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HomeMy WebLinkAbout020-1041-40-000 . Croix epartment of Commerce PRIVATE SEWAGE SYSTEM County: St Building Division Sanitary Permit No: INSPECTION REPORT 600267 ER AL INFORMATION (ATTACH TO PERMIT) State Plan ID No: final information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. mit Holder's Name: City Village Township Parcel Tax No: :ERNON BAST TRUST TOWN OF HUDSON 020-1041-40-000 CST BM Elev. Insp. BM Elev: IBM Description: Section/Town/Range/Map No: 5 19.29.19.172K 'TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic 1 1000 Benchmark • a 'O~.A i, 4 Alt. BM l l l V Aeration Bldg. Sewer ~D G3 9~. V di St/Ht Inlet p/ TANK SETBACK INFORMATION St/Ht Outlet 11 pa• 9. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ?o- Septic Dt Bottom 6 Dosing Header/Man. 1;). ~v ' -7t u, Aeration Dist. Pipe a ;0 c~~ Y Holding Bot. System _ ~ ~r1 g.a-~ / Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover J x 1 ar C*_ V/ G/.P~Mf,, Model Number - TDH Lift Friction Lois System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM [f! ! E(sv, iS BED/TRENCH Width _y r Length No. Of Tenches LL_~ PIT IME No. f,Pi Inside Dia. Liquid Depth DIMENSIONS _.7 bYJ~-~/r~iA a SETBACK SYSTEM TO P/L BLDG WELL LAK STREAM LEACHING Manufactures INFORMATION CHAMBER OR Type Of System: T UNIT Model ber. 7 ~Oh r , (7 Ll E, Distri 'on x Hole Sias x Hole SRa ng Vent to Air Intake Pipes) , A\ reader/Manifold aa2th Dia Length1 Dia Spacing SOIL COVEf;t-- x Pressure Systems' Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth ln~ rSeeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges I Topsoil Yes No [I Yes :::N,] COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2: tt/ Z ~UC.Y -,z. Location: 353 WILLOW L t R A16S -r4-[.. 1.) Alt BM Description = I ~40LI ~l/`e~+ e~. j ✓ I d , 2.) Bldg sewer length = ! - amount of cover T,_6~ Plan revision Required? ❑ Yes E] No Use other side for additional information. Cert. No. Date Insepctor' ign ture ; / SBD-6710 (R.3/97) ~c - 'SAN 2Sq County 2F1 a Safety and Buildings Division 201 W. Washington Ave.; P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, Wl 53707-7162 l -~J CROIX COUNTY V A,; Sanitary Permit A YFH18M9TAS4S4 State Transa; o~yber In accordance with SPS 383.21(2), Wis. Adm. Code, submission , 1 is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to project Address (if diflarent than marling address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondayt 000! purposes in accordance with the Privacy Law, s. 15. 1 m), Stats. t j L Application Information - Please Print All Information 35 ~j` Property Owner's Name Parcel 6 ~5v~►, . QrC Property Owners Mailing Address Property Location Gj -7,1 `tC, 6q , Govt Lot tim State r, Zip Cod} Phone Number i/7A /brio rIA_J_ At ,~-~G~,"_--~ r' , L.' .~i'~ I T ~ _ ► II. ype of Building (check all that app Lot N R E W ,or 2 Family Dwelling-Number of Bgd~o Subdivision Name Block # ❑ Public/Commercial -Describe Use ❑ City of El State Owned -Describe Use CSM Number ~❑,yViage of wn of III. Type of Permit: (Check only one ox on lie A. Complete line B if applicable) A. .++i. Q New System lacemcnt System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) rm List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber 11 Permit Transfer to New Before Expiration Owner IV. Type ofPOWTS S stem/Com onent/Device: Check all that apply)_.. Non-Pressurized In-Ground ❑ Pressurized in-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaVrre ent Area Information: Design Flow (gpd) Design Soil Application dsf) Dispersal Area Required (s Dispersal Area posed (st) System Elevan n 50 17 1~ i /y L VL Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units g New Tanks Existing Tanta m v d 2 l /1/ tt t~ n U in vs E C~ Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- the undersigned, assu a possibility for installation of the POWT'S shown on the attached plans. Plumber's Name (Print) Plumber' i attire W/MPRS Number Business Phone N be in" Plumber's Address (Street, City, State, Zip t VIII CountirADepartment Use Only pproved sypp Permit Fee Date ued Issuing nt Signature v Reason for Denial • / / IX Conditr ns sSpproval 1 R~ b~6~ q WORE ~:,u J U Gt, GL d pert„ cell rust all be -ic s ' r tt e es per,gwr, pment plan o!udaerl by plu noel. 2. eelb~lydf'tJresr~sn;s rrnt,t,u rKi nt, lr,( •t els per tW*wbls c4dl! 1 cMinaimx. i Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in sin SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Kernon Bast Trust ADDRESS 948 LaBarae Road Hudson Wi 54016 NW 1/4 NE 1/4S 19 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 91.5/91.4 5' below qrade @ B-1 DATE 11 /7/17 BEDROOM 3 CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter r❑ BOREHOLE O WELL *H.R.P. same as benchmark Willow Lane Seale 1 S 1" = 40' unless otherwise Please note: if a portion of the new noted drainfield lies on top of the old drywell, extra chambers will be added to the system to compensate Property Line for this. Well Vent 90' >6' Quick4 Standard of Co er Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' ong 12" Grade at System Elevation Existing 3 34" Bedroom ouse Old tanks are to be B•M. pumped and buried Garage 8' Combo Tank 1% Slope 10, All piping shall be ASTM SDR 30/34, within 30' 10' of tank, piping shall be ASTM F891 B-3 6_ k ! 2-3' X 66' cells 14 6, ` with >3' spacing B-1 35' 35' Q~ 5 5' B-2 .40 Property Line /C 0 P Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11/7/17 Owner: Kernon Bast Trust Location: NW 1/4 NE 1/4 S 19 T29 N,R19W 353 Willow Lane Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sh~et 8. Dose Tank Cross Se i n 9. Pump Curve Signature License numbe #226900 System PLOT PLAN PROJECT Kernon Bast Trust ADDRESS 948 LaBarge Road Hudson Wi 54016 NW 1/4 NE 1/4S 19 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 91.5/91.4 5' below qrade @ B-1 DATE 11/7/17 BEDROOM 3 CONVENTIONAL CONVENTIONAL LIFT XXXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter r ❑ BOREHOLE O WELL *H.R.P. same as benchmark Willow Lane Scale is F = 40' unless otherwise Please note: if a portion of the new noted drainfield lies on top of the old drywell, extra chambers will be added to the system to compensate Property Line for this. Well Vent 90' >6' Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' ong 12" 1~l Grade at System Elevation Existing 3 34" Bedroom ouse Old tanks are to be B.M.* pumped and buried Garage 8' Combo Tank 1% Slope 10, All piping shall be ASTM SDR 30/34, within 30' 10' of tank, piping shall be ASTM F891 B-3 2-3' X 66' cells with >3' spacing 5' S B-1 35' 35' B-2 Property Line 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 96.5' ,jv ent Grade Vent 4„ 3' /34 Septic Tank x/30 5' S' Long Grade at System Elevation 3 6 " Grade at System Elevation Spacing- 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A-91.5' B-91.4' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEW NT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address C4- c Property A&hwg (Verification required from Playing & Zoning Department for ne 'on.) CitylState _ Parcel Identification Number 0 LEGAL DESCRIPTION Pmperty Location 1/4 , Li/4 , Sec. T ,~N R_,& W, Town of Subdivision , Lot # Certified Survey Map # Volume Page # Warranty Deed # Volume - , Page # Spec house yes o Lot line;- identifiable ~ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION ImFoper use and maintenance of your septic system could result in its premature faik= to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it needed, by a licensed Pumper- What you put into the system can affect the fnmeti on of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 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 plunim, 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. Uwe, 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 Commerce and the Department of Natural Resources, State of Wisconsin. C,,ertification stating that your septic system bas been maintained must be completed and returned to idle 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. Uwe am/are the owner(s) of the property descril)ed above, by virtne of a deed recorded in Register of Deeds Office. Number ma~ /Z/Z)/Z f f V- SI ATURE OF APPLICANT (S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Inchule with this application a recorded warranty deed from the Register of Deeds Ctffice and a copy of the certified survey map if reference is made in the warranty deed WV-0W POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner L Septic Tank Capacity al O NA e- Z ' Permit # Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Fitter Manufacturer - ► ❑ NA Number of Bedrooms a ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility Units NA Pump Tank Capacity al ❑ NA j Estimated flow (average) al/day Pump Tank Manufacturer NA On g Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate avda /fe Pump Model ❑ NA i i Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 6220 mg/L ❑ NA D Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) S30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L 1;14A ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other. !Maximum Effluent Particle Size %s in dia. ❑ NA Other. ❑ NA L n Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE M Service Event Service Frequency linspect condition of tank(s) At least once every: q earn s(s) (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (36) of tank volume ❑ NA pyear(s) (Maximum 3 years) ❑ NA !Inspect dispersal Dell(s) At least once every: ❑ month(s) Clean effluent filter At least once every: ❑.month(s) ❑ NA j4year(s) Inspect pump, pump controls & alarm At least once every;; ' ❑ rno r(s}s) ❑ NA 1=lush laterals and pressure test At least once every: D eoart(sjs} NA y ether. At least once every: ❑ month(s) NA ❑ year(s) ~?ther. 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 lincude 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 Iegulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of j:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of <12 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 nt tank(s) for the presence of painting products or other cttemicais that START UP AND OPERATION de of the pOWi S check treatme For new its prior to use may impede the treatment process and/or damage the dispersal cell(s). if high cone are detected have { cements of t" tank(s) removed by a septage seining operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface- the excess wastewater will ble tanks may fill above normal highwater levels. When power baockuredp or surface doge of effluerill. During power outages pump s dose, overloading the cell(s) and may result in the to restoring power to tide discharged to the dispersal in one large tank removed by a SSW Servicing operator i~ to restore ppower levels effluent avoid this situation have the contents of the pump m manually operating the pump controls pump or contact a Plumber or POWTS Maintainer to assist ' within the pump tank, disturb or compact, the area within Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. rrnanc~ and prolong the We of the POWT$: Reduction or elimination of the f WiAng tram the te< stream may improve the pe dis rTfedants' fah foundation drain curette butts; condoms; cotton swabs; d~jresisers; dental floss; s+ ~~Tned{cations; oil; painting products; antibiotics; baby wipes; f tine; grease; herbicides; meat scraps; (gyp pump) water, fruit and vegetable peelings; 9aso pesticides; sanitary napkins; tampons, and water softener brine. ABANDONMENT taken out of service the following st and safey abandoned in compliance eps shall be taken to insure that the system is Propetly When the POWTS fails and/or with permanently Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. Operator. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage removed or their covers removed and the void space filled with soil, , all tanks and piss shall be excavated and • After pumping gravel or another inert solid material. CONTINGENCY PLAN have been, or must be taken, to provide a code caripfsnt If the POWTS fails and cannot be repaired the following measures replacement system, soil absorption system. 17 A suitable replacement area has been evaluated and may be utfted for the location of a to replacement nt sod won by requited The replacement area should be protected from disturbance and compaction and stmld riot area infringed in the need replacement setbacks from existing and proposed structure, lot lines and welts. Failure to protectthe c ill result with the the le 4 in for a new soil and site evaluation to establish a suitable replacement area. Replacement effect at that time. advances in POWfS technologlt a Q A suitable replacement area is not available due to setback and/or soil limitations. Barring rig tank may be installed as a last resort to replace the failed POWTS. failure of the POWTS a sal and site evaluajon Ll'ie site has not been evaluated to identify a suitable replacerr►ent area. Upon be installed as must be performed to locath a suitable replacement area. {f no replaoemeM area is evadable a holding tank may a last resort to replace the failed POWTS. be reconstructed in place fo8owing removal of the biomst at the infiltrative O Mound and o gradersttucti absuch yes must comply with the rules in effect at that time. surface. Reconstructions ~ SEPTIC, PUMP AND OTHER TREATMEATTANKS MENT TAN Y UCONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. NDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE NOT ENTER A SEPTIC, PUMP OR OTHER O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DI SCULT OR IMPOSSIBLE ADDITIONAL COMMENTS S INSTALLER POWTS MAINTAINER Name Name Phone 0> r Phone r SEPTAGE SERVICING OPERATO LIMPER LOCAL REGULATORY AUTHORITY - "L Name a ~ L Name , /r4! -7 E Phone Phone Administratfire Code. This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wilsconsn I N 11:: f i t t a 1,.. ._L..,I j a I jsi$s14 1 i f 1r 1tiJ~,c. 111i I 1 L_liit~l I j ~ a I o; o I o , { 10 , J u ~ f 4 i I U- 1 I I / Up i 1 j CN v 1 l.1 C w ~f I Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Required Tank Model Number r y1, GPM @ ! i > Ft TDH Total Tank Capacity Max. Bury Depth ~ Total Dynamic Head (TDH) - Feet Pump Manufacturer Elevation Head Pump Model Number J Distal Pressure Alarm Manufacturer Network Pressure Loss Alarm Model Number Force Main Pressure Loss Switch Type Total Manhole Min. 4" Above Grade With Locking Device Vent Min. 12" Weather-proof Above Grade Junction Box With Cap - - - Finished Grade - - - - - - _ - 1 T Depth of Cover) _ Ft Disconnect Means i'<4 ['tt't't'<'i't'<'i'i't't>t'<'t't'S't'S'i'[' < t / } } > < t outlet _ Inlet Switch Settings and Reserve Capacity Tank Volume = GPI > > Dimension Inches Volume Gal. A > (reserve) At ' '/a» > Weep < (alarm) B 2 0 B < < > Hole (dose) C Off Elev. C 't (dead) D = Ft > > t > ' Total t Bottom of 'l'ank Elev. Ft D i s<<< t t t > t[ S t[< S[ S S S< t< t t< t t t t<< S<<< t t S<[ S S S t« < t<<<< S t t[ t t< t<< t<<<< GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the 3 ` manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/051gj Page of Ln TOTAL DYNAMIC HEAD/CAPACITY _u w HEAD CAPACITY CURVE PER MINUTE g MODELS 53/55/57/59 EFFLUENT AND DEINATERING 25 Model i 53/55/57/59 6 20 Q =t. Meters I Ca!. Ltrs. ~Ij 1.5 43 63 S \ 1.0 3.. 34 29 a ~ 15 4.6 19 72 10 Snit-off Hecd 19.25 ft. (5.9m) 0 2 5 3 15/166 5/32-1 c 5/8 ~ /2 -11 : /2 NFT 0 1 U. S. GALLONS j 10 2 30 40 50 ITERS 80 100 i ► FLOW PER MINUTE ~ oosesl ~ 4 1/16 v - y f Variable level float switches available. Variable level long cycle systems available. ~h -Available with special cord lengths of 15', 25', 35 and 50'. Alarm systems available. 10 / Duplex systems available. I 3 3/32 _cc1'.YTE SK858 S' € u sD= Single Seal Control Selection ElsIngs echanical switch, no external control required. Model Volts Phase Mode j Amps Simplex Duplex 1. Integral float operated m M53/55 & M57159 115 1 Auto 9.7 1 2. Single piggyback-variable level float switch or double piggyback variable level N53/55 & N57/59 11 1 Non 9.7 2 3 or 4 & 5 float switch. Refer to FM0477. BN53 115 1 Auto 9.7 SN57 115 1 Auto 9.7 3. Mechanical alternator "M Pak" 100072 or 100075. BE53157 230 1 Auto 4.8 i 4. See FM0712 for correct model of Electrical Alternator. D53155 & D57/59 230 1 Auto 4.8 1 5. Variable level control switch 10-0225 used as a control activator, with Electrical E53/55 & E57/59 230 1 Non 4.8 2 3 or 4 & 5 Alternator (3) or (4) float system. Single piggyback switch included. s cnunaN For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches, FM0477; = e s Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase a e ' c ` ` o Simplex Pump Control/Alarm Systems, FM0732. S_-,ec; and For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - - MAIL TO. P.O. BOX' 15.247. / Louisville, KY 4025" Manufacturers of . . "~k l SHIP TO: 3649 Cane Run Road ® - Louisville, KY 40211 1961 r&WryPUMPS,F#ri- /9,79 ' 1(502) T77 2731 1 (800) 928•PUMP http://www.zoeller.com t P!!MP .~O_ FAX (502) 774-3624 - - - - - C Copyright 2002 Zoeller Co. All rights reserved. p -7 YFH18M9TAS4S4 Wis ~ns~ntD h jiTyrce Page of Divi ' ~iSMm(('' 'MEN' 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 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. k-L percent slope, scale or dimensions, north arrow, and location and distance to nearest road. /)L V' Please print all information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 8/207 Property Owner Property Location -77 a Govt. Lot / 1 /4 1 /4 C T Z N R E( r) W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 7 c ' ~ , City State Zip ode Phone mber ❑ City ❑ Vill a Town Nearest d ❑ New Construction Use~tesidential / Number of bedrooms c 3:1 Code derived design flow rate GPD 11 eplacement Public or~°mmerclal - Describe: Parent material (4 (J~~ Flood Plain elevation if applicable ft. General comments and recommendations: }34p/~►uJ ' System Typr n/~l'~ni[.t System Elevation ! A~ 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 GPDKF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 7 3h- J I 17-q '-s q3-i 1<e if ft,1)4 X-2,4 /z r 17 ® Boring # ❑ Boling ER" r -1 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. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 1071> Effluent #1 = BOD. > 30 < 220 nxyL and TSS >30 < 150 ri1g/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 ' Property Owner _ Parcel ID # Page of Boring # ❑ Boring L , a nit 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 0-12- Qv,,31,L Cj- VZ -7 '5 to SC ' ~l I~ Boring # ❑ Boring F-1 ❑ 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. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff 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/L ' Effluent #2 = BOD5 < 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. sea8330 (8.6/00) Property Owner _ Parcel ID # Page of Boring # ❑ Boring A a ~it Ground surface elev. ft. Depth to limiting factor in. Soil ligtion 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 G l d - I C'~~ '01 L 11000, Boring # ❑ Boring 11 ❑ 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. ❑ Pit 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 ' Effluent #1 = BOOS > 30 < 220 mg/L and TSS >30 < 150 mg/l- ' Effluent #2 = BOD, < 30 mg/I- 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. SBM330 (8.6/00) Soil Test Plot Pla Project Name Kernon Bast Trust Sh Bird Address 948 LaBarge Road Hudson Wi 54016 CISTM #226900 Lot Subdivision Date ( i 1/7/17 NW 1/4 NE 1/4S 19 T 29 N/R19 W _ Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 91.5/91.4 *H R pSame as Benchmark Willow Lane Scale is 1" = 40' unless otherwise noted Property Line Wel 90' Existing 3 Bedroom ouse Garage KB. M. * 8' ST 10' 10' 1°Io Slope DW B-3 15' 15' ' B-1 35' 35' B-2 5 S Property Line