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HomeMy WebLinkAbout030-2125-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600340 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: Pavel & Elena Miligoulo TOWN OF SAINT JOSEPH 030-2125-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 25.30.20.1021 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet I St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM pth BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid De DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution IX Hole Size IX Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes E] No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1353 BIRCH PARK RD 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. -r ~0 95 mril P !5 i Indus Servi es Division nty -NA D rl 1400 Washington Ave a I V V P.O. Box 7162 Sanitary Permit Number (to be filled in by Cb, ps AR p'I 2 U Madison, Wi 53707 7162 ~m 3 ~ IG T CIa111tarPermit ApplIC~ ArSC~~ State ransaction Number JVQJ ate governmental unit In accordance with SPS 383:21(2), Wis. Adm. Code, submission - ~N is required prior to obtaining a sanitary permit. Note: Applicatior, 1,3 wned POWTS are submitted to Project Address (if different than mailing address) irs P~ 0 o the Department of Safety and Professional Services. Personal info _..~n you provide may be used for secondar Y-U purposes in accordance with the Privacy Law, s. 15.04 1) m), Stats. 2 ~ 1 "IMa -1 041 1. Application Information - Please Print All Informati Parcel # Property, Owner's Name t; r v ~ • ~'V~ C C ~ Property Owner's Mailing Address Property Location a 5.30. go. OR I • " Govt. Lot City, State Zip Code Phone Number Section (circle on VV~I f✓V~~ V TSL-N; R2-() E. W IL Type of Buildin (check all that apply) Lot ~Subdivision Name l or 2 Family Dwelling - Number of Bedrooms l Yn dk, q,~ OJ'Se~ Block 4''/11 l''V I El Public/Commercial -Describe Use ❑ City of CSM Number ❑ Village of h El State Owned -Describe Use flown ofd, T~- 2 -}-1 1 ,~.,~Oe( A own III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable) A' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) KNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretre t Device (explain) El Holding Tank Other Dispersal Component (explain) A ' C Iq Wes. G V. Dispersal/Treat nt Area Information: Elevation Design Flow (gpd) Designs oApplication Ka (gpdsi) Dispersa~ ea Required f) ea Proposed (s~ System t.15• r I L ? G- ~y c VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a ° U New Tanks Existing Tanks k 1l A y Septic or Holding Tank 1 I 11 , Dosing Chamber U) l ' _CC VII. Responsibility Statement- I, the undersigned, assume responsibility Inst iallation of the POW TS shown on the attached plans. re M P m ber Business Phone Number ~32-y 7 15- `ql -5'1 Plumber's Name (Print) Plumber' 11al Plumber's Address (Street, City, State, Zip Code) tz W, VIII. ount /Department Use Only Permit Fee Date ssued Issuin gent Signature Approved isapprov ven Reason fo ial IX. Condii~ls IReasons for Disapproval rk, e t tm litter . nd uisper. a cell nust aU be Sit tc~s ' i4 sit<. As per i :~yetnen'. plan h!'o nded by pluinoe;. 3. *Att aclkr k recstens tn~rst uer i tang irE i as per a i W,.i c-nr.'!: I .:.rdi ;nip r:i. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 08/14) ,I ~ v I I r t~ I t~ v I ~ _yy E 1 ~ E ffir -77 f J I 1 Z CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE I Project Name: I Owner's Name: Owner's Address: Legal Description: 41 S Z-5 _ 3t, 2C Township: - 1L~.Sf: H .ouniy: Subdivision Name: j k:)(yI pt, V.? .ot Number: 'arcel ID Number. s'- -S Page 1 index and title Page 2 Plot Plan Page 3 _ System Sizing & Crass-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Mana ement Plan_ Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans esigner/Plumber: JE I= License Number z~3z~1 ~ ate: J Phone Number 5-- y ignature ;signed pursuant to the 1n-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 i ~I J J ~ j j rJ r~J J - i et 4-) -h FFv~ rq J 1 i k y! N ~ a v F 0- - 4'SdWtrO 40 iii Grade PVC Vent Pipe Mft Vent Cap i_ Chamber SyWa Elevation -ft - s' ft t~ n a View _ ft Vat n Or Tcen+cObserwAm P" h art ;;ICE OwnbeM Ir Die. TtlriCi12 Header Man And Mo" Ij:I c CTk t-m ►Z ~ ~ ►c I~ 1 MSA Rating Z-L Sq ft per chamber S Application Rate qw" ft 2 rows of chambers each. Page of INSTALLATION INSTRUCI"OKS E ES VPL-625 FEATURES ated f 13, GPI Fed of vir FlbzOw on F of it Fft - oA=epft 4 and Pl. . . efficl%* a Bunt in Gas r n 2l condftWs re d PR ~ it s Alaffn ad way *w lhe tm* is or at * readr. .S i or RMWW a-OWWOMM P PVC - _ ~ r' ? ~ . '-moo' : y. l: ENWW q. - z•sx_:•.;~c - ,ate'-~. = - AML Few Q, awwwwor- a zfnw GQVW8 & &Lak Oalk b law ID Use PwMtvvOGa=kwft Ppv* r Bonn ponds *10% SW *MhWpoMgbVd*Nw *J4 so t +jc e ' end Pes 9M wAMM PVM ° % s we POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner -'f f eL Tank Manufacturer: ❑ NA Permit # ( Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: dZ ❑ NA Number of Bedrooms: ❑ NA ❑ Septic ..Dose ❑ Holding Volume: (gal) Number of Public Facility Units: K~NA Vertical Distance Tank Bottom(s) to Service Pad: ) (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: { 5(i (ft) Design (peak) Flow = (estimated x 1.5): al/da Specific servicing mechanics must be provided if vertical is >15 feet or t-A (g y) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/e) Effluent Filter Manufacturer: L. r TI N~ ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: I Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer: Z (L~ELI. L-,' irl Biochemical Oxygen Demand (BOD5) c220 mg/LA ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pump Model: ]V j High Strength InfluentlEffluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L XNA jA El (TSS) >150 mgJL Mechanical Aeration El Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BODs) 530 mg/L Soil Absorption System (TSS) <_30 mg/L i NA Fecal Coliform (geometric mean) x104 WIn-Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) ;jLWhen combined sludge and scum equals one-third (%s) of tank volume When the high water alarm is activated Inspect condition of tank(s) At least once every: ~3 ❑ month(s) (Maximum 3 years) ❑ NA year(s) Inspect dispersal cell(s) At least once every: 5 ❑ month(s) (Maximum 3 years) ❑ NA j year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA (9 year(s) Inspect pump, pump controls & alarm At least once every: month(s) ❑ NA or(s) Flush laterals and pressure test At least once every: ❑ month(s) fi~NA ❑ year(s) Other: At least once every: ❑ month(s) A ❑ 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 (%a) 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) -apoo aA!1eJIS!ulwpy u!suoos!M'(£) V (Z) '(0t,9'C8 PUe (1)'S(P)(6)(q)(Z)ZZ,Sg wwoo suo!loes gl!ne aouepdwoo ui sa!oua6e Alolein6aj SiMOd A1unoo ejegsneM pue allanbjew 'a~ e-j ueajE) aq1 1o sgels aq1 Aq pal}ejp seen luawnoop s!qi auogd auogd -V rrcp 7 -Y ~02 ' aweN aweN All IOHfnv Amoly-im)M W001 (213dwnd 2101Vi3dO JNIOIAS3S 3E)V.id3S auogd I.I b~7 m Cam, auogd aweN x~~ auaeN NEINIVINIVIA! 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Aew weeils 1alemalsem aqI woal 6uimopol aqI 1o uo!leumla Jo uo!lonpad -eaje uo!Idiosge l!os apej6-1e 1o punow Aue 1o adols uMop 1991 gl, u!ll!m eaae aqI 'pedwoo Jo ganls!p asimjE)glo Jo 'aano Mied Jo aA!ap IOU oQ walsAs uo!ldiosge pos aqI Jo s~ueI aano salo!gaA Need Jo anup IOU op -eoelps aA1lealI!1u1 aqI le uazoal ace suog!puoo pos uagm inooo IOU !legs do liels walsAS uel dwnd aqI u!gl!m paaolsai WE slang1 luanp}a lewaou pun sloaluoo dwnd aqI 6upiedo Apenuew u! Is!sse of aau!elu!el/v SIMOd to jagwnid e loeluoo Jo dwnd aqI of JaMod 6u!aolsaa of joud (jadwnd) aolejedO 6up1AaaS a6eldaS e Aq panowaa duel dwnd aqI to slualuoo 94l aneq uo!1en1!S s141 pone o1 -walsAs aqI of 96ewep pue luan1119 1o abjegosip aoelms ao dmp2q aqI uj llnsa.i Aew Iegl peolaano ue 6ulsneo asop a6ael auo ui walsAs uogdiosge pos aq1 of pa6aelos!p eq p!nn Jalemalsem ssaoxa all se 'papuawwooei Iou si suo!l!puoo asap japun JaMod to uo!leiolsai Jo do I1eIS -saanl!e} dwnd of anp Jo dnlaels of aoud slanal aalemg6lq lewJou anoge p!1 Aew s~ uel dwnd -asn of joud (aadwnd) .aoleaad0 6u!o!naaS a6eldaS e Aq panowaa (s)Juel aqI to slualuoo aqI 9Aeq paloalap aje suo!le.iluaouoo q6!q 11 walsAs uo!Id}osge pos aqI a6ewep jo/pue ssaooid luemeeil all apadw! Aew legl luaw!pas jo sleo!wago 3aglo 1o sluanlos 'spnpoid 6u!lu!ed 1o aouasaid aqI col (s)Muel Iuawlea4 Noalo SJA0d aqI to asn of joud 'uo!pnilsuoo Mau jod NOIIVS3dO (INV do 12iviS 10 abed Page of START UP AND OPERATION 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 dose 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site 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 x Name Phone -,Yq rj"Co Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 64% 4~6,j A, Phone Phone & /w r 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. Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer ► ~ • e M' um Pump Performance Required Tank Model Number / GPM @ Ft TDH LP X Total Tank Capacity C, Max. Bury Depth Total Dynamic Head (TDH) - Feet Pump Manufacturer Elevation Head Pump Model Number jv 5 Distal Pressure Alarm Manufacturer ~ Network Pressure Loss Alarm Model Number Force Main Pressure Loss j Switch Type Total - Manhole Min. 4" Above Grade D With Locking Device Vent Min. 12" Above Grade Weather-proof With Cap Junction Box - Finished Grade - - - Depth of Cover Ft Disconnect 1 Means { }i { i { i { {};}i i iii { t {}.r{. JC { {}i}i i i}{"{ { i i {}i Ci i i i i } C { { i} Outlet {i Inlet Switch Settings and Reserve Capacity II Tank Volume = GPI ; Dimension Inches Volume Gal. A (reserve) A '4' t Weep (alarm) B 2 B Hole } { } (dose) C { Off Elev. rt> (dead) D Ft C <;< -4 1— s } Total E 3 (G-10 ; i D 1 L I'ti` III` Bottom of Tank Elev Ft } t{ S S } } } > } } } } } } } } } } } } > J } T r } } } } } } Y } } } > > } } } } } } } T } } } } } } } } } } 1 } I { S S S{{{ S S L< i S S S L S S L L S L{ i l{ t{{{ S S S { S S S{ S S <1 S GENERAL. INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05lgj Page of Site Search - Zoeller Pump Company Page 3 of 3 UJ Uj PUMP PERFORMANCE CURVE MODEL 1511152/153 50 14 45 153 12 40 Q 35 10 152 30 a 8 25 151 6 20 15- 4- 10- 0- 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508 http://www.zoellerpumps.com/en-na/distributor/sitesearch?search=152 6/2/2017 JIM11 04111 III at 21, 11M 1W All Ali W I - d SONV3 0311V7dNO .69'9lt AA.IK3600S 1a cc -49L -Y ti/ C IA co Ns, - r! 9y-C4f / / i , F 1R ~ I ' Puawdolana uno9a fXr ti1 ST. CROIX COUNTY $~OZ $ adW SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Pavel Elena MIIIgoulo 3316 York Bay, Woodbury, MN 55125 Mailing Address v Property Address 1353 Birch Park Rd. (Verification required from Planning & Zoning Department for new construction.) City/State Houlton, Wl Parcel Identification Number 030-2125`70-000 LEGAL DESCRIPTION Property Location 40 ,,A 160 '/4 , Se 25 , T 30 N R20 W, Town of Saint Joseph Subdivision Plat: Birch Park Lot# 7 Certified Survey Map # Volume Page # Warranty Deed # (before 2007)Volume Page # Spec housel]yesMio Lot lines identifiable ©yesOno 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 lank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383,52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic lank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & "Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are the to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nuinber of bedroom 3//1//'9 S ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. i Include with this application a recorded warranty deed flour the Register ofDecds Office and a copy of the certified survey map if reference is made in the warranty deed. (121, V. 04/12) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed _ ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ( G~ >i I`~ '~GV l Property Owner Property Location ~ a Quest Development, Inc. Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Suite 150 10700 Old County Road 15 17 Birch Park City State Zip Code Phone Number City ❑ Village ■ Town Nearest Road Plymouth MN 55441 ( 7¢3-595-9512 County Road E El New Construction Llse:Q Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 1.oess over nut wash sands Flood Plain elevation if applicable General comments ti - and re mmendations: This it is suitable for an on-site conventional below grade sy~st rr, ; ,,w A- /W UG~G aU1I l C~ ~1~ /2 a Boring # Boring Pit Ground surface elev. 98.48 ft. Depth to limiting factor >98 in. ` "ion`.Ra to' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Root!i GP /fi$ *Effikt v 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-7 10yr3/3 - is I mgr mvfr cs 2f~ 1.2 2 7-98 7.5 r5/4 s Osg ml - - .7 1.2 /l 7 Boring # n Boring 99.07 >110 Q 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 10yr4/4 Is 1 mgr mvfr cs 2f .7 1.2 2 7-13 10 r3/2 Is Imgr mvfr cs 1f .7 1.2 3 13-29 10yr3/l sil 2mskb mfr cs - .5 .8 4 29-56 10yr4/4 sil l mskb mfi cs - .2 .3 5 56-110 7.5yr5/8 s Osg ml - - .7 1.2 rr,,,, l~ W) * Effluent #1 = BODS > 30:< 220 -my and SS >30 < 150 mg/L E _ < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signal CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 715-246-2454 Property Owner Quest Development.Inc Parcel ID # Page 2 of 3 Boring Boring # pit Ground surface elev. 99.59 ft. Depth to limiting factor >115 Fq 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 0-16 10yr312 - sil 2msbk mfr cs 2f .5 .8 2 16-68 10 r4/4 - sil Imsbk mfi cs - .2 .3 3 68-115 7.5yr5/4 - s Osg MI - - .7 1.2 ❑ Boring # U Boring M pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= 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. 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