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HomeMy WebLinkAbout032-2179-03-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division I INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600245 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)) 3003565 Permit Holder's Name: City Village Township Parcel Tax No: SUSAN HANSON TOWN OF SOMERSET 032-2179-03-000 CST BM Elev: Insp. BM Elev: BM Descriptio /y Section/Town/Range/Map No: 6//•~ 16.30.19.1522 TANK INFORMATION L NATION DATA TYPE MANUFACTU CAPACITY STATION AQ FS ELEV 'l r 1~ (f V Septic 5~ ` < L5 44 1 /0 A0 L Benchmark `~.90 160,6) Dosing Alt. BM 07 A AWativrr, Bldg. Sewer ~ 5- 12.06 ttirrg_ Ht Inlet r0 r Z g Z SUHt Outlet (v to TANK SETBACK INFORMATION TANK TO P/i, , WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' Dt Bottom A V~A qra. , / Dosing Heade a [ Qjs 7e,~- 4 SV /9 l AerB ion Dist. Pipe •I y' 4 Holding / Bot. System 4- CYO 2,~ l Final Grade PUMP/SIPHON INFORMATION II 04/ Manufacturer GPM Demand St Cover 10, 24-0; Model Number °'l//2 ' 717 &3 d( TDH Lift°I, Frictio Los System Head. 2D I ~t - Forcemain 11-enckh ( Dia.Z ~j Dist. to Well 79 4- SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengtle- No.. Qf Trenches PIT DIMENSIONS No. Of Pits Inside DDia. Liquid Dept DIMENSIONS 1(r /Y SETBACK SYSTEM TO P/L rrr"""JBBL"`--DrG- WELL LAKE/STR M LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ~UNIT Model Nu r: f~ ov~6 DISTR TIOlr SYSTEM Header anifol ' 4 Distribution I , I Ix Hole Size +I x Hole $ ac~g l ° Ven to Air Intake Pipe(s) Length Dia Length~~ 2-AD ia- Spacing / SOIL COV / x Pressure Systems Only xx Mound Or At-Grade Systems Only pth Ov rt y/ Depth Over ) Depth of i1 xx Seeded/Sodded xx Mulched' Be~d/Trroh!,Qbnter j J Bed/Trench Edges f Topsoil 1XX 'Yes No -Yes [ No COMMENTS: Include code discrePencies, persons present, etc.) Inspection #1: J J 7 Inspection #2: / ! / `a I I 'Zd 5 Location: 581 155TH AVE IFIOW + ~ ~ rJ /O 1 ' ~N~ 1.) Alt BM Description = A ~rs-I-QI~¢d IBS c Q~ ~►ev~ed rolie~~ P r N, ( , 1~ 2.) Bldg sewer - amount of cover = AI Plan revision Required? ❑Yes YYc No 11 Use other side for additional informati 8 'J",- _ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) f 1r Count ~r0tpnn'r t St. cry J~1 V rVl V Industry Services Division st Croix r11 G 11 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co_) RECEIVED P Box 7162 r 66 Madiso 1 &07-T162jrjL A ~~~a State Transaction Number . C „rmit Lipp 3003565 In accordance witj,I~ PMEM mission of this form to the appropriate governmental un t is required prior td utg a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary roJ~ t Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 155 Avenue L Application Infor tion - Please Print All Information 611 Property Owner's Nan Parcel # Hanson, Susan 032-2179-03-000 16.3 Lail O( Property Owner's Mailing Address Property Location 573 155"' Avenue Govt. Lot City, State Zip Code Phone Number NE 1A, SE '1A Section 16 Somerset, WI 54025 ( 'le one) T30N R19Eor V~ II. Type of Building (check all that apply) Lot 4 ® 1 or 2 Family Dwelling - Number of Bedrooms 17- Subdivision Name Narnia Nook ❑ Public/Commercial Describe Use 6k &h Block # IN ❑ city of ❑ State Owned - Describe Use ❑ Village of CSM Number O✓ ,/Q_(~~C/,/ ®'I awn of Somerset III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New Svstem ❑ Replacement System ❑ TreatmenUHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) i B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner O W Ov IV. Type of POWTS System/Com onent/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ® Mound > 24 in, of suitable soil ❑ Mound < 4 . t. of'suitable soil F-1 Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explam}~~ V. Dis ersal/Treatme Area Information: Design Flow (gpd) Design Soil Application Dispersal Area R%ned(st' Dispersal ire- roposed (so System ElevaI jol" 300 Rate(gpdsn 500 947 98.38' 0.6 VI. Tank Info Capacity in Gallons 2 ° ~5 y 1'ofal ° M ntfacturer -~Gallons New Tanks aSeptic or (folding Tank 840 840 eser ncrete ® ❑ ❑ ❑ ❑ Dosing Chamber 500 500 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pltunber s-Si tat e ~ MP/MPRS Number Business Phone Number John Schmitt ~f lit fv~1Z Mp M0 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 150d' Ave. Somerset. WI 54025 VIII ounty/De artment Use Only lpproved ❑ D' provek Permit Pee Date sued Issuin gent Signatur ❑ ~tw ,venA Reason for Denial $ 14 IX. ConditGhi$TiEpQ NfiJ;Utc tsons for Disapproval 1. 'apti tack, ~fflnt tifte- t+t~i ' c3twtr.::n cell must all e~pte•icas'rt+z ~nt~;r;ec Ct.r2. r+~ ei per Mar:ag~. plan prorided by piumber. 2.,ael4iM ns;fr►tb;~ k:t taint, irfd U Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 1 I inches in size SBD-6398 (803/14) TT aged PLOT PLAN N Project Name: Hanson 2 Bedroom Mound Legal Description: NE1/4, SE1/4, S16, T30N, R19W P.I.D: 032-2179-03-000 Subdivision Name: Narnia Nook Lot 3 SCALE: 1" = so' Township: Somerset Parcel Size: 3.399 Acres County: St. Croix Contour Line Elevation: 97.63 Cell Dimensions: 6' X 75' 4 inch Sch 40 -ASTM D2665 System Elevation 98.38 Mound Dimensions: 67.41' X 23.45' 2 inch Sch 40 -ASTM D1785 Slope 12 1 1/2" Sch 40 -ASTM D1785 e BM1 Elevation: 100.00' To of 2" PVC pipe BM2 Elevation: 97.94' To of 2" PVC pipe ■ Backhoe Pits: Septic/Dose Tank: W840/500-MR W/ POLYLOK 525 effluent filter n r~L J~ .P r CV) 7 11L e I i 2 - 4 &D .v ~ D~ Pcsc / ~ ~ .r~ PI f ~ L eqI) 56t 3 L) jvrt 17L ..c ` 1. nn OL i wj Z N l i Page 11 ~e7n1F~ DIVISION OF INDUSTRY SERVICES ~ roe 3824 CREEKSIDE LN 02 i 9 HOLMEN WI 54636-9466 s Contact Through Relay S P S ` http://dsps.wi.gov/programs/industry-services 7 w www.wisconsin.gov O .tiv ION 5~4 Scott Walker, Governor Laura Guti6rrez, Secretary October 06, 2017 OUST ID No. 223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1 101 CARMICHAEL RD SOMERSET WI 54025-6920 HUDSON WI 54016-7708 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10/06/2019 Transaction ID No. 30035615 SITE: Site ID No. 843103 Hanson Please refer to both identification numbers, 581 155TH Ave above, in all correspondence with the agency. Town of Somerset St Croix County NEl/4, SE1/4, S16, T30N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1728489 Maintenance required; 300 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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 requirements. 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01/01). • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.01/01). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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. JOHN F SCHMITT Page 2 10/6/2017 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. Si y Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Matthew Allen Janzen Please Include a Copy With Your Wastewater Specialist , Division of Industry Services Payment Submittal. (710340-0407 , WiSMART code: 7633 matthew.janzen@wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENZ..DESLGN- G i'jFll'llU':I lit; 3'LI :1 ~a..,~` 4E i V RE) ~I INDEX AND TITLE PAGE P - y 2 Project Name: Hanson 2 Bedroom Mound Owners Name: Susan Hanson Owner's Address 573 155th Avenue Somerset, WI 54025 Legal Description: NE1/4, SE1/4, S16, T30N, R19W Township Somerset County: St. Croix Subdivision Name: Narnia Nook Lot Number: 3 Block Number Parcel I.D. Number 032-2179-03-000 Plan Transaction No. Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications ? S[ ` z 0NI A? -Y Page 6 Management and contingency plan APPROVED Page 7 Septic and Dose tank specificationst APT OF SAFE-rf r Page 8 Effluent filter information c° ~i P~VIC~~ NA Page 9 & 10 Pump specifications and curve ' ``~`F FSS-10 Page 11 Plot plan Page 12 Septic tank maintenance agreement Page 13 Warranty deed Page 14 CSM Attachment Soil evaluation report Designer: John Schmitt License Number. 223760 Date: 9/15/2017 Phone Number: 715-760-0486 Signature: Ll 6~11 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 200.00 (g pd) Table 383-443 in-situ soil treatment for Estimated Wastewater Flow fecal coliform of 36 inches. 1.50;. Peaking Factor (e.g. 1.5 = 150%) 300.00 Design Flow (gpd) 12.00; Site Slope 97.631 Contour Line Elevation (ft) 27.00= Depth to Limiting Factor (in) 0.60= In-situ Soil Application Rate WOW) Distribution Cell Information 50.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00" Dispersal Cell Design Loading Rate (gpol ) 1; Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution _ Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 41 Number of Laterals of the highest point- _ 0.188 Orifice Diameter (in) 2.50; Estimated Orifice Spacing (ft) = 7.50 ft2/orifice 2.001 Forcemain Diameter (in) - - 120.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00; Pump Tank Elevation (ft) Enter Y or N MI System Head (ft) x 1.3 19.57 Forcemain Drainback (gal) 5x Void Volume (gal) Vertical Lift (ft) 44.45 Friction Loss (ft) 64.03 Minimum Dose Volume (gal) 0.00! In-line Filter Loss (ft) 26.21 System Demand (gpm) 16.03 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. o tions choice in. dia. _optionl5 choice 0.75 1.25 x 1.00 x 1.50 x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 840.00; Septic Tank Capacity (gal) Total Working Liquid Depth (in) , Wieser Concrete '.Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 500.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 11.82 Dose Tank Volume (gal/in) 525 Filter Model Number ,Wieser Concrete ;Manufacturer Project: Hanson 2 Bedroom Mound Page 2 Mound Plan and Cross Section Views J 1/10 B Observation Pipe : FK~- 5 AB I L Mound Component Dimensions ft A 6.00 ft E 17.64 in H [Aft ft K Aft B 50.00 ft F 9.50 in z ft L ft p 9.00 in G 0.50 ft J W 300.00 (ft2) Dispersal Cell Area 947.27 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.17 (ft) Latera ( I F Dispersal Cell 98.88 (ft) Invert I 98.38 (ft)-► - ?i Dispersal Cell D Elevation 1 97.63 (ft) Contour Elevation 12.0 % Site Slope Geotextile Fabric Cover Shading Key- Dispersal Cell See lateral details on a 1.5 ft - = Page 4 for number, size, 1 Topsoil Cap o 0 and spacing of laterals. a o Laterals are equally Subsoil Cap © ASTM C33 Sand spaced from the ® Tilled Layer c 0.5 ft ? Typical Lateral. distribution cell's © Aggregate v o . centerline in the ..A..,~ distribution cell (AxB). Project: Hanson 2 Bedroom Mound Page 3 ~ Center Connection Lateral Layout Diagram Laterals are identic at Force main connection via tee or gross to manifold of ang point. s i; P O=Turn-upviballvahfeor ~<--xX 'Exf2 ( rig-)1 Laterals &forcemanScfi40PVC cleanoutplug per SPS Table 334.30.5 Hole_ drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.55 ft Lateral Length (P) 24.23 ft Orifices per Lateral 10 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft2/orifice Lateral Flow Rate 6.55 gpm Manifold Length 3.00 ft System Flow Rate 26.21 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.03 ft Forcemain Velocity 2.68 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and 01 SPS 316.300 WAC 4 in. min. Disconnect F--- Alternate outlet Tank component is properly vented location Forcemain diameter Wieser Concrete Manufacturer 2 in. Ca acit 500.00 Gallons Volume 11.82 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 23.88 282.31 C B 2.00 23.64 Plump off elevation (ft) C 5.42 64.03 87.92 D 11.00; 130.02 D Total 42.30 500.00 Dose tank elevation (ft) Bedding un er tank. 87.00 Alarm Manuafacturer :SJE Rhombus Note: Switches containing mercury Alarm Model Number ~ 1036378 may not be used in Pump Manufacturer Zoeller this systern. Pump Model Number 98 Pump Must Deliver 26.21 gpm at 16.03 ft TDH Project: Hanson 2 Bedroom Mound Page 4 Mound System Maintenance and Operation Specifications service Provider's Name John Schmitt PhoneC._71_5-760-0486 POW-TS Regulator's Name St. Croix County Zoning ! Phone` 715-760-0486 System Flow and Load Parameters Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 200 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 840 gal maximum TSS 150 mg/L Soil Absorption Component Size 300 ftZ Maximum Maximum Fecal FOG 30 mg/L Coliform >10E4 cful100 mL Type of WastewaterDomestic Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for ponding and seepage once every 3 years 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 mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 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 Finished Grade Threaded Cleanout 6-8" Diameter Lawn Plug or Ball Valve Sprinkler Valve Box Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Page 5 Project: Hanson 2 Bedroom Mound Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole 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 a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. 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 continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 t abed are-oos/ooolM :31Id 95{8-5Z~-008 ° z \ :anod-lsod 00 :3iva ostas IM 'A008 rl3a1vw of lMH Sn 9lL£M ibnNyW OIld3S w o 'A321 31va 00 00 :2Jnod-3ad „o-,L=„b t :31VDS dOM VG NMV214 313dOu03 13531M dW-OOS/ObBM W ~ J w w c`''n z m O a o DC v V) CL C) Q v a W m vwi t/) d U A a w o Fg o } w O O O Q a O (n v w m J Z0~ m¢ w I- J a ¢ F 0 w us a :2 H O o z 0 co z 0o Hof- D ~W- C) LL > v 0 m o¢ z Z wm~ Q a o C) cs Q - C.) J o Q d C7 OW WV¢-W oo Z d o~ 0 ~ a s o m cn w w z V) J W F (f~ Q C) F ~r~r)o ~o ~V)¢ E-~¢ ao o F~ zz L-Li N N M I-yW.`- W¢ W U) W U C9O z o Q LO -j rnz J =U)~ ozx v v w 0 w ow d' V7 N .1 o("L.) ~ O0w a Li m a Lo '-`0x °U 0 Li C) To- i zF ¢ zN0 C) L~ a w 0 5X gp Y oa00`ZWwow~ ¢~L7 ¢~s.. z U o Y Y 0U- z Z~mU =J~smJ F o 6 Q w _o a z z o E-' a Z z J O r O~ 0 I J a w V) I I r 0 ° w w - CY l / ~ I N V) LLJ p U), x ¢ o~ ilS w 5 I I, 0O -j J. o 0 F W N ~ W U Z_ U- z a aD32~ ~ J6S ,,£6 SV a V) Y z ¢ H Page 7 g aged l A V_ J_ J~ nu6~7lI_u uI I'r 41 7 ~r,)a r Zabel 4'7 ! a stc..7Pt, r,t,d..e.L A II (vi dal e.I PolylA Inc. ter' [ ` The PL 525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. E trl~~,. Alarm Switch Rated for 10,000 GPD (gallons per day). ~xPD t (Optional) 525 linear feet of 1/16" filtration. ' .G^ Accepts 1" PVC " and 6" SCHD 40 pipe. Extension Handle Accepts 4 n Built in gas deflector. Automatic shut-off ball when filter is removed. Rated for Alarm accessibility. 10,0000PD -auile. Accepts PVC extension ]n~ f 525 Linear Ft. Ideal for residential and commercial waste flows up to Filtration Slots 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. Accepts 4" & 6" 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the Ply 525 filter into its housing. er4tfi 5. Replace and secure the septic tank cover. ` t i~Z)'d'16 MS stanflard 4G %Vnc, w f "M , rM, . The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter J-_- Gas Deflector needs servicing. Servicing should be done by a certified 1 Automatic septic tank pumper or installer. shut oft Ban 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 3 4. Pull PL-525 cartridge out of the housing.` t 5. Hose off filter over the septic tank. Make sure all solids fail back into septic tank. ' 6. Insert the filter cartridge back into the housing making sure 8ne filter is properly aligned and completely inserted. Polylok, Zabel &'Best filters accept Easily installs the SmartFilterOo switch and alarm. into existing tanks. 7. Replace and secure septic tank cover. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.potylok.com Page 8 6 a2led SECTION: 2.20.035 FM0973 0312 ,VA/TK LIMPS NN'T Supersedes \:A,OO a 0310 Product information presented here reflects conditions at time of publication. Consult factory visit our web site: regarding discrepancies or MAIL TO: P.0- BOX 16347 • Louisville, KY 40256-0347 www.zoeller.com nconsistencies. SNIP 7o: 3649 Cane Run Road • Louisville, KY 40211-1961 (502) 778-2731. 1 (800) 928-PUMP • FAX (502) 774-3624 98 Cast iron Series Non-clogging engineered plastic vortex impeller design Corrosion resistant powder coated epoxy ' finish [(FOR PUMP PREFIX IDENTIFICATION SEPTIOC TANKIVEWS & VIEWS 0052) Durable cast construction. Cast switch LOW PRESSURE PIPE (LPP} case, motor, pump housing and base. No sheet metal parts to rust or corrode. AND ENHANCED FLOW STEP SYSTEMS Castings - All cast iron class 25-30 25000# tensile strength Stainless steel screws, guard, handle, arm SUBMERSIBLE and seal assembly s.~AAey Float operated submersible (NEMA 6) '31/2' NPT DISCHARGE 2-pole mechanical switch Motor - Permanent split capacitor, 60 Hz, - 1725 RPM, oil-filled, hermetically sealed, fl CIP automatic reset thermal overload protection Tested to UL S,and„d ul778 an Ccrti6cd So CSA - s~ C.di~.z~SA Bearings - Upper & lower oil fed cast iron d ~`141 Carbon and ceramic shaft seal Entire unit pressure tested after assembly. 51, Watertight neoprene "0" ring between Automatic or Nonautomatic M motor and pump housing 1/2 HP,1 Ph., 115V or 230V Maximum temperature for effluent or Available with Piggyback 1 Variable Level Float Switch. t dewatering 130°F - 540C Passes'/ inch spherical solids ' s No screens to clog SS7,bfA Standard cord length 15 ft. (UL Listed) cru)td 1'/' NPT Discharge (1'/2' X 2" PVC Adapter j t included with BN & BE Models) On point - 9'/2' Off point - 3" r Major width - 10 'la" E~ POWDER Height - 12" n COATED TOUGH S r { J 1 a ~.f Note: The sizing of effluent systems normally requires 1 variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. © Copyright 2012 Zoeller Co. All rights reserved. Page 9 01 abed TOTAL DYNAMIC HEAD/FLOW W PUMP PERFORMANC CURVE PER MINUTE 2 ~ MODEL EFFLUENT AND DEWATERING _ 3713 6114 - 98 VV I_ - MODEL 98 1 25 Feet Meters Gal. Liters 3M 5 1.5 72 273 s ' 1 J ~ g 20 id 3.0 61 231 1 _ 15 4.6 45 170 ° 4 S 20 7.1 25 95 } 4 ~jj Shut-off Nead: 23 ft. 7.Om 1 I C, • 009971 'i 10 I I 0 1 r i 2 5 i i 121116 0 10 20 30 40 50 60 70 80 1 --t 1 1 GALLONS 421132 LITERS 0 80 160 240 I FLOW PER MINUTE 591102 itches are available for controlling single Electrical alternators, for duplex systems, are available and anVariable level d three phase t systems supplied with an alarm Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available or with or without alarm switches variable level long cycle controls Refer to FM1922 and FMO806 for temperatures above 130°F 98 Series Control Selection Model Volts-Ph Mode Amps Simplex Duplex M98 115 1 Auto 9.4 1 4 N98 115 1 Non 9.4 2 or 3 4 Easy assembly" pgg 230 1 Auto 4.7 1 4 (pump & discharge pipe E98 230 1 Non 4.7 2 of 3 4 .~I not included.) 1. Integral float operated mechanical switch, no external control required. 2. For automatic use single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3. See FM 1228 for correct model of simplex control panel 4. See FM0712 for correct model of duplex control panel or FM1663 for a residential alternator system. Reduces potential clogging by debris. Replaces rocks or bricks under the pump, For information on additional Zoeller products refer to catalog on Piggyback Variable Level Made of durable, noncorrosive the Switches, FM0477; Electrical Altemator, FM0486: Mechanical Alternator, FM0495; Sump! ABS. Sewage Basins, FM0487; Single Phase Simplex Pump Control, FM1596; Alarm Systems, Raises pump 2° off bottom of basin. FM0732. Provides the ability to raise intake by adding sections of 1'/s" or 2° PVC piping. caurlort Attaches securely to pump. Accommodates sump, dewatering and effluent applications. {NOTE: Make sure float is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. Z~7- MAIL TO: P.O. BOX 16341 Louisville, KY 40256-0347 Manufacturers of.. SHIP TO: 3649 Cane Run Road % Louisville, KY 40211-1961 Q11-1rrl/pyps ~wcE 1,qyg www.zoeller.com -2731- 502)778 7 FAX (502) 7(800)928-PUMP © Copyright 2012 Zoeller Co. All rights reserved. Page 10 TI DOed PLOT PLAN N Project Name: Hanson 2 Bedroom Mound Legal Description: NE1/4, SE114, S16, T30N, R19W P.I.D: 032-2179-03-000 Subdivision Name: Narnia Nook Lot 3 SCALE: 1" = 60' Township: Somerset Parcel Size: 3.399 Acres County: St. Croix Cell Dimensions: 6' X 75' 4 inch Sch 40 -ASTM D2665 Contour Line Elevation: 97.63 System Elevation 98.38 Mound Dimensions: 67.41'X 23.45' 2 inch Sch 40 -ASTM D1785 Slope W 12 1 1/2" Sch 40 -ASTM D1785 0 BM1 Elevation: 100.00' To of 2" PVC pipe BM2 Elevation: 97.94' To of 2" PVC pipe ■ Backhoe Pits: Septic/Dose Tank: W840/500-MR W/ POLYLOK 525 effluent filter ~L ~l. %A \ A r~~ L \ P ~`f -14 L de `,5 t r / ~13MI ,3 1= Z ✓ t / i / 8.2- L, IV tf e ~ f y` t t 1. `~c 4 L. ` . < ' i^r~l Z t N I Page 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Hanson Owner/Buyer Susan Mailing Addres 573 155th Avenue Property Address 581 155th Avenue (Verification required from Planning & Zoning Depart nt for new construction.) City/State Somerset, W1 Parcel Identification Number 032-2179-03'000 LEGAL DESCRIPTION Property Location NE , SE y4 , Sec. 16 T 30 N R 19 W, Town of Somerset la , Subdivision Plat: N a rn i a Nook , Lot 4 3 Certified Survey Map # , Volume Page # Warranty Deed # 4791 22 (before 2007)Volume 934 , Page # 492 Spec house ❑yes0no Lot lines identifiable ElyesE]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 year's 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 1/3 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 witl 'n 30 days of the three year expiration date. I/we 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 arranty deed recorded in Register of Deeds Office. Number of bedrooms 2 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. (REV. 04/12) - trZ abed } SECTION 16, T 30 N, R 19 Vii z Town of Somerset St, Croix County - Indicates Fence=' ~0~`'~ Indicates Roadway Setback Line _ (100' from Right-of-Way) y 22 - -Limits of Drainage Easement Utility Easement a - (12 Wide and Adjoining Lot Lines O b u'o ;ne as Shown on Map) o Town of Somerset ' ~ ~ Contiguous Buildable Area 41(/~11.1'1': + I. + , CD1 v(711 't,564,1Xc(~sI -50 W V, 00 X X, x, X, K x, 31;41' Y 66 t/,~' ~7' f BENCHMARK ^ Top f Iron Pipe Elevation = 976.05' o m d. t (r 4b X X 'X 'X L , ^ ,".i . A ,ri ``C~ ` ,Y'r` r~ ~j' 7~ .Y r r"` r•^eS` l )~^'x X 2.5 rCr `t ^ f 1yTc.}~L `+C (r ,<Ej X44 l , 95 ` ~ 1 ,`E/AI'YaQQq~ y 9, Sq. Ft i . ) ,pro ~6~0 F X33 ' " 155,066 953.E S i r N6e x833/ Page 14 RECEIVED OCT 2 4 201 I 5T. CROIX COUNTY OMMUNITY DEVELOPMENT r. t t 5 a'A 5 w f _ - i i 1 _ f' RECEIVED ST. CROIX COUNTY :OMMUNITY DEVELOPMENT . j i r I I - I 1 } j r I _ ( a I _f 1 c ' n i J , A tom. i c n Depart' of #1904 is gnfP;11A ~ t_]WIL EVALUATION REPORT If F5 - with Comm 85, Wis. Adm. Code Page 1 of 4 Pmfes Y2JC7TPDH 107T Schmitt Soil Testing, Inc. _ CST-- n - YU99 County Attach complete site plan on paper not less than 8'%x 11 inches i St. Croix include, but not limited to: vertical and horizontal reference po1~ and - - percent slope, scale or dimensions, north arrow, and location & istance to nea broad. Parcel I.D. 032-2179 3 00 Please print all information. N.r( `viewed Date Personal information you provide may be used for secondary purposes (Privacy Law~.~l JLnr't ° 16 Z6 / Property Owner V~ ocalltJJio~~n Hanson, Susan ~QN►MV Govt. Lot NEII , SE1/ , S T30N, R19W Property Owner's Mailing Address Lot # Block # i Subd. Name or C # 573 155th Ave 3 Narnia's Nook -y~ City State Zip Code Phone Number City -Village I Town Nearest Road Somerset WI 54025 715-247-5968 Roberts 155Th Ave. New Construction Use: Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement Public or commercial -Describe: Parent material Glacial till (Santiago-Antigo Complex) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a mound system. System elevation is 98.38' based off the contour line established at 97.63'. Depth to limiting and recommendations: factor is 27'. Slope of area is 12%. X Boring ❑ Boring # 'Pit Ground surface elev. 98.08 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary j Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sl 2mgr mfr cs I 2vf 0.6 1.0 2 12-21 10yr4/6 none scl 2msbk mfr gw lvf 0.4 0.6 3 21-29 7.5yr4/6 none sl imsbk mfr gw 1vf 0.4 0.7 - - - - 4 29-74 5yr4/4 c2d 7.5yr6/8 51 Om mfi gw 0.2 0.6 7.5yr6/1 5 74-86 10yr5/6 c2d 7.5yr6/8 s Osg ml cs 0.7 1.6 7.5yr6/2- 6 86-92 5yr4/4 m2d 7.5yr5/6 sl Om mfi 0.2 0.6 - - - ----7.5yr~2--- Boring ❑ Boring # 'Pit Ground surface elev. 98.08 ft. Depth to limiting factor 27 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 1 0-15 10yr3/3 none sl 2fsbk mfr gw 2vf 0.6 1.0 2 15-27 10yr3/4 none sl 2msbk mfr gw 1vf 0.6 1.0 3 27-42 7.5yr4/4 c2d 7.5yr6/8 sl Om mfi cs 1vf 0.2 0.6 7.5yr6/2 4 42-78 10yr5/3 m2d 10yr6/8 10yr6/1 sll imsbk mfr 0.4 0.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 - - Address Schmitt tt Soil Testing , , Inc--- - - ---Telephone-l--- -Number------- . Date Evaluation Conducted 1595 72nd St. New Richmond, WI 54017 8/25/2017 715-760-1978 SBD-8330 (R.07/00) Proep,rty Owner Hanson, Susan Parcel ID # _032_2179-03=000 _ % Page _ 2_ of _ 4 Boring -5-21 ft. Depth to limiting factor 3 Boring # Pit Ground surface elev. 9 39-- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary I Roots GPD/ft2 _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#l *Eff#2 1 0-11 10yr3/3 none sl 2fsbk mfr as j 2vf 0.6 1.0 2 11-24 5yr4/4 none grsl lmsbk mfr gw ivf 0.4 0.7 3 24-39 5yr4/6 none grsl Om mfr gw lvf 0.2 0.6 4 39-66 10yr4/6 c2d 10yr6/8 sl Om mfi cs 0.2 0.6 5 66-84 5yr4/4 c2d 7.5yr6/6 sl Om mfi 0.2 0.6 7.5yr6L-- - Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. F-1 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#t *Eff#2 I 'Boring F-1 i 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 - - - - - - - - - - -I---- - - Effluent #1 = BODS> 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 TIN 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 of 4 t Conducted by: Conducted For: Schmitt & Sons Excavating, Inc.. Name: Susan Hanson Thomas J. Schmitt, CST 227429 Address: 573155th Ave 586 Valley View Trail City, State, Zip: Somerset, W1 54025 Somerset,Wl 54025 Phone: 715-760-1978 P I D: 030-2179-03-000 Signature ' Lot No. 3 Naria Nook Date A" Legal Description: NE1/4 SE1/4 S16 T30N R19W ■ Backhoe Pit Township, County: Somerset, St. Croix County ♦ Bench Mark 1 El. 100.00' Top of 2" PVC pipe D Bench Mark 2 El. 97.94' top of 2" PVC pipe Slope= 12% Scale 1"= 60' Contour Line El. 97.63' Contour Line Length 75' oj^ NOTE: For full view of Lot see Aerial Photo (Page 4 of 4) y~. , r i ~ ' ~ Sao /09 ~fl D f V otAa /N6- I C" do } 10. 05 cl% 4 D Q Ln 00 Os W ~t m ar- C, 0 t ~ U; y 1 .Y, ~ y_ N A 542, wrsoonsin Department of comrnerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County S;r CAD/ X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Ptah must -7 1 Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0 -1 Percent slope. scale or dimensions, north arrow, and location and di- Ps~ce to nearest road. U 3 2 2 • aSG • 7d -dza Please p " Reviewett)4 /"7 J~O to Persoaat klfomration you Pry may for purposes (Privacy t w. s.15.04 (1) (m)T. 1L y ` e+ Property Property t AV DEC 2 6 2003 GoA Lot IVA.) 114 5j 1/4 S T 30 N R &4w) w or CSW Property Owners Mailing Address A- /t/ O17 s~ l~ S ~v ST NINGOOPICEY Loth t3todc# Subcl. NNName City State Zip ❑ City ❑ Village r®1 Town Nearest Road $ 0MF-RSet T ~vl 579102-51(-7/5) 2-Y-7•5968 50ME9 SE7- /SS fi.' A v 194 New Construction Else: Residential / Number of bedrooms ~ Code derived design flow rate 0 C2 GPD ❑ Replacement ❑ Public or commercial - Describe: I Parent. material -Cl ll L lls Flood Plain elevation if applicable General comments NO n nrnetdatiais: -,e g + T j ~EVUI' S ,r Bing # ❑ &Xg 3 5 557 , Pit Ground surface elev. _ ft. Depth to WrAing factor 2 in. Sol Application Rate Horizon Depth Dornmant Color Redox Description Texture Structm Consistence Boundary Roots GPDtff In. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 / 0-(.0 SOW X3 L I s G S 3 'F •4~ Z 6.12- /,9 3 L /f SA CS 3 la 15 /o yR ,3/ 5iL 2 f s bK s A CS / . s 27-1 s 7- SYR y _ Sid fs 'S 3 r 5' S 6• 6 7.5Vk s/ -Pi 5L 0, kUk co e4 I ? t Boring # Q Boring (P S S. S , i 1 K pit Ground surface elev. I ft Depth to liming factor in. sor7 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#i 'Eff#2 / O' W /0 yR 3/3 L /f sbik-' a517 ~v 3 f- 9 • ~f A/ /d yie 31-- L If Ale 15 G S l f^ . ~f 3 N- 1 0 3------- siL z s s c5 -S' -9 5 -2959 ? S S e:2,~Q- M D 51_ Dr nit d- S /a yI2 del ~ 5 \,(iP yl • Etfluerrt #1 = SOD > < 220 mg& and TSS >30 < 150 mg![ - Effluent #2 = BoD < 30 mgtL and TSS < 30 mgtL CST Name (Please Pant} Signature cST~ 3 S t=2 o E tzT -14 z Address Date Evacuation Conducted Telephone Number b 3 71~7a • 341„ fZ Private Sewage Consultants 2812 10th Ave. Spring Valley, fit! 54767 svc ~f vSoN 03aZ ~oSG• 70 - crertyCIYrt7Pr PamelID# GO r~ 3 P e 2- ~ fn~ S S. Pit QMMdsuriace etev v tt- Depita to ~9 tacw 32- a~ S . 14mLon Depth Don-inant Colo, Svd R # €tedox t}escriptlan Texture Shucture Corrsistence 8cwndary Gp Roots r # in. Munsett Qu. Sz. cent color Gr. Sz 5b. o !b ,e 3/3 L a fs& 40 z 6 sh cs i 5r 6 6L) '(0) s 02- C i 8.7 s 2~ duo fs s .A-14 v .3 s Sod"g. Boring Pic Ground suetace e4.v. _ tt DeA to lintiti09 factor ;n. Depth .SOS[ Application Re li on DCxfM;mit`do, /^Red(~o~X t/l~~~sc~xiptiro~n~ Texture S~t oclure canwer~ BourKin Roots GPDff [ta irk ll told. 8z. Cont Color (~t . i. V. Sz Sh_ 1E1p/.t 4~(ijly3 . ~tff 5 ~ i7T Sorirrg # Goring t _t Pit Ground surface eisv. ft. Depth to lkr tiro 111. g~,,,,~ Sod Geation Rat t-totizon DMM Dm*nant Cd Redox Description- Texture St ucture istence Botaxiary ;:toots G,pD~gg in. Munselt Chid. Sr. Cont. Color Cf. Sr. j `F"2 4 _<s i 17 n a i 'f t i r El Pit C-o" surface efev. tT. Dew to film ng tadot in, tior: Rat Fiortzan Depth Dommant coky ff edox Desuipto Text Stnidwe Consistence Boundary Roots GPt31i im Munse# OUu Sz. Cont or Gr. Si- Sh. •0#1 *EW2 4 a_ 1 3 'Effluent f 1 = BODt > 30 < 220 stte~3l and TSS >30 < 150 mg?L " t=tt2ue*tt #2 = BGD3 < 30 nxA and TSS < 3J tug? The Department of Commerce is an equal oppflrtunity service provider and employer. If you need assistance to access services 177 need material ie an alternate fotrrta2, please contact the department at 5013-266-3151 or A''7Y 608-264-2777, sa~zk-rzoraarewti