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Home My WebLink About042-1089-10-300Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. CFOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 624809 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Lew, s.15.04 (1)(m)]. Permit Holder's Name. City Village Township Parcel Tax No: LEN TRIEBOLD I TOWN OF WARRFKI 1 042-1089-10-300 Elev. IBM Description: R_ I TANK INFORMATION TYPE MANUFACTURER R\ 1 CAPACITY Septic _ Dosing Aeration TANK SETBACK INFORMATION ®WMAEMMM® a., mmmm�m Mw=1W1.1 WA= ®■„1-„-,--- M"um�= PUMP/SIPHON INFORMATION Manufacturer Demand GPM Mode um TDH L ft Friion L s Syst m Head TDH Ft Forcernabil Le gt DI.Dk.j JDAt. to ell ELEVATION DATA STATION BS HI FS ELEV. Benchmark 7 /��• 18.3 ! O AIL 13 Ors{ O ._j Bldg. Sewer 2 •6 ID1• g St/Ht Inlet 3 .Z I /po . G SVHt Outlet 3 •J j � Me Dt Inlet Dt Bottom Header/Man. ,y Dist. Pipe Bot. System 7•T 5 Final Grade .s r�.3 litr a•`f �o .% SOIL ABSORPTION SYSTEM 1 L. J-1 b /_ L & M Jr ii BED/TRENCH DIMENSIONS Width 1 Len th ,� No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR UNIT V-'(•/-wJ• % , Model Number: t DISTRIBUTION SYSTEM Header/Mrcl b oU t/ Length Dia Distribution Pipe(s) Length Dia Spacing x Hole Size x Hale Spacing Vent to Air Intake SOIL COVER ■ Pressure Svstems Only xx Mnund Or At -Grad. RC Marne Only Depth Over eetl/TrenU Center �7 3 _ `t Depth Over Betl/Trench Edges> � 7-% ( xx Depth of Topsoil m Seeded/Sodded O Yes 0 No xx Mulched Q Ves j& No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: No Address Available ,Vic-) I "^' ' NS r ^,LIAr � % I,.S r et:�.bn. 1.) Alt BM Description = f''t ,�`^/ Cow ow V �4s 0 h We-4 EJ 2.) Bldg sewer length = 2 q ' II / - amount of cover = 7 J e tt L—U ,�s ( kA'— Plan revision Requiredti 0 YNo / Use other side for additional iniormati mati�nl r-( OLLJ SBD-6710 (R.3/97) Date Insepctor's Signature Can. No. r7o( 2r�renn SAN-2020- IDZ SYST 1. Se dis as _ Z , p ��t MAY 01 2020 Safety and Buildings Division 201%WWashington Ave., P.O. B®x 71w Madiso 5 7— 2 sanhnry Paint Nmnba(to be filled in by Co.) &24 St. Croix County even tApplicati O=nIn we Transaction Number aocordmcc with SPS 393212), this. ALL Coda submission of this form to We appsopri ste governmental unit is required prior m obtaining a sanitary permit Note Application forms for stsasowned POWTS are submitted n the Department of Safety and Professional ServiS Personal information you provide may be used for secondary ----- Project Address (if different than mailing address) purposes in aeeurdmx with the IAW, S. 15.04(I m), Stars. L Application Information - Please Print AN Information Property Owner's Name v Paad s Property � 4-5— tang 7 rddressi J/-�f j/�,L� GOVL L Location cmvt �) T N; or W Cityot w; Zip Code Phone Number 11 of Batlding (chock all that apply) Lot err 2Fandy Dwelling -Number ofBedmy�i f — .7, Subdivision Neste c 1\� ❑ PublicKbmmveiai-Deaatbe Use fork s 1 d City of ❑ state owned -Desmbe Use ❑ V'� o�—_S(�'�� M, 3 ��e III. of Permtt: (Check only one box on line A. Complete line B if applicable) A- ❑ Repbseem®t System ❑ TreetmenvHoldtog Tank RNIa�um otih' ❑Omer Mod�cetionm Eaistmg s'� (eviam) B. ❑Pamir Renewal ❑Permit Revision ❑Qsange ofletumba ❑Permit Trnosfam New List Pteviom Perna Number and Daft lssard Before Expiation owner IV of POWTS S stem/Com onent/Device: Check all that apply) *Iw-Presmr-d bsGmuod ❑ Pressurizod In-Grormd ❑ AtGrade ❑ Motmd> 24 a of suinble sotl ❑ Mound <24 in. of suitable soil ❑ Holding Task ❑ Olher Dispersal Companant explain ❑ P�eanttwrt Dmice (oVlatn) V. Uis 132 reatmeat Area Information. Flow(gpd) Design Soil Applieatran Rate(gpdsf) Dispersal Apra Required st) y Dispersal Area Proposed( System - , Tank info Capacity m Toth Gallon a of Units M orshemerCialions \ IL/Li m -V% fCl�/ i CJ , 'o�-i 2 rn EEO o 0 5. New Turks Fmm Taola septic or Holdbg Tad Dosing Chamber VIL Responsibility Statement a and responsibility for installation of the POWTS shown an the attached plans. 's Name (Prim) C signature hIP/MPRS Num6a 7 Business Phone Number r Phnober-s Adding; (Street, ,Sena, ) VM Coati /De rtm Did: Use only Approved ❑ ptsay\pr d ❑ OwnAus'�an rDertial Pamir Fee $ D Issued Issued ��/�Z-O Agar Sigosdae,t `futre _ - DL Conditions of ApprovaVReasoas for Disapproval /� t— Ic OWNER: )J MVtAtC4 � �cg--Q Lt ct t t is tank, effluent filter and � fe rsal cell must be prviced I maintained a..e t �. 9 ea+�� IL(. Parµ�t�--1 r management plan provided by plumber, rav?� 2. All rot der gsaeas antisqbens the Cam oro ' pa as lcw"m�a to: a i.3ea iv as per applicable code/ordinances. r aatita�13 p enpac� rpr%a SED-6398(R- 11/11) e:(. �njSe D 518%Z4z*) System PLOT PLAN PROJECT Len Triebold ADDRESS 1065 70ih Ave Roberts Wi 54023 NW 1/4 NE 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 98.5/97.0 4.6 below grade 4130/20 BEDROOM O � 6 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SI J MOUND i I E HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 p B CHMARK V.R.P. Top of wood fends DOSt ASSUME ELEVATIO 00' Filter Lifetime Filter BOREHOLE O WELL *H,R,P. same as benchmark 4 Scale = 1 /4" = 10! 1� Property Line Driveway to 70th Ave '/350' J *� a40i IYM 2-3' X 66' cells with >3' spacing 102' 100, 12% slope All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 >6" of Cover 4' Line 35' 079 �- 04 af " en 1 Li W N A24% /b 35' _,,. I .M.B Quick4 Standard Leaching Chamber with 20.0 ft2 of Area \5.6ft^2/pair of end caps .-Grade at System Elevation Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/30/20 Owner:Len Triebold Location: NW1/4 NE1/4 S 32 T29 N,R 18W 1065 70th Ave Warren Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and Contigency Plan 7. Filter Cross Section /1 Signatu License rtuatber #226900 e! ' S F D 51SIz020i System PLOT PLAN PROJECT Len Triebold ADDRESS 1065 70th Ave Roberts Wi 54023 Ir NW 114 NE 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 98.5/97.0 4.5' below grade 4/30/20 o DATE BEDROOM G N CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK T_i o x _ o 1000 gallons MOUND SEPTIC TANK SIZE 9 LIFT TANK SIZE DOSE TANK SI -; ¢ J YgLD,ING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 c B CHMARK V.R.P. Top of wood fenC� 6 POSt ASSUME ELEVATIO 00' Fllter Lifetime Filter BOREHOLE O WELL •H.R.P. sameasbenchmark Scale = 1 /4" = 10EB a'�� B�iyfl ce Li Property Line V60, . aa,l.2 Q V F04 s�j�izo . Pro 3 Bedroom House 150 ; 10 2-3' X 66' cells with >3' spacing Driveway to 70th Ave 20 102' r p�„•,_ j,� , Vents 5, IOC+4t& 5(6VI - 350' nrota B 30, 35' 35' M.8 8 5' B-1 12% slope f All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent >6"jgI Quick4 Standard ?4' Leaching Chamber with 20.0 ft2 of Area ::�5.6ftA2/pair of end caps Grade at System Elevation Line System PLOT PLAN PROJECT Len Triebold ADDRESS 1065 70th Ave Roberts Wi 54023 NW 1/4 NE 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 98.5/97.0 4.5' below grade 4/30/20 3 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of Wood fence post ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL-H,R,P. same as benchmark Scale = 1 /4" = 10' rm.n Pro 3 Bedroom House Property 150'; 10' \23'' cells spacing Driveway to 70th Ave 20' �'n nVQ D B-3 U Vents 100' u )� _ 1 35' 0' , 35' slope Vent >6., Quick4 Standard of Cover Leaching Chamber All piping shall be ASTM SDR 30/34, within 5.6 ft 20.0 ft2 of Area p p g 5.6ft 2/pair of end caps 10' of tank, piping shall be ASTM F891 12" 4' Long Grade at System Elevation Property Line 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates Typical Installation Vent Grade 4" &'30/34 Septic Tank 5' Lone�l 5' Grade at System Elevation Spacing 5' 61 To be >1' above grade Finish grade elevation 102.0' ,Vent 1" at System Elevation 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A 98.5' B 97.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _Of ILE INFORMATION Owner Permit # )ESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units ! -fi!f NA j Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) gaviday Soil Application Rate �! al/da /flz ! Standard InfluendEflluent Quality Fats, Oil & Grease (FOG) Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) Monthly average* 530 mg/L 5220 mg/L ❑ NA 5150 mg1L Pretreated Effluent Quality Biochemical Oxygen Demand (BODs) Total Suspended Solids CM) Fecal Coliform (geometric mean) Monthly average :M mg/L 530 mg/L NA 510' cfu/100ml iMaximum Effluent Particle Size Ya in dia. ❑ Other NA "Values typical for domestic wastewater and septic tank effluent IAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer NA Effluent Finer Manufacturer [ ❑ NA Effluent Filter Model l� ❑ NA Pump Tank Capacity giaI I NA Pump Tank Manufacturer NA Pump Manufacturer IAINA Pump Model NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA In -Ground (gravity) ❑ in -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other. Other. ❑ NA Other: ❑ NA Other ❑ NA Service Event Service Frequency (Inspect condition of tank(s) At least once every: _7 ❑ ea s(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Ya) of tank volume ❑ NA Ilrspect dispersal oll(s) At least once every:ffl ❑ mordh(s) (Maximum 3 years) ❑ NA euent filter At least once every: lyear(s)Clean r onth(s} earls) ❑ NA nspect pump, pump controls & alarm At least once every: ear(s>a) NA =lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) NA 17ther. At least once every: ❑ month(s) ❑ year(s) NA ether. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 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 ccmbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(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 Igulatory authority. Men 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 shad be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. I8dI other services, including but not limited to the servicing of effluent filters, medwnieal or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory autho0t;• within 10 days of completion of any service event Page _ of _, START UP AND OPERATION For new construction, prior to use Of the POWTS check treatment tank(s) for the Presence of painting products or other chemicals thrit may impecle the treatment process and/or damage the dispersal cell(s). If high concentraiiOrts 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 sal conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above norms) highwater levels. When power is restored the excess wastewater will be discharged to the dispersal MAW 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 dye effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal leve s within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 115 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 Ide of ; fat foundation PoOn drain antib looks, baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers: (sump pump) water, fruit and vegetable peelings; gasoline; grease: herbicides; meat straps; medications; oil; Painting Products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanentty taken out of service the following steps shall be taken to insure that the system is prope'iY and safely abandoned in compliance with chapter Comm a3.33, 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, afl tanks and pits shall be excavated and removed or their covers removed and the void space filled with sail, 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 compham replacement system: *A— suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption system. he replacement area should be protected from disturbance and compaction and should not be infringed upon by requiried setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soli and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruW in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The 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 reconstructed in place following removal of the biomat at the infiltrative surface. 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 OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS — POWTS INSTALLER Name Phone , ' POWTS MAINTAINER Name r'� s — Phone i/ J — SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name ,r � Name lux Phone L ) Phone 1 '71 1 This doc men t vres drafted in corpflanoe with chapter SPS 383.22(2xb)(1)(d)&(1) and 363.Wi), (2) & (3), Wisconsin Administrative Code. 2014004aA J� .. �v�� •dvGv SECTION A -A 1921 Parcel #: 042-1089-10-300 Valid as of 05/08/2020 09:16 AM Alt. Parcel #:32.29.18.492A-30 TOWN OF WARREN ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): LEONARD L & DIANE P TRIEBOLD PO BOX 25 Physical Property ROBERTS WI54023 Address(es): Information Not Available Districts: Dist# Description Parcel History: 2422 ISCH DST CROIX CENTRAL Date Doc If voimage Type 1700 1 WITC Abbreviated Description: Acres:35.550 SEC 32 T29N R18W PT NW NE& NE NE BEING 05/23/2008 875W4 23/5530 CSM 02/21/2006 818907 / EZ-U 11/04/2002 696846 2033/256 WD 06/25/2001 649231 1667/068 TD T SM 23-5530 more... Plat Tract (S-T-R 40'/41601h GL) BbcklCondo Bldg ' 5530-CSM 23-5530 042-2008 32-29N-18W LOT 03 2020 Valuations: Values Last Changed on 09/04/2018 Class and Description Acres Land Ynorovement Total G4-AGRICULTURAL 1 10.0001 1,300.00 0.001 1,300.00 G5-UNDEVELOPED 1 6.0001 11,000.001 0.001 11,000.00 G51VI-AGRICULTURAL FOREST 1 19.5501 48,900.001 0.001 48,900.00 Totals for 2020 General Property I 35.550 1 61,200.001 0.001 61,200.00 Woodland 1 0.0001 0.001 0.001 0.00 Totals for 2019 General Property 1 35.5501 61,200.001 0.00 61,200.00 Woodland 1 0.0001 0.001 0.001 0.00 2020 Taxes Taxes have not yet been calculated. Key Primary ST. CROIX COUNTY SEPTIC TANK IvMAINTIa'NANCE AGREEMENT AND OWNERSHIP CERTII7CATION DORM OwnerMuyer Mailing Address Property Address (Verification required from Planning & Zoning Depantnient for new ronstmebou.) City/State Pamei Identification Nui.aber LEGAL DESCRIPTION q Property Location ��l/Z/4 , _'/a , See �' , T . �l_.N R1— W, Town of'__ f/� (/'CPfi✓ Subdivision p� tom_ �- _ Lot # Certified Survey Map # r 't 6T� �87 , VC -tune �i Page # =j Warranty Deed # fps%% _ ,Volume ____� Page # Spec house yes no I.oi tiro .. identifiable (9 on SYSTEM MAINTENANCE AND OWNER CERTITIC'ATION lmproper use and mainumance of your septic system could result in its promramre failuru to lran dle wastes. Proper Maintenance consists of pumping out the septic tank every three years or sooner, it 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 disposalsystem Owner maintenance responsibilities are specified in §Corti. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix Ckmuty Planning & Zoning Department a wrti£ication Torn, signet) by the owner and by a master plumber, journeyman 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 iapeadon and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above ruluireurens mid ugeve to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commercc and die Dopartment of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completal and returned to the St. Croix County Planning & Zoning Department within 30 days of the three yew expiration date. I/we certify that all statements on this form are we to the best of mylour k nowlcdge. Ilwe anJure the ownetts) of the property described above, by virtue of a warranty deed recorded in Rugister of Dcods Office. Number Fbedrooms.—? SIC ATORE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Deparitneat. *** 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. M". 08I05) OF OD I I I i i i.l I ' � i � 1 I i I •I I , F I I j ; tl.mW® mmeo OiN � I I 1 J➢I�il ..s • a , 1 a --------------- ---- I li i. -,.. - wR.M1 41: I i �I I 9RW9® I (hll fl 0 I I ai -- .11 �r -• __ -- -------- ----- - ---- --- ----- ------ ------------ �W� :k r I I 11 I I ±7x 1' I I I I I I I I I I I I I I ME I -WED WaL LINE Be PANEL DELAYS MM" SO.FN LEVELL inL EK--; LALA�CD csr- 2026- MAY 01 2020 vl)n)r Wisconsin Department ofcojnmerce SO EVALUATION REPORT Page of Division of Safety and Building-"r,ix Co.i,lty s _ -.-,. -" �-RB m 85, Wis. Adm. Code county Attach complete site plan on paper not less than 8 1Q x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O � pZJ Please print aff information. Re 'awed by Date PM l fi fm ation you prmsft may Da used fa a Mary Purposes (Privady Law, S. 15,04 (1) (m)). Property Owner le r Property Locatio 2 xA Govt. Lol � 114 � A S 32—T j�—N R U E (o W Property Owners Mailing Address b 6S `70� Lot # — Block # �— Subd. Name or CSM# t;1194rre14 Cay State, Zip Code Phone Number w, a ( , ❑ City ❑ Village ` Zown Nearest d ; o�� New Construction Us Residential / Number of bedrooms Code derived design flow rate y.Y7J _ GPD ❑ Replacement ❑ Public orca/p/lnerdial - Describe: Parent material Q 4Xil/ Flood Plain eleva " Aao—•p*able /r�i fr----'--- R., General comments �� WeX — wt r24WwP and recommendations: - F� °J'y` _ �,,,ri X 0 _ System Type CrSystem Elevation 7 Boring # Boring . Pit Ground surface elev. ft. Depth to limiting factor M2 in. Soil Application Rafe Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDMf 'Eft#1 /EfI#2 sY o i CY # ❑ Boring G1 CI. Pit Ground surface elev ft. Depth to limiting factor �-6--r--=— in. Soil 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 'EB#2 f - in �� s / ✓ , 7 - sa t111.4-1L Effluent #1 = SOD. > 30 5 220 nng4 and TSS >301 j Effluent #2 - BOD, 5 30 mgll and TSS < 30 rngrL CST Name (Please Print) VAnature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 17 w— 7 7 715-246-4516 073 old P Property Owner Parcel ID # Page —of �TEf M. M.M.P.0691M Mr.�■■M=®r' ■ Depth to limiting�. ....Structure ■ �. . Effluent #1 = BOD, > 301220 mglL and TSS >30 c 150 mg1L ' Effluent #2 = BODO 130 mg& and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sao-vwm.um� Soil Test Plot Project Name Len Triebold Address 1065 70th Ave Roberts Wi 54023 Lot Subdivision 3TM #226900 4/30/20 N W 1/4 NE 1/4S 32 T 29 N/R18 W Township Warren Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of wood post System Elevation 98.5/97.0 *HRpSame as Benchmark =1/4"=10' Driveway 0[h Ave S 1� 102' 100' B-2 35' 98' 12% slope 150' A1S rty ine �S . tt ��1FrtdL Q BB-33 0 '.M.8 Line System PLOT PLAN PROJECT Len Trfebold ADDRESS 1065 70th Ave Roberts Wi 54023 NW 114 NE 1/4S 32 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX JJ SYSTEM ELEVATION 98.5/97.0 4.5' below grade 4/30/20 3 N E a DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK l c o 1000 MOUND SEPTIC TANK SSIZEgallons LIFT TANK SIZE DOSE TANK SIZE LJmi E E HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 u ,', L BENCHMARK V.R.P. Top of wood fence post ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL "H.R.P. Same aS benchmark Scale = 1 /4" = 10' Property Line Driveway to 70th Ave 350' M 150' 2-3' X 66' cells with >3' spacing 102' Vents 100, 30 B 35' 98, 12% slope All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent 02 M 4 ! Neld Isle„ s -1 t om e 10, 20' B-3 35' ".M.8 I >61, Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6f A2/pair of end caps 4' Long 12 Grade at System Elevation Line L+3 uh F 29vx a' ZONE X f Y 'A ----------------- t k. r, d 0 400 600ft • DISCLAIMERThis map Is guaranteed to be d+�Y- accurate, mrten. cu t or canplaba en0 mnGYsW�sbavni are reslbM1slbiiiry of Ode Una the YSBI VOL 14`PG 39 SM VOL 2 PG 5� CSM V L $ P 2352 3L 26 PG 5 51 j20 PG 5 124 »t+2 PG 5 34 k SCC ArcGIS Web Map 4 CSM VOL 23 PG 5530 5/6/2020 9:23:26 AM 1:4,514 Percent Grade Classes 20 - 25% Lot — % Tax Parcels Flood Hazard Areas 0 0.03 0.05 0.1 mi ---�- 0 - 12 % > 25% Limited Common Space or Park I= Subdivision/CSM Boundaries =1 ZONE A 0 0.04 0.09 0.17 km L,-,-- 12 - 20% GMZONE AE Wa DNR SCC COD. SCC COD, Esgl%and SCC COD, FEW, SCC COD Public ROW Private Right -of -Way Shoreland Zoning Web Appautl for ApGIS SCC COD I WDNR, SCC Coo I SCC COD and SCC Highway Dept I FEW, SCC CDD I National Geospagal-InlNlge A99M (NGA); Dana SWh, Unhen:ay; Eed I EagM and SCC CDD I