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HomeMy WebLinkAbout010-1059-95-000St. Croix County Planning and Zoning Detail Sanitary Information Tceesda}~, Apri103, 2007 at 2:23:01 PM Page 1 of 1 Computer #: 010-1059-95-000 Sub/Plat: 40 acres Section: 25 Parcel #: 25.30.19.379 Lot: TN/RNG: T30N R16W Municipality: Emerald, Town of CSM: 114 1/4: SW 1/4 SE 1/4 Owner: Borchardt, Brian 2476 130th Avenue Glenwood City, W 154013 State Permit: 408284 Issued: 08/08/2002 POWTS Dispersal: Mound less than 24" suitable s Permit: New County Permit: 0 Installed: 11/27/2002 POWTS Detail: NA Bedrooms: 5 POWTS Pretreatment: NA Notes Issuer/tnsoector As Buili Plumber Other Requirements Rod Eslinger >4/1/00 -Not Required Hudson, Dale Grabau/Quinn ~: `! Yes aintenancs Scheduled Puma Date Pumped 1st Notification 2nd Notification 3rd Notification 11/27/2005 11/1/2004 04/20/2006 11/1/2007 WI Fund: Additional Notes Monev Owed found 1993 soil report by Ulbricht in southern part $0.00 of 40 acres, 65' north of 130th Ave. that had A+0" conditions -will file with permit Wisconsin Department of Corrtmerce ~ PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ELEVATION DATA Permit Holder's Name: City Village X Township Borchardt, Brian Emerald Townshi CST BM Elev: Insp. Blvl Elev: BM Description: o.Z~ ~.2~ ~, c TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~t5~ Dosing 1.,.> Ill $ ~YL---- ~ Z (06 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ rpp t ~ l uo ~ 3 3 Dosing , ~ I DO / ~ I t7p ~~ / Aeration Holding PUMPISIPHON INFORMATION Manufacturer l~ Demand GPM lp~ Model Number ~ ~ ~ I' ~ ~ ~~' `• H Lift Friction Loss System Head TDH ~ Ft Forcemain Length t Dia.2 ~~ Dist. to well ~ ~ It7C SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Length DIMENSIONS ~ I Zsi t SETBACK SYSTEM TO INFORMATION Type Of System: . DISTRIBUTION SYSTEM ~l~ Number: Header/Manifold // Length Dia_~ Distribution sr ~~ q ~ Pipe(s) ~ ~ Q Length b(. Dia_~ Spacing x Hole Size I r ~ ~ x Hole Spacing ~ r( 3 Vent to Air Intake SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedJTrench Center Bedlrrench Edges Topsoil u Yes ~ No ~ Yes ;~ No 4~3 ,~ ~ COMMENTS: `(Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ / O w Inspection #2:~/~/ D lpc~tlon: ~~ 13 ~ merald, WI 54013 (SW 1/4 SE 1l4 5 30N R16W) NA Lot ~~ t7K~~~Parcel No:''CC2"'5~.3~0t.19.379 ' • 1.) Alt BM Description =~u~S~ O~ S•Ul , Q~-k/rel~~'/..td- C-?1df07~/~---~tTY~ c:~,r,~ 2.) Bldg sewer length = » '3 3' -amount of cover = i 3.) Contour = ' U ?) ! / ~~ ~ ,, 'j 7~ _, ,_ _ _ -- -------- - - - - Plan revision Required? If ~I Yes No 1' i Z~ ~~; r ~1_ ~'~ Use other side for additional Information. ~_ __ _ _ _,I ~ I_ _' SBD-6710 (R.3/97) Date Insepcto~'Si~gna~tu~r~e Cert. No. ~'r ~~w ~~•~ ~ ~ S ~ 'J~ county: St. Croix Sanitary Permit No: 40$2$4 0 State Ian ID 8y6 zTi~.~. !4. Parcel Tax No: 010-1059-95-000 -~ STATION BS HI FS ELEV. Benchm rk Y-1- ~L 3.3 S / ~ 7 . ~ , Alt. BM •0_ - '~' . (P(o, ~0~.$ ~ Bldg. Sewer 3' `~ ~~ ,~ • ( b St/Ht Inlet S,~Z tol•o8 St/Ht Outlet ~, ~ ~ • ffi t Dt Inlet 5,1~ •6~~ Dt Bottom Header/Man. ~.~ os'~S`~t Dist. Pip rdPi ]S ID'S •u (.V2. l • dZ r ~$'`f Bot. System ~ p' ~ Final t,Z~ r ^ 4.S St over a,,~s.{ ~~rw>l'k .~ lam, `~ h~' l 0 3 , ~ --fD p.GnS ~ t U' 3"'~'" ~ CSC ~ l0• Sa) ( I r,G •s-a) /~ .y PIT DIMENSIONS No. Of s Inside Dia. Liquid Depth (' ., ~ r Safety and Buildings Division County ~t /~ . ~ '~ ~ 201 W. Washington Ave., P.O. Box 7162 J - (,, r ~ c/~/y~/1~~~ Madison, WI 53707 - 7162 Site Address ~~ ®~ ~ ~~ ent of Commerce De Sanitary Permit Number Sanitary Pernut E9.ppiication ~~~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information -Please Print All Information State Plw I.D. Ntunber ~ t to ~ Q "1 Property Owner's Name _ _ arcel Number' ~„' 3 7~ ` ~ h Q~- O5 -95_(1 © nrc r rian iling Address 2002 a Property Owta e r' s M Property Location ~ y ~ / n l 777 '7/sf ~GG~rf C~~ ST CR01 •SW 54 SE54;S~~ Tad N.R ~~O City, State " ~ Zip Code N{~OFF~ Lot Number Block Number ~' /1 ~ e r Gr©/e / e ~ hfS S°54 ~7 ~ ~p 5 ~ " Subdivision Name CSM Number M N Da cr%e II. hype of Builtling (check all that apply) ~ ~ OCiry 1 or 2 Family Dwelling -Number of Bedrooms ^Village l ~ ^ Public/Commercial -Describe Use _ Township m e r Q ^ State Owned Nearest Road/3~ ~~e , III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A ~,/' For County use 1 !~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to S stem Tank Onl Exis ' stem Permit Number Date Issued B, ^ Check if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that apply (numbering scheme is for internal use) 44 ^ Non -Pressurized In-Ground 21 Mound ~ 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line , 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other ~. D' ersal/Treatment Area Information: lt.lL- O .-S Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation ~~o t~so ~~o ~ ~~ i~y,~.~ ~a~ -~~ VI. Tank into Capacity in Gallons .Total Gallons Number of Tanks Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass Plastic H~ ~ ~ ~ 100 ST ~ t Tanks Tanks . Septic r Abtdietg~anlc '~~ ~D / r ~~ Dosing Chamtxr _s- / ~ 1 fr dersigned, assume responsibt7ity for installation of the POWTS shown on the attached plans. VII. Responsibility Statement- I, the un Pltunber's Name (Print) Pl s Signature MPMII'RS Number Business Phone Number ~ aa0 g 5.3 r1 ~5- C9B'~ -33°7 ~ ' k ~uc~ah . (~ ~' O h . r a e Plumber's Address (Street,~sCity, State, Zip Code) ~ ~///~ L~Ct - d~®~ VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agem Sig tore (No Stamps) Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse 3 25 l d ~~ $ ~ 02_. Determination 1X. Conditions of Approval/Reasoas for Disap royal ~ at v.~3 - ,~D i/>'t /'O ~P ~ /- ~ a»~ ~•c/e n ci ~~ G~'16f[r6u ~fillJv~ ., vk-S ~2 . vS'~ br v,t.ii~.4~+ ~~i,~/~r • ,Q// ss~b« ~! y~~ ~ , - y / 1 W •~(jG i Li tv~ r4 f ~'~^'tF G' f ~ t H f j ~• wa- W ~ / 'l- l ~/ ) Tca~ G~~ rG` C /t, /Q, Y// 7 8 ~2- -} ~ ~ ~,,~,,, h ~~ ~ ~ n c..e ~ ST'S F'~1 ~., ~ ~ /-~e ~ r. v w-G., ~ ~ e r~ ; ~; ~ ~~- 3 %~.C,- ti ati•.e rn,rrt,e~, %5 ~V+~q p~ s, B f¢. ~- 7~+ t-,~-~ uh ~ Attach complde plain (to the County only) for the system on papa' not tens than 81/2 x 11 tncha In size SBD-6398 (R. OS/O1) ~'' ~~~. t $ 7S ~'~ b wta..~~f •' TP°fJ~°nr~ta.-/co~dk;f.,~o~ ~ /~ ~~ ~ ~i~e(~Gt~k4~'On `o,,. , ~~ Prf • ~~ ~ ~ E/~eda~ion ~ i~ 83 ~~ ^ i / `~ ' /, o• . i ~' i / ~ v~ ~ ~ ~ i ((( ~ ; ~ ~ ~ ; ~ F}'a posed ~oknd a-~ zz..~.9,r /!/3, 97 cJ,~ v+ ; , ` a ~ lyi x G ~ ~y'equc w. riC y8'b~: ~ces~ac~c '~ ~~ ~ - ( ~ a~ 1. SZ' ~sp~a . ~ ~~ ~ ~ ~~ ~ ~ I( / y~ ~ ~; j ~-- pr°h1pXp( ,,?SO~~4urnp C.Aa~n~ j :~ ~ ~( I Q ; i ~ ~ ~~ ~ 1 ~ i I ~. _ ' ~ Proposed , ab Gc~ ~ ~ ~ Cpm6~%~a-~,~ ~• s Lam- "`~'~,f'.•....y~+-~/A-~a~ ef~Yu~., E ~C~ ~, , ~ A~ ~ ~ ~ : 7-o~oFJ~ ineYa.P ~"P~ - -~ -v~,y , y""s•1. s/o Rrc. 6wld;~a sa,x~ PI'oPosed s 62druo,.. r~ 5 ~ dQ ~+CG I ~--p~opcs~d wc(( _.,__J e 8~ ~i r .. _.-~ ~ ~ v U ~, h ~. ~9 isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary July 1 s, 2002 CUST ID No.220853 DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. PO BOX 78 BALDWIN WI 54002 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/15/2004 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Brian Borchardt 130TH Ave Town of Emerald St Croix County SWI/4, SE1/4, 525, T30N, R16W FOR: Description: Five Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 859279 Identifica Transaction ID o. 764896 Site ID No. 647 67 Please refer to bo identification numbers, above, in all cones ondence with the a enc . 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 ~r•Q~~) 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: ~,P~R General Approval Requirements: PARTMgIT ON • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) ~~ C~RRE and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Access to the filter for cleaning must be provided per Comm 84.25 (7) and (8),Wis. Adm. Code product approval conditions. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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 private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • 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. i DALE E HUDSON Page 2 ?/15/02 Owner Responsibilities: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. 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 may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, l~~ ~~B,r Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerc e. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code'7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 s MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Brian Borchardt 5 bedroom residential mound ~~ ~~~ ~~ Owner's Name: Brian Borchardt ~~ /~~ ~~ ,,.~pp c'a' a Owner's Address: 3949 71st Crt. East Y~~ ~~~~, ~® Invergrove Heights, MN 55076 ~~ O~~ Legal Description: SW1/4SE1/4, Sec.25, T.30N., R.16W. Township: Emerald County: St. Croix Subdivision Name: NA Lot Number: NA Block Number: NA Parcel I.D. Number: 010-1059-95-000 Plan Transaction No.: „~ylQ,lry Page 1 Index and title ~~~D Page 2 Data entry jF COMMER Page 3 Mound drawings ~ CE ? ~~~D1NGS Page 4 Lateral and dose tank Page 5 System maintenance specifications ~PONDEN Page 6 Management and contingency plan Page 7 Pump curve and spec cations Page 8 Site Plan Page 9 Soil Evaluation report Designer: Dale Hudson License Number: Date: 06/18/02p /A Phone Number: Signature:~G~-~Gc, ~ • T'I x-r.C~~ 220853 715-684-3378 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Infor mation (r or c) ! R Residential or Commercial Design _ r 500.00 Estimated Wastewater Flow (gpd) __ 1.50 Peaking Factor (e.g. 1.5 = 150%) 750.00 Design Flow (gpd) _ 4.00 Site Slope (%) 103.50 Contour Line Elevation (ft) ___ 'r 21.00 Depth to Limiting Factor (in) _____0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information ( 1_25.00 Dispersal Cell Length Along Contour (ft) _ ____ 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) i^ 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c ore) r~- c~ Center or End Manifold 3.00 Lateral Spacing (ft) 4 Number of Laterals _ 0.125 Orifice Diameter (in) (e.g. 0.25) '_ __ 2.50 ~ Estimated Orifice Spacing (ft) _ ~ 2.00 Forcemain Diameter (in) _ r _ 50.00 Forcemain Length (ft) 97.00 ~ Pump Tank Elevation (ft) ___. 6.50 System Head (ft) x 1.3 7.25 Vertical Lift (ft) 1.74 Friction Loss (ft) 15.49 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 I 1.25 x j __ - ~ 1.50 x x 2.00 x ~ _ _ 3.00 x _ __' _-__.~ Treatment Tank Information 1500.00 Septic Tank Capacity (gal) .Wieser Conc. Combo ;Manufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ sal treatment for fecal coliform of <= 3g inches. 6.00 Cell Width (ft) Are the laterals the highest int in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. ~__J 7.50 ft2/orifice Does the forcemain drain back? ~--~' Enter Y or N 8.16 Forcemain Drainback (gal) 113.30 5x Void Volume (gal) 121.45 Minimum Dose Volume (gal) 41.19 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 x 3.00 Gallons/Inch Calculator (optional) __1260.07 Total Tank Capacity (gal) _ __ 47.00 Total Working Liquid Depth (in) 26.81 gal~n (enter result in cell 649) Dose Tank Information Effluent Filter Information `~__ 1260.07 Dose Tank Capacity (gal) Zabel ~_ ~ Filter Manufacturer w 26.81 Dose Tank Volume (galfin) A-100 Filter Model Number W ieser Concrete ~ Manufacturer Project: Brian Borchardt 5 bedroom residential mound Page 2 of 9 Mound Plan View 1- Observation Pipe • K.:. :;Qr .5. :•••• ..'.']~•' '..'.. .•...•..•~ .'. .. •I.•• ......................................... I Mound Component Dimensions A 6.00 ft E 17.88 in B 125.00 ft F 9.50 in ~ 2 D 15.0 G 0.50 ft 750.00 (ftz) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate -T _~ _~ -1 H 1.00 ft K 9.49 ft z 9.48 ft L 143,97 ft l y'~ J 6.81 ft W 22.29 1935.37 (ftz) Basal Area Available 12.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 106.54 (ft) 1 ,fig r».. G t hi 1 .i~~~~~sri 2 r~~~rfrf., y teral F . • :: ~ : ~ : ~ Dispersal Cell 105.25 (ft) La 104.75 (ft)-~ - ~~~~~~~:~:~:~:~:• Invert Dispersal Cell :::~:::::::::: :• :::::::::::::::: ;:;:;:;;;:;:•:::;:::. ~ Elevation ~: E ~: ~~~ D :~:~:~:~:::~ ::::::::::::. . .Y V' 4 4.0 % Site Slope Shading Key ~ a ~~ 1^ ®Topsoil Cap o ~ 1.5 ft "~~~ Subsoil Cap ~ ~ ©~ ASTM C33 Sand `-° ® --;:--~:-~;' Tilled Layer ~ ~ 0.5 ft 05 0 Aggregate v c Dispersal Cell 103.50 (ft) Contour Elevation ~~ f :~• :~~ :~~ ~~~ : F :'•Typical Lateral :::::• i°1' q ---~ Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Brian Borchardt 5 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. I P •=Turn-uprvlball valve or IFX-~I~xl2 I xl2~I cleanoutplug Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.52 ft Lateral Length (P) 61.74 ft Or~ces per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ftz/orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 41.19 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.49 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -~ Comm 16.28 WAC Disconnect ~ 4 in. min. ~_ Laterals & force main of PVC Sch 40 per COMM Table 81.30.5 Laterals are identical Tank component is properly vented Wieser Conc. Combo Ca ac' 1260.07 Volume 26.81 Manufacturer Gallons galfinch A B C D Dimension Inches Gallons A 27.34 733.10 B 2.00 53.62 C 5.66 151.63 D ~ 12.00 321.72 Total 47.00 1260.07 ~- Aftemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~mp off elevation (ft) 98.00 ~ Dose tank elevation (ft) ~- 97.00 Alarm Manuafacturer LevelArm ~~~ Alarm Model Number DLV ___~~` _~ Pump Manufacturer Goulds __ _ __ Pump Model Number 3885 WE03L __^_ __~ w Pump Must Deliver 41.19 gpm at 15.49 ft TDH Project: Brian Borchardt 5 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name B_oldt's Plumbing =Dale Hudson _ Phoner715-684-3378! POWTS Regulator's Name ~ _ St. Croix County Zoning ~ Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 750 gpd Mabmum Influent Particle Size 1/8 in Estimated Flow -Average 500 gpd Mabmum BOD5 220 mg/L Septic Tank Capacity 1500 gal Ma~amum TSS 150 mg/L Soil Absorption Component Size 750 ftz Ma~amum FOG 30 mg/L Type of Wastewater Domestic Mabmum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ct and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ondin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •.....•........ ................ Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box • • • • . . • . Plug or Ball Valve Distribution • Lateral ~~~ Long Sweep 90 or Two 45 Degree Sends Same Diameter as Lateral Project: Brian Borchardt 5 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may Ue present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole users, access risers and corers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the canpletion 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 effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet finer shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall tie serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the amer of when the next service needs to be perforrr-ed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at Icest once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10' cfu/100 mL for highly treated effluent. Influent flaw may not exceed mabmum design flow specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is perfom~ed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall lie checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its componenrts become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump contrds, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basa- area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page`s of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Brian Borchardt 5 bedroom residential mound Page 6 of 9 Performance Curves METERS FEET GPM m'/h ~' METERS FEET 120 Submersible Effluer~~ Pumps I.HYAGI 1 T wed, (~ GOULDS PUMPS, INC. SEPE{A FALLS PEW YDRIC i3ia8 MODEL 3885 SIZE 3/4" Solids ~ iu 2U 3U 40 50 60 70 80 90 100 110 120 GPM i i ~ i 0 10 20 m'/h CAPACITY 70 ~' 9 ®1985 Goulds Pumps, Inc. E dive July, t985 35 110 100 30 90 25 80 Q 70 w s 20 J Fa- ~ 1- 15 50 40 10 30 20 5 10 0 0 0 8 iS't / ~ i i.a' ~ ,4ssuned elev: =iod.m' ,' ~ e9 ^ ~;/eda/ka~ron ' ~ Art ti°.' r , o~• , ' ~ ii ; 83 ~ i /lti° ^ ~ / o• ~ ~ ,_ , j ~ /l ~ C ~ /~ ~ ~' F}'oPOsed ~noknd a-~ ,ZZ.2I jr /1/3,97 c,,)iY~ l`/ ~ r/ 11 'I '~ ~ ~ ~'~' ~ ,~ b'x /?S' d;~rSc+.I Cc l/. Fug (rf) /afva /S 1 ~ ~ ~ a t /f2YX G / 7~ -e~~ wi ~c Y8 "or: ~ceS~eaU ~ ~ ~~ ~ ~/ ~ ! ~ ~_ Pro(aC'S~:o~ ~,~SO ~ ~Du,n~O darn fier l i )~ ~ -0 ~ ~~ ~ I ~ ~ ~ ~ ~ ~ ~ ~~ ~ ' i ~ M i~ I~ ~~ ~ Pra~0o5¢d ;a~o~Gcv ~ e0mbinadir-j ~~ ~~ ctf au-Eltf p ~',Z ^~ cltarnbu n~ O` o~ ~~ Ali. ~.,~t. ~ 7oooFyiineto•( Corrdc~, E . E/eve- = dos! z.! A'oposed s bedroo,.. r'c S i de.,ct `~,, Ci b V. 87S'~ Y"s.,f. vo P, r.c. bw/d,~~ scw« i~ --proposcd wctl e ~J ~, a l • ~< --~,. ~- _~,~ ,, Wisconsin DeperUnent of Commerce 5~IL ~VALIJAfi IbN ~2E~~~1" I Division of 5atety and f3ulidings fn accordance witfl Comm 85, Wis. Adm. Code County St. C Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must O ! ~ ~, Cxk~ include, but not fimlted to; vertical and horizontal reference point (BM), direction and Paroel LD, ~ ' / 9 S ~ ~. percent slope, scale or dimensions, north arrow, and location and tlistance to nearest road. Z S, 3d . ~ ~ ~ 3 7~ ~ __ Please print all information. Reviewed by Date Personal Inlormatlon you provldo may Do used for cecondary purposos (PrNacy l.aw, c. 15.03 (1} (m}}. Property Owner Property Location ~ Q Brian Borchardt rovL Lot SW if4 SE 1!4 S 25 T -30 N R 16 E (or) W Property Owners. MalQng Address. .Lot # Block # Subd. Name or CSM# 3949 71st CT E - Fn.vergrove. Heights t MN I 550.76 t f 651t-450-6973 W Village • Town Nearest Road 130th Avenue Q New Construction Use Residentfai / Number of bedrooms 3 Code derived design flow rate ® Replacement ©Publ'~c of commeraal -Describe: Parent material ____G1ar.;al r;lt Flood Plain elevation if appligble . General comments Mound System and recommendations: BM1 Top of Conduit 100' BM2 Top Of Conduit 104.17 450 ______ OPD R~ ft. ~iAR 1 ~ ?_002 cT cRntX COUNTY • goring # ~ Boring Ground surface elev. 103.37 pit ~ tt. Depth to limiting factor 21 ZONING OFFICE Soil A , Iication Rate Horizon Depth in. Dominant Color Redox Description Munsell Qu. Sz Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Roots GPD/fF `Eff#1 'Eff#2 1 0-11 10yr3/2 sit 2msbk mfr cw 2f .S •8 2 11-21 7.5 4/4 sit 2msbk mfr cw 1f .S .8 3 21-44 7.5yr4/6 tzdsyrai6 scl Om mvfi - - 0.0 0.0 Boring # ~ Boring r•..,rmf4 ~~ irfnra alPV 103.39 ft. Depd1 to Limiting factor 23 in. Coil Annlirafinn Rata ., Horizon Depth in. «±. •' Dom[nant Color Redox Dasafption Munsell Qu. Sz. Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Roots GPDlf1? 'Eff#t `Eff#2 1 0-10 10yr3/3 - sit 2msbk ~ cw 2f .5 .8 2 10-23 7.S r4/4 - sit 2msbk mfr ctv If .S .8 3 23-30 7.Syr4/6 tzdsyra~6 scl Om mvfi - - 0.0 0.0 `Effluent #1 = BOD > 30 < 220 rnglL and TSS >30 < 150 mg/L 'Effluent #Z = BUD < :sU mglL ana t as ~ ~u rncy~ Slgnawra CST Number CST Name (Please Print) C,... ~/`__.__ Thonnas C el a 227387 Address Date Evaluation Conducted Telephone Number 1432120th Street New Richmond WI 10/28/OI ? 15-246-2454 ,~,,, T~ ~onr, non ~T r vcrJ Tc • rr nor ~n iii 2 Page ,_ ? of Borchardt Parcel ID # Property Owner a Boring # B0dn9 101.42 ft 24 In. Depth to limiting factor Soil A lication Ra pit Ground surface elev. , G PDIt~ Dominant Color Redox Descrlptlan Texture _ Structure .Consistence Boundary. . Roots •EfF#1 •Eff#2 Horizon Depth ~ Munseli Qu. 5z. Copt, Color Gr. Sz. Sh. 8 : sit 2msbk mfr cw 2f .5 • 1 0-1 S 10yr3l3 - sit 2msbk mfr cw if •5 8 15-24 2 7.5 414. Om mvfi - - 0.0 0.0 24-34 3 7:Syr416 fLd5yr4/6 scl ~~ # Ground surface elev. _____-- ft• DeP~ to limiting factor ~p ligtion Ra' Plt. Horizon Depth Dominant Color Redox Description Texture Gr. SzuSh. Consistence Boundary Roots •E~GPD1ffE~2 {n. Munseil Qu. Sz. Cont. Color ~~ fl, pepth to limiting factor in• ^ Boring ~ ~ Ground surface elev. ___.__~__- Soil igti0n Ra Pif Horizon pepth Dominant Color Redox Description Texture Gra'uS Sh. Consie4erice Boundary Roots :EGPD/f4Eff#2 in. Munsell Qu. 5z. Cont. Cobr > e and TSS >30 < 150 mglL 'Effluent #2 =BODE <_ 30 mglL and TSS < 30 mg1L • 6ffkient #1 = BODE 30 _220 mglL amnent of Commerce as an equal opportunity 5ervi.Ce Ftovi,det and employer.. jf you n@ed assistance to access services Or The pip ......... lease contact the department at 608-266-3151 or TTY 608-264-8777• need rnatcrial in an alternate format, p SeD9330Tat (R07J4~ n r~r •sn i~ .~ ., ~~'~ S w 'f,.j ` S ~'~~} r Sec ~~~ ~3~ ~ ~_ 1(0 ~J ~y~ ifo~ ~~ba ~~ r / z 5 I~ ~ N- I ,- ~St'~11 ~o~ ~~concQ~t~ i~C (~1 l03 ~.j ~ ~,,~ ~Z ~ 03.3! ~ ~ .3 1 o i ~ '~ ;~ ~~~~~~~ N ~.----~ ti ~, o Y~., ~ s 1'~ ~ 1 ~ a r., ~~73~~ r- .--~~_ _ t .._ 1Nisconsin Department of Cflmmeroe Division of Safety and BuHCHngs an ava.v~wa~mv rr~u~ ~.wnnn vu~, vna, num:...we ~" l St. Crtl1aC /4tteCh complete arts plan On paper not less than 91/2 x t't inches in size. Plan must Include,. but not limited to: vertical and hortzonta{ reference point (BM), direction and p~ l,p, percent slope, scale or dH'nerislons, north arrow, and location antl dlstanos tO nearest read. Please print ap lnformatlon, by Date Peroonal Information you provide may be used for eaoondary purposes (Prrvaay Law, c. 16.04 (1) (m)). g -' S ~pedY Owner Property Location Brian Borchardt :Govt, tot SVJ tt4 SE t14 S 25 34 ~ ~ 16 ~ W PropsrLScC)wner's.MailingAddrsss. Lot # .Block # Sid. Nine a CSI 3949 71st CT E - - - C~! State Zlp Code Phone Number ~ViNage ^ Town Nearest Road Fi•V~tgt'o'Ve ~'«~~~ MN 55.0.76. 6~ -45Q-6973 W 130th Ake~-ae New Constn~ction Use Residential/ Number of bedrooms 3 Code derived design flow rate 450 OPD Replacement ~ PUb1iC Or commerdal - Desalts: _ Parent material. Clarisll tilt Flood Plain elevation N appNCabie it. G ~ lvlound system RECEIVED and recommendations: BMI Top of Conduit 100' B1V12 Top ofConduit 104.17 MAR 1 2 2002 goring 8©ring# 21 pit Ground surface elev. 103.37 ft. Depth to limiting feotor ST. CROIX COUNTY 20NING OFFICE ~ Rate 19oriaon Depth ,Dominant Color . Redox Description. Terre Struc~rre Consistence Boundary Roots. GP DffF in. Munsetl Qu. Sz. Cont.. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0.11. 10yr3/2 - ail 2msbk mfr cw 2f .5 .8 11-21 7.5 4/4 - s7 2tnebk mfr cw 1f ,5 .8 3 21-44 7.Syr4/6 fzdsyr4r6 scl Om moll - - 0.0 0.4 . ~~ # ~ Bering 103.39 23 Pit Ground surface etev: ft. Depth to limiting factor ~ in. ~ Rais Piorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary .Roots GP D(iF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 1 0-10 10yr3/3 - ail 2msbk mfr cw 2f .5 .8 2 10-~3 7.5 4/4 - ail 2mebk mfr cw If .5 .8 28-34 7.Syr4/6 Pldsyr4/5 scY Om mvf~ - O.b d.4 - tnlUent iF7 = B(JU > :30 < F20 mg/L and TSS >30 < 150 rTiglL " Effluent fR2 = < 30 TSS < 30 mglL CST Name (Pleese Pfvrt} Signature ~. CST Number N l ."/~--- 227387 ~d~ Date Evaluation Corxlucted Telephone Number 1432120th Street New Richmond Wl 10/28/4 t ? 15-246-2454 NTT M1/.TMI/1M1~ Property Owner _,r_ Borchardt Parcxl lD f~ Page 2 of ? ~ Boring ~~ # ~ Pit Ground surface elev. 101.42 ft. Depth to limiting factor 24 iri. Sal .Rate Horizon Depth Dominant Color , Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Cobr Gr« Sz. Sh« `t:}f#1 'EffA62 1 0-1.5 10yr3/3 - sil 2msbk mfr cw 2f .~ ,g 2 IS-24 ~ 4/4 - sil 2msbk mfr cw 1f .5 .8 3 24-34 7~Syr4/6 f2d5yr4/6 scI Om mvfi - - ~.~ 0.0 BOririg ~ Bonr-g pk Ground surface elev. _,~ it. Depth. to iimdtng factor in. Soil tbn Rata. Horlxxon Depth Dominant Color Redox Description Texture Structure Consistence toundary Roots GP D/fE In. Munsett Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#Z _ _. Boring # Boring Pit Ground surface elev. __ ft. Depth to limfling factor. in. Soil Rate Horizon Depd~ Dominant Cofor Redox Description Texture Struoture Consistence Boundary Roots "Gl~t )%fT' in. Munseil (1u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BOD, > 30 < 220 mgll and TSS. >3t3 < 150 mglL 'Effluent #2 =BODE _< 30 mglL and TSS < 30 mg1L ~'~-~ D~partmenc of Commerce is an equal: opportunity ~$rvice provider and employer, If you need assistance to access s~'vi~o~ or need material in an alternate format, please contact the department at 608-266-3351 ar '1°I'Y 608-264-8777. sen-a~aor~a ~.u~~oo) ~ ~I o ~, r~~° / 3~~ ~~~ ~ R ~~ w 6~ ZS I~µ ~,9 B~ g~~ ,~ ~ S ~~ ti ~e 1= 3 0 i (~1'rll T~~ ~~con~~t~ Ib0 amp ~ ~ io y,ll ~---~ a, ,03,3-, 42 io3.3~ a3 lol.y~ N ----.~ i ~~7387 - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~'" ~~~ ~ ~ D ~'G ~l~ r ~.iT ~ Mailing Address Property Address 39y ~ I ~ ( ~ ~ 7~~0 :f ~" ~~~~ t/' ~/, ~~0~6 (Verification required from Planning Department for new City/State ~~~,r'a ~Ql . l~/~~ ~ Parcel Identification Number O/CJ "~~9 "" 9~"000 LEGAL DESCRIPTION Property Location -~~ '/4, ~~ '/4, Sec. ~~ , T .3oN-R~W, Town of P Subdivision ,Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ~~~ ~ ~~ ,Volume ~ ~~~~ Page # ~~Z Spec house ^ yes G7' no Lot lines identifiable (~es ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. _ w SIG OF APPLICANT 7// / OZ DATE OWNER CERTIFICATION 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. n~.a~-~ .~ t~c~ ~ ? l l ~ ~ Zi SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i . ~ ~~ ~ 7~~ P~~E ~~~ I ST AR O SON M I - 2000 WARRANTY DEED Document Nwnber This Deed, made between Donald E . Hoglund and Patricia A Hovland husband and wife _ _ Grantor, and Brisn R Borchardt and Jennifer A. korchardt, Grantor, for a valuable consideration, described real estate in St. C: Wisconsin (the "Property") (if more space SW 'ia of SE ~ of Section 25,~ 16 West // Grantee. to13'rantee the lowing i County, to of please attach adden um): X30 North, Ra ~' 662741 KA'TNLEEN N. WALSH kEC;ISTEk OF DEEDS ST. CkOIX CO., WI I~CEI~D FOR REC~tD 11-21-2001 11:90 AN WARRANTY DEED EXEMPT N CERT COY FEE: COPY FEE: TRANSFER FEE: 297.04 RECORDING FEE: 11.00 PAGES: 1 /~ Name and Relum Address River Valley Abstract & Titl , Inc. 1200 Hosford Street - Sui 201 Hudson, WI 54016 /~/~~~~~ 010-1059-95 Parcel Identification Number (P1N) Together with all applrrtenant rights, title and interests. This is not homestead property. {is) (is nok) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and lteatrictions of Record. Dated this ~_ day of November 2001 AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets.) THtS INSTRUMENT WAS DRAFTED BY Michael H Forecki Attorney S~oa,aQdZ ~ . `~ ~' +DOnald E. Hoglund , 6~~z~;,, •Patricia A. Hoglund ACKNOWLEDGMENT STATEOF>~OH0Q4 FLORIDA ) ss. -+/ County. ) Personally came before me this / ~~ day of vem r 2 1 the above named ' •.ra r4. Ord to me known to be the person .~ who executed the g instrument and acknowledged the same. ~~_(~, - s ;70 ..t;~~G~o Notary Public, State of F I or i da My Commission is permanent: (]f not,~tate expiration date` Si stores m be authenticates w aexnowten ea. tsorn ate nor ncccns 'Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OFWISCONSIN - 0 omey MichMl H Forecki 1830 Brackett Ave, Eau Claire WI 54701-4627 ~µ,/rv4 ~.ItttlIL1EY me: (715) 835.3029 Fax: (715) 8354112 Michael H. Forecki F ; •' •. 4 015n8 T4673413.ZFX ProEUOed wah LpFamTM bl RE FamsNel, LLC 19025 Fiaeen MiN Rwd, Clinton lam ~~,~ y~'Ean°` Sra!»TtnuaW4a aarM arxvbw ~~.1 ~~ N ~ ~ ~ O I CO „~-.~5 .~ rt~i O *r ^~ ^~ _~ ^~ ~~ ~_~ ~_J ~ ~ f 0 d s ~. !/ Y Cl~ ~` C . ~ CCU C ~ L +-.~ ~ Q~ ~ i V U ~ c'C5 ~ ~ > ~ LC ~O O -a ~ ~ ~ .~ ~a0 ~~~~0 ~~~0 OU~cCS N C ~ to c ~ ~ ~ c 'u' ~'~ a~ °' ~ ~' a~ ~ ~ ~ ~ ~ ~ N c.~ +-~ O O : ~= c~ ctS cCf ~ O ~ ~ O ct3 ~ ~ c~ .~ -~ cn O a~ Cnc~sc~ `~c.~..QO~ Q~~° ~~~~ ~t~ m N ~ t/~ ® ~ ~ ® ~ ^ ^ D m E E H iNisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Pie L of 2-- COUNTY sT epo/~X 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 % of slope, scale or PARS EL I.D., dimensioned, north arrow, and location and distance to nearest road. J.-,~~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY TE PROPERTY OWNER: Pi9-T ~ ~O~ ~ ~v-V~ PROPERTY LOCATION GOVT. LOT sGU 1/4 ~ 1/4,S zST 30 ,N,R ~~ E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLACK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER .So ,~ ~/ S S~oi (~~s ~ ,LPG - 7~3 ^CITY ^VILLAGE ]TOWN Ei~l~'iP~9-L~ NEAREST ROAD i3o o~- New Construcction Use (J Residential / Number of bedrooms Z- ~ ~ [ ]Addition to existing building j ]Replacement [ ] Public or commeraal desaibe 3~ Code derived dairy flow ~©a gpd Recommended design loading rate bed, gpd/ft2~trench, gpd/It2 Absorption area required . bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 ~~ trench, gpd/it2 Recommended infiltration surface elevation(s) /UST /~~~ ~'f7'`~~ ft (as referred to site plan t~enchmark) Additional design /site considerations S,c2. .v0 7~ S /y'G o Parent material SGS , y7 ~~~~"~-~-~ ~ /l/IA(r~p~2 Flood plain elevation, if applicable /V!f' ft S =Suitable for system U=Unsuitable for s stem CONVENTIONAL ^ S U MOUND ^ S U IN•GROUND PRESSURE ^ S AT-GRADE ^ S U SYSTEM IN FlLL ^ S U HOLDING TANK ^ S U SOIL DESCRIPTION REPORT Boring # ~, Ground elev. ft. Depth to limiting fac~i/ Boring # ,~ .~ ;~~.. Ground elev. ft. Depth to limiting facbr Horizon Depth Dominant Color Mottles Texture Structure ~~~~~ ~~ Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rertdi ~ ~,~ ,nv~ ~~ ~ , ~, 5,~ ,f, s~~ ~f~ s' of , s . ~ ~ __ Remarks: ,~' GT/U~ S~ 1~~ ~Uijll /~Gt~j .S~~=~~~~ ~ % vZ Q ~' ~~~ -~ / ~~s~ - r~. s v ~ s~~~~/~ ~n ~1/~ o /3~t~ Goy- .T `'~G t. ~ ~ sic 0 Remarks: Name:-Please Print 7`f'Iy''-i' ~`r cress: 655 O'NEIL RD., HUDSON, WIS. 54016 ~P ~ ~ s °~isTiy i~~Z Signature: ~~~., ~ ~ Date: CST Number: ~(.1rn~ ~/~'~ v1S. MASTER PLUMBER UC. N0.3307 M.P.R.S. ~, __ /1 _ : /_. LI "TJN tr,-~Tni i Ga ~. nce~rnicQ i it ain nnaa~ `S ~~ i 5~A-~E : / = l00 ..~ I,wD ruff f`oa' HOMESITE SEPTIC PLU1~81NG CO. 655 O'NEIL RD., HUdSON, WI$. 5+1016 R06ERT UtBRIC,HT iVIS. I~ASTEfl PLl:M9ER LIC. N0.3307 w1,P.ia.5. '.4gWV{, I~~ST,ApL~LE~R 8 DESIGNEII LIC. N0.00663 ~~ svfiT~'~ 1' ll~ ' ~3 I 1~0 ~" .~ ~s 3 L