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Home My WebLink About040-1288-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bwilding Division i INSPECTION REPORT Sanitary Permit No: 405162 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: Mark Anthony Homes, Inc. I Troy Township 040 - 1288 -20 -000 CST BM Elev: ' Insp. BM Elev: BM Description: 0 vw 2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2. SS Dosing Alt. BM -�I S .T . Aeration Bldg. Sewer Holding St /Ht Inlet �L 6.2 f q TANK SETBACK INFORMATION St/Ht Outlet rv• �f�f , S r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ♦ � c7 I Dt Bottom ---�. Dosing H 5;m �s Aeration Dist. Pipe 10. 114 t S• Zf Holding Bot. System (� • /a�� Final Grade I If PUMP /SIPHON INFORMATION 5 `t' >?1•Z9 Manufacturer De and St Cover f GP 0.0 Model Nu ber � V ' zbb TDH Lift Kction Loss System He TDH Ft Force main Length to well SOL PTION SYSTEM(( /TRENCH dth Length ( No. Of Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 31 ( DIM (� Z SETBACK SYSTEM TO Di P/L JBLDG WELL LAKE/STREAM LEACHING Man acture,� INFORMATION CHAMBER OR �pGLr Type Of System: 5 O / 1 f UNIT Model Number u b 7 DISTRIBUTION SYSTEM `_/ wistribution x Hole Size x Hole Spacing Vent to Air Intake � Pipe(s) :lot � Length y Dia Length Dia Spacing ^' 1 v 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 — 1 Yes LJ No j Yes I&I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection // Z� � Inspection P tion: 360 Indigo rR' alas, WI 54022 (NW 1/4 NE 1/4 31 T28N R1911f) NA Lot 2 Parcel No: 31.28.19.1637 t BM Description = 1 �n�►•yL , g ws/ 2.) Bldg sewer length = Zp' u - amount of cover = y ofv , - Plan revision Required? L ' ; Yes I.f/No Use other side for additional information. ` _._- Q"�J��^•. _ (' Date ` Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County s ' m 201 W. Washington Ave., P.O. Box 7162 57 ' e e t X �scvns►n Madison, WI '53707 - 7162 Site Address 3& rti t yo Tip. Department of Commerce ��V F4 S� " Yo L z Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21. Wis. Adm. Code, personal information you provide t may be used for secondary Law, a15. 1 m ❑ Check i Revision I. Application Information - Please Print All Information State Plan I.D. Number N i Property Owner's Name � �{.Q /� AA/ �� V ! O Partxl Number R 0 6& , ' 1'C„ t ,if'/a 1 t 5 Property Owner's Mailing Address Property Location PO• /.SOX.. /07 JUN 1 1 2002 ' Q w ��" 'A A �u: S" TV N. R I/ It City, State Zip Code ST RP�Mt"gTY Lot Number Block Number V�SO� 4 j S y Subdivision Name f JOLF H. Type of Building (check all that apply) 'X& p,,- �_ o,� am 3t i or 2 Family Dwelling - Number of Bedrooms / O'VHla e El Public /Commercial - Describe Use g owns hip 'j' o Y ❑ State Owned Nearest Road X. _ 3 x �{- .vo %6-v 7';1PA z- III. Type of Permit: (Check only one box on line A (numbering scheme for Internal use). Complete line B if applicable) A. 1 )(New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use System Task Ord Existing S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) Ar p O 44 O_Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line %3 O 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 0 Recirculating 30 ❑ Other V. Dis ersaUTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Rate System Elev n Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation (000 p / ,4A! S SP 4 S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Pi95tic Gallons Gallons of Tanks Concrete Constructed Glass t New Hxisting t Tanks Tanks Septic or Holding Tank X_ / / �/_ • e Dosing Chamber � VII. Responsibility Statement- I, the undersigned, assmne rea risibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number. z� . s '7 G - Sid's Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl i t Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) - ❑ Owner Given Initial Adverse . Determination 2 f IX. Conditions f Ap rove easons for Disappro 1 AftilM complet p o the County ) for the "em on Oiier not lent than SM s 11 tech le du spe u SBD -6308 (R. 05(01) M VN MN M Q d aj • p !t • A O \ jo d O W _ d p. `� _ A co Fw cl CL uj im W O0 �O b X I t 01 ? LL TA o f - e 00- � \ � V O e ur_lur rrrL,r r r t� ��a5u�.M�i�S �� 655 O'Neil Road • Hudson, WI 54016 neg..Deslgne►s of F.nglnoering Systems 715 -386 -8185 Private Se►vage Consultants PROJECT INDEX PLAN I D fl DATE Ro6- OWNER E"IQ ;1, PHONE ��S " 7" 02 ADDRE P. o. /3ok LEGAL DESCRIPTION LDT '# Z �A s7. l -O WS , PIA yp. /// . 5 /7 ' 4,Pnets'S : 3 /O o : rwhiw 7XA L ,P. j Sy ZZ .2 0 • oa e N W, Vg S31. T.z'AJ, R /fw TOWN OF _ COUNTY ST 6X401 X CSTUI R . W&c — 2-z-43 7 S LOCAL AUTIIORITY/ SUPERVISION sT Cho/ X 6;P Zpwl, 6— PROJEC DESCRIPTION! • 7 9 AA- IN f IG 7 P-5 jK 13,',o 31- S¢- fl • c SSkW , THIS POWT SYSTEM SHALL ' Uibricht & Associates INCORPORATE PER COMM. p sewage Consultants 83.44(2)c A PROPER ZABEL 655 O'Neiil 16 FILTER MODEL # .4 , /0 rl), " �2,0 ) Hudson, 0 �1RL pq - z Pg.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg.4 " to of of of it P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /01. y - h Q AN oo 113 T DU o � 1 � y Nb � oa 4 n JN � ?p Z �N s O c o �o q � 0� �� , air I y Zx Lv 00 rh oxpl i � r cn cn O m I p ► ► I C -r ''` ^ '� U3 W i ol , r I i 'o► O _ ( A I ti k :r O B \ O �Zpw e a O \ os c o w Ri �a LAI • Crflcv�h�ED i Sfi�NGG f0 p 1 9 /p0 o e 1 �r Tfe- .yiv 1/� - !K 1 ;; 3 -m- Em l� K S ST�ti1 y W 1 A ) (r IN i 7e4 7 - 01<',5 y „ L ��.�,. c,� Acs r ;��E�v,,v�;Z° �o�� 3 x G a. — 1// j — I /// 9 ut 1.1 . 9 �- eq OVER: See Reverse Side for Vent/ Observation Pipe Details. An observation pipe may serve as a combination observation/vent pipe providing it terminates in f the same manner as required for vent pipes. See Figure 6. I -Vent capes Return Lend Cap 12" miry. _.�.. _..._._ 12" min. V Final grade Aggregate ` Distribution lateral typ. I . A � : k =, System elevation ` Figure 6— Vent and combination observation/vent pipes Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance >_ 4inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. Water tight cap F Top of 4" min. dia. leaching Repair couplings chamb .. Slat�� 6" min. min min. Infiltrative surface Water Closet Collar Bar(318" min. dia.) Figure 5 - Observation pipes Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4 inches. OPjNETt's MAINT'AI OF SEPTIC SYSTEM PAGE 6 REVEi2SE SIDE POWTS (landowner) is reponsible for proper operation maintenance of this sys and tem. Regular periodic inspections and servicing is necessary for the safe healthy operation of.this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling,authorities. SPECIFIC CONTACT AGENTS ' * Governmental authority/ inspectors: GTy ZOW ",A)6— -h t� - 3 8(v - 4,(p gv * Licensed installer, responsible for providing an operation/ maintenance "Users" manual. 7/ • 3 S6 • S /8S Zl� / 3 R7 - �y�ot'S # Z z 3 - 7 S * Licensed serv�ce / inspection agent other than installer: n3 ,�v 1q01e6-,¢N 3 (� • ?,1 a * Electrician, for pump, electric controls, wiring units: IMPOR'T'ANT' OWNER MAI NTENANCE REQUIREMENTS i• Winter traffic (sledding, shove*in area shall not be permitted, or frost e can /will into the cell, freezing up the system. Discontinuos use in the lead to freeeze eze u pss. . winter (a trip, resulting in no water use) can also u Z• Water conservation needs to be exercised) Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of C-0 gals. daily. 3• POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4• in a power outage occurs, or a pump fails, it may L result temporary overload of effluent being Pumped Into the cell., which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your Installer immediately for advice. 5• Neglect of the vegetative cover (the cells insulation & erosion preven';ive) can lead to failure. compaction or heavy RErU traffic also can destroy F, lie system. It IS NECESSARY TO i. WR'I'ER T'11E VEGETATION OVER A SYSTEM! i Effluen the system beneath IS NOT sufficient alone t0 maintain an grass cover. G• Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system. on the mound basal area inspection pipes), cleanout terminals on th of T level. laterals, at each ti pressurized out. The filter s p - for flushing and cleaning the laterals ground cove r /manhole)• in the tanks (via a locked above Person should be e ) . Only a licensed properl & severe safety rpsks�rr� enc e swor whInt Involvesihealth system's treatment cell shall also be regularlydinspected. � y. vYY : Ro AfARK2/s &46 /44'W' A ow �S 7/ -3 PS • fir - . `o. 18e x 7f, #- UPSOA) W,. SVo c y :: XT• z Wisconsin Depaitmenl of Commerce VALUATION N SOIL REPORT vision of Safety and Buildings n Page / of 3 QG _ i o -� J 53i cF 7 � In accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper riot less than 8 112 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction nd !` percent slope, scale or dimensions, north arrow, o ne rest road. Parcel I.D. Yo , /�� . 02. 0 D O O I � pq Please Print all in nnPfF , U Reviewed by Date Personal information you provide may be used for sec dary purposes (Privacy 15.0 (1)`(m)). Property Owner TWS Al I � rope y Location M N /- �•� R I N !v Nom" z rl l7��" -C c0U govt. of � 1/4 1/4 S 3 / T 6 N R // 4* (or) W Property Owneailln Addr • ass -ONI 2 � tG tOs �, /�/� � Block # Subd. Name or CSM# /� Z T MEpo W City Stale Zip Code Phone Number E] City [] Village J4 Town Nearest Road g VIA,, ��'1 //S 4 4 Syo ZZ ( 7 /S Y)s • (3 � RO ri w Y. New Construction User Residential / Number of bedrooms Code derived design How rate I O O El GPD Re p l acement Public or commercial - Describe: Parent material S�NP a w Cil _ �i "`"' Flood Plain elevation if applicable f . General comments /_ and recommendations: / �l ( i - OWN7-QNW L 1A) fjlIPd 0412) 1Xk4 4,Q7_ Ili Borin g # [j Boring C 7 �qD / V-Pit Ground surface elev. 10 0 ft. Depth 16 limiting factor / 0 in, Horizon Depth Dominant Eff#1 'Eff #2 Color Redox Description Texture Structure Con i Soil Application Rate In. Munsetl Qu. Sz. Cont. Color s stance Boundary Roots GPD /fit . O• /� l� Gr. Sz. Sh. 1 G SbKT4 w .s • 8 . ),0 /o yR S/ S K ,• c41 xf . s 4�1 /D --- r .S Z- Boring # ❑ Boring Iq • ys Pit Ground surface elev. ft. f•D Depth to limiting factor `O in, Florizon bepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD /ft n Rate In. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 o- /0 3 � 2 CS •G • y v L If .wt C • y �• s R y c1Gl� GS — c i . . 4�7 i. T /LandTSS Effluent #1 = BOD > 30 < 220 >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name Please Print) Signature or�.r �tlbRi�147-- Zz�3 s Address Dale Evalual ion Conducted Telephone Number G oZoo z. 7i5' 38G • /Bs Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. HiMson, Wis. 54016 ORI GINAL r �N S T /� - S Properly Owner Parcel iD # page Z of Poring # ❑ Boring 9 M_pll Ground surface elev. " . ft. Depth to limiting factor -> /J In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /n= In. Munsell Qu. Sz. Conl. Color Gr. Sz. Sh. 'Eft #1 •Eff#2 YX 2 z fsbx ,� w 3 • •s 0 A 45 44" d,e e / Z 7,5 - Z ❑ Boring # ❑ Boring ❑ pit Ground surface elev. tt. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /H: In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •EH#2 R r ❑ Boring # ❑ Boring ❑ pit Ground surface elev. H. 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 'EH #1 •EH#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 02 = BOD < 30 mg/L and TSS < 30 mg/L ' ' J The Department of Commerce is an equal opportunity service provider qnd 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. sn6- e��drrt Fmnr T � � � I D � VN x' C � C Q ° I . , m D 3 3 N , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address - Property Address (Verification required from Planning Department for new construction) yo . �� . 2 ,.0 • trr� City/State ,A SonJ 4V / Parcel Identification Number o LEGAL DESCRIPTION Property Location /1/4/ r /., AI�F V4, Sec. T,? -R -7—W, Town of �'d S/ Subdivision iC 7 II ' PIV 4J s . Lot # _ Von, Certified Survey Map # 4) ' Q . Sow , Volume _ . Page # Warranty Deed # �- 3 . Volume 9 7 . Page # s S Spec house q yes ❑ no Lot lines identifiable W 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 li cense d pum verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of year expiration date. S N OF APPLIC DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. /J,* O _ SIG A OF APPLICANT DATE s « « «ss 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 * t U 1907P 055 68 STATE BAR OF WISCONSIN FORM 2 - 1999 RAG SEER OF A DEEDS Document Number WARRANTY DEED ST. CROIX Co., VI This Deed, made between Mann Valley Contracting, Inc., RECEIVED FOR RECORD 06 -10 -2002 8:45 AN IIARRRM DEED EXEMPT # Grantor, and Mark Anthony Homes, Inc., REC FEE: 11.00 TRANS FEE: 227.70 COPY FEE: CERT COPY FEE: 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): E D I N A REALTY Recording Area c/o Metro Legal Services Name and Return Address Lot 2, East Meadow, St. Croix County, Wisconsin. '`Y)&ro Le AND 33a rnl n r lC, Sfi 1J�05 Outlot 2, East Meadow, St. Croix County, Wisconsin. 1, rnro 55101 040- 1118 -20 -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 7 -- day f May 2002 Y Y , Mann lley Cont ing, Inc. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ��" ) ss. S ZNot 4 , l ., Y County authenticated this A. STAYHRG u IC Personally came before me this � day of Ma 2002 the above named i 'cr nsin Y �'" Mann Valley Contracting, Inc., * by TITLE: MEMBER STATE BAR OF WISCONSIN it's ' (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrum t and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of isconsin Hudson,WI 54016 My Commission is pe anent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) f ) * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company. Fond du t ae wl STATE BAR OF WISCONSIN 800 -656 ZOZr WARRANTY DEED V� "&,. u„ - 1000 V V T V Y! T J❑ I `/ J F- � � I 888888 8888 8888 �,Vo x —_-j °N cm �N��mm�g i^-F -1- M _ W JJJ LDWU 0 0 0 ° z 7: 0 3"pE[b°OtN r N N W N r � � C9 08800 b r N b crj -n- co / v 0 I / cV / W I I N a: a ~ L I I a° w cv) 14 103 ' �� i 3O bNlb�Q � - -� • - - - ��. � °i Z 3.99,8 0.60N 1 OUT OT 2 -4-9,091-SO.. FI___ - 1 .� w M.B I, ge l GOS .£@'@E 00•9W ATS 3dld a NO>:il «G d0 d01 Nr:i`dWHON38 ZY t MAn.e L. �0. cos g r $ - --- - - - - -_ r Ilan • H ■ wL ■ O , r 6 88E 381 10.10N cQi 4'8 8 31doV saz S jL olln — — — — — — — 90'09 oft mm"Aos �3.19,@0.00 S 4 HLnos - HJWON ®�� inNOw W3NN00 -- �Ol MWVV*I'JN38 C � 10 C Z- 3 1 / i V V I Wisconsin DeOwtment of Commerce SOIL EVALUAT REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St Croix Attach"complete site plan.on_paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 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 Property Location Mann Valley Contracting Govt, Lot 1 ) 0 1/4 n L 1/4s31 T Z gj N R l �1 ®r® Property Owner's Mailing Address LoV Block # Subd. Name or 14 Dry Run Road $,k QIQLJ S City State. Zip Code, Phone. Number oCity Village • Town Nearest Road River Falls WI 54022 ( ) Troy e i New Construction UseC Residential / Number of bedrooms Code derived design flow rate O GPD Replacement O Public or commercial - Parent material tti k9 R n e ev We Yl ft General comments �► [[ and recommendations: RECEiVCO i AVC 2 9 Boring # 0 Boring � �� pit Ground surface elev. 0 ft. t in. Soil Applicat Rate Horizon_ Depth, Dominant Color Redox Description Texture 6` tence Boundary Roots GPDW in. Munsell Qu. Sz Cont Color Gr. *Eff#.1 *Ef#l2 1 0 -10 10P V Sr 2MAk 1V Tr Q( 2 S S i, IM5 VW r C j f_ .15 Ile D Boring ,# D Boring �^�, U Pit Ground surface elev. o . 5 Depth to limiting facto g s in. Palo Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efl#2 0.1 1) 10 f? Z t 2.f15 �( 0 Z S � Z 0 0-J 5 It 5 , 6) 3 5-95 1-5 - 5 v I - ,7 A * Effluent #1. = BOD > 30:E 220 mg/L and.TSS >30 <150 mg/L. * EfAu - BOD :E 30 mg/L and TSS < 30 mg/L. CST Name (Please Print) Signature. J~— CST Nurir o, Gc ILZ 7 :3 7 Address Date Evaluation Conducted Telephone Number 143 1 20 Property Owner Parcel ID # Page 2 of 3 Boring # Boring pit Ground surface elev. `'! , q - - ft. Depth to limiting factor �_ in. . Sal Application 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 TRW 2 - /0 r VA Sr 1 2M sbi, r eLa a Boring # 9 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 GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. S Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf? 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. SBD43Mest (807100) 4 JZ- C;/� qve 0 \e 5 d �fl � b � ?oh 100 cn y, Top COn to 0 � pip„ 0� Q1 10 �,�� Q Z 100 5 'Z 7-7 3 �7 -40- ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner N Address ,3Co 7,44 +/4 , iWk, 145fl1r; Syd22— City /State Legal Description: C Lot Z Block Subdivision/428*f4 '/, NW ' /4 ,Sec., , T N -Rjf Town of d PIN # OY&' 1//,C• illd 6v�,(/ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION 7e) • ,9,4 /2.50 .2 Tank manufacturer Cv) Size ST/PC / Setback from: House Well x P/L 3 5 Pump manufacturer N /A- Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM CW . Type of system. Width 3 Length 8 Number of Trenches Z Setback from: House ( 07 Well P/L Vent to fresh air intake > .5'd ELEVATIONS No veil y&r C'S T's 3Iy Pt/c PIA_ Z / 03• l S Description of benchmark Elevation ' Description of alternate benchmark Top or S• T• 4 i4 iAv P owti Elevation / — 0 5. A , , Building Sewer / y � ST/HT Inlet ST Outlet � �' S7 PC Inlet 1y 1 4 .77- p /Os•�y� PC Bottom Header/Manifold To of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System Final Grade ( ) ( ) ( ) R1 1v Date of instal anon / / Permit number Lju�� 2' State plan number /- Z1 Plumber's signature -R License number Z z `e 3 - 7 5 Date Inspector / + /V tr��"�� 1 7 Ulbricht & Associates Complete plot plan Private sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 'TI W 2 Z m�0in � N � O Q °m 1 Q r>m "0 U) c� }s O M ( 4 m 7° �y 0 +` WCD d I' ii • Io I II I' it G - QN �. eE I N S I I I v\ c VN � I I 3 b CIP o c �