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Home My WebLink About032-1089-60-025Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15 04 (1)(m)] I""""`y St. Croix I Valley View West Investments I TOWN OF SOMERSET 032-1089-60-025 CST BM Elev: Insp. BM Elev: BM Description Sectionfrown/Range/Map No: ADO NUL l I`p1 33.31.19.428A-10 TANK INFORMATION TYPE MANUFACTURE l CAPACITY Septic w I G71 I —7 5 (/ Dosing Aeration di O TANK SETBACK INFORMATION ®m®®® e,s ®®"Zvm-- ®�,d W—NW„- ®■„W, W/R._M .. . mmm�= PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model umb TDH ift Fri cti Loss Sys m Head TDH Ft ForcerTUn Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION % FS mil/. Benchmark 11, 9G 1 V 104 too A)j)kr _ .?3 �J3 B7 Bldg. Sewer /� yt ` 81 a /9o. SVHt Inlet /�7 ,x St/Ht Outlet Dt Inlet Dt Bottom Header/Man, if68197 G Dist. Pipe Bot. System /O 1 ' Final Grade r �8(0 stcy�r)!_r WHM BEDITRENCH DIMENSIONS Width , Leng�o s No. Of Trenches Z PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO JPIL N JBLDG IWELL LAKE/STREAM LEACHING CHAMBER OR UNIT 1 Q. e Type Of System'. V��/�.�'t 1f9✓fir / IC)dr 1 FManufaNcturepriINFORMATION u r: J i t. DISTRIBUTION SYSTEM Header ndold It Length Dia Distribution Pipe(s Length Dia Spacing I x Hole Sae x Hole Spacing Vent to Air Intake SOIL COVER xPressure SvstemsOnly x Mound Or At -Grade Svstems Only Depth Over Bed/Trench Center 3r . I Depth Over Bed/Trench Edges;> It >a Depth of Topsoil xx Seeded/Sodded 1roc Mulched - —ti -6 J ■ Yes ,'� No ■ Ves � No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ,If Inspection #2: Location: 188645TH STD �! /� �� ,tk Ch y�jyL�V 1.) Alt SM Description =�J' �'' ' " Cav,,L V ,(' 2.) Bldg sewer length =* 14 v 33 J-rd✓V1 Di�M . Q� C- ✓sl f e� v�Vk� - amount of cover = 71 n `\ Plan revision Required? ® Yes No Use other side for additional informatioM1. ' SBD-6710 (R.3197) Date Insepct fs nat a Cert. No. cAni - aoao_ od4 '' _!�"lr.► �r t r1..,�,; ,,_ Bufdrgs Division Copy U `u' IS-1 t Q 2U1 . Wesllilglon Ave.. P.O. Ba17162 siao� 7�,gQ�� Smd.y P,Z=A r (Io be 91ed a by Cm) ncYment17 �s Z�Z rc_x Co Application T� In.ocadaoce.ri% SPS 3r32 Wa Aden Cod-, mbmisam ef*os foobHe mr is negadpnrbobdmrg+�YPr� Nose App[rabm io®a for slob -named POW Sam b th e Dgmb mt of Soft ad Plai®ond Save+ Praorl miooa6on yo+p.oride may be mrd forPmPown smmd�y RJ0]�.d (d' AM,=b6nmttlm�lag addta) 000r +deme v4&On I.ew,a IS. 1 Shh L Application to ro atim—lbaehiotAnlwlrnatiaa Pruprly ~ a Nmr P.od r Q3a —1a89- lf�- opa - Pf� ' Addraw Pmpaty Loco im 3 . 1 - i cOTL Iar Cey,Sar Zip Code Phm 14mb r 1 T . 3� N; R—(� a IL Type of Hat (ebe& all apply) Iar f 3rbdnmon Noe �I r 2 Fady Dwdlhg-N.mbr of Bodio{{,m�o QR. ❑ PbliaCaeme®1-Dube Hlrb ❑ mr of ❑SWe Oma-Deobe Use ❑ VMW of CSMNmbr Z N.w 5 a�'r 2ZrLz G�l RTmaof.-�„n,F�sFf IQ. Type efPerrit: (faleet eay o e bo: ae lice A. CmpjoW Bme B dappinble) A' New Sylem ❑RVbv=tm Syd . ❑T matw./BoWurgTdcReplae®eol Only ❑Oac bfoddaorimbBtictiog SYma,(COM) B. ❑Prmit R=w*W ❑Pnmil Rm-nim ❑Ch WofPdobr ❑Prmil TrsoeErto New Lot Peeviore Pemr Nnmbrmd Der Imwd Bdae Fi�iobm Ownr L/4 ry Comic a6 that apply) Nm-Premam<d lo{aemd ❑ Prcmwmd hoot d ❑ Atllade ❑ Mo®d> 24 is of=**k awl ❑ Mrmd <24 im of auilabk nod G ❑ T-k ❑ DnpcmWlCm4mca1(cVjau* ❑Wdma/mmlDerice(=q m) V. rea Area fa&n atioax 11 DcsiVftwSol Appiimtioallm Dipemd Atr+&*"(st) Daprsd&-hope-d (et) System Emmson �/ / VL Taak b& Capseym TOW fof Mmzlkch r Callen Caen Uore i✓ I et s $ m g § iz 5 o K: New Tab Fmt�Tmb Up&rHoWW"Tmk 5' Dares Clmbor VII. 9h/amst-;"rieiseseme fraaa sfAsPON78aYswa ea Heamadwd plena rNme ) l� Plobc'a - WIMAM Nmahr Henan Pbos Nrabr ,J2917 " Plomber'a (s++el. Qiy, Code VHL ur Ap�w� r=ROwffR,, F4o`itFm Dre Isa®g sigmtme - D,,W s l DO • O� �f �T DL CONOW"Vor*Raftow lr Dbopprosal , 1. Septic tank, effluent filter and dispersal cell must be serviced) MaintainedJnJr as per management plan provided �Yr Gs1��iv�G�' ., Plumplumber 2. m. QL /0.• na� All setback requirements must be ai maintemed Asper PP' Gawe e0de,fe.6jim At aurmram�.r�mrme,ywtsaYew�kmlcr'i/e�/G_mll mllrlpRr Wls /Wpya�a M:u idmiie � / - ' J ►C��`we'y� N' �`- aJr—O �Gf SBD-6399M IUln i( J _/o 0 CONVENTIONAL COMPONENT DESIGN Resit AppkaGon INDU AND TITLE PAGE Townshgx saber Name: Lot Number_ Pace! Il) Number_ .- I IFXIM and We Page 2 Plot Plan :0. Page 7 - SL Cf= « Form Page 8 _ . Died c`' ' •' A Sol Test & House Pkais DeWigneiAllkwriber ✓ %_LcenseNumber_ [leap /L �; fin_ l^� Plane Nunes /-79, 7 _ 7Lr— 3KJnaWe _ � pasw�[61s Y�-iaa.dSdwpam cmponwif Yamal for POWZS Version 20 saatams.v QwUn j. Pace 7 IW iJ J r��✓rs Ro aw A*7 J 2je P//17J � 3 W PVCVeerFfpe Wi Vfert(ap y veAorab9mv;AmPitm _ �- ��- 2 rows of - �?� r�am6es aarh Page of FURA Qw2 I Trench 1 1 Trem3r 2 header Filters s a� Q 4J H �rl �t6�c �u� PL-525 EFFLUENT RLTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD (gallons per day) making it one of the largest commercial filters in its class. It has 525 linear feet of 1167 filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No ether f0fer on the nradwt can make that claim! PL-525 FWatntenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer, 1. Locate the outlet of the septic tank. Z.`Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 out of -the housing. 5_ Nose off fitter over the septic tank. Make sure all solids fall bade into septic tank. 6. Insert the filter cartridge bade into the housing making sure the filter is properly aligned and completely inserted. 7. Replace septic tank cover. k Alarm .� A PVC accesmW iffy ` c� �sextmdon howle l a 525 fiamrfeet Of 11161, - filtration slots' 10,909 GPD oeeptr4 & C S(iiQ. 46 Pipe Gas deflector r Automatic slut-aff ball when flter is removed U.S. Pam* Nag 6AIS.466 SX1.640 Pi.-525I; statlatic-n: Ideal for residential and com- mercial waste flows up to 10,000 Gallons Per Day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4' or 6' outlet pipe. If the filter is not centered under the access opening use a Polylok FJdend & Lok or piece of pipe to center filter. 4. insert the PL-525 filter into its housing. 5. Replace the septic tank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —Of FILE INFO ION SYSTEM SPECIFICATIONS - f Tank Manufacturer tjl4KSEe ❑ NA Permit ❑ Septic ❑Dose ❑Holding Volume: 1_4�5�0 I (gal) DESIGN PARAMETERS Tank Manufacturer: El NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: 9 NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gallday) Horizontal Distance Tank(s) to Service Pad: (ft) Design (peak) Flow = (estimated x 1.5): (gaUday) Specific servicing mechanics must be provided if vertical Is >15 feet or if horizontal Is >150 feet. Specific Instructions to be provided on back. In Situ Sal Application Rate: 7 (gaUday/fl) Effluent Filter Manufacturer. ❑ NA Standard (Domestic) Influent(Etfiuent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) !Wmg/L Pump Manufacturer. Biochemical Oxygen Demand (BOM) s220 mg/L ❑ NA 13 NA Total Suspended Solids (TSS) s150 mg/L Pump Model: High Strength Irifluent/EBiuent Monthly average Pretreatment Unit (FOG) >30 mglL Manufacturer. (BODs) (TSS) >220 mg/L MrNA >150 m ❑ Mechanics] Aeratlon ❑ Peat Filter JI NA Pretreated Effluent Monthly average ❑ Disinfection ❑ Wetland ❑ Sand/Gravel Filter ❑ Other. (Boo,) s3o mg/L Soil Absorption System (rSS) Fecal Colfform geometric mean 2 0 mg/L J9 NA 5104 In -Ground (gravity) ❑ fn-Ground (pressure) . ❑ NA Maximum Effluent Particle Size in dia. ❑ NA At -Grade ❑ Mound ❑ Drip -Line ❑ other. Other. ❑ NA Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third (JS) of tank volume When the high water alarm is activated Inspect condition of tanks p () At least once eve every: month(s). year(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) �year(s) ❑ NA Clean effluent filter At least once every: ❑ month(s) [IIyear(s) NA Inspect pump, pump controls & alarm At least once every: - ❑ month(s) ❑ year(s) NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) DNA Other. At least once every: ❑ month(s) ❑ year(s) ❑ KA Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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.falling condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02105) Page _ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) pdorto use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Startup or restoration of power under these conditions Is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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: jjj 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort ❑ 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. ❑ 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 that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK 1 SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTAItER Name Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU TO�RY--AUTHORITY Name Name. /rP•� l Jemt a�.VP Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page —of — START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal hlghwater levels prior to startup or due to pump failures. Startup or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the purr p tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: adds, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fndt and vegetable peelings, gasoline; greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort ❑ 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. ❑ 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 that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INS A ER POWTS MAINTAINER _ Name Name Phone _ Phone I SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU TORY AUTHORITY Name Name po• y „110 Phone Phone vs)-/ El Thls document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies In compliance with sections Comm 8322(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I ST. CROIX COUNTY SEPTIC TANX MABTFD4MCE AO1EENUNT . AM, OWNTERSHIP CERTIFICATION FORM City/State Parcel IdenUcation Number Propatty Lttaaaiaaj/L Y , i/ } Sec.. , !£ N R e W, Tovm of Subdivision Plan rF Lot Certified Survey Map 4 Nary Deed 6 Spec-homsaxyes Liao Volume . Page (before 2047)Yolume _ . Page SYSTEM MAINTEXAME AND OWNER CERTMICATiON rtnl • 11 11 . t t t t r 1 NO ••r t a- a t.naau n it a ►m' t liii .," Xf.tt 1vslva-i :ilf ft S' Rl _fi! \ L:Ifi-• • l .r m- a .Ira! i •itl am tite property owner agrees to submit ro Se E.= Comfyl'law*2 & Zonmg DBpart mw a cattkatioa form• signed by the owner and by a master plumber, journeyman plumber, resale d pltmtber or a ho ased p=pa vmj6&g zbw (1) the cn-site wastewater disposal system is m proper oparatme condition aad(or (2) after inspection and p»pmg goecesmy), the septic taok is less than 113 &11 of sludge. r _tm• Zan-. 1: • h above r _\ U n-{s - o maintin -U_ Private disposal 11 system I' ra _ tt.L by h t_ nm r 1�` �•eM -a. • and [u7 fIn-i... ••u w Ln • It i [i'tY ✓:Lpt'.l atzi't L1 , ! ✓t l -1 l:tlf v1 m Y d m :nt rewme - tl n ' St Croix bfYp2t : mdz nli 1> f Dqwtzie= vmb�a 30 ds3sP 1..23i': :S i4![Fl ]F-L F dam. tstatzments on man we iri•_ • ' t of m property described above, by --drtne • e•o • n m Dee; \w Office. t tl I. 1 1 :dpi 1 /1 / SHMAUft OF I **4Azy It nguad f N:1 misrepresented may resuhtt fae SaMtarvt" L[ a"L• i.}i f It ' .flll tf' r/In• )"lrl tb"! t ��ta n .1 - n\ �i1 nt {-.�.[ Itu m, _ { i>.-a. ia]�- to ..•. r - _ \h -t v! /e-n at.- flq AINARY PLAT OF: ELOISE ACRES IN PART OF THE NEl/4 OF THE N W 1/4 OF SECTION 33, TOWNSHIP 31 NORTH, RANGE 19 WEST, TOWN OF T, ST, CROI%COUNTY, WISCONSIN, BEING LOT 2 OF CERTIFIED SURVEY MAP VOLUME 17, PAGE 4496. os II �y RUN STOCK®KEWE EMMECK r LOT6 ZONED RURAL RESIDEN➢AL / / MICH4ELNRTIS / I LOTS / 20NEORU116IRESIDENTIAL F S i A T E-S °a Ra.LMI1.E / yflA /. le , LETA a i a AAA. -JL a LOT LOTS / °°BmERm —LL __ t..._ I4 L ROF6RTCLL 20NEO RVgµRESIDE0.E51DFNMt C S.MVOL B_PG 2104 L.. \ u.o,yEom I. vlir 11 I1 II 1If`.,. ►��. HI III I�'ll� �� 5. r__—wrnmAWNUE-_—_—_f A. '— — �� .i'V y � i5f/' ➢ I III ,I t` I Irl i�r.mR.w rwe o / I LOT 3EDCI RURALRODENTIAL \ ZONED RURAL RFSIpENTIAL I MARK 66NARON DUN , / IIf➢ 111TRI... LRamRo r M f / Al•„M. // 11 f / I I / / CSM VOL 1�RG 3576 1 .nNre.Muw Rwr..�E�.r^✓Ns+�r�w.rn Ile ZONED RURAL RESIDENTIAL BRIAN 5MM- wl�4aGA. nx e/� µ_ 'Fd fawWw*epsvAIJhW Wlscasin Department of Safety and Professirviceg^It; OQ ��O fc CC,'ADivision of Industry Services J•i �I DSOIL EVALUATION PORT o,mVl .Code FR py Attach complete site plan on paper not less than 8 112 x 11 inches in sTYa'.en , but not limited to: vertical and horizontal reference point (WM direction and percent slope, cel I.D. en scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ^ byA, Pape of �� rrop rry owner Property Location / I.! 1 Q9• Govt, Lot Y. Y. SJ N R E (or) W Prope Owner's Mailing Address Lot # Block # Subd. NWA or CSM# City State Op Co3ie Phone Number ❑ City ❑ Village ® Town _ Nearest Road, , M New Construc9bn Use:0 Residential/ Numberofbedrooms?L::�' Code derived design flow rate _ GPD 7s-lsCYr ❑ Replacement // ❑Public or commercial - Describe: _ Parent material rC`itF,, Flood Plan elevation if app ble44kR General comments and recommendations ,2n �,/�Ae,d a) -Sr I I Boring # U Boring ® Pa Ground surface elev.� R Depth ro WaVriq f�actor In -- RNI Annll irntinn Rato I � �11 Boring # ❑ Boring q�� Pit Ground surface!/ elev. �-ft. Depth to limiting factor 1,1C_ In. Shcl A.M adon R; I =Mu�g� 1 ®®®®coo �� IfI WN AM�- �IW. �-,W WQ� CST (PI ) Signatu 1 CST Number / Address i� Date Eveluetion ConductW Telephone Number / -5- �% .1,., E Boring # 10 Pitnng Ground surface elev. tin ft. Depth to liming factor,in. V `. , 1 Boring # ❑ Baring I ! I ® Pit // Ground surface elev. ft. Depth to linulting factorlz(Q_ In. ®®®wma�® '®�JJ m®w _,-\ k D Boring �' Boring # ® Pit Ground surface elev�ft. Depth to limiting factor in. Q J _l�1�►lI�l�� Effluent #1 = SOD, > 30 <_ 220 mglL and TSS > 30 5 150 in ` Effluent #2 = BOD, > 30 <_ 220 mg& and TSS > 30 <_ 150 mglL �� ..r� �- sue. 73/s�-x'xi✓ Wisconsin Department of D Professional, �gces Z J Page l of Division of Industry Servi 01 �U t� SOIL CQUntyVTLUATION REPORT 5t Gf nC PS 385, Wis. Adm. Code County Attach complete site plan on pap ncA It x 11 inches in size. Plan must include, but not limited to: vertical and hod eference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi by Data I q'rq Personal information you promde may be used for secondary purposes Privy Law, s. 15.04 1 m . irc.�JL Property Owner Property Location ❑ ®• Govt. Lot '/. t 'h S T N R E (or) W Prope Owners Mailing Address Lot # Block # Subd. Name or CSM# AA bl Sl C e ra! City .,L St to Zip Phone Number El ❑ Village ® Town Nearest Road ® New Construction Use:Residential/ Numberof bedrooms. Code derived design flow rate_ GPD �fSO'—�✓iOP� ❑ Replacement El Public or commercial - Describe: I Parent material zz MFlood Plan elevation if applicable ft. General comments and recommendations: ipgeysr-a .sus}cr. G FT C{.f'4.n4 Boring ex-IeAd�d h0��^q ALatilo�, Boring # pti Ground surface elev.'21z ft. Depth to limiting factor in. SoilAool mil, f l�DillrAl WIN ►!l 11�S!l�,W WARS Bonn / ❑ Boring Pit GmundsurfaceelI ft. Depth to limiting factory in. Steil Annll m tirvr Rafe Redox Description Qu. Az. Cont. Color f PM..M 81 = Rnn I In < 99n moll —A TCR , In < 15n fl M * Fm,—f k9 a Qnn I IA < 99n moll and TCR > 3n < 1 Fn moll CST (Pleas ri / Signatu ' CST Number f Address �n J Date Evaluation Conducted Telephone Number r S,/6:520 SBD-8330 (R04/15) Boring # Owf .... ice--- Ground surfiDe elev. 2�6 ft. Depth to limiting factor 1r in. Soil A.M.M.iRate 7WEM. 0 - ❑ Boring At ❑ Boring ❑ Pit Ground surface elev. —ft. Depth to limiting faces _ In. Snil Aooll ication Rafe Horizon ' Depth In. Dominant Color Munsell - Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 •Eff#2 Boring # ❑ Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Coil Annlil ,.firm Rwfw Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FF •Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L • Effluent #2 = BOD, > 30 < 220 mg/L and TSS > 30 5150 mglL EilBoring # ❑Bon laa�t �ra Ground surface elev. iaft. Depth to limiting factor in. c..rr e.,� o..ex.... D- e MAWMAMMIM FWAIMM 0�_�� ❑ Boring # El El ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ In. Horizon '. Depth In, Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or. 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