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HomeMy WebLinkAbout032-2167-37-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: Ann M & Mike D Sargent BM Elev: TANK INFORMATION Insp. BM Elev: City TOWN OF SOMERSET TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well 501E ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: ELEVATION DATA County: St. Croix Sanitary Permit No: 617852 State Plan ID No: Parcel Tax No: 032-2167-37-000 Section/Town/Range/Map No: 26.31.19.1417 DISTRIBUTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing JVIL C.VVCK x Pressure Systems Only xx Mound Or At -Grade Svctamc nniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � Yes � No � Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 672 196TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Inspection #1: Inspection #2: Plan revision Required? 0 Yes 0 No �— Use other side for additional information. J Date Insepctor's Signature L�� Cert. o. Industry Services Division county �, i 1 D 1400 E Washington Ave car \ r M P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 11 P 2020 Madison, WI 53 07-7162A / ��1�� (P \ AR 13 State Transaction Number St. Cro`,ixRR�C ermit Applicat' __ In acco datfAAit� P , M. ode, submission of this form to the appropriate governmental unit 'prior Note: Application forms for state-owned POWTS are submitted to Project Address it different than mailing address) is requi ec3 obtaining a sanitary permit. the Department of Safety and Professional Services. Personal information you provide may be used for secondary u uses in accordance with the Privac Law, s. 15.04 I m , Stats. 7 I. A lication Information — Please Print All Information arcel # Property Owner's Name L 2re 44 W Property Owner's Mailing Address w /111J finer roperty Location Viso 3t 9 (91""7 Z Govt. Lo Phone Number i� %4 Y4, Section City, ate Zip Code �� (' cle o `J T�_N; RE rW ype of uilding (check all that apply) atfj t # ✓ Name Y-2 Family Dwelling —Number of Bedrooms 57 CW/ 7,bivslon p lock # ❑ Public/Commercial — Describe Use 1 �' ❑ City of CSM Number ❑ }pillage of ❑ State Owned — Describe Use n of �- III. Tyye of Permit: (Check only one box on line A. Complete line B if applicable) aan A000reA A' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement On y ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued ❑Permit to New B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber Transfer Before Expiration Owner I T e of POWTS System/Component/Device: Check all that apply) . -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil on Holding Tank ❑ Other Dispersal Component (ex lain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: X u ' C Design SoiApplication Rate pdsf) Dispersaal Area Required (sf) Dispersal A ea Proposed (st) System Eleva ion Design Flow (gpd) b 7 ,, �� , VI. Tank Info Capacity in Total # of ` „M�rtufacteurer�-/j, 0 Gallons Units �/r1�(ajyf`fl ? U a Gallons ''(CCUtw 0 New Tanks Existing Tanks 0 a. U vt Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, as responsibility for installation of the POWTS shown on the attached plans. Phone Nurpber Plumber's Name (Print) Plum s ignature MP/MPRS Number Business `Z PI mber' Acjd✓rress Street, City, State, Zip Code e r L VIII. Coun /Department Use Onl Permit Fee Date Issu Issog Agent Signure Approved ❑ Disapproved $ ZAZa (/C/ El Owner Given Reason for Denial lS IX. Conditions of Approval/Reasons for Disapproval 3 also, N SYSTEM OWNER: 010 t4c Ar w 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. t� S,h, Q �� 26 II setbackr it s as per applica6W"67(1RrA 1SNdb�r the system and submit to the C i my on y on paper not less an 8 t ; nc es in size �� �L�� I e T SBD-6398 (R. 08/14) PROJECT Mike Saraem SW 1/4 NE 1/4S 26 /T 31 N/R 19 System PLOT PLAN _ ADDRESS 672 196th Ave Somerset Wi 54025 COUNTY ST. CROIX W TOWN Somerset 3/11 /20 SYSTEM ELEVATION 98.0/97.5 4' below qrade BEDROOM 3 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 eeee BENCHMARK V.R.Pe"Te ArE s4emelle. e, 1 ASSUME ELEVATION 100, Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchma k Be 196th Ave Vent >6" of Cover 4' Lon�1,12" = Scale Pro 3 Bedroom House Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps at System Elevation All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 1/4 "=10' 8% Slope E B-2 100' M.* 40' 15' ents 102' 2' • �40•Am Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-2464516 Date: 3/11 /20 Owner:Mke Sargent Location: SW1/4 NE1/4 S26 T31 N,R19W 672 196th Ave Somerset Manuals Used: In -ground absorbtion system (version 2.0) Page# 1, Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance 7. Filter Cross Signature License n Contigency #226900 PROJECT Mike Saraent SW 1/4 NE 1/4; SYSTEM ELEVATION CONVENTIONAL System PLOT PLAN ADDRESS 672 196th Ave Somerset Wi 54025 26 /T 31 N/R 19 9860/9705 4' below grade W TOWN Somerset COUNTY ST. CROIX 3/11 /20 DATE CONVENTIONAL LIFT HOLDING TANK ZE 1000 gallons LIFT TANK SIZE BEDROOM 3 DOSE TANK SIZE MOUND SEPTIC TANK SI HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 kk BENCHMARK V.R.Pd /1fE e ' ' ASSUME ELEVATION 100' ❑ BOREHOLE O WELL H.R.P, same as benchma k 196th Ave Scale 8°Io Slope Pro 3 Bedroom House Vent �6„ Quick4 Standard ?4' ver Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps Long 12 b. Grade at System Elevation Filter Lifetime Filter 0' B-2 All piping shall be ASTM SDR 30/34, within 100' 10' of tank, piping shall be ASTM F891 B.M.* ents 102' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates Typical Installation Vent Grade ,A/30/34 Septic Tank 5' Long�l " 5' Grade at System Elevation Spacing_ 5' 3' 5' Long ! 2-3' X 66' Cells To be >1' above grade Finish grade elevation 102' Went 1" at System Elevation Same on other end Observation tube/Vent At end of cell A B 16 chambers per cell System elevations: A 98.0' B 97.5' ILE INFORMATION PARAMETERS Number of Bedrooms Number of Public Facility Units Estimated flow (average} POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page SYSTEM SPECIFICATIONS Septic Tank Capacity �Z Septic Tank Manufacturer Effluent Filter Manufacturer ❑ NA Effluent Filter Model .� NA Pump Tank Capacity Pump Tank Manufacturer Design flaw (peak), (Estimated x 1.5) Soil Application Rate Standard Influent/Effluent Quality Fats, Oil &Grease (FOG) Biochemical Oxygen Demand (BODs) Total Suspended Solids {TSS) Pretreated Effluent Quality Biochemical Oxygen Demand (BOD5) Total Suspended Solids (TSS) Fecal Coliform (geometric mean) iMaximum Effluent Particle Size ��J` at/da Pump Manufacturer � ailda Ifl� Pump Model Monthly average* Pretreatment Unit S30 mg/L ❑ Sand/Gravel Filter <120 mg/L ❑ NA D Mechanical Aeration <_150 mg/L ❑ Disinfection Monthly average *lip ersal Cell(s) 530 mg/L .fin -Ground {gravity} <_30 mg/L I ❑ At�rade 1101 cfu/100ml ❑ Drip -Line Other. 3� in dia, ❑ NA Other: Other. "Values typical for domestic wastewater and septic tank effluent NTENANCE SCHEDULE Service Event Ilnspect condition of tank(s) (Pump out contents of tank(s) Ilnspect dispersal cell(s) 1^.lean effluent filter Inspect pump, pump controls & alarm I=lush laterals and pressure test At least once every: ❑ Peat Filter p Wetland ❑ Other. of © NA ❑ NA ❑ NA ❑ NA ❑ NA NA NA NA NA ❑ NA ❑ In -Ground (pressurized) ❑ Mound Ci Other: Service Frequency ❑ NA a raA ❑ NA (Maximum 3 years) ❑ NA When combined sludge and scum equals one-third {�) of tank v6lume ❑ NA At least once every: At least once every: l/ At feast once every: At least once every: At least once every: (Maximum 3 years) ❑ NA. ❑ NA 0 month(s) NA ❑ year(s) ❑ month(s) NA ear(s) C] month(s) NA ❑ yearls) — rIA IVdA1NTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenrato orTanlcfinspections must plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Ope 1include a visual inspection of the tank(s) to identify y back up orpondi g of or broken tefflue ai on thetif any ground surface acks r IThesdispersal cell(s)oshall be ;combined sludge and scum and to check for y of surtacer ivisually inspected to check the effl ound surface may observation a fling condifjores and to e and requires thegimmed aiet notification on the of the local The ponding of effluent on the ground �egulatory authority. nk When the combined accumulation of sludge and scum in any er for ad'disposeddofi�in acco dance with chapter tNRe113, Wiseconsi�n !'.he tank shall be removed by a Septage Servicr g p (Administrative Code. IAII other services, including but not limited to the servicing of ei`fluent fitters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of <12 months, shall be performed by a certified POVdTS Maintainer. service report shall be provided to the local regulatory authotit �evithin 10 days of completion of any service event. Of for the presence of painting products or other chemicals th t START UP AND OPERATION cell(s). if high concentrations are detected have the contents of tha For new construction, prtoto ofthe go damage th -dispersal nt tanks) may impede the "Orientprocess servicing operator prior to uses tank(s) removed by a cePtag at the infiltrative surface. ter will ble shall not occur when soil conditions are from power is restored the excess wastewater System startup flit above normal highwater levels. When P in the backup or surface discharge Of During power outages Pump tanks may overloading the cell(s) and may O rator prior to restoring Power to tide to the dispersal cep{s} in one large dose, Servicing Fe restore normal levels discharged the contents of the pump tank removed by a Septage ®rating the pump controls to To avoid this situation have effluent pump or contact a Plumber or POWTS Maintainer to assist in man Y °p d� or oomPa the area within within the pump tank. ' e or ark Vehicles over tanks and dispersal tilon areasnot drive or park over, or otherwise the � of the ��'�: Do not drive P mound or at -grade soil absorption rfomiance and prolong 15 feet down slope of any rm rove. the pe disinfectants; fat; foundat►on drain Reduction or elimination of the fopowing from the wastewater stream may P s �ilI pairfing producks; condoms; cotton swabs; degreasers; dental floss; 0 medication ; aritibietics; baby wipes; cigarette butts; - rases; herbicide meat scraps; (sump pump) water, fruit and vegetable peelings; gasoline; g . pesticides; sanitary napkins; tampons; and water softener brine. � roe I ABANDONMENT ate shall be taken to insure that the system � P P t Y When the QpWTS fails and/or Is permanently taken out of service the following t a and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: openings sealed• All piping to tanks and pits shall be disconnected and the abandoned Pipe a Servicing Operator. ri die of by a Septag ® The contents of all tanks and pits shall be removed and props Y iced space filled with Will, s After um ing, all tanks and pits shall be excavated and removed or their covers removed and the void spa A P P gravel or another inert solid material. _ a...to®., tn provide a code compli*nt CONTINGENCY PLAN be rep aired the following measures have ueen, u, ,,,,.o. -_ - If the POVV 10 fans and cannot iacement soil absorption system. replacemert system: utilized for" location of a rep by requUled suitable ,replacement area has been evaluated and may and compaction and should not be infringed upon moment area will result in the need The replacement area should be protected from disturbs Replacement systems must comply with the rut" in setbacks from existing and Pion to structure, h arsine and )area to p�ect the rep) for a new soil and site evaluation effect at that times kiback advances in pOWTS technolo9K a � A suitable replacement areasnot a last 'resort to replace the ►ed/POWialable due to se'Sor soil m'�t'ons. Barring holding tank may be installed n failure of the POWTS a soil and site evaluatMon if no replacement area Is available a holding tank may be installed) as ❑ The site has not been evaluated to identify a suitable replacement area. Upon must be performed to locate a suitable replacement areas a last resort to replace the failed POWTS. I reconstructed in place following removal of the biomat at the infiltrative ❑ Mound and at1rade soil absorption systems may i with the rules in effect at that time. surface. Reconstructions of such systems must comply «WARNING» ER TREATMENT TANKS MAY CONTAIN LETHAL GASSES At DOR INS MAY RESULT. OXYGEN. UE NOT SEPTIC, PUMP AND OTHER ER TREATMENT TANKUNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O>✓ A ENTER A SEPTIC, PUMP OR OTHER PERSON FROM THE INTERIOR OF A TANK MAY BE DI FI ULT',OR 1MpOSSIBLE. COMMENTS Name Phone r � ^ � � d and 383..54(1), (2) & (3}, sirr administrative Code. This dxument was drafted in coir�liance widh chapter SPS 383.22(2)(b)(1)( )&(� e C.� a .J U w Sl P'T JC '1'ANI IV(Ali�t'I'l NA.N E riGR HME T AND t)Whllt:61111' C.lslt'1':I({1CA'C1ON FORM Owner/.Buyer V ailing Address &-tC.e, /OmN 1'roperly Addre8S<i-._..�/'�---__ (Verification required 1io(n Planning; & Zoning (kpart,nenl lily tiew cnustruotton.) ✓ CitylState Parcel ldcntificaliorl Nimaber ®� Z--o�I b7 7 %®011 I7 I,�ff�CYAY.1uli.;5 GlttX''I' 1 +()1�( Properly Location �_.. %, , ly.�`/^ , Sci;, Z L rib N X ! . l W, Town Of l c 7Subd. vision — _._ ....., Lot ;<r -.....LT . _..._.. — --- Certified survey Map � —^_ > W111tnc; _ 'Warranty Deed # -. ---- -- � � � \/alnnic _�-.Y 1'aga It . _.._..... _ __ Rp(:c. house yesn) ).of liuc! idewirtal le es no sArsti>lp.m NiArlv?c P N'ArrCO'1J .A>vJI c1W�vr�.>!t (:)Iffr1+ICA,','[+<�1v lrnproper use and n�aintenauce of your septic system could rrsull in its pr;mature railure to hutulle: wastes. 1'roper nainleuance consists ofpurupinl; out Ute: septic tame every three years ar snoucr, it needed, t)y a licensed putnl)er. �0.�hstt ycni put into ttic systell, etln affect the lEmction ol'the septic tank as a treatment stage in Il,e waste disposal systeur. Owner maintetuurce responsibilities are specified in §C:onnn. 83.:i2(1) and ut Chapter IZ • Sl, 0t)ix (W(nty iianitary Ordintutce. '1'hc property owner agrc,es to subtnit io St. Croix County ('ltutniug ,Se ''/,churl; I)eparhnenf a ccrtitiaalion iron, signal by (lie owner and by a plaster phunber, •juurneyruan phnuher, restricted phunher or a licensed pumper verifying that (I) the on site wastewater disposal systeat is it, proper operating; ct)nditiou all(W), (2) tiller inspu(Inmil aril ptunpinl; (if llecessary), the septic ttmlc is fuss than 1/3 full o!'sludgc. 1 /we, the undersigut:d havu read tlw above ri:yuircutc;uts and agree I<t maitstain ila; private savage disposal sys(en, With the n,,nulards set girth, hea•cin, us set by the:[)uparn�le:nt oi'Caunnurt:e and the 1-h;parhr,cnt ofNaiural Resanrces, Sterie o('\'Viscousin. C:urlil'ication staling that your septic system has been maintained trust he complelc,I and returned to the St. Cloir County Planning; & toning Department within 30 dayl; of file 1:111•t:e year rxpiration date. w 1/we certify that all statornents oil this forth art: true to the hest ol'nrylour knowJrdga. 1/we au'Jaro the owuer(s) 0141he property described above, by virtue of a warranty deed recorded ill Register ol'Deco is Office. Number of bedrooms - SIGNATURE T Al'l?Y,I(:ANl'(S) DATE '+'**Any iufbrlrlation that is tnisreprescntctt nl(ty result ill the sanitary perutil bring; (Li-:vaked by the Y.launretg & .7UItli19 .I)01)ill't717Cll1. include with this application a recorded warranty deed !i'oui the Register of Ueeds C.+(Tice atu(a copy o1'the certified survey slap if refi:renee is made in the wan'anty dE;ed. (RE,'V. 081115) lam's yD�+rawmg Room, LLC 20I8 R4S83 �4 3�5=� d �Gas6 S I°I IOI r e> d 672 196th AveJOM Ki "Is w 54025 T _m���n«ma \ \ ƒ \ b z / 3 R Q e > E C z S \�/\��/&�wypG�T «„09@��7r7v,o4� , /j . .�© \ \z f �fam's Drawing Room, LLC 2018 _�q Asa I o.e*ewr an ao��«orrcun ore?a•orr a.n � w In Q Q O� 00 —1 Z 79 o O Z E § av�ro" Iain's Drawing Room R A MIKE & AA /ARGFJIT r s s = � �SOU�THtP_IN�E 3 ? 672196th Avefolvitp •ET, WI 54025 - - - »� � s « m z \q�`\� KK/& � �7pG�T � ,�,��� «#R >,n4a .a. ««� �\?. Document Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Name THIS DEED, made between Pinecliff Partnership, LLC, a Wisconsin limited liabilit com an ("Grantor," whether one or more), and Ann M. Sargent and Michael D Sargent, wife and husband as survivorship ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant State of Wisconsin ("Property") (if more space is interests, in Saint Croix County, needed, please attach addendum): _ �__. of 37 \ at of Pine Cliff Second Addition in the Town of Somerset, St. Croix County, ' consin. �� Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated �� I%L� �. ZolB Pinecliff Partnership, LLC, a Wisconsin limited liability company * Michael J. Hartman, member AUTHENTICATION Signatures) authenticated on July 20, 2018 e TITLE: MEMBER STATE BAR OF WISCONSIN (if not. _ V�iV�INlII�'�IIIIIINIII�I� 1068496 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 07/23/2018 03:11 PM EXEMPT#: REC FEE TRANS FEE Recording Area 30.00 195.00 PAGES: 1 Name and Retum Address St. Croix County Abstract &Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 c'�p�CA' �� c-9,p =, ` � N G Tq�, � Z� -��. GeCIG �- ,,���� i'vl S C �� �� �''��ununu„'�• 032-2167-37-000 Parcel Identification Number (PlN) This IS NOT homestead property, ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. Saint Croix COUNTY ) Personally came before me on ����_Z�'� the above -named Pinecliff Partnership, LLC, a Wisconsin limited liability company, by Michael J. Hartman, member to me known to be the persons) who executed the foregoing (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THI5 IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY ID FORMING. I-2003 WARRANTY DEED ©2003 STATE BAR OF W ISCONSIN s Type name below signatures, St. Croix County 1068496 Page 1 of 1 HUDSON, S O_ wm[ED YV @u [gn@ M[n1f�dLQu�t C DD L�LI[�DD NORTH LINE OF THE SWt/4OFTHE NEt/4 I OG`�7G7CD C3�`I O4Ci]GG3�5 I � . 58901210611E 1323.42' Y jw d1 316.9T v; �} I _ — — — — — — BUILDING SETBACK PER DE DEED IN VOL 1571, PAGE 424 WL= 881.5 0 35 ui \ I 3,04 ACRES p/, 132MI SQ. FT. NII1 LBO= 883.5 , F: To , ) 886.0 / ' � 6°5z49E379•� ' � Sj6. i 6 qg^N 28 • . ST J �i 45A0 / 3ACRES 130AN SQ. FT. LBO= 857.0 / /gyp. / :XONO N 1 ? �8 �, w8 1 IZ •� 1 D ' JOINT w ' DRIVEWAY \ � ' EASEMENT I ill g / �' 36 IN ACRES / 3 �^ 131948 SM FT, r _ LBO= 889.5 r YS / HWL= 857.5 N88°291371E 178.21' �t 1g� S88029'37'W 178.21' �Ci 8._ 88.95'. 39 ' 3,00 ACRES 'I 130seo sa. FT. I IV LJ L.IIl. "I V�V1V PREPARED FOR PINECLIFF PARTNERSHIP P,❑, BOX 731 HUDS❑N, WI 54016 BENCHMARK 2=873.17 AT TOP OF PIPE / r r r � r C 37 >, 40--ACRES 148,237 SQ, FT. LBO= 869.5 y ') 80' RADIUS TEMPORARY CUL-DE-SAC EASEMENT / TO BE REMOVED UPON ROAD IXTENSIOtN a3 Vn I 1�68.55i• 38 3.00 ACRES , 130j706 SPA FT, LBO= 869.0 N83°36'24°W HWL= 867.0 � N l 89°7 9' G 9 $ r N89078'3 W � 0 0 .I cq T .r Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secon. dary purposes (Privacy Law, s. 15.04 (1) (m)). ���� �.i'�=• ropetty Locati� Page 1 of County Cid�X l.D. ' :;el 7-3 7_ )r e C I/t er Govt. of (�!� 1/41f 1/4 S A 6 T .5 ( N R li Lot # Block # Subd. Name or CSM# operty wner's Mailing Address / A rU L1 2 9 2 0 0 �t 17 C C/ r rl 96)(, 7 ty State Zip Code Ph ne NPOMR01x COUi�I f ❑ ty ❑ Village ® Town Nearest Road (� New Construction ❑ Replacement Parent material A 14 General comments and recommendations: oZ Use: © Residential / Number of bedrooms _ �L__ Code derived design flow rate G GPD ' ❑ Public or mrileJ�vial va Describe: 2 {P;.f e oe./ r' } ¢ Pi, C/ Flodd Plain elevation if applicable ft y Boring # Horizon Depth in. 2 i� 11 3i 7d ❑ Boring © pit Ground Dominant Color Munsell NONE — IIL lope 7A %5Y� S/ �f�� s, surface elev. ft. Redox Description Texture Qu. Sz. Cont. Color All S YL- ifs De th to limitin p g Structure Gr. Sz. Sh. � V'�Tzk �S � q�, factor —= in. Consistence Boundary Roots Y'��� G G✓ 2�'�^ L — v� Soil Application Rate GPD/ft2 *Eff#1 *Eff#2 QoS i% D ! d f3/- y3 Boring # ❑ Boring Pit * Effluent #1 = Ground surface elev. /1009 3 ft• Depth to limiting factor in. * Fffli cant #9 = < 30 mq/L and TSS < 30 mg/L Property Owner 12 C�! czo�_erJti,� Parcel ID # 3 ❑Boring Boring # jfe1,2, � ft. ® Pit Ground surface elev. Depth to limiting factor 6 in. Page 2 of Soil Application Rate Horizon 3 y Depth in. ZY 33, 33_ 9 Dominant Color Munsell 7,syit 7 7i''/a Z Redox Description Qu. Sz. Cont. Color /U/� Pik Texture 5 z SL Yy Structure Gr. Sz. Sh. 2 lot, 2,,,��k Consistence r�� Boundary C C- Gam, Roots 2 M Z.n ,ow. I (jok GPD/ftz *Eff#1 ©c SS (� 00P o/ r Z *Eff#2 Of 9 ®.. Q /9 d 2 .SD I (Boring # � Boring n Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rat Horizon Depth in. Dwill Color Redox Description 'Texture Munsell Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 I I Boring # � Boring (-1 Pit Ground surtace elev, ft. Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant or Redox Description Texture Munsell Qu, Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220'mg/Land TSS >30 < 150 mg/L *Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need as 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.07/00) Name � 6 C l ,4e� Address �C7 ox 7W enchmark 1 j6e G enchmark 2 %69 LI Soil Boring _ Suitable Area 1" = 40' Scale L Lof S;keg�e L /ez D 40Y'Y ,(r �a%4p- Page 3 of 3 Brian Parnell CST 231314 Date i ! ( I i I I r--�--- -,- r--,- - -;-r-- - I i- ! ! i , y t I I I I i ! - - -- +!- r--T�-1— : li !j� { � �!� ._i!i-;Ili► Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Page � of f-, C�J,� �1� 7-3 Please print all informafion. Rev'ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). oz Property Owner /� Property Location / 1 e C // /��� � e� �� ,! Govt. Lot � li�i 1/4�� 1/4 S � � T � � N R � � i (or� PropertyS?wner's Mailing Address � c) g Lot # Block # Subd. Name or CSM# � A , '.Ji ��ra G zo��� � 37 �`�� c lr`� //�/C/�/ City State Zip Code Phone Number r, ❑City ❑Village ®Town Nearest Road /-lu.�r�.�, i wy i YS'��/6 i (7/S,3 �� /sSs" Sovt-�c�ss�e � � 6 � st New Construction Use: � Residential / Number of bedrooms _� Code derived design flow rate (., G � GPD ❑ Replacement -(� ❑ Public or mme cial -Describe: Parent material � G" 2 �' � e� ���' F fi ��, � � Flood Plain elevation if applicable �" ft. General comments and recommendations y ❑ Boring # ❑Boring © Pit Ground surface elev. � /•�3ft. Depth to limiting factor �FJ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 t o-. �� /orr� �2 � S� L �z � � �J�� c �, � rn o. � c�Q i Z 11-7� 7sr,� r/ SL vardk i''�F� � � 2.�- Coos D. � -. ���.t�' �- , y3 ❑ Boring # ❑ Boring / pit Ground surface elev. !!� 9 .3 ft. Depth to limiting factor � � � in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 t �-/o D/�% �� S Z�s�� �'`��' c w z� 4 ,S a o 9 Z lD.. / ��� 1/ S � ,,,, .s� h2v�� C: cam. 2�h D , S D , 32-gs �,�Y� �� �f �� ��. � /�� D 7 /' p2 -- ,- - �- `f 3/ 8 .o � 9-�. 3sl �-. � ��.1� �f1.�6 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L � *Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L CST N e (Please Print Si ture CST Number 1�r f`C� � �ct r� e 11 �/�.� c�c.-��� , �Z � >3 / S� Date Evaluation Conducted 3 y� -� �� 2 �� e ��>� ems �T �s � - Zy W o z Telephone Number fir- z v7 3203 cnn oz�n ion�mm OW TR C /%'36 fz e,J ti,'lo Address EO o e 7V / Yti 10 !� T enclunark 1 v Of enclimark 2 'Top rJ Soil Boring 1_ ' Suitable Area ./ 1" = 40' Scale �L0 14� S'f26.t le L /c/q, o tv IYELOy"S•-qxt ©.2f�� Page 3 of 3 Brian Parnell CST 231314 Date qgo _ t -t-- j }-i—__;.__ — !� �' I f j ` i j i + i 1 M1�ve (��j�°_ry I ' ' �� --�-•— ! � I j I , l � ! - l i ! t i pp �- t i i � ' I i � I I I i � I 1 --j'_'-I'-___ • �I { -r— { -- ..- '.—_ter_ .........--i—�--j—r—__ �—t--�— ----�---�--;—�-•— ICI --.i---�--1---�--__;..__.;-__�-�---j--j--