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008-1086-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 589785 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 2741685 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township arcel Tax No. Lyle & Sonja Gunderson TOWN OF EAU GALLE oNA46, ~cIG 008-1086-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Lai- Gary 30.28.16.455A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ~`rV1 CAPACITY STATION BS HI FS ELEV. Septic s /600 Benchmark ~ rot, /dc) /O$. 9 A Dosing Alt. Go BM 3, y9 „V(00 Cooo pr, Bldg. Se er . 11Z .15, Z-41 7 H SUHt Inlet ` 77 olding St/Ht Outlet TANK SETBACK INFORMATION TANK TO IJ P/L WELL BLDG. ent to it Intake ROAD Dt Inlet \ e f ~ Septic 5'7 IT 7J ~ Dt Bottom a 9► s. 3 R7 j~q y tT , ,Oy• Dosing J'7 Header/Man. 5 7 - 7 Aeration Dist. Pipe / Holding Bot. System Gg /03~ Final Grade /d7 ~ .3 \ PUMP/SIPHON INFORMATION / L Manufacturer Zo / Demand St Cover t C.+O A t7 ? J ~O Al, .4 Model Number GPM P-1 - L, 3V Z- 7. A) p~V c7 D J0, J TDH Lfj, Friction Loss System Head TDH Z .-7 5 •5 0 1% 2 1 111 Forcemain Length Dia. 11 Dist. to Well /66 Z SOIL ABSORPTION SYSTEM BED/TRENCH Width Length jr No. Tren s PIT IMES No. Of Pits Inside Dia® Liquid Depth DIMENSIONS 90 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION w CHAMBER OR Typ System: 3(o/ UNIT Model Number: 60 AAW i DISTRIBUTION SYSTEM Header/Manifolds Distribution 1.y x Hole Size' x Hole Spacing V t o Air Intake J L~ Pipe(s) yq Length v Dia J. ~ Length ' " Dia /0 Spacing Z' OLO SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Q.~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 - Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: 137 Got. Location: A" HWY 63✓~ 1.) Alt BM Description = POO 2.) Bldg sewer length= - amount of cover = ~Z a• Gig b y~ 7 O~ ~f Plan revision Required? l Yes No Use other side for additional information. Date Insepctor's S nature Cert. No. SBD-6710 (R.3/97) S 6 ~ ~7r EC Ct. Clr Safety and Buildings Division St Croix 201 W. Washington Av P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) t AUG Q 9 u1n Madison, Wt 5 j i-7 2 5- " OI)(COUNTY 08p9N A 7R6HSR State Transaction Number COMMUNE n1< ary Permit Application , In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 2741685 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POW TS are submitted to Project Address ' 'different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary- y purposes in accordance with the Privacy Law, s 15.04(1)(m), Stats. US H63. Baldwin. WI 54002 1. Application Information ease Print All Information Property Owner's Name ) Parcea l O~ ~ Lyle & Sonja Gunderson I PFrom 008-1086- 0-00 0 Property Owner's Mailing Address Property Location 1A, 149 US Hwy. 63 Govt. Lot City, State "Lip Code Phone Number NW SW 'a, Section 3V (circle one) Baldwin, WI 54002 (715)684-3930 T 28 N; R 16 F,orw II. Type of Building (check all that apply) rg, UV- 1 of # Subdivision Name I or 2 Family Dwelling - Number of Bedrooms 3 Block Public/Conmiercial Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Numbe ❑ village of ❑ Town of Eau Galle Ill. Typ j of Permit: (Check only one box on line A. Complete line B if a pl► •able) ew System ❑ Treatment, Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 1;. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner /100,1 o- e 1, -7 1 IV. Type ofPOWTS System/Component/Device: (Check all that a Iv bu Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 0- A V777 V. Dispersal/Treatment Area Information: Pol •1,ok Pl-525 effluent filter to be installed at ST outlet • Design Flow (gpd) csign Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Proposed (st) vatiou 1.0 Gpd/sq. ft. ASTM-C 33 sand 103.62 at 17" above 450 Gpd 0.4 Gpd/sq. ft. native soil 450.00 sq. ft. A1~ 450.00 Sq. Ft. contour VI. Tank Info Capacity in Total ta of Manufacturer Gallons Gallons Units o at :s P~ W ! ~Z v r ' .n CIO r ~ ^ 0 a U U ~ is. C7 a, Septic or Holding Tank Na 1,000 1,000 1 Wies r Concrete X n"sing Chamber Na 600 600 1 Combination ST/PC X VII. Responsibility Statement- , the undersign d, assume responsibility, for ii n of the PowrS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MRS Number Business Phone Number James K. Thompson _ MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State ode) 340 Paulson Lake Lane. Osceola, W1 54020 VIII County/Department Use Only pproved Permit Fee Date Issue Iss~ nahi even Reason for Denial $ $ 1Z IX. Condi t eas s for Disapproval `>ioRkt e.u=ntner and G disom t cell mu; all be 5Pl Ices ! rn~Jnta;, as per n.agement plan prondedby plumber, ^ %T ~ r 2. 'A - - Il jjt regwnraents mustbe mamtEiiied as pw *W, icalblel coda / Ordinanoea. er o ha Attach to complete plans for the system and sub it to tupa i h, in SBD-6398 (R. 11/11) 0 so✓Q 1,44Y ,elrl 4iL A _-i- 6, dP e Ie %Iorz/ate/~n& Ly/~.f~,ja (~cc„alrrso~ /o%v 'n cJl. 59W--- ^ ~/o~oscO'G's~r( lu^v~J' hcv/t~Sc~ff!Src 30 Tz£~~( O cJ•, T. of ~-au Coix Cu ; cJ/. lacl WooB -logo, -,zc -coo Propo teanowE PreFhsedbu;101, . <,.4- P~opmsedre~~-esefCor,crcEc cv~~/~~~ -,s2~C ss~p~S 35 yi457'n1-0303y.;_,Z P~~6;~o onS.r/~C.~(~b/y~Ofl~L-szS o c6-c,?7 Qr,owS,0s3 .30(ll)(C.) Asrot-Du Gs` TA5J t 3G9 t~~ pro OS~I 3~ ~w~ tl.s W- y. 6,3 P ,ecs,ldenct- d~~ ,2's~. yoR✓.C. ~ fo~ce,+~arr~ \ r 02.29 ' O ,ti 62 bt~_tia oP° P,-oposedAtow.ida~. z/.YZx/09,do 9o'8r'a✓tpo'('~WS4ICcJ/ t/ 613 `t4i o'?e Sy sc~,-, ,arc 4 Apt., B.nf. T~ o~/off Residential Mound POWTS Index & Title Sheet Project Name: Gunderson 3 Bedroom Mound Owners Name: Lyle & Sonja Gunderson Owner's address: 149 US Hwy 63, Baldwin, WI 54002 Site address: XXX US Hwy 63, Baldwin WI 54002 Project Location: Subdivision: Proposed CSM Legal Description: NW%SW%, Sec. 30, T.28N., R. 16W., Town of Eau Galle, St. Croix Co., WI. Parcel ID From 008-1086-20-000 Page 1 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 Parcel Map Page 7 Warranty Deed Mater umber stricted Service: James K. Thompson, DSPS Credential #30021 Signature: Date: Z c Page I of 7 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) »i~ARTMr'T DIVISION OF INDUSTRY SERVICES PO BOX 7162 til MADISON WI 53707-7162 S Contact Through Relay P http://dsps.wi.gov/programs/industry-services l w www.wisconsin.gov 'RossioA~' Scott Walker, Governor Dave Ross, Secretary August 01, 2016 CUST ID No. 30021 ATTN: POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSEN LAKE LN I101 CARMICHAEL RD OSCEOLA W1 54020-5413 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/01/2018 Identification Numbers Transaction ID No. 2741685 SITE: Site ID No. 826709 Lyle and Sonja Gunderson Please refer to both identification numbers, Hwy 63 above, in all correspondence with the agency. Town of Eau Gal Ie St Croix County NWI/4, SWIA, S30, T28N, R16W FOR: Description: Three Bedroom Mound System / 1% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1613844 Maintenance required; 450 GPD Flow rate; 19 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, 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. ~..P 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. "~OFE '.'ION O The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. ca • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. JAMES K THOMPSON Pagc 2 8/1/2016 Note: If a well is to be on site then; the well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting; a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Sincerely, Fee Required $ 250.00 ! Fee Received $ 250.00 t Balance Due $ 0.00 Tiffa Marshall Wastewater Specialist , Division of Industry Services WiSMART code: 7633 (608)267-9378 , tiffany.marshall@wisconsin.gov JAMES K THOMPSON Page 2 8/1/2016 Note: If a well is to be on site then; the well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. in granting this approval tree 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. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Tiff Marshall Wastewater Specialist, Division of Industry Services WiSMART code: 7633 (608)267-9378 , tiffany.marshall@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE RECEIVED JUL 19 2016 Project Name: Gunderson 3 bedroom residential mound Owners Name: Lyle & Sonja Gunderson Trust INDUSTRY SERVICE Owner's Address: 149 Hwy 63, Baldwin, WI 54002 Site Address: XXXX Hwy. 63, Baldwin, WI 54002 Legal Description: NW1/4 SW1/4, Sec.30, T.28N., R.16W. Township: Eau Galle County: St. Croix Subdivision Name: Pending CSM Lot Number: Na Block Number: Na Parcel I.D. Number: From 008-1086-20-000 NDITIc- APPRG'' Plan Transaction No.: OF Page 1 Index and title 'S1C)WA ;r.' l~ iws Page 2 Data entry F INDUS ACES Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan .:ORRESPO~~ Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached Soil Evaluation Report Design James K. Thompson License Number: 30021 Date: 07/11/16 Phone Number: (715) 248-7767 r Signature: 0 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both 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) Version 5.1 (R. 06/06) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 1.00 Site Slope 102.20 Contour Line Elevation (ft) 19.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (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 =Y I Pressure Disribution Information network? Enter Y or N (C or E) m c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. F7:071 25 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 5.11 ft2/orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back?Y _ vmm 95.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 8.20 Vertical Lift (ft) 56.44 5x Void Volume (gal) 2.75 Friction Loss (ft) 72.75 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 36.25 System Demand (gpm) 17.45 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 603.36 Total Tank Capacity (gal) 100000 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) l Wieser Concrete I Manufacturer 16.76 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 60336 Dose Tank Capacity (gal) Poly Lok Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser Manufacturer Project: Gunderson 3 bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views T J 1.0 B Observation Pipe FK-. 1, l B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •'[31 L Mound Component Dimensions A A17.00 ft E 17.60 in H 1.00 ft K 9.64 ft B ft F 9.25 in z 8.47 ft L 109.28 ft D in G 0.50 ft J 7.83 ft W 21.29 ft 450.00 (ft2) Dispersal Cell Area 1211.98 (ft2) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.89 (ft) H G F Dispersal cell ? 104.12 (ft) Lateral 103.62 (ft)-► Invert Dispersal Cell]. Elevation D s ~ I ,l,~F ].•`r.'.1 ,11 k).r ,Y L.l,~, 44 t,?,.1.?..~..~`~'5...,_ 717C< 'X n..;...,..:,:.._.. 102.20 (ft) Contour Elevation 1.0 % Site Slope Geotextile Fabric Cover Shading Key EL- Dispersal Cell See lateral details on ❑ Topsoil Cap o 1.5 ft y Page 4 for number, size, Subsoil Cap y o 5 and spacing of laterals. ASTM C33 Sand ; • ` Laterals are equally Z F spaced from the Tilled Layer 0.5 ft :fir:; Typical Lateral ~ y • distribution cell's Aggregate - o ^ • . ti,y;::::y..:, centerline in the A distribution cell (AxB). Project: Gunderson 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram 1 r e rr a+r. ort~xecaon via tee or revs, to manifold at any point: L atorafs ate identw al qE P •=Turn-upvrlt~sftvafvaar i --;IEvI tI.;ri241 Laaeral & bDf c e maw, of PVC Sch 40 I xlaanautp8a19 f der CO Table 4.3~f-5 f=c'rw driftt3 or, the L rftom, rxi` the latexl Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.06 ft Lateral Length (P) 44.29 ft Orifices per Lateral 22 Lateral Spacing (S) 2.50 ft Orifice Density 5.11 ft2/orifice Lateral Flow Rate 9.06 gpm Manifold Length 2.50 ft System Flow Rate 36.25 gpm Manifold Diameter 1.25 in Total Dynamic Head 17.45 ft Forcemain Velocity 3.70 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and _ Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacity 603.36 Gallons -T Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.66 312.73 B 2.00 33.52 C Pump off elevation (ft) C 4.34 72.75 95.92 D 11.00 184.36 D Total 36.00 603.36 Dose tank elevation (ft) 3" Bedding under tank. 95.00 Alarm ManuafactureESSJ=El Rhombus f Alarm Model Numbe 114 21=j Pump Manufacturer ZoePump Model Numbe BN Pump Must Deliver 36.25 gpm at 17.45 ft TDH Project: Gunderson 3 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name James K. Thompson( Phone (715) 248-7767 POWTS Regulator's Name St. Croix Co. 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 ft 2 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 Should inspect and clean at least once every 3 ears Pump and Controls Test once eve 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 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 Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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 Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Gunderson 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, 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 of 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 Department of Commerce. Pump Tank The pump (dosing) 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. 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 BOD5, 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 18 months. 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 6 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. w PUMP PERFORMANCE CURVE MODEL 151/152/153 TOTAL DYNAMIC HEAD/FLOW 50 PER MINUTE 147 45 153 EFFLUENT AND DEWATERING 12 40 MODEL 151 152 153 35 152 _ 10 Feet Meters Gal. Liters Gal. Liters Gal. Liters v 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 71 20 61 29 110 44 167 52 197 0 7 JAV 6 20 - 25 7.6 16 61 34 129 42 159 7 A • 30 9.1 - 23 87 33 125 15 35 10.7 22 85 40 12.2 11 42 1D 2 Shut-off Head'. 30 H. (9.im1 38 ft. (116m) 44 ft_ (13 5 0145088 0 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 VOW PER MINUTE 014508A Model 151 Models 152 1153 36.25 g,orn m it ma r! Su~oP/y r4& /e~ o! NSULT FACTORY FOR .J L=CIAL A! PIt..il✓A IONS 67132 ~-1 6114 3 118 4 518 3 27132 ~-t~- 4 56 ~j Timed dosing panels available. Electrical alternators, for duplex systems, are available and 3 7/8 \ 3 27132 supplied with an alarm. • Variable level control switches are available for controlling OO 3 7fl ; 27;32 single phase systems. e ------1 / Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed QWk-Box available for outdoor installations. See FM 1420. Over 130°F. (54°C.) special quotation required. - r 1111/16 12178 - l~ 15111521153 MODELS Control Selection -7- B N151 115 1 Non N1 -1VoltsPh--r- AMods uto Amps 6 0 Included I Duplex 2 or 3 -43,8 i E151 230 1 '[Non 3.2 1 2 or 3 - BE151 230 1 Auto 12 Included 2 or 3 SK2444 SK2064 N152 115 1 Nan 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2o,3 El 52 230 1 Non 43 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N1535 1 Non 10.5 1 2 or 3 BN1531 115 1 Auto 10.5 Included_ 2 0 3 E153 230 1 Non 5-3 1 2or3 N13i_JIUE -BE 153 30 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float o CAUTION swatch Refer to FM0477 ~uo le aices , ;Ia ne a I a quay lea 2 See FM0712 for correct model of Electrical Alternator E-Pak 3. Variable level control switch 10-0225 used as a control activator, specify duplex (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 T0: R0 BOX 16347 Lours 3, 40256-0347 Manufacturers of ~ SHIP T0: : 3649 49 Cane Run Road pp Loursville, KY 40211-1961 QU1[/TY PUMPS SNCE u httpl/www.zoeller.conn PUMP !O. 1(502) 77&2731 • 1 (800) 928 PUMP FAX (502) 774-3624 © Copyright 2004 Zoeller Co. All rights reserved. P~ 10 o -s e✓a/aa~wt/,p,t ' ~~1/3tJ /cde G%G~ • /-cx a EY ~qo sic .Sca/e ~ ~ ye ' n P~o~o.scc✓Gs..q w nu~iySwy~; ScG .3~ Tzf~.r., U -56, Croix 61; P~o(~os~.d cleanawE Pre~hsedbu;/d:~', Isc~c,- P~opms~du.7,^GSeI '~a,c.P<,E.c c~~i°/dvo~6co-~, aspkS~os3Q2.3S yiOSTM-03o.3Y.~F~°s~ Pp.~b;ga~%~nS.T/~C,uJ/pQi/y~O~fL-SAS ouc6'onor,ows.~a(r~)(~) e/a~~~~~ats.~o/~~. /iAsr,.~ Ouch 5~. ~!O N.✓•C. i7~owE c{f•~ e8 ~o 3 6,ea- ~ ~ T~rCQH14r1~ C io2.29 ' ~ j 61 0 0 „ pioposed/ltou.nda e, 2/.V1 rio9.9(4' •~'S'x90'8r'a✓e-/'d/.~,avsa/Ct//. ~ ~ -ri. )o 'V3 6-"b 6 63 `t~2io,.cyC .SyScy,,QYcq Cv~ i I sou rL /"E /i.te Assumc.~L/uf .4 . CS..rI. T~ o,~/oc She. F/u! ~ ice. 0.3.' D z 11 vi 56" AS 84 i D READ m 42„ > z D r- z m C ~ n +I A - - o I I ~I J~ D II. m 1 II 3„ I 48. I 5„ D 0 II m m cn I m x D II x L/) 11 C) D I 36" O i mr :u r I t o m I I I < I II II i N I II Il N V ~ ~ ~ II i t ~ I I N -0 0 D 39 z D o rrT, ~ i D I N m D r c >0 y r r Z z ~ D TIO 7C T O - -m-I --A Z Z C 0 r- N .Z07f~Tl> 0 0 0-{ Z D-0sZ -pmrozrrT, :c _1DOOD~ ~ Co xx Nam mm "DU Sn~ 0 CDO 2p~ 02=;a0rU) -0 0 U)D No \m ON cl) 0 X°z° ~mz~~~r- 00 Ul C) V) Oz ~N ON c z NZ~ I FA m~cnCy) :W M O zz N 0 ~N D.i > 1 v~~0C'O~ D ztkz 00 n ~J M N fr1CO O v > zT. 000 2" O X00 ()(T1-q IDD rOiN p p TI ' p ow ao (/)0 r W O - N vMz z m c o mmp (ncn o O c o v D p ~O z DD mDm m0 0 D I n o -n ~ z Cm O D :rD rD'O m O H D ~m - zZ DSO "'D O oo (n o m< Z -1 A D 40?1 O;0 Z Gl D to F --j ° D to m o o C/) V) co > 0 (!1 mm m NO m r ;u ~C7 C A r- D O n ~ G 3 z DH m m m m p ' \ cn WLP1000/600-MR DRAWN BY: WCP SCALE: 1/4"=V-0" PRE-POUR: ° I SEPTIC MANUAL MIESER CQtiCAETE DATE: 00 00 00 DREV. ATE: POST-POUR: z W3716 US HWY 10 MAIDEN ROCK, WI 54750 800-325-8456 FILE:VION/600--WR 3 Technical Specifications PL-525 EFFLUENT FILTER (COMMERCIAL) 61 R'BALLCHECK EXCEPTS fi"SHD 4U I ~U. FOR INLET EXTENTION - 14,35 11.57 R I OUTLET BUSHING EXI~PTS--, I~ 1 4' SCF' 40 d S' SCh 1068 II ~ ~ T ~I I 33.02 ht I~ I L4 t_ _771-t I PL-525 FILTER HOUSING , - 1B3a _ PART NO, -30142.525 MATERIAL: HOUSING - POLYPROPYLENE - d OUTLET BUSHING - PVC I 6.5 BALL -HDPE ~I J p _f - SOCHETEXCEPTSF:OATSWCi ?C - - - 10.23 EXCEPTS I'SCH 40 l~ FOR HANDLE EXTENTION 1584 533DF1d6'SLOTS x614 o SCCKETEXCEPTS 6.04 6.56 BkLPUSH ROD r OPENING " I l I 7.09 £ 'H I OPENING _y I rur*~-~ aw wv~P 11 i X1,,71 i , € I 16162 ~I 2z4, J ~ i i I ~I I POLY-OK PL-525 F r ILTER CARTRIDGE PARTNO. - 30141.525 II MATERIAL-POLYPROPYLENE I j 7' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Lyle & Sonja Gunderson Mailing Address 149 US Hwy. 63, Baldwin, WI 54002 Property Addre1' 1XXX US Hwy. 63, Baldwin, WI 54002 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number From 008-1 086- -000 LEGAL DESCRIPTION Property Location NW '/4, SW '/4 , Sec. 30 , T 28 N R 16 W, Town of Eau Galle Subdivision Plat: Proposed CSM Lot # 1 Certified Survey Map # N a Volume N a Page # N a Warranty Deed # (before 2007)Volume Page # Sl)cc house ❑vesDio Lot lines identifiable El yesnno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of Your septic system could result in its premature failure to handle vsastcs. 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 thew ante disposal system. Ova-ner 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 yyastcwater 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. f/\\ e, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/yye certify that all statements on this rm are true to the best of my/our knmx ledge. I/Nv e am/arc the owner(s) of the property described above, by virtue of a warm ty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE ***An.\ 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) u j s~f T :uo"eoo~ A8 pasinaH oocs~Muo.rzllb wum vn:=t,e ua A8 Panolddy .Pafoad 91/11/1 :alp(] As PapaU NOs2134N(10 dfNOS 8 31AT13"o Sdd x8 UMLJ(l S~Ulppnq S.mjjuM 9I0-09d oN 9of Q 0 a~~a ~ o° X03 N i 3mm3 m 0 0 0 ~ o 0 H1J „b-,6 s I - 0 0 0 o w' w z - w o ~w 3z w w ° J a U 3 w N Q 2 W rv^ ~ O w t, o J I ~ - n 3 O C7 F a ~ a ~ 0 0 w o z o a ~ x o° C~ 'o w Q ~ U 3 Z ~ J ~ 3 w a z. 3mmN ~ :a r 'o', m ~r 3 3 % - :Uoilzao '9 t' ItaSinaN Aq pano-jddy 'JP II NUI))R#; "'fl ~A aaafoad 91/1 112 aau4 Parau NOSUMNA9 dfNOS 8 ll kl:JaUMO SdV :A9 un\e.i4 S23LIIplITlB S zaiILM T I 910-09d oN 4Uf H19 „b-,6 H10 „b-,6 0 0 m a a 0 - ° o ° o 0 3 - ~o x~ m > n F " o < z Q w - o \ n3 wJ = f-~ w w w~ x Ca w ~~/yam SCI/~ U F+Y rFx+l N > MV W 3 2 ~ U ~ - ~ n ~ a ~ ~ Jz~~ m ai m o - w N~ 3 m w Q m N O N 3 W O - - Q Q G w w F a F ~ am a w o Q m ~ amp w z N 3 am _ ~I u0"'e30~ ~9 paslna~ ' ' A q vw~o3sax~eud P H 9 10afoJd 91/11/L :ale(] AgParau NOSNIIOM19 t/fNOS 3'IlITJ3uMO SVV'X9 UMCJQ SSulplln8 S.miluM 910-09d :0N 90f ONIN3d0 ?M(l OHAO ,8",6[ I I I I I I I I ° I I ~ I I - I g I o I I I I u I I - I I ~ I I n I I I ia „o-sz - I I ~ I I ~ I I I I I Q - I I o I I I I ~ ~ o I I ° I I v o I zo I ~ ° I I a II 3 O O O Q I I I I a N 0 °z f~ .,6- 90 ~ I I gym- so I I ° I ~ o oll° „8-,L a G I ~w Ja II n o -N o a o ~ a i I~ 0-9 --I I I ¢ I n I I ~ o - ~5-Sl - ip I I I o I I ~ „~8-,llw I I I - - - - - - - - - - - - - - - - - - - - - - - - „0 0 G. r_ UOIlEOO A aSIAa anoe,Lti o-Ilv 7 9 P ~ up==iihoosa sse*eon Ag panoiddy °a[oad 91/11/L:a1~Q a Pail°a4~ NOSalaKA9 HfNOS 12 ]T T au w0 Sdd :xa umuja SSUIpl1Tla SI2llLAk T 9I0-09d °N q°f - oNIN3do aooa aHno ,e",zl I i I I I I z I - - - - - - - - - - - - - - - I v I I _ o I o o 3 I o - - - - - - - 3 I I I ~ I I a x ~ I ' - - - - - - - - ~ I I ; pr o II z 0 - - - - - - - - - - - - - Y a ' I . - II _ ` I I I ' - - - - - - - - - - - - I r~ " I N I r~ I - - - . z- - I o U I N o _ n 'o oLLj z i oo ~ I I ~ a I - - ssn?ji5 318V0_,6-,Lb I I I I I I I ~ I I I - „0-,zb ,.o-.9 u a x z, RECEIVED P-A LIP q Wis. Dept. of Saalnd of sion~al Services SOIL EVALUATION REPO Oct Page 1 of 6 Division of S"GacMNrY OMMUNITY DEVELOPMEN'~accordance with SPS 385, Wis. Adm. Code County Y 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 Parcel .11 . 8-10 -20-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Lyle & Sonja Gunderson Trust Govt. Lot NW 1/4 /W1/4 S 30T 28N R 16E (or) W ■ Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 149 US Hwy 63 1 -1 City State Zip Code Phone Number City Village own Nearest Road Baldwin Wi 54002 ( 71)5 684 3930 US Hwy 63 1 E.211 124211C El New Construction UseE] Residential / Number of bedrooms 3 _ Code derived design flow rate 450 GPD 0 Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable N ft. General comments Mound system Contour 8102.2 and recommendations: Boring # 11 Boring FT] E Pit Ground surface elev. 102.2 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 1-7 10YR3/3 sil 2mbk mfr as if 0.6 0.8 2 7-19 7.5YR3/3 sil lmpl mfr cw lvf 0.4c 0.6 3 19-44 7.5YR3/3 f1dIOYR5/6 scl 2mbk mfr cw lvf 0.0 0.2 2 ] Boring # ® Boring 102.2 24 Pit Ground surface elev. ft. Depth to limiting factor in. F Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 1 0-12 10YR3/3 sil 2mbk mfr as if 0.6 0.8 2 12-24 7 5YR3/3 sil lmpl mfr cw lvf 0.4c 0.6 3 24-48 7.5YR3/3 f7d10YR5/6 scl 2mbk mfr cw lvf 0.0 0.2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effl nt = BOD 5 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signaturg CST Number Thomas W. Gedatus ~ 4 962178 Address Date Evaluation Conducted Telephone Number 670 10th Ave. #17 Baldwin, Wisc. 54002 5/19/2016 715-684-5166 SBD-8330 (Rl I /11) Lyle & Sonja Gunderson Trust 008-1086-20-000 2 6 Property Owner_ ParceIID# Page of 1 Boring 3❑ Boring # Pit Ground surface elev. 101.8 23 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 1 0-9 10YR3/3 sil 2mbk mfr as if 0.6 0.8 2 9-23 7.5YR3/3 sil lm I mfr cw Ivf 0.4c 0.6 3 23-45 7.5YR3/3 fId10YR5/6 scl 2mbk mfr cw lvf 0.0 0.2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate : Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 ❑ Boring # Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/- and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SB13-8330'rw (R) 1/11) Ly~~ SC) CA C-~~nc~ecSO~ tiq u5 +4wy (2- 0 ti I cL w:n, kJ ~S~• S`fOOZ Sd~N T TO SC•PsLE V ~ b ~ os~~ (tea r ~ ~ t res) N w '/y S W `A4 S 3 o TZ &N R ~(o VII ~D~ oog-~o86-Zp--ooo Tc~ w n o Ea A CIA 61 ~ ~ro'a,c c o u n'a'y I ~ ~j EL 1C)> '1, 102,E g-Z 9o g-1 lua•a~a-~ t Is, L 102-10 - - ~ EL 102-00 E I-- I o J Ala - O~ - - T ~L o/. ISO' ~c~cr Ma~K j e oe o + SUrw~y 'j ~1 C .S -7- 9 z/ 7 8 El- ioo. 00 W r J ~ Z t O ~ LL m m a a `o C omZ. O 4 m m o c C.) @E irC a $ n 0 0 N 2L ro Z age m o m~m~ 6 o Em°`° ~ c U ui ~ gm6 C) wmc w Lm` s 3 Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. j 78-1086-20-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. PJ~ Please print all information. Re ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Lyle & Sonja Gunderson Trust Govt. Lot NW 1/4 114 S T 28N R 16E (or) W® Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 149 US Hwy 63 City State Zip Code Phone Number []City rJUllage ■ own Nearest Road Baldwin Wi 54002 ( 71j5 684 3930 F-21-1 C42111- US H 63 µ'Y New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Q Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable NA ft. General comments Mound system Contour n 102.2 n A and recommendations: palt _ n FtJ`1 ZaA 1❑ Boring # Boring Q Pit Ground surface elev. 102.2 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 1 1-7 10YR3/3 sil 2mbk mfr as if 0.6 0.8 2 7-19 7.5YR3/3 sil mp mfr cw lvf 0.4c 0.6 3 19-44 7.5YR3/3 f1d10YR5/6 scl 2mbk mfr cw lvf 0.0 0.2 F 2 Boring # Boring 102.2 24 0 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 0-12 10YR3/3 A 2mbk mfr as if 0.6 0.8 2 12-24 7.5YR3/3 sil lmpl mfr cw 1vf 0.4c 0.6 3 24-48 7.5YR3/3 171dIOYR5/6 scl 2mbk mfr cw 1vf 0.0 0.2 * Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = OD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Thomas W. Gedatus ~ Iv- 962178 Address Date Evaluation Conducted Telephone Number 670 10th Ave. #17 Baldwin, Wisc. 54002 5/19/2016 715-684-5166 SBD-8330 (R] 1/11) _ CSrr-a~)~► .~3 ORIGIN" Property Owner Lyle & Sonja Gunderson Trust Parcel ID # 008-1086-20-000 / Page Z of / ❑ 3 Boring # Boring 101.8 23 J/ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cant. Color Gr. Sz. Sh. ff#1 * ff#2 1 0-9 10YR3/3 sil 2mbk mfr as if 0.6 0.8 2 9-23 7.5YR3/3 sil Im I mfr cw lvf 0.4c 0.6 3 23-45 7.5YR3/3 f1d10YR5/6 sel 2mbk mfr cw lvf 0.0 0.2 ❑ Boring # CI Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 Boring ~w.tw1 Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 *#2 I * Effluent #1 = BOD 5 > 30 < 220 mg/- and TSS >30 < 150 mg/L * Effluent #2 = BOD s < 30 mg/- and TSS < 30 mg/- The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330Te t(R11/11) i EL 102-00 - - --~5 - - - E 1.. 101 0 - - _ E L F. L X30 i tr~yttG~~ ~jC^Gh MAfk; . -roe o f S4r~►~Y k-M cs T- 9 z i 8 E~. X00.00 Pa Q C_ _2 n L/ ~ Lyl~~Son~a C~nncie~p,r, jyg us +4w7, 1Z ~sm_ -03s O R I G I N ge t c~ w (~7 TS. c- ~ ~f O O Z ~ Scatt , 5di~►0 - --O sc^Le' - os~.~ a r c y~ ~.s ! ~ P I NW 'Ay t5 \,\J 'A4 S 30 TL &N R!6V'l -~:D-4~ 0og-i086-ZO-000 w n C -P £a sn (I I t e ro•%-c C o u n'1'y ~l \I9 i ~o J EL ~o'..z ~L io lot 0 EL 10200 - --~5 - - E I 0 7, 40 ~ - \0 - E L Iot. Qe --r T L /o/ E30 12>0 i c, Ir UM`~ -roe a f S4n►,%.Y P61 q e _2 n L/ ORIGINAL ' Sm , do it o Nmm o f ~~A m mn3 0 c o c~ O v x~~N z _s Dpp O 4~1 O vb ~ W O oma x m m CD r r~, G M1 ~O m