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HomeMy WebLinkAbout026-1064-10-300 (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)) Permit Holder's Name: City Village Township Michael & Kristie Faust TOWN OF RICHMOND CST BM Elev.Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration F/ � Exisl-1 �a.�e -10v TANK SETBACK INFORMATION M®Mm®w M�Ml m-- s. . �W—\--_M �—,,__ ®-/.-, IALWAN' PUMPISIPHON INFORMATION Manufacturer Demand GPM MogumbeDFr lion Ls Syst Hea D Ft Forth Dia. Dist. to VvV STATION BS HI FS ELEV. Benchmark`' %q/ I �T wz 5,2. a 9jg Alt. BMBt .4- C �[. 3.) / 11 r V-2 Bldg. Sewer SUHt Inlet CC x�S ` SUHt Outlet -7- `? '�j q,J- Z J8 Dt Inlet Dt Bottom Header/Man. 'i �J p 30 p�, L47 _1�� Dist. Pipe /may Bot. System T 4: 73 0 Final Grade %. 1 �/ �Dr 37 Stc !�)e/ 4itr 3.) RD9. G7 SOIL ABSORPTION SYSTEM / * % FZ ;:--IoL,J5 BEDITRENCH DIMENSIONS Width r� 5 Length "-'7� ( No. Of Trenches Z PIT DIMENSIONS No. Of Pits Inside SETBACK SYSTEM TO P/L 5 BLDG WELL LAKE/STREAM LEACHING ManufactY�r- fr INFORMATION Type Of System: enV�V.� f`orw " \ Zti —%f i ( —_ CHAMBER OR UNIT Model Nu �ow5 DISTRIBUTION SYSTEM Header/Manifold old „ 7 Length Dia Distribution Pipets) Length Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Bed/Trench Center 3 — r Depth Over Bed/Trench Edges > r 2 1 t to Depth of Topsoil xx SeededfSodded xx Mulched A Yes Q No M yes ®No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2: Location: 1458112TH ST 11 /&/' 2vN votjl,t ® ST WtI�T. 1.) Alt BM Description = 0 ��rC!`^ O„ QK _1� 2.) Bldg sewer length = �X`Sf yam, . I / ` („) _ - amount of cover = ,J �/QKiS t � !` � I n On of � Cyr LL r7 Plan revision Required? [� Yes IhI No / �1 tJ �7 ';'F I AD ill Use other side for additional information. _ _.__ !._/II tJll✓ !_7L SBD-6710 (R.3197) Date Ins al gnature Cert. No. 2. ®" " `' �n // f� D Industry Services Division Coun SCCno x 5* d4:w � � ��" `/ �C 1400 E Washington Ave S _ P.O. Box,7162 ��, P it Number (to be filled in by Co.) MAY 272020 Matron, WI53707-7162 / Vf�/ St. Croix er-nit Appl cation State Transaction Number In eccor a TnEru ,submission of this onn to ental unit is required prior to obtaining a sanitary permit. Note. Application forms for state-owned POare . d to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15. i m Stats. 1458 1 120 Street 1. Application Information - Please Print All Information Property Owners Name E Parcel p Michael & Kristie Faust 02"064-10.300 Property (Tuner's Mailing Address Property location 1458 112a Street Govi. Lot SW '/4, NW '''A, Section 21 City, State Zip Crde Phone Number New Richmond, WI 54017 J*0e one) T 30N RlgEo 11. Type of Building (cheek all that apply) Lot N Subdivision Name ® 1 or 2 Family Dwelling - Number of Bedrooms 2 NA Block 8 ❑ PublirlCommemial - Describe Use ❑ City of ❑ State Owned - Describe Use ❑ Village of 'SM Say NumberAvev V. Iy P e/jl Z ® Town of Richmond Ill. Tvot of Permit: (Cher"niv, one box on line A. Coco lete line B if applicable) A. ❑ New Svstem ® eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal Before Expiration ❑ Permit Revision ❑ Change of ❑ Permil'fransfer to New List Previous Pe,(mit Number and Date Issued Plumber (honer 430381 e of PO WTS S stem/Coco nertUDevice: Check all thatapply) on -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At-Gmdc ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) / / /Al I V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 Rate(gpdsO 643 700 93.75' 0.7 VL Tank Info Capacity in GallonsTotal y.. /�JlaSa.L ��••�"� _-Manufacturer c #of New Tanks Existing Tanks Gallons Ulu 4A4(q( .'? v in V Septic or Holding Tank IOW 1000 1 Huffcutt Concrete El El U Dosing Chamber V 11. Responsibility Statement- 1, the uodersigned, assume responsibility for installs this of the POWTS shown on the attached plans. Plumber's Name (Print) Plum m I MP/MPRS Number Business Phone Number John Schmitt J,,L�L _ Zi L%/GL r' ` 223760 715-760-0486 Plumber's Address (Sheet, City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 VIII, Coma /De rtment Use Only 1A1 Approved ❑ Disa roved Per(m(StjE(ee ssued g Agem S re a ❑ Reon for Denial 5 /'�5 070 IX. Conditions of Approval/Reasons for Disapproval ?�\ li r�_n,tsrt/ 1mt(rve_ ` L tk 1 • ` OWNER: { �y� o�"-t�eS� tao _• 3STEM*ptic eptle tank, effluent filter and v � spersal cell must be serviced / melntalned s per management plan provided by plumber.ty1 as per applicable code/or0lnancestNEp 7T! fur Ihe'yxrem end sub it Me C'o my or votr.14 (f a�i�r I een c I Inch"Ir size,SBD-6398(R03/14) 5)itQQy",� e SYSTEM PLOT PLAN Faust 3 Bedroom Septic System Design Fbw, 450 GPO Atladr design flow cek�aationa W commamlol plow: Prgetl Addmss: 145e 112m Steel 4f�;Aymbol: - SM Elevellon: JQLQZ, Plpa Materiels l ASTM Standard BM Description: Top of house toundadon Tables 384303 8384.30-5 Scale. 1" o W SM2 Symbol: Q SM Elevation: 95.28' 4' SCH 10 PVC ppe ASTM. D2685 0 60 90 120 BM Description: Septic tank wde( Slope Gradient of Tested Area: ('1%) 30M V PVC pipe ASTM-M0 Well Symbol (d applicable) 152 Notes: See Piet Map for complete map 11rr Property line T1- 3'x88.75'Infiltrator Standard trench EI.=92.95' T2- 3'x88.75' Infiltrator Standard "rich EI.= 92.95' c T3- 3'x70EZ Flow trench El.= 93.75' T4- 3'x7D' EZ Flow trench EI.= 93.75' v 2 °e' �y�1 l9✓i j/G N Eldsting 1000gal Slopabel epticTenkwl Exisbng3 A-1 DO BedroomHouse UGarage 4B3SVS 81 Driveway 41 Wdl Pm re C1Cory CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Faust Replacement Septic System Owners Name: Michael & Kristie Faust Owner's Address 1458 112th Street New Richmond, WI 54017 Legal Description: SW1/4, NW1/4, S21, T30N, R18W Township Richmond County: St. Croix Subdivision Name: NA Lot Number: 2 Block Number Parcel I.D. Number 026-1064-10-300 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 Management and contingency plan Page 8 Septic Tank Maintenance Agreement Page 9 Existing Tank Certification Page 10 Warranty Deed Page 11 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 5/27/2020 Phone Number: 715-760-0486 Signature: ..7 In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Faust 3 Bedroom Septic System PmjW Address 1453112w 5Veat r9oAymbol:. BM Elevafem: IQUI „ SM Descnpoom Tap of house awndatlan BM2 Symbol: Q SM Eleviman 95 28' BMDeecrlpllon: SePactankcuael SioPe Gradienlo(Te5ad Ales(<I%) Well Symbol (d applicable) Nolea' See Plat Map for complete map <1% Slope Design Flow: 45o GPO Aaach design now caWaions for commemal pans. Pipe Meledels / ASTM Standard Tables 384,30-3 It 354.30.5 4"SCH40PVCPaa IASTWJD - 303a x" PVC P" Property line Tt-3'xIIISIVInBltrator StandaN trench El-92,95' T2- 3'x88.75' Infiltrator Standard branch El -92,95' T3. 3 x7O' EZ Fbw trench El = 9175' TA- 3'x70' EZ Flow bench El.- 93,75' Exiting 1000gal Septic Tank w/ Existirrg3 Zabel A-100 Bedroom House WNI Garage N Scale: 1' = 60' 0 50 90 120 15' KA Driveway INLET BAFFLE WARNING LABEL EMBEDDED INTO CONCRETE COVER READS AS FOLLOWS- CAUTIOW DO NOT ENTER WITHOUT PROPER VENTILATION. COULD CAUSE DEATH... DANGEROUS GAS. 29' DIAMETER CONCRETE COVER (TYPICAU SEE 'ACCESSORIES' FOR OTHER COVER OPTIONS GAL. PER INCH = 28.23 LIQUID CAP. = 1,030 GAL. MAR LIQUID CAP. = 1,115 GAL. (BELOW INLET) SECTI13J (TAW BASE, TOP, 6 COVER) NOTE- THIS DRAWING REPRESENTS A SEPTIC TANK. SEE ACCESSORY N11 FOR OPENINGS LOCATED IN THE TOP OF A HOLDING TANK. 4' D1 DIA5' . II A. OIIRET I`7 w PAY. 4w1 141 K o n m 4BIm M 4ME VMLI M s PAGE 2of2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter® alarm, you will be notified by an alarm when the fitter needs servicing. Step 1: Locate the outlet of the septic tank and remove the tank cover. Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank. Step 2: Remove the tank cover and pump the tank If necessary to prevent any solids from escaping to the the drain field when the filter is removed. Step 5: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. Step 2: Firmly pull the filter handle and slide the cartridge out of the case. (D Residential Applications certified to ANSIINSF Standard 46 Copyright 2014, Polylok, Inc All rghts meawad Product's) covered by one or more U S. and/or Internahonel patents Other U S. and Internaponal patents may he peothng. 1-877-765-9565 1 www.potylok.com Page 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I GeoteXtile Cwxr SOIL COVER re min. trench depth L (typical) System Elevation' 93.75 ft. (typical) min 12' (typical) Septic Tank(s) Manufacturer Huffcutt Concrete Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer Zabel Effluent Filter Model #: A-100 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3ft separation between trenches. TYPICAL TRENCH (Show location of inlet! outlet pipe connection on plan view.) PLAN VIEW Obse rvation pipe shall ba Insmlatd (No Scale) Perforated Lateral at)unceon oetwaen two units. Observation Pipe (typical) (typical) r- -------- ----- 7%--------- _--== L---------------- �OL --------- B = 70 ft (typical) INSTALL PER TRENCH: 0 7 10-ft bundles @ 50 fe EISA/unit = 350 ft' + 0 5-ft bundles @ 25 ff EISA/unit = 0 ft' = Proposed EISA per trench = 350 ft' OBSERVATION PIPE DETAIL (No Sob) Saaw-Type or Shp Cap (loose) 4"0 PVC Ppe — Top of p,pa to tah xhate at or above finished grade (4)IM--1 'X6"Slot..• @X aped Anchonng Dews 10 ft (typloal) �A=3.0 ft (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. — FFnishad Grada (mulched & seeded) — Topsoil Cover (min. 1 foot) Infinrathon Sudam Required Infiltration Area = 643 ft' Distribution Method: x 2 trenches = Proposed Total EISA = 700 ft, branched manifold m W O n .RESET Installation Instructions for EZflow Systems in Wisconsin Wisconsin Department of Commerce, Safety and Buildings Division, has reviewed the specifications and/or plans for this product and determined it to be in compliance with chapters Comm 82 through 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin Statutes. AN sites must meet the 5k & Soil Conditions & Locations & Isolation distances as noted in local regulations. The approved products are 1208H (3-12' bundles with pipe in center bundle in 5' or 10' lengths) and 12MHP (3-12' bundles with pipe in each bundle in 5' or 10' lengths. A single pipe bundle contains a four inch perforated pipe sur- rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is held together with polyethylene netting. Materials and Equipment Needed • EZflow Bundles • EZflow Geotextile Fabric • EZflow Internal Pipe Couplers • Pipe for Header and Inlet • Backhoe/Excavator Installation Instructions The instructions for installation of EZflow products are given below. This product must be installed in accordance with state rules defined in chapters Comm 82 through 84, Wisconsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design manual. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake or mark with paint the location of trenches and fines. Be careful to set correct tank, invert pipe, header line or dis- tribution box and trench bottom elevations before instal- lation of pipe bundles. 2. Remove plastic EZflow shipping bags prior to placing bundles in the trench(es). Remove any plastic bags in the trench before system is covered. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending down along the sides of the product to a point at least six inches from the bottom of product. 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- tion, but also provides better load -bearing capacity after backfilling is complete. to EZflow- by INFILTRATOR 5. The Absorption area (SF) necessary for a given site shall be sized based on maximum daily sewage flow (GPD) and the Permeability for the site. If certain criteria is met, the EISA sizing can be used in Wisconsin, resulting in a 40% smaller drainfield. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- lar site. The top or center -most bundles containing pipe are joined end to end with an internal pipe coupler. Any additional aggregate only bundles that may be required, should be butted against the other aggregate -only bun- dles and do not require any type of connection. The top of each GEO cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer shall make sure the the GEO is positioned upward and is in contact with the fabric contained in the adjacent cylin- der before backfilling. 8. The EZflow Drainfield Systems should be installed in a level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground surface elevation (uniform depth), with all continuous adjoining 10-foot cylindrical bundles placed end to end, with central bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 9. The trench top shall be graded such that water will not pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 10. EZflow EPS bundles are flexible and can fit in curved trenches as may be necessary to avoid trees, boulders, or other obstacles. I I.EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to cause EZflow assemblies to float out of ground when ponding occurs. Field experience has shown, however, that this is not a problem when systems have a minimum of 6' of soil cover as recommended by manufacturer. 1203H-GEO r Material Page 6 PAGE 4OF4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BODE 5 220 mgL^; TSS 5 150 mgL"; FOG 5 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS type of use age of system nuisance factors (i.e. odors, user complaints. etc ) mechanical malfunction (i.e, pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filterfs) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local govemment unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Schmitt & Sons Excavating, Inc. Phone: 715-760-0486 Local government unit: St. Croix County Community Developement Phone: 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson zip 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Page 7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Michael & Kristie Faust Mailing Address 1458 112th Street, New Richmond, Wl 54017 Property Address 1458 112th Street (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond, w Parcel Identification Number 026-1064-10-400 LEGAL DESCRIPTION Property Location SW'/, NV'/, Sec. 21 , T 30 N R 18 W, Town of Richmond2 Subdivision Plat: Lot #�) Certified Survey Map # 2 �p �J Volume l s Page # 41Q_ Warranty Deed # -7 -` 2 Sto-? (before 2007)Volume 2(0qg- Pag�P2sy Spec house 13yes0no Lot lines identifiable Dyesono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §SPS. 38352(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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 1 /3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. property described above, by virtue of a warranty deedytorded in Register of Deeds Office. _. _. . . , 3 /r) Uwe am/are the owner(s) of the 052220 DATE ••'Any information that is misrepresented may resuh 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. 04112) Page 8 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 1458 112th Street located at: SW '/4, NW 1/4, Section 21 Town 30 N, Range 18 W, Town of Richmond St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service & j (-( - �'z Did flow back occur from absorption system? Yes_ No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete x Steel Other Manufacturer (if known): Age of Tank (if known): Huffcutt Concrete 17years Permit number (if known) 430381 t~/"/ John Schmitt (LKAsed Plumber Signature) (Print Name) (Title) _ a �- 9® (Date) 223760 (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 9 • Wisconsin Department of Commerce SOIL EVALUATION REPORT -Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ S/ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited lo: 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. , Page of S Please print all Information. Revl by Date Personal Inf yMborl you provide may be used to seconds ` y secondary puryoses (Privacy law, s 75 04 (t) Im1) Property Owner n/ � � J Property LocationAlb -r�1 Jd[� 541C Govt. Lot 114 114 S T 3V N R /py E(or)0 Property Owner's Mailing Address yC. CSM# 'v/Sty// Z 31 iZ ciState zip Code Phone Number age ,}.Town Nearest Road w'/I Wj I SYO /7 I VS New Construction use: ❑ Residential / Number of bedrooms = Code derived design flow rate S O GPD ❑ Replacement j] , Public or commercial - Describe: Parent material Flood Plain elevation It applicable ft. General comments c/� • 9 and recommendations: Bodng # ❑p Boring rl pit Ground surface eiev. / 0 J ft. Depth to limiting factor f/s-- in. Soil Applicabon Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Sz. Cart. Color Texture Structure Gr. Sz. Sh. Consistence I Boundary Roots GPOMV i 'Eff#1 'Eff#2 l 0 k�4�Z/t- — L dr ,gC /wFtPS l�rf . S y Y7i6 Zy-WVA '11�S 6r, h7 9 . aWtA ?X-, o S a Boring # ❑, Boring [Tpit Ground surface elev. �!Y • I ft, Depth to limiting factor in. Soil -Application Rate Horizon Depth In. Dominant Color I Munsell Redox Description Ou. Sz. Cont, Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDMt' 'Eff#1 I 'Eff#2 16. Y 01k , L ASQ1l rn AV qs 111F , s , 1, -z /o R /y _ S,cc PWo ;? Q'r e d li to'S ©ff, tro t . 7 �, Z 2 ct� - cmuem * l = ovus , Ju _< zzu mgrL ano r 53 >Ju _< 1 bU mgtL ' tmuem T,! = ttUDs < JU mg1L and 155 < dU ❑iglL CST Name (Please Print) / ignature CST Number Ir �l'e ZZ/Y� Address Date Evaluation Conducted Telephone Number 3.7 2 VU 17 S T kot .ev &Al �o Au- 3 c) J 71r=,,Z(,r-6617 swn.atnn ron]mm Property Owner a Parcel ID # Page Z of 3 3 Boring # ❑ Boring p ® pit Ground surface elev. / d ft. Depth to limiting factor !� in. plication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary RootsGPD/ft' 'Eff42 o Z Z �- Z Ah S 09 Ae a UIZo E*Eff#l RW 5/ — S.cz �fise ,P as meCos rW 04V — /, G yd l SY / ✓ S O `nor i . 7 /, L ❑ Bodng # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont- Calm Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM2 '£ff#1 'Eff#2 ❑ pit Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. Fs-oijAppiicabon Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft° 'Eff#1 'Eft#2 Effluent #1 = 8006 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD,! 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or = 608-264-8777. M-8330 (R 071" &�14- A , Nh✓Nw,s � t ?oN�!>$�✓ La Z >eo' J�RP ski CO-� I�Ze %,o,,.� a D D Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division r INSPECTION REPORT GEkLRAL INFORMATION (ATTACH TO PERMIT) Personal information you pmvzle may be used for secondary purposes (Privacy Law, s.15.04 (1 KmKj Permit Holdees Name: City Village X Township Halle Builders Inc. Richmond Township CST SM Elev'. I [nap. BM Elev. BM Description Cn Ito. O '99 6u4A. Bw TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic 8t7!) Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 42, e 4, f I Dosing Aeration Holding PUMP/SIPHON INFORMATION SOIL ABSORPTION SYSTEM ( I IN - (1 .. L. _ County St, Croix Sanitary Paint No: 430381 0 State Plan ID No: Parcel Tax No'. 026-1064-10-300 SectionrrowniRange/Map No'. 21.30.18.318A20 STATION BS HI FS ELEV. Benchmark O. I �. AIL BM Bldg. e * S4 �I •� r O S17HtInlet St/Ht Outlet • I'� I 4 S. 2$' Dt Inlet Dt Bottom Header/Man. �•�. q�•1S/ O ,ps r r,st� /OfC .Qs Malty i • / 3.38 g•o} Bol. System Final Grade St Cover 3- . 711 H idth I Length I No Of//Trenches PIT DIMENSIONS No. Of Pile Inside Dia. Liquid Depth DMIRM �' lZ� SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manu INFORMATION CHAMBER OR Type Of Syslarn �� �' I — Medal Number �- sl UNIT Ulb I KIMU I JUN SYSTEM HeadW1Ma ifcld DieMbulion x Hole Size z Hole SDaUng Vent to Air Intake rf� Plpe(e) I 7 L Dia en91h Le SOIL COVER s Pressure S.farn. nnlu N. Mn,.,.n n, n..1., Depth Over Depth Over xx Depth pf xx Seeded/Sodded xx Mulched Bad/Trench Center Bed?rench Etlgas Topsoil yg6 No yes No QgMMF�IT$1 ((Incude dis en�lgar per�ons present, etc.) Inspection Iflfi olr� Y/ c inspection#2:_'__._I__ 4ocattiioon: 1458112th Street New Richmond, Wl 017 (SW 1/4 NW 1/4 21 T30N R18W) NA Lot 2 Parcel No: 21.30. 18.318A20 1.) Alt BM Description = A" A. 2.) Bldg sewer length = 24.0 / - amount of cover = zq "+ , '� y AA-A14 W"* AAJA v�� Vre`v�lsl� Required?N L_ Use other side for addition In d eJ' II 1t-IIAM.--�W�V�----- SBD-8710(R 3l67) Inm clo(s .I url'Ji a +so,w s.� l n•.aa. 1yt7C0.4TM L)CSO L11 s:ll Il:s-I- f � rtestAalL .d' 7wyec�� .