HomeMy WebLinkAbout006-1083-70-000
~;,raccnsir ❑cpartnro rl of COmmC'ce PRIVATE SEWAGE SYSTEM Gerry St. Croix
safety inc So 1-9 Dwoion
INSPECTION REPORT San Jary Pe•ma No
(ATTACH 10 PERMIT) 600367
GENERAL INFORMATION Slate Parr Di
Perna ne n'c-ma:ion you aicvde may be used fur secunda'y ourocses'~m:pCi Lsx. s 1 C4 it )inn it
Pem1n He 9ers Name C¢v Village Tennsh p Pa,:A Tax N.
Scott Ellevold TOWN OF CYLON 006-1083-70-000
CST P.Y. Flew Insp BM Ell B1.! Descripl of? ^ • , , e v.? Sec:rn,Te•ixr* Rsnr_c; Map NO
1(
lCh/ A` t 36.31.16.557
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
s~ S
Septic I,~er Benchmark Z-(~ /dt•
Dosing / I / Alt BM
(~.~.a. b .i r0 UQ i .tl~• z - ~t/ 9 Q' 7pT
i (n a ak- Szs - Bldg. Sewer 12- 9!r 919
Holding 1 Sli Inlet 124 8 9d A
TANK SETBACK INFORMATION SVHt Outlet
\
TANK TO P+L WELL BLDG. m't Au htaRe ROAD Dt Inlet
Septic 7 /all 7 41 Z'7 - DI Brllom K• 9 . `7
Dosing 7 /&J r 7dM6' Z y 1 HeaderAllan. s(J 715. 0'5
Aeration Dist Pipe l r 71 97-%(
Holding Bol. System 57.79 9 G •41
piq J
O 3 Z
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand y. St Cover /
D.l~ 5 GPPA j u Lo Z •B4 97. 7
Model Number j~
VVV
TDH Lif` Fricfion o System Head I,A IUII y
r r ^JA ✓
Fusco n Len th ! Dla Dill roN;ell
SOIL ABSORPTION SYSTEM !P•'F i fy laZ. S
BED-TRENCH V1 Rh Lenyll v~.. Cl t -one .ps PIT DIMENSIONS No Of RIs Inside Dia LIUwd Uvp:O
DIMENSIONS Z_ I fe'A..il 1
SETBACK SYSI FPA TO PL BLDG WELL LAKEiSTREANI LEACHING tdpruiacture( INFORMATION T^ O' S7s:c^' CHAMBER OR Z haw
iFC -7 /)A- UNIT A!ncel Nr.^r:
O
DISTRIBUTION SYSTEM 47TIL-7
1,111' y t Dis:nbu'icn x Hole Size v Hole 5p=ng VC•I}t toA fInlake a ^
persl, • -'S
ILcrgth 4K Uia Lengln ED ~ Spuru-,7 ~ /l!O l~ e.H
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only d I~5 !v i-~.
DepAh Oo-,er Lir_p'n D';er xx LbpIP Of xx usudc:i SaS tled r. Mulched
fi~a0;laanrh Ce¢e' .2 6edr.c...4n E'CY.s T'I No
Nu
COMMENTS: IlnUbtle code discrepancies persons present. may Inspection n1. Inspection a2.
Location: 2511 H44h' 63164 r
Fl~v. CaJ~ (..~w.~5a- 1-•a~~ a.~
1.1 Alt BM Description =
2.i Bldg sewer lenglh =
- amount of cover = n
g O t' LOJ<.`
Plan revision Required? Yes .p<N Q
'
Use o;ner side for adcitional information. O _t7
Date - _ - (Q v I~
Irsea:^tor• Signal Ce,t No
SI4D tyf 0 IR 3 ;5'1
- S/` /V -,~Ou - 0,/ 7
tA~-I _-7 mp
rd/, t -Safely and Buildings Division co ST Croix
^ 201 W. Washington Ave., P.O. Box 7162 S
F` D 4 Madison. WI 53707-7162 anitary Pcrrnit Pomace uo br filled to by Co.)
! F P O1 ~lSanitary Permit Application I `mu; learn non Number
In accordance with SPS }Si 21(20. N9s ;Wm. ('el.:. subm..iun of this farm to lhgovrmm I unit /I/'-~}T
t nxryircd prior to obtaining a salunry pcrmn Nol,r Apphcauon farms for s11,,,ned POWTS arc submitted to Project Address (ifdiffererd than mailr ad ens)
rr//11gg
the Ucpa ,m t of Safely and I'rofrasmnal S,-,,,c, . Personal fnfirnnabon you provide may be used fn secondary
ses in accordance with the Prisacy I.aw, s 1504(I)Imi. Suite. G3
1 Application Infor please print All Information / V I
pmlxxty Owncr s Name, Parcel a
Scott Ellevold W t. , 16% U~ y
1•ro-perry Owner's %1111fng Address Property Local lion
Ciry, Smlr 517-
Zip Cxlr Gov I, I of _
Phone Number Nw Nov 86
Emerald V1fi Section
_ 31 f rcle oncl
H. Type of Building (check all that apply) Ok I of a - I N; R L or W
Ell 1 or 2 Family Dwelling Number of Bedroom, Subdi"siun Name
NOKL [Huck it
J Public: C ommercial Describe Use ~~apN
❑ City of
L State Owned - Describe Uu J G r~ 7 -1 Numhcr ❑ N,.Ibsp of
Z l 1. 5 3- CILp ZS 7 I / F~1 -town of _ _ r
ow -
III. Type of remit: (Check only one ox
on line A. Complete line B if applicable) e
ff
® New System r, Rgda:cmem System ❑ 1 reaulleatt loldmg Tank Replacement
Only LJ Other Modification to FxisMg System (explain)
I
Penwt Ren ewal r Permit Re, won Ubangs of Plmnber ❑ Pamil I ransfer to New fist Previous Pmnfl Number ad Dal, Issued
cfurc E:xpiraliu^ Owner EZ. ~Aot-. )
a of POWYS Syatetm/C'em ooenVDevfee: ('heck all that apply?
Z Non-Ncssmvai In-Gmund U pressurized In{',round ❑ At-(undid ❑ Moum1? 24 m. of,unable it C Mound - 24 in of suitable foil
❑ Holdng Fang k L Other Depercal C'omponcil (,xpli ini_ _ ❑ Pretreatment Device (explain)
V. Dis enallll•reatment Area Information: -
4501 Plow (gill IAsign Sod Application Rald s1) Dispersal Area Required is Dispersal .Area Pro
.5 900 po a s0 System Lleranon
. 900 98.17
^ ,I, Tank Info Copacity to 1otai # or Manufacturer
Galluru Gallons Units ° c t
NewiWcs Lusting Tank
/ I Y ° ~ s2u ~A d
Srpic. m IlAlin, Tent
- x 1000 1 wiener
Dosing Chamm x
600 1 Wieser x
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation or the PORTS shown on the anached plans.
Plumber's Nanr (Print) Plumber's Sugnemm MPNPRS Number Uusmese Pbun, Nlunhv
Paul R Koehler Mp 225410 715-246-2660
Phonbcr' AJJr,ss (titrh'1, 'rry. Slate. Zip ('M1rI -
321 Wisconsin Drive New Richmond wi
Vlll. ntv/De artment Use Ooh
provdd mtppnnc,l Permit For Do Ins Issufn gent Sirnat"
s5 x~ 23
)ovrtai Zliven Reason for Denial U
IX. Condl easons for Disapproval upli,:- Na f
1. r k, edlimr. AW e1Uf Lod o
ui+yet: Cep must 411 e¢ L%A?, tL ~
is per,ilaraiyemen' plan p•orken;,~..L, :,o:. Yt>•L. •'~,~e.ck-CrL
~e-~•' ~vo. CaW.;r rrarl5.
2 AA aeet»nk rnrt,Ne..+errn tN4tlLfx . / 1J.(~s I//~~~
as par lrpFilGiblet c,)05,':.rdiVlmt2. C ,4t--i O A. h Amrb
--e--flue plan for tae -1111- en4 mbnrtr o the County nnly oo paper not le++[hao IIIII, 11 latest. in slrr r(
r~f2 0 J- w1 ru<:S Vs.- I a~.
SBD 6398 (R. I I' 1 I )
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: SCOTT ELLEVOLD
Owner's Name: SCOTTELLEVOLD
Owner's Address:
Legal Description: NW 1/4 NW 1/4 SEC36T3IR16W
Township. CYLON
County: ST CROIX
Subdivision Name:
Lot Number:
Parcel ID Number: 006-1083-70-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter 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. PAUL R KOEHLER License Number: MP225410
Date: 04%042018 Phone Number (715) 246-2660
Signature
Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (14.01101).
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SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page L of 1
Project Name: Scott Ellvold
2 No. of Cells 9 Per Cell
3 h Cell Width 18 Total No of 9
90 tt Cell Length 50 so h EISA Per Cell
3 a Cell Spacing 1600 sq n Total EISA
Manufacturer Model V I Length ELSA Raan
Inflltrator EZ1203H.5ft 5.0' 25,0
EZ1203H-10h 10.0' 50.0
Graveness Leaching Unit Manufacturer: INFILTRATOR
Graveless Leaching Unit Model: EZ1203H-10FT.
Typical Cross Section
Finished Grade It
- Observation Pipe with
approved cap or vent
18 Soil Backfill
_in
Geotextile Fabric
2,4_k Infiltrative Surface
12 it
h Limiting Factor
6 X0 -5!~ ~
T
3,11
in Slotted and Anchored Vent!
yi Observation Pipe with Cap
Plumber/Designer Signature:
License M 225410 Date: 4/04/2018
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Scott Ellevold Septic Tank Capacity 1000 C NA
Permit rr al
Septic Tank Manufacturer 1/VieSef ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer polylock C NA
LDesign f Bedrooms 3 0 NA Effluent Filter Model 525 0 NA
f Public Facility Units O NA Pump Tank Capacity 600 al rJ' NA
flow (average) 300 al/da Pump Tank Manufacturer Wieser C NA
w (peak), (Estimated x 1.5) 450 al/da Pu mp Manufacturer Goulds 0 NA
ation Rate .5 al/da /ft' Pump Model epo 4 E3 NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 0 NA
Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BOO,) 5220 mg/L C NA 0 Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Cellls) 0 NA
Biochemical Oxygen Demand (BOD,) 530 mg/L aln-Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids ITSS) 530 mg/L RNA 0 At-Grade 0 Mound
Fecal Coliform (geometric mean) 51W cfu!1OOml 0 Drip-Line 0 Other:
Maximum Effluent Particle Size Y. in dia. 0 NA Other. 0 NA
Otter:
C NA Other:
0 NA
'Values typical for domestic wastewater and septic tank affluent. Other: 0 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: .0 monthlsl
3 ear(sl (Maximum 3 years) 0 NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA
Inspect dispersal cellis) At least once every: 0 monthlsl
3 Oyear(s) (Maximum 3 years) 0 NA
Clean affluent filter At least once every: ❑ month(s)
1, 1 aYear(s) 0 NA
Inspect pump, pump controls & alarm At least once every: 0 month(s)
3 U year(s) ❑ NA
Flush laterals and pressure test At least once every: 0 monthis) 0 NA
0 year(s)
Other: 0 month(s)
. At least once every: 0 year(s) DNA
Other:
❑ NA
MAINTENANCE INSTRUCTIONS -
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; 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 broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cellis) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The pone ing of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y,) 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 Administrative Code.
All other services, including but not limited to the sevicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page 2- of Z
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal celffs). If high concentrations are detected have the contents
of the tanklsl removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wili be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Soptage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feat down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipos; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pumpl water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and 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 Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has bean evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and she evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in 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 failed POWTS.
The
alua or mg jark
e are fZDtd115rTELL~ ScD Q- n/~1✓ a&JS79UC:n 0
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at me
infiltrative 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 AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Countryside plumbing Name Paul Koehler
Phone 715-246-2660 Phone 715-246-2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Darrels Septic Narne ST, CO
Phone 1715425-1025 Phone
This documam was dratted in compliance with. chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54111, (2) & (3), Wisconsin Administrative Code.
Septic-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Wieser Pump Manufacturer goulds
Tank Model Number 1000; 600 -Pump Model Number epo4
Total Tank Capacity 1,600.00 Alarm Manufacturer sjrontbus
Max. Bury Depth 8.00 Alarm Model Number s patrol
Switch Type float
Filter Manufacturer olylock Total Dynamic Head (TDH) - Feet
Filter Model Number 525 Elevation Head 10.00
Distal Pressure 0.00
Network Loss .00
Min' um Pump Performance Regmred Force Main Loss ,pp
GPM 10.00 Ft TDH Total 10.00 D
Outlet Manhole Min. 4" Above Grade With , D
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
< 6" Below Grade Sealed Watertight Securely Mounted With Locking Device
EEESEE~ Weatherproof
Finished Grade Junction Box
Depth of
Cover Vent Min. 12"
Above Grade Disconnect
Ft Means
With Vent Cap
Outlet
Outlet Filter
Inlet Inlet Battle
Switch Settin sand Reserve city A y„
Tank Volume = GPI Weep
Dimension Inches Volume Gal. B Hole
(reserve) A 18 301.68
(alarm) B 2 33.52 Off Elevation C
(dose) C 6 100.56 Ft Bottom
(dead) D 10 167.60 D Elevation
Total 36 603.36 Ft
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC.
02/05 U Page of
Goulds Water Technology
Wastewater
METERS FEET
70 I - T_ T
9 30 - -
-
i I
2.5 FT J
C 25 - _
2 5
15
Q 4 - -
O 5
EPO
~ 3 1 j ----I
---____L_ - - i- t-_ --I
EPO
2
5
1
0 0L_
0 10 20 30 40 50 GPM
0 2 q
6 8 t0 72 m'/h
CAPACITY
MODEL INFORMATION
~T~'A - T _
Order No. HP voks mps M ClIm" Phase (Float Switch Cord Discharge (Minimum ) Minimum Minimum Maximum S uit ~ hipping
Breaker Style Length) Connection On Off Basin Solids Weight
Level Level DiameterI Size Ibs/k
EP0411 g' 1~' 1". dan~al 'da noel 15'
No 5'.vilch 2019 1
~
P'g-ngf ~ - -
EP041 1 A U' 1'h, 12' 6' 15' 2119
Wide-Angl~e 1
5
EP0411 F~ 115 I 12 20 I Plug/ 20' 1 Manual Manual ! 15"
,q J No Switch EEL
EP0411AC I Pi99Yhack/
-
Ij~7-~ J Wdc•-Angie 20 I ! 12' 6' 15" 21/9.5
EP0412 I I 1 PIu9/ lp 1•b• Manual Manual 15' Y..' 20191
230 6 10 No Swgdi
Plug / 20' 1 h" Manual Manual 15'
No Switch 20/9.1
r Pluy/-~f 1Manual Manual 1
11 S I 13 20 I No Switch S' 22 / 10
5 I Piggyback/
PP0511AC
Wine Anae 70 1'h' 12' 6" 15" 23 / 10,4
230 6-5 10 PSwa 201'b• Manu
al Manual 15'
No Sv.•itc 22 / 10
PAGE 41
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner-'Buyer-Scott Ellevold
Mailing Address
Propem Address ~5~ ~ ~t (A3 Jt✓~ /OWE rr55~P Fat a.red taq
(Verification required fro Planni g & Zoning Department for new construction.) ✓ 0. f ul l
CIIV,State emerald Wi Parcel Identification Number 006-1083-70-000
LEGAL DESCRIPTION
Property Location nW nw , Sec. 36,
1' . 31_N R16
W. Town ofcYIon
Subdivision Plat: Lot #
Certified Survey Map # Volume Page i?
Warranty Deed # (before 2007)Volume Page,4_ _
Spec house ❑yesl3to Lot lines identifiable ❑yes❑no
SYSTE1*1 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 lank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic lank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in $SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition an&or (2) alter inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
1, 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 he completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
Fwe certify that all statements on this forth arc true to the best of myour knowledgc_ I!we am are the owmer(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Nu °r of bedrooms 2 ~v~,vtf, ~JC n ~dae vnc..
4 ,4 ,1s
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the ceriified survey map if'
reference is made in the warranty deed.
(REV. 04/11)
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Wis. Dept. of Safety and Professions loServices SOIL EVALUATIQN REPORT Page of 3
Division of Safety and 8oilrlito g/ \ 1J
Attach aaordancewith SPS 385, A ST CROIX COUNTY
Attach complete site Plan on paper not less then 8 V2 x 11 inches in sae. Plan must Courdy
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 006- 83-70.000
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Ravi by t-ko o
Personal mtomnaew- you prowee me tie uwd for seconaa / 1;29+1 g
Y ry purppaes (Pnvecy Law, s. 15.00 (7) (m)).
Property Owner Property Location
SCOTT ELLEVOLD Govt. Lot nw 114 n 1/4 S 3.6T 31 N R 16E (0 o
Property Owners Mailing Address Lot # Block # Stbd. Name CSAW
City State Zip Code Phone Number ity Yllage • own Nearest Road
NEW RICHMOND WI 54017 ( 71157815635 C IDTI
Q New Construction Useo Residential! Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Flood Plain elevation it applicable h.
General comments the majority of the soil is sandy loam with pockets of massive silty clay . the pockets are few. yet exsist
and recommendations. rccomend useing a .5 loadinq_rate to compensate for the massive pockets. at a .6 loading rate would be 750 sq ft. i
would size it at a .5 900 sq ft.
Boring # 0 Boring
Pit Ground surface elev. 99.27 R. Depth to limiting (actor 86 7 in.
Soil "62n Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence ourdery Roots GP, "M '
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. t#ti fl#2
A 0-6 10)72,2 - 1 2mgr mfr clear 3m 6 .8
B 6-16 7.5yr5l4 sl gr'c 2msbk mfr gradual 217 6 .8
C I6-57 7.5yT55!4 - s Osg ml gradual 0 7
1.6
CI 57-86 5T5.3 ° -
y is Osg ml gradual 0 .7 1.6
Bodng# Boring 99.67 86"+
Pit Ground surface elev. fl. Depth to limiting factor is Soil Abolcation Rate
Horizon Depth Dominant Color Redox Desenptron Texture Structure sistence ndary Roots GPD/8 '
in. Munsell Qu. Sz. Coml. Cokx Gr. Sz. Sh. ff#l ff#2
A 04 10yr2,2 I 2mgr mfr clear 3m .6 .8
B 4-36 7.5yr5.`4 - sURc 2msbk mfr gradual 2f 6 8
C 3G-R(i 7.5),5;4 s s;gravel 11111 0 .7 1,6
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg,1L • Effluent #2 = BOD < 30 mryL and TSS < 30 mq1L
CST Name (Please Print) Signature CST Number
Paul R. Koehler 225410
Address Date Evaluation Conducted Telephone Number
321 Wisconsin Drive 3!27,,2018 715-246-2660
SRU-n;;n iKl l I!'.
Property O« Scott Ellevold Parcel ID # 006-1083-70-000 p 2 of 3
Boring# Wring 11 Pit 99.96
Ground surface elev. R. 86+
•
Depth to limiting factor in.
Horizon Depth Dominant Color Rerbx Description Texture Structure onsistence, undary Roots Sal GPDlication /R Rate
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. R#1 • ff#2
A 0-9 10 yr2.'2 I 2mgr mfr clear 3m 6 8
B 9-36 7.5 yr 5!4 svglc 2msbk mfr gradual 21'
C 36-86 7.5yr514 6 .8
srg srgravel ml gradual 0 .6 g
1
Boring # Boring 99.96 60"
LLuJJ Pit Ground surface elev. R. Depth to limiting factor in,
Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsiatence oundary Roots Soil lirabon
GPDM '
in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. R#1 R#2
A 0-6 10 yr212 I 2mgr trlfr clear 3m 6 8
B 6-36 7.5yv54 slig`c 2msbk mfr actual 2f 6 8
C 36-60 7. Syr 5;4 s g srg ml wave}' 0 .6 .R
Cl 60-86 5yr44 c2dl0yr6r6 s/g/m s.'giro mUm 0 .6
8
single grain +graveV massive pockets
1-1 Boring# HBoring
pit Ground surface elev. R. Depth to tmidng factor- in.
Horizon Depth Dominant Color Shc bon Rate
Redox Description Texture Structure onsistenoe oundary Roots GPOI t '
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. R#I If#2
' Effluent #1 = SOD , > 30 1220 nx t and TSS >30 c 150 mgrL • Effluent #2 = SOD < 30
_ ngfL and TSS < 30 nxyL
The Dept. of Safety and Professional Sen,ces is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
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