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Home My WebLink About008-1033-90-000 (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)]. Permit Holder's Name: City Village Township Charlotte Heimer & Frank Stout TOWN OF EAU GALLE CST BM Elev: 1 Insp. BM Elev: BM Description: 1O9.D IOt— TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing ` , ` t In - Aerati Hold' TANK -SETBACK INFORMATION------' =I'�� E PUMPISIPHON INFORMATION Manufacturer / Model Number '^/D 4L TDH Lift$#\A Friction Loss SI N .t7 Forcemain Length % Dia. t' to SOIL SORPTION SYSTEM RENCH idth Length DIM ! 3 SETBACK SYSTEM TO INFORMATION Type Of System DISTRIBUTION SYSTEM Ft STATION BS HI FS ELEV. Benchmark dot. Oo. a r AIL BM Bldg. Sewer SUHt Inlet S1/Ht Outlet T cl` `33 t Dt Inlet I6•10 Dt Bottom l 94.b111 Header/Man. 5-. Dist. Pipe ot. System Fin I Grade St Cover �S0 Y It -0 DIMENSIONS INc. Of Pits "A -, CHAMBER OR UNIT 2S HeaderlManifpld t1 1 Length_ Dia Distribution Pi Lengt Dia pacing x Hole Size x Hole Spacing Vent to Air Intrke JVIL GUV LK Y Prassura, Svcfwms Only xr Mmmd nr At-f:rndu Svefnme rinly Depth Over joepth Over xx Depth of xx Seeded/Sodded xx Mulched BedrTrench Center Bed/Trench Edges Topsoil Ecj Yes a No Q Yes O No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: f►/ t}(2,92 / Inspection #2: ( Location: 2607 50TH AVE EXK S T D °� ``S-t -� �a� CCaa/mr�I• 1.) Alt BM Description �� ` = (� ! -i-�'0 2.) Bldg sewer length = ` 64d y - amount of cover = / L •� �, ,• -^'� 71 �tVvNa 'u y a Jt►K f'(�e%`i2q, S�"f�"�� Plan revision Required? [ Yes No 3 / c Use other side for additional information. S 0-6710 (R.3197) C. - 5 Insepctor's Signature Cart. No. �, I - u► CAN � � y 1 I 1101 Carmichael Rd Hudson WI 54016 T: 715-381-4382 Kevin.Grabau@sccwi.gov ST. CRO PNTY ' 'f?'('i771 it!' From: Paul Koehler'<paul@countrysideph.com> Sent: Thursday, May 13, 2021 8:46 AM To: Kevin Grabau <Kevin.Grabau@sccwi.gov> Subject: FW: Message from KM_368 This email originated from an external source. Verify the legitimacy before clicking links or opening attachments. Can you put this with charlotte heimer. Pump tank . From: infoCd)countrysideph.com [mailto:infoCa)countrysideph.com] Sent: Thursday, May 13, 2021 8:51 AM To: paulCabcountrysideph.com Subject: Message from KM_368 2 � Ilo?f�rrNf�[/�Fnl Sfin)- _0d Iel _ ?S/_ / ' Safety and Buildings Division County ST CROIX Sanitary Permit Number (to be filled inbyCo.) APR 2 7 2021 201 W. WasNngton Ave., P.O. Box 7162 ' • St. cro�x County Madison, WI 3707-7162 &333kfq �._.� Commun,ty Development Sanitary Permit Applicatio StateTransactionNumber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate g unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are su ed to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1Xm), Stats. 2607 50 TH AVE I. Application Information - Please Print All Information Property Owner's Name Parcel # CHARLETTE HEIMER AND FRANK STOUT IJEx 008-1033-90-000 Property Owner's Mailing Address Property Location 2607 50 TH AVE Govt. Lot NW NW 12 /., /., Section City, State Zip Code Phone Number WOODVILLE WI (circle one) T 28 N; R 16 E or W I1. Type of Building (check all that apply) Lot # 911 or 2 Family Dwelling - Number pf Bedrooms Subdivision Name VJ�Ap��t►+•tilY� ¢Xl 4 Block# ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number — Town of EAU GALLE Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New S stem y Replacement System ep y ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑Permit Renewal ❑ Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner pq / Z�$�SL 9nQ /99 / IV. Type of POWTS S stem/Com onent/Device: Check all that appi1 LNNon -Pressurized In -Ground glaiessurized ta-6irrutid ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component ex lam r ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information 3 X K +(2-) 3 x :i0 a,l u.A'%t - •p Design Flow (gpd) Design Soil Application Ra f) Dispersal Area Required (sf) Dispersal AV Pfoposed (sf) ystem Elevation 750 .7 1072 1075 95.00 VI. Tank Info Capacity in Gallons Total Gallons # of Units, Manufacturer /_ o '$ u }Je,, P f =Sa'�. U New Tanks Existing Tanks /1 t�'� y o 0 U in m rn W 0 R. Septic or Holding Tank X 1600 UN KNOWN Dosing Chamber X 750 WIESER X Vll. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number PAUL R KOEHLER 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI 54017 VIII. Coun /De artment Use Only rAV U r- w 2*1 t StTe. 1o(ApprovedP Permit Fee Date Issued Issuin Agent Signa e •�Y $�3 t ner Given Reason r Denial Zp2.� IX. Con prova val rye 1 SYSTEM 1. Septic tank, effluent and 5 L� A I J qe� dispersal cell must be serviced / maintained ��" jQ�ill dL a se (^J as per management plan provided by plumber. �.(. n ✓ � � ,,�- �� 2. All setback requirements must be maintained `) w LbbP� r5 ��ll ar C / 1 r` `� --- - • Artach to gplans for the system ands bmlt to the unty om n paper not less than 8 1 h size � 11 Inches ib si/II t0/J •Il7•x•'a G'0`e"4 bR- e..� dt.t ce C11gd[ SIo d.�`}WR8 �Ra *ems, /j�rDt1Y�/ • '� �� 5 (/ PAGE 3OF3 SOTH AVE ram' PLOT PLAN N1(SCALE 1" 40 FT FOR SOIL TEST AREA O well' DRIVE WAY O PARCEL ID 008-1033-90-000 =BENCH MARK 100 S BEDROOM HOME 0 = BORING BORING 1 APT' O TREE GARAGE = 97.98 System ele 'on 95.00 Q$� LAND SCAPE AREA BENCH MAR.K,!N SHED AND . �tj DECK co � � I BORING 2 CZ� 3 k #p '`� 2n force main 98.62 EXSITING SEPTIC TANK (), 31 Q ,. '�. O instal Sim tech filter in tank BORING 3 •"T`...... . 1 I� Re •••. lacup with a go ids ep04 I" .�....... 97.83 Diverter valves inside j e p`� nx— _••——••—••s��/�'2� ' ink I `'—'— FAILING DRAIN FIELD I j i } I I..—..—..—.. ...... 0 DRY RUN CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: CHARLETTE HEIMER Owner's Name: CHARLETTE HEIMER Owner's Address: 2607 50 TH AVE WOODVILLE Legal Description: NW /NW / S12T28RI6W Township. EAUGALLE County: ST CROIX Subdivision Name: Lot Number: Parcel ID Number: 008-1033-90-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: PAUL R KOEHLER License Number: 225410 Date: 10/15/2019 Phone Number (715) 246-2660 Signature Designed pursuant to the In -Ground Solt Absorption Component Manuel for POWTS Version 2.0 S13D-10705-P (N.01K)1). Page 1 I SOTH AVE PLOT PLAN N1(SCALE 1" 40 FT FOR SOIL TEST AREA PARCEL ID 008-1033-90-000 =BENCH MARK 100 Q = BORING BORING 1 = TREE 97.98 System el on 95.00 Apo (,)3,k�s, LAND SCAPE AREA BENCH BORING 3 97.83 0 well' 5 BEDROOM HOME SHED AND DECK 2" force main BORING 2 98.62 Diverter DRY RUN PAGE 3OF3 DRIVE WAY APT. GARAGE R, us-x- J0EDXSITING SEPTIC TANK Knstal sim tech filter in tank 1�0 R�lce pump with a golds ep04 inside !V]x_.. I � I I ..... FAILING DRAIN FIELD I j SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Paga 1 cr 1 Project Name: CHARLETTE HEIMER 3 No. of Cells 3 ft Cell width / \ It Cell Length 3 ft Cell Spacing Per Cell W a i,S Total No of 10 50 sq ft EISA Per Cell aq ft Total EISA MnmAnrh�w� Und.1 I ..I. 1 arena♦ PIRA R.H.. Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Graveliess Leaching Unit Manufacturer: INFILTRATOR Gravelless Leaching Unit Model: EZ1203H-10FT. %2 j7? Finished Grade it In .x, •x, r ' ■' 'xYS:' 12 in UP ...............:::::: Plumber/Designer Signature: License #: 225410 Typical Cross Section Observation Pipe with approved cap or vent Soil Backfill 3.t3 d Infiltrative Surface O ( :ed fi Limiting Factor Sloand Anchored Vent/ Observation Pipe with Cap ............................................... Date: 10/15/2019 0 A 8 I I NLESS STEEL TYPE 347 WITH 0,062 HOLES i i i 17.61 2382 1 18 I 1/40 NPT FOR PRESSURE ALARM SWITCH (STF-101) 13. I PART# STF-100A2 DATE: 09/22/06 MATERIALi I REV, A DRAWN BYE JAS❑N MAY APPROVED BY: DESCRIPTION: FIELD ASSEMBLE, d91 , RESSURE FILTER=--J��il//1/f 1 ` - ' �I,LTIR POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pape of 2 FILE INFORMATION Owner CHARLETTE HEIMER Permit # DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units 0 NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) l elide Soil Application Rate -7 al/da /ft2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD6) 530 mg/L Total Suspended Solids (TSS) S30 mg/L ❑ NA Fecal CoMorm (geometric mean) 510' cfu/1 OOmI Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al (KNA Septic Tank Manufacturer NA Effluent Filter Manufacturer SIMTECH ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al K NA Pump Tank Manufacturer NA Pump Manufacturer GOULDS ❑ NA Pump Model EP04 ❑ NA Pretreatment Unit ❑ NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Collis) ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ monthlsl (Maximum 3 years) year(s) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume ❑ NA InsInspect dispersal cellls) p p At least once eve ry' 3 monthls) moat year(sl (Maximum 3 years) ❑ NA Clean effluent finer At least once every: r L7- month(s) IDSontyear() ❑ NA - — - Inspect pump, pump controls & alarm - - - _ At least once every: 3 _ month(s) - Dk yearls) _ ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) i)jNA Other: At least once every: ❑ year(s) ❑ m ) p§ NA Other: J� NA 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 tankis) 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 cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y.) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All 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 within 10 days of completion of any service event START UP AND OPERATION Page Z of 7/ For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal callis). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellis) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels 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 any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; 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 brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely 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 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 soil, 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 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 will result in the need for a new soll and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. alua ' o mg ank -- - - -- - - - — e ° - — -_ }elf 1l � ¢i1i21__ • io"S7Xc1G7tn+�1 ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomet at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING AND 1HE TlNrame AUL R KOEHLER Phone 15-246-2660 1 1Phone 715- 4 - 2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name darrels septic service Name ST C ( 2DAII,U Phone 715 426 1025 Phone —7/ G� _ 3W'(P— (G CD This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d)&(f) and 83.54111, (2) & (3), Wisconsin Administrative Coda. RECEIVED MAY 13 2021 ST. CROIX COUNTY COD Sept' se Tank Cros Sec ion And Pump Performance Specifications Inlet Minimum Pump Performance Required ?1) GPM ta� I a Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet ale <b" Below Watertight — — --I — Finished Grade ' Depth of Cover :t Filter Baffle Swito Settings an eserve Capacity ank Volume = GPI imension Inches a Gal. (reserve) A 18 560.0 (alarm) B 2 55.66 (dose) C 5 139.00 (dead) D 12 336.00 Total 37 1.031.00 h Pump Manufacturer wiener Model Number epo4 Alarm Manufacturer si hrombus Alarm Model Number Switch Type Total Dynamic Head (TDH) - Feet Elevation Head 8.00 Distal Pressure Network Loss Force Main Loss .00 Total 10.00 Manhole Min 4" Above Grade Securely Mounted With Locking Device \ Weather-proof Junction Box Vent Min. 12" Disconnect Above Grade Means With Vent Cap Off Elevation C Ft _ '< Bottom D Elevation Ft GF.NF.AAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of 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) located at: '/a, '/4, Section , Town N, Range W, Town of , 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 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 199) 6S'd Construction: Prefab Concrete Steel Other Manufacturer (if known): W IESeV,- S Age of Tank (if known): /r fQ_e , $1 71,E 1 Permit number (if known) (Licensed Plumber Signature) (Print Name) (Title) (Date) a, z S�;elt4' (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 I FP) (M(� [I P, it f�l 5ftlri►- --Ja ►a _ /. -- County Safety and Buildings Division ST CROIX APR 2 7.202P 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) ,P Madison, WI 07-7162 ` St. Croix County \� Community Development Sanitary Permit ApplicatiO State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate g l unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are sub cd to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 m), Slats. 2607 50 TH AVE I. Application Information - Please Print All Information Property Owner's Name Parcel # CHARLETTE HEIMER AND FRANK STOUT 008-1033-90-000 Property Owner's Mailing Address Property Location 2607 50 TH AVE Govt. Lot NW y, NW ysection 12 City, State Zip Code Phone Number WOODVILLE WI (circle one) T 26 N; R 16 E or W I[. Type of Building (check all that apply) Lot # )KI 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM ❑ Village of Number E� Town of EAU GALLE III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ❑ New System y RI Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. El Permit Renewal ❑Permit Revision El Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stern/Com onent/Device: Check all that apply) ❑ Non -Pressurized In -Ground (X Pressurized to -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 750 .7 1072 1075 95.00 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o $ u c b New Tanks Existing Tanks septic or Holding Tank X 0 UN KNOWN Dosing Chamber X WIESER X VII. Responsibility Statement- 1, the undersigned, assume re po ib' y for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signal MP/MPRS Number Business Phone Number PAUL R KOEHLER '�-`�/�� 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI 54017 VIII. Count /De artment Use Only El Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature S ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval Arracn to comprete plans for the system Ran summit to the uounly anly on paper not less than a In x 11 inches InsIce SBD-6398 (R. I Ul t) RGOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/3" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'12" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 1040F (40cC) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single pphase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer, Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EP04 Impeller: Thermoplas- tic semi -open design with pump out vanes for mechanical seal protection. METERS FEE 101 9 8 7 2 0 Submersible Effluent Pump EP04 & EP05 Series ■ EP05 Impeller: Thermoplas- tic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ME'. nadiaii Standards Associalion o GFie * LR38549 Goulds Pumps is ISO 9001 Registered, L1 r 5 GPM -C�- } J '0 10 0 2 20 30 4 6 8 CAPACITY 40 50 GPM 10 12 mvh Goulds Pumps ® 20D3 Goulds Pumps Effective July, 2003 83871 <& ITT Industries ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer CHARLETTE HEIMER Mailing Address 2607 50TH AVE Property Address SAM E (Verification required from Planning & Zoning Department for new construction.) City/State WOODVILLE Parcel Identification Number 008-1033-90-000 LEGAL DESCRIPTION Property Location NW '/4 , Subdivision NW '114 , Sec. 12 . T 28 N R 16 W, Town of EAU GALLE Lot # Certified Survey Map # �� Volume ,Page # Warranty Deed # �� I IM q p O to 1 (before 2007)Volume , Page # Spec house ❑yes Trio Lot lines identifiable Elyesono 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. 383.52(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 rystem is in proper operating condition and/or (2) after inspection and pumping- if necessery�, _t_he septic tank is less than I/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. I/we am/are the owner(s) of the property described above, by virtue of a warreAty deed recorded in Register of Deeds Office. DATE ***Any information that is misrepresented may result 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. 04/12) vri, lull- JJb /' County f .x Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ST CROIX Sanitary Permit Number (to be filled in by Co.) 15 2019 Ma7-7162 Vfl$``bCT �- St. Croix County dorr mun odillLal"ermit Applitation Z State Transaction Number A ltA- In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this fd'"n to etTi a�ppiop e g ve enta unid / `� Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application fors fm state-owned POWTS are submitted to the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. ( #'�' �/� �'] Ave, / ��' JJJ Application Information - Please Print All Information Property Owner's Name Parcel 4 CHARLOTTE HEIMER a' Property Owner's Mailing Address Property Location 2607 50 TH AVE Govt. Lot y, NW 12 /., Section City, State Zip Code Phone Number WOODVILLE WI 715-781-1762. (circle one) N; R t E or W II. Type of Building (chec 11 that apply) Lot g Subdivision N UV El 1 or 2 Family Dwelling - Num of Bedroo 6 I MID BMAV ❑ Public/Commercial - Describe Use I(6\ ❑ JrJW OW ❑ State Owned - Describe Use ❑ f CS u 3 ow f EAU GALLE III. Type of Permit: (Check o on line . Complet applicable) A' ❑ New System y ®9teplacement System rear ding Tank Replacement El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑Permit Revision f Plumber ❑XP r NewList Previous Permit Number ao Date Is d Before Expiration O stem/ eck alit atN1 on -Pressurized In-G s e - d At -Grade Ao/un_ . of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank er Di ❑ Pretreatment Device (explain) 1� V. Dis ersal/Tre tment A a Inf Design Flow ( Desi oil A 1 e(gpcisf) Di equ' Dispersal Area Pro sed (sf) System Elevation 900 .7 86 1350 95.00 VI. Tank Info apacity in Total f Manufacturer -- -- --- - - - 11 Gallons &allons nits - - - -- - - U v - New Tanks Exis ks � �! o u o�o inn a `✓ a Ci rn c,. v Septic or Holding Tank 1 N/A N/A Dosing Chamber ofN/A N/A X VII. Responsibility Statement- 1, the iplidersigned, assume responsibility for installation of the PO WTS shown Nolbe attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Business Phone Number PAUL R KOEHLER ��/G�G— 225410 715-246-2660 Plumber's Address (Street, City, S , Zip Code) `�� !?sJtPJa) cw zD (Cl 321 WISCONSIN D E NEW RICHMOND WI V1II. Countv/Deoartmeaf Use Only S T C R oZx ❑ Approved ❑ Di proved Permit Fee ^(� $;�!'l1KSL/t I ❑ ner Given Reason for Denial IX. Conditions Approval[/Reasons for Disapproval tl/`Gj r Attach to complete plans for the system and sub SBD-6398 (R. 11/11) Project Name: Owner's Name: Owner's Address: CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE CHARLETTE HEIMER CHARLETTE HEIMER 2607 50 TH AVE WOODVILLE Legal Description• N W / S12T28R16W Township: EAUG LE County: ST CROIX Subdivision Name: Lot Number: Parcel ID Number: 008-1033-90-000 • Page 1 Page 2 Page 3 Page 4 — -- —_ Page 5 Page 6 Page 7 Page 8 Page Designer/Plumber: PAUL R Date: 10/ 15/201 iex and ti Plot Plan If ter Specs Mainten a Information Mana a nt Plan St. Croix Ctv Septic nk Maintenance Form CSM or Plat Soil Test & House Plans License Number: 25410 Phone Number 7 Signature Designed pursuant to the In -Ground Soil Absorption Component Manual for POWfS Version 2.0 SBD-10705-P (N.01101). Page 1 PAGE 3OF3 50TH AVE PLOT PLAN SCALE 1" 40 FT FOR SOIL TEST AREA 0 well DRIVE WAY PARCEL ID 008-1033-90-000 N10 =BENCH MARK 100 5 BEDROOM HOME 0 =BORING APT. GARAGE BORING 1 •• = TREE v 97•98 System ele on 95.00 0 LAND SCAPE AREA BENCH MARK-.ltavaj SFID AND B G 2 a. 2" force main 98.62 BORING 3 �................ 97.83 `"' Diverter DRY RUN EXSITING SEPTIC TANK O instal situ tech filter in tank Replace pump with a goulds ep04 inside_.._.._.._.._.._.._.._.._.._.._.._.._.._...7 I I FAILING DRAIN FIELD I I SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page 1 of 1 Project Name: CHARLETTE HEIMER 3 No. of Cells 9 3 ft Cell width 27 90 ft Cell Length 50 3 ft Cell Spacing 1380 Per Cell Total No of 10 sq ft EISA Per sq ft Total EIS RAM.1 1 avim I .nth AA RaNnn Infiltrator IEZ1203H-5ft 1 5.0' 25.0 FZ1203H-10ft 1 10.0' Z 50.0 Gravelless Leaching Unit ufacturer: INFILTRATO Gravelless Leaching Unit Mode EZ1203H-10FT Typical Section Finished Grade ft Observation Pipe with approved cap or vent Plumber/Designer Signature: License #: 225410 Date: 10/15/2019 NLESS STEEL TYPE 347 WITH 0.062 HOLES 1761 2382 18 1/4"' NPT FOR PRESSURE ALARM SWITCH (STE-101) 13.01 PART# STF-100A2 DATE, 09/22/06 MATERIAL, REV, A DRAWN BYE JAS❑N MAY APPROVED BY, DESCRIPTION,FIELD ASSEMBLE M1i1t� -+ PRESSURE ��/� MISOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/4" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/2" NPT. • Mechanical seal: carbon- rotary/ce ram ic-stationary, BUNA-N elastomers. • Temperature: 1040E (40°C) continuous 140OF (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EP04 Impeller: Thermoplas- tic semi -open design with pump out vanes for mechanical seal protection. METERS FEET 10- 9- 8- 2! 0 a Motor: _ • EP04 Single phase: 0.4 HP, `- 115 or 230 V, 60 Hz, 1550 RPM, built in overload with c automatic reset. Q • EP05 Single phase: 0.5 HP, 115 V or 230V, 601 z1 1550 `p , RPM, built in overload with — automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). 7 6 21 5 1! 4 3 11 2 1 ` 0 Submersible Effluent Pump EP04 & EP05 Series ■ EP05 Impeller: Thermoplas- tic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING Canadian Standards Association sA' File # LR38549 Goulds Pumps is ISO 9001 Registered. - — 7__ -*.[::!:].-5GPM 2.5 FT - I.� -- --- - -- - - -- EP05 — - --- -----, - - - .--------� - - - --- - --- �.... -_.. -- Po ----- 00 10 20 30 2 4 6 8 CAPACITY 4U \ w urm / 10 12 rnr/m Goulds Pumps & 2003 Goulds Pumps ITT Industries Effective July, 2003 w B3871 e, GOULDS PUMPS 10 8 2 _ r COMPONENTS Item No. Description 1 Impeller 2 Base 3 Pump Casing 4 1 Mechanical Seal 5 Ball Bearings 6 0-Rings 7 Power Cord 8 Oil Filled Motor 9 Motor Housing/ Stator Assembly 10 Motor Cover PERFORMANCE RATINGS Total Head (ft. of water) Gallons Per Minute EP04 EP05 5 53 — 10 46 62 15 36 55 20 1 21 46 25 0 33 30 1 — 11 MODEL INFORMATION DIMENSIONS Submersible Effluent Pump -MODEL 3871 EP04 &EPOS Series (All dimensions are in inches. Do not use for construction purposes.) 6" MINIMUM WATER LEVEL WHEN) SUPPLIED WITH FLOAT SWITCH IPT Order No. HP Volts Amps Minimum Circuit Breaker Phase Float Switch Style Cord Length Discharge Connection Minimum On Level Minimum Off Level Minimum Basin Diameter Maximum Solids Sue Shipping Weight Ibs/k EP0411 4 115 12 20 1 Plug / No Switch l U 1'/," Manual Manual 15" /:' 1 20 / 9.1 EP0411A Piggyback / Wide- le 10' 1'A" 12" 6" 15" 2119.5 EP0411 F Plug! No Switch 20' 1'A" Manual Manual 15" 20 / 9.1 EP0411AC Piggyback/Wide-Angle 20' 1'/2" 12" 6" 15" 21/9.5 EP0412 230 6 10 Plug I No Switch 10' 11/2" 1 Manual Manual 15" 2019.1 EP0412F Plug / No Switch 20' 1'A" Manual Manual 15" 20 / 9.1 EP0511 F .5 115 13 20 Plug / No Switch 10' 1'A" Manual Manual 15" 22110 EP0511AC Piggyback/Wide-Angle 20' 1'/z' 12" 6" 15" 23/10.4 EP0512F 230 6.5 10 Plu / No Switch 20' 1'/i' Manual Manual 15" 22 / 1D Goulds Pumps Goulds Pumps and the ITT Engineered Blocks Symbol are registered trademarks and tradenames of ITT Industries. www.goulds.com PRINTED IN U.S.A. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. <& ITT Industries POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z FILE INFORMATION owner CHARLETTE HEIMER Permit # DESIGN PARAMETERS Number of Bedrooms 6 ❑ NA Number of Public Facility Units X NA Estimated flow (average) 600 galida Design flow (peak), (Estimated x 1.5) 14111111,900 al/day Soil Application Rate al/da /ft' Standard Influent/Effluent Quality Mont average" Fats, Oil & Grease (FOG) '30 mg Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA Total Suspended Solids (TSS) I _<150 mg/L Pretreated Effluent Quality Monthly averag Biochemical Oxygen Demand (BOD.) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ Fecal Coliform (geometric mean) _<10` cfu/100m1 Maximum Effluent Particle Size Ys in die. NA Other: ❑ NA *Values typical for domestic wastewater and septic tank ery[�ent. MAINTENANCE SCHEDULE / SYSTEM SPECIFICATIONS Septic Tank Capacity gal XNA Septic Tank Manufacturer RNA Effluent Filter ManufactuZr SIMTECH ❑ NA Effluent Filter Model ❑ NA Pump Tank Capac' gal K NA Pump Tank Ma facturer RNA Pump Mau cturer GOULDS [I NA Pump M el EP04 ❑ NA Pretre ant Unit ❑ NA ❑ d/Gravel Filter ❑ Peat Filter echanical Aeration ❑ Wetland Disinfection ❑Other: Dispersal Cellls) ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA NOther: ❑ NA er: ❑ NA Service Event ervice Frequency Inspect condition of tank(s) (eaonce every: El month(s)st 3 QQ year(sl (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum eq one-third (Y.) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 Elnth(s) (Maximum 3 years) t y (s) ElNA Clean effluent filter At least once every: ❑ mon (s) I year(s ❑ NA Inspect pump, pump controls & alarm At least once every: 3 ❑ months � year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) IXNA Other: At least once every: ❑ monthis) ❑ year(s) NA Other: Jl(I NA 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 tanks) 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 failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y.) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_72 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of 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 levels 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 any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; 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 brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely 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 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 soil, 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 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 will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. �� alua ' a o mg tank a aie _ _DI,405TTF� �D�h/$l� ^41VS77Z(l�LDfJ— ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING AND HE e AUL R KOEHLER Phone 715-246-2660 Phone 715-246-2 660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name darrels septic service Phone 715 426 1025 Name Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&Ifl and 83.540), (2) & (31, Wisconsin Administrative Code. Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with SPS 385, Ws. Adm. Code County ST CROIX Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 008-1033-90-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal infonnalion you provide may be used for secondary purposes (Privacy Law, s. 16.04 (1) (m)). Property Owner Property Location ❑ El CHARLETTE HEIMER Govt. Lot NW 114 NW1/4 S 12T 28N R 16E (or) W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 2607 50TH AVE L'ny oia1e zip uoae vnone Ivumoer I LFity Village LjTown Nearest Road WOODVILLE I Wl I I( 71�-781-1762 EAT T r A i T E I CTY RD B New Construction UseEj Residential / Number of bedrooms 6 Code derived design flow rate 900 GPD 0 Replacement Public or commercial - Describe: ------------------------------------ Parent material LOESS OVER LOAMY DRIFT OVER SANDY Flood Plain elevation if applicable NONE -ft. General comments NOTE :IT HAD RAIN FOR THREE DAYS BEFORE SOIL TEST. SAND MIXED WITH LESS THAN 30 % and recommendations: COBBLES. 1❑ Boring # ❑ Boring ID Pit Ground surface elev. 97.98 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft 2 ff#1 ff#2 A 0-12 10YR2/2 — ------ ----------------- SIL 2MSBK MFR CW 3C .6 .8 B 12-24 10 YR 4/2 --- —------ --------------------- SICL 2MSBK MFI CW 2M .4 .6 C 24-96 10 YR 5/4 --------- — ------ -------------- S/COB OMSG ML CW ------ .7 1.6 2 Boring # ❑ Boring 98.62 96+ 0 Pit Ground surface elev. ft. Depth to limiting factor in. Anil Annlir�Tinn Raln Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots ' GPD/ft ' ff#1 ' 02 A 0-18 10 YR 2/2 ------ —------ --------------- SIL 2MSBK MFR CW 3C .6 .8 B 18-30 10 YR 4/2 ------""--""-`----------- SICL 2 MSBK MFI CW 2M .4 .6 C 30-96 10 YR 5/4 -------------------------- ------- S/COB OMSG ML CW ----- .7 1.6 - tnluent FF7 = uQu > dU < ZLU mg/L ana I c. >3u < l aU mg/L - tmuent;FL = buu < JU mglL ana 155 < 3u m91L CST Name (Please Print) Signature CST Number PAUL R KOEHLER �- 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NEW RICHMOND WI OCT 3 2019 715-246-2660 SBD-8330 (Rl 1/11) Property Owner CHARLETTE RIMER Parcel ID # FT]Boring # 0 Boring Ong 97.83 Ground surface elev. ft. 008-1033-90-000 Depth to limiting factor 96+ in. 2 3 Page _of_ Cnil PM. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence undary Roots GPD/ft = f1#1 ` if#2 A 0-12 10 YR 2/2 ------------------------------- SIL 2MSBK MFR CW 3C .6 .8 B 18-28 10 YR 4/2 ---------------------------- SICL 2MSBK MFI CW 2M .4 .6 C 28-96 10 YR 5/2 --------------------------- S/COB OMSG MIL CW -------- .7 1.6 ❑ Boring # ❑�Boring f __I pit Ground surface elev. ft. Depth to limiting factor in. Snil Amlirafinn Ratw Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh.` onsistence Boundary Roots GPD/ft ' ff#1 102 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. _ Pit Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ' ff#1 ff#2 Effluent #1 = BOD S > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD e < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and emplover. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBA-8330Test nt 11/11) St. Croix County Planning and Zoning Thursday, August 30. 2007 at 9:59:13 AM Detail Sanitary Information Page I of I Computer #: 008-1033-90-000 Sub/Plat: metes & bounds Section: 12 Parcel #: 12.28.16.174B Lot: TNIRNG: T28N R16W Municipality: Eau Galle, Town of CSM: 1/41/4: NW 1/4 NW 1/4 Owner: Bossman, David 2607 50th Avenue Woodville, WI 54028 State Permit: 218952 Issued: 09/28/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Permit: 0 Installed: 05/24/1995 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Not determined Yes Aaby, Steven Jim Thompson Signed Off: No Maintenance Scheduled Pump Date Pumoed 1st Notification 6/14/2000 04/20/2006 6/1/2007 04/20/2006 6/1/2010 5/ Other Requirements check 1995 In case filed /erpection date -permit missing from 19 2nd Notification 3rd Notification hVin!`J( Additional Notes Money Owed outcard only thing in file folder - JT took paperwork $0.00 to inspect POWTS and wasn't returned np� Wis. Dept. of Safei and Proffsio I Sery SOIL EVALUAJIO 0 , Page 1 of 3 Division of Safety. d Buildings in accordan e with SPS 385, Wis. Adinn"tode County ST CROIX Attach complete site pplan on tia�ier`rol 1 x 11 inches in size. Plan must include, but not li itdd4 ence point (BM), direction and Parcell. 8-1033-90-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location CHARL®ITE HEIMER Govt. Lot NW 114 1/4 S/121/28N R 16E (or) W❑ Property Owner's Mailing Address Lot # Block # Subd. Name o CSM# 2607 50TH AVE t;lry State tip t;ooe Nhone Number �ity Village L frown Nearest Road WOODVILLE I WI I I( 71I5-781-1762 I EST T G A I T E I CT'Y RD B New Construction UseEj Residential / Number of bedrooms 6 Code derived design flow rate 900 GPD Replacement Public or commercial - Describe: ---------------------------------- Parent material LOESS OVER LOAMY DRIFT OVER SANDY Flood Plain elevation if applicable NONE -ft- General comments NOTE :IT HAD RAIN FOR THREE DAYS BEFORE SOH, TEST. SAND MIXED WITH LESS THA 30 a/o and recommendations: COBBLES. !"t� 5 1Pfe, 54-(7 Zoe K.- 1 L-1 I Boring # U Boring Q Pit Ground surface elev. 97.98 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ' ff#1 ' ff#2 A 0-12 1OYR2/2 --- ------ --------------- SIL 2MSBK MFR CW 3C .6 .8 B 12-24 10 YR 4/2 ------------ SICL 2MSBK MFl CW 2M .4 .6 C 24-96 10 YR 5/4 --- — ------ -------------------- S/COB OMSG ML CW ------ .7 1.6 ❑2 Boring # U Boring 98.62 96+ Q pit Ground surface elev. ft. Depth to limiting factor in. Cnil Gnnlirn}inn Rn}u Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ] ff#1 ff#2 A 0-18 10 YR 2/2 ------------------------------ SIL 2MSBK MFR CW 3C .6 .8 B 18-30 10 YR 4/2 ---------------------------------- SICL 2 MSBK MFI CW 2M .4 .6 C 30-96 10 YR 5/4 ---------------------------------- S/COB OMSG ML CW ----- .7 1.6 N7all } . Effluent #1 = BOD 5 > 30 < 220 mg/L bnd TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number PAUL R KOEHLER 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NEW RICHMOND WI OCT 3 2019 715-246-2660 SBD-8330 (RI I/11) Property Owner MARLETTE HEIMER Parcel ID # 3 Boring # 11 Boring 97.83 0 Pit Ground surface elev. ft. 008-1033-90-000 Depth to limiting factor 96+ in. 2 3 Page of Snit Annlinelinn Aefn Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots ` GPD/ft 2 ff#1 ` ff#2 A 0-12 10 YR 2/2 ------------------------------- SIL 2MSBK MFR CW 3C .6 .8 B 18-28 10 YR 4/2 ---------------------------- SICL 2MSBK MFI CW 2M .4 .6 C 28-96 10 YR 5/2 --------------------------- S/COB OMSG ML CW -------- .7 1.6 1� 7D ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots ` GPDtft t ff#1 ff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots * GPD/ft ' (f#1 102 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD , < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SB683307F a (Rl1/11) 50TH AVE PLOT PLAN SCALE 1" 40 FT FOR SOIL TEST AREA PARCEL ID 008-1033-90-000 Nto =BENCH MARK 100 0 = BORING BORING 1 °° = TREE v 97.98 5 BEDROOM HOME BENCH MARK 100,_"k SHED AND "° DECK BORING 2 ..>... a98.62 o 0 p.s BORING 97.83 a ..... DRY RUN PAGE 3OF3 DRIVE WAY APT. GARAGE EXSITING SEPTIC TANK I I FAILING DRAIN FIELD I j r NO. 633349 STATE SANITARY PERMIT OWNER �YrE PREVIO PLUMBERPikW. (.QE�R LIC �.# �S41Q TOWN OF XZIFU 4/ELLE SEC JZ ,T:Z_N, R AND/OR LOT BLOCK SUBDIVISION o. ZIS 145.135 (2) WISCONSIN STATUTES Th) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168;1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. %5 # AAW Ugi ED ISSUING OFFICER -DATE ZI PERMIT EXPIRES NLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)