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F onsin Department of Commer PRIVATE SEWAGE SYSTEM County: St. Croix
.-fety and Building Division
INSPECTION REPORT sanitary Permit No: 430037 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:
Hawley, Pete I Glenwood Townshi
CST BM Elev: Insp. BM Elev: BM Desc' tion: , L Section/Town /Range /Map No:
(r 9.� .1 �y ?/ 32.30.15.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY ST 10 BS FS ELE
3 S.L A �
Septic Benchmar '
Dosing
boo Alt. BM
r� A — Sr . Go � 9l0• �a
Aeration rl �_ -- `_ /� � Bldg. Sewer
Holding St/Ht nlet
(o. O k . 7. 72 3?
I SU40 utlet pj �-
TANK SETBACK INFORMATION
TANK TO I j P /L� WELL BLDG. Ve t to Air Intake ROAD Dt Inlet
Septic , t Dt Bottom
12 0 1 -o z. 3 NtiE -
Dosing A4 c'7++ Header /Man.2.r
Z
Aeration Dist. Pipe
2.
Holding Bot. System --7,• /
Final Gr d
UMP /SIPHON INFORMATION Q , 0
Manufacturer OU
PM P ernand over f �/ K q&
SPJ
G
Model Number
?AJ �D hI-1 (e 3-7 b o "� 1'k15
TDH Lift Fricti Loss Syste Had TDH Ft
•�� T �• �► y 000 ,S
Forcemain Lent , Dist. o Well
1 1 o� I Dia . 2 ' 6-r t CT E KI !22 N � 2
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length t No. Of Tren PIT DIMENSIO S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L CHIA Manufacturer:
INFORMATION Typ Of System: r CHA OR
���I Model Number:
DISTRIBUTION SYST
Header /Manifo d 7 / 1 x Hole Size x Hoe Spacing Vent to A Length Dia ' Dia 2 Spacing 3 �/O
SOIL COVER U+ oy�, { x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center I _ / _ _ Bed/Trench Edges Topsoil`
Yes i C D Ye
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: �7 // / / 0- Inspection #2: /1
Location: 2862 Cty Rd DD Glenwood City, WI 54013 (SW 1/4 SE 1/4 32 T30N R15W) NA Lot 21 � " 946 f10 1I -1 Parcel No: 32.30.15. /
1.) Alt BM Description = ST •C6Ve0_ , barr 4 �,'h Ltlt/ UyW�// �v
2.) Bldg sewer length=
g 41'_ r f //
- amount of cover = �GI�7 l'lda �bUhf� Vkt
P�
Plan revision Required? i Yes ` No Q !� I (��j
Use other side for additional information. ! L" G%� —
SBD -6710 (R.3/97) Date Insepctor's Sig ture Cert. No.
Safety and Buildings Division County t
201 W. Washington Ave., P.O. Box 7162 ' �4_0 x
F
I SV O�SIII Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 - 3151 ? ?
State Plan I.D. Number
Sanitary Permit Application Y d
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if ifferent than mailing address)
I. Application Information - Please Print All Informati KtUM
ZEN. 2- R OC - D D u
Property Owner's N ` MAY 19 2003 cel ` of # Block #
✓ 2—
Property Owner's M ailing Address I ST. CROIX COON Property Location "�
O�U �L /� ZONING OFFICE �� � 1 A Section ✓' a AL
City, Sta Zi Phone Number
(MC 1945
Aj
of Building (check all that apply)
OW N;E w
Subdivision Name CSM Number
or 2 Family Dwelling - Number of Bedrooms
❑ Public/Commercial — Describe Use O ccc, w. C pl V. lY
1 X P �[cG
❑City ❑Village;Township off 7'0
❑State Owned - Describe Use Jt-- V� �.�.dC
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A" New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal El Permit Chan Permit Revision Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
j
IV. Type of POWTS System: (Check all that apply)
❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (sf) Dispersal Ar Proposed (sf) System Elevation
VI. Tank in Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks I Tanks
Septic or Holding Tank (lGw
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersi sume 'responsibility for installation of the POWTS shown on the attached plans.
Plumber' Na me (W Plumber' tore MP /MPRS Number Business Phone Number
�C
Plumber's Addre ss (Street, City, State ode) ��� �✓C/V
VIII. County /Department Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signature ( o Stamps)
Surcharge Fee) 3 b 2m3
❑Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
((
Attach complete plans (to the County only) for the system on paper not less than 81/2x 11 inches in size
SBD -6398 (R. 01/03)
PLOT PLAN
.{CT Pete Hawlev ADDRESS 1095 210th Ave Baldwin Wi 54002
; N 1/4 SE 1 /4S 32 /T 30 N/R 15 W TOWN Glenwood COUNTY ST. CROIX
4PRS Shaun Bird 226900 DATE 5/8/03 BEDROOM 3
' ONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
tOUND
)00( 1000 TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
(OLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none
BENCHMARK V.R.P. Top of nail in post ASSUME ELEVATION loo' Filter Zabel A -100
BOREHOLE O WELL *H.R.P. Same as Benchmark
Cty Rd DD SYSTEM ELEVATION 102.5'
Scale = 1/4 = 10
Grading is to be done to
divert run -off away from
system
102'
01
101 ' �'n/���� Well is to meet all setbacks found in Comm.83
`
100 - 2
CD B -1
B -3
/L
B -4
B.M. #1 Pro 3
Huffcutt combo tank Bedroom
6% House
Slope
B.M. #2
Area 15' below system
is to remain Tank is to be properly bedded and
undisturbed provided with lockdown covers with
approved warning labels
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
isconsin www.commerce.state.wi.us /sb
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
May 15, 2003
CUST ID No.226900 ATTN: POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/15/2005 Identification Numbers
Transaction ID No. 867064
SITE: Site ID No. 659078
Pete Hawley Please refer to both identification numbers,
County Road DD Road above, in all correspondence with the agency.
Town of Glenwood, 54012
St Croix County
SW1 /4, SETA, S32, T30N, R15W
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 903298
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:
General Approval Requirements:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01)
and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems
VERSION 2.0" SBD - 10706 -P (N.01 /O1).
• Per manual cited above, limited activities are 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
are prohibited. CA
• Comm 83.44(6)(a)2.The orientation of the cell is to follow parallel to the surface grade contours on sloping APF
sites. The upper effective edge of the cell is to follow the 101.5 foot contour. DEPARTA
OF
• The off setting (D) is proposed to be at six inches from the bottom of the tank. The pump pad, along with the SEE COI
legs of the pump, may leave the impellers out of the liquid effluent before the pump off setting is reached. This
should be checked at time of construction to insure this condition is not encountered. This setting maybe
adjusted, with the inches coming from the reserve capacity area.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812c
SHAUN R BIRD Page 2 5115103
• 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. Stat
• Comm 83.22(7) 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.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
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 to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz @commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
Cover Page
Shaun Bird
Bird Plumbing Inc RECEIVED
1008 192nd Ave
New Richmond Wi 54017 MAY 12 2003
715 - 246 -4516 SAFETY & BLDGS DIV,
Date: 5/8/03
Owner: Pete Hawley
Location: SW 1/4 SE 1/4 S 32 T30 N,R 15W Cty Rd DD Glenwood
System type: Mound System
Manuals Used: Mound Component Manual version 2.0 (01/31)
Pressure Distribution Manual version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -9. Maintance and Contigency plan
10 -12 Soil test
���nally
Signature �►��ED
License num 26900 FEY COMME
Dt
5/8/03
'SPot4j)EkC
PLOT PLAN
PROJECT Pete Hawlev ADDRESS 1095 210th Ave Baldwin Wi 54002
SW 1/4 SE 1 /4S 32 /T 30 N/R 15 W TOWN Glenwood COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/8/03 BEDROOM 3
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND )= SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of Chambers none
BENCHMARK V.R.P. Top of nail in post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL «H. R. P. Same as Benchmark
Cty Rd DD SYSTEM ELEVATION 102.5'
Scale = 1 /4 11 = 10'
Grading is to be done to
divert run -off away from
system
102'
C'
101 ' O�/y�{ Well is to meet all setbacks found in Comm.83
CD Off
B -2
100
r
CD ` �B -1
B -3
B -4
B.M. #1 Pro 3
Huffcutt combo tank Bedroom
6% House
Slope
B.M. #2
Area 15' below system
is to remain Tank is to be properly bedded and
undisturbed provided with lockdown covers with
approved warning labels
m .
Designer
Date
Non -Woven Filter Fabric
4" Observation Pipe Perforated Distribution Pipe
Below Filter Fabric
ASTH C -33 Sand
4N G
Topsoil ; `_ _ o ._
----� E -
�•. Scope
Force
Bed Of It — 2 %2 Main \
Drain Rock
From Pump Layer
Cress Section Of A Mound Sys tem Using F „e,--
A Bed For The Absorption Area G ��
r �
p —dam- Ft .
Ft.
Ft.
i
Lt F
7 k � u ,�s
L
4- 'Observation Pipe -�
o A - - - - -- , Force MOM �o - - - -- ------- - - - - -- -------- - - - - -- _ i From Pump
3
p Distribution bed Of %Z�— 2 !Z.
Pipe Drain ROCK
I �
4 Observation Pipe Permanent Marker
Pipe or Rods
Plan View Of Mound Using A Bed For The Absorption Area
PAGE .._0F__ __
Perforoted Pipe Detoii
End View
(Perforatea
Y+ PVC P,pe
ore• e
Holes Loaaled On Bolton,
Are E SPOceo
L' /:ran v
A
3r
I
11D` + Q
4 L1 f
5 PVC Force Main
i NI. FIKS i#*LL ASYT VC, CanntC�u
PVC
Manifold Pipe
D /� Qisryous +on
Pipe
/s
i3isl Pipe Layout Ft.
R R.
I►�ches
Y _._._,.. Inches
Signed: Noce Diameter Inch
License Number: Lateral �` Inch(es)
Manifold Inches
Date: Force Main
Inches
# of holes /pip22
Invert Elevation of Laterals cOFt...
SEPTIC TANK PUMP CfiAMBER CROSS SECTION AND SPECIFICATIONS
Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF
JUNCTION BOX APPROVED
> 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COYER
FRESH AIR INTAKE W1 PADLOCK 6
WARNING LABEL
FINISHED GRADE ��� MIN.
n
•
b. r.
18" IN y 4diaERtMt+o�i ZSuMfN•
i a
INLET
GAS-
WATER TIGHT SEALS TIGHT NAPPROVED
FILTER A SEAL , JOINTS WITH
LM APPROVED PIPE
8 : ' AP ON
PIE 3 " --,�— , 3
OLID SOIL
PIPE 3' C E � .
ONTO SOLID OFF
SOIL PUMP OFF ELEV . FT. D
3" APPROVED BEDDING UNDER TANK CONCRETE PAD
SPECIFICATIONS
DOSE DOSS PER DAY:
SEPTIC l NUMBER
TANK MANUFACTURER: INCLUDING
ANK SIZES: SEPTIC GAL. DOSE VOLUME FLOWBACKK: 1 GAL.
T DOSE GAL. _ ' ES = l . j L.
CAPACITIES: A - f� ` J INCH L�
ALARM MANUFACTURER: `` " "'� z GAL.
MODEL NUMBER: � B = Z INCHES --
SWITCH TYPE: c = t I NCHES
�
PUMP MANUFACTURER: OR��SpONDF D INCHE = lGAL
MODEL NUMBER: NoF �
SWITCH TYPE: to 15.23 WAC
REQU IRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR
REQU FEET
DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE � 1 FEET
VERTICAL FEET
+ MINIMUM NETWORK SUPPLY PRESSURE - FEET
+ - ' o FEET FORCEMAIN X FTI100 FT FRICTION OTALDYNAMIC AH HEAD �= f / 7 4 r s z
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH �WIDT�
DIAMETER
LIQUID L`"�ry - -_im .--
LICENSE NUMBrR : DATE
SIGNED:
}f88
TOTAL DYNAMIC HEAD /CAPACITY
PER MINUTE
HEAD CAPACITY CURVE EFFLUENT AND DEWATERING
MODEL 152/153
,a, MODEL 152 153
UJ
50 Feet Meters Gal. Liters Gal. Liters
153 5 1.5 69 261 77 291
10 3.1 61 231 70
152 231
265
12 40
15 4.6 53 201 61
0
w 20 6.1 44 167 52 197
L , 30 25 7.6 34 129 42 159
�E 8 30 9.1 23 87 33 125
0
J 2 35 10.7 — - -- 22 85
a
' 12.2 -- -- 11 42
0 40
~ 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m)
10 0145M
0
20 40 60 80 100
GALLONS 6 1/4
LITERS O 80 160 240 320
3 27/32 4 5/8
FLOW PER MINUTE
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Timed dosing panels available. "' O 3 27/32
Electrical alt ernators , Y for duplex systems, are available and supplied with
• p
an alarm.
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable
level long and short cycle controls. '
• Sealed Qwik -Box available for outdoor installations. See FM1420.
• Over 130 °F. (54 0 C,) special quotation required.
i
1522153 Series 12 1/8
1521153 MODELS Control Selection
Model Vo lts - Ph Mo Am s Si mplex Duplex
N152 115 1 Non 8.5 1 2 or 3
BN152 115 .1 Auto 8.5 Included 2 or 3 f s�czos4
E152 230 1 Non 4.3 1 2 or 3
BE152 230 1 Auto 1 4.3 Included 2 or 3
N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE
BN153 115 1 Auto 10.5 Included 2 or 3
E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float
BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477.
o caunoN 2. See FM0712 for correct model of Electrical Aftemator E-Pak.
Ail installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex
(3)
licensed electrician. All electrical and safety codes should be followed including the most or (4) float system.
recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
Louisville, KY 40256 -0347 Manufacturersof..
SHIP 70: 3649 Cane Run Road � �;
O Louisville, KY 40211 -1961 QCMZ1rr !/MP8 SNCE lc9 ,7c9�
PUMP !D (502) 776 - 2731.1(800) 928 -PUMP
http:/ /www.zoeller.com &" FAX(502)774 -3624
9 Copyright 2000 Zoeller Co. All rights reserved.
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the mound is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. Owner agrees to leave the area 15' below mound undisturbed.
8. The owner agrees to save this plan.
9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is
not be driven over.
10. Effluent Quality is not to excede the requirements found in Comm. 83
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump with out float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
it
rock, retil I soil, install new mound system.
3. Replace any other failing components as needed.
Important Phone Numbers
Plumber: Shaun Bird 715 - 246 -4516
Pumper: Tom Mondor 715- 246 -5148
St. Croix County Zoning 715- 386 -4680
i
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa ge of
FILE INFORMATION SYSTEM SPECIFICATIONS
Septic Tank Capacity ��" al ❑ NA
Owner
Permit # Septic Tank Manufacturer ❑ NA
Effluent Titer Manufacturer �� ❑ NA
DE SIGN PARAMETERS
Number of Bedrooms [3 NA Effluent Filter Model f ❑ NA
Number of Commercial Units 4NA Pump Tank Capacity 4!<j 0 gal ❑ NA
Estimated flow (average) al/da Pump Tank Manufacturer = (3 NA
Design flow (peak), (Estimated x 1.5) aVd Pump Manufacturer NA
I ❑ NA
1
Pump Mode J .>
i P
Soil Application gate ti aUda /ftiz
Monthly average' Pretreatment Unit NA
InfluentrEffiuent Quality p Sand/Grlvel Filter ❑ Peat Filter
Fats, Oil & Grease (FOG) 530 mg/L p Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BOO 420 mg/L ❑ Disinfection ❑ Other.
Total Suspended Solids (TSS) 5150 mg/L Manufacturer
Pretreated Effluent Quality jNA Monthly average" Dispersal Cell(s)
Biochemical Oxygen Demand (BOO 530 mg/L ❑ In- ground (gravity) ❑ I round ressurized
(P )
❑ At rade Mound
Total Suspended Solids (TSS) 530 mg/L 'g
pe ❑Other.
Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Dri ire
Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non- commerciaq wastewater and
septic tank effluent.
** Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Frequency
Service Event
Inspect condition of tank(s)
At least once every ❑ months/ (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume
Inspect dispersal cell(s) At least once every j ❑ months year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every ❑ months . ear(s)
Inspect pump, pump controls & alarm At least once every ❑ months ears) ❑ NA
At least once every ❑ month year(s) ❑ NA
Flush laterals and pressure test
Other At least once every ❑months ❑years) ❑ N per At least once every ❑months ❑years) ❑
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying ectoor. PO Maintainer, Septage
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspe
Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken
hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up
or ndin of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check g of effl efflue l the
Po 9 . The n
effluent on the gr surface po
in the observation pipes and to check for any pondrng of effl g
ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority_
When the combined accumulation of sludge and scum in any tank equals one -third (4) or more of the tank volume, the
entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR
113, Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatrgment components, and any
other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products o r other
chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
r
s Page of
System start up shall not occur when soil'conditions are frozen at the infiltrative surface.
During power outages Pump tanks may fill above normal hlghwater levels. When power is restored the excess
wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the
backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a
Septage Servicing Operator pdor.to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to
i assist in manually operating the pump controls to restore normal levels within the pump tank
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,
the area within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or- elimination of the following from the wastewater stream may improve the performance and prolong the life
of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers;
disinfectants; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat
straps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONKMENT shall tie taken to insure that the
When the POWTS fails and/or is permanently taken out of service the following steps
system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code
m liant replacement s tem:
co P Ys
• A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil
absorption system. The replacement area should be protected from disturbance and compaction and should not
be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to
protect the replacement area will result in the need for a new soil and site `evaluation to establish a suitable
replacement area. Replacement systems must comply with the rules in effect at that time.
• A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area_ Upon failure of the POWTS a soil and
site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a
holding tank may be installed as a last resort to replace the failed POWTS.
ound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at
the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN.
DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POVYTS MAINTAINER
Name , rL/ j Name G: Lf` J j
Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Agen v
Name j E�"�`�
9 cy �''
�v /
Phone Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets
the minimum requirements of ch. Comm 83.22(2)(bX1)(d)&(f) and 83. 54(1). (2) & (3), wiisconsin Administrative Code. Use of this document does not
guarantee the performance of the POWTS. GMW (2/01 )
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ( of
Diviiion of safety and Buildings
in accordance with Comm 85, Wis, Adm. Code minty
,
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
evi ed by Date
Please print all information.
Personal information you provide may be used for seco ary puREC Ere 15.04 ( (m)).
Property Owner Property ocation
vt. Lo 1145A:1/4 A :1/4 S� T N R or)
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
CROlXCO TY� '� Cr I Ifo v 1} /P 4W.9)
city State Zip Code Ph e N ❑ Village To Nearest Road
of
New Construction Use,0 Residential / Number of bedrooms Code derived design flow rate J' GPD
❑ Replacement ❑ �F}ublic Dr meraaI -Describe: -- _ —_ - -- ------- - - - - -- — 00 ,
Parent material Flood Plain elevation if applicable ft.
and recommendations: lr e&.,a /
® X Boring
Boring #
❑ pit Ground surface elev Z�W• 0 ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 g
3V 3 r Y /
F-1 # Boring
a Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
All
Effluent #1 = BOD > 30 220 mg/L and TSS >30 1150 TJ ' Effluent #2 = BOD <_ 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) S CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 a 3 715- 246 -4516
Soil Test Plot Plan 2 Z
Project Name Pete Hawle Y Shaun ,
Address 1095 210th Ave
Baldwin Wi 54002 CSfKd #226900
Lot --- Subdivision ------- Date 5/1/03
SW 1/4 SE 1/4S 32 T 30 N /R W Township Glenwood
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Nail in Gate Post
System Elevation 102.5' *HRpSame as Benchmark
Cty Rd DD
i
Scale = 1/4" = 10'
102'
4 101'
0
- 0
m
a
100 B
r
CD 13 B 1
13 B -3
-4
B.M. #1
6%
Slope
B.M. #2
e ��P
Wisconsip Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size a n
�I� J t o
include, but not limited to: vertical and horizontal reference point (BM), di ction 5P1� - C'E� Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distan to nearest road.
Please print all information. JAN ® 2 mo wed y Date
Personal information you provide may be used for secondary purposes (Privacy La s. 15.04 (1) (m)).
Property Owner Prop FFlCi
a a
of 1 /4 114 S� T 3 N R t� W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Clode Phone Number ❑6ftq- ❑ Town Nearest Road
r A W
New Construction Use: Q Residential / Number of bedrooms Code derived design flow rate 9's C) GPD
❑ Replacement ❑ Publi or commercial - Describe: /V "4 , ,,r1
Parent material C4� fi-C.' t t - P , l� Flood Plain elevation if applicable /V . A ft.
General comments /
and recommendations: i C ,�� , S ;, ;,� rt� Z f cs
1 E] Boring
❑ Boring #
pit Ground surface elev. �.�/ ft. Depth to limiting factor 1�� _ — in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
i _ .. _.
61
3 1 J 1 I
�I
i VJOrt J
Boring # ❑ Boring
❑ ® Pit Ground surface ele ' `— ft. Depth to limiting factor y in .
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -
hA J C. 0 5
> IP, ?> . - , S: 3 L.
-
' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 0 mg /L ' Efflue #2 = BOD < 30 mg /L and TSS < 30 mg/L
CSI N me (Please Print) ") 1 Aignature CST Number
V `
.
Address Date aluation F onducted Telephone Number
3BD -8330 (R07/60)
a
Property Owner 1 f Parcel ID # 01 G ' Page L� ' of
❑ Boring
® Boring #
°� Pit Ground surface elev. lG /. S ft. Depth to limiting factor in.
/—' Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
13 ti 5 k
m
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # ❑ Pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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)
..................
............ ............
............ ............
<I
............ ..........
... ............ ............ .
I ............ . . . . . . ....... . ......
I ..... ..
.......... ........... ............
...........
CoWners
L I
Clarei ice Glotfelty C) C)
-Tech Systems &
po
10 0
....... . ............
N4955 Sunny Hill Road
' `
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT`
AND
OWNERSHIP CERTIFICATION FORM
i
owner/Buyer
Mailing Address ...
Property Address g�o 2- C-f 9 ® Q
(Verification required from Vlanning Department for new construction)
City /State Parcel Identification Number
I
LEGAL DESCRIPTION
Property Location V" Se . T ,,V N -K � W, Town of kta—
t Subdivision , Lot # cZ
Cerffied urvey Ma # 1 3 3 `� Volume 2 i � - 2-- Page # X-45— Deed Volume Page # /
Spec house ❑ yes 0 no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenanceof 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.
The property owner agrees to submit to St. Croix 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.
Uwe, 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 Zoning Office within 30
days of the year expiration date.
' / SD3
000"
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
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.
Sf GgA - TURE 0 OF APPLICANT DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
J 2 1 72 275 ?'13345 �
STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
This Deed, made between Duane H. Midtlincs, a single RECEIVED FOR RECORD
person
03/17/2003 09:30AK
Grantor, WARRANTY DEED
and Peter C. Hawley and Julie A. Hawley, husband and EXEMPT #
wife as survivorship marital property REC FEE: 11.00
TRANS FEE: 288.00
Grantee. COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE:
described real estate in St. Croix County, State of PAGES: 1
Wisconsin (the "Property") (if more space is needed, please attach addendum):
t 2 f Certified Survey Map recorded in V Q?ume 17
page 44CL4 as Do cument No. 711150 being a part of
the Southwest Quarter of the Southeast Quarter (SW% Recording Area
of SE'a) , Section 32, Township 30 North, Range 15 Name and �y dd�cs
West, Town of Glenwood N1'(WA I BAN OF BALDWIN
990 Main St
PO Box � 2060
54002
Part of 016- 1069 -80 -0
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record.
Dated this 14th day of March 2003
• o
114 .12
* * uane H. micftlin
*
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ��„� y_ palm ) ss.
.r„t p ��billC St. Croix County. )
authenticated this day of 111 &r laeec>ISin Personally came before me this 14th day of
st a te March 2003 the above named
Duane H. Midtling
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not, to me known to be the person who executed
authorized b 706.06 Wis. Slats.
Y § ) the for g ' me d ]cnowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Palm
Michael H. Foreeki , Attorney otary Public, State of Wisconsin
Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date:
( Signatures may be authenticated or acknowledged. Both are not necessary.) December 12 2004 .
*Names of persons signing in any capacity must be typed or printed below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000
ttomey Michael H Forecki 1830 Brackett Ave, Eau Claire WI 54701 -4627
Phone: (715) 835 -3029 Fax: (715) 835 -4112 Kay Palm T4812086.ZFX
Produced with ZlpFonn° by RE FonnsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -9905
71 1 150
VOL 17 PAGE 4469
KATZ= H. arn
REGISTER OF DEEDS
ST. CROIX CO ' L VI
RECEIVED FOR K ECORD
02/26/2003 09:15AN
REC FEE: 13.00
COPY FEE: 3.00
PAGES: 2
CERTIFIED SURVEY MAP
Duane Midding
Being the Southwest 1/4 of the Southeast 1/4 of Section 32,
T 30 N, R 15 W, Town of Glenwood, St. Croix County, Wisconsin.
APPROVED
ST. CROIX COUNTY
Planning 7nri ^n and Padas Committee
NORTH QUARTER CORNER f E g 2 S 2003
SECTION 32, T 30 N, R 15 W
FOUND 2 IRON PIPE) UNP tTTED LANDS
5
1`!rt 1 G _ W� If nct recorded within 30 days of
Q approval date approval shall be
1 1 nut; and v,-td e I 1
North Lila SW 1/4 - SE 1/4 Section 32 �,SCONg��
.
W.
n u MUR Y
ul 5 13 = * 2
d � p ; t0 ELDENVILLE,. 0 �5
IC1 � p WI. a
�, � RF D O L.4 NP 'gvP
r r 0�
o! $ 342.79' 31610Aars 75q ft. o I DATED -
Z T - bl r ? 86°38' 35' E fIYK ,?/�j Z January 9, 2003
Si 30.845A,3 359 3Sgi ft. S c ° ill ul OWNERS' ADDRESS
�j 2854 C.T.H. "DD"
Z GI.ENWOOD CITY, WI.
5Mirq 299.78' 54013
°i"°"ay N 89 . E
thg
8441Aaq.w367,7085f ff. I 41 t -M
BU DING SETBACK LINE
� __11oo:EuoMwcH_r-oFwAn_____
-- N89 1317.51' --
650.85' 666.72'
50.OP. 7.42 —r 4 9'
' o '31" 7.49 - -
SOUM QUARTER CORNER - - N 89 ' T W 2634.98 Una sW 114 - SE 114 S01J1 HEAST CORNER
SECTION 32, T 30 N, R 15 W LOT 1 (Centerine C.T.H. 'DDry SECTION 32, T 30 N, R 15 W
(FOUND BERNTSEN SURVEY NAIL) - (FOUND BERNTSEN SURVEY NAIL)
va I UNPLAT - -Lm .
UNPLATTED LANDS --- ° -- 045
---------------------------
N
LEGEND E
O Indicates 1 "O.D. x 18" Iron Pipe Set 7K
(Min. WL -1.13 IbsJlin. R) 5
Section Corner Monument S in Fed r = 300'
0 (as noted)
300
— "— Indicates Fence Bearings are referenced to the North -South
Quarter section Gne of Sedfon 32, assumed
® Indicates Sal Boring bearing N 00'23'06 W.
This Inslrrrmt Drafted by Mark W. Peavey SHEET 1 OF 2
VOL. 17 PAGE 4469