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HomeMy WebLinkAbout032-1092-70-000 (2) sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ,afety and Building Division INSPECTION REPORT Sanitary Permit No, (ATTACH TO PERMIT) 597318 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 BRIAN & SONJA VERNSLAND TOWN OF SOMERSET 032-1092-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: G~'naa* 69 lie, OR- 33.31.19.437B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 1 Septic :x Benchmark wicy 0 AA Wow . I G2.ra low Bec- Alt. BM Aeration Bldg. Sewer ` Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent o it Intake ROAD Dt Inlet Septic / Dt Bottom Dosing Header/Man. , f Aeration Dist. Pipe 1,{ } 114.5 to p Holding - - Bot. System /7 114, j p~. . (t Final Grade PUMP/SIPHON INFORMATION Rt A. Manufacturer Demand St Cover uv* 3_v GPM Model N mber TDH Lift Friction Loss Syste ead TDH Ft Forcemain Lent Dist. to wen, SOIL ABSORPTION SYSTEM \ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS 4 A- - - - - I SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION r CHAMBER OR fol Type Of System: I UNIT Model Numbero~ n DISTRIBUTION SYSTEM Header/Manifold Distribution - ix Hole Size x Hole Spacing Vent to Air Intake t p I 1! Pipe(s) t 1 t(YS"~ Length Dia I Length Dia Spacin S 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth (~f xx Seeded/Sodded xx Mulched Bed Trench Center Bed Trench Ed~~~~-~~.. JJJJJJ ~ Topsoil ` es C No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 474 184TH AVE 4- t~s YI 1.) Alt BM Description = S / ~~V IL 2.) Bldg sewer length - amount of cover Plan revision Required? Yes No G /1 I Use other side for additional informat n. SBD-6710 (R.3/97) L'A Date Insepct#Signatur Cert. No. 1AN- )UI-7- 0 6 County Safety and Buildings Division St.CroiX 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) pS PS `I MAY 0 5 2017 Madison, WI 53707-7162 s 5q .73 / ,9 41-1,11 1~1! SIC MCOMY, ~0 M MR(j'T'~ajpj j,ra©[ELl?e t1 A vp > /State Transmber v* ~T In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form --iat v ntal unit is required prior to obtaining a sanitary permit. Note: Application forms for state r S ar't miffed to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provio, for secondary i~ u ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. f i:2 Y1tA-4-4 1. Application Information - Please rrN All Information Property Owner's Name ( Parcel # Brian and Sonj 9 Vernsland 1 ' 1092-70-000 I~ Property Owner's Mailing Address Property Location 3 3 3) , ia7, 4 3 474 184th Ave Govt. Lot - City, State Zip Code Phone Number NE_ /a, S E__- Section 33 Somerset W. 54025 T 31 M R 19 (oirolE ore H. Type of Building (check all that apply) Lot # I or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name lock # ❑ Public/Commercial -Describe Use City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z 3 t-Z3 t 13 Town of Somerset III. Type ofefPPemitt:(Check o one box on line A. Complete line Bnif~applicable) Q A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and ate Issu d ❑ Permit Transfer to New 4 _ n Before Expiration Owner 3 3/63 cj~j 1/Y►d'/► IV. Type of PORTS System/Component/Device: (Check all that a I ) Q Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil "Lid ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) +y~p~ V. Dis ersal/Tr atment Area Information: Design Flow (gp) Design Soil Application Rate pdsf) Dispersal Area Requiredf Dispersal Area Proposed sf) System Elevation 450 .50 900 C 89.5 86.5 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o ° ° New Tanks Existing Tanks pOlylOk 525 filter 14 °c y a C7 a a~ 'n U. Septic m Holding Tank I Wieser X ~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assn a respon ibility stallation of the OW FS shown on the attached plans. IrAp< ' S, ~ MP/MPRS Number Business Phone Number Plumber's Name (Print) Pin Keith Knudtson r 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St. Roberts Wi 54023 VI oun /De artment Use Only Approved ppro~ Permit Fee Date Issued Issuing ent Signature El Owne ..,Cavc f`1eason for Denial $ r 5l~ Z IX. Condit easons for Disapproval 1. l5bpfin rk, a nr 1iRe~ tttki f31<sl7er tai Cell _ttSt 811 es<per mar:39ement plan pratlot,! Gv N u-r 2 'AN t~C` et tertas m~xltut+t► ii&ntl 1'~ i sty per *pc4dit / cxdina rlot3, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R. 11/11) t(NUUTSnN PLUMBING-"` ,2z74- 6ONTFtACTI G, LL y 927150TH ST. 6=7MPRS /'c? fV vt- 5'D FtOBERTS, WI -`023-8526 CELL 651-470-1737 i7 0 4 1 i 1 14,96, G ~ f OIL Ll e- L r~ I I I I J CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Vernsland sewer Owner's Name: Brain Vernsland Owner's Address: 474 184th Ave Somerset Wi. 54025 Legal Description: NE 1/4 SE 1/4 S 33 T 31N R 19W Township: Somerset County: St.Croix Subdivision Name: Lot Number: Parcel ID Number: 032-1092-70-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Keith Knudtson License Number: 648443 Date: Phone Number (651) 470-1737 i Signature J: Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 S13D-10705-P (N.01101). Page 1 & I(NUpTsC?N PLUI~iBING ~ ,o~ACTING3 LL, 927150TH ST.6=7MPRS G f~ 5 ~cr / 526 L . VV, 1-470-1737 RO CSLRTS, 7- 3 cz' C) cJ~ °~5-' ~ -112 I ~4e Lk" Lt ~ b S T c~ .~~(/S7`.`g Win, ~.~7 r''LfE'r 4001' ~pf0 b i L 4e 5'n f lei ' ~v } Soil Absorption System Cross Secdon 92.00 ft Final Grade 4' Schedule 40 PVC Vent Pipe 86.50 With Vent Cap Leaching 89.50 Chamber ft System Elevation 86. 0 ft Soil Absorption System Plan View ft 3.00 ft 5.00 ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4' Dia. Trench 2 Header Leachina Chamber oecifications Manufacturer And Model Infilterator EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.50 gpd/sq ft 450.00 gpd Design Flow + 0.50 Soil Application Rate T 20 EISA = 45.00 Chambers 2 rows of 23.00 chambers each. j Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Brian Vernsland Septic Tank Capacity 1000 gal ❑ NA Permit # Septic Tank Manufacturer Wieser ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Poly LOk ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units RI NA Pump Tank Capacity gal 5a NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer IR NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer N NA Soil Application Rate .5 gal/day/ftz Pump Model M NA Standard influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter ' Biochemical Oxygen Demand (BOD6) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) <_30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L M /NA ❑ At-Grade ❑ Mound Fecal CoMorm (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: y ❑ear h(s) (Maximum 3 years) ❑ NA E'J year 1 Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ yeas( s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ onth(s) ❑ NA ~ Cd year Inspect pump, pump controls & alarm At least once every: ❑ month(s) 2<A ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) llA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of !02 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. 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and 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 filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or:must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. J7 T / J" aluaf / g be e ai e ank ~-171VS7?ZtIG'7L0 '~fZD}-{i 0 8 TTY ❑ 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 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Keith Knudtson Name Phone 651-470-1737 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Powers Liquid Waste Name dV &L-QZ 2o1J14) "T- Phone 715-246-5738 Phone _J / S- 3 :?(p- (O This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. t VA V o i PL-525 EFFLUENT FILTER 525 Filter is rated for -0,000 GPD (gallons per day) 1116" Filtration Slots Alan ;s4 it one of the largest filters - ;are, Cass. It has 525 linear feet filtration slots. Like the' rj Accepts PVC ..cok PL-122, the Polylok Extensionriandle -525 has an automatic shut - sail installed with every filter. v n the filter is removed for ng, the ball will float up and a charily shut off the system so effluent won't leave the tank. szsLinea.R.ol,nc~ ' Y other filter on the market can Eltranon Skft rye that claim. RIME.rover k 10,000 GPD ANN, ' 7 C- 51; n: 8 , a n o Accepts 4' & G SCHD. 40 Pipe e PL-525 Effluent Filter should }aperate efficiently for several years - --der normal conditions before 0 -squiring cleaning. It is recom- :ended that the filter be cleaned every time the tank is pumped or - :f a feast every three years. If the to ' 1,500 - - stalled filter contains an optional While this filter =arm, the owner will be notified can handle larger. flows and dy an alarm when the filter needs commercial used in ' servicing. Servicing should be applications done by a certified septic tank NSF certified Gas Dellector ;yam per or installer. , Automatic Shut-Off s.;R . U .S. Pat ent No# 6,015,488 eatr When Filter is 1. Locate the outlet of the ' 5,871,640 Removed septic tank. 2. Remove tank cover and pump tank if necessary. ri ;j - f 3. Glue the filter housing to 3. Do not use plumbing when the 4" or 6" outlet pipe. If filter is removed. Ideal for residential and com - the filter is not centered 4. Pull PL-525 out of the housing. mercial waste flows up to under the access opening 10,000 Gallons Per Day (GPD). use a Polylok Extend & 5. Hose off filter over the septic Lok or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page back into septic tank. septic tank. 19-21 for Extend & Lok 6. Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is properly aligned into its housing. and completely inserted. 5. Replace and secure the 7. Replace septic tank cover. septic tank cover. r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Brian VVensland Mailing Address Same 474 184th Ave Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Somerset Wi. Parcel Identification Numbcr 032-1092-70-000 LEGAL DESCRIPTION Property Location NE =;4 SE ,a seg. 33 T 31 N R 19,, Town of Somerset Subdivision Plat: , Lot # Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume Paae # Spec house OyesE] o Lot lines identifiable RlyesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the 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. 383.52(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 113 full of sludge. I/we, 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. 1/we certify that all statements on is form are true to the best of my/our knowledge. l/we am/are the owner(s) of the property described above, by virtue of a arranty deed recorded in Register o1'Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(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. (REAr. 04112) Wisc6nsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division County INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353103 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: B SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 66) c) 0 032-1092-70-000 TANK INFORMATION - Z P- ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - 160o Benchmark 0.3 0. 3 /60 i~ 92•Q All, Brv P (1/ Aeration Bldg. Sewer - Holding Ht Inlet TANK SETBACK INFORMATION Ht Outlet ~3 ~Z Verit TANKTO P/L WELL BLDG. AirIto ntake ROAD Air Septic t Ono NA D - NA Header / Man. Aerati N Dist. Pipe 7•f 4• L I 441 Z- Holding Bot. System L, rI -3t 0, 9S' tt .3L 14 , Ise PUMP/ SIPHON INFORMATION Final Grade 37 ? 9S nufacturer errand S Model NUM M TDH Lift Lric System TDH F Fo ain Length Dia. H I SOIL ABSORPTION SYSTEM rS ctr~ BED ! REN Width / Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEWWKS 3 / DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACH M nu acturer:~ ~ o✓ INFORMATION Type Of r AMB Model Number: System: C J 7-7~ "12 S IT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole acing Vent To Air Intake Length _L% Dia Length Dia. Spacing S 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) SOMERSET 33.31.19.4/37B,NW,SE 474 184th Avenue ar~ w~l1 W44 erliSdt~~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. 9 2 Inspector's ature Cert . No SBD-6710 (R.3/97) Dak 7- ST. CROIX COUNTY ZONING DEP AS BUILT SANITARY REP PET V Owner L Eow 13R Euc/1 Property Address V 7 y /B y 7-H .4 UE City/State ~Dtle-/u&-r /1Ji SS/D2S" a Legal Description: Lot A(A Block )W Subdivision/CSM # A&O t/4 ,~E t/a, Sec. L, T,JN-R-W, Town of s~o/yE2sET \'`~~F P 32 -/D~~ -70 -&VO SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer Size S ac or:: House Well P/L Pump manuf Model ocation (HOLDING TANKS ONLY) Setbacks: Service road V r m e Water Line Meter location on SOIL ABSORPTION SYSTEM: Type of system: 16lEivc.U Width 3 ' Length r Number of Trenches 22-_ , Setback from: House 30' Well f00' P/L 7 7'_ Vent to fresh air intake '26 ELEVATIONS: n Description of benchmark &T7-C1 0~ Sf,Q~~vG- iv lus-- Elevation DD,O Elevation F2.06 Description of alternate benchmark / T Building Sewer ST/HT Inlet ST Outlet 93,9K PC Inlet 1(A PC Bottom &A Header/Manifold 5-. Top of ST/PC Manhole Cover Distribution Lines 2• 7 91 ( ) Bottom of System (I) /3 (1) "I 3 ( ) Final Grade Date of installation !ZIAXI& Permit number 3,5'710 3 State plan number A6A Plumber's signature - License number 92/ 7VI Date /19-2-/ Inspector Complete plot plan or i NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW S 64c C- Ilri UQ I N BM. ~T/'J o F7 s/Ornr~- o.v Lfowsrr c:-G- po.o ~ EX~'ST/N4 /000 C.L Si I 77 ~C3 3 /3E/> Qodri /kiu s~ 3 ~I If'yT~u Avg INDICATE NORTH ARROW I Wisconsin ~r~ S T - 0~ ct 7 l7epaMient of Safety Division of Industry Services SOIL EVALUATION REPORT #3187 MAY 0 4 2ui1 1 page I of 3 COUN f ? ar ' Wk Wis. Adm. Code Keith Stoner CST Attach complete site la CR4~ >Tt 1 in, County "%n, must St. Croix include, but not lim I and horizontal reference poi. `nn and, percent slope, scale or dimensions, north arrow, and location ano wrest road. Parcel I. . 03 092 0-000 Please print all information. Revi d By Date Personal information you provide may be used for secondary purposes (Privacy Law, Property Owner Property . Iv a - Brian & Sonja Vensland Govt. Lot 1/4, E1/ , S33, T31N, R19W Property Owner's Mailing Address Lot # Block # Subd. Na a or CSM# 474 184th Ave City State Zip Code Phone Number City [ Village ~ Town Nearest Road Somerset WI 54025 Somerset Same L] New Construction Use. E Residential ! Number of bedrooms 3 Code derived design flow rate 450 GPD M Replacement F Public or commercial - Describe: Parent material Sandy Outwash Flood plain elevation, if applicable NA _ ft. General comments Propose 2 dispersal cells 3 x 94' using a.5 SAR. Center the upslope cell over the 90.70' contour with a system elevation = 87.70'. and recommendations: Center downslope cell over the 89.25' contour with a system elevation = 86.25'. Centerlines of cells staked onsite. Boring # Boring Z Pit Ground surface elev. 88.89 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-9 10YR3/2 - sil 2msbk mvfr cs 3f-co 0.6 0.8 2 9-20 10YR3/4 - cl 2msbk mvfr gs 3f-co 0.4 0.6 3 20-43 10YR4/4 - Ifs Osg ml gs 2f-m 0.5 1.0 4 43-70 10YR5/4 - gr sr fs Osg ml gs if-m 0.5 1.0 5 70-96 10YR5/4 - srs Osg ml - - 0.7 1.6 V -V GG 1 Boring # L, Boring ~*-1 ~J Pit Ground surface elev. 93.00 ft. Depth to limiting factor >112 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10YR3/2 - sil 2msbk mvfr CS 3f-co 0.6 0.8 2 12-28 10YR3/4 - cl 2msbk mvfr gs 3f-co 0.4 0.6 3 28-47 10YR4/4 - Ifs Osg ml gs 2f-co 0.5 1.0 4 47-58 10YR4/4 - gr Ifs/fs Osg ml gs 1f-co 0.5 1.0 5 58-112 10YR5/4 - sr fs Osg ml - if-m 0.5 1.0 r~ • Effluent #1 = BODS> 30 < 220 mg/L and TS$ >30 < 150 mg/L " Effluent #2 = s ~J0 mg& and TSS j,30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner t 224059 Address Keith Stoner CST Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 4/17/2017 715-566-0900 SOD-8330 (R07/13) i Prop" Owner Wan & Sonja Vensland parcel lp # 032-1092-70-000 Page _.2 _of 3 F xj J Boring 3 Boring # pit Ground surface elev. 88.00 ft. Depth to limiting factor > 104 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ( *Eff#1 *Eff#2 1 0-7 10YR3/2 - sil 2msbk mvfr cs 3f-m 0.6 0.8 2 7-18 10YR3/4 - sl 2fsbk mvfr gs 2f-m 0.6 1.0 3 18-25 10YR4/4 - gr Ifs/s Osg ml gs if-m 0.5 1.0 4 25-49 10YR4/4 - Ifs Osg ml gs if 0.5 1.0 5 49-60 10YR5/4 - fs Osg ml gs - 0.5 1.0 6 60-104 10YR5/4 - srs Osg ml - - 0.7 1.6 f~ U -V t -i Boring `~~77 FI Boring # Pit Ground surface elev. ft. DApA to I iting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ] Boring FIBoring # iL] 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. Sz. Cont. Color Gr. Sz. 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