32 -45 7.5yr414 r2d7.5yr5/8 9r.sl Om dh - - 0.3 0.5
i
EMuw t #1= SOD 30 4 220 n1g& end T33 3- 30 - 150 tn91L ' EMuwd 112 BOD L30 mglL aril TSS c 30 mWL
The Deparbmoat of Commerce is an equal opponuntty seavice provider and ompbyar. If you need mi4xnm to access services or
need material in an aloemato format, please contact the ftortmont at 608- 266.3151 or TTY 605.264.8777.
OCT -22 -2002 03:28 PM A.C.E. Soil & Size Eual. 715 248 7764 P.04
Pmpo* Owner . Unle & Dia ne Waifs _ .._ .� Pared ID fl 028 - 10 46.40 - 000, 36. Papo 3 d • _ 4
F 67 m Pk Ground Suilow slw.._ 97.84 fL Depth to IImft factor _ Q" In. S0 AA%:W;1 on Rafe
Horizon Depth w C Raft Talthn Struowre onskter" tloiardery Room _
'Ef�1 "E11[M't
1 0-6 ' 10y m/3 none w 2fsbk ds as 2f,1 m 0.5 0.8
2 6 -18 I 10yrb 14 n one si t 2msbk do a 2d 0.5 0.8
3 18,30 1Oyr4/4 non SI 2msbk dh Ow 2f 0.5 0.9
4 30.49 I 7 .byr4/4 t2d7_SyrS/8 Qr.sl Om dh _ 0.3 0.5
* Baring
a � Pk Ground Surface slew... 93 -2>— R Depth to frntho factor _ 42' In.
Soi Appica5oru fiats
Horizon Depth Dominant C ow Radon Deauipdm Tadurs Sb uchim Consilmnoe Roobs . GPM - -.- --
'Et1e1 •EffM2
1 0.5 10yr4/3 none al 2fsbk da as 20m 0.5 0.8
i
2 5 -f b 10yf5 14 none to 2msbk do ea 2d 0,5 0.8
3 1 15 - 23 1 Oyr /4 none 61 1 m d ah tw 2f 0.2 0.3
4 23.42 7.8yr4/4 none we Om doh ow - 0.4 0.6
6 ; 424 2 7.5yr f2 d7. 5yr5/8 atrat b Om dsh - - 0.4 0.6
❑ Bow s 13or"
� PR Ground Surface aloe. . _.._.. _ ..... _. 6- DWh to knkvV fecbo► m• SoN AppYOSliorl Rate
Nort=on Depth Dominant Color RWox Desaom Teshas Stnrctun Islencs 8oiardary Roots l •, _ C4PdR'
t =ffsK1 "Eff#tZ
...
• Effluent 01 c BOD ,? 30 220 r%& and TSS >30 < 150 mgFL ' EAluem a2 = BOD c 30 mWL and TSS 30 rt>QIL
The Department of Commune is an equal opporumity WACO provider and anploycr. !f you need asAstenec bo acaoess services or
need mnlerinl in on alternate format, vlcaac conted the department at 609.266 - 3131 or TTY 608 264.8777.
OCT-Z2-2002 02:58 PM A.C.E. Soil & Site Eval. 715 248 7764 P.05
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VOL t 1577PAu 513 637189
STATE BAR OF WISCONSIN FORM 2.1199 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Diane M. Waite and Ernie Wai te, wife 01 -22 - 2001 12:30 pM
and husband —
WARRANTY DEED
- EXEMPT li
Grantor, and Michael S Wagner and Linda M. Wagner, hu and Copy FE
FEE:
wife - TRANSFER FEE: y6E.00
RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Name and Return Address
/.
A parcel of land in the Southeast Quarter of the Southeast Quarter (SE' of R T0: TITLE ONE
SE A), Section 36, Township 28 North, Range 17 West, Town of Rush 7091911 STREET SOUTH ( 4, ^ � -
River, described as follows: Beginning on the West right of way line of HUDSON WI 540111 V
U.S.H. "63", 451.5 feet North of the center of Harmony Road also known as
Pierce -St. Croix County line road; thence continuing North 417.42 feet;
thence West parallel with center of Harmony Rcad for a distance of 417.42 028.1(A6 -40 - 000
feet; thence South parallel with U.S.H. "63 for a distance of 417.42 feet; Parcel Identification Number (PIN)
thence East 417.42 feet to place of beginning. This is homestead property.
0s) 06}100
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of January 2001 , , L4 w9;�61�
+ Diane M. Waite � /Cm
Er nie Waite
+
ACKNOWLEDGMENT
AUTHENTICATION
STATE OF WISCONSIN )
Signature(s) ) ss.
1 r County )
authenticated this da Personally came before me this - day of
Public January 2 001 the above named
a -
State of tsc onSin Mary M. Waite and Ernie Waite, wife a nd the —
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(if not, instrument and acknowledged the same.
authorized by § 706.06, W is. Stats.) _ - --
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, 154016 My Commission is p manent. (If not, state expiration date:
fi - a y- C ) )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
I nformation Profess anaa Company. Fond au L.C. W1 +Names of persons signing in any capacity must be typed or printed below their signature.
e0o-s5s -202
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2.1999
�
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1313
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 028_1046 - - 000 ID #36.28.17.290
Please pri nfomlla1 Reviewed B Date
Personal information you provide m6i b�,us fot�e on3dry p�tp�Se P+ZvacY Law, s. 15.04 (1) (m)).
Property Owner Property Location
Ernie &Diane Waite � Y Govt. Lot SE 1/4 SE 1/4 S 36 T 28 N R 17 W
Property Owner's Mailing Adf „ j Lot # Block # Subd. Name or CSM#
10 Hwy. 63
City --:, tate . ip C N M ' I City I Village ri Town Nearest Road
Baldwin 5400 8 - � 1 Hwy. 63
New Construction Use. ' � rooms 3 Code derived design flow rate 450 GPD
Replacement ' - Describe:
�.
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: Evaluation completed to determine potential suitability of site for future replacement septic system.
Further evaluation needed to determine specific system type and location.
Boring # �j Boring
1I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft
1 0 -7 10yr4 /3 none sil 2fsbk ds as 2f,im 0.5 0.8
2 7 -12 10yr5/4 none s 2msbk ds cs 2d 0.5 0.8
3 12 -36 10yr4/4 non sil imsbk ds cw 2f 0.2 0.3
4 36 -60 7.5yr4/4 f2d7.5yr5/8 Ifs Om dsh - - 0.4 0.6
Boring # Boring —
Pit Ground Surface elev. ft. Depth to limiting factor 38” in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft'
1 0 -5 10yr4 /3 none A 2fs ds as 2f,1m 0.5 0.8
2 5 -17 10yr5 /4 none sil 2msbk ds cs 2d 0.5 0,8
3 17 -38 10yr4/4 non A imsbk ds cW 2f 0.2 0.3
4 38 -62 7.5yr4/4 f2d7.5yr5/8 gr.sl Om dh - - 0.3 0.5
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L * ffluent #2 = BOD <30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sign ure: CST Number
James K. Thompson y -' 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
Osceola, WI 54020 9/20/00 715- 248 -7767
I
per o Ern & Diane Waite Parcel ID # 028 - 1046 40 - 000, ID #36. 28.17.290 Page 2 _of _ 3
3] Bo . ; YJ Boring
i Boring # ft. Depth to limiting 30 in.
1 Pit Ground Surface elev. —____ fact " Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
'Eff#1 *Eff#2
1 0 -4 10yr4 /3 none SO 2fsbk ds as 2f,lm 0.5 0.8
2 4 -15 10yr5 /4 none sil 2msbk ds cs 2d 0.5 0.8
3 15 -30 10y r4/4 none sl 2msbk ds cw 2f 0.5 0.9
4 30 -57 7.5yr4/4 f2d7.5yr5/8 gr.sl O dh - - 0.3 0.5
4 ] F Boring
Boring # ft. Depth to limiti factor 16 in.
Pit Ground Surface elev. � ft " Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD Ift? -
*E Eff#1 *Eff#2
1 0- 4 10yr4/3 none sil 2fsbk ds as 2f,lm 0.5 0.8
2 4 -16 10yr5/4 none 2msbk ds cs 2d 0.5 0
3 16-41 10yr4 /4 m2d7.5yr5/8 & sil lm ds cw 2f 0.2 0.3
10yr6/2
F-1 Boring # Boring
Pit Ground Surface elev. _._____. _ ft. Depth to limiting factor _ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : GP
*Eff#1 *Eff#2
I
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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.
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