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Home My WebLink About018-1096-09-000Wisconsin 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)(ri Permit Holder's Name City Village Township Todd and Mary Benck I TOWN OF HAMMOND CST BM Bevy Ins�pyy� Elev BM Descr}�n `FYI T 1�1�.. .. 1 G.1 � _r • - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic N •'• 1 0 Dosing collwbo '1 V U Ho tng TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Au Intake ROAD Septic Dosing 1 p I _ Aeration Holding PUMP/SIPHON INFORMATION N Manufacturer cremand jyWA GPM / Model Number PM S7 Y TDH LIfL-r Fnctio¢ ass System ead S TD Ft Forceman Len th DIa t, Dist to N If J VIL MOJVRr 1 IVIY JI J I CIYI STATION BS HI FS ELEV Benchmark �• 5 0.� 9%'' o t BM i4e., COVS v s Bldg Sewer 3 •q5 loo. 05 StlHt Inlet b St/Ht Outlet Of Inlet DI Bottom D•3 n 8 • ,1 7 J Header/Man z's5 l00.95 Dist Pipe O Z'So VO. 7,2 Bot System 3.5 /00• D Final Grade over 3 BED/TRENCH DIMENSIONS Wain 1 i Length No Of T es I &At/01'6PIT DIMENSIONS o Of Pits t a Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L IBLDG JTVELL LAKE! REAM 'LEAGHIN C MBE OR , UNI Manufacture P. Ty Of Syst m 1 t `1 10 Model Number UIJ I KIOU I IUIV J TD I CIVI Header Maryfold 1 � 1 s� Distribution PI a s) ` p( 5� 1 t I � �' 1 5 x Hole Size I r� x Hole S a mg Vent to Au Intake Length Di� Length Dia 14 Spacing SOIL GUVLK x Pressure Svstems Only .. Mound Or At.nrade ninha. -d . _t Depth Ov r 1� Depth Over xx Depth of ` •% xx Seeded,Sodded xx Mulched BedRr ch Ce er Bed/Trench Edges �•� Topsoil r i ( Yes No - Yes _- No COMMENTS: (Include code discrepencles persons present. etc) Inspection #1 Inspection #2 Location: 1084 173RD ST 1) Alt BM Description =� ykitl ra ii 2) Bldg sewer length =16 - amount of cover = >qe Plan revision Requiredv I � Yes 'Q' No Use other side for additional information.LICertNoO _ Date ep is Signature SBD-6710 (R 3t97) Buildings Division County "vM25ZOV fety and Sannary Pannit Number (to be filled m by Co ) $2 Washington Ave, P.Q Box 7162 adison, WI 53707-7162 lication In accordance with SPS 383 21(2), Wis Arlin Code, submission of this form to the appropnate governmental unit ` J o 0 • C- Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Servms Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s 15 04 1 Xtri Stars /� Q (� / n� L ✓ i C 'T I. Application Information- Please Print All Information Property Owner's Name ENE X Parcel # d lS - o , Property Owner's Mailing Address Property Location /Pco5m) wa Govt Lot /j LJ y,, N A, Section Zip Code Phone Number City, State 14) ^ ^P /- t-2�/6-. k2l fL ucle one T N; R E II. Type of Building (check all that apply) Lot is Subdivision Name 1 w2 Family Dwelling - Number of Booms jt ^'` H6 !^K\I� r"T Block ❑ City of ❑ Public/Commercial- Describe Use �� ❑ Village of CSM Number ❑ State Owned - Describe Use pt,,. i^J�10\Nl of f-F A'WMJ %11i1 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Perron Revision ❑ Change of Plumber, ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner /f f IV. Type of POWTS S stetn/Com onent/Device: Check all that apply). c ❑ Non -Pressurized In -Ground ❑ Pressmvzd hi -Ground ❑ At -Grade Mound > 24 in of suitable soil ❑ Mound <24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (exp in) Pretreatment Device (explain) V. Dis ersaVfreatment Area Information: Design Flow (gpd) Design Soil Application liate( t) Dispersal Area,RL�uired (sf) Dispersals Proposed (sit) System Elevat on _ O /�t//I 0 t VI. Tank ofo Capacity m Total # of Manufacturer u Gallons Gallons Units J.. r''� 1� - l�rel m U °�' _ New Talcs Existing Talcs &S Gr-ID- d o P. V � v: H no Septic or Holding Tank f / • . 1!_ Dosing Chamber ✓ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's azure MP/h}P1tS Number Business Phone Number C er �C711,,J �� ZZb�y 7ls <� Plumber's AddAss (Street, City, State, Zip Code) - �L`5ry �(4 Gti al VIII. Court /De artment Use Only Approved ❑ Disapproved Fee Date Issued sin Agent Signature J]ownerG ea m nial $ennit IX. Conditions of p rova Q th 3 S ,kCl YSTEM1. OWNER:t ' Septic tank, effluent filter and W�' j l uS �3C(IAtitT I �-- dispersal cell must be serviced./.maintained. ,(� CNn.Cl02( /J U` S` a Ak��1111- C L"rn• as per management plan provided by plumber. All setback requirements must be maintained as per applicable co a e®6plete plans (or the system cud submit o the ono ou paper not less than 8 IQ x 11 inches is sin SBD-6398 (R. 11/I1) Daeignx. Ryan Bee. ADVANCE D Certified Soil Teeter. SP-111500001 Des*er of Engineering Systems D 2263-7 e a V i n o u m e u T a i SCALE 3 I 20' / I 0' 40' o Garage sch 40 PVC I T \N-050 \o�\ I New 46R Home II t20' 2"\ o sch 40 PVC } \ O BMl = 100'00 Top of 1" PVC f �� 00 9 .00 BM2 = 99.30 Top of I" PVC *All property lines not O Benchmark drawn are >10011 from system Soil Bonng **Well to be located >50ft f to ** I II O I II II I II I II I I � I o. I I \ rom sys m components I PAL a tYlmea Sluherreah Mae 01W.1 ha tim dalsrad .b a duvletl M accmbrav ash Rate ortl Lard =ode Tb ate bouln..e vet aunt ranter Vrde=t!a f an dekefivo and/or . pwam loafers and our an Ya01W1V F YYY TY7 Septic Tank: .120WW gallon 2acmpartnent tank -Bnng nsem 4' above final grade -Best GF-10 filterwl alarm -Do not route clear wafer sources into septic tank Tank: ,as; = 4OWn @ 13TDH necessary, maintain ell setbacks. urap Fnclon Loss and TDH star insist , line mete, or vela mats recommended STA: -T,W Mound -29 absorption w,dth .6'deen send lifl(ASTM C33 sand) -Cut stumps gush to ground, sued dggng -Mow aline absorption see and move dppnp -Roughen ebsaplon am W depth of 5'A' -Doren sudane Water my tom System -Depth to restriction = W (Redonmmphm features) -Centaur = 9950 -Slope = 2% Distribution: -Winds tone spread 17 hen and of bed s 20 to arcs -Wad raven deveoan = 10060 .(3)1 t sch 40 pvc laterals win deencuh-use spnnkla bares for patechon .1 t treader, endled not ak tte mfices @ 30 spedng .Protect 15 dwmsbpe absopton armfrom campe son dinngonnshuceen -Danenddose goat sebrgs par design LOCATION MAP (not to sde) ksr 1pgTHgV6 W PREPARED Todd & Mary Benck FOR: 1084 173RD ST Hammond, WI W15 PID: 018-1D96-09-000 1.6 "n's Legal: Lot 09 Pheasant Ridge NW 1/4 NW 1/4 S09 T29N Rt Town of Hammond May 20, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES. 2023-05-20 Plan Review: PWTS-052101055-C RYAN GARY BECHEL 779 Spring Creek RD S Red Wing MN 55066 SITE: Todd & Mary Benck 1094 17=_R_D ST Town of HAMMOND St. Croix County Total Amount: $250.00 FOR: Description: 600 GPD (4 Bedrooms — New Construction) Maintenance Required br' Z� DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY yN 54304-5211 Contact Through Relay http //dsps.m govlprograms/industry-services www.Msconsin.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 IN 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. • Preserve dispersal area prior and during construction to avoid disturbance, 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 All loose organic material to be removed from POWTS Dispersal Area • Divert surface water from all POWTS Areas • 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 • All piping shall conform to SPS Table 384 30-3 and SPS Table 384 30-5 • Insulate building sewer beyond 30 feet per SPS 382 30 (11)(c) Well setbacks to meet chs NR 811 & 812 • Tank Installation to follow all manufacture's recommendations • Verify property line(s) pnor to installation • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, it roots, stumps and boulders reduce the amount of soil available for proper treatment If no other site is available. trees in the basal area of the mound must be cut off at ground level A larger fill area is necessary when anv of the above conditions are encountered, to provide sufficient infiltranve area Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owners manual for the POWTS described in this approval SPS 383.54(t). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans 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 budding, 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. Thanks, q /� 7 Ua,�ca�i�deaf POWTS Plan Reviewer - Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email Cell 608-516-6134 Property Owner Todd & Mary Benck Site Address: 1084 173RD ST, Hammond, WI 54015 INDEX Page: 2 Site Plan Page: 3 Management Plan Conditionally APPREWED Page: 4 Management Plan DEPT. OF SAFETY AND PROFESSIONAL ccanrcc Page: 5 System Design Summary I CI�n.SM OF NDUSTRY SERVICES Page: 6 Mound Design Worksheet Page: 7 Mound Design Worksheet SEE CORRESPONDENCE Page: 8 Mound Design Worksheet Page: 9 Pressure Distribution Design Page: 10 Pressure Distribution Design Page: 11 Pump Design \��ullwll,i„� NS�N Page: 12 Dose Tank ��```��5 Page: 13 Tank Specifications �\` RYAN G. = BECHEL Page: 14 Soil Test = D-2263-7 RED WING Page: 15 Soil Test MN Page: 16 Soil Test /'/��''�.,�£S I G Page: 17 Soil Test „11i Milli, Component Manuals: SBD- 10691-P Mound (N.01/01; R.10/12) SBD-10706-P Pressure Distribution (N.01 /01; R.10/ 12) Designer Signature: Date: 5/7/2021 Designer Ryan Bache) Certifiad ifled Soil Teeter. SP-111500001 ADVANCE - Designer of Engineering systems: D 2263-7 � I I SCALE I > 201 / C 0. 40' o 1 Garage 1 o~ \ t75'4"-- L---TJ ,vim sch 40 PVC \° \ New 4BR Home 11 \ \ i _J t20' 2n O \ O sch 40 PVC \ \ Q y, O� BMl = 100.0() Top of 1" PVC •oo BM2 = 99.30 Top of 1" PVC 'All property tares not O Benchmark drawn are >100h from system 19 Sod Boring **Well to be located >50ft from system components** 1 11 1 11 II 11 �11 I I I i `PA 2 P� I \` I e.en.d sbr rwrb mr q lwn b br+r drwr.a am .wrroe.d la aomemry re, state arm Lead ova.° Tr» .1 townr.rc a., malt r.ale rrona a.e.mo wwar —rill orb. and de. ao.n„den. had wWMNry 6 WDE nMT nos SYSIMA wa1 Cal Its Fluill IeaEFleh Lr- sM.n, hr.w ere PreP.ry rranrmrel. LhNee yn,ar _,bei 'a muawrent Ploy le, brivrrr can an prep. o err 1 _ NYSTF,M NOTES 1 Septk Tank: -12rxYB Tgalbn 2ompariment tank -Bong risers 4' above final grade Best GF.l0 titer wl alarm II Do rat route clear water sources into septic tank Pump Tams: -Pump reeds= 40gpm @ 13TDH -wogmons -Ivbvetenk as necessary, meiaan all sebeaks -Re alcdme paN Fndm Loss andTDH efts instill Event coude ame mew awaterm er recommended STA: -tin Mend -29 absorption width Filson send hft(ASTM C33 send) -W stumps flush to goum avad cil Mow soave aasapbon area and remove cal -Roughen absuphm see to Win of 6'-6' -Overt sell weer away hen sow -Depth to resbiNm = 30' (Redmmiaphmfailures) Cadwr=9950 -Slcpe= 2% Dlatnlhution: -Lateralstobespe ed12'banendofbed524'0sdn -laded invet ewabon = I00IfJ Y(3)1 t son 40 pvc laterals wiwithean domsuse, sprinkle I bmesforpale Lion a }• neaaer, emfad nevark * onkes @ 3a sleang -Rasa 15' dawnslape ettaption xee from mnpadion dfnng mrrovudm -Demmd data floe seWgs per design LOCATION MAP (wt to sod.) III J W Sf� zo9TH 4VE PREPAREDFOR: J Todd & Mary Benck Site Address: 1084 173RD ST Hammond, WI 54015 PID: 018-1096-09-ODO 1.6 Acres Legal: Lot 09 Pheasant Ridge NW 1/4 NW 1/4 S09 T29N R17W Town of Hammond Management Plan This management plan identifies operation and maintenance achvities necessary to ensure long-term performance of your septic system. Tasks that should be performed by the homeowner are idetiffied Professional management tasks must be performed by a licensed septic maintainer or service provider, however, it is the homeowner's responsibility to ensure all tasks get accomplished in a timely manner No, Keep this Management Plan with your Septic System Owner's Guide. ► Keep copies of all pumping records, maintenance activities and repair invoices with this document. ► Review this document with your maintenance professional at each visit, discuss any changes in product use, activities, or water -use appliances. Management Frequency My system needs to be checked Designer Required Frequency: Check every 36 months every 36 months. I State/Local Gov't Req Frequency: Check every 36 months Design Parameters I System Specifications Number of Bedrooms 4 Septic Tank Manufacturer Weser Design Flow (gpd) 600 Septic Tank Capacity 1200 Soil Loading Rate (gpd/ft2) 0.5 Effluent Filter Manufacturer & Model Best GF-10 Standard Effluent Quality Effluent 1 Biological Oxygen Demand (SOD) 220 mgrl Pump Tank Manufacturer Weser Total Suspended Solids (TSS) 150 my! Pump Tank Capacity 800 Fats, Oils, Greases (FOG) 30 mgnl Pump Manufacturer & Model Per Installer Treated Effluent Quality Nokxpcal Oxygen Demand (BOD) - mgrl Dispersal Cell Type Mound Total Suspended Solids (TSS) - mgrl Fats, Oils, Greases (FOG) - mgrl Pretreatment Unit Description NA Max Effluent Particle Size in 1/8 Check (listen, look) for leaks in Repair leaks promptly. Regularly check for wet or spongy soil around your soil treatment area. Contact service provider if issues arise. Control burrowing animals (gophers, groundhogs, etc.) Keep bikes, vehicles, snowmobiles and other traffic off treatment area. Alarms - Contact your service professional if any alarm signals. Lint Filter - check for lint buildup and clean when necessary. If you do not have one, add one after washing machine. Effluent Filter - Inspect and clean twice Per year at a minimum Caps - Make sure that ail caps and Ids are intact and in place. Inspect for damaged caps often. Fix or replace system replacement area: - Check and clean per levels - Check sludge/scum/effluent levels in all system Recommend if tank(s) should be pumped. Pump all every 36 months at a minimum Inspect tank inlet and outlet baffles (if applicable) Check drainfield effluent levels (if applicable) Verify pump and alarm system functions (if applicable) inspect wiring for corrosion and function (if applicable) Clean drainfield laterals (if applicable) Check event counter/elapsed time meter and evaluate water usage rate compared to system design flow. Check dissolved oxygen and effluent temperature in tank Check for surfacing of effluent or other signs of problems. Verify inspection pipes are capped and intact. Provide homeowner with list of management results and any action to be taken. secondary system site from traffic, compaction, etc Page 3 Inspections of tanks and dispersal cells shall be made by an appropriately licensed Individual or business. I anK Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum, and to check for any backup or ponding of effluent on the ground surface. Access openings used for service and assessment shall be sealed watertight upon completion of service activities. Any unsound/defective access openings must be replaced immediately 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. Ponding of effluent on the ground surface may indicate a failing condition that requires immediate attention by a licensed septic professional Tanks must be pumped when sludge accumulation is within 12 inches of the bottom of the outlet baffle, or whenever the scum layer is within 3 inches of the bottom of the outlet baffle. In no case shall total sludge and scum volume occupy greater than 25% of the tanks liquid capacity The effluent filter shall be cleaned as necessary to ensure proper operation. The filter should not be removed unless provisions are made to retain solids In the tank that may slough off the filter during removal If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously Intermittent filter alarms may indicate surge flows or an impending continuous alarm. Pre-treatment components shall be maintained and serviced by a licensed septic professional according to the manufacturers recommendations hor new construction: prior to system operation, cnecK septiapump tanks tor the presence or painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells. If high concentrations are detected, have the contents of the tank removed by a licensed septic professional prior to use. System start-up shall not occur when soils are frozen at the infiltrative surface. During bower outages, pump tanks may fill above normal high water levels for system utilizing pumps. When power is restored, the excess wastewater will be discharged to the dispersal cell in one large dose potentially resulting in overloading the cells. It may also result in backup or surface discharge of effluent. To avoid this situation, it is highly recommended to have the contents of the pump tank removed by a licensed septic professional or have a septic professional manually dose the system to return the pump tank to normal operating levels prior to restoring power. Do not drive or park vehicles over any septic system components. Do not drive, park over, or otherwise disturb or compact the area within 15 feet downslope of any mound or at grade system or secondary septic system site. CONTINGENCY PLAN If the septic tank, or any of it's components, become defective the tank or component shall be immediately repaired or replaced according to the original system design specifications If a dosing tank, pump, pump controls, alarms, or related wiring becomes defective, they shall be immediately repaired or replaced with components of the same or equal performance. If the soil treatment component fails to accept wastewater or discharges wastewater to the ground surface, it shall be repaired or replaced by: increasing basal area (if toe leakage occurs), rebuilding the component at the secondary system site, or removing and replacing biologically clogged absorption and dispersal media and associated piping. ABANDONMENT If the septic system fails and/or is permanently taken out of service, the system shall be abandoned according to approved abandonment regulations. These include: - All piping to tanks shall be disconnected and abandoned pipe openings sealed. - The contents of all tanks shall be removed and disposed of by a licensed septic professional - Tanks shall be crushed & filled, or removed. - A septic system abandonment notification shall be submitted to the appropriate local governmental unit. WARNINGH SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC TANK, PUMP TANK, OR OTHER TREATMENT COMPONENT UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ALWAYS CONSULT A LICENSED SEPTIC PROFESSIONAL BEFORE DOING ANY WORK. Page 4 System Design Summary Property Ovmer/Client: Todd B Nary Benck Partial ID: 018-10%-09-000 Site Address: 1084 173RD ST, Hammond, WI 54015 DESIGN FLOW, WASTE STRENGTH, TANKS A. Type of Wastewater: Rendermal Treatment Level: Effluent 1 Residentiai Design Flow = # of Bedrooms 4 X 100 GPD X 150% = 600 GPD Commercuil Design Flow (data/calculations attached(: ❑ sk -a GPD ❑ Ew.NxJ GPD Design Flow: 600 GPD Comments: New 48R Home; No home business; No sewage ejector/grinder B. Septic Tank(s). Minimum Capacity = Design Flow X 2.088 Wastewater received by: Gravity Cade Minimum Septic Tank Capacity: 1253 Gallons, in 1 Tanla / Compartmentls) Designer Recommended Tank Model(s): Wieser WLPI200/800-MR Effluent Filter 8 Alarm 0 Fuu r rite -Alen Effluent Filter Model: Best GF-10 C. Pump Tank Code Minimum Capacity: 645 Gallons Pump Tank 2(Code Minimum): NA Gallons Designer Recommended Min. Capacity: 800 Cations Pump Tank 2 (Designer Req): NA Gallons Pump 40.0 GPM Total Head 12.5 ft Pump 2 NA GPM Total Head NA It Holding Tank Only: ❑ Minimum Capacity Residential - 2000 gallons, or 5x estimated daily wastewater flow; whichever is greater Minimum Code Required Capacity: Cations, in Tanks Holding Tank High Level Alarm Type: Designer Recommended Capacity: Cations, in Tanks DISTRIBUTION AREA Soil Treatment Area Type: Mound Distribution Type: Pressure Distribution -Level Benchmark 1 Elevation: 100.00 It Benchmark Location: SEE SITE PLAN Component Manuat 1: SBD-1D691.P Mound (N.01/01; R.101121 Distribution Media: ❑✓ Drainfek Rock ❑Appr Dedon Component Manual 2- SBD-10706-P Preswre Distribution IN.01/01; R. 10/ 12) 1/2'-it/2'Aggregate SITE EVALUATION DATA Depth to Limiting Layer: 30 in 2.5 ft Soil Texture: Slit Loam Contour Elevation: 99.50 SHLR: 0.50 GPD/ft2 Elevation of Limiting Layer: 97.00 Perc Rate: MPI Minimum Required Separation: 36 in 3.0 ft Soils with >60% Rock F2gments Present? ❑ ya ❑' W If yes, describe % rock and layer thickness, depth of soil treatment needed per Maximum Depth of System. Mound in SPS 383.44-3 and any additional information for addressing the rock fragments Measured Land Slope: 2.0 % in this design. SOIL ORGANIC LOADING RATE 1. Organic Loading to STA/Pretreatment Unit - Design Flow X Estimated BOO in mg/L in the effluent X 8.34 s 1,000,000 600 gpd X 220 mg/LX 8.34+1,000,000= 1.10 Ibs BOD/day a. Pretreatment Unit information (if applicable(: Not Applicable Is. Organic Loading After Pretreatment (if applicable) - Design Flow X BOO in mg/L in the pretreated effluent X 8.34 r 1,000,DD0 gpd X mg/L X 8.34 + 1,OO ,ODD = - Ibs BOD/day 2. Organic Loading Rote to Soil Treatment Area (Ibs/day/ ft I . Soil Treatment Bottom Area ft' = Ibs/day/ftt on WO/W 11Pd/n') eoo,/n'/an 1.10 tips BOD/days 1200.0 ft2- 0.00092 lbs/day/ft' i ._.._.._.._.._._.._.r..____....................... ..... ._..�._.._. Comments: j I i I � i i......... ._.._.._.._.................. _............... _........ ._..._.._.._................. ........... _._.._._.._.._. ...... J Page 5 Mound Design Worksheet SYSTEM SIZING: Parcel ID: 018-10%-09-000 Design Flow: 600 GPD Soil Loading Rate: 0.50 GPD/ft' N Depth to Limiting Condition: 2.5 ft nY YH Percent Land Slope: 2 % Design Media Loading Rate: 1.0 GPD/ft' DISPERSAL MEDIA SIZING Dispersal Bed Area (A x B) = Design Flow a Design Media Loading Rate 600 GPD > 1.0 GPD/ft' = 600 ft' If a larger dispersal media area is desired, enter size: ft' A. Select Dispersal Bed Width (A): 10.0 ft Can't exceed 10 feet Linear Loading Rate = Bed Width X Design Media Loading Rate 10 ft X 1.0 GPD/ft' = 10.0 gal/ft Can't exceed Table 1 B. Minimum Dispersal Bed Length (B) = Dispersal Bed Area a Bed Width 600 ft' a 10.0 ft = 60.0 ft DISTRIBUTION MEDIA: ROCK Rock Media Depth Below Distribution Pipe 0.50 ft (Estimated material quantities found on Mound Materials page) DISTRIBUTION MEDIA: APPROVED TREATMENT PRODUCTS: CHAMBERS AND EZFLOW i. Select Dispersal Media: ii. Enter the Component Length: ft Width: ft Depth: ft iii. Number of Components Per Row = Bed Length = Component Length (Round up) ft ft = components per row iv. Actual Bed Length = Number of Components per row X Component Length per row X - ft = ft v. Number of Rows = Bed Width = Component Width ft s ft = rows Adjust width so this is a whole # vi. Total Number of Components = Components Per Row X Number of Rows x = Components Page 6 MOUND SIZING D. Fill Depth Below Upstope Edge (D) = 3 feet - Depth to Limiting Condition (6" Min.) 3.0 ft - 2.5 ft = 0.5 ft Design Sand Lift (optional): in E. Fill Depth Below Downstope Edge (E) _ [Bed Width X Land Slope . 100] + T" 10.0 ft X 2.0 % e 100 + 6.00 in = 8.4 in F. Distribution Cell Depth (F) = 8" + Nominal pipe size of distribution lateral (12"for approved products) 8.00 in + 1.25 in = 9.25 in (Nominal Pipe Size adjusted on Laterals sheet) G. Cover Material Depth at Cell Edges (G): 6.00 in >_ 6' Min.) H. Cover Material Depth at Cell Center (H): 12.00 in (_ 12"Min.) I. Downstope Width (1) _ (E + F + G) x (horizontal gradient) x Downstope Correction Factor 1.97 ft x 3.00 x 1.06 = 6.29 ft Or 10 ft J. Upstope Width (J) _ (D + F + G) x (horizontal gradient) x Upstope Correction Factor 1.77 ft x 3.00 ft x 0.94 ft = 5.01 ft Downstope Correction Factor: 1.06 Upslope Correction Factor: 0.94 Endslope Horizontal Gradient: 3.00 (usually 3.0 or 4.0) K. Endslope Width (K) _ ((D + E) s 2] + F + H x Endslope Horizontal Gradient 14.40 in a 2 + 9.25 in + 12.00 in : 12 x 3.0 ft = 7.1 ft L. Mound Length (L) = Endslope Berm Width + Bed Length + Endslope Berm Width 7.1 ft + 60.0 ft + 7.1 ft = 74.2 ft W. Mound Width (W) = Downstope Berm Width + Bed Width + Upstope Berm Width 10.0 ft + 10.0 ft + 5.0 ft = 25.0 ft Verification of Minimum Required Basal Area " Sloping Site = B x ( A + I ) MINIMUM = 1200 ft2 (Min. = GPD+Loading Rate 60.0 ft X ( 10.0 ft + 10.0 ft) = 1200 ft' ............... " Level Sites = B x W MINIMUM = ft2 (Min. = GPD , Loading Rate) ft x ft = ft2 Page 7 W MOUND DIMENSIONS IF— / J obs. pipes 11 - - --L--------------1----------------- - I O i A I. LE— B O I 7 -----------------� A 10.0 ft B 60.0 ft D 60 in E 8.4 in Obs. Pipes (1/10th of B) 121 J L F 9.3 in J 5.0 ft G 6.0 in K 7.1 ft H 12.0 in L 74.2 ft 1 10.0 it W 25.0 ft 6.0 ft Absorption Width (A+I) 20.0 ft DISTRIBUTION AREA CROSS-SECTION 101.77 TOPSOIL 8 SEED \, FILTER FSSRic. 99.50 2% 100.60 't 100.00 >s!} r PLOW 6"- 8" DEEP PRIOR TO PLACING SAND OBSERVATION PIPE DETAIL Screw -type or Finished grade slip cap Topsoil cover ) 4" SCH 40 PVC pipe (1' min Top of pipe to terminate at or above finished grade a' - z' x 6" slots spaced 90 degrees apart _ Infiltration Toilet surface Flange Page 8 Pressure Distribution Design ParcellD: 018-1096-09-000 Bed Width: 10 ft Manifold Connection: End Preferred Orifice Spacing: 3.0 Minimum Number of Laterals in system/zone ={[(Media Bed Width - 4) 3] + 13 X # of zones (Round up) [( 10 - 4) : 3] + 1 = 3 - 1 zone(s I = 3 laterals Designer Selected # of Laterals (optional): laterals 'Can't be less than 2 (except In at -grades) Min. Lateral Spacing: 3.5 ft Designer Lateral Spacing (optional): ft Min. Manifold Length: 7.0 ft Designer Manifold Diameter (see table 51: 1 1/4 in Selected Orifice Diameter Size: 3/16 in (Orifices nwst be z 6' & s 2' from cell edge) Lateral Length = (Media Bed Length - 3 Feet) _ # of zones 60 - aft 1 = 57.0 ft Orifices Per Lateral = Lateral Length + Preferred Orifice Spacing +1 (0,5 for center feed manifolds) 57.0 ft 3 ft + 1 it = 20 Orifices Orifice Spacing = Lateral Length _ # Orifices Per Lateral -1 (0.5 for center feed manifolds) 57.0 ft 19 Spaces = 3.0 ft (ZOnfi eSpacmgfor At-Gradesl Total Number of Orifices = Number of Orifices per Lateral x Number of Laterals 20 Orifices Per Lateral X 3 Laterals = 60 Total Orifices Recommended Orifice Density is 4-11 f t z per orifice; can't exceed 12 f t 2 Orifice Density = Bed Area a Total Number of Orifices (Does not apply to At -Grades) 600 it, 60 Orifices = 10.0 ft2/Orifice Lateral Diameter (See Table 6): 1 1/4 in Minimum Average Head: 2.5 ft Orifice Discharge Rate: 0.66 GPM per Orifice (Based on Table 4) r.m1. t, I,reNJe•io 1iA1 '1111 mla I,.niu ilea• NP_ d NP NP _ _ _ ^ 1 2. ___NF a _NP tl__ CS61 I_BB__ _ _1 5 i pal L64 C93 3 '4l_ R10 _ _ b i_ e <5 _ 071 1 M 1.0.0 OP _IW__ i - Oda 076 110 _ — "-' a aw 079 ua 202 zoz —B 012 oat I n 206 - __ C Is 09G 120 221 95 17 __ _ L_ I0 D" 59 09i � 131 233 Iil�.i•I„�v.-1,JI��..li:i:. iiitil'\I=II'v♦.��I�.: nllllle.l-in�nh •P�•we nla'ii Page 9 Pressure Distribution Design Lateral Discharge Rate (GPM) = Orifices per Lateral x Orifice Discharge Rate Check Table 5 to make sure rnaximurn header length is not exceeded. 20 Orifices Per Lateral x 0.66 GPM per Orifice = 13.1 GPM per Lateral System Flow Rate = Total Number of Orifices X Orifice Discharge Rate 60 Orifices X 0.66 GPM per Orifice = 40 GPM Distribution Piping Liquid Volume Per Foot (Table 7): 0.064 Gallons/ft Volume of Distribution Piping = [# of Laterals X Lateral Length X Liquid Volume Per Foot of Piping] 3 X 57.0 ft X 0.064 gal7ft = 10.9 Gallons Minimum Delivered Volume = Volume of Distribution Piping X 5 10.9 gals X 5 = 54.7 Gallons PRESSURE DISTRIBUTION LATERAL LAYOUT P 57.0 ft X 3.0 ft S 3.5 ft P/2 ft X/2 ft y 3/16 in Manifold Length 7.0 ft Manifold Diameter 1 1 /4 in Lateral Diameter 1 1 /4 in Ckerwu[ Dabll � J \y X 6ti _ r � S Page 10 Pump Selection PUMP CAPACITY (GPM) Parcel ID: 018-1096-09-000 Distribution Method: Pressure If pumping to gravity enter the gallon per minute of the pump: GPM (10 - 45 gpm) Minimum system flow rate: 40.0 GPM Dosing method: Demand Dosing Soil Treatment TOTAL DYNAMIC HEAD (TDH) Elevation Difference: 8.6 It b pain of axMige (between pump and hghest duchaiae point) Distribution Head Loss: 3.25 it Additional Head Loss ft due to s petal e9ulpment, Mc.) Forcemain Diameter: 2.0 in Forcemam Length: 20 it Forcemam Friction Loss = Friction Loss in Plastic Pipe per FT of Forcemam (frown Table 6:) X Forcemam Length Forcemam Friction Loss = 0.66 ft Add Equivalent Pipe Length from pump discharge to soil dispersal area discharge to account for fitting loss if needed. (Estimate by adding 25% to supply pipe length for fitting Lou if desired. Forcemam Length X 1.25 = Equivalent Pipe Length). Use 1.0 for standard systems. 0.66 it X 1 0.66 it Elevation Difference + Distribution Head Lou + Additional Head Lou + Forcemai Friction Loss = Total Dynamic Head (TDH) 8.60 it + 3.25 ft + ft + 0,66 ft = 12.5 ft TDH PUMP SELECTION A pump must be selected to deliver a minimum 40,0 GPM at a minimum 12.5 TDH Pump Model Option 1: Goulds EPOS Performance Curve Pump Model Option 2 Goulds PE41 'A.'t..�'t e, MMn Flin rros � 0 rro+ i urncm m /n Performance Curve =ram r a vo . v s wncm GM °, Page 11 Demand Dose Pump Tank TANK CAPACITY AND DIMENSIONS Pamel ID: 018-1096-09-000 Design Flow 600 GPD Code Minimum Pump Tank Capacity: 645 Gal Designers Minimum Capacity: 800 Gal Tank Manufacturer: Wieser Tank Model: WLP 1200/800-MR Capacity from manufacturer. 800 Gallons Impartand: Dose design calculations are hosed on this specific tank. Substituting a different tank model may alter the pump float settings Contocl designer? dxinges ore necessary. Gallons per inch from manufacturer. 22.2 Gattons Per Inch Liquid depth of tank from manufacturer: 36.0 inches DETERMINE DOSE VOLUME Calculate Volume to Cover Pump IThe met of the pump must be at least 4-inches from the bottom of the pump tank a 2 inches of water covering the pump is recommended) Pump and block height + 2 inches X Tank Gallons Per Inch 'tdding 2lndies amures effluent darn, operabm ( 8 In + 2 inches) X 22.2 Gallons Per Inch = 222 Gallons Minimum Delivered Volume = 5 X Volume of Distribution Piping: (From Pressure Distribution worksheet) = 55 Gallons (minimum dosel Maximum Pumpout Volume = Design Flow x 20➢6 600 GPD X 20% = 120 Gallons (maximum dose) Select a pumpout volume that meets both Minimum and Maximum: 108 Gallons Doses Per Day = Design Flow ? Delivered Volume 600 gpd- 108 gal = 5 Doses Per Day Dramback: Diameter of Forcemain = 2 inches Length of Forcemain = 20 feet Volume of Liquid Per Lineal Foot of Pipe - 0.163 Gallons/ft Drainback = Forcemain Length X Volume of Liquid Per Lineal Foot of Pipe 20 ft X 0,163 gal/ft = 3.3 Gallons Total Dosing Volume = Delivered Volume - Dramback 108 gal + 3.3 gal = 111 Gallons Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank -3 inch alarm depth iemmmended to ra ent 3 in X 22.2 gal/in = 66.7 Gallons turbulence remlm, unnecessary pump rvcbng FLOAT SETTINGS Float Separation Distance for Dose: -- --- -- Total Dosing Volume t Gallons Per Inch! - ill gal 9 22.2 gallin - 5.0 Inches Float Distance Settings Imeasured from bottom of tank): 'V, Distance to set Dump Off Float =Pump +block height * 2 inches -- a In + 2 in = 10.0 Inches Reserve Cap. 18.0 in A 100.3 Distance to set Pump On Float = Orstance to Set Pump -Off Float + Dose Separation Dntance Alarm Distance 3.0 in 10 in + 5.0 in = 15.0 Inches Pump On Distance 5.0 in C 111.3 Distance to set Alarm Float = Distance to set Pump -On Float + Alarm Depth Pump Off Distance 10.0 in D 222.4 15 in • 3.0 in 18.0 Inches Pump Off Elev- 93.1 ft Ili Page 12 TANK SPECIFICATIONS • Minimum cover = 6 inches; Maximum cover = 8 feet (unless specified by manufacturer) • All manhole covers shall extend 4 inches above final grade • If the tank is within 2 feet of final grade, insulate the lid to an R-Value of 10 • Quick disconnect (Cam -Lock) reachable from final grade (24 inches max) required for pump installations • If forcemain will have a "1-Hook" assembly, drill a weep hole in the "hook" • Building sewer: No 90's, keep 3 feet between 45's, maintain 1 inch in 8 feet (1%) slope, install cleanouts at the building connection and every 100 feet at a minimum • Insulate building sewer if less than 2 feet from final grade and under all high traffic areas (driveways etc.) Watertight Lontrol box with separate 99.50 \ pump and alarms rcuns 95.75 1%Mlydmum Slope � LJ V +/- 75' 92.00 — ------ 164- N 4[AS--A-SEAL .ili l 0), \ \ T FILTER OR l I BAFFLE li II TOP VIEW SIDE VIEW OR EXCEED ASTM C-1227 REQUIREMENTS 4" Puri Block Sleeve 2" 5CH 40 to rcemain in 4" SCH 40 pipe across tank excavation to prevent pipesettlmg Cam Lock FbetTree: Install floats separately from pump on I" to 1.5"PVC pipe ill I\ Weep Hole WLP1 200/800- MR TANK SPECIFICATIONS DIMENSIONS 1 WALL: 3- BOTTOM- 3- COVER IT MANHOLE: 24- ID PRECAST CONCRETE RISER HEIGHT- 53. 0 D- LENGTH 164' O D WIDTH M, 00. BELOW INLET 41' O.D 4' CAST-n-SEAL LIQUID LEVEL 36- WfIGHT BOTTOM 12.000 LBS. COVER 8.170 Les. INLET ANC OUTLET 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER' WISCtNNSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY 3346 GAL/IN SEPTIC) 22 24 GAL/iN PUMP) LOADING DESIGN, 8' 0" UNSATURATED SOIL 4- VENT TANK CAN BE USED AS. SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON COVER MIX DESIGN /8 (NO FIBER) TANK MIX DESIGN /9 (SMALL FIBER) CUSTOMIZED TANKS FOR CUSTOM TANKS CONTACT ai CONCRETE FOR APPROVAL xxi^FOYEP a,: >cw'% vaan.,Io nucm m: Page 13 4Y� D"arbrterif or Continence SOIL EVALUATION REPORT Division of Safety and Buildings in arrmlance wim r',rr,m RS Wit dnm r , Page of Attach complete site plan on paper not tens than 8 12 z 1m irtcltes in size. Plan ust Include, but not limited to: vertical and hortzontal reference point (BM), direction and percent slope, scale or drmerisions, north arrow, artd location and distance to nearest road. Please print all information. Personal r4wriairm yat provide may be used law. 15 b4 (1) (m)l County1 I Parcel I.D. 0/'F' /d q6.— Qz-;itD- fie b Date vw a$ 0 Prey Owner F opedy Location ovL Lot Ntil 114NIUJ1/4 S n T Z9 N R E(or Property Owner's Mailing Address I (t �# Block # Subd. Name or CSM# fF State ZipCodee r ,, 1(Q ' pry Village IVaTown Nearest Road p- �"COnShl[tion Use: Residential / Number of bedrooms - Code derived design Saw rate q SU GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Z-i l i Flood Plain elevation if applicable Al/ �/� ft. General comments S rsS err el t v r /Do' O c and remmmendatiats: Co�,�r,ur eleJ. 99r5-0 Boring # Boring gi pit Ground surface elev. lQ. I k) ft. Depth to limiting factor ` 5 in. Soil Application Rate Horizon Depth in Dominant Color Mansell Redox Description Ou. Sz. Conti. Color Texture Structure Gr. Sz_ Sh. Consistence Boundary Roots GPO/ftr •EM •Eff#2 -� Z 31 2 r l rr c 11 5 Z l �Z SiG1 � kr �5 3 l 3i _ ) L rY4 C C _ - 413 v I m+ — — �i . 41 7 Boring # Boring ® Pit Ground surface elev_ qP -"o rL Depth to limifing factor in. Soil AWicabon Rate Hort m I Depth in. I Dominant Color Mansell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDW •Eff#1 Ttf#2 S� 1 zooa& r1'Nfr 5� d Z rn5tk rrr�r 3 I 51 CZ - emuent Pi = tsDDr > 90 < 220 mryL and TSS >30 < 150 mg/1- ' Effluent #2 a BOD, < 30 mg/L and TSS < 30 m9r. ��s-ay7 yo Property Owner Parcel ID# /0-T / Page `-` of Boring # ❑ Boring D-p:t Ground surface elev. / 00 !r ft. Depth to kmbng factor in. Soil Application Rate Horzon Depth in. DomthantColorl Munsa Redox Description ' Qu. Sz Cone Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GP •EfM •GEff#2 C Z ? "--V7�f` I I { I I I ❑ Boring # ❑ Boring — ❑ Pit Ground surface elev. ft. Depth to 6mibng factor _ in. Horizon Depth In. Domutant Cdw Mansell Redox Descripti Qu. Sz. cone C= Texture Struchue Gr. Sz Sh. Consistence Boundary Roots -- GPD/ft' - - 'Effltl � I � lJ Bon,g# ❑ 'o 'g ❑ Pit Ground surface elev. fL Depth to (uniting factor in. Horzon Depth in. Danvunt Cola Munsell Redox Description Du. Sz ConL Color Textu a Saudure Gr. Sz Sh. Consistence I Boundary Roots GPDM.2 'Eff#1 EfNY2 1 I f i 1 I 1 I I 1 j I Effluent #1 = BCD, > 30 < 22D rng/L and TSS >30 < 15o nwA 'Effluent 92 = BOO, < 30 MgfL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. IW you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 15 PAGE__Z� OF NAME & 4 f LQT# 9 LEGAL D SCRIPTION Al v X Uk SCALE: I — BM I ELEVATION BM I DESCRIPTIONS n+_}� - BM 2 ELEVATION q. O BM 2 DESCRIPTION SYSTEM ELEVATION 4X - O SYSTEM TYPE aa l � G y v✓ CONTOUR ELEVATION SG v?, SIGMA a �-3 c C�, NPLA TED LANDS { j 10 95-3 — -■-. .� . - 3f�5 24 01' Q 2 4. 4 I 174. g \ x O 1095.2 ia...... .... LOT 17 8-53 \� M 1.78 ACRE O L O 7 h L T 8 1.66 CRES 1. 1. ACRES ^� \ e M 3 j 0.40, a. . T a 1 0 8 s: p , 10O v- ' 1.5 ACRES 0' j LOT 11 W S,so i j g4 N 1.52 ACRES IW.49T0, n 39l\\ q 3 LFE 1072' h \ s? gl 9 75' p�L0 10 z o 3'. ^"�'AG�c F4Sf Hl V.54 A0CR0 , `t14 all 00 /soo2g0.2j 1, z rn 0' ��\ 4.73. 33' 0 1 _ d ( LOT 2 \ � ® ------A.,62.8 —30 (.77 ES t \� �r N ........ f..--. ^� , erArB W 17 , Sr. CRc7 uN rY SANITARY SYSTEM File` — OWNERSHIP/ADDRESS FORM -C,. e212021 y Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system' This information will be provided as part of our ongoing efforts to protect public health, your well groundwater. surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email OWNERIBUYER INFORMATION Owner.'Buyer _tQdd � filt L_ Mailing Address Clty,!State/ZipYYsoc.aaacarsa.�Jt.✓1�.>.------- -- Phone Number :req� nil. 1-J;2.�%' Email Address ,required,_ t • r^_AYYI Parcel Identification Number _- (2 `i6q�-(pq000 (found on the property tax bill'. NEW SYSTEM: LEGAL DESCRIPTION I , /�v�W 1 0 �,O Property Locatio �'v ran ,, W". , Sec. tom. T �_N RJJW, Town of 44 &M Subdivision Plat: _h-ea5arTt- 02. Lot#�. Certified Survey Map # Volume — Page u Warranty Deed # before 2006)Volume Page u Number of bedrooms �_ Spec house O yes M/no Lot lines identifiable dyes O no New Property Adaress I U D-1 I (vertcal� nnoof (S(A InRialsl (Da J OFFICE USE ONLY 016 address required from Community Development Department for new crostnxtion.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form 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. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax ccldfdsccwi,aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwiaov { a p -1 < 8 l "I-LCPCII tl n .Yoolo I. B Bl Oil Ii ❑'' 11'll El El'I I�I Ali III II i ill I � r I LLl'I�'�Illll�l;l�i�l��ll��ll'��I ' I II I lilllu t III, I IT ��' 111 l � ill111 �' Il III I II yy I. u 9 a : o - cu euILDERs il�� pc t��li GLENMEADOW Pit A3 f ��♦' y I IY r U'.T' DO ..,.� ��. ...« .....,....m -- .7 as yu r.nyr v � it �' aw .! ^___- nr -v--_..r•. �-Y- - � Z I i �-- u i7 .. um....e sl { Found&lon Plan A2 7. Lul 3 LOT 16 h ry 81, 204ASO. FT. 3 1.57 ACR S 1.65 ACRES L 01 m 1.60 ACRES ^� 68,396 S0. FT. 72,050 SO. FT. 2. 10 / p 69, 492 SO. FT. i I 91,582 E s S54°59'54`E y I�01" gF Ssq, 108. 14' S9, y\ s9 OO4 h s LOT 5 0.13 g•W 3T9. g/ o.,'" - ��/n� I ,n 1.90 ACRES / N LOT 8 ®' i 82, 716 SO. FT. 1.51 ACRES , ` ��`1 I 65,863 SO. FT. 1 O \ y` LOT 3 LOT 1' W S,6n Q m 9Z 1.50 ACRES 1.52 ACRES i. /6� //•E 65,409 SO.FT. 66,232 SO.FT. P^ 06 ron 936 "(="39'��:. �9 •�\ Nf.76T375' Qe. :`��'!�%'p0'h r. N bb d F / LOT 10 e N , e \ dl6 �1h c, �. 2 ti 1.54 ACRES N .g3 p4 66,906 SO. FT. LOT 4 �O'19'�9 ti� 0 Q 00 �....... `........ 3 LOT w 1.56 ACRES ;\/ ry I 67,804 50. FT. p 4j n 50i i •[ I 9g. y \ ryj3o v 6 654 SO. FT. 3 ` 3• E \• 6 �N7 Si s3j 6g 3 ,266. O0 '.......... o f I' / ® 6. .... '63 `, ";`_,? Bge36, _`/p zjO6gL.. m� 33J{33 i� ��'r'® LOT '.. , 2j 69 1= -�i�_ i0 `` i i • I ... %'.... 1.53 A ✓0/N7 \ / OR/YEMA \ a�,t'........ Qit�- '-'-_✓ 1 ��-^' .'� 66,861 o - ..m .®"-- ----------- � LOT 23 N o .... ..............�........ tiw LOT 26 q0 it 1.64 ACRES W 1, 26 ACRES W LOT 24 . I �. 71,367 SO.FT. i LOT ACRES aa,2sz so.Fr. N- N 94,413 ASOEF7l; y ,1 N HNf 1061' N _ Q. LOT 25 or i m LFE 1063' 1.69 ACRES �• n P HIrE 1061' al m ; m M 73H1*E IMO.FT. £ 1.71 ACRES ^ro LFE 1063' a; 3 P Pn '� N LFE 1063' 74,417 50, FT. / L O ro1 2 ; O O N DRAINAGE an _ 90'. -1scrnsinDeparhnentofCommerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County , Attach complete site plan on paper not less than 8 12 x 11 inches in size. Plan must CY OI include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0/Y ; /0 9(i— &1- OCX� Please print all information. v e by Date Personal information you provide may be used semrh T,Fph(l 2 f Law. 15.04 (1) (m)) /W✓✓` �,a� I Pa$//l . Property Owners Mailing Lot N KJ 1/4 Nit) 1/4 S 9 T ZG N R/ 7 E Block # I Subd. Name or CSM# T� 'f-, I ST cecixccuvTv I I `'I I I PhCL64ktd�L City' State Zip Code on City ❑ Village &Town Nearest Road 4d l (-71 ` )7 -1I ZIo f f 1) Y-) Yy-d I I e ®-New Construction Use: Residential / Number of bedrooms - q Code derived design flow rate 95C1&1 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material .4�1 1 Flood Plain elevation if applicable /l/'f4 ft. General comments S�-s-fpo Q/2(/, /D�•QO and recommendations: C o`er I J , MBoring # Er7]t Boring lZS pit Ground surface elev. ` ` ft. Depth to limiting factor_ in. Soil Application Rate Horizon Depth in. Dominant Colorl Munsefl Redox Description Ou. Sz. Col Color Texture Structure Gr. Sz. Sh. Consistence I Boundary I Roots GPD/ft' 'Ef#1 'Eff#2 I h-(Z -- 1"r I cS I IVf .i 2 I-4 SId �r I c5 3 mar 1 c5 1-1 `( - -„�n4' I — I —I L-1 Il� Boring # Boring ® pit Ground surface elev. ft. Depth to liniting factor .XO in. �� Soil Aooli tion Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture4r�.Sz. Consistence Boundary Roots GPDM2 'Eff#1 'Eff#2 - S� II'ncr s1 V1s'd rv,(� �5 - �3 I CZ �l� S; dmar Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L s-- 0 Z 71S z5/JF-YGo Properly Owner 1 .CX L Parcel ID# A / Page `— of 3 Boring # 1❑ Boring LET -pit Ground surface elev. /00.10 ft. Depth to limiting fa i Soil Applinflon Rate Horizon Depth I In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence - Boundary Roots GPDtft' ff#1 - 'Eff#2 C5 tv 7Ez_ 2 Z- ID (L Zm5 yr ❑ Bodng # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate ❑ Boring # ❑ Boring ❑ Pil Ground surface elev. R Depth to limiting factor in. Soil Apolication Rate ®®� � , �. • ®®®®®i7Yiil�i7GiL7 ' Effluent #1 = BODs > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sao-erw(zmM) T PAGE--f, OF� NAME f LOT# 9 LEGAL DESCRIPTION A/,n) XUI) is S q T 2q N R 1 E(or SCALE: I" Z/O M I EVATION/(')0.0 BMMII)DESCRIPTION n��p p� EVATION jT �,,� O BM 2 DESCRIPTION ��cc g SYSTEM ELEVATION /�- O SYSTEM TYPE w no ilct �, e v✓ CONTOUR ELEVATION 79. Sc) U, o m2 1 CC �\ �Co SIGNA � j I ' —'� NPLA TED L NDS x 1095.3 Ono If I ---- - - --- ----- I-- 3®5 24 01' ® 2 4.54 --- --- 1174. x O 1095.2 of •................................... M...... ................... ........ ............. ................. ........................ ...... ............ LOT 17 B-4� L O T h d. 3 B-53 N 1.78 ACRE L $ 1.86 CRES 1. AC T 1. ACRES M �? O O � � CT .. /,g 3 N7,3o20, N O.hO' A. • B N T 8 1.5 ACRES , y M Q 0. LOT 11 W S16',6, 5� N W. 49Y0' 39' LFE 1072' a-) • o L O 10 0 53 •,9A. \ OF a 54 ACR (2 0 ••... FASF.1fNT 1070' ,/ L E 1072' • 50 ................ _ 94, 'L3T9 �W M 1 \ Nj30 - fs Z s 10 - - _ i 1 �" - /5 - -�- QO' y g• • •w w1 w • .... 44 01 d LOT 2 -30 -® -- ----- 8 p.182. 1.77 ACRES to OT rn N......... ....... �0j r eracc W ( Zjw,8dM**A) DI COUNiv NO. 633390 STAT4SANITF,4RY PERMIT 21084 1;3 sT\ PRE\'IdUS NO. OWNER LIC.#� SUBDIVISION CHAPTER 145.135,r WISCONSIN STATUTES (a) 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. jDTraA/LAU H RI ED ISSUING OFFICER - DATE EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20)