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HomeMy WebLinkAbout036-2006-80-000 \ j CD j & ] � � 2 04 . \ � ƒ w ] x 2 §� 8 $ }_ \0 c } 2 me _L c ■ \ / k § \ 7 °f m J n � 2 n � z ± [ \ t 0 I � E � c I i g i § z « 2 2 ) t■® § n G a 7 / k E 2 I-) 5 e n 2 m ] 2 j M [ } -� k § ) f § ) ) § \ k < k ) < Q 2 z m z z= z ) \ t - ] - .. .. ) 2 ) 2 41 2 ■ ° - ■ / �\ § ) k / k ) ) / \ co I / k k / ) o E a m m E m m m I (L 5 US u � 0 a $ o ; e » z \ § \ § \ \ § 2 \ ;< o g _ < _ E _ § 3 ! § ] E £ ® �e <} f 2 § a # z J ] _ 7 $ to 7 } $ ) o E / \ 2 \ k 0 / / k 7 j § £ \ \ c e . _ ¢\ k @ 2 2 0 / R f§ __ [ ■ R g \ 7 § E / \ _ © F 2 § . , m 2 R ) G o o m m 4) 0 2 2 0'{ o n m ;a « P, z /__ (L G z_ z m ■ . � \ k « L B C �, » » co� k \ k \ k o u a■ 'o U) Q o■ u Department pf Commerce PRIVATE SEWAGE SYSTEM county: St. Croix A Building Division INSPECTION REPORT Sanitary Permit No: 51 4ERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: onal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). mit Holder's Name: City Village X Township Parcel Tax No: ?ederson, Joel I Stanton Township 036- 2006 -80 -000 :ST BM Elev: T77 BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet ' TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [� Yes [] No � Yes ®No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 1476 185th Ave New Richmond, WI 54017 (NW 1/4 SE 114 31 T31N R17W) Oak Ridge Estates Lot 38 Parcel No: 31.31.17.660 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Fes] Yes [z] No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. +� County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN O In � Gp accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER 0, [Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road �y�'�0 �7 7 (715 Fax Hudson, WI 54016 -7710 715 386 -4686 O Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application QCSi I. Application Information - Please Print all Information Location: Property � Name. r � � WED (.J 1/4 s 1/4, Sec \ �� S� Y-1 e: T N, l R E (or) N Property Ownets Mailing ddress - Lot Number Block Number City, State Zip Code Phone or,6 Subdivision Name or CSM Number �- II T pe of Building: (check one) OCity ❑ Village MTown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): � ❑ State -owned Nearest ad IL Type of Permit: (Check only one box on line A. Check box on line B if applicable) �� •6 f Parcel Tax Number(s) A) 1.❑ Repair 2. ❑ Reconnection 3. ❑Non- plumbing . Rejuvenation Sanitation d,3�j — � B) Permit Number Date Issued C] State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) "I Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: . Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade 1 e Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation Vi. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks Ii. Responsibility Statement 1, the undersigned, assume responsibility for repair /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or thistaqation of non - plumbing sanitation system. Plum er's (print) PI r' S ature (no stamps): MP /MPRS No. Business Phone Number � E1= Plumber's Address ( treet, City, State, Zip Code) 20 19 -) 1 New Vj'c car . ci; /00 VIII. County Use Only Disapproved Sanitary Permit Fee Date Issued I sui Agent Signature (No stamps) Approved Owner Given Initial Adverse � 4 Determination / IX. Conditions of Approval /Reasons for Disapproval: P.� �J-�i t''t Zpe 1 0.r A 14� P c,�So ►,1 Ne 'l , Su . 31 J 1 310 1 R 1 N 1,3 et �S 1.0'1' lot 1 34 �6 t S v 5 ►� h N OUSC a•' h iH 7V t : wc, C -0. (I U_ 2 0 2 4 P 4 05 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., MI Document Number Document Title RECEIVED FOR RECORD 10 -25 -2002 2:45 PM St. Croix County AFFIDAVIT EXEMPT i Affidavit of System Rejuvenation 7c FEE 11. TRANS FEE: P n COPY FEE: 2.00 C Son CERT COPY FEE: Name - (Owner) Typed or printed PAGES 1 being duly sworn , states, under oath, that: L He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 2 a Page S Document Numbe Croix County Register of Deeds Office: RecordinaArea Name and t � Address A parcel of land located in awj&f% of thZE Y. of Section 3 SOel F� de /son T aL_ N — R / n _ W, Town of 51jj , St. Croix ' y � 6 t �� �� County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): loot' 3g 04.4c ,e,�qe e7m-��s / s ' -,2«O - - einn Identification Number (PIN) As owner of the above described property, l acluxmiedge that the septic system serving this residence (islis not) undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. 1 also acknowledge that 1 will make this information available to any future parties interested in prudwsing this property. Dated this 7 ay of o 0 0 A itC) i s AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenticated this day of SL Croix County. ) J/��-. /� Personally came before me this day of n 1 J - 0 0 Z the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who e authorized by S 706.06, Wis. Stats.) Instrument and acknowledge the ���. •••.;,� Q C THIS INSTRUMENT was DRAFTED BY y`I` NOT,A R••••A o Y authenticated or adc Notary Publi State i (Signatures may be P 1•G� rwMAedged. Both are not My Commission is permanent. It e>rr Dares y neces sary.) Date: �-y 6 —�lo0 3 '•......•• THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" This information must be completed by subrnitter: doammWOW name&ratum and EN (if required). Other information such as the granting clauses, leggal description, etc may be placed on this that page of the document or may be placed on additional pages Of the document. Dote: Use of this cover Porte adds one Dews to viour document and S2- 00 to the recording fee. Wisconsin Statutes. 59.517. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer noel ijd Q „sc n Mailing Address JV 6 I gS r ' 'V/ ' Property Address (Verification required from Planning Department for new construction) City /State /Ww /?kA,n / Parcel Identification Number 3� - goo C,' - sw -gym LEGAL DESCRIPTION Property Location AliO Y4, ,.! �E '/4, Sec. Z I , T 3 / N -R / . Town of sfi Subdivision 04 Z� / e ifsf' � / � . Lot # ►� Certified Survey Map # Volume . .Page # Warranty Deed # &Y.-7 99:r . Volume Page # Spec house ❑ yes It no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTEAANCE 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 pfanber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days a three y xpiration date. ��z 1--1112'14� , � / 3 / SIGNA L 7 ” Of APPLICANT 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 owner(s) of property d bed above, by virtue of a warranty deed recorded in Register of Deeds Office. " a L-, e� D / 3 / 0 SI ATORE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the JDcI �c e t5 on residence located at: Sec. 31 T om\ N, R 17 W, Town of ST;&AyTrbn St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Ptu� - u5T oF 0100 a Did flow back occur from absorption system? Yes SC No (if no, skip next line. Approximate volume or length of time: 0 100 gallons minutes Capacity: )dD0 Construction: Prefab Concrete te, Steel Other Manufacturer (if known) Age of Tank (if known) Pi _AA (Signature) (Name) Pleas Print �pt. e- h vlez (Title) (License Number) 10 - 3 -oa (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (exc t for inspection opening over outlet / baffle). Name x/72/5 Signature MP /MPRS y AS BUILT SANITARY SYSTEM REPORT • °:dER , TOWNSHIP 57NpZr a SEC. i T N, R 0. AffDRESS A , ST. CROIX COUNTY, WISCONSIN. 'BDIVISTON �/ , LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SY STEM IV rya a 4e 'TIC TANK(S) MFGR* _Ip ,Py+S (',p CONCRETE STEEL o N0. of rings cover 4 Depth DRY WELL ,NCHES NO. of width length area no. of line width _o I length area 16 -I!d n� depth to top of pipe . REGATE '.K RATE �S AREA REQUIRED Z& AREA AS BUILT :claimer: The inspection of this system by St. Croix County does not imply complete .pliance with State Administrative Codes. There are other areas that it is not possible/ inspect at this point of construction. St. Croix County assumes no liability for stem operation. However, if failure is noted the County w 1 make every effort to .ermine cause of failure. �ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST ' DATED Q' •-- / •7 PLUMBER ON JOB LICENSE NUMBER REPORT OF INSPECTION-- 114DIVIDUAL SETPAGE DISPOSAL SYSTEM Sanitary Permit State Septic t r. HE TOWNSHIP S t. CroiA County S'? C u," i Size } => gallons. "dumber of Compartments Distance From: p• ?ell ft. 12% or greater slope it. Building _c2 ft. Wetlands ft 17ighwater ft. DISPOSAL SYSTEa2 Tile Field or Seepage Pit(s) Distance From: hell > =' ft. 12% or greater slope ft. Building �' C ft. Wetlands f;: FIELD 1- ft. Total length of lines r C ft. !lumber of lines , Length of each line T ft. Distance between lines ft. Width of the f ¢1 trench ft. Total absorption are `l sq. ft. Depth of rock below tile in. Depth of rock over the in. Cover over rock � -C cl [� d ~ ' Depth of file below grade ��, in. Slope of - trench inA 101 ft. Depth to Bedrock %T ft. Depth to ground water _y� ft. PITS slumber of pits Outsid diarleter ft. Dept! below inlet ft. Gravel arq` p-1t: yes no. Total absorption are sq. ft. Square feet of s epage trench bottom area required ( /v Square feet of eepage nit rea requires? ..� Inspected b ,�, ��A l CAL, Title: Approved Date A / 197x. Rejected Date 197 EH-115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 �� '� REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Ivy /4,O ' /o, Section , I , T 1N, R L (or1QW�Township or Municipality a Lot No. , Bj No. © Subdivision Name County Owner's Name: i Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW �— ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS '7 7 ERCOLATIO TEST SOIL MAP SHEET �•� SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BERR j 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 J Iry go * C //, uk C v a lAiia P SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) a ° 2.0 - ! L S " / s Z 1 L_ PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square fe � of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. S In dicate scale or distances. Give horizontal nd vertical reference points. Indicate slope. 100 Li c �r I µ L +N I, the 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 Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) G✓ ��' Certification No. ms's Address Name of installer if known CST Signature COPY A —LOCAL AUTHORITY __ State and County State Permit # Z17 PLB67 Permit Application County Per it for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. OCATION: Y4, Section , TJt N, R� E (or) IN Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village e Township C. TYPE OF OCCUPANCY: Commercial C I�strial t C �� U *Other (specify) *Variance Single family X Duplex No. of Bedrooms , - 3 No. of Person D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms-2— Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY O©C) Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation _ Addition Replacement — Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) �- 2)_ 3) Total Absorb Area / sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile pepth No. of Trenches Seepage Bed: Length , Z! Width / L' Depth �' Tile Depth 3 No. of Lines 2-• Seepage Pit: Inside diameter Liquid Depth Tile Size y % Percent slope of land /%W Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Ce d Soil , Tes er NAME 1 C.S.T. # , S'S and other information obtained from (owner /builder). Plumber's Signature P /MPRSW* � �b� Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). / ©a ,v '*7 PA T �ll Do Not Write in Spac , / geloy FOR DEPARTMENT USE ONLY ate of Application Fges Paid: State �_ Co nt Date y .Z 7 ermit Issued /Rejected (date Issuing Agent Name pection Yes�No Valid# Date Recd C( (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 tate (pink copy) 4. plumber (canary copy) R Date 6/11/76 � STATE 13AR OF WISCONSIN —FORM 2 DOCUMENT NO. WARRANTY OEEO TH S SPACE RESERVED FOR RECC'V!NG OATA 347�8 REGSTERS OFFiCE I Har W. H o 2 B._Ho0_,_hAs)?a__�nd ST. C;ZOIX 7ec'd. ', :Z.�,Ccrd "s __ day o' ­)rl 1 A.D 19Z-P - h — conveys and warrants w ___ Toe l__E P-aders-cn-An - d-udit and Wi: as jL0_iD_t__ MtTimm TO Croix County, Ai(a 1jQNAL the following described real estate in-- hamAowk WIL State o f Wisconsin: Lot Thirty -eight L(_30 of Oak Ri:]ge t he T F- '�' n of Tax Key No. FE:��aes First Addition to 9 being a part of the Northwest Southeast Quarter (NWj of SE�4) Quarter of the of section Thirty-one (31), Township Thirty (31) North, Range Seventeen (17) West, except municipal zoning ordinances. This Warranty Deed is given in satisfaction of t�-at Land Contract dated July 6, 1976, and recor ded on July 12, 1976, in Volume 539 of Records on Page 569 in the St. Croix County Register of Deeds office. 0 D FEE This is not homestead property. (is) (is not) Exception to warranties: day of April 19— 78 Dated this (SEAL) (SEAL) Harry W. HOP Ruth B. HOP (SEAL) (SEAL) ACKNOWLEDGMENT CKNOWLEoGMENT t h i s_� gay 0 1 STATE OF WISCONSIN Signatures authenticated ss. Ap ri l County. 78 day of Personally cam before me, this Cherrill Hirst the above named TITLE: (if not, Notary Pub lic authorized by § 706.06, Wis. Sta �JATE OF WISCONSIN ST. CROIX COUN, NOT1 PUBLIC This instrument was drafted by CHERRILL HIRST MY COMMISSION Exripts DOAR, DRILL, NORMAN L _BAISKE, BELL & SKOW to me known to be -Se person — who executed the fore- going inst: and ac k no wledged the same. New Richmond_, Wisconsin 54017 (Signatures m ay be authenticated or acknowledged. Both County, Wis. Notary Public are not necessary.) m Commission i re anent. (if not, state expiration date: WARRA47Y DEED -STATE BAR OF WI C FORM NO v­ v, 7. t u j 0 ?_002 Wisconsin Department of Commerce SOIL EVALUATION REPORT loge of Z Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 5 Q. Attach complete site plan on paper not less than 81/2 x i 1 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. 0 - O o lo d Please print all information. R iewed by Date � 11 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` 1A A Property Owner p Property Locations c . c, + � V ` C �" Govt. Lot N G 1/4 5 F 1/4 S 31 T �j N R 1 E (or Property Owner's Mailing Ad ess Lot # I Blodc # I Subd. Name or CSM# r sY 14 to 5 *'~ 39 00-v, Ritine, E +& 4G city p State Zip Code Phone Number ❑ city c� ❑ Village ® Town Nearest Road om' 1- N %C-'tv►,on 1 >T o (7 (7) )0��4° �7 -'5 a / fin Use:l2 Residential / Number of bedrooms Code derived design flow rate GPD 1.�1Ehw 'Ova ❑ cement ❑ Public or commercial - Describe: Parent material 4 4L c . e.- 1 e> 0 -- t - r ',� Q c 1„ Flood Plain elevation if applicable / . Q I S General comments d r H c; t Id and recommendations: 4 a^ A - b o � S don C Fo w- p 06s ; 61 c T ` u v � C K 4`4 a r. o f e-,4 '. S + ►^ J Sys�^tv.. �o+ ysav -s plict . p 1 �pQ f ��1 . (s " a ►;�w.e 'v. p; p�. . Sys +e�r.. se_{— C,+ 4 ca... Q.r 8oft �vw /'t,vvew. e 14 lil OIL Boring # Boring _ Q ❑ pit Ground surface elev. g D'� ft. Depth to limiting factor 0 in. Soil Rate Horizon Depth Dominant Color Redox Description Texture Stnxxure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 (5 -15 I oy R 3 )aL 1-- — ' 5 , 15 -19 IDl yl q CL — — — — • `1 ftea — L 5 — — — t 7 1, ;Z Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil . cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP 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 CST Name (Please Signature CST Number c + r A:Wl dress S +• Date Evaluation Conducted Telephone Number DL7 ;L o'r h 71 -2% 35919 1 Property Owner Parcel ID # Page of 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 a 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 a Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal AmAcation 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 5 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 130 mg1L 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. SBD68330 (R.07 /00) 10/09/2002 07:27 7152483588 SUPERIOR AUTOMOTIVE PAGE 02 M mwmn Depor"r•m of camwm SOIL EVALUATION REPORT pop -J— 01A oivleion aSetegr and In e000r01111ta wtat Comm 0. vas. /ldrrr. Cods Aftch ottnrplmo 64 plat on papa not INS (hen a 112 x 11 wm In eme. Plan molt Canny i Irtdrde, but net lindted to: venlcel end hotixonial n*Wmoe point (aMQ, dlracdon am Peroel I.D. P•tcertt OW. sale ar dim"Ieione, noM mmw, and Wosaon end daanm to now" road. Phws print all kdoRltlNpq. RowWwsd by Does Pw ..... ador.eMtYOn you p■"4ea �ney tw ueoe tar o�oona�ry ( ■or . �. t 6,04 (1) (m)). Pr'ePeM Property Lacaefon �t 4 ♦ lva3 PG Govt. Lot NE 1/4 515 19 S 31 T N R 17 E Pub a Lot a Sk ck 0 Subd. None or CSW 14 V st'" G . 3,9 o.t.k R � E -14� _ / ol st Umb Piml. Number 0 CRY ❑ Village GOTONT News( Rood (lee: M Rseidendal / Number of bedmorns Code derived design Ilow rat GPD YWN ❑ «ll ❑ PubNc or aamyrval - Deeabe• Parent nwu" 4 k d : - 1 6 .s" f" 1< 4. Flood PW elevation it q*&=We Gwww aamwft v aadne00111rhsrldolons: haws - bnr:M3 r{oAE fer PC&S; lb I r4+Jvva. P o f `M�Sf : rs jr iCel 'r / S�sl+Lr.. JL p *4 00-0- a1d. . tit! "dew IS ! I"s :•. P. Pa . 5 C.'t 4 y .ga . O n l ti av 4* w. ,ems Foe ID ❑ Pit Gmund etsfaos etv. " R. Dept, a brong i aor _ 0 M+ sox Aaalloolion Rot Norkon Depth Dor'*w Color Redm Oesaip`m Texture SWidure Consistnce SwWwy Root in. Wrooll Cu. $a. Goa Color tar. 3L Sh. 'ElA11 - EfAKt C L `I . 3 143 Y�-yl L5 r r 7 /, F sonrrp N ❑ e«w Q Pit C~W sutf m Wev. R D■prf to IYniling berm in. Sot ADOWAM Role hlatort 060 DorrivW Calm Poedox Deeaitrtbn TW&" S(rum" Consimunce lewd" Root GPM In. Munsell ou_ Ss. Cont. Colo► 6r. �. 9h. "EtttlH •Et1Al2 " filwusnt Ili s S()D s 30 s 220 nrgrL end TW *30 IN mglL ' Efiuent 02 ■ SOD 5 30 mpR and TS3 a 30 mg& cw Now tPI.... r N 17y T. �.�� p•t S �" Dale EvskoWn CandtmM Telephone Number sYoa � -7- S -a`I$ 3588 f 10/09/2002 07:27 7152483588 SUPERIOR AUTOMOTIVE PAGE 03 3vio soR,! W�yy,. S_C'Jy� S am - 3J 131 � PM1114 •�• eLr I, _ s, v le Sm . � y 1 ®� v ��4 � � p-e• -- No t� P