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HomeMy WebLinkAbout040-1118-10-070 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556341 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Hill, Thomas W. & Barbara Troy, Town of 040-1118-10-070 CST BM Elev: Insp. BM ev: BM Descripti : Section/Town/Range/Map No: 6-,f d ,6' o y', "I ,r - I o of fi*11K ~ 31.28.19.480A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 5 n / V b.,- V- hvf" ng Alt. M~ Aeration BI . Se er -7 by g - Inlet Holding o er TANK SETBACK INFORMATION S Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD A9 V 92 3 (..EVNI t AAf- Septic i Z I CIO bP, D,f ~Z. 7 d l l oo lot) ' Header/ an. > s 9e S' to Z V'7. S Aeration - \ Dis e o'f ✓ 3 - Holding Bot. System Gf„iC ~ ® 3 7 Yo a Final Grade~ c~ PUMP/SIPHON INFORMATION uv~S'f SI 'St y•D / 33 Manufacturer Demand St Cover GPM o Po e7s Model Number i ~Z lei SQ vS -i ✓ TDH Lift Friction oss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len 6th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHI Manufacturer: 1 ~j / INFORMATION HAMB R h11 I ! '~wV V J` n/ Ty Of System: 'OL &,k , I ' IT Model Number: a-n 7S DISTRIBUTION SYSTEM hover vbsPr/. ~s S x Hole Size x Hole Spaces en to it Intake eade anifold r Distribution t ~Xu i dT- 1y Pip Length f qa IlLength Dia Spacing 1 > ( SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over L Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center r Bed/Trench Edges Topsoil Yes M No Frill Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ 2 / Inspection #2: Location: 399 Cty. Rd. MM River Falls, WI 54022 (NE 1/4 NE 1/4 31 T28N R19W) metes & bounds Lot P~ Parcel No: 31.28.19.480A30 1.) Alt BM Description Dp dlF Sl fL 5 ~ ~ ~b 2.) Bldg sewer length =2 51 U ~ - amount of cover = Plan revision Required? ❑ Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Ins pctor's Signature Cert. No. County Safety and Buildings Division St. Croix $ 0 $ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, WI 53707-7162 ~rmit,tI pplication State Transaction tuber Sanpry' In accordance with SPS 383.21(2), W .Adm. CodeQ,01 mission of this form to the appropriate 'governmental unit is required prior to obtaining a sanitary permij.liete: Application forms for state-owned POWTS are submitted to Project Addres 1J1 A (if different than mailing address) the Department of Safety and Professio*Sirvices. Personal information you provide may be used for secondary purposes in accordance with the Priv law, s. 15.04 1)(m , Stats. Same 1. Application Information - Please Print All Information Property Owner's Name Parcel # Thomas & Barbara Hill 040-1118-10-070 Property Owner's Mailing Address Property Location e p 399 Co. H MM Govt. Lot Q City, State Zip Code Phone Number _NE_'/<, _NE Section _31_ (circle on River Falls, WI 54022 (715) 425-8184 T-28 N; R 19 II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms 3 Na Subdivision Name Block # Na ❑ Public/Commercial - Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of P,10; n of Troy Na III. Type of Permit: (Check o X on 1 A. Complete line B if applicable) A. ❑ New System Re lacement System Treatment/Holding Tank Replacement Only El Other Modification to Existing System stem P Y g Y (explain) B. 11 Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued rlv_ Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade ❑,,,Nound > 24 in. of suitable soil p Ma nd < 24 in. of suitable soil ❑ Holding Tank El Other Dispersal Component (explain) (~t_~'C~ 1~Pll Prete@a~;envic- (eiz'p V. Dis rsal/Treatment Area Information: 45 Infiltrator "Q-4 Plus" standard chambers, 6 end s, Pol Lok PL-525 effluent filter in new Wiser Concrete canister Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation o 4 450 Gpd 0.50 Gpd/Sq. Ft. y/ 900.00 sq. ft. 930.60 Sq. Ft. 89.00' r/ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o JA 2 New Tanks Existing Tanks 4 7 k-ela 111 o z - /lJ 2_ 4;' w` U y vi w t7 A, Septic or Holding Tank 1,000 1,000 1 Unknown X Dosing Chamber ` VII. Responsibility Statement- I, the and rsigned, as ume responsibility for installation of the POWTS own on the attached plans. Plumber's Name (Print) Plumb 's Signature MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 (715 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII oun epartment Use Only Permit Fee Date ssued Is ing Agent afore i Approved ❑ Disapproved _ j Owner Given Reason for Denial ~ 5 U y Z / l y~V ❑ $ IX. Conditions of ApprovaUReasons for Disapproval .i~''" 'Al - ~ SYSTEM OWNER: A1 Septic tank, effluent filter and Vd 'A' dispersal cell must all be serviced / maintained as per management plan provided by plumber. as per applicable co a/o~~Pnaer>~es. or 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) Conventional POWTS Index & Tilte Sheet Project Name: Hill 3 bedroom Replacement Conventional POWTS Owners Name: Thomas & Barbara Hill Owner's adress: 399 Co. Hwy. MM, River Falls, WI 54022 Site address: Same Project Location: Subdivision: Na Legal Description: NEi/4 NEt/4, Sec. 31, T.28N., R. 19W., Town of Troy, St. Croix Co., WI. Parcel ID 040-1118-10-070 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Filter Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Attachments: Soil Evaluaiton Report Mater P ber Res 'cted Service: James K. Thompson, Dep't. of Comm. Credential #30021 Signature: Date:_-`' Page 1 of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ♦ EXr~f% n(~ ~i'c~de SCa/eV : / y0 . ~mk3 f~'/%o~fur~r II 3~! Co. mod. /K/►T rQ,-vcrF~s, cJ/ SYd~2 P~opos~dd,spc~sa/ec.//.7~r'tc (3) ~ EIrY SeC; 3/ T.,28/L c ~.a..r, 6NS ~b-t~,aC. T f•/ ~-Fi'✓c ~9c+~, of'Toy, Sue eace a./ev' ~vbe= 890.' Cro%x ~oc% ~oyh-~~/8 io-off u~t,•~ke.Oc~,t/-~ (3:us-~y bey' ~$.~3T4~s be prot~cc~cd $ wu ~ / 9So o(u►-t law n • 9S.e~' grOrOcu~r~locoi ~~a~ Co. fy...~m"--~ ipF' bai':c.d 90.31T,1C (y~~ y L'oat+al` , r♦.., ~ it - coded 1 t 1 ° ! .4 ppr~. /ora.~.r~ ob:IXpi+ d;~/.WSaI EXiSfinq 5/o/~Qr/ar~csa,~ 9.~y/• 7,1 ~/Er~Ue v .z - 8,$ t ~u0uy~ , I I ~awF+~u elc% = QsD ~r 8u r n ..4. ~i rol i r, y S fie,.-r Q /'ea r r h r r 1 0` / i$1 r I r I rlcywoa r 1Ylr~o/e r ' / Proposed Dt~ers Valve ~ty-ji mark.' -r.,o 'oY►cre e Slab fk seat etas cancfv& i / *r ( a #~~~~•~a P✓. e lei - / , ~ ♦ ~ Tai oFa~.;s.~,, sepE.'~ j ~+4 Aafso : nu~.~ • Ct crJ~!,' Fled •tf1S. G Ex~7><in~ ESfi~rJat~ e l e c~ o f -E-P v~ t 3 6eahVn ~aP C on ere.E.e dri vew0.y tyr,'Sti. s . r dwg77e t = 9.Z o ,~s Bence ¢ Oaark,- C/ L o~''~ I EX,S~` `~q u~~ll V o 0 0 4 HILL DISPERSAL CELL SUING CALCULATIONS 1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft. 3. Absorption area required: 900.00 sq. ft. 4. Absorption area as proposed: 1,230.60 sq. ft. (60 chambers total) Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft, EISA 900.00 sq. ft. - (6 endcaps)(5.10) = 869.40 sq. ft./20.00sq.ft. EISA = 43.47 chambers required Number of trenches: 3 & 15 chambers per trench (60 chambers total) Trench width: 2.83' Trench length: 63.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 21.00'x 63.00' Pg. 3 of 10 Soil Absorption System Cross Section 9~ o ft 93. i5= 9S.c~ • ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap yv o ft Leaching Chamber Ke ft System Elevation .22. 83 ft G.0 ft 6.0 ft Soil Absorption System Plan View ft 2.63 ft ~.0 ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe I Trench 3 Leaching Chamber Specifications Manufacturer And Modeli1'~'at~ EISA Rating .7.0.0 sq ft per chamber Soil Application Rate S gpd/sq ft gpd Design Flow Soil Application Rate EI A = Chambers 3 rows of /S chambers each (/C I Page of 16 Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old Drainfield at 4 year anniversary of new system installation. Drainfield to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. Pg. 5 of 10 r • ® r Filters PL-525 EFFLUENT FILTER ( M 'R 1AL) Polylok, Inc is pleased to add its . new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4° & 6^ SCHD. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should _ operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned" every time the tank is pumped or at least every three years. If the. installed filter contains an optional F, . alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be U Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ~ ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the back into septic tank. filter is not centered under the access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. I 43 D 7 n m 0 v D D O M2 D D D D I D~ ~ Nr~iZ r m D O n c)Mr D D I_- 3711, N 0 ^ 0 m 2., zm 6„ moo; m r n D = m D C 0 18" MIN < < N o / r 37 21„ (n D m \e F p m i to r D N I A ~ N N D m D r Il l O C~ D j .70 O Z tT. I~ Z C7 C O m r Tl C- ~l D F7 I O m 7J D -1 I- D z O~ z~ I ~ I FILTER CANISTER DETAIL SCALE:3/4" I' REV NC. 7 WIESER BURGRETE DRAWN aY.SWT J\ SEPTIC MANUAL W}716 US HWYIO. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE: SHEET 13 P 7o /a OD {rJ j g m 4- NJ ~m o m i w 0 C) 0 C) iz, M1 v [c Paz 9-r c-) Q a C-n W ro j ~ 9z 1t+£ I u: C> p a rI ~ i w T 1= 9;7 - C., r 0 r CD M I I ~ oo s~ U { P .Bo~9 5 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/fir o m~t.S dA1.ii1qAa 1--//, / Mailing Address 3P el. A-.) , NW. s l c~/. 501 Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location /9F- Sec. 31 , T ?-8' N R. W, Town of 7;~7G y Subdivision Plat: Lot # Certified Survey Map # Act , Volume , Page # Warranty Deed # 1:2q 7 3 (before 2007)Volume 937 , Page # 3--7 Spec house Cis k<o Lot lines identifiable Pyes ❑piP SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms GNAT RE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) 9000 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 399 ev, Aux, zJ/. S~DU located at: ✓IE 1/a, 1)t5'-'14, Section 3/ , Town ,28 N, Range~F_W, Town of 777;r~ty , St. Croix County Wisconsin. Upon inspecti n, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur :from absorption system? Yes No_,,~ (if no, skip next line.) Approximate volume or length of time: _ gallons ` minutes Tank Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): dWn Age of Tank (if known): -ocJn _ ermit umber (if known) ltn /1hoa)n icensed Plumber Signature) (Print Name) (Title) (License Number) MP/MFRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 8 DOCUMENT NO. :...a e'.:<g :.e~c:.rco r witr-r..ae.,no awa WARRANTY DEED STATE: BAR OF ti4IeC0~)3I?~i FORTM{ 2 - 388 479730 von 937 FACE 37 REGISTER'S OFFICE _ Pamela Ann Taylor .Pag1P,, f/k/) Pamela Ann Taylor and S;. CROIX Co., w( Shawn lJ.. i'AgQ. ...!?er._iLusbantf. -anci: each in his or her Own for ne'%Ord gl A- 'An k (luzlbdnd and Wife AS-su>rv3~[o.rGh p,.marltal_prape.rtv__ E Reg(staf of Deed! ,!2C[~ GLa..~ ~3 t C`p3~ S - 2 I. ~c. the fallowing described real estate in S C Cro 1x County, State of Wisconsin: Tax Parcel No: - - - - The NEI of the NU of Secri-on 31-, `township 28 North. Range 19 West except Lot l of CSM recorded in Volume "7" at Page 1899 arae except Lot I of CSM recorded in Volume "7n at Page 1495. And &t-n Fxc-pt p )rcel described in Voluno 927, paqx: 1-3, as doctiment number 476687, TOGETHER WITH an easement for ingress and egress over the Northerly 66` of Lot 1 of a Certified Survey Map recorded in Vol. "7", Page 1899 and an easement described in 73-1_. .._Gfff:iee 5.11 _rI-,IC ,.a_.c....o _1.-'.. :.wt` r`• c . zx County, a -i nL[1C)'.!LaiC 4 ~'F ~".6 ~•~cgs vi ac , . ~'T.i.-.-c This .as hotnestoad-propcrtti. Exception to warranties: easements, restrictions and reselrvations if any of record. Dated this . 2Sth Feb ry. 92 day of ....(SEAL).......: (''"`~~~y AL.) P ela Ann Tayl ji fii_ . Pa An y (SEAL)_G_ (SEAL) Shawn D. Paa4e:..,.. AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE Ole WISCONSIN ss. County. authenticated this day o£___________________________ 19 Personally came before me this 25th .day of Feb. y.ruar 19. 9.2.._ the uLove named 1?amela•-...... Taylor e- f•/k/a Pamela. Ann T._._._... z: f'~~ .Shawn n P1 ~ U •N« ry~y TITLE: bIUMBER STATE BAR OF WISCONSIN t Lf not . - authorized by § 706-06, Wis. Rtats.)© bl •>'(che ne n 8 . who executed the t ~goi t i~~ c wludgc t} sum^. r...---...._..- 'AF ,an ~D,cu rxS. s. - :lam Rnssel.l E. Berg. L+ ttorne ; . v ~ ^~^1`r~~ ii _ River Falls, WI 54022 },,'~Y~w•07.l t7ZL~N.ltj( LL~ Counts, ~Vis. • }il (Signatures may be authenticated or acknowledged. Both my .o iisLslon is permanent. (If not, state ex1fli-,ation are not necessary.) date: -s )f ~n 7~ -Nome. of nersons siuning in nnY cm-oty shuuld bm typed or n~in Lrd 1,1- thoir eig nn U~rc+. i4A:RRANTY DEED. STATr.. RAR OF WISCONSIN Wisconsin Lnyal BIAr t~o , lryGo 0 FORM No. 2 - 1U82 Milwaukee. Wisconsip- a 2299 Wisconsin Department ol"Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site on paper not leis, t)tifn8%x 11 inches in size. Plan County St. Croix include, but not limited to: vertical,.a4firk6ntal reference point (BM), directio h-N percent slope, scale or dimerpris; north arrow, and location and distance to road. ' Parcel I.D IV. I'll -1118-10-070 Please print all information. ev' wed B Date" Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Thomas & Barbara Hill Govt. Lot NE 1/4 NE 19 S 31 T 28 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 399 Co. Rd. MM Na Na Na City State Zip Code Phone Number City _]Village 0 Town Nearest Road River Falls WI 54022 (715) 425-8184 Troy Co. Rd. MM New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD beReplacement J Public or commercial - Describe: Parent material Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gpd/sq.ft./day loading rate. Recommended trench elevations to be 89.00'. Boring # Boring e Pit Ground Surface elev. 93.15 ft. Depth to limiting factor >1 10" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/3 none I 2fgr dsh cw 2fl m 0.6 0.8 2 6-48 10yr4/3 none sl 2msbk dh gw 2fmc 0.6 1.0 3 48-70\ 7.5yr4/6 none grsl 2msbk dh cw lvf,f 0.6 1.0 4 70-78 7.5yr4/6 none gr Is Osg dl gs 1vf 0.7 1.6 5 78-110 10Xryyrr/y5/6 ya noonee !X s & gr Osg dl - f - n 0.7 1.6 ztz Horizons #4 & 5 contain approx. 40% gravel & bbles. Garbage & refuse pit found at northwest corner of soil pit. Rem der of soil pit comprised of undisturbed native soil. Boring # Boring f Pit Ground Surface elev. 94.78 ft. Depth to limiting factor >119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 `Eff#2 1 0-6 10yr3/3 none I 2fgr dsh cw 2fl m 0.6 0.8 2 6-36 10yr4/3 none sl 2msbk dh 9w 2fmc 0.6 1.0 3 36-50 7.5yr4/6 none gr sl 2msbk dh cw 1 vf,f 0.6 1.0 4 50-62 7.5yr4/6 none gr Is Osg dl gs 1vf 0.7 1.6 5 62-119 10yr5/6 noone s & gr Osg dl - - 0.7 1.6 Horizons #4 & 5 contain approx. 40% gravel & cobbles. 0 - 50" at east side of soil pit contains construction debris and backfill material from original system j al a ' n. Remainder of soil pit comprised of undisturbed native soil. Effluent #1 = BOD? 30 < 220 mg/L an TSS >30 150 mg/L ffluent #2 = BOD5 S30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson o 3602 Address A.C.E. Soil & Site Evaluations Data Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/14/2012 715-248-7767 Proper v Owner Thomas & Barbara Hill Parcel ID # 040-1118-10-070 Page 2 of 3 F 3 Boring # Boring bel Pit Ground Surface elev. 93.33 ft. Depth to limiting factor >118" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/3 none I 2fgr dsh cw 2f1 m 0.6 0.8 2 5-24 10yr4/3 none sl 2msbk dh gw 2fmc 0.6 1.0 3 24-38 7.5yr4/6 none gr sl 2msbk dh cw 1vf,f 0.6 1.0 4 38-42 7.5yr4/6 none gr Is Osg dl gs 1vf 0.7 1.6 5 42-118 10yr5/6 noone s & gr Osg dl - - 0.7 1.6 Horizons #4 & 5 contain approx. 40% gravel & cobbles. I ❑ Boring # Boring _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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # - I 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 Gl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 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) A.C.E. Soil & Site Evaluations . I • EXi~~Ein/g ~rac(e '7~dm43 r, /~~O/b/kl~r 399 ~Par..n lA)i so~Z o nE. 3 /oc~ Afosh-///8 -/0 OX u~{.:•6e.0~-t`v (3rks~y be,' ,1374er~s be Pr &r-t .d $ w ~ ~l 9So~ o(un l4~ n 95.x' 4P rN~,!v V)of • ~o~buri cd (33 ~ , has lint ,~y ~ ~rks 9S oz' t r J~~ - r o~ajle'3Fr1+ d:~(J~sa1 EXiSfin,9 5 /eke da,rrc s ~:-E. 9.~ 1~/' ~ ~ ~-c..e.~r, x=n~ lfia,b✓~ " SSfe,r~a/eQ i ± ~r° Y ;8i • a, ~u,rcaa yle ; / / Ex~ be Prot 1 % n!• 9s~Y% mzw,,e-`Topo,,"d-vi ece;& Slab i ,~j~cr/S~.' bk:laf.7~ cc Corn~°o ~jp"Se. 4sS4,,mcd 17JYbC( /a ~ " /rP«~L~..- ~./g• = T/a e~'~ii3~rr~c'j S~{i~C AyEio~; fin. 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