HomeMy WebLinkAbout016-1005-80-100Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)I
Ian & Ann.Hubbard City
TANK INFORMATION
TOWN OF GLENWOOD
TYPE
MANUFACTURER
CAPACITY
Septic
Ih
Dosing
{� O ��- a •5
!�
Aeration
H
TANK SETBACK INFORMATION / n tic c (11 n:-r o
TANK TO
P/L
WELL
BL G.
Ventho Air Intake
ROAD
Septic
71S1
-1 t
! t
Dosing
7( t
7�,
Aeration
Holding
PUMPISIPHON INFORMATION 111., ')4 1
Manufacturer
Demand
GPM
}� ((
Model Number
TDH
+—
_
Fri on LOSS
System ad/
TDH Ft
rLen
Forcemain
^ t
Dia. r,
o,s to -Well
-- ---
J
7
SVIL ABSORPTION ION SYSTEM
ELEVATION DATA
Benchmark
:..
-ME
Ili
-�Mes
_-117APIEW.MPE
WA
r • .
BEDITRENCH
DIMENSIONS
Width t
Len lh r
No Of,;aaehes- ItV t
PIT DIMENSIONS
No. Of Pits
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
JBLDG
WELL LAKE19TR AAM
LEACHING
Manufacturer.
CHAMBER OR
UNIT
Type
S slam:
9�
t
7 SQ r
Model Number'
O
� ✓
nleTolol ITlnu
r.vn
��..
V. , r\l Ou I IVI\ J 1 0 1
Header/Mandold 11
Q r (
Distroulion
Pipets) r I
x Hole Size
A
x Hole Spacing
y
Vent to Air Intake
LengN (� Dia
Length Dia Spacng
cnli r+nvrc
vW' v W v ter` x Pressure Systems Only ry M.....d n, e._I^-,.we t A- _
Depth Over ,'
Depth Over
Depth of
..7 a.o...a vary
xx SeedetlBodde
xx Mulched
Bed/Trench Center
��
Bed/Trench Edges
Topsoil
�l
X-Yes No
I
_
-kYes_ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection ir1: Inspection K
Location: No Address Available Z
1.) Alt BM Description I �v mvev2.) Bldg sewer length = C 2 ' �l
amount of cover = �o1y ��W ✓i
Plan revision Required? Yes iNo
Use other side for additional information. �_! ✓ _ _ I _ _ _ _
SBD-6710 (R 0/97) Date In p ws Sig allure Can No.
D
0.. ^�
Safety and Buildings DMlsion
If V
County-
;C �
'= JUN '04 2021
201 W. Washington Ave.. P.O. Box 7162
Madison. WI 53707-7162
.5.
SanitanPermit Numb�err(to lefilled inbyC'o.)
St. Croix County
Co nit Devell Fill $L
it Applicati
State Irunsaction Number
�(,,-cs-Olzt00o -(!- .-h-,ssae
In accordamx with SPS 383 2112). 145s. Adm. Code. submission of this form to the a r cmmc unit
PAWS - OI 000 - me 1NxD-
is m4uired prior to obtaining a sanitw% permit. Note Appiwation forms for smicowne )NT. fined to
Project
the Department of Safety and Professional Services. Personal information you provide may be used for se dery
Address (if dif crent than mailing address)
purposcs in accordstwe with the Pnvac Lavv s 15.04(1gm),Stets
l It ' Rom,
_
1. Application Information - Please Print All Information
Propem Owner's Name �(
Parcel 0 it) p -
TTu
TALIiao�•i
_
Properly Location
Propem Owner's Mailing Address
II
9 IL 4h 1..3
I'
JW Govt Lot
/. y�1/4 Section 03
City. State Zip Code
Phonc Number
"z.- ZSO-112Q
larcle
T 30 N; R �_T_test)
It. Type of Building (check all that apply)
Lot a
1 or 2 Family Dwelling - Number Bedrooms
I
Subdivision
Public,, commercial - Describe u
Block w --
❑ Clty of
illage
a8
'�{y,ll e of
Vof
State owned -Described use
Na
Number 3
• 4�
V
FY
CSM ( ���
7'
Town
' 1211
111. Type of Permit: (Check on one box on li a A. Compkte line B if applicable)
A.
ew 'vstem
Replacement System TreatmenCHoldmg Tank Replacement Onh
❑ Other Modification to Existing Svstem (explain)
B.
❑ Permit Rcncwal ❑ Permit Revision
❑ Change of Plumber
❑ Permit Transfer to Ncw
List Previous Permit Number and one issued
Before Expiration
(w�r
IV. Type of POWTS System/CompomMUDeVlce: (Check all that apply) ( =-70
lion-Pressurved In -Ground U Pres9urmcd In -(,round At -(trade Mound :, 24 in of suitable 7( ound < 24 in of suitable soil
Holding Tank ❑ (Nhcr Dispersal Componers (expl ) (-explain)__ _
V. DispersaVfreatmentArea Information_
'W =
Design Flor(gpd
Rate( fl
Dispersal Area Requ d (sf)
spersal Arcs Pr d Isfl SystemElevation
115m)VI.
Tank
FL)csignApplication
Capacity in
Gallons
7oW
Gallons
. of
UnitsDIQ-MCD
Manufacturer
Q1�Cc+C
d
Fxuuna Tarts
X y
Septic Tank
X
—
l00o
I IL
K
Lift Tank
—
V IL Responsibility Statement- I, the under d. assume yea a in ealion of the POM TS aaowe on the attached plans.
Plumber's Name (Print) Plu one MPMPM Number
Business Phone Number
Lewis Bork 253976
715-231-7375
Plumber's Address (Street Cit). State, Tip C
E7818 County Road E Menomonie. Wl 54751
Vill. County/Department Use Only
Approved
❑ Di awed
Permit( Fee l
$
Issued
9
�b/�2
ssw Anent Signature
❑ (hv en w Uenial
`� '
IX. Coedit(i�o�tt,l I'Approv 3) m1i (svcQ'-fts15 tv. D v/v�J+.lh
SYSTEM OVVN
1. Septic tank, effluent filter and
maintained
dispersal cell must be�S01]li �( S f1Qrst,t
plan provided by plumber. 1
as per management n n `S i
2. All setback requirements must be maintained t Q�rCx-t
SBD-6398(R. I 11) PXpQzX4- d"yV%X-f
M
CMECK 40X A$ APF`I L; ALE. CHECK BOX 46 APP.hGtbLE.
SOIL EVALUATION u Scale: — W +5 aD �-x3 SYSTEM PAGE 0E-3
30
SITE MAP PLOT PLAN
PROJECT NAME: S, DESIGNFLOW: `I((��TV[�yyy�
GPD
Attach deahgn flow cokAftliona for commercial piano.
PROJECT ADDRESS 11 Pipe Material i ASTM Standard (Tables 384.303 & 384.30,6)
N6anaary satyr �_4
a"9ymbdl, � dwlgM E!�rt �_ FT _ ...CL• �.�--
Fomo MOW:__
BM DnkApao� � �%�li� . �_ S
SlopeC!odwvA(%l Well ddt rtM Inae unennp IMPORTANT:
of Toated Aran: l aFp:udei O on Vnwmg w.oprdit.*AW nr�ur Show Ordlnd elevAllon C0:1WVlf at W{fetlb IrnorvNa,
opM Yr
SIe�AC Its Blba
r
_0
1-
6rv+
yftf*L ��Lx,
1-`457g16
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a
January 14, 2021
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2023-01-14
Plan Review: PWTS-012100048-C
LEWIS BJORK
E7818 County E
Menomonie WI 54751
SITE:
James Severson
170" Avenue, Proposed Lot
St. Croix County
Town of Glenwood
SW Y4 - SW Y4 - S3 — T30N — R15W
FOR:
DIVISION OF INDUSTRY SERVICES
10541 N RANCH RD
HAYWARD WI 54643-6462
Contra Through Relay
htWJA*p•.wipoNpo¢ems/ndustry4•rvKn
w .Wmcwl wr.pov
Tom Evers• Gov~
Down Crlm - 8eoret
COADJ'TJ'OIVALL JP
APPROVED
DEPT OF SAFETY AND PROFESSIONAL SERVICES
DIVISION OF INDUSTRY SERVICES
i
to 2t&
SEE CO ESPONDENCE
Description: Mound Component Manual — Ver. 2.0, SBD-
3 Bedroom Mound — 450 GPD — New 10691-P (N.01/01, R 10/12)
Construction - 6" to limiting factor — Pressure Distribution Component Manual — Ver.
Effluent Filter- Maintenance required 2.0, SBD-10706-P (N.01/01, R. 10/12)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per
s.14S.06, stats.
The following conditlons shall be met during construction or installation and prior to occupancy or use:
Reminders
• This approval is subject to the conditions of the Interpretive Determination approved for this site on
1/14/2021
• The building sewer shall be installed/insulated per SPS 382.30(21)(c)
• All electrical equipment and wiring shall meet SPS 316.300(1)(a) and Table 3 of the Pressure Distribution
Component Manual. There shall be no more than 3% voltage drop in the wiring to the pump per the
National Electric Code.
• Care must be taken to set the dose volume as approved in the plan design. If the minimum tether length of
a single switch mechanical float does not allow the proper dose volume, two separate floats must be used.
• 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.
• The mound site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short
and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut
trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the mound site. If
necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made
with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• 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.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a
copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s. 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.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in
this review shall relieve the designer of the responsibility for designing a safe building, structure, or
component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and
any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
CeCe (Elizabeth) Rudnicki
Wastewater Specialist/POWTS Plan Reviewer, Division of Industry Services
(608)400-3186
elizabeth.rudnicki@wisconsin.pov
PAGE 1 OF 6
Mound Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10691-P (N.01101, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10/12)
Pg 1 of 6 Index & Cover Page
Pg 2 of 6 Plot Plan
Pg 3 of 6 Mound Cross -Section & Plan View
Pg 4 of 6 Distribution Network Specifications
Pg 5 of 6 Pump Tank Specifications
Pg 6 of 6 Management Plan
Attachments: _
Enclosures:
Pump Curve
POWTS Application for Review
Tanks
Soil Evaluation Report 8 Site Ma
Effluent filter
Project Name / Description
James Severson - Mound Design
Owner Name(s): James Severson Phone: 952 _250 _7128
Owner Address: 6928 Winter Rdg st Las Vegas, NV Zip: 89149
Project Address: 170th Ave Glenwood
Govt. Lot: SW 1 /4 of SW 1 /4, Section 03 T 30 N-R 15 E ❑ or W
Township: Glenwood County: St -Croix
Project Parcel ID *: 016-1005-70-000
Designer Name
Lewis Bjork
Designer Address:
Designer Information
E7818 County E Menomonie WI
E-mail; IewisbjorkYahoo.com
License Number: 253976
Remarks:
Phone:715 -231 .7375
Zip: 54751
CONDITIOXALLY
APPROVED
DEPT OF SAFETY AND PROFESSIONAL SERVICES
DIVISION OF INDUSTRY SERVICES
CIC6 �2c�eu' C�k,:
SEE CORRESPONDENCE
Signature: Date: 12-18-2020
Orgnal s"ture repured on each submitted copy.
-MWN0�&1ENWD0tj WL
CORK YUY AS JktKt"' k:. t;"b.i aL r C,
Scale: r = 30 PAGE [ OF-3
SOIL EVALUATION ) 30 4S bo� ['SYSTEM 3
SITE MAP PLOT PLAN
PROJECT NAME: `
' S. ot:S.:;tlILUVV 4GPo
see l►RE,ni.1
Attach eeaipn now txbulali0ns for commerreisl plans.
PROJEC' AOORE45 I G7A\ _ _—_ _—_ Pipe MeterIal : ASTM Standard ('ablaa 384.30.3 Sp384 30-6)
RM 9ymMl dN F evalhn --- --____ F r N Gana" sewer. F4
ju�,,� n L an MOO I .�
em
SIG" GradwM('tii �— •Hat sr ryppl is KvtuOYf; Q
of Tasod Mr
sLm I,-s- qkII,4
de
k-W,w n m t -N IIMMMANT:
aawrq a, ww . Show ground alevatlon eonlours at uAtahle inu v/ta.
e ea.raauarlb w
.f 1 I ftr^uY
}
qVK +{- 2.
4�' arty
E�
� t �
%IV$
1� zSd9 �6
�'—Ito1 40
�u Aje,
n
C
0
32 3
OS' TO 25' WASHED AGGREGATE
(min. 6.0' beneath distribution pipe - min2.0'
over distribution pipe and covered with
approved syn",wbc tabric)
ASTM C-33 SAND FILL
w = 32.3 ft
min. OS ft
CROSS SECTION VIEW
(No Scale)
MIN. 6.0' OF TOPSOIL COVER D = Z s y— 102.5'
min. 1.0 ft System Elevation = T ft
w I Lateral Invert Elevation =
O
. O
/ plowed SuAaoe J No Slope
Surface Elevation 100 MOUND DISPERSAL AREA
PLAN VIEW
(No Scale) (Show force main, manifold, and flush valve locations on plan view.)
a
0 Schdl40
PVC Lateral
(bpi)
• Dispersal Cell
(. B= JT ft
A= a ft
H.3 3 1z.1
j= 4.3 ft .81 TV
r ft
l
K= ( ft
12 ft (Wpic+)
1.32. I 13-1
L = �1i_� rt 0 i
Resat Pa" srue 5,1
DISTRIBUTION NETWORK SPECIFICATIONS
(No Scale)
FLUSH VALVE DETAIL
(No Scale)
(ftw pip"
+ optional)
Orifice in \ Valve Box S = �_ �
Center of Threaded Cap (insulation optional)
for Head Testing -0 Schd140
(optional) \ \ PVC Manifold
Shield orifices for
\ \ graveless appkabons /
Ball Valve I \�
(optional)
Lateral Length (P)
Orilces equally spaced: \
'check a) OR b) betowl
s).Eckalong bottom of lateral OrMlces squab spaced
Flush Valve abrg bottom of lateral
b) n along lop of lateral Assembly
with every _ th hole (typical - see detal)
facing down Last Orifice D
(typical)Otfice� oacinolX) = in
LATERAL INVERT ELEVATION = lo� ` ft (typal)
(typical) Orifice Diameter = in
OBSERVATION PIPE DETAIL
(No Scale)
Screw -Type or •; _
Finished Grade
sIP Cap (loose) +
(mulched & seeded)
4-0 PVC Pipe • •
Top" Cover
Tap of pipe to tem#nate
(min. f foot)
at or above * W*d grade
(4) 114% x B' Slots
®9apart
Andiodrng Device ; ':..'
Infltradon
Surteoa
2 -e Schdl 40
PVC Force Maxi
(slope to pump tank
r- for dralnback)
First Orifice
(typal)
/� Laterals to be level
'— Schdl 40 PVC Lateral 0 = in
(typical)
Number of Orifices per lateral =
Orifice Discharge Rate = • ro(o gpm
Number of Laterals = os
Lateral Discharge Rate = 2 -54 gpm
TOTAL DISCHARGE RATE = C6 GPM
(types) First Od ke
(typal)
7box.
x _� END MANIFOLD
(typical) CONNECTION
Check
applicable Madold
Ft* Orlbce (leer pipe optional) D
(typical) G)
m
--4— xn x --I -9111
a CENTER MANIFOLD
man old CONNECTION
(deer pipe optional)
PAGE 5OF6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4-0 vent Five
>IO il Lom BuildingElectrical moral oomPlY with
12' W. or 2.0 R above SPS 316 and NEC 300
EatebNhed Flood Elavallon weetherprod EMend manhole deer ae necessary.
(aP+call Approved Junction Box Approved Locking Manhole
Vent Gp µ,ph wemng Label Atlaf7tad
IMPORTANT: (typical)
Anchor tank(s) as necessary Conduit 4' Mon. or 2.0 R above
pursuant to SPS 383.43(8)(g) T/-E"blal,ed�)Elevation
Finished Grade
CAPACITIES @ • l gaUn
a
/ AlBgnt Sol
Quick Decon nod 1I
g Min.
. )typical) I
a i
9y
— * weep Appo�wd Janhwp wn
Mob APPna'b wW 3 p onto
S �t�)nd A
*Pump Tank Liquid Level �In
Force Main Diameter =min
2.0
rMain Length =ft
3- Approved Bedding
1 (03
��O
' Fi6rce Main Void Volume ,4
�[C] T
=Xtotal
=Void
= 2. 3 � gal/dose
me <_ TOV c D.2X design flow)
+ (force main dralnbaCk vdume)
MIN_ PUMP DISCHARGE RATE = S• OS 9Pm
PUMP TANK:
Volume =_1 O0�gal
Manufacturer. ,_ :LL
Pump Manufacturer t D y
Pump Model: N 162 (Sao aaamed PUMP cu".)
Controls/Alarm Manufacturer. 5T—Ede3M1aS
Controls/Alarm Model: AQ
Float sWtches containing mercury are prohibited
Abrm
on
PUMP-OFF4 , ft
lib —off ELEVATION =— `�
INSIDE BOTTOM
e ELEVATION = ft
Beneath Tank
CP
04 Vertical Head
+ Min. Supply Head = ��ft
+ FM Friction Loss
+ Fitting Loss"
"(min. supply head x 0.3) i—eft
= TOTAL DYNAMIC HEAD = ��
SEPTIC
Total Volume = gal
Manufacturer(s):
Install approved effluent filter at the septic tank outlet_
Imme .:.....t., „nQtrea Of the numb tank inlet.
II111I101ta tc� -, �_ __ r-
Filter Manufacturer. 044kj�
Filter Model: IPr- OS1Z.- I HA
PAGE 6 OF 6
Mound Management Plan
IMPORTANT:
The owner of this mound system shall be responsible for is perpetual operation and maintenance pursuant to
requirements of SPS 382-364, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be
considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore,
all inspection and maintenance activities shall be performed by a registered POWTS Msintainsr in accordance with SPS
383.52 (3), Wisc. Admin. Code.
Design Flow s
450
gpd; BODs <_ 220 mgL"; TSS 5150 mgL"r; FOG S 30 mgL.t
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution ! drop bores)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.)
o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Slats. when the volume of solids In the tank(s) exceeds one-third (113) the liquid volume of the tank(*) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent Fllteds) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
o Distribution laterals shall be flushed once every 3 years or when necessary.
System maintenance reports shall be submitted to the proper local government unit In accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Lewis Bjork Family Septic Service Phone: 715-231-7375
Local government unit: St . Croix County Zoning Phone: 715-386-4840
Local government unit address: Carmichael Street , Hudson WI
zip: 54720
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Continaencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be
re -constructed within the originally approved area after removal of all failed components.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
50 Series rt lucm Pumps Zoeller Pump Company
https:. www.zv6letpumt)s.ann en-naproducts'sump-cfflucnt-pumps ef..
LL
f—
LL
I
14-
12
4
2
0 1—
GALLONS
80 120
160 200 240 280 320 360
FLOW PER MINUTE
100
2'21'2018. I0:05 AM
'nf5
WARwnG DEATH AAA Y OCCUR IF TANK IS ENTERED
WITHOUT PROPER EOUIPMEMT
NOTE: SEE WHER WALL PHOTO ON 1!f'EXCLUSNELYAT SKAWS'PAGE
20C
00
�— L sKuW +mumo
t t
1 1
1
1-- 7t100
1 1
I
1 1
1 1
t 1
t 1
t 1
1
1 1
1 I
1 1
i 1
1
i 1
1
1 t
27.00 27NK
.00 OUTLET END VIEW OF TA
27.00 24 W
x.o--"'i
z�.ao � o — l
Soo 16.00 � 1,00
NCH PRESS
SEAL GASKET
INSTALLED
IMEN POUREA
300
2W
7.00
I BAFFLE
18.00
FILTER G
SECTION VIEW OF TANKAND COVER
200
/Model Mwte : 1000 / 600
,4plxored iDr sePTW,SEPTIC.sEPTK'APUW.S£PT1Cj51PtfON OR HO�DiMG
• (iq. Depth Gal. / In. CW.13,OWft.I2-39' 16.47 16N4m2-"
33 gel.
10.00
Roo
OUTLET
I I11Gi1
PRESS
SEAL
GASKET
SKAW PRECAST Phone: (715) 967-2277
Toll Free: 1-800-924-8625
26255 SOW Street. New Autl' n Fax: (715) 967-2707
Wfmcwsin 54757
www.skawprac *ac,x'
8-in. to 15-in. Dia, Biotube Effluent Filters
Applications
Orenco* 8-inch to 15-inch BiotuWA Elffvem Filters are designed to
remove solids from off vent Iea*g commercial septic tanks. They can be
used In new end exsRig tanks.
General
Oferlcoif 8-Inca to 15-inch NOW Effluent Filters' are used to Improve
Vm Welty of Woo exlcrlg a corrowdal septic tank The ktlotube
cartridge fits snugly in the vault and Is removable Wr maintenance, N
hvde assembly snaps, Into the notches in the top of the vault, and the
Its hande can be extended for alley removal of the cwWge. A'bese
Inlet" mollel (see p. 2) is available for low-prolke tanks. An optional slide
rell system, available on larger models. *npM*s Irstallarlon and prandes
tank access for servicing.
r'
Cutaway view
Hands & semdy
Win flow awenloy
Skis ► ow
0101oT[agate FN,r+ Aw " cup~~ ndla► US dw Apo ftWa.w1a
Standard Models
FT0854-36,FT1254.36,FT1554-38,FT0822-148,FT1254-36AR
Product Code Diagrarns
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Maintenance Instructions
Biotube' Effluent Filter
How to Clean Your Effluent Filter
To ensure your effluent filter is functioning properly, it should be inspected ovary year. Under normal conditions, your
effluent filter will function for several years before cleaning is necessary. The fitter should be cleaned when it becomes
clogged enough to restrict normal flows out of the septic tank. At a minimum, the fitter should be cleaned whenever the tank
is pumped.
Most people prefer to have a septic tank service provider take care of filter maintenance and cleaning. You can find a
septic tank service provider in the Yellow Pages, under 'Septic Tanks & Systems.' Or you can contact your county health
department for a list
If you wish to inspect and/or clean your effluent filter yourself, be sure to dress properly. Weer full-length pants and shirt,
shoes, gloves, and goggles or glasses. Then follow these instructions:
Remove the access lid to your septic tank by unscrew-
ing the stainless steel lid boles with hex head wrench
provided. If your lid is above ground, it will be easy to
find. If it is buried below ground, find the markerthat
indicates its location.
2 Remove the fitter cartridge try grasping the tee handle
and lifting it out of its housing (see phM N.
3. Spray the cartridge tubes with a hose to remove arry
material sticking to them (see photo Z/ Ensure the three
orifices in the optional flow modulation plate inside the
filter are clear of any debris. Make sure the rinse water
runs back into the tank, but do not allow solids material
to fall into the open filter housing.
4. Firmly place the cartridge back into the housing.
5. Some effluent filters come with an alarm that activates
when the filter needs cleaning. If you have an alarm,
checkto make sure it is working by lifting the float
with a stick An audible horn should sound. The alarm
panel is normally mounted on the side of the house or
in the garage.
NoW If your effluent fitter doesn't have an alarm system
and you would Eke one, call your local septic system
installer.
6. Record the date that you inspected and/or cleaned
your filter on the form that inflows. If you checked the
alarm or made any other observations about the tank
or system, include that information under Notes!
7. Attach access lid by placing it on the riser, matching
the openings in the Ed with the bolt catches. Insert lid
bolts into catches and tighten with hex head wrench
provided.
Photo 1. Remove the fitter cartridge by lifting it out of its
housing.
Photo 2 Spray the carbidgs rubes with a boss.
reurur-r
an. LL Im
► "j,W4
January 14, 2021
CONDITIONAL APPROVAL
DIVISION OF INDUSTRY SERVICES
10341 N RANCH RD
HAYWARD WI 518434462
Corxaa TNmo Relay
h"PJft9 .mgov roWammAndustry-services
www.wwcrmsin.pov
SOILS SATURATION DETERMINATION
Plan Review Number: PWTS-012100048-C
LEWIS MORK
E7818 County E
Menomonie WI 54751
SITE:
James Severson
170" Avenue, Proposed Lot
St. Croix County
Town of Glenwood
SW X-SW'/.-S3—T30N—R15W
Tony Even • Governor
Dawn Crlm - SecrWry
CONDITIONALLY
APPROVED
DEPT OF SAFETY AND PROFESSIONAL SERVICES
DIVISION OF INDUSTRY SERVICES
CEO 4 2LAAA�J.
SEE COORESPONDENCE
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:
• Approval is hereby granted pursuant to S. SPS 385.60(2), Wis .Adm. Code, to estimate the depth
of seasonal soil saturation based on an interpretive determination process completed by Lewis
Bjork, Certified Soil Tester (CST) and his recommendations.
• This approval is limited to the soil characteristics within the tested area. This approval is based
upon best management practices and does not warranty the functioning of the system. Water
conservation, wastewater disposal practice and system maintenance will aid in the longevity of
the system.
• On -site visit was conducted by CeCe Rudnicki, DSPS on December 9, 2020. -"
• The estimated highest level of prolonged soil saturation approved under this determination is 6
inches below grade. At least 30 inches of sand lift on top of 6 inches of unsaturated, in -situ soil is
required for adequate treatment and dispersal.
• The basal soil application rate for the mound shall be 0.3 gpd/sf, and the linear loading rate 6.0
gpd/ft.
• 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.
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.
• Chisel plowing to a depth of 12 inches immediately prior to sand placement is required to
improve vertical water movement into the soil solum.
• Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent
surface water from concentrating along the up slope edge of the mound and to divert surface
water drainage away from the system.
• This approval shall remain valid unless the site is altered in such a way that the depth to soil
saturation would change or if saturated conditions are observed for seven consecutive days at
depths less than 3 feet below the infiltrative surface of the POWTS distribution component.
• This approval in no way relinquishes the use of color patterns to estimate the depth to high
groundwater on any other parcels or portions of parcels.
• A copy of this approval letter and attachments must accompany the mound system design for this
site for purposes of plan approval and sanitary permit issuance.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open
to inspection by authorized representatives of the Department, which may include local inspectors. All
permits required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or
additions should conditions arise making them necessary for code compliance. As per state stats
101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe
building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at
the address on this letterhead.
The above addressee shall provide a copy of this letter and the POWTS management plan to the owner
and any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
6 eL & Rudn
CeCe (Elizabeth) Rudnicki
Wastewater Specialist/POWTS Plan Reviewer, Division of Industry Services
(608)400-3186
elizabeth.rudnicki@wisconsin.�ov
INTERPRETIVE DETERMINATION REPORT
Property Owner: James Severson
6928 Winter RDG St. Las Vegas NV 89149
SW -SW-03-30N 15W TOWNSHIP OF GLENWOOD
ST CROIX COUNTY WISCONSIN PIN $k- 0 i6 - ADO 5' 10 -000
This report prepared in accordance with Wisconsin department of
Commerce Administrative Code. 385.60 (1) (7)
Prepa Lewiswis Bjork, CST #
_ _— . I-'
Lewis Bjork LLC
E7818 County Road E Menomonie, WI 54751
Phone: 715-231-7375, cell 715-308-2173 Fax: 715-231-7376
E-mail lewi -);a -kLyahoo.co
CIONDITTONAur
AFPROVED
DEPT OF SAFETY AND PROFESSIONAL SMICES
DIVISION OF INDUSTRY SERVICES
C'e& 1 lick.
SEE CO ESPONDENCE
Conclusions, Recommendations why this proposed mound
system will treat and disperse residential wastewater on this
site
1. This site has supported cultivated agricultural crops in past years , most
resent ( last 10) has supported upland hard and soft wood trees
combined the non- hydric type plants.
2. Seasonally saturated soil conditions do not occur in the upper 6 inches
of the soil profile as indicated by the absence of redoximorphic features.
3. The A horizon in the proposed system area is Munsell color 10 YR 3/2 to
10 YR 3/2 which indicates an organic matter content nominally of 25
g/kg in the range of 20-30 g/kg or 2.5 percent. This level of organic
matter is indicative or relatively good drainage and aerobic conditions.
(Tyler presentation, Reading shallow Soil Saturation, Chippewa County)
4. The relatively low level of organic matter indicated by the Munsell value
of 3 would facilitate observation of high chroma redoximorphic features
in the A horizon. The general lack of observation of these features in the
A horizon is strengthened by the low organic matter content which lends
further evidence to a conclusion that at least six inches of soil is present
which is not periodically saturated for more than six days.
5. No hydric soil indicators are present in the observed system area soil
pits; this conclusion is based on particularly careful review of the
indicators for silt loam Soils. There is no hydric vegetation in our
proposed area, when in lower elevation areas hydric vegetation is
present closer to base of hill north and west.
6. System area pits demonstrated root penetration to depths of 10-12
inches; such depths are not expected in soils which remain saturated for
significant time periods.
7. The small scale cross slopes of 8% is better than none for lateral
movement of effluent down -slope via the more permeable upper soil
horizons and away from the mound system without surface ponding or
surface discharge.
8. The available length is 100' allowing for a lower liner loading rate and
enhances the ability of the system to allow effluent to infiltrate the in
situ soils along a contour without a surface discharge.
9. The site is acceptable for a mound septic system with a minimum of six
inches of unsaturated soil for treatment and dispersal of treated
wastewater effluent as allowed by Comm 383.44 (3)(b)1.
10. The observed 6 inches of redoximorphic-free natural soil will allow
treated effluent to be assimilated into the subsurface without ponding
on the ground surface.
11.Site preparation requires mowing and removal of as much vegetation as
possible followed by deep chisel plowing to at least a 16- inch depth.
12. Additional fill landscaping soil shall be added to the up- slope area of
the mound structure filling the concave, upslope area behind sup slope
the mound non collection of surface waters
13 Mound construction requires 4" of sand lift placed on the basal area
then plowed into the grounds surface and then more sand added to 30"
depth. Construction must take place under relatively dry conditions.
This 30" depth of sand creates an effective sand filter and can be
expected to produce a treated effluent with less than 30 mg/L of both
BOD and TSS and fecal coliform concentrations of <10,000 cfu/100mL
14. The rock cell in the mound structure shall be 6'by 75' for a linear
loading rate of 6 gallons per day per foot for a 3- bedroom residence.
15. The sand basal area loading must be a maximum of 0.26 gallons per day
per square foot.
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Ut
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page or 3
Division of Safety and Buildings
in accordance with Comm 155, Wis. Adm. Code Courtly $l. Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in site. Plan must
include, but not limited to: vertical and horizontal reference point (Bid), direction and Panel I.D. 016-1005-70-000
percent slope, scale or dimensions, north arrow and location and distance to nearest road.
Pfease print all lnformetlon. Reviewed W Date
Perso" inlorrrmetion rou provide may be used for secondary Purposes (Prtvecy law, s. 15.04 (1)1m)).
Property Owner Property Location
James Severson Govt. Lot SW 114 Sw 1/4 S 03 T 30 N R 15 E (or)
Property Owners Mailing Address Lot M Block M Subd. Name or CSMY
6928 Winter Ridge Street 1
Stale ZIp Code Plane Number ity Ovaego ElTown Nearest Road
Las Vegas NV 89149 ( 9�2-2504128 Glenwood I 170th
0 New Construction UseQ Residents! / Number of bedrooms Code derived design lour rate 450 GPD
Replacernent Public or oornnerdei - Describe:
Parent material loess dencse till Flood Plain elevation d applicable A4p
ents R.
General commInstall 2.5' D sand fill mound on 100' contour , basil loadind will be 1,725 or .26 gpd and liniar of 6
and recommendations:
B-I
Boring M6
IDPit Ground surface elev. 98 R. Depth to limting factor In. Soil Ap Rate
Horizon
Depth
In.
Dorrwnant Color
Munsell
Redox Description
Qu. Sz. Cont. Cola
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPONe
'ER01
'ERM2
a
Ofi
IOyr3/2
sit
2fgr
mvfr
gs
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6
8
let
fr10
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n .,. nrrvrrvl mirfar»alav_ R. Depth to limiting factor
in. c,u ruvm Ratty
Horizon
Depth
In.
Dorrwnant Colm
Munson
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/N
'Efl#1
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at
0-7
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sit
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CST Name (Please Print) Sil
Address uow rvwusurrl wr� ......,.. -.._ . __...__.
E7818 County E Menomonie WI 54751 10-7. 10-10. 2020 715-231-7375
Severson
Property Owner Parcel ID #
B 3� #� Boring 100
pit Ground surface elev. ft.
016-1005-70-000
6
Depth to limiting factor in.
Page ` of
42.2 s � o■e
Depth
in.
Dominant Color
Munsell
Redox Description
Ou. Sz Cont. Color
Texture
Stricture
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDIfF
'ER#1
'Efki2
F$1bt
0-6
1Oyr3/3
sil
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8
B 4 Boring 0 Boring 98 6
■ Pit Ground surface elev. ft. Depth to limiting factor in. ca eQ.t■
Horizon
Depth
in.
Dominant Color
MunseM
Redox Description
Qu. Sz. Cont. Color
Texture
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Gr. Sz. Sh.
Consistence
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Roots
GPOM
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cif Ground surface elev. ft. Depth to limiting lector In.
■ SrJ Amliratien Rate
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M��Mm
�C";'
1
EMN37M
Effluent #t = SOD, > 301 220 mgtL and TSS >30 < 150 mg& ' Effluent #2 = SOD, 130 mg& and TSS 5 30 mg&
The Department of Commerce is an equal opportunity service pro%ider and employer. If you need assistance to access services or
need matenal in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
5e0-0301'" ma o• un
5 -mwNo�&I NWaoWr. 4
CHECK 9()Y AS hDFtai�BLE. �'i 4VV�ILAbLE
SOIL EVALUATION n Scale: t�T=3o' ♦S to SYSTEM PAG�3oF3
SITE MAP i PLOT PLAN
�(yy�y�
PROJECT NAME:K11111T s, DESIGN FWw 4(Z GPD
IlA , -- k -- - Ansch des n kw CelaYations for cornmerual plans
PROJEC' "RESS
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NFwuq
sewer ----
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NMu" none �,
IMPORTANT
W. np.,r,u
Show ground alevffilan cWtoum at SWIstilie intervals
M V • Awwft ar
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3
Division of Safety and Buildings
in accordance with Comm 85. Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must ---
include, but not limited to: vertical and horizontal reference point (Bk4), direction and Parcel I.D. 016-1005-70-000
percent slope, scale or dimensions, north arrow and "bon and distance to nearest road.
101Mse print oR lnformeffon. Reviewed by Date
Personal intormarlon you provide may be used for secondary purposes (Privacy Law. S. 15.04 (1) (m)).
Property Owner Property Location ❑ 0James Severson Gout. Lot SW 114 SW 114 S 03 T 30 N R 15 E (or) W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
6928 Winter Ridge Street 1
ity State Zip Code Phone Number[]City wage • own Nearest Road
Las Vegas NV 89149 ( 9�2-250-7128 Glenwood I
170th
Q New Construction UseO Residential 1 Number of bedrooms Code derived design low rate GPD
❑ Replacement Public or commercial - Describe.
Parent material loess dencse fill Flood Plain elevation 0 applicable NAB R.
General comments Install 2.5' D sand fill mound on 100' contour , hasiI loadind wi11 be 1.725 or .26 gpd and Iiniar of 6
and recommendations
D eon
B (
Boring#
Q Pit Ground surface elev. 98
6
R. Depth to timiting factor in.
Soi
Rate
Horizon
Depth
Dominant Color
Redox Description
Texture
Stnx3ure
Consistence
Boundary
Roots
in.
Munsell
Ou. Sz. Cont. Color
Gr. Sz. Sh.
'Eff#1
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r'I o» Ground surface elev. ft.
7
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Depth
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Dominant Color
Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
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Gr. Sz. Sh.
Consistence
Boundary
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Effluent 01 2 BOD > JU < UU rng(L arc 15S >JU : I OU mq- ••a -
CST Name (Please Pint) Sig _ 1 T Number -
E7918 County E Menomonie WI 54751 10-7, 10-10. 2020 715-231-7375
Severson
Property Owner Parcel ID 0
Boring
B-3 tni Bng 0 0 Pit Ground surface elev. 100 ft.
016-1005-70-000 2 3
Pape of
6
Depth to limiting factor in.
Horizon
Depth
in.
Dominant Color
Munsei
Redox Description
Qu. Sz Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDMt'
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61
4 Boring 0 Boring 48 6
Hpil Ground surface alev. ft. Depth to limiting factor in.
And Amlimtirin Rate
Horizon
Depth
in.
Dominant Color
Munsai
Redox Description
Qu. Sz. Cont. Color
Texture
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Gr. Sz. Sh.
Consistence
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• Pit mound surface elev. R. Depth to limning facts in
Effluent #1 = BOO, > 30 1220 rng/L and TSS >30 1150 mg/L ' Effluent 92 = SOD, c 30 mg1L and TSS < 30 mp+L
The Department of Commerce is an equal opportunity service pro%ider and employer. If you need assistance to access services or
need matenal in an alternate format, please contact the department at 608-266-3151 or M 608-264-8777.
seo-rnoT. iaWwi
S -mmN o� Gl
wL 4rC2n�
CHFCN 9UX AS APPLk-QLk. '^ �i bti.r kS APPO:AbLE
SOIL EVALUATION scale: I' = 3a 45 SYSTEM PAGE 3OF-3
do
SITE MAP PLOT PLAN
PROJECT — T Sr sl oe,� r ow �cPo
Attach dea nMary GeIc1rF11iprr, for cgmmerGal dent.
PROJEC' ADDRESS
am ayn� 7 aM . avMY�� — 1 V
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Pipe Material; ASTM Standard (Table. 384.30.3 d 384.30.6)
Force Main
IMPORTANT:
Show ground alevatlm contours at auRable Intervals
Cs') U
1 61ve
AtKA• .
I ,
� ew
I7A�
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Af %A
N
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4
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings N 0 V 2
ante with Comm 85, Wis. Adm. Code ■
Attach complete site plan on paper notdess than 8 1/2 x'11 inches in size. Plan must
include, tot not limit to`vettisal an¢ Ipdzwai referen point (BM), direction and Parcel I.D.
percent slope, scale or m tion and distance to nearest road. �-70+ coo
Please print at/ informadon. CeV1eWed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)l. Ste- 5.15• iP
Property Owner Property Location E] ❑e
GovL Lot SW 1/4 1/4 S03 T 3o N R 157 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM#
6211 2 w
City State Zip Code Phone Number ity village ■ awn Nearest Road
i nlj i flu1i (qw -z -a126LIEN
El New Construction UseE] Residential / Number of bedrooms Code derived design flow rate 430 GPD
❑ Replacement Public or commercial -
Parent material �.fi�jl QMI OJti r- Flood Plain elevation if applicable
General comments
and recommendations: —�^` � �-4%i �A 0 Vn 1 � too' 05$6. . `\
Dem.-+Im'��1-jD ` `9ll
B-1
Boring # 0 'ring
��
Q pit Ground surface elev. ft. Depth to limiting factor in. soh i Rate
Horizon
Depth
ed x De niption
Texture
Structure
Consistence
Boundary
Roots
GPDRF
in.92
CmSnl Color
Gr. Sz. Sh.'Efl#1
'Eff#2
IGS
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se CST Name (PleaPrint) - _ Signs CST Number
Lewis Biork 253976
Adder Date Evaluation Conducted Telephone Number
E7818 County E Menomonie WI 54751 I V . cl+ 20 715-231-7375
Property Owner OAf • W5 `'•�! ' ��� Parcel ID # 0 �tV�7 r7 Page
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Qu. Sz- Cont. Color
Effluent #1 = B005 > 30 < 220 rngn and TSS >30 < 150 mg/1- ' Effluent #2 = SOD, c 30 mglL and TSS < 30 mglL
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.
SaD8330ha (R07.ro0)
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CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. PAGE L OF-3)Q SOIL EVALUATION o sCale:'30 so 45 60 SYSTEM 3
SITE MAP PLOT PLAN (�yy��
PROJECT NAME: 75' DESIGN FLOW 49D GPD
,A "N Attach desi n flow calculations for commercial plans
PROJECT ADDRESS: 11 Ar► N Y
BM Symbol: + BM Flevatlon- _lop_ FT Yiai
BM Deurlplon:
a GradlerA % Indkata nanh bq
Slope f ) Well S�mbol(Happllcable; drewing an anwr
of Tested Area: 8 on tr4 dwopras M,
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Pipe Material / ASTM Standard (Tables 384.30.3 8 394.30.5)
Sannary Sewer. -
Force Main� /
IMPORTANT:
Show ground elevation contours at suitable intervals.
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File #:
ST. CRO ,LINTY SANITARY SYSTEM Office use Only
OWNERSHIP/ADDRESS FORM creaw2/2027
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 lan T\ l)�CA
Mailing Address 144()-7 Y0r''6i-,4-\ tom- L.Aeie
City/State/Zip
Phone Numbe
Email Address (required) i h► hhc.-d 0 ekeme,4cv[D c nen
Parcel Identification Number d l b - /4)05-- go— / o 0
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location 1/4 , ` 1/4 , Sec. 3 . T �N RW, Town of Is l� n
Subdivision Plat:' 113LO Lot #
Certified Survey Map # Volume Page #�
Warranty Deed # L/211' <)1 (before 2006)Volume Page #
Number of bedrooms 3_ Spec house 0 yes ■ no Lot lines identifiable O yes O no
OFFICE USE ONLY
New Property Address 0 '91 $ d T7t-1 14i/C—
(Verification of new address required from Community Development Department for new constriction.)
-=9-4 71/ 2-
(StaffInitials)(Date)
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.aov
RECEIVED
JUN 3 0 2021
ROD( COUNTY COD
(pg1pIQ Y/4. n."ll
Ian M. Hubbard
Nm�v Mu{ e
O�� Caeu�v
umamr �.
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nv�mnamwm
1STORY
SINGLE FAMILY
WALKOUT
Hubbard Residence
Rnitla. � l
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RECEIVED
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JUN 3 0 2021
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MV, COUNTY CDD
loonuorw-moron
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I STORY
BINDLE FAMILY
WALKOIR'
Hubbard
Residence
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RECEIVED
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7.�i1Y.4.�I.MIf �wYArfI1UG IF p1.�.Y10OYl�� Yi ri�A��WOY MIY'
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Hubbard Residerax
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NO. 633817
STTE SA PERMIT
at SoVB 1?o Arc.
PREVIO
Own
OWNER
PLUMBER]J%15 ftf-4. LIC.#2n ?X
TOWN OF
SEC _9T N, R�
AND/OR OT BLOCK
V% --0IL AW R2.1115 SUBDIVISION
NO*
CHAPTER f45.135 (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 or 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.
A R ED ISSUING OFFICER - DATE tZ
THIS PERMIT EXPIRES G UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)