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Home My WebLink About014-1040-10-150Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law s 15 Oa (1)(m I) Permit Holder's Name City Village Township Tabitha Lunning TOWN OF FOREST CST BM Elev Insp 13M Elev BM Descriction TANK INFORMATION Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist to well .7UIL AtSJUKV I li JTJ I tM ELEVATION DATA STATION BS HI FS ELEV. Benchmark All BM Bldg- Sewer St/Ht Inlet StiHt Outlet Dt Inlet Dt Bottom Header/Man. Dist Pipe Bot System Final Grade St Cover BEDlTRENCH DIMENSIONS Wdth Length No Of Trenches PIT DIMENSIONS No Of Pots Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System Model Number LIIO I MIDU 11101111 J T Q I tM Header/Mangold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipets) Length Dia Length Dili_ Spacing AVIL VUyCR ■ Preaaura Svatoma Aril. vv 1 M Al-r,� /n C.. 6— A. 1 Depth Over Depth Over xx Depth of xx Seeded Sodded xx Mulched Bed?ranch Center Bed'Trench Edges Topsoil - Yes No Yas No COMMENTS: (Include code discrepencles, persons present. etc.) Inspection #1 Location: 2092 270TH ST 1 ) Alt BM Description = 2 ) Bldg sewer length = - amount of cover = Plan revision Required? - Yes No Use other side for additional information _ SBD-6710 (R 7!97) Date fnsepctor's Signature Inspection #2. 1- Can No � a f I Industry Services Dmsim ST CROIX ^( � D lJ (eil lJ V 1400 E 1Neshington Ave Sanftary permit Number Ito be filled in by Co.) P.O. Box '_' JUL 112021 707 Madison, WI 53707-7162 — 1,(,Pl Azc, pplieation O State Transaction Number In accordance with SPS 3 is m. o e, submission of this form to the appropriat 0:MOLO k c{{.Z - L is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to act Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide ma) be used for secondary 2092 iiRr" ST purposes in accordance with the Pfivacy Law, s. 15.04 I X m Stats. �� ST- I. Application Information - Please Print All Information Property Owner's Name Parcel # TABI"IHA LUNNING 014-1040-10-150 Property Owner's Mailing Address Property Location 1792 220m AVE Govt. Lot NE ''/., NEV., Section 19 City, State Zip Code Phone Number NEW RICHMOND, WI 54017 (circle one) T31N R15EorW II. Type of Building (check all that a ply) Lot # ® I or 2 Family Dwelling - Number of edmoms Z Subdivision Name 0.ei ptr�4 S •) 1 �� ❑ Public/Commercial - Describe Use Block # Cl City of ❑ State Owned - Describe Use ❑ Village of CSM Number u G� - 5 an A)& .g}5Q- 3Z ®Town of FOREST III. Type of Permit: Check only o e bolt on line A. Complete line B if applicable) A. New Svstem ❑ Replacement Svstem ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner t/ n IV. Type of POWTS S stem/Cora onent/Device: Check all that apply) t IT _ ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grad 0 Mound > 24 in. of suitable soil ® Mound <24 it. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) retreatment Device (explain) GEOMA r V. Dia ersal/Treatment Area Information: )c Design Flow (gpd) Design Soil Application Dispersal Are Required (sf) Dispersal Area Pro(sf) System Elevation 9q• �2 300 Rate(gpdsf) 150 195 97.75 CONTOUR / (( 2 VI. Tank Info Capacity in �q"^ Gallons Total Gallons # of Units Manufacturer S ,,}.+, ° New Tanks Exisnn Tanks Septic or Holding Tank low low 1 SKAW Dosing Chamber 600 600 COMBO VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plunjo!�>Styatury MP/MPRS Number Business Phone Number ROBERT HARDINA es 824825 715491-5039 Plumber's Address (Street. City, State. Zip Code) 477 170TH AVE TURTLE LAKE WI 54889 VIII. County/Department Use Only Approved ❑ Dis roved Permit Fee 135c Issyed kgenLSign ason for Denial ice— s �ZZ — IX. Condition Appro 3� l 1�5 t •� PS LA. YSTEM OWN U Septic tank, effluent filter and dispersal cell must be se iced I meld as managementplan provided by plu plumfxf. /1 6 Allper manplumber. m rare puns ,or me s erem an ep uppnc w rns `vino y on� r e a .�• ...••«. ••, ..�. 8S per applicable codelo t7�•supmaat io �y`e +t► SBD-6398(R03/14) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. EVALUATION Scale: w 40' ® SYSTEM PAGE 2 OF �44IL G SIA` E MAP. 60 Do PLOT PLAN OO �� (tO tt WId) 102 DESIGN FLOW: 300 GPD LUNNING Attach design llowcekuladorrs for commercial plena. PROJECT ADDRESS: M2 270 ST. Pipe Material ! ASTM Standard (Tables W4.30-3 3 W4.3M) ` N Sanaary Sewer.!_ /�, BM SymCd: BM Elevation: 100 ._ Force Male: SM Description: NAIL IN LARGE PINE 10.6 acres per St. Croix County GIS Gradk tt %) ested Aroe:l 3 Well Symoa (n epp9cehle): 0 Indkah; north ov dr.wry en ertav IMPORTANT: Show ground elevation contours at sultable Intervals. on the approprhe atw tXQ Qe, o� t -'�'ry t s), 6u- �Y July 8, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-07-08 Plan Review: PWTS-072201462-C BOB J HARDINA 477 170th Ave Turtle Lake WI 54889 SITE: Lunning 2092 270th St. Town of FOREST St. Croix County Total Amount: $250.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 543045211 Contact Through Relay hUp:i/dsps.vA.gov/programatindustry-services www.vAsconsin.gov Tony Evers - Govemor Dawn Crim - Secretary Cond/r/on•lly APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES D ION OF I TRY SERVICES SEE CORRESPOND CE FOR: Description: Two Bedroom Mound System 1 Sloped Site GeoMat Mound Manual (5/18/22), Pressure Distribution Component Manual — Ver. 2.0, SPD-10706-P (N.01/01, R. 10/12), 450 GPD, 16 inches to limiting factor from original grade, Maintenance required, Effluent filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved Plans specifications and this letter shall be on -site durina construction and open to inspection by authorized representatives of the Department which may include local inspectors In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, l�Gv * 7ReR' d POWTS Plan Reviewer —Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: Katie. PetzeI awisconsin.gov Cell: 608-574-1189 GeoMat MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE OWfier Project Name: WINNING Owners Name: TABATHA LUNNING Owner's Address: 1792 220TH AVE NEW RICHMOND WI 54017 rope Mn Property Address: 2092 270TH ST Legal Description: HE NE S 19 T 31 N R 15 W Township Forest County: St. Croix Subdivision Name: Lot Number: 1 Bk)ck Number: CSMB: 5352 Parcel I.D. Number: 014-1040-10-150 Plan Transaction No.: n ex ges Page 1 Index and title Page 9 Tank cross sections Page 2 Data entry Page 10 Site Diagram Page 3 GeoMat mound drawings Page 11 Filter Maint. Page 4 Lateral and dose tank Page 12 Soil Test Page 5 Distribution media Page 13 TANK SPECS. Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications ROBERT HARDINA License Number 7 824e25 Date: 0&26J22 Phone Number. 715491-5039 Signature: e Designer Stamp: State of Wisconsin Approval Stamp: Condklonally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES D SION JITRY SERVICES Designed Pursuant to the Synergy Systems L.L.C., GeoMal Mound Component Manual (Edition 1, 2017). (N. 4H7), updated (511&22) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and SEE CORRESPOND CE Pressure Distribution Component Manual Ver. 2.0 SBD-10708-P (N. 01A1, R. 10/12) GeoMat Mound Edition 1, 20W Page 1 of 121 Mound and Pressure Distribution Component Design Design Worksheet Site Information R Residential or Commercial Design Igo ply �00.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) Design Flaw (god) 340 Site Slope (%) W-76 Installation Contoux tine Elevation (ft) 16A0 Depth to Lim" Factor (in) 010 In -situ Soil Application Rate (gpolfr') 100.00 Contour Length Available (ft) Distribution Cell Information 6.601 Cell Width (ft) 3 25. 6 5 or 9 75 Only i0 00 Designer Input Cell Length (ft) 2.001 Dispersal Cell Design Losding Rate (gpdM7) 30.Op Dispersal Cell I ength Required (ft) 2; tnfluent Wastewater Quality (l or 2) Pressure Distribution Information Center or End Manifold Are the laterals the highest oilM Number of Laterals in the disUitwlion Y Lateral Spacing (ft) neN+ork? Forcemain Drainback (gal) If N above, enter the elevation Forcemain Filter loss (ft) of the highest point. Focemain D' meter in) Forcemain Lencith-12D Does the forcemain drain back? Y Inside Pump Tank Elevation (ft) Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Sparing (R) _ System Need (R) x f.3 Venial Lift (ft) Friction Loss (ft) Total Dynamic Head (ft) 5x Void Volume (gal) Minimum Dose Volume (gal) System Demand (gpm) Diameter Selecb(m 6.86 ft'/onfice 1lardlold Disc ater Saleotlon in. dia. opitkoxnasdroios 1.25 x 1.50 x X 2.00 3.00 Manu acturer Inform on Treatnunt Tank Information Etthxmt Fifter information 1000.00 Septic Tang Capacity i Lifetime Fillsr LLC Filler Mrwfadrxer PtecaatMantrbchuar LT ti Finer Model Number Dias TW* laionaation OaBoasAocA Calcalidor (optionah 8tZ.00 Done Tank Capacity (f7M) 812 OD Total Tank Capacity (gal) 18.W ji Doan Tank VoMnre ) _ 39.00 Total Working Liquid Depth (in) akaw _ Manufacturer 18.16 galin (enter result in cod Dow7a *VONxne) Project LUNNING Page 2 of 13 Mound Plan View FK B ' '' Poe aA w..................... B L Mound Component Dimensions Down slo toe extension made. A 6.50ft E 10.34� HI 1.00ft K 8.92ft B 30. IF14.50 in I 18.50 ft L1 MW ftg17. Sri D 8. in G 1 0.50 ft J 1 6.54 ft w 31.54 It 195.00 (ftt) Dispersal Cell Area 1 750.00 (ftt) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 1 3.00 (ft) 1/10 8 Obs. Pipe Plaoement GeoMat Dispersal Area Observation Pipe 12" C 33 sand as GeoMat required for Geo Mat Distribution Cell component [ GeoMat + 12" ASTM C-33 sand 100.63 Finish Grade 99.50 Lateral Invert Elevation I11 . F 11 98.42 Dispersal Cell Elevation Tilled Area Forcemain In situ soil In situ soil ng Key i Q Topsoil Cap 2 Q Subsoil Cap 3 ASTM C 33 sand (F) 4 ASTM C 33 sand (D) 5 Q Tilled Layer 6 Geo Mat Cover Material Slope 3.0 Contour Elevati �97.75 6 See details on page 4 for number, size, and spacing of laterals. Project: LUNNING Page 3 of 13 End Connection Lateral Layout Diagram 1u orNke IocatW at erifks point down IaOarak i tap frlallt M /YC fdf 49 oar fK Tabb Number of Lebrok Lateral Dia no* Lateral Length (P) Lateral End (Z) Lateral Spscirg (S) Lateral Flow Rate System Flow Rate 2 in ft ft ft gpm gpm 1.50 29.50 0.50 3.25 12.82 25.63 Dose Tank Information I •rlinp nn cr a Mt atoning IJr•1. L w 4.i�q• .kvaf :VW aacf litJN xrol 1 kaarirJ b+ NIX Me IL LtS 1tw.?i W�( ( 4 ! 11- f iiJK_(LM•• : i I 94 .144, ' l' lean lila iMpf Wka•+imin 1�krlrk+n,urc Mr4 t I Il.n. ♦Myr e' anJ aaaMr •1• 111•J11 tpa6tY Sim / Tech Filter STF 100 1/16 p�Iti4i. hy��ye .1 1'wyr tlo IMef Prayl[M'Ilo� 26.88 442.71 2 32.94 2.12 34.92 8 131.76 39 642.33 Dimension I Gallons A 2 . 1 447.65 B 2. 32.06 C 2.12 33.95 D 6.00 1 32 -Total-40.021 642.00 Orifice Diameter 0.25 in Orifice Spaclg (X) 2.90 ft Orifices per Lateral 11 Orifice Density 8.88 ft°loririce Manifold Length 3.25 ft Manifold Diameter 1.50 inForcemain Velocity 2.82 Rine J' VmwJ t'.ar l:l�id Uiweww�Y� riplw�,lldta a'f Famrnein demeler 2 in. IOgYew i Il,lam •y��hrf I �I r� C j 4 Pump on tiit elaYaliatl (�) ( P 62.67 „� r 0or IaAt tlWaam Ift1 Illg ~- 82.00 skew C1 642.00 Vokxne 6.471 gaVinch Fiter ManufacW w 131m / TOM Filer Fier Model Nwriber ISTIF 100 1M6 Alarm Manufacture ISE RhOrrtbus Alarm Model Number AB Pump Manufacturer IzOOIw Company Pump Model Number 152 Pump Must Deliver 25.63 gpm at 21.23 ft TDH Note Switches containing mercury may not be used in this system Project: LUNNING Page 4 of 13 GeoMat Distribution Cell Media Layout 6.50 Cell Width (ft) 1.63 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Q Q Component Legend G Distribution Pipe With Pressure Lateral Lr.J Orifice Shield • Tumup Enclosure - - - - - Pressure Lateral GeoMat is covered with approved geotextile fabric as per the their product approval Distribution Cell Plan View Layout -Typical 6.yp Call! WkIth _ A (IQ 30.00 Cell Length - B (ft) End Connection Lateral Layout Diagram �� .w.r +r w+ .+r• .wq� .yw ..ram IPI T�plcal]Msoeigial Cell Distribution Lateral Sow Fa RawOrifice Shield Approved infiltrative Fabric Pipe Dia. itP-Squ31DiA .' Geofvlat Component f tv'il A't}(f.11 rri' o infiltrative Surface/Plow Layer tY�A Observation Pipes Wain Tv lit sehtf4p I �• w" �. I pens Ir• Fip:CXr. T,AI/F Project: LUNNING Shading Key Topsoil Cap Subsoil Cap 3 ASTM C 33 sand (F) .1 ASTM C 33 sand (D) 5 0 Tilled Layer 0 Geo Mat See details on page 4 for number. size, and spaang of laterals. Page 5 of 13 Mound System Maintenance and Operation Specifications Service Providers Name(ROBERT WIRDINA Phone T15-401-6039 POWTS Regulators Name St Crobt Cotady SPIA - Zwft Olfoe Phone 1 3e6 46d0 System Flow and Load Parameters Design Flow -Peak 300 gpd Maximum Influent Pattkie Sizeallcfu/1100ml. Estimated Flow - Average 200 gpd Maximum GODSmg/L Septic Tank Capacity 1000 gal Maximum TSSmg/LSoil Absorption Component Size 195 fe Maximum FOGmg/L Type o1 Wastewater Domestic Maximum Fecal Coliform Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Froauencv Inspect and/or service once every 3 years Inspect and clean as necessary at bast once every 3 years Test once every 3 years Should test periodically Laterals should be flushed and pressure tested every 3 years Inspect for ponding and seepWo once every 3 years Miscellaneous Construction and IMab►ials Standards 1 Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the Synergy Systems GeoMat Mound Component Manual Version 1, 20W. 2. Dispersal cell media conforms to GeoMat products approved for use with the Synergy Systems GeoMat Mound Component Manual Version 1, 2017. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code, 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail W Diameter finished Threaded Cleanout Lawn Sprinkler `acts Plug or Ball Valve Box Lateral Ends at last Orifice Where Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Distribution Lateral Lateral Cleanout 1.5 Feet Project: LUNNING Pape 6 of 13 Mound System Management Plan Pursuant to SPS 363.54, Wis. Adm. Code GDTWMI This system shah be operated in accordance with SPS 382-84 Wis. Adm. Code. and shall maintained in accordance with IW component manuals [Synergy Systems L.L.C., Geomal Mound component Manual version 1.2017, Pressure Distribution Component Manual Ver 2.0 SBD10706-P (N. 01/01) and SSWMP Publication 9.6 (01181)[ and local or state rules pertaining to system maintenance and maintenance r Septic and pump tank abandonment shall be In accordance with SPS 383.33, Wis. Adm. Cods when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water lightness and soundness. Access opefill s used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defectve, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Scotto Tank The septic tank shall be maintained by an individual Certified to service septic tankunders. 28the . Sti is Tnk ad outlet contents of th ellabe ic tank shall be disposed of in accordance with NR 113. Wis. Adm. Code. The operating condition assessed at least once every 3 years by inspection. ration. The filter cartridge should not be removed unless Drovlsro ns The outlet filter shall be cleaned as necessary to ensure proper opeure ifthe filterthe are made miter shall tberetain serviced if the the alarm is activatedscontinuoush off hy. filter Intermittent filter alarn removed ms may indicate its sure flows or en impending continuous he alarm. The septic lank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. if the contents of the tank are not removed at the time less a triennial assessment. scum and sluntenance udge accumulation shall the tank. Me der as to when the next service needs to be performed if such products The addition of biological or chemical additives to enhance septic tank performance is generally not required. However' are used they shah be approved for septic lank use by the Wisconsin Department of commerce. Pump 7ertk , alarms, and pumps shall be tested to verify Proper The dosing (pump) tank shah be inspected at least once every 3 years. All svnlcnes operation. it an effluent fitter ls installed within the tank a shall be inspected and serviced as necessary- If the force main has a weep hole, it should be noted tit is functional during pump operation, and if not, it should be cleaned present that cold cease death.""*" No one should ever enter a septic or dose tank sinaa e dangerous gasmay be pre r, -� �re Di1tribu92 U11lIM , and the "pact shall be No trees or shrubs should be planted on the mound. Plsntirgs may be made around the mound'+parimelm( than seeded and mulched as necessary to prevent erosion and to prov'de some Faction°" from sa�r ot��T^fitt�� surfacewithinthe vegetative maintenance) on the mound is not recommended since soil compaction may mound and snow compaction In the winter will Promote frost penetration. Cold weather installations (Odober-February) dictate that the mound be heavily mulched as protection from freezing BOD.. 150 rtg/L TSS, and 30 mgA. FOG for septic fan* effluent or 30 Influent quality into the mound system may not exceed 220 mg/L mgfL BOD,. 3o mg/L TSS, 10 mg/L FOG, and 104 chilloo mL for highly treated effluent. Influent flow may not exceed maximum design ow specified in the permit for this installation. The pressure permit distrifolbn system b provided MN a flushing point al the end of each lateral, end tt Is recommended that each later al be flushed of accumulated solids at least once every 3 years. When a pressure test is Perfomled a should be compared to Ilse initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell.for effluent ponding. olevels shall be to the owner, an any Observation ppeswithin the diasshcell shall achlkearequent mitoring.levels above considered aipedril failure requiring Q0 ncerrov Plan If the septic tank or any of its compon ents become defective the tank Of ComDo^e^t shall be repaired or replaced to keep the system in proper operating condlOW. becomes detective the defective component(s) mall be immediately lan^ or related vririrp If the dosing tank. pump, pump controls. e repaired or replaced with a Component of the same or equal performance If the mound component hha tto accept wastewater occurs or by removing or begins to discharge wastewater to, the ground surface. tt will be repaired or replaced in its' comp location t>increasing basal area if toe leakage oloiNsliCly clogged absorption and dispersal media, and related piping and areplacing said components as deemed necessary to bring tiro system into proper operating condition See Page 6 of this plan for the name and telephone number of your bat pOWTSregulator and semce provider. regulator Page 7 of 13 Project: LUNNING PUMP PERFORMANCE CURVE MODEL 1611162/153 djo,.. dA CHECK BOX AS APPUCPBLE. CHECK BOX AS APPl1CABU. SOIL EVALUATION Scale: I"4U ® SYSTEM PAGE 2 OF D SITE MAP go EZA PLOT PLAN PROJECT NAME: VA 70, 1 DESIGN FLOW 900 c;ao (+o n yrw) SUNNING Attach design nowwlculations for carmnardat pens. PROXCT ADDRESS: 2092 270 ST. P 4m iMetariet / ASTM Standard (Tables 3N.303 A W4.304) N SwIsarr Sewo:____ am &jmbd BM EMVM nn 10o F Force Male: aM Desalgbn: NAIL IN LARGE PINE 10.6 acres per St. Croix County GIS Skip a ieasAt l%) Arw:3 Weu Syntd (1 appketIle): O dr s� Show ground elays bliss at aaltabM IrMwvMe. on ab approprae die. t"40C e_,H 5JFM01//1 E9 MuiriMF Addmu 1455 Lcxanw Drive. Hoync City. M149712 Rdr Feee MMM-799-3290 OJfx 231-342-1020 Far 231S82-7324 Exwu xioralalarmeway.NBT Web WA vV ps-simlcrhsum INSTALLATION & SERVICE INSTRUCTIONS INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2' National Pipe Thread. Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter to the desired height and a 2" union will need to be added to the outlet end of the filter. Always install the fillers in a position where they can be easily serviced. "Always use caution when starting threads to avoid cross threading". Plumb force main into the 2' sch 80 PVC union. "We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface". SERVICE: Service of fitter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the fitter. Once the service interval Is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Note that in cold conditions the fitter cap may be difficult to remove. Keep the fitter in a warm area or pour warm water over the cap before removing. Once the filter is installed in the tank it maintains a stable temperature and removing the cap will not be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove Y plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm switch Is working correctly. ""TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. Installation service lnstruclitxis.doc 1 a 1 moo 4 8 A installation and Maintenance Instructions Installation step t lily ;R tl r lilt r lake wlto thu r itlet pipe golne to the &Wi Gold. Enstae h Is ccritcrrd +Ilrwily uAder the am m opening. (it outlet pipe Is already In a filed position, additional pipe may need to be added) Step 2 If uti * g the atididonal single sloe support and the two bottom supports: While the case u .dA dry Ill. to the ouUCt papa, nreasliro and t:w 2":fa1C(h ill: 911 �VL t71NC CO +h(' IG1/jfh n edod t4 r:at n(i (corn the hubs Nat ate ptG4vv3 dtrd Into ttia race to file side wall and die hiskie float of lank. solvent weld plpo hito lho hubs that are pre -molded onto the case. Step s solvent weld the rase to the outlet pipe. Insert the ftlter cartridge Into the case pressinly clown on the caruklp antA It klcAa Uo Plata fit the hOUOnl of Cato. Step 4 B utltlzttM a vertical read switch: Insert svrRrh Into the hole pre -molded Into tile top of the filter, Press strakdtt clown unto It k,dls Into ifaur Malntmaalce 1) Remove the access Id of the tank. Note: To ensure undesirable solids do not exit the tank and Into the drain iltdd, the tank Shahid be pumped out until the level of effluent Is below the outlet react of tltc tank. 2) To rmoye the If r catttfdge km the Mw case, pull up fh Italy on the handle of the co"dge dhlotitloP. k from the case, (if utNift a vertical read mRd4 rentapal Of Switch Is optional) ,i) ttslW chi nprtlnarygarden from, rhrse Nor ilRor cartridtt:: en7urinIS al! VWble septase materlel is removed. 4) p6;e tiw liker wrutdge lack Into llw Allo+ caw pressi+ig (kmm uli dlewtui4it ut+tfl It inc:r; Juioylara 5) pace the access lid back onto the tank ensuring It is secure, RECEIVED FEB 6 zap sarr- Y a BUIL : rjg�,; Ilothni` rNiar pal a dfatana "Od iwrrranty: Uetinie Itiler tIL warrallls Unl ukia WM lie Iree of,nasrlsM011,riit aial n+rWWWAr hlis laieeh abduct n W W'A me for lue radar It tills the wlalnel airchaln owes uIe product. lMetlliw pNar call wows a ivplaoa»rq fetarhr taw avw that the owillilw tRar tray sat d,nllr,rd dagnr the InAall, tlnn or ralNtenanre prose ss, favnaee to thh prndtict naimil by naldent rofsas(b or ahiise will not Ire uwl IxI aliuu Cda V)L lamb. dnyn nyei [1r, c ul u,41 W 0.114n iS 1u Udlllg fi.aa Produa corn hohlg 111SUL4oparwil or ualaLi ied pmpKlr will weld Coll twangjW4• alheme Idtw smash( no respolm1bli tr far War OWxi ►MINNal dlarees, k%Uft as ar AW XladClllat u+ ton;rllarnlhd coral.. contad:Mroiial.SM-724-2"t WARNING DEATH MAY OCCUR IF TANK IS ENTERED WITHOUT PROPER EOUIPINENT VOTE SEE MINER WALL PHOTO ON THE 'EXCLUSIVELY AT -VA WS' PAGE. 3.00 1.00 27.00 27.00 2.00 24.00 24.00 1--- 21.00 L� &c r-16,a1 —4 I.00 WLET 4 INCII SEALf WSTAI WHEN 3.00 OUTLET END VIEW OF TANK OU4WCH PRESS SEAL GASKET Model Number 10001600 SKAW PRE -CAST Phone: (715) 967-2277 Approved for. SEPTIC/SEPTIC.SEPTIC./PUMP.SEPTIC/SIPHON OR HOLDING Toll Free: 1-800-924-8625 Wei Inlet Weight Dim. outlet Dim. Li . Depth Gal. / In. Nom. C 26255 isco Street, New Auburn g 4 �• Y�iswnsin 54757 Fax: (715) 967-2707 13,050 tbs. 44" 42" 39' 16.47 642.33 gal. www.skawprecast.com V101sconsin Deparbnent of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Ws. Adm. Code County Page _ d Attach eompiete site plan on paper not lass than 8 1/2 x 11 inches M sea. Pion must include. ST.CROIX but not knfled to: vertical and horizontal reference point (BM), direction and percent slops, Parcel I.D. scale of dimensions, north arrow, and location and distance to nearest road. 014-1040-10.150 Please print all Information. Rs„iaiwed by DA* Personal gdomnalion you provide mw be used for Pdv Law, s. 15. 1 m . Property Owner Property Location ❑ TABATHA LUNNING Govt Lot NE X NE Y. S 19 T 31 N R 15 E (or) W Property Owner's MAN Address Lot 0 1 Block a 1 Subd. Name or CSM# city Phone NEWRiCHMOND I IMF I '54017�-- I_( Number.L�—� —L� ST �L 2M 70THS ® Now Construction Use: ❑ ReNdentW / Number of bedrooms 2 Code derived design lbw rote = GPD ❑ Re*memant ❑ Public or oonxnercial - Describe: Parent malarial OU7INASH Flood Plan elevation if applicable M A. General comwwn s and recommendations: RECOMMENDED SYS MOUND F1-1Borirp * ❑ Boring u ® Pit Ground surface alsv. 97.75 R. Boo to wrdbig factor j•4 in. Horizon Depth In. Dominant Color Mursel Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consiatanca Boundary GPOJFP •E1fA1 -EW2 1 0.0 10YR314 40- SIL 2MSBK MFR GW JRooft A a 2 9-18 10YR5/3 .0.SCL 2MSBK MFR CW .4 .6 3 18-32 10YR513 F2D5Y4/4 SCL 2MSBK MFR WA .4 .6 NLA U Boring s ❑ sorw% ® Pit Ground surface slay. 97.15 R Depth to limiting faclor 22 in. c.w A-..Yn� 0r Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cant Color Texture Structure Gr. Sz. Sh. Consiaanoa Boundary Roots GPDIFt' 'E11101 'EIN2 1 0-8 10YR3/4 .0. SIL 2MSBK MFR GW 2M .6 .8 2 0-20 10YR4/6 .0. SIL 2MS8K MFR CW 1M .6 .8 3 20-36 5YR4/4 C2135YR4/6 SL 2MSBK MFR WA WA WA N.A CST Nam* (Please Print) CST Number ROBERT HARDINA 524825 _ Address Date Evaluation Conducted Telephone Number 47717V AVE TURTLE LAKE WI 520/2022 715-491-5039 rani. a.nn mnu.e� aSoring• O eoonw ® pit Ground surface elev. UJI ft. Depth to Wnitinp factor SS in. Sob AodicNbn Rate Norizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh, Consistence Boundary Roots GPD/W 'E11M1 'E8i2 1 08 10YR3l4 -0- SIL 2MSBK MFR GIN 2M .6 .8 2 6.16 10YR416 -0- MI. 2MSBK 1NFR CW 1M .6 .8 3 18-36 SYR414 C2D5YR416 SL 2MSBK MFR WA WA N.A N.A Soong It ❑ Boring Pit Ground surface elev. _ R. Depth to WrAinp factor _ In. PM An ilenfi n RMA aftmv# ❑ Boring ❑ Pit Ground surface elev. � R. Depth b MnbV factor _ In. Sell Aooarstlon Rate Effluent •1 m 800, > 30 s 220 MgA. end TSS > 30 s 150 mplL ' Elflue d i2 = BOD, > 30 s 220 mplL end TSS > 30 9 150 mprL dA CHECK BOX AS APPLICABLE. CHECK BOX AS APPUCABLE. ❑ SOIL EVALUATION scale: 4D 4U ❑ SYSTEM PAGE 2 OF D SITE MAP 60 eo PLOT PLAN PROJECT NAME: 1D' DESIGN FLOW 300 am llon") LUNNING anal, design flow oataagaimsto colnn+aclat two. PROJECT ADDRESS: 2092 270 ST. Ape Malertaf / ASTM Standard (Tablas M4.30-3 a 364.304) au syn" + ell sevasorc too FT N spy sews. / aMoaeoAptlon. NAIL IN LARGE PINE Farce Main / � d Mw("4=M) 3 W01 av"+d (l Awkmis) O wlo" farm by IMPORTANT: Show ground elevaem contour at shaft Intervals. an so a 7 6 APPLICATION FOR REVIEW -Complete all papes- la�� %1 NOTE: Personal information you provide may be used for secondary purposes � �✓�+/ [Privacy Laws. 15.04(1xm), Stab.) Private Onsite Wastewater Treatment Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharePoint User name below: For plan status, check our website all http://dsDs.wi.aov Email technical code questions to mailto:DSPSSBPowtsTe00.wi gov Several CtxfnUeS have been delegated certain authonty to review plans in Neu of Division of Industry services. For a current list of those counties and their des' nation check our website at htt ://ds s.wi. ov 1. Project Information . F81 In all known information. Confirmation of assigrnerd to a reviewer. Proted/Site Name: Mena" Transaction ID: Location, Number &Great of projed (if unknown, indicated nearest road) Previous Related Trans. ID: Q IDS2 a 7 4.S i Estimated Completion Date: Assigned Reviewer: Legal Description: ll�t '4c' ITS' /a; LA.;i County _ _.S % . e-b IX Assigned Office: ❑ City ❑ village ® Town of FO9 7- Mall to your office of choice below: La Crosse, Green Bay 2. After plans are revlawsA please: (check all that apply) ❑ Call customer 1, 2 (circle number)* NOTE: We reserve the right to re -distribute plans to another office If ❑ Requesting party will pick up heeded to reasonably balance turnaround times. Check ® Mail plans to customer$ 2 (cycle number)* http://dsps.wi.nov for next available review date 'Refers to customer number from below. 3. Complete the following designedownerfrequesting Information. Utilize the check taxes when designer, owner or fequeslfrla party Is the same to avoid repeating Information. Designer Information (Customer 1) DSPS Other Please Spealfy Below (Customer 2) DSPS First Name Last Name Customer Number First Naar Last Name Cuslomsr Number ROBERT HARDINA 824825 Company Name Company Name HARDINA SEPTIC SYS. Address Address 477 170r" City State Zlp+4 (9 dlpNs) City State Zip+4 (9 di9b) Tt1RTLE LAKE WI 54889 Phan Number E-mail address CON phone Phone Number E-mall address CON phone (area code) (area code) HARDINASEPTICCRGMAIL.COM 715-491-5039 OA applicable Check N applicable a cabspecifyrolatbmhlp — Owner 0 Other - specify relationship Information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application form and e-mail it, along with your registered SharePoint username to DSPSSBPlanscheduletaTWisconsin.gov. If plans are being submitted via paper, they will be assigned to a reviewer after receipt at a DSPS office. Submittal checklists can be found in each applicable component manual Sri on the POWTS program page under Publications POWTS Components Manuals NdmeNOnaInka Area OSPS Green Bay OSPS 2850 Midwest or Ste 104 2331 San Luis Place Onalaska, VA 64650 Green Bay, VIA 5430.4 608-785-9334 920-492-5601 Fax: 606-785-93M Fax 920492-5604 Emat DsDsWianSchedukawr aov Email: DepsSbPlanScheduleQwi gov Make Checks Payable to: Division of Industry Services OR ❑ Check box to invoice designer and sign below Designer Signature SBD-10577 (R 3119) TOTAL AMOUNT DUE i _ Review Code 7633 5. POWTS SUBMITTAL (check all that apply - Incomplete forms may result in processing deletes) ❑ NEW ❑ Aerobk Treatment Unp(a) ❑ Chlorinator ❑ Tank Replacement Only ® REPLACEMENT ❑ Correneri;W System ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPES) NOTE: Submit separate stise0s for each system If submitting multiple systems on the same Nte War Fee ❑ Revision to previously approved plan $"Do ❑ Miscellaneous Review (i e. replacement of a septic tor, addition of an olMrent filter or pretreetmerk device to an axis** system, sta) $8ftr — ® Component Manual All treatment conWarients are previously approved ® At -Grade Component Manual - Ver. 2.0. SOD-10854 (N.03/07, R. t12) Design Wastewater Flow in under s. SPS 384.10 (2) or (3): ❑ In -ground Component Manual - Ver. 2.0. SBD-10705F (N.01)01, R 10112) ❑ Mound Component Manual -Vat, 2.0. SSD-10691-P (N.01101, R 10112) Gallons Per day Design wastewater (low of the proposed system., [] Pressure Distribution Component Manual - Var. 2.0. SSO-10706-P (N.01iol, R 10112) 1,DW gpd or less S 250.00 ❑ Other - Please specify GEO MAT MOUND GPD 1.001- 2A00 gpd $325.00 2.001 - 5,000 go $400-00 ❑ Sou Based Individual Site Design• One or more treatment components are not ❑ At Grade piously approved under s. SPS 384.10 (2) or (3): (Individual site design/deviation from component ❑ Non-Pnysur=d 1tr-ground Design manuals and use of components without product ❑ Pressurtietl In -ground Wastewater Flow in aPP(o"alY ❑ Mound ❑ DnP-tee Gallons Per day Design wastewater now of the proposed system ❑ Constructed wetlands GPD 1,000 gpd or less $450.00 ' Documentation must be provided to support treatment and dispersal dawns. In a separate 1,001- 2.000 gpd WW.00 statement provide rationale for the project and attach supporting documents (code sections, test 2.001 - 5,000 go $750.00 reports, technical papers, research articles, etc) gamer then 5,000 go $900.00 pit* $0.08 for each gallon over 5000 gpd State-owned facilities. Desi9 ^ Holding tanks previously approved under s. SPS ❑ Holding Tank Component Manual, Ver. 2.0, SBD-10055-P (N.03M7. R1112)' Wiltst"'ateir Flow In 384.10 (2x3). Design wastewater flaw of the proposed syamm Gallons Per day Non -state owned Commercial and Residential Holding tanks that completely util¢e this manual 5,000 gpd of lass 390.00 and have an estimated dairy flow of less than 3000 gallons per day must be submitted to the GPO 5,001-10„000 gpd $150.00 -- appropriate govemmental unit for review instead of the Department. (see SPS 383.32(3)(a)l greater than 10.000 gpd S22S.00 ❑ Holding Tank Individual Site Design*, (Le, ass constructed, <5 day holding capacity. Co- Holing tanks ncluding site eorxiLuctsd tanks NOT mingled wastewater, etc.) fig^ Wastewater Flow in previously approved under a. SPS 384.10 (2) or (3). Please specify: _ Gallons Per day Design wastewater flow of the proposed system: ' Documentation must be provided to support the rationale for the project. In a separate statement, 5,00gpd or 0.00 5,001 _ 1p.0,0 00 9P$30 d S300.00 _ please include all code sections, test reports, technical papers, research articles, etc.} GPO greeter than 10,O00 90 S450.00 ❑ Soil Saturation Detennquuorh Report (uskrg observation pipes) ❑ interprVive Determination $240.00 ❑ ExpenknarrtM System (One the additional fee). Submit fee for individual system as per appropriate above system type) Fxperlment Number $400.00 Priority Review (enter earns amount as normal review tee kited above) S , Enter Total (rounded to the nearest dollar) $ � SBD-10577 (R 3119) File #: ST. CRO - IUNTY SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM Created2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer L (,� It 0) G Mailing Address / 7"j. ,,?olai `RAJ r✓ City/State/Zip Ale W F LC 9 N1 pF1 t w I 5 qo f 7 Phone Number (required)-to::j- $'s?- Email Address (reguired)�' 4U; 7 NA D"5le. r< kD VA{-{DD - Crn, Parcel Identification Number 17 ` /D yid - /p (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location 1/4 E 1/4 , Sec. Z9. T,LN RLB W, Town of FD K C's-T- Subdivision Plat: Lot At ertified Survey Map #_ �`i3 Volume Page # 535� P 15--OJ Q $ (before 2006)Volume Page # Number of bedrooms oQ Spec house ❑ yes l'no Lot lines identifiable IN yes ❑ no New Property Address _ VA— (Stak Initials) OFFICE USE ONLY Z 2 s'r (Verification of new address required from community Development (Dat ) for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded worranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov 7110122, 7:18 PM Farmhouse Style House Plan - 2 Beds 2 Baths 988 Sq/Fl Plan #126-236 - Houseplans.com Floor Plan - Other Floor tsars - , w4 o r ,�• V 4 r.o NID ROMIMNEM 110 it *4 Y # r PATH tiles � - ... _.. ��. .�: I 4*PwE / GJIST� LNNG ROOM ' i d '44 12-0 x Ills n47,rulr4T rrnJNM-e>r,r 14 N VIV, r.FOPT i 04MFPC: F: Br 2 FEET (r/AIM -Edi- SOJaAE \•, FofiCFl FtI�iACaE 15 tiG4 SG iT : y; 14-UsG: Floor Plan - Other Floor Farmhouse Floor Plan - Other Floor Plan #126-236 FULL SPECS & FEATURES Basic Features Bedrooms. 2 Baths 2 Stories: 1 Garages: 0 Dimension Depth . 32' Height ITS' Width 38' https /Iwww.houseplans.com/plan/988-square-feet-2-bedroom-2-bathroom-0-garage-fannhouse-country-cottage-craftsman-sp275332 6112 Wisconsin Departn Division of Industry JUL 11 2022aco°rd Attach complete site pill on paper not less than 8 112 x 11 but not limited to verb I and Ao fflo ink t�(B scale or dimensions, n h A IF PA E SOIL EVALUATION REPORT ice with SPS 385, Wis. Adm Code riches in size Plan must include. ), direction and percent slope, to nearest road C ST- ZoZ2- 04$ Page _ of County ST CROIX Parcel I.D. 014-1040-10-150 Rgviewed by w _Date 21 / - Property Owner Property Location ❑ ❑ TABATHA LUNNING Govt Lot NE '% NE '/. S 19 T 31 N R 15 E (or) W Property Owner's Mailing Address — — Lot 17922# Block # Subd Name or CSM# — — — 1792 20r" ST 1 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road NEW RICHMOND I WI 154017 j (507-838-7529) I I FOREST i 2092 270'"ST New Construction Use: (❑ Residential Number of bedrooms?, Code derived design flow rate M00 GPD ` ❑ Replacement ❑ Public or commercial spfibe: . Parent material OUTWASH /lilio s' �; 00+ Flood Plan elevation if applicable PUA If General comments and recommendations RECOMMENDED SYS MOUND Ong # ❑ Boring u ❑ Pa Ground surface e4ev. 9L.75 ft Depth to limiting factor j§ in. cwaAn- wsru. aMe� Horizon Depth In Dominant Color Munsell Redox Description Qu Az. Cont Color Texture Structure Gr SZ Sh Consistence Boundary Rooks GPDIFt' 'Ef1#1 •Efi#2 1 2 0-9 9-18 10YR3/4 10YR5/3 10YR513` -0- SIL 2MSBK MFR GW 2M 6 .8 1 0' SCL 2MSBK MFR CW 1M .4 .6 3 1 32 F2D5Y414 SCL 2MSBK MFR WA NIA .4 6 NLA I 2 I Boring # ❑ Boring Q Pit Ground surface elev. 97_15 ft. Depth to limitingfactor$Q in —� Horizon Depth In. Dominant Color Munsell Redox Descnption Qu. Az Cont Color Texture Structure Gr Sz. Sh Consistence Boundary Roots GPD/Ftz •E1f#1 L 'Eff#2 1 0-8 10YR3/4 •0' SIL 2MSBK MFR GW 2M .6 .8 2 8-20 10YR4/6 .0. SIL St 2MSBK MFR CW_ 1M 6 .8 3 M36 5YR4/4 C2D5YR4/6 2MSBK MFR WA NIA WA NA yam--- — --- PE - tmueni *i = ovu, > zu > ccv CST Name (Please Print)- - - - CST Number ^ Address I Date Evaluation Conducted I Telephone Number Boring x ❑ Boring (� Pit Ground surface eleil -9LI5 ft Depth to limiting factor 1 S 1 Annliration Rate Horizon Depth In. Dominant Cofor Munsell Redox Description Qu Az. Cont. Color Texture Structure Gr Sz. Sh Consistence Boundary Roots GPD/Ft2 6001 'Effi2 1 0.6 10YR314 0 SIL 2MSBK MFR GW 2M .6 .8 2 6-16 --- 16-36 10YR416 - - 5YR4/4 -0- -- - -- -- C2D5YR4/6 SI; t� ( -.ter--- SL 2MSBK - ---- 2MSBK MFR _ - _ - -- MFR CW - 1M_ - NIA .6 ` - — NA .8 N.A 3 WA ❑ Boring f1 ❑ Boring Pit Ground surface elev ft. Depth to limiting factor - in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Az. Cont. Color Gr. Sz Sh ;;d Application Rate GPD/Ft2 'EM1f1 'Eff82 I I Boring # ❑ Boring Pit Ground surface elev _ ft Depth to limiting factor _____ in. _ Soil Application Rate Horizon Depth In Dominant Color Munsell Redox Description Qu Az Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/Ft2 •Ef #1 'Eff#2 • Effluent *1 = BOD. > 30 5 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOO. > 30 s 220 mg)L and TSS > 30 s 150 mg1L 3 Boring # ❑ Boring ®Pit Ground'surface e11S -n.15 fL Depth to limiting factor 1¢ Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft= •Eff#1 •Eff#2 1 0-6 10YR3/4 •0- SIL 2MSBK MFR GIN 2M .6 .8 2 &16 10YR" a -0- S1; S; I 2MSBK MFR CW 1M .6 .8 3 1636 SYR4/4 C2D5YR4/8 SL 2MSBK MFR NIA N/A N.A N.A 0 Boring # ❑ Boring ❑ Pit Ground surface elev. _ IL Depth to limiting factor _ in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots GPD/FP 'Eff#1 6Eff#2 ❑ Boring # ❑ Boring ❑ Ph Ground surface elev. _ ft. Depth to limiting factor _ in. Cnil ArvJirnlinn Rira Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr Sz. Sh. Consistence Boundary Roots GPD/Ft= 'Eff#1 •Eff#2 Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5150 mg/L 0 Effluent #2 = BOO. > 30 5 220 mg1L and TSS > 30 5 150 mg/L APPLICATION FOR REVIEW Private Onsite o>c Complete all paces- Wastewater Treatment i P S NOTE Personal information you provide may be used for secondary purposes Systems " [Privacy Law s. 15.04(i)(m), Slats J y Division of Industry Services El Plans to be E-filed Provide SharePoint User name below For plan status, check our website at 11q iki> ps avi gcw Email technical code questions to,, :-dto U:iP1S1;('O:'Asl erhui%vn g,,v Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our website at r:• n,v _ 1. Project Information - Fill in all known Information. Confirmation of assignment to a reviewer. Pro)ect/Sde Name L."A" Location, Number 8 Street of project (if unknown, indicated nearest road) o? 0y,9 ] 7$4 s Legal Description A/C, 4E, I`j .31 , / S L✓ County i . GQ.d lX ❑ City ❑ Village ❑ Town of CG94.'!qT 2. After plans are reviewed, please: (check all that apply) ❑ Call customer 1, 2 (circle number)' ❑ Requesting party will pick up ® Mail plans to customer$ 2 (circle number)' 'Refers to customer number from below. Transaction to: Previous Related Trans. ID: Estimated Completion Date: Assigned Reviewer: Assigned Office: Mail to your office of choice below: LaCrosse, Green Say NOTE: We reserve the right to re -distribute plans to another office If needed to reasonably balance turnaround times. Check ,r i i, ; l i, , ,•: :Inv for next available review date 8. Complete the following designerlowner/requesting Information. Utilize the check boxes when dasignor, owner or requesting party Is the same to avoid repeating Information. Designer Information (Customer 1) DSPS First Name Last Name Customer Number ROBERT HARDINA 824825 Company Name HARDINA SEPTIC SYS Address 477 1701" City Stale Zip+4 (9 digits) TURTLE LAKE WI _ _ _ 54889____ _ _ _ Phone Number E-mail address Cell phone (area code) HARDINASEPTIC@GMAIL.COM 715-491-5039 Check if applicable Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number Company Name Address City State Zip+4 (9 digits) Phone Number E-mail address Cell phone (area code) Check if applicable or specify relationship ❑ Owner ---- _ I U Owner __ U Other-- specifyrelationship _ Information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application form and e-mail 4, along with your registered SharePoint username to I 1'' d r • , If plans are being submitted via paper, they will be assigned to a reviewer after receipt at a DSPS office. Submittal checklists can be found in each applicable component manual aMeaftan the POWTS program page under Publications ;,t Holmert/Onalaska Area DSPS 2850 Midwest Or Ste 104 Onalaska, WI 54650 6D8-7B5-9334 Fax 608-785-9330 Email: I Make Checks Payable to: Division of Industry Services OR ❑ Check box to invoice designer and sign below Designer signature SBD-10577 (R 3119) Green Bay DSPS 2331 San Luis Place Green Bay. Will 54304 920492-5601 Fax 920492-5604 Email TOTAL AMOUNT DUE 5 _ Review Codo 7633 Cz-ems. � ECRON. couNnr STA OWNER Q PLUMBER ?,p99Vr *AMMA TOWN OF SEC_9T_31 _N, AND/OR LOT_ OA(U' S S2) W 6 Sq3 M NOa 644738 'A Y PERMIT s-r. P VIOU$ NO. BLOCK Z SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of a sanitary permit (e) Renewal of the sanitary permit will be bused on regulations in force at the time renewal h sought, and that changed regulations may Impede renewal. (f) The sanitary permit Is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. A ORI ED ISSUING OFFICER - DATE r/ tq z0ZZ, PERMIT EXPIRESIS UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)