HomeMy WebLinkAbout016-1055-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 556372 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. -
Permit Holder's Name: City Village X Township Parcel Tax No:
Miller, Timothy & Katie Glenwood, Town of 016-1055-20-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range/Map No:
/0d - D av _ 25.30.15.386B
TANK INFORMATION EVATION D A ZZ J05 Z /eC15
TYPE MANUFACTURE(] CAPACITY STATION BS HI FS ELEV.
3,0(0 /63.a
Septic Benchmark
Dosing Alt. BM
Aaratierr ' ` % 66 /9367
Bldg. Sewer Z. 16
U~
Holding
St/Ht Inlet
~ces .
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL Bl}DG. V t to Air Inta RQAD Dt Inlet i
Septic Dt Bottom
(~(o r 17 _ -9.34 %.13%
Dosing Header/Man.
U )A4# -7
Aeration ' I d !~O
Dist. Pipe
Holding
Bot. System
/OD. 2
PUMP/SIPHON INFORMATION Final ade
Manufacturer ' ~7 162
Demand St Cover
C3t/ GPM i--, I C~ ! J.~5 /43 S-7
Model Number 37 j
q3
TDH Lift. Friction,Loss System ad TDH Ft
+.74 7 Z Z 50 2. f ~ l
Forcemain Len th Dia. ) 1 Dist. to Well
2
SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /O L15 An Q ~ ~ \ \
SETBACK SYSTEM TO P/L BLDG ~JWELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: /
M, I /V~(J / / Q~ SQ ! UNIT Model Number: \
DISTRIBUTION SYSTEM (O O
Header/Manifold Distribution / / x Hole Size r S acin
g Pipe(s) 71 P 9 J e o Air IntakLen th Dia Length Dia Spacing Zrj r
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
FdDepth Over Over xx Depth of xx Seeded/Sodded ~ Mulched
/rrench Center / r ~i:E rench Edges Topsoil f n, -
es H No Yes F-7 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ( Inspection #2:
Location: 1380 DUNN/ST CROIX RD Glenwood City, WI 54013 (NE 1/4 NE 1/4 25 T30N R15W metes& boun s Lot tercel No: 25.30.15.386B
F , I CG,/„~~ r
1.) Alt BM Description = i 4, `J~S, j /y
2.) Bldg sewer length = 3c~ I - (f rrK/ a'(e
- amount of cover = d ~C
Plan revision Required? Frj~ Yes No 1
Use other side for additional informati n.
Date - . L - i
SBD-6710 (R.3/97) Insepctor's gnature Cert. No.
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,COPY
7 2 5-
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C0 rnerce.wl. w Safety and Buildings Division ~t l u
yl V~~~•\NINGD FV'` 201 W. Washington Ave.. P.O. Box 7162 Permit vmber(tobe filled in by Co.)
Madison. W1 53707-7162 SantaI
ISC~6
Department of Commerce State Transaction Number
Sanitary Permit Application 2.~ 1~.3b 7 g
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropnate governmental
unit is required prior to obtaining a sanitary pem+ii. Note: Application forms for slate-0 Ted POWTS are project Address h(difrerent thanrnatling address)
submitted to the Department or Commerce. Persnnal information vov provide may he used (or secondary !
u ses in accordance with the Privacy Low. S. 15.(+~ I m . Stus.
1. A lieation Information - Please Print All information parcel a
Property Owner's Name ~ AI I ~L Erb ~L~
V9 " I(E-ir II 6W _e, eme, Property Location ( J
Property Uvners Mailing Address 3X& 13
/ V Q &"",'7 OW r l. d-l r RO Gojtt.. Lot 2 5
Phone Number A. Section
City, State Zip Code 3 circle one
e)
T .36 N: R~Eor
Subdivision Name
11. Ttpe of Building (check all t tat apply) Lot a
I or 2 Family Dwelling - Number o j edroogts ~
SS Block
v - ❑ Cr. of
❑ Public/Commercial -Describe Use
-
❑State Owned -Describe Usc CSNI Number ❑ Village of
.Town of ro ~ln iN~__
Ill. Type of Permit: (Check only one box on t Complete line B if applicable)
A C Other Modif~canon to Existin g System (explain)
❑ New System eplacentent System TreatntentlHoldingTank Replacement Only
List Previous Permit Number and Date Issue l7
B. 1) Permit Renewal O Permit Revision ❑ Chan or plumber O Permit Transfer to Nc,,'
Before Expiration Owner
IV. Tv e of POWTS System/Coin oncfit/Nvice: Check all that a Iv
❑ Mound > 24 in o(suitable soil Mound < 24 in of suinble soil
O Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ~
❑ Pretreatment Device (explain)
❑ Holding Tank ❑ Other Dispersal Component (explain)
V. Dis ersalfrreatment Area information: Dispersal Area Proposed (s() System Elevation
Design Flow (gpcl) Design plicati Rat gpdsl ~ Dispersal Area Required ( I)~ ~~5a ~ /aOr GS
1/50 1 • 2- 1 Capacity in Total M f Manufacturer
VI. Tank Info a o
Gallons Gallons Units
U y v
3
it U : " v
New Tanks. Existing Tanks 0
Seytic or Holding Tank
Dosing Chamber / p U 0/
VII. Responsibility Statement- I, the undersiencd, ahume responsihiliI for installation of the r wT5 shown on the attached plans.
Plum 's Signature MPIMPRS Number Business Phone Number
Plumber's Name (Print) n / IfY5 715 24, -
-715- 72 -
Plumbers Address (Street, City. State. Zip Code) /
2
VII . Count /De artment Use Only inA ent $ azure
Permit Fee d U Date Issue ssug g
Approved ❑ Disapproved S 40,2s /0
❑ Owner Given Reason for Denial /
IXS98r(t0Mf&Wroval/Rensons for Disapproval (IYl.O yl" jT-W1W_1'1t6I
1. Septic tank, effluent filter and
dispersal cell must be serviced / maintained'
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per app Ica a co tipf7fltt144ItYj for the system and submit to the County only on paper not less than a to + I I inches In site
SBD-6398 (R. 0 1/07) Valid 10 1/09
PART A. Safety and Buildings
Toy 141 NW BARSTOW ST FL 4TH
o~ P WAUKESHA WI 53188-3789
a Contact Through Relay
www.dsps.wi.9ov/sb/
www.wisconsin.gov
°ss~oNPys Scott Walker, Governor
Dave Ross, Secretary
October 18, 2012
CUST ID No. 267985 ATTN: POWTS Inspector
MICHAEL J MYERS ZONING OFFICE
NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA
2943 130TH AVE 1101 CARMICHAEL RD
GLENWOOD CITY WI 54013 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/18/2014 Identification Numbers
Transaction ID No. 2163078
SITE: Site ID No. 785002
Ron Obermueller Please refer to both identification numbers,
1380 Dunn St Croix Rd above, in all correspondence with the
Town of Glenwood, 54013 agency.
St Croix County
NE1/4, NE1/4, S25, T30N, R15W
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1396561
Maintenance required; Replacement system; 450 GPD Flow rate; 48 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.01/01); 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 "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatme t Sy V 0"
SBD-10706-P (N.01/01).
Q
The building sewer and distribution network piping shall be of material listed Ifs 4.30-3 and
384.30-5, Wis. Adm. Code. ~p 8
In the event this soil absorption system or any of its component parts malfunctions so as Areate a health hazard,
the property owner must follow the contingency plan as described in the approved plans. In addition, the owner
must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound
component manual. A copy of this information must be given to the owner upon completion of the project.
All holding/treatment tanks are to comply with SPS 384.25(7)(a).
MICHAEL J MYERS Page 2 10/18/2012
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 SPS 384 product approval conditions.
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.
Owner Responsibilities:
• SPS 383.52 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. SPS 383.54(1).
• SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. SPS 383.54(4) shall be considered a human health hazard.
• SPS 383.55 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.
Sincerely, 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@wisconsin. gov
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
Mound System Cover Page Pg1ofPECEIVED
OCT 11 2012
[MIESERIGNIFTE
SAFETY & BUILDINGS
Project Name: Obermueller-mound
Owner's Name Ron Obermueuller
Owners Address 1380 Dunn St Croix Rd
Glenwood City,Wl 54013
Legal Description Ne ' i Ne % Sec 25 T 30 N, R F175 1 W ! w
Township Glenwood
County j Saint Croix
Subdivision
Lot#
Parcel ID# Q C /v- /D 55-. 24 bob
Table of Contents
pg-
1 Cover page
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map
7 aein;> Cc ry~
total # of pages: 6
Designer Name: Michael J. Myers
MP/License 267985
Date: 10/8/2012
Ph. 715-265-4115
d
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onade Wastewater Treatment Systems" (version 2.0) SBD-10691-P (N.01101) GJ,
per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N O~J
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3baQ3bedvisementoom
Mound System Page 2 of 6
Mound Sizing Calculations
Project Name: Obermueller-mound
Site Conditions Design of Entire Fill
Project Type: 1 or 2 Family Dwelling % Cell depth at upslope edge (D): 19.0 in.
% Slope: 4 % Cell depth at downslope edge (E): 23.8 in.
# of Bedrooms: 3 Distribution cell depth (F): 9.5 in.
Depth to limiting factor: 17 in. Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal/ftz/day Cover thickness over center (H): 12 in.
Absorbtion rate of in-situ soil: 0.2 gal/fe/day End slope width (K): 10.8 ft.
Effluent quality ; Eff#1 w Fill length (L): 66.6 ft.
Max BOD effluent value: 220 mg/l Upslope width (J): 7.8 ft.
Max TSS effluent value: 150 mg/I Downslope width (Toe) (1): 40.0 ft.
Fill Width (W): 57.8 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal/day Basal area required: 2250 fe
Distribution cell width (A): 10.00 ft Basal area available: 2250 fe
Distribution cell length (B): 45.0 ft
Area of Distribution Cell: 450.0 ft Observation Pipes
Contour Elevation of Mound: 99.07 ft Location from end of cell (Z): 7.5 ft
System Elevation of Mound: 100.65 ft
Final Grade of Mound: 102.45 ft
Mound Plan View
/Observation Pipes
Kam. o Distribution Cell A
B ILK
I Tilled Area/Fill Material
L
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric H G
Distribution Cell
System Elevation an +:`A• F
3
Cover Material Lateral Invert
Fill Material Tilled Area
Slope-Forcemain System qq'o e7
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with SPS 384.30(6)(1)
Synthetic Fabric covering on cell per SPS 384.30(6)(g)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of 6
Pressure Distribution Calculations
Project Name: Obermueller-mound
Lateral Layout Lateral/Manifold Design
Lateral elevation: 101.2 ft Lateral diameter: 1'iz ! In.
Rows of Laterals: ! 3 1 Lateral spacing (S): 3.5 ft
Manifold type: I center Lateral to cell edge: 1.5 ft
Orifice diameter: p,125 In. Lateral discharge rate: 6.18 gpm
# of Laterals: 6 System discharge rate: 37.07 gpm
Distal Pressure: 5 ft Manifold diameter: 12 v In.
Lateral Length: 22 ft Manifold length: 7 ft
Orifice Spacing/Distribution Forcemain Friction Loss
Orifice spacing (X): 18.21 Inches Forcemain length: 120 ft
Orifices per lateral: 15 Forcemain diameter: 12 In.
Avg. ft2/Orifice: 5.00 ft2 Friction loss in Forcemain: 3.441 ft
Lateral Side View
Manifold
Lateral Lateral
x x x x x x x x x x x 71, x
2 2
Lateral Length Lateral Length
Lateral Plan View
Lateral Length T urn-up w/ball valve or cleanout plug
O G
S
D A
S
Q
Orifices on bottom of PVC laterals and forcemain to comply with
lateral equally spaced speciications per sips' 384.3%2Xel
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean-out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
6" Minimu L may be used in
Long Sweep 90 U place of W bar
or two 45's 3J8" Bar
Lateral
Mound System P~ 4 of s
Septic, Pump and Dose Tank
Project: Obermueller-mound
Tank Information Dosage Volume
Forcemain drains back to tank? Q Yes O No
Pump tank manufacturer: Wieser Concrete
Pump tank size/model: ; W1000/650-MR Lateral void volume: 14.0 gal
Pump tank gal/inch: 17 Dosage to absorbtion Cell: 69.8 gal
Actual Pump Tank Volume: 646 gal Forcemain volume: 20.9 gal
Tank bottom elevation (inside): 89 ft Total dosage: 90.7 gal
Septic tank size/model: W1000/650-MR
Pump and Filter Total Dynamic Head
Pump Manufacturer: Goulds Are laterals highest point? y
Pump Model: PE51 P1 if not, enter highest elevation: 0 ft
Effluent Filter: Polylock 525 System head (distal x 1.3) 6.50 ft
Vertical Lift ("D" to lateral) 11.49 ft
Note: Access opening of sufficient size to be provided to allow Friction loss in forcemain: 3.44 ft
removal of filter. opening to terminate at or above grade.
Pressure loss from filter: C~ft
Total dynamic head (TDH): 21.43 ft
Pump Tank Diagram Dose Tank Levels
Watertight Locking Cover In. Gal
4 Inch Wldh Warning Label 22.7 385.3
mished A Reserve
Minimum Grade
B Pump off to Alarm 2.0 34.0
Alternate C Total Dosage 5.3 90.7
o~~ D Effluent depth for pump 8.0 136.0
Location Elect per Comm
16.28 and Total Capacity: 38.0 646.0
Forcemain- ~ NEC 300
Weep Hole A
or Anti- B
Siphon
Device
C
I
D
Pump must be capable of: 37.1 GPM
and head pressure of: 21.5 Feet
Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and/or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied
by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1 /3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump/Dose Tank
If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump/dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce its absorbtion capabilities and/or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
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ITT GOULDS PUMPS
Residential Water Systems
APPLICATIONS MOTOR
Specially designed for the following uses: General:
• Mound Systems • Single phase
• Effluent/Dosing Systems • 60 Hertz
• Low Pressure Pipe Systems • 115 and 230 volts
• Basement Draining • Built-in thermal overload protection with automatic reset.
• Heavy Duty Sump/ • Class B insulation.
Dewatering • Oil-filled design.
• High strength carbon steel shaft.
SPECIFICATIONS PE31 Motor:
Pump - General: • .33 HP 3000 RPM
• Discharge: 1 1/2' NPT • 115 volts
• Temperature: 1040F (4000 maximum, continuous when • Shaded pole design
fully submerged. PE41 Motor:
• Solids handling: 1/2" maximum sphere. • .40 HP 3400 RPM
• Automatic models include a float switch. • 115 and 230 volts
• Manual models available. • PSC design
• Pumping range: see performance chart or curve. PE51 Motor:
PE31 Pump: • .50 HP 3400 RPM
• Maximum capacity: 53 GPM • 115 and 230 volts
• Maximum head: 25' TDH • PSC design
PE41 Pump:
• Maximum capacity: 61 GPM AGENCY LISTINGS
• Maximum head: 29' TDH
PE51 Pump:
• Maximum capacity: 70 GPM
• Maximum head: 37' TDH c us
Tested to UL 778 and
CSA 22.2108 Standards
By Canadian Standards Association
METERS FEET File #LR38549
40
PE$1 MODELS: PE31, PE41, PE51-
_.i HP:33.40..50
35
1 o 2 GPM Goulds Pumps is ISO 9001 Registered.
30 PE41
1 FT
0
Q . PE31 _ '
25
}
a
20
z
F 75. .
- -
10 5
0 00 10 20 _ _
50 60 70 GPM 80
0 5 10 15 m3/h
CAPACITY
ST. CROIX COUNTY
SEPTIC TANK. MAIN'l-ENANCI AGREEMENT
AND
ONN'NERSHIP CERTIFICATION FORAM
Jwner'I3u) er -_M /K► I~4C - -
Mailing Address - -j 3 $O j ?C,4
Propert) Address
(Verification required from Planning & Zoning Department for new construction.)
City%State_6Parcel Identification Number
LEGAL DESCRIPTION
Propert)- Location tF '4 . Sec. _2-S , T '3 D N R 15 W. Town of t.-vt wbo d~
Subdivision Plat: ML-fGS~A~ , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # qO J l (O > (before 2007)Volume Page # _
Spec house yes Lot lines identifiable _ les no
SYSTEM IVIAINTENANCE 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.
Tlie property owner agrees to submit to St. Croix County Planning & Zoning Department a certification [form, signed by (tie
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 andior (2) after inspection and pumping (if necessary). the septic tank is
less than 1 3 full of sludge.
Irwe, 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
~125712r
'~'~--IGNATURE 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.
(RE\'. 08/05)
qr~ SOIL EVALUATION REPORT #85
Department of CommerCL~"' 25 CU1 in accordance with Comm 85, Wis'A'dm de Page 1 of 3
Northland Plumbing, Inc.
Division of Safety and Buikiingp,,:,,, _
PLANNING Zqq~~I o
Attach complete site plan on paper not les~l$~i4 x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parce CO
Q l6-IOS~
Please print all information. eviewe Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Ron Obermueller Govt. Lot NE1/4, NE1/4, S25, T30N, R15W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1380 Dunn-St.Croix Rd
City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road
Glenwood City WI 54013 Glenwood Dunn-St. Croix Rd
❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Sandstone Flood plain elevation, if applicable ft.
General comments Use contour 99.07', bed size 45'x10'. - i2v ~'j r/4~ / ci 3
and recommendations: U
❑ Boring
1 Boring # ❑ Pit Ground surface elev. 97.48 ft. Depth to limiting factor 17 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 0-9 10YR5/4 sil 3sbk mvfr Cs if .6 .8
2 9-17 10YR5/6 sil 3sbk mfr Cs if .6 .8
3 17-21 10YR5/8 SC 2abk mAI Cs .2 .3
4 21-39 2.5Y5/3 SC 2abk mefi Cs .2 .3
5 39-48 2.5Y8/4 W-0 4`t' 0('~ fs Om mvfi Cs .5 1.0
re (e
❑ Boring
2 Boring # ❑ Pit Ground surface elev. 99.15 ft. Depth to limiting factor 23 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-14 10YR5/4 sil 3sbk mvfr Cs if .6 .8
2 14-23 10YR6/2 sil 3sbk mfr Cs if .6 .8
3 23-30 10YR7/4 SC 2abk mvfi Cs .2 .3
4 30-39 10YR6/4 fs Om mvfi Cs .5 1.0
5 39-50 2.5Y5/3 SC labk mefi Cs 0.0 0.0
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS S30 mg/L and TSS S.30 mg/L
CST Name (Please Print) ignature- CST Number
267985
Michael J. Myers
A/1'
Address Northland Plumbing, Inc. Date Evaluation Conducted Telephone Number
2943130th Ave Glenwood City, WI 54013 9/20/2012 715-265-4115
S13D-8330 (R.07/00)
• T
Property Owner Ron Obermueller Parcel ID # Page 2 of 3
3 E] Boring
Boring # 0 Pit Ground surface elev. 99.15 ft. Depth to limiting factor 17 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 0-10 10YR5/4 sil 3sbk mvfr cs if .6 .8
2 10-17 10YR5/6 A 3abk mfr cs if .6 .8
3 17-21 10YR5/8 sc 2abk mAI cs .2 .3
4 21-32 2.5Y5/3 sc 2abk mefi cs .2 .3
5 32-42 10YR fs Osg mVf1 cs .5 1.0
6 42-48 2.5Y7/2 schale pl mefi cs 0.0 0.0
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 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 (8.07/00) Northland Plumbing, Inc.
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BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
10/23/2012 3:45 PM
EXEMPT#: N/A
REC FEE: 30.00
TRANS FEE:'480.00
DOCUMSNT No. STATE BAR OF WISCONSIN FORM 1-2003 PAGES: 1
WARRANTY DEED
THIS DEED, made between Ronnie J. Obermueller and Kimberly
Obermueller a/k/a Kimberly J. Obermueller f/k/a Kimberly Johnson,
husband and wife("Grantor" whether one or more) conveys and warrants to
Timothy F. Miller and Katie E. Miller, husband and wife ("Grantee", whether
one or more), the following described real estate in ST CROIX County, State of
Wisconsin:
Part of the NEV. of the NE34, Section 25; Township 30 North, Range 15 West,
Town of Glenwood, St. Croix County, Wisconsin, described as follows:
Commencing at the Southeast corner of said NEVa of the NE'/ in the middle
of the road; thence North down the middle of the road 160 feet; thence West
394 feet; thence South 160 feet; thence East 394 feet to the point of beginning. RETURN TO
St. Croix County Abstract & Title Co. Inc.
219 S. Knowles Avcnue
New Richmond, W1 54017
Tax P el No: 016-1055-20-00
This Is is not homestead property
Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the
distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2012
real estate taxes.
Dated this 22nd day of October, 2012.
Ro a Obermueller
Kim ly Ober eller
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF WISCONSIN
20 1
COUNTY OF ss'
•
TITLE: MEMBER STATE BAR OF WISCONSIN I h
Personally came before me this X(:k day of October, 2012, the
(If not, above named Ronnie J. Obermueller and Kimberly Obermuelter
authorized by § 706.06, Wis. Stats.) a/k/a Kimberly J. Obermueller f/k/a Kimberly Johnson,
husband and wife to me known to be the person(s) who executed
the foregoing instrument and acknowledge the same.
THIS. INSTRUMENT WAS DRAFTED BY
Robert L_ Loberg / Loberg Law Office
Notary Public County, Wis.
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1211967 / alp /TCommission exvires: 17~
WARRANTY DEED t111 Form Na 1-2003
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Parcel 016-1055-20-000 PAGE E 02:51 PM
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Alt. Parcel 25.30.15.386B 016 - TOWN OF GLENWOOD
Current 0 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - OBERMUELLER, RONNIE J & KIMBERLY
RONNIE J BERLY O ERMUELLER
1380 DUNN/ST CROIX CTY RD R
DOWNING WI 54734
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1380 DUNN/ST CROIX RD
SC 2198 SCH DIST GLENWOOD CITY
SP 1700 WITC
II
Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE ~i
SEC 25 T30N R15W PRT NE NE COM SE CORNER Block/Condo Bldg:
IN CENTER OF ROAD, TH N 160 FT, W 394
FT, S 160 FT, E 394 FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
25-30N-15W NE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
03/24/2006 821411 QC
05/30/2001 646804 1648/602 WD
05/30/2001 646803 1648/599 TI
05/30/2001 646802 1648/598 QC
more...
2012 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/07/2011
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 20,000 175,100 195,100 NO
Totals for 2012:
General Property 2.000 20,000 175;100 195,100
Woodland 0.000 0 0
Totals for 2011:
General Property 2.000 20,000 175,100 195,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 214
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00