HomeMy WebLinkAbout030-2127-30-000 (2)
Jvxo~.~•''~cR,nTC:,l of C.or,mcme PRIVATE SEWAGE SYSTEM S1. CfOIX
an,. `rc Nn
;:ate+r am duiln'.°p Division INSPECTION REPORT 607008
i A', TACF' TO Or Ftlv9T Y Slatc war. ID ICG.
GENERAL INFORMATION r„ ve I.C', ,-;ltrj
arogl'a+N>
pe- a iorm;d on vo_ p-ovge "I be "fd fo, 5e rr -
cnr 1e 030-2127-30-000
SN11` TOWN OF SAINT JOSEPH
Jeff Mears >nn n---
25.30.20.1037J
=ra I-.ICV^zp nM EIr.' Ev ;,eumnrn SSA v, 1^ L~c~' 1:r.~c~ V ~
ELEVATIO DATA _
TANK INFORMATION ;,ArIDN PS HI Fs
Ir• - I.4.4N'.1F.a 'URPR
Ficnrl, rk
Septic / •7.~ O\~ +l-r., i.F+
All. BM ~S 3
Dosing- ~_v i L- f , . s • c, el
eld9 -evict X; : n
+\eratiou -
StVHI mlel S4-
Hofdinc;
L_ - Sul It Dutiet ~j Z 5?
TANK SETBACK INFORMATION
TANK TG PrL :4 r-" 5-Db 4erc t, F~'In+uk_ t2OAD ;X tole;
t
r t, rn D; Bottom \ \
Septic . Z-j Ybd :
;w;
Header+Man Z-
6aslny
Acraa:>a
Bol Sysle", `(y
I Iodine, c
Fina~ Sradc 4;Z 159. 37
PUMP/SIPHON INFORMATION penland ,,.over 1) 9lj 37
9L
Model Number c
r F I l Z
tL" Lit', Fnehor.I u. s System neac FAH f r.
-4, Q
Fol Jemair, ~e:lyln Dla.
SOIL ABSORPTION SYSTEM Fns n,mc ; L.c,1H4enr
PIT DIMFNSIUNS 14, BLD7RERGN
>
IdanulapNmr ,
DIMENSIONS O
F':I BLCF; 'Oh-Li Li LI AKL'81 RFA61 LEAC •t._`• `.F!
SLI6AGK SYSIL": 1" CHAMBLRER OK -
MFORMATION 11N1T lar.Cei N.:mber. f C. r
.,rem ^t 'V c1,> .1
DISTRIBUTION SYSTEM r:dr 3pm_,r,n ~'e rw.Ainmake
r Horc Sr_e v 1~ r S
V Ell
Ii-adc'y~l~ -
l
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Nllh;ned
:x UcGfli of xz 5:ndev' - 'p^nd
,,ti 0^ur _oGs>fl V,_. +kp Yn`. VO
[ I tr e: p,
1. I. en,:h Ed',.
I!ISP2CIipf #1. Inswituor #7
COMMENTS: ilna.kloe ::ode euscr txncrea. persons present' elc i 1
Location: '3GG UIRCI• PARK RU L /I/ - ' " .1 r c
1.: All BM Descnplior = / ~q-..•Z
Bldc sewer length=1~F-lv~ ply+"U~
- amount of ::over = ! 1
Liar revision R,quiredo Yes )60 J
'nn tic
[I5e OtfH:(Gid[ lot addlbona' dliofmalior. 7 we - - in:~•ppv' `a'1 11
-
171,111 tr I:ion 6*V ao _ Co s
1:11111 \1' hind n 1v:: b~t
_~E I`::. L~~ I !L li ♦ Ir SI It1rv Ye'Inrt Vmn..-r!tu Y 111,J I
G6700S
Sanitary Permit npplicau Oak l;alln:,cnon Nalltvr
11 Im..1 AIv h 7 rm r u n:1I -:•tn p rc. nay rnllt ntllUntl
r pl I lu•1 I 1 1' I, : IT I I r n: t M1 t ll I1, r r n t t- 1 t i a11J P- N I> tr 1.11 WI { 10 14 PI cc t.1:.J t~s III ti1'R•c11I Ihan
math n:hlrt. !
011)I 1.'t It \ tl t IT Jl 1 ru S11, a :.JI tt 1. Ir rde ar." nc u: ul let x: ond,wv L
I'LL PIT iJ1 i'' Itl ty la;. I_t14.111111 vot. G
1. Applic Informaliou flea"IV in III Information
~Fr:n N\CfiRS I 130-a1a~ -3O-000
I'mp.erl•; I!•.. r,.atn;,l::.l-::.., - Ptv;':=t•: ::n
1366 ~311Z~N__~ARK i~D 1
C m. _ O:i c /th Cuec I`'-.mc N'_mhcr ~ ti, y.el n
I'S fol (0
_ i 30 N f
~I(I ~Fypc• of Ruddmp Ichnh all that appitl \ Lnt
fn ITT' - jE) N.r u;
pn yam, ,
tJ IYd.GirC or. mcnua' - Ilcscnbc Ilse iµG+~
❑l h(.I'
CSMNII'11 ❑ Ullrrol
❑\rvr inl.cxc Ursclc.c l:,r ~iv~-IJII
z U;br Ce~`~ w L2kZl C $T vc ~t rTJ
111. Iypeor I'crnlit.• I(lie nn~y online:\• Complete line 11 ifapplicable) _
\ ❑ (hh r\I Jih; 1 t I..E\r.bn mlrc lain
❑\r:. It nl-- ~lty fr'rn:n+t.t;-n 0\ r•t naal I''.'ltutl. F21 . :n cl(Jnly r`• 7
I{ I ern t Kuu 11:11 ❑ I rt nt IL:'. t r: n lJ ! - I In tLu I I Irv' u= 1'ertnd Mvnhcr and U.I Iv.:.u'.I
❑ f t ml, I u:nsli•r In Ncw nb q
'.I, 1 rr. lAvnrr 2 33g SC ~G60 Z_ '.1
1\ I ypr of I O\\ I S Salcol?Compnnutl I)ccicc f(lucl. all that :gtph) _ _ _ ~-J,
xNor. P.-, , III (it .mm.I ❑ I........ is :I I (non:..1 F A:-(;c.Jc ❑ M.zn l . 111 of Y11, I'll =a.:l ~ VlrrnJ !1 t J-I-. '-'d
LIIl I I) IIInet l) 1iu Item a lI p.1111 ❑P Ill:'I Ucq•: ~17u-1 Ls1 n>
\ Disperi;a I real P11 nl:\rca Information
U(tutl ~~I III JaIJI}sI\II annll n.l tisl7 741 p.: n:J 40.•. napr 1 r J\ua lt.p ::I'} \+ttn'.f lc', un
( t l 8S1 Y 57ioa~65. r
IA ank Info C:q 111 m IAJ :nl ln...r
r dl (ills ns Uuno J
Iq•e:.n IL:L.fq: la''t' 250 ~LsalU- I 'VI sCP-
111. Respon,lbllil) Statement- 1. flit andersi^ned• a I ntr it v,.bH.11 for Intl filllion of the 1,01% 1 N shoal n Ihr anaehtd pl'ms
1•lhtl N,r.1 i1-nl N .w a/, fiI .1I 111 r:1P.:r Ifu.':...I e nDL n•f er
T-LFf rO lY/ +~(~~1~ zz3zyz GIs-`iRl-s'is8
I'lUn:b.r AlJt~.,IS. rr'. C 11, M.ttc./i (.oJA':
PO. -Box 56S DRESS4rR- wl -
\ III ('oan to Dc t Irtinent 1 sc• Onlc
a1{r:s.c1 1: 11:v It,., Ic, Do-1.~u1} 1-tri- epri titenal rc
ncrt l at Kca>o 4u1 I):If 5ob GO / / //1~
I\ (ondi/NIrFI`4-SyI~.,i~, FftcI.on+ for DaatIro, al
1 seat-Mark ltlt.,,.~ inc ni ll
F'r::I Ocll tall be ' - - ht '2e. 7 d'C J
as paf mar ayemen' pltn laea Lv olumoe:.
2. N toe!k1+rA nl4tilm^MUS Vnint Lo r-.c::It it 1 1 tS TCdOX 0..~
as pw rppkito1i ur.}s ; ;rtl'.nnn;ct.
\uaoh to auvytrm Phuu for Ihr sc.trm :n¢I whmil o. nw lTnmry onN nn lunar and Ir.. lhaa 1 l : x I I uralrrs r..r,,
N!t l-fi39S,IR.rIS 'II7
w
~ ~ ~
~ _
r
L
v
e~=~~ -1
a G, , ,
----r- ri-(-~
'g
i
;i',
~
~~~r'~ ISb~
~ ~ ~
'i ~ i ;
ti~ -
- i
- ; ~ ~ j 7_
i `~~I -
ti
V! ~ I
i ^ ~ ~
~ ~
~ ~ y
~ y
J 1I l~
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name:
Owners Address: )366 tIRN -PARC R Y
i
Nv(1soN WI
zs
Legal Description: Ei~7 SW I~`1 S 3-30 WIR Zo tt/
Township: ST Tc~o li
:ounty:
Subdivision Name: Ei P,04tPARK
-ot Number. 3,3
'arcel ID Number. DR O -2- 03 9 - -2-C)" 00 U
Page S Index and title
Page 2 Plot Plan
Page 3 _ System Sizing & Cross-Sectron
Page 4 Fitter Specs
Page 5 Maintenance Information
Page 5 Management Dian
Page ? St. Croix Cry Septic Tank Maintenance Form
Page B Warrant, Deed
Page 9 CSM or Plat
Attachments Soil Test & House Plans
esigner/Plumber. j-~ ~Qx License Number
r~ 1V1Ph5 7~3ZyZ
ate: /U Phone Number -715. 491
3458
gnature - t /
signed pursuant to the In-Groand Soil ,.Absorption Component Manual to. Pot^^S'dorstor 2.0 SDD-107n5-P iM.Otl01).
Page t
J
r
I
II I i;
3 tYJ
1-
lW ®b igumm svsbem Croce "coon
a ft 9C~ 5
~L
~t cam. No vwt fte z6 (.0
~
Leachtrg
gs•~
DO AboonMonjhnaM l%n MW
Vert Or ObWv4m F" ` / e'tanch 4
TT%:a 2 Mwdw
~
Manu&ckLmr And Model 55, t I 15 (i~ U l C K- Ll
MU Reling eq ft per cMmbw Sod AMication Retie gp&* It
CoOC gpl De*n Hoar t 7 sod Appame m Re* 2 Elsa U ChwV n
2 rows of Z 1 -Z Z- cham►fws each.
Page of
I
i
,V
;i
S ! 1
S( (i li i<11i L i
VJ
V '
S1'. CROLX COL' T~ ZC>5LNG OFFIC-I;
CERTLFIC ATIO ST.4TE;vf}:_v I'
FOR L'M-IZ.4TIO\' OF E' ISTLNG SEPTIC T-A-\A(SI
t:. ..i _ L~l4t, a- _nz.C.I 1 L}l. C. ':tee ~~.1 1;, aST:.1 J,~ C .cf!}.
:!~-T SOESipo L•'JU :'i
LL ~•..Jl..__ ,:1 L 1'
c,+r_1 da:~ or 3~ __1:» :r s : i__ 18 19
S o, ,kin line.
lal vii, u17A- Or ICR_.h ca--,l,.,
r)L-AA
',1z-tu ac2:-~r i~i; }:n~_}.•~rl: v~l I~SE(Z - - -
Q
- _NNP R- s Z 3Zy Z
;j : Jul
-41
' -3 4
/ i 3. r,,2 .qr
N.B2.4T~AC
U{ ~
~D.U s ♦ 4 ~
of .
co m
zb o
t L
40
33
U11 \ 1
V L L\ \ 1 AC
L' ~i 1 \ N.B. 1.81 AC I
2 r r
p, V
\ 1 . 1 ♦ z rn I ,
1 I I \ I G7 ;
+ \ z
a
N. E,
32 \ t.~ ' +
3.07 AC,
N.B.\ 1.13 AC \ 1 I
+
, . t ♦ r
t L
s 20 .
i \ \ N.B. 1.02 AC
i
OA of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Na:aco•_
FILE INFORMATION SYSTEM SPECIFICATIONS
Dwnor Septic Tank '-aDacny call 11 NA
Penn[ # Septic Tank Manufacturer W(£SE.rZ O NA.
DESIGN PARAMETERS Effluent Filter Manufacturer .17 O N.4
Number of Bedrooms c1 . NA Effluent Filtei_Mode' (0 b. 0 NA
Numbe: of Public Facility Umts NA Purnu Tank Capacity al NA
C,O I 1 N
_stimated flow (averaoel _ aaliday Pump Tank l0anufaclurer .A
Design, flow (peak) (-stimatee 1-5) galiday Pump Manufacturer - I NA
Soil Application Rate - - _7
galidayift_= Pump Model A
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA
Fats, 01 & Grease (FOG) 530 molt 0 SanoK;ravel =iltel IJ Peat Filter
Biochemical Oxygen Demand (BODi 5220 moll 0 NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids ('SS; - 15C mg/1 Disinfection El Other:
~retreatea Effluent Quality I Monthly average Dispersal Cells; _ NA
Biochemical Oxyger. Demand (BOD-0 530 mgf, Ground (gravity) ❑ Ir-Ground (pressurized)
Tnta Suspended Solids jSS1 ' 530 ril ~0 A. = At-Grade IJ Mounc
Fecal ;:ilrform (geornetric meant 5104 chi: 100ml 0 Dnp-Line - I.I Other
Maxi Effluent Parace Size X in din. ;AA. tther - Nt%
L l NA 1)
-Values typical *or .rner ❑ NA
dorneslic wastev;ater anc septa- :anr. of iuent
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tank(si A' least once every. U l (Maximum 3 years) a Nn
ear;st
^ump out contents of tanks) When combined sludge and scorn equals one--thirc f Y,) of tank. volume fl NA
ye alhi5)
Inspect d:soeisa' cell(st 2 At least once every: F] montsi (Maximum 3 years) G' NA
-
;Bear effluent filter At leas! once ovary: ❑ month(s) - NA
gycagsy
inspect pump, pump controls & alarm - Al -Ie- asi once every: - - Moh. _ NA.
- year(s)
=lush laterms and pressure test At least once every- _ moo s, NA
Otac-r. - -
A' Icast 0nre every G months: NA
❑ yean;si
Dtner. - 0 NA
MAINTENANCE INSTRUCTIONS
Inspections 0` tanks and dispersal cells shall be mad= by an individual narryino one of the following licenses or certifications: Master
Plumber, Master Plumber Restnctec Sewer. POW75 !nsnecto-: I'O'C"v?S Maintainer, Seotage Servicinc Opeiatui. Tank inspections must
inchrae a visual inspection of the lank(s) to identify any missing or broken hardware, ocntify any cracks or leaks. measuie the volume of
combinec sludge anc scum and to check for any back us o: oonding of effluent on the ground surface The dispersal cell(si shall be
visually irwecioo to check the effluent levels jr the observatior pines and to Check for any pending of effiuew on the ground surface.
the ponding of effluent on the ground surface may indicate a fading condition and requires the immediate notification of the local
.
regulatory authority
+dhen the combined accumulation o` sludge and scum in any tank equals one-mvc l or more of the tank volume. the entire contents of
the tank shall be removed by a Seplage Servicing Operator arid disposed of in accordance with chapter NR 113, Wisconsin
Aammistrative Godc.
AI'. other services, including but not limited to the servicing of effluent filters. mechanical or pressunzed components. pretreatment units,
anc ary servicinc at into vais of -12 months, shall be performec py a codified 'A'-S Maintainer
f, service report shall be provided to the local regulatory autnorny tvi nin IC d iy® of cornolet:or o` any service even;.
cf
START UP AND OPERATION
i or new construction, prior [Cl use o- the POWTS check treatmew tank(si for the presenv of painting orooucts or other Chemicals that
rnav impede the treatment process andior damage. the dispersa' cell(s) If high concentrations arc detected have the contents of the
tank(s) removec by a septage servicing opemfor prior to use
System start up shall not occur when soil conditions are frozen at the infiltrative surface
=wring power outages pump tanks may fill above normal highwafer levels. When power is restored the excess wastewater wit! be
discharged to the dispersal cells) in one large dose, overloading the cell(s) and may resuf' in the backup or surface discharge of effluent.
o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prio: to restoring powe• to the
effluent pump or contact a Piumbe, or POVV'S Maintainer to assist in manually operating the pump controls io restore normal levels
within the pump tank.
Do not drive or part, vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact . the area within
5 feet down slope of any mound o' at-gage soil absorption, area.
Reduction or elimination of thr.• following from the wastewater stream may improve the performance and prolong the life of trie POVvr-•S:
antibiotics. baby wipes. cigarette butts. condoms. crotton swabs: degreascm: dental floss diapers; disinfectants, fa:; founoabon drain
sump purnp) water. fruit and vegetable peelings gasoline: grease: herbicides; ill scraps mrdicatirins: oil; painting products.
pesticides. sanitary napkins. tampons: and water softener brine.
ABANDONMENT
V;'~Cn the P1')6NTS fails andior is permanently taker, out Df service the following steps shall be taken to insure tha' the system is properly
3rd safely abandoned in compliance with chapter SPS 383.33, Wisconsin Administrative Coee.
• All piping to tanks and pits shat. be disconnected and the abandoned pipe openings sealed.
• I he contents of of tanks and pits shah be removed and properly disposed of by a Septage Servicing Operator.
• After pumping all tanks and pits shat be excavated and removed or their covers removed and the void space filled with soil,
oravel or another inert spire material.
CONTINGENCY PLAN
V the P'YA'TS fails and cannot be repaired the follovving measures have been. or must be taken. to provide a Cape compliant
replacement system.
❑ A suitable rcplacomeni area :"s been evaluated and may De Utilized for the location of a repiacenri soil absorption system.
The replacement area should be protected from. d:sturbanCe and compaction and should not be infringed upon by required
setbacks from existing and broposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is no, available due to setback andior soil limitations. Barring advances in POIPo7S technology a
nolding lank may oe installed as a last resor. to replace the failed POVVT S.
❑ The site has not beer, evaluated to identify a suitable replacement area. Jpon failure of the POVv''S a soil and site evaluation
,Rust be performed to locate a suitable ieplacemaot area. If no replacement area is available a holding tank may be installed as
a last resort to replace lire failed POVsTS.
❑ Mound and al-grade soil absorption systems may be reconstructed it place following removal of the biomal at the infiltrative
surface. Reconstructions pf s.rc•f systems roust comply with the Riles 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
Names Name
~nonr.~- Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name f tk'_l' k r'v-'~ /CL'J(+ !
Pnene - Phone 7/f... 3~, - `A,' 9& -
This oocumant ,vas d-aRcc ; r ccr I;ar,e ,v n' cnarter SPS 3E2.22;2;i$1 1,a;&':", and 3f,2.r4' . 2) S.;3i Wis=rsin Administrative Cude. Rev sec 3r.^j: 1
3
I~
~IrL YImm{L.V4l .>7t8tQ1 rI~4S~OQ.`
W. 7
NriYnn !4<d< _.._.-_'ICC.. ~!'?Jvali-•IC. aj:
F.K1iyt_ S .J ~m3 •M.. c.\.L J.10t
•):'1 im NIALN- NAANCE A.Vu f5N%_L. CFM CA771✓:
lxszae W rs5--•.a.«e M.T"Fa ta_` m n vv , S.l..r s?s s• veer P.+,v
•.ze•::L:.~xA-T.~i:r_3e:.T=_kn~-_~-c i•a>sw-s.~~~}~e~-:;..r-<r t•~cS~:Ptc-
-e-~y.2f+~3e?u-iso:3: r~Zi[in:+c .:e ~~=:t wzv.. C_.:agsc- _:a;-ucnwe
:s:csvba~e <ps~aa:m i>?S 7RS~X:)o6c.:+ge ::-9. +:r+<:a¢)Sa~Y G,forr<
-L[P~yeey.n]e+L~cac cti:ni`:~ry CaC.YumrcilZavni Ygzfinea •sa5:c..-r: rac-.y;n; ~i~
rnz e>t,7 • ucr ~m!+r, joe+Yme plcahn, scut ::.a::.r a. Som•d 1~+~ 5'4=Y+' ^s ;:l*• passe
~scresx fj•ao<t cYSS~ u 6 RWo 5`~b :•c~+z aia f-' z~ocx ~ pz-~^-L (C .rrv;4 xc.: h3 a
ins :5 f--Y m! ,or-
:V . CF L9 ST:4➢CL t.,. ~ ~s C➢'sSJS LY F x~Y 61 YA S w:A
s..-I.r6I,,-. ue t) Sr:+~+r9m: e! Ww) Az'Frd-- d..i a: 4e ?~eSC<•^:Gi eu.rn<:,
$Sd d. wsY Cc rsi is •z sya. ~s¢m :ss ba xh_^'d ea be cot*ad n6]lzol ¢ S: S`-
C:cryP^^, 7~T. `t•.msG rtl.a 3G dM•a:s mac y*r
-wx=9'the ciuena~msfss sets m9x be5d nr3ade~. =tee ®'rt ~ecre!s)a`. `.e
i'~ deamYeG e••.wq yy<•ytee 0.'s+'000~ 6eed:eoadeC P.eevr
\uber of bed~2
s soD. DAB'
SI( .1T AZ: ~Gti'w:~cl
-jlox CeCs =39 rick m be _My 7cm ~•--Z;''atnd CY ms °+~i S ~Y
syde <rd-1k 4➢ • remded sc'sLp iwd 4m Cs Aepss dJeN• OSs eed a ~Td d 3e ar.5ed Bey aC f
dt amde mb*s}a7 am
IV. K^7
Vdsconsin Deparmie"I Of CorMnerce PRIVATE SEWAGE SYSTEM County:
St. Croix
Safety and Building Di",wn
INSPECTION REPORT Sanitary Period N0' 420338 0
GENERAL INFORMATION (ATTACH TO PERMIT) Stale Plan ID No:
PFrsdlal infotmabon you provide may be used for secondary purposes (Privacy Law, x.15.04 (t)(m)I.
Pemxl Folders Nanxe. City Village Township Percal Tax No:
Quest Development Corp. St. Joseph Township 030-2127-30-000
CST BM Elev: 1 I Insp. BM Etev: BM Desaipion:
"IZ• `f 31 12- 1` s CS i t w 2 a
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic! Benchma ! Z
Dosing Alt. BM
Aeration Bldg. Sewer
Holding SUHI Inlet
~•°`f 42•x61
TANK SETBACK INFORMATION svHt ousel
21 92.39r
TANK TO Pit. WELL BLDG. Vent to Air lNake ROAD Ot Inlet
Septic 7 DI Bottom
Dosing Header/Ma Ax / _ _
Aeration Dist. Pipe
r 3r
Holding Bel. System p dr. W
I
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM a 60"e C-.
twr
TDH Lift dcgon Loss System Head TDH Ft
Model N.
For in Length Dia. Dist. to WON
SOIL B ORPTION SYSTEM J
ENCH idth Length Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DI 3, 1 S7
SETBACK SYSTEM TO O P/ B ELL LAKEISTREAM LEACHING Man uer
INFORMATION CHAMBER OR p
YDe OI Syxlem: v . I UNIT Model Nu rr
DISTRIBUTION SYSTEM
Header r 'told 10,stributI11111,. X Hole Size Ix Hole Spedng eM to Air Intake
Longth a_ _ Length Dia Spapng_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 1 Depth Over xx Depth of xx Seeded/Sodded Mulched
BeNrronch tr' ~nntteyer Bedrrrench Edges Topsoil 'tj Yes ,Ml No r~l Vas Bi No
BF7W+uEn~tew(71uudeFodediscrePe~GCp ~t~) i ~ecpgr, , atD~ppL- inspection#2:_-
L doy, 1366 Birch P, k {loukon, WI 54062 S 1/4 SW 1/K2+4 25 TT,330N R'20W)Birch Park LoY-(t331~ • Parcel No: 25.3020.1037
Q~a aaC IF -Icv
L) Alt BM Description=
2.) Bldg sewer length = ZS •0 1
~amount of cover - Ig sr
Plan se other n Yes Osto )2 10 02 I I ~ -
U
Use other side for additional information.
Insopdors
SBDE710 (R.3107) - S SgneWro Can. NO.
q 40,1-t )
3
wmconein Department of Commerce SOIL EVALUATION REPORT Page 1 of
Division of Safety and Buildings
in accordance with Comm 85. Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must county St. Croix
incl de; but not limited to: vertical and horizontal reference point (BM), direction and 9 ,~n
percent slope, scale or dimensions, north arrow, and location and distance to nearest road parcel I.D
. ~3c / -2-d ozro
Please print all /nformafYon. R Date
Personal rMOrmetwn you provide maybe used for secondary purppys (Privacy Lew. a. 15.01 (1) (m)). P/,o "
Property Owner Property Location
Quest Development. Inc. Govt Lot E 1/2 114 SW 1/4 S 25 T 30 N R 20 E( 0
Property Owner's Mailing Address Lot 0 Block if Subd- Name or CSW
Suite 150 107W Old County Road IS 33 Birch Park
City Stale Zip Code Phone Number ity DNillage • own Nearest Road
Plymouth I MN I 55441 ( 7¢3-595-9512 County Road E
Josenh
Q New Construction LlseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replaoement ❑ Public or commercial - Descrbe:
Parent material I tw'cc nv nut wash u ds Flood Plain elevation if applicable, XTA \A' R
General recommmmenb mendations: This site is suitable as a
s below grade conventi~tat sYs O
and rec.C~, t- 1i
°5 y67&73-7 7-0 RE i t/s~ ~c ^T 92.0 " y Xd' d rsrizF'rca=~
8c rcr a 71/ B1 9 6Z. ,t°Wv49- 4wCX ,4.e E79~~ In fll i + ~XOrU~2
ring
❑ d()N
1 Boring N n Bo Ground surface elev. R. U /
n- Pit Depth to limiting factor 96
n Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou i"Root&. GPD/fF
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'EfWi 'EfW2
1 0-8 IOyr3/2 sit 2msbk mfr cE2f,
.5 .8
2 8-19 _ 10 r5/6 sit 2mcbk mfr C.5 -8
3 19-37 I0yr6/6 - 7 Ivfx Osg ml - .4 .6
3 37
-100 7.5yr5/6 s Osg in) 7 1.2
92 .o b~I l 7~ 44- of 88
y8 y„
a ~m9s 0 Boring 7, 31_06/ 14_50 - SyS~I°~'t" ~a21611j
Pit Ground surface elev. ft Depth to limiting factor in
Soil Application Rata
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rani. GPDRF
in. Munsetl Clu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'ERt2
1 0-6 1Oyr3/1 sit 2msbk mfr cs 21' .5 .8
2 6-9 10 r4/3 sit 2msbk mfr cs if .5 .8
3 9-14 IOyr4/6 sit 2msbk mfr cs .5 .8
4 14_50 1Oyr6J6 t20.5yr58 Ivfs ]fgr mfi cs 4 6
5 50.110 7.5yr6/6 s Osg ml .7 1.2
/ w 4~c1~1~//tom/
Or &
Effluent #1 = BOD > 30:5 220 AWL and TSS -30:5 150 mg/L ' Effluent V =J160,<
ntg1L and TSS < 30 nrglL
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Dallis Evaluation Conducted Telephone Number
1432 120th Sttoet, New Richmond, WI 715-2462454
t. r~ICil L
Property Owner Quest DevelopmenLInc Parcel ID 0 _ Pape 2 of 3
❑ Boring Al Boring -7 bl .
❑ pit Ground surfaceelev. ~R Depth to limiting factor >96 in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EfW1 •EIfM2
1 0-7 10yr3/2 sit 2msbk mfr cs 2f .5 .8
2 7-20 I r4/6 sil 2msbk mfr cs if .5 .8
3 20-32 10yt6/6 7 Ivfs Ifgr mvfr cs .4 .6
4 32-96 7.5yr5/6 s OSg ml 7 1.2
Boring 0 Boring
pit Ground surface elev. ft. Depth to limiting factor in. Sol ton Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMP
in. Munsell Qu. Sz, Cont Color Gr. Sz. Sh. '0101 'E102
❑ Boring# Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Sol Applicaticon Rare
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu Sz Cont Color Gr. Sz. Sh. 'E11f1 'E102
Effluent 01 = BOD, > 30:5 220 mgr. and TSS >30 < 150 mgrL ' Effluent 12 = BOD, < 30 mg1L and TSS < 30 mg&
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 ountact the department at 608-266-3151 or '11Y 608-264-8777.
S80 U10rW atow)
3" qo'
~o of lAncQ~1 14 '
gill
4~'.i `id43 to Rw,'
V) (A vo
89.0 \0
63 &j, e
3v
~y Pe
r~ ,,,,v - 13.8
21l S Q,~
PE,vt~i N (r Lop'- TU 13 E r~SS!(rv ~cp
~ .yE~v i.v0 i U%D U~ L ~v F'o,P iSSvty c~ ~F
~xi STi t1(r P~it/s ~¢i/ GEC Nf *T5
0 3f9 • 2-/) 2 4 . L D oab CeN rte T tviS.