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HomeMy WebLinkAbout038-1111-80-000 Department of Safety & Professional Services, Industry Services Division County St. Croix Sanitary Permit Number (to be filled in by Co.) Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. State Transaction Number Na Project Address (if different than mailing address) Same I. Application Information – Please Print All Information Property Owner’s Name Steven J. Christen Parcel # 038-111-80-000 Property Owner’s Mailing Address 1986 100th St. Property Location Govt. Lot NW ¼, NW¼, Section 28 T 31 N R 18 W City, State Somerset, WI Zip Code 54025 Phone Number (651) 307-3986 II. Type of Building (check all that apply) Lot # 01  1 or 2 Family Dwelling – Number of Bedrooms 3 ☐ Public/Commercial – Describe Use ☐ State Owned – Describe Use Subdivision Name CSM Vol. 04, Pg. 1014 Block # Na ☐ City of ☐ Village of  Town of Star Prairie CSM Number 367197 III. Type of POWTS Permit: (Check either “New” or “Replacement” and other applicable on line A. Check one box on line B. Complete line C if applicable.) A.  New System  Replacement System Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. Holding Tank  In-Ground (conventional) At-Grade Mound Individual Site Design Other Type (explain) C.  Renewal Before Expiration  Revision Change of Plumber Transfer to New Owner List Previous Permit Number and Date Issued IV. Dispersal/Treatment Area and Tank Information: 32 Infiltrator Quick 4 Standard Plus chambers, 2 pair end caps, PolyLok PL-525 effluent filter Design Flow (gpd) 450.00 gpd. Design Soil Application Rate(gpd/sf) 0.7 gpd./sq. ft. Dispersal Area Required (sf) 642.86 sq. ft. Dispersal Area Proposed (sf) 654.40 sq. ft. System Elevation 90.50’ Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer Pr e f a b Co n c r e t e Si t e Co n - st r u c t e d St e e l Fi b e r Gl a s s Pl a s t i c New Tanks Existing Tanks Septic or Holding Tank 1,000 1000 2 Wieser Concrete Triple X Dosing Chamber 650 650 1 Combination ST/PC X V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber’s Name (Print) James K. Thompson Plumber’s Signature MP/MPRS Number MPRS 30021 Business Phone Number (715) 248-7767 Plumber’s Address (Street, City, State, Zip Code) 340 Paulsen Lake Lane, Osceola, WI 54020 VI. County/Department Use Only Approved ☐ Disapproved ☐ Owner Given Reason for Denial Permit Fee $ Date Issued Issuing Agent Signature Conditions of Approval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) Project Name:Christen 3-bedroom Repl Dose-Conventional POWTS Owners Name:Steven J. Christen Owner's address:1986 100thSt., Somerset, WI 54025 Site address:Same Project Location:1986 100thSt., Somerset, WI 54025 Subdivision:Lot 01, CSM Vol. 04, Pg. 1014 Legal Description:NW1/4 NW1/4, Sec. 28, T.31N., R. 18W., Tn. of Star Prairie, St. Croix Co., WI. Parcel ID #:038-1111-80-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 POWTS Design Calculations Page 4 POWTS Design & Pump Chamber Calculations Page 5 Zoeller BN 53 Pump Curve Page 6 Septic Tank/Pump Tank Cross Section Page 7 Effluent Filter Specifications Page 8 Distribution Box Cross Section Page 9 Dispersal Cell Cross Section Page 10 Infiltrator "Q-4" Chamber Specifications Page 11 Dose-Conventional POWTS Management Plan Page 12 Sanitary System Ownership/Address Form Page 13 CSM Page 14 Warranty Deed Attachments: Sanitary Permit Application Soil Evaluation Report Mater Plumber Restricted Service:James K. Thompson, DSPS Credential #30021 Signature:Date: Index & Title Sheet Page 1 0f 14 Dose-Conventional Replacement POWTS Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) }�roPos�c1 drs��rs�/ a6 3 `X G�'G.riSEiacE�/ a ba,7Lurre dCL DspS SS dGne��S`Jtr /�SpS 36 3.33 J / y �3. mat 7r 3e�s , , r ^ o � d �,ua ,�•ivvO 7 � a U of s.7' out/e� 0 Sp��Q1/RI/.cQ�; N'1/Di � E"X:S�, � � rode e le �• KC� rF2 7.� v /4BG /Do`s St. Q �4 y0) %y see. Z& r314 i Zf b� ? 3o7v /ope System Design Calculations Christen Dose-Conventional Residential POWTS JOB DESCRIPTION: Existing hydraulically failed drywell and damaged septic tank require replacement. Limited available area requires dosing to reach new dispersal cell area. Design based on In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems, Version 2.1 (May 2022-2027). ABSORPTION AREA SIZING: 1. Design wastewater flow: 4500.00 gpd (300 gpd estimated wastewater flow as per code)(150% conversion factor) = 450.00 gpd Design Flow 2. Existing grade elevation: 95.08’ at B-2 – 95.62’ at B-1 3. Depth to limiting factor: 87.29’ @ B-2 (100”) 4. Proposed system elev.: 90.50’ at 55.0” – 61.5” below existing grade 5. Infiltrative capacity of soil at or within 36" of system elevation = 0.7 gpd/sq.ft. 6. Absorption area required: 600.00 sq. ft. 450.00 gpd design flow / 0.7 Gpd = 642.86 sq. ft. absorption area required 7. Absorption area proposed: 634.40 sq. ft. Two (2) distribution trenches proposed, 16 chambers per trench = 32 Infiltrator “Quick 4” Standard plus chambers total. EISA per chamber = 20.00 sq. ft. , EISA per pair end caps 7.2 sq. ft. 32 chambers x 20.00 sq. ft = 640.00 sq. ft. per cell 2 pair end caps x 7.20 sq. ft. = 14.40 sq. ft. per cell 654.40 sq. ft. per cell Number of trenches: Two (2) @ 16 “Quick 4” standard plus chambers per trench (32 chambers total) trench width (A): 34.0” trench length (B): 67.00’ SEPTIC TANK MANUFACTUER & CAPACITY: Wieser Concrete W1000/650-FDL Triple combination septic tank / pump chamber with PolyLok PL-525 effluent filter at outlet of septic tank. PUMP CHAMBER CAPACITY CALCULATIONS: 1. Force Main: Diameter 2" Length 65’ Flow rate 40.00 gal./minute ± Friction loss 3.75 ft. (65')(3.30 ft./100ft.) Friction loss 3.75 ft. (65')(16.3 gal./100ft.) 2. Total dynamic head: Min. supply pressure 0.00’ Vertical lift 4.25’ (elev. @ top of highest forcemain elevation = 91.25’, Off float elev. = 87.00’) Friction loss 2.25’ (forcemain & fittings friction) Total dynamic head = 6.50’ Pg. 3 of 14 3. Pump selection: Manufacturer: Zoeller Model number: BN53 (Pump will discharge 40.0 gpm ± @ 6.40’ TDH) 4. Dose chamber: Manufacturer & capacity: Wieser W1000/650 MR combination Septic tank / pump chamber (41” liquid depth @ 15.93 gal./inch = 653.13 gal. actual capacity) Sizing calculations and float settings: A) One day holding capacity: 26.30” = 375.90 gal. B) Alarm setting: 2.00” = 31.86 gal. C) Dose volume + flow back: 5.80” = 92.45 gal. Max. dose = (450.00 gal.)(20% Design flow) + (10.60 gal. flow back @ 65') = 100.60 gal. D) Reserve storage: 9.60” = 152.93 gal. TOTAL: 41.00” = 653.13 gal. EFFLUENT DISTRIBUTION: Wieser Concrete Distribution Box to 4” gravity flow header. Pg. 3 of 14 SELECTION GUIDE 1.Integral float-operated mechanical switch, no external control required. 2.Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3.See FM0712 for correct model of Electrical Alternator. 4.Variable level control switch 10-0743 used as a control activator with electrical alternator (3) or (4) float system. PUMP PERFORMANCE CURVE MODELS 53/55/57/59 FLOW PER MINUTE LITERS 0 80 5 20 15 10 GALLONS TO T A L D Y N A M I C H E A D 0 2 4 6 10 20 30 160 40 50 FE E T ME T E R S 009897 Model MODEL COMPARISON Seal Mode Volts Ph Amps HP Hz Lbs Kg Simplex Duplex M53/M55 Single Auto 115 1 9.7 3/10 60 23 10 1 --- N53/N55 Single Non 115 1 9.7 3/10 60 23 10 2 3 & 4 * BN53 Single Auto 115 1 9.7 3/10 60 25 11 *--- * BE53/BE57 Single Auto 230 1 4.8 3/10 60 24 / 30 11 / 13 *--- D53 Single Auto 230 1 4.8 3/10 60 23 10 1 --- E53/E55 Single Non 230 1 4.8 3/10 60 22 10 2 3 & 4 M57/M59 Single Auto 115 1 9.7 3/10 60 29 / 33 13 / 15 1 --- N57/N59 Single Non 115 1 9.7 3/10 60 28 / 29 12 / 13 2 3 & 4 * BN57 Single Auto 115 1 9.7 3/10 60 30 13 *--- D57/D59 Single Auto 230 1 4.8 3/10 60 30 / 33 13 / 15 1 --- E57/E59 Single Non 230 1 4.8 3/10 60 28 / 29 12 / 13 2 3 & 4 E59 Single Non 230 1 4.8 3/10 60 29 13 2 3 & 4 TOTAL DYNAMIC HEAD FLOW PER MINUTE © Copyright 2020 Zoeller® Co. All rights reserved. 502-778-2731 | 800-928-7867 | 3649 Cane Run Road | Louisville, KY 40211-1961 | zoellerpumps.com All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA).CAUTION * Single piggyback switch included. Additional cord lengths are available in 15' (5 m), 25' (8 m) and 35' (11 m). 50' (15 m) cord lengths available for 230 V units only. BE and BN models include a piggyback variable level pump switch. Model 53: cast iron switch case, motor and pump housing, a plastic impeller and base. Model 57: all cast iron construction with a cast iron impeller. Model 55: bronze switch case, motor and pump housing, a plastic impeller and base. Model 59: bronze construction with a bronze impeller. Optional pump stand (P/N 10-2421). SPECIAL MODEL FEATURES OPTIONAL PUMP STAND P/N 10-2421 • Reduces potential clogging by debris • Replaces rocks or bricks under the pump • Made of durable, noncorrosive ABS • Raises pump 2" (5 cm) off bottom of basin • Provides the ability to raise intake by adding sections of 1½" or 2" (DN40 or DN50) PVC piping • Attaches securely to pump • Accommodates sump, dewatering and effluent applications NOTE: Make sure float is free from obstruction. TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING 19.25 ft.(5.9m) 53/55/57/59 Shut-off Head: MODEL 15 10 Feet 5 4.6 3.0 34 19 1.5 Meters 43 Gal. 72 129 163 Liters Pg. 4 of 13 FOR APPROVAL DRAWINGS SUBMITTED APPROVED BY: PRODUCTS NEEDED BY: APPROVAL DATE: 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-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. 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 & Lok or piece of pipe to center filter. 4. Insert the PL-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. PL-525 Effluent Filter Accepts 4” & 6” SCHD 40 pipe 10,000 GPD 1/16” Filtration Slots p p & 6 00 tration Slot Accepts 1” PVC Extension Handle Alarm Switch (Optional) Rated for 10,000 GPD Gas Deflector Automatic Shut-Off Ball 525 Linear Ft. of 1/16” Filtration Slots Outdoor SmartFilter® Alarm Polylok, Zabel & Best filters accept the SmartFilter® switch and alarm. Extend & Lok™ Easily installs into existing tanks. E d & L k™ Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Pg. 5 of 13 Pg . 9 of 13 Pg . 7 of 13 Contact Infiltrator Water Technologies’ Technical Services Department for assistance at 1-800-221-4436 4 Business Park Road P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • Fax 860-577-7001 1-800-221-4436 www.infiltratorwater.com U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, MicroLeaching, PolyTuff, ChamberSpacer, MultiPort, PosiLock, QuickCut, QuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. © 2016 Infiltrator Water Technologies, LLC. All rights reserved. Printed in U.S.A.PLUS05 0816 Quick4 Plus™ Series INFILTRATOR WATER TECHNOLOGIES, LLC (“INFILTRATOR”) Infiltrator Water Technologies, LLC STANDARD LIMITED Drainfield WARRANTY (a) The structural integrity of each chamber, endcap, EZflow expanded polystyrene and/or other accessory manufactured by Infiltrator (“Units”), when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator’s instructions, is warranted to the original pur- chaser (“Holder”) against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installa- tion of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator’s liability specifically excludes the cost of removal and/ or installation of the Units. (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the instal- lation instructions; failure to maintain the minimum ground covers set forth in the installation instruc- tions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator’s installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different war- ranty requirements. Any purchaser of Units should contact Infiltrator’s Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. Quick4 Plus Standard Chamber ___________________________________________________________________________________ Quick4 Plus All-in-One 12 Endcap ________________________________________________________________________________ Quick4 Plus All-in-One Periscope ________________________ EFFECTIVE LENGTH48" 12" 34" QUICK4 PLUS ALL-IN-ONE PERISCOPE (360° SWIVEL) 12.7" INVERT PRESSURIZED PIPE DRILL POINTS LOCATIONS (2 PLACES) 33" 18" 8" INVERT 13" EFFECTIVE LENGTH48" 12" 34" FRONT VIEW SIDE VIEW EFFECTIVE LENGTH48" 12" 34" QUICK4 PLUS ALL-IN-ONE PERISCOPE (360° SWIVEL) 12.7" INVERT 6" 5"9" Pg. 8 of 13 Dose-Conventional POWTS Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01) and SBD-10706-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. All inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS383.52 (3), Wisc. Admin. Code. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Tho mpson at (715) 248-7767 or the St. Croix County Zoning Department at (715) 3586-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). The septic tank is located within 150’ of service pad, with the bottom of tank  15’ below service pad elevation. The contents of the tank shall be removed and the operating condition of the septic tank and outlet filter shall be assessed at least once every three years. The septic tank contents shall be removed on a three year cycle or when the sludge and scum in the tank exceed 1/3 the liquid volume o f the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code , by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual a ssessment, maintenance personnel shall advise the owner of when service will be needed to maintain less tha n 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned annually or as necessary to ensure proper operation. The filter cartridge sho uld not be removed unless provisions are made to retain solids in the tank that may slough off the filter w hen removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank man holes risers, access risers, and covers should be inspected for water tightness and soundness. Access opening s 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 greater than 8 inches in diameter shall be secured by an e ffective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wi s. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used, they shall be approved for septic tank use by the Department of Professional Servies, POWTS Division. Pump Tank The pump (dosing) tank shall be inspected annually. Switches, alarm, and pump shall be tested to verify proper operation. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and ar ound the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traf fic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltr ative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installa tions (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in th e permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding annually. Ponding levels above 6 inches indicate an impending hydraulic failure requiring additio nal, more frequent monitoring. Contingency Plan If any POWTS component becomes defective, the component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eli minated by alternating the diversion valve between dispersal cells to bring the system into proper operating condition. If alternating cells does not result in a properly operating system, a new dispersal cell will be installed. Pg. 10 of 13 Community Development Department – Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov SANITARY SYSTEM OWNERSHIP/ADDRESS FORM 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. Owner/Buyer Mailing Address City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number (found on the property tax bill) Property Location _____ ¼ , _____ ¼ , Sec. _____, T _____N R_____W, Town of . Subdivision Plat: , Lot # _____. Certified Survey Map # , Volume , Page # . Warranty Deed # (before 2006)Volume , Page # . Number of bedrooms Spec house  yes  no Lot lines identifiable  yes  no New Property Address (Verification of 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 made in the warranty deed. NEW SYSTEM: LEGAL DESCRIPTION File #: ______________ Office Use Only Created 2/2021 OFFICE USE ONLY OWNER/BUYER INFORMATION Pg. 11 of 13 Pg. 12 of 13 Pg. 13 of 13 Wisconsin Department of Safety and Professional Services Page 1 of 3 Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, County St. Croix Parcel I.D. 038-1111-80-000 Ref #2732 Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Reviewed by Date Property Owner Steven J. Christen Property Location Govt. Lot NW ¼ NW ¼ S 28 T 31 N R 18 E (or) W Property Owner’s Mailing Address th Lot # Block # Subd. Name or CSM# th New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial – Describe: Parent material Glacial Outwash Flood Plan elevation if applicable na ft. General comments and recommendations: Site suitable for In-ground POWTS installation with 0.7 gpd/sq. ft. design loading rate. Recommended infiltrative surface elevation to be 90.50'. Pressurization required to reach system location. Boring Pit Ground surface elev. 95.62 ft. Depth to limiting factor >100" in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 1 0-8 10yr3/3 none sl fill 2fgr mvfr aw 2vf,f 0.0 0.0 2 8-14 10yr3/2 none sl 2fsbk mvfr cw 1fmc 0.6 1.0 3 14-22 10yr3/4 none ls & gr 0sg ml cw 1fm 0.7 1.6 4 22-30 7.5yr4/6 none ls 0sg ml gs - 0.7 1.6 5 30-49 10yr4/6 none gr s 0sg ml cs - 0.7 1.6 6 49-100 10yr5/4 none s 0sg ml - - 0.7 1.6 Boring Pit Ground surface elev. 95.08 ft. Depth to limiting factor >98" in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 1 0-8 10yr3/2 none sl 2fgr mvfr cs 2fmc 0.6 1.0 2 8-22 10yr3/3 none sl 2fsbk mfr cw 2fmc 0.6 1.0 3 22-30 7.5yr4/6 none gr ls 0sg ml cw 1f,m 0.7 1.6 4 30-52 10yr4/6 none gr ls 0sg dsh cw 1f 0.7 1.6 5 52-98 10yr5/4 none s 0sg dl - - 0.7 1.6 * Effluent #1 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L CST Name (Please Print) Signature CST Number Address Date Evaluation Conducted Telephone Number SBD-8330 (R04/15) 1 Boring # 2 Boring # Boring Pit Ground surface elev. 95.10 ft. Depth to limiting factor >97" in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 1 0-6 10yr3/2 none sl fill 2fgr mvfr aw 2fm1c 0.0 0.0 2 6-16 10yr4/4 none sl fill 0m dh aw 1vf,fm 0.0 0.0 3 16-23 10yr3/2 none sil 2fsbk mfr cw 1vf,fm 0.6 0.8 4 23-41 10yr4/4 none sl 1msbk dsh aw 1vf,fm 0.4 0.7 5 41-51 7.5yr4/6 none gr ls 0sg dl cw - 0.7 1.6 6 51-97 10yr4/6 none gr s 0sg dl - - 0.7 1.6 Boring Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 Boring Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 * Effluent #1 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L 3 Boring # Boring # Boring # aba,7C"E da5/°er rJ s P5 3$ 3, 33, E,xiSzii� C✓ama s J J y ? 3o7v lope Dehch CSC o�S;CLi� 4SSuIntC/ { /ev, = /UD.Co., V Se/3-�,'c Z-c"/r(r+1Lco/P ES-6'n7¢icc� OF S,T oc4.2-'/,e� 8- L�,-f, 3