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HomeMy WebLinkAbout032-1007-80-200 WisconsinDepartmerttofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453432 0 GENERAL INFORMATION (ATTACH P 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: Trucke , Randy I Somerset Townshi 0 32 - 1 - -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Q , a can . o _e eA = C--57- 16"A 03.31.19.48A20 TANK INFORMATION I i ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �3 J Dosing os •3 r Aeration g. Se er 3 4 / 03• Holding SVHt Inlet sS a2 . TANKS BACK INFORMATION St/Ht Outlet $ o24 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 76 , ` y I Dt Bottom Dosing ) Header /Man. Aeration Dist. Pipe TO - _ 15' • 3 I0- ,i3' Holding Bot. System (1. 0 % . / 3 ' ' Imo? PUMP /SIPHON INFORMATION Final Grade :" Z BCD- 2- Manufacturer emand St Cover I M � 2 - Z e5.11 Model Number TDH Lift Fr' Loss System Head TD Ft p) '81M �' 3 tp o� -31v cT0 . o Forcemain ength Dia. SOI ` ABSORPTION SYSTEM BED/TRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Oepth DIMENSIONS 7 J � f 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR `o ` Type Of System: UNIT Model Num er:� y DISTRIBUTION SYSTEM Header /Manif I Distribution x Hole Size x Ho;Spacing Vent to Air Intake n Pip Lengt Dia Length Dia pacing y JV SOIL COVER x Pressure Syst Only xx M ound Or At - Grade Systems Only + Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es To soil g p []- Yes [� No [ Yes g No C�M3�1�NT (I ude code dlnt A�" es, persons present, etc.) Inspection fl A" / Inspection #2: --! --- Location: 9 232nd Ave. Somerset, WI 54025 (SE 1/4 NW 1/4 3 T3 N R1 9 NA Lot f Par el No: 03.31.19.48A20 1.) Alt BM Description 2.) Bldg sewer length = Z `•• fO�e�x� ' �� r e-� p - amount of cover = I $�r ° —� 3 ) :a"et A - t 0v l s) e du 4 k sLA-,� �. Plan revision Required? Ljj Yes X No Use other side for additional information. e a sepctor's Si ature Cart. No. hcum r J I V 7� �� � fi' � � �' � �� 1. r ?�''` ,� � ' � �`� r - Safety and Buildings Division County 201 W. Washingtcii Ave., 40. Box 7162 I vis c onsi n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (603) 26b -3151 (1 533 Department of Commerce Sanitary Permit Application Stag Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you pdd may be used for secondary purposes Privacy Law, sI5.O4(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Informs on Pr erty er's Name i � Parce # Lot # Block # Jv �� • 632 - oar Av6 erty ' 0<mer 's sailing Addres Property Location y • ��,9 CXtyte . Zip Code Phone Number � ��° '�, Section ( 3 - 4 0o I / T � N 1 1/ rcl rW Type of B ing (check all that apply) B� 'Al or 2 Family Dwelling - Number of e?Tdrro�oo�'m��s Subdivision Name I CSM Number 4 41 ❑ Public /Commercial - Describe Use rGl�b� �r y 1 ( I V 1 0 ❑ State Owned -Describe Use i ❑Ciry_ V it ageownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System p y g p ❑ Re lacement System ❑ Treatment/Holding Tank Replacement Only Q 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 — 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 Q Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter YLeachingC.4amber ❑ Drip Line ❑ Gravel -less Pipe Q O (explaz ) V. Dis ersallTreatment Area Information: 1 O 1 •� Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfl Dispersal Area ropo d (s . Sy�jem El at�ton �- VI. Tin Info Capacity in Total Number Manufacturer Prefab Tite Steel er Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic Holding Tank - Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) a Plumber's Sig e MP /MPRS Number Busines / s Phone Number y P1 ber' d (Street, City, State, ip ode) ,6 �'�! � "� Leh 1 • � �O VIII.County /De artment Use Onl pproved ❑ Disapproved . tary Permit Fee (includes Groundwater Date Issued I ing Agent ignature (N ps) Surcharge Fee) /� Q Owner Given Reason for Denial r `� ,�(� IX. Conditions of Approval/Reasons for Disapproval ( STEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained ( n G� /GL as per management plan provided by plumber. / ,� _ e u; � All setback requlremen s 7`� as per applicable code /ordinances. 6k !, /0 Attach complete plans (to the County only) for the system on pa& not] tha c inches m uza- SBD -6398 (R. 01/03) " PLOT PLAN PROJECT Randv Truckev ADDRESS 1441 72nd st Amer Wi_ 54001 SE 1 SE 1/4s 3 iT 31 Pde 19 W TOWN' N. Somerset COUNTY ST. CROIX MFRS Byron Bird Jr . 220527 DATE 7 -27-04 BEDROOM 3 CONVENTIONAL XXXX t C VENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.R.P tgop of 112 steel pipe ASSUME ELEVATION 100 1 ❑ BOREHOLE O WELL •H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 -96.5 T -2 -95.9 >12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber 6" Long 34" Elevation 232nd Ave 294' Drive 170' PL Bed House 30' Easment Rd st 30' 13' Y ' Garage 30 M 15' 10 K( 33 ' ��/ 15' B 20 80' B2 4' 439' B3 � Ob pipe � B4 S6 286' PL ST CROIX COUNTY SEPTI.0 TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � G Owner/Buyer L A Mailing Address e 6-1 do/ Properly Address o`Z 2 73. ), (Verification required from Planning Department for new construction) City /State Parcel Identification Number 03 /00 1 — y �� 0 LEGAL DESCRIPTION Property Location ' /,, 4 Sec. T N -R4—� Town of Subdivision . Lot #. Certified Survey Map # l , Volume Page # Warranty Deed # 7(P 17 , Volume 2 Z � . Page # I Spec house dyes ❑ no Lot lines identifiable JA 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three ear a lion date. SIGMA F C 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 the property des above by A a warran deed recorded in Register of Deeds Office. SIGNATURE OF APP ANT 1 * * * * ** 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of v FILE INFORMATION SYSTEM SPECIFICATIONS Z � Owner 7 >-7&_C / ` Septic Tank Capacity a l ❑ NA Permit # 3 Septic Tank Manufacturer ,C t ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model �� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 1 al /day Pump Manufacturer ❑ NA Soil Application Rate al /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L - Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 5530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) Cfg axl um 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tan vo u A Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) year(s1 ❑ NA Clean effluent filter least once every: ❑ month(s) ❑ NA �r yearlsl ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) pressure test At least once every: ❑ month(s) ❑ NA Flush laterals and P ❑ year(s) E3 month(s) Other: At least once every: [3 year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. 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 to check for any back up or ponding of effluent on the ground surface. The dispersal 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 (Y 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 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 10 days of completion of any service event. GMW (4/01) 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 or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(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 POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits 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. • 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 rep 11 ce ant system: A suitable replac area has been e 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 that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. h ha of be valuated i tify a sui le lacement a a. U on fai e o a soil and site valu t n us be erf med t locate suita replace ent are If no rep ment area is available a holding tank ay a stalled a last 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> > 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 THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE& POWTS MAINTAINER �, Name ,�, r Name u �z /^ t'iiC /� -C Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name v1� ` /1 Name /'G� r k Phone - c Phone This document was drafted in compliance with chapter Comm 83.220(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. PLOT PLAN PROJECT Randv Truckev ADDRESS 1441 72nd st Amery Wi. 54001 SE 114 SE 1/4s 3 /T 31 N/R 19 W TOWN N. Somerset COUNTY ST. CROIX j MPRS Byron Bird Jr . 220527 DATE 7 - 27 -04 BEDROOM 3 - 4 � CONVENTIONAL XXXX t ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE .5 ABSORPTION AREA 900 # of chamb rs 30 BENCHMARK V.R.P tgop of !/2 steel pipe ASSUME ELEVATION 100' 7/ ❑ BOREHOLE (DWELL sH.R.P, Same as BM Vent SYSTEM ELEVATION T -1 =96.5 T -2 =95.9 > 12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber 6" Long 34" Elevation 232nd Ave 294' Drive 170' PL Bed House 30' Easment Rd st 30' Garage 30' 40' 15' 10K 33' 15' BI 20' 80' B2 4' 439' B3 B4 O Ob pipe � 2M PL STATA p (n} 769950 AAM SIN P`bil 4 P 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF D EED This Deed, made between Mark J. Crotty RECEIVED FOR RECORD SINGLE Grantor, 07/27/2004 01:15PM and Randv Truckev WARRANTY DEED Grantee. EXW # Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 11.00 the following described real estate in St. Croix County, State of 1f more ace is needed lease attach addendum): TRA FEE: 179.70 Wisconsin ( P ,P ) COPY FEE. Lot 4 of Certified Survey Map recorded in Volume 17 of Certified CC FEE: Survey Maps on Page 4468, as Document No. 711038, located in part of PAGES: i the Southeast Quarter of the Southeast Quarter (SE' /4 of SE 1 /4 ), Section Three (3), Township Thirty -one (31) North, Range Nineteen (19) West, Somerset Township, St. Croix County, Wisconsin. Recording Area Name and Return Address Fain Seams We % cd 206 2nd Street # Hudson, VA 54016 032 - 1007 -80 -200 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. vt�L Dated this D day of July , 2004 ;°� * * Mark J. Crotty * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ k "I—j - STATE OF ) SINGLE ) ss. County authenticated ) authenticated this �j day � U Z r C Personally came before me this day of July 2_ the above named Mark J. Crotty TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, W1 STATE BAR OF WISCONSIN 800 - 655 -2021 WARRANTY DEED FORM No. 2 -1999 5E E Vy Se.`. 3 .0 T 31 %4T Lo -- � / 5 �' a l t . � 1 � '.1 c� � / � + �b l'1 � ►4� :T, ��t.,,r. tC, ;t9 `l 35' stc rJ- P: pe-) - � -11f� lbs. Do ( Ve _-a re 11, 13 - _ v , Y 9 q.3 y 0 1 ` D , I - MD y Ofe F; re LQ 1 _ 1 -- _ / Soot►• Io 1.►i'0--> - - - l Wisconsir/bepartmentofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 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. �c7 7 _o Z 3 f �i V( Y Please print all in t ddaZry ' nn Re ' ed Date Personal information you provide may be used for seco t E �� Ql f 5.04 ( Property Owner Prope Location 44 DEC 17 2 9&t. Lo 5 r 1/4 5 1/4 S 3 T3 N R l q E (or Property Owner's Mailing Address Lot Block # Subd. N or CSMN ST. CROIX COU T t 'O 3 City ZWte Zip Code P e Num ❑ Village IR Town Nearest Road wvz v w 0 ( ) /ll, S vvvla iQ3a 'v- Ala W New Construction Use: P Residential /Number of bedrooms , Code derived design flow rate 4 -1 GPD ❑ Replacement 0 Public or commercial - Describe: Parent material T` A.G % O uTw k S Flood Plain elevation if applicable ft. an recommendations : S S"'�5� S� 1— '! $.'? S Tie ENS a r-�- 1 - SO r 'f !: E IV G1�t Fo ,r s;-Ee - Sr�G a : T 3 ( 95. T.y (9 +. 87 A F 71 Boring # Boring Pit Ground surface elev. to ft. Depth to limiting factor / 00 in. uiYt Soil Acolicatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I a- 10 L art R, M aks aP - 13 n k 5 1q cw 3 13 101e - , y --- CL & A&6 ) Z, M F, c.Lj I _ - • tv 3 - 7, 5 `I/ - S D -S m L <w kj 1 ,7 1. a 7, 5Y 5 /9 S o-S L. ctr? 1. G Z. ✓fir _ Boring # Boring Pit Ground surface elev. 9 9. 13 ft. Depth to limiting factor G D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2 1 0-1 I 3 aF a" 6 19 9 -a Ye y t.. OAJ S Cw Ir 3 3 sw 41 fi rsbj Nw Fr- c'A-) F .�� 5YR 51 _______ FS — 115 "1 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg/L CST Name (Please Print Signature CST Number nI r Address Date Evaluation Conducted Telephone Number I Property Owner m o— r C r o ,l Parcel ID # Pe-m g; ^ s Page . _ of F 3 - 1 Boring # ❑ Boring E} pit Ground surface elev. 9 9 1 � J I ft. Depth to limiting factor 10 in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Ef1#1 •Eff#2 0 -1 t 3 L "cam M V- qlq _ uo 3 11 - 31 7, '94 FS M r ZJ0 %/F 0 5 -20 ?,5Y2 ' s A Ql 1V mV r , 9 Boring # I❑ Boring 4 4a Pit Ground surface elev. 13 ft. Depth to limiting factor D a in. Sal Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh. •Eff#1 •Eff#2 D n 3 L F& s, F S F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF - -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& and TSS 130 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- 2648777. SBD8330 (R.07 /00) 4 5E / - -- SE yy Sec.3,?3fN A. %-ILO 3.3 2 a. c. re .--- C s-r m a 1 9 (cw a3a ;tg y. 35 Bfn 106. 00 (V k1D 0-:1 -:1 rc feircv% t. 4L 1 � l gg.1.3 h 9- 9 g,ay f 9T.3Y o 1. �J o s a c� 1 � p M mo +ly ofeti F: W s t 1.54 >u - th loo- �.hC> DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR HUMAN NDLATIONS PERCOLATION TESTS (115) P.O. BOX 7969 ADISON, WI 53707 �'S� LHR 83.09(1) & Chapter 145) / p LOCATION: SECTION: gTW MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISI N NAME: "� /a /Ti N /R/ E ( ,,�er,sz� -- or C COUNTY: MAILING ADDRESS: � O.� i^ S 6 t3 A USE DATES OBSERVATIONS DE )p NO. BEDRMS.: COMMERCIAL DESCRIPTI PROFILE ES RIPTIONS: PERCOLATION TESTS: ON: L5( R,sidence NNew ❑Replace _ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ji� S ❑U QS ❑U 51 ❑U ❑ S U EIS U �O If Percolation Tests are NOT required DESIGN If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: �0 PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 13- �- o _ , xW 3_ S B- B- �f PERCOLATION TESTS TEST H WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIQW6 PERIOD 3 PER INCH P- t ^, e P- P- ,Z 6 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION - � 5 .' / s %© I__ .t_ E � q t f 10 X I mm.. I m• I E E Z � [? ` �e.� _ I + i F T I, t e undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Ad inistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pri TESTS WERE COMPLETED ON: ADDRES / CERTIFICATION NUMBER: IPHONE NUMBER (optional): CST SIGNA UR : i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SOD-6395 (R. 10/83) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Otbsr Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well Is — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand 'c — Less Than '1 — Loam Bn — Brown 'sit — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point I TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. ' RECEIVED . DEC 16 2002 ST. CROIX COUNTY ZONING OFFICE Certified Survey Map No. Volume _ ,Page BEING A PART OF THE SOUTHEAST 114 OF THE SOUTHEAST 114 OF SECTION 3, TOWNSHIP 31 NORTH, RANGE 19 WEST, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. LE_ LE V IP r 10 ...... Government Corner (as noted) r�i'•(m�!,y I u Yi.YLN fly $ Y PREPARED FOR: " " � 0._...... Set 314 x 24 rabar weighing GARTi'e °l+,S c i Mark Crotty ._...... 1.502 lbs. /lineal ft. a f 2316 Co. Rd "I" • Found I" iron a unless noted NAP Somerset WI 54025 �p I y y. Drainage arrow �+� W *fiUR %j Unpl Lands Joint driveway — _ _ _t�• West line of the of SE 1/4 of the SE 1/4 Access 165 ' Accsss Easement . t 1.. _ For Lot 4 A CIO LOT 3 4 100 I � /� � / A � Including R/W Including /W 44 806 Sq.Ft. taj I 182 477 Sq.Ft. tv • S' 4.1x9 Acres 3.�2 Acres' cres o Excluding R 179,207 g Sq. p { 4. 11 Acres A 100' I \ \ \ \ SOT 5 1{ ! ( I Including R/W '\ P. 7 Sq.Ft. I y i f 6.88 Acres { I � Excluding R/W I c A n F 77 897 Sq. 1.56 Acres I i { I• p Ln A j �0 I I= wfo I K I \ y {o — w-- - - - -• \ I X I _; CA n rn I A \ \ \\ \ \ Inaq� awol \ \ # I # Existing drive { \ \ Buildinj Setback Line) 100' I Ic Southeast corner — — _ •� Section 3, T31N, R19W I r -- Found Aluminum Monument Plat of Grand View II — ' — ' — ' — ' — East i/4 Corner Section 3, T31 N, R 19W Found Aluminum Monument Note: The parcels on this map are subject to state and county CEAAR CORPORATION laws, rules and regulations (ie. 604. WILSON AMMUE North is referenced to the east wetlands, lot siss. Access to parcel, Etc..) UBNOXONIB, WI. 64761 line of the Southeast 1/4, which before purchasing or developing Drafted by Pager,/. Gartmann is assumed to bear N01 39"B parcel. Contact the St. Croix County Zoning Office for advice. PAca f OF 2 � �• Y iA o� -- .� �� � \�� l �' ��' ��� �� � � � �� � �:� �o 7 .--� �� ��� I o .* r p .1 c d T A o w c O44-- C , °w °w CC 0 00 a . = n H N CD O C CD _ Q N '',. M O 4 ( 1 N Q r � a c (DD C a O O 3 7 N Ly _ O p 5'i w c to cn z D A a ro (D Q D N CL N = 00 t) O c (D y 3 C p c m " v o 000 r r W� � !v v C cr v q 0 3 (D ; �, cn _ °° N CL ,. I z o y N CD N C C N -+ (D W (D CL z 3 N C - 1 CO) ° N D c p ? c •* N a A z 7 I j CD I c � A Z p ^' Z co 3 y Z w C A I N O a t O = a � c � -'•C z a o - R ° o'°0d CD C m w v V CL m o I - M M C '„e I ? !n O N CL fD y = Q M a 0 N 4 x N p V tv CD 0 a O Cn O ti ° °p N c 0 ti A CD o a