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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(ni Kathy Lanners TANK INFORMATION TYPE MANUFACTURER r1>+�f In CAPACITY Septic a� Dosing Rrrvrtf w ,Holdiinng TANK SETBACK INFORMATION mm[1 ml = mm ►Rt'`k min = �i;1i►%VAWl:_•7 --���!�►R%I////%!i, v PUMP/SIPHON INFORMATION Manufacturer t Demand GPM Model Number t 1 O �0- TDH Lift 1 Friction Lost System HeadIla TO Forcemain Length ( Dia. Dist. to Well A 1 A SOIL ABSORPTION SYSTEM ELEVA i • t 1 1111-/ � . MANAZI ' I/Ev La'W' 0 JI" t;a,f ILM" BEDfTRENCH Width { Length Igo. Of Trenches PIT DIMENSIONS No. Ot Pits Inside Do. Liquid Del p DIMENSIONSoff 1 ' SETBACK SYSTEM TO P/L S, BLDG WELL LAKE/STREAM LEACHING 110anufacturer INFORMATION CHAMBER OR UNIT Type Of System'. otA✓t` � I syl {/V s ( vO Model Number'. IsTL"llI d:71-11li 0 141: IWk. 19= Lr' Headerl andPld I( Distribution Pipes) 11'' 1 I I 1 x Hole Size 1 x Hole Spacing r Vent to Air Intake Length Dia_ Length-'1 Dia L Spacing_ ' ' J 1 Z SOIL COVER x Pressure Sustains Only _ xx Mound Or At -Grade Svstems Ontif Depth Over , Depth Over Depth o xx oddetl Seeded/S xx Mulched Bed/Trench Center n Bed/Trench Edges Topsoil Yes No es Q No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 140 HILLCREST GT 1.) Alt SM Description = v'r qLW'W 2.) Bldg sewer length = V 2 1% - amount of cover = - 7 411 Plan revision Required? n Yes No 0 Use other side for additional informa n. Date SBD-6710 (R.3/97) Inspection #1:—C..1A .oit!' Inspection #2: 16161— 11 h WqAql ai rremo i-eA panccglly kilied _ npper►oo1'h ass• Safety Buildings Division and Sanitary Permit m*a (to be filled in by Co.) ; 201 W. waSniM,Jt Ave., 7162 JON 2 8 2019 ^ . ((.00 +� St, Croix County commune eIIllll .tip Stm T Nomber In accordance with SPS 39321(2), Wis. Ada Code, submission Yof this fom to the approprime governmental unit 06 1 ct Address (if di great tbm mailing address) is mgnircd prior to obtaining a sanitary pe®ic Note: Application fams for stmeosroed PORTS me submiurd to the uses . oo rd Sway and a Priveior L w. s. 1s. Persmal State. ion you provide may be used for s in acemdance with the Priv Law, s. 15.04(1 m Stets. L lication Information — Please Print All information Property Owner's Name l�l)e�.'�5�� 14 U i 1' n 70-0 Property Owner's Mailing Address �� Al -I Property ucanon ol-7, 3O .15, 7-S . 1 �r GovfLot rA run, S,= 22— City, Same Zip Code -J Phorc Number M - % /ally J7 �jS _ T 30 N; R�E W IL Type otBmilding (check all that apply / Subdivition Name pir1 m 2 Fmmly Dwelling -Number of / , t ak � B10 ❑ PublicAConcamial-Desctibe Use City of ❑Stateowmd-Desmbe Usc CSMNwrJ= Village of V61 5-2dr Town of III. eck only one box on line A. Complete line B if applimble) ❑ Replacement System ❑ Tmat scot 3elding'fank Replacmem only ❑ Other Modificmimm Existing System (explam) R. 0 PamitRcme wa! ❑ Permit Revision ❑ Change ofPlumbet ❑PermitTramfam New List Previous Permit Number and Dale ksued Before:Expirmion owns IV. Type ofPOWTSS stem/Com nent/Device: Check all amwn 59 ❑ Non-Fresssmiad In -Ground ❑ Pressurized Ice -Ground ❑ At 2:24 in. of mitabk wil Mamd <24 im of stimble soil ❑ Holding Tad: O other Dispersal Component (explain) ce (explain) V. Die t Area Ioformatio Iksi Flow (gpd) Design Soil Applic dsf) ., Dispersal Aces Requs Dispersal Area S>snm Elevationav r16 y:;- VL Tank bafo Capacity in Gallons Tool Gallons a of Unite Maoutacmer c 3 a flew Tanks sxknTwits r3 m vsi ic [z. �. L.� e .*&, w ]]oldivg Tank Dosing Cbse Ne 6 ' VII. Respomibitiny Statement- f, the undersigned, qrmiresponability for installation of the POWTS shown an the athcbed plaaa phttop's Name (Prim) r Plim s gomurc MP/h1PR8 N®bun Phew Nmobw Z —Buusmess [ j Phmbv' Address (S�oea. City State. Zip CO&I ZL L� i I VM eat Use -Only Ap t PCMMFeset S heal •D-a7te Q Z Issuing Siga ❑ m Reason for Denial 1 / DLCon ' _ asfor.Disapproval /✓. thy„) 3 aae�o Pr as per nar':ayartran. pkn n• o ndert tw ;lt mbei. ,^"L- 6t..A,-A 2 AM~ ml;Lire,:le ms ttvsut Lou Md� aft per R0pia1Mg C0131 I cat MAN.". 1 AV �0 if 7 Auachmosarete planfor dre syswr and abvcm the CaungodT Mpapaam Mar WoB ]nxll iorbesv vae 4�ram/ //1 e ce ,,,q � /gra ta..4— sB»�(R 3vsline) G„t:, ;^ ` / - System PLOT PLAN PROJECT Kathv Lanners ADDRESS 7041 6th St. N Oakdale Mn 55128 SE I/4 SE 1/4S 27 /T 30 N/R 15 W City Glenwood COUNTY ST. CROIX SYSTEM ELEVATION 100.0' 5/27/19 BEDROOM 3 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 1/2" pvc pipe ASSUME ELEVATION 99.3' Filter Lifetime Filter ❑ BOREHOLE O WELL •H.R.P. same as benchmark Scale = 1/4" = 10' 0 40' 80' 4 acre Lot Well is to meet all WDNR setbacks Area 15' below system is to remain undisturbed Pro 3 Bedroom thy` House OHuffcutt Combo Tank n J 12% Slope fl B-3 13 Grading is to be done to divert run-off away from system N,( 96' J N 98' 99, BOO, 400' Property Line B.M.' LECOP`' June 24, 2019 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2021-06-24 Plan Review: PWTS-061900912-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Kathy Lanners Lot 15 Hillcrest court Town of Glenwood Saint Croix County Total Amount: $250.00 FOR: Description: 450 GPD (3 Bedrooms —New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay httplldsps.wi.gov/progmmsfndustry-services www.wisoonsin.gov Tony Evers - Governor Dawn Crlm - Secretary COtJOITIONALLY APPKOVLO DEFT OF SAFETY AND PROFESSION.4i. SERVICES NVISK)N OF 1RDCSTRY SERVICES 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) 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 requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, slats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots. stumps and boulders reduce the amount of soil available for proper treatment. if no other site is available. trees in the basal area of the mound must be cut off al ground level. A larger fill area is necessary when am of the above conditions are encountered, to provide suliicient infiltrative urea. 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 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. 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/instal lation/operation. 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, Tim Vander Leest Private Sewage Plan Reviewer, Division of Industry Services (920)492-2214 , Mon- Fri, 6:00 am. - 3:30 p.m. tim. vanderleest;b;:wi.gov Cover Page Shaun Bird CONDITIONALLY Bird Plumbing Inc. APPROVED DEPT OF SAFETY AND 1432 120th St. F4:O: ESSIONAL SERVICES New Richmond Wi 54017 DIVISION OF INDUSTRY SERVICES 715-246-4516 Date: 5/28/19 Owner:Kathy Lanners Location: SE1/4 SE1/4 S27 T30N,R15W Lot 15 Hillcrest Court Glenwood Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingency plan Attachments: soil test Shau Sign Licer Page 1 of 9 System PLOT PLAN PROJECT Kathv Lanners ADDRESS 7041 6th St. N Oakdale Mn 55128 SE 114 SE I148 27 /T 30 NIR 15 W city Glenwood COUNTY ST.CROIX SYSTEM ELEVATION 100.0' 5/27/19 BEDROOM 3 DATE CONVENTIONAL. AT -GRADE CONVENTIONAL LIFT HOLDING TANK y MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE. 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 g ambers none BENCHMARK V.R.P. Top of 1/2" pvc pipe ASSUME ELEVATIO 98.3' Filter Lifetime Filter ❑ BOREHOLE O WELL +H.R.P. same as benchmark Scale = 1/4" = 10' 4 acre Lot Pro 3 Bedroom House 0 40' 80' Well Is to meet all WDNR setbacks Area 15' below system is to remain undisturbed Huffcutt Combo Tank M Grading is to be done to divert run-off away from system 12% Slope 98' 99, B 1 00. 96' 400' Property Line /# B.M.' .tJ 0.S --e, \ t4 lx�, 01 Mound System Cross Section and Plan View 1 l ---------------------- - ----------. UR 1 r I t I 1 J I -----------'�) Topsoil = ASTM C-33 ® = Clean aggregate O = 4 in. sch. 40 pvc Cap Material sand fill 1/2 to 2 1/2 in. dia. observation pipe I L - 0 Ft Contour Slope Direction �i GENERAL INSTALLATION: The mound area is staked out along the dcontour.with Existboard og vegetation is mowed and raked off the site. The mound basal area (L x w) is plowed chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gi Page 3 of� Manifold Force Main CA,C) r I Pressure Lateral Layout Two Laterals — End Manifold -- Threaded Cleanout Lateral Turn -up --► Plug fUTl —X_4 L — Long Sweep 90 Bend Force Main Diameter I i Force Main Leneth i A 03/05 lgj Ft. Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral tum-ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. ••••• Grade 0 0 0 0 00 6-8 Inch Lawn Sprinkler Valve Box Page q of �_ • Septic -Dose Wank Cross Section And Pump Performance Specifications ANN Total Dynamic Head (TDH) - Feet Elevation Head ! t7 Distal Pressure Network Loss Force Main Loss Total S I Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade { Locking Device. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof I p J unction Box '� -' • Finished Grade — — _ T Vent Min. 12" Disconnect Above Grad Means With p Outlet Filter Inlet I f--- Inlet Baffle ' and Reserve capacty olurn = / GPIn; inches Volume Gal. A oZ ,B KSwit�chS 2 3Q , 6. s 71 / S- /." A , Weep B Hole Off Elevation C QO, Ft Bottom D Elevation F, GENERAL INSTALLATION: The sepucldosc tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical servic mplies with NBC300 and Comm 16.23. 02l05 LJ Page of 280=SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: " Vortex style impeller permitting passage of solids up to #" " 416 stainless steel rotor shaft a Permanently lubricated upper and lower ball bearing " Epoxy powder coat finish a All fasteners - corrosion -resistant stainless steel " 114 Discharge " Stainless steel bottom screen - easily removable " Maximum fluid temperature:140' F. 280-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 50'(-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional WA WA 1 V cord length standard on all models. For optional lengths, add "-2, -3 or-5" suffix to model number. Example: for model 280 with W cord, order 280-3 Motor Specifications Yz hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (2081230V) VA Model 281 Wide angle float switch with quick - disconnect ® 0- c us Certified sp.unanae o.gan m verge wm„A ,bsc.. Performance Curve: 280-Series %25 U. ' 20 2 1 = 10 5 .. ........................... r � :. r U.S. Gallons Per Minute 0 38 78 114 156 192 228 Z70 Vters Per Minute Dimensional Data: Weight: 29 lbs. Height.13" Major Wfdth:l0" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" Factory switch Model 281,283 I Model 287 I settin s VMF Tum on level 13" 9.5" Tum off level 7" 1 4.0" The Model 283 features a fully adjustable wide-angle float 0ltferentiel adjustments can be made easily by tethering the float b the dM- charge pipe or other mounting point vertical fast model 287 is not adjustable. rll M 11101 Mode1287 VMF-Sxift Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps " 7000 Apple Tree Avenue • Bergen, Now York 14416 " Phone 800-543-2330 Fax (5B6) 494-1839 www.Obertypumps.com cop2rghto LbQM Puff eh .2017 ra dym rewrVed. un2abp Rtan7 60- / POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ler FILONFORMATION SYSTEM SPECIFICATIONS a"'nefJu Septic Tank Capacity Septic Tank Manufacturer Pertntt# `�1 ( 1 v DESIGN PARAMETERS Effluent fitter ManufacturerNumber of Bedrooms 3 ❑NA Effluent Fitter ModelNumber of Commercial Units Pump Tank CapacityEstimated Z11NNA Boa' (average) aVda Pump Tank Manufacturer Design flow (pgak), (Estimated x 1.5) aVd Pump ManufacturerSoll APp��n Ram j- [7 airda /ftll Pump Model NA Influent/EBl lent Quality Fats, Ol & Grease (FOG) Biochemical Oxygen Demand (BOO,) Total Suspended Solids (TSS) Monthly average• -ao mg/L !=0 mg/L 5150 mall. Pretreatment Unit ❑ Sand/GrgW Fitter ' ❑ Peat Filter ❑ Mechanical Aeration O Wetland Disinfection O Other. Manufacturer Pretreated Effluent Quality Biochemical Oxygen Demand (BOO,) Total Suspended Solids (TSS) Fecal Coliform (geometric mean) Monthly average" 530 mg/L 530 mg/L 510' cfu/100m1 Dispersal Cell(s) ❑ In -ground (gravity) O I -ground (pressurized) ❑ At -grade and 1 ❑ Ddp4ine ❑ Other. Maximum Effluent Particle Size Y. Inch diameter • values ryprm fm domestic (nontorrenerdaq wasfewater end sore tamo„m� .� valor typical for preheated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ mon year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum eq Is one-third %) of tank volume Inspect dispersal oell(s) At least once every 1 ❑ months-Ayear(s) (Maximum 3 yrs.) Clean effluent filer At least once every ❑ months V4earm Inspect pump, pump controls & alarm At least once every O months ar(s) ❑ NA Flush latbrals and pressure test At least once every ❑months earls) ❑ NA Oder. - At least once every ❑ months O year(s) ❑ NA ce1W. At least once every ❑months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or cerfifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for arty back up or ponding of effluent on the ground surface. The dispersal oell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 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 (4) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 i3, Wisconsin Administrative Code. The servicing of effluent fitters, m"nical or pressurized POWTS components, pretreatfinenl components, and any other maintenance or monitoring at iritervals of 12 months or less shall be performed by a certified POWTS Maintalner. A servkp report stall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painfing products or other chemicals that may Impede the treatment process and/or damage the dispersal oell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ' Page _ of _, START UP AND OPERATION For now 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 andfor damage the dispersal cell(s). If high concentrations are detected have the contents of tha tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(a) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage, Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or perk vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade sail absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental Noes; diapers; disinfectants; fat, foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT PetIY When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is pr o and safety abandoned in compliance with chapter Comm 33.33, Wisconsin Administrative Code' 4 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 propedy disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code complirfnt replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soll absorption systetm. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requirled 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 rulett in effect at that time. ❑ A suitable replacement area is not available due to setback and/or Boll limitations. Bering advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. e site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site ev iluat)on must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be Installed) as a last resort to replace the failed POWTS. Mound and et -grade soil absorption systems may be reconstructed in place following removal of the blomet at the Infiltrative ca. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER �-- Nama , /.. — PhoneOgg Phone SE N�EBERVICINO�.1Name OPERATOR P/U ER LOCALAUTHORfTY Phone 7%ram _ (� Phone 7/S�8G This document was drafted In wrtrpllance with chapter 8Pe 383.22(2)(bK1)(d)&(f) and 383,84(t ), (2) & (3), Wisconsin Admine,160 a Code. 20140048A 0.s20019Afg0 10.0WD t 1.1921 t � 1 981M � 93759 �h\ AlGap beheen Lrne and Sa.penGne (� r-d9. 9.4156 \`R/ { r:- SECTION A -A _ _ Wisexain DepeNnentofcononeve SOIL EVALUATION REPORT Division ofSaktyand Building^ r, in accadmce with Carom 85, Wu. Adm. Code Page I of 3 . ��.. a✓:.'. a 1/f� L•a a.awary St. Croix Attach compkoc a r ony ne ten dnm 9 `h x 11 inches in size. Piro must Parcel I.D. 231-1 7- 0-070 �pa_p�er Include tout not 1 :1•i�!�ypslporimnkl teferecntt point (BM), direction old Percent slope, scale a dimawioM,4ntbh snow, and BM referenced to ftlera t Dow IV purvei`' RT,,i-nt all information vc� Rn,, y s Personal infamatiou you provide may Ina uerA'UF4d mdary purposes (Priywy 1.aw, s. 15,04 (1) (in Z Propety Owner, Brian Hutt y Lass'0^el GevL La SE Y. SE i s 2 T 3 N R 15 w Property owner's Mailing Address lock a Subd Nerve a CSMa 70410 Street North 1 S city state Zip code Phone City ❑ Village ❑ To Nemm Road Oakdale MN 55128 612-369-15S )�&Qc &I Hi1lCrest ® New Construction Use: ® Residential / Number of Bedrooms_ Code derived design flow rate 450 GPD ❑Replacement ❑ Public or Commercial — Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: 1 onng Boring H r 31 H Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor in. Pita Horizon Deptn Dominant Color Redox Deaeriptlon To Jura Structure Conshitenoe SouMary Roots 'ERat 'Enarl 1 0-14 10YR3/2 SIL 3-m-bk dh list 3f 0.6 0.8 2 14-31 t0YR4/4 - SICL 2-co-bk mfi cs If 0.4 0.8 3 31-36+ 7.5YR4/4 7,5YR5/8 C-2-d CL tco-bk mvfi - 1f 0.2 0.3 ❑ 2 Boring # o Boring ®Pit Ground Surface Elevation 100.1 ft. Depth to Limiting factor 25 in Still Apailloaflan Raft Horrton Depth In. Dominant Color I Redox Dasvlptbn Texture Stmctum r Consbtence boundary Roots npow TMt *EIU2 1 0-10 10YR2/2 - SIL 3-m-gr dh gs 3f-Co 0.6 0.8 2 10-16 t0YR4/4 SICL 2-m-bk mfr gs 1f 0.4 0.6 3 16-25 7.5YR4/4 SICL 2-rrbk mfi list 1f 0.4 0.6 4 25-32+ 7.5YR4/4 5YR4/6 c-1-d CL 1-m-bk mfi 0.2 0.3 ..,..._�.., _a , _-..,«.an�em m-n r- •ammm� a2m ADD. <so mdL aM TSS<30 ma/L CST Neene(please Print) _ --��/ - CST Number Mark Iverson i / i✓ 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond WI 54015 September 20 2012 715-796-5664 Property Owner Brian Hunt parcel1D 231-1047-70-070 fage_2—of 3 Boring # ®Pit �g Ground Surface Elevation 95.3 ft. Depth to Limiting factor 32 is "Often DepN Dominant Color Munaell Redox Oeamlption Qu. St. Corti. Color Texture Souci n" COImWenoa BoundaryIn. Roots 'E/Mt •EM 1 0-8 10YR3/3 SIL 2-m-gr dh Cs 3 fco 0.6 0.8 2 8-14 10YR4/3 SICL 3-f-bk dh gs 1f 0.4 0.6 3 14-22 t0YR4/4 SICL 3-m-bk dh gs 1f 0.4 0.6 4 22-32 7.5YR4/4 SICL 1•co-bk dvh ge 1f 0.2 0.3 5 3238+ 7.5YR4/4 7.5YR5/8 0-d GRCL 1-co-bk mfI 0.2 0.3 II' �• e I _ 0 Boring S Borina YY n M., n ..-a C.. J' ..- CI n...A ... I;—iNnn f~, in MIR -EnluentNl -DODI> 305220 mg/L and TSS> 30 s 150 mWL •Emumt a2- 00%:S30 mg/L and TSS 530MOIL The Deperunent of Commerce is an equal opportunity service provider and employer. If you need assistance to aeoeas services or Need material in an alternate format, please contact the department at 608-266.3151 or 7TY 608.264-8777. Page 3 of 3 Spruce ft. 40 ftso O ft. 24�■�11. N 94,1 195t ) 9Q, \ 9T t � 0.0 99. aM# & Dewfi fion Elevation = Bench Mark toot = Boring Location 8. Elevation Owner. Brian Hunt Site Information: Completed By: Mark Iverson, PSS #197 7041 6th Street North SE114, SE1/4, S27, T30N, R15 680 Larcom Street Oakdale, MN 55128 City of Glenwood City Hammond, tM 54015 St. Croix County 715-796-5684 Phone: 612.369-1590 CST# 46672 J' : TO Property Address City/State ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM / !V (Verification required from Planning & Coning lltpartment for new constntetimtJ Parcel identification Number p Z =1p _7-70 '071 LEGAL DESCRIPTION / Property Location '/a , -1-T, t/4 , Sec. , T 3 'D'D N R, j � of "r�l �` CJQ7lQ Subdivision Certified Survey Map # 5 3,9 02 C, 1 Warranty Deed # , Lot _—_— I Volume _�I I Page # ---- 3D5 _, Volume Page # 1_ot lines identifiab ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Spec house " /no 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 nr sooner, if needed, by a licensed pumpeir. 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(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County planting &"Long Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pamper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sat 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 Departineat within 30 days of the three year expiration date. i/we certify that all statements on form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w ant deed retarded in Register of Deeds Clffice. Number of bedrooms GNAT F APPLICANT(S) 6/ lo?dl/? 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) ------------------------ e ROW I � I �m I• � I I I I I I I I I I I I I i I 1 N y> r I � i�➢. �Y=1=M3�_ I • i - Y i 1 I 1 . r ,. 4a�� ly_y ii r________ ___ I�r I 1 dor • I r 1'1 r 1 I I i - � =t( I �I I i 11 I• I an .. iruaw�em 1 H w 1 . r.. .. ... .. - ___- I__________ _________ __________ ICI j e � -=xei'miow _1 I r I ly II I j j y yLe I.I r I 11 I WRG 1'I 'I j e i II k bI I 1 1 I wu.odO 1 �w..��nya .yews rn. 1 eiio � • � r _________� �_____I ____ ' RECEIVED WismrLsin oepartrnent of Commerce MAT Af �T10 REPORT Page L of Division of Safety and Buildings 1"F`T LCIUJUU in accordi Ice with Comm 85, Wis. Adm. C de Coun Attach complete site plan on paper not less than 8 112 x f3T4AQL )must include, but not limited to: vertical and horizontal re rence �j"Q�@ and Pam( I.D. percent slope, scale or dimensions, north arrow, a a TTsTnce to nearest road. Please print all information. Reviewed Date ' 1 wntla uryoaes (Privaty law, s. tS.oa (t) (m)). Garsonsl iMorrne you pw ey E ue nor ter' i=;� I Property Owner f �� Property Location _ Govt. Lot � 1l4,5L lA S ^ T N R / J E (a W Property Owners Mailing eiss r Lo # � Block # Subd. Name a CSM# city. State• Zip Code_ Phone Nurmber 2 7- j C ❑ Village ❑ Neared WjaW �7 New Constructim Use: ntial / Number of bedrooms Code derived design flow rate yJ".r] GPD ❑ Replacement ❑ Public Of �r/�rt�erda.,I - Describe Parent material [T7iG�t� //`� •% z, Flood Plain elevation if applicable 11114 General correnarns and recon rnendationnss/:BMIN # n Boring IZI pil Ground surface elev. Depth to limiting fads in. Sill nation Rate Horizon Depth in. Dominant Ulm Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 •ER#2 0 CL �❑# 9r `� Pit Ground surface elev. / v ' `"� ft. Depth to limiting factor in. � ica� Rate Horizon Depth in. Dominant Cola Munsell Redox Description Qu Sz. CorIL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 ' • i Etlhuenl #1 = BOD > 30 1220 mg/L and TSS >30 < 150 " tMuem 1r2 = BUD < JU mg1L ana 1 J s , nlgn- CST Name (Please Prim) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017—� _ J — 715-246-4516 Property Owner Parcel ID # 1> Page _of © it ` • Depth ' -1=1 &- 'O1.T1Tf1 Mom ... ., m®�®®®� ■ : Eflluern #1 = BOD. > 30 < 220 rrgrL and TSS >30 < 150 mall . Effluent #2 = BODt < 30 mg1L and TSS < 30 mg1L 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 fomnat, please contact the department at 608-266-3151 or TTY 608-264-8777. serww ne.sat Soil Test Plot Project blame Larry Mastella Address 482 Carriage Lane Hudson Wi 54016 Lot 15 Subdivision SE 1/4 SE 1/4S 27 T 30 CSTM #226900 Date 5/10/05 City Glenwood ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation *HRPSameasBenchmark 622' Property Line N/R15 W 10% Slope 10' 70' B-3 0' JB-2 93' 95' B-1 B.M. 100' S Scale is 1" = 40' unless otherwise noted .KI Parcel #: 231-1047-70-070 02/15/20PAGE 1 OF E I OF 1 P1 Alt. Parcel #: 27.30.15.754-0 231 - CITY OF GLENWOOD CITY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-owner O - CITIZENS STATE BANK CITIZENS STATE BANK 398 RED CEDAR ST MENOMONIE WI 54751 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 4,940 Plat: 3051-CSM 11-3051 SEC 27 T30N R15W PT SW SE & SE SE BEING Block/Condo Bldg: LOT 15 LOT 15 CSM 1113051 4.94AC Tract(s): (Sac-Twn-Rng 401/4 1601/4) 27-30N-15W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 11/26/2007 864664 SD 09/05/2007 859955 ORDER 011007 117 OC O6/23l23/12006 828111 LC mon... 2008 SUMMARY Bill #: Fair Market Value: 0 Assessed with: Valuations: Last changed: 09/21/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.940 39,500 0 39,500 NO Totals for 2008: General Property 4.940 39,500 0 39,500 Woodland 0.000 0 0 Totals for 2007: General Property 4.940 39,500 0 39,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Cc" St Croix .•s• rteereat road. Parcel I.D.11 APPLICANT INFORMATION - PI b Olal6soao 1DN 33.30.16.493 Reviewed By Dale Pwoonel krrormeaon you yoMde may be usM ( .j.aw, a. ts.04 (1) (m)). Property Owner -z x, J Jr. & Pam Rose REcE(VEO .f�' PmpegL"ati'n Goys Lot NE 1/4 SE 1/4 S 33 T 30 N,R 16 W Property Owner's Mailing Address o 2000 Lilt B %W.Nano or T 1248 240th Street JIl I. 2 k CSM CityCade bar CAy Village ®Town Nearest Road Baldwin 002 5 Emerald I 24OTh Strat / Nu 3 QAdlftlon toexisting twilling 4f El Use: ❑ t Code Derived daily flow 450 gpd Recommended design baling rate 0 bed, gpdM2 .5 trench, gpdt2 Basal area required 900 bed, ft 900 trench, ft Maximum design bading rate 0 bed, gpdff .5 trench, gpdM2 REComme(lded infiltration surface elevabon(s) 100.0' at 12" above 99.0' contour. ft (as referred to site plan benchmark) Additional design I site considerations Parent material Glacial outwash & loess over glacial till Flood Pain elevation 'rf applicable na ft S=Sudable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U=Unsudable for System ❑ S E U E S❑ U ❑ S® U ❑ S E U ❑ S E U 1 ❑ S D U Ground aiev gem fl 060 to krog lal4Dr 3V GmmM slay gem ill f. W lwll--Iy:11JEL�)� Ha¢oh Depth n. Dominant Color MUnsell Moores Clu, Sz Cont. color Texture StructureCorlasistence Gr. SZ. Sh. Boundary Roots GP�-- Bed Trench 1 0-10 10yr3/3 None sil 2fsbk mvfr as 2f 0.5 2 10-19 10yr5/4 None sil 2fsbk mvfr aw If 0.5 3 19-31 7.5yr4/6 None coal 2msbk mfr cw 0.5 4 31-49 7.5yr4/6 f2f/.5yr5/8 s&gr Osg ml aw 0.7 5 49-63 7.5yr4/4 rn1p5yr5/8 sil 161inpl mfr 02 1 0-9 10yr3/3 None sit 2fsbk mvfr as 2f 0.5 2 9-15 10yr5/4 None sil 2fsbk mvfr aw if 0.5 3 15-21 10yr4/4 Now sil 2msbk mfr cw - 0.5 4 21-34 7.5yr4/4 None Is&gr 2csbk ml ow 0.7 5 34-55 7.5yr4/6 f28yr5/8 s&gr Osg all - 0.7 Remarks: —_ CST Name (Please Print) Signahlre: Telephone NO. lames K. Thompson 715-249-7767 Address AC.E. Soil & Site Evaluations Dale CST Number Ret/ 340 Paulson Lake Lane, O 106 WI 54020 7/3A0 3602 12" THIS MAP IS A TRUE AND CORRECT REPRESENTATION OF PART OF THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 AND PART OF THE SouTHEAsr 1/4 OF THE SOUTHEAST 1/4 OF SECTION 33, TOWNSHIP 30 NORTH, RANGE 16. TOWN OF HAMMO`ND,aST. CROIX COUNTY, WISCONSIN. Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildin"'RECe/ver In accordance with Comm 85, Wis. Adm. Code r�4� FE Cou Attach complete sit�,p( on paper not less than 8 1/2x I l inches in sire. Plan must Include but not limlYdil 2taurizontal reference point (BM), direction and Parc Percent slope, scale or dimenslo " arrow, and BM referenced to nt iP4 ptAsNNlNG t mt all information lr A �v� Personal information you provide may be us 4eiondary purposes (Privacy Law, s. 15.04 (1) (m)) roperty owner Property Location Brian Hunt Govt. w SE Y. SE v. s roperty Owner's Mailing Address L lock 8 Subd. Name or 7041 6TH Street North 15 Page I of 3 St. Croix ' 231-1 7- 0-070 Date r 1. T 3 N 4 R 15 W Fly awe L1p Loue rI100C 14city U Village LJ Tov Nearest Road Oakdale MN 55128 612-369-1590 a (�I 1 _ ,... 11llCrest 0 New Construction Use: 0 Residential / Number of Bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or Commercial — Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: J Boring # 0 Pit Ground Surface Elevation 100.0 R. Depth to Limiting factor 31 in. Gil e.Winel nDare Horizon Depth in. Dominant Color M nsell Reciter Description Qu. Sz. Cont. Color Texture Structure r. h. Consistence Solmdery Roots G *F fal *01102 1 0-14 10YR312 - SIL 3-m-bk dh gs 3f 0.6 0.8 2 14-31 10YR4/4 - SICL 2-co-bk Mill cs 1f 0.4 0.6 3 31-36+ 7.5YR4/4 7.5YR5/8 c-2-d CL lco-bk mvfi 1f 0.2 0.3 Boring # ❑ Boring OPit Ground Surface Elevation 100.1 R. Depth to Limiting factor 25 in. c ae Horizon Depth in. Dominant Color Munsell Redox Description Qu. Si. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDMe 'EfF#1 1 0-10 10YR2/2 SIL 3-m-gr dh gs 3f-co 0.6 0.8 2 10-16 10YR4/4 - SICL 2-m-bk mfr gs 1f 0.4 0.6 3 16-25 7.5YR4/4 SICL 2-m-bk mfi gs 1f 0.4 0.6 4 25-32+ 7.5YR4/4 5YR4/6o-1A CL 1 1-m-bk mfi - 0.2 0.3 -nilumu1N1—UVL5 � Ju] LLU mg/L ar1U 1 sa n 3U g 1au mWL-Cr[1ue111XL=tlVU51JURWL0110 133$3Umg/L CST Name (Please Print) CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 September 20, 2012 715-796-5664 Brian Hunt 231-1047-70-070 Property Owner Parcel 1D# page �_of,�_ 3 Boring # ❑Boring J/ 13Pit Ground Surface Elevation 95.3 ft. Depth to Limiting factor 32 M. Cntl AnNirarinn RNA Horizon Depth in. Dominant Color Munsell Redox Description u. Sz. Cont. Color Texture Structure Gr. h. Consistence Boundary Roots QPDte ;Eff*l .Ef1*2 1 0-8 10YR3/3 - SIL 2-m-gr dh CS 3 f-Co 0.6 0.8 2 8-14 10YR4/3 - SICL 3-f-bk dh gs 1f 0.4 0.6 3 14-22 10YR4/4 - SICL 3-m-bk dh gs 1f 0.4 0.6 4 22-32 7.5YR4/4 - SICL 1-00-bk dvh gs 1f 0.2 0.3 5 32-38+ 7.5YR4/4 7.5YR5/8 o-1A GRCL 1-oo-bk mill - - 0.2 0.3 4] Boring # ❑ Boring QPi[ Ground Surface Elevation ft. Depth to Limiting factor in. qaA Horizon Depth in. Dominant Color Munsell Redox Description Qu, Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/a' 'Etf#1 •Etr#2 F Boring # ❑ Boring ®Pit Ground Surface Elevation fL Depth to Limiting factor in. cnn A. Horizon Depth in. Dominant Color Munsell Redox Descnpbon Qu. Sz. Cont. Color Texture Structure Gr. h. Consistence Boundary Rook GP 'E1F#1 -Elf#2 *Effluent#1=BOD,>30<220mgl1. and TSS>30S I50mg/L • Effluent #2= BOD,S 30 mg/L and TSS530 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.