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032-2132-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 552379 GENERAL INFORMATION State Plan ID No: 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 Parcel Tax No: Gasman, Christopher & Amanda Somerset, Town of 032-2132-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: e,)!s,' ti 01.30.19.1178 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. s Septic Benchm rk /Z 40 6 rte.- t L- Alt. 1-- h' h' ! O Aeration Z Bldg. Sewer 3-3 'R . 7 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet . ~ 9S 52 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /JA- / 4 Dt Bottom O Dosing Header/Man. d, .6 Aeration 9. ?J5 Dist. Pipe 7 /S. od $5 Holding Bot. System Le --Ty 4 Final Grade PUMP/SIPHON INFORMATION -7 q 92 . Manufacturer Demand St C r GPM Model Number TDH Lift Friction Loss System Head TD Ft Forcemain Length ito Well SOIL ABSORPTION SYSTEM Z BED/TRENCH Width / Lengt 13 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t~(_ SETBACK SYSTEM TO Y~ ~P P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Ty ge" peOO^yJsteCm~a 1 w UNIT Model Number DISTRIBUTION SYSTEM ,A. AA- 17 J►-1-7 a-Ito Sb Header/Manifpld Distribution x Hole ize x Hole S\ Vent to Air Intake 7 i Pipe(s) \ Length Dia Length Dia Spacing hleb~e AJ-4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth over xx Depth f xx Seeded/Sodded xx M Iched Bed/Trench Center y Bed/Trench Edges Topsoil Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 897 174th Ave/Ne Richmond, WI 54017 (NE 1/4 SE 1/4 1 T30N R1 9W) Rocky Ridge Estates of 10 Parcel No: 01.30.19.1178 1.) Alt BM Description = r` I GaJ~~ C~ 6 J c,A SGre"i S 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes ~Z Use other side for additional informs ion. b SBD-6710 (R.3/97) Date Insepctor's gnatu Cert. No. ;,v~Aaa''~vTO County RECEIVED Safety and Buildings Division ST 0.2Diii_ ©S K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P.' Madison, WI 53707-7162 JUL 13 Z012 PI'S 5 5Z 37`~ o~ A, _ - Pug arMA f M-Mit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit / V is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. „f 4 Q Q / 1. Application Information - Please Pri t All Information 7l UU Property Owner's Name m L Parcel # 4- fi /,4 V I STOPA C2 C ASS Mw\! b22 -2 112 - Ckl - Mb Property Owner's Mailing Address Property Location S 2Z . J\BbLT Govt. Lot C City, State n h t Zip Code Phone Number 1/4,'a' I1 1/4, Section 1~ . MPLS M IV :5-S q:3 qq(circleor T Z~ N; R E o~ II. Type of Building (check all that apply) O Lot # L4 - El 1 or 2 Family Dwelling - Number of Bedrooms CAA C1 Subdivision Nam(e~ Qr~ . Block# 1 ❑ Public/Commercial - Describe Use , a ❑ City of ❑ State Owned - Describe Use C CSM Number ❑ Village of Z ✓ C .A~4 s~►~. C Town of Sei M' 1~ ell C-) Z 5 4 III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A. "°lNew System [I Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ]IV. Type of POWTS System/ omonent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) atment Device (explain) V. Dis ersal/Treatm nt Area Information: bc) 400r_ 77 Design Flow (gpd) Design Soil Ap lication Rat gpdsf) Dispersal Area Requ' d (sf) Di al Area Prop Id (sf) System Elevation JD0 C 1 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks / y -2 Cd Cn Cn W. E5 Septic or Holding Tank 'Z JZ k)o C67 tJ~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S' nature MP RS umber Business Phone Number aEFF V-0 \,k U J21Y 2 Z -S 22'1 z ZIS _7'5S-Z'-)6J Plumber's Address (Street, City, State, Zip Code) P1b. 6 SOS CJr/7 9 -112 V0 JJ60 VIII. Count ep'artment Use Only XP'proved .e Permit Fee Date Issued Issuing nt Signature 7 13 /L ❑ eason for 1 '9 5 06 $ . ` IX. Condit*M Weasons for Disapproval 1 l`^- -w- _ _ 1 ' , 0ic tank, effluent finer and 3~ ~-~4 G~.J~ " Gzt2~~ l~~G(1! dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN seffisok requirements must.ba;mainta'hrdd as per appkable code / ordkua caa Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/I1) ~'2Z ~tu mzol, i sar~EZ4 C ~~1J1~ 1 T ('~CtfL~L = (b~ h N1 2 `rbP C.F -CAQ V LaV ~ ~ ~ CL r3 Soi~ 136~~IV " q ocD - Rm o, 6 tk 4y az /90 Ceis~cP~2 CNE~'%y s~l~ s i~ ivlPi~ w -ZZv hfl~aL i sb~ ~AAPLS : M A jlaupc i ~y CO 2ZYZ'/Z- -RZ ar ~ a t r, o iz © ; i F pry rr, Vn J rc3 i 0 .4s h1 a p, O vr- q- 4-7 4-4 4" • R, fA PLO ~ n i .io o 6:4 m F Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north anow, and location and distance to nearest road. . Please print all information. Reviewed by Date / Z Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property Owner Property Location 8 Govt. Lot A/Z 11~ 114 S T N R~ E r Property is Maili Address Lot # Block Subd, or CSIM City State Zip Code Phone Number ❑ City illage Town Nearest Road ( ) i✓ O New Construction Use:,4 Residential/ Number of bedrooms Code derived design flow rate _(fY~ GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material Flood Plain elevation if applicable ft. General comments and recommendations: Ts~a~t2sro s55tc,.~ tts7 Boring # Boring pit Ground surface elev. ft. Depth to lanitM factor in. Sal Application Role Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDff In. Munsell Qu. Sz. Con). Color Gr. Sz. Sh. `Efi'#1 `Eff#2 s i r-71 Boring # Ip~ Bonng toll, Ly Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rae Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. MunseN Qu. Sz. ConL Color Or. Sz. Sh. *M1 'Eff#2 4-1-2 ~Vz aiv 3 7 X /Z) 46 ~2'P± eOllident #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L t #2 = BM ,:S 30 mgft- and TSS < 30 mg& F ST Ne ) S' CST Number ddress bath Evaluation Conducted Telephone Number 917 Property Owner g in~.t/ Parcel ID # J - - W Page of .JBoring # O Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rata Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. -Eff#1 -Eff#2 q R ~ Q F-I Boring If ❑ Bing ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 Boring F # O Boring ❑ Pit Ground surface elev. ft Depth m gmiting factor in. Soil cation Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPQ/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Eff#2 ' Effluent #1 = BODE > 30 5 220 mglL and TSS >30 150 mglL. ` EfIluentA2 = BODa < 30 mglL and TSS 30 nVIL 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. SS"30tR W) II Property Owner Parcel ID # - - ~~Jo Page of ❑ Boring n Boring # .L ~ i ®pit Ground surface elev. .~x~..~ it. Depth to limiting factor ~ in. Soil Applimation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munseil Qu. Sz. Cont Color Gr. Sz Sh. `EfI#1 -Eff#2 T 9 7• QS 7-7 a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munseil Qu. Sz Cont. Color Gr. Sz Sh. `Eff#1 '092 a 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 GPDIff In. Munseil Qu. Sz Cont Color Gr. Sz Sh. `Eff#1 `Eff#2 Effluent #1 = BODS > 30:S 220 mglL and TSS >30:5 150 mgA. ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL 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 608-266-3I51 or TTY 608-264-8777. saD4330(L6W) X'> q ct~ 3~a,3 ~ 'sue /q,2 d ~e z~l 9 /d S 4 d a6 SS 7 Jun 19 12 08:42a Jeff Fox 1-715-755-2464 p.1 fA F V f 5E ~q sel I -PLb 19 V Tows o ~ntt~S~S`~'tC~4 Lat" 1b izocv,-V R1 70 s ~12' f J/ Z7- ~F~S~ LLiT" Lf~u~ ~L1~~= Jack fil 6e bf7 ~'bs QUf- = 1aZ.9S ~ sG~L. _ /aZ >a T-j v G ~3paxrtyro~ County 0 RECEIVED Safety and Buildings Division ST C Rn ( $ K 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) F, r Madison, WI 53707-7162 JUL 13 Z01Z `j 5Z 37`7 ~9pFFSStOhAtig A! P l' 'Mffiit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Q I ~7 / 41XV 1. Application Information - Please Print All Information [l / T Property Owner's Name ~M1 Parcel # /',9k1STbPAE2 CPSSMAd b3Z-2132-G1b ~L~Db Property Owner's Mailing Address Property Location S 22_ i4\ EaT Govt. Lot C City, State h Zip Code Phone Number 146 ~'/y, Section PL) M I ~i ~S q3 61 o/(circle one T 3~ N; R ((circle or& II. Type of Building (check all that apply) O Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms SA I Subdivision Name • Block # V~1~L ~y RunLC I IFS ❑ Public/Commercial - Describe Use q, ❑ City of ❑ State Owned - Describe Use C C CSM Number ❑ Village of Z Qtt t--j ZcJ LJ C~f~L~k~. C KTownof SnNlgg~ET III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A. New System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/ omonent/Device: Check all that apply) S-Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) atment Device (explain) V. Dis ersal/Treatm nt Area Information: 1, 5C) 4olor- 14 - Design Flow (gpd) Design Soil Ap lication Rat gpdsf) Dispersal Area Requ' d (sf) Dal Area Prop ed (sf) System Elevation - ie s,~s VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units p o New Tanks Existing Tanks Y n`i y V U v~ r~ k. C7 R.a Septic or Holding Tank /tZ Dosing Chamber VL VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP PRS umber Business Phone Number aC FF 1:7 V WPlumber's Address (Street, City, State, Zip Code) Val 6 13( ~ 5z_ -S%07 VIII. Coun /De artment Use Only pproved Permit Fee Date Issued Issuing nt Signature ❑ $ $5 . ea 7 3 /2 son for ' 1 us IX. Conditk"TfA easons for Disapproval c 1. Septic :tank; emuent fiMar and 3~J pap 64. Ac-~ GZ N .dispersal cell must all be servlces / maintained per management plan provided by plumber. 2 Ab k requirements must be maMtainrd as per amble code / ardis►anca, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) CklI TtNca ►~l~icl W ~'-Z2 4fu mzoG i sbc~~ 0, MPt.S, MIS 551130 ~a?~1 1 Q 1'1 ~r L ~tir- CL i bn too 1 2 Z SZ'I Z- 3 ~yQ t7' 88 O j copy ku r FfJ A ~ 2 t z CL) IV • , pin ry~ t4 . i 1~ qlrt lo co F y. to :2 n° a 84 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _L_ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but riot limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road: / Z Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location _50 7 AIZ 1/4- 1/4 S T N R~ E Govt. Lot or C~SAA# Lot # Biodc Subd. Address r Property lOwner'sMaln qam City State Zip Code Phone Number ❑ City Village Town Nearest Road New Construction User Residential / Number of bedrooms Code derived design flow rate _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material :~W f=lood Plain elevationrf applicable ft. General comments and recommendations: /f-~ ~jkS ~o~t0 v40' /~aL~k' TUS vri ~r+~ ` ` CJ -9e ❑ Boring # Boring Pit Ground surface elev. ft. Depth to ihrti ng factor In. Scd Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munseil Qu. Sz Coit Color Gr. Sz. Sh. •Eff#1 •Eff#2 to) s !:W 11 1 E Boring # Boring ® Pit Ground surface elev. 3~" ft. Depth to limiting factor =z jam in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. , Munseff Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 f Qal I-V- F-2 r 7 4 k) #1 = Boo > 30 < 220 mg1L and TSS >30 1150 mg/L #2 = BOD < 30 mg/L and TSS S 30 mg/L CST Na ) Sig CST Number 2 L. !!;~;1// LZ Address Date Evaluation Conducted Teliphone Number Property Owner Parcel ID # 7 - - i` ol~ Page of n Boring # ❑ Boring l J I ® Pit Ground surface elev. ft. Depth to limiting factor in. 1, SON NEtLd ~Ratq Horizon Depth Dominant Color Redox Description Texture Structure Consists Boundary Roots GPDM In. Munsegli Qu. Sz. Con. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 A, "04 q R F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to Hm ting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f! In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 J F-1 Boring # ❑ Pit Boring Ground surface elev. ft Depth to limiting factor in. Sol Rate Horizon Depth Dominant Col Redox Description. Texture Structure Co_ iisWence Boundary Roots GPQ/fF In. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Efl#2 ' Effluent #1 = BOD' > 30 5 220 mg& and TSS >30 1150 mA ' Effluent A2 = BODa < 30 mg& and TSS < 30 mglt. 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. se"30 (LfiW) Property Owner Parcel ID #J Page of n Boring # ❑ Boring .L7 i ®pit Ground surface elev. S ft. Depth to limiting factor in. Soil rption Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1,--;~ - .41 6! R M~, re ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E1f#1 '0102 ❑ Boring ❑ Bonng # ❑ Pit Ground surface elev, ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description• Texture Structure Consistence Boundary Roots GPDff In. Munsell Qu. Sz. Cont Color Gr..Sz. Sh. 'Efl#1 'Eff#2 ' Effluent #1 = BOD, > 30 ; 220 mg1L and TSS >30:5 150 mglL ' Effluent #2 = BODS < 30 mglL and TSS 30 mglL 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. sen-9330 (L&W) / /®f ~,nIES pcJ,JfL , ~ufs~Il /,E1~so~ f 'X~ JeC zva /th2 - ll/ a Al v 1 70 S 4 ~ a6 88 y t r• o~TvT County Safety and Buildings Division ST AD 0 o K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ~ K Madison, WI 53707-7162 552377 Sanitary Permit Application State Trans N"er In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit AJ~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address 1 - eren ng address) the Department of Safety and Professional Servies. Personal information yo ide may be used for secondary u oses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Q 1 y ~-f. / ~Aue, 1. Application Information - Please Print All Information o / , Property Owner's Name GM S~6p6". 4- -MA , ^ Parcel # ALi UnKISS CHASMhsj A~C 8 41' a3z-Z 3z - ~a - 00-c> Property Owner's Mailing Address d ' , Property Location V Mkt, d/11 I oN/NCO,c. Govt. V C Lot Ci 7 g City,,, State ' n Zip Code ry~ Phone N ber i' 1/4, SE y,, Section r V 6KTH M RS, 1~ 1 N S SUD of circle one II. Type of Building (check all that apply) Lot # T N; R ~ ! E o> Kai l b Subdivision Name ~I or 2 Family Dwelling -Number of Bedroom 14 -f- Block 1 ~1 ]C 1~~ 1\ ~S 1 p SS4;ii ❑ Public/Commercial - Describe Use Ok- ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 6 O ~ JW ~ AL,Town of III. Type of Permit: `(Check only one box on line A. Complete line B if applicable) A. DLew System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner ,4 IV. Type of POWTS System/Component/Device: Check all that a 1 ) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil /a 5 ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) r..lpe (~'J V. Dispersal/Treq~t ment Area Informa 'on: Design Flow (gpd) Design Soil *pplic ion Rate(mdsfl Dispersal Area Requi (cfl Dispersal Area roposed (sf) System Elevation dab 6.7 1~59 1 /S 7 1 160-Al qB.S c'? 3 VI. Tank Info k.apacuy 111 iuLai n Manu act er Gallons Gallons Units 2. o o New Tanks Existing Tanks w = ° Y ^ R Cn w c7 i~ 4 Septic or Holding Tank )Z&b Dosing Chamber ~OIJ 1 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. usiness Phone Number Plumber's Name (Print) Plumber's Signature MEZZRS-9timber ~(S--755-ViLl .-JEFF tbX U ZZ3ZyZ Plumber's Address (Street, City, State, Zip Code) IT/ tcv- k f 5y6b f P. C), skS W/ C VIII. County /De artment Use Only pproved El Disaroved Permit Fee Date I sued Issuing g t Signature e36 ~ fOw, iven Re for Denial $ IX. Condi ' easons for Disapproval 3 -'A dL wu1L 1 Septic tank, etfhler>It filter mull t~ ~R.l~ ~ !>c o. ~ g dispersel cell must all be ser*es /'maintained as per management plan provided by plumber. , Q 2. ° w ckXequkemes must.b4maintained ~Ww.x~Gt.a a,dr q l as code ! orb: „ rp/p~ . Attach to complete plans for the system and submit to the County on on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) } CONVENTIONAL COMPONENT DESIGN Residential Application 64A INDEX AND TITLE PAGE Project Name: Pi'SS fa•6MPJJ Owner's Name: Owner's Address: SSzz V "bLZT N, l~PLS. ~n n1 • / Ss~i3o Legal Description: IJE /y 1`'7 S T30 M Jk IR Township: SD N1CRS~T~ County: Subdivision Name: Lot Number. Parcel ID Number v3Z- Zm6- do Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs ✓ , Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranter Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Fr X License Number. ~32yz Date: ~o l iy 1Z Phone Number 5' 755` ~yco~ Signature q / Designed pursuant tZ~soll Absorption Component Manual for POWTS Version 2-0 SBD 1Q705-P (N.otlot). Page 1 Jun 19 12 08:42a Jeff Fox 1-715-755-2464 p.1 bMq&1 GASANA AEiy SEW Seal -rL~b~,31KM V/ -rowo aw snr\ CI' 3 ~12' l ~.Z3ZIZ n 14 t r~(vFlS Lfs`r Lfr~3£ ~L11~-1ac3 ZEMW l ,R:Ir~ 2 -Tbe ~'ds QLV. 7 )D?. q5 iwo ic)Lzs ~a3 I p SG1L. ~dZ l 16S V1, I II q~ 0 ~}Ryy, of ~ o Ile N 0° as a - a a •d a 4-4 O Fo 9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner G► D i Septic Tank Capacity Z&O gal ❑ NA Permit # ►~t Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer CI NA Soil Application Rate gal/day/ftz Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average*' Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 mg/L gun-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) S30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :_104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA Ad year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 Oyear(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) 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 (%3) 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. GMW (4/01) Page of START UP AND OPERATION For Tiew 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 cell(s) 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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 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 POWTS MAINTAINER Name J Name Phone 71 24f 4 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name • w Phone Phone 15 - 3f& - TVo This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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 cell(s) 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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 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 POWTS MAINTAINER Name Name Phone 71 Z Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name . Phone Phone ~S - W& - /~04n This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. STM VAQIX COON 1 ' SSMC TANK IV AINTAINANCE ACaEENMNT AND ffW1MSUW CMTMC,ATE FORM OwnedBuyer 1- y cT / eiutC. l SY~ t t t & ._r wf t +4: (va~ea~im:.gwrakaran'Pta~g Depattmp~t, gnaw mupsvedm) Citylststq l csfioamw&*r = Z133 6c), b 0 l+„DESCRIFTION Pity Location S j__ 7iG IAA j °I"W, Town of ~510mcesel- Subdivision E S XAO V Certified Surrey Map# . Volumes Page warranty DeeM 66 . volume ear Sow house yes -X.-no Lot lines identifiable Imtnoper use and- ce of youw,septic system coutd nesuit its prealatmobMwe to handle wastes. Proper mainteaance cmdas ofpuwpiug out then septic teak every dww Yom or soone, ifzeeled by a licensed pw*T What ywtpatbto the-qdouwAffid din fawtion ofthe septic tank as a treatment stags in the waste disposal system 'the pv*aty owner •s toaubmit to St. Crok ?wing Dep.rt amt a aerbificefim harm, signed by the owner and by a maatesplumber, joumeyman plumber, reatrkted }slumber or a hicsaaed pumper verifying 69 (1) d w on- site wasted d4caal SystemisiaguW.%MMtiugcoadition softr(3) after inspecfm and putuping(ifaccowetY). the septic tank is less thim. U3 full of shtdge.• Uwe, the undenaigned bone M the abaWanquina s and agree to maintain the private omp disposat system with the staadards set fort), herein, as set by th Depattmaut of Commerce and use the Deparwaarit of Pratt M R esou pow State of Vvi ~oru~» r`+M+~`+r ,tires do dist c system has been nwintaiced must la+compldcd and returned to the St Croix County n8 Office within 10 days of the three yew mWimhon date4 &it}NA7t7R8 e)F APPUCANF D) Tie #of proposed laKhooms OWNER CERTIOC&TI, Q I (vue) +certify that alt statements on Ws fonrt are tine to the best of my (our) know+le* I (we) am (ace) the owner(s) of the property described above, by virdte of a warranty deed recorded in )register of Deeds utter ~3 SIONATL'ln OF A"U CANP t►Axa aayaeamimtlarti.mipreeamry,etaar,seraaeeeiag,+awicatbyth,zag+~*• hid.withm;e.p~>i~ado•st~rr~e,,~a...at~,t~tt~•~t~~ea. a copy d'dw art&d aarvsy coop ilierannae ia=ade inch. ww"y dead. low 846.45' . . . FR cw,7 CENTE N 87"01 5,5E 8 34 2,30' r .r ;.-270.30 12't,7741Ty EA SEMEN T lp 46 • e a ■ • • oleo • • • • r • - III r LOT to 154o 294 SO. FT. r 15 4 ACRES MIN. f. Ir. ~=065. 7 Lor 11 F360 819 SO. FT. 0 'ww 3. 14 ACRD " ,wry: ~ ~ : ell Hid , l !VO,+A 4 _ +,r, .a. _ k - _ - r• ! ' eM° A , ...N'r''."•... yYP'~' Opp. ~ ~ a~ ~ ~ ~ ~ ~ wL'~:'.• _ Alper wow* .,..a. _ _ ; - 0, Ap, U 2 8 7 8 P 491, gPnsGD 71 KATHLEEN H. WALSH State Bar of Wisconsin Form 2-2003 REGISTER OF DEEDS ST. CROIX Co., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 08/31/2005 10: 30AK WARRANTY DEED EXERT # THIS DEED, made between Bruce A. Wang, a single person REC FEE: 11.00 TRANS FEE: 231.00 ("Grantor," whether one or more), COPY FEE : and Christorlher T. Gasman and Amanda E. Gasman, husband and wife CC FEE: PAGES: 1 ("Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address s interests, in St. Croix County, State of Wisconsin ("Property") (if more space is THE RIVER BANK needed, please attach addendum): PO BOX 188 Lot 10, Rocky Ridge Estates. St. Croix County, Wisconsin. Otoe". WI 54020 032-2133-00-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated 2 3 G . (SEAL) (SEAL) * *Bruce A. Wang (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Bruce A. Wang, a single person STATE OF ) authenticated on Z ) ss. = COUNTY j *Kristina O gland Personally came before me on , TITLE: MEMBER STA BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO-PRO- Legal Forms 800-655-2021 www.intoprofbrms.com Wisconsin`Department of Commerce SOUL AND SITE EVALUATION 3 Division of Safety and Buildings ~ - ~ Page of Bureau bf Integrated Services in ac6Or arlcb' /ithl s.'fl HR 83.09, Wis. Adm. Code r Attach complete site plan on paper not less than 1/2 x 11 inOes Plan mu$t,,, County include, but not limited to: vertical and horizontal reference pdi}rt (B0, di#ection a6 d" / percent slope, scale or dimensions, north arrow; and locati on and distance to nearest rpad• Parcel I. D. # r ell D APPLICANT INFORMATION - Please`print all infb" # T n. ! Reviewed by Date Personal information you provide may be used for secondpry'purposgCRgVgCW(t 15.94,11.) (fi(n)). Prop rty Owner P'Xpe Location LA S1 le ~...i t ~ I Govt. Lot N ~ 114Se 1/4,S ! T_70 N,R E (or)© Propertywner's Mailing Address Lot # /Cn /J City State Zip Code Phone Number city ❑ Village ® Town Nearest Road /yebl /~1c,4mo,,n( ltil TX017 (7/s ) 2Y~ S7 75- ❑J rnM e~- ~s-14 ® New Construction Use: ® Residential / Number of bedrooms dition toe fisting building L ❑ Replacement / ❑ Public or commercial - Describe: 7 Code derived daily flow gpd / Recommended design loading rate ' q be , gpd/ft2 1 trench, gpd/ft2 Absorption area required 00 bed, ft2 do trench, ft2O Maximum design loading rate bed, gpd/ft2 0- trench, gpd/ft2 Recommended infiltration surface elevation(s) 100"4 ~g 1?73 ft (as referred to site plan benchmark) Additional design/s/it+e/considera-tiions 5tep -T,,CAChs Re coy use U4R Sao' e Parent material C la,;,, / !''/f ~S 27 C /P2 x°41 fle-4z A Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U Es ❑ U © S ❑ U © S ❑ U ❑ S LO U ❑ S MU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench zm ~ ~ .S- 0- DSO 4T ~.4 Aar, C a,-, Ground ~'~l i/t 1414 l~ /~ifb~ l/7~✓ G G~ /ov isft. /0Y G3~s I of .7 ~ o 8 Depth to limiting factor. ' in. Remarks: Boring # 1 -7 '14 11~Wh !✓vv- C w 2 . ' .7 ~l 2 7-7,5 6 4 lo- /5 Ground elev. S ~ft. Depth to limiting f ctor 02 in. Remarks: CST me (Please Print Signature Telephone No. c•t TYamell 7/S=ZS/7,Y20 Addre s Date CST Number 3W-1yza a e Sow,el-f -eT tv 1 3- 0 ZS 27- C/8 23 191V PROPERTY OWNER ~u sSf!/ ~Ef~Jb`1 SOIL DESCRIPTION REPORT Page "Z of / PARCEL I.D.# 032- 2006- L l~ © t /D Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 57 312- /o? C Z Ground 3 Zy y 7, TM 6 1114 S~ lyjS6~ /JW'- elev. 9 ft. Depth to limiting factor >E`f in. Remarks: Boring # /o/Lx A 0r'e - C G~ 2 C • ' . ~ Ground elev s Depth to limiting actor 78 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 0-~ b 1w 414 yz _77j `L 14! pT C 647 Z C S S Z y-1y ~ S D~►s~ G C Z C -7 OAS Ground 5i1 ft ~I Depth to limiting Y fac or in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) SOIL DESCRIPTION REPORT 2 PROPERTY OWNER w~ Page. of PARCEL I.D.# 032- 2 6~ ld Lo t /0 i Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 3 i -Y Ground 3 27'Y7J~le 3'6 /Y~t 5Z l~ fX CCU 1 , ,os elev. CZ L -?fft• Depth to limiting fa for in. .Remarks: Boring # p-(- gyp/ fl /0O e - !ee - C Ground elev Depth to limiting Ain. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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J, ! ; ~1 ~ w / ' ~ • ~ ~ ~ r \:1;1;1 lllxll,t,111/ p hy ' y ll '11141 1,/ 111 i. 1 1x 1 ~1 • • f'I ! ± 111' 1 Iii, 111 ' ~ ~ 1 / 1'1'11I11';14',t; 111 r . .~~."h' 1 4 ' 1' 11 1 1 , 1 . j Ing x 1 .....«.....1...» (~Nl..q.».....«....w.«....«+..«.«.w..wi:r.«. « w«w.... Silt 'r( .~_s. •-~~.t... 4 f•% ' ;~;j 1/ i. .....r.'..t - 1►'--»- wlrYi4 . aV -7-1?-d/ 1432 Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ACE Soil & Site Evaluations County Attach complde site plan on paper not less than 8'h x 11 inches size. Plan must St. Croix include, but not limtied to: vertical and honzontol reference pant (BM), direction and parcel I.D. road. percent slope, scale or ctimemsions, north grow, nearrrst 03 0-0 0#1.30.19.1178 Please print ail i _ _ R By Date S Persons infonriation You Provide maybe ary gNI~Y s. t5.04,lt} (m}). / ` Property Own ~~~~~y~ 15 Property location B an Govt. Lot NE 1M SE 1/4 S I T 30 N R 19 W Property owner's Mailing Address t } r? - tot # Block # --FS d. Name or csN~k - - 1 ~ 505 Valley View Road Plat Of Rocky Ridge Estates - ~ - City State Z ;Coode Phone City _j Village ✓ Town Nit Road Hudson I WI 54016 . 715- 861683 Somerset 174Th Ave. 16 New Construction Use: -e Residential! Number of bedroo►fis _ 4 Code derived design flare rate - 600 GPD I Replacement _j Public or commercial`- Describe: - - Flood plain elevation, if applicable na Parent material Glaci N' General can \ and recommend Mound system elev. = 98.67' at 8" above 98.00' contour. Boring # -j Boring 32" in. Soil Application Rate Ir!~! Pit Ground Surface e elev. 98.21 ft. Depth to limiting factor Dominant Color Redox Description Texture Structure Consistence Boundary Rood GPDIfe Horizon Depth *Eff#1 1 0-4 10yr4/3 none Ifs 2fsbk ds as 2f,1m 0.5 0.9 2 4-20 7.5yr4/6 none IS 2fsbk mvfr CS 2f&vf 0.5 0.9 3 20-32 10yr5/4 none sl 2msbk mfr -cw if&vf 0.5 0.9 4 32-56 7.5yr4/4 f2d7.5yr5/8 sl 2msbk mfr gw -0.5 0.9 5 56-77 7.5yr4/4 f2d7.5yr5/8 sl 1 csbk - mfi _ -0_4 0.6 - a Boring # -.--j Boring 28" in. Soil Application Rate 16 Pit Ground surface elev. 98.33 ft. Depth to limiting factor Horizon Depth Dominant Color Redo x Description Texture Structure Consistence Boundary Roots GPDIft= 'Eff#1 ''E 5 0.9 1 0-8 1Oyr4/3 none Ifs 2fsbk ds as 2f,$fO.. 2 8-15 1 Oyr5/4 none sir 2fsbk- mvfr - cs 2f5--- -0.8- 3 15-25 1Oyr5/4 none sl - 2msbk mfr cw 5 0.9 4 25- Y1'416 none gr. sl 2msbk mfr gw 5 0.9 5 28-41 7.5yr4/6 f2f7.5yr5/8 gr. sl 1 msbk mfi - 4 0.6 f2d7.5yrsl Om mfi 3 0.5 41-63 7.5yr4/4 & 2 contain 100 cobbles and stones Effluent #1 = BOD ? 30 < 220 rmglL. and TSS 30 < 150 mg/L ' E = BOD,,,5.30 mg1L and TSS <_~0 mg/L CST Name (Please Print) Sig ure. CST Number James K. Thompson 3602 Address AC.E. Soil & Site Evaluations DE Conducted Telephone Number 340 Paulson take tone, Osceda, WI 6/27/01 715-248-7767 I ♦ Eleda ~:o~ N i=1/0 ,I uu c,In~ ro . /o-~ Co , IPo cXy ~,'d~ e ~j¢c, Tn. O~So~ersP~ 5-t . Croy co., ccyv. 03z - z/3z - 90-cev 30-19.1176 Ee ck6 o 're 6,,. Ass wncd elev. - /00. Co., O ~ $I 105. CP YO ~ S, r4 p 0 83 Q~. ■ ez . o 4~8y- 'o - lY lob c.or'he~, Ele~'= 7G, 83; n-°