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HomeMy WebLinkAbout651375 038-1242-05-000 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Richard & Lindsey Westphal TOWN OF STAR PRAIRIE CST BM Elev: r.—W ws�{e Insp. BM Elev: 0 .r7, BM Description: L04nS C('at&ad-62. aal sf TANK INFORMATION TYPE MANUFA TURER CAPACITY �' i ` map_ Septic Aeration Holdin TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t � / 1 �C. � I Dosin Aeration Holding PUMP/SIPHON INFORMATION Manufacturer and GPM Model Numb TDH Lift n Loss System Head TDH Ft Forcem Length Dist. to Well SOIL ABSORPTION SYSTEM ELEtJATIW DATA County: St. Croix Sanitary Permit No: 651375 State Plan ID No: Parcel Tax No: 038-1242-05-000 tion/Town/Range/Map No: 31.31.18.1320 STATION BS HI FS ELEV. Be hmark BZ i l L• D Z�.t� �D��O r Alt. BM Bldg. Sewer 5 � ° / � .40 SUHt Inlet �qn SUHt Outlet Dt Inlet Dt Bottom Header/Man. V147� I ' /I dJ e r2 d� 13.ao 1+30 to <go 0 Di Bot. System [ .2D S, 3o /05. So p y. 7o' Fi al Grade L� [vLo St & ,U �" eMv ?•3D Cover VIA0,Ylk.e /0- BEDCELNCW DIMENSIONS Width 3 I Length 1 `p No. Of Trenches 2.) PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: P/L 1 BLDG „ / WELL \ LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: ' Rrot� Model Number: tµ LF DISTRIBUTION SYSTEM Header/Manifold Distributio x le Size x Hole Spacing Vent to Air Intake Pipes Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Over xx Depth ofxxSeeded/Sodded xx Mulched BedtTrench Center TBedprench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (include*- discrepencies, persons present, etc.) Inspection #1: Z1z} [Zazy Inspection #2: 1_67cc-ationQ:8873183RD 6T ,�1 1.) Alt BM Description = 7 / 2.) Bldg sewer length = I 11 �} A„ np„l�n�h �n�t i5a amount of cover = 2 4 (- $) 4 o ri5ar5 ^k* s 2.o r s etf• bed a b�aunod2 (ockad! . /- 3 �_ _1' 2nn� elexra�+•� �-'aX . �-. � �xlsw-�l�e a.� Plan revi99ion Required? ❑Yes R No #1�ert � Use other side for additional information. Date 1 Insepctor's Signature . No. S D- 10 (R.3/97) H� ,,� d? i-Pam°,-i -�n.�� w� y �'.° a suet Industry Services Division 4822 Madison Yards Way County I,�RJ -2412-tom{ i S'I ? IiS j 1 Madison, WI 53705 P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) JAN 17 202>+ Madison, WI 53707-7162 r 1375 v r..itilri�n+.v tog State Tmilsa6orl Milllber t Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if di the Department of Safety and Professional Services. Personal information you provide may be used for secondary pUlpciscs in accordancc witlm the Privacy Law, s. 15.04(1)(111), Stalls. 1. Application Information -Please Print All Information C a ✓ Property Owner's Name �j //f� / yw♦ Parcel #7r�7 Property Owner's M`adingg Address Property Location �? O �; Govt. Lot City, State - p Code Phone Number 11. Type of Building (check all that apply) Lot # 2 Family Dwelling - Number orBedrooms Block # 'ublic/Connnercial - Describe Use D ❑State Owned - Describe Use CSM Numbcr Subdivision lV nt than mailing address) 5 , Section � ' Ur� y of Hoge or P wn o 4,e!!.__ n 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C it a licabl '�' New System []Replacement System Dther Modification to Fxisting System (explain) Additional Pretreatment Unit (explain) �ilalding "tank �orvelltionaj -Ground [_]At -Grade ®JMound Individual Site Design Other Type (explain) C. ❑ Renewal Berore I__l Revision "hange of Plumber Expiration to New Owner ist P-r�eevious Permit Numbcr and Date Issued IV. Dispersol/Treatment Area and Tank Information: vtc,Gad ---9 t5,1 if Design Flow (gpd) Design Soil Application ltate(gpd/sf) Nspersal Area Required (sf) ispersal Area Proposed (sf) System F,Icvation , p ,I; / n13 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units rr ( a v New Tanks Existing Tanks hi G R -R m U n <n i S7 a V. Responsibility Statement- I, the undersigned me responsibility for installation or the POWTS shown on the altslnct,tl plans. Plumber's Name (Print) P er's Signature MP/MPR Numbcr Business Phone Nu her Ill mb is Address (Street, City, Star Tip Cod 1 L) VI. CountylDepartment Use Only Approved ❑ ved Permit Fce Dale Issued Issuing Agent Signature $ wrier nial 5-50l/Zz 12A2-Lf - Conditions M OWNER:�- 1. Septic tank, effluent filter and dispersal cell must be serviced 1 maintained as per Sap Qom` management plan provided by plumber. 5) 2 56, ,,,_ fl Ws4, ,+. 2. All setback requirements must be maintainedw4� (; zeA as per applicable code / ordinances Attactu to complttr pl;im for the system and submit to the my Anly on paper not less nran 8 sia x 1 I inches in size SBD-6398 ( k :I.} 2 1 ) System PLOT PLAN PROJECT Richard Westphal ADDRESS 1388 Osorev Court New Richmond Wi 54017 NE 1/4 SE 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 106.0/105.0 7' below grade DATE 1/16/24 BEDROOM 5 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1093 # of chambers 54 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1 /4" = 10' 20' AL 0' 113 111' 109' REB-3 B-2 Ik 90' � 15% Slope 2-3' X 110' cells with >3' spacing B-1 10 371' Property Line Pro 5 COPY Bedroom House 183rd Ct. Vent to be >5' o 88' / 150' Vent M.* >6" of Cover 4' Long 12" Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 6.6ft^2/pair of end caps Grade at System Elevation � � 1 I� e not c4a i ft,�W . t a 4 F'� Over Page Shaun Bird Bird Plumbing Inc. 1432 120th St, New Richmond Wi 54017 715-246-4516 Date: 1 f 16/2024 Owner:Richard Westphal Location NE114 SE114 S31 T31 N,R 18W 873 183rd Ct. Star Prairie Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and ontigency Plan 7. Filter Cross Se do Attachments: S st Signature License, ber #226900 System PLOT PLAN PROJECT Richard Westphal ADDRESS 1388 Osorev Court New Richmond Wi 54017 NE 1/4 SE 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 106.0/105.0 7' below grade DATE 1/16/24 BEDROOM 5 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1093 # of chambers 54 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1 /4" = 10' 20' AL 10' 113' 111' 109' \Nt B-3 B-2 Ik M 15% Slope /\-N 2-3' X 110' cells with >3' spacing B-1 10 371' Property Line Pro 5 Bedroom House V r'- to be >5' 8 8' / 150' Vent M. ` >6" of Cover 4' Long 12" 183rd Ct. WSJ :2 l a a Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 6.6ft^2/pair of end caps Grade at System Elevation Gross Section of infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chambci- with 20.0 ft2 of Area per Chambci- 6.6ft^2 pair of end plates Typical Installation Vent G rade 1 jLong �30/34 Septic Tank5' " Gracie at Sic in E;Ic � at1011 Spacing 5' System elevations: A 106.0' 13 105.0' W To be > 1' above grade / Finish grade elevation %( 113.0' ,Vent _`+' Long 1 I LGrade at System Elevation 24 X 110' Cells Same on other end Observation tube/Vent At end of cell A B 27 chambers per cell POWTS OWNER'S MANUAL & MANAGEMENT FLAN Parse cr IrILE INFORMATION 41 pOwner i Permit # { DESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units 6NA i Estimated flow (average) gal/day I Design flow (peak), (Estimated x 1.5) �J 't gal/day Soil Application Rate i al/daylftZ Standard Influent/Effluent Quality - Monthly average' Fats, Oil & Grease (FOG) 530 mgfL Biochemical Oxygen Demand (BODS) s220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg1L !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) S30 mglL E30 mg/L NA Fecal Coliform (geometric mean) 5104 cfuf100ml iMaximum Effluent Particle Size lf3 in dia. ❑ NA -IOther: NA "Values typical For domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tanis Capacity pal 0 NA �� �lJl� Septic Tank Manufacturer CJ NA Effluent Filter Manufacturers ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al 111 Pump Tank Manufacturer HNA Pump Manufacturer NA Pump Model NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other; Dispersal Cell(s) ❑ NA -Grcund (gravity) 1304 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: °� ❑ months) (Maximum 3 years) 0 NA _ ;Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA WlInspect dispersal cells) At least once every: (Maximum 3 years) ! m ()) ti.�years p NA Clean effluent filter At least once every: mon f ❑ ear th}s) El NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) jA © year(s) ❑ NA 1=lush laterals and pressure test At least once every: CJ month(s) © ear(s) ❑ NA 17ther: At least once every: CJ montl ❑ year(s) NA lather: NAY MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master IPlumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank Inspections must Pinclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of icombined 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 pending 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 (:) 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, mechanlcai or pressurized components, pretreatment units, I3nd 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. Page of _., START Ufa AND OPERATION For new cons'Juction,-prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thCt may impede the treatment process andlor 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 infiNtive surface. During power outages pump tanks may fitl above normal hlghwater levels. When power is restored the excess wastewater will bye discharged to the dispersal cells) In one large dose, overloading the cell(s) and may resuR In the batKup or urf�o die nd discharge ofe fa the To avoid this situation have the contents of the pump tank removed by a Septsge Servicing eope controls to restore normal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating pump whhln the pump tank. Do not drive or parts Vehicles over tanks and dispersal ceiis. 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 aliminsUon of the following from the wastewater stream may improve file performance and prolong the it-, of the i oWT�: antibiotics; baby wipe tru lgandttet itts', cop emng cotton sneb grease; herblc€des meat ; dental isarapsrsmedications; t ail a eon ti gatproduon rc s; asers {sump pump] water,vegetable 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 propeily 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 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 soil, gravel or another inert solid material. CONTINGENCY PLAN easures have been, or must be taken, to provide a Cade compli If the POW T S falls and cannot be repaired the following mant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm, repiacement area should be protected from disturbance and compaction and should not be infringed upon by requiijed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the nEled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule.1 in effect at that time. A suitable replacement area Is not available due to setback and/or soil limitations. Baring advances in POWTS technolocdl/ a holding tank may be Installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluai�ion 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. ❑ Mound and at -grade soil absorption systems may be reconstructed In place following removal of the bi❑mat at the infiltislive surface, Reconstructions of such systems must comply with the rules In effect at that time. a<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR INSUFFICIENT OXYGEN. DO N01 ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIPF1CULT OR IMPOSSIBLE, ADDITIONAL COMMENTS POWTS INSTALLER Name Phone POWTS MAINTAINER Nam e Phc SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name �, h II Phone t ` 'I tin" Phone (rj I '' This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383,54(1), (2) & (3), Wisconsin Administrgtive Code. 5i -t \ uw ox Daoo I»ox DaoP FRONT ELEVATION I!4' = I'-0' REAR ELEYATION ve•:r� - FOUNDATION: 2,080 5Q.FT. MAIN LEVEL: 2.080 SQ.FT. GARAGE: 830 5Q.FT. T 14U C6MJp10Us wYE.. SUIII A NEW RIONIpO. wI DWO ns,zo. m AVANT RU➢-DEM COPYRIGHT NOTICE CoPYRICNT F FW TNESE du SMoW MW NT AVARUADERS. TNESE UNS "Y NOT RE REA SED POR ANY ADDITIONAL M MAYIWT SUY NOT BE ASSI us OR OTIFD. ANDlMY NOTES PhopaD Do USED p1 ANY RE DESKN WITHOUT MOPE! WRITTEN CONSENT OR AVwNi NIID9t5. DATE DESORITION XX-XX-XXXXrt_ ORIGINAL PLAN DATE WEBSITE ELEVATIONS b-FN" NOLA 1 /7 xk As indicated .o= -NeAxa HEaNrsroaear s FOUNDA-TZON LEVEL PLAN __ ll4'=r' --s 2,080 SQ.FT. UNFINISHED I4NOERNp lAVE -TEA NEW �C Wa�SSWA —l",w COPYRIGHT NOTICE COR "T FOR TNESE wAW SIS OWIED Rv AVANT MRl.DEPS THESE FLANS MAY NOT BE REd1SE0 FOR ANV ADDITSONAL STRIKTIAES MAY NOT RE AZT&WC OR CpP[ED. AND MAY NOT HE a fttMD OR USED 3N ANY.*_bB 6N WIINOUTFROFER W W "N CONSENT OR AVANT MOLDERS DATE DESCPRITION ORI61fJAL PLAN DATE ___ WESSITE FOUNDATION °1e+ii Nin°"' WEBSITE 2/ l xda 1/4' = P-O' �s% )ISIAVAWMMDEM COFYEtl6HT NOTICE copm"iT FoR Tf"3F D"WtH65 15 oWKb BY A�rk=M . M ADOr�&5TAUCTURES,B YWTBE ASSZ"ED DO CO"ft,N—WTBEADDVIED MUSED M M RE-MSZfiN WITNOUTPRO" W1rrr&4CONSEWMAVM SUMDERS DATE DESCMTION PLAN DATE T WEBSITE MAIN LEVEL - ——- W--E B5 TE WLA 3/7 - --- ------- ---- 1/4' = 1'-0* 1 MAIN LEVEL WALL BRACING LOCATION OF BRACED WALL PAWLS ALONG OWL BRAG U-6— BRACING SUPPLIED 12-6" MAX DISTANCE FROM END OF SIDE BWL-I 21'-W MAX, DISCTANCE BETWEEN PAWLS BLW-2 E= 4*-W BRACED WALL PAWL UNO, RWL-A EXTENDED HEADER BwL-B LOWER LEVEL WALL BRACING BRACING REQUIRED; BRACING SUPPLIED BWL-I RWL-A BWL-B 9 MAIN LEVEL WALL BRAC046 3TUV 6T:&�— -- - --- -- FOUNDATION LEVEL WALL BRAC046 1112 03MiO 1 Ave., SVTIe A NEW WOMIDTAWISAI'17 Tf5 43D AVANT WOAERS COPYRIGHT NOTICE COVYlIWT FM THESE NAWTaGS IS OVANED P AVAKTbNAM TWSEPIN ANY NOT MEW—Fb F—ADDTTIO"STRUCTME$.MAY NOT $E ASSK M COIF, AM MAY NOT SE MWDSREb VAtrrrEN CONSENT OR AVAW $VVbM DATE WEBSITE DETAILS WE95ITE NOLA 4/7 3/16" r I'-(r . � q -77 IMtst� wn [;npgrytcgnt at Cpnme.,-J. iit _ C 2 9 20ZI � �;L E1'r EVALUATION REF RT ovisian a` Safss � and Buiidinps Fage of ir, ac=oa"rce v.Iir ^ r 85 �Y!5 Aor'. Cole 7 ,ry1931,) tr �} kriach gmplete site plan fear k nchss in sae. Plan nzust Co rrtty s7 I r Z inziude, W not firnfted to vertical and harizonta' reference pant rSfJ'; direction and ! Pane percem slope, scale or dimensions, norm arrow, and; location and drstar,Ge tc nearesr road. � y please print all trrformavor. Revrewev//.by Date j pbrsonsi rn6OMWOM ya; JDOOy16c msy be unp:c (cx sBconnrr) PurgastrF (Pri"aC}' Lsx : ¢. G f! C Prvpo- 'per i Prwer v Locatror+ ` r - /3�! r 2 ? Govt. Lot �f �:r4��r �4 S .5 � T � ! f Ft � E d Property Gana, s Mai' ddrsss I Lot* lilac! # Subd. a F CSfv�v �•, +` to Lip Cads Phone hiur.>bsr [f City hfeares! RoacL mv t: Cazstrudio- US6, Residential 1 Nurnber o`bej-- ,-n - Cade de iced design fow rate U 3PD i U RQa`•d n+eni I Pubfic r oomrn,eraaf - Describe: Parent nsateria! r� ��,a.% `.� Rood Plain eievation V applicable - _ A' l 14 114, ft Ge-mral rarr n—w is aI'd rs,=TvrrendC--te11;?DL& khctYc 1 i k t SysternType ? Svstsr, Elevation �_- i_ r 0 LJ Banrrg Pit Ground surface elev. i4� Aepth to limiting factor -S HortzMs Depth Darnfnan! Color Eceoax Description T etture Sim a Consistence Boundary Roots in. Munse6 Qu. SZ Cont Coicx Gr. Sz, Sh. /J(- O-S�q ' I PI Soil Application Rate 'Efif#i ! 'Eff#2 f, q-o 4, (.-# ---c- I I 9 Lf 120 t � �� � ❑ Bonng Pit Ground surface eiev�ti Depth to limiting tatter Horizon Depth in. r Domhant Color Mwmeeff z— Redox Description au. 5z. Cont. Color Texture / Structure Gr. Sz. Sh. Consistence boundary Roots C ,- Soil Application Rate GPDfff `ER#1 `Efh#2 `f12o ` Effluent #4 a 900, s 30 a 220 m9VL and 7315 >30 < I5o CST blame (Please Print) Si Bird Plumbing, Inc. Shaun Bird Address 1432 t 20th St, New Richmond, WI 54017 w :' r rl ,-,2/ I's,; ` Effluent 02 = 9CD, 130 n'@& and TSS K 30 ffXVL l CST Number 226900 Date Evaluation Conducted Telephone !Number r` �` r,-,-? , " �: 2 '"-: Z. ( 715-246-4516 f Property Owner r� Baring # Boring Pit Parcel ID # Ground surface elev. `� t Page —of— Depth to limiting factor Cnil ❑nnlir�ll,,., o��.. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 v,. g t2o L Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz, Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDlff 'Eff#1 'Etf#2 Boring # ❑ Boring El Pit Ground surface eiev. ft. Depth to limiting tartar In. Soll Application Rate Horizon ')epth tn. Dominant Color Munsell Redly Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz, Sh. Consistence Boundary Roots GPD/ff 'Eff#1 � *Eff#2 ' Effluent #1 = SOD6 a 30 c 220 mg/L and TSS >30 � 150 mg/L. . Effluent #2 = BOD6 130 mg/L and TSS f 30 mg+1L 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 608-266-315I or TTY 608-26d-8777. 5B6-M336 (R.6m) Soil Test Plot Pl Project Name aevering Homes Investments ail Bi Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 CSTM #226900 Lot 5 Subdivision Bella Vista [Pate 12/22/21 N 112 SE 114S 31 T 31 NIR18 W Township Star Prairie ❑ Boring 0 Well PI, Property Dine County ST. CROIX l;�l . !'!Z1' Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRPSame as Benchmark r." 371 COUNTY PLAT OF: SOIL TEST MAP/CBA EXHIBIT W/ CONTOURS BELLA VISTA _x'ti fF;[f i!e PAfii GE riff N(NCt]RVEST �)VnRTF.P OPnIE Yu[f'HFiI t)uAS/: v.N nHn vnxi WE'RE. 4[N( M 9; 51w�p-3t [1s THP 9[y-ri[Iaxr y+wkBH uF Yt•:c,r 3I.TOW.Y9srtv at n:Rtni, s1nFk:R 16 W 6.4T.:[]W7i nT 4fAF vaA:F]P. 5". [fe[]LT CDitt/^I. WT4Ct)RS In, wulro.eec. NAe[i ua tuF , nP nfY. CERT:PtEb sL'fefeY uAP feet-rlfuleu w yOLJNR ). PRuv- iAU R5 ppCl nrp--ri +n:Mfll9t SSLt t] l'[C'T1 r Ty. L o r d tEar +i[n ,JaY= !MP— CERT'F =o i' v F'+�P _ ! V (/LUmF 9. PAGr ?511 VOLUMF LG Vl b9 IJ Loz LA141, .., -Aw $ . - w— �..� ��d w• r i •� � "4°_Je-1 � 1 ,t r �1�-. �Rt ".`�"�'�': �"'�'�+3 � m 5 ati e�a�:�]�T y � � � � 'sue : f ,. ��o.R ��. ,,. ' a 19 [ •3 41 �. �..rc. n� yu•�.� .3e.a r..� my'..'`9 • ' 7 0 LA�Lgj Tm— f — j— �i g� CYbaNM9y4M'>a'Ww 1 � . \ far ] TIF)E SURVEY MAP YdG P+E 29, P-fE 6U4 SHEET 1 OF 2! -77 womwnonvavnwaca�,EC 28 2OZI S IL EVALUATION REP 1T J.tlatl+epellpmY aaa pmnSl and t ref r u in U[a. Pmn m1,N—.xF - z- o 'Irk#' van rt hduee. bN nd a'naa0 tawNGYI and naVenW nrwanee D3in1 (SM), 6iWiwi seM Parast I,D.�Ar'�' /' eroam $we, seem a dimensions, nom anon, and beedon and dswwo (d now" road. _ Pluae Pdn( all Information. ROAOWr+ dM ♦�r{OMl wlsin�tlMTW VunY n�IMVM/10tiKosO�T OM0a�1 iIMM'lI`'. r. 11.00 (i)ITIi. // G �'� ? .f�•' .� rol' a� tOGi1d1 �J O- La( �/ZyA tq S./ T 3 N R p E t N pmwy s I" Lai Y Sbrk Y or ' Co","Ll i Coy IWapa Town Nears ram"' ConawpNn Use. R9664mm f N Xritw db4*wml ❑ Rapada ❑ Pubft�.r� Mo asl • Dowribc ,W �� __y Paws mawar� �C.4.I ir�.../L1�G�y_� Flaad Plsin Wwion Y sppYeeMs A/, � i :t I X Iaorranandatpy:C7U+i,-, •!7' �1-i/�/n7 ;� System Type -.(_rr,;�y[(,+ A�V.�L� System Eisradon 1 1 J _ �f ❑&*v I & pe Ground ala(aee m, I tR, U UZ"Y nu(�« * !/ 2 GL PN OrwMaWaa Wv`p papY bti+tlpmtla_ L .0 SR- n....-- / 3 L • Wkwd Yt s SM s 30 ! 030 rl and TSS >30 ! 130 • Effluent a2 - SM.! 3D _ myt, and T88 130 myi CST Name (Pies" Print) S CST Number Btrd Plumbi , In¢. Shaun Bird 228� MGHs Dus EvYwYen Carta .W TW.O n samba 1432 12Oth St, New Rlchmond, WI 54017 —.-2a --Z, i 715-246-4516 /W Property 0~— PAree1100 Papa .---of • ' e Iola�////jjam� � ■,'+'.�J1J/L�Il m1P MFwPFmrjAP-mmwm IMF) Mm©iIM ©Pm'MEYA©MM MM 0UNAVfAKr�r,�r.� MINIAMMIN ■■■■■■�� ■Mmmm ■ OB�0�®® OB mpa O -EtauwA01-DW.> 305220 mWL Arid TSS.30_160 mot. - EM. e2 a 000, 130 mpl. And T"130-Vt The Department of Commerce is so equal opportunity service provider and employer. If you nand Assistance to Access smiCAs of need material In an Alternate format, please contact the department at 608.266.3131 or TTY 608-264-8777. Soil Test Plot Pl Project Neme Oevering Homes Investments ACS Bir Address 1433 Cernohous Ave Suite A New Richmond WI 54017 #226900 Lot 5 Subdivision Bela Vista ate 12/22/21 N 1/2SE 1/413 31 T 31 N/R18 W Township Star Prairie Boring Q Weii PL Property Llne County ST. CROIX ' BM or VRP Assume Elevation 100. ft. Top of survey iron 1 System Elevation TBD 371 'HRPSame as Benchmark t Magya. COUNTY PLAT OF: BELLA VISTA LOCATED IN PART OF THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER AND PART OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 31, TOWNSHIP 31 NORTH, RANGE 18 WEST, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN; BEING PART OF LOT I OF THE CERTIFIED SURVEY MAP RECORDED IN VOLUME 3• PAGE 780 AS DOCUMENT NUMBER 356113. \ 9\ VICINI�ToYs<AE[ MAP PREPARED FOR: o[nawa xoARllxs<siwRriRA SURVEYOR: / LOT 12 ��T�\O l O T 1 5 / �� nm[xw[m[n W / xuosox,vn swM I I / P R A I R I E \T i P O N LOT 4 I LOT 2 ��/ \\ \`' ' UNPLATTED CERTIFIED SURVEY MAP CERTIFIED SURVEY M_AP I LOT 13 LOT 14 IAN DS VOLUMES, PAGE 2.531 1 VOLUME 26, PAGE 6087 11111-11-E 1661.38'-_ur- IxM4.%• 33• M' _____ v SMSI'-- M3 �'N -- wl.D' �DRArNAGE 3)4']]• NwR rwRMcroxM MDN MAA wm3+ 4 £AS LM.NT - i ' 89,8225O FT. R 3 n�4 .i 6 a WET 4A ND 2.%2 ACRES �' ='f K756 SQ, FT. ���`s L8.0.-844.0 1 1.533 ACRES �' +r4�T mfe], r+y_ 11v .s 65,45154 FT. .'-�I f'+^' aW�g♦'- 67,2J�SQ FT. SECTION 31, T31N, RISW iU SN OF STAR PRnSRI£ SMALL T. CROS% COUNtr ♦f ^nR�# o•F u7A4•-- W xs t.e r-. selsr4n ,:.+ LB.0.=871.0 } -. Ao - +° ryx 1.503 AOIE5 q; k��Dj 1.SM ACRES a TRACT - 00°DE � . � � , 1DSt'�M�De' i S ir+0 a � Uz SMr,rsa•L ] ,ISSN W4 0 +. 1:. \y ;Z 03/3D/22 ee�' 1 P �.�\ ;B w _ 2 '" slc {� 68�6/134 FT. _ xea unuwf nu'.l xw L4.MV�--• a ` :•1` E,D+C\ fi],]6z5O FT. r A[RFSO f . L. i ACRES LA srwrxr •. 76 966AUES r-!y"�n, a ti.., . J xs 1B - D rE'p B3 L.B.O6 <a✓ " LB 06866D / " :J_ s'P� r ye?... �� �, ^ " L8.0. _ 844.0 Stia 6 r�3 a R r].W \ '•+� ! UeG/�� /, w of ,,, . +Y� �' 145i x 3 71•%250. FT. M1, [n $ / A�� I J 'k3'... c �ek.�.. 5M•l6'N'F 4S1.73• (WE72AN0� '•• F-I , O� LEGEND t� \ `94'O 1789 ACRES /n7 0 $ 1 3 07 pt- L8.0. - 849.0 / 71.629 SCL [WxOCWx)vzF[,px COaxu wwvuWM. ASxmlp C� .y6'C /,h 1.]36 ACRES �+Q�t,b,,r�• ��]+iy, � ��Z � ' / j6 O e rauxD Elxo[W+Ru aw3r3a xtW nPE. uxussw O0`Fq d h l .�% d I G y `•a y^°,)s+e.r; 74,M0350. R. <� �i m O iti5 U41xa dAwtT[A ervlxa EFRw�aOx aan. +teLxxsM [W* \r, 96. ^8 ,^ 8a s' i1.]OBAEs e� .�' ,'f , ,.-NIr23. -E °'4e• �eJ LB.G.z aD Tx u+Fss v. sFc[xw e5 �ss o xcx4oursro(wpwerzaee uwatDw eroxnn G\7F �v. rex,xG 113 u5.![R uxue[om \M \o �O k `D.v w, ° �' �' _. M9x'n T o �^ + s. Jr^,�;» '. '-1.n [ 9 sMrle'w•F u4sr r . Ana r.Dapw71�ATE srsrF�wN �++ Rr t F«MOUFw[ auAtttM Mr u "tx 'oxG iMox O nrF. \L9� i : g' �1e_ um• ;[ xe' �84•I. Nix LD vna�^nG 1.t3Ees.Fuuxue[WF BJ`)A4 \O yl xas.oio'—_=•�Fo'�4 C.Y, 1.O. •, 'w w9.ev' o" 8 ti o eLB.0.=8440 ! \ \ f �\\ WQ.t e[xcxwAax ELEwiwx.ia O[ietw sroxuwtM ,o\/' \9 W .. Y ` 2^ \ v\, \' 5SO- n) 1 .... Yc]]c Ac DA)uw xAvO M] u SwrvnoED G[ ruuwEvnrn AxoxD5pclx \may .jT ,MtiQR1+nn 1. 1 c .. ,1~~\\ �''-..S^1B06A8440i S'° ^' 6991050 Fi ' . ._ �x % �'• \\ 6IA15 ACRES S S ..i T� p� —______ nwaGt EAstw[xT w) \ds 'Yq ,9� 8 1.605 ACRES •. i _ c�a .�,y '$.y\NL' Yv 854Fx.40l LB.O.=878.0 w wl �,. wW w5 xw)1 eE\I 'm�l Ixwmsbf+mm'1 aFC00rwwlFx px[F][wwvhttA«rn �949y,�._.. y \\ 11"0 A . O T -, quVFWAY IOGigx DRLA.8I.N0= 41EEN. ".a\ i :+u Mli'S]'61" DRAINAGE'' ME N( f—) Q w U 18.0. tow[st aunwxGOTFx,nG wFVAnDx NMf2 �' .. �954 •3 EAIE -i' •.D .. . 0 ._ -, f 0 I 14 cwu nT G m O 3m�_ (f h leD .,A. M ' 6155 x03.5l S+E R 9aM M3'49W F m7S1s.s1 1319,p[ xu nsiw m 5 n - 1)w 4s-w 13 Oe %YO.i 59 �v N49 n 45 t G1 yj� I 3—.t0 -»v � F'00 6) u'la• t 3 9!'N'31' S7eV,Msa F,—, cu m pm Y' ) N I u 6] ,61.m LG6 N•31' S to i XYu ls'f %s1'F �— M4Tp3 SP3[ L l3)9l' 4 W.08250. I.511 ACRES O n n: {• 99925 so, Er. 7. / L.B.O.=8780 2.294ACRES rca,A Ec +wnl � LSO..-854.0 -uFr wLnAxofox+nf]rs.A+s[avrD. xg y., 'A ? (�� /R mrois,•E 2s2,.• _ — — — — arrvw[M[ADUTtM £ >S,m' 333.63' / 0 y / , i ,M3 C, 3 WEIIAID W4551-W 394.0' 3 ' QJ CU / 8n o ry & o� • 8 ^ < " RUH PABST ja R �� 3 8 N RSTC OXDCO.EWIS n mow/ �� nx'n 170.303S4 FT Ae12q fT o x'N+ c') 3910 ACRES �M RECFNEDFOR RECORD Zw2 Heats 1. /•SSA L.B.O.-867C p > m• 03(Wj;,c= lD'•41 AM LB.0.=850.0 +i ° PLAT ,'jx Z.F r m 'L 't}, Su.� •i88 DOCUMENT* 1150PjLla. VOL 11 PAGE: 126 PAGES/: �a, $W ETf AN D-i_ % JJ/ l EASFFA olAl"" r-�SR�gi pew r�l �l REGISTER OF DEEDS sox•so'lrw..l "' s7 �/. HlAA- - - - 3-- - — _ _. = _ — - --R8TD9bs^w 909.20'-- -- .-- ---. --_NIV FRS E-DGC DRIVE-..-__ CI �•7 _ _. -� _ 139.66' UNPLATTED �sourx uxr«e u4 Mv. . M89-27-35^W LOT 1 I,LN P LATT ED LANDS-�'--_' �.� /! CERTIFIED SU_RVE_Y MAP LANDS �y - - - { «nna nrtrufM `L_ VOLUME 29. PAGE 6624 my2y{AKFR*Lxy2E, .uflulxr No_ evitwxs°r[ tvc Rao.r °wMr cw / \ \ — — — 10eA(YDFMSxALLM �`euWr°rFOw9tt[vAnpvS,6wFR iW nAr6c0G RDM[u crow �w{SIyi�AxD / auutD�Sra"oipD�iwDrrt w�awuf mau`e wxrp xqutDu[i(uFaF cNwcr r[N DrcA.rlwva )x+ wAtR Wrirrvprgx3.wD neoxm+c olFxwDSR.e.°.I <Dp[w.cut A[uaDAftmnFs xivnoximma.r»e DMGIE(. wriux6t uWIMDA[lw) nuerroe[rwvwsvaw \�\ \ i� I \p — uwus 1Rc(xsMu a� Enna Mc7 tN4cxt c x) xu ss E» aut aM 1�5) ..- ,+�a unu „Muuonrrzw NconRw11.1xrsxu.7wvi rAuw[AAxw �%'rnws rr(xns n[r]YN(ref momeRpesrpn[si .Rr mirror eusroNeu. rDR osnA6c+w4. urtw9c nux4. rRUVAm.G Da,LaMlxGrx ANrrxAvt e�sn -mitor a.Rp`""rr,'c.xn Awvurxrxort +mlNp[D awtuswxe•rD i� e AD55[M(x4(xrs swAw[wlx�s )n rxr anAn °ES as AxD rxl rovao+nAa mFttOln�0F0MDrW`�xN, rtOr: rows (\ \ t \ aIr . s r sax—n.r.ew s xruxr«r oR,. rED lr , mn�;'mv mrtwsr'«n ° eE rx+n fuss sfi'wvresa( rixr.er MS D+ M°r.".TMr w« �id't'- \ \ SHEET 1 OF 2 : p ol� I ub I W1, 15rrC9Prx r __1'T , 1 OWNER V,",W% 1. Gi NrssEY WE NO. W 11-3 aki/ [ell►�►�� AL J SEC —.-00 a IT 3, Nq R *49 AND/OR , BLOCK • SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. RENEWEDAUTHORIZED ISSUING OFFICER— DATE 1122-1 Lf THIS PERMIT EXPIRES UNLESS BEFORE , 1. DATE SBD-06499 (R11/20)