HomeMy WebLinkAbout034-1007-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
563814 0
GENERAL INFORMATION (ATTACH TO PERMIT) 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:
Johnston, James H. & Lucinda Springfield, Town of 034-1007-20-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
U` 04.29.15.50A
TANK INFORMATION ELEVATION DATA 1 • /d'(~!)
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
16. 6Z ZL
Septic . 1 l~s Benchmark Z, 95 /OZ. 5 1166
/d
Gb
Dosing k -t Alt. BM i Y. Sts 17.
Bldg. Sewer
Au. 16 k ~Z6_
Holding St/Ht Inlet d ~~1L ~7 ~O8
C
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO WELL d~ I~D~G. Ent Air Intake ROAD Dt Inlet
Septic i / h Dt Bottom
7/64 93 /40 - ag1 $7.67
Dosing 7 ,66/ 93 / 40 1406 / Header/Man. SI 413 • /
Aeration Dist. Pipe
Holding Bot. System 67
PUMP/SIPHON INFORMATION Final Grade ,14 9to, f rZ
Manufacturer 1 Demand St Cover,
QJ` 5 GPM lti( G r.~ •Sts 7
c7'
Model Number C 3~~ 9 /6~ J ~ Q3
TDH Li$,'t~ Frictions Los ~ System Head T T DH Ft
~7 •✓✓V 1-7, f
Forcemain Length, / JD,/ Dist. to Well /
r~ 3
SOIL ABSORPTION SYSTEM 9. 3
BEDITRENCH Width / Length / No. Of rench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~6
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of S Vm: UNIT Model Number:
c ✓ D I lS9 !QO /QZ
DISTRIBUTION SYSTEM d
Header/Manifold Distribution ole Sizel y Ix Hole Spacing Vent Intake A
Pipe(s) /~I~ J ✓Ir~/'/
Length U , Dia Z Length 7/' Dia A Spacing x H S 2 3, 73
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of 1 xx Seeded/S dded r Mul ed
Bed/Trench Center 44 Bed/Trench Edges ` Topsoil L Yes ® No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /0/ Z nspection #2:
Location: 2955 Cty Rd DD Glenwood City, WI 554013 (NW 1/4 NE 1/4 4 T29N R1 5W) 40 acres ot. J OB Parcel No: 04.29.15.50A
1.) Alt BM Description = Jk ( C4-- 66 J e.&,
2.) Bldg sewer length = ~b Gltm..., , '7Z
- amount of cover
Plan revision Required? 0 Yes JKINO
J L /
Use other side for additional information. U V
SBD-6710 (R.3/97) Date Insep Sig re Cert. No.
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~rc_o s'c~5a 6' ; C. d2'
;~.4~cy~ eve
`~~Aarnr~T County
4jr Safety and Buildings Division S~.
l,; f"O-(JC
B a 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
S P Madison, WI 53707-7162
IpT1~~'~
tary Permit Application State Transaction Number
.1A 1W In accordance with 3. 2), Wis. Adm. Code, submission of this form to the appropriate en% unit 6 6 ,?,0 76,
is required prior to obllrlfling a sanitary permit. Note: Application forms for state-owned POWTS are sub o Project s (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secon
purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. Jam. C.r~
1. Application Information - Please Print of on
Property Owner's Name &atrcel #
JQ nn ,e J-o- S "r,05 T-* /4177 ZD - 6cln
Property Owner's Mailing Address Property Location
L/Oy S~o 5~
Govt. Lot
City, State Zip Code Phone Number Section
/-G1 t W 0 0C/ & ,Ol 3 ' rrcle one)
~
IVype of Building (check all that apply) r Lot # T N; R EorW
1 or 2 Family Dwelling - Number of e s V Subdivision Name
~usert~..e~/'O Block# zJA
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use~~, _ CSM Number ❑ village of
J14 Town of /-P
III. Type of Permit: (Check only one box on line A. Complete fine B if applicable)
A. S m eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem/Com onent/Device: Check all that a 1 r
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
/i
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Propos (sf) System Elevation /
7- o ?Sd "750 44 lt> ~Y 5'f ✓
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units b c
U
New Tanks Existing Tanks I L. o a m `c~
W YO 1,6k :Z a U v y ~n u. 0 a
Septic or Holding Tank
Dosing Chamber / Q
VII. Responsibility Statement- I, the undersigned assume responsibility for ins Ilation of the POWTS shown on the attached plans.
Plumber's Name (Print) ~j~ Plu s Signatur MP/MPRS Number Business Phone Number
fitf e-~Jt l vt -e-j-5
lumber's Address (Street, City, State, Zip Code) v C/
VIII. un /De artment Use Only
Approved Disappro Permit Fee DateJIssued + Issuing t Signature
iven Reaso r Denial $ 6Zee✓ ` 46 (,o ! o j
IX Condit OihOYtt~fReasons for Disapproval 3, t'ti 5Ue nrp,J ~-e,
1. Septic tank, ett Ant filtertlnd j) eP~ ~ I J~ ,fir
d0-7
ispersal cell must all be servlces / maintained A r~
as per managetnent plan provided.by plumber.
2. AN hack regt~rements.must be YrAk taitt6d ) d~ d a J ~ e (`on o n up
m per amble code f 1 a 10
Attach to complete plans for the system and submit to the Count only on paper not less than 812 x 11 inches in size
SBD-6398 (R. 11/11)
t oEPARr, DIVISION OF INDUSTRY SERVICES
141 NW BARSTOW ST FL 4TH
WAUKESHA WI 53188-3789
3i'e Contact Through Relay
www.dsps.wi.gov/sb/
w
www.wisconsin.gov
~~E397~Nl~l S Scott Walker, Governor
Dave Ross, Secretary
June 19, 2013
CUST ID No. 267985 ATTN PO WTS -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: 06/19/2015 Identification Numbers
Transaction ID No. 2258076
SITE: Site ID No. 791765
James Johnston Please refer to both identification numbers,
29655 Cty Rd Dd above, in all correspondence with the
Town of Springfield agency.
St Croix County
NWl/4, NEl/4, S4, T15N, R29W
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1432968
Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade;
System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution
Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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" S1313-10691e 101/01) and the
Pressure Distribution Component Manual for Private Onsite Wastewater Tre~tmvt Syste RSION 2.0"
SBD-10706-P (N.01/01). W f cror qAA/~/
The building sewer and distribution network piping shall be of mat isted ii4.3Q'd 384.30-5,
Wis. Adm. Code. /4/®V
In the event this soil absorption system or any of its component parts rr~ o a create a health hazard,
the property owner must follow the contingency plan as described in the ed plIn addition, the owner
must comply with the operation, maintenance and monitoring duties as desc section VIII of the mound
component manual. A copy of this information must be given to the owner upon mpletion of the project.
All holding/treatment tanks are to comply with SPS 384.25(7)(a).
MICHAEL J MYERS Page 2 6/19/2013
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 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, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Julia Lewis-Osborne
POWTS Reviewer 2, Integrated Services WiSMART coder 7633
(262) 397-6005, Fax: (608) 283-7481
julia.lewis gwisconsin.gov
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services
(formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been
replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of
Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have
been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code
will be addressed by SPS Chapters 360-366.
s
Mound System Cover Page pg 1 of fIECEIVED
'WHESER JUN 32013
DcRET INDUSTRY SERVICE
Project Name: Johnston-mound
Owner's Name James Johnston
Owners Address 1444 320th St
Glenwood City,Wl 54013
Legal Description NW• NE W %4 Sec( T 15 N, R 29 wy
Township Springfield
County Saint Croix
Subdivision
Lot#
Parcel I D#
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
total # of pages: 6
Designer Name: Michael J. Myers
MP/License 267985
Date: 5/21/2013
Ph. 71,6-265-411 5 4 `z)~.
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N. V
per " Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) 06-P (N 011/01 ~
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-606688,vee 3badvisement.com
Mound System Page 2of6
Mound Sizing Calculations
Project Name: Johnston-mound
Site Conditions _ Design of Entire Fill
Project Type: F or 2 Family Dwelling Cell depth at upslope edge (D): 12.0 in.
% Slope: P24in. % Cell depth at downslope edge (E): 12.6 in.
# of Bedrooms: Distribution cell depth (F): 9.5 in.
Depth to limiting factor: Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal/ft2/day Cover thickness over center (H): 12 in.
Absorbtion rate of in-situ soil: F:~~gal/ft2
/day End slope width (K): 8.5 ft.
Effluent quality Fill length (L): 107.0 ft.
Max BOD effluent value: 220 mg/I Upslope width (J): 6.7 ft.
Max TSS effluent value: 150 mg/l Downslope width (Toe) (1): 7.3 ft.
Fill Width (W): 19.0 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal/day Basal area required: 750 ft2
Distribution cell width (A): 5.00 ft Basal area available: 1107 ft2
Distribution cell length (B): 90.0 ft
Area of Distribution Cell: 450.0 ft2 Observation Pipes
Contour Elevation of Mound: 93.51 ft Location from end of cell (Z): 15 ft
System Elevation of Mound: 94.51 ft
Final Grade of Mound: 96.30 ft
Mound Plan View
_,,,~(Jbservation Pipes
T
A
T SIC
I Tilled ArealFill Material
r L '
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric-__-
Distribution Cell- 'N
System Elevation F _
n e , 7 ~ --ti-
Cover Material 1 . { L,ytpral
t IE Iri . art v
Fill Material
'Tilled Area
System
r Slope Forcemain
Contour
Notes:
Fill material to consist of ASTM C33 Sand ~S
Distribution cell aggregate to comply wSF mm--1 0(6)(I)
Synthetic Fabric covering on cell per Gcrit 4.30(6)(g)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of s
Pressure Distribution Calculations
Project Name: Johnston-mound
Lateral Layout Lateral/Manifold Design
Lateral elevation: 95.0 ft Lateral diameter: Vh ! j In.
Rows of Laterals: 2 Lateral spacing (S): C~ft
Manifold type: center Lateral to cell edge: 1 ft
Orifice diameter: 0.125 In. Lateral discharge rate: 9.47 gpm
# of Laterals: 4 System discharge rate: 37.90 gpm
Distal Pressure: 5 ft Manifold diameter: 2_7J In.
Lateral Length: 44.5 ft Manifold length: 3 ft
Orifice Spacing/Distribution Forcemain Friction Loss
Orifice spacing (X): 23.73 Inches Forcemain length: 120 ft
Orifices per lateral: 23 Forcemain diameter: 2 W In.
Avg. ft2/Orifice: 4.89 ft2 Friction loss in forcemain: 3.584 ft
Lateral Side View
Manifold
7L - - - Lateral v Lateral
55 'J
r'L 1 x 71' X, x X 7r x x f rX ' x x X
2 Z
Lateral Length Lateral Length
Lateral Plan View
Lateral Length 1 Turn-up w/ball valve of cleanout plug
❑ ❑T
❑
Orifices on bottom of
lateral equally spaced PVC laterals and Forcemain to comply with
specifications per C+ 84.30(2)(e)
Forcernain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean-out plug
Final Grade or ball valve
~u-- Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
6" Minimum may be used in
Long Sweep 90 place of 318" bar
or two 45's 3/8" Bar
Lateral
Mound System Page 4of7
Septic, Pump and Dose Tank
Project: Johnston-mound
Tank Information Dosage Volume
Pump tank manufacturer: Wieser Concrete Forcemain drains back to tank? .O Yes O No
Pump tank size/model: W1000/650-MR Lateral void volume: 18.8 gal
Pump tank gal/inch: 17 Dosage to absorbtion Cell: 90.0 gal
Actual Pump Tank Volume: 646 gal Forcemain volume: 20.9 gal
Tank bottom elevation (inside): ft Total dosage: 110.9 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) 9.34 ft
Note: Access opening of sufficient size to be provided to allow
removal of filter. opening to terminate at or above grade. Friction loss in forcemain: 3.58 ft
Pressure loss from filter: Loft
Total dynamic head (TDH): 19.43 ft
Pump Tank Diagram Dose Tank Levels
~Watertight Locking Cover In. Gal
4 Inch With Warning Label
~-Finished A Reserve 21.5 365.1
Minimum
Grade g pump off to Alarm 2.0 34.0
Alternate z- Total Dosage 6.5 110.9
Outlet
Location Elect. per Comm D Effluent depth for pump 8.0 136.0
_T 16.28 and
r em in NEC 300 Total Capacity: 38.0 646.0
Weep Hole A METERS FEET
or Anti- 40
MODELS: PE31, PE41. PES
Siphon B PESt
Device 35 HP:.33..40..50
t; - - - ` -
10 2 GPM
D 30 1FT -
Q
25
Q -
Z 2 - -
Pump must be capable of: -
and head pressure of
a 15 -
o ,
10
5 -
0 10 20 30 40 50 60 70 GPM f
L
0 5 10 15 m3/h
CAPACITY
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 it's 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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NVIsconsin SOIL EVALUATION REPORT #86
' Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of-3-
Division of Safety and Building 1001--n Northland Plumbing, Inc.
~A County
Attach complete site pla n of les 8/z x 11 inches in size. Plantc St. Croix
include, but not limited al an zontal reference point (BM), direction and~4 011
percent slope, scale or si , north arrow, and location and dista" nearest roa arcel I.D.
Please print all information. v/~/ ~Jr2 Revie ed By ~ Date
Personal information you provide may be used for secondary purposes (Privacy 15.04 (1 qo ~ L-3
Property Owner Pro's 5-40-
Johnston,
Johnston, James Govt. Lot : r NW1/ , NE S4, T29N, R15W
Property Owner's Mailing Address Lot # Block # Subd. Na or CSM#
1444 320th St
City State Zip Code Phone Number ❑ City Village
❑ ❑ Town Nearest Road
Glenwood City WI 54013 Springfield County Road DD
❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable ft.
General comments Mound site. Using 93.51' contour.
and recommendations:
❑ Boring
1 Boring #
Pit Ground surface elev. 91.24 ft. Depth to limiting factor 25 ""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. j *Eff#1 'Eff#2
1 1-13 10YR3/2 sil 3sbk mvfr cs 2f .6 .8
2 13-23 10YR4/3 sl 3sbk mvfr cs if .6 .8
3 23-25 10YR3/8 fs Osg ml cs .5 1.0
4 25-29 10YR6/8 lfi 7.5YR7/8 spots fs Om mfi cs .5 1.0
5 29-52 10YR7/8 1f1 7.5YR7/8 spots sc 2abk MAI cs 0.0 0.0
❑
2 Boring # Boring
.
Pit Ground surface elev. 94.02 ft. Depth to limiting factor 31 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
1 1-15 10YR3/2 sil 3sbk mvfr cs 2f .6 .8
2 15-24 10YR4/3 sl 2sbk mvfr cs if .6 1.0
3 24-31 10YR6/8 fs Osg ml cs .5 1.0
4 31-39 10YR6/8 if17.5YR7/8spots fs Om mfi cs .5 1.0
5 39-51 10YR7/8 if1 7.5YR7/8 spots sc labk mvfi 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
CST Name (Please Print) Si ture CST Number
Michael J. Myers 267985
Address Northland Plumbing, Inc. Date Evaluation Conducted Telephone Number
2943 130th Ave Glenwood City, WI 54013 5/10/2013 715-265-4115
SBD-8330 (R.07/00)
Property Owner Johnston, James
Parcel 1D # Page 2 of
Boring /
Boring # ;pit J ~
Ground surface elev. 90.57 ft. Depth to limiting factor
24 in.
Horizon Depth Dominant Color Soil Application Rate
Redox Description Texture Structure Consistence Boundary Roots
in. j Munsell Qu. Sz. Cont. Color I GPD/ft2
Gr. SZ. Sh. I 'Ef(#1 'Eff#2
1 1-16 10YR3/2 sil 3sbk
mvfr cs 2f 6 .8
2 16-19 10YR4
/3 j sl 2sbk mvfr cs if .6 1.0
3 19-24 10YR6/8
fs Os9 I ml cs 5 1.0
4 24-34 10YR6/8 lfl 7.5YR7/8s ots fs
P Om
mfi
cs
.5
1.0
5 34-52 1
OYR7 8 lfl
/ 7.5YR7
/8s ots sc
P labk muff cs 0.0
0.0
I
Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 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 TTY 608-264-8777.
SBD-8330 (R.07/00)
Northland Plumbing, Inc.
Property Owner Johnston, James
_ Parcel ID #
Boring # Boring Page 2 of
Pit Ground surface elev. 90.57 _ ft. Depth to limiting }actor
Horizon Depth I Dominant Color Redox Description °Texture -24 in. Soil Application Rate
In Munsell Qu. Sz. Cont. Color " Structure (Consistence Boundary I Roots
1 Gr. Sz. Sh. GPD/ft:
1-16 10YR3/2 I 'Eff#1 'Eff#2
sir 3sbk mvfr cs 2f .6
2 16-19 10YR4/3 I j .8
i sl 2sbk
fs mvfr cs if
3 19-24 6
10YR6/8 1.0
Osg ml cs5 1.0
4 24-34 10YR6/8 1f1 7.5YR7/8spots fs
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5 34-52 10YR7/8 I 1f17.5YR7/8spots sc Om m f cs .5 1.0
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Effluent #1 = BODS> 30 220 mg/L and TSS >30 <150 m /L
- 9 Effluent #2 =Bops < 30 mg/L and TSS <-30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608_264-8777.
SBD-8330 (R.07/00)
Northland Plumbing, Inc.
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ST. CROIX COUNTY
SEPTICTANK 1\IAINTENANCE AGREEMENT
AND
II ONVNERSHIP CERTIFICATION FORM
J\vrter'Buyer htie
Mailing Address - / C/e/ 'Y2'0 tic
Property Address _ 2 ASS lei d i~ u~oeo~ ~e~y, G~J/ SfCd /3
(Verification required f-~roiiil Planning & Zoni g Department for new construction.)
City/ State /-uz c.~ Gv~ Parcel Identification Number
LEGAL DESCRIPTION * P1
Property Locution N'i , '/4 Sec.T _ 14- N R 2_W, Town of Spr- in
Subdivision Plat: DV aclltl~ , Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # la 3 CO j~ (before 2007)Volume / 5-7 3, Page # - 3
Spec house yes no Lot lines identifiabl yes 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 ss'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 andior (2) after inspection and ptnnping (if necessarv). the septic tank is
less than 13 full of sludge.
liwe, 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.
live certify that all statements on this for are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warrant deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNA E OF PLICANT(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.
(RED`. 08/05)
T1573PAG£ 33
STATE.. BAR OF WISCONSIN FORM 1 - 1998 tEi. :239 4EI.
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between William C. Ullom and Louise S. Ullom
husband and wife, - RECEIVED FOR RECORD
- 01-08-2001 9:30 AM
YARRANT
Y DEED
Grantor, and James H. Johnston and Lucinda S. Johnston, husband and EXEMPT # 17
wife, as survivorship marital property, CERT COPY FEE:
COPY FEE:
TRANSFER FEE:
REC13RDING FEE: 10.00
Grantee.
PACES:
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County, State of
Wisconsin (The "Property").
Recording Area
Name and Return Address
W 1/2 of NE 1 /4 of Section 4-29-15. James H. Krave
Attorney at Law
P.O. Box 304
Glenwood City, WI 540 1 3-03 04
034-1007-20,034-1007-30
Parcel Identification Numbcr (PIN)
This IS homestead property.
This deed is given in satisfaction of land contract recorded October 18, 2000, Volume 1552, Page 1 11, Document Number
632060.
'Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements and encumbrances of record
Dated this - - day of JANUARY 2001
* William C. Ullom
~---yp_CS rrl
* Louise S. Ullom
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signaturc(s) William C. Ullom and Louise S. Ullom ) ss.
County. )
- - - Personally came before me this day of
authe ticated this ay NUARY , 2001 the above named
Ja es H. Krave
E: MEMBER STATE BAR OF WISCONSIN (11 to me known to be the person(s) who executed the foregoing
" " instrument and acknowled a the same.
authorized by § 706.06, Wis. Slats.) g
THIS INSTRUMENT WAS DRAFTED BY
James H. Krave, Attorney at Law__
Glenwood City, WI 540 1 3-03 0 4 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not state expiration date:
necessary.) )
*Names of parsons signing in any capacity should be typed or printed below their signatures
WARRANTY DY&D STATE. MR RF WiSCQNStPI
FORM ,44 1 - 19%
INFORMATION PROFFSSIONAI.S COMPANY FOND) DU LAC, WI 900-655-2021
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