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002-1022-80-300
S't. Croix County Planning and Zoning Wednesday, January 30, 2008 at 5:00:79 PM Detail Sanitary Information Page 1 of 1 Computer #: 002-1022-80-300 Sub/Plat: NA Section: 11 Parcel #: 11.29.16.158A30 Lot: 2 TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: Vol. 16 Pg. 4362 1/4 1/4: SW 1/4 NW 1/4 Owner: Bloomquist, Brad 1067 250th Street Baldwin, WI 54002 State Permit: 499208 Issued: 10/16/2006 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 10/26/2006 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Ryan Yarrington >4/1/00 -Not Required Helgeson, Bennie existing failing system identified in soil report has $0.00 Ryan Yarrington Signed Off: Yes surface discharge - WI fund? Ma°ssrtenance Scheduled Pump Date Pumped 10/26/2009 Parcel #: UU2-~ 022-80-3UU 09/18/2006 03:19 PM PAGE 1 OF 1 Alt. Parcel #: 11.29.16.158A-30 002 -TOWN OF BALDWIN Current ~ X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - BLOOMOUIST, RICHARD M & DONNA M RICHARD M & DONNA M BLOOMOUIST 1067 250TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 1067 250TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 W ITC Legal Description: Acres: 12.673 Plat: 4362-CSM 16/4362 002/02 SEC 11 T29N R16W PT SW NW BEING CSM Block/Condo Bldg: LOT 02 16/4362 LOT 2 12.673AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) J~~~~//~ ~ /~~.~~n. e ~p '`' v` 11-29N-16W SW NW C ~i 0~ ~ ~ Notes: Parcel History: ~~i7^~~ ~~ ~~ ~-~ Date Doc # Vol/Page Type 10/04/2002 692837 1998/667 W D 09/04/2002 689178 16/4362 CSM 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.000 13,200 77,100 90,300 NO AGRICULTURAL G4 5.000 500 0 500 NO UNDEVELOPED G5 1.673 700 0 700 NO Totals for 2006: General Property 12.673 14,400 77,100 91,500 Woodland 0.000 0 0 Totals for 2005: General Property 12.673 14,400 77,100 91,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 556 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ ~~~ Wisconsin Department of Commerce SOIL EVALUATION REPORT--^~~"'~ Page / of! Division of Safety and Buildirtgs m accoraance vinm ~.omm ao, vvis. Ham. ~,oae Attach com lete site lan on a er not less than 81/2 x 11 inches in size Plan must County ~ ~ 1 p p p p . include, but not limited to: vertical and horizontal reference point (BM), direction and parcel ,y~~ ,~ (f7, ~ ~ i/h ~ ~ , l jjU percent slope, scale or dimensions, north arrow, and location and distance to nearest road. I ~ _ CJ P/ease print all information. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9 /~ a6 Property Owner ~ S ~ u o w ~ ~ ~ k 1- ~ Property Locat'ion1 G L s ~ ) 1 /4 ~JU~ 1 /4 S ~ ~ T ~ 9 N R ~~i E (o W - p t . h nt_ t c. e w ovt. ot , Property Owner's Mailing Address to ~ 7 Aso f~ St----e-~f Lot # Block # Subd. Name or CSM# City ~ State Zip Code Phone Number l,(~~v/~~~ ~l Syo2S (7/5)698-39~o ^ City Village own ,~[ ~r~ Nearest Road aSC>-><~ S~t~ ^ Ngw Construction Use: Residential / Number of bedrooms Code derived design flow rate ~~d GPD ~~'i R/eolacement ^ Public or commercial -Describe: T- ....L~ Parent material ~O'e5 5 6U qtr / i ~~ __ FI od Pla'rnaievtt;pa~ ft• General comments , j 1 ~ S ~ ~~~ j _ ©~ / 1tClrC and recommendations: ~'-{ b l l ,n (~ I ~-- ~ JUL l ~ Z00~ ~ ~ , Boring # Pit Ground surtace elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l i~ - b~l 3 L w. f2 ~ ~ r ~ v -~ ~~ -~ b ~ ~' ~ ~Fs i I WL I tl GCI.t~ lU~ I ~ ~' M3 o ~ ~7. ~~~ ~ ir' t I t.( a Boring # ~ Boring q ~ pit Ground surtace elev. ft. Depth to limiting factor / in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l o- °l t o YK 3 -~ L Pl ~'~- a s ~ .~ ~~ ~ --~(~ S 7 ~ 0 ~ ~ L ~, r/ Cc * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST a (Please Print) 'nature CST Number vt !n !-? -2. c D Gt ~ ~ ~ ~ 9~ Address , Evaluation Conducted Telephone Number Property Owner ~ 1 ~-K } ~ hV~~- ~ ~~V~'!~ u' ~~parcel ID # Page ~of~ Boring # ~ ~Boring L~ Pit Ground surface elev. ~ ft. Depth to limiting factor ~~ in. Soil Ap I'x:ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Gonsistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / e---~~ ~y2 ~ -- ~ w ~~~ . ~ ~ c5 ~ ~o a t L ,~ s ~ ~ c.J ~v ~ g ~3 3~ . s -~ 3 ~ c c 6 -~`' -' . ~ Boring # ~ joring -_ ~' Pit Ground surface elev. ft. Depth to limiting factor ~~ in. Soil Ap lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPD/fl~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 0 12 3 ~ 6 ~ iL ~ ~ l' O ,3 ~~ ~~ ~~~ %~ s L -~ sb ~, ~ ,~~ , ~ - 3 -3 . sy 7 s ~- o yn ~ ~ ~ ~~ ^ Boring # 0 firing ^ l• Pit Ground surtace elev. ft. Depth to limiting factor - in. Soil A placation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DifP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 h r S ~~.-- 4 ~ al' . I ~.s ~ .~ ~~- I ~- ~ ,~ l~ * Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =BODE < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.W/00) F~~~ Property Owner ~tC ~ ~ ~O(n Yl CL ~'OOV+'t~'GCt ~ parcel ID # Page ~ of~ ® Boring # ~ ring pit Ground surface elev. ~ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o- roy ~ -- ~ ~ ~ S~k ~ ;~~ . ~ . 8 - ~ S J' - C L a.s " ~ O v ~- %oyR ~ ~ i ~ ~ ~ _y S`12 ~ IoY sD ~ ~ _, a Boring # O j g ~J pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ ~ 7 5 .sy 2 ~- ~ c s ~l ~~ ~- , a ,3 Boring Boring # Ground surtace elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) ., . a 0 ~V ~~c a V ~ v~ ~~°`~ ~~ J ~, ~ ~~~~~ s s ~ ~~~ ~\\ 9~ r commercewigov i ^ lscons~n Department of Commerce INSPECTION REPORT Date of Inspection: August 3, 2006 Project Name: Bloomquist Use: Residential Legal Description: SW, NW, 11, 29, 16W Site Number: 716461 Subdivision: NA Municipality: Town of Baldwin County: St. Croix Plan Transaction Number: 1307924 Sanitary Permit Number: NA Wastewater Flow: 450 gpd Persons Present: M. Iverson SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 E~ct Spruce Street Chippewa Falls, WI 54729 www. commerce.wi.gov/sb (715) 726-2544 Plumber Name and Address: .Unknown Certified Soil Tester Nam and ,~ r~Ep Mark W. Iverson, T 46672 PO Box 155 qUG 0 9 2006 Hammond, WI 54 5 Owner Name and AddressT. CROIX COUNTY Rick & Donna Bloo st 1067 250th St Woodville, WI 54028 An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon. The intent of this investigation is to confirm initial observations by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil. In-situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surface water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. One soil boring was reviewed located slightly up slope of CST B-2 and found to be as described by the certified soil tester. The estimated highest level of prolonged soil saturation should be greater than 6 inches below grade at the mound site. If-a--mound-system is designed to-overcome limitations-of-a -high level of-seasonal- soil-saturation--and- slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated should not exceed 0.2 gpd/ftz. The additional basal area will partially compensate for the gentle land slope and prevent wastewater leakage at the mound toe. At least 30 inches of sand lift is recommended when applying septic tank effluent to the distribution cell of the mound to ensure .proper treatment. The longest portion of the mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much as possible. In addition, an up slope drainage ditch should be considered if it is determined that surface or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me. eroy G. ansky, astewat Specialist cc: ~ County ^ Plumber Ljansky@commerce.state. '.us E-mail ©CST ^ Owner 715/726-2544 Voice 715/726-2549 Fax ®Other ~L~K~t.~ w_`~_.~ ___._ _...__._._---- ---/-----/-.___---- ~~____-- ____~ ._._~~ ~ _~~~.~-.~:~----~~~--_____--_________--------N-- 4 H Vlysconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildi, g 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)i. Permif Holder's Name: City Village X Township Bloom uist, Brad Baldwin, Town of CST BM Elev: ~o ..S 3' Insp. BM Elev: / 0 3.5 BM Descri do ~ ~-v ~nl ~ ~. TANK INFORMATION TYPE MANUFACTURER ,`,,,15 CAPACITY Septic , ~~ `~ ~ / ~~ Dosing v,n..~oa ~ QC5 Aeration F; l o (d ~ SZ Holding TANK SETBACK INFORMATION TANK TO P/ 5oJ WELL BLDG. Vent to Air Intake ROAD Septic ,~ ,~/ 7 ~GZ~ 3S/ ~$ ~ Dosing y 5C~ / 7 /vZ ~ 35 ~ 35 ~ '_ Aeration Holding PUMP/SIPHON INFORMATION ~ I. Manufacturer //~~ p,J 115 Demand GPM Model Number w~a s ~F- 2 J~ ~ /_ ~J w TDH Lift9 5~ // , Friction~~ ss System Heads ,,TDy„ 7' a~t ~ 3 ~ Forcemain Length / 5~ Dia. ~/ z Dist. to Well , ~ /oz. SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 499208 0 State Plan ID No: Parcel Tax Nd: 002-1022-80-300 Section/Town/Range/Map No: 11.29.16.158A30 ELEVATION DATA STATION BS HI FS ELEV. 3• /o .g X03. ss Benchmark ~M2 ~~5 ~pB,, $ /03.53 Alt,. IBM Ko~MQ, Fe.,~a•~~ Z'Z2- °!7•$Z' 95 ~ 4.. Bldg. Sewer ~ 9•Z $Q•!oZ St/Ht Inlet ~ JD. g7 Sb •9 5 SUHt Outlet ~ ~ Dt Inlet ~ ~ Dt Bottom ~!' I~~ZS g3•S7 Header/Man. 3,77 /63 •llv Dist. Pipe 3.77 /a3 • /~ Bot. System ~.'~3 /bL - Final Grade Z ~ 17 /Q5~• / ~ St Cover ~j..,,,~ e.~" 3 • 9 `f , b Z /~ ~leoc Qfa; ~... ~' 1o,a5 ~7.~7 BED/TRENCH Width , Length / No. Of Trenc s PIT DIMENSIONS No. Of Pits_ Inside Dia. Liquid Depth _ DIMENSIONS (~, 5 ~ Od _ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR Type Of Sy ~t~~ 5 / 7 /A^ , ~'~ i /~ UNIT Model Number `_ nISTRIRIITION SYSTEM A)..rl]_ Header/Manifold ~ ,/ N ~ Distribution ,~ 1 ~ 1 ~/ Pipe(s) ~ ~ /Z Z~ x Hole Size r~ ~ / x Hole Spacing L ~/ 7 3/ Ver~(to Air ke `IFS Length z~ Dia Z q7• / Length Dia Spacing $ v , ~a S[lll r(1VFR ., n..,«...e e.,~~e.,,~ n.,i.. ~~ Mnunrl nr At.(~ratlw Svctamc Only Depth Over Bed/Trench Center / , I - r Depth Over Bed/Trench Edges ~ xx Depth of Topsoil , ~.- xx Seeded/Sodded es No xx Mulched Yes ' ', No s. S COMMENTS: (Include code discrepencies, persons present, etc.) inspection #1:~~ / «i V ~•~(,lj Inspection #2: / / Location: 1067 250th Street Balldwin/WI 54002 (SW 1/4 NW 1/4 11 T29N R16W) NA Lot 2 ~~„~ f°'p Parcel N~o: 1~1/.29.16.158A30 1.) Alt BM Description = 2.) Bldg sewer length = ~/~' Gl ~ ~~ ~ ~; l~~ ~... - amount of cover = , 5 Plan revision Required? Yes ~o ~ Z~ t,1.' ~ T Use other side for additional information. Date Insepct is Sig lure Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 St. CfOIX ~~~~~~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)266-3151 ,/9 ~f z b~ Sanitary Permit Application to Plan I.D. Number vans. Id # 1328660 In accord with Comm 83.21, Wis. Adm. Code, personal information you may be used for secondary purposes Privacy Law, s15.04(lXm) 'ect Address (if different than mailing address) I. Application Information-Pleas rintAllInformatio RECEIVED ~/0~7 ZSo ~ S~- Property Owner's Name Parcel # Lot # Block # Rick & Donna Bloomquist OCT 1 6 2006 002-1022-80;00 2 N/A Property Owner's Mailing Address Property Location 1067 250th Street ST. CROIX COUNTY SW NW Section 1 1 '/< ''/ City, State Zip Code er , s, Baldwin, WI 54002 715/698-3960 T 29 N, R 16(circlfone) /' /5g~- C II. Type of Building (check all that apply) / 3 ~~SL..~~~ Q 1 or 2 Family Dwellin -Number of Bedrooms Subdivision Name CSM Number g Public/Commercial -Describe Use 689178 ^StateOwned-Describe Use ~~ ~~Q' OJ ~ ^City~Villagel_Ilownshipof Baldwin III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S stem y 0 Replacement System ^ Treatment/I-Iolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ IV. T e of POWTS S stem: Check all that a 1 p ter' ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil /^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ~ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber 0 Drip Line ®Gravel-less Pipe ^ Other (explain) V. Dis ersal/'I'reatment Area Information: Design Flow (gpd) Design Soil Appli n Rate(gpdsf) Dispersal Area aired (st) Dispersal Area Fr osed (sf) System Elevation 450 / 1 6 , 5 450 ~ 450 22~jb 102.5 /' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steei Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks Existing Tanks o IDtz ~LSZ F~ ,. F;~ Septic or Holding Tank 1000 1000 1 Wie r Concrete X Aerobic Treatment Unit Dosing Chamber 600 600 1 Wieser Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu is Signature MP/MPRS Number Business Phone Number Bennie Helgeson 292 715/772-3278 Plumber's Address (Street, City, State, ip Code) W1229 770th Avenue, Spring Valley, WI 54767 VI . Coun /De artment Use Onl Approved ^ D' approve Sanitary Permit Fee (includes Groundwater Date Issued Issuing ent Signatu (1`r tamps Surchazge Fee) ~ C~~ ~O J /0 / / O~ ( ^ iven Reason for Denial p IX. Conditions ~of~App~r~o~w~aUReasons for Disapproval \ „~_ SYSTEM OVYNER: ,3) 6 ~ S ~`a a,~pa. cJ. ~ 1. Septic tank, effluent lifter and l dispersal cell must ail be servibes !maintained (~c~. ~p~.Q., . as per management plan provided by plumber. r 2 Ali tfk requirements must be rrwirttailtsd, n . l-r~ licable tsode /ordinances as er a [ S ! ~J ~ {~~ ,1~1 S~a.~2 ~ O /l ~ . p pp , a,~t.d t Attach complete plans (to the County only) for the system on paper not less than 81/2 x Il inches in size ~~ J SBD-6398 (R. 01/03) r I f ~` i e ~ of 1 C~ w S J 'L.1 ~~ i ~ N ~ ~ a s~ ~ ~ ~ i ~ ~ ~ = ~ ~ ~, ~ o ~ _ ~ ~ w ~} ~ Ac x ~ ~ - ~ 3 4 Z. a ~ ~ At r- , ~ ~~- p `~ ~ ~." ~ N O ~ ~ .~ ~~ ~\ '~ ~ ~ ~ ~ ~ ~ '.~% ~ \ \~ I ~~ ~ ~ ~_ --- ~ ~~~ ~ 9 ~~ ~. \ ~~ i \ .s ~ \ ~~ C \ ~ ~~ ~ ~ ~ ~ ~~ ~ ~ ~ `~ 1 Q.+ ~J, M ~ ~. I ~ ~ M ~r~ O~ j ~ b ~` }- ~~ ! ,- d - 3 V ~~ .~ T ~~ .g ~ ~' ~ ~ t~ ~~ a ~- ~~ ~~~~Q `~. V }~ ,J ~ 3 D.( ~ v ~ d ~~ ~3 j a~ ~ ~s ~~ >0 0~ a d w ~- ~- v `~ t~'4 ~ i ~ ~~ M ~~ S _, ~~ d `v ~, ~ ~ U y o~ .9 0 ~ C o° s !!~~-d k °~ ~`s ,o a ~- s ~~ o ~ $-~ G~4 o ~~ ^ „~__- a ,~ i"1~ ~ ,aa Oo Or o r (Y)}~ o y~ commerce.wi.gov ~ a isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 09, 2006 CUST ID No. 220292 A7TN.• POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2008 Identification Numbers Transaction ID No. 1328660 SITE• Site lD No. 716461 Rick & Donna Bloomquist Please refer to both identification numbers, " 1067 250th Street above, in all' corres ondenee with the a enc . Town of Baldwin St Croix County SWl/4, NWl/4, S11, T29N, R16W .- - FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1101542 Maintenance required; Replacement system; 450 GPD Flow rate; 6 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD-10572-P (8.6/99), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) ~ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use; • -This system is to be located and constructed in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • The treatment tank shall be anchored securely per Comm 83.43(8)(g), Wis. Adm. Code. • 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. Access to the tank filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • Comm 83.22(7) - 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. ~'•a.~'~~, ~ ~, cj~d~~r`t~(~~rrrl~'~~ Dki~AR7M~N7 nx rnu~~.~o~~ BENNIE W HELGESON Owner Responsibilities: Page 2 10/9/2006 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, v erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - h'ri, 7:15 am - 4:00 pm j erry.swim@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 t r, INDEX SHEET PROPERTY OWNER: RICK BLOOMQUIST 1067 250TH STREET WOODVILLE, WI 54028 PROJECT NAME: RICK BLOOMQUIST PROJECT LOCATION: SW 1/4, NW 1/4, S 11, T 29 N, R 16 W MUNICIPALITY: TOWN OF BALDWIN COUNTY: ST CROIX REC~I~~Fr~ 00T - Z 200fi SAFE & BUILDINGS DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP1000/600-MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Signe `~ Date: September 29, 2006 !!'i5!~,r; vF S FE7Y ANG SUI;DlNGS SEE COR SPONDENCE t7'l,)~~~v4t ~ ~Ir`~.~~faR,~tnr ~. i S~ Page ~ OfQ Synthetic Covering ,~srM c 3.3 Medium Sand -~ _ Topsoil ..J i 3 3 % Slope E isiribution F 0 ~' Cr~.~.Of 2~- 2'a Aggregate ' Cross Section Of A Mound Signed: License Number: Date: Force Main From Pump q ~/,S" Ft. g 1Q~? Ft. K ~ Ft. L ~~~ • F t . J /p. S Ft . T / ~ Ft. W ~ Ft. Pipe /oy•-~ ~ n., ~G ~ ~ /G~-~ ~or~tou,r Ck~. ioo. ~~ \ Plowed Layer D a. S Ft. E ,~, by Ft. F ,, ~.2 Ft. ~ _~ Ft. H ~_ F t . L Observation Pipe- d ~-8 - __ __ -_.,--- ~K r-- _ _ ----- ~-- ------------- ---,1 . ~ ~ 0' I ~ ~ ~~~ o f ~,~_ 2 L„ / Distribution 2 Pipe llA''99fe9ate Observation Pipe Plan View Of Mound C ~ e o. ~. 0~--1' /-~cCC5~ , PerforolnA f'I . Dn~oll a ~ J End Vl.w Perlorolcd ~ ~ I Holes Located on Bottom are Equally Spaced ~ Ifel ripe Distribution Pipe Layout_ Signed: License Number: Dace: ~ ~ ~i P 97 " ~D.Y . . R ,~ S ~$ x ~y Y ~_~ Hole Diameter ~ Inch Lateral " ,~_ Inch (es) Manifold ~ Inches force Main ~_ Inches ~oleffs ~e~ jq~e~4~ = 3 ~~~n ~f''. Q ~ Ck ~ I~,~-.~ c~ ~._ , ~~+- Page 4 0f g, SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS u" ~UC.VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E ~~2J WARNING LABEL ~~, f° -- ~~--4" MIN. 2y., 18" IN. ~ ~ r. D. ~• \ ~~ 18 MIN. ~ INLET ~ ~, ~ . WATER TIGHT SEALS GAS- TIGHT ~ ~~ ~ / /APPROVED FINER - A , SEAL JOINTS WITH l 10 (~ c -f-- ~ ALM APPROVED PIPE APPROVED ' o 4 SaS B ~ ~ ON 3' ONTO PIPE 3 - ~ ~ SOLID SOIL ONTO SOLID C ~ SOIL PUMP OFF ELEV . g3.•I ~FT. --~- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE ~ ~ X S ~ ~ ~~.~ ~ . TANK MANUFACTURER: ~,L~i~S~~ TANK SIZES DOSEIC ~bTQ(~- GAL. D77° `/3 ~,.~,FLO BACKG ~ I, ~ GAL. ALARM MANUFACTURER: ~. CAPACITIES: A = ~ ~ INCHES = 30/ ~~ GAL. -MODEL NUMBER: / lJ 1,_ L B = 2 INCHES = .~5_? GAL. SWITCH TYPE : + /~'I~~ yr (.~-~ _ ~~J / 1 / C = ~~ INCHES = ~~y GAL. PUMP MANUFACTURER : C~Cx-~ ~~ ~ J MODEL NUMBER: WEt~ p INCHES = C~G~•S~GAL. SWITCH TYPE: Ffo~.~ ~ ~'-- REQUIRED DISCHARGE RATE ~~G~ GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~ fEET + _~l7S FEET FORCEMAIN X ~,~ FT/100 FT. FRICTION FACTOR ._. /~SFEET TOTAL DYNAMIC HEAD 3 n, ,FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER SIGNED: LICENSE NUMBER: DATE: 1/88 cJ.. Q ~- 0 Z W J Q Li.. ~ Z J ~ Q F~ Fa NQ io Y ~ ~~ W = X01 ~ a ~~ °~ vv p ~Q JU (%') Q JJ Q Q U7 I O U o ~ m ~~ o~ ~ww ~ ~" O W ~ ~ ~y~p -~ ~ Na Q~ ~r CO p ~~'~ ~ O O ~ mWW ~ N N r O N Mt ~~~Z~d- t N O ~ J r W~ Q ~ U JZ~ 1 ~ a F Z O Y ^ ~W ~~..~ ~ -J~ o~w o ow a w O Z , z . o~==~ o~~ o0°N o"= n. ° ~ ~ N3mU~iw~m~~ a<t~ a~° o z ~ J J ~ a0 ~ Z ? J J (n Z ~ W ~ W „Z~ e J d Z : V' a O .,~ ~'-(~ . ~ 1 1 ~ 1 ~' ~ I I ~ ~ I I ~ . ~ I ~ I ~ I• .~ ~. I ~ I ~ ~ I , 1 ~~ ~ 1 . ~ `~ ~ '~ ~`' .1 ~ \` ~ 1 :.~. . ..' ~. I ~ I ~ . ~ I ; 1 ~ 1 ~ ,~ I' • ~ I , ~ I ~ 1, / ~ ~~~~``` i . I ~ . ~~ ~ I . ~ ~ ~ ~ , I /~ I N~N ~~ W, W O J ~ a U N U F e -~1N ~ ~~ ~ ~~ ~ m ~ ~ Ups ~~ ~ o d ~NZ ~ o ~ ~ ~ U d L2-~J``~tf~ 0 _ °o~~' a N CDwU ~ C ~J p ~ O U ~ W J O _ `;. ~ O I(~7~~~ 1I r 3~ ~ ^, ; "` " - ~cnO n n n I - - I N o ~ W - _ ~ ~ `- W W F- W FJ- ~ „6~ „95 __Q~j Y1 r~ r,~~ I ~ ~ lcxm u u ~ s~' Performance Curves METERS FEET 90 25 ~ g 70 I 20 60 O H 15 ~ 4D 10 ~ 2C 5 1C 0 C v ~~ -- --1._ ~- 10 _ ~. ~'Ui1f~~J5 CAPACITY 20 GPM J 30 m'/h GOU LDSPPU~M PS~N~CB. METERS FEE 1. 35 1' 11 30 = 20 O F- 15 10 5 0 V ~ ~ 10 0 CAPACITY 20 30 m'/h Eflecdve July, 1965 c r , . ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of b ,. r 1-ICAt7-/IATIAAI 'ILG Inwntn~..v.. Owner iiiclc Blootuquist Permit ~ NG.71 ~71~ r /111n,~,.. • r• ••• Number of Bedrooms 4 ^ NA Number of Public Facility Units ~ NA Estimated flow (average) 300 al/day Design flow (peak), (Estimated x 1.5) 450 al/day Soil Application Rate U.5 al/day/ftZ Standard Influent/Effluent Quality Monthly average ' Fats, Oil & Grease IFOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L C~NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (8006) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ya in die. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tanK errlueni. ,irrlell~nTl/1 AIC J ..~ . a-,~, - Septic Tank Capacity lUUU al ^ NA Septic Tank Manufacturer Wieser Concrete ^ NA Effluent Filter Manufacturer Polylok ^ NA Effluent Filter Model YL-525 ^ NA Pump Tank Capacity 6UU al ^ NA Purnp Tank Manufacturer W' ^ NA Pump Manufacturer Goulds Puwps Inc ^ NA Pump Model 3i•3t35 WEUSI-i ^ NA Pretreaunent Unit ANA ~^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Ce(lls) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade Q Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANt:t ,trnGUUI_G Service Event Inspect condition of tank(s) Pump out contents of tank(s) At feast once eves When combined s Inspect dispersal cell(s) At least once eve Clean effluent filter At least once eve Inspect pump, pump controls & alarm At least once eve Flush laterals and pressure test At least once eve Other: At least once eve Other: Service Frequency ^ month(s) (Maximum 3 years) ^ NA Y~ 2 ~ year(s) Judge and scum equals one-third lY3) of tank volume ^ NA ^ month(s) (Maximum 3 years) ^ NA Y~ 2 Gi! year(s) y~ 13 Y~ 13 Y~ 3 y: montnts~ veer(s) Q month(s) ^ year(s) ^ month(s) Q year(s) ^ monthlsl ^ veer(s) ^ NA ^ NA O NA ^ NA ^ 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 tank(s) 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 cell(s) 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 around 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 IY,1 or more of the tank volume, the entire consents 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• GMW (4/01) Pape i3• of ~. r ~ . ~U~iN~R: Dick Bloontquist START UP AND OPERATION. 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 cell(s). If high concentrations are detected have the contents of the tank{s) removed by a septaga servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surf wer Is restored the excess During power outages pump tanks may fill above normal highwater levels. When po wastewater will be discharged to the dispersal cell(s) in one.large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoi1d8 to the effluent pump orncontact a Plumber o POWTS Maintainer W Septage Servicing Operator prior to restoring po assist in manually operating the pump controls to restore normal levels within the pump tank. po 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 soli absorption area. Reduction or eliminatlon of the following from the wastewater stream may Improve the performance and p,~long the I(fe of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degr~os~elde~~e h~~~ ~~~t disinfectants; tat; foundation drain (sump pump) water, fruit and vegetable peelings; g 9 scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONKINENT When the POWTS fails and/or is permanently taken out of service the following,Mssconsln'!Adm nlstratlve C~ethat the system is properly and safely abandoned In compliance with ch. Comm 83:33, • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealee Servicing Operator. • The contents of all tanks and pits shall' be removed and properly disposed of by a Septag After pumping, all tanks and pits shall be excavated and removed or their covers removed and the Vold 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 co e compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location o(a replacement sot absorption system. The replacement area should be protected from disturbance and compaction,and should not be infringed upon by required setbacks from existing ar)d proposed structure, lot Imes 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 eKect at that ~e• advances N POW7S O A suitable replacement area is not available due to setback and/or soil limitations. Barring technology a holding tank may be Installed as a last resort to replace the felled POWTS. O The site has not been evaluated to Identify a suitable replacement area Upon faJlure of the POWTS a soU and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installed as a last resort to replace the failed POVJTS, ~ Mound and at-g dace oReco sW Uonstof su hasystems must complypwit)7 thelrules9n effect at that time. tat the infiltrative «WARNING» s EPTIC, PUMP AND OTHER UMP OR 07HER TREATMENT TANK UNDER ANY C1RC MDSTANCESF DEATH MAY G . DO NOT ENTER A SEPTIC, P RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOS$IB gDDITIONAL COMMENTS POVYTS INSTALLER Name Hel eson Excavation Inc Phone 715/772-327fS POWTS MAINTAINER Name •Phone 715/273-5llill_ LOCAL REGULATORYAUTHORI'TrY SEPTAGE SERVICING OPERATOR PUMPER Name Johnson Sanitation ~ Agency St. Croix Coun n'n Phone 715/273-St311 Phone 715/356-46F~U Tnis document was draRed by the staffs of the G(son Laks, Marquette and Waushara County Zonlny and Sanltatlon apendg+; Thla d~+d ~~ the minimum requirements of ch. Comm 83.22(2)(b)(i)(d)3(f) and 83.54(7), (2) b (3), Wisconsin AdmWsVative Coda. Uia of ihla doaur7entdas tsOt guaranies the performsnes of the POWTS. GBfbY (Zpt) Z9£fi abed 9 [' IAA F- ~o ~¢ ° o~=~ how Z^o Q O 3 a I Sti311b~d ~l9 03NM0 * ~ sat~ro=i a3u~dNn y • z • „L ~ . 65' i z5 M.. bZ, 8E o00S J ° .., 4 v N O 70~ m N v °- 'da X m ~~ o a " 0. ° N w 3 Q ~ c C.J') Q ~ n. N H >^ ~~ UU] F"J° U lL NU NUJ OH 3 ¢°Z WZ O Z p .yam Z ¢~ Q 3 ZO Z:Nf _~ ® ~- x H W ~~ LL ~ \F-- 3 ~ ii z W --+ ~o V a H m ~~ W U3 Wf Oo z ~ J F- '" , ~.......•-`.P o ~ ~ °' `" .,~" o ~ N ~ U7 V7 ~ is ~p f" ¢ Q / ~ ~ ~~ c~ w a a // 3 ~ ~ L] y~j ~ ° ma°a / / a c~ ~ ~I= O •~-~ tO~N3~y /// ~ - N~Np ~~ m W o I I °c ~ ~I ~O ti ~ ~ W¢W¢ I I ° ow ®wcaLL.c~ I I I I jl° ~ ~ ~ a~~o I~, Q ~ J o~o~ IH ~ cn z~. cn W I Q ° o I o m I I I I II II II ~~ i z H J W 3 O I ~IZI~I~ I ~ ~I,I~ --~_--- i _ L_ '6l l ti ' - ~ -- -- ~5 ~ ~~^ M ~h1'S'~ ~O l 1~~~ m OI Q W m t° I m a D a. Q a ~~m a o ~ ~ O q a+ W LLLLLL Z ^~ 3 ?I o AVM-tlD-1}fJItl YIOtl~ 3rQ1 9NI0'IIf1B .OOT ...................... . O I I ~ ° 6b' 06L BO' Zi Ei cn ( I m , M., i b. 9i o00N NL, i V, 9i o00N ~ . 09_i Z5 Mdi . 9i o00N _ ~~ ~--_-_- _. _. -- ~.... - A - - m~~...r.. -- t7/iMN 3Hl ~0 3NI~ 1S3M SH3H10 1~9 03NM0_ sannn a3ufndNn O O n Q n 3 o ;~ v I ~~ zo ~ o w Z Z LJJ ~¢ Qm ee •e ~ aa.~ ~do~ ee•et :~$~ Asa Kv ee~e zeez->be-se Q~I003~i ?!Od QSAI303t! IM ' '0~ XIO~t~ '.LS SQSBQ ~0 ti'3.LS I ~J98 HS'fYM 'H N3S'IH.LYH Z9£fi 3~JVd g [ 'IOA 8 L T 6@ 9 ,~~, c~ Z ~ O H ~ H V Ng O ~ 3 ~ W W W Q ~ m~C.~WwV' O z a~ ~ c~i¢am~Zm Z H W ~ a~o ~ ~gQ~Z~~ v ~~t,U F- ~ ~G~HH~Q 0 vOj~a °8 ~~° g° a ~Q ~m ~ Z = zoz¢~= QZ a ~ ~ ~ fll~~~OwF- Zv Z`ti0 Z °~ZH Q~..~ H LMT.... F-UL7 U?F- > i i ~ ~~yjQJaa~j`t wao~~zt;~~ ~u~iaaac°~o° 0 0 N ~'1 W J a U N U H 2 a Q Q c9 o {1J~(DNN = 3 N N rn°^°zw cn~"m= N+QW~~ Z 3 za `ti > .-. Z O N ° W N~H ° ~oz o~~ U Q ~~~ 3 0 O 'U W O Q ~ 3 ° O (1! m 0 w a Q O O -- z ° H +*~ 2/ ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AG K EEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~jcJK- ~ot~.g, ~~x.>Mq~.~.~ ~ Mailing Address j(`~t9 ~ ~J O ~ J~' ~~ )~~,PV~ ~~ Property Address ~ c~-m~ (Veritlcation required from Planning & Zoning Department for new construction.) City/State i Gc>~ S Parcel Identification Number 06 ~ /O~ ~ -~6 ~o a LEGAL DESCRIPTION Property Location ~ec~ `/ , NUJ '/a ,Sec. ~/ , T a g N R / ~ `~V, Tuwn of ,~~~,-~~ ~ Subdivision ,Lot # ~ . Certified Survey Map # ~~ ~ / ~ ~ ,Volume ,Page # y3~a Warranty Deed # ~ ~I ~,~ ~ `~ , Volwne % ~ c(8 ,Page # (p (o "] Spec house ~ yes~no Lot lines identifiable yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prer~~,iure failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in Comm. 83.52(1) and in Chapter 12 - St. Croix Count,' Sanitary Ordinance. "fhe property owner agrees to submit to St. Croix County Planning & Zoni~~~ Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to mainu~u~ the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departmcut of Natural Resources, State of Wisconsin. Certillcation stating that your septic system has been maintained must be completed and returned to the St. Croix County Plamung & "Coning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er of bedrooms -yam SIGNAT E F APPLICANT(S) ~%~i~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds O f~tice and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 1016312666 65:55 7156'3^o23ba F~1FiK.VIEW HOME ~~ l~sas~' ss l 4 sTns`WA74t1tANTY DF~L~. to'!v !)oeffmonl t4aMber (~ttrvlAA L iltccht and Sharon R _-.,._ TTti9 Decd, made trerwecn _~~ --" --` .~- ..._ t;;rantt}r. antl Riel+artk M• Dlndtetgn!s~ stfd Donna M'~~3taorngrles~- ~•~--- - _..~.--r~•--~--.--~-_ ._ Grtlntca. Grttntar, far s ~slugble consfderati4tn, cottvcys tt+ Gxantcc the Caunry. falfowir-g described xcsl eftt7ttc in ~- Croix ~_~.... -~- gtntc or W iRCfrnsitY (if more Kpatt is needed. IStf3a9C altaCh etdticndutr+}. Part of kite Southwef3t ! is of the t~Sorxhwost i ra of Section t 1, To on ! 4pAa~c ~#6'2~filad Sept tuber 4, zf}p2, ac Doc ent (,Tr,. 6ki9178 lyap N PAGE 62 ~,~~~~~ ]tpTgHLEk~N Tk. MALSH sFT~,'xGROIX C~U>~E~S BFCETVSti k:'Ol~ BECiClR1? lfn~04-2002 9 -30 Ak) upRRt~itTY D~.J=D E'XE'MPT '~ R>aC ~E : 11.00 T1xAN8 FEE f 52=.- 90 COPY f>~fi' FN.GEraCdP~ FES e R+eording nrea ~- N~tfe and Return Addrxu I'T3E FIRSS 1CL1.'TIOt3AX. B~P.t!IK OTC' kTTJDSON p0 Box 187 1;tu8Reyn.. WI Paola t'arccl ldentiCcation Number fr1N) MomR.tetl4 P>'atteTSY• -~ {i4t tlanot} Exceptlon~ to wRrCdrtiCc: Easements, rastrietions and rights-af--way of record. if;tny~ _.,^~ ~ t'OOZ__. [latCd Ch19 daY of ~SC bCp mber_..-. ,._.-._ . -- AI.~T4IENTIfL:ATC~~ Signaturoigl _~___ authenticatOd thlq , _,„_dgY of YtTL~. MFMC3eR $TA."t"1; gAR Qi' WtgCDN51N nuthi7ri>!ed by ;5 70d~9fi, W ia~ ;,oats,) (If nnTlal5 fNSTtiIJME;v'P WAS DRnPT T-... . tsC? Cay _ a _,,-. ._....~ Attorney ICrfutlna !!.._ ~~ ywa t ._ ~. _.. _, _~ . --- (SIRn+fntec may be mntNantlcated ar a¢knowtarl6cd. Seth a•o nor nececs:nrw.l Names at p+rsbns xigning in nay cnpneisy mttbr be ryp+d ar printed (+~ nw thci wAFiRANTV blrFtf • 1Ner~:n k.• Utecht - " -- - ne~taowt.~:>yc:swFNT S7ATI"s pF W1gCONS1N ~ Sa 9t. firol% Cbttnty ) _-'- ~ r dny of pQrsanallY ~pmc btafpre me this ..r vC nmmCd gapt~r*hnr ,.. ___ 20112 chc abo-°- .'__ Life:hi wed Shnrnn Tt. Uttchk_,,, _ tp ,Ytc known to t7e fh~ t,ercon{s) who exCLnt@d the fpreK.lintX 9nctrUt nt cost ncknow e d th ca1nC' _.,,. _,M1 - t`lntary Public, Stpte of Wisconsin n Gate, My {'c~mmiySillft is p nttrnl. (kf ndt, r*+tP•nMp~ PTCMl7fen~ C,xnp+r,y, f'arw ~u Lr~ +M 9GO.OSy.~tR' S'x'ATG BAR OF WISCOVSt~ IrpRiM X0.2. t9~9 .~ commerce.wi.gov i ^ iscon~in. Department of Commerce REC~t~lED A~~ ~ ~ zaos ~T. CROIX COUNTY Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www. commerce.wi.govlsb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 04, 2006 CUST ID No. 46672 MARK W IVERSON PO BOX 155 HAMMOND WI 54015 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/04/2008 Identification Numbers Transaction ID No. 1307924 Site ID No. 716461 SITE: Rick & Donna Bloomquist .1067 250TH St Please refer to both identification numbers, _ Town of Baldwin, St Croix County above, in all corres ondence with the a enc . SW 1/4, NW 1/4, S11, T29N, R16W FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1090292 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the highest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is six inches below grade. At least 30 inches of sand lift on top of six inches of unsaturated, in-situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be < 0.20 gpd/sf, and the linear loading rate < 4.5 gpd/ft. 4. Chisel plowing to a depth of >_ 12 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. The down slope toe slope shall be at a 4:1 ratio rather than the standard 3:1. 6. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. 7. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. 8. A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. If the Interpretive Determination Report was accompanied with a plan and an expiration date is shown on this letter, the expiration date only applies to the plans for the design, not to the decision on the Interpretive Determination Report. MARK W IVERSON Page 2 814!2006 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. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. If this construction project will disturb one or more acres of land, an Erosion Control Notice of Intent (NOI) shall be filed with the department 14 days prior to any earth disturbing activities. In granting this approval the Division of Safety & Buildings reserves the rift 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 compona~t. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Leroy G. ansky, ,Waste er Specialist Integrated Services Bureau (715) 726-2544 Office (715) 726-2549 Fax Leroy. j ansky@wisconsin.gov Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633. INTERPRETIVE DETERMINATION REPORT Property Owner: Rick & Donna Bloomquist 1067 250' Street Woodville, WI 54028 130`7924 ' ~'.~.V'~.T.~. Coa~diti~~a~t~ly DEPARTMENT OF COMMERCE DIV SON OF SAFETY AND BUILDINGS SEE C RRESP DENC Site Location: SW '/4 of the NW '/4, Sec. 11, Town 29N, Range 16W Town of Baldwin St. Croix County Evergreen Irrigation Inc. Mark Iverson, Professional Soil Scientist P.O. Box 155 Hammond, WI 54015 Phone: 715-796-5664 Fax:715-796-5246 e-mail: evergreenetc@baldwin-telecom.net July 28, 2006 Date I. II. III. IV. V. TABLE OF CONTENTS Introduction .............................................................................................................1 Project Information .................................................................................................. l Method .....................................................................................................................2 Discussion of Results ...............................................................................................2 A. Local Hydrology ..........................................................................................2 B. Geomorphology ...........................................................................................2 C. Soil Disturbance and Hydraulic Modifications ............................................3 D. Landscape Position and Local Topography .................................................3 E. Soil Series and Mapping Units ....................................................................3 F. Additional Data ............................................................................................5 G. Comparative Analysis ..................................................................................5 H. Government Reports and Comments ...........................................................6 Conclusions and Recommendations ........................................................................6 VI. References ................................................................................................................7 TABLES Table 1 - Soil Series Characteristics Table 2 - Hydric Soil Classification FIGURES Figure 1 - USGS Topographic Map Figure 2 - Soil Map APPENDICES Appendix A - Soil Evaluation Report Appendix B - Preliminary Assessment Data I. INTRODUCTION On July 25, 2006 Mark Iverson, Professional Soil Scientist #197 and Certified Soil Tester #46672, completed an interpretive onsite soils evaluation. An interpretive evaluation is required because the site does not meet the requirements to install a new private on-site waste treatment system (POWYS) through completion of a conventional onsite soils evaluation (<A+4 inches of acceptable soil must be present). The onsite evaluation was completed through the observation of the soil profiles at five backhoe test pit locations. This report has been prepared to present the results of an interpretive onsite soils evaluation. The evaluation was completed at the request of the owner Donna Bloomquist. The property is located 3/4 mile north of Co. Rd. E at 1067 250m Street. In June 2006 test pits were observed by Ben Helgeson and Mark Iverson to determine if a suitable site for installation of a POWYS could be found through conventional testing methods. The preliminary evaluation concluded that A+4 soils were not present within the tested areas. However, potential sites were identified to complete an interpretive assessment of the soil characteristics. Acopy of the data collected during the preliminary assessment is included as Appendix B. II. PROJECT INFORMATION The following is site-specific background information, which has been collected: Property Owner: Rick and Donna Bloomquist 1067 250' Street Woodville, WI 54028 715-698-3960 Site Location: SW '/4 of the NW '/4, Sec. 1 1, Town 29N, Range 16W Parcel ID # 002-1022-80-300 Town of Baldwin St. Croix County Historic Land Use: Agricultural crop production Current Land Use: Agricultural crop production Vegetation: The site most recently has been used for soybean production. The vegetation within the tested area consists of 100% soybeans. The beans are showing signs of stress within the tested area. While the beans downslope from B-5 are not showing signs of stress due increased soil moisture levels. Hydric vegetation was not observed within the project area. III. METHOD This interpretive evaluation and report was completed following the guidelines set forth in Comm 85.60(2) of the Wisconsin Administrative Code and in the summary provided by Leroy Jansky titled, "Preparing the Interpretive Determination Report" (Mazch 13, 2002) IV. DISCUSSION OF RESULTS A. Local Hydrology 1. Surface Water Drainage Patterns -Surface water drainage is uniform over the proposed system area. The proposed system location is on the backslope. The slope within the proposed system area is approximately 2 to 3%. Evidence of concentrated surface water flow was not observed within the proposed system area. 2. Subsurface Water Drainage -The silt loam texture and lack of compaction within upper 6 to 9 inches of the A horizons offer good infiltration for the typical rain event. During and immediately following frozen conditions and following heavy precipitation events, runoff will be much greater. Water percolation is limited in the soil profile at 6 plus inches below surface by a number of factors. The factors observed include: • Platy structure observed at 6 to 9 inches below surface • Increase in clay content at 11 to 35 inches below surface 3. Artificial Drainage Devices - No artificial drainage devices were observed during the completion of the evaluation. 4. Contributing Drainage Area -The system is located on the backslope of the hill slope profile position. The slightly convex shape along the horizontal contour distributes the surface water over a wider area. 5. Soil Saturation -Saturated soil was not encountered within the tested azea. The area has had unusually dry conditions for the last two months. 6. Surface Water Elevations -Surface water within 1/4 mile of the site if present has been identified on Figure 1. B. Geomorphology 1. Parent Material -The parent material is loess or silty deposits over glacial till. 2. Landform Type -Ground moraines. C. D. Soil Disturbance and Hydraulic Modifications The proposed system location is in a soybean field. No hydraulic modifications, such as drain the or ditches, were observed at the time of the assessment. No additional surface water is received from impervious surfaces. Landscape Position and Local Topography The regional topography is shown on figure 1. The proposed system location is near the highest point on the property. The ground surface elevation is approximately 1240 feet mean sea level (msl). The topography within the proposed system area is shown on the site map included in Attachment A. The proposed system elevation is 100.00 feet msl. The shape of the slope within the proposed system azea is lineaz (perpendiculaz to the contour) and convex (parallel to the contour). FIGURE 1- USGS TOPOGRAPHIC MAP ,~ ~ ~• , '.C /' ~ ( . . '. ., ~, ti ~ i ~ ~~ .' L / ~ ~, .` ` .... ~~ _ _ Pra~erty~ - ~, -_~ _--. F Location; '~ .` ` ~r v 1 _.-, . _., ~, ~ '•~. ~,op~s~d Systeifi,Are -~ -- i - E. Soil Series and Mapping Units The Soil Survey of St. Croix County maps the soils on the property as Adolph Silt Loam (AdA), Freeon Silt Loam (FnB), and Magnor (MaB). The location of each soil type is identified on Figure 2. The primary soil characteristics asdescribed in the series description aze identified on the Table 1. TABLE 1-SOIL SERIES CHARACTERISTICS Texture ~ Parent Material ~ Permeability Soil Series A Horizon E or B Horizon Surface Subsurf. Surface Subsurf. Drainage Class Ad SIL SIL/SL Silty Sed Sandy Till MS MS VP Fn SIL SIL/SL Loess Till M MS to S MW Ma SIL SIL Loess Till M MS to S SP Abbreviations Permeability IM =Impermeable VS =Very Slow MS =Moderately Slow RA =Rapid M =Moderate VR =Very Rapid S =Slow MR =Moderately Rapid Drama. eg Class VP =Very Poorly W =Well P =Poorly SE =Somewhat Excessively SP =Somewhat Poorly E =Excessively MW =Moderately Well TABLE 2 - HYDRIC SOIL CLASSIFICATION NRCS -USDA Soil Series Com onent Inclusions USACOE Ad Yes H dric Yes Fn No None No Ma No Adol h No USACOE = US Army Corps of Engineers FIGURE 2 -SOIL MAP 4 F. Field Observations The soil identified during the completion of the test pits is similaz to the mapped soil unit Freeon. The soil saturation chazacteristics aze similaz with redox features present directly beneath the A horizon in the majority of the test pits. The texture characteristics of the mapped unit and the soils on site are primarily silt loam over sandy loam. Layers of sandy clay loam and silty clay loam were observed at varying depths in the soil profile. The A horizon extended 8 to 11 inches below surface. Blocky structure was present in the upper portion of the A horizon from the surface to 6 to 8 inches below surface in all test pits with the exception of B-5 which has platy structure from the surface to 9 inches below surface. Platy structure was present in the lower portion of the A horizon and the upper portion of the B horizon at some locations. Redoximorphic features were not observed in the A horizon within any of the test pits. The soil on site does not meet the hydric soil criteria. The lack of hydric soils indicates that the soil is likely not saturated for greater than 5% of the growing season (approximately 7 consecutive days). A dominance of hydrophytic vegetation was not observed within the proposed system azea. The lack of these features does not preclude the possibility that the soil is saturated for a prolonged period of time prior to or on occasion during the growing season. G. Comparative Analysis Soil borings (B-1, B-2, and B-3) were completed within the proposed system area. Two additional borings were completed, one upslope (B-4) and one downslope (B-5) of the proposed system area. The conditions observed at borings B-4 and B-5 had some minor differencesin comparison to borings 1, 2, and 3. Boring B-4 (upslope) had 5 inches of separation from the bottom of the topsoil to the redox features (A+5). This area was not further investigated because the potential system contour in this vicinity was very irregulaz. In addition moderate platy structure observed at 8 to 13 inches below surface would have required a very low loading rate and a similaz mound design if a suitable area was present. The soil conditions observed at B-5 downslope were similar to that of the system area with one exception. Platy structure was present from the surface to 9 inches below surface. The presence of platy structure from the surface indicates that this area is likely wet for a longer duration each spring and is likely still very moist when the tillage and planting is completed. H. Government Reports and Comments No government reports or comments were available for this site V. Conclusions and Recommendations The saturation appears to be limited to greater than 6 inches below surface the majority of the time. The lack of soil dominated by low chroma colors within the profile indicates that the saturation is not due to a high water table or perching conditions. The cause of the redox features observed in the test pits is most likely attributed to short-term seasonal saturation due to slow permeability of the subsurface horizons. The site is suitable for installation of a POWTS (mound system) for the following reasons: l .) Redoximorphic features were not observed in the upper 8 to 12" along the proposed system contour at B-1 and B-2 or at B-3, downslope from the system contour. 2.) Neither hydric soils nor a dominance of hydrophytic vegetation aze present within the proposed system area. 3.) The convex shape of the slope parallel to the contour will divert surface water prior to the POWTS. The influence of surface hydrology at this point will be minimal. 4.) There are no features that concentrate surface water flow toward the proposed location of the system. 5.) The slope at the proposed system locatian is 2 to 3%. The slope is uniform with no dips or valleys at the proposed system location. 6.) Lack of redox features in the upper 8 to IZ inches of B-1, B-2, and B-3 indicate that the soil is not saturated for prolonged periods during the growing season. 7.) The lack of soil dominated by low chroma colors indicates that the redoximorphic features observed at depth are due to temporary seasonal saturation and not from a permanently high water table or perching condition. The following recommendations should be considered during installation of the proposed system: 1.) The system should be installed on the 100.0' contour to stay within the tested area. 2.) Sand fill shall consist of 2.5' of material meeting ASTM C-33 specifications. 3.) The tillage must be completed with a chisel plow to a minimum depth of nine inches below native ground surface during dry conditions. Chisel plowing to 12" is desirable. 6 4.) The basal loading rate shall not exceed 0.2 GPD/ftz for EFF#1. 5.) The system shall be designed to have a linear loading rate of 4.5 GPD/ft or less. 6.) The system will follow the contour (100.0') and be slightly convex. 7.) The mound downslope should be constructed at 1:4 rather than 1:3 to increase the toe absorption area. 8.) The area upslope of the mound must be altered to limit the influence of surface water received from upslope. The final approval of this site must be made by the Wisconsin Department of Commerce and the St. Croix County Zoning Department. This report represents the observations and professional opinion of Mark Iverson, Professional Soil Scientist (#197) and Certified Soil Tester (#46672). VI. REFERENCES 1.) United States. United States Department of Agriculture Soil Conservation Service, in cooperation with Research division of the College of Agriculture and Life Sciences University of Wisconsin. Soil Survey of St. Croix County, Wisconsin. 1978. 2.) State of Wisconsin. Department of Commerce Code, Chapters 83 and 85. 3.) US Department of Agriculture, Natural Resources Conservation Service. 1996. Field Indicators of Hydric Soils in the United States. G.W Hurt, Whited, P.M., and Pringle, R.F. (eds,). USDA, NRCS, Fort Worth, TX. 4.) Schoeneberger, P.J., Wysocki, D.A., Benham, E.C., and Broderson, W.D. (editors), 2002. Field book for describing and sampling soils, Version 2.0. Natural Resources Conservation Service, National Soil Survey Center, Lincoln, NE. 5.) United States. Us Geological Survey. Topographical downloaded from http: //terraserver.microsoft. com/ 6.) St. Croix County. St. Croix County Land Information System. http://72.21.23 0.178/website/pasystem/gisportal.htm 7.) United States. United States Department of Agriculture -Natural Resources Conservation Service. Hydric Soil List for St. Croix County, Wisconsin. ftp://ftp-fc.sc.egov.usda.goy/WI/Soil/hyd/hyd109.htm 8.) United States. Us Army Corps of Engineers. 1987. Corp of Engineers Wetland Delineation Manual, Technical Report Y-87-1. USAEWES Environmental Laboratory, Vicksburg, MS. 7 APPENDIX A SOIL EVALUATION REPORT Wisconsin Department of Commerce SOIL EVALUA ION~~]'Ep 1 of 3 Division of Safety and Buildings In accordance with Co 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 '/z x 11 inches in s' Plan ~d~iG 1 5 20 06 C St. Crolx Include but not limited to: vertical and horizontal reference point (BM) direction and P cel I.D. OO2- OZ -80-300 Percent slope, scale or dimensions, north arrow, and BM referenced to earest~ac~ROIX COUNTY Please print all information Re iew by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) 9 ~ ~v Property Owner Property Location Rick & Donna Bloom Lust Govt. Lot SW r. NW v. s 11 T 2 R 16 w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1067 250' Street City State Zip Code Phone ^ Clty ^ Village 0 Town Nearest Road Woodville WI 54028 715-698-3960 Baldwin 250`" Street ^ New Construction Use: 0Residential /Number of Bedrooms_~ Code derived design flow rate 450 GPD 0 Replacement ^ Public or Commercial -Describe: Parent Material Loess over Till General comments and recommendations: Flood Plain elevation if applicable N/A ft. ^Boring 1 Boring # 0 pit Ground Surface Elevation 100.0' ft. Depth to Limiting factor 12 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-7 10YR3/3 - SIL 1-m-bk mfr cs 1f 0.4 0.6 2 7-10 10YR3/3 - SIL 1-m-pl mfr as 1f 0.4 0.6 3 10-12 7.5YR4/4 - SL 1-m-pl mfr cw 1f 0.4 0.6 4 12-20 7.5YR5/4 10YR6/2 & 4/6 f-1-f SIL 1-co-pi mfr cw 1f 0.4 0.6 5 20-35 7.5YR4/6 7.5YR5/3 & 5YR4/6 f-1-d SL 1-co-bk mfr gw 1f 0.4 0.7 6 35-45+ 5YR4/6 5YR4/3 f-2-f SCL 1-co-bk mfr - - 0.2 0.3 ^ Boring 2 BO~g # aPit Ground Surface Elevation 99.1' ft. Depth to Limiting factor 11 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/RZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-9 10YR3/3 - SIL 1-m-bk mfr cs 1f 0.4 0.6 2 9-11 10YR3/3 - SIL 2-f-pl mfr as 1f 0.0 0.2 3 11-17 10YR4/4 7.5YR5/3 & 4/6 f-1-f" SICL 1-m-pl mfr cw 1f 0.0 0.2 4 17-35+ 5YR4/4 5YR4/6 f-2-f SL 1-co-bk mfr - - 0.4 0.7 * redoz is present at the top nd twttom inch of the horizon l;rnuent tit = t3UUs> JU <_ "LlU mg/L and t5S > 3U < 15U mglL * h:Hittent #'L =nulls 5 3U mgfL and 1 JJ 5 SU mg/L CST Name (Please Print) ,., ~'~'ature~> CST Number Mark Iverson ^-~' r j~_~ 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 Julv 25.2006 715-796-5664 Property Owner Rlck & Donna Bloomquist parcel ID# 002-1022-80-300 page 2 of 3 ^ Boring 3 Boring # ppit Ground Surface Elevation 100.0' ft. Depth to Limiting factor 8 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *EtT#2 1 0~ 10YR3/3 - SIL 1-m-sbk mfr cs 1f 0.4 0.6 2 6-8 10YR3/3 - SIL 2-f-pl mfr as 1f 0.0 0.2 3 8-12 10YR5/4 7.5YR4/6&10YR5/2f-1-d SIL 1-m-pl mfr cs 1f 0.4 0.6 4 12-36+ 5YR4/6 5YR4/6 c-2-d SL 1-co-bk mfr - - 0.4 0.7 Boring # ^ Boring OPlt Ground Surface Elevation 100.9' ft. Depth to Limiting factor 13 in. S it lication R to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 'EtT#2 1 0-8 10YR3/3 - SIL 1-co-bk mfr as 1f 0.4 0.6 2 $-13 10YR5/4 - SIL 2-f-pl dh gs 1f 0.0 0.2 3 13-20 7.5YR4/4 5YR4/6 f-1-f SL 2-m-bk mfr cw 1f 0.6 1.0 4 20-40+ 5YR4/4 5YR4/3 & 516 f-3-d SCL 0-m m~ - - 0.0 0.0 Boring # ^ Boring OPit Ground Surface Elevation 97.3' ft. Depth to Limiting factor 9 in. Soil li ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EtI:#1 *EtT#2 1 0-7 10YR3/3 - SIL 1-m-pl mfr gs 1f 0.4 0.6 2 7-9 10YR3/3 - SIL 2-f-pl mfr cs 1f 0.0 0.2 3 9-18 10YR5/4 10YR5l2 8~ 4/6 f-1-f SIL 2-m-bk mfr gw 1f 0.6 0.8 4 18-35+ 5YR4/6 5YR5/3 c-2-d SCL 0-m mfr - - 0.0 0.0 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L • Effluent #2 = BOD, < 30 mg~L, and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft. place system on the 100.0' contour B-a 100.9' +~0'~ a~ Q! ~. 0 N. ,~p0 0 ~~ ~'~o / 00 ` ~@~~ I BiVq~2 - Top gofgg 3/4 inch PVC pipe \\\ I \\\ I l /i \\ rrj73 \\\ I 1 ~/ \\\ I I // \\\ I / // \ \\ I / ~ \ U / \\\ I I / \ / \ / \ /i \\\ I I /i / \ / / \\II/ \\I// \\I/ ~ r~ r `\ /r ` r~ r~ r r~ r~ r= r` l~ r ~~ ~; ;~ ~~ \~ Evergreens \~ ~~ \~ \~ ///I1\\ //ll\\\ r/i~~~~\\ //lI\\\ ~/ll\\\ ///I\\~ //ll\\~ //ll\\\ //lI\\\ /jl1\\\ ~/lI\\\ //li\\\ /i,i~\\ BIVI# 8~ Description . Bench Mark B-1 _ Elevation 100, -Boring Location & Elevation Owner: Rick 8~ Donna Bloomquist 1067 250th Street Woodville, WI 54028 Phone: 715-698-3960 Site Information: SW1/4,NW1/4,S11, Town of Baldwin St. Croix County Completed By: T29N, R16W Mark Iverson 680 Larcom Street Hammond, WI 54015 715-796-5664 PSS#198 / CST# 46672 APPENDIX B PREMINIARY ASSESSMENT DATA SOIL EVALUATION REPORT Page / of Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ~~y ~ ~ ~/ Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must but not limited to: vertical and horizontal referer-ce point (BM), direction and Parcel I.D. include , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Please. print a!/ information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) {m)). Properly Owner7~ lahrf c~ ~~Oo~ ~r5~ '~ ~ k ~ f Property Location GovLLot „~lU 1/4~1~U714 S ~f T~~ N R ~~ E(o W . t - Property Owner's Maitirxf Address f f Lot # Block # Subd. Name or CSM# t-~-e-c~ ~o ~ ~ ~S©fti S City State Zip Code Phone Number ^ City C~7 Village own Nearest Road ~~~ ~SO-f~ (,l.~t;~'~v~je (,(?1 SyO2g t7~5)69$-3i~o .~~t~d~:rn ^ Ngw Constructron Use: Residential / Nfanber of bedrooms ~_ Code derived design flow rate ~St7 GPD !.~- RReplacement ^ Public or comm_e.,rLC_`ai - Descrbe: f , Flood Plain elevation if appl;cable /v ~ ft• ~ '" Vi ! r ~. c Parent material L O ~ 5 S b U General comments ((,, `{' ~ ~ ~ tions: n ©~ ~ t'"q ` ~~1- d a and recommen J ~ U Boring Boring # .--- pit Ground surface elev. ft. Depth to limiting factor tn• Soil A lication Rate Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz. Cori. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft= 'Eff#1 'Eff#2 .-~ ' ~ ~ ~ ~7 5 ~ ~ ~ ~ ~ 1 r 1 I C~ Lf Borin9 C Boring # De th to timfing factor ~ in. c~~ Lam" Pit Ground surface elev. ~ ft. P Soil pl"ication Rate Horizon Depth Dominaf~ Cobr Redox Description Texture Stnrcture Consistence Boundary Roots .E~GPD Eff#2 in: MunseU Qu. Sz. Cori. Color Gr. Sz. Sh. ~~ -is ~ -~(~ ~~~ 5 7 ~ ~sY ~ - o ~ ~ ~ - ~. 1 c. )t r • ~~ r~~ f1 .a .a - ~ _~ Tic ~ on ..,.,~ • Effluent #1 = BOD > 30 < 220 mg/l and T55 >3U <'15t7 mgrc r=rnuc~ ~a .rte - .~...- ..-- •--a_ _ -- . _ _ _ _ CST e (Please Print) / 'nature CST Number Address Evaluation Conducted Telephone Number sy~~~ PropeRyOvmer ~~~-" ~ lAhv~0. ,~~odb'~C~'u~~Parcel{D# Page ~_ of Boring # U Boring pit Grourxi surface elev. ~ it. Depth to limitln9 factor ~~ ~'~ Soil A I'rcation Rate Horizon Depth in. Dominant Cobr MunseB Redox Desaipt~ Qu. Sz. Cord. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft= 'Eff#1 `Eff#2 ~~ ^ Boring I P-. ...a .. L:J Pit Ground surface elev. ft. Deptfi to !Knifing factor r ~ m. Soil lication Rate b tion scri D d R Texture Str~ture Consistence Boundary Roots GPD/R' Horizon Depth in. Dominard Co r Munsefl p e e ox Qu. Sz. Cord. Cobr Gr. Sz" Sh. `Etf#f `Efftt2 -~ o ~.. 3 3 b ~ r i- c.J r r O t -3 . sYR . s a yn ~ ,; ~- ~r U Boring ~' Boring # Ground surface elev. __.. ft. Depth to IKnding factor "'- in. Pit Soil ication Rate Horizon Depth Dominant Cobr Redox Description Texture Stnx:ture Corrsisterx~e Boundary Roots GPD~ in. Munsefl Qu. Sz. Cont. Cobr Gr. Sz. Sh. `Eff#f 'Eff#2 ~~~5 ~~ 4 1 ~.5 - ~~ f~ l - ~'~ ~ 61~. ' Effluent #f = BODS > 30 ~ 220 mgit_ and TSS >30 ~ 150 mg/L ' Etfluent #2 =RODS < 30 mg/L and TSS < 30 mg1L The Deparhnent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. si3p-s33o ~x.oiroo> j=,1 ~- Property Owner ~ti th ~ ~~ t'~ ~ `~ !6~'~LL r ~ Parcel ID # Page ~ of_~ Boring # ~~~~~ng 1~ pit Gro~d surface elev. ~ ft. Depth to limiting factor `F' in- ~ ;~~ Rate Horiz n th De Dominard Color Redox Descripfron Texture Structure Consistence Boundary Roots GPDlft~ o p in. Munsell Qu. Sz. Cortt. Cobr Gr. Sz. Sh. 'Eff#1 'Ef~2 C - Icy ~ -- L ~ ~ s:~~ a_ ; ~ F , ~ 8 '- %~ o ~ ,~ ~ `I SyP~ ~' l0 7 3D C ~ _, f Boring # U Boring ~7 pit Ground surface elev. "' ft. Depth to limiting factor / ~n• Soil Application Rate H izon De th Domir~rlt Cobr Redox Description Texture Structure Consistence Boundary Roofs GPDIft~ or p in. MunseN Qu. Sz. Cont. Color . Gr. Sz. Sh 1 'Eif# 'Eff#2 ii `/ ~ ~ 7 ~ .5Y ~ •r ~ C ~ Boring Boring # Ground surface elev. ft. Depth to 6mi4ng factor in. Pit Soil A plbation Rate H i th D Dominant Gobr tion Redox Descri Texture Stnrcture Consistence Boundary Roots GP D/ft' or zon ep in. Munsell p Qu. Sz. Cord. Color Gr. Sz. Sh. •Etf#1 •Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL `Effluent #2 = BODS ~ 30 mg/L and TSS < 30 mg(L "The llepartment of Commerce is an equal opportunity service provider and employer. If you need assistance to access servtces or need material in an alternate format, please contact the department at 60$-2t>G-3151 ar TTY 608-264-8777. SL;D-6330 (R.07/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Page 1 of 3 County CrO1X St Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must . Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 002-1022-80-300 Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location Rick & Donna Bloom uist Govt. Lot SW ~i. NW ~i. s 11 T 29 N R 16 w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1067 250' Street City State Zip Code Phone ^ Clty ^ Village 0 Town Nearest Road Woodville WI 54028 715-698-3960 Baldwin 250' Street ^ New Construction Use: ®Residential /Number of Bedrooms Code derived design flow rate 450 GPD 0 Replacement ^ Public or Commercial -Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments The site was evaluated to determine if it was suited to complete an interpretive determination report for and recommendations: installation of an A+0 mound. The preliminary evaluation completed on June 14 by Ben Helgeson indicated that suitable soils might be present near the driveway. The property on the south side of the trees is not suitable for a POWTS. 101 Boring # ^Boring H Pit Ground Surface Elevation 97.42 ft. Depth to Limiting factor 5 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. MunseN u. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eti#2 1 0-5 10YR3/2 None SIL 2-f-pl ds gw 2f 0.0 0.2 2 5-11 10YR3/2 7.5YR4/6 f-1-d SIL 2-f-pl ds cw 2f 0.0 0.2 3 11-16 10YR4/4 7.5YR4/6 f-1-d FSL 1-m-pl dsh gw 1f 0.2 0.6 4 16-24 10YR4/4 7.5YR4/6 c-2-d SL 2-m-bk mfr gw 1f 0.6 1.0 5 24-30+ 5YR4/6 7.5YR4/6 c-2-d LS 1-co-bk mfr - - 0.7 1.6 102 Boring # ^ Boring ®Pit Ground Surface Elevation 97.67 ft. Depth to Limiting factor Surface in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 "Ett#2 1 0-6 10YR3/2 10YR3/4 f-1-f SIL 1-m-pl mfr cw 1f 0.4 0.6 2 6-11 10YR4/4 10YR4/6 f-2-f SL 1-m-pl mfr gw - 0.4 0.6 3 11-25 10YR4/4 10YR4/6 f-2-f LS 1-co-pl mfr gw - 0.7 1.6 4 25-35+ 5YR4/4 5YR4/6 f-2-f LS 1-co-bk mfr - - 0.7 1.6 hIIluenr if 1 = riVlls> SU <_ llU mg/L ana 1 JJ > SU ~ 1 JU mg/L ' t,IlluenL iFL = t3VU5 ~ SV mg/L 8na 1 AJ ~ JV mg/L CST Name (Please Print) Signature CST Number Mark Iverson ~ v----' 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 !~- Z$ ~oG 715-796-5664 Property Owner Rick & Donna Bloomquist Parcel ID# 002-1022-80-300 Page 2 of 3 103 Boring # ~ Boring ®Pit Ground Surface Elevation 98.17 ft. Depth to Limiting factor Surface in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EtT#1 'Et'f#2 1 0-7 10YR3/2 10YR3/6 f-1-f ox. rt. ch. SIL 1-co-pl mfr cs 1f 0.4 0.6 2 7-9 10YR5/2 10YR4/6 m-1-p SIL 1-f-pl mfr gs - 0.4 0.6 3 9-18+ 10YR4/4 10YR5/1 m-2-p SCL 2-m-bk mfr - - 0.4 0.6 ^ Boring Boring # 0pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 'Eff#2 O Boring Boring # 0pit Ground Surface Elevation ft. Depth to Limiting factor in. S it I' ti n R e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. 'EtI#1 'EtT#2 * Effluent # 1= BOD, > 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L * Effluent #2 = BODS <_ 30 mg/L and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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'~ i% a . r commerce.wi.gov i ^ ~sconsin Department of Commerce INSPECTION REPORT Date of Inspection: August 3, 2006 Project Name: Bloomquist Use: Residential Legal Description: SW, NW, 11, 29, 16W Site Number: 716461 Subdivision: NA Municipality: Town of Baldwin County: St. Croix Plan Transaction Number: 1307924 Sanitary Permit Number: NA Wastewater Flow: 450 gpd Persons Present: M. Iverson SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www. commerce.wi.gov/sb (715) 726-2544 Plumber Name and Address: Unknown Certified Soil Tester Name and Address: Mark W. Iverson, CST 46672 PO Box 155 Hammond, WI 54015 Owner Name and Address: Rick & Donna Bloomquist 1067 250th St Woodville, WI 54028 An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon. The intent of this investigation is to confirm initial observations by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil. In-situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surface water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. One soil boring was reviewed located slightly up slope of CST B-2 and found to be as described by the certified soil tester. The estimated highest level of prolonged soil saturation should be greater than 6 inches below grade at the mound site. If a-mound--system is-designed to- overcome -limitations-of-a -high. -level of--seasonal--soil--saturation -and--slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated should not exceed 0.2 gpd/ftZ. The additional basal area will partially compensate for the gentle land slope and prevent wastewater leakage at the mound toe. At least 30 inches of sand lift is recommended when applying septic tank effluent to the distribution cell of the mound to ensure proper treatment. The longest portion of the mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much as possible. In addition, an up slope drainage ditch should be considered if it is determined that surface or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me. eroy G. ansky, astewat Specialist cc: ~ County ^ Plumber Ljansky@commerce.state. ~.us E-mail ©CST ^ Owner 715/726-2544 Voice 715/726-2549 Fax ©Other pL~+vA~~