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HomeMy WebLinkAbout040-1287-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420472 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: Angus, Steve & Cathi I Troy Township 040 - 1287 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: CD.0 1 c0.�� T J- ;Ca ,& TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r I I W&(S6t2- 00 r.o () a�.o Dosing Alt. BM . o.Zo D Aeration Bldg. Sewer 2 - ' 39 Holding St/Ht Inlet t 5.5`5 9S. `tS TANK SETBACK INFORMATION St/Ht Outlet S �9O O TANK TO P/L WEL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t 1 Dt Bottom Z Dosing Header /Mm. T L- tN �[ Aeration Dist. Pipe Holding Bot. System ! � . PUM64IPHON INFORMATION Final Grade Manufacturer Demand St Cover Model Noll< TDH Lift tion Loss System Head TDH Ft For cema' Length ia. Dist. to well IL ABSO RPTION SYSTEM RENC Width Length 11,1 Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSMITS SETBACK SYSTEM TO P/L - PL [TG IWELL LAKE /STREAM LEACHING Ma r / INFORMATION t `� CHAMBER OR Number: .S Type Of System: . ZS z DISTRIBUTION SYSTEM + x � • UNIT Model Number: 4 J Header /Manifold istribution x Hole Size x Hole Spacing r o Air Intake ipe(s) f Length en Dia Spacing SOIL C VER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of TSeeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil g Yes I No Lei Yes [W No C MMENTS: (Include code discre ncies, pers s rese etc.) In pection 1: 22. ?c0 3 Inspection #2: — �"T - ' Location: 605 Glover Road River F 1 4022 (NW 1/4 SW I/4 1 T28N RI 9W) Glover Prairie : 15.28.1 l �� Parceko9.1627 X" fl: 1.) Alt BM Description = 1 " � AI cr(�a.b?G• 3. 2.) Bldg sewer length = (,P0 / - amount of cover = 4 , 1 1revition k -too Re wired . Yes No �L Use other side for additional information. Date �A �tt SBD -6710 (R.3/97) Insepctor's Signature Cert. No. � j a �4. •,�; �� ,� �1 1 �, �� � �° ,z�+ 1� �j - \ J �o v� —'1 � � .. ,� J � � � � �� ti °�� � �' �� Sanitary Permit Mplication Safety & Buildings Division + in accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. Nv See reverse side for instructions for completing this application PO Box 7302 isconsln Personal information you provide may be used for secondary purposes Madison, Wl 53707 -7302 Department of Commerce (Privacy, Law, s. I5.04(1)(m)] (Submit completed form to county if not v _ �ft_ Oh state owned. Attach com lete tans to the county co o r not -1/2 x 1 l inches in size. County S& ^ 0 f State Sanitary Permit Number [I ston to previous lication State Plan I. D. Number I. A n Application Information - Please Print all Informatio Location: Property Owner Name U 1 Property Location �.OU��� (� 1/41/4, S��T B,N, W Property Owners Mailing Address Lot Number Block Number 2 e c���- 5-�. 1 c,�J s city, State Zip Code Phone Number Subdivision Name qtr ❑ city II. Type of Building: (check one) S ,) ❑ vi rage ®" I or 2 Family Dwelling - No. of Bedrooms : own of ❑ Public/Commercial (describe use):_ ❑ State -Owned u 1 _ Nearest Road Q (---) t �$fl -�,r CaS ���! 7 J 1 Tax Number(s) 09 III. T vue of Permit: Check only one box on line A. Check box on line B if applic able A) I. ew 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.'ype of POWT System: (Check all that apply) in N on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ SingIe Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculatmn ❑ Other: V. Dispersal/Treatment Area Information: I. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Elevation Required Proposed Rate (GalsJday /sq. ft.) (MinJinch) CO 8s8 A 870. -A ©.� e77 5Zo y'3,�S -9s� VII. Tank Capac in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing New structed Tanks Tanks ❑ ❑ ❑ •e eye / — jlaol Cl VIII. Responsibility Statement 1, the undersigned, assume res n ibility for installation of the POWTS shown on the attached plans. Business I'hore Number Plumbees Name (print) Plumber's Signature (no stamps): MP/N4'RS No. - Da le /: X e Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Pemtit Fee (Includes Groundwater Date Issued Is ing Agent Sign (No stamps) I� Approved ❑ Owner Given Initial Adverse Surcharg Determination X. Conditions of Approval�/ sons for Disa�l: �9'VV,�9{l,.•hy,l �CA.G,. -.. a ove►'" b 36y. Z2-' y� � \ ■ 50o ava 0 t 6 ,v / me s 7C . / •a0m I l6. . TpP Oc4,zleP�ane /0/ p.ed . Elev. = /00" SEe ✓c � Ga�r'A��ks /]tvyySC.�Yy, Ste. i5 - r,. o A.W. • 8z 1'reP d ;s p.e rso,l ce 1(. Two W � X � :1{r �Qr ca.,iis eac lam. \ (�' loves � � � ( • �.u7. s'" �� � 8 r" I / ■ 9.187 ■ 8z s �z nsu. 42sptr code. m K1 v ProlO o s ed CDO -00 BsA P r ppa ses� q c� 6Gd roo.a, � l�{r�(, t. � / W e 6 t.7zL G�ac �;'��e.r a ouf(•c�. dwe / %� 5,� c : 1os.2S.' I prepostd ,►o (� we if I I I 1 d propo�zd r�ve - n /— �av�►' K by 3 &q. 22' ■ 50i/avalP- � 6 y y L ,� es e 3 % 1 fJ. Tap oF' Felepkohe � 1 " / = !/0 I � 177 7 7 71 l SEe ✓e Q G a Rt�yySWyy See. /S 77j. o Y " ° r �roPascc� d ;SpR�so,c cell. ! 93 1tYa�cr u,1itS eac. k. C! L S y I O 10 I� to v 3 • � Koad � O ' 9 0_ I // ■ 9U7' ■ 82 \ 8 t f 'So • �n saCaXe asp Co e. �\M M �/ I M v � P/'o � cot) /sue SaP. Preposexl �a t,tl /W e ff /uc►�f bcd�oo.►, #- Glad. Qf bu; /d,,� a-t oc.�/z�. dw2!l� ^U I p�apas� 1 p ropo5zd drive��y I L: 1589 Wisconsin Department of Commerce SOIL EVALUATION REPORT page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and p I.D. percent slope, scale or dimensions, north arrow and location and distance to nearest road.f Y/f� 040 - 1287 -10 -000 Please print all i forme , k "' "' � 3 yet / R , By Date Personal information you provide may be used for ndary purposes (Privacy Law, s. 15.04 (1 (m)). , IO Property Owner R ; ' T Location Steve & Cathi Angus Govt. I NW 1/4 SW 1/4 S 15 T 28 N R 19 W Property Owner's Mailing Address Block # Subd. Name or CSM# 522 West Cedar Street Glove Prairie City State Zip Code Phone Number _j City J Village M Town Nit Road River Falls ( WI 54022 715 - 426 - 5429 Troy Glover Rd. & South Glover Rd. 0 New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _I Replacement _j Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at 87.50' using 28 leaching chambers. U Boring # -:j Boring 01 Pit Ground Surface elev. 93.39 ft. Depth to limiting factor >120" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= *Eff#1 *Eff#2 1 0 -27 10ur3 /3 none sil 2fsbk mvfr cs 2f,1m 0.5 0.8 2 27 -35 10yr3 /2 none sil 2f &msbk mvfr cs 1fm 0.5 0.8 3 35-45 10yr3/3 none sil 2msbk mvfr cw 1f 0.5 0.8 4 45-69 10yr4 /4 none sl 2msbk mfr ai 1f 0.5 0.9 5 69 -120 10yr5 /6 none s 0 sg ml - - 0.7 1.2 Soil profile obser>ed by use of backhoe pit to 108". 108" -120" observed by use of 2"' hand auger through bottom of soil pit. Boring # J Boring #I Pit Ground Surface elev. 94.84 ft. Depth to limiting factor >125 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff# /ft2 1 *E ff#2 1 0 -25 10ur3 /3 none sit 2fsbk mvfr cs 2f,1m 0.5 0.8 2 25-43 10yr4 /4 none sil 2msbk mvfr cs 1fm 0.5 0.8 3 43 -56 10yr5 /4 d.5yr5/8 & sil 2msbk mfr cw 1f 0.5 0.8 4 56-67 10yr4 /4 none Is 2msbk mvfr aw - 0.7 1.2 ' 5 67 -125 10yr5 /6 none s 0 sg ml - - 0.7 1.2 fl a�� ��' , Redoximorphtc coneentratiats and depletions reported in HIIKi are due to greater matric potential of sil over Is. Comm 85.30 (3)(a)2 applied to discount featrures as limiti facto * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > < 150 mg/ #2 = BOID S mg/L and TSS <30 mg/L CST Name (Please Print) Sign ure: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/30/02 715 - 248 -7767 prope4 Owner Steve & Cathi Angus Parcel ID # 040- 1287 -10 -000 _ Page 2 of 3 31 Boring # Boring MI Pit Ground Surface elev. 94.10 ft. Depth to limiting factor > 121" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 1 0 -12 10ur3 /3 none sl 2%bk mvfr as 2f,1m 0.5 0.9 2 12 -20 10yr4/4 none sl 2msbk mvfr cs 1 f 0.5 0.9 3 20-64 10yr514 none sil 2msbk mfr ai 1f 0.5 0.8 4 64 -121 10yr5/6 none s 0 sg ml - - 0.7 1.2 Sal profile observed by use of backhoe pit to 105 ". 106'- 121" observed by use of 2 "' hand auger through bottom of sal pit. F—I Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor acor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDALI *Eff#1 *Eff#2 F Bores # I 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 *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD S_30 mg/L and TSS < 30 mg& 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, vlease contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. ' A r� La.�Qq¢lcr i�a'l�o/ �OC4 -'�fCl (l�Or�. StR7f�e' 2 2- So ; /aua� %t by b. 7T p of Eelepko�e SEe✓eQ Laz`�C I lot / Rcvyyswyy -See. iS 7'; o j I �\ To S.&. C, C. 0 1 G cell. Two Cz) • .(.ca� 9.P .o, \ o \ / 8i ■ 987' ■ 82- o as � n sk ps i code. \ m IV) l jolaPosed cD v/sov Sa P ProPoSkid r Ice e64 /uonf 4 bLdboo.►, ♦ /�; G.ac�. QE P �o I weu l Pro 05zd drive I BioDiffuser Specifications I A, Tt K � , dv; 76 i �� O O OD OCO OD 0 �7 �� OC OG7 �O 00 OO COO OO c� 0 00 OC OO Chamber O 00 OO COO OO 00 OO 00 OO Hegnt OO 00 OO OO OO 00 00 OO COO — � � OO OD CEO DD 00 OD OO OD �� 1 00 O OO OOH 00 00 COO OO —��� OO oo OO �0 00 00 OO C=== A li inslld �+I` CnamDer and comp \ He 9m for, 1.0 t 'w• ) `, End View �\ Capagt,. B,iop' P desi t gned fo 34" A minimu of`1$' 1, required fort` �a 4" Knockout Universal End Cap Available Sizes , is r Length` q 7e 7615 Width „t �,, 455 3411 i ts 16 v Invert 65 9 11.3 ;�; �� �f r 11 Q . x m LL V l Q - , 3 Q ° --� � m o < Z 0 m Q Q a 0 � Z v X Q r .. Q of O Q CC n V x O a cQ Q Q 3 p -- CT Q. n �IN T RT� 77 8 7 6. v CTi __3 x I W CD i1 i Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG /L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to your plumber, Jim Eichten at (715) 483 -5194, or the Polk County Zoning Department. ST CROIX COUNTY , SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer & JQ & lam, CA i c r1 CGS � - - -- Mailing Address SZZ W @St Ce crate 5� /C�� /�S � SS�OZ T Property Address p �Y r (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location GJ '/4, 5cd 1 / Sec. T / , 2 N -R /9 W, Town of 7O P �Y 1�_ Subdivision �,/od��' /"/a Li e , Lot # Certified Survey Map # AA-- , Volume Page # A — Warranty Deed # 6o ZV , Volume / J� , Page # Sa7 Spec house ❑ yes [P f o Lot lines identifiable 2-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. 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 of the three ear W expiration date. /© /o? SIGNATURE 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 the property des 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLI ANT 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 U. 1858 P 5Z7 67 C STATE BAR OF WISCONSIN FORM 1 - 1998 I; x1tT1LLgSH I. VAL5H I WARRANTY DEED RE13ISTER OF bfi5Li5 11 I� l ST. CROI CO.. w I r Docterant N fnhe I, RECEI VSD FOR RECORD 83 -19 -2902 320 PH Sam•E: miLler, a single paraon „1 I This Deed, made between ypppgfry ^. " Grantor, NEC FEE::' 11.08' and teve ngus an a i Aagus, us and an w e TTRpGpIyi5p•�FEgBe 180.0@ CC<•R1'sC FEE PAGE SS Grantee. I, to Grantee the following i( Grantor, for a valuabit considetatlon, conveys Co State of Wisconsin St. Croix described real estate In ; RecorOW Aron (the 'Property' }; r4rm tnd RetwnAddroea Heywood S Caxi, S.C• at Plat of Glover Preir a in she Town 1200 Hoaford St., Suite 106 of Troy, St. Cro x ounty, Wisconsin �� P,O, $ox 125 Hudson, W1 54016 • 040- 1287 -10 O ' Parcel 1dmdllonow ra,rttber MM t: This is not horresmel propenK .. � US tio0 II Together with all appurtenant rights. utle and interests, Indefeasible in fee simple and frao and clear of ennumbraneea except Grantor warrants that rho title to the Property is good, 14th "larch 2002 Dated this _ — day of ` &A) (SEAL)' j S J � _ (SEAL) i t (SEAL) (SEAU !� ii AUTHENTICATION ACKNOWLEDGMENT t � rl Sam S. Miller it Sl<nature(s} State of W1aeottain, St. Croix County I Ma -Ch Z002 Fersonally carne before me this Loth day or authenticated shit 14 th day of March 20 2 , dte above rtalltad .1 Sam E. Mil as:' 3 0 to TITLE: MEMBER STATE BAR OF WISCONSIN me known to be the person ' the foregoM (If not. and acknowledge the am !t7 - suihorized by 5706.06, Wis. Srets•) instrument a. t fj• THIS rNSiFUMENr wA90RAFTED ev 5 H eywoo d & Call. S.C., 1200 Hoa St-, Notary public, State of Wisconsin Suite 10 _6. P.O. Box 125, Hu dson, WI 54016 My eotnmtseton is permanent. Of not state exptreton dace; (Signatures may be authenticated of acknowledged. Bath ate not _ �tetessary} it i 1ain�e ut peaona synhp In .r,y c•p.��tr m��t b° �1'Prd °r Prinmd erlow STATE BAR of w1SCONSIN wi WIM LeQal9b^ OA . rm, II Mirwat *et, W* rnRMNe.t.ION * TOTAL FAGE.02 ** m`� oz mC) cn CD 0 y. Im J z cn m cq Z / C 0 � O 0 / 0 o I �o I mm / I d - -- ---- ----- - -- -- 4 T 0 nn I t �/,� -------------------- m / I-O- �o�oaWa I i Vodp o- P@o I Tag g a - - - - - -- I / 11 0 VV1/4 CORNEA rn _ SECTION 15 179.24' — — j 6 d I0 S $ so CID rA n / , ............I Jill OQ� I I K" I �. 'Y V • 'll I� � vy I o II LOT 1 o m I 9: 2.31 ACRES : 100,750 SQ. FT. i O A I F.F.E. = 969.0 i 1 i IIII� 1 N89 13"E 267.38' ob 14.62' 26.00' ,o I I� t o I I 33' I � b l O z I i y SW CORNER 1 I SECTION 15 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ST• C1�O l X include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ? EN'Z >) Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner R��� �, �T Property Location Cho �� ZSTCI�T Rft&+ff2. 1/4 1/4 S \ 5 T Z- N R 1°I E(or W J�cepe�w Mailing Address Lot # Block # Subd. Name or CSM# s l o b e tz Iry t �v �1 Z1 u tr 1 GL_O City State Zip Code Phone Number ❑ City ❑ Village [K Town Nearest Road HU Dsp1v wl sg 0Llo ( -1 L S) 38b -3 osi - r7 - XZ)' - f GLUV �( New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate 6 00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent rtJ,aterial 6 L P �l t O Q TviNS Flood Plain elevation if applicable General comments and recommendations: Z 0 - 0 -Is j l! 3 r xg3.1S ' La),jG wt'T14 !S U" to of �* i G e fYPA L' L`i� SL L �nJln/I�L�VL is Cl� CL't s P�1L F-11 Boring # ❑ Boring ® Pit Ground surface elev. 0 1 Z • S ft. Depth to limiting factor ? L L 0 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 Z 3z �b lt�ytZ3!` _ si I Z►-n sbl m �>^ �S - - . 8 3 6-6n S`s231. 1 S O S9 m CS ��� � t- Z bD =LLo tpY2� _ —j 4 E U ` qFf� ® Pit ce elev, factor in; So9A0pl xion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary' Roots /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 •Eff#2 O - t0"1 R 3L — SL 1 Z'-s 't> hA'V- LS Z 1Z - 31 1. — S)1 Zwl Sh1C \'n� 3 3o_�ls fo�2 S. us yn • 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 Print) i 0signattp CST Number Arthur L:'Wegerer � =01 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 1 _ u L4 - OI 715 -425 -0165 ICI ' Property Owner RSTL�T Parcel ID # 12 LF1'C>1 N G Page of Fa] 3 Boring # ❑ Boring ® Pit Ground surface elev. S - ft. Depth to limiting factor > 1 �l 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 1 0 - 1 2 1TwtR— 1.Z - SO t zcsbk 1n'ft- ��► 1 .S . 8 Z 3 1 CS - , 3 �z- b� - S `i1Z31 — 1 S M J 0S .� Z Z- F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. it. Depth to limiting factor 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 ❑ Boring # ❑ 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 /ft' In. Munsell Qu. Sz. C©nt. Color Gr. Sz. Sh. •Eff#1 •Eff#2 i • 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 (X6/00) PLOT PLAN Page 3 of 3 • Scale 1' = 50 ' 6 oV EZ- B.. q3.?s' °I I NW. I s.z. L'J 11 3 � i3 bh ( 6.3c{� �l Z l u �l Q � 0 a'�� .�-c 1� o= A'_.o►� __l�� of u � eo�v � oi� wooC�'c�_ aox�i�vL�7 -. �a� ture vl 715 - 425 - 0165 220254 CST Si Date Telephone I.io. CST !To. Job Pd0. I 33 33 W 114 CORNER SECTION 15 _ 1 7 _ 264.22' . - } 010 +, 616 �rn m . . .. . . . . . . . �. 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