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HomeMy WebLinkAbout030-2024-80-000 c °; F O A, m m v w S 7. 7 FfT z O 00 L7 (n N W `"� � • _ < < N tt? v O O t0 N p N N N IV O r N ? a. N N N . j' ? ? Z• 'p 0 p C 0 C C A N � O W O � • CD W O .a N D ° O o D m f2o N i15 (D D A N L7 m N a O 0 W a r N N f O N N O O ! V�'' ? co � N NZ1 N 0 0 ID N O C N O O O 3 '''• ' FT �E - p :E * * - i '' 'I OC w z cn to to v — D v o v o a CL ID !Np tr 0 = (n o 0 N 0 W CD A - '., 00 N a ° D D o o n O ° N 4A7j (,.... C 5 a Ul o a lit • CD o c 3 I m O 3 CD CD O c A Z CD X n N A ( Z 7 N O ((0 N o z 0 a N) 0 z N N z CD A U1 r N V 2 O X L1 C O � - G (00 O N _ 7 - 1 0_ v 7 O o O C. N CD N d N y ID C I N A rz� 41 cc (D A v C � o I N L , m o0 o w ° b ° o CL `" Parcel #: 030 - 2024 -80 -000 09/10/2009 11:16 AM PAGE 1OF1 Alt. Parcel #: 12.29.20.43663 030 - TOWN OF SAINT JOSEPH Current X 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 - GIVENS, MICHAEL G & LINDA A MICHAEL G & LINDA A GIVENS 229 RIVER HTS TRL HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description * 229 RIVER HEIGHTS TRL SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.300 Plat: N/A -NOT AVAILABLE SEC 12 T29N R20W GL 1 LOT 3 OF CSM 2/388 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 29N -20W Notes: Parcel History: Date Doc # Vol /Page Type 10/22/2001 659734 1743/36 EZ 03/01/2001 639512 1594/36 WD 07/23/1997 1139/309 WD 07/23/1997 1139/307 WD more... 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.300 400,400 1,161,400 1,561,800 NO Totals for 2009: General Property 3.300 400,400 1,161,400 1,561,800 Woodland 0.000 0 0 Totals for 2008: General Property 3.300 400,400 1,161,400 1,561,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/19/2005 Batch #: 05 -37 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITAR Owner m �IUEiII f ,� i'7 3 Address Z:z- 71/E 174 R ECE, City /State jZ U PS D ,J &IIS _ 2 06 Legal Description: ST UAW Lot_ Block /` -- Subdivision/CSM # 3 �I '/, A] 1 /, Ad Sec. 12 , T N -R 2. 6 W, Town of ''� E 'S ,.1� IN # 034 2 9�'• ,Po • 0 0V 'e SEPTIC TANK -- DOSE CHAMBER -- HOLDING 'WANK INFORMATION: to /e5ai UG�.��� N S �i 25 > S Tank manufacturer l.ze ST/PC / Setback from Well P/L �8 Pump manufacturer X" oEA&A Model (e� 6E>tp U•y Alarm location IN SiDe - (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location larm location l S ABSORPTION SYSTEM , A^ p ��tl fl Type of system: /_, Width Length Number of Trenches Setback from: House H3 Well 10 2- PAL g0 , Vent to fresh air intake y SO ' ELEVATIONS No gjk ) I - re? or !0 • d Description of benchmark Elevation Description of alternate benchmark 7 i9A of Elevation / • I4/ Building Sewer �.3. 05 ST/WF Inlet ST Outlet O PC Inlet 9 O PC Bottom 0 ' Header/Manifold y�' Top of ST/PC Manhole Cover Top o� Distribution Lines( ) Bottom of System( ) q. 5 * .So P ( ) Orr G s. Final Grade ( ) / 7 w i Sep f • ti° ( ) ( ) oI Date of installation / / Permit number 3 y/ z State plan number Plumber's signature ��G► License number Z Z& 3 75 Date s �� • / � g Inspector N :�&AV r -Cr Complete plot plan �'� 0 1 1 li I� x� 1 0 o � 0 Is-11, 4 a AGRICULTURE PUMPS ■■■■■■■.■■■ ►■■ =■■■ go- ■ \ \11 ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■■■■■ ■��■■■■.•�■ ■ \■ \II■■■■■■■■■■ ■■■■■■■■■■■■. ■■■.a \\\01�\ \■■■■0000 ■ \OII►� \� ■ ■ ■ ■ ■ ■■ \► \;1�1 \ \ \� ■ ■ ■ ■■ �;� \� 1 ■I ■ \; ®NOON■ �;`, \11 \.�■ \NOON■ ��� \.1111 \ ■ ■\ \;NONE ■ ■0IN19V IN \00\ \00■ ■■■almm\\\■■\■■■ '31 GRINDER PUMPS \gi,��1� 01 1 ..� w \\ \N■ ■►■ MEN ONE ■1,IL \1. ►QI\ 0011111111 I LI ■iii ■ri��lli ■ ■ ■ ■ ■ ■ ■ ■■ of 1. * Zvt g.-W- lj"w " PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix ' GENERAL INFORMATION (ATTACH TO PERMIT) sanitary Permit No. Personal Irdomiadon you provtoe may be used for secondary purposes [Privacy Law 9.15.04 (/xm)). 384172 Pic r s Name: 0 City 0 Village Q Town o : S e Plan 10 St. Joseph Townshi 12(97 u 1 Insp. 8M Elev.: 8M Description: Parcel Tax No.: (p U TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e C S� Benchmark rI Dosing L A a ' Bldg. Sewer 13, n 3 _ 9 St Ht Inlet TANK SETBACK INFORMATION t Ht Outlet , TANKTO P/L WELL BLDG. Ver ROAD Ot Inlet Septic 2 i > NA Dt Bottom 1,W Z= 11 f 6 d 6- IS Dosing `` 3 _ 3 57 NA Header / Man. �. 2� �' . / NA Dist. Pipe H Bot. System 6' Z't- QS7.SV PUMP/ SIPHON INFORMATION Final Grade Manufacturer , �L De nd f ��5 Model Number 5 ' GPM I It Friction S tam ,�" �� / l TOH Lift $.S3 9 -(.I 3, DH %V51 Ft IlSIMJ'� ( �i'►tls 1 2, �Z I bZ - (cam. a Forcemain Length Dia. Z / Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth SYSTEM TO P/L BLDG WELL LAKE/STREAM IN Manu SETBACK CHAMBER M e r INFORMATION ype System: (L r ) 6 Z Z OR UNIT DISTRIBUTION SYSTEM H er / Mani o u Distribution Pipe(s) cc / x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. Z Length S3 Dia. Spacing T• 3 3 SOIL COVER x Pressure Systems Only 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 ❑ Yes ❑ No Q Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / `� /n/ Inspection #2: O 1l l o 1 Location 229 Rfver Heights, Hudson, WI 54016 (NW 1/4 NW 1/412 T2 N R20W) - 122920436B3 -Lot 3 1.) Alt BM cription = o Ww ,,,ti 2.) Bldg sewer length =2, -IS - amount of cover = 3.) contour = ��.So C y .� I -IL '� toz. j 11- re"AW-d a-- Plan revision required? ❑ Yes ta No 13 ,# othersi eforadditionalinformation. 1 � Date kapector s s7gnatur (Cert. No.rt 2 `tS Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. � See reverse side for instructions for completing this application PO Box 7302 W`/Scons Personal information you provide may be used for secondary purpo es Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach com lete plans (to the count' co only) for the system ort r4toCless than 8 -1/2 x 1 in s' e. County State Samt ry Permit Number ❑ Check if revisipp t pfew¢us'appl cation State Plan 1. D. Nu b (� I. Application Information - Please Print all Information • Location: Property Owner Name , t Property Location ARA �� /4 1/4, S� T ,N, R E r W Property Owner's Mailing Address i' L�t Number .Block Number �7 13S dE7 ;5X 4/t/ sr �. a;� x City, State Zip Code P m�fday1N OFFIC -' r ' ubdivision Name or CSM Numb flSo�✓ �t s y41 Cr ' ; �� /� �S� 3 f�a�f 3 °�/3 S g II Type of Building: (check one) G'. pA' "/ �"^� + ❑ City 1 or 2 Family Dwelling — No. of Bedrooms: S 1 ° ❑Village ❑ Public /Commercial (describe use): Town of `y • Si% (3 State-owned J III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) 1. ew System 2. ❑ Replacement 3. 13 Replacement of 4. ❑ Addition to Parcel Tax Number( (s s)� - / gy p , I System Tank Only Existing System �.3 &) • ZD-' 7 - 6 D $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued (a • 1 ;1 C1. ao IV. Type of POWT System: (Check all that apply) * 'In • Non - pressurized In- ground Xvlound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At -grade 4 X lve� MW Gt� CH. 61) 1 r r n ❑ Aerobic Treat m t Unit ❑ Recirculating Other: • Dispersa1hreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min /inch) Elevation - 7 Sa YO 7 S (:�, . 7 /� �s' S f �. O VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks l� �S logs -- ��15 / ❑ ❑ ❑ ❑ PC • ���� 0�5v — ��o GO ❑ ❑ ❑ 11 VII Responsibility Statement ' I, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signatur (no stamps : P /MPRS No. Business Phone Number 7 . Plumber's Address (Street, City, State, Zip Code) 1 VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑Owner Given Initial Adverse Surc ge Fs M�I�VI Ir0 •� Determination J� 2001 I, IX. Conditions of Approval /Reasons for Disapproval: � ,cc a S n4ai V f �� u1[3C ✓NM a�ti� . Y \S �k &. f&1k&r� i - t - � ` _1 J� _ �,t�., 1 SBD -6398 (R. 07 /00) A M ONO I tggs t" NF- d /7� = o o op ,.� Q � � 4�• 0 03 4 o.0 r , ' m1 g ot n, 61101 to oil ode d wi1 wool, tog od Nk /5'07_6 5cx6r 30 cST � 113.20 S 'l Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 _ TDD #: (608) 264 -8777 ,,sconsin www•commerce.state.wi.us /SB Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary March 12, 2001 CUST ID No.226375 ATTN. POWTS Inspector ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/12/2003 Ident N ers Transaction ID No. 621 9 SITE: Sit ID No. 627066 MICHAEL GIVENS - RESIDENCE Please refer to both identification numbers, ST CROIX COUNTY, TOWN OF SAINT JOSEPH above, in all correspondence with the agency. NWl /4, NW1 /4, S12, T29N, R20W; RIVER HTS TRAIL LOT: 3, CSM 340893, V. 2, P. 388 FOR: DESCRIPTION: NEW MOUND SYSTEM / 750 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 783480 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This approval assumes that the following component manuals were used in this design. The manuals were not indicated on the plans as required: a. "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01 /01). b. "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N 01 /01). 2. On page 1, contour lines at an appropriate interval were not shown as specified in the mound component manual. 3. On page 2, the aggregate shall conform to s. Comm 84.30(6)(1)., Wis. Adm. Code. There shall be six inches of aggregate under the distribution pipes and two inches of aggregate over the distribution pipes. The aggregate shall be covered with approved geotextile fabric that conforms to s. Comm 84.30(6)(g)., Wis. Adm. Code. Refer to the approved mound system component manual. 4. On page 3, the following adjustment was made to the distribution network to facilitate equal distribution as specified in the approved pressure distribution component manual: P = 52 feet 5 inches X = Y = 34 inches 5. On page 4, the following adjustment was made to the total dynamic head calculation as specified in the approved pressure distribution component manual: 0 tCE� NL r ROBERT W ULBRICHT Page 2 3/12/01 Minimum discharge rate = 49.8 gpm Friction factor = 4.95 ft. / 100 ft. Friction loss = 7.42 feet Total dynamic head = 24.47 feet 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 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. SinceeEPA('(6tL DATE RECEIVED 03/06/2001 FEE REQUIRED $ 175.00 C FEE RECEIVED $ 175.00 TE BALANCE DUE $ 0.00 POWTS PLAN RE WER 11, INTEGRATED SERVICES (608)266-2889, M - F, 0700 - 1530 HRS PEPAGEL @COMMERCE.STATE.WI.US WiIRTco 7G' cc: MIKE GIVENS i U LBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson WI 54016 Reg. Designers of Engineering Systems Private Sewage Consultants 715 -386 -8185 MAR 0 5 2001 PROJECT INDEX 'FETY & ELDGS. r .; Plan I.D. # _ 2 -1 -- (----- ._. - - -- - - Date Owner �l G/ U�Ns Phone 7 /S' - M6 151 C _1_c_V._ p_t.4___ Address 7 PE Z . 11U 9SD , 0 4 e-) 1, S Legal Description Z0 3 <2511 3 y 4 0(91. 2 - . J N ov, A)W, 5 / T N, 2 2-0 w 0 30.2 Z Town of S7 : TOS F p m County 5 C P— 0 r K C.S.T. �. �c �cG, T` 2a4 3 S Installer T — Local Authority/ Supervision ST• cR 0 f X ks zo�t>JCr J7'E'PT', PROJECT DESCRIPTION Cvr�`S T Go�40 LSD g alA� ViVY a 7 Uibricht & Associates Private sewage Consultants S f 655 O'Nell Rd. D/ Ep 4 'l� j Hudson, Wis. 54016 (4 3- 15 f qF � M p o S pH M FF U £ 0 Z C0RRFSpO�� 1 PLOT PLAN VIEWS . 2 SYSTEM CROSS SECTIONS & SYSTE EWS PIPE LATERAL LAYOUT DOSING CHAMBER CROSS SECTION & SPECS. W Pg. 5 PUMP PERFORMANCE SPECS O U Pg. 6 OPERATION, MAINTENANCE, AND PERFORMANCE REQUIREMENTS <5 W ea , i T his design for installation is based entirely on measurements, elevations, i� landscape conditions (slopes etc.) and soil suitability provided by CSTM The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. Any use of this POWTS design by any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, �. substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement i if working under adverse damaging weather conditions soils) by any such parties or persons. (wet /frozen I � �n 0 p � • 1 a I mom MEMO lb �PQR ����SQO 0 3 P �' 0i AN •a �a =Now NE /7 � O sev � �Pp o 13.5 II. boiow the 10WO Op edge i 11 sofa mill mail III* CPOSS SECT 10k) oF Moo Aj D w i r ti BB D OORRE0�10 p�lyCE e o � F % " ra SEE � v�sTRi�uT,n,u '.� A13er -SATE G, pipiNG- °F T °P SOi L w/ w1wwz- sys TEM W e'vAr ioA3 VOi FOPM TO 't S o � H �I L i E Fi t, o Ma o' � SAup , ... . ... . .. Plows° -r p,5 uu FdRM % SIoPE FO R � StWATA00 UAJM-R Fr — ELEvADoo S -- E /.yZ Fr. 1mv6RT' of 2 JAT£RA(5 9�v 0 ' • X12. FT. . p o F R o�,� 5� • 32— H /-0 F ' TOP . IATERA Js PLA VI EW OF MoU )jD wi rtt t3E D c e 0 -t, FoRm MAW A 7 FT• • I (3 /o o F L 12-9 F i t = ! 1 F T w K -�� f x F r w 31 r � F B of !12" PVc. cAppep TO � L U A 9 ri P r p e s 10C,4 r%ays = S' PERMA-J P- 3T MARLERS R ECqumeD RA5AL AReA� 'D Aicy wh 5i' E F'J ow - 750 /07 sc it- .-7 sa. FT• C APACi Ty Rn oSt_ [3 A + z P d (3 s A-i �Re � P A A � 2 � + Ap FT. _J Till (3uT1p� pipE / AyOU - CE P Imo__ 'Pof j Fr F r CEtJTR�L... �nitc MA ro���Q� x � IWcNE /�-o Fr. o 2— pVc y IIUCHF /J PARI•A(3LE TOTAL VOID U010ME GA15 , ' tj PA L ETE`R 2- CEuTRhL MJ1tv�F 2 ��12c M Aw Z 14 OIE5 pi PE IrucN�s I."Vr--RT' E LEUATIOK3 O F LATERA SE1= IPtUtPSE SIDE F op o ' WA (._ Cho b L T - A f L 17E Iii � f�ER Fc�R ATE v pi QE' • R�Mov�- All DRill BvpR5 tc o,v BOTTOM v � �i►r spAcE D . • 1 : ) i STRi Burl()" I SChAR (rE _ RATE f~h LgTERq L /2 y �oR Ac GAL /MiA-1. -T O T A L O(STRi(3OTIoO 'DiSc v i^R&E RATE r-o R ►UEr woR K SO.I� GAS /�"11��. a•� r MI'N ETA i L_ o F L AT E7R A L C I D All � o w - !%flab 130 ► w _ T E10D 10 TlY/f'Er�G'�Z� I /�' �9��t/�TE,� PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS p ��� of 6 v ? /O ' f0 6)A-'D0cJ, -D ,tf i,P ;'V 2' } pl�G _ VENT CAP PI i VENT PIPE WEATHER I PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER GRADE `"MIM. CONDUIT -- --- - - - - -- 11� PROVIDE I - - = -- �_ W LE T AIRTIGHT SEAL S APPROVED JOINT A �N i I APPROVED EOIN I PIPE ZXTEHDIMG 3' •�O�� I I ALARM EXTENDING 3' I ONTO SOLID SOIL 7�1T0 SOLID SOIL B p II 3 I I I 15C4 . f / sc` , -40 P G j �a 3 I I oN ELEV. 91 FT. __J & PUMP � OFF 'Z/SE' ,3 Ore Dp�,J D �, $ ` 1 OF BLOCK Sit vl� P f VA f i0d RISCR EXIT PERMITTED OIJLy IF TAkW MAMUFACTURER HAS SUCH APPROVAL SEPTIC E �✓y� SPEC,IFICATIOAIS Co DOSE L(/ jC /f 'ZJ UG.P t 7J TANKS MA IJ UFACTURER :— IJUMBER�� DOSES: PER DA-4 YANK SIZE: ,�/ /GALLONS DOSE VOLUME ZS T r LSD ALARM MAUUFACTURER: L�V /� INCLUDWG BACKFLO� GALLONS MODEL AIUMBER: -D. V' L CAPACITIES: A= !G• ! INCHES OR 5� GALLONS SWITCH TYPE: F` / 9 �4 � B = Z INCHES OR GALLOWS PUMP MANUFACTURER: 1 " 40 ' C = 3 INCHES OR (fie —� GALLO MODEL NUMBER: Mme 5b D= ' S S IMCHES OR y�o GALLONS SWITCH TYPE: Y r B `�� MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE $� GPM IN�S�TALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTIOM PIPE.. 13 a FEET - rANk SPIEL'S + MINIMUM NETWORK SUPPLY RE .. . . . .. . . . . '' FFEET EAC(A, -} DSO FEET OF FORCE MAIM 2 - T looFTFRICTION FACTOR..�-r<—�rEET LtI, 30 � TOTAL DYNAMIC HEAD = �' FEET 73 �- yo „ INTERNAL DIMEIJSIONS OF TAUK: LENGTH ;WIDTH �UID DEPTH ;�- N FOI II SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a licensdd service pumper. '� s a - F - M E Series M YGM 1/3 through 1 -1/2 HP Effluent Pumps Performance Curve CAPACITY LITERS PER MINUTE 0 50 100 150 201 250 3G0 350 400 SO 100 90 28 80 24 rn 0 W �- MF w W O 20 2 L` 60 Z z o Q 50 M FG 16 w W = r J 40 MF J�0 12 O O \ 30 i 4 IU 0 0 0 10 20 / 130 40 50 60 70 80 90 10 110 120 130 i' CAPACITY ALLONS PER MINUTE i ' a F. E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3327 7/91 Printed in U.S.A. - - Pg. 6 of 6 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code 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 tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at 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 are 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 filter shall be serviced if the alarm is activated continuously. Intermittent filter 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 tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next 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 are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. 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 seeded 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 snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified 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 flushed of accumulated solids at least onr;e 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 levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)) 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 subject 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. 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 proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired 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 in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO THIS SITE, DESIGN, AND COMPONENTS �i fi Pg. 6 Continued. POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS 57 G/t C y- Governmental authority/ inspectors: 2,0,0 ,U (r 386 • Licensed installer, responsible for providing an operation/ maintenance "Users" manual: 4 S so c' 3 96 • Licensed service / inspection agent other than installer: 3 86 • )-1 o M o (2--� , • Electrician, for pump, electric controls, wiring units: /Pi'�.�v ells �/ S • - 733 ( o IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveting, etc.) across the mound area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the ' winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of - 7Sd gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the ' cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone tO maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated �1 into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. Wisconsin Department of Industry SOIL AND SITE E V l},'1 I V T Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILH 3` Wis. , COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches e. Plan muslrirjglua�, but not limited to vertical and horizontal reference point (BM), direction o of sWoe scalePC ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest roe ; �" ;. =C. ^•� `� ©3 G X r �G �O tJ y . n' %I-' IEWED 8 APPLICANT INFORMATION- PLEASE PRINT ALL INFORM DATE u v M�fMG� 16 GT PROPERTY OWNER: _ FjOPFtTY I 1ACl- T. C V11e rl5 Jvvrff e 5 T) 1/4 ,UW 114,S12- T L 9 ,N,R 2 O E (o Wt� PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAM OR M # 61 S , L,9,f��Sil�E 9�° • 3 cs.H 3 0� P 3SY CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE OWN NEAREST ROAD I�4 V T /'%v- 55003 y39- 77 S JoSEPtt 1 'el - mr t lrf5 7.P, [ New Construction Use [ r]Residential /Number of b6drooms [ ] Addition to existing building [ ) Replacement [ ] Public or commercial describe Code derived daily flow a0 gpd Recommended design loading rate - bed, gpd1ft trench, gpolft Absorption area required So a bed, ft2 S ° ° trench, ft Maximum design loading rate - 7 bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations 51 VIE ')e Parent material ✓ -tifif ,E S Grp Flood plain elevation, if applicable ft S = Suitable for system CONVENTIO M IN- GROUND PR URE AaT-GS DE lo STEM IN FILL HOL TANK, U = Unsuitable for s stem O S Gd'U LA'S ❑ U F os b B SOIL DESCRIPTION REPORT �e a O - --- - - "P Boring # Horizon Depth Dominant Color Mottles Texture Structure Boundary Roots GPD /ft in. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. Bed Trench E.1 2- K --? - Ground 3 - 70 is Y y/� G z � /`f 5re /wfe elev. ft. 5 YR y�L� S/ 6 2 i ' ► Depth to 7 LF �� �rE,v� v limiting factor �If5 -:54744e Phe7 7%/ Remarks: .�f �.P� S5is73faT F�/EN Boring # Z- Z y- 27 7,S y /S / `�iP �S /`- .7 Ground elev. 1 7 S Y,4 y v _� ✓� (/ f �'�iP f° G� / i f yy� ft. G 2- it a /Jn /1/ AP Depth to limiting factor it Remarks: fi TS o f i .v 4i6'r= A°l77LE CST Name:-Please Print RO RT ?4 L 6 P / • r-Gi 7 Phone: 7/3 J P6 - �/ cr" 5- A ddress: 7- 2 CS 7,z/2 Signature: Ulbricht & Assoclates Date: CST Number: Private Sewage Consultants 656 O'Neil Rd. Hudson, Wis. 64016 tie G1 SY- PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D.t 0.30 - 2p1 �7 " F — 00 0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou>clary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed r Ground 3 -(y 7,5 YP y�LP e lev . S %/Z %16 .� Depth to limiting fac Remarks: Boring # / e 2- �a r�e yl � 1401 L 2 U -1 ®y,� y/3 /, J;e es luf . -11 Grou nd 3 7 -y 7, s VP y elev. S y14Q y �.--- Depth to limiting ( /O �� S� / factor 5 SS Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: con 000nio nc,nn% , J So . Lod- L r o _ LNa 70 C O 0 O rq ° LA Ln GN G m � w nr °p �I w � r � y (n► CERTIFIEQ SURVEY it j . 0 4 Ct}R `itiR SECT 10 K 12 T 29 N, R Z13'* S g2.OT'22 ' ',�� tEN TER1.lNE OF AN E T29. 48. t1N P' . � ?' � . rXIS•r1NG ACCESS £45E�tEN1 t LANG RECORDED IN VOt-42 ",PG., ' 539 t3 VOL. 448 , pa. 41 v Li=29 " t Vi 0.00' -P 268'00 43" t. S SG R- » NN rNG T -- V 5U 19 A. . Q 4 .� X21. `6 G2 • is w • D L- 9$-34' © �Z•$A 2 C(STtN 4 5 0 — 5 1 48 W m 5 5 6 96 ga _ 'IT .14 R Q' ' ,•• r ' 97.36' _ — 271'59 c . ie b�- ; + 2'Ga •4g . j •�� � 2 PURL i C 116 b63 E XISTING ACCESS » 1 Qg° 3 G Nt2 t• EASEMENT s AN T4`0220 A t02� 1 , , S� 233. -• F�•. NI • tt3.28 �� 0 S N2'4.`N ? f9 •• TTE,,] Lg!O m X17 a 4'W �1 . G OV L 0 { < O „ P tf TRUE' BEARING y. Z « O i.a. IN in t ` — v • t r 0 0 I" X 24" 1274 PTPG WEIMING 01 3 O. °• Z.691 /LIDML IWT 0 . BUILDING SETBACK C 9 LtN6 _ ,t Q (� -x 3fl" IRON I'1I't: ;tL!t]ll;iG a '� p• 4 t 's 0" W h .65� /t.ts.'li\!, ti`A'T SLT 0 201. q z 1 SCLADM ruL7IC!� GOli tliR, 3EI��'SiiV \ 2 0 P of BLUFF f �..�TOP Ot: aw,FF • m �� t0 1 0 PIPE FOU i .` 01 SCALE INFEST too 3( j •. N .1 v a�t �t o — this 4 • � i Waiter J. crcgov m ;� r Q LAXPPR VED `�- - �'� �`� - °� ► 1 JUN 15 1 .917 0 • Cptvtt+Hr+svt rna� n,,.ua+o 0ITC c,d P C / A! r aFR .fip APPROVAL OF THIS MINOR StS3CIYi51,. ' IS;,. DOS Z G T .MEAN APPROVAL FOR SVP M 1 ST CROIX COUNTY SEPTIC 'TANK M AINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer 1 "r I (�� �t � L / �,r'¢ 640 Al 5 Zo Mailing Address 5 67Qi, 6 '4) Property Address c;Z f— (Verification required from Planning Depa ment for new construction). = City /State U � b Parcel Identification Number 0 3 — 2 0 -1 V 90 LEGAL DESCRIPTION Property Location a� '/4, N I� '/4, Sec. / '- , T 2- N -R L e) W, Town of ST Subdivision , Lot # 3 Certified Survey Map # 3 7 0 8 � , Volume , Page # 3 s Warranty Deed # (-0 ` ( �1 �_ , Volume 6 , Page # 3 Spec house ❑ yes no Lot lines identifiable kyes ❑ no SYS'T'EM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 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 full of sludge. I /we, 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 Commerce 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 Zoning Office within 30 day of the ttuee ye r expiration date. ZZ Sr NATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) Am (are) the owner(s) of 4 the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. - UtC�Ccz v SIG ATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with (his 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 ` 1594PA ;E 36 68512 STATE BAR OF WISCONSIN FORM 2 -1999 .KATHLEEN H. WALSH WARRANTY ANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI � This Deed, made between Robert G. Wendeborn RECEIVED FOR RECORD 03- 0:-'001 11:45 AM -- WARRANTY DEED EXEMPT I Grantor, and Michael G. Givens and Linda A. Givens, husband and CERT COPY FEE:. C O P Y F c • wife, TRANSFER FEE: 930,00 RECnRDING FEE: 10.00 -- - PAGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee t he County, following described real estate in St. Croix State of Wisconsin (if more space is needed, please attach addendum): Part of Government Lot 1 of Section 12, Township 29 No ange 20 Recording Area West, St. Croix County, Wisconsin, described as follows:( of f Certified Survey Map filed in the office of the Register of Deeds for St. Croix County, Name :Rctum ress Wisconsin, on June 17, 1977, i Vol. 2, P age 38 8 of Certified Survey Maps, yy � Doc. No 340893. / � / � / Subject to the Declaration of Covenants recorded in the office of the i /�/ /(o Register of Deeds for said County. /`� Together with an easement for an access road over the parcel of land marked Pare el ficatian Number (PIN) "Public road" as shown on the Certified Survey Map recorded in Vol. 2, homestead property. Page 396 and 388 over the road described in paragraph No. I on Page 3 of This is not the Roadway Agreement recorded in the office of said Register o D in s 0J) ( is not) Vol. 574, Pages 92 -01, D st Doc. No. 348583, and bjegtc of said k4eSn3`1lt• of re=d, if arty• pueptia s to warTmhies: E reStr l. rls and rig tts•cf Dated this da cf March, 200 , + Robert G. Wendeborn - + AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) _Robert G. Wen deborn __ —_ )ss. — — County ) ,1 day of K& I ` c t of March g ea a ,tty's L day 2001 Personally came before me this the above named J = CD _ : ♦ ist a O land MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing ••J`jk'_t} • Pt instrument and acknowledged the same. '• •.autf ortzed by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin Attorney Kristina Ogland Hudson, 1 54016 My Commission is permanent. (If not, state expiration at ) (Signatures may be authenticated or acknowledged. Both are not necessary.) nramatpn Profeaaior is Company Fond du La . Wt +Names of persons signing in any capacity must be typed or printed below their signature. 800- 655.2021 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2. 1999 I jal,i2 95 THU 12:33 BURNET REALTY STILLWATER FAX NO. 6124300212 r 7 = t •, � , �..r� I Y .r• i N 1J4 CORNER ;ERTIF SECTION 'i2 T29�!• 92 S 52•07�22`'w CENtE4,tNE OR AN 729 48' Will T&Q.. lXIS7ING. ACCESS E&SVENt, LarfC� R- COROCO M vOt_42t,PG. PQ. 4 I s 539 A VOL. 448 , 1 w 4 ?23 s V a v % • 56 �' 288'00 C3 4 1' SE S (5 S NNj) Rs2:•3.00 :' T -- 50.19 c Z a'� 3� �6A.6' :Q�.1 Y 4 ZIS 1 p L= 9(3.341 5�2'9a O 65.04 - H ka . ` 4 5i97036 wn. 96 R�A, Tf Z71 49 + 2ti4�4 S .3 ,�� _ (18.1 - t:.. '24~W EXISTING ACCESS 4 ; AUt3L 1 C lOg• ggb � N 52. t:ASEMENT� . ' A � 7 `..02 20 A (pmt, S 23 - i�•. S ►13.28 ,� p, * 143 - E • Nr. 4w GOV;Y l.pT_. • - d ,•• n � . j v tf TRUE • BEARING t. 0 3.3 AC •t• i 09- — p i p 1" , 24 "�TA(V PTPC KCUMIliG 1 ( b. 4 °c 0 . ;gtiT,ptNCi SGTaA 1.681 /LIi1LFd, iilpT �� X 311" IRON t'1I9i _?tlS:;F;� — 'L1. wT SO ...a' . • Q t 1 V 0. t o w �( 1.66i/L1�• 0 201. 94 q z Ml S��. 5 T COMER, 381�"'.'Si:`t W a*S0uW. '. MI) BLUFF - r'POP CIF awr t IsC1 f e: IRO�t PUB r0U�n , m ` SCALE - I N cl--T Fill !M en ta ( t too' 3( a cc j �' '� `�( at itii� in- tn ",:t;L ,t:::CLC1 ;,y • waiter J. um. M� 7 s - e ( APPROVED JUN 1 5 1 911 1l .4,;; A '�` a 1 ST. cout.r. g •, Of 0 G 0 C�wttMn+svt rrcx� n..+►a+O O „no to....a coAamMUr. pE'C,rr R F C t �� �� •� APPROVAL cF THIS MINOR SUUMVMC :E8 ' ( y ?r• 00 %oCT MEAN AFPRCVAIU MIR SEP'll HEAD CAPACITY CURVE EFFLUENT M MAE M o mm ®m ®mmmmemmem Q, � ®Qamm�m ®mmm®mmmmm�m� ' ■ \ ���I� ommmmmmmm�mmm ®m ®0 ®mmommaa ® ®maa ��►\ ��Im .mmmmmmmmmmm�m ®mmmmm ®mm � ® ®mmm�mmmimm \�\ ��I�aammmmmmmmmm�mmmm ®maa ®m��mm��maa .. ■\ �\ �I� ■mmmmmmm�mmmmmmommmmm� m � + a €■mm mmmm�■mmm�mmmmmmmmm ® ® ©o . �\,\ �► �laa�mmmmmmmmmmmmmmmmmmmmmmmmmmm® . \� \. � . a���� ®mmsmm��m� ®���® so - '\ ►11111 \ \������� a����� \ \���� C HEAD M SEWAGE ------ - - - - -- mMO ON sm ONES almoommum, mom BONN QVIEN Momm moll MEMO Emmum 40 l»s S Z 2 1'TS V PSD „> Gv/ . Y r� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Cop - 8 -- yu���in' Code _ �. County 5• h CieO!'x Attach complete site plan on paper not less than 8 1/2 x 1 iitr in size. Plan include, but not limited to: vertical and horizontal referen s t (BM), c ' and Parcel I.D. :O percent slope, scale or dimensions, north arrow, and to •' and �� ° ares� d'a'�. 30 ' 2 ). Y ,?O . 090 Please print all info as n. Reviewed by Date Personal Information you provide may be used for seconda pu�ses (l y Lf w�9. 16. 4 ( ) Property Owner S ert I-O fARKM lIC Z�* �Lo(," � 1/4 N 1/4 S /Z T �/ N R >R (or) W Property Owner's ailing Address Lot ck # Subd. Name or CSM# ?2 S Owner's 4 --V • T� ' �S�i 3yd�f 3 City State Zip Code Phone Number El City E] Village �wwn Nearest Road ff vP ( a.) !0/ • I Sy'a* (7 15 ) 3 Alo • /5/ 6, Si- .1 o S& /PiUE7 1XII 5 . �] New Construction Use: )Q Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material /0, T d/f� 445 ,yj-e Flood Plain elevation if applicable I W A: ft. Ge'heral comments �'�,¢SSES p� SJ& (/ .���%�16NT - -� � S j� and recommendations: / 4& ..� O%G 1W X Cam-/ 1eA-) 4� / 7 mil � x Z / iPgl3 o/ © Boring # [] Boring l0 • 7(0 3 S P 9 Pit Ground surface elev. Q • ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o • /o 313 GS / �,Q t^S /� /• L lS .3 5 2 - S /? GS If 4ve /U4 �' — �7 i• Z s /.j 0# 1 yf /)"fk . Boring # ❑ Boring ® Pit Ground surface elev. / 7' ft. Depth to limiting factor ` G in. 1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 Z 17 F 1 "' I A I q::d 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) Signature - CST Number R tlllXX 7 Zl /�J�'i�CG 'Z �-�- 4 3 7 5 Address Date Evaluation Conducted Telephone Number 715 3 Ulbricht & Associates Private Sewage Consultants Gy Z 2 ^ 1a0� 655 O'Nell Rd. Hudson, Wis. 54016 0,4/ IY4Y. z/ sore /117- 2 � s ���• Of F OF LpT ���` To .SoiGS �if�°lr'r'�1G 1Cox Avzlr� s uch / CD,�S /Si�,ucy / 't oes - 1*7 /'S �d /.v ��p� 7��� o l C y V , I Property Owner Z. 3 Parcel 1D # 3 � g Page of Borin ❑ Boring # /00./& 2 X Pit Ground surface elev. ft. Depth to limiting factor ( in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color Gr . �' GPD /ft o •� /oy,P . Sz. Sh. . Eff#1 Eff #2 7. 2f ZgZ Ls _ yc / f a 16r/ . cf�1�'i�c�T�`77 � •� r --i- -- t Boring # ❑ Boring A 21 _ � 3 3 Pit Ground surface elev. �ft� D Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence - Boundary oots Soil Application Rate In. Munsell Qu. Sz. Cont. Color ry GPD /fl Gr. Sz. Sh. 'Eff#1 'Eff#2 /lv •3 3 /oYR L•5 /� /� �, r.5�,e c4,) SSiG�e p Sr 004 -C A C_?e lv Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description T Soil Application Rate P exture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L _ 9 Effluent #2 = BOD < 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 need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) s !' V ieV G4 5 yf - e lt -1 / D 7;L vf,� 4 4�1 /4 P17 Tr J d 1, • Si % ��( tiI /W / �' T • i;(� CT�! �Z- a 00/ 0 M U o� /a 3 , s 2 1 0 l SST /OO f T