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016-1030-10-050
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law. it 15 04 11)(m)I Permit Holder's Name City Village Township Grace Farms LLC I TOWN OF GLENWOOD TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ni Dosing 1 �0 Aeration 9 TANK SETBACK INFORMATION I Ar Iv. f 1. --.A C? TANK TO P/L WELL BI- Veel Ir Intake ROAD Septic % Dosing I S� 7 ! t d'J f Aeration Holding PUMP/SIPHON INFORMATION .A A l.r A1t 7,R Manufacturer Demand S GPM ,� .CG ✓ JFf Model Number TDH L Fric Ion oss Sysl He TDH 4 � Forcemain Len t Dia. Dist 10 well t 1 SOIL ABSORPTION SYSTEM BEDlTRENCH Width s Lengl DIMENSIONS SETBACK SYSTEM TO INFORMATION Type 9f ystem DISTRIBUTION SYSTEM Header/Mandold Distribution Pipes) Length Dia Length SOIL COVER k INo Cf ,7611(�'l 17 5o1 ELEVATION DATA Far1�117161dr3�.- / � NMI -mm i , i / -��l■ , / :. --iffl / 'l i m-� A.. .. is CHAMBER OR UNIT food; r 1 x Hole Size , x Hole Spacing s Dia� Spacing i I (P, 3. 6. Y Pr9SSnra Svstoms nniv .. Mnund ryr At.Grarto Svetome Aril. / Liquid DepN Ov Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTr ch Center • Bed/Trench Edges Topsail l a Yes No Yes No COMMENTS: (Include code discrepencies, persons present. etc) Inspection #1 `sy[� Inspection #2 Location: 3178 158TH AVE 1.)Alt BMDescription =_(k,,C0VY✓ 2.) Bldg sewer length - amount of cover ='>•!1 yr` �{ 11� �� �ia� �/ �j���7) 0�` �? �SSG�S r P��� ( (/ ✓��YV�GI/✓U ��r,fy�Il/l$ Ir/ �i ��`° �Li�� (�(%l� _ ��{r�pPnr� Plan revision Required? Yes V No Lo /yr 1 /y� '""' 4 7 =S.gnturi '�/"'�l`��Use other side for additional information ilVl J �jD (SBD-6710 (R 3197) Date ns is e/, Carl No C; o F Co ff W�`N� R11 Ll r�Ci� � ' ty, Safety and Buildings Division ST CROIX s• 3 0 2022 201 W. Washington Ave., P.O. Box 7162 sanitary Permit Number (a>x filled in by Co.) ► pUG Madison, WI 53707-7162 * r G4J 7" - �i k menu Permit Arn)plic State Transaction Number In accordance with SPS 383.21(2). Wis. Adm. Code, submission oTthis form to the appropriate ovmunental unit (9 V ZZ 0Z�!2 I— is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if diffamt than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy l.aw, s. 15.04(l m Stats. 3178 158TH AVE I. Application Information - Please Print All Information Property Owner's Name Parcel p RUSS JOHANNESSON b-2rae rm�, uL 016-1030-10-050 Property Owner's Mailing Address WATERFORD LN Pun, A6688 I �I. 3n 5 , Z Z1 Govt. fat NE S NE t Section 14 City, State Zip Code Phone Number EXCELSLOR MN 55331 312-961-2494 (circkeoe 30 N; R 15 E or II. Type of Building (check all that apply) Lot 4T IN 1 or 2 Family Dwelling - Number of Bcdmoms 3 1 Subdivision Name Block 11 ❑ Public/Commtacial - Describe Use ❑ City of ❑ State Owned - Describe Use Village of CSM N 36 �J _ � 2-6— 576 g Town of GLENWOOD Ill. Type of Permit: (Check only one box on line A. Complete line B If applicable) A' ❑New System ®Replacement S ❑ Trvmrem/Holdin2 Tank Replacement Only ❑ Other Modification to Existing System (explain) B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Tn msfer to New List Previous Permit Number and Date Issued Before Expiration Owner � u IV. TyK of POWTS S stem/Com neovDevice: Check all that a 1 h )1 t o - uri ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑Pretreatment Device (explain) 5a h - ► I V. Diet rsal/Trea at Area Informatl(Jl Ov Design Flow (gpd) Design Soil Appli i Rate(gpdsf) Dispersal Area (sf) Dispersal System Elevation 450 .8 246 6& 2. S 246 =0� 100.48 VI. Tank Info Capacity in Gallons T 1 Gallons p of Units Manufacturer. P LD k 5 46 g b $yy u New Tanks Existing Tanks 111 � m h � VO FC k7 p, Septic or Holding Taok X 1000 WIESER X Dosing Chamber X 600 WIESER ovvl t7 X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number PAUL R KOEHLER 000 225410 715 246 2660 Plumber's Address (Street City, Sate, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI V111. County/Department Use Only ;(Approved ❑ Disapproved Permit F« Date Issued Issuing Agent Signature ❑ Owe for Denial s 6�5- 9e Zz IX. CooOWNEo prove s-fos�lsappwval3)A'1 �OK l )/ e� � G Olprova !t l l �,.) 35 YSTEM OWNER: / 1. Septic tank, effluent filter and GiK��- dispersal cell must be serviced / maintained 1 ( t as per management plan provided by plumber. �i)� ` i JAA� ��� St % PVI't 4An Jt'Ylalj( R.All setback requirements must be maintained ..� r+.....rr�...........................w,,w.rr^•• w•• •••• •.. n .w ..van w ur..vv.ry va7' w WPrr au reds seta a ua x r rPaaer u me SBD6398(R.11/11) 4 r110y1L br" 2 ' lS,CI �c�cs p�2 / G nace 'F-Iif rn .1.(:- 1D3b-10-050 "ownv� G�hIvODP �� 4 ^cL�lcrr{Z 1"Pre =1ve,� Qth�► Mari I1�1— p%os/ Prt2 953 Q ,+3 �- � S to p� L'b o LIud 'Ba 16 f1RDW loel-�Vl %OW4 County Safety and Buildings Division ST CROIX 201 W. washirglon Ave., P.O. Box 7162 Sanitary Permit Number (to be filled m by Co.) t ,r� Madison, WI 53707-7162 Sanitary Permit Application — Start Transaction Number In eccordamc with SPS 383.21(2), Wis. Aden Code, submission of this form to the eppmpriatc governmental unit is required Prior to obtaining a sanitary permit. Note: Application foam for state-owned POWTS arc submitted to the Department of Safety and Professional Servies. Personal information be for Project Address (if different than mailing address) you provide may wed secondary Purposes in accordance with the Privacy Law, s. 15. I ml Stats. 3178 158TH AVE I. Application Information - Pkase Print All Information Property Owner's Name Parcel It RUSS JOHANNESSON 016-1030-10-050 PropertyOvmWe Mailing Admess Property Location 6688 WATERFORD LN Govt. Lol NE ,A NE X, Section 14 City, State zip Code Phone Number EXCELSLOR MN 155331 312-961-2494 (circle one) T 30 N; R is Eor jy It. Type of Building (cheek all that apply) Lot M ® 1 or 2 Family Dwelling Number of Bedrooms 3 1 Subdivision Name ❑ Public/Commercial - Daen'bc Use Block p ❑ City of _ _ ❑ State Owned - Describe Use - — ❑ village of -- CSM Number - ®Town otGLENWOOD 111. Type of Permit: (Check only one box on Hot A. Complete line B if applicable) A' ❑ New System Replacement System ystem ❑ Traurlerd/Hokling Tank Rephnceanernt Only ❑Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revi im ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before ExpuaOoo Owner IV. T of POWTS Svstem/Com ent/Device: Cheek an that apply) ❑ No Pressurized In—G o and ❑ Preasurbrd In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil (g Mound <24 in, of suitable sold ❑ Holding Tank ❑ Other Dispersal Component (explam) _ - _---- --- ❑ Pretrahneat Device (explain) V. Db rni/Trestmeot Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required s Re+q (t) Dispersal Ara Proposed (st) System Elevaliaa 450 .8 246 246 100.48 VI. Took Info Capacity in Total p of Manufacuuer Gallons Gallons Ihtin R Nm Tanlu Fi stws Tanks e Septic w Holding Tank X 1000 WIESER X ooamgfxanaer X 600 WIESER X VII. Responsibility Statement- 1, the undersigned, ayune respoadbWty for Itnta4tloo of the POWTS shown on the attached plans. Plumber's Name (Prier) Plumber's Signature MP/MPRS Number Business Phone Number PAUL R KOEHLER 225410 715 246 2660 Plumber's Address (Stme4 City, State, zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI VIII. Conn /Departmenit Use Only ❑ Approved ❑ Dtsapprovod Permit Fee Date Issued Issuing Agmt Signature ❑ Owner Given Reason for Decrial S IX. Conditions of Approval/Ressons for Disapproval �— ........, M uv ..vvv.r v�r ve aka m fir• meal • Vl f 11 O1taY r aloe SBD-6398 (R. 11/11) Wisconsin Department of Safety and Professional Service. Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, W 153707 August 25, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-8-25 Plan Review: PWTS-082202021-C Paul Koehler 321 Wisconsin Dr New Richmond, WI SITE: Russ Johannesson 3178 158" Ave Glenwood Township St Croix County NE Y. NE Y. S14-T30N—R15W FOR: Phone: 608-266.2112 t. Web: http://dsos.wi.2ov Email: dsp§Awisconsin.aov F Tony Evers, Governor ,, a+ Dan Hereth, Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Description: GSF Mound Component Manual — (11/19), 3 Bedroom Mound — 450 GPD — 20" to Pressure Distribution Component Manual — Ver. limiting factor —Effluent Filter - 2.1(May 2022-2027) Maintenance required 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 • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Install the GSF products and distribution piping per instructions. If using pressure distribution, distribution pipe should be sleeved through the 4-inch corrugated pipe located in the GSF product. One out of every five orifices in each distribution pipe shall be installed at the 6 o'clock position so as to allow for thorough drainage of the distribution pipe following each dose. The remaining four orifices shall be installed in the 12 o' clock position. All pipes must drain after dosing. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 14S.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(i). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)634-5124 Joshua.rowley@wisconsin.gov GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Project Name: GRACE FARMS Owner's Name: RUSS JOHANNESSON Owner's Address: 3178 158TH AVE Conditionally GLENWOOD WI APPR nFar nF RAPPTV AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Legal Description: NE NE SEC 14 30 N 15W Township: GLENWOOD County. ST CROIX SEE CORRESPONDENCE Subdivision Name: Lot Number. 1 81ock Number. Paroel I.D. Number. 016-1030-10-050 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 GSF mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Designer. Paul Koehler License Number. 225410 Date: 8/2/2022 / Phone Number. 715-246-2660 Signature: �+� � Designed Pursuant to the GSF Mound Component Manual (N. 08/16), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF Mound Version 2.27 Page 1 of 8 GSF WI MOUND DESIGN PROGRAM DATA ENTRY Site Information R Residential or Commercial Design ONumber of Bedrooms (optional) 450 Design Flow (gpd) 6.0% Site Slope (%) 99.15 Installation Contour Line Elevation (ft) 120.00 Contour Length Available (ft) 20 Depth to Limiting Factor (in) 0.3 In-Sltu Soil Application Rate (gpd/ftz) EFF #2 Distribution Cell Information A42 Unit Used 6 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 101 = Dispersal Cell Length (ft) 2.0 Dispersal Cell Design Loading Rate (gpdtft2) 2 Influent Wastewater Quality Are the laterals the highest point in the distribution Pressure Distribution Information network? Enter Y or N E Center, End, No Manifold (Pump to Gravity), or Gravity (No Pump) 3 Lateral Spacing If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) (e.g. 0.25) 3.5 Estimated Orifice Spacing (ft) = 10.82 felorifice Forcemain Diameter (in) Forcemain Length (ft) Inside Pump Tank Elevation (ft) / 4.55 System Head (ft) x 1.3 l0 O 1207.Vertical Lift (ft) riction Loss (ft) Add'I Fitting Friction Loss (ft) 17.79 Total Dynamic Head (ft) Project: Lateral Diameter Selection in. diam. options choice 0,75 1.00 1.25 1.50 2.00 !XI--7- x Se tic Tank Information 1000 Se tic Tank Capacity (gal) WIESER Manufacturer Dose Tank Information _ 654 Dose Tank Capacity (gal) 11.82 Dose Tank Volume (galin) WIESER __ ____]Manufacturer GRACE FARMS Does the forcemain drain back? 9.79 Forcemain Drainback (gal) 160.75 5x Void Volume (gal) 159.79 Maximum Dose Volume (gal) 30.16 System Demand (gpm) 50x 3=150+9.79=159.79 Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallonslinch Calculator 654 Total Tank Capacity (gal) _ 39 Total Working Liquid Depth (in) 16.76923 galfin _ Effluent Filter Information POLY LOCK I Filter Manufacturer 525 Filter Model Number Page 2 of 8 GSF WI MOUND DESIGN PROGRAM GSF MOUND DRAWINGS Mound Plan View mvui n. wrnyvi earn unntrnrrwne A 6.00 ft E 20.32 in H 1.00 ft K 9.29 ft B 101.00 ft F 7.00 In I1 10.16 ft Ll 119.58 ft DI 16.00 in G 0.50 ft il 6.14 ft W1 22.30 ft 606.00 (ft) Dispersal Cell Area 4.46 (gpd/ft) Linear Loading Rate Finished Grade 102.07 (ft) 1632.01 (ft2) Basal Area Available 10.10 (ft) 1110 B Obs. Pipe Placement .. Lateral Invert F . Dispersal Cell lto. Elevation 1oo.4s (ft) —. j.. Dispersal Cell Elevation :•" 3 3. 1 41 Contour Elevation B% SRe Slope Shading Key Typical Dispersal Cell 1 millTopsoil Cap $ - See Page 5 2 I.Y; Subsoil Cap as a I 2 ft Geotektle 3 ASTM C33 Sand _o` 19 Fabric i i� 4 5 r,' c: Tilled Layer GSF Media & F r I Ll I Cell Header ;y a 0.5 ft 1 1 /Footer SF A See details on page 4 for number, size and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project GRACE FARMS Page 3 of 8 GSF WI MOUND DESIGN PROGRAM LATERAL AND DOSE TANK End Connection Lateral Layout Diagram Place Appropriate Lateral Dlacram From Riaht Relevi Tumrq VA" valve or cmaxxtt plug �2 Iat orrifioe lolled at z L - —X�u — — — - Oh orze patq up auwapt every SMr ane potYa down fa L--Edge d dlaabution 0@1 -- -- -- - drainage.- - - Faroe mein connection via tee cr cross to manifold at arty pdm. Laterals 8 face mete d PVC Sch 40 AN latorok IderHical with artfgoa equaly spaced_ (Par COMM Table 354.30-6) Edge of cl trbAw cal mumoem or Laterals 2.00 Orifice Diameter Lateral Diameter 2.00 in Orifice Spacing ()n Lateral Length (P) 99.28 ft Orifices per Lateral Lateral End (2) 0.73 ft Orifice Density Lateral Spacing (S) 3.00 ft Manifold Length Lateral Flow Rate 15.08 gpm Manifold Diameter System Flow Rate 30.16 gpm Forcemain Velocity 9855 Pump Off Height Dose Taut Information BacetI mpr tEC 300 Ind 0 m IfLZ AC r Tr* emptret is pCps lyv.,ted r WIESER Manufacturer Capactry 654 Gallons Volume 11.82 gal/Inch Dimension Inches Gallons A 2690 317.98 B 2.00 23.64 C 13.43 158.72 D Total 55.33 654.00 f — A B l A/rL 3" Bsdlrp undo Mc asp V amervth we t / and taro dwioamid Seim 50 1 ♦n1mh. �\ J Alarm Manufacturer SJE Rhombus or Equiv Alarm Model Number -- AtenNemad tr�tm �) Famn do man 2 in i...i 11VhW hW a +*rahm dMa Pump Manufacturer __ _ Gaa Pump Model Number EP 05- J1 Pump Must Delivery 30.16 gpm at 17.79 it Ratpdeaeavt(t) L- 0aeeta*deeaanM u9M 89 Project: GRACE FARMS Page 4 of 8 GSF W 1 MOUND DESIGN PROGRAM DISTRIBUTION MEDIA GSF Distribution Cell Media Layout ©Cell Width (ft) 1.5 Sidewall to Lateral (ft) B FT WIDE END CQN EcnDN Distribution Cell Cross-section Arrangements Component Legend ■ ASTM C33 Sand/Mound Sand A42 or B43 Module -- - - Lateral Turn -up (contained In Turn -up Enclosure) Distribution Cell Plan View Layout - Typical 6 Cell Width - A Ift) 101.00 Cell Length - B (ft) 25 A42 IModules Required per Row 50 A42 JTotal Modules Required L End Connection Later Layout Diagram Drag appropriate drawing from left to space below. Project: GRACE FARMS Page 5 of 0 GSF WI MOUND DESIGN PROGRAM SYSTEM MAINTENANCE SPECIFICATIONS Mound System Maintenance and Operation Specifications Service Provider's Name PAUL KOEHLER IlPhone 11S-246-2660 POWTS Regulator's Name ST CROIX COUNTY Phone 715-3913800 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 In Estimated Flow -Average 300 gpd Maximum GODS 30 mg/L Septic Tank Capacity 1000 gal Maximum TSS 30 mg/L Soil Absorption Component Size 246 ft' Maximum FOG 10 mg/L Maximum Feral ColHorm 10E4 cfu/300 ml Sepik and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once every 3 years Should Inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.S years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured In a as shown in the Ellen mound component manual. 2. Dispersal cell media conforms to Ellen products approved for use with the Ellen Mound Component Manual approved August 2016. Ellen media Is covered with the manufacturers geotextik fabric. 3. All gravity and pressure piping materials conform the requlremenu in the state code. 4. Tillage of the basal area is accomplished with a moll board or chisel plow. S. 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 6 - 8' DIAMETER LAWN SPRINKLER FINISHED GRADE- - LATERAL ENDS AT LAST 4' PERFORATED PIPE — RCE WHERE VARIABLE LENGTH QEANOIJT BEGINS \ 4' ENI r•Jr �- DISTRIBUTION LATERAL LATERAL CLEANOUT LONG SWEEP 90 OR TWO45 DEGREE BENDS SAME DIAMETER AS LATERAL Project GRACE FARMS Page 6 of 8 GSF WI MOUND DESIGN PROGRAM MANAGEMENT AND CONTINGENCY PLAN Mound System Management Ran General This system shall be operated in accordance with SPS 82-84 Wis. Adm. Code, and shall maintained in accordance with Its' component manuals ElJen Mound Component manual August 2016 and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 83.33. Wis. Adm. Code when the tanks are no longer used as POINTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greaterthan 6- Inches in diameter shall be segued by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stela. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the miter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triemial assessment, maintenance personnel shall advise the owner of when the next service needs to be pertorrod to maintain less than maximum scum and sludge accumulation In the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank It shall be inspected and serviced as Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mounds perimeter, and the mound shall be goaded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing. The pressure distribution system Is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed It should be compared to the 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. Observation pipes within the dispersal cell shall be checked for effluent ponding Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequerd monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or componem shall be repaired or replaced to keep the system In proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective componert(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removfng biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system Into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: GRACE FARMS Page 7 of 8 0 i ql fvlr 1 O �4'�'F'Q MAr-q 9l %0? 'd°!S ,do/y FSI� Z�s(3 r 050-01-q�°� -9�a Q y r-)l rd :old 4 0 1. GOULDS,PUMPS ,o e COMPONENTS Submersible Effluent Pump EP04 & EP05 6 e — Series 3 t 1 11131111 No. 1 Y6pds 2 Ibm 3 R" Caft 4 M6dd" Seel S 9M 9aw%p 6 0AW 7 PWAN Cord 1 01 Fled MOW 9 Molormowebw 9mm AssnaEly 10 loft Corals PERFORMANCE RATINGS ToW Nod Ill. al we" Gdan ►a Miwce EM EPOS 5 53 - 10 46 62 15 36 55 20 21 45 25 0 33 30 - I 11 MODEL INFORJ>IIIATION DIMENSIONS W daasmW a aae d kKtm. Do not w for mnsrurnon pwposW 0 6' MINIMUM WATEEIEVEL WNENJ Sl1PPM WRM RGAT SW CH OrdvNO. IM hold Asps Mro slss Orak PAoe Floc Wtd1 Cad N w On Mrdsro Do MY, "n Wln So" 9111AW Style lamb COrunctiorl lad Law OleraEEN SIN EF0411 , 115 12 20 1 my I No Switch td 1'R Me" Mwwl 150 w 20/9.1 FEO111A ftyback/Witli6ko 1d 1D1• 12' L' 1S 2119S EP0411F q /Mo5w" 20,ren) 1w MWAW W ISO.20/9.1 EPOIIIACP40tad / WWRArsk 2d 1W 12' 6' 1S 2119S 11111112 230 6 10 1 NO With 1 d I w Mo,i Merenl 1 S EP04/2F 1NoSwhth 29 1w*M.M-" Waol 1S' EP0511 F ,5 115 13 20 / No Switch id 1 %. Mv" 15, FO511AC 17 Plpgybedt/WldrArgk 2d tYS' 6' 1S EP0512F 130 6.5 10 / No SssNdr 2d 1 Y,' Msranl 1 S 221410 Goulds Pumps and the fly Eopaeaed Blacks Symbol are e&wed trademarks and tradenames of -r lndustnes. www gaulds.wm MINTED N USA SPEORU1THM ARE SUWECT to CmANW vAT"Otff NOTIQ. <& ITT Industries MPT paLY' 4x-� Innor�tiaun%rwt Drairuyr zi. PLC-525 Effluent Filter a K'mrwatM %eM<tt a Dhbor of Coybk M[. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-12Z the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. if the filter is not centered under the access opening use a Polylok Extend do Lok or piece of pipe to center filter. 4. Insert the FL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2 Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. IA6" Filtration Slots 10..* GPD I r Accepts 4- k 6" SCHD 40 pipe Alum Switch topdomQ Accepts V PVC Extension Handle Rated for IQ000 GPD 525 Lines Ft. of 1/16" Filtration Slots I ®Certified to NSFlANSI Standard 46 Gas Deflector Automatic Shut -Off Ball k --L - L,-. L Outdoor SmertPiltere Alarm Extend h LokTM PolyloX Zabel & Best filters accept Easily installs the SmartPilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 1b11 Rce: 877.765.9565 Fax: 203.284.8514 www.polylok com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION Owner RUSS JOHANNESSON Permit f DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units fXNA Estimated flow (average) 300 gal/day Design flow (peak), (Estimated X 1.5) 450 gal/day Soil Application Rate •3 al/da /ft' Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y. in die. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluard. SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer WIESER ❑ NA Effluent Filter Manufacturer POLY LOCK ❑ NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity 600 al ❑ NA Pump Tank Manufacturer WIF.RFR ❑ NA Pump Manufacturer GOULDS ❑ NA Pump Model EP05 ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ NA ❑ Pest Filter ELGINS ❑ Wetland X Other: Dispersal Cellist ❑ In -Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) jQ Mound ❑ Other: Other. ❑ NA Odwr: ❑ NA Other: ❑ NA mwn � rnnna.� o�.nu.v� Service Event Service Frequency Inspect condition of tankls) At least once every: ❑ mont 3 Mal aerial (Maximum 3 yews) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y.) of tank volume ❑ NA Inspect dispersal call(s) At least once every: 3 eajs)(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(sl ear(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) 3 M year(s) ❑ NA Flush laterals and pressure test At leaonce every: st ❑ yawls ❑ year(stsl ) AS NEEDED ❑ NA Other: At least once every: ❑ month(s) ❑ year(s) Ex" Other: 'R NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankis) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page Z of 2 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal ceg(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the Ufa of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: a All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. W/1� slue' o mg lank b e ai ?2 D4180"i ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDJOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name COUNTRYSIDE PLUMBING Phone 715-246-2660 POWTS MAINTAINER Name PAUL R KOEHLER Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name BERANDS SEPTIC Phone 715-265-4623 ame Fh s—�— C ZOAII�Jone —J/s— 3g(o— (O ifo This document was drafted in compliance with chapter Comm 83.22(2)(b)(1l(d)&If) and 83.5401, (2) & (3), Wisconsin Administrative Code. 111 Wis. DaK ofSafety and d OIL Ej/ALUr0I'f10N R'EPDRr- Page 1 of 3 Division of Safety and 8 in SPS 385, Wb. Adm. Code St. ro'x n t County gt Attach nwrlpleb sib p t Inchas In sloe. Plan must you include, but not Bmlled ntal reference Point (BM), direction and Parodl.D. 016-1030-10-050 percent slope, scale or dimensions, north arrow, and location and distance to nearest mad, FURS@ pint Oil information. Reviewed by Dab Panonar luforrrreon YOU WOMS may be umd fw asomwary purpaaaa (pdv" law. S. 16.04 (1) (m)). TopertY Owner Property [—= i— GRACE FARMS El Gout Lot NE V4 NE114 S 14T 30N R 15E (r) roperty, Owner's M•r N Address Lot 1891 0 Subd NameorCSW 6688 WATERFORD LN unbar own Now" Road EXCELSIOR MN 55331 ( 3IF-961-2494 CTY X n I 13Nw Consru thn USPE3 Residential / Number of bedrooms 3 Code derived de"n flow tab 450 GPD Ea Replacement 13PuWc or Commercial - Dmcrttrs: Parent material LOAMY TILL Flood Plain @"bon If sppic" R General corrnrnb and reoortmendabons: 1 I eor;,g • u Mal" L� a Pit Ground surface elev. 99.15 R Dooth to immotilo facer 38 1., Horizon DepthDortnhnant in. Color mum" Redox Description Ou. Sz. Cont Color Texture Strum" Gr. Sz. Sh. bonsisbrics ry Rods Soll • Rob GPOJR 11H 1M2 A 0-9 10 YR 3/3 ---- SIL 2 M GR DSH CA 1F .6 .8 B 9-38 10 YR 4/3 _ _ _____ SIC 2 M GR DH CA 1 VF •2 .3 C 38-50 10 YR 616 — ----- SL 0 M DH -- — .2 .3 r—� n 1 Boring u 1 1 El Ph Ground surface slev. _ 95.3 it Damith to It Also fim*w 2$ 6 Horizon Deptln in. Dominant Color Murrell Redox Descriplion QI. Sz. Cont Color Textue t>trudue Gr. Sz. Sh. nce ry Roob 30� Rate GPD/ft Mt fllt2 A 0 9 10 YR 3/3 SIL 2 M GR DSH CA 1F ,6 g B 9-28 10 YR 4/3 ---- SIC 2 M OR DH CA 1 VF 2 .3 C 28-37 10 YR 4/6 --_—_____ SL 0M DH — — 2 3 --••7� uwwnrc—wan �JV I71pIL r41�<ylr lnprL CST Nrne (Please Print) Signature /� CST Number PAUL R KOEHLER G- 223410 Address Dab Evaluation Conducted Tsbptlone Nlarlber 321 WISCONSIN DRIVE NEW RICHMOND WI 54017 JULY 14TH 2O22 715-246-2660 SBD-trio (R] IA 1) Properly Owner GRACE FARMS Parcel ID # 016-1030-10-050 3 Boring N Borg 99.15 Page a Pit Ground surface elev. 20 Depth to limiting factor in, Horizon Depth Dominant Color Redox Description Texture Structure Soil in. Munsel Qu. Sz, Cont Color onslabrice Gr. Sz. Sh. ndary Roots GPD/R A 0-9 10 YR 3/3 __—_ SIL 2 M GR DSV 11111111 Rt2 CA IF B 9-16 10 YR 313-----____ SIL OM DH 6 g CA 1 VF .2 C 16-20 10 YR 4/3 .3 ----- ------ SIC 0M DH CA — C1 20-33 10 YR 4/3 7.5YR 5/6 F SIL 2 M GR DH .2 .3 CA C2 33-50 10 YR 4/3 7/5 YR 5/6 F SCL 2 M GR DH — .6 .g .4 .6 aBoring 0Boring B Pit Ground surface elev. ft Depth to limiting factor in. Horizon Depth Dominant Color Redox De Description Texture Structure Sol W in. Munsel Qu. Sz. Cont Color naiak Gr. Sz Sh. ry R� C,P , e.,. .�� Boring [a Boring Pit Groff surface ekv. ft Depth to knitici factor in EMuent 01 = SOD > 30 < 220 "WA and TSS >30 < 150 ` mg2 ' tJBwnt N2 = BOD , � 30 mgrL and TSS 130 mgrl The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. sew»orm 0. i vi n O 0 b ti'd Sd� L =-'Od LTI ST CRo NTY SANITARY SYSTEM File#: OffiUse OWNERSHIP/ADDRESS FORM Crarftd 1anfy 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 RUSS JOHANNESSON Mailing Address 3178 158TH AVE City/State/Zip GLENWOOD CITY Phone Number (reauired) 312-961-2494 Email Address (required) RUSSJOHANNESSON@HOTMAIL.COM Parcel Identification Number 016-1030-10-050 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NE y� NE y, Sec. J T 30 N R 15 W, Town of GLENWOOD Subdivision Plat: Lot # 1 G3 Certified Survey Map # ! 0q Volume ZS Page* 57L 1. Warranty Deed # _� jr):2s4 2L]' , (before 2006)Volume . Page # Number of bedrooms 3 Spec house O yes ■ no Lot lines identifiable Cl yes ■ no New Property Address OFFICE USE ONLY (Verificationyt new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is mode in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.00v • • �� CST aoaa - 155 Vft. Dept of safety and POIL EVALUATION REPORT Page Im ► of 3 Division of Safety and Bui Ena ith PS 385. Wis. Adm. Code County st croix Attach complete site Ia p priches in size. Plan must include, but not limited te point (BM), direction and Parcel I.D. 016-1030-10-050 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rir by Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Q 1 v Z Property Owner Property Location rC GRACE FARMS Govt Lot NE 1/4 NE114 S 14T 30N R 15E(or)W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 6688 WATERFORD LN I I 76 _157 6 City State Zip Code Phone Number ity [3ViIlage a own Nearest Road EXCELSIOR I MN 1 55331 1 ( 31)2-961-2494 CTY X ❑ New Construction UseE3Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD OReplacement Public or commercial - Describe: Parent material LOAMY TILL 4 Flood Plain elevation if applicable G rLL X ft. General comments �� l0. - At ('ptArU and recommendations: Boring # O Boring El Pit Ground surface elev. 99.15 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft }f#1 11#2 A 0-9 10 YR 3/3 SIL 2 M GR DSH CA IF .6 .8 B 9-38 10 YR 4/3 ------------------- SIC 2 M GR DH CA 1 VF .2 .3 C 38-50 10 YR 6/6 ------------------------- SL 0 M DH 2 3 ❑2 Boring # U Boring 95.3 28 Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ' ff#1 ' 1192 A 0-9 10 YR 3/3 ------------------- SIL 2 M GR DSH CA 1 F .6 .8 B 9-28 10 YR 4/3 --------------- SIC 2 M GR DH CA I VF 2 .3 C 28-37 10 YR 4/6 ------•------------- SL 0M DH -- ---- .2 .3 - tmuent syl = tsuu > :w <[u Zmg1L ana l as >su < l au Mg1L - tmuent wz = tsVu .su nlgrL ano 100 � .w mgfL CST Name (Please Print) — — Signature J CST Number PAUL R KOEHLER ����iL� 225410 Address Data Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NEW RICHMOND WI 54017 JULY 14TH 2O22 715-246-2660 J Property Owner GRACE FARMS Parcel ID # FTIBoring # 11 Baring 99.15 ❑ Pit Ground surface elev. ft. 016-1030-10-050 Depth to limiting factor 20 in. 2 3 Page of _ Cnir Ar"ir.hnn 0n1. Horizon Depth in. Dominant Color Munsefl Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft = fl#1 '101102 A 0-9 10 YR 3/3 -------------- SIL 2 M GR DSV CA IF .6 .8 g 9-16 10 YR 3/3 --------------- SIL 0M DH CA 1 VF .2 .3 C 16-20 10 YR 4/3 ------------- SIC 0M DH CA ---- .2 .3 C 1 20-33 10 YR 4/3 7.5YR 5/6 F SIL 2 M GR DH CA --- .6 .8 C2 33-50 10 YR 4/3 7/5 YR 5/6 F SCL 2 M GR D►{ ---- ---- .4 .6 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Cnil Onnli�Yu.n RnM Redox Description Boring # g Bay Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aoolicaflon Rate Redox Description Qu. Sz. Cont. Color Effluent #1 = BOD S > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 130 mg/L and TSS 130 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format. contact the department at 608-266-3151 or TTY through Relay. SBD4330TM (RI 1/1I ) p. � I u 15,L1 oM� `�- i� Gra,c.e_ �q�+h 1. LC -Aw - 31706 15$}L aC P. cc.l 1 b alb-1o3a-ID-o5o Bm,�P,�3 _ TO w rU� GIG M1..lJ pp� N E % N��y S��iy 3oN ISw �v �thol- 1'`IlarlC 1 .C2onc COUNTY Mif I STATE �-SANITS 3i8 Ave- qQTfMN1 NEWAL OWNER fi4em("b NO. 645409 RY PERMIT PREVIOUS -NO. --' PLUMBELIC.# ZZS O TOWN OF_ SEC_ ,T. 3o N, R IS ' AND/OR LOT I BLOCK ;,�►�2y'-,g)p,c; 09s`� SUBDIVISION Cam: ER 145.135 d) WISCONSIN STATUTES ta) Thejhrpose of the sanitary permit is to allow Installation of the p vate 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 maybe renewed fora specified period. (d) Changed regulations will not Impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit Is transferable. History: 1977 c. 168;1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. A, A w ED ISSUING OFFICER — DATE PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20) w � J r• . gnp DPW