Loading...
HomeMy WebLinkAbout022-1042-20-000 (2)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)(m)l Lisa L Christensen INFORMATION TOWN OF KINNICKINNIC TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH LiR Friction Loss System Head TDH Ft Force In Length Dia Dist. to Well SUIL AtSbUKF I WIN SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet StJHt Outlet Dt Inlet Dt Bottom Header/Man. Dist, Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: Model Number. UNIT UIS 1 KIFSU I WIN SYSTEM Header/Manifold IDistribution x Hole Size x Hole Sparing Vent to Air Intake Pipes) Length Dia Length Dia Spacmg SUIL COVER x Pressure Svsteme nriw . Mn..nd nr At-nr=a= s..ae.n= (1..1. Depth Over Depth Over xx Depth of xz Seeded/Sodded xx Mulched BedfTrench Center Bed/Trench Edges Topsoil Q Yes ® No Q Yes ® No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 1280 CTY RD J 1.) Aft BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ® Yes ® No Use other side for additional information SBD-9710 (R.3/97) Date Inspection #1: Insepetor's Signature Inspection #2: Cart No Al- Zoze - d5 2 Industry Services Division 1400 E Washittglon Ave ounty Ct P.O. Box %2 Sanitary Peitnit Number (to be filled in by Co.) b �, R O 9'iplp Madisoq WI 5370 -71 4? l 3-g ? Ito` ermit Application glBfe Transaction "amber In acco a with 811 is. Adm. Code, submission of this form to the WP govemmenral unit —� Project Address (if different than mailing address) is requi tg a sanitary permit Note: Application forms for suteoVed POWTS are submitted to the Dep afety and Professional Services. Personal infomtetion you provide may be used for secondary Purposes in accordance with the Privacy law, s. 15.04(1 m , Stars. �f� n x� L Application Information - Please Print All Information Property Owner's N [ S � Parcel a , e ` , aaa-o� a, _ Property Owner's Mailing Address piwerty LocatiafS. 28 . 0 Z28 $ p _ Govt. Lot y yti Section City. to Zip Code Phone Number /rye•, -,le onit TZEN; E rW R/ !!/-4!1 !I. ype of Building (check all that apply) I.m X r 2 Family Dwelling - Number of Bedrooms SuhdwxeienA7ame reial Block ElPubliNCommerc- Describe Use ❑ Crty of ❑ State Owned - Describe Use ❑ Village of SM Number F Town of III. Type of Permit: (Cheek only one box on line A. Complete line B if applicable) AJ A' ❑ New System ement System ❑ TrearmentlHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Chan of Plumber Change ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner of POW TS S stem/Com nent/Device: Check all that apply) unzed In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable snit Holding Tank ❑ Other Dispersal Component (cxpl )n) PremeaWnent Device (ezpl in) it Al V. Db rsal/Treatment Area Information: Des gn Flow (gpd) Design Soil Application Rat s spersal Area Requ d (so mal A (s System Eleve "on f/! ' —� 4;4,D S'S. S �f 3 S VI. Tank Info Capacity in Total s of Manufacturer Gallons Gallons I Units L/r/'y _ F/T $ u New Tanks g 7W ��l-Cam 5j Septic or Holding Tardy DwingCWmber i jundmiga-4ed,:m.3 VIL Res Onsibility Statement- L thespomibalty for instaWtion of the POINTS shown on the attached plainPlum is Name(Print) ature MP/MPRS Number Business Phone Nwn`,/` j_ Plumber's Address (Street, C" te, Zi e r 3Z , VIII. County/DepartmAtIse—Only �P`oved ❑ Disapproved permit FFyeee Issues 1 uin Agem Signat ❑ Owner Given Reason for Denial S J w �3 �yZQ IX. Conditions of Approval/Reasons for Disapproval '3 SYSTEM OWNER: S 1. Septic tank, effluent filter and 011,aA / ` G dispersal cell must be serviced / maintained by as per management plan provided plumber, Vr maintained as per appheab*endwlyrdffywMS r me sysren ana suonn re me,aunty Dory on piper not Ices raga in x rl inetypt it. SBD-6398 (IL 08/14) PROJECT Thomas Christensen System PLOT PLAN ADDRESS 1280 Ctv Rd J River Falls Wi 54022 SE 1/4 NE 1/4S 15 /T 28 N/R 18 W TOWN kinnickinic COUNTY ST.CROIX SYSTEM ELEVATION 95.5/95.3/95.1 2' below grade 3/9/20 4 DATE BEDROOM — CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1200 # of EZ Flows24 Ilk BENCHMARK V.R.P. TOP of concrete porch ASSUME ELEVATION loo, Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. Same as benchmark Scale = 1 /4" = 10' >61, Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Lon 12" 5.6ft^2/pair of end caps g Grade at System Elevation Q �C O PY Property Line Well 3-3' X 80' Cells with >3' spacing Existing 4 Bedroom House 20' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Q� Huffcutt Combo Tank �c\Go County Road J B-1 55' r 3% Slope to be >5' B-3 50, 95' 30' i Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/9/20 Owner: Thomas Christensen Location: SE1/4 NE 1/4 S15 T28 N,R18W 1280 Cty Rd J Kinnickinic System type: In -ground absorbtion system(conventional) Manuals Used: In -ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Sectio 9. Pump Curve Signature License nu PROJECT Thomas Christensen SE 1/4 NE 1/4S 15 /T 28 System PLOT PLAN _ ADDRESS 1280 Ctv Rd J River Falls Wi 54022 N/R 18 W TOWN kinnickinic COUNTY ST. CROIX SYSTEM ELEVATION 95.5/95.3/95.1 2' below qrade 3/9/20 BEDROOM 4 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1200 # of EZ Flows24 BENCHMARK V.R.P. Top of concrete porch ASSUME ELEVATION im, Filter Lifetime Filter ❑ BOREHOLE O WELL sH.R.P. same as benchmark 4 ALong Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 7:�5.6ft^2/pair of end caps Grade at System Elevation Existing 4 Bedroom House B. M.�&- : All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Well Scale = 1 /4" = 10' Property Line 3-3' X 80' Cells with >3' spacing 5' \60,5 20' Huffcutt Combo Tank 5 5' 3% Slope to be >5' B-3 95 Road J 30' Cross Section of a Three Cell EZ Flow In -Ground Dispersal Component Design Flow 6L6 = Loading Rate = Required dispersal area OW Sq Ft Required dispersal area 1.7oV + 50 (EISA) = 2V (number of units) Cell #1 System Elevation: r-5 Ft Final Grader .,-�_ Ft Geotextile fabric to meet Comm 84.30(6)(g) Wis. Adm. Code Minimum of 12" of cover over top of cell Two observation/vent pipes to be provided per cell Not to scale Cell #2 System Elevation: Y—U Ft Final Gradejz,7> Ft Cell#3 �jj System Elevation:: _4E/Ft Final Grade: ?Z/ Ft ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ownerBayv Ti-1OA S V1 i L1SfI L. e-+1kl5TVW,<W Mailing Address I. mat :G ��1 —i� 1 z,D 6-T.-M. -' Z�rd (Verification required from '9 ;-- Department for new construction) City/State Rt V&K TA / / St W1- Parcel Identification Number 02Z- /042—,�t) —00l) LEGAL DESCRIPTION Property Location 5E '/. , )\J t '/. , Sx. Subdivision Plat: Certified Survey Map # T Lg NR 18' W,Townef K1N,#(MNN/C Vohtme , Page # Warranty Deed # g2q 10A3 (before 2007)Vol me . Page # Spec house 0yespato Ina tines idmdifiu6ta�yo❑oo SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # Improper use and maintenance of your septic system could result in its premature failure to handle wastes Proper maintenance consists of pumping our the septic tank every three years or sooner, if n a licensed ceded, by pumper- What you put inb the system car. affect the function of the septic tank as a treatment stage in the waste disposal system_ Owner maintenance responsibilities are specified in §SPS. 393.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. 7be property owner agrees to submit in St Croix County Plarming & Zoning Department a ceatifiration form, signed by the owner and by a matter plumber, journey® plumber. restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in Proper operating condition and/or (2) after lion and pumping (if necessary), the septic t ink is less than V3 full of sludge. Uwe, the undersigned have read the above requirements and agree to rnaustain the private sewage, disposal system with the standards set forth, he n, as set by the Department of Safety And Ptofessu mat Services and the Department of Natural Resources, State of Warna9a Certification stating that your septic system has been maintained mutt be completed and returned to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. the certify that all statements on this form are true to the best of my/our knowledge. I/we amtare the owners) of the PmPcq dwCoW above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrWaiii; / i SIGNATURE OF APPLICANT(S) .3 DATE *'*Any information that is misreptesented may result in the sanitary Permit being revoked by the Planning & Zoninrg Departmet — Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if re fuenee is made to the warranty deed. (REV. M/12) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of_ "1LE INFORMATION Owner Permit # G1 O DESIGN PARAMETERS Number of Bedrooms _ 0 NA Number of Public Facility Units Estimated flow (average) (] aYda Design flow (peak), (Estimated x 1.5) 6G suds Soil Application Rate '�� avda /filz Standard Influent/Effluent Quality Fats, Oil & Grease (FOG) Biochemical Oxygen Demand (BODE) Total Suspended Solids (TSS) Monthly average* 530 mg/L 420 mg/L ❑ NA 5150 mg/L Pretreated Effluent Quality Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) Fecal Colifomt (geometric mean) Monthly average 530 mg/L 530 mg/L 7'j�NA 510° cfu/t 00ml Maximum Effluent Particle Size 36 in dia. ❑ NA Other. NA "Values typical for domestic wastewater and septic tank effluent MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity l ❑ NA Septic Tank Manufacturer Cl NA Effluent Fitter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity l ❑ NA Pump Tank Manufacturer ❑ NA Pump Manufacturer — ❑ NA Pump Model";,4 ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter 0 Peat Filler ❑ Mechanical Aeration ❑ Wetland Cl Disinfection 0 Other. Dispersal Cell(s) ❑ NA Ground (gravity) 0 In -Ground (pressurized) El At -Grade ❑ Mound ❑ Drip -Line ❑ Other. Other. 0 NA Other: 13 NA Other. ❑ NA Service Event Service Frequency (Inspect condition of tank(s) At least once every: 2 m a s(a) (Maximum 3 years) 0 NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: S Er 0 orirt(Fsi,a) (Maxknum 3 years) ❑ NA Clean effluent filter At least once every: mordh(s) year(s) 0 NA inspect pump, pump controls & alarm At least once every: S 0 month(a) NA Flush laterals and pressure test At least once every. ❑ month(s) ❑ year(s) NA At least once every: 0 year(s) NA �Iher. NP. MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certifications: ster Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspection must bnude a visual inspection of the tank(s) to identify any missing or broken hardware, identify arty cracks or leaks, measure the vol m oir�e of combined sludge and scum and to check for any back up or ponding of effluent on tine ground surface. The dispersal cell(s) s all 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 (%) or more of the tank volume, the entire contents of !:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 1411 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, Pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POW $ Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page _ of _, START UP AND OPERATION For new construction, prior to use of fhe 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). If high Concentrations are detected have the contents of the 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(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of affluent. To avoid this situation have the contents of the pump tank removed by a Septa" Sending Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump centrals to restore normal levels within the pump tank. Do not drive or park yeh6das over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area wdhln 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$: antibiotics; baby wipes; cigarette buts: -condoms; cotton swabs; degreasers; dental floss diapers: disinfectants:. fat: foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease: herbicides; meat scraps; medicsitbths; OR; painting products; pesbades; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propefiy and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property 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 compliaant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption systelm. The replacement area should be protected from dWwbance and compaction and should not be infringed upon by requited 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 campy with the ride in effect at that time, ❑ A suitable replant area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a homing tank may be installed as a last resort to replace fhe failed POWTS. 2", site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be recorwhuGed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in affect 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 Name —" Phone POWTS MAINTAINER Name Phone 71 i— SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone 72 L Phoner jG—L` This document was drafted in corOa wkh dwpfer SPS 383.22(2)(b)(1)(d)&(8 and 383.wi), (2) 3 (3), Wlamnsim Ad inMalive Coro. 2 0 1 4 0 0 4 8 A SA l+il:%1?rUJ SECTION A -A 1.1921 Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Tank Model Number Total Tank Capacity / - Max. Bury Depth Filter Manufacturer Filter Model Number Minimum Pump Performance Required GPM' (a3 p,_�FtTDH Outlet Manhole Min 4" Above Grade With Locking Dac ice. Inlet Manhole < 6" Below Grade Sealed Watertight -� . — — -i — Finished Grade Outlet Filter r -- - Inlet Baffle Inlet IX IX Switch Sett}ngs and Reserve Capacity Tank Volume = GPI Distension. Inches Volume Gal. (reserve) A 6 - S z� 5 (alarm) B 2 (dead) D Total S 1 7,4 i Pump Manufacturer 1 Pump Model Number Alarm Manufacturer (/ Alarm Model Number Switch Type /h ec `e Total Dynamic Head (TDH) - Feet —� Elevation Head (� Distal Preeaure - Network Loss ^ Force Main Loss �• Total /O Manhole Min. 4" Above Grade Securely Mounted With Locking Device - Weather -proof I Junction Box • �� Vent Min 12" Disconnect Above Grade Means With Vent Cap 1w, _ Weep B44 Hole Qff Elevation C Bottom D Elevation �57 Ft GENERAL INSTALLATION: The septic/dose 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 service complies with NEC 300 and Comm 16.28. 02/05 U Page of 250=SERIES 113 hp Sump/Effluent Pumps for Professionals! ALL MODELS FEATURE: • Rugged 1/3 hp motor, oil filled with thermal overload protection. • 1/2" solids handling. • 1-1/2" discharge. • Hermetically sealed motor and switch cavities, and permanently lubricated bearings. • Liberty's UNI-BODY casting -a solid, one- piece housing that eliminates the lower motor seal ring found on other pumps. • Epoxy powder coat finish • Vortex style impeller for superior solids -handling. Made of high temperature engineering polymer. • Fasteners - all non -corrosive stainless steel. • 416 stainless steel rotor shaft. 250-series Cord Lengths Model 101 251(-2) 351(-3) 501(-5) 250 Standard Optional Optional Optional 251 Standard Optional Optional Optional 253 Standard Optional Optional N/A 257 Standard Optional N/A N/A 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 250 with 35' cord, order 250-3 Model 250 Manual, no switch. EFFLUENT MODELS Model251 Quick -disconnect wide-angle float, mercury -free. G. Certified Dual safety certification fw �nFRD C US the United Statesand Canada Specifications ere wbiect to charge without notice. MOTOR SPECIFICATIONS: 1/3 hp 115V 5.2 amps 60Hz Thermally Protected & Permanently Lubricated (PSC) Permanent Split Capacitor Maximum Fluid Temperature:140"F DIMENSIONAL DATA: Weight: Model 257: 20lbs. Height 10.5" Major Width:9.6" (manual model 250) PERFORMANCE CURVE 25 20 PERFORMANCE CURVE Iq U.S. Gallons Per Minute 38 78 114 156 192 Liters Per Minute Model 253 Wide-angle float with series (piggy -back) plug, allows manual operation of pump. m m m y Model 257 VMF VMF switch, magnetically operated vertical float - operates in a 10" diameter sump. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com copyright® Uberty Pumps, Inc. 2017 All rights reserved. LLrr2500-R5/l7 SCC ArcGIS Web Map '.� 1286 CIFY RD ) lot 1280 CIY RD ) ;fir 5 t r t .a.. :u CZ I n44-1C,-1:i 3/13/2020 1:05:52 PM 1:1,128 0 0.01 0.01 0.02 mi Percent Grade Classes 20 - 25% Public ROW Unit Limited Common Element i1 1 � . t , r 1 . .0-12'/u 0 0.01 0.02 0.04 km ----- > 2ga/a Lot and Units Park General Common Element ,'.12 - 20%' Outlot WDNR, SCC CDD, SCC CDD, Eaglevi. and SCC CDD, FEMA, SCC COD Site Address Points Lot QTax Parcels Web Appeuilder for ArcGIS SCC CDD I WDNR, SCC CDD I SCC Coo and SCC Highway Dept I FEMA, SCC CDD I National Geospalial-Intelligence Agency (NGA); Delta State University; Earl I Eagleview and SCC COD I 0 Wisconsin Department of Sa - off Mims IP Division of lndu �-r •:,A I�_—L.'�, V� o SAIL OR . w )nib CS T acau - O q i Page 1 of 4 p V Nwires Utll wmr Ora . J' vrra rwm. u uu iA ' Attach complete to plan on paper nqt n 81 x 11 inches in size. Plan must include, but not li ited to: nefe nce point (BM), direction and percent slope, o�700 Coirlg, , and location and distance to nearest road. Please print all information. Personalmrm mlatiun you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (in)).✓ County ST. CROIX Parcel I.D. 022 - 1042 - 20 - 000 Re by D e w 37,3 21020 Property Owner THOMAS W. & LISA L. CHRISTENSEN Property Location ❑ El Govt. Lot --- SE 1!4 NE 114 s 15 T 28 N R 18 E (or) W Property Owners Mailing Address 1280 C.T.H.I Lot # — Block # — Subd. Name a CSW - City State Zip Code Phone Number RIVER FALLS, I WI 1 54022 ( 715 ) 307 - 0728 ity []vllage own Nearest Road XWNIOUNNIC I C.T.H. J New Construction UseEJ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD eplamment ❑ Public or commercial - Describe: Parent material silty sediments over sand and gravel Flood Plain elevation if applicable NA ft. General recommendations, comments recommendations,and reConventional In -ground trenches -- 0.6 loading rate — pumping required 1❑ Boring # ❑ Boring El Pit Ground surface elev. 97.53 ft. Depth to limiting factor 70 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Clu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD#f 'EfF#1 I -Eff#2 1 0-13 10YR2/2 1 3fa&sbk mvfr es 3vf-co 0.6 0.8 2 13-31 IOYR3/3 -- I 3fabk &sh cs 2vf-m 0.6 0.8 3 31-49 IOYR3/4 - is lmsbk ds cs Ivf-m 0.7 1.6 4 49-70 IOYR4/6 - s Osg ill - Ivf-m 0.7 1.6 2 Boring # Boring 97.68 66 El Pit Ground surface elev. ft. Depth to hinting factor /' in. Shc icafion Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz- Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Rods GPDIfff 'Eff#1 I 'Eff#2 1 0-14 IOYR2/2 -- 1 2f-msbk mvfr cs 3vf-co 0.6 0.8 2 14-26 10YR3/3 - I 3fabk dsh cs 2vf-m 0.6 0.8 3 26-40 IOYR3/4 Is lmsbk ds Cs lvf-f 0.7 1.6 4 40-66 10YR4/6 -- s Osg dl -- - 0.7 1.6 6 - fractured Isbr Effluent 41 = BUU > 3U < "ZM rtxyL and TSS >30 < 150 mglL 'Effluent #2 = BOD, < 30 rtngrL and TSS < :io rtxyL CST Name (Please Print) Sig thw Q CST Nurriber MARY JO HUPPERT (Hollisters Soil Testing&Design) / t 224832 Address Date Eva ation Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 08 - 22, 2019 715-426-1775 SBD-8330 (R07/13) Property Owner CMSTENSEN, Thomas & Lisa Parcel ID # 022 - 1042 - 20 - 000 Page of 3 V Baring � # 0 Pit Ground surface elev. 96.35 ft-Depth to luriting factor 6. Soft Application Rate horizon Depth in. Dominant Color Munsed Redox Desaiption Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 I 'EfF#2 1 0-14 I0YR2/2 sil 2f-msbk mvfr cs 2vf-co 0.6 0.8 2 14-24 7 5YR3/4 sil 2fabk dsh cs Ivf-56 0.6 0.8 3 24-36 7.5YR3/4 -- sl 2fsbk dsh cs lvf--m 0.6 1.0 4 36-56 10YR4/6 -- s Osg dI cs Ivf-f 0.7 1.6 5 56-62 IOYR4/6 — Is Osg df as — 0.7 1.6 6 6 66 IOYR4/6 f1f7.5YR4/6 Is Osg dl — — 0.7 1.6 1-1 Boring # Baring Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 I 'EW2 -4-4 Bonng # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal APoiiration Rafe ��Redox ®®®®®® D.. Color .. ..Cont. Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 rngiL Effluent #2 = BOD, < 30 nxyL and TSS < 30 m g/L SB042)0(ROM i) Plot Plan Page 3 of y PROPERTY OWNER: T4i0/A&5 IA)4 /-s L= 6*KIST&4.S&4 Legal Description: FM-- I�J lnff- 4��A OF-I-tiE Nle jj% SEC...Ia,yzg4 'R18W/ TbW/J of KINmLCK%hWI Ji' omx- CO MI Wi9 Ozz- 10yZ-2D-rCb / IZ40 /9sH. J- ii �I t 1:AssLt /DO. TOP C. PotZc�i r.ro' Aeo..F 6RONN�, \P-.Nf O 'top DRy WELL ?'P nF VENT— `i8—_y .g3IAB0VE GROU.Np in == 40 FT. (except where noted) M== backhoe pit 1.21 S 1 %Q q�.00' o � 'C Fr0- W r:WE C: r.+I. ,S Site location: G r; North