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HomeMy WebLinkAbout030-2008-95-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 600292 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Zachary & Jacqueline Henneman TOWN OF SAINT JOSEPH 030-2008-95-000 CST BM Elev: Insp. BM Elev: BM Description: A0 Section/Town/Range/Map No: 0O,,JeA.~ A0 34.30.19.382A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /OZ.b /ad Septic 1400 Benchmark Dosing AIt.~IV l/~ efzc,~, 760to a f, q rp •9 on Bldg. S wer ` Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TAN TO WELL BLDG. Vent tor Intake ROAD Dt Inlet 66 / 7 ~o 75 Septic` / , , Z7 Dt Bottom AU - Dosing / 1.00~ Header/Man. zb 5 Y. 4 Aeration 1 ' Dist. Pipe Holding W qu Y.5 Bot. System 97` 1 Final Grade PUMP/SIPHON INFORMATION 3. 2A 99• y SS Manufacturer 6,5'.U Demand St Cover Z 79 14 84 Model Number 41 ij/ ~1~ I 6W J7 r TDH Lift. ( Frictionkj.3 System HeadL TD i Ft Forcemain Len %f Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Trenc s PIT DIMENSIONS No. Of 'ts Inside Dia. Liquid Depth DIMENSIONS /O 7-v/.a SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type ystem: CHAMBER OR /4 UNIT Model Number: OJ I .70 ,V DISTRIBUTION SYSTEM Header/ManifolQ istribution / x Hole Size Ix Hole Spacing 1 _j Length V Air I e 2 . Lrr Dia Pipe(s) Dia 1'5 Spacing T SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 44 1 Depth Over Depth Over Ixx Depth of xx Seeded/Sodded ulched Bed/Trench Center J 1 Bed/Trench Edges Topsoil I ~ No 1 -4- es L No COMMENTS: (Include code discrepencies, persons prese tc.) Inspection #1 Inspection #2: 1 r Location: 610 CTY RD E 1.) Alt BM Description = t 2.) Bldg sewer length = 00r - amount of cover = ' G ~a; ` Plan revision Required? ❑ Yes >(No ( g LI-7 Use other side for additional information. I ~ G_ 1 SBD-6710 (R.3/97) Date 71nsepctor's Sign re Cert. No. x>« ` County -eel - Safety and Buildings Division ~ ` t} a © 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) r• P S~Ir~ O !l. Madison, WI 53707-7162 C~ rRoix CC3UN State Transaction Number ;OMMUNIYY Dgyffik(KITTermit Appl , ~1 J In accordance with SPS 383.21(2), Wis. Adm. Code, sub--' XGWG9E2 nal unit So o / is required prior to obtaining a sanitary permit. Note: Ap Ds5V 49 fitted to Project Address (if different than mailin ddress) the Department of Safety and Professional Servies. Pets( _ r. Luc may be used for secondary for oses in accordance with the Privacy Law, s. 15.04(1 )(.,.t, Mats. 6/6 1. Application Information - Please Print All Information Property Owner's Name Parcel # G ~ ~rL C. lI4` C ' ii Itf'.1r1 ~ C✓ C.. LE ~f ~ ~ ~ ' ~ Property Owner's Mail' g Address Property Location 3 q f J _ q rf i• & C Govt. Lot City, State Zip Code Phone Number L_ y Y<, Section .7i_"'_ circle one) Gzc~S~ J C / /-'Zs Il Type of Building (check all that apply) ~ Lot # T ~C.' N; R E or W Subdivision Name .8:11'.r 2 Family Dwelling - Number of Bedro 3 Q(,Q~ Block # L1 Public/Commercial - Describe Use ❑ City of ❑ State Owned- Describe Use CSM Numbeeer,/~" ❑ Village of r- D '°fown of Sgr Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. El r New System 1~.Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) an B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List oil Previous Perm~it Number ~~Datc ssucd Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑l At-Grade j<Mound ? 24 in. of suitable soil ❑ Mound < 24 in. suita le soil El Holding Tank }'Other Dispersal Component (explain) f r lie f ~ El Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Applicatio ate( dsf) Dispersal Area Required Dispersal Area Proposed System Elevation 00, b 4017 W. VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons units o New Tanks Existing Tanks fn/ ` m ce v c7 a 7l M''rEGVf lam; U ,v Septic or Holding Tank Aoc f r . e-e Dosing Chamber 0 JJ e.:., C rc- VII. Responsibility Statement- I, the undersigned, assume responsibility r installation of the POy1'TS shown on the attached plans. Plumber's Name (Print) Plumber' ipatuV MP/MPRS Number Business Phone Number .y N1 4 ,4 rt c t~> ' ~ • y s " ;.313 7-Q-- *S-- &za e Plumber's Address (Street, City, State, Zip Code) AI ot VIII. un /De artment Use Only Approved El Permit Fee Date I ued Issui gent Signatu ove G' en Reason for Denial S 6LLA. 17 IX. Condit a ROXA tsapproval .JP r. Et snt l~t`e errs V dlspet :d cell must all be af~iIcas ! rm 11 ec es per management plan h!tvideri by plu,nbe:. 2. AD to. recUrelnon2s rnuut LE~ inia:nt: it.E as per apFlicribii c.ndt. / crdiaan~aao Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R. 11/11) p4p 4 l (wave *b" now b F 7tiF,,, s s n : mlla ST ~ 6 f L2N7~~ lid Olaf sr q, A & AWS b ft sw" 'Ile / 4 G ( 9°oF 4 lot w 14 eoMP Cps'; T ~ Ova t 3 F!E^"°.e P RTyT DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 5 o~ } P GREEN BAY WI 54304-5211 Contact Through Relay P / http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Laura Guti6rrez, Secretary November 29, 2017 F"r,R CUST ID No. 224832 ATTN.• POWTS Inspector F SA -I MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD DANBURY WI 54830 HUDSON WI 54016-7708 - CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/29/2019 Identification Numbers Transaction ID No. 3030166 SITE: Site ID No. 844949 Hennemann Please refer to both identification numbers, 610 County Hwy E above, in all correspondence with the agency. Town of Saint Joseph St Croix County SWI/4, SW1/4, S34, T30N, R19W FOR: Description: EZ-Flow Mound (3 Bedrooms - Replacement) Object Type: POWTS Component Manual Regulated Object ID No.: 1737723 Maintenance required; Replacement system; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual, (R. 7/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/0 1, R. 10/12), SSWMP Pub. 9.6; 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: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS dispersal area. I • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Abandon Existing System per SPS 383.33 • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. MARY JO HUPPERT Page 2 11/29/2017 • Final elevations of pump off and invert of distribution pipe; need to be verified for proper pump sizing. • 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 "EZflow Mound Component Manual " (R.7/12). • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at the 12 o'clock position. The laterals shall drain fully after every dose. • The lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The observation pipes shall be located in between where bundles come together. These requirements must be followed so that the aggregate bundles will not be damaged during the installation process • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. 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. MARY JO HUPPERT Page 2 11/29/2017 • Final elevations of pump off and invert of distribution pipe; need to be verified for proper pump sizing. • 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 "EZflow Mound Component Manual " (R.7/12). • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cutoff at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at the 12 o'clock position. The laterals shall drain fully after every dose. • The lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The observation pipes shall be located in between where bundles come together. These requirements must be followed so that the aggregate bundles will not be damaged during the installation process • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. 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. MARY JO HUPPERT Page 3 11/29/2017 Sincerely, Fee Required $ 250.00 oZ~e This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services Wyment Submittal. code: 1. 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Mike Rodewald, Bettendorf Excavating (Plans Mailed To) RECEIVE,) 'tVOV 2 4 V I? ij'J iii<S FRY SERVi EZf/owo MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN GES Residential Application INDEX AND TITLE PAGE Project Name: ZACHARY & JACQUELINE HENNEMANN Owner's Name: (SAME) Owner's Address: 610 C.T.H. E Hudson, WI 54016 Legal Description: SW1/4 of the SW1/4, Sec. 34, T30N, R19W Township: St. Joseph County: St. Croix Subdivision Name: NA Lot Number: 3 Block Number: NA Parcel I.D. Number: 030 - 2008 - 95 - 000 Plan Transaction No.: F t!" F,, Page 1 Index and title • ~ ~ ~ p Page 2 a yy~ Data entry 114 Page 3 Mow mound drawings Page 4 Lateral and dose tank ry : @=oi `p'R'T =Page 5 Distribution media ay d-Page 6 System maintenance specifications •;@~i l Eb".°'H' Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Plot plan !!~lfp/JlldBt6l1"1~`~A~ Designer: Mary Jo Huppert License Number: 1859-007 Date: 11/21/17 Phone Number: 715-426-1775 Signature: /--Z1 6 Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101) • Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150°x6) 450.00 Design Flow (gpd) 3.00 Site Slope 97.25 Installation Contour Line Elevation (ft) 76.00 Contour Length Available (ft) 36.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 10.00 Cell Width (ft) 3, 4. 5, 6, 7, 8 9 or 10 Only 45.00 'Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gp~2 1 Influent Wastewater Quality or 2 ) ( ) Are the laterals the highC!poin, Pressure Disribution Information in the distribution y (c or e) jee Center or End Manifold new`°? Enter Y or N Lateral Spacing (ft) If N above, enter the elevation Number of Laterals of the hi hest Orifice Diameter (in) (e.g. 0.25) g hint. Estimated Orifice Spacing (ft) = 6.82 ft2/orifice Forcemain Diameter (in) Forcemain Length (ft) Does the forcemain drain back? Inside Pump Tank Elevation (ft) Ent o Forcemain Filter Loss (ft) er Y or N 4.55 System Head (ft) x 1.3 3.26 Forcemain Drainback (gal) 6.25 Vertical Lift (ft) 59.83 5x Void Volume (gal) 0.53 Friction Loss (ft) 63.09 Minimum Dose Volume (gal) 11.33 Total Dynamic Head (ft) 5 35.54 System Demand ~J (9Prr►) t/D Lateral Diameter Selection 44 ~pM' Manifold Diameter Selection in. dia, o #ions choice in. dia. o tions choice 0.75 1.2 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity 1000.00 Se tic Tank Capacity (gal) (gal} Weiser Concrete Manufacturer Total Working Liquid Depth (in} t~j gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Sim-tech 20.28 Dose Tank Volume (gallin) Al 00 Filter Manufacturer Weiser Concrete Manufacturer Filter Model Number Mound Plan View ? t 1/10 6 3 J . Observation Pipe K _j 5 T A W :I L Mound Component Dimensions Down slo a toe extension made. A 10.00 ft E 9.60 in H 1.00 ft K 7.95 ft B 45.00 ft F 12.00 in I 15.00 ft L 60.90 ft D 6.00 in G 0.50 ft J 5.50 ft W 30.50 ft 450.00 (ftz) Dispersal Cell Area 1125.00 (ft2) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZfiow Dispersal Area Finished Grade 99.75 (ft) • H il' Ali G 1 F t Dispersal Cell` 97.75 (ft)--►• 698.25 (ft) Lateral Dispersal Cell , Invert Elevation Elevation , D 0 f Q 97.25 (ft) Contour Elevation 3.0 % Site Slope Shading Key Typical Dispersal Cell Q Topsoil Cap a See Page 5 Subsoil Cap 0 2 0 ft Approved Geotextile Fabric Cover 3 ASTM C33 Sand Tilled Layer 0 = EZflow Media - Q [5,] : F N C X0.5 ft 1 See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. End Connection Lateral Layout Diagram 0= Turn-up nfball valve orcleanoutplug 14 P FFome EOrifice ocated at Ex---*l RN laterals identical, with ogees equatty spaced. bia tee or crany point. Laterals & force main of PVC Seh 40 per SPS Table 384.30.6 S Orifices poirR up except every 5th one points down for drainage. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.07 ft Lateral Length (P) 44.24 ft Orifices per Lateral 22 Lateral End (Z) 0.77 ft Orifice Density 6.82 ft 2/orifice Lateral Spacing (S) 4.00 ft Manifold Length 8.00 ft Lateral Flow Rate 11.85 gpm Manifold Diameter 1.50 in System Flow Rate 35.54 gpm Forcemain Velocity 3.63 ft/sec Dose Tank Information Locking cover with roaming label and locking device and sealed watertight Electrical as per NEC 300 and rr SPS 316.300 WAC Disconnect 4 in. min. Disconnect t~ Tank component is properly vented E--- Altemate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in Ca acit 750.00 Gallons - T Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B A 19.87 402.99 siphon device B 2.00 40.56 C ♦ Pump offelevation ft) C 3.11 63.09 92.00 D 12.00 243.36 Total 36.98 750.00 D Dose tank elevation (ft) Bedding And Backfill As Per Manufacturer 91760 Alarm Manufacturer SJE Rhombus Alarm Model Number AB Tank Alert I Pump Manufacturer GOULD Pump Model Number PE 41 Pump Must Deliver 35.54 gpm at 11.33 ft TDH Note: Switches containing mercury may not be used 6 1,is?system. ~}am&vw l EZflow® Distribution Cell Media Layout 10.00 Cell Width (ft) 1.00 Sidewali to Lateral (ft) Distribution Cell Cross-section Arrangements 10 ft Wide wi a' b; Component Legend D SRI-7A Bundle - 5 ft or 10 ft lengths " SRI-12A or EZ 1201A in 5 ft or 10 ft lengths KI SR3-12H or EZ 1201P or e; . f. SR3-12H in 5 ft or 10 ft lengths 0 4" Perforated Distribution Pipe With Pressure Lateral Inside 0 Turnup Enclosure - - - - - Pressure Lateral I Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 10.00 71 Cell Width - A (ft) 45.x^ ^^11 1 --gth - B (ft) Force Main - - - - - - - - - - - - - - - - 10 ft Wide End Manifold - - - - of jA.A)~ Af Mound Svstem Maintenance and Ooeration S ecifications Service Provider's Name ULBRICHT PUMPING POWTS Regulator's Name ST. CROIX COUMMUNITY Phone 715703-8337 DEVELOP Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 Septic Tank Capacity 1000 gal mg/L Soil Absorption Component Size 450 ft2 Maximum TSS 150 mg/L Maximum FOG 30 mg/L Type of Domestic Wastewater Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Ins ect and/or service once eve 3 ears Effluent Filter Ins ect and clean as necessa at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test eriodicail Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Ins ect for ondin and see a e once eve 3 ears Other 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 EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 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 •r~°rrrrrrrrrrr'• \\/7~ •rrrsrrrrrrrr~~~ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins &d' x, °:'t. „ :4 ;t*G7 t..+,t~ X,+.,..,4 .tea, .i. d i ham, i~ 3 +4"S L 3 Ali .i y, 4 x l y # • .A ~ A y 1 dam" A~°+~ h11Y YYe- w:4 `M' tri•'Y ii/ i4 ilY Yf "rYYII^- A~ Longg Sweep 90 or Two ?F??;,'r 45 De ree Bends Same h a Diameter as Lateral EZflow S nthetic Media 2.03 Feet Distribution Lateral Lateral Cleanout Project; ZACHARY & JACQUELINE HENNEMANN Page 6 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code This system shall be operated in accordance with SPS 382-84 Wis. general . Code, and shall maintained in accordance with its' component manuals [F1flow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rtes pertaining to system maintenance and maintenance reporting. 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 shah 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 fitter 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 as to 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 Wisconsin Department of Commerce. Puma Tank The dosing (pump) tank shall be inspected at least once every 3 years. AN switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be Inspected and serviced as necessary. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. *****No one should ever enter a sapdc or dose tank since dangerous gases may be present that could cause death.1 Mound and Pres una 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 BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 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 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. continaencv Plan If the septic tank or any of its components become defective the tank or component shah 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. -Ac - Wastewater METERS FEET 40 MODELS: PE31, PE41, PE51 PE51 HP:.33, .40, .50 35 10 2 GPM 30 PE41 1 FT _ f ! _ t Q } t- PE3.1 z 25 20 a 15 - - rt 10 Y t , _ f . 5 1-2 0 0 10 20 30 '-A, 40 50 60 70 GPM 80 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 PEST Total Head GPM Total Head Total Head (feet of water) (feet of water) GPM (feet of water) GPM 5 52 8 61 10 67 10 42 10 57 15 59 15 29 15 46 20 50 20 16 20 33 25 39 25 0 25 16 30 26 35 8 ~N~M;4AI Pbt PAW PAP L7 q Amon I f - - pp in 4Wft 3. Cseyi /a ag;~e- .~srcl~y ( Nw* t sY 1 ) ~XISTINls w~~ 67 lot , 4 F~At~A ,F t T; op ~bMVA 9 Lkf 4R,A is ~ e ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 46 L) located at: .5to 1/4, (,J 1/4, Section 5q , TowneN, Range l I W, Town of St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Vie, '-7 Did flow back occur from absorption system? Yes Nom (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Construction: Prefab Concrete C Steel Other Manufacturer (if known):.~C e' AsAge of Tank (if known): deg ' Permit „number (if known) 6 q q (Vicensed P umber Signature) (Print Name) (Title) (License Number) MP MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP/ CERTIFICATION FORM Owner)-- Mailing Address jej Property Address (Verification required from Planning Department for new construction.) City/State Parcel Identification Number 030 -Jod -1.5'06`6 LEGAL DESCRIPTION Property Location 5l4J 1/; , Sec. 3 y , T _30 N RLI _W, Town of ST S~ Subdivision / , Lot # Certified Survey Map # i y 2 , Volume Page # OZ 3 WarrantyDeed # _ 42O P 3 D , Volume /50 / , Page # (o G Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE ~/S7 Yh rn P&--b J.r.-:jE 2-o ej Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 Commerce 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 Zoning ,pepar\ne thin 30 days of the three year expiration date. 11127 l IONATURE OF APPLICANT DA E a O R CERTIFICATION Vwd certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the prop rty &skribed above, by virtue of a warranty deed recorded in Register of Deeds Office -7 / SIGNATURE OF APPLICANT DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. A Parcel 030-2008-95-000 09/29/2004 03:01 PM PAGE 1 OF 1 Alt. Parcel 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address. Owner(s): ' =Current Owner ' HENNEMANN, ZACHARY & JACQUELINE' ZACHARY & JACQUELINE' HENNEMANN 610 CTY RD E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 610 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.300 Plat: N/A-NOT AVAILABLE SEC 34 T30N R19W PT SW SW BEING LOT 3 OF Block/Condo Bldg: CSM 10/2831 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/07/2000 620830 1501/66 WD 07/23/1997 1198/481 WD 07/23/1997 1099/209 QC 07/23/1997 10541125 WD more 2004 SUMMARY Bill Fair Market Value: Assessed with: 199,400 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.300 91,400 112,000 203,400 NO Totals for 2004: General Property 4.300 91,400 112,000 203,400 Woodland 0.000 0 0 All 4.300 91,400 112,000 203,400 Totals for 2003: General Property 4.300 53,500 91,200 144,700 Woodland 0.000 0 0 Total 4.300 53,500 91,200 144,700 Lottery Credit: Claim Count: 1 Certification Date: Batch 111 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0100 0.00 ' Form- STC - 104 AS BUILT SANITARY SYSTEM REPORT I / SEC. T '70 N-R OWNER ~P/EM Jfl N TOWNSHIP 5 - k ~!f~ ADDRESS r ~W (L ST. CROIX COUNTY, WISCONSIN s54 - s ..SyOP Z. SUBDIVISION / LOTS D / ez't- LOTSIZE _ PLAN VIEW Distances and dimensions to meet requirements of TLHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I APPS X• 500' f V AD-1-Or c.i )A Fwv I 1 ~dtRM " i.~ 1AK fpvs` fR~"` 7d 'y ^ I 24 O SE~ViYE ~ fO#AA I -17 #9 CATTIJ ~c. 370 23 d ---~-x- ~s- liv I i ~4Z - w~ER SE,QvIcE - -I - - - - - - - - - - - - - • ~~I1 o i-- / Pipe (vc•e r- Per pr) INDICATE NORTH ARROW I I Powt a Pot e 3/y -If i pe SET NETT ro pdW A'`- BENCHMARK: Describe the vertical reference point used j20 C. OL 7 5'0 1 f f 3k , A~otiY, Elevation of vertical reference point: IOO O fT • Proposed slope at site: 3 /O 5 SEPTIC TANK: Manufacturer: ~OEC/Nf 1~7 - Liquid Capacity: /'9 0,9 Number of rings used: / Tank manhole cover elevation: /b(p . fT Tank Inlet Elevation: /Q/ f , Tank Outlet Elevation: Number of feet from nearest Road: Front,© Side O Rear, O a 0 O feet From nearest property line Front,O Side,O Rear, O 10 O feet I I Number of feet from: well -2o0 , building: -1& (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE If this POWTS should fail at any time in the future, the system will be need to be inspected by a licensed plumber or POWTS maintainer to determine if it must be replaced according to state code requirements in effect at that time. The proposed remodeling and room addition project must comply with all applicable building codes. Please contact the Zoning Administrator for the town of St. Joseph to obtain a building permit. Should you have any questions, please contact this office. Si rely, Pamela Quinn Zoning Specialist Cc: Dwight Farnham, St. Joseph Z.A. file PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: P hon Manufacturer: Pump Size Elevation of inlet: Bo tank elevation: Pump off switch elevation: Gallons pe cle: Alarm Manufacturer. Alarm Switch Type: Number of t from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTI~O/N SYSTEM Bed: ^ Trench: $T- ~i ~3 1 Width: Length: S Z Number of Lines: Z Area Built: / co " (A v~R~rvt- yo " Fill depth to tap of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Sd Number of feet from well: 162 Number of feet from building: I I 1 f+ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: eter: Liquid depth: of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: city: Number of rings used: Elevation of bottom of tank: Elevation of t: Number o feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: _ License Number: HOMESITE SEPTIC PLUMBING GO. ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.& MINN. INSTALLER & DESIGNER LIC. N0.00663 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMON RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI-53707 CONVENTIONAL DALTERNATIVE Stete Plan T. Number: Ilt l E Holding Tank E In-Ground Pressure D Mound assigned NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER'. INSPECTION DATE'. Harlem Duden R. R. 2, Box 321, Hudson, WI 54016 ;;411 9Jr- 12:310 BENCH MARK (Permanem reference pointl DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.' CST REF-PT. ELEV SW SW, Section 34, T30N-R19W, Town of St. Joseph Name of Plumber JMP!VPRSW No County. Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 64879 SEPTIC TANK/HOLDING TANK: MANUFACTURER JLIOUID CAPACITY' TANK INLET. TANK OUTLET ELEV.: WARNING LABEL JLOCKING OV / PROVIDED: PROVID Ct/G 7 ` /0 `;3 /0 l • ` c DYES b4lNO ❑ NO BEDDING. VENT DIA.. VENT MAT JHIGH WATER NUMBER OF ROAD: fROPERTY WELL- BUILDING. VENT TO FRESH ALARM FEET FROM INE~. _,0,l 1 ,.f1 AIR INLET: DYES ENO EYES ENO NEAREST .20 ~JV DOSING CHAMBER: MANUFACTURER BEDDING-. LIQUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL JLOCKING COVER PROVIDED. PROVIDED. DYES ENO EYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PH OPERTV WELL BUILDING. JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LE "GTR 1111AM11IR MATERIAL AND MARKING Or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH NO. OF DISTR. PIPE SPACING COVER INSIDE CIA *PITS LIQUID BED/TRENCH TRENCHES. MA4-ylrAL PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR PIPE DISTR. PIPE MATERIAL. NO DI R. NUMBER OF PROPERTY WE L: BUILDING. VENT TO FRESH LINE: /,I WE AIR IyL~~ BELOW PIPES ABOV OVER. ELE INL4 ELENELT _27 f ^ PIPE FEET MOUND SYSTEM: Q( (11 N^11 LIl 7 oC t! Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ENO SOIL COVER TEXTURE JPFRMANENT MARKERS JOBSERVATION WELLS DYES ENO DYES ENO DEPTH OVER TRENCHIBEO DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED' MULCHED. CENTER EDGES- EYES ENO DYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER. BEDITRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL IN O DISTR ID I STR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV.. DIA. ELEV. PIPES. DIA.'. ELEVATION AN . DISTRIBUTION HOLE SIZE HOLE SPACING OHILLED CORRECTLY COVER MA INFORMATION TERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'. G~ FEEL. FROM LINE: 1 DYES ENO EVES ❑ 140 NEAREST o•-l~ Sketch System on Re in county file for audit. Reverse Side. SIGN TITLE. ' DILHR SBD 6710 (R. 01/82) ) DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI-53707 DALTERNATIVE State Plan ll.D. Number C ONVENTIONAL n assigetl ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound III INSPECTION DATE: NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER : Harlem Duden R. R. 2, Box 321, Hudson, WI 54016 2-9-5- BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. SW SW, Section 34, T30N-R19W, Town of St. Joseph Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 64879 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING OV PROVIDED: PROVID G✓4~ /0/,33 /Ol lj DYES NO ❑ NO BEDDING: VENT DIA.. VENT MAT HIGH WATER NUMBER OF - ROAD: PROPERTY JWELL: BUILDING VENT TO FRESH ALARM FEET FROM LINE AIR INLET DYES ENO DYES ENO NEAREST -13Q iot DOSING CHAMBER; MANUFACTURER- BEDDING: LIOU ID CAPACITY PUMP MODEL. UMP PHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ENO DYES ENO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING IVENTTOIRES11 (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JDIAMFTFR MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO. OF DISTR. PIPE SPACING. COVER INSIUE DIA. SPITS LIQUID BED/TRENCH TRENCHES MA~yAL PIT DEPTH DIMENSIONS la S3 / f GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DI STR, PIPE MATERIAL: :NO . DI R NUMBER OF PROPERTY WELLBILDING: VENT TO FRESH BELOW PIPES ABOV OVERELELEV\ E FEET FROM LINE: (2 / Z ~'t, AIR IyL~ 7 NEAREST -2 7 9- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ENO SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DYES ENO DYES ENO DFPTH OVER TRENCH/BED JDEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED. CENTER EDGES: DYES ENO EYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/Tf9ENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL IND DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.: DIA. ELEV.: PIPES: DIA.: ELEVATION AN . ' IISTR MATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS'. OYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMER OF - - - PROPERTY WELL: BUILDING. FEET FROM LINE: E ST _ G~ DYES ENO DYES ❑ O INEAR;._ 5$1 ID 05 Sketch System on 1.7 Re in county file for audit. Reverse Side. SIGN TITLE: 'DILHR SBD 6710 M. 01182) Wisconsin Department of Safety and Professional Services C ST o i 7 S ~ Division of Indusft'-ftEIV , /ED SOIL EVALUATION REPORT pap 1 of 3 DEC a 4 2417 in accr~~ ~h cc~f'&- VIS. Adm. Code AtEa«,ro.xn le it _ County ~ ' T. CRD p ~ - =as that ~ u 112 x 1 •i inches ins' I - st include, but n t.BYfonzontal reference point QM), Parcel LD percent IWiQ&EW w, and lokf+s - f~p Bp G 3C D07J Please print a .TY7-r9JVFi pD Rev' by Date Personal information you provide may be used foi cy Law, s. 15.04 (1) (m)). / L Property Owner '-00 ll/ Property Location AJAI Govt. Lot ' j 1/4 5414 S AT"'-30 N R EE ( or) W P roperty Owner's Mailing Add Lot # Block # sub d. Name or M# 16 eT fl. -2s CRY State Zip Code Phone Number ity village ' own Nearest Road i 1A IT i Oib ( s`T. •3 New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD -31 eplacement Public or commercial - Describe: - arenrt material. _ SA tL 41 A S1-I Flood Plain elevation if applicable Gft. eneral comments CIA and recommendation: .41 t) u'N k~> S STB.M - S IVb P J y 4 El Boring # 0 Boring Pit Ground surface elev. 7 g, Depth to limiting factor in. Rate Horizon Depth Dominant Co Redox Description Texture Structure Consistence Boundary Roans ~ GPDff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E1f#2 0 Z - as Z v 0. Cl g' Z 7_S 3~ -St Z r c s Z , 1) Al K 'N i L3b- 7_ SY5 r. k Z 6 NA i ~ 2~ F Boring # ® Boring Q Pit Ground surface elev. qs fL Depth to limiting factor in. Sal Rate Horizon Depth Dominant Color: Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munseli Qu. Sz. Cont. Color Or. Sz. Sh. *E1falF't " Etf#2 i 2-1 5Y zs L 2-f~4. , w-Pi F~. tZ. I& - 75 L -2 rrk-pf as # • to '3b-70 75YK sL 0;4 1 0,7- 66-, Effluent #1 = BOD > 30 < 220 mall and TSS >W < 150 mg& • Effluent #2 = SOD 130 mg& and TSS < 30 ffQ& CST Name (Please Print) Sig -7 4- CST Number MARY JO HUPPERT Hollister's Soil Testi &Desi gn) 2 224832 Address E Telephone Number W9875 690th Avenue, River Falls, WI 54022 1/-J5 2617 715-426-1775 SBD-8330 (807/13) Property Owner A ~B n AJ'V i / V/U~s !!X% Parcel ID # _ 030(,'Y^'l~ p 2 3 in. ❑ Boring # [D Pit g Ground surface elev, tt. Depth to limiting factor 3(0 Sod Applice~ Rate Horizon Depth Dominant Color Redox Description Texture Sb-Wure Consistence Boundary Roots ndary GPD/fP In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Etf#2 0-y 75,83 y - 5`t I asb f s -7 -5 S L 7-r odd D Boring # Boring Pit Ground surface elev. R Depth to limiting factor in. Horizon Depth Dominant Color Redox Des Sod Applicatiori Rate cription Texture Structure Consistence Boundary Roots GPDlfE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 +Eff#2 Boring Boring D Pit Ground surface elev. ft. Depth to limiting factor in. SW Apokatim Rate Horizon Depth Dominant Cdw Redox DescriPtion Texture Stnxture Consistence Boundary Roots GPDM in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. `Eft t .Eff#2 Effluent #1 = SM, > 30 < 220 mg& and TSS >30:5 150 mg& ` Effluent #2 = BODs < 30 mg& and MS < 30 mg& SBD-8330 (807113) I PIW PAM OWSM ZAMAKY eA CP E G:5 et~1 ~ ' ' 1 ~ t ST: aF 9 sf S 112 y j~bP S'7 GRo o X c1 ctN Gt11 SeLa N SI n)~ Tj( 6io e.-:H. p Zo S yS- CG~L~ Ndr9k 3 f P G. i ~ r~ ~.xa oti A . v e tr N ,r t c, F t` L k t F +471- s Alf r ~`sp c _ h / o ~d I~ 7Y&VAI E1Pl.AJIA1, L,9cH K 1 i0 w Aw+ a' 7 2YS -iw A: AAA, ` r r x 5w@@~r ~ CAI f M~ YM' f R~ y~~y f 4. r e ~ ~ pn L i p e . u~„ ,