HomeMy WebLinkAbout032-1050-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 579084
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 Township Parcel Tax No:
Lane & Tweed Browne TOWN OF SOMERSET 032-1050-10-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
1301 17.31.19.250C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic W 1e y ~ /odO Benchmark ~ 7Z lts1. 7
/ Q D Alt. BM J ALe4- Co 3. $ $ COI ! y
Aeration Bldg. Sewer
ke. 10.3 98'•S/
Holding St/Ht Inlet
•59 9~'/3
TANK SETBACK INFORMATION "§t/Ht Outlet D
,9 9 71
TANK TO P/L WELL BLDG ent toit Intake ROAD Dt Inlet
l~o r s we,
Septic _756 3(o A)* Dt Bottom
Dosing Header/Man.
I eration Dist. Pipe
o lding Bot. System le, 91
PUMP/SIPHON INFORMATION Final Grade S. Sd7
Manufacturer Demand St Cover
GPM ~d1~ CO 3• fd
Model Number
TDH Friction Loss System Head Ft
Forcemain nth Dia. o Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li epth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR 'i►
49 ~ Type Of System:
UNIT Model Number: /
Co n J~.~`d 1►~-+ ~ ~ ✓ `f r.7 , f
DISTRIBUTION SYSTEM j~ I q 19 = ~s
Header/Manifold It Distribution x Hole Size x Hole Spacing Ve ID Air Intaakke
Pipe(s)0 r, 7
Length Dia T Length Dia Spacing a `
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
~G J Yes [id No es FS-] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 351 RICE LAKE RD ~ ~
1.) Alt BM Description= dig".,
2.) Bldg sewer length
-amount of cover = ~ / f j ~~Oa
l a ~30 z~ 3
Plan revision Required? ❑ Yes XNo
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor' i9nat Cert. No.
Pak
^Ta~~xarsrgtiT° _ County
Industry Service vis'
DS
~•1 1400 E Washln on ve Sanitary Permit Number (to be filled in by Co.)
P.O. Box 7162
S, . T.N ~''`)U7 , Madison, WI 53707-7162 S7q6 8~
" tZV
9OF~ssrosP~ Pr.~w _:i1 i:7~
Sanitary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit G
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
1. Application Information - Please Print All I rmation ~&gz--, ZZ
Property Owner's Name I Parcel # l d
Property Owner's Mailing Address Property Location
r: iG~ovt. Lot
City, State Zip Code Phone Number /v by '/4, Section / 7
(circle o
T31 N R/9 Eo C, V,
II. Type of Building (check all that apply) Lot #
❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name
❑ Public/Commercial -Describe Use Block #
❑ City of
El State Owned - Describe Use
CSM Number ❑ Village of
Town of~^
IIl. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. 0 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 qzo j~ / Q_77 `f U 3c) -e?
ItV~. Type of POWTS System/Component/Device: (Check all that apply)
yJ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
Rate(gpdsf)
VI. Tank Info Capacity in
c
Gallons Total # of Manufacturer 4. o U
Gallons Units w °
New Tanks Existing Tanks U i;5 V
w a
Septic or Holding Tank - S% ❑ ❑ ❑ ❑ .1 A9196 Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibili or' stallation of the POWTS shown on the attached plans.
Plum s Nam (Pr' / Plumber's Si ` MP/MPRS Number Business Phone Number
7917
Plumber's Address (Street, City, State, Zip Code)
VIII. County epartment Use Only
Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Si ature
W❑ Owner Given Reason for Denial $ 1-17~ rC2
IX. Conditions of Approval/Reasons for Disapproval
~Ccgcl~~ (o~J sT~~-T~.
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 (R03/14)
CONVENTIONAL COMPONENT DESIGN
Residential application
INDEX AND TITLE PAGE
+~rt +,4 -x+,4_•4-\ •>..:xa`3]5+,:`+)'\Fif. ,{a'-++44,C
4 FFi•: L+ , •{F4r:----°`:-. Project
• Fes, :<;ca::4\\ .
,•,4 ::.u Name: e~11~
Owner's
. - . Name:
Owner's r
Address:
;4 +r+• r:;: `4-,= ~i~FS'T ~S~IK..~ 'c%//c.c//J/,''// J\Y~~
Legal Description: .~1i1 r~~/- 7- 7-~~~►/- ~°/`~s~
Subdivision:, Lot #
Town:
County:
Parcel ID#
Designer/Plumber: License
Uate:
Signature: -
Comments
noc;csnorl nr,rci rant to the ln_Prn>>nrl CnH Ahcnrntinn f mmnnnant Manual fnr Pr)WTC vPrSicm 7.0
~ d~>>/,~ 11/x11 s~ 17- r,✓~ 9K! _ _
oed
jol
/00
/,C o
o
° 1
S
- z _
6 t
.
Y
r
i'
l _
Soil Abso i4on :vstem Cross Sion
~S ft
Sc hedUb 40 Fir2ai Grade
PVC Vat With vent t~ ft
Leaching
Chamber .4..._ ~ft
System Elevation
ft ft
Soil Absorption System Plan View
ft
Leaching Trench 1
Vent Or Observation Pipe Cherr~bers
IIIIIIIIIIIII Oa ~/os
4° Dla.
Trench 2 Header
i eachina Chemb/ec S/peciizcations
Manufacturer And Model :1 e,r y
EISA
Rating,- -.;?a _ sy ft per chamber Soil Application Rate gpd/,--q ft
_ gpd Design Flow _ Snit Application Rate s EISA = . Chambers
2 rows of chambers each.
Page 3 of
INSTALLATION INSTRUCTIONS-
ZabeP
Vx PL-5251PL-625 FILTER
Allifidn
INSTALLATION INSTRUCTIONS
center ter
opening v~.. ~ •r. 3 r fie..
w , - G 1 f' e~S~. CI^^.F~ ysF-v, yXs ,s
Big
- " . s•' f rn t-•~yF S x
tY'jx ~ C Y t
$ 3. -ter Ftl~D~< - ~ r~,G'~'*
ay.-: j - r. _ .s'~'~_•~,..-:.•
Step 1: Step 2: Step 3:
(A) Locate the outlet of the septic tank. (A) Before lMt3 laf Dn, Ph-Me the (A) Glue the fftw housing on the
(8) Remove tank cover and pump flank tinter housing on to the outlet pipe. outlet pipe.
if necessary. (8) Make sure that the housing (B) Insert the filter cartridge in the
is positioned so theilter can be housing, making sure -the fitter
removed from the tank for cartridge Is properly aimed and
maintenance and service. completely inserted in the housing.
MAINTENANCE INSTRUCTIONS
.r
may,- 1 1 . t. 's.> A Cs..~ iy Y~A:~~ w'~ .1L.T d-• ~L]Q
L
',-HS.t. .s.. • ~i•`~i'.. '.~s'' .•-t.~~~s=s~'^-'~+'v;, z~ t _ •.a~ Y: :*~'gc. ~•'s
Step 1: Ste P2-
Step 8:
Locate the outlet of the septic tank: (A) Remove tank cover and pump (A) Insettthe MlBr car ifte back
e; o e if necessary. into the the housing making sure
HM fe7w Is properly awed
o s (8) Pull the ter out of the housing_
(C) Hose ofrti a der over ft septic tMic and completely kwerted-
E Make sure all sods fag back info the (B) Replace septic tank cover
11flf t+I:G AT? l!}jiC; 7L R ~ . septic Janke
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page , S''of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal ❑ NA
Permit # Septic Tank Manufacturer S ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units 12( NA Pump Tank Capacity gal JZNA
Estimated flow (average) gal/day Pump Tank Manufacturer 13 NA
Design flow (peak), (Estimated x 1.5) r~ gal/day Pump Manufacturer NA
l
Soil Application Rate gal/day/ft2 Pump Model '121 NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) _<150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD5) 530 mg/L W In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) mg/L (9 NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) <10' cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size YB in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
19 year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
H year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) 0 NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) 1 NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third 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 Administrative Code.
Ali other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
_ _ of
START UP AND OPERATION Page
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During 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, overloading the cell(s) and may result 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) water; 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 and pits 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 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 that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ 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> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name l Name
?j ~79) 7 E Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
s
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK 1\LkLN EVANCE AGREEMENT
AND
O'V~72\TERSHIP CERTIFICATION FORM
Owmer/Buyer L ivc- ANIO Tw o 3 •~v r vv~
Mailing Address z o z7' 9 0 ~/~JLy, /-~VE' . N, , 1506 3 7- L/-f <C ~i✓ ssd2~
Property, Address ~ EL/+K4 ~d • . sU/1/IE/25"- l/~/ 5 • . Sy0 Zs
(Verificanon required from Plawzmg & Zoning Department for new consiruction.)
City/State ~YIc72 S //V / S Parcel Identification Number o3 Z -lQso . Seo ^ooc) ,
032-/os0-/0-orx~
LEGAL DESCRIPTION
Property Location S Gt/ 1/4. N5_1/4 , Sec. / 7 . T .3 / N R_Lq W, Town of So itil ~,25gT'
-t' /V Gt/ ~5 E
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house Q yesino Lot lines identifiable,yes 11 no
SYSTEM MAII~'TE_~TANCE 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(3) 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.
Itwe, 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 form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a . deed recorded is Re-ester of Deeds Off ice.
Number of bedrooms ,
ZA4,Le ~n r o 1,34/ ~•5
SIGNTATU-RE 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 Resister of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed
(REV. 04/12)
Li~ 'I
I: o
f 1 -
m0?(n rn
z rn 1 - -
tf
I ,
-n O I I -
O ~ OT z
rro C -
70
- -
zQ
i
70
D <
r7l
I
-
D
y 1 ~ f
yi
s
F ~ D
i-
i } i ~ C
i 4. 4
~ _ \ Ij
,l.3
r 1 _ r~p
`'gyp m T cr
0
rTJ
M
Gzl ~ 1 . ~a~
lot
z 2
G -
poi
R dIy
a 7 O
Scw
i t
d. n
?7
RECEIVED P-AJL)')
d3
JUN 0 8 2015
Wis. Dept. of Safety a ~r~fp~t;st. SOIL EVALUATION REPORT Page of
Division of SafetyJ~Ifd~yt~sY DEVELOPMEIaIT
MMM~'`M~~'~~• in accor ance with SPS 385, Wis. Adm. Code
County
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 Parcel I.D. -OHO
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)).
Property Owner _ Property Location
Govt. Lot 1/4 1/4 S T N R E (or
Property Owner's Mailing Address Lot # Block # Subd. Name orjCSM#
k 7 - -
City to Zip Code Phone Number ❑ City ❑ village own Neares oad
New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement / ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable A11,4 -A Zy~E X ft.
General comments?
and recommendations:
LOID (Q) • d ZAw t- &P a 1 e ors
F-/1 ❑ Boring a e4) D.
Boring #
Pit Ground surface elev. ft. Depth to limiting factor s in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2
F
116 .41 d4 ° U
. e
s s 4
` _ Q 9
n Boring # Boring
A I ® Pit Ground surface elev. /~,J yS ft. Depth to limiting factor>Z.2~1 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
a 0
/
7
Al "'X
Q y
_'2 Ai Z 7
4
/A I -ell / /9
* Efflu t #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L uent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name ase P ' Signature CST Number
Address Date Evaluation Con ucted Telephone Number
L -;7,917
SBD-8330 (RI 1/11)
Property Owner Parcel ID # Page '-;L' of - -51
1-51 Boring # ❑ Boring
® Pit Ground surface elev. 2411-1-5- ft. Depth to limiting factor>Z,,?Z in. Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
4
?Z2 / g &
V-2-17 / 4 Q
g 9
'vs s d t- -
(t~ f kte
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
Boring
F-1 Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit =Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
SBD-5330 (Rl 1/1 1)
Property Owner Parcel ID # Page
`
Boring # Boring of
-75 ® Pit Ground surface elev. , ~ Zs ft. Depth to limiting factor>Z2&/ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft
z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 fF#2
al') -12 ' , F 4
1-2-17 s Q 9
_ 9 9
d
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * fF#2
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
SBD-8330 (R11/11)
i
I_ -
:
t ,
Q
I I
II
I
i
I I
I-
I
i I
I
I
I
f
r-
- T -
I ;
I j I ; I
I
I t
,
I I
I I I
i
I
j _
I I
,
i
Safety and Buildings Division County
201 w. Washington Ave.. P.O. Box 7162
Madison. WI 53707 - 7162 Site Address
`
mefce 3 l
tary Permit Application Suuuitary Permit Number
to 83.21. Wis. Adm. Code. personal information you provide ❑ Checker;
d for socondary-purposes Privacy Law, s15. t m
- Please Print All Information State Plan I.D. Number
Property is Name R 4- IV L- parcel Number
Property Owner's Hollins Addes NUL - O
OPeni' Location S.0
ii'( u S T? N R
-,E 15PA (Sty. State Zip Cade iC.:.
Lot Number Block N er
Su 'vision Name CSM Number
Jz =2 2% ZI
IL Type of Building (check all that apply) -
Al or 2 F,* Dwelling - Number of Bedrooms ~
OViUage
❑ PublidCommercial - Describe Use r-1-
❑ State Owned
Nearest Rom
IQ. Type of Permit: (Check only one box online A (numbering scheme for Internal use). Complete B it applicable)
A. 1 ew 2 0 ReplacementSystem 130Replacementof Fa' ~y tae
ti ❑ Addition m
Tads
B. g Check if Sanitary permit previously Issued Permit Number Date Issued
18' '2a+o Z
IV. Type of Permit: (Check all that apply)(numberiog scheme is for nternal use)
AL A- ,,IpO I
"too -Pressurized In-Ground 210 Maned 47 0 Sand Filter 50 0 Constructed wedaW
22 Pressurized In-Ground 410 Holding Tank 48 ❑ Single Pan 510 Drip Line
45 0 At-Grade 46 0 Aerobic Treatment Unit 49 ❑ Ro*cwacmg 30 ❑
V. taremt Area Intimation:
Design Flow (Spd) Dispersal Area Dispersal Area Soil Application percolation Rate ^
System Elevation Find Grade
Required Proposed Rao:(Gals./Days1Sq.FL) (Min.Rnch) Elevation
VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanta Concrete Conshucoed Gass
New E3dg
Tanis Tanis
Septic of Holding Tank
Dosing Chamber
VII. ility Statement- I, the undersigned, spumie
ility for installation of the POWTS shown on the attached plans.
w Plumbe S' Mp/1"PR8 Number Business Phone Number
I• _
77/ -5 78
Plumbers (Street. City. .zip Code `~s /
VIII. Coon /De eat use O
KApprored O Disapproved Ste
Surcharg ' Pert Pee Fee (dudes Groundwater Date Issued ltsu~g Agent Signature (No Sumps)
O Owner Given htidai Adverse • OD `
Determination f -P 45-0 EK. Conditions of Apps for Disapproval
C*-- DAA)~Sti-cP
$ t- w:11.,ut. C0.~ L. 4 a tc3a)
+Lt
F, 0
A#wb eampteee tins *a ere CAumq a*) for the gsim an paper ate tee tlrn 8W :11 taclms Is $be
SBD-6398 (R. 05101)
wumnsint~a a~,~ssnnttotindustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
labor aixf Htmt6rfRelations
Or-jision6l Safety A euildkVs in accord with ILHR 83.05. Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St • Cr0]X
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or FPARCEL I.D. tt
dimensioned, north arrow, and location and distance to nearest road. -1050-10-000
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ED BY DATE
P ROPERTY OWNER: PROPERTY LOCATION
.J. H. Dielentheis GovT. LOT NW 114 SE 114,517 T 31 NR 19 )(Fjor) w
PROPERTY OWNERS MAILING ADDRESS LOT S BLOCK i SU80. NAME ~q V-M i
15.05 Ni First St. zip ~g~~ 250c na Vol. 399-pg. 385 doc.#274461
Stillwater, lT. 55082 CODE P~~It°~7I 4 9-4814 O~TM omer N NRRice ROAD
Rd.
[4 New Construction Use [x) Residential / Number of bedrooms 3 I 1 Addition to existing building
j) Replacement Public or commercial describe
Code derived daily flow 450 , gpd Recommended design loading rate • _7 bed. 9pdAt2 -8 french, gpdM'
Absorption area required 643 bed, Ill 563 trench, ft2 Maximum design loading rate 17 bed, gpd/ft2 .8 trench, Wdlit2
Rooonylended infiltration surface elevation(s) area A--96. 20/&eV. 00 N (as referred b she plan benchmark)
Additional design / site considerations na
Parent material stream terrace Flood plain elevation, if applicable na It
$ - sult" gys CONVENTtONAI MOUND IN t,ROt1ND PRE55URE AT -GRADE SYSTEM IN FL L HOLDING- TANK
for tem
e for tem ®S D U ®S ❑ U as o u S O U [3S oU O S GFU
U- Unsuitabl
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Cors6lence Bout ely GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.. Roots Bed Tienrh
1 -34 1 r2/2 none el r mvfr Cs 2m .5 .6
El 2 4-90 Syr4/4 none co s Osg ml na na .7 .8
Ground
ev.
.7 ft.
Depth to
limiting
(actor
+9011
Remarks:
Boring # 1 35 10yr2/2 mane sl Zmgr utvfr cs 2m .5 .6
2 2 r5-90 5yr4/4 none co s Osg ml na na .7 .8
Ground ;
elev.
99.7 ft.
i
Depth to
limiting
Remarks:
CST Namee-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th. AVb- New Ric on WI 54017
Signature: Date: 8.-17_99 CST Number m02298 jZZ=;t 5~r'- A3=~-
Boring # Horizon Depth Dominant Color Mottles Structure jConsiencejj GPD/ft
in. Munsell pu, Texture
Cam. Color Gr. Sz. Sh. Bar~ Roots Bed Tiprx~
1 yr 2 none s r
. 3 my r cs
2 0-90 5yr4/4 none
co s Osg ml na na .7 .8
Ground
Do* + to
Win
aj facb
r
+9011
r
Remarks:
Boring # 1 21 10yr2/2 none sl
s; Zmgr mvfr cs 2m .5 .6
4 2 al-go 5yr4/4 none co s Osg ml na na .7 i .8
Ground
elev.
101.0 ft.
Depth to
k*ng _
factor
I.+90"
Remarks:
Boring # 1 7 1 _
Oyr2/2 none sl 2mgr mvfr cs 2f .5 .b
2 -41 5yr4/4 none scl 2mgr mvfr gw 2f .4 .5
3 1-90 5yr4/4 none co s Osg
Gm ml na na . .7 .8
aavund
10?. 2
X10
factor
+90,
Remarks:
Boring #
13
Ground
eev.
tt
Depth to
limftiog
factor
1 STEEL' S 'SOIL SERVICE
Gary L Steel J.H. Dielentheis 1554 200th Ave.
CSTM2298 NWkSEA S17-T31N-R19w New Richmond, WI 54017
MPRSW-3254 town of Somerset (715) 246-6200
lot #25OC-csm
N i Et
EM nail in Elm tree @ el. 100.00'
O
Alt. EM.= nail in Oak tree @ el. 100.30'
i
~ v
W o
L. Steel
8-17-99
'W Frans
safety and Buildings Division Cry
NVISConsin zol w. Washington Ave.. P.O. Box 7162
Madison. wI 53707 - 7162 sae Aamess '
Department of Commerce
Sanitary Permit Application Sanilary permit N '+Z0 S-ZI
In aecotd with Comm $3.21. Wis. Adm. Code. personal imbrantion you provide ❑ C1xek Revision
uuw be used for secondary purposes P*iacy Law s15. 1 m
L Application Information - Pkase Print Ali Information State plan I.D. Number
Ptopmty 's Name R L Parcel Number
Property Ownces Mailing Address 0 C ► Property London J
if• S T-? N R it
city, State Zip Code C Lot Number Block N
Zp
a Name CSM Number
DL Type of Building (check all that apply) ocky
or 2 Family Dwelling - Number of Bedrooms
OVMMP-
O Public/Commercial - Describe Use OT
O State Owned Nearest
13L Type of Permit: (Check only one boa online A (mmsbubg schatne for internal use). Complete Hue B V applicable)
A. 1 ew 2 O Repiaameot System 3 O Replacement of 6 O Addition to For County M
Tank
B. 19 Check if sanitary Permit Pnvioasly Issued Permit Number Date Issued, (g. ~ Z
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ~...IW
44u -pressurized In► Gwwd 210 Mound 47 O Sand Filter 50 O Constructed Wetland
22 (LJ PrPressurized in-Ground 410 Holding Hunk 48 0 Single Pass 510 Drip Line
45 0 At-Grade 46 0 Aerobir Treatment Unit 49 ❑ Recirculaft 300
V. Area Information;
Design Flow (R4 Dispersal Area Dispersal Area Soil Appiiaoon Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals./DaysISq.FL) (MbLAwN Ek"doa
7 l®1.2
-'Ulex- w 2 VL Tank Info Capacity to Total Number Man u6cwter Prefab Site Steel Fiber Plastic
Gallons Gallons of Tub Concrete Constructed Glans
New B, Wft
Mugu Taolm S P& or Holding Tact zaa -z
Dosing Chamber
oil Ststemmt- 16 the undersigned, tespotsibititj for 1oda0ation of Ore POWTS shown on the attatdaed plans.
VIL
A S W MFRS Number Business Pho s Number
AdcW= (Street. City, Stem. Zip Code
Plumbers
1417-
el' J-
VDL me use Only
Agent Stsnamre (No Stamps)
Usaigg
YApproved 0 Disapproved Sanitary Permit Fee (iochdw Groundwater Date Issued
Fee) "'cI7
O Owner Gim Iaitiat Adverse . dD -2jZ
Determination I 17C. Conditions of Approval/Reasons for Disapproval
`ms s - b~ Std iP
,,ems ll .;i.,..e._&) fe Qua S t oD a~ ~ 4,jfAA.4"J
Attach esmplaaa Herrera So tier C mmq nab) for do sysaw an paper ant lean tt oo Sher a It trio in aloe
SBD-6398 (R. 05101)
r
3
ti
_ Ally
f ,
'POW-TS OWNER'S MANUAL 8t MANAGEMENT PLAN Page l_ of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner J, 77- Septic Tank Capacity Pal ❑ NA
Permit # _ va Au : 110 L( a Septic Tank Manufacturer 14 ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms O NA. Effluent Filter Model _ ❑ NA
Number of Commercial Units ® NA Pump Tank Capacity gal IZ NA
Estimated flow (average) gal/day Pump Tank Manufacturer ZNA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer 0 NA
Soil Application Rate gal/day/W Pump Model d NA
Influent/Effluent Quality Monthly average* Pretreatment Unit -0 NA
Fats, Oil at Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) x220 mg/L ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average** Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) 530 mg/L ,0 In-ground (gravity) ❑ In-ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ❑ Mound
Fecal Collform (geometric mean) 5104 cfu/100m1 ❑ Drip-line ❑ Other:
Maximum Effluent Particle Size inch diameter
* Values typical for domestic (non-commercial) wastewater and septic
tank effluent.
* * Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every ❑ months 0 year(s) (Maximum 3 yrs. )
Pump out contents of tank(s) When combined sludge and scum equals one-third (4) of tank volume
Inspect dispersal cell(s) At least once every -5p ❑ months 5tyear(s) (Maximum 3 yrs. )
Clean effluent filter At least once every ❑ months ayear(s)
Inspect pump, pump controls ex.alarm At least once every ❑ months ❑ year(s) O NA
Flush laterals and pressure test At least once every ❑ months ❑ year(s) JZNA
Other: At least once every ❑ months ❑ year(s) NA
Other: At least once every ❑ months ❑ year(s) 19 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Maste
Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections
must include a visual Inspection of the tank(s) to Identify any missing or broken hardware, Iden_ tify any cracks or leaks, measure the
volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal
cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on
the ground surface. The ponding of effluent on the ground surface may indicate a falling condition and requires the Immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (A) 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 ch. NR 113, Wisconsin
Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other
maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical:
that may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a sentage servWng o;^~ :.tor prior to use,
' i
System start up shall not occur when soil condlUuns art (roan at the Inflitratlvt surface. Pill '2 of,-?
During power outages pump tanks may fill above normal hlghwater levels. When power Is r+ u nd the excess wastewater will 0%
discharged to the dispersal cell(s) In one large dose, overioading the cell(s) and may result In the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump unit removed by a Septagt Servktng Operator prior to restorirt
power to the effluent pump or contact a Plumber or POWTS Malnulner to assist in manually operating the pump control, to
restore ncrTnal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise d4wrt) or compact, the ere,
within I S feet down slope or any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater wtarn may Improve the performance and prolong the life of the
POWTS: anUblotlcs; baby wlpes; cigarette butu; condoms; cotum swabs; degreasers; dental floss; diapers; dlsinftctants; (at;
foundation draln (sump pump) water; fruit and vegetable peelings; rasoAne; grease; herbicides; meat straps; medicativns; oil,
palntlnst croducts: westiddes: sanitary naokins: urnoonsi and water softener brine.
AAANDONEMENT
When the POWT5 fails and/or is ptmsanently taken out of service the followlnE steps shall be taken to Insure that the system is
properly and safely abandoned In compliance with ch. Comm 83.33, WlscorWn Adminsatradve Coder
• All piping to tanks and pits shall be disconnected and the abandoned pipe opening= sealed.
• The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator.
• Ahe, lumping, all t.snb and pits shall be excavated and removed or ttstlr covers removed and the void space filled w;lr
soil, gravel of another Inert solid nsaterlal.
CONTINGENCY PLAN
If the POWTS (ails anti cannot be repaired the following measures have been, or must be liken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption
system. The replacement area should be protected from disturbance and compaction and should not be In(rtnerd upon:
required setbacks from existing and proposed swcwre, lot Ilm and wells. Failure to protect the replacement area will
result In the need for a new soil and site evaluation to establish a sultable replacement area. Replacement systems rnu,t
comply with the rules in effect at that time.
O A sultable replacement area b not available due to setback and/or soli limitatlons. Barring advances In POWTS technvloe/
a holding tank may be Installed as a last resort to replace the failed POWTS.
0 The site has not been evaluated to Identify a sultabte replxement area. Upon failure of the POW'TS a soil and site
evaluation must be performed to locate a suitable replacement arts. If no replacement area Is available a holding tank m.;
be Installed as a last resort to replace the failed POWTS.
0 Mound and at-grade soli absorption systems may be reconstructed In place following removal of the biomat at the
Inflluative surface. Reconsvvctlorts of such systems rrwst comply with the rules In effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RLSULI', RESCUE OF A PERSON FROM TWI INTERIOR Of A TANK MAY IIE DIFFICULT OR
ImpnWRI F
ADDITIONAL COMMENTS
POWTS INSTAL POWTS MAINTAINER
Name Name
Phone - Phon=e
SEPTAGE 5ERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name R nicy
1___Phnnr one
Parcel 032-1048-40-000 11/08/2005 09:37 AM
PAGE 1 OF 1
Alt. Parcel 17.31.19.242B 032 - TOWN OF SOMERSET
Current ! X j 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
JUDITH A TRUC 0 - TRUC, JUDITH A
15136 BOULDER POINTE
EDEN PRAIRIE MN 55347
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description *351 R LAKE RD
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
0~
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 17 T31 N R1 9W 3A PT SW NE & NW SE Block/Condo Bldg:
FROM NW COR GO S 710.5' TO S LN, TN RD,
S 68 DEG E ALG RD 208', S 342', S 41 DEG Tract(s): (Sec-Twn-Rng 40 114 160 1/4)
E 103.7' TO POB S 41 DEG E 600', S 50 17-31 N-1 9W
DEG W 194.7 FT CONT ON SAME COURSE 75'
TO RIVER, NWLY ALG SHORE 600' TO PT S 50
mon...
Notes: Parcel History:
Date Doc # Vol/page Type
08/09/2004 771124 2634/354 CO
05/13/2002 678851 18891357 WD
2005 SUMMARY Bill M Fair Market Value: Assess
0
Valuations: Last Changed: 07/2312003
Description Class Acres Lan Improve Total State Reason
RESIDENTIAL G1 3.000 150, 0 150,000 NO
Totals for 2005:
General Property 3.000 150,0 0 150,000
Woodland 0.000 0
Totals for 2004:
General Property 3.000 150,000 0 150,000
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
Parcel 032-1050-10-000 11/08/2005 09:58 AM
PAGE 1 OF 2
Alt. Parcel 17.31.19.250C 032 - TOWN OF SOMERSET
Current i.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
JUDITH A TRUC O - TRUC, JUDITH A
15136 BOULDER POINTE
EDEN PRAIRIE MN 55347
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 17 T31N R1 9W 3A PT SW NE & NW SE Block/Condo Bldg:
FROM NW COR GO S 710.5' TO S LN TN RD, S
68 DEG E ALG RD 208', S 342'S 41 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
103.7' TO POB,S 41 DEG E 600' S 50 DEG W 17-31N-19W
194.7' CONT ON SAME COURSE 75' TO RIVER,
NWLY ALG SHORE 600' TO PT S 50 DEG W PF
MOM-
Notes: Parcel History:
Date Doc # Vol/Page Type
08/09/2004 771124 2634/354 CO
05/13/2002 678851 1889/357 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed:
Description Class Acres Land Improve Total State Reason
Totals for 2005:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Char68ges
Total 0.00 0.00 00
69 zs9; 774. C, 1
1 Z ,909c
~t
t~ I
Y
s
N
t,
cr)
N
o
-Q
W N
r ;
O r
i
r
i J
y~v I
FJ
N O
LO
C N N
N
N i m
IRT N N e-
Q
N
N
r
V- Z - CL $
N
WOSb3
r
i
x
n
s
air
i~
.y
j~
f
wiscdi4inuopK"ntof Indus". SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Hum&n Relations
Division of Safety & Willi gs in accord with ILHR 83.05, Wis. Adm. Code [PARCEL U .-Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include,
but St . Croix
no! limited to vertical and horizontal reference point (BM), direction and % of Mope, scale or I.D.
mensioned, north arrow, and location and distance to nearest road. 032-1050-10-000
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
J. H. Dielentheis GOVT. LOT NW 114 SE 114,S17 T 31 ,N,R 19 NVx or) W
PR1505 O. Firs AI St. ADDRESS t ~8~~ 250c naa 1l SUBDvolME US pg. 385 doc. #274481
CI Stillwater , I+M+I. 55082 CODE P€i 1439-4814Y OWN NRSTAD Rd.
( 21 New Construction Use (x] Residential / Number of bedrooms 3 Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily now 450 gpd Recommended design loading rate .7 bed, gp(W - 8 trench, gpolft2
Absorption area required 643 bed, ft? 583 trench, tit Maximtutt design loading rate • 7 bed, gpolft2 -8 trench, gpde
Recommended infiltration surface elevation(s) area A--96.20/B-97.00 ft (as referred to site pan benctanark)
Additional design I site considerations na
Parent material stream terrace Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL MOt1ND "GI ID PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
❑ u ®S O U CS ❑ U (3S ❑ U ❑ S ER
U = Unsuitable for stem ®S U ENS
SOIL DESCRIPTION REPORT
GPDift
Depth Dominant Color k4olles Texture Structure Roots
Baring # Horizon in fdlunsell Qu. Sz. Cont. Coker Gr. Sz. Sh. Bed 'Tre &
Fr;u ` sl 2mgr mvtr cs 2m .5 s .6
1 -34 1 r2/2 none
1
2 4-90 5yr4/4 none cos Osg Ml na .7 .8
Ground
9~~'7 ft.
Depth to
limiting
factor
+9011
{
Remarks:
Boring # 1 ~-35 10yr2/2 none sl 2mgr mvfr cs 2m 5 .6
s:> 2 2 5-9Q 5yr4/4 none co s Osg ml na na .7 .8
~:«dCsi~~xc.<•Ground
elev.
99.7 ft.
Depth to
limiting
+90'{
Remarks:
CST Nanic. -Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th. v . New Ric n W154017
Signature: Date: 8-17-99 CST Number: m02298
e
Boring # Horizpth Dominant Color Mottles
T
Texture Structure GPD/ft
n. M
unsetl
Qu. ft,
1 - r2 2 Sz Cons Color Gr. Sz. Sh. Roots tied Tn~nch
Y f none
sl my r cs
3
2 0-90 5yr4/4 none
CO s Osg ml na na .7
Ground
A'a
Depth to
limiting
factor
+90„
Remarks:
Boring #
<.k»t€ 1 21 10yr2/2 none sl 2mgr mvfr cs 2m .5 .6
sr
2 1-90
5yr4/4 none
hTGyt~m\ i?N CO s
Qsg ml na na .7 .8
Ground
elev.
101.0 ft.
Depth to
limiting
factor -
+901,
Remarks:
- ping # 1 -7 -
1QYr2/2 none sl 2mgr mvfr cs 2f .5 .6
2 j
--41 5yr4/4 none scl 2mgr mvfr
<,x 9w 2f .4
.5
Ground 3 1-90 5yr4/4 none co s Osg all na na .7
ev
1 .2 ft.
Depth to
limiting
factor
+90`
Remarks:
Boring #
Wt R~~
j `
Ground
elev.
ft.
Depth to
limiting
factor
I
u
STEEL'S SOIL, SERVICE
J.H. Dielentheis 1554 200th Ave
NW4SE4 S17-T31N-R19w New Richmond, WI 5401
~~54 town of Somerset (715) 246-620C
lot #250C-csm
N
1"=40'
BM.= nail in Elm tree el. 100.00'
Alt. BM.= nail in Oak tree el. 100.30' S`} ti
~I
AID
a T steel',,,,
8-i7:-9
9 ~ l
-
J
C!) COOD Go
m ' Q co DO 00
j
x
C002
C/ m
n
CID
m fi
m:
71 s ~ry
too
T S W
C O --i r
w
p 0
0 r-
rn > c)
--q
f'T'1
0 o + Q
C ~ Z E
M C)
Cl) -n
p C/) 0 Q
7, m 11
2 7
L
~ O a
v ~o ;p A~ w` y'AD -l m
_ ` 'an3 p
CID
rn ~'a N H6 f m sC r Ut
< 73
-ID Z;
rn c m o ~ 7 (7
1;~= < nF _ ~
f' a y ZOO
T
r, cr - -
D n"o u -j D
G
O < n O ! R
F p 0:3 u bao 3~ C lwy
z K 4 y 7 7 L :J l/1 r
m j = 3 ` ° ' o -Ph,
yid ..S.C -a J7. 7:?*
,~:.,y~r ~i~.J:r✓ Nom, ~ , `.J L~yhr( ~~.rr .F.~/l'G?. ~ .
w •Sm, ~ Joss+~ ~ f
3X 93 rs
i.
i
7 ~y
:!op"
t ys•- 3s~
T.~'Er~as.~'n
,o; ~s;k o gar