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HomeMy WebLinkAbout032-2148-50-000 (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)] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic x Dosing Aeration i i 0 %S TANK SETBACK INFORMATION ®�_ =I= �,a AM M■„=.-„-■■ �®■„1_I -._,I ■' wm=�MMMF = PUMP/SIPHON INFORMATION Manufacturer Demand GP Model I umber TDH U Fnct n Loss Sys m Head T H Ft Forcemai Length ia. Di ell SOIL ABSORPTION SYSTEM 7_ i-7n t')S County: St. Croix Sanitary Permit No: 624852 State Plan ID No: Parcel Tax No: 032-2148-50-000 Sectionffown/Range/Map No: 15.31.19.1296 STATION BS HI FS ELEV. Benchmark J 1 Alt. BM Bldg. Sewer SUHt Inlet '[ yi�lS SLIM Outlet r Dt Inlet Dt Bottom Header/Man. li T11 �(. Dist. Pipe Bot. System 71 .5 Final Grade . St Cover VC4 o 5 BED/rRENCH DIMENSIONS Width t Len D % /u No. Of Trenches G_ PIT DIMENSIONS No. Of Pits Liquid Depth SETBACK SYSTEM TO P/L ff I BLDG IWELL LAKE/STREAM I LEACHING Manufacture. INFORMATION CHAMBER OR UNIT h rg, i Ty�ppe Of System: (ontlLn p1.�1 %5 i Z) IZ�1 Model Number^ tZ Flov DISTRIBUTION SYSTEM Header/Manifold g q �f Length Dia Distnbulion Pipe($) x Hale Size x Hole Spacing Vent to Air Intake Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Bed/Trench Center i t 3 ,� Depth Over Bedrrrench Edges I 1� 71 � xx Depth of Topsoil xx Seeded/Sodded ed I ©Ves ®No ❑M Yes C No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Location: 2108 54TH ST 1.) Alt BM Description = Y w,1V�l.. �►✓ `y'j -J� 2.) Bldg sewer length = ',y�C }, �% 51 try{ rEj�-1 / k f ✓r7.1 �-1 - amount of cover Inspection #2: ✓aIVt / 17 fAi Plan revision Required? Fal Yes i No �'.27 , Use other side for additional informatio (�I7_' Dale ee Cert. No. SBD-6710 (R.3/97) S` 1. 2. 9N, -d-OdO - I f 7 4 Services Division 1400 E ashington Ave County , s I U 2 4 J . Box 7162[ Madiso WI 5370 l6 ` Sanitary Permit Number o filled in by Co.) , /��� St. �� 7 roix Count Y a Sant Un th State Transaction Number In accordance with SPS 383.21(2), W is. Adm. Code, submission of this form to the appropna - -� is required prior to obtaining a sanitary permit. Note: Application forms fpr srateo WTS are submitted to the Department of Safety and Professional Services. Personal infomutiod may Project Address (if different than mailing address) you provide a ndwy in accordance with the Pri Law s. 15. 1 m Slats. Sa , .-0—� L Application Information - Please Print All Information Property Owne's Name / Parcel # Q /` L2P 77 /9% Property Owner's Ming Address L5f Propertyv • 42 Govt. �Lm ` `�/yt Zip Code Phone Number ACi lS�tate �> 4 'C - \ [I. Type of Building L4ZA.. Section e T N; R E (check all that apply) Lot # 2 Family Dwelling -Number of Bedrooms SubdivisionNvW' d #ibe ❑ PublirlCommecial - DescribeUse ❑ City of �- ❑ State Owned- Describe Use ❑ Vill of _ /J CSM Number of��� III. Type of Permit: (Chet ly one box on line A. Complete line B if applicable) A' ❑ New System ement S stem y ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Exhaling System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumbs ❑ Pewit Tmmfa to New List Previous Pemdt N ber and Date I Before Expiration J of POWTSS stemlCom onent(Device: Check all that a -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component ( la') ❑ tment Devwe (ex lain V. Dia rsaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rat 6 Dispersal Area Required (sf) Dis I Area Proposed (sf) System Elevation a c y ,�' y�e 93.E VI. Tank Info Capacity in Toter # of Manufacturer Gallons Gallom Units 14C�) v e V New Taeu F.xis' Tacks w/n 6fsT 4 6 U 2 . _ N Yn septic o Holding Tank �. Doing Clumbtt VII. Responsibility Statement- 1, the undersigned, a ponslbility for installation of the POWTS shown on the attached plans. Plumber' Name (P�riynt) PI ignazure �MJP�//MPRS Number Business Phone Num _ Plumber's Addjress (Sweet. City. Stet ip C ^ � L ^ T e ) VIII. Court /De riment Use On Approved ❑ ved Permits/ Fee Datt issued Iwuin Agent Signature ❑ Owner Given R for Demel IX. Conditions of Approval/Reasons for Disapproval LV)L STEM OWNER:t Lam. I_ _.n/)�t•CL°u/ Septic tank, effluent filter and "lCal eS, '� ispelsal cell must be serviced I maintained �� ������f r1JCr s per management plan provided by plumber. f.N� S 5k„r,x, cQ se a re i irem . as per applicable code/ordinances. SBD-6398 (R. 08114) nr me system an `augnit to me �,rywy pnryao aper t i t tocites inrd n System PLOT PLAN PROJECT Matt Foucalt ADDRESS 2108 54th st. Somerset Wi 54025 SE 1/4 SW 1/4S 15 /T 3 A7j19 W TOWN Somerset COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 20 BEDROOM 4 CONVENTIONAL XXX IN -GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # EZ FLOWS 18 �..,., ENCHMARK V.R.P. Top of ST Cover ASSUME ELEVATION 100' Filter BEST ❑ BOREHOLE O WELL-H,R.P. Same as Benchmark SYSTEM ELEVATION 93.8/93.7 525' Property Line s ' 2-3' X 90' Cells with >3' Spacing 40 B-2 � B 1 �ntLO��_ 445' f 0% Slope Cd,weiver_Valvg/ M1 Plans Designed Using Conventional Powts Manual Version 2.0 174' Property Line 30' 35' Well 4 Bedroom House q(olcoPY System PLOT PLAN PROJECT Matt Fouoalt ADDRESS 2108 54th st. Somerset Wi 54025 SE 114 SW 1/4S 15 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX 6/24/20 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN -GROUND PRESSURE CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 , ENCHMARK V.R.P. Top of ST Cover ASSUME ELEVATION 100' Fitter BEST ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark BEDROOM 4 HOLDING TANK DOSE TANK SIZE SYSTEM ELEVATION 93.8/93.7 525' Property Line 40' 2-3' X 90' Cells with >3' Spacing B-2 B-1 /' 20' e"E 3 5 45' 30' 0% Slope 4 Cd,Mxf_r_Valv)j' Plans Designed Using Conventional Powts Manual Version 2.0 174' Property Line P"kj 30' # EZ FLOWS 18 35' Well 4 Bedroom House Cross Section of a Two Cell EZ Flow In -Ground Dispersal Component -- 3' ► 3' Design Flow o6 f Loading Rate f 7 = Required dispersal area 2%� Sq Ft Required dispersal area 1S" z + 50 (EISA) _ Ae (number of units) Geotextile fabric to meet Comm 84.30(6)(g) Wis. Adm. Code �- Minimum of 12" of cover over top of cell Two observationtvent pipes to be provided per cell Not to scale Cell #1 Cell #2 System Elevation: Ll Ft q Final Grade: / /• : Ft Final Grade Observation Pipe Geotextile Fabric System Elevation yoV Z, System Elevation:/J. / Ft Final Grade: % /' �t Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/22/20 Owner:Matt Foucalt Location: SE1/4 SW1/4 S 15 T31 N,R 19W 2108 54th St. Somerset Wi Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and Contiden�v Plan 7. Existing Septic Tank Sianature License number ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMLTIT AND n OWNERSHIP CERTIFICATION FORM Owner/Buyer 4^7%- 4. t j� -4 0 e 1, Mailing Address o2( Property Address 2 t 0 8 54' 5 �_ ---- (Verication required from Pkm lg & Zoning Depairwin for new commuetion.) City/State _�pi SA e &(fil Lkj ParceI Identifticarioii Nmaber (�32 j(e{ $ L' t�V-1 LEGAL DESCRIPTION j Property Location � V. , y J Subdivision— go } t`2�_� - -- Lott) Certified Survey Map # _— Vcdume _ -- ,Page # - - Warranty Deed # # Volume _, Page # Spec house yes no Lot ling, identifiable 1 yer:' no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and main[ertaxnc of your septic system could result in its prcmatuce failure to Candle wastes. Proper maintenance consists of pumping out the septic tank every three years or somrcr, it needed, by a liccumd pumpei. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal systen>. Owner maintenance, msponsmiiit are specified in §Coran. 83.541) and in Chapter 12 - St. Croix County Sanitary Onhmnce The props ty own agrees to smhmit to St. Cmur County planing & Zoning Department a u;rf eafioo fcamk signed by the owner and by a Masmr plumber, journeyman plumber, restricted plumber or a licensed pmtgter verifying that (1) the on -site wastewater disposal system is to Pmper operating condition atui/or.(2) after inspection tuttl Pumping (if that (1) t the Septic tank is less than 1/3 full of sludge. I/we, the utdwugoed haw read the above requncmemts and agree to maintain din private sewage sumdards set fulilt, hnrtin, as act b the D dr Stumt system with file y Department e e mammmerce and the Department ofNatu a! 12esoa xs State of Wiscoa m Certification stating that your septic system has been xp i ati n d must be completuI and returned to the St. Cmix County Planting & Zoning Depmtutent wP[him 30 days of the three yar expiration date. -. Uwe certify that all statements no this form ate true to the best of my/otu t aOw W ge. Uwe uaV= tin ownmf s) of the Property described above, by votne of a warranty deed recorded ln. Register of DouJs Office. Number of bedrooms S GNATUI p APPLICANT(S) �21 /_2oti DATE ***Any infom alion that u mix rpt omcd may result m the. aan lary permit being revoked by the Plum n g & Zoning Department. ♦aa Include With this 2.1"ti.v, n ..�.....r� rrvey map if POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of ar- FILE INFORMATION Owner .r Permit # DESIGN PARAMETERS Number of Bedrooms ❑ NA i Number of Publle Facility Units I Estimated flow (average) gal/day i Design flow (peak), (Estimated x 1.5) aUda Sal Application Rate 1 allda i Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOOS) 5220 mg/L ❑ NA Total Suspended Solids (TSS) <150 mg/L !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) s30 mg/L Total Suspended Solids (TSS) !�30 mg/L %� W Fecal Coliform (geometric mean) 510° ctu/100ml Maximum Effluent Particle Size Ya in dia. ❑ A Other. A 'Values typical for domestic wasOswater and septic tank effluent. AINTENANCE SCHEDULE SYSTEM Septic Tank Capacity al ❑ NA Septic Tank ManufacturerAILAae ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Fitter Model F _ ❑ NA Pump Tank Capacity al E NA Pump Tank Manufacturer I NA Pump Manufacturer I NA Pump Model NA Pretreatment Unit I NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Lire ❑ Other. Other. ❑ NA Other: ❑ NA Other. ❑ NA Service Event Service Frequency !inspect condition of tank(s) At least once eve every: mont (s) s (Maximum 9 years) ❑ NA !Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal ceH(s) At least once every: ❑ ear(s) month(s) (Maximum 3 yea rs) ❑ NA Clean effluent fitter At least once every: orrth(s) / ar(s) ❑ NA nspect pump, pump controls & alarm At least once every: � year s)s)IN NA 1-lush laterals and pressure test At least once every: ❑ month(s) ❑ A ❑ year(s) Other. At least once every: ❑ month(s)❑ year(s) ❑ A i�thar ❑ P. 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 combined 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 falling 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 be tank shag be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. IOJI 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 POWTS Maintainer. A service report shall be provided to the local regulatory authority Rhin 10 days of completion of any service event. Page _ of _, START UP AND OPERATION For new construction, prior to use Of the POWTS check treabnent tank(s) for the presence of painting products or other chemicals thst 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 hlghwater levels. When pourer is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) 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 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 15 feet down slope of arty 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 woes; cigarette butts; condoms; cotton swabs; degreasers; dental moss; diapers: disinfectants; fah 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 brume. ABANDONMENT When the POWTS fags and/or is permanently taken out of service the folknving steps shall be taken to insure that the system is prope(1Y 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 shag be excavated and removed or their covers removed and the void space filled with sNil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption syste►n. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requimled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nged for a new sail and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulei4 in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologW a holding tank may be installed as a last resort to replace the failed POWTS. `C7 The site has not bow evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation r" cW 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 reconsfix;ted 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 TANI� UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OP A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. POWTS INSTALLER POWTS MAINTAINER Name 1� Name Phone 1 7 Phone t SEPTAGE SERVICING OPERATOR 1111511JIMPEIRLY LOCAL REGULATORY AUTHORITY Name Phone -7 i- Name Phone This docti ment was drafted in Compliance with chapter SPS 383.22(2xbx1)(d)8,(f) and 383.54(1), (z) 8 (3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspe the septic tank presently serving the resid nce located at: � �„ -e<1 ,, Section ` T 12/ N, R W, Town of %0M0/rJ-e'�— Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur rom absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity /�2 Construction: Prefab Concrete_ Steel Other j Manufacturer: (If known) :/`414ec, - Age of T (If known) : /y�y4".1--s/ ( ature) (Title) �-- 2- % 20 Date 7�h/r (Name) Please print zz� (License Number) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to t best of my knowledge will conform to the requirements of ILHR 8 is. Adm. Code (except for inspect�n pening over utlet baf A Name J lzt, Signat a MP/MPR0'&;V t eco.ao S^ Y � g oI V � i a LOT 24 1Ja6m sa Fr. �• /''y'a \ 12NvWrrE�-9wo ' j me - �c7 ,mod - • �' 4 S, N8915'2YW // M11' /p 334.43' / LOT 2 see / /� �• ; cane sa rr. e i' '> JOO ACRES AM RF-9128 I $ _ ............................ g OE IC 9.0 ry -- yu------------------`4� u', um ? 890217�W 1324.18� --- - � N89'02'17'W 404.18' �------- 413.75 --A' - Tna - - - N89iD2717`W 854 I _ 21OTH l VENbE N89ron 2'•w ------cAWi'/)CM'RIY---------- 132718 � rsr coRwER — — - - — — — — — — — ' /5-11-19 ALUMINUM I I - � N89'02'17"W 2648.36' — ------�-- I MQNUMEN r) I I UNPLATTED LANDS I WismnsinDepartment ofCommerce SOIL EVALUATION REr5R-;—, Page _of Dvision of Safety and Buildings n� in accordance with Comm 85,F • curry Attach complete site plan on paper not less than 8 1/2 x 11 inches ins include, but not limited to: vertical and horizontal reference point (BM),rl - r1Mcel I.D percent slope, scale or dimensions, north arrow, and location and dictaea� Please print all information.Reviewed y Date Parsorul mfomuUon 01) UN you pmviEe may be uxCfor tewrMe7 Purposes (Privacy(ml). Property Owner A // rope ocation / ) / tcu �. Govt. Lot C 1/4J(� 14S%S r�� N R/ E(o W Property owner's Mailing Address Lot # Block # Subd. or a� k)- a s- — a CityState Zip Code Phone Number ❑ City ❑ Village wn Nearest Road 1.,��1,�, Construction Us esidential /Number of bedrooms Code derived design flow rate GPD ❑Replacement ❑ Pu�bli/�/r commercial -Describe: Parted material C6l�c.i-6-�' � Flood Plain elevation if applicable 'f/z ft. General continents and remrmtendations: System Type.. _ System Elevation Boring # ❑ Boning / pit Ground surface eley fi7���7 ' L ft. Depth to limiting factor L in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'EHA1 'Eft#2 f rf ' 93. 70 d-` Boring# ❑ Boring 9 &Pit Ground surface elvf; .� — ft. Depth to limiting factor � /lam in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GPD/fP 'Eff#1 'Eff#2 I� 5 4 r Z77 1 Effluent 41 = BOD > 30 < 220 nVL and TSS >30 1150 mgiL ffiudnt #2 = BOD < 30 mg/L and TSS < 30 mgrL CST Narita (Please Pritt) Signa CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Cond cted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 O 715-246-4516 M Property Owner _ Parcel ID # / Page _ of _ ■ I ©►rsr.� � �. a WA ■ Depth- ■ :i WI Effluent #1 = BOD, > 30 < 220 nv& and TSS >30 < 150 mg2 ' Effluent #2 = BOD, 130 wQ& and TSS < 30 mg0l 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. aeD 3"0.�1 Property Owner Parcel ID # Page —of i Boring Ground surface ele%g. / M-M .. 1-1 Bong # ❑ Boring ❑ pit Ground surface elev. R. Depth to 8miti g factor in. Sell Application Rate horizon Depth in. Dominant Cola Musses Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIIF 'Eff#1 'Eff#2 Boring # a Boring El Pit Ground surface elev. —ft. Depth to Irttiting [actor in. Sol Applicatiort Rate Horizon 'lepth In. Dominant Color Munself Redox Description. Ou. Sz. ConL Color Texture Structure Gr. Sz. SR Consistence Boundary Roots GPOM 'EMI I 'Eff#2 Effluent #1 = BODr > 30 < 220 mg(L and TSS >30 < 150 mglL ' Effluent #2 = SOD, < 30 nwA and TSS 130 nglL 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. sae-U)Qt LW) System PLOT PLAN PROJECT Matt Foucalt ADDRESS 2108 54th st. Somerset Wi 54025 SE 1/4 SW 1/4S 15 /T 31 N/R 19 W TOWN Somerset COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE6/24/20 BEDROOM 4 CONVENTIONAL XXX IN -GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # EZ FLOWS 18 ,`� ENCHMARK V.R.P. Top of ST Cover ASSUME ELEVATION too' Filter BEST ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 525' Property Line 2-3' X 90' Cells with >3' Spacing .r on, et E SYSTEM ELEVATION 93.8/93.7 B-1 0' 0% Slope 3 30'( (a '4eAr_Valve Plans Designed Using Conventional Powts Manual Version 2.0 174' Property Line MIN 30' 35' Well 4 Bedroom House Wisconsin Departmentof 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 Holders Name: City Village X Township Landucci, Nathan Somerset, Town of CST BM Elev: Insp. BM Elev: BM Description: lot), e)M \ 6ST Rw:6i o 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Z 4 Q:n CAPACITY Septic aw / Z•400 own Aeration o mg TANK SETBACK INFORMATION rr m e,• mm m�= M—_—MM MM— _= PLIMPISIPHON INFORMATION MINNIE MEMO SOIL At5SUKP 1 IUN STS I CM STATION BS HI FS ELEV. Benchmark A Ft -BM Z•ib 49.1�,3 Bldg. Sewer �. �. 5 7•sy Inlet Outlet Ot Inlet Ut bottom ea er an. st,.�j S+ 1,. y ; b 46 —v34 er . s3 s. Ipe S Z;- -t 95.•4 . 83 fl-oFgy-s em yE e(6J9.4.il`13 7.4s CH , % 1 •y5 I-mal uraule over I A ct ,/CFI DIMENSIONS q lJ (,6 Z. I rf'o-c ' \ INFORMATION CHAMBER OR UNIT r r USv� 601fl a (� n SN WI 775Au N� �4;;ii ., -.t Qt 7 ` Length Dia Length Dia_____ Spacing avrL. a.vv�n x Pressure systems runty xx mounu Urt,vmraue oyorr+nla Willy BedRrench Center )! J!3 Bed/TrenU Edges ` Topsail ,,,. y� n No Yes I J No C:UMNItN 1 S: (Include code discrepancies, persons present, etc.) Inspectton Bt:_r_i_ Location: 2108 54th Street Somerset, WI 54025 (SE 1/4 SW 1/4 15 T3i1N R19W) Oak Haven Lot 25 {ep 2j0 c. cic•'' v weS �" ) O' `.� 1.)AIt BM Description= 2.) Bldg sewer length = 3i - amount of cover = y Plan revision Required Yes ,J No Use other side for additional in rmation. SBD-8710 (R.3197) mspecuon wc._r_ _ Parcel No: 15.31.19.1296 C0m— M J F, Asconsin afety and Buildin ' t'� 20 0 (T�162 Counry� 4 - 162 Sanitary Permit Number (a be filled in by Co.) De artment of Commerce OB) 266-3151 T9 Sanitary Permit A li te PlmhD "Mesh" In accord with Comm 9311, Wis. Adm. Code info ��'QQ��1( COUNTY ject Address (ifdifferat than mai ling ailing address) may be used for secondary purposes Privacy s .ONO Xfi) 1. Application Information- Please Print AD information /fig 54 T^ $y •, Property Owner's Name / Parcel Lot# Block# (/ IQ Property Owner's Meiling Address Property Location ///}f' SasE ro lZ� i�-+� N; or W C'ry, S vJ Zip Codc Sv�Z— Phone Number II. of Building (check all that apply) ok _ Subdivision CSM Number c/�, /�,-� ,. dr2 Family Dwelling- Number of Bedrooms / f%ot)SQ.,! f !' asL ❑ PublirlCommercial Describe- Desct Use ❑city_❑Vi tp or I1 ❑Slate Owned-Dnttrtbe UseZ m •O�'• CeL`6 LJj QL Type f Permit: (Check only out box on line A. Complete line B if applicable) O A' New System ❑ Replacement System ❑ Trarmentilloldiog Tent: Replacement Only ❑ Other Modification Existing System B. ❑ Permit ermmt Revision ❑ Change of ❑ Permit Transfer to Now List Odom Permit Number and Date Issued BeforeE pimtion ��� Plumber Owner IV. 1)r of POWTS System: Check all that apply) uriaM hr-Cnomrl ❑ Mound 224 in, of suitablesoil ❑ Momd <24 in. ofsuitable soil ❑ At -Cede ❑ Single Pass Send Filter ❑ C Wedmd ❑ Pressurized ln­Ground ❑ Hok"gTank ❑ Pat Filter ❑Aerobic Trestment Unit ❑ RceircuMong Sand Filter RecircuJimag Synthetic Media Fitter hies Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other ( lain) V. Dispersalfrreatment Aro ormation: Des ' Flow ) Design Sou Application Rwa(gpdsp 7g5� Die Ara 'reds Di Pro (s0 system Etevatuxv 3bd ZC VI. Tank Info Capacity inI Total Number Manuaemucr Prefab She Fiber Plastic Allgts Gallons of Units Concrete Constructed Goss New Fida6ng T T aks Septic ar Heldioe Tavk Aerobic lYramae Unit Davnt Chembv VIf. Responsibility Statement- the aadm lga responsibility for imsalhtbn of the POW TS ahosra on the atbc►ed pbas. Plum Name (Prig Plumbees ber Business Phone N MP sf 1 s A -m City Stets Zip - GG rJ VID. fZomaDLIDepardisent Use Onl ved ❑ i Sanitary Permit Fee (includes Groundwater Date Lnuing t Signs (N Surcharge Fee) ❑ Reason 1 /J Di. Conditions ofApproval/Rtasons for Disapproval SYSTEM OWNER: 3l 1. Sophe W*. aftra Nor and dispomal cell must all he sw*n I makdakrd as par n atrpament pan provided by owdler 2 N oamork M**Wlaraa mud be rrtahaaFiad an par appbahM coda / or*wics& SBD-6398 (R. 01/03) AIKL enrtspfete pram lro tM t:auvry my) ror ras ayrrem m PaPar m. � ,u.0 ow. a .. ,...,o......o Soil Test and System PLOT PLAN PROJECT Nathan Landucci JDD kss 2871 Lesion Ave N Lake Elmo Mn 55042 SE 1/4 SW 1/4S 15 /T 31 N/ W TOWN Somerset COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE6/6/06 BEDROOM 4 CONVENTIONAL XXX IN-GROUNV2515 R CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK St gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36 IL BENCHMARK V.R.P. Top of ST Cover ASSUME ELEVATION 100' Filter BEST ❑BOREHOLE O WELL 'H.R.P. SameasBenchmark SYSTEM ELEVATION 93.9/94.2 525' Property Line 0% Slope B^2_ 9B-1 0, 30' 25' Vents 45' 30' 2-3' X 90' Cells with >3' Spacing B.M.* 35' Pro 4 Bedroom House Plans Designed Using Conventional Powts Well is to meet all Manual Version 2.0 setbacks required by WDNR Vent A>6" ARC 36 Standard 174' Property Line Biodiffuser Leaching Chamber with 25.0 ftA2 of Area 1" Grade at System Elevation