HomeMy WebLinkAbout006-1067-90-000
:n~~ oeF'3r,rn<nt ~r c,~»~n~n~e PRIVATE SEWAGE SYSTEM Gon_ r` St. Croix
?,fc'.y ona Ii ild ng Div. or Sansi Perms N,
INSPECTION REPORT 605010
GENERAL INFORMATION (AT 1 AC:H TO PERP;tI fj Sate Plan ID No
Pclgpral r-dnr^atior <ou p-u':utp mny ne i.see'o: seeu'rddty pu'U'-'<ef. Pd:acy Lee, ; L`. {r1 i I'amii
Pvnnt Renee's Name Cry Vtl are Toxnsn,p ParcCi Te. Na
Don Gleason TOWN OF CYLON 006-1067-90-000
CST BY 1:1, 1-sp BM Lie, Hrd Des: •ip:ion SertiomTcwr,ntanreftdap No.
16C> /o e~ ,mac. 30.31.16.465E
TANK INFORMATION ELEVATION DATA
ELEV.
IYPF htANL)FACTURER 12, CAPACITY STATION Bs HI IS
Septic ~W." ft- 'TI /rA /746 Denehmark
t w~ 6.9 M. iaa
Dosing •w.Seo I 3 6o66 Alt. Rr,t ; 1I, J 77- 7. C~: iii_ Bldg Sewer ro, 96 •3
Holding y_ SVHt Inlet ~ q ,
TANK SETBACK INFORMATION St'Ht OW el
TANK 10PiL WELL Bl entt 'ir una..e ROAD Dt lntet pC~
Sepllc Dt BOItOT
ll
- ll
Dosing Sot J I 24 1 Hcaoer:naan. 6,7 Z_ Z_ 4 Ae'alion IV Dist Pipe '7 7 L
.Z
Holding Bot. System to • to t/ V. 3
. s V.
rntal Grade
PUMP/SIPHON INFORMATION 1'6 "17.
Idan,ilac:urcr f \ _ _ Demand St Corer J` 1 Jl~ 7. Z 93. 7
1 GPM ~ W~
model Ni
F H Lift ftict on LOSystem Hei TDH t
!r comain Lerlytl~ Ts. I, Al i_I
SOIL ABSORPTION SYSTEM
BEDJRENCH L".eli- LengP v~. CifTrcn`.">•p. PIT DIMENSIONS No. O' t'rs Insice Dia L qu c C-gir
DIMENSIONS % Z J I CAA G
srTBACK SYSTFM TO U P:L BLDG WELL LAKCtSTRFAIA LEACHING Dd::n.da:Wrc< ~/e
INFORMATION 1 II CHAMBER OR
UNIT l.lpdel Numoe,
Type Of Sisern f Q ' U/i
DISTRIBUTION SYSTEM EZ ~Or.dS <a~
Heacer; r,ti:n I~ I~ DisPrt..lior. r Fr, e Sizc x Hole Spacng L•en A't Ir e
Pixsl 1 ~ V
Lu" 1'11 Cia Lengn_ a a_ F;parng_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
1 t_ rr D(p•n . '_r ::1,p'n e1 51• Iodacd f•'u4red
l
BedrTi n r;,enter Be]"i thI Tcasc vc VCS Nc
COMMENTS: (Include code d,screpencies. persons presen t } Inspection 41 Inspection #2
~ ~ ow
Location: No Address Available
1 ) All BM Description = r .IIFIF e_^-SS
2.i Bldg sever length = 1z CF M O(~ ~ p l~~ J4-., "5
amonnl or cover = 7 yL
Plan revision Real Yes ^ -7 3b 10 ~ i 1 7
"
Llae other side for additional intormaU::a - - - - Cen No.
Ua'.e InLP.DCiefS gnalUre
SHI}Er iB 1 R 3r17?
- i conao• -
Safety and Buildings Division f e 1
!t. I~ql~~ VD 1
x ~ U 11 , t- 201 N' Wa.,hingl0❑ Ave P.O 13ciz 1-162 i .Saniran ?emit[ Fomb¢ (to be rJtec in by Co)
Madmon, Vsn 537,1107-7152
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.::.:r,rdar~c {dt Gp -r rrtd., sj..w w.r. u Si u. r of this wr,z I .i.: appropt[ac ,m•a:cnrnL l mul _
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:.ten; •.itc? poor tc ~tucu r >un.v, ;>,-e.dL V t • ,hcwr Ieruti le 5[21e-.rvmr:t IN'i S are cubmtued to Pmteet Address ;if liiaeni ;tau madin, addtasi -
aw Driamnem Of saf tv n Itr.rl ;iooal sn,trs Fns. na in orrwlior_ vva providc inn be usrd for ccwvrdar•' Zo
s q, cant's r toe nv wv le r s il
I Application c atinon on Information Fleasc Print Ali lnfurmatio
Y v Onm 51v nr - I - _ Yaral N
P» /
~Fropertv Owner 5 klailmf Address FiupeMY Luctiunn 5 C. > I I E
7 J .._.~1+ •r 07, T C GOrtLo Z~
Crl.•, state II /n Gslc Phom Ixw:b:x / :y L Swum
/ / ✓ ~ uclen
T ype of Building (chak all that appl - Lon n
Fatndy llvvcilio;- V umber u::3cdr iutMtvtsuu Sane
111 ilnck ~ _
RibadCuacnacial-D_,,rbc ze.
❑ Ciy of__- -
4
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t ly{pwtl of
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4-
;Tf. Ty pc of Permit. ((,beck only one bbx on line A. Complete line B if applicable) t~
N. KVr tnr._ ❑ Rcpiaer czi: sysrcta I El7rr.:c:nr. I l -~d:u., T. r * Rrpi.,r,.rnr :miv ❑ C)Iws Moduwu a is i<<tcting SyaYnc ; plaid
B. F tint KMVA t a Perini! Revitem D chz^izt 1 I l.,= Pxmt Tramier U, Few C.ut ?nnt n Perms 9umbee L) w Jssucd
54rt n i xYirilcn:
W. Type of POW'IS SrsteiNCnmpmiaroT)eviee. (Check alf that a i Iv Ownrr ~ L~
..'boo Prav -a Ie1S, ~r i`r t r d L~-tic. r A[-lr.adc Mozut 24 in. of suitable sod 11 Mound' 24 in rfsuuablesod
❑ !ickinty. fauk i J CiLVe h'p .vn. nP. um: Icxplnr I- _ , PrCnealmna ❑eV,U (eXDlano .
6'. Dupersa1?reat nt 4rrs Inform abuu.
7eztgt I9vw ep _ L~t~ \ d .',pet n•x, ,t:uc;r d) Uispeoai vcn I:eGwed Dspersal As. Proposed Svslar. Elevano
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\T. Tank Info Cal V_ g otai n v4 Vlarwfacmm V e _
rnll `ns Val:um l:nns
l+cw TaNcR x~vc Tz U a
A,/ „LC_
--T- -
Ste: m tinlnyy Tau.
CNVCng tkamixt ~ F~+~
I VTT. Responsibility Statement the uadenigned ass r poosibdit for inciailanoo of the POW IS shown na the attached Haas
rr
Y'imiba \ nc Linty P'.uut attic _ 1fP:):P ~ Bnsintsi PawcN
171
k r nnt>n . .Wren (Street !atv:. e.lt} code
ri t )epartmeut 1'sc Oni
4T 'ouuri4
rJi: fCC DN(C~ :~.RSULYI scum it jigltallae
App C r ate" d~ ` ~$!J • CSD 5/Z$
'~j~,hr-r cn C.ca i 1"i Jcr.ti
la. Coodit stout fr i AiSapprnval - r /
1-
fork, arlA:cnt, tro 6,
3~ ~eQ~a~e..x.c ~ec~ t}a
' .per. s~ cril t?lddt all be3:~!:1~3II~a int... -
«pw,Tw.3G~ Wan p' u,ded by wd-
ej ~1tl~lfit ~ Tue)CW ea;H. c - .
M pw Ipi&%Ws t46! I cf inara}. - - - -
.{nv<n m ;vmV4n Wain fur tae sY>!eo and wbme to tb<Couory only oa 1-11 am b:cr than t le a 11 IwNe m sin
SBD-6398 (R. I l r i 1)
Srst-m PLOT PLAN
PROJECT Donald Gleason ADDRESS 920 Jefferson Road New Richmond WI 54017
Sc 1;4 SW tr'as 30 ;T 31 \f R 6 11 TOWN Cylon coCN'r~ S -C O:X
s)'S't'ICN ELF`.' 1'I'ION 96.0'95.5 3.6' bebw c rao9 5'2011 °
DATE REDRUUA7
C'pNC hNl'ION aI. 4'T-(;BADE CONA't:NTIONAL LIFT ) HOLDING TANK
1000 oaho't5 LIFT IANIK SIZE630 DOSL TANK SIZI'
MOt'ND SEPTIC "LANE SIZF
HOLDING TANK SIZ[ Lo_ &L) It T7'- 5 AIiSORP'1'ION AREA 900 i; of EZ Flnwsl8
BUNCIINIARK N Le. 7)p of stee', fence Dolt ~SSt' tt: ELe\ Al 10\ 1110' Filter L•,fetim: Fihcr
ItOREHOLE Nvn,iI . H -s benchmark
Seale is 1" = 40'
Propett\ I_inc~
LIHICS,S 00101-Wise
Il0[ed
\ 90' CAls Nx-ah sDa, imF
B . NJ.,
~0 30' 00'
B- I
gy; Slope
600'
B-2
40'
97.5*
Pro 3
Bedroom ] . 4'
House
Hu`I::utt Comhn Tank
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120Th St.
New Richmond Wi 54017
715-246-4516
Date: 5/20/18
Owner: DonaldGleason
Location: SE 1/4 SW 1/4 S 30 T31 N,R16W State Hwy 64 Cylon
System type: In-ground absorbtion system (conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Pressure Distribution Manual (version 2.0)
Page#
1. Cover Page
2. dot Plan
3.`I. er 6ross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Meet
8. Dose Tank Cross Se 'on
9. Pump Curve
r
Signature II,'
License number yr226900
II\V i
System PLOT PLAN
PRO.IECf Donald Gleason .ADDRESS 920 Jefferson Road New Richmond Wi 54017
SE 1/4 SW 114s 30 /T 31 NIR 16 W TOWN Cylon COUN7.1• ST. CROIX
SVSTEA1 ELEVATION 96.0195.5 3.5' below qrade 5/20x'18 BEDROOM 3
DATE
CONVENTIONAL. AT-GRADF, CON1'ENTIONAL LIFT XXX HOLDING TANK
MOUND SISI''I'IC TANK SIZE 1000 gallons LIFT TANK sIZE630 DOSE TANK SIZE.
HOLDING 'T'ANK SIZE, LOAD RATE .5 ABSORPTION AREA 900 # of EZ, Flowxl8
BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATU)N tolr Filter Lifetime Filter
❑ BOREI101.E O WE"- all. R.1'. same as benchmark
Scale is I" = 4W
unless otherwise Property Line
noted
VCD1S
2-3' X 90' Cells with >3' spacing
B
50' 30' 13 .\1. 200'
B1
35' 8C Slope
99.5' 600'
10,
97.5'
Pro 3
Bedroom I5'
House
1hltfcutt Combo Tank
I Iighwav 64
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of
'ILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity _ gal LI NA
_
Pem:it # Septic Tank Manufacturer ❑ NA
)ESIGN PARAMETERS Effluent Fitter Manufacturer ❑ NA
Number of Bedrooms - - O NA Effluent Filter Model O NA
Number of Public Facility Units Ad' NA Pump Tank Capacity ~ al C NA
Estimated flow (average) : -LTC aVda Pump Tank Manufacturer O NA
Design flow (peak), (Estinated x 1.5) t~ gat/day Pump Manu acturer z ' ❑ NA
Soil Application Rate gal/day/itz Pump Model / 0 NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit JaNA
Fats, Oil & Grease (FOG) I S30 mg/l. C Sand/Gravel Fitter O Peat Filter
Biochemical Oxygen Demand (BODs) 15220 mg/L ❑ NA 71 Mechanical Aeration C Wetland
Total Suspended Solids (TSS) <150 mg/: ❑ Disinfection O Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) c30 mg/l. in-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) _30 mgt NA ❑ At-Grade ❑ Mound
Fecal Cofifonm (geometric mean) S10" ofiillooml ❑ Drip-Line O Other.
Maximum Effluent Particle Size k in dia. C NA Other. - O NA
Other. NA Other ❑ NA
Values typical for domestic wastewater and septic tank effluent Other L: NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tankO s At least once eve O month(s)
every:
<3II:year(.q (Maximum 3 years) 0 NA
Pump out contents of tank(s) When combined sludge and scum equals one-third ()J) of tank volume ❑ NA
!Inspect dispersal Dell(s) AI least once every: , aKs~s) (Maximum 3 years) C NA
;lean effluent filter At least once every: r C 'onth(s) iJ NA
year(s) _
1
nspect pump, pump controls & alarm At least once every: _ ' month(s)
Lf7 (s) 0 NA
LL
=lush laterals and pressure test At least once every: G month(s) :1 ANA
year(s)
"'thee 'f month(s)
At least once every C year(s) NA
)thee
NA
(MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
iPlumber; Master Plumber Restricted Sewer: POWTS Inspector. POWTS Maintainer: Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any missing or broker hardware, identify any cracks or leaks. measure the volume of
cembined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall he
visually inspected to check the effluent levels in the observation pipes and to Gneck 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
,egulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (i5) or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
4dministrative Code.
I: it other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units.
13nd any servicing at intervals of <12 months: shall be performed by a certified POWTS Maintainer.
k service report shall be provided to the local regulatory authonty within 10 days of completion of any service event.
pop -of -
START UP AND OPERATWN S ctheck treatment tank(s) for the presence of painting products or other ctveRHrzb ihtlt
may For new de t i prior use of the POVYf cell(s). high concentrations are detected have it* contents of the , to impeede the e treatment pr ocess and/or
damage the dispersal tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface. ater will be
effluent.
During power outages pump tanks may RI above normai highwrater levels. When power is the geda restored p or the surface excess discharge
discharged to the dispersed cell(s) in one large dose, overloading the cell(s) and may rest* in Operator it s r to restoring power to the
To avoid this situation have the contends of the pump tank removed by a Septage Servicing controls to restore normal loves
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump
within the pump tank. disturb or oanpect the area vdtltln
Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise
15 feet down slope of any mound or at-grade soil absorption area. and prolong the We of the POWT$:
Reduction or elimination of the following from the wastewater stream may improve the pertortnarhce anit prolong fat foundation drain
antibiotics: baby wipes: cigarette buts; condoms; cotton swabs: degreasers; dented floss; dlapers~ Ong fond rain
(sump pump) water: fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps;
pesticides; san'dary napkins; tampons; and water softener brine.
ABANDONMENT shall be taken to insure that the system is property
When the POWTS fails and/or is permanently taken out of service the following steps
and safety abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and property disposed of by a Septage SarAchng Operator.
• After pumping, all tanks and pits shall be excavated and removed of their covers removed and the void space filled with shod,
gravel or another inert solid material.
CONTINGENCY PLAN code compliant
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
rep system:
As---A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption syste►n.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requtW
setbacks from existing and proposed structure. lot lines and wells. Failure to protect the replacements will y result '
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the tailed POWTS.
❑ The site has not been evaluated to identify a replacement If repti meetarea failure of the is available POWTS a soil and she evaluation
tank may be installed as
must be performed to locate a suitable l e repl aoernent area.
a last reson to replace the failed POWTS.
❑ Mound and at-grade sal absorption systems may be reconstructed in place following removal of the biomat at the infihra'tive
surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PU OR OTHER NTERIOOF A T TE MAY BE DIFFICULT O IR MCIRC II STANCES DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE I
ADDITIONAL COMMENTS _
POWTS INSTALLER POWTS MAINTAINER
Name
Name
Phone - - f / Phone
SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY
Name
Phone - x_~ c % ? Phone
This document was drafted to compliance with chapter SIPS 383.22(2)(b)(t)(d)&(f) and 383.54(1), (2) & (3), Wisc«hsih Administrative Code.
Septic-Dose Tank Cross Section And pump performance Specifications
i 1tank Manufacturer j~Imo, _ Pump Manufacturer ;t1
I arrk Model Number / ~~C --I Purim Model Number ~U -
w!-
t Alarm Manufacturer
'Tot il `lank capacity_ C z», I Alarm _Model Ntnnber
Max. Bury Depth
witch'1'ypo 1.!n`'r4t?!-' -
- I J Total Dynamic FIead (TDH) Feet -
j Filter Nlamfircturer f'o~_.
f Filter M. odel tTu_mber^ r111 - - - ~F,levation Head-- -
r Distal Pressure
[Network Toss
Mmimtun Pump Performance Required Force Main Lo
-
Ft TDI1
Outlet Manhole Min. 4" Above Grade With
Manhole Min. 4" Above Grade
hocking Device. Inlet Manhole Seurrely Mounted With Locking Device
< b" Below Grade Sealed Watertight Weather-proof 1
Junction Box
- Finished Grade - - t- ~
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
Outlet Filter
-Inlet Baffle
-
Inlet w-
TA
Switch Settings and _ Reserve _ CaPacif-
_
Latrk Volutnc = GPI + weep
hole
I
]runt Gal.
_ V
Dimension
Inches o (reserve) A
(alarm) B 2 Off Elevation C
( Ft
(dose) C
Bottom
r (dead) D 2 ' 1) llevation
[C Total Ft
(:ENERAI, INSTALLATION: The septicidose 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 tank
excavation and the sleeve is sealed watertight. Electrical service complies with NLC 300 acrd Coman 16.28.
02105 U Page of
250-SERIES
113 hp Sump/Effluent Pumps for Professionals!
ALL MODELS FEATURE: MOTOR SPECIFICATIONS:
• Rugged 1/3 hp motor, oil filled with 1/3 hp 115V 5.2 amps 60Hz
thermal overload protection. Thermally Protected & Permanently Lubricated
• 1/2" solids handling. (PSC) Permanent Split Capacitor
Maximum Fluid Temperature.: 140"F
• 1-1/2" discharge.
• Hermetically sealed motor and switch cavities, DIMENSIONAL DATA.
and permanently lubricated bearings.
Weight: Model 257:20 lbs.
• Liberty's UNI-BODY casting - a solid, one- Height: 10.5"
piece housing that eliminates the lower motor
seal ring found on other pumps. Major Width: 9.6" (manual model 250)
• Epoxy powder coat finish PERFORMANCE CURVE
• Vortex style impeller for superior PERFORMANCE CURVE
solids-handling. Made of high temperature 25
engineering polymer.
• Fasteners - all non-corrosive stainless steel. 20 s
• 416 stainless steel rotor shaft. v m
15 5
c ~
250-series Cord Lengths
Model 10' 251(-2) 351(-3)_ 50'(-5) ti 10 - a m
250 Standard -Optional -Optional Optional 5 _ - r a
251 Standard Optional _ Optional Optional
253 Standard Optional Optional N/A o 0
257 Standard Optional N/A N/A 0 10 Z 30 40 5a
U.S. Gallons Per Minute
1 o' cord length standard on all models. For optional lengths, i
add "-2. -3 or -5" suffix to model number. 1'' 38 7e 114 ios toe
Example: for model 250 with 35' cord, order 250-3 Liters Per Minute
EFFLUENTMODELS
a
:A^
Model 250 Model 251 Model 253 Model 257 VMF
Manual, no switch. Quick-disconnect wide-angle float with VMF switch, magnetically
wide-angle float, series (piggy-back) operated vertical float-
mercury-free. plug, allows manual operates in a 10" _
~p w operation of pump. diameter sump.
S I' ; Dual sa ftey cortlknuon for
Certified the United Statesand C:xcada.
Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839
www.libertypumps.com CuPynght c Uberty Pumps. Inc 2017
All nghInm-jvrvrr.. 1-1-I7250(M WIl
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OWNLRSHIP CER•I TFICATItiN FORM
nw'nei;''13uver J
lv9ailing Address U Je
Properly Address
(Verification required from Plan /our Oepatt new for new eons!racooll
Cit),'State - - Parcel Itit:ntifit:atiun Number _ C 8 -2
LFGAI, DESCRiI' tON
Property Locatj()
< r
See
l_ b1, r)wnol_
Subdivision
f `i' C< ~
It- VL~
Certified Survey ti1ap 4 Vt in r _
- Page -
Warranty Deed Vohunc
--,Page T,
Spec house yes 1 (it haul. identifiable ye;:
SYSTFM MAINTENANCE _ND OWNER (-'ERTIFICATION
Improper use and rnainhmance of your sepac svstcm could result in its pr.mlature failure !o hurdle wastes- Proper
maiittciiamcc consists of pumping our the septic tank eves v three years or soonet, (I needed, by a hccnsrd puugxr W hal you put imp
the system can aflcct the limchon of the septic tank as a treatment Stage in the waste disposal system Owner maintenancr,
responsibilities are specified in Wonnn. 83_ 2(1) and at Chaluo 12 St. Croix County Sanitary Ordinance
the property ",net agiocs to submit to St. (';oix I-ouniy Planning d: zoaatf, f)cparnneat it certification form, signed by the:
owner and by a matter plumber, jo!uneymian plumber tcstlicied pimnbcr or a liceuwd pumper vmifying that (1) the on-site
wastewater disposal system is in proper operating tam dinun an,:, in (2) after msne:;:ion and pumping (if necessary),
less than I%3 fun of sludge. dry), the septic tank, i5
i%we. (he uudersignrd lv ve read the above regaltcmrmS and aviec to ia. Irtaut the povatr. sowagc disposal iystem With (he
standards set Furth, hercim. as set by the Depi rtinent of Conimm, and die Depalm.-nr of Vatmai Rcsowees, Stare of Wisconsin.
Cettificadion stating that your srplic system ltas been n amtaeled must hr complete,( and retained to tile, tit. Croi.e County Planning ,t
Zoning Department within 30 days of tLe three year expiration date.
Irwc certifvthar all stalemerirs on fern :"tr tnw to the best. of my/;au knowledge . Ilwve anYarc the nw•uer(s) of the
property described above, by vinle, of,I µ ranty docd :ecotded ir, kegis!c: oFDerrLs ptfiu.
Nuz"-of bedroof ?
STCiNATURIOF Al'P1.ICAN'I'(S} -
DATE
"*Any allonuation that is rrisrepresented relay resin: III the saintaly pctmrt bring f,-voked by the Planning & Zoning Department.
Include with this application a recorded wvaltanty decd firm :ire Regislci u: Dceds 'eice and a copy of the certified survey reap if-
referem:c is made, in the vrarranty deed.
(REV. ORMS)
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Wisconsin Department of Commerce SOIL. EVALUATION REPORT Page of 3 _
Division of Safety and Duildtnys
accordance with Can a, 85 Wis. Adir:. Code ~
~~~1~[1~ County C + J r f
Attach compete site plan on ~l{x~'i vsb5 than 8 V2 x t t inches in Sire Ian must J
include. but not limited rt(c~i F enz :tal relerencerx>ml (BM)d+ and Parcel LD.
percent SIODe, 5cel0.Or ns. _nortifarrow, and location at distance tin" st road. o 0
p Se print all information. Sl c~ e"r~,q~ Date
Personalinfomlewnyouor v,de may De used Iwsecondary purposes(Privary lnw,eG4~ 1111 14
Property Pro e 0 aliool s (yv 0 SF 7
GoN. Lot Sr 1;4J(,(~ ti4 S.30 T N R 16 E 1 r) W
Pmperty Owner's Mailing Address Lot # I ]Block # Subd. Name of CE _
7 - ~
City Stale Zip Code Phone Number 0 CTi ❑ Village [~4,Tcwn Nearest Road
A/ot jZ cG m C :I 5-10i 7 (/j- )6r `132.(0 /,7>✓
ew Construction Use Residential lNumberof bedrooms Coda derived design flew rate _.500 _GPD
❑ Replacement ❑ Public o~°mmerclal - Describe:
Parent material Flood Plain elevation if applicable orv 1,4
General comments D Z C. n i1
and recommendation
System TYPO ~P :</•~P•.'`--~-~.Fh~-!~ ~ Sy.Irm Fle,:rhut ~ 1 - -
Boring ~❑7 Boring
+_C~/1 t. Depth to limiting torpor m.
F71 # ICA Pit Ground surface elov,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Sructure Consistence Boundary Roots GPD.'ff
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etf#2
Fs- 05ye; hl/ /14~
Borbg # Bonng
Pit Ground surfaceelev. l ' r ~ ft Depth to limiting factor - in
Sad Apph~abon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD.*
in. Munsell Ou. Sz. Cont. Color Gr. Sz, Sh 'EN#1 'Eff#2
Z -
Effluent #1 = BOD > 30 < 220 nxyL and TSS >30 < 150 _ • EMuont #2 = DOS < 30 mg'L and TSS < 30 mgI
CST Name (Please Print) CST Number
Bird Plumbing. Inc. Shaun B rd 226900
A9d'2cs Jxte Fv.il,linon Ca1duc'pr_ -C e:lnur'e N.1rnber
1008 192nd Ave. New Richmond. Vdl 54017 - j 115246-4516
}
Property Owner _ Parcel ID # Page _ of
Boring # ❑rn Boring I 1
pit 4s Ground surface elev-,~~{ ~ ft. Depth to Lmiurg fader in.
Soil Application Rate
Horizon Depth Dominant Color Redox fhsniption Texture Structure Consistence Boundary Roots GPDtff
in. Munsell Cu. S_z. Cont. Corr Gr. Sz. Sh. 'EH#t I 'E",2
- l 9 l0 51 r j,2
L - 5 fi_ _ V rJ
J ✓ S h' ' rv Q.
iLLL
r
-
I
Boring # ❑ Bonng
pi, Ground surface ele•r_ fl Depth to limrtiq) fatter in
Sal Application Rate
Flonzon Depth Dominant Color Redox Descnplion Texture Structure Consistence Boundary Roots ' GPDIff
in. Munsell Ou. Sz Cont. Color Gr. Sz, St 'E##t •Eft#2
_ I
Boring # Bonny
Ground surface elev. H. Depth to limiting factor in
El Pit . I~
Sal ,"fion Rate
Honzon ')epth Dominant Color Redox Descnpllon. Texture Structure Consistence Boundary Roots GPO#Y
n. Munsell Ou. Sz. Cont_ Cola Gr. Sz. Sh- 'ERlJ1 'EH#2
Effluent #1 = SOD. > 30 < 220 mglt. and TSS >30 150 m9l ' Effluent #2 = BODE < 30 rrxyL and TSS < 30 mg-
1-The Ucpartment 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.
CFf111 ii: I0. AII:1'
PmDem' Ow Or PaioB i0 C - _ PanE _ of -
Boring b ❑ Bormg
I ~ Pit Gmuntl sur'ace erev ~ it. Depth to limitrrg lad« -IL-0 Ic.
Soii Aa tiicanon Rate
HonZOn Depth Dominant Calve Redox Uesaiphun Textutu Structure Consistrnce Boundary Roots GPD1ff
m. tAUnsell Ou S: Cont. -al). c-
~t
Ly V,/,r
"Vi
1 L3
❑
Bonito R Bonng
pit Ground surface elev. ft . Depth to hmitind laao' ir..
- -t_ Snil catior Rae
t-Inn>sn :froth Crxninani Color Rix Descmuon ~ esture i Structure ~ Cons:sterc<, 16oun:a koo;e GPD;'Ff I
in. 1 I
MkInsal Ou. Sz. {7cn; Color r Sa St. 'EflKt 'Elf#2
1Boling # !❑-1 Bowie -
~_I U Pit Ground strrr., ce elev. H. Depth to hrtWng factor in
_
Soil ApWrdhan Rate
Horizon 'lepfh Dominant Color Redox Description Texture Stria-cure, Consistence Bouncarv Roots GPD!'!"
n. Alunsell Ou. Sz. Cont Colo' Gr. SL St.. •Eflk1 'E N#2
i
j
I
' Effluent k' = SOD. > 3C < 220 ng4 and -SS >3C < 150 mgL ' Etfluont 42 _ BOCK < 30 m14. and Tv: < 30 mgtL
The Deparunent of Commerce is an equal opponuni4 service provider and cmpio%cr. If N'ou need assistance to access services or
need material In an alternate format, please contact the deparrnent at 60&?u6-?ISI of 60F--264-577?1
W0.nr0 r0. Nro:
r ' Soil Test Plot Plan I
Project Name Donald Gleason Shau $i71
Address 920 Jefferson Rd /
New Richmond Wi 54017
CSTM #226900
Lot Subdivision Date / 8/28/13
SE 1/4 S W 1/4S 30 T 31 N/R16 W
Township Cylon
Boring 0 well pi- Property Line County ST. CROIX
RM or VRP Assume Elevation 100 ft. Top of steel fence post
System Elevation TBD *HRpSame as Benchmark
Scale is 1" = 40'
~LCrruv2t CU 'at
UI11eSS Otherwise Property Line
noted
B-3 s.n~l.h.
5c1' 30' 200'
13- I
35'
R'~b Slope
99.5'
000'
B2
97.5-
Highway 04
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