HomeMy WebLinkAbout034-1026-70-000 (2)Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)],
Permit Holder's Name:
City Village Township
Jacob Utphall
TOWN OF SPRINGFIELD
CST BM Elev:
Insp. BM Elev:
BM Description:
r
TANK INFORMATION
TYPE
MANUFACTURER r
D reV,-,L.0 9
CAPACITY
Septic
Dosing
Ae ra
Holdin
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
\/ 0 �
� )
� r
Dosing
L(
-5 k
Aer
Hol
PUMP/SIPHON INFORMATION
C., -;C) 640t�UCQ
Manufacturer
OE LI.,C-2...
bemaed
GPM
Model Number
1�
TDH
Lift ���
1 z�
Friction Loss
16o `
System Head `
�{.
TDH Ft
-3
Forcemain
Length
I
Dia. 2 ,�
I
Dist. to Well `� 5
I
�
__j
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
648412
State Plan ID No:
Parcel Tax No:
034-1026-70-000
Section/Town/Range/Map No:
12.29.15.182
STATION
BS
H I
FS
ELEV.
Benchmark
(s,.b0
`ob,bo
�
00,D
Alt. BM
Bldg. Sewer
z�-�
o.
f
gs'.�D
St/Ht Inlet
25-.t{0
J1 Q'1r4�%D '
V
St/Ht Outlet
Dt Inlet
Dt Bottom
1
Header/Man.
qms-
Dist. Pipe
q.15
!
1016�
Bot. System
fo p
`
1
101.0
Final Grade
+
Ist
flt�
Cover _ t�
t �. ` "fin.19.10
BED/
DIMENSIONS
Width r
Length r
9D
No. Of
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Ma fact r:
Type Of System:
l DO
15V
} �
11> boo
odel Nu er:
DISTRIBUTION SYSTEM
Header/Manifold
Distribution f 1( f
Pipe(s)
1
x Hole Size
x Hole Spacing
Vent to Air Intake
Length Dia l Z
2. S^ V
Length Dia Spacing
1
-
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 01 3 t j2o23 Inspection #2:
Location: 1098 RUSTIC RD 4
1.) Alt BM Description = MIA V p mc.>w�.
2.) Bldg sewer length = 1K !f �guc_ . t.53
-amount of cover = } 14 2 ct
C6,r Ply "UAX �0 , XA, s tie 6 r,M.eC1 bkr
�)VCL
r-ebvlision Required? ❑ Yes No r
1 3ws"2*�
Use other side for additional information. 23
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
� n3
(.ounh,
afetj and Buildings ision
201 Washington Ave, P.O. Box 7162.
FEB 0 7 2023 Madison, Vol 53707-7162 Sanitary. Permit N
kk fi U itt by
St. Croix C Owl'
Z
77-
Corq
7# State Transaction
si64W . plication N uni�v
It) accordance witil SRS 383.21(-2-). Wis. Adrn. Cbde, stll'-',�mission of this form to the appropriate g0vernrrental. unit 00
is required prior to obtaining a Sanitary permit. Note. Application forms for state-oNvned' P(,-)WTS are subm' Z 3
itted to Project
the Department of Safety and Professional Services. Pe:rwna"1 infonnation you Provide mav be used fbrsecondary
TIM"es inkdance with the Priyacy Law. s. _ 04LI Address ("if different titian mallincy address)
'LM Stats.
L Application Information — Please Print All Information
r_ty��.S..........
Prope OwnSL:_ --------
Property ownerl�s Mailing Address �— 0 Z/o -7()
ss Property Location
LfSj �kA S'�_
City, State Z I P C'.ode (_'Jo%,i. Lot
Z
Phone Number
PAX,. _Uaj_I a
(circle ore)
Ile Type of Building (check all that apply) Lot #
['29 N R West
I or 2 Family Dwelling — Nunilvr of'Bedro,oms 3)
'Subdivision
Public / commercial — Describe use Block # f 111% 4-
tate owned — Described use
13 City Of
011 A-Y of wI_3Z!F_
Ton of
411.-Vyvpt of Perm
it: (Check only one. box on A e m p lete 1-1i n e B J F a p licable)
New S: ystem Replacement Sy1.1cin nent/Ho1*Ttn_gTan1: Replacement
Y Elother Modification to Existing Svstem (explain)
Permit Renewal Permit Revision Change of Plumber 11 Permit Transfer to New I- ist FlrevOus Permit Number and Date Issued
Bcfore expiration
IV. Type of POWTS SYstlem/Com__�—`
port en VDevice: (Check all that apply)
Non -Pressurized In -Ground Pressurized In -Ground At-GradL�Aomi.,d 24 in. of' suitable -jsoi Mound 24 in, of suitable .s-43jj
Holding Tank Other Dispersal Componert (expi Pretreatment Device (explain'f
&4
V. Dispersal!Trestment,Area Information:
6
Design Flow (gpd) Design Soil Appli�ition Rate('9+1f) Dispersal Area Requined (sf) 136persal Area Proposed (0) Elevation e-0
Lt, L-t G 0 Ll c. _....._
> ---- ----
V1. Tank Info Capacity ill Total 0 of Nlanufacturer
Gafle-ils Gallons Units
New I'anks Existing anks, T
XWAv g
aw
Septic Tank T
Iwo W 1 1 _SFO,14�11.
Lift Tank t L cr-. __.._.. _.._w.
- ib
VII. R!�.s2oLnsij)ili!x Statement 1, the undersign as$U installation of the POIA"I'S shown on the attae-hed plans..
res onsi
Plumber's Name (Print) Plu rg11Z1�1n_a_ t —ur c
Nfi`/MPRS Numbcr Business Phonc. Number
Lewis Rjork 253,976 715-231-7375
City, tnto 7i I" A --------- - Plumber"s Address (Street
E7818 Co!��t Roacl E Menon-io*e
W1 54751.
III. County/Department Use Only
V
Approved 0 Disapprove Permit Fee Date Jssucd 4sui ig Agent S Igillatu 4!
s 101A V n for Denial
I. Condition
A K%saftral-7
YVffM"WW N�Ep R:
1. Septic tank, effluent filter and dispersal cell
must be serviced / maintained U Per
management ed h
land
.All All r
"+ti
tSA"t I qL^. OUA
4L,
SB 0
C X(
Na
�> &, I
�I�i NU.1 S
4 �sw�mtallo�SKw�Fi
CHECK BOX AS APP0GA$LE.
SOIL EVALUATIONScale.-T!-30'SYSTEM
CHECK BOX AS APPLICABLE.
SITE, MAC' 0- 30 45
F2=
60 N
PLOT PLAN
JECT Ni:
752
DESIGN FLOW: GPO
Jacob Utphall
Attach deslign flow calculatims for commercial plans.
PROJET APDRESS'.
Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5)
8 N ow
M FT S5 y ntd 00- W"-"
SanNary Sewer.,,44 q 0-
jW
Force Mah,
Bm Desc#tk�n:
SloGradwInctiosta nonh try
pe o Well Symbd (I appllcab�e)-. draw(N an amy
of Tested wooJL 1 /-1
IMI6NT,, -
E!QR
ma
Show ground elevation contours at suitaNe irdls,
.4 qn 1�* appmpflte Me.
e,- Tv
VV\j\4Xme VL J��j v4ww "� I
-A 7"53 4114
9!
717
" oesm As044
N
�oos�ss�- �.u. �s�rx
,�-� LirLtU6
FLI too'
LiLUD 6"
4, M4wJi,-�r p
Asa
0
V
m
Lkwsa-1
Wisconsin Department of Safety and Professional Services
Division of Industry Services
4822 Madison Yards Way
110 Box 7,302
Madison, W1 53 707
January 12, 2023
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2025-1-12
Plan Review: PWTS-012,300069-C
Lewis Bjork
E7818 County Road E
Menomonie, WI
SITE:
Utphall
:1098 Rustic Road
Town of Springfield
St Croix County
NWY4NWY4S12-T29l\l-R1SW
FOR:
Phone: 608-266-2112
'Web: liqp://dspL1Li.�Ov
[-mail: t,kp I [is I f 1.ga
P
Tony Evers, 41-1rovernor
- Dan Hereth, Sect eta rWy
Description:3 bedroom-450 GPD mound-24"
to limiting factor- Effluent Filter -
Maintenance required.
Ccwditionafly
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
Mound Component Manual — Ver. 2.1, SBD-
1.0691-P (5/221-5/27)
Pressure Distribution Component Manual — fifer.
2.1 (May 2022-2027)
Verify proper dose is achieved and system is not being over closed.
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This systern 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(lo), 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,, stoats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and
removed. To avoid matting, any leaves or loose organic matter shall be raked up sand removed. Cut trees
and shrubs flush to the ground and leave stumps. Avoid operating equipment on the
Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid
compaction.
• Components and sail removed from an existing drain field shall be properly disposed of so that there is no
risk to public or environmental health.
•
A sanit-ary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19, Wis. States.
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made
with the clesignCated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis.
..mats.
A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
A, copy of the oproved lans. spec
-p ifications and this letter shall be on -site during construction and ppen to
iris gn by au
thorized. representatives of the Department which may include local inspectors.
owner Responsibilities
The current owner, and each subsequentowner, shall receive a copy of this letter. Owners shall also receive a
copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s. SPS
383-54(l).
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 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 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 and the POWTS management plan to the owner and
any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
41091 .0
U/UZ/
Joshua Rowley
POWTS Plan Reviewer, [division of Industry Services
(715) 634-5124
Joshua.rowley_@wisconsin.gov
r
La
LA-) e, Ll
PAGE 10F 6
Mo ur! d 1l*r' I a n
Index & lltoU re.,.4tm Sheet
Comporient Manual Design References
Mound Version 2.1 (May 2022-202) & PresSUre Distrib(ition Version 2.1 (May 2022-2027)
P Of 6 Index & C..JOVer Page
Pg 2 of 6 Plot Plan
Pg 3 of E Mound C ross- i
Si--�ct'on & Plan View
P g 4 of (3 istrIbUt n Net -work Specifications
Pg I N" of 6 Puny 'T"Ei n Specifications
Pg 6 of 6 fng'ii-)n F]Ian
Aittachments.
,-Pump Curve
Tanks
effluent filter
Enclosures:
PCfWTS._Application for Review_
Soil Evaluation Report &Site Map
Project Nai"ne / Description
a.tL
Ovonef, Nanw�s)t' 'IVA Co. r Pn'q Phone:
r)
Zip: 15'�-745-( lovnei- Addres9S. 9
C
F" 1r, r:,)j o, co Acid res4s
W
t, Lot: 1/4, Section t 2. T -N-R.L'��_E L
To
1� c'
Ipc wnsh" County., -.�s
Pro'ect Pamel ID #-N C- �- Q (-D
Designer lnflorr-nation
Designer Name: Lew Phone: 715 .231 .7375
Designer Add re:Nss: E7818 Co:u my E Menomonie W1 Z-p: 54751
0l
1%
E-mail ,, ewic,�obj(:)rk@yahoo.com
Conditionally
Lijeense Number: MP#2531976 APPFtOVED
DEPT. OF SAFETY AND PROFESSIONAL
Remarks: SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
Signature: Date*.
Cori trial sigo-')-atir#7 ri�qUffeci a,*. each submitted copy,
�i�_h5w sizr�4N Q�sw�iUWNaFSK.�N(,�1
- TO
F Y^ 4el-w J2 02
6C CDJA
CHECK BOX AS AP4%*;AHL�- HECK 00X AS APPLCABLE.
1 30'
SOIL EVALUATION SYSTEM PAGE 2 OF
SITE MAP 30 45 6011e PLOT PLAN TEscjN
PROJECT NAME: . .....
DESIGN FLOW: Gpo
Jacob Utphall 7
Attach deslign How calculations for commemal plans.
F!RrDJ F TADDRESS: os- Pipe Matedal J ASTM (Tables 384.30-3 & 384.30-5)
N Sanftary Sewer L4►
Bm Elevallon: Lo- j.
AS+Aj dp--O-n Force Maln,
"C 1) 6r F4�gje% -IF U-J
Slope Uradienl
WeyMap IMPQRT`6NT
ll sff*)d (c-aW drawi-ij; a-1 arrim
of 0 Show ground elevation contours at suitable intervals,
ILI
on 0* appmprile fiw
I G
0001�
Ir4v a
Ir
rnntmV.. i�1.�J�w- Lw,�s� ��
-A --z'53 9'r G
.� �wd1
loco
'wpo".. ' cyrw sod-4.
N
y� ` yPt��►oo'
►�OOSPSSF(" �cu. ss�5cw"�, L�� )�uD SI��I
1�R-'i
C ILO*
0.5" TO WAS EiT AGG REGAT E
(Min. 6.0* beneo-th diz>tTibutbn plipe - min-2.0'
-01W diSttiti,itik')n ;pie and Covered vvith
E IF.
a ppuvt Ve fahrir-�
2 1 1 1 VL- L f-- kPY
L E`CEL
L
A
MOUND DISPERSAL AREi i
N 4141 1 sk", 6.00 OF TOPSOIL COVER
ASTM L.-30103. SA%D F,11 I
min. 0.5 ft
0
min, 1 .0 ft
M
1=
Stem Elevation -=
Lateral Invert Elevation --
f
mow%
ft
ft
R SSVIL:IAI 0 -.,
ft (Nr) Scale)
D- ------- --- E
-4
IL
Or
PbWed SuffaLce =�f -_ ` fL,,,'
X
Surface Contour % Slope
( toldand flush valve locat"ons on plan
'-Now lurce no a t. irnam", view.,
PLAN VIEW
n
N
' -
Ile 0 Schdi 40
PVC 'Lateral ft ft
(typical) i #L1 J0
ObservaUm
W
q0
ft
K ft
ft
(typical)
Bend as necessary to follow contour
DOWNSLOPE TOE
L ft
Prohibd disturbance and vehicular traffic
within 15 feet of downslope. toe.
Reset Page
NE"v%lu DECIFICATIONS
U I
- -u N NK 6,
(No c -0 Schdl 40
PVC Force main
FL U l�ALV �T 1 --;
(slv� to PUMD tank
11_
\ Onser Pipes for drain -back)
(No Scale)• ' N PS F
O1ce 1nValve Box
Center of Threaded Cap S_
f
(insulation onbor.,-- "
for Head Testes 1.5
0 Schodl 40 First 06fice
It UpItional) icallf
Shield orifices forPVC � p
liess applications
Ba! V21 v --- _, Laterals to be level
(option a.) Schell 40 PVC Lateral 0=1 # 5 in
f
; Number of Orifices per Lateral w 3
%N_ 1, t!l
Cktfices equally sue:jowk a) OR b) below] . .--
` Oidfice Discharge Rate = ;M
a t2n along bottom of lateral Orifices equally spate P
Flush Va_ bottom l?atera alf
along top of tateml Assembly
Number of Laterals
(typical - see detal) x 4 �
if d" th cur ;..�., x
Liz
fa6N dawn R Lam` DLvf:arge Fate = _ gP
Last ��� --� _ �'
LATERAL. INVERT ELEVOrff.,.e Spacing (X in
O- TIO = � ' � �; ��������
TOTAL. DISCHARGE RATE -- 24 •011 GPM
(typical) 513Z
Orifice Diameterin
W ; ,I F Est r�P
(eal}0
----�ti
OBVAT10"N P i rE DETAIL r._
E ----- .. (No Scale) X ' END MANIFOLD
_ (ypi11
Screw -Type e or .1 ICONNECTION�
- } Find Grade Check
Slip Cap (Ioosiz)
I. cable box.
TVManifold
A PVC Pam .. Topsol Cover st Q�ce (riser p� optional) U
z of p� to t d in. of l)
a I Dr above fhed grade
# dr M
'TER MAMFOLD
Anchoring Dever � ' * Infitration CEN
Manifold
,r rT
Surface riser o t�l ..
PAGE 5 OF 6
S1***E"PT1C.# PUMP TAN K SPEC IF ICATIONS
(No ice'
.a w rx w f �%. 0 Cl.-... A)
0 N Vt"It %.AJ �
fly; W1 I ev 1.
Arichcr tank(s) as necessary
punsuart to SPS 383-43(8ft
Finqshod (1
ad&
"
WROMM
JJpwVtTU L.U%'?cInq Manrom
with Wamog Label Altschad
(typical)
4" Min, or;!.O ft aWve
EStablished Pwd Eieve*n
Extend hiser es nece,.-O,,ary.
CAPACITIES @ gal/in >
Deptii (in) Volume ((jai)
3 3, e) Z.
IQ
i
10) in
.-
A
.--
B
[C Purrip
R.irrip'Tank. Liquid Lzjvel',
F r (.-,e Main Diarnete),r
*mom
3" Appiwa"
Force Main Length D ft
Force Main Void Volume
[C] lotal Dose "7r galldose
1-,."(5X total lateral void voturne < TDV < 0.2X design S)w)
+ (forcc,,. main drainback V(Aume)
MIN. PUMP DISCHARGE RATE gpm
FDUMP TAJ'14K
'Volume gol
Manufacturer:
Pump Manufacturer. Z,4D;-J11 �IAL
"mom"
P�ump Model.. w W I (s. atLacried p�- rr' ro ca rve
C I ontrols/Alarm Manufacturer:
C.ontrols/Alarm Model: NO
Fl at switches containing m!prcg[y.-C--1M._Dr0hibited,
B&M
Weep
Hdo
(typical)
Quick 04conn4mt
----w
f typical)
Awovedo'oints NvItt)
Approved Rpe 3 9 onto
0
Soid Groure
Oypl(*
MU St com C61
e
6 and NEC, 3G0
Wealherpmf
Junction Box
--M arr"I
FF PUMP-Or-
)tb� Off ELEVATION ft
INSIDE BOTTOM
SICK* ELEVATION -
90
isnai Beneal 'rank
lo. (0
'Vertical Head - ft
+ Min. Supply Head ft
+ FM Friction Loss= ft
+ Fitting Loss
(min. supply head x 0.3)
Tom. DYNAMIC HEAD - ft
S E: P TA C TA N
Total Vowme LOCI gal
Manufacturer(s):
Install apprqved e
luent filter at the qgktjc tank outlet
Imm Ja _upstre,pM of the purnp 1. rh. i det,
POP
Filter Mantifacturer: �0
ff
3
[C Purrip
R.irrip'Tank. Liquid Lzjvel',
F r (.-,e Main Diarnete),r
*mom
3" Appiwa"
Force Main Length D ft
Force Main Void Volume
[C] lotal Dose "7r galldose
1-,."(5X total lateral void voturne < TDV < 0.2X design S)w)
+ (forcc,,. main drainback V(Aume)
MIN. PUMP DISCHARGE RATE gpm
FDUMP TAJ'14K
'Volume gol
Manufacturer:
Pump Manufacturer. Z,4D;-J11 �IAL
"mom"
P�ump Model.. w W I (s. atLacried p�- rr' ro ca rve
C I ontrols/Alarm Manufacturer:
C.ontrols/Alarm Model: NO
Fl at switches containing m!prcg[y.-C--1M._Dr0hibited,
B&M
Weep
Hdo
(typical)
Quick 04conn4mt
----w
f typical)
Awovedo'oints NvItt)
Approved Rpe 3 9 onto
0
Soid Groure
Oypl(*
MU St com C61
e
6 and NEC, 3G0
Wealherpmf
Junction Box
--M arr"I
FF PUMP-Or-
)tb� Off ELEVATION ft
INSIDE BOTTOM
SICK* ELEVATION -
90
isnai Beneal 'rank
lo. (0
'Vertical Head - ft
+ Min. Supply Head ft
+ FM Friction Loss= ft
+ Fitting Loss
(min. supply head x 0.3)
Tom. DYNAMIC HEAD - ft
S E: P TA C TA N
Total Vowme LOCI gal
Manufacturer(s):
Install apprqved e
luent filter at the qgktjc tank outlet
Imm Ja _upstre,pM of the purnp 1. rh. i det,
POP
Filter Mantifacturer: �0
ff
3
lo. (0
'Vertical Head - ft
+ Min. Supply Head ft
+ FM Friction Loss= ft
+ Fitting Loss
(min. supply head x 0.3)
Tom. DYNAMIC HEAD - ft
S E: P TA C TA N
Total Vowme LOCI gal
Manufacturer(s):
Install apprqved e
luent filter at the qgktjc tank outlet
Imm Ja _upstre,pM of the purnp 1. rh. i det,
POP
Filter Mantifacturer: �0
ff
3
0
Mound 9Vlariagernlerit Pian
[ I I'll * I*- 1 160, 4'
The owner of this mound syste�rn shall be responsible for its perpetual operation and maintenance pursI.J.-iint to
requirements of SPS 382-384. Wisc. Admin. Code. Pursuant to SFAS 383 512.1 (2), Wisc. Admin. Code, this systerr shall be
considered, C-1 human health hazard if not maintained in accordance with this approved managernew, plan. Furthermore,
all inspection and maintenance (,-3ct�vifies shall be performed by a registered POWTS Maintainer in accordance with SPS
38,152 (3), Wisc, Admin, Code.
Ma,xinil uin Di., ersal Area
Design Flow gpd; BODE 5 220 rn,gL.-'; TSS S 150 nil: gL"; FOGS 30 mgL-'
in,spee n Checklist INSPECT EVERY 3 YEARS
o type of use
age of system
c) nuisance factors 0, e. odorrz.,, user, complaints, etc.)
c) mechanical malfunction (i.e, pumps, valves, switches, f'oa,.s, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc,)
,r--) solids volume in anaerobic treatment tank(s) and any di;3tribution a-ppurtenancefs) (i.e., distribution drop boxes)
neglect or improper use (i.e., exceeding design capacities, proh.lblite.Cl activities, etc.)
• extent of ponding in distribution cell prior to dosing
• dosing irregularities (i e., pump re-cycli nq. Za A It n
float switch csi gs etc S' etc.)
C) electrical cornpomjvnts (1.e., wirin,'... conriections, S,Mtc1ie,,_;., controls, tiTiers, alaar'rT1
1- distribution lateral or lateral onfice piugging (rneaSUre. lateral distal pressure -- (.'-ompare to design spe..ification)
surface discharge of elffluent or savage bac*-up into structure
Maintenancl. Checkfis-t MAINTAIN EVERY 3 YEARS for when necessary)
ro shall be purrpedby a certified staptage servicing operator licensed ur%,d-Br s 281.48 Wis.
Stats. when the vo",Mume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance, Oispo:�4 ot contents shall be pursuant to NR 113, Wisc. Admin, Code.
gm, cat filt� j shall be inspecteid every 3 years and sh,,:-fll be cleaned when necessary to remove any
aCCUMulated solids) according to manufactUrer's specificZitions. A servicing period will always be greater than 12
months.
wl ributi!on laterals shall be once every 3 years or When necessary.
System maintenance reports shfall be submitted to the proper local government unlit in accordance with
SPS 383.66 Wisc. Admin. ('-'.ode. Reporit any component failure or mcm-illfunction to:
Name of individual or cornpany,' Lewis ,for F-Carnily Septic Service Phone.-
Local cjav t :,,rnm e nt u ni t: C c
715-231-7375
�ts_3�'d- ygoy
Local Z I P.. 7 c7
4("vernment unit addres,
Any di-').fective part of this system shall be repaired, replaced, or removed pursuant to ")PS 38151 (1), 'wVisc. Admin.
Code Repair or replacement of failed or mcalfunctioning components shall compiy with Sly' S 383, Wisc. Admin. Code.
No prt,)duct for chemical or physical restoration of the POWTS (-Tiay be Ljgyred unless approved by the department in
accordance with SPS 384, Wisc, Admin, Coode
Contin ltn Ian
,w
In the event that any failed treatment component of this F'OVV7S 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 approve KJ,-C'3rea after removal of all fallsed componerts.
Abandonment
n acco -,e with SPS 383.,33,'vV4,sc, Admin. Code.
POWTS is discontinued, it shall be aloandoredi rdanl,..
'4
fly
uj
HI
P U M P E R F 13 m A N (""', F �. 0
WLP1000/6uC-iJR
6"
4" CAST—A—SEALI I
*- -- —A
--------------
I riz rl �v
FILTER OR
BAFFLE i�
1
4" eC A S -T— A— SEA.
40 VENT
CUTLET
Ln
PUMP PAD
A IN' L K-i TNS
A0
DIMENSIONS:
0
WALL! 3*
BOTTOM: 3"
COVER: 5"
MANHOLE: 24" I-D. PRECAST CONCRETE RISER
HEIGHT: 56"
LENGTH: 1 6
WID TH: 7
cr
BELOW INLET: 4'2'"
1-10JUID LEVEt-
WEIGHT: 14,970 LBS.
a-
U3
0
INLET AND 071%lr-1 "T
0
4" CAST —A —SEAL 1300T OR EQUAL GASKET
o
INLET AND OUTLET BAFFLE AND FILTER:
uj
--j
0SCONSIN. SEE DETAIL #10
10THER ':'iTATES SEE CHART)
LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC)
16.76 GAL/IN (PUMP)
LOADING DESIGN: 8'—Om UNSATURATED SOIL
% °
TANK CAN BE USED AS:
SEPTIC /SEPTIC, SEPTIC/PUMP,
OR SE-P'*PC"/SlPH0N
COVER: MIX DESIGN #80 (ANIO F18%EW1
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
CUSTr)MI 7f7r) TANKS:
co
FOR CUSTOM TANKS CONTACT MESER CONCRETE
REVIEWED Ry
RE\AEW DAlr_Fl-
iDR-AWINGS SUBMT ED[
FOR APPROVAIL--
APPROVE-D BY:
APPM1011VAL DA'I-E:
Vv%viJvCTS NEEDED- 81:
CL
SHEET NO-
nF
A —1227 REQUIREMENT'-'�
TANkc,- ARF KA NUFACTURED TO MEET OR EXCEED ASTM C
0'*"ff"' t
x: ent3lottloell Flo'
x+„'.�:r:;,yr:Y:'r.rlr+Mile�w�;�rwMwrtrwlWwllR�wwNRtll�ww.a:wrer�IM+?�Y�IIk.yJ4fmwltn+il�c7Waw►e:�r,�.y�y,.,,,�,,..+Mr+r�s�l'+ww.:W�;'+ma4r►�wrat;� s *.,#•;,y�,,,•�Y.Ix,e �+WAk w.ar� r:.kn y,+.www �'w�-aw �^�eas,AYr.wr�a�rr". aaw.
+�Y.i.w't�Yr'tllMur�-irr�*�1k�wpPRr',w�++r�V+wwv�i.R�wwM.:+,n.nr.��rlr�.«�w..�wr.r.,*
Effluent Fihers (FYI
Y
dam.
Sample Produc..
SANITARY SYSTEMS�� �� Office Use Only
OWNERSHIP/ADDRESS FORMCreated 212021
Community Development [}epartrnentvviUud|izethis infomnationtoprovide the prope�vovvnervv�h
information
regarding operadonand rnainbenanceofyour nevvorrep|acernentsanharysystem! This
information will be provided as part ofour ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
dosobyusing the Pro,pertv Files Scanned vveb|(nk.
OWNER/BUYER INFORMATION
k.A(
Mailing Address k-ky
Cf
`
City/State/Zip.
L/ Qc 0
Phone Nurnber (required)
Email Address (required)_l
Parcel Identification Nurn
(found onthe property tax bill)
P, V'V ( t <..-o LA ".3. ro 6 -�"
C3 `1 - t (:)Z-(o er0 -4 00 C'
Property Locato
m\��
Subdivision/
—
Warranty Deed #
Number of bedrooms
New Property Address
(Staff initials)
NEW SYSTEM:LEGA�-DESCRIPTION
Page
(before \urne Page#
—�` Spec house 0ye S/Xf o Lot lines idendfiabi sK�no
OFFICE USE ONLY
�~ Rt�~
(Verific tion of ew address required from Community Development oepa
7o o, 9
ent fotnew uonstmction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form orecorded worronty deed from the Register of Deeds Office and ocopy of the certified
survey map // reference ismade /nthe mxornrntydeed.
CommunhxDeve\opmentDepartnert—LandUse Division
715'3864680 St. Croix County Government Center
715-245-4250 Fax
t � #
/iJ • i f
O ;
V rr
- _
v _ -
7017
�'s .ask
r
no
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,Ty t
{ � vuit
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� � �tfs 4=--30
STATE BAR OF WISCONSIN FORM 3 - 1998
Denise Lynn Utp h a 11, quit -claims to Jacob R. Utph a 11, alk/a Jacob Utp h a 11,
the following described real estate in St. Croix County, State of Wisconsin:
NORTHWEST QUARTER OF NORTHWEST QUARTER (NW 1/4 OF NW
1/4) AND THAT PART OF SOUTHWEST QUARTER OF NORTHWEST
QUARTER (SW 1/4 OF NW 1/4) NORTH AND WEST OF HIGHWAY,
ALL IN SECTION TWELVE (12), TOWNSHIP TWENTY NINE (29)
NORTH, RANGE FIFTEEN (15) WEST., TOWN OF SPRINGFIELD;
ALSO, EAST HALF OF NORTHEAST QUARTER OF NORTHEAST
QUARTER OF NORTHEAST QUARTER (E 1/2 OF NE 1/4 OF NE 1/4) OF
SECTION ELEVEN (11), TOWNSHIP TWENTY NINE (29) NORTH,
RANGE FIFTEEN (15) WEST, TOWN OF SPRINGFIELD.
Subject to Rustic Road R4 right of way.
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX Co., Wi
RECEIVED FOR RECORD
07/19/2006 10-.30AM
QUIT CLAIM DEED
EXEMPT # SM
REG FEE: 11.Q10
TRANS FEE:
COPY FEE -
CC FEE:
PAGES: I
Recoj ding Area
Name and Return Address
Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S.C.
201 S. Knowles Avenue
New Richmond, WI 54017
034-1024-10-000, 034-1026-70-000 and
034-1026-80-000
Parcel Identification Number (PIN)
This is homestead property.
This conveyance is given pursuant to divorce judgment granted in St. Croix County, Wisconsin, Case No. 05 FA 428
on June 16, 2006.
Dated this J Lf day of Tu t_ 2006.
0
eni e Lynn Ut urphall
AUTHENTICATION
Signature(s)
authenticated this _ day of' 2006.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S.C.
201 S. Knowles Ave., New Richmond, W1 54017
(Signatures may be authenticated or acknowledge. Both are not
necessary.)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
St. Croix County
ersonaIlly, carne before me this day of
2006 the above named
Denise Linn UtDhall
to me known to be
the person,-) who e:,�ecu-.ed the fore-oi.,,Ot iul,:trurri�--nt and
Z -C"
acknowledge the same.
Notary ublic State of Wisconsin
My CoTrn)ssion is permanen (if qoi %%%
date:
T A
*[dames of persons signing in any capacity should tx-- typed or printed below their signatures W9S*S"%% C. � %
QUIT CLAIM DEED STATE BAR OF WISCONSIN I MW.%%
FORM No. 3 - 1998
1 of I
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, W1 800-655-2021
3
Wisconsin Department of C.. SOIL EVALUATIONREPORT Page _ of
Division of Safety and Buildin f
FEBin'Qao&Z&,
with 4mrr�'� �. '►�+' i Ad r». cede
County t. Cryro1X
1tVcXhpPWsit n o paper not s t x 11 in hes in size. Plan must . �_..-. ..�.�. .
r nt BM , direction and 034- t 026
c : w icy l am •h � V '' i Parcel el W. -�' " i�[. �i
perctt slope, scale or dire s r anr! distance to nearest road.
Please print all lnfornial��o.rt. Re ewe4-i by Date
Personal information you far rvice may b } .0 bra ,ec-r. nog iry purposes (Privacy Law. s. 15.04 (1) (m)).
Property Owner Property Loran ion 1:1 El
J,c-icob U'tphall Govi:- Lot N�tk� 1/4 /4 s 12 T N R 1�p E (or) VV
Property ()w,ner's Mailing Add s Lot; lock #a" Sut)d_ Nan; or ("iSN1#
59
Li 0 tc)
t.:,t,�,..n.a Zip, Code Phorr # lVur r ,11t �` ��llage5 15
Town Nearest Road , N
1\A 1p L (40
��►�.
I'NeAi Construction Use f "al Residential i Number of bi.,1cfroorns._q �.. 'Code derived design flow rate 4Z. ".` � y ._w.� GPD
act PUblic or commercial - Describe: _ __.� _._� � �....�....w.�.�.�. _ ~-�►
fear(,=nt material � '" 1 .. Flood Plain elevation if applicable
General comments r) m opinion there is, �' min o l' non -saturated, non consolidated soil above limiting factor , I would
and recommendations: � � � nelit � a a t after coup and state approval of an mound treatment dispersal
rc.3�o:�� a �t����lard crom�c���et�t nrt� t � l � install county ��
system p44Aek 0-14�-M c40.
+�grXJ
- nip.• '1w�
w�.,,...n.r.wrw.w........-,,..�.r+w...�...-...w..�..,.....,._.-.....,.._.,,..-_.�.`._............. --_..,+rw,..�..da+�,..d..-...r...,,�-.....,.e.......,.....+�,.wr,�.."+i..��...�......-.......-....,..,r-w...+.�......w,...nw,.....W... ......,..+-.--.�........�
round surfs ace eleV, _�....._. ,. i Depth to limit r �o 1 r� :t r in.
..., ...�.. ,,. Soil AeOcation Rate
. Hof � rr'� tp E wiz , i n color Redox Descript+c�rl Texture Structure , i onsister� . our�dar F c: its _... SPt]l
!flu. Sz. Cont, Color Gr. Sz. Sh. ..�......,_�...,� ... "Eff91 'Etf#2
344
L41, 4
1
OEM MONO"
k(oAft
�*AL 6�40uo ++ram
4
li - ? Boring # Boring
�...- �._.�..�.
-_
Pit Ground surface ele��r..... ... Depth to 1it�r�t�r factor
END--�----- Soi# Ec.ation Rate
Horizon Depth th [)orrjoant Color Redox. Description Texture Structure Consistence Boundary F��,��t� GP��f�
Color
irt. N1 r�setl u. z. Cont,r #2
fir. Sz. Sh.
u�.... 'Elf#1 f
.� _.. ...._.
11100
<Y
Ito% M4L
44
FZ
WL 2,
fflc rrt #'t : BOD > 30 < � mg/L and TSS >30 < '1 �ti i#�' =MD, � 34 arKi TSS � �0 rr�ii..
,..,.
- ..-. CST Number
��'')T P4 sr ie ( Please Print253976
)
{.,1 .� _. _.. ---� Datevalcsaton Coru ur.�ted Telephone Number
*17
E7818 County E Menomonie W1 54751 .. '" ,cf
ov Z � 715 -23 l w 7 1 75
Y....r.,...n.......�,w.r.....rr.,�...n....�......w....-....«.wYwlr..r..+n.nr � r :Nrf%f"1 r'L, 'p iI`. r ►\ �". +4 :f►/r.
1)
Property Owner Jacob Utphall Parcel 10 # 034-1026-70-000 Page of 3
B-3 Boring o
in,
.ice ele
Pit Ground surf, Depth to firriting fcautoir A22tation Rate
Horizori Deptt) DorTiMant Color Redox Description Texture Structure Consistence Boundary Roots GP I Dff
;n, MUIISeli Ccrit. Color Sz. Sh' % Eff# 1 Eff#2
hjL —1 a,��
TFW
441 6
M4 6
*owl
0
Bonling # Boring Ground surface elev,
Depth to limiting factor in.
■ Pit
F-§+ A Aulication Rate
IHorizon
Depth
in.
Dominant Color
Munsel
Redox Deticription
tau. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
! GPD/ft'
"E"i
*Eff#2
Baring 9 Boring
Pit Ground surface
IHorizon Depth Dominant Color. Redox Description
in. NiunsO I Qu. Sz. Cont. Color
Depth to limfting factor in. ion Rate
Texture Structure Consistence Bcundary Roots GPD/ft'
Sz, Sh. 'Eft4i *Eff#2.---q
/L
Effluent $0 = BOO > 30 < 220 mgfL and TSS >30:5 150 mgmom..Effluent #2 = BODk < 30 mgand TSS < 30 rrig/L
U
Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate fbirmat, please contact the department at 608-266-3151 or "rrY 608-264-8777.
or
N, mo C43
.�"EF K JJOX AS APKICABLE.
SYS
PAGE 2 OF to TEM
Atli
S( I L E\,vl AL U AT 10 N 30 4 60
PLOT PLAN
SITE.MAP 4% Gpc
t)ESOGN FLOW
PROJEECT NAME:
�f
JaCoblUtphall Attach (iesign jjQW C,.8,Cujaiojj5 for CoMfnerr.,pial plans.
ndard (Fables - 3PA30-3 a W.30-5)
44 pipe Mateda� Sta CLI-- Ke- dIMS
!7
PROJECT ADDRESS Sanawy
SM E.'Ievaftn: FT Fcyoo
Bm sylyod. Ae ( -.A
Fmj
.my V-T
BM NsCAP101' rt-)r.b ty� Stlow ground olov�00(1 contours sultible Interval,-;.
I" �' IV' up-'v' ........
lope. Woo SvrrqOf ovpfi4cauk) 0 or,, 1ne i1pproprtio R14,
n locKIN04V
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10
CL
o c COUNTY No. 648412
STATE SANITARY PERMIT
nrrue�Te�D�;,= T�-����, PREVI US NO. '-
r"Al V^ -&d
OWNER,-- R�� I - ■ r�� CfIAPIE ]05.1]5(2)WISCONSINSiATUTES
PLU-M-BERJ,90&# D, 0 Kmk P
LIC.# ,2s30
TOWN OF Do a
SEC,T_2k? N, RLj
AND1 OR LOT
EXPIRES
BLOCK
SUBDIVISION
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period..
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note; If you wish to renew the perpit, or transfer ownership of
the permit, please contact the county authority.
G OFFICER -DATE 24S "0%% 10
!P4 f - lb Aff"
UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VIS E FROM THE ROAD FRONTING THE LO� DARING CONSTRUCTIONrap
i�Y �10
SBD-063 ( , '
North is referenced to the
(St. Croix County Grid System)
IMPERVIOUS SURFACE AREAS
WITHIN 300' OF HWM
Road & Drive = 21, 900 sq. ft.
House & Shed: 2922 sq. ft.
Septic: 800 sq. ft.
NOTE:
Landowner owns entire area within 300' of HWM,
proposed impervious surfaces will be minimal, at 2%,
well below the 15% threshold of requiring mitigation.
�:�ill 1■rK■uwill I'm
:
BM is a 3/4" Iron Rebar
MSL Elevation = 1036.45 feet
Vertical Datum: NAVD88
Base Flood Elevation
MSL Elevation = 1019.00 feet
_FLOOD PLAIN
Mapped Flood Lines are based on the
Flood Plain Management Study of April,
1984, prepared by the United States
Department of Agriculture.
UTPHALL SITE PLAN
LOCATED IN PART OF THE NORTHWEST
QUARTER OFTHE NORTHWEST QUARTER
OF SECTION 12, TOWNSHIP 29 NORTH,
RANGE 15 WEST, TOWN OF SPRINGFIELD,
ST. CROIX COUNTY, WISCONSIN.
PREPARED FOR:
Jacob R. Utphall
514 Hwy 12 East
Knapp, WI 54749
(4�
MDT
-2603
WD CITY,DRAFTED BY:
Joel A. Brandt
JB Surveying LLC
Completion Date
November 2022
SURVEYOR'S CERTIFICATE
1, Joel A. Brandt, Professional Land Surveyor, certify that I have surveyed
and mapped the shown parcel and believe this map to be a correct
representation of the boundary thereof. This survey was done in
compliance with Chapter A-E 7 of the Wisconsin Administrative
Code"Minimum Standards for Property Surveys".
Joel . Brandt, P.L.S., S-2603
JB Surveying, LLC
North is referenced to the
(St. Croix County Grid System)
IMPERVIOUS SURFACE AREAS
WITHIN 300' OF HWM
Road & Drive = 21, 900 sq. ft.
House & Shed: 2922 sq. ft.
Septic: 800 sq. ft.
NOTE:
Landowner owns entire area within 300' of HWM,
proposed impervious surfaces will be minimal, at 2%
well below the 15% threshold of requiring mitigation.
BENCH MAKK
BM is a 3/4" Iron Rebar
MSL Elevation = 1036.45 feet
Vertical Datum: NAVD88
Base Flood Elevation
MSL Elevation = 1019.00 feet
FLOOD PLAIN
Mapped Flood Lines are based on the
Flood Plain Management Study of April,
1984, prepared by the United States
Department of Agriculture.
UTPHALL SITE PLAN
LOCATED IN PART OF THE NORTHWEST
QUARTER OFTHE NORTHWEST QUARTER
OF SECTION 12, TOWNSHIP 29 NORTH,
RANGE 15 WEST, TOWN OF SPRINGFIELD,
ST. CROIX COUNTY, WISCONSIN.
PREPARED FOR --
Jacob R. Utphall
514 Hwy 12 East
Knapp, W1 54749
DRAFTED BY:
Joel A. Brandt
JB Surveying LLC
* N"DT
S-2W
" Gi.fMW00D qTY,;
Completion Date
November 2022
SURVEYOR'S CERTIFICATE
1, Joel A. Brandt, Professional Land Surveyor, certify that I have surveyed
and mapped the shown parcel and believe this map to be a correct
representation of the boundary thereof. This survey was done in
compliance with Chapter A-E 7 of the Wisconsin Administrative
Cod "Minimum Standards for Property Surveys'
Joel A. Brandt, P.L.S., S-2603
JB Surveying, LLC