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HomeMy WebLinkAbout030-2120-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420409 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Coulter, Fred & Amy I St. Joseph Township 030 - 2120 -30 -000 CST BM Elev: 2 Insp. BM Elev: BM Description:: T � /U o f or TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark zGU 3t3 I� .�s Dosing - - -- - — - - Alt. BM _ s` a3 Zb Aeration Bldg. Sewer - Holding S t Inlet S Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION 6 e - facturer Demand St over GPM Model Number TDH Lift Friction Loss I S Head TDH t Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM G Manufactu,/ INFORMATION CHAMB R R Type Of System: �--� Mo el umber: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia / Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of T77�ided T Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes J No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / , 1 2- Inspection #2: Location: 806 134th Avenue New Richmond, WI 54017 (NW 1/4 SW 1/4 25 T30N R19W) Bass iR dge Pines Lot 3 Parcel No: 25.30.19.976 - to irks RlC {,�►� `�� �ik� 77 l� w.e Csh s�kt<K> S �R f� kAd fa iti 5 Gf 14 t S4 L 4 e 1.) Alt BM Description - Y 2.) Bldg sewer length = 4 '' 3 [ wo CoRKa v 4c �ti• t f . is Oee><, A df �ee(j -amount of cover= 73' h0i l w 4 n�� tmA� tut 3 vel be S e f 3� olsev,, �iol. P ` ct 1 ks�t ���� ii, 1dr✓ cv:ll ,suk14;/ ' h .� / t leu .s anal as4ailX �Q.�;._ No —!' - -- _ _ - - -- -- - -- — I— Plan revi l L - Use others de for add tional information — J SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. X Safety and Buildings Division Count V visconsin 2ol w. Washington Ave., P.O. Box 7162 Madison, wl 53707 - 7162 Site Address Oe artment of Commerce - 3� - 1�od (P 3 Sanitary Permit Number Sanitary Permit Application fzo f pq In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision ____ may be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Informatio -- , State Plan I.D. Number Property Owner's Name Parcel Number .3 • �� Property Owner's Mailing ddress Property Location .S u : T N. R City, State Zip Code --. Phone Number- -.--- • - - -_b Lot Number Black Number Subdivision Name / C9M - tVtt rfr�r l �' . Type of Building (check all that apply) 11 ❑City i or 2 Family Dwelling - Number of Bedrooms ❑village ❑ Public/Commercial - Describe Use Ownship ❑ State Owned r Nearest Road L2 J t � Ii" � �`f) r Ixr f , M. Type of Permit: (Check only onring sch eme for ' ternal use). Complete line B if applicable) A. For County use 1 0 New 2 ❑ Replacement Sy stem 3 ❑ Replacement of = C � A;m stem Tank Onl B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(num ru bering scheme is for internal e) '4 - laD ` 44 Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 3o ❑ Other V. pispe rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate( Gals . /Days /Sq.Ft.) (Min./Inch) Elevation s . VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank j ` Dosing Chamber VII. Responsibility Statement - I, the undersigned, a responsibility r installation of the POWTS shown on the attached plans. Plumber's ame (Print) Plumbe s S' MP/IvIPRS Number Business Phone Number Plumber's duress (street. Ci cafe, zip Code)' VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issu' eru Signature (No Stamps) fa p( Approved El Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse A 2 �� Determination 1X. Conditions of Approval/Reasons for Disa — n 'A .1 ►Moa•� a per, s np u AttacL complete plans (to the County only) for the "em OR paper not less than 81/2 x 11 inches to size SB�D- -6398 (R. 05101) � � M a � � e 0 I�� � � M � a i i r I V) � � b � 7 t - Wbwnsin Depart of Cmmwce SOIL EVALUATION REPORT page / of _ -3 Division of sate(y and Buikirgs in accorderroe wRr (aomm K Vft Adm. coat Aftch conplale site pion on km then 812 x 11 inches in same. Plan must kxMis, but not t I lac venr�cai and hodimatai mknwme point (ft dk9c11 n and Panel 13. psm"da^ scoleordimens)om rwne anmw: and location and diafanncelbneerestroad. Planet print all kdwmwmL Dees Pewwpr � yon pto.itls anp 4s uaad torseaonda�r w ay lPrNacp �•,: �so4 (�) (�. , 2`{ 2- Plopwvowner ; 7Z 11N 114 S„Z,� T �fJ N R E( props ftOwnw's Address l.d Subd Nerve or f� � � us cw side Zip code ; Nm9w ❑ Cty ❑ VEW lE'f'own Nfiersd r ErNtw Cm*ucbn else: ►Q'tb9sift" I Nernst of bwkocros Y Code derived design tbw tale GM ❑ t ❑ teaor oonm ordel- Descabe: parent melenial Flood Pimin elevation w oppRrsble General aotmterds F-1 - v �d � c�t9ry c Z 99s - t (fauna suftw elev. Abi — IL Depin to erg tailor * M4 1 . in- T7 S I Solt Rd& GPEW Morison Depth Dm&=dCAkiff Redox Desuiplio n Texture Studue caaaslenoa Boudery hoots in. Owned du. SL Cat. Odor Gr. Sz Sh- '�1 'EM2 _ 3 Z st c. 2 Z 7• — �'L 2 r 7 F-1 3 Q G BOtlrlg !c-' Pg Grand swfaoe ele+r 3 R Deli I° srryg facbr h' Sol Rate i Radcr� Teed= Sbuckwe Consistence Boud Raab !mo GPDIII' Fiorinon �r Oonrtirerrt In, Wined ` e*ti rWined 4u. Sz Cat. Cdor or. SL Sh. -EM / 0- _ „� sL 2 D cc/. Av4 .2 Efguent d'1 =1300 > 30_<220 w40L w d TSS >305150 vngL ' Minet 82 = BDD < 30 nv L, and TSS S 30 mU L CST Number s PWk T.dkg Addtass MW NkPWISO Rd. Dele Ev® uWm OxWucled Telephone Number Spooner. 1M 54801 rr Z t OL Properly Owner 4MI EX Parcel ID # Page - ;k- of # ❑ �9 3 eo�g [a' pd Ground auraoe dew. / d. - R Depth to ir&g rector h Sal Appkeksa Rare Hmiaon Depth Dominant Redox Descrlpliion Texaae Sauaae Consistence Bourdary Roofs GPEW ar. Muar� Qu. SL Cori Color Gr. Sz Sh 'EIM1 'HM1 w.{' °l.a" or S L r ~ F Borag # Borbg pit Grand sutaoa slay I Depth to IN iN g factor n. Sall Appkallan Reis Horizon Depth Dor*wt Cob Redox Desulpion Texture Sauckm Cwdslance Bou tlwy Roots GPOW irr. Mursell Qu. SL cont Color Gr_ Sz. Sh 'EW1 MIN Bodrg # �`'' (� BosNg Graud sufaoe stay A. Depth b irriBg factor is PR Soi Fib Moizon Depth Ma*MwtCGb De3aaiplion To* pa Svu*m Cmvlence Borndary Roofs GIROM kr. Mtrrsell Qu. Si Cont Color Gr. Sz. Sh. 'EW 'EW2 EMxwd #1 = BOD > 30 5 220 m WL and TSS >30 _< 150 m9 L ' Eftxm t #2 BOD _< 30 nVL and TSS 130 mWL 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 608911611:31 Y1 or.gVY 608 - 264 - 8777. saoeseocas�ool V � o , 1 � - k 1 v � 1 h N, N ' �6 h � a a 1 CN D ("; C # i N ;� r O h � X71 L'�. ` -A a w POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATI N Owner - Septic Tank Cap acity al o NA Permit # p Ct Septic Tank Manufacturer o NA Effluent Filter Manufacturer - o NA DESIGN PARAMETERS Effluent Filter Model - 1,V o NA Number of bedrooms c NA Pump Tank Capacity al cYNA Number of Commercial Unit id NA - Pump Tank Manufacturer zNA Estimated flow (average) gal/day Pump Manufacturer 6NA Design flow (peak), Estimated x 1 Zso _ - gal/daZ Pump Model 2WA Soil Application Rate _ Tnl /da /ft Pretreated Unit I111*1 ue110;111 ucnt (Quality fvlunthly AYVI - age* a Sand /(;ravel Filter t_l Not filter hats, Oils & Grease (1'OG) <aU ing /L n Mechanical Aoration u Welland Biochemical Oxygen Demund (BODs) 5220 mg/L o Disinfection o Other: Total Suspended Solids (TSS) <150 m L Manufacturer Monthly Average" Dispersal Cell(s) Pretreated Effluent Quality ❑ NA to In- ground (gravity) o In- ground (pressurized) Biochemical Oxygen Demand (BODs) :530 mb /L o At - grade o Mound Total Suspended Solids (TSS) <30 . o Drip-line o Other: Fecal Coliform (geometric mean <_10' cfu /IOOmL Maximum Effluent Particle Size '/� inch diameter Values typical for domestic (non - commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater rea . MAINTENANCE SCHEDULE Service Event Service Fr@q Inspect condition of tanks At least once every c months42 o< ears Maximum 3 Yrs) Pump out contents of tanks When combined and scum a als one third '/� of tank volumt: Inspect dispersal cells At least once every o months e s Maximum 3 rs Clean effluent filter At least once e very o months 0 your(s Inspect pum , pullip controls & alarm At Dust once ever u months o �u NA Flush laterals and pressure test At least once every o months o eur(s) NA Other: At least once ever o months o earls MINA Other: At least once every o months o ears NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septago Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding 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 tank equals one -third (A) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Wisconsin Administrative Code, The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). U high eoncentmdons are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: System start up shall not occur when soil conditions are frozen at the infiltrative surface, During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. C1 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o 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. u Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL POWTS MAI NTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULAT Y AUTH ORITY Name Name Phone Phone ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address � t Property Addresses y /r'"' f r (Verification required from Planning Department for new construction) City /State 1 � Parcel Identification Number c 311' — »o -30 —cx:; LE GAL DESCRIPTION Property Location /V tk) '/4, w '/4, Sec. , T �36) N -R / W, Town of W . Subdivision s s ,� 1 001, e ., -e , Lot # _ Certified Survey Map # / , Volume , Page # Warranty Deed # (Wd&f3 , Volume M 03 , Page # A Y 3 Spec house ❑ yes] no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 days of three year a iration date. SIGNA F 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 the pro described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 1903P 183 Ea6PJ693 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. NALSH Document Number WARRANTY DEED • • - REGISTER OF DEEDS ST. CROIX Co., MI This Deed, made between David H. Railsback, II, and Aria J. RECEIVED FOR RECORD Railsback, husband and wife, 06 -03 -2002 2:15 PM WARRANTY DEED Grantor, and Fredrick P. Coulter and Amy L. Coulter, husband and EXEMPT i wife, REC FEE: 11.00 TRANS FEE: 203.70 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area 1 501 Bass Ridge Pines, Town of St. Joseph, St. Croix County, Wisconsin. Name and Return Address Edina Realty Title 400 S. 2nd St., #115 Hudson, WI 54016 !015_<R3 95 030 - 2120 -30 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this lr t day of May 2002 ' * * David H. Railsbac II i * * Aria J. Railsbac AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback, II, and Arta J. Railsback, STATE OF WISCONSIN ) husband and wife, ) ss. �j4j County ) authenticated this"" �� o May 2002 Personally came before me this day of the above named * Kristina Og and TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY * _ Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) •) * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company, Fond du Lae. WI WARRANTY DEED STATE BAR OF WISCONSIN eo0455 FORM No. 2 - 1999 1 M I SS 1 =�I�GE PINES 'Located In part of the Northwest Qvarter of the Southwest Quorler.ot SeatN11 25. Township 30 North, Range 19 West, Town of SL Joseph, S!. Cra& County, Wisconsin. I 9N 11 TOP pllR4MV1.1 CO. HOMIDF)IT LEVATION.91 . 1 I J _ 1 rusr -uESr r/4 ewr csscrrxAV x - - - _ — -- - - - -- _ _ _• _ _ S60'80'6B "W 6274. -- ` UNP jDD LANQS QF OWttie (TO BE DEEDED TO ADJOININCI LAND .OWNER) I / - 500'04'47'E TOP ATION T - 9 13S DTI u / / 100:00' __ - - - -- - -- ---- N69W55'E 1319.66 - fi� 1 / - 277M -- - --- -- 1302.51' - - -- - - -- A11EA )oils .�- -- 10310' -- - 1 _ W PONONO 2S•rr.Art Aft l►Ara a A 139.113 so. rT. V so 9waro Setback DRAMAGE EASENEN Ling / ' 1 ar �� 1.19 ACRES. $ ,t • .T' : , ~ i 1 • • 1 £ASa9MET/r• • 7• PO"MIN AREA a r 6tA' EASEIIOIr �y�7:' . ®>� SS I - - y 1 _ - 01 l 142AW © 0 q t I ?e • i 1 I • O.N. N Il.9r `��4: tiY a fe• 1 I •�. ' S • • 1 •s 'i / s1��Tr • �' y �' �i ��>� ? r. i / � 1 s`s' ' "''y�. ✓ si 1 `ra o "'� �. 1 - J � 1� I � 0 1 o f ° 184.790 So. r r. 0" rJ1 EA EHi V ® I \ O I 1 d 4.14 ACRES 3 -7 ` © .e I y E 130,984 SO TV. s eiabs9'e9'E�� 1 I I I 8. 67eo I at I r1 1 3.01 3 $0. A rt. 1 q) ` y 3.01 ACRES z I �^ I` NIIII 56'25 "W 427.63' /✓A41I/ f/1'f Or WAM" Y DUV ( 1 § '• ° 11_ s0, m 1 3 I L ___ f I 2Y1JaE 981 P,iee AJ9 1 " >G4? ACRES it a I 1 ' A.% s " PiM 619ty � 1 �I o UIVPLATTED LANDS `�` Zbe,y1. j.I M I WAP,_RANTY DEED I 1 \ �� ? d I 35' 1 I V_OL61AE 991 •139 g8 1 i 1 _ _ lsy� i 1 AT' j � 1 8 n� I s7s•4�3p,� e»z4•, _� �� a7 1 1� I Z 1 o 1 I I r' °W pl n . XOOSACRti FT. g1i 8 1 f p I 116 o 1 1 j 1311 , 81 n. / I . ZI � I 1 1 i '3• a1• .IDwr DwoERAr- / . J � / ® o I . S' ' Ix I .........IaO' B9Sdiq•SHbaell.......... Sff 6ETAR. ........ . . ' 1 J/ 5i 0 1 t 1 ` T�" R.O.N. I32nd AwR1e § 39— — —. - 213.50 _ • . f .. .. _ .. - .........- .. _ 1 _ -. r N119 - 743 68 — 13 2ND AYENU1:® / a I I f I 1 I / swnA uuE cs trrF N1 r/4 ar r7rE sw r/f UNPL/ZTTED EA 1 I VIIIPLATTED LANDS I ¢� TOP A ai•9 1 ml VNPLATTEI ANS D OF WN ER HOTE: LOTS NA BE 11Te ECr lO FViURE �ECIIL ASSES511Ef1 is / 4 • - - - - - O - - -' roet ANY UPGRADES AfU 1LIP1104E11rNi3 10 711E ROAR R7ONOVAL UMOR CONTROL PLANS AW REONRED FOR Rf i CO111TT1UCLON Or HOPE SAES ON Lots 11-0. ComPLEUD EROSION 401 CONTROL PLANS SHALL K MUTTE6 To Ul SE CROS COUNTY ZOISNO.Or a PRIOR 10 THE ISSUANCE Of THE SANITAnM PER144T. %*Asconsin Department of Commerce SOIL AND SITE EVALUATION �� of Safety and Buildings Page of Bureau�w Integrated Services in accordance with s. ILHR 83.09, Wis. Adm ode Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ^ f include, but not limited to: vertical and horizontal reference point (BM), direction and /�/ a 1 X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). < - t {_zwo Property Owner Property Location Cl ► l 6 C Govt. Lot Al kJ 114 5Ld 1/4,S dST 30 ,N ,R d` E (or)N Property Owns s Mailing Address Lot # I Block# Subd. Nar# or CSM# City to Zip Code Phone Number El city ❑ Village JR Town N cad ec,�J/eir 0 1 -`'�01 (71�114K-3/ 02 I S 4- . a s .a. � 3 rJ 1 3a ,New Construction Use: 54 Residential /Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd / Recommended design loading rate � Zbed, gpM? trench, gpd/fi? Absorption area required _ bed, ft _525 trench, ft2 Maximum design loading rate - bed, gpd/ft ?— trench, gpcW Recommended infiltration surface elevation(s) -1 • ft (as referlied to site pi benchmark) s/ Additional design /site considerations Parent material Flood plain elevation, if applicable // ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ,) S U JO S ❑ U XIS ❑ U g E ❑ U ❑ S g U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell / Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ,24 - = S Ground elev _� 9� -eft. Depth to 42.6 , VLU limiting - (. factor -_ i // i c 1g Remarks: Boring # El a � Ground 4 74 Depth to limiting J n. Remarks: CST Name (Please Print) r nature Telephone No. Address Date CST Number .,� s �� PROPERTY OWNER Q - SOIL DESCRIPTION REPORT Page ,Pf ' PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground elev Depth to limiting I �factor Remarks: Boring # i L:: Re 0 Ground Depth to limiting fc�o r 7 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground Depth Depth to o Z limiting factor 7 Li n ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) k. Soil Test Plot Pla Project Name Dave and Arla Railsback Sha ' d Address 845 133rd Ave New Richmond Wi 5 4 01 7 CSTM #226900 Lot 3 Subdivision Date 6/4/99 NW 1 /4 1/4S25 T 3 0 N/R 19 W Township St. Joseph ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence P s t with Orange Ribbon System Elevation 92.0 * H R P Same as B Alt. B - Top of Nail in Tree with Orange Ribbon @ 100.3 277' Property Line Soil Test done to satisfy zoning requirements, may not be suitable for buyers desired building site. B.M. Alt.- 354' M. Property 15' Line B -1 -5 5 ' 3% -3 ,Slope 80 , 0 0 0' r B -2 15' 15' ,-4 80' urn Around to 514' Property Line 50' pro town road