Loading...
HomeMy WebLinkAbout008-1046-95-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569570 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Jaszczak, Daniel I Eau Galle, Town of 008-1046-95-200 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /z ( 6:ST— 16.28.16.238B20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,�,�.,i CAPACITY STATION BS HI FS ELEV. Septic Tr. Z / Benchmark Dosing Alt.B Co 7. 1 `7- S kBldg.Sewer Holding St/Ht Inlet �Z•.3 0 /• TANK SETBACK INFORMATION St/Ht Outlet TANK TO A '�{L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic >�J-5a �� Z-7 _ � Dt Bottom . Dosing 7 so / Z-7 �` Header/Man. /� . i Aeration Dist. Pipe . C / • 7 Holding Bot.System 2F-131 1610 Final Grade PUMP/SIPHON INFORMATION It . Manufacturer v, Demand St Cover Model Number ( Z7.Ae 3 • 6CP ��j TDH Lift Friction Loss System Head TD , t a.98' S Forcemain Len h f Dia. I I Dist.to well Y. SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Tren PIT DIMENSIONS No.Of Pits Inside Dia. Liq id Depth DIMENSIONS e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Tynustem: UNIT Model Number: ,ti Z yZ > / DISTRIBUTION SYSTEM Header/Manifold I/I Distribution I� // / x Hole Size ( x Hole Spacing V o Air I ke Pipe(s)` 5 ! �" L Length J Dia � � Spacing_ �Zj 3• �p SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over /' Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ' / Bed/Trench Edges Topsoil ` � es � No es 2] No 10 1j COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: $/ / / Inspection#2: C.61--se-Q- Location: 381 230th Street B Idwin,�v1 54002(NW 1/4 NW 1/4 16 T28N 16W NA Lot 2 Parcel No: 16.28.16.238620 �j.�. 1.)Alt BM Description= f 2.)Bldg sewer length -amount of cover a✓� �C�C_. Cr�d.w� �o�S III Plan revision Required? Yes No Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's nature Cert.No. r 1'la �la� age��g Property Owner j—,AA)►EL � K.��r-yd I" = 40 ft. Legal Description Lr�rr �'� , P z& (except where noted) AtQtfi�F Tft&�� sip .TZ9A), ���� TvWa r�F F✓ u - =Backhoe pit Auk s'f �Rbi ` C0U-u7f?- North EK`a �r I tom' t4 e`aypo 04( �• i�'1 �� a t71IS 1.4 Pi rtE >.Z Site Location: � x . 41, N paTA County Safety and Buildings Division sT di �� 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number to be filled in by Co.) �� � �► j`' Q1� Madisan,r N0J[ if7 State Transaction Number ermit Application 36 In accordance with SP ), is.Adm.Code,submission of this form to the appropriate governmental unit is required prior t g a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � 5 I. Application Information—Please Print All Information Property Owner' Name CL oar\,e Parcel# 0,"1 Taszc Za 6 0 9 -/ 0 D Property Owner's Mailing Address ,(�. Property Location �/ ) 81 a 3 /✓V� Govt.Lot 2 (I Z 3 " — FZO/ City,State 75P Code Phone Number �t)y4 �C�/, Section 6 ( 1 00 Z ?/ 7 3 (circle on II.Type of Building(check all that apply) 0�� Lot T�N; R�E o� 1 or 2 Family Dwelling—Number of Bedrooms Z Subdivision Name Block# ❑Public/Commercial—Describe Use ❑City of ❑State Owned—Describe � Use CSM Number 177 El Village of F l� /D / Co t> I n Uu l 3 Town of Cr Q )l I11.Type of Permit: (Check only one box on line A. Complete line B if applicable) a A' XNew System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.T e of POWTS System/Component/Device: Check all that a I O✓L o ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil A Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Trea ent Area Information: Z Design Flow(gpd) Design Soil Applic ion Rate(gpdsf) Dispersal Area Re uired(sf) Dispersal Area Proposed(sf) System Elevation ©o ►( 1 .0 0 6 t�` G100 /200 0 0112�3 /DO. 3 3 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units o e Existin g Tanks New Tanks SZS 9 U un in w 0 a Septic or Holding Tank I /J(y d ;2OO t Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number I �S Plumber's Address(Street,City,State,Zip Code) VIII.Count /De artment Use Only proved Permit Fee Date ssued Issuing t Signature ��=as,n for 'al IX.Conditions of Approval/Reasons for Disapproval / t,. __ / ��la SYSTEM OWNER: lI w��/ ►G�►'ld Il/11X G� 1.Septic tank,effluent filter and �I f-Uf1" � �� 1 �d�{�, dispersal cell must b serviced/.-Maintained t .3�, Z , /I1/S Is n()7 Gc ��ol]� / p as per management plan provided by plumber. 1) 2.All setback requirements must be maintained f1.fl as per applicable 6WgW0grSl4 glans for the system and submit to theC ugty only on'aper not less than 8 rn x 11 inche#n size SBD-6398(R. 11/11) L/A, MARY JO HUPPERT Page 2 4/15/2014 ' Owner Responsibilities: • 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. • 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. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. erard M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code:7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012,all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally, all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. ptiYpRr� DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA o� ( HOLMEN WI 54636 _ , l Contact Through Relay www.dsps.wi.gov/sb/ y www.wisconsin.gov _ems A�0 S101V�*LS� Scott Walker,Governor Dave Ross,Secretary April 15,2014 CUST ID No. 224832 ATTIC•POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING&DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022-4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/15/2016 SITE: Daniel and Kathryn Jaszczak Identification Numbers 381 230TH Ave Transaction ID No.2389266 Town of Eau Galle Site ID No. 801168 St Croix County Please refer to both identification numbers, NWl/4,NW1/4,S16,T28N,R16W above,in all correspondence with the agency. FOR: Description:Four Bedroom Mound System/2%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1479796 Maintenance required; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01 101,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance'with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code CON requirements. A No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT O stats. PROFESSI DIVISION OF The following conditions shall be met during construction or installation and prior to occupancy or use: Ih Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the --66 requirements of Sec. 145.135 and 145.19,Wis.Stats. SEE COR • 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.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. MARY JO H PPERT Page 2 4/15/2014 Owner Responsibilities: • 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. • 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.SPS 383.54(1). . • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. erard M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code:7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1,2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed -366. by SPS Chapters 360 5 A ' I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN C/) Residential Application W INDEX AND TITLE PAGE (D t U Project Name: DANIEL&KATHRYN JASZCZAK L� Owner's Name: (same) C) cif- L1.1 Q cn Owner's Address: 1326 218th Avenue C.] z New Richmond,WI 54017 Legal Description: NW1/4 of the NW1/4, S 16,T28N, R16W Township: Eau Galle �iTIO County: St. Croix PROVE<<Y D Subdivision Name: NA � SAFES-y AND NAB SERVICES Lot Number. 2 Block Number: NA DVSTRY SERV/C ES Parcel I.D. Number. 008-1046-95-200 Plan Transaction No.: PENCE....�„� Page 1 Index and tide X101 :;111rrti'` Page Z Data entry g � Page 3 Mound drawings -'r Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot plan .��y�ii�+r�rturtlsns►t►�1���''`1�° Designer. Mary Jo Huppert License Number. 1859-007 Date: 04/08114 Phone Number. 715-426-1775 Signature: p Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SD&10691-P(N.01/01),and both iSSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0(R. 03/2012) Page 1 of 8 i i Mound and Pressure Distribu tion Component onent De si n Design Worksheet Site Information (R or C) (� R Residential or Commercial Design Note: Sand fill(D)calculations assume a t-400.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of-36 inches. 600.00 Design Flow(gpd) 2.00 Site Slope(%) 98.50 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/fe) Distribution Cell Information 60.001 Dispersal Cell Length Along Contour(ft) = 10.00 Cell Width(ft) 1.001 Dispersal Cell Design Loading Rate(gpd/ft) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.156 Orifice Diameter(in) 3.50 Estimated Orifice Spacing (ft)= 11.76 ftz/orifice 2.00 Forcemain Diameter(in) 30.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft)x 1.3 4.89 Forcemain Drainback(gal) 11.93 Vertical Lift(ft) 55.97 5x Void Volume(gal) 0.49 Friction Loss(ft) 60.86 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 27.46 System Demand (gpm) 16.97 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options I choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x _ 3.00 x Gallons/inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1200,001 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser __I Manufacturer Ti gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity(gal) Po!y ok � Filter Manufacturer 22.24 Dose Tank Volume(gal/in) L 525 _ Filter Model Number Weiser V� Manufacturer Project: DANIEL&KATHRYN JASZCZAK Page 2 of 8 Mound Plan and Cross Section Views JJ 1/10 B Observation Pipe . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . K. r•r.r.f•r•r.Nr•r•r•NrY•r.r.r•r•r.f.r•r.r•J.r.r.r•r•r:rsr•r.r.r•r•:•r•rM.r�r r r r•r • '..L•L•L•L•L•L.L•L•L•L•L•L•L•L•L•L. L.L.L L•L•L•L•L•L•L•L•L•L•L•L•.L�L•L•L.L• '�..L•L•L• A •r•f•r•r r•f•r•P•f•r•r•:•f•r•r r•r•f•r•f•r•r•f•f•r•r•f•r•P.1'•r :•f• f•r•P•r .L.L L• 1•L•L•L•L•L�1.1.L.L•L• 5 L•L•L L•L•L•L.L•L••.•L•L.L•L.L.L.L:L.L. ti•L.L•'.• •r•f.r•r• r•r•f•r•r•. r•r•r•r•r r•r.r.f•r•r•r•r•P•:•r•f•r•f•f•r•r•r•r• rir11'tir;r L.L•L•L.L. ti•L•L•L•L•L.'.•L•L•L.1• ti•L•L L•L•L•°.•L•L•'.•L•L•L•L•L•L•L•L•L•L• L• :•r°r1f•r•r•r•f•r•r'.iyr{::•r1rh�'•.••1r.r,�rLr�ryf�f1l1rtiPti••Lf1f,y�tid1�1r,i�ti�1�;•�11y�,i�:�ry;1�1? . .L.L•L•L•L•L.L• L• WI. . . . . . . . . . . . . . . . . . . . . . ............... . . . . . . _ . I.:.:. . . B I L — Mound Component Dimensions A 10.00 ft E Mft in H 1.00 ft K 11.11 ft B 60.00 ft F in z 10.55 ft L 82.23 ft D 22.00 in G J 8.79 ft W 29.33 ft 600.00 (frz) Dispersal Cell Area 1 1232.71 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 1 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.10 (ft) .,rrrrrrrr,,, ♦ H G 1 I F : : Dispersal Cell 100.83 (ft) Lateral 100.33 (ft)--► -- Invert Dispersal Cell ': : :.D Elevation 4 4 i 98.50 (ft)Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover Shading Key $'. — Dispersal Cell See lateral details on 10_ Topsoil Cap c °• 1.5 ft Page 4 for number,size, r.r.r.r.r.r.r.r.{{•r.r.r•r.r L•L.L•L•• L L•L L•L•L•L•L• C •l•:•r•r�l%r•r.P•r•r•r•r•r•f•r Subsoil Cap f.r� r rL Lrti V. and spacing of laterals.G :L:S.L.L.L. `�, L :L.L L•L Laterals are equally � � � r•r•r.r•Yr�r• r•r•r• r•r•:•r ASTM C33 Sand yL.L•L.L.L•L. L•L•L•ti•L•L•L•ti ti• r•r•r•:•r•r•r f.r.r.f_r;r;r•r•. r ti.L••. -.-. L.L.L. f.r• :•:•:•: spaced from the Tilled Layer m 0.5 ft =f:r Typical Lateral L•L.L. C! r r•P.r distribution cell's L.L•L.L L•1�ti•L;.L°L.L+L.L r•f.P.r:r.r.. r.l�r.r.l.r•r 1 r.r•r•r Aggregate L•L•L•L L•L•L•L•L .YL L•L.L © '.•L°L.L• � r•P.r•r.: .Z . { centerline in the O L•'.f1•g•L•L•L••.•L L•L•L•�•ti•L �._._A distribution cell(Ax6). Project: DANIEL& KATHRYN JASZCZAK Page 3 of 8 End Connection Lateral Layout Diagram Cenarr the laterasoverdwA&19difnansion •�Turn-up ballve1v4Doroloenout_p_luo _t P PvAPat*raNwr►id►nNCaf Holes-bill►don the bottom of the 100rai g eque"o$P►oed Laterals&forcemain Sett 40 PVC per SPS Table 384.30-i6 S Forasr 1.1I-anrw'etttanw►eeeerorosseomanifvM►t►rgpaint. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing(X) 3.66 ft Lateral Length (P) 58.56 ft Orifices per Lateral 17 Lateral Spacing(S) 3.33 ft Orifice Density 11.76 11f/orifice Lateral Flow Rate 9.15 gpm Manifold Length 6.67 ft System Flow Rate 27.46 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.97 ft Forcemain Velocity 2.80 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented TVForoemain Alternate outlet location diameter Weiser Manufacturer 2 in. Capacityl 800.00 Gallons T Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.33 452.24 C B _ 2.00 44.48 Pump elevation(ft) C _ 2_.74 60.86 1 88.91 D 10.90 242.42 D Total MY6.971 800.00 iF Dose nk elevation(ft) 3"Bedding un er tank. 88.00 Alarm Manuafacturer rs JE Rhombus Note: Switches Alarm Model Number Tank Alert AB containing mercury may not be used in Pump Manufacturer _Gould _ t is system. Pump Model Number PE 41 Pump Must Deliver I 27.46 gpm at r 1-6-9-71 ft T D H Project: DANIEL&KATHRYN JASZCZAK Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Ron's5ewer Service Inc Phones 715-74"153 ._ POWTS Regulator's Name + St. Crblx County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 600 gpd Maximum Influent Particle Size 118 in Estimated Flow-Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliforml >10E4 cfu/100 ml. Service Freauencv Septic and Pump Tank I nspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should best monthly PressureSysteml Laterals should be flushed and pressure tested every 1.5 years Mound Y .. Inspect for ponding and seepage once every 3 years rt Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, j and are secured in as shown in the around component manual. 2. Dispersal cell aggregate conforms to SPS384.30(6)(i),Wis.Adm.Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, 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 j and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8"Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Hall Valve Distribution `► ; Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: DANIEL&KATHRYN JASZCZAK Page 5 of 8 i Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system hall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals(SBD 0691-P(N.01/01),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N. 01/01)]and lood.i or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS compoonts. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 84nc hes 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 fitter shall be assessed at leas;.t 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 be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic�ank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 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 owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(,osing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or 1hrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and m_uIched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be hea ily mulched as protection from freezing. Influent qualty into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,301mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in theperrnit 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 perforred 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 be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 Inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continuencv Plan If the septic Tank or any of its components 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 controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or rep"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'�resent location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and rel ted piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5f this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The inform4-on and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. f I w . �A t5 ZZ,K Project K � Page 6 of 8 L(gJGOULPS PUMPS Submersible Effluent Pump - p i PE i C I w%ftwo•ow i s�lECi�MrARM MOTOR i'�Anl�s Prtmp—Getletai: a Canosion • Disdfarge:t�•tvPT • single phase Oonstnraion. • TwpwaWw.i W%(40°Cj • 60 Hertz ■Cad iron body. mg(puln,Gomm when • 115 and 230 Molts ■Them►oPlastk kn and �dty wbmetged. • &"#wW*Adod pro- cover. j • �Iids i g:%" faction with manadc reset ■tipper sleeve and iow s nwfthrnan sp►em, ' (3m 8 inudwon. heavy duly baN beaiifl9 • Auomafdc modeh h kWe a • 004 led design- aonsauction. 1 ANIKKATUM I float switch. • High strength carbon wed a Maw is *ddy designed for the • Mafwel models avWk6k. shale N+bficated for elAe>tide� •Wowing nd s • �+pk9�:see PE31 MOW.. semb Me. 1 Systm draft Or curve. • 3314P,3000 RPM to Pow&ed for • NuentlDos4 Woes • ks • inw ftnure ph*Systems ma*num capedty:53 GPM • S thaded pole design ■ "moils of file rota • Basement Draining Maximwn head.25 TDH PE41 motor: m Qk dhrn rutect •Heavy Duly Sump) PE41 hop. • .40 HP,3400 RPM Dftatelhfg • Mmdmum Ggmdyr.61 GPM • 115 and 230 voils �' sandand • Maximum heed:29'TDH • PSC design 115 o 230 ok vtlth 115 or 230 vot PE51 hmW PE51 Motor. pp* • A odmim capacity:70 GPM • 50 HP,3400 RPM a UrA$hq,4 duk • Maximum head.37'TDH • 115 and 230 vob portable and oolr METH ffEr • PSC dess* ■Medmr"seat is �BUNA Moons:v3,.Paul,FM andlI 35 1 NP:.]],AD.M a SWAM st o fiA no%. 10 2 GPM 1 FT ACtENLY 115TNr>BS � 25 � SA• U } C USI 20 Toad?a K 71 tl1 I C3A 22.2108 15 !".s r �_... y INS ~ 10�•-E-�� � � �„��. -! -�.. •t,.�.-. Ilr�ckIS09EKr1 . 0 Ec 0 10 20 30 40i 50 60 70 GPM 80 0 5 10 15 e► , N Ass V.S'i 0 .Property owner AAA)j&L K^TWKY4 1" = 40ft Legal Description ,7 , V j#, Pilo (except where noted) tiw'/r4 QF IRS new/ T— s FNf(WL -CWA) of 45Au =Backhoe pit Co,Auk. sf: GRDI COUAJTP- W i evAuf tJ Z7 Gf I� North ?oCt�✓�a�i� arc+ 7! st OCt C7 ♦ \ m sop N60 fed.,0 plot 1°tK'� .SS IjW6 I � �r�opcs�D i Site Location: � x M N A �j SEPT1(-,—TA.'.JN5<. M'3jRE,1;,.-7M.ENT Owlier/BuVer -A 71, Mailing Address_/ Property Address A (Verification for new tonstruction.) City',State, �J( CIA, LEGAL DESCRIPTION Pro erty Location A 'Sec. TJ T-, /L W, Town of Q,,, p Subdivision Plat:. Lot 4- C , Certified Survey Map# V c I u m e t# ? warram ty Deed 9 2�"'07)"lot nrne Spec house 11'e slwl,to f4 yesollo SYSTEM MAUNTENANCE Al�,,111'f1 -A ............... .Improper use and maintenance of• oui &-ptic Usteni c:ould result in its pi,-.mature-railure to handle wastes. Proper maintenance consist.,;of pumping out the scptic tz?;ik c,!�-�ry thv'-,--,1c01S(114, if needed,by a licensed pumper, What you put into the system can affect the function of the septic tattle as il, 11 itt the,waste disposal system. Owner maintenance -Oi-` Ay -y Ordinance. t.C; COL11 'Mitai responsibilities are specified in ASPS.383.52H)Fnd it? Chapic. The property owner agrees to subinit to i31- (,'.';-oix Zoning Department a certification form,signed by the owner and by a master pluniberjourneyman pfijribe or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating com.Ution a, ('j)Oter insfx;(Jion and pumping (if necessary},the septic lank is less than 1/3 IbIl of sludge. Fwe,the undersiRried have read the above it in,.Jntain the private sewage disposal system with the standards set forth,herein,as set by die 1.crviucs and the Department ofNatui-al Resources, g ri State of Wisconsin. Certification stating, y!.,,w. --Jintained niust be corripleted and returned to the St.Croix County Planning&Zoning Department d,-m- I/we certifv that all statements on irtw IJ`r,� ot".rV Clint w -10 kno-,viedgc. L" e ant/are the owtier(s)of th� property described above,by vii tae of rte;dmd �tl Office. 7,,Tumber of bedromns 7 A ,�IGKATME OVAPPLICIP T DATF ','**Any information that is misrepresented May r�sul� iii Otc, beiou revoked by the Planning Zoning Department. C11 Include with this application a recorded v.mrranty 6": ""cgistcr 1);-r:;eees Office and a copy o •the certified survey map if reference is made in the warranty deed. (REV.04/12) 8 1 1 1 1 0 5 STATE BAR OF WISCONSIN FORM 7-2000 968682 TRUSTEE'S DEED BETH PABST Document Number REGISTER OF DEEDS Mark A. Sturtevant and Linda Sturtevant, as Trustees of the Mark and ST. CROIX CO., WI Linda Sturtevant Living Trust, dated April 30, 1999 for a valuable 12/04/2012 08:41 AM consideration conveys without warranty to Daniel B Jaszczak and Catherine EXEMPT#: NA M Jaszczak Husband and Wife,Grantee,the following described real estate REC FEE: 30.00 in St.Croix County,State of Wisconsin: TRANS FEE: 262.50 PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: a Title One Premier Group 706 19th Street South Hudson,WI 54016 008-1046-95-200 Parcel Identification Number(PIN) Dated this 8'h Day of November 2012. Mark A. Sturtevant,Trustee Linda Sturtevant,Trust AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST.CROIX COUNTY. )ss. authenticated this Mark A. Sturtevant and Linda Sturtevant Personally came before me this 8th day of November,2012 the above named to „ me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instru ent d acknowle ged the same.r (If not, authorized by§706.06, Wis.Stats.) -'Itjac!�h O Neill THIS INSTRUMENT WAS DRAFTED BY Notary Public,State of Wisconsin My commission is permanent. (if not,state expiration date: ) Michael H. Forecki 8/14/2012 (Signatures may be authenticated or acknowledged. Both are not necessary.) JACKIE O'NEILL 'Names of persons signing in any capacity must be typed or printed below their signature NOTARY PUBLIC STATE OF WISCONSIN 1 of 2 TRUSTEE'S DEED STATE BAR OF WISCONSIN FORM No.7-2000 i EXHIBIT A Part of the Northwest Quarter of the Northwest Quarter(NW '/<of NW '/<)and the Southwest Quarter of the Northwest Quarter(SW'/4 of NW '/a) of Section Sixteen (16), Township Twenty-eight (28) North, Range Sixteen (16) West, Town of Eau Galle, St. Croix County, Wisconsin, more particularly described as Lot Two (2) of Certified Survey Map filed August 7, 2000, in Volume 14 of Certified Survey Maps,at Page 3926,as Document No.627741,office of the Register of Deeds for St.Croix County, Wisconsin. 2 of 2 r. Parcel #: 008-1046-95-200 03/29/2007 09:29 AM PAGE 1 OF 1 Alt. Parcel M 16.28.16.238B-20 008-TOWN OF EAU GALLE 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-STURTEVANT, MARK A&LINDA MARK A&LINDA STURTEVANT 2420 20TH AVE BALDWIN WI 54002 Districts: SC = School SP= Special Property Address(es): '=Primary Type Dist# Description SC 0231 BALDWIN-WOODVILLE AREAG ,L� SP 1700 WITC gal Description: Acres: 26.901 Plat: 3926-CSM 14/3926 SEC 16 T28N R16W PT NW 1/4 BEING CSM Block/Condo Bldg: LOT 2 14/3926 LOT 2 26.901 AC EZ-U-1646/251 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-28N-16W NW Notes: Parcel History: JDate - -- Doc# Vol/Page Type 09/2 630759 1546/320 WD -07/23/1997 949/628 07/23/1997 942/217 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 20.901 9,400 0 9,400 NO PRODUCTIVE FORST LANDS G6 6.000 6,800 0 6,800 NO Totals for 2007: General Property 26.901 16,200 0 16,200 Woodland 0.000 0 0 Totals for 2006: General Property 26.901 16,200 0 16,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q 12 ' t I�OU -- 3 2000 I:: .,�,.. 6" 741 �e9�ste�o /, � i EKr�( �OL4dTY W CERTIFIED SUR VEY MAP Located in the NW '/4 of the NW '/a and the SW '/a of the NW '/a of Section 16, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin. BEARINGS REFERENCED TO THE OWNER/SUBDIVIDER WEST LINE OF THE NW'/.OF KEVIN KROENING NW CORNER, SECTION 16, SECTION 16,ASSUMED N00° T28N,R16W, ( FROM TIES ) 07'09"E. 332 C.T.H "BB" Woodville,WI. 54028 in S0(?07'O91'W? -C-1-� 8.38' Pou ,p'° 0' UNPLATTED I I _ r,o o i 66 i LANDS LU i 100'BUILDING SETBACK LINE_ C- FROM RIGHT-OF-WAY Ch s I ' LOT 1 33'� M r ' 1,152,015 SQUARE FEET(26.447 ACRES ) m a: Cl) INCLUDING RIGHT-OF-WAY °'- 1,080,5011 SQUARE FEET(24.805 ACRES ) O-n m ZI rn 32; EXCLUDING RIGHT-OF-WAY M m� N W Scale Ve = 300' W o W I �-33, O _ M �I o w r I Nl S I NST UM IV ro'S9 zS o o Z% F3 °c I2 °o c D��FO /'3�153 (jr, w c � w y� Z I 4 JOSEP A ly Py ? w 'IRA JA _ LOT 2 �� o p I rn 'M2 1,171,806 SQUARE FEET(26.901 ACRES ) ' in Z w ro NI ° I c i INCLUDING RIGHT-OF-WAY U- 1,136,878 SQUARE FEET(26.099ACRESr z 0 I EXCLUDING RIGHT-OF-WAY �l x w A4 z a I O J w i /� /uc NOTE: for curve / information see r--O I \ yF—FROM WATER u o / /� / sheet 2 of 2. f /. � r LU 431�4' OUT\H LINE OF N1/2 OF THE SW1/4 OF THE NW1/4 � I -,-1275.16' N 87° 15' 1,308.20' (R S87 20'48"E 1308.43') I o N LOT 1 OF CERTIFIED U') SURVEY MA-p 0 IN VOLUME 9, PAGE 2595. INDICATES SECTION CORNER MONUMENT w b NOTE: an erosion control plan is • INDICATES 1"X 24"IRON o � p PIPE WEIGHING 1.13 LBS./ required on Lot 2 LIN.FT.SET. V prior to issuance of a sanitary –n INDICATES FENCE o z permit. ( R ) INDICATES PREVIOUSLY Z RECORDED INFORMATION INDICATES PERC TEST W1/4 CORNER, SECTION 16, AREA. 00 T28N,R16W( FROM TIES ) -E— PROPOSED DRIVEWAY (ESTABLISHED FROM TIES OF RECORD) LOCATION , SHEET 1 OF 2 VOL 14 PAGE 3926 r R PROPERTY OWNER lZ� I►J6 PARCEL!D. ti SOIL DESCRIPTION REPORT Z 3 Page_of . � \��l 6 Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft In. Munsell Qu.Sz.Cont.Color Texture Consistence Bour by Roots � ; Gr. Sz. Sh. Bed llench ou i,• S i I Z``'sbk w l� Ground 3 l y 1 S`f fZ if/y •S Ll R S 1 fi S 1 C 1 e sbl� yh1 F z 3 °18.5 ft. Depth to limiting fact Qr, L:rr Remarks: Boring# Ground elev. It. Depth to — limiting factor Remarks: Boring# }V�� :,s. Ground elev. It. Depth to limiting factor r Remarks: 3oring # {{{ around ?Iev. It. )epth to imiting actor Remarks:_ •a o•r•rnrf+.�.r+ .• Wisconsin Department ti Industry, SOIL AND SITE EVALUATION REP 0 R J,, , age \ of 3 Labor arxi Human Relations 1 � �--T Divijion oPSafety 3 Buildings in accord with ILHR 83.05,Wis.Adm.Code lv I, _ COUNTY ' Attach complete site plan on paper not less than 81/2 x 11 inches in size.Poor must include, ST- ClZC1 x not limited to vertical and horizontal reference point(BM),direction and% f scope,scale CEL I.D. dimensioned;north arrow,and location and dstance to nearest road. ' , RECENEd �r � APPLICANT INFORMATION–PLEASE PRINT ALL INFORMAT QK� '\ _ BY DATE D� PROPERTY OWNER PRO L ya NW,1/ds b T Z8 AR l� E( W PROPERTY OWNER':S MAILING ADQRESS• i !E� AME:OR Esm a CITY,STATE ZIP CODE PHONE NUMBER 4�2� NEAREST Z _' 0 [ New Construction Use[J9 Residential!Number of bedrooms 14 [ I Additi on to existing b inn j ) Replacement [ ] Public or commercial describe Code derived daily flow \sGg gpd Recommended design I ing rate .S bed,gpd/ft2 — trench,gpd/ft2 Absorption area required V 0o bed,ft2 b or3 french,ft2 - Ma)dmum design loading rate ' S bed,gpd/ft2_- 6 trench,gpd/ft2 Recommended infiltration surface elevaiior,(s) �'3 o- O' - ft (as referred to site plan benchmark) Additional design/site considerations I"1 1�U tti/ M iti_ Z 4 O SN,J Ft LL Parent material_ O U LIZ &JI A.I R-L 1-1 L L Flood plain elevation,if applicable N R ft S=Suitable for system CONVENTIONAL I MOUND MROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system ❑S ®U as ❑U I [Is OU [Is 1$U ❑S I211 I ❑S I[U SOIL DESCRIPTION REPORT Boring# Horizon Depth I Dominant Color I Mottles Structure GPD/ft in. Munsell Qu.Sz Cont Color Texture I Gr.Sz.Sh. I Consistence BarxSery I Roots Bed Tiench 0--7 W- R-3 L Z Z -fib t�1112- Liz Ground 3 �63� �•S�rz yly �"�•SLYZS/8 SIQJ \Lsbk m:- elev. q.Ls ft Depth to _ limiting ,gr Remarks: Boring# 0-7 t 0"1123 !Z — st 2r`fs�k hi-fi, Z Z -z� �o� y�Y - sit Z�sbk m�� s 1� ,S= Tk Ground Z.SLiR Vey Z•S�V2S�8 si ca 10Sbk q8 I Depth to Wffng 22" Remarks: '1-1S1 T Name:—Please Print Phone: ur L. We erer 715-425-0165 ' egre. Soil sting & Design Service-P.O. Box 74 River Talls,WI 54022 *.* Sgnahrre: -.. .. - ... • CEO—6_S Date: ! – Z8-00 CST Number:. O 220254 PROPERTY OWNER 1Z-LLoe-m w C, SOIL DESCRIPTION REPORT Z 3 PARCEL I.D.# rj S page of Boring # Horizon Depth Dominant Color Mottles Structure In. Munsetl Qu.Sz.ConL Color Texture Consistence BMXbry Roots GPD/ft x v Gr. Sz. Sh. 0 6 will 3 t Z Bed Trench z sblz � 'Fh wi.`f`Ir e s 1 s elev.and 3 1 y..� S L!fZ �/y �-tj•S LIP. S 1 ti s 1 C 1 L° sb12 IM. X18.5 ft. Depth to limiting fact gr, Remarks: Boring# ` sw:� x'. Ground elev. it. Depth to limiting factor Remarks: Boring # .T i Ground elev. rt. Depth to limiting factor Remarks: 3oring# C: around Nev. ft. )epth to imiting actor Remarks: PLOT PLAN Page 3 of SCALE 1"= �p ' le �'ju k S T� S� gr1 I ei- oN q"iftrs 31,1„ DIA, Q J `4L�\ PVC`_ Pips t�/LRTN_ J A cLb s �-3 I eo��z v..9.�•o' --� s°�►� a� B erg , 0 �r \ d �,°r BI \\\ 11t. 10 A7 9 Z o qb-S' av "\k15 N, 3 I b I t- � , PVC PIPE wlL� G V.)' N ivtiSr '10 8E Prr U!ft'3T Z_S' 1 I2zcui Y,90 i-b. ---- _ oo-6s zzozs`f _"15 ) 425-ni tis CST Signature Date Signed Telephone No. CST# PROPERTY OWNER ``ZC 1G SOIL DESCRIPTION REPORT Page -2—of 3` PARCEL I.D. Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed TmrK:h £?.�:.. z� 1 o-S to�lR ZLZ � sib z ►� �of� a,s s 6 <:? 73 {>; Ground 3 11-ZZ R- �S1 i• �; S`1 R S/43 S l�°Sbtz elev. Q� -)-$ ft. y 72z-38 'Y FL VA ,-s 'ltt 5 I S0- O-Sbk Y4 ,z .3 Depth to limiting factor I Remarks: Boring # vo-i%I z I Z - s t I Z`�9� r�vfiti- a, S - •S .I, - S 3 l6 S�R Y/Y �-� .g y R S/a S t c l \cs bw Ground elev. 98.6 ft. I Depth to i limiting fac of Remarks: �� 1 Boring # iu\i:?•� ii Ground elev. It. i Depth to limiting factor Remarks: 3oring # around ,lev. ft. )epth to imiting actor Remarks:_ Wisconsin Department Industry, Lat%ir and Hurt+an Relations tions SOIL AND SITE EVALUATION REPORT Page \ of 3 Division of fery&l3utldings in accord with ILHR 83.05,Ws. m.Code .y COUNTY Attach complete site plan on paper not less t n '?cc:he s' iz e.Plan must include,but not limited to vertical and horizontal refere rtE nil) and%of slope,scale or PARCEL I.D.#toy((dimensioned,north arrow,and locatin d de to near fa APPLICANT INFORMATION–PL PRI TI FOfiMa7tON REV DATE PROPERTY OWNER: PROPERTY LOCATION Q t LZ- -� r. n; 'f6VFt6T S>Q 1/4 N W1/4,S )-b T 2.`d ,NCR l b E( W PROPERTY OWNERS MAILING ADD SS . I , „ ST Gq0 0,' LUBD.NAME OR CSM# '7 �`1 CXWUNTY 4/CITY,STATE �l'OWN NEAREST ROAD . ►tibo�Vt1�...t. X11 Sao S'�.,...,.(")t5)68�.:�� Gf'R,L� CoUtv`� N" [� New Construction Use Residential/ rooms 3 [ ] AdditiQn to existing building ( j Replacement [ ] Public or commercial describe Code derived daily flow L4 S j gpd Recommended design loading rate_=_bed,gpd/ft2 ZZ°) trench,gpd/ft2 Absorption area required 31 S bed,ft2 1-15 trench,ft2 Maximum design loading rate - S bed,gpd$•_6 trench,gpd/ft2 Recommended infiltration surface elevation(s) l DO.3 ft (as referred to site plan benchmark) Additional design/site considerations I wSTttt L A VfN�T �SZA U 4 w/ Parent material LpEs ) 0\X_'1Z G Lft-r_L Prt. -n LL Flood plain elevation,if applicable M -A , ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem E]S O U RS ❑U EIS ®U ❑S R U ❑S [ U I IDS &1U Su rW\kt ,Le Fob 13N tA-e� r SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture I I GPD/ft Boring# Horizon Structure Consistence Roots in. Munsell Cu.Sz.Cont Color Gr.Sz.Sh. Bed Tmrich z t z :- st 0.,S Ground 3 1S-3o �.S Y2 y/y elev. R8-q ft. Depth to limiting fa;or Remarks: Boring# o�S 0 12 Z Z ZL — sil 1 l.0`iR ��Y sr1 Z�Sbk mfg C � . S .b fz y/y Ground -a S Y2 JE:S St C1 l�Sbk w�'�1 !, : •3 elev. 48.3 It sR�� Depth to limiting i factor Nk Remarks: CST Name:—Please Print Phone: dress: Arthur L. We erer 715-425-0165 egerer Soij. Testing & Design Service-P.O. Box 74 River .Falls,WI. 54022 •' Signature: Date: CST Number: � • • Ob-EIS-) 0 220254 L r PLOT PLAN Page 3 of 3 SCALE 1"= SO ' UP�v a ��S � �`'1,j�'�L'1 - E51.t00•C)`0►�:± SPlki= \S"�l3�Ut G'y2pVh/p }N_�`1J1� YR.��,. `qu N r 3►� I Q �'`.9S.S' T'f0►'L OF 'r}ZFkjcffjM fig$4 a 3•I S� \\ t�:L9�g �� ti0T C�►"1P qe.T V12 \\ �\S'Tti\Z..6 ht1S ►�Z.�Z� �3 $_z L-L ',Bit \ Z5, \"-� Hv�gL l�-8E, F4fi ��sT Z5`�►�l wluU��— ` 0 x 00-bs_I 1``=loop ' 00-65 - viL i , / zzoZSy s��%f�h�. 3` Z'7`QO ( 715 ) 425-0-16 5 CST Signature Date Signed Telephone No. CST#