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HomeMy WebLinkAbout008-1035-90-150Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GE'iVERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Benck, Gary Eau Galle, Town of CST BM Elev: 6U/Oa Insp. BM Elev: ~~'a ~ BM Description: S :fir{ ~,;,~ tl~~+ee -- CST ~~ TANK INFORMATION TYPE ' ~ ^MANUFACTU ER ~~~.o~ J¢-!Cp E~~R.~' CAPACITY Septic ,~ >/ , i~ C~/ Dosing ~~s ~~ ~" ~~~ t„t~w- ~ , i ( Aeration Holding TANK SETBACK INFORMATION . en o it n a e epic } ~I ~pl v osmg e. ~, I/ ~~ / 'V' era ion o Ing PUMP/SIPHON INFORMATION 0, ., anu ac urer // fit,(;, l7 N°Ml-T eman GPM / o e um er l~ ~ ~2 q i p•o~ ric Ion oss ~ . 9w ys em ea ~•Sb ~~• t al eng ~~ i .~ (( ` ,VIL At3JUKl' I IVIV ,TJ I tiVl ELEVATION DATA County: St. CiOIX Sanitary Permit No: 488271 0 ate Plan ID No: arcel Tax No: 008-1035-90-150 Section/Town/Range/Map No: 12.28.16.182820 STATION BS HI FS ELEV. Benchmark 2 ~ ~~ 02.5 -~ ~ / Alt. BM dg. ewer .~ ~ ~ ZO. / ~_ O.o ! ~ t t net f3. / . 3~ t t ut et ~y net ~~ 0 om ~~'os SS~O~ ea er an. 9s s3' Is . Ipe •~~ / qs S3 o. ysem ,~a qs...~s, I~j r~ 12 I d- ~ flees - ato over~.Ot ~ ~.6 !S r S- ,s 9~ , Length 3'D / Dia 2 It 1 Pipe(s) / ~r ~ Length Dia I ,` Z Spacing ~~ ( ~(~ C` ~ ~ $ ~ ~' JVIL V V V Gr[ x rressure sys[ems vmy Y.X IVIOUna yr H[-~araua ~ya.Cma vn~y BedlTrench Center IBed/Trench Edges 1Topsoil I Yes ', No I Yes ' No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 449 270th Street Woodv~illjg, II 54028 W 1~(~y~SE 1/4 1~T28N 1.) Alt BM Description = ST' ~~'0 ~~~~JI""~ 2.) Bldg sewer length = ~ ~~ ~~ ~~L~ -amount of cover = ~ , tS~ 3) W~ ~~+15-4rc~.t:~e. .tom" ~~ec~7~- aQ..~, , Insp ction 1: of / ~ Inspection #2: ~T / ,, ni~ ~t 1 ~ ~ ~ ~ Parcel No: 12.28.16.182620 Use othesis de for add tional information. No ~ 1 'I ` ' /~ i~~',1-2 - - _ __ No. pates-~ ctor gn ur - SBD-6710 (R.3/97) ~-- 201 W. Wuhington Ave., P.O Box 7102 5 ~G>'Ck I~~O~~~~ Madison, WI 5370'7 - 7162 Sanitary Perms Number (to tx fillod In by Co ) De artment of Commerce (~8) 263151 ~$' Z ~ / Sanitary Permit Application D Number l Pl an e Sta'r ) -~i ~ Q ~ ~ 2 ~~pd~L' ~' ' s °~ In accord with Comm 83.21, Wis. Adm. Code, persoru! intormadon +t. ' may be used for secondary purposes Privacy Law, s15.04(l (m) RCI~G~V~® Proje t Address (if different than mailing address) I Pri All I f i Pl q ~' y~ ! Z7~ ~'~^ 5~. ! ease nt n ormat on I. Application Information - f Property Owner's Na me / Parcel X Lot N / Btock X C?Rr:.b ~EN~ ST, CROIX COUN TY 0 ~ _ C i Property Owner's M ailing Address r ry Location It.. i~~~ 2TC)t $ _ Nt'~ ~,c.SE ~2.Sauon / Z City. State Zip Code ne Number / ~_i./ ~ll~f7V u.. w ~~b ~i8 y p , circle one) C • ~Z~'f LT, cy N. R~ )~E or W II. Type of Building (check all that apply) s~b.,~,~' OK a5 {~++.• . ~ ~ ~ ! / _e or 2 Family Dwelling -Number of Bedrooms Subdivision Namc CSM Number sJ~~ 5~ ~'~ ? v' ~ ^ Publlc/Commerual -Describe Use 1. ~ ~G C7 ~ / ~ f ~~ J / ^ State Owned -Describe Use S Ov ~City_^villagc Township of~rtae III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ~^ ^ Replacement System ^ TreatmenVHoldin Tank Re lacemene On:y g p ~ Other Modificauon to Exisnn S stem B Y r, j B. .~ Permtt Renewal (l Permit Revision ^ Change of ^ Permil Tra2sier :o `;e~~ gist Previous Permit Number and Date Issued j ~ Before Expiranon I I Plumber Owner - -- - / ~_ .-_~ ~~--~ IV. Type of POWTS System: (Check all ,that apply) __ _ Otn)loJ 1 /V ' `~ I '; ,~ Non -Pressurized In-Ground ^ Mound >. 111 in. of suitable soil Mound < 2a ,n of swtan!c so: ^ At-Grade .~ Single Pass Sand Filter Constructed wetland J Pressurized In-Ground U Holding Tank ^ Peat Filter Ae ;bit "-eatment t/nn _. Rectrculaung Sand Filter ~/ ' /S C/~~~ u Reurculaung Synthetic Media Filter ^ Leaching Chamber ^ Drip Linc ^ Gravei iess P,,~ ~ Other (explain) 5q~„ ~r.~- V nicnercal/Treatment Area Information: Design Flow (gpd) ate(gpdsf) Design Soil Application R auon ~ Dispersal Area Required Dispersal Area Propose s 1 ! System Elcv / pp ~~$d ~ 2 VI. Tank Info Capacity In Total Number anufacturr; Prefab i Site i Steel i Fiber PIaSUc I Gallolu ~ Galloru of Units oncrete Constructed i Glass , New Tanks Ezisung Tanks ( ~ ~ `~ / i `/ ~~ / i --- _._- Septic or Holding Tank __^__- / ~~ a / I __ X t Aerobic Treatment Unit Dosing Chamber ~ ~- i V[1. Responsibility Statement- 1, the undersigned, assume responsibility (or installation of the ;'O~~`(~S shown on the attached plaru. Plumber's ,N`a me (Print) Plum 's gnatu MP/MPRS Numtx: ; Business Phone Number ~ f .~ ~~. .~ 22.~~~~ I ~~r X43-zsz~ ~ Plum is Addre ss (Street, Ciry, State. Zip C e) ~ (SS4 S fa~C- ~.1Z~p~~ Y~EVIC,~-G- u, / 5~9~2 S -- '- VIII. ounty/De artment Use Onl __ _ _-. Sanitary Permit Fee (includes Grrund~~ale: ,t;e Issued Issum grit Signa a (. Stamps) tsapprove APProved i ^ er n Reason for al I Surcharge Fee) .pO. ,7 / O~ ~ 551 IX. Conditions of ApprovaUReasons for Disapproval r / ~ // 3N=TEM OWNER: (/ ~ i. Septic tank, effluent filter and dispersal ceH must all be servibes / mair>tained as per management plan provided by plumber. ~ 2. All ssRtack nt~remertts must be mainlairtsd I I ~ t~ aPP node / oMNler>ces. ~_ - ~ Attach complHe plasut (b the Count? onl7) for the s7stem oo paper not Icss than 81 2 z I l inchn in size SBD-6398 (R. 01/03) 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.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 03, 2006 CUST ID No. 224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 STATE ROAD 64 BOYCEVILLE WI 54725 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/03/2008 Identification Numbers Transaction ID No. 1286012 SITE: Site ID No. 714825 Gary Benck Please refer to both identification numbers, 270TH Street above, in all cones ondence with the a enc . Town of Eau Galle, 54737 St Croix County NW1/4, SE1/4, S12, T28N, R16W FOR: Description: Mound, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1083182 Maintenance required; 450 GPD Flow rate; 18 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 use: 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- 10706-P (N.O1/O1). 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. ~, r' All holding(treatment tanks are to comply with Comm. 84.25(7)(a). '9''~ ~jl ~ ~ ~~ Maintenance information must be given to the owner of the tank explaining that pe ' dic cle~ii~f the filter is required. Access to the filter for cleaning must be provided per Comm 84 product app al con itions. c~~. 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. LYLE J MYERS Page 2 7/3/2006 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, i ;~=" Julia Lewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 548-8638, Fax: (262) 548-8614 j ulia.lewis @wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART coder 7633 i ~ t Mound System Cover Page ~ 1 ~ 6 WIE~EB COACRETE Project Name: Benck-Mound Owner's Name Gary Benck Owners Address 441 270th Street Woodville, WI 54028 Legal Description Nw • '/., sE • '/. Sec 12 T 28 N, R 16 w • Township Eau Galle County Saint Croix • Subdivision N/A Lot# N/A ParcellD# Pending RECEIVED Table of Contents JUN 2 2 2006 Pg• c~,~r_,t-mss " ~! III f11 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: Lyle J. Myers MP/License #: I.D.# 224617 Date: 5/14/06 Ph. #: 715 2520 Signature: Mound System Desig"~'~Vlethods Used ~-~~ ~ .. ~- per "Mound Component Manual F0~ Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) ~;,,' , '~ per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) S60.10706-P (N 01/01) ~ ~ ; s ~,. - \ ~., Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 7151'x43-6068 email: 3ba~3baYalV nt CPm ~•~ `ul t `c, C/uL~ Mound System Pe9a z °r s Mound Sizing Calculations Project Name: Benck-Mound Site Conditions Project Type: 1 or 2 Family Dwelling ~ Slope: 5 # of Bedrooms: 3 Depth to limiting factor: 18 in. Absorbtion rate of fill material: 1 gaUftz/day Absorbtion rate of in-situ soil: 0.6 gal/ftz/day EfFluent quality Eff#1 ~ Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): 18.0 in. 21.6 in. 9.5 in. 6 in. 12 in. 10.4 ft. 95.8 ft. 7.3 ft. 11.0 ft. 24.3 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 750 ftz Distribution cell width (A): 6.00 ft Basal area available: 1275 ftz Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 {~ Observation Pipes Contour Elevation of Mound: 93.40 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 94.90 ft Final Grade of Mound: 96.69 ft Mound Plan View J Observation Pipes ~ ~Z~I~ y,, K~ Distribution Cell f3 ILK I Tilled Area1lFll Material L _ ' Mound Cross Section Final Grade bservation Pipe Synthetic Fabric H G Distribution Cell System Elevation an:: ~ ~a.~ F d y Cover Material ~~ u 3 Fill Material Invert Tilled Area Slope ~''~Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page3of s Pressure Distribution Calculations Project Name: Benck-Mound Lateral Layout Lateral elevation: 95.4 ft Rows of Laterals: 2 ~ Manifold type: center ~ Orifice diameter: 0.125 ~ In. # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 37 ft Orifice Spacing/Distribution Orifice spacing (X): 22,77 Inches Orifices per lateral: Avg. ft2/Orifice: 5.63 ftz Lateral/Manifold Design Lateral diameter: i~iz ~ In. Lateral spacing (S): ~ ft Lateral to cell edge: 1.5 ft Lateral discharge rate: 8.24 gpm System discharge rate: 32.95 gpm Manifold diameter: 2 ~ In. Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 12 ft Forcemain diameter: 2 ~ In. Friction loss in forcemain: 2,768 ft Lateral Side View Lateral Plan View Lateral Length ~ ~ Turn-up wlbaN valve or deanout f]rifices on bottom of lateral equally spaced III PVC laterals and forcemain to comply with specifications per Comm 84. ~[2xe) Forc~mmain correction via tee or cross to manifold at any point Clean Out Detail Clean-out plug Grade .-or ball vahre Observation Pipes dJater tight cap or plug Sprinkler Box Long Sweep 90 ortwro 45's--.~ 6" Minimu~ L Plots: []oast Co1ar may be used in place at 3!g' bar X318' Bar x '~ x '~ x '~ x '~ x '~ x' x '~ x '~ x '~ x ~~ x •~ x .I 2 2 Mound System Page a ~ s Septic, Pump and Dose Tank Project: Benck-Mound Tank Information Pump tank manufacturer: Wieser Concrete Pump tank size/model: wiooo/6so-MR • Pump tank gal/inch: 17 Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): 84 ft Septic tank size/model: wiooo/65o-MR • Dosage Volume Forcemain drains back to tank? Q Yes O No Lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gal Forcemain volume: 20.9 gal Total dosage: 99.1 gal Pump and Filter Pump Manufacturer: Little Gian Pump Model: 9EH Effluent Filter: Zabel A100 Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to tem-inate at or above grade. Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: p ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 10.73 ft Friction loss in forcemain: 2,77 ft Pressure loss from filter: Oft Total dynamic head (TDH): 20.00 ft Pump Tank Diagram Dose Tank Levels Watertight Locking Cover In. Gal 4 Inch With Worming Label finished A Reserve 22.2 376.9 Minimum Grade B Pump off to Alarm 2.0 34.0 Akemate C Total Dosage 5.8 99.1 o~net Loc tion D Effluent depth for pump 8.0 136.0 a Elect per Comm 16.28 and i 38 0 646 0 Total Capac ty: . . NEC 300 v ~ Weep Hale '4 Q ~ ° 3'0 ~ ' ~ ~ u~' Sio h n B ~ J C D FLOV- LITERS/HWR 0 ]000 2000 3000 ~• 30 ~ 10 1 ) W 7.$ W W ~"' W I 1 , A g Q ~ Pump must be capable of: 33.0 GPM =10 25 and head pressure of: 20.1 Feet 0 20 4o bo eo Little Giant FLOV- G LONS/MINUTE 9EH PUMP PER ~RhIANCE CURVE 0 32.~~~-- Mound System Management Plan pursuarrt to comm 83.54 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 and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "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 1/3 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. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral 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 problemsffailure. 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 and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: 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 surface, 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. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of~ Division of Saf'ty and i3uildings d ' in accord rr~5 .Adm. minty Attach complete site plan on paper not less than 8 1/2 x 11 ' ~I"~" ~~ ~ ~ / inGude, but not limited to: vertical and horizontal reference Int ( ~n and Parcel I.D. percent slope, scale or dimensions, north arrow, and locati and distance to nearest road. Please print all informatio ApR 1 g 2005 Review y Date Personal Information you provide maybe used for secondary purpos (Privacy Law, s. t5 ~ ~ - P O r t9 roperty wne ZO ~~v~- „~ el~~ ~ l It // Govt. Lot ,N i,V 1/4s 1/4 S ~ T ~ $ N R / t0 E ( W Property Owner's Mailing Address ` " ' Lot # Block # Subd. Name or CSM# ~ Sit i e-eT ~/ j ~ 7C~ ~ City State Zip Code Phone Number ' ^ City ^ Village own ~ Nearest Road ? 7C~ f ~ S~'Pee pis ( ~S) 33 ~,~, ~ o ~lew Construction Use: [9'~sidential / Number of bedrooms ~- Code derived design flow rate 4r SC..) GPD ^ Replacement ^ Public or commercial -Describe: , /~ ~ Parent material ~~~„c l~vr r ~ ~/~ Flood Plain elevation if applicable N General comments ~ J W /-~ (~ ~ ' SQ~.~ r~~ c~.e~ ' g Y sec . `C S C ~ ~ 5 ~ ndations: ( , . and recomme ~~ ~f°t~ Cdl~-e-- o~ Co~'~u_v- gg3• y s ~~ ~, ~~ev ~y, y ^ Boring \/ Boring # ~--~~ ~ _ ~ ft. Depth to limiting factor ~_ in. nd surface elev C G tion RatE il i S . . rou !~ Pit ca o t R P D Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary s oo `Eff#1 'Ett#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r~ 3 ~ ~ 1 J ~ ~ ~ . -sue to y- ~tF~ ~- c~ ~ ,~ ~~ ~ ~ ^ Boring ~ Boring # r~/it / lJJ PP Ground surface elev. l ° 7 ,t. Depth to limiting factor ~~ in. S~ ~~ ~~ ts R GP D/fP ` Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary oo 'Eff#1 'Etf#2 1 ~ b- , t-~ o ~ a ~ o ~~ _ -~ 3~ s f 1 ~ L ~, vn~ ~ << 1 V ~ . ~ , ~ ,. ' Effluent #1 =BODE > 30 _< 220 mglL and TSS >30 < 150 mg/L t ~; CST e (Please Print) ~ Signature ©rn rni~e ~`'`icSo~ - - A?d'dr)ess q '-7 (~ I W lo~~ / / ~~~ f'l ~J ~- 5,/Jr-r VDT l P 'Effluent #2 = BOD < 30 mglt. and TSS _< 30 mglL CST Number ,~~0~9~ e Evaluation Conducted Telephone Number ~_ o ~ 77a .3~ 78' ne\~ nw.\nTMMI\\ Property Owner .( )tom t.~ 2 ~2 vv L- K;, Parcel ID # Page a of ~ Boring # U~ Boring Ud' Pit Ground surface elev. , Q ft. Depth to limiting factor ~ in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E~ - ~ ~o y~ ~ - s .1'yt ~ ~ k t 1 tt ~ 8 '~ ~ ~ / L L ` ` 1.~ ~ ~ 1 9 ~' / t 7~+ ,yy a ~~~ `=~ u s s I v~ , I~ Boring # ^ Boring !_~ U Pit Ground surface elev. tt. uep[n co umiung ractor ~~'• Soil A lication Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 L U Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Sop ication Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i i i I `Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BODE < 30 mglL 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. ti R U-83)0 (R.07/00) Property Owner ~U.. L% P ~~ ~ ~ ~-- 1L Parcel ID # ~--~ ^ Boring , ,, Page o7 of _~ - Pit Ground surface elev. ft. Depth to limiting factor (n• Soil icatlon Rate r t T Structure Consistence Boundary Roots GP D/ff Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ex u e Gr. Sz. Sh. 'Eff#1 'Etf#2 1 b-f~ Oy(~ ~ ~ ' sbk 4- c~ ~ ~~ t ~ 8 ~. ~~y _ `~" cL .~ ,t lei' ~ ~ ~ ~yy o`I~ ~~ - v. 5 s~ rv.~ -~ _ n Boring oui n iy .. ^ Pit Ground surface elev. ft. Depth to limiting factor (n• Soil A lication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 -~ n Boring °C""~'~ Ground surface elev. ft. Depth to um(ung raaor rr~. ^ Pit SOU ication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 D/ff 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BODE _< 30 mg/L aril TSS _< 30 mglL '1'I,e Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services oc need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must inGude, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Personal Information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). Proipe~rty Owner Property Locatio~ n1) ^ .J G~• v 'L- ~ e ~ C ~ Govt. Lot /(,I /rV 1 /4 S 1 /4 S ~ d. T Property Owner's Mailing Address ~ Lot # Block # Subd. Name or CSM# y ~ 7v rth S~'r~~ .~ Page ~ of 6/x Date I ~ N R ~r0 E (~ C;(y r State Zip Code Phone Number ^ City ^ Village ` own oZ 7~'~ ~ S~'lee~ Q'~Jew Construction Use: Q'~sidential ! Number of bedrooms ~_ Code derived design flow rate S~S U - GPD ^ Replacement ^ Public or commercial -Describe: t~~ R Flood Plain elevation if applipble ' ` ~~ ; 1 ~ Parent material ~ Dc ~ S n yr r 'General comments a . S~ c, ~-~ ~' ~ L~ LJ tTh (~ S ~ Spt~~ c~.vi c~-e~ X ! and recommendations: (,l 5 ~ ~ u'11'P~y C~.St~~.z_ Cr. Ca•L'~uv- 93. y ~1 ~ ~ ~ c=~> S ~~ ~. E/e~ ~~~ y ^ Boring Boring # ,~ , (,,~ ft. De th to limitin factor ~ ~ in. L~ Pit Ground surface elev. ~ P g Soil igtion Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ~~ •Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ t" g r ~ w 'oy~ ~' - 5. ~ ~ ~ l ~ . .. O -j.:1 p Boring # ^ Boring ~/ ~. 7 c. Pit Ground surface elev. ~ ~ Depth to limiting factor ~~ in. ~ igtion ~~ ~ da B Roots GP ' D/fE~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence ry oun 'Eff#1 'EtiYl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I _r J b- o ~ ~ k ~' c ~ F~ ~~ 6. . ~ _ I ~ o ~ ~-. ~ i 1, ' s ~ ~ ,. ~~' 3 ll-~ ~ st ~ ~ r ~ ~- -~ 3~ ~ L vn.-~ I V F , ~ ~ o _ I `Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BOD < 30 mgll arxt TSS < 30 mg/L CST (Please Print) Signature ~ CST ~~ e Evaluation Conducted Teleptttxte Number Address u~ lay 9 U~ 1 /t~ ~ ^ ~~~~ ~ ~~ ~ s Y- ~_ o 5-~ 3~ ~ ~l ~7~ d r t~~ ,~r MIS A 1n TMMIN 1 1~ ~~v,~~ Ph~h~ t~~4. 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M l3. y s T~~ ~.f ~!" ~~a ~eKCe ~es~~ ST CROIX COUN'T'Y SEPTIC TANK MAIlVTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer G A -Zt? i~rc~1GFC Mailing Address ~ 27o f'- ~~ s~Fo z ~ Property Address ~ ~ ~9 °~ ~ d ~ `~ ~ (Verification tequired from Planning Department for new construction) City/State LEGAL DESCRIPTION Parcel Identification Number ~$- ioa5- 9d -/S:5 Property Location 4L__ `/., ~ `/., Sec. ~ TZ-~ N-R~W, Town of ~,I y ~r~ `~~ Subdivision ~ ,Lot # Certified Survey Map # ~~ 3 ~~~ ,Volume Z~ ,Page # ~~~ .3 Warranty Deed # '~ Zo 3 ~ / , Voltune ,Page # Spec house ^ yes ~no Lot lines identifiable ~ yes ^ 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 is 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 wastewaterdisposalsyctem 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 fog herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stn ' g that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 'e thre yea xpiration te. x ~~ ~~~ y 4 SIGNATURE APPLICANT 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 th pro e c ' ove, by vi of a warranty deed recorded in Register of Deeds Office. SIGNATURE O APPLICANT 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 State Bar of Wisconsin Folm 2-2003 WARRANTY DEED Document Number I I Document Name THIS DEED, made between David A. Benck ("Grantor," whether one or more), and Gary D. Renck, A Single Person ("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 interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Part of the Northwest Quarter of the Southeast QuErter fle`W 114 of SE l/4) of SeLKion Twelve (12), Township Twenty-eight (28) North, Range Sixteen (16) West, Town of Eau Galle, St. Croix Couety, Wisconsin, more particularly described as follows: Lot One (1) of Certified Survey Map filed November 28, 2005, in Volume 20 of Certified Survey Maps, page 5113, as Document No. 813069, Office of the Register of Deeds for St. Croix County, Wisconsin. 820341 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , iiI RECEIVED FOR RECORD 03/09/2005 08:00AM MARRAHTY DEED EXEIPT ~ REC FEE: 11.00 TRANS FEE: 17.40 COPY FEE: CC FEE: PAGES: 1 Area Name and ltetum Address Thomas A. McCormack 102010th Avenue Baldwin, WI 54002 008-1035-90-100 Parcel Identification Number (PIN) This is not homestead property. (as) (is not) Exceptions to warranties: easements and restrictions of record. Dated 3 - ~ ~ QG/' v Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06 ) THIS INSTRUMENT DRAFTED BY: Thomas A. McCormack - Baldwin, WI 54002 to me known to be the person(s) who executed instrument and acknowledged the same. , ~~~~ Notary Public, State of WIS ONSIN My commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both arc not accessary.) NOTE: THIS IS A STANDARll FORM. ANY MODIFICATION TO 'T'HIS FORM SHOtiLD BE CLEARLY ID1 WARRANTY DEED STATE BAR OF WISCONSIN "Type name below SlgilatUfeS. p State Bar of WiBCOnSIn 2003 INFO-PRO'S LopW Fmns - AUTHENTICATION o (SEAL) !(SEAL) * David A. Benck (SEAL) (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) Personally came before me on _ the above-named David A. Benek .. , ~- p -c,: /C A ,~ Loft '3 3 8 1 3 6 9 VOL 20 PAGE 5113 KATALEE)T H. REGISTER OF DEEDS ST. CROIX C.O.L tAI RECEIVED FUR 1[ECORD 11/28/2005 12:15PN ~.ur t r rr.: ~. lop PAGES: 2 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 12, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN Prepared for and at the request of: Drafted by: Owner: Bradley Canaday Dave Benck GRAPHIC SCALE 441 270th Street Woodville, WI 54028 0 loo' toot SCALE IN FEET: 1 INCH = 100 FEET ~N@9°47'17"W 3610.28' ~'-^- - - W I/4 CORNER SECTION 12, T2@N,RISW / Q. ' ~, tc/ ' Ste' O ,' o '~ / ~~/ Z ~ i ^ - ~, •V ~/; ~ •~ O' ~ ~~/ ti ~ ~ ~. ~' . / Q~ 33. J~ L~°rY4~ ~~ ~?' AREA '' O~ i' ' ~~ i FIED SURVEY ?IAP 3~ W f/1 ~v N z 0 0 N Z i J r a _ w S85°44'55" 2.30 ACRES EXCLUD{NG R/W 92249 SOFT. 2.12 ACRES 7.01' E 461.51' UNPLATTED_ LANDS_OF OWNER W' Z. ~' O; O. N~ ~~ a' J, ~; W. ~~ 1-' Q , ~~ Z~ ~~ I~ NOTE: The parcel shown on this map is subject to State, County, and Township laws, rules, and regulations (i.e.. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, oaltad the St. Croix County Zoning Office and the appropriate Town Board for advice. Bearings are referenced to the East -West Quarter section line of Section 12, Township 28 North, Range 16 West, which is assumed to bear North 89 degrees 47 minutes 17 seconds West. Prepared by: BRADLEY CANADAY SURVEYING 6976 26th Street Court North Oakdale, MN 55128 Phone No. 651 - 779 -6435 Sheet 1 of 2 sheets LEGEND County Section Corner Monument of record 0 1 "x 24" iron pipe weighing a minimum of l .13 pounds per lineal foot, set O 1.5" x 24" iron pipe weighing a minimum of 1.502 pounds per lineal foot, set 0 3/4" x 24" steel bar weighing a minimum of 1.13 pounds per lineal foot, set 33,/33' ` E-W OUARTER SECTION LINE _ _ N@9°47'17"W 1695.fi6~ --Q-- 'a UNPLATTED ~-LANDS OF OWNERI ~- / Nero l - -- ------g ---------------_ EI/4 CORNER SECTION 12, d` ti~ ~"'/ .~ N89°4T17"W y 361.34' I T2eN,Rlsw i 325.99 i ~ ~4:' LOT ~ N u Q~ TOTAL AREA 100294 SQ.FT. ~, ~~ '~~ ~ o !~~ ~ ti 3 ~,3~ ,~ a _ ~ rytL 3Q O~ ° i /~ ~ ~N c~ a ~~~~ Vol 20 Page 5113 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 12, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN SURVEYOR'S CERTIFICATE: I, Bradley J. Canaday, a Registered Wisconsin Land Surveyor, do hereby certify that by the direction of David Benck, I have surveyed, divided, and mapped a parcel of land located in part of the Northwest Quarter of the Southeast Quarter of Section 12, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, described as follows: Commencing at the East Quarter corner of said Section 12; thence westerly along the East -West quarter section line North 89 degrees 47 minutes 17 seconds West 1695.66 feet; thence South 21 degrees 12 minutes 21 seconds West 70.69 feet to the point of beginning, said point lying on the centerline of 270th Street; thence continuing southerly along said centerline South 21 degrees 12 minutes 21 seconds West 242.48 feet; thence South 85 degrees 44 minutes 55 seconds East 461.51 feet to the east line of said Northwest Quarter of the Southeast Quarter; thence North 2 degrees 28 minutes 34 seconds West 259.18 feet to a point 66.00 feet southerly of said East -West quarter section line; thence westerly along a line parallel with and 66.00 feet southerly of said East -West quarter section line, North 89 degrees 47 minutes 17 seconds West 361.34 feet to the point of beginning. Containing 100294 square feet (2.30 acres}. Subject to 270th Street right of way over the westerly portion thereof. Also subject to all easements, restrictions, and covenants of record. I also certify that this map is a correct representation to scale of the exterior boundaries surveyed and described and that I have complied with the provisions of Chapter 236.34 of the Wisconsin State Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Eau Galle in surveying and mapping the same. ~~~~ ---: _ ~/somas Bradley J. y, Regist onsin Land Surveyor No. 1462 Date~~ Bradley Canaday Surveying 6976 26th Street Court North Oakdale, Minnesota 55128 APPROVED s r. cteoa aallArrr ~.lllwllo s, zenlnq c«~w~ NOV 2 8 2005 If not reoordad rviNin ~ days of approval dale approval shed) be nuN and void Sheet 2 of 2 sheets Vol 20 Page 5113 Parcel #: 008-1035-90-150 o7no/loos 10:00 AM PAGE 1 OF 1 • •Alt. Parcel #: 12.28.16.1826-20 008 -TOWN OF EAU GALLE Current 'X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11 /28/2005 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -BENCK, GARY D GARY D BENCK 441 270TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 449 270TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.300 Plat:. 5113-CSM 20-5113 008-05 SEC 12 T28N R16W PT NW SE CSM 20-5113 Block/Condo Bldg: LOT 01 LOT 1 (2.3 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 12-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/09/2006 820341 WD 19/28/2005 813069 20/5113 CSM 07/23/1997 1226/126 WD manna c~ ~nenner~v Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class Acres AGRICULTURAL G4 2.300 Totals for 2006: General Property 2.300 Woodland 0.000 Last Changed: 07/06/2006 Land . Improve Total State Reason 300 0 300 NO 05 300 0 300 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00