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010-1037-10-050
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may he used for secondary purposes [Privacy Law, s 15 04 (1)(m)] Steven Black TANK INFORMATION Y,r" % TYPE MANUFACTURER CAPACITY Septic rCr-1 n �f�60 Dosing UAW Y�'� Yq" t & /_ O Q �f / olding TANK SETBACK INFORMATION LOGS d- tkN%W ! TANK TO P/L WELL DG. (//GG�< t D Ventto Air Intake ROAD Septic Dosing ' 7�t . ,7 —7 /5 1 7 Aeration Holding PUMP/SIPHON INFORMATION &51 0IL)ike,- 25•09 Manufacturer L I /_j� 7 V Demand GPM Model Number —r 7 TDH Lif� Friction Loss System Head 7 TOH/6' V�Ft m Forceain Lena" I Dia Z ,. Dist to Well 1 SOIL ABSORPTION SYSTEM TOWN OF EMERALD ELEVATION DATA County_ St. Croix Sanitary Permit No 630333 State Plan ID No Parcel Tax No 010-1037-10-050 Section/ rown/Range/Map No 15.30.16.225A-50 STATION B 2 HI z. FS ELEV. Benchmark roa , coo Alt PM rvlwcoy4! ' Y5 f 5! 7s Bldg. Sew r Ll A lbl St/Ht Inlet /r( '( %T QV St/Ht Outlet Dt Inlet Dt Bottom I �� Header/Man 5.58 9-7 l 2- Dist. Pipe / J 97, I Z Bot. System Final Grade St Cover � -l. 95 75 , / �n �-0�"fU ✓ Y 1 BED/TRENCH DIMENSIONS Width L• Length ` 5 e 2 J '11, f C PR DIMENSIONS No Of Pds Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLD`G WELL) LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of,$ystem. o 7 r 4- w3 + y �C + J Model Number DISTRIBUTION SYSTEM Header/Manifold q r• 3 ' L Distribution 1 +• Pipes) lZ x Hole Size t t x Hole Spa ci VeOt to Air Intake Length Do 2 �2 Length Dia Spacing %J/AD S t Tel ` y SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only D pdi ^ er o •• Depth Over Bed/Trench Edges xx Depth of Topsoil -r v xx Seeded/Sodded xx Mulched er �- l ` Yes No -, Yes No COMMENTS: (Include code discrepencies, persons present, etc.) IL.Inspyectionv#1 1,1-0 1 A) 1U Inspection #2: ,1q� Location: 1529 240TH STt� " S IVY 1 Ld+ • `��� o`�'" �a� `L ^'�OW 5151�'` {r 1.) Alt BM Description -- I" Y, 2 ) Bldg sewer length - G Lr + -amount of cover -- 1.. Plan revision Required? Yes No J ,! Use other side for additional mho forma1 _ _ SBD-6710 (R 3l97) Date Insepctofs Sgnalure Cart No 5AN- ZOO r- , 2,b I Industry Services Division I CmmLy I c� 1400 E Washm-con Ave r SC C P 2 1 20A P.O. Box 7162 DLoruiry permit Number (to be filled m by Co ) ,-71161 y Madison. WI � St. Croix Cojnl V3 mu o Trxnsacpon Number pplication I hr en.ordancc uvth tips 383212), Ns Arlin Cutesubmnao,, f thu lomr to the app�WTS -OQ Zoo�23 r 1 oc) is required prior to obtaining a sanitary permit Note Application farms for oate-oancd PON•-fS arc submmed to Prolecr Address (if dificrent dean mailm., address) the 1) 'n' "' -. d Snfery and Profcssional Scmres Personal mlommoon you puxrdc may be used for sccomlary w osa m.wvordanee n'rtIt the Pmacy Law, s. li 04(I )(ni), Suits ���Q r,4 1. kpplication Information- Please Print. Ail Information -1�y0— �Y, Properry 0uner's Name - __- - Parcel f: STEUELACK ��n Y/<•/A6c_K/ECE o.rEJ a/o - A137-`/e- aP G" 5G Prop,-m O,sricr'. starling Address Property 1-matum 1 3 6 , I ' f� iVsa/s SS7 `d Sr, cn.'r Lit, ! l in', Sretc Zy, Cudc 1'itoac Num6cr SW „ Section 15 _ EvdwON/E Lil-'/7fT ,30 R / %/rr SdS' 6781 (circle one N, I Type of Building (check all [hatl apply) - / (Lot = VI lu•'_Fmnily Dtceilmg-tvmnber ofBR�oinsJ_,3� ✓/ � Subdivision llamc ll// I/►A1oo__�i �ilKf+Kt I�A_�•t(S Blod" ❑ PubliciCommercial - Desenbe Use � ❑City of ❑ State Uwv-d Doanbe Use CSM Nomb r !U}- (1 `idInge Of c - O �X 11 30 67Q� �Tm„rof_" ErEc�- I - II1. Ts pe nt Permit: (Check only one box on line A. Complete line B if ooplicah c) 4 - 9 Neu Syminn ❑ Replacemmt System - ❑ "freauucnt'I folding Tank Replacement Only - ❑ Ot , Nd udifi.mou to E.imme System fcvplmn) B. ❑Permit Rcncaal ❑Permit Revivon List Prevmue Pemnt Number and Date Issued i❑ Cbaupc of Piumba f O Pcrmrt Traiuicr to Nrn L `� i I , � A� 1 Hcfoic Fgnrznon I Osmer /J iV. TsPe of POWTS Svstem/Compancnt/Device: f (Check all that apply) w f \'un-I'icti.uri'rcd In -Ground ❑Pre..crnicd In -Ground El At Grad, l\round 124,n o fsu,iabIc soil meund=?= mof suitable sod El lloldni_ "Cant, ❑ Od,c, rbspersal Component (oxplainl Preu,nunum DP9¢ (capiulu) } V. Dispn-saill'ruatmem Area Information:l0 � � D V Daagn Ro:M1 (gpd) Design Soil Applicaunn utc(_p Ism Drspersa Area Require lsQ Disnenal Area Pvrp cd (St) System Elm. anon 5'6e /i �.i YSo 11Z5 YS_o 90 9C.e/ er 9Y.yca�nw !9. Tank ]ofa zpactly to Cruliuns Tore) Gallons i; or Units anoractur, r p0`IM 1 D'ic I �_ , ,\'ew Tank, f_vanre Tm'k, ` c o _ ? _ - S,puc ni -I hi --n, 1,W. l /O60 I _ _ �da0 r _. /J/ESE �o. c<. I ✓ I Goo � i Go.vbo ✓ _ I —_I Goo I � 1 VII. Responsmlltiv Statement- 1, die undersigned, assume respunsibihn for installation of the PORTS slm,vn on the attached plans. Plombar s Name (Pont) Plum 's Signet re r y1PP,df9l5 Number Btu;n�s Phone Number j LN/`/S i/hrE/t i 1 ?17068y 71S e7.1-877Y 'i Plumber s Address (Snot, City- State. Lip Cade) N G Y&3 AAAalr`s //icc (v &4'1.1.7 GlI SY734 µNA�D- Coun [Department Use Unit permit ❑ Fee 14Date Issued I lssuint Aeeii 1!mamre El Appmerd DrsaPProvcd / `` , ��� v0 �30 I 0 0,,ne, Gs en Reason for Denial "� _ i IX. Conditions of Approval/Reasons for Disapproval Tx5 I { {, Jrv1 5Y64 it y✓I r'tt`0').1 i SYSTEM OWNER'. 1. Septic tank, effluent filter and +0 oL-1 r dispersal cell must be serviced / maintained ll 1. h1 l (oyA�1 ; 54^•�e. � 2t4kr as per management plan provided by plumber. ot�-s `N G��f OVA q L. f111 JO LlP—.ayen•.i�.{n(kylM1tl�'�tnpltlCtriSrHrrrfvrRY,vun auu'tio",mrp,t/_o-,—)vn yarn n.n—n'.. o`y...... ........ ..1-1 +11 4J de, �.�u,, "i.... �..�..... u. ' I l `i`r \ L� W 1� 1 V\\C' f tr-i �1 1 �tL�e M SBD-6398 (R. 08/14) 70pj J. sew �n N J/ 'off X�vY�:IS p7PVYAh�7 ay.!� r7 P/ J 04 r September 15, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-09-15 Plan Review: PWTS-092002100-C CHRIS M BAUER N6483 Dorwins Mill Rd Durand W154736 SITE: TR-Steve Black 240th St Town of EMERALD St. Croix County Total Amount: $250.00 FOR: Description: 450 GPD Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay hftp://dsps.m.gov/programs/industry-services w wisconsin.gov Tony Evers -Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • It is recommended to fence off dispersal area prior and during construction to avoid distu chance, compaction and use of the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • It is recommended to cut as short as possible and remove ground cover prior to tilling the ground surface for the dispersal area. • Remove and maintain woody vegetation on or near the dispersal component to minimize root infiltration into the dispersal cells • Electrical connections shall comply with SPS 316.300 and NEC 300 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewers beyond 30 feet per SPS 382.30 (11)(c) • Cleanouts shall be installed per SPS 382.35 • Well shall be located 50 feet from drainfield and 25 feet from treatment or pump tanks. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Travis Wagner POWTS Wastewater Specialist, Division of Industry Services (608)598-0715 travis.wagner@wi.gov Pace I of 9 Private Onsite Wastewater Treatment System Index and Title Page ProjectName: Snac 4,,cK- 3-,6R IY-u+o 1aMr3 (Wcj) Owner's Name: Owner's Address: c% j i vsE� .riot € /i o.ict /V 5215 SS712!, 5r, Conditionally S/ Legal -Description: /v4j S41 75 36,41 !G W SERVICES DIVISION OF INDUSTRY SERVICES Municipality: Town, Village, CAy of E.r�r scy County: Lot Number. S1ockNumber_ CSMNumber: Subdivision Name: dYo '�, St, SEE CORRESPONDENCE Parcel LD. Number. d/G - /o37- /o- Page 1 Index and Title Page Page 2 Plot Plan Page 3 Cross -Section & Plan View of Mound Page 4 Pipe Lateral Layout Page 5 Septic Tank / Pump Chamber Cross -Section & Specifications Page 6 Pump Performance Information Page 7 POWTS Owner's Manual & Management Platt Page 8 PO WTS Owner's Manual & Management Plan Page 9 Filter Information Name of Designer. _ l,SAa€A License#: ,y/- ,??44f851' Signature: 1ALDate: 8 - 3 f - 174te SBD-10691-P (N_01101) "Mound ComponentManual" Version 2.0 SBD-10706-P (N.0]/OI) "PressureDistnbution Component Manual" Version 2.0 Attaehment Coil Avah,ation Report 7hp, i 1- ry pi aas si rVs 'r7/Y ;YS N.1 oci—x7r7.f/ 30315• b fob ,v Nq 7 pAt, D = / 6 ft 195 ft k = 9 ft G = 5 _ ft 14 = ft A = d ft B = 79' ft _ =, 112 ft J = 8.1 ft K = //. ;? ft L = 97. Y. ft W = 'IS3 ft 4" sch 40 PVC observation pipe yd 1 o u� I1.5ft .1 ry M x 3 0 0 3 T0.5 ft m PL `m ui a 8 Page 3 of 4 CROSS-SECTION OF MOUND UPTURNED LATERAL & ACCESS BOX -$r / TOP SOIL // OBSERVATION PIPE & WATERTIGHT CAP GEOTEXTILE FABRIC COVERING / DISTRIBUTION LATERAL ( A in. sch. 4D PVC 02666) ASTM C-33 SAND FILL VI Lateral Invert El.= 94 5' ft Srl TOPSOIL ` }Y(nr'a i>. �� H t�iTti;`. Y '`r� v, .G System EL= 9d,6 TOE ft t ,% ei 1 �� %.; /r p . ,, { \ r✓ Contour Ei.= 9Y. t' ft .' `::''.PLOWED SURFACE % SLOPE - " FORCE MAIN (2" Bch, 40 PVC D2665) — DISTRIBUTION CELL=_ftx 7S It= 'Y&O fe (I/V-21W aggregate) Min. Required = Y$'O + /, 0 = Ysd ft' 2" Force PLAN VIEW OF MOUND Main T Observation pipe Observation pipe 75 8. j A � B K— G N p v Manifold r i lox (pia in. RXJIN I�...... I....:'.: ...... .,, ...,._,...: ..,......: ... .... ,1 i sch, 40 D2GG5) 1168- Distribution Cell Distribution pipes /e8 La S" ft (%"-21/V aggregate) r 1W.S ft Cx75r (/Z In.sch.40) OX= Upturned Lateral Win Access Box Prohibit disturbance and vehicle traffic within 15 ft of downslepe toe. L 97.'I , Basal Area = /7.7 fix 7 5 ft = /-196 ft, Mln. Required = ySO - , G = 7S6 ft` PIPE LATERAL LAYOUT OF MOUND (End Manifold with Aggregate) HOLD DIAMETER = 114 in, LATERAL DIA. _ I/2 in. MANIFOLD DIA. = iz in, (sch, 40 PVC dad pipe D2666) rtes a TAccess FORCE MAIN DYA.= i/ in. aaVske, P4G5\ee4 Box F = -. Z� ft. \Vtr \\r JS s — 3 ft, �Ip/e\�0s\Nora 95\�0�0� J% ft. Neyy Y� v5 0 xX W. G� 1 1� \ ��d y i kYy, prar MANIFOLD ( Z& in. sch. 40 PVC D2665) Y,y, ,/X FORCE MAIN (2" $ch. 46 PVC D2666) Minimum Number of Holes = '/,fo ftZ Y 12 = 39 Holes Page _' of yr HOLES LOCATED EVENLY ON BOTTOM OF PIPE. Holes/Lateral x 2 Laterals = 38 (3/16") Holes x 0.56 gpm / (3/16") Hole = T 68 GPM = SYSTEM FLOW RATE PIPE VOLUME = /99 ft. Laterals (total) x 0.092 gal/ft. = _ /3. 2s x 5 = _ C6, GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = 9L. S ft. Page S of 9 COMBINATION SEPTIC,'DOSE TAPIR CROSS-SECTION (DRAWING NOT 1 O SCALE-) FINAL GP.ADE BUILDING SEATER 1 (ae,sPS39230(91)) _s`over ,MANHOLE RISER & COVER (perSPS 3642SC) a (9). approved locking device. Lvae.ng label, end n2 .Ie ds3as n ^l-1 <- rdm. ScA 4DPVG Tznk Vent bovePadabovegrade vali. above P.vaional Flood �avalion rr ' OGLYLe L,G - is �04-SST 5£Faticc S¢a -_ enedEl ReQubetl Ono+met — ELECTRICAL dumc 1 [oiv Box <raOPlg\mlh SP53,S and TIEC3a0) _A A T,WR Sch.40 PVCTank Vent formal AT above o2de ar24" above P.eyronal Flcad0evation FOP.CE MAIN ,,. O.Fi rIONS �Fcs .. Jj.�Ij r3311 `::J ,. MINIMUM OF3' OF SUITABLE BEDDING BENEATHTANK c MAh. MUM BURY DEPTH OF 9G Anchueng oft.7* rnsy be requked per SPS383.?3(8)(g) ouA Y.bn Tank Manufacturer l)IESeA Le��cacTe Daily WastetvaterFlow PVVF): Z/ 0 GPD Sept(c(PumpBre: 14661G60 gallons plumber of daily doses: 5.3(/7f.i A(amManufacturer_ -:.TF X�,-5n03 iAdX A1ZAT- 1 3 ga ForcxmamvolurnE SO f,x ./Alfr�= $..2 gat Model Number. - Switch type_ Actmldose volume: 93q gal - $a gal= 85,'7 gal (total dose Volume -Volume affmrca main) E-Ifluent Pump Manufacturer Zr ; rEC 17lAdY Model Number 4EN i;oSE=al�iscaMAo=fE;:: Reserve above alam Y in = 3Y/.4 (D) �J Minimum Discharge Rate_ .73. 08 Gplt+f <2O. gal Alarm float above an floor .2 in = 33.5' gal (C) 0n10ffstoat noeasurement S.6 in = `?-?. 4 gal (B) Vertical lift (pump ot; to lateral invert) -------- /3. s R 0, r above tank bottom _ - in = /3 Y. / gal (A) System head (distal pressure ai S" x •1-3 %): 3.3 Z SO 8 Force main x /. y 1100 friction factor .7 ft DOSE 71 DIMIRNSIONS: - rrterfictionloss ------ ..___.___-------- ___..__ - z Length /SO in Width 8`/ in i offal Dynamic Head (TDH): /6 , $ ft Outlet height 34 in Gallonsfrnch &I76 9EN SERIES - 4/10 HP 99i-CA-59 wm4w f 161C NI51' aN' Zmm tEstm 20mm 95" 96' 5r .� 21W. il]a an QR. 41S W eF 9EN-W M4mr wemi In= va 9II e e m m a m m m to aeon-ee Frgu9klin Electric XmffiLwlw& I W° p ' EFFLUENT PUMPS PE. G 6t ? [aver Epmry led cast imp `ihermo lactic Alotor Nousing Epoay-caated cast!= Impeller material Thermoplastic elastomer ImpeflerType Non -dog Mute Epoxy -mated cast iron NowshaR Steel HechardcalSba tseal Nitrite with mrbonandceramhc faces Fasteners Stainlessteel Bearings uppersinteredsleeve and lower hall bearN Power Cord 51TW —51TOW •msnwas • • m m� gx-at-a=ara �ml emd, Page 7 of POWTS OWNEWS MANUAL AND MANAGEMENT PLAN FILE INFORAkTION Otvnzr .Sr6'u£ /SLACK Formica DESIGNPARMVIEF 'ERS Numbcrof Bedrooms (10D gpd/bedmom) 1 „3 Number oECommercial Units — j Estimated flow (average) ,300 gaUday Design flow (DWF) = estimated x l.5 yfp gallday Soil Application Bate /,p gaUday/fr'- InfluentTfHuemQuality(aNlt) ManthlyAvemge Fats Oil & Grease (FOG) <_ 30 me/L- Biochemical On}•gen Demand (BOD5) :mo mgiL. Tom] Suspended Solids (TSS) < 150 mall - Pretreated Effluent Quality (21 NA) Monthly Average Biochemical Oxygen Demand (BODs) 530 mgV Total Suspended Solids (TSS) 530 mJL Fecal Coliform(geometric mean) <10 cfu/100ml, Nlaximum Efluent Panicic Sim I I/g inchdiameter Dispersal Unit iklf .[Kodel Numbe. Calculations: SYSTEM SPECIFICATIONS Septic Tank Capacty 1 /006 gal ❑ NA Septic Tank Manufacturer i 41/£sS.c A£casr ON £filuent Fitter Manufacturer Otylozx NAJ Effluent Fitter Model PL-s.YS ON -Al Pump Tank Capacity boa Gal 0 NA Pump Tank Manufacturer ONA Pump Manufacturer Lfrrur bmar ❑NA Pump Model 191fll Cf N Pretreatment Unit (0 NA) ❑ Sand/Gmvel Filter O PentFilter 0 Mechanical Aeration 0 'Wetland O Disinfection 0 Other. tManuracturcr Model- - i Soil Absorption Component( NA) Q In -g-round(gravity) t7 In-ground(pressurized) ❑ At grade 12 Mound O Drip -line © Other Vertical Distance Tank Bottom to Scrviec Pad- A? ft Horizontal Distance Tank(s)to Sen'ice PacL- Tfr I NA Soil Dispersal End Cap (Dispersal Emit EISA) DWF Anolication Rate = Area Required - EtSA } or (french U iddi) = n Units or Total Length ofTrench(sl 1 S& - /.0 y54 - G = 7S r C1 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption S}stems" Publication 9.6 (SSWMp lWanual) • '[CC Flowtoch Mound Component Manual" Version 1.2 G "EZ Flow Mound Component Manual" Version 3/20f2007 • SBD-10854-P (RU12) "At -Grade ComponentManualIIs"mgPrenweDistdbuuon" Vetsion20 a SBD-10705-P (N.01101)"In Ground Soil Absorption Component Manual" Version30 till SBD-10691-P (N.01101) "Mound Component Manual" Version 2.0 O SBD - 10657-P (R6/99) "Drip -line Effluent Disposal Component Manual" Or SBD - 10706-P (N_01101) "Pressure Distribution Component (Annual" Verson 2.0 vetM1"rr N'A?1'Cr MONITORING SCiLEnr ft-r,- MArnrrr•.N A NCR AND MA- 1_iCiEMEN-F San -ice keen[ Servtee Fro uency Pump/inspect dispersal cell{sj clean Cuter ( Stleastonceevery_ ® 13 months Sd 3 years O Other. j Inspect pump & pump controls, alarm, pretreatment unit At Icast once every- O months 0 3 yc= ❑ NA LFlush dud pressure test laterals At ]cast once even. 0 months l9r3 years O NA START UP AND OPERATION_ For new construction, prior to using the PG%Vn check treatment tank(s) for the presence of painting products ar other chcmials that may impede the treatmentprocess and/or damage the dispersal cell(s)_ If high concentrations are detected have the contents of the tank(s) removed by a septage servicing opemtorpriar to use S)5t=startupshall aotoaur when soil conditions are frozen at tb¢ II}IlltrrtivC sarfac, The property owner is responsible for the operation and maintenance of the PO'4TS and submission of required reports. The quantity and quality of & wastewater stream t+dll affect the performance and longevity of your POWTS. The insWiatim of amter-saving appliances and fixtures along with prompt repair of leaks reduces the tvastnvater volume. Also the brine or i astc from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible Note: this does not include laundry waste, shovers, dishwater- etc. This system is designed to handle domestic strength wastewater however, the disposal of food based _greases, oils, vegetablelfruii peels,_ seeds, bones, and food solids, suchas those produced by a garbage disposal should beminimized. Toilettissue is the only paper that should be discharged into the system- Other non-bmricyadable items, such us baby wipes, tampons, sanitary napkms condoms, ci^oxotte butts, dental floss, and cotton swabs, should not enter the system. Chemicals, such as petroleum products; paint, disinfeciants, pesticides, antibiotics, solvents, etc- should not be flushed into thcsystem because they can seriously damage yourPO WTS and comanrftlateyour ?age $ of 9 drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction ofsnow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diametershall be secured with effective lacking devices to prevent accidental or unauthorized entry the tanks. When the combination ofsludge and scum in any tank exceeds one-third (113) ormore of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Ch. NR 113, Wisconsin Admin. Code. Specific servicing mechanics must be provided ifvertical is>li feet or if horizontal is>1 50 feet and instructions to be provided belmv. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep thesystem operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a t day reserve under regular operating conditions, however water should be conserved until any problems with the system ate corrected to prevent back-up of sevvage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and properly 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 sail, gravel. or other inert solid material_ CONTINGENCY PLAN: If die 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 soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure. lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with die rules in effect at the time of replacement O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a y 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 soil 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 ofsuch systems mustcomply with the rules in effectaE drat time. (YARNING!!!! SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAV CONTIAN LETHAL GASSES ..AND/OR LNSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OFA TANK MAYBE DIFFICULT OR IMPOSSIBLE - ADDITIONAL COMMENTS: POWTS INSTALLER �J POWTS MATNTAINER Name: LNAfs .rEJAUE2 /%P Name: ,quE,t 44"Vo/✓4 Phone: /S L7,7— ,7 Phone: 3. —/ ]-a'IaY SEPTAGE SERVICING OPERATOR (Plumper) ? LOCAL REGULATORY AOTBORITY Name: � Name: 7r 15""'X e-o u l-✓ U [. Phone; Phone-- /,S 384- 9e86 APPLICATION FOR REVIEW 8S = �-Complete all page- -� �\ PS s NOTE Personal information you provide may be used for secondary purposes (Privacy Laws. 15.04(1)(m), Stats.l ❑ Plans to be E-fited. Provide SharePoint User name below: Private Onsite Wastewater Treatment Systems Division of Industry Services For plan status. check our website at htto'lldsps wi.aov Email technical code questions to malto:OSPSSBPowtsTech1&wi.00v Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those 1_ Project Information -Fill in all known information, eonftrmadon of assignmentto a reviewer. Pmjectfs1te Name- Si-FUE /J LiL [,r Transaction 10: Location, Number & Street of project (if unlmown, indicated nearest mad) Previous Related Trans- ID: 2Yd rli SY. Estimated Completion Date: Legal Description: /vLJf Stli �S 3d N���IJ I Assigned Reviewer Ceunty Sr. Cse/X Assigned Office: _ Cl City ❑ Village [Town of 2. After plans are reviewed, please: (check all that apply) ❑ Call customer 1, 2 (circle number)' ❑ Requesting party will pick up . KJ Mail plans to customer 1o2 (clyde numberp `Refers to customer number from below. Mail to your office of choice below: La Crosse, Green Say NOTE: We reserve the right to re-disbibute plans to another office H needed to reasonably balance turnaround times. Check hdp:lldspsvd.00v for nest available review date j3. Complete the falfowing designedownedrequesting information, utirme the rhEck boxes when designen owner or requesting party is the same to ` avoid repeating information. Designer Information (Customer l) OSPS First Name Last Name Customer Number �'Ha:ls 6AuE2 /7F-,77JOG9IV Company Name q �r AuE,c i"[ins/✓t it S�yr�c Address City ��77 State ZIP+4 (9 digits) ,041AWIA W_7' S973G Phone Number EKrlal address cell phone {area code) .,!. G72-877r/ d4hgnelsen—�'e/nej Check ifapprimble ❑ Owner Other Please Specify Below (Customer 2) OSPS First Name Last Name Customer Number SPEri6 ,StAtK Company Name r /J we address N J;2/.S 5S7 rK ST, city State Zip+4 (9 digits) /'%fi,Jeire.r/� QX St/7S/ Phone Number E-mail address Cell phone (area code) Check if applicable or specify relationship information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application form and e-mail it, along with your registered SharePoint usemame to DSPSSBPIanSchedukeAwiscortsin.gov- If plans are being submitted via paper, they will be assigned to a reviewer after receipt at a DSPS office. Submittal checklists can be found in each applicable component manual Hofinen/Onalaska Area DSPS Green Bay DSPS 2850 Midwest Dr Ste 104 2331 San Luis Place Onalaska, WI 54650 Green Bay, WI 54304 693-785-9334 920A92-5601 Fax: 6011-7e5$330 Fax920-492-5604 Email: Email- DomSbPlanSch"ukm ,knov Make Checks Payable to: Division of Industry Services OR ❑ Check boxto inyfi ce igner and sign below TOTAL AMOUNT DUE $J-75b.415 Review Code 7633 t7esiyrter signature 88D-10577 (R3hg) 5. POWTS SUBMITTAL (check all that apply -incomplete forms may result In processing delays) NEW ❑ Aerobic Treatment Units) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT ❑ Commercial System ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPES) NOTE: Submit separate sheets for each system If submitting muitio(e systems on the some site Enter Fee ❑ Revision to previously approved plan $85.00 ❑ Miscellaneous Review (I.e. replacement ate septic tank, addilion of an effluent filter or pretreatment device to an existing system, etc.) $80/hr '— ® Component Manual Design All treatment components are previously approved ❑ At -Grade Component Manual - Vec 2.0, SBD-10854 (N.03107, R, 1/12) Wastewater Flow In under s. SPS 364,10 (2) or (3): ❑ In -ground Component Manual - Vet. 2 0, SBD-10705-P (N.01101, R 10112) Gallons Per day Design wastewater flow of the proposed system, ® Mound Component Manual - Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Y56 a�rp a-o ® Pressure Distribution Component Manual - Ver. 2.0, SBD-107GS-P (N,01/01, R 10112) 1,000 gild or less $ 250.00 ( ❑ Other - Please specify GPO 1,001 - 2,000 gild $ 325.00 2,001 - 5,000 gild $ 400,00 ❑ $oil Based Individual Site Design' One or more treatment components are not previously approved under s. SPS 384.10 (2) or (3): ❑ At Grade (Individual site design/deviation from component ❑ Non -Pressurized In -ground Design manuals and use of components without product ❑ Pressurized In -ground Wastewater Flow In approval): ❑ Mound Gallons Per day Design wastewater Pow of the proposed system: ❑ Drip -line ❑ Constructed Wetlands GPD 1,000 god or less $450.00 _ ' Documentation must be provided to support treatment and dispersal claims. In a separate 1,001 - 2,000 gpd $600.00 statement, provide rationale for the project and attach supporting documents (code sections, teal 2,001 - 5,000 gpd $760.00 reports, technical papers, research articles, etc,) greater then 5,000 gpd $900.00 plus $0.08 for each gallon over 5000 gpd State-owned facilities: Design Holding tanks previously approved under s. BPS Wastewater Flow In 384.10 (2)(3). Design wastewater Pow of the ❑ Holding Tank Component Manual, Ver.2,0, SBD-10855-P (N.03/07, R1112)' Gallons Per day proposed system: " Non -stale owned Commercial and Residential Holding tanks (hat completely utilize this manual 5,000 gpd or less $ 9000 and have an estimated daily Pow of less than 3000 gallons per day must be submitted to the GPD 5,001-10„000 gpd $150.00 T appropriate governmental unit for review Instead of the Department. Isee SPS 383.32(3)(a)) greater than 10,000 gpd $225.00 ❑ Holding Tank Individual Site Design', (i.e. site constructed, <5 day holding capacity, Co- Design Holding tanks Including site conslruded tanks NOT mingled wastewater, etc.) Wastewater Flow in previously approved under s. SPS 384AD (2) or (3). Design wastewater flowed the proposed system: Please specify: Gallons Per day 5,00gpd or lase $180,00 ' Documentation must be provided to support the rationale for the project In a separate statement, p P 5,001 - 10,000 gpd $300.00 please Include all code seGlons, lest reports, technical papers, research articles, etc.) GPD greater than 10,000 gpd $450.00 ❑ Soll Saturation Determination Report (using observation pipes) ❑ Interpretive Determination $240.00 ❑ Experimental System (One time additional fee), Submit fee for individual system as per appropriate above system type) F� pedment Number_ $400.00 Priority Review (enter same amount as normal review fee listed above) $ _ Enter Total(i ounded to the nearest dollar) $ SBD-10577 (R 4118) N INSTALLATION INSTRUCTIONS A dW PL-5251PL-625 FILTER INSTILLATION INSTRUCTIONS Step i- (A) Locate the outlet of the septic tank. (B) Remove tank cover and pump tank if necessary MAINTENANCE INSTRUCTIONS Step 1- Locate the outlet of the septic tank. a SERUBBER GLOVES EN GLEANING FILTER Center Htter with opening 0 WN J0 LL0 Additional pipaor Polylok Edend & Lok- forcenlenng. Step 2- (A) Before installation, place the filter housing onto the outlet pipe. (B) Make sure that the housing is positioned so the filter can be removed from the tank for maintenance and sendce. Step 2: (A) Remove tank cover and pump if necessary. (B)Pull the filter out of the housing. tiC tank. Make sure cif solids fall the into the septic tank, a Step 3: (A) Glue the filter housing on the outlet pipe. (B) insert the fitter cartridge in the housing, mating sure the filter cartridge is properly aligned and completely inserted in the housing. Step 3: (A) Insert the filter cartridge hack into the the housing making sure the filter is properly.alighed and completely inserted. (0) Ropl000 oopt. lance ewer SOIL EVALUATION REPORT V4123 tf� �?�Tr <icr.reif�'le?'M3ssLr>:; s-:�s gage 1 of _3_ Nv;trr�fS xtaril ari m; N4n1;ri-1sr4u to in g;)y�:ypl wat, : A4lm d5. we 1-dr wd: Aeach mmt7411e v7o ;,I;n Zr tans* not'ass Nen 5:5 z i 1 inJ>.s aa. Ran m:�. cr�rry c! } ,ndude, b�-A no! Ikn4d to YG l :m 4o2cMai Wefef!Ce pw.7f 4WAy Gtfec4on 3'nr —.... Pl F;Mfi siom 01D 1037-lp -650 P7sssepf At a!1 iq)6h»atidR. (sr?vW4-td ae - Dew jj i'?'stl:rStr.IG watr. y6v PrrnL'Fra. Ee Cwty t4Sr3C rpi.�1ftipr-w_e l.b,s tS JA i-t gin';+ �ts�xssltart __ _ _ �,.r. La ata,�tla, cvJ:ta_513. T�Gh., iii6J1 f'f' Erp Gk'�sr'0 h1GlEng tWCre;-5 Lwd slate =1G Ldt3E Fort Num'xr - -- - -- te•- t;;lrtge " -an-t [J��res/ Rage cmF: etd wt 1w1.1 Emerald 24G3+7 S1 New cwlsVa mr 6l.e' b Y at cgCcp,,^,rre n - _ 1 = �. Coy dEl�d �A�r, rtm r-* 45C R"41ce'rerl F�bi><, cx-tnEral-E74scr _ _ _ aarnnrtxte-al Glaalet¢ Flood plareErehenAatplity., - fE 7 :�enerps oyrn.xens ! _ eet7o Pit GMvrJ aucFs=r;.p,.. 93.74t=, pqvi;c mmminG t8^3bt 29 n ia..a e.._.r-..:.... a,..,.. rrt$�m, "xplh. CA.+AL4afi4 �k'r Ged".,x iJt6cn fe,care �iIS5UF9 wGflr>;4Bea,Aaryl RC.^� Pi' -- #Su,sett Qv. IS?- r=L Cc:nr G; sz S§ __GP_ -llsr `Em 1 +7'4 1,7YR317 SIf 7, yk" Tf3 - C$ 2f .fi 'la J 2 ._- 4-10 1GYR41& sit_' 20k mf, C� if ,a I x 20124 16YR:/c Stl i551 mfr 29-48 l4Y 5 8 ?.Si Rti18f;d spys st isb1 nz �a8-N_t - 16YRSj8 75'(R6(Sf?d sp^ts _ sc El r :l CrOand 93.74 X&IOce citov. tL Dmplh to Impirg tactir _17_ _ zt .'aoil;,pprtatan Rats Hctitzn' t7eptn [}wrwaticator Reda111)"mptim i Tw4um 3011 M 0tcfsl9tet 86ciu3arY aaaif IR Mssniell Q-1 w.-C*01 i+`wv I - ST 5.2. 5h 0.10 10YU12C21 -- 2r 5 .3 -- LL2 - _ iG17 " 1DYR4,+6 sd �A4 is'n{ a if .@ i -`c4 1]_75 -- uYR5,16 - 7.:YR61$fldspots ski --Lsbk---- MG�- ". q+-_--, _f_ Z 4 0_ ?DY!i4/B 7.5yR618(13 spots 0M=; fJ.� 3.0 -- f '€T1,1EnI<7.. EL,"...e>3�:�25 'r+gi�anO TS r',.-0c15Cr �gR 'E;IIuer1 M2=BC05�3G mly'L Ene 7SS -�30my}1, "�St SidflC ft�t)A pnnn - _ _,gnttB / 1 nt rht"Rit ,3. caa ^1SLa-a-E"! GZOTWI j 1%d12$59 t�l3F:umb [. t:t[ s7,t{p ,cyAlv2li�4 GirFhrW Te�e6nene Nunbr I if 2&13130C Aw GSimvpbl ,^,"ry. Wt SkOca 71fiJ2L+59 7t5.285-6t :5 { r=oxt, Owner Francis mrz 7 �ori-ea l' 3au� ass= ... '�,llxan ^epth Cominar.; C�In Rcdps Gas:,rryr,o^ T?#Ir;-E 3:n.�,;.-6 Ccrst4iecc�.3cV•'rdaY RxL' GFJ7f} • MLseO Cu 3c. Qur,: nvfr G r .5 CS 3 1? 2d ki1YR5in '.5`/n6j9°1C ma's SG: ?;hk r15 CS Ii----- ! 4 -- Z6-�� -- 1�iYR5;Yt ;.h'R6;still'l� isbk _ nx`; 35 O.B J.0 Ii 3e J9nrt��? Pd ��r�ni wctar,� env -- - R Cetr;c _ rrrs:tn3 Baer _ _ to Sot dpFareFtm Rr.F ---JJ "''"'m^ �'C'•I' m>r.^: vpsvr Rtdoi DRSUzDN7n iexire S1r71FL'� r etLiiVlrrc dn�:+Car4 ryWIV nr G. �.'R' r MUn521 :7u i` I i Hump R P^ urbtni slr(am emv 'l DBF4t 7a W165113 (scot Sni nrclrca4Un 4a>3, •-_�rnr , eo% Comrea�4 CB'v0r RedO+['.esrnnror Td ..n, 5:.eua� Ca:»!!Leer 3rn:n� f cfn is GF__.T.- Sz COm r-or, C< Sz. Sn •E:nt I t r , • y1r+Jnrtt?-'t a aRD.> oc «2e m^_ any l5S �3:• <_7 �'1`8it ' EMUInt OP n E ]OCR K 40 r,C,'L w:d 7SS c• ]a Met i he tha.�nem or icier,, yne R..rrcy;::;.,t � iccse rs nn ryun: uplrririim+ry sez�,irz .inn wG aRy empl01n Ji yrL^ nuM .+.csisl2os a. IM-tCCS ut and mcibmal in ^n atmrrimc Cunn:u, COMACE lle dcphnnrcra at 608-266-31_<I or rTV fn, u h Rd, ! Nuf'�y.S+U'1�C5i�3�3nN�l1�w 7��•� xly'.�.iww�a.r'riP< a#L Tp �C siY y.+V Arr J Prpr 3f - 13.71 FjZ = °Y7Y jj:?.ft,,xy, �t•Iu si�,r" rims -id&ns ttg - "A 4L Eme,-iV In- 6'YO1 C h/State hEf %,r,I�1�(1,5 Paull Idetttificatim N=bx 0 NO - %BG. DEsow,riox ProF -'�-r Lc*.=n:: -49 ',: � % , Sx: 15J' , T �N P W. T.w. of Spbdivisma, oC I.of Certmed Survey Afap d % <j Yoltroe 30 Page = 6 79; WKP"MfJ -B R 1 /U Z ?%3 (t Ciforehate Page Qkj ai+h Spx bouse Dyer) rno LO aces 1deot5able)Cyes:? or, SkST;ghi C"ER=CATIQN %rrr ttsn xv—' ,ra�tt =cc of vote sock Mt= could TIME in its ?r-== 5a rr m biaedle w2sres. Pr cr 'R'�� aUt fzte xptic tm:k c,-rp *T= rone,r :u au . irao ioct, b a Hccnya; p=p:7, Waal yac plc :nw the e)sbm affect �a ftt r'isw c2 as :ic oak as a nt aM=stage is the Wiat2 disposal Systea Gwttet maiotet mace rksportsr2iliCtsereslroci5cdinSSPS.3'83.5 (llenda;C^�apta12-:kCrsuCa vSsuftarytM}ioancr_ :be property owva erees to sttbma to St QMtx County PlsMg k ZMMS 7cparnnetlt a c- 5C2=k= fc t=. s€gam by th Gn'Ma end by a rhsaw plumber, journeymsz Ph=be restricted Phtmb rac a fiswased pamper vejfym t!j= (1) tb w--she 'Alstew•aW d4csat syacem is in p optr Pou,iitior end or (2} efldt hapoc act and p tmstmg W ==sswyj tu: septic tatak is In" that V. -fud of 014a, Lcce, ; nalesigaed havt rran the atwv: Toq=cm=ts ead epee to mat4;a-' _ the vNs_ sewage dis Sal `iv= vt:b :he sraadards set froth, harm, as sedby the Dr vtnoem of Safsiy And lrotusimal SM- ims zod :!•_ DRmr-_nent OfXa=za Rrqou-ces, Suite of Cc-d5cati= sraCic1g ZO yo:c s4pdc syAcm hat bxa inehttafaodoiust be compl=d end• r=med to the S_ -,J.O l.'-t=ry i kMnmg & 7mmgg Depm-meot witbit i0 days.of ctb.'e[ vp ek�hap� dot. L`u: it.--fy that e" statements nn this Intro r[ tv[ to the besi of taylom lmnwleidge. L'ooe amrare $t: ewn-- Ss rf lire pTo,perty deszibcd above, by im-mrc of a :sartats;y aaed nth ded m Reg-= of Ards DmLt. , Number of bedrooms J I x iO r t)1 f j�j SIGN' T�C :E OF AP?LIC NT(51 DATE • • •An} itlfur*a�o*_ toot is n i rr erixi ay rr `; n r e aai:a -'Mma h[i g : c; ❑ cd by *b Plsanirg Zoy D:pa-ot IU--Iutic wiib this zPP!J ct.iun a ZCUW Jrd wa ra lcef &u u air Rngistm ai L ri —'' = rf5ce and a copy oftYe cerd5td siL'VCY trap refraenr s matt it fh: we^ann- zOrti (gE'r G4rL) .roryi,i 7 4PPt 2 3 2820_ SOIL EVALUATION REPORT CST 303c-0(C1 #123 of sarery ana rrolessional services rage i or 3 R�=)epanment - ivision of. Safety and Buildings Northland Plumbing, Inc. E in cwrdence with -Comm 85, Wis. Adm. Code County eteeite pf orrpaperrrot�rss an 8% x 11 inches in size. Plan must St. Croix t not limited to vertical and horizontal reference point (BM), direction and ope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D 37-_to-oso _ Please print all information. Revi wed By Date formation you provide may be used for secondary purposes (Privacy Law, s 15 04 (1) (m)) pi 4 l !p ZZ 7 r429160th op wner Property Location h Govt Lot NW1/4, SW1/4, S15, T30N, R16W wners Mailing Address th Ave Lot # Block # S Name or ClS�M# S v, 30 S • to-j�'L I �p Ili L13 City State Zip Code Phone Number - _ - 'City Village J Town Nearest Road bmerald WI 54013 Emerald 1 240Th St New Construction Use. Residential / Number of bedrooms _ 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe. Parent matenal Glacia_ I _Till _ - _ Flood plain elevation, if applicable General comments and recommendations: X�E Boring Boring # F -1], _ Ground 93.74 Pit surface elev. _ ft Depth to limiting factor _ _ 24 _in. Soil Application Rate Horizon Depth Dominant Color p p Redox Description Texture Structure Consistence Boundary Roots GPDIfI'__ _ in Munsell Qu, Sz. Cont Color Gr. Sz. Sh 'E!1 •Eff#2 1 0-9 10YRi 3/2 t 2sbk mvfr cs 2f 6 8 2 9-20 10YR4/6 sid 2sbk mfr cs if 4 6 3 20 _ 3s- �--isbk -mfr 4 24-48 +isbk �0.0 0 0.05tOM mf T ❑ Boring # . Boring Groundsurface 93.74 Pitelev. - - tt. Depth to limiting factor _ 17 _ _in Sod Appbcabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary �,' Roots GPD/_f 2 •EfF#1 •Ef1#2 in Munsell Qu Sz. Cont. Color Gr Sz. Sh 1 0-10 10YR3/2 sll 2sbk mvfr a 2f .6 .8 2 10 17 10YR4/6 sid 2sbk mfr csif .4 .6 3 17 25 10YR5/6 7.5YR6/8fld spots sid isbk mfi gs if 2 3 4 25-62 10YR5/8 7,SYR6/Sfld spots' sc j OM -mfr cs 0.0 0.0 • Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Prfnt) Signature CST Number _ Michael J. Myers 267985 Address Northland Plumbing, Inc Dale Evaluation Conducted Telephone Number 2943 130th Ave Glenwood City, WI 54013 11/4/2019 715-265-4115 SBP8330(R II11) Property Owner Francis Klatt Parcel ID#— ___. ___ _ _—_— _ Page 2 of 3 Boring 3 Boring # Pit Ground surface elev. _94,44_ _ _ ft Depth to limiting factor 18 in - -- Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Co. Sz Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDtf 'Eff#1 'Eff#2 1 0-9 10YR3/2 sil 2sbk 2sbk mvfr cs mfr cs mfi cs mfr gs 2f .6 .8 2 9-18 10YR4/6 sicl if if .4 .6 3 18-24 10YR5/6 7.5YR6/8fld spots scl 2sbk lsbk - OM - .4 .6 4 24-36 10YR5/8 7.5YR6/8fld spots - -- sc sc 0.0 1 0.0 5 --- J— 36-61 — 1�OYR5/8 — -mf-- -9s 0 0.0 - - - - L I I i Boring Boring # --, Pit Ground surface elev ff Depth to limiting factor m _ - - - - -- - -- Soil Application Rate Horizon Depth Dominant Color Redox Description In. Munsell Du Sz. Cont Color Texture Structure ',Consistence Boundary Roots '', GPD/ t7 Gr Sz Sh 'EB#1 •Eff112 � I i — I i _ Boring Boring # Pit Ground surface elev ft Depth to limiting factor in. — - - --- -- Soil Application Rate Horizon : Depth Dominant Color Redox Description Texture Structure Consistence in Munsell Ou. Sz. Cont. Color Gr Sz Sh. Boundary Roots GPD/ft' •Eff#1 'Eft#2 i — i r Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS - 30 mg/L The Department of Safety and Professional Servicesc is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fnnnat, contact the department at 608-266-1151 or ITY through Relay. SaA8330Te t(R till II Northland Plumting, Inc. 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