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008-1053-95-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 584744 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2697621 Permit Holder's Name: City Village Township Parcel Tax No: Gary & Shellie Theisen TOWN OF EAU GALLE 008-1053-95-300 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: }J~A 18.28.16.269D TANK INFORMATION ELEVATION DATA TYPE MANU ACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2 23 Ib~ 2 C. C) Dosing Alt. BM Aeration Bldg. Sewer Holding F, / St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L, WELL BLDG. Vent to Air Intake ROAD Dt Inlet i Septic f Dt Bottom i Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand StCover GPM Model Number ' I TDH Lift Friction Loss , System Head TDH Ft Forcer-l Length Dia. - Dist. to Well SOIL ABSORPTION SYSTEM i ` BED/TRENCH Width Length _ No. Of Trenches • • PIT DIMENSIONS No. Of Pis Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type, Of System: CHAMBER OR T i Model Number: , DISTRIBUTION SYSTEM Header dnifold t Distribution x Hole Size x Hole Spacing Vent to Air Intake c . • Pipe(s) Length Dia Length Dia t a Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only DepthiOver Depth Over xx Depth of xx Seeded/Sodded Mulched r Bed/Trench'Center Bed/Trench Edges Topsoil [-F] Yes E] No O Yes El No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2121 CTY hw ~ ~LUvV \I~~e t~ I VDtf I - (Dy- 1.) Alt BM Description = I'\ti)k f O (\c~ LO[~~ i n nS ~P~ 2.) Bldg sewer length = J - amount of cover = ' ? Plan revision Required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Count}' Safety and Buildings Division St Croix RECEIVED 201 W. Washington AV .0. ox 7 2 Sanitary Permit Number (to be filled in he Co.) SP Madison, WI 53 7 S MAY 0 5 2016 O !5Fq 744 F. COMMA ermlt Application StateTransaetion Number In accordance with SPS 383.21(2). Wis. A m. mission of this form to the appropriate governmental unit 2697621 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to project Address (if differ°nt than mailing addres the Department of Safety and Professional Services. Personal information you provide maybe used for secondary S purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. I. Application Inform atio lease Print All Information ame Property Owner's Name Parcel Gary & Shellie Theisen 008-1053-95-300 Property Owner's Mailing Address Property Location ! a g a~~ k~ 2121 Co. Rd. N Govt. Lot City, State Zip Code Phone Number _NE_' NW_,- , section (circle one) Baldwin, Wl 54002 (715) 410-5050 T_ 28 N; R-16- E or Nri' It. a of Building (check all that apply) Lot t Subdivision Name l l or 2 Fanuh Dwelling - Number of 11edrooms 3 PLO- i ❑ Na 4k Daiti st >ck Public Commercial -Describe Use ❑ City of v/ VI Na 'SM Number ❑ Village of State Owned- Describe Use -7:5 t2 X[ gown of -Lau Gallo a^a Vol. 13, Pg. 3733 - - - Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ Other Modification to Lxistin System (explain) X❑ New System ❑ Replacement System F1 Treatment Ilolding Tank Replacement Only g List Previous Permit Number and Date Issued B. ❑ Penuit Renewal ❑ Permit Revision ❑ Change of Plumber [I Permit Transfer to New Before Expiration Owner TV. Type ofPOWTS System/Component/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade XL I 'Mound 24 in. of suitable soil ❑ Mound ' 24 in. Of suitable soil Holding'farilc ❑ Other Dispersal Component (cxplam)_ TI'reu eatmeut Dcvroe (eaplanl) _ j V. Dis ersal/Treatm nt Area Information: Po1YLok 142 ~ cfthtent filter to be installed at ST outlet Design Plow (gpd) Design Soil Application Rate(gpds" ispersal area Required (sf) Dispersal Area Proposed (sf) Elevation 1.0 Gpd/sq. ft. ASTM-C33 sand 97.5`0' at 6" above 450 Gpd 0.4 Gpd/sq. ft. native soil 450.00 sq. ft. 450.00 Sq. Ft. .00' contour VI. Tank Info Capacity m Total of Manufacturer Gallons Gallons Units P,, Newtanla stingIanls 5 7 s w c Septic or holding Tank Na 1,000 1,000 1 Wiese oncrete X Dosing Chamber Na 650 650 1 Combination ST/PC X VII. Responsibility Statement- I, the undersi ' ed, assume respo t y r installation of the PORTS shown on the attached plans. Plumber's Name (Print) Plumber' Signat re MP,MPRS Number Business Phone Number James K. Thompson 5--- MPRS 30021 (715) 248-7767 Plumber's Address (Street. City, State Code) 340 Paulson Lake Lane, Osceola, WI 54020 VITI. C my/De artment Use Only Permit Fee Dat Iysssu lw Issuing ent Signature Approved ,r Given Reason Denial (0 IX. i2. TWA4*NfiRl/Reasons for Disapproval 1 dt~. a f~ eptic tank, effluent titer and 3 COr 1 c ~Y oA- ' +iisper si cell must all be swvitps a±ntarec: t t per as per fiaragerr►erd plan provided by plumber. t w' ~ l lbli * r ks fi 06 murttzitie+i as per appficsbla cade / ord nacres. :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 SHID-6398 (R. 11/11) S5oi/e✓a/ccG~iun~i~by°mPSin 2c/~ ~Exr:SEinS ~~4dt c /zJu~;or~ I GQt ~ 5~e//'c~crsc,~ ~a Gam./~+.v~ rv 1. Sf~2 O Lot 3 Csrv( ✓o% /.3 3733 S~.cro;y~e.C~ aIle, U PraPcsc~! n'1 aid ~E ,~o.u X 9o.po' w,z w/~'rrS'd'~l~s"/cep/Two C=) rr, CC'S a d ~ /S a^ ti - 4g . oo .a f~!'o(~osad(.c7;cs~IC~o.xr~ v~-•Pl~l~ gr~.q 3.T~Pc ~/Oo/y Lo~~L S1fe~,x/uW a ProPost-d , 3 bed~~om Rcs ~c~~e ~'jtsrrn3o35/6u;/d,:rSc J~l381 P.opos//mod l.Je(1 ~ n'lw/l. o{-~'y~ l~i• loGa.brCln u,.ri e 4 641 Gk7'~o CMG Wta/c, eGf~6 0r,A?-6 /y(o,t•.-r al Q'."sP~sc,/ Cam// it Residential Mound POWTS Index & Title Sheet Project Name: Theisen 3 Bedroom Mound Owners Name: Gary & Shellie Theisen Owner's address: 2121 Co. Rd. N, Baldwin, WI 54002 Site address: Same Project Location: Subdivision: Lot 3, CSM Vol. 13, Pg. 3733 Legal Description: NE% of the fractional NW%, Sec. 18, T.28N., R. 16W., Town of Eau Galle, St. Croix Co., WI. Parcel ID 008-1053-95-300 Page I Index and Title Sheet Page 2 State Approved Mound Design Page 3 Treatment Tank Cross Section Page 4 Filter Specifications Page 5 Septic Tank Maintenance Agreement Page 6 Certified Survey Map Page 7 Warranty Deed Mater P1~ tuber Restricted Service: James K. Thompson, DSPS Credential #30021 Signature: ~jp Date: 3 2016 Page 1 of 7 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~oF~SSfols N Scott Walker, Governor Dave Ross, Secretary April 27, 2016 CUST ID No. 30021 ATTN.• P 0 WTS Insp e ctor JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSEN LAKE LN 1101 CAR-MICHAEL RD OSCEOLA WI 54020-5413 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/27/2018 Identification Numbers Transaction ID No. 2697621 SITE: Site ID No. 823200 Gary and Shellie Theisen Please refer to both identification numbers, 2121 Cth N above, in all corres ondence with the agency. Town of Eau Galle St Croix County N1/2, NW1/4, SI8, 1-28N, RI 6W Lot: 3, FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1597150 Maintenance required; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual, (R. 7/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/O1, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: AF DEPT 01 • Page 5 - Manifold is 3 feet. FESSI • Fence off dispersal area prior and during construction to avoid disturbance, compaction and use of t-iojN OF 11 the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over COQ construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch f JAMES K THOMPSON Page 2 4/27/2016 wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384,30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Final elevations of pump off and invert of distribution pipe; need to be verified for proper pump sizing. • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01101). • This system is to be constructed and located in accordance with the approved plans, and the "EZflow Mound Component Manual " (R.7/12). • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • Owner Responsibilities:SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383,54(1). • The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at the 12 o'clock position. The laterals shall drain fully after every dose. • The lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The observation pipes shall be located in between where bundles come together. These requirements must be followed so that the aggregate bundles will not be damaged during the installation process. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. JAIvES K THOMPSON Paae 2 4/27/2016 wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Final elevations of pump off and invert of distribution pipe; need to be verified for proper pump sizing. • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01 /01). • This system is to be constructed and located in accordance with the approved plans, and the "EZflow Mound Component Manual " (8.7/12). • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • Owner Responsibilities:SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at the 12 o'clock position. The laterals shall drain fully after every dose. • The lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The observation pipes shall be located in between where bundles come together. These requirements must be followed so that the aggregate bundles will not be damaged during the installation process. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2); nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. L JAMES K THOMPSON Page 3 4/27/2016 Sincerely, Fee Required $ 250.00 J Fee Received $ 250.00 Balance Due $ 0.00 Tim Vander Leest Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tvanderleest@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday- Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. I ...d it EZf/ow® MOUND AND PRESSURE DISTRIBUTION COMPONENT ?EF,IGN Residential Application APR ~ ' INDEX AND TITLE PAGE INDUSTRlY SERVICES Project Name: Theisen 3 bedroom replacement mound Owner's Name: Gary & Shellie Theisen Owner's Address: 220 Willow Crt., Baldwin, WI 54002 Property Address: 2121 Co. Rd. N ' Legal Description: N1/2 NW fractional, Sec. 18, T.28N., R.16W. Township: Eau Galle County: St. Croix Subdivision Name: CSM Vol. 13, Pg. 3733 Lot Number: 3 Block Number: Na Parcel I.D. Number: 008-1053-95-300 Plan Transaction No.: Page 1 Index and title AFETY AND Page 2 Data entry 'AL SERVICES Page 3 EZflow mound drawings 1STRY SERVICES Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications dDE INC Page 9 Site Plan Page 10 Attached Soil Evaluation Report Designer: James K. Thompson License Number: 30021 Date: 04/06/16 Phone Number: (715) 248-7767 Signature Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) EZflow Mound Version 3.0 (R. 3/1/12) Pagel of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 5.00 Site Slope 97.00 Installation Contour Line Elevation (ft) 100.00 Contour Length Available (ft) 31.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 6.00 Cell Width (ft) 3, 4, 5, 6, 7, 8, 9 or 10 Only 75.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution r Y j Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.08 ft2/orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? F -Y 91.00 Inside Pump Tank Elevation (ft) Enter Y or N 0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) i 6.00 Vertical Lift (ft) 67.38 5x Void Volume (gal) 0.80 Friction Loss (ft) 73.91 Minimum Dose Volume (gal) 13 .30 I Total Dynamic Head (ft) 30.48 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 646.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser concrete Manufacturer 17.00 gai/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 646.00 Dose Tank Capacity (gal) PolLok Filter Manufacturer 17.00 Dose Tank Volume (gal/in) PL525 Filter Model Number Wieser Concrete Manufacturer Project: Theisen 3 bedroom replacement mound Page 2 of 10 Mound Plan View 1 1/10B J Observation Pipe K 7.7 . . , 5 A W I•. I . B 3 I L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 9.60 in H 1.00 ft K 7.95 ft B 75.00 ft F 12.00 in z 9.00 ft L 90.90 ft D 6.00 in G 0.50 ft J 5.22 ft W 20.22 ft 450.00 (ft 2) Dispersal Cell Area 1125.00 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 99.50 (ft) ♦ F Dispersal Cell 98.00 (ft) Lateral 97.50 (ft)~ - 6 Invert Elevation Dispersal Cell i::::: .3. Elevation D 0:.:..i:i.. { Y 1- 1 1. J 1 J iJ a J J{: 97.00 (ft) Contour Elevation 5.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 U -0 Topsoil cap > a .c- 2 Subsoil Cap o o = Approved Geotextile Fabric Cover 3 0 ASTM C33 Sand 2.0 ft 1 ® Tilled Layer :6 5 5 F ❑5 EZflow Media U) 0 0.5 ft See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Theisen 3 bedroom replacement mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below ` f P •=Turn-up idball valve orclean&utplug Z{ 1st brilice ibcaler# at Z X Orifices paint u except every Sih S one points down for drainage. Force main connection via tee cg cross to manifrdd at any point. Lawals & farca main of PVC Sch 40 All laterals identical with orifices equally spaced. per SP'S Tab)* 3a4.3O.6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.04 ft Lateral Length (P) 74.22 ft Orifices per Lateral 37 Lateral End (Z) 0.78 ft Orifice Density 6.08 ft2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 15.24 gpm Manifold Diameter 1.50 in System Flow Rate 30.48 gpm Forcemain Velocity 3.11 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ► SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacity 646.00 Gallons T Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.65 334.09 B 2.00 34.00 _ CC Pump off elevation (ft) C 4.35 73.91 92.00 D 12.00 204.00 D Total 38.00 646.00 Dom se tank elevation (ft) Bedding And Backfill As Per Manufacturer 91.00 Alarm Manufacturer SJ Rhombus Alarm Model Numbed SJE 1011421 Pump Manufacturer Zoeller Pump Model Numb jN151 Pump Must Deliver 30.48 gpm at 13.30 ft TDH Note: Switches containing mercury may not be used in this system. Project: Theisen 3 bedroom replacement mound Page 4 of 10 EZflow® Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 6 ft Wide ~ 1, Component Legend SR1-7A Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or OND SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6 q0 Cell Width - A (ft) 75.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Force Main u Fft~W End Manifold Project: Theisen 3 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Jmaes K. Thompson Phone (715) 248-7767 POWTS Regulator's Name St, Croix County Zoning Dep't Phone (715) 386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn ♦ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same ~EZflowSynthetic Media Diameter as Lateral 2.06 Feet ~ Distribution Lateral Lateral Cleanout Project: Theisen 3 bedroom replacement mound Page 6 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZflow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component, Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing (pump) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. "`No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death."" Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. to "fl PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 1511152/153 PER MINUTE 50- „ 45 153 EFFLUENT AND DEWATERING ,z +0 MODEL 151 152 153 t0 35 15: Feet Meters Gal. Liters Gal. liters Gal. Liters _u 30` 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 0 8 25 151 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 0 8 20 25 7.6 16 61 34 129 42 159 30 9.1 - 23 87 33 125 35 10.1 22 85 7-4. 44 t0 40 12.2 I - 11 42 2 \N1 I Shut-of Head. 30 ft. (91m) 38 ft (11.6m) 44 ft (13.4-r) 5 0145088 0 10 20 30 40 80 1'70 80 90 100 GALLONS LnERS 0 40 80 1 0 160 240 280 321 360 p FLOW PER MINUTE 014508A Model 151 Models 1521153 30.$16 P/rfKn7 S!(i,,v/y / r CONSULT FACTORY FOR a SPECIAL APPLICATIONS 67/32 r_ 6t,, - 7 719 45/8 7 27M --r---~ 4 510 Timed dosing panels available. _T Electrical alternators, for duplex systems, are available and 2 a „e supplied with an alarm. Variable level control switches are available for controlling ® 3719 J 27n2 single phase systems. 1 / -4 Double piggyback variable level float switches are available r for variable level long and short cycle controls. i Sealed Qw*-Box available for outdoor installations. See - FM 1420. - - Over 130'F. (54'C.) special quotation required. 12118 15111521153 Series L 1511`1521153 MODELS control Selection Model Volts-Ph Mode Amps Simples Duplex 1 31B N 1-5 -1 N-1 115 1 Nan 6.0 1 2 or 3 4 BN151 115 1 Auto 6.0 Induced 2a 3 E151 230 1 Non 3.2 1 2o( 3 BE151 230 1 to 3.2 chided 2 or 3 s~ 44 SK-1064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Induced 2 c x3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Induded 2 or 3 N153 115 1 Nan 10.5 1 2 or 3 BN153 115 1 to 10.5 Induded 2 a 3 H53 H- 30 1 Non 5.3 1 2a3 SFLECTIC)N GUIDE BE153 30 1 Auto 5.3 Induced 2 or 3 1 Single piggyback variable level float snatch or double piggyback variable level float O CAUTION switch. Refer to FM0477 wa11211G of controls, protection aevices ana wiring sho.tlo De none oy a qualunec 2 See FM0712 for correct model of Electrical Alternator E-Pak ece:uea eie<aician. All electrical ana safety cones snouo De forowea incluom.0 the mosl .scan/ National Electric Code (NEC) ana the Occupational Safari and Health Act (OSHA) 3. Variable level control switch 10-0225 used as a control activator, specify ouplex (3) or (4) float system RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P0. BOX 16347 Louisville, KY 4 02 56-034 7 Manufacturers of 0 SHIP T0: 3649 Cane Run Road ® Louisville, KY 40211-151 PUMP CO_ (502) 778-2731.1 (800) 928-PUMP Q~t2/TV PUMP6 SNCE ~9~9 y httpllwww.zoelier.com FAX (502) 774-3624 © Copyright 2004 Zoeller Co. All rights reserved. • •Soil e✓a/uaU~i~~f.SY rc~a~c~~ /i'~Qv~ r,'~ X33 L Ary$ •S~{e/%c7~c~sc~~~c~-L1 Lot 3 Csrv~ ✓o% /3, ~j• 37j3, - ~~y /1 O ~t~ ~F~raC1:o ?w y SGG. ,2 T .26X,, being 3. So a cues. v b o 370. SD' U P~opos~ ~1 ou., ~ 46 ~ o.,tz 'x 9a~o' Wnz w/6~rls~~~•sP<~s~/ce//Two (z~ d:sEr~ ~jkL~.on /4~cra/~cti%2"x7S~~Z' 9Ssa ' ~ %g ors i'Ces 3aa Cu d& 6 Y. ose' ^ 33 ' P~o~-•.b~r.~ ~ ~ ~ ~ MO w.d 1~ O 91.9 0 2"5d. el C. ~ - PPoPOSaa~LC7~ GS~~o~x1'~iC w~-P l~/~ 4 d ~ L:• lava-6 s. r.' ouf,~~. ,,'s_,~t,.1 cTr7~s" F Pfo~os~ 3 oo~ RtS; dc11~~ 5['~4srm3035/6u,/d. Sewu aS~ar381.3a(~ ~icooSt'dLOC(1 nlw~' % o{~Y% /oca,~igv~ n,~F,/9rsuint .E c.v`=/l/a• d "Gea.~ a~ a SPA/s_FS.?,8~ • 3s w ceF /o c•a .fc d ~ Bc , gC, O'cAIe in 2, P5.9 c~' l o v D Z can 54j" AS 84" m REQD m 43 D z z r C ~ D 0 m 1464"1 m 0 3" ~ ~ WI x O m z ~ m D m m I I 11 I~ N I I II II. J l III ~I II ;o _ ~0 m III z o rr 41 " -Zi ° m N I D I cl m D r z 0 z O J0 rz- r cz D c_ m m m D o -1 -1 (n o z ° _ rcoglr=~owgz Z r or, x~ zmz O D O z D~'z r-r°z~zoor° XN vx N~ CC) m ~n° ~0O E, 0:: OrN om m° mom 0 D moo m(no . -iO• cf) O co NN o o cn =arc <zo0 mcn O n c: T. Z N ° 00 N N I~ ID~ O C% Q'-' O) DN o N c oW cnmD I D °rwwc~,°°^;- -Ti v n z c/MZ O cn O tJ rn v m D r m s s ° 0. N 5d o Z v z c> o rmrl M FT, rn w cn o o~ D O n o v D m D o ~ D =Fz N > z ~m z2 c) 0 N O m D o O H D y" C y v 0 ?1 O ;u -i Z u co z r _0 M C m r- O~ m o OC z < N ~m m 7 n Z (n v ni r ZO7 N m m 70 C v F ,D O co Oo r 22 D H Z m r~ m m 0 DRAWN BY WCP SCALE: 1 4"=1*-0" PRE-POUR: \o WLP1000/650-MR MIESER COt1CAETE REV. T1 SEPTIC MANUAL DATE: 00 00 00 DATE: POST-POUR: \ z W3716 US HWY 10 MAIDEN ROCK, WI 54750 ° 800-325-8456 FILE: M1P1000/650-Wt r~J : 3 o Technical Specifications PL-525 EFFLUENT FILTER (O ME-11 IAL) 61,7 BAIL CHECK r - EXCEPTS 6'SHD 40 1 \ 14.35 FOR INM_ETEXlEN TJN 1157 i JUTLE BUSHING EXCEPT$ SCH 40 & o" SCH 1G ' ~ A 310 1 r~ 523 33.02 11 ~i PL-525 FILTER HOUSING '1834 PART NO -30142-525 MATERIAL S-` HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC &.5 BALL - HDPE r -SO%XET=XCEPT$F_OATSW TCr1 10:3 EXCEPTS I' SCH 40 _9~ r(e_ FOR HANDLE EXIEN500, IC_84 + Ulm- 630' OF 1 1.6' SOTS 614 7 1 .....6.47 ,:-SOC~(ETEXOEPTS _ 604 BALL PUSH ROD f OPEN ING _ 77 I - i 1.09 D OPENNG 20 7 i I i L loj of 19 2 2244 y ~ II ~ -al ~ r i ~ol i POLYLOK PL-525 FILTER CARTRIDGE PART NO - 301 41-525 MATERIAL -POLYPROPYLENE ~ J ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Gary & Shellle Theisen Mailing Address 2121 Co. Rd. N, Baldwin, WI 54002 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 008-1053-95-300 LEGAL DESCRIPTION NE NW 18 28 16 Eau Galle Property Location _ r/a , r/4 , Sec. , T N R W, Town of Subdivision Plat; Na , Lot # 3 Certified Survey Map # Volume 13 'Page # 3733 Warranty Deed # (before 2007)Volume Page # Spec house ❑vespno 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 svstem 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 systern 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. 1/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 jll~~IIJ6 ATE SI ATURE OF APPLICANT(S) ***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) C S T_ aufb D s' AL-D Wisconsin Dept~tiessional Services Page 1 of 2 Division of Industry Services +3~ 7q S APR 06 2:1; SOIL EVALUATION REPORT ST. CROIX COUNTY In accordance with SPS 385, Wis. Adm. Code County Attach complWINIM ~IUdY ~ St. Croix ~ V~fli(D(s311y~Rt~f~r 8 1!2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 008-105A95-300 Ref #2433 Please print all information. Revie d by DatQ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location Gary & Shellie Theisen Govt. Lot N1/2 fractional NW S T 28 N R 16 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 220 Willow Crt. 3 na CSM Vol. 13, Pg. 3773 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Baldwin WI 54002 (715) 688-4424 Eau Galle US Hwy 65 ® New Construction Use: ❑ Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Glacial Till Flood Plan elevation if applicable na ft. General comments and recommendations: Site suitable for mound POWTS. Recommended infiltrative surface elev. to be 97.50' at 6" above 97.00' contour. Boring # ❑ Boring ® Pit Ground surface elev. 97.30 ft. Depth to limiting factor 35" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sil 2fgr mvfr cw 1 vf,f 0.6 0.8 2 12-25 10yr4/4 none sicl 2fsbk mfr gw 1 of 0.4 0.6 3 25-35 10yr4/6 none gr Ifs Osg ml gw - 0.5 1.0 4 35-68 10yr4/6 f2f 7.5yr5/8 gr cosl Om mvfr 0.2 0.6 2❑ Boring # ❑ Boring / ® Pit Ground surface elev. 98.33 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-12 1 Oyr3/3 none sil 2fgr mvfr cs 1 vf,f 0.6 0.8 2 12-22 10yr4/4 none sicl 2fsbk mvfr gw 1 of 0.4 0.6 3 22-31 7.5yr4/6 none gr Ifs Osg ml cw 0.5 1.0 4 31-50 7.5yr4/4 f2f 7.5yr5/8 gr sl Om ml gw 0.2 0.6 i * Effluent #1 = BOD, > 30 :s 220 m / and TSS > 30 150 m /L * Effluent #2 = BOD, > 30:5 220 m /L and TSS > 30:5 150 mg/L CST Name (Please Print) Signature CST Number James K. Thompson 30021 Address ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 March 29, 2016 (715) 248-7767 SBD-8330 (R04115) ❑ Boring Boring # ® Pit Ground surface elev. 95.20 ft. Depth to limiting factor 41" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 1 Oyr3/3 none sil 2fgr mvfr cs 1 vf,f 0.6 0.8 2 13-30 7.5yr4/4 none sicl 2msbk mfr gw - 0.4 0.6 3 30-41 7.5yr4/6 none gr Ifs Osg ml cs 0.5 1.0 4 41-53 1 Oyr4/6 f2f 7.5yr5/8 gr Ifs Osg ml 0.5 1.6 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft' In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I ~_ifii~IG'nt #i - t5UL' f 3 Boring # ❑ Boring ® Pit Ground surface elev. 95.20 ft. Depth to limiting factor 41" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. Eff#1 Eff#2 1 0-13 1 Oyr3/3 none sil 2fgr mvfr cs 1 vf,f 0.6 0.8 r 2 13-30 7.5yr4/4 none sicl 2msbk mfr gw - 0.4 06 3 30-41 7.5yr4/6 none gr Ifs Osg ml cs 0.5 1 0 4 41-53 10yr4/6 f2f 7.5yr5/8 gr Ifs Osg ml 0.5 1.6 i I ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. Eff#1 Eff#2 I i I Boring # ❑ ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft' In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 i i i I I~- Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 150 mg/L Effluent #2 = BOD, > 30 220 mg/L and TSS > 30 s 150 mg/L Wisconsin Department of Safety and Professional Services Page 1 of 2 Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County St. Croix 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 percent slope, Parcel I.D scale or dimensions, north arrow, and location and distance to nearest road. 008-1053-95-300 Ref #2433 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location ❑ ❑ Gary & Shellie Theisen Govt. Lot N1/2 fractional NW % S 18 T 28 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 220 Willow Crt. 3 na CSM Vol. 13, P 3773 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 1 Baldw' WI 54002 715 688-4424 _ Eau Gall, US Hwy 65 ® New Construction Use: ❑ Residential; Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe. Parent material Glacial Till Flood Plan elevation if applicable na ft General comments and recommendations: Site suitable for mound POWTS Recommended infiltrative surface elev. to be 97.50' at 6" above 97 00' contour. - B I Boring # ❑ Boring ® Pit Ground surface elev. 97.30 ft. Depth to limiting factor 35" in Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft` In Munsell Qu. Az. Cont. Color Gr. Sz. Sh. j "Eff#1 `Eff#2 1 0-12 10yr3/3 none sil 2fgr mvfr cw 1vf,f 0.6 0.8 2 12-25 10yr4/4 none sicl 2fsbk mfr j gw 1 of 0-4 0.6 3 25-35 10yr4/6 none gr Ifs Osg ml gw - 0 5 1 0 4 35-68 10yr4/6 f2f 7.5yr5/8 gr cosl Om mvfr 0 2 0 6 'ice r I~ I ( i ,L ❑ Boring 2 Boring # ® Pit Ground surface elev. 98.33 ft . Depth to limiting factor 31" in - r Soil Application Rate_ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD,Ft- In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. _ *Eff#1 "Eff##_- 1 0-12 10yr3/3 none sil 2fgr mvfr cs 1 vf,f 0.6 0 8 2 12-22 10yr4/4 none sicl 2fsbk mvfr gw 1 of &4 0.6 13 22-31 7.5yr4/6 none gr Ifs Osg ml cw 05 1,0 ~r 4 31-50 7.5yr4/4 f2f 7.5yr5/8 gr sl Om ml gw 02 0-6 Effluent #1 = BOD, > 30 220 mg/ and TSS > 0 150 m /L q fluent #2 = BOD, > 30 220 mg/L and TSS > 30 150 mg/L CST Name (Please Print) Signat e CST Number James K. Thompson 30021 Address ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 March 29, 2016 (715) 248-7767 SBD-8330 (R04,1 S) ~ Soile✓a~K.a.ulanPi~fiy~orn~oJin, 1o/G 6cale.-I" =2 ,Qc~ X33 Lot 3 Cs ^1 ✓a 3 793, Pew y s,. /4 f , z-/Oc& /o s3 9S-3cb "v Zt 370.50' Wdz • 9sso' w'r - ■ " _ ; -a~ Mom i - 97.5' w cep /v c.~ d 8a ^-/93 ~f/urn /v/~~o•s I i I P5.3 a~~ Wisconsin Department Relations Industry, Labor and Human Relati SOIL AND SITE EVALUATION REPORT Page of 3 . Oivisio").tf >29fety & Buildings in a cor w th ILHR 83.05, Wis. Adm. C de ~-9 9 COUNTY ~?uc3 b 9~-h ST • C,R.t11 X ttach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pla must include, qut not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 008 - 10 S 3 - S 3 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION WREVWED Y ATE PROPERTY OWNER: ~ / PROPERTY LOCATION N kJ Dtvr~-t 0 y GTDI't J~f IQ IS GOVT. Le = 114 - 1/4,S 1 'U T ~v N R l b E (o' J PROPERTY S WNEtR':S MAILING ADDRESS !LO T3# BLOCK# SUED. NAME OR CSM # CS M )3 3 37 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®I OWN NEAREST ROAD 6~ Dwt >v Iti ► S V U a L (I t 6a~! L)o 6 y G kt_L_~, c.-n t ~v [ New Construction Use Residential / Number of bedrooms y [ J AdditiQn to existing building Replacement [ ] Public or commercial describe Code derived daily flow 640 gpd Recommended design loading rate bed, gpd/ft2 3 trench, gpd/ft2 Absorption area required 500 bed, ft2 S oo trench, ft2 Maximum design loading rate bed, gpd/ft2 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 91 • S ft (as referred to site plan benchmark) Additional design / site considerations "~3 U>ft~ w/ s 'x lu o' `TIZQ Ct f . MI iv I "L. M 12 4 OF- SA-kj:> Ft LL Parent material % I k-T- f pU )nZ 6 LMi14 - 1 ~L Flood plain elevation, if applicable N A It S = Suitable for system CONVENTIONAL MOUND 7 IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ® U ®S ❑ U ❑ S O U ❑ S ®U ❑ S [WU ❑ S 21) SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench tit, 1A2 111 - s i t z s b12 tin'Fr c vv - , S MOM= ....-,.x....... Z I q ~O ystc~ Zmsbk wt'f1- cs ~q 5 Ground 3 0 -'Bo t~ ti ti YA, - ~G D S g J+'1 - S elev. 96.3 ft. Depth to limiting - factor > B Remarks: Boring # :v I o-tc~ to-tR3 /z, - s~1 Z`~s 6>t mfr e w _ s <;:<> 3 Z Io-z. -1 ti - l 0 3L (o s t 1 Z 'FS ~bt Wj S . • S' I Ground 3 2l 3S ~.S'1 231`f GrSt1 lMS~~ ~~t- 0--s 3 elev. e y S~ttZ 31y s/P, Gas ft r sl o~ cWL - ~n`tit~ Depth to limiting factor Remarks: CST Name:-Please Print Phone: Arthur L. We erer 715-425-0165 V ess: - gerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnature: Date: CST Number: 220254 j I PROPERTY OWNER E~ ~RSDN SOIL DESCRIPTION REPORT Page of 3 PARCEL LD.# Oorc.,' -lpS3-O!S Roots GPD/ft Depth Dominant Color Mottles Texture Structure Consistence Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trench L•.}•++.4vY.v~\j -V ~ L V l1Z 3 L Z - SL 1 Z sbk M '6- O , • s Z 1Z-z4 ~.5~2 fly - Sect zw~Sbk r►~'Fh. eW .y .S Ground 3 2 9 -3~ -1 S `2 R 31 - Gti- s 1 e S~~ k rn ~H e S S elev. ele v. ft. L ~•S~tRSlB Grsi O~v1 m Fi i .2 Ta. Depth to limiting factor Remarks: - Boring # Ground elev. ft. Depth to limiting ' factor Remarks: Boring # i aCw,4}, Ground elev. ft. Depth to limiting i factor Remarks: Boring # V 4 Ground elev. ft. Depth to limiting factor Remarks: ^nn ",,r) In nr•nrn PROPERTY OWNER Ell kz_~O►y SOIL DESCRIPTION REPORT p, Page of i PARCEL LD.# 00 ?1 -1OS3--/S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Banfary Roots GPD/ft:1 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed- rem 'I 3 o-~z t~~ tz 31 z - s~ 1 2 s~k m `Pt- s 77- Z 1Z~z9 ~.SYfZ fly - SIC.t. z,W 3S 4r rnfr C W - .y .S Ground 3 Z 9-37 7 •S 4 R- 3! - Gr g) ~ C S~~ k m C S , ~J S I elev. 1 ft 3-60 1 o`t 31 L -S~t R S/a G►- si Ott m Z Depth to limiting f facto w i i i Remarks: a Boring # - Ground elev. i f Depth to limiting i factor i i Remarks: Boring # fGround ' elev. fL Depth to limiting factor h3 Remarks: Boring # j Ground ! f elev. =I ft Depth-to limiting t factor I L _T_1__ Remarks: F rnn nonnro nr nm