HomeMy WebLinkAbout022-1099-30-002
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 589755
r
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 'v
Permit Holder's Name: City Village Township Parcel Tax No:
Bradley & Wendy Harrison TOWN OF KINNICKINNIC 022-1099-30-002
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
-4 -1 34.28.18.535A-2
IC~c~ D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURJ Fy APACITY STATION BS HI FS ELEV.-
d S b .9 5 n)
C
Septic Benchmark C11 I Of. 1 CC)
Alt. BM `
Bldg. Sewer ~ I J I b `0 ` -
Hol 9 -Ht Inlet ~ K
~ . 1 103.8
S Ht Outlet
TANK SETBACK INFORMATION 0S. 3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
J
Dosing Head, Man.
Aeration 912-
Dist. Pipe f 2 3
`l ] o 7 3
Holding = ot. System T-6, _T4
'T
1,0 an Cf
Fina rade r I 5c r
PUMP/SIPHON INFORMATION I `I J
Manufacturer Demand St Cover 0
_1 C~
GPM
/ 4 T Y ~F J O V J
Model Number
t
TDH Li~ Friction Loss System Head _ T Ft ,ems +
Forcemain Length Dia. Dist. to Well
Ls7
SOIL ABSORPTION SYSTEW .r~~ ~T
BEDITRENCH Width I ANo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
T.\kg ;l~O /
DIMENSIONS
I,<- L4
SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING Manuf tt
INFORMATION (1(
Type Of System: CHAMBER OR +IC , , t UNIT Model umber:
0ONVENTAY-Old (_I_ St. 710 S
DISTRIBUTION SYSTEM io Al
Header/Manifol tt Distribution x Hole Size x Hole Spacing
Len Vent to Air In
9th ' Dia Length D G/ I Ptak 1 I/e~
ia Spacing
jS
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded r Mulched
Bed/Trench Cente ed/Trench Edgrs i Topsoil Yes No 11 Yes N
(f n o
o w
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1220 CTY RD M y~
1.) Alt BM Description = T 1au_ Crwa_ r,~
2.) Bldg sewer length l Ac 1\\,A1 `
~`YJe 1)e&V6L,~
-amount oficover = v (
V~ v\ l~ C/\\\_J - 1DR o ~ ` 1`l t p e 1r
Plan se other side qfor additional information. )k No (1 I I
U
v t ` Il
SBD-6710 (R.3/97) Date / Insepc or's Signa Cert. No.
County
a3 o Safety and Buildings Division
8~ a~'t q 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
Gl.. I~16 Madison, WI 5370'-7162 C
ago CROIX COUNTY '06' 5199 7J S
UNFrY DEVELOPMENT S` State Transaction Number
Sanitary Permit Application S,,
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate Bove" ~Q
,9 P
C
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Sub,. V✓ t Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for seco..
purposes in accordance with the Privacy Law, s. 15.04 1 (m), Stats. i Z [ J CC
1. Application Information - Please P i All I rmation parcel #
Property Owner's Name 4-
8 VP Ibl " 22- /o` ~ & -00 7-
Property Owners Mailing Address Property Location 3q.,29,, iS3. `J 3 5 A-a
i 7- 0 C() Govt. Lot
City (State Zip Code Phone Number 5'Uj y4, ) VIA/ 1/4, Section
0 ~ (circle one
Z T7 Q N; R E o
II. Type of Building (check all that apply) Lot # -
Subdivision Name
A-1 or 2 Family Dwelling -Number of Bedroo s
1 O Block #
❑ Public/Commercial - Describe Use tok0 ❑ City of
a~. Number El Village of
P [CSM
El State Owned -Describe Use ® Town of A) A)1 L r 1 AIA/1 C
~,5~ i'l
III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) p
A. Pew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
W. T e of POWTS S stem/Com onent/Device: Check all that apply)
AL'on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil C
❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) -21 F"064J 76A
V. Dis ersal/Treat nt Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Prop ed ( System Elevation e)
dIUC~ D 5, G ~s-3 7,z.
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units t, U °
cd U Ne
w Tanks Existing Tanks U
a v Z; v: a.
Septic or Holding Tank >y Zj-`f W s h-
Dosing Chamber _
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/NQAF&Number Business Phone Number
- ~ Z~_
Plumber's ddress (Street, City, State, Zip Code)
6j u1)4 f / LrJ / 14
VIII. County/Department Use Only
Approved Permit Fee Date Issue Issum cut Sign re
$ gJ x~ ~P
' n Reason for Denial
IX. Condi' easpns ffoorr Disappruival
,e ffi1~M**
.0 es ! maiMaiM I
dhtpers9i cep must aN be e
as,per management plan provided by plumber. \ Q~G
2. ' alt liR>Ihok ' mush be r tiair~ktir:ed 1 4re,,- r
n par INpplicrft cod* 1 crdimts. JJ I
4C YYUX2 Attach to complete plans for the system an su 't to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398 (R 11/11)
Plot Plan `
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P~~ ert'~owner ®
Legal .~eser tkn ..~°..~._,s~,~`~ of - ~'e~eept where n. -put
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: A-
Owner's Address: Z 2 0 c f y Rt>
1 L~ l~'~{- LG S C.z.~ r 5 ~Fv z Z
Legal Description: ~,c1 S'
Township: K t ,JA1 If- K (ti' AJ l C
County:
Subdivision Name:
Lot Number: `
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section &,-Li zK
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:ny License Number: Z 6 `j
Date: Phone Number 7j~_ 2 73 ~k
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
plot Plan `
Property Owner ~R ~RLJIL
Legal Decor tlon ff-- (except where noleo -
o+o..~5r North
t-Y A-
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44
1 or 2 Family Dwelling In-ground Soil Absorption System (3-cell Conventional)
Daily,Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom = b gal/day
Design Loading Rate (DLR) or Soil Application Rate = ~ gpd/ftz (per SPS Table 383.44-1, 2, or 3)
Z = ftz
Required Distribution cell area = DWF t'r- gal/day -•DLR r gpd/ft
# Chambers = Required Distribution cell area ( O U ft~ i D ftZ/ unit EISA Chambers
Chamber Manufacturer and Model: +ti2 t-%-lck
Actual Distribution cell area = Required cell area D c 3 ftz + 1-5-1 3 ftZ/ unit EISA End Cap Pair= ft Z
Cross-Section In-ground Soil Absorption System (3-cell):
y; 4" Schedule 40 PVC vent pipe with vent cap
12 inches minimum 12 inches minimum,
` I `~'-5( ft T3 Final Grade (FG)
?""Ft T1 FG j ft T2 FG
inches Soil Cover
ti Z inch Chamber Height
Trench 1 System Elevation Trench 2 System Elevation Trench 3 System Elevation
tt ft~g~ :ft inch to limiting factor
Trench
Separation
Plan View In-ground Soil Absorption System (3-cell):
Trench 1
Modify
ft header/
L~ design as
ft Leaching Chambers C~ needed.
Trench 2
4 inch Header
Sch. ,3L) 3/
Trench 3
< tJ ft with end camps
Draw 0 for a Vent and for Observation Pipe above. They will be located ft from the end of the cell.
Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade.
Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC.
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POWTS OWNER'S MANUAL &'MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner q dN Septic Tank Capacity Z>(~ al ❑ NA
Permit # Septic Tank Manufacturer (.I 1 &3 Lr_ Z ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units J$t NA Pump Tank Capacity al ❑ NA
Estimated flow (average)QO gal/day Pump Tank Manufacturer r ❑ NA
Design flow (peak), (Estimated x 1.5) (coon gal/day Pump Manufacturer ❑ NA
Soil Application Rate al/da /ftx Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit O NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD6) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/l_ ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ys in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: CI I NA,
"Values typical for domestic, wastewater and septic tank effluent. Other: ! ❑ NA
i
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s)
Inspect condition of tank(s) At least once every: ear(s) (Maximum 3 years) NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume O NA
Inspect dispersal cell(s) At least once every: ® ❑ year(s) month(s) (Maximum 3 years) 13 NA
Clean effluent filter At least once every; ® month(s) 0 NA
Inspect pump, pump controls & alarm At least once everY month(s) ❑ NA
3 ]8 year(s)
Flush lateralg and ressure test At least once ❑ month(s) ❑ NA
P every: *3 year(s)
Other: At least once every: 0 month(s) ❑ NA
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 ell(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 (Y3) 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.
All 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)
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 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 recbristructed 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 tROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name CL Sow' Name
Phone -7 1 - z 7 3 _ 7 !/L Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name :'o µ.vso^J Ni f.t+e -V Name 4 6&/x 2" J
Phone 7155 Z 73 ~-5 `5 Phone _ ~%"~~r~s7~U
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.540), (2) & (3), Wisconsin Administrative Code.
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SEPTIC TANK MAINTENANCE AGREEMENT
a u jai
OWNERSHIP CERTIFICATION FORM
l- l u ji vI LY' 1•Lt1LJ1 GJ ~ : Y 1 ham,, V ~ ~l L 1 / ~ ~ ~
(verification required from Planning & Zoning Department for new construction.)
City/State Rio-tk ! 11 La' 1 Parcel Identification Number
JnbaiviSlon L S/A
, L(11 tt
Certified Survey Map # / l~ 6 55 Volume Page # - 97 Warranty Deed # , Volume Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MA.INTENANCF, AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
uld111LCL1iLilliC l:VliJ1JLJ Vl jJUlu~JUl ULLL Luc A'G(l Uli ta11a GYGly LLl GG yGA,La Vl JVV1LGl, u uGGUGU, Uy Q uliG11JGLL fJ111AJ~1G1. YYL1aL yL1U UUL 111LV
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
owner and b; a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
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
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County planning &
7nnir0, Denartmert within Io in-V5 of the thrnQ veer rxn±ratinn rlatP
f7we certify that all statements on 's form are fife. to the best of my/61Jr ltnnwtPdga, T/tue am/arQ then n,Qr(~1 nfthP
property described above, by virtue of a anty deed recorded in Register of Deeds Office.
Number of b dro
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rally uuvlautauvll 4ual1J Lu1a11>Y1U0QAUVU 14iAy 1WLLlt u1 L11G J4111L41y 41G1uuL UGlur, 1--ou Uy Luc r1d1imug o[. LuLmg Leparunent. ' "
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reference is made in the warranty deed. =
(REV. 08105)
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^~fi-k4 plus Standard harnber Side and End. Views
48"
(EFFECTIVE LENGTH)
12"
34„
Yom- ~I '
y $ 1" „kr F-Acap Front, Side and i,..id Views
11.2"
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e
T 13"
8" INERT 5.3" INVERT
8" INVERT
tH t
f-18.2" ~ 33"
QUICK4 PLUS
ALL-IN-ONE PERISCOP ri
(360- SWIVEL
12.7" INVERT QUICK4 PLUS
ENDC -ONE 12
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Quick4 Plus Standard Chamber Specifications
c
Size W x L x H 34" x 53" x 12" 86 cm x 135 cm x 31 cm
( ) ( ) I Invert Height 0.6", 5.3", 8.0", 12.7"
(1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm)
Effective Length 48" (122 cm)
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( 'Units"), when installed and
operated in a leachfield of an ons'de septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder
against detective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units;
i
provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the
septic system commences_ To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook,
Connecticut within fifteen (15) days of the alleged defect_ Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered
by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units.
(b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT
TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
(c) This Limited Warranty shall be void if any part of the chamber system Is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR"
does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages,
including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. t ' 3
Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse
or neglect of the Unitsthe Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure r
to maintain the minimum ground covers set forth in the installation instructions, the placement of improper materials into the system containing °
6 Business Park Road • P.O. Box 768
the Units, failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, 7
or improper operation, or any other event not caused by Infiltrator, This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475
terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 • FAX 860.577.7001
third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to
apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's
installation instructions. 800.221.4436 y
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty, No warranty applies to any party other than the www.infiltratorsystems.com
original Holder.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty
requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase,
to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. B
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U.S. Patents'. 4,759.661, 5,017,0415,156.488; 5,336.017; 5,401,116; 5,401,459; 5,511,903: 5,716.163; 5.588,778; 5,839,844
Canadian Patents. 1,329,959; 2.004,564 Other patents pending.
infiltrator. Equalizer. Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc 0 2009 Infiltrator Systems Inc. Printed in US,A. PLUS0510101SI-2
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ST. CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan
include, but not limited to: vertical and horizontal reference point (BM), dire~l1n 4 7 t I Lp. jPending) 027'
percent slope, scale or dimensions, north arrow, and location and distancE; 611e
,
w bao Date
Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ -yam I Z /l field
Property Owner Property Location
BRADLEY J. & WENDY J. HARRISON Govt. Lot SW 1/4 NW 1/4 S 3 T 28 N R 18 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or SM#
1224 C.T.H. M 18 TL4 of P ding)
City State Zip Code Phone Number ity Village • Town Nearest Road
River Falls, WI 54022 ( 715 ) 425 - 0493 C.T.H. M
New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material loess over till Flood Plain elevation if applicable plA ft.
General comments Conventional In-ground Trenches 0.6 loading rate
and recommendations:
❑ Boring # Boring
Pit Ground surface elev. 97.30 ft. Depth to limiting factor 58 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-13 7.5YR2.5/1 1 3fabk ds cw 3vf-co 0.6 0.8
2 13-24 7.5YR2.5/1 I 2f-ma&sbk ds cs 2vf-co 0.6 0.8
3 24-31 7.5YR3/2 1 2fabk mvfr as 2vf-m 0.6 0.8
4 31-37 7.5YR3/3 1 2fabk mfr as 2vf-f 0.6 0.8
5 37-57 7.5YR3/4 is Osg dl Ivf--m 0.7 1.6
57-lsbr
N
❑2 Boring # Boring 62
6.80
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 7.5YR2.5/1 1 3fabk ds cs 3vf-co 0.6 0.8
2 12-17 7.5YR2.5/1 I 2f-ma&sbk ds cs 2vf-co 0.6 0.8
3 17-52 1OYR2/2 1 2fabk dsh as 2vf-m 0.6 0.8
4 52-62 7.5YR3/4 sl 2fabk dsh Ivf--m 0.6 1.0
goo
* Effluent #1 = BOD > 30:< 220 mg/L and TESIS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sign CST Number
MARY JO HUPPERT Hollister's Soil Testing & Design 2~ C ' 224832
Address Date Evalu o Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 11 - 16 - 13 715-426-1775
Property Owner HARRISON, Bradley & Wendy Parcel ID # (Pending) Page 2 of 3
Boring
[-3 Boring # ❑ Pit Ground surface elev. 93.80 ft. Depth to limiting factor 64 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2
1 0-9 7.5YR2.5/1 1 3fabk ds cs 3vf-co 0.6 0.8
2 9-26 7.5YR2.5/1 I 2fabk ds cs 2vf-co 0.6 0.8
3 26-46 10YR2/2 1 2f-ma&sbk dsh as 2vf-f 0.6 0.8
4 46-64 7.5YR3/4 Is Osg dl 1 of-m 0.7 1.6
Horizon 3 has some gr <1%.
❑4 Boring # tJ Boring 95.00 67
n 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2
1 0-22 7.5YR2.5/1 1 2fabk ds cs 3vf-co 0.6 0.8
2 22-40 7.5YR3/2 1 2fa&sbk ds cs 2vf-m 0.6 0.8
3 40-60 1OYR3/6 A 2fsbk ds cs 2vf-f 0.6 1.0
4 60-65 7.5YR3/4 s Osg dl Ivf-m 0.7 1.6
a Boring # Boring
1H Ground surface elev. ft. Depth to limiting factor in.
Pit Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
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 = BODS < 30 mg/L and TSS < 30 mg/L
'rhe 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-8330Test (R_07/00)
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