HomeMy WebLinkAbout038-1099-80-000
Wisconsin Depacmenl of Commi PRIVATE SEWAGE SYSTEM County St. CrOIX
Safety are Bu Id nB Division
INSPECTION REPORT rani:ay Perr^'t No 605177
GENERAL INFORMATION (ATTACH TO PERMIT) sateplan ID No
3132932
Personal m'crma:ion you crc<ice may be -see `C• secu-da•y ou,ocses ;P,ivucy Law s 15 0+;r.
Permit He der's Name Cry V Ilape To:vns..iP Farce. Tax NO.
Jonna and Dick Klucas TOWN OF STAR PRAIRIE 038-1099-80-000
Cu" SV Lle: T; 77&K F ev .=,v. Cesnri Cl on SbCGC"oa'n, Ra-gc Map No
&XI(l N, V&ep 24.31.18.417A
TANK INFORMATION ELEVATION DATA
TYPE f.IANUFACTURLR i CAPACIIY STATION BS HI FS ELEV.
~s
Septic BencPmark
91 1drxA,40 l zo a.i ct~•oo
6~ 1 Alt. W.4 5.9p Aeration' Blot', sewer
H°Iding SHt Inlet p
TANK SETBACK INFORMATION SvHt Outlet •~O
TANK TO ':JELL MBLDG~erl ROAD Dl Inlet -
Septic Dt Soltom
L, 1-52 /
Dosng HeaderrMar
Aerattoa Ds! Pipe . 5 ~D
Flo.oing Bat. System 840 OQ
PUMPISIPHON INFORMATION F ral G,ade O o
Marufaot.ne• Demand St cover
GPNI ~cu -0
btdde. Nunrecr t7
TDH LiR Frict on Le Sys;ert• Head 1 DI ft i
I
rcrcemain Leng:n Dia. Dist to We Il
SOIL ABS TION SYSTEM
BED' TRENCH [wit.- '_yv;P. t Nu CI lo-i xr PITDIk1ENSION$ No O!Pts InsicLy:---_ Licui~F:h
DIMENSIONS O1- -
SETBACK SYSTEM TO P1 BLDG Volt- LL LAKUSTREAM LEACHING m!~nr ~aca.•nr ~ r
UNIT OR • i'xrHo lyy
INFORMATION Ir r Ir t J T CHAMBER
tt/t___--111JJJfMYYJy.. I~ ✓ tdcJ¢ N.mher /
1n4it. 't8 l~ 4-
DISTRIBUTION SYSTEM a eQ.
-ieaeenr,lenifold D 50 anion _ a I lulr Sloe x Hole S(,~Gn9 Vcn: to A I Irma
. crotn 9 D a •'1 LBr:th_ U a _ Spa: n9 OD ELI Z
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Dep:h :ivc- Depth Dyer xn IirpC of ~ - xx SccJc.d+$ooceo _ nx rddtche'S~_
Ne:.!-'e-r,n Cc'9Ct ~•Qr lied"en:'I eves f Top SCI / Ye; Ye5 _ No
COMMENTS: Ilrcludel code discrecercies pe,scrs cresent etc ? Inspecion #1: Inspection #2.
Location: 2050 H'PJv ^5 c4i 4. 10-3
1 Alt RNI Description = gtvkr Gut/
2 1 Bldg sever en°ta = t ,
arn,brt of cover =
Plan revision Regl.iredn Yes I No 1211 '
Use other side for add Iional mfo7rna4on_ l (Jll 1/
d:u _ Irv y^a 'e :.er.. No o.
5?D fi'IG iR S~4?I
~N dd a s3 Salely and oiv,sloll
St. Croix
201 Washington Ave P-O- Box 7162 Sa~~ tom,,.. \u> t+cr In be fiikd n e Cu 1
wL-Kkw 1. WI 53707-7162
'
SdD1t}dYti ~ \ .e~+
f
- Pe unit Applicatt(1_~Mdtd
In az~s•URC anh ~Cx,Y~ ii t U n kdm C J •ubtnusan of Ihn loon In dtc agsoput`• A~•Rt,ta~tll 1a1e 1 2
n roq•~N pr.ar u dYannc a inar• Pcrmrt. \a~ .{ndt.YSw. liatto (a 4alc' wtcd (vM IS src vdsnttcd u Ptafcct % khm w difk.a■ than ntalna atteast
Ih Ik utrta a•f CAct. an) A.Y.sswscal 4n Pktxsd ufa®thn •ut pm. iiM sm he isal IR scemtr~ Ze ✓l h
FtsPu.inna~'as.lttaYwsfi dr ltnac•I.tv.. l~.-A l N.I.
1- \ Pli"lism Isfenustle■ - P I Al 1■fsrt•aoe~
Nayeth lT•R+ \ame I PanYt %
Jonna and Dick KkK2s 038-1099-80-000 ~y x J~
N•Y•eth lla•tn . \Lulmc .{ddrctt• - _ - Pto(x+,. 1 ayxn y.3 ~ "t ~ 1 ~x
2050 State Hwy 65 lw t I
ri, ul - ~ - T5402153 p cuk rr.w Numi x. N16[-' a SE url 24
New Richmond W- t 31 N R 1$ cclea m w
T~ pc of B■aduR lawk an rbst apph / 1 a1'
Slddneum \attr
1 a, tam.h Ih•ailan• \.vntx+.N F1cS•x~n.>
P,dda:cit.ncr: ul u.7o+•c l; 300 GPD ❑ cd. d
C 4'dxnc of _
"%I Numb"
G sutc 1I R I Ik x< 1_ < ra.n w Star Prairie -
IIL Tspe o(hr~iC ((fret wh u■t b.a i■e faompklt i■r Bifappirslae)
M ?4xhfcasin M 1 snnn¢ \•.e® (cX.L°)
\.~a \a »cr L Rcl+a_a.®na 1..rcrn I ❑ 1.c,nx~a I{.J3 T., a Rccla'~vl Ooh- PD,,',
\ond•e and tL Ivutd
c•T Pvme
R I [j 4'c.mu R.av'a1 C1 Pt Rn ~.a ❑ Cb o c f 1'S~a►v~ ❑ P1nms 1 T..&f u .`ica•
Il fSCi xc 1 zc+.trn ~ (laxr ' ~ {.xl N
i 1V - rMX-apglpwe.t/lk,ite_ I(lect all that s) JI ~...P.a...~,.al lo-rn~,~.l ❑ ercn,=...,x In-u.~.a D :v-~;~ ❑ ~xo..a ~ v •.f ~da~ x.l ❑ ~x...a - 'a
.n ..f ~>_.r.<..•,1
.1. IAil.m loot ~ (kfa.T Utal•c'rsal c'oa4` ',+(~an) - ❑ Rctrumer[ fk•.~e x . - •1
Ares 1■far~al= -
~I)`stgn F k..• Isydl lavgn Sod ,~l1Ya..ao. 1)i~>v Nr% R~rcd ( Unr•ayl Atra R ltn S)von F]n~tws~
300 .7 428.57 440 1 94.0
\1 Tat t■fo Q wm Isom
~Gallea
POy -LOk 525
T k' Ta
=
I Ji
)cyerc n Ihihst f.► 750 750 1 Weser X
I %-IL Be~poacipiih Statemetel- L the eadr.siesed. u ssse re~eaoaiYl• tfsa sf tt. PONT sMtta dr dumbed Pass
R.Wbcr-. ti.wc (Korb - 1'F % % j Mr NI R-S N Ed IS•..ecis Phs.c N..ba
JL Keith KnUdt50f1 ~ .tdt~_ 648443 651-470-1737
PIS(rta,{d•x>sxw~cn..w~.i~c..~> f
927 150th Street Roberts W. 54023
N IIL Cs■■n_. e xr e e hie Ooh'
Pmm~ 1tt IJaec
y•~r~ g Q
I\. Co■ea+~br,IKsapprs.a! ^ ~~~~~J
$e4t'r. tank, eYlccn: ItRa-PtM1
biyper.a~ crll c+ust all be y^.n ! nuin'<S.a_r 05,
as per .;/ar.3yement plan p!o nom by plumber.
AY stllbx'Ax ISS\Jrs.-enz mtr(ty: r. a,nt.'iYe
2.
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.trcY r i11te petty it ~ siv.. ar •shs+ r re c.r. ~ ~ MQ st h•. ■r s..] : 11 ia... oR
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'~rsar tin( DIVISION OF INDUSTRY SFRVICES
2331 SAN LUIS PL STE 150
GREEN BAY WI 543C4 5211
y.1 O~ i
- \ Gontacc I hwagh Relay
\ P hap '~dsps m goviprograrns+mdusiry-services
-mm a•Isccnsm gov
Scott Walker. Governor
Laura Gutierrez. Secretary
Augur; I+.'i11F
COST ID No. 224059 :17"lava 1'O111 S Imp'.,
KH I*H 1, S'1 0\F:R ZO\ING 01:1 ICE
KEITH S'FO\FR SOIL. TESTING SANITARY DIISIG\ S'I- CROIX CM IN I Y SPIA
`~.'..'.0 \VOODCKLEK RD 1101 CARMR HAI'A. RD
SIRIfA \V'I 548?2-8728 HUDSON M i-1016'708
CONDITIONAL. APPROVAL -
PLAN APPROVAL, EXPIRES: 08 13,2020 Identification Numbers
Transaction ID No. 3132932
SITE: Site ID No. 851688
Klueas Please refer to both identification numbers.
_050 I Ivy 65 above, in all correspondence with the agency.
I ovan of titan Prairic
St ('rois COlllnv
\W1'4.SIA 4,524. 131\.RIBW
FOR:
Description: Gravity in-ground for Greenhouse Retail- New Construction
Object I ype: POW TS Component Manual Regulated Object ID No.: 1787 172
Maintenance required; 3,00 GPD Flog rate, 96 in Soil minimum depllu to limiting factor from original grade: S\sten)(sl:
In-ground POWTS Component - Ver. 2.0, SI3D-10705-P (N.01 01. R. 10 12): Ctfluent Filler
hhc submittal described above has been reviewed lirr conformance with applicable \\'isconsin Admirmtrative Codes
and \L'isconsin Statutes. the submittal has been CONDII IMAI.I Y APPROVED. 'this system is to be conrirtlcted
and located in accordance with the cnclo,ed approved plans and with any component manual(s) referenced above.
t he uwner. as dclmcd in chapter 10L(1 It 10), \\'isuwsin Stanukti. i, responsible for compliance with all code
requirements.
No person may cnpa,~c in or work at plumbing in the state unless licensed to do so by the Department pers. 145.06.
stars.
The 16111 wing conditions shall be met during construction or installation and prior to occupancy or use:
Key Items- POW7-S Design Approval
• I he design included the principles and best management practices ofthc In-ground Soil Ahwrpuon
Cumponcnl Manual for private Onsite Wastcwatcr'Ihafnlcnl Systems \ersion 2.0" SBD-10705-P (N.01!01
• Install gra.eless chambers per manufacturer's recommendation.
• The owner is responsible li,r the operation and maintenance of 0u• pi wale onsile veastevcaucr treatment system Cl7(ti`
tp0\1'TSI in accordance with SPS 383 and the approved management plan A
• The owner of a PORTS shall be responsible for ensuring, than access opening covers remain locked or DEPT O
secured except for inspecion. rc:du:uioa. nls1:11CI mca or>cnlci:ic purpose+
• Owners shall receive a copy of the appropriate operation and maintenance manual and or owner's manual fay;, I RO E SI
the f'Mk I'S described m this approval. U
i
• Provide a copy of the approved PONNTS plans and this letter to the uwner.
A copy of the approved plans. pecifications and Ihis Ictlcr <hall be on-.ire during construction and open to
inspection by authorized representatives ol'the Departnlenl. which play include load impeclors..All permits
rcquircd by the state or the local municipality :hall be ohc:ined prior m conuocnccnml of
construction installation' operation.
In ;,ranting. this approval the Division of Indusiq 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.
Inquiric concernin;= this correspondence may be made to me at the telephone number listed hclow. or at the address
on this letterhead.
I he above Ie0 addressee shall provide a copy of this letter and the POkk US management plan to the owlter and any
others who are responsible for the installation, operation or maintenance of the POW IS.
S:nccrely. Fee Required 5 250.1111
1 his Amount Will Be Invoiced.
When You Receive That Invoice,
Mark S I inger Please Include a Copp With Your
POW IN Waslewater Specialist , Division of Industry Services Payment Submittal.
i608)57 1-11 81) . Mon-hi, 7:00 a.m. 33:4~ p.m. W'iSMART code: 763,
mark. t i n;_er; r w. _os
ce: I dw in l oV lor. Wastewater Specialist. (15i o.,4- 15:. Mon-&i. 5:00 A.,\1. - 1: 30 P.M.
Keith 1, Kuudt*on . Knudisoo Plumhinu Who, klai'.ed I of
is
Index and 'I itle sheet
Property C)micr: Ionna mid Dick Moen.
Address: P.U. Box 141
Stain Prairie \V'1 54026
1 coal Description: N~1' Si -SF Ir'4
Sec. 24 1 >1 V-K18\V
-1 omiship: Star Prairie Count.: St. Croix County
Property Address: 2050 State l lvlV 65
SubdilisionName: Na Lor Na
Co-11P.-.1 Parcel Ill: 019-1099-80-000
c'U;1F;TS JA 1-LY
D
T
Pxge: I Index and Iitlr Sheet R A
Es
VICES
Page: 2 Plot flan and Plan Vida Y
Page: ? Cross Sections of Cells land
GE
Page: 4 Management and Cunline.cnc\ Plan ✓ C)~vE
Vtachments: Soil and Site I;l;tlualion Pone
In-Ground Soil Absorption Component N9anual I Ised - SIM-10705-11 (N.01 01 K. 10111)
Dcsig.ncr: Keith I`.. Sl}I ~~Q\5 ON,y~ Iksisttiers License , t; s7;_00~
7
KE,1'N. E k _
tii~~nnturc: l r~~ ;g1eN`n - Phone Ti (71 i 65 i-2`4
p-t575
Sion.
Daic: JUlle 26111. 201
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Page 4a bof4
System ta1-1 rep shall not occuf whoi soil an;ditinn<arc Irozl~n,:t the wtiltr ikc surtak c.
During power outa_,cs pump tanks maN fill above normal high water Icwls. Nk hen power is restored the excess waslccvater %%ill Lie
discharged to the dispersal cell (s) in one lane dose, overloading, the cell (s) and may result in the backup or surface discharge of
elthlent. 10 avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin power
to the eflLtent pump or contact a Plumber or POW'TS Maintainer to assist in manualk operatine the pump controls to restore normal
levels ce'ithin the pump tank.
Ito not drive or park vehicles over tanks and dispersal cells. Ott not drive or park over, or otherwise disturb or compact. the area
within 15 feet of the down slope of any mould or al-grade soil absorption area.
Reduction or elimination of the following Isom the w'astcwater smeam may improve the performancc and prolong, the lilt ofthe
P(Ak I S: antibiotics, baby wipes: cigarette butts: condoms: (.1111011 swabs, deereasers; dental floss: diapers: disinfectants: fat:
foundation drain (sump pump ) water: Inuit and vcpzetable peelings; gasoline: crease: herbicides; meal scraps: salad dressins;
medications: oil: painting products, pesticides: sanitan napkins: lampons: and water softener brine.
WAN DONENIENT
NN'hen the POW I S tails and of is permanunll. taken out of service the tidlowin, steps shall be taken to insure that the system is
proper[)' and safe's abandoned in compliance with (h. SPS NVisconsin Administrative Code.
• 111 piping to tanks and pits shall be disconnected and lire abandoned pipe openings sealed.
• I he contents of all tanks old pits shall be renxrved and properly disposed of by a Septage Servicing Operator.
• After pumping. all tanks and pits shall he escava(ed and removed or their covers removed and the void space filled with
soil, gravel or another incrl solid material.
Contingency Plan
If !lie POW 1S fails and cannot be repaired lire Rd1ow ins measures have [)evil. or newt be taken. to provide a code compliant
replacement system.
La A wilahle repktecnlent area has been evaluated and nun' be uliliied for the location of a replacement soil absorption
~)stenl. I he Icplaccmcnl area should be protected from disturbance and compaction and should not be infrinvcd upon b.
ruyuircd setbacks from existin,~ and proposed structures. lot lines and wells. failure to protect the replacement area will result in
lire need for a new soil and site evaluation to esfahlish it suitahle replaccnu•nl area. Replaccmcm svslcros must comply with rtJcs
in effect at that time.
A suitable replacement area is not available due to setback and or soil limitations. Barring advances in POW 1 S
Icchnology it holding tank nwy be installed is a last resort to replace the failed POW FS.
I he site has not been evaluaed to identify a suitable replacanlent area. Lpon failure of the I'M I S a soil and site
evaluation must be performed to locate it suitable replacement area. If no replacement area is available a holding, lank may be
installed as a last resort to roplaec• the tailed Pr )WTS.
Mound and at-evade soil absorption systems may be reconstructed in place following removal of the hiomat at the infiltrative
surface Reconstructions of rich systems must comply with file rules in effect at that lime.
< NN arniIt Septic., pump and other treatment tanks man' contain lethal gasses anti/or insufficient oxygen. Do not
enter a septic, pump or other treatment tank under am cirenuastanec:c. Death may result. Rescue of a person
from the interior of a tank man he difficult or impossible.
Additional comments: Future replacement option vwould he to re-locate the sanitary system, or complete an ISD to
install and engineered system in the same foot print.
PONV'1.S IN'S'hALLER 110W'fS MAINTAINER _
Name Korth Knudison Name
III Name
Phone ((i.l)1,(I-1'.. Phone -
SIT 'I VA. SERVICING OPERATOR LOC'AL_REGULATORl' AL.-I HOW I N
Name Powers Sanitation Nalltc St. ( rok C ounh Land Services
phone (?1>)246-5738 Phone ~ ('15)386-1680
]'age4at bufd
PON1'I'S ONN'NER'S M ANAGE.MEN-I' PLAN
FILE INFORNIA'I'ION SYSTEM SPECIFICATIONS
ONTf.R "Garden Ecpressiuns" Jonn_a and Dick Klucas Septic lank (".apaeity 1S0 Gal. - -
1'I.RMFI a - _ _ - _ Septic Tank \1 noLicturcr \\icser Concrete
Lltlucot Filler \hlllnlaclulel Pull Lok
DESIGN PARAMETERS - - -1:9111ent filter Model 1'L-$25
\utnhcr of Bedrooms filter Rn,in
\unJ.crof ( onln+m6al I;nits I ( Sec Sizing) Pump lank klanufacturer
I -:stunatcd0all) 11 low 200 ~:.•,-d das _ { Pump Manufaclurer
Dc,i_,n llo%% Wcak) irsl. s 1,51 - 3(I(I al day _ Puna, Model -
Soil \pplicalion Rmc _ "al iim fF Prclicatnunl I fill 11 ;l
InllucntiF.Mucnt Quality Monthly :\vcrage Sand !Gravel filter Peat Filter
I'nr,,Oil,c4. ireasc(FOG) :-30Ing1, Mechanical Aeration Wkclland
Biochemical Oey;~cn I )errand (BUD: ) °20 me !L Disinfection r Olhers:
1 ulal Suspended Solids f'I SSI _ 1 i0 me !L
Pretreated I Ifluent Quality n n Monthly !lverage Dispersal Cell Is) 2 1lispersal Cells (Leaching )
Biochemical Cis) ,ell Demand 1801),) 30 mg!I A In-ground gravity In-grand (piessmizcd)
I sal Suspended Solids II-SS) >0 mgal, AI-grade Pelound
I -ecalColitoon (eornetriemean) lif t slit 1001111 Drip-line f)Iher:
Masinxun L:Ilkacnl Panicle Sizc - 'i: inch diameter Quick a Standard-W Chambers F.ISA - 20.001 sq. ft
NIAINTENANCE SCHEIR LE -
SERVICE EVENT SLR\•ICE FRFQI:t:V-1
In,pec condition otlank(er ;V least once were mnnlhs ) near ls) (Maximum 3 tears)
Ptuup out contents ol'uunk I A- - \1 `hen Mllbined 11LllllC and sctun equ:ds one-Ihtrd I of tank volume
In,pect disnetsal cell f,) Al Icas once every mnnlhs near Is) (Maximum( 3 wars)_- -
---1 Ican cifluent filler :\t least once even months I year fs) or as needed -
In,apect~ur~l. pump controls and alarm At Icas once every' months I bear Is1 n'a
Flush lalerals and pressure test_-_ Al least once every months 'year (s) n ;a
( )Iher. Al least once every months 'war (s) 11 11
l )Iher._.__
Maintenance Instructions
Inspection, ottanks and Dispersal cells shall he nrule by a individual carryine one of the litllowing licenses ar ccnificuinns: Mater
Plumber. Mlawr Plunnhei 1tesfiictcd Sower; PO1V'-I S Maintainer: Septage Servicing Opcraurr. 'tank inspection must include a visual
inspection of the lank (s) to identify any missi11e or broken hardware, idenlifv any cracks or leaks. measure the volume ofeombined
sludge and scum and to check Ibr am back up or pondin, of salient on the LIOUnd surface. the Jispereal Cell Is) shall be visually
inspected to check the c klucnl levels fn the observatam pipes and to cheek fix am pOndi11g of eflhlem On the ground surface I le
pondine ofeffluent on the around srriace may indicate a failing condition and require; the immediate notification of the local
;tulhurih.
When the combined accumulation otsludge and scum in any lank equals one-third or more otthe tank uolumc. the entire
contenlS of the lank shall be vernmed by a Septa e Serv•icin, Operator and disposed of in accordance with ch. NR I 1 \\'iscunsiu
Administrative Code.
1 he servicin, of el luenl Iilters- mechanical of pres,urized 110\\`1 S
' components, pretreatment componenls, and m other
maintenance or monitoring at intervals of 12 mnnlhs or less 4all he performed by a certified PO1\' I S Maintainer.
A service report shall be provided to the local re ,2ulnton a111101'6 Nv ilhin 10 loge 01connpletiun of am service scent"
START 1 P AND OPERATION
Pop new conSOUCliun. prior to use of the P(AV I S ;Leek ircauncilt tarn;, rite the c,encc of p:rintim• product, m olha r chemicals that
may impede the Ircalnrcnt process and of dxm Ilc :iispei,al cell i>b If hi,-,h concentraliom are de(eclcd haw life :otltcrns of
[tic (auk Is) removed by a .,•plauc sera icim• opcrntnr prior hr ,r,e.
ST. CROIX COLINTI'
SEPTIC TANK MAINTENANCE AGREEMENT
AND
O\\ NLRSIIIP CERI IFICATION FORM
Dick Klucas
Mailing Add _ y P.O. Box 141 Star-Prairie.
Property A:12050 Hwy 65
n l is t~,-ali:wn rci)uiryd from g & 7AOIDg Department few or.. N n rnK-, k~r..l
Citv:°State Parcel Identification Number 038-1099-80-000
LEGAL DESCRIPTION
Property Location NW n.. SE , Sec. 24 , T 31 N R 18 Town of Star Prairie
Subdivision Plat: . Lot a
Certified Survey Map # Volume . Pane u
Warranty Deed # Ibefw 2007)%"olumc . Page zf
Spec house ON csdxn Lot limes identifiablc❑ycs❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic s. stem could result in its premature failure to handle wastes. Proper
maintn cc consists of pumping out the septic tank ever three years or sooner, if needed. b, a licensed pumper- What %Ou put into
the s. sxm can affect the function of the septic tank as a treatment stage in the waste disposal s% stem- teener mansctance
nt_pontsibililws arc specified in SPS_ .8 ~_i'I 1) and in Chapter 1! - S'L Croix Counts Sanitmy Ordinancce.
The propem owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumlwT, jnwrneyman plumt eT, restricted plumber or a licensed pmnper vrrifying that (1) the on-side
wastewater disposal system is in proper opmaung condition and or after inspection and pumping (ifnccesswr k the septic tank is
less than 1.3 full of sludge.
fwe, the undersigned ha%e read the above requirements and agree to maintain the pri.ate seuage disposal stem with the
standards set fort& herein as set by the Department of Safety Arid Professional Services and the Department of \atural Resources,
State of Wisconsin Cenifw-arioo stating that your septic system has been maintained must be cooplaed and returned to the St. Croix
County Pb tmung d Zoning Department -ithin 30 day s of the three % ear expiration date.
Uwe certify that all statements on this form arc m tltc best of my: tar knowledge. I we am are the owncri s) of the
property described above. b. virtue of a warranty deed riled in Register of Deeds Office.
Number ofbedrteumN 300GPD
D Cb t~~ 5 to :
SIGNA Il RF. OF APPLICAN F(S) DVFL
`•'An% information that is misrepresented may result in the sanitary permit being revoked to the Planning & Zoning Department.
Include with this application a rRwded warranty deed from the Register of Deeds Office and a cop) of the certified survey map if
reference is made in the warranty deed.
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Division _ ' - #3330
SOIa EVAL UAAIT ON EPOR
Page 1of 3
JUN 1Z g Z~~6 in accordance with SPS 385, Wis. Adm. Code Keith Stoner CST
County
mplete site plan on paper n less than 8R x 11 inches in size. Plan must StCroix
ut not tiledlo4 M-cal iknd onzontal reference point (BM), direction and
ope! so a fN;rlonedbi h arrow, and location and distance to nearest road PaLl
n 038-1 9-80 00
P/ease print aff information. RoDate
Pe+s
on,W information you provide may be used to secondary purposes iPmacy Law. s. 15.04 (1) (m)).
Property Owner Property Location
/4, 4, T31 N, R18W
Jonna & Dick Klucas Govt. Lot 1A, Ics
Property Owners Mailing Address Lot # Block # Subd. Name M
#
PO Box 141
City State Zip Code Phone Number City Village Town Nearest Road
Star Prairie WI 54026 715 246 0257 Star Prairie 2050 H 65
New Construction Ilse: Residential / Number of bedrooms Code derived design flow rate 300 GPD
Replacement Public or commercial- Describe. Retail Store Greenhouse
Parent material Sandy Outwash Flood plain elevation, if applicable NA ft.
General comments Propose ;wo 3 x 46' dispersal cells using leaching chambers. Center the chambers over staked area with a system elevation =
and recommendations 94.00' 8 employees x 13 -104 gallons. 2 Floor drains x 25 = 50 gallons, 864 sq ft retail space x 70 = 605 30 = 21 gallons.
-ro}zL1 1T5 ~Jlegsx L5. :4, 7.50 DWF, r'ropcSt' Sec g Pei of 7)LJF. zor-f' >C'
F 1-1 Boring # Boring
Pit Ground surface elev. 98.00 ft. Depth to limiting factor >99 in Sod Application Rale.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Mansell Ou. Sz. Cont. Color Gr. $z, Sh. •Eff#1 •Eff#2
1 0-9 10YR2/2 I 2msbk/lmpl mvfr cs 3f-m 0.0 0.2
2 9-16 10YR3/4 sit 2msbk mvfr gs 2f-rn 0.6 0.8
3 16-25 10YR4/4 sid 2msbk mfr gs if-m 0.4 0.6
4 25-31 1OYR4/4 Is Osg ml
i gs if 0.7 1.6
5 3199 10YR4/4+5/4 ' s Osg ml 0.7 1.6
I~
,
A tgnz&r mm ed from service across road for greenhouse'
❑ Boring # Boring AA
Pit Ground surface elev 97.75 ft. Depth to limiting factor >96 in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNt'
in. Mansell Ou. Sz. Cont. Color Gr. Sz. Sh. 'E##1 •Etl#2
1 0-5 10YR2/2 I 2msbk mvfr Cs 3fco 0.6 0.8
2 5-12 10YR3/4 sit 2msbk mvfr gs 3f-co 0.6 0.8
3 12-17 10YR4/4 sid 2msbk mfr gs 2f-m I 0.4 0.6
4 17-29 10YR4/4 Is Osg ml gs if-m 0.7 i 1.6
5 29-96 10YR4/4+5/4 S Osg ml if I 0.7 1.6
-I - -
' Effluent #1 = BOD? 30 4 220 mQ& and TSS > < 150 myL Effluent #2 = BOO S30 mg/L and TSS -s30 mgA-
CST Name (Please Print) Signature. _ CST Number
Keith Stoner 224059
Address Keith Stoner CST 'i Date Evaluation Conducted Telephone Number
23220 Wood Creek Rd Siren. WI 54872 6121/2018 715-566-0900
sruH 13Q(Kvm3)
Property Owner 3onna & Dick IOucas Parcel ID # 038-1099-80-000 _ - Page 2 of 3
Boring
Boring # Pit Ground surface elev. 9835 R. Depth to limiting factor > 104 m.
Soil Application Rate.
Horizon Depth Dominant Color ! Redox Descrption Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Foal 'Ef%#
1 Ar 0-9 10YR2/2 I 2msbk mvfr cs 3f -CO 0.6 0.8
2 9-18 III lOYR3/4 sil 2msbk mvfr Qs 3f-co 0.6 0.8
3 18-28 10YR4/4 sid 2msbk mfr gs 2f-m 044 0.6
4 28-34 10YR4/4 Is Osg ml gs 2f-m 0.7 1.6
5 34-100, 10YR4/4+5/4 s OSQ ml if-m 0.7 1-6
Boring 51.'
❑ Boring # pit Ground surface elev. R. Depth to limiting factor in.
Doll Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfR'
in. Munsell Qu. Sz- Cont. Color Gr. Sz. Sh. -FBMi - -'Effp2
l
Boring
❑ Boring # Pit Ground surface elev. R. Depth to limiting factor m.
Soil Application Rate
Horizon Depth Dominant Color I Redox Description lexture Structure Consistences Boundary Roots _ GPDiR'
in. Munsell Qu Sz. Cont. Color Gr Sz. Sh 'Fff#t -Ef #2
I
Effluent 01 = BOD, > 30 5 220 mglL and TSS >30 <150 mg/L ' Effluent 02 = 8005 < 30 mfg/L and TSS <-30 mgr.
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