HomeMy WebLinkAbout002-1053-10-000yvisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safe.y and Bu;lding Division
t INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
'ermit Holder's Name: City Village X Township
Veenendall, Tim Baldwin, Town of
;ST BM Elev: Insp. BM Elev: BM Descriptio
TANK INFORMATION
TYPE MANUFACTURER ~~`
.J CAPACITY
Septic / ~ ~
~~JI Z~.w ~ 0~1 ~(~
Dosing
Co,n~raa
b
,~ana~, Pa 1alz, sz5
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic 7 ~~ ~ 1
3~ i
Dosing i
i~ ~ I
3~ ~~ ~. .~,
Aeration .
Holding
Pt1MPISiPHON INFORMATION ~~/
Manufacturer /
n~t Demand
1
_ '
/
Ldl ~ GPM
l~~v
Model Number ~~ ~' 3~p .
TDH Lift
~b •~ Friction Loss
Z • Z System Hea
+~~ TDH Ft
~~ s
Forcemain Lengt~l ,~/ Diaz ~~ Dist. to well ~
c(111 AQC!'-DDTI/lAl CVCTGIIA
County:
St. Croix
Sanitary Permit No:
50600 0
State Plan ID No:
Parcel Tax No:
002-1053-10-000 I
Section/TownlRange/Map No:
22.29.16.326
ELEVATION DATA
STATION BS
3.91 HI
I ,91 FS ELEV.
ico
Benchmark
AIt.,~Q
yn~e~ Gam
•~ i.. ~~q'. 03
Bldg. Sewer ~[r g, J
/ `~ G~ z ~ a?
SUHt Inlet
12• q)~ a-7
SUHt Outlet ~ ~
Dt Inlet ~ ~
Dt Bottom ~ ~ ,~ /
( Q
Header/Man. /_ ~~
W 17 $~
l
Dist. Pipe ~.L
~~~U q7' Sf~P
Bot. System
7. Z
Final Grade ~ `~G
/ ~,,Qy_
vvtf
~
St Cover y~~r / ~ `,' Z
7 / a et , O
33
a,r~ ~ r $ . 95 , 8'7
BEDITRENCH Width
I Leng~ / nch
No. Of PIT DIMENSIONS No. Of Pits Inside Dia. Liquid C\
_
DIMENSIONS ~ ! S ~
~ ~- ~" ,
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~
CHAMBER OR
INFORMATION Type Gf S tem:
~ ~ ~ ~~ / /~~ ~ /~
!'t' UNIT Model Number: ~
pJ
I'11CTDIC2IITIlIiAI CVCTiGM
Header/Manifold - ~
~
Length_~_ Dia ` Distribution / /zL
Pipe(s) (• T
Length ~ ~ Dia
~ / ~ ~~
Spacing ~
~ x Hole Size ` //
p
p x Hole Spacing ~ ~
Z O' ~ Ve Air I ke
4
C(111 ('fl\/FR ., o.-,.~~...,. c.,~.e...~ n.,i.. .... Mn~~nrl nr Af_(Aratie Systems Only 1 ~... /~
Depth Over 1
~~
Bed/Trench Center 1 Depth Over ~
Bed/Trench Edges xx Depth of ~
Topsoil xx Seeded/Sodded
N
Y xx Mulched
Yes Nn
~ ~ o
es
i/
61C,
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:? _i Z~-_~ / Inspection #L: ____r /___
Location: 859 240th Ave~Baldwin, WI 54002 (SW 114 NW 1/4 22 T29N R16W) NA Lot ~~~ ~~J Parcel No: 2:'.29.16.326
1.) Alt BM Description = 'y~,~v~ LsJ~t.,~-
2.) Bldg sewer length = 31 171 ~k
- amount of cover = i
~~
Plan revision Required? ~ Yes o ~ 25 b~ ~~ 3
Use other side for additional mforma4on. ~-_ I ~ ,_ ' --- -- - J
Date insepctor's nature Ceit. No.
SBD-6710 (R.3/97)
commerce.wi.gov Safety and Buildi vision County ~s~
~
+
201 W. Washington Ave., 7162 ~uY
Jr//~-
~ s e o n s ~ n Madison, W I 707- Sanitary Permit Number (to be filled in by Co.)
Department of Commerce 5 ~ 200
Sanitary Permit Application StaceTransactionNumber
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governm 1 X3950 G~
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different thanmailing address)
'
submitted to the Department of Commerce. Personal information you pr ./j gs~
L!~(~ ~,
u oses in accordance with the Privac Law, s. 15.0-!(I)(m), Slats. Tr
S.
gm~
L A lication Information -Please Print Information
Property Owner's Name arcel #
7~,... cH•rc-~D~ MAY 2 ~ 2007 60 -. /o - ao
Property Owner's Mailing Address
f~
~
ST. CROIX COUNT-Y roperty Location
/
3 Z~p
,
85~' 2 40 ,
l
L
ovt.
ot
Ciry, State Zip Code ~$~,~J /, ff fit} ~/., Section 2 ~.
-p
•- tJ 141,. W /N fJ~-~ / S'4Uo 2 ?/$-G$-¢- 58G 4 (circle one
T 2 / N; R ~ ~P •iwr~
II. Type of Building (check all that apply) pk„ Lot #
I or 7_ Family Dwelling - Number of Bedrooms ~ ~ Subdivision Name
/~ /~
5~~.~ µQ/` Block # 3~ KG1
^ Public/Commercial -Describe Use 1
^ City of '
^ State Owned -Describe Use CSM Number ^ Village of
L
~ Town of BIo1tL.~W /~
d/+~
III. Type of Permit: (Check onh~ one box on line A. Complete line B if applicable)
A' New S stem
y
^ 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 System/Com onei[UDevice: Check all that a 1 0 O ~
^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound _> 24 in. ofsuitable soil Mound < 24 in. of suitable soil
^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain)
V. Dis ersal/I'reatmentArxc Information: r
Design Flow (gpd)
~ Design Soil Application Rare(gpdst) Dispersal Area Required (s Dispersal Area Propose (sf)
~ System Elevation
'¢So . 2 J ZZSv also 97.20
Vl. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ~
~ e °
U °'
'_
\ New Tanks E~istin.Tanks
6 - ^
/ y// G {,/.~/
N / Q ~ ~~ ft I ~ •L '~ c
G. U :: 2
Vl v~ '+~
to ~ ~
k. C7 ~'
W
Septic or Holding Tank ~ /
r ~O /
GlJ/ES .~/GGt1G
Dosing Chamber t~
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) PI tber's Si aturc MP/MPRS Number Business Phone Number
~t. c/~x/t;/ ~f ers ,2G 7985 7/5-G 9~3-2520
Plumber's Address (Sn~eet, City, State, Zip Code)
c l ss rte 4- yc~v/c~,~c- u~i sg72.5
Vlll ount /De artment Use Only
Approved ^ Permit Fee Date Issued Issuing nt Signature
'en Reason forDenia! S ~~~ • ab 5 Z ~~
IX. Conditions o~An~~r_oyal/Reasons for Disapproval
SY'BTEM OWNER- L
3~
~
~
~ r
1. Septic tank, effluent finer and
b`
Jy~b
'~-- T a
°'
di
l
ll
~J
spersa
ce
must all be sefvibes /maim
n~,
A
G
oe~.i1.
as per management plan provided by plurnbet, at
~
2. AU se'tbaclc tequ'rrements must be maenad
~ t~ 4'iSA~>ltRfp~I~OKihe system and submit to the County only onIpaper not less than 8 lr1 .c [ t inches in size
~~r~ I/~o~4.~.. ~o IQ.I~ rG~t~~.
SBD-6398 (R. 01/07) Valid t)tnt 01/09 ~~
3
z
J tom. ~
a
~~3~
~ ~, ~-- v
3 ~ .-
7 ~ ~ V
~~ ~ h
,~
w
~=
~ ~
N
o$.
,. ,~ ~
~, ,~ . ~,
~-.
~
~. o ~
~,
~ ~
0 v ~
hl ~ ~ J
I
-~
~ ~
~ ~ ~ ~
~' P°
o /
r~
'1
~~ .
i
x~ ~ _ ~ ~~~
cis'
Fy r
~
v~
~
I
i
~ I
I
1 ~
I
~
~
I ~
M
I
I
W
~~ ~
M "
~I
P
~_
~.
1.
~r
J tom.. ~
~~- N?
~ ~ ~r v
~ 3 `~ d
~ f a o!
~3 v
¢ ~
~h~~
,~
w
• 1~ N
o
'
. ~
~~ 1
~,
z
~,
s
~, ~,
~-
~
M o a
0 v ~,
~ ~
~
lr
~
J
-~
~
~
~
~
~
~ ~
~
~
~;
i
~ ~
~ -~
I
~
~ ~
~ j
~
i
1 I
~ m .
~
1
,
~ 1
~
~.
M
I
o /
~~
Z
~ ~~
.F~,-
~ ~~
a4c~
wl ~
~W
~~ .~
M
7I
e!
~•
commerce.wi.gov
isconsin
Department of Commerce
Safety and Buildings
141 NW BARSTOW ST FL 4TH
WAUKESHA WI 53188-3789
TDD #: (608) 264-8777
www. com me rce.wi. gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
May 17, 2007
CUST ID No. 267985
MICHAEL J MYERS
NORTHLAND PLUMBING INC
E1556 STATE RD 64
BOYCEVILLE WI 54725
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/17/2009
ATTN: POWTS Inspector
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
Identification Numbers
Transaction ID No. 1395064
SITE: Site ID No. 725290
Tim Veenendahl Please refer to both identification numbers,
859 240TH St above, in all tortes ondence with the a enc .
Town of Baldwin, 54002
St Croix County
SW 1/4, NW 1/4, S22, T29N, R16W
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1130956
Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version
2.0, SBD-10706-P (N.O1/O1)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with the component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or user
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-
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. In addition, the owner must
comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component
manual. A copy of this information must be given to the owner upon completion of the project. ~~
All holding/treatment tanks are to comply with Comm. 84.25(7)(a).
~-: ,
~j.
~y/
~~
a/~.t
Maintenance information must be given to the owner of the tank explaining that periodic clea~i~g of.~e filter is
required. Access to the filter for cleaning must be provided per Comm 84 product app~l conditiYfns.
r ' ,..,`
A Sanitary Pemut must be obtained from the county where this project is located in accorda`nc'e with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
MICHAEL J MYERS Page 2 5/17/2007
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.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
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.
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,
~~~~~~
~-_
Julia Lewis-Osborne
POWTS Reviewer 2 ,Integrated Services
(262) 548-8638, Fax: (262) 548-8614
julia.lewis@wisconsin. gov
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
WiSMART code: 7633
{. _ .Y
Mound System Cover Page ~, ~ 6
R~C~lV~'D
MAY 7 2007
Project Name: Veenendahl-Mound ~iA~E~ & ~U'LD~J
Owner's Name Tim Veenendahl
Owners Address 859 240th St.
Baldwin, WI 54002
Legal Description sw ~ '/., Nw ~ ~~4 Sec 22 T 29 N, R 16 V1- ~
Township Baldwin
COUnty Saint Crooc ~
Subdivision
Lot#
Parcel ID#
Table of Contents
P9~
1 Cover page
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map
total # of pages: 6
Designer Name: Michael J. Myers
MPILicense #: 267985
Date: 4/12/07
Ph. #: 7'15&43-2520
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01)
per "Pressure Oistn'bution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) S8D-10706-P (N 01A1)
3f>Advisement N12486 220th St. Bovoev!lle. W! 54725 Ph: 715643.6068 email:
_b
~~~
<~~ dG
C
Mound System
Mound Sizing Calculations
Project Name: Veenendahl-Mound
Site Conditions
Project Type: 1 ~ 2 Famly DwElling
°~6 Slope:
# of Bedrooms:
Depth to limiting factor.
Absorbtion rate of fill material:
Absorbtion rate of in-situ soil
Effluent quality
Max BOD effluent value:
Max TSS effluent value:
o~
20 in.
al/ft2/day
0. galfftz/day
Elf#1 ~
220 mg/l
150 mg/l
Design of Entire Fiii
Cell depth at upslope edge (D):
Cell depth at downslope edge (E):
Distribution cell depth (F):
Cover thiclvtess over edge {G):
Cover thickness over center (H):
End slope width (IC):
Fill length (L}:
Upslope width (J):
Downslope width (Toe) (I):
Fill Width (W):
r~zae
16.0 in.
18.9 in.
9.5 in.
6 in.
12 in.
9.8 ft.
94.6 ft.
7.1 ft.
24.0 ft.
37.1 ft.
Design of the Distribution Ceti Basal Area
System Design Flow: 450.0 gal/day Basal area required: 2250 ft2
Distribution cell width (A): 6.00 ft Basal area available: 2250 ftz
Distribution cell length (B): 75. ft
Area of Distribution Cell: 450A ftz Observation Pipes
Contour Elevation of Mound: 95.87 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 97.20 ft
Final Grade of Mound: 99.00 ft
Mound Pian View
L
Mound Cross Section
Final Grade ~-
Synthetic Fabnc
Distribution Celle
System Elevation ~ .b; ,-
Cover Material
Filt material ~~
~.--Slope
Foriyemain~`'-SY~m
Contour
Notes:
FIN material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(8)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(g)
Distribution Cell to have m'mimum 6" aggregate below lateral and 2" above.
Mound System
Pressure Distribution Calculations
Project Name: Veenendahl-Mound
Lateral Layout
Lateral elevation: 97.7 ft
Rows of Laterals: 2 ~
Manifold type: C~erroer
Or~ce diameter. o.i25 ~ In.
# of Laterals: 4
Distal Pressure: 5 ft
Lateral Length: 37 ft
Orifice Spacing/Distribution
Orifice spaang (~: 20.65 Inches
Orifices per lateral:
Avg. ftz/Orfice: 5.11 ftz
Pepe 3 or 8
LateraUManifold Design
Cetera! diameter. hh • In.
Lateral spacing (S): ft
Lateral to cell edge: 1.5 ft
Lateral discharge rate: 9.06 gpm
System discharge rate: 36.25 gpm
Manifold diameter. 2 ~ In.
Manifold length: 3 ~
Forcemain Friction Loss
Forcemain length: 12 ft
Forcemain diameter: 2 ~- In.
Friction loss in fof~cemain: 3.9eTft
~6~
Lateral Side View
~I
3rd
i~
Lateral Plan View
-~ Cetera! Length --=~ f rrrn-up wJbaN valve or deanout plug
Orifices tm t~ottom of
lateral equally spaced
PVC laterals and forcemain to comply with
specifications per Comm 84.30[2)(e]
Forcemain cotx~ection via tee or crass to manifold at any point
Clean Out Detail
gearrout plug
Grade r or ball valve
Observation Pipes
~lJater tight cap
or plug
Sprinkler
Box
Long Sweep 90
oriwa 45's1
6" Minimum
L
lUote: Closet Cofer
may fee used in
place of 318" bar
'~-318" Bar
Mound System
Septic, Pump and Dose Tank
Project: Veenendahl-Mound
Tank Information
Pump tank manufacturer. Wieser Concrete
Pump tank size/model: wiooo/c5o-MR--~~
Pump tank gal/inch: 17
Actual Pump Tank Volume: 646 gal
Tank bottom elevation (inside): r 871ft
Septic tank size/model: wiooo/6so-MR '~
Pump and Filter
Pump Manufacturer. Goulds
Pump Model: PE61P1
Effluent Filter: Pol
Note: Access opening of sufficient size to be provided to a/bw
removal of filter. Opening to temr/nate at or above grade.
Pump Tank Diagram
Waterer locking Cover
4 Inch With Worming Label
ini:
Minimum ~, ,.__
outlet
lotntion
Eled. per Comm
16.28 and
NEC 300
Weep Hole p`
or Arrti-
Siphon B
Device
C
D
36.2 GPM
19.6 Feet
~s
r
~eaore
Dosage Volume
Fort;emain drains bat~c to tank? ~ yps (~ ~
Lateral void volume: 16.6 gat
Dosage to absorbtion Cell: 78.2 gal
Forcemain volume: 20.9 gal
Total dosage: 99,1 g~
Total Dynamic Head
Are laterals highest pant? y
if not, enter highest elevation: p ft
System head (distal x 1.3) 6,50 ft
Vertical Lift ("D" to lateral) 9.70 ft
Friction loss in forcemain: 3,30 ft
Pressure loss from filter. ~VJft
Total dynamic head (TDH): 19.50 ft
Dose Tank Levels
In. Gal
A Reserve 18.2 308.9
B Pump off to Alarm 2.0 34.0
C Total Dosage 6.8 99.1
D Effluent depth for pump 12.0 204.0
Total Capaaty: 38.0 646.0
FtQV- tLTERS/ttlltlt
f
io
5 ~
es
0
Pump must be capable of
and head pressure of:
Little f3i8rrt FL~V- GALLOgSlM[NUTE
9EH PUMP PERFORMANCE CURVE
liSV 6lttt2
Mound System Management Plan pursuant to Comm s3.54 w. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction andlor the department.
Septic Tank:
Septic tank(s) an: to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemicaUbiological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety
and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids
from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by
sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied
and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. if the
inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping
should be done as to not exceed 113 sludge volume. Septic tank should be routinely inspected to be
watertight and of good repair.
Pump/Dose Tank
If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pumpldose tank should be routinely inspected to be watertight and of good repair.
Mound and Cetera! System
The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches
or more water level is detected in the observation pipes, the owner must be notified of possible
problemslfailure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities andlor possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the Geanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Pertormance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Pian:
If the septic tank, pump tank or any of their components therein (inGuding floats, alarms, pumps, etc) become
defective, the defective tank or component must be replaced immediately to ensure that the system can
operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surtace,
the component must be repaired or replaced in it's current location by either: extending basal toe to provide
added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within
the mound and replacing said components in order to return system to proper working order as required.
.. ~~SC~I~S11~ ~5
SOIL EVALUATION REPORT
Department of Commerce in accordance wit ~ mm 85, Wis. Adm. Code Page 1 of 3
Division of Safeiv and Buildings /~ Northland Plumbing, Inc.
County
Attach complete site plan on paper not less than 8%: x 11 inches ' size. mus St. Croix
include, but not limited to: vertical and horizontal reference point ,dire n a
Parcel I
D
percent slope, scale or dimensions, north arrow, and location and dLs to t r d. .
.
Please p " Revie y Da
Personal information you provide may be sect fo Pri Law, s. 15. (m)). J! L ~
Properly Owner 2007
1 9 Property Location
Tim Veenendahl APR Govt. Lot SW1/4, W1/4, S22, T29N, R16W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
859 240th St. ST. CROIX COUNTY
City State ~ City ^ ~Ilage ®Town Nearest Road
Baldwin WI 54002 Baldwin 240Th St
®New Construction Use: ®Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD
^ Replacement ^ Public or commercial -Describe:
Parent material Glacial Till Flood plain elevation, if applicable ft•
General comments Mound site using 95.87 contour.
and recommendations:
^
1 g ^ Boring p
Borin # ®Pit Ground surface elev. / a, S 8 ft. Depth to limiting factor 28 ~ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/fl'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etfi't 'Eft#2
1 0-12 10YR3/2 sil 35bk mvfr ce if .6 .8
2 12-18 10YR4/5 sil isbk mvfr cs if .6 .8
3 18-28 10YR5/6 s Osg ml a .7 1.6
4 28-30 7.5YR5/8 7.5YR7/8spotsfld scl isbk mvfr gs .2 .3
5 30-50 7.5YR6/8 7.5YR7/8spotsfid scl lsbk mfr gs .2 .3
^
Z g ^ Boring
Borin # ®Pit Ground surface elev. ~5 SF ft. Depth to limiting factor 28 ~ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description • Texture Structure Consisten Boundary Roots GP D/ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#r2
1 0-10 10YR3/2 sil isbk mvfr a if .6 .8
2 10-18 10YR4/5 sil isbk mvfr cs if .6 .8
3 18-28 10YR5/6 s Osg ml cs .7 1.6
4 28-31 7.5YR5/8 7.5YR7/8~otsfid sct isbk mvfr gs .2 .3
5 31-54 7.5YR5/8 7.5YR7/8spotsfid sd isbk mfr gs .2 .3
'Effluent #1 = BODS> 30 < 220 m Land TSS >30 < 150 mg/L 'Effluent #Z = BUUS < 3U mg/L ano i ss Hsu mgiL
CST Name (Please Print) ignat CST Number
Michael J. Myers 267985
Address Northland Plumbing, Inc. Date Evaluation Cpnducted Telephone Number
E 1556 State Rd 64 Boyceville, WI 54725 4/10/07 ?f,f ~4~-2$2a
SBD-8330 (807/00)
Property Owner Tim Veenendahl Parcel ID # Page 2 of 3
3 ^ Boring ~4
Boring # ®Pit Ground surface elev. 93•' ! ft• Depth to limiting factor 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(ta
in. Munsell Qu. Sz. Cont. Cobr °'~ Gr. Sz. Sh. 'Efr#1 'Eft#2
1 0-12 10YR3/2 sll ~`° 3sbk mvfr a if .6 .8
2 12-19 10YR4/5 , sl1 3sbk mvFr a if .6 .8
3 19-20 7.5YR5/8 sd isbk mfr gs .2 .3
4 20-39 7.SYR5/8 7.5YR7/8spolsfld sd isbk mfr gs .2 .3
5 39-52 7.5YR 7.5YR5/8spo~sfid sd isbk mfr gs .2 .3
`Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #k2 = 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.
Property Owner Tim Veenendahl Parcel ID # Page 2 of 3
3
Boring # ^ Boring ~4
®Pit Ground surface elev. g3•' / g; Depth to limiting factor 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft~
in. Munsell Qu. Sz. Cont. Color ~"• Gr. Sz. Sh. 'Eff~e1 *Etr1r2
1 0-12 10YR3/2 511 • ~`~ 3sbk mvfr cs 1f .6 .8
2 12-19 10YR4/5 ~ ail 3sbk mvfr cs if .6 .8
3 19-20 7.5YR5/8 scl isbk mfr gs .2 .3
4 20-39 7.5YR5/8 7.5YR7/8spotsfid sd lsbk mfr gs .2 .3
5 39-52 7.5YR 7.5YR5/8spotsfld scl isbk mfr gs .2 .3
'Effluent #1 = BODS> 30 < 220 mg/t_ 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.
.I .
1
~'"
,~,,,~.,~..~_r::
-- - _ __
Z
~
~
~
~
~ h Q- Q" ~- ~ -' ~`
~ ,..
~ ~
~
~
~; h
~ ~ ~ ~ ~ ~
`~
s
00
M
~ ~ ~~
00
~ 6~-- Q-
If
. _ ~~
~ N ~
~ ~~I
~~ i ~
-~
I ~ ~ `'
n
~ ~ + ~
~ f ~
I
-M ~ ~~,~
~ o
~ ~ -
,.-..~ 1
~ !
~~~;~.
~~ "~
.a
,~ ~~, ~
~ ?~
v
~.
J
a
s
z
N
h ~
w 1~
3~,~
~ ~ 3
7 ?~ ,o
~~~~
~S -~
~,
ST CROIX COUNTY
SEPTIC TANK MAII~ITENANCE AGREEMENT
.AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer ~~
Mailing Address $ 5 ~ 2~a ~ x'70, ~i~tLa w ~~/, w / S~¢a o Z
Property Address 85 `f ~'`f'e ~ sf /3A ~ ~ ~-~' ~~ , w / -S4a a Z
(Verification required from Planning Department for new construction)
City/State aA~d ~ ~N; u~ / Parcel Identification Number
LEGAL DESCRIPTION
Property Location S e~ '/., ~~-~-' '/., Sec. 2 2 , T 2 9 N-RAW, Town of 13s~e.~i w ~~
Subdivision ,Lot #
Certified Survey Map # ,Volume ,Page #
Warranty Deed # ~ ~~Z~ fo , Volttme~ Z'1(Q'L ,Page # 15Z
Spec house ^ yes ($L no
Lot lines identifiable ,dyes ^ no
SYSTEM MAINTENANCE ,
Improper use and maintenanceofyour 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, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposalsystern
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with 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 ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of a three ar expiration date.
~ s 2/ /~ 7
G ATURE O APPLICANT DATE
OWNER CERTIFICATION
I (we) cert' that all statements on this form are true to the best of my (our) knowledge.
e p erty crib bove, by v' e f a warranty deed recorded in Register of Deeds Of'f'ice.
S NATURE OF APPLICANT
«««««« Any information that is nus-represented m~ result in the sanitary permit being revoked b}
I (we) am (are) the owner(s) of
~ S /2/~ o'er
DATE
««««««
the Zoning Department.
«• Include with this application: a stamped warranty det~i from the Register of Deeds office
a copy of the certified slrrvey map if reference is made in the warranty deed
'a~3
`~
U 27o2P 152 =1~
State Bar of Wisconsin Form 2-2003 KATHL}::EN }l. wAL.SN
REGISTER OF DEEDS
WARRANTY DEED ~T. CROIx c~. , wI
fsECEIVED FOR RECORD
Document Number Document Name
0.i. 03i 2005 10:00AM
WARRANTY DEED
THIS DEED, made between Eloise Veenendall a/Wa Eloise L. Veenendall, a ~.:°"="
single person REC FEE: 13
00
.
TRANS 1'EE: 300.00
("Grantor," whether one or more), and Timothy G. Veenendall and Bonnie L. COPY FI:E:
CC FEE:
Veenendall, husband and wife, holding as survivorship marital property PAGES
("Grantee," whether one or more).
Grantor for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area
interests, in St. Croix County, State of Wisconsin ("Property") (if more Name and Retum Addrass
space is needed, please attach addendum): Thomas A. McCormack
See Exhibit A attached 1020 10th Avenue
This deed is given in fulfillment of a certain land contract between the above parties, dated June 6, Baldwin, W 154002
1990, and recorded June 8,1990, in the otl'ice of the Register of Deeds for St. Croix County,
Wisconsin, in Volume 873 of Records, at Page 43, as Document No. 459383.
002-1052-70,-90 '
002-1053-10, -20,_-3_0, -60____ _ __
Parcel Identification Number (PIN)
This is not homestead property.
ias) (is not)
Exceptions to warranties:
easements and restrictions of record, and except any liens or encumbrances created or suffered to be created by the acts and
defaults of the grantees, their heirs, successors, or assigns.
Dated __ 1_~ ~ ~t ".~~~~~, ~ , 1'~rj
~ ~ , ,
(SEAL) ~ ~.,J • ~ ~~~~~~~c~~t.E ~~ (SEAL)
* * Eloise L. Veenend '
Signature(s)
authenticated on
(SEAL) (SEAL)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
--- )ss.
ST. CROIX COUNTY )
Personally came before me on (j.~!
the above-named Eloise Veenendall alk/a Eloise L. Veenendall
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to known to be a person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) in ru ent and le d the same.. _ ' =- ...,., ~:
~~, t. "~
THIS INSTRUMENT DRAFTED BY: , ,~~ ,n,-, E ',•,••'~ •••,';) ~
Thomas A. McCormack - ~~~~~~~~ '-
Notary Public, State of WISCONSII `. ~ ~ . `; ~r ;_
Baldwin, WI 54002 __ My commission (is permanent) (expires:-'-T )
W'., ',•`
(Signatures may be authenticated or acknowledged. Both are not necessary.) 1..~ '~, n J ~~ f• t' t
NOTE: THIS IS A Sl'ANDARD FOR19. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARI,'tY ID~!V'i'll~'EDa • L Q
WARRANTY DEED STATE BAR OF WISCONSIN , ((J,, ~••.F i~O: 003
~. ~~ ~r
'Type name below signatures. ®State Bar or Wisconsin 2003 INFO-PROTM Legal Forms ~(eoo2d731' s com
AUTHENTICATION
U 2762P 153
EXHIBIT A
----- -- _
South Half of Northwest Quarter (Si of NW4) and the South Quarter of [North Half
of Northwest Quarter (S4 of N~ of NW4} all in Section Twenty-Two (22), 'Pownship
Twenty-nine North (T29N), Range Sixteen West (R16W).
East Half of Northwest Quarter of Southwest Quarter (EZ of ~a of SW4); 'lfie West Half
of Northeast Quarter of Southwest Quarter (W'~ of NE4 of SW4}, and Northeast Quarter of
Northeast Quarter of Southwest Quarter (NE4 of NE4 of SWq)~all in Section Twenty-two
(22), Township Twenty-Nine. North, (T29N), Range Sixteen West {R16W).
Subject to the terms and conditions of that certain Farmland Preservation Agreement
dated June 29, 1981, recorded July 17, 1981 _, in Volume b32 Page 483-484,
as Document No. 372182
~,A`~'l
=OREST Pl~ODUCTS ~~ ~,'
~~ ~ 266.7917 . P pN
iUALiTY ~, .
~~
~~ ..~
~c ~I
'~
L.
R.
B
r
S
0
4•
~`~ ~ ,
C °~~
.._
~',
~.C
P ~'~
\~; . s,
•~.
.,
ti
as
~~
_.
.. ~.,
~t.
;.,
-~ ~ ~ r