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HomeMy WebLinkAbout004-1017-70-050 Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600328 GENERAL INFORMATION 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: Dean Davis TOWN OF CADY 004-1017-70-050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /ap Q ( G ST 08.28.15.119A-10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. fAJ4 Septic 2 76 Benchmark 60 4 164, 1,0 /Zliab 0 Alt. BM r ii Aeration Bldg. Sewer a Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet V g" 99.,7 TANK TO A/_A WELL BLDG. Cent Air Intake ROAD Dt Inlet Septic *756 1 ,72 u 147 Dt Bottom VJ Dosing Header/Man. - / Aeration Dist. Pipe 7• I 1°jg. Holding Bot. System Final Gr de 4•tP PUMP/S!F'I-ON INFORMATION J40 Manufacturer Demand St Cove GPM Model Number TDH Li Friction Loss System TDH Ft ForcemaIn i Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Depth DIMENSIONS 3 G` +1 SETBACK SYSTEM TO J P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION 1117' CHAMBER OR ` TypE Of Syst > SA • G Y14- Q Vl I Q 1 • :5 DISTRIBUTION UNIT Model Number: SYSTEM All 7,6 7:5- Header/Manifold/ Distribution ix Hole Size x Hole Spacing Vent to~A Intake JPipe(s) Length Dia T Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth i E] lth of~ jxX Seeded/Sodded No xx Mulched es ❑ No Bed/TreOnch Center Bed/TreOnch Edges Topsop COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 461 CTY RD NN Z a ^sJ 1 ~~.y~ LJ~ C-11 CQC 1.) Alt BM Description = i l~-, 2.) Bldg sewer length = 75 L 4' J1 p d~f C.~R ae - amount of cover = Plan revision Required? Yes No Use other side for additional nformatio _ 17 SB D-671 0 (R. 3/97) Date Insepctor' ignature Cert. No. d --Olt County Safety and Buildings Division St. Croix 0j4 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be tilled in by Co.) S P S! f 6 2018 Madison, WI 53707-7162 ~e 6MM S State Trar saction Number SanitA ermit Applica_t In accordance with SPS 383:21(2), Wis. Adm. Code, submission of this form M ital unit is required prior to obtaining a sanitary permit. Note: Application f- VTFp 1 J itted to Project Address (if ifferent than mailing address) the Department of Safety and Professional Servies. P(rsrv=_w6Ay ■ .,,u ror secondary 741 /~I ur oses in accordance with the Privacy Law, s. 15.04(l tw% l ash 1. Application Inform on-Please Print All In County Road NN - Ad& Property Owner's Name / arcel 00 N 10 1 •'1- - aar) Dean Davis 68. a$. 15.1 ))00 Property Owner's Mailing Address Property Location E905 770th Ave. Govt. Lot City, State Zip Code Phone Number SW NE 8 /a, /a, Section (circle on Knapp WI 54749 715-440-0074 T 28 N, R 15 E o,~j IL Type of Building (check all that apply) Lot # X 1 or 2 Family Dwelling - Number of Bedrooms 1 ) Subdivision Name Ok eAA Block # ❑ Public/Commercial - Descri be Use 0 J~ ❑ City of ❑ State Owned - Describe Use CSM Number D ❑ Village of Ve1Z$ 1 Tovvn of Cady Q:aH Ge uS S ~o~s /o is s III. Type of Permit: (Check only a box online A. Complete line B if applicable) A. ] New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner G~ 'O~ ~+~Q/ W IV. Type of PORTS System/Component/Device: (Check all that a 1 G ; gn6A X Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank 77-0-t Me? Dispersal Component (explain)- ❑ Pretreatment Device (explain) / V. Dispersal/Treat ent Area Information: ut Design Flow (gpd) Design Soil Application +te(gpdst) Dispersal Area quired (st) Dispersal Area Proposed ( System Elevation 300 .4 ✓ 750 _ 750 98' & 97.5' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks 2 m v Septic or Holding Tank X 700 1 Lewis Bjork X Dosing Chamber VII. Responsibility Statement- I, the undersi d, assume respon ibili r ins Ilation of the POWTS shown on the attached plans. Plumber's Name (Print) P s re MP/MPRS Number Business Phone Number Lewis Bjork ' 253976 715-231-7375 Plumber's Address (Street, City. State, Zip Code) E7818 County Road E, Menomonie, Wi, 54751 VIII. 'ount /De artment Use Only pproved Permit Fee Dat issued Issuing ent Signature liven Reason for Denial $ 440. ~ ' IX. CondiffiM east s fot,Disapproval lam ' '1'~ t'pt!r. t rk, Er111:c, ti~e~ t:n+ i ~ ~ ~+I GSGr T. 5 IM 0 tii5per :'.i cell trust atl be sq iss itz,';_ e / As per,naracement plan Z `AV WhZ1rA( rechitet:^e^,s m'.;;t Lc n ;t, tr:E•i a per Witl*14t cod.-: / Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 a I I inches in size SBD-6398 (R. I I/ 11) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. FV~ SOIL EVALUATION 0 Scale: 1so~ 30 45 so CJSYSTEM PAGE 2 OF 41 SITE MAP I PLOT PLAN PROJECT NAME: 52 DESIGN FLOW: 300 GPD 7. 0 Dean Davis Attach design flow calculations for commercial plans. PROJECT ADDRESS: SW NE S8 28N 15W / CTH NN Pipe Material / ASTM Standard (Tables 384.30-3 R 384.30-5) N Sanitary Sewer:_ BM Symbol: ! BM Elevation: 100 FT Force Main:. / BM Description: Orange Dot on Oak Tree Base Indicate north by IMPORTANT: Slope Gradient 14 Well Symbol (If applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. Q l t~ f 4 { ~ EE{ 4'~ iiJJ n i f r tea 1A,;, it 'Et 1, c r,. PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: Manholes POWTS Application for Review Tank Approval Letter Soil Evaluation Report & Site Map Effluent filter Tank Maintenance Contract Warranty Deed Project Name / Description Dean Davis Owner Name(s): Dean Davis _ Phone: 715 -440 - 0074 Owner Address: E905 770th Ave Zip: 54749 Project Address: County Road NN Govt. Lot: ?W 1/4 of NE____1/4, Section 8 , T28 N-R 15 EEI or W Township: Cady County: St. Croix Project Parcel ID Designer Information Designer Name: Lewis Bjork Phone: 715 _231 -7375 Designer Address: E7818 County E Menomonie WI Zip: 54751 E-mail: lewisbjork@yahoo.com License Number: 253976 Remarks: Signature: Date: a signature required on each submitted copy. CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE. l / V SOIL EVALUATION Scale: 1" = 30' SYSTEM PAGE 2 OF 47 0 30 45 60 SITE MAP PLOT PLAN PROJECT NAME: DESIGN FLOW: 300 GPD 7.5 Dean Davis Attach design flow calculations for commercial plans. PROJECT ADDRESS: SW NE S8 28N 15W / CTH NN Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) t 100 A' • Sanitary Sewer:_ BM Symbol: ! BM Elevation: FT Force Main: BM Description: Orange Dot on Oak Tree Base Slope Gradient I%) indicate north by IMPORTANT: 14 well Symbol (If applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals, of 'Tested Area: on the approprite Hne. Jr ~ti GowG'YL. a A Ak O A r r 4- l05 I J613 ~\6 1AE..LL CA V, Icy- h'$ L11 kl n~.., 99 3t PAGE 3 OF 4 O N I N ,z of N-2 L Q LL N d N L: M W w m C m E m ~ c W O x -co > m N c 0 d~ c v N E O o a O Y C `N O N F Z T ~ o~ ii. I p > m m L U v W Ll N 0 a o c fn V aai d co (n v € s Ch .a g J to ~t d. m 317 m a: 'm 11 C/) J w m O O ~o o Q c c o N v ,a d i O ID X m o~ Y ~~n ~.a> Nm o I I O _ N m mom 1(9 . u I- -1 i O 75 ca 0) o C:)l ~ C c ~ m y to m _ - M -C5 L0 Lo J r- O w A I I C° a m 01 C) I ° II II = W a i i W a o co Q a ~ Cl) wZ co o o I II I E a o w O s 1 U C) N I c O I I) i Q W O t" U cn Z _ a ~ a U) 3 I I a w W V} O ~o = s o (!1 ry I- O o m z l I ~ I a ww $ I I II _I = U ° ° E o I I CY) U) 4 N c a O O 1 ry I a~i C~ ~ ~ ♦ U N N W N 'N . • o. I 1 ~ ~ ~ 0 N M N •cl) I• c _ I I °I u x C: C: =1 =3 N I I C-) Lo Jay ym W U) QC: C: I r o l9 o c~ ( 1 a m a V O cc O I I `n N H - - J c $ 't U D E--~--I I„ I z c: IL q q) Z 0 I Cf- CY) n cu @C) U) O> D i° _ = I I w a (D W ao U II I d o W O I J z~ w II ~W.M I 1 Q o o Jz~ I I11 N ° U J ,Z I 4.4 + ~ w da I (I E L-I PAGE 4OF4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. f=urthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BODr,<- 220 mgL"'; TSS 150 mgL"; FOG 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Lewis BjOrk LLC Phone: 715-321-7375 Local government unit: St , Croix County Phone: 715-386-4820 Local government unit address: Carmichael Drive , Hudson ZIP: 547 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Tuf-rite Riser System l`uf- I ite makes a full line of Risers and accessories for Pre-Cast applications. j Riser 1.id with Molded-in gasket. Availably:: in 12", 16", 20" and 24" diameters. Green Only. j ~ ✓ Concrete [,id - with handle. (se the Safety O N ( "t Pan to cast your own concrete lids. Safety I id May be used in place of t , w"tC' xc st concrete lid. Fits 24" Riser Pan only. Black z. Only, s, S~iei: l'aii Safety P'an' available for 10 20" and 24" Risers. Green Only. 0" "1'a11 Riscr - For septic tanks. Stackable in 6" increments. Available in 12". 16". ti 24" and 24" diameters. 12 " la l1 Riser - For septic tanks. Staekable in 12" increments. Available in 20" and 24" diameters. Black Only. ank dapter ing - For mounting riser or lid to tank when casting;-in is not an option. 1 i ! .40.401KTUF TITE' p{ r. i T 6. K AM, Tough Problem ~ reviding a simple, reliable, and r permanent means for dividing septic ` tank effluent flow. i TUF-TITE Solution . , A strong, stable, permanent, non-corrosive Tuf-Tite Distribution Box, with a Tuf-Tite Speed Leveler in each outlet. s E? z: k f -A k_tAo, ■ Injection molded HDPE ■ Non-corrosive ■ Simple to install ■ Easy to level In a septic environment, no other material can match High Density -41 Polyethylene in delivering a lifetime of trouble-free service. Tuf-Tite Snap-in pipe seals They're permanent Distribution Boxes are injection They're patented. Simply insert your Unlike cement-based pipe grout, molded, using only premium HDPE PVC pipe and push it through the Tuf-Tite seals will not crack or corrode which contains no fillers or foam. flexible, polyethylene Tuf-rite seal. in septic conditions. They stay pliable Pipes fit watertight. Installation couldn't and watertight permanently. be easier. JAI 1 Hole Box 4HD2 istfl .0 04.0 O~ ;,'.TUFwT1 ■ Injection molded. 11°~ 11 Interlocking Lid. Heavy-duty HDPE Lid is ribbed for added Exceptionally strength and rigidity. Slotted strong. sides interlock on the Distribution Box to assure a ■ HDPE is non- tight fit. 0 The 4HD2 Distribution Box corrosive r 11„ comes complete with a in a septic 15Y Regular Lid or an Inspection environment. , 11„ t t„ Port Lid, and 5 snap-in fittings of your choice. ■ Patented snap-in 2" Drop 1 d Model Bi Riser. For series pipe seals 7„ 16" B1 Box. Stackable HDPE Risers extend to grade in 6" simplify increments. Accept 11 x 11 installation. lids and grates. INSTALLATION IS JUST THIS SIMPLE 1. Position the Distribution Box "K It' on level virgin soil. Do not place box on a r Y` concrete slab. ' 2. Install the inlet pipe and s-s, s-40 outlet pipes. Be sure the bottoms of all pipes rest on ,F virgin soil. P_10 3. Level the Distribution Box and all pipes as needed. Choice of Fittings Choice of Lids Tuf-Tite Speed LevelersTM 4. Backfill the pipes to within 5-35 Pipe Seal, for: Regular Lid. Molded of rugged Control the flow of effluent from two feet of the Distribution ■ Sewer and Drain HDPE, the Distribution Box. Simply Box. Recheck the level of the 0 SDR 35 ■ ASTM 3034 Inspection Port Lid. For easy insert a Speed Leveler into each box, then backfill up to the N Thin Wall ■ 1500 Lb. Crush access and inspection, Models outlet pipe. Rotate each Speed top lid ridge. 5. Install and adjust Tuf-Tite S-40 Pipe Seal, for: available to accept either 4" or Leveler so the flow is distributed Speed Levelers. ■ Schedule 40 6" extension pipes. as desired. Available for 3" or 4" 6. Place lid on the Distribution ■ 4" Corrugated PVC pipe. Box and finish backfilling. P-10 Plug, for unused holes I now A full line of ' innovations for better septic systems 1200 Flex Court Lake Zurich; Illinois 60047 01999 Tut-Tite(D Corpora'.ion Form IHD2-3. Printed in USA J~,pARr,MZ_vT DIVISION OF INDUSTRY SERVICES PO BOX 7302 i MADISON WI 53707-7302 Contact Through Relay P http://dsps.wi.gov/programs/industry-services 11141 www.wisconsin.gov ~~4stot+~~ Scott Walker, Governor Laura Gutierrez, Secretary May 19, 2017 Identification Numbers Transaction ID No. 2944957 Site ID No. Please refer to both identification numbers, above, in all correspondence with the agency. CUST ID No. 253976 LEWIS C BJORK LEWIS BJORK LLC E7818 COUNTY ROAD E MENOMONIE WI 54751-6637 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/31/2022 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: LEWIS BJORK, LLC Product Name: (tyrans id 2944957) SEPTIC, PUMP OR HOLDING (TANK AND ADAPTOR) Model Number(s): LB700, LB1150 (700 AND 1150 gals.) [LB700 BASE TANK; LB1150 CONSISTING OF 3 SECTIONS WITH THE 450- GAL. ADAPTOR AS THE MID-SECTION] [38 IN. L.L., 18.85 GAUIN.; 96 IN. MAX. DEPTH OF BURY, 335 OR 551 GPD WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; TANK DIMENSIONS = 66 IN. L X 36 IN. W X 54 IN. H; ADAPTOR DIMENSIONS = 66 IN. LX 36 IN. W X 24 IN. H] Product File No: 20170,151 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SIPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of May 2022. This approval supersedes the approval issued on 6/28.12012 under product file number 20120193. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • All manhole covers terminating at or above grade must have effective locking devices. • When this product receives wastewater from dwellings, it will produce an effluent quality with a maximum monthly average value for BOD5 of less than or equal to 30 mg/L, TSS of less than or equal to 30 mg/L TSS and F.O.G. of less than 30 mg/L. IIIOTIJ1IE@ FT SERIES BASE INLET EFFLIJENT FILTERS (FT) IITTP://WWW.ORI,'NCO.(')ill/PROI)IJCT_CATAU)GS/(;] \NERAL... WX~ d 2, is ¢ a i~k~ 9111111h h. Corporate Home About Orenco » Markets » Product Catalogs Technical Resources Regulatory Resources » Orenco Literature Corporate Home , Product Catalogs General onsite Products » Effluent Filter Biotube® FT Series Base Inlet Effluent Filters Orenco - Biotube( FT Series Base Inlet Effluent Filters remove about two-thirds of suspended solids from effluent, helping extend drainfield life. They have the flow area of a full-size filter in a small package for short septic tanks. Biotube FT Series Base Inlet Effluent Filters are installed on the Schedule 40 or Type 3034 outlet pipe of a new or existing tank. They come with a filter cartridge, PVC housing, and an extendable PVC handle. An optional overflow plate is available for 8-inch (200-mm) models, to prevent effluent from bypassing the filter if it clogs. 8-inch (200-mm) nominal filter diameter 14-inch (356-mm) filter height, standard 22-inch (559-mm) housing height, standard 1/8-inch (3-mm) or 1/16-inch (1.5-mm) filter mesh available Corrosion-proof construction Extendable handle Easy to clean Optional overflow plate available Optional float elbow available for high-level alarm assembly High-level alarm assembly ordered separately (see "Float Switch Assemblies" in the "Product Ordering Information" section of this catalog) Sample Product Codes* einr~Rr<w~ms~x.ESHvs~rnzc~tFt~uE:,~tr~rtk.~ FT0822-14B - Biotube FT filter, 8-inch (200-mm) diameter, 14-inch (356-mm) filter height, base inlet FT0822-14B-FSO - Biotube FT filter, 8-inch (200-mm) diameter, 14-inch (356-mm) filter height, base inlet, overflow plate installed * For the full range of available product options, contact your local Orenco Distributor or Orell jechnical Data Sheet Product Sheet © 2015 Orenco Systems ® Inc. Follow us I OF 1 6%2%1016 4:1It Pill ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Dean Davis Mailing Address E905 770th Ave. 4 1j/_ Property Address TW / , (Verification required fr(Vn Planning & Zoning Department for new construction.) City/State Parcel Identification Number-061- 10l7- 76 - 65 d LEGAL DESCRIPTION Property Location SW 1/4 , NE 1/4 , Sec. 8 , T 2$ N R 1 5 W, Town of Cady Subdivision Plat: , Lot # Certified Survey Map Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house Oyesi:4 Lot lines identifiable N(Yes[)no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three 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 §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plarming & 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. 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on t ' form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w ranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) RECEIVED 02/12/201.8 02:23PM 71523173'76 EJORK SEPTIC 02/12/2018 15:21 1566522688 DA'VISBROTHESEXC PAGE 04 E x ~ j Klh i ~ i CST-aW~~-0a 0 f= L ~ 2~ Sgt Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance wito Comm 85, Wis. Adm. Code c County St . Croix o5~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plap;nust include, but not limited to: vertical and horizontal reference point (BM), ctiond Parcel LD. 7Q percent slope, scale or dimensions, north arrow, and location and distafa -1W, 1617•-~ Please print all ink-- ACV ~Fpi5cwt r1~, ".eviewed by Date Personal information you provide may be used for secono ZVAr-,, ) (m)). 4A Z-12,011-8 Property Owner Property Location Dean Davis Govt. Lot SW 1/4 NE 1/4 S 8 T 28 N R 15 E( r)® Property Owner's Mailing Address Lot # Block # Subd. Name or C E905 770th ave - Part of 7 acres city State Zip Code Phone Number ity ®Village ■ Town Nearest Road Knapp WI 54749 ( 7)15-440-0074 County NN Cady New Construction UseE] Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Replacement Public or commercial - Describe: NA Parent material Loess / out wash Till Flood Plain elevation if applicable IN4 ft. General comments Install in ground cells / use .4 loading / two cells , 24" below surface contours , - and recommendations: Ryan was present on to view soil pits , x B1 Boring # Boring Pit Ground surface elev. 96.5 ft. Depth to limiting factor 60 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 1 0-8 1Oyr3/3 sl 2fgr mvfr cs 2f .6 1.0 2 8-19 7.5 4/4 grscl 2fsbk mvfr gs if .4 .6 3 19-28 7.5yr5/4 grscl 2mabk mvfr gs l f ..4 .6 4 28-36 7.5yr5/6 grscl 2fsbk mvfr as if ..4 .6 5 36-60 5yr5/3 Co Osg ml - - .7 1.6 F B2 Boring # ® Boring 100 65 El 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 1 0-7 10yr3/3 sl 2fgr mvfr Cs 2f .6 1.0 2 7-16 7.5 5/4 is lfsbk ml gs 2f/lm •7 1.6 3 16-28 7.5yr5/6 is 0 ml gs l f .7 1.6 4 28-65 7.5yr6/6 Co Osg ml - .7 1.6 It * Effluent #1 = BODS > 30:< 220 mg/L and SS >30 < 0 mg/L * E ent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) gnature CST Number Lewis Bork 253976 Address ate Evaluate n Conducted Telephone Number E7818 County E Menomonie WI 54751 10-10-2017 715-231-7375 a t Property Owner Davis Parcel ID # Page 2 of 3 P3 Boring # 3 Boring Pit Ground surface elev. 96.5 ft. Depth to limiting factor 62 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 - sl 2fgr mvfr cs 2f .6 1.0 2 7-23 7.5 5/4 - grls Osg ml gs 2f .7 1.6 3 23-62 5yr5/3 - s Osg ml - If .7 1.6 - Fl 134 Boring # Boring 100 Pit Ground surface elev. ft. Depth to limiting factor 66 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 1 0-7 1Oyr3/3 - sl 2fgr mvfr cs 2f .6 1.0 2 7-25 7.5 r 5/4 rsl 2fsbk mvfr cs 2f .6 1.0 3 25-66 5yr5/3 - s Osg ml - if .7 1.6 ' C11 ❑ Boring # 0 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/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 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Te t (R.07/00) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. SOIL EVALUATION Scale: 1" = 30' ❑ SYSTEM PAGE 2 OF SITE MAP 0 30 45 60 PLOT PLAN PROJECT NAME: 52 DESIGN FLOW: 300 GPD Dean Davis Attach design flow calculations for commercial plans. PROJECT ADDRESS: SW NE S8 28N 15W / CTH NN Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) / BM Symbol: * BM Elevation: 100 FT N Sanitary Sewer: / BM Description: Orange Dot on Oak Tree Base Force Main; Slope Gradient Indicate north by IMPORTANT: of Tested Area: 14 Well Symbol (if applicable): Q drawing an a ow Show ground elevation contours at suitable intervals. on the approprite line. Aka t i E +;SOD 8 SIM + log c O~ t~ n 4- 140 1`