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HomeMy WebLinkAbout006-1043-90-050St. Croix County Planning and Zoning Detail Sanitary Information Wednesday, March 28, 2007 at 11:13:39 AM Page 1 of 1 Computer #: 006-1043-90-050 Sub/Plat: 40 acres Section: 20 Parcel #: 20.31.16.301A Lot: TN/ T31N R16W Municipality: Cylon, Town of CSM: ~- 114 1/4: NE 4 NW 1/4 Owner: Anderson, Paul M. 2131 210th Avenue Deer Park, WI 54007 State Permit: 395230 Issued: 08/25/2001 POWTS Dispersal: Non-Pressurized In-ground Perm' : New County Permit: 0 Installed: 09/14/2001 POWTS Detail: Infiltrator- High Capacity Bed oms: 2 WI Fund: POWTS Pretreatment: NA Notes Issuerllnsoector As Built Plumber Other Additional Notes Money Owed Rod Eslinger >4/1/00 -Not Required Bird, Shaun Owner of both .298 and .301A at time of permit - 2 $0.00 Jon Sonnentag ~ `tf: Yes permits issued ~ ! ~ Maintenance ~ ~' Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification __.\~ 9/14/2004 11/23/2004 04/01/2005 I 11/23/2007 ~ I` - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1+ -~- - - Parcel #: 006-1043-90-050 os/2a/2oo7 11:20 AM PAGE 1 OF 1 Alt. Parcel #: 20.31.16.301A 006 -TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -SCHLEGEL, NEIL A NEIL A SCHLEGEL C -FALL JOANN M FALL JOANN M 2131 210TH AVE DEER PARK WI 54007 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 2131 210TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 44.750 Plat: N/A-NOT AVAILABL E SEC 20 T31N R16W THE NE NW & SE NW EXC Block/Condo Bldg: THEE 35 1/4 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-31 N-16W NW Notes: Parcel History: Date Doc # Vol/Page Type 07/10/2003 729515 2308/253 WD 08/17/2001 654193 1702/265 QC 07/29/1998 583933 1344/115 WD 07/23/1997 758/256 more... ~nn7 CI IMMeRV Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 30,000 201,500 231,500 NO UNDEVELOPED G5 7.000 10,500 0 10,500 NO PRODUCTIVE FORST LANDS G6 32.750 78,600 0 78,600 NO Totals for 2007: General Property 44.750 119,100 201,500 320,600 Woodland 0.000 0 0 Totals for 2006: General Property 44.750 119,100 201,500 320,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 547 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Jisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildhig 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)]. Permit Holder's Name: City Village X Township Anderson, Paul C Ion Townshi CST BM Elev: Insp. BM Elev: BM ascription : Q / ~r ~r Z// TANK INFORMATION ~ ELEVATION DATA County: St. CfOIX Sanitary Permit No: 395230 State Plan ID No: .~~ Parcel Tax No: 006- 043-90-000 STATION BS HI FS ELEV. Benchmark Z Alt. BM Bldg. Sewer # ?~ , ; 5/~ q~.y(p S t Inlet ~' ~ 3 ~,/ / S S Ht Outlet # r 5.,~~ 9~v-3 ~ ~ ~~h I~~ ~Z y Z~ s1< `~1~4 ~rZ `/ y~ ~'~ y Header/Man. ~ / >~ Dist. Pipe le, S, ~ ~ © ~ Bot. System ~ ~. /S 0 ~/~ ~ -fz Final Grade 4 St Cover ,tL/ ~ 0(~ tp0. TYPE MANUFACTURER CAPACITY Septic / / ~ ~~ (/lJ S S, c r O Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD s~~Z '' SD ~ z{ Aeration Holding PUMP/SIPHON INFORMATION ufacturer Demand PM Model Number TDH Lift Friction Loss Syste ad TDH Ft For main Length Dia. Dist. to well SC11L ~4BS~RPTI~N SYSTEM // ~ I _ / ./ BED ENC Width Length No. Of Tre es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME ~ ~ r ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM L G Manufa rer: f~ INFORMATION OR C A Type Of System: >Z ' Z ~ y y~Ua ~ T Mo el umber: ~~ DISTRIBUTION SYSTEM Header/Manifold Distributi on x Hole Size x Hole Spacing Vent to Air Intake (f -' / (} -~ ~ i - Di S Dia Length ng pac Length a SOIL OVER Y Precc~~ro Rvc4ame Anly YY Mnnnd C)r Ot-CradB Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / / Location: 2131 210th Avenue e(r Park, W~I ,5~4_0,0Q7 (NE 1/4 NW 1/4 20 T31N R16W) NA Lot NA n Parcel No: 20.31.16.301 1.) Alt BM Description = ~ e~ W~,s~ ' """`"'~'^~- Y~) NQ I.uG ~~ ~ ~r~l 2.) Bldg sewer length = ~3' I akZ -~' J IW p-1 ~Q 'ok~C ~ 'i'i ~A~l -amount 1of' cover = > (~ `~ / /_ \ ( ~ 1 ~1~- -/ ~ /.,L/ 3.~ B65P~vQTav~- l';pft5 ~ws~ar~~C(~ /__/w/ lR•J ru'ulSe- ~~('l7vlOv--- C.~+ ~l. ~1/~~ _aJ Plan revision n Requ r~ ed? ^ Yes No Use other side for additional informatio ~ ` 4 Date nsepcto s Signa n: Cert. No. SBD-6710 (R.3197) ~~ i ~ ` 2 r ~ 4~~ ~/ r Fes( 1 ~ I j .R (: 3U Safety and Buildings Division ' ~ 201 W W County r . aahhsgttaa.Ave.. P.O. Box 7262 , ''~ .~~j~~$ ~ MaQlaOn, W1 J3707 - ? l62 De artmbnt of Commerce Sine Addrasa T ~ a~ ~ 1 a/~- ~~ . Sanitazy Permit Applica IZ , ~~' Y•ermlt Number ~ ht aaeocd with Comm E3.21 ~ Reis. Adm. Code, persoml provide be us d f ~~~~ ^ CMct if R i i a Pri Law 1 av a on L App~tgoo Intorim~atloa - Pisses Prlrtt All I~rftnmatlan ,q p ~~~' 1, erase Plan l.D. Narpber ~ Prope+r{Y gwaar'a N ,~ ,~ ~QQ1 Number -v~a/ C3' ,~~~_ _ ©d ~ - ~D ~3 ~p ~~j Property Owaer'a iu3 Addeeaa ~ J,~,, ~tii'r ~ \`~. Property Loontion City, Ssste Zip Code C Lot Number yNunrber 9 ` ~ ~ ~ ~~ subdivlsiou Nerve GSM Number e 7>Z~ 7~~ - zG9- s 13 ~ ~--~- ~ ~~o II. 'iypa of Btu (check eau that s~pl~'>: ~ ~ !nom 1 2 F d D U per, or un y welling - Nuasber of Hedroonia l~~- "~ (aV311Age 0 Pt~iWCotaaaereiai -Describe use 0 Stave Awned Nearest Road ?? ~~~~ III. Type ni Plem~ (Chadc orr~ oae boot on Bus A (mtmbesiag sdreme for interaai use). Co srrPkte lira B U stpplit~ble} A' Z ^ lteptaoemant sysresr- 3 ^ Rephicmnent of 6 ~ Addition to For Covaty use O~~ ~~D _90 '_ O ~~ s . ~6 . o B. ^ Chsck is stntitary Perrdt Previously lestted Fe1'°~ Number Date !awed N. Type of P'eemft: (Check aU llmt aPPi79f~` acherne id fbr ittterua! use) ~Ron ->'tewrisad lt~C4couad 21D Mpuad 4? 0 sand Filter so Cl Conatrueeed wetland ~ zz ^ Prassuelaed !n-atrwma .1©Holdi~ Tank as ~ singe rasa ~ s2 a nrlp L.ioe ~.rx1 ~'eo a as 0 ~a D ~,~ Treatment unit 49 ©lteeireula ~ ~o O other ~ 3 'x ~~• ~ S` V. t mwe Are.l[afor~t lons 2 e Din Fiow (~,a} Dlspet:si Area Area soil pplieadeu Pereolation Roes sy~arn mevadon Finai c}rade Retlttited Proposed Rate(t3als. ~G~'f {M~a,/lnah) ~ Skrat(on VL. Tarot Info Capaoky ip ToW Number Mamdacturor Pre&b sas Steet Pibpr Plaetie Gallons GaRoas of Tanks Concrete Catgtnteted (}~ New Sristipf Ho~'1'selt X d VII. eioaeat- I titre aa~ for baeta0atioo ai! the F4R+T8 shown en fire stttaehad Phttnber's Name (Print) Plnruber'a MP/MPlts Nv~er Bushsees Pltotre Nnanber Plumber. Aameea (st:ti.e, GRy, sate, zip e) ldo ~ • s~ ~ ~ v.. Approved ^ Diss~pproval P ~it Foe (inehtdes ClrooMwater Date lseaed 1 Iyettt sijaaeure (No Samps) 0 ow,n»e Gives mlmi Adverse . ~ ~ ~~-S O o i~ u. ~oAaasosa: otr wpproaaurReeeoos xtn vreepprarni •• ,~~ d~ ~~. ~ ca~,~.,,~-a,,,,~ ~b~(TS wc~.wv~ E/.ers~~y ~,a ~(1~.,~,~uy~t~ dwY«t i3 /~c.d-rat G>°e ~'~~k~vn ~ -~ ~i~e ~ptiz~~ f2 ~~~~`~~ r lam' ill c.ax4vvr.~''- itiw~d- i~r~ cifil z~ ~G-~ ~` ~Jcc~;.acp~$_ s~ ~~ ~s~,D•6 98 (R. OSlOlY • I ~ ~.~~t~ sin ~.>~ Z~e~ ' ~ l.' ~~-`' s ~ 7 ~ ~ ~ G ~tfGl lnn,t(~ . ~~' ~ ~ ' i I~LOT PLAN PROJECT Paul Anderson ADDRESS 2149 210th Ave Deer Park Wi 54009 ' NE i/4 NW 1/4S 20 /T /R 16 W TOWN Cylon COUNTY ST. CROIX ?/30/01 2 MPRS Shaun Bi rd 226900 DATE BEDROOM CONVENTIONAL ~~ IN-GR D RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/261 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. TOp Of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.8 Alt. BM Top of 2" Pipe @ 100.0' Vent >12" of Cover 16" 6' Long System is being oversized due to Sidewinder High future additions Capacity Leaching Chamber at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 Tested area has 0% Slope and thus no contours lines can be drawn Pro 2 edroon House n slab 30' Weeks ST ~n~ Vents 2-3' X 69' Cells with >3' Spacing B-3,_, 30 Vents ~~is~Cpf~f plat 30 and sink only, no living quarters, no commercial use, will not add to gpd, 0 g] .ve .~ ~ a~ ~ ¢ w ~ 0 ~o N -1 n ~. B-210 *B 5 35 y 60' 50' Weeks 261 gallon septic tank •~ • ` SLOT PL PROJECT Paul Anderson AD RE S 2149 210th Ave Deer Park Wi 54009 ~~ i/•4 NVU i/4S 20 /T 31 N/R 6 W TOWN Cylon COUNTY ST.CROIX 7/30/01 ~ MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PR SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOA D RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM Top of 2" Pipe ~a 100.0' •0 2 Bedroom I ruse on slab Vent System is being oversized due to possible > 12" Sidewinder High future additions of Cover Capacity Leaching Chamber 16" 6' Long „ , „ Grade at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 SYSTEM ELEVATION 94.8 Tested area has 0% Slope and thus no contours lines can be drawn 'B-1 i0' 0 N Alt. .M. B-210 *B.M. 5 LAh f 30' Weeks T 60' Vents 2-3' X 69' Cells with >3' Spacing B-3_. 30 Vents ve Paul Anderson 2131 210th Ave. Deer Park, WI 54009 I I I I Floodplain Proposed pole shed location (as submitted) - Proposed house location (as submitted) Proposed septic site per Shaun Bird Future land spilt -- Property line Soil Boundaries Map produced by the St. Croix County Zoning Office 500 0 500 1000 Feet M ~ ~ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary August 17, 2001 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08117/2003 Identification Numbers Transaction ID No. 668370 SITE: Site ID No. 634334 PAUL ANDERSON -RESIDENCE & POLE SHED Please refer to both identification numbers, 210TH AVE, 54007 above, in all correspondence with thee. agency. TOWN OF CYLON, ST CROIX COUNTY NE1/4, NW1/4, 520, T31N, R16W FOR: DESCRIPTION: NEW NON-PRESSURIZED IN-GROUND SYSTEM / 300 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 806764 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. The system elevation was not shown on the plans. This approval assumes that the system elevation is 94.8 feet as shown on the soil test report form. 2. The header pipes shown at both ends of the dispersal cells shall be 4-inch diameter, state-approved, solid wall pipe. 3. Observation pipes were not shown on the plans. There shall be two observation pipes installed in each dispersal cell. The observation pipes installed on leaching chambers shall have the following characteristics as specified in the approved in-ground system component manual: a. Have an open bottom. b. Have a nominal pipe size of 4 inches. c. Anchored to the leaching chamber in a manner that will prevent the pipe from being pulled out. d. Extend from a distance greater than 4 inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade. e. Terminate with a removable watertight cap, or f. Terminate with a vent cap if greater than 12 inches above finish grade. g. The observation pipes shall be located at opposite ends of the distribution cell, and 1/5 to 1/10 the length of the distribution cell measured from the end of the cell. 4. The plans are not clear with reference to the "vents" shown on the ends of the dispersal cells. If these are combination observation pipe/vents they shall meet all the requirements of the observation pipes shown above with the. following exceptions: SHAUN R BIRD Page 2 8/17/01 a. Extend from the infiltrative surface to greater than or equal to 12 inches above finish grade. b. Terminate in such a manner that will allow a free flow of air between the leaching chamber and the atmosphere. c. The vent opening port is downward. 5. The plans are not clear with reference to the "vents" shown on the ends of the dispersal cells. If they are stand-alone vents, separate from the observation pipes, they shall have the following characteristics: a. Anchored to the leaching chamber in a manner that will prevent the pipes from being pulled up. b. Have an open bottom. c. Have a nominal pipe size of 4 inches. d. Extend from inside the leaching chamber to greater than or equal to 12 inches above finish grade. e. Terminate in a manner that will allow a free flow of air between the leaching chamber and the atmosphere. f. The vent opening port is open downward. 6. Each of the leaching chambers is 6.25 ft. long. Each dispersal cell shall have 11 leaching chambers installed end-to-end for a length of 68.75 ft. 7. The soil test plot plan does not show all of the lot lines or provide the parcel size as specified in s. Comm 85.40(3)(a)4., Wis. Adm. Code. 8. All of the lot lines or parcel size was not shown as specified in the approved in-ground system component manual. This approval assumes that the actual lot line locations will not impact any part of the onsite sewage system and that the entire system is located on the same parcel as the residence it serves. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. r Sincerely % r' G E ER E PAG POWTS PLAN REV~WER II ,INTEGRATED SERVICES (608)266-2889 , M - F, 0630 - 1500 HRS PEPAGEL@COMMERCE. STATE. WLUS FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART Bode 7633 cc: PAUL ANDERSON P CT Paul Anderson IOT PLAN ADDRESS 2149 210th Ave Deer Park Wi 54009 ' NE i/4 NW i/4S 20 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX Y MPRS Shaun Bird 226900 DATE?/30/01 BEDROOM 2 CONVENTIONAL ~~ IN-GR N PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.8 Alt. BM Top of 2" Pipe @ 100.0' Vent System is being oversized due to possible > 12" Sidewinder High future additions of Cover Capacity Leaching Chamber 16" 6' Long „ , „ eat System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 2 Bedroom use on slab 30 Weeks I 60 T a 0 N Vent 2-3' 69' -1 Tested area has 0% Cells w 3' Slope and thus no Spacing contours lines can be g_ drawn ,., 30 P.O.W.T.S. Conditiojirxldy ~~ DEP R ENT C ERCE~ o n n ~! SEE CORRES Co ~837C~ CORRECTION NEEDED ve SEE CORRESPONDENCE 60 Weeks 261 gallon septic tank 30 and sink only, no living quarters, no commercial use, will not add to gpd, 0 g] Alt. .M. B-2-10 *B.M. • 5 .,,,., ve ",~ , ' ' '~' ,~, Maintenance and Contingency Plan for a Septic System Maintenance Plan 1, Septic Tank is to be pumped once every 3 years. 2. Effluent Miter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower eleva#ion. 2, Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 ~'"~-~. Shaun Bird #226900 ~-r~/ FILr . ~C..ner TION DESIGI~I PARAMETERS P4WTS OWNER'S MANUAL 8t: MANAGEMENT PLAN Number of 9edrvoms ~ ^ NA, Number of Cottunerclal Units NA iistimated flow (average) 6 ~ t~~Y Dest$n flovl- (peak), (Estimated x 1.S) 3~~ Eat/day Soil Applkatton Rate gal/day/ft influent/Efliuent Quality ~ Monthly averaEe * Fats, G!I 8t Grease (FC7G) s30 mE/L Biochemical OxyEen Demand {BODs} s220 mg/L Total Suspended Solids (TSS} s150 mE/L Pretreated Effluent Quality ^ i~[A Monthly average*'` Bfochemkal OxyEen Demand (BODs) s30 mE/L Total Suspended Solids (TSS} s30 mg/L Fecal Conform { eometrfc mean) <_10' cfu/100m1 Maximum Effluent Particle Size ~ inch diameter MAINTENANCE SCHEDULE SYSTiIrM SPECIFICATIONS page ,~ of _,___ Septic Tank Capadty ~ ~ { ^ IdA Septic Tank Manufacturer ~ ~ ~ Q IVA Effluent l=itter Manufacturer 2 ~,,/ /} .- i Ob Q NA Effluent Fliter Mode[ _ p p a ~ Pump Tank Capacity ,-- Eat NA Pump Tank Manufacturer NA Pump Manufacturer ~1VA Pump Model A Pretreatment Unit ^ Sand/Gravel Fllter ^ Peat Fitter ^ Mechanical Aeration D Wetland © Dhinfecdon D Other: Manufacwrer Dispersal Celt(s) fin-ground (gravity) Q ln-ground (pressurized) ^ At-grade ©Mound ^ Dri -line ^ Other: * Values typical for domestic (non-commarclal) wasuwater and sepdc tank eliiuent. * • Vales typical kr pretreated wastewater. SeNtce Event Servke Fregaenry inspect condition of tank(s) At least once every ^ months year(s) (Maxisemm 3 yrs.) Pump out contains of tank(s) When combined sludge and scum equals one-third ()~} of tank volume Inspect dispersal cell(s) At least once every 3 O months year(s) (Maxfmasa 3 yrs.} Clean effluent filter At teak once every . ,,5' ^ months ~d year(s) inspect pump, pump .controls et,atarm Ac feast once every C1 months earls} Flush Laterals and pressure Lest At least once every O months D year(s) '~lA other: At least once every O months O year{s) A ~'m At least once every ^ months [:] year(s) NA MAINTENANCE INSTRUCTIONS lnspecdons of tanks and dispersal ceiis shall be made by an indlviduat carrying one of the followMg licenses or certiflcatlons: Master Plunnber, Master Wumber Restricted Sewer; POWTS inspector; tsOWTS Maintainer; Septsge Servking Operator. Tank Inspectbns must btdude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or teaks, measure ~e volume of combined sludge and scum and to check fear any backup or pondinE of effluent on the ground surface. The dispersal tells} shah be visually inspected to check the effluent levels in the observation pipes and to check for any pot~inE of etltuent on the ground surface. The pondin$ of effluent on the graund surface may indkate a failing condition and requires the immediate nottftcatton of rite local. regulawly authority. V+Then the tortsbiried accutrwlation of sindge and scum fn any tank equals one-third (K) or more of the tank volume, the endrQ contents of the tank shaft be removed by a Septage Servicing Operator and disposed of in accordance whh ch. NR 1 t 3, Wisconsin Administrative Code. The s~vici~ of effluent filters, mechanics! or pressurized pOWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the torsi regulatory authority within 10 days of completion of any service event. START VP 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 titre treatment process and/or damage the dispersal cell($), if high concentrations are detected have the contenu .~ Pace of Systatn slut up shwa not occur when soil conditlorn' are frozen at the lnfiltrathre surface. '- Cut1t~ outages pump tanks tray flit above norms! h[ghwater levels. When power IS restored the excess wastewater wiU be dtschar~id to the dispersal aU(s) in one urge dose, overloading the cell(s) and may result In the backup or surface discharge of efiktent. To avoid this sittiatlon have the contents of the pump tank removed by a Septage Servidng Operator prbr to restoring power oo the et+fluettt pump or contact a Plumber or POW'TS Maintainer to assist }n manually operating the pump controls to restora narntal levels withal 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 wltltbt 15 feet down slope of any mound or at-grade soi! absorption area. Reduction or elbtrinadon of the following from the wastewater stream may Improve the performance and prolong the life of the POWYS: antlblodcs; baby wipes; dgarette butts; condoms; cotton swabs; degreasers; dental Ross; dlapen; dtsinfectants; fat; fow~dddan draM (sump pump} water; fruit and vegetable peelings; gasol~e; grease; herbiddes; meat scraps; medications; oil; tsaalndret products= pesdddes: saNtary napkins; tampons: and water softener brine. ASANDONEMENT When the POWYS falls and/or k permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned In compliance with ch. Comm 83.33, Wbconsin AdminLstrative Codes • Ag piping to tonics and pits shad be dLsconnected and the abandoned pipe openlrtgs sealed. • The totrixtrts of all tanks and pits shall be removed and properly disposed of by a Septage Servictrtg Operator. • After pumping, all rinks ate pits shall be excavated and removed or their covers removed and the void space flUed with soft, gravel or another Inert spud material. CONTINGENCY PLAN if the POWYS fails and cannot be repaired the followln; measures have been, or must be taken, to provide a code compliant r! ~yitetni A suitable replxentent area has been evaluated and may be utllttzed for the locadon of a replacement salt absorption system. The replacement area should be protected from diswrbance and compaction and should not be infringed upon by recPt4~ed setbacks d'om existbtg and proposed strucwre, lot lines and wells. Failure to protect the replacement area wili result In the need for a new sou and site evaiuadon to establish a suitable replacement area. Replacement systems must comply with the ruNes in effect at that time. D A suitable roplacet~ent area b not available due to setback and/or soli ilmitatlons. BaMng advances in POWYS techndogy a holding tank may be installed as a fast resort to replace the failed POWYS. D The site has not been evyaluated to identify a suitable replacement area. Upon failure of the .POWYS a soq and site evahsadon mtrat be performed to Locate a suitable replacement area. !f no replacement area is available a holdlrrg tank may be Installed as a la>`t resort to reptave the failed POWYS. D Mound and at-grade soq absorption systemm Wray be reconswcted in place following removal of the bksrnat at the inl9ltradve suthce. ReconsWcdons of such systems must comply with the rules M effect at that time. < <wARNINO> > SEPTIC, PYMP AND OTHER TREATMENT TANKS lrlAY CONTAIN LETHAL GASSES AND/OR INSUPi1WENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT' TANK TINDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OP A PERSON PROM THE INTERIOR OF A TANK MAY SE D1PFiCULT OR ratrn~iRt,~. ADDtTtONAL COMMENTS POWYS IldSTALLER Name ', Y Phone ! s-~ _~ ~° 3EPTA~iE SERVICING OPERATOR PUMPER Name ,1/~,c~~-~,~~..,, i.s-~ ~tj~ 373' M POWYS MAINTAINER iJame r r a Phone , ,y-~ /a~~- (~ LOCAL REGULATORY AUTHQRfTY ~` Agency aGC ~ , -~ '$d 6-~`/6 b w,~-,,. IMaintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septt~ Tank is to be pumped once every 3 years. 2. Effluent fiker is to be oleaned once a year. Please note: a larger filter is being Inskall~t in order to extend the main#enance interval of the filter, 3, Oncre every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Uwner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contt~gency Plan 1 • If system fails, determine cause of failure, use alternate area and install new system or instal! system at a lower eleva#lon. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 ~--' a~ -his- 3~d-Y~~~ ti~~4~-~C~-." Shaun Bird #22fi900 ~-ter r ' Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page of u~ acwroanc.-~ wan t..ui nrn oa, vv~s. ron~. x. uuc County Attach complete site plan on paper not less than 8 1/2 x 11 Inches I I n indude, but not limited to: vertical and horizontal reference poin Parcel I. . ~' ~ d~ " d - percent slope, scale or dimensions, north arrow, and location nceLto neares ~. r jj 3 f1 - ~ Please print all infomta#1 RFC~~~~~J t j L ev wed b _ , Da ~ Personal Informat'ron you provide may be used for secondary pu Priva L , s. 15.04 (1 ~`~ )). O l Property Owner ,1 ~ u F~o a ratio /1~I /4 S t d T3 ~ N R ~j E (or~ /4 n J ~ ~ ~ Property grL'.s~MGa~iling Address ~Q, ~~ Subd. Name or GSM# City State Zip Code Phone Number Village ~''fown Nearest Road New Construction Use: Residential /Number of bedrooms _~,_ Code derived design flow rate 3„~[~, GPD ^ Replacement ^ Public or commercial -Describe: Parent material G u .c/~ Flood Plain elevation if applicable // 11'~ ft. ~ General comments ~ c~r,~~>Q,(~2U~~=~-cs~ ~ y ,` !and recommendations: L~ I Boring # ^ Boring ` ,~ pit Ground surface elev. ft. Depth to limiting factor 11 ~ in. gpt) A llcaflon Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPDfft~ in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efl'#1 *Eff#2 ~ ®~ll 3Iz s ~ c ,~ ~,? ~ s' ~. !l- 3~ , 6!3 ,~ m ~ - a -3 ~ 3~-y~ ,~~~ ~ r ~ , s ~/~ / s Os -fi-~ ~ ~ - Z ~~ q,.z I~~ „_s__ „ ^ Boring o~~ ,1 /~ a .~ L~~ ~~~~"a .. ~ pit Ground surface elev. /_f ,~__ ft. Depth to limiting factor //// gyn. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate GPD/ft' *Effa'f1 *Eff#2 1 b~I o t~ ,3~z 6 3 s ' ~. rn ~6k ~, e ~ , s ~ . •3 3 ~ ,~ ~ S ~ ~ ~~z _. tan . inn ran .,nn!! ~nrl TRC c ~n rno1L EfRueni #1 = 130OS > 3U < z~u mgrl. ana , ~~ .w ' ~ ~" 'n pure _,...,_.._ .. - - - -5 _ - - CSCT-NJame (Please Printy ~ C$T N~ bar `~„~~^"' ~ Telephone Number Address Date Evaluation Conducted ~oo~ l/~L~'~~ ~~~ .sue ~' - ~v1 -1 -y~l~ . sni>-x33o ~aavoo> . ~. Property Owner Marcel ID # Page of ~orittg # ^ Boring TT ~, pit Ground surface elev. ~ ' ~ ft. Depth to limiting factor ~,Ly in. Soil Appllcagon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ttz in. Mansell Qu. Sz. Cont. Color Gr. Sz. 5h. •Eff#1 •Etf#2 3 D ~ ~ ~ L ! ~ c.~ a s~ -s m-/~ rY! ~~~ ~ j ~ Z .S2' .~ ^ Boring # ^ Baring [~ pit Ground surface elev. ft. pepth to limiting factor in. Soil A Ilcation Rate Horizon Depth Dominant Color Redox Desc:riptlon Texture Structure Consistence Boundary Roots GPDlft~ ln. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 a Baring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sail Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •E1f#1 •Eff#2 • Effluent #1 = i3ODa > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 ~ BODE < 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 608-2Gb-3151 or TTY 608-264-8777. i. S6D-6330 (R,07l00) • ~ ~ Soil Test Plot Plan • Project Name Paul Anderson Shaun Address 2149 210th Ave Deer Park Wi 54009 C~ Lot ----- Subdivision ------- Date ~/30r01 NE 1/4 NW 1/4S 20 T 31 N/R16 W Township Cylon Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 94.8 *HRP Same as Benchmark Alt. BM Top of 2" Pipe ~a 100.0' Pro 2 Bedroor. House on slab Tested area has 0% Slope and thus no contours lines can be drawn 100' c c ~B-1 Ali ;0' ~ . 30 10' ~` B.: B-210 , Upon visual inspection and conversations with home owner, these measurement are accurate, and show that the house is not in the flood plain 50' .ve ~~~' . ~ . ~ Soll ,Test Plot Plan 'Project Name Paul Anderson Sha B• Address 2149 210th Ave Deer Park Wi 54009 Lot ----- Subdivision ------- NE 1 i4 N W 1 /4S 20 T 31 N/R16 W Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft System Elevation 94.8 Alt. BM Top of 2" Pipe @ 100.0' M #226900 Date 7/30/01 Township Cylon County ST. CROIX Top of 2" Pipe * H R P Same as Benchmark ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r OwnerlBuyer Mailing Address Property Address City/State SCRIPTION CJ l~ Parcel Identification Number ~ D 6 " /~/ ~~ ~.~1/' ~' ~' ~ ~.1I- NO'{~.. ~,EGAL DE ~. ~ c,v ,~ / ~ tx~ ~./ S ~S`~e~- ~ -^ep ~ ~ ~~;,. Location ~L~ %4, ~ ~ '/., Sec ~ . T 3~ N-R (~ W, Town of ~/ ~P~y ~"' ,Lot # ~_ Subdivision Certified Survey Map # r- ,Volume ,Page # ~ Warranty Deed # ~~ ~ p 3 3 , Volume ~ Page # l Spec house ^ yes ~no Lot lines identifiable~es ^ no SYSTEM NIAAINTENANCE 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 ncededby a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master Plumber', journeyman plumber, restrictedplumber 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 loss than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system v~nth 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 bean maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the thr'ee~yea/r expiration date. ~ ~ ~~ SIGNATURE OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, b virtue of a warranty deed recorded is Register of Deeds Office. SIGNATURE OF APPLICANT DATE «««*«« «««««« Any Formation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ,1l '~ `f of ~~~~ v (Verification required from Planning Department for new «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~~~ ~~~ ~N ~ ~ ~ U O iZ `~ t-~ p . h c, ~ 1~} c~ 2 W ~ ~'~5 L- /4 ST ~'~' T~ L,f= O f= ~ 1^,r~= 8 d 1~ ~}-V ~ ~ ~ ~C ~ y Cr) Sv +ti ~~~~. ~ ~ ~ 7 i~ ~-~ a ~ L~ ~~~,,.,~ £~o ~-~r . _ . I STATE BAR OF WISCONSIN FORM 3 - 1999 Document Number QUIT CLAIM DEED This Deed, made between Paul M. Anderson and Laura L. Anderson, husband and wife Grantor, and Paul M. Anderson and Laura L. Anderson, husband and wife Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area RECEIVED FOR RECORD 08-17-2001 12:30 PM QUIT CLAI!! DEED EXE?1PT 11 3 CERT COPY FEE: COPY FEE: 2.00 TRANSFER FEE: RECORDING FEE: 10.04 PAGES: 1 The East 35 1/4 acres of the following described property: NE'/, NW %., SE %, NW Name and Return Address '/,, All in Section 20-T31N-RI6W. -~l~.~L\ ~v~~t.~SLYI 2>,4~~- Ztc~ ~~ 006-1043-60, 006-1043-90 Pazcel Identification Number (PIN) Together with all appurtenant rights, title and interests. Dated this ~ day of August 2001 This is not Q~) (is not) homestead property. * P .Anderson ~~~ A,l * Laura L. Anderson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. County ~ authenticated this day of / ~ da of Personally came before me this y August , 2001 the above named * Paul M. Anderson and Laura L. Anderson, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by ~ 706.06, Wis. Stats.) TH[S INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: ~` ~ ,~3 ~) E~Sr4194 KATHLEEN H. WALSH kEGISTEk OF DEEDS aT. CF;DIX CO. , WI ~~ * Names of persons signing in any capacity must be typed or printed below their signature. ~nformaNon Proressfona~s company, Fond du sac, WI STATE BAR OF WISCONSIN ppNNA SATTERLUND ~-~5-2o2t QUIT CLAIM DEED FORM No.3 - 1999 Notary PublicState of Wisconsin VOL 1~C~~PAGE ~tj J Document Number STATE BAR OF WISCONSIN FORM 3 - 1999 QUIT 'CLAIM DEED This Deed, made between Paul M. Anderson and Laura L. Anderson, husband and wife Grantor, and Paul M. Anderson and Laura L. Anderson, husband and wife Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): The NE '/< NW %,, SE %<NW '/< of Section 20-T31N-R16W, EXCEPT the East 35 '/. acres thereof. Recording Area 654193 Kii'1'NLEEN H. WALSH REGISTEfi OF DEEDS 5T. CROIX CO., WI kfCEIVED FOk RECORD 08-17-2401 12:34 PM QUIT CLAIM DEED EXEMPT # 3 CEkT COPY FEE: COPY FEE: 2.04 TkAt+SFEk FEE: kECOkDING FEE: 10.00 PAGES: 1 Name and Return Address ~~ t.- -~~,~'sv~-~ Z i 4 ~ ~ ZI O-~~ ~~ pct / ~ W - ~ cx~ 7 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. Dated this ~ ~ day of August 2001 This is not homestead property. day of * Signature(s) authenticated this * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, AUTHENTICATION authorized by ~ 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Pau .Anderson i ' ~~ * Laura L. Anderson ACKNOWLEDGMENT STATE OF WISCONSIN (3t) (is not) ss. County ~ Personally came before me this ~ 7~day of August , 2001 the above named Paul M. Anderson and Laura L. Anderson, husband and wife to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * _-Y[CL_ Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: 7- ~ ,~~~) to * Names of persons signing in any capacity must be typed or printed below their signature. ~nformadon Froressiona~s company, Fond du l,ac, wi STATE BAR OF W ISCONSIN eoo-s55-zoz~ QUIT CLAIM DEED FORM1I No. 3 - 1999 DONNA SAT'1'ERLUNO .Notary Public-State of Wisconsin Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page of m acw,aanc;C wnn ~,unun oa, vvis. Muni. ..uuo ~,t /' I Attach complete'siie plan ~n paper not less than 8 1/2 x 11 inches in size. Plan mu / ' ( , include, but not limited to: vertical and horizontal reference poi M), direction an rcel LD. / i o ~ ~ d Q ~ 3 ~ ~~ percent slope, scale or dimensions, north arcow, and I i n d' d_ istaizse to nearest oad. ~ , t 1 L7 `~`~ Please print all inf r n 5 1 Rev' ed by ~ Dat~/ ~ ©` .03 ( ) (m)). Personal information you provide may be used fors purpo c Law, s. 1 ~ ; Property Owner _ , - -v c. ~ n , r,; ~ t~ !~ Property Location ? Govt.-Lot ~~ 1/4/(~,~1/4 S o~0 T N R E (o W Property Owner's Mailing Address - ST ~AOlX `~ Lot:#, 4 Block # Subd. Name or CSM# c~` / J ~ J ~ ~ntY C/i~ State Zip Code Pt,~onp`N .OFFICE 'b Clty , ^ Village Town Nearest Road ew Construction t1se;~_ Residential / Number of bedrooms ~ Code derived design flow rate GPD ^ Replacement ^ Public or commercial -Describe: ~ ° Parent material i1 .~ Flood Plain elevation if applicable >~ General comments ~ ~ and recommendations: ,f~ ¢- © ~'3') ~ ~,~ n~cL~1 ~,'~~ ~,Ll~ ~ ~ /)-) ~~~ ~ ~ I . 9~ \ C/ ` s c~F...i7 ~omMc' Cr~'l t Boring # ^ Boring ~ ~ ~ -- (L~;,,ti ~ .C~,e-~ ~ 'J Pit Ground surtace elev. ' ft. Depth to limiting factor in. S DDIICa to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E l ~yy v~ ^ Boring Boring # ~. Pit Ground surface elev. ~ ft. Depth to limiting factor~_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l - ~3 ~/~ 0 ~ i rte- ~ . r c ate.- - s _ 1 /' V ~3 /,-f {~~ j ~~ ~I ~ '~ /~ ~/ ) /' //7 ~ p /4 • ~J/V~ '7 i * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' tmuenr rtz = tsuus ~ au mg,u ana i ~a ~ ou my,~ CST Name (Please Print) ~ i atur~e,..-- CST Nym~ber Address Date Evaluation Conducted Telephone Number %o ~ / % Z.~,-1, ~ i-c',. l c'~/J ~ i C~i rY•~vu~/z/i~S ~/u / 7 ~ ~'.~ - a ~ 7/ s d ~,l '~.7~/ b SBD-8330 (R07/0( Property Owner Parcel ID # Page of ^ Boring ^ Borng # ft, 3 ~ Pit Ground surface elev. ~ 5 ' ~ Depth to limiting factor ~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz `Eff#1 'Eff#2 Cont. Color z S Q u in. Munsell 'f Gr. Sz. Sh. //- c // , ~~, , Q / ~ ,,, ~ i3-3` /o~.~~/-~ ~z o,:- .~ ter'` -m ' N~9 N,,~ , ^ Boring ^ Boring # De th to limitin factor in. ^ Pit Ground surface elev. ft• P g Soil Appliption Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 PDlft Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ^ Boring ^ Boring # Ground surface elev. ft. Depth to limiting factor in• ^ Pit Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E~GPDIft*Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` Effuent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 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 TTY 608-264-8777. SBD-8330 (R.07/00) ... Soil Test Plot Pla ~ Project Name Paul Anderson Sha ' d Address 2149 210th Ave Deer Park Wi 54007 M #226900 ---- ------ ~ 6/12/01 Lot Subdivision - Date SE 1/4 NW 1/4S 20 T 31 N/R16 W Township Cylon [~ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation see soil test *HRpsame as benchmark Alt. BM Top of Lath (a~ 101.3' Property Line Pole Shed ll not add the gpd Ali .M. 10' ~ B.M. 10' B- 7% Slope B-3 70' 30' 3' B- 97' 96' ~ 95'' ~opr 300' 100' Bedroom Cabin/House, to have no Please note to County and installer: This soil test needs to have on-site done by Leroy Jansky because it is a A+0 mound site. For more information contact the soil tester or Leroy Jansky. 210th Ave 720 'a" a 0 0 M H 'Wis'~onsinDepartmentofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings 'n rdan 'th C 85 W' Ad C d i acco ce wi omm is. m. o e ., County ~~ ~ ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference poi M), direction and l Parcel I.D. o~ ~ ~ ~ y "' 9 percent slope, scale or dimensions, north arrow, and I i n ~~ dista se,t`o nearest road. j Q 3 0 ~ ~ D ''"` ` ~ Please print all inf r " n. Reviewed by Date Personal information you provide may be used fors q~ purpo c Law, s. 15.0,4 (1) (m)). Property Owner Property Location _ G ~ , ~` ~ ~~~ Govt..Lot S~ 1/4/4 S o~o T~ N R E (o W Property Owner's Mailing Address -- ST C~iOIX - "_ Lot #~ i Block # Subd. Name or CSM# 07! U ~ ~unTV Ci State Zip Code d~'N K%E ,n Cfty ^ Village Town Nearest Road ~. ~~r ~ S~bd ~ ( ~ ~ j ... ,<~ ~ . ew Construction Usc~.~ Residential /Number of bedrooms ~ Code derived design flow rate 3(51 GPD ^ Replacement //~~~, ^ Public or commercial -Describe: Parent material .X.®.(~ ~ ~ Flood Plain elevation if applicable // J ~ ft. General comments /~ ~ // ®~ ~ ~ / and recommendations: ,~ -f- © ~ ~ ~ ,vZ(/ , ! p ~t ~ ~ 1 _ ~ I , !I J /~L- /I c~ P-~., C. D m ^ Boring # ^ Boring Off, ~ ~ /~ . pit Ground surface elev. ( ~ ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E f f#2 D''~ O - ~ ~ ~ ,~' -I P m" ~ ( y ~ 0 ~~gg Boring # ^ Boring Pit Ground surface elev. ~ ft. Depth to limiting factor ~.,,~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 - r3 0 ~12 ~- ,~ .~ c ate- - s _ {~ /~ /J ~rw w, )^! ~/v~ 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CSTcN_a_me (Please Print) i ature.,..--~-~ CST N1ym~e~ v ~ Q ~ ~ '~ U lJ Address Date Evaluation Conducted Telephone Number ~ Z ~~~ ~t 1~.~LJ_~C./~.,~,:~in/1~~5 yG I "7 ~-f2-of 7/ s=d 5~~ `~~1 6 SBD-8330 (R07/001 M r Property Owner Parcel ID # ~ ~ Page of Boring # ~m^7 Boring L`J Pit Ground surface elev. ~ ~ ~ ~ ft. Depth to limiting factor ~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 f -~ 3 ~ ~- ~L ~~~ .~ ~ s a~. - s 02 3-3C /O ,- s ~z fJ ~- /~ °'/~ - ~ , N/~1 N~r~ , ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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 TTY 608-264-8777. SBD-8330 (R.07/00) ' ~~ ~ H Soil Test Plot Pla Project Name Paul Anderson Sha ' d Address ~ ~ 2149 210th Ave Deer Park Wi 54007 M #226900 Lot ---- Subdivision ------- Date 6/12/01 S E 1 /4 N W 1 /4S 20 T 31 N/R16 W Township Cylon Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation see soil test *HRpsame as benchmark Alt. BM Top of Lath ~a 101.3' Property Line Pole Shed ll not add the gpd 10' 10' B-2 Alt. B.M. B.M. 7% Slope B-3 70' 30' 3' B- 97' 96' ' 95' 300' 100' Bedroom Cabin/House, to have no Please note to County and installer: This soil test needs to have on-site done by Leroy Jansky because it is a A+0 mound site. For more information contact the soil tester or Leroy Jansky. 720 a~ t~ a 0 0 M 210th Ave