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HomeMy WebLinkAbout030-2131-33-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Qivision ? INSPECTION REPORT Sanitary Permit No: 430543 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Dan Lang Homes I St. Joseph Township CST BM Elev: Insp. BM Elev: BM Description: S ction/Town /Rang ap No: 3 l bo . !3 s� B S c 23.30.20. D TANK INFORMATION ELEVATION DA A TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark 20 0 `! o 16q, o /00 , o Dosing Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet TANK SETBACK INFORMATION brJwko SVHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Iq Dt Bottom Dosing 5 Header /Man. �• 3V 91.30 Aeration Dist. Pipe T of 5 1.30 q 2 / .3 6k- Holding Bot. System • 30 / w 3 a Final Grade PUMP /SIPHON INFORMATION Manufacturer ^ Demand St Cover .2 ma4,&, k6 - seph'c, ✓i F CX GPM 3 ' bn (,) c 2•l� �UZ •!'ri Model Number TDH Lift riction Lo System Head t Forcemain Length Dia. Dist. to I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches ZZ f�kl� PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 b / SETBACK SYSTEM TO { P/L JBLDG WELL LAKE /STREA LEACHING Manufacturer: INFORMATION Type Of System: t1u UNIT Model Number: .J . CHAMBER OR •-1- n ` - � _ n / �/ � DISTRIBUTION SYSTEM U�•cex, 10 5k- e � "7 HeaderlManifold Distri x Size x acing Air Intake / I( Pipe(.) Lengt Dia_ Length is Spacin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded es No xx Mulched Bed/Trench Center ! Bed/Trench Edges `, Topsoil s 7,N COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1_ :f� //E Location: 1415 Thelen Farm Trail Hudson, WI 54016 (SE 1/4 SW 1/4 23 T30N R20W) Settler's Glen Lot 33 Parcel No: 23.30.20. �. eef�"" 1.) Alt BM Description = "' 7J4Y� CG.wkj LOL�iI so � T eS� dd- i � I A,""a 2.) Bldg sewer lengt sySlLUr amount of cover = $ km "'VA J Veit," er 4 / OIL Sa c aQ— ° �'`� C X , Plan revision Required? _ Yes No Use other side for additionainformation. I V �! � d�� SBD - 6710 (R.3/97) Date Insepctor's Signature Cart. No. PA �, i Safety and Buildings Division County 4 ty n r0 1 P V 201 W. Washington Ave., P.O. Box 7162 M adison on, WI 53707 - -` "'' " "P t Number (to be filled to by Co.) (608) 266-3 1 RF_GEi o Department of Commerce State elan L Number Sanitary Permit Application Nw 1 'ZOU ____ - ----� In accord with Comm 83.21, Wis. Adm. Code, personal information you vide Pr . eci (if different than mailing address) sos may be used for secondary ptapo Pnvacy Law, sl5.04(1 xm) t) o l�t 1' ix T N 1. Application Information - Please Print All lnformatioo �ONINC' ►4 l L Propen Owner's Name Parcel k Lot k Block N Wopert 33 .�- Property Owner's Mailing Address y Location �LZ1 ITT tr( arL4 ST'A"T r., v., Section City, State Zip Code Phone Number (circle one) (PSI t �4� Sd R (P 8 439 3 T 'jD N; 20 E ol& 11. Type of Building (check all that apply) Subdivision Name CSM Number Y, or 2 Family Dwelling - Number of Bedrooms S S � ❑ Pub5c/Commercial - Describe Use �! ❑ State Owned - Describe Use 2� k S ❑City_❑VJlage*wnship of 111. Type of Permit: (Check only one box on line A. Complete line B If applicable) A. tNew 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 1V. Type of POWTS System: Check all that appl 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 C3 Holding Tank ❑ Peat FJter [I Aerobic Treatment Unit C1 Recirculating Sand Filter ❑ Recirculating S thetic Media Filter ❑ ❑ Dri Line ❑ Gravel- P' lain) M V. Dig ersal/Treatment Area information: Design Flow (gpd) Design Soil Application Rate(g Dispersal Area Required (sf) Dispersal Area posed (sf) yttem Elevation _ f�pp g 57 8 9 G• 3 ic t iv Total Number Manufacturer Prefab Site Steel Fiber Plastic Vl. Tank Info Capacity Gallons Gallons of Units Concrete Constructed Glass New Exining Terra Tura Septic 0P4 .�. Aerobic Tma[mcra Unit Dusing Chambcr VII. Responslbili Statement - 1, the unde ned, s usibili for installation of the PON'i'S shown on the attached Tans. Plu 's Name (Print) PI MP/MPRS Number' g ,ci ice Phone Number AAD G 7!'NL �� /3g'!�w Plumber's Address (Street, City, State, Zip ) "56o a Ei✓o�OWIC 6 VA * =7 /Department Use Onl Sanitary Permit Fee (' eludes Groundwater Date lssuod Issuing gent Signature ( Stamps) ❑Disapproved Surcharge Fee) A �- /, ( ❑ Owner Given Reason for Denial Qn 7 1X. Conditions of Approval/Reasons for Disapproval 3� S�tJC mil _ C&,A SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. p 2. All setback requirements must be maintained ��r c nne�- S t , A41LA.iL CS as per applicable code /ordinances. `S at..tZC- Attaeb complete plans (to the County only) for the system an paper o than S112 r. 11V�WCJ.1a alxa SBD -6398 (R. 01/03) r <; Are- . al► � N � a 3 z IZJ a I L E H N N - � �� Z 3 ' 1 .r • A4 C 1 i aU s M 11 O 2 a J 2 a ? � " i 1940 Wisconsin Department of Commerce SOIL ION R POR Page I of 3 Division of Safety and Buildings in accordance with :e. mm �srt8lisr �b Certified Soil Testing t[Gl� Co my Attach complete site plan on paper not less than 8% x 11 inches in si Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM direction and percent slope, scale or dimensions, north arrow, and location and di ance to t rdpdo 1003 Pa el I.D. Please rint all information. Re ie d By A Date Personal information you provide a M4MW be used for secondary purposes (Priv y Law,�T5.1 O Y FFICE / /vW t4 - UD 3 Property Owner rope y -cation Lang, Dan Govt. Lot SE 1/4 SW 1/4 S 23 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 221 East Myrtle Street 33 Settler's Glen City State Zip Code Phone Number City � Village 0 Town Nearest Road Stillwater I MN 1 55082 651 439 - 3430 St.Joseph I Thelen Farm Trail Vi New Construction Use: 16 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe Parent material loess over sandy outwash Flood plain elevation, if applicable NA General comments and recommendations: install trench system w/ 0.7 gpd /sq ft loading @ system elevation 45 below surface contours as trench center lines Boring # __j Boring Pit Ground Surface elev. 100.8 ft. > 100 in. Soil Application Rate Depth to limiting factor pp' Horizon Depth Dominant Color Redox Description Texture Structure 7 dsh sistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -6 10YR 3/2 - 1 2 f gr mvfr cs 1m .5 .8 2 6 -21 10YR 4/4 - 1 2 f sbk gs 1m .5 .8 3 21 -40 7.5YR 4/4 - sill 2 m sbk dh cs 1m .5 .8 4 40 -100 7.5YR 3/4 - s 0 sg dl - - .7 1.2 ai R4 . g "/ CI O occasional gy si coats on peds in horizon 3; occasional gr /cob /st in horizon 4 Boring # l Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 100 in. Soil Application Rate Horizon I Depth Dominant Color I Redox Description Texture Structure 7 dsh sistence Boundary Roots GPD/ft- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -6 10YR 3/2 - 1 2 f gr ds cs 1 m .5 .8 2 6 -23 10YR 4/4 - 1 2 f sbk cs 1m .5 .8 3 23 -40 7.5YR 4/4 - sil 2 m sbk dh cs 1m .5 .8 4 40 -100 7.5YR 3/4 - s 0 sg dl - - .7 1.2 y -5 Y occasional gr /cob /st in horizon 4 ` Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' effluent #2 = BOD < 30 mg /L and TSS < 30 mgL CST Name (Please Print) Signat r : � CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 11/7/2003 715- 233 -0398 Property Owner Lang, Dan Parcel ID # Page 2 of 3 F3 ]Boring # jj Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDjft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0 -6 10YR 3/2 - 1 2 f gr ds cs 1 m .5 .8 2 6 -14 10YR 4/4 - 1 2 f sbk mvfr cs 1M .5 .8 3 14 -26 10YR 4/4 - 1 2 m sbk dsh cs 1M .5 .8 4 26 -39 7.5YR 4/4 - sil 2 m sbk dh cs 1m .5 .8 5 39 -100 7.5YR 3/4 - s 0 sg dl - 7 1.2 yY y s C. < occasional gr & cob in horizon 5 p Boring # Boring — 'j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring # I Boring W } Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD 30 < 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 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) Certified Soil Testing � S C^ 0 �� ® z�r o 3 _CA 4 d✓ t } I _ t G a + J 1 C' C r ` J o i J/� N L q , p t f ` f -V S j u I j 4► � � s9 a ci- cC POWTS OWNER'S MANUAL at MANAULMtr4l rtAN "fic /FILE INFORMATION SYSTEM SPECIFICATIONS Owner j� f Septic Tank Capacity 0 a g al ❑ NA Permit # 4 5-�3 Septic Tank Manufacturer wj!' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA, Effluent Filter Model .•1QQ ❑ NA al e'NA Number of Commercial Units NA Pump Tank Capacity g , Estimated flow (average) gal /day Pump Tank Manufacturer �^A Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer Ja'NA Soil Application Rate gal /day /ft' Pump Model Influent/Effluent Quality Monthly average* Pretreatment Unit �A ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil 8z Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) 5150 mg /L Manufacturer Pretreated Effluent Quality ' ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg/L In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Ta_r�ticie Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event. Service Frequency At least once every Z. ❑ months year(s) (Maximum 3 yrs.) Inspect condition of tank(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months $ year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every ❑ months ,6 year(s) �„t Inspect pump, pump controls ez.alarm At least once every ❑ months ❑ year(s) gNA Flush laterals and pressure test At least once every ❑ months ❑ year(s) 2 NA Other: At least once every ❑ months ❑ year(s) 7NA Other: At least once every ❑ months ❑ year(s) Z NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made b aeCn POWTS Maintainer, Septage Septage Servicing n Oprator. Tank inspect or Plumber; Master Plumber Restricted Sewer; POWTS p must include a visual inspection of the tank(s) to identify n missing � ponding of effluent on the ground surface. e The t1 e dispersal volume of combined sludge and scum and to check any cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Ys) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wiscon! Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a ce0fled POWTS Maintainer. I regulatory authority within 10 days of completion of any service event. A service report shall be provided to the loca START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or ocher chemu that,may =impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the concer „f rka rarsk(s) rpmoupd !.y z - senwe servidng operator prior to use. System scary up shall not occur when soil conditions are frozen at the infiltrative surface. Page During power outages pump tanks may fill above normal hlghwater levels. When power Is rtstortd the excess wastewater will tie discharged to the dispersal cell(s) In one large dose overioading the ceil(s }. and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWT5 Maintainer to assist In manually operating the pump control3 to restore ncrmal levels within the pump tank. Do not drlve or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise dlswrb or compact, the area within 15 feet down slope of any mound or at-trade soil absorption area. Reductlon or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swats; degreasers; dental floss; dtapers; disinfectants; fat; foundation draln (sump pump) water; fruit and vegetable peelings; gasolne; grease; herbicides; meat scraps; medications; oil; PalntlnK products: Pesticides; sanitary nookins: tampons; and water softener brine. ASANDONEMENT > When the POWTS fails and /or Is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administrative Codes • All piping to tanks and plts shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and plts shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all Links and pits shall be excavated and removed or their covers removed and the void space fllied with soil, gravel or another Inert solid materlal. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A sultable 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 strucwre, lot (Ines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluatlon cc establish a sulwMe replacement area. Replacement systems rnust comply with the rules In effect at that ume. 0 A suitable replacement area Is not available due W setback and /or soil IlmluWns. barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to Identify a sultabte repfacemer t 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. O Mound and at-grade soil absorption systems may be reconstruRed in place following removal of the biomat at the Inflltradve surface. Rrconswalons of such systems must . comply with the rules In effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN 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 TH`9 INTERIOR OF A TANK MAY BE DIFFICULT OR IMpMM1141 F ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name L A/Z A- Af Na me — N E- �tlL Phone — Phone S SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency GI v /M Phone hen �_ Oct 09 03 08:48a P.1 10/09/2003 09 :32 FAX 7152352592 T L SIN2 P1.044I& JAP 49 002 ST CROIX COUNTY SEPTIC TANK MAINTENANCL' AO"EM31 AND OWNLRSRIP C1?RTMCATION FORM oaotnr/$uyer _ +-1-e� S Mailing Address r proporty Address T�R, ­P, `mot &A , 4 rvl (Vcnf,cst i io d required ftom Planning DePaMcw for new coostruttion) City /state t Parcel Identification Nturtber L F . 1I aSC — B- 'r'70N a 5 T 30 N �b W. Town of 2( I Propctty Location 't•. �` /•. sec. _._.,, Subdivision Lot # 3 . Volume Page t! Certified survey Map � _ G warranty Deed # _ ` (� �OM Volume t Page # � Spec beusc 0 yes 0 no Lot lines identifiable O yes El no cv * M dTt11'I'FrfANCE WV ��y to t� . �Pcr mainteaanu �' S• o use and =6 of your M;pfkC slrst= eoWd Malt is to PMM t Pu c thti a or sooner, if aesdad by a tioensed pumper. V T yen put iota the ao system e�sists of ptttnpia$ oat 6 septio tsalt +*ery gene can aHcet t1k function of tits septic tank as a matment stage in the waste disposal system �t a ee rdfmtioa form. signed by the owner nod by a The Pt p�m' ow= srtecs to attbttui to St Croix 2' r Deport- v«ityiog (f� the oo - cite w w :watetdisposal nvs = Qus o er plumDor. i° utuaY��PlaodYar. tesYtietadpla�mbeta �is lemd'An 1A fall ofdudge- is in psop,r operat m eoodirioa andlor (2) after inspection and pumping (if treo�ssaty), ow acp rfwa the uadeecigned bave read the above tcquiremeaa and agrx tc sasidain die pavate jewsp disposal system with the madards sat Earth, beteies asset by the Deparmont or caum tt:e and the bepgMcut O f 14,100a Rewuncs State of WimanshL Cerdflation stag tbat your m e NY bas been mait ujucd toast ba completed aadzetumod t° the St Qroix County offi within 30 da of rte dutc y expiration date. V 1 el 61 pwTE SL 'k OF Apps tcAN'r QVV �A CL�'RTr1*ICJt►�QM Laomlcdgc. I (we) am {are) me oaner(s) of I (we) Certify tbat aLL statenscnts ou this fame arc true to the best of my cur ZSj A 'M___ ._.00'F pety dn above, by virtue of a worranry decd recorded W Register or Deeds Orrice. DATE APPLICA DG �tcnL ••••■• Ayy informstiou that u s:tis•repraseotnd MAY result in the sanitary permit being revoked by the Zoning P' •• Include w11b this agplicatioa a copy of the ocr$ W God survey W3P if o et"oe Ls Mae in the wasfaury deed I r - Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 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. Please print all in : r Reviewed n Reviewed by Date Personal information you provide may be used for an purposes (N-0a " s. 154 (1) (m)). Property Owner PropIrty Location t " `i ti 8 2 0 0 Govt Lot 1 /4 W 1 /4 S T O N R U E (or)gG r r�� 0brvice S i Z 3 3 z Property Owner's Mailing Address ail ty Block # Subd. Name or CSM# ( - p - 1 2 - 0 5 11 \ vJO,�e City State Zip Code Phone Number ❑ Village STown earest Road MN 1 55 C5 Z 104 5 - � h w 3s - New Construction Use: Residential / Number of bedrooms _ Code derived design flow rate �1 �G ,Z 0 O GPD 0 Replacement ❑ Public or commercial - Describe: � L" _ Flood Plain elevation if applicable �f / / ft Parent material 0 U 1 General comments S y v, 9 Y 0 and recommendations: ' E] Boring Oct Boring # / ft. Depth to limiti factor In. ® pit Ground surface elev. g 1 30 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color I Gr. Sz. Sh. 'Eff#1 'Eff#2 0-1Z 311 r I 2 Is m L S I v� -5 -9 Z 1 -49 jb1 ' r qjcj S c I I Zrn k i c - 'q , (D CoS OS ml Boring # ❑ Boring ® pit Ground surface elev. 99 ft Depth to limiting factor 3q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 3H 5' 2.n-bk nor S I vV 5 g mr C5 { (� 3 1 5Z -V% C " O ' Os m Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name ( Please Print ) Signa a CST Number ACla)r c h rn er 25336 Address Date Evaluation Conducted Telephone Number 2-113 �o�� Sa . Socre e } , UJ l 5'4 02 S ( ) 24 7 - `4 0102 1 Property Owner �Lr ( GCS e. 1 Parcel ID 0 ' Boring Page o f ,3 a Boring #. 11 : . . &Pit Ground surface.elev. 0 ft. Depth to limiting factor _ I� In. Heron Depth Dominant Color Redox Description Texture Soil Application Ra Structure Consistence Boundary Roots GPD/fl= In. Munsell Qu. SY. ConL Cobr - - Gr. Sz. Sh. 'Eft #1 •Eff112 2r, cS I v 5 g -Lis I y r � I cl ZmSbk m -�- cs • � . � 3 `+$-13 / 2 7 F-1 Boring # ❑ Boring ❑ Pit . Ground surface elev. ft. Depth to fimiting factor In. Horizon Depth Dominant Color Redox Descripio Soil Application Rai n..... Texture Structure Consistence Boundary Roots GPD /f1 In. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2 Boring # ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rats Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /h= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff #2 • S ' Effluent #1 = BODS > 30 < 220 rrxt/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/l and TSS < 30 mg /I. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3.151 or TTY 608 - 264_8777. SB69770 (R07/00) 1 PAGE3OF 3 i t NAME C rr � 'ac � TOT# .35 LFC,AL DESCRIPTIONS � ,S Z 5 T 3U N R. ZU E(or SCALE: T"= 7 BM I ELEVATION /D Q 0 BM I DESCRIPTION &n 0-f Du BM 2 ELEVATION BM 2 DESCRIPTION 1 D_ P ✓c e� Dom_ _ SYSTEM ELEVATION vy �U SYSTEM TYPE 4- CON'T'OUR ELEVATION q `, 5y 4 9$ od 1 �i Y i SY eol" \ ,k< i I SIGNATURE DATE ORIGINAL' 1929 Wisconsin Department of Commerce SOIL A EP RT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing ounty Attach complete site plan on paper not less than 8% x 11 inches i size. F1� E � � E Q St. Croix include, but not limited to: vertical and horizontal reference point ( M), dir t percent slope, scale or dimensions, north arrow, and location and istance to nearest road. arcel I.D. Please print all information. NOV 1 O Z003 eviewed By Date Personal information you provide may be used for secondary purposes ( ivacy Law, s. 15.04 (1) (m)). Property Owner Z on Lang, Dan 1/4 SW 1/4 S 23 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # ubd. Name or CSM# 221 East Myrtle Street 33 Settler's Glen City State Zip Code Phone Number City Village kjf Town Nearest Road Stillwater MN 1 55082 1 651 439 - 3430 St.Joseph I Thelen Farm Trail New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 5' x 124' rock cell mound on 100.0 contour as upslope edge of rock w/ 1.0' sand fill FTI Boring # Boring Pit Ground Surface elev. 100.0 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 1 0 -4 7.5YR 3/1 - 1 2 m gr ds cs 1 m .5 .8 2 4 -14 7.5YR 3/3 - 1 2 f sbk ds gs 1M .5 .8 3 14 -30 7.5YR 4/4 - fsl 2 m sbk ds cs 1m .5 .9 4 30 -34 7,5YR 4/4 f2d 7.5YR 4/6 fsl 2 m sbk ds as 1m .5 .9 5 34 -44 5YR 4/4 f2f 7.5YR 5/3 sl 0 m mfr cs 1m .3 .5 6 44 -54 7.5YR 4/4 c SYR 3 7. 5YR 5//3 scl 0 m mvfr - 0 0 7. a Boring # �j Boring kJ Pit Ground Surface elev. 99.5 ft. Depth to limiting factor 35 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 1 0 - 7.5YR 3/1 - 1 2 m gr ds cs 1m .5 .8 2 7 -14 7.5YR 3/3 - 1 2 f sbk ds gs 1 m .5 .8 3 14 -26 7.5YR 4/4 - fsl 2 m sbk ds gs 1M .5 .9 4 26 -35 7.5YR 4/4 - fsl 2 f -m sbk ds cs 1M .5 .9 35 -42 7.5YR 4/4 f 7 / ds 5 f2 7.5YR 5 3 fsl 2 m sbk as 1m 5 .9 6 42 -50 7.5YR 3/4 f2d 7.5YR 5/8,5/3 7.5YR 5/3 sl 0 m mfr - - .3 .5 i ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BO D < 30 mg /L and TSS < 30 mgr - I CST Name (Please Print) Signatur : CST Nurpou. Henry F. Grote ` 5EEt 4 Z 222774 " -4- : Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 10/27/2003 715- 233 -0398 Property Owner Lang, Dan Parcel ID # Page 2 of 3 Y F3]Boring # Boring In Pit Ground Surface elev. 98.4 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -4 7.5YR 3/2 - 1 2 m gr ds gs if .5 .8 2 4 -10 7.5YR 3/2 - 1 2 f sbk ds cs 1M .5 .8 3 10 -24 7.5YR 4/4 - fsl 1 m sbk ds cs 1 m .4 .6 4 24 -30 7.5YR 4/4 f2d 7.5YR 5/3 fsl 1 m sbk ds as 1 m .4 .6 5 30 -36 7.5YR 4/4 c2d l OYR 6/2 sl 0 m mfr - 3 5 7.5YR 5/8 a Boring # . j Boring j�- Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -5 7.5YR 3/2 _ 1 2 m gr ds gs 1f /m .5 .8 2 5 -12 7.5YR 3/2 _ 1 2 f sbk ds cw 1M .5 .8 3 12 -24 7.5YR 4/4 - fsl 1 m sbk ds cs 1 m .4 .6 4 24 -28 7.5YR 4/4 f2d 7.5YR 5/8 fsl 1 m sbk ds as 1 m .4 .6 5 28 -34 7.5YR 4/4 f2d l sl 0 m mfr - - .3 .5 5 /8 8 5 7.5YR I I i F 1 Boring # _j Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I I I ' Effluent #1 = BOO 5 > 30 < 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 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) Certified Soil Testing y � r 0 � v r t C r � ! f a \ i DO ct \� al r A Vi DO s 0 K 7'e+9 - 7 - 7 1� U 2 4 2 9 P 14 8 KATHLEEN H. WAISH f STATE BAR OF WISCONSIN FORM l - 1998 REGI5TER OF DEEDS ST. CROIX CO.. YI x t�umen Number t WAILRAt�TTXDEED RECEIVED FOR RECORD 030 - 2043 -10 -000 030 - 2032 -10-M 030 -2032- 20/06/2003 12r05PH 70 -000 030 - 2033 - 40-000 030 - 2033 -20 -000 WARRANTY DEED 030 - 2032 - 5000 -000 EIEW, f Pared tdmtiEcation Number (FtN1 REC FEE: 13.00 Tim DEED, made between St. I evelopment Corporation, s COPYSFEE: 268.90 Minnesota corporation, Gramtar, and an Lang Home,, Ltd. a Mm=0'a CC FEE , 2 Corporation Grantee- PA Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croat County. State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recerdiaa Ann N,arnc and Rcrum Address This is not homestead property. Land Tide Inc n 1 Together with ail appurtenant rights, title and interests- Icw Silver Lake Read Suitc 200 `✓},' \cw Iirighltxt 4fn 551 12 Grantor warrants that the tide to the Property is goad, indefeasible in # fee simple and free and clear of encumbrances except Dated this 3rd day of 0cwber 2003. St. 302c Devclopmment Corporation lfd!fi %r (SEAL) (SEAL) * Kellei St. Martin, Vice President ` (SEAL) (SEAL) AUTUENTICAITON ACK-NO AILEDGAfENT Signature(s) STATE OF Mum esoa WASHINGTON COUNTY. authenticated this 3rd day of October, 2003 Personally came before me this 3rd day of October. 20D3, the above named Kellei St. Martin, Vice President of SL - - Joseph Development Corporation, a Minnesota corporation to y me ]mown to be the p who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Scats.) TIJIS INSTRUMENT WAS DRAT -'I ED BY Greg Booth Attorney 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 Notary Public, Slat of Minnesota (Signatures may be authenticated or acknowledged. Both are My commission is permanent. (If not, stars expiration date: not "ccessary.) 134% _ •Naum of pawn signing in any capacity must be typed or pixttal below their signtwte. 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