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010-1074-30-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15 04 (1)(m)]. TANK INFORMATION TYPE MANUFACTURE t "(\ S CAPACITY Septic w;R- Fl�c� L{� /Z sc Dosing 11, O -7C O Aeration) Ho VM'c 1 I lor, 525 TANK SETBACK INFORMATION TANK TO P(L WELL BLDG. Vent to Air Intake ROAD Septic z�6 t zt-v� t Dosing 3a • ZGo� Zy t L17 L Aeration Holding PUMP/SIPHON INFORMATION CCf IFi\,jn.iu 38.7-7 Manufacturer Zb Lcr Deman GPM Model Number h 4 TDH Lift Friction Loss System ea TDH Ft Forcemain Length Dia. �. lie,I Dist. to Well 1 1 x SOIL ABSORPTION SYSTEM Iuounry. St. Croix 010-1074-30-100 16.454E ELEVATION DATA � STATION BS HI (03. FS ELEV. 100 Benchmark �. Alt BM Bldg. Sewer t{, g5 93.148 SUHt Inlet 8 8 SUHt Outlet Dt Inlet Dt Bottom 3. 61 8 4. 7 2 Header/Man. I' S l I a 1 I , Dist. Pipe 81101, Bot. System Z .31 loo , q9 Final Grade St Cover II �;�itr Z-7 031 (ally, 1 r. 161C (e _-7_-7 — 1. 3b 11. L 8 -61,Sz BED/TRENCH DIMENSIONS Wdthr., • VX Length 7 5 • es 3 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO IP/L (� BLDG WELL LAKE[ T LE HI an ct rer: INFORMATION T Of System y y 1 /r, O V vuCJ �I�� LI /'xv �17 • HA E OR U M el Nu t DISTRIBUTION SYSTEM Header/Manifold I r. 2 • Distribution // r, I Z �•��• x Hole Size 5 ., x Hole Spacing t Vent to Air Intaakkee Lengths Dia Lengthl`3. Dia Spacing �i J. L y0 1'Ih%i SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only 17iv 0. v�)L t• DapihGver rr r. . Depth Over zx Depth of xx Seeded/Sodded xx Mulched Bed3raaeB-Beeter grt Bedrrrench Edges +� g > 1Z Tsoil �� o p Yes G No Yes Ej No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 1 12z)� Inspection #2: Location: 2186130TH AVE LbCi.�S 4-Cl.`q t~5 �h�U V� 1.) Alt BM Description = I 0 t J 2.) Bldg sewer length=3 ! ( �r CNeed « 'Pvif - amount of cover 'r A! 17N 153 i VkS44)(,�3 0 7 �fG�ttlh Plan revision Required? Yes (] No / '7.� D� Use other side for additional information. Date Insepctor's Signature Can. No. SBD-6710 (R.3/97) iD �� ' AUG 2 2 200 sae Industry Services Division 1400 E Washington Ave P.O. Box 7162 Madison, WI o7 162 county Saint Croix Sanitary Permit Number (m be filled in by Co.) G uD t Applioatio i In accordance with m. o e. su mission of this form to the appropriate gov Fatte is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Suite Transaction Number PwrS-071901100 C Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy law, s. 15.04 I m , Stets. Nearest oad 290th Sty I. Application Information- P ase rint All Information Property Owner's Name Al Gausman (GQgt{AM Parcel 4 010-1074-30-100 Property Owner's Mailing Address Property location ` 0, 304 1170 9th Ave. Govt. Lot y4, SE Y4, Section 30 City, State Zip Code Phone Number Baldwin, WI 54002 715-245-9251 _6C— T 30 N, R 16 W II. Type of Building (check all that apply) Lot ® t or 2 Family Dwelling- Number of Bedrooms )lL a --I—Subdivision Name Mr- 4ab Block ❑Public/Commercial - Describe Use I ❑ City of ❑State Owned -Desenbp Use I CSM k75 � ❑Village of ©Town of Emerald Number/6•/ / ig 7- oG IA IQ� III. Ty eck on line A. Complete line B if applica I)� X A ® New System "placement System Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of Plumber I_Irermit Transfer to New Lis[ Previous Permit Number and Dale Issued Before Expiration Owner that apply) W. Type of POWTS S stem/Com onenUDevice: ChlIe--c- IkI'�all []Non-Pressunzed ❑Pressurized In -Ground LJAt-Grade ❑Mound> 24 in. of suitab soil ❑x Mound <24 m of suitable soil ltl--n---ItG��ro�und /I ❑Holding Tank [3Cither Dispersal Component (explain) ❑Pretreatment Device (explain) I art V. Dis ersaVfreat at Area Information: 4 t Design Flow (gpd) Design Soil Application Rate(gpds 600 1.01.4 Dispersal Area Required 600 A5°� Dispersal Area Propos 0 1,147 System Elevation 101.99 VI. Tank Info Capacity in Gallons Total Gallons k of Units Manufacturer //�� r l r /� 1 G i/ l ✓�� V '$ New Tanks Existing Tanks Septic or Holding Tank 12507750 1250 1 Wieser J x J Doting Chamber 1250f750 750 1 Wieser x VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Si mre MP/MPRS Number Business Phone Number Chad Willger 1042644 715-790-5802 Plumber's Address (Street, City, State, Zip Code) N2414 Narrow Gauge Road, Shell Lake, WI 54871 VIII. Caun 7Depairtment Use Only pproved pprov n Reason for Demal ve Permit Fee $ Date Issued Issuing "tit Si IX. Condi e, Reas4ts forpisapproval / t 1. SepSepticrk, t.sn: I a' pry bisprt�'Z" Cell must all _-'nt_ tL1/+'--., �///�� 2. AA aaRNr�h fa5ta�:^arew tnurst uo i-c,rtak E i as per ,xtarh W agemen! plan po�ioeNlumbe;. GL�a.✓�tl�W�-Ot .pe►>�«6:/c4unoti. '4a d' low Atluch to complete plum for tee system am submit to me lounry only apV paper not M. mre � us a t t rucnee asstar orp r✓a�C- r I SBD-6398 (R0313) /� �a C 7'7fdY1 M { �l.A (Z c f (A� A)I f N28-rz � s �� & MO A 0, anti m�rk- N Tip 4 I %a Rv P, s� EIS. lot.00` 13e�ch M.'k Top o� Pr� 54PAtt 8 gi port P-4- ParceJ -41- 010 - 1074 - 30 - 100 5E 6f� , 5e4.30,'130 R lbw �jr,ci4tr� G ewSr+aJ1 of I BG 130"' Ale. 21L1;,, A , ti,T 94oz- IdSo/75o V,0-9-r T. k 149%���r L I 611 peA a��.� M�k dcMO 1-f DF S�a,-C ��---- )cc.CL 41 rcicop e. July 11. 2019 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2021-07-11 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://daps.wi.gov/programs/industry-services www.wisconsin.gov Conditionally APPROVED Tony Evers - Governor Dawn Crim - Secretary Plan Review: PWTS-071901100-C DEPT. OF SAFETY AND PROFESSIONAL CHAD M WILLGER SERVICES DIVISION OF INDUSTRY SERVICES SITE: Graham GAUSMAN Town of EMERALD Saint Croix County Total Amount: $250 FOR: Description: 600 GPD-New Residential Mound Maintenance Required SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manuals) referenced above. 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: Key Items- POWTS Design Approval • This system is to be constructed and located in accordance with the approved plans, the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01/01). • Fence off dispersal area prior and during construction to protect and avoid disturbance, compaction and use of the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c). • Provide surface water diversion around the treatment tanks and mound dispersal component • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS) in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection, evaluation, maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/insWIadon/operation. In granting this approval the Division of industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, %/1,er2,P r7.r� Mark S Finger POWTS Wastewater Specialist, Division of Industry Services (608)574-1189 mark.finger0wi.¢ov • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soiL Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c). • Provide surface water diversion around the treatment tanks and mound dispersal component • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS) in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection, evaluation, maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits 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 Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stars 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Mark S Finger POWTS Wastewater Specialist, Division of Industry Services (608)574-1189 mark.fineer@wi.gov PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10/12) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Al Gausman Owner Name(s): Graham Gausman Owner Address: 1170 9Th Ave. Baldwin, WI Project Address Nearest Road 290Th St. Govt. Lot: SE 1/4 of SE Township: Emerald Project Parcel ID #: 010-1074-30-100 Phone:715 _245 Zip: 54002 9251 1 /4, Section 30 , T 30 N-R 16 E ❑ or W ✓� County: St. Croix Designer Information Designer Name: ChadWiillger Phone: 715 _790 -5802 Designer Address: N2414 Narrow Gauge Rd. Shell Lake, WI Zip: 54871 E-mail: Chad@willgerph.com This space reserved for approval stamp. License Number: 1042644 Remarks: Signature: ez�L Date: 6/3/19 Original signature req a on each submitted copy. 0 M BR_ 7 alp. a,,Y-K Mark. +ol.bo` px,4, MIA To? v� slake- loc. `b �2r, 0. &-. c4 Mark T,P 4 1 V} Pvc- P, E-)�J. 101.00, ^ Murk Top oG Pr+AY S"e- t I v, t oo.4b, R� gore. P4 ;Irce-1 -0- O(o - 1 o7K - 30 - too 5E'�, of �, Sec.30, i 3o Ri`w Town Emerald (jr�ar� Ga..sn�n a ISd IWh Ale. &). %.tn, kZ s90DOI idso/7so wreser T,^k I. 4° SLk vo Put. 4 ^� odf>bM� � zS' Q A)1, a--t-4 F�.rk A Top 4 1 VA- We P, P.- / \I tlu. lol.00' Tq cx prof& ` M-ke- tlV. ioo.vo` B� &2 P.4- ��rc�� * 010 - 1074 - 30 - loo SE'/y SV% 5ec.30,'130I R144W I oWn [r� �m eralc� �rti}�acM G asn�n a I SL 130'" A✓e. wZ S4ap2 idso/�so t✓:eser To.kqo D kk- 1 l y El aia. jj,, 4X M„rk. I demo lol.ro' I pencl Ms.ric I SINGLE -CELL MOUND DISPERSAL AREA 1.5"TO 1,5'WASHED AGGREGATE (Inin. 6.0"Ibeneath distribution pipe - min.2.0' over distribution pipe and covered with H MIN. 6.0' OF TOPSOIL COVER D. 1.5 fl E = 1.78 it approved synthetic fabdo) min, 1.0 it System Elevation = 101.99 ft ASTM C-33 SAND FILL Lateral Invert Elevation = 102.49 it min. I �i I' 1 r CROSS SECTION VIEW 8 (No Scale) D E sud-1. Ploomed Suffma Statism Comm 3.5 % siope Elevation - 100.49 ft w= 27.58 ft (Show force main, manifold, and flush valve locations on plan view. 1.5 '0801u:140 PVC Lag" j (M*Q r- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — L--------------------- B- 75 it Band as nacessery to follow oardour DOWNSLOPE TOE PLAN VIEW (No Scale) 10 ft prstey --------------- ------------------------ it L - 95.59 ft Prohibit disturbance and vehicular braft within 15 feet of dcnmnslope toe. Reset Pa e K- 10.30 It Qyp,� ) G) m CA) 0 ,n (7) DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) FLUSH VALVE DETAIL (No Scale) Orifice in — — Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) r k \ \ Ball Valve I \ (optional) / \ Orifices equally spaced: ^[dmcic a) OR b) below) \ nalong bottom of lateral n, along top of lateral Flush Valve Assembly with every _ 1h bolo (typical - see detail) facing down LATERAL INVERT ELEVATION = 102.49 (typical) Lateral Length (P) = 73.60 It Shield orficea for gravelless applications Last Orific (typical) OBSERVATION PIPE DETAIL (No Scale) Screw -Type or :� ' Finished Grade Slip Cap (lam) +' (mulcted & seeded) 4'0 PVC Pipe Topsoil Cover (min. t foot) Top of pipe to terminate at or above finished grade (4)1/ lobs 4 � part Anchoring Device Irdlltration Surface Lateral Spacing S = 2.67 ft 2 -0 Schdl 40 _ PVC Force Main (slope to pump tank for drain -back) Laterals to be level 1.5 ^0 SchdI40 PVC Manifold (riser pipes optional) list Orifice (typical) "I—Schdl 40 PVC Lateral 0 = 1.5 in (typical) Number of Orifices per Lateral = 24 Orifices equally spaced Orifice Discharge Rate = .538 gpm along bottom of lateral Number of Laterals = 3 Orifice Spacing (X) = 38.4 in (typical) Lateral Discharge Rate = 12.92 gpm TOTAL DISCHARGE RATE = 38.77 GPM Orifice Diameter = A 56 in (typical) First Orifice (typical) END MANIFOLD (nyw l) CONNECTION Check applicable box. Manifold _ rince(riser pipe optional) D (typical)) Q {-- X---i'—X/2 X/2--i x ---i O (tow) (typical) CENTER MANIFOLD -n Manifold ❑ CONNECTION (riser pipe optional) DISTRIBUTION NETWORK SPECIFICATIONS FLUSH VALVE DETAIL (No Scale) Orifice in — — ` Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) \ \ I 1 \ I \ Ball Valve i \ (optional) / _\ inch Orifices equally spaced: Z = _ \ ^[check a) OR b) below] _ r . r k, along bottom of lateral ,n along top of lateral Flush Valve Assembly with every _ th hole (typical - see detail) facing down LATERAL INVERT ELEVATION = 102.49 (typical) (No Scale) Lateral Spacing S = 2.67 Lateral Length (P) = 73.60 It Shield orifices for gravelless applications Last Orific (typical) OBSERVATION PIPE DETAIL (No Scale) Screw -Type or •�.:�.- Finished Grade Slip Cap (loose) (mulched & seeded) 4"0 PVC Pipe ` '.'•t Topsoil Cover (min. 1 foot) Top of pipe to terminate at or above finished grade (4)111/ lots part r ` Anchoring Device Infiltration Surface 'R .,P, 2 -0 Schdl40 _ PVC Force Main (slope to pump tank for drain -back) 1.5 "m Schdl 40 PVC Manifold (riser pipes optional) First Orifice (typicafl Laterals to be level 40 PVC Lateral 0 = 1.5 in (typical) Number of Orifices per Lateral = 24 Orifices equally spaced Orifice Discharge Rate = .538 gpm along bottom of lateral Number of Laterals = 3 Orifice Spacing (X) = _38.4 in (typical) Lateral Discharge Rate = 12.92 gpm TOTAL DISCHARGE RATE = 38.77 GPM Orifice Diameter = .156 in (typical) First Orifice (typical) END MANIFOLD (typical) IZI CONNECTION Check applicable box. Manifold -D First Orifice (riser pipe optional) D (typical) m X- iw22 X/2—i x cal) 0 CENTER MANIFOLD Manifold ❑ CONNECTION (riser pipe optional) ilc(v1c�'c� SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4 0 Vent Pipe >10ftfrom Building 12" Min. or 2.0 ft above Established Flood Elevation (typical) IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383A3(8)(g) Finished Grade CAPACITIES @ 16.12 gal/in Depth (in) Volume (gal) A 35.32 569.36 B 2.0 32.24 [C] 8.31 133.92 D 4 64.48 PAGE 5OF6 Electrical must mmply with BPS 316 and NEC 300 Weatherproof Extend manhole riser as necessary. Y.� *T I IjA a [c) *Pump Tank Liquid Level = 51 in D Force Main Diameter = 2 in Force Main Length = 200 ft Force Main Void Volume = 32.62 gal Approved Locking Manhole with Warning Label Attached (typical) 4" Min. or 2.0 ft above Established Flood Elevation (typical) Seal Quick Disconnect 18" Min, • (typical) 1 Hole Pump 3" Approved Bedding Material Beneath Tank [C] Total Dose Volume (TDV) = 133.92 gal/dose (5X total lateral void volume < TDV S 0.2X design flow) +(force main drainback volume) MIN. PUMP DISCHARGE RATE = 38.77 gpm Approved Joints Wth Approved Pipe 3 It onto solid Ground (typical) PUMP -OFF ELEVATION = 85.33 ft INSIDE BOTTOM ELEVATION = 85 ft Vertical Head = 17.16 ft + Min. Supply Head = 4.55 ft + FM Friction Loss = 5.18 ft + Fitting Loss' = 1.05 ft (min. supply head x 0.3) = TOTAL DYNAMIC HEAD = 27.94 ft PUMP TANK: SEPTIC TANK(S): Volume = 1250 gal Total Volume = 750 gal Manufacturer. Wieser NEENNE Manufacturer(s): Wieser Pump Manufacturer: Zoeller Install approved effluent filter at the septic tank outlet Pump Model: 153 INEENEEN (See attached pump curve.) immediately upstream of the pump tank inlet. Controls/Alarm Manufacturer. RJE Rhombus Filter Manufacturer: Polylok Controls/Alarm Model: Tank Alert Filter Model: 525 Float sw[tches containing mercury are prohibited. PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Plpe >10 ft from Building 12" Min. or 2.0 ft above Established Flood Elevation (Nplcui) IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383.43(8)(9) Finished Grade CAPACITIES @ 16.12 gaVin Depth (In) Volume (gal) A 33.03 532.41 B 2.0 32.24 [C] 7.50 120.87 D 4 64.48 x� a *Pump Tank Liquid Level 51 In Force Main Diameter =� 2 in Force Main Length = 120 ft Force Main Vold Volume = 19.57 gal Electrical must comply with SPS 318 and NEC 300 5 __ Weatherproof (Junction Box 4 .. . *T t IAj J.� e � 0� Extend manhole riser as necessary. Approved Locking Manhole Mth Waning Label Attached (typical) 4" Mr. or 2.0 ft above F�lablished Flood Elevation (hW-O Quick Dlac mnecl 18" Min. 1 Approved Joints vAlh Approved Pipe 3 ft onto Solid Ground (hplcal) PUMP -OFF ELEVATION = 91.82 ft SIMON INSIDE BOTTOM ELEVATION = 91.49 ft 3" Approved Bedding Material Beneath Tank [C] Total Dose Volume (TDV) 120.87 gal/dose (5X total lateral void volume S TDV < 02X design flow) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = 38.77 gpm Vertical Head = 10.67 11011ft �+ Min. Supply Head as eft � + FM Friction Loss = 3.74 ft + Fitting Loss' = 1.05 ft `(min. supply head x 0.3) = TOTAL DYNAMIC HEAD = 18.95 ft PUMP TANK: SEPTIC TANK(S): Volume = 1250 gal ommoommem�Manufacture Total Volume = 750 gal Weiser ManufacturersWeiser Pump Manufacturer Zoeller Install approved effluent filter at the septic tank outlet Pump Model: I D (Sea attached pump cume.) Immediately upstream of the pump tank Inlet Controls/Alarm Manufacturer: RJE Rhombus EMISSIONFilter Manufacturer. Polylok Controls/Alarm Model: Tank Alert Filter Model: 525 Float switches containing mercury are prohibited PAGE 6 OF 6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin, Code. Maximum Dispersal Area Operatinq Limits: Design Flow = •Iti gpd; BODE 5 220 mgL-'; TSS 5150 mgL"; FOG 5 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e,, pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution ! drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(sl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Slats. when the volume of solids In the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113. Wisc. Admin. Code. o Effluent filtertsl shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Dlstributlop'laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Willger Plumbing & Heating, LLC Phone: 715-790-5802 Local government unit: St. Croix Falls County Phone: 715-386-4680 Local government unit address: 1101 Carmichael Rd., Hudson Zip: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Continuencv Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. Svstem Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow= •11 gpd; BODE <_ 220 mgL"; TSS 5 150 mgL"'; FOG <_ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e, odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution I drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e_. Pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113. Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution'laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Willger Plumbing & Heating, LLC Phone 715-790-5802 Local government unit: St. Croix Falls County Phone: 715-386-4680 Local government unit address: 1101 Carmichael Rd., Hudson Zip, 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383,51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin, Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384. Wisc. Admin. Code, Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. ati 4 2 0 8 6 4 2 45 40 35 30 25 20 15 10 5 153 152 0 3ALLONS _ITERS 0 PUMP PERFORMANCE CURVE MODEL 151/152/153 10 20 30 40 50 60 70 80 90 40 80 120 160 200 240 280 320 3E FLOW PER MINUTE w w PUMP PERFORMANCE CURVE MODEL 140/4140/145/4145 ra 22 70 20 65 60 18 55 16 50 14 45 0 12 40 U r 35 10 0 30 B 25 6 20 15 4 10 2 5 145! 140/ 4145 0 0 10 20 30 40 50 60 70 80 90 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE 150090 Wisconsm Department of Safety and Professional Services Oiwsion of industry Services SOIL EVALUATION REPORT In accordance with SPS 385. Wis. Adm. Code Attach conlplele site plan on paper not lees then 8 112 x 11 Inches In size. Plan must Include• b.x not llmded to vertical and horizontal reference point (BM), direction and percent slope, scare or (1imensions. north arrow, and location and distance to nearest road. Please print ag Information. Property Owner Ruben & Wig Larson Plot)" Owners Ma91ng Address Page 1 of 4 Raf M2485 ❑ 0 E (of) W Lot # Block # Subd. Name or CSMM 1 Na CSM Vo1.13. P0.3660 city State Zip Code Phone Number I ❑ City Cl Vltlege, ® Town Nearest Road i Baldwin---__--•--� WI _J 54002 ( __l._ I Emerald 2W St ❑ Ne* C:onstfuctton Use: ® Residen6aliNumberofbedrooms -4 Coda derived design flow rate 09 GPO ' I 1 Rpplacemenl ❑ Public or commorrdal- Describe: — , Parcm material-j2kQW1.T111 Flood Plan elevation if applicable •aft, IL Gariefel comments and recommendations: Site suitable for mound POWTS. Recommend nllitralive surface elev. to be 102.00' at 18' above 100.50' •z r4ocl I County at. Croix Parcel 1.0 010-1074-30.100 Reviewed by Property Location Govt. Lot SE Y. SE Y, S 30 T 30 N R 16 Boring 1 I Boring s ❑ ® PB Ground surface elev. 100.58 m. Depth to Knitting factor 16 ir. I Rae AnnlicanM Rate Horizon DepUl Oommant Color In. I Munaoll Redox Deacdpllon Du. Az. Cont. Color Texture Structure Or. Sz. Sh. Conelatenee Boundary Roots GPDIF_C —� •E1M1 )- •F.IW2 r -- ' �? OA : 10yr3/'S 9.18 10yr514 7.6yr4/4 none none 12f 7.5yr618 sll 311 sl i 2fgr lmsbk tmsbk mvfr mvfr _ Mir rS c1v�-_ t1vfj"M 0.8 0.4 0.4 38 _y 0516.30 07 ! 4 ---- 30-48 5yr416 V f3d7.5yr518 set icsa mfi .—� _ 0.2 _-. 03 ' 2 I Bod rg a ❑ Boring ® PA Ground surface alley. OW 8. Depth to limillurg factor 3f b,. ra.,x aaaa�r..o a.a I Horizon Depth Dominant Colo) Redox Descrilog Texture Structure Consistence Boundary Roofs GPWF_t'__'1 In. Munsell Du.A2- Cont. Color Gr. Sz. Sh. 'EW2 'EfN406 1 - 0.10 10yr3/3 none ail 21gr ds cs 2vf•lm 0608 2 10.19 --- 10yr514 none $It imsbk dsh -_ cW _- ivf,fm 0.4'_� 3 19-31 07 7.5yr414 — none sl tmsbk mfr 9w IYI,fM 0.4 Id3bk milli _ lvi 0.2 03 --- 31-44 7.6yr414 ^—_ 12MIlyr016 act - ---- ' •!•flkrenl9l=BU_D,,30S220m LandT S>305150n_11g1 Effluent #2=BOD,>303220inglLand TSS>:Ws16U�x�'L_ CST Name (Pkinse Print) Signature CST Number James K. Thomson ___ _.____. __ _.__-.___. ___._.__- 30021 :Address Dale Evaluation Conducted Telephone Number � 340 Paulson Ldkc Lane, Osceola. WI 54020.5413 August 9, 2011 715 248.7767 _ — en __ ..._.._1 Wisconsin Department of Safety and Prolassional Sanrires Division of industry Services SOIL EVALUATION REPORT Page 1 of } In accordance with SPS 305, Wis. Adm, Code County --_ - Attach complete sae3t. Croix plan an paper not teas Than B 112 z 11 Inches In size. Plan must include, -- — bat not Ibn.teo to, vertical arw horizontal reference point (BM), direction and percent slope, Parcel I.D scmie or dlmansions. north arrow, and location and distance to nearest road. 010.1074.3D•100 _ kzf #e"465 ; Please print all Information. Reviewed by y Dalc-� Property Owner Ruben 6 Lots Larson Property Owner s Mailing Address CRY State Zip Code ems--- - .-J y�!- _1 5M Ypu aces Pi yLaw a.15.04(1)(m)) Prop rty Gott Lot LSE V. ❑ GoW- Lot SE Y. SE Y. S 30 T 30 N R 16 E (00 W I Lot # Block & Subd. Nerve or CSM# 1 Na CSM Vol. 13 Pb. 3W0 --T Phone Number I ❑ city ❑ \Allege _ ® Town Nearest Road i ❑Nc-wConstrucion Use: ®Residenliel/Numberofhadrooms_4 Code dedveddeslgn now rateNQOPD Replacement ❑ Public or commordal- Describe: Parem materlat . Glacial TBI Flood Plan elevation it applicable nL it. General comments and recommendations: Site suitable for mound POWTS. Recommend mliafative surface elev. to be 102.09 al 16• above 100,50' "UnIoul I ._�.__ ❑ Sorirlg I I Bonny a ® Pa Ground axlaa elev. 100.56 (L Depth to Bmaing lector t 6 is . i Sell Auaacallon Rate Hnnzon Depth Dominant Color In. I Munson Redox Description Off. Az. Cont. Color Texture Structure Or. Sz 9h. Consistence Boundary Rooks OPD;FI'__� 'E6#I r _ EH#2 ,r ' OA i0yr3/3 none so 121gr mufr a 2v1,(m 0.6 08 y --- b Ifi t0yr514 none sn tmsbk mvfr at lvr,tnl 0.4 06 --3 _ to-30 7.5yr414 Rf 7.5yr516 at tmsbx Mir 'gw. tvt,fm 0.4 07 ; 4 - -- -_ 3045 5yr476 J f3d 7.5yr 5/8 ad left mfi I - 0.2 03 ( 2 BorYq a ❑ Boring Pll Ground surface elev. HE it. Depth to milling lector Zy u-. Horizon Depth Doment Color m Redox Description Texture Structure Conskience Boundary Roots GPWFrr - _ In. aw Mteii Ou. Az Cont. Color Gr. Sz. Sh. 'Ey91 •Eaa2 . 1 0-10 10y= noire all 2fgr ds a 2vf.tm 06 08 2 10.19 10yr5r4 none so 1msbR dsh ow tvl,fm OA' 06_� 3 18-31 7.5yr414 none sl lmsbk Mir Ind 9w ---�-tvl IW,fm 0.4 07 I 03 e at-49 7.5yr4M' 1217.6yrera all 1Gablk -2 F" ant O1=&)0_�3052201 and Ss305150m�1 v �EfOuenl#2=WD,>3Us2201 andgpt-5051Ntmgft____ _ CST Hama (Pluose Print) 9lgnelure T Number � KI.. Thompson -- ---- _- — -E:HNOK021 _James Address Dale Evaluation Conductedephone Number340 Poulson Lake L-drm, Osceola. WI 54020.5413 August g, 2017 61249.7767 - -- --. tiRn.nn�,Sia.Smtst 3 I Boring M ❑ Being I—J ®Pit Ground surface elev. IWA h. Depth to longing lector N4 in Solt Ariallcabon Rate I Hodmn Depth In. Dominant Color Munsek Redox Description Ou. Az. Cant Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPDfFT° JI •EM#1 'EW2 _I 1 0-0 t0yr313 none eft 21gr mvlr as 1vUrn 0.6 0.8 ~f 2 9-19 10yr5/4 none on tmebk do aw 1vf.im 0.4 0.0 3 19.30 7.5yr414 none sl lmsbk _ mlr T OW tvf,lm 0.4 0.7 4 30-48 7.8yf4/4 Md 7.5yr4/8 set lcsbk mg Q2 0.3 v i i D sod" a ❑ Boring ❑ Ph Ground surface elev. —ft. Depth to ranking factor _ in Sall AAppli=Von Rate Horizon i Depth In. Dominant Color Munsell Redox Description Ou. All. Cant Color Texture Structure Or. Sz. Sh. Consistence Boundary Rode GPD/Fe 'Elfl{1 'Eti#2 —� i i t i 1 Boring # ❑ Boring ❑ PR Ground surface elev. _ n. Depth to xmkktg factor __ in. Soft Application Rate Horizon r Depth In. Dominant color Munson Redox Description Qu. Az. Cant. Color Texture Structure Dr. Sz. Sh. Consistence Boundary Roots GPDlflr 'EBI7 'ERR - - I I Effluent 91-SOD, > 306220 MWI and TSS>30s150 mgfL 'EBiuenl#2eBOD,>30s220mgfLand TSS>3051SDmg/L ✓. t. Inept. Arlev, v /oiov.' ��.,� a «G rl�lTepoF/o&3EaA/e. l3omNlt c4e&�cd p/apW4yv6AJ • sa;/ edalaa,Eo-^P,& � E�tr's%in� �radt c/t� Qubin'e /ar Lk/.canlorop. eq/dVJ,n� C'M 4N402 U Drl 3EV/,Sr�'� 3sC.9 . , ,. It, u1.,T.of IfMttlt44 aE•arol Co;Wl. 1;a,, a: o/o-10711-Jo • /co h4t'y f.0,24cf-is Ex,a6� 1^owe 'Al. frlal.,� E;t)3Gf H Y� till/ u/xu,..te.Yc br r u' h� i jp' �69)� Ald. Tvp eF IV:S.{, do pr/re. erkv,,,o4ao,' c��dprepw�yv��t � Soil ¢dd!NaLar�!),fi Erls�in�o grad( akr, V' u Pl( )yes Qubrn� /a,s L4a",M prop. �z/ob lj0ly.41(. ,6,/da),'n, L,)l. 5t/�L02 (� p LSE/,C:8n1 ✓ol �3,F1T'� 3CYI✓'E�'�.4tC.9. � Q, IG Nl„ Tn. of Enicra Caj yE . arD4 Cu•, cJr. pu,/ /� D/ D-/o7y do • rco Now e „je// uti ,',utiie, fc bi' NOTE* This horse may regtire wall bracing de -downs depending on windlseismic design. Please refer to the permit set for Bedowrl bads and locations if applicable. Some areas of the exterior wall sheathing may he shipped loose to allow access for fie -dawn installation. All be -down designs are by others. pn ON o" d Bdrm 2 .`I Den 9'-3'x1f-7.C' 9'-7•x11'-7 4j MONO moommor- uomvmmou ja fin n... u.-u� I nu uouum me .:■.\mice memo a ■■/■■■ ■eemm .mime. l I u .m ■ .. i ■ .■0ema© . memmmmel ........1 r ,...... ..Diem. le/melt Immmc■ 1...,..^ IHUN me I a Or in 6 Imm■mml Ic mmmm. ■■mmm■ mem/ . ..................in ......� .p■■111 m■■.//m Um.mm ml in I on J issmommmmammmomm:mm IN Piving Master IA' .. •=miiiii .. �.� 1 u moue uuuu■ umuuu luuuu .....:.. Note. Because of varying stale requirements and optional equpment, some or as of the utility, locations might charge per floor plan RX780-Al2 3258 Approx. 1740 Sq. Ft. saesrepms.wmiveforea Consu"your sales representative for exact sperd'callom. w a.w.w Coerature HomesdIrtTana ° "" ' �sy 0B 019 a A-1MOBILEHDMES RX76 Al2 `'" Literature amen nr nW s,l 1 O ro. LIT NOTE: This home may regtire wall bracing Ik downs depending on windlseismic design, please refer to the permit set for fie -doom bads and locations if applicable. Some areas of the exfenor wall sheathing may be shipped loose to allow access for dedown installation. All L-dam designs are by others. t d �i� iiC:C:■ 11 ■qm� nuu •ruoumos ■uuuuu muumuus I Bdrm 2 Den W-B' x 14'-21 9'-r x 1�'-r .i :( r 10, ----�- --10' -�- - RX780-Al2 3258 Approx. 1740 Sq. Ft. Literature pan iGuuu■ uSuum PRORH Master Bed( iom 13'-3' x 14' 2' Note. Because of varying state requirements and optional equipmi some or all of tie utility locations might charge per floor plan (ie: f imaces, wlh, stairwell). Consul your sales representative for exact specifications. rroOwFiq Ilv AU7 OBILEHOMES RA90-Al2 ••' Properly Address ST. CROIX COUNTY SEPTIC TANK MAINTENANCE ACrREEMENT AND OWNERSHIP CERTIFICATION FORM NAM (Vorifioaaon regmmd from Planning I ;] new Sys City/State R A1.Ot yw% ,s &e M Parcel Identification Number 010- M4 - 30 • ICX-') LEGAL DESCRIPTION Property Location S£ %. , SIE /. , Sec. pl , T C7 N RGW, Town of C ( ere 1C3 Subdivision Certified Survey Map # Warranty Deed # Spec house 0 yes C no Volume , Page # (before 2007)Volume , Page.# Lot Imes identifiable 0 yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # Improper use and maintenance of your septic system could result in its premature f Lure, to handle wastes. Proper maitonance consists of pumping om the septic tank every three years or sooner, if needed, by a licensed pumper. V,7= you pot into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specifiem d§SPS. 38352(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fall of sludge. I/we, the undersigned have read the above requirements and agree to maintain the pricaYe sewage disposal system with the standards set fords herein, as set by the Department of Safety And Professional Services and the Deparimeent ofNaniral Resources, State of Wlsoonsm. Certification stating Thai your septic system has been maintained must be completed and retried to the SL Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we ceit fy that all statements on this form are hue the best of my/oir knowledge. I/we am/am the owner(s) of the property described above, by virtue of a warranty deed recur in Register of Deeds Office. Number of bedrooms a C, osp) SIGNATORE 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 waaanty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV- 041U) Wisconsin DepJ�ssional Services Division oflndu YY GGLLJJ CST -aQ n - 143 Page 1 of 3 Allr 1 7 9n17 SOIL EVALUATION REPORT r1Vu r r w r r In accordance with SPS 385, Wis. Adli�CodP Attach complete sit��laG 6Wthan 8 1/2 x 11 inches in size. n m�t ;^ i�' &n County St. Croix Parcel I.D. 610-1074-30-100 Ref #2485 but not limited _VN"Wbl j�EW point (BM), dire an - KSQO 06 scale or dimensions, north arrow, and location and distance to near���Vacy Please print all Infermat: `y� Re by D Da Personal information you provide m be used for secondary` aw,s. 115.040)(m)). Property Owner Property Location Ruben & Lois Larson Govt. Lot SE % SE %. S 30 T 30 N 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. N e or CSM# 2186 13(f Ave. 1 Na CSM Vol. 13, P . 3660 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Baldwin WI 54002 Emerald 1.10014t. 0/1911,110 ❑ New Construction Use: ® Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement ❑ Public or commercial — Describe: Parent material Glacial Till Flood Plan elevation d applicable na ft. General comments and recommendations: Site suitable for mound POWTS. Recommend infiltrative surface elev. to be 102.W at 18" above 100.50' contour. 1❑ Boring # ❑ Boring KN{-Ok. Wzh ® Pit Ground surface elev. 100.58 ft. Depth to limiting factor 18" in. c..a Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FP 'Eff#1 'Eff#2 1 0-9 10yr3/3 none all 2fgr mvfr cs 2vf,fm 0.6 0.8 2 9-18 10yr514 none sit 1msbk mvfr ew 1vf,fm 0.4 0.6 3 18-30 7.5yr4/4 f2f 7.5yr5/8 sl Imsbk mfr gw 1vf,fm 0.4 0.7 4 3048 5yr4/6 f3d 7.5yr 5/8 ad 1 csbk mfi - - 0.2 0.3 Boring # ❑ Boring 2❑ ® Pit Ground surface elev. 99_57 R Depth to limiting factor 31" in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe •EB#1 •Eff#2 1 0-10 10yr3/3 none all 21gr ds cs 2vf,fm 0.6 0.8 2 10-19 10yr5/4 none sit 1Mabk dsh cw 1vf,fm 0.4' 0.6 3 19-31 7.5yr4/4 none sl 1msbk mfr gw 1vf,fm 0.4 0.7 4 3144 7.5yr4/4 f2f 7.5yr5/8 scl 1csbk mfi 1vf 0.2 0.3 CST Name (Please Print) Signatu CST Number James K. Thompson %-'-- 30021 Address ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020.5413 August 9, 2017 715 248-7767 WS"JJU (KU4/1 b) aBoring # ❑ Boring ® Pit Ground surface elev. 100.56 ft. J Depth to limiting factor 30" in. SoilSotl Aool Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FP 'Eff#1 'Eff#2 1 0.9 10yr3/3 none sit 2fgr mvfr cs lvf,fm 0.6 0.8 2 9-19 10yr5/4 none sit lmsbk ds cw lvf,fm 0.4 0.6 3 19-30 7.5yr4/4 none at lmsbk mfr gw 1vf,fm 0.4 0.7 4 30-46 7.5yr4/4 f2d 7.5yr4/6 ad tcsbk m6 - - 0.2 0.3 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. Sail Annlicafinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 -Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. Soil Annlioafinn Rafe Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 'Ef1#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS > 30 5 150 mg/L ' EMuent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L 'A!: T°P of/o,63CA14. e IA4 _ /dv. co' • 6oc�i<dn.apcs•�ystu� ■ 60,7 ada/ua�.w�,E ors/da1,'n, �.7/, sv0oz 0 3EY4St�/,-9iC.iFf,T.3on•. /k re 0/0-/0711- ,So'/x be.3 S. a2 a cres EX. 3d'�r,p/ On 14 5. d. of^,o.-5e. to be R$rnds+ ai� 7,5 p- pl. 3a3 LEON,ECEN St. Croix County mmunity Develow SEPTIC or HOLDING TANK SERVICING CONTRACT 4-28-2020 IThis contract is made between the Tank Owner(s) Name(s) and Pumper's Name Graham and Jill Gausman Berends LLC We acknowledge the installation of (a) septic/holding tank(s) on the following property: (Provide legal description): Parcel 10 010-1074-30-100. SE 114, SE 114, Sec 30. T30,R16W. 30.30.16.45413 1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County Planning & Zoning Department) to document maintenance by a certified septage servicing operator as required in SPS 383.52(1)(c)2. Wis. Adm. Code and the approved Component Manual. 2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the septic/holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septic/holding tank is installed; d. The sanitary permit number issued for the septidholding tank (if known); e. The dates on which the septic/holding tank was serviced; f. The volume in gallons of the contents pumped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten (10) business days from the date of change to this service contract. Graham and � � r Pumper's Name (Print) Pumper's Signature JuAt arer& I jW1 &W. 930,50 �)uoscrloea anc sworn to me on this cat 7'L,7'U Mt46tot. "moo ;:air tUCaYbf " _ 111 rr/ Votary �� ip pxpira �N' UBL � OF W1So f/rr 1 n tt`�