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Home My WebLink About020-1466-19-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Budding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Lays s 15 Oa (111mI] Permit Holder's Name City Village Township BFG1, LLC--William Bergstrom TOWN OF HUDSON CST BM Elev Insp BM Elev De nphon Q BM ri TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Lgrr.io �• x , A Holding TANK SETBACK INFORMATION 11VLc s, ( hrk,'- , TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic ) q L Dosing ,9I 75d t Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length DIa Dist to Well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV Benchmark p Alt BM yDh dg Sewer SUHt Inlet .S`f St1Ht Outlet 7. z 77. 3s Dt Inlet Dt ottom /6.3 96.38 Hik?ader/M.4in 5 B •Q 72 Dist Pipe Y Bet System Final Grade qq C ver q ��•�i/ BEDITRENCH DIMENSIONS Width 3 Length —/J V /, 1 No Of Trenches PIT DIMENSIONS No Of Pits Inside Die Liquid Depth SETBACK INFORMATION SYSTEM TO JP/LW BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Ma f j r r Type Of System 1 !/ ,�� t L)IJ I Klt$U I IUN JYJ I LM V, Header/Manifold 1 P Lengih� Die � Dislnbuhon pipes) Length DieSpacing Hole Srze x Hole Spacing Vent to Air Intake SUIL UUVIZK x Pressure Svstems Only xx Mnund nr At-nrade cv,;te,n< nnu. Depth Over I Bed/Trench Center /f- L , 7 _J] Depth Over It BetliTrench, Edges �% xx epth of To atl ed tl — No xx Mulched J Yes No 1--/ COMMENTS: (Include code dlscrepencies persons present etc) Inspection #1 Location: 750 STERBEe�NNZ{Z DR ' / I/IYfI lV�7� !!f� 1) Alt BM Description =Kcill' ( ^VC (` 5i'0W" eli /Oi 2.) Bldg sewer length � Q lit 4ii 8� II // - amount of cover �' 0 r - `J4�5• im Q(,ii 1p 01`AlrlR e Plan revision Required? ❑ Yes y No /! / Use other side for additional information SBD-6710 (R 3/97) Date Inspection #2 077.6 '�3 is - �h '1 G • d Can No Atli- 'I r9q „feaar ;y =^- Safety and Buildings Division St. St. Croix t, f aj 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co ) y�� ) JUN Madison, WI 53707-7162 1,P 33 '01 Comrrt+7[t P it Applica on State Transaction Number In accordance wi 21(2), Wis Adm Code- submission of this form to the a ff��ovemmental unit PWTS-062101202-C is required prior to obtaining a sanrtars permit Note .Application forms for state-owned POW 'S'dlesyynrtted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you onivide may be us it fur secondaran purposes in accordance with the Privacy Law, s 15 04 I -m , Stats 750 $teibenz Dr., Hudson, W 1. Application Information - Please Print r inn R}E Property Owners Name Parcel q BFGI, LLC- William Bergstrorr(5 020-1466-19-000 Property Owner's Mailing Address Property Location 12 Point Rd. Govt. Lot 7NW �, SW '/,,Section 27 . City State Zip Code Phone Number Bayport, MN 55003 (circle one) T 29 N, R 19 W IL Type of Building (check all that apply) Lot k ❑Ior 2 Family Dwelling- Number of Bedrooms Na Subdivision Name ( - Na 1l1 ?:>�fNK Block ® PuMic/Commercial Describe Use Office/Warehouse Na ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number Na ®Townof_Hudson Ill. 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. [I Permit Renewal ❑Perini[ Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Daze Issued Before Expiration Owner r IV. Type of POWTS System/Component/Device: (Check all that apply) 3 )(40f-e,k ® Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in of suitable sod ❑ Mound <24 in of suitable sod ❑ I lolding Tank ❑ Other Dispersal Component (e plain) ❑ Pretreatment Device (explain)_ V. Dispersal/Treatment ersal/Treatment Area Information: 2 EZ-Flow EZI203 distribution media u Is. Pol yLok PL-525 effluent f er at se tic tank dischare Design Flow (gpd) Design Soil Application Rare(gpdst) Dispersal Area Requved (sf) Dispersal Area Proposed Is System Elevation 921.0 Gpd 0.7 Gpd/Sq. Ft. 1 ,315.72 sq. ft. 1,400.00 sq. ft. 97.50', 97.25', 97.00', 96.75' VI. Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units L L v o � o New Tankc Existing Tanks u 'm s Septic or Holding -rank 800/1,200 2,000 1 Wieser Concrete X Dosing Chamber 2 chambered ST VIL Responsibility Statement- 1, the and igned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Slgnamr MP/MPRS Number Business Phone Number James K.Thom son 1 M131 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulsen Lake Ln., Osceola, WI 54020 Vill. County/Department Use Only r`yApproved i`` � Perm�it�Pee Da[ Issued I awn Agent Signat \ �en Reason for Denial '/,�✓_ `z `� 3) t% vl Lk— IX. Conditions f Approva R,easeerler-Bisappreval __ ff S PEM O Se tic tank. effluent filer and k. eMu Se r � I_ S dispersal cell must be serviced / maintained {{`y� as management by t W t ' "`�" ILA _S So t per plan prcwded plumber. All setback reawrements must be maintained v i D-A... _ 0 0 for the syste su mi ty the CouoQ' onlry�on�paper o Ina than 81Q t 1 inches in sia s 5 W^--fir'-J� V-jL� 1/1I�Q i n�crwta� tl\��, 4-o �. 7 ab p.QrDSTS �+OPv qc:�V 1 prvpase,clji � d w1/ tren<:as e.f Sx 70' L41 7 EAO-J E�/7�3f/al.'s(r'buruoy.�Med:R - b Sur{.c< elWu%'ens Lz be: 97.5v Propoet d "; [set Cori er008019,v Zdpm�Oerf..aantJ,�Ot2, eff/K�i F,'/t<ia d +� 3' o P�apas<d o�`ct�tahrl�ioc6G E - Fae�l: br r'""T� O�S�oi GSA O� � Sa/bo/y /7•E • trx.'sd.� tslcv • to<..fado<go.sb..(�o —+,�— Exsb'� eycbef�ncc - 40c,#24.2.1 /iFG 1, cI.c - // B Vjt-e.,•, Q./%ca1; T,oP /fudsM, 3'E.Cro+,r 5ern� 3.o77gclYs, ao4-' r � d r r , < PL ,COPY o_ 00 I A. z0fe DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http'//dsps w.govlprograms/industry-services v ww.wscwsin.gov Tony Evers - Governor Dawn Crim - Secretary June 7.2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-06-07 r Plan Review:PWTS-062101202-C JAMES K THOMPSON 340 Paulsen Lake Ln Osceola WI 54020 SITE: Bergstrom Office/Warehouse Complex 750 Sterbenz Dr Town ofHUDSON St. Croix County Total Amount: $500.00 FOR: In -ground Component Manual - Ver. 2.0, SBD-10705- P (N.01/01, R 10/12) Description: 961 GPD (Employees and Flood Drains) Maintenance Required 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 constmcnon or installation and prior to occupancy or use • Only waste that is categorized as domestic waste is permitted to enter a POWTS unless a letter of concurrence from the DNR that permits commingled waste accompanies the plan. • 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 drams discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site • Divert surface water from POWTS Area. • 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 (I1)(c) • Tank Installation to follow all manufacture's recommendations • Verify property line(s) prior to installation. 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 andor owner's manual for the POWTS described in this approval SPS 383.54(1). • 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 101.12Q), nothing in this review shall relieve the designer of the responsibilit}for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, / /7 1q1_11 el Non -Residential In -Ground POWTS Index & Title Sheet Residential Strength Waste Assumed Project Name: Contact Name: Site address: Project Location: Subdivision: Bergstrom Office /Warehouse Complex BFGI, LLC - Bill Bergstrom 750 Sterbenz Dr., Hudson, WI 54016 Lot 19, Plat of Hudson Business Center Legal Description: NW1/4 SW I/4, Sec. 27, T.29N., R 19W., Town of Hudson, St. Croix Co., WI. Parcel ID #: 020-1466-19-000 Mater Signature: Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Design Overview, Daily Flow, Septic Tank & Dispersa Cell Sizing Calculations Page 4 Dispersal Cell Cross Section Page 5 Infiltrator Ezilow EZ1203H Distribution Media Speicifications Page 6 Septic Tank Cross Section Page 7 Filter Detail Page 8 POWTS Management Plan Attachments: State Plan Review Application Soil Evaluation Report Jim Thompson, DSPS Credential #30021 S' Date: Pg. 1 Of 8 Design Pursuant to In-Caound Soil Absorption Component Manual for POWTS, vusion 2.0 SSD-I0705-P (N.10101; R. 10/12) POWTS Index & Title Sheet Non -Residential In -Ground POWTS Project Name: Bergstrom Office /Warehouse Complex Contact Name: BFG1,LLC- William Bergstrom Owner's address: 12 Point Rd., Bayport, MN 55003 Site address: 750 Sterbenz Dr., Hudson, WI 54106 Project Location: Subdivision: Lot 19, Plat of Hudson Business Park Legal Description: NW va SW IA, Sec. 27, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID #: 020-1466-19-000 Page 1 Index and Title Sheet Page 2 State Approved Design Page 3 Sanitary System Ownership and Address Form Page 4 Parcel Map Page 5 Waranty Deed Attachments: Sanitary Permit Application DNR Letter of Concurrence Mater Pt er estricted Service: James K. Thompson, DSPS Credential 43 1 Signature: -- Date: 207-/ Page I Of 5 Design pursuant to In -Ground Soil Absorption Component Manual for POWTS, version 2 0 SBD-10705-P (N 01/01, R 10/12) O ^ E ^ f�oposcdd;s�s�Cv// fur Cv} 4� tcenclas e.f 3'x 70' �l -/ ER �� n (o E�/1 o3Na:'s M Swil oy� Nt ed; af%r/f rj�,1\ bundrfs�oer!/..neL.s,��/Er 3. fAce eltdaf-< j be be., 97.Sd,' P Proposed..%eW/ Con u ofc ,Jc oohw firm ZCam p,.rt.nsn't SC 2 fff/a.n E �/tva E i� o �' Scce n d Ch�mbfl: Pr°p•s�cl o�{'ee/wkrf�oraSe FaC; lr 6r ov--14"oposed o� Sa/borr P,E • ex"j 'nq ceit✓, • V/rp�op.3 ✓ �S-C&A : / � S//o7 /3FG I, LLC - dV// L%mv St-d", LoE/9 P/a� af'llkdsa„ Bask�ss C'o,,�Jr• l�c1. Soto-/T�LG-/9-arz 5tr%� 3.a774c/'ts. . o r v'' lo 33 rO / ;I S A . 7-ae BFG1, LLC — Bill Bergstrom Non -Residential ATU POWTS In accordance with In -ground POWtS Component Manual, Version 2.0, SBD-10705-P (N.01/01) JOB DESCRIPTION: Installation of in -ground PO WT'S to serve Office Complex/Warehousing facility. The facility is open 8:00 AM — 5:00 PM, Monday — Friday. 30 employees occupants maximum. One kitchen/lounge area on site, no meals prepared or served, no shower facilities available. The 8 parking bays are for vehicle storage only — no vehicle maintenance, cleaning , etc. will be conducted in this area. The Soil & Site evaluation report of record indicates soils that will accept effluent at a rate of 0.7/1.6 gpd/sq.ft./day. PROPOSAL: The system installation will consist of an 800/ 1200 gallon two chambered septic tank with effluent distributed by gravity to a 1,350.00 sq. ft. dispersal cell constructed using EZflow EZ 1203 distribution media. Effluent will be monitored at 6 month intervals. Should high strength waste levels be encountered after the system is placed in service and mitigation efforts to lower the effluent strength are unsuccessful, the 800/1200gallon two chambered septic tank will be converted into a trash/surge equalization tank that will time dose effluent into a Bio-Microbics High Strength FAST ATU. Effluent leaving the ATU will be discharge by gravity to a 500 gallon settling chamber and then into a 1,000 gallon pump tank. The effluent will then be demand dosed into the existing dispersal trenches. Design Wastewater Flow: 921 00 Gpd Code prescription (30 employees all shifts) (13 gal./employee) = 390.00 gpd (Kitchen/lounge facility) ( 2 gal./employee) = 60.00 gpd (4 floor drains) (25 gal. drain) = 100.00 gpd (8 parking bays w/ trench grate) (8 gal. drain) = 64.00 epd Estimated wastewater flow = 614.00 gpd x 1500/6 = 921.00 gpd Dispersal Cell Calculations: 1. Design Wastewater Flow: 921.00 Gpd 2. Infiltrative capacity of natural soil: 0.7 gpd/sq. ft. 3. Absorption area required: 1,315.72 su ft. (921.00 gpd/0.7 GPD/sq.ft./50.00 sq.ft. EISA = 26.31 EZFlow EZ1203H units) 4. Absorption area proposed: 1,400.00 s0 ft (28 EZ 1203H units at 50.00 sq.ft. EISA per unit) Number of trenches: 4 r 7 EZ 1203H units per trench Trench width: 3.00' Trench length: 70.00' Total system area w/ 6' trench spacing: 30'x 70.00' Dispersal cell infiltrative surface elev.: 97.50'. 97.25', 97.00' & 96 75' SEPTIC TANK CAPACITY CALCULATIONS: 1. Design wastewater flow = 614.00 gpd daily flow @ 150% = 921.00 gpd design flow 2. Minimum required capacity: 1.923.04 Gallons (921.00) + (11.61)(921 /75)(3 *) + (46.77x921 /75) *(Requires a three year maintenance cycle) 3. Proposed Capacity & Manufacturer: Wieser Concrete WLP 800/1200 - 2 chambered septic tank (2,101.44 gallons actual capacity) Pg. 3 of 8 IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) ;Wz�12' _n TYPICAL TRENCH a ar sa�covEa CROSS SECTION VIEW Provide minimum 3ft 1T (NO Scale) separation between trenches. inn. lrenn dent L Highest Trench Lowest Trench (as applicable) System Elevations= 97 50 ft; 97.25 ft: 97.00 ft 96.75 ft; TYPICAL TRENCH (show location of inlet! outlet Pipe connection on plan view.) PLAN VIEW (No Scale) 4„0 om.mmn nee area eenmre a Mneeobrae Perforated Lateral Obtiobserva.tib on Pipe (typical) (lywcal) —14-__----__ 70 It INSTALL PER TR F e = lNMcaU ENCH: 7 10-ft bundles @ 50 ft EISA/unit= 350 }t' + 0 5-ft bundles 0, 25 ff EISAlunit = 0 ft, OBSERVATION PIPE DETAIL 1No sold S--T,p — ft srpovvosai 410 w,�eq v�pje.� r Tocn�:Ynr�'A'd alo�a g.e � lm yr-an. x6. sne-- 5 Anrt�Mrg pavb Infdlralon 10 d® ft (tyWcaU D °= I �A=3.0 ft J NPi�) m � W EZ120311 Bundle n (typical) Ul (mfd by Inflbator Systems, Inc I Install pursuant to mandwWri l's Inoift vs = Proposed EISA per trench =350 ft, Required Infiltration Area =1,315.7 ft' Distribution Method: x 4 trenches = Proposed Total EISA = 1,400 0 ft° branched manifold gam 6. W8 Bundle System Configurations: Available In 7". 8", 9", 10", 12", 13" and 14" diameter bundles 0801P-GEO 1401 P-GEO 1201 P-GEO 1801P-GEO 1001P-GEO 1203T-GEO 1403T-GEO 1003V-GEO 1202V-GEO 1204V-GEO 1402V-GEO 1004V DEG d Business Park Road P 0 Box 768 Old Saybrook, CT 064]5 INFILTRATOR" 1-80D 22°° 66°-5"-'°°' Water technologies wevw.mfiltratorwateccom Notes: 1. Other systems Include 10" and 12' bed systems, Bed size will dictate the number of bundles. 2. System dimensions are dependent upon bundle diameter and configuration 3 LLP is for "Low Pressure Pipe" In which a pressunzed distribution pipe is field installed within the corrugated pipe. 4. Internal pipe and couplings meet the requirements of ASTM F405. 5. Bundles are also available without geotextile between the netting and synthetic aggregrate. INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED WARRANTY 18) The structural integnty of each EZflow by Infiltrator expanded polystyrene dramfield system and other accessories manufactured by EZflow by Infiltrator ("Units"). when installed and operated in a Ie ichfield of an onsite septic system in accordance with Imitators Instructions, is Warranted to the original purchaser ('Holder') against defective materials and workmanship for one year from the date that the septic permit is Issued for the septic system containing the Units, provided, however, that if a septic Want is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notdy Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect Infiltrator will supply replacement Units for Units determined by EZflow by Infiltrator to be covered by this Limited Warranty EZflow by Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the EZflow, system is manufactured by anyone other than EZflow by Infiltrator The Limited Warranty does not extend to incidental. consequential, special or indirect damages- Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and matenals, overhead costs, or other losses or expenses incurred by the Holder or any third parry Speciftcally excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions, failure to maintain the minimum ground covers set forth in the mstallatlon instructions; the placement of improper materials into the system containing the Units, failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes, all other applicable Laws; and Infiltrators installation instructors (it) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the original Holder. The above represents the Standard Limited Warranty offered by Infiltrator A limited number of states and counties have different warranty requirements Any purchaser of Units should contact Infiltrator s Corporate Headquarters in Old Saybrook, Connecticut prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units U S PAous 4I59,661 5,017,041 5, 1513,4613; 5,336.017 5,4m 116, 5.401 653, 5,511,903, 5,716.163, 5.fails ]]6, 5,659,a44 Oanadish Patents 1,329 959, 2,034,564 Other patems gentling Infiltrator, Equalizer (hiic44, and 9tleWinder are reginered trademarks of Infilnaty Water TecMGogies Infiltratoris a registered trademark a France Infikrator Water Te Mdogies is a regstered trademark in Meuco Cortour f licvLeach.ng Pal ff ChamtrerS{aer, MukiPon, P.Lockpu;ckCM p x,,Piay Snapl�k antl SUa,gMlock are trademarks of InM1ltrator Water Tachrwlogies So j G Pr,yLok e a trademara k o' PdyL Inc TUF-TITS is a regist2�ed trademarR of TUF-WE INC Ul" Rib a a trademark of IPD(Ia r 0 € 2015 i,firatdr Water Technologies LLC Nl rights reserved PrintedmUSA 010315 G Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-8DO-221-4436 4" CAST -A -SEAL II illi o � I II IIII II I I I I� I II l�I - - - - I1 r--------- II' --------- __ �. INLET N M N V TANKS ARE ACE SOILS & SITE EVALUATION PROJECT: BERGSTROM HUDSON, WI (1 EA.) WLP800/1200—MR TANK SPECIFICATIONS 0 1" CAST -A -SEAL DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" LENGTH: 13'-B" WIDTH: B'-O" BELOW INLET: 41" LIQUID LEVEL: 36" WEIGHT: BOTTOM 14,800 LBS. COVER 8,170 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET LIQUID CAPACITY: 33.46 GAL/IN (SEPTIC) 22.24 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL COVER: MIX DESIGN #B (NO FIBER) -NT TANK: MIX DESIGN #9 (SMALL FIBER) O1 OUTLET N U a m � � n REVIEWED BY AD REVIEW DATE IDRAWINGS SUBMITTED APPROVAL FORII APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: II o m o- � m W 0 H a Oz00 G.7 w oU, N � 0M H o x 00 W_ 3 OF/I 0 PAL AO%1W__ Inc Inwuanbns rn Prxas(Dra�nape � Za6el` & Wastewater Products A�meonot Pdy 1rM PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent wont leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1 /16" filtration • Accepts 4" and 6" SCHD 40 pipe, • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PI -525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover, PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should btc done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4 Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank Make sure all solids fall back into septic tank. 6 Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 1/16" Filtration Slots Accepts 4" & 6" SCHD 40 pipe Outdoor Smarttilter, Alarm Polyhrk. Label & BCSt filters accept the SmartFilterl, snitch and alarm, Acccpts 1" PVC Extension Handle 525 Linear Ft of 1/16" Filtration Slots Gas Deflector Extend & Lokr"' Easilv installs into existing. tanks Polylok. Inc. 3 Fairfield Blvd. Wallingford. CT 06492 Toll Free: 877,765.9565 Fax: 203.294.8514 www.polylok.com P -W 8 Non -Residential POWTS In -Ground Dispersal Cell Management Plan Pursuant to Wisconsin Dep't. of Safety & Professional Services 383.54, Wis. Adm. Code General The POWTS shall be operated in accordance with Dep't. of Safety & Professional Services 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10706-P (N.01/01). All local and/or state rules pertaining to system maintenance and reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber Effluent Quality Influent flow may not exceed maximum design flow specified in the system design and sanitary permit. The sewage effluent concentration levels generated at this site are assumed to be residential strength. effluent quality entering the dispersal component of the POWTS may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Effluent testing will be conducted 3 months and 6 months after the system is placed in service. Samples are to be collected from the second chamber of the septic tank. Tests to include BOD, TSS, Ph, FOG. All test results will be submitted to the County Community Development Department. If effluent concentration levels exceed residential strength waste standards, additional testing will be completed to determine average effluent concentration levels as per SPS 383.44. A mitigation plan will be created to bring concentration levels into compliance. Effluent quality will again be assessed as described above. An ATU pre- treatment package will be installed if effluent strength cannot be brought into compliance with above standards. Septic Tank The operating condition of the septic tanks and outlet filter shall be assessed at least once annually by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1!3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. Any treatment tank opening deemed unsound, defective, or subject to failure shall be replaced. Exposed access openings shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. Dispersal Cell Observation and vent pipes within the dispersal cell shall be monitored for effluent ponding. Pending levels shall be reported to the owner. Any ponding will be deemed an indication of an impending hydraulic failure requiring more frequent monitoring. Persistent ponding of 10" or more within the system will be addressed by installation of new dispersal trenches. Contineencv Plan If the septic system or any of its components become defective, the component shall be repaired or replaced to keep the system in proper operating condition. A replacement dispersal cell or an ATU pre-treatment package will be installed as per design specifications if effluent pending occurs and cannot be brought into compliance with above standards. Monitorine & Inspection Schedule All system components shall be monitored and inspected semi-annually for 24 months after the POWTS is placed in service. Monitoring and inspection shall be conducted annually thereafter. Monitorine & Inspection Procedures: Visually inspect all system components. Evaluate sludge levels in septic tank, inspect manhole rings, covers, locks, vents, etc. Inspect outlet filter & clean as needed. Preform field tests for dissolved oxygen, settleable solids and Ph of effluent. Collect effluent samples for BOD, TSS, Ph and FOG laboratory analysis if field testing indicates stronger effluent levels than residential strength waste. Monitor existing trenches to determine condition ofbio-mat development. Pg. 8 of 8 Wsconsin Department of Safety and Professional Services Division of Industry Services Page 1 of 3 SOIL EVALUATION REPORT In accordance with SPS 365, Ws. Adm. Code unty CoSt Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, Croix but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I D scale or dimensions, north arrow, and location and distance to nearest road 020-1466-19_000 Please print all information. Reviewed by ersonal information you provide may be used for secondary numrxx mrivary i au, 1 s narivm%% Ref* 2624 Date Property Owner Property Location ❑ BFG1, LLC - Wlliam & Beverly Bergstrom Govt. Lot NW % SW Y. S 27 T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # 'Subd Name or CSM# 12 Point Rd- 19 Na Hudson Business Center City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Bayport MN 55003 I ( ) I I Hudson Bmake Dr. ® New Construction Use. ❑ Residential/Number of bedrooms _ Code derived design flow rate 921 GPD ❑ Replacement ® Public or commercial — Describe Office/Warehouse Parent material Glacial Outwash Flood Plan elevation if applicable na ft General comments and recommendations Site suitable for conventional POWTS with 0.7 gpd/sq ft. loading rate Recommended infiitrative surtaPe elevation to be 97 50', 97 25', 97.00' & 96 75'. [71 Boring # ElBoring Spit Ground surface elev 102.63 ft. Depth to limiting factor >110" in. Horizon Depth In Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots w PD/Fe naur 'Eff#i -Eff#2 1 0-22 10yr32 & 4/4 none Is/sl fill na mumfi gi 2vt,fm 0 0i 0 0 2 22-31 10yr4/6 none s Osg ml av - 0.7 1.6 3 31-70 10yr4/6 none gr s Osg ml cs - 0 7 1 6 4 34-110 10yr5/4 none s Osg ml - 0 7 1 6 L2] Boring # ❑ Boring _ ® Pit Ground surface elev. 99 00 ft Depth to limiting factor>107" in Horizon Depth In Dominant Color Munsell Redox Description Qu Az Cont. Color Texture Structure Gr Sz Sh Consistence Boundary Roots oun mppcauun Kate GPD/Flz 'Eff#1 'Eff#2 1 0-21 10yr3/3 & 4/4 none Is/ sl fill na ml/mfi ci 1vf,fm 00 0.0 2 21-80 10yr4/6 none s osg ml cs 0.7 16 3 80-107 10yr5/4 none s Dsg ml - 0.7 1.6 CST Name (Please Print) SgnaWre / CST Number James K Thompson 30021 Address ate Evaluation Conductiiid Telephone Number 340 Paulson Lake Lane, Osceola, W 54020-5413 June 1, 2021 15 248-7767 btlU-6330 (R04/15) 3 Bonng # ❑ Boring �—J ® PR Ground surface elev. 98.11 ft. Depth to limiting factor>� in Soil lication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots D/Ft' 'Eff#1 'Eff#2 1 0-22 10yr3/3 & 4/4 none Is/sl fill na mumfi ci 1vf,f 0.0 0.0 2 22-47 10yr4/6 none s Osg ml cs - 0.7 1.6 3 47-108 10ry5/4 none s Osg ml - 0.7 1.6 00 ml 1vf,f ElBoring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots sour ucanon rca[e G D/Fe 'EfI#1 'Eff#2 LLL�1Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limdbng factor_ in. Horizon Depth In, Dominant Color Munsell Redox Description Qu Az Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots son n iwnon Rate GP[)/Ft' 'Eff#1', 'Eff#2 r Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 305 220 mg/L and TSS > 30 5 150 mg/L i i4PRTl j APPLICATION FOR REVIEW -Complete all pages. ' NOTE. Personal information you provide may be used for secondary purposes Wi [Privacy Law s 15.04(1)(m), Stats.] Private Onsite Wastewater Treatment Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharePoint User name below: For plan status, check our website at http://dsos wi.gov Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our website at htt /Ids s.wt ov 1. Project Information - Fill in all known information. Confirmation of assignment to a reviewer. Project/Site Name BFG1. LLC - Bergstrom Office Complex/Warehouse Transaction ID: Location, Number & Street of project (If unknown, indicated nearest road) Previous Related Trans. ID: 750 Sterbenz Dr. Hudson WI 541016 Estimated Completion Date: Legal Description NW114SW1/4, Sec.27 T.29N R 19W Tn of Hudson Assigned Reviewer: County St. Croix Assigned Office: ❑ City ❑ Villa e ® Town of Mail to your office of choice below: Hayward, LaCrosse, Waukesha 2. After plans are reviewed, please: (check all that apply) ❑ Call customer 1, 2 (circle number)` NOTE: We reserve the right to redistribute plans to another office if ❑ Requesting needed to reasonably balance tumaround times. Check party will pick up httD:l/dsos.wi.gov for office availability and next available review date ® Mad plans to customer 1, 2 (circle number)* 'Refers to customer number from below 3. Complete the following designer/owner/requesting information. UtIllze the check boxes when designer, owner or requesting party Is the same to avoid repeating information. Designer Information (Customer 1) DSPS Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number First Name Last Name Customer Number Jim Thompson 30021 Company Name Company Name A C E Soil & She Evaluations, LLC Address Address 340 Paulsen Lake Ln City State Zip+4 (9 digits) City State Zip+4 (9 digits) Osceola WI 54020 Phone Number E-mail address Cell phone Phone Number E-mail address Cell phone (area code) (area code) (715)248-7767 Check if applicable Check if applicable or specify relationship ❑ Owner ❑ Owner ❑Other—s c relahonshi Information and Plan Submittal Checklists. POWTS pre -scheduling is not available. Plans will be assigned to a reviewer after receipt at a DSPS office. Submittals received may be assigned to offices other than the receiving office depending on reviewer availability. Submittal checklists can be found in each applicable component manual appearing on the POWTS Publications page, http//dsos wi.gov/php/sb-r)palopp/prodrode result oho/POWTSM/POWTS COMPONENT MANUAL. You may email technical code questions to DSPSSBPowtsTech wi. ov. Hayward DSPS LaCrosse Area DSPS Waukesha DSPS 10541 N Ranch Rd 3824 N Creekside 141 NW Barstow St Hayward WI 54843 Holman WI 54636 0 Floor 715-6344870 (NOTE CHANGE) Waukesha WI 53188-3789 Fax 715-634-5150 608-785-9334 262-548-8600 Email: Dsps$bPIanSchedule(@,wi qov Fax 608-785-9330 Fax 262-548-8614 Email DsosSbPlanSchedule(o)wi gov Email DsosSbPlanSchedule(rDwi.gov Make Checks Payable to: Division of Industry Services OR ❑ Check box to invoice designer and sign below TOTAL AMOUNT DUE $ 500.00 Review Code 7633 Designer Signature SPS-10577 (R 10/15) 5. POWfS SUBMITTAL (check all that apply —incomplete forms may result irr processing delays) ® NEW ❑ Aerobic Treatment Unit(s) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT ® Commercial System ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPE(S) NOTE: Submit separate sheets for each system if submitting multiple systems on the same site Enter Fee ❑ Revision to previously approved plan $85.00 ❑ Miscellaneous Review (i.e. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) $80/hr ® Component Manual All treatment components are previously approved ❑ At -Grade Component Manual - Ver 2 0, SBD-10854 (N 03/07, R 1/12) Design Wastewater Flow in under s SPS 384.10 (2) or (3) ® In -ground Component Manual - Ver. 2.0, SBD-10705-P (N.01/01, R 10112) Gallons Per day Design wastewater flow of the proposed system. ❑ Mound Component Manual — Ver 2 0, SBD-10691-P IN 01/01, R 10112) ❑ Pressure Distribution Component Manual — Ver 2 0, SBD-10706-P (N.01/01, R 10/12) 921 1,000 gpd or less $ 250 00 250.00 ❑ Other - Please specify GPD 1,001 — 2,000 gpd $ 325 00 2,001 — 5,000 god $ 400 00 ❑ Soil Based Individual Site Design' One or more treatment components are not previously approved under s. SPS 384A0 (2) or (3) ❑ At Grade (Individual site design/deviation from component ❑ Non -Pressurized In -ground Design manuals and use of components without product ❑ Pressurized In -ground Wastewater Flow in approval) ❑ Mound ❑ Drip -line Gallons Per day Design wastewater flaw of the proposed system ❑ Constructed Wetlands GPD 1,000 gpd or less $450 00 ' Documentation must be provided to support treatment and dispersal claims. In a separate 1,001 — 2,000 gpd $600-00 statement, provide rationale for the project and attach supporting documents (code sections, test 2,001 — 5,000 gpd $750 00 reports, technical papers, research articles, etc) greater than 5,000 gpd $900 00 plus $0.08 for each gallon over 5000 gpd State-owned facilities Design Holding tanks previously approved under s. SPS [:]Holding Tank Component Manual, Ver, 2.0, SBD-10855-P (N 03/07, R1/12)' Wastewater Flow in 384 10 (2)(3) Design wastewater flow of the proposed system Gallons Per day ' Non -state owned Commercial and Residential Holding tanks that completely utilize this manual 5,000 gpd or less $ 90.00 and have an estimated daily flow of less than 3000 gallons per day must be submitted to the GPD 5,001 — 10„000 gpd $150 00 appropriate governmental unit for review instead of the Department. (see SPS 383 32(3)(a)) greater than 10,000 gpd $225-00 ❑ Holding Tank Individual Site Design', (i.e. site constructed, <5 day holding capacity, Co- Design Holding tanks including site constructed tanks NOT mingled wastewater, etc) Wastewater Flow m previously approved under s SPS 384, 10 (2) or (3) Please specify Gallons Per day Design wastewater flow of the proposed system. must be provided to support the rationale for the project Ina separate statement, ' Documease 5,000 gpd or less $180.00 5,001 — 10,000 gpd $300-00 _ include al please include all code sections, test reports, technical papers, research articles, etc) GPD greater than 10,000 gpd $450 00 ❑ Soil Saturation Determination Report (using observation pipes) ❑ interpretive Delennmation $240 00 ❑ Experimental System (One time additional fee) Submit fee for individual system as per appropriate above system type) Experiment Number_ $400.00 Prior approval from a section chief Is required for a priority review. If approval is granted, the priority will be reviewed within 5 days of receipt Priority review fee is double the normal review fee. Priority Review (enter same amount as normal review fee listed above) Enter Total (rounded to the nearest dollar) $ 500.00 SPS-10577 (R 10/15) 1 Sr. Cr`o lutvrY SANITARY SYSTEM File#: Office Use Only OWNERSHIP/ADDRESS FORM Created 212021 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. OWNER/BUYER INFORMATION Owner/Buyer BFG1, LLC - Bill Bergman Mailing Address 12 Point Rd. City/State/Zip Bayport, MN 55003 Phone Number (required) (651) 261-6625 Email Address (required) _BBergstrom@FocusFinancial.Com Parcel Identification Number 020-1466-19-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION a` - Property Location NW t/4 , SW t/4 , Sec. 27 T 29 N R 19 W, Town of Hudson Subdivision Plat: Hudson Business Center Lot # 19 Certified Survey Map # Volume Page # Warranty Deed # 1112056 (before 2006)Volume Page # Number of bedrooms NA Spec house ❑ yes ■ no Lot lines identifiable ■ yes ❑ no OFFICE USE ONLY New Prop rty dress �� fE2�E� . (Verifcatio of new address required from Community Development Department for new construction.) 40 (Sta Initials) ( �Z ) 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 cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.00v 3a><'s 14 j 15 ! BENCH MARK: TOP ! OF i' IRON PIPE. { ELEVATION 930.3 10' WOE DRAINAGE EASEMENT I - I BADLANDSIPR4IIRIE ------.�----- I N$9.4SWE — 528.43 50' PARKING p G4 SET (p e� ................................................. �100' BUILDING ........................... s1......... SETBACK DRAT ---- �-------{p DRAINAGE _ _ w EASE �^ EASEMENT w � AREA r HWE- Pi LOT 19 HWE-917.5 / LB.O.-921.5 L•.— —G6—or-• 20' WIDEDRAINAGE �EASEMENT 20N89'43'WE 448.42'— — — —� 20—' � B i SRi� 9i pa�2¢i1s;9w� ' yp..lyyt u� PF�G AS ip Gtia — _.avaaeass. _ a a ataa 4&�E�E�9Apap s� .aoe cec rc:re 6 Nket all p49�PFta9tdE aaae eaecna a -a J. ------------ 4. -- p II r p @9 F f9 p g IV 1` ��z 3 az.aoos i i e N W, $H Y1'iltl-.._ i via (tttCAG�6[[CagqpH��iaAAgsA� oPp�� „,�'i J1 @flail;AAA 5 a L.Uraa—r s s`� � �wiao �ebley�ptgQ�kp�dp�ok�PA�Gyg� � Est so e 8 State of Wisconsin DEPARTMENT OF NATURAL RESOURCES 101 S. Webster Street P.O. Box 7921 Madison WI 53707-7921 June 11, 2021 James K Thompson 340 Paulsen Lake Ln Osceola, WI 54020 Tony Evers, Governor Preston Cole, Secretary Telephone 608-266-2621 FAX 608-267.3579 TTY Access via relay - 711 Project No. S-2021-0490 Subj: Mixed Wastewater POWTS in Town of Hudson, WI for Bergstrom Office/Warehouse Complex Dear Mr. Thompson: The Department of Natural Resources has received and reviewed your recent submittal which proposes a mixed - wastewater Private Onsite Wastewater Treatment System, which will be located at St. Croix County Parcel Number 020-1466-19-000 (NWY, SW'/., S27, T29N, R19W) in the Township of Hudson submitted on behalf of Bill Bergstrom. The proposed- POWTS is to consist of an 800/1200 gallon two chambered septic tank with effluent distributed by gravity to a dispersal cell constructed using EZflow EZ1203 distribution media. The design of the concrete tanks has been pre -approved by the Wisconsin Department of Safety and Professional Services for the disposal of domestic wastewater. The wastewater treatment system is designed to receive up to 921 gallons per day of wastewater. The domestic wastewater flow consists of waste from 13 employees and a kitchen/lounge facility (450 gallons per day) and the industrial wastewater from consists of waste from 4 floor drains and 8 parking bays (164 gallons per day). The proposed building will only serve as vehicle storage and no vehicle maintenance, repair, or washing will take place within the proposed floor drainage area. Based upon the information provided, the Bureau of Water Quality finds the inclusion of the industrial wastewater described above is acceptable. The Department of Natural Resources does not regulate sanitary wastewater flows that are under 12,000 gallons per day, so the final authorization for this application will come from the Department of Safety and Professional Services (DSPS). Please note that DSPS is also responsible for review and approval of any catch basins, sewer lines / connections, and other plumbing appurtenances associated with the installation of the proposed POWTS. Conditions of concurrence This letter documents the Department's POWTS design review for the industrial wastewater described above. The Department otherwise concurs with DSPS' standard conditions of approval. Based on the information provided above, no additional conditions will be necessary for the above -mentioned industrial wastewater. Discharge of wastewaters not identified above. This concurrence only covers the disposal of the industrial wastewater described above through the POWTS system, also described above. If a future change in operations may lead to other industrial wastewater being discharged to the POWTS, please contact the Department of Natural Resources for review to ensure underground sources of drinking water remain protected, and so this letter of concurrence can be appropriately modified. dnr.w.gov wsconsin.gov Naturally WISCONSIN Please provide a copy of this correspondence to Bill Bergstrom for his records. If you have any questions concerning this concurrence, please contact Ashley Brechlin at the Department of Natural Resources, at Ashley. Brechlinanwisconsin.gov . STATE OF WISCONSIN DEPARTMENT OF NATURAL RESOURCES For the Secretary Wov `' Ashley Brechlin Wastewater Engineer Bureau of Water Quality Cc: Tim Vander Leest Department of Safety and Professional Services (e-mail) � §M vision f Departurerpna F n� ��( Page 1 of 3 Division of Industry Se` l 1 l IN 2120 OIL EVALUATION REPORT In accordahce with SPS 385, Ws Adm. Code County St Croix Attach complete site plan n papey@pt7e9thAiF'6'i%f� x, 1 inches in size Plan must include, but not limited to vertical rid ,y(1{W(ltolref" �� " r , direction and percent slope, Parcel LD. scale or dimensions, northlardcation and distance to nearest road 020-1466-19-000 Ref# 2624 Please print all information. Reyiewed,by B QQta, , Property Owner Property Location ❑ BFG1, LLC - William & Beverly Bergstrom Govt Lot NW % SW % S 27 T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # I Block # I Subd- Name or CSM# City State Zip Code Phone Number ❑ city ❑ Village ® Town Nearest Road Bayport MN 1 55003 1 ( ) I I Hudson I Braake Dr ® ew Construction Use: Residential /Number of bedrooms Code derived design Flow rate 921 GPD Replacement ubhcc or commer i — sc�iye ffce Warehouse Parent material Glacial Outwa 4 it4 V ��, rtf Flood Plan elevation if applicable na ft General comments and recommendations: Site suitable for convent oval POWTS with 0 7 gpd/sq ft. loading rate F to be 97 50', 97 25', 97 00' & 96.75'. 1 Boring # ❑ Boring ® PR Ground surface elev 102 63 ft infiltrative surface elevation Depth to limiting factor >110" in. cnJ A-1-1— D�I- Horizon Depth In, Dominant Color Munsell Redox Description Qu Az Cont Color Texture Structure Gr Sz Sh. Consistence Boundary Roots GPD/FP *Eff#1 •Eff#2 1 0-22 1 Oyr32 & 4/4 none Is/sl fill na mumfi gi 2vt,fm 0.0 0.0 2 22-31 1Oyr4/6 none s Osg ml ow 0.7 1.6 3 31-70 10yr4/6 none grs Osg ml cs 0.7 16 4 =V Ij4=110 1Oyr5/4 none s Osg ml - - 07 1 6 9 Boring # ❑ Boring / ® Pit Ground surface elev 99 00 ft Depth to limning factor>107" in Snil Annhratinn Ratp Horizon Depth In Dominant Color Munsell Redox Description Qu Az Cont Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPD/Ft' 'Eff#1 'Eff#2 1 0-21 1 Oyr3/3 & 4/4 none Isf sl fill na ml/mfi cl lvf,tm 00 0.0 2 21-80 10yr4/6 none s osg ml cs 0.7 1.6 3 80-107 10yr514 none s Osg ml - 0.7 16 2� CST Name (Please Print) Signa re / �� CST Number James K Thompson J 30021 Address ate Evaluation Conduct4if Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 June 1, 2021 715 248-7767 SUD-8330 (RO4/15) nBoring # ❑ Boring _J ® Pit Ground surface elev 98 11 ft. Depth to Ilmdmg factor >108" In, Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPD/Ft' 'Eff#1 'ER#2 1 0-22 10yr3/3 & 4/4 none Islsl fill na ml/mfi ci lvf,f 0.0 00 2 22-47 10yr4/6 none s Osg ml cs - 0.7 1.6 3 47-108 10ry5/4 none s Osg ml - - 0.7 1.6 0.0 ❑ Boring # ❑ Boring — ❑ Pit Ground surface elev R Depth to limiting factor In. Snil Annhratinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring — ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Anoliration Rate Horizon Depth In Dominant Color Munsell Redox Description Qu Az Cont Color Texture Structure Gr Sz. Sh- Consistence Boundary Roots GPD/Ft' 'Eff#1 I -Eff#2 ' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ` Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L e� • �,.��rgo.sb..tp —� ExsE� �ebmF.,rt 5calt:/ L o E/9 P/a E eel 1`sktrs Cl'7�. 4".) f JwJy5tc27, T.19T 5crn� 3.o�74cns, z ' U OtiA .! i9s /aods' , \ narcic s/KWa I8 qb° / \ � m c,. r, cRoiXcouNTv NO. 633818 P RMITS=TATLSANITARY 5D51�L LE PHEv10pS N0. � OWNER W IU.IAMG PLUMBE "FlYA/01 V p SUBDIVISION CHAPTER 145.135 (2) 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. (t) 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 tw cougy authority. ISSUING OFFICER - DATE 'Z/ UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (Rl1/20)