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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 572818 0 GENERAL INFORMATION State Plan ID No: 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 Parcel Tax No: Staats, Jim& Lydia Glenwood, Town of 016-1059-10-000 CST BM Elev: Insp.BM Elev: BM Des cri on: Section/Town/Range/Map No: v 1/00. 0 & 28.30.15.410 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark T. Dosing Alt. BM J Aeration ci O U Bldg.Sewer Holding St/Ht Inlet 303 Y-Iti,- to', L/b 0- 3 3 TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet i Septic > > O > &O i Dt Bottom Dosing f k Header an 4" ` 0 98- R Aeration Dist• Pipe vS- �B+S G- Holding Bot.System P7 g� Final Grade U 4%— PUMP/SIPHON INFORMATION ?a �,c P nw Manufacturer GPM Demand St Cover n��,� �? 4-A Ga �' 99• Model Number � �� (Lr\� -7 e/ TDH Lift -33 Friction Loss Syste H�� TDHS. Ft .dG p Forcemain Leriga% jEja2-11 Dist.to Well, SOIL ABSORPTION SYSTEM S' 6-4- saw BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 /06) s SETBACK SYSTEM TO P/L BLDG WELL LAKE/ EAM LAC G Manufacturer: INFORMATION CHA R OR Ty f System: / r / IT Model Number: DIST N SYSTEM Z Head Man' Distrib io i �� x Hole Size x Hole Spacing V o Air Int ke pt ) 3 Length 3 Dialdsoh Length Dia ! �� Spacing O �Sb / v V6! 1 d SOIL COVER x Pressure Systems Only xx Mound At-Grade Systems Only ` Depth Over Depth Over I jxx Depth of xx Seeded/Sodded Mulched 70 4 Bed/Trench Center Bed/Trench Edges Topsoil ,k Yes D No E Yes No COMMENTS: (Include code discrepancies,persons present,etc.) Inspection#1: 10 /Z2/ l4 Inspection#2: /L Z2/shy Location: 1386 300TH ST Glenwood City,WI 54013(NE 1/4 NE 1/4 28 T/30N R15W) 40 acres Lot P,alQcel No: 28.30.115.4 10 1.)Alt BM Description=T+Ip of O&`aa C �` p�k��'/ -4��r � (( Q 2.)Bldg sewer length=� :� _ k -amount of cover= It f Plan revision Required? [] Yes /No Use other side for additional information, Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) o (� 3 � N L � � v 4c o � QK 3 a �- �' V �- = m —Ile AQ M a s: m W �ti � N � s / Oo i 44 yS ' #„A on Ego ro its d-- 92- — — — — v .a 1 O QARTM- County ,. �5a o Essfl Industry Services Division S R CC Number to be filled in b Co.) � 1400 E Washington Ave Sanitary Permit ( Y P.O. B$W 71 EP k� OCT r .)„ ' Madison,W 1 5374 -72, 5 72a I 'S' ION Pd' o•.. i State Transaction Number iC ,1Ru i Application Zyl156 3 in accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Slats. ePi I. Application Information-Please Print All I tion Property Owner's Name �. ;Ol Parcel# 'J ryt D/(P- /0,5 '- /Q-D o0 Property Owner's Mailing Address Property Location / /91f 300 Sri Govt.Lot City,State ,r� Zip Code Phone Number ADM t/4, Af F_ t/a, Section 2-g 6 e 1,L1oo,,9/ W -�7O/3 7/$ 2Z�'-�5<i5 T ,30 N; R�lEon� H.Type of Building(check 1 that apply) Lot# �. Subdivision Name 1 or 2 Family Dwelling-Number of Bedrooms Block# Public/Commercial-Describe Use l City of CSM Number Village of State Owned-Describe Use / 1 — Town of G�G/7 64.100 k O✓ III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System eplacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System(explain) B. Permit Renewal Permit Revision Change of Plumber Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / IV.Type of POWTS System/Component/Device: (Check all that apply) 6&T-6 J La Non-Pressurized In-Ground Pressurized In-Ground At-Grade Mound>24 in.of suitable soil ✓Mound<24 in,of suitable soil Holding Tank Other Dispersal Component(explain) Pretreatment Device(explain) 1/ V.Dis ersal/Treat ent Area Information: ' Design Flow(gpd) Design Soil Application Rate(g sf) Dispersal Area Required(sf) Dispersal Area Propos (sf) System Elevation //� /0-0 a Ji /01010 ff 3t) p?.,ZG (Q C9U Y VI.Tank Info Capacity in Total #of Manufacturer y [ Gallons Gallons Units ° v U w v «y New Tanks Existing Tanks � U 2 h °te,r w 0�� Septic or Holding Tank v 1260 Dosing Chamber 4-- VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name � Plu ' is Signa e / ,^ MP/MPRS Number Business Phone Number-2,67 fX5 Plumber's Address(Street,City,State,Zip Code) 2� 3 36 tom. _ ��riu�oa�/ GcJ/ s f o/j VIII.County/De artment Use Only Permit Fee Date ssued Issuing ent Signature ppm ' approve $ / n Reason for O ) IX.Condi 0V1%tq�teasons for Disapproval 31 / ,�` 1'ti t. Septic tank,effluent fitter and l C.D , dispersal cell must all be servtces/maintained as per management plan provided by plumber. (� 2 J�gre iiii ►'qu emertfsmirstbe`tnair etne d�d� �j 1;TE•4•. za �/J ��Oay. CtsD as paf coew Ii 6r Attach to complete plans for the system and submit to the County ly on paper not less than 81/2 x 11 inches in size SBD-6398(R0313) 5� N0 MICHAEL J MYERS Page 2 10/9/2014 Owner Responsibilities: • The current owner,and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • 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. • 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. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Oerl'od M Swan POWTS Plan Reviewer,Integrated Services (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WiSMART code:7633 jerry.swiin@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm t r nxTIA.IP DIVISION OF INDUSTRY SERVICES yS' „ 0� 3824 N CREEKSIDE LA o� 19 HOLMEN WI 54636 3 ��Es Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ADO 's,ION�+ S� Scott Walker,Governor Dave Ross,Secretary October 09,2014 CUST ID No. 267985 ATTN:POWTS Inspector MICHAEL J MYERS ZONING OFFICE NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA 2943 130TH AVE 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2016 SITE: 'Identification Numbers Jim Staats Transaction ID No.2465037 1386 300TH St Site ID No. 806836 Town of Glenwood Please refer to both_identification numbers, ,\ St Croix County above,in all correspondence with the agency. NXE-1/4,NE1/4, S28,T30N,R15W FOR: Description:Four Bedroom Mound System/7%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1506676 Maintenance required; Replacement system; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver.2.0,SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code CO requirements. A No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT stats. PROFESS The following conditions shall be met during construction or installation and prior to occupancy or use: ')wISION OF Reminders: • 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. SEE COR • 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 state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm.Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans Tecifications and this letter shall be on-site during,construction and open to inspection by authorized representatives of the Department which may include local inspectors. * The elevation changes made to plan were acknowledged and approved by the system designer. MICHAEL J MYERS Page 2 10/9/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. • 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. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 erard M Swim POWTS P1an.Reviewer,Integrated Services (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WiSMART code:7633 jerry.swim @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm r Mound System Cover Page Pg 1 of 8 _ MIESER �D�AETE Project Name: Staats-mound Owner's Name Jim Staats Owners Address 1386 300th St Glenwood ity C ,Wl 54013 Legal Description s A I NE 1 v %+ Sec F2--8-1 T r 3O N R 1--5 Township Glenwood r— County Saint Croix 0lTioNq Subdivision LAY, � V�D Lot# �Nq�ET YANG Parcel ID# VQUSTRESV/CFS �RV1eEs Table of Contents pg- Z 1 Cover page ONDEN�E 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map 7 Effluent Filter -' 8 Pump Curve total#of pages: 8 Designer Name: Michael J. Myers MP/License#: 267985 Date: 9/25/2014 Ph.#: 715t-Z65-4115,, Signature: Mound System Design Methods Used per"Mound Component Manual For Private Onsite Wastewater Treatment Systems"(Version 2.0)SBD-10691-P(N.01101) per"Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems"(Version 2.0)SBD-10706-P(N 01/01) Spreadsheet provided by. 313Advisement N12486 220th St,Boyceville,WI 54725 Ph:715-643-6068 email:3ba@3badvisementcom Mound System Page 2 of e Mound Sizing Calculations Project Name: Staats-mound Site Conditions Design of Entire Fill Project Type: i i or 2 Family Dwelling Cell depth at upslope edge(D): 18.0 in. %Slope: 7% Cell depth at downslope edge(E): 23.1 in. #of Bedrooms: 4 Distribution cell depth (F): 9.5 in. Depth to limiting factor: 18 in. Cover thickness over edge(G): 6 in. Absorbtion rate of fill material: 1 gal/ft2/day Cover thickness over center(H): 12 in. Absorbtion rate of in-situ soil: 0.6 gal/ft2/day End slope width (K): 10.6 ft. Effluent quality Eff#1—J. Fill length(L): 121.2 ft. Max BOD effluent value: 220 mg/I Upslope width (J): 7.0 ft. Max TSS effluent value: 150 mg/I Downslope width (Toe) (1): 12.3 ft. Fill Width (W): 25.3 ft. Design of the Distribution Cell Basal Area System Design Flow: 600.0 gal/day Basal area required: 1000 ft2 Distribution cell width(A): 6.00 ft Basal area available: 1830 if Distribution cell length(B): 100.0 ft Area of Distribution Cell: 600.0 fe Observation Pipes Contour Elevation of Mound: -96-00 ft`14,:76 Location from end of cell(Z): 16.67 ft System Elevation of Mound: 4'A-W ft I 43.-2-G , Final Grade of Mound: 4gg-28 ft t Oo.05 Mound Plan View Observation Pipes }� W Distribution Cell AA T B I—K I Tilled AreaJFill Material L Mound Cross Section Final Grade Observa i n Pipe Synthetic Fabric Distribution Cell System Elevation s ¢A" F i Lateral 3 Cover Material Irtve ft Fill Material ~Tilled Axen Slope �–Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with SPS 384.30(6)(1) Synthetic Fabric covering on cell per SPS 384.30(6)(g) Distribution Cell to have minimum 6"aggregate below lateral and 2"above. Mound System Pa"3of 6 Pressure Distribution Calculations Project Name: Staats-mound Lateral Layout Lateral/Manifold Design Lateral elevation: `98kft g$,Z6� Lateral diameter. 111/2 '�' In. Rows of Laterals: i? _1w Lateral spacing(S): ft Manifold type: ;Center Lateral to cell edge: 1.5 ft Orifice diameter: i o.156 i In. Lateral discharge rate: 10.74 gpm #of Laterals: 4 System discharge rate: 42.94 gpm Distal Pressure: 3.5 ft Manifold diameter-, 12 !• In. Lateral Length: 49,5 ft Manifold length: 3 ft Orifice Spacing/Distribution Forcemain Friction Loss Orifice spacing(X): 30.46 Inches Forcemain length: 80 ft Orifices per lateral: 20 Forcemain dia I In. Avg. fe/Orifice: 7.50 fe Friction loss in forcemain: 3.011 ft Lateral Side View Manifold Lateral � Lateral x x x x x x x x x x x x 2 � Lateral Length Lateral Length Lateral Plan View Lateral Length Turn-up w/ball valve or cleanout plug o a S CO) o Orifices on bottom a of d PVC laterals.and forcemm to comply with lateral equa�y space specifications perSPS 384.30(2Xe) Forcemain connection via tee or cross to manifold at any point Clean Out Detail Observation Pipes Clean-out plug Final Grade /-or bell valve �Nater tight cap or plug Lawn Sprinkler Box lot Note:CkYW Collar be Long Sweep 90 6"Minimu a 3M'ba Olace or two 45's 3/8"Bar Lateral Mound System P�"°` Septic, Pump and Dose Tank Project: Staats-mound Tank Information Dosage Volume Pump tank manufacturer: _Wieser Concrete Forcemain drains back to tank? Q Yes O No Pump tank size/model �W12gO/8�MR ! Lateral void volume: 20.9 gal Pump tank gal/inch: 20.6 Dosage to absorbtion Cell: 104.6 gal Actual Pump Tank Volume: 783 gal Forcemain volume: 13.9 gal Tank bottom elevation(inside): 92 ft Total dosage: 118.6 gal Septic tank size/model: W1280/800-MR Pump and Filter Total Dynamic Head Pump Manufacturer: Goulds Are laterals highest point? FAft Pump Model: PE51 P1 if not, enter highest elevation: Effluent Filter: Polylock 525 System head(distal x 1.3) 4.55 ft Vertical Lift("D"to lateral) 6,1 t-3s ft Note.Access opening of sufficient size to be provided to allow Friction loss in forcemain: 3.01 ft removal of fitter opening to terminate at or above grade. pressure loss from filter: =:�ft Total dynamic head(TDH): 13,4,V Q-w ft Pump Tank Diagram Dose Tank Levels In. Gal Watertight Locking Cover 4 Inch ��Warning Label mished A Reserve 22.3 458.4 Minimum Grade g pump off to Alarm 2.0 41.2 Attemate C Total Dosage 5.8 118.6 outlet D Effluent depth for pump 8.0 164.8 Location Elect.per Comm 1 6.28 and Total Capacity: 38.0 783.0 r � NEC 300 Weep Hole �' or Anti B Siphon Device G D Orr �2•(olv Pump must be capable of: 42.9 GPM and head pressure Of 12.9 Feet • •. ' � :tDULDS PUMPS Submersible Effluent Pump it PE Mutuffwmp SPECIFICATIONS MOTOR FEATURES Pump—General: General: ■Corrosion resistant • Discharge: 1'/t"NPT • Single phase construction. • Temperature: 1040F(4000 • 60 Hertz ■Cast iron body. maximum,continuous when • 115 and 230 volts ■Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover. • Solids handling:'12" tection with automatic reset. ■Upper sleeve and lower maximum sphere. • Class 8 insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■Motor is permanently Specially designed for the • Manual models available. shaft. lubricated for extended P Y 9 service life. following uses: • Pumping range:see PE31 Motor. a Powered for continuous • Mound Systems performance chart or curve. • .33 HP, 3000 RPM operation. • EffluenVDosing Systems PE31 Pump: • 115 volts ■All ratings are within the glimits of the motor. • Basement Draining • Maximum head:25:TDH PE41 Motor: ■quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM cord,20`standard length, Dewatenng • Maximum capacity:61 GPM • 115 and 230 volts heavy duty 16/3 S1TW with • Maximum head:29'TDH • PSC design 15 or 230 volt grounding PE51 Pump: PE51 Motor: plug. • Maximum capacity:70 GPM • .50 HP, 3400 RPM ■Complete unit is heavy duty, • Maximum head:37'TDH • 115 and 230 volts portable and compact. • PSC design ■Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless 40 - -- PES 'MODELS:PE31,PE41,PE51; steel. HP 33, 40, 50 ■Stainless steel fasteners. 35 ---- -� --- - 1 0 2 GPM( AGENCY LISTINGS 30 1 FT -- ---- i w - - --- z 25 , u C Teste us - - d to 01778 and Zo CSA 22.2108 Standards c� By Association Canadian Standards Assod ' File#LR38549 ~ AM— j + Goulds Pumps is ISO 9001 Registered. 10 5 — ._ . i ---- -• 0 0 0 10 20 30 40 50 60 70 GPM 80 0 5 1L- 15 m3/h Goulds Pumps CAPACITY ®2004 ITT WaterTechnofogy,tnc. ITT Industries Effective June,2004 BPE31/41 <& 'Y/L go � NN c AC v � � v �d � r V IL v 40 r m vi — Me o x W " pQ tb LL i m y- W AA W .A 1 � � 1 A FAQ W oN r4 1r i ry OLD l 1 d .j I MAINTENANCE INSTRUCTIONS I i J Map 1: Stop 2 SSimP 3: -acate"outlet of the septic tank. (A)Remove tank cover and pump (A)Insert the filter cartridge hack ff necessary. Into the the housing making sure • • • the filter is properly alighed (By Pug the freer art of the housing. and completely inserted. (Cj w off the fiAerover the septic tank. 8 Replace RU13SEROLOVES Make sure al solids fag hack irto the O� egic tank cover WHEN CLEANING FILTER,,` septic tank. P�7►L` ' ', INSTALLATION INSTRUCTIONS PL-525/PL-625 FILTER PL-525/PL-625 FEATURES & BENEFITS f 4 Features & Benefits: e Rated for 10,000 GPD •PL-525=525 Linear Feet of 1/18"Filtration PL-625=625 Linear Feet of 1/32"Filtration PL-525 PL-625 •Accepts 4"and 6"SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently •Built in Gas Deflector for several years under normal conditions before ,Automatic Shut-Off Bag when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every •Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the .Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. I Property Owner Jim Staats Parcel ID# Page 2 of 3] Boring# E] Boring ❑ Pit Ground surface elev. 96.34 ft. Depth to limiting factor 20 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#i *Eff#2 1 0-8 10YR3/2 sil 3sbk mvfr Cs 2f .6 .8 2 8-12 10YR5/4 sil 3sbk mvfr Cs if .6 .8 3 12-20 10YR5/6 grs Osg mfi Cs if .7 1.6 4 20-33 10YR5/6 7.5YRf2d spots grs Osg mfi gs .7 1.6 5 33-42 10YR6/8 sc Om mvfi Cs 0.0 0.0 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 11 GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#f *Eff#2 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/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *Etf#2 *Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<_30 mg/L The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SM-8330Tea(ft.11/11) Na#da d Plumbing im. RECEIVED -,x' rwr SOIL EVALUATION REPO #s2 RT d 2,014 �' _ Page 1 of 3 Departme` j Saiefy and Professional Services Divislgrroiflftil95 Northland Plumbing,Inc. ccordance with Comm 85,Wis.Adm.Code County 10MMUNITY DEVELOPMEN'ta ri Attach complete site plan on paper not less than 8/s x 11 inches in size. Plan must St.Croix 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. Gr4, /p ^ 60d Please print all information. Revie d By Dat Personal inforrnabon you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /6 //o / Property Owner Property Location Jim Staats Govt.Lot SE1/4 E1/4,S28,T30N, R15W Property Owner's Mailing Address Lot# Block# Subd.Na or CS 1386 300th St State Zip Code Phone Number �I City �__j Village �� Town Nearest Road City 300Th St Glenwood City WI 54013 Glenwood Use: " Residential Number of bedrooms 4 Code derived design flow rate 600 GPD New Construction _� Residenal Replacement i -J Public or commercial-Describe: Parent material glacial till — Flood plain elevation,if applicable ft General comments l D p and recommendations: Boring Fil B oring# -' Pit Ground surface elev. 98.50 ft. Depth to limiting factor 18 in. Soil Application Rate Structure Consisten Boundary Roots GPD/ftz Horizon Depth L Dominant Color u.Sz Description Texture *Eff#1 *Eff#2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Sill mvfr cs 2f 6 8 1 0-8 10YR3/2 2 8-15 10YR5/4 sil 3sbk mvfr cs if .6 .8 3 15-18 10YR6/8 fs Osg m) cs 5 1.0 4 18-34 10YR6/8 7.5YR5/8f2d fs Osg ml gs 5 1.0 5 34-42 10YR8/1 SC Om mvfi cs 0.0 0.0 Boring# - Boring El pit Ground surface elev. 95.39 ft. Depth to limiting factor 20 in. Soil Application Rate Structure Consisten Boundary Roots GPD/fe Horizon Depth Dominant Color Redox Description Texture *Eff#1 *Eff#2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 1 0-8 10YR3/2 sil 3sbk mvfr cs 2f .6 •8 2 8-12 10YR5/4 sil 3sbk mvfr a if 6 8 3 12-20 10YR6/8 fs Osg ml cs 5 1.0 4 20-27 10YR6/8 7.5YR5/81 2dspots fs Osg ml gs 5 1.0 5 27-43 10YR7/2 fS 0s9 ml 6 43-50 10YR6/8 SC Om MAI cs 0.0 0.0 Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<_30 mg/L and TSS<_30 mg/L CST Number CST Name(Please Print) ignatur 267985 Michael J.Myers Date Evaluation Conducted Telephone Number Address Northland Plumbing,Inc. 9/19/2014 715-265-4115 2943 130th Ave Glenwood City,W154013 $BO 330(R.ltnp Property Owner Jim Staats Parcel ID# Page 2 of 3 F ❑ Boring 3 ] Boring# ® Pit Ground surface elev. 96.34 ft. Depth to limiting factor 20 in. Soil Application Rate Horizon Depth Dominant Color TRedox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 1 0-8 10YR3/2 A 3sbk mvfr cs 2f .6 .8 2 8-12 10YR5/4 sil 3sbk mvfr cs if .6 .8 3 12-20 10YR5/6 grs Osg mfi cs if .7 1.6 4 20-33 10YR5/6 7.5YRf2d spots grs Osg mfi gs .7 1.6 5 33-42 10YR6/8 sc Om mvfi cs 0.0 0.0 F-I ❑ 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 GPDtW in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 ❑ 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/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 `Eff#2 Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L "Effluent#2=BODS<30 mg/L and TSS<_30 mgA- The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TrY through Relay. SM-8330Tea(Rl1/11) Northland Plumbing,Inc r j I A �p I r � Q f / � l 0�0 I th � l I VA Mr i � �� V1 N G' W t.• -c r7) 2 (A r IA \.v oQ f CAI vi � Z fi 3�7� VV/ LV1v 1V.1" 1'1]lL I1V4VV"t16V 1'IVIXL"1 I11.L AA VULL 11,V .tu VVV Oct. 9. 2014 11 : 55AM No. 1003 P. 2 START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that may impede the treatment procegs and/or damage the dispersal cell(s). If high coneenlrations are detected have the contents of the tanks)removed by o septage servicing operator prior to use. System start up shell not occur when soil corKlitions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the eXceso wastewater will be discharged to the dispersal call(s)In one large dose,overloading the cell(s)and may resat In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septaae Servicing Operator prior to restoring power to (he effluent pump or contact a Plumber or POWTS Malhtalnor to aeslst In manually operating the pump controls to restore normal levels Within the pump tank. ' Do not drive or park vehicles over tanks and dispersal calla. Do not drive or park over,or otherwise disturb or compact,the area within 16 feet down elope 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 POWT3; antiblotles; baby wipes; cigarette butts; condoms; coilan swabs; degreasers; dental floss; diapers; disinfectants; kt; foundation drain (sump pump) water, frult gild vegetable peelings; gasoline; grease; 'herbidides; metal scrape; medications; oil; painting products{; pesticides;sanitary napkins;tainpons;and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the tbltowlnS steps shall be taken to Insure that the system is properly and safely abandoned In compliance with chapter SPS 383"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. • Mier pumping, all tanks and pits shall be excavated and removed or their covers removed and the Vold space filled with soil, gravel or another Inert sokd material" CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement"tam: 9-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. 0 A suitable replacement area is not available due to setback and/or soil Ilmltal(ons. Barring advances In POWTS technology a holding tank me y be Installed as a loot resort to replace the Palled POWTS. 13 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 vulteblo replacement area. If no replacement area Is available a holding lank may be Installed as Q test resort to replace the failed POWTS. ❑ Mound and 4t-grade sell absorption eyslems may be reconstructed In place following removal of the blomal at the Infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that lima. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSE8 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 POWTB INSTALLER POWTS MAINTAINER Name J. .erg Name Phone '7(rj 2 6 5 5 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name S+, C I^e l aC 00 u 1t Arria Phone Phone -715- ?845 76,Ve) This document was drafted In wVjancs with chapter 43158 383.22(2)(b)(1)(d)81(1)and 583.54(1).(2)a(3),Wisconsin Administrative Code.Revised=9/13 Zvi - _V -- .- IIV LVV`i1LV iVVl\111L311\L LLVifiLll\V Ltw VVA. Oct. 9, 201411 :55AM No. 1003 P. 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner /;Il S7ZR 4t-7XS $eplic Tank Capacity /2 o r✓ al ❑NA Permit?/ Z�G 50 3 2 Sepik:Tank Manufacturer (.CJt C'SE2 D NA. DESIQN'PARAMETERS Effluent Filter Manufacturer 1,Y4jc1C 13 NA Number of Bedrooms O NA Effluent Filter Model 52,5 CI NA Number of Public Facility Units .0"NA Pump Tank Capacity g Q C) al 13 NA Estimated flow(average) soda Pump Tank Manufacturer WIC�C , ❑NA Design now(peak),(Estimated x 1.5) gat/day Pump Manuf®cturor ❑NA Boll Application(isle sial/dooll Pump Modal 7>&s7t p/ ❑NA Standard Influent/Effluent Quality Monthly everage• Pretreatment Unit Q NA Fats,ON&Grease (FOG) s30 mg/L I7 $and/Gravel fritter 0 Peat Filter Biochemical Oxygen Demand (BODE &220 mg/L 12- IA ❑Mechanical Aeration Cj Weiland Total Suspended Solids (TSS) 51130 mg/L ❑glsinfection ❑Other. Pretreated Effluent Quality Monthly average Dispersal Call(a) O NA Biochemical Oxygen Demand (BODa) 530 mg/L ❑ In-Ground(gravity) O In-Ground(pressurized) Total Suspended Solids (TSS) 530 mg& )2I`NA D At-Grade A' Mound Fecal Collforni(geometric mean) aW nfu/100m1 D Drip-Line Q Other ,Maximum Effluent Particle Size 36 In'dla. ONA OdL°` ❑NA Other: DNA Other. ❑ '1/aluea typical for domestic wastewater and septic tank effluent. Other: Q NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 monrta s (Mbaclmurn 3 yamm) Cl NA Pump out contents of tank(s) When combined sludge end scum equals one-third(4)of tank volume ❑NA Inspect dispersal call(s) At lees(onos Avery: ❑month(&) (Maximum Maxi S ears) ❑NA Ayear(s) y Clean affluent filter At least once every: 0 monrts(e) 13 NA Inspect pump,pump controls&alarm At least once every: `j moMs(s) 13 NA e Flush laterals and pressure teat Al[anal once every: 3 f l4Q ar s ar(sja) ❑NA Other. Q month(e Al least once every: O ar s � ❑NA Other. Q NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal coils shall be mada by an individual carrying ono of tho following Itccm*cs or ccrtificartionr Meatcr Plumber;Master Plumber Restricted Sewer;POWTS Inspector;POWTS Maintalner, Septage Servicing Operator. Tank Inspeollons must include to visual Inapectlon of the tank(s)to Identify any missing or broken hardware.Identify any oraoks or leeks, measure the volume of combined aludge and scum and to check for.any back up or ponding of affluent on the ground surface. The dispersal cells) shall be visually Inspeotad to check Me effluent levels In the observation pipes and to check for any ponding of efflulant on the ground aunace- The ponding of effluent on the 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(%)or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed 'of ►n acoordarco with chapter NR 113. Wisconsin Administrative Code. All other services,Including but ndt limited to the senrtcing of effluent filters,mechanical or pressurized components,pretreatment units, Land any servicing at Intervals of s12 months,shall be performed by a certified POWTS Malntalner. A service report shall be provided fo the local regulatory authority within 10 days of complstion of any service event --. __-,- ----- -.W �..�....���.. ....�.-�._....,.. c� .... Oct, 9. 2014 11 ;55AM No. 1003 P. 2 Pape of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting.products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). It high concentrations are detected have the contents of the iank(9)removed by a seplap servicing operator prior to use. System start up shall not occur when eofl conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal hiahwater levels. When power is restored the eXoess Wastewater will be discharged to the dispersal eall(a)In one large does,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 W a 3eptase Servicing Operator prior to rastorin8 power to the e[tluent pump or contact a PIUmber or POWTS Malhtalnor to assist In manually operating the pump controls to restore normal levels within the pump tank. Do hot drive or park vehicles over tanks and dispersal calla. Do not drive or park over,or other iviss disturb or compact,the area within 16 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, antiblotice; baby wipes; cigarette bulls; condoms; cotton swabs; degreasers; dental floss; dmpers; disinfectants; * f6uridation drain (sump pump) water, fruR and vegetable peelings; gasoline; grease; 'herblaldea; meal scrape; medications; oil; painting produetlr, pesticides;sanitary napkins;tainpons;and water&oftener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the fdhovAQ steps shall be taken to Insure that the system Is property and safely abandoned in compliance with chapter SPS 383.33,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 6eptage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the vold space Oiled with soil, gravel or another Inert sold material_ CONTINGENCY PLAN If the POWTS felts and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system; --A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should ba protected from disturbanco and compaction and should not be Infringed upon by required setbacks from existing and proposed structure,lot Ilnse and welts. 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 mast comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a hatding tank may be Installed es a last resort to replace the failed POWTS, 13 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soli and site evaluation must be performed tv locate a puilable replacement area. If no replacement area Is available a holding tank may be Installed as a last resort to replace the failed POWTS. 1:1 Mound and of-grade soil absorption systems may be reconstructed In place following removal of the blomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that lime. t-cWARNING» SEPTIC, PUMP AND OTHE=R TREATMENT TANKS MAY CONTAIN LETHAL GAS$E$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 ATANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name J, erg Name Phone (5 2(a eJ / (S Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name S+. ( i^e t k a nr 4rrip Phone Phone -71 :5- 3 845- 76 f e) This document was dratted In o"Joince with chapter&S 383.22(2)(b)(1)(d)8.(0 sod 383.64(l),(2)&(3),Wisconsin Admintsirative Code.Revised 31'29113 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning&Zoning Department for new construction.) City/State Slp.,zAh o� Of all Parcel Identification Number Oxy - LEGAL DESCRIPTION Property Location SLR '/4 , 4- '/4 , Sec. L8 T 3o N R (5W, Town of G r-MLv Subdivision Plat: , Lot# Certified Survey Map # , Volume , Page# Warranty Deed # l©D 2 (before 2007)Volume Page# Spec house yes ►o Lot tines identifiable < es) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber, restricted plumber or a licensed pumper verifying that(I)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 13 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this rm 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 wan' qty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) lII iI ! i (l! II II IIII�I�IIfI�I�IIIIIIIIIIIIIIt 8261439 State Bar of Wisconsin Form 11-2003 Tx:4213683 LAND CONTRACT 1002624 (TO BE USED FOR NON-CONSUMER ACT TRANSACTIONS) BETH PABST REGISTER OF DEEDS Document Number Document Name ST:CROIX CO., WI 10/08/2014 11:36 AM CONTRACT,by and between Daniel M.Monson and Marilyn M.Monson,husband EXEMPT#: NA and wife and Priscilla M.Robinson,tka Priscilla M.Monson REC FEE: 30..00 ("Vendor,"whether one or more),and James Staats and Lydia Staats,husband TRANS FEE: 450.00 PAGES: 4 and wife ("Purchaser,"whether one or more). Vendor sells and agrees to convey to Purchaser,upon the prompt and full performance of this Contract by Purchaser,the following real estate,together with the rents,profits,fixtures and other appurtenant interests("Property"),in Recording Area ,r A.M St.Croix County., State of Wisconsin: Name and Address "t Thomas A A.McCormack Northeast Half of Northeast Quarter(NE 1/4 of NE 1/4)of Section 102010th Ave.,PO Box 2120 Twenty-eight(28),Township Thirty(3 North, K an Fifteen (15) Baldwin,WI 54002 West,.St. Croix County,Wisconsin. RESERVING AN EASEMENT for access to and from the 0ts•10ss-10.o00 Southeast Quarter of Northeast Quarter(SE 1/4 of NE 1/4)of said Parcel Identification Number(PIN) Section,over and across the east 66 feet of said Property. This is not homestead property. (is)(is not). This is a purchase money mortgage. (is)(is not) Purchaser agrees to purchase the Property and to pay to Vendor at 510 Rosenlund,Woodville,WI 54028 or a place designated by Vendor the sum of$ 150,000.00 in the following manner: (a) $5,000.00 at the execution of this Contract;and (b) the balance of$ 145,000.00 ,together with interest from the date hereof on the balance outstanding from time to time at the rate of 1 %per annum until paid in full as follows: Monthly payments of$350.00 per month commencing November 1,2014 and on the first day of each month thereafter. Purchasers shall pay an additional$20,000.00 toward principal within 30.days of the closing of the sale of Purchaser's residence in Auburndale,Wisconsin,after which monthly payments shall be$800.00 per month. provided the entire outstanding balance shall be paid in full on or before three years from date hereof ("Maturity Date").Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. CHOOSE ONE OF THE FOLLOWING OPTIONS•IF NO OPTION IS CHOSEN OPTION A SHALL APPLY: A. Any amount may be prepaid without premium or fee upon principal at any time. B. Any amount may be prepaid without premium or.fee fee upon principal at any time after . l i C. There may be no prepayment of principal without written permission of Vendor. . State Bar Form I t-Page 1 . St.Croix County 1002624 Page 1 of 4