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Home My WebLink About030-1040-90-000Wisconsin 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.15.04 (1)(m)], Permit Holder's Name: City Village Township Mary Frawley TOWN OF SAINT JOSEPH CST BM Elev: Insp. BM Elev: BM Description: 100 '�M I an 50\� _ s TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ie ym- Dosing Ae� io ofbi ng...-. L 5"25 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Wu �� Demand GPM � 5 Id Model Number �E5112)9.-62-c TDH Lift Friction Loss System Head TDH Ft 15.24 2 b � 3. 2 S_ 2.1. 3�- Forcemain Length Dia. Dist. to Well1 go L ll uJL�� I/13�4I�24 SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 651256 State Plan ID No: Parcel Tax No: 030-1040-90-000 Section/Town/Range/Map No: 19.30.19.145 STATION BS HI FS ELEV. Benchmark c$� o�16&b f Alt. BM Bldg. Sewer 11 y 5 St/Ht Inlet I � •�1 St/Ht Outlet Dt Inlet Dt Bottom Header/Man. 1,05 Dist. Pipe Bot. System 3•� Final Grade St Cover Lmtb ��J Sir '� �c�ra�lC V • �.5 � �� - Do BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Insid Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT '�DrIL c Type Of System: MDOI d I �c) ��-`BSI I LOA tic n Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Pipe(s) Length %.52 Dia i 5 Spacing 3 �� I lw k °� SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil VYes ❑ No K Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7Z(Z hn23 - �C1 Inspection #2: 012)2623 Location: 335 144TH ST 1.) Alt BM Description = e 14D Well a� -h'm� A 'IOSpeeiiun, 2.) Bldg sewer length - amount of cover = Plan revision Required? ❑ Yes ❑ No I� 2 Z 3 ? N5 Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Pignature Cert. No. F-,-'---------- �trJ-2o2�— 1 72 F1 tip. � -Y Set -vices Divisi t ion County • 4822 Midison Yards Way 12 1-0 F— S aTI j t �.i ry Pori i i I i 'N'0 m I-) er (t fi 11 cd in by Co.) "S P AUG 11 2023 7[7, Madison, W1 53705 P.O. Box 71 62 M adis 'un W1 53707-7162�! 2 56 C a rn in it Application Stato Ti section Num bur In aceordance with SPS 383-'?1(-'), Wris, Adm. ot e, -.4tbmission of this form to the appropriate govemu"ental urtit P07S� - 0 9 2- ill F-NuiTe. d ])Ti 0 r to obtaining a sianitiry pknnit, Note: Appllcwion forins for siate�'wned POWTS are submitte(I to Proi eC L Address (i f d i JTe vc n I I ban mai I I Illy, ad dre&s I [lie Depamueiit of Safety and Pro fessionrit Services. Personal inforination you provide may be used for secojidafy puipo.�eg in ui:c�rdance xvith the Priv-Licy Li3w, s. 15.04(1)(ri), Slats. I. Applira tio,11 Utfortilation Plcase Print All Inforniation - .3 T-7 i i c r's Na ine 11w1fen"y' 0--%� - J�Iail ingAd Loc;jlion Govt., Tjot Otv' S14 to 7-1p CUIC ?MT10 NtLniher T od 11. Type of 1' t i i I d n g (check k aI I that apply Lot 0 I01 or 2 Fiinii ly 1) Nv(� i IM g - Miniber o f B edrooms Subtfivision Nanic o Block -.4 r�Public/Commercial - Describe Use City of IE]Stale 011'nM - Describe Use Tillage of CWMIN"iber "Town of V111-1 III - 'Uype ref PO W TS Per it; eck either "New" or "Rep]7�ement" and other applivable on lint- A. Check one box on fine R. Ct)niplete line C if A, EDNov Sys-w-I'll eplaccMent sy'.'-will []ln-Ground (hbor i f cai iaii to Ext 'Irl) (e-,\'Pjajn) ElAddifiomil. Pretreatment Unit (explain) oHolding,rank Mound Lf Individual Site Design Ot lie r Typc I e x 1) 1 aM I F P (conventional) 2- 2 C • Re. vwal Before Rev i �,i c, i i []I"" - I '�'l I j LT'C 1) 1' PT Ll 171ber LiTransfer to Nev OwPL-i� Per1nil NJttsrbcr,,wd MIte ls��ucd Expiratiou W. Dispei-sal/Treatment Men and Iranl� 1jiforinau O�W. UW_ F=Ep -10 r S-D A De,Mga Fto%A, (gpd) Design Soil Application Rate(gpd-%O Mper--fl Ai-i�� Recinirc(I ("i") Dispel %al Area Proposed (so Symejoi Elevation eerkttAkw'= I I capacity ill 41 of Gal kjils G i I I ol'i Units I'LM!, 111101-�IIA1101� PIE "4 46.J E X i,;ti ng Tanks riay rt- U V11 'If-i Lon P. S'pI, u H Old i 11(gr Ta 11 K D(IL'iTig Chxibu V. 11 esp o Isi b i 11tv S ta I e m e Fi t - I t h e u n d asigned, assu ii] Q rv's 11 si bi 11 ty for I n s I a 11 ation of the POWTS shown on the attached pLuis. Number's 'ame rint), plunibe S Si') "e N111"MMS'Num r-t P ione NtuA)vr bEeT ivs,,.; Slwei�Cily,,,,ai, Zi VT. Co U 111 v/ D el) a r M ell t lNe 0 ly PTApprovocl L 4111m %'Cc PernAL Fce 1 Date Issucd Issuln -tit Signature o s ,on n Conditions P1 YOV1,11 %'J I JS Hill k1-P1%3ttF ,s (�, �SD S 1► CtAo L,,A STEMMW�NER' 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintain as per applicable code / ordinances. Nttach in coutplele plans for the s+stern and subw 11 try fliv County on]y oil papve not less than 8 V2 x I I Inclie-q In Sj/A- 9 N '? X I lal --dvol AVv -1 W-1 AdO3 1.. 1) A R Th It,` Wisconsin Departaicnt aml Pro fcNmonijl ServiLc-S 4 Division of IndustTy Servicc." 4922 Madinon Yards Way PO Box 7302 Madkon, W1 51'?07 10111% August 10, 2023 CONDITIONAL APPROVAL PLAN PHIAL EXPIRES: 2025-8-10 Plan Review-, PWTS-082301656-C Kim 0 Connell 504 3,d Ave E Osceola, WI SITE: Frawley CGunty Hwy V St Croix CC) U 11ty Town of St Joseph SW Y4S E XS19 T30N R19W Phone: 608-266-2112 Web: ht1P:fldSps'Wig'k)% Tony IFvers, Governor Dan Hereth, Secretary Conditionally APPROVED DEPT.'OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES '41 WK41161 00 W1 041-1271, MW liq 60 4 FOR4 1 Description: 4 Bedroom- 600 GPD mound- 32-'-' to restrictive feature- EfflUent Filter - Mown d Corn ponent M a mial — Ver. 2 . 1, S BD - Maintenance reqSri red. 10691-P (5/22-5/27) Pressure Distribution Component Manual — Ver. 2.1 (May 2022-2027) Verify proper dose is achieved and system is not being ovor dosed. The submittal described above has been reviewed for co. nfornirance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed arid located in accordance with the enclosed pproved plans and with any cornpoiient rriwwal(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 viorl( at plLmilbing in the state unless licensed to do so by the Department per s.145.06f stats. The fallowing conditions shall be met during construct ion or instal latlon and prior to occupancy or use: 1T .1T_[=,1 �= The site shall be properly prepared prior to piowing. 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. ib Compone nts a rid so! I removed fro m an exi sting d Ira in fie Id sha 11 be properly d isposed of so that there is no risk to public or envi ronmental health. 0 A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Ms. Stets. 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. stets. A sta Lo i pp roved effluent filter is required. Maintenance information must be given to the own er of the tank explaining that periodic cleaning of the filter is required. A cop of the approved plans, specificatlons and this letter shall be on -site during construction and open to inspection bV aUthorized representatives of the -Department, which may include local inspectors. Owner Responsibilities The current owner, anc] each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance rnanual(s) and be responsible for ensuring that PO Ts is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(l), In the event this soll absorption system or any Df its cornpurient parts nialfunctions 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 su b ii-iltting a maintenance verification repo i't acceptable to the count. f o r maintenance tracking purposes. Re. ports 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. I nquiries co n tern 1 ng this correspondence may be mad e to me at the telephon e n U n'iber listed below, o r a t the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS nianage�nient plan to the, owner and any others who are responsibie 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 M.PAPPLICATION FOR REVIEW S P -Complete all pages - NOTE: Personal information you provide may be used for secondary puwses [Pnivacy Law s. 15.04(l)(m), Slats.] D Plans to be E-filed. Provide SharePoint User name below: Private nsite Wastewater Treatment Systems Division of Industry Services For plan status, cheer our websi te at. Email technical code questions to .. .... 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 designaflon check our website at. 1. Project Infortnation - Fill in all known Information. Project/Site Name: .4. x_1t1.)'iE;1 7 Location, Number & Street of project (f f unknown, indicated nearest road) Leg a I Description: County El city El village �J Town of 2. After plans are reviewed, please: (check all that apply) Ej C@11 Customer 1, 2 (circle nurnber)� El Requesting party will pick up (A Mail plans to customer 1, 2 (circle number)* 7Refers to customer number from below. Confirmation of assignment to a reviewer. Transaction ID: Previous Related Trans, 111); Estimated Completion Date: Assigned Reviewer. - Assigned Office: Mail to your office of choice below. - La Crosse, Green Bay NOTE: We reserve the right to re-disbibute plans to another office if needed to reasonably balance turnaround times. Check for next available review date 3. Complete the following designer/ownerfrequesting Information. Utilize the check boxes when designer, owner or requesting party Is the same to avoid repeating Information. Designer InfPrmation (Customer 1) DSPS First Na a t�ame Customer Number mpC �n N�ame' Address City St to Z.ip+4 (9 digits) Phon Number E-mail address Cell phone (area c C/ Other Please Specify Below (Customer 2) DSPS First Na La Name Customer Number Company'. a Na Address, Y C11 .�p+4 (9 digits) " f one Number E-ftll address Cell phone (area code} Check 1 applicable Check If applicable or specify relationship .. . .... ..... El ovvner Owner El Other — specify relationship Infomiation and Plan Submittal Checklists. To request electronic plan review complete the appropriate application form a"nd e-mail it, along with your registered SharePoint usemame to If plans are being submitted via paper, they .. ... . . ... .. .1 ..' " - - " ' � � - - : -_ . ;1 -.1 .... . will be assigned to a reviewer after receipt at a DSPS office. Submittal checklists can be found in each applicable component manual pearing on the POD" S program Pa e under Publications Holmen/Onalaska Area DSPS Green Day DSPS 28.50 Midwest Dr Ste 104 2331 San Luis Place Onalaska, Wl 54650 Green Bay, Wl 54304 608-785-9334 920-492-5601 Fax: 608-785-9330 Fax 920-492-5604 Email: . . . .. ..... ...... . .. Email: .... . . ....... Make Checks Payable to: Division of Industry Services OR E Check box to invoice designer and sign below TOTAL AMOUNT DUE DaMgner Signature Review Code 7633 SBD-10577 (R 3/19) PCWTS SUSMITTAL (check ,all that apply — Incompl&to forms msy result In promising d Aerobic Treatment nits Chlorinator R "an l epiacame t Only �L-AEWc=Marcialrn E) UV DisinfectlanUnit Add Effluent Filter SYSTEM TYPE(s) NOTE: separate sheets for each system if submitting =Wple systems an the same siteEnter ReAsion to previously approved pf2n � Miscellaneous Review a : rep acemen septic tank, addition of an effluent filter or pretreatment . device to an axistIng system, 01hr Component Manual �Design� All tro�components coonen arepreviously approved 0 At -Grade Component Mann - Ver. 2.0, SBD- 54 (N.03107, R.1f Wastewater Flow in under s. SPS 3S4.10 (2) or (3): In -ground Component Manual -'der. 2.0, SBD-10705-P (N-01107, R 101 �) Gallons Per day Mound Component Manual,,- Ver. 2.0, SBO-10691-P (N.01601, R 01 2) Design wastewater flame of the proposed stern: Pressure D�bution Component Manual �-- Ver, 2.0, SSO-1071 P (N.0110 , R loll2) �° 'Other - Please GP 3 --� 1 O� or less �5 �. .00 sper4 1100127000 5.00 C3 5oll Based IndMdual Site Deslgnor 2,001— 5,000 $ 400.go One or more treat'nent components are not At Gride previously approved under s. SPS 384.10 (2) or (3): Nan- Pr'essurIzed In -ground D"n (fndiVidual site design/deviat on from component mamals and usO Of components withcwt product �. Pressurized In -ground Wastewater ater Plow in Mound approval): ' Gallons Per day Drlp-line Design wastewater flaw of the proposed system; ConsVucted Wetlands � �n'rentati®n must be provided to support treatment and d1s rsaal c4airns. in a separate P� 0i d or less ".."" `..." 10001 -- 21000 go $600.010 statement, provide raboride for f and Bch suppor�g d�rnent5 (fie s tons, test 2,��31 �-- 5,000 gpd �7��.�� +project Worts, technical P�f i �ea�, etc.) greater than 5,V0 L7 $1900.00 plus $0.08 fbr each gallon over 5000 Spd State-owned facUtl Design Holding tanks proybusty apgroved under s. SPS HaWhg Tank Component Manual, 'der. 2.0, SBD-1085 -P (N.03107, RI/12)" Wastawater Flow In 384.10 (2)(3). Design was ter flog of the proceed ern: Gallons Per day Non -state oYned Commercial and Residen#al Hoiding tanks that compfet&y ufflze this manual 6,000 gpd or le $ 90.00 and have an estimated dally flow of less than 300D gallons per day must be suhm#fted to the D 5,001 ~ 10„0 gpd $150.00 P� appropriate governrnental unit for review instead of the Dement, [see SPS 333.32(3Xa)] greater than 10,000 9ld $225.00 0 Holding Tank lndMdual Site sign', i.e. site nstructed} <S+day holding capaci�, co- mangled wastmaw, etc. Design Holding finks lrwJuding site constructed finks NOT g. Flow in Please specify. Wastewater previously approved under s. SPS 384.10 (2) or (3). Design wastewater flaw o the prop d system., Gallons Per dad " Documentation must be roomed to support the rationale for than e nt5ry.,g}�00 �' �i` �i�.r�w Ina separate statement, gpd or less r.�. lease include all cede sections, test reports, technical papers, research arUcles, etc.) "" yy80.�€p��i0 1001 V lit V � � � V i�� 3r►tV GPI than �� 4pd 4 9 q . SOil Saturation Deternanst= Report (using onion pipes) 0 lntarpreWe Determina6oan$240.00___.,.. Experimental Stem (one time add orial lee). SubMit fee l"cr Individual system as per appropriate above system type) ExpedMent Numbor $400.00 .....�... Pdorfty ReAe (enter swine $Mount as normal review fee listed above) Enter Total (rounded to the nearwt dollar)- - SBD-10 7 (R 3119) MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ReSWODU'al Applic-ation INDEX AND TITLEPAGE Conditionally APPROVED Project Name- Frawley __,__._UPROFESSIONAL SERVICES Owner's Name: MFrawley MVISTOMOF INDUSTRY SERVICES a Owner's Address- 791 Southshore Diamond Lake Road a.W9440 New Part WA 99156 SEE CORRESPONDENCE Legal Description: Township: County., Subdivision Name: Lot Number. Parcel I.D. Number. - Plan Transaction No.: SW-SE-sec.1 9-T30N-R 1 9W StJoseph St Croix 40 AC A a rOW1.10P in, mo 030-1040-90-000 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Filter Spec Page 10 ATT soil evauation Designer: -Kirn onnell License Number: Date-, 07123/2V Phone Number: Signature 224263 Designed Pursuant to the Component Manual Dasr(Jn References, Mound Version 2.1 (May 2022..2027) & Pressuro I)istribution, Version 2.1 (May 2022,2027) Version 7.0 (R. 11/12) Pagel of 9 Mound and Pressure Di h. stribution Component Design Design vjorvslieet Site Information (R or C) R I Residential, or Commercial Desig n 400.00 1, Estimated Wastewater Flow (gpd) 1.50 1 Peaking Factor (e.g. 1. 5= 150%) 600.00 Design F[ow (gpd) N 3.00, Site Slope Cont.Wr Line Elevation 32.00 Depth to Limiting Factor (in) 0,,601 In -situ Soil Application Rate. (gpd/ft 2 DiStribUtion Cell Information 60.00 Dispersal Cell Length Along Contour (ft) 1.001 Dispersal Cell Design Loading Data (gpd/rt) I I Influent Wastewater Quality 0 or 2) Pr& sfibution Information ressue Di i (C or e Center or End Manifold 3,33 Lateral Spacing (ft) 3 1 Number of Laterals 0.1881 Orifice Diameter (in) 3.001 Estimated Orifice Spacing (ft) 2. 001 Forcernain Diameter (in) 7 5.001 For` main Length (fl" 90.001 Nump Tank Elevation (ft) 3,25 System Head (ft) x 1.3 10.33 1 Vertical Lift (ft) 2.40 Friction Loss (ft) 0.00, In -line Filter Loss (ft) I o Total Dynamic Head (ft) Lateral Diameter Selection in, dia. options —choice 1 0-75 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information '1200.00 Septic Tank Capacity (gal) vVieser Man Ufa. CtUrer Dose Tank Information Dose Tank Capacity (gal) 800,00 22.24 Dose Tank Volume (gal/in) Wieser it Manufacturer Note: Sand fill (D) calculations assures a Table 383-44-3 in -situ soil treatment for fecal cojifc,rm of <= 36 inches, I I Are the laterals the Ili Best point-..... in the distribution Y network? jfr)ter Y or N If N above, enter the elevation (ft) of the highest point. 1 o.00 r�/Ori f ice Does the forcemain drain back? Y Enter Y or N 12.23 Forcemain Drainback (gal) 80.54 5x Void Volume (gal) 92.77 Minimum Dose Volume (gal) 39.32, System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1. 1.50 2.00 x x 3.00 Gallord' rich Calculator (optional) 1200,00' Total Tank Capacity (gal) 36,00Total Working Liquid Depth (in) 33, allin (enter result in cell B49) Effluent Filter Information P'olylok Filter Manufacturer PL-525 Filter Model Number Project" Frawley Page 2 of 10 W .• , • • i � f �•� � ° a. [ y • ! • • _ 1 v • • . 1 , 1 x • y • ^ Y , e : , 1 f 1 1 • _ . ; Observation Pipe , - : • . - . - 1 I S 1 A i ! . i 1 r r o 9,'py�°� k , r,: r s 1 r �•, . • •''• a - x •p65 ri n. k' x"° qam a x•T„r a J' a a d , � y•� ��`,ry .. ••' IavT°i r ''!�` .r • n. r y x�fiv (�/°�J�• .L x6 •a ?/*�'a ef y •. i.� •=•. ny ,Sa�NRnx • `yx FFY 1l. y•.."°,/}•.r°'C •s �» A•y••y .•QVT[. •Ai •.•�vR ni�LY•pf �•�l �,=r 1 • 1 i� " reRa� aM p�'x Sn/y"• t'�e F�i� Ry`$a �` pa�A� a x��ti.R� i� •va yWxyfciRa'e'Sel y .x f1A •°F .W °•1t•>•`z . i.. ix .r •f Y' .v Rl, gals sp.}•Mr •'-0 � "i • f • f e Ye's aTIY. ^ n Y irpS•E •rF ° = 1 • r ' N V A x 3 }'� SYi + q • x� v x a } •x n tl0p T•e '� •- wr;. � x x'.•' a w l as lq �^-y f¢ k kA } x a ^ �N• � ',�vY •" xx nk tl.b x» +^ i Y Y A " • ° 1 .. t• a 1 y '. s b A. a ^ter •` F9 nosy, .�y. • x[. F.• • 1.• • rl`el. • .. _ • • • n . • ..-•- Y_ ••.• nr ..•"1•-fl °v.° .V Y x a 1 n r ,�. • n • • x • • Y a e • r ° e . e • ^ • •r x . n •. f , r } • • • r } r ., t • • a � � e / • . [ _ • . . . .. r ° } - . . . , y n ' T • • • - - . . • ^ '' - ' . • • . r w . Y • • . _ w e e a r r e x • . v a e .. • . ! a e • e n c ., m a r• 4 x. i • x � 1 x• n' x r a r 1/ i c •` _•/ f a .. r , . r x x � ` . • , n " . • v . � s 1 • " ' r r I .. c ' ° / r ... 2 r . . r ° . n n . • y ` � • ' • x • a • • . . . • y . . Y . X F ..e •,°°e" �_ 'rs`•�1.0 •,,••r�r rr,•^.� eY ny•. x..� tn'„•t�Rr'. 1 .I�f�° ,"•i•F-a1 ' F t 4 r •' 1 { r � .. y .. 4 e • • • � a 1 f 1 • . • / a r s • • • x • • • n r • ` • • • ` " • ` . ° • • r x • r • • ^ • • _ r r - � , , ^ • e • y • • • • • • e '^ - . n ^ • F • e o a . : • L n • .. a n • • ' • .. a • ' . . 1 • n L r 1 ° e. r ° r 1 n ° • • • A ' � r r • .. x r . a 1° , y A • • c A S 1 1 " , 1 r • • e. ' r . � { r r a r n n t 1 A y 1 e • • � • e . F , a • r 9 l • n x i 1 > • ' . r ' • • , ` n. k + Y , r • � Aft L Mound Component Dimensions A 10.00 ft E 9.60 in B 60.00 ft F 9.50 in p) 6.00 in G 0.50 ft 600.00 (ft2) Dispersal Cell Area 10,00 (gpolft) Linear Loading Rate H 1.00 ft K 7.33 ft Z 6.90 ft L 7 4.6 5 ft J 4.93 ft W 21.$3 ft 1013.74 (ft Z) Basal Area Available 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section Vie Aggregate Dispersal Area Finished Grade 102.29 (ft) 20 w�... �. +r+rr r'ial'v .�! rJJ� rl Sr�r1 �•!l a'1.•,J'f1 -- .K•�. "'� Y•[•r[Y rY 1.1 ei[.ia. •r.l ' x Dispersal Cell * .. ' 101,00 (ft) Lateral ��jj,"� _ :�yr; -.,, �,.° Invert 1DDr5D i1L} r p4 ,.... ., r Dispersal Cell Dis >sr a�.i^ � 0. b '� ` • • � ^ • • 1 e 1 s C 1 A � ! , . ' • , r l f A , • i � • 1 c 1 p Elevation M �� R i r Y i b• ,• -, Y l v• Y t f R a v o a c. L 4 ;. r l • p N ° Y a F Y - i Y Y d i• i � • Y y°. 1• A° ° 3 . � a r r w • .•d'�Y�a .,gip, '.,;;� . :.�•'`-- _q``" ek "a k ° - 3 Contour Elevation .... .� n•rE A.1 ,,� ✓��•'t _} �- �'- ~3 „1 � .i �`� �s � '�.. 1C rw� °� n ^t �T �n]�n] �� .00 3.0 °Io Site Slope /,/� Geotextile Fabric Cover ShadingKeyi Disper a De See lateral details on .— er, size, �- 'I.5 ft - ... Page 4 for numb . Topsoil Cap a • " y by W9 y. q... Y r / ° P f � = 9 •x . er. ay d�sf �� bl / 4�. • ! tla'> iiw�Yl • •.a..,e r- and spacing of laterals �.J`✓�.°f.+��' :`r�� sf [�''y, 0 1•a r'j��yjJ r a /„ 1 ty e far elf, Subsoil Cap ys : ;'q➢a`'if '.• ��1� ��„Y " - „�.�RT 1�^�; Laterals are equally n ° ril YY r .` �] ASTIVI hand asm-. A::.. Ars :�a .a., :4y.= Feb�e"n F spaced from the Tilled Layer D. ft Typical 3La#erl .% Ra a65, ° • r. x ■n '�.; : R F ; e ; r ��lYrYkxfa n distribution cells �• �N+°I •�e y`ya rs �-a �r. '�R x �°• •rJaxm � ••, : �� ;•, : as r•;m :x ;,r. F•= ;f�. =":s ;�°�7' centerline in the Aggregate a •�_ °�° A distribution cell (AxB). Project: Frawley Page 3 of 10 End Connection Lateral Layout Diagram Centel th Q, I a t Q F a L; v I i c, A il� e 411 nri 0 n 0 rt 4W : Tarn -tip -eik%J t;A � P N late r ;A z-- ar e id 41. DT I C a I X - �-i ol f df i I kA on e $10 bot t o m Qf t h C 13t4c- F --A S T '10 F'VC PeI- SPS T 1 3�"gl S r--0(qtC- t,:- rnanifoW at on!j point, Number of Laterals — 3 Orifice Diameter 0.188 in P Lateral Diameter 1.501in 0 rife Spacing (X) 3.0 8 ft Lateral Length (P) 58,52 ft Orifices per Lateral 20 Lateral Spacing (S) 3,3 3 ft Orifice Density fi 10,00 ft /orice Lateral Flow Rate 13.11 gpm Manifold Length 6.67 ft Systern Flow Rate 39.32 gpm Manifold is 2.00hn Total Dynamic Head 3d 8 15-98 ft Forcernain Velocity 4.02 fUsec Dose Tank Information Locking cover with warning lat)ol and ioc,1rq device and sea led wa to rt ig lit Electrical as per NEC 300 and --- r 4 in, Alin_ SPS 316.300 VVAC Disconnect- ....................................................... ........... Tank component is properly vented Alternate outlet location Wieser Manufacturer Capacity $00.001 Gallons F—Volume j 22,24 gal/Inch Dimension A Inches 20.80 Gallons S] 462-59 B 3.00 6612 C 4-17 8,00 35.97 92,77 D 177,92 Total 800.00 I Forcemain dianicter 2 in. A Weep hole or anti- -B siphon device C ptilirip off elevation (ft) —t 9 D 3" Bedding under tank. Alarm Manuafacturer is"'J-E i Rhombus � Tank, A ' lert - -, I Alarm Model Number I1 01-0- 1H . ......... J Pump Manufacturer Goulds pump Model NUMber IPE�5�1 II I ftTDH at 15.901 pump Must Deliver nn ?eliver 39.321gpi Project. Frawley -d Dose tank elevation (fl) 1% r go Note: Switches conta'Mire g meMLIFY [-["iay not be used in Lill s System. Page 4 of 10 Mound System Maintenance and 012cration SRecifications Service Providers Name Phone Phone ! 715-386-468jo POVVTS Regulator's Name St, Croix County Zoning 1 11 1 Syt.em Flow and Load Parametel"! Design Flow - Peak -600 gpd Maximum influent PartiGle Size 1/8 in Estimated Flow - Average 400 Igpd MaximulTi BOD5, 220 rng/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L it Absorption Component Size 600 ft Maximum FOG 30 mg/L Type of Wastewater Donn i M2XIMUM Fecal Coliform >j()E=4cfu1100 mL Service Frequent Septic and Punip Tank Inspect andlor service once eve [y 3 years Effluent Filter Shou clean at least once every 3 years Pump and ControlsTest one eve!y, 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1,5 years Mound Inspect for pondinq_�n_q age once every 3 years Miscellaneous Construction and Materials Stan dardS 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 mound rornponent manual. 2- Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. Code. 3, All gravity and pressure piping materials conform to the requirements in SPS 3841 Wis. Adrn 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. Laterail Turn -up Detail Finished -P aa o 0 0 & 0 Ch 0 0 Grade • b F + 1 4 Threaded Cleanout 6_8' Diameter Lawn Plug or Ball Valve Sprinkler Valve Box + + Distribution Lon Sweep 90 or Two 45 &gree bends Same Diameler as Lateral P roj e ct: Frawley Page 5 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Cade General operated in accordance with SPS 382-8411ilis. Adm, Dade, and shall maintained in accordance with its, component This system shall be p manuals [SBD-1069 1 -P hi.4'110'1 R. 1 11'1 2}, SSviIIVIP Publication 9.8 (01 18'1 ), and Pressure Distribution Component Manual liar. 2.0 SB 10706-P (hi. 01101, R. 10112) 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 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. or urx� tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Adefectdefective, or openings Septic p p used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, subject to failure must be re. lacedExposed access openings greater than 8-inches in diameter shall be secured by an effective locking p p device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tan k shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats• The contents of the septic p 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. filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions The outlet are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the filter is equipped with an alarm, e may indicate surge flows or an impending cont nuvus filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms alarm. p The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume ofthee tank. if the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner o when the next service needs to be performed 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 d 9 are used they shall be approved for septic tank use by the Department of Commerce. Pu mnTTan k The um tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper pump (dosing) 9� operation. if an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure distribution S stem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perlmeter, and the mound shall be seeded 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 ie mound and snow compaction in the winter will promote frost penetration. Cold weather installations October -February) dictate that mound be heavily mulched as protection from freezing. I fluent quality into the mound system may not exceed 220 mgfL Body, 150 mglL TSS, and 30 mglL Fob for septic tank effluent or 30 n q y m IL Bob , 30 mg/L TSS, 10 mg/L FOG, and 10 4 cfU/J 00 mL for highly treated effluent. Influent flow may not exceed maximum design ow 9 � specified in the permit for this installation. The ressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be p 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 clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation ipes within the dispersal cell shall be checked for effluent pending. Ponding levels shall be reported to the owner, and any p levels above 6 Inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic Y tic tank or an of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dvsin tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately 9 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 removing 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The Information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. awle Page 6 of 10 �r��oct. Fr Y Ulastewater R.S FEET r% p E V ut, 1� MODELSt PE31, PE4') r PEM so is 10. fi OL o 5 1 0 60 70 GPM 80 0 10 20 30 40 1-�ml INN ft - I 0 5 10 CA CI TY PERFORMANCE RAUAGI'W, PE31 To"I Head (feet Of Water) GPM 5 52 42 29 20 16 25 0 PF*41 Tel "*ad (ke,t of waic 10 46 20 33 25 16 TOW He -ad water) 10 Gm 67 20 59' so 25 39 30 26 3 S B PAGE 8 1 . N /Pl p; tog vi� I k'o f I i �*fl N k� �-1 K t' n rz i'f I Zabel I Flo 9NVS A ON'Voil d N-W, Thep Filter is rated for 10,00O.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-122., 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. F it "It-eatioll S-10tF, Rated for 10,000 GPD (gallons per day). 525 linear feet of 1/1.6" filtration. Accepts 4" and 6"' SCHD 40 pipe. 13uilt mi gas deflector, Automatic shut-off ball when filter is removed. Alarm accessibility. Accepts PVC extension handle. JIL-525 ideal for residential and comiiiercial waste flows up to 101000 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 & Lok or piece of pipe to center filter. A lnvztart the Pl.-.59.5 filter into ILs housing. M Dwilcil iional) !cepts 1" PVC tension Handle Rated for 1010W GPD 1 525 Linear Ft. Of 1/16, Filtration Slots Certified to 5. Replace, and se -cure the septic tank cover. NSFIANSI Standard 46 ,MIS ramove filter it �V ater 'evel is'AbriV61 PL-525, Maintenance# ka, or . ..... .... a. . . . . . . . . . . The PL-525 Effluent i t-e—.rs wx operate dicient y several years under normal conditions before requirmig 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. Serviemig 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 necessiucy. 1 TKO not use plumbing,when filter is 'removed. 4. Pull PLC-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank, not into fitter housing, 6. Insert the filter cartridge back into the housing making surc, the fflter Ls propfflyarligned and completely inserted. 7. Replace and secure septic tank cover. OVIC10011 ISH)"Wrilteol MaY111 Polylok, label. & Best filters accept Easily ilistalls the SmarffiltcrO switch ant alarm. into existing tanks. Polylok, Incl. 3 Fairfield Blvd, Wallingford, CY 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 Nvww.potylok.com SOIL EVALUATION REPORT Page of Wis. Dept. of Safety and Professional Services Division of Safety and Buildings In accordance with BPS 385, Wis. Adm. Code County'' ., Attach complete site plan on paper not less than 8112 x 11 inches In size. Plan must' limited to: vertical and horizontal reference point (M), dlrectton and Parcel I.D. , include, but not percent slope, scale or dimensions, arrow, and location and distance to nearest road. p P ons, nor Please print all InformatioD. Reviewed by Date Flarsonal information you provide may be used for secondary purposes (Privacy Law, s, 15.04 (1 ) (m)). Property O ner Property Location C r. Govt. Lot '3l T Li Vj N R f or) W .K.�s114 "�s Mailing Address Lot Block # Subd. N e or CSMtt Pro a rty Cwn r g ' 4 L �� city State Zip Code Phone NumberEIC*ty Village own Nearest Road I- Code derived design floor rate UY, New Construction Use - : Residential 1 Number of bedrooms g r GPD Replacement Public or commercial - Describe: ft_ Flood Plain elevation if applicable Parent material- ` General comments and recommendations. Boring Boring Ground surface elev....• Pitf �- �';� Depth to limiting factor iL in. .............. Boring Boring .�- Pit Ground surface elev. .- ft. Horizon Depth Dominant Dolor Redox Description Texture in. Munsell Qu. Bz, Cont. Dolor /V 11f . ...... .... - - * Efflgent 91 = BOD - 30� 220 mg1L and TSB >30 < 150 mg CST Nam 16ase P -Tit) �gne Address 4- , Depth to limiting factor' in. Sell Application mate Structure onsIstence oundary Roots CPD/ft Gr. Sz. Sh. ` ff1 ff##2 1 ice,+ 1- � i S * Effluent ##2 = BOD :� 3a mgfl- and TSS 3D mglL �. --~` CST Number Da a Evaluation Conducted Telephone Number MD-8-330 OU tit t ) f •� 1 " ■ -r 1 ...-' ...r Page of ...._� Property Owner t Parcel ID # TU Boring ^ . Sonng Pit Ground surface oleo..-31 ft. Depth to limiting factor `�� In. Boring # Boring. . . ...... .... . Pit Ground surface olov. ft. Depth to limiting factor n• Sail A'+ lication Rate HorizonDepthh Dominant Color Redox Desefl tion Texture Structure onsistence oundary Roots CPDf ft '2 in. llunsell Chu. Sz. Conti Color fir. Sz. Sh. �'t f##2 Qoring Boring # Ground surface elev. Pit Hon on Depth Dominant Color Redox Description In. Munsell Chu. Sz. Cont..Color Depth to limiting factor in. Soil tion Rate Texture Structure onsistence oundary Roots GPM 2 Gr. S Sh. * ff# 1 "2 Effluent #1 = SOD s > 30 a 220 mg/L and TSS >30 < 150 mglt. * Effluent #2 =130D x :� 30 mgk and TSS 530 rng/L The Dept. of Safety and Professional Serviecs is an equal opportunity service provider and employer. If you raced assistance to access services or need material in an alternate format, contact the department at 608-266-3 151 or TTY through Relay. WD4331AO (fit[ 1111) ST. Croy AQ=Q;uNTv SANITARY SYSTEM File#: OWNERSHIP/ADDRESS FORM Office e4� e��zoz�i"�y 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 Proneqy. Files Scanned weblink. OWNER/BUYER INFORMATION 4� Owner/Buyer ' Mailing Address City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location .5-vt)'14 = 1/4 Sec. ' p tY L� �► T�-� N RAIN, Town of . r Subdivision Plat: C'c.�i� , Lot f# Certified Survey Map # Volume E^�r:�.,,:ty Deed # (before 2006)Volur-rie Number of bedrooms Spec house 0-yes. no OFFICE USE ONLY Page # , Page -# Lot lines identifiable yes ❑ no New Property Address s J59-17/0 Ci82 (Verification of new address required from Community Development Department for new construction.) Z cy i Aii / 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 made in the war-ranty deed. Community Development Department — Land Use Division 715-386-4686 St. Croix County Government Center 715-245--4256 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, Wl 54016 www.sccw[. oV Slate Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number ii Document Name THIS DEED, wade between Edward L. Frawley, Jr. and Maryjayne Frawley as Trustee of the Edward L. and Joyce K. Frawley Living Trust dated November 26, 1996, as amended ("Grantor," whether one or more), and Edward L. Frawley, Jr. & Mary Jayne Frawley, as Co -Trustees of the Edward L. Frawley Survivor's Living Trust; Edward L. Frawley, Jr. & Mary Jayne Frawley as.... .... .... ..... ... . Co -Trustees of the Joyce K. Frawley Family Trust ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): E 1/2 of SW 1l4 and All of SE 1/4 of Section 19-30-19 EXCEPT Part to Vernon L. Donnelly and Lilah M. Donnelly in Vol. "858", Page 285 and EXCEPT Certi Pied Survey Map in Vol. "8 ", Page 2273 and EXCEPT Certified Survey Map in Vol. "9", Page 2416 and EXCEPT Part to Mark R. Ness in Vol. " 1137", Page 311 and EXCEPT Lot 3 of Certifed Survey Map in Vol. " 11 ", Page 2990 and EXCEPT part to Christopher P. kludachek in Vol. "772", Page 291 and Vol "1238", Page 366 and EXCEPT Part to Mark R. Ness in Vol. " 1 214", Page 90 (NOTE: This description includes Lot 2 of Certified Survey Map in Vol "11 ", Page 2990) * * * Parcel Identification Numbers: 030-1039-95-075; 030-I039-95400; 030-1039-95-500; 03 0-1040-40-000� 030-1040-60-000; 030-1040-80-000; 030-1040-90-000; 03 0-1040-95-000 Dated * * Signature(s) authenticated on * AUTHENTICATION TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Jennifer A. ]'Neill Lornmon Abdo Law Firm., Hudson, Wisconsin Ii ll1llillli llllllillllllllill � 9 7 4 5 5 2897455 BETH PABST REGISTER OF DEEDS ST. CROTX CO., WI RECEIVED FOR RECORD 06J09/2009 08;00AM TRUSTEES DEED EXEMAi # 9 ftEC FEE: 13.00 PAGES: 2 Recording Area Name and Return Address Lommcn Abdo Law Firm Attention: Jennifer A. ]'Neill, Grandview Professional Building, Suite 210 400 South Second Street Hudson, WI 54016 030-tO39-95-075; 030-1039^95AOO; Parcel Identification Number (PIN) (SEAL.) (SEAL) * Edward Frawley, Jr., Trustee (SEAL) �- .(SEAL) Ma Ja e , Tru ee ACKNOWLED NT (Signatures may be mithenticated or acknowledged. Moth are not necessary.) NOTE: `THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED, TRUSTEE'S DEED CD 2003 STATE BAR OF WISCONSIN FORM NO, 7-2003 "'Type narre below signatures. of 2 13' +i 1� 't Edward L. Frawley, Jr., Trustee STATE OF WISCONSIN ) SS. COUNTY OF DUNK Personallycarve before me on Z 2oo� he above named Edward I , � � � �. L. Frawley, Jr., as trustee of the Edward L. and Joyce KFrawley Family Trust dated November 26, 1996, as amended. N t C. State o4sconsin My commission expires NOUMV& 11, [:J:ESSICA J. HANDORF ottary Public o of Wiscons. 2 of 2 _ T - l 'tit J J J J J J .' n ♦ � \ `♦ J ♦ J J . � J J J J J J \ J \ i♦ �' T. F1r. # f ..J I L--- I f I I f f L----,..----..... --- ----- 4 1 f f f 1 1 f I 1 I I I Z-... «.--- «.-------......-----...,.-J I # f t # f Iva F-1 v CD un fit 41 V -s. �■ ltg R [ SOIL EVALUATION REPORT Wis. Dept � ofSafety and Profe,$'8ionsl ServIces Page of Division pM Safety and Buddings 7W 3 -'2..,3 2 in accordance with SPS 385, Wis, Adm. Code 'k 1 2�, 0 2 3 County Attach,complate s e Pn on paper not less than 8 112 x 11 Inches In size. Plan mustr- includo, but not limited to: vaft-al and horizontal reference point (BM), direction and Parcel M. Pe f Ceqt Slope Sea re 0 d 1kiMbilibhs, norM a r(ow, a n d loc ati on and d Ista nee to nearest road. cornn-jurl'itV 1 r-eveloptinen PIMW�romation. Riavie, by 0 a A "411 1nf Personal Information you provide may be used for 5erondary purposes (Privacy Law. s., 15.04 (1) (m)). z Properly Ovvner Property Location now" 6L IL22 Govt' Lot 114 14 S T N R E (or) W Pt art n6rs Ala lling Address Lot # Block # SuIK V�me or GSM# ti ZC4 & City State Zip Code Phone Number its Mvillage LATown Nearest Road U Now Construction UseQ Residential / Number of bodfooms Code ale dyed design flow rate GPD Replacement Public or commercial - Des cfie: Parent material Flood PWri elevaVon if applicabID General comments and recommendations: 11 Boring Boring # m 4 Pit Ground surface alev. _ZdKp,,"" ft. Depth to timiting factof in. I Rnll AnnlieAtinn P:;tp- Horizon Depth M. Oom[nantGGION Munsefl Redox DescdpUon QU. Sz. Cont. Color Texture Stfucture Gr. Sz. Sh. onsistence oundary Roots GPD/ft 2 1 02 ...... 1 ---- 1 0.4 J, 0 ': .2 tj Boring Boring # 71 pit Ground surface elev. ft. Depth to limiting factor in* qnil AnAiratirm R:Am Horizon Depth in.Munsell Dominant Color Redox Description Qu. Sz. Cont. Color Texture Sttucture Gr. Sz. Sh. n, onsistence' oundary Roots GPD/ft ff#2 4m' r (_/1 �da2 J4yJ Effluent # 1 T 80 D > 30 220 mg1L and TSS >30 150 Mg/L/ -Effluent #2 BOD 4 < 30 mg/L and TSS � 30 mg/L CST Nam P46ase P Ar CST NumbaT Address Da Evaluation Conducted Tekph ono Number 7> dE LIM-% 911ML FD I Ill 1 Property Owner Parcel ID #L22 .:4 Yz-)� . 22,-D0 1,31 Bonin # ._ Baring g Ground surface elev. ft. Depth to limiting factor In. Pit p g Page of 3 Sail Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. insistence Boundary Roots GPDfft 2 -02 Baring # Baring Pit Ground surface elev. ft. Depth to limiting factor in. Sail Application Fate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. insistence oundary Roots GPDIft 2 ff#1 02 Boring Baring # - Pit Ground surface elev. ft Depth to limiting factor in. Sail Application Rate Horizon Depth In, Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. insistence oundary Roots GPDfft 2 ff#1 * 02 * Effluent #1 = BCD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BCD S 5 30 mg/L and TSS S 30 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. WD-8330Tcst (R11111) (V -dr,21 lb la MWAI, rl, --flaw m oamr, All, j 1.4.� s NG CHAPTER 145.135 (2) WISCONSIN STATUTES a The rose f the sanitary permit is to allow installation �� purpose o n y 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 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: 1f you wish to renew the permit, or transfer ownership of # ca authority. t e erm�t lease contact he uu h permit, P ty AMLI .9 ... . .... ..... .... ... . .. .. . ..... ..... .................... ...... ...... . . ....... .. OWN21'. .. .................. LMA ....... .......... ..... ....... SBD-06499 (RI 1/20)