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HomeMy WebLinkAbout040-1143-30-000 Parcel #: 040- 1143 -30 -000 12/16/2008 09:47 AM PAGE 1 OF 1 Alt. Parcel #: 01.28.20.573C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DOUGLAS J & SUSAN K ROWEN O - ROWEN, DOUGLAS J & SUSAN K 295 RIVERVIEW DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 295 RIVERVIEW DR SC 2611 HUDSON SP 1700 WITC - Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 1 T28N R20W 2 AC PT G.L. 1 SEC 1 COM Block/Condo Bldg: NE COR SEC 1, TH WLY ALG N LN 300' TO W R/W RR, SELY ALG R/W 201.5 S 46 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30' SELY 354.85' TO POB; SELY 175'S 46 01- 28N -20W DEG W 504.6' TO SHORE TH NWLY ALG SHORE TO PT 175' NWLY FROM PREY. DESC LN NELY more Notes: Parcel History: Date Doc # Vol /Page Type 04/10/2006 822505 EZ -DR 11/22/1999 614310 1473/46 WD 07/23/1997 792/412 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 260335 661,400 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 290,500 303,200 593,700 NO Totals for 2008: General Property 2.000 290,500 303,200 593,700 Woodland 0.000 0 0 Totals for 2007: General Property 2.000 290,500 303,200 593,700 Woodland 0.000 0 0 Lottery Credit: Claim Cou nt: 1 Certification Date: Batch #: 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildiy g Divis INSPECTION REPORT Sanitary Permit No: 479454 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)]. r Permit Holder's Name: City Village X Township Parcel Tax No: Rowen, Dou g & Sue I Hudson, Town of 040 - 1143 -30 -000 CST BM Elev: Insp. BM Elev: / BM Description: Section/Town /Range /Map No: r� .D lot) 'D y, = CSI km / 01.28.20.5 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 • � Dosing r t Alt. BM eA Aeration Bldg. Sewer lQ- 9 Holding SVHt Inlet Q f St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t / Dt Bottom i 2u t > S6 �0 /S, 5 1 Dosing t � t L Header /Man. �p D Aeration - - Dist. Pipe Holding Bot. System ' f PUMP /SIPHON INFORMATION Final Grade 6 '��' x•26 Manufacturer D and S Cover L •D , .l }. r t✓t 'L UP �.o 5 r ,,,. 3. 30 -20 Model Number Friction Loss t System Head Ft Q r �e 3$ 2 so 3.58 gS �v 4; •�� �«�.6D) t3o . Forcemain Length / Dia. t , Dist. to well 1p 2 SOIL ORPTION SYSTEM REN Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V& Cr SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Mau ct per OR 6 INFORMATION CHAMBER �� Type Of System: Z2_ i y Z � r UNIT Model Nu er. DISTRIBUTION SYSTEM PlL Header/Manifold Distri ution x Hole Size x Hole Spacing Vent to Air Intake PIP (s) r Length Dia Len Dia Spacing SOIL COVER x Pressure Systems Only xx hi nund Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [ ] No [J Yes No ov, � " // ENT . S:_ (Inclu �iscr�pe1 + pers, ops prC`efn�t�etc.1, )C a-e- �ctiQ 5 n #11: : / ' / � Inspection #2: Locatlori: 29 River View Road Hudson W1 540�1�6 (NNW 1/4 NW 1/41 N F220VV� bou P r el No: 0 C 1.) Alt BM Description = N 14 (/ *t co,,,, use i 2.) Bldg sewer length = 3 /0 9Z ,38' q0 .f,3 amount of cover ' - = �Z �; I C r 10 • �E3 3) C.,cU �eQ � �•(,X,� a � s `�• 11- �Z = R2. Plan revision Required. ] Yes Nor -I� Use other side for additional informatio , n. ' _` Cert. No. Date Insepcto s Signa ur SBD -6710 (R.3/97) Safely and Buildings Division County v 201 W. Washington Ave., P.O. Box 7162 5 Cie 0 N *iscon s ft Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by o.) Department of Commerce (608)266 -3151 Sanitary Permit Applicatio e n . C State Plan I.D. Number N/ In accord with Comm 83.21, Wis. Adm. Code, personal information yo may be used for secondary purposes Privacy Law, x15.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Informs on EC I � n � 01/ 'S11(13 • 3 OO O Property Owner's Name Parcel # Lot # Block # 'Do UU - S vc ROW SEA �; ��5 �ce ,l�u��/' Property Ownee ! s 1 v U l e I, �, Property Location , K . � [�,�, ! /// ST. CROIX COUNTv �G�V1 , I��) City, State �• J Z Zip Code /, ZONI ys Ivi 1/4 on P fB i l Sy0_/0 8! - ( 'Z'�O T ZK, R Type of Bnikling (check ail that apply) A l or 2 Family Dwelling - Number of Bedrooms Subdivision Name ,(� CSM Number El PublidCommercial - Describe Use A` l 1 1 ❑ State Owned- Describe Use ❑City ❑V o ip of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System Y eplacearrent S w- ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Lisa t Previous Permit Number and Date Issued Before Expiration Plumber Owner �vT uxJD //" Ajen -o& IV. Type of POWTS S stem: Check all that a P on Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 im of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter K eachnig Chamber Q ❑ Grav -less Pipe ❑ Other ( ain ` V. Dis ersaVfreatment Area Information: — De sign Plow (gpd) Design Soil Application Rate(gpds Dispersal Area Requi (sf) Di rsal Area tem levation S 9 /•Co' VI. Tank Info Capacity ty in Total Number Manufacturer fhb Site Steel Fiber Plastic loins Gallons of Units Concrete Constructed Glass Existing arks Septic or Holding Tack O ' i n Aerobic Treatment Unit 1 .0 Dosing Chamber VII. Responsibility Statement - L, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI tier's Sign MP/MPRS Number Business Phone Number P,ruf iCGc7 2zG3�I /s•77.) •3Vy Plumber's Address (Street, City, State, Zip Code) g� /o d7 7.Nle • S�/�i%vlr Uhl/ �� s�� 7 VIII. oun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee ludes Groundwater D Issued I ing Ag Sigma (N Surcharge Fee) �J ps) ❑Owner Given Reason for Denial - K IX. Conditions of A roval/Reasons for Disapproval SYSTEM OWNEK ( - ) -� --X." 1 ep Ic ank, a Nent filter and dispersal cell must all be serviced / maintained / 0 /p �S ��G �o as per management plan provided by plumber. T" o _ /- f /j 2. All setback requirements must be maintained 3 (� ti SVS 1 'yt as per applicable code /ordinances. A, J G -�� t U 444 1 4 CY) 4 "a J O-D Attach complete plans (to the County only) for system on p r ao ffess &Y, v fx ' ll Ilan in SBD -6398 (R. 01/03) o n lb V\ v � o o o ULBRICHT & ASSOCIATES CO. l 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers ofEngineefing Systems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN IID� # DATE OWNER ���(T � SUE (�CO PHONE 30 ADDRESS 2 _'4 5 to ;W tll; i ! W �• �.S�O „� S �{ D( LEGAL DESCRIPTION P1R / 4 1 ' 6PU GO T - NLJ Pu), 1 TZ A2660 P!N 0y0• l(`3 • ooC') TOWN OF L7 DS 0 - COUNTY S T. CP.O /• CSTM aE g�Y u � 5 LOCAL AUTHORITY/ SUPERVISION PROJECT DESCRIPTION: • �' � i S T - 7OX /f A p w ? Nov - Goy li ti o �o ALL NON- CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY PER COMM. 83.33. ISO' j7q1'C 1 " 2 U� 7, _Ro EP- T_ Z(1 )eiC117_ THIS POWT SYSTEM SHALL Ulbricht & Associates Private Sewage Consultants INCORPORATE PER COMM. 281;c ;0th A �, 83.44(2)c A PROPER ZABEL Spring Valley, W! 54767 FILTER MODEL # Pg.l INFILTRATOR SIZING WORKSHEET P9_2 SYSTEM PLOT PLAN P CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P . `Y " i 11 if 11 11 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) SRn- 1n75_P(vn1 /ni Z � w 1 v O s 41 �',r VN o zz �o m 00 q a- BFI im d _. m 0 (fit m X " N ml 0�0 �0= ITI m r ' fi b- �'� lr:A C` kA O d � G o y k/N I� m C a m Y� m ro ` m 1 � z "'r ® _ ;. Cp kA I ff t iii NO; Wt 7/>rl Z7MT - 4, A -1 �ell . C� oSS SEc'Tio� of TAIEW44h' y o c K see T/000 1/ sc�,l ; I ? 7. & 0 TH Ili 1 t m L )'� riW 7 .-z� OVER: See Reverse Side for Vent/ Observation Pipe Details. - f C`l� lcvLh��II d i >tNGG .H / r NS/��� o �P F tt M C� y 4APAP4P 4 7- C-A/0 C a SS Sic Io,,) �l ll SEPTIC TAN t PUMP CHAMBER CR OSS SECT AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE & "WEATHER a ? PROOF LO' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE C S 40 W1 PAD LOC f ul /�E�T /Os� f" WARNING L Ila � -A _4" MIN 18 IN. IA)4&7 ie gD.OINLET _ � - = GAS - TIGHT A SEAL APPROVED PVC pip»; ALM JOINTS W/ 3� fo SOLID M 419 e L � - - ' ON PIPE 3' 0. SOIL p7 �(� C 3 ' i SOLID SQI PUMP OFF ELEV . '• FT, 1 ,�,� -rt- , A �- _ OFF RISER ; t3 O `� D I PERMITTED �t IF TANK MANUFACTUI 3" APPROVED BEDDING UNDER TANK HAS APPROI CONCRETE PAD 0 , )50 PECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: Gtj 1V (,� - C d NUMBER DOSES PER DAY: S TANK SIZES SEPTIC I ZClfl 1 Z.b GAL. DOSE VOLUME INCLUDING DOSE 0 GAL. 2(D FLOWBACK: GAL. ALARM MANUFACTURER: 4,eyz 41A" CAPACITIES: A =Z INCHES = Ob MODEL NUMBER: V (� __L G SWITCH TYPE: F1 �� -- - B = 2 INCHES = H G. PUMP 'MANUFACTURER: Zo64l C - -7 1 (9 INCHES = / 7 �p G. MODEL NUMBER: SWITCH TYPE: D• D = 4 INCHES = I�(J G, REQUIRED DISCHARGE RATE .2-0 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE Q y , + MINIMUM NETWORK SUPPLY PRESSURE . " •` D FEET + .�... O FEET C FEET `._ FORCEMAIN X I• FT /100 FT. FRICTION FACTOR AC Z OR F TOTAL DYNAMIC HEAD EET _ • j,� FEET INTERNAL DIMENSIONS F 0 PUMP TANK: LENGTH r WIDTH �(� DIAMETER, LIQUID DEPTH SIGNED: LICENSE NUMBER: DATE: To TA-L, JN GET To h 1 f x -- -� P/c S'pEcS THIS POWT SYSTEM SHALL 6 4C& I of= be ., INCORPORATE PER COMM. 83.44(2)C A PROPER ZABEL �• Z C/ s FILTER MODEL # /1 - 0 -- SEPTIC TANK, per Comm-83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fiiter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a l i rpn.Q enrvi r+.. ..,......... f ZOELLER EFFLUENT P MODEL'98 HEAD CAPACITY CUgvE so MODEL .. > >n a 1/4 e ! 5 3 5/a s ! 3 /fe to ,.. . a _ t 1 /2 -11 1 /2 NPt A auoNS to 2 3o 4e 5D . [nuts so 70 so so 160 t!o IF LOW PER MINUTE lotat WMAM aucKtow►tA ��.n,u n►cvt►n uee oewanwno HIM eA►At:n1 12 . tttT # 646 t1R1 0 Im T # at3 u t.er of so I. tE Ito to*vatw s 6 /14 CONSULT FACTORY FOR SPECIAL APPLICATIONS s ENcidcel ake►►tal «s, for duplex systems, are available and triilVW wkh an aMerm. a Mercury 1 10811 awkches ere avallaMe lot f Medar>tcd skernetore, Isar three phase syMems. aktgte laid wUlottt Harm ewkcltes. tit,ptex Wetems, ere evelleble wkh or a botlble plimbeck mercury Iloal ewdches are ilvellabte IM verlsWe lo ve , "Cycle controls. - Etanda/d tit mode - weight 39 lbe - v tI,P, t. "*" "sled* 111LE�� UM M s. conk s•acq t. "0 Pboreitk ma " '. no 0womd oawa t•quked lAoad v A,•Ph Mod. A . s te .*Itch. "Ww b FM411� No t «allot[ a AetA+to acv. $ad at dt t i 1 ub It i s E bu •o & Modmw •ntdm 160072 or wee?& !. too I Mor 12. for Owfd 1 130 t e 6 Mote" o•�aa AM *h 1 al E�irlcd AM•tnMet "E P•k ". Ste 230 1 t of t a< 7 dpt• M a (41 ao•t M wm 10 6 :� of a oorwol Aak." t ,per t 3 "446 .. a F t�x 1p:it) I, ..� r.k ". k„►alod boll, a dupbx "aim to "N. N t1on a wlrw a dm p >. as hell J-rak ;101 "Gultvt gw0w. - _.. aT [pile[, ' avNk Nrs w f tbI1 Fbct*d dlRti nitw b cadet an N. Ftb6tl; t Manatm, MUM. AV I VvcAankat Marntlp, MItm1 aM N aantr•b, pd�eYa• CAUTION � u t#; t rnp�„p eye FMONt; ans 84VA" card GeR Ad 160404 06bk4a AN • kaa •111 111111E aAeaN w �oaa 0 M.1 Mw a.saT 81381311[ kaNead El.gdCeM �� awIaa ant ell ►� 1811181. j Nada Ad 109" . M ci ant as f aarpaa„d fat RESERVE POWEPED DESIGN �a untt suei conditions a reserve saley lac to T fingineered Into the design Of e,iery Zoeller PCM. t Z&Z -1, w:: Z = MAN 181: r.o. sox 16341 lot*" -Mmss 111"1 1* 3 10 Ot- tETirs Istt 11 4M04cowars of ... I it . A1' 4016 % /00 11 1.2131 .a Mi." 114.X? rdOUM fftr jYjy9" A A;E -rFST OF Solt - T ' S'r DvN:E dlu wwondn Department of Commerce SOIL EVA ON REPORT Page / o f 3 Division of Safety and Buildings in accordance with ,1Ms. County ST C R01W Attach complete site plan on paper not less than 8 ,/2x,1 ' as 0 y o • /y3 • 3 0 • D'1rU Include. but not rxrdted to: vertical and horizontal reference ' nt (BM), Parcel I.D. percent scope, scale or dimensions, north arrow_ , and lop ' and distance to nearest road. SE� � �' Re ' by Date Please �Intt all fifor►nat n. r� ,005. r. Personal kdoanabon you txovfae may be used for secondary ( Law. s.15.04(14 Properly Owner k QD ��� ZONIN OFF 19 �� 1/4 S f T N R�9 E (ore ,DO a 45ve Proparty Ownees Mall ng Address Lot # Block # Subd. Name or CSW 49 R/ v vitsw kD ` ;i� o Gwr. CRY State Zip code 'Phone Number ° ❑ City ❑ visage Town Nearest Rdad 1- t l/DSON W I 5�4oK c sir) 39/ rya TR.oY rV�2vl/ WAMUCGMV~ Use ' Residential / NwntW of bedmorrts _ Code derived design flow rate 0 GPD g Replaoerrlent ❑ Pubic or comrnerdal - Describe: N a Parent md Rood Plain elevation if appr�cable / A Gerwal carnments and recornmendations: MOa_Spot Tested suitable for a conventional inground system (RONT.S.) Boring a# ° ® Pit Ground surface elev. 97.59 is Depth to running factor 9 7 in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 7F#1 in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. M -/ 10 - 1 4 2 • 25 1 o M 5 /3 5 iC/ &kE .(o 3 25-32 jo m sAm - Sir,! d VL4 C 5 I V4 .-e+ Z- 1 c, 5 /4 >P io s/2 / d S 2 -f 6K a W - -171 d , _ - 77 Boring r # ® Pi Ground surface elelr. • I R Depth to knifing factor —Z L-- m• App Rate Sol Horizon Depth Dominant Color Redox Description Texture sut a Consistence Boundary Roots GPD/f! In. Mtmsell Qu. SL Cont. Color Gr. Sz Sh. 'Eif#1 *002 J - 6 -22 10YR 2-m b C S 2 r Ylt3 1 2 m bX. C'. S 3 v lid I Ova 3 - 56/ 3Vcbn V✓ l 5h • •� R s D s cl _ ot I 1:1� • Effluent #1 - BOD > 30 1 220 mglL and TSS >30 _< 150 • Effluent 02 = BOD 1 30 nV& and TSS 3 nvWL CST Name (Please Prird) 9 8 , Address Date Evaluation Conducted Telephone Number 28fZ Ivro• AtiE SptuAt) 0 wt Ulbricht & Associates Private Sewage Consultants ORIG AL • 2812 10Th Ave. Spring Valley, WI 547 .67 ftpstty Owner /` p.W E/J Parcel lD # Page Z of 3 a Boring # 1 i PiB t Ground surface elev. ft ooh to C96 In. Sol Applicstion Rate Modaon Depth Dominant Color Redox Description Texture Structure Coralstence Boundary Roots GPD/fF in. Munseti Qu. Sz. Cant Color GL Sz. Sh. •Etf#1 'Eff#2 p- j I uric,'y, 2 m bg d 5 C3 2. - 0 f�.$`G' 1 l 2 rT 3 1 YO. ra* + bk d5h law t of ❑ Pit Ground surface Wev• ft. Depth 10 r mVV factor in. Sati Application Rate t orimn Depth Dominant Color Redox Description Texture ShmAure Consistence Boundary Roots GPDW In. Munsell Qua. Sz Cont. Color Gr. SL Sh. •Eff#1 'Eff#2 Bodng T, M # 0 Boriry ❑ Pit Ground surface elev. ft. Depth 10 Smiting factor in Sot Applicstion Rabe Horimn Depth Dominant Color, Redox Description. Texhme Structure Car roe Boundary Roots GPOW in. Munsetl Qu. Sz Cant Color Gr. Sz Sh. 'EW1 •01112 • Effluent #1 = BOD > 30 5 220 mg& and TSS >30 1 150 mglL ' EtAuent 02 = BOD 1 30 mgR and TSS <_ 30 not The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or the d at 608- 266 -3151 or TTY 608- 264 -8777. need material in an alteraau format, please contact epartnae (RAM) s oo 4 1 cot . 5 z l co 0 Co 0 J � o N / a •Q � a m o o � {7 r G 0 1* f N . �M a► Q �. r . S —s Zia (D C N D n !D (D (7 CD < a O g -" C31 O �1 m 2 A• (D c s m c6 ML Cos _ oil ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - D 0 0 (r S (� �' 1 �') Mailing Address 2- �2i UtZ VIz?FG0 Property Address 5A E (Verification required from Planning & Zoning Department for new construction.) City /State _V P S 0 N hP• Parcel Identification Number D y 0 Lt 3' 3 D - �Z7 LEGAL DESCRIPTION (S C Property Location /N A ) '/4 , A 1 / 4 , Sec. , T 2 N R 20 W, Town of U�sON Subdivision N P ? l 2z' 6 r l , Lot # Certified Survey Map # _ /V/ /� , Volume ,Page # Warranty Deed # 1 �3 Volume / , Page # T �° Spec house yes no Lot lines identifiabl yes 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. 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 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 J Syr - sJ-2d f& T 3 SIGNATURE OF 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) ;7 Ulbricht & Associates Private Sewage Consultants 2812 1 Oth Ave. Spring Valley, WI 54767 7— -- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Z ` FILE INFORMATION SYSTEM SPECIFICA71ONS ` Owner �' " ' Septic Tank Capacity 1Z0 rr? ga l ❑ NA Permit # Septic Tank Manufacturer �'� 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer j,.�(s ❑ NA number of Bedrooms j 713 NA Effluent Filter Mode€ Q ❑ NA Number of Public Facility Units NA Pump Tank Capacity al ❑ NA Estimated flow (average) Q Q al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Q gat /day Pump Manufacturer ❑ NA Soil Application Rate — 7 2! da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Month verage" Pretreatment Unit 13 NA Fats, Oil &Grease {FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (130D 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality MonW age Dispersal Cell(s) ❑ {CIA Biochemical Oxygen Demand (BOD S30 mg /L ❑ In- Ground (gravity) ❑ 1n- Ground (pressurized) Total Suspended Solids (TSS} — _0 mg /L ❑ NA ❑ At- Grade El Mound Fecal Coliform (geometric mean) <10 cfu /100 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency 3 Inspect condition of tank(s) At least once every: 60, month(s) (Maximum 3 years) ❑ NA ❑ year(s Pump out contents of tank(s) When combined sludge and scum :equal one -third (y) of tank volume NA Inspect dispersal cell �-Y (s) Y s) At (east once every: El on ) (Maxinwm 3 ears) NA Clean effluent filter �"� �j At least once every: 91 month ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: Mmo- rith(s) ry 0 years) ❑ NA Flush laterals and pressure test At least once every: 13 month(s) ©NA 11 year(s) Other: At least once every: ❑ month(s) ❑ year(s) ❑ NA Other: ❑ NA, MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or''leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR i 13, Wisc istra " All other services, inctudirg but not lirrfited to ervicin of ef fiiuent filters mechanical or pressurized components, pretreatm its, and any servic(ng at intervals 512 months, hall be performed by a certified I'c3WM u- 1 ;R - A service report shall e provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION 2- For new constructibn Page _ of that may prior to use of the POWTS check treatment tank(s) for the presence Y im Pede the t of paintin r eatment process and /or damage the dispersal g. Products or othet chemical: Of the tank(s) removed by a septa } I(s • If hf ge serservicing ce! g operator prior #o use. high concentrations are detected have the contents System start up shall 'not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored_ the excess discharged to the dispersal cell(s) in one large dose, overloading the cells} and may result in the backup or surface di effluent. To avoid this situation have the contents of the pump tank removed by a 3eptage Servicing Operator wastewater will b Power t the effluent scharge oi bump t thor contact a Plumber or POWTS Maintainer to' assist in manually operating n prior to restoring restore normal levels within e pump tank. - g the pump controls tc Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise d' .within 15 feet down slope of any mound or at -grade soil absorption area. isturb or compact, the area Reduction or elimination of the following from the wastewater s tream may . improve the performance and prolong the life o POWTS: antibiotics; baby wipes; cigarette butts; condoms; cot foundation drain ( sump pump) ester; fruit and peelings; g ton swabs; degreasers; dental floss; diapers; disinfectants; f fate vegetable eel s; asoline grease; herbicides; meat scraps; medications, oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS faits and /or is permanently taken out of service the following steps shall be taken to insure that the system Properly and safely abandoned in compliance with chapter Comm 83 i Y s .33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and properly disposed of b a Septage Servicing Operator.' • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. LONTINGENCY PLAN ft the POWTS fails and cannot be repaired the following treasures have been, or must be taken, to replacement system: provide a code compliant LJ A suitable replacement area has been evaluated and may be utilized for the location of system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and pro a replacement salt absorption result in the need for a new soil and site proposed evaluation to establish a suitabl repl tern t a a Rep comply en stems a will comply with the rules in effect at that time. sY must © A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replac evaluation must be performed to locate a suitable replacement area. a rea, If no cJpla failure of the POWTS a soil and site may be installed as a last resort to replace the failed POWTS, replacement area is available a holding tank P Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at th infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <WARNING> > e ;EPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIE INTER A FROM CIRCUMSTANCES. DEATH MAY RE SEPT IC, PUMP OR OTHER TREATMENT TANK UNDER ANY SUL� RESCUE OF A ERSON FROM THE INTERIOR OF A TANK tIAAY gE DIFFICULT OR IMPOSSIBLE. 0 NOT �DlTtONAL COMMENTS +VITS INSTAUER rIC t Associates Name POWTS M 'i I tom A ve. Phone � �N M 0 � Name G�� ���s7 Phone ?�S PAGE SERVICING OPERATOR (PUMPER) � Name LOCAL REGULATORY AUTHORITY Phone Name s �- + C go f �( �� r 1 S � OWNER Is MAINTAINCE OF S EPTIC SYSTEM POWTS ( landowner) is re maintenance of Ponsible for proper operation and maintenance servicing this system. Regular periodic inspections and is necessary for the safe healthy operation of this system. The owner is require maintenance /inspection reports o btcode to submit all necessary the controlling ,authorities,. SPECIFIC CONTACT AGENTS * Governmental CT` . authority/ inspectors: ! 6 * Licensed installer, responsible for maintenance "Users manual: providing an operation/ - 1 - 7 3 kyZ • �� c �� /9 t * Licensed servmce / inspection agent other than installer: El ectrician, for PUMP, electric controls wiring units: IMPORTANT OWNER MA INTENANCE RE U i• Winter traffic IREMENTS area shall not (sledding, shovekin et c-) across the Permitted, o the cell, freezing p °r frost can /will penetrate into . (a vacaction�trihe system. Discontinuos use - P. resulting in lead to freeze no in the winter ups. water use) can also 2 • Water conservation need y hydrolicall be exercised! Or system can be - desig overl s to oaded and destroyed. Thi gned f or a maximum flow Of 's (40.06) wastewater hem was s sys gals. d 3 . POWTS are afly, not designed to accomodate disposal unit, or any other wastes from a Any introduction of unnatural sources garbage destr such waste materials will overload and Y this system. 4• If a ower in a Power temporary occurs, or a pump fails ` cell overload of effluent being it may result . which may adversely pumped into the recommended that a y impact the cell allowing licensed (leak#ing n , the pump to return Pumper empty the dosing tank, Consult to dosing the correct amounts. Your installer immediately for advice. 5 ' Ne glect of the ve q erosion lls etative cover (the ce traffic P can lead to failure, insulation & also can destroy t he s Compaction or REGULARLY WATER THE VEGETATION OVERm• It IS eavy NECESSARY TO the,@Wstem beneath IS NOT A NECESS SYSTEM!! Effluent in y t cov�rr • sufficient alone t0 maintaia a 6• Periodic i nspections b necessary. Inspection y the owner, or his a Into the system: Pipes and Ports have gents is inspection °n the mound basal Ve been incorporated laterals PipeS), cleanout area (effluent level at each terminals on the pressurized out. The filter s tip - for flushing and cleanin stem ground cover /manhole). in the tanks (via a g the laterals Person /manh ole), Only a licensed locked above & severe min performing this work which properly quali6ied system's treatmentsks. Evidence of effluent involves health cell shall also be P i n s c the � regularly inspected. Parcel #: 040 - 1143 -30 -000 09/07/2005 03:34 PM PAGE 1 OF 2 Alt. Parcel #: 1.28.20.573C 040 - TOWN OF TROY Current !XJ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner DOUGLAS J & SUSAN K ROWEN O - ROWEN, DOUGLAS J & SUSAN K 295 RIVERVIEW DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ` 295 RIVERVIEW DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 1 T28N R20W 2 AC PT G.L. 1 SEC 1 COM Block/Condo Bldg: NE COR SEC 1, TH WLY ALG N LN 300' TO W R/W RR, SELY ALG R/W 201.5 S 46 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30' SELY 354.85' TO POB; SELY 175'S 46 01- 28N -20W DEG W 504.6' TO SHORE TH NWLY ALG SHORE TO PT 175' NWLY FROM PREV. DESC LN NELY more... Notes: Parcel History: Date Doc # Vol /Page Type 11/22/1999 614310 1473/46 WD 07/23/1997 792/412 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 290,500 303,200 593,700 NO Totals for 2005: General Property 2.000 290,500 303,200 593,700 Woodland 0.000 0 0 Totals for 2004: General Property 2.000 290,500 303,200 593,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � tY ~ �I DOCUMONT NO. i' WATB nAR- OF WISCONSIN FORM 1-1982 6 1. •& f WARRANTY DEED KRTHLgEN 3 t voL 1 • REGISTER OF DEEDS 1 IJ ST. CROIX CO., MI RECEIVES FOR RFCM 'hi$ I7oed, made betwoon ......... ................. ......................... ...... . 11-22-IM Me AN Room _Qtrgn„ anft .Mari IYO._ RQfrRn. .................. ............................... .- husband - m) Q__91Cl .................• - - -• --••••-••---•-••••---- •--- ._....•••--- ............... - -- YAIiIIiM(TY DEED ......................... -._.._...... ........................................................ Grantor EX91PT R and .... DnLBlas ._�._.Rowen..and..Susan._K_ _ tinwsn..----- •_-- •---- •-- -------- - - - - -• CM COPY FED ... ........... .................... .........._....... - .........._.. ............ TRER iP1S.00 ..--•--.... ..............................-•-------...---....._._...._. __._..--- _..._..........._.._.. IIiO FEE+ IL AO ................ ......•--....._-..._ _.._......_.......__........_._ ............................. Grantee, WnesseC1} That the said Granter, for A valuable consideration.._.._ described real estate in .._Stx_. ' " 7O conveys to Grantee the following a Grnix ............. County, State of Wisconsin: See Attached Exhibit "A" Tax Parcel• No: • vlfwvewsw�. T�IT�� 4i memo PhoDUCFj —" This ?1 - WASHINOT0#4 #W -_-_ is .....- °- homestead property. �6 INA MN (is) (is no 6D Toaethee with all and sinsular the hereditemeiuts and appurtenances thereunto belonaina; And .............. .................... ......_.... ............... - warrants that the title good, and -'a'l - •--' -•- o! -"-e-numb----- c---r- a•-nces •---_... ................. indett}arlble in ies simple and ... tree ear a:cept and will warrant and 'defend the same. 7 914 - -- .... - - S1._.... - .... day of ..... SZ tL . e> C ..:............ ............................... 19_ -99... ................... (SEAL) ........... .. .. _ l.l._ .... (SEAL) �o�xeO-------- •--- • ......... .......... .. filar].yn_. Raid........................................ -- ----• -----•-•-•-••--•----••--- --------------- -•---- ••- •••-- -- (SEAL) ............ ........._..._...... .._...._............._...._.._. (SEAL) --------°----° ................... ............•- --- _._....•---- -- • ._......-•---..................._. ........_.........._.._........ AUTUICNTICATION AOIXNO W LNDGWZNT signature(s) ....................... ................................... Minneso STATE OF lli'XS,Q>s>m[ --._--- ................................... -- .... ........ ................. Ku h_instl?n ........ ........... I so. .County. • sutbentleated this ........ day of ........................... 19 ...... PersonaIly cams before me this 1St. . day of ------- °•_-- - ----- •--------- --- - -- ---- 3 eatt�er. ..... . 29 –9-9– the above named f l • .......---- •- '-- • -• -•- ----- J3s�s�x._ia.. 13�a>e<sn. diIl,�. l�axf_lyn..)3n111�,. • - - - - -- • .................._-••---• •------ •--- ••- •----- ••- •- -• -••• ...... -- ......... ------------- bjuSbj0juLi =. -w-f_ fie..---- •- ;--------- '-`............. TITLE: MEMBER STATE LIAR OF WISCONSIN (If not. .. °--•-_---•-° ............... r..........----°- ----- .______..__._.....__._._.. i authorised by $ 708.0, hlie. Ststi.) .. . - --------------- •-• •- .............................................. "--------------------•----°•- to me known to be the person t.......... who executed the feregaina instrument and acknowledge t TWO QM-1 Ut49NT WA8 D11A /T<D DY Bat -vP csa_ 1 ._ Tixie.,.. 1B .I.L.Veix..Ar_....- _Ste._120.. J '- - - .. ...... Woodbury, MN 55125 .... ..... ................... °-• ............................................ ..••- •-- °•- ..._........_....... Notary Public -------------------------------------- Count . Wis. (Sianntures may he nu then Lien too[ or acknowledavd. Moth My Commiss ion -•• c rat are not necessary.) date: date: ........_- 9ltY-lYt. .. _ ... -- 4t1lrt!l7.. *Naawa of Fr.wn"w .daninK p l ' t ie.,. MTCOIIMMON VIM 1.81 -20W in way conmr,ty J.—hi hr Iriwnl ar rimal bAow tlwir w ontrrw, �{ NOTARY T� i� 40.55$7Q2 1473P,� 47 All that part of Government Lot 1, Section 1, Township 28 North, Range 20 West, and that part of the Northwest Quarter of the Northwest Quarter of Section 6, Township 28 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the Northeast corner of said Section 1; thence Westerly along the North line of said section a distance of 300 feet to the West right -of -way line of the Chicago St. Paul, Minneapolis and Omaha Railway Company; thence Southeasterly along said right of way line a distance of 201.5 feet to an iron pipe monument; thence South 46 degrees 24 minutes West a distance of 30 feet to an iron pipe monument; thence Southeasterly parallel to the West line of said right -of -way a distance of 354.85 feet to an iron pipe monument, said monument being the point of beginning of this descriptions thence Southeasterly parallel to the West right-of.-way line of the Chicago St. Paul, Minneapolis and Omaha Railway Company a distance of 175 feet; thence South 46 degrees 24 minutes West (the angle being measured from a line parallel to the East line of said Section 1) a distance of 504.6 feet to the Easterly shore line of the St. Croix River; thence Northwesterly along said shore line to a point where a line drawn parallel to and 175 feet Northwesterly frpm the line Just described intersects said shore line; thence Northeasterly along said parallel line 477 feet to the iron pipe monument which is the point of beginning of this description. That portion of the Westerly one -half of the 100 foot right-of -way of the Chicago St. Paul, Minneapolis and Omaha Railway Company (former Hudson to Ellsworth line) which is adjacent to and East of the above parcel; the strip of land hereby conveyed being approximately 50 feet wide. Together with right -of -way over a 30 foot road, the center line of which is described as follow: Beginning at a point on the Westerly right -of -way line of Former Wisconsin State Highway "35 ", said point being 735 feet South of the North line of said Section 6, and running thence West in a line parallel to and 735 feet South of said North line said Section 6, 2,381.9 feet; and also over a 30 foot strip lying Southwesterly of and parallel to the Westerly right -of -way line of the Chicago St. Paul, Minneapolis and Omaha Railway and extending from the West end of the above described road to the North corner of the land conveyed hereby. Together with an easement for a right-of -way over and across the following tract of land in St. Croix County, Wisconsins Commencing at the point where the Westerly line of the right-of -way of the Chicago St. Paul, Minneapolis and Omaha Railway Company intersected a line drawn parallel to and 236.5 feet East of the West line of the Northwest Quarter of the Northwest Quarter of Section 6, Township 28, Range 191 thence Southwesterly by a deflection angle of 46 degrees 24 minutes froth said parallel a distance of 30 feet; thence Easterly to the point where the Westerly line of said railway right -of -way intersects a line drawn parallel to and 750 feet Southerly from the North line of the Northwest Quarter of the Northwest Quarter of said Section 6; thence Northwesterly along said railway right-of -way to the place of beginning. Together with a permanent, nonexclusive easement for ingress and egress over the following described parcel: Commencing at the POINT OF BEGINNING of the above described Parcel A; thence Northwesterly, parallel to the West right -of -way line of the said Railroad, 354,85 feet; thence North 46 degrees 24 minutes East, 244.8 feet to the centerline of a 66 foot roadway, which is the POINT OF BEGINNING of the centerline of the 66 foot roadway to be described; thence North 15 degrees 42 minutes West, 136.1 feet, to the North line of Section 6, Township 28 North. Range 19 westt thence Easterly, along said North line to the existing Town Road. Together with a permanent, nonexclusive easement for use as an access road to and from subject premises over a 30 foot wide strip of land being -15 feet on either side of the centerline of the existing private road which extends from the Southerly end of the 66 foot wide easement described in Parcel B above, to the Northerly line of Parcel A above. 3 . G-9 r �L • lam 1 �f Parcel #: 040 - 1143 -30 -000 04/07/2008 03:37 PM PAGE 1OF1 Alt. Parcel #: 01.28.20.573C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ROWEN, DOUGLAS J & SUSAN K DOUGLAS J & SUSAN K ROWEN 295 RIVERVIEW DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 295 RIVERVIEW DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 1 T28N R20W 2 AC PT G.L. 1 SEC 1 COM Block/Condo Bldg: NE COR SEC 1, TH WILY ALG N LN 300' TO W R/W RR, SELY ALG R/W 201.5 S 46 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30' SELY 354.85' TO POB; SELY 175' S 46 01- 28N -20W DEG W 504.6' TO SHORE TH NWLY ALG SHORE TO PT 175' NWLY FROM PREV. DESC LN NELY more Notes: Parcel History: Date Doc # Vol /Page Type 04/10/2006 822505 EZ -DR 11/22/1999 614310 1473/46 WD 07/23/1997 792/412 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 290,500 303,200 593,700 NO Totals for 2008: General Property 2.000 290,500 303,200 593,700 Woodland 0.000 0 0 Totals for 2007: General Property 2.000 290,500 303,200 593,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 J UL 1 2005 Wisconsin Department of Comrrnerce Z©Ni1dG OFBG'AL UATiON REPORT Division of Safety and Buildings Page _� of 3 in accordance with Comm 85, Wis. Adm. Code G Attach carrrplete site Plan on paper not less than 81/2 x 11 irx Y hes in size. Plan must RaCD l X indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slop#. scale or dimensions, north arrow, and location and distance to nearest road. D / - — — 06 Please print all fnformatfon. R Date Personal information You Provide msY be used for secondary Purposes (Privacy Lew. s. is.o4 (1) (m)). ` d 0 PAY Owner Property Location Dd u ) SUE /R U GoA Lot /V W 1/4IV W114 S / T Zf N R 201 Y E (a) Property Owner's Malting Address Last # Block # Subd Name or CSW Z 9 S 2 t v FR V CKy State Zp Code Phone Number ❑ City ❑ village blown Nearest Road t v�so►� w i 5446 1 CI 15 ) -77 - 5�21 - TP o ❑New Construction Use;' Residential / Number of bedrooms - Code derived design flaw rate (o O O GPD ❑ Public or commercial - Describe: Parent material Flood Plain eievation if applicable N A R Genes Q - 2 and recommendations: Wes( -b B # [] Baring a ® Pit Ground surface elev. c l 7. � q 5 / t Depth to On" factor 3 2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW 11L Munsell Qu. Sz- Cont. Color Gr. Sz Sh. 'EM1 'Eff#i2 l 0- /8 10 — I m f l' zr, Cs 3v--F •.G Z /8•2-5 m CS 2\9 • •� 3 ' 25 - lvYRs�rp - kSiC/ i CS l ✓-� .� . to /vYRS _ r �- O /z C / m -�' . F 2 # ❑ 9�. ® Pit Ground surface elev. 39 8. Depth to CurrxY6rrg factor �iL in. � Rate Horizon Depth Dominant Redox Description Texture Structure Coruistence Boundary Roots GPD/(f In. Mtmseti Qu. Sz Cont Color Gr. Sz Sh. 'Eff#1 - Efr#2 O -Z2 JUM21 _ 2M bK huff^ CS 3 PM 2 22 -34 1 v YR-3/3 — S ie / 2 M e 3 v 3 3� A , 0YR- 3 i — SC' l 3 vG bK Me i _ — • -e j EMuerrt #1 ° BOD > 30 < 220 nrgfL and TSS >30 < 150 mg& • Elil ent #2 = BAD < 30 _ _ mgll and TSS 130 mglL. CST Name (Please Print) LA I- Signature i CSTNumbW Addhss i 1 Data Evaluation Conducted Telephone Number 2- l csr+I k �'2 t/� VALU 1 x'76 7 7 7 S ?•72- 3"Z i © ■ • in .: � n, -r � rti a .. i , ir. r., .• i it � .. nu, -+nu . . � � :.� - :::� 34>.o 3 ♦ = Go�TouR LD t. o w NORTH pRb �Y 1 tie 1 1 f w, o O o If LL r _ Q Q IL q 1 ` �` o o to -� CD LbT ST�K� N yi 1w r (00' 3p' 15 `-L 21 4 - 7 , SOUTH PR OPErz r LI E