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HomeMy WebLinkAbout026-1014-50-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CCOIX Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 600311 : 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: Jim Lauck TOWN OF RICHMOND 026-1014-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No, 04.30.18.50D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t 4^, 1 ~54J /Z!50 Benchm60A L 40 QQ_@- 14 XZa r" I L., L.Q S }.tom Alt. BM (AC'zA L(, Z 414 15, Bldg. Sewer ti •a Holding St/Ht Inlet it, St/Ht Outlet G. / S 7 TANK SETBACK INFORMATION TANK TO I P/L WELL BLDG. ent Air I take ROAD Dt Inlet Septic %Alt Dt Bottom 1~ Dosing Header/Man. Aeration Dist. Pipe o$ 96 • 7 9S.-TS Holding Bot. System y, Y " • '7'j d. Final Grade/ 9G, 35 PUMP/SIPHON INFORMATION L-d Manufacturer Demand St Cover/ GPM l7TC~~ Z /d /I Model Nu pt,k 7.d 98. 3 TDH ift Friction Loss System TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 12b 7, i ^e~ SETBACK SYSTEM TO P!L BLDG I ! WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type -of Syste 7_1 93 UNIT Model Number: S DISTRIBUTION SYSTEM (,J 1Z,}-IZ Z. dLp~•.~ Header/Manifohl J Distributio~ x Hole Size` x Hole Spacing Vent to Igt~ e Pipe(s) S Length, ~ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Depth Over Depth Over xx Depth of jxx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil No ~v^^ I-] No 7 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1135 173RD AV - ( 6l O + 5 1.) Alt BM Description = ~1~~ GOJ~it, 1 2.) Bldg sewer length = V Cw~N~G /fir SP 4V VG~ - amount of cover = Ex~ I J IMnJe1 e wt~ : Joe-," ~ulZ Cock, Plan revision Required? Yes No ' Use other side for additional information. I(~ SBD-6710 (R.3/97) Date Insepctor's Signa re Cert. No. RECEIVED- ri - "liI - q:) -7 County Industry Services Division Saint Croix 5 -~',2 8 , : 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) 71 ST. CROIX C©UhdT`f Madi 70 Ell) / S tLA ` OAAN UNITY DRIEGOPRAE lQ 6b ~ I I Sanitary Permi~MVRHK7RDM2SHM State Transaction 'u ber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmemal unit is required prior to obtaining 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 Pro'ect Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 1. Application Information -Please Print All Information 1734 Ave,, Property Owner' e Parcel # Jim Lauck / 026-1014-50-000 Property Owner's Mailing Address Property Location 1135 173' Ave Govt. Lot City, State Zip Code Phone Number SE '4, SW !i4, Section 04 New Richmond, WI 54017 (circle one) T30N R18EorW II. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedroot 1 Subdivision Name ❑ Public/Commercial - Describe Use Block # ❑ El State Owned -Describe Use _ City of G CSM Number ❑ Village of CSM 5/1306 ® Town of Richmond III. T e of Permit: Check only one box on line A. Com le m applicable) UA~ A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ystem (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Perinit Transfer to New List Previous Permit Number an Date Is ued Before Expiration Plumber Owner IV. Type of POWTS System/Component/Device: (Check all that apply) O ® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil [Holding an tier ispersal Component (explain) ❑ Pretreatment Device (explain) Z6 9~~ t--j V. Dis ersal/Treatm t Area Information: -.1 45gg-f-7 Design Flow (gpd) Design Soil A plication Dispersal Ar equired (sf) Dispersal Ar roposed (st) System Elevation 600 Rate(gpdsf) 600 0o° 600 Doo 96.0 .6 Vt. Tank Info Capacity in Gallons Total # of Manufacturer b o y a New Tanks Existing Tanks Gallons Units t U v- rn L ~5 1 Septic or Holding Tank 1250 1250 1 Wieser ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ !r-1 0 VIL Responsibility Statement- 1, the undersigned, assume responsibility for i nstallation o t e T shown on the attached plans. Plumber's Name (Print) Plumber's Signatur~; , MP/MPRS Number Business Phone Number Thomas Gushtm ~ 227618 715-658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 937h Street New Auburn WI 54757 VIIL~eounty/Departrnent Use Only Approved 17PeVrmit Fee Date ssued ]ssuin gent Signa re ner Ciiven Reason for Denial All 60 )'L Z1 IX. Condi§% TA ~ rReas ns fo Disapproval ! ~e 1. in k r, ucm, u~er vn+ J 1rCw~ C..GI t'i tA/~ 1~0~ dK-pelt•:+i cell ryust ell be s~ic. s ' rn n ec it . es per Wr.39ement plan pro ncied by plumbez. e4<i 44101 2. AO a OWb k tree it+scZen.s mlrat,bl +;„A rt, tr.E ae per iKacsbls vo l+= J wrdinax r. ,l a, J eq& Attach to complete plans for the system nd so it to the o ty only o paper not less than 8 112 x I t inches e -ease. o PQ-''. A ~~2 SBD-6398 (R03/14) g q. 4_Z~l J a p U m Q r _ o r O 0 O n H U p~ o o~ U U o LO > c6 § -0 2 cc w V y j O n CY) Q O L \ o Slope 2.6 0 m ° E U 0 L N;, CO m ui i ~ U i i 0 0 Q I X i,', I i 7 M -!----ice Q i i ~ J Ii m ~ CL m ~ 1 J J E LO n a az cn n N o aa) U) 0 I T cu c N O = O c O co ° O o E U 0 O m co F° ~ GO p g Lu cn p J T z Lij c w ~j Q m W r` O J J M LU W U = 11 0 it U) II m m OD mob' P-1Cj L ----------------ea------- - Chambers Page 1 of 5 Cover Page Project Name: Jim Lauck 600 GPD Conventional Owner's Name Jim Lauck Owners Address 1135 173rd Ave New Richmond, WI. 54017 Legal Description SE v %4, SW ' Y4 Sec T 30 N, R 18 W Township Richmond County Saint Croix Subdivision Lot# 1 ParcelID# 026-1014-50-000 Table of Contents pg- 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Management and Contingency Plan 5 Plot Plan I total # of pages: 5 Designer Name: Thomas Gustum License 227618 Date: 12/20/2017 Ph. 715-658-1344 Signature: i Design Methods Used "IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 2.0) SBD-10854-P (N.03/07) Chambers Page 2 of 5 Calculations and Drawings Site Conditions Infiltration Elevations Site Type: I Private V Cell #1 Cell #2 Cell #3 %Slope 2.6% Contour Elev: 98.90 98.70 Ft # of Bedrooms 4 Infiltration Elev: 96.00 96.00 Ft Depth to limiting factor 70 in Limiting Factor Elev: 93.07 92.87 N/A Soil Application Rate: 0.6 gal/ft^2/day Treatment and Dispersal Zone: 2.93 3.13 N/A Effluent Quality Eff #1 ' J Cover Material Required: 0 0 N/A In Design Flow: 600 gal/day Finished Grade Over Cell: 98.90 98.70 N/A Max BOD 220 mg/I Max TSS 150 mg/I Distribution Cell Septic Tank Choose chamber type: Ez Flow 3 X 1o cell • Septic Tank Manufacturer: Wieser # of Cells 2 Septic Volume Chosen: 1250 Laying Length: 10.00 Ft Effluent Filter Selected: Biotube FT0822-14-B FSO EISA Determined Area: 50.0 Ft2 Note: Access opening of sufficient size to be provided to allow removal of filter. Open Bottom Area: 35.30 Ft2 Opening to terminate at or above grade. Chamber Height: 12 Inches Required Infiltrative Area: 1000.0 Ft2 Actual Infiltration Area 1000 Ft2 Total # of Chambers: 20 Total Cell Length: 200.0 Ft Cross Section of Septic Tank Cross Section of Cell Vent in manhole cover ° 4 Min. - samef P p I, /i\\ ~10\i l\\ h Flow nann~ V All joints to _ be water tight Plan View t LEffluent Filter V V V J> ~ V der Tank V J V < > V < A L POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _:3_of-5_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner Jim Lauck Tank Manufacturer: Wieser ❑ NA Permit # X Septic ❑ Dose ❑ Holding Volume: 1250 (gal) DESIGN PARAMETERS Tank Manufacturer: Skaw pre-cast X NA Number of Bedrooms: 4 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: X NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : 400 (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): 600 (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: 0.6 (gal/day/ft2) Effluent Filter Manufacturer: Biotube ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: FT0822-14-B FSO Fats, Oil & Grease (FOG) <_30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) <220 mg/L ❑ NA X NA Total Suspended Solids TSS <150 m /L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BODS) >220 mg/L X NA X NA (TSS >150 m /L ❑ Mechanical Aeration ❑ Peat Filter Pretreated Effluent Monthly average e ❑ Disinfection El Wetland Y 9 ❑ Sand/Gravel Filter ❑ Other: (BODS) <30 mg/L Soil Absorption System (TSS) <30 mg/L X NA Fecal Coliform (geometric mean <104 X In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size 36 in dia. 171 NA F-1 At-Grade 1771 Mound ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) ❑ When combined sludge and scum equals one-third (Y3) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: 3 years ❑ month(s) (Maximum 3 years) ❑ NA X year(s) Inspect dispersal cell(s) At least once every: 3 years month(s) X year(s) (Maximum 3 years) p NA Clean effluent filter At least once every: 1 year ❑ month(s) ❑ NA X year(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) [I NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (4) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and 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 30 days of completion of any service event. GMW-005 (02/05) START 00 AND OPERATION Page _4- of -5- 'For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large doge causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. x The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and sate evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING " TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER Name Tom Gustum Name Tom Gustum Phone 715-658-1344 Phone 715-658-1344 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name St Croix County Zoning Phone Phone 715-386-4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. a` o ~ C) CO Q 7 CD r O O O ~ ~ U p~p c M U O _ v 06 CC gg 0) r O c;5 CL 06 00 Slope 2.6% ! -2 .2 E J U ~ rnLo 3 clz~ W 0t~~zgaiA u N O N N+'', 'ice W 3 E 75. fCf cM U (D Q m W U) O r X, ` M MG { co r Q I q] rn v co O m N J J ~n a a - to a- cr c o = o ~ m N (D O I E m o8 o ~ o ~sg w o z U) cm > Q 3 W `o J a U > ~ m w w U) p n m Ab JCL L - (Y) 4- O C~3 O v N W N O j I I I 0 Form- ST C- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ! SEC. T ~r N-R t W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION l LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t+ i I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used t'; Elevation of vertical reference point: Proposed slope at site:," SEPTIC TANK: Manufacturer: t Liquid Capacity: J 42 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation:- Tank Outlet Elevation: Number of feet from nearest Road: Front 10 SideIQ Rear, O feet From nearest property line Front,O Side,O Rear, Q feet Number of feet from: well , building: (Include this information of the above ~ Plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: t j Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: { Width: J 0 Length: 1 Number of Lines: Area Built: ' Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Q Rear, O Ft. f Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom 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: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of 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: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN AELATIONS P-O.BOX 7869 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISON, W! 53707 kk CONVENTIONAL ALTERNATIVE [_]Holding Tank i In-Ground Pressa;e Mound ,__t Fn IT ii)Lll EH =RR.' , I'F Jim Lauck 1, Box 159-F, Somerset, WI BEf,CM Mr.FK ~~r~a , ter. nnr IT' 11 FIE.I(Rill If 111F FEf4 NT Fi.Okl ~t AN -FL P' E E,, Nr_~ Vr F~r~ SE SW, Section 4, T30N-R18W, Town of Richmond 1 LG. aylord Worrell 5285 LSt._Croix X74976 SEPTIC TANK/HOLDING TANK: -~i A~ac1T.. 1 i T Tr! t ^-t r.:' ff_ L)(.RIJ CCi~EP n i iV CEG tir f y S NC ~N O CIA vLVr F - ~YFS TriOAr r Ff, - i NUMBER OF - - ol_. ~~ErLT , FH=sH FEET FROM .Wl°LFr YFs -YES -'NO NEAREST - - DOSING CHAMBER: i ,.,~I~ tr. ~ rN•,Ilr L...;t IvRCVIt~f Ci CiVEH 3F1 _ YES LJNO - YES NO YE C ! NO LLONS PER CYCL F FC~ +r, r Td, ,l NU E$M O- F enT n)FHES, IFFFRFNCF BFTWEEN - FEET FROM + UlP 0N ANO OFf-1 __!_Y _ES -Nti INE_AREST---0~ wIL ABSORPTION SYSTEM Check the soil rnolsturr it th d ,v, of T - - - - f Plowing - ~avahc , .I' oil can be m!led ir"!0 a wire, cnnstri,non sh all cease tir hl FORCE I 1 vrI a .iry , nou ih t,. _ow r •e.l MAIN E- - 1 L - - - ..;NVENTIONAL SYSTEM. l E. DIMENSIONS ~ y Pi r BEDlTRENCH o~srn FicL arr ,a: r FI n 'n, i It l )Fr TH 1., 1 I ,Srf F a` i. 61 ILUlti , TENT rO -FESN 1Pi ` r c . r 1 NUMBER OF y_ FEET FROM F NLE -7 - _ _ _ L - NEAREST--sf MOUND SYSTEM: - Vound Sate plowed perpendicular to slope Check the textipe of !r ;ill ,Tjterlal for PROVIDEADIAGRAMOFSYSTEM~ a,td turrovros thrown upslope mound systems to m lS e Cr_ tJ1r! that :t ON REVERSE SIDE. SHOW ELEVA- meets the criteria `or mE!iur sand. TIONS MEASURED. Y rS III CT - SO€L COVER - rFC NO YES N I YES NO -YES 0 O ~ ,__,1'ES _iN0 PRESSURIZED DISTRIBUTION rSYSTEM: BEDITRENC ao ,F i $PG, hh N:,Ht1 ~ DIMENSIONS j t - n rY r c - i h}P CI$iN - PIPk Avri11 1 .(r::l :1{E t.l '.'lliK '4, _ r I ~V ttFV III;. ktF II,~ ELEVATION AND) DISTRIBUTION 1 1111 -_-_----_1-- _ INFORMATION "ol F srrE 1-,E SPr.r'la . ;ir 1=eEn A :.-~n . e4 N,I 11;-~ ,vI,N-5 T1 41111 t. NO YES !NO 4}R~'~ENTS: PtMAIIENTMARKFHS NUMBE R OF fl`v AtIC)N LYE LLS - - PHnPEHT~ WELL tllilt-CI^: LINE FEET FROM 1 YES L_'NO L__ YES NO NEAREST-- 1 c r 30:;'7 ~yS2e"xt on I c n coun,y I-ie reir jolt. F2°vs-rso Side. f)ILiaR SBD G710 (R 01182) - - IMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS I RY, DIVISION ,.Nn P.O. BOX 7969 ,N RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(II & Chapter 145.045) / i5N'. SECTION: - TO SUBDIVISIO N NAME, .L_ 1/ A /T- N/R ~ earl W i I Y: O ER'S BUYER' NAME. MAI ING ADDRESS l / 14 DATES OBSERVATIONS MA E IIND. DRMS-: COMMERCI L DESCRIPTION Replace TR0-VI I PT IONS: A ION TESTS J dence I BE o New C _ 1 :G S= Site suitable for system U- Site unsuitable for system -P.TIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE - N-FILL OLDING TANK RECOMMENDED SYSTEM aoptionall S DU ®S ❑U ®S ❑U ❑S U ❑S ©U o anon Tests are NOT required DESIGN RATE If any portion of the tested area is in the ,.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH -R (DEPTH IN. ELEVATION OBSERVED S HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) y ) J / l y - 33 1 _ 7- (9-1 7Zj4' i 3.3 L PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES 'FR INCli.S AFTERSWELLING INTERVAL-MIN. RI RI P PER INCH 7 j 'LAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn rd vertical elevation reference points and show their location on the plot plan. S ow the surface elevation at all borings and the direction and percent aope_ STEM ELEVATION ~oaa _ R- ~t~r! Tars i ~ • ~,1 ~ . ~8, ' • I a e:.lrz.!„~E N x ( `f 9~ /ar~senrra~ b i. T0i3V ea as i undersigned, 1reby certify that the soil tests reported an this form were made by me in accord with the procedures and methods specified in the Wisconsin „tratrve Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. l as+fd: TESTS WERE COMPLETED ON: °36 CERTIFICATION NUMBER: PHONE NUMBER (optional): --'C`am-`-/--------- CST AT E: . 3UTION: Original and one copy to Loral Au;l,-ily. P101"Ity Ownrr and Soil Testes. 'iUD-6395 (R. 02/82) OVER - C57 - 3ci-7- a65 Wisconsin Department of S f services Page 1 of 3 Division of Industry Servic 7 RDMZSHwA R 4 4 4 4,i , soiWI H . . r ~ordappe with SPS 385, Wis. Adm. Code County Attach complete site plan on paWrn~~ gtxrA~ inches in size. Plan must include, but not limited to: vertical and ho' ~f4point (BM), direction and percent slope, St. Croix scale or dimensions, north aroPt location and distance to nearest road. Parcel I.D. 026-1014-50-000 Please print all information. Revi ed by Date Personal information you provide may be used for seconds purposes Privac Law, s. 15.04 1 m Property Owner Property Location ❑ Lauck, Jim Govt. Lot SE SW S 04 T 30 NJAK 18 E (or) U Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1135 173rd Ave. 1 N/A CSM 5/1306 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road New Richmond WI 54017 Richmond 173rd Ave. ❑ New Construction Use: ® Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD ZdYt4- 0 Replacement ❑ Public or commercial - Describe: Parent material Outwash plains Flood Plan elevation if applicable n/a ft. V_ I Qom` General comments and 1ec mendations: 2.32 acre parcel. Recommend system el. 96.0' along the 98.9' and 98.7' contours. V r r ❑1 Boring # ❑ Boring ® Pit Ground surface elev. 99.1 ft Depth to limiting factor >80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2mgr mvfr as 3f 0.6 0.8 2 8-14 10yr3/4 none sil 2msbk mvfr cw 1 m 0.6 0.8 3 14-26 10yr4/6 none sil 2msbk mfr cw 0.6 0.8 4 26-35 10yr4/6 none sl 2msbk mfr cw 0.6 1.0 5 35-80 7.5yr4/6 none gr. sl 2 sbk mvfr 0.6 1.0 '614 1 lid ❑2 Boring # ❑ Boring C5? ® Pit Ground surface elev. 98.3 ft. Depth to limiting factor >80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2mgr mvfr as 3f,1m 0.6 0.8 2 10-16 10yr3/4 none sil 2msbk mvfr cw 1 m 0.6 0.8 3 16-27 10yr4/6 none sil 2msbk mfr cw - 0.6 0.8 4 27-39 10yr4/6 none sl msbk mfr cw 0.6 1.0 5 39-80 7.5yr4/6 none gr. sl 2 sbk mvfr - 0.6 1.0 2 * Eff luent #1 = BOD, > 30 220 m /L and TSS > 30 < 150 m /L * Effluent #2 = BOD, > 30:5 220 m /L and TSS > 30:5 150 m g1 CST Name (Please Print) Signature ; . CST Number Thomas D. Gustum ~ ya ~ Ile 227618 Address Date Evaluation Conducted Telephone Number N13450 937`h St. New Auburn, WI 54757 11-28-2017 715-658-1344 SBD-8330 (R04/15) Borin ❑ Boring 73 g # ® Pit Ground surface elev. 99.1 ft. Depth to limiting factor >80 in. 1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. `Eff#1 ,Eff#2 1 0-10 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 10-14 10yr4/4 none sii 2msbk mvfr cw 1m 0.6 0.8 3 14-24 10yr4/6 none sil 2msbk mfr cw - 0.6 0.8 4 24-33 10yr4/6 none sl 2msbk mfr cw - 0.6 1.0 5 33-80 7.5yr4/6 none gr. sl 2msbk mvfr 0.6 1.0 I ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon l Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 j In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 I I i i r Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. i Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I I i * Effluent #1 = BOD, > 30<_ 220 mg/L and TSS > 30:5 150 mg/L ` Effluent #2 = BOD, > 30:5 220 mg/L and TSS > 30!5 150 mg/L. I 37 Boring # ❑ Boring ® Pit Ground surface elev. 99.1 ft. Depth to limiting factor >80 in. i w Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 1Oyr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 10-14 10yr4/4 none sil 2msbk mvfr cw 1m 0.6 0.8 3 14-24 10yr4/6 none sil 2msbk mfr cw 0.6 0.8 4 24-33 10yr4/6 none sl 2msbk mfr cw 0.6 1.0 5 33-80 7.5yr4/6 none gr. sl 2msbk mvfr - 0.6 1.0 F7 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I Effluent #1 = BOD, > 30:5 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BOD, > 30<_ 220 mg/L and TSS > 30:5 150 mg/L ~ J ~ I - ~ 1 m Q Q a 0 z cy. o ° o P U ~Qp C 0 M v O F - W m a o 06 G ~ -C a Slope 2.6% m g w - ~Kw0 E W w v v~ N 3 z -o p N uj Chi m ' v I' j I ~ N mrn (D U) b N O i' U- x co ih M III' i' , Q 3 l.L y/ it O r ~i m N Q. LO d j LO v vZ c CL Mn a ° T ~N u cu m V7 cr c N o r ~ o o co ~ E o II o L/ o a m co H ~ b z 'n ° J I~ 0) W mW W U 11 ~ m I i I i i 00 j ao - - Ab PI CZ -------t,----- ST. CROIX COUNTY ZOhT'~G OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EA'ISTING SEPTIC TANK(S) This is to certify that I ha~Te inspected the existing septic and/or dose tank presently serving the following residence: (Street address) located at: 1/4, 1/4, Section , Town NT, Range Town of , St. Croix County Wisconsin. T Tppn v that T have, foilnrl the, tankiD-cpeCf ink I rerr (s)5 to the beet of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) dllpedllJ1 to Lamle 1LLnl Llor1111g properly. Most recent date of inspection or service E' Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: ' Construction: Prefab Concrete Steel Other Manufacturer (if known): IZTic's c r Age of Tank (if known): Permit number (if known) (Licensed lumber Signature) (Print Name) (Title) (License Number) M2/IN4:PRS 1.l X27 (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 VVisconsin Administrative Code) Rev. 9/2008