HomeMy WebLinkAbout038-1062-60-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) .597468
GENERAL INFORMATION State Plan ID No. i t --t
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:
Mark & Jodi Olson TOWN OF STAR PRAIRIE 038-1062-60-000
CST BM Elev: Insp. BM 7 BM Description; f , Section/Town/Range/Map No:
15.31.18.271132
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
. - f Benchmark Septi . ^ i
Dosing 1 i Alt. BM
Aeration ~ - Bldg. Sewer
Holding St/Ht Inlet
r\I' flLH! Outlet
TANK SE C! JNFORMATION
TANK TO P/l,` WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe f: r l t 07
ay
I
Holding Bot. System - , f r t •-7 U/
Final Grade eti
PUMP/SIPHON INFORMATION
IY-
Manufacturer Demand St Cover
GFIM
Model Number
TDH Lift Friction Loss System Head TDH Ft r
o se r Z rGC~ $
Forcemain Length Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width , Tngttl I No. Of Trenches,.. w4 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dept_
DIMENSIONS `i r.
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR ' l
Type Of System: UNIT
t . Moder Lmber: r r- ` r
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size ix Hole SpacirW ~ieQt to Air take
Pipe(s) ~~j~`y.]
_ C
LerxJth " Dia_ Length Dia Spacing tl
SOIL COVER r x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 4ed/Trench epth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Edges Topsoil
_ ❑ Yes E No E Yes E] No
COMMENTS: ( clude code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1152 CTY R C ~ f r ~ ~ t • r"
jjPc`~lar
1.) Alt BM Description = ! ~1 7 nr
2.) Bldg sewer length
- amount of cover
j
Plan revision Required? ❑ Yes No ? / j( F r C
Use other side for additional informatip
SBD-671 0 (R.3/97) Date Insepcfor~s gnature Cert. No.
o~ WIN County -
rsl a Safety and Buildings Division 1.~f
201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707-7162.
~ ► ~ 5q-7 S
Sanitary Penn. HYJ8H723PDQEE State Transa;oo Number
In accordance with SPS 383.21(2), Wis. Aden Code, submission of this form to the appropriate governmental unit / A
is required prior to obtaining 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. 15. 1 m , Stats. uc e-.
L Application Information - Please Print All Inf r tion
Property Owner's Name d Parcel #
038 - I m
I
Property Owner's Mailing Address Property Location . 3
ZZ Govt Lot
City, State Zip Code Phone Number Section
le gne)
11. Type of Building (check all that apply) T i / N; R it ~ or W
r 2 Family Dwelling-Number of Bedroo Subdrvtsron Aamc / /v
Block #
0 Public/Commercial - Describe Use
0 City of I
0 State Owned - Describe Use CSM Number ❑ Village of
own of
2 - w l f z X013 Grir
III. Type of Permit: (Check olgly one x on line A. Complete line B if applicable)
A. *__tttVew S stem Re lacement System ❑ Treatment/Holding Tank Replacement Only 0 Oilier Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision 0 Change of Plumber ❑ Permit Transfer to Nm Lug Previous Permit Number an'Daatte ued
Before Expiration Owner ;.419 376 ~ia+ g 5
W. Tn* of POWTS Svstem/Com onent/Device: Check all that apply)
77 " essurized In-Ground 0 Pressurized In-Ground G At-Grade 11 Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable so l J`
0 Holding Tank er Dispersal Component (explain) _ ❑ Pretreatment Device (explain)
V. Dis rsaVrrea ent Area Information: t /t
Pcgigri Flow (gpd) Design oil Application dsf) Dispersal Area Required (sf) Dispersal Pro 7 d (sf) System Elev n.-
r--
,r C
/A-77
VL Tank Info Capacity in Total # of ManufaMirer
V
Gallons Gallons Units 1' c v I
-y
Now Tanks Existing Tana ( ~ ~ o m - y .o m m
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- the undersigned, m responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Priat)r Pl s mature MP/MPR ber Business Phone Number
Plumber's Ad ess Sfeet City: State, Zip
. c ~l C1
VIII duntv/De artment Use Only
Approved 0 Permit Fee Date su Issuing 'I Signature
=,7< on for Denial "t ~
71-7
_
~E 0 f" fAt.`. .
IK Conditi t~ns Kao~ , eMC liffer-P PP..val -3
"Y 1' v
Gi -pzr.<sd cell must all be air ir:?s ! r, 1 sec 0 1~• F'~~ Lr-
as per ~nacagement plan p!a tided by piu ibe=. +"ti 1v • n ~P
2. AO scRb~:k rect,i~r,^en;~ must r,;c: ~:k.~:r;i, ~r r f; /
Attach G .OJT
~ " per balbllt cxxl,€ rdi 1A1M;rA . ®e to complete plans for the s?>stem and submit to_ County ly oa paper not less than 8 12111 inches in size
SBD-6398 (R. 11/11)
System PLOT PLAN
PROJECT Mark Olson ADDRESS 1152 Ctv Rd C New Richmond Wi 54017
SE 1/4 SW 1/4S 15 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION 100.8/100.6 3.3' below grade DATE 8/30/17 BEDROOM 3
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Vent Scale = 1/4" = 10'
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
Long 1
34" Grade at System Elevation
Apple River
OHM
pp 52' 59
36' bed Failed
t.41 B-2
All piping shall be ASTM SDR 30/34 An' 51'
10' of tank, piping shall be AST 891 Vent It
Vents 37'
B-1 B-3 B-5 41'
60'
Valve
Manhole opening is over the 10 40 38'
outlet, a filter is to be
retro fitted ST
60' 1 114'
Well B-4
3 2-3' X 66' cells with >3' spacing
Bedroom
House
Cty Rd C
op
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/29/17
Owner:Mark Olson
Location: SE1/4 SW1/4 S15 T31 N,R18W 1152 Cty Rd C Star Prairie
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Leaching Chamber Cross Section
4-6. Maintanance ' Contingency Plan
v 7. Existing Sep ' nk Agreem¢nt
r~
Signature
t
Licens number #226900
System PLOT PLAN
PROJECT Mark Olson ADDRESS 1152 Ctv Rd C New Richmond Wi 54017
SE 1/4 SW 1/4S 15 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION 100.8/100.6 3.3' below grade DATE 8/30/17 BEDROOM 3
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE WELL *H.R.P. same as benchmark
Vent Scale = 1/4" = 10'
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4 Long 12
Grade at System Elevation
34"
Apple River
B.M.* b
OHM Q(0~
~60
opb~ 52' 59'
36' bed Failed B-2 51'
All piping shall be ASTM SDR 30/34 ithin Vent
10' of tank, piping shall be AST 891
Vents 37'
B-1 B-3 B-5 41'
60'
Valve
Manhole opening is over the 10 3 8'
outlet, a filter is to be 40'
retro fitted ST
60' 1 114'
Well B-4
O 3 2-3' X 66' cells with >3' spacing
Bedroom
House
Cty Rd C
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
5.6ft 2 pair of end plates
Finish grade elevation
Typical Installation 104.1'
Vent Grade Vent
3' 4" 3'
X30/34 Septic Tank
5' Long 1 5' S' Long 1
I- ; -
3 6" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
r Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-1 00.8'
B-1 00.6'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
)ESIGN PARAMETERS Effluent Fifter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units _ NA Pump Tank Capacity al E] NA
j Estimated flow (average) c'= Pump Tank Manufacturer NA
. < < avda
i Design flow (peak), (Estimated x 1.5) fJ'r gal/day Pump Manufacturer NA
Soil Application Rate / al/da /fe Pump Model NA
i Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) s30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODr,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) S30 mg/L -Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other
iMaximum Effluent Particle Size Yin dia. ❑ NA Other. ❑ NA
(Other. NA Other: ❑ NA
`Values typical for domestic wastewater and septic tank effluent Other ❑ NA
IAINTENANCE SCHEDULE
>"f Service Event Service Frequency
{inspect condition of tank(s) At least once every: ; ❑ month(s) ( y )
ears Maximum 3 ears ❑ NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: C' ❑ month(s) /1_trear(s) (Maximum 3 years) ❑ NA
3lean effluent filter At least once every: ❑ ear(s)s) ❑ NA
inspect pump, pump controls & alarm At least once every: ❑ month(s) O NA
.year(s)
1=lush laterals and pressure test At least once every: ❑ month(s)
❑ year(s)
ether. 0 month(s)
At least once every: NA
❑ year(s) ~~tner.
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
ioombined 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 (36) or more of the tank volume, the entire contents of
{'he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
Ill other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
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.
Page of
START UP AND OPERATION other chemicals 1t>Flt
For new construction, prior to use of the POWYS check treatment tank{s} for the presence of painting products or
and/or damage "41spersal cell(s). If high concentrations are detected have the contents of tht;
may impede the treatment process prior to use.
tank(s) removed by a septage servicing system start up shall not occur when soil conditions are frozen at the infittra#ive surface. wastewater will ble
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess of effluent.
discharged to the dispersal call(s) in one large dose, overloading the cell(s) and may resort in the badwp or surface discharge to restoring power to the
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior
effluent pump or pct a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank. the area within
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,
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 di and snfe prolong to of the d~ants• fat; foundation pOWTT$:
:
anfiblotics; baby wipes; cigarette butts; -condoms; cotton swabs; degreasers; dental floss; diapers' . fond rain
prots;
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; , Ping
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT shall be taken to insure that the system is propeltY
When the POWTS fails and/or is permanently taken out of service the following steps
and safely abandoned in compliance with dmpter Comm 83.33, Wisconsin Administrative Code:.
• All piping to tanks and pits shall be disconnected and the abandoned pipe opertings 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 code corripGnt
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeim.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule* in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWfS 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 sal and site evaluaOon
ust 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 sod absorption systems may be recormtructed in place fodowing 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 TAN 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
E I Name r , > Name
Phone
Phone
SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY
Name / Nam
Phone
i.
Phone e
il A, Z7
E i " w>
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(t) and 3&3,54(1), (2) & (3), Wisconsin Administrative Code.
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
?'his is to certify that I have inspected the septic tank presently
resid ce located at:
serving then; Y,_ K ~s✓
Section T N, Rf W, Town of
Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced:
I`)id flow back occur\rom absorption system?
Yes No (If no, skip next line)
Approximate volume or length of time: gallons minutes
'apacity:
Construction: Prefab Concrete Steel Other
Manufacturer: (If known)
Age of /Ta (If known) .:(,~,/jL7e
~ i
(S (Name) Please print
(Title) (License Number)
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement reglbof xisting septic tank
condition, I certify that the tank to my knowledge will
conform to the requirements of ILHR 83dm. Code (except for
inspection opening over outlet baffleNam_ i,rte Signature MP/MPRS f
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIRCATION FORM
Owner/Buyer /✓fG r t~ /s7~~ _
Mailing Address //-;-2- G c r Y P/
Property Adds r S Z G /L~
(Verification required from Planning & Zoning Dep meat far new construction.)
City/State Parcel Identification Number 6 315 - /0 (a 2 - G - 0.~0►
LEGAL DESCRIPTION
Property Location' T i~ N Rz~ W, Town of
Subdivision , Lot # .
Certified Survey Map # Volume , Page #
Warranty Deed # Volume CI~7 Page #
Spec house ' yes no , Lot line` identifiable yes no
F
SYSTEM MARMNANCE AND OWNER CERTIFICATION
Imisopm use and ==tmauce of your septic system could result in its premature bih= to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, ii needed, by a licensed p n4= What y(}" put iii,,
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner mamtenanrA
responsibilities are specified in §Conmr 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, joumeymaa plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic teak is
less thaw 1/3 full of sludge.
I/we, the undersigned have read the above, requirements and agree to m2unjam the private sewage disposal system with the
standards set fortk herein, as set by the Department of Commerce and the Departrraent of Natural Resources, State of Wisconsin.
Certification stating that your septic system bas been mailrtained must be completed and returned to the St Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a deed recorded in Register of Deeds Office.
Number of bedrooms _'D
S ONATURE 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 CIffice and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. O$/05)
-
AS BUILT SANSTC ITARY 104
SYSTEM REPORT
OWNER(z k ~So~l
ADDRESS
Af, ~KA1Ri P
SUBDIVISION / CSM#
LOT # {J
SECTION`T _R W Town of
- StAK VKA ) k) C
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Nose : (na11ko) '15 OVe K
Ou~
y , ,~~o SA 1
r r 18x3 b 8~~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form-
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK' ICS T~ t~eeI Q~` ` ~eU 10V , V
ALTERNATE BM:
SEPTIC TANK / H NG TANK INF ION
Manufacturer: Wee- k5 Liquid Capacity: 'UQV K o
~ 11
Setback from: Well N4 1W House Other
Pump: Manufacturer Model# Size
i
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
.~N fS
Width: Length Number o J3
q51
Distance & Direction to nearest prop. line:
Setback from well: House_ 5w Other ~NPp~a 1aI.Sg - {01.5 Coven
101-95 U~' 7S ELEVATIONS 'Off/ V
Building Sewer ST Inlet: 03.05 ST outlet _
103-0-
PC PC bottom------- Pump Offer,
Header/Manifold Bottom of system 4Q.5 5
Existing- Grade 10y. 85 Final grade
i
DATE OF INSTALLATION: 31 5
PLUMBER ON JOB: Q- , f (otb1),
LICENSE NUMBER: V 3YOV
INSPECTOR:
3/93:jt
W` in*n Department of Industry,
La and Human Relations PRIVATE SEWAGE SYSTEM County:
• ~r
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State P
OLSON, MARK & JODI X
CST BM Elev.: Insp. BM E ev.: BM Description: Parce Tax No.:
U/ r y
, 1lGr[..
/00~ a4
V C/ 0064
TANK INFORMATION ELEVATION DATA
i
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic a Benchmark .8~ a.0
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet
ir
Septic >~b Q g • yz s NA Dt Bottom
Dosing NA Header / Man. a q ' / U! 58
Aeration NA Dist. Pipe
Holding Bot. System
3.3 2' goo, 5-5-
PUMP / SIPHON INFORMATION Final Grade
1-0 Ivy SS"
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft Loss
Forcemai n Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
No. Of Pits Inside Dia. Liquid Depth
BED/TRENCH Width Length3G No. Of Trgpches PIT DIMENSIONS
DI NSIONS SETBACK
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type O /yc~ CHAMBER Moe Number:
System:D ~f s ' ' ' MI5 OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake
Length Dia_ Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges 3G Topsoil ❑ Yes ❑ No C] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Star Prairie.15.31.18W, SE,.6W, Lot 2, county Road C
Plan revision required? ❑ Yes Ef No
Use other side for additional information.
SBD-6710 (R 05191) Date Ini ctob s Signature Cert. No.
tAb„a°tlid^R,aw SOIL AND SITE EVALUATION REPORT Pepe 1 d?
r!I w saw, a Bwdrwe In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St. Croix
Attach mnlpNis ails plan on paper not lase than 8 7rz z 11 maws in s@s. Plan moat irlcMsde, but
not limited to vsrbcal and honzomel reteraros Point (BMA, dracow and %d slops, sole or PARCEL I.D.,
climnaioned, moan arrow, and bcetion and dial a to nwaw road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REWEWED BY DATE
PROPERTY OWNER: PRCPERTYLOCATION
Herz Olson GOVT. LOT w SN 1/015 T31 lent 18 f"IN
P90PEITTY OWNERS MAILING ADDRESS LOT, BLOCIL, SLBD. NAME OR CSM,
414 Irv. 64 CON ~a n a n a
CITY, STATE ZIP CODE PHONE NUMBER CO • ILLAGE fj FOWN NEAREST ROAD
171 2vr6-3544 Star Prarie Co. Rd. rC
New Calshchon Used Residenfd/Number of bedrmm 4 I J AddConberisWphlilkV
l I Replaoanad [ 1 Public or oo mlerael dmaibe
Code dwtved dally Ica 600 ppd liemrn ended deNpn beftp rde_,7 bed. pP W88 "-.WdV
Abw,ionarearequired 958 bed,r2 750 tench.R2 Mvdmundgetiabaringrole .7 bed.gde .R Worduwd*
Nemmrwldsd iMSYadm surlaw devaial(s) 100.55 N (as rebned b sits plan benchmark)
Ad6hmN design/ s8s oxaidNafore_ _ n/a
Pamt.lift nrtwa.h Flood plain elevation, l applicable n/a it
$ MDNa TAK
I LL
.=I AADE SYeIBI F
U.r9ya d.. I ®s ❑u CCwVB~rIo1Nl ®s eolRN1311 ®sNMDUAI❑u 0. DU uS AF ❑S ,®u
SOIL DESCRIPTION REPORT
Bomar Horizon Depth Dominant Color Moses Texture Structure Cortss BOUdny Rods GPD/
in. Munsell Ou. Sz. Cora Odor Gr. Sz. Sh. Bed :n
E! 0- 1 3 3 none sl. 2/m/gr c/w 1/f .5 .6
2 8-84 10yr4/4 crone co.s. 0/sg ml n/a n/a .7 .R
Gmurd
105(1)
Do* ID
Mdirp
la ft
>PA_
L_J
Remarks:
Borhv r
1 -6 10yr3/3 crone .51. 7/m/gr ervfr g/w 1/f .5 .6
0
2 2 _V 10yr4/4 none co.s. 0/sq "I ?,/w n/a .7 .8
3 30-80 10yr5/4 none S. 0 ml n/a n/a .7 .A
GmuM /
elev.
103 SS R 2
a,
Depth to
baI ~O
Remarks:
CST N--4PP6 -Pmt C L. Steel 15-246-6200
Addr- 155 th. Av w Richrmid, Hl. 54017
$rnesn: _ 4-7-o3Dnr: C$a~anbw:
STEEL'S SOIL, SERVICE 72
Gary L Sled
C.S.T. 2298 Mark Olson New Richmond, WI 54017
MPRSW3254 SF%SN', S15-T31N-R1Pt4 (775) 2464M
tocm of Star Prarie
i
/ i
I
,~n ~t/•fU I ~,y ~ e,n
log 4-
J vo
q - e, x~c, 207o 39.
~UZVI et2 Ali f it
wlrnt- Ksi- Pp~
PSOPFRfvawNa !lark Olson SOIL DESCRIPTION REPORT P4-1--.00
PAWALU).s
Boring f Horizon Deplh Dominant Color Ma" Texture Structure Root; GPD/ttz
in. Murrell Ou. SL ConLColor Gr. Sz. Sh. Bed Nrvh
1 0-6 1 3/3 rare sl. 2/m/gr mvfr d/w /f .5 .6
2 6-84 10yr5/4 none CO. S. 0/sg ml n/a n/a .7 .0
Gmwd
elev.
104.115
Deph to
1111169
Iemur
>84
Remarks:
Boring i
1 0-18 10yr3/3 none S. fir n/a n/a d/w 1/f n/pi n/p
2 18-76 10yr4/4 none co.s. O/sg ml n/a /a .7 ' .8
Gmud /
elev.
1Nr.O5 R
l g
balm
~76
Remarks:
Boring.
E3 1 0-20 10yr3/3 none a. fil. n/a n/ d/w 1/f n/p n/p
2 20-00 10yr5/4 rwne co.s. 01sg a n/a n/a .7 .0
GmW
dw.
103.55 R
D" Ill KA. 725
_ I
Ramada'
Boring f
Gwd
elBe. ✓.i
R
D" ID
Im"
lectx
in oar
m
v
0
c U ` a N
m d N w E w >m o O m o n
N Q U d N m > v I C O N
N W r 0
U~ W 9 N N y
0 N O 9 C
EMS N
N Z L' -
O A p h U y U O C N d _OI Z 0 of
N N d j
C LL a m Z E E O Q a rn ° U h m U E 0 m
h o m v y m x °i ~ U °i d I ? E ° O o y 6 c
of
•O m 0 o E o 3 m o m o m o m s `m o o m o ~ Lo t 0~
L V/ m LL > m O a W LL J m 0 U > m (n O J
af (n
U J (2 Ir Ir > ~ OO ~
J w.h
w
•F+ ~ m'O- a
- m
O D U U n
D v
44
r7w
A4W
• }
40 .
a
VIA
-
.
.
LLJ'
.
LLJ
)'44
N \
rt-. e
J
{
i'w
N 4 F
II ~
i ,
"pri
Nat,
,LLJ
6
ce,
z
4
r