HomeMy WebLinkAbout231-1047-70-030 /* CPL; c{�
W ' " Depa of C:wnrnerce PRIVATE SEWAGE SYSTEM C ount y :
Satety and Buildings Division INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.:
Personal information you provice may be used for secondary purposes (Privacy law s.15.04 (txm)). 384271
Permit Holder Name: ❑ City ❑ Vi lagl ❑ Town of: St Pan ID No.:
N ssen, Jason City of Glenwood "fe 2 r = M-r,.
CST BM Elev.: r l insp.BMElev.: j BMDeScrijt'on:,, P e Tax No.:
ap .4 c.. ; .,. 231- 1047 -70 -030
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� _ IZSo Benchmark 1e4 - (TOrp�
Dosing um c ` t. BM 0T en - 11 /
Aeration Bldg. Sewer /'} q7,
Holding St / Ht Inlet ,� qs, os. r
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Airi t nta o ke ROAD Dt Inlet
Air i nt a ke
Septic > }� r O ( NA Dt Bottom J , ZS' c j0. 30 ,
Dosing y }� ( `� x- NA EHead er / an . . /
Aeration NA Pipe S, ?I. 9 I
• 2
Holding Bot. System
r ( .
PUMP / IPHON INFORMATION Final Grade
Manufacturers Demand t Cover
Model Number GPM
TDH Liftcil,ZL Friction ( Syste •� TDH jy.S3Ft r k�;� �•`l "1
/ Forcemain Length I Dia. Fi K Dist. To Well �(
SOIL ABSORPTION SYSTEM
Width- I Le h I No. f PI IM IO N No. Pits Inside Dia. liquid Depth
b(M ENSION S
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM
LEAPNI G Fui r:
INFORMATION Type n / — CH a Number:
System: y k&A lC $� �
DISTRIBUTION SYSTEM kA fel"'L i t 9, $ 1 (,. 8 & — 4
Header/Manifold 4 Distribution PPipe(s) 1 II tl x H� Size x Hole pacing Vent To Air Intake
length c Dia. 2 Lengths 3.3 Dia. �� - Spacing qz > Z
SOIL COVER 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 Bed /Trench Edges Topsoil Yes ❑ No Yes C] No
COMMENTS: (Include code discrepancies, persons present, im i jection #1: 08 1, 2 01 6 / Inspection #2:
Location: 160 Surrey Trail, Glenwood City, WI 54013 (SE 1/4 SW 1/4 27 T30N R15W) - 273015754G -Lot
7
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover =
3.) contour = J. ?tf
Plan revision required? ❑ Yes AaNn. o I
Use other side for additional infor lobh
S80 -6710 (R.3/97)
Date Inspector's Signature ert Nq�
Smarr 'T�a Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21 Wis. Adm. Code 201 W. Washington Ave.
4 PO Box 7302
Se reverse side for instructions for completing this application
Per nal information you provide may be used for secondary purposes Madison, WI 53707 -7302
`�SCOnS�
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County State ermi Number ❑Check if revision to previous application State PI I. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
/' sm S e � 1/4 S;(V114,S L30 ,N, R iW) W
Property Owner's Mailing Address Lot Number Block Number
M i 7
k ity, fate Zip Code Phone Number ubdiv' ion Name or CSM umber
r . I P S-30ioz�-
II. Type of Building: (check one) ity
J 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village
❑ Public /Commercial (describe use):_ ;' ,�- '' 13 Town of
❑ State -Owned ,�� l ' & O
Nearest Road
r ��n �. d 7`��
0 k $(v CJ� t'J[ 1 c; ra S`f D a = `f Z (17 Parcel Tqx Nprrr r s
d
I1 . Type of Permit: (Check only one box on 1 g,A°:: Check �b ` line B if ` plicable) , 30 7 5q
A) 1. q New 2. ❑ Replacement 3. feplaceffent of 4.' 5. 6. ❑ Addition to
System System Only .' "� Existing System
B)etiit N Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground k Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Q Elevation
CO ( e9 0 Ej � .2 � / i 1.2 /D v r
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
' Tanks Tanks
❑ ❑ ❑ ❑
1 4 , leseR Q Zle, e
P am /
VIII. Responsibility Statement
I, the u ndersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no stamps): MP,4 Xo. Business Phone Number
Plumber's Address (Street, City, State, Zip Code) ,c-
3 Z2 .1 R 11tv Y /�® (r ,/ e ev zt., , 0rs 0 /
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss ng Agent Sign re (No stamps)
IR Approved ❑ Owner Given Initial Adverse Surcharge ee)
Determination 200
X. � I Conditions of Approvall /Reasons for Disap roval: r �
Nxk� > dk&4& Irv�tt i +�' n,� 5� Td*aC 1' I s e/ S
SBD -6398 (R. 07/00)
1—
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_— _ p N o Y Aw
es - - - - - -- -- -
Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
C \,. BIZ TDD #: (608) 264 -8777
N tisconsin www•commercestate.wi.us /sb
-; `'�y r www.wisconsin.gov
Department of Commerce
y C�lFlG Scott McCallum, Governor
Brenda J. Blanchard, Secretary
June 11, 2001
CUST ID No.222234 ATTN: POWTS Inspector
ZONING OFFICE
GALE W SMITH -1%T,.GR6IX COUNTY SPIA �
3228 HWY 170 1101 CARMICHAEL RD
GLENWOOD CITY WI 54013 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/11/2003 Identif bers
Transaction ID Noo. .
SITE: Site ID No. 630346
JASON NILSSEN Please refer to both identification numbers,
SURREY RIDGE TRAIL above, in all correspondence with the agency.
CITY OF GLENWOOD CITY
ST CROIX COUNTY
SEIA, SW1 /4, S27, T30N, R15W
FOR: NEW MOUND, 600 GPD
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 794200
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 Conditions:
• 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 Wastewater Systems" SBD- 10691 -P
( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD- 10706 -P (N.01 101).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of
the mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The maintenance plan for this system must be given to the owner of the POWTS.
Site Specific Conditions:
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area.
GALE W SMITH Page 2 6/11/01
• Maintain well and waterline set backs per COMM 83.43(8)(i).
• Holes must be drilled with sharp bit and all burrs and foreign matter removed before installation.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
PATRICIA L SHANDORF
POWTS PLAN REVIEWER, INTE RATED SERVICES WiSMART code: 7633
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE. STATE. WI.US
cc: JASON NILSSEN
I
Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
�sconsin www.w
www•commerce.s s i n.gov
isconin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
June 11, 2001
CUST ID No.222234 A7TN: POWTS Inspector
ZONING OFFICE
GALE W SMITH ST CROIX COUNTY SPIA
3228 HWY 170 1101 CARMICHAEL RD
GLENWOOD CITY WI 54013 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/11/2003 Identification Numbers
Transaction ID No. 648258
SITE: Site ID No. 630346
JASON NILSSEN Please refer to both identification numbers,
SURREY RIDGE TRAIL above, in all correspondence with the agency.
CITY OF GLENWOOD CITY
ST CROIX COUNTY
SETA, SW1 /4, S27, T30N, R15W
FOR: NEW MOUND, 600 GPD
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 794200
P.O.W.
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Co n di tiO
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. PRC
The following conditions shall be met during construction or installation and prior to occupancy or use: TMENT O
OF S
General Approval Conditions:
• 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 Wastewater Systems" SBD- 91 -P SEE CORFtES
( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD- 10706 -P (N.01 101).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of
the mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The maintenance plan for this system must be given to the owner of the POWTS.
Site Specific Conditions:
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area.
GALE W SMITH Page 2 6/11/01
• Maintain well and waterline set backs per COMM 83.43(8)(1).
• Holes must be drilled with sharp bit and all burrs and foreign matter removed before installation.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
TRICIA L S FIDORF
POWTS PLAN REVIEWER, INTEGRATED SERVICES WiSMART code: 7633
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE. STATE. WI.US
cc: JASON NILSSEN
MOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project "M NO O G//`/G� .S y S�e/yl
Owner
. d,3 - 0 / N /Z f e'- A/
Address ;Z2= DA?
Legal Description ,S� S'L*J, ,$� ;?-:2 Ji",� or /Vz �z 1— /cJ
Town G /env i.Jood 6 7�y County
0" eAlw"0C/ Mehc/o -'5
Subdivision Name p 5 y; 6 g o /X C p , Lot No.
Parcel ID Number , /OG�/ 2 20-0, ; 2 e,> ytall
y
Plan Transaction Number VE
Index and title sheet Page 1"'
Mound calculations Page 2
Mound drawings Page 3
Pres. dist, calcs. and laterals Page 4
TDH and pump tank drawing Page 5
Pump curve , Page 6
Site plan Page 7
Soil test (a,b,& c of page 8) Page 8
M.4 NA g MeAif Pl.9�v
Designer ,> V, / f/7 License Number ;2
Signature Phone No.
Date — :�7 /
Notice: Tampering with this file by unauthorized persons Is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Pa9e &Of 9
Straw, Morsh Hoy, Or
: Synthetic Covering
Distribution Pipe
Medium Sand :-w--
�~ G
Topsoll F
3 I --
b
% Slope
Force Moir, I'iu.,cd
Bed Of '-2'-2 z
Aggregate Frorn IIump E aycr
D
Ea
Cross SEC 1 iGn Of 'k t'our Sy stern Using
A Bed t or f he !,t sorption Art. c
H ,D trt. H
STgnccd: V'0 Fr—
Li�cnse IIu1.t,cr: 1 t.
s rt
[iatt�:
K Ft.
paS�rrafivn Pipe
A �'� �f orcc tAoiri
From Pump
E3 e d Of F
� — Distribution
Pipe Aggregate
I
Observotion Pipe Permanent Markers
1
pi View Of Mound Using A Bod For The Absorption A(CO
r
Page - y Of
Perforated Pipe Detail
End View
peA
F At &d
P V C We,
a boo
Side of cell
0�
St
R
Force -Lain PVC
inspection box
1\ ,
Holes located on bottom of force
main are equally spaced
Last hole should be
next to typical long sweep
ell with valve or cap
D.Istributation pipe layout Q
qq
q ����
Invert Elevation of Laterals L L4 ,, � Ft RILInches
S�Inches
X 1/DInches
S igned s i
Y Inches
Liae nse
Hole Diameter - 322L nches
Dates
Lateral " L, Linches
Manifold Inches
141 GPivi Discharge rate per lateral Force Nain " Inches
# of holes pipe a 6
# of laterals — 12—
Page
COMBINATION SEPTIC TANK /PUMP CHAMBE
(No Scale) 4" Cl Vent Pipe with
Ap Locking Manhole Cover Approved Cap, +25'
pp g
With Warning Label Attached From Buildings
Weatherproof Approved _
Junction Box Vent Cap - -�
12" Minimum
Final Grade 6 Minimum 4" Minimum
Quick
18" Minimum Disconnect
--
i
1/4" Weep
' Hole
Baffle:.
:)LfeR
Al arm B
On 6�
C
*A
7�7 PPROVED Off Q� e �, - 6 a ,
JOINTS WITH 'F4
APPROVED PIPE D
3' ONTO Conc. Block '
SOLID SOIL
3" of Beddinq Under Tank -
Note: Pump and Alarm Are On Separate Circuits Number of Doses: ,�J� Per Day '
Gallons Per Day /f fio - Doses : /_ Gallons '
Volume of Backflow: ....... +
Tank Manufacturer: I / e S e Total Dose Volume: ........ = /, L Gallons
Tank Size - Septic /Pump: la-6 - -J G allons
Alarm Manufacturer: 5Sjr L Led l o
Model Number: /a / /Y all Capacities: o Gallons
Switch Type: M -e-g C k '1? Y + 'B inches or 3 ;?- Gallons
Pump Manufacturer: GO y L d S + C 9.•3' inches or Gallons
Model Number: o + D,4/, inches or Gallons
Minimum Discharge ate: GPR Total .....= _inches or 2y,,I-_ Gal Ions
Vertical Difference Between Pump Off and Distribution Pipe: p Feet
Minimum Required Supply Pressure: .......................... eet
c> Feet of Force Main x Friction Factor /100 Feet: + ,S2 eet
,Z - Inch Diameter Force Main
Total Dynamic Head: ... 102
/ Feet
Internal Tank Dimensions: Length Width �; Liquid Depth / 6,1�2
4 L PeR /lv.
Signature License Number Date
12 DUSYRIAL RD. Goulds /°��
ON, WI 54016 Submersible
Effluent Pump
�~ MODEL C
3871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Full submerged in high Y g g ■ Motor Housing: Cast iron
Specifically designed for the stainless steel, grade turbine oil for for efficient heal transfer,
following uses: • Capable of running lubrication and efficient strength, and durability,
• Effluent systems dry without damage to heal transfer. ■Motor Cover: Thermoplas
• Homes component.,, tic coder with integral handle
• Farms Motor: Available for automatic and and fiver switch attachment
• Heavy duty sump • EPO4 Single phase: 0.4 HP. manual operation. Automatic points.
• Waler transfer 115 or 230 V, 60 HZ, 1550 models Include Mechanical
• Dewalermg RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duly
automatic reset. preset at the factory. rated oil and water resistant
SPECIFICATIONS • EP05 Single phase: 0.5 HP. ■ Bearings: Upper and lower
1 15V, 60 Ili, 1550 RPM, FEATURES heavy duty ball bearing
Pump EPO4 tuilt in overload with ■ EPO4Impeller; Thermo Cons!ruclion.
• Solids handling capabi automatic reset.
' /4' maximum. • Power cord: 10 foot plastic Semi -open design . AGENCY LISTING
• Capacities up to 53 GPM slandard Icngth, 16/3 SJTO with pump out vanes for
• Total heads up to 24 feel JIh three prong grounding mechanical seal protection. SP Canadian Slandards llssociaiion
• sire 1 Discharge NP lu . Opt ■ EP05 Impeller: Th ermo-
i C g pt onal 20 foot
p
• Mechanical seal carbon- lmglh, 16/3 SJTW with plastic enclosed design for CSA listed model numbers
rolary /ceramic- sl,il,on,iry three prong grounding plug improved performance, end ln' F" or "AC ".)
BUNA-N elaslomers (slandard on LP05) ■ Casing and Base; Rugged
• Temperature thermoplastic design provides
104 'F (40'C) coil nuous superior strength and
140 F (60'C) inlermillenl corrosion resistance
• Fasteners 300 see es METERS FEET
stainless steel 10
• Capable of running i
dry without damag.; to 9 30' I i
CCrrponentS 5GPM - —
-! —
Pump: EP05
l
251 I .. 2.5 FT
— �--
• Solids handling capability o I _
a /i' maximum. w 7 I I
• Capacilies up to 60 GPM. _ I
• Total heads up to 31 feet. 6 20
• Discharge size 1'12' NPT. a
• Mechanical seal carbon } 5 ( S'•53 r
rolary/ceramic - stationary, ° t5 -- -- POS
BUNA -N elaslomers 0 4 l
• Temperature: ►-
3 10 - _
104 ^F (40 - C) continuous " — r - -- ._...._ __.
1401 (60 ^C) intermittent 2
0 00— 10 20 30 40 50 GPM
0 2 4 6 eL 10 12 m'/h
CAPACI TY
0 1995 Goulds Pumps, k.
Effective May, 1995
�-
IlTlce
- - - - -i - -- - --
i
A n/ i o
14
-: - -- _ -
- - -- --
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f
•.,. p��eyaFy
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter, shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall approved for septic tank use by the Department of Commerce, Safety and
Buildings Division..
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil conpaction may hinder aeration of he
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October - February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /LTSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months, When a pressure testis peformed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding, Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82 -84 Ws, Adm. Code, and shall maintained in accordance with its'
component manual (SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintence and maintenance
reporting.
t
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be repaired
or replaced immediately with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintence of this system should be directed to your county zoning or health inspector.
Z
YX sl1 eel
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
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. . J�
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q '/Q D�
Please print all information. R 'awed by Date
Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). C 2 I
Property Owner Property Location
d eMeA G G Govt. Lot .S 1/4 S S,2 / T2 N R 1_5 211" W
Property Owner's Mailing Address Lot # Blod(# Subd. Name or CSM# G,4 e �l/ w O d' o/
3 c Me down' of t6 o/ �o
City State Zip Code Phone Number City C3 Village ❑ Town Nearest Road yAF /Pjf ey
el 00 1 4
(� New Construction Use: Residential /Number of bedrooms �/ [� Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material f�T� f>/ r� / T� L Flood Plain elevation if applicable A 1A vo ft
General comments
and recommendations:
a Boring # ❑ Boring /
JZ pit Ground surface elev. 6� ft. Depth to limiting factor in.
Soil e
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l ®- 8' /0 3 S//- ,Axf - h S , F
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® pit Ground surface elev. ! 0 �ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
e- // ► R 3 S .L Ms61G G .� S M 18
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Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signa re r CST Number
Address Date Evaluation Conducted T Number
Property Owner a 2M eNT - Parcel ID # rf+31 - le f Lo - 02 Page of
F- 71 Ong # ❑Boring �Jp
®pit Ground surface elev. / 7r , .2 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
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F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Hodwa 't$epth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
1P. • Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Ong # ❑ 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 I '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.
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----- - -� - -- -- ----1 -- ---� --
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Mailing Address Al o
Property Address .J
(Verification required from Planning Departme t for new construction)
City/State N w 0 o c7 G /�Y `U/ Parcel Identification Number -3 1" �U�' "
LEGAL DESCRIPTION fy
eiy4.vo0d /�
Property Location ' /., YA) v, Sec. ? . T ,34 N -R LL W, Hof y
�� � y '_ nor l , c .� f' /!,Rc�i,r / _ 1 .� . .Lot # /
Subdivision
G /Y v(%u v y / i Grp v U w J • v� -
Certified Survey Map # Volume Page # 3 O
Warranty Deed # 0 / // F1 9 , Volume Page # o -
Spec house ❑ yes no Lot lines identifiable A yes ❑ no
SYSTEM MAINTENANCE
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.
property gees certification form, signed by the owner and by a
The owners to submit to St. Croix Zoning Departm ent a certi
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 three year expiration date.
a�0i0/
IGNATURE 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 owners) ) of
the p erty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
G6 /SRO 0
GNATURE OF APPLICANT DATE
An information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.*
*ss * ** y
** 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
Vll�..1659PME 302
r�
STATE BAR OF WISCONSIN FORM 2 - 1999 648199
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO. WI
This Deed, made between Clement P. Guthro and Gayle J. RECEIVED FOR RECORD
Guthro, husband and wife and Mae D. Schwab,
06 -14-001 9:15 AM
iIAARANTY DEED
Grantor, and Jason Nilssen and Teresa Nilsen, husband and wife �T T COPY I FEE:
COPY FEE:
TRANSFER FEE: 78.90
RECORDING FEE: 10.00
PILES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Name and Return Address
Lot 7 f Certified Sury ey Map, filed January 30, 1996, in Volume 11 of V„�,
rtifie urvey aps, age , as ocument o. 9027, located in the
Seutheast tlt of the a an part of the Southwest' /. of the V S. °�'
Southeast ' /< of Section 27, Township 30 North, Range 15 West, City of 40600. W"-t- 4 rqoiu
Glenwood City, St. Croix County, Wisconsin, together with a private road
easement for ingress and egress as shown on the recorded Certified Survey
Map thereof. 231- 1047 -70 -030
Parcel Identification Number (PIN)
This is not homestead property.
(K) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this _ day of May , 2001
* * Gay a J. G hro
• Clement P. Guthro * Mae Schwab
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
• ) ss.
County )
authenticated this day of
Personally came before me this � day of
D IAl May , 2001 the above named
Notary Public Clement P. Guthro and Gayle J. Guthro, husband and wife and
*
: �l TSM
Mae D. Schwab,
TITLE: MEMBER STATE -- - BA ' XM SCONSIN
(If not, to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Not Public, State of Wisconsin
Hudson, WI 54016 My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) ' �y' - 0 1 00
)
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company. Fond du Lac, WI
STATE BAR OF WISCONSIN 800.655 -2021
WARRANTY DEED FORM No. 2 - 1999
•`/ FORM NO. 985-A
Qhnw- 00
Stock No. 26273
9 �0
FILED
53902'"f 5 JAN 3 0 1996 01 11
olio
14 UL CERTIFIED SURVEY MAP NO 3049
VOLUME 1 , PAGE 3049 w
THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4, AND
PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4,
SECTION 27, TOWNSHIP 30 NORTH, RANGE 15 WEST,
CITY OF GLENWOOD CITY, ST. CROIX COUNTY, WISCONSIN
OWNER: SCALE:1 " =300'
AMERICAN INVESTMENT CO.
1673 13 1/2 AVE. HWY 8 E. P.O.BOX 99
BARRON. WI 54812
0' 150' 300' B00'
I DRAFTED BY : I
DONALD M. CLARK UNPLATTED LANDS /
L N 89 W 483.57' N <89'33'10' W � ue ff x v,-w v� me v 1313.31'
c ` k• ..
515,221 SQ. FT.
(11,83±ACRES) ss
a t 495,905 SQ. FT.
(11.38±ACRES) LESS R \W a
1447
ti o LOT 8 I.
499,133 SO. FT.
a
w w
(11.46±ACRES)
zi a 491,739 SQ. FT. , y
iE ¢I (11,29±ACRES) LESS R \W I a1
JI
z ti tn
N 89 E 1384.00' J 1 w cc
W 1 `6 1351.00' 3
i
F- 3 LOT 9
¢I o 0 414,904 SQ. FT. �) �1 z N
(L1 o . . m (9.52±ACRES) 405,217 SO FT C5 ' v 0
=1 0 (9.30±ACRES) LESS R \W ,
N 89 E 1383.54' Z
v1 � z
1350.54' 3 . I c�
M o LOT 10 �. <w<
<ma
C3. 470,355 SO. FT. of m m
(10.80±ACRES) o
458,791 SO. FT. °
5.5' (10.53±ACRES) LESS R \W 38.70'
semi LW IF se 1/ 4 - SW vt mC n
S 89 E 1311.30' S 88 E 1/4 CORNER N 88 W 2622.24'
UNPLATTED LANDS SEC., T30N,
SOUTHEAS 3 CORNER
27 R15W
--- - - - - -- - - - -- SEC.27, T0N. R15W
ST, CROIX CO. MONU. ST. CROIX CO. MONU.
r
DONALD M ' * z LEGEND
LAR Z GOVERNMENT CORNER
(AS NOTED)
MENOMONIE,
wl f'Q t • SET, 3/4 "X24" REBAR
WEIGHING 1.502 LBS.
PER LINEAL FOOT.
CEDAR CORPORATION
604 WILSON AVENUE
MENOMONIE, WI 54751
(715) 235 -9081 PAGE_LOF�
�l a. oo mod,
FORM NO. 985-A -
�H+C1Y�ar
Stock No. 26273
CERTIFIED SURVEY MAP NO 3049
VOL UME 11 , PAGE 3049
THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4, AND
PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4,
SECTION 27, TOWNSHIP 30 NORTH, RANGE 15 HEST,
CITY OF GLENWOOD CITY, ST. CROIX COUNTY, WISCONSIN
SURVEYOR'S CERTIFICA
1, DONALD M. CLARK, WISCONSIN REGISTERED LAND SURVEYOR, HEREBY CERTIFY:
THAT I HAVE SURVEYED, DIVIDED AND MAPPED PART OF THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4
AND PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4, SECTION 27, TOWNSHIP 30 NORTH.
RANGE 15 WEST, CITY OF GLENWOOD CITY T.
S CROIX COUNTY WISCONSIN MORE PARTICULARLY
LA LY
DESCRIBED AS:
COMMENCING AT THE SOUTHEAST CORNER OF SAID S ;
THENCE N.88'55'42 "W. 2550.54 FEET TO THE POINT OF BEGINNING;
THENCE N.00'07'24 "E. 650.54 FEET;
THENCE 580.15 FEET ALONG THE ARC OF A CURVE TO THE RIGHT, HAVING A RADIUS OF 664.80 FEET,
A CENTRAL ANGLE OF 50'00'00 ", AND A 561.91 FOOT CHORD THAT BEARS N.25'07'24 "E.;
THENCE N.50'07'24 "E. 210.00 FEET;
THENCE 17.69 FEET ALONG THE ARC OF A CURVE TO THE LEFT, HAVING A RADIUS OF 1975.90 FEET,
A CENTRAL ANGLE OF 00'30'48 ", AND A 17.69 FOOT CHORD THAT BEARS N.49'52'00 "E.;
THENCE N.89'13'35 "W. 483.57 FEET;
THENCE N.89'33'10 "W. 1313.31 FEET;
THENCE S.00'02'09 "W. 1311.20 FEET,
THENCE S.89'34'53 "E. 1311.30 FEET;
THENCE S.88'55'42 "E. 71.70 FEET TO THE POINT OF BEGINNING;
CONTAINING 1,899,613 SQUARE FEET (43.61 ACRES) MORE OR LESS, AND BEING SUBJECT TO EXISTING
EASEMENTS.
THAT I HAVE MADE SUCH SURVEY, LAND DIVISION AND MAP AT THE DIRECTION OF GERALD WAGNER,
FOR AMERICAN INVESTMENT CO., PO BOX 99, BARRON, WI, 54812, OWNER.
THAT THIS MAP IS A CORRECT REPRESENTATION OF THE EXTERIOR BOUNDARIES OF THE LAND
SURVEYED AND THE SUBDIVISION THEREOF MADE.
THAT I HAVE FULLY COMPLIED WITH THE PROVISIONS OF CHAPTER 236.34 OF THE WISCONSIN STATE
STATUTES AND THE SUBDIVISION REGULATIONS OF THE CITY F
0 GLENWOOD CITY AND THE COUNTY OF ST.
CROIX IN SURVEYING, DIVIDING AND MAPPING THE SAME.
�e�
DATED THIS � 0�SA, DAY OF 1995. a`S� 0 fs' '4 !.��
C *
Ex
DONALD M'�
DONALD M. CLARK, R.L.S. 1580 CLARK
5.1580 i
MENOMONIE, s
APPROVED OF GLENWOOD CITY WI ,r'O
Terrance Klinger, Mayor t�!
CURVE DATA TABLE
CURVE LOT RADIUS ARC CENTRAL CHORD CHORD BACK FORE
NO. NO. LENGTH LENGTH ANGLE BEARING LENGTH TANGENT TANGENT
1 -2 664.80' 580.15' 50 N.25 561.91' N.00 N.50
8 664.80' 214.59' 18 N.09 213,66' N,00.07'24'E. N.18
7 664,80' 365.56' 31 N.34 360.96' N.18 N.50
3 -4 1975.90' 17.69' 00 N.49 17.69' N.50 N.49
5 -6 697.80' 608.94' 50 N.25 589.80' N.00 N.50
8 697.80' 220.92' 18 N.09 220.00' N.00 N.18
7 697.80' 388.02' 31 N.34 E. 383.04' N.18 N.50
CEDAR CORPORATION
604 WILSON AVENUE
MENOMONIE, W1 54 751
(715) 235 -9081 PAGE eZ_OF--.2
II�