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Home My WebLink About016-1070-10-200Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building DIVISjpn * ~ INSPECTION REPORT IaENERAL INF•~ORMATlON (ATTACH TO PERMIT} Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township McCarth , Philli Glenwood Townsh CST BM Elev: ~ ~ ~ ` Insp. Ele~ ~~ B CSTpt$~~~ TANK INFORMATION OQ TYPE MANUFACTURER CAPACITY Septic ~~ L~ Dosing ~~~ . k Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic y S`~ 1 y ~ i ~ 3 ., Dosing ~4 ~ ~~ ti Z ~ t Aeration Holding PUMP/SIPHON INFORMATION ~~.U.E~~'C" r ~~ O' Manufacturer De nd ~ GP Model Number l0 ' C2 •J Lift '•y.• Friction Loss ~ Syste ead S DH ~/ _Ft orcemain Length ~ Dia. ~ A Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 420787 0 Plan ID No: Parcel Tax No: 016-1070-10-200 Section/Town/Range/Map No: 33.30.15.4906 STATION BS HI FS ELEV. Benchmark ~ ~~ • Alt. BM O (p. S Gt. ~~,. L L p, l 'f b Bldg. Sewer • 3~ ~q• ~l3 St/Ht Inlet ~ , ~'~~ t SUHt Outlet Dtlnlet Ut Bottom Header/Man. Dist. Pipe ~~ C } 1 Bot. System 1 ~T s• F~~nal Gradue ~ w. ~wv ~{ •. St Cover I srj 2 ~• bq ~ Ilo•4z- Q3.9o r~.o.~t.~~,.r ^ r~ . 7z i ~ _ 4z i ro .y Z BEDITRENCH Width Length No. Of'Frenehss PIT DIMENSIONS No. f its Insi Di Liquid h DIMENSIONS • / , ~ ~ ~9 \ ~ S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA M f urer: INFORMATION CH BER O Type Off Syst~ d ~, ' ~~ -•' 5 ~ , - UNI Mo re DISTRIBUTION SYSTEM Header/Manifold Distribution r ~ K ~ Pipe(s) x Hole Siz ~ 1 ~ x Hole Spacing •1 Vent to Air Inta Len th Di 3 • O L th ~~ Di i S O 1 1 g a eng _ a_ pac ng SOIL COVER Y Pressure Systems Only YY Mnund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedlrrench Edges Topsoil i ~; Yes f ~j No ~] Yes No COMMENTS: (include code discrepencies, persons present, etc.) Location: 2977 130th Ave Glen/w~o City, WI 54013 (NE 1/4 N 1/4 33 T30N 1.) Alt BM Description = ~~ •F ~ ~~~~ ~~' 2.) Bldg sewer length = ~?jr ~u - amount of cover = > ___ --, r-- Plan revision Required. es Use other side for addi i nal i ~ Z(f~ SBD-6710{R.3/97) ~} ~'~~ lL1d..~ ~ _ Inspection #1 . 06/ d~ _ a ~,,,QQ~,/~~ 3 ~ r1 ~-~. No: 33.30.15.4906 ,~f Ce ~-+ ~'~ . `" ~T Safety and Buildings Dtvis on 201 W. Washington Ava, P.t:). L:~ox 7162 I c:ounry,,,,/, a _ `1~}/ Madison, WI 53707 -• r I lit Sanitary Permit Number {to be filled in by Co.) ,~~~n~,~ {606}2G4-3151 ~f2~ ~-g`~- De artment of Commerce -._._. State Plan 1.D. Number Sanitary Permit Application ~ g ~_ ~~ar/~~ ~o ~ [n accord with Comm 83.21, Wis. Adm. Code, personak information you provide may be used for secettdary purposes Privacy Law, s15.04(1){m) ._. pro ect Address sf different than mailing address) ) ( I. Application Information -Please Print All Information ~ ~ ,, ,> jf'~ ~/y ~./~ - . Property Owner's Name ~~-' Parcel # Lot # Block # Property Owner's Mailing Address - t O-ZoO erty Location ~~ (o ~ ~OyO Prop / ? _~ f U G:) r 1 ~'l~- ~1, City, State Gl Zip Code ,,,,- ~ ~ ~ ~~ ~ ~ Phone Num13e; -~ ,(circle yl ~ 8 • ~ ~c om- .- q C.~ ~~' ~~.:>L%,~ t ~ _ _~ ""' , _ . N, R „ II. Type of $uiltiing (cl-eck all th apply) a.S 5 w ~ °~' SM Number _.__.. or 2 Family Dwelling -Number of oms - / `fy2y ~I $63 C~'~~P s `l~ `jD ~ ~ - • ^' O4J~ ^ Public/Cornmereial-Deseribe Use --T 8u ~ ~ X ~' S r uVl cltdCll ~~ ~ _ ~ • ~ ^City_^Villa a ownship of _, -` ^ State Owned -Describe Use ~.L t.~ III. T ype of Permit: (Check oNy one box on line A. Complete line H if applkable) A. ~I~New System ^ Replacomeat System ^ Treednent/Holding Tank R~laastiunt Only ^ Other Modification to Existing System ~~~ List Previous Permit Numbet' and Dace Issued 13. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Perm~c Transfer to New Before Expiration ~ Plumber Owner N. of POWTS S stem: Check all that a 1 r i ~ Mound < 24 in. of suitable soil ^ At-Cnade ^ Single Pass Sand Filter ^ ^ Non -Pressurized In-Ground _ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ A..erobic Treatment Unit ^ Rccircuiatittg Sand Filter ^ Recirculating S thetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-les:, Pi ^ Other ( lain) Y. Dis aaVTreattnent Area Intormation: roposed (sf) System Elevation P A rea Design Flaw (gpd) Design Soil Appli on liate(gpdsf) Dispersal Area Required (s~ Dispersal s \ , ) _ L/ U ~~ e ~~ ~~ ,_ VI. Tank Info Capacity i Total Number Manufnch:rur Prefab Site Stoel Fiber Plastic Gallons Gallons of Units Concrete Constructed Chess New Existing Tanis Teaks _..r. Septic or Holding Tack ~~ Aerobdc TrestaseM Unit ~ ~ Dosing Chamber ~ _.^. . VII. Res onsibiiity Statement- >4 the undersigned. assume responsibility for 6 dlaiica of the POVVTS shown oa the attached plans. umber hone N sin~ss P B ' RS Number yu ~/J Pium 's Si /M.7 Fitunber's Name-(Print} 7 / Z~ / ~~% >2 S~Z~ ~~ ~ , i ~J ~ / ' l ~ S ode) Z ' Plu er's Address (Street, ity, State ~ - - /b VIII. Coup /De ttment Ube OAI gn (N tamp } Sanitary Pertttit Fee (includes Cfrour~.dwater Date Issued ssu' Agent Si a e o S s Approved ^ Disapproved Suroharge Foe) 3 zS ~ l r' ^ Owner Given lteasott for Denial p~~ ~ IX. Conditions of ApprovaUReasons for Disap ~ ~~ ~ ~~~C. .~..,, ~°~ Soc. t ~~pea,~~~~^ s" _ 5~.~ - "'1 "'d p.er Attach complete plese (to the County ody) system ne paper nol less rhea 8lR x tl i~Yes in size cRn_~~4R !R fI1 /031 /'.1 ( 7 L ~' ~~ r 7 ~ -~ ~~ ~ ~~~. t ~~`y1r ~, .......~........~,...,e....~.r.~.~...~....~...•.~....,..•... .....,..,..J~ ,...... ... , ,...,,,,, - y ~9 ~ , ~~+~ ~t ~~ Z: .G~' ~~ ~2o~~~~n ~ C -~• U ~ .~ „ ~, ~Pi~X j,~ ~'!~'1'/ ,D R, /~0 V+ L~ dI ~ i ,/ _ ,~ r'l ` ' ^ ~~ rk 5~°i ~' ~~. .. .' r' .. ~ry ~(L. A'B Y / N ~~ r r' . r -( ~~ ~~ ~ ~l ~ / I ~ I~~j ;1 ys ~ ~ ~ y!•o ~~'~, ' ~,~ ~ _. tr l ~/D ~~~ V ' ' Q~,f M ~•' ,- ~. a. D ~!` r'' f M /!~ '~ ~ ~scons~n Department of Commerce Safety and Buildings 14i NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary March 31, 2003 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 ST RD 64 BOYCEVILLE WI 54725 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/31/2005 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Phillip Mccarthy 130TH Ave Town of Glenwood, 54012 St Croix County NE1/4, NE1/4, S33, T30N, R15W FOR: Object Type: POWT System Regulated Object ID No.: 896957 Description: 450 gpd design wastewater flow mound system. Identification Numbers Transaction ID No. 852855 Site ID No. 657182 Please-refer to both identification numbers, above, in all corres ondence with the a enc . 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 Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10691-P (N O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" 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, 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Maintenance information must be given to the owner of the tank explaining that periodic ni~f t6~ilter is required. Access to the filter for cleaning must be provided per Comm 84 product a~r ~itil~~ `~ • A Sanitary Permit must be obtained from the county where this project is locate in acc~'~~ requirements of Sec. 145.135 and 145.19, Wis. Stats. 5~,~ s F~L~~ • Inspection of the private sewage system installation is required. Arrangements for ins n sh~ be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), ats. 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 LYLE 7 MYERS Page 2 3/31/03 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, ~~~ Thomas J Perkins POWTS Plan Reviewer ,Integrated Services (262)521-5064 , 7:30-4:00 tperkins @ commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 __ __ Mound System COVer P~9e ~, ~ e~~~ ~ Alf ~ ~~; M~,i~ ~~ ~~~~~ CD~IIETE Project Name: PHILLiP McCARTHY MOUND ~3wnet's Name Phillip McCarthy Qwners Address 1284 300th St. Glenwood City, Wi. 54013 Legal Description (NE ~ ~ j '/4, i NE . ~ ~ %4 Sec 33 T 30 N, R 15 i ~' ~ ~, Township Glenwood County ,saint Cra1x Subdivision Pending Lot# N/A Parcel iD# 028-1000-09 Table of Contents Pg• 1 Gover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Lyle J. Myers MP/License #: I.D.# 224617 Date: 1121/03 ~, ~~ Ph. #: 7156432520 ~t+~ ,? ' 1. •• Signature: ,~ ~>,,~ ~,. Mound System Design Methods Used ~~,~~ `'~~1 icF per "Mound Component Manua! For Private 4nsite Wastewater Treatment Systems" (i/ersion 2.0} SBD-1G691-P (N.GiR31} `~F . ~ per "Pressure Distribution Component manual for Private Or~ite Wastewater Treatment Systems" {Version 2.0} SBD-iG7G6-P (N G1~1} ~~ N124t36 220th St, Boyceville, WI 54725 Ph: 715-&49-6968 email: ' 'Mound System ' Mound Sizing Calculations Project Name: PHlt_L!P McCARTHY MgUND Site Conditions Project Type: 1 or 2 Family Dwelling i ~'' Slope: 10 % # of Bedrooms: 3 Depth to limiting factor: 18 in. Absorbtion rate of fill material: 1 gallft`/day Absorbtion rate of in-situ soil 0,5 ga!/ft2/day Effiuenf quality I Eff#1 ~ ~ s Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Page 2 d B 18.0 in. 25.2 in. 9.5 in. 6 in. 12 in. 10.8 ft. 96.6 ft. 6.5 ft_ 14.6 ft. 27.1 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basa( area requited: 900 ft2 Distribution cell width {A}: 6.00 ft Basal area available: 1545 ft2 Distribution cell length {B}: 75.0 ft Area of Distribution Gell: 450.0 ft2 dbservation Pipes Contour Elevation of Mound: 93.90 ft Location from end of cell (Z}: 12.5 ft System Elevation of Mound: 95.40 ft Final Grade of Mound: 97.19 ft Mound Plan View / ~ r~bservation pipes ~,~ ~:~ ,=t' i?ii~ibicl'i~r~~ mil '~ ~ ,:, ~~ v Tiled ,AreatFill P~aterial , ~~ i_ Design of Entire Fi#( Cell depth at upsiope edge (D}: Cell depth at downslope edge (E}: Distribution cell depth (F}: Cover thickness over edge {G}: Cover thickness over center (H}: End slope width (K): Fififi length {L}: Upslope width {J}: Downslope width (Toe) (!}: Fill Width (W}: Mound Cross Section Fins! Grade - Synthetic i=abti~c Distribution Gelf ~"~ System Ele~a~on~ ~n,a~L,~ -~ ~ ~ Lat ~.a~er h~lateria( ~ In+~ert' Fill lViateriai ,~ ~'' ~~~~Sii~pe ~--t~bser~ation Pike l~ ~ rG ~~`, ' ` ~ F ~.,.....~.~ d ~$ n 1 ~ 3 "'Tilled Area ~'~``-Fnrrarrie.in 'System ~: on#our Notas: Fill material to consist of ASTN! C33 Sand D+stnbution ce!! aggregate to comply with Comm 84.30{6){!} Synthetic Fabrtc covering on ce(I per Comm 84.30{6){g) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Septio, Pump and Dose Tank Project: PHlLLlP McCARTHY MC3UND Tank Information Pump tank manufacturer: Wieser Concrete Pump tank sizelmade#: j wig/&5o-~tR ~ ~v ' Pump tank gaUinch: ~ 7 Actual Pump Tank Volume: 646 a! g Tank bottom elevation {inside}: ~- 80 ft Septic tank sizelmodel: (wino/sSaMR Pump and Filter Pump Manufacturer: Little Gian Pump Model: 9EH Effluent Filter: Zabel A100 I ~ /t~ofe: Actress opening o(suffioienf size :a bs provided to a/lnw ~ removal of filter. Opening to tem~inate at or above grade. Pump Tank Diagram V`datettight Lociciny Cover -0 incl: VdSth U`Jr~rnir~g L~iY,ef h4inimum ,r-Finish gads Alternate! Qutlet Lu~aiiun Elect, per Corrtm 15.28 and ~rr~mRin ~ P~fEC 300 A~tti- Pump must be capable of: and head pressure of: t3 D Puye 4 of 8 Dosage Volume Forcemain drains back to tank? a Yes Q rvo Lateral void volume: 15.6 gal Dosage tt? absorbtion Cell: 78.2 gal Forcemain volume: i4.8 gal Total dosage: 93.0 gal Total Dynamic Head Are laterals highes# point? y i# not, enter highes# elevation: 0 ft System head {distal x 1.3} 6.50 ft Vertit:al Lift ("D" #a lateral) 15.23 ft Friction loss in forcemain: 3,30 ft Pressure lass from filter. C~ft Total dynamic head (Tl3H}: 25.04 ft Dose Tank Levels In. Gal A Reserve 22.5 383.0 $ Purtip off to Alarm 2.0 34.0 C Toial Dosage 5.5 93.0 D Effluent depth for pump ~ 136.0 Total Capacity: 38.0 646.0 FLDV- LITERS1t 0 1000 2000 3000 I t I I . W d 15.7 GPM ~ 25.1 Feet 30 2!? to 4 1 -10 -7.SW r W - 5 t q W - z.s -0 u c'>7 av rau uu Little Giant LDw- Gad.LDNSJMtNUTE 9EH PUMP PERrpRMANCE CURVE llsv aal+z Mound System Management Plan pursuant tc comrrt 83.54 w. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or PGWTS service contractor may make periodic inspections of the components, checking for surface discharge, Crested efiflusr:t :svs:° °tc. The ov:ner or o:vna:`s agent is requ:.ed to scb.^.i * ns:.es~; f maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemicaUbiological "treatments" is not required or recommended. if such additives are used, make sure They are approved by ilepartmeni of Commerce, safety and Buildings Giv.. Effluent filters are to be removed ~ ceaned as necessary, with provisions to keep solids fr^^'' '~Tw£$:ng fhg cor€in r{,~;;nnv :°:T:,^,a:$i hin mnrn ±i~gn 1! 2 of Cho wSBhio ian4 ynt~ma mM~ t'$ ^n~r,~~,~niarl by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be noted of when pumping should be done as to not exceed 1!3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pumpldose tank, it must be removed ~ cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. T,iv ~ii~i:p, tl+~at awii%e`~es dF'~u alai~5 TriiSt ire iriSNeGtcu at i6a5t 8v6~ y ti ~rce ji6ar~ ivr ,roper operation. Rumpfdase tank should be routinefy inspected tc, be watertigi-it ar~d of good repair. Mound afid La#e~l Systewt The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible probiemsifai"sure. The designedi daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the :.or^por;e^t. A~ iYit ~ :;TH~° than ^:.,..~^g/n:ai^te.^.a^ce ~i.e. ax :°.ssivs .:a! ~~^g, pats, vehiw'es, etc...; c: uld compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. ~.ateral distribution pipes should be flushed out/tested every 16 months usinq_ the ceanouf points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Perft~rmance? manitrring mint he done at least nnre every three years fnllnwinn the installaticsn or at the #ime of a problem, complaint, or fa"shire. Contingency Plan: If the septic tank, pump tank or any ofi their components therein (including floats, alarms, pumps, etcj become f~PfPl~'tfl1P flip ~1PfPr~fiVP fink pr __mnnn~nt m~~gt hp ra larnrt immArli~t¢I{l t: angl~r¢ that the cvatFm r'n _..... ,._.._... __ . _p.____ _,.._... operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's r_urrent location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. ~ r ' Nr rt ~. ~ ~_ n ~. r- , ~ .• ~LU ~n ,~ ~"vz ~ L...l.~ jam. :J` ~ i'Y'"~ ~ ~ 12 , rrr -' ~_..>.uunrnwra.uerc~.w. y.,.n„.~..,w.tw.].ww,u,s+~rw,~Yru~,.,wmaR4tM.+n] ...n..u.. ~ eu~." aweattrJ:~ ._, ~~{{}} -., .. ~'rttA~ )~~ i r} C~o~~SaL/~ '~,,,~ ~-rz.L.- U ~ .,.~ ,~ ~ t ~('~~ r-, ~~ (1 ~ ~ . •'" / ~' IAN ~~ ~I ~Iff~~ ~ j .3 ,, t '` ;{ 1. ~'' ~i d '' ~ ~ `~ '~ ~ ~ a .-- ~ 3i I ~~' `lc. ~pc ~} ^\~ S ' ' l r r ~~ ~~ / ~ ;~ ..~ ""'~ r ;:. ~ ..,,,._ ...,. "~ ~ ~, pp ~Z~' ' ! y ~ L.- ~ ~' ~ I'~1 l~t~ DF' a?' /'~ ~PF ~~;e r l~Dldlr~ss .F ,/a/~~ 9 ~~ Q(3~o,,[f~ . Cr,~Cfl4~A~ l[ /~ . ' Wisconsin Department,of Commerce f)ivisinn of Safety and BuIIdInOS t~v ~, Sao 3 SOIL EVALUATION REPOR RECE1VEDage of 3 in accordance with Gomm r35, wis. Aam. ~.oae t l Coun ~ ~~ 002 an mus Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P include, but not limited to: vertical and horizontal reference point (BM), direction and p~ ,p, ROIX COUNTY percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ST. C Please point all information. Revie b Date ~ Personal infonnaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~ ~3 Property Owner `` ~s-(e~", , ,~ ~ a ~in~~e~ ~~-t~o~1r CYp~~ia Wes~t~ Property Location Govt. Lot /U~ 1/4 ~,1/4 S33 Tab N R /~ E( W P perty owner's Mailing Address /I 11~~ - S' t Lot # - Block # '' Subd. Name or CSM# r~ n ~ ~T .. Tv< G. /c7 ~ ~ ~ OCR t1 ,~^ q City State Zip Code Phone Number ^ City ^ ~Ilage A['town Nearest Road GI~~-~wc~~~C,~-~ CAS Syof3 ( i$')~~5`_ y(p0 C/~.t,.~oe,cX /3C7f~ /¢v~--- New Construction Use: residential / Number of bedrooms ~_ Code derived design flow rate ~~~ GPD ^ Replacement ^ Public or commercial -Describe: ~~ ~ Parent material S; ~~ v veo ~-~ ~~ Food Plain elevation if applicable General comments 5 ~ G • X 7 S ~ C ~-/1 b 2 C b~ ~O ~,, ~- ~.,~ , 9 ~ d i ons: at and recommen M~.~,~~ sys~~~.- ~/~J. 9s ~ / U Boring Boring # ,$; (~ ft. Depth to limiting factor ~~ in. Q~ Ground surface elev. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f'~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 a Q ~ - / ~,,.~ r ') t.J J t~ ~ ~ 3 c ~ " c~ ~ Sc L ~ s b k ~; FI " ~ f ~l - - ~ 15-- V, S J .b (( T r ~ 7 .. ~- ~ `t S awe ~/-a ~ n c ~ fiz 6 3 d ®Boring # u ~oring /` ~" Pit Ground surface elev.y , ~ ft. Depth to limiting factor ~ in. Soil licatlort Rate i C l Descri tion R d Texture Structure Consistence Boundary Roots GP D/fP Horizon Depth in. Dom o or nant Munsell p ox e ou. Sz. Cont. Color Gr. Sz. Sh. - `Eff#1 `Eff#2 ~}-(o ~ ~ ~ ~ ~ ,_- C ~ a ~ S ~ p o ~ '~ dC ~ o ~ ~ L r- c,J t ~ ~ ~ c~ p_ ~ ~ v ~ Vn G(J ~, ..c. .S ~O/7 t. ~/'Cc _ tiL G~ L'.// /~O I'/ Z-b.-. Effluent #1 = BOD > 30 _< 220 mglL and TSS >30 < 150 mg/L - Crnuern rrc = ova ~ ~~ ~~~y,~ a ~~ ~.~.• . r.. ,,.a,~ CST Name Please Print) ~ / S ature ~T Ntur~eer e vi yr ~ -P 2 2 Sew c ,~~ Oct /`'~ Address ~~~J // Date valuation Conducted Telephone Number 5~~~ Property Owner ~~~,w-~ci(~ ~"' ~ -e,~ Parcel ID # Page ~ of U Boring Boring # ~ L~ Pit Ground surface elev. ~ ' `~ ft• Depth to limiting fador ~ ~n• Soil lication Rate tion Descri R d Texture Structure Consistence Boundary Roots GP D/fP Horizon Depth Dominant Color p e ox ' ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 Eff#2 ~u b ~. 1 ~ ~ ..s~ . ~ a - ~~ _--. . ~`14L .s o ~ b ~f as ~ ~ f~, ~ s P O y ~- ^ Boring # U Boring . ^ Pit Ground surface elev. _~__ ft• Depth to limiting fador in. Soil lication Rate ti ri D Texture Structure Consistence Boundary Roots GPD/ff Horizon Depth in. Dominant Color Munsell on esc p Redox Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 `. Boring a Boring # Ground surface elev. ft. Depth to limiting fador in. ^ pit Soil lication Rate t R GPD/ff Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz: Sh. Consistence Boundary oo s 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) PIo~ ~~a~ ,~cil v~ ~e r' '~ e V~'a 1cX ~Ir ~ -e ~u~-a -~ v~ v~ ~ ~-c .e~ o~ ae~ %~ r____ /3 c~ ~/. ~-l~ -~ ~~~ 3 ~~ ~ ,Sc~I-~ ~~~_ ~(v ~xc-e ~ f ~s 5 ho~~ti ~~ ,~,op~b .. ~ cx~~~o.~ ~r oS~G~ 3 ~3e ~Q vk ~e., ~'e n « 5~~ f y .~ ~l g~ j / i / ~A - X090 ~ ' / ,/ e~-/ 1 A ~ -^ '~ 5 i.~ ~ ~ - p B/ ~ ~ ~ V / q~% - _ - " ,~ t'~c~ ~ .. ~~ _,,, _ , ~J ~ ~81ti, qS.L~ 3.rt. goo. oo q~ y~~,~ qy~ rah o r ~ P. Pe 1~~~ o~ ~ ~ ~, p~c P~~~ V J~ ~~ ST CROIX COUN 1'~! ~~ ' SEPTIC TANK MAINTENANCE's AGREEMENT AND ' OWNERSHIP CERTIFICATI011 FORM OwnerlBuyer ~%~ i LLB ~ f~ " ~' -r-f -- _ Mailing Address properly Address ~~ (Verification required from Planning Department for new o ~3 CitylState ~ 4=~/~~yo~,~ C ~ ~~- ~• Parcel Identification Number ~ / ~ /~ `7 y ~~ ~`~ ~'`v ~.,la,'~AL DESCRIPTION Property Location /~G~ %4, Q/~ '/+, Sec. 33 , T 3o N-R; ~ S W, Town of ~ ~~~JuJod ~ . Lot # ~ Subdivision ---~- Certified Survey Map # _ ~ ~ .Volume ,._.._.~LS~._--_ .Page # c / ~ - - Warranty Deed # , ~~ ~/ ~ c'3 ~ .Volume :~~.._.+ Page # ~ ~ ~ . Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTEM MAIN'T'ENANCE Improper use and maintenance of your septic system could result in its l~remature 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 dis~~asal system. Tbc property owner agrees to submit to St. Croix Zoning Departme,at a certification forth, signed by the owner and by a masterplumber, journeymanplumber, 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 ne+:essary), 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 Wisconso~C,e v~v`r~thcn 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning da of the three a ira ' n date. - ~ ~~~3 DATE SI NA OF APPLI OWNER CE~tTIFICATION our knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this form are true to the best of my ( ) the prope described bov , virtue of a warranty deed recorded in Regi:,ter of Deeds Office. -~ ~ io 3 l,G DATE S A OF APPLIC «««««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning DePartm°nt• "««*«« '`'` Include with this application: a ~tamlxf the certified survey map I~f rgcfcrence~mado~in the warranty deed ~J 2117P 260 • STATE BAR OF WISCONSIN FORM 1 - 1998 ' ~ ~ WARRANTY DEED This Deed, made between Donald E. Frieburg and Julie A. Frieburg, husband and wife, Grantor, and Phillip J. McCarthy and Cynthia M. McCarthy, husband and wife, as survivorship marital property, T Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): 706684• KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 01/22/2003 09:15AK E1IEMPT # REC FEE : 1 l . 00 TRANS FEE: 41.40 COPY FEE: CERT COPY FEE: PAGES: 1 Part of North East Quarter (NE 1/4) of North East Quarter (NE 1/4) of Section 33, Townshi North, Range 15 West, St. Croix County, Wisconsin described as follows of 2 f Certified Survey Map Filed December 11, 2002 in Vol. 16, Page 4424, Doc. No. 701863. Name and Return Address Citizens State Bank 113 W. Oak Glenwood City, WI 54013 016-1070-20-000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and encumbrances of record. w 7 0 1 6 3 VOL ~ 6 PAGE 4424 KATHLEEN H. MIALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 1L/ 11/LIOIOL IOy: ~EFf~D S4JRVE1( MAP REC FEE: 15.00 COPY FEE: LOCATED IN THE NE1/4 OF THE NE1/4 OF SECTION 33PA19~S~{HE3 SE1/4 OF THE SE1/4 OF SECTION 28, T30N,R15W, TOWN OF GLENWOOD, ST. CROIX COUNTY, WISCONSIN. SCALE IN FEET i" 150' 0~ 75~ 150 300 BEARINGS REFERENCED TO THE NORTH LINE OF THE NE1/4 OF SECTION 33, ASSUMED TO BEAR N89°21'41"E, PREVIOUSLY RECORDED AS N89°39'33"E. 'SS/4 CORNER, SECTION 28 ( ESTABLISHED FROM TIES OF RECORD ) N89°21'41"E 1518.33' OWNER / SUBDIVIDERS JOSEPH 6 GLORIA WALZ 3028 SOOTH AVE. GLENW000 CITY, WI. 54013 OWNERS / SUBDIVIDERS ( LOT 2 ) DON 6 JULIE FRIEBURG 1284 300TH STREET GLENWOOD CITY, WI. 54013 ~~ ~- / a~~ C ~ ~~~ vN 'ate ,,~~ SE CORNER, SECTION 28 ~'' pP~' g5 ~~ ~~ Q~-Oj 1 (TIES OFIRECORD ) PG ~ ,...-. (CIE SEE ~ TAI ^~ 3 .,,..FOR '~ /( ~ ~QS ~-ti pV ~~~ ~~ ~~ 'H LINE OF THE P ~'~ ~ ~~ '4 OF SECTION 28 ~ 1 da1`~wi Ni/4 CORNER, SECTION 33 ~ ~E ( S AB ~ WIDTH TIES OF RE ORD ~ ~ ~~ _ ~~~ ~ H ~ p~~ 3 m (V p m a~ o ~ ~ I LEGEND -INDICATES SECTION CORNER ( AS NOTED ). ~- _~ . J f iE 5EE SHEET ~2 OF 3 FOR CURVE INFO. -' " ~ NORTH LINE OF THE _ NEi/4 OF SECTION 33 APPROXIMATE CENTERLINE - OF DRAINAGE WAY L~ ®~ 199,897 SQUARE FEET ( 4.589 ACRES ) +- N89°56'31"W 380.00' UNPLATTED LANDS ,, pWNEQ.~Y: FRIEBURG ~ ~~~~ 4 'Jt ` ~~, „t, ~, _. ~~ ~ N89°21'41"E 838.23' NE CORNER, SECTION 33 (ESTABLISHED FROM TIES OF RECORD ) N~ m p ~' ~I Q ~, pl m 0 N gi 0 ~I ~~ ~ ; ;s `~~~ / =... ••., ~~ ~ ti W. ; fr r „_ TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING 0 x a a r O r MODEL 151 152 153 Feet Meters Gal. L'Aers Gal. Liters Gal. tilers 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 30 9.1 - - 23 87 33 125 35 10.7 - - - - 22 85 40 12.2 - - - - 11 42 ShutoB Head: 30 h. (9.1m) 38 ft (11.6m) 44 ft (13.4m) ol~soea SPECIAL APPL(CATIQNS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • DouNe 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°C.) special quotation required. 151!152/153 Series 1 5111 5 211 5 3 MODELS Control Selection Model Volts-Ph Mode Am s Slm lex Du lex N151 t15 1 Non 6.0 1 2or3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2or3 BE151 230 1 Auto 3.2 Included 2 or 3 N152 115 1 Non 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Aulo 4.3 Included 2or3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 w 3 BE153 230 1 Auto 5.3 Included 2 or 3 Model 151 r- 6 7/32 -~ 3 '/8 -~- 4 5/8 +1 i i ~..~ ~ ~ 3 7/P, / ~i ~ '~ ~.1 I -,~ 1 ,~ ~~I -- J 'L~~ Models 1521153 .z i/a a 3,/B 151TEMP 3? src2aw SELECTION GUIDE 1. Single piggybadt variable level float switch or double piggyback variable level float switch, Refer to FM0477. O CAUTION 2. See FM0712 for correct model of Electrical Attemator E-Pak. All instailaUon of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, speciflr duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code {NEC) and the Occupatianal Safety and Hearth Act {OSHA!, Or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. Nat ro: P.o. Box 16347 Z Louisville,KY 40256-0347 Manufacturerso/.. O SHIP T0: 3649 Cane Run Road ® ~~ Louisville, Kv 40211-1961 Q~qL/TYPUMPB SNCE ~r9i~i9 http://www.zoeller.com PUM~ ~O (~~1 F~~502~~~3624~UMP m Copyright 2002 Zoeller Co. All rights reserved. 1 S• bs fLOW PER MINUTE o11509A CONSULT F C~ FGR •~ .• ~, ` _J ~_~~ z 32 - ~~ ~ .. ... '~ 3 'mil It If a -:4 ` •a R ~~~.,.,~ ~~ ..~ ,t5 \jhv~ ~R 4~ LEGEND _ •••••••••••••••• FLOOOWAY BOUNDARY FLOOD FRINGE BOUNDARY 1~- - CROSS SECTION k ~G ~~'~ ~ J z~~ ~. ~ { \\ WA c