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HomeMy WebLinkAbout589725 032-2032-40-110Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Craig & Annie Casperson TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description: (50 &M F�iil TANK INFORMATION CI cvATInK] nATA TYPE MANUFACTURER CAPACITY Septic r S Dosing `✓ G $Z S Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r } �b r r w Dosing Aeration Holding PUMP/SIPHON INFORMATION Ma ufacturer """" — and GP l ; Model Nu er TDH Lift ction Loss System Head TD Ft Forcemain Length Di Dist. to Well SUIL Ab5il IIUN 5Y5TEM County: St. Croix Sanitary Permit No. 589725 State Plan ID No. Parcel Tax No: 032-2032-40-110 SectioniTown/Range/Map No: 08.30.19.591 D STATION BS HI FS ELEV. Benchmark Ntii Alt. BM Bldg. Sewer I' .0 96-I0 SUHt Inlet 7Y St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System S 3 y3 go Final Grade ¢ St Cover o 1 10Z-6c BED/TRENCH DIMENSIONS Width No. Of Trenches n ,, .tC LengtkW PIT DIMENSIONS _ No. Of Pits __- Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDFT WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: /V l� Iy I VK Type Of System: ,,��J/ LO�tS(i6ArnO %t. L ��. i E i� (� /QO r N Model Number: '``,, [tert-1 Su UI5 I t<IBU I IUN 5Y5 I EM Header/Manifold a 7' Distribution Pipes) x Hole Size x Hole Spacing Vent to Air Intake Length $' Dia_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Onlv Depth Over r Depth Over xx Depth of xx Mulched Bed/Trench Center -7 s Bed/Trench Edges 50qii Topsoil rSeeded/Scdded Yes V-No C Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 /f `/_ Inspection #2: Location: 403 165TH AVE nT /40) CTtO/✓� � (�1�i 9 j,6V*7J p-ll �jvLs lt/� /jj/�Ss��/fi if//�i �Lr►�j1� 1.) Alt BM Description =S, j" &,167 , 1'�t'1iYi(� M10 MA?-T— 5_/Z/404 j S014 72F3T W,—; Ai_64G_,07— fa4-e,/�-%�" q 2.) Bldg sewer length =le IN GH�mB�I?1, 4-N"JI 1411 D QE,i9DjNP 56-(E--M ivo -�- Cobc -amount of cover = � fZ oft �"W1 uA1r/G 5on►ET'KfNv► is -00,Ut w/ 12-E'!,gsuA). Plan revision Required? Yes [J No _1 1 yor `OP� (0MPj,1AA1- * Use other side for additional information. L Date r Insepctor's Signature W I" , a Cert. No. Qom=ivFn __.0011 7Aal cxe.viA,gov — E; SaCtty attti Buildings Divisinn -- -- 201 W. Washington Ave., P.O. Box 7162 Madianu, Wl 13707-•716?__ County jLs fign - . _ wuur vary Permit State1ranse umhet ,Application In nresrrrlenrn with s. Comm, 23.21(2� Via. Adm. Cody suhmitelon of ibis farm to the appropriate gcweru metal mlit is required prior to ohmining n sanitary penult, Note: Appllcadon forms for statc•owned POWTS are - project Addmss (if dif amt than mailing addreta) onhmined to the Deparnnent of Commerca. Personal infornxadoll ynu provide tatty be used for wcondary in accordance with the Priviw Law, s I S.04 1 m Stair. Ave,ores A I. 1! icrtian IntortnutMn Please Print .A,1t Infww0bit,M _ _----- prni", Owner'R Narnn4- ' pRrml # ----------------- Property ?wner'n �nilirig UllmannsR pmPeY �O()�. S `I f 0 -T/t /41p-e-_ — — — uoo. Lot _ t r A, Seadoo i'fty, 9rMn zip Codc 1'honnNwnber SO_in --- - li. 't'ylte of ]enilriIng (ebeek all that apply) �/yi int 5)rbdtVision Tiame ---- 3 i Or?. Pnmily i )walllinq -- Number of iledraomnLge • /� ;06,L t_ 3 L 1 PxhlicJCrut»nnrcial•-Descrlhai;se.___..- — _ _- to ❑City of —T_ '— -___ .. d.. I _I Stnte owneri -- Dmctihc Ilse --------___--__ t CSMNlrmhte , ❑ VitlaEeof-------------------___---._..- . A pyyrBY g't - ).V �_ o teal70nNYA IIT.. Type rri ermlt; {Ghee only one hex on Nn A. Cowkpl a line -9 f appikab)e) µ --- A_ -KN. Riem ❑ Re Ttcanant 3 sy p ygtem fl treaattnent/Hnlditlg 1'ankReplaoemonOther Modifiaetion to Existing Syetelt7 (explain) I� Permit Renewsi F1 Pmrmit Revision ❑ Chenee mOlamber O patmit 'i'remtfer to New List. Previom Pormit Nuii&e and Dana Maned Hefnm A-Apirntion OWMr f !, f L i) T of P'OW"s r Yalt+ln/GtntaponantJAeyiee: (Cheek aq Hat apply) — _ _- _--_ --- - nn-Prn!:SWM ln-(;regond n Pmasurized ln-Orotund O At -Grade CI Mound > 2A in. or mritoble toil U Mounds 2a in. ofnaitable 1roi1 G' ! . I Holding Tank Other DispetaatCmrq+aAent (oxplaln) _--.._ __.---_ ._.. (.) t'retreatment Device (explain}_ _ �..__. `'. J)1�ers�UT> _ InentAm Inforim on" Derain" Flow (gp(l) r>raripin 3oi1 Appliontion Rote(p Diapersxl A.ren Required (of) Ditpertal Aron Proposed System Mevadon Vl. 'L aok LnfA Capncity in Tnb+l # of Manafgaturer — _ Gallons r.3allnns Units %�O �D I -A � � a N6w Tanks - i?Kitthls Tanks — _ Srplle ar Heidita TMk Dnaieg T7 _V LI. Rt!p9n9LMilty Statement- k the andnngplad, roams 1 tt at W- torintq►Batioa et the POVM ehewn on the attached plans. ------- Piornher•R Walnts (Pdni)Plumber's Slostum P PRS Number Ausineas Phone Number Thrmher'.c Aridmsa (Street, City, State, Zip Coda) V)Il. �lnr%Da�tarensellt Ute Qxnfly_---- - -_ — _ Permit Sec Darr las AppmverA j t Sig., S n Reag a tar Denial S •5 17C. (Alllr��1fT" R'p1OYgI 6 11 11- -. e 3' 2l aQ e� --x kq a per: jai ayemen plan p onde,r uy plumber. { J 2. AN setback regWremerns rgtlst,oe matMzired P «wry Colk / wdiu ass. n.�• A !) n .r AtlgCb M cnmptcre lunar fir the s7stnat qn4 snlnma to flip C ounty any ran pn�nr not Im- than a rct 111 Inebat An •Is• 7�i Iv sill)-6398 (R.. 4)2l09) 14 It Z4ya 0:)Jl PA �J CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGF- Project Name: Owner's Name:Y Owner's Address: ._.y6 ,5' 7�.s" TA ,4 SQ ,,,., o r s.. .7' u�� I._egai Descrf tion: P -Sj21 q !,J Town$l1ip.- Cotinty: — Sy'Gr�o v Y, Sutidivisian Name: I-ot Number, Parcel ID Number: ©32 t a2B�� y -G L14 Page 1 Index and title Pnga 2 Plot Plan Page 3 System Sizing & Crass -Section Page 4 Fllter Specs Page r Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Uaed — Page 9 CSM or Plat Attachments: Soil Test & House Plans r)eslgnerlPtumber: GrJ•� /L%a y e r� b e. 3r.se lTrr License Number, Date: / %G Phone Number 5 - 3 Signature I )eSMwi I)ursuarlt to the In -Ground Soll Absorption Component Mailunt fir POM's Version 2.0 SBQ-1070E-P (N.09/01). Page 1 a- 3�_x/d fra-e- lc5 �� Leaching --i• Chamber ft &"_ft Soll Absorption Svstem Cross Section ft Soil Absomtlon System Plan View y. ft y'7, r () ft Final Grade ft _, 4- / L I: System Elevation 3�+ 4' Dia. Header Leaching Chamber Specifications Manufacturer And Model E1SA Rating _� O sq ft per chamber Soil Application Rate 1#g"a`�pd/sq ft 15D gpd Design Flow `2` Soil Application Rate +d EISA.,chambers 2 rows of /O chambers each. Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner �.�'G �ct r JD .✓ Permit /f DESIGN PARAMETERS Number of Bedrooms IV NA Number of Public Facility Units 4 NA Estimated flow (average) �j""Q gal/day Design flow Ipeak), (Estimated x 1.5) gal/day Soil Application Rate al/day/ftz Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) !00 mg/L Total Suspended Solids (TES) !00 mg/L ❑ NA Fecal Coliform (geometric mean) <_104 cfu/100m1 Maximum Effluent Particle Size Ya in dia. ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity Y�Z 0 gal ❑ NA Septic Tank Manufacturer 5 e y ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer ❑ NA Pump Manufacturer ❑ NA Pump Model ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: ❑ NA Dispersal Cell(s) OL In -Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tankls) Y At least once every: 1 ❑ month(s) (Maximum 3 years) �Oyear(s) ❑ NA Pump out contents of tankls) . When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) A, least once every: ❑ month(s) (Maximum 3 years) ®-.year(s) ❑ NA Clean effluent filter s' At least once every: f ❑ month(s) I;Kyear(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ❑ NA 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 (Y3) 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 512 months, shall be performed 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. START UP AND OPERATION Page _ of —_ 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 tank(s) 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; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat 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 be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 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: ❑ 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. ❑ 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. �A ❑ T site has e d site -6 ti beige logo tank ❑ 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. < < WARNING > > 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 FName Gt��' l Ze�i 44'1 5'c h u vvca�'ei^ POWTS MAINTAINER EName SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S , Gco Phone > - - 715 This document was drafted in compliance with chapter Comm 83.22(21(b)(1)(d)&(f) and 83.54(t), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address __� 4/ 0,3 /6: S'71) /-? PC s 6 e ,- s r-�7" -r yo Property Address._ (Verification required from Planning & Zoning Department for now construction.) Pity/State _ X AP n erse:7' 1-✓ �Parcel Identification Ntunber LEGAL DESCRIPTION .Property Location 414✓ 1/4 , T' of 1/4 , Sec. 9 _, T 30 N R.�W, Town of Subdivision Certilled Survey Map # Warranty- Deed # Spec house yes no Volume 4; , Page # ,/G d , 'Page # Lot tales identifiable yes ljo 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 die septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified irk §Comm. 8-1.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. '1"he property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, jottrneyrnan 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. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural ,Resources, State of Wisconsin. Certification stating that your septic system has been mintamed must be completed and returned to the St. Croix County Planning & Zoning Department within 34 days of the three year expiration date, I/we certify that all statements on this form are true to tho best of my/our knowledge, i e arn/are the owner(s; of the property described above, by virtue of a warranty d reco rtl ' Register ofMlow Office. l Number of bedrooms ` SIGNATURE OF APPLICANT(S) DATE 'Any information that is misrepresented may result in the sanitary permit being revoked by the Platntxing & Zoning Departmwnt. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey ntxp if reference is made in the warranty deed, (REV. 08/05) Vcrc i i r mu JUNVt Y MAH 'jWupm 'DINT OF BEGINNING Located in the NW1/4 of the SW1/4 of Section 8, T30N, R19W, Town of Somerset, St. Croix Co, W 1/4 CORNER Surveyed for: John Walsh, Rt.#1, Somerset, WI SECTION 8 UNPLATTED LANDS T30N, R19W c �< /� E I/4 CORNER N 89 54 3 6 E 783.53 /\ 4 f Q----.C.. LJKnVIi1V HILL MVHU 33.54' V IRL/ 8N 890 54 ' 36" E 756.15 $ a-t ,. SCALE IN FEET I I 90 RIGHT OF WAY LINE \ qQ, p 5.98 ACRES \OO 260,356 SO, FT, 0 400 200 LEGEND IC w EXCLUDING RIGHT OF WAY ', f la +mow Lo LOT 3 W � l COUNTY SECTION CORD IC .82 EFT. O -1 41� ♦ �� PIPE 1 FOUND rp 297268 SQ. - "i N >� O I��X 24`� IRON PIPE WE', INCLUDING RIGHT OF WAY ,^ +, Q�� 1.68 LBS. /LIN. FT. SE �rrj ' �=1 fop �I' N 890 54 36' E 853.39' m o ��D �.. 820.39 Al` 1 2 I �90 10.00 ACRES 0 �� G'� Iz i 0 �9 4 435 600 ggQ_ . T. �� EQ + INL�LUDINGIGHTOF WAY NousE f �0 D l� I LOT 2 9,63 ACRES 419, 401.56 SQ. FT. EXCLUDING RIGHT OF WAY rn CO rnD c� �LO oz zG) r z m rn_q rn D � �m �Z C n KM mQ State Bar of Wisconsin Forni 1-2003 WARRANTY DEED Document Number II Document Name THIS DEED, made between _Guillermo T. Fernandez, a single person and Mary_ Brataeer Fernandez, a single person ("Gianlor," whether one or more), and Craig M. Caspersori and Amie J. Casperson, husband and wife rantee," 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, Slate of Wisconsin ("Property") (if more space is needed, please attach addendum): See attached Exhibit A 1026403 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/23/2016 9:51 AM EXEMPT#: N/A REC FEE: 30.00 TRANS FEE: 1095.00 PAGES: 2 "The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Arca Name and Return Address l,nnd Title, Inc. 2200 West County Road C, Suite 2205 Rosevillc, MN 55113 LT File No. 532627 032-2032-40-110 Parcel Idcnlification 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 encumbrances except: Easements, Restrictions and Covenants of record, if any. Dated March .2016 (SEAL) 1 (SEAL) • Guillermo T. Fernandez s Mary Bratager Fernandez EA AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Slat. § 706.06) THIS INSTRUMENT DRAFTED BY: Larry S. Mountain. Attorney at Law (SEAL) ACKNOWLEDGMENT STATE OF Wisconsin ) ) ss. St. Croix COUNTY ) Personally came before me on March 151h, 2016 the above -named Guillermo T. Fernandez, a single person Mary Bmumer Fernandez, a sinLlc verson to me known to be the person(s) who executed the foregoing nstrumcnt and uknow, �t �Isa�ino * e ilec J. Bune Notary Public, State of Wisconsin My Commission (is permanent) (expires: 10/17/3017 (Sign aturesmay beuuIhenIirledcraekru Iedged, ]in th:Irenulnccessan'.) NOTECHI1S IS A STANDARD FORM. A\1' AIOi)1ftCA'1'IU\S 1 O'fDIS FOlttil SI101ILD HE CIX,%RLY I D F'N'TI F If D. WARILMN71' DEED 0211I13 SI,%TE 11AR OFIYISCONSIN FORM NO. 1-2003 • -D-yrc tvaa+c belti�s'siYrratwc�s. St. Croix County 1026403 Page 1 of 2 LT File No. 532627 EXHIBIT A Lot Three (3) of Certified Survey Map filed in Volume 6, page 1620 as Document No. 408585, located in the Northwest Quarter of the Southwest Quarter (NW'/, of SWX), Section Eight (8), Township Thirty (30) North, Range Nineteen (19) West, Town of Somerset, St. Croix County, Wisconsin. St. Croix County 1026403 Page 2 of 2 RECEIVED JUN 01 2016 SOIL EVALUATION REPORT De Ni I rvices aILRtlits d w th C mm 85 Wis Adm Code F- A ID 19 3� C/ #2952 Page 1 of 3 Geo Tech Soil & Site Evaluation, LLC m actor ante i o County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032-20324- 10 Please print all information. Reviewed By Date Personal information you provide may be used for secondary pu o vacy Law, s. 15.04 (1) (m)). 1 Property Owner Property Location CASPERSON, CRAIG Govt. Lot NW1! , SW1/ , S , T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CA 403 165TH AVENUE 3 NA CSM 6/1620 City State Zip Me P ❑ City ❑ Village ® Town Nearest Road SOMERSET WI 1 540 1 651.214.0291 Somerset 165TH AVENUE ® New Construction Use: ® Resi otial / Number o ms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: POLE SHED Parent material LOESS OVER LOAMY TILL Flood plain elevation„ if applicable NA ft. General comments Site is suitable for a non -pressurized conventional POWTS. Maximum recommended SLR = 0.4 (eff #1). and recommendations: Zdri4, X Boring # ❑ Boring ® Pit Ground surface elev. 97.10 ft. Depth to limiting factor >80 in. Soil Application Rate Horizon Depth Dominant Color in. Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ConsistenceBoundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-4 10YR 2/2 SIL 2 F SBK MVFR GS 2F-C 0.6 0.8 2 4-11 10YR 3/2 GRFSL 1 C SBK MVFR GS 2F-C 0.2 0.6 3 11-40 7.5YR 3/3 GRSL 1 C SBK MVFR GS 1F-M 0.4 0.7 4 40-80 7.5YR 3/4 GRSL 1 C SBK MFR -- 1F 0.4 0.7 l� z 2 ® Boring Boring # ❑ Pit Ground surface elev. 98.10 ft. Depth to limiting factor >76 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistent Boundary Roots GPD/ftl 'Eff#1 *Eff#2 1 0-6 10YR 2/2 SIL 2 F SBK MVFR GS 2F-C 0.6 018 2 6-10 10YR 3/2 GRFSL 2 F GR MVFR GS 2F-C 0.4 0.6 3 10-28 7.5YR 3/3 GRSL 1 C SBK MFR GS 1F-M 0.4 0.7 4 28-76 7.5YR 3/4 SIL 1 C SBK MFR-FI -- 1F 0.4 0.7 �r ) 15 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and 155 < 3u mgiL CST Name (Please Print) Signature: CST Number William J. Bergh 227819 Address Geo Tech Soil & Site Evaluation, LLC at valuatio cted Telephone Number 11091 30th Avenue Chippewa Falls, WI 54729 8/2016 715-577-6838 SBD-8330 (R.11/11) Property Owner CASPERSON, CRAIG _ Parcel ID # 032-20324-0110 Page 2 of 3 3 F® Boring Boring # Pit 99.80 Depth to limiting factor >80 El Pit surface elev. ft. in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Roots GPD/ft2 'Eff#1 'Eff#2 1 0-4 IOYR 2/2 SIL - -- -- 2 4-12 10YR 3/2 GRFSL -- -- -- -- 3 12-35 7.5YR 3/3 GRSL -- -- -- -- 4 35-80 7.5YR 3/4 GRSL -- -- -- -- 17 ❑ Boring Boring # Pit Ground surface elev. p 9 in. ❑ ft. Depth to limiting factor Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 'Eff#1 •Eff#2 7 ❑ Boring Boring # t Ground surface elev. . Depth in. ❑ pift. Deth to limiting factor Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 `Eff#1 'Eff#2 ' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330Test (& 11/11) Geo Tech Soil & Site Evaluaton, LLC N W E S SCALE 0 15 30 (UNLESS SHOWN OTHERWISE) WILLIAM J. BERGH WISCONSIN CERTIFIED SOIL TESTER DESIGNER OF ENGINEERING SYSTEMS CUSTOMER ID 227819 WOODED AREA TO BE CLEARED AND USED FOR FILL — — — — — — — — T\ I a DEPRESSION `� TO BE FILLED (95) Y i 1 1 i I j I I 1 i THE INFORMATION CONTAINED WITHIN THE ATTACHED SOIL REPORT IS NOT TO BE USED _------�— TODETERMINE THE SUITABILITY AND/OR DEPTH OF ANY PROPOSED FOUNDATIONS. —_—�—�— POWTS COMPONENTS ARE NOT DESIGNED TO RECEIVE THE ADDITIONAL WATER (98.10) GENERATED FROM ANY WATER TREATMENT DEVICES. (96) #1 r BUILDING SEWER MUST COMPLY 1 (97.10) ` WITH SPS 382.30 WAC (11) LOCATION OF WELL MUST COMPLY ( ) I I i (99.80) L WITH WDNR CHS_NR 811 & 812 J ssi (98) r � BENCHMARK ELEVATION 100.0' i I BASE OF FENCEPOST i o LOCATION OF SOIL BORING(S) I ® LOCATION OF SOIL PIT(S) I NEIGHBORING PROPERTY I * NO APPARENT SPS 383.43 SETBACKS I (HORSE PASTURE) I DESCRIBED LOCATION OF LOT LINE I ® LOCATION OF RIGHT-OF-WAY (1) CENTERLINE OF DESCRIBED ROAD L----------------I REUSE OF DOCUMENTS This document has been developed for a specTic application and not for general use. Therefore it may GEO TECH, LLC 11091 30TH AVENUE JOBSITE INFORMATION: LOT 3, CSM#6.1620 NW-SW-19W SOIL TEST CRAIG CASPERSON not be used without the written approval of CHIPPEWA FALLS, WI 54729 403165TH AVENUE SOMERSET TOWNSHIP PLOT PLAN Gap Tech, LLC. Unapproved use is the able PH: (715)577.6838 FAX: (888)466-8573 SOMERSET, WI ST. CROIX COUNTY, WI responsibility of the unauthorized user email: billy@wastewaterpras.com PARCEL DESCRIBED AS 6.82 AC.