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034-1008-60-000
,Aconsir. Department ofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety a Builc'ing Division ft ' INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514868 0 GENERAL INFORMATION 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: Lindstrom, Craig M. I Springfield, Town of 034 - 1008 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / CD Vl(\ I 04.29.15.63B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER - CAPACITY STATION BS HI FS ELEV. i Septic Benchmark Dosing Alt. BM 6 S o,N„1o z �� r; ►Vs,.... Bldg. Sewer ♦ 177— F: 1 F.' (_.J- le �0.7�7 Holding St1Ht Inlet I. Y S 1 . -Y, TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 96 �� / Z J. 2 I Dt Bottom �. 7g 9/ . 93 Dosing ! It. If Z/ ! Header /Man. I '3. 1 161,91 Aeration Dist. Pipe /d( . 8 t Holding Bot. System 3.g PUMP /SIPHON INFORMATION Final Grade 2 /e2 , Ff Manufacturer ' Demand St �3q c r - 6 S Z GPM J 11 Model Number TDH Lift Friction Loss System Head TDH I �t 3. 2. ` Forcemain Length ! Dia. i Dist. to Well Ann.ef SOIL ABSORPTION SYSTEM j Sv t c� ,ti 3 4 BED /TRENCH Width / Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (0 '52- 6e SETBACK SYSTEM TO P/L _ WELL LAKE /STREAM LEACHING Manufacturer: IN, INFORMATION CHAMBER OR Type ka J : Z , ` 2— ' Cl � �/t UNIT Model Number: DISTRIBUTION S � YSTEM T � 5 1�" Header /Manifold Distributio ! ! / x Hole Size x Hole Spacing V Air I ke /► v 1 - L Pipe(s) ll ,S u 1 1-ength ��� Dia � J Length N Dia /' ^'�' Spacing � 3 Z SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center ' 1 7 Bed/Trench Edges Topsoil 1 rt t^ - Yes a No l nc�. es No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /W/ �� Inspection #2: / / Location: 2976 110th Ave. Glenwood City, WI 54013 (SW 1/4 SE 1/4 4 T29N R15W) metes & bou d Lot Parcel No: 04.29.15.63B 1.) Alt BM Description = F: �� Go -j t,� 1- L6,6 a.-- G�.kQ, Ptow ot- 2.) Bldg sewer length = 21 N � 7�{'s C-64.V%.J0^j 46& amoun of ver I7 , � M.... S. Plar revision Required? ❑ Yes No O$ Use other side f� additional informatio- _ _ - - - -- L Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) I "N'1 9jn;eu6lS s,iolodesul ale(] (L6/£'2J) G11L9 0f -- - �– — uogewjo ;u! !euo! ;!ppe Jo; ap!s a o, asfl ONE] saA ❑ 6pannbad uolsr. J ueld = aanOO ;o;unowe - = q;6ual James bp19 ('Z = uopduosaa We 11V (' l M'91,'6Z•b0 :ON laoaed lo spunoq g selaw (M91,b N6Z1 17174 3S WL MS) M179 IM'Al!O pooMUalO 'anV g101 l 9L6Z :uol ;e30 :Z# uolloadsul / / :l# uolloodsul (•ole 'luasaid suosaad 'salouadaaoslp apoo apnloul) :S1N3WW03 ON El sad ON 0 99A El I!osdol s96p3 qO —Lpag a9lua0 gouaJI/pae PagolnW xx poppoS/popeaS xx 10 gldaa xx janO glda0 aan0 gldad Alup swalsAS opea0 - 3V jp punoW xx Alup swe;sAS a.inssaad x N3AOO 1105 6uloedS e!d gl6ua e!Q gl6ue (s)adld alelul ny 01 luau 6woedS 910H x az!S aloes x uognqulslp plollueW /JapeaH W31SAS Wunewisia :jagwnN lapoW 11Nn :walsAS 10 adA1 NO H313WVH3 N011b'WUOdNl :aajnloe;nueW ONIHOV33 1NV3211S /3AV1 113M 0418 1/d Ol W31SAS NO` S13S SNOISN3WI0 q;daq pinb!1 'e!4 aplsul slid 10 '0N SNOISN3WIa lld sag0uaj110 ' WBUG - 1 glP!M H3N3M1 /a38 W31-SAS N011dHOSIN 110S IIaM Ol 'ls!a - e14 L116ua1 u1ewaoao3 1d Hal peaH wa;sAS ssol uolloud u!1 HOl aagwnN IapOW WdJ JanoO ;S puewad jain;oe;nuelN NOUVW210AN1 NOHdIS /dwnd apeJ0 jeuld welsAS ; ;08 6 u 1 PIOH ad!d •;sio uol;eaay 'UeW /JapeaH 6ulsoo wollog ;d of ;dag lalul ld r( J!t/ 01IUGA J418 113M 1/d Ol JiNt/1 NOI1VW210z1N1 MOVe13S MNVl ;apn0 IHRS lalUl lH/iS bu1p1 aannaS '6p18 uopeaay We 'lib' 6u!soa �Jewgoua8 olldeS 'n313 Sd IH SO N01lt/1S lkllovdt/O NM:jniov=inNt/W 3dJU VJLVO NOIIVA313 N0I1VW2103N1 MNVl 8E9'9l'6Z'b0 :ON deyV/96u6&umoLuogoaS :uogduosa4 We Aa13 W8 - dsul A W81SO 000 - 800 L-t1£0 10 uMol 'pjaij uia S. •]N 1eJo 'W0.gspu]1 :ON xe1 jawed dlgsumol X a A310 :aweN s,aaplOH Pwaad [(w)(1) qp gl s 'Mel (oenud] sesodmd /uepu000s jo; pasn aq !ew apinoid noA leuosJad :ON 01 Ueld 91e1S (llw2��d Ol H�blltl) NOI1VW21O3�I 1VM3N3J 0 9£8t769 :ON ;luuadtiel!ueS INOd321 N01133dSNI . r uolslnla 6w, p q pue Aa1WS X10Jo ' IS R;unoo W31SAS 3JVM3S 31VAINd aoaawwo0 ;o luawpeda0 ulsuooslM 1 r , Commermwl.gov Safety and Buildings Division County n 201 W. Washington Ave., Bo 162 St. Croix t ( ID sco n s i n Madison, WI 537 62 itary Permit Number to be fi ed in by Co.) apartment of Commerce Sanitary Permit Application State Transaction umber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1478506 unit is required prior to obtaining a sanitary permit. Note: Applicatio r state -owned POWTS are Project Address (if differe t than mailing address) submitted to the Department of Commerce. Personal information you rovid�g purp oses in accordance with the Privacy Law, s. 15.04(l) in), Stats. n C a �? (p s I ST I. Application Information - Please Print All Information Property Owner's Name Parcel # Craig Lindstrom MAY 0 9 2008 034 - 1008 -00 -000 Property Owner's Mailing Address Property Location / j 3 9 \ 2976110th Ave. ST. CROIX COUNTY ( (� /J ZONIN Govt. Lot City, State Zip Code Phone um SW '/4, SE '/4, Section 4 Glenwood City, WI 54013 715 - 265 -7811 (Check one) II. Type of Building (check all that apply) Lot # T 29 N; R 15 ❑ E E] W ❑✓ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name F1 Public /Commercial - Describe Use -' ( S. Al Block # A City of ❑ State Owned - Describe Use CSM Number ❑ Village of V 1 48, P 2 Town of Springfield III. Type of Permit: (Ch n " ne x e A. Complete line B if applicable) FB. ❑✓ New System Replacement Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System d D d to I ssue ❑Pe rmit Permit Revision ✓ Change of Permit Transfer to List Previous Permit Number an � Renewal Before Plumber New Owner E y 83 ��/ Expiration IV. Type of POWTS System/Component/Device: C at appl LJ Non - Pressurized In- Ground ❑ Pressurized In -Ground LJ At de LJ Mound > 24 in. of suitable soil ❑✓ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) E] Pretreatment Device (explain) V. Dispersal/Treatment Area Information: / Design Flow (gpd) Des' Soil A pliatio Rate(gpdsf) Dispersal Area Required ( Dispersal Area Propose sf) System Elevation 300 .4 34 750 894 3/2 101.0 VI. Tank Info Capacity in Total # Kf Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks Z2. --I Y 6 A Septic or Holding Tank WLP1000 /600 1000 Wieser Prefab Concrete Dosing Chamber WLP1000 1600 1600 1 Wieser Prefab Concrete VII. Responsibility Statement- I, the undersigned, assume responsibility for in§iallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' gna MP/MPRS Number Business Phone Number Mike Rogers 225094 715- 235 -1132 Plumber's Address (Street, City, State, Zip Code) E4457 , , Hwy 12 Menomonie, WL 54751 VIII oun /De artment Use Onl pproved _ Disapproved Permit Fee Date Issued Jlg'suing Agent gn tpre _Owner Given Reason for Denial $ }� ✓ 1 (� r ' 5Yg?"1 ftg&provaUReasons for Disapproval 1 Septic tank, effluent filter and � dispersal cell must all be serviced / maintained 4Ai), as per management plan provided by plumber. C dLfirt �y .frL . 2. All setback requirements must be maintained qv— J as per applicable CA119ft 92PWR for the system a d sub it to the County only on paper not less than S 1/2 x t t inches in size , SBD -6398 (R. 01/07) Valid thru 01/09 �� 1 PLO K CL S 0.r IA. a 1LS k � 1`tL o � � f �4 16 a Sid b gcopy Ily — 3s' f Safety and Buildings commercemi.gov 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 ' TDD #: (608) 264 -8777 i www.commerce.wi.gov /sb/ epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary I October 29, 2007 CUST ID No. 222774 ATTN. POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/29/2009 Identification Numbers Transaction ID No. 1478506 SITE: Site ED No. 731923 Craig Lindstrom Please refer to both identification numbers, 110th Avenue above, in all correspondence. with the agenc Town of Springfield St Croix County SW1/4, SE1/4, S4, T29N, R15W Subdivision: CSM No. Vol. 1348, Pg. 362 FOR: Description: Two Bedroom Mound System / Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1159217 Maintenance required; Replacement system; 300 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101) - 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 and prior 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 of Sec. 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. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Copim 84 product approval conditions. • 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 P.0.W.T.S. Conditionally APPROW"n ncoA0TKArk1T nF Cnr VII -kCE HENRY F GROTE Page 2 10/29/2007 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 acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 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 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. �l Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: Project Name and System Type: Location: Street Address Legal Description Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey ME Page 11: Copy f House Plans Attachments: Plumber/Designer: Mike Rogers Signed:-., Credential Number: 225094 Date: 6 -7 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner (rM,41 (, Septic Tank Capacity I a1 NA Septic Tank Manufacturer $ Permit # '3 NA DESIGNPARANMTERS Effluent Filter Man er ❑NA Number o edrooms 100gpd/bedroom 2 — D N E u entFilter Model � - /ycQ9 ❑ NA Number of Commmrc Units NA Pump T Pa3' v gal p NA Estimated flow (average)* average) Z-, g al/d ay Pump Tank Manufacturer w ; - E3 NA Design flow (peak), estimated x 1.5* gal/day Pum Pump Man er CJ NA Soil Application Rate c' gal/day p Model� M NA ue�lEflluent Quality (NAE3 Monthly Average Pretreatment Unit In +• p NA Fats. Oil & Grease (FOG) 5 30 m 13 Sand/Gravel Filter D Peat Filter Biochemical Oxygen Demand (FOG) mg/L E3 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5 220 mgt Disinfection p Omer: 5 250 mg/L Manufacturer: Model: Pretreated Effluent * ** Dispersal Cell (s) Quality ❑ Monthly Average E3 In-ground vi Biochemical Oxygen Demand (BODs) S 30 mg/L p At-grade ( ') C3 In-ground (pressurized) Total Suspended Solids (TSS) �9.Mound Fecal Colifonn (geometric mean) 5 30 mg/L ❑ Drip -line p O0er __ <lVefu/100m1 ❑ Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 i-a diameter Model Approval Stipulation *Wastewater Flow Verification on and Soil Application Rate _____g XW Area Req. ` f1r 7_ (Other than bedroom based) Absorption Area Credit per unit fe Minimum Number of Chambers c3 Aggregate Design Flow/Loading Rate- min * * Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM94 and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA 0 "Wisconsin At- Soil Absorption System, Siting, Design & Construction Manual" (Converse etal.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis— ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80-012 October 1980 O SBD — 10570 -P (8.6/99) "At -Grade Component Manual Using Pressure Distribution ❑ SBD - , 10567P (8.6/99) "In Ground Absorption Component Manual" SBD — 10705 —P (N.01 10I) "In Ground Soil Absorption Component Manual" Version 2.0 E3 SBD — 10628 —P (N.6199) "Recirculating Sand Filter System Component Manual" M SBD — 10656 -P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" 0 SBD 10572P (8.4/99) "Mound' Component Mannar' 'SBD - 10691 P (N.01 101) "Mound Component Manual" Version 2.0 c3 SBD - 10595 —P (86/99) "Single Pass Sand Filter Component Manual" 0 SBD - 10657 —P (86199) "Drip -line Effluent Disposal Component Manual" E3 SBD - 10573P (R 6199) "Pressure Distr Component Manual" 4WSBD - 10706P (N.01101) "Pressure Distribution Component Manual" Version 2.0 C7 Drip -line Bflluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGE b AINTENANCE MONITORING SCHEDULE rvice Event Service Frequency Inspect con lion o tanks At east once every 13 months yem•(s) (Maximum 3 yrs.) Pump out contents of s en combined sludge an scum eq one-third (l oftank volume Inspect dispersal cell(s) At least once every ❑ months y ear s) (Maxii ri um 3 yrs.) C lean effluent uent ter At east:once every E3 monthsears) hupect Epp, pump controls & alarm At oast once every ❑ months "year(s) E3 NA Flush laterals an .pressure test At least once every ❑ months s O NA Valves Atleastnnce every ❑ months p y s) Other At least onto every ❑ months p years A ge of START TIP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. valves Valves shall be operated in the following manner. Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certification: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). tic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filters) shall be inspected and cleaned to remove any accumulated solids according to manuhicdtrer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. P Chamber/TYeatmant Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leeks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. E3 In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of / C �dound, At- Grade, In- Ground Pressure V The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface, seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75 % of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the I gevityof the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Baying advances in POWTS technology a holding tank maybe installed as a last resort to replace the failed POWTS. M The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a lastresort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING>> " SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL CON[MENTS POWTS INSTALLER POWTS MAINTAINER Name 44* O.e' 4 Noma Phone '//3 � Phone SEPTAGE SERVICING OPERATOR (Pumper) REGULATORY AUTHO Name Agency, Phone Phone K IWPDATAIE WWf9' OWNER'S MAM1ALdoe Page ' of (No Scale) _Approved Locking Manhole Cover Approved Cap, With Warning Label Attached Wpatherproo€ Approved _ Warning Label Junction Box Vent Cap 1ocX.� •.� l eo k 12" Minimum Final Grade—,,,, 4" Minimum , , Quick '18" Minimum _ , Disconnect 1f4" Weep Hole Baffle-. r Approved Joint A �I JB� W f V_ S�A90 we,_ Extending 3' Alarm Onto Solid Soil On Approved Joie W/4 e � C Extending 3 Off 6' Onto Solid Sc Conc. Block 3" of Beddi nq Under Tank--" 1.5 Note: Pump and Alarm Are On Separate Circuits Tank Manufacturer: Tank Size-Septic Pum` p : �` { O0 Gallons 4 3.0 54k, "`•"• q 1. SU � ,v.�c Alarm Manufacturer: a gjec6p d. Model dumber: Im W- Capacities: A 21 inches or 9b Gallons Swi tch Type + B z inches or 5 a Gallons Pump Manufacturer: 3 + C inches or 677. Gal l ons Model dumber: + D _ i ncheVA -ior fso. &{ Gallons Minimum Discharge Rate: _ �. 2 Total .. _ . _ = 36 inches or . Gal l ons Vertical Difference Between P Off Distribution Pipe: E5 Feet eY1 1(o.'76 Minims Required Supply Pressure- - - - - - - - - - - - - - - - - - - - - - -- - i - 2 Feet 5 o-u 12 Feet of Farce Main x 3.0b Friction Factor/100 Feet: + Feet }} /2 inch Diameter Force Mai n Total .Dynamic Head :... = 15.58Feet 1 3) 6 64' w' :� s W TOTAL DYNAMIC HEAD /FLOW LL PUMP PERFORMANCE CURVE PER MINUTE MODEL 98 EFFLUENT AND DEWATERING 37/8 61/4 25 MODEL 98 4518 Feet Meters Gal. Liters °a 6 20 5 1.5 72 273 3718 u3 10 3.0 61 231 15 4.6 45 170 — t- Y 4 15 20 7.1 25 95 ® 4 o Shut -off Head: 23 ft.(7.0m) j a � 10 — 1- 12zu_12evt � 009971 2 5 I I 0 I 10 20 30 40 50 60 70 80 121116 GALLONS j I ( I LITERS 0 80 160 240 f j 421/32 FLOW PER MINUTE i SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available for with or without alarm switches. variable level long cycle controls. • Refer to FM 1922 and FMO806 for temperatures above 130 °F. SELECTION GUIDE 98 Series Control Selection 1. Integral float operated mechanical switch, no external control required. Model volts -Ph Mode Amps Simplex Duplex 2. For automatic use single piggyback variable level float switch or double M98 115 1 Auto 9.4 1 4 piggyback variable level float switch. Refer to FMO477. N98 115 1 Non 9.4 2 or 3 4 3. See FM 1228 for correct model of simplex control panel. D98 230 1 Auto 4.7 1 4 4. See FM0712 for correct model of duplex control panel or FM1663 for a E98 230 1 Non 4.7 2 or 3 4 residential alternator system. CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Switches, All installation of controls, protection devices and wiring should be done by a qualified FM0477; ElectricalAltemator, FM0486 ;MechanicatAltemator,FM0495 ;Sump/Sewage Basins,FM0487; licensed electrician. All electrical and safety codes should be followed including the Single Phase Simplex Pump Control, FM1596; Alarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupatiogal Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 %c7,, Louisville, KY 40256 -0347 Manufacturers of.. SHIP TO: 3649 Cane Run Road ,.� ® Louisville, KY 40211 -1961 OO PUMP !O. (502) 778 - 2731.1(800) 928 -PUMP QMWrY PutirPS ,ONCE I.R N http: w. //wwzoellercom FAX(502) 774 -3624 © Copyright 2004 Zoeller Co. All rights reserved. FD Craig Lindstrom - Mound OCT 2 SqF� 5 2007 Construction Materials and Techniques eUl OVIV S' All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Pressure Distribution, SBD- 10706 -P (01/01) Mound, SBD - 10691 - P (01 /01) Location: SW '/4, SE '/4, Sec. 4, T 29 N, R 15 W Town: Springfield County: St. Croix Date: October 26, 2007 Owner: Craig Lindstrom Address: N 2976 110` Ave. Glenwood City, WI 54013 `��` �S C O ' HENRY F. Designer: He y Grote _ *. GROTE D -1699 *_ Signature: MENOMONIE" i Wis. ; License: WI D — 1699 -007 ���FSIGNE������ Attachments: SBD -10577 - Plan Approval Application SBD -8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 DIVISiaN OF SAFETY Afyu bUiLUIvIGS 4 ._q EE GGRVRE ONGEI3CE Design Criteria �Vr'S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 0` gallons /day hydraulic load f Design Calculations In situ designed loading rate gallons /sq. ft. per day Depth to estimated high ground water �� Z �� in. Depth to bedrock in. Cross slope at system % `^~ Force main length t 2,- ft. of �� c in. IS" Manifold/header length 3 ft. of 1 � 4 in. Drain -back b 9 gallons Lateral length @ `�'� ft. of �/d- in. Lateral elevation t °�� ft. @bottom of lateral Lateral hole size ���� in. @ fig' ° in. ( 4 ' ° ft.) Spacing 13 holes /lateral 6 holes total Lateral volume b 44 gallons Total lateral discharge rate gallons /minute @ 2 - ft. head Network pressure compensation losses © ft. Elevation difference Friction loss 3 'g ft. @ gallons /minute Total dynamic head ft. Pump /sirkon � gpm @ —� ft. of head Manufacturer Model # S H F 3 0 Dose volume S a ' gallons Lift/sipkn tank LO 00 gallons Septic tank t a-t-0 gallons Effluent filter Measurement pump on and off ¢' in. Height alarm from tank bottom ° in. Reserve capacity 4-o - Z.a gallons specs.calcs.res Page Z of g v0- c� L.�,kc, vNro OZ4--1 "o 2 qk o Cwa�r - �H.+rycw�� (l '"� 1° 13 �4. c�L.4•o t -av� -2 j. `.w � �� l o�tp -CV V QA: JQ 3 O k � 3-0 ! a- ova o..v • 1 � 1. � >,"S Ol l o �, 0 1 tLtir►� 1 i ............ o CL z 43, r� h N S �`V ...1 r, �. 4C. _` ° i' o �► o..�Y -� i o c.� b a� h '\ l`c4' Pvc s�, 4o I / l 11 tt U w: J I 1 \�Ptr.Y }� `"/ Vw`vt �•X�C �� �gvdL�ow� u U � 4 C X i t 1J ¢'4 •.; I 1�� R one i WEATHERPROJ� LACKING COVER JLNCT�o� Gva��v a .c ABED! . ism OVIcK 014000VICT —^, Grade, elev. �� f LQ ---� D IL r 4 7 PVC sch / 40, 3' onto solid ground \4 PVC 2Q I . fl �I sch 40 MA�1u4 vent /A"r .4 wL► 1� P-P 9 c'V L-0 cra s�.c T +� BAFFLE s o � w'c-t �4" PVC (iQ ` a AL sch 40, �' O r o Lp R�" m Rtit -14� f1 ON ^ 3' onto La Nt� \ITL T O hL C solid CLUi ev :1 o...,a..t �.o•' �'Z'. ground P urlP C o Nt�e E-r� X2.0 14 .E SEPTIC t _SPECIFI'CATIQFJS TAU. S MAUUFACTURCR: QUMbrR OF OOSCS: per day TA ).J K SIZE: `').� taALL0QS DOSE VOLUME A_ARr1 M/JJUFACTURER; S J �,�r� IMCLUOING 6ACKPLOW: S �'� gallons MODEL WLIJA15ER; ` �� ` CAPACITIES: A= '� WCHCS OK 4oZ'3 gallons SWITCH TtIPC; - w"p Z 8= iuCHES OR gallons ✓u ^.� i ° 7 7"- C • ' , uC<S OK S �' b gallons MODEL QUMDCR; S Nv Iz 3O �3 4 .1 D ` � •J INS HES cR gallons SWITCH T>jPC; VwQoA4674v ,, WOTE' PUMP A1JD ALARM ARC TO DC r11AJll'1Uf*\ OISCMAIIGE RATL = GPM INSTALLEO OW S[ PA RATC iaLu v[R,rIcAL o�rFCRCWCE OETWCC►J PUMP OFF A►JO OISTRIDUTIOw PIPE., FECT r,iuIMuM WETWORK SUPPLY PRt;$UKC , , , , , , , FEET * 12� FEET OF FORCE MAIN X 3 ° 0 b IFT✓✓ /100►LFRICTIOW FACTOR. �.� FEET TOTAL 0t3Qkm1C. KEAD - FEET �2� F TA .�2 IUTER►.1AL. DIMEIJ61OA1L • O►JK; LE►.1GTH J ;WIDTH ;LIQUIO OCPTH ti `f Engineering Details - 1 Pump Characteristics Performance Data pmf IlAolor uedt SerbOWS161+ AoEewatk #446 S14EE30A1 WM40ew" •30 j FW W Amp A4•ter Typo Slated Fels 14 1 ' VAL 1554 ►lase 8 - Velt 115 Hoyt: 60 I l t Wmp•rotsr• 120 AtItN«n NUIIA D•s4n A uwuswr s 1 t s bts•IatiM Gas A Dectlta She I - I/2• N►T ISitrta0 ivtel K*4d foot 4 1 i 11 1 16 1 ZO 24 5914 Mete 3/4' I14wtt1 GPM (U.S.) 44 26 29 SS 12 0 Usti Wolglt 30 bs• hw•r Cord 16/3, S W sht Dimensional Data Materials of Construction (mom IN W* '. tee. 1i w� i (a9t Mwdat mg) a Netedl• S1�s1a: Sto•I my 2 U1 ed+ A tobrkff* OA DWKtrk 011 e't WO ObWWM Motet Ro" Cat WON o t � Igo n p S. t1a/0A brit a{ MWI PVW Ges tat Ma 4, we fora M * o male ,New a W prilw eed rAet Nleclettkal SMIEtxos: /(crack �pe3lmfaroeltl°Naelke sl,olt S•d W hdr A&O" Stool �, �• WS: bWN r E 1k con IoM Sorn :ion loww Raw W satin 11Ho $1k r�> ► s l'3°�.► tv f Fostow Steid•ss Stoat 1999 H dromotic' Pumps, Ashlona, Ohio. AP R' b Aeaved. I �,` f HYDROMATIC w - Yow Authorized Local Distribvtor - %141 U 16401aney Rwd AsNaad, Cho 44105 14: 419-269-3042 Feat 419. 211.4017 Web Site: ww•p4aloump.com t rte, SALES OFFICES IN ALL IVAJOA CRIES AND COUIVI11115 item w: WU2.0350 1200 5M System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Department, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, Aseptic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run - off, final settled slope should be 2 -3% over the system or 2 -3% diverting surface run -off around the ends of the system. Maintenance I . The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system al lo\\ s reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designin`,, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 I ORIGIN (, #2632 ° SOIL EVALUATION REPORT Department of Commerce i acco dance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site plan on paper not les n 8%2 x 11 inches in size. Plan must County �n St. Croix include, but not limited to: vertical and horizona'T9fete"9&4 pl Ut &), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and stance to nearest road. 034- 1008 -60 -000 Please print all Information. Review By Date Personal information you provide may be u w, s. 15.04 (1) (m)). 16 O Property Owner roperty Location Lindstrom, Craig � ovt. Lot S011 14, 1/4, S4, T29N, R15W C Property Owner's Mailing Address of # Block # Subd. Name or CSM# 2976 110th Ave. CSM V 1348, P 362 City State City ❑ Village ® Town Nearest Road Glenwood City I WI - Springfield 1 110Th Ave. ❑ New Construction Use: ® Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments install 6 x 62' rock cell mound on 99.7 -100.0 design line as upslope edge of rock w/ at least 1 sand fill and recommendations: (sys elev @ 101.0) @ 0.4 gpd /sq ft basal loading F- g Z Bor # Boring ®Pit Ground surface elev. 99.0 ft. Depth to limiting factor 30 � in. Soil Application Rate Horizon Depth r Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EB #1 •Eff#2 1 0 -3 10YR 3/2 - sil 1 f gr mvfr gs 1f /m .4 .6 2 3 -9 10YR 3/2 - sil 1 f sbk mvfr cs lm .4 .6 3 9 -18 10YR 4/4 - sil 2 m sbk mvfr gs lm .6 .8 4 18 -25 10YR 4/4 - sl 1 m sbk mvfr cs lm .4 .7 5 25 -30 7.5YR 5/8 - fs 0 sg ml cw if .5 1.0 6 30-40 10YR 5/4 c2d 7.5YR 4/6 fs 0 sg ml aw - .5 1.0 7 40 -50 7.5YR 4/4 - fsl 0 m mvfr cs - .2 .5 [ 7 ia] Boring # ❑ Boring Z Pit Ground surface elev. 99.0 ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Etf#2 8 50 - 54 10YR 6/4 - scl 0 m mfr - - 0 0 Effluent #1 = BOD 5 > 30 < 220 mg /L andO >30 < 150 m /L • Efflu nt #2 = BOD < 30 mg /L and TSS S30 mg /L CST Name (Please Print) Si nature: CST Number Henry F. Grote U . 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 10/11/2007 715 233 - 0398 ss SBD -8330 (R.07 /00) I? Property Owner Lindstrom, Craig Parcel ID # 034 - 1008 -60 -000 i " Page 2 of 3• 2� F ❑Boring Boring # Pit Ground surface elev. 99.7 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ _ - Eff#1 •Eff#2 1 0 -11 10YR 3/2 - sil 1 f sbk mvfr Cs lm /C .4 _.6 2 11 -17 10YR 4/4 - sil 1 m sbk mvfr Cs lm .4 .6 3 17 -25 7.5YR 5/8 - fs 0 sg ml Cs 1m .5 1.0 4 25 -37 10YR 5/4,4/4 c2d 7.5YR 4/6 fs 0 sg ml Cs - .5 1.0 5 37-46 7.5YR 4/4 - fsl 0 m mfr Cs - .2 .5 6 46 -50 Gll 6 5GY - scl 0 m mfr - - 0 0 ❑ 3 ❑ Boring Boring # ❑ Pit Ground surface elev. 100.7 ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0 -4 IOYR 3/2 - sil 1 f gr mvfr gs if /m .4 .6 2 4 -11 10YR 3/2 - sil 1 m sbk mvfr Cs lm .4 .6 3 11 -21 10YR 4/3,4/4 - sil 1 m sbk mvfr Cs 1m .4 .6 I 4 21 -30 10YR 4/6 - fs 0 sg ml Cs if .5 1.0 5 30 -35 10YR 5/4 f2d 7.5YR 4/6 fs 0 sg ml Cs - .5 1.0 6 35 -52 7.5YR 5/8,4/6 - fs 0 sg ml - - 5 1.0 @ field capcity below 35 "; side seep below 45" F 4 ❑ Boring Boring # Pit Ground surface elev. 99.3 ft. Depth to limiting factor 0 in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff #2 1 0 -8 7.5YR 3/3 - sil 2 8 -46 10YR 5/6 f2f 7.5YR 4/6 s 3 46 -50 7.5YR 3/4 f2p 7.5YR 5/8,5/3 sl H3 is tight, weakly cemented ?; lacks A +4 ", presumptive limit is 0'; adjacent to apparent dry well which measures 6' below grade to soft bottom; WI Fund Category 1 failure Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L ' Effluent #2 = BOD 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 - 8777. SBD -8330 (R.07 /00) Certified Soil Testing, LLC i Property Owner Lindstrom, Craig _ Parcel ID# 034 - 1008 -60 -000 `'' _ Page 2 _of 3 ❑ ❑ Boring Boring # Pit Ground surface elev. 99.7 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture 'Stricture Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efffl Tff#2 1 0 -11 10YR 3/2 - sil 1 f sbk mvfr Cs lm /c .4 .6 2 11 -17 10YR 4/4 - SO 1 m sbk mvfr cs 1m 4 6 3 17 -25 7.5YR 5/8 - fs 0 sg ml Cs lm .5 1.0 4 25 -37 10YR 5/4,4/4 c2d 7.5YR 4/6 fs 0 sg ml cs - .5 1.0 5 37 -46 7.5YR 4/4 - fsl 0 m mfr cs - .2 .5 6 46 -50 GI1 6 /5GY - scl 0 m mfr - - 0 0 3 ❑ Boring ] Boring # Pit Ground surface elev. 100.7 ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMI in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t •Eff #2 1 0 -4 10YR 3/2 - sil 1 f gr mvfr gs 1f /m .4 .6 2 4 -11 10YR 3/2 - sil 1 m sbk mvfr cs 1m .4 .6 3 11 -21 10YR 4/3,4/4 - sil 1 m sbk mvfr cs lm .4 .6 4 21 -30 10YR 4/6 - fs 0 sg ml cs if 5 1.0 5 30 -35 10YR 5/4 f2d 7.5YR 4/6 fs 0 sg ml cs - .5 1.0 6 35 -52 7.5YR 5/8,4/6 - fs 0 sg ml - - .5 1.0 @ field capcity below 35'; side seep below 45" ❑ 4 Boring Boring # Pit Ground surface elev. 99.3 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 1 0 -8 7.5YR 3/3 - sil 2 8 -46 10YR 5/6 f2f 7.5YR 4/6 s 3 46 -50 7.5YR 3/4 f2p 7.5YR 5/8,5/3 sl H3 is tight, weakly cemented ?; lacks A +4 ", presumptive limit is 0 "; adjacent to apparent dry well which measures 6' below grade to soft bottom; WI Fund Category 1 failure ` Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) Certified Soil Tesbng, LLC � n cU34- -\ " Y5.1 3.sh � r `l 31 + ,g t- t Ck " ,a� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerfflW x Mr. Graig Lindstrom Mailing Address Tx j2q76 1 1 ntr Avp , r'i Pnwood Ci ty, WI 54013 Property Address same as above (Verification required from Planning & Zoning Department for new construction.) City /State Glenwood City, WI Parcel Identification Number 034 - 1008 -60 -000 LEGAL DESCRIPTION Property Location sw _ ' /4 , s - E_ '/4 , Sec. 4 T 29 NR 15 W, Town of Springfield Subdivision , Lot # Certified Survey Map # N.A. kq-Vt z l L ' OA4 '`; "'volume N.A. , Page # N.A. / f l ay Z Warranty Deed # ��0`[ 1 , Volume , Page # Spec house USX no Lot lines identifiable yes XR% 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 (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/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 Wi$consin. 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Ilwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. A(. Number of bedrooms two y GNATURE 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. 08105) r - VOL 1 - 34 S PA c - 16 Orr 5 , 8 504 11 - STATE SAP, OF WMCONSIN FORM 1 - 1982 WARRANTY DL DocuMENT NO. ST. OROM C-o„ W1 _ Itie'a kdr (t�aard This Bred, taade hiinux S is. AUG 1 4 1998 9:15 A , tl Grantor. and e/ bs�rfa grantee. VAtne Seth, T im the said cra um fora t- .duabk G T 1 ti " convcys to ` nlea' the iotlou u1g de c-riDtd real estate in ' • C C J : X " %= t SPAC aGsEnvea FDA aacee:av�e aAr: County, State of Wtsr-oresn: xWAE AND n=nupm AoC E ss A pnreet or t1.e �*.ve Half (S-%) or ; � 0- t oo 'U E 5 ^ >!e South Eajc Quarter (5£ '" of se.tj m a ievrtahlp LL d.. � , -5 = "31'lorch of range fiCtt -ems (t5? vest, descrlbed as '� ! at a po int !320 feet east of the seven .est corner(Sy) oC the south east ou.arter(S£A of aeetLen 4, tic — nship (2•9) noreSf , sr range fSFte•e.t {lS) sresc; Chance north 254 Ceet; thence ) v 153 Ceet; thence north 200 reet;thence east Se35 Ceet; thercr South .1 Ceet; thence vest 3_ feet co••ahe point of beslnn Lng• i PNGEL t0_Nf1itCAT10e1 2"MEA Grantees hereof agree that there shall be reserved to "a J q ttratltors, their heirs ZnJ .aSSingns, an easement upton and over the drtvera3 aresentlq situated on sa_J prealoes for vehicular land foe - :rave!, xLth the rights of .ln,;ress and egress; and alsci the arantaes rurcher agree, for G�emsetves, their heirs and aos L;,ns, to furretch water to Via barn th ough the present cistern nyacea,. or throua,h a preasvra Sj %tea In t he event they change the syscea. Except the jrrnntors heraoC shal)- nalntaln the pipe system Croat the cistof,t Lo the bare; than cte gretntors s;1011 have the rl.;;ht to make entry on the propert gnat oreratn Cn and raintain said well ano .ater system, F - ER This ^ ���fi r�d homestead property. (is) (is not) Together with 311 and singular the_ hereditaments and rppiurienances thereunto belonging; And _ warrrnts chat the title is goad. indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. f Dated this <� ! S} day of _ �� t9 . _ (SEAL) �.• CSC .-.� - (SEAL) Tim ,� (5[Li AUTHENTICATION ACKNOWLEDGMENT State signature(s) -- LC County. authenticated this flay of _, 19_ Personally_ came before me this , doy of IB� , the above named Y Q TITLE; h7EMBER STATE BAR OF WISCONSIN ' (If not. a o• ! :vF.o executed the foregoing authorized by §706.06, Wis. Seats.) to me known to - C- pe�soF`;,...�..,_ g B instrument and ackrp!X dge the me. THIS INSTRUMENT WAS DRAFTED BY • •tk1 tD A ' )" _ v ( _ Ej T77% Notary blic.._ —4 9, t Count , Wis. —�_ Y (Signatures may be authenticated or acknowledged. Both are not My commission Ls lea t',',Yjj , state ex i lion dace: •�- .19 J necessary.) - . JEAN R. JOHNSTON vane of pvs, ns sign ;ng m any capacity should by typed or It nied below th— signatures. N NDary LS SC'Q Ubitr� STATE BAR OF WISCOSIN 0 �� �f _. YVi n I Laps/ W .. Inc. Form No. 1 - 1982 v M ee. W.S. C commerce.wi.gov Safety and Buildings Division County 201 W. Washington ve., P.O- Box 7162 St. C Y o i X i Madison, W 707 -7162 s e o n s i n Sanitary Permit Number (to be filled in by Co.) Department of Commerce 51q 1,3 Ap Sanitary Permit Applicat>i State Transaction Number In accordance with s. Comm. 83 .21(2), Wis. Adm. Code, submission of this form to the appr - e governmental tranq 1478906 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owne vTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information ary u ses in accordance with the Privacv Law, s. I5.04(1)(m), Stars. Pri t _ / 1 0 I. A lication Information - Please II Information p Property Owner's Name � � Parcel r Ildskroal M 1 2$$$ 034 - 1008 -60 -000 Property veers tailmg Address Property Location �3 6 N2976 110th Ave ST. CROIX COU NTY � �, Go L Lot City. Y Zr Code Zip ' /,. Section sw %, Glenwood Cit , 54013 (circle one) x II. Type of Building (check all that apply) T N; R 1 5 Kor W Lot � ! or 2 Family Dwelling —Number of Bedrooms _ two Subdivision Name Block El Pubhc/Commcrcial - Descrrtx Use _ ❑ Cih of Num El State Owned - Describe Us, � CSIVI ❑ Village of 11 `e s z A O Jagown of Sprj ncif; el d III. Type of Permit: (Check only one boz line A" Complete line B " pplicable) i A. ❑ New System Replacement System ❑ Treatment /Hot g Tank Repl S h!tp to� explain) - - f B. ❑ Permit Renewal ❑ Permit Revision ❑ Ch a lumber List Previows Permit Number and Date Issued ❑ Permit Transfer to New ! ' Bcl'ore Expiration Owner I V. Tv a of PO\ \'rS System /Coln onenttDevice: (CIIec6AJIt t a ly ✓ ❑ Non - Pressurized fn -Ground ❑ Pressurized In- Ground At -Grade Mound 2:24 in. ofsuitable soil ❑ Mound < 24 in arsultabje s it ❑ Holding Tank ❑ Other Dispersal Component (explain — E) Pretreatment Device (explain) 1 / V. Dis ersalll'reatment Area Information: Design Flow (gptiy Design Soil Appiicatio te( f) Dispersal Area Requi Dispersal Area Pro ( System Elevation 300 '� 0.34 300bed 312bed ��'� 101.00 \ Tank Info Capacit n Total # of Manufacturer Gall Gallons Units U y , Nm Tanks Existing Tanks " - o u � c W GrG� G6 � v Septic or Holding Tank Dosing Chamber F,nn 600 VII. Responsibility Statement- , the undersigned, assume responsibility for installation of the PO\ \'TS shown on the attached plans. Plumber's Name (Print) Plumber' Signatu MP /MI Number Business Phone Number i Jack A. Bowman MP222839 '15/235-4634 Plumber's Address (Street, City, State, Zip ('ode) 2819 Knapp St., Menomo le, WI 54751 VIII. ount /De artment Use Only Permit Pee Date sued Issuing ' nt Signature pproved [] D pprov S %� R ❑ teen Reason for Denial �t)b , 3 ' Z V I\. CondiVWE" easons for Disapproval \ 1. Septic tank, effluent finer and J TP dispersal cell must all be services / maintained L4 G as per management plan provided by plumber. 2. All setback requirements must be maintained aspera *19h e sure. and submit o the County only on paper not less than 3 It' s l l inches in size ry 1 n 6 •.. SBD -6398 (R. 01/07) Valid thtu 01J09 I tf . ,. ; ML ,, 1 tTu F � TMA W -Irlor PUMP PERFORMANCE CURVE MODEL 15111521153 50 i53 12 40 152 c 30 8 20 151 4 10 0 20 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE "QUALITY PUMPS SINCE 19-7 Too of PM •Web pages created and maintained by Zoeller Company © 2008 Zoeller Company. AU rights reserved. Send information regarding this web site to webmaster @ zoeller.com r hq: / /www, zoeller .com /zcopump/Products/onsitp /151 152 153data.htm 4/23/2008