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Home My WebLink About034-1007-60-000 (2)Wnsmmmn Department of Commerce PRIVATE SEWAGE SYSTEM y"a"`Y St. Croix Satiny and Building Division INSPECTION REPORT Sanitary ParmrcNp_ CH TO PERMIT) GENERAL INFORMATION Smre plan I (ATTAD No. Pemonai .lfcmlabor you pmwoe may be used for semooery purposes Privacy Law. s.t5-0< (1)(m)I Pedna Ndtlerc Name. CHy village Townsmo (��Gt �aJ�(� Y{� TOWN OF�� P .$' ON-PO-7 -60 :.S7 BM. Eiev. Insp. BM ElmIBM Del -tumor. • s _ \ I S^_ehcn/Town/RangelMap No:_ TION TYPE MANUFACTURER r �i CAPAOn' Septic Dosing - nn V 1(JZ t Pol l0 C. Id TANK SETBACK INFORMATI0NZ-6.1 _ts 111111411114"21 9101,1973 (11 ` ®MCI �� ---Mid' I�Li,Vffj&w �m PUMPISIPHON INFORMATION Manufacturer I cm Al &S lFor�rrain ILengoth 6O IDia. 11/( ID.s_ m Wel; cnn &RRnRPTIr)N SYSTFM --Il.i In eEmil. I/flfi7L.. _ W �111 NI .0 litpq mi�'llm Ell �W m bli ��= Ell '' 1 i _�M1titJli"La'lI �0 s ;M -mile r2 I! W"I�� zti 3-tit ". 17M OL 14Zs �'�G, � �in�fo n_�11•?0 BEDr BENCH DIMENSIONS Width '_e o Of Trenches Z W1.(('j%1 65 PR DIMENSIONS No , PI Elf Inmde Dia Uquid Depth SETBACK INFORMATION SYSTEM TO PIL LDG WELL LAKE/STREAM LEACHING CHAMBBR OR DNrT Manulaowrer a, �Q L� Type (Y System' , 1 f 1 r /� , r Model Number 1 DISTRIBUTION SYSTEM COMMENTS: (include code discrep_anncies, persons present. etc. Loation: nV� �/ T (�. N 1 1da1 k ".) Alt BM Desonphon = \ ", a "' 4\� 1AOASC- L G fl f (`''T 2.) Bldg sewer length = i5 Oo OBI ` IUD_ �~� - amount o` mver = � �` yZII I Plan revision RequlredT [ Yes 0 No Use ofrter side to, adtll6onal infodnation. I O bi v i✓—� Dare SBD-6710 (R.3/ST,� Inspection C1: 1 0 `� 6VL1521 �1 l i Inspection i2 q 1mk-s CWIInS SAW . .A "r �ganrpvr q" • �, a n � - uildings Division Lounry 'j!=PA00 a '-.. . Vfj(f' 35714t n Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ,sa LL EP 11 Zip ison, 153707-7162 0154151 Sanitarr IF64' C °A.W n State Transaction Number` In accordance with SPS 38321(2), W is. Adm. Code, submission of this form to the appropriate governmental unita Q / 'V project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for State-owned POWTS are submitted to the Department of Safety and Professional Servies. Personal information you pmvide may be used for secondary purposes in accordance with the Privaey Law, s. 15.04(l Hat , Stars. Os.� Q f 6Gawa.� L Application Informafi - Please P nt All Info ma6on Property Owner's Name L N-V Parcel 4 i ?oJ44l?6ajVM 0 7 , Ga - ab on Property Owner's Mailing Property Location //Address /' ??3 CpdK•G if/ // Govt. Lot , W y.,_A1�'/., Section_ City, State ZipCode Phone 1 /Number p ` 26 cncle orre) T / N; R E o U. Type of Building (check all that apply) /^�\ Lot # Subdivision Name or 2 Family Dwelling - Number of Bedrooms `J 2 ,K1 6)c Blockif ❑ Public/Commercial - Describe Use ^ : ❑City of u Jd'Ar El State Owned - Describe Use �% / I�/ C'�S`%M El Village of _ Townof �-[Irtt /tt� Number 9 3 1-3 N 3 g "� OJ VDf Ill. Typyye Check only one boa on line A. Complete line B if applicable) a� A IR New S teat Ys ❑ Replacement System P Yat ❑ Treatment/Holdin Tank Replacement Only g P Y' ❑ Other Modification m Existing System (ex lain 8 Y P ) B. El Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Perron Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Com nent/Device: Check all that a 1 ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At ound> 24 in. of suitable Sail ❑ ound <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Prehea ce (explain) 11 V. Dispersal/Treat ant Area Information: d Design Flow (gpd) Design Soil Application Rate( ds Dispersal Area Required (sf) Dispersal Area Prop (s System Elevation VI. Tank Info Capacity in Total 11of 'Manufacmr Gallons Gallons Umts P / e, ;? v o U d 2 in y ='• 2 C7 New Tads Existing Tanks (o d U h Septic or Holding Tank e�ea� Dosing Chamber So VII. Responsibility Statement- 1, the undersignpd, assume responsibility for installation of the POVM shown on the attached plans. Plumber's Name (Print) P her's Sstore MP/MPRS Number Business Phone Number 2 0?Y_5 /rnf, r Plumber's Address (Smed, City, State, Zip Code) 2 9 s /3o'aL Josto �Gvw uo of VIII. County/Department Use Only Approved ❑ D Permit I= Date sued Issuin rnt gamine 11 $ 6✓0 C, 9 1 '1 I ❑ r9u�r•Kvrn Reason for Denial IDL Coed"VVReasons for Disapproval / citsper::aa ec. ,n tide? by z � emit, all be s: •:fides! bpi 9s per,nan8gemer.t pizn pp•o r+a plwnbe,. Ct.��- �. AAaelbeMtn4t;iax..^,an:smrxtuo..:x;nkA.tt? jo pet applloabla cWA / rfdinanoea. Attach to complete plow for the system and submit to the County only on paper not less than 8 In all inches is Sim SBD-6398 (R. 11/11) CHECK BOX AS IPFUCABI.E. CHECK BOX AS APPII^.ABL SOIL EVALUATION Scale: 1°=40' Fv/� SYSTEM PAGE 2 OF 6 SITE MAP I `0 6` PLOT PLAN PROJECT NAME: Kzelzll(101t t0, DESIGN FLOW_ 450 GPD dl Pottebaum-Mound Attach des ge flow calcuia5ons for commercial plans. PROJECT ADDRESS: 1183 29Dth St, Glenwood City, WI Pip- Material r ASTM Standard (Tables 384.30-3 d 384.30-5) 100.0 T eM hecid: IW. FJeveao N sanaary sewer °VC f ASTM D3034 • Len F. Mom: PVC QSTM D2665 � SM Da� Nail in 4"x' en fence post Slope Gnafienl (%) of Twee Mee 11 Well Symaai (a appicaoiel: a)dl iomu 1e^^ w en. IMPORTANT: Show ground elCOr1tDlas at still Ml orals. m Ne epMWme ft< T NI 570 --;i ,It f as*-d P ell, � L1,ti 8 �•rp.e V- u tcicopY , ps. September 11, 2019 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2021-09-11 Plan Review: PWTS-091901865-C MICHAEL J MYERS 2943 130th Ave Glenwood City WI 54013 SITE: Pottebaum-Mound 1 183 290th St Town of Springfield Saint Croix County Total Amount: $250.00 FOR: Description: 450 GPD Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI W04-5211 Contact Through Relay http://dsps.YA.gov/pmgmmsrtndustry-services www.wisconsin.gov Tony Evens - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES dtsttti &4 jfa& SEE Mound Component Manual— Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) 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 any 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: • It is recommended to fence off dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left -over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall he properly disposed of on -site or off site. • Any tall grasses, leaves, and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • To meet flow velocities between 2 to 10 feet/second. • As always, good workmanship and attention to detail during the installation process is critical in achieving a final product that will perform as designed. • Electrical connections shall comply with SPS 316.300 and NEC 300 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewers beyond 30 feet per SPS 38230 (11)(c) • Cleanouts shall be installed per SPS 38235 • Well to be located >50 feet from mound component and > 25 feet from septic and pump tank component. 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. In granting this approval the Division of Industry Services 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 wmponent. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, "A- oM Travis Wagner POWTS Wastewater Specialist, Division of Industry Services (608)598-0715 t ra v i s. wa g n e r@ w i. eo v PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design Referenc s: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0APP O " D/01, R. 10/12) Pg 1 of 6 Index & CIAWf Pi3q6FETY AND PROFESSIONAL Pg 2 of 6 Plot Plan DIV SIO OF NRVISERVICES Pg 3 of 6 Mound Cross ec�ion ��anSTS �%iew Pg 4 of 6 Distribution Netwi Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan -- SEE CORRESPONDENCE Attachments: Enclosures: Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Pottebaum-Mound Owner Name(s): Ron Pottebaum Owner Address: 973 Coulee Trail, Roberts, WI Project Address: 1183 290th St, Glenwood Cit 114, Section 04 T 29 Govt. Lot: NW 1/4 of NW Township: Springfield County: St. Croix Project Parcel ID #: 034-1007-60-000 Designer Information Phone: 651 _788 _5995 Zip: 54023 WI 54013 15 E❑or W❑✓ Designer Name: Michael Myers Phone: 715 _265 _4115 Designer Address: 2943 130th Ave, Glenwood City, WI E-mail: mcmyers@centurytel.net License Number: MP267985 Remarks: Zip: 54013 Signature: ��14 Date:08/14/2019 Original signature requireon each submitted copy. CHECK BOX AS APLICABLE. ❑ SOIL EVALUATION ° SITE MAP PROJECT NAME: Pottebaum-Mound PROJECT ADDRESS: 1183 290th St, Glenwood City, 4N asom 1000 � am ' '.� eM Eler.FT BM DewnpWn: Nail in WY wooden fence post Slope Greden� (%) ofTeamd Alva.11 WeB Symod In eplre pobl: O Scale: 1"-40' 40 ( 10 n N karau riots ty e'*`Kw •"a'^"' an va eppapXs ax CHECK BOX AS APPLICABLE, 80 Q SYSTEM PAGE 2 OF PLOT PLAN DESIGN FLOW. . 450 GOD 10 Attach design now calculations for commercial pans. Pipe Material I ASTM Standard (Tables 384.303 8 384.305) sanmySawer. PVC ASTM D3034 Farm Male: PVC / ASTM D2665 IMPORTANT: Slaw ground ebvatlan contoPxs at auttable Intervals. 1 V1 j I [Y I I ' j� -1 � l I ° i J k #1 — —! 0.5" TO 2.5" WASHED AGGREGATE (min. 0.0" beneath distribution pipe - min.2.0" over distribution pipe and covered with approved synthetic fabric) ElASTM O33 SAND FILL Plowed Surface SINGLE -CELL MOUND DISPERSAL AREA MIN. 6.0" OF TOPSOIL COVER min. 1.0 it min. 0.5It T r--o->/— -- o I L -- ,ti r A = 6 ft --I Surface Contour 11 % Slope Elevation = 105.0 ft (Show force main manifold and flush valve locations on plan view.) D = 1 ft E = 1.67 It System Elevation = 106.0 ft Lateral Invert Elevation = 106.68 it CROSS SECTION VIEW (No Scale) PLAN VIEW (No Scale) -- -- — —--1-- -1—/2-- ----0 — S-c--hd-1 -4—0 ------- -- --- --- — — — — J— —51I.—2 —ft ---01r—2.-5 1 -- ^ft PVC Lateral (typical) — — — — — — — — — — ootb— --- C—----- —-- — — � \ ----------- W=24.5 ft B= 75 ft K= 9.4 ft I = 13I.3 ft (trwCA Bend as necessary to follow contour DOWNSLOPE TOE L = 93.8 It Prohibit disturbance and vehicular traffic within 15 feet of downs" toe. Reset Page j D m W 0 rn DISTRIBUTION NETWORK SPECIFICATIONS FLUSH VALVE DETAIL (No Scale) Orifice in — — Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) \ \ r 1 \ Ball Valve I \ \ (optional) / \ (No Scale) Lateral Spacing S= 3 Shield orifices for graveless applications \ ` i i Lateral Length (P) = 74 ft (dser pipes optional) 2 -o Schdi 4o PVC Manifold 2 -0 Sd dl 40 PVC Force Man (slope to pump lank for drain -back) lost Orifice (typical) Laterals to be level hdl 40 PVC Lateral 0 = 1.5 in (typical) Number of Orifices per Lateral = 45 Orifices equally spaced: ` (check a) OR b) below] ` \ Orifice Discharge Rate = .41 gpm a) abrg bottom of lateral � Orifices spaced �I Flush Valve b) yy along top of lateral Assembly along bottomottom oO f lateral ` Number of Laterals = 2 with every _ th hole (typical - see detail) Discharge Rate = 18.54 gpm taring down Last Orifice Orifice Spacing (x) = 20.18 in LATERAL INVERT ELEVATION = 106.68 fir (typical) (typical) (typical) TOTAL DISCHARGE RATE = 37.08 GPM (typical) Orifice Diameter = .125 in (typical) First Orifice OBSERVATION PIPE DETAIL (No Scale) Screw -Type or .,� SIP Cap (loose) +' Finished Grade (mulched & seeded) 4.0 PVC Pipe Cover Top of pipe to temilnate .'t (min. 1 foot) at or above finished grade (4) 1/4'-112- x 6' Slots $o open Anhori g Device Infiltration Surface (typical) END MANIFOLD (typical) CONNECTION pi, END Check applicable box. Manifold First Orifice (riser pipe optimal) (typical) E.- x-� xn -I --x —I CENTER MANIFOLD (riser pipee optional) MaCONNECTION pt G) m A O 0) PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4.0 Vent Pipe -10 A from Building IT Min. or 2.0 A above Established Flood Elevation (typical) IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grace CAPACITIES @ 17 gaUn Depth (in) Volume (gal) A 20.9 354.7 B 2.0 34 [C] 5.4 91.3 D 10 170 Approved Vent Cap e. *Pump Tank Liquid Level = 38.2 in Force Main Diameter = � 2 in Force Main Length = �775ft Force Main Void Volume = 15.6 gal Electrical must comply weh SPS 316 and NEC 300 �We6thon Box J Weather Sox a *T A I I` I� B Pump Extend manhole deer as necessary. Approved Locking Manhole with Warning Label Attached typical) 4' Min. or 2.0 A above t0uicklDi�ned d Flood Elevation (typical) Ur Mm. ed Jants wM Approved Pipe 3 A onto Solid Ground (typical) PUMP -OFF ELEVATION = 88.8 ft ° INSIDE BOTTOM �Blodc ELEVATION = 8 ft 3" Approved Bedding Material Beneath Tank [C] Total Dose Volume TDV = 91.3 gal/dose (5X total lateral void volume S TDV < 0.2X design flow) + (force main drainbadc volume) MIN. PUMP DISCHARGE RATE is 37.1 gpm Vertical Head=�5•17 ft + Min. Supply Head =.5eft + FM Friction Loss st 2.15 ft + Fitting Loss' = 1.95 ft "(min. supply head x 0.3) = TOTAL DYNAMIC HEAD = 15.77 ft PUMP TANK: SEPTIC TAWS): Volume = 650 gal Total Volume = 1000 gal ManufactureWeser Conctrete Manufacturer(s): Wieser Concrete o.� Pump Manufacturer: s;+atic _ Pump Model: 7Mhef 40 ;C'�See attached pump curve.) Install approved effluent filter at the septic tank outlet Immediately upstream of the pump tank inlet Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Polylok Vasa Controls/Alarm Model: PSP120V6H150P17A Filter Model: 525 Was Float switches containina mercury are prohibited. PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operatina Limits: Design Flow = 450 gpd; BODs 5 220 mgL"; TSS <_ 150 mgL4; FOG 5 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Northland Plumbing Inc Phone: 715-265-4115 Local government unit: St. Croix County Local government unit address: 1101 Carmichael Rd, Hudson, WI Phone: 715-386-4680 zip: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc, Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc, Admin. Code. Contlnaencv Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. [. GOULDS PUMPS Submersible Effluent Pump APPuu,nONs Spedally designed for the following uses • Mound Systems • Effluent/Dosing Systems • low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump) Dewatermg METERS FEET SPECIFICATIONS Pump -General: • Discharge: I'A' NPT • Temperature: 104OF (4000 manrourn, continuous when fully submerged. • Solids handling'/z' maximum sphere. • Automatic models include a float switch. • Manual models available. • Pumping range see performance chart or curve PE31 Pump: • Maximum capacity. 50 GPM • Maximum head: 25' TDH PE41 Pump: • Maxdmum capacity. 60 GPM • Maximum head: 29' TDH PES1 Pump: • Maximum capacity: 70 GPM • Maximum head:37'TDH PE MOTOR General: • Single phase • 60 Hertz • 115 Wehs • &&-in thennal overload pro- tDchon with automatic reset • Class B insulation. • OiMled design. • High strength carbon steel shaft PE31 Motor: • 33 HP, 3000 RPM • 12.0 Maximum amps • Shaded pole design PE41 Motor. • .40 HP, 3400 RPM • 75 Maximum amps • PSC design PE51 Motor. • _50 HP, 3400 RPM • 9.5 Maximum amps • PSC design 0 5 10 15 n>3fi CAPACTTY 0 2002 Goulds n,mps �.•_� -.,_�_ , FEATURES ■ Corrosion resistant mrntruction. ■ Cast iron body. ■ Therrmeplassuc impeller and cover. m Upper sleeve and lower heavy duty hall bearing construction. ■ Moto is pelmanendy lubricated for extended service I&I ■ Powered for continuous operation. ■ AN ratings are within the worldng limits of the motor. ■ Quick disconnect power cord, 26'standard length. heavy duty 1613 S11 W with NEMA 5-1 SP, three prong, 115 volt grounding plug_ m Complete unit is heavy duty, portable and compact. ■ Mechanical seal is carbon, ceramic, BUNA and stainless steel. ■ Stainless steel fasteners. - G 0 us Tested to to 778 and CSA =108 Starxiards By Cma&W %odadsAmaabmr File #UB850 Garldshmpsatsogo0t negisrMr L Gooukis Pumps � ITT Industries ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 0 WNERSHIP CERTIFICATION FORM Owner/Buyersn�d Mailing Address 477 9 aV4 e �-� I W'0 6t , ui , Sfle Z PropertyAddress,�K//83 2%O'44 Sf Cleenwooz) a4. cv/ .Sf<oi_ (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 6 3 4 - /66-7" G 0 - .n LEGAL DESCRIPTION Property Location W�f/ I/a , �l�i I/a ,Sec. T _2-tN R /s VJ, Town of S-es I �/i Subdivision Plat: Certified Survey Map # Warranty Deed # Spec house 0 yes Pno Volume Page # (before 200 )Volume , Page # Lot limes identifiable Yyes C no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # 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 §SPS. 383.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, 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 Safety And Professional Services 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 3 days of the three year expiration date. Uwe certify that all statements on this orm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a ty deed recorded in Register of Deeds Office. er f b SIGNATURE 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. 04/12) �.70• fry-E�a► pE� 2 ww� w s 9y 3sy CERTIFIED SURVEY MAP Leroy A. Storley Part of the fractional Northwest 114 of the Northwest 114dod the Southwest 114 of the Northwest 114 ofWection 4, T. 29 N., R IS W. Town ofSprinxfiald St. Croix County, Wisconsin a:. i� OWNER'S AOORE55- 990 H/LLCREST STREET BALDWIN, WISCONSIN54072 R� NORTHWEST CORNER / SeZWON 4, T 29 N., R./5 W. / R ;. /COUNTY 5[.WVEYOR MOMI o' SCALE IN FEET /",300' O 50 A" 300 600 Be -RINGS AR-- REFERENCED TO THE W4FT LANE OF THE FRACTIONAL NWI/4 SArTION 4, T 29 Al.. R. /5 W., ASSUMED AS NOO.54'30' W. x I E?_' 'E0 s/_9:ErMAP 6C�tuu_ :� _n_acEss:s !W coRNFR ra , I Iba�i I I� _ Ism N ly 14 I I: 33.0¢ I 1 ST �� "Ioo• _, r3 la�JI ��' Z O • 41 3 O"• I I� n`I Zma, -,I -- /286 74' -- LOT 3 CONTAINS 87I,62I So FT OR 20.010 AC. /B49, B36 SO. FT. OR I9. 510 AC EXCLUDING ROAD RIGHT OF WAYI ..../288.33%._- r.ur•L. 537 86'- -- 750. 47' -- -' -- N 89•59,33 "£ 1521,33' -- APPR S. LINE FRACTIRRAL NW"-NWI/- CONTAINS 035, 195 SO. FT. OR I9.1r3 AC. 119I4.346 SO. FT. OR /8. 695 AC £XCLUO/NG ROAD R/GNT OF WAYI i< c w Z u WEST / CORNER SECTION 4,T 29 N., R. /SW /COUNTY SURVEYOR MON. / I2B9.85---- - - 753.73'- LEGEND IL rye INO/CA TES /'X24" O IRON PIPESET tM/N. WT /./3 LB/L.F. / INDICATES FOUND / IRON PIPE INDICATES COUNTY SURVEYOR MONUMENT /SURVEY NAILI INDICATES FENCE L/NA —CORNER <$ LOT/ W M RPHV I °O S h713 RI FALLSr: aft/ LAND _ �` Revised x December 7, 1998 THIS INSTRUMENT DRAFT£0 BY ✓ERALD L LARSON-Si7E-FT t Oi`Rr Datedc October 22, 1998 Vol. 13 Page 3580 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number I Document Name THIS DEED, made between David G. Lindquist and Linda J. Lindauls husband and wife ("Grantor," whether one or more), and Ronald D. Pottebaum and Joann K. Pottebaum. husband and wife as Survivorship marital property ("Grantee," whether one or mare), Grantor, for a valuable consideration, conveys 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 addendlun): Lot Three (3), Certified Survey Map as recorded in Volume 13 Certified Survey Maps, Page 3580, as Document No. 594359; Being part of the Fractional Northwest Quarter (Frac'1 NW 'A) of the Northwest Quarter (NW 'A) of Section Four (4), Township Twenty-nine (29) North, Range Fifteen (1S) West, Town of Springfield, St. Croix County, Wisconsin. d�giU�qiiiq1 1073937 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 11/06/2018 03:50 PM EXEMPTS: REC FEE TRANS FEE Recording Area 30.00 312.00 PAGES: 1 Name and Remm Address WFSTco sin Title Services P.O. Box 607 Hudson, WI54016 034-1007.604M Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Zoning ordinances, rights -of -way, all easements, covenants, conditions, reservations and restrictions, and general real estate taxes and assessments levied in the year of conveyance. Dated: November 1.2018 , AUTHENTICATION ..� . F� •,''rat.. Signature(s) P "- authenticated on BAR OF WISCONSIN , authorized by Wis.Stst § 706.06) THIS INSTRUMENT DRAFTED BY: Tony R Schrader. Attorney (715) 235-3403 File No. OR•18-12294 & J4 � • (SEAL) *Linda J. Lindquist ACKNOWLEDGMENT STATE OF WISCONSIN ) ) as. COUNTY OF ST. CROIX ) Personally came before me on November 1. 2018 the above -named David G. Lindauist and Linda J. Lindquist to me ]mown to be the person(s) who executed the foregoing instrument and acknowledged the same. *Allison Marltall Notary Public. Stone of Wisconsin My Commission (is permanent) (expires: 2/26119) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. I-2003 'Type name below signatures. St. Croix County 1073937 Page 1 of 1 E e 0 '3 3 b 7 8ll p5g------------- 3 6fitilii ! li 111�{ � ' � �I9,ti�y�;�MM pi .......r RON a JOANN E€� 1 ! ! ! 4i1 f11'a!k�'j`I!9`i�R9 POTTEBAUM 1'¢ !;;11' IY N• T ' i j r .r+w ri .• -- - rr s V• r .a...- .Y.v� S t rr yr ry r rr rr r --- - . . ............. ... .. - - - -- ------------ -- --- ..................... ................. ... ........................................ F ---------------------- ......... . ......................... -------- - - - .................... - . ................. ...... .... .... . .... ---------- .. . .................... ....j ................................. ------- T................. - ---------- ..... ..... ... . ..... .................... . ..... .... ... ..... ................. ........................... . . . . . ................... ............... .. . ......... ...................... ............ ---------- - ----- - ................ .. . ...... ii 1. r_l - RON 4 JOANN fmOTTEIBAUM p (fST—aoit -a76 r Wisconsin Departme 11�� "�� " Services Page 1 of 3 Division of Ind s V V 05 2p1� SOIL EVALUATION REPOR NQ�) Ina rdanoe with SPS 385, Wis. Adm. Code County Attach complete site P Ian on paper not I p p11 6 1 x 1 inches in size. Plan must include, St. Croix but not limited to: Vert I and btri;k*R M), direction and percent slope, Parcel I.D. scale or dimensions, rthCarrr�hy and distance to nearest road. 034-1007-60-000 Ref #2522 Please print all Information. Rev#wed by Dater Property Owner Property Location f / E David & Linda Lindquist Govt. Lot NW % NW Y. S 04 T 29 R 15 E (or) W Property Owner's Mailing Address Lot # Block # Subd. hame or CSM# 2909 Co. Rd. DID Na Na Na City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Glenwood City Wi 54013 Springfield Parcel address:1183 29(P St. ® New Construction Use: ® Residential/ Numberof bedrooms A Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: z�){ Parent material Glacial Till Flood Plan elevation if applicable na ft. General comments and recommendations: Site suitable for mound POWTS. Recommend infiltrative surface elev. to be 106.00' at 12" above 105.00' contour. 1❑ Boring # ❑ Boring V ® Pit Ground surface elev. 105.04 ft. Depth to limiting --factor 27" in. c,.:i e..l u�...:..� .- ,. I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD1Ft' •Eff#1 -Eff#2 1 0-8 1Oyr3/3 none Ifs Osg ml as 2vfflm 0.5 1.0 2 8-18 1Oyr4/6 none Ivfs Osg ml cN 1vf,f 0.4 0.6 3 18.27 1Oyr4/4 none fsl tmsbk mvfr cW lvf 0.2 0.6 4 27-40 10yr7/3 f2f 7.5yr 5/8 fs Osg ml gw 0.5 1.0 5 40.51 1Oyr7/3 c2d 7.5yr5/8 SSBR Om mfi - 0.0 0.0 2 ] Boring ❑ Boring ® Pit Ground surface elev. 101.40 ft. Depth to limiting factor 36" in. c..:r e..l r....;-- o...- I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FF 'Eff#1 ,EfW 1 0-8 10yr3/3 none Ifs Osg mI as 1.0 2 8-15 1Oyr4/6 none IVfe Osg mI cw 0.8 3 15-22 1Oyr4/4 none fsl 1msbk mvfr cw 0.6 4 22-29 1Oyr4/6 none Ivfs Osg ml ci %0.4 0.6 5 29-36 10yr4/6 none Ms Osg ml cw 6 6 36-47 10yr4/6 2f 7.5 vfs Osg ml gw.6 7 47-59 10yr6/4 c1 7.5yr416 SSBR mill - 0.0 0.0 CST Name (Please Print) Signet CST Number James K. Thompson ..- 30021 Address ldste Evaluation ConducteY Telephone Number 340 Paulson Lake Lane, Osceola WI 54020-5413 October19, 2018 715 248-7767 S6U-b330 (R04115) 3❑ Boring # ❑ Boring ® Pit Ground surface elev. 104.45 ft. Depth to limiting factor 24" in. Soil Anclication Rate Horizon Depth In. Dominant Color Munsell Redox Description Gu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 "Eff#2 1 0-7 10yr3/6 none Ifs Osg ml aw 2vf1fm 0.5 1.0 2 7-15 10yr5/6 none fs Osg ml aw lvf,fm 0.5 1.0 3 15-24 10yr6/4 none fs 0sg ml aw lvf,fm 0.5 1.0 4 2442 10yr6/4 f2d 7.5yr5/8 fs Osg ml gw 1v 0.5 1.0 5 42-46 10yr7/3 mld 7.5yr5/8 fs Osg ml gw - 0.5 1.0 6 46-60 1Dyr7/3 f3p 7.5yr4/6 SSBR Om mft - 0.0 0.0 ❑ Boring # ❑ Boring ❑ Pit Ground surface stair. _ ft. Depth to limiting factor _ in. Snil Annliratinn Ratn Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fly 'Eff#1 T'ES#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe Eff#1 'EfW ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS > 30:5 150 mg/L ' Effluent #2 = BOD, > 305 220 mg/L and TSS > 30 5 150 mg/L ESfiM6'�� L lee at aPprq",r" 4 1Ja✓IC ��/�IC14 Li/I�GI/,f1 ,29o9G.,Pd..IId G kn d;fY/ cJi. Y c�T19� tip o k'4 K0-k 4n ¢u�t P9.30�3