HomeMy WebLinkAbout032-2151-50-000 commelrce.wf.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
t seo n s i n Madison, WI 53707 -7162 Sanitary PA.Num r (to be filled in by Co.)
faepsrtmeM of Commerce S0 & _'�
Transaction Number
er
Sanitary Permit Application Stat Nu er
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appr to go mmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state ed S e sect Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be u
p urposes in accordance with the Privacy Law, s. 15.04 I m , Stats.
I. Application Information — Please Print All Information CJ
Property Owner's Name el � t ,
RECEIVED �_ r
Property wner's Mailing Address Property Location
AUG 0 9 2007 / O
Govt. Lot
City, Stale Zip Cod Phone Numb t /,, A %., Section �_
ST. ROIXCOUNY (circleoner
T R e) ,
II. Type of 13tilding (check all that apply) E5i
�1 or 2 Family Dwelling — Number of Bedrooms Subdivisio Name S�
/� j l �'' Block # S
El Public /Commercial — Describe User ❑ City of
- 4 744-L V /
CSM Number ❑ Village of
El State Owned — Describe Use
19 Town of 6�1f1 r�
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List OUS Permit Number and Date Issued
B. El Permit Renewal Permit Revision ❑ Change of Plumber Permit Transfer sfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that a 1
Non - Pressurized In- El Pressurized In- Ground ❑ A�❑ Mo > 24 in. of uitable soil e gKrr�i 24 in. rtal)je so Vt/
❑ Holding Tank Other Dispersal Component (explain _ retreatme t ex pl m
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ispersal Area Proposed (sf) System Elevation
87 r
VI. Tank Info Capacity in Total # of Manufacturer c
Gallons Gallons Units �"�
tl V V y y
New Tanks Existing Tanks 6Fl G 119 n d a
�>� R U h A is C7 P.
Septic or Hoiding Tank / ✓ '
Dosing Chamber
VII. Responsib' tt tatement I, the undersigned, assulne respo 'bility for installation of the POWTS shown on the attached plans.
Plumbc 's N c (Pr' t) Plumber' Si MP/MPRS Number Business Phone Number
um er's Address (Street, City, S te, Zip Code
VIII. unto /De artment Use Onlyf
Permit Fee Date ssued Xssuing Agent gnu
pprovcd Disapproved $ � �s d'v
❑ Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
7
I d
Attach to omplete plan for the syste a submit todk County only on paper not less than Ile x inches in size
R�/ Q '0
SBD -6398 (R. 01/07) Valid thru 01/09
ICI
i
START UP AND OPERATION Page ',�of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone ->
1
"s document was dra`'=_= __ — c "ante with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ) Septic Tank Capacity ga l ❑ NA
Permit #
O� Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units *NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA
Soil Application Rate 7 gal /day /ft2 Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit )2�NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD :_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L J�ln- Ground (gravity) Orin- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L P( NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA
y ear(s) y
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA
O years) y
Clean effluent filter At least once every: ❑ month(s) ❑ NA
A year(s)
aspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
3!� year(s)
aterals and pressure test At least once every: ❑ ye [3 (s) (s) [3 m ) ANA
` At least once every: ❑ month(s) A
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services. including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units. and anv servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer.
A service report shaif be provided to the local regulatory authority within 10 days of completion of any service event.
I i
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and —►
Comm 16.28 WAC4 in. min.
Disconnect
Tank component is properly vented E— Alternate outlet
location
Forcemain diameter
Manufacturer 2 in.
Capacityl 800.00 Gallons
Volume 21.76 gal /inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A C
B �'? Pump off e levation (ft)
C
D _ D
Total
—Dose tank elevation (ft)
Alarm Manuafacturer _
Alarm Model Number 7
Pump Manufacturer
Pump Model Number _
Pump Must Deliver F7 9pm at :: � _ ]ft TDH
NGOULDS PUMPS 6 Submersible
Effluent .Pump
MODEL 3885
WE Series
PROSURANCE AVAILABLE FOR RESIDENTIAL
APPLICATIONS.
APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase (60 Hz): can be operated continuously
Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully
p y g design. Locknut on all models maximum starting torque, submerged.
following uses: to guard against component • Built -in overload with ■ Bearings: Upper and
• Homes damage on accidental reverse automatic reset. lower heavy duty ball bearing
• Farms rotation. • SJTOW or STOW severe duty construction.
• Trailer courts oil and water resistant power
• Motels ■ Fasteners: . series p ■ Power Cable: Severe duty
stainless steel. cords.
• Schools •'/3 and '12 HP models have rated, oil and water resistant.
• Hospitals ■ Capable of running dry NEMA three prong Epoxy seal on motor end
• Industry without damage to provides secondary moisture
• Effluent systems components. • grounding plugs. /, HP and larger units have barrier in case of outer jacket
event oi
damage and to l
r
■ Designed for continuous bare lead cord ends. Standard cord is l
SPECIFICATIONS operation when fully g
submerged. Three leng Three phase (60 Hz): 0 the are available.
Pump Class 10 overload protection
P ■ 0 -ring: Assures positive
• Solids handling capabilities: MOTORS
g must be provided in P sealing against contaminants.
1 /4 " maximum, separately ordered starter
• Discharge size: 2" NPT. ■ Fully submerged in high- unit. and oil leakage.
• Capacities: up to 140 GPM, grade turbine oil for lubrication • STOW power cords all have AGENCY LISTINGS
• Total heads: u to 128 feet and efficient heat transfer. bare lead cord ends.
P Tested to UL 778 and
TDH. ■ Class B insulation on ■ Designed for Continuous ® CSA22.2 Standards
• Temperature: 'A-1 1 12 HP models, Operation: Pump ratings are By Canadian Standards
104 °F (40°C) continuous ■ Class F insulation on 2 HP within the motor manufacturer's CM us Association
File #Ut38549
140 °F (60 °C) intermittent, models. recommended working limits Goulds Pumps is 1509001 Registered.
• See order numbers on
reverse side for specific HP METERS FEET
voltage, phase and RPM's 40 � 30 r r
E15HI' I SERIES: WE
SIZE: 1 /4 " SOLIDS
RPM; 3500 &
1 101 i +
FEATURES wiz a ►��"—.�ac���M 7 — 1
■Impeller: Cast iron, semi 3 ° i
100
t
90 .W
open, non -clog with pump -out 25 so _ �-
vanes for mechanical seal - - - -
proiection. Balanced for 20- H ._
-. _. 1 _ ._. . _ _ _
smooth operation. Silicon 00 - - - - - -_ fi
bronze impeller available a< wEo I _
�..._ -
g 1 5 1 J
fir} option,
� 1
9 type
vu
r
� Casing: Cast iron volute t e
for maximum efficiency,
2" NPT discharge, s z0 - -- - - - _ - -
■ Mechanical Seal: SILICON 10 f 7 -... I _
_ - y r - - -
CARBIDE VS. SILICON o L oC° - -� . - ° '
CARBIDE sealing faces. 10 20 3r' 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM
tiainless steel metal putts, 0 :0 15 20 5 30 35 m
BUNA•N elastomers. CAPACITY
Goulds Pumps
2003 Pumps ITT Industries
c July, 2 fec;ive Duly, 2003 ovwvv..aouicis,tOm
8388.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer
Mailing Address r /YL� f
Property Address___,.
(VVrifmcation recluirc�d fiom Plannici, %omring Depurtnront for u(:w construction.)
City /State Parcel Identification Number
LEGAL, D ESCRIPTION
Property location'�f___ ' % -� , %4 , Sec. /2_ , T ,�N 1Z_Jq Town oi' _ 2
Subdivision /I/� y;, � , Lot #
Certified Survey Map # , Volume , Page #
Warranty olume Pa
Deed # e # � � , Volume g
Spec house yes C Lot Imes identifiable no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of puniping out the septic tank every 0wrc year~ or sooner, it mcded, i.ry a iiccnscd pumper. What you put into
the system can aftcct the function of the septic tank as a treatincnt stage in the waste disposal sysicnt. Owncr uwintcuanCe
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St, Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Conuneree and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms X __^
SIGNATURE; OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary uermit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed front the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Wiscgnsin Depanment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 499181 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Boardman, Barry I Somerset, Town of 032 - 2151 -50 -000
CST BM Elev: Insp. BM Elev: BM Description: /_ Section/Town /Range /Map No:
—0 (; 13.30.19.1318
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
2 & O 1 2.2,5 - l o 2.2 10,0 .6
Dosing A lt. BM 6n , G
Aeration Bldg. Sewer —
� i � 9 Y 51
Holding S Ht Inlet C&iv iktr _ Z . t% 2, .
%
TANK SETBACK INFORMATION s Ht O�u_t►Q W5 Z015 61. 3 o
TANK TO P/L WELL D V Intake ROAD Dt I A 1 ' • I
Septic Dt Blom 6 f
Dosing Bader/ an. �j"� , ` f ,/ ' C/ ®• D
Aeration Dist. Pipe
Holding Bot. S stem ( ' � Q ^� r
Final Grade 7 g u O /
PUMP /SIP ON INFORMATION 13>
Manufacturer Demand St r h
S GPM ?.
Model Number Vito 3''
TDH Lift , ` Friction Loss System He a TH Ft
Y I
Form air Il th / D ,� Dist. to W�
shit ABSORPTION SYSTEM / t _" '!5 7. 2
BEDITRENCH Width �ength L No. Of Tre has tj PIT I ENS No. Of Pits Inside Di A. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WE LAKE /STREAM EACHING Manufact er ,
INFORMATION HAMBE R
Typ Of System: , �� �/ Y s� T Model Number:
IS IBUTION SYSTEM ((,/
Hea anif id Distribution ,+/ `� V e Size x Hole Spacing Vent to� /J r Intake
_!- Pipes) f rr (� 0.XX T ►�"�
Length Dia Length Dia Spacing -� ! J
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bch D ed/Tren er Center fls Bed /Trench Edges Topsoil Yes No " Yes `j No 1
y
COMMENTS: (Include code discrepencies persons present, etc.) Inspection Inspection #2:
Location: 1594 86th Street Somerset, WI 54025 (NW 1/4 NE A 13 T30N R19W) Nathan Hills Lot 13 Parcel No: 13.30.19.1318
1.) Alt BM Description
2.) Bldg sewer length =Gr� Znd
- mount of cover = 1 4- - `1 '
Required? Yes
Plan revision Re � I ;� No
Use other side fo tion.
q o
Date Insepctors Signatu Cert. No.
' SSD -6710 (R.3/97) 'V... �/ � /` ���li �n�0/�2a��1�- Q
Safety and Buildings Division County
, m 20I W. Washington Ave., P.O. Box 7162
iscvnsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
qq /Q/
I Department of Commerce 608) 266 - 315I
merce ¢ ° ! U
Sanitary Permit Applicatio State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you /' " A
may be used for secondary purposes Privacy Law, s15.04( Project Address (if different than mailing address)
L Application Information — Please Print All Information.
.............
Property Owner's Name / Parcel # Lot Block #
Property Own s Mailing Address S E P property Location
�
City's /y vv �, %. Section
ATYP, Zip C e ne umber Q
, (circ or / v ✓
T��N; R Eor
Iguilding (check all that apply)
pt 1 or 2 Family Dwelling — Number of Bedrooms �� ��► ( t } yQ- iv" ion Name umber
F Public/Commercial — Describe Use ' S
11 State Owned — Describe Use CpM (,J $} Y.�ets ❑City ❑Village[XTownshipof
IIL Type of Permit: (Check only one box on line A. Complete line B if applicable)
A " New System ❑ Replacement System ❑ Treatment/Holding Tank
g Replacement Only ❑Other Modification to Existing System
B. ❑ permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner --1 V I (_1
N. T of POWTS S stem: Check all that a 1 -
XNon — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade 71 Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaUfreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
7>�
� VATank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units C Concrete Constructed Glass
New Existing
Tanks Tanks L✓ PO ! O j. PL 5
Z
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, a me responsibility for installation of the POWTS shown on the attached plans
Plumber' ame (Print), ) Plum 's Si MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, tate, Zip C e)
)Jt
VIII. Coun /De artment Use On
Approved ❑ ved Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Sign o S
Surcharge Fee) # , / e
❑ R Denial t 1 '7� ' 0 b // 26 1 4(c
IX. Conditions of Approval/Reasons for Disapproval l '
MTN "09
1. Septic tank, effluent lifter and
dispersal cell must all be services I maintained u
as per management plan provided by plumber. -,
2. All sedMk requirements must be maintained CL
as per applicable cads /ordinances.. sal �Vd P k
Attach complete plans (to the County only),for the system on paper not kss than 91/2 inchn in site
SBD -6398 (R. 01/03)
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Wisconsin Department ofCommerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildin
n accords with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper n ran 8 1/2 x 11 inches in size. Plan must
include, but not limited to: ve ' d horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - 0
i
Please print all reformation. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I
o
Property Owner Property Location
RECEI Govt. Lot 114 1/4 S T N R ,Ee(or
Properly e s Mailing Address Lot # 1 131b ck Su bd Name o CS s?
T
City S e Zi Code r F1 City ❑ Village ® Town Nearest Road
UNTY -
jN New Construction user Res oms Code derived design flow rate /6rh GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material �y,.t s �1 Flood Plain elevation if applicable ft.
General comments ,
and recommendations:
r 1 Boring # ❑ Boring
Pit Ground surface elev. 9Y, ?.? ft. Depth to limiting factor x %86 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
AIZ
, 7 d s _ _ R a
n , f&
►3
Boring # El Boring
Pit Ground surface elev. 9 ?, ft. Depth to limiting factor }/ '/1 in. Soil APDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
zo
4 A
44 Z/3 s It In, 3
* Effluent #1 = B > 30 220 mg /L and TS9 >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please P!LW Sig natu CST Number
.�
Address ate // D Evaluation Conducted Telephone Number
Property Owner 6 Parcel ID # Page _ of
F-31 Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor -.�, in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 I *Eff#2
/ 0 / / ,�
i )
_ _ 9
�4.
F Boring # F1 Boring
❑ pit Ground surface etev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2
❑ Boring # ❑ Boring
F1 Pit Ground surface elev. ft. Depth to limiting factor in.
F - sonApplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 5 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
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.
SBD -8330 OL07 /00)
Property Owner Parcel ID # f>� ; �?I S /d - i�Dt'�... Page of
Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I *Eff#2
7
_ _ 9
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *0102
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L
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.
SBD -8330 (R.07 /00)
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address G °
VQ 14)7
Property Address
rec dire 1r m P1 cur � & Zoning Department for new constia tior 1
(Verification i d o an t� b p
City /State _--Parcel Wentification Number
LEGAL DESCRIPTION
Property Location ,� t /4 , _ `,% , Sec. J :, T _E�2_ R_ _Z�?_W, Town of'
s�
Subdivision � � — � � , Lot It .
Certified Survey Map It ._ Volume _ , Pagc It
Warranty Deed # � � , Volume � _ , Page #
SSpec house yes Lot lines identifiable no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic lank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic lank. as a treatment stage in the waste disposal system, Owner maintenance
responsibilities are specified in §Comm. 83,52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
i
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a nester plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 frill of sludge.
I /we, the undersigned have read the aooVC reduireuicnts 0111 agree to maintain the privatr scwaf;c disposal system with the
standards set t'ortli, herein, as set by the Dcparuucat of Couuucrce and the Department of Natural f:csourccs, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the
property described above, by virhte of a warranty deed recorded in Register of Deeds Office,
Number of bedrooms q____
L fi, ajie4 l /A
SIS4eATURE OF APPLICANTS) DATE
** *Arty information that is misrepresented may result in the sanitary perrriit, being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified Survey mapff ..
reference is made in the warranty deed,
(REV. 08/05)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity 1 gal ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units 13NA Pump Tank Capacity gal EONA
Estimated flow (average) gal /day Pump Tank Manufacturer ANA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ,9 NA
Soil Application Rate g al/day/ft' Pump Model -15 NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit J9 NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD < 30 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L E NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA
y' year(s)
y
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once ever ❑ month(s) (Maxi 3 ears) ❑ NA
y' mum year(s) y
Clean effluent filter At least once every: ❑ month(s) ❑ NA
0 years)
Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ year(s)
A
Flush laterals and pressure test At least once every: ❑ month(s) JCrNA
❑ year(s)
Otne,-: ❑ month(s)
At least once every: ❑ year(s) ❑ NA
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was drafted 'n =mpfiance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
Id
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone — Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
P
Phone
Phone
This document was drafted ccmpiiance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
U 2663P 512 7 -7 s4ILI lik
STATE BAR OF WISCONSIN FORM 3 - 1998 KATHLEEN H. WALSH
QUIT CLAIM DEED
REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number
RECEIVED FOR RECORD
This Deed, made between � � � 0.4. t � � � i c } e to
09/28/2004 09:15AN
s e s i� L G. �� \,.1 i s c o .� ', � L te e, ' �r c a
$ r'• QUIT CLAIM DEED
EXEMPT #
Grantor TRANSE REC
and Q o FEE: 11.00 O
dtr� r v u v. s +_.
COPY FEE:
_ CC FEE:
_ - - Crantee.'' PAGES: 1
Grantor quit claims to Grantee the following described real estate in
-ST" Cis e, �� County, State of Wisconsin:
14', z .i N and Return Address
-7- 4Jwr r y
q d 3't -r . OYl • l �� J O W t1 O F
sot- Y.�rs�► `: New �.c4.,„� ►,�� W, SN017
C S 0 1V R 19 \/.1 NW
c53 :I_ D ) 5 I - o -_d oc�
1 Parcel Identification Number (PIN)
This 1S ri oT homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
Dated this ems- U day of
- s _ (SEAL) _ .. -- _ (SEAL)
SEAL _ _ SEAL
i
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
State of Wisconsin,
_ST CROIX County
authenticated this day of Personally came before me this 28 __ day of
SEPTEMBER —_ 2004 , the above named
t BRIAN K BOARDMAN
t �`'; •.. ..� -fir — —
TITLE: MEMBER STATE BAR OF WISCONSII j _ to
(If not, � � '�,� me nown to be the person _who executed the foregoing �
=
authorized by §706.06. Wis. Stats.) t . � � fhsttument and acknowledge the same.
o• .
THIS INSTRUMENT WAS DRAFTED BY a• ' 1 -
} f) N X Q) R R D Nis • Ill a1 , e •, PAULETTE ORF
'.•......••e� Notary Public. State of Wisconsin
_ My commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not 12 -31 2004 .)
necessary.)
" Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
! QUIT CLAIM DEED FORM No. 3 - 1998 MMraukae. Wis.
I
Sep 22 06 11:06a barry Boardman 715 -246 -5410 p.3
:DLF.14.2006 8 :35AM 17152467012
N0.803 P.2
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! Master suite
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1
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1
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1
li �c,_r � COVE
1 � -
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tnelualss theeter room
Sep 22 06 11:06a barry boardman 715 -246 -5410 p.2
'SEP•14.2006 8:35AM 17152467012
N0.803 P. 3
thsa w room
Damon
parch
bath
J� � of ►Fes �°, .
master salter Z) p
1 rtia14er eat I
U.I.C.
Low er•
� r tau+odry p nery i � Math �' „ .�
fw Master bath
kttehea dtntrt�
Fivtng room
cov er ed porch
�>�{) Zo C
i
r
Wis'nsin Department of commerce SOIL EVALUATION REPORT
Division of Safety and Buildings Page of
In accordance with Comm $5, Wis. Adm. Corte
Aftch COMPkft site plan on paper not less than a 1/2 x 11 Inches in size. Plan must COUniy d
Include. but not whited to: vertical and horizontal reference point (SM), direction and
Parcel I.D.
percent slope, scale or dimensions s, north arrow, and location and distance to nearest road.
Please pdnt all lnliormation. Reviewed by Date
Parsonpi Inf calif ion you provide may be used for secondary purposes (Privacy Law, a 1 5.04 (1) (m)).
Pio-peY Owrw Property Location
Govt. Lot NrI A S T 3 R/ E ( ) yy
Property Owrter"s Hfng Aess Lot # Stock # Subd. Name or C3M#
urry State ip ode one Number tJ4 w. rl) )!r
City (] ViUage Town Nearest Road
rue CA) 5�t01 ( ) �.S'
Construction Idential / Number of bedrooms Code derived design flow rate
Replawnent (3P0 ❑ Public or Gamrnerciel - Describe:
Parent rrlatrartai Flood l inelevatio if applies
General conwrients
and r*00(nmen0ations:
S
5 r p �c�i,/7
MIN
Boring # 6orinp
t Ground surface elev. J ft. Depth to fimiting factor _ in
Pale
Horizon Depth Dominant Color Redox Descriptlon Texture Structure Consistence W pppma
In / Muna�l Qu. Sz. Cont. Color Gr. Sx. Sh. "Efl K2
c , 02
aodnq # Boring
t Ground surface etev. ft, Depth to limiting factor � In.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/tN
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. . ,
3 ?
z.
" affluent #1 2 GOD, > 30 < 220 mg/L and TS$ . 150 mg/L nt = 8U0 � 30 rngiL and 7$$ < 30
CS7 N me (pteaso Print) Ignmturo .��
U
Address (� Date Evaluation GonduCtad 1d~ 4_0(TTelephone Number
L19+ 1)
Property Owner Parcel ID # Page of
Boring # .1 ❑�I Boring /,1 / / n
Pit Ground surface eiev, v ��a 1 / � �ft Depth to limiting factor () in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
In. Munsell Qu . Sz. Cont. Color Gr. Sz. Sh. •Effp1 •Eff#2
- Z
Boring # ❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. °Efi#1 'Eff#2
E Boring # E] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 'Eff#2
` Effluent #1 = SON > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L
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.
SRA8330 (R 07100)
II
ti
Soil Test Plot Plan
Project Name Brian Boardman Sha d
Address 824 East 11th St.
New Richmond Wi 54017 WM #226900
Lot I3 Subdivision Nathan Hills Date 10/30/01
W 1/2 NE 1/4S 13 T 30 N/1319 W Township Somerset
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 91.6/90.4/88.6 *HRpSame as Benchmark
Alt. BM Top of Steel Fence Post @ 93.4'
12%
* .M 65' Sl Alt. 500' Property Line
5'
5 10'
-3 B -2
Soil test was done to satisfy
zoning requirement, test may not
35' be suitable for owner's desired
building location
96' 3
B -1 0'
95'
8%
Slope
94'
a,
0
�o