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HomeMy WebLinkAbout030-2131-14-000 r L 14 e��e�v 6 6y b bso PL �D�� �I cv lvr/- LL r - Wisconsin Dqpartment of Commerce County. PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430514 0 GENERAL INFORMATION ( ATTACH TO PERMIT) State Plan ID No. . Personal informatrSn you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Harvey, Dwight St. Joseph Township CST BM Elev: I Insp. BM Elev BM Description: . ` Section/Town /Range /Map No: ( co C MA r $ IM rt Ott 23.30.20. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS Hl FS ELEV. Septic (��JGR_ l Ov17 �6� n �a r,�a,. 4W D . V O(•�1 (� Ll . Dosing t f t. BM Aeration Bldg. Sewer u I N11 BIZ - Holding St/Ht Inlet o (• / SUHt Outlet , TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > l , ( _� Dt Bottom 5 O 96- i Dosing L � �� k 2 it Header /Man. , Aeration Dist. P• a .O / �. o 15% 30 tlkto Holding Bot. ystem o ( 1P 0 PUMP /SIPHON INFORMATION Final Grade 3.1 C7 Ij Manufacturer Demand b St Cover 6fL GPM 3• l 9g. l3 1 Model Number M6 _ Og 1 TDH Life Friction Los � System Head TD K Ft Forcemain Length ( I Dia. Z 11 Dist. to Well 570 1 SOIL ABSORPTION SYSTEM ( 2 1 ) j r RENCH Width ( Le� th I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM •(p�.5n SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Ma ct e{:� - INFORMATION Type Of ystem: 5 S r , 1 r — CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold t( Distribution x Hole S' x H Vent to Air Intake p , 1 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 xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [� Yes No [] Yes _J No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2: Location: 169 Heritage Trail Hudson, WI 54016 (SW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 14 Parcel o: 23.30..20_.,�,,�^ 1.) Alt BM Description 2.) Bldg sewer length = 2 - amount of cover = > $40 �• Plan revision Required? E Yes N L^ Use other side for additional inform SBD -6710 (R.3197) `� to / ` /� _ () , Signature Cert. No. �m, .of } • •11.�„�tJj CQ.XG. i ._ K �.S 4 • d I • � �a �• i Safety and Buildings Division County � *6consin 201 W. Washington Ave., P.O. Box 7162 d Madison, WI 53707 - 7162 Sanitary Permit Number (to be tlled in by Co.) Department of Commerce (608) 266 -3151 30 Sanitary Permit Application State Plan I.D. Number f� In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) roject Address (if different than mailing address) I. Application Information - PI ase Print All Information _b , T -Ty — I A 41L Property Owner's Na me �� T� /` _ Parcel ll Lot J C.� C�(J b.Boo Property / Owner's M ailing Address Property Location / 2 /- S'1� /V ST. CROIX COUNTY ) �l/ /a,� /a,Section ,� City, State Zip Code // /'� C,y�� �L�t �� ��oT Z "_"'_ trcle e) II. Type of Building (check all that apply) T � N; R Z E o 04 ,nn . fAr %-1 or 2 Family Dwelling - Number of Bedrooms L Subdivision Name J;&ht #mnber ❑ Public /Commercial - Describe Use r L 1 646-V ❑ State Owned - Describe Use ❑Cit ❑Villa e J�R,�j6t y g Township of j' - f' i III. Type of Permit: (Check only one box on line A. Complet l in e B if applicable A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) )- Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter each' ❑ Drip Line ❑ Gray -less Pipe Other (ex lain) V. Dis ersal /Treatment Area Information e(gp 1/ 3/, / Design Flow (gpd) Design Soil Application Ratdso Dispersal Area Required (sf} D' ; , l Area �Yopgse� (so System Elevation 1 5 - 5 41 (�� 5 - � Ayz y VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Ato Aerobic Treatment Unit Dosing Chamber �- ✓mob Z At1�� VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu is Na me (Print) plumber's Si gnature MP /NHVS Number Business Phone Number m t?t 66 4 z6� Plumber's Addre ss (Street, City, State, Zip C Z 4 Code VII Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee in Q cludes Groundwater Date Issued ssuing Age t Si natur Stamps) Surcharge Fee) Z! ?,S� �` /k ❑ Owner Given Reason for Denial IX. Conditions of Appj:qya11//RKeasons for Disap _ Y Septic tank, effluent filter and 1 dispersal cell must all be serviced / maintained ?3 ' 67Z - as per management Ian provided by um er. 2. setback requirements must be main as per applicable code /ordinances. �l7 Attach complete plans (to the County only) for the system on p er not less Man 81/2 xtfl inches in size SBD -6398 (R. 01/03) -PLO y � C LL 3 l +ir 1A� �ti vv Z) 401 ppow vie v 30�2- gro A �r /010 6 p�' .{- P p �+ t' ?o/ ov�PivE' 1 71P - Zzb Y q-7 cl6px LL i . L / � I t s - P Q � D rAA Wfo 8�Z (p +of P I G B► 99 � p�P� 10/ o+/e�iv� Combination Sep-G;ic- Tank and PUMP CHAMP�ER CROSS SECTIOtJ 212 SPECIFICATIORIS - VE1JT CAP WCAT'HEK PKOOF JU►JCTIOIJ BOX H`C_I. VEt PIPE f.PPAOVEO LOCKIIJG jQ' FROM DOOK, MAuHOLE COYER rvl y vvARtJl •4iIJDOW OF FRCSH co>, D��r uasPloiJ f'1PE A.LIWTAKE • biMPaC . � I Y MI1.I. , � 1 VJ I I • � IU /\I1�• �.; PROVIOE I IAILET AIRTIGHT SEAL ! APPKOYED JONT: APPROVED JoIWT Z�tB�t Ft� I + W/ C. T. ?IPE� pi W /C.T .?IFEOK Tank construction I II ALARM shall comply with I I! ILHR 1 and 33.20 a I • I 1 ou C i I I Pu r�P OFF D COIJCRETE , 3" APPiN•e RISER EXIT PERMITTED OIJL`J IF TAIJK h1AWUFACTUREK HAS SUCH APPROVAL BEDOfNG SEPTIC F SPEC.IFICATICKIS POSE IN� COjC Z� IJuMbER OF DOSES: PER DAB T,-, W K5 MAWUFACTUREZR::�� / TA)-JK :,IZC: �� �/ , GA .LOIJS I b AGKFLOW: Z - GALLOrus ALARM A'AWUFAC7URCR: MODEL IJUMOER: �QL CAPACITIES: A= Z�CLAICHES OK 1 5ALLO►1S SWITCH TAPE: ��- B = Z IWCHES'OR� -� G�LLOUS (JUMP MAIJUFACTURER: ��� G :&A�2 IWCHES OR l / ► ^ ` I*ALLOUS MODEL IJUMBER: _ ? D=�I&IrHES OR L�- -2-GALLOIJS . SWITCH TYPE: » f� 1JOTE: PUMP AIJO AL ARE TO OL MWIMUM DISCHARGE RATE___� GPM INSTALLED QHl SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEIJ PUMA OFF AuO..DISTRIBUTIOIJ PIPE.. �1 EET + MIWIMUM NETWORK SUPPLY PRESSUKE , ; , , . , , , .. D FC.ET + FEET OF FORCE MIM Y, L-7PF /�QQfLFKICTIOIJ FALTOK.. 7- FEET TOTAL CO QAMIC. HEAD = FEET As per - manufacturer gal /in. 4 . ti ME40 Series 4/10 MP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 � 30 Z 25 8 z Q M 20 6 d 15 F- 4 0 F- r 5 2 0 0 ct9E' N5fe4%w 0 JO 20 30 40 50 60 7 90 90 100 CAPACITY GALLONS PER MINUTE i F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. i D 1 V D o 3 0 CD —. Q r D CD IV W Z (� V x D /� V X n o D \ lo �INVERT� _ C 7• 6.� fl'1 41 ml n � � b w � a l 0 0 n D ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer (9'v LL N �p DEAL Mailing Address a. 0 5 6 S s /Vt 21 rt �'� N . Y o 4 7 Property Address 169, - c OA AC i — T't - < A l � (Verification required from Planning Department for new construction) City /State }fir, \ L I e5 INJ yv' , S' Parcel Identification Number LEGAL DESCRIPTION Properly Location - W %4, t 1 /4, Sec.S . T 30 N -R A - Town of 0 y . Subdivision S — r, - + - t R s C L N , Lot # 1 1 4 Certified Survey Map # Volume I . Page # ( / Warranty Deed # �/7 S 6 , Volume ZO 5 Page # 7` 8 Spec house ❑ yes no Lot lines identifiable`91 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, 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 113 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 statin that your septic system been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the year expire • � SIGNATME OF APP ANT 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 owners) of perty escribed bove, by a of a ty deed recorded in Register of Deeds Office. ` yv x l 493 S101 OF APP ANT 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 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number D S Number of Bedrooms Design Flow - Peak (gpd) p Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years oil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Pl- 7�- '2� 7 - 3 C O z73 6 797 P(�' 3 J 2065 P 598 -7 0 m569 XATHLEEN H. N►ALSH ' Document Number TRUSTEE'S DEED ST. CROI X O Co DEEDS HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable RECEIVED FOR RECORD Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 12/02/2002 01:00Ph sideration conveys without warranty to EXEMPT # ST. JOSEPH DEVELOPMENT CORPORATION, a Minnesota orpora Ion, rantee, the following escrt a rea es ate in St. Croix REC FEE: 13.00 County, State of Wisconsin: TRAYS FEE: 4590.60 COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND TITLE, 1900 5 "_'.: ' c. , ^.OAD NE''1 ERiG ?�T :., N% 551i FILE NO. X 11 - 1 030 - 2032 -50 -000; 030 - 2032 -10 -000; 030 - 2032 -70 -000, 030 - 2033 -20 -000; 030 - 2033 -40- 000;030- 2043 -10 -000 (Parcel Identification Numbers) Bernice A. Lentz, wife of Henry J. Lentz, joins in this conveyance to relinquish any homestead and marital property interests, but does not join in any of the warranties. Dated this 4 day of �/l1dy. 2002. 5 "Henry J. L �, Trust SCR *Bernice A. Lentz AUTHENTICATION / ACKNOWLEDGMENT Signatures) 2 Gt v� STATE OF WISCONSIN r rl ,Y•a- A , LQ -V1 42 ST. CROIX COUNTY .11 Personally came before me this _ day of authen Zted t isay of V ac 2002, the above named Henry J. Lentz, as Trustee of the Henry J. Lentz Family Revocable Trust, and Bernice A. Lentz, to me known to be the person(s) who executed the signature r / foregoing instrument and acknowledge the same. type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature type or print name (If not, authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (If not, state expiration date: .) Robert F. Wall "Names of persons signing in any capacity should be typed or printed below their signatures. Lentz TrusteesD eedStJosephDevelopment -02 I Property Description - (Henry J. Lentz Family Trust /Grantor to St. Joseph Development Corporation, Grantee) A PARCEL OF LAND LOCATED N PART OF THE NW 114 OF THE SW 1 14, PART OF THE NE 1/4 OF THE SW1 /4, PART OF THE SE1 /4 OF THE SWl /4, PART OF THE NWIA OF THE SE 1/4, AND THE SW1 /4 OF THE SE1 /4 ALL N SECTION 23, AND N PART OF THE NE1 /4 OF THE NW1 14 OF SECTION 26, ALL M T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, NVISCONSN; DESCRIBED AS FOLLOWS: BEGNNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 23, THENCE S89 °59'28 "E ALONG THE SOUTH LINE OF THE SE 1/4 OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SW I/4 OF THE SEl /4; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NW 1/4 OF THE SE1 /4, 2662.66 FEET TO THE EAST -WEST QUARTER LINE OF SAID SECTION 23; THENCE S89 1 57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1103.88 FEET; THENCE S00 °15'03 "E, ALONG THE EAST LINE OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED N VOLUME 3, PAGE 711, AND THE SOUTHERLY EXTENSION THEREOF 541.62 FEET; THENCE S89 °44'57 "W 349.84 FEET; THENCE N00° 15'03 "W A DISTANCE OF 100.00 FEET TO THE SOUTHWEST CORNER OF SAID LOT 2; THENCE ALONG THE SOUTH LINE OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4 PAGE 944 S89 0 44'57 "W A DISTANCE OF 699.66 FEET TO THE WEST LINE OF LOT "A" OF CERTIFIED SURVEY MAP RECORDED N VOLUME 4, PAGE 944, AT ABOVE SAID OFFICE; THENCE N00 15'03 "W, ALONG LAST SAID WEST LINE, 445.55 FEET TO SAID EAST -WEST QUARTER LNE OF SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1107.54 FEET; THENCE S00 °17'14 "E A DISTANCE OF 304.14 FEET; THENCE N89'4 1'28"W A DISTANCE OF 404.95 FEET; THENCE S00 °17' 14 "E A DISTANCE OF 1025.47 FEET TO THE NORTH LINE OF THAT PARCEL DESCRIBED ON DEED RECORDED IN VOLUME 562, PAGE 563; THENCE N89 °05'35 "E ALONG LAST SAID NORTH LINE, 1222.12 FEET TO THE EAST LINE OF SAID PARCEL; THENCE S00'1 5'40"E ALONG LAST SAID EAST LINE, 1352.12 FEET; THENCE S02 1 52'23 "E, ALONG LAST SAID EAST LINE 1324.16 FEET TO THE SOUTH LINE OF SAID NE1 /4 OF THE NW1 /4 OF SECTION 26; THENCE N89 °55'00 "E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED N VOLUME 5, PAGE 1352, AT ABOVE SAID OFFICE; THENCE NO2 °52'23 "W, ALONG LAST SAID WEST LINE AND THE WEST LINE OF A PARCEL RECORDED N VOLUME 623, PAGE 331, 1325.87 FEET; THENCE N00° 15'40 "W, ALONG LAST SAID WEST LINE, AND THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED N VOLUME 2, PAGE 348, 521.61 FEET TO THE NORTH LINE OF LAST SAID LOT 1; THENCE S89 °53'49 "E, ALONG LAST SAID NORTH LINE, 894.17 FEET TO THE EAST LINE OF LAST SAID LOT 1; THENCE SO4 °28'32 "E, ALONG LAST SAID EAST LINE, 523.40 FEET TO THE SOUTH LINE OF THE SWI /4 OF SAID SECTION 23; THENCE S89 0 53'32 "E, ALONG LAST SAID SOUTH LINE, 107.05 FEET TO THE POINT OF BEGINNING. PARCEL CONTAINS 162.778 ACRES, SUBJECT TO RIGHT -OF -WAY FOR S.T.H 35/64 AND C.T.H. "E" AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. C \ i N67 2909 E 86 5a TO CENTER OF CUL -DE -SAC �> " \ \ C7 4 1 _ N89'54'07 "E 82. - 46 / 80 RADIUS TEMPORApY°' C IS \- 8 EASEMENT TO BE NGISNE 89 54' 7"W 82.46 ROAD EXTENSION • /' mi ` i ' 16 46 r - \ /SEE DETAIL ON SHEET 4 o s 66 ?• Li s LOT 15 3.000 ACRES ` \ 130,681 SO. FT \�• O , \ Q I t d �cp (Jt I a s. W VA �12✓ `� I _ - r i r }� S� E r' Q * \ f t LOT 14 \. I ; '... rn 3 000 ACRES t 30.685 SO FT �. 0 • (b PY Q4 t \2 . , ... A y �S µ CORN 23 ,�• L11. 264.92' t329' I ETER IRON PIPE FOUND Nk 1 26 w 20' RECREATIONAL •TRAIL EA SEMENT t Wisco Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code minty Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must O include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel percent slope, scale or dimensions. north arrow, and location and distance to nearest road. (J Please print a in Reviewed by ` Date / f'� Law, .75.04 (�) (m))• l G 3 Personal information you provide may be used seoomdary purposes Property Owner A, roperty Location �r 5 '� y ��Z ovt.Lot `ji J 1/4 SE 1/4 S Z�>T 3(U N R Z O E(or)® Property Owner's Mailing Addrets 1 �t�# Block #9 Subd. NaTW or CSM# (p S}, 1t - City State Zip Code Phone Number ❑ City ❑ Village ED.Town earest Road }� 55ogZ (CO51 HN- Z-41LI 1 5 _ J w (� New Construction Use: Residential / Number of bedrooms Code derived design flow rate ySo/rg D O GPD ❑ Replacement ❑ Public or commercial - Describe: Flood Plain elevation if applicable "1611114 Parent material Jca S tL General comments s �S Fp c y� -e ! e t/ 9 2 7 j D and recommendations: ❑ © Boring # Boring `� ft. Depth to limiting factor 1 15 in. Pit Ground surface elev. P ng Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1� 312 Sit 2 c5 (j -5 • 9 I `f 5 i U m mfr `i 3 3cP-uS 10 yl m5 ml - T Boring Boring # Z ® pit Ground surface elev. % - - 7d ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 l O - 5 1 31Z _ 5 Z n C 5 Iv� -5 -9 Z 5 --i3b 1t. 414 s 0:4 - o • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' EffluW#2= S < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature CST Number Ado�m Z 5 3369 Address Date Evaluation Conducted Telephone Number 211 5. &Mex:�)61LJl Property Owner r t I Parcel ID # 7 + Page ' Boring of J 1 Boring # ❑ '` ' Pit Ground surface elev. 7 ft. Depth to limiting factor 2(o in. Horizon Soil Application Ra Depth Dominant Color Redox Desaiptfon Texture Shuchrre Consistence Boundary Roots 31 In. Munsell Qu. Sz. Cont Color G�. Sz. Sh. 'Eff #1 •Efff12 -� IU r3)? Sil... 2 cS I vy 5 8 Zzn sbk, rrCr c�) - y La !- 2 i F] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Desafption..... Texture _Structure Consistence Boundary Roots GPD /fl= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 0 Eff #1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rah Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ftr In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff #2 • Effluent #1 = BODS > 30 < 220 mg/t- and TSS >30 < 150 mg/t. ' Effluent #2 = BOD < 30 mg/1 and TSS < 30 mg /l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SB61310 (R07M) D r Property Owner L'wrnaae Harifs Parcel ID # ' Page Z- of 3 'Boring # ❑ Boring ❑ Pit Ground surface.efev. `1 g 50 ft. Depth to limiting factor Z(o in. Soil Application I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell t1u. Sz. con Color Gt. Sz. Sh. c5 'Eff#1 'Efft; Iv- .5 ,8 Z 5 k 04r _ Boring # ❑ Boring ❑ Pit ' Ground surface elev. ft. Depth to limiting (actor in. Boil Application R Horizon Depth Dominant Color Redox Description Texture _Structure Consistence Boundary Roots GPD /fl= In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'EffN a Boring # ❑ Boring ❑ Pit ' Ground surface elev. ft. Depth to limiting factor In. Soil Application R; Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /W In, Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'EIM .. Effluent #1 = BOO ;> 30 < 220 mg/L and TSS >30 < 150 rnA ' Effluent #2 = BOD < 30 mglik and TSS < 30 mg /t. The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD1330 (R07/00) 1 RECEIVED Wisconsin Depart ent of Commerce A SOIL EVALUATION REPORT' Page _ of Division of Safety nd Buildings ' 9 Z004 in accord nce with Comm 85, Wis. Adm. Code ^. County � Attach complet site fits ' �han 8 1/ x 11 inches in size. Plan must �r include, but not ' erence point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. R 'awed by Date !/ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ZT� Property Owner Property Location Govt Lot S CU 114 F 114 SZ T N R ?(3 E (o e Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# C �� r �__ _ City State Zip Code Phone Number C'ry [J Village ® Town Nearest Road C- - ( f4) Y Zq Z - 0 63 New Construction Use: Residential / Number of bedrooms _ A /-__ Code derived design flow rate _ ���es2�_�_ —_ GPD ❑ Replacement ❑ Public or commercial - Describe: ___---- -_ - - -- Parent material.--- —_— _____ Flood Plain elevation if applicable _— _-- _ - -___ - - -_ —�_ h• General comments and recommendations: n Boring # Q Boring T 1909 ' J6 Ct eel- t I I pit Ground surface elev. Depth to i1 rllting factor « in. p S oil A "li catlon Rate Horizon Depth Dominant Color Redox Description Texture SW xure Consistence Boundary Roots GPD/fR in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o f Ih 14 K 3 SL -2,1 r - e - � 4`f• `f0 Boring # El Boring _J © pit Ground surface elev. �qr� ft. Depth to limiting factor 4i�_ in. - Soil Application Rate Horizon Depth Dominant Color Redox Descripton Texture S1ruc;ture Consistence Boundary Roots GPD1ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - U 16 L S� G Y 7 16 C S 1 U < <• _ GYM 4 YA qZ. Effluent #1 = BOD > 30 < 220 mg/L and V: S x-30 _< 150 mg/L ' Effl #2 = BOD < 30 mg1L and TSS < 30 rng1L CST Name (Please Print)(^ _ Signat� CST Number Address Date Evaluation Conducted Telephone Number Property Owner ____— Boring - -_ - -- Parcel ID # __ _��__ Page �� of © Boring # Ground surface elev. ft. Depth to limiting factor �oy in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cent Color Gr. Sz. Sh. `Eff#1 `Eff #2 f o-1 Z 3 2 S Z S 1 V1 s l �. l i t T__ s El - -- Boring # Boring ft. Depth to limiting factor _— in. ❑ Pit Ground surface elev. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F pit Boring # Ground surface elev. ___ —_ ft• Depth to limiting factor — _ in. Sol lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt� in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 'EH#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. M -8130 (R.mrua) I Property Owner _- _--- ___ - - - - -- Parcel ID # —_ -- -- Page_ of Boring Boring # Depth to limiting factor , o y in 1:0 Soil Application Rate pit Ground surface elev. qq,/0 ft Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Ef GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ' Z K- 1 vj — r7= Boring ❑ Boring # - -- Depth to li factor _— in. Pit Ground surface elev. ft. p g Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound GPD ary Roots •E /ft2Eff#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ❑ Boring # Boring pit Ground surface eiev. _-- _ -_ - -- n• Depth to limiting factor __ — in. Sol lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPD/ft2Eff #2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ' Effluent #1 = BOD > 30:S 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access serviccs or need material in an alternate format, please contact the department at 608 - 266-3151 or TTY 608 -264 -8777. SBD -8330 ( R AW00) YX PAG OF 3 � � r I`� Sw ` E ` a SCALE: 1 " = - -..__. �..... ...._. BM I ELEVATION X00, C) BM 1 DESCRIPTION )'�Uc •0� 13M 2 ELEVATION eC Z 3 BM 2 llESCR1PTION -- SYSTEM ELEVATIO 0 ' SYSTEM TYPE l�(�L1ti�ena CONTOUR ELEVATION r , i i i f� r� N � I� i J� t f S E, I I f -Z 0 5� ' a a� L E DATE g -a--oZ ' z n T Zs Jr- e� Q p � � N� a 0 / � r _ - e-w,n d — PAG _OF 3 /q S Y aS F i 4 zo SCALE: I"= BM I ELEVATION C) BM 1 DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTIO py � SYSTEM ELEVATION O SYSTEM TYPE �}— CONTOUR ELEVATION ` SZ� =4 I1n� —`�`� S 1 S v q' .Z 0 r SIGNATURE DATE �ZZ` V J t� I Pa inn Subject: Nelson, Settlers Glen Lot 14, 430514 Location: Joe Start: Tue /20/2004 10:00 AM End: Tue 4/20/2004 11:00 AM Recurrence: one) Note: Adam did a new soil report to extend the tested area - he was in to submit it on Monday a.m. Roger said that was the only change to plans. 030 - 2131 -14 -000 23.30.20.1068 169 Heritage Trail i f c y 0 1;3 0c d I c � N M n I li c :7 l9 m - � n O A= III N N O "� • 0 g CD CA 2 w ° O O A Q ��. 7 N N CD O O N) O O_ O C W C » O co p c co ° O m u>zD c I m to D y n CD. 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