Loading...
HomeMy WebLinkAbout038-1193-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safejy and Builu^ig Division INSPECTION REPORT Sanitary Permit No: 395128 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Drews, Todd I Star Prairie Township 038 - 1193 -30 -000 CST BM Elev: Insp. BM Elev: SM Description: loo L cZ 2" W t- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W Benchmark -S t ' lZ.va a38 eo Dosing n Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet Sbt 48 s 47. TANK SETBACK INFORMATION St/Ht Outlet & F�J' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � S- � !a � � i , � � f/ � Dt Bottom Dosing Header /Man. ("too 9z•2 Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number /I•S'� TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '� r y?' L SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Ma ufa urer: INFORMATION CHAMBER OR ?A Type Of System: UNIT Model Number: �$ lt•y (.o — t-f- DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake y Pipe(s) % _ Length lfl Dia Length '15-1 Dia 3 4 V 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 Al Yes [W No [W� Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 16 17 / d / Inspection #2: Location: 2155 134th Avenue New Richmond, WI 54017 (SE 1/4 NW 1/413 T31N R18W) Pine Acre Parcel No: 13.31.18.998 1.) Alt BM Description = `to P � .Cou,..rlo* yh y f e% � �./2O(�� 2.) Bldg sewer length= NA .Gt - amount of cover = 4t" a+,. A4 �1ni�d 044 -Wo-- P r op,. 11,4 4 4-5 L Plan revision Required? 10 Yes n No p I _ Use other side for additional information. ' ` / L _ Date Ins ctor's Signatun; Cart. SBD -6710 (R.3/97) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 1 4se onsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(lxm)] state owned.) Attach complete plans (to the county copy only) Wi�ste , ,oi% er not less than 8 -1/2 x I 1 inches in size. County State Sanitary Permit Number revisf n ,'pr00qus application State Plan I. D. Number I. Application Information - Please Print all Informat' Location: Property Owner Name Pro erty Location s l rrfR q )1/4 , 41d1/4, S Ul ,N,. (o Property Owners Mailing Address 4 fi r, {t, t Number Block her If City State Zip Code Subdivision Name or CSM Number 11 . Type of Building: (check one) s P" S � w.� ❑ City 1 or 2 Family Dwelling - No. of Bedrooms :�_ h,Lc. ❑ Village ❑ Public/Commercial (describe use):_ 1 ,Z Town of ❑ State - Owned = Nearest Road 2 3 K 13 ad 5 Parcel Tax Number(s) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) / 3 / . / g CJ j A) 1. Pff New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) A 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: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. S it Application 1 5. Percolation Rate System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inc) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ VIII. Responsibi y tatemen I, the undersigned, assume responsibility for installati of the POWTS shown on the attached plans. Plumber's ame (print) Plumb 's Si e o ps) MP/MPRS No. Business Phone Number - G Plum er's Address (Street ity, State, Zip ode) ' IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' g Agent Signature (No stamps) Ad Owner Given Initial Adverse Surcharge Fee) CD L Determination 2 2 Z X. Conditions of Approval /Reasons for Disapproval: SBD -6398 (R. 07/00) 1 ry � k r n� A z I �� 51 i I � e � i I � L Wisconsin Department of Commerce 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 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal referenr�'7 ection and Parcel I.D. percent slope, scale or dimensions, north arrow, and I n�i i$tahge earest road. j _ _ .,.. ._ M.;. , `` Rev wed by Date Please print all in f itin. Personal information you provide may be used for se �� p po w, S. (m)). p /Z- Property Owner ' , Prop ocation ZS ovt +Lvi , 114 1/4 S T N R o Property Owner's Mailing Address ST C RC A X Lot #! Block # Subd. Na me or CSM# f 9 _ COUNTY? k City 'State Zi ode Ph `W rp ❑ Village 0 Town Nearest Road New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate C(Y GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable A ft. General comments and recommendations: �' °'�s his �ZiJW� aJt� ®�� T >T TS is �✓vr / 4 &4 AOIX Av "' eew:2A s ❑ Boring # Boring � Pit Ground surface elev.-22-L, ft. Depth to limiting factor } /7t' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 � J 2 zzz s s - Boring # ❑ Boring 1Z Pit Ground surface elev. % ft. Depth to limiting factor �/7 &) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr Sz. Sh. *Eff#1 I *Eff#2 Af l h 7 8 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L uent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Pleas P ' t) Signature �' i CST Number Address - Date valua ion Conducted Telephone Number 2 Z SBD -8330 (R07 /00) I Property Owner S Parcel ID # -,Jr�/ 3 -. �� - �° f Page _ of Boring # ❑ Boring Pit Ground surface elev. 9� ' -/-, ft. Depth to limiting factor �4 — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 C ' F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F] Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) 4t o a t - - - w - a - G , 0!' o i } � e a _ ,_ _ I _ _ _ __ -:, ___ __ __ - -. �I _ __ _ _ -- _ _ _ _'__ -- __ -- _- ', ' , • - -_ - - - -- _. _, ', ' '� � i -- _- _ �- ', ; I � !, -- ._ � � ', I ', ' ', ' ' I ! I ._ � _ _ __ _ �_ __- _ _' i - ____ __ _ - - -� - I - __ - - - - - -- _ ', Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page I of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8'A x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and to -arid distance to nearest road. parcel l.D.# APPLICANT INFORMATION - PI et �rr►'t all /nformaiion. Pending Personal information you provide may be used for Ac6n Purpose (Privacy Law, 0. 15.04 (1) (m)). revved Da t e 7.dD Property Owner �.,� i,._ - ' Property Location Lakes & Hills Develo ment - / Gott. Lot im NW 1/4,S 13 T 31 AR 18 W 2�iope Owner's Mailing Address Loit# Block # Subd. Name or CSM# tea it O(� ;Z_ 3 - -- Pine Acres City Sta a PhoWNMRir City ❑ e ExTown Nearest Road ❑ New Construction Use: Res 0 !'Nli)ri�e ooms 3 ❑Addition to existing building ----------- ❑ Replacement ❑Public or c ascribe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/W 8 trench, gpd/ft Absorption area required 643 bed, fts 562 trench, fF Maximum design loading rate .7 bed, gpd/fp 8 t rench, gpolfF Recommended infiltration surface elevations) 96.5 ft (as referred to site plan benchmark) Additional design I site considerations Parent material ----------------- - - - - -- Flood plain elevation, if applicable --- - - -- ft S= Suitable for System Conventional Mound In Ground Pressure AT Grade System in FBI Holding Tank U= Unsuitable for system ® S❑ U ® 8 U ® S❑ u I ®S ❑ u ❑ S N U ❑ S® U SOIL DESCRIPTION REPORT Ce.Ra : E l - Lo - , v E Horizon Texture Depth Dominant Color Mottles Structure Structure Consistence Boundary Roots GPD/ftz Boring# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed i Trench 1 1 0 -10 10yr3 /3 ---- -------- - - - - -- 1 Ims bk mvfr as if 4 .5 2 10 -20 10YR4 /4 ------------ - - - - -- I lmsbk mvfr gw lvf 4 .5 , Ground 3 20 -45 7.5YR4/4 cs osg ml gw .7 .8 elev 19-LO—ft. 4 45 -94 10YR5 /6 ------------ - - - - -- cs osg MI - - -- - - -- 7 8 - Depth to limiting factor >94" Remarks: 2 1 0 -11 1 0YR3/3 ------------ - - - - -- I lmsbk mv fr as If 4 .5 2 11 -27 10YR4 /3 ------------------ I l msbk mvfr gw l of .4 ! .5 Ground 3 2745 7.5YR4/4 -------- cs osg ml gw - - -- .7 .8 elev 100.2 ft- 4 45 -85 10YR4 /6 cs osg ml - - -- - - -- 7 8 Depth to limiting factor >85" Remarks: CST Name (Please Print) Signature: Telephone No. Jacque Hawkins ( OL Address _ - � - - -- Date CST Number Ref # J 026 +� u Z A We V0 1) 4/8/00 7 7 Z z.. S'7 Z_._ 375 PROPERTY OWNER: Lakes & Hills Development $OIL DESCRIPTION REPORT Page 2 of 3 PARCEL 1.D.# Pending Depth Dominant Color Mottles Structure GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed I Trench 3 1 0 -10 10 /3 - -- - -- I lmsbk mvfr as if .4 .5 2 10 -23 10YR4 /3 ------- --- - - - --- I l msbk mvfr gw l of .4 5 Ground 3 23 -49 7.SYR4/4 cs osg ml as - - -- 7 ; 8 elev------------ - - - - -- , 100.7 4 49 -89 10YR4/6 - -------------- - - - - -- es osg ml - - -- - - -- 7 8 Depth to limiting factor >8910 I Remarks: 4 1 0 -9 10YR3/3 --- -------- - - - - - -- I lmsbk mvfr as If .4 .5 2 9 -24 10YR4/3 ------------ - - - - -- I lmsbk mvfr as 1vf .4 .5 •`� Ground elev 3 24 -46 7.5YR4/4 ------------ - - - - -- cs osg m1 gw - - -- 7 8 100.2 4 46 -86 10YR4 /6 - - cs o sg ml - - -- - - -- .7 .8 , Depth to limiting factor >86" Remarks: 5 1 0 -10 10YR3 /3 ------- - - - - -- I I msbk mvfr as if .4 .5 , 2 10 -21 10YR4 /4 1 lmsbk mvfr gw lvf .4 .5 `f Ground elev 3 21 -45 7.5YR4/4 ------------ - - - - -- cs osg m1 gw - - -- 7 8 99.7 4 45 -79 10YR5 /6 cs os ml - - -- 7 ft. ------------ - - - - -- g - - -- .8 Depth to limiting - -- factor >79 Remarks: Ground elev ft. Depth to limiting — - - - -- — -- — factor ; Remarks: i a � E) �. CAJ Li CA o o ` rj r � fw o' w Z � 1► 3 i ti Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number BSI Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) bfl Septic Tank Capacity (gal)© Soil Absorption Component Size (ft') Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) -Z o Z Maximum Influent Particle Size (in) U 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septi_cLMk and outlet filter shall be assessed at least once every 3 years by inspection. T outlet filt r s hall be cleaned as necessary to ensu proper operation. The filter cartridges ou d not be removed unless provisions are made to re ai` soli�c s in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. _ Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once eve three ears. The inspection shall include recording the levels of ondin , if any, in every Y p 9 p 9 Y the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. AA S vG S � � � RD sfi C_X D LX ?PW " C, 3 06/14/2001 07:12 7152473038• BELISLE EXCAVATING I PAGE 04 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND —( OWNERSHIP CERTIFICATION FORM Owner/Buyer �i 0 U (A 0 r___ S Mailing Address 1 3 3y J l m`J LA z � 01�­ Property Address (Verification required from Planning Department for new construction) City /State dguj ����vlt('AJ CAJL Parcel Identification Number 0 w LEGAL DESCRIPTION Property Location 1 A, ' �, L. .,�� /., Sec. 3 T N -R W, Town of I , ax- Subdivision n e A C +t > ,Lot # Certified Survey Map # , Volume , Page # _ Warranty Deed # 1.07 l o q l , Volume 16( , Page # 5 � Spec house © yes )2'no Lot lines identifiable &yes O no SX§3:EM 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, joumcyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) a(ier 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 statiriS that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the thpq year expiration date. _ rK 1 SIGNATURE OF APPLICANT DATE QWNE& CERTIFICAI ON 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 the prope d scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 i VOL 1U65PAGE 566 STATE BAR OF WISCONSIN FORM 2 - 1999 649041 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Lakes and Hills, Inc., a Minnesota RECEIVED FOR RECORD Corporation, 46 -21 -2001 1:00 PM WARRANTY DEED Grantor, and Todd J. Drews and Stacy M. Drews, husband and wife, EXEMPT t CERT COPY FEE: COPY FEE: TRANSFER FEE: 71.10 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 3 ine Acres, Town of Star Prairie, St. Croix County, Wisconsin. Name and Return Address BREMER BANK NA 532 KNOWLES AVE S NEW RICHMOND WI 54017 038 - 1193 -30 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this c day of June 2001 Lakes and Hills, Inc. � k + By: Richard S. Nelson, President resi ent • a AUTHENTICATION ACKNOWLEDGMENT Signature(s) Lakes and Hills, Inc., by Richard S. Nelson, its STATE OF WISCONSIN ) President, ) ss. Athis7day County authenticate of June 2001 Personally came before me this day of the above named Kristina O 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 Kristina Ogland Notary Public, State of Wisconsin W udson, WI 54016 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. Intormatim Protessiomis company, Fond du Lae. WI STATE BAR OF WISCONSIN 600$55.2021 WARRANTY DEED FORM No. 2- 1999 r / D/ /Cv A S tpS O ° O • C W co m y 9 R` �• t rn �vM3l`u!O 0 d ww 0 \ Aso 6.51'c� S89 °59'25 "E 50 `269`17' 0 33' °' v WAY PRO (n vii a V Q N —" ;' No PROPOSED o " 2 \� - � CD � V . (A O N89°59_25 Z 0 o S87 °53'16 ° E My 276.20" 0\ 224.9 �_ L J � o � Op 4 I PROPOSED V I `4 DRIVEWAY CA Qn � N 100' v) O n N rt 1 _ I (b rt DRIVEW / 1 Z ; n O I AY I ° � x 0 t=s E FF 1 ' A N7gg 3 a o n :U I 20..W 0 In m - ° 1 P 296.94' l m x N a ROp n ° � � ° N 0 0 Q -� l ORI� K q �0 I ° N ; 9 rn ° z --.1 P o n Cr NUE W 0 4 OF 4 i Q, m o • O 0 / 1 �$9 3 ?y v Q 6 6Y co 1 CD D \ Q � f `�' 0 0 Q O E 0 `" PR � 4 � U) C y �, y �,! n/ 1 OR�►E1y,�y a l V o m s to C / m o c o o 0 z m c�o -n ry 1 C �. 3 I' PROPOSED w o Z Op \ Z O O� a 0 O 1_�..;' / DRIVEWAY ! v ? Z �' W 0 p C ^ - :3 1 - 00 � I O C (� 0 \ 0 M / (A Lo 0 7 O O O -. 100 . J � I q C (n ° n 00 1- I 1 ( .� 3 1 I � N I i 7 O N I N - — Q C O Gi Cw y o :3 Q a , -2" iron pipe found i ; I' S89`07 "E C ::E rn r ; 2640.20' N, �— 6 00' 425.58' S00'16'55 "W 26"lI 26 1.67 ��� i 1 5 NOR�1 -{ _? -�? x'264 66 Co r3 — 3 - - - - _ _ S 1/4 Comer S•c 13, T31N. R18MC Sec. 13, T.31N.,R18W. -- i --- ita —" N00 "E x - - - - -- 0 8 a a o� y Ln m c O n M -1 p O. Z D co o �vs. w N w 7- Fy C m �r z x O ' LM C� ���uR innnm►�n D � o � vi r' `" .. 1 a m r ° V) l=J O � cA z D m � O Z ( (� o m .J d C Z rn _ n rn V D D < ^ cn N ° a OD '= CD N O C.T.H. "C„ a u o o '< p 3 ° -A. Co u rn • O Q �,CD °� :� o l� 3 ND ST. C O a ° o ° C Co co m Co -� Co <D m g co Co ^ a O O O O N O O j O (MA �' O C O a °° cn 3 `° ° m a c N c o b 3 a c rn c� o 0 0 ° _ �' c a f < o iD m o o a sD c a 5 a ° (D co o Ux o� l Z cN ° S . ✓ � � N 3 O CD a D m° C Ln J z a z o 'D < , m m o 5- c m o C i rt CCD � � CD Q 7 p rt Cb 7 y N 3 r Z OQ j 0 oo rt rn �a w m :3 �o m OO O '" n ° � � y S.T.H. "65" U ' o ° ' 'a m ° ` co ° 3 0 c co c 4 WI;onsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of ,3 ,Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 834 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and County percent slope, scale or dimemslons, north arrow, a Parc 'and location and distance to nearest road. Z e11.0.# _... _. - APPLICANT INFORMATION - Please print all Information. _ _ Pending Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed By Date Property Owner _-._._.__._..._. Property Location Lakes &Hills Developtnent Govt. Lot 1/4 NW 1/ 4,S 13 T 31 N,R 18 party Owner's Mailing Address Lot # Block # Subd. Name or CSM# r, CJ , �a X �U(, Z 3 - -- Pine Acres City State Zip Code PhoneNumber ❑ City , ❑ Mown Nearest Road wlh7 ate,-, I v ye-awg �: New Construction ® l / Residential Number of bedrooms 3 ❑ Replacement Use: ❑Addition to existing building - - -- P ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ftz 8 trench, gpd /ft Absorption area required 643 bed, ftz 562 trench, ft" Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/fF Recommended infiltration surface elevation(s) 96.5 ft (as referred to site plan benchmark) Additional design / site considerations Parent material----------------- --- --- Flood plain elevation, if applicable - - - - - -- ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system N S❑ U ED S❑ U ® 8 U ® S❑ U ❑ Sou ❑ so U SOIL DESCRIPTION REPORT D Borin # FHorizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD /ft g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 1Oyr3 /3 _ ____ ______ _______ I lmsbk mvfr as If .4 r .5 Ground 2 10 -20 10YR4 /4 ______ ________ ____ I Imsbk mvfr gw lvf .4 .5 r elev 3 20 -45 7.5YR4/4 ------------ ------ cs os ml w - - -- 7 .8 g 8 OlOft 1 4 45 -94 10YR5 /6 ____ _____ ___ ______ cs osg ml 7 i 8 Depth to limiting factor >94" Remarks: Z 1 0 -11 IOYR3 /3 I lmsbk as mvfr if _ .4 .5 2 11 -27 1 OYR4 /3 ----------- ------- l 1 msbk mvfr gw 1 of 4 5 Ground 3 27.•45 7.5YR4/4 elev ------------ - - - - -- cs os ml 7 I g gw - - -- .8 ] 00.2 ft. 4 45 -85 10YR4 /6 _____ __ ___________ cs osg ml - - -- ____ — 7 I .8 Depth to limiting _ factor >85 i Remarks: _ CST Name (Please Print) Signature: Telephone No. Jac ue Hawkins Address _ +� U � 1 d d ., u Z i j �f' Date CST Number Ref # ve `� , 7 Z ` 2?7 1 _._ 375 PROPERTY OWNER Lakes & Hills Development SOIL DESCRIPTION REPORT - PARCEL I.D.# Pending Page 2 of Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Copt Color Texture Gr. Sz. Sh. onsistence Boundary Roots -- Bed Trench 3 1 0 -10 10YR3 /3 -- ---------- - - - - -- 1 l ntsbk mvfr as if 4 5. 2 10 -23 10YR4 /3 --- - - - - -- l 1 msbk mvf gw lvf . . 5 Ground — — — -- - - - - - -- - -- elev 3 23 -49 — 7.5YR4/4 ------------ - - - - -- cs osg ml as - - -- 7 8 100.7 4 49 -89 10YR4/6 cs osg ml 7 ----------- - - - - -- _ - - -- ---- .7 8 Depth to -- limiting - -- - - - - -- — — - - -- -- - F factor >89" - Remarks: 4 1 0 -9 10Y.R3 /3 ------------ -- - --- 1 Imsbk mv as if 4 5 2 9 -24 10YR4 /3 --- - - - - -- 1 Imsbk mvfr as l vf .4 .5 Ground - — - — -- -- 3 24 -46 7.5YR4/4 cs osg ml w 7 g elev ------------ - - - - -- g - - -- ] 00.2 ft- 4 46 -86 10YR 7 i -- - -- _---- - - - - -- cs osg ml - - -- - - -- — - - - -- — - -- - - -- -- - -- -- 7 .8 Depth to limiting - - -- - -- factor >86" - - -- — Remarks: 5 1 0 -10 10YR3/3 ------------ - - - - -- 1 Imsbk mvfr as if .4 .5 2 10 -21 10YR4/4 -------------- - -- 1 Im sbk mvfr gw lvf .4 , .5 Ground -" - - — -- — -- -- eleV 3 21 -45 7.5YR4/4 ------------ - - - - -- cs osg ml w - - -- 7 8 _ g 99,7 ft- 4 45 -79 10YR5/6 ------------ - - - - -- cs osg ml - - -- - - -- 7 i .8 Depth to �" - - -- limiting - — — - — -- -- - - - - - -- - - - - -- factor >79 — Remarks: Ground — — - -- elev Depth to limiting factor — Remarks: v N M14 a V � � h r pQ p o 1 2 In rj I� I