HomeMy WebLinkAbout020-1159-30-000 (2)Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
Personal information you provide may be used for secondary purpose
Jim & Theresa Spaii
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
s [Privacy Law, s.15 04 (1)(m)]
City Village Township
w i om Lieu Insp BM Elev BM Description
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
�+ T
Aerate
Holdloa-
TANK SETBACK INFORMATION
�
M---M�-
.. '
M--�=
PUMP/SIPHON INFORMATION
SYSTEM
TOWN OF HUDSON
ELEVA
STATION
BS
HI
FS
ELEV
Benchmark
i
3
93.e
Alt M
Bldg Sewer
—
Stj Inlet
St/Ht Outlet 17>414
A..
m m f
O
,
Dt
C�
Dt Bot�prn�
He �an.
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�
�• ID
p �7
O �.7�
Dist Pipe
Bat System
tl•Z
6.L}
Final Grade
p,3?'
St Cover
3• �'D
93.��'
TRENCH
Width /
Length
I
1V
No TreDI
a)nches
PIT DIMENSIONS
No Of Pits
Inside Dla
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLOC
WELL
LAKE/STREAM
I LEACHING
CHAMBER OR
UNIT
Ma�yfaptuyCi �
-1N.�r
Typ/�e Of System {� n
lA f�VFnro�O �a.1L
/
/
'n
v {7[/ ,
Model y1m bar - L
VIJ I KI6tg I IVIVATS I tM
Header/Mamf It
Distnbutwn
x Hole Sae
x Hole 5 clog
Vent to Air Intake
Pipes)
Length Dia
L DIa pacing
a VIL COV Em n Prmii Svetemc rin lv — Kil ni, A.•_fz—, , e.....,...... n..u.
Depth Over
Depth Over
x Depth of xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed.Trench Edges
Topsotl —
Yes E] No
IJ Ves
COMMENTS: (Include code discrepancies, persons present, etc ) Inspection #1 "/I SAD ZI
Location: 494 MAUD CIR
2 Alt Description =
2.)sewer
Bldg
s sewer
- amount of
Plan revision Re fired? '_—. Yes No
e of er side for additional mforma on'L- -
r5®Dtla'R � 9-r, Cali 11' �(�(4�1� D tee _ (I.Insall ,t is Signatw
Inspection #2.
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s per management plan prov,ded by plumben
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ST.. C Ro NTY SANITARY SYSTEM Fde #c
Ofike Use Only
OWNERSHIP/ADDRESS FORM
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
Owner/Buyer
OWNER/BUYER INFORMATION
k-f7t4S p S-n p"
Mailing Address Di Y MbU9 C� 9 ✓
City/State/Tip 6A b1 r t) W i
Phone Number (reouiredl VS P �17 - l b y/
Email Address
i '�—l1'ISDPic ll4'/ 1 hNAmipcn<_ GuYt.
Parcel Identification Num
(found on the property tau bilo
NE -TON
NEW SYSTEM: LEGAL DESCRIPTION
Property Location -�-E t/4 S _ 1/4 , Sec. a b T a 4 N RLLW, Town of 4 DS ► Iy
Subdivision Plat
/ •I
Lot # Q 7.
Certified Stunmy Map # Volume . Page #
Warranty Deed # (before 2006)Volume . Page # .
Number of bedrooms T Spec house O yes,lfq no Lot lines identifiable O yes 0 no
OFFICE USE ONLY
New Property Address
(Verification of new addn required fan Community Deielownent Depmunent for new con mKbm)
(Staff initials) (Date)
This form must be submitted with alt Private Onsite Water Treatment System (POINTS) applications.
Now Systam tndude with this form a recorded warramy deed from the Register of Deeds Office and a copy of the certified
survey reap if reference is made in the worronty deed.
Community Development Department- Land Use Division
715-386-46M St Croix County Government Center 715-245-4250 Fax
cdd@SCCwi aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwiaov
Page Of
POWTS OWNER'S MANUAL AND MANAGEMENT PLAN —
NotdterafBadto�s OO dlbedm�
Number ofCamoettiai Units
End Bow (average)
tF0
Design flow (DWF)=camaeda1.5
UU galtday
Sag Application, Pme
dayW
kfiOCVffJOmmut Quality (Q NA)
WauddyAvwAge,
Fats. Oil & Grease (FOCI)
:530 mg1L
Hodmumal Oxmm De®d (BODs)
<220 mg/L
Total Suspended Sods (lW
< 150 ntWL
Pretrrmed Ftffivent Quality (0 NA)
Wouthly Average
BiOCINSIMiCulOzygmD®d(BODS)
:530mWL
�Suspended
mm<10�
FocalComm( )
_ to afir/h00m1.
Mw= m Effluent Particle Size
118 inch diameter
Septa: Tank 0 ao
Q KA
cTankMaC
W ().Q1(
OKA
Effiuen Filter MsmBctarer
NNW
(3 KA
E�FMcW lAodCI
Q NA
PUWPT=kcwacity
Pmmp Tank Ma>nafictma
Pmmn manaliachmerV:A
Pretreatment ilmc (O KA)
17 Saad/GmvrlFilter
Q Mescal Aeration
Q Dis &ct m
Q PatFiitrr
Q wdLad
Q odb -
ModeL-
Soil Absorption Conn mint (Q NA)
® In -groom (gravity) Q iP mod)
Q At -grade Q Mound
Q Drip� ❑ Other:
Vertical Distance TankBoCamao S=v=&Pa&
HcmoffiiDiVAmc:Taek(s)ioServv=Pad:
8
ft
Dkm-jd UnA MfgJMadel Na®Ler- Q NA
son Dispersal Fad Cap (Dispersal Unit ELSA)
DWF = Amiicafitma Ram Area ELSA or (Trench Width) _ # Brats or Total Lan th ofTmxWs)
u u®paatPrrssameDnftftbmNerworksfor SgmcTmk-SWAbsorption SyVt Pobfieation9-6MWMPManuel)
Q ^ICC Rowkch Motes Component Mannar Version 12
13 `EZ Flow Mound CoMmerd Mutual- V=mm g2o2007
Q SBD-10854-P(RU12) "At-C>rade Competent MMI UsmgPressme Distribution" Verswn20
S SBD-10705-P (PLOIPoI)"In Ground Soil Absorption CompmentMamor Version2-0
Q SBD-1o691-P (NAU01)'mmw Component Mannar versim 2-0
Cl SBD-10657-P (R-6u99) `Drip-lim Eft3amtDisposal Component Mannar
❑ SBD-10706_P (KOINI)'Pressme Distribution Ca npmeot MananP Verson 2-0
-
s dean files
At least once . i7 13 C13ycars Q Other
Inspect munp & zmano annuals, slam. ureftealtment ffi
At least once _ Q mouths Q 3 yens Q NA
1.1ash and test iateals
At least once _ Q mouths Cl 3 yam Q NA
START UP AND Od'SBAIIOaT: For ixw wastroeaco, poaa to using the POWTS dyer I trealmucal tanks) for the presence of painting
prodmbcw*dwd--k*Umays»pc&d=UeoneWpno=md/ordat W&edrspemdccWs)� ffbighoo medftecaedhm
der �tlx tasks) reatovod by a servieiag opesatncPm'tin use, System9at�sYO�«�a w6ea soft eao�eas are fe�ea
at do bmurallae swfun,
Tlm F*Perty otter is regmuslile for the opeadim and maintenance, of the POWTS and salmrissipn of repined tepmta 'Due quantity and
gmrdy of the wastmaler st[am wdt affect the perfmmumm and longevity of your POW & The mas alLebon of waterer apprmaces and
Pishaes along with prompt rvwr of lake nrrhtces the wassewshm vahmw- Also the him or waste Sam water aoBeuac i m removal units,
other cla<wala fteshmem device and founder drains should be dadtaged to the round surface whenever pom"hle. Plate this does not
iarlude lambrymaste. showers, dishwater. CO -
This system is designed to handle domestic strength wastewa er: however, the disposal of food based grases, oils vegetablJfrerit peels,
seeds, banes, and food solick suchas thome, pmduccd byagarbage disposalshould beminimize& Toilet tameisthe onlypaperthat shodd
be discharged iaD the syaant. Other nos -bit ble items, such as baby wipes6 tom, shy n condoms, cigarette butts,
dental Boss, and twlnom swabs, should not eater the "sment. Chemicals, such as petroleum products, pew dammilisclants, pasbcides,
anthmbcs,sdvmts,etr,dmmnttbxgushedifothes-s he-&eycrosmwuslydamageymwPOWTSmdcomtmnmatevmw
dtinkiugwaterstgrpiy. i,amealnar�¢a1a�Rx�tr
46PIpmeou0mopmEum QrnRpoetttmorsnowovcrunatspetsal unitltlayWUMit to fi==M
BUSPIrl't IOl3 & aattarrea NCE. Impectiam stall be made by an individual carrying one of the following licenses or
certifications: Master PlUmber, Master Plumber Restricted Sewer, POWTS htamtamer, or Septw Servicing Operates (per the attached
Kaimbmaaee Scbeauk). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware,
40maR ass Nair r lcai:s, measure the volume of combined sludge and scum and check for any backup or pondiioag ofef lent to the
ground surface and ted all electrical equipment such as pumps and alp. Any dew shall be promptly corrected- Exposed opesin�
greater than g mcbes ui diameter shall be seamed with effative kxkmg devices to prev ea[ accidental or ®mahmved entry the tacks.
When the cou"natim of sludge and scom in any hink exceeds one4third (In) or mom of the tank vokung the - comesmofthe
tank sball be removed by a Sc~ Servicing Operator and disposed of in accordance with Ch. NR 113, Wncousi a Admin. Code -
Specific saviciagmearia be provided if vertical s>ISfeeterifhauls>Mfrstand' msumctiomtobeprovidadblow.
The oraletfrltr(s) shall beinsprected and cleaned toremove any arcumin anti sob dsaccurchngto mmfitchne r'sspecificirtions. Solids
wasted from the filter shall be ruined in the tank. Filter cleaautg may be necessary at more fiegaeat intervals rhea stated in the
mauftmnee awe tokeep the syA= apamdng-
Alarms should be tested an a regular basis by the home owner. If an ala n roads, contact an individual licensed to service POWTS,
There is normally a I day reserve under regular operating a»odAions, however water should be conserved uoul any problems with the
system ate corrected to prevent bwko-� of sewage into the dwelling or surlacaw,
ANAPIDONMBATf: Whys the POWTS fats amdibr s permanently mks out of service the foDuwing steps shall be takes to ensure that
the system is property and safely abeadomd in eomrplitmce with Ch SPS 393.33. Wiscnottm A . Code
• All piping to tanks and pits shall be discs mteered and the abet doned pipe openings sealed.
• The of all tanks and pits shall be removed and property disposcd of by a Septage Servicing Operator.
• Afar pumping, all moks and pits shall be excavated and removed or they covers removed and the vend space filled with soil,
grave, or other inert solid material.
CONTINGENCY PLAN: If the POWTS fials aad cannot be repaired the following measures have been, or mint be takes, to provide a
cede comet replacement system:
A A suitable replacement area has been evaluated and may be utilized for the locsbm of a replaced sui I absorption sysh. The
re placemem arcs should be protested tram disturbance and compaction and should not be ®Gimged upon by required sedneha
from egg and proposed snvexme, lot lines and wells. Failure to protect the to en[ area readers it Ala Resent
systems mast comply with the rules in effect at the time of rt'pt
❑ A sunimble teplarxmest area is not available elite to setback andlar soil Imumbons. Barring advances in POW IS txbflology a
holding taink may be installed as a has resort to replace the failed POWTS.
❑ The site has not been evacuated to identify a saimhle replacement area Upon ferlme of the POWTS a soul and site evalusfion most
be performed to locate a suitable replacement area. If no tephmme nt area s available a holding teak may be installed as a last
resort to reprice the failed POWTS.
❑ Mound and at -grade send absorption systems may be reconstructed in place following removal of the bio®at at the infiltrative
surface. Reonnstroetiooa ofsuch systems mast comply with the miles an effect at that time.
WARNQ -GO SEPTXC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES ANDM DWJFFICIMT[
OXYGEN. DO NOT ENTER A SEPTIC, POMP, OR OTHER TREATMENT TANK UNDER ANY CIRCQ11WL4TANCES, DEATH
MAYRF.SDt.T.RESCUE OFAPERSON FROM THEINTERIOR OFATANKMAYBEDIFFICULT OR RiPOSSMAL
ADDITIONAL COMMENTS:
Name:
INSTALLER POWTS MAINTAINER
f Name: r' 6 0 L w,t-t3 P 4 [�PhM:
Phon= � r � Tt L / 4vab
j S�EIFTTAGE SE�RjVICING OPERATOR LOCAL REGULATORY AgAMM
i Name: 1LON f Name_ 5T LXV liC L1J)NCt
Phone: r Phone:
ST_ CROI% COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING -SEPTIC TANK
This is to certify that I -have inspected the septic tank presently s
the i�rt, a 'r�iWSA S�jS residence located at:
Sec. 0 -N, R_Lj W, Town of P?APSISt.
County, Wisconsin- Upon inspection, I certify that I have found the t<
baffles to be in good con it'on, and it appears to be functioning prc
Last time serviced-
tth---r
Did flow back occur from absorption system? Yes_ Now
line.
Approximate volume or length of time: gallons
Capacity: );�D) —
Construction: Prefab Concrete +/ Steel -Other
Manufacturer (if known) : IJl1SCK
Age of Tank (if known):
I 'h (i6Y'
a a►
(Dat -
(if no, skip
minutes
Form to be completed by 11censed plumber (s. 145-06, Wisconsin Statutes))
licensed disposer (NR 113 Wiaiconsin Administrative Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank conditic
certify that the tank, to the -best of my knowledge, will conform to
requirements of ILHR 83, Wis: Adm. Co _ e ept for inspection opening
outlet baffle). LJ��
Name Vl{ih)C<� Signature
MPJMPRS-
aaa9ay
or
I'
I
.... . .....
1p
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I
Mole PINEGROVE HEIGHTS 38701e
A SUBDIVISION LOCATED IN PART OF THE NE 1/4 OF THE SE 1/4 OF SECTION 20, T29N, R19W,
TOWN OF HUDSON, ST, CROIX COUNTY, WISCONSIN.
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LOCMT'!DN SKETCH
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TDWII CF H'JCSON
'HIS IN3ID!MENT AL CFAFTEO 3•
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ALL BEARINGS ARE REFERENCED TO THE EAST
LINE OF THE &114 GF SECTION 20,T294,RIEw
;eS5UME0 CO BE N C'564E'WI
im roux t [:
SURVEYOR'S CERTI°ICATE
LEGEND
D-Ya 30' RO.N PIPE SET ASISHIN6 365LU
PER LINEAR FOOT
-i RON PIPE FOUND
ALL OTHER LOT CORNERS STAKED WITH A
N 24' IRON PIPE NEIGHING 168LB$YLIN FT.
6-ST. CROIX COUNTY MONUMENT WITH A
BENNSTEN CAP FOUND,
-- TELEPHONE EASEMEAT
— ELECTRICITY EA5EMW
NOTE
ALL DISTANCES, LENGTHS, AND WIDTHS ARE
MEASURED TO THE NEAREST ONE HUNDREDTH OF
A FOOT, ALL ANGULAR MEASUREMENTS PAVE BEEN
MADE TO THE NEAREST TWENTY SECONDS AMC
COMPUTE; TO T-E VALUES SIOMA,
KALE IN FEET
IDO F. 0 ISO 200
1, ALLENC NYRAGEN, AEGISTERED LAND SUAVEYOP,HEREBY CERTIFY THAT IN FULL COMPLIANCE
WITH TIE PROVISIONS OF CHAPTER 236 OF T-E AISCON5N 3;ATUTES AND THE SUBDIVISION
REGULATIONS OF THE TOWN OF HUDSON,AND CNCER THE DIRECTION OT IICHAROSTCUT,OWNEd OF SAID
LAND, I HAVE SURVEYED, DIVIDED, AND MAFPEC PINEGROVE HEIGHTS, THAT SUC• PLAT CORRECTLY
REPRESENTS ALL ECTERIOR BOUNDARIES AND THE SUBDIVISION OF THE LAND SURVEYED, AND THAT THIS
LAND IS LOCATE) N THE HE 114 DF THE BE IA OF SECTION 2D,T29N,R19W, TOWN OF HUDSON.
ST, CRCIN COUNT°,WISCONSIN.OEECRIKD A5 FOLLOWS
CCMMENCINGAT-HE SE CORNER OF SAID SPCTIOO 20, THENCE NOO'5843'W 13606 FEETALONG THE EAST LINE OF
THESE'l4OFSAq SECNON 20 TC TIEFUNTOFBEGNIYa THENCE 50Y0ISI 1G8:65 FEET ALONG THE SOU IE
Or THE NE II4 OF TYE SAID BE d4 OF SAID SECTION 20, THENCE N W'St5D'W 300 GO FEET,', ENCi 5 B9'0132`IW
SHOW FEET, THENCE N 00'BE SO' 1 66OC RET ALONG THE WEST LINE OF SAID NE V4 OF THE SE Ill OF SAID SECTION
20,T°EN:E N 89'01 VE SEE 88 FEET, THENCE N 00'S2 WW 3000D FEET, THENCE M1B9VF3YE 506W FEE
THENCE S 00'569E ZOO FEET, THENCE SDUTPWESTEPLY 26141 FEET ALIOXG THE ARC OF 288INT RACILS
OUNIE DOI NO&WEETERLY WHOSE CENTFLAL AROLE IS 52'OO 2f00WOE O'GRO BEARS 925-0143'0252`.4
FEET, Ti EBCE 5 37:5;3'E 6E00 iEB, THENQ `AB'161STEPLY 393 04 FEET A.pG THE ARC OF 304 FOOT CASKS
C'; OF CCNCAI'E NOR-N WESI WHCSF CEI(RA; ANQE IS 57IY01'ANO W-a CN'CTO EEAPS N 25'IDO' E
319E FEET, T•ENCE ND;'S02B'W 39C FEE-, THENCE 5 7S'4Y'2' E 38 O i'FEST. TrWE NBYCh7 E ROOD FEET
7EN2 5 C0'S 043'E 53: OCFE37 LONG SAO JST LB'. OF T-E BE 1,4 OF S<CTON 5C 70 TPE RVANT OF BE;INMG
E .AND :ES OR EEO AE' T: CCNTAINS "D, 120 SOWIE FEET 11S'-'- ION' S)MORE OR LESS
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Sh'EET I OF 2 SHEETS
Wsconsin Department of Safety and Professional Services Page 1 of 3
Division of Industry Services
SOIL EVALUATION REPORT
In accordance with SPS 385, We. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,
St. Crook
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. e- c'
scale or dimensions, north arrow, and location and distance to nearest road. Ref* 2630
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary pwwrwposems
Law, S. 15. 1 m .
Property Owner
Property Location
Jim & Theresa Spaght
GovL Lot NE '% BE '% S 20 T 29 N R 19 E (or) W
Property Owner's Malting Address
Lot *
Block *
Subd. Name or CSM*
I
494 Maud Cir.
07
Na
Pine Grove Heights
City State Zip Code Phone Number
[] City ❑ Village ® Town Nearest Road
Hudson WI W16 .S
Hudson Maud Rd.
❑ New Constnc9on the: ® Residential/ Nurnberof bedrooms 4 Code derived design flow rite 600 GPD
®Replacement ❑ Public or commercial - Describe:
Parent material Glacial Outwash
Flood Plan elevation if applicable 0 fL
General comments and recommendations: Site suitable for conventional POWrS with 0.7 gpd/sq R loading.rate. Recommended infiltrative surface elevation
to be 85.50' & 86.50'.
L k
Boring * ❑ Boring
PR Ground surface elev. 69_80 R
Depth to lkni rig factor>100" in.
enan
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cant Color
Texture
Structure
Gr. Sz. Sh'
Consistence
Boundary
Roots
GPD/W
'Eff#1 .
`Eff#2
1
0-5
10yr3/2
none
I
2fgr
dsh
as
2vt,fm
0.6
0.8
2
5-12
10yr414
none
sil
2fsbk
dsh
ce
time
0.6
0.8
3
12-15
7.5yr4/6
none
gr sl
2fsbk
dh
as
11mc
0.6
1.0
4
15-21
7.5yr4/6
none
gr is
Osg
di
as
2vf,fm
0.7
1.6
5
21-26
7.5yr4/6
none
Is
on
dl
as
1vf,fm
0.7
1.6
6
26-32
IWr4/4
none m
h
Osg
dl
cw
-
0.5
1.0
7
32-100
10yr5/4
none
s
osg
d1
-
-
0.7
1.6
2❑ Boring * ❑ Boring
® Pit Ground surface elev. 91_70 ft.
Depth to fimiting factor >102' in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cant Color
Texture
Structure
Gr. Sz. Sh
Consistenbe
Boundary
Roots
GPD/W
-Eff*1
-Eff#2
1
0-16
10yrM & 4/4
none
Is/ sl fill
na
dh
ci
2vffmc
0.0
0.0
2
16-22
1Oyr4/4
none
sil
2fsbk
dsh
cs
2fm1c
0.6
0.8
3
22-28
7.5yr4/6
none
gr sf
lmsbk
dh
cw
1v2f,m
0.4
0.7
4
28-34
7.5yr416
none
gr is
Deg
di
M
tvf,fm
0.7
1.6
5
34-102
10yr5/4
none
s
Osg
di
-
1vf,fm
0.7
1.6
-FflOwntal=r n >%n<99n mnA ..AT Q,"n icn .n..a +em.e...�-onn -on I'In .....n -..w rc -an seen......
CST Name (Please Print)
Signature
CSTNumber
James K. Thom on
30021
Address
Date Evaluation Conducted
Telephone Number
340 Paulson Lake Lane, Osceola WI 540205413
Juty 9 2021 .
1 248-7767
581Y83311(R94/15)
3] Boring # ° Boring
®pit Ground surface elev. 09.33 ft
Depth to funding factor>9T in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description .
Ou. Az. Con. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/W
,EftIM
'Ef#f2
1
0-12
1 Oyr3/3 & 4/4
none
siusl fill
na
dh
ci
2vf(mc
0.0
0.0
2
12-18
10yr3/2
none
sil
2fsbk
dsh
M
2fm1c
0.6
0.8
3
18-35
1Ory4/4
none
sil
2fsbk
dh
as
2fm
0.6
O.8
4
35d2
7.5ry4/6
none
Is
Osg
di
cw
2vf1fm
0.7
1.6
5
42-51
7.5yr4/6
none
gr is
Osg
di
M
1vf,f
0.7
1.6
6
51-99
1Ory5/4
none
s
Osg
dl
-
0.7
1.6
ElBoring# ElBoring
❑ Pit Ground surface elev. —ft.
Depth to limiting factor in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz- Sh
Consistence
Boundary
Roots
GPD/Ft'
-EfW
I -Ef #2
Boring # ElBoring
El Ground surface elev —ft.
Depth to limiting factor _ in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft' Y
'Eff#1
'Eff#2
` Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mgfL ' ' Effluent #2 = BOO, > 305 220 mg/L and TSS > 30 5 150 ngfL
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10 Wisconsin Departo sional Services / {� .. I Page 1 of 3
Division ` Ip Im
SOIL LVALUA I ION REPORT I
UG 2 2021 In accordance with SPS 385, Ws. Adm Code County
Attach com ete site plan on paper not less tha 8 1/2 x 11 inches in su:e Plan must include, St Croix
but not Imi to verb l ep,pdrBpRf4 r glen point (BM), direction and percent slope, Parcel I D.
scale or di sions, f� {ggpmd)S rid distance to nearest road 020-1466-1 MOO Ref# 2630
COmmu R iewed b Please print all information. y eJ_"UVr,`aK. - to
Personal information you provide may be used for seconds purposes Priva Law, s. 15 04 1 m ..Z1ttJ./23 Aa.LJ
Property Owner Property Location ❑
Jim & Theresa Spaight Govt. Lot NE % SE %. S 20 T 29 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
494 Maud Cu 07 Na Pine Grove Heights
City State Zip Code Phone Number ❑ city ❑ Village ® Town Nearest Road
❑ New Construction Use. ® Residential/ Numberof bedrooms 4 Code derived design flow rate 600 GPD
® Replacement ❑ Public or commercial — Describe: _
Parent material Glacial Outwash Flood Plan elevation if applicable na ft.
General comments and recommendations Site suitable for conventional POWiS with 0 7 gpd/sq ft loading, rate Recommended infiltrative surface elevation
to be 85 50' & 86 50'
❑ Boring
1 j Boring #
L—J ®pit Ground surface elev. 89 80 ft
Depth to limiting factor>100" in
c,.z e...a—.,.,., o.re
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
1
0-5
10yr3/2
none
I
2fgr
dish
as
2vLfm
06
08
2
5-12
10yr4/4
none
sit
2fsbk
dish
cs
1fmc
0.6
08
3
12-15
75yr4/6
none
grsl
2fsbk
dh
as
11mc
0.6
1.0
4
15-21
7.5yr4/6
none
gr Is
Osg
all
as
2vf,fm
07
1.6
5
21-26
7.5yr4/6
none
Is
Osg
di
cs
1vf,fm
07
1.6
6
26-32
10yr4/4
none
Is
Osg
dill
cw
-
05
1.0
7
32-100
10yr5/4
none
s
Osg
07
1 6
r�� ❑ Boring7�
2 Boring # TJ'� -4 j�. 2 �i.'L
�J ®Pit Ground surface elev 91 70 ft Depth to nmg factor >i in
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Qu Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
•Eff#1
•Eff#2
1
0-16
10yr3/3 & 414
none
Is/ sl fill
na
dh
ci
2vffmc
00
_
00
2
16-22
10yr4/4
none
sit
2fsbk
dsh
cs
2fm1c
0.6
08
3
22-28
75yr4/6
none
gr sl
1msbk
dh
cw
lv2f,m
04
07
4
28-34
7 5yr4/6
none
gr Is
Osg
all
cw
1 vf,fm
07
16
5
34-102
10yr5/4
none
s
Osg
dl
1vf,fm
07
1.6
1.+ $ Sa
crnuent w i = ou au n zzu m 1L an
3 r SJ > 3U $ 1 bV 119WL ent 92 = JUL) > 30 5 220 m /L and T55 > 30 5 150 m /L
CST Name (Please Print)
"Signature,
CST Number
James K Thompson
30021
Address
,,We Evaluation Conducted
Telephone Number
340 Paulson Lake Lane. Osceola, WI 54020-5413
July 9, 2021 r
715 248-776 1
SBD-8330 (R04/15)
3-1 Bonng # ❑ Boring
®Pa Ground surface elev. 89 33 ft
Depth to limiting factor>99" In
Horizon
Depth
In
Dominant Color
Munsell
Redox Description %
Qu, Az Cont Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots
GPD/Ft2
'Eff#i
'Eff#2
1
0-12
10yr3/3 & 414
none
sivsl fill
na
dh
cl
2vffmc
00
0.0
2
12-18
10yr3/2
none
sll
2fsbk
dsh
cs
2fmtc
06
08
3
18-35
10ry4/4
none
sit
2fsbk
dh
as
2fm
06
0.8
4
35-42
7.5ry4/6
none
Is
Osg
dl
cw
2vflfm
07
16
5
42-51
7 5yr4/6
none
gr Is
Osg
dl
aw
1vf,f
07
1.6
6
51-99
10ry5/4
none
IS
Osg
dl
-
-
07
1.6
Boring ElBoring
_UU❑ Pit Ground surface elev It
Depthto limiting factor in
.,il Annhrahnn Ratn
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr Sz Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
_
'Eff#2
I
C� Boring # ❑ Boring
❑ Pit Ground surface elev It
Depth to Iimfting factor _ in
Snd Annh,finn Rnla
Horizon
-_
Depth
In
Dominant Color
Munsell
Redox Description
Qu Az Cont Color
Texture
Structure
Gr Sz. Sh
Consistence
Boundary
Roots
GPDIFtL
'Eff#1
'Eff#2
Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 305 150 mg/L r . Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L
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633884
STATE SANITARY PERMIT
OWNE
PLUMBED, ROMA
TOWN OF nsmi
SEC 7-b ,T N, R
AND/OR LOT _
PREVIO
LIC.# 2zz9oy
NO.
CHAPTER 145.133 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
SUBDIVISIONthe permit, please contactthecounty authority.
� U19ORIZ#ED ISSUING OFFICER -DATE Z
2I
S PERMIT EXPIRES 7 UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11/20)