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HomeMy WebLinkAbout572884 040-1320-00-003Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Hanke, Benjamin Troy, Town of CST BM Elev jInsp. BM Elev: IBM Description. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SFTRACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding Pt1MP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well IL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 572884 0 State Plan ID No: Parcel Tax No: 040-1320-00-003 Section/Town/Range/Map No: 24.28.20.2150 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEOD/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade System Depth Over Depth Over xx Depth of xx Seeded/ Bed,Trench Center Bed/Trench Edges Topsoil COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 ! / Location: 291 Croix Ridge Dr Hudson, WI 54016 (NE 114 NE 1/4 24 T28N R20W) Cove Ridge Lot 3 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes [] No Use other side for additional information. Date Insepctor's Signature SBD-6710 (R.3/97) Hole Spacing Vent to Air Intake s Only Sodded xx Mulched Yes E No ❑ Yes [l' No Inspection #2: / / Parcel No: 24.28.20.2150 Cert. No. ►.�Cjcopy 89 3 . L-( � ENS cc' Sou+�-taS� c r rL� , -t -b I o -F- lYvn IDe 2 -7 mili r J i 5' 7 cof»merce.wi.gov Safety an"uildings Division 201 W. Washington v�'Box'7TS2 County �►% i yL t► S c o n s i n tiepartmerd Madison, WI 53707-7162 Sanitary Permit Number (to be filled i by Co.) --T2 b. of Commerce 5 8 Sanitary Permit Application In accordance with s. Comm. 53.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental State Transaction N m r J/^I,//' `//%t�,_ unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are project Address f if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1 m Stats. aCY I C and X9, 1. Application tnformation - Please Print All Information , Q - Property Owner's Name a.✓ t �-Alll � ` Parcel # oho - 3�a -ao 6� 3 Property Owner's Mailing Address Property Location y J � F -.-- CI ..[/ ! Govt. Lot 1 './ � y,, 6- !s y., Section (Chaek One) ' 1 City, State Zip Code Phone Number It ZLJG 2 T �N; R a d E E II. Type Building of (check all that apply) Lot # Subdivision Name �41 or2Family Dwelling -Number of Bedrooms /_/ / Block ❑ Public/Commercial - Describe Use hoes e ce .)fan ; d �. # � as Per P City of ❑ State Owned - Describe Use CSM ❑ Village of Number Town of yL� III. T heck only one box on line A. Complete line B if applicable} o in e LAQ New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System 3 P)swrsal C80S vol 25 wits eatA B. Permit Permit Revision ❑ Change of n Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner 1 5 X �� Ex ira ion e o POWTS S s m onent/Device: Check all that applyl Non -Pressurized In -Ground Pressurized In -Ground At -Grade LJ Mound > 24 in. of suitable soil Mound 124 in, of suitable soil ❑ Holding 1 an c Other Dispersal Component (explain) Pretreatment Device (explain) V. Pis ersaIlTreatment Area Information: G tC� ♦� y. Design Flow (gpd) lv Design Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation '`►�" l' O . ✓9 06 1 dd ✓ ! G d G� L o .r✓T Vi. Tank Info Vapacity in Total # of Manufacturer tt rial Gallons Gallons Units n w/ p / to c k- 525 New Tanks Existing Existing Tanks /� y Septic or Holding Tank �i IJ / ; �/�f dr/ ` zt)`� � Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PORT wn on the attached plans. Plumber's Name (Print) Plumber's Signatwe PRS Number I Business Phone Number Plumber's Address (Street, City, State, Zip Code) <o 7d 2,.- a ..t/ Gv / I VI . ountyNCPR t ... ent Use Only _ Approved _Disapproved Permit Fee Date Issued Issuing A r _ Owner Given Reason for Denial $ po ZD/t J fX. Conditions ofApprovaUPg"O oval haVe >12 tan 60 1. Septic tank, effluent filter and dispersal cell must t serviced / maintained ,sfG //t� 50 , 7%D as per management plan provided by plumber. 7 2. All setback requirements JYW1 Z-5 r K must b Gl 11 C( (7 Attach � the Count' only on paper not lesh than 8 In it 11 Inches to size SBD-6398 (R. 01/07) Valid thru 01/09 M ler CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: J/ 5- /- Legal Description S Township: County: S i e- mac - Subdivision Name: e- ,v Lot Number Parcel 10 Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans t)eslgnet/Plumber. kcJ / e 1 "A. yve%; ck�-=fy tcense Number. Date. 3% /�% J— Phone Number Signature Designed pursuant to the In -Ground Soil Absorption component Manual for POVVTS Version 2.0 SBD-10P70�5-P (N.01101). 'e- Al ►L .v , ` Al `: rh�e-,� i K e. l- e-'t 3 e ya I. Y / , 69 S . Cl� Em @ scu+iu-gS+ �Yvn ?I s_ 1 Leaching Chamber Soil Absorption System Cross Section k .y _J V _�____ ft : ft ft Soil Absorption System Plan View ft a•Y ft Final Grade ft system Elevation pia. 3der Leaching Chamber Specifications/ / Manufacturer And Model X elea& 7 � � Pluf EISA Rating 'old) sq ft per chamber Soil Application Rate •'� gpd/sq ft gpd Design Flow Soil Application Rate EISA = Chambers J 3 rows of 5 chambers each. Page of 6 112" BALL CHECK ACCEPTS 6" SCHD 40 FOR INLET EXTENSION iUTLET BUSHING ACCEPTS 4" SCHD 40 & 6" SCHD 40 PL-525 -625 FILTER HOUSING PART NO. - 30142-525 MATERIAL - HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5" BALL - HDPE 11.59 [29.4 cm] 10.52 [26.7 cm] 2.00 [5.1 cm] 14.34 [ 36.4 cm ] OUTSIDE DIAMETER ACCEPTS 4" SCHD 40 SOCKET 8.10 OPTIONAL BUSHING [20.6 cm] (FOR 4" THIN WALL PIPE) PART N0.30142-R OR (FOR 11010 MM. PIPE) PART NO.30142-EUR 12 cm m\ /\ @E \ \ / f E§ §\ § / \ / CO LO CN Cf) S\ \2@ JO w b?LL \ /// I= / \ /\\ �/ /CL \E , ƒ CL LO 0 \? k\\ Cl) CL \ \k/�_j -i » wLu < o«<00 0 ILCoe e POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ____ of __ FILE INFORMATION Owner gjLN I KKO HAN }LE - Permit # — DESIGN PARAMETERS Number of Bedrooms 11 ❑ NA —� Number of Public Facility Units ❑ NA Estimated flow (average► gal/day Design flow Ipeak), (Estimated x 1.5) �p d p ai/day Soil Application Rate all/da /ftz Standard Influent/Effluent Quality ; Monthly average* Fats, Oil & Grease (FOGi 530 mg/L Biochemical Oxygen Demand (BOD6) i <_220 mg/L C) NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biorhemical Oxygen Demand (1300b) 530 mg/L Total Suspended Solids (TSS) _<30 mg/L 0 NA Fecal Coliform (geometric mean) <_10" cfu,)100m) — NA Maximum Effluent Particle Size Y8 in dia 0 Other: - NA "IAloes typical fnr dornestic wastewater and septic tank effluent. nnAMTEKIAWIL; cr+ucr.eu r SYSTEM SPECIFICATIONS Septic Tank Capacity / aS (D gal ❑ NA Septic Tank Manufacturer �� ��� ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model J `'�' ❑ NA Pump Tank Capacity _pal ❑ NA Pumpanit fdtanufacture�--[- S e ❑ NA _00 ❑ NA Pump Model _ — ❑ NA Pretreatment Unit ❑ NA ❑ Sand/Gravel Filter ❑ Peat Filter U Mechanical Aeration ❑ Wetland n Disinfection ❑ Other: Dispersal Cells? ❑ NA 0 In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: _ J- Y ❑ NA Other. ❑ NA Other: ❑ NA ` Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ monthls) (Maximum 3 years► 13 9 year ❑ NA !—_ Pump out contents of tank(s) When combined sludge and scum equals one-third (33) of tank volume ©NA Inspect dispersal cell(s) At least once every: 3 ❑ month{s) (Maximum 3 years) 14 year(s) ❑ NA Clean effluent filter At least once every: ❑mont h{sl a nte} ❑ NA Inspect pump, pump controis & alarm I At least once every: p ear(s)(sl _❑ NA Flush laterals and pressure test At least once every: ._ ❑ month(s) _ ❑ year(s) [I NA Other — At )east ones ever Y -- ❑ month(s) ❑ years) ❑ 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 tanks) 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 (Y31 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 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be perfa med by a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page - of START LIP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) removed by a Septage 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 discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result in the backup or surface discharge of effluent. 'To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels 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 POWTS: antibiotics; babv wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain isump pump! water; fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; medications; oil; painting products; 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 he taken to insure that the system is properly and safely abandoned in compliance with chapter Comma 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected And the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly 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 soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 11 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. N�AEl The sitelbas n"en evaluated to identify, a suitable replacement area. Upon failure of the POWTS a soil and site N evaluation ref be performed to locate a suitable replacement area. If no replacement area is available a holding tank may b ,9,i#T§talIed1Ap a last resort to replace the failed POWTS. C, Mound and at -grade soil absorption systems May be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNINO> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name` — Phone POWTS MAINTAINER INTAINER Name —i--- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name �5G Lb j k,' Co %lj -r-Y Phone 15 - 30 ( - 4 � 8b This document was drafted in compliance with chapter Comm 83.2212)(b)l l Nd)&(f) and 83.54(t ), (2) & (3), Wisconsin Administrative Code. 03/12/2015 11:25 7153811528 BOH_ELECTRONICS PAGE 01/01 ST. CROIX COUM, SEPTIC TANK MAINTENANCE AGR EEMENT AND OWNERSHTP CERTIFICATION F AM Owner/Buyer�-� Mailing Address _� Property Address a �v 1` (Verification requited fmm ftming & Zoning Deparunem for new conatrnction.) City/State 10 Parcel Identification Number j rQ D U LEGAL DESCRIPT 11 Property Location t6 '1. , '/.. , Sec. Y"� . �T, IN Rq' W. Town of 3ubdiviaiuil k'1at t ' Lot fi .... Certified Survey Map # Volul ie , Page # VYamanty Deed # (before 2007)Vol+wee , Page # Spec house clyesljto Lot lines idc Wifiable (]yesjJno SYSTE M MA-HIV-MANCE AND OWNER CFRTIkTQnON improper use and maintenance of your septic eystem could. it in its prenn• nuo fWlwv to handle wastes. Proper tnafiatenaacc consists of pumping out the septic tank every three years or sooner, if M dcd, by a licensed pumper. Whet you put into the system can affect the firnudon of the septic tank as a treAtment stage in the waste d Spew, eystem owner maintenance responsibilities are specified in §SPS. 393.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix Ccwnty Planning & Zoning Department a ce<tiftcation form signed by the owner and by a master plumber, journeyman phunbcr. restricted plumber or a licenser 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 113 full of Oudge. 11we, the ttodessigned have read the above requiremems and agree to maiwan % the private sewage disposal system with the standards set fords, herein, as set by the Dcpartment of Safety And Professional Servit es and the Department of Natural Resources, State of Wisconsin. Cortifieatton stating that your septic Systcm has been maintained oust be completed and retorned to the St- Croix County Planning & Toning Department within 30 days of the three year expiration da' e. Uwe certify that all statements on this form are true to the beat of any/our knowledge. Uwe atn/are the owners) of the property described above, by vit�of a warranty deed recorded in Register of Deed% Wiice. Plumber of bedroomis l 3- 1 i15- LICA iT(S) DATE 'Any infrnmation that is misrepreseatcd may r mit in the s4uitary permit being rev ,kal by the Planning & Zoning Department. •• ( ncbido wilt this application a recorded warranty dead Yore the Register of Deeds Ofl ice and a copy of the certified sunray map if reference is made in the wormy deed. (REV, W2) State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number I Document Name THIS DEED, made between Kevin P Mergens, a single person ("Grantor," whether one or more), and Benjamin Hanke, a married man ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): 1004282 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 11/17/2014 08:00 AM EXEMPT # NA REC FEE: 30.00 TRANS FEE: 495.00 PAGES: 1 -The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Lot 3, Plat of Cove Ridge in the Town of Troy, St. Croix County, Wisconsin. Name and Return Andress Partners Title - Maplewood 2103 E County Rd. D, Suite B Maplewood, MN 55109 040-1320-00-003 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrance except: Dated November 11, 2014 (SEAL) Kevin P Merge AUTHENTICATION Signature(s) authenticated on November 11, 2014 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY:��,' Bruce Clark 2103 County Road D. Maplewood, MN 55109 ? P. ACKNOWLEDGMENT State of Wisconsin ss. St Croix County (SEAL) Personally came before me on November JL, 2014, the above named Kevin P Mergers, a single person to me known to a rson(s p executed the foregoing and Notary Public, Sta of W consin My Commission Expires: August 02, 2015 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 . Type name below signatures. File No.: 23915 Page 1 of 1 St. Croix County 1004282 Page 1 of 1 ` Q*mcz U. r THAT | HAVE BOTH IN T28N Rl COUNTY OF 3T. Cl CERTIFIED SURVEY THAT | HAVE MORE OR LESS 8i (BEARINGS REFERE IN VOLUME 20, PA THENCE WESTERLY SURVEY MAP, VOL SAID LOT 1; THEN, (PREVIOUSLY RECC LOT 1; THENCE S LOT 46 AND OUTL 300.17' ALONG Al LOT 2; THENCE S( RIGHT—OF—WAY Ll'i CONCAVE SOUTHEF LOT 7; THENCE S LOT 6 TO THE PC SW 1/4 OF SAID THAT SUCH F THATI HAVE COUNTY OF ST. C SOIL EVALUATION REPORT Page I of 3 Wisconsin Department of Commerce Division of Safety and Buildings in accordance wdh Comm 85, Wis. Adm. Code sty ST. CROiX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must horizontal reference point (BM), direction and Parcel I.D. (Pending) include, but not limited to: vertical and percent slope, scale or dimensions, north arrow, and location and distance to nearest road Date RevleweJ l,y Please print all information. Personal information you provide may tie used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Location Prop" Owner -- SE 114 SE im S LLC (Buyer. Bruce Lenzen Homes) Lot T 28 N R 20 E (or) W BOMAR HEIGHTS, Lovt. Lot # Block # Subd. Name a Property Owner's Mailing Address dY village Town Nearest Road CAY State p Code Pone South Cove Road NK Salt Lake City, UT84121 ( ) 4 Code derived design flow rate QNew Construction Use Residential /Number of bedrooms 600 GPD ❑ Replacement Public or commercial - Describe: Flood Plain elevation if applicable ft *' ^ till Parent material General comments Conventional In -ground trenches -- 0.4 loading rate and recommendations: To be designed by installer. ❑ Boring 52 in. a Boring # ❑ Pit Ground surface elev. 912.49 ft. Depth to limiting factor Sol licafion Ra TPxtnrn Smrrh,rc rrn...... re tin„ ary - _ - , r'rc rpnrnR •Elf#1 �E�2 Depth Dominant Color Redox Desrfintinn Horizon - - in. --Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. - sl 3fsbk mvfr cw 3vf co 0.6 1.0 1 0-8 7.5YR2.5/2 1.0 sl 2fa&sbk mfr cs 2vf-co 0.6 3 17-34 7 5YR3/4 - ml l of-m 0.7 1.6 4 34-52 1 7-5YR4/4 -" s Osg -- 4B Boring If Boring 914.75 52 Q Pit Ground surface elev. ft- Depth to limiting factor to Soil tication Rate C teBout nse Boary Roots GPDff Ho izon Depth in. Dominant C01or Munsell Redox Description Qu. Sz. Cont. Color 1 0-4 7.5YR2.5/2 - 4-15 3 15-1 34-52 7.5 1 R4%4 7.5YK4/4 - Texture Structure onsrs •Eff#1 'Eft#2 Gr. Sz- Sh. sl 3fa&sbk mvfr cb 3vf-co 0.6 1.0 r_r y�r s1 t,,aun 2fabk mfr as 2vF cc 0.6 0.8 n:.. • Effluent #1 = BOD, > 30 < 220 rng/L and TSS >30 < 150 rngA- CST Name (Please Pnrd) �f/$ignatu Mary 7o Hollister Adtl255 ` W9875 690th Avenue, River Falls, WI 54022 Effluert #2 = BOD < 30 rng/L and TSS f 30 mgrL CST Number 224832 Evaluation Conducts Telephone Number 10 - 21 & I I - 17 - 05 (715) 426 - 1775 Property Owner BOMAR HEIGHTS, LLC (Lot 3) Parcel ID # �-1 ��� SC: Baring '917.72 El Pit Ground surface elev. ft. (Ping) 54 Depth to limiting factor in. Page 2 of 3 horizon Depth in. Domment Color Munsell Redwc Description Qu. Sr- Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots -D-- GP[NffIE 'Etfl#1 'Eff#2 1 0-5 10YRV2 — sl 3fa&sbk mvfr cw 3vf-co 0.6 1.0 2 5-31 7.5YR3/4 — sl 2f-msbk mfr cs 2vf-co 0.6 1.0 3 31-51 7.5YR3/3 — Is If-msbk mvfr cs Ivf-m 0.7 1.6 4 51-54 7.5YR3/3 — s 0sg dl — — 0.7 1.6 BG�g # t._! Bow n face 919.69 Pit Ground surenv. ft. Depth to limitirtq factor 50 in. Horizon Depth in. Dominant Cow Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDW. •EW *002 1 0-6 7.5YR2.5/2 — sl 2f-msbk mvfr cb 3vf-co 0.6 1.0 2 6-25 / sl 2f-msbk mfr cW 2vf-co 0.6 1.0 3 25-41 7.5YR4/4 — sl 2ft&sbk I mfr as Ivf-m 1 0.6 1.0 4 41-50 7.5yR4/4 — sl 2fa&sbk I dsh — — 0.6 1.0 Horizon 4 has many si cts. BorkV # R Borvxg Ground surface etev. 1L Depth to Wr#tina factor K, Soo Rate Horizon I Depth I Dormant Coon Redox Description Tedure Structure Consistence Boundary Roots GPW in. Mrrtse@ Qu. Sz. Cord. cow Gr. Sz. Sh. 'Etf#1 1 *"M Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mgA- ' t=_tlluert #2 = BOD < 30 mg& and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 60$-266-3151 or TTY 608-264-8777. M-8330idt OL07MM (pending) 2 3 Property Owner BOMAR HEIGHTS, LLC (Lot 3) Parcel ID # Page of LPit SI- Boring # , ..y 917.72 ft. Depth to limiting factor in. Ground surfaceelev: $O1l I�t Structure Consistence Boundary Roots GPDIf Horizon Depth Dominant Colo Redox Description Texture Gr. Sz. Sh- `Eff#t `Eff#2 in. Munsell Qu. Sz- Cont. Color 3vf co 0.6 1.0 s1 3fa&sbk mvfr cw 1 0-5 I OYR2/2 __ cs 2vf-co 0.6 1.0 2 5 3I 7 SyR3/4 — s1 2f-msbk mfr 0.7 1.6 ls if-msbk mvfr CIS Ivf-m 3 31-51 7.SYR3/3 — 0.7 1-6 4 51-54 7.5YR3l3 — s Osg dl — — Boring # Boring 919.69 50 4C ft. Depth to limiting factor in. n Pit Ground surface elev. _ Soil licetion Rate B nda Roots GPD/ff Horizon t Color ell Redox Description Qu. Sz. Cons Color l 2.5/2 — 2 314 — 3 4/4 — 4 R4/4 91�9 — on 4 has many Si cts. {{��j � Boring 1� Boring # ❑ Ground s Pit Horizon I Depth I Dominant 1 l in. l Munsell Texture Consistence ou ry `Eff#t `FW Gr. SL Sh. r. Sz- S sl 2f-msbk mvfr cb 3vf-co 0.6 1.0 s] 2f--msbk mfr cw 2vf-co 0.6 1.0 s1 2fa&sbk mfr as 1 vf-m 0.6 1.0 sl 2fa&sbk dsh — — 0.6 1.0 surface elev- R Depth to limiting tailor rn- Soil ication Ra Redox Description Texture Structure Consistence Boundary Roots GPDffF Qu. Sz Cont. Color Gr. Sz Sh.f1 Effluent # i = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L , Effiuent #2 = BOD, < 30 mg/', 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 608-264-9777. SBD-8330Tat (R.07/00) Plot Plan for Sunset Ridge Town of Troy, S� Croix County, Wisconsin Lot 3 Legal Description sci/y of -mE SG'ly, T2W tzuxaJ Page 3 of 3 1"=40ft. 2 ft contours = Backhoe pit Wisconsin Depar t'ffir�r++ �+011= UAITION REPORT Page I of 3 Division of Safety and Buildings RR�d E'�% E in anCe'�ORtt tomm 85, Ms. Adij . Code I County ST. CROIX Attach complete site plan on paper not less t n 8 1!? tc pins iq Plan ust include, but not limited to: vertical and horizon I ref BNAy `l ion nd Panel I.D. endin percent slope, scale or dimensions, north an o , and location and distance to ne rest road. Q Q U Please print all r16i? « T G` Re wed by Date Personal information you provide may be used for nd -f5 (1) (m)). 4� 1 Property Owner Properly Location 12 W ? ZQ , BOMAR HEIGHTS, LLC (Buyer: Bruce Lenzen Homes) Govt_ Lot --- SE 1/4 SE /4 S 13 T 28 N R 20 E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 010 bfoekhill Brine -- P6fldifl City State Zip CMe one um tY Vllage • Town Nearest Road Salt Lake City, I UT 1 84121 ( ) NK Troy South Cove Road I 0 New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD n Replacement © Public or commercial - Desaibe: Parent material till Flood Plain elevation if applicable ft. General comments 0 / t , Conventional In -ground trenches 0.4 loading rat and recommendations: D�f, ^q Gllelw 6_n.5 nn J To be designed by installer. Coo ✓mow L- C-0" .') C 5 5 �� ,�. 1 Z I S„ A ' Boring # L-j ___""' u Q Pit Ground surface elev. 912.49 ft. Depth to limiting factor 52 in. SM Anolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 'EfW2 1 0-8 7.5YR2.5/2 — sl 3fsbk mvfr cw 3vf-co 0.6 1.0 h=17 - §l 113f>: 0:h 1:0 3 17-34 1 7.5YR3/4 -- sl 2fa&sbk mfr cs 2vf-co 0.6 1.0 4 34-52 7.5YR4/4 s Osg ml -- 1 of--m 0.7 1.6 E V-W 4B Boring # U Boring 914.75 52 ❑ El pit Ground surface elev. ft. Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 'Eff#2 1 0-4 7.5YR2.5/2 sl 3fa&sbk mvfr cb 3vf-co 0.6 1.0 2 4-15 7.5YR2.5/3 fsl 2fabk mvfr CAW 2vf-co 0.4 0.7 3 15-52 7.5YR4/4 — sil 2fabk mfr as 2vf-co 0.6 0.8 34-52 7.SYR4/ — Os, -- -- 0.7 1.6 1� • Cm....M IF1 - OM an TCR >'in < i sn maA_ ' Effluent #2 = B()l.)• < W mglL ann I Jj < M mgrL CST Name (Please Print) �ignatune (r CST Number Mary Jo Hollister _// [ (. -{, C t-i ` C 224832 Address Date Evakuation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 10 - 21 & I I - 17 - 05 (715) 426 - 1775 Property Owner BOMAR HEIGHTS, LLC (Lot 3) Parcel ID # 3C Boring # 11 Boring rM"� c„� PtP� 917.72 ft_ (Pending) 2 3 Page of 54 Death to limiting factor in. Depth in. Dominant Color Murrsell Redox Description Qu. Sz. Cont. Color Texture Structure Structure Gr. Sz. Sh. Consistence Boundary Roots GPDff Horizon 'Efl#1 'Eff#2 I 0-5 1OYR2/2 -- sl 3fa&sbk mvfr cw 3vf-co 0.6 1.0 2 5-31 7 5Y/4 - sl 2f-msbk mfr cs 2vf-co 0.6 1.0 3 31-51 7.SYR3/3 — is if-msbk mvfr cs IVf--m 0.7 1.6 4 51-54 7.SYR3/3 — s Osg di -- -- 0.7 1.6 l� EE -I Lj Boring 919.69 50 '� FW1Boring # Soil lication Rate Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Murrell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Ef1#1 'Eff#2 1 0_6 7 SYR2 5/2 sl 2f-msbk mvfr cb 3vf-co 0.6 1.0 2 6-25 7 4 __ sl 2f-msbk mfr cw 2vf-co 0.6 1.0 3 25-41 7.5YR4/4 --<< sl 2fa&sbk mfr as lvf-m 0.6 1.0 4 41-50 7.5YR4/4 sl 2fa&sbk dsh -- — 0.6 1.0 Horizon 4 has y i cts. F-1 � Boring Boring # f""-� Ground surface elev. ft. Depth to limiting factor in. pin Soil Anolication Rate Horizon Depth in. Dominant Color Murrell Redox Description Qu. Sz. Cont. Color Texture Structure Gr_ Sz. Sh. Consisterxx; Boundary Roots GPDAf 'Eff#1 'Efi#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L . Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or "I'TY 608-264-8777. SBD-833(Trmt RORK)) Plot Plan for Cove Ridge Town of Troy, St. Croix County, Wisconsin Lot 3 Legal Description sE % o►- Or 4 1' EId917 Page 3 of 3 I"=soft. 2 ft. contours Q = Backhoe pit tat ;H M M: TO nr + A ' / 9 AEI: 12_ 6 n� 7. 15 7' E yysoft.� ILi WOW 1 ill1lili i� � `�ial B��ARK� I Tl1D il1C .l A!i• . Plot Plan for Cove Ridge Town of Troy, St. Croix County, Wisconsin Lot 3 s T L� L L Legal .uescripiion :5F- /e, or -m F sEY4, a o� TZSA) RZ W SCALE:1 "=50' Cb tz--� R/o �- � 200, Gl- �'F BENCH MARK: 40d SPIKE IN 17" OAK \ 1:922.64507' R-3CI I � 1 31 1 1 sco i �1: 920.044� - i G R B I AEI:119. 89E N Q` 17.71 74950' Page 3 of 3 (mvL<Z-D; os-15-C6,) I"=Oft � J�. Lrvrssvura d = Backhoe pit K BENCH MARK: TOP OF 1 1/4" IRON PIPE :I _ ENCH MARK: OP OF 1 1/4 `IaON PIPE AEI: 921.03321' BAD 1: 914.95209' B-4B 893 I: 895.87608'