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Home My WebLink About006-1061-70-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15 04 (1)(m)] Steve C :ST BM Elev TANK INFORMATION Elev P;Kc'c o^ N!I TYPE MANUFACTURER CAPACITY Septic Aeration Holding TANK SETBACK INFORMATION Loi i—ckIii _' TANK TO P/L P0L^.) WELL BLDG. Vent to Air Intake ROAD Septic NL�O. % Z J Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Num er TDH Llft Friction I-ss Sy m Hea TDH Ft Forcema Length iltz Dist to W014,1 SOIL ABSORPTION SYSTEM TOWN OF CYLON ELEVATION DATA County: St. Croix Sanitary Permit No 633973 Slate Plan ID No Parcel Tax No: 006-1061-70-100 Section(Town/Range/Map No: 28.31.16.428B STATION BS HI FS ELEV. Benchmark / C• �C / /DZ AIL �M „ cov« l.e too.S Bldg. Sewer 6-3V Q6. 7-6 SUHt Inlet // Q to L t7y . SUHt Outlet O 70 p7 DI: Inlet Dt Bottom Header/Man n 88 ?3 7 Z— Dist Pipe To (� 1 �3 , Bat System 4.9 � qz(/ pli Final Grade cep StrCover !oyyr BEDrrRENCH DIMENSIONS Width x Length " r `i 77 -/75 No. Of Trenches �4J' PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/ BLDG WELL LAKE/STREAM LEACHING CHAMBER OR ManufacturerTYl'FI 71/ `` 11 ' 17r Type Of System: Lor of K4-4 ' 1 O Y p r 0 ` 5UNIT Model Number Z CIv DISTRIBUTION SYSTEM Header/Manifold )1 Distribution lVent to Air Intake Length lY Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over ' / Bedr-rench Center Depth Over Bed/Trench Edges >�"Z `t xz Depth of Topsoil xx Seeded/Sodded xx Mulched L_I yes o as . No COMMENTS: (Include code discrepancies, persons present, etc) Inspection #1. (' Inspection #2: 1 Location: 1953 220TH ST II�O h C_,r,;„ .s' a -[+ 1 71 O 1-1 Ot5 �— {yid . 1.) AIt BM Description �VNc 11 C9 Nc t- i1L 2.) Bldg sewer length = Z S' —' V'Cyt on C A,5 - amount of cover = -2 / g ` Vtrl �Tti Soll .tyJ -r-t.v cA S Skvl, el-evG io,,, (((j(��/�/ i 0.7 SKn15. Plan revision Required? D] Yes No I 0 Z % 21 _. Use other side for additional informati Dale Insepctors Signature 36 ' -1c l,� Can No. ctil mI , )--I l _ ?l / th .os r --20110 County ED Safety and Buildings Division ST CROIX a �l 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled n by Co.) lji 2021 Madison, WI 53707-7162 33 73 ' st. rev etmit Applie�awt, State Transaction Number In acen ce `v (2), Wis. Adm. Code, submission of this forunit is required Or to obtaining a sanitary permit Note: Application forms for stateowned POWTS are submitted to the Department of Safety and Professional Servres. Personal information you provide may be used for secondary Project Address (if different than mailing address) rtpurposes in accordance with the Privacy law, s. 15 1 gm), Stats 0'tx f 1. Application Information - Please Print AB Information - Property Owner's Name Parcel # vo ' Steve Olson 006-1061-70-A0@' Property Owner's Mailing Address Property Location1953 220TH STREET Govt. Lot SW . NW ti, Sectioa8 o City, state Zip Code Phone Number DEER PARK WI 54007 (cycle me) T 31 N; R la E crW L 11. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms 3 I Subdivision Name • Block # ElPubhc/Commercial - Describe Use El city of ❑ State Owned - Describe Use of CSM Number ✓• �3 M powElVillage /� �Townof CYLON hoe: o}9oz i 111. Type of Permit: (Check only one boa on line A. Complete line B if appikable) s A. ew S in Replac System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T of POWTS S stem/Com nentfDevice: Check all that apply) PS Non-Pressunzed In -Ground ❑ Pressunzed In -Ground ❑ At -Grade ❑ Mound ? 24 in of suitable soil ❑ Mormd < 24 in of suitable soil Holding Tank [I Other Dispersal Component (exp ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Informaton: tA/V�. Design Flow (gpd) Design Soil Application Rate( 0 D is persal R (sq Dhspersd Area Proposed (sf) System Elevati `�3) 450 .7 650 6 650 92.68 ( VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units, la� ._ New Tanks Existing t-,Qy..i- tc-1 Tanta �-{ �, � 0 5 , U in in i.. U a Septic or Bolding Tank X 1000 IWIESER Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number PAUL R KOEHLER .�� iG/ 225410 715 246 2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI 54017 VIII. Coin /De artment Use Onl Approved ❑ $ermiCt FDee/ Date Issued Issuitig Agerit Sr ❑ O 'van Reason for Denial 5-25 -- q,) I o,, 9_ / Y Conditions Approve tac-Diaappt•eva4 \ �s IS AUk -k 6 -t� 36Lt SYSTEM OWN 3 �,Q11+�S ( �,t�t 1. Septic tank, effluent filter and dispersal cell must be / serviced maintained as per management plan provided by tliD_ /P** Pik 2. All �l!Qe Z ^ tarn d setback requirements must be maintained e?� ( QX as per ap 2 Tkt i r sperm or a system and submit to tbeCoustyJARly on piper notleeatandlax Iliac a SBD-63 (R.11/11� B�Q �Q�du t`�edC� 1 Sa - weed or 5' S r�p1,ti� Olson P Oob - JD6J-3D-ko s w/i NwY4 c-19 Yal R14 � QLw PA r � W ; 5100? (3�ra mti To p of f'6v,� W I Go r,4 h a PJ,7e S (7� `S CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: STEVE OLSEN Owners Name: STEVE OLSEN Owner's Address. 1953 220TH STREET DEER PARK WI 54007 Legal Description: SW 1/4 NW 1/4 SEC 28 T 3 1 R 16W Township. CYLON County: ST CROIX Subdivision Name: Lot Number: Parcel ID Number: 006-1061-70-100 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: PAUL R KOEHLER License Number. 225410 Date: 09/29/2021 Phone Number (715) 246-2660 Signature Designed pursuant to the In -Ground Solld Soll Absorption Component Manual for POWiS Version 2.0 SBD-10705-P (N.01/01). Page 1 S tt4-t,,, o Iso,n PI 006 - IDO-?0-k0 SLv"� TOWY4 sag131 R14 „loll Q&-f Pf,, k w ; 5 1 oo? i Qo.,a,mar� �, (3ailo+ti.a{S�av„fpas- 90,7, Scglc 1"-�r D�* SlopcL -i.o/& q� SyStcr Pik ,t %on l GarJt„ P4,)f i E 7 Flows { POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION Owner Steve Olsen Penult 9 DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units QI NA Estimated flow (average) 300 gal/day Design flow (peak), (Estimated x 1.5) 450 al/de Soil Application Rate .7 al/da /W Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand fBODs) :=O mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD,) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Colifonn (geometric mean) 510' cfu/100ml Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 1000 al O NA Septic Tank Manufacturer Wieser ❑ NA Effluent Filter Manufacturer poly lock ❑ NA Effluent Filter Model 525 0 NA Pump Tank Capacity al A NA Pump Tank Manufacturer ® NA Pump Manufacturer 0 NA Pump Model V NA Pretreatment Unit O NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Call(s) 0 NA >j In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other. ❑ NA Other: ❑ NA Service Event Service Frequency inspect condition of tank(s) At least once every; 3 month(sl (Mwdmum 3 years) If0 earls) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA Inspect dispersal ceil(s) At least once every: 3 0 month(s) y IR year(s) (Maximum 3 ears) ❑ NA Clean effluent filter At least once every: C,1 0 month(s) year(s) 0 NA Inspect pump, pump controls & alarm At least once every; 0 month(s) ❑ year(s) )D NA Flush laterals and pressure test At least once every: 0 m ❑ year(s) ls) )P NA Other: At least once eve every: 0 month(s) ❑ year(a) 13 NA Other: IY NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls 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(si 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 call(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 fitters, 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. START UP AND OPERATION Page Z of 2 For new construction, prior to use of the POWTS check treatment tankis) 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 collie) in one large dose, overloading the call(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 replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at 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. �! - � - - _ •'�-l-�.IIY-IgPalf-Inghau-�..�..-. _. �. _ _ ___ :�_.�.:.=—��_d �_ _ 1__'RY.IIYI.II-ii-..]fIH-lIIt-IIr-I`l-fl�l�\V1\-• •,t.�\-f-� r.11F1.11AM, ❑ 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 ANDIOR 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. COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLG AND HEATING Name PAUL R KOEHLER Phone 1715 246 2660 —� Phone 715 246 2660 SEPTAGE SERVICING OPERATOR (PUMPER) Name POWERS Phone 715 417 1429 LOCAL REGULATORY AUTHORITY Name s C ( g ZDA(«f Phone %lS— 3F40— (O Z) This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 33.5401. (2) & (3), Wisconsin Administrative Code. SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Pagem L—olm—_ 1 1 Project Name: 2 3 65 3 Steve olsen No. of Calls 6.5 Per Coll ft Cell Width 13 —Total No of 10 ft Coll Length 50 sq ft EISA Per Coll ft Cell Spacing 6505 sq ft Total EISA it mtftctuw mm.1 I ..I. I . FICA 0._ infiltrator EZ1203H- Eft :F 25.0 Gravelless; Leaching Unit Manufacturer: INFILTRATOR Gravelless Leaching Unit Model: EZ1203H-10FT. Finished Grade 99 It .......... Typical Cross Section Observation Pipe with approved cap or vent Soil Backfill Geotextile Fabric � 62 ft Infiltrative Surface ___FF46� Limiting Factor Slotted and Anchored Ventf Observation Pipe with Cap ........................... 0 .................. a Plumber/Designer Signature: PAUL R KOEHLER License #: 225410 Date: September 29 2021 Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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 atl information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)) Page I of 3 ST. CROIX 006-1061-70-100 Date nupwrny uowuon ❑ ❑ STEVE OLSEN GOvL Lot SW 1/4 NW1/4 S 28T 31 N R 16E (or) W Property Owner's Mailing Address I Lot # I Block # I Subd. Name or CSM# 1953 220TH ST amity uVllage Mown Nearest Road DEER PARK I WI 1 54007 1 ( 65)1-470-1581 I CYI,ON I HWY 64 QNew Construction Use[] Residential / Number of bedrooms 3 Code derived design Bow rate GPD 13 Replacement 11Public or commercial - Describe: Parent material LOAMY DRIFT OVER LOAMY TILL Flood Plain elevation if applicable R. General comments CONVETIONAL and recommendations: 1❑ Boring # 0 Boring Q pit Ground surface elev. 98.72 ft. Depth to limiting factor 108 + in. Soil Aoplication Rate Horizon Depth i Dominant Color Redox Description I Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft 2 ff#1 • g#2 A 0-14 10 YR 3/2 -------------- ------------- SL 2 MABK MFR GW 2 VF .6 .8 B 14-24 7.5YR4/4 ----------- ---------- ---- SICL 1 MBK MFI GW 1 VF .4 .6 C 24-39 5 YR 4/6------------------ ----- SG 0 F SG ML GW ------ 5 1.0 Cl 39-66 10 YR 5/4 -- ------------------- SG O M SG ML CA ------- .7 1.6 C2 66-108 10 YR 4/3 ---------------------------- SG/G O M SG /G ML ---- ------ .7 1.6 Boring # ❑❑ Boring 99.55 108 + ' pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD/ft 2 tf#1 • 0#2 A 0-14 10 YR 3/2 --------------------- SL 2MABK MFR GW 2 VF .6 .8 B 14-24 7.5YR 4/4 ---------------------- SICL 2 MBK MFI GW 1 VF .4 .6 C 24-39 10 YR 4/3 ------ ------------------------- S / G OM SG ML CA _____ .7 1.6 CI 1 3948 1 7.5 YR 4/2 1 ---- ----------- ----------------- S 0 F SG ML I CA ------ .5 1.0 C2 48-84 1 10 YR 5/4 ------------------------------- S O M SG ML CA ----- .7 1.6 C3 84-108 10 YR 4/3 -------------- -------- ----------- S 0 M SG ML ----------- ------ .7 1.6 "Iy,u 61n2 r oo moo . ioff mgri - trrruenl Wd = BUU FT < JU Mg/L. ano I55 < M mglL CST Name (Please Print) Signature CST Number PAUL R KOEHLER 224410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE MAY 6TH 2O21 715-246-2660 cun_uaan m 1 r n r Property Owner STEPHENOLSON Parcel ID# 006-1061-70-100 panty 2 �r 3 Boring # U Boring Ground surface elev. 97.98 ft. Depth to limiting factor 108 in. Pit FSoilApplication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots • GPD/ft ' ff#1 tfF#2 A 0-16 10 YR 3/3 ----------------------- SL 2 MABK MFR GW 2 VF .6 .8 B 16-34 7.5 YR 4/4 -------------------------- SCIL 2MBK MFI GW 1 VF .4 .6 C 34-50 5 YR 4/6 ---------------------------- S O F SG ML G ----- .5 1.0 C 1 1 50-72 1 10 YR 5/4 --------------------------- S/G O M SG ML CA --- .7 1.6 C2 72-108 10 YR 4/3 ------------- ----------- S/G O M SG ML CA ---- .7 1.6 uc 3 G 60 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Awlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. nsistence Boundary Roots GPD/ft ft#1 M#2 F-IBoring # la Boring Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots w i na.c GPD/fl ' 1f#1 • f1#2 • Effluent #1 = BOD : > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOO s < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SRD-8330Tw (R 11/11) 3 B[,Iraa,t S tt 4,, o lso r) PT 00b - ID6f--�D-tOo SO/INwyy c,-JS131RIGW p)& -( N' k w ; K l oo7 Q� �LmurL S Top o� Rba -Pj loo P"t � 1�,7 P;t 2 91,5 Q,t s) C6 SGAIC l o SlopC- '1o/b Lnl P41, r ST. C1z I pvTY. SANITARY SYSTEM File #: OWNERSHIP/ADDRESS FORM are`a 12021 illy 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. ram_ OWNER/BUYER INFORMATION V �U Owner/Buyer �.J7-��'�'Ie� - ��f d YJ OCT b 4 2021 Mailing Address.. /`/ S3 �}7j sip !G Commun)rope °unty City/State/Zip Phone Number (required) /, S % p/ _ Email Address CfC V'OeS � � `;' l� a �� GD t'✓1 Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location Su/ '/a , 00 t/a ,Sec. T U N R�W, Town of - 61,Ub 7 Subdivision Plat: Lot # Certified Survey Map # 13 / 3 70 / n O -7 ?f) Z ,Volume 13 Page # � I Warranty Deed # (o 139 to (before 2006)Volume /'I&'k Page #_� Number of bedrooms 3 Spec house O yes P(no Lot lines identifiable Ayes O no New Property Address (Stall Initials) (verification or new (Date) USE ONLY required from Community Development Department for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-24S-4250 Fax cdd2sccw co v 1101 Carmichael Road, Hudson, WI 54016 www.sctwi.00v ED 65T a°a i - ya l Ws. Dept. of Safety and Proles Dn rvices SOI EVAL N REPORT Page I of 3 Division of Safety and Buildings „rn 9 a MI. J4 acoe oa ce wim ara oa, vv s. nam. �oa� y i Attach complete site plan on p per not las �nt�11 inch in size. Plan must include, but not limited to'. verb I and h`eiiz M), direction and percent slope, scale or dimens n£ oration and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s, 15.04 (1) (m)). nN ST. CROIX Parcel I.D. 006-1061-70-100 Date 11 W2Y Property (Tuner STEVE OLSEN Property Location Govt Lot SW 114 NWt/4 S 28T 31N R 16E (or) Property Owners Mailing Address 1953 220T14 ST Lot # Block # I Subd. Name or CSM# City State Zip Code Phone Number DEER PARK WI 1 54007 ( 65)1-470-1581 ity ❑Village • own Nearest Road CYLON I HWY 64 New Construction Use[3Residential / Number of bedrooms 3 Code derived design lbw rate GPD ElReplacement Public or commercial - Describe Parent material LOAMY DRIFT OVER LOAMY TILL Flood Plain elevation it applicable ft. General comments CONVETIONAI- and recommendations: 1 �QJCJ2aov1 f - I❑ Boring # 0 Boring 0 Pit Ground surface elev. 98.72 ft. Depth to limiting factor 108 + in. Soil lication Rate Horizon Depth in. Dominant Color Munsell Redox Description Du. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ' ft#1 111#2 A 0-14 10 YR 3/2 ------ --------------------- SL 2 MABK MFR GW 2 VF .6 B 14-24 7.5YR4/4 - ---- ------------------ SICL 1 MBK MFI GW I VF kL:4-- C 24-39 5 YR 4/6 - --- - -- f SG 0 F SG ML GW ------ �5 1.0 CI 1 39-66 1 10 YR 5/4 ------ - ------- ------ SG O M SG I ML CA ------- .7 1.6 C2 66-108 10 YR 4/3 - - - - - SG/G O M SG /G ML ---- ------ .7 1 1-6 •`le o F21 Boring # ❑ Boring 99.55 108 + 0 Pit Ground surface elev. ft. Depth to limiting factor in. Shc hcabon Rate Horizon Depth in. Dominant Color Munseti Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft' H#1 fi#2 .A 0-14 10 YR 3/2 ------ ------------------ SL 2MABK MFR GW 2 VF .6 -.8-• B 14-24 7.5YR 4/4 ---------- ------ --------- SICL 2 MBK MFI GW I VF .4 .6 C 24-39 10 YR 4/3 ------- ----------- ---------- S / G OM SG ML CA ___ .7 1.6 CI 39-48 7.5 YR 4/2 - - - — -- -- S 0 F SG ML CA --- .5 1.0 C2 48-84 10 YR 5/4 - - - --------- S O M SG ML CA -- .7 1.6 C3 84-108 10 YR 4/3 - - - -- 0 M SG ML ----------- ------ .7 1.6 - tmuenr F7 = nuu S > sU c "U mgrL a rss 1:1u < IOU mgru - emuem �, mgL arw r a � ou mqL CST Name (Please Print) Signature y CST Number Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE MAY 6TH 2O21 715-246-2660 rRIIIII) Property Owner STEPHEN OLSON Parcel ID# 006-1061-70-100 Page ` of ' 3 V Boring Boring # [3pit Ground surface elev. 97.98 ft. Depth to limiting factor 108 in. Soil icetion Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft ' fl111 111#2 A 0-16 10 YR 3/3 ------------- -------- SL 2 MABK MFR GW 2 VF .6 �8- B 16-34 7.5 YR 4/4 ------ 2MBK MFI GW 1 VF .4 .6 C 34-50 5 YR 4/6 ---------------------------- S O F.$G ML G — .5 1.0 C1 50-72 10 YR 5/4 S/G O M SG ML I CA --- .7 1.6 C2 72-108 10 YR 4/3 ------------------------- S/G O M SG ML CA .7 1.6 z. tip %saaz Boring # 1-1 Boring - - Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. nsistence Boundary Roots GPDHt ' ff#1 11#2 Boring El Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate WWI== Redox Description ' 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 Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or M through Relay. s110-e330rev(R1in3) Qm1°100 poloo^-" S feP} c+ 0ls0Y1 el 006 - lo6f- _?0-too sw'/. n1wYy It T21 RIL (3��a.mtir� S Top off' PI,aN�pu� Ic�b (�p�o c{ S ac �uas Ho,i 3 Q[,Irea� 1, Scgl[ I ' = rfo 41, vy4ceomr- SY44W 1001)(cOUNW NO. 633973 STATE SANITARY PERMIT PREVIOUCS NO. EC OWNERDLW CH"TER 145.135(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. PLUMBER LIC•# The sanitary permit is valid and maybe renewed for a 2 0 specified period. TOWN OF sanitary Ty Changed regulations will not impair the valid of a sanitary permit. (e) Renewal of the sanitary permit will be based on tt SEC 9T i �N9 R regulations force at the time renewal is sought, and that changed regulations may impede renewal. Nab (1) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 AND/O OT B OCK Note: If you wish to renew the permit, or transfer ownership of • the permit, please contact the county authority. S V .1401 HOC : 04CM& SUBDIVISION _ A . ��4Up RI ED ISSUING OFFICER -DATE PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)