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HomeMy WebLinkAbout038-1242-12-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Budding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Pnvacy Law s 15 Oa (1)Im i] Permit Holder's Name City Village Township Oevering Homes TOWN OF STAR PRAIRIE CST BM Elev Insp BM Elev BM Description IANK INrUKMATIUN TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P1L WELL BLDG Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Model Number ema PM TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist io Wen ELEVATION DATA County St. Croix Sanitary Permit No 645408 State Plan 10 No Parcel Tax No 038-1242-12-000 r tiowTown/RangeiMap No 31.31.18.1327 STATION BS HI FS ELEV. Benchmark Alt BM Bldg Sewer St/Ht Inlet St1Ht Oullet Dt Inlet Dt Bottom Header/Man Dist. Pipe Bot. System Final Grade St Cover SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No Cf Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth DIMENSIONS SETBACK SYSTEM TO P1L BLDG IWELL ILAKEISTREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System UNIT Model Number DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size Hole Spacing Vent to Au Intake Pipets) Ix Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Ontv Depth Over Depth Over Depth of xx SeedeMSodded Mulched BedTTrench Center BedfTrench Edges jxx Topsoil T Yes No Yes No COMMENTS: (include code discrepencies. persons present. etc) Location: 1818 90TH ST I -) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information Date SBD-6710 (R 3/97) Inspection #1 Insepclor's Signature Inspection #2 1 i Cert No <A(V — —7 Q SY" 1.5 a 2.A ocrr;4"ey,4 Industry Services Division 4822 Madison Yards Way CountyC r •5•,i'�`t{ Madison, WI 53705 Number be filled in by Co.) Sanitary Permit (to �ha P.O. Box 7162 'Madison, WI 53707-7162 / 8 (0 Sanitary Per it Applicat SiateTransaction Number In accordance w h SPS 38*§1� ,L)Wi4.-i{dMk Code su ission orillhis form to the iat ov me I nit Project Address (if diffe-enl than mailing address) is required prior o oftki M t lication forms for state-o ' d to the Department of Safety and Professional Services. Personal information you provide may be use for sec n ry purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stats. D o 1. Application Information - Please Print All Information Property Owner's Name Parcel N d 4 9- v D o r Property Owner's Mailing Address Ll Ce Property Location 3 L Gout. Lot City, Stele Zip Codc Phone Number %jLj ^ � r7 T N R E W 11. Type of Building (check. all that apply)_Z Lot M 1 or 2 Family Dwelling - Number ofBedrooms _ / ! fff Subdivision Name Block N 0PublidCommercial -Describe Use ❑Cityof Diane Owned - Describe Use inageof CSM Number Y own of 111. Type of POWTS Permit: (Check either"New" or "Replacement" and other applicable on line A. Check one box ai line73. Complete line C If appl[cable.) A. ew System ❑Replacement System ❑Other Modification to Existing System (explain) OAdditional Pretreatment Unit (explain) B' Holding Tank In -Ground Dt-Gn de Mound pe ype (explain) Individual Site Deli Other Ty (conventional) Z L C• ❑ Renewal Before [:]Revision to or Plurnbcr --q 11 ran ter to New Owner 1; tst Previous Permit Number and Date Issued Expiration 6 1V. Dispersal/TreatpOntArea and Tank lnfor atlon: D 1 it Flow (gp Design S'I Application R gpd/sf) Dispersal Area Require 0 Dispersal Area Pro ed (sf) Sys ten Eavat n I Tank Information Capacity in Gallons Total Gallons Nor Units Manufactur . I 1j �e`j�% y E u New Tanks Existing Tanks J w S u 2 in 8 LC 1 U v, N V a. Septic OFHolding Tank Dosing Chamber V. Responsibility Statement- the undersigned, ass a responsibility for Installation of the POWTS shown on the attached platilli- Plum 's Name (`Print) Plu is Signature MP/MPRS Number B` inesa Phone N ber ' Plumber's Addmss (Street, Ciry, Stetc, i ode r ^ L'//l3 L S1. 1. Count /De artment Use Only Approved O Disnp Permit Fee E r �1pt Issued `1 Is uin Agent Signature C rven or Denial �— Z Conditions Approv eacaasfersisnpprvoal k(CY�Ch �Y`tANs j C��\ J T'EM OWNER: pertank, filterand OL)tNt�_-.VN^vsI n"V)A S 1j ►M ✓�Gcevl%.{r,uy7 lmusteffluent persal cell must b�satYs�d /maintained T'�) � �r per management plan provided by plumber, r h ��,t 40kj it0 -pro/ / �" a w r.4 r setback requirements be must maintained' ✓ fr.,, L / J— applicable __- �+lti-Ci PA %�S fl A&.L per code/ordinances. r' , SBD-6398 (R. 03121) Al Imeh to complete plane for the system and submit to the County only on paper not less Ihan a In x 11 Inches In sire Q System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cemohocs Ave Suite A New Richmond Wi 54017 N 1/2 SE 1/4s 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 96.0/95.6 5.5' below grade 8/31 /22 BEDROOM 3 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHO O WELL *H,R,P, same as benchmark Scale = 1/4 = 10 397' Property Line �,B . M .216' Vent 20' >6" Quick4 Standard of Cover Leaching Chamber B-1 20' with 20.0 ft2 of Area 20 6.6f A2/pair of end caps ST 12" 4 Long 30, 34" Grade at System Elevation 3W B- 5% Slope 60' 2-3' x 66' cells with >3' spacing Vents B-2 100, 102' 101, Pro 3 Bedroom House 90th St. Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 08/28/22 Owner:Oevering Homes Location N1/2 SE1/4 S 31 T31 N,R 18W 90th St. Star Prairie Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance an ntigency Plan 7. Filter Cross S i n Signature License t�dmt(er #226900 System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 N 1/2 SE 1 /4s 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 96.0/95.6 5.5'below grade DATE8/31/22 BEDROOM 3 CONVENTIONAL XXX CONVENTIONAL. LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 kk BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL : It. R.P. same as benchmark Scale = 1 /4" = 10' 397' Property Line B.M.216' Vent 20' >6„ Quick4 Standard of Cover IF Leaching Chamber B 1 20' 20' with 20.0 ft2 of Area 6.6ft^2/pair of end caps 4' Long 1 30' Grade at System Elevation 34" _30, B 5% Slope AL 44 60' 2-3' x 66' cells with >3' spacing Vents B-2 100, 102' 101, Pro 3 Bedroom House 90th St. Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 6.6ft^2 pair of end plates Typical Installation Vent Grade A/30/34 Septic Tank 5' Lon gjI" 5' Grade at System Elevation Spacing 5' 5' Lon To be >1' above grade Finish grade elevation 101.5' ,Vent at System Elevation 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A 96.0 B 95.6 File #; ST. C RO : ,I)INTY SANITARY SYSTEM office use only OWNERSHIP/ADDRESS FORM Created 2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addre City/State/Ziil Phone Number (required) LI J — !6 U - Email Address Parcel Identification Number d30- (found on the property tax bill) !/I NEW SYSTEM: LEGAL DESCRIPTION J Property Location N 1 S f 1/4 , Seca I T 31 N RIW, Town of 514 a e(CtJA'k'jE Subdivision Plat: stl m/ U% l 5 I +Lx r-ee , Lot # �7! Certified Survey Map # , Volume . Page # Warranty Deed # 111361 (before 2006)Volume Page # Number of bedrooms 23 Spec house'Ayes 0 no Lot lines identifiable O yes 0 no Qn A OFFICE USE ONLY New Property Address Iy l 4h 5+ (Verification of new address required from Community Development Department for new construction.) 1 y 0 7- (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is mode in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccLA . 1101 Carmichael Road, Hudson, WI 54016 www.sccwi_goov POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page _of_ 91 ;ILE INFORMATION Owner Permit # DESIGN PARAMETERS Number of Bedrooms �wp NA i Number of Public Facility Units .,4 NA j Estimated flow (average) �/77' gal/da i Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate aUda /ft Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) s220 mg/L C1 NA Total Suspended Solids (T'SS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) <_30 mg/L _AA _ Fecal Colifonn (geometric mean) 5104 cfu/100m, !Maximum Effluent Particle Size X in dia. ❑ NA (Other NA "Values typical for domestic wastewater and septic tank effluent NIAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer )� ❑ NA Effluent Filter Manufacturer r �M,(� ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer qNA Pump Manufacturer NA Pump Model NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -'Grade ❑ Mound ❑ Drip -Line ❑ Other: Other. ❑ NA Other: ❑ NA Other. ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) 3 ❑ NA -iLyear(s) .Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ moMh(s) (Maximum 3 years) earls) ❑ NA Clean effluent filter At least once every: month(s) ❑ NA ea s ' nspect pump, pump controls & alarm At least once every: p month(s) _ NA I=lush laterals and pressure test At least once every: ❑ month(s)NA 11 year(s) Other.C] At least once every: month(s) ❑ year(s) 1 ❑ [NAdtither:El MAINTENANCE INSTRUCTIONS X Ilnspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Maxtor (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 affluent 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 condhiwi and requires the immediate notification of the local Pegulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ('h) or more of the tank volume, the entire contents of !be tank shall be removed by a Septage Servicing Operalar and disposer! of In accordance with chapter NR 113, Wisconsin Administrative Code. INII other services, including but not limited to the servicing of elfluent filtera, mectranical or pressurized components, pretreatment units, (mid any servicing at intervals of 512 months, shall be performed h; a certified POV•!TS Maintainer. A service report shall be provided to the local regulatory authority .vithir! 10 days of completion of any service event. page , of _, START UP AND OPERATION tank(s) for the presence of For nim col tl�ctro , priorment to use of the pOWTS check process and/or damage the dispersal hO tcell(s). if high concentrations a ndetected haveor othe cons ner its ofcals ttho may tank(s) removed by a septag e servicing operator prior to use. 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 wastewater will be e Servicing operator prior a restoring power to the discharged to the dispersal ce0(s) in one large dose, overloading the cells) and may result in the backup or aurfeoe discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septag g um controls to restore normal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the Pump within the pump tank. Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT li antibiotics; bywipe ; cigarette and vegetable peerlingscotton swab grease; degreasers;herbicides; edries meat scrntsaps; smedication ;;S oil; disinfectants; ) painting (sump pump) pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is proper y and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disoonnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by 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 nett, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliapn replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. ed from disturbance The replacement area should be protect and compaction and should not be infringed upon by requbled and welts. Failure to protect the replacement area will result In the nded setbacks from existing and proposed structure, lot lines for a now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled in effect at that time. t setback and/or soil limitations. Barring advances in POWTS technologN a ❑ A suitable replacement area is not available due o holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil end site evaluatMon must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. ❑ surfaceadReconstructions of suchabsorption systems must comply the rules in ed in lect atfollowing that time move) of the biomat at the infiltrative «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO ENTER A SEPTIC, PUMP ROTHER MENT NI� UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� A PERSON FROM THE INTERIOR OF A TANK BE DIFFICULT MP E. ADDITIONAL COMMENTS POWTS INSTALLER hame �hone SEPTAGE SERVICING OPERATO PUMPER Name Phone POWTS MAINTAINER Name 5�tcs„� _ Phone %/; LOCAL REGULATORY AUTHORITY EPhName Phone '7/j— 6- d 3a3 "MI m) & 13% Wisconsin Administrative Cods. This docum*M was drafted in eomplisnce with chs*t SPS 383.22121(0)(t)(d)S(f) an I . . MeconslnDepartment otCommeres SOIL EVALUATION REPORT Page _of_ Division of Safety end BuMdinps k, ac=rdsncs YAh Comm 85, WIS. Adm. Code Attach ofmpieh site plan on paper not less than 8 1/2 x I 1 inches in size. Plan must Coum "S77 / ,,• in:iude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent elope. Scale or dimensions, north arrow, and location and distance to nearest road. Please Print all Informetlon. Reviewed by Date Personal Intmmadon you orovidg mar ba uadd Iw wwndary pur"Ps (Privacy Law, s. 16.04 (1) (m)). EP er Properly LocationU(�lQ „ Pl% Govi. Lot {IZ114 f,114 S ?I T 3 N R Q E( wsarel ddrota Lof p ubd. ac$7 / Bb&, SM , 7- L� 0 t�"' Constan Uea. eeidentiel / Number of bedrooms _ Code derived design Row rate v GPD Roplaosmam ❑ Pu'bliicc�'r commerclat • Describe: Parent materiels Flood Plain elevation It applicable A/_ General oxrrnents and reaammerldattaie: System 1ype�'q/01yy kt.QX, System Elevation Bar4>> # �U} Boring /,�Q / PIl Ground surface elev. R. Depth to limtena factor _ / 30 In. ©® aikedox Description •Color d !". P. A I M FOM' E42M _ F01MMEMMININ # U Boling 19 Pit Ground surface ele�Il12 (7 ft. Deoet to IlmMr o factor /3 In ©WAFA A Wm11! ARMElPi7[lJ,�UMWAJI O.M.0 _.___.. _ . - -- a — ,,.✓r w w , w .a -9111 nVL ' Cmusni wi x tivu, c Au ffWL. end I bb < .f0 "WL CST Nome (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 /CZ —c,?a -,7-, 1 715-246-4516 iL Property Owner. a] Bodng fl Parcel10 0 ❑ Boring G pit Ground surface elev. �ft. Page _of Depth to Urniting factor TD— In. icafion Rale_ n r ► ©%. ��r ii� �F"01 ©[owlffM-M � I IE'MMAf -. Boring a ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Sob Appllcalbn Rate Redox Description 'Kilo --_ _ — mom ❑ Boring Boring; p Ground surface elev. ft. Depth to Ilmleng factor In. ❑ Pit Soil Application Rate • Effluent p1 - SODS > 30 1220 nV& and TSS >30 _S 150 mg& ' Effluent C2 • BODI _130 nV& and TSS ! 30 mp4 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 TPY 608-264.8777. sBD1310rRAj Soil Test Plot Pl, Project Name Oevering Homes Investments S Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 ird ;TM #226900 Lot 12 Subdivision Bella Vista Date 12/22/21 N 1/2 SE 1/4S 31 T 31 N/R18 W Township Star Prairie Boring Q Well PL Property Line County ST. CROIX L BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation TBD •HRPSame as Benchmark Scale = 1 /4" = 10' El 0 Z M rn D O I JOD MIIGRMNTION sm" lmpo y" OEVEKING HOMES 1°O --- .. ...... eur ...r�o.rt n.�new. uf.ec r� ✓ee w, rentr. _ e w000�i............. I OF 5 menu. �e rv. mrta. •aan cmTue„T wrKe "" " '°n ELEVATIONS A5Z h�� 6�t i�! 6�� 1 I A A A A ! a si �, �g S Z ;� 0 � 2 ryT Z �.0 �� OEVING HOMES RAN WOODMION roe WOKTroN WET iNrorrwTOW �+.rw aR gN.eFYM1Y)YQ ry[,1N Npp.Nl 3 OF 5 MAIN LEVEL COrrWW NO'" a r q 'NOXCT I, 2P1f �R. IJM qn 4,.� Yw4 NC l.W.- 5CAU Ai SHOWN �r� pro sr� �>:a 01 Of, OR illi I! rt n • 1 \1 ryAN IWOMMAt lOG lwrc AlION 5KR IWOIb F" EVE T HOMES 40P5 COIIR 11 NO r rrtaear. xiaI 2ND LEVEL q.Y. tlN Nln YM. W.Y. tl.tlOn 5CNL: A55roo" M r u g,� ¢ z I I i I, / �d►�Sti`N �ti sn � � � ,��• I • NtipLp•S,`1•�E / S •�-!j � ` "� a% '? '26•tSF •S�s£ o\� � I • "GO,6yFN o� d t oo I Oj Z.. oN+ 41. 0, isF ,bs J�o�o 6 zJ W Z p� p u W w '' sa£�92N O m 1 30' u�+ d cc U ONO 3 ' o W I - u,v % 1p � a II Ln� CO N Q Q "`Aj� x_ OiN . m � v%I L V40to N ¢ O1Nm V CA: ID J Ch 0) kZ co Z ll3j�n 3 AS J < J Z K 4y. a, . I wpe 6, 00.0q&'9GNWM !0 3903 ZF• m _ — _ -o I �I O I d c°C� o`to� 2FF ^+n /o Ci 3 6qs�/9by �N lg.tb :2 / n W o I I �Qo � s �N I o O7 �E`gg03' N Q It o a9'E ov 5s'h�00 �E��N '�8� N08°58'36"W ey a � ci 46139 _ o S 9 i � Ps /5 0-j r m t P% s P j2 S / nZ ►(9i=S A 92N t 5 w o " 7 O 00 ¢mF st 4• LL o: f-Sru2w O 4 I I w z N l� U 2 fm �V CO w� 2 w r + cf oo C) Q , ¢ w �;•o of tim v a� QWa��� I ¢W�y I N 0 uj _ .� w � � Np w?�CH�<n ujZ ooze < I f m y0. 2 i LA Z! 2 '' z J �- ,� r t� wi?Cit �!o itn3 / Or sb�'R INI I rN � 1nj D/I35-Y/I3N3NI71S3M-. . _p tt _ � ,58'99E 00'08i .� S8'9trS M�Ab,LLOON ry0 o i; W g IF- Q , J y DEC 2 8 2021 ' YA` D t epa:toentofCommer-..e SOIL EVALUATION R POR a �y L Page_ot_ D vision of Safety end Bu ldings 0 9l/ rl Y�/ ac�roance mih� Comm 85. Vdis. Adm. Coda Attach oOmPlels site plan on paper not less than 6 12 x , t Inchat in size. Plan must CauntyS!' ` /� X" miude, bul not limited to trertical and horizontai reference point (BMI, direction and Psr�I D. q r Percent slope. $rate or dimensions, north arrow, an* location and distance is nearest road. (ram � Please print an Irttormatlorr. Reviewed by'y Date P•rsorn•I rrtor be YOU pro••.b4 m•tbe U"Q im ••LJno•r)' W p,,," (Privy LSN', r. 1:,t)/ (! ) Props ty Qw-te• D �(`/'J� Proper♦)-Lowtlon i j P �C q !i1e� ZC% Goti4. Lot Z 145��',;4 S ?�I T 3 I N R E( Vt roperty O~s Mal'. ddress Lot C Bit p �. a (S j Pi r rZ l (l NI (L a, L/, cti e Zip Cale Phone Numow e, „ I 1 ❑ City ❑ "liege Kj Town Nearest Road ,�I-+filet" Cortstrudlon Use. Residentla' / Number of Ded,-ourtts Cale derived design fiow rate v _ GPD Rap a3vment ❑ Public r comme:aal . Describe Parent material f `/ Fiat Plain elevation i` applicable �✓ / %�i ZOlt t Genera! wrmm-ft Gc and ra.'xmnandatiais 7 Sy am TypeSystem Elevation / r _ ❑ Boring Pit Ground striate efev. �, OR. Deoth to limitina facmr 130 to •WME • ��'L/ r -- - ciirwrw we. OWW.-'JU rrl9FL ar10 Ibb<;U ftVL CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation conducted Telephone Number 1432 120th St, New Richmond, WI 54017 /C: o� o2 —,•"Z 1 715-246-4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring 0, pit L Ground surface elev. / k. Depth to limiting factor _ �� in. ® WA MWAIM ❑ Boring # ❑ Boring ❑ Pit Ground surface elev k. Depth to limiting factor in. Soil Mnlir`atinn Rnta Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 I 'Eff#2 Boring # ❑ Boring Cl Pit Ground surface elev, k. Depth to limiting factor in. Soil 4nnlir ion Rnfc Horizon Dominant Color Munsell Redox Description. Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Ef #1 I 'Eff#2 Pin. Effluent #1 = BOOS > 30 < 220 mgrL and TSS >30 < 150 mgt. ' Effluent #2 = BODr 130 mgtl 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. SM1330 (RAM) Soil Test Plot Project Name Oevering Homes Investments Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 Lot 12 Subdivision Bella Vista N 1/2 SE 1/4S 31 T 31 N/R18 W Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. ird >TM #226900 Date 12/22/21 Township Star Prairie County ST. CROIX Top of 3/4" pipe System Elevation TBD *HRpSame as Benchmark Scale = 1 /4" = 10' o a. rm—o ,.w�.v yp�(py Pml Nis wlqjomqrm �! w �� �. ,...--. 1Vld IVNIJ y-v-rr ti UN10J �(YIJ 1S 3tlMN dY151NOl MEIN Nlf1'If ]353S-3J93S'MN 0ll 'SlN3rUS3ANI S3YIOH JNIN3A30 V1SIA V1138 .. • O z m bk �4RWA� croo z 0 •a° 9 a F s > a m v IL Lam" Y QSal A M ' B e a�. ^� O 00 O Y G py7p Y Y p 6LJ �G IL 00 V F�(�-9F�UgOG9 mFe 3 3 . 3oeV-C6.0 A ����8o're W W z CA a z 3 w 4 H O a