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HomeMy WebLinkAbout040-1314-02-000 \4 sconsin of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514831 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: Anderson, Jerome & Patricia I Troy, Town of 040- 1314 -02 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /06 6 /v l]- o ljyh / 33.28.19.2052 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W _ Benchmark Dosing Sad � AILSAk� Aeration U Bldg. Sewer Sc l C/o ��� S Z 1 3.91 Holding St/Ht Inlet . � � ��• I TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Intake ROAD Dt Inlet S Septic / Dt Bottom > > )15 } 13. 1 3 - 7 Dosing zS Header an: ,-7 Aeration Dist. Pipteetj,. a AN). r Holding Bot. System rff/ Uxkii14 q 3• Final Gr e PUMP /SIPHON INFORMATION A) e-- - j- r,�Q�, Manufacturer 4 " Demand t Co r -7 PM r 6 /7.� Model Number / / � TDH Lift Fri t' n L s System He TDH Ft Forcemain Lenoth Dia. �� Dist. to Well / SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PI IMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BLDG WELL LAKE /ST AM LEACHING Manufacturer: INFORMATION CH R Type Of System: IT Model Number: rw DISTRIBUTtqN SYSTEM 10 CR I kF> Heade anifold Distribution / x Hole Size x Hole Spacing V6toAir take P ipes) �) J, / 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 ,, 6 xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No pp COMMENTS: (Include code discrepencies, persons present, etc.) 1: /�/ dd Inspection #2: / Location: 21 Serenity Court River Falls, WI 54022 (NE 1/4 SW 1/4 33 T28N R19W) Serenity Meadows Lo't 21 Parcel No: 33.28.19.2052 /+����� 1 1 Alt BM Description _ )-r w�"�C Ix ��� -� :> / Of itional information. 1 p? / O " ; ---- - - - - -- - -- G -- J -- - - -- -- Date Insepctor's Signature Cert. No. RECEIV commerce.wi.gov Safety and Buildin Division County r 2Dtlt NY V1{a�n Ave P.O. Box 62 - f C dZ 0 IV w � � 1 f C D [me I 53 07 -7162 Sanitary Permit Number (to be filled in by Co.) Department as Coauneres Sanitary P � lU State, Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may sed for secondary p urposes in accordance with the Privacy Law, s. 15.04 I m , Stats. �/ S P+r / da� , L Application Information - Please Print All Information Ir [� Property Owner's Name Parcel # � 2 o/n E o o1,315-K o z o o Property Owner's Mailing Address Property Location 5 12 GC�.7 G�ovt. / Lot City, State Zip Code Phone Number / �/ (,w /, Section �3 9 �9 „Q / G l �jZ -�_ trcle one V r' � T�N; R�Eo& II. Type of Building (check all that apply) Lot SubdiyisiQnNgrtte ._.____.. 64 or 2 Family Dwelling Number of Bedrooms i O k ors Block # If Vf ❑ Public/Commercial Describe Use ' a.�.. ❑ City of ❑ State Owned - Describe Use A 0q CSM Number ❑ Village of k ^ , � C ownof y III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System C1 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑Permit Renewal ❑Permit Revision 11 Change Previous Permit Number and Date Issued Change of Plumber ❑Permit Transfer to New � Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) rJ • ❑ Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade ® Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreatment Area Information: q Des i n Flow gpd) esign Soil Applic ion Rate(gpdsf) Dispersal Area Requited (st) Dispersal Area Proposed (sf) System Elevation f bov 9, z� VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 01 o New Tanks Existing Tanks Q 2 " 2 � Septic or Holding Tank Z 7, JV W 1 6`5 -tm- Dosing Chamber /�" ' �6 VII. Responsibility Statement- 1, the undersigned, assume re sponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) / Plumber's azure MP /MPRS Number Business Phone Number R D tin 6 0 (_VI - z 76 - 7 7i� z a 3 XY,�� Plarnb Address (Street, City, State, Zip Code) V11I. Count /De artment Use Onl '� Approved Permmit Fe Date issued QQ Issuing Signature �iven to Denial $ l0 66 ' Oa �L1 IX. Condir.K #tWeasons for Disapproval 1. Septic tank, effluent filter and 3' ���� �ie> r,•. J�a J dispersal cell must all he services -1 maintained 44, .- Gt �-C �1 i1 � DGrt^^ • �. as per management plan provided d by pNmber. / 2. AD sdtback requirements must be w4 tttsined as pa Ipp tine t to complete p arts or t e system and submit to the County only on paper not less than 8 1/2 x t 1 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 3 Plot Plan Page 8 of 8 Property Owner 1 " =40ft. .Legal Description LoT z S ER EN rt MT-a ov w s (except where noted) of TtcE 5W � /'j S 3 3 T 28� R19 v�, Tow OF = B pit _ TRaV. ST. CRo \x Cro u�.nY�,w� sca�sti n.3, 5.OY, t��'R'ES North 0 T w 3 � (N v w x o� v ry J Q Q1 3 y ZY.t aosa�� - 4b ' SZ- .83' J'® P * V C �bl 'moo 2° c 000 0� � � 4Mti p ._..__.... ---._ �M,Op� ���•�.' `U Vim" 4� Fi�� �tA' Q � I �. \p GD 49 Site Location: rJ. ft. MM C SEA a J ECOPY O Z J C.T. ti M " P e8 o 8 Plot Plan � .f Property Owner A 1 " =40ft Legal Description to-r z sERrNrc / r -Ac*ws (except where note me 4- 'TttE SW YLL 51. T 28JQ , R19 vA , Tow N OF = Backhoe pit T910Y ST cRo \x coul yn\4, 1 sca�5i N. _ 5.0`b ACIZEs North 0 T w 3 h O N C V J Q y �P of 2p ap 055 4b� g7,op' �(DaQU),p �bl �C80 2n MA1A►? 0 00 J b M YP ,GO' 101.0D, ED a� S V Site Location: Q 33 C a z J C .T M Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi:gov ` C�y LA CROSSE WI 54601 -1831 i s c o ns■ TDD #: (608) 264 -8777 n www.commerce.wi.gov /sb/ e f Commerc ■ L �u� www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary R ECEIVED December 14, 2007 tr C 21 2001 CUST ID No. 224832 ATT1V. POWTS Inspector MARY JO HOLLISTER ST. RO COUNTY ZONING OFFICE HOLLISTERS SOIL TESTING ZONtFVG OFFICE ST C OIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/14/2009 Identification Numbers - Transaction ID No. 1491131 SITE• Site ID No. 733264 Jerome & Patricia Anderson Please refer to both identification numbers, Serenity Court above,, in all correspondence with the 'agenc Town of Troy St Croix County NE1 /4, SW1/4, S33, T28N, R19W Lot: 2, Subdivision: Serenity Meadows FOR: Description: Four Bedroom Mound System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1165437 Maintenance required; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes.. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. P.O.W.T.S. Conditionally A PPROVED DEPARTMENT OF COMMERCE DIVISION OF SAFETY AND BUILOIMrs • MARY JO HOLLISTER Page 2 12/14/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 erard . Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WSMART code: 7633 jerry.swirn@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. i a ' RSQ MOUND AND PRESSURE DISTRIBUTION COMPONENT� DE i& 3 200,7 Residential Application �p INDEX AND TITLE PAGE s Project Name: JEROME & PATRICIA ANDERSON Owner's Name: (same) Owner's Address: 1678 S. Ridge Road River Falls, WI 54022 Legal Description: NE 1/4 of the SW 1/4, S33, T28N, R19W Township: Troy County: St. Croix Subdivision Name: Serenity Meadows Lot Number: 2 Block Number: -- Parcel I.D. Number: 040 - 1314 - 02 - 000 Plan Transaction No.: ®NS�/�••.• title Page 2 Data entry �. ®'�:: '•.• Page 3 Mound drawings 1~f MARY JO :• Page 4 Lateral and dose tank HOLLISTER Page 5 System maintenance specifications 1859 a Page 6 Management and contingency plan : RIVER FALLS, :' ; Page 7 Pump curve and specifications •® WI : Page 8 Plot Plan Designer: Mary Jo Hollister License Number: 1859 -007 Date: 12/11/07 Phone Number: (715) 426 -1775 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 8 SEE CORR PONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) col form of - 36 inches. 600.00 Design Flow (gpd) 5.00 Site Slope ( %) 98.75 Contour Line Elevation (ft) 36.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/fl?) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest po int in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 8.33 ft /orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 8.75 Vertical Lift (ft) 46.83 5x Void Volume (gal) 2.49 Friction Loss (ft) 59.88 Minimum Dose Volume (gal) 0.50 In -line Filter Loss (ft) 38.77 System Demand (gpm) 16.29 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser IManufacturer gal /in (enter result in cell B49) Dose _Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) 113est _ Filter Manufacturer 22.241 Dose Tank Volume (gal /in) BTGF10 -8 Filter Model Num` Wieser Manufacturer Project: JEROME & PATRICIA ANDERSON Page 2 of 8 Mound Plan and Cross Section Views 1/10 B 3 J Observation Pipe K ::t : i.r :.r '? r' �r7: r:r��:r:'.i�r�r�r�r� "•': :r.r.i. } Ti�:.:.:. ?.r. . . . X . Mound Component Dimensions A 8.00 ft E F i n H — 10 - - 00 ft K 7.41 ft B 75.00 ft F 9.25 in i 7.66 ft L 89.83 ft D 6.00 in G 0.50 ft J 1 4.62 ft W 20.28 ft 600.00 (ft Dispersal Cell Area 1 1174.63 (ft) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.02 (ft) --► G ♦ H F ' pispersai Cell 99.75 (ft) L I_ atera l 99.25 (ft)--1- Invert Dispersal Cell ,:...�] :::::::::::.:.: ............... ....... . E D 3 ... Elevation �...........•....:.:.:.. 4 1 �x 98.75 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key 'a a'. I — Dispersal Cell See lateral details on 10 — Topsoil Cap a 1.5 ft ,•,••.•�•�• Page 4 for number, size, © '..... Subsoil Cap 0 o tr �' r r r and spacing of laterals. ASTM C33 Sand :� `�° ' {` °' {` ?�? �� '�? {?'���r' ` F Laterals are equally ;fyfy+.. �:.: r; r;. Tilled Layer 0.5 ft •: }, Typical Lateral :rj� ?:: ?:: spaced from the ' " "'' "� ' }''' 4 ' distribution cell's Aggregate centerline in the A distribution cell (AxB). Project: JEROME & PATRICIA ANDERSON Page 3 of 8 J Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical i P s Al— •= Turn -up Ydball valve or If- X-�IExf I W2->l Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 4.00 ft Orifice Density 8.33 ft /orifice Lateral Flow Rate 9.69 gpm Manifold Length 4.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.29 ft Forcemain Velocity 3.96 fUsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ---► Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented E— Alternate outlet location Forcemain diameter Wieser Manufacturer_ 2 in. Cap acityl 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.28 428.76 B 2.00 44.48 C Pump off elevation (ft) C 2.69 59.88 91.00 D 12.00 266.88 D Total 1 35.971 800.00 Do se tank elevation (ft) 3" Bedding uncTer tank. 90.00 Alarm Manuafacturer ITank Alert Alarm Model Number IHW101 Pump Manufacturer lGould f Pump Model Number I PE 41 Pump Must Deliver 38.77 gpm at 16.29 ft TDH Project: JEROME & PATRICIA ANDERSON Page 4 of 8 t Mound System Maintenance and Operation Specifications Service Provider's Name Darrell Septic Service Phone 715 425 -1025 POWTS Regulator's Name St. Croix County Zoning Phone 715 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft' Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished .. , ........ �,,..� .............. . Grade . 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JEROME & PATRICIA ANDERSON Page 5 of 8 •' Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be In accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the finer shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 afu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Pion 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. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: AU- DCK50,J 3cRn �E P TTzt eti� Page 6 of 8 v N UOULDS PUMPS Submersible Effluent Pump PE VNIMMIG mom WA TM Pump — Geral: ■ Carron rrt • Disdrarge: l % N" • Single ptrase aonMucML • Term; I off OODQ • 60 He& • Cast iron body. maximum, continuous when • 115 and 230 vdm ■ TM=Pbsdc impeller and • Mt4n 1homlal ar ked • 1!' I P "'k - with ara�rradc rem ■tipper sleeve and lower maximum sphere. • Class B insulation. heavy duty hall bearing APIIICATtONS • Automatic mods irrdnde a • 094OW design. a xubuction. float switch. • High strengdr carbon steel f Motor is wmarreraiy SPedally desgW for the • Manual models avaBaW. shaft. lubricated for aftnded falbwing uses: • Pum*g rang: see PE31 Motor: sewiae W. • Mound Symns perbFIR IM chart 0r cave. • 33 HP, 3000 IPM ■ Powered for continuous • Effluentbosing Systems PE31 Pumpc • 11 S votes operation. • taw Pressure Pipe Systems • Maximum cape ft S3 GPM • Shaded pole design m AN rAW am within the of the motor. • Basement Draining • Maximum head: 25 TDH PE41 Motor. • Hey Duty Sump/ PE41 Puuuap: • .4014P. 3400 RPM ro Quick d1swaned Pour DewakAig • Maximum Gwadty. 61 GPM • 115 and 230 volts axt 20' stmrdard leroo, • Maximum head: 29' TDH • PSC design heavy duty 1 6/3 SRW with ! 15 Or 230 vo!*. � PE51 Purr: PES1 Motor. • MaldrmMll capa*. 70 GPM • • !j0 HP, 3400 RPM ■ unlit is heavy duty, • MaAvwm heed: 37' TDH • 1 f5 and 230 volts portable and compact. METH FEET • PSC design ■ Meduar,W seal is carbon, 40 ceramic, BUNA and stainless 71 '' T • ' I " . f MOORS: PBT. P641, PE511 steel. 35 7-1 HP: A% AO-50 i ■ Stainim Steel fasteners. 1 10 �- i 1 2 GPM p 304 v =-1 I 1 1 FT ; ^� a I 1 T" �ck 0 20 , � i Tested to UL 778 and ' j ",- e- ' CSA 22.2 IN Standards r 15 -. _ _ _ -`_;_ 9�rCa1latinSfaAtso�tlon FI• *UB" 10h` _--..* 1 - _1 ! ua�iasnrapcisMriller6d 0 0 0 10 20 30 so 1 s0 60 •' 70 GPM 80 - 7 Gf Q �}FiR1GPt 0 5 10 1s m3/h Wisconsin Department of Commerce TIOPORT Pag 1 of 3 Division of Safety and Buildings RE g in rdance with Comm 85, Wis. A m. Code County ST. CROIX Attach complete site plan on paper not lose an 81 1 e. Pla must include, but not limited to: vertical and horiz ntal reference ifit (�liredio and Parcel I.D. 040- 1314 -02 -000 percent slope, scale or dimensions, north a ow, and location and distance to arest road. ST. CROIX COUNTY Revie by Date Please Print / infOQj OFFICE Personal information you provide may be used for secondary purposes ( acy .04 (1) (m)). ZZ Q Property Owner Property Location JEROME & PATRICIA ANDERSON Govt. Lot ---- NE 1/4 SW 1/4 S 3 T 28 N R 19 E (or) Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 1678 S. Ridge Road 2 -- Serenity Meadows City State Zip Code Phone Number [ []MIlage ■ Town Nearest Road River Falls, WI 1 54022 ( 715 425-6381 Serenity Court New Construction LlseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ff. General comments Mound System -- 0.50 ft. sand fill -- 0.6 loading rate and recommendations: Relocation of system area due to proposed house location. F71 Boring # 0 Boring Q pit Ground surface elev. 96.80 ff. Depth to limiting factor 39 in. Soil 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 1 0 -4 10YR4 /3 1 2f -msbk mvfr cs 3vf -co 0.6 0.8 2 4 -12 10YR4/3 1 2fabk mfr cs 2vf-f 0.6 0.8 3 12 - 30 7.5YR3/4 sl 2f - msbk mvfr cs Ivf - -f 0.6 1.0 4 30 - 39 10YR4 /4 sl If- -msbk mvfr as lvf -f 1 0.4 0.7 5 39 -43 10YR4 /4 c2d 10YR5 /6 SO Imsbk ME -- -- 0.2 0.3 Horizon 3 has some gr. 2 Boring # ❑ Boring 97.13 36 Q pit Ground surface elev. ft. Depth to Ilmldng factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 1 0 -4 10YR4 /3 1 2f -msbk mvfr cs 3vf -m 0.6 0.8 2 4 -11 10YR4 /3 '- 1 2fabk mfr as 2vf -f 0.6 0.8 3 11-22 7.5YR3/4 - sl 2f -msbk mvfr cs lvf -f 0.6 1.0 4 22-36 7.5YR3/4 sl If- -msbk mvfr cs Ivf -f 0.4 0.7 5 36 -40 10YR4 /4 c2d 1oYR5 /6 scl Om mefi -- -- 0.0 0.0 Horizons 3,4 & 5 have some gr. * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg& CST Name (Please Print) Sigriature 1 CST Number Mary Jo Hollister Hollister's Soil Testing & Desi i ' G 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 11-28-07 (715) 426 -1775 ti ANDERSON, Jerome & Patricia 040- 1314 -02 -000 Property Owner Parcel ID # � Page 2 of Boring 3 Boring # a pit Ground surface elev. 96.83 ft Depth to limiting factor 39 in Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -7 7.5YR3/2 -- 1 3fsbk mvfr cs 3vf-m 0.6 0.8 2 7 -12 7.5YR3/2 -- 1 2fabk mfr cw 2vf -m 0.6 0.8 3 12-21 7.5YR4/2 -- 1 2f -mabk mfr cs lvf -m 0.6 0.8 4 21-39 7.5YR3/4 -- sl lmsbk mvfr cs lvf -f 0.4 0.7 5 39 -44 7.5YR3/4 c2d 7.5YR4/6 scl Imsbk mf -- -- 0.2 0.3 Horizons 2 -5 have some gr. 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 F-1 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 GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I *Eff#2 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD 130 mg/L and TSS :5 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. seD- avareg (FLO7100) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner A Nzx�,zoa mT- t P,RR,� I " =40ft Legal Description LaT ?. seReNny P EAryows , (except where noted) X3e' /y OF TKE S VW � / 5 33 T 22M, K19 uJ, Tow N OF a = Backhoe pat TRfly ST CRo%x 0 DU�T�( wt sco NSt nl, S. ,Rc s North 1; O r W K 3 n 0 a v r-i \ 0 p�P sA D 0$3 9b• °17.00' T � s T0 fs� � • Jt 0 0 8 5� k �� .00 100 .00' o q � �G , 1� ..�� tip Site Location: l y .T.H.M�► d Q P Z J C.T. COUNTY PLAT OF: SERENITY MEADOWS LOCATED IN PART OF THE NW1/4 OF THE SWT/4. THE NE1/4 OF ME SM/4 AND PART OF ME SET /4 OF ME SM/4 OF SECTION 33, T28N, R19W. TOM OF TROY. ST. CROIX. WISCONSIN. SR9-43E —7.27 UNPLATTE �EASIWCSI 1/� LINE 114111.94- - - --- ------- WI/I C- El/. CDR. - .7 777777:77:77� I C. DIFIC boc# 7 FOE N REGISTER'S 01 o/ LOT 3 202,88 51711 AC (2,603,866 SQ. M) 1 5 FARMEM TO TOO—L�. (RECMDED XO- 2)54 PC. 25-30) LOT 4 7B.. AC (3�573 SQ. FT.) A. V" 50 CONI EASERIENT (RECERDE(I VOL 2754 K. 25-38) LOT I SAH AC (Q..O.0 C.. 'T.) C—ERVA'DON EKSTWENT (RECORD. —4 P. IS yy 120 "1" 1* 1: TOP OF Z V S•- — 2 858.92 / (- 21 B.1 OF COV-0. SURVEY Al 11 vOL. 7. PC 2017 LOT 2 LOT ry Of WIS 60 PREPARED BY. S&N LAND SURVEYING U-5 I, —ER 2920 ENLOE STREET S 1113 HUDSON, N 54016 N CC q 'A (71 5) 386-2007 1 .% PREPARED BY' I ti AU TH CONSULTING/ASSOCIATES - 6ig 29 20 ENLOE STREET HU 0 SON, Wt 54016 715) 381-5277 LOT 2 5"' (22 1,2)6 1, Fl) usEMENT PREPARED FOR: ONCEIIAl'" CH RIS M. KUSLUK & �NOCCRCEC 211. K. 2—R) D NNA ILEK NOTE. E ST, CROIX COD I— J 41 HWY A 35" " KU 5 '0 — 'Al IL FE I "Al CAXICS ' WI A LOT RIVER FALLS, 54022 IMESS. LOT 4 OF A C ..F C -1 SURVEY MAP 11 — 6, PACE .... M"' Sl IN E.0 C TH CONP"PORI OF TNE NEW ACCESS I— SERENITY COURT. LEGEND A.um —NTT SEC C TION CORN MONUMENT MNT D 6op FOLND I' OUTIRRE PE Ll 4 IOINT 1111 PI C E —WAY ------------------ j RE DEW Rl VEWAV E LI TSICE DAME— I—E"T 11 "'C" . 0 Y LONG RON WE WICHING -11,21- — C" uu .E. FOOT IS S!"", OF IRON PIPE WEIDIDN. LQVC AM OTHE . R LET AND OUT-OT TA CORNERS . ­TE. WITH N90W'Odf? ) 9 LIT T." OUT.. DIAMETER BY 18' — R 1.13 — PER UNEAR FOOT OUTLOT 2 ISOAC N y ti FT.) LOT 4 ( 72.60 { . DRAINACE EASEMENT LINE SEPTIC EASER6T —DON AREA - �z 2k f ;; IT CON— AREA - TO BE OWNED BY HOMEOWNER S ASSOCIATION COR DUE NO SETBACK UNE To BE RETAIN By I 8B9'1T'9lW 881.91' (AS sNOWN) OWNER " m ` p ' m ' EASEMENT —1— — ------------------------ I I RECORDED BEARING AND/OR MSTANCE - r 0 / ALL LOCATION SKETCH P—SED ORTWWAY LOCATION 0 .4 sm TRACT TOWN OF TROY H.w E m96{.9 . - E. - RCI 11111. ELEVATION C' I CmTmHr MM� c ­0 968.9 0 ST OUIUDDIC (WE-C - THE n LOWEST WROO. ON DOOR I.-D.N. N V! 12 UTUTY FAST— FIE=DETE W— - TP.S. .—R.T. A� CO TO - VC (88) 11: AIL LOTS T11 IlAll 'MALL'rRACT I ACRE NEn DIRAINAM 0 T �A . �8d ' ENT - - _ -- — - - - - - - - - - - - -- - - - sw COR SEE SEC. 13 1006.67' '37OBO —TN UNE OF THE S./4 - - - - - - - - - C. 1 N SC.L. IN 11- V - - - - - - - - - - - - - — LESS TO C-UNN' 'M' BY ROAD EA ­T ___� k Too 100 SECTION 33, T28N, R19W RECORDED IN POK -9 --- AT THE PIERCE COUNTY REGISTER OF DMS-,, BY — —E 1. 4 . R.31— CAFE REA— SHEET I OF 2 SHEETS " m ' oyr • DOp � m Aa —z{ p Z h —� Z N E4 NDZ. W � t coo 0 0 A r r. w - -m � ..� m 5 3: . o.rn as + 0 67 (� (A O m Z - T ! p m 00 0 s iA g ; m rw `vco 1 C.S.M. VOL.. 7 ]PG. 20 17 r ie/ tMS 3HL d0 'r/ t3S v - o rn £'M M60 & MOON 3HL .40 3Nll 1S3M „ AO'61:E f ALO 1..mb ,00.9 {, Ot ➢1 rt ` . a _ In °f - - ,sa'ss 6 0 °DTI -Co' ci w. o f iftlz" ii °a .� ° s �w' rn os 1 ` : �- z sip r R < hao o .E Z AA ? it , • �f�k:.. n CA Mr R 1 Y m j - u -,a9 ,09 -► ! �r p .. l.x Ny Wivl SJaO �� m ,�- 4 I Z C3 -� m ,fi o ..: w � 00 LGS 8 C I 9 •g� g _ `w Of _�" "_ M-6 .g�� N _ -� -µ `£�•6 -� `0. OF , �.9d,Vj 6z�8aM " 00'6 a z jS du MK f t , � r n ► st :,`•� -. . 111111111111111111111111 { 1111111 111111111 { 1111 IN 6 6 6 1 9 3 2 866193 STATE BAR OF WISCONSIN FORM 2- 2000 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Chris Kusilek and Dianna Kusilek, 12/26/2007 01:OOPH husband and wife, Grantor, and Jerome C. Anderson and Patricia L. WARRANTY DEED f rantee. EXEMPT I Anderson, husband and wl e'�G r valuable consideration cones and warrants to Grantee REC FEE: 13.00 Grantor, for a Y the followin g described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 360.00 *as Survivorship Marital Property PAGES 2 SEE ATTACHED EXHIBIT A R Area J3 IV; ri RO LEGAL SERVICES, IN 83!1 SOUTH 2ND AVENUc., SUITE 150 Exceptions to warranties: IiRME.r1POLiS, 4614 55 - 2217 Easements, restrictions and rights - of - way of record, if any. 819342 )Metro Legal Services 040- 1314 -02 -000 ED1RET 8 19342 A Parcel Identification Number (PIN) 806557 WD 166275 This is not homestead property. Dated this �Q Ylf I� �� "02 Chris Kusilek * Dianna Kusilek AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this Personally came before me this /,? A day of * 11ZMrWA. , aRA0 7 the above named Chris Kusilek and Dianna Kusilek, husband and wife to me known to TITLE: MEMBER STATE BAR OF WISCONSIN be the person(s) who executed the foregoing instrument and (If not, acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman — Steven H. Bruns Notary Public, State of isconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If � date: d -. �v (Signatures may be authenticated or acknowledged. Both are not necessary.) a► 'Names of persons signing in any capacity must be typed or printed below their signature a � � U , , ra a WARRANTY DEED STATE BAR OF WISCONSIN �0 1 of 2 EXHIBIT A Parcel 1: Lot 2, Plat of Serenity Meadows, in the Town of Troy, St. Croix County, Wisconsin. AND Parcel 2: Together with an easement for ingress and egress, including installation and maintenance of utilities as shown as Document No. 471810, Pierce County, Wisconsin, described as follows: A parcel of land located in part of the NE '/. of the NW '/. of Section 4, T27N, R19W, Town of Clifton, Pierce County, Wisconsin, described as follows: Commencing at the South Quarter Corner of Section 33; thence along the south line of the Southwest Quarter of said Section 33 S89 °4 1'29 "W a distance of 1006.67 feet to a point 305.00 feet east of the Southwest corner of the Southeast Quarter of the Southwest Quarter of said Section 33 also being the point of beginning; thence along the extension of the west line of that deed recorded in Volume 425, Page 61 at the St. Croix County Register of Deeds Office S21 °09'29 "W a distance of 57.40 feet to the northerly right -of- way of C.T.H. "M "; thence along said right -of -way N73 0 14'57 "W a distance of 134.59 feet; thence along said right -of -way N82 °04'11 "W a distance of 96.51 feet to said south line of Southwest Quarter; thence along said south line N89 °40'05 "E a distance of 245.19 feet to the point of beginning. 2 of 2 i l� 2 P .. 75�t 030 administration of this easement at all times. The election provides for lower potential subdivision and dwelling unit densities on 40% of the subject property and for greater potential subdivision and dwelling unit density on 60% of the subject property under the terms of the Subdivision Ordinance and as set forth herein. This 40/60 Farm Plan Choice by Grantor sets and determines the presumptive number of development rights available on the subject property at 19: two lots of twelve acre density in the 40% area and seventeen lots of three acre density in the 60% area. The location of the specific 40% and 60% areas would ordinarily be identified herein, and in that way each area distinguished from the other. However, because all development rights are being used either to create fewer lots than allowed or are being transferred off of the subject property pursuant to a separately issued and recorded permit from Grantor Town of Troy and because the property will be subdivided in a manner such that lot density will not be an issue anywhere on the subject property, the parties have agreed that no specific area for a 60% area designation or a 40% area designation is required and that Grantor's right or obligation to so designate is hereby released and waived, in perpetuity. As to the entire subject property, Grantor's right and ability to subdivide and create more than four new lots anywhere on the subject property is hereby severed, extinguished and released, in perpetuity. The development rights used to create the four lots on the subject property shall be one lot of twelve acre density and three lots of three acre density, leaving one lot of twelve acre density and fourteen lots of three acre density available for outgoing transfer and holding by Grantor for transfer into other land located in the Town at a later date. B. Uses On any lot(s) created now or in the future on the subject property, one single family residence may be constructed, along with related outbuildings to be used in direct and exclusive furtherance of single family residential purposes and/or in furtherance of the previously stated purposes and values of this easement. Minimal and necessary public or private roads and public or private, enclosed or underground utility installations are also allowed on the subject property. These uses are intended to supplement the permitted uses set forth in Section 5 of this easement. C. There shall be no subdivision of the subject property encumbered by this easement or uses made of the subject property being encumbered by this easement except as authorized herein, in perpetuity. D. St. Croix County shall have standing to enforce those aspects of this easement that define and limit the subdivision and residential development of the subject property. St. Croix County acted to rezone the subject property from exclusive agricultural to ag- residential zoning in December of 2004 in reliance on the perpetual limits that are created herein on the subdivision and development of the subject property. The limited subdivision being authorized herein will serve to preserve large areas of the subject property for agricultural purposes and production, one of the objectives of 5 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 /K � A* /Z / C / A Mailing Address 1 6 79 /& P I� FA Property Address rA) I f Lf C_ d CL Z4 (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 19� o f 3 O Z C) LEGAL DESCRIPTION Property Location 4 � /4 , 1 /4 , Sec. �, T _Z_�4 R_4�_W, Town of �y Subdivision Gj eN Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �Q �ij [ q Volume , Page # Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE F APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Wisconsin Departme OIL EVALUATION REPORT Page 1 of 3 Divi ' po MED t `°-- R+�r � ode County St. Croix Att ch complete site plan o r n less than 8 12 x 1 1 ChBS in e, mdgo:� and orizontal reference point (B direction and Parcel I.D. Pending per rlt sl�` I or dimensi s, n arrow, and lo M and d tanee to nearest road. SY CROIXC I p d f, rmation. Revl 1 1, i e Pe onal WON t o�ea (P acy Law, a. 15.04 {1) (m)). { �{/Yt/lr� ( DS Property Owner Property Location W Chris Knsilek Govt. Lot NE 1/4 SW 1l4 S 33 T 28 N R 19 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# N8618 1090 Street 2 Serenity M ws City State Zip Code Phone Number Ity o Village ■_ Town Nearest Road River Falls WI 1 54022 1 ( ) CTH M E l New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD 0 Replacement Public or commercial - Describe: Parent material Loess over bedrock Flood Plain elevation if applicable General comments Bedrock limitation for mound and recommendations: — 7 Boring # Boring 0 pit Ground surface elev. 99.24 ft. Depth to limiting factor 30 in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '00#1 "Eff#2 1 0 -16 10yr4 /4 sil 2msbk mfr as 2f .6 .8 2 16 -28 1 4/4 sl lmsbk mfr cw - .4 .7 3 28 -30 7.5yr4/6 fsl 0m mfi cw - .2 .5 4 30 -50 7.5yr4/6 f2d5yr5 /8 scl Om mfi cw - .0 .0 5 50 -56 - Bedrock Brx - - - - - - 27 Boring # 0 Boring 101.24 20 El Pit Ground surface elev. ft. Depth to limiting factor in. Sell Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -10 10yr4 /3 sil 2msbk mfr as 2f .6 .8 2 10 -20 1 4/4 sl l msbk mfr cw if .4 .7 3 20-28 1 4/4 scl Om mfi cw _ .0 .0 4 28 -34 _ Bedrock Brx Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/— CST Name (Please Print) Signature CST Number Thomas C Nelson ` 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11/20/04 715- 246 -2454 r f Property Owner Kusilek Parcel ID # P ending Page 2 of 3 3 Boring Boring g E] Pit Ground surface elev. 102.00 ft. Depth to limiting factor 36 in. Soil 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 1 0 -10 10yr3 /2 - sil 2msbk mfr as 2f .6 .8 2 10 -20 7 5 /3 - sl lmsbk mfr cw if .4 .7 3 20 -36 7.5yr4/6 - sl Om mfi cw _ .2 .6 4 36 -52 7.5 4/4 - scl Om mfi cw - .0 .0 5 52 -56 - Bedrock Brx - - - - - - 4] Boring 99,9Q� Boring # Pit Ground surface slev. � ft. Depth to limiting factor 33 in. of i on ate 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 1 p_g 10yr3 /2 - sil 2msbk mfr as 2f .6 .8 2 8 -17 sl lmsbk mfr I cw if .4 .7 3 17 -25 7.5 4/4 - sl Om mfi cw _ ,2 .6 4 25 -32 - scl Om mfi cw - p 0 5 32-46 - Bedrock Brx - - - - - - F-1 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/iF 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 mglL 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. ssD- 8330Test (R07/00) TOM NELSON CST - Lie. # 1432 120TH STREET ph. # 718- 246 -24514 r NEW RICHMOND, WI 64017 Chris sllek Lot #� -- Plat of Serenity Meadows NL 1/4 OF THE 5 1/4 OF SECTION 33, T26N, RI 9W, TOWN OF TROY, ST. CROIX COUNTY, ,. WISCONSIN. L ® SOIL BORING •�•/ BENCHMAR _ SCALE IN FEET IN= A ALTERNATE BENCHMARK_ �* 80 NX ■ \ �� i �- -- AD I 1064.8 I . � I I X .....�.1.�. / / �05 .5 I I APT 070.5 \ l /► f I ` �'• \� "`� \ \ X \ (795 AC.) \ � I I `\5�'!8,� 1066. X X 1068.9 / 064.4 // / % ` �• l 67.3 / / X `� / I RAC = 84Y 62.4 X 1066.9 , I ( r \ ` I 6 AY I \ `', • - ` vu SMIN � s �"iP sue •'�'' �F3 w AUM 110111 MA /� VJ RIq1i O>n M/la -1Nlfl CEIVED ' • i% FI V I z / /- ,/� 17 - -rr± - / / / -' //- _. 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