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HomeMy WebLinkAbout004-1012-95-400 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 592103 State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2740608 Permit Holder's Name: City Village Township Parcel Tax No Taira & Nicholas Wallin TOWN OF CADY 004-1012-95-400 CST BM Elev: Insp. BM Elev: BM Descriptionh Section/Town/Range/Map No: I d~lst s d ( 06.28.15.87D TAINK INFORMATION ELEVATI DATA TYPE MANUFACTURER CAPACITY STATION B I FS L V Septic Benchmark 5, 2 7 9~ 2 9y. Dosing / Alt. BM Aeration Bldg. Sewer Holding , St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent toir Intake ROAD Dt Inlet y Septicl Dt Bottom l 7;~ Dosing Hea r/Man. ' X7.3 Aeration Dist. Pipe Holding Bot. System , 7 Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand 8t-C" eerr "7 J }e:'__ . GPM - lei kI t / •U l Model Number TDH L ft~ Frictionf ossSystem Heat.. TD _ t I e , Forcemain Lent Dia.. Dist. to Well dk- SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengtt,Y Not Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid DeW DIMENSIONS v SETBACK SYSTEM TO P/L P BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR (JK- Type Of System: , _ r• l e1 ' ) °•j)~ ` UNIT Model Num t T'2 G1-Iv a(Z DISTRIBUTION SYSTEM Head Manifold r . Distribution io-j rle Size r1e Spacing Ve to Air Intae Pipe(s) o~ ) t Length Dia Length Dia 1 • Spacing SOIL COVER X-Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over q Depth Over xx Depth of. xx Seeded/Sodded Mulched Bed/TrenM,C~ ~ t Bed/Trench Edges Topsoil t Yes No Wes No ti COMME S: (Include cod)iscrepencies, persons present, etc.)~,;vlN Insple~n #1: • 15' I Inspection #2: Location: 553 270TH ST Low ~ C h;13ti P10W U410P 74 JiSc -i 0 t -1+"fnr4a mowed rass c~i ~n s G6~d, 1.) Alt BM Description - jo,~~ LtW- r 2.) Bldg sewer length = !\I I ~ { a -t f a 1 S ?YSA I Cell e~ - amount of cover =1 n 1 ! to,,, VY, Plan revision Required? ❑ Yes 1 No ~_-t: J, Use other side for additional information.`--? l Date Insepctor's ignature Cert. No. SBD-6710 (R.3/97) J j,j ;RECEIVED C'r Safety and Buildings Division St St. . Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be [illcd in by Co.) 4 S P ! Madison, WI 53707-7162 AUG 23 216 ST (-ROIX COUNTY -,OMMUNIT`rMARF~ rmit AppliCati 3425NNEF02T~ State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to 0X _ _ governmental unit 2740608 is required prior to obtaining a sanitary permit. Note. Application forms for state-owned PO\yTS are submitted to pro, cot Address (of diftarentthan mailing address) the Department of Safety and Professional Services. Personal information you provndc may be used for second, t purposes in accordance with the Privacv Law, s. 15.04(1)(m). Stats. 553 270d' St., Woodville, Wl, 54028 1. Application Information - Please Print All Information Property Owner's Name Parcel h I?^n._ Y*.Q,r&Ql1 4- j a L • v~ 004-1012-95-400 Property Owner's Mailing Address Property Location o 645 270' St. Govt. Lot City, State Zip Code Phone Number -SW-, -o, N W , section 06 (circle one) Woodville, WI 54028 (715) T _ 28 N_: R 15r or W It. Tempe of Building (check all that apply) Lot u 3 Subdivision Name I• z or 2 Family Dwelling -Number of Bedrooms 4 Stook # CSM ❑ Public/Conin ercial-Describe Use s 11 City of Na State Owned Describe Vse CSM Number ❑ Village of 'to own or CAN, CSM Vo1.17, Pg. 4618 Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) ❑ New System eplacemcnt System ❑ Treatment'HoIding Tank Replacement Only ❑ Other Modification to Existing System (explain) 13. ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Isled ❑ Change of Plumber 11 Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a lv d ❑ Non-Pressurized In-Ground ❑ Pressurized hi-Ground ❑ At-Grade ❑ Mound % 24 in. of suitable soil P'5-found 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)_ Ira V. Dispersal/Treatment Area Information: Existing Zabel A-100 effluent filter at ST outlet t Design Flow (gpd) Design Soil Application Rate(gpdsfl Dispersal Area RequirA\\ ispersal Area Proposed (sf) Scs ,levation 1.0 Gpd/sq. ft. ASTM-C33 sand 96.75at 21" above 450.00 Gpd 0.4 G d/s . ft. native soil 450.00 s q. ft 480.00 Sq. Ft 95.00' contour VI. Tank Info Capacity in Total Y of Manufacturer v Gallons Gallons L"nits o y U N N n ~ New Tanks Existing Tanks cl- A-160 0 Septic or Holding Tank Na 1,000 1,000 1 Wieser Concrete X nosing Chamber N( 600 600 1 Combination ST/PC X VII. Responsibility Statement I, the undersig ed, assume responsibility llation ofthe POWTS shown on the attached plans. Plumber's Name (Print) ~11umber's 'ignature MP/MPRS Number Business Phone Number James K. Thompson s---~~ MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State, Li ode) 340 Paulson Lake Lane, Osceola, WI 54020 VI . Count v/De artment Use Only Approved [ Permit Fcc Date sued Issuing Signature ",6. q su I l~ eason for Denial IX. Condi,QiT-W11 ~Reasons for Disapproval 1. Iiptbs tank, filtr.'.and ~1 0 • ~ 1 f0 rxai oglintust all Qtr ten*-" !maint irec J/ %L e-~ • ~Gr / aggtnent plan provided by plumber. are, ~ ti l~Jl Mig be 2 ` I q~l saintained l` as PK 4* Attach to complete plans for the system and submit to the County only on paper not less than S 112 x 11 inches in size SRI)-6398 (R. 1 111 1 j ♦ Ek 5~'O gradc .elzl' Pas~4re Z)O,, t7Q ljzZ4-Sr r-,/o,-gv. ujc,cdd://e, WI. SYo?,~ G3 ~o~f Ice Lane 5~. CroiYSee- ~v)l. re PLC ~DOS~ /O/.L-9S-S~~ be; S, v / a c,-es o y~ l A Vic' d ~~0 / r I r O i rl B 3 ~ r ~ ~r p ~ hr~ Ip ~t1 e nG~i a l ~ ~ks~t-o~» 0{ 5, cl,'n 1 ~0c~l73 i'1$-a.Ila&"C^l '1,,51oe 6cr7 ~4 rE'{~~{~Cu+np/eEcdB/oy~,ZoOS, ~'i I \ o / Nlj uy fro ox¢d 2~wtic driu A16. B rrl.t 7'0~ o~'f?C. i/a de Con~a.~td vi P /nu++k olccGC/%/ :93.07,. W- Ma..l ak r ~~s fp sip /.'Is' U q a.~a~CL e o' / JoAr/,~. ~vrceww;n ~jj 5 tI'7cj 7' EXrS2i Z" c4lC~ 3 hedravcn--/ s~.yc~r?v~ T` ~'arccww+~r^ ~o-~c 0 i w~ P 1, ~/G a7 yt ? C u~l~r%a•~,~-~ Q~ s y~,o ~ . w/ ~ (,c/ A~ f rfl e-~/rwrf. EXiS ~'n q rr7 d w, d cJ/ ltyd~a/"C {ter/u C.~.SUd~ ~7~•o.,f. s.ra~r,r✓~, ~x/s~~ at 54.-,~~ro~r.,P;~~{~c. f~ u-.1.ya a{,a eler~-: B/.7~"; f~,~. ~o1a~d ~f`ema;n:a,P/dce P~ i LS 2`~-~J ~rd u.H/'~ ~n~ r/1ti~~' i n /J ~E C~ bG L,~ri~ ~✓iGe G/e(~' ' a~g.8 Z~GI `f ~.f /GUY ~J Q~t'tY ~'YQQI /c S t~• n~ G,2$. Sro ~ 0 10~ ~%n e. P~ . 9 0 /o Mound POWTS Index & Title Sheet Project Name: Peterson 3 Bedroom Replacement Mound Owners Name: Donna Peterson Owner's address: 645 230th St., Woodville, Wi 54028 Site address: 553 230th St., Woodville, Wi 54028 Project Location: Subdivision: CSM Vol. 17, Pg. 4618 Legal Description: SW%NW%, Sec. 06, T.28N., R. 15W., Town ofCadte, St. Croix Co., WI. Parcel ID 004-1012-95-400 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Existing tank certification Page 4 Septic Tank Maintenance Agreement Page 5 Warranty Deed Attachments: Soil Evaluation Report Mater Pin er Restr ted Service: James K. Thompson, DSPS Credential #30021 Signature: Date: Page 1 of 5 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ~tiyNRTAfE , DIVISION OF INDUSTRY SERVICES Toy 3824 CREEKSIDE LN HOLMEN WI 54636-9466 0 a Contact Through Relay P K http://dsps.wi.gov/programs/industry-services ~y S ~w www,wisconsin.gov o ,1 ~-yossior ~tiS~e Scott Walker, Governor Dave Ross, Secretary August 18, 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 1101 CARMICHAEL RD OSCEOLA WI 54020-5413 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/18/2018 SITE: Identification Numbers Donna Peterson 553 270TH St Transaction ID No. 2740608 Town of Cady Site ID No. 826647 St Croix County Please refer to both identification numbers, SW1/4, NW1/4, S6, T28N, R15W above, in all correspondence with the agency. Lot: 4, Subdivision: CSM in Vol. 17; Pg. 4618 FOR: Description: Three Bedroom EZFlow Mound System / Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1613394 Maintenance required; Replacement system; 450 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual, (R. 7/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); (1) Zoeller Distributing Valve; 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 CONDIT requirements. APP 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. DEPT OF S The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESSIO DIVISION OF IND Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. p • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made wi - 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. • 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 Page 2 8/18/2016 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. Sinc Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 and M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with t "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. I JAMES K THOMPSON Page 2 8/18/2016 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. Sinc Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 and M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swiin@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed SPS Chapters 360-366. EZf/ow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application U INDEX AND TITLE PAGE E ( U?~ IT- Project Name: Peterson 3 bedroom replacement mound Owner's Name: Donna Peterson Owner's Address: 645 270th St., Woodville, WI 54028 Property Address: 553 270th St. Legal Description: SW1/4 NW1/4, Sec. 06, T.28N., R.15W. Township: Cady County: St. Croix Subdivision Name: CSM Vol. 17, Pg. 4618 Lot Number: 4 Block Number: Na Parcel I.D. Number: 004-1012-95-400 ONALLY Plan Transaction No.: OVED '4FETY AND Page 1 Index and title AL SERVICES Page 2 Data entry JSTRY S£ Page 3 EZf/ow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan Page 10 Attached Soil Evaluation Report Z ZELAXX VA EVE Designer: James K. Thompson License Number: 30021 Date: 07/10/'16 - Phone Number: (715) 248-7767 Signature: = Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) EZflow Mound Version 3.0 (R. 3/1/12) Page 1 of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) { 3.50 Site Slope 95.00 Installation Contour Line Elevation (ft) ,120.00 Contour Length Available (ft) 15.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpolft2) Distribution Cell Information 6.00 Cell Width (ft) 3, 4, 5, 6, 7, 8. 9 or 10 Only 80.00 = Dispersal Cell Length (ft) 0.95 Dispersal Cell Design Loading Rate (gpd/ft2 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest poir in the distribution I Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.00 ft2/orifice t 2.00 Forcemain Diameter (in) { 140.00 Forcemain Length (ft) Does the forcemain drain back? Y 81.00 Inside Pump Tank Elevation (ft) Enter Y or N 0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft) x 1.3 22.84 Forcemain Drainback (gal) 15.50 Vertical Lift (ft) 71.93 5x Void Volume (gal) 3.23 Friction Loss (ft) 94.76 Minimum Dose Volume (gal) 25.23 Total Dynamic Head (ft) 32.95 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x .w 1.00 1.50 x x 1.25 2.00 E 1.50 x x 3.00 2.00 x 3.00 x i Gallons/Inch Calculator (optional) Treatment Tank Information 603.36 Total Tank Capacity (gal) 1000.00 Septic Tank capacity (gal) 36.00 Total Working Liquid Depth (in) Wie ersers Concrete Manufacturer 16.76 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 12 603.36 Dose Tank Capacity (gal) rPL5ff25 Filter Manufacturer 6Ckb(`~ 16.76 Dose _Tank Volume (gal/in) ~Filter Model Number {Wieser ConcreteManufacturer Project: Peterson 3 bedroom replacement mound Page 2 of 10 Mound Plan View T 1/106 J Observation Pipe K::. 5 A W - B ~ I I_I I • L Mound Component Dimensions ft K ft B ft F 12.00 in z ft L ft A Ain ft E 23.52 in H [A[ilft D G 0.50 ft J ft W 480.00 (ft2) Dispersal Cell Area 1407.82 (ft2) Basal Area Available 5.63 (gpd/ft) Linear Loading Rate 8.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 98.75 (ft) ar; ~t rrrrrrr«rrrr `'~`.ay"`ya ` t t¢ a rrrr rrrrrrrr 2 rrrrrrrrrrrr`~~.`~?~:,... G rrrrrrrrrrrrrrrrrrr irr~rrrrrrrrrrrr a. 1 F Dispersal Cell 97.25 (ft) Lateral 96.75 (ft)--►• yc 6invert Elevation . Dispersal Cell . D s Elevation E...:... ❑ a„^^ q 95.00 (ft) Contour Elevation 3.5 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Topsoil Cap > a 2 rrrrrrrr Subsoil Cap c o Approved Geotextile Fabric Cover ASTM C33 Sand a) 0 ° 2.0 ft 1 75 ®0 Tilled Layer L 0 Q F 0 EZflow Media s in 0 0.5 ft A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Peterson 3 bedroom replacement mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below Turn-sip rrfballvalve orcleanoutplug . 1st orifice located Z I.X?r2aly, p,lyd except pry 51h one poiclts down for drainage. Force main eonnK~Wn via to o . vss to mareifoW at .ang point L~t~raa$ ~ f~rtc r rrrair~ ~ PVC Sch 40 All laterals identical with orifices equally spaced. per SPS Table 3a4,U-6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 79.20 ft Orifices per Lateral 40 Lateral End (Z) 0.81 ft Orifice Density 6.00 ft 2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 16.48 gpm Manifold Diameter 1.50 in System Flow Rate 32.95 gpm Forcemain Velocity 3.37 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect ---!ll--- Tank component is properly vented E- 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 19.35 324.24 B 2.00 33.52 C P4 ump off elevation (ft) C 5.65 94.76 -t 81.75 D 9.00 150.84 D Total 36.00 603.36 Dom se tank elevation (ft) Bedding And Backfill As Per Manufacturer 81.00 Alarm Manufacturer SJ Rhombus Alarm Model Numbe SJE 1011421 Pump Manufacturer Hydromatic (Existing) Pump Model Numbe SP50H Pump Must Deliver 32.95 gpm at 25.23 ft T D H Note: Switches containing mercury may not be used in this system. Project: Peterson 3 bedroom replacement mound Page 4 of 10 EZflow® Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 6 ...'..1..{`.l. ..1..1..1. ?.,1..1.1•~ '...,1•~','. ,._i_i.:i..; Component Legend SR1-7A Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths - SR3-12H or EZ 1201P or 61~ ~ SR3-12H in 5 ft or 10 tt lengths Q 4" Perforated Distribution Pipe With Pressure Lateral Inside Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 80.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Force Main 6ftWide End Manifold Project: Peterson 3 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Jmaes K. Thompson _ _ Phone((715) 248-7767 0 POWTS Regulator's Name St. Croix County Zoning Dept i Phone (715)386-468 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 480 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail FinishedGrade\ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral EZflowSynthetic Media ....1:1.~ %1::. 2.11 Feet Distribution Lateral Lateral Cleanout Project: Peterson 3 bedroom replacement mound Page 6 of 10 Mound Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The mound septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715) 386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system must be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Effluent flow shall be alternated between dispersal cells on a two-year rotating schedule by use of diversion valve. Effluent to be diverted from new mound dispersal cell to old mound dispersal cell at 4 year anniversary of new system installation. Old mound dispersal cell to be utilized for a 2 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Observation pipes within the dispersal cell shall be checked for effluent ponding at 6 month intervals. Levels above 4 inches indicate an impending hydraulic failure requiring more frequent monitoring and may trigger need to alter system rotation frequency. Contingencv 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. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 7a of 10 HYDROMATIC" S P 5/ P 501-1 Pump Characteristics Performance Data Pump/Motor Unit Submersible Exptosion-Proof Sump 40 35 30 - - - + f Rik" SPiX (I LL 2b Z i SP 50 I I 20 15 10 I 5 0 0 10 20 30 40 50 60 70 BO 90 100 110 120 130 CAPACITY GALLONS PER MINUTE - 25;23 ya M.+1:h:~►n~nda~~w.9P/'a.~ - - - - D Im ! ; l Data a^ [102] it V 916 ` 1102] [236] 1 E Materials of Construction t Part Name Material 15„f - - 9T2 - - - 20•,1 2411 1Z NR'r 31" ~t 1sO] a 13 16 - - [1221 , >1 PENTAIR 0~/0 CG O Soi/eda/cca~'UniD.~b ♦ Ek.s'~ ~r4dc ~lc~ Scale: PaS'~kV'e bcnrm P2~1/S~m/0/c~4, 6.r3 2 70 ±'St - uJ,,odd://e, c..)4 5110.26 G3 s~~~td /ot dine Sw%yrlu~%y Sec L r.zbA•, t'7Ziil.j S J/ QGrG3 tl qo 0 c9 , ~~~pose~/yfer~..~c✓G.E r ~o~ / Elec!• = 99!os a.s~oc.o~,b; ~a / ~I y 9f~z' ~ ~ 10ouJ73%~S-6LAatd-l inSPA~' 7 A~ Rep C'.v,p/cEca/8/oy~zocS A~E.B.r(,: Yoh of PC. ✓'~o o--ed2 drr t/GL~d2 l,c+n~+t~~td in ~w-~~~` r r , \ "E /liccn/~ orCCs~/e{': 93.07,' 1 rul' a,ra~G y~,,o' i /3ropdudzcil . i j i 5 Er ~~7 p Exs 2" F'dret w~a~~/Q~~ 8 l <\~5 olenC2 ~ 4"v Ex,;3Ei~yy uJ~'t,5cr Cor~C~caEc r' . -1,7 /Ion. wlY-a herA-'iev r./"44t EXis~i'ngIndundcJf ~7Ec.-o,£ s. r v,.~r.c,£. ~ x%s,~, ~S hya/ai ~✓,~i/urn ~wrv~l u.,.y~ oF~ elegy B47~: tzrtL~wt~,~, at Sc.,~~ro✓co: ~ ui. a1ow..~d {vI`tma:n:1 fJ eX; is zyira u~/ C /0 u,./,/~ ou.P"~' i n ~ ~ /a cc-d ba ck~r'n 5~✓i Ge lc6 c164A= 68.bz'li~(OSC/OtJ ~j QFtu 3yPar/cSt' O idGri00~ ~XiS~i.•~J~~~' U.28. 56 o /06 An e. P~. y a~/o 'j7T f/jf7/'f~',jy'~ -7 SECTION: 3.20.170 N fl - ~i ~1lA1fTiUtLIPS ' 19,7 fNLf p ` 1 M1628 'W "I yea co"' { a 0602 Ow AX ?t€ t d w © Supersedes Product information presented here reflects 0200 conditions at time of publication Consult factory : regardmg discrepancies or MAIL TO: A.O. BOX 1634' • Louisville, ICY 40256--0347 visit ourwebsite: inconsistencies. SHIP T0; 3549 Care Run Road - Louisville, KY 40211-1961 httpa/www.zoeller.com (502) 778-2731 • 1 ('60C.?) 923-PUMP - FAX (502) 774.3624 ZOE1616CR OK-SITE WASTEWATER PRODUCTS LVT Y q~ ¢Jti*w 4dF SQS'LACR S! .VTfC SYSrEN ACClZSSORISS W~s. tg ul' Zone Valve LPG For zoning of larger.. effluent distribution W networks. Zoning may reduce pump size. COMPARE THESE FEATURES: 1't Never needs lubrication. : Nighlyreliable. 170-0150 Easier to install, easier to use. Best materials & design. Made out of CPVC. j Zone valve body is designed to allow maximum 11 74-0 49 I water flow it i wh e ma ntaining structural sirength. 18 quality tests on every valve. Valve Part Number Socket Connection ~j Easy to motorize, simple to automate. - Two Port 1700(148 2" ID x 2.z OD Can be operated manually. 170-0150 1wz" 1D x 2" OD " 24 Month Limited Warranty. 170-0049 2" ID x 2'h" OD Three Port i 170-0149 1'1z" ID x 2" OD Valve Actuator COMPARE THESE FEATURES- Offers a convenient alternative to manually turning valves. Built in safety & simplicity. Can stop or start diverters in any rotation posi- tion, so the danger of deadheading the pump is eliminated. - ' 24 Volt. 92 Month Limited Warranty. Valve Actuator P/N 170-0050 Distributed b : f tiD P1l~LIP I"~T. Copyright 2002 Zoeller Co. All rights reserved. II Materials Used: STANDARD POSITIONS B. Remove four Phillips-head screws from H Valve Screws: Stainless Steel Standard Plumbing position is with the the valve. Which screws you remove depends on how you mount the actuator. ;Valve Knob: ABS Plastic middle (Port B) as the incoming or com- C. Turn the actuator over so you can see . mon port to the valve (diagram 1). into the brown actuator shaft. There are , Valve Handle: ABS Plastic Standard Mounting position is with the four "teeth. Nate the one which is main body of the actuator over Port B as Valve Cover: CPVC Plastic smaller than the others. Align this small- i in diagram (2). est tooth with the smallest slot on the Large O-Ring (151): valve diverter. Teflon-impregnated plastic `'Note; If the valve or valves are plumbed D. Rotate the actuator white keeping the " ( with Port B as the common port (Stan two shafts engaged until the holes on ( I Shall O-Ring dard Plumbing) and the main body of the g (116): the actuator legs align with the holes 1 actuator(s) is mounted over Port B {Stan- left when you removed the screws in Teflon-impregnated plastic dard Mounting}, there is no need to adjust y step B. i 1 Valve Housing (Main Valve Body): the actuator cams, E, Use the long screws (packaged with the actuator) to secure it in lace. CPVC plastic } p F. Put the valve handle on the actuator ( c Valve Diverter: Class-filled Naryl shaft, Screw down and tighten the lock- ing knob (finger tight only). Valve Diverter Seal Valve: t a c ~ NeverLube'" Material Technical Specifications: l Working Pressure: 50 psi. ~I 1 Burst Pressure: 200 psi. l I Positive Seal Back Pressure: 15 psi [ Chlorine Resistant Place Actuator . on valve so Acid Resistant ACTUATOR MOUNTING ON VALVE smallest key aligns with smallest slot i Ozone Resistant A. Unscrew (counter-clockwise) the lock- ing knob and remove it and the valve SK 1846 'I - handle. . . . _ _ Valve Actuator-- _ t [ PIN 170-0050 € Technical Specifications: Voltage: 24 V,A,C. SK1rst7 - - i 1 Amperage: 0.75 AMPS t . 1 Cycles: 60 HRZ. Wire: 3 Conductor 1 l Black Common r j Reif l Switch Legs White I i' SK 181A SK7fla8 _ _ ALL ZOELLER ON-SITE WASTEWATER PRODUCTS MUST BE INSTALLED IN ACCORDANCE WITH LOCAL ANDIOR STATE PLUMBING AND/OR HEALTH DEPARTMENT CODES. Oc Copyright 2002 Zoeller Co. All rights reserved. _ • 1"i 'IML Materials Used: j STANDARD POSITIONS B. Remove four Phillips-head screws from C Valve Screws: Stainless Steel I the valve. Which screws you remove Standard Plumbing position is with the depends on how you mount the actuator. i Valve Knob: ABS Plastic middle (Port B) as the incoming or com- Turn the actuator over so you can see I mon port to the valve (diagram 1). I i Valve Handle: ABS Plastic I I into the brown actuator shaft. There are 1 Standard Mounting position is with the j four "teeth". Note the one which is Valve Cover: CPVC Plastic main body of the actuator over Port B as smallerthan the others. Align this small- i in diagram (2). est tooth with the smallest slot on the Large O-Ring (151): valve diverter. 1 I 'Note: if the valve or valves are plumbed 1 Teflon-impregnated plastic i D. Rotate the actuator while keeping the with Port B as the common port (Stan- two shafts engaged until the holes an Small O-Ring (116): lard Plumbing) and the main body of the the actuator legs align with the holes actuator(s) is mounted over Port B (Stan- I Teflon-impregnated plastic left when you removed the screws in dard Mounting), there is no need to adjust step B. I i Valve Housing (Main Valve Body): J the actuator cams. E. Use the long screws (packaged with i j CPVC plastic I the actuator) to secure it in place. j ( F. Put the valve handle on the actuator Valve Divet'ter: Glass filled Noryl 1 shaft. Screw down and tighten the lock- I I I~ j Valve Diverter Seal Valve: ing knob (finger tight only). I. I I' n ~ I NeverLubell Material i I I Technical a Specifications: ' j Working Pressure: 50 psi. I Burst Pressure: 200 psi. Positive Seal Back Pressure: 15 psi I j Place Actuator Chlorine Resistant SK1845 on valve so Acid Resistant ` ACTUATOR MOUNTING QN VALVE smallest key aligns with i Ozone Resistant i A. Unscrew(counter-ciockwise)thelock- ing knob and remove it and the valve SK 1846 ,i lI is i i handle. Valve Actuator . PIN 170-0050 Technical i Specifications: Voltage: 24 V.A.C, _ _ : _ Amperage: 0.75 AMPS SKIM 7 3 Cycles: 60 HRZ. i i Wire: 3 Conductor Black « Common Red T - Switch Legs I White I SK1848 SK4849 . _ ALL ZOELLER ON-SITE WASTEWATER PRODUCTS MUST BE INSTALLED IN ACCORDANCE WITH LOCAL ANDIOR STATE PLUMBING ANDIOR HEALTH DEPARTMENT CODES. rJ Copyright 2002 Zoeller Co. All rights reserved. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 553 270th St. Woodville, Wl 54028 located at: SW 1/4, NW 1/4, Section 06 , Town 28 N, Range 15 W Town of Cady , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service April 15, 2016 Did flow back occur from absorption system? Yes x No (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,000 gallon Construction: Prefab Concrete x Steel Other Manufacturer (if known): Wieser Concrete ,Age.Of Tank (if known): 11 Years, installed 8/24/05 Permit umber (if known 479292 James K. Thompson Icensed Plumber Signature) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS August 22, 2016 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ~J ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND Reczl i OWNERSHIP CERTIFICATION FORM AUG Nick Wallen Sr 3~ Owner/Buyer CR Mailing Address 553 270th St., Woodville, WI 54028 0eeei/V Property Address Same City/State Parcel Identification Number 004-1012-95-400 LEGAL DESCRIPTION Property Location SW '/4 NW '/4 , Sec. 06 T 28 N R15 W, Town of Cady Subdivision Plat. CSM Lot # 4 Certified Survey Map # Na Volume 17 Page # 4618 Warranty Deed # Na (before 2007)Volume Page Spec house Elves (no Lot lines identifiable [3vesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of Vow- septic system could result in its premature tlrilure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.2(1) and in Chapter 12 - St. Croix County Sanitarv Ordinance. Fhe property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed b.\ the oN- ncr and by a master plumber, journeyman plumber- restricted plumber or a licensed pumper verifving that (1) the ou-site wastewater disposal system is in proper Operating condition and/or (2) after inspection and ptmIping (il nccessai~ the ,optic tank is less than 1 /3 full of sludge. 1/v-ve, the undersigned have read the above regniremcnts 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 he completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. e certify that all statements on this f m are true to the best of my/our knot ledge. l!~le amlarc the O~~ncrt s) of the propcrt\ described above, by virtue of a wana y decd recorded in Register of I)ccds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE "k env information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded wan-anty deed from the Register of Deeds Office and a copy of the certified survey map it' reference is made in the \varranty decd. (REV. 04/12) ir RAJ,-]) 1"51 Wisconsin Department of f u-muLProfessional Services Page 1 of 3 Division of I VBCEV67NR75X4 SOIL EVALL AUG 2 3 ZO~a In accordance with SPS 385, Wis. Adm. Code County St. Croix Attach complete site M~Vcmew U "ss than 8 1/2 x 11 inches in size. Plan must include, but not limited toSEr ce point (BM), direction and percent slope, Parcel I.D. scale or di cation and dis tance to nearest road. 95-400 Ref #2442 Please print all information. Rby Daa Personal information you provide may be used for secondary purposes (Privay Law, s. 15.04(1)(m)). • Z /Property Owner Property Location ❑ 'EE Donna Peterson Govt. Lot SW % NW % 28 15 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 645 270" St. 04 na CSM Vol.17, Pg. 4618 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Woodville WI 54028 715) 977-0899 Cady 553 2701h St. ❑ New Construction Use: ® Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial - Describe: Parent material Glacial Till Flood Plan elevation if applicable na `t. General comments and recommendations: Site suitable for replacement mound POWTS. Recommended infiltrative surface elev. to be 96.75' at 21 above 95.00' contour. 1 Boring # ❑ Boring ❑ ® Pit Ground surface elev. 96.37 ft. Depth to limiting factor 15" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sil 2fgr mvfr cs 2vf,fm 0.6 0.8 2 8-12 10yr4/4 none sil 1thinpl to mvfr cw 2vf1fm 0.4 0.6 2fsbk 3 12-15 10yr4/4 none sil 2fsbk mvfr cw 1 vf,f 0.6 0.8 4 15-20 7.5yr4/6 f2d 7.5yr5/8 sicl 1 msbk mvfr gw 1 of 0.2 0.3 5 20-33 7.5yr4/6 map 7.5yr5/8 scl 1 csbk mfr 1 of 0.2 0.3 [21 Boring # ❑ Boring ® Pit Ground surface elev. 94.81 ft. Depth to limiting factor 24" in. _ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sil 2fgr mvfr cs 2vf,fm 0.6 0.8 2 8-17 10yr4/4 none sil (10% 2fsbk mvfr gw mvf,1f 0.6 0.8 cobb. 3 17-24 10yr5/4 none sicl 1 msbk mvfr cw 1 vf,f 0.2 0.3 4 24-36 7.5yr4/6 f2f 7.5yr5/8 Ifs Osg ml ai 1 of 0.7 1.6 5 36+ 10 r6/2 none LSBR na na 0.0 0.0 y (>50% * Effluent #1 = BOD, > 30:5 220 m /L nd TSS > 0 150 m /L * Ef ent #2 = BOD, > 30!5 220 m /L and TSS > 30 150 m /L CST Name (Please Print) Signat e CST Number James K. Thompson 9- 30021 Address ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 April 15, 1106 (715) 248-7767 SBD-8330 (R04/15) F3 Boring # ❑ Boring Pit Ground surface elev. 94.30 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none sil 2fgr mvfr cs 2vf,fm 0.6 0.8 2 9-16 10ry4/6 none sil 1fsbk mvfr gw 2vf1fm 0.4 0.6 3 16-24 7.5yr4/6 f2f 7.5yr5/8 sicl 1 msbk mvfr cw 1 vf,f 0.2 0.3 4 24-42 7.5yr4/6 m2d 7.5yr5/8 sicl - LS Om mfi 0.0 0.0 resid. 17 Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rat= Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#<" El Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 220 mg/L and TSS > 30:5 150 mg/L Effluent #2 = BOD, > 30:5 220 mg/L and TSS > 30s 150 mg/L ❑ Boring # ❑ Boring ® Pit Ground surface elev. 94.30 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In_ Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/3 none sil 2fgr mvfr cs 2vf,fm 0.6 0.8 2 9-16 10ry4/6 none sil 1 fsbk mvfr gw 2vfl fm 0.4 0.6 3 16-24 7.5yr4/6 f2f 7.5yr5/8 sicl 1 msbk mvfr cw 1 vf,f 0.2 0.3 4 24-42 7.5yr4/6 m2d 7.5yr5/8 sicl - LS Om mfi - 0.0 0.0 resid. ❑ Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD, > 30:5 220 mg/L and TSS > 30:5 150 mg/L ` Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L Wisconsin Department of Safety and Professional Services Page 1 of 3 Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Croix but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 004-1012-95-400 Ref #2442 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location ❑ Donna Peterson Govt. Lot SW NW % S 06 T 28 N R 15 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 645 270`" St. 04 na CSM Vol.17, P g. 4618 _ City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Woodville WI 54028 715 977-0899 Cad 553 270" St. ❑ New Construction Use: ® Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial - Describe: Parent material Glacial Till Flood Plan elevation if applicable na ft General comments and recommendations: Site suitable for replacement mound POWTS. Recommended infiltrative surface elev. to be 96.75' at 21 above 95.00' contour. iI 1 f Boring # F-1 Boring ® Pit Ground surface elev. 96.37 ft. Depth to limiting factor 15" in. Soil Application Rate Roots GPD/Ft2 Horizon Depth Dominant Color Redox Description Texture StructurVmf EBoundary In. Munsell Qu. Az. Cont. Color Gr. Sz. SEff#1 Eff#2 1 0-8 10yr3/3 none sil 2fgr 2vf,fm 0.6 0.8 2 8-12 10yr4/4 none sil 2fsbk l to 2vf1 fm 0.4 0.6 fsbk 3 12-15 10yr4/4 none sil 2fsbk 1 vf,f 0.6 0.8 4 15-20 7.5yr4/6 f2d 7.5yr5/8 sicl 1 msbk 1 of 0.2 0.3 5 20-33 7.5yr4/6 m3p 7.5yr5/8 scl 1 csbk 1 of 0.2 0.3 I I 2 ❑ Boring L Boring # ®pit Ground surface elev. 94.81 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 Eff#2 1 0-8 10yr3/3 none sil 2fgr mvfr cs 2vf,fm 0.6 0.8 2 8-17 10yr4/4 none sil(10% 2fsbk mvfr gw 2vf,1f 0.6 0.8 cobb. m 3 17-24 10yr5/4 none sicl 1 msbk mvfr cw 1 vf,f 0.2 0.3 4 2436 7.5yr4/6 f2f 7.5yr5/8 Ifs Osg ml ai 1 of 0.7 1.6 5 36+ 10yr6/2 none LSBR >50% na na 0.0 0.0 i Effluent #1 = BOD, > 30 220 m /L nd TSS > 0 s 150 m q/1- * Ef ent #2 = BOD, > 30:5 220 mg/L and TSS > 30!5 150 mg/L CST Name (Please Print) Signat e CST Number James K. Thompson 30021 _ Address ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 Aril 15, 2106 715) 248-7767 SBD-8330 (R04i15 nn , ~craCG I ~as'~tiV'e manna Pe~u's~-,%a~qa, S~~ 2 70 ~ St u~u~dd://e, W/. SSio1,~ G3 ` r(ort~ /oe LAC S! C-S.►1 ✓0~:7, .SwYyr/W%f! Sec l ; TzbR•, orA be;~ 57,01 acres tl y~~ / A O C hU , B 3 ® q~ o ~ i ~ ww M ~ Awz' /~o c J73 i~ 5 //a'~ n SPe ~iOn X10 t!~v -6C,"P/cEcdB/oS~ 2ocS 3i i <P~ /f i A/L. dIrj,: Too of F.C. rrtar~, o/ecc✓~-; 93.07' Sion o ~ ~ a~a~G ~9s.o• ~i I i cJ ~ hedrC/orr, bo-^c BI a` X,;SEin,y~flt~i c5~/ ~ar)crt~.C DY,:D , wL. f' I, bQ~/6W ~+'1 ~ C ccw6r~•~•+ Q( 4-~ioel~/+w+~ Ek.s'~irrdw~d~v/ B47-~-' 97 1.-- G,~B S(o SOLtz~+ !06 ~i~1 e