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016-1045-20-000
° m a� a o � I N c0 w y c N a o �7 N V N O= co�-�.= N to M (°0 3 r w m•�° c m N X c Y C U E O c U o :: °o - m ti -2 La w C CE`s mmC � m O ��r0. 7 0 0 0•N N U C! E N n t E N N O m O O Co t N N m L O. �c Sao 3 `—° m o a3i y �ccc 'a vCD cm 3 u, c w N 0 mo a N p°p 'O N N 16 30 Q V 3 C N y z on m W v z co E m O�v C 7 N O) c a0 7 NC c to Z O C O LL C N LL C �p 0-O y N N 07 O O N N•- E - C m C 3 v �� �� o ' a ooLJmtN �=° O O-- u maa Q -stn U).0��Sa I Cl) � I � (D I z z E E O a m a m N F � N N O Z m c cUi 2 w c co F- r N c E N N C _ N N w N N d •N c s a m s O 2 z z 0 m z to z co N Cl) a � .. a � m c C2 Ll G a a a a�i O G d a o LD ;4z U O O O a H U O O O a • R oaaa �, aaa if " O 3 W J U c o co m o m rn rn o N N U z � o O c')i } v C9 N z 0 O O O c O 1[1� O K 3 !. 0 C> ._ C0 .O 3 �, p p .= 0 N > m c a rn V1 O) .... N c n W m o v Q N CD N O O E m Oto ',, Y tea ° r \ N v• L' o Q a a 4) L6 (I w LO ci o c m° fO M , E m� m O O N m O N (7 U) o z M a cn (7 o z z I m € a I € a E c c «' 1 3 ' o m l 3 o o A uCL lou) u 0 (j) U 81705 .43 Docutent Number Document Title Tx:4140386 982753 St. Croix County BETH PABST REGISTER OF DEEDS Affidavit for a single POWTS ST. CROIX CO., WI servicing Two Structures via Private Interceptor Main RECEIVED FOR RECORD 07/22/2013 3:03 PM CL"IreK W/ k EXEMPT #: Name—(Owner) Typed or printed REC FEE: 30.00 being duly sworn ,states, under oath,that: PAGES: 1 He/she is the owner/co-owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume_N/A_,Page_N/A_ Document Nilmber_ 559 335 St. Croix County Register of Deeds Office: Recording area A parcel of land located in the_SW %4 of the SW '/4 of Section 20—,T30 N Name and Return Address —R 15 W,Town of_Glenwood_, St. Croix County, Wisconsin, being duly Derek T.Wink described as follows(include lot number and subdivision/CSM or detailed 2855 Cty. Rd.G legal description): Glenwood City, WI 54013 All of the SW '/4 of NW '/4 that is lying south of Soo Railway Section Twenty(20)Township Thirty(30) Range Fifteen (15) . The W '/z of SW '/4 014-1045-20-000 rcel kl Parcel Identification Number(PIN) of Section 20,Township 30 North, Range 15 West. Commonly known as: 2816 Co. Rd. G,Glenwood City, Wi 54013 As owner of the above described property, I.acknowledge that a Private On-site Wastewater Treatment System (POWTS) serving the primary residence is sized for_4_bedroom(s)with a design wastewater flow of 600 gallons/day(DWF calculation based on 150 gpd/bedroom cr 2 persons per bedroom). A maximum of 8 occupants are permitted. An accessory structure will also be connected to the POWTS via Private Interceptor Main Sewer(PIMS) in compliance with SPS 382.30(12). There are currently a total of occupants generating domestic wastewater, therefore the POWTS can be considered code-compliant at this time. However, i understand that if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate any increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge that I will disclose this information to any parties interested in purchasing this property in the future. Dated this as day of ITV/y ,2013. * Derek U/�%1k * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )SS. St. Croix County. ) authenticated this day of `` ����NSO�1.4 Personally came before me tthe�d dof 'y P0 TITLE: MEMBER STATE BAR OF WSC Sl�v�� ��� to me known (If not, i�i's� �y��be the person(s)who executed the foregoing Authorized by § 706.06, Wis. St s.) $110111 4% Instrument h01 11F1; Instrumenl and acknowledge the s me. THIS INSTRUMENT WAS DRAFTED BY Pamela Quinn,Land Use Specialist _Community Development Dept. * vsN tT � ✓ Notary ublic, State of Wisconsin (Signatures may be authenticated or acknowledged. My Commission is permanent. If not, state expiration Both are not necessary.) date: Date: ���� d/J "111 IS PAGrs IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE" This information must he completed h),submitter: document title,name&return address,and PIN(if required). Other information such as lire granting clauses,legal description,etc.may be placed on this first page of lite document or may be placed ou additional pages of the document.LqtL Use of this 1 ofAver page adds one page to pour document and$1.00 to lire recording fee. Wisconsin Statutes,59.43. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563845 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: Wink, Derek T. Glenwood, Town of 016-1045-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /b0 • ~3 /VA it~ Z. < ~ 20.30.15.326 TANK INFORMATION ELEVATION DATA TYPE jANUFAI TURER CAPACITY STATION 3B~ HI FS ELEV. Septic / Benchmark -7 , Z J1? '/1 5 Dosing AIJ~a,RQCalicrf' ~r Bldg. Sewer 7- 31 ar-7. 9 Z 52 -5 Holding St/Ht Inlet ,I~~ 9z• TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. ent t it I ake ROAD Dt Inlet Septic 7Iw 67. Dt Bottom K,31 < J • 6 Dosing Header/Man. Z1s~ 16 JZ 6 Aeration Dist. Pipe 2.311 1,6Z. 6 Holding Bot. System Z. 1e PUMP/SIPHON INFORMATION `I /ad 6 Fina rade Manufacturer lip Btnand St Cover ' 1 GPM 1.... o~.~i AA, 36 /da . Model Number L ~4~k 'LG 27,11 TJ d v~ a c~ 7 7t' TDH Litz. Friction 2.( ystem He ' TDH ..A I Forcemain Length Dia. Dist. to well 2 SOIL ABSORPTION SYSTEM tf, 39 BEDITRENCH Width Length No. Ojz~v PIT DIME SIONS No. Of Pits Inside Dia. Liquid Dept` DIMENSIONS 0 (006 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O I CHAMBER OR J~♦66 /'I cr T UNIT Model Number: DISTRIBUTION SYSTEM G~ , Header/Manifold// 6-1. ibuti671, ~ x Hole Sizx Hole Spacing Vent it Intake rp~spu.(s) t7 Length Dia ength i7Dia Zs Spacing ,3L -5 b` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of t1 xx Seeded/S ddded/ xx A I hed Bed/Trench Center Bed/Trench Edges Topsoil ~r~f Y.es 0 No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: g / q / 13 Inspection #2:_ 4R/n/ Location: 2816 Cty. Rd. G Glenwood City, WI 54013 (SW 1/4 SW 1/4 20 T30N R1 5W) 40 acres Lot n Par I No: 30.15.326 1.) Alt BM Description / a 1. 14-~,•Y~ V a 2.) Bldg sewer length d - amount of cover Q'b °ti7 ,,",per 4Z (00 v -Jt, WL~ e Plan revision Required? ® Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insep rs Si ure Cert. No. ~ / SHEF Series Page 1 of 1 RESIDENTIAL ENGINEERED Customer Access Product Registration HELP PENTAIR ROMAn PRODULTS ROOURCE ['.ENTER A80UT SEARCH z a 15 Hydromatic /Residential / Hydromatic Residential Products / SHEF Series Print PRODUCT IMAGES ococnoneeNrc 50 40- 30' SHEF45 Et5 2. I 10 SPE l0 BODY( 0 US GPM 20 i0 60 80 100 HORSE] MAXIMUM HEAD: 24 ft. (7.3 m) MAXIMUM CAPACITY: 44 GPM (2.8 LIPS) FLOW at 10' LIFT: 36 GPM SWITCH TYPE: Wide Agie Tethered Float MINIMUM SUMP DIAMETER: Simplex: 18" / Duplex: 30" DISCHARGE PIPE SIZE: 1-1/2" to 2" NPT (model dependent) MAXIMUM SOLIDS HANDLING SIZE: 3/4" AMP DRAW (full load): See Spec Sheets (model and voltage dependent) CORD LENGTH: 20' SJTW VOLTAGE: available in 115v / 208v / 230v / 460v / 575v MAXIMUM LIQUID TEMPERATURE: 120°F (49°C) MAXIMUM (intermittent) LIQUID TEMP: 120 -140 degrees F (49 - 60degrees C) IMPELLER: Thermoplastic Vortex . s SITEMAP CONTACT US € BECOME AN AUTHORIZED DISTRIBUTOR CAREERS TERMS OF SERVICE PRIVACY STATEMENT Copyright (0 2013 Pentair Ltd. http://www.hydromaticresidential.com/ResidentialProduct hy_se_ef shef30.aspx 9/5/2013 e-r P~Mmwjrff 0 tvv Pump Specifications LE40 Series 4/10 HP Submersible Sewage Pump LITERS PER MINUTE 0 100 200 300 400 500 T FTIT-1-T- 6.0 204 1 t 1 11 111 11 5.5 5.0 4.5 15 4.0 3.5 W w W 2 U. Z 2 p a _ - 3.0 Q w 10, s J F 2.5 0 r 2.0 1.5 5 1.0 - 0.5 0 0.0 0 20 40 60 80 100 120 140 GALLONS PER MINUTE LPAO_PI 811/4/2011 ®Copyright 2011 Liberty Pumps Inc. All rights reserved. Specifications subject to change without notice. F1~ IU*s Property Owner V J t a -1 4o, ft. Legal Dew* on .sj'/y w- Tm swA sue; (except where noted, ? N, T swy r Cw C19." "VZ ~r e x cO:IN-7v. = Backhoe ph 1A}iSt'~n1Sl1J, A10 AdxCsi - ` North f i=r Sz /s, 0. Leo ~ . , pf,1 • a 16) Lis f I w oF. pvt P' ~p QIK E 6;'Fos~PJ" j ~ Y St Ue Location: - ~ t ~w ~N~ ~ County i L PLO I )c =b• R~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 San itary Permit Number (to be filled in by Co.) a 'S K Madison, WI 53707-7162 p~ 3 Y °"~srox"` State Transaction Number it Application in accordance with SPS 1 Wi . Code, submission of this form to the approp ' governmental unit is required prior to obtain s permit. Note: Application forms for state-owned P submitted to Project Address (if di Brent th ailing dress) the Department of Safety and Professional Serv ies. Personal information you provide may be u dary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. J " 1. Application Information - Please Print All Information ~J pazcel # iC U Property Owner's Name 4 U 13 a1 - 2~ v K S7. CR011 Property Owner's Mailing Address Property Location 3 Govt. Lot Section ~Q City, State Zip Code Phone Number S~ y,, _S (~'J V I (circle on l✓`Z- F~ D' 3 T 3Q_ N; R _/_457~ E o(W) 1L Type of Building (che all that apply) Lot # Q Subdivision Name ~ or 2 Family Dwelling N}rmber of Bedrooms 41- 't~tiL/✓/,,/?IG Block# /7(iI W ❑ Public/Commercial - Describ se ❑ City of CSMNumber El Vi age of El State Owned -Describe Use / fown of 4 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS System/Component/Device: Check all that apply) O ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil Mounds suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/ I reatment Area Information: Dispersal Area Proposed s System Elevation Design Flow (gpd) Design Soil Application Rat gpdsf) 7FF (fl D 0 , 00 V VI. Tank Info Cap ity in Manufacturer Gallons U y New Tanks Existing Tanks !y/G y c aj aU y wC7 G. ° Septic or Holding Tank 2-00 Zx~ ~ ~ fe Dosing Chamber 0~ G~ I ~i✓/ VII. Responsibility Statement- 1, the under7771~~E~ as y for installation ofthe POWTS shown on the attached plans. Pl ber's Name (Print) b is MP/MPRS Number Business Phone Number M C 933D 9 7J549 - 937 Plumber's Address (Street, City , State, Zip ode) P• 1 e ar tment Use Onl Permit Fee Date Issued uing ent gnatur tC 2_ ❑ Disapproved ~ ❑ Owner Given Reason for Denial W URE'R a~easons for Disapproval ®alit- &Ih 1. Septic tank,, effluent filter and dispersal cell must be serviced / mainta' as per management plan provided by pl c 2. All setback requirements must be maintained unty only on ABger not less than 8 12 I inches in size for the system and submit the Co Ivan Maw SBD-6398 (R• 11/11) / " LIC ~ ~ per: &CFf Property owner Dsk'R-K T, yJ ! A16 I"=40ft Legal Dewfiption .sji/4 cr- -nom .su-j/, sue; (except where notes TWA 1 T16uj T#?UW C4- GL" Aky i ST CfWx cou vTY. 1A115eADM I nt yo ACES North MIS' ?frig 'PC S Vi Ac Site Location: N th A A+►F.1~ ~ ~ o ~ ° # stt~~ N~ o `4 b pro ~v ,i 1~ ~ Route \ vt Qh,~^0Cooh" . T gViW I N C ~c - ~ ' c~-~ rt_ J of ~vJ~N ~ 1 - - 1, ~a~' L-> w ~N~ Private Interceptor Main Sewers Comm 82.30 (12) - •'3 sq<:.: Cleanout r_" <a = 4" PVC Not a PIMS when Building 2 separate pipes „ ? \ Sewer are used in A_.. approved Directional Fitting :~inlet/outlet POWTS access openings Pri vate Interceptor -C openings are not Main Sewer * Holding considered Tank cleanouts because of possible Access Road component damage Watertight Tank Joints Pipe to tank joints must e 1 • x- be an approved type as M well as watertight .w. i9 y' df a~ No concrete joints, openings cast in place or smooth bored. Private Interceptor Main Sewers 1 July 1, 2002, Comm Table 82.20-2 1 4 inch diameter private interceptor main sewers no longer require department review Counties should review designs Code change pending regarding department reviews for 2 buildings served by one POWTS 1 Defined: Means a privately owned sewer serving 2 or more buildings and not directly controlled by a public authority r iii-- 16 Aa4" 11P-0-) Private Interceptor Main Sewers Comm 82.30 (12) 13 . d~ Setbacks, pitch, SyS-I~r'' o in stallation same as a 3e": 010 = 4" PVC for building sewers Building Comm 82.30(11)(c), =s' « Sewer (d), and (e) 1 Frost protection same as for building Pri vate Directional Fitting sewers Interceptor Frost Sleeve 1 C nout r uired at Main Sewer the most CO in Direction point of the DIMS Holding of Flow See Comm 82.35 L Tank 1 Cleanouts 100 ft Access Road apart. Cleanouts require a frost sleeve r~pnRrMFA, Safety and Buildings 51~' Toy, 10541 N RANCH ROAD HAYWARD WI 54843 0 Contact Through Relay P www.dsps.wi.gov/sb/ 1 S ~w NOV 2 6 2012 www.wisconsin.gov Scott Walker, Governor S1 Dave Ross, Secretary November 13, 2012 c`j.dl~~ ~r Fc:`` CUST ID No. 224832 ATTN.• POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/13/2014 Identification Numbers' Transaction ID No. 2174131 SITE: Site ID No. 785837 Derek Wink Please refer to both identification numbers, 2816 Cth G above, in all correspondence with the agency. Town of Glenwood, 54012 St Croix County 0 S SWIA, SW1/4, S20, T30N, R15W y(1~; FOR: co Description: Mound, 4 br res & accessory bldg .V Object Type: POWTS Component Manual Regulated Object ID No.. 1400618 a Maintenance required; 600 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; stem Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - 2.0, SBD-10706-P (N.01101), S$WW Pub. 9.6; Effluent Filter GOP`R The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Cod s 5 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: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. Reminder • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. MARY JO HUPPERT Page 2 11/13/2012 ' f • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle ' size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per SPS 382.30(11)(c). • Provide frost protection per SPS 383.43(8)(c). 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 Patricia L Shandorf POWTS Plan Reviewer, I4 ed Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer H, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday 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. MARY JO HUPPERT Page 2 11/13/2012 • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stars. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per SPS 382.30(11)(c). • Provide frost protection per SPS 383.43(8)(c). 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 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer H, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday 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 AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE RECEIVED NOV05Z012 Project Name: DEREK T. WINKS & BUILDINGS Owner's Name: (same) Owner's Address: 2855 C.T.H. G Glenwood City, WI 54013 Legal Description: SW 1/4 of the SW 1/4, S 20, T30N, R1 5W Township: Glenwood County: St. Croix Subdivision Name: NA Lot Number. NA Block Number. NA Parcel I.D. Number. 016 -1045 - 20 - 000 S J. Plan Transaction No.: G Page 1 Index and title ~pONp~N Page 2 Data entry ,~~.°a,¢~, _,V✓.!pgf,~~lf Page 3 Mound drawings Page 4 Lateral and dose tank C: w Page 5 System maintenance specifications I 3 Page 6 Management and contingency plan 1 Page 7 Pump curve and specifications 1 Page 8 Plot plan Designer. Mary Jo Huppert License Number. 1859-007 Date: 09/16/12 Phone Number. 715 - 426 -1775 Signature: GZ LG ~.~G~ ~~V t7 157- j gZ J 'lYb Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01!81)1 and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101) Version 7.0 (R. 03/2012) Page 1!of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 38344-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 5.00 Site Slope 99.71 Contour Line Elevation (ft) 16.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/fe) Distribution Cell Information 1 60.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) a Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 3.50 Estimated Orifice Spacing (ft) = 11.76 fe/orifice 2.00 Forcemain Diameter (in) 176.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 28.71 Forcemain Drainback (gal) 13.21 Vertical Lift (ft) 55.97 5x Void Volume (gal) 2.90 Friction Loss (ft) 84.68 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 27.46 System Demand (gpm) 20.66 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser - I Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 22.24 Dose Tank Volume (gal/in) _ 525 Filter Model Number Weiser Manufacturer Project: DEREK T. WINK Page 2 of 8 Mound Plan and Cross Section Views 1/10 6 Observation Pipe . . O D A 011W .....F B I L Mound Component Dimensions Down slope toe extension made. ft A 10.00 ft E 26.00 in H 1.00 ft K gift B 60.00 ft F 9.25 in I 15.00 ft L ft D 20.00 in G 0.50 ft J 7.66 ft W 600.00 (fe) Dispersal Cell Area 1500.00 (fe) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate F 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.15 (ft) -10 G H I F Dispersal Cell 101.88 (ft) Lateral 101.38 (ft)-► - Invert Dispersal Cell Elevation D 99.71 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key a a T- Dispersal Cell See lateral details on Q Topsoil Cap a 1.5 ft Page 4 for number, size, 0 Subsoil Cap o and spacing of laterals. ASTM C33 Sand v t / F Laterals are equally m 0. ft Typical Lateral spaced from the Tilled Layer c distribution cell's ©Q Aggregate o @ centerline in the - A } distribution cell (AxB). Project: DEREK T. WINK Page 3 of 8 End Connection Lateral Layout Diagram CehtOr the Ii-H aJZ.-thfA&Bdmen.-. •a Turn-up wlbell valve or <;loanoutplug P NIP All laterals ale tdemd al lF 7[--jl Holes dolled on the bottom of the lateral equally spared S Ltltere■1s a f wicetnain Sch 40 PVC per SPS Table 384 30-6 9 Force main connection via tee or cross to manifold at ang paint. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 ft Lateral Length (P) 58.56 ft Orifices per Lateral 17 Lateral Spacing (S) 3.33 ft Orifice Density 11.76 ft2/orifice Lateral Flow Rate 9.15 gpm Manifold Length 6.67 ft System Flow Rate 27.46 gpm Manifold Diameter 1.25 in Total Dynamic Head 20.66 ft Forcemain Velocity 2.80 fVsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC Disconnect 4 in. min. Tank component is properly vented F- Altemate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 800.00 Gallons Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 22.16 492.92 B 2.00 44.48 C Pump off elevation (ft) C 3.81 84.68 88.67 D 8.00 177.92 D Total 35.97 800.00 1 Dose tank elevation (ft) 3" Bedding un er tank. 88.00 Alarm Manuafacturer Tank Alert Note: Switches Alarm Model Number 415 4LLKN1containing mercury may not be used in Pump Manufacturer Gould _ this system. Pump Model Number PE 41 T Pump Must Deliver 27.46 gpm at 20.66 ft TDH Project: DEREK T. WINK Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Cassellius Sanitation Service Phone 715-265-4623 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz 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 Should 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 pondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished Grade Threaded Cleanout 7 6-8" Diameter Lawn Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: DEREK T. WINK Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Vft. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] 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 SPS 383.33, 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 &inches in diameter shall be secured by an effective kodking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shalt 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 fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filer 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 tirm of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxhnnum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required; However, N 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. Au switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shag be inspected and serviced as necessary. Mound and Presswe Diewbution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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. Coll weather installations (October-February) dilate that the mound be heavily mulched as protection from freezing. Influent quality into the mound 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 BOOS, 30 mg/L TSS, 10 rng/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified 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 best 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaerim 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 mound 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 removing biologically dogged; absorption and dispersal media, and related piping, and replacing said 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. i Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. i i -t KROK "tax: f~ of 8 &qj'QOULOS PUMPS Submersible Effluent Pump sells] PE WOW fEAUM Pump-General: C*nww: ■ Corrosion resistant • Discharge: I W NPT ' Single Phase construction. • Tempetature:1040F (400Q • 60 Heat ■ Cast iron body. maximum, continuous when • 115 and 230 voles ■ Thermoplastic impeller and fully submerged. • "4n thttrttaal overload pro- cover. • Solids handrvhg: 'A' tection with alltWkldC reset ■ Upper sleeve and hrirer maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models induce a • 01141led design. construction. APPLICATIONS float Switch. • High strength carbon steel • Motor is permanently Specially designed for the • Manual models available. shaft. lubriated following uses: • Pumong range: see Pf31 Moor: service life. • Mound Systems performance chart or cum. • 33 HP, 3000 RPM r Powered for conftous • fffluentousing Systems PE31 Pump: • 115 volts operation. • Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ AN ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor: wonting limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ ~dc disconnect power Dewaterng • Maximum apacitlr; 61 GPM • 115 and 230 volts ltd. 201 tfd ` • Maximum head: 29T DH • PSC design heavy dory 16/3 S1TW with 115 or 230 volt yramdirhy PE51 Pump; PE51 Motor. Ply Mahdmum capadty. 7o GPM .50 HP, 3400 RPM ■ Complete unit is heavy duty, Maximum head: 37' TDH 115 and 230 volts portable and compact METERS FEET • PSC design ■ Mechanical Seal is carbon, 40 ceramic, BUNA and stainless -YES+ r-9-~ 4AOOtiS. PF37. vE+4t, pE51 0M. 35 Hr J3. AO. .50 r r Stainless steel fasteners. 1 10, , -~--:-'t~-1'-1- - 2 GPM 30 . ' I a { AGENCf LISTINGS T- I FT ~Ck 0 Tead to UL M &-A /gyp (•l,~ry File OLIC!" 10 . j -r-.3 1 ^ " i.-r-!~- • tiohdtk Pthhhaps B 1509001 pdtd -77 7 .1. .L{:.~. _ _.~^►-1-:--" ~f ' t -ice. _T - L - 0 10 20 J 30 40 50 60 ' 70 GPM ' 8o PRr3E I~l//AJ 0 5 10 15 m3/h N Property Owner T, 1 N t K l»=40.A Legal ' lion .soj#/4 w-Ttm .9wllg (cWdW whee nag _7-WN, ersW - 40P Arg-L" waA eRax cc:,T 0 1 r~ = Ba d*oe pA 1A1i5f~alSl111. ~ jkG~E:S Nor& Ate' ~s, w 1t .o , y~. y 3 Ago's 'I~° ,~v ~~P t OP• DO' Y b Site Loca don: ~ a o v y _ 'POuF, O yROUaW ` O sUL)WACE 94.00 ' oa L.oc.&m Oro w ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /Buyer ber-e,,L - tyt Ic- Mailing Address Z. o 55 C~~ ' ` , G__ 6y- Property Address 2 f I (c, C-4-y. 29. (Verification required from Planning & Zoning Department for new construction.) City/State64e_jnU,600d, C1411 arcel Identification Number LEGAL DESCRIPTION / Property Location 1/4 , K S 1/4 , Sec. , T _~O N R / W, Town of en~~'Od Subdivision Plat: k y'L , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # ff (before 2007)Volume , Page # Spec house D yes /no Lot lines identifiable /Yes 0 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 §SPS. 383.52(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 Safety And Professional Services 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- ,6p 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. 04/12) Parcel 016-1045-20-000 07/19/2013 09:13 AM PAGE 1 OF 1 Alt. Parcel 20.30.15.326 016 - TOWN OF GLENWOOD Current ❑ 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 DEREK T WINK O - WINK, DEREK T 2855 CTY RD G GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description • 2816 CTY RD G SC 2198 SCH DIST GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 20 T30N R1 5W SW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 04/30/2012 955335 WD 02/03/2012 950090 SD 10/26/1998 589893 1369/431 WD 10/26/1998 589892 1369/427 TI 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/01/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 20,000 12,600 32,600 NO UNDEVELOPED G5 34.000 41,500 0 41,500 NO PRODUCTIVE FORST LANDS G6 2.000 5,200 0 5,200 NO MFL BEFORE '05 CLOSED W8 2.000 5,200 0 5,200 NO Totals for 2013: General Property 38.000 66,700 12,600 79,300 Woodland 2.000 5,200 5,200 Totals for 2012: General Property 38.000 66,700 12,600 79,300 Woodland 2.000 5,200 5,200 Lottery Credit: Claim Count: 0 Certification Date: 02/26/2009 Batch 09-01 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 955335 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI WISCONSIN SPECIAL WARRANTY DEED RECEIVED FOR RECORD art a, oZ01 "1 04/30/2012 09:40 AM ED IS EXEMPT FROM TRANSFER FEE PURSUANT TO CHAPTER EXEMPT # 2 77.25 (2), STATS REC FEE: 30.00 FEDERAL HOME LOAN MORTGAGE CORPOkATI0N, (hereinafter PAGES: 2 called "Grantor'). Hereby conveys and specially warrants to "The above recording information DEREK T. WINK verifies that this document has His/her (their) heirs and assigns (hereinafter "Grantee(s)'j, for been electronically recorded valuable consideration, the following tract of land in ST. CROIX & returned to the submitter County, State of Wisconsin: ALL OF THE SW1/4 OF NWi/4 THAT IS LYING SOUTH OF SOO RAILWAY SECTION TWENTY (20) TOWNSHIP THIRTY (30) RANGE FIFTEEN (15). Prepared byAad-retom~To: Tina Mullins THE W1/2 OF SW 1/4 OF SECTION 20, TOWNSHIP 30 First American Tide Insurance Company NORTH, RANGE 15 WEST. 2605 Enterprise Road East, Suite 300 Clearwater, FL 33759 7040651d Commonly Known As: 2816 CO RD G, GLENWOOD CITY, WI Tax Parcel No. 016-1045-20-000 54013 TO HAVE AND TO HOLD the said premises as above described, with the hereditaments and appurtenances unto the said Grantee(s), and to his/her (their) heirs and assigns forever. SUBJECT TO ALL covenants, restrictions, easements, conditions and rights appearing of record: and SUBJECT to any state of facts an accurate survey would show. AND THE SAID GRANTOR specially warrants that he/she will defend the title and possession of the Grantee(s), his/her (their) heirs and assigns against all lawful claims by persons claiming by, through, or under the said Grantor, and none other. WHEN RECORDED, RETURN TO: FIRST AMENGANMOBTGAGE SFRWCFS 1100 SUPEWORAVZWT, SU=200 CLEVELAND, OHIO 44114 NATIONAL RECORDING 1111 Jill 11111111111111 WINK 44968038 WI FIRST AMERICAN ELS SPECIAL WARRANTY DEED IIII IIII IIIiI 1111111 IIIIIAIIIII IIII III II I I III III I II H i!I 1 of 2 i • I l IN TESTIMONY WHEREOF, the undersigned on has set his/her hand and seal as Attorney in Fad and on behalf of the FEDERAL HOME LOAN MORTGAGE CORPORATION signed, sealed and delivered in the pres ce of: FEDERAL HOME LOA ORTGAGE CORPORATION w.. By: -(Seal) Is 6p- Attorney in fact Jav (Print 6r Ty uthodzed signer of National Default v"a Reo Services, A Delaware Umited Uability Company Doing Business as First American Asset Closing Services ( "FAACS"), as attorney in fad and/or agent. State of U1nami 1 } )SS. County o T l } I The foregoing instrument vyas wledged before me this day of by pavls.17 who is Authorized signer of National Default Reo Services, A Delaware Limited Liabil om any doing busin Fw merican Asset Closing Services ("FAACS"), as attorney in fad for F DERAL HOfqlrl O TGAGI-CIAR PO TION. Notary Public My Commission Expires: b0 eunr " Drafted b 9 . 'f Y: sej!dx3 u oIsc'wwoo AN I sexe1 jo 9191$ 'o!lgnd AMON 11 : ro•~ Vdd3111VA VC11dVd VIHINAO O 2 of 2 ti• • VVMconsin Department of C~ SOIL EVALUAft, "FmPQjRT Page 1 of 3 Division of Safety and Buildings _Po fy / lq*rdanoe with Comm 85, Vifls. Adm. Code b Attach complete site plan 44r not less than 1/. ?x 11 inches in size. Plan must include, but not limited to: vertical and hglikp6t51I point (BM), direction and Parcel I.D. 016 - 1045 - 20 -000 percent slope, scale or dimer, arrow, and location and distance to nearest road. ;jlP Rev" by Date Please print all infonfieatron. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). T+ Property Owner Property Location a DEREK T. WINK SW SW 11 ,/0 T 30 N R 15 E or W Govt. Lot 1/4 4 (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# O 2816 C.T.H. G DC* Y__ City State Zip Code Phone Number Village [DTown Nearest Road Glenwood City, WI 54013 ( ) Glenwood C.T.H. G El New Construction User Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD D Replacement ❑ Public or commercial - Describe: Parent material loess over till Flood Plain elevation it applicable ft. General comments and recommendations: Mound System 1.67 & sand fill 0.40c loading rate All , Gl~; vat Pl .rj~" I q, -:srrE fZ AAN YA1pR1/JCTo Zon;rjG 5 ft-- CI In Boring # ® Boring ~J El Pit Ground surface elev. 100.41 ft. Depth to limiting factor 19 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#l 'Ef#2 1 0-10 10YR3/3 - sit 3f-mgr ds cis 3vf-co 0.6 0.8 2 10-16 10YR4/4 - sit 2f-msbk ds cis 2vf-m 0.6 0.8 3 16-19 7.5YR4/6 - set 2fabk dh as lvf-m 0.4 0.6 4 19-32 7.5YR4/6 c2f1.5YR5/6 set Orn deh 1 vf-f 0.0 0.0 10% gr. F2 Boring # ® Boring 97.51 16 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/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#l 'Eff#2 1 0-10 10YR3/3 - sit 3f-msbk ds ai 3vf-m 0.6 0.8 2 10-16 10'YR4/4 - sit 2f-ma&sbk ds cs 2vf-m 0.6 0.8 3 16-24 7.5YR4/6 f2f 7.5YR5/6 sl 2fabk ds cis l vf-m 0.6 1.0 4 24-32 7.5YR4/6 c2d 7.5YR5/8 scl l fabk dh l vf-f 0.2 0.3 Some broken lfpl 9-11°; Some gr 1-5'/. * 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 (Piesse Print) S" CST Number Mary Jo Hu ert ollister's Soil Testing & Desi 224832 Address Date Evaluib6n Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 08 - 08 - 12 (715) 426 - 1775 Property Owner WINK, Derek T. Parcel ID # 016 - 1045 - 20 -000 Page 2 of 3 ' Boring J 3 Boring # pit Ground surface elev. 99.11 ft. Depth to limiting factor 19 in. Sol AppAcation 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 1 0-10 10YR3/3 sil 3fgr&abk ds cb 3vf-co 0.6 0.8 2 10-19 10YR414 sil 1 1 ds cS 2vf-m 0.4c 0.6 3 19-24 7.5YR4/6 f2f 7.5YR5/6 sl 2fsbk dsh i vf-m 0.6 1.0 Some gr 1-5% one stone T F-1 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Sol Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sol ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#l -Eff#2 Effluent #1 = BOD3 > 30 < 220 ng/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD6 < 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-833Rreet (R.07/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner s T W i 4 I"=40ft Legal Description 5kJ'/4 OF THS -SW /4, s zo; (except where noted) 730AJ, PJsW Gar- t4-ay wcoA, s;. dRUx cck Ev. ~ = Backhoe pit IA)i`eDMSiq> 1/0 .7tGCES North q7.s/' A\ 7- Iy'F'10E .foP 6RpUl . G~ b~ P° .TOP Dr- nvc- ~~v rt. s tIA. G~ Site Location: S€ C. V X CT . ~ II liillllllilillllllllllll11111 8 1 7 0 6.4 3 Document Number Document Title TX :4140386 982753 St. Croix County BETH PABST REGISTER OF DEEDS Affidavit for a single POWTS ST. CROIX CO., WI servicing Two Structures via Private Interceptor Main RECEIVED FOR RECORD 07/22/2013 3:03 PM R re WOn EXEMPT Name - (Owner) Typed or printed REC FEE: 30.00 being duly sworn , states, under oath, that: PAGES: 1 He/she is the owner/co-owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume _N/A_, Page_N/A_ Document Number _ 559 335 St. Croix County Register of Deeds Office: aecordirr Area A parcel of land located in the _SW %4 of the SW %4 of Section 20 , T30 N Name and Return Address - R 15 W, Town of_Glenwood_, St. Croix County, Wisconsin, being duly Derek T. Wink described as follows (include lot number and subdivision/CSM or detailed 2855 Cty. Rd. G legal description): Glenwood City, WI 54013 All of the SW '/4 of NW 'A that is lying south of Soo Railway Section Twenty (20) Township Thirty (30) Range Fifteen (15). The W % of SW '/4 0 5-20-000 Parcel cel Identification Number (PIN) of Section 20, Township 30 North, Range 15 West. Commonly known as: 2816 Co. Rd. G, Glenwood City, WI 54013 As owner of the above described property, I acknowledge that a Private On-site Wastewater Treatment System (POWTS) serving the primary residence is sized for _4_ bedroom(s) with a design wastewater flow of 600 gallons/day (DWF calculation based on 150 gpd /bedroom @ 2 persons per bedroom). A maximum of 8 occupants are permitted. An accessory structure will also be connected to the POWTS via Private Interceptor Main Sewer (PIMS) in compliance with SPS 382.30(12). There are currently a total of _ occupants generating domestic wastewater, therefore the POWTS can be considered code-compliant at this time. However, I understand that if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate any increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge that l will disclose this information to any parties interested in purchasing this property in the future. Dated this as day of jVIY , 2013. * Derek w/nk * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. St. Croix County. ) a -day authenticated thi eat day of O 14~Personally carne ~~fore (year ithee namedof 400 O + TITLE: MEMBER STATE BAR OF W; BC SI1ovoV to me known (if not, is~ C be the person(s) who executed the foregoing --i,_ rs of instrument and acknowledge the s me. Authorized by § 706.06, Wis. Stats.) 1111jiIHt THIS INSTRUMENT WAS DRAFTED BY Pamela Quinn, Land Use Specialist -Community Development Dept. * wy L~ Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My Commission is permanent. If not, state expiration Both are not necessary.) date: Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" This information must be completed by submitter: document title, naine & return address return address. and PIN (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of lire document or may be placed on additional pages of the document. Note: Use of this 1 of Aver page adds one page to your document and $2.00 to the recordingee Wisconsin Statutes, 59.43.