HomeMy WebLinkAbout038-1196-40-000 (2)
WIXAM1jIn Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safely and Budding 0 vision Sanjay Perm! NC
INSPECTION REPORT 578964 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information ya provide may oe used for s Wry purposes IPr vacy Lax s.15 04 t it
Permit Holders Name. GCy wage X Tov nSMp Parcel Tax No
Johnson David R. 1) Star Praine Town of 0381196110-000
CST SM Elev. 1 Insp. BM E43 `v WA Description. SectiMrTowrVRange/WP No.
13.31 18,1028
9b• r a d~~SN~
TANK INFORMATION ELEVATION DATA yy
TYPE MANUFACTURER CAPACITY STATION G81-15 ICLI• F$ ELE3
Septic Benchmark ~ttL,zi 9(i' 3
Dosing Alt. BM/ COL) 7~ ~.a~ ~bZ. t1
LA-
Aeration Bldg. Sewer
bl n
Holding SUHt Inlet
Sblit Outlet
TANK SETBACK INFORMATION
TANK TO PIL WELL 6LOG Venl to Air Intaxe ROAD D: Inet
Septic 3 DI Bottom
Dosing Zoo C HeadeaMan
Aeration Dist. Pipe O d / ` ,4~
Holding Bot. System C- •7 25 • b
Final Giaoe 3 1 4
PUMP/SIPHON INFORMATION /
Manufacturer Demand St Covor
GPt, IIF t'`•
Model Number _ A.lV 6o • D 9~
TOM Lift nchon Loss System Hasd Fl
Forcemai flglh Dist to Well
SOIL ABSORPTION SYSTEM
BEDrrRENCH vi - Length No. Of Tenches / PIT DIMENSIONS No. Or P,tS InsAe Uia Ugub Depth
DIMENSIONS 3 Z rj'Q1,~t,k.aD
SETBACK SYSTEM TO P!L BLDG T WELL LAKEtSTREAM CLEACHIRG Mdu.Aacaie'
INFORMATON Type 01 SysleTi _ Cr I / ha UNIT Model Number G
DISTRIBUTION SYSTEM E 7 11 7-
x Hole Size x MPIa Spaong Vent to A' Intaxe
HcaoenManlf~d 1, pe!wtirn ~'y ~C.n.
.qf Pipefsl
Langdi Dia Len;71o D o Spot ng__ # v G./~
SOIL COVER If Pressure Systems Only xx Mound Or At-Grade Systems Only
Dept, Over xx Depth' I xx Seeceo~Sodded xx MutHmd
Dep:h Over
Bed.Tren^.li Center 1 11 BedTrenth Edge Tc9aoil Yes IMl No a No
COMMENTS: (Include code discrepancies, persons present, cic.) Inspection inspection #2 -y_
Parcel No: 13.31.18.1028
Location: 1338216th Avenue New Richmond. WI 54017 (SE 1/4 NW 1i4'3T3~1 NR 1I8W) Pine Acres Lot 33
(I _ t~~~1I
1 ) All BM Descnption = f~vrl C l/ 4, l J C~ rt v l cQ p1
2 ) Bldg sower length = / I ) X11 6 r
-amount of cover X
= l,- I ` - e6 I
T1 r
Plan revision Required? a Yes No L I qp ) I I// 6,34
Use other side for additional mformati r' ,J Cate 7 nsepctors ~p'al Con. No.
SBD-6.r1p iR 3Wj
Y rr C.
fi/ r sly St.Croix
~s: ~yCC1YC~ Safety. -
$ 201 W Washin On Ave P.O. Box 7162 Sanitary Pamir Numbix (to be filled in Irv Co )
r_ 162015 Madison, W 53M7-7W1-
5 1 S`f
_kOIX COUNTY
Permit Application Sur`siwbianNumbs
In arrotd.%n wn!i SIN IS 1 21(2), W'I< Ann: Olkfc, >,Ihmrc>um Ot Ihlt Inml n+the appropnalc FOVCmmenad :inn /d for
is rnyuucd mot to obtaining a sanitary pemut Vote Application Corms for AWc.ow,Rd MWPS are submlred to Pm)ea Addr (if diffemnt than mailing address)
the Mpamnent of Safety' and Pmfessixial Serves. Personal infi, + ion you provuk may be used fw Wordary 13,.36 216th Ave
u tics m accwdnnc< w+Ih Inc t4rvucv I ru . 1 Si Wt l Xm . SWU. .tT
1. Application Informati - se Print: All information _
Property (Tuner's Name I Parcel n
David Johnson 038-1140-000
Propcm'(T~na's Matllrtg Address PmpertyPAM:Iiliai
1336 216th St. f e„ 1 W 16 Z8
City. Suite 7ip Code Phone Number SE ..NW SW-n 13
New Richmond Wi. 54017 (ei2eonrj
r_31 N, R_18 Eorw
IL Type of ftuildinR (cheek all that apply) Lm W
®Ior 7I;ionly ITUJtmg- Number of lkdroums_k J -)33 Subdivls+on Name
4s,yc✓~ Block 0 Pine Acres -
i. PrblldCommacial - Dewribe Use e
(7 ON of
I~1 State Owned-Dctl tiers CSM Number ❑Village.(_--
IXTownof r Ime
M. Type of Permit: (Check on y one bos on line A. Complete line Rif applicable)
A ❑ New System D(Replacem<nt System ❑ Treaunenullolding lank Replacement Onh ❑ (Rlla Modification to Existing Syarrm (explain)
B. ❑ permit Renewal i D Permit Revision D Change of Plumber l I permit Transfer to Nc>v List Prcvmua Pamir Number and Date Pew d -
Before [xpira:lon CTUSirr 3~., j 9V
IV. Type of POWTS Svatem/Component/Ikvicr. (C6ak all_thal aDP!))-
[ CNw-Prm,urrsCd Io-Ground D P e ,unrnl Io-GmwiJ F1 At Oa& Wood > 24m of .unable wJ ❑ MwrN < 24 in. of suitahle `unl 77
❑Holding Tank t7 r Dispersal Component (explain) ❑ Prelreatrnem Dcvix(explain CfG /d(")
V. b_is ersatfy"al ent Area Information: If
Drsiga Flow (gpd) Design Sod ApplicWlon Ra:gF SA Disperal Area Reglli (s0 DlspaslJ Al lam . d (sl) Syslan F]cvatlan 7
450 _7 643 700 8
V _L Tank Info Cal in Total N of Manufacturer
Gallons Gillum unit. Zabel A100 filter a i s
SCV TaJ> rang TnJ> o " s _Vd
.,pas or Holding T.aa 1000 1000 eeTcs
[xx- - -
iog ChrIIM
V111. Ra~iirnsibthty Statement 1 the oad_enl Ill suame i eapoarill for lu lhwioa ofthe 14)WTS lib"a oa the attached plain.
Plumber's Nam (Pam) Plumhcr S+grl.,lur 57R'MPRS Number Husiticss Phone N'umN'r
Keith Knudtson I~ X648443 651470-1737
Plumber s AJJreu IStrcel, C i:v, Suite, Llp Cali) '
927 150th St. Roberts Wi. 54023 .4 /7
_
VII .ountl,/Department Use only.
_
ApprovW ppmv 1'amit ltx fye4lsvtid Issuing tSigawttrc
_at i is 47$ .`a / ~s
_ t ' sawn for I?cruel I _
M. Coadi cawns for Disapproval rte. ~ 5
.'-Septic lank, effluent flrter and 3~ Pia f
dispersal cell -rust all be servtces; rpaintdineJr a C,/ •pa~/
as per management pain provided by plumber. /'Y O O
2. Ad t4Nbeck baulk wft mtW be r interned
as per pplicade code I ordinances.
+n.rh w rainpksr'I..t far IM gstem mad wiaolt m roe Couafy only on i lvr ant Iran MANS lair 11 usher V Am
G
SHD-6398 (R. I I!11)
`1`rr `i`
~3 4t
V V IN
^1
K
y 4 b
$ -
.41
c v J h 1
3~ ~ 33v
z m
I~
o
V
Q ~ ~ ~ v v ~ ~ lS -14 I
o
14,
7
COpti'
i'
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name Johnson replacement sewer
i
Owners Name. David Johnson
Owners Address: 1336 216th Ave
New Richmond Wi.
Legal Description: SE 1 /4 NW 1 /4 S 13 ' 1' 31 N R 18N'
Township: Star Prairrie
County: St. County
Subdivision Name Pine Acres
Lot Number. 33
Parcel ID Number: 038-116940-000
Page 1 index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Fitter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. Keith Knudtson License Number. 648443
Date: 05/15.12015 Phone Number (651) 470-1737
Signature /
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SuD-107M-P (N.01/01).
Page 1
V 5 re,
Lq
i
v ~ a
E
3 ~ 3
Ja• o `g
z ~
~I
0
V
a 1 .v I ~
h
C 'J ~ ~ v c ~ ~ ~ { ~ •I
vj @ y c1
a
SOIL ABSORPTION SYSTEM DETAIL ! GRAVEL.LESS LEACHING UNIT Page-
of-Project Name: Dave Johnson
2 No. of Cells 7 Per Cell
3 n Cell width 14 Total No of
70 fl Cell Length 350 sq it EISA Per Cell
4 n Cell Spacing 700 sq It Total EISA
Iranutaclum model Laying Length EMA Rath
Infltretor EZ1203H 511 5.9 25.0 -
EZ1203H-1011 WV 50.0
Gravelless Leaching Unit Manufacturer. EZ Flow
Gravelless Leaching Unit Model: EZ1203H
\ Typical Cross Section
Finished Grad4 9~ ~
-----Observation Pipe with
\ approved cap or vent
a...
i
Soil Backflll
40
In
~Geotextile Fabric
n Infiltrative Surface
12 in 0
n Limiting Factor
40 In -Slotted and Anchored Vent/
Observation Pipe with Cap
PlumberlDesignerSignature: Keith Knudson ~
Liconso s: 648443 Date: 5-15-15
• Filters
X25 EFFLUENT RLTER
1Ne PL 525 Filter is rated for
#rer 10,000 GPD (gallons per day) 1/16° Filtration Slots
ng it one of the largest filters
~..*w
tts class. It has 525 linear feet
1 16" filtration slots. Like the' try MaOM
k PL-122, the Polylok 61°inNi°'
PL-525 has an automatic shut
off ball installed with every filter.
n the filter is removed for
meaning, the ball will float up and
temporarily shut off the system so
the effluent won't leave the tank. szuw r avw
No other filter on the market can Fftrwi.Slm
wtake that claim. e~peao
PL-525 Maintenance:
.„;W-
The PL-525 Effluent Filter should""
operate efficiently for several years ® -
ender normal conditions before -
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified
by an alarm when the filter needs
servicing. Servicing should be
c
DAB
done by a certified septic tank i9~~
pumper or installer. A~~
U.S. Patent Nor 8,015,488 --o YYlt es✓~ _
1. Locate the outlet of the 5,971,640 ~.e..e
septic tank.
2. Remove tank cover and pump
tank if necessary. PL-525 'tnstallat'or: 3. Glue the filter housing to
3. Do not use plumbing when the 4" or 6" outlet pipe. If
filter is removed. Ideal for residential and com- the filter is not centered
4. Pull PL-525 out of the housing. mercial waste flows up to under the access opening
10,000 Gallons Per Day (GPD). use a Polylok Extend &
5. Hose off filter over the septic Lok or piece of pipe to
tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page
back into septic tank. septic tank. 19-21 for Extend & Lok
6. Insert the filter cartridge back 2. Remove the tank cover and information.
into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter
the filter is properly aligned into its housing.
and completely inserted. 5. Replace and secure the
7. Replace septic tank cover. septic tank cover.
l~
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.
Furthermore, 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 = 450 gpd; BODs 5 220 mgL"'; TSS S 150 mgL"'; FOG :5 30 mgL°
Inspection Checklist INSPECT EVERY 3 YEARS
c type of use
age of system
c nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
c material fatigue (I.e., leaks, breaks, corrosion, etc.)
c solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
c 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 recycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
c 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 (113) 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 fiker(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: Keith Knudtson Phone: 651-470-1737
Local government unit: St. Croix Co. Phone: 715-386-4680
Local government unit address: 1101 Carmichael Rd Hudson ZIP: 54016
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 POW TS 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 sub mittod to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a codecornplying dispersal component in a pre-deternined 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.
ST. CROIX COUNTY
SEP I IC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP ('ERTIPICATION FORM
Owner,'BLIver-David Johnson
Mailing Address1336 216th Ave
Property Address _
(Verification required finnt Planning & "Zoning Department for new construction.)
New Richmond Wi. 038-1169-40-000
City/State _ Parcel Identification Number
LEGAL DESCRIPTION
Property Location 1~ 14.. Sec. .13-,.1' 31 N R 1 8 W, Trown oC Star Prairrie
Subdivision Plat: H~ Lot #
Certified Survey Map Volume . Page ti
Warranty Deed # (before 2007)Volume Page
Spec house OyeslZbo Lot lines identifiable Dycs❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenanct of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic twik every three years or sooner, if necded, 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 we 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, joumevman plumber, restricted plumper 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.
Tiw•c. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set turth, herein, asset 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.
Five certify that all statements on th' form are true to the best of myiour knowledge . trwc am;are the owner(s) of the
property described above, by virtue ol'a wa airy dced recorded in Register of Deeds Office.
Number of bedrooms 3 v
SIGNATURI/OP 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 from the Register of Deeds Oftce and a copy of the certified survey map if
reference is made in (he warranty dced.
(REV. 04/12)
i
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 1335 215th Ave. located
at: SE ''/a. NW Section 13 , Town31 N, Rangela __W,
Town of Star Prairrie St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 5-15-15
Did flow back occur from absorption system? Yes Nox
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1000
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): weeks
Age of "Tank (if known):
Permit number (i 'k wn)
i
Keith Knudtson
(Licensed lumber Signature) (Print Name)
rv18"3
(Title) (License Number) MP/MPRS
05-15-2015
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
I
29 r" 0
65.992 sq.ft. ml I" 67.922 sq./t.
1.51 acres z I 1.56 acres J - `
J r
/ X69 ' r i LECE
, ?•ISe• 0 }9~1 2e'W Denote:
v, sr4~. /,ptP Alum.
1 a
1 O Denote!
^y~ 67.930 sq.ft. 1 I a,Y~,u• weigh:,
``b046 " =M^~° 1.56 acres I h! • Denote:
~1 !I (unle
~ Denote;
° C{6
.r\ \ ^ -61.54,S_OJ55~1'w~ i 1 1 U 0 - - Denote;
_j 12(t,
ti ` ' ,o/yyq° o Z I 67,220 sq.ft.
q.ft. 5 ` 32 I I 1 1.54 acres Denot
es
=1 !Wy 6 I (rec.) Denote
7,082 sq.rt. F
al h u 1.54 acres (meas.) Denote
w ^ 'N I I I Vertical Datum
T
n : 362.83 NOO'49'40'W i All Other Lot c,
y„ f 1' X 24' Iron F
rH, IJI,a6' . i2& n' w.
i Ib
m~ o „ In r Distances ore
n rte, 0.001' and me
y
Angles are com
and measure
airy i ~'I ul 'I rr'i7i
n n
o ~1v ~ pl 100
y'~ =bb b ! 4 I 1 C)B
bb n eau bl q 1 I 1
34 1
n b$ J ~ - ~ 5.766 sq.ft.
/ 778 sq.1 1.51 acres , I
of n W/i 1.79 acres (y g
m N ' o ~ 199.4' ~ W
~ f
_ 12.00 211. , z
REE 4 x
U ~O"~ i r O
N
CC)
nl iv N
~I m r 0 1 Or' ~ 'ISONi
di eb i t1E 1 : ~
.e s~' SE
ti~~+ C0JAVI
~P HE DE D PREPA
_
MOTAH,
Todd A/. Hende•sholl, RLS 2362 WI OQ
Registered W-SC sin Lord Surve for Dated this ^ day of A 2000
SURD .
rtM
This instrument drafted by Todd N. Hendersholt
Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page _1 __of - 3
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
Aftch complete site plan on paper not leas than 8% r 11 arches in sire. Plan must County
Include, but not Invited to: vertical and hanaontel refererw4.p R(BhI), direction and Sf ['X._ J(
percent slope, Scale or dknenakwa, north anowrpypmn tan lad disrwi@e to neared road. Parool I.Da:
APPLICANT INFORMATION - P all tintorr»atlon\ py~•~~C ~'ptdtnR Qaar
PsraonW ido -W you prowas nvy to urea b- (FrT!aCl V"•. * 15 ,11(1) ;m)) y ~ ~ p - 1 - 2aCrv
Property Owner Property l oca on
Lakes & Hills Development CaA 1r4 . 114,S . 13 T 31- N .R 18 (WProperty Ownafs Maikg Add Lots; I Bock # 'i Subd. Name or CSW
3 _ Pine Acres - - -
ty Zo Code PhoeelladtAlCity 17 e ZTown Nearest Road
Slate
~L / P daYllf, 216 Th. AVE.
GNew Construcbm Use: Reside4allAApimber9fbe4froonu 3 rlAdditiontoexstrngblilding---
Replacement t Public of comrnerciai describe
Code Derived daily flow _ 450 gpc Recommended design loading rate .7 bed, gpolM 8 trench, gpdfR
Absorption area required 643 bed, fP 562 trench, re Maximum design bailing rate .7 bed, gpW B trench, gpol F
Recommended inffltrabon surface elevation(s) 95.2 ft (as referred to site plan benchmark)
Ad3tional design 1 site considerabons
Parent Flood plain elevation, if applicable fl
S--Suitable W system Comenwrial Mound Inavind P.•assure AT~Grado System in FIR Holding Tank
U--Unsuitable for system s C u r S U ✓1 S L) ^ S F U 7 S l U r-. S k1 U
S& DEMOTION REPORT r" 4=
7M
Depth Dominant Cola Mottles Structure onsistermcdBoundary Roots
Boringft Horizon in I Munsell Qu. Sz. Cont. Cola Texture Cr. Sz. Sh. Bed Trench
-10 I0YR3 3 I msbk mvfr as If 4 5
- I
I 0 I _
Ground 3 25 I lvf 4 .5
2 10.25 -49 10YR4OYR4/4 /4 I msbk mule 1, .5
cs os8 m1 Sw .7 .8
- - -
99-5 fL 4 49-94 10YR416 cs os8 ml .7 1
I-
DO" to
irNtinq 1m -
" -
factor
Ram3rks:. r/~ - - -
/ 1 0.11 10YR313 r I Imsbk mvfr as 2f 4 .5
2 11-26 10YR4/4 I Imsbk mvfr Bw lvf .4 1 .5
Ground 3 26-50 7.5YA4/4 os8 ml cw .7 .8 Isis elleav
y9 6 R a 5 -93 I OYR4/6 Si osg ml •7 .8
l ;lt.
Depth to
limiting -A
factor
>93" 12.. 6
Remarks:.
CST Name (Please Print) Sgnature . l Telephone No.
Jacque Hawkins y7L -JIV Y'6 -
A *y Oate CST Number Ref 0
J_V
er_
4/10/00
-7L soe
rS wok l.~.
PROPERTYOWNER: L.kna Hai Dmiop® SOIL DESCRIPTION REPORT Pape 2 co 3
Horzon Depth Dominantcolor Mottles ShrWre GPM
in. Munseil 0u. Sz Cont. Cole ' eic4re Gr. SL Sh. Roots T
,,.,•3._' 1 0-9 I0YR3/3 I Imsbk mvfr as If .4 .5
2 9-26 10YR4/4 r-----~ I Imsbk mvfr gw Ivf 4 5
Ground
elev 3 26-52 7.5YR4/4 cs osg m] Cw 7 .8
98.8 ft. 4 52.84 I OYR4/4 cs 038 ml - .7 .8
I""n N
I"ng
factor
1 - -
>84- - - - - r
1-7 1
Remarks - - - - - -
4 _I 0.10 IOYR3/3 I Imsbk mvfr as 2f 4 .5
5
2 10-25 IOVR4/4 ----I-- Imsbk mvfr , gw Ivf 4
Ground f- - - -
elev 3 25-$2 7 5YR4/4 gw - ' .8
osg ml 7
- - -
4 9.1 ft. 52 IOYR4/6 CSC osfS ml .7 -8 •
Depth to I
IlmrDn
- -
Iacbr
4h4i.lo_ n l_n jrfLw •~eti
L
RemaAcs: _
5 1 0-111 IOYR313 I Imsbk mvfr as if 4 .5
2 1 ] 23 1OYR414 I Imsbk mvfr gw Ivf 4 .5
- - -
Ground
elev 3 ( 23-51 7.5YR4/4 cg osg ml gw .7 .8
993ft. 4 5 9 I0YR4/4 oa osg m11 .7 .8
Depth to
- -
llli*gmyng - - . - - - - T_
Remarks:
i
Grouts I - -
elev
Depth to I
factor
Remarks - - -
i
N --F 01
r C p b1 (fJ = F O
rl)
J
v ~ ~ ~ t7 L, ~ O
i
r U U
o ~
r t-ki n
t q~
-b
- - ZI
I a
1 ~ ~ o r I
Wscurlsas Department of Commerce PRIVATE SEWAGE SYSTEM y
Safety end Buildings Division Dune
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) fanita,y Permit No:
personal Information you prMce may be used for secondary purposes [Poo 363984
sty Law, 3.15.04 h)(m)).
Permit Hpl ersName: City [I VI age T no: state Plan to No.:
Warner, Jeff star Prairie'Ibwnship
T BM Elev. Insp. BM lev BM escnpnon. Parcel Tax No.:
~cJ 038-1196-40-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark f /6 Z. (00
Do ' Alt. BM j 4 0400
Aeration Bldg. Sewer t
H Ing t Inlet fig. ra", n
TANK SETBACK INFORMATION (2/ Ht outlet
TANKTO P/L WELL BLDG. VAuen" Intake ROAD
Septic *>16 0 ' / a NA
D sing NA Header/Man. L P
41 61 y
Aeration N Dist. Pipe l• rr I~ ay
d". 7Y- PCF-
H g Bolt System rul. r ?-I
PUMP/ SIPHON INFORMATION Final Grade 3. 9
liihamurer mand St cover
Model Numbe G .
TDH t Friction stem TDH
Porcemain Length Did. Dist n
SOIL ABSORPTION SYSTEM t
BED/TRENCH Width, IF? VO of?Trenches PIT No Of Pits (nude D~a Lquid Depth
Menu act e'
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHING •
INFORMATION Type M o N m r.
System: dY~ _ i /
DISTRIBUTION SYSTEM
HeadeNM,an,doTd rl Dntnuvon P,pes •HO CSite .IIOaSDSOng vent oAUmta e
w -0.4 viii Spacing
Length ~ Dla. 7 I Length -
t/A st/
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over I xx Depth Of S"cledrSodded - Mulched
Bed I Trench Center Bed r Trench Edges 11 Topsal ❑ Yes No ❑ ves C) No
COMMENTS: (Include code discrepancies, persons present, etc.)
ImInction # 1: l 1 ~1 od jnsMction #2:
Location: 1336 216th Avenue, New Richmond, W l 54017 (SE IA NW V4 13 T31N R18W) - 1331181028 Pine Acres -Lot
33 l•~f0 t( d YA.~ /
l.) Alt BM Description =40,0 a{ tve
a
2.) Bldg sewer leno /Dr S S r,"SS,d 0^
~ r,. .5 i~6(2Qrr1 0s. 7r~ fhnm-a~✓ tq-r..+
-amount of'cover= > t#4
3 ~•~•bs,:. yr p:~
3~~
Plan 94d ~}j2,a 'trWer
revision requ re 7 ❑ Yes No
Use other side for additional information.
SBD-6710 (R.3"97) Date O Inspecto Ignature Can No.
k ,
-
Wisconsin, Deuattreent of Cornmorce SOIL EVALUATION REPORT Page of
Divisla, of Safely 2"d Buildings
In nccarJar,cc vnlh Conde 05. Wis. AJnr. Code l'uuulY
Attach a>mPlete. site plan a, paper not less Thar, 0 12 x 1 I Inches it, size, Pia,, trust
Include. but nul landed lo: verUcal slid houzunlnl telewnce Pui,n (BM). &oclion and Parcel IQ.
percent slope, scale or cimenslons. lion snow, and lowllon and distance to nearest toad. Reviewed by Cale
please print all bdormafidn.
Pemolol nWmaliwr you pmvde nmy ee oxntl fet shv..Nery pmpWe4 (nri.aCy law, 6 1504 it) 90)
Properly Owner ProPedy Localwn
Gov:. Lot IM A/ ~b4 S /J T 3 / N R / E (or W
Lol P Gluck A Subd. Namo or CSMp
k of
Pro,xny owners Mailing Address
33 - Nearest Road
Vil ~T
Gay Stale Lip Code PUur:e lmnd,et ~JCitY Own LI ~@ z14~'++ V 2✓
.fir °r..~ h' Mar~i~si/v (~sl) ~YB-ovv8
GPD
New Construdlon use; tez Residential I Number of bedwaus Code derived design [low rate _ T4~0
C] Replacement Public a comrllercial - Desuibe~
flood plain elevation if applicable ,J-Il.
Parent maletial
Geraral tonvntt,ls
arid Tewumniteldations:
❑ noting QO 9q/Jy in.
® Boling p / / • ^II. UeDO, to limiting factor in Soil Icaga, Rele
pit Ground surface elev. _ GPDrIP
I extae Structure Consistence Boundary Roots Elipl •EIIe2
Horizon Depth Denia l Color Redox uesuiption u'r. Sz. Sh.
u,. Mansell Ou. Sz. Coral. Color
15
C:2 ed4
3 ~ ,-J w
S !is- O 4~ S~ n-. J S
orln9 In.
❑ Doling a B q, OePU, to IlmiOr,g lacier Shc ApPgeagon Rale
pit Ground surface elev. Gam,
Shudutn Cosistence Boundary RoV1s
Horizon pep0, Dominant Color Redox UesuipUOr, Texture •EIIMt 'EI102
Gr. Sz. Sh.
In. Mansell Ou. Sz. ConL Cola
Effluent 92 : BODE < 30 n)WL and TSS < 30 ni
• Effluent pt • BOO, > 30 < 220 mart. and TSS 4t) < 150 MA CS7 Number
CST (Please Print) L y / Signature , ~aa
d , . K dvJ 'l z N`~ Uate Evalua0a, Ca,Jucled Teleplwne NvrtUer
Address Y7Z- Y1/(~
(o/d a 004, u(1 lN: SYP~C3 7-zc~- o0