HomeMy WebLinkAbout016-1003-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 538871 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:
Stack, Harold J. & June Trust Glenwood, Town of 016-1003-20-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/GAD 5AA / G57- 02.30.15.30
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV.
Septic 3 / Benchmark
o ioa
Dosing ~ / ~ l Alt. ML, 9Z
Free-
/ Bldg. Sewer 4 7r ,IL
64 `f7
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ;7 A) Z~: i Dt Bottom Q
z U
Dosing i Header/Man.
y ia~ 7iadLr~ 3a z wZ `I$
Aeration Dist. Pipe Z
Holding Bot. System 3.33
Final Grade
PUMP/SIPHON INFORMATION /I lyz
Manufacturer Zo t
(Al- Demand St Cover G C
GPM I Z 717,
/
Model Number /
TDH Li Friction Loss System Dead TD Ft
I.7L Z. ` J. Z,::> IJ,7, I. , Z 5 47.53 /Z• '97. 7Z&
Forcemain Length Dia. Dist. to Well 3 33 7$.l t IZ, 73711',
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. X;~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS O
SETBACK SYSTEM TO _J P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Systegi: I UNIT Model Number:
(/JC 7~ >/C~ ~ /dam > Jr' a \
DISTRIBUTION SYSTEM G/ee he:
Header/Manifold Distribution / Z x Hole Size r I - / x Hole Spacing Vepo Air Intake
Length~_ Dia ` Length 3t , Dia Spacing r (!J 7
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only w_
Depth Over Depth Over xx Depth of xx Seeded/Sodded (r e
Bed/Trench Center 3 Bedrrrench Edges Topsoil
z ( Yes d No s 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: J /
Location: 1725 310th Street G nwood Ci WI 54013 (NW 1/4 SW 1/4 2 T30N R1 5W) 40 acres Lot Parcel No: 02.30.15.30
1.) Alt BM Description =C- I`j~' tr 05j
G` `A
` Plow 2.) Bldg sewer length = ..--r
- amount of cover =
o~ o nn t
7p
Plan revision Required? Fi7a~ Yes No (I I I 1
Use other side for additional information.
Date Insepcto ignature Cert. No.
CBD-6710 (R.3/97)
afety and Buildings Division County ST CROIX
I~CNtlrlrfef+C~-~9t~'" ,0201 Washington Ave., P.O. Box 7162
adison, WI 53707-7162 Sanitary Permit Number (to be 611od in by Co.)
1 SCO 53
of 1 State Transaction Number
atlon 07153
rs form to the appropo Address (ef different °~Og adds mss)
San au rdm!C'
In accordance with s. Comm. 8321Wis. lication forms for state-own 1 310 ST. G1 ENWOOD CITY
unit is required prior to obtaining a amtary~ffe~ P
ay be used fo ndary
p~ information you provide in
submitted to the Department of Co er~ce
u ses in accordance with the Priv al~J .04 1)(m), Stats.
1. Application Information - Please Print All Information Pared #
Propeety Owner's Name 0164003-24000
HAROLD STACK Property Location
Proputy Owner's Mailing Address
P.O. BOX 69 Zip Code Phone Numbs Govt. Lot °t-
Cam' STATE 54013 715-5654843 _~j,.f _ cam! '/4, Section
GLENWOOD CITY (circle one
Lot # T U N- R I S E
H. Type of Building (check all that apply) 3 N/A Subdivision Name
3 ~,4
1 or 2 Family Dwelling -Number of Bedrooms n
Block #
N/A ❑ City of
❑ Public/Commercial -Describe Use
C'SM Number ❑ Village of
❑ State Owned - Describe Use it Town of GLENWOOD
IIL Type of Permit: (Cbeck t dy A. Complete line B if appliable)
❑ Other Modification to Existing System (explain)
Replacement System Treatment/Holding Iolding Tank Replacement Only
New System
Lest previous Permit Number and Date Issnod
B. ❑ Permit Renewal ❑ Permit Revision Change of Plumber 0 Permit Transfer to New
Own" ' J~ ~~aw~
Before Expiralioru V
. f /Com onent/Device: Ch that apply)
IV Type oPOWTS S stem ❑ Mound < 24 in. of suitable soil
® NarPtepg i h Ground ❑ Pressurized Poo At ❑ Mound ? 2a in of suitable soil
❑ Pretrfatrnent Device (explain)
® Holding Tank ❑ Other Dispersal Component (explain)
Ara Pry (s✓ System Elevation
V. Dis ersaUTreatment Area Information: Area Required DiLq~)"& "Spam
4Design Flow (gpd) Desegte Sal Application RaWpdst) Dim
t -1 So '750
Total # of Manufacturer
c d
D
VI. Tank Info Gallons Capacity m Gallons Units 2
w ~ y
d
r~.
),kw Tacks Existing Tacks a U VA w 3
septic or Homing Task 1000 1000 1 WEEKS X.
800 1 WEEKS X
Dosing Chamber 800
C N~
VIL possibility Stateeteat- 1, the undersigned, assume responsibility for installation of the POWTS sshowwnn oSnNattache plans.
Plumber's Name (Prim) Plumber's Sigaahua Gl /I'/~` . 824825 715.986-2508
ROBERT HARDINA
Plumber's Address (Street, City, State, Zip Code)
477 1701b AVE. TURTLE LAKE WI 54889
VI1L rtrent Use
Pproved [I Disapproved Permit Fee Date Issued
$ ~ 2 ~ • Qt7 1 2 5 ~
❑ Owner Given Reason for Denial
Ix- 9"WRP~~iA~oval/Reasons for Disapproval t~
1 SS~etptic tank, effluent filter and ~ nA
dispersal cell must all be serviced / maintained / k ~;s ~Gd7GC ,1~ '
as per management plan provided by plumber.
2, All setback requirements must be maintained G(/17 _
fir tie eTsWe the Cawh salt • ..t tees s e2 x ll " an
x'3.33•
HA-RDfNA SEPTIC SYSTEMS
MFRS/CST 824825
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Safety and Buildings
go~era~~a~ 141 NW BARSTOW ST FL 4TH
WAUKESHA WI 53188-3789
Contact Through Relay
www.commerce.wi.gov/sb/
r www.wisconsin.gov
A~o~EssroetE+LS~~ Scott Walker, Governor
Dave Ross, Secretary
October 18, 2011
CUST ID No. 824825 AT'N: POWTS Inspector
BOB J HARDINA ZONING OFFICE
HARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA
477 170TH AVE 1101 CARMICHAEL RD
TURTLE LAKE WI 54889-9187 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 10/18/2013 Transaction ID No. 2007153
Site ID No. 772900
SITE: ease refer to both identification numbers,
Harold Stack Pl above, in all correspondence with the
1725 310TH St agency.
Town of Glenwood, 54013
St Croix County
NW1/4, SW1/4, S2, T30N, R15W
FOR:
Description: At-Grade, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1340270
Maintenance required; Replacement system; 450 GPD Flow rate; 39 in Soil minimum depth to limiting factor from
original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution
Component Manual -Version 2.0, SBD-10706-P (N.01/01); Effluent Filter
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:
This system is to be constructed and located in accordance with the enclosed approved plans and with the At-
grade Component Manual, Version 2.0, SBD-10854 (N.03/07), and the Pressure Distribution Component Manual
- Version 2.0, SBD-10706-P (N.01/01)
On paper, the slope appears to be slightly concave, however, the designer states this is not thg,aase$ea'sete that
if, at time of system layout, this site does turn out to be concave, a revision would be re uirMtot the c
resulting from the amount of deflection.
In the event this soil absorption system or any of its component parts malfunction a hAlth hazard,
the property owner must follow the contingency plan as described in the approved p t, addi the owner
must comply with the operation, maintenance and monitoring duties as described in sect I of the at-grade
component manual. A copy of this information must be given to the owner upon completiof the project.
Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is
required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions.
BOB J HARMNA Page 2 10/18/2011
lA 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.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation
and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan
under s. Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
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 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 and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Si erely, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Julia Lewis-Osborne
POWTS Reviewer 2, Integrated Services WiSMART code: 7633
(262) 397-6005, Fax: (608) 283-7481
julia.lewis n wisconsin.gov
tGN ~~~~i~
RESIDENTIAL AT-GRADE DES OCT 14 2011
Pressurized - Sloping Site
INDEX AND TITLE SHEET SAFETY & BUILDINGS
Project STACK
Owner HAROLD STACK
Address 1110 PARK DR.
GLENWOOD CITY WI 54013
Legal Description W S a. T 3C~ . N- i-~ Li
Township GLENWOOD County ST. CROIX
Subdivision Name Lot No.
Parcel ID Number J)j U - { Qj2'3-orb , f J0&
Plan Transaction Number
Index sheet Page 1
Calculations Page 2
At-grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump curve & specifications Page 7
Filter Specs Page 8
Plot Plan Page 9
Soil Test (a b c) Page 10
Designer ROBERT HAR iNA License Number 824825
Signature Phone Number 715-986-2508
Date 09/29/11
31a1~ Ea~z,o
t' y
Designed pursuant to: 10 9S T
At-grade Component Manual for POWTS SBD- 42 and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (O'')<j81)
53> /07aG - f (tj oihbl) ~ b 10
Version 4.0 (Qet/03} g d,
PRESSURIZED AT-GRADE DESIGN
At-grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
4.00 % Site slope
97.00 Contour elev. below lateral (ft)
39.00 Depth to limiting factor (in)
0.60 In-situ soil application rate (gpd/ft^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
10.00 Linear loading rate gpd/ft
10.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
75.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.188 Orifice diameter (in) e.g. 0.188
Not calculation ae2.00 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in)
2.55 Forcemain flow velocity (ft/sec)
180.00 Forcemain length (ft) y or n Does Forcemain drain back?
64.00 Pump tank elevation (ft) y or n Are laterals at highest point?
NA
3.25 System head (ft) x 1.3 29.4 Forcemain drainback (gal)
32.75 Vertical lift (ft) 33.5 5x Lateral void volume (gal)
2.49 Friction loss (ft) 62.9 Minimum dose volume (gal)
38.49 Total dynamic head (ft) 25.0 System demand (gpm)
Lateral Diameter Selection Gallons/inch Calculator (optional)
Pipe diameter Design options Design choice 804 Total Tank Capacity (gal)
Designer 1 in 37 Total Working Liquid Depth (in)
must select 1.25 in x 21.7 Gal/in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x 00 S eptic tank capacity (gal)
[W?E!E KS `Manufacturer
Effluent Filter Information Dose Tank Information
BEST Filter manufacturer 804.0 Dose tank capacity (gal)
GF10-8 Filter model number 21.7 Dose tank volume (gal/in)
WEEKS Manufacturer
Project: STACK
Transaction Number: Page 2 of 10
AT-GRADE PLAN VIEW
D -t
1/6 B Observation pipes (2 typical) A 10.00 ft
D B 75.00 ft
1/6 B 12-50 ft
C 12.00 ft
W C
D 5.00 ft
E 2.00 ft
D L 85.00 ft
B W 22 22.00 ft
A x B 750.00 ft^2
L
T
E--- Cap obs. pipe.
= Total aggregate cell A x B Slotted l nt he lower
L~J and anchored
= Plowed area L x W securely.
6°
AT-GRADE CROSS SECTION
Svnthetic fabric cover 913 79 ft Finished grade
Lateral elevation
invert elev. 97.50 ft
Observation pipe
at aggregate toe
E
Surface contour q 4%~Slope
y
and system 97.00 ft C
elevation D
= 12 in. topsoil and subsoil
® over aggregate and tapered to toes. Plowed layer
below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: STACK
Transaction Number: Page 3 of 10
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
I` P I
I4- X->I4-x/2 I 02+1 Laterals & force main of PVC Sch 40
Last hole drilled next to end cap (per COMM Table 84.30-5)
Holes drilled on the bottom of the lateral,
equally spaced • =Turn-up wwfball valve or cleanoutplug
Lateral Specifications
0.188 Orifice diameter (in) Center Lateral connection point
X 1.97 Orifice spacing (ft) 2 Number laterals
19 Orifices/lateral P 36.45 Lateral length (ft)
12.5 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
25.0 Sys. discharge rate (gpm) 180.00 Forcemain Length (ft)
38.49 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather-proof warning label and locking device
Final grade junction box -'0 disconnect 4"
Alternate
Tank component is
properly vented outlet
location 18" min.
Electrical as per NEC 300 and
r'-Approved outlet
Tank full joint
Inches Gallons JA Provide 1/4"
o A 23.2 502.4 Alarm on weep hole or
c B 2.0 43.4 g antisiphon
0 C 2.9 62 9 Pump on device.
G D 9.0 195.3 64.75 ft C
Totals 37.1 804.0
Pump off
D
3" Bedding under tank 64.00 ft
ZOELLER Pump manufacturer SJE RHOMBUS Alarm manufacturer
161 Pump model number 101 ~ Alarm model number
Project: STACK
Transaction Number: Page 4 of 10
• r
At-grade System Maintenance and Operation Specifications
Service Provider's NameROBERT HARDINA Phone 715-986-2508
POWTS Regulator's Name ST. CROIX CO. Phone - 33L, 4 $ a
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 750.0 ft2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Inspect for ondin and seepage once eve 3 ears
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap,
and are secured in as shown in the at-grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99).
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral
Long Sweep 90 or Two
97.50 ft 45 Degree Bends Same
Diameter as Lateral
Project: STACK
Transaction Number: Page 5 of 10
At-grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals ISBD-10570-P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,
the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At-grade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or
30 mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design
flow specked in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: STACK Transaction Number: Page 6 of 10
N
PUMP PERFORMANCE CURVE
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MODELS 16114161-163/4163-165/4165
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24-
70- 165/4165
20 163f4163
60
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50-
12- 40
i
30-
20-
4- 161 f4161
10--
0
10 20 30 40 50 60 70 80 90 100 110
GALLONS
LITERS 0 80 160 240 320 400
FLOW PER MINUTE
Purnp Performance Curve
Models 161/4161, 1.63/4163, 165/4165
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Wisconsin Depa t onnt~`y{'R SOIL EVALUATION REPORT Page 1 of 2
Division of Safety nd Buildings
W1 a~corda with Comm 85, Wis. Adm. d
l1' ST. CROIX
Attach complete a plan*, apZr ?loot ess, n 81 x 11 inches in size. Plan must
include, but not li 'ted to: vertical , rice point (BM), direction and Pa
percent slope, sea or di►nenW cation and distance to nearest road. to - f7 03 pZ~ -DUD
~u4t'S~
print all information. eviewe Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1)(m))- t o Z S
Property Owner Property Location
Harold Stack Govt. Lot NW 1/4 SW 1/4 S 2 T 30 N R 15 E❑(or)W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1110 Park Dr N/A N/A
City State Zip Code Phone Number []City []Mllage Town Nearest Road
Glenwood City WI 54013 ( 715-565-4843 310th St.
New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
a Replacement 11 Public or commercial - Describe:
Parent material GLACIAL OUTWASH Flood Plain elevation if applicable N/A ft.
General comments .4 L
and recommendations: l~ - 91 51A-d-C (JyL 641 d `
a Boring # 11 Boring
Q Pit Ground surface elev. 97 ft. Depth to limiting factor 58 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f(z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2
1 0-12 10YR3/3 -0- SIL 2MSBK MVFR GW 2M .6 .8
2 12-20 10YR5/4 -0- SL 2MSBK MVFR CW 2F .6 1.0
3 26-58 7.5YR5/6 -0- SL 2MSBK MFR CW IF .6 1.0
4 >58 N/A LIMESTONE N/A N/A N/A N/A N/A N/A N/A
F2 Boring # Boring 96.5 39
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfT#1 *Eff#2
1 0-10 10YR3/3 -0- SIL 2MSBK MVFR GW 2M .6 .8
2 10-39 10YR5/4 -0- SIL 2MSBK MVFR CW 2F .6 1.0
3 39-56 5YR5/6 C2D5YR4/4 SL 2MSBK MFR CW IF .6 1.0
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signatu CST Number
ROBERT J HARDINA 824825
Address ate Evaluation Conducted Telephone Number
477 170th AVE. TURTLE LAKE WI. 54889 6-20-11 715-986-2508
10,4 i s
Property Owner STACK Parcel ID # a ' t1Oy -140 - 000 Page 2 of 2
Boring # E] Pit Boring
Ground surface elev. 97'0 ft. Depth to limiting factor 60 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2
1 0-8 10Y"/3 -0- SIL 2MSBK MVFR GW 2M .6 .8
2 8-39 10YR5/4 -0- SIL 2MSBK MVFR CW 2F .6 1.0
3 3954 7.5YR4/6 -0- LS OSG L CW
IF .7 1.6
4 >54 N/A LIMESTONE N/A N/A N/A N/A N/A N/A N/A
❑ Boring # Boring
a Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # H Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5 > 30 1220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg&
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2648777.
S13D-8330Twt (R07/00)
HARDINA SEPTIC SYSTEMS
MFRS/C$T 824825
R
p
i
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address O •3~x &,2cJ , Cry C,~) 540
i 1 a 1 '3
Property Address C17
(Verification required from Planning & Zoning Department for new onstruction.)
Parcel Identification Number lao 3 d?~ "UU
City/State ~
LEGAL DESCRIPTION
Property Location Ill W '/4 , 6Lt) '/4, Sec. oZ , T 30 N R / ✓ W, Town of ~i Lbw J
Subdivision Plat: Lot #
Certified Survey Map # NOA-1F Volume , Page #
Warr # (before 2007)Volume Page #_5'1~_•
Spec house D yes S~6o Lot lines identifiable P-yes D no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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 Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms ,
/L~ /G~I LL
~
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. 09/07)
G
o(~ . 1.5 9~ 5
Vt. 1479FAGE 546 KATHLEEN H. WALSH
T. CROIXOCO., WI
I ___j QUI T CLA IM DEED RECEIVED FOR RECORD
DOCUMENT NO.
12-22-1999 11:20 AM
HAROLD J. STACK and JUNE M. STACK, husband and wife, quit-claim to QUIT CLAIM DEED
EXEMPT M 16
CERT COPY FEE:
HAROLD J. STACK and JUNE M. STACK, Trustees, under COPY FEE:
the STACK LIVING TRUST, dated NOVEMBER 17, 1999 TRCA RDa FFEFEE: 10.00
PAGES:
THEIR interest in the following described real property
in ST. CROIX County, State of WISCONSIN:
The Southwest Quarter (SW'/4) in Section Two (2), Township Thirty (30)
North, Range Fifteen (15) West.
RECORDING AREA
RE TURN TO
s/( ~,c tt Q~c
Sal 0l3
v 1 Ip { COS- to - 00 a
PIN= c`7 t (n J W-3 - 10- OQ O
This (is OR s n homestead property. O tCo - 00j - 3O - 000
Dated this 0,. of / 1999. C) 1( (oU J -OCfO
(SEAL) (SEAL)
~AROLCD J. ST C ll~t M_ STAG C
ACKNOWLEDGMENT ~j
STATE OF WISCONSIN j SS.
COUNTY OF Y`V 1 ) .J v
Personally came before me this j day of ~i°M ~1~" 1999 t Mried
7 HAROLD 1. STACK and JUNE M. S TACK to me known to be the persons who exe end
foregoing instrument and acknowledged the same. 1 ON
lVO My commission expires
-7 d
tary SlgndtU re
GRANTORS SUPPIJEO THIS LEGAL OF.SCRIPTION. ORAFTOR MAKES NO WARRANTY OR REPRESENTATION A.S
TO WHf_-Tlif_"X Tiff SAMC IS CORREC:'T' ACCURATE OR WITHOUT ERROR.
DOCtJMENT DRAI'TED BY: Robert L. Firth, £sq., 1o39 West Mason, Gre- Bay, WI 54303
Wis6onsin Department of Commerce SOIL EVALUATION REPORT Page I of 2
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ST. CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in sue. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q~ la " DO,j pZ0 -OUO
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Harold Stack Govt. Lot NW 114 SW 1/4 S 2 T 30 N R 15 EE((or))WW
Property Owner's Mailing Address ;j-- Block # Subd. Name or CSM#
1110 Park Dr N/A
City State Zip Code Phone Number rl Vllage Town Nearest Road
Glenwood City WI 54013 ( 7115-565-4843 310th St. C41 ENWOOD ® New Construction UseE] Residential / Number of bedrooms 3 Code derived design
flow rate 450 GPD
El Replacement ❑ Public or commercial - Describe:
Parent material GLACIAL OUTWASH Flood Plain elevation if applicable NI/n ft.
General comments
and recommendations:
171 Boring # ❑ Boring
Pit Ground surface elev. 97 ft. Depth to limiting factor 58 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2
1 0-12 10YR3/3 -0- SIL 2MSBK MVFR GW 2M .6 .8
2 12-20 10YR5/4 -0- SL 2MSBK MVFR CW 2F .6 1.0
3 26-58 7.5YR5/6 -0- SL 2MSBK MFR CW IF .6 1.0
4 >58 N/A LIMESTONE N/A N/A N/A N/A N/A N/A N/A
Boring # Boring 96.5 39
q 2
Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
E
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-10 1OYR3/3 -0- SIL 2MSBK MVFR GW 2M .6 .8
2 10-39 IOYR5/4 -o- SIL 2MSBK MVFR CW 2F .6 1.0
3 39-56 5YR5/6 C2D5YR4/4 SL 2MSBK MFR CW 1F .6 1.0
* Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signatu CST Number
ROBERT J HARDINA 824825
Address C-Date Evaluation Conducted Telephone Number
477 170th AVE. TURTLE LAKE WI. 54889 6-20-11 715-986-2508
~p/~- ID
a
Property Owner STACK Parcel ID # 000 Page 2 of 2
F3i Boring # Boring 97.0 60
Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 " Eff#2
1 0-8 l0YR3/3 -0- SIL 2MSBK MVFR GW 2M .6 .8
2 8-39 10YR5/4 -0- SIL 2MSBK MVFR CW 2F .6 1.0
3954 7.5YR4/6 -0- LS OSG L CW IF .7 1.6
3
4 >54 N/A LIMESTONE N/A N/A N/A N/A N/A N/A N/A.
❑ Boring # 1J Boring
Pit Ground surface elev. ft. Depth to limiting factor in. _§;i-Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2
S Boring
F-1 Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:S 150 mg/L * Effluent #2 = BODS < 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 'ITY 608-264-8777.
SBD-8330Te l(R.0'7i00)
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HARDINA SEPTIC SYSTEMS
MPRSICST 824825
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RESIDENTIAL AT-GRADE DESIGN RECEIVED
Pressurized - Sloping Site
INDEX AND TITLE SHEET OCT - 3 2011
SAFETY & BUILDINGS
Project STACK
Owner HAROLD STACK
Address 1110 PARK DR.
GLENWOOD CITY WI 54013
Legal Description tt:,~~, S. o~ T 3Q 1-9 W
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Township GLENWOOD County ST. CROIX
Subdivision Name Lot No.
Parcel ID Number t) - ( ID
Plan Transaction Number
Index sheet Pagel
Calculations Page 2
At-grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
_Pump curve & specifications Page 7
Filter Specs Page 8
Plot Plan Page 9
Soil Test (a,b,c) Page 10
Designer ROBERT HARDINA License Number 824825
Signature Phone Number 715-986-2508
Date 09/29/11
Designed pursuant to:
At-grade Component Manual for POWTS SBD-10570- (R.6/99 nd
SSWMP Publication 9.6 Design of Pressure Distribution Networks T - SAS (01/81)
Version 4.0 (04/03) Page 1 of 10
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