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HomeMy WebLinkAbout040-1306-30-000 FF;7...mepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ety and Building Division Sanitary Permit No: INSPECTION REPORT 556354 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: Jerrick, Charles & Shanna Troy, Town of 040-1306-30-000 CST BM El v: Insp. BM Elev: IBM De r' tion: Section/Town/Range/Map No: Z. j✓vl V,1 C v~ f ~ 08.28.19.1857 TANK INFORMATION EL ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L 25D Benchmark /V f, f r~ Z. Dosing t>~Zzj Alt. BM ✓~.,/I'I w /A to Aeration Bldg. Sewer(( C H P 3 7 Holding St/Ht Inlet O\L y L TANK SETBACK INFORMATION St/Ht Outlet 6 TANK TO „ I /L WEL , BLDG. Vent o Air Intake ROAD Dt Inlet ~v--- Se tic f Dt Bottom Dosing/ eader/ an. S G ,4 t v` fn tAMti ~"b' S Aeration Dist. PPipe Ih 401 - g y 5' Holding 77 Bot. System Final Grade PUMP/SIPHON INFORMATION - Manufacturer Demand St Cover GPM Model Number TDH Lift Fric oss System.yoad' TDH Ft `jy~ jyt ~l Forcemain Length Di~ Dist. to Well SOIL ABSORPTION SYSTEM e22- BEDITRENCH Width ( Length jNo. Of Trenches PIT DI EN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ SETBACK SYSTEM TO VV P/L BLDG WELL LAK ST AM EACHING Man~ej~w~ - I INFORMATION CH R 1'r Ty a Of System:. M / s, ~UNIT~ Model Number: 1(0 r` f0 ~ RIBUTION SYST I 3y / c/ SLN D G in Head anifold I S0 Distribution t { Ix Hole Size Ix Hole Spacing' Vent to Air Intake r(~. jj !t Pipe(s) Length l Dia_ Length / O Dia Spacing ~D, , ~n SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Cg Z Depth Over Depth Over xx Depth of xx Seeded/Sodded x Mulch Bed/T a ch Center Bedrrrench Edges Topsoil n ❑ Yes NYes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Inspection #2: Location: 425 Jordyn Lane Hudson, WI 54016 (NE 1/4 SE 1/4 8 T28,N~R1W) $t~rlset View Lot 30 Parcel No: 08.28.19.1857 , 7. 1.) Alt BM Description = 64f a !jdn _ 5~^ /I' = I ' IN 2.) Bldg sewer length Z - amount of cover = t 0-42- Plan revision Required? ® Yes No l!(/ Use other side for additional information. I v G~~'~ G~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) 4~7C 36(v3d ood PLOY PzAW 2 (3~ 8 I I SCALE 1 '50 LOT 30 ~Il r ~i a 4 oz ' J. c s r ~ is `S4' pot a r k N . r r vt"c d a rG 1 4 or r uIvOT.r r County Safety and Buildings Division S V ' 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number to be filled in by Co.) Madison, WI 53707-71r r,, s h 1 4 556v 35~ `444` STransaction Number San,, y . 50it'Application AM- In accordance with SPS 383.21(2),~ode, submission of this form to the appropriate governmental un is required prior to obtaining a sad permit. Note: Application forms for state-owned POWTS are submitted to "PFoject Address (if different than mailing address) the Depar tment of Safety and Professional Servies. Personal information you provide may be used for secondary I/-%~ purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. JOr~ ti ~4,~_ 1. Application Information - Please t All Information Pr y Ow er's N~eL( ~ Parcel # Q crrl t 040-1306- 30-060 Property Owner's Mailing A/nddress Property Location ?LO5 J a NQ , Govt. Lot YO City, State Zip Code Phone Number 4) IE Section 5 (circle on 4'~< <P T N; R E o1W II. Type of Building (check all that apply) Lot # ^ .30 Subdivision Name ~,1 or 2 Family Dwelling -Number of Bedrooms T f tJ T t~ ! livv> - ti's ! ~ k'vv~ LL. slop cS u, h S C~ 1 iz: ❑ Public/Com rcial - Describe Use ❑ City of CSM Number El Village of El State Owned -Describe Use 04 Town of 7- l'0 Y cap L 9 IL 9 Ez ot.,~s III. Type of Permit: (Chec only one box on line A. Complete line B if applicable) A. 21 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. El Permit Renewal El Permit Revision ❑ Change of Plumber El Permit Transfer to New Before Expiration Owner l~~o IV. Type of POWTS System/Component/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) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsfj Dispersal Area Required (sf) / Dispersal Area Proposed (s System Elevation n J o. r D 917, c4k B VI. Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units p U Y y v New Tanks Existing Tanks a U ~ w C-7 a Septic or Holding Tank 1 50 ZfcQ 1 L-1 Dosing Chamber pp X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS show a attached plans. 81 ber's Signature MP umber Business Phone Number Plumber' Name (Print) 11 gg§X 00-vi 12 d SSA' (rSl 49Z ,S'y'4 Plumber's Address (Street, City, State, Zip Code) W o- 91o~t ` t Falb, 50 z VIII. County/ eartment Use Only Approved Permit Fee Date I ued Issuin gent Signature y7-S 4, ,0 9 i Given Reason o nial IX. Condi &gWft .Reasons for Disapproval 3` ~1 ✓ ~ ro y3 1 'Septic tank, atflus~rtt filter and ) l J .Olspemal cell must all be ser0res l maintained v j1e~ Sub t g tt **,per management plan provided byplumber. l n J 2 All so6ock T*q**rhwft must. bs3 maintained as per appNc" code / or noes, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: _ 4 (fir 1 C /V Owner's Name: Owner's Address: i Legal Description: y D Ytf LA v~~ eS e~~s Township: T hG y County: S ►-O ! a< Subdivision Name: a 5e 1// 1 Lot Number. 3 0 Parcel ID Number: 90 if - 00 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 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans I , / o~c7 4 Designer/Plumber. ~rA1r Q /~~/S er License Number: 5-5 Date: ~a g t~ Phone Number loS-~ `gam Signature nlz ed~ Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 aye' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity S al 13 NA 614- ) C 120 - - Permit # Septic Tank Manufacturer j; ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Pd L O ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units I* NA Pump Tank Capacity gal ( NA Estimated flow (average) 400 gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer lff NA Soil Application Rate , gal/day/ftz Pump Model ,10 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :522Q mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/Ll,In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L 19 NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 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 month Inspect condition of tank(s) At least once every: ear( )(s) (Maximum 3 years) 13 NA 19, y Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA %6 year(s) Clean effluent filter At least once every: 45 month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ~Ll NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) 451 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A"service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 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: J~. 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 A Name Phone S` 9) 5 9j Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name '7 cu)'Lc Z an 4, Phone Phone 4 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. y III o ~ o 0 0 0 II U O Lq U _ r u N O M N m U N O U~ O N u N U Qi M O oi co O ~ u U~ U u CO U U9 dt- 4~e] n~.a 1~ U CO r 10PI~Rii ~ tD U C4 W O u U w W Y d J O Q VJ m U Q co ~II~~I~PI~ N ilk II co ''U') x co c~ O E z ZZ co N U 0 ¢ o w o \O 04 g co LO ti V'w H~o ~ o O LL J U a~.. ~Ov S ¢ U fr W ILO w tz Y ¢ OLL c (D LIJ r I- cD LL WU) Z o U~ U Q W M r- M U I LO co CL ~w N J W L9 l¢L z LO M o w 0 CL - F- Y -J J J J M O ¢ - ~ E: O z - \\\\\\\\\\\\\\\u\\\\ J W O aa...EL C-)0 0 O _0 _0 r v, iv M --A 22 z cn O P') O = w m cu,CO °;;0 OD C -p = M CO Cj) C Z c _ 'C7 .P O 'n m ~ n M c m ? v CO o~ zX c 0 90 F < I cn m % cn - cn Z = m m rn m ° m _ 0 Z~ N C) o Z o - oo N ? W O W A W W ~ O cm N 0 s 0 IF! ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSFHP CERTIFICATION FORM Owner/Buyer ~k G r r ~ Mailing Address Property Address oZ S (Verification required m Planning Zoning Department for new construction.) City/State Parcel Identification Number © 30A -30 ''00o LEGAL DESCRIPTION Property Location 1/a F, 1 Sec. -2--, T N R~W, Town of Ty- Subdivision Plat: It Yl $ G~ y j^ ltJ , Lot # Certified Survey Map Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes K no Lot lines identifiable A yes ❑ no 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 LO-/ SIGNA F APPLIC (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) State Bar of Wisconsin Form 1-2003 8 0 9 4 0 4 4 WARRANTY DEED TX :4072625 964943 Document Number Document Name BETH PABST REGISTER OF DEEDS THIS DEED, made between B & L Land Development Inc a Wisconsin ST. CROIX CO., WI Corporation 10/08/2012 2:41 PM ("Grantor," whether one or more), EXEMPT#: NA and Charles J. Jerrck and Shann L Derrick REC FEE: 30.00 ("Grantee," whether one or more). TRANS FEE: 140.40 COPY FEE: 2.00 Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Arca PAGES: 1 estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): David J. Estreen 304 Locust Street Lot 30- Plat of Sunset View Development in the Town of Troy, Hudson, WI 54016 12 (p o ✓I St Croix County, ilW sconsin. 1~ 040-1306-30-000 Parcel Identification Number (PIN) Dated this day of October, 2012. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, If any. B & L Land Development, Inc., a Wisconsin Corporation i L (SEAL) (SEAL) " le T. Weatherholt President/Treasurer (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF KENTUCKY ) ) ss. authenticated on 1--Er.'25 a COUNTY ) j V/N/r2 * Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Lyle T. Weatherholt. (if not, President/T reaau rer authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the me.;i.;, THIS INSTRUMENT DRAFTED BY: Dom Berg Notary Public, St t l 1200 Hosford St. Suite 201 Hudson WI 54016 My Commission (s permanent) (expires: (Is It 'r ) (Signatures maybe authenticated or acknowledged. Both are not necessary.) NOTE: WARRANTY DEED THIS IS A STANDARD FORM. ANY 2000MODIFICATIONS TO THIS 3 STATE BAR OF WISCONSIN M SHOULD BE CLEARLY IDENTIFIED. FORM NO. 1-2003 • • ~tvt4>~j f ; r ' • Type name below signatures. AN Joshua • 3f1Et1tI0f1 < _ Commission.Eores 11/15x2018 ~-,r w:' • t • ~ ? v) _ Notary Public State At Large; KY • , -^'r N . ; iJ r 1~ 7 f 1 of 1 SUNSET VIEW DEVELOPMENT OCNn MAP U UIED N DE SN I/1 OF RE NE 1/A X SE 1 /1 OF THE AN I//• li NORTH W [g7ER,~ K NN 1p DE TIE SE 1/1 AND N 1K K 1/1 Of THE SE 1/1 OF N A " ttrnOY a. FONE L IN N, rlsa a1r,100 OF W,, IDIM MO. VOW NW-NW NE-Nw NW-NE NE-NE ® 8 D>al p N,T \ UNPLATTED LANDS n• N A.LN10 IDAKNr Al ~UNPlAT1ED LANDS; SQiQL't1t NISSSISE 15717e Ntl6771EA181 AnxUNOras.OFK \jb - - - - - - - - - - p I $W-NW E Nw SW-NE SE NE \ llaa / , 1° CTfI RD. °FF",u 9134 S. N w' N W51,111 K501, JJ•. [ / HL In LOT I CSN vm 5 PACE 1775 I V NW-SW NE-SW INw-SE NE-SE = III 'A, \ + /n\, DGT ON AT, ~ Ii ' I Is AN WE um 9 /LOT 5 ! 5 Sw-SW SE-SW Sw-SE SE S E own am / dE 4m 5.1. a►P E-- 4w It / 192 k/. 4 li I ImN A w An, VN m IRm, CSY KL 5 Pa 1275 E ° N.EIaO mum. IMP 14At0 I SI LOT 19 g u ! sms um LAN womae N To off 2 41 " . 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ICA U10 ROMD DOWN 0 SUkY' SOME, OR WINKET WRNS ! / O UK NN Lot LK of STREW K LOT 31 /c $ SECTION 0, FOUND THE DmuM9NE OF A RATEY SING: IN AYON 5 A MATTER OF 19377 AF n M 1 IT MIX CDNTY SECTION 334.52 OF THE IDSWNN7 SDMES. VOUN EAR]EXIS AS 113 k AAA~, / 05 ku4m IUAKNT FIORE N SO FDNN AN FOR THE UK OF RUC ICONS NO RATE NW-SE .uJ M1° - `5.01•oy AAapi AM WINO M MIT To 703E TIRE AREA pi /344 /LOT 30 /i / ~'~3---- s.r. yh ryCp~M,N,IF PRICES ROVN ON THIS NAP AN WV roR1ESNDtq[$, m YMNRI lOT 9II. AC4ISNKO. EICI. b i 1.35 k. LOT 29 IEFORCµRNmM9fi OR 195N 5.1 I; OEW; . NN NACfI. OOMN.T 1AL m cauDr SDNN ~ MN[ AO TIE IN OF TOY FOR ADKE. I.DO k to WS PUN 5 LOU1E0 N RI IGNORM9E AIM HOMEOWNERS S= I z EXPECT TWA FAN RELATED MSMA6 THAT NICA DEL - - Tao O IW 200 990 WX DENIED ACROSS OF OPERATION. M J 191 p' 245.50' t01,Ii OW 7701 WaAm ALTO THE COM EW THE STORM WATER aza9RE Eeff AREA 5 1X1'01159 124 Cut . 5 FAaxaDm. NF-s" 1H;S INTTRU'ENT WtED S1 7AKS N 11KR 371hGS 1 OF •3 ~ •W ~ g~ r r:g ~.r . I rn (44558 S.F. 1.14 Ac. 1.02 Ac. 17 V 28 f QUART iZ LINE co 79.77 ~ i iLOT 31 149377 ST] E 1.13 Act, , I ~ LOT 30 ~ 58855 S.F. r ,/.LOT 29 1.35 Ac- v 43584 SY, u~ E 2 1.00 Ac. r cr / y ! + x 197.2` 245.50 201. S ST0401 SOW 1440.55 NF---5E e ce rV tu Wisconsin Departm CE SOIL EVALUATION REPORT Pag Division of Safety as e \ of AR 2 2k6Lrda with Comm 85, Wis. Adm. Code ,Attach complete sit paper not I s1pn 8 1 x 11 inches in size. Plan must County include, but not limiQrtiQ~tal refe ence point (BM), direction and percent slope, scal3;J Parcel I.D. nd location and distance to nearest road. Please print all information. Revi wed by "Date Personal inforrnaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 3 $ L 7~v~Q7 J` NL 1/451; 1/4 S F_3 T Z.~ N R E (or) Property Owner's Mailing Address ~ Lot # Block # Subd. Name or CSM# P o. fox 3 3 30 - IS~r~s~ City State Zip Code Phone Number ❑ City Village Town N ❑ Barest R pr\_S~h/1 1R1~-~ Lv I 5 ~1 10 (-l I E ) t1$S Road New Construction Use: Residential / Number of bedrooms - Ll Code derived design flow rate S O - Qb 1 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G Lie] 1~ L Q„~ j LV } ; Flood Plain elevation if applicable hl General comments ft and recommendations: Ly~Yvi&J C( LLS w / / (lu L~Z R L~ C ~}-tYJ•-r ~ ~~'RS 3o~-s p Y„) D F- 'L C S TD L 0 " L'L-p wti tJ 'S i Boring # ❑ Boring n~ Ajo= Cad H(6, 2"L(4 Wxl~_ ® Pit Ground surface elev. Ol • ft. Depth to limiting factor 46 in. p 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 I 0-~Z lb 1CL ZLZ - S1 1 S'or; -I,- 5j, 11 lZ_5~. to~rZ 31~, - St i Z'MS hz ;v?= - - ~ f•(~ 3 sz-9 ) o~ Iz v 1 L - s o S kyt i Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor (DI 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 _ lI ItM Q- Z 1 2 - Si I Z`~S blz m-p - (2 w Z-~- - Z lz-3 Z )0Jgt L 31b O-S - S • d I. Z~ tt ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L . CST Name (Please Print) Sign re . CST Number Arthur L. Wegerer 0 3 Z 1 S- 3 v 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number . 421 11. Hain St, River Falls, WI 54022 \Z_lg-OZ 715-425-0165 r Property Owner z ` C~Parcel ID # Page of Boring # ❑ Boring rr ® pit Ground surface elev. ` •.d ft. Depth to limiting factor > b in. Horizon Depth Dominant Color Soil Application Rate Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 U -LZ 12;11 IL Z Z. s I z `~s b 1L V1'~ `F c w z~ s . z lz-q 8 o~ rz. 3~ 6 _ S i I Z Sri s k m c s - - s 3 LQ -CY 6 10 - R~ S O S9 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Rate Horizon Depth Dominant Color Redox Description Texture Structure C Soil Application onsistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 4 ❑ 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/ft= 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 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Corninerce is an equal opportunity service provider and ernployer. If you need assistance to access services or need material in an alternate format, please contact tine department at 608-266-31 S 1 or TTY 608-264-8777. SOD-8330 (R4100) Property Owner ` w~~ (7I✓~~1~/~-- Parcel ID # NJ1~] 1 j~/ t~j Page Z ' of Boring Boring # ❑ ® Pit Ground surface elev. ` •d ft. Depth to limiting factor > 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 •Ef(#2 z I-L-q8 OtifZ 3/6 _ Si I Sris k )nfi- cS - - s - 3 LQ 6 1 p,-j 2 y/6 - S O S9 vti 1 - . -1 t. z I 7- 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 GPD/its in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ 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/ft2 In. Muns eiI Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L Tlie 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 die department at 608-266-3151 or TTY 608-264-8777. SDD4330 (R.6/00) III Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Pace of in acocrdance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S C include, but not limited to: vertical and hcrzcntal reference point (BM), direction and } percent slope, scale or dimensions, north arcw, and location and distance to nearest road. Parcel I.D. . 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 i _ Property Location _ \ n Property Owners Mailing Address J N 1/4 S ` 1/4 S C~ T 7 CS N R Lot : Block # 1 E (c~) b. ~OX 3 T1d me or CSM;. Ci 0 - ty 71 Zip Code City own ❑ ❑ Village T Near est R i3f}tSRr~ ~R1-LC ILV ! 5 ~j `3'! 0 ~ (-l I -?3 S I oad New Construction Use: Residential / Number of bedrooms Code derived design flow rate ~ S ~ - UC7 ❑ Replacement ❑ Public or commercial - Describe: GrD Parent material G LOCI L ~ ; ~ r Flood Plain elevation if applicable N21 !`1 General comments ft and recommendations: Rt~WY'- `rJ 1 dV 1=: LTR Boring # ❑ Boring ® Pit Ground surface e!ev. -I I Depth to limiting factor ~o in. Flizon Depth Dominant Color Redcx Description Texture Structure Consistence Boundar RIGS Scil Application Rase in. Munsell Qu. Sz. Cont. Color I I y GPDIft Gr. Sz. Sh. I 'Ef #1 'E~~ 2 C) ~ b t lZ- 4Z _ r, 7' 0 1Z_SZ to~lz 31~ _ , . _ 7 SZ-9 ) r3--I )l Y 1 LI - S I I a Boring # ❑ Boring ® Pit Ground surface e!ev. 3 ft. Depth to limiting factor 7 in. Horizon Depth Dominant Cofer Redcx D p Soil Application Rate esci lien Texture Structure Consistence Boundary Roots GPO/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1 •Eff,2 0_lZ ItM1Z Z1 Z _ L ~J Z-T - C~ ' Z IZ-3 Z lo~trZ 31b s i ' Z1~ S~ rite- as 3 3z q7 It)-flzgl _ I I Effluent #1 = SODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m CST Name (Please Print) - S _ 9/L and TSS < 30 mg/L . -Arthur L. Wegerer sign re CS Number 254 Addn:ss Wegerer Soil Testing 2200254 Design S e r v 1 C e Date Evaluation Conducted Telephone Number 421 154. Hain St. River Falls, I-TI 54022 ~Z-lg -O 3 715-4'25-0165 PLOT PLAN Paae of 3 Scale A ~Q- 3 , ~0 Lu7-- 3 0 \l ~ Gds . Lo7- z.g 'v o s., , Sv ~F` 1hZ 3/y "D1 A, PV c- Pt w/ Lr. = l~ 715-425-016 _ `q -O3 5 220254, 03 Z1S - 3 p CST Signature Date Telephone No. CST No. Job PTO.