HomeMy WebLinkAbout034-1037-30-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
479344 0
GENERAL INFORMATION (ATTACH TO PERMIT) St to Plan ID No: LA I N
Personal information yo'u provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 5( =
Permit Holder's Name: City Village X Township Parcel Tax No:
Klatt, Tim I Sp Town of 034- 1037 -30 -100
CST BM Elev: Insp. Elev: BM Description: �� SectionlTown /Range/Map No:
I C OD-0 3 4 UL = e&T g&" 16.29.15.250A40
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark i f t �
Ott_ t7vo (o •
Dosing , A �,� Alt. BM
Aeration Bldg. Sewer 82— 47,Y. 9 `
Holding St/Ht Inlet 1 /
TANK SETBACK INFORMATION SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic �5 ( ' �sl „�-- Dt �3•s /.zil�
Dosing t tt 4 I Header/ an. .SZ
1 1 02.
Aeration Dist. Pipe .8y
Holding Bot. System i
Fin Grade
PUMP /SIPHON INFORMATION OL+. I z �-� s 1 - -coo
Manufacturer J
emand St Cover >�i f- 3.31 11
T f ►qN ( GPM
\ Model Number / 3 'k• O � 2 • � 3• �� ���� O /
DH Lift Friction Loss l/ System Head TDH Ft
l �• z . i 5 9.23 ( 5 l )o • st [�.
Forcemain Lengt`�� Dia. a Dist. to Well y t
SOIL ABSORPTION SYSTEM
ED Width Length No. Of T, .
peRe '= PIT DIMENSIONS No. Of 'ts Inside D' th
ENSIONS ( 5_ 1 6' I ��
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACH Manufacturer.
INFORMATION CHA R O
el Number
Type Of Sys I -3 /D / UNIT :
DISTRIBUTION SYSTEM 0-b -.it 'µ l
Header /Manifold Distribution ' f� �� x Hole Siz� / I x Hole Spacing 7 � Vent to Airto Air l
of ;7 I f 1pe s 30 Length Dia Lengt TL 2� Dia 2 ' Spacing D
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of x xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes] No D Yes No
C� OM!TjS� (Includ de discrepencies, persons present, etc.) Inspection #1: u� Inspection #2 : �• 7��
�(y '�� & —� o`
Location. 907 29th Stre�Wilson, WI 54027 (SW 1/4 SW 1/4 16 T29N R1 5W) NA Lot 4 I P 6 Pa rcel N 16.29.1 .250A40
1.) Alt BM Description= > to,. -ae.
2.) Bldg sewer length = Z 3
- amount of cover
Plan revision Required? ;r Yes �No •.,, ,,,/ `
Use other side for additional information. • �T 1 I� _ `
Date Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
m.
51on Coun
201 W " 62
adi 07- 7162 Sanitary Permit Number (to be filled in by Co.)
I fisconsin
De artment of Commerce (608) 266-3151 7c� V 41
` Sanitary Permit Ap lick ion State Plan I.D. Number
Imaccord with Comm 83.21, Wis. Adm. Code, pers in ggrtiatio` u rgJ �� ✓
may be used for secondary purposes Privac Law, s" t'� Project Address (if different than mailing address)
I. Application Information - Please Print All Information #- �d 7 Z c 66 �4,
Property Owner's Na me Parcel # 1 Lot k Block p
Property Owner's M ailing Address Property
( i Location ``
Zr� [ A L) ,C- -50) ' S , C(J i ,Section
City, State Zip Code Phone Number
O�f circle ` x
II. Type of Building (check all that apply) T - 1 N; RE L, 6 U/
� d a: per E; Subdivision Na CSM Number
or 2 Family Dwelling - Number of Bedrooms A6 IV
❑ Public /Commercial - Describe Use )_
L_i State Owned - Describe U e . ❑Ciry_❑VillagcVTownship
S
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) [ ,�d
A. y ❑ Replacement System g p y g
New S ❑ Treatment/Holding Tank Replacement Onl Other Modification to Existing System
B. i ❑ Permit al ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner /
IV. Type of POWTS System: c o vl 60
❑ Non - Pressurized In -Grow Mound > 24 in. of suitable soil K Mou < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
j Constructed Weiland ❑ n- roun Holding Tank ❑ Peat Ft er ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching hamber �t
g ❑Drip Line El Pipe ❑Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rat Dispersal Area Required (s ispersal Area Proposed (s System Elevation
��D S ✓ � d Z5 /Q , S
VI. Tank Info Capacity in Total Number Manufacturer Pre ab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing 1 n
Tanks Tanks 2 .6.Q, A
Septic or WeidFrtgSank
4 D e.6 t 1 A .1 15
A t V :tj 01i
Dosing Chamber
VII. Responsibility Statement I, the undersigned, assume responsibility forjjx of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's Si gnature 1(21 Number Business Phone Number
le- ;7- 2 7 7 Z r'Zd
Plum is Addre ss (Street, ty, State, Code
I ,�� s � C � L L B t .—
VII .Count /De artment Use Onl
Approved ❑ pproved
7 Pe Fee (includes Groundwater Date Issu Issuin gent Signage Fee) �7 ! -7 D5
Reason fo nial G �J
IX. Conditions of Approval/Reasons for Disapproval 16 // ((��
SYSTEM OWNER: 3 Cot u ; 0�,5 ,/`.
i
J
dispersal ed Must all be services /Maintained
U per manapemeM plan provided by plumber.
2. AN selback requirements must be maintalnsd
as per appkable code / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81R x 11 inches in size
SBD -6398 (R. 01/03)
f
l uLprr
S w `i•} S w' /4 S 14 T ZQ K l5 w
S'aa i �► G �c.D "fow �1SN -� P
S f CRv 1 CvUAJT�
o
4a y f �
N / 0
l A�
.,\.�.v
v
3 /4" rvc
Mt = 102.E _ to? of
SW ?i/c F m
't l - 96.0 3�
.
Lgg . Qq.S'
CO PY
Sw� /4 s14 -r2-g14 K15w
St CaVAJT�
�C
_ o
3 { 3� ' /
N 0
v
3tK( 100.0' —
3n�s 2 = to
4V TVe-'B PC
�t:94.o 3•
B2 = t 02.5' '� / �22�'•L /�-
B3
49.5' I
l Bm¢�
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
` in accordance with Comm 85, Wis. Adm. Code
— i
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ST . (-' -�Zz `
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O 3"A — 3 _ 6 O
Please print all information. Rev iewe by Date
Personal information you provide may be used for. secondary purposes (Privacy Law, s. 15.04 (1) (m)). -7 �Zb G
Property Owner Property Location wT 0 t, J
L3�LGso" Gent -bet- ,SLv 1 /4SI.v 1/4 S ) 6 T ZCJ N R 1 S E (o
Property Owner's Mailing Address L # Hlock # Subd. Name or CSM#
q Z Zci O T-f S7 _I
City State Zip Code Phone Number
❑city ❑Village 0 Town Nearest Roads
GUWwW7 ctN I Lv1 I s y o l3 t�� 2 O r sr 91
R New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rat 5 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material y Flood Plain elevation if a PP li R ? `
General comments
and recommendations: ' — A'D S`-(,S7� 1 Z CE-L3, L �R2t-} (6, L-01JG P
�3c�` ��S'f1ZL6�iZ01J �tl�t� — �O1.5' 5 ac Cr
T Boring # ❑ Boring ✓/ ,
® pit Ground surface elev. c l�-C) ft. Depth to limiting factor L ) Z
oil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
1 0 -6 %'t Q- - 2-L - L my f7-- o,,S s . S
Z 6 -Zg Y - s ZMsbh rn. -,
3 Z&Az ro-IR-VIL - is la M\)
10 1R- .SLr".5/p, 1g oV in U
Boring # ❑ Boring /
® pit Ground surface elev. LQ Z . S ft. Depth to limiting factor L l in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
e - 1 "%L zI — L Z -P9�- mv . S _
Z
- I-Z3 , X0`2 R y) — S III z'P S b k M fl-- C-- S • s -
3 21-3b -) S lrL31. - � s Les bl m U-f�- nt • � � Z
LI I -Lj I 1p`1 R S1G - O s 9 Y n es S `1
S 4 1 - c1 - 7 l O`f rZ,Sl6 . CL & Z -S `l rZ S /S -� O Y�l m v'f� , 4 • b
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Arthur L. Wegerer Y . U1 -Z68 220254
Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, [7I 54022 10 - - 715 -425 -0165
r +
Property Owner 8�IZ6L11� Parcel ID # Y - b 3� - l� d Page Z of,_
❑ Boring # ❑ Boring
3 ® Pit Ground surface elev. �Q- S 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. •Eff#1 •Eff#2
0--6 1wj zL L Zfgl- M U-P- a.S S .$
Z 6 -ZI I&- lrz.V /St — S 1 Z - 9: 1bk mfr C>ti • s .g
3 ZI -3 ru22 — S) lesb� f e S . q .L
L l 3 - -- ) , SIL 2 31 4 -- )- SKtZSAS 6r-'n , .
❑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. •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 /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff41 •Eff#2
Effluent #1 = BOD > 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.
SOD4330 (R.6/00)
r `
Property Owner ' Beiz6hm Parcel ID #
Boring # ❑
F
Boring Page Z of �l
® pit Ground surface elev. ° 1Q- S ft Depth to limiting facto ✓ 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. .
Eff#1 Eff#2
0--6 104 i2 Z- — L M U+- q-S S .$
L l -k4 Z 6- L0�12 yly _ S' J
i 2�sbk
>n�>^ c w • S -8
3 ZI -3 tv`l2 y�6 _ s ) lesb� cQa h C S •� � �
s ,
G>"s
Boring # ❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ApGPD //ft n Rate
z
in. Munsell Qu. Sz. Cont. for 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 /ft'
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
`Eff#1 •Eff#2
Effluent #1 = BOD > 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.
SBD -9330 (8.6(00)
PLOT PLAN Page 3 of 3
Scale 1' _ L�)'
EEL. L O'ON 8 "M L 3)q' . PVC PIPS
w �u. 8E 'PsT LET 5 U ' FSRt� S `tS'Tp' -t .
BUlL�1/v G y �U G -�
V1 S rm R-t-1 t
L iW tS
!J — — — — — - - - - --
l !
0 / /
ti or cowl, P ►
/
C°..Dh1rOV L tl�L, D' ., 3
v' lot.S,
1�,O,W . LIJV(✓ o �
Ii
1
1p -tS -b) 715- 425 -0165 220254 UI_Zb$
CST Signature Date Telephone No. CST No. Job PTO.
Safety and Buildings
141 NW BARSTOW ST FL 4TH
commerce.Wi.gov WAUKESHA WI 53188 -3789
TDD #: (608) 264 -8777
i sco n s i n www.w
www.coe.W.gov/s /
Department of Commerce isconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
July 12, 2005
CUST ID No.224617 ATTN: POWTS Inspector
LYLE J MYERS ZONING OFFICE
NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA
E1556 STATE ROAD 64 1101 CARMICHAEL RD
BOYCEVILLE WI 54725 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 07/12/2007 Identification Numbers
Transaction ID No. 1151640
SITE: Site ID No. 701100
Tim Klatt Please refer to both identification numbers,
90TH Ave & 290TH St above, in all correspondence with the agency.
Town of Springfield, 54013
St Croix County
SW1 /4, SW1 /4, S16, T29N, R15E
FOR:
Description: Mound, 3 Bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1027003
Maintenance required; 450 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version
2.0, SBD- 10706 -P (N.01 101)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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:
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD -
10706 -P (N.01101).
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. In addition, the owner must
comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component
manual. A copy of this information must be given to the owner upon completion of the project.
All holding/treatment tanks are to comply with Comm. 84.25(7)(a). "/ 0
Maintenance information must be given to the owner of the tank explaining that periodic eamn' tthe filter is
required. Access to the filter for cleaning must be provided per Comm 84 product approto ditions.
r
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
LYLE J MYERS Page 2 7/12/2005
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 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.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 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 Safety & Buildings 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 to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Julia A Lewis- Osborne
POWTS Reviewer 2, Integrated Services WiSMART code: 7633
(262) 548 -8638, Fax: (262) 548 -8614
jlewis @commerce. state.wi.us s
Mound System a IV t a a
F 'mum
M El
Cover Page 9
r,.x •:
CDpCl1ETE
Project Name: Klatt-Mound
Owner's Name Tim &Lori Klatt
Owners Address
Legal Description ++ '/, Sw v '/4 SecF T 29 N, R r 15 1 , w .
Township Springfield
County Saint Croix
Subdivision
Lot#
Parcel ID# RECEIVED
JUN 2 9 2005
pg• Table of Contents SAFETY & BUILDINGS
1 Cover page
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map
total # of pages: 6
Designer Name: Lyle J. Myers
MP /License #: 224617
Date: 3/14/05
Ph. #: 715-643 -2520
w
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onaite Wastewater Treahnent Systems" (version 2.0) SBD- 10691 -P (N.01)01)
Per" Pressure Distribution Component manual for Private Ons@e Wastewater Treatment Systems" (Version 2.0) SB0- 10706-P (N 01/01)
Spreedshaet provided by: 36Advisement N12486 220th St, Boyoevffle, WI 54725 Ph: 715 -643 -6068 email: 3ba @3bsdvisenwnf:dgtn
Mound System ''°o° z of s
Mound Sizing Calculations
Project Name: Klatt-Mound
Site Conditions Design of Entire Fill
Project Type: 1 ar 2 Family Dwellimy I V I Cell depth at upslope edge (D): 6.0 in.
% Slope: 12% Cell depth at downslope edge (E): 16.0 in.
# of Bedrooms: 3 Distribution cell depth (F): 9.5 in.
Depth to limiting factor: 39 in. Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal/ft /day Cover thickness over center (H): 12 in.
Absorbtion rate of in -situ soil: A0.5 gaUft /day End slope width (K): 8.2 ft.
Effluent quality Iff *1 I . I Fill length (L): 81.4 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 4.0 ft.
Max TSS effluent value: 150 mg /i Downslope width (Toe) (1): 12.4 ft.
Fill Width (W): 23.3 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal /day Basal area required: 900 ft
Distribution cell width (A): 6.92 ft Basal area available: 1256 ft'
Distribution cell length (B): 1 65.0 ft
Area of Distribution Cell: 450.0 ft Observation Pipes
Contour Elevation of Mound: 101.00 ft Location from end of cell (Z): 10.83 ft
System Elevation of Mound: 101.50 ft
Final Grade of Mound: 103.29 ft
Mound Plan View
Observation Pipes
W K
T B I--K
I Tilled Area/Fill Material
L '
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric—
Distribution Cell
•
System Elevation
Cover Material Lateral 3
Fill Material Invert
Tilled Area
lope � Forcemain System
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6" aggregate below lateral and Y above.
I
Mound System Pop 3 of 6
Pressure Distribution Calculations
Project Name: Klatt -Mound
Lateral Layout Lateral /Manifold Design
Lateral elevation: 102.0 ft Lateral diameter. 11 1 w In.
Rows of Laterals: 3 Lateral spacing (S): 2.5 ft
Manifold type: Center Lateral to cell edge: 0.9615 ft
Orifice diameter. 0.125 In. Lateral discharge rate: 6.18 gpm
# of Laterals: 6 System discharge rate: 37.07 gpm
Distal Pressure: 5 ft Manifold diameter: 12 1 . In.
Lateral Length: 32 ft Manifold length: 5 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 26.48 Inches Forcemain length: 75 ft
Orifices per lateral: 15 Forcemain diameter. 2 In.
Avg. ft` /Orifice: 5.00 ft` Friction loss in forcemain: 2.151 ft
S
Lateral Side View
Manifold
Lateral Lateral
_ 2 2
L ateral engt Lateral Length
Lateral Plan View
Lateral Length Turn -up w /ball valve or cleanout plug
° °T
5
° ° �-
S
° °
Orifices on bottom of PVC laterals and forcemain to comply with
lateral equally spaced specifications per Comm 84.300e)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean-out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
"
6" Minimum 'ay be used m
Long Sweep 90 place of 318" bar
ortwo 45's 3M" Bar
Lateral
Mound System Pa" 4 d 6
Se p
i and Dose
Tank
t c
Pump
Project: Klatt -Mound
Tank Information Dosage Volume
Pump tank manufacturer: Wieser Concrete Forcemain drains back to tank? (* Yes Q No
Pump tank size /model: W1 000 /650 -MR Lateral void volume: 20.3 gal
Pump tank gaVinch: 17 Dosage to absorbtion Cell: 90.0 gal
Actual Pump Tank Volume: 646 gal Forcemain volume: 13.1 gal
Tank bottom elevation (inside): 92 ft Total dosage: 103.1 gal
Septic tank size /model: I wi0o0 /65o -MR •
Pump and Filter Total Dynamic Head
Pump Manufacturer. Little Giant Are laterals highest point? y
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter. Zabel A100 System head (distal x 1.3) 6.50 ft
Vertical Lift ( "D" to lateral) 9.00 ft
Note: Access opening of sufficient size to be provided to allow Friction loss in fo rcemain: 2.15 ft
removal of filter. Opening to terminate at or above grade.
Pressure loss from filter. �ft
Total dynamic head (TDH): 17.65 ft
Pump Tank Diagram Dose Tank Levels
"With Locking Cover In. Gal
4 Inch ng Label finished A RBS @fVB 17.9 304.9 Grade
Minimum B Pump off to Alarm 2.0 34.0
Aternaie C Total Dosage 6.1 103.1
L c � D Effluent depth for pump 12.0 204.0
Location Elect. per Comm
16.28 and Total Capacity: 38.0 646.0
NEC 300
Weep Hole A
or Anti- B
Siphon
Device t LUV- L I i LKS/MAN
C o ,ow aw 3000
1 to
D
7 .5
Q r s
Pump must be capable of 37.1 GPM Io zs
and head pressure of: 17.7 Feet
0 0
u eu 4 /M eu au
Litfls Giant FLOV- ONSINUTE
9EH PUMP PERF MANCE CURVE
113V 60HZ
Mound System Management Plan pursuant to comm 83.64 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and/or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety
and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids
from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by
sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied
and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the
inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping
should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be
watertight and of good repair.
Pump /Dose Tank
If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump /dose tank s )iould be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches
or more water level is detected in the observation pipes, the owner must be notified of possible
problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become
defective, the defective tank or component must be replaced immediately to ensure that the system can
operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface,
the component must be repaired or replaced in it's current location by either: extending basal toe to provide
added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within
the mound and replacing said components in order to return system to proper working order as required.
.r�.�. I wls w, ■ v n61I.Ra see s r rnv1% a n, nnnyu a.r n...r I ,
TOWN OF SPRINGFIELD. ST.CROIX COUNTY,WISCONSIN.
�+ N89'39'19 "E 660.71'
G�.o� -o O �N? O
• p �t I ! 627.71 ' c ^-n i �Q z
T N T
i o
7 it 0i3 2LA2 artrnWO n�ro
rn
CL
G� m cl
tn D
cr 9, r IC : 1 Iw I ✓� Q x n ? C
I 1 Z I I I m �' tin M ''n
2 U
m oD rn rn Id I� rn ( I r N w w m ca
O f/1 OD r
Gr O
I `
Z
J 9
M
C I i�
0 0
N
ap
I�
ro
a
I
0
I 1 v; I It71�
? I N89'28'35 "E 659.06' Icn Imo.
W I ! 630.01' 3'c I
! N:° NO
CA
O 1 I 0 = O •a yo `
<,- ov
a o o , io g� o a► �+ ao O
fil
N89'28 35 E 658.08
iF rn
C & " 'o d v 10 631 45' g N �y +►
n: WS b� O. { N tjm + x as I w oao Ig v, ? w rn
o ,a N r I o o co w D`to t h.
V1 N 3 7 p f0 C f'1 1 0 m SL tr W
d
.. " G N D' � I .. SC O O>
y in GD m
A. y o w m , N � p A S te' t ~ N r � C� o
D-1 d C .� i �O i s �^� ^ N .
c o Ito ^ -,
ryNQ an I . o -.
v n< o, o �' N89'28'35 "E 656.91' o ff °, �.
o < N m
- c
a
�.i� �� z 628.41'
r t
I on? z
IP N N "G 7
b O e
O d I CC
� M m m o, n !p l I N I o co v 3 D:t I I ro R. c1
O �:or ? s +o 0 ; 1 I d i •-+' cn itu� 11� r 1 o c.
`° ^ o 'o o ck 1171 8 - . -•
a 4. Gq
A , m C 3a 11 W I g i ,�,.�` o$ .A �p j I N ro ? 99 00
v co
I
-, I
a o
° c t r,• o v tvv I' I �, ggam,
CL ?�, ,� ^ Id I 'g
c c. 13u'I�'rq 13c _'ne _.
CL o' o 622 - _ 1967.12 � =
-, m M M 9Qth AYE.
CL" X - -_b _S89'17 - 46 "W 655.70' -
h
Vol 19 Page 4867 Page 1 of 2
ST CROIX COUNTY '
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 1 —
Mailing Address 4,
Property Address
(Verification required from Planning Department for new construction)
City/State _ Dr1n .� ,� i r Parcel Identification Number
LEGAL DESCRIPTION
Property Location �' / 5_Zj� y4, Sec. T�N -R / W, Town of S7lll/if
Subdivision Lot # _t_
Certified Survey Map # /q Volume �d Page #
Warranty Deed # – / I F 7 3 Volume Z7 4 Page # z
Spec house ❑ yes Xno Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
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 tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix 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 wastewaterdisposal 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 Commerce 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 Zoning Office within 30
days of the three year expu3Ppn date.
SIGNATURE OF APPLICANT
DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(i) of
the property described above, by vi a of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT V/2v1 t l l S
DATE
« «s « «« Any information that is mis- represented may result in the sanity emit being revoked b the Zoning
ry p g y e n g s « « « *«
«« Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
� 2, 7 1 8 P 2 4 6 STATE BAR OF WISCONSIN FORM 1 - 2000
KATHLEEN H. MALS11
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. cROIx co., xi
This Deed, made between Theodore E. Bercum and RECEIVED FOR RfiCORD
Shirley A. Beraum, husband and wife
02/11/2805 01:15PN
Grantor, WARRANTY DEED
and Timothy W. Klatt and Laurie R Klatt, husband and EXDPT #
wife as survivorship marital property
REC FEE: 11.00
Grantee. TRAKS FEE: 147.08
COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE:
described real estate in St. Croix County, State of PAGES: 1
Wisconsin (the "Property ") (if more space is needed, please attach addendum):
Lot Four (4) of Certified Survey Map recorded in Recording Area
Volume 19 on Page 4867 as Document No. 778156;
BEING a part of the West One -half (W) of the Return to:
Southwest Quarter (SW' of Section Sixteen (16) , Title One Premi Group, Inc.
Township Twenty -nine (29) North, Range Fifteen (15) 706 19th St. S.
West, TOWN OF SPRINGFIELD, St. Croix County, Hudson, WI 54016
Wisconsin.
034 1037 -60 -000 (pt)
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and roadways of record.
Dated this y day of t 2005 ,
* Theodore E. Bergum
v
* *Shirley A.
AUTHENTICATION AtKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
r ) ss.
Imo- County. ),
authenticated this day of Pe nally came before me this �_ day of
r , 2005 the above named
* Th odors E. Bar
TITLE: MEMBER STATE BAR OF WISCONSIN Shirley A. Sercrum
(If not, husband and wife
to me known to be the person s who executed
authorized by §706.06, Wis. Slats.) the instrument and wledged th
THIS INSTRUMENT WAS DRAFTED BY
Michael R. Foreeki, Attorney Notary Public, State of Wi p,,�
Eau Claire, Wisconsin My Commission is perman�fh�{ 011IY180011*1
S ma be authenticated or acknowledged. Both are not recess ,state exptratiOn date:
) O—
*Names of persons signing in any capacity must be typed or printed below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000
Attorney Michael H Forecki 1830 Brackett Ave, Eau Claire Wt 5470113627
Phone: (715) 835 -3029 Fax: (715) 8354112 Marge Stafford T4659888.ZFX
Produced with ZipFormT" by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -9805 www.zbfonn.com
Parcel #: 034 - 1037 -30 -100 07/26/2005 01:58 PM
PAGE 1 OF 1
Alt. Parcel #: 16.29.15.250A -40 034 - TOWN OF SPRINGFIELD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/26/2004 00 0
Tax Address: Owner(s): * = Current Owner
*
TIMOTHY W & LAURIE R KLATT KLATT, TIMOTHY W & LAURIE R
420 ELM AVE W
MENOMONIE WI 54751
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 907 290TH ST OR
SC 2198 GLENWOOD CITY 2904 90TH AVE
SP 1700 WITC
Legal Description: Acres: 9.530 Plat: 4867 -CSM 19 -4867 034 -04
SEC 16 T29N R15W PT SW SW CSM 19 -4867 Block/Condo Bldg: LOT 4
LOT 4 (9.53 AC) 907 290TH ST OR 2904
90TH AVE Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
16- 29N -15W SW SW
Notes: Parcel History:
Date Doc # Vol /Page Type
02/11/2005 787308 2748/246 WD
10/26/2004 778156 19/4867 CSM
07123/1997 10021464 QC
07/23/1997 829/392 more
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/25/2005
Description Class Acres Land Improve Total State Reason
PRODUCTIVE FORST LANC G6 9.530 17,150 0 17,150 NO
Totals for 2005:
General Property 9.530 17,150 0 17,150
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r
aGe L99V 988 61 TOA
Zj l d c rn
m .- .&
,O _ _b,L
_ - _ _ - - __ 19d - --- -- 06 - - -_ -- -- -- W � u ��
,Zt'L96tJ 8 66'ZZ9 r. ._$a o ca n m fA ...L a a�.S
�:)n4,.:G 5•j.CI." EI ' I O) I I d E `L •�
� •� j AO
L a._
+ al
+- n� a0 i b I zl Q a ` I 0 0°
o �I i ',iiT, •�
v N o o I �� V of .� �M ad ° c I iv I
lid i dad ai c o
Z a r �% c I , lb'BZ9 Z i a g'o 3t H~
L- +. ai Z c Q d a► .� o �o s.
o ,N L ° ,1,6'999 3„S£,8Z.68N o d a '- c c
o v H a + o
iU .X 3 O I L d Y1 p , w o
vao _ ��I /- i +- " '° vim �
o �� i[1 �i r o @d c O u x
M _ Q L- L �O
Q a 7 L+ J ai rj II N a& � I 1 N � W n'► C L 61 m L a
z 3 O 3 �g I o 'U - -� i I I J M o a. o. a+ v
i •�
co o vi 3 °d'r Y I o0 Q d o E N N
rn c u o +
►i V ro+.s W ait c.cv° z =}
n Go ; { I d N
s = u
r r � 9 \pQ i I d O °u C
t 1,p I a
LA
io
Z I Z a L o m
,80'999 s 3 « 9£.8Z.68N M I_ - -- a s �, 3 a
• .........,. o . .............................� �,.o�....fq.......i.,. °
I i o }
il - a o a! C
d , � n I I i F a Z 2: A
I Ld
O r7
3 I
N , l0'0£9
I �I ,90'699 3„S£.9Z.68N I t
II o, I I N 3
c �-
�I I 3 I CA
c
E `• 0 CD
I I ZI � �I AI W oo °J
is o . 1 c
ai M +.
OC aD o o to .. cz a0 l7
U. ,, ,r I ; �, I I p��1 W c i X �
Q a `n w b W, I v I I, al J 6� a M
0
n a 3 + � M 3 `� ; r�' �` al �I aa) M c
•-
I
LL i M N V m m Y- �, �-' O �;� �r' I j t' to Ui in
C aLV G c-wZ� �i,.s" ^ ° I ; 3 ui
ly � ; U- a�rY O •
Z ° aci a °' N %D d lL'LZ9
3 L
C4 IY O m
A I - T l7 O'A - rc
WON 3.61,6£.68N
L
'NISNO)SIM'AiNf10) modnS 'Q13130N1ddS 30 NM01
0 1S3M St 30NYd 'H180N R dI14SNM01 '91, NOUNS
' k131uvno 1S3MHinoS 3H1 30 d31dvno 1S3MH1f10S
314140 31V14 iS3M Ni ONV 'a31ad(o 1S3MHinos J
Z p'dHl 30 2131ayno 1S3MHMON 3H1 30 31VH 1S3M 3141
OR 13AHM a31JI1 3 ' �OVd ` 2[Wf1'IOA
Nd eV" 79Z79T •
ayomq mu 03A I3ms ON dVW XaAHfIS (1511M MU
U
1,x •�xzoat� •,� -
SM0 30 &USIMS
1191rN "N WMINIVI
L98 3OVd 61 "IOA SZ99y .ON 4
3 Go T 9 L L .•........,
, aPAY PH
v - ;G6 O N wao!
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, bUt not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all inf Reviewed y Date
Personal information you provide may be used fors condarftl�w, s 1� )• 7 �O
Property Owner J ( � Pr cation
-r k e D fib rc S UJ 1 /4 S W 1 /4 S 6 T N R E or W
`JGt" INL.'.l�` 1 Govt. Lot °� j
Property Owner's Mailing Address 4 Lot ( Block # Subd. Na or CS�M#
( 7X7 (? 0 th 1 V r c -t: i eh L^ I
City State Zip Code ` _ q '. City ❑ Village own Nearest Road
Wf SY013 ( ) 7 V SO
ft�l� �!
rNew Construction Use: Residential / Number of bedrooms , Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material D '& S S CUe --l(' Flood Plain elevation if applicable � A - ft•
General comments � s A
and recommendations: d Q� J
� ou.YXc�
❑
Boring # Boring
o
l ET--P-it Ground surface elev. ( 7 s ft. Depth to limiting factor -3 Y i n Soil Application Rate
Horizon Depth Dominant Color Redox Description J Texture Structure Consistence Boundary Roots GPD /fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
- - p r� d� Vn i t J
S c
Boring # � Boring �
pit Ground surface elev. 9 S ft. Depth to limiting factor 3 3 - 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. r `Eff#1 `Eff#2
Q p 2 C
a -1 0 ti� — t ft� Ci 1 " Y
c L VA 1 61
` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Si ature CST Number
rnl 2 0 G�
Address Date Eval ation Conducted Telephone Number
fill
m
It n
Property Owner TA e o dOrC P ei - 'q ( .kw - , Parcel ID # Page
F3� Boring # o Boring
Pit Ground surface elev. [ � r . � ft. Depth to limiting factor ��P in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. S/Ih11 ff
. 'Eff#1 'E
-fi
— b 5 5-- &' 5 / 5 t- I lJi C�
a 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
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 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
Effluent #1 = BOD > 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.
S I M-8330 (K 07/00)
1 n
Property Owner T A e o JOre �el'q t iw' Parcel ID # Page --) — Of _
a F Boring # j n g / /
Pit Ground surface elev. I b l . � ft. Depth to limiting factor �P (n. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. S//h11. "Eff#1 'Eff#2
2 � � SbK r w a � r
5 5�-k 5' t' -)t "4 1 8
F -1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor (n• 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
F-1 Boring # F] 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
Effluent #1 = BOD > 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.
S B D -8330 (R.07 /00)
v\ e w- 'Th eodore B v v - \ -
C . -T evlo '�e Oe-(<Z e
q;R
S
r
i
14 _e L6i
f- - -
'4
L
d
e
fir
I
M, IO OC� I
TO t3 PUS \.
14 9d
/orl)
/ 03. S
� r
t3
'Q 1
9s s
-
COPY
Wisconsh Department ofCommerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), directio Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance t neare� ad.
Please print all info Reviewed by Date
Personal information you provide may be used for seconpary pu
Property Owner roperty Location
`r h e o Clore. &f LA, LMI Govt. Lbt S (•U 1/ 114 S j is T N R J S E( W
Property Owner's Mailing Address Lot # Block # Subd. Na or CSM#
9 .190 f S' "—ti c v�dw.
City State Zip Code P e Nu bbr lA ❑ 04 ❑ Village Rfown Nearest Road
G Ie Cr�' WI ol3 ( ) so
�. rim f
New Construction Use: Residential / Number of bedrooms Code derived design flow rate ? GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material L&gs S G+V c t - Flood Plain elevation if applicable ft.
General comments
and recommendations: �,S L a d 5 a. c� �� ✓
opt 062
0 LJL VX d)
/ Boring #
❑ Boring
Ground surface elev. q 7 S ft. Depth to limiting factor - 3 Y in. Soil Aoolicafion 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 'Eff#2
b -!s' u 11 �u�sdh v ��
Si?
Boring # Bo
Pit Ground surface elev. 9 S 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
2 v4 e w '
Q O
!oY
CL - ,
' Effluent #1 m BOD > 30 —< 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <_ 30 mg/L
CST Na (Please Print) Zsiatur e CST Number
nnl e ^ °Z>
Address Date Eval ation Conducted Telephone Number
y� 7
i
1 � t°Y ( ,� W\- Parcel ID # Page -. ,I — of _
Property Owner art e o cQOrC. � `i
5-1 Boring # 0 Bori
Ground surface elev.
l• Pit � O /, � ft. Depth to limiting factor �� 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 `Eff#2
J f a s
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor (n• Soil A2plication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 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 'Eff#2
Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 5150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS _< 30 mg/L
I I
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 -8310 (R.07 /00)
PI o +
C)yl er ! eod Dh�e !�erGC�
c T_ cviv\ � �t�1 ��
g ay
i
� S
r
d
aq el
s�{r
T pJO of &rtcn T
- s60' , -� �1 — A On ,East �a !-'A P
R. \"y� s +a►�`,
i r \
1
FXc , ef 1 45; '5 .
9s: s