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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 605123 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 3127399 Permit Holder's Name: City Village Township Parcel Tax No: David Hallstrom TOWN OF HUDSON 020-1104-00-050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 34.29.19.412D-20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 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 T i3H Ft Forcemain I Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 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 x Hole Size x 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 E] Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 608 WHITE OAK DR 1.). Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ij Yes [Ifl . No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) County y OWED Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) dis , WI 53707-7162 P S f G 01 2018 4 St. Croix u errillt Ap State Transaction Number community ~ / In actor .21(2), Wis. Adm. Code, submission of this form to the app mate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secon ses in accordance with the Privacy Law, s. 15.04 1 m ,Stets. L Application Information - Please Print All Info Property Owner's Name Parcel # ,Ct 9A o ,gOr 1 .VdV (1-5711f-0 ~9 Property Owner's Mailing Address Property Location SLI. 1. --P,4 Le ao C' r~ Govt Lot City State Zip Code Phone Number yy Section s r J j- T9 (circle one) N; R EorW ~ILL Type of Building (check all that apply) Lot # A, or 2 Family Dwelling - Number of Bedroo Subdivision Name 46 Bloc El Public/Commercial -Describe Use ❑ City of eJse_ 10 a ❑ State Owned - Describe Use CSMnNumber ❑ Village of R--- 6. &532T-- of ~ JU I 1 IV III. a (Check only one box on line A..Co pl e B if applicable) A' New Stein ❑ Re lacement S stem y p y ❑ TL.;Tent/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of PORTS System/Component/Device: Check all that apply) ❑ Non-Pressurized ZInId ❑ Pressurized In-Ground Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank Dispersal Component (exp ) D Y" PC ❑ Pretreatment Device (explain) j/ V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Ra dsf) Dispersal Area Re aired (sf) Dispersal Area Proposed System Elevation ,q %f I C) VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c New Tanks Existing Tanks ll w ° U v Septic or Holding Tank Dosing Chamber 060 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) E P o 2 -7 VIII. oun /De artment Use Only A ❑ Perm/it Fee Date sued Issuing ent Signature Approved ppr ❑ er easo Denial $ (0 ~ IX. Cond+116tReasons fn isapproval I,: , tart v fl, y:; $9 3 < <00.tl w. 01 be fint~ e t ~►~tn,`~. ~ pp,.•: a ~r,~ =.n prudded by piwnber. '1 !fltb8i k F s ~tlttaf t nMt rtt.:+t`:E i ell - Attach to complete plans for the system and submit to the County only on paper n than z 11 inches in size Fri , q / 1 40 SBD-6398 (R. 11/11) i~LLSTRQM O 20-11D4-DO-O[3p P~tbE J~ of ~D L o-t 2 SCr►I-a IM= AW ~ = ~~KHoE ~Fttnl~tS - ADM '~~dtW.S 7~ST 1-iftP1LS '~RLJJ(;s aL gV7?T f2~ NORT&I poopegrre j.,,, i3~;~vc~t t (s;r*Keo 13Y owwwr4i "N' a'efcS1M M' 4C }2S Foci -tea e~5 W +y ¢ Zu~t 5T t~ Zle LS S c "i4. ~A i~ thm~ rim Jaa- /30 _ SLQPE h7~3r' ~S~ t , 11Y $+Ch *2= j Y !05 it masts csr y S- ' ~ e - 5 `+~RS ~OC~ aD LOT COR+3EiZ, SR -72- VS j I #a yi'oy~D w CLor -5-) LoT Coi *p, s ~oEenxTn,FN DIVISION OF INDUSTRY SERVICES T 0~5~ °s 2331 SAN LUIS PL STE 150 U GREEN BAY WI 54304-5211 3 i S p Contact Through Relay http://dsps.wi.gov/programs/industry-services y~ $ U www.wisconsin.gov A ~O~'ssvoyA~S~ Scott Walker, Governor Laura Gutierrez, Secretary July 23, 2018 CUST ID No. 224832 ATTN: POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 28497 KING ARTHURS 1101 CARMICHAEL RD DANBURY WI 54830 HUDSON WI 54016-7708x,7 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/23/2020 Identification Numbers Transaction ID No. 3127399 SITE: Site ID No. 851293 Please refer to both identification numbers, David Hallstrom above, in all correspondence with the agency. White Oak Dr Town of Hudson St Croix County SWI/4, SWIA, S34, T29N, R19W FOR: Description: GeoMat Mound Q Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object ID No.: 1785755 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6, GeoMat Mound Component Manual (Edition 1, 2017), (N. 4/17); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area • Divert surface water from POWTS Area. • Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sample between the hands If it rolls into a 1/4 inch wire the site is too wet to prepare If it crumbles site reparation can proceed If the site is too wet to prepare do not proceed until it dries. MARY JO HUPPERT Page 2 7/23/2018 • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 r/~~rr ~~1eo~ This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services W SMART code: 7633 (608)516-6134, Mon- Fri, 6:00 a.m. - 3:30 p.m. tim.vanderleest@wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. Keith Harings , Advanced Septic Installation (Plans Mailed To) 6"Q MUM AUF Residential Application INDEX AND TITLE PAGE Project Name: DAVID L. HALLSTROM Owner's Name: (SAME) Owner's Address: 620 GILBERT ROAD HUDSON, WI 54016 Property Address: 608 WHITE OAK DRIVE Legal Description: SW SW S 34 T 29 N R 19 W Township HUDSON County: ST. CROIX Subdivision Name: NA Lot Number: 2 Block Number: NA CSM#: 22-5312 Parcel I.D. Number: 020 - 1104 - 00 - 050 Plan Transaction No.: n e1r a s Page 1 Index and title Page 9 Tank cross sections Page 2 Data entry Page 10 Plot plan Page 3 GeoMat mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifiqqirjgns 'wit MARY JO H License Number. 1859-007 Date: 06/15/18 ' •r°• • e ' Phone Number: 715-426-1775 Signature: Designer Stamp: * 9 g 'State of Wisconsin Approval Stamp: .f RWM 4D, "'°~~SIGN Desig'ff9d u1rsuant to the Synergy Systems L.L.C., GeoMat Mound Component Manual (Edition 1, 2017), (N. 4/17), SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) RECEIVED GeoMat Mound Edition 1, 2017 JUN 18 2018 Page 1 of 10 INDUSTRY SERVICES and Design Worksheet t1 I.00 Residential or Commercial Design ISD Required? Estimated Wastewater Flow (gpd) Peaking Factor (e.g. 1.5 = 150%) Design Flow (gpd) Site Slope Installation Contour Line Elevation (ft) Depth to Limiting Factor (in) In-situ Soil Application Rate (gpd/ft2) Contour Length Available (ft) MUt#Mffdh @ (7Tt>1 Ci11 Cell Width (ft) 3.25, 6.5 or 9.75 Only 45.00 Designer Input Cell Length (ft) Dispersal Cell Design Loading Rate (gpd/ft2) 45.00 Dispersal Cell Length Required (ft) 2 Influent Wastewater Quality (1 or 2) fEiS311 a . ~ . E Center or End Manifold Are the laterals the highest point 2 Number of Laterals in the distribution Y 3.25 Lateral Spacing (ft) network? 4.89 Forcemain Drainback (gal) If N above, enter the elevation (ft) 0.50 Forcemain Filter Loss (ft) of the highest point. 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Inside Pump Tank Elevation (ft) 0.156 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.65 ft /orifice 4.55 System Head (ft) x 1.3 11.46 Vertical Lift (ft) 0.38 Friction Loss (ft) 16.89 Total Dynamic Head (ft) 40.46 5x Void Volume (gat) 45.36 Minimum Dose Volume (gal) 23.69 System Demand (gpm) am er _ - ain . , . Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Treatment Tank Information Effluent Filter Information 1060.00 Septic Tank Capacity (gal) Lifetime Filter LLC Filter Manufacturer INFILTRATOR Manufacturer LT 1/16 Filter Model Number Dose Tank Information Gallonslinch Calculator (optional) 475.00 Dose Tank Capacity (gal) Total Tank Capacity (gal) Dose Tank Volume (gal/in) Total Working Liquid Depth (in) INFILTRATOR Manufacturer gal/in (enter result in cell DoseTankVolume) Project: DAVID L. HALLSTROM Page 2 of 10 Mound Plan View T . • • • • • • • • • 3 J 1/10 B Observation Pipe Q . . a~rs° :r= :r: :r: :r: :r:r. :r• :r•r• W B 0. • L outs . omponen# mens ons A 6.50 ft E 9.36 in H 1.00 ft K A21.93 ft 45.00 ft F 14.50 in 1 11.66 ft L ft tD 0.00 in G 0.50 ft J 3.77 ft W ft 292.50 (ft2) Dispersal Cell Area 817.38 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement OU i: t`OSS 8 Ott @W GeoMat Dispersal Area Observation Pipe 12" ASTM C 33 sand as GeoMat required for Geo Mat Distribution Cell GeoMat + 12" ASTM C-33 sand component t. 105.26 Finish Grade Cover Material 104.13 Lateral Invert Elevation 103.05 Dispersal Cell f ` Slope 12.0 Elevation Contour Elevation 103.05 Tilled Area Forcemain In situ soil In situ soil s ey 1 0 Topsoil Cap 2 Q Subsoil Cap 3 17, ASTM C 33 sand (F) 4 ASTM C 33 sand (D) 5 Tilled Layer 6" Geo Mat See details on page 4 for number, size, and spacing of laterals. Project: DAVID L. HALLSTROM Page 3 of 10 Lffiid- Connecftn Later~I Laro-t F~o~rittc-es~ -up w valve of cteanou plug Ist orifice located at Z Z int dow n 3E P tatetals main of PVC Sclh pef SPS T 3 .30-51 7:Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 44.55 ft Orifices per Lateral 22 Lateral End (Z) 0.45 ft Orifice Density 6.65 ft2/orifice Lateral Spacing (S) 3.25 ft Manifold Length 3.25 ft Lateral Flow Rate 11.85 gpm Manifold Diameter 1.50 in System Flow Rate 23.69 gpm Forcemain Velocity 2.42 ft/sec Locking cover with warning laM. locking device and water tight seal Electrical K.. Vented Cnvcr as per sJFC 300 and SPS 316.28 %-C l - Fini~hed Grade lliscoru>ect~ i "Clean out Pipe j - - Optional ball v111ve / to control spefd of Wires From Eleelric source , k_ effluent o dosed tSim Optionalnutlet Forcemain diameter oca 2 In. 4" A'S l o5s Stop Boss and water tight gasket olidg-u.d Funlco /Tech Filter STF 100 1/16 tIIigh water alarm, ^i to ~,I 3 t Pump On Float c ~ I v1 Pump Off Hoat• F- Pump off elevation (ft) ( Pump E-• I 92.67 31-k Dose tank elevation (ft) k3edd= i under tan • ' 92.00 Dimension Inches Gallons INFILTRATOR A Zed32 90 •328-64 3,37 Capacity 475.00 B 2.00 28.90 Zy Volume 448:SA gal/inch 6P-E ~ C r" ■#5- 4, 1 D 8.00 8B s0 55, Total -42.68 475.00 ZN- Fitter Manufacturer Sim / Tech Fitter Filter Model Number STF 100 1/16 Alarm Manufacturer SJE RHOBUS Alarm Model Number AB TANK ALERT Pump Manufacturer ZOELLER Pump Model Number 98 Pump Must Deliver 2169 gpm at 16.89 ft TDH Note: Switches containing mercury may not be used in this system. Project: DAVID L. HALLSTROM Page 4 of 10 GeoMat Distribution con is t 6.50 Cell Width (ft) 1.63 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements ~oooooooo`ooooooooaooo 000000(-)00000000000000 o-0-0_00.0.00.0.0.0;~00ooooon~~~~c~~~n ft 0 Distribution Pipe With Pressure Lateral L-._J Orifice Shield Tumup Enclosure - - - - - Pressure Lateral GeoMat is covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.50 Cell Width - A (ft) 45.00 Cell Length - B (ft) End Connection Lateral Layout Diagram 0000 1 'D oo~~o'b°or5o~o°obQOb~~o$oboo$~UOdob°oo$~ob~b~o 0 0000000000000000000000000000000 O O O O O C 0000000000000_000.00oo_aoo_U_Uo_,o_000000000 Sand C- recommended Distribution Lateral Orifice Shield Pipe Dia. Approved Infiltratve Fabric i "{12'ltSTM 33 Bird, - _ G-Mlt Component . Infihrah- Surface/Plow Layer r 1 Q Topsoil Cap Toilet Flange ti ZSubsoil Cap laebar 3 ASTM C 33 sand (F) 4 Q ASTM C 33 sand (D) Min 1.... 1 5 Tilled layer Mn 6 Q Geo Mat *MCIAxxiLIARj + 1;n>sas~ See details on page 4 for number, size, and spacing of laterals. Project: DAVID L. HALLSTROM Page 5 of 10 M nd tl afi ln~rnr SM Service Provider's Name ULBRICHT PUMPING Phone 715-703-8337 POWTS Regulator's Name St Croix County SPIA - Zoning Office Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 30 mg/L Septic Tank Capacity 1060 gal Maximum TSS 30 mg/L Soil Absorption Component Size 292.5 f:2 Maximum FOG 10 mg/L Type of Wastewater Domestic Maximum Fecal Coliform 10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean as necessary at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test periodical) Pressure System Laterals should be flushed and pressure tested eve 3 years Mound Inspect for pondin and seepage once eve 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the Synergy Systems GeoMat Mound Component Manual Version 1, 2017. 2. Dispersal cell media conforms to GeoMat products approved for use with the Synergy Systems GeoMat Mound Component Manual Version 1, 2017. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail O n n nn n O_O O UAI O c6-8"Diameter aoooaaoo oGOo 0 0, o 0 0 0 o cFinished J o0o 0 0° Threaded Cleanout C > O O O U G O O a 0 0 0 0- °c Lawn Sprinkler ° ° <Grade °Ga°"Ga Plug or Ball Valve oaGO , Gca C ) O 0 0 0 0 O G O OBOX )000 ovoo oo 00 G U v 0 0 0 0 0 O G 0 0 0 0 0 U O 000 G C~ OOi?"00 0000 O 0GG 0000 O.. 000 D O o Lateral Ends at Last Orifice Where 0-0-0 V V V V V V V V V v c~~O°000°0 °000° o_oooooooGO o000oooooaoD Long Sweep 90 or Two U U O O O O O CO) O O G G O G O Q O O O G O 000000000000 oooooGOOao 45 Degree Bends Same a ooooo"G,000CiGOaooooo000 ooo°o~o°oGGO°ono°o°o°o°o°o°oooo°oc)o°oGOZJO°o Diameter as Lateral a°OOOOC?OOOOGOO°00000000©000G000000000pUC3aG0 O O D D D O 0 0 O~O v 0 0 0 0 a000n 000 00 GCi Ci O C O 0'V"O C7 O O G G G O G O 0000,00 ) O ~ ~ 00 0.G 0' O.a O-O O O`O 0 ~~O G 0 i~ a OUO0V0000°000°OpO00p0°CtOpO00npGO0pap°pp O°O°O°000aa°0000.0 C) (3-C,n4~00000° 101 Distribution Lateral Lateral Cleanout 1.4 Feet Project: DAVID L. HALLSTROM Page 6 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (Synergy Systems L.L.C., Geomat Mound Component Manual version 1, 2017, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) and SSWMP Publication 9.6 (01181)] and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm_ Code_ The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Puma Tank The dosing (pump) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOOS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: DAVID L. HALLSTROM Page 7 of 10 ( HEAD CAPACITY CURVE DEL 'W 4 5/8 8 23-F III 35/8 = s 20- w M-2 q T1 Of 4 15 4 s to- 2- 3/16 e 1 1/2-11 1/2 WT 0 tLS. GALLONS to 20 so 4o so 60 7tt ao 0 a0 160 240 FtM PER Loan moo& so fie CYCLE Feet Caeotm Lif@wm La. 5 72 IS 213 to as 3.1 231 1s 45 4A na 12 zo as as ss tads w.c zr seem 43/16 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alterrialors. for duplex syshwss, are available and - variable level float w&tdm are available for conhof V sk*e supplied Witt an alarm and three phase SYSIMM Mechanical afternalors. for duplex sVshw .S. are available - Double piggyback variable level float swilcties are ava1abie vMh or waltou t alarm w&*c ie3_ for variable level long cycle =*olS_ SELECTION GUIDE Standard all models -Wei it 39 lbs. -'/z H.P. 1. tl~e9 tloatgpsw d2°°tsna atsrrI'l noez natco~otnqusad. 2 Shot pbgditadt %wW* kvd Goat strict) ardatble piggytl®dt )ra1te61e Irwi. sesarks; Cootroi Babes= 900 sttIcA IUWlb1:&*477. Modal Yatf-PA Made 3. Maggnieaf aNerrrelor 1040072 or 100075. AM 115 1 Auto 9.4 t or 1 R 7 4L Sm Rt MZ farcorraet modal of EledncaL ANenudor. N98 115 1 Him 4 2 or2 36 3 ar4 d.5 5. Co1M1o(att0 1 104¢25 used as a eared meta specib duplex (3) or (4) 09a 290 1 Arta 4.7 r ort d.7 - GaatsySwM 12913 230 1 Pion 47 2a2d.6 3or48~5 6_ Fa(4)~~bMfwa crtdmpiear duO-aPeraGou 1104M 7. Tyo(2)habJPak,forureisdWtcmmcbmorsomm CAUTiOM ForNOMafoeaaaddOmdaodorpmdKbmfrbcd&goaPbWbw*lfai in LowlSwllhes, All installation of controls, protection devices and timing should be done by a qualified H10M PitOleQibdarioaill m=IKfllM8ur#&rtagef!)shs,Fll0t01": rtceused etedridan. AN electrical and safety codes shattd be followed Inclu ft the most Bogle MwseSnipletparrpW tb ffA= CAam &pft A ROM recent National Electric Code (NEC) and the Otxupationaf Safety and Health Act (OSHA). RESERVE POWERED DF-SiG N For umnual condibm a reserve safety lac kIr is engineered info the design of every Zoeher pufnp. Mill. 70: P.Q a01f Mla j. -La& gl(Y.4SMIT . Yeefms,aad.. 1(7+3101 PfJiP - a 4Gtf1-1981 MP rap t~l~x~nt~az+ ha" P!! r-1A t_I_s )9 Q M ~ ~Au l0 ~ /9 t o+ lv IM-540 General Specifications and Illustrations A Ar The IM-540 is an injection molded two piece mid-seam plastic tank. The IM-540 injection molded plastic design ° allows for a mid-seam joint that has precise dimensions e1_7 for accepting an engineered EPDM gasket, infiitrator's ° gasket design utilizes technology to deliver from the water industry proven means of maintaining a watertight seal. The two-piece design Is permanently fastened using a series of non-corrosive plastic alignment dowels and locking seam clips. The IM-540 is assembled and sold 64.9 [1,W] EXTERIOR LIFTING sraAP INLET NECTION through a network of certified infiltrator distributors. CON TOP MEW i lTrai Must be backfilled and Installed in accordance with INLET CONNECTION Infiltrator Water Technologies, Infiltrator IM-Series Septic mmrPi Tank General Installation Instructions and for shallow ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance, 54.13 11,3871 Please visit www.infiftMorwater.comAmages/pdf/ EIGH IXTERIOR ManuaisGuldesNANK01. pdf for the latest information. ,I Total Capacity 552 gal (2090 Q END VIEW Length 64.9" (1648 mm) 2116101 M n. AOCEW OPENING 14TH LOCO M LID Width 61.7"(1567 mm) / Height 54.6"(1387 mm) ' Maximum Burial Depth 48"(1219 mm) Minimum Burial Depth 6" (152 mm) Maximum Pipe Diameter 4" (100 mm) V%ght 169 ibs (77 kg) SECTION A-A' CONf1NUM GASKET TANKTOP HALF SEAM CUP TANK INTERIOR ALIGNMENT DOWEL TANKBOffOM 4 6lxktess Park Road HALF P.O. Box Ise MID-HE16NT SEAM Old Saybrook, CT 06475 SECTION DETAIL ! 960-577-7000 - Fax 86x577-7001 INFILTRATOR* 6 1-800-M-4436 www.Ir318t W0rwater c0IM US. Patents: 4,759,651; 5,017,041; 5.156,465: 5,336,017: 5,401,116; 5,401,459; 5,511,903;,%716,1163; 5,5 ,778; 5,839,844 Caned m Patents 1,329.859; 2,004,564 Other patella pending, k r. Emiabar . Quick4. and SidelNMer we MW A is a regstered tradem"rk in Franca. Infiltrator Water Tedvwkgee is a registered trademark to Mmdeo. Cat= PdYT~' Chkttt Qtlidc lky, Dwo ock aKi Straighttodt are tradernatke of kaftafar Water TednologIes. Potyl ok is a trademark of Pdyt ok, kv- TUF-TITE is a registered trademark of TUF-T1TE, INC. Ultra-Rib is a trademark ofiPE.x Inc. 62013 trgKrae"r wam"rradv,dgkaa, t.L.O. Aa.fyp,is,a,,,,,,d. Printed ti 0.5.0. • • • IM11 1116 9, OPi~) IM-1060 Oral Spedffcaftw and IllusfratiOn LIFTING STW LIFTING UM IRISIMCONNSCIM (4TOOW UYW- Q The IM-1060 is an injection molded two piece mill-searn Plastic tank. The IM-1060 injection nV*Jed plastic design allows for a mid-seam joint that has precise dimensions A A for accepting an engineered EPDM gasket Infiltrator's O% °o gasket design utilizes technology from the water industry B 622 to deliver proven means of maintaining a watertight sew. ° %0 11" EXTEF" The two-piece design is Perrnanentiy fastened using a series of non-comrsive plastic alignment dowels and locking seam clips, The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. 727A13126!©CiHtlOa tENGTfi Must be backfilled and installed in accordance with 70P VIEW Infiltrator Water Technologies, infiltrator IM-Series Sept Tank General lnstaliation Instructions and for shallow O"n"- ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. c Please visit www.infdb-atorwatercom/imagestpdf/ n FEF" ManualsGuidw/TANKOI4xif for the latest inforno ion, SEAM CLIP r ,T %G ur~av~ sraar 'Capacity 1094 gal {4141 L) (TYpICAI) ac ity 1287 gal (4872 L) END V EW FToot Airspace 16.5% Length 127"(3226 mm) 024 t6101 ACCESS OPENNGSWUH LOCKING LDS (2) INUF1EE X0.2 WM FREEMM 04,7021PVCOR Wdh 62.2" (t58mm) AMOUMETTU Length-to-Width Ratio 2.3 to t seer , M otmET Height 54.7"(1389 mm) va a SPACE Liquid Level 44" (1118 mm) L Wa1QLAS j 4" Invert Drop 3" (76 mm) SUPPORTS s u s 2 wrm sAffilE Fiberglass Supports i wAUw~E kEtlwiao Compartments 1 or2 Maximum Burial Depth 48"(1219 mm) SIII!E h~ Minimum Burial Depth 8" (152 mm) Maximum =VVekjht Pipe Diameter 6"(152 mm) O 320 kas (145 kg) THA~LFP IENrLWUs TANK INTERIOR SEAM CLIP ALIGNMENT DOWEL TANK BOTTOM 4 Br/*xm Park Road HALF P.O. Box 768 Old Saybrook CT 06475 INFILTRATOR' 81-8~r ~ -4436 w-577-7001 NM)-HBM S SEMM www.inflibakmw*mw.com U.S. Paw is 4.759.661; 5.017,041; 5.156,488; 5,336.017; 5,401.116; 5,401,459; 5.511,903; 5.716,163; 5.588.776; 5.BM.844 camdian Pawts 1,329,959; 2,004.564 A8kWd+ k . Quiok4, and SideWaxW are registered tradamaks of k Rbator Water Tedrabgiea, kAWtor is a registered trademark In France. k*kakor Water Tednobgies i8 a registered vademmk b K4"= GOf1101y, 9• Willi 1511mpacer. Batt, Poscock, QLk*LLL GhridtPtay, &VVLndc and 9Uaghtl ogc are ltadenum of kakabr YVma Tearm"IeS. P*Lok IS a badsTa rk of P*Lok, krc. TUF-TrrE is a rago red twi mmk of Ti1F-Tn INC. Lfta ft is a tredemmic of IPDt kr- ® 2016 k traWr Waiw Tednabgies, LLr- A® rights reserved. PmAed in U.SA lam rMal "M 1116 • i~a v a 2.o.-,1 oq- oo-coo t o~ 2 Sta1I-6 low A4& ~ ca*~TOU+R~ a ' i3~,e.KH~ Saat~brs - ~M p~►,aus ~sT hlANn 4~Ra~3C s * 0 b . ae. 13Ea ff~~ri (sz*,ceA av o►~K ".tSiM i7II5 .4C 2-?AI. 47 AjeW jurALI tor, per e t Q~• WELL TOM F }25'r-Kom -f'AA3tKs + ° ~yVDCDS~ >-,5v" F9" n cwty / . F z"gsw b u. V S SG+t. sY .T.Gµ / f$ f20/0 1 WAY A 1 RCtduil Still s ~ Fauns as s LOT CORER , .a2.1 s Ft~tN~ r Lo-r 3g ioT coe~nitR ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buyer i helef /~l /w ~0 q7) 0 ~ - E~.6&' Mailing Address S0 k 4. Property Address 6 J (Verification required from Planning & Zoning Department for new c instruction.) City/State Parcel Identification Number (-)r~ -116 y' -0 Sy LEGAL DESCRIPTION q Property Location ~'/e , 50'/4 , Sec., T ~ l N R~W, Town of Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 13yesono Lot lines identifiable ❑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 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 tank is less than 1/3 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. I/we certify that all statements on this 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 wart ty deed recorded in Register of Deeds Office. Number of bedr oms 1Ltv4,-g7- SIGN RE 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) Parcel 020-1104-00-050 04/07/2008 04:14 PM PAGE 1 OF 1 Alt. Parcel 34.29.19.412D-20 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/17/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HALLSTROM, DAVID L DAVID L HALLSTROM 620 GILBERT RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 608 WHITE OAK DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.010 Plat: 5312-CSM 22-5312 020-06 SEC 34 T29N R1 9W PT SW SW CSM 22-5312 Block/Condo Bldg: LOT 02 LOT 2 (2.01 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11/17/2006 839004 22/5312 CSM 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/05/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 69,100 0 69,100 NO I Totals for 2008: General Property 2.010 69,100 0 69,100 Woodland 0.000 0 0 Totals for 2007: General Property 2.010 69,100 0 69,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 All, L-.6Z I \I I ] t Q W W o z ~ - p~F- - w o Z ig z ~ ~o F W p O 1 w - sml J= ` LLJ ZaQ~ '/Wp 5 W Om RUM III - - ' III - III e III oll AaaNnvi III Q 1 111 I O ~ ~.-~r ali z Q m- m v A\~ iV A V~~Vv :9 'L NI11IN6 - , •.~0'.6 ~ 0 ,OZ~,. o-.b IV ~ \ I 4 \ 1t \~I I 1 1 I ~ iiiNI9V0 C z •,A81NNd \ 0 N W N N z rr t ~ ~ 1L i u zPo L of off NA V X oz" o 4 W 4 • ~ U cox-x~ caa~ cam- m If g 4'-0" 9518•• 29'_9" 95/e" }r-~-12 51/2 - ~i ~ l 1 1 ~ LL _ c ti- 3 W = m Vl mAD xS C~ MM P~ 3) Wisconsin Department of Commerce SOIL EU U1 "ALT Pa 1 of 3 Division of Safety and in accordance with Comm 85. Wis. Adm. Code Attacil oolnplete site plan on paper not less than 6101 x 11 inches in size. Plan must C"Ity inckxle. but not limited to: vertical and horizontal reference point (BMj direction and Parcel I.D. percent slope. scale or dimensions, north arrow. and location and distance to nearest road. O 2 O - 1 / O'S4 - 00& Please print BY Mormatfon. by Date Persona( hdornw - You provhb may be use • a 5.04 (1) (m)). /Z /z 2/.0:5 ProperlyOwner P"edyLocfion S/,t/ DAVE H A L-L5TRO M Lot 5 E 1/4 V S &T N R 19 E(or V) -A )nnt Properly Owner's Mailing Address # Block # bd. Name or X 20 3s2'r R D 3 q1 2 IS 2d -v State Peupli- COQ Y9age n IT MR, OTow Nearest Road 74 vDSo~/ V,, ~~f ole ( o Y W, IT)s A G i I be rt 1244 f2 New ConshucGan Use: j8 Residential / Nwrdw of bedrooms 4 - Jt- derived desic)n flow rate (o UO - 750 GPD ❑ Rglacemerd ❑ PcMc, or commercial - Descrloe: Parent maternal Flood Plain elevation if applicable N / A ft General corm erft and w Q © Pit Ground scrface elm 99- oo it Depth to runfng tad O 98 Vin' Sol Role Fbr¢orr Depth Dominant Redox Descripfion Texture StrucU a Consistence Boundary Roots GPD1 f In. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Efi#2 0 -13 p 4'R 3/. - Q 2 m b K m-f r- 5 3 rn FS Z 13 20 I 0-Y P. "f/4 - y y S I M bK M-fr 0-5 3 of 3 32 1 uqR 416 ):5 p s m I a 5 2vf 1 ~lO 32-98 IUYA514 S O s I - - I F21 Bourg # ❑9 o L/ Pit Ground suface elev. / 27 & Depth to rnnft lac for ' 30 IrL Aafmlion Pwm Depth Dominant Cola Redox Soo .Rate Description Texture Stnich" Consistence Boundary Roots GPOW In. Munsell Qu. Sm Cont. Cdor Gr. Sz. Sh. 'EGfF1 'EfT#2 2- 15 11)`+R21r - Im 6K mfg Cs 3 m 2 z5 30 IV YR`I'13 - S I 2" b K rn -h S 3v-F 3 ?0- 4 ►UY~`fl~} 2- Stye 5/ Si ( 2- f bK nnfi C S 2 $ 'Y 42"lao U k rIZ4•l (0 2 SYR-- 1 2--f b K M-H ✓f '4 : (o i luertt #1= BOD > 30 <220 mglL and TSS >30:5 15o nv& ' Objet #2 = 80D.:5 30 Mq L and TSS `30 mglL CST Nana (Please Print} _ Sigoahre CST Number J A) /J k' u L e Q-i c-" T " AA)Ai~ 993.5- Address 28 /2 I C T'* S Date Evah~an Conducted Tekq*wm Number J- e, rJ L~ V -,kt,LCY, L.1 I A E C 2 0 -r-w , z.oe S-' (-115) 772.341-1-Z Property Owner y 4- LL S T RO M Parcel ID # O 2.0 O `f - o d - 00 o Page Z of ~j ❑ ❑ Bonng 1-11, # 3 © Pit Ground surface elev. 'q3-33 ft. Depth to limiting factor `I 3 in. Sod Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Mtnsell Qu. Sz. Cont Color Gr. Sz. Sh. -M1 'Eif#2 l 0.22. f o YR'/, Q 2 rA b K s 3 . f 2 22-`13 Io yR "13 - 1 / m bK Yv1-f r S v4 7 3 43- I0YR'`/Ilp r»3 5YR `tl~ 5 1 D m mF-r' _ ~,t/f ~.o # Boring ❑ Pit Ground surface elev. ft. Depth to fanning factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struc h" Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Bond # ❑ Boang ❑ Pit Ground surface elev. ft. Depth to 9 factor in. Sod Application Rate Horizon Depth Dominant Color: Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '01#2 Effluent #1 = SODS > 30 220 rngIL and TSS >30 < 150 nV& ' Effluent #2 = BODS 130 mg& and TSS < 3o rng& 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. seaaswOL&W) Property Clymer y 4- LL 5 T ROA j Parcel ID # 02-0 - O - 00 - 00c, Page Z of t Boring #Elt Boring tt 11 ER1 Pit Ground surface elev. '13-33 ft. Depth to limiting factor 't 3 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in Munsell Qu. SZ Cont. Color Gr. Sz. Sh- O 22 o YrR Z/i - e 2 M 6K TAT Z 22- `6 10 yR'4l3 5 m 3 43- `75 rR f,,,3 5 / O m [ { Boring # 0 Boring ff__Jj 11 Pit Ground surface elev. ft. Depth to limiting factor in. Horizon D th Soil tication Rate ep Doriurrarit Color Redox Des Pion Texture Structure Consistence Boundary Roots GPDff Gr. S, L-- Jh. "Eff#1 .'Eft#2 Boring,0r Boring IJ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color SOtI Rate Redox Description. Texture Structure Consistence Boundary Roots GPDM m- Munsefl OM Sz. C;ont Color Gr. Sz. Sh. `Efr#l 'Eff#2 Effluent #'i = BOD$ > 30 < 220 MY- and TSS -30 < 150 mg& ' Effluent #2 = BODS, < 30 nrgtL and TSS < 30 mg& rile 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_ sgnaaaonc~roor (33= 93.33 ( C~ L S IEZ-r R D m ry M ~ 4 NOR ~ y ~RO~VI.T+r LINE o` 0• ap C BMz. = 99.E S2' 30' IZ°/d f33 ~1 bh~~ 9b' PouoD 61 8M~# I = !bo.00 SvR~EYVR$ 5S' LOT C0Rf4EtR- 5 / 2-1' -72. 5r3' 3ti-.ep, I►b•2o' Fovt,►p Lo-r > Lo-r 3 LOT CORt~tf~ Z•d')b =7,9 0p.6 6 = S17Cvi~Jo9 .3oH?~~~f8 ~ ~ A g -L-3 S d = .z/~ ~ T~bw w~rag = ~ Z Lo-7 000- 00 -f70 it -OZ 0 W 0?l S 77 ty Wisconsin Department of Safety and Professional Services Division of Industry &,,ervce ~SOIL EVALUATION REPORT Page I of ~C in accordance with SPS 383, Wis. Adm. Code County ST. CROIX Atta compf t~ t inches in size. Plan must inclu e, but n ~fl ih risszontal than 8 1/2 x 1 reference 1 point (BM), direction and Panel I. 02 11 00-050 per nt slopes ort arrow, and location and distance to nearest road. Com+rut, all information. Revie d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location DAVID L. HALLSTROM Govt. Lot SW 1/4 S 1/4 S l 4 T 29 N R 19 EE((or) W Property Owner's Mailing Address Lot # Block # Subd. Name M# 620 Gilbert Road 2 V22, P5312 City State Zip Code Phone Number []City [:]Village ■ Town Nearest Road Hudson, WI 54016 ( 715 ) 386 - 9866 Hudson White Oak Drive 0 New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD © Replacement Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable NA ft. General comments Mound System 1.0 ft. sand fill 0.6 loading rate GeoMat System and recommendations: ,g Additional borings conducted to verify soils. A (,Oy WtMe OAK em% Ong # l2.i Boring Q Pit Ground surface elev. 105.00 ft. Depth to limiting factor 24 . in. 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 1 0-10 7.5YR2.5/2 sl 2fsbk ds 0.6 1.0 2 10-24 7.5YR3/3 - sl 2f-msbk mvfr 0.6 1.0 3 24-30 7.5YR3/4 ftf7.5YR4/6 scl Om mfr - 0.0 0.0 Horizon 3 is almost saturated. -T- F-1 2 Boring F rl Boring # 0 na 24 Pit Ground surface elev. ft. Depth to limiting factor in. mil, App lication Rite 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 0-12 7.5YR2.5/2 - sl 2fsbk ds 0.6 1.0 2 12-24 7 5YR3/4 sl 2f-msbk mvfr 0.6 1.0 3 24-32 7.5YR3/4 ftf7.5YR4/6 scl Om mfr 0.0 0.0 Horizon 3 is almost saturated. * Effluent #1 = BODS > 30:S 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg& and TSS < 30 mg/L CST Name (Please Print) SM~9LDate CST Number MARY JO HUPPERT Hollister's Soil Testin &Desn 224832 Address Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 06 - 07, 2018 715-426-1775 SBD-8330 (807/13) I h RLLSTROAA 020-11 o4-00 -OOP I0A676 oP L Z SCA"C I+= 40• AN, ° Co'1T°u4S 11 BAcKHOE 8C4Z1a4S . F/CcM fp,6jlCUS TEST I • HANG Fl.K1N(G s (CTIL8e-rt-F r2p~ v~ NORTH PaoPEItTY LINE \ ~ ~O' R'~iFG~E:D 2 I~cnRLCAI~ ('>TAKFD by GKAID 1 274.47 87 _ _ . 30• 1 W CY.O~i 68 \ 12°~° As u u6p /OO CD AOL ~_I . srTl~ IH r ISM 71 L= Iµ D' FOUJ aOiApJ 3URFA ~ ~ FBVCE flew- (),A I SyR3wRS Boa ' LoT COPAek SOL 2-1, 72.93' ! 111..20' 34.b. FOI/Nb L crr 'S LOT 3 j Lot tORtJeR