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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
• INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
'ernit Holder's Name: City Village X Township
Hoffman, Bill Glenwood Townshi
:ST BM Elev: Insp. BM Elev: BM Description: .
(JD •`d I (~ . D
TANK INFORMATION NATION DATA
TYPE MANUFACTURER CAPACITY
Septic
Dosing , ` ~
~'I ~~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
septic N 3n t o - `f3 -
Dosing ~~ ti N r
r•5ti
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer ,I
Model Number S, ^ ~
o~aD TDH Lift Friction Loss System Head
.~ p • 3'8 2 • so
Forcemain Length - Dia. Dist. to Well
of • 21~ ~ I~z a
SOIL ABSORPTION SYSTEM
B DITRENCH Width ! Length t No. Of 1
DIMENSIONS 3 S ~ ~(
INFORMATION Tvae Of
DISTRIBUTION SYSTEM
TDH Ft
12.2$
r
! - I
5 S5 sa
~i ~~,.,_ renD Q . o, w
County: $t. CrOIX
Sanitary Permit No:
399566
State Plan ID No:
G~lOo81
Parcel Tax No:
016-1023-60-000
STATION BS HI FS ELEV.
Benchmark
.~
ol•
(t7o.o
Alt. BM N~iq-1
Bldg. Sewer a b~ !
~3• is
SUHt Inlet q• ~~ q2 ~ -
SUHt Outlet
Dt Inlet
Dt Bottom
12-~ g9 -
Header/Man. 2. ~ 98.901
Dist. Pipe Z•9`f c~, g6
Bot. System 'S•r•9
3,~ '
. 2 or
Final Grade
St Cover
DT-c>A~ 2.20 9rg.9o
Header/Manifold Distribution I-
t x Hole Size
!! Spacing
x Ho
le
tr Vent to Air Intake
^- Flpe(s)~
i
S
I IZ ~^ 3~l(0 t
`
T8 ~"~"_
Dia
Length pac
ng
Length Dia
SOIL COVER x PrassurP SvwtPms Anly YY Mound Or At-Grade SVStemS Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No
COMMENTS: (Include code dis2crepyencie~, erso s prje7~eVn`'t~n-etc.) Inspection #1:_ f ~/ I S~ / o l Inspection #2: T-T~
Locati n: 3183 oad G G er woo6~ity, ~ 5~ (SE 1/4 SW 1/411 T30N R15W) NAL(ot ~ `~~ ~ ~ n yP~arcel No: 111.30.15.1848 _
' ~Ge•K~•~tt ~~,~!) ~ ~v~NL q~¢.tX7i ~^"°`- w ~l~ ~ 4~ .I~ ~~{' SOt
1.) Alt BM Descrip Ion = 9999_____ ~j n l_ _ _
2.) Bldg sewer length = ~~ M ~~" `p~_ `~+'
-amount of cover =~ > `{ 2 0 ~. ~ _ ] o 1. ~)
3.) Contour = `j(Q .qp ( S ~'~" ~ ~ `~
~~ . ~.- I~ ~' c ---
lan revlslon Required? ^ Yes No ' I ~ O 1 ,~^'i5.~
Use other side for additional informs on. T
Date epctor's Signature Cert. No.
SBD-6710 (R.3/97)
!~~ ~ Zl/ 395/
Safety and Buildings Division County
~ ~
`
® ~ .~ 201 W. Washington Ave„ P.O. Box 7162 (
m/X
Esc®nsin Madison, WI 53707 - 7162 Site Address
Department of Commerce 3 ~~ 3
Sanitary Permit Applica
t Sanitary Permit N er
~ 3~qs~~
In accord with Comm 83.21, Wis. Adm. Code, perso erm tic~n~c~ti r
^ Check if Revision
ma be used for second oses Ptivac aw, 515.04 j(i~•-~ ' ±;°
I. Application Information -Please Print All Inform 14n ,:~ ~
'`~~
,:
~ State Plan LD. Naunber
-
~.., ~'
Q ~
Property Owner's Name i parce~ N3
~~ ~~"f~
0
Property Owner's Mailinr Address "- •
.. 5 Property Location
?0
3 /'J ~ ~/ /Y~ 1~ 6~ O~'~_ .':` tai ~/i sWi~i: S I T J~V N, R /~~
City, State Zip Cod ne Number'., ~ Lot Number Block Number
nn -
~/rte w ~',~y wL ~
syo~ 3 r
' ~ ~ `~
- ~5,~9 Subdivision Name CSM Number
II. Type of Building (check all that apply) ^City
^ 1 or 2 Family Dwelling -Number of Bedrooms ^Village
^ Public/Commercial -Describe Use
Township O d
^ State Owned Nearest Road
III. Type of Permit: (C box on line A (numbering scheme for internal use). Complete line B if applicable)
`~' 1 ^ N 2~Replacement Sys m 3 ^ Replacement of 6 ^ Addition to For County use
S stem Tank Onl Existin S stem
B • ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued
1V. Type of Permit: (Check all that apply)(numbering sche a is for internal use)
44 ^ Non -Pressurized In-Ground 21~:11Zound (~ ~X ~p ~ ~ ; , " ..,,,,d Filter 50 ^ Constructed Wetland
22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line
45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other
V. Dis ersal/Treatment Area Informat ion: Q . ,? - > ,
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation
SU / ~~ll
~~v '~
VI. Tank Info Capacity in Total Number Manufac er Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank _ ~ ~ ~~
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ass a sp ty for installation of the POWTS shown on the attached plans.
Plumber's N
me (Print) Plumber' na a /MPRS Number Business Phone Number
oO
tv emirs - !'~ ~ / S ~ 3 S=//.~ Z~
Plumber's Add ss (Street, City, State, ip ode)
~ 3~ s'T-_
VIII. Count /De artment Use Onl
~' Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
^ Owner Given Initial Adverse . Surcharge Fee)
~ 3 ~~
~
~ ,:./-~
/ _
Determination U ~~ ~
~
IX. Conditions of Approval/Reasons For Disapproval
1. Effluent filter to be installed and maintained per manufacturer's recommendations.
2. The septic system is sized fora 1 bdrm residence. A violation of the state administrative codes would be created if any modifications are made
to the structure that increase the # of bdrms/design wastewater flow. ~`
1 tuber stated that all the information on the a lication would be consistent with the state
plans. ^••°µ ~~WY«« v'°°° rw .uo wuu~y vwy~ rur mo sysgpn on paper nor less man ati~ x tt mcnes m size
SBD-6398 (R. OS/Ol)
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601-1831
~ ~ ~ TDD #: (608) 2648777
iscons~n www.commerce.state:wi.us/sb
Department of Commerce www.wisconsin.gov
Scott McCallum, Governor
Philip Edw. Albert, Acting Secretary
October O1, 2001
CUST [D No.225094 A7TN.• POWTS inspector
ZONING OFFICE
MICHAEL P ROGERS ST CROIX COUNTY SPIA
N4563 320TH ST 1101 CARMICHAEL RD
MENOMON[E W[ 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/01/2003 Identification Ntunbers
Transaction ID No. 676081
SITE: Site [D No. 636233
BILL & MABEL HOFFMAN Please refer to both identification numbers,
160TH AV above, in all cones ondence with the a enc .
TOWN OF GLENWOOD
ST CROIX COUNTY
SEI/4, SW1/4, Sl 1, T30N, R15W
FOR:
DESCRIPTION: ONE BEDROOM MOUND SYSTEM
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: $12565
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
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.O1/O1)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD-10706-P (N.O1/O1).
In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, tl~e 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 manual, and section VI of the pressure distribution component manual aze complied with. A copy of this
letter including instructions and information relating to proper use and maintenance of the system must be given
to the owner and each subsequent owner upon completion of the project.
• The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code.
• Limited activities aze allowed in the area 15 feet down slope of the component area. Soil compaction,
excavation, vehicular traffic and other similar activities that impact the treatment and dispersal aze prohibited.
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1). In addition, 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.
MICHAEL P ROGERS
Page 2 l0/1/Ol
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the
initial installation of the POWTS in accordance with an approved management plan shall be conducted by a
person who holds a registration issued by the department as a registered POWTS maintainer.
• 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.
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. Alt permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
to 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 slats 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.
Sincerely,
Charles L Bratz
POWTS Plan reviewer [[- Integrated Services
(608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM
cbratz@commerce.state. wi.us
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
WiSMART code: 7633
cc: B[LL HOFFMAN
Bill & Mabel Hoffman -Mound
Transaction #
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD-10691-P (01 /01)
Pressure Distribution, SBD-10706-P (Ol/Ol)
Location: SE 1/4, SW 1/4, Sec. 11, T 30 N, R 15 W
Town: Glenwood
County: ST. Croix
Date: .September 5, 2001
Owner: Bill & Mabel Hoffinan
Address: 3183 CTHW G
Glenwood City, WI 54013
Plumber: Mike Rogers
Signature:
License # MP 225094
Attachments:
6748-Plan Approval Application
SBD-8330
page l: cover
2: design criteria & calculations
3: plot plan
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
8•
RECElVE,D
SEN 1 ~ Luul
SAFETY & BLDGS DIV,
. system management GOtt~llOl?llljy
APPROVED
DEPARTMENT OF COMMERCE
i~°"oF~ r~rA~~~
page 1 of 8
SEE CORRESPONDENCE
r ,
Design Criteria
~`r'S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/100 mL
Fats, oils, grease < 30 mg/L
Bedrooms x 100 gal/bedroom/day x 1.5 ~ ~D gallons/day hydraulic load
In situ designed loading rate
Depth to estimated high ground water '~ L ~
Depth to bedrock ~ 3 V
Cross slope at system Z' • ~
Force main length ~ °~
Manifold/header length ~~'
Drain-back ~ • a
Lateral length ~ @ ~•~
Lateral elevation ~'~• ~
3
Lateral hole size J t b in. @ ~ •O
~ ~ holes/lateral ~ 1
Lateral volume `~'`~~
Total lateral discharge rate ~' Sg
Network pressure compensation losses `~'~~~
Elevation difference ~ 2 ,c~5
Friction loss I•$~~1~ ~ •3b
Total dynamic head ~ 5 ' ~ t-
Pump/sij~ion ~3 gpm @ ~ b
Manufacturer ~'~ ~ ~ ~wS+~
Dose volume Z4'
Lift/si~kton tank w ~ ~'+°X ~'~ - ~'~ ~"~' '~~'
~,
Septic tank ,, .,
Effluent filter ~ " ~ '~ ~`°
Measurement pump on and off ~-• ~
Height alarm from tank bottom ~ ~' `t
Reserve capacity 4-$ 3 •r'
specs.calcs.res
Design Calculations
~ ~ Z ~ gallons/sq. ft. per day
in.
in.
w ~ ~.
ft, of ~ t in.
ft. of in.
gallons
ft. of ~~~ s- in.
ft. @ bottom of lateral
in. ( 4"• ~ ft.) Spacing
holes total
gallons
gallons/minute @ ~'~ ft. head
ft.
ft.
ft. @ ~ 4' gallons/minute
ft.
ft. of head
Model # S ~ ~ ~ n
gallons
~ a~
t~
in.
in.
gallons
gallons
_ gallons
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_ SPEC.IFIGATIOI.IS
ThAlr.S Mh-JUFACTUftCR: IJUM6ER OF VOSfS: ~ ~ PEK D~.~
TA1JK SIZC: ~~iD~~"O GALL01J5 •.DOSC VOLUME
4
S J ~}~ ~e.tv~
ALAKFI M/WUiACTUiICR: IIJCLUOIAJ6 6AGKFLOW~ Z' LA~~ONS
MOOCL -JUN~CR: • `O 1 1~ `''~ CAPACITIES A= ~~ hJCHfS OK ~;'~ C,A.'~0+~.
SWITCH TyP[: ~~~~ w`~O 8 e Z' I-JCNES OA Z;~~ ~ GA~~CtiS
PUMP MA-JUFACTURCR: ~ °'""'' ~' C• 2~~ iuLHES OR 2ar.o G~~~CuS
~ MODEL IJUM~CR: ~~+~ ;~ D~ ~ INLHESGR ~Oi4Z GAI~Gu~
SWITCH TtiPC; ~~"`~ "' -JOTE: PUMP A1J0 ALAitM ARC TO 8C
MIIJIMUPI DISCMARCrC RATE~_G-M INSTALLED OA1 SEP^RAT C CIKC~~•'~
1t~u~'
VORTICAL DIiFC0.CWCC ~CTW[CAJ PUMP OFf NUO OISYRI~UTlO1J PIPE..
FECT
+ MI-.Ilh'\UM -JCTWORK SIIPPLy PiiCttUR
C ~'~ FLCT~`~'~'~
~T
~.
,1
+ `~ i'CET OF FORCC MAIIJ X 1'~Z' Fipp~tFRICTIOrJ FACTOR. ~'~~' FEET ~ 1 a'
,,
,,
~
~~
TOTAL Oy1JAMIC HEAP ~S'(,(2 fEET
,~
..
~05 f ~
~~
S`,~
IIJTER/JAL DIMCAJSIOAJt; 0/ TAAJK: LEIJGTH ;W~oTH
;LIQUID DEPT H
6
P a SZ
A~~
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WEATNERPRO~F
JUNCTION
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Puma Characteristics
P /Metes lMt ~_. Sr~na'swh
Aratootwth Makh SNEiSOA)
tlors.pawa .34
feN tad Aa~s 1.0
IMIa T Slated Pois r14 1
R.P.M. 1330
P~ ~ 1
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Vert: b0
lelppuolwe 140'F Atl~iatf
N~ aart ~
instrlatloo Goes A
Oictha' Sao 1-I /E" NPl (3bow~
Sobds Ht>w~ 3/4' 119aw1
Uzat 1Matgit 30 ~s.
P~war Cord 1 b/~, SJTW, x0' etd.
Materials of Construction
p~/I. SMIoMss Stt>~
la6rita~ p~ Dielestrk 01
Nbtor Nero Gst lroo
Cos Gat Moa
Nle+#eWtai
Shalt Seal Sal Feees: CistieaJCot*aatic
Sai Mdrs Aeedi:.d 3tul
sp~i.~ swMlse,e st«I
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Gst Naa Sleaw
lows Rew MN
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4 i 14 16 40 4~1
Dlm®nsienal Data
j, At 11 indss.
lam) br ieureetienel en.
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~~ HYDRQMATIC
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1844 Baeey Rood AsHetttl, Oho 44801 Tel: 419.189.301 Fox 419.981.4081
Web Site: wxw.penidryumptom
SALES CtFFKES IN Al.t NUJQA CRIES AND COUN'fIIIES
u~m w: W-u2.83S0 t2a8 5M
w 1499 H~drorncAic' Purnpe, Ashland, C~+~o /~~ Ruts Resnved•
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System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715-235-1132, or the St.
Croix County Zoning Office, 715-386-4680, should be contacted for assistance.
General
Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
in a manner to protect ground water quality and public health.
1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
2 Install water-saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
~. Garbage disposals are not recommended; if you must have one, use it sparingly.
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
Maintenance
I . The septic tank must be inspected every three years by a properly licensed person.
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contain~.specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area.
11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient
oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and/or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
Wisconsin Department of Commerce
Division of Safety and Buildings
~RICIIl~'~ ~~
SOIL EVALUATION REPORT
in accordance with Comm 85, Wis. Adm. Code
8~ q-~-~~
1394
. Page 1 of 3
Certified Soil Testing
ounty
Attach complete site plan on paper not less than S%: x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal referencg(poih irection and
nearest road
w; and location and tlistan t
scale or dimemsions
north arr
ercent slo
e parcel LD.
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~ . 11.30.15.1846
Please print all information.
~ , e gy Date
Personal information you provide may be u~dedfor secondary ~rivacy tzw, s.15.04f t) (m)).
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1
ropey wner / ~
~ ro } y oca ion
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Hoffman, Bill & Mabel ~ ` ~-, ~, Govt. Lot SE 1/4 SW 1/4 S 11 30 N R 15 W
Property wner s ai mg ress
.- ~~ Lot fb' Block # Subd. Name or CSM
..
3183 CTHW G ~ w• 5~ CTF
City State Z C Phone ;' ; ~ Cit Village Town Nearest Road
Glenwood City ~ WI 54 ~~ ~1~'.`-,Z1~-265- ~ Y Glenwood 3148 160Th Ave.
New Construction Use: Residential / edrooms 1 Code derived design flow rate 1 ~U GPD
~~ Replacement Public or commercial -Describe:
Parent material loess Flood plain elevation, if applicable NA
General comments
and recommendations: install 3' x 50' rock unit mound on 96.9-96.7 design line as upslope edge of rock w/ 1.4' sand fill (1.6'
sand fill @ NE end)
^ Boring # Boring
Pit Ground Surface elev.
96.9 ft
. Depth to limiting factor ~ 24 in•
Soil Appligtion Rate
Horizon De
th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft'
p
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-12 7.5YR 2.5/1 - sil
2 .. 12-24 10YR 3/3 - sil
3 ~ 24-36 10YR 4/4 I OYR 6/2 sil
mo mg ecomes c p - e ow a ou
^ Boring # /'~ Boring
>!; Pit Ground Surface elev. 96.8 ft. Depth to limiting factor 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-13 7.5YR 2.5/1 - sil
2 , ~ 13-20 10YR 3/3 - sil
3 20-28 10YR 4/4 lOYR 6/2 sil j
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`Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/Land TSS < 30 mg/L
ame ease not gn ure: ~ um er
Henry F. Grote 222774
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 8/30/2001 715-233-0398
Property Owner Hoffman, Bill & Mabel Parcel ID # 11.30.15.1846 Page 2 of 3
Boring # _:_,! Boring
Pit Ground Surface elev. 96.9 ft• Depth to limiting factor 21 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
1 0-4 7.5YR 2.5/1 - sil 3 m gr mvfr cs 2f1m .5 r .8~
2 4-10 7.5YR 2.5/1 - sil 3 f sbk mvfr cs 1 m .5 ~ .8 /
3 10-21 10YR 3/3 - sil 3 f sbk mvfr cs 1 m .5 ~ .8 /
4 ~ 21-30 10YR 4/4 f2d 7.SYR 4/6
l OYR 6/2 sil 3 f-m sbk mvfr - - .5 r .8 ~
a Boring # Boring
Pit Ground Surface elev. 96.7 ft• Depth to limiting factor 24 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 . ~ 0-5 7.5YR 2.5/1 _ sil 3 m gr mvfr cs 2f1 m .5 ,, .8
2 _ ~ 5-13 7.5YR 2.5/1 _ sil 3 f sbk mvfr cs 1 m .5 „ ~ 8 ~
3 13-24 10YR 3/3 - sil 3 f sbk mvfr cs 1 m .5 r i .8 /
4 - 24-36 10YR 4/4 f2d 7.SYR 4/6
l OYR 6/2 sil 3 f-m sbk mvfr - - .5 „ .8 r
~~
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^ Boring # _:j Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
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Effluent #1 = BODS> 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.09/00)
Certified Soil Testing
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SEPTIC TANK MAIl~1T1?TIANCE AGP~EEh2ENT
A11-D
O~'~'NEP..SI3IP CERTiTICATION T'OR.1\~
O`vrte r/}3 uyer
r,~l.ailing Address
Properly Address
(Verification required from Plaaning Department for new construction) f~ 2
~/'~ s ~! J I ~J
Cit}~/State ~,~ arcel Identification Number
1.~GAL DESCRIPTION
Properry Location ~.~. `/., '/,, Sec. ~, T~'~N-R~W, Tov~rn of
Subdi~~ision
Certired SurveS~ I~fap #
`~'arrant~~ Deed #
Spec house- ^ yes ^ no
Volume
,C.,ot #
Page #
Volume ,Page #
I_ot lines identifiable ^ yes ^ no
Sl'STEI\f A1A.INTENANCE
Improper use and maintenanceof your septic system could result in its premahtre failure to handle wastes. Proper maintenance
consists of pumping out the septic tattl: ever} three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the functiop of ttte septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by
rnast~rplumber, jottrneyrnanplumber, restrictedplumber or alicensed pumperverifying that (1) the nn-sitewastewaterdisposal systen
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.
Uwe, the undersigned have read the above requirements and agree to maintain the. private sewage disposal system with the standard:
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatin,
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office with~~ 3i
dsy3 of tl~e three year expi~~-ation date.
//!/// o~
SIGNATURE OF .4PPT. DATE
O~'~'NFR CERTIrICATION
I (we) certify that all statements on this form are tnie to the best of my (our) knowledge.
the grope described above, by virtue of a ~;~arranty deed recorded in Register of Deeds Office.
SIGNATURE OF A~ ANT
I (we) am (are) the owner(s)
/O ~ /// ~ ~
DATE
«««*«« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **«'"
«* Include with this appticatioa: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey reap if reference is made in the warranty deed
~ DOCUMENT NO. STATE BAR OF WISCONSIN FORM 5-19f
PERSONAL REPRF_SENTATpIVE'S DEED
~9~1.09 YOL• 990PAGE 85
----------W 11 am__ C . __ Ho f f man -----------------------------------------------------------
_________________________________________________., as Personal Representative of the estate of
,_________Alice__ K.___Hoffman
----- ------------------------------------------------------------------------------------ ("Decedent"),
for a valuable consideration conveys, without warranty, to _____W111.1_am___C___.__
Hoffman
-------------------------------------------°-----------------------------------------------------, Grantee,
the following described real estate in ______ St_. CroiX_______ ______ County,
State of Wisconsin (hereinafter called the "Property")
THIS SPACE RESERVED FOR RECORDING DATA i
~ ~~~S~~R~s ~~F~C~
~ ST. CROIX CO., WI
Recd fol~ Record
JAN 1 8 1993
at s:oo a.M
~` ~'~~
Register of Deeds
RETURN TO
Beginning at the Quarter Section corner
between Sections Eleven (I1) and Fourteen (14) , Tax Parcel No_ _____________________________
Township Thirty (30), North Range Fifteen (15)
West; thence West on the Section line for a distance of Three Hundred
(300) feet, thence North 145.2 feet, thence East parallel with the
Section line between the said Sections Eleven (11), and Fourteen (14),
Three Hundred (300) feet, thence South 145.2 feet to the point of
beginning.
This Deed is given in satisfaction of that certain Land Contract dated
October 13, 1983, and recorded October 17, 1983 in Volume 675 Records
at Page 273 as Document No. 388577.
.1 `. I a. t •7:t L.AAll3
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which ij
the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the !'
Personal Representative has since acquired.
Dated this ~ '
--------------~- ~---------------------------- day of ---------De~ember---------------------------------------~ 19__2__.
----------------------------------------------------------
--------------------------------------------------------
Personal Representative
AUTHENTICATION
~, I
--- - ---- G - - ----------------(SEAL)
~`~~- yyQ illiam C. Hof man
Personal Representative !~
NOTARY `~
~ PUBIJC ?~ !
_ OQ:
Signature(s) -----------------------------
authenticated this ________day of___________________________ 19_____.
------------------------------------------------------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
yl-1~,, ACSNOWLEDC}MENT
STA~1`E ur' wSCuNSiid
ss.
_AIIAIN--------------•--- !~
--_-_-----County. SL ~~
Personally came before me, this __~_~________day of
_____-Dec~mber__________________ 19_.2_ the above named ~;'
William__C_.__-Hoffman
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A
142.00'
LOT 1
C.S.M. .~
2182
1 7A-1 ,
860/559 t
SW 7/4-SE 7/4
187A
984/309
1846
i ~ 990/85
142.00'
COUNTY
S 1 /4 COR. ~--
SEC. 11
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