HomeMy WebLinkAbout026-1151-19-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597325
GENERAL INFORMATION State Plan ID No: A
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. / *
Village Township Parcel Tax No:
Permit Holder's Name: T77-
OEVERING HOMES TOWN OF RICHMOND 026-1151-19-000
CST BM Elev: Insp. BM Elev: B escription: Section/Town/Range/Map No:
I P_ al-Ai X- 20.30.18.1134
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTUREitlAtL CAPACITY STATION BS HI FS ELEV.
IrS
Septic HV~kVH_ IV /000 AI Benchmark q O
6" mg Alt. BM
nuhp v , 2,1
~lerdttorr ~ Bldg. Sewer
Ht Inlet
8. a
TANK SETBACK INFORMATION /Ht Outlet 7 Gy
/ 7i ~p
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic j Dt Bottom
Dosing Header/Man. -7. ? p2
J 7 J
I _
Aeration Dist. Pipe 7,
Holding ot. System
y , 0 93.9
m-- - 419,
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand 7_0 v e r
GPM 07 n r
Mod I Number
TDH Lift Friction Loss System Head Ft
2
Forcema Length Dia. __T t. to well /1ew 0100V rl t /P1/11 1 7r, J
SOIL ABSORPTION SYSTEM N - 6-r - /t~
BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ' `0 I -Z_ I e-~
SETBACK SYSTEM TO P BLDG WELL LAKE/STRE LEACHING Manufacturer/ ,A./*,
INFORMATION CHAMBER OR
Type Of System: x ~.y UNIT Model Nu r: i k y s_~ p'v
DISTRIBUTION SYSTEM 'J L
Hea anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
/ Pipe(s) n
Length Dia I 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 Bed/Trench Edges- - No
❑ Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ? Inspection #
Location: 1042 144TH AVE ST V ~ C C U ( CA 1 t
C ~u~t -
/
1.) Alt BM Description = J7~ CQ(/Yir At 4
2.) Bldg sewer length as-e o , /f
- amount of cover = 28 ~ it I POWs S~..~rl aV lP
~ ~n a! /l C o~-I-o~ IrS. V~
Plan revision Required? L Yes >ONo
Use other side for additional informs otf n.
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97) AV ~ I I
I't ~0 Q ~s Sal D~ a~ Apo
z`y9~rR. County / l
Safety and Buildings Division ganiJ V
8 = Cc" 201 W. Washington Ave., P.O. Box 7162
r .y Cary Permit Number (to be filled in by Co.)
z P Madison, N 53707-7162
5g 73 2dS
CRatsal State TrnNumber
Permit Application
in accords } eode, submission of this form to the appropriate governmental unit
is require o taining a sanitary permit Note: Application forms for state-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
,purposes in accordance with the Privacy Law, s. Stats.
L Application Information - Please Print All Informatiow*\ /110
i <
Property Owner's Name Parcel #
j~ Property ,Owner's ailmg Address Property Location
5 I. 63q
r-1- /t i CL Iv Go t
City, State Zip a Phone umber yli Lion
rr)
~1~ 1 ✓ C' T N R uolE°
H pe of Building (check all that apply) Lot #
` T'2 Family Dwelling- Number of Bedrooms SubdivisionN C
6lC G~ Blo i< /~DL (f~Lk
❑ Public/Commercial -Describe Use
Y~~ ❑ City of
❑ State Owned - Describe Use _ CSM Number ❑ Village of
own ofL /L
c,,, Z7+ Z'7 Glen
III. Type of Permit: (Check only o box on line A. Complete line B if applicable)
A.
Lw System ❑ Replacement System El Treatment/IHoldirg Tank Replacement Only ❑ Other Modification to Existing System (explain)
B
❑ Permit Renewal ❑ Permit Revision i ❑ Change of Plumber ~l Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration /
owner
IV. ofPOWTS Svstem/Copionent/Device: (Check all that apply)
-Pressurized In-Ground 11 Pressurized In-Ground 11 At-Grade F1 Mound > 24 in. of suitable soil ❑ Mound < N fin- of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) _ ❑ etreatment Device (explain)
' . Dis rsal/Treat ent Area Informatlou:
Design Flow (gpd) Design Soil Application Rate(gp Dispersal Arreea Required (sf) Dsper al Area Pr posed sf) System Elevatro I
VL Tank Info Capacity
in Total # of Manufacturer i-3
Gallons Gallons Units _ J
New Tanks
Existing Tama
~ ~C sU .8` I yr
W °
Septic or Holding Tank
Dosing Cbamber f
VII. Responsibility Statemen,011 1, the undersigned, assume esponsibility for installation of the POWTS shown on the attached plans.
Plypnber's Name (Print) ( Plumber azure MP/MPRS Number Business Phone N ber
Phmmber's Address (Street, City: ate, Zip bode)
VIII. ountv/De artment Use Only
pproved rsapprove Permit Fee Date sued Issuing ent Signature -
If 75 Ce? S ► y I ~1
en eason for Denial
DL Condltro tins` r_I) pproval .
i11at+o~4troEaM~'g;te+nta;rec 3~ /vo o„-- i-- J 6r y64'Z..e.~
sw,AI A1 plan Pm4ded by Nlunber. / J
it 2 -
«10..
M llaw~ltbe.btslrtcEd i ti ~a..~a / p0i.
``f I
W MAW* ax% / +afdil11~A0s1. 1 -A
~
Attseb to complete parrs for the sysn.v-~ and submit a the County only oa paper not less thin-8 r/1 1 11 ioches in size
SBD-6398 (R. 11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/10/17
Owner:Oevering Homes
Location: NE1/4 SW1/4 S20 T30 N,R18W 1042 144th Ave Richmond
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance a ontingency Plan
7.Filter Cross Sec
Signature
License num r #226900
System PLOT PLAN
PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 1/4 SW 1/4s 20 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 95.0/94.0 4' below grade 5/10/17
BEDROOM 5
DATE
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091
# of chambers 54
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
93'
Vents 9 97 95'
Scale = 1/4" = 10'
-2
t
B-3 5
272' Property Line 20 0'
J
\
20 13% Slope
5'
10,
2-3' X 110' Cells with >3' spacing
B:IVI.
-1
10'
ST
Vent
30' >6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
12" 5.6ft^2/pair of end caps
Pro 5 4' Long
„ Grade at System Elevation
Bedroom 34
House
e
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
187' Property Line 370'?
144th ave
L
Cross Section of Infiltrator Quick 4 Leaching Chamber
r Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ftA2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 99,
Grade Vent
3' Vent 4„
.A~30/34 Septic Tank 3
5' Long 5' S' Long 1 36 Grade at System Elevation Grade at System Elevation
Spacing- 5'
2-3' X 110' Cells
Same on other end Observation tube/Vent
At end of cell
A
27 chambers per cell B
System elevations:
A_95.0'
B_94.0'
FILE INFORMATION POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
Owner SYSTEM SPECIFICATIONS
? rat
Permit # Septic Tank Capacity
L-)
El NA
Septic Tank Manufacturer
»:SIGN PARAMETERS Z2 ~,L ❑ NA
Number of Bedrooms Effluent Filter Manufacturer j'
❑ NA ❑ NA
Effluent Filter Model
Number of Public Facility Units ❑ NA
UA Pump Tank Capacity
j Estimated flow (average) al m NA
S60 al/da Pump Tank Manufacturer
i Design flow (peak), (Estimated x 1.5) NA
'Soil Application Rate gal/day Pump Manufacturer
~ NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit
Fats, 0i18~ Grease (FOG) 530 m L 10J NA
Biochemical O ~ ❑ Sand/Gravel Filter O Peat Filter
xygen Demand (BODs) 5220 mg/L ❑ NA p Mechanical Aeration 0 Wetland
Total Suspended Solids
Pretreated Effluent Quality (TSS) 5150 mg/L
El Disinfection 11 Other
Monthly average DIs ~ersal Cell(s)
Biochemical Oxygen Demand (RODS) 530 m 13 NA
Total Suspended Solids (TSS ~ In-Ground (gravity) ❑ In-Ground (pressurized)
s30 mg/L _10r+4 ❑ At-Grade
Fecal Coliform (geometric mean) 5104 cfu/100ml / ❑ Mound
Cl 'Maximum Effluent Particle Size Drip-Lips ❑ Other:
~O xi Ya in dia. 0 NA Other.
S NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent 11 Other.
IAINTENANCE SCHEDULE ❑ NA
Service Event
Ilnspect condition of tank(s) Service Frequency
At least once every: 0 months}
(Pump out contents of tank(s) ears (Maximum 3 years} ❑ NA
When combined sludge and scum equals one-third (X) of tank volume
Ilnspect dispersal cell(s) 11 NA
At least once every: ❑ month(--}
Mean effluent filter ear{s) At 3 years) ❑ NA
At least once every: J ~ month{s)
Inspect pump, pump controls & alarm / ear(s) ❑ NA
At least once every: ❑ month(s)
f=lush laterals and pressure test ❑ year(s) NA
At least once every: ❑ month(s)
Dther 13 year(s)
NA
At least once every: ❑ month(s)
ether:
❑ ar(s)
ye NA
MAINTENANCE INSTRUCTIONS NA
!Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
!Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leak Master
i~mbined sludge and scum and to check for any bade up or ponying of effluent on fo
volume of
loom fin inspected to dick the effluent levels in the observation pipes and to check thfor e an ground surface. The dispersal measure cell(thes) shall be
I-egulatory pond authority. Y ponying of effluent o the ground surface.
The ponying of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
When the combined accumulation of sludge and scum in an tank heal
(
Ad tank shall removed by a Septage Servicing Operator andal disposed of~) in or more of accordance the with tank volume, chapter the NR 1 entire contents of
Administrative Code.
13, Wisconsin
I~il other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment land 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. units,
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 tt*t
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thf3
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 ble
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluentt.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to thle
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 floss; diapers; disinfectants; fat; foundation drain
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat swaps; medications; oil; painting producils;
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 propefly
and safety 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 propedy 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 sail,
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;
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelrr.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirjed
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nged
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rufe;i in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infittralive,
surface. Reconstructions of such systems must comply with the rules in effect at that time.
«1NARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANI~ 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 r r E Name
Phone -
Phone
SEPTAGE SERVICING OPERATOR MPER LOCAL REGULATORY AUTHORITY
Name
Name
Phone ^ _ ° <T t Phone ~;~i P.
This document was dratted in compliance with chapter SPs 383.22(2)(b)(t)(d)&(f) and 383..54(1), (2) & (3), Wisconsin Administrative Code.
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SEPTIC ST. CROIX COUNry
TANK MAIlYTEN
ANllANCE AGREEMENT - `
Owner/airy., f OtiVNERS i~p CERTIFICATrON FO _
RNA[
Mailing Addres
.Property Add,
(Verification rid r2uy?
City/State e4uired from planning & Zo
for new eons
traction.)
LEGAL D - Parcel Identification
ESCRYp'TIO~ ~nber
Property Loc '
anon rV~ ~
, 7-0
Sec.- T R
Subdivision. - /
- W, Town of ~ U'1-
c=ertifted Survey lure
parr Lot
auty Deed # - Volume
Page #
Spec house yes Volurne
no
Y M ~A-INT'Ely~rCE x-11 Lot lines ident~ab Page #
ye no
Fnaint~e coP~ use OVER CERTii+'rCATTpN
enanc
and maintenance
the SYstein nsists ofp of o
s~tic systern could result
can Ieot the functi~mg out the septic
re~nsibilities are on of the septic ~ every three years or son its premature failure to
specified in §Corrmj, 8e ( tank as a treatnjent stage in thner' if needed, by a licer,8e a wastes. proper
The S2 ) and in Cha waste P
owner and by arster p~~r, agrees to subjriit to St Pter t 2 - St. Croix Count. Sii 1 system, Owner rr~ Ceou put into
adisposals Croix Co ~pl mlary Urdfuance.
less than 1/3 fall system is in oper Plummer, restricted Plumber & "Coning Department sludge. operating condition and/or (2) lum6er or a licensed p mnent a
ce
1eification forni, signed b
'/we, the after inspection an verifying that (1) the on- Y the
s dards set tor~Undersigned
have read the Pumping (if necessary), the site
Certificatio ' h erein, as set by the Department requirerijents and septic tank is
7o on st8ting that yon, ep~ent of Co nd agree to
ntilg DeParftrient within 30 ptic sys rn has been rnruerce and the De rriamtam the Private sev{a e
days at the maintained mu
1lwe st be Parer m of Natural
Reso g disposal system with the
certify that t7iree year expiration date. completed and reeurued to the St s, State of Wisco
rhr described aboveall stateme
Pe Croix County plann
prO ing &
~ on this o
by virtue ofa gran rrn are true to the best oi'jn
deed recorded in Re y/our fowled e.
Number of bedrQOms gister of Deeds Office. I/ we am/are the owner
(s) of the
,GNAT OF APPLICAN__ _T{
"*'Any information .J /
that is misrepresented jiia
1-7
I
nclude with this app Y result iu the sanita'' DA IE
reference Ifcatiori a recorded permit being revoked by the plan,
in
made in the warrauty dee want. deed fro g & Zo
from the Itegister of Deeds p niug Depa
is rtrne
08/05) ffice and a copy of the certified survey nt
map if
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Wisconsin Department of Commerce SOIL EVALUATION REPORT
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code Page of
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
34. ,1
include, but not limited to: vertical and horizontal reference point (BM), direction and Cray
Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
11 Please print all information. Sr~~ ~t
Revi a Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner
/ ECEIVE Prop Location
(rRO
lit i► Govt. of 114 114 S T
Property Owner's Mailing Addres
Lot Block # Subd. Name or C M# N R E (or) ft
city a 2 Z( uet' APR 2 2 23 I / t~
State Zip Code Ph ne 77 umber i LXCI ❑ . Tow
(7 k; Village Town Nearest Road
( New Construction Use: 0 Residential / Number of bedrooms
Code derived design flow rate
❑ Replacement GPD
❑ Public or commercial -Describe:
Parent material
Flood Plain elevation if applicabl
General comments
and recommendations: V 76
I ❑
Boring # Boring
Pit Ground surface elev. Z L/ ft. Depth to limiting factor
Hin.
orizon Depth Dominant Color Redox Description Soil Application Rate
Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color
I Gr. Sz. Sh. •Eff#1 'Eff#2
b~ LO ~3 2 5L 2n1c~k
r cs Ivc 5 ,9
5 / Z n--v -r- C5
3 15-! ~ i r4
rr13 s M -
Boring # f❑ Boring `
Pit Ground surface elev. A ft. Depth to limiting factor (rr
in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots z
in. Munsell Qu. Z. Cont. Color D' GPDlft' O,,Z 0 -31Z Gr. Sz. Sh.
'Eff#1 'Eff#2
S f . 9
Z i 2 $ I p L)-,gL ~ S V4 5
Zry," i r c5 ~ . 5 . g
~ /.2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD <
CST Name (Please Print) - S _ 30 mglL and TSS < 30 mg/L
Sig ature -
Sc hLamrr~.ke~ CST Number
Address 253 3C9
Date Evaluation Conducted Telephone Number
2113 D??' 55J.~n,e LLB i -IUvZS
i
page of
ParcelID#
Property Owner
❑ Boring Depth to limiting factor Soil Application Rate
Boring # z~
Pit Ground surface elev. ~ Roots GPD/ftz
Redox Description Texture Structure Consistence Boundary =Eff#1 =Eff#2
Horizon Depth Dominant Color Gr. Sz. Sh. r
Munsell Qu. Sz. Cont. Color 2 t`/ vbL L 5 (Y+
in.
3t2- - 5 8
2 7-1L (o r`tIli-
1Z'-1w v)
❑ Boring Depth to limiting factor in. Soil Application Rate
Boring # Pit Ground surface elev. ft•
GPD/ftz
Redox Description Texture Structure Consistence Boundary Roots =Eff#1 =Eff#2
Horizon Depth Dominant Color Gr. Sz. Sh.
Munsell Qu. Sz. Cont. Color
in.
❑ Boring Depth to limiting factor in.
❑ Boring # Ground surface elev. ft Soil Application Rate
❑ Pit GPD/ftz
Redox Description Texture Structure Consistence Boundary Roots =Eff#1 'Eff#2
Horizon Depth Dominant Color Gr. Sz. Sh.
in. Munsell Qu. Sz. Cont. Color
/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
Effluent #1 = BODS > 30 _ 220 mg
264acces services or
The Department of Commerce is an equal opportunity service provider department and e at1608 . If 3151 ord aITY ssistance
need material in an alternate format, please contact the SBD-8330 (R.07100)
Property Owner t/~ >L`U r(~ ! T
1 Z 3
Boring # E] Boring Parcel ID # 47 7L Page of
❑
3
LLI Pit Ground surface elev. 91?, / ft.
Depth to limiting factor Z~ in.
Soil Application Rats
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
I 0--~ SL Zff LS 1Y~ cj
Z 7-/Z tb I~ 11 Z k ~m r CS 5 8
rr~5 N'6 7L
l tl
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Soil Application Rate
Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#l '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. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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 (R.07/00)
r Y
PAGE ` : OF
NAME w v _ LOT# LEGAL DESCRIPTION 'F k,(, 14 ,S T XR, t E orJ C/
SCALE: 1"= Fr'
BM 1 ELEVATION %/L
BM 1 DESCRIPTION, BM 2 ELEVATION
BM 2 DESCRIPTION { ~s f
SYSTEM ELEVATION l -
ALTERNATE ELEVATION w c''
CONTOUR ELEVATION
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ✓ ~ ^ ~
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must A 41
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. b - e
Please print all information. Re ' ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property location 7 1f
j r Govt. Lot u~ 1 /4 ( ) A S Z N R f E (or) 44
Property Owner's Maih Address Lot Block # Subd. Name or CSNW
Mate Zip Code Phone Number ❑ City ❑ v age Town Nearest Road
*41ew Construction Usqg~ esidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Publi or commercial - Describe:
Parent material " Flood Plain ;elab7ion if applicable
General comments ,n ` rQ.p
and recommendations: 4' ! r j~+ J y
t~T
System Type~2 System Elevation
t
❑ 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 GPDM
in. Munseli Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •E11#2
1:1 C_
F~ El Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 rrYA and TSS < 30 mg/L
CST Name (Please Print) S' u" _ CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date-Evaluation Conducted Telephone Number
5-246-4516
1432 120th St, New Richmond, WI 54017 Z 'Z 71
Property Owner _ Parcel ID # Page of
F-1 ❑ 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
❑ 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 # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit
Soil Application Rate
Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS < 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.
SOD-8330 (R.6/00)
ze~4- 2
System PLOT PLAN
PROJECT:Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 1/4 SW 1/4S 20 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 95.0/94.0 4.5' below grade 6/22/17 5
DATE BEDROOM
CONVENTIONAL X00C CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54
BENCHMARK V.R.P. Top of 1" pipe/B94.0 ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
30' 10'
Pro 5 Bedroom
House
30'
13% Slope
20'
272' Property Line
30' B-3 0B-2
40
Vents
Replacement area Replacement area
0 40'
B-4 B
100'
2-3' X 110' Cells with >3' spacing
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
12"
4' Long
34" Grade at System Elevation
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
187' Property Line
144th ave
System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 1/4 SW 1/4S 20 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 95.0/94.0 4' below grade 5/10/17 5
DATE BEDROOM
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54
BENCHMARK V.R.P. Top of 1" pipe ' ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WEL as
eochmark
Ik % r% I
9 '
Vents 9 5'
n 2 Scale = 1/4" = 10'
d
g~
B-3 5
272' Property Line 20 0'
20' '13% Slope
5
10'
2-3'X 110' ells with >3' spacing
B.
-1
10'
ST
Vent
30' >6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
12" 5.6ft^2/pair of end caps
Pro 5 4' Long
Bedroom 34" Grade at System Elevation
House
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
187' Property Line 370'?
144th ave