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HomeMy WebLinkAbout032-2144-70-000 County 2 RECEIVED Safety and Buildings Division T t% p 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) I,t SF K DEC ~~yy1 /4 2015] Madison, 3707-7162 7 ~Oqp 1~" ST. C14®1/~ CVV f/~~ g' 'r+W WN~~'~ WMA MCA 0, ariltaTy ermit Applicatio tf Transactl°n~N/"n'ber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the ~ggove unit (10 ` O 7 Hs r is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing addre)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. 14- L Application Information - Please Print All Information Property Owner's Name Parcel # j,&6J? + 5 i~32c & - any - -77 -0() C) Property Own 's ailing Address I Property Location 9 -7 v JAM(t t J V C:, woti/, City, State Zip Cde Phone Number •66- y, Section 7 y~ C (,~kG V~ circle one) r1 T:30 N; R0Eo(ID Type of Building (check all that apply) Lot # Subdivision Name i i 2 Family Dwelling - Number of Bedroo s 1or k N CS ~s . El Public/Commercial - Describe Use 6 G d J . retv ❑ City of CSM ❑ El State Owned -Describe Use P60^_ Number Village of 114*144-16- own of I III. Type of Permit: (Check only nebox on line A. Complete line B if applicable) 2 e% ej- A* XVew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 13. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) XNon-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) /ElIfVtreatment Device (explain) V. Dis ersal/Treat ent Area Information: C ( Wl /C f Design Flow (gpd) Design Soil A pli cation R gpds fl Dispersal Area Required (s ispersal Area Propos (sf~ System Elevation ~00 a S ~ 8S7 ~V ZS C195 ` 7.75 VL Tank Info Capacity in Total # of u er Gallons Gallons Units t/~ New Tanks Existing Tanks ° o 14)h IafL 5 ZS O a U ~n 2 cn w 3 Ci. Septic or Holding Tank 5 Dosing Chamber J VII. Responsibility Statement- I, the undersigned, assume responsibility for inst elation of the POWTS shown the attached plans. Plumber's Name (Print) PI n ~ MP ber Business Phone Number ~a ~ ~ 3 YZ 15 `l 6/ Plumber's Address (Street, City, State, Zip Code) VIII. Coun epartment Use Only atur proved ppro Per/m~itt7Fee Date Issued / IssuAgent Sign en Reason for ial $ r f ~.0b_] 2 ` IX. Conde easons for Disapproval r ~b 4-6 d 7 ank elfitlehtfiWsnd 3, 5~6~et • 2~~f1~+~~o~ K ;ieraai cefi,mustall: as per mer►agsmsnt plan provided by p1utE 4 0.7 ~✓~L~ q . 2. Ats#b ck farqWWAllf" , I;* MOO* J as R«'appMaabls cods l ofdfrnos , i Attach to complete plans for the system and submit to the County only on paper not less than 8 1/1 z 11 inches in size SBD-6398 (R. 11/11) 71 -OWL, L r st"Y~C-P-s t ~ l Z )A :rl 3t~eZ 1 f A`►`7C.` 11 f 1~"c j 1, c E~~ f 2QX,HA"IlAAL ~ CL- `l ,-7 7 , I 61 t, Jy I V e-- FI I? )btL. a za~ ~~1=ice=- I Y CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Law S(EfZR652±Jt Owner's Name: ' Owner's Address: q~g ` JAM gzl- i5~ c) 16 Legal Description: IA/ Township: ~(ViCP_-, " T County: Subdivision Name: NJM(OIU AC ~CSTA_16> )`J Lot Number: '7 Parcel ID Number: 2- 2)'Y'-/ --70 -00() Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: EL F License Number. fy\~Z 223Z `t2 Date: 12 5 Phone Number 76 q%, 3q.6-(g Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 s-E'C 7 -sn W icr VJ F+~KKI Ov LAWLICt2 LCTT -7 NMW)1\)fW f-s IAA ES KI, 151 ~ i~U1-1 ='rz 0LTT' LI,I -~.vJ~1 f?F ~(>~-~1f lZ`~~T Ivti ~s z2-,3Z4 Z d''~ 1•~YISC' a ~ Ql~~l ;~M Z El'Citl~1i~C # EL l c`?I 7 I #11L tl ~/~1 ~I fVLI C Il~f 1, Rf70CkMAidL"2 CL- c79,7 c~t,1 7' thttlAfvt r t'( a SOIL Fze w ZiS ~{C~-rri 5-r WMAI=gm ~ ~j.5 a , ec~. -z s chmOur S- q-7, 75 3 n IBM le OL Tmmh Vsd arp" Tiot I3 s And Model 1 M VI( L;~ 2~lC ►C 11Z chmem ~ oe@w forsA0100on ROs 4- ? EI A+~___ 8 nos d ~ ours a~oh. Y I R INSTALLATION PL-525/PL-625 FILTER `L-52WPL-W 1=FA'1'UMS & IBENERT'S - Features a Rated for 10,000 GPD PL-525 = W5 Linear Feet of 111W F bBfm - - PL-625 = 625 Linear Feet of 1W Filtration PLA25 PL-M5 *Atxepts 47 and 6- SOM. 40 Pipe he PL-625 25 went FAH ' sl'xid operate elkaeritty 0 Built in Gas Deflector :)r several years under normal conditions before aAutomatic Shut-0ff Bag when FMer is Removed Nuiing cll. tt is recommended that the fifer be [eaned every gme the fiw* is pumped or at lit every e Alarm AccessibNiijt Tree years. if the installed filter contains an optional eiarm, the owner will to notified by an alarm when the eACCOM FVG Extension Hardie lwr needs servicing. Servicing should be done by a ertifed septic tank pumper or installer. OF, RECOMMENDED PRODUCTS Mg= Y--• - xp die wR:ff Ye-.. 9, U-41 Risers covem End & t.,tI Parml and Poiyic~c~sbd19 ~ct. c Y swuch Is a sk101e, SW to use pwoenttragic amkWft sapfic ' awin tom wW sakAon Ind can exbwW ton hqpnft by duldw 5 vlds servxkv Yom mar easier ~ Net or oudet i and MW Pab fang bib open w*Q by e&W- make aer arm beft aa9 i and tardc b ftrx! UK* s Rts ~ and C pipe. F;Qra full f of P M& products pi `vidtour web site at r41*Wk C6M POWTS OWNER'S MANUAL AND MANAGE YIENT PLAN FILE INF, 0RMATION SYSTEM SPECIFICATIONS Owner WLEO Septic Tank Z50 gal p NA Permit # Septic Tank Manufacturer WIC ,495 O NA DESIGN PARAMZTERS Effluent Filter Manufacturer L - Fff 11 -1. -6 ❑ NA Number of Bedrooms l00 at p NA Effluent Filter Model p NA Pump Capacity gal !Z Tank NA Number of Commercial Units NA Pump Tank Maaufactiiter NA Estimated flow (average)* ~ ] jdg Design flow (peak), estimated x 1.5* gaYday Pump Manufacturer A Model NA Soil Application Rate , Uda Pretreatownt Unit NA Influent/Effluent Quality (NA❑) Monthly Average** p Sand/Gravel Filter ❑ Peat Furies Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) < 220 mg/L ❑ Disinfection ❑ Other_ Total Suspended Solids (TSS) Manufacturer Model: mg1L 250 Pretreated Effluent Quality p Monthly Averages** Dispersal Cell(s) Ommniwd) Biochemical Oxygen Demand (BODS) 5 30 ~L pan-ground (gravity) 0 M kVujnd ound Total Suspended Solids (TSS) < 30 mg/l, ❑ Drip-line ❑ Oth er: Fecal Coliform (geometnc mean) <l0 cfu/104m1 p Leaching Chamber Mamibcbm -'M Maximum Effluent Particle Size 1/8 inch diameter Model aIQ K y Laying Leng&Chwnb-7 14 *Wastewater Flow Verification and Calculations: Soil Application Rate .7Md/fle Area Req. (Other than bedroom based) Infiltrative SurfacelChamber ESIA Rating ZQ fe Minimum Number of Chambers Design Q Aggregate Flowamading Rates min Values typical for domestic (non-commercial wastewater Materials: all materials must comply with W1 Adm. Code and septic tank effluent. COMM84 and be installed per manuftwavers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At-grade Soil Absorption System, Siting, Design & Constriction Manual" (Converse etal.1990) E3 "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Mannar" Converse, J.C. and E.J. Tyler. Publication 15.22 p "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 E3 "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and ` Pesign Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 E3 SBD -10570-P (R.6J99) "At Grade Component Manual Using Pressure Distnbution" $ SBD -10567-P (R-6/99) "In Ground Absorption Component Manual" p SBD - 10705-P (N.01101) "1n Ground Soil Absorption Component Manual" Version 2.0 p SBD -10628-P (N.6199) "Recirculating Sand Filter System Component Mannar' ❑ SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" D SBD -10572 P (8.6/99) "Mound Component Mannar' ❑ SBD -10691--P (N.01101) "Mound Component Manual" Version 2.0 p SBD - 10595-P (-6/99) "Single Pass Sand Filter Component Mannar p SBD -10657 P (8.6/99) "Drip-lime Effluent Disposal Component Manual" p SBD -10573-P (R 6/99) "Pressure Distribution Component Manual- 0 SBD -107064 (N.01(01) `T'ressure Distribution Cbmponent Manual" Version 2.0 p Drip-line Effluent Dispersal Component Manual for Multi flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Anency Ms 01:~ (Maximum, yrs.) p months s 3 pqq condition of s At least once every LNMout contents of taws) When combined sludge and scum uals one-third 1/3 of tank volume Inspect dispersal s At least once every Q months s 3 Clean effluent fiber At least once every Q months s hM pump, pump ct controls & alarm At least once every s NA Flush laterals and pressure test At least once every ❑ months p s ❑ NA . ♦ . _ _ At 1Psct nnrP Pvr±rv r i montbs 0 year(s) p NA System _rt up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and ails, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ valves Valves shall be operated in the following manner: 0 Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a l day reserve under regular operating conditions, however water should be conserved until any problems with the systern are corrected to prevent back-up of sewage into the dwelling or surfacing. INPECTIOPiS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Phunber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Q Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or pending of effluent to the ground surface. Access openings used for service or assessment shall be sealed anifor locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be seemed with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (113) or more of the tank vohurne, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. C3 Pump ChamberlTreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the cx»idilion of any Mt=. Any service needs or repairs shall be promptly taken care of. ❑ Ire Grounnd Gravity Component Dispersal Cells The inspection shall include recording the levels of pending, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic farlure necessitating more frequent monitoring. Pstge d+t ❑ Mound, At-Grade, In-Ground Pressure Tire inspection shall include recording dw levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75°x5 of the height of the component may indicate overloading or impending hydraulic faihue necessitating more frequent monitoring. Tile pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submittal in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin A&ninistrative 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 other 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 ration of a replacement soil absorption system The replacement area should be protected from disturbance and compaction and should not be infiuged upon by required setbacks from existing and proposed sttuct re, lot lines and wells. Failure to protect the replacement area will result in the wed for a new soil 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 tmbnology 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 coniply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 WTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name --7L-:Ff" W-_ I Name -1 J:S - 1191 Phone -31M Phone SEPTAGE SERVICING OPERATOR J?umpw LOCAL REGULATORY AUTHORITY Name Agency , Phone Phone (o Dec, 0, 2015_12,56PM, No, 1141 P. 6 NE 1, t "I t c ~ 4 X873 t t 33' 1 :fill l^ 17 c7 R ow TES LEGEND MACTOR RF.WMtl "W NATIONAL ESTATES NORTH SAINT CROIX LOCATED IN THE NE I/4 OF THESE 1,14, THE SE 1(4 OF SE 1/4 OF SECTION 7, TOWNSHIP 30 NORTH, PINGE 19 M, TOWN OF SOMERSET, ST. CROIX COUNTY WISCONSiB w .u Ce, T~ LEGEND _ 31C nu tr t~ 't 4e. w. 2' % 10' WCN oP, 17.65 IgSibv. F7), SET UNITY M 3 eno4 ~a Ea rna o A - - R AJ'YAY SMSCK l;NE A"'ra:a m I i Z I I];1 d' 0'I (F'l 'TC..S ~ Gtl Math A. CM~7 I a n.l sate ,a,nt~ x~d I I, u4'!Y EtSE~c61 Godhale Sptun ~ I :n is aec e IONS / - _ - - - mrnar s e f 9A GCkmrx15 ~'1 t tREa GRAPHIC SCALE ~I - 1 i(C M6 KC D ,.n o' Merset icr e"e .ra t -e . al D.tlR O cFIER c I , Q4 ~RN97p<IL69tE5/I.X S- _ i.. of K6WiN H;' q 1FFWSPCRiA7;p, acM0 t1 i OaWNT ttjVt [R SS-15 3 6 .uG i s , ~ app 5~, i T~ r 4 i F ~T,y_,~r 3 a~ D w70~H~0~ H75i9,z `1P 7 EC L `,:I 26,,3 3, w - X514'.. i 8 6 g""5 779, E m O I 3~I ICI I 11 ;4 SS'h S, I im , I N.ro wd H24 a i ~ 7-1 SQ I ~ I °~g ~po wb 59a wn ~ ca k~aw eu~ II G3k 7,00 Afrn sss A- B2 s;4; 64 Oi I C4~ 169 1~ro (BA. 5.W ~w i 9„ F >r I l I \ o'sY s4 't N~ V17 1, F1 F. _ o,. 9,A 5W lao ~ ~ ~I ~ = I j _ - - - _ ,1r- - - - NLh~4701'~ Ih'- - - ui9' I 49'.66 u6 ~ ti 75~ Tn , a - 466ar %N N 0McATM TO W V i' 1•j((d'.~ - - 7.552....... I S00'42 s 6,15 ~ N ~ N _.r ' - _ _ -T T 1 nud 1"~ . « , iq 261321' ! me h. Fa E fiZO. I ,>la o_`~gr ' fi.U _ d z. .wai ` Tt2'00`e a 6 ty,Oni ax a h SD7440CY - - j I ~lF=+ i ~ ,+J~ 1lELCHERI ~91i6(Y ~za s a s<«v lcds apt ArUtclm HIsdm 1u rIn SIOtB el'I eg,neenng ph., ('+t5; 796-Y7d9 and serve ug°' nal ~6_ree9 SHEET 2 OF 2 Kati Q~dl>b ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM' OwnerlBuyer Lee and Susan 5febtech'i M Address 9798 Hamlet Ave S Cottage Grave MN 55016 X1606 40th St =T~ Property Address (Verification required from Planning g Department for new constmetion.) City/State Semersett vv 1 Parcel Identification Number LEGAL DESCRIPTION Property Location< 114 , 1/4, Sec. , T N R W. Town of Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page# Warranty Deed # (before 2007)Volume , Page # Spec louse ©yes0ao Lot lines identifiable [3yes[Ino 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. Crops 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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. Uwe certify that all statements this form are true to the best of my/our knowledge. Ilwe amlare the owner(s) -of the property described above, by virtue o warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 /S4E!f7 jot / oac)t 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. 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Parcel I.D. ~1v RJ . _ 032 - 2! - 40 - Please print all information., R iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law w *4 (1) (m)). , 1 IUA tAML, Property Owner n r f Pro~e Loca'on E1/4 S 7 T3113 N R Ica E(or W Property Owner's Mailing Address f of Block # Subd. Name or CSM# s7 r x _ S'r. CVA31)4 ~tl0)uk-L N . City State Zip Code Phone, NumberCc_ur~ ~qi ❑ Village Z Town Nearest Road t tt►Jt•1 ~pIV1-c )4 MJNJ SS~u 3 (6iZ} cl N - S0 Y-1 1Z3 Er 14 O mi- Sl'- New Construction Use: ® Residential / Number of bedroom Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G l_Pr'-° _L VTE _ 1 ~L Flood Plain elevation if applicable ft. General comments and recommendations: ) M SZ`1'TtL c~Ct K 6Z- S , (_1)kl G Lji 1. ) p UN LAS Or= 6 E { c O if S O Cwl+t, L ! C tS-tL S ACS e L-z L. wt 01= Cl vl 8 CAS Tt~ t3L S 7 F Boring # ❑ Boring Pit Ground surface elev. 7 ® ft. Depth to limiting factor R in. . , Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 -.r 1D`11_VL31Z SLR Z`FSb12 n'i ~W Z'E' S_. r~. . Z 11-a) lb'm 31 b - S11 z.`Fs bk Yn fi-r cS - . s 3 -11~ -s~2~ty G~, S1 1 "_S bk Y-0 X16=~~I 1.SYfL3/ - s$6► Ds9 m I ROL - .f 9 . Boring # ❑ Boring ❑ pit • Ground surface elev. g g Z fL Depth to limiting factor ? C V& in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z 11-38 lb`l1? 31 - Si I 2'~Sbk m•f>^. ~S . S . ~3 3 3g b ~~3Li1?- 311( Gv`sl lesbk VVIjF_ 5~ 93 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD.,< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) signature CST Number Arthur L. Wegerer r49L ~O- Z3y-7- 220254 Address Wegerer Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St". River Falls, III 54022 ~ )-l-T-00 715-425-0165 . 1• 3 Parcel ID # t~ ~ G Page 4- of , Property Owner 17- ❑ Boring ❑ Boring # ® Pit Ground surface elev. t ~ 0 S • S ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPD/ft.Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. J D-~ t~~-1~31Z si 1 Z`Psbtic m`f~- c w z~ _ S. .8 Z °1 _ 3 l o R 3! b sl 1 Z`Fsb 11 M e tAJ 3 3-~9 31 &-.21 1e.Sbk m v e-S • L-L -b y qq -~3 -7,5- - S46V- 0%9 m 1 - t a,4- too • fib" S9? Boring # ❑ Boring F-L)] ® pit Ground surface elev. ~l • S ft. Depth to limiting factor '7 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 0-~Z, 1b`~1\Z.31Z - st1 ZiS\D WY-C~- CW Z`~' `s Z 12_~lI 1~yR 316 si 14 be VW-PF- cw • 5 3 i-qR '1.$`-1t2all G1^S`) \e-5~D12 %-V- Cg `j -lo y8-°►8 ~.S~tz31 - S461- O s9 vn 1 - - i. z 9`f- i' S~ q3 . ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate- Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD.8330 (R.6l00) MEN *c ,sin Department of Commerce Divisi,~n of Safety and Buildings SOIL EVALUATION REPORT • in accordance with Comm 85, Wis. Adm. Code Page of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ST. C~ Lx percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. P~h.ri] lIU G Please print all information. t ! Re ioewed b 2 / OW • 12(02 Personal information you Provide may be used for seco da y Date Property Owner rY Purposes (Privacy Law; Y! 1 4 (1) (m)). l^T r..._ J L GO l.~ °1Lr Lo'on (.a() Property Owner's Mailing Address , 1 * o S 1/4 S 7 T 3D 6,316 , of ~ Block # Subd. Name or CSM# N R 19 E (or W L .,z~+ City ST CRUX State Zip Code hbne Number(;pi1hE; ST. Cp'V`x ,Uta~lpiV/~ ( ' ID h-11►JIU~1-p)ljlz /v ft! hN SS3~ 3 (6 Z ;~liN ' p fir. ❑ Vllage Town ® Nearest Road L~ New Construction Use: ® Residential / Number of'bed< d_ _r 5 T~ ❑ Replacement - Code derived design flow rate 6 0 O El Public or commercial - Descri be: GPD Parent material G l P-4- General comments Flood Plain elevation if applicable I IvST-t L ~ ' A and recommendations: c-LtS ' ft. C L`C`-j S L C) CG~11rC1 'l L U 1J t`1'S U l- )t t'S H L . E J Boring # ❑ Boring ® Pit Ground surface elev. ~D Z. ] ft. Depth to limiting factor 2 4 q in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate in. Munsell Qu. Sz. Cont. Color GPD/ft Gr. Sz. Sh. 'Eff#1 'Eff#2 f lD`! 6Z 3! Z SL 1 to~r~ 316 - s>:1 Z`Fsbrr m~ 3 -1E6 ~-s~23ty cS - , s .43 G t, ~ I 1 ~ s'D nm ~ g . 6 ~ 46=`I 1 SYlz3/ _ S $ 6►. D S4 I. Z 97 •g.S a Boring # ❑ Boring ® Pit • Ground surface elev. g g 2 ft Depth to limiting factor ? C2 96 in Horizon Depth Dominant Color Redox Description Texture Soil Application Rate in. Munsell Structure Consistence Boundary Roots GPD/ftz Qu. Sz. Cont Color Gr. Sz. Sh. O-l I 16`12 3/z - 'Eff#1 . 'Eff#2 Z 11-38 lb`1>z 3! b - Si I 2Sb1t Yn G",si le-Sbk .wi`FJ- cQS S.~f G>^ sq I - -C/,( . 53 93 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mgjL 11 11 CST 11 Name (Please Print) - ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L Arthur L-: Wegerer si ature - Number 00- Z 3 V_7 CST 2202--54 Addres W e g er er SO 11 T e s t ]n¢ Date Evaluation Conducted s o& Design S e r v ice Telephone Number 421 if. Main St'. River Falls, WI 54022 )~Z'7 X00 715-425-0165 PLOT PLAIT Page 3 of • Scale 1'= SO' r 77 i ion 610 4f 1,0 \102-R~►rr~ Deus. z : 00 --~---11 _0 cf16If,_31) A P_VC_PIPN-_ kl/1671+..- Is - FROM S w~_ soy t ~I0 `1 ST• oAL 4*1 11-7-1-00 715-425-0165 220254 0 o-Z3y -7 CST Signature Date Telephone No. CST No. Job NO.