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HomeMy WebLinkAbout008-1075-20-100 VVisconsir of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514935 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: L num, Jacob I Eau Galle, Town of 008- 1075 -20 -100 CST BM Elev: Insp. BM G,le BM Description: Section/Town /Range /Map No: I / ✓ \/ v \ ( 26.28.16.391 B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER kri CAPACITY STATION BS I FS ELEV. ia. z Septic �rWf Gr ' ( Benchmark Y.2 f � yy6 7'°� ) d Dosing Alt. B f wetf�r y ' 6tD l 7. 7 Aeration Bldg. Sewer f y. a f S/i 3 7 Holding St/Ht Inlet ( 7 1s,67 12.7'I St/Ht Outlet TANK SETBACK INFORMATION TANK TO t I P/ /L L 4 WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic W A15 �� Dt Bottom ' 3 1 _F1 ITT Dosing 7i0 _� Header / Jl 4k C Z 3. Aeration Dist. Pipe P Holding Bot. System • O ,� PUMP /SIPHON INFORMATION Final Grade /46' Manufacturer Demand St Cover �evAr V PM 16. 7Z 1 7 7y Model Number E Po Z3. �.(J ) _ � , ( TDH Lift Friction Los System Head TD T [ Ids yl - 3, 0 7 8 5% b I RS x.64. wr I f.96 7 AIC Forcemain Length Q Dia.. if Dist. to Well / SOIL ABSORPTION SYSTEM BED /TRENCH Width Length N c s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS "� `- to 1 SETBACK SYSTEM TO ! P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: — � INFORMATION CHAMBER OR Type System: A / q ' UNIT Model Number: &,j �� 84 DISTR IBUTION SYSTEM Header /Manifold � 1 utio i Dstribn I �� � rle Size ( x Hole Spacing Ve Air Inta / D Lengt Dia �. Length 3 ' Dia '' Zs Spacin 4(,p v SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed /Trench Center' w � Bed/Trench Edges Topsoil ' (�� Yes 0 No Yes No Y! YA �� COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0 * / /S Inspection #2: / / Location: 151 250th Str t Wo dville, WI 54028 (SW 1/4 SW 1/4 26 T28N R16W) NA Lot 1 / 4,'5,e Parcel No: 26.28.16.391B ,W Goy ��� 1.) Alt BM Description = ` G�C4. : *.. 2.) Bldg sewer length = t� to ) - amount of cover It 7 j 2 E„ ts'^ -. ✓ ❑Yes No Z� Plan revision Required? Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's ignatu Cert. No. lv i Sa fety and Buildings Division County m 201 W. Washington Av 0. Box 7162 C ;x onsin Madison, WI 5 - 71 Sanitary Pen it Number (to be filled in by Co.) (608) 266 1 511`735 L Dep artment of Commerce _ I.D. Number Sanitary Permit Application State P I. 06' 3 In accord with Comm 83.21, Wis. Adm. Code, personal information y>provide may be used for secondary purposes Privacy Law, s15.04(1)(t Project Address (if di� t th��ng address I. Application Information — Please int All Information %.P E I VED 1` Prope w e ' ame JUL 1 8 2008 Parcel # L Block # e n u wI C., ,61J � / � Property Owner's Mailing Address ST. CROIX COUNTY Property Location 1,5 _7 ®V S typ,, f- i f ZONING OFFICE (S f 2 C City, State Zip Code Phone Number % t " Section (( ircle 00 U VV�� T R I or II. Type of Building (check all that apply) d, �� .AAA 11 /// /// D z 1`or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use r,� �{ El State Owned - Describe Use ❑City_ ❑Village * gTowns of J ✓ i ✓ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New S stem ❑ R System y p y ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System �1 B. El Permit Renewal El Permit Revision El Change of Perin it Transfer to New List Previous Permit Number and Date Issued J Before Expiration Plumber Owner ti IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil IF 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 Pipe ❑ Other (explain) V. Dispersal/Treat ! t Area Information: / Design Flow (gpd) esign Soil ApplicatioJRasf) Dispersal Area Required (sf) Dispersal -Area Prp ed (s System Elevation VI. Tank Info Capacity in Number Manufacturer refa Site Steel Fiber Plastic Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks 111, 1 Septic or Holdin Tank FOO/ti Aerobic Treatment Unit ! V Dosing Chamber / VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plum is Address (Street, City, State, Zip Code) VIII. County e artment Us Onl Approved E Disapprov Sanitary Permit Fee Qincludes Groundwater Date sued Issuing t Signatu ( S nps) ❑ Surcharge Fee) / /1�� - �a ; ; D en Reaso r Denial �(�(� IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 3) t ortfj " 54;, 4p rc j Ls. 1. Septic tank, effluent filter and dispersal cell must all be servk:es'/ maintained a "� �' °✓! 1 � ) �' t as per management plan provided by plumber. 2. All setback requirements must be maintained as per applcable code / dfd. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 1 , f P in FPPt Po a A !;�- ai /I\ C- U U /I\ �� -- ' u r _ ' T I Y i -C o A o \ © I W W o 0 (� eve`' I / e ' \ 61 \ , y A � cm I \ I U) o o Con \ I _Ln_ c 1 _ I 110,0 ic1,n i., I n X , ��"'sf lUUU/ l3JULI'IIVU I W „� Downstiope t �I$__ F i teen f ----— k I lu f Approximate Eot One 5 Z6 TZ8 tit R(ew IS-AV WLLe- Gc oix Co . Z • o Ac . *PaKc2t � 5�ce.. -r' rccaPY ScaIP in Fpm 0 �u An i ► i �Uu II\ c� aj�: �- So�,LAo cl c ���• 1 5 o O e:v�o.. v4 Q I C � � I oy � i ' co \ I --{_;' f ----- --� C o n \ I +1 I teen : F c)O Downslop F w Approximate Eot One 5 Z6� TZG Nt� RIew s. - 0 Ac !PA ce-� / 50a, res-r } Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 TDD #: (608) 264 -8777 sco n s i n www.commerce.wi.gov /sb/ www.wisconsin.gov , t i c epartm of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary July 10, 2008 CUST ID No. 220499 ATTN: POWTSInspector BRUCE A WEBSTER ZONING OFFICE WEBSTER PLUMBING & ELECTRIC ST CROIX COUNTY SPIA N3659 CTY RD C 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/10/2010 Identification Numbers Transaction ID No. 1556063 SITE: Site ID No. 739561 Jake Lynum Please refer to both identification numbers, 157 200TH St above, in all cozies ondence with the agency, Town of Eau Galle St Croix County SE1 /4, NEIA, S26, T28N, R16W FOR: Description: Three Bedroom Mound System / New construction / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1189986 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.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation andprior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cianing of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans specifications and this letter shall be orrsite during construction and open to inspection by authorized representatives of the Department which may include local inspectors P.o w• c ,,,Wwona ��►� ) RONE0 f comM_ "' ' BRUCE A WEBSTER Page 2 7/10/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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 acceptabb 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 nn 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, Required $ 175.00 �!�� L� „'v � Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code :7633 jen cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Mni K)r� PI n nc� -Pnk- In !erg I \7�ni am 157 200th Street Woodville Wisc 54028 CIO ® (5 l ror n +pry iv) C\,/ n-F Nl \,/ Sr->r P( C Co Town Ot Lau Gabe St, Croix Lloun W PaQe 1 Title Page PaQe 2 Plot Plan, Page 3 rl Pion PaQe 4 Cross Section & Plan View n no 1)i + P1no Tlo f n it Page b T aYlk retail�� PaQe 7 Pump Curve Page 8 Mainto. Plan Page 5 i'viaintenenee Pian PaQe 10 Combo Tank Page 11 Additional Boring rata e y ^ �a u l Fal l e r :' erIn +'I �e Dist Muriuui v ersion2,0" n BBD- 10760- P(N,01 /01) Mound COMP - M anual Version 2.0" SBD- 10691- P(N,01 /01) V)l I IAr it - I - P l non T, CA inl -J- i 1 n . � (l., i e r L r I I H V e r i u �1 01VI5lON�f SAFELY Ah" r SEE CG SporinENGE T { n H121ON a �pl v1 I { I zt� r •z, 4 I g 11 1 I I�. uo 111S aP+ ono iy i � t l 1 }uawa�pU0 S it�tt �+� ,°. M ti oj A, ani.A C7u1151Xa ` { Z t 1 cq s 1 C -� --�.'IX 1 th c� I I f f i I I I � { 1 f i I I � I I r I f 1 I W � I I 1 -4- ! P n n p 4 o f 11 �r U5S S u10r i H I NV cif i ioUK - 1�i T �� �- I , f Lateral discharge @ 9 —H IV W L .� / � I Anrann_ tc> i F ✓ 1 1 A � T - rnn Matana " ✓ - �-- o W Go CSI o �! e "r Fd� Turnups at end M of laterais with D 7. J l o p e threaaed r i Vi a � pIUC� rear view ot- Mound i t 1 —T J I - -- — -- — —� — -- - - -- — I 1 -- k e Main n v I v e C ru j4 i � {• X q, Ili Ow A= o I1= -7 1� E= L8 �= is 1 M I = 99 n. J %.a I-I- 1,n — 1•. -l.5 Upslope l_orr f actor - U 1 1 —r1 W — i uownslope corn f actor 1,18 Min supply_ Pressure 3,5 X 1.3 = 4,55 plus 0.5 symtex = 5,05 Backflo11 tan Y n,163 = ??,8 Max dose 450 i 5 + 22,B = U2,0 Jake Lynum P��o O 11 Q i!M I O p Cy O v- IV ��� L ast Hole Near Tur''t''p P= ` A n E: -D -D L U J 9.QM ' Per 46 inches I'll 5r32� - 1LJt� e J_�- J I L1f'l�'�t.ej'' nn �1 rmiv, rJncr� `-1 III ' "' `l -' Lateral Diameter 1 1/4" �n + v�ori `- ` Manifold Liameter 1 1%4 inch -A V FYI WaC, r Farce Main 2 inch Holes per Lateral 10 Invert Ele Laterals 99,76' 2" void 0,163/ft )K2 )K60 =19,56 GPM Rea 1 1/4 Void 0,064x36.5x4 )K5 =46.72 gal min dose v Jake Lynum Pn n 11 (' n m in n 1 n n n c o r) +; C Approved Locking l� t_J I I NJ t_.! 1 V V V v l_ Manhole Cover with ( warnino label rea rein 4' above ground V�JV �j PUmP c 1 Cover within 6' +• ��f�� —} of grade °' ° I I I ► I �� � �1� -- -ri warning label roG 4U `" � 11 � I I 1 L -1 I► ► I X 111► 111 �--' r--- 1 it 1 11 L E 111 11 11 Cl- ICI 11 1 (11 �IA 1 �-i i i I I 11 L _I B 1 I 1000 gal Septic 11 O ►► I (( C 1 I I 1 U II Q ITT Uirl .J of f t ► ► `'-' Il r-, i l I 87 1 1 e,ock X-,\ I I ID I 1 Manu- Facturer Weiser n ®s iP y 5 u S1Ze i000i 650 Cui�iOO Gallons/Dose 100,5 pal Alarm Manufacturer Level Arm Rn -Li4- (11A/ \/,l ume 22 P 2 1J LA` I\ i \LJ VV v V l Model # DLV Totat Dose 77, chat Switch Type Steel Ball ®limy i an , ,A , ti,ir er^ uutiiG1 Model # EP05 A= 21,5" = 2G3.5 Qal Min Dischar c 2 � u M D= G " = 3�"r fat Verticie Lift i2,7e C= 6,5' _ X8 ®all�o,5 D = o " - 136 g Min c11nnI prA arm 5 05 Tot 38" 646 pal Friction 2,46x1,4 = 3,45 Total Dynamic Head 21.26 �6 Farce Main Dia 2.0 Manufacture Tank Specks included in Plans Jake Lynum �GOULDS PUM Submersi Effluent Pump M 38 EP ( " X - EP05 - Seri APPLICATIONS • Full submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper mid lower C__..:[ -_ r ., fo - tw � grade turbine oil for tic enclosed design for heavy d uty bail 'bearing 'FIM"Ma —,v. ° „” lubrication and enicierii lm OltW nruit`idiiEO. following zs?s: _ _ 1N� heat 6 Casing and Base: Rugged • Effluent systems r c - t "Cr"piasiic design pr�r�a' AsEltlEY �— T•l1IG Homes Available far automatic and • supee 4arms manual operation_ Auto- x st rength and corrosion cart�dta•11 s{, A►s , x isuui, • resistance. Heavy duty sump matic models include ` Fits # u:asstst • Water transfer A46dianitzi F oat Switch P Motor HotWipg: Cast iron i'ugsis itvosiaw- uew' asse and 'vow at the for efficient heat transfer ta€torY. stlemp, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. W maximum. N EPO4 impeller: ThBiTnu w Power Cable: Severe duty • Capacities: up to 60 vPY,, tic semFOpen dcsign wilh rated oil and water O SiSlanl. • Total headsc up to 31 f eet_ p r„p ailt wanes fax nnxhanical • bischaroe size: 1 NPT. seal protertinn. • Mechanical seal: carbon - rotarykeramic- stationary, BUNA -N elastomers. • Temperature: 104Y (40'V) ctomUniuous FEET 1 aC:F (60)C) intermittent. h • Fasteners: 300 seria, 10 l stainless steel. • Capable of running 4 , 30 s crnn dry without damage to ror ip[XiWRS. 25 ..- .. A J� d I ...... .... _.. .. • FPO4 Single phase: 0 HP, U 6f 24' 115 or 230 V, 60 Hz, 1550 RPM, built in ovedoad with automatic reset. a a� _ Bros • EP05 Single phase: 0.5 HP, i; „av�oo 11 5,1 u 1 . 1 �.. _' _.. ....... _... ... - 11 11 J V or 2 , 11111. , r " cG DPN built in overload vyith ! EPO4 automatic reset. z • Power cord: 10 foot 5 .. standard length. 1613 bTf W with three prong !p7Y lding plug, Optic iai 2('i p i v ZO �0 , d "' GPM foot lcr h. 1613 SJ ! with diree orana arcwnding plug ` & iu (standard on EP05), Goulds Pumps 2003 Goulds Pumps ITT Industries Eifeciwe July, AUOA 23471 Mn nn nernen t: M an Pa ge 8 o-F 11 Owner Jake Ly_num Permit # par ft - - - - -- System Specs Tax iD i ---- - - - - -- Septic Capacity 1000 gallon Design Parameters Manufacturer Weisers Pump Tank Can 650 Gal of bedrooms 3 Man if- c tore r VV isc r r -1!... 1 1 rl rinn n f 11 � o ._ Cam. � �5 l l(Tla yea r lo �uu gat 1 Er r r luerit r li ter GYM ,ex Peak Flow 450 coal /day Model 100 Sail Application Rate Pump Manufacturer CIO uld 1 n ., n .. /e �+ M S y H ul /du, „ lJdCl # EPOS Er iuent QUaiity BOD >30 <220mg /L Max Particte Size 118" Start Up Prior to use of POWTS check treatment tanks for presense of paint or chemicals that may Design Criteria damngB nli�p ® v-r -ement cell �1 VI 1 lu IL 1 1 V LL rr essur e Dist Ma nual If concentrations Version2.0' are detected have tank SBD 10760- P(N,01 /01) pumped prior to use. Mound Como Manual Version ?,0" SZ)Ij 1up71 -P11 1,01/ U1) Maintenance Monitoring Schedule lnspect Tanks Every 3 Years Pump Tanks .:'h ®n sl udge 1/ ± nL� T nspect dispercement cells every 3 years Clean Symtex Filter every 13 months inspect pumps controls alarm every 3 year= Flush laterals every 3 years Jake Lynum Mn vin r-)Pment P� n r) Par q n4�' 11 Operations The property owner is responsible for the operations and m the POWTS and submissions of required reps -t Tlrne nUn v,+ t\i n V% el nt In I i+xi ��` -tln® stn � +ar dream I L L../ I V f I i IL \..{ UI I V I y o f f%A 1j V �w ll V y V I 1 IL Y \A� V YY V L I V I L 1 1 r r i t h e i. . r MM% ITC` ar r ec e t he performance and lo ngevi ty or your r w l IN, The installation of water - saving appliances and f ixtures along with I prompt f I relaair of leaks reduces the wastewater � i�nl t tmtn The lirivie or wa tee, from water So f te lnners a n d oth 1 II i V 1 Y 1 f I I Y Y \A V\. I �V f VL f 1 1 1 1� VAf oth f t water= treatment devicesshouLd discharge to ground surface whenever possible, Thissystem is designed to handle domestic strength _ g wastewater, food grease and oil discharging into this system should be kept to a minimum or avoided. Non biodegradable product such as tampons cioareete butts dental floss,sanitary napkin; should not be dispos ®d 1. ll_ _ POWTS C� T I _ 1 1_ I that 1 of in th PO l S, i oice t paper i t h trhe only paper= Arta t, should be disposed into any POWTS Inspections Should be conducted by a licensed plumber, POWTS maintaner, or Septic system service operater, Tank inspections include visual inspection of tank and system for leaks or surface discharge. When sludge f ilia i !3 of the ;ep tic i t . be removed by a iicen�ed pumper, T he of f Lue nt f iiter shou be ciearled twice yearly, Contingency plan. Mounds and at - oracle may be reconstructed by removal of biomat at the infiltration areal POWTS INSTALLER Bruce Webster phone 594 -3080 Septic Pumper Johnson Sanitation Ellsworth POWTS Maintaner Johnson Sanitation Ellsworth Regulating Authority St Croix Zoning Office Jake Lynum 54 2 41 " 0 0 84" r 1 � 1 i 1 1 i 1 I I °U 46 I 1 2 z � i I 1 I 1 I � I � 1 1 D D r m Q rl m � 1 1 I I I I A rn II rn i p C m O m 3 - 9 m I r 1 1 1 1 i Y I 43 m D� M z i m m = p Z s 0 z Cn r"D M r C (n -a O > r r Z Z zm Z D m m T` O Cl O y 0 Z O n Z D? z m Q o z m = n O O D m Z Z p r ✓1 O V1 D G7 O C7 m l ' - z T r� m m 0 "O =z10 Cod = 0 n ZO m 2..r w0 m �C n� �m� mz� =z C m Z { i � - P-mlml O D O � , N D� ---a O M/ (�� V CD I r< - mw i m o J �D o wA�Jv- n I _ o w r C L z D w lJ N �m C �N mprm- 1 0 co C m rn 0 r-i rJ z z O O r� -i m-0 O p V/ r U. � p < --1 D D D D n D O 4 _ i7J Z � m C Z Z O Co v cn � , O { -1 Vo OO m O O D 20 m C m m O I !Il Q D L Z _ n ` C11 m [� m < a O 0 rn Z m m O' ,A r _ 00 A A >M V' 0 n z 0 Z m C� ( O r�i o 0) Z 0 D \ a m r s� m m 0 u Soil and Site Evaluation Page 11 of 11 County St. Croix Parcell ID # Applicant Inf orthation Reviewed by Date Property Owner Property Location Steve Lynum Jake Lynum Govt Lot S W 1u N W L4 s 2 6 T 2 8 xa. 16 v PrgW iv a X N@AbV ndi eas er 157 200th street City State Zip code Phone Clty ❑ Village Pg Town Meorest Road Woodville Wis 54028 Eau Galle 250th Street [@New Construction Use ® Residential /# of bedrooms 3 Code derived daily flow 450 ❑ Replacement ❑ Pub11c or comerclal - Parent Material This evaluation is a required boring to install Mound system, It is in addition to report filed by Lewis B fork (cred # 253976) Genernl Comments Dated 5/13/06 I � { Boring B ❑ Boring II �� II Pit Ground Surface Elevation 95 Depth to limiting Factor >26 Soll, Application ftte Horizon Depth Munsell Re dox Descrotion Texture Structure OnceRoots Inches Color lu ft C." cal- r., i& fh a° y Effkl Effie 1 0 -7 10YR 5/3 --- - - - - -- sit 3 f abk d s Qs 2 f 0.5 0.8 2 7 -13 10YR 4/3 --- - - - - -- sit 3 f abk ds gs 1 f 0.5 0.8 3 13 -20 10YR 4/6 --- - - - - -- cl 2 m ab m fr gs 1 f 0.4 0.6 4 20 -26 75YR 4/4 --- - - - - -- scl 1 m abk m fr 0.2 0.3 Remarksi r Horizon 1 Is platty that breaks to abk deep plowing desire ❑ Boring F] Boring # ❑ pit Ground Surface Elevation Depth to llydthg Factor So! Application Rate Horizon Depth Munsrll Redox Desaiptbn Texture Structure GPDJ ft Inches Color m :: c nt CAW en es M CenIft a Bound" Ow"m Eff /1 Efft2 Remarksi CST Name n Signature Bruce Allen Webster rdate address N3659 Cnty Rd C Ellsworth Wis 54011 2204 9CScstm5501902 F Wisconsin Department of Commerce SOIL EV ATION REPORT page of Division of Safety and Buildings in accordance with Com . Code County s�. G d1p t Attach complete site plan on paper not less than 81/2 x 11 inches in s Plan include, but rat limited to: vertical and horizontal reference point (BM), di ' n a Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to rest r (/l/ `V Please pri C Rev by Date s u I,/ FqrSnnpl information you provide may be u d for ses cy LaA s. 15.04 (1) Prope ' :Owner Property Location NV Eu F MAY 2 6 2006 Govt. Lot l,,,� 114 0.J_P 1/4 $�' Td N R /6 E (or) Pr Properly Owner's Mailing Address Lot # Block # Subd. Name or CSR1rle ST. CROIX COUNTY State Zip Cod ❑ City ❑ Village Town Nearest Road - ?A 31 J� "-" 6)`— New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement .� ❑ Public or commercial • Describe Parent material O(ktL Flood Plain elevation it applicable 111 14 ft. General comments "�" W` '�dytlL ZQ6 and recommendations: 6�'9 -// / a#V oI J 1W l� CPn F(� Boring # ❑ Boring O l� ✓ Pit Ground surface elev. 1W ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efl#1 `Eff#2 -F3 8 a Boring ❑ Boring / � ' Q r 1 � 1 D �o 4 it Ground surface elev. 16 Depth to IanIhng factor 1 o in. Sal Application Rate n _ .... 'r.......,. o— ..n r.,..c:..•..nr.e 4 >- ..le..r D v[�ntf► r%V1Wvf. voyth Domiiflar.' ReCivwv@6:.riptiv.. .cx"- ,.�.,;^L,.. . ., =' Roc in. I Munsed Qu. Sz. Cont Color Gr. Sz. Sh. I `Eff#1 I `Eff#2 ..� ------- 1 430 -00 i Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 1 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS 130 mg/L CST ame (Please P i Si na re (;, < f [/ ' _ Address Date Evaluation Conducted Telephone Number L�E C2 3�- lam,.. 3 Property Owner Z Pdir el IDAK Page 0? of 41 Boring W 1Z Boring # nom' X P "Pi{ Ground surface elev. � it. Depth to limiting factor � � in. i Sal Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary Roots GPD/le in. Munsell Qu. Sz, Court. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-2 10W I Is dykr1W M MAL Ab< - _ F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. it Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff #2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. P ❑ it Soil Apoication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt= in. Munsell Qu. Sz. Court. Color =Gr. Sz. Sh. •Etf#1 •Eff#2 Effluent #1 = SOD, > 30 220 rng/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 - 2648777. SBD -9330 (R07 100) I x Property Owner Pdk.1 I D 7► Page of 1Z Boring # (� Boring / i2' Pit Ground surface elev. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. `Eff#1 `Eff#2 .27 - y a� 4- ­i- 1 D 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 GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 i I Boring Pit F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF irr, Munsell Qu. Sz Cont. Color sGr. Sz. Sh. `Eff#1 `Eff#2 I ` Effluent #1 = BOD > 30 < 220•tng/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 m an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 2648777. SBD$330 (R07 /00) Sk�rEl d ��v 94 Ile 0 btu ll (Itz �rq.vS1— G IC . kc C. N qrt4p AcaF� L / 5aci — ♦� IL b + P �VD r e lr - 7j fC4' 8362 - 7 -3 KAAT P H GEKALS � . REGISTER OF DEEDS o = ST. CROIX CO., Wi W C/) g RECEIVED FOR RECORD CA 0 M�JG°�LCQ44 = D [�LQ�nID� m 10/09/2006 04: --------------------------------- m W o o n CERTIFIED SURVEY HAP m m m 250TH STREET °z � REC FEE: 13.00 z _ _ W _ - ry m COPY FEE: 3.00 ° _w N00 °06'15 "W 324.45' 0' PAGES 2 D ° w o , N 00 °0615" W o -i _ w WEST LINE OF THE NW1 /4 rn 2313.70' b o _ , _ N00 °06'1 - 325T21 - 8 - ------- - - - - -- - - -- L - - - -W c> m o ° _ 37 -0Zm N < N 0cn Z o op o �,�0 0 ...................... X ....cn rn ............ m W= Z p Ul m m o W � <C>> Z n ,L z �` R p Gi i w r7l S ` rT i cn � m mm� w n Z o m� < <o Q N G O A -� /'� O m A 3) - n w rr� ° 0 0 o° 2 z D Z� z = M om m p Z � c cn mZ Z m p G \\`\\Ua�auu�munrp /iiigii, Y m \l`s p 0 :N T m m ;� 0 co N � b D r- - ;� N '[� N A a A W C) N n� ` m `° m 0 0 p cn c/) C/) �_ -� o � x O z v Ci ilt u� 5 ... c _I s v- \ Z N ' ..i _. // , .a w m V) CID v1 °0 G x Z m °� U1 (�ri c w ' ° • �� M x Z cn m w v nD N0D O o x in a w Q r r Z F W � orx � z� o WC9 ° WC 0 Z rn D Z MMo 50 o0 Z O Z 13 m � Z m v � O v D 03 art z D m> m z m m m - n (m r O M C Q on C :::! 0 m m 0 pOz D - N 0 S mm v� N w -1 m o D w A r CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW1 /4 OF THE NW1 /4 AND IN PART OF THE SE1 /4 OF THE NW1 /4 OF SECTION 26, T28N, R16W, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. OWNER SURVEYOR STEVE AND PEGGY LYNUM EDWIN C FLANUM 175 250TH STREET NORTHLAND SURVEYING, INC. WOODVILLE, WI 54028 P.O. BOX 14 ROBERTS, WI 54023 SURVEYOR'S CERTIFICATE I, Edwin C. Flanum, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Steve and Peggy Lynum, I have surveyed, mapped and described the parcel of land which is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as follows: A parcel of land located in part of the SW1 /4 of the NW1 /4 and in part of the SE of the NW1 /4 of Section 26, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin; described as follows: Beginning at the W1/4 Corner of said Section 26; thence N00 °06'1 5 "W, along the west line of the NW of said section, 324.45 feet; thence; thence S89 0 29'38 "E 1313.54 feet; thence S16 0 21'48 "E 375.66 feet; thence N88 0 04'43 "W 1419.53 feet to the point of beginning. Described parcel contains 10.70 acres (466,249 Sq. Ft.). Parcel is subject to town road (250th Street) right -of -way and all other easernents, restrictions, and covenants of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of the County of St. Croix, and the Subdivision Ordinance of the Town of Eau Galle, in surveying and mapping same. APPRO OCT 0 9 2006 EFLANUM 487 S -2487 If not recorded within 30 days of AMERY ` approval date approval shall be %y l_ W IS null and void "Y 0 a- ' d ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND V OWNERSHIP CERTIFICATION FORM Owner /Buyer a, Mailing Address j �/ - S — O a/l, 5 0 2 8 Property Address �'��� Z fa r� Sf; vd�(/r �/ f' z� (Verification required from Planning & Zoning Department for new construction.) City /State I ) j Parcel Identification Number LEGAL DESCRIPTION Property Location S G( / i, , V � 1 '/q , Sec. T � �^ N R f f W, Town of /; to q JA ` Subdivision Plat: , Lot # Certified Survey Map # 9Y 2 7-3 Volume n ,Page # Z_ 9 d Warranty Deed # (before 2007)Volume , Page # Spec house yes 1n0 Lot lines identifiable)(yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb L f bedrooms 7 SIGNATURII OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 1 1 Ifflfl 111f1 fllfi 11111 Iflll lilil fill flflfl flil lift State Bar of Wisconsin Fonn 3 -2003 * 6 5 3 9 7 5 1 QUIT CLAIM DEED 858975 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Steven M. Lynum and Peggy A. Lynum, husband 06/21 /2007 10 :40AM and wife QUIT CLAIM DEED EXENPi t 8 REC FEE: 11.00 ( "Grantor," whether one or more), and Jacob A. Lynum a single person PAGES: 1 ( "Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Recording Area County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and Return Address i Pert of the SW 114 of the NW 1/4 and in part of the SE 114 of the NW 114 of Thomas A. McCormack Section 26, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin, more PO Box 2120 particularly described as follows: Baldwin, WI 54002 Lot One ID Certified Survey Map Tiled October 9, 2006, in Volume 21 of Certified Survey Maps, page 5290, as Doc. No. 836273, Office of the Register of 008 - 1075- 20-100 Deeds for St. Croix County, 0"is Parcel Identification Number (PIN) This is not homestead property. (is not) Dated - 7 (SEAL) A (SEAL) * *Steven M. Lynum (SEAL) n • ATJ (SEAL) * — * Pe - - -- – AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF Wisconsin ) ) ss. authenticated on St. Croix COUNTY) Personally came before me on to ' – p '7 , * the above -named Steven M. Lynum and Peggy A. Lynum TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ��+� me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) �G C ent and acknowled ed th e. THIS INSTRUMENT DRAFTED BY: R . Thomas A. McCormack KoTA No bli , State of Wisconsin B aldwin, WI 5400 - �! tl om (is permanent) (expires: (Signatures may nut • o aclyrD d. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ® TR I It* CONSIN FORM NO. 3-200 'Type name below signatures. •a INFO -PRO"' Legal Forms . (9oo)655.2021 • idopwams.com 1 of 1 I I t i c,A A l I I � f G 4 m I