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HomeMy WebLinkAbout032-1047-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 578991 0 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID No: Permit Holder's Name: City Village X Township Bicha, Gerald Parcel Tax No: Elev: G Somerset, Town of 032-1047-20-000 CST BM Insp. BM Elev: BM Description: pn Section/Town/Range/Map No: L. 16.31.19.238b TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER •`^~45 CAPACITY STATION BS HI FS ELEV. Septic / Benchmark /66 Alt. BM C Aeration Bldg. Sewer 325 S►8. GS Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO J7 /L n 1 C r WELL BG. Intake ROAD Dt Inlet Septic > 56 76 Dt Bottom Dosing Header/Man. Aeration ~,C•~.• Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM ,j,/~I.e,11-- dJ Z• 1J5 led "03 Model Nu TDH if' Friction Loss System H H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: x 1 CHAMBER OR ~Q• UNIT Model Number: DISTRIBUTION SYSTEM VV Header/Manifold =bon x Hole Size x Hole Spacing Vent t o Air IntaLength Dia Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over =Depth Bedlrre nch Center Bedlrrench Edges Seeded/Sodded xx Mulched Fm~ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 452 210th Ave. SOMERSET, WI 54025 (SW 1/4 SE 1/4 16 T31N R1 9W) NA Lot 2 Parcel No: 16.31.19.238b 1.) Alt BM Description = J-✓L CI L / S 2.) Bldg sewer length = / l~+a. % 8c./~c~ nn b -amount of cover = 4-- I ~ / ~ dL X fv S lower-~Q ~d•~-~!( Plan revision Required? ❑ Yes ,No Use other side for additional information. l(J ~J 3 j SBD-6710 (R.3/97) Date Insepctor's nature - Cert. No . County 1 Industry Services Division St. Croix N Q 1400 E Washington Ave P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) S Madison, WI 53707-7162 T. CROIX CC~UN ..OMMUNITIr" DEVELO MENT 5 < ~L Sanitary Permit Application State Transaction Number accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit - i required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide'may be used for secondary Project Address (if different than mailing address) u ores in accordance with the Privacy Law, s. 15.04(1) m), Slats. 1. Application Infor - Please Print All Information `f52-Property Owner's Name Parcel # Bicha, Gerald & Judy ML -1047-20-000 ,Z39 8 Oil Property Owner's Mailing Address P roperty Location 452 210'b Avenue Govt. Lot City, State Zip Code Phone Number SW %4, SE 1/4, Section 16 Somerset, WI 54025 (circle one) II. Type of Building (check all that apply) T31 N R19EorW ® 1 or 2 Family Dwelling -Number of Bedroom J 2 Subdivision Name NA ❑ Public/Commercial - Describe Use Block # E3 State Owned -Describe Use _ City of ❑ C M Number ❑ Village of 0 XTown of Somerset III. Type of Permit: (Check only one box on line A. Complete line B if a licab A. ❑ New System ❑ Replacement System ® Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. e of POWTS S stem/Com onent/Device: (Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground El At-Grade ❑ Mound > 24 in. of suitable soil E3 Ho mg Ta-nF-Lj Other Dispersal Component (explain) ❑ Pretreatment Device (explain) Mound < 24 in. of suitable soil V. Dis ersal/Trea nt Area Information: Design Flow (gp Design Soil Application _ Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 Rate(gpdsf) VI. Tank Info Capacity in Gallons Total # of anufacturer U New Tanks Existing Tanks Gallons Units / w q U 15 1. Sz w U va ~ rig u; C7 Li, Septic or Holding Tank 1000 1000 1 Wieser Con ete ❑ ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum i re MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 15011 Avenue, Somerset, WI 54025 VIII. un epartment Use Only Approved ~ ed Permit Fee Date Issued Issuin gent Signal e en Reason Denial $21,56-00 15 IX. Condi Ifteasons et, for Disapproval n - " `eptic " nk, effltlient Net, and d[ I / 0 L dispersal cell must all be services / rnalritainec! ~ 1&4- as per management plan provided by plumber. 3 setbAt:k rst}ufr¢mitnfe rpullt t rpraintild a per applicable COds I wdifl111im. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (803/14) PLOT PLAN N Project Name: Bicha Replacement Septic Tank Legal Description: SW1/4, SE1/4, S16, T31N, R19W P.I.D: 032-1047-20-000 F ti Subdivision Name: NA Lot 2 Township: SOMERSET Parcel Size: 17.63 SCALE: 1"=40 County: ST. CROIX Existing Soil Rock and pipe bed approximately 50 feet long. Slope: 10% Absor tion area Width is unknown BM1 Elevation: 100.00 Top of Patio Slab Backhoe Pits: 4 inch Sch 40 -ASTM D2665 NOTE: See page 10 for a complete plot of the parcel. 4 inch 3034 - ASTM Q3034 -WELL 3 $ED~ /01 }}au5 t POk L4 1V IC 77 C~ t :,1 J 4- i ;Ac Ic0 r I 2- j 0 Page CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Bicha Tank Replacement Owners Name: Gerald & Judy Bicha Owner's Address 452 210th Ave Somerset, WI 54025 Legal Description: SW1/4, SE1/4, S16, T31N, R19W Township Somerset County: St. Croix Subdivision Name: NA Lot Number: 2 Block Number Parcel I.D. Number 032-1047-20-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Filter Information Page 5 System Evaluation Page 6&7 Management and contingency plan Page 8 Septic Tank Maintenance Agreement Page 9 Warranty Deed Page 10 CSM or Plat Attachment Boring Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/15/2015 Phone Number: 715-760-0486 Signature: 4~gdE ~~"_O In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Bicha Replacement Se tic Tank Legal Description: SWIM, SE1/4, sic., T31N, R1 9W Subdivision Name: NA Lot 032-1047-20-000 Township: SOMERSET Lot e: 2 Parcel Size: 17.63 SCALE: 11" = ao' County: ST. CROIX Existing Soil Rock and pipe bed approximate) 50 feet Ion Slope: 10% Absor tion Width is unknown y g BM1 Elevation: 100.00 To of Patio Slab area Backhoe Pits: a inch Sch ao NOTE: See page 10 for a complete plot of the parcel. -ASTM D2ss5 4 inch 3034 - ASTM D3034 Il. ~ GAB. 3 $tD900 ~ a l~ou5 t , _ ~ p0 A2tve PROP05EO ~Q I-aCfJ ~r~t. SST ur~i~ [rd j _ SZS' 77 J 4J.. i f i A/;() 2 1©T t+ ~di_ an-OWld'M :3'11J 99-ve-5Z2-008 OLOZ 'N`df 43SIA38 o \ OSLirS IM 'NOON N301M Ol AMH sn 9LL£M Z :anod-isod :31v0 mol ~ 8vnNvr :31v0 l`dnNb'W OIld3S ~ ~ :8nod-38d „o-,L=.V 1d~s 3ws :.ka NMVaO 3131 Oulu 1313'M dyy-OOOLd-M V)) J Z (_W!) w z Q Z 0 W H ~ d J_ _ U m x JW O F-~ o i Q U) M O O p O W 0° iJ V N m w 0 -1 0 0 (n O\ O - M C9 ~ M(n O LL < r w H LL Q Qa m o 4h< Z d L U Z Q Wco~ oQ a_j C) -j °o a o~ ? Mo z W °w m a U a 'n a~ o m (3 WrQ-w a m~ j t-o a O m Z W W o Vi m ti Li- 0 w U C7 Zli1 \ z m ~n m z > a 0 LL U Z DUO ° (V cO m Q Q Q W ° (n OMO J p > N Z (D Y 0 V n0 w ac O 0 o W I U F° z V) mw aU w ¢o pp Z ° Q r7 a Cl. a 0 LJ TWO NMIQ1 *OwW-.0) W¢a WNQ }N JCL 00 o~< WO Z Q aQ CL N=xv..W0ti-co-W~W( I-'! U 0 N I- =U > J D= 00 zO J N~ OI_ J~ OQW pzx U Z~J QJ w0 0w N Y Z~K ~z~ o~~ °~vYi °~F- Q P o Ci J° ma x° Wc~i Z U) m m~i ~Nm~ a~~ aN° Z0< Z zz a aN N0 Q w w w 0 U OU- I- J J O O O Z Z ~Z N Z Z J m -i la- C0jH U w 0 z a U w x > W Q °o w F- w Q -1_j U° 1 mw (n Q J M 4- U HQ~ 6£ W A !Y O Q ~ N O 0- ~ :2 D W I N N / O J\ Sb'o "-V a O a „8c do Ln 1 w o Q W 5 > a CL "92 w LU V) 0 U / 1- U W O \ nN~ / Sdo „t do w w 0 W N w J Z_ U- Z „98 „l9 g w a N Y Z a F 1PUY lox- Inc. A A Innovations in Precast, Drainage^ Zabel, PL-525 Effluent Filter & Wastewater Products A Division d Polylok Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: 1/16" Filtration Slots • Rated for 10,000 GPD (gallons per day). Alarm Switch • 525 linear feet of 1/16" filtration. ZO, 000 GPD (optional) • Accepts 4" and 6" SCHD 40 pipe. Accepts 1" PVC • Built in gas deflector. Extension Handle • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for • Accepts PVC extension handle. 10,000 GPD PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. 10,000 gallons per day (GPD). of 1/16" 1. Locate the outlet of the septic tank. Filtration slots 2. Remove the tank cover and pump tank if necessary, j 3. Glue the filter housing to the 4" or 6" outlet If Accepts 4" & 6" pipe. SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. Certified to NSF/ANSI Standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring V cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified Gas Deflector septic tank pumper or installer. JAutomatic 1. Locate the outlet of the septic tank. Shut Off Bail 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. outdoor el & B filters accept Easily Alarm Extend in Lalls 7. Replace and secure septic tank cover. the S artFilter® switch and alarm. into existing hanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 4 ~HMITT Sc S NS CAN/ A / V INC. 586 Valley View Trail Somerset, WI 54025 schmittandsonsexcavating.com (715) 760-0486 June 15, 2015 To Whom It May Concern: An evaluation of the septic system on the property of Gerald and Judy Bicha located at 452 210' Avenue, Somerset, WI was conducted on June 12, 2015. At the time of the evaluation the soil absorption area appeared to be functioning properly. The soil absorption area is covered with brush and trees that could affect the performance of the system. At this point the septic tank has collapsed and will be replaced. This evaluation does not in any way warrant or guarantee future functioning or operation of the system. If you have any questions or concerns, please feel free to contact me at 715-760-0486 orischmitt@somtel.net Sincerely, John Schmitt Master Plumber Restricted Service #223760 Page 5 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Gerald & Judy Bicha Tank Manufacturer: Wieser Concrete Permit # NA E' Septic E Dose EHolding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: NA Number of Bedrooms: 3 rIA Septic Dose Holding Volume: gal NA Number of Public Facility Units: 0 1w A Vertical Distance Tank Bottom (s) to Service Pad: Estimated (average) Flow: 300 tt gal/day Horizontal Distance Tank(s) to Serivice Pad: ft [Design (peak) Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 al/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok r Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: 525 NA Biochemical Oxygen Demand (BOD5) 5220mg/L NA Pump Manufacturer: Total Suspended Solids (TSS) 5150mg/L Pump Model' NA High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) <_30 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L ' NA C° Mechanical Aeration Peat Filter NA Total Suspended Solids (TSS) 5150mg/L Disinfection r Wetland Petreated Effluent Monthly average Sand/Gravel Filter Biochemical Oxygen Demand (BOD5) <_30m /L f Other: g Soil Absorption System Total Suspended Solids (TSS) 530mg/L 177 NA V In-Ground (gravity) l In-Ground (pressure) Fecal Coliform (geometric mean) 5104cfu/100m1 At-Grade I° ]NNAA Mound Maximum Effluent Particle Size: % in dia. NA r Drip-Line Other: Other: N Other: MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('Y) of tank volume Pump out contents of tank(s) When the hi h water alarm is activated 177 - month(s) Inspect condition of tank(s) At least once eve every: 3 year(s) (Maximum 3 ears) NA Inspect dispersal cell(s) At least once every: 1.5 myea ~s) ti'' (Maximum 3 ears) NA Clean effluent filter At least once every: 3 myea (s> NA Inspect pump, pump controls & alarm At least once eve : monm(s) year(s) NA Flush laterals and pressure test At least once every: most s year(s) NA Other: At least once eve month(s) ry: year(s) NA Other: 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. (Rev.2/05) Page 6 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do 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 soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void 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 the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines 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 effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil 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 POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Powers Liquid Waste Management Name: St. Croix County Zoning Phone: 715-246-5738 Phone: 715-386-4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) Page 7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Gerald & Judy Bicha Mailing Address 452 210th Avenue Property Address Same 11.52- (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI Parcel Identification Number 032-1047-20-000 LEGAL DESCRIPTION Property Location SW '/4 SE '/4 , Sec. 16 T 31 N R 19 W, Town of Somerset Subdivision Plat: , Lot 2 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 0yesOno Lot lines identifiable ❑yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this orm 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 warra ty deed recorded in Register of Deeds Office. Number o drooms 3 SIGNATURE OF APPLICANT(S) / 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 Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Page 8 y.Yie~it Departrimt of SOIL EVALUATION REPORT #1788 " S p Safety and in accordance with Comm 85, Wis. Adm. Code Page 1 of 2 Professional Services Schmitt Soil Testing, inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all Information. 033 1047 0-000 Personal information you provide may be used for Rev By Date secoridary purMies (Privacy Law, s. is-oa (1) (m)). Property Owner Property Location F-T Bicha, Gerald & Judy Govt. Lot SW SE1/4, S16, T31N, R19W Property Owner's Mailing Address Lot # Block # Subd. or CSM# 452 210th Ave. 2 CSM 144 City State ZipCode Phone Number [ City Village Town Nearest Road Somerset ` ' WI 54025 715-247-5207 Somerset 210Th Ave. [-j New Construction Use: r !T, - Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD D Replacement ' Public or commercial - Describe: Parent material Outwash (PmC Plainrfietd loamy sand) Genera! comments This Flood Plain elevation, if applicable NA It, and recommendations: boring was completed to very the soft on the existing drainfiel at theis described property. This boxing was dug at the west ebt of the vest end of the drainfWd by the vent pipe. These soils provide the 3' of separation required. 1 Boring # Boring Pit Ground surface elev. R Depth to limiting factor $g+ in. Horizon Depth Dominant Color Rem Soil Application Rate Description Texture Structure Boundary R~ GPD1ft= in. Munsei! Qu. Sz. Cont. Color Gr. Sz- Sh. •Efi#r -Etlyk2 1 0-12 10yr3/3 none si 2fsbk mvfr as 2m,2f 0.6 1.0 2 12-16 10yr3/3 none sl 2fsbk mfr as 2m,2f 0.6 1.0 3 16-26 10yr4/4 none sl 2msbk mfr 9W 1vf 0.6 1.0 4 26-54 10yr5/6 none is 1csbk mvfr gw 0.7 1.6 5 54-63 10yr5/4 none Ifs lcsbk MA. Cs 0.5 1.0 6 63-88 10yr6/4 none Is 0sg ml 0.7 ' 1.6 " Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOO 30 mg/L CST Name (Please Print) Signal 5 < - and TSS < gN mg/L Thomas J. Schmitt CST Number Address Schmitt So!! T r 227429 M9' Inc. Date Evaluation ~rr-ornnwed Telephone Number 1595 72nd St. New Richmond, W{54017 6112/2015 715-7130-1978 SBD4330 (8.07/00) r g NRI, A. 7C ov. ~r., j`•4S. bd. .r • . o'ff' t " :y 'Cis r>• iz; • ~ ~ f 'Ys .A ~r fns $i.3'~ a Q •,~-s~~ tp } z ' m Mr m w O t7 - do