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022-1011-30-125
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 453359 0 GtNERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Philen, Christopher & S acey I Kinnickinnic Township 622 611 - _' CST BM Elev: Insp. BM Elev: BM Description: Section/rown /Range /Map No: 05.28.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark q g O / Dosing Alt. BM Aeration Bldg. Sew Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet 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 , p Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM S BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /LS BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type pf System: r CHAMBER OR C f� n^ 1 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 IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Y� {� No Yes ] No COMMENTS: (Include co de discrepencies, persons present, e(�M)v(L Inspection #1� / _ spec /, #2: Location: 1055 CTY Rd N n U b rr(SSW 114 NE 1/4 5 T28N R18W) NA Lot i is Parcel No' 1. Alt BM Description 0 1 14 O q F L S0 / Oy _q ll' 2.) Bldg sewer length = W[{IWrl.d 5/{. amount of cover = C�rY Sy546"n 3.) Contour Plan revision Required? Yes J No I Use other side for additional information. _� _� __- __ _ -_ — __.___ ___ ____�_. _.1 SBD -6710 (R.3/97) Date Insepctors Si nature Cert. o. p - rains /ns s _ Safety and Division ' f al TAI w. w Avg 2 ST. CROIX � n�,n Wied istna 15 I ( / Panak Nw Am (to be filled in by Co.) Department of Commerce ( )z61 Sanity Permit A iic do c 07 Jim I.D. Number In mcmd with Co mn Sanitary we. Adm Code, P� - `X 2004 may be toad for —ooauy pwp— Pnmvy law, S.tW(t C un,TY Address N/ ifdiecroA d m mailing �N L Appha lon Ioferteatba - Plow Phut AM Worm" I�G 055 C� � Property O nnr's Name 4 Q Parccl # Lot # dRoek .# CHRISTOPHER & STACEY PHILEN Q Z - /0 - 30 - 1d4 -- rfoperty Oww's Mailing Ad*= Fropcoy Loation 306 W. MAPLE ST. SW v, NE �� salien 5 City, State zip code Pb=Numbw ROBE WI 1 54023 1 651-587-4842 '� L °n ` ) T 28 N; IL Type of Boilftg (cbeclt all that apply) R IXta2vano 4 PER SUBMITTED HOUSE PLAN V.17/P4525 723166 ❑ amteo..d D..b twat RIO DEFUSER CHAMBERS (3) 100' TRENCH GuW Llvtbt KINNICKIN III. Type of Permit: (Check buly one bas at line A. Covapk6eldo B ff sopulsk) A (XN. System g ❑ Rq wconc Syd. ❑ T oeo naah MMM Talc Repiaeemmt Udy MM ❑ Odw oMeauion to Egg Sydow B. ❑ Pweait Rmte W [*Pmadt Revision ❑ Chata¢e Of ❑ Permit Traver to New List PWviow Pem d Number and Date In=atd Bdb a EWWAH o elmnba ONaw 453359 -7/ IV. T of POWTS Cbe& all that gft [Uon ftem iaed lad3rottad U M..W > 24 m ofst Wde soil ❑ Mood < 24 is of sabW sod! ❑ At-Qr I J Saagk Pas Sand Filter ❑ Commum eland ❑ Preaaulaed 1rWkowad U HoM ft Tw* ❑ rnt Firer H AQabie 7Y 9=ft Uetit ❑ KL9K = 3 1, Recircu13g%Syattl e*MtetliaFilter tiaagCf MAW ❑ line ❑ Grs ❑ vlt er(woplaat) V. reate t AMS "fornwtiaaa _ Flo" (Bpd) Design Sw7 AppUcati n gpdA) Area Requ ( �t Area %V'Of d (4i 5 3atem FJettatao 600 .4 1500 °� _LU8.2& /5 2 33 102.68 YL Tank INo City in ToW N,"w mandkoover Aefab Site Stud Fiber PlwUc CoYom clonow of thtim Ccnade C ondnuted Glats New Emu* Turks Taa6 xAWcr1kM"Taak X 1250 1 WIESER YES Aeu%c TmdznW Unit r TMs'ng ('- Ipmiier VIL Roponsibility Statement I, Ae ataietaiptsi, attt�e for iMatiMtsn a�tLe deOVV13 tisw e�t`e atlheier plstat Pltoobm's Name(Prud) � ttWtetwv 715 - 381 - YtrmeN TODD FEATHERSTON 1704 Plwnber s A"— (Sb*4 Cdr, &at , Zip ) PO BOX 467 HUDSON, WI 54016 v t use Orly_ - - - - -- ff� Swkuy Permit Fee (jndtdes Gro mdwoer Dart Agin AoDrvved LI DirapCtvnbd 9meLsrgo rw) ❑ Owner Gi+m Reasetaa for I)eeia! IX Conditions of Approval/Reams for Disapproval Gf/vC� l � /�,p1�4� G�Q�R.�i. /I/ rd�d t/• � �iSd� �. J ux& cosop ete pts tta dw Cwmtr a*) br the oyfto so ss@a meet ka (Ma tan i 11 bwdv a to stmt Parcel #: 022 - 1011 -30 -125 04/02/2010 03:26 PM PAGE 1 OF 1 Alt. Parcel M 05.28.18.6713 022 - TOWN OF KINNICKINNIC Current [A ] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - FEDERAL NATIONAL MORTGAGE ASSOCIATION FEDERAL NATIONAL MORTGAGE ASSOCIATION 7105 CORPORATE DR PTX -13-209 PLANO TX 75024 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description * 1055 CTY RD N SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.700 Plat: 4525 -CSM 17 -4525 022 -2003 SEC 5 T28N R18W PT SW NE CSM 17 -4525 LOT Block/Condo Bldg: LOT 01 1 (5.7AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 28N -18W SW NE Notes: Parcel History: Date Doc # Vol /Page Type 12/30/2009 909400 SD 04/07/2005 791678 2780/082 EZ -U 10/17/2003 744077 2438/464 WD 05/28/2003 723166 17/4525 CSM more 2010 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/07/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.700 80,000 184,000 264,000 NO Totals for 2010: General Property 5.700 80,000 184,000 264,000 Woodland 0.000 0 0 Totals for 2009: General Property 5.700 80,000 184,000 264,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 G� w� U' s i w l I f � °® \ (D % 2 ( 0 # � , $ 0. U \5 0� ca 2 �° U . :2 < \ i� 2 § j E « 7 @ E IL to » } \ \ 0 ( £ o i ( K \ c 2 f ( 7 i � 2 ( I� \ / _ \ k5 2 § £ o w' �� § z § �® LO / - 5 ] 0 .. L Qsl- £� - CL k ° L 2 ■ z / \ LL 0) 2 � k \ .. �z 00 \ E .2 � a a a t a � \ L) / o U-) © § (/r �[� �/ 2 §< t ƒ ji4 2 = < z n 2 Lo %� 2 ��� _ _ } F \7 j c m / \\\ \\\ & > - § S) '� g)o z / ) , 2���» a .. c / 0 CL 2 \ 0 k k r - - y -,r Z>T,s9t-&-Y s. . ` Sr -dip I RP 1 ti 4 0 1 • - " �i1�' -.EL ,m'o'o � . " - _ - - -- - o .s y 3 ,- At Y S7 .09e-" rJ 6/ Sf� grew. ;t* O 1ko -- - - ob p ea SYSTEM CROSS SECTION CHRIS PHILEN 1055 CTH N - KINNICKINNIC MAN HOLE INSPECTION PIPE GRADE 10 5.1 0 1 ' 1250 U E - ZABEL FILTER �L..__......__._._..�«. SYSTEM ELEV. 102.68 16 BIO DEFUSER C A 100' O 1250 0 ' o 16 BIO DEFUS R 7 ` -j 1 e BIO DEFUSER CHAMBERS A id ryu- -fo Vn�- Io * 1007314= TRANS.ID# 44 SW 14 NE ' /4,S 5 T 28 NA 1 =5 I LOT 1 BL Sm C T KINNICKINNI - �i14 EROSION & SEDIMENT CONTROL PLAN Parcel #05.28.18. Site: 1055 Ctv. Rd. N, Lot 1C (Kinnickinnic Twp,) — owner's) Christopher & Stacy y hilen Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement off site. Surface drainage is to the northeast with >50 ft. from septic system to adjacent drainage swale and Lot 2 of CSM #723166. 2. Create temporary diversions graded ALONG CONTOUR between excavation areas and any potential receiving waters (this includes road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. Do not allow diverted runoff to be directed onto neighboring properties. (Refer to specification sheet for Temporary Diversions provided by Zoning Dept.) 3. If builder /excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with diversions and vegetative buffers. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment control installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #665054 Owner acknowledgement of ESC Plan requirements: / /2004 eA fy I c N 3 v n d d o eD 3 m I c :: c e 0 A 13 � m d rr A T N a m m y 0 ° 0? c N • 3 :5. Np W CD 7 IV N I�1 I p O w O 0 y O CA O O O ° c' v 7 CD cr 7 m w 0 V O O C C O O W 7 w S 0 � w C CD cn v cn z D U� v 0 z D - a e I p c= D w c5 it c D w a C a° a W o. c n W ° m ` �1 I 0 a 0 0 "`` FP m m N (_T1 O �. O O �. O A C1 0 lr. CL n 3 z a c a I S N a O O O z 'M m m� m mo o < z w d m m tntncnQ nD s CD 3 � � Cr T v v (D m m CD D D N fD .d.. w Cn A O O O O 0 C CL S. a 0. !T N I w I c D o N, m 0 y. m 0 X c I 0 f°o c °o s 0 a CD Vl (D cD w m I a� ;0 a = X y cr CD 3 cn O m C O m N 0 A 7 96 k w CD m W C CA CL m C <� z OD A M C CD 0 :7 z 0 � a m I O O R z < I D- 1 0 -4'0 C/) D D - io 0 - Cl) D o00 �oy ?a O�o���<3on��a I S. 3 0 < C a< 3 _? C Q < , c o 0 �- a 0) CD "a m 3 o f o rn"a m n �o c m 0 ?a y v m Q. I - =r MOL m z a 0: -smQ mC z 0. <, (0 w m. m = w 0. O < co w gyp. m m 0� S a o C Q m < < * Zz c = §, m CD p ( D N < : E C c S. m M fo m�- 0. CD w< S 3 w w 7 0 CD a m w< 7 ? w a. o330 �'o�rn ca o330 ca % O fp =-0 CD S �; O ' j O S Qo =- D a W O S A ? m m m m 3 0 cD m A m 0 3 0 0 0 m @O <vo� g 0 -0!Z o n <Moc, vA. CDm:o����c� _0a. b CL l< ° -'o o m -A 'S m 0 0 3 03 3&ga w l o w3w O L a ) 0 0 c c� Dam a w y ?�� 3 c c$ a' a w w ? i o� c 3 m e CD �� o � 3 CD f � o I w ___.� w v 3 __o m +� I 3 m m m 3 m m o o m m A o o o o kj CD 0 a f Wisconsin !D airtmentofCommerc RECEIV IL E ALUATiON REPORT Page of 3 Division of Sarety and Buildings in accordance with Comm 4, Wis. Adm. Code ( f n Q , County Attach complete site plan on pa not lektha n e 14x 4YInCIIes in size. Plan must include, but not limited to: vertical ind horizontal reference point (BM I, direction and parcel J.D. percent slope, scale or dimension , nortlWrrdki 4hd IdWolb4arid dis nce to nearest road. Z Z - 1 6 // - 3 _ 4) Pleaselaria, NI G OF t viewed D Personal information you provide may be used for secondary p eg (Privacy Law, s. j5 V l) (m)). G�� ' 12 /1 Q Property Owner Location +, '\ {1 y ✓� Govt. Lot S 1/4,t/ S r j' T z IS N Ri E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# , 7 City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road I C- 0 New Construction Use: ® Residential / Number of bedrooms _ 3 - � Code derived design flow rate S [9 r7 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 0 U +1-, c, / oil Flood Plain elevation if applicable ✓��� ✓�- fft. m General coments � '9 GvC. - ,� and recommendations: 1 U I � 5- r-? v . JY �it-, 3 to a Boring # Boring pit Ground surface elev. _1_ ft. Depth to limiting factor �{_� in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfffF1 - Eff#2 - --� o / Z- s r' z- 1-! l W4 I' r C S 1 V - r S 3Z 0." vya:— . L U-1 Boring # Boring ® pit Ground surface elev. /0.5 • /b ft. Depth to limiting factor in. Soil A Rate Horizon Depth Dominant Color Redox Description Texture Structure tuure Consistence Boundary Roots GPDlfft In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 S, 'I I V Z -3 u. S1 CI-/ Yr cS 32 - , K y /& S as W\ I CS r - /n • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) - - S CST Number > .a✓ z G� Address Date Evaluation Conducted Telephone Number i l Property Owner Parcel ID # Page Z Of F-51 # Boring ❑ Boring pit Ground surface elev. lJ ft. Depth to limiting factor in. Sal Applicati Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 v _I 3/ z 5, Z S 1M r-- S ( S- Z ti ;3Z _ r 3Z -6 w. ►M - ( F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor 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. 'Eff#1 I 'Eff#2 a Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 • Effluent #1 = BOD > 30 1220 mg& and TSS >30 < 950 mg4- ' Effluent #2 = BOD 5 30 mglL and TSS 5 30 mg/L 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. see- s3wtaeool ! PAGE OF_j L N /. �!S T" N R 1 lrE or W NAME L,OT# � � LEGAL DESCRRTI� , SCALE: BM I ELEVATION --- U U BM I DESCRIPTION L o L (' l r BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION �G • S ALTERNATE ELEVATION CONTOUR ELEVATION t X65 DATE —o SIGNATURE - w I ST CROIX COUNTY SEPTIC MAINTENANCE AGREEMENO AND OWNERSHIP CERTIFICATION -FORM Owner/Buyer Mailing Address 1017 Property Address /O s 5 & u h f rd (Verification required from PlanniWg Department for new construction)_ City/State Parcel Identification Number 0 a ibtJ a .s o a LEGAL DESCRIPTION Property Location- %, / %,, Sec.. S . T2 &::W, Town oCZ i�v v.�iL Subdivision . Lot # Certified Surrey Map # '2,7 3 / Z. i�, . Volume Page # o v� Warranty Deed # r W Volume - 2y 3 Page # Y Spec house 0 yes b( no Lot lints identifiable yes O no SYSTEM MAINTENANCE Improper use and mainteaanceof ynnrseptic system could resalt in its faflnae m bandle vwastes. Propermain Dente consists of pumping oat the septic tank every three years or sooner, if needed by a licensed pumper. What you pat into the system can affect the fmtctioa of the septic tank as a ttr fitment stage in the waste disposal system. The pmpecty owner agues to submit to St. Qoix Zoning Department a certification for, signed by the owner- and by a msta phmgw.3oumcynmpbmkc4nstncWphmbaorahcensedptimpavmf j mg*9(1)&em4dewastewatc &Vosalsystem is in proper operating condition and/or (2) aftariatpoc . and pampiag. (if near), the septic tank is less than W full of sludge. Uwe, the undersigned have read the above rcquirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Counna a and the Department of Natural Resources; State of Wisconsin. Certification stating that your septic system has been mast be completed and returned to ttre St. Croix County Zoning Office within 30 days of the three expirati te. SIGNATURE OF DATE OWNER CERTIFICATION I (we) certify that all teams a =waaanty form are true to the best of my (our) knowledge. I (we) am (are) the ownet(s) of the abov , deed recorded in Register of Deeds Office. y/ j vq SIGNATURE OF CANT DATE $sssss Any information that is mis- Mrascated may result in the sanitary penult being revolted by the Zoning Depaitment• ssss «« ss Include with this application; a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I U 2438 P 464 - 744077 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 1 — 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD Document Number 10/17/2003 10:00AK This Deed, made between Frederick G. Lenertz AKA Frederick G. Lenertz. Sr.. a singto person , Grantor, and Christopher Philen and WARRANTY DEED Stacey Philen, husband and wife , Grantee. EXEMPT # Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRANS FEE: 149.70 Wisconsin (the "Property "): COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address First National Bank of New Richmond PO Box 89 New R±ckAp7FLq1pjWTj Burnet Title 7550 France Ave- S- L �a First Floor Edina. MN 11 ! ( 022 1011"Li -01000 1',_, Closing Central 2 Parcel Identification Number (PIN) l This Is not homestead property. (Is) (is not) Lot 1, Certified Survey Map filed In Vol. Page 4 45A5 as Document No. In part of the SW % of the NE' /. of Section 5, T 28 N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this kg day of kmsk, 2003 (SEAL) (SEAL) F erick G. Le rtz (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix County authenticated thts O T PhEf 6f P U B L I C STATE OF WISCONSIN Personally came before me this j5: day of A 2003 the above named 3 Frederick G. Lenertz AKA Frederick G. Lenertz. Sr.. a sinale person to me known to be the person who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing in trument and acknowledge the (If not, A pme. authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY W `L / Coldwell Banker Burnet Notary Public, Statd, Wlscdnsin 1301 Coulee Road Hudson, WI 54016 My commission is errnalte (If not, state expiration date: 3 -24176 \� (Signatures may be authenticated or acknowledged. ) Both are not necessary.) ` Names of Pe rsons s in an y ca Da cItv m ust be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 —1998 Milwaukee, Wis. �- uuttiunturutt►p to I t i / .� ct1 ZO� (��4G W Z > N p V) O W w w i W W w W } C7 O�lr d ^ ^ r+= 2 Z 7 co N .. 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WAZSR - - ` REGISTER OF DEEDS � I ST. CROIX CO.. WI S N � RECEIVED FOR RECORD m O (E) 05/28/2003 12:45PH CERTIFIED SURVEY MAP o cn 50 � REC FEE: 13.00 $ 003 COPY FEE: 3.00 C s^ tZ. �v @- r- m rpm mNC� N� 1" PAGES: 2 mn g o :Ced G » O � g mcZ7� �i�� mzg m w a a 1 f np�lLt rB.1� ��g 9PP ��� ,� R Z p a_ g m x p r n x r Z O �!•ry OD I'�1 p O z N i BEARINGS ARE REFERENCED TO THE ,p[� EAST —WEST 1/4 LINE OF SECTION 5, c> E N , OO - Y - - - Dp - - -o, p ASSUMED TO BEAR S88'04'02 "W J W' ------------ ---- -- -- ---- --- ---- -- - - - - -- �>>• w NORTH -SOUTH 1/4 LINE 0/ C.) Z g NOO °0W03 'W 788.80' �� 2679.86' _ 751.87' 36.9 1946.66' 0 / p m & - --- SOO °09'03" E 5415.32'- - -- ' ' N r A Q v Ln � I cn ��— o O j • cnnzU p r ODD m rn � n D O 25 g Z �o „ ��p Q z g� �j: 4 �� OD m O I QQ i Vg...► 9 A vg° m -cc _1....�� cr nM rn M Z4 6 C Z ra m Z N I ..r Z N f N rt O 7C 0o I d N "� � 1 OD N < M N X -+ Z r O . 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C a) w N U) (D 3 c oZ 3 y u; $ c oZ 3 y C ° U d v ac)) c� ° U y o c cw Z > ` Z a) N.- 3 tU O y L C 0 0 Ia O(a L C a) 0 LL c vY�0 3 E 0 0v 3 E 0 .. : �v a w a p M C V) E' 'O O D M — C "O t 0 N O >. O y a L a) N O p >. O Q f/) a I� Vl U Q fn a I� w fd U L 3 c c Z y o -5 o o -r o 3 w E ° E 0 E ° Z _ :: o a) a) Cc m a) M I v Q E a.5 E a.6 Z M m aC m a N a m ° m ° ca U � N L T N w rn p ENE C EE C C9 N Y 0 0 Y 0 a) 0 + � r m m Q dS '� m Q �a •~ E E 4) , N c m o a) o m @ o a) p c d) F- r N E 0 0 N U E 0 0 > U ° o m o E po 0 ac ° o t p c 3 c E L_ o c 3 c E o y O LUV5 ZS O w'v) Z = I N Z N ' d H H H f- LO E ai ai aS ai a 0 0 0 o m vai d y E2 E2 a) P E LL o c a a L t n L L Z V > > = 0 a � a N a LL LL a. LL LL z a a a a m J U V °o Z Z Z Z LO N O O = O o m m c c m c c Z <n Z . 9) n Q Z . 9) n Z in Lo ' L N f t�q y C CN a y A O m ~_ y = = 1 V U C ♦ a) a) y CM C I L C ♦ C c1.O.I W Y I U `o 7 Q V C ° ao m Lo N y c r a c • ' o o Y a o Z Y a Z c Y a V E € r a 0 a 3 • a! am.2 ma E r Q 0 a 2 O N C> i ;onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix �.afety and Ouilding Division - INSPECTION REPORT Sanitary Permit No: 453359 0 G INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Phifen, Christopher & S acey I Kinnickinnic Township bZ2 W '-3)" CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 05.28.18. r TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet f 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 J � Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM � Z 3 • S�{ Model Number !M TDH Lift Friction Loss System Head TDH Ft Forcemain 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 S ystems O nly 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 Ye� No F%' Yes � ]N, COMMENTS: (Include code discrepencies, persons present, e ) Inspection #1 * (/ / Inspection #2: / / Location: 1055 CTY Rd N n (SWW 1/4 NE 1/4 5 T28N R18W) NA Lot / - . Parcel No: 1.) Alt BM Description = ta /t LtI `r 0 _ �L � � yt�M.�'e� 1 101 �5 ✓LbY4'G1 /LvcaT v.� (h �4 'r/� f!'� 2.) Bldg sewer length = WtUt✓rt� 5 /{� sRih dS/ - amount of cover = CAdY S)/ -�f.`h 1�/� 3.) Contour = r - - -- - -- Plan revision Required? [:'_I Yes (] No Use other side for additional information. _ _ � D SBD -6710 (R.3/97) Date Insepctors Si nature Cert. No. �4 Vd� — 7 ^ � u� • - - - Safety and aquiDnivismion county 201 W. W ortAv�,g ST. CROIX r7Vi/C /sin Madisrnl 15 Permit Number (to be Died in by Co Depar tm ent ( 8)26I�b546 k sera_ 3 J Sanitary Permit Applic do G 072004 P In ammd with Cogan 83.21. Win. Adm Code, prwnd vide toayt�eusea for seWOuatyputps Privacy law, S.oack M�GkCCUNTy r55 . H Nereatnsattma;Img L Application Inforawum - Please Print Atl Infortoatkm I �1�=✓ J PsVe ty Own is Name Q Parcel H Lao # Block # CHRISTOPHER & STACEY PHILEN Q 7 - - ! // - 30 - 1d C Ptoperty Ovma's Mmft AAkvn Proparty Lovdk m `- 306 W. MAPLE ST. SW y, NE v. sediare 5 city, alte A) Code Phaoe Number ROBER WI 54023 651- 587 -4842 28 .raeaBe) T N-, R I.I. Type of Building (check all that apply) il�zraIyl>we7tag_Nmraleeaoas� 4 PER SUBMITTED HOUSE PLAN �N``"' 0 Pobli.Commrrcial - os u �( - &3� QyuQ_ =1v �/t -fin, V.17/P4525 723166 D t wO, n d Dwee 11. BIO DEFUSER CHAMBERS (3) 10�TRENCH Cit y_Uvaiaae &..Kipof KINNICKIN In Type of Permit: (Check me bus on One A. Complek4ide B A. Ix Ne-system ❑ Ra w--- 'sys6am D OA+ermomicafmwE'dsf"system B. ❑ Pit Renewal I * Pe n mt Revisi ❑ Change a ❑ Pamir Trwnfer net New list Previous Permit Number and Date hsw4 sef«e Expwahw Pnm*Ptx ovaar 453359 --/ i OY IV. Type of POWTS Cheek all that mft Lyon -PYwn zed In -GrouW ❑ W wW > 2a m of sWWde soil 14�am�d < z� ai at suAabk soil ❑ Ai Gtada U single Pf�as ssaa Filer ❑ Com uww wai and G n uw iwd b Graort U hold=s 1=C D pea viii r1 Aw.%c 7n=tesa ih:t o R Fjty D Re�uisting synthetic Media Filter ALe&clW Cl aanba ❑ Drip Lore ❑ cant ❑ 09. (c-0—) .3� / Y V. Din rsaLrfreatareat Area "fo rmation: _ D-8103 Fla- (a -: D� Sea AppLewtiao � Area � D.spr>uJ Ana P-"- ed (0) SY�n FJevalon 600 .4 500 >54&.2 - 102.68 Vi Talc Info CwAay in Total Number Matstf cum Plsfab Site Sled FRw Plastic Gallons call"M ofiit M Concrete CombvcW Glass New Enoft Tanks TA36 X 1250 1 WIESER YES Aerobic Tmd nest Unit VII. Responsibility Statement- L the s s[+, sssoe — hss11,112 w *rat >'OWTS ion. M fbe alhebed pk.s. Plwober's Nmme(Print) Pbamber' YMPtms Nattba tiaMMM theme WORAW TODD FEATHERSTON 242514 715 - 381 -1704 Plumber's A"— (Sb (S - aty StstS ZP ) PO BOX 467 HUDSON, WI 54016 oas riaseat Use On _ —,— Amvtw ed L7 Dissppov ed Ssmrtup Pamd Fee (mdadw GmwdwMw Date Aged o D OwnwGnvu Room farpowd / U DL Conditions of ApprevaMeasess for Diss"vowal a /YAJ lYaad 1� (b �e �7 �]') rsr tbt s�laia w!s@�' ant lea thus ttflL t it indses ie stmt { lift Al 3 0 I o c � ' cy E 4).o N o'� N o° 3 3? 3 c st N w E m� Ui �taw`o E c -c �. a c 0 m ° L N L (D 'y Q o a) f0 ro '- C U o ° >I acco�aLV�oi O N v w 'C 'rn N y a) « m N C N y p N 'c �p > O O w O _ (0 O'S O O �L r O - U c O N c O O N c c CL 0 ro C 7 N ' D y E O N g o_ ro 7 N E .. i a .- O N O v� N �a y o cL o 3 -- N a 3 - a •- C o N N iy L 3C L 4)r— ?�o�cDz 4) c Z o o C D CoD c m �� mY >> LL c Vi c ° 0 m CL i O 0� w c o °L N o Q) � E o v c o 3 E a) oro `�cD L c° a� o v .o a •- c° ro t0 a >r y N C c a� c a' E N O co 4 li �Y ai 3 c -Q° ° u �CO a� 3 ` V' m Z w E c z a m g Lo N a c E o U O Z C N a Z :!t to F- 4) o c c a E € v O U C N O O N • C C •� d � L y O o o Q O S; Y ��- O Z m Z O Z 4v Q ro v N O d H I- CV L It La s t c Lo Lo n N EI N N �•J Z .- > IS. 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Lp J Z U > ° c ` a LL LL o •~il R c y CL ° o w '' 4 fAJU z � m c c N Q ° Q Z fn n U) co cl 1 - O � € c E € c ° N co C c c E d b.w 1 � N *4 O N C d N c C N • ' o a Y z N z Y z a co O co CL VV 4Z ° c l r� r A 0 eam r Safety and Buildings Division Courtly 201 W. Washington Ave., P.O. Dox 7082 ST. CROIX CO. Madi wm, W 1 53707 — 7082 SaAtar - mit Number (to be filled in by Co.) CO sin Department of Commerce ( )2b1-6 Sanitary Permit Application St Plan I.D. Number In accord with Cam 83-21, Wis. Adm. Code, pemorW fi6m ation you provide I n — S • [� TC I maybe used far secondary purPoses Privacy Law, s15. I m) - _ .. .. - € Project Address (ifdifferadthan mailing address) L Application Information - Flex Print All Informs $ p s CT� ` 'v Ply (Nmer's Name r; 7 Q 04 1 t,� La a 1 Box CHRISTOPHER & STACEY PHILEN Property 0%='s Mailing Address 7 _1 7 7 771 ; Property Location 1217 LARPENTEU VE. ';;v�� o . ~I ( SW ,/, NE �. sestet 5 City, State lap Code Phone Number MAPLE 1 55109 651- 578 -25 T 28 N., R 1s# ) IL Type of Building (check all that app �TIor2 Family Dwellimg_Numbwoh ER SUBMITTED HOUS P LAN Sabdvis;onN �'� Nt®ber ❑ Public Commtercial - Describe flan r _ - - - -- - -- ---- - — N/A �• S� ; — ❑ Smw t>a..„ Lr� _ - - - -- — -- �� D — ( 'SDl ❑Ciri❑v ;tls>^e EFlbtvruhip KINNICKIN III. Type of Permit: (Check only out box on tine A. lltmplete line B if icabk) — _ - -- A ' IX Nov System ❑ Replawneot System ❑ T T Only ❑ odw mw&wation to Exisdns System B. ❑ Permit Renewal ❑ Permit Revisim ❑ rou Chimp Permit Transfer to New List Pret�i Permit Number J Before Expirat IV. of POWT5 System: Cheep all that appl ❑ Non - Pressurized ludittxsud ❑ Maasd? 24 in. ofsu;tabde i � M < 24 in ofsuitable soil ❑ AKira& Side Pass Sand Filter ❑ Cow Walaod ❑ Pressurrad In -GrauM U Holding Tw* ❑ F, ❑ Aerobic TTY! Unit ❑ ltw*. ding sea) Fd>R ❑ Reme.1ating Synthetic Media Rter ❑ L ting esd Ch..ber ❑ Drip I ' ❑ less Pipe ❑ Odwr (explain) V. DispersaVrreatment Area Information: Design Flow (Spd) Design Sot] Application Rene( Area irm Din;waki Area ( em Elevation 600 .5 ��• D S A4Vj 00 1572.8_0 99.50 VL Tank Info Capacity in Total Number Mamd Prefab Site Steel Fiber Plastic Gallons Golkwo of I knits /' n ^ _! Concrde Constructed Class New Exrstwg Tanks Tanks SeVtio,ar.1k tTwk X 1250 1 WIESER YES Aerobic Trasivr nt Unit - - - -- ---- ---- -- - - -.. rftwM(1wnbCr X 1 10001 11 WIESER XYES VII. Responsibility Statement - I, fire mrla Well, eespuaei of Obe "tie aalaehed plena Plumber's Name (Print) Plumber's S MP/MPRS Number "mirk= Phone Number TODD FEATHERSTON 242514 715 - 381 -1704 Plumber's Address (Street, City, Statr, 7aP Code) P.O. BOX 467 HUDSON, W 54016 DATE: ' .2 /— d VIM Cone !De artment Use Only _ - - -- -- Approved ❑ Disaot raved Sanitary Permit Fee ( lodes Groundwater I Date dratted rstr'mg errl Sigtatare (N Stamps) 3uttLargc ❑ Owner Given Reason for �`� I rr �•-.. IX. Conditions of Approval/Reams /eserviced approval SYSTEM OWNER: 1 Septic tank, effluent t _p r --� n dispersal cell must al / maintained izC; taC as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. attach osarpiete plan (a t`e t:,asuy uoly) for the ►7aesm w inner eat �`� In slat 4 1 -- y C N i \ Ln a� 0 9 �L D e z LOT 1 (;Op*i 1 ate' , e - OF. S/o W.e3 0.? f Tai e,- / 00 0 . "� '00!�p. 1 I I i �. , x . i i I Mound and Pressure Distributia T Design Workshe Site Information (r or c) R Residential or Commercial Design 400.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150 %) 600.00 Design Flow (gpd) 3.00 Site Slope ( %) 98.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = i .,. ..... ....... ..__. ,__, 1.00 Dispersal Cell Design Loading Rate (gpd /fe) 1 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) = 10.71 ft /orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 13.05 Forcemain Drainback 7.00 Vertical Lift (ft) 62.79 5x v " , - 2.25 Friction Loss (ft) 12.50 Total Dynamic Head (ft) ' O V Lateral Diameter Selection in. dia. options choice 0.75 1.00 C". 1 1.25 x x 1.50 x 2.00 x n , ^ 3.00 x (Its 7 Treatment Tank Information 1250.00 ""' " Septic Tank Capacity (gal) WIESER IManufacturer Dose Tank Information 1000.001 Dose Tank Capacity (gal) ! Filter Manufacturer 27.83 Dose Tank Volume (gal /in) H 00 Filter Model Number WIESER Manufacturer Project: Page 2 of 12 Mound Plan View _ t J 1/10 B ::::::::::Observation Pipe ... :.:....... 3 r 1 K 5' A ........... W . .. ............ ................ : B z L Mound Component Dimensions A 6.00 ft E 20.16 in H [ Aft ft K 10.08 ft B 100.00 ft F 9.25 in z ft L 120.17 ft D 18.00 in G 0.50 ft J ft W 23.35 600.00 (ft) Dispersal Cell Area 1 1572.80 (ft) Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.27 (ft) l 1 F `" Dispersal Cell 100.00 (ft) Lateral atera 99.50 ft —►` — _ Invert Dispersal Cell .... ] :.:.:.:.:.:.:.: ............ ....... . 1 E Elevation � :.:.:.:.......:.:.:.:.. t .. l l . { 7r , 1. ? �.1 : � � - �� r 1. -� 1: 4 1•t tom' 98.00 (ft) Contour Elevation K 3.0 %Site Slope Geotextile Fabric Cover Shading Key _o. Dispersal Cell See lateral details on 10 ® Topsoil Cap a 1.5 ft - - Page 4 for number, size, © " " " "" Subsoil Cap w e :`.' "':° :'-':':::.':`,: and spacing of laterals. ���" 6 Laterals are equally ASTM C33 Sand F Tilled Lay 0.5 ft Typical Lateral spaced from the ❑5 Aggregate o t�J; distribution cell's Aggrega ''r' ' ``` ``:``'''` :' :' ' "" -�- centerline in the -- A distribution cell (AxB). Project: Page 3 of 12 Center Connection Lateral Layout Daigram Force main connection via tee or crass to manifold at any point. Laterals are identical P S •= Turn -up Ydball valve or IE x - -11+02 I x12 }I Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 54.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.65 ft Lateral Length (P) 49.28 ft Orifices per Lateral 14 Lateral Spacing (S) 3.00 ft Orifice Density 10.71 ft /orifice Lateral Flow Rate 9.18 gpm Manifold Length 3.00 ft System Flow Rate 36.70 gpm Manifold Diameter 2.00 in Total Dynamic Head 12.50 ft Forcemain Velocity 3.75 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -� 16.28 WAC 4 in. min. Comm Disconnect �_ Tank component is properly vented iZ L Alternate outlet location Forcemain diameter WIESER Manufacturer _� 2 in. Ca aci 1000.00 Gallons Volume 27.83 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.21 534.54 C B 2.00 55.66 Pump off elevation (ft) C 2.73 75.84 93.00 D 12.00 333.96 D Total 1 35.93 1000.00 Do se tank elevation (ft) 3" Bedding un er tank. 92.00 Alarm Manuafacturer LEVEL Alarm Model Number LVL1 Pump Manufacturer IZOELLER Pump Model Number 1152 Pump Must Deliver 36.70 gpm at 12.50 ft TDH Project: Page 4 of 12 Safety and Buildings ov PO BOX 7162 COmmerce.wi. g MADISON WI 53707 -7162 TDD #: (608) 264 -8777 i sco n s i n www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary June 15, 2004 CUST ID No.242514 ATTN: POWTS Inspector TODD C FEATHERSTONE ZONING OFFICE FEATHERSTONE EXCAVATING INC ST CROIX COUNTY SPIA PO BOX 467 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/15/2006 Identification Numbers Transaction ID No. 1007314 SITE• Site ID No. 68 4822 Christopher & Stacey Philen Please refer to both identification numbers, Cty Rd N L above, in all correspondence with the agency, Town of Kinnickinnic, 54022 St Croix County SW1 /4, NE1 /4, S5, T28N, R18W Lot: 1, FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 962832 Maintenance required; 600 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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: Reminders • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD- 10706 -P (N.01 /O1). t • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01 /01). P . 0 • The pressure network is to be constructed in accordance with publications SBD- 10706 -P 0 '�?* sk x Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Ve n sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribu A ' (01 /81) S�QH Fr�FNT • The depth to the limiting factor is 18 inches below grade. The D is increased tQQ inches a� increased to 20.16 inches. JyFF C o A copy of the approved plans, specifications and this letter shall be on -site during construction and o inspection by authorized representatives of the Department, which may include local inspectors. All permits TODD C FEATHERSTONE Page 2 6/15/04 i 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 n � Fee Received $ 175.00 /VtJ'X(J Balance Due $ 0.00 Allen C Wendorf Wastewater Specialists , Integrated Services WiSMART code: 7633 (608)235 -0595, awendorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Christopher Philen MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE w -c.s. : o ' nal y Project Name p,j.ti Owner's Name: CHRISTOPHER & STACEY PHILEN IL Rix O OMM ER� � Owner's Address: 1217 LARPENTEUR AVE. p EppR�IM Rj �r( D�W� MAPLEWOOD, MN 55109 R' ESPO ENC� SEE GO Legal Description: SW1 /4 NE1 /4 S5 T28N R18W RECEIVED Township: KINNICKINNIC JUN 0 4 2004 County: ST. CROIX SAFETY & BLDGS, DIV. Subdivision Name: Lot Number: 1 Block Number: ----- ---- -- Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Soil Test Page Soil Test Page 19 Plot Plan Page 1;24.1 POWTS Application Page 19- Mgmnt Plan Designer: TODD FEATHERSTON License Number: 242514 Date: 05/19/04 one Number: 715 - 381 -1704 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SD13- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) � Version 3.11 (05/01) Page 1 of 12 �/ Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 % coliform of - 36 inches. 600.00 Design Flow (gpd) 0 3.00 Site Slope ( /o) 98.00 Contour Line Elevation (ft) I -22-00 Depth to Limiting Factor (in) j� 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /fl 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) = 10.71 ft /orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 6.67 Vertical Lift (ft) 62.79 5x Void Volume (gal) 2.25 Friction Loss (ft) 75.84 Minimum Dose Volume (gal) 12.17 Total Dynamic Head (ft) 36.70 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons /inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1250.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) WIESER I Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1000.00 Dose Tank Capacity (gal) JZabel Filter Manufacturer 27.83 Dose Tank Volume (gal /in) JAI 00 Filter Model Number WIESER Manufacturer Project: Page 2 of 12 Mound Plan View .. 1 /10 B ::::::: J Observation Pipe 0. , . • , :::::::::::::::::::::<:::':::: . :::.:... l M A ` ; ::: iii• z; ', j'i ?. :.':' ' :: ``., }: i......: . W ::::I :::::::::::::::::::::::: B I ❑....•. .......................... ........... ................. ................ . L Mound Component Dimensions W,10 A 6.00ft E n H .00 ft K 9.08 ft B 100.00 ft F 9.25 in z 8.63 ft L 118.17 ft D "=in �� G 0.50ft J 6.71 ft W 21.34 ft 600.00 (ft Dispersal Cell Area 1 1462.91 (ft') Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.94 (ft) --► its G I H ......... F :,,,;;,;;;;;r„ ell 99.67 (ft) Dispersal C Lateral 99.17 ft —► I — 9 Invert Dispersal Cell ?[] ;; ,,,; 1 D Elevation ..................... E 3 ❑4 - 98.00 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key 'o C T — Dispersal Cell See lateral details on 1❑ ®Topsoil Cap °• 1.5 ft .;; Page 4 for number, size, Subsoil Cap 0 c and spacing of laterals. Laterals are equally M C33 Sand - F G y AST © •o m 0.5 ft Typical Lateral spaced from the ® Tilled Layer , :::`::: 5 distribution cell's Aggregate a ❑:.. ❑ ❑ 0 �. �: ?% �:; �:: �:`:.: �::: �::: is� ::::as::i:�.::::� ::::::::::::: �- centerline in the — A distribution cell (AxB). Project: Page 3 of 12 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical I P S •= Turn -up Ydball valve or IE X---->IEar2 I 1;12 +1 Laterals & force main of PVC Sch 40 aleanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.65 ft Lateral Length (P) 49.28 ft Orifices per Lateral 14 Lateral Spacing (S) 3.00 ft Orifice Density 10.71 ft /orifice Lateral Flow Rate 9.18 gpm Manifold Length 3.00 ft System Flow Rate 36.70 gpm Manifold Diameter 2.00 in Total Dynamic Head 12.17 ft Forcemain Velocity 3.75 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented Alternate outlet location Forcemain diameter WIESER Manufacturer 2 in. Cap acityl 1000.00 Gallons Volume 27.83 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.21 534.54 B 2.00 55.66 C P ump off elevation (ft) C 2.73 75.84 —f 93.00 D 12.00 333.96 D Total 1 35.931 1000.00 Do se tank elevation (ft) ,,r --- 3 7 ' — Bedding un er tank. 92.00 Alarm Manuafacturer LEVEL Alarm Model Number LVL1 Pump Manufacturer IZOELLER Pump Model Number 1152 �- Pump Must Deliver 36.70 gpm at — 1 - 2 - 171 ft TDH Project: Page 4 of 12 Mound System Maintenance and Operation Specifications Service Provider's Name F EATHERSTONE EXC. INC Phone 715 - 381 -1704 POWTS Regulator's Name ST. CROIX CO. Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1250 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears 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 Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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 Finished .............. *0 ............... Grade \ �1 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Page 5 of 12 i Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, 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 subj 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 tan shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assesse 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 a 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 fiftei shall be serviced if the alarm is activated continuously. Intermittent fitter 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 tan the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the ne) 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 used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) 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. 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 seed 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 sr compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulct as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOP 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10` cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow sped( 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 flus of accumulated solids at least once every 18 months. 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 le above 6 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 pro operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repair 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 its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and re piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Page 6 of 12 5 %. HEAD CAPACITY CURVE _ = VI OM ! 152 / 153 50 l �gr Li. 94 i c 12- 40 152 - - - ') /0 - i w I I a I —� - -- x 7 19 . v 30 a 8 0 J 20 - -- 10 — I oiasoe I � I 0 20 40 60 80 100 GALLONS LITERS o ,'z 0 80 160 240 320 _ .�- FLOW PER MINUTE T CONSULT FACTORY FOR SPECIAL APPLICATIONS' • Timed dosing panels available. � • Electrical alternators, for duplex systems, are available and supplied with , an alarm. • Variable level control switches are available for controlling single phase systems. I • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. �_7irz Over 130 °F. (54 °C.) special quotation required. 1521153 Series 1571153 MODEL 9 Co Selecti Model o lts Ph Mode Amps Simply _Duplex Ll _N152 ! 115 _ 1 I Non 8:5 1 2or3 --- - '. BN1.552 115 1 { Auto 8.5 Included 2or3 f ltl� � � sr<2eea E152 230 1 Non 43 1 2or3 B 230 1 Auto 4,3 Included 2or3 N 153 115 1 - Non 105 _ 1 2o(3 131 , 1 153L 115 1 1 .auto 105 1 include 2or3_ SELECTION GUIDE E153 230 1 Non 5.3 1 2or3 _ . a ck variable level float switch or double BEi53 230 1 i Aul 1 Sin u 5.3 Indu 2or 5 P99Y piggyback variable level float snitch. Refer to FM0477. a CAUTION 2. See FM0712 or correct model of Electrical Aftemator E -Pak. All Installation of controls, protection devices and wiring should be done by a qualified 3 Variable level 3ontrol switch 10 -0225 used as a control activator, specify duplex 13) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float sy em. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 1634 Z 7 ? J LC I3 anc Run Ro / Manufacturers of., SHI T T0: 3649 49 Cane Run R d Louisville, KY 40211 -1961 Q�aurr S NCE /939 PU/i�1P !O. 5L2J 1J &2731.1(800) 928 F MP http: / /www.zoeller.com FAX 1502) 774 - 3624 Q Copyright 2000 Zoeller Co. All rights reSE rv ed. .05/22/2003 09:03 7153814232 NIELSEN PAGE 02 r SOIL EVALUATION REPORT vlsoarsin Daw►rnent of co -nerme %Wslon o f Seely and quow in a=nWM vM Came es. Vft . Adm- code Cast Attach as We €fan on PaW not foss thae a UZ x 11 t>dus vs atEs. Plan PWM pupal I.D. de include, * not bmlwd w ve+deel and haftonml rt!taeence 0" IBMh. pawed gW*, seafe or dMtWvwk * nom oeaw, and taDtfen and dfsSal ' t nab Rc+r�eVrad by LiaQ phase psw as ism= vElmo' tdaaraoa yov 1de a W es used ee ucmgrry PWP. -- fo--y L "'• e.1s a y Location topeAy Oa++er t ►opettY LomtiOn J GOVL tat 114 € VQ s S T Z j V N R jr E w f ig Block 0 Name C4td�1. j — " pwnefs MaMV Addraas 144 Q •r tale r Q� t4earestRoad :lty a � �p,�y„�o�t lie: � Re,fea�,raf J t�r.aoer a b.dioottn - d~ 9 ftw "oa O O Gply Renbcome Q Pubft or QwmwMW -0e8odbr- qtr Went materiol Ti /I _ Flood slam elevation 11 aP ;v ww ooaarrenls s {cM elcv. ! S-0 and recor�mmmdotionw. Y ('et4.wr Gt a v. `rs. C o 1 C yzr !.J (i Mt C�.und 11 10 fL own a — -- k k sal w» herb Vioh bor~ Redax Dam(pw Taxrae SrndvA Rode fir. M MM Qu Si- cam. cow Gr. Sz Sh. t 'EfCdf 'Etfa2 S k tl�. • s b ❑ Be** &_7 4-1 Pe Ground R D� to Sol AOPb f7tle ' "udM Depth DominarM Color Redox Dates T Slrudee UL user Qu. S:. Cw* Bator a. sz. SK. $, . Oftew t 12 g < 30 -Q& and TSS C 30 mplL • Effluent #I = tipD, > 30 r 220 ma =W TSS 200t 150 mgl1. �'- CST Phm+ber e T Hama {Piea9e ) � IT t?al! Evaiwtlort e0 eo Telephoto Hurnbar Add1 Q�S.. �. s// - O � t7�5 05/22/2003 09:03 7153814232 NIELSEN PAGE 03 Property Owner Z ar• �' FuoB110 N Pop of F t3ofulo N ' sir'° f7 �( M. �n in wn Iing P1t Gmurd swiKS . . Sab , � t fe iwn Depth DenYrtanl color Redon Dasu"M Tsatur► StNauoa tY t In. Munro Qu- 6z- Cent btor Gr. Sr- Sh. 'MI 'EIIM2 u Pit Cox" M*faca 6%%% It. D&P& W*Rditp led- In- Soo l Ru Hatton Depth Daninant Cda Red= Deso" n, Testufe _Sb OUM Cavbtstree If-rAwy Roou OPDMI ln. MtMep Du. 37. Coat Cobs Cr. Se: sh. 'E(fit<r •Ewz F-1 8od`� M D � Ground surfam eiev. ft Depth to 11MG w�lactot In. (I F4( S f lat Moflton Depth DOnthaot CUM Redox Desotipiion Taub" . Shudws Cotablshas BMW" Roots GPDW In. MunasN Ow. Sr CML Cakir Gr Sz Sh 'E# NI •EW ENuent Nt - 8W, > 30 -C M nVX aad TSS , 30 < tSb mq& • EMuent N4 a BOD < rnplt� and TSS: 3t7 mpr1. Tile Depaf1mcul of Comnm = is an equal oppommity service provider and employes- if yotr need assisunee to access services of need ssatefial in en Skesuaie format. please contact the-deparentew st 688 -M &USI at TTY surer lornrm� 32 PAGE 04 0.,1 22 «12003 09:03 7Z538142.� hliELSEN PAGE'OE OT# ! r_Fr,AI DE5 R1PT10rJ ' 5�� K t DM 1 ELEVATION i HM 1 DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTION s. SYSI'EM ELEVATION Y Sd SYSTEM TYPE Al ou q CON7'OlfR ELEVATION `YFr. OO f 4 a 3 ?0 i 1 ro I SIGNATURE 1 DATE r sw •i Z i I At- 41 ` IV A \. • \ 6- � o d s a a T o Z LOT 1 ,t ,Bfj f - Z42'a�, o Tam 6sf / AV - yY "/ Ar .eY3 Page 2 of 2 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 cell(s). if high concentrations are detected have the contents of the tank(s) 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 will be discharged to the dispersal cells) 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 Septage 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 feet 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 wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) 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 safely 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 properly 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 been 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 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 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 site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. (3 Mound and at -grade soil absorption systems may be reconstructed in place following removal . of the biomat at the 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 Named Name FEATHERST Phone -� 7©r(/ Phone 715- 381 -1704 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY j — I — Name PINKY'S Name Phone 651- 436 -5788 Phone /S -3 6Z This document was drafted in compliance with chapter Comm 83.220(b)(UM &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. P Plete site plan on paper not less than 8 112 x 11 inches in size plan must vV rO t it .out not limited to: vertical and horizontal reference point (BM), du P i slope, scale or dimensions, north arrow, and location and distan and i Please print all information. + IDate Personal intamalion you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) Nt Property Owner Property Location Z en e'--1 Z Govt Lot s•w 1/4 T Z N ,. E (or) 10 Property Owners Mailing Address Lot Block # Subd. Name City State Zip CodeLT Phone Number ❑ r ❑ Village Q Town Nearest PCZ o r1 Sol ( > C (� New Construction Use: Residential / Number of bedrooms 3 - y Code derived design flow rate O GPD ❑ Replacement ❑ Public or commercial - Describe Parent material i lain elevlio if applicable n /L - f. General comments S ys>�f 6�tv �9 SO h t` fA atNwX,C — and recommendations: )n ) Boring # ❑ Boring ® Pit Ground surface elev. �� ��torirriiting factor Z Z- In. - te k- ! horizon Depth Dominant Color Redox Description Texture Structure Consistence 1 t. r in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ! k e O - /y h �✓ /Z — Sir E: Z I f -Z7- of Z 70 ervr 31 C / in k S 3 I °' j Boring # ❑ Boring u d - - : '`" .e ®Pit Ground surface elev. � � ' Sol Application Rate Horizon Depth Dominant Color Redox Description ..: .. Texture Boundary Roots GPD /ftz r i in. Munsell Qu. Sz. Cont. Colo - •Eff#1 'Eff#2 a 2 1 _ y J m C r 6 u s S Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number X6 Address Date Evaluation Conducted Telephone Number to R evlsarr A -_.. THIS INSTRUMENT DRAP I"P v': m u.. OZ ••••••_ tt G G Jr1LL I J .1 JOB N0, 00 Attar on �d Parcel t.D. Inclu g Poe to nearest mad. caeca Reviewed by Date �) ivacy Law. S. 15.04 (1) (m)). property Location rope Govt Lot s 114 E 114 S S T z N R E (Of) i Lot F Block # Subd. Name or CSM# Property i O City [COD] Village ® Town Nearest Road city C y G 3 _ GPD Code derived design flow rate (� New Cc 0 Replacer Flood Plain ele tion if applicable Parent mate QM► wt,(,Q,Q r General comments S Y Slt/1't e /tv I / s / �-- O ) -Frrv► and recommendations. ` � el C V. ('ff . 0 � `f✓ Bon n # P ❑ Boring De th to limiting factor Z ? in. Soil Application Rate Pit / g Ground surface e ft- ® Roots GPDlftz 4 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary •Eff#1 'E i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. s� .nab yi'1 G S V Z � o ❑ Borin9 Z Boring # 9g� Depth to limiting factor � _ In. Soil Application Rate Ground surface elev. Pit PD /ft Z ® Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G Gr. Sz. Sh. •Eff#1 •Eff#2 in. Munsell t2u. Sz. Cont. Color I �z r �/z _ S. •/ ube l s6t Z - 7.S r / C lb �p ru k I I, •c Ie • Effluent #2 = BOD < 30 mgt- and TSS < 30 mglt. li • Effluent #1 = BOD > 30 < 220 m91L a nand TSS >30 < 150 M9 re CST Number CST Name (Please Print) Evaluation Conducted Telephone Number Date � v Address Sp/ylD /.��i W/' `' �L $— 6� t Signature M omrrq ee Chaln»An L 11/10 r 1 .,.. ,� .... `'7- Property Owner Page �f - Boring # ❑ Boring .;;. 1 JI ❑ Pit Ground surface elev. 9:7, it.. Depth to limiun9 factor- in. - —" :. Soil Application iorizon Depth Dominant Color Redox Description 'Texture Structure Consistence Boundary Roots GPD/It= In. Munseu. Sz Cont. olor ,_'. Gr. Sz Sh. •Eff #1 *El p t] 013 .i/Z - 6 r✓L - fr 61Y Z 13 - Si' 6 r- G F-1 Boring # ❑ Boring Ground surface elev. ft. Depth to Gmtling factor in. Pit Soil Applicalia; Horizon Depth • Dominant Color Redox Description- -. Texture _Structure Consistence Boundary Roots GPD/1l' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 6 Eff #1 •E F-1 Boring # Bor ❑ ing ❑ Pit Ground surface elev. ft Depth to limiting factor in. I S, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsetl Ou. Sz. Cont. Color Gr. Sz. Sh. ' i a - - • Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD, < 30 mg& and TSS < 30 mg/t. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access service need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. S86873041L07100) i —' 519nature bf om ee Chairman - _ _ — r -r PAGE -;�*OF - Z� ' t t 4 $ SCALE: I "= G� � • BM I ELEVATION BM 'DESCRIPTION BM 2 ELEVATION 9Y. 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