HomeMy WebLinkAbout038-1095-20-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 578915 0
GENERAL INFORMATION (ATTACH TO PERMIT) 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: Village X Township Parcel Tax No:
River Stone Kennels, LLC Star Prairie, Town of 038-1095-20-000
City
CST BM Elev: Insp.BM Elev: BM Description: Sectionlrown/Range/Map No:
6.5� 23.31.18.397
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ; CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /' 97-3
Z, Alt.BM/ /' Z� 7
Aeration Bldg.Sewer
Holding St/Ht Inlet �� V_ 5541
St/Ht Outlet rj',LZ cjZ
TANK SETBACK INFORMATION
TANK TO W P//L� WELL BLDG. ir Intake ROAD Dt Inlet
Pt�-
Septic /�C �^ 15 �� Dt Bottom
Dosing J Header/Man. / (� 9a , 7
Aeration Dist. Pipe ya , 7
Holding Bot.System .l' 17 -7 �rL
Final Grade 2 S� r-j-5/, 7L
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover / J /, Z$ 7&- 6 Z.Model Number (.0
TDH Lift Friction Loss System TDH Ft
Forcemain Length-- Dia. Dist.to well
SOIL ABSORPTION PYS TEM
BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 96 1 _`
SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer: T;A'
INFORMATION / CHAMBER OR
Type f System,
Je� o� yZ N Pr k UNIT Model Numbe r j1u y 44 /
DISTRIBUTION SYSTEM UC6+-
Header/Manifold Distribution x Hole Size x Hole Spacing Vn4j e
L Length Dia Spacing
e
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
Bed/Trench Center �� Bed/Trench Edges Topsoil Yes ® No ® Yes FW-1 No
COMMENTS: (Include cod repencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 2036 124th Street New Rich nd,WI 54017(NE 1/4 SW 1/4 23 T31 N R1 8W) NA Lot Parcel No: 23.31.18.397
1.)Alt BM Description= la GK a
I G �
2.)Bldg sewer length= Z9 L'.401/ l s s ,if, /6j�
-amount of cover= t n�G('e.a. �0� P�` '
3 6 �-u re, tY�— I
Plan revision Required? �$ Yes No !� Z� 5
::1
3 7
Use other side for additional information. Cert.No.
Date Insepct Signa e
SBD-6710(R.3/97)
`ryi.a '...-, , •. .�. County
tr.;� 'm Safety and Buildings Division C no I
b 201 W.Washington Ave.,P.O.Box 7162 Sanit Permit Number(to be filled in by Co.)
-4 adison,W1 53707-7162
� .
d
w; ermit AppllCatim- State Transaction Number
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit ��
is required prior to obtaining a sanitary SP ermit. Note:A PP lcation forms for state-owned POW TS are submitted to Project Address(if
different than mathn a address)
the Department of Safety and Professional Servies. Personal information you provide m be used for P . Y P may secondary
purposes to accordance with the Privacy Law,s.15.04(1)(m),Stats.
� 7 /�I. Application Information-Please Print All Information
Property Ownej-'s Name Parcel#
,AtLl v�� l� � 65i3� • �� �J -' Z0 -ate
Property Owners Mailing Address Property Location
//,� e__1 Gott.Lot � -3 q
7
City,State Zip ode Phone Number /�/� 7 Z
/�`-"-�-� � W 1 P i /_�'l/Q !��" '±, °fW Y., Section ��+�'-7/ J cle on '
II.Type of Building(check all that apply) --- #
�M R E. W
2 Family Dwelling-Number of Bedrooms G' ►.� `� j Subdivision Name
Block#
❑Public/Commercial-Describe Use r.
�� � � �----- I ❑City of
❑/Stat Owned--Describe Use S CSM Number ❑ silage of
f �'� G C,Ju awn of
III.Type of Permit: (Check only oni box of line A. Complete line B if applicable) 7 o
A. New System ❑Replacement Sys em ❑Treatment/Holding Tank Replacement Only ❑Othcr Modificazion to Existing System(explain)
I
B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New Lust Previous Permit Number and Date Issued
Before Expiration // Owner
IV.Type of POW TS System/Corn onent/Device: Check all that apply) IJ
Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil ❑Mound<24 in.of suitable soil Cf"
❑Holding Tank [1,pter Dispersal Component(explain)_ ❑Pretreatment Device(explain) ",36 V.Dis ersal/Trea ent Area Information:
Design Flow(gpd) Design o pplicanon Rate(gpdssk Dispersal Area Required(sfl Dispersal Area Propo (sf)
VI.Tank Info Capacity in Total #of Manufacturer
w
Gallons Gallons Units
hew Tanks
Existing U
Taal;s / / .m v
U n w ( v
Septic or Holding Tank 6 _
G i
Dosing Cbamba
VII.Responsibility Statement-J,the undersigned,assupwe• onsibility for installation of the POWTS shown on the attached plans.
Plb�ame(Print) Plumbe lure MP/MPRS Number Business Phone Num er
Plumber's Address(Street,City; •te,Zip Co
Z�
VI OUR e artment Use Onlv
pproved tsapproved J/�J� suing. g t 5i;�rature
Z
ermit Fee Date Issue
� i
weer raven TZeason for Denial
I.X.ConditWAXW1QWNRkasons for Disapproval <� 5G T-95 2,_7
�J
1. Septic tank,effluent filter and J
dispersal cell must all be services/maintained
as per management plan provided by plumber.
2. A 'set ,scfC f�equirementg must be Pnaitaairisd
1
as perappilcable`ctxle%ondiriar�c�.
Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size
SBD-6398(R. 11/11)
PLOT PLAN
PROJECT Josh miller ADDRESS 1008 192nd ave New Richmond Wi 54017
NE 1/4 SW 1/4s 23 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX
SYSTEM ELEVATION 92.3' 3.5' below grade DATE 4/10/15 GPD 77
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 280 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 205 # of chamb rs 10
BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
1320' Property Line
IN-
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40.
Scale is 1" = 40'
�. unless otherwise
4 noted
Vent
619 Quick4 Standard
k'b Cover Leaching Chamber
600' ii with 20.0 ft2 of Area
94' 95' 6' \ ° ng 12" 5.6ft^2/pair of end caps
B.M. B 2 93 Vent
T 3 Grade at System Elevation
75'
77 all s pe ay,
25' 2e plo s nd 1
Pr Dog Ken el flo dr in, o
wi bathroo calc lation p oses
20, no commercial use! onl ,no co rcial
use, a access
25 B-1 building only!
'
12% Slopg
IT L 1-3' X 42' cell
B-3
To 124th St.
1320' Property Line
t_lc j
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 4/13/15
Owner:Josh Miller
Location: NE1/4 SW1/4 S23 T31 N,R18 124th st. Star Prairie
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
Signature
License nu #226900
PLOT PLAN
PROJECT Josh miller ADDRESS 1008 192nd ave New Richmond Wi 54017
NE 1/4 SW 1/4s 23 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX
SYSTEM ELEVATION 92.3' 3.5' below grade DATE 4/10/15 GPD 77
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 280 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RAT E .7 ABSORPTION AREA 205 # of chamb rs 10
BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100° Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
1320' Property Line
AV All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40.
Scale is 1" = 40'
unless otherwise
noted
C>6Quick4 Standard
of Ceaching Chamber
00' ith 20.0 ft2 of Area
94' 95' 96' .6ft^2/pair of end caps
BM * 93'B-2 ent 1 3 4Grade at System Elevation
75' g,
77 gallons per day,
25' 2 employees and i
Pro Dog Kennel floor drain,for
with bathroom, calculation purposes
20' no commercial use! only,no commercial
use,a accessory
25 B-1 building only!
'
12% Slops
1-3' X 42' cell
B-3
To 124th St.
1320' Property Line
Cross Section of Quick 4 Standard-W Leaching Chamber
Typical cross section for 1 of 1 cells
Quick 4 Standard Intial Grade Elevation
To be >1' above grade Leaching Chamber 95.0'
with 20.0 ft2 of Area per
Chamber 5.6ft^2 pair of Finish grade elevation
end plates
Typical Installation
Vent Grade
41 411
��30/34
From Septic Tank j
4' Long
2"
3491
Grade at System Elevation
1-3' X 42' Cell
Same on other end Observation tubeNent
Located at end of cell
A
10 chambers per cell
System elevations:
A-92.3'
S'E CROI X COI II T`
SEPTfC1ANK IVIMN ITNANCT' riGRF,EMUNT
AND
OWN 1251-11P C:I?IZTIFIC'.AT1+.-N I ORM
Mailing l�ddress.. ���_ C�s7 _ /�f���./. -�2' _ _ -._ tu�
Property .Address S-9-4-7 fir, ='' `F'
(Veri-fication re(lntred FrOM l'lannitrg Oopatt.lwnt Jot ueN2 consiruc.tion.)
C.1ty/State l'.�rc�l leit;nti('tc.�rtion ; i.trilre► __ _.___
LEC;AL DESCRIP'1401",i
t: l r i 1 ��% ,/
Property Location �i-e� i:, , Sc.cZ S--"I' 31 hr.�_ �, , "fowl), of kr
5ubdivisioil /-/0 / 1.ot fl
Certified Stu vey Pvlap 4 ` V( lttutt; Par,c: )' '6
Warranty Deed #_ - \%c:iunr Page r _
Spec )rouse ye; n, l t-,t ling itletttiliah)c. vc. ttr;
SY5'1'EM N1MNTENANC"lE AND OA 4'?�i1�; :1'1f;R1 1AC"A'I'10
itnprotter use and irlaintenance of your septic 5ystc,ut could tesulr it) its pr.°mattuE idilltic to handle wastes. 1'rope.t
maintenance consists of pumping out the septic tank eveiy three years or sootier, ., rim-dud,by a 11ccrtsed pumper. what you l'ut nit:
the system can affiect the function of the septic tank as a itcaYutent stae.e in tilt', Masse disposal sysu;tn. Owner uutinlcnalwo
responsibilities are specified in Womzn. 83.520) and ❑t(.'6a1>tc1 t? �;f. C'roix County Sanitary()rdutancc.
'['he property owner ague,_s to submit to 5t. Croix(_'eau iy Plantut d. loci n,; I'Wparintrcnr it certification Bunt, t)v.' Uu
owner and by a master phunbei,journeyman pturnbcr,restiicicd phtmher or a Licensed pumper rerily tug, that (11) '{hc%on-sm:
wastewater disposal system is if)t,rolrer operating condition author(2) after inspct;.ion and pumping(if the Sepik tatth is
less than U3 full of sludge.
11we,the undersigned Julvc read the,ahovt, an(i agree to nazu'Mill the prrvaic sc%mart, disposal ',Y i4Wnt will; tl,r
stauciards set tbrth,herein, as set by the Departs-rent alld tlx: Depanir,ert, o!Natural Kc,tiontt c+s. Suite of Wis(tow ,.
Certification stathig that yotu septic system has heen maintained trust h,e complete,l and eelirrned to the tit Croix County Plmnrut
&rwig L7cpari�rncrit within 3o days of the thrm .year exj,.m1uo.n(Ituc.
Lwe certify that all statements oil this form arc 'cluc to 11W hest of utv;'otn k nowledge- LWt' atrt'are the ttN,'rter(sj qi tllr
property described above, h y virtue of a warranty decd recorded.in Rrt,Ism W'Devi is 01fic.e.
tV tuber of bedrooms °
_.
i
SlCr'� IRf' of Al'PL1( AN'I (� ) 1)A,F1
4.**
Any mforrnatron that is rntsreptesented may result tit the sanitary pcatn)t hcnrht o,vohed bV the 1'1:111nurg %oninfz Oepttn,.iu w. ,
Include with this application a recorded warranty deed Irom the Rcgist(, of l)'e.ed, Tfiae,tad a crop ut'the certified survry malt t
reference is rlulde in the warrarrty d:•ed.
(REV,08/05)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
EOwneE�:3.I Yy0 t ,,�'�r,,,• FTank ufacturer: ❑ NA
t# ❑ Dose ❑ Holding Volume: �&'C? (gal)
nufacturer: NA
DESIGN PARAMETERS
Number of Bedrooms: A ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: r ❑ NA Vertical Distance Tank Bottom(s)to Service Pad: (ft)
Estimated(average)Flow: (gailday)
Horizontal Distance Tank(s)to Service Pad: /(//17 (ft)
Specific servicing mechanics must be provided rf vertical is>15 feet or
Design (peak)Flow=(estimated x 1.5): f —7 (gal/day) i if horizontal is>150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: , (gal/day/ft) Effluent Filter Manufacturer. F �✓ ❑ NA
Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model:
Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (BOD5) s220 mg/L ❑ NA Pump Model:
Total Suspended Shcds(TSS s150 mg/L
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer.
(BODE) >220 mg/L NA ❑Mechanical Aeration ❑Peat Filter
(TSS) >150 mg/L ❑Disinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(BOD5) s30 mg/L Soil Absorption System
(TSS) 530 mg/L NA -Ground(gravity) ❑In-Ground(pressure) ❑ NA
Fecal Coliform(geometric mean) s1C rade ❑Mo und
Maximum Effluent Particle Size 1/8 in dia. ❑ NA El Drip•Line ❑Other:
Other: NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out Contents of tank(s) hen combined sludge and scum equals one-third(3S)of tank volume
p ❑ the high water alarm is activated
Qmonth(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: _j-A5gear(s)
❑month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: 3 years)
m s) C3 NA
Clean effluent fitter
At least once every: ❑ ar(sj
❑mon h(s) NA
Inspect pump,pump controls&alarm At least once every: Cl years)
❑month(s) NA
Flush laterals and pressure test At least once every:. ❑year(s)
Other. ❑month(s) NA
At least once every: year(s)
NA
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
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 a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 treatment tank equals one-third(%)or more of the tank volume,the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper)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 30 days of completion of any service event.
GMW-005(02/05)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use.
Start u or restoration of power under these
failures.
rt or due to um P 11
P m tanks may fill above normal highwater levels prior to startup pump sin an
Pump Y one large dose causing conditions is not recommended, as the excess wastewater will be-discharged to the soil absorption system in o g
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette'butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps,medications,oils,painting products, pesticides,sani4r napkins,solvents,tampons, and water softener brine discharge.
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 S. Comm 83.33,Wisconsin Administrative Code: .
• All piping to tanks,pits and other soil absorption systems 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(pumper).
• 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
rep/ ement system:
A ,uitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
i 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 the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort
❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT
ESCAPE OR RESCUE SUSTAIN
LIFE. NEVER
INTERIOR OFRA ANY TANK TANK MAY UNDER STANCE. DEATH MAY
OT BE PO POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER.
Name �` Name
Phone —L�/'� Phone J
SEPTAGE SERVICING OPERA OR PUMPER LOCAL REGULATORY AUTHORITY '
-� Name
Name �
Phone 21j Phone 7 ,
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)8(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
r 01V
`} FILTER CARTRIDGE INSTRUCTIONS
j"
2Qt1a
Installation u�• t ���
STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is
under the access opening. If not then either insert more pipe into the
centered ,
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support:
solvent weld the 3/4-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four.
STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
STEP S If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 901.
Maintenance
1, The effluent filter should be cleaned every time the septic tank is a' w
serviced. "
Z. Open the outlet access opening to inspect the tank and filter,
Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent. * >Ya
4. Once the effluent level has been lowered below the invert of the "
outlet pipe, firmly pull up on the filter handle to dislodge the
cartridge from the case.
5. Slide the cartridge up and out of the case for cleaning. :
6. If a VRS switch connected to an alarm is present, the switch 4y
should be removed by turning counterclockwise 901 and cleaned
with water only. y.
�. ,<
7. While holding the cartridge on its side (large flat surface facing 3
down) over the access opening, rinse off the cartridge with water
only, making sure all septage material is rinsed back into the tank.
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 90°.
9. insert the filter cartridge back into the case, pressing down until
the filter locks into the bottom of the case. _ Wiz{
10.Replace and secure the access opening on the tank.
BEAR ONSITE--FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY
BEAR ONSITE"Filter case-Lifetime Limited warranty
;.: -. � ,.,.,E .... ,..,..er,. .. ✓. .. _...., ..,� :. �._ ._ _
F
'ic.her, 3,yr. dP
c �
R S
..��'1��v,.. .....,.A#' _ � e v �..7J6��'�+� ..4�.F .S."w..6'.!`�.r. �&�tl 7�..c., s ..:Y�.Baw w.t:�•�Sr�`K'm
Property Owner_ Parcel ID# Page of
❑
Boring# Boring
3 pit Ground surface elev. 0� " ft. Depth to limiting factor�oV in. Soil—Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'EfF#2
❑ 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 'Eff#2
E) Boring
F] Boring# Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Applicabon Rate
Horizon ')epth 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 =BODS>30<220 mg/L and TSS>30<150 mg/t_ 'Effluent#2=BOD5<30 mg&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-6330(8.6/00)
Wisconsin Department of C rcb SOIL EVALUATION"REPORT Page of
Division of Safety and Buildi `' �r
_`; `(
wth Comm 85,Wis. Adm. Code
County �r
Attach complete site I�ji,on,* r 116t less than 8 1/2 x 11 inches in size.Plan must
include,but not limit�@b:°vertical and horizontal reference point(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road.
Please print all information. Revi ed by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 5
Property Owner Property Location
v 1 Govt.Lot F 1/4 r t!1/4 3T �' N R S E(or)
Property Owner's Mailing A ress Lot# 1 Block# Subd. Name dr CSM#
YO
My fate Zip Code Phone Number ❑City ❑Village Town Nearest Road
New Construction Use Residential/Number of bedrooms Code derived design fl a ^ C� /J2� GPD
Replacement❑ pl ❑.Pu-bli�JC or commercial-Describe: .f't'.�e.5-s a ,���L�,�Cx.l _-_ _--,------ --
Parent material ft&&�c� Flood Plain elevation if applicable
General cornments
and recommendations: • 5 rS(�I/L �-�
System Type L�47 t✓C System Elevation��/ �. �7
F Boring# E3 Boring r /�,
`Pit Ground surface elev. ft. Depth to limiting factor Zt�in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKF
In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
7-2--7
A1
~i(
Ong# ❑ Boring g
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 •Eff#2 Zo
��1J
•Effluent#1 =BOD.>30<220 mg/L and TSS>30<150 •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L
CST Name(Please Print) lure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 5 -' 715-246-4516
Property Owner Parcel ID# Page of
® Boring# ❑ Boring 0 7
Pit Ground surface elev. ft. Depth to limiting factor Z072 in . Sol[Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
F-1 Boring# E] Boring
11 pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fi=
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2
❑ Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Cola Gr.Sz.Sh. 'Eff#1 •Eff#2
Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD5<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.
SOD-8330(8.6/00)
Soil Test Plot PlaJB'
Project Name Josh Miller Sha
Address 1008 192nd Ave
New Richmond Wi 54017 C 226900
Lot ------ Subdivision --------- Date
NE 1/4 S W 1/43 23 T 31 N/R18 W Township StarPrairie
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of steel fence post
System Elevation 92.3/91.0 3.5' *HRpSame as Benchmark
1320' Property Line
AC
Scale is 1" = 40'
unless otherwise
noted
600'
94 95' 96'
B.M.* B-2 93'
75'
25' Pro Dog Kennel
with bathroom,
20' no commercial use!
B-1
25'
12% SlopS
B-3 AT
To 124th St.
1320' Property Line