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HomeMy WebLinkAbout006-1039-95-075 (2)Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may t Tamera Belisle TANK INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. City Village Townsl BM 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 SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man Dist. Pipe Bot. System Final Grade St Cover BEDFrRENCH DIMENSIONS Width Length No, Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO I P/L JBLDG IWELL LAKEISTREAM I LEACHING OR UNIT Manufacturer. Type Of System:CHAMBER Model Number: OISI RIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade SustemA Ori Depth Over Depth Over xz Depth of roc Seeded/Sodded xx Mulched BedrTrench Center Bed7Trench Edges Topsoil O Yes ® No Q Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2046 215TH AVE 1.) Alt BM Descnption = 2.) Bldg sewer length = - amount of cover = Plan revision Required? U Yes No Use other side for additional information. L�J�J SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. I , , - , �, erg ?o r —I -s3oci tv .,w Wisconsin ' 1 andBuildingsDivision C St. Croix J/TN—?AZd Department Safety and MAY 0 2ffi W. W Mad ington Ave., P.O. Box 7162 son, WI P7462 Sanitary Permit Number (to be filled in by Co.) Professional ServicesCratCounpi State San' ` pphea 1 State Plan LD. Number a In accord with SPS 383.21 (2) Wis. Adm. Code submission of this form to the appropriate governmental Project Address (if different than mailing address unit is required prior to obtaining a sanitary permit. Note application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide my be used for secondary purposes in accordance with the Privacy Law, sI5.04 I m , Slats �4 I. Application Information - Please Print All Information Property Owner's Name Parcel # Tamera Belisle 006-1039-95-075(269B) Property Owner's Mailing Address Property Location 14.31. ice . 2 (01 B 2046 215d Ave. Govt. Lot SE %., NW V., Section 18 City, State yip Code p Number Deer Park, WI 154007 715/222-5711 T 31N/R 16 W H. Type of Building (check all that apply) Lot # Subdivision Name X I or 2 Family Dwelling- Number of Bedrooms Two CIL Public/Commercial- Describe Use / /L 'r- Block# City ( State Owned - Describe Use Y`O he,t(%rAa CSM Number Village of X Town of C%Ion In. TyRe of Permit: (Cbeek only one box on line A. Complete line B if applicable) A. X ew System Replacement System ❑ TreatmenNHolding Tank Replacement Only ElOther Modification to Existing System B. [I permit Renewal ❑Permit Revision _Change of ❑ permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV of POWTS System: Check all that apply) 11 i{ on -Pressurized In -Ground _ Pressurized In -Ground _ At -Grade Mound >24 in of suitable soil _Mound Q4in of suitable soil Holding Tank _Other Dispersal Component (explain) _Pretreatment Device t V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rat gpdst) Dispersal Area Requved (s Dispersal Area Proposed (st) 1 anon 300 0.7 428.6sq.ft. 450.Osq.ft. 9 .087hru 89.3' VI. Tank Info Capacity in Total Number Manufacturerr /� �ti Prefab Site Steel Fiber Plastic Gallons Gallons of Units GF10 Concrete Constructed Glass lsxr- New I Existing Tanks Tanker Septic or Holding 750 750 1 Weiser Concrete X Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shows on the attached plans. Plumber's Name (Prim) PI her's Sign MP/MPRS Number Business Phone Number Loretta Larrabee MPRS 224580 715/664-8184 Plumber's Address (Street, City, S p Code) N2089 County Road Y, Menomonie. WI 54751 VILL Coon /DePertinent Use Only Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ er eason for Denial f~jML*AApprovaI/Reasousfor Disapproval ate., 1 n 11_ M` _ t �� � � ) dl t[r.��{f t,,I k f12r 3 � 1. Septic tank. effluent filter and CAS^ dispersal cell must e i d 1 maintained u^ 3"" �S �k'�f as per management plan provided by plumber. a( p �� — 0. W14A:k- 61- p4As.,-,tQ ` 2. All setback requirements must be maintained "f �"���C� as per applicable code/ordinances. { �a r rwry sto twtit M Athd couplers, plam (%the County only) for the system on paper not less thanaaU2 a 11 inches in sire SBD-6398 (R. 01/03) Tamera Belisle SEY,NW'/4,S18-M1N/R16W P*4 cylon township GO St. Croix cotmty LEGEND IBM: 100.0' bottom of siding of lofting shed 5 2BM: 100.8' top of orange i paint steel post X — backhoe pits .— - contour ytr i No SPS 383 set back problems Scale 1'7- 40' / if Z' io% Site Plan zt— Ov 3 e. L4 s 4o O - Nrv, ZLSo, lsa `4, fAa W � R .1- 31aea . project: BELESLE page 0 PRIVATE ON -SITE WASTEWATER TREATMENT SYSTEM (POWTS) New construction site Index and Title Sheet OWNER: Ms. Tamera Belisle PROJECT NAME AND SYSTEM TYPE: BELISLE/ Conventional system LOCATION: Street Address 2046 215a' Ave. Legal Description SEl/4,NW1/4,S18,T31N/R16W Township/County Cylon township, St. Croixcounty CONTENTS: page 1: page 2: page 3: page 4: page 5: page 6: page 7: page 8: PLUMBER: Loretta Larrabee L an L Testing CREDENTIAL NUMBER: MPRS224580 title page owner's manual start up reports tank detail filter information cross section site plan Attachment: Soil Test Septic tank agreement Warrenty deed Barn floor plan SIGNED d.t, DATE: May 5, 2020 Designed pursuant to the In -Ground Absorption Component Manual for POWTS SBD-10705-P (N.01/01), page 1 of 8 POWTS OWNER'S MANUAL MANAGEMENT PLAN OWNER Ms. Tamera Belisle ph 715/222-5711 POWTS MAINTAINER: L an L Testing ph. 715/664-8184 LOCAL REGULATORY AUTHORITY: St. Croix County Zoning ph. 715/3864680 DESIGN PARAMETERS Influent/effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) fats, oil and greases (FOG)<30mg/L, Biochemical Oxygen Demand (BOD)<220mn/L, total suspended solids (TSS)<250mg/L SYSTEM SPECIFICATIONS Two bedroom (300-GPD) Proposing 750gal Weiser Concrete septic tank Proposing Best effluent septic tank filter One distribution cells, 3R X 90ft. with E-Z Flow soil application rate 0.7gpd/ft2, area required 428.6sq_ft. absorption area credit 50.0 per chamber, proposed area 450.0 sq ft (components must comply with DSPS 384 code and be installed per manufacturers specifications) DESIGN CRITERIA SBD-10705-P (N.01101) "In Ground soil absorption component manual" Version 2.0 MAINTENANCE MONITORING SCHEDULE Inspect condition of tank(s) at least once every year (maximum 3yrs.) Pump out contents of tanks when combined sludge and scum equals 1/3 of tank volume Inspect dispersal cell(s) at least once every year Clean effluent filter, (septic tank) at least once every year project: BELISLE page 2 of 8 POWTS OWNER'S MANUAL MANAGEMENT PLAN OWNER: POWTS MAINTAINER: LOCAL REGULATORY AUTHORITY: Ms. Tamera Belisle L an L Testing St. Croix County Zoning ph 715/222-5711 ph.715/664-8184 ph. 715/386-4680 DESIGN PARAMETERS Influent/effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) fats, oil and greases (FOG)<30mg/L, Biochemical Oxygen Demand (BOD)<220mn/L, total suspended solids (TSS)<250mg/L SYSTEM SPECIFICATIONS Two bedroom (300-GPD) Proposing 750gaI Weiser Concrete septic tank Proposing Best effluent septic tank filter One distribution cells, 3ft. X 90ft. with E-Z Flow soil application rate 0.7gpd/ft2, area required 428.6sq.ft. absorption area credit 50.0 per chamber, proposed area 450.0 sq.ft (components must comply with DSPS 384 code and be installed per manufacturers specifications) DESIGN CRITERIA SBD-10705-P (N.01/01) "In Ground soil absorption component manual" Version 2.0 MAINTENANCE MONITORING SCHEDULE Inspect condition of tank(s) at least once every year (maximum 3yrs.) Pump out contents of tanks when combined sludge and scum equals 1/3 of tank volume Inspect dispersal cell(s) at least once every year Clean effluent filter, (septic tank) at least once every year project: BELISLE page 2 of 8 START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septic tank pumper prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater strearn will affect the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: This does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non -biodegradable items such as baby wipes, tampons, sanitary napkin, condoms, cigarette butts, should not enter the system. Chemicals such as petroleum products, paints, disinfectants, pesticides, etc. should not be flushed into the system as they can seriously damage your POWTS system. Avoid traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septic tank pumper. Septic tank component inspection must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings >8" in diameter shall be secured with an effective locking device. When the combination of sludge or scum in any tank exceeds 1/3 or more of the tank volume, the entire contents of tank shall be removed by septic tank pumper. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacture's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. In -Ground Gravity Component Dispersal Cells inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths >75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Septic filter cleanine. To be done at septic tank pumping. Remove from tank, hose off filter residue in tank, reinsert filter into canister. project BELISLE page 3 of 8 REPORTS Reports for maintenance, inspections and monitoring shall be submitted in accordance with Comm83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with DSPS 383.33. 1.) All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 2.) The contents of all tanks and pits shall be removed and properly disposed of by a servicing operator. 3.) After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other 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: { x) 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 are will result in the need for a new soil and site evaluation to establish a suitable replacement area. { } suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank maybe installed as a last resort. { } 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 located a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort. { } mound and at -grade soil absorption systems maybe reconstructed in place following removal of the biomat at the infiltrative surface. Reconstruction of such systems must comply with the rules in effect at that time. l" 15 3►`I 16ye; SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES 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 MAYBE DIFFICULT OR IMPOSSIBLE. project: BELISLE page 4 of 8 0 0 w u 4" CAST -A -SEAL Sn OUTLET f M r. M PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP750- MR TANK SPECIFICATIONS DIMENSIONS: s cc WALL.• 2 1/2" BOTTOM: 3° COVER: 4" MANHOLE:: 24" I.D. PRECAST CONCRETE RISER a HEIGHT: FLAT COVER 54' O.D. OUTSIDE DIAMETER: 84' O.D. a BELOW IIILET: 42" O.D. LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. o INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL o 0 INLET AND OUTLET BAFFLE AND FILTER: WISCON'3IN, SEE DETAIL J10 m $ (OTHER STATES SEE CHART) LIQUID CAPAC'.TY: 20.28 GAL/IN W n HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS ~ OUTLET HOLE PLUGGED W LOADING DESIGN: B' 0" UNSATURATED SOILco TANK CAN BE USED AS: C tr) SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN NO FIBER a M TANK: MIX DEIGN #10 STRUCTUR EAL FIBER) o_ I N CUSTOMIZED TANKS: � p FOR CUSIOM TANKS CONTACT WIESER CONCRETE W = D7 N � 7 J z m a ZLO LO . V C F, a y N DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. 4PPROVAL DATE: PRODUCTS NEEDED BY: /OF 1 Installation Instructions for the GF10 Filter step is locate and remove step 2: Before installation, the septic tank cover, on place the filter case on to the outlet side of tank. the outlet pipe. Make sure the case Is positioned so the filter can be removed from the tank for mainte- nance and service 'A nssmi i 1� Step 4: Glue the Alter case onto the outlet pipe. Insert the filter cartridge Into the use, (Make sure the filter Is completely Inserted Into the case.) BEST TECHNOLOCY Step 3: For installations that require or desire additional support. (If additional support is not needed, go to Step 4) Glue a section of 1'Sch. 40 pipe to the two hubs located on the bottom of the case and the hub located on the side of the case. I Steps: For Installations where It will be difficult to reach the handle, piece 1"Schedule 40 pipe Into the tee on the handle and extend It to height that will make it easy to remove the filter. Installation of an same as a new system onlythe septic tank (� n� existing system. most be pumped prior to Installation. L' ® M . © . da ® G Cal C Lam] = no C © 4 = M O r 4"3 Maintenance of the GF10 Filter A time frame In whkh septic tanks are serviced Is set by state and local codes. Although they may be different, most regulatory agencles suggest two to five years. We recommend the GFtaAlter be cleaned when the septic tank is normally cleaned and pumped, or as needed. WARNING: If the liquid level in the tank is above the top of the filter, pump the tank prior to removing the filter cartridge. ® CAUTION: USE RUBBER GLOVES WHEN HANDLING FILTER Step 1: Remove the septic tank cover and pump the tank if necessary to rdA prevent any solids from escaping rothe c'-°'^'pv� field when the filter Is removed. '� Step 2: Pull the filter handle and slide the filter out of the case. ®' Step 3: While holding the filter cartridge over the access opening of the tank, rinse the cartridge off with fresh water. Take care to make sure all solid material falls back Into the tank J IBEST 4� 0 TECHNOLOGY 3 Falrlleld Blvd, Wallingford, CT 00492 1.677-765-9565 FBX:203.284-0614 aim.. �4� Step 4: Insert the cartridge back Into the case making sure that It Is properly aligned and completely Inserted Into the case. Place at connection observation pipe, extend 12"above grade Fabric —may • LKU55 5EL I IUN - not to scale One cell 3ft. by 9011. *"Connect vent at end of lateral w/6" drop piece, extend vent 12" above grade >3ft of suitable soil Finish grade 96.3' 1 ..05' thru 89.3' System installed using E-Z Flow 1203H 9 bundles per cell = 450.Osq.ft. Bundle credit 50.0 observation/vent at end of cell attached to pipe lateral (6" pipe extended to system elevation end of cell \ TOP VIEW - not to scale I E-Z Flow 1203H I 3ft. by 90ft. front of cell 10' \ 4" Sch 3034 observation project: BELISLE page 7 of 8 Tamera Belisle SE'/4 NWY4,S18T31N/R16W Cylon township St. Croix county LEGEND IBM: 100.0' bottom of siding of lofting shed 2BM: 100.8' top of orange paint steel post X - backhoe pits — - contour No SPS 383 set back problems Scale P- 40' b Y� Site Plan e,...roc.�t• I g�b.nea�' t S' 4�yo trv\ zt Go, psi%� .. -i w.,5�.. •� f �:1�.. w u�- project: BELESLE page 8 of 8 oZfrs B- }�ne.: ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer i bupAs )d t. — U Mailing Address 2-0 H b 2i S yoo Property Address Z.C7 4 `p (Verification required from Planning & Zoning Department for new City/State 0� k, \-,) L_ Parcel Identification Number LEGAL DESCRIPTION Property Location �� ''A , N W '/. , Sec. , T 3 I 1IR 1 IG W, Town of h Subdivision Plat: N A. Lot # Certified Survey Map #�,' I" 'I 1^ / , Volume — , Page # .--_ Warranty Deed # '1 � I Li 14 (before 2007)Volume Z Page # OA3 Spec house ❑yess Lot lines identifiabloyes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1/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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numer be bdrooms N P\ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) _«»» ■d`2»»� <2ma Parcel #: 006-1039-95-075 Valid as of 05119/202011:51 AM Alt. Parcel #: 18.31.16.269B TOWN OF CYLON ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): DOUGLAS & TAMERA TR BELISLE 2046 215TH AVE Physical Property DEER PARK WI 54007 Address(es): 2046 215TH AVE Districts: Dist# Description Parcel History: 0119 ISCHDISTOFAMERY Date Doc # Vol/Page Type 1700 !ITC 12/02/2004 781 2707/093 OC 8020 UPPER WILLOW REHAB DIST 05/1M003 721258 2239/552 OC 05/13/2003 721259 2239/553 OC Abbreviated Description: Acres: 24.030 10,24/2000 632346 1553/243 CA-C SEC 18 T31N R16W PT SE NW THEE 793 FT OF SE NW I more... Plat Tract (B-T-R 401/41601/4 GL) Block/Condo Bldg * N/A -NOT AVAILABLE 18-31N-16W SE NW 2020 Valuations: Class and Description Acres Land Values Last Changed on 06/2512018 Improvement Total GI -RESIDENTIAL 1 4.0001 30,000.001 209.400.00 238,400.00 G5-UNDEVELOPED 20.030 20,000.00 0.00 20,000.00 Totals for 2020 General Property 24.030 50,000.00 209,400.001 259,400.00 Woodland 0.0001 0.001 0.001 0.00 Totals for 2019 General Property 24.0301 50,000.001 209,400.001 259,400.00 Woodland 1 0.0001 0.001 0.001 0.00 2020 Taxes Taxes have not yet been calculated. Key Primary p A I I) 65T-2020- o$ti MAY 08 2020 � I ouX,� Wis. Dept of Safe4bril 'SOIL EVALUATION REPORT � Page l of - - �N DNlsiono Win ccordance with SPS W5, Wis. Adm. CodeCountyAttach than 8 112 x 11 inches in size. Plan must include,4bo 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. cc ' _ wag -CIS - u'i 5 Z lc Q Please print al! information. Re d by Dale Lew, 15.134 Zo Personal inlolmaaon you provide may be used for aecandry purposes (Privary s. (1) (m)). Property Owner Property Locabon ° S Govt. Lot 51= 1 /4 N'v.11/4 S 1 E T j N 1(D K (or Properly Owner's Mailing Address Lot # Block If Subd. Name a CSkAB 2.1 G *L- - P- -- - I City State Zip Code Phone Number ❑ City ❑ V lage ATown Nearest Road \ •z: 10.YK W 5457 ('-Ik5)ZZZ-S°1}} C- �S�- 1�uL, New ConsWkdion Use: ® Residential / Number of bedrooms Code derived design flow rate 3IX) GPD ❑ Replacement ❑ Public commercial - Describe: Parentmateriel a,� Flood Plain elevation d applicable ft General cormnents - A%a. c:.' 1.. r).r-�;--- - L and recommendations: — G (: - L Bong Cw. cy � Boring s La" Ground surface elev. q (P-3 fl. Depth to limift factor. 1 2C in. t Pit A cation Rate Horizon Depth Dominant Color Redox Description TextureFI-fn re ence ourdary Roots GPDM ' fN11 f1#2 in. Munsell Qu. Sz. Cont. Color h. 1 -7 io )t tr t -' s C.1'c v- �r , d. c- 7, 5 I R .3�y r s -mar r TI 1. � '7.S I ❑ &airs Bring * Pit Ground surface elev. Cf 5. ft. Depth to limiting factor > 1 Z.1 in. Soil ADplicatim Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft ' Rllt ff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. L z5 toy 3�a S ant k +rCi S -7, S w� c i t -rn�� --' ---ice I, ✓a 3Y•S`f Pam/ J•Z o n 8 It Effluent #1 = BOD I, > 30 < 220 mg/L and TSS > c 150 mg/LF. ' Eflluent f2 = BOD < 30 mWL and l bb _< Ju mgrL CST Name (Please Mint) - - Signature CST Numb Mz Address _ Date Evaluation Conducted Telephone Number 1` ac s q G,um�u �l. NlEn�mLi Cc . W L s ilsi _ as aoa °"��cc4-B IFs CRr Rlvllui III I1 • (U Property Owner Tm eer, 17 e. i Q 1 Parcel IDA c66-IC:39-9 S- c -L ? f3) Page Z_of Z.' Bonng# ❑ Boring .. Pit Ground surface elev. gs,j ft. Depth to limiting factor z -s in. Soil Aimilication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDAt ' fftti f #2 1.O-lp Ip 3/a i a m qbk (r� YS- 6 4 33- ZS %.b YR `t S .-Y n - V`Y' 9z a9 9 . o S 1tr be. va.e_ D. D s Ste, s ❑ Boring9 ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. - Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots GPD1ft ' ff#1 02 ❑ Boring Pit Banrg # Ground surface elev. ft. Depth to limiting factor in. . ❑ ' Soil Awlication Rate Horizon Depth in. Dominant Color Munsell Redox Desc plion Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. nsistence oundary: Roots GPDtt ' Milli 111+{2 ' Effluent fit = BOD . > 30 < 220 mglL and TSS >30 < 150 mglL • Effluent #2 = BOD s < 30 mgfL and TSS < 30 mg1L "fhe Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, contact the department at 608-266-3151 or TiY through Relay. SBR83314RI I I II t o Propertyo r Tm e G 1& i I zj e- Parcel ID#oob-LO39-q5-o`19(Zby f3) Page-., of �j< Boring# ❑. Boring - Pit Ground surface elev. 95.3 ft. Depth to limiting factor in. Soil Aciolicatim Rate Horizon 'Depth in. Dominant Coloi Munsell Redox Description Qu. Sz. Cont: Color Texture Structure Gr. Sz. Sh. onsistence Boundary. Roots I GPD/ft ' Mfr#1 fW2 1.05--lo l0 3/1 �i m,�bk s 8 2 0- A 3 t0'4 4/,# n(r� 33-3q3� ci Yn or I,S 021 M S r 5 -mv .-,- .y. t • 6 12.4 9. o :o o `f . 57 .� (S 1ae tN E_ 0. CBorin # --� Boring �$ .� pit . Ground surface elev. fl. Depth to limiting factor in. Soil Application Rate Hodiog ,1Septh : . in. f)ominantColor Munsell Redox Desaipdon Qu. Sz. Cont. Color Texture" - Structuresistence Gr. Sz. Sh. Boundary Roots GPDIfl ff#1 f#f2 ❑ Boring # ❑ Boring pit Ground surface elev. ft. -Depth to limiting factor -in... . Soil Awlication Rate Horizon _ Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color - Texture Structure Gr. Sz. Sh. onsistenoe �ourxl fy -Roots 11 GPD/ft MI 110112 `Effluent #1 = SOD : > 30 < 220 mg/L and TSS >30 < 150 miyL • Eflhrent'n = SOD �< 30 mg/L and TSS S 30 mg/L The Dept. orSafety and Professional Services is an equal opportunity service provider and employer. ff you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. Sar}U30JR1111II Tamera Belisle AM AL SE'/a NW'/a,S 18T31N/R16W Cylon township St. Croix county retta Larrabee CSTM 22458VN �LEGEND L'Jr' : 100.0, bottom of siding of lofting shed 213M: 100.8' top of orange t steel post backhoe pits contour No SPS 383 setback problems Scale 1'% 40' I je y ' r r r f t f (low Soil Evaluation Site Plan d-e �c.c_v-r..mn ovt� J Y tea. �4V 0218 R- Legend Surface Water Data Viewer Map ❑ FIRM Panels .i9 — Cross -Sections r Flood Hazard Boundaries Other Boundaries i} Limit Linea O } SFHA/ Flood Zone Boundary ' Flood Hazard Zones '_; ■ 1% Annual Chance Flood Hand . Regulatory Floodway, ■ Special Roadway Area of undetermined Flood Hand ■ 0.2% Annual Chance Flood Hazard . Future Conditions t% Annual Flood Chance Flood Harnd ■ Area with Reduced Risk Due to Levee �' ♦ Wetland Identifications and Confirmations A �� -+ •r Wetland Class Points 311 0 Dammedpone P N Excavated Ibnd 55095C•0� D Filled excavated pond eff. SAW Filled/drained wetland Wetland too small to delineate Filled Points Wetland Class Areas Wellan Upland Q Filled Areas 0.1 0 0.03 0.1 Miles DISCLAIMER: The irdarmatlon shown on these maps has been obtairetl from various sources, and are of varying We. reliability and resolution. These maps are not intended to be used for navigation, nor are these maps an authoritative source of information about legal land ownership or pudic amass. No warranty, expressed or implied, is made regarding accuracy, NAD_1963_HARN_Wlsconsln_TM r9� applicability for a particular use, completeness, or legality of Me information depicted on this map. Far more information, see the ONR Legal Notleas web page: htlpl/dm.wi.govllagaI/ Notes Tammy Belisle property 2046 215th Ave, Deer Par§, W I