HomeMy WebLinkAbout008-2009-01-000 (3)
YJ_sonsin Department of Co.-rnerce PRIVATE SEWAGE SYSTEM Couel'. St. Croix
Safety and Building D.v son INSPECTION REPORT San la Permit No:
~/53 ry
Seale Pla° 10 No 578960 0
GENERAL INFORMATION (ATTACH TO PIERMIT) 17
Pe•sonal infnr^aran you provide may he used for se✓indary ;;_tposes. (Pr v[my Law s I`.:':411 o`-;)
Per^nt Ilo'1Je• s Ndrre pN• Village X TaNnship Parcel fax No.
Vadnais. Jerome & Ma Eau Galle, Town of 008-2009-01-000
CST BM Elev Insp BM Elev. RM Desc,ete- SecIomTDwwRangeRvlap No
01 28.16.568
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACI FY STATION BS HI FS ELEV
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding StiHt Inlet
SVHI Outle!
TANK SETBACK INFORMATION
TANK TO PI WELL BLDG ventle Ai wakc ROAD Dl Intel
Septic Dt Bottom
Dosing HeaderWan
Aeration Dist. Pipe
Holding Hot System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Fl
Forcemam Length Da. Dist to WeI
SOIL ABSORPTION SYSTEM
BEDJRENCH l'v'rith Lcuy:h Ne Of T,Prep s PIT DIMENSIONS No. C:I PlS h•.s Uri I iJL,d rx+pth
DIMENSIONS
SETBACK SYSTEM TO PiL BLUG :^JFII IAKESTREAM LEACHING Manu :atnue
INFORMATION CHAMBER OR
Type Of Syste- UNIT Atodel Nunner
DISTRIBUTION SYSTEM
I I leadefmgv. 1011i Distnnuticr X Hole See x Hole Spacirg Vent to A., Intake
Pipe(sl
Length Di L, rqt, Dia Spac og
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth UVC' F", O'vef xx Devi Of M%$eeded~Sodded U Mulched
Bed.Trench Center -)Vi Edges Topsoil Yes. No J Yes ~1 No
COMMENTS: ;Include code discrepencies. persons present etc) Inspection #1:__ _ Inspection #2
Location: 598A 270111 Street Woodville, WI 04028 (;NE LA NE 1 r4 1 128N WSW) White Pine Meadows Lot 1 Parcel No: 01.26.16 566
I Alt BM Description -
2.) Bldg sewer length =
- amount of cover =
Plan revision Required-, Yes I N:3
Use other side for additional infcrmatior.
SBD-e710 iR v~'i Dale Insepctor's Signature ::cit. No
-
Cuunly
zt! Industry Services Division R l
DS ° I l ~~~9 1400 E YV :on Ave Sanitary Permit Nurl (to ?ed n bs Col
PS. d P.O. Box Box 7162 / C`J!
vd ` i+/, I I: 'I ldadlsor. 'e4r 7~?-?1G2 ~
-ganltan, Yerrrllt 1ppl1Ct1t1017 Sta TmnnchonNumbcr
yyv
in •e VP]al su s)PS;S 2It_•N'•s.A , Coll, sAnisswr' "this to" to lac a, mental unit C Ci
. yr r r t brat y r Illn ary P.MI N -r A: Al plcuti n forms for suuc-ovmed ooN'TS arc n. . to P 101m:1 Address (ddil2rent than meilingaddress)
- I r: i t t e ,lzN and P s ss oral )e s ies. Porco gal ii lonnaln^ you porch may ne dud t yh
o- uenntlary v-
r sin i, • with Ih Privacv I ss s c tml I' ms S"IS
I kpplicttion information Please Print All Information l
rrgsorry Dscle,'c Nine _ Yalcel a
Scror+nc+ MQ I Cr0°-_1C+"'I CC.r
F'wPerly 0%iecr's Mailing Address ` _ - Prof=ny Lo:iitiun oov
'7 C City Suite I s /.It. Cndc Pho. c Ntrnhesr - _ : - Section
L~ /S~ ~~`'S' - ~1C / C T N• R cilcIC nnc J
II. T,vye of Building (check all that apply) 7 W 9
moo: 2 Family D%dimv, - Niniihti of Bedrooms a-~ Subdivis tin Name - -
ok pli"I-
L]I`ubhcKommereta!-DseriM: Use pf; rr-
~`VT .1 Cry of
uN-•i
fl State owned - Ocscnt%: use P [Std Nun I ] village of /
fX 5d'_-y 7 `/Y C I o 9 r~wr or , f F ~~i rr//~
IIf. Type it.-(Check only one box on line A. f:ompline line B if applicable)
A New Syvrm Rc le:^-I n1 sicrr L.
I'I p ICntrraHob=r6 Tm,.k Hrphccmrcl Onlq ❑61h:.r M1foClhcutwr :a Exist n, )
_yst:m!:,,p'mn;
" lire her . v mi: Tr.:ns`e- to New List ftt•:1uus I dmb: rus 4
mil
P
1 59735(0 SJt, ~
V~ a oc PONaI'SlSy vlem f'I Bonr:nn L Caanyc n
-
-_.P rmpnnenWeviee. (f hcek all that apply)
J Nor-P c,orwed In-Ground :7 Presme..A In Ground ❑ .AI-ooadc I hlnu,d'24 sr.. ofswtable soil ound <24 m. ofsuimSlcsoil
Iloldmg Tcnk n Omer Dispersal C.,mmicni i;splair; Pretreatment rkvicc (explain) G
Dispersod 1Tfatment Area Information: - q LrPtiass v5
l iesiga Flo.u,Vpd)' Dc Ire S d~ApI:L n m Itak;gP II Lisp; ;rl 1-ri I(eyu'ri, 1) U.sp_•g1 Area P -:ac 'stn Systeas Elevation
'sOC Y -7 $7,a) 7 So ~Y D S-
vl. Tank Info Cavnry ni foal ° of Wan,Ifa:;.:Ici
Gallons ("opens Jriis u v
New Tanks E.cs:iu Packs
x wrPo1 lbk- sz„-
i of EcJng TSk - t _
\ II Hesponslhthly Statement- L the undersigned nssnme sesl onsibihty for installation of the POWTS shown on the attached plans
Piunil -r'; Van H icl) / PIUnI I ))-,:j;,nc tl'•?IPR2 N one, Hi. i.vphoneNU l;w•
~7/v;
PIumM.'s vi , unrcl ..nv SIAfs. Zip Codci
It' 7.4 /Jcl
1'111 ountV'+Uc arlmall else Only
Appnned [ • Perim ter Da'c 7s>u.c q Issue Agenl Sign it
I .-(r '.r. Remit for Dtini,I S s L;s)
~ f
I\. Condil(pYGkEIstIspOills"easons for Disapproval n_ - / - ~ - s
1. Sapl'r tack, erfluthm like- l•n•1 dZ Yp Q_~((J[j~ r ~al.~_
u'yper:•}t cell must all be m, ~C'_s e.S /I D ✓""t. K%M"~
as per mar.nemen! plan !)•cnoe t by plwnoe.. ta,
2. Al mftwk recuher:^an:s mtatft w re..rt: it .1 J f r / ~
"Pill, lt~ikmel tin;, I cm':raLrm C Wee-.r f,..J
,vnad, o,omplne plans fc - the system and submit to the Counry only on paper not Ins than S I 11 inches I. e
5) Pt, 64- , a%&UAe.
SBD x;395 ;Kp313
Industry Services Division
°s r SAY 2 4 201 1400 E Washington Ave SanitaqPermit Number (to be lilted n by Co.)
RQ Box 7152
~CROIX COUNTY 1• 13707-7162 7 q /
\N4TY nFVELOPMEN7T~ ! /
Sanitary } t'nnit Applicavolt Sut(cTransacuonNumber
la accordar:.c +vith SP$ 2I(<), N%is. Man Codc. submission of (hls loan io the apoTUC'tn.. ~ rJ ~ .✓7 3~`--
is required l n r t r. Pia n, >a-ntary firma. Noie Applica!ion fon. a for str.ICOwnt.l TC1N'IS arc . Proicct Add-ess 0i 'different than maLmg address)
tYS Depurtn t 'at^:+ en t I .ofessim al Sarvt Percenal in rmm~, .you orn+°de may M issd h,r sxo.._ [~_r
purp~sesn cur'.. tthe l'riva:v Law .s m„Slavs a-,CIG /1 7_76d4,
1. Apphttlmnlnfonnatioo -Please)rint:All Information or7 Prn;xr:y (:',.,ncr'. to Parcel s
(tiO 3
c r ~~Cu _r i -)f: 0)00
Proper.; D-,:ncr's bladiog Add:;v Property Location q
c-J f'T l .SFIY <-.r Govt. Lot 36 U>•J
C av sale ^ 7tp Code ` Phore NamY.r -
O G Section
(L 'o f; 11-C C F S C~cJ * S t -7/ s i~ '0 -cZ 7y (Circle o
IL Type of Building (check all that appl)) Lola T- U N: R _ _1(a. _ L•
i~
LKI of Fsnuly D_wclling KunrC~t ofliedmoms_. J_,_ S'ubdwision Npi
D1C ca lbckd - - 1t,_t4 f ln< J,-1e4c~0,
S
Pcbhc:Co.=ictal-Describe Ilse- - _ )
] City of
] Village of ~
Stair Owned- Desa iVsc
. r - 3_~Fpwa of T_ , " C7t1
Ill. Type of permit: (Check only one hux on line A. Complete line
i
ayitem .J - L-ealmcrUl>uldnR giT f apll
cw Sv cn Replace^cnt r) rnt 03, y r
J Otlwr Modification _ to Fe song Sytem (cxplanpl
B . ? f e Mt R •aewa: Permh Revision Orn"c J Petmi: Transiency New L,sl Preaous Pt-rn I Number w id Dale isi,.^w`
ri Uwr,er / 5 7'F5;
Rc.rc Fxptrstton
1V. TVIM of PCRy s stcm,C.om orient Tlevlcellr l ,ec hats Iv
U
Nun-Pressurizt» In-( nmd Presv >sd ImG l •:Ic [ hl unA' J n+..J'. .hnk.." I Pr\1ound 24 m. of suitable soil
IJI to I ank ]Other Dispersal Cc
V. Disperui mat craft Area Information:
Uusrgn Flmx le•I*0 • Deargn Soil ANW'cptnr Itato(gpdst) Dupcrsa: Area Re4uircd (at) D'spersal ATn ?ropascd(s6 System Llrvatpaal
VI. Tank Into
II iu Gdll';ns :Jots eo ,2
new Ian YS .riot a, I'm+ks ~ J r•
7.i Ill Wisy,Tark
\'11. Responsibility Statement- 1, file undersigned, assumr responsibility for installation of The POWI S shorn on the attached plans.
Pumtte-'s N- me Ws,ni) - - Plumter's slar4Rro r MPW?RS Nunoc Brs:nr>< Phone Ncrnbci -
ci V1 , 4- irl , Y. ,lam r r~~+f.1 -PS)7)
I'lumis^.r'> A ~dress Inc t Ci-y Sxlc •p Codc) -
VIII.CountVI)cpartmcnt Ilse Only D•aatrynoted / P- tr'.t P;c it,;le laced t Isswrg A 9 xipnaturc
Appm': cd $
OS 7
P'.t.. Gi:, r. Rcu.on to Ucnia
IX. C'onJit asons for Disapproval r
W4(, SAAW. or
perad cell oust all bry-jc*s
M
to per ywrayement plan pro .Wen ov plurbbei.
2. AYftlft" OqUOsf.'tem's mrrut.taujmnt rrif1 .4 ~
M per flppAcMh foist /:ft6,yM.b},
- -A Hai 1. ro ma.ptttc plans for the system and ubnir In the County only an pip tar not lets than a in x 11 inch • in size
A^ eA)
f 17
sun-6399 (tn;l3) r
rv\~ re?
RECEIVED PLA- 111i
°'"`~rls`F Cotmty
MAY 2 6 20151ndustry servic-- -)7 t, cox
1 ` 8 'ra' 1400 E Washington Ave S 'p ST. CRC IX CONN P O. Box 7762 Sanitary Permit Number (to be filled in by Cb )
n, VN 53707-7162
- -CDNIMUNl DEVELOP"
O
~'yiYhwwl~_e'/
Sanitary Permit Application State ,'ransac err Number
In accmdan r with SPS 3g:.21(2), Wix. Adm. Code, .rubmixsion of thix fmm m the appropriate g.,e,ur endl unit S r 3
rs rcqui¢J prior tooMainine, a xaniLUy permit Nom: r\ppli:atien thlms far aLitc-owned POW"PS an xubmilled to Pin ea Address (il'diffncot than mating addrens)
Jrc fkpanmenl of Safes and fmfessional Sna icn personal mflnmation you provide mar be n.ed l r cecendarv , L 5q~ ^ 2 z
,aP in-.oManccwilh dr. ftnacvLaw x. l5.rt411)(m),Slats. '~{(ly -L-V21---non Information 1easa_Print All Information
kwn Nati i5i-f Parcel
r
_ t7flk4`-' Ilczr c c - -""1 rJ'C%/ - Lr C2)
IYopcn} O.nc.', 11 ding Address propcrtr Location /
S~8
t o
.'it State vt. Lot
Y• /.rp 1. Jc phone ~umbcr Section
~l. C,A'~,.II.(. l>`-"T - 5 /t 5 (circle onc) i
11.'Ij'pe of Ilaildutg (check all that apply) Lot
LI/Iar 2 Family Uwclling Numhcr of BcdroumLLs, ttttt~~s~~ Subdivision Name
- OR- Blocks L.:_.~61 r io1/f ilo, (-'u r
PoI+IiJCommcrcial-Dcxa the llsu Pm wo- UCity of f
i l slate Owned Deezribe ltxe C'Sll Number C Village of
. T_J l O J % r Town of A.
111.'I ype of Permit: (Check only fine box on Ibte .A. Complete tine B if applicable
x,<, System rI Rcylacenuenl Svocns I TrcatmcnUfloldwk Tank kcplac Only ❑ Other hlnditication to Existing Sym. (explain)
It. ❑ Pecrut Rcncwal 11 Permit Revisiam I I CI nyc o forth omit Irmufcr to Ncw Lrxl Prm•iom Permit Number and llalc lowed
Before Fxpir atin^ is
IV,': cof P011"I'S SvstrntiComponentMevice: (Olec'k at Iv rye - -
❑ Non-Presxarirod In Ground I.l Resmrircd In-0munJ C V-f do I I Mound ] ?4,n . of suitable nail W NI nund- 24 in. of suitable soil
U I Iolding Tank I1 Other Dispersal Cmnpanenl (explain) 7 Preueatnrad Device (cxplaen)
V. Dixpena6?rca ent Area Information: q
Design flow (qpd) Doiyn Soil ApplieadRale(gpds Dixpenal :Uu Requirul (aQ Ui pccsal Area Pmpoaed Is System Rlpm•atiou
11. Tank Info Capacity in total a cat' Manufacturer
Gallo,, Gallon, Len u
1 Iix,CrpTw+ks Nw Tank V -
ti C
1,11P6 V L s
<,4 r~
Pzwmg Cfsahn
V11. Responsibility Statement- 1, the undersigned, axxume responsibility for installation ofthe p01yTS shown on the attached plans.
f Iumh r x Nettle f ludi Phrmber . Siynahua MPNIMS Numhcr Litmus Phone Numhcr
PI I e,'s AJdtu iSved, i ty Statc• zip t .,dc) v--
c I,
1111 untvrDe artitscnl 1'sc Only
wi. IT
\{pr 'cd Duappr c~ F, Fee Dan: nud Issuing Ag Signalure
n RRcanmr fu, l genial 5 L
L\. Conditil9NSaM(SIVII{hlBRcasune t'ot• Uis weival LL _
1. Septic !ank, elfltoent filter and 3) - L, r S etF- t or, GJ r✓'C-
dispers.,l can must al pe vervkes, ^taintaine 1l /a- re
nrJ_" n
u per Inetrge7nent pan provided by plumper. I r, v 1 /
2..ALI nelpaek MquIrpmee to must be maintained r
as per W01cable rode / ordinances. r • , (b J
Attach to romplett plan, for the asxtnn and submit to the County only on paper not le n s Ie x III
Inc It slae r r if
a re c CJ f/fir A d.tn r
SI313-6399 ('R031 4)
P"l)4_ i l1v~^ /Grt- ~ c :F 9
L o
P r. ..1_c, ° c c.c•, ~1_a C'.~ ~/d
&0-64 A)
.
F G~-(n..{
1, -7
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AkV/
Tod; rA Ia-POC_~}~`~
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DIVISION OF INDUSTRY SERVICES
j'- 3824 N CRFFKSIJ - LA
HOl Veil 54635
Contact l hrouch Relay
S h ndsps. a ~i.eov;prrocrarnViccustry services
mvw wisconsln. jov
Scott Walker, Governor
Dave Ross, Secretary
Mac 21, 201
CLSI ID No. 220292 Aff;V. PON'T.SbspectUr
BENNIL N' HLLGLSON ZONING 01`FICL
HLI.GLSON FIN FFRPRISF.S ST CROIX COLNIT SPIA
N7644 SIA f F ROAD 12S 1:0' CARMICHAF1 RID
SPRING VALLEY WI : 1,6- HUDSON WI 51---
CONDITIONAL AppljO%r kI.
PLAN APPROVAL. EXPIRES: 05121'201?
SITE: Idcnlilication Nrmher;
Jcm Vitc1l Transaction 111 \o. 2542130
:9S A 2?06 Street Site ID No. 812409
I uvun of Lau Gal le Please rcl*~r to both idencillcerion numbers,
St Croix Court}' abnve..r all cerrespondcac: with the aeencv.
NEI4. NEE 4, S1, 128N. RI6W
FOR:
Description: Two Bernnm Moand System f ? ~'.a clone
OL?ject l'ypc_ PM % fS Componcl:t Manual Rcgula:cd Obiect Ill No.: I SLW3
Maintenance i aired, ;00 GPD Flow rare; `I in Soil minimum depth to limitin, factor f om original ride
S)stcjl Mound Component Manual - Ver. 2.0, SBD -10691-P l1l01. R 1017_), Pressure Distribution
Component Nlanua: - Vcr 7 0, SBD-10706-P iN.01!01, R. 10!17); I Bever Fill
l'l:e sabutatal dcscrihcd above has been reviewed for conformance with applicable Wiseoucin Administrative Code,
;cod Wiscon ~in Sramtea. The submittal has been CLINDITIONAL I Y APPROVED. *1 I his sustcm s to be constructed
and located in accurdance with the enclosed approved plane Ord %N any componem n .nual(s) referenced -,l CONDITI01
I I owner, ac defined in chapter 101.01(10), Wisconsin Statates, is responsible for compliance evith all code APPRa
regt:h-enlent>. DEPT OF SAI
No person may cn=tare in or work at pirmbirP. in the score. unless licensed to do so by the Dcparuncnt per s. 145, 06PROFESSIONA
S:aTS,
DIVISION OF INDUS
I tic Ibllow in,, conditions shall he met during cons:rttetior or instal'alion and prior to occupancy or use:
Reminders
• :1 salrvuy permit must be obtained frum the county where Uric project is located in accordance with the 5~ GURRES
requirements of Sec. 145,19, Wis. Slats.
• Inspection of the private sewage system installation is required. Arrangements for inspection Nall be mai+.c with
the dcaie le wunty official in accordance with the provisions of Sec 145.20(2)(dl, 1'v'is. Stars.
• A state approved cff.ucla filter is required Maiutcrancc rllbruMlio:l must f±c •_ivcn to the owner of the, lark
explaining That per=.odie. cleanctg of the filler is reduired Access to the filter for cleaning must be provided
per SPS 384 product approval conditions.
• Al! POA' I S ecrmponc•nt p:pine material shall he SPS 384, WK Adm. Code eornpliajli_
• The area within ' 5' downslope o= the dispersal cell shall remaur undisturbed. Vehicular traffic, excavation or
soil compaccon is.prohibited in the area.
• A copy of the approve plans, specifications and this letter shall. be on-site during construction and open :o
inspection by aulhoriicd roprc;cnlalivcS of :he Dcpartmcr.t, which may include local uI
.
Owner Responsibilities
• 'Fhc current o"ncr, and cacti subsequent o" rer, shall recc:ve a copy of this letter uuludirI inStructions relating
to proper I: se and nraanenance of :he sy:aetu Owners shall receive a copy of the apprepria:e operation arid
in a intenaucc manual and or owners mamial for the POW IS described it this apprm z.1
• The owner of a POWTS shaa be responsible fix ersurint' :hat the operation and maintcnance of the P(AVI S
occurs :n accordance with this chaptcr and the appic acd mat:agcmenl plan under s SPS 383.54(1).
• In the evcrt this soil absorption system or am of as component pans :na'runcimis so as to create a I:calth
hazard, the property owner must fo:iow the contin,cncy pleas as described in the approved plane.
• The owner is responsible for suhmittir.' It maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submiucd at inter als appropriate for the comItonent(s) utilized
in the POWTS.
In _ranun, tiis approval the Divsioc of Industry Services reserves the righ. to require changes or addaions should
conditions arise makin, then: necessary for code compliance. As per state stats 101.1 A.'), nothing Cn this review
shall relieve the desi mer of the responsibility for dcsi,nin< a safe budding, structure, er component_
Inquiries concerning, this currespondcucc may be made to me et the telephone number 1,'sted bolo", or at the address
on dais letterhead,
The above till addressee shall provide a cop}' of this letter and the POW 1S rnaaavcmem plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POW IS_
Sincerely, Pee Required S 250 0o
I'ce Receivcd S 250.00
Balance Due $ 0 00
.rare h9 Swhn
POW I S Plan Reviewer. Division of Industry Services
(608)739-7892, Mon - Fri 7:15 am - 4:00 pm WiSMAR l code: 7633
jemsw'im~a'wiscuesin.ruv
cc. Ed"ut A I a\ let. Wastewater Specialist, 15) 634-3,484 . Monday - Friday 8 00 am To 4 30 pin
r
Q.
1't
a
0,A ner Responsibilities
• Ch., c,=ent owner, and tact suhsepueat t`wrer. S-1alI ia,. viu,_ ins-ucti,as
Droner use arc maintcrancc of the system. Oh+nc-s z:hall rccca.-c a copy of tits approp-tale operation anc
ma tenarrcc manual :md'o. owners mama: for $r: AV I S described a•. this appraca:.
• Tht• owner of 'a P'Ak7S shall be -esnon>iKc f,r ersurins Caa: the obcratioc Gtr :na:atenmce of the POV75
occurs ai accordance tiitt:Ls caapte: and tae approved management p;n unde- s. SPS 383.54(1
• In the uv:at :his soil absorp:roz syslcm or aay of tts co:upoaaIIt na_t :naL°LIDeri0Ds ~o as to create a health
:nza ct, the propen,, oskau. mast fo:;ow the cont:r.~tacy plan as describe' in rLe approved Glans
• . ne owner is rer,onAhle MY subriV ing a n or)tmarcc vcrilkaiioo report acr.eptable to the Minty for
taainter:ancc t-aceling pa-puscs. Reports stall be Sab SMI m in:en'als appropriate for the compcneau;s) uuhzud
in It POUTS.
LI u: a:rtlt_ th:s apbrov a: ttte Div:sloe of Indus-,r: S,-vices :'eSen'es the rto require c:aar.ges or additioae sho.Iic
c❑ndiaons arise. ma:arg there accessary for code compliance. As per sow sm 10L i_12)> nothieg in this rmc--s
shah'. r H"Z be desisncr; 151 %spocsibiliryfor desi`nire a safe Mudig. stpacturc. o: component.
inquiries concerrAng th:s correspoadcncc any bc• made to = at tnc ielvphcme munber lister below, or at tat, addross
jr rhos leuerbead
ahovc lei', addressee shall provide a copy of this iatc•r and tilt POW'I'S management plan .o the owner Gad an•.
:rthers who are respomible for :hc iastslla:ioc, operatioa or maaAetortee of tat PCri'.''1'S
Sincerely. rce Regmred S 25(t.OG
Fee Reccivice $ ?=U.JQ
Balance Due S U.00
i, .rare'.! SWCn ~
POWTS PRs Reviewer. Div:>ion Of Incus:rv SC-VICCS
6081789 89', Mob Fri, 15 am - 4 00 pm WiSNIAM code ?6
,y.mrrn,xwisc~r 7:ev
cc: F.cwin :1 Taylor. R'asra•ater SDecia:ist, I S: :=-:JBd , lvfondav - Fricav 8:00 am T 1 pu
i
1
cCEIVED
INDEX SHEET „,IAY 1 2015
-US MY SERVICES
PROPERTYONNWER: Ferry v0.d-no.i.c
S9YA 70f-k • SJtr<ct
Wer)A;-N-v it~i. Syo~S
PROJECT NAME: .7c4,rI lei jna~ r
PROJECT LOCATION: NL y 04 ,IJE~ $rc. 1 T.~FN R 16 W
MUNICIPALITY: COUNTY: S7. Ck'oi u
DESIGN: PRESSURE DISTRIBUTION MANUAL VERSIj~t&"
SBD-106706-(N. 01 /01)
MOUND COMPONENT MANUAL VERSION DSBDp
10691-P (N.01 /01) DR ft
CONTENT'S: L SERVICES
TRY SERVICES
Page 1: Plot Plan
Page 2: Cross Section and Plan View of Mou
UDENCE
Page 3: Distribution Pipe Layout
Page 4: Septic Tank and Pump Chamber Cross Section and
Specification
Page 5: W I 000IS-00, M R Tank Specifications
Page 6: Pump Specifications
Page 7: Observation Pipe Detail
Page 8: POWTS Owner's Manual & Management Plan- Pg I
Page 9: POWTS Owner's Manual & Management Plan- Pg 2
Name: Bennie Helgeson Signed
Address: N7649 Hwy, 128
Spring Valley, «7 54767
Credential Number: 220292 y a~~/~
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Synthetic Covering
ASTM C 3:3 Distribution Pipe
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CELLOIF V- 2 Force Main Plowed
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Aggregate From Pump Layer
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Cross Section Of A Mound E 4 Y Ft.
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License Number: K 9,S" Ft.
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Page_Y_Of.
SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
PKVENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF
2S' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK E
TTER WARNING LABEL
k MIN.
I3
GHT SEALS GAS- TIGHT EO
ILTER A SEAL INTS AP_-_ JOINTS EDIPIP;E
PIPE 35~5 B ONTO SOLID ~ SOIL
SOIL PUMP OFF ELEV . ~po'OFT. - D
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE _Yofal GeJ!6 r L ~rmlc
TANK MANUFACTURER: S
TANK SIZES: SEPTIC 11000 GAL. DOSE VOLUME INCLUDING
DOSE Soo GAL. /'y. 93 FLOWBACK: ~3 GAL.
ALARM MANUFACTURER: 5] E Ay"i)" CAPACITIES: A = lo~~ INCHES = ~O/.,7;i GAL.
MODEL NUMBER: /o/
SWITCH TYPE: B = 2 INCHES = GAL.
PUMP MANUFACTURER: C = /0 INCHES = / y GAL.
MODEL NUMBER :
SWITCH TYPE: vJ{ ~~oaf D = ~ ,INCHES = /,fD,nyGAL.
REQUIRED DISCHARGE RATE 33 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 5--5--FEET
MINIMUM NETWORK SUPPLY PRESSURE . FEET
* //O FEET FORCEMAIN X ),3 FT/100 FT. FRICTION FACTOR FEET
TOTAL DYNAMIC HEAD = /S FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER
LIQUID DEPTH
C~/,y ?y I~~P/LSE St-n<_ /Qtk oPc
SIGNCD: LICENSE NUMBER: DATE:
i/88
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Submem1ble Effluent Pump'
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CAPACITY
Purnp Specifications Features and Benefits
YM and 1/i HP •EP04 impeller- semi-open design
Up to 60 GPM with pump out varies.lo protect
Maximum head to 32' mechanical seal.
Discharge size VA' NPT -EPOS impeller - enclosed design
Solids:'/ maximum for improved performance.
Motor -Rugged glass-filled thermoplastic
All motors feature ball casing and base design provides
bearing construction. superior strength and corrosion
j Single phase: 115V resistance.
J Materials of Construction -Cast iron motor housing for
Cast iron efficient heat transfer, strength,
Thermoplastic and durability,
Stainless steel *Corrosion resistant threaded
stainless steel shaft.
*Available for automatic and
manual operation.
•CSA listed models available.
rperation and leature stainless steel hardware.
kD266-5, ter tight ca4A
min, terial 785 oSlot
6
min.
ve. sWater Closet Collar Bar(3I8" min. dia,)
ObseNation pipes must..
• located such that there area minimum of
en
ends from one another two Installed in each dispersal cell at opposite
• be located near the dispersal cell ends
• be at least 6Inches from the and wall andsidewall
di Installed ce cell at an elevation to view the horizontal or level Infiltrative surface wthln the
di
Observation pipes may be located less than 6 inches from end walls or side walls It specified in
state-approved manufacturers'installatlen instructions.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pages.nf
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner feYt-~ Ik,~dnali_- Tank Manufacturer: Wteser ❑NA
Permit r! V $'Seplic 0 Dose ❑ Holding Volume: /000 (gal)
DESIGN PARAMETERS Tank Manufacturer: [I NA
Number of Bedrooms: ❑ NA ❑ Septic ER Dose ❑ Holding Volume: S'00 (gal)
Number of Public Facility Units: CI NA Vertical Distance Tank Bottom(s)to Service Pad: 7 n!)
Estimated (average) Flow. On (galida)q Horizontal Distance Tank(s) to Sorvice Pad.- / O D ;n)
Specific servleieg mechai,cs mull be provided it vertical is >15 `eet or
Design (peak) now = (estimated x 1.5): 3(>(j (galiday) 1 horizontal is >15o feat. Specific insWc:,ons to bo prodded on t,e:,k.
In Situ Sal Application Rate: (gaVdalvft°) Effluent Filter Manufacturer: two (Y f u ❑ NA
Standard (Domestic) Influent(Efrluent Monthly average Effluent Filler Model: $".,2 S
Fars, Oil 8 Grease tFOG) s30 mg+L Pump Manufacturer: 6c," I S
Bimbemical Oxygen Demand t80-4) s220 mg11. ❑ NA ❑ NA
Tolal Suspended Solids (TSSj _ 5150 mg(L Pump Model: ,387/ _ '61001V
High Strength Influent-Effluent Monthly average Pretreatment Unit
(FOG) >30 mg'L - k1anufaclurer.
(BODO >220 mgiL Cir NA ❑ Mechanical Aeration ❑ Peal Filter l~'NA
_ (TSS; _ >150 mg+L _
ii-
I'retreated Effluent Monthly averse ❑ Di' rev ❑ and
S average 0 Snnd Gravel Filter ❑ 0!hec
(BOD;,) s30 mg+I. Soil Absorption System
(TSS; 30 mill. 5rNA
1`a al Codcrrn tgocmobm muon) _10` ❑ In Ground (gra•Aly) ❑ In-Ground (presscre) l7 Pi.A
Maximum Effluent Particle Size ro in dia. El AOGrudu W Mound
❑ NA ❑ Dnp-_inu ❑ O!hec
OQter. ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out crx+lents of tam(s) X Wher combined sludge and scum equals one-ttn-c (h) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑ "O1ll (s) (Maximum 3 years) O NA
E] mor(s)
Inspect dispersal cell(s) At least once every: L) month(s) ck year(s) (Maximum 3 years) El NA
Clean effluent filter At least once every: /3 montb(s) ❑ NA
_ ❑ year(s)
Inspect pump, pump controls & alarm At least once every: 13 r"onlh(s) 0 NA
❑ yearls)
Flush laterals and pressure test At least once every:. 3 ❑ $'rnontl{(s) ❑ NA
year(s)
Mher. ❑ month(s)
At least onre every: ❑ NA
_ ❑ year(s)
tither. -
L NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the 'ollowing licenses or certfiications-
Master Plumber, Masler Plumber Restricted Sewer, P0,%TS Inspector, POWTS Maintainer or Septage Servicng Operator (pumper).
Tank irsoecbons must include a visual inspection of the tank(s) to identfy any missing or broken hardware. identify any cracks or leaks,
measure the volume. of combined sludge and scum and a check for any back up or pond!ng of effluent on the ground surface. The soil
absorption system shall be visually inspected to check the effluent levels m the observaton pipes and to check for any pending of effluent
on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third or more of the tank voluma, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113.
Wiscons'n Administrative Code:
All other services, including but not limited to the servicing of effluent fillers, mechanical or pressurized components, pretrea'•nerd unts.
and any servicing at intervals of _12 months, shall be performed by a certified POWTS Maintainer.
A service repel shall be provided a the local regulatory authority within 30 days of completion of any service even!.
GP,ta-pC5 (C ~i75i
L%L1 e
-2- of
START UP AND OPERATION Page
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or othe•
chemicals or sediment that may impede, the, treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the, pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POINTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 fret 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 treatment
tanks and soil absorption system: acids} antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation dram (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the PO'RTS 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 s. Comm 83.33, Wisconsin Administrative Code:
• NI piping to tanks, pits and other soil absorption systems 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 Septaga Servicing Operator (pumper).
• A`.ter pumping, all tanks arid pits shall be excavated and removed or their ccvers removed and the void space filled with soil,
gravel cr another inert solid material.
CONTINGENCY PLAN
If the PO'R'TS fails and carnot 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 wall 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 the time of their permit issuance..
A suitable replacement area is not available due to setback and/or sail limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ 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.
,i' Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of s„ch systems must comply vnlh the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
~v
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone L-71 $ 7 :)-z Pi-one /S- % Sg)
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name ST_~ tot' co I~
Phone. Phone
Ibis dxumer! wa c,afted by the s:a'fs of the Green Lake, Narqueee and',Naushwa County PO678 regulator/ agenc!as in complance vilh sections
Como 8122(21(b)(1)(1;&M aid 63.54(1}, {2T & (3), Wisconsin Ad^ inist'at.•c Code-
START UP AND OPERATION J
=or men' construction. pnor tc use et the i10'v%7S check treatment tanktisi for the presence of painting products, solvents or other
chemlcels o• sediment that may impede the treatment process andeor carnage the soil absorption system. If high concentrations are
::elected have the donten:s of the tankis} rr r. Ovec oy a Septage Servicing Operator !pumper) prior to use.
Pump tanks may fill aoove normal highWoMr levels prior tc startup or cue to pump failures. Start up or restoration of power under these
conditions is not recommended. as the excess wastewater wel, be -discharged to the soil absorption system in one large dose causing a^
overload trial may result it the backup or surface discharge of effluent and damage to me system. To avoid this situation have the
cc-,tents of the pump tank removec by a Septage Sorvicing Operator (Dumper; poor to -restoring power to the purnp or contact a Plumber
or POWTiS Maintainer to assist in manually operating the plume controls until normal effluent levels are restored within the pump tank.
System start up snall not occur when soil conditions are frozen at the infiltrative surface.
Oc not drive or park veriicies over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 fre• down stripe of any mound or w-grape soil absorption area.
Reduction or elimination of the follovng from toe wastewater stream may improve the performance and prolong the life of the treatment
tanks and snip, absorption system: acids. antibiotics, baby wipes cigarette butts. condoms. cotton swabs, degreasers, dental floss,
d:aDers, d:s:nfec:ants. fats, foundation Pain ;surtr. Dumpj discharge, fruit and vegetable peelings. gasoline, greases, herbicides, meat
scraps, medinw.o^s. Dill, painting products, pesncdes, sanitary neoki-s, solvents, tampons, and •.vater sokener brire discharge.
ABANDONMENT
W he- the POVJTS fails andipr is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safnly abandoned in compliance with s. Comm 83.33, WiscDnsin Administrative Code:
• NI piping to tanks, pits and other soil absorption systems snal! 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 (pumper).
• Alter p.:mpirl all tanks arc pits shall be excavated and removed or their covers removed and the void space filed with soil
.
gravel or another inert SoI c material.
CONTINGENCY PLAN
F rte ?OVdTS fails and cannot oe repaired the followwng measures have been, or must be taken, to provide a code compliant
reDiacanent system:
7 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 is tF,e neec
fcr, a new soil and site evaluation to establish a suitable replacement area. Replacement systems Must comply with the rules .r
effe^ at the time o` tneir permit issuan"...
O A suitable replacemem area is riot available due to setback arl sail limitations. If the soil adsorption system cannot be
rehabilitated and barring advances in PO'A7S technology, a holding tank may be installed as a last resort
7 Toe site bas not been evaluated to identify a suitable replacement area. Upon failure of the POV•; TS a soil and site evaluation
must be performed in locate a suitable reply-ement area. If no replacement area is available a holding tank may be r l as a
last resor to reply..e the failed POWTS.
,Ar Mound and at-grade soil absorption systems may be reconstructed in place following removal of the prim) at the infiltravve
surface. Reconstructions of such systems must comply •n4!- the riles in effect at that tine.
WARNING TREATMENT TANKS. PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
s' RESULT. _ESCAPE OR RESCUE FROM THEINTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name ,f
L'yht•2 P~ ~~S Name
Phone Ovl i Ot~
r7/S~ 77 'hone
/s-~ 7 -SS) i
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
?hone 5 ell phpne (7/S-~ 38~:" `1
This document wits crayec D, the staffs 0 the Greer Lake:, Marquette and Wx.!sna2 County PON%'S wpii.atoy aoencies it rump-tar: t. mt~ such nos
Cnmc E3.2Z2)rnl; I)id;i&i;'I aria B3.~4r i ) (2) R r3„ bVlscrosin Adm ricaat:v= Coca
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE. AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
_{r
Owner/Buyer
Mailing Address_ i9~ /a ~tJn~h Sf'`
Property Address S9 8 -0 7 f"ix S7<►"t
(Verification required from Planning & Zoning Department for new construction.)
City/Start oo~ d 1 c W Z Parcel Identification Number O o 8 06 9 -o O o 0
-
LEGAL. DESCRIPTION
Property Location Sec. T _W, Town of _L~N RJL
u>h/f r Lot It
Subdivision Plat:=/t
Certified Survey Map # _ ( ~ 6 , Volume / Page # `
WarrantyDeed # 9/ I3 (before 2007)Volumc , Page #
Spec house 11yesC3 oo Lot lines identifiable B'y'es❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance emaiSIS of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the fimction of the septic tank as a treatment sage in the waste disposal system. Owncr maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The properly owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by The
owner mid by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
w'astew'ater disposal system is in prOPCr Operating condition and'or (2) after inspection and pumping (if accessary'), the septic tank is
less than l!3 full of sludge.
Irwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
llwe certify that all statements on this fo m are true to the best of trylour knowledge J/%vc am!arc the owner(s) of the
property described above, by virtue of a Warm] deed recorded in Register of Deeds Office.
Numbe of bedrooms __.2_ J
7,
-SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04112)
1
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\tilsa, Depnitmerl of Commerce SOIL EVALUATION REPORT Page / u'
Division of Safety and Buildings
in acxxdanco •.vith Ccmm 55, ::'s. Ado- Code:
County f 10c^/ 1l1
Attach complete si:e p:an on paper oo•. less than 9 1/2 x 11 inches in size. Plar• must -
i*rcluoe. but riot landed to: ven cal and horizoral re;ipe'pil-``point (BM), direction and Parcel I.D.
pu'cent slope, so?le or dimensions. nCth arrow, and IOC911o1J and dislaece to nearest road. `/t,/ ~1C L C~- l
Please print alt inf0rr"41ti.I. view/b! Date/
',~L;Cnai inlDnc4ltipr po, povido May De used fcr 5eoIIC awplrG'S505 !,>rrvac~ La'N. 5 15 C4;1)(a+); • 102
!o D~
y am:;cni Owner Property Location '
Lu1i } Gaut Lot U 1i4 1/4 S I (r N R j r- E (o W
Prop--:y Owner's Mailing Address Lei # I Block # - ubd. Na CSM#
^
City Slate Zip Code Phone Number ❑ City ❑ village Town Nearest Road
'r i"', Vc L" C t 1- .J (7i:7 I tt?~a L'<e~i<' ) ~crt.
FL]KNew Construction Use: Res:Cenlial I Number of bedrooms Code derived design Ill rate GPD
❑ Replacement ❑ Public or cornmerc:al - Desontie:
Parent material Flood Plain elevaban it appicabfe /L" A f•
Goren comments
and rewmmendations, ((✓f 1'~ Il ~ c, I,
ti1cc0, y F L--=1It-iJ 9`I,c>S
/ ❑ Boring
Boring LJ Pil Grounoswfaccele•:. -ft. Deplh to hrri:w; !actor__:. in.
Soil Application Rate
F:Sri;on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAt,
in. Munsell Qu. Sz. Cont- Color Gr. Sz. Sh, 'Eft#1 'Ef((f#2
tZ ii
i
I ~ 1
Boring # Boring
I~.. apit Gcune su~ace elev ft. Depth to limding factor in. Soil Apaication Rate
-iorz^r Depth Dominant Color! Redox Desvip: jr, Text:,re Structure Consistence Boundary Roots _ GPDIrt
Mansell Qu, Sz, C'w color Or, Sz, Sh. 'Eff#1 'Eff#2
in
^ rr o
I'-'' -L ' ~ i r I wl _Y t- L O
c - I v1,
L_ L ~I
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LL L
Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgiL ' Effluent #2 = BOD < 30 rngrL and TSS < 3D mgrL
CST Name (Please Pn q S.gnat ure CST Number
Address Date t- al.ation Conducted Telephone Number
Ace-
Property Oo:ner awl )C Ivo_ Page of
Boring Boring
-~tS # r
~J P;t Ground surface elegy, Depin to IimiLng factor in. Soil A Ac-alicn Rate
Roots GPDrff
Horizon Depth Dominant Color Redox Description Texture SWCtore Consistence Boundary
ir., Idunsell OU. Sz, Cone Color _ Gr. Sz. Sh- 'Eff#1 'Eff#2
- f5 r o
vre -9i
1 I't- "
- 1 1 0 YK t -.i
r"
Q Born.
Boring
Grow^d surlacr: (ttcv_ _ it Depth to Lm¢uy factor _ in. Steil q:;filira:.on Rats;
> i _ GPJ:fr
H '.':,n Depth 'Doti i nant Color R.a:ox Description texture S7UC.nue Consislona; BOUrCary No
n minsell - 0u. Sz. Cont. Colo Gr. Sz_ Sh. _ 'U90 *E",2
Boring
boring # Grc,.ntl surface elev. it Dep:s to hrmt.ng fa; cg in.
Pd _ Soil Application Ra:e
1!ori; r-- try. Dominant Colcr Redox Description Texture Structure Consistence Boundary Roots GPD.fY ,
i _ t~tunsell Qu. Sz. Cent. Color Gr. Sz. Sh 'Etf#1 'Eff#2
I
i
I ~ I
' E"l-vn: #1 = BOD, > 20 < 22C mglL and ISS >30 _ 15C~ n~G l ' Of uem tt; - BOD < 30 myrL and 1 SS < K ®giL
I.. 1) partmcnt of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate lorntal, please cmauct the department at 60s-266-3191 or TTY 608-261-8777.
PCaner J. v,-~ Parcel lDn Page 7 of 3
' Sonny 9 Baring
~
.3 apit Ground surlaceelev. Depth to limiting factor o1 i in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
_ in. Munseli Qu. Sz. Cant. Color Gr. Sz Sh. 'E(fat •Eff#2
io ff2 - R c i s by ? 3
I ~
1 Hrv,ng u ❑ Boring
❑ pit Ground surface eiev i:. Depth ;e Lmning factor in.
Soil A p rl.c Ucn Rae
_
+ vii Oeplr. Dom,nanl Co.or Rodex Desa.poon Texh.n: Shucnue Consistence Boundary Roos GPD?IF
i^. folursel ~Cu. Sz. Con:. Colcr Gr. Si. Sh. 'Effg1 'Eff#2
I
❑ Boring
BG^ng A Grcurd'.,dace elev. ft. Depth ;u 1,maing factor in.
Pit I
Soil A licalion Rate
Horizon Depth Dominant Color Redox Descr,pWri Texture Structure Consistence Boundary Roots GPDifF
Sh. 'Ef`Rt 'Effp2
i P.7,.nset, Qu. Sz. Con:. Color Gr. Sz.
r---
i
Effluent qt = BOD, > 30 < 220 m_;.;L and TSS >30 < 15C mgiL ' Ellluent N2 = BODr < 30 mg+L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
nrcd mutcrial it an uiiem to Ita'mat, plcusc eonurct the departn:crit at 608-266-3151 or TTY 608-264-8777.
'vVisconsin Department of Commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
n a: corda!j:,e with Comm 85. bLtis. Adm Code -
Co:my S7
Atlacn comP;ele site plan on paper not.ess than 8 tr2 x 11 Inches in size. Plan must
include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope. scale ordimensions• north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
.
Personai information you provide maybe url for sewndary purposes (Pwacy law. s. 15040)111[1p
Property Owner Property Locaton
Gan. Lot ,VE V41~ 1145 r I N Rl(~ E(O Wl
Progeny Owner's Mating Adcress got # Block # - utd. Name or CCSM#
j Cry t h State Zp Code Phone Number ❑ City ❑ b'i.lage own Nearest Road
Ll,L2Q,, Lt i. I J` :L (71:i) e a~.~ chi = /O fl roue
d6"New Consuudon Use: E~fResidentra! Number of bedrooms Code cerived design flow rate CEO -GPD
❑ ReJacement ❑ P;.blic or commercial - Describe: _ -
r T / Food Plain elevavor, it appliable / fL
Parent material ~~f! . /
Ge'reral comments
and fe CA-nmenda:ions:
117, f~
~cl t~cC)
l l Boring l-
Bori-g r
L Gupta to.imdm factor Y in.
Grounc surface elev. r- _ g Soil A b atan Rate
Ho^zon Depth I DominantCo:or Redox Description Texture Structure Consistence Boundary Roots GPD#F
in. Munsell Qu. Sz Cent Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
S / _ 3 r1t 1' Ln: l U
11 . D .3
\1 A ( i vQ c r v" C h
f ~ -
Boring« ~~-~/Be,-ny
Lf7 Pit Ground surface elev. - it UeCm :o limiting factor 1 . in. Soil Application Rate
-anzon Depth Dominam Color Redox Description Text.~re Struclcre Consistence Boundary Roots GPDIff 11 fdunsell Qu. Sz. Con:. Color Gr. Sz. Sh. 'Eff#1
'Etf#2
l - O
~Yt TY r Q
I L;
VIA j I l
_ -y f er U-)
bL -3
I
'Effluent fe 1 = BOD, > 30 220 ml and TSS >30 < 150 mgrL ' Effluent 02 = BOD < 30 mg L and TSS < 30 nl
CST Name (Please Pri t) _ Siynalure CST Number
l ~p 9~
Adtlress J Date Eva:ualion Conducted Telephone Number
At -~~7
1 c I ~i ~l 7