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HomeMy WebLinkAbout038-1058-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 589800 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: Harlan Vehrs TOWN OF STAR PRAIRIE 038-1058-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Om 1 14.31.18.255 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic flu +4_11~11. Moo Benchmark /aZ. / Alt. BM jL '2I Aprafinn ( T (~C Bldg. Sewer ZZ Holding St/Ht Inlet I1 `t 96.37 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. Vent o Air Intake ROAD Dt Inlet Septic Dt Bottom 7 N.0 Dosing 7 /CO 1 19-9 3(0 ~3 l Header/Man. 7.61 ` 3 Aeration Dist. Pipe IS, Z, 4 !Z 44. C) Holding Bot. System p c~or f, Final Grade , PUMP/SIPHON INFORMATION c?$.4 Manufacturer r Demand St Cover ~l 37' L 97,1 l GPM Model Number M 4- TD Lift Friction.Los System He TD ~O Ft ooo~ / Forc ain Length if Dist. to Well SOIL ABSORPTION SYSTEM /p7 ' BED/TRENCH Width Lengt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ±2 f SETBACK SYSTEM TO III P/L BLDG) I Pi WELL LAKE/STREAM LEACHING Manufacturer: t INFORMATION Type Of System: CHAMBER OR A ) UNIT Mode6umber: p - 0 A-1 e,4 4. DISTRIBUTION SYSTEM A4 8- 3 4- 3 ~f !v5 A Z Header/Manifold Distribution x Hole Size x Hole Spa ' g IVe o Air I ke Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ti Al C Bed/Trench Edges Topsoil Yes ~o Yes ~N, J COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1230 CTY RD C/C ~C VX e~ 1.) Alt BM Description = F, s~e~ to g LA 2.) Bldg sewer length = 5f - amount of cover = 7 ZIO Plan Use otheriside q for additional Yes information. SBD-6710 (R.3/97) Date Insepctor'egnature Cert. No. County v P Division '2< M ECEIVED Safe and Buildings W. Washington Ave., P, Box 7162 Sanitary Permit F Number (to be filled in by Co-) F _ Madison, Wi 5370-i62 -AUG ~.29 2016 T~Sac2ion Numbrr voMMI INITY ER mit Application QHI~j~PVNSA In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for Stara-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary PuWses in accordance with the Priyacy Law, s. 15. 1 m), Stats. r / L Application Information - Please Print All Iaforma . n Property Own ' Name C le, I parcel # r to r,/ Cllr 4 ~ z 0", -z ell Property Owner's Mailing Address _ Property Location Govt. Lot city, state Zip Code Phone Number Section , r~ i' le one to 11. Type of Building (check all that appI # T _ N; R f E W1 or 2 Family Dwctling -Number of ` SurbdiKision Name Block A Y-16 Public/Commercial-Describe Use LeA-M 11 city of ❑ State Owned - Describe Use CSM Number ❑ Village of ` Z- W Z '~'Z G.► G.~ own of ,T' _ J IIt. Type of Permit. (Cbeck o ly one box line A. Complete line B if applicable) ~zo A. 1~lew S Q ystem eplacement System ❑ Treatment/Holding Tanis Replacement Only ❑ Other Modification to Existing System (explain) B. 11 Permit Renewal 11 Permit Revision 'Ell Change of Plumber Q Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / P^A k, n- IV. T ofPOWT'S System/Component/Device: Check all that a 1 ` S l on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in of suitable soil 13 Mound <24 in, of suitable soil /1 y ❑ HXr.;Tank Other Dispersal Component (explain ❑ Pretreatment Device (explain) C•~ V. Dis rsalrTrea ent Area Information: Design Flow (gpd) Design Soil Application Rat f) Dispersal Arca Required (s Dis Area Pr se s System Elevation ~ ;y 6-3' VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ~ 1~1 ~ m o U ~.J ~ rte.. 7 P Septic or Holding Tank t Dosing Gliamber ~ VII. Responsibility Stateme - 1, the undersigned, assume risibility for installation of the POWTS shown on the attached plans Z Plumber's Name (Print) ) Plumber's Si e MP/MPRS Number Business Phone Number Plumber's ess (Street, Zip Code) CA VHIL.oCountv/Department Use Only Approved Permit Fee Date su I.ssnina. t Signature 105.00 g 31~ Ito ven Reason for Denial iK Condi •ason _ or D' pproval 3~ 1 -s 66, 4b 4 ~ cO SA be Ikke f al pry 0 w * Phn PMVWG by plumber. t!.~ 40A, i 3 t l WAM be MWr*I led n pllr opplaft COOK I ordWanow. 1clid Attach to eompiete plans for the *stem and submit w the Cofty7only oa paper not Tess than 8 in x 11 mches in size S. S13D-6398 (R. 11/11) System PLOT PLAN PROJECT Harlan Vehrs ADDRESS 1230 Ctv Rd C New Ri chmond Wi 54017 SE1 1/4 SW3 1/4S 18 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 95.094.5' 4.5' below grade 8/25/16 BEDROOM 3 DATE CONVENTIONAL CONVENTIONAL LIFT XX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE (DWELL *H.R.P. same as benchmark Scale = 1/4" = 10' Cty Road C Vent New Well >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ftA2/pair of end caps 12" ~'~,ong Grade at System Elevation 34" 130' Vents 98, 2-3' X 94' cells with >3' spacing -2 B-3 3 Existing 3 Old Well 5% Slope Bedroom (abondonded as per House WDNR Code) 40' B.M.* 15' 40' S' Old system is to be pumped and 31 A, buried ST Huffcutt 80' Combo Tank CIO d~ a~ Dw 90' B-1 20' Driveway 150' le Nf. All piping shall be ASTM SDR 30/34, within+ P 10' of tank, piping shall be ASTM F891 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/25/16 Owner: Harlan Vehrs Location: SE 1/4 SW 1/4 S 14 T31 N,R18W 1230 Cty Road C Star Prairie System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section n 9. Pump Curve 10.-12. Soil Test i Signature License number #220 I System PLOT PLAN PROJECT Harlan Vehrs ADDRESS 1230 Ctv Rd C New Ri chmond Wi 54017 SE1 1/4 SW3 1/4S 18 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 95.094.5' 4.5' below grade 8/25/16 BEDROOM 3 DATE CONVENTIONAL CONVENTIONAL LIFT XX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' Cty Road C Vent New Well >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps `bOk'Ong 12" Grade at System Elevation 34" 130' Vents 98, 2-3' X 94' cells with >3' spacing -2 B-3 3 Existing 3 Old Well 5% Slope Bedroom (abondonded as per House WDNR Code) 40 B.M.* 15' 40' 5' F~ - - Old system is to , be pumped and 3 buried ST 60' Huffcutt 80' Combo Tank DW 90' B-1 20' Driveway 150' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99.5' Vent Grade Vent 3' 4„ 3' ,30/34 Septic Tank 1 5' Long 5' S' Long 1 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 94' Cells Same on other end Observation tube/Vent At end of cell A B 23 chambers per cell System elevations: A-95.0' B-94.5' ST. CROIX COUNYf SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer- 4 1 Mailing Address Z ✓ C---~ / / o Property Address IZ 3 b C4 (Verification required from 3anning & Zoning Department for new construction.) City/State Parcel Identification Number J 3 3 - 39' lr`~?ZJ`b LEGAL DESCRIPTION Property Location ~ % j4 Sec, T N R W Town of ✓ ~r~;t~~ Subdivision V C/' Lot # Certified Survey Map # , Volume Page # r Warranty Deed # Volume l Page # -2 --7 Spec house 0o) Lot lines identifiable yes no SYSTEM MAIMNANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system owner maintenance responsibilities are specified in §Comm 83.52(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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departmont 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 Plamin & Zoning Department within 30 days of the three year expiration date. B Uwe certify that all statements o this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a / deed recorded in Register of Deeds Office. Number of o3SS~ --z MNTURE LICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (RF,V. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r "1/ ' Septic Tank Capacity tcro- al ❑ NA Permit # Septic Tank Manufacturer ❑ NA ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA 1 Number of Bedrooms O NA Effluent Filter Model ❑ NA i Number of Public Facility Units ;WL.NA 'Pump Tank Capacity al ❑ NA j Estimated flow (average) -3v aVda Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) avda Pump Manufacturer ❑ NA Soil Application Rate ,J aUda lif Pump Model ❑ NA i Standard Influent/Effluent Quality Monthly averagee Pretreatment Unit p NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA D Mechanical Aeration O WWand Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODr,) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) 40 Total Suspended Solids (TSS) 40 mg/LNA ❑ At-Grade ❑ Mound Fecal Colifonn (geometric mean) 5104 cfuH ooml ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size X in dia. ❑ NA Other ❑ NA 10ther. Other: D NA "Values typical for domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE V Service Event Service Frequency linspect condition of tank(s) At least once every: ❑ month(s} Maximum 3 -ears ( Yore) ED NA (Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA (inspect dispersal cell(s) At least once every' 11 month(s) 'year(s) (Maximum 3 years) ❑ NA (Clean effluent filter At least once every: ❑ month(s) ❑ NA -1 J21 year(s) nspecf pump, pump controls & alarm At least once every: 1 ❑ month(s) year(s) ❑ NA i9ush laterals and pressure test At leLoonneee every: ❑ onth(s) ether. ❑ year(s) NA At leevery: ❑ 13 month( Year(s) ar(s) } ether: NA NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made 'by an individual carrying one of the following licenses or certifications: Master PPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections must iindude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of i=mbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 'visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local Igulatory authority. I+Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of j;he tank shad be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 14JI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, 13nd 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. 1 Page of 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 chemicals th-It 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 POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; d'rslnfec ants; fat; foundations 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 propetiy and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • Ail 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 property 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 fined 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 systeim. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nOed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule: 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 installedl as a last resort to replace the failed POWTS. ❑ Mound and at--grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO MOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANIf UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - POWTS INSTALLER POWTS MAINTAINER Name Name u--- Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~.1 Name Phone Phone This document was dratted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. CID 0 ~ I i i i _ o P F i f 71, TIVI ii - - ;f j Septic-Dose Wank Cross Section And Pump Performance Specifications tMax. anufacturer 11 Pump Manufacturer u odel Number Pump Model Number A-1 3 ank Capacity Alarm Manufacturer ury Depth Alarm M odel Number Switch Type C C' ,~GG 2lit~. Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number r~ Elevation Head _ Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM1 @ Ft TDH Total Outlet Manhole Min 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Locking Device < 6" Below Grade Sealed Watertight Weather-proof Junction Box F ITlis. Grade Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Tnlet. Baffle - - - - - Inlet A l4» Switch Setongs and Reserve Capacity Weep Tank Volume = GPI B Hole Dimension. Inches Volume Gal. (reserve) A' E evation C (alarm} B 2 Ft (dose) C Bottom ` (d D Elevation ew) D ~ ~ Total . , a , 'a,`•> > f ,~i Ta...( < . a a 1 l;t>aay.<a..~/•a•i >°i >•a•a•i >•r°>•S•>'a'i >`a `r a°a >•>•i a~r~r~a i. fir; ~>~>~>~a ~a aai .'i a>ta l't'la a'c'.>i 'i i .''a' INSTALLATION. The septic/dose tank is bedded and back filled in accordance manufacturer with the may not GENERAL manufacturer's product approval specifications. Maximum depth of bury as specified by the menu be exceeded without prior approval. Manhole covers ~ have o t~,he tank wig wa egtight fi (padlock) and installed. Piping at the inlet and outlet is of approved laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. Page of ozias U _r AL DYNAMO, H`AD/ APACITY HEAD CAPACITY CURVE PFR MINUTE MODELS 53/55/57/59 EFFLUENT AND DE'NA ER':NG 25 j Model 53/55/57/59 i 20 6 i Ft !Meters '_trs. < I 5 1.5 43 63 0 3.' 3c ' 29 < \ Q z 4 15 4.6 ' 19 72 10 ~5,,t-off HecS 19.25 ft. (5.9rr~ o 2 1 5 --:3 ,5/15~E 5/32 -1 I I L 5/a ~l /2 - i NF l 10 2P 3C 40 5C U. S, GALLONS 1 LITERS 80 160 V/lo 0 SLOW PER MINUTE 009897 - / = Variable level float switches available. Variable level long cycle systems available. -ice Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. Duplex systems available. f 3 3132 1 L~11r"t~ SK858 Single Seal Control Selection Listings Model Votts Phase i Mode Amps Simplex Duplex CSA UL ; 1. Integral float operated mechanical switch no external control required. M53/55 & M57159 115 1 Auto 9.7 1 - Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55 & N57!59 115 1 Non ~9.7 2 3&4&5 Y YY float switch. Refer to FM0477. BN53 115 1 Auto 9.7 Y Y 3. Mechanical alternator "M Pak" 10-0072 or 10-0075. BN57 115 1 Auto 9.7 N Y~ I of Electrical Alternator. 4. See FM0712 for correct mode BE53 57 230 1 Auto 4.8 - Y Y I y Y 5. Variable level control switch 10-0225 used as a control activato•, with Electrical t D53/55 & D57/59 230 I 1 Auto 4.8 3 or 4 & 5 Y Y Alternator (3) or (4) float system. , E53l55 & E57l59 230 1 Non i 4.8 2 Single piggyback switch included. A CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. _C, P _ For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - - - - - MAIL TO: P.O. BOX "F,141 Louisville, KY 4025&-_ Manufacturers of. . SHIP T0: 3649 Cane Run Road Louisville, KY 40211-1961 &AZ/TY 41AI-9 pNCE llgYAY ~ ® zz (502) 778-2731 •1 (800) 928-PUMP http://www.zoelleccom PVMP !0 FAX (502) 774-3624 © Copyright 2002 Zoeller Co. All rights reserved. RECEIVED L's Wisconsin Dep yn`A-1=ce SOIL EVA, 6HNBW4ZVB5H02 Page of Division of Safety and Buildings ST, CROIX COUNTY in accordance with Comm 85, Wis. Adm. Code ~y tPIEVELOPMENT County ~ ili" Site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Att include, but not limited to: vertical and horizontal reference point (BM), direction and Parcei I.O. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 6 Xf/, Govt. Lot 1 /4 1 /4 S T j N R E (l ( W Property Owner's Mailing ddress Lot # Block # Subd. Name CSM# J U4 City S e Zip ode Phone Number ❑ City ❑ Village (}Town Nearest Road / X ❑ New Construction Use: Residential /Number of bedrooms --Code derived design flow rate _-'7fU GPD Replacement ❑ Public commercial - Describe: Parent material Flood Plain elevation if applicable 'Pd/ J ft. General comments 41 and recommendations: /V ` y/_ ,r / j+~{T~; ~'r2~7! System Type I J /'S'ystem EI ation~ D/ '1 9 6 Boring # Boring F I 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 7 F3 wl"4- a # ❑ Boring Boring r ® pit Ground surface elev9 ft. Depth to limiting factor Z/ J 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 4 77- I I Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) i ature CST Number Bird Plumbing, Inc. Shaun Bird _ 226900 Address / Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 ~i~ - / 4 715-246-4516 Property Owner _ Parcel ID # Page of Boring ® Boring # E] ry~ ILy. Pit Ground surface elev. 011 L r ' ft. Depth to limiting factor a• 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 r, -I 7~ ~ Sr ~J r 1~ it -liv 46 'di'000, ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-9330 (8.6/00) Property Owner _ Parcel ID # Page of Boring # E] Boring q pit Ground surface elev.' _ ft. Depth to limiting factor On. 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 c 4J~Z4 C-, -fi C6 4 ❑ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg(L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Soil Test Plot Plan Project Name Harlan Vehrs Sha"' 'rd Address 1230 Cty Rd C New Richmond Wi 54017 ~ C M #226900 r~ Lot Subdivision Date 8/25/16 SE 1/4 S W 1/4S 14 T 31 N/R18 W Township Star Prairie Boring o Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 95.094.5' *HRpSame as Benchmark Scale is 1" = 40' unless otherwise Cty Road C noted New Well 100' 130' 98' -2 B-3 30' Existing 3 Old Well 5% Slope Bedroom (abondonded as per House WDNR Code) 40' B.M.* 80' 15' 40' 5' 3' ST DW B-1 20' Driveway 150'