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HomeMy WebLinkAbout040-1298-80-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572893 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: Herda, Robert Troy, Town of 040-1298-80-000 CST BM Elev: Insp. S BM Elev: BM Description: 2 Section/Town/Range/Map No: • 3 b s V-r 09.28.19.1726 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic U ! t ~J J Benchmark 1 ✓ • J ,~..J Alt. BM (1 , t O• a A - ti Bldg. Sewer , , Aeration .J Q Holding SWIt'lnlet S 1 . V StfHtOutlet ~ i Ca TANK SETBACK INFORMATION 1 TANK TO ~~PP//LLr WEI~~,. BLDG. Vent to Air Intake ROAD 9Hrdet' w 6&A 7M om Septic ~b t MM- ~l ka I C? I Dosing lV Header/ an. (p. ,3 Q((p, D Dist. Pipe ' O Aeration Holding Bot. System '7. ctS•C Final Grade t $ 3,3 PUMPISIPHON INFORMATION Manufacturer Deman St Cover GP l{J V Model umber TDH Lift Friction Loss System TDH Ft I n 5• / (0 Force ain Length Dist. to Well ~w SOIL A ION SYSTEM f BEDITRENCH Width th5 No. OfTrenches ~ PIT DIMENSI S No. Of Pits Inside Liquid De 7th DIMENSIONS 3 IF SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION T e801' System: z UNIT Model Number: 5D 6"Y"I Ma pNy~7~iN ' DISTRIBUTION SYSTEM 0T keth Nlanifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake I Pipe(s) Dia LengthDia Spacing COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only G/ Over Depth Over TT Depth of xx Seeded/Sodded nch Center Bed/Trench Edges psoil Yes ®Nos 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:--0-/ 1-YA15 Inspection #2: / / Location: 423 Glen court Hudson, ,WI 54016 (SW 1/4 SE 1/4 9 T28~N~~ R19W) Glover Glen Lot 8 Parcel No: 09.28.19.1726 ~ r ' ( I ) r D-~ I l I A Spe 1~ ~U 1.) Alt BM Description = i 1' co / 2.) Bldg sewer length = C11 T31 ~IS ~~~.7 X7'1 - amount of cover = Plan revision Required? Yes ~ No Use other side for additiona information. Date VV Insepctors Signature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Robert Herda lr ADDRESS 850 Settlement Drive Hudson Wi 54016 SW 1/4 SE 1/4S 9 IT 8. N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6124/15 BEDROOM 4 CONVENTIONAL XXX IN- R ND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1255 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 911 # of chambers 45 IL BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE WELL r r;' t SYSTEM ELEVATION Pro 4 ru r S ` Bedroom House 20' 78' 661' roperty Line 99.5' sT Seale is 1" = 40' ti B_2 ' Z1 unless otherwise 65' L 95.5' noted 10% Slope All piping shall be SDR 30/34, within 10' 90' of tank, piping shall be Schedule 40. / Well is to meet all 1 st cell 14 chambers, 2nd cell 15 / setbacks required by B-3 chambers, 3rd cell 16 chambers V WDNR 1321 Vent 24 >6" Quick4 Standard Vents of Cover Leaching Chamber with 20.0 ft2 of Area B • ~ • * 95' 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 347' $88.0 WV ~k ESQ v`,Y~,o 214' Property Line I c County C <1 - r tAJJJ!y and Buildings Division J~ 9-7~ q 3 201 W. Washington Ave., P.O. Box 7162 Sanitare Perrot Number (to be filled in by Co j ' ---1 0ison, WI 53707-7162 -7 Z (8 V NN IoM anitary Permit Application State Transaction Numb In accordance with SPS 38311(2), Wis. Adm. Code, submission of this fort to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u asps is accordance with the formation law, s. 15.04(1 m), Stats. / ~ j 1. A liation Information - Please Print All Information Property Owner's Name Parcel # ayU'- l2 8-8o-dz~ Property Owners Mai ing Address j Property Location 8S'~Jjl~C~ e Govt. Lot City, ~te i .ip Code I Phone Number Section ~ f S ~/(yircle o T N; R or II. Type of Building (check all that apply) Lot # Subdivision Name r 2 Family Dwelling -Number of Bedrooms { Block9 ❑ Public/Commercial - Describe Use ❑ City of CSMNumber ❑ lillageof ❑ State Owned - Describe Use G / Town of -~w 11f. -Type Permit: (Check only one box on line A. Complete ne B ' applicable) A. New S stem El Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) B. ❑ Permit R wal it Revision ❑ Change of Plumber ❑ Permit Transfer io New List Yrevio is Permit Number and Date Issued Before Expirat n f Owner J IV. Type of POWTS Svste evice: (Check all that a iv on-Pressurized In-Ground 11 Pressurized In-Ground 11 At-Grade LJ Mound > 24 in. of suitable soil ❑ Mound < 24 e soil i ❑ HoldmgTank ❑ Dispersal Component (explam)____ ❑ Pretreatment Device (explain) _ is ersal/Trea ent Area Informatiot: Des' 50w (gpd Design Soil Appli ton Rate(gpdsf) Dispersal Area Required fl Di a posed (st) System '7711 VI. Tank Info Capacity in Total #i of anufacturer Gallons Gallons Units New Tanks Existing Tank, 2 2 .J i tV1 Septic or Holding Tank I ' daj i Dosing Chamber i VII. Responsibility Statement- I, the undersigned, assn r •ponsihility for installation of the POWTS shown on the attached plans. Per's Name (Print) Plumber' attire MP/MPRS Number Business Phone N ben Plumber's Address (Street, City, State, Zip Codej ' t / VIII. fod'untv[Department Use Only Perm nee Dale v4~ suin_ agent ignat ls Approved proved ❑ Ovacr- en ' on for enia$ ~ IX. Condifions o 0 ~0?9ors o "pp' oval SY V 6 )rj /~/D V V e V, VVz 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements mint be maintained , ) fi/ n as per aptldi 8+ f3~ tern and submit to the County only on perpnotess tb u s rr i'lliachesinIfte ft-W le SBD-6398 (R. 11/11) PLOT FLAN PROJECT Robert Herda 17l! ADDRESS 850 Settlement Drive Hudson Wi 54016 SW 1/4 SE 1/4S 9 /T - 8 ` N/R 19 W TOWN Troy COUNTY ST. CROIX 6/24/15 BEDROOM 4 MFRS Shaun Bird. 226900 DATE CONVENTIONAL XXX IN-.zK UND PRESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE ,7 ABSORPTION AREA 911 # of chambers 45 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter BOREHOLE WELL SYSTEM ELEVATION Pro 4 Bedroom House 20' 78' 661' Property Line 99.5' ST Scale is 1" = 40' B_2 10' unless otherwise 65 95.5' noted 10% dope All piping shall be SDR 30/34, within 10' 90' of tank, piping shall be Schedule 40. 2' Well is to meet all 1st cell 14 chambers, 2nd cell 15 setbacks required by B-3 chambers, 3rd cell 16 chambers WDNR F321 Vent 10' 24' >6„ Quick4 Standard Vents of Cover Leaching Chamber with 20.0 ft2 of Area B.M.* 4' Long 12" 5.6ft^2/pair of earl caps 95' Grade at System Elevation 34 i 888.0' 214' Property Line ST. C.ROIX Ct)1. TTY SEP'T'IC TAI'®i:K. M.AIl`v'Fl. NANCE Y LGRI IJIi%J NJ' ANI ) OWNERSHIP CFRTJ-FK"AT1vN FORM Mailing Address._ 44 Property Address _ _ ____~~O f- (Verification required frornPlanning ~ . Zoning, Oehatt.nent l03 new Con,,[Iac:tion.) City/State Parcel Identification Niii-ther LEGAIL DESCRIPTION Property Location 5Ld /4 ,.SE '/4 , Sec. 1 $ v T 1- W, Town. of Subdivision -_6j tj2 Lot # . Certified Survey Map # Warranty utxtf~ - Page ~1# Deed # , 90 V .tutrte T'a;e Spec house yes no 1<ot. lint;:: identifiable yes SYSTEM MAINTENANCT AND OWNER CERTIFICATION` Improper use and maintenance of your septic system could result in its pr,miature failure to handle wastes. }'.roper maintenance consists of pumping out the septic tank every three years or sooner, it needed, by it licensed puniper What you put into the system can affect the function of the septic tank as a treatment stage in the wasie disposal syst:enr. Owner rrrainierrance responsibilities are specified in §Coznm_ 83..i2(l) and in Chapter 12 - Slt Croix Cointy Sanitary ()niiaaiwc The property owner agrees to submit to St. Croix CoLulty Plarnzing 8, Zon Ong Departirtcia it certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plurnbcr o.r a licensed purnper verifying, that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspcc ion and pUrr1pir1g (if necessar,y), the septic tank is less than 113 full of sludge. Vwe, the undersigned have read the above reyuireutents and agree; to maintain the private srxvage disposal systern with the ,,tandads set forth, herein, as set by the Departn:rent of (.:onrmercc; and the epartrnwit of Natutal Resow c es, State of Wiscon , irl. C..crtitication stating that your septic systern has been maintained must be conrplew, I and returned to the St. C i oix County .11hi ninlr: & Zoning T3epartxnent withirt 3f} days ofthe three year expiration date. ]/we certify that all st i )aW his form arc: true to the hest of tny~four k_uowledge. 11~ue antlarc: the ovcnrer(s) of the property described above, b, v' tic; -anty deed recorded in Register of llee as Office. Number of bedroo s SIGMA IM " OF APPLICA I(S) DATV', ''**riiy infor-ramion that is misrepresented play result in the sattitatY pei mit being wvoked by the Planning & Zoning I)epartinew. * Include with this application a recorded warranty deed fi-orn the }2egisier of t)eeds Office and it copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) pJLE INFORMATION 'OWTS OWNER'S MANUAL & MANAGEMENT FLAN Page of • Owner SYSTEM SPECIFICATIONS Se ti j Permit o p c 'tank Capacity al 0 NA Septic Tank Manufacturer CJ , 1 0 NA 3BSIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA O NA Effluent Filter Model Number of Public Facility Units El NA NA 'Pump Tank Capacity j Estimated flow (average) al_ NA > axi/dav pump T~ink Manufacturer Design flow (peak), (Estimated x 9. NA al/da Pump Manufacturer NA soil Application Rate ai/da /ttz Pump Nlodel Stndard influenf/Effluent Quality rage* Pretreatment Unit NA ?(FOG Fats,' Oil & Grease ❑ Sand/Gravel Filter d Peat Filter NA Biochemical Oxygen Demand ©NA Total Suspended Solids 0 d Mechanical Aeration ❑ Wetland Disinfection ❑ Other: 1 Pretted Effluent Quality rs e - Biochemical Oxygen Demand (BODs) 530 mg/L !n-Gound ravit 1:1 NA Total Suspended Solids (TSS) 530 mg/L NA (g Y) O In-Ground {pressurized) Fecal Conform (geometric mean) 5404 cfu/loom) d At-Grade L~l Mound ❑ Drip~Line ❑ Other: Maximum Effluent Particle Size K in dia. 0 NA Other: lu7ther: - d NA 13 NA Other `r..._ "Values typical for domestic wastewater and septic tank effluent. Other O NA .NIAiNTENANCE SCHEDULE C1 NA I Service Event !Inspect condition of tank(s) Service Frequency At least once every' 17> mont s) `li'ump out contents of tank(s) - wear(s) (Maximum 3 years) 1) NA When combined sludge and scum equals one-third (36) of tank f muvo Ilnspect dispersal cell(s) ❑ NA At least once every: ~ d ~s) - Clean effluent filter a s (Maximum 3 years) p NA At least once every; grmonth(s) gear(s) _ NA Iurspect pump, pump controls & alarm_ At least once every: Month(s) - - I"'lush laterals and pressure test ' © year(s) NA At least once every: d month(s) 17ther: Cl year(s) Nq At least once every: b months} -~:)ther; - ❑ year(s) NA r• , MAINTENANCE INSTRUCTIONS NA Ilnspections of tanks and dispersal c ells shall be made by an individual carrying one of the following licenses or certifications: Master iPlumber; IVlaster Plumber Restricted Sewer; POWTS ins actor, linclude a visual inspection of the tank(s) to identify any missing or b okenMhardware, identtifg any cracks or leaks, measure tthee volumeuof combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shah 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. 14'hen the combined accumulation of sludge and scum in any tank equals one-third (l►6) or more of the tank volume, the entire contents of :he tank shall be removed by a Septage3 Servicing Operator and disposed of in accordance with chapter NR 113, Wiscon ihdminlstrative Code. sin All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. 13 service report shaff be provided to the local regulatory authority within 10 days of completion of any service event. 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 th~jt may impede the treatment process andlor damage the dispersal cell(s). If high concentrations are detected have the contents of thj3 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 tale 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. "1'o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to thle 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 riot drive or park over, or otherwise disturb or compact, the area within "16 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 fife of the POWT13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (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 andlor Is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with scull, gravel or another inert solid material CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code complirlint replacement system; 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 requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruleal in effect at that time. 0 A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. 113 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluallion 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. Cf Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inflltrative 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 NiOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0= A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER r Name ; . Name >14 one 67 Phone J Ph c SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Namew rte, Phone Phone 7 / ?J ~G - ~7 C7 't'his document was drafted In compliance with chapter SPS 383,22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 0jV ILTER CARTRIDGE INSTRUCTIONS Installation S'ri5P Y Dry tit the alter case auto the lard lif i hr nllCleet i cehterrad under the aCCertlts openfnQ. If n gi th b pe to ensure it et tarok khrough the outlet or solvent wdid an dither inset C trtme pffyd iteo the pipe (gAne) additluhaf pips cafe Clio outlet CVEP 2 While tleG case is aAj dry ffttud lit, the uudet aloe, rneatsura tide it" ivy tie of 44-Inch pipe rranded to bra m the filter to the tank tend wail if utilizing the uptiutral supplomwirtal xiile supourt•, if side support lrtat-hod. is nut utilized, proceed to steii (bur, :r•rk•►. R For instauatkrhs ut9haing this vlrtidniii supplenidnta! sides suppott: solt►eirt Weld the $i•-ihalr pipe onto the filtbl, trig. If side support histfitld is trot udliled, iwoeeed'to step four. Solvent WOW the 111ter ruse Otto the nutlet tripe, truur rt the filter ~ 'd~ cartridge into the rose, prevslh!p dowts unfit the filter 106r; into the button, of the case- -:rr If b vas i t:iNltrdt is ut414✓.axd= insert into ttra litt :•-L,rc.;. clockwise *3t)s. er sirtet lock by hinting bylgs Mali te"ance 1. 't'he effluent 111tat should be tloarred every tune the rreptic taM( is sarvirdd. 2. open the outlet access apahbiu to inspect the tank and Hlitur. N. Puntp the septic tank corriploWlys rnaikiny .vure to retnt)IJe the sludyli L laywk tm the botturre of this torus and riot,fuea His scum ahd brflutgnt. 4- otace the afituisht level has Liven lowered bell 'v outlet pipe, flmdY Pull up on the alter handle to the invtsrt of the } chrtfidyre train tim case, dislodge the 5. Slide the wrtridye up acrd of u: of the case fur cleaning. , 6. It a V&i swftcb connected to ;ore afarhl is pi-daent, the s;wggh should he removed by turaintq uountardodewise 911' and deaned with Water only, y. While holding the cartridge an its side {large fiat suo4ce facltry c' 4t down) eider the access opening, 01146 off the caitridus with wkirair only, snaking mire A saptago nraitarial is rinsed back Intu the trdr& a. if vas switch Is utilized, repliycla by Insertkigi into Inter iind f ..i. turnibry rdockwlse 813". . n 9. ittsmrt the weir cartridge bark ftito the case, irra"Itig down until the direr locks into the bottom tit the case. 1el.Rapiare and secure the avxvtiAi upenbig on the tank. r.,ir..ars~.,•c"'oIc-y r:;gPi:'itli'rrrsi .1,Ri yr;J~Srrf-id.`.:,Vay!Pt.~.1.bearoasjte.Com 8711-MLVICrTIMS [653-458.3) 3 ~ ftl~ z O O a) w ~fi 3l6 $g. ~c N ) W E J W '1 LL W j` "r~x map ~ t Kr' .0 : ~w~vw J LL W I TT N Ur { r + 1 ljo a oW 0 W, i= zoo r ~a f zr,~ sr,A o -O ~o TZ,21; E 2 u2 a W Z Ri3 rc'a°a °w9Wg N } a 5ss.$ 3aa~'€ 8s8~ 3sa€;: sN j€'bsg5 - O e ~h w Yqg ab,~ a~ ~ J J J o8 a¢E js o~ a Mam ?sW as ww ~ ~ ~ sym ~ n .z Q F 4 $ a ~ - m ~ < E I A~~ @ -MM + MUM I I T' 4 tk~ iae mbb _v bbbb n 0 10 e -Nhy~ III -1 E III ~ bbbb" M I 5 3 - b b b ytl `3 of ~ 91 ° .1~ r E ooh `:4IgE$ CM, N Z a E O ~ w §o !HIM i t?€8g.~~y C v O c ~ z °ffl s n~ Z 3g 2 O ~g pa w z J J J - - - - - - - - - - - - - - a K cz ¢ W ~ as a.. 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' LEGAL DESCRIPTION EXHIBIT A Lot 8, Plat of Glover Glen, St. Croix County, Wisconsin. (130126.PFD/130126/25) 2of2 ~l 'Nisconsin Departmen(of Commerce SOIL EVALUATION REPO )tvision of Safety and Buildings REPORT Page of In accordance wish Comm 85, Wis. Adm. Code Attach cornplele life plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County K 6rclude, but not limited lo: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ~rL/ Please print all Information. view bate i Personal Informafion you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z Property Owner Property Location sL ty Govt. Lot .SW 114 SV 114 S T N R Properly Owner's Mailing ddress ` fc (or) W 3 ~ 9 A/• 6/OU &;V L # Block # Subd. Name oc 6SA4iL„ 2 q G/o DER G/~•v f}•Gt,CS "try State Zip Code Phone Number ❑ City ❑ Village ©Town Nearest Road RUP56,) ~2 y3 ~,eb r 5r New Construction Use: Residential / Number of bedrooms 3 _ Code derived design flow rate yj~0 - ~p Q a Replacement GPD Public or commercial -Describe: Parent material _ ~D~S S' Dl -S~{.e7l,Y d(J f~01 Flood Plain elevation If applicable General comments n and recommendations: S,ee_ RAy U Boring # Boring f~0~j OFF C~ Y Pit Ground surface elev. ft. Depth to limiting factor 1> / In. ► Roofs Soil Application Rate Horizon bepih Dominant Color Redox Description Texture Structure Consistence Bounda . ell Y GPD/ttt Qu. Sz. Cont. Color In. MU; Gr. Sz. Sh• 'Eft#1 'Elf#2 0,/.-1- /o 2 3 L :2 f 5 hie ~w1 f/~ w 3 f . S` , y 2 3 J. 00Y 3/ sL iw, -1C/z q S / f y 3 32 - ~ -7,s ye I Oil Z Boring # Ej Boring Pit Ground surface elev. ✓ ' ft. Depth to limiting (actor in'. Horizon beptlr Dominant Color Redox Descriplion Texture Structure Consistence Bounda Roots Soif Application Rate In. Munsell rY GPD/flz Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eft#2 o-).,7 1 °Y~ z3 - ~L Z- She- A-if'2 Z f s 2 2 7 - -40 /D 2 3 - S `L / f5 It- cs /v z 3 i® /O /2S S p~ s ~c.a r, L fo S 501? Li ore s % Effluen 01 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 =BODY < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) D ^~-Signature olsEt' F 71/6/l ,(c / CST Number ! ~ Zz.437S Address Dale Evaluation Conducted Telephone Number y/ ~ Glov>~i2 Clew - rroperty Owner I I ` l a yo - ion Parcel ID p 3 ' 3 ❑ Boring N Boring Page Z of It Ground surface elev. fl. Depth to limiting factor > `p In. ilorizon Depth Dominant Color Redox Descri tion Soil Application Rafe p Texture Structure Consistence Boundary Roals GpD/0' In. Munsell Qu. Sz. Con(. Color Gr. Sz. Sit. 'Efifll 'E(fAZ v•Zz 10YR1t Sic z7`shk 4-2 J 7' .00 Z- 2- -36 YK 7'7540,11~- ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ it. Depth to limlling factor in Horizon Soil Application Depth Dominant Color Redox Description Texture Slrudure Consistence Boundary Roofs Rate In. Munsell Qu. Sz. Conl. Color GPD/fl Gr. Sz. Sh. 'EffMi 'Egfi2 Boring 0 ❑ Boring ❑ pit Ground surface elev. 0. Depth to limiting factor In. Horizon Depth Domlmml Color Redox Description Rate Soil Application Texture Slmclure Consistence Boundary Roots GPD/B' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. TIM TF11#2 • C~ Effluent Al = BODs > 30 < 220 mg/(. and TSS >30 < 150 mg/_ - ' Effluent A2 = BODr < JO mg/L and TSS < 30 mg/L 1 he Department of Cornmerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department al 608-266-3151 or TTY 608-264-8777. snn.r~~n to sronr i 3 OT Uibricht & Associates Private Sewage Consultants ` 655 O'Neli Rd. Hudson. Wis. 54016 yE~- OF 3~Y 9 y s-5 - t GQ~1 30 Go fo dD 15 vp- ' CO ~3.D ~ q'9, sa ~ a 0 Lew /Vole ~ qp i z- / o / yo za' /o. lU~ 13til 5ET d = Gov~ov.P TAP o f 3iy Y Pv~ G1NE s /d O. O ' N SU1~~S TED /3ioDi f'~-u,Sc,,~ J/O /lIl A Ti4.v 5 t~~ 7.Pcticfti 9y, p ~ /off 71f~~W64~ 93 O ° r So, /-o % L . 1 i y ~a T 7 ) IMsconshi Department of Commerce SOIL EVALUATION REPORT Page / of 3 rtvislon.Df Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Altach cornplete site plan on paper not less than 8 112 x 11 Inches In size. Plan must County include, but not limited lo: verlical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Or~ , /Q Y , 4 JC". t~U Please prin[ all Information. viewe / Date Personal Information you provide may be used for seconder y purposes (Privacy Law• s. 15.04 (1) (m)). Z Property Owner v~~" vv1 Property Location / ?yy S I\~ ~0 f,' e5 Govt. Lot SW 11456114S 9 28 ~Q Property Owner's Malting ddress T N R / f (or) W 3 G p N. /oU!~-k lot # Block # Subd. Name or-~ City State Zip Code Phone Number G~O vE/~ t~~FiV 7 ,r/U~SQ~ s El CIIY ❑ Village ®Town Nearest Road ` &Y, . 0916 (-7,s ) 40 (o - i2 y3 New Construction Use: KI Residential / Number of bedrooms 3 ' . Code derived design flow rate _ 313-0 - (od7> GPD Replacement ❑ Public or commercial - Describe: Pa►ent material -~~S s Q( dUFlood Plain elevation if applicable General comments fl and recommendations: S_ C~® T~. 3 r~- 5cul. Mq y c v 15 2402 ( / ( Boring # 0 Boring k F OF lCF yo c74/ Pit Ground surface elev. 0. Depth to limiting factor in. Horizon bepih Dominant Color Redox Description lion Soil Application Rate p Texture Structure Consistence Boundary Roots GPD/fl: In. Mun sell qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '002 /O 2 3 : f 5h,< Iso f4 w 3 f _ s , 9 3 /o yl? 3111 sL / /wt Ail a s f 4/ 3 32- -7.s VP 4, "1 0. o S 1. Z s . Or ,Q ~r r ( U Boring # Boring L--J ~ pit Ground surface elev. / ✓ f(. Depth to limiting factor >f~ . flortzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color GPD/fl O Z / V~ l 3 Gr. Sz. Sh. •Eff#1 'Efl#2 1 Iont'2 2 •~I '0 23 - StL /fS fi' ~S /v Z 3 SF /a R S~ / f ~e fe Q s D /G ~c' S s' S Y G -7 1. Z L W 00 S ' t A " 1L s i ~SoiL PAL C,f 7 /o /per E / Efltuen 171 = BODE > 30 < 220 mg/Land TSS >30 < 150 m /L CST Name (Please Print) p - g ' Effluent 92 = BODE < 30 mg/L and TSS < 30 mg/L 7 Gf~ /f C,7Signature CST Number Address Z Zee 3 ?S Dale Evaluation Conducted Telephone Number >9 30 ~~s 3k26 Private Sewage Consultants 2 ,O 2- 6s5 O'Neil Rd. Hudson, Wis. 54016 AL 1 I a I • ~ . I 1 4 s ii Property Owner 1 Parcel ID it ~ 7 t~ Z 3 Page of 13:1 Boring 0 ❑ Boring it Ground surface elev. it. Depth to limiting factor. > G0 In. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Rate In. Munsell Qu. Sz. ConL Color D' GPD/(I: Gr. Sz• Sit. •E1141 'Eflfi'2 • v z z /o y,P Zl -sic Z 7`SA& 4,6t 7F~q 3 7- Y , 8 z z2 ' 30 /o c3 S!L 2 fSlr~ fiP w 3 . S e 3 ~o z3v s~ f~ a s . Z . 3 S. O-Sq Yle Boring 0 ❑ Boring ❑ Pit Ground surface elev. It. Depth to limiting factor In. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ApC'pP~/n n Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff ji 'Eftlt2 Boring [j Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horir_on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soli A GIPicDa~'on Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t '002 Effluent ill = 8005 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent N2 = BODS < 30 mg/L and TSS < 30 mg/L r The Department of Commerce is an equal opportunity service provider ilnd employer. If you need assistance to access services or need .material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. Spn-R)7n to r;mrt) Properly Owner 1 d 7 ~al~ % ' ,37 - !J(J`~ 3 B 3 Boring Parcel ID # page 201 oring # lvxfl Ground surface elev. II. Depih to limiting factor > ` o in. Horizon Depth bominin, Color Redox bescri Iton Rai,. p texture Structure Consistence ZFR In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sfr. l#2 ZZ •30 YZ 3 ~o Y S s~ 9 ioY,P t-7 ~ • i. U Boring # Boring . L1 I'll Ground surface elev. _ H. Depth to limiting factor In. Horizon Ueplh Dominant Color Redox Uescri Icon Soil Application Rate P In. Texture Structure Consistence Boundary Rools GPD/I, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1~ ' U Boring # Boring pit Ground surface elev. tl. Depth to limiting factor in. 3 Fbrizon Depth Dominant Color Redox Description texture Structure Consistence Boundary Roots Svfl Application Rale In. Munsell Qu. Sz. Cont. Color GPD/11' Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 - BOby > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent 02 = BODs < 30 mg/L and TSS < 30 mg/L r l he Department of Cornmerce is an equal opportunity service provider qnd employer. If you need assistance to access services or need.material in an alternate format, please contact the department at 608-266-31 S 1 or T1 608-264-8777. snn.e~an rrt FirKq i i 3of3- G- 0 7- 8 Ulbricht & Associates Private Sewage Consultants 1 655 O'Neil Rd. Hudson. Wis. 54016 55 ~ y c~ 30 10 s f '1, b (z dfn ~ 9'9, So ~ d Cov rove 0 v qO V) o q a / \9 \31 00 e = / = 3 0 i' - 1 Z-„vE s /00, 0 SU~~~S TEI~ fjioDi f~c-US-~ 4e7/ .?v 01 /elf) T/'~,vc 3 O ' So, Z-0 T 1 zoo- 7~ County 1 ! Safety and Buildings Division I • ~o~ l~ ~a fi 201 W. Washington Ave., R O, Box 7162 Sanitary Permit Number (to be filled to by Co.) l 0 $ 4~' Madison, V~yi 537077162 r t. 1. i Stain Transaction tuber l {:F iy permit Appliinn__-_._ N c1. 'a3h. 1(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit in accordan01 1 is required btaining a sanitary permit. Note: Application fortes for state-owned POWTS are submitted to project Address if different than mailing address) i the Department of Safety and Professional Serv ies. Personal information you provide may be used for secondary j purposes in accordance with the Privacy Laws 15 04('1)(m 1 Stats - 1. A lication Information - Please Print All Infor tion I Parcel # Property p~ l✓Name~ ~ b yb- f 2 9 g - gb ~ o~ Proper Location Property Owners Mailing Address A / -7 Z(-o Govt L< ZAP Code Phone Number Section City , State ~ ~ rcle o _1t tt~~,~) .GO 1j -S J N_ R E R 11. Type of Ouildi ng (check all that apply} Lot rSubdivision Name C1 1 or 2 Family Dwelling-Number of Bedrooms ock # 7 (n/J~/L l J C/F~~ i E Public/Commercial - Describe Use ~CSM Number ❑ Village City ofitiage of 1^ ul ` State Owned - Describe tisewm of _ Dlsf i'ILS V J/ CHa bars lA,-1'~-- e ! II[. Type of Permit: (Check only one boa on itn A. Complete hue B if applicable) X /b WS S stem ❑ Replacement System ❑ Treatment/E3olding Tank Replacement Onh Other Modification to Existing System (explain) Issue List Previous Permit Number and Date B. Permit Renewal I ❑ Permit Revision ❑ Change of Plumber Permit Transfer to New Be re E it Ow r h L iV. _ pe of POWTS System/Component/Device (Check all that apply) Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-tirade C Mound > 24 in. of suitable soil ❑ Mound < 24 in. ttabl soi 4 PI ❑ Pretreatment Device (explain) v! _j Holding Tank [I Other Dispersal. Component (explain) - V. Dis rsal/Treat ent Area Information: Des. Flow (gpd) Design Soil A plication ate{gpdsf} Dispersal Area Required (s Dispersal Area Propos (s Syst Eieva on , D ~~0 # of Manufacturer Capacity in Total l y „ VI. Tank Info Gallons Gallons Units fin[ //y New Tanks Existing Tanks { Y" I J e0 ) W ?3 y p m m J lS i septic or Holding rank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assu esponsibility for installation of the PORTS shown on the attached plans. Plumber's ature MP/MPRS Number Business Phone Number Plumber' Kane (Print) s ~j) zzd i Plumber's Address (Street, City, State, Zip Code) 1 L Z, iN 1,V1 57~~~ 11. County/Department Use Onl I Permit Fee Date su Approved sapproved S OD ! P85 ❑ Owner en IX. Conditions o provat(Reasons for Disapproval N' O SYSTEM OW ER: S t J S YJ 1. Septic tank, effluent filter and Gt 0~ r eXA + dispersal cell must bg serviced / maintained as per management plan provided by plumber. 2 All setback requirements must be maintained as per appllCable A 6 9 6 1 1 L ' f O M 1 p 1 ► 1 A0ft5 for time system and submit to the County only on paper not less than R t r . i l l inches in size t SBD-6398 (R- 11111) PLOT PLAN PROJECT Brian Haves ADDRESS 850 Settlement Drive Hudson Wi 54016 SW 1/4 SE 1/4S 9 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/22/13 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1511 # of chambers 75 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION same as benchmark Pro 4 661' Property Line 99.5' Bedroom ST 30' House 20' B-2 65' 95.5' 90' Scale is 1" = 40' 42' 3-3' X 102' Cells with >3'spacing unless otherwise noted B-3 FB 21 10% Slope All piping shall be SDR 30/34, within 10' 10' of tank, piping shall be Schedule 40. 24' Vent Quick4 Standard Well is to meet all B.M. * >6 Leaching Chamber setbacks required by Vents of Cover with 20.0 ft2 of Area WDNR 5.6ft^2/pair of end caps 395' 4' Long 12" 'Grade at System Elevation 34" Please note: original soil test was measured from the wrong lot corner, and the dimension to the south lot line is off 85', hence the different dimension, this also matches the plat map for slope direction and puts the tested area out of the rention area, also note the original soil test was not dug deep enough to install system properly despite CST suggestions, a additional boring will need to be done to raise loading rate and lower system elevation. 214' Property Line Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99' Vent Al Grade Vent 4' 4" 4' ~~30/34 Septic Tank 4' Long 191 5' 4' Long 1 3 4" Grade at System Elevation 3 4" Grade at System Elevation Spacing 5' 3-3' X 102' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A__94.7 B 94.0 25 chambers per cell C--93.3 ST. CROIX ('MATT' SEPTIC TANK. MAIN' °I: NANCE r ~GRFHMENT ANI ) OWNERSHIP CERTI-FICATIt- N I`ORM Owner/Buyer Maihn AdtLress Property Address (Verification required (iornplanning & Zoning, Oehart rent for new consituctiou_) City/State Parcel Mentiiication Nut-1bet- OL LEGAL DESCRIPTION I' 2 $ N I) W, Towrt o F 7r Property Location 5 yy , S 1/4 , 's cc. Subdivision Lot # ~ . r Certified Survey Map # - Vt iutnc Page It Warranty Deed V A11111e Page # - Spec house yes no I.ot. line.- identifiable yes SYSTEM MAINTENANCE AND OWNER CERTIFIC'A;CLON Improper use and imiruenance of your septic system could result iii its pr.-mature failure to handle wastes. Proper maintenance consists of purnpirrg out the septic tank every three years or sooner, it needed, by it licensed pumper_ What you put into the system can affect the function of the septic tank as it treatment stage in the wasie disposal system. Owner maintenance responsibilities are specified in §C "ornin. 133.52(1) and ui Chapter 17 - Croix Co!nnty Sanitary Ordinauce The propertyowner agrees to subutit to St. Croix County Planrtirrg~ & IonOng Departrncra it ccitification fbim, signcxi try the owner and by a roaster pl rnber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating cortditiorr and/or (2) after inspc c ion and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the ithove. rectuirerrrerits and agree to n-tairtam the private sewage disposal systeru with tho standards set forth, herein, as set by the Departrrlent of C,orlrlrlelcu and the f)epartinciii of Natural Resources, State of Wisconsin. C .cutitication stating that your septic system has been maintained must be completc,t and returned to the St. Croix. County Planning, ; & Zonurg Department within :30 days of the three year expiration date. 1/we cert ify that all st on this form arc: due to tJ-,e hest of try/our knowledge. live ant/ale, the owner(s) of the property described above, b, v'5 ir trle of a w ranty deed recorded in.ltcprster of Deei 1s Office. Number of bedroo s - - SIUNAI URA=? OF APPLICANT(S) DATE, -1.**Any infbrination that is misrepresented niay result in the sanitary permit bt.ing (iwoked by the 1'lannirrg & Zoning I)epartment. Include with this application a recorded warranty deed fiomthe Regisier ofi)eeds liffice and a copy of'thc; certified survey map if reference is made in the warranty deed. (REV. 08/05) 'OWTS OWNER'S MANUAL, & MANAGEMENT PLAN page of p INFORMATION SYSTEM SPECIFICATIONS Owner i w Permit # Septic Tank Capacity al El NA Septic Wank Manufacturer 1L39810H pAi7AMErts DNA Efffuant Miter Manufacturer ❑ NA Number of Bedrooms - ~ O NA Effluent Filter Model - Number of Public Facility Units ❑ NA NA Pump Tank Capacity - I Estimated flow (average) dal NA y P.> I/da Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) .10 aUda Pump Manufacturer NA Soil Application Rate _ ai/da lftz Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 930 m /L Sand/Gravel Filter NA Biochemical Oxygen Demand (BODs) 420 mg/L IJ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (I'SS) 5150 mg/L ID Disinfection Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L In-Ground (gravity) O In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L -XNA ❑ At-Grade Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Mound ' ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size A in die, p NA dtlier: IOther: ❑ NA I❑ NA Other, - ❑ NA "Values typical for domestic wastewater and septic tank effluent, other: ❑ NA I iAINTENANCE SCHEDULE ' Service Event Service Frequency linspect condition of tank(s) At least once every: mont s) tear(s) (Maximum 3 years) © NA ]rump out contents of tank(s) When combined sludge and scum equals one-third W of tank volume ❑ NA [inspect dispersal cell(s) -'-~°5 0 At feast once every: (s) ar(s) (Maximum 3 years) ❑ NA I::lean effluent filter - At least once every: ` qLmonth(8) 19.year(s) AfNA I respect pump, pump controls & alarm At least once every: D month(s) I='lush laterals and pressure test _ ❑ year(s) At least once every: ❑ month(s) ether: ❑ year(s) _ At least once every: 13 month(s) er: _ ❑ year(s) MAINTENANCE INSTRUCTIONS flnspections 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 ]include a visual inspection of the tank(s) to identify any missing or broken Mhardware, identtifgy anServicing operator, Tank eions y crack or leaks, measui eft ectvolu euof icombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be ivisually 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 hagulatory authority. 14ban the combined accumulation of sludge and scum in any tank equals one-third (16) or more of the tank volume, the entire contents of fine tank shall be removed by a Septege Servicing Operator and disposed of In accordance with chapter NR •113, Wisconsin IWdministrative Code. INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. 12L service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page - of 5TART 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 th.,It may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thh 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 till above normal highwater levels. When power Is restored the excess wastewater will ble 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, "1'o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to this affluent 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 riot 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 fife of the POWT:13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (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 andlor 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 shalt 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 su►II, 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 comphilrnt replacement system; Th t Itable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. e replacement area should be protected from disturbance and compaction and should not be infringed upon by requliled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the noed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruleal In effect at that time. ❑ A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technologN a holding tank may be installed as a last resort to replace the failed POWTS. 17 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaiuallion 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 ANDIOR INSUFFICIENT OXYGEN. DO NIOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0- A PERSON FROM THE INTERIOR OF A TANK MAY 89 DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - POWTS INSTALLER POWYS MAINTAINER Name Name l.1°' -GJJ / 67 Phone Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY i Name Name Phone Phone t5 0 i J~' This document was drafted in compliance wlth chapter SPS 383,22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code, "O LTER CARTRIDGE INSTRUCTIONS Installation S'r'r p Y Dry fit kite 111tm. Casa ,tratet the end of t:ttl uuClet pure, tae *We it is t ehteered under tiro --W"" oparefhq. If nut, ti«yn •toner Ihswrt tnae a plpid Ytrto Haar tank through the outlet or eolveat wuted (glue) aitlditJahal pipe tt"tu the uuth t pipe. .MFP a Whole time case is Still try fitted rah the outlet plog, rneasurv the ieayth of'14-indt pipe needed to bract, the filter to the tank Acrid wall if utiltLlrig tl►o apUonal ruppleuaarrtal side &VPPort, If side support rreathud. Is nut utilized, proceed to step feat. s-rir•w ~ Far installOWNS UtIN trig thel afrtienai SUpplenrontal side support: soiustet wield the IN•-iieh pipet onto the Mtky case. If iside: support hfathad is toot utilised, proesad to ste i, four. Salveat wow the toter case atito the outlet Pipe, Xhsert the tiitel• cartridge into the rase, pressRt t doWn untll the filter leae:kea iteto the buttatri of thb rasa. r . if a VIi5 sSNitc It is utlii✓ard: itre art inter tiro titter and lack fry tUrnlne{ )a ~+4r , „ r clockwise *30a', NoWtonance I . The effluent filter should be tioahed every tiMN the aduptic tank IS serviceed. 2, upeh the outlet raccese opondttt to Inspect the tank dtld filtel•, ` 5. i5unep the septic tuttk carnplaitely, makitty ,sure to rutntole tfes siudelti layea' oa the bottom of this t.arik and "at just the scum and ,effluent. ,e+ 4- once ti m etnuent level has t, van (towered below the iaevurt of thu outlet pipe, linens pull up ale the tutor handle to dislodge the , cartridge frasr the case. S. slide the cartridge up aad at x of the cuss hoV tleatnlhy, ti. it a V&i switch curthe cteti to an alartrl is "Sent, the switch sh'auld be removed by turhihi: couriterduckwism 904 chid deeoued with water only. 7. While hultlbt{y the c* 0011190 city its side (large flat surfo a facarra down) over the aecass apesning, rktse off the cadrWile With wirtne , only, makirty sure all amptaga irraterial is rinsed back Intu the twin.- t ` s. lr VRS switch is utilized, replw,nt by Insetting into filter and turning clockwise Mr. n r 9. Insert the liner cartridge back into the erne, )ire "ing down- uettii than riltsr locks into the bottom of the case. 'wh to, taplace bend secure the ameetai Ulaehllrll on tha tank. r.. t:• •:ab.<' ec ••oq ; gr+'$:,bSr;T t. q;. v ,;,t t eewt c.a~ :NaJ!dtx ~r• N^me a wg= a'pa T MHO 0) N Z doglip p°8~ W Hlfi- w OP ~ 4 E 1113E°: him lulm 9 T J H ; LL W QJ N m0 f~ II ~a11 F ryW 1 w N F W owg . r- 11, J1 ym a a FEI ~H O eo~8 Z m ~BaQ 'w§ ~q S w w~ r~ gstbb 's N p - § E w / W JiO w'~ = Q , CIS is et. F Z C\1 r_ O q~ ~88w s~ 3< c m Y " glib! 1,11i'l um 11111.. ~ 41 ~ 7 m g3 ~ Y ~ a 90` W ~ Qa ~e~ I~ ~ ~ y k'~g bw~ s~y a .a< .r n W B: y z Z ~~y Qg a.z a.s .o QG tl.8 Q a... 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CROIX CO., WI 11/03/2014 11:37 AM THIS DEED, made between Brian J. Hayes and Molly M. Hayes, husband and wife EXEMPTO: NA as survivorshi ro7)ert REC FEE: 30.00 and Robert S. Herda and Lindsay F. Herda husband and wife as TRANS FEE: 294.00 PAGES: 1 ' Survivorship property ("Grantee,"whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): FSA Title Services, LI-C 5649 Memorial Ave Stillwater, MN 55082 Lot 8, Plat of Glover Glen, St. Croix County, Wisconsin. File Number 140748 Property Address: 423 Glen Court. Town ol'Troy, WI 54016 PIN 040-1298-80-000 Dated October 30, 2014 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: None * Brian J. S,es * Molly M. Hayes (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ~ 1hh tCSa ) authenticated on was "►i4` ) ss. ) a COUNTY ) * Personally came before the on _October 30, 2014 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Brian J. Hayes and Molly M. Hayes (If not, HUSBAND AND WIFE AS SURVIVORSHIP PROPERTY authorised by Wis. Scat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: LOre 11 .kaehty Baiers Pleeren, attorney for FSA Title Services Notary Public, State of Y\ 11J 5649 Memorial Ave. N., Stillwater, MN 55082 My Commission (is perma nent) (expires: (7l S ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: r111S IS A STANDARD FORM. ANY MODIFICATIONS TO TI-IIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEI>1) O 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * T\pe name below siena~ures. LORELEI A. KOENJ2015 Notary Public Minnesota kav eY ;,miyor4es January 3'1, St. Croix County 1003757 Page 1 of 1 RECEIVED WbmRehDeperesetttdcatrlmerae WL EVALUATIO PAMM13 Pags~d -3 Dh~eiolt of5'ef.grand +Beialrgs inaoo1 lie-nstr~hcm no&vfe. *A& co* C:R I~ica.y„ MachcowshftlMa0m=paperm*l=*e S Wxll - a i g inaboyomm rt itWuftb1*o0ftftdlwvm fdmdBp"mid. p tQ p '1sbPa.salsar~rarionl~tnarr►attaa~Kandfecadonandd6rMtortbwrrsowtluatl Plfosse pr&t off i ~ Dire P.s..etlde.~erenyaYpYOSid~.nyl~eawdrs~ovd~q}rr~s~ri+~►[sryait(7jl~II h~ Poop" Laloeiwn dr, A Goa Lat In SE7 tM S T N R E. +0 Lds oxkS gwl& !iltrltarCSIM v r. o Day - t vftfp l3tom .QlrnrrtRmd ErfNsw*n*t fim U.13 Rrwitialietliww+6e*afb.~boms cbdsdiea ed~siynlow►salr O ciPO ORrpaoeerwd ❑ Pltbftcar - Wbe: faraelttmereief fioodPfefnafelterwnlfapo:im a oea.rafarmnnaMS ® - A~ a FIBER woe ~ Y A'g~ /fr~,P/`Nf~ Jam' y~3 le w c ' a avtboe.iaw ~ ~ dor Ob -teab f&v~w_ 6L sail Rwts f♦ 0t on Depa Dottti~stt CCU ftftf]ar *kn- Teem a Z oar te>etloe Baunft Rmel • = GPM Il. MWAM tem. St cort color G~ Saw 51►. OEM •Bp2 L w lip a Alh Im as Are- 00, 31,16 3 • Elea" ls.A~ F-1 !2r t a B P ..r~dw.~a#3 Dopkbffwtlrttgfto j+• Sd Rite 4W M Do& Dwwabettt Pmdmc D=a"m T.*.s ne Oanwi*6= Ro.tw GPM ins Ollraweff C1 L SG Onlt c*r A. at uL `EOurpt~ts80t) >S,<2~tttdt.aad't86~9<-~~. '~~:ppp-<39sig~~•igD<~~ CSf'Nrrle-(AesesPfirij - cSTtirlleder Arldrers s. Qonduded TeiaplonsNtmber a ze wc Ac pct >s = li~o>oo . SOIL EVALUATION REPORT 3 b scow dw- wrr COMM IM VVIL Ado,. Code A"mh sae also on paper not less wren. IQ x It bidles b s@e. Plan moat C0tl dy ST- 0~'Gi X hdade. but not lmaed w ver" and hodm" releromm pow 04 dbedon and Po Ia. p P ebpe, male or dknen*m. "a,& snow and bcasm and dle w in noomm nxia. Ao • /o to t s-. ozro Please pnw on hdormaNon. Dols x'00 war Posse na ee eaea+b, sir owomes pMwq a~. a ,s a p)4 f t)rrrrM Gr.G„ ~q 2 M arooerh t7wnar 9 1,11, U cos. LM SW 1114 5~ tN s 9 T ;L N R np / w 317f G/OU+E72 • t q,+► elod. seed Nsna a ceMa. y . uly S G/o~ER G/F.v A495 N tl f/uDSa,J !v/. s f~oiG ~~s i a 0 I~Tmn ~ ZY3 a s P G/pv~ie ~o lk"' c dlan U-II Reddenwel i Mm*w or bedrooms 3 - Cods dwWvd dadp.ow nle O~MaaemMw 0 Ps6MaoraMrx+rxdd-Desabe ~ /acs sP S~t► ar~y eyf rl„od ~aln derawon r aaprca,nre c onerel aamnenb IL 941 4t4-ffJ; w4-k 44Y 15 20 p2 C~~X d ~l D q ol;~ 1 ter: mpg alt Peens srsbae ele,r- a. t)eplr b.nafnr tsaar / y Sian ► itedax TMdtss stuck" crosmmm em"My 1100AS bPQla' l^• Mluber colt. ft cont odw Gr. Sk 2 Lx - 3 /o 913 St.. / .wt 6W q s / f . y : G L- s ~e p ~ o_ S • 7 1. 2. AP2 %ftt l+ll ttrannd surf** ,W,. IL tleplr b tYrilnp blur N0f~0n t"Ih Dm*m t Color Rsdmt Oesablon taxbre slrodu~s Sol tYr 0-M 0 8s. Cant. Cobr Consistenos BaaslMy Root Bf' 6r. Sz Sh. .27 12 ~ o•z~ ipYR zfsbee. M,t7e 4, zf- . s oA •9 •s /a sc !t ,e ~ fe as . Y . G /m S. D, s cdaQ 1.7 CST jpywyg *ta80Us>3e.<2enV&sodTSS>30a150nV - 'EftMM eZBMIc 30 nikadT8S<3eam& ' Ro13ERr Z he.,cy7.29 ~ ~P ~ a~ 37"s • ^ Condoeled Tekp~ane ►Mlrwber - h4 a/L. 30 i atlrlds 8rwsws cones Atoms it-+7~ Z • ~ ~ O'Nia'Rd.  County- r gam'.:` Safety and Buildings Division v7-, L lx a 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 J ~4 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form a appropriate gov ental unit A)rT is required prior to obtaining a sanitary permit. Note: Application to st wned POWTS are ed to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal mde may be used for ~idxy _ptuposes in accordance with the Privacy Law, s. 15.04 1 1. Application Information - Please Print All I tion Property Owner's P 1 4 c l ~ ST r1 Property Owner's Mailing Address ` ' CpGN Property Location • City, State r ry GOVL Lot np ode Phone Number y,, Section /Ioircle on U C 47 -2 V II. Type of Building (check all that apply) Lot T y N; R/ E t!2 or 2 Family Dwelling - Number of Bedroo Subdivision Name ~K 4>4 P Block ❑ Public/Commercial - Describe Use _ 14 A- ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 3 i Z•. ~e.C3 _2<-n of ea~ M. Type of Permit: (Check onl one box online A. Compiete line B if applicable) A. New System ❑ 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 f c1cr- IV. Type of POWTS S stem/Com onent/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil A415 ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain V. Dis ersal/Trea ent Area Information: Desk Flow (gpd} Desi Soil Application R (gpdsf) Dispersal Area Ile ui 6 q (sf) Dispersal Area Proposed m E ion gs i sir✓y~ 3 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units Cg ° New Tanks Existing Tanks Q ~ 44, caa ~ y' y~ iJeQ r r, o -,7, a id a, U ti rwn w C7 A, Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWI'S shown on the attached plans. Plumber's Name (Print) PI ignature MP/MPRS Number Business Phone Number c Plumber's Address (Street, City, State, Zip Cod V . oun /Department Use Only Approved Permit Fee Dat Issue Issuing A ignature ,00 tven Reason for Den $ 75 3 /3 DX. Condi1SW4P*ppd easons for Disapproval nl r 1. Septic tank, effluent filter and L O % Q. ~`l0~ „dispersal cell must all be services I maintained , ~4G /_o>ti 1 a5.per management plan provided by plumber. i A a Ah se~lack requirements must be maintait>~CI II 11 Dn / 1 1 / t 'as-per aipplicSble code /ordinances: '1, Nd lra,('~- ~ 7 R."'~ T 0 b~- / ~t~ Attach to complete plans for the system and submit to the County only on paper of leas than 8 i/z x 11 inches io size • SBD-6398 (R. 11/1I) PLOT PLAN PROJECT Brian Haves ADDRESS 850 Settlement Drive Hudson Wi 54016 SW 1/4 SE 1/4S 9 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/22/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1511 # of chambers 75 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION same as benchmark Pro 4 661' Property Line 99.5' Bedroom ST 30' House 20' B-2 65' 95.5' 90' Scale is 1" = 40' 42' 3-3' X 102' Cells with >3'spacing unless otherwise noted B-3 BB21 10% Slope All piping shall be SDR 30/34, within 10' 10' of tank, piping shall be Schedule 40. 24' Vent Quick4 Standard Well is to meet all B.M. * Leaching Chamber setbacks required by Vents of Cover with 20.0 ft2 of Area WDNR _ 5.6ft^2/pair of end caps 395' 4' Long 12" 3 4 " Grade at System Elevation Please note: original soil test was measured from the wrong lot corner, and the dimension to the south lot line is off 85', hence the different dimension, this also matches the plat map for slope direction and puts the tested area out of the rention area, also note the original soil test was not dug deep enough to install system properly despite CST suggestions, a additional boring will need to be done to raise loading rate and lower system elevation. 214' Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/22/13 OwnerBrian Hayes Location: SW1/4 SE1/4 S9 T28 N,R19W Lot 8 Glover Glen Troy System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License numb #226900 PLOT PLAN PROJECT Brian Haves ADDRESS 850 Settlement Drive Hudson Wi 54016 SW 1/4 SE 1/4S 9 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/22/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1511 # of chambers 75 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION same as benchmark Pro 4 661' Property Line 99.5' Bedroom ST 30' House 20' B-2 65' 95.5' 90' Scale is 1" = 40' 42' 3-3' X 102' Cells with >3'spacing unless otherwise noted B-3 E13 2 10% Slope All piping shall be SDR 30/34, within 10' 10' of tank, piping shall be Schedule 40. 24, Vent 91 Quick4 Standard Well is to meet all B.M.* >6 Leaching Chamber setbacks required by Vents of Cover with 20.0 ft2 of Area WDNR 395' 4' Long 2 5.6ft^2/pair of end caps 14 1 34 Grade at System Elevation " Please note: original soil test was measured from the wrong lot corner, and the dimension to the south lot line is off 85', hence the different dimension, this also matches the plat map for slope direction and puts the tested area out of the rention area, also note the original soil test was not dug deep enough to install system properly despite CST suggestions, a additional boring will need to be done to raise loading rate and lower system elevation. 214' Property Line Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99' Vent All Grade Vent 4' 4" 4' X30/34 Septic Tank 4' Long 1 „ 5' 4' Long 1 349) Grade at System Elevation 3 4" Grade at System Elevation Spacing 5' 3-3' X 102' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A__94.7 B 94.0 25 chambers per cell C__93.3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pag® of +;1LE INFORMATIO Pot N SYSTEM SPECIFICATIONS Owner I-_ i Permit FSeptle' rank Capacity ❑ NA ank Manufacturer D NA 3ESION 12A~RAMETERS Filter Manufacturer Number of bedrooms 0 NA D NA Effluent Filter Model - - Number of Public Facility Units - ❑ NA _ NA 'Pump Tank Capacity j Estimated flaw {average} ntN y PZ2 gal/day Pump Tank Manufacturer I Design flow► (peak), (Estimated x 1.5) - allda Pump Manufacturer Soil Application Bate of/da /ftz Pump Model Standard In fluent/Effluent Quality Monthly averaw [LEI] retreatment Unit Fats,'Oi! & Grease (FOG) 530 m /L g Sand1Gravel Filter CJ Peat Filter Biochemical Oxygen Demand (GOD6) x220 mg/L NA Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L Disinfection Pretreated Effluent Qualit Cl Other Y Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg/L ❑ NA In-Ground (gravity) D In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L -XNp 0 At-Grade Fecal Coliform (geometric mean) st 04 cfu/100ml D Mound ' D Drip~Line ❑ Other: 'Maximum Effluent Particle Size 36 in dia. ❑ NA Other; Iv3ther: El NA 0 NA 'Values typical for domestic wastewater and septic tank effluent, ' - ❑ JNA Other; NIAINTENANCE SCHEDULE ❑ M Service Event Service Frequency 4nspect condition of tank(s) At least once every: month s (Maximum 3 years} O NA 0-year(s) Il'ump out contents of tank(s) When combined sludge and scum equals one-third (1~) of tank volume © NR [inspect dispersal cell(s) At least once every: (s) ear(s) (Maximum 3 years) ❑ NA [::lean effluent filter - At least once every, ears}s) T NA I aspect pump, pump controls & alarm At least once every: d month(s) i°lush laterals and pressure test 1.1 year(s) NA At least once every: 0 month(s) ~7ther: 0 year(s) NA _ At least once every: a nts(s)NA er: yea MAINTENANCE INSTRUCTIONS NA ilnspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Rumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank Inspections must linclude a visual inspection of the tank(s) to Identify any missing or broken hardware, ldentify any cracks or leaks, measure the volume of ,:ombinad 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. 16ben the combined accumulation of sludge and scum in any tank equals one-third (35) or more of the tank volume, the entire contents of $he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin [Administrative Code. I NI other services, including but not limited to the servicing of effluent filters, medlanlcal or pressurized components, pretreatment units, find any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. IA service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 thElt may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thin 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 effluerilt, "I"o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to thle affluent 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 riot drive or park over, or otherwise disturb or compact, the area withln 16 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 fife of the POWT:13: 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 productss; 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 su►ll, material. gravel or another inert solid CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compiiiIirnt replacement system; IA ,suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requhled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soil and site evaluation to establish a suitable replacement area, replacement systems must comply with the ruleil in effect at that time. 13 A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technologN a holding tank may be Installed as a last resort to replace the failed POWTS. Q The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluallion 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. 13 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inflitmIlve 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 OI= A PERSON FROM THE INTERIOR OF A TANK MAY 89 DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name .u- Phone Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY i Name i a3 Name 5 ~ 11 Phone J ~j' Phone 7 / 3 - C { This document was drafted In compliance with chapter BPS 383,22(2)(b)(%d)&(f) and 383.54(l),(2) & (3), Wisconsin Administrative Code. % qr► -10keC~ hTER CARTRIDGE INSTRUCTIONS Insatatlatliriln s 5p x ory tit the IlllfaY crfsw ,f"to the troll of t:hr, nuCtat pip, 1,"m erratum it k centarod under tit. aCCwas nffdnIng. If ff tit tank fit (glue) +sn dthdr l pipe ora f You nh the outlet ar +:oluatst wefd (Ulue) addliluhaf p pd itr~titw pl a Innto C pipe- A hit outlet 5 EP a While tine case is aM dry tlttdd orl the outlet plod, trreasure the iewyth of §b-ihdi plies nanded to brace the tiltaar to the tank and wall if utilFLing file aptio►eal aupltl"Mantal snide 5lfpwnft, If s•Idw support frtathud. fro not utiffind, prom ed to 51:10 (out.. 5•rF•t' ~ For installations tallizing thtl uptigneil uUpplenft ntm) side support: soivef t wrhd the 4 -iheh pipit onto the filter ease. if rider support frfamd is hat utililod, proCead to step tout: IP! Solvent weld the Met 1:050 utito the nutlet pine, l'f+a:ort tits teltel' cartridgv into the rose, Grefssih!l down Until this filter l0eks into the buttntri of : ~YVr:tc lire case. If a Vti5 switch is u~Ei: axd= intswrt Into arcs fitt ;.w;. clockwise 906, er' vans lock by L'Urnint{ maintenance 1. 'I'he effluent toter should be t1aianed every thne the of4ptic teknlc is serviced. 2, olreh the outlet access stionlf►g to inspect the tank dttd Niter, 9. Pump the septic tam k CnrrfpleCrrly, making yore to ristnuvn the sludytu Itry. k- wr, the batten of the t;rrkk and not Jual: tits scum and erytuent. At a_ orn:e the afiktwrt level has bean lowered beloW the itevert of tho outfit pipe, firmly pug up nn the fitter hendte to dislodge the curt'ridge froth thr rase. 5. slide the rartridcye up and atrr of fife Gallia ff►r cirtaning. o. if a Vats Switch uannect,d to art alortrt is Irittfient, the sw#L11 sh'nutd be removed by WrWhO vounterdodkwtsw 94W end deaned with water only, p Wmile: holding the catriftdge on its side flarpe flat surface fsdrry down) ever the access upenhi% rinse off the caltsidus With Wirkae . Ai. , only, 4-napkirig sure all raoYfago: ufattsrfal Is rinsed back Into the oink- fr. 1r Vras wwkch Is utilized, repliWe by InsartEng into Nlteet• and . turning dockwise S30 9. litsart the idler cartridge bark If, to the fiev iireflsutg daUUn, Until v.• a , the filter locks into the bnttoun Of thw Case. 10,Kepiace and secure the accdhs SIP01110 On the Wnk. r.,lr••=rcs.<";'~tt"1x;;vN;'~';r,trd •NR;.y,;•;,S,wt-c.r_:,vaNa4.xx`. tittaWlA►"klils'a'roli-dte.CIDltltll rte" lU#ia`IC I S (653-4583) 12 rr r w w w r w w w ' NORTH LINE OF THE E~ 57" E (x~-s sarw, w) SW 1/4 OF THE SE 1 /4 N . ww' 25 0' 11 200-W -it lmq- - - - - - - - - 114 626.44' 8ENCH1 MARQ ' - RAL110AD SPIKE N EAST s„ it WE OF ISE CIfRRY TREE IiTIO•~6S4.D6 ~ AAT~ i BENCH MAW, I + } RALROAC SPICE N SOUTH 30' s 517E OF 1T10 -M97 TREE • - ~ NDZ7} } I 4MO ACRES b 1, 184=8 S.F. I L07' I 4.614 ACRES r \ F. I r 201.164 SF. / 1+} PROPOSED l 100-YEAR f 'V ` ST~ATER 1 ~ `i' , LAID DRAINAGE o AREA, j '47 r ELEVAT10Nr61l6.01 4 V 6 4} 2= ACRES 87,M S.F. 7 * 1. i ?x331 ACRES Z 'r LOT z 110.263 S.F. 6 r / LEGAL DESCRIPTION EXHIBIT A Lot 8, Plat of Glover Glen, St. Croix County, Wisconsin. (130126. P F D/ 130126/25) 2 of 2 II IIIII IIII I III ~ II II IIII III 8 8138206 State Bar of Wisconsin Fonn 1-2003 Tx: 4111667 WARRANTY DEED 974710 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 03/08/2013 1:50 PM THIS DEED, made between Craig A. Kellogg and Kristen B. Kellogg, husband and EXEMPT#: NA wife REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 239.70 and Brian J. Hayes and Molly M. Haves, husband and wife as survivorship PAGES: 2 marital property ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): FSA Title Services, LLC 5645 Memorial Avenue Stillwater, MN 55082 See Attached Exhibit A File a 130126 040.1298.80.000 Parcel Identification Number (PIN) 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: None Dated March 1 3 (SEAL) (SEAL) * Craig A. Kellogg * Kristen . Kello (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) . authenticated on ss WASHINGTON COUNTY ) * Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Craig A. Kellogg and Kristen B. Kellogg, (If not, husband and wife authorized by Wis. Stat. § 706.06) to me known to be the perso ho executed the foregoing in ent and ackno edged the same. THIS INSTRUMENT DRAFTED BY: T FSA Title Services, LLC 5645 Memorial Avenue Stillwater, MN 55082 Notary Public, State of Minnesota C~'' My Commission (is permanent) (expires: 01/31/2014 ) rRISTINA T. pt~I i, i y be authenticated or acknowledged. Both are not necessary.) T ~rli K$AFY N~ltu11) FO ~1. ANY n10D1F1CAT10NS 'r0 'rt11S FORM SHOULD BE CLEARLY IDENTIFIED. wARR 1) Minnesota C 1-003 STATE BAR OF NVISCONSIN FORM NO. 1-2003 *1-P ,p an anlrussionExpires Jantla 31.2014 ST. CROIX COUNTY SEPTIC TANK MA'NT'EXANCE A.GREEME NT AND OWNERSHIP CERTMuCAT ION FORM Owner/Buyer ; j Marling Address ~ J 0 Property Address (Verification required from Planning & Zoning Department for new construction. City/State Pateel Identification Number ~~~:~D_LSC~IrrTl~clN Property Looation.5t_~ y4;5 _-N R._aW, Tom of Subdivision ~~b Lot # Certifltad Survey Map # - _ - Volume page # Warramty Deed # - ---------_Y Volume _ Page - Spec house yes uo----' Lot lines identifiable yes no SYSTEM MAINS'ENAI CE NER CERTIFICATION Improper use and maintenance of your septic syste maintenance consists of m could result in its prerrmture failure to handle wasmss t Y r punwirlg out the septic tank every three gears or sooner, if needed, by a li,:ensed pumper. ' haprop the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance put into responsibilities are specified in qCoatam, 93.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. ou i The Pa oPerty owner agrees to saabrnif to St. Cr owner and by oix County Plaruting & Zoning Department a certification fornn, signed by the j a master plumber, journeyman plumber, restricted plumber or a lit' ens wastewater disposal system is in proper operating less than 113 fallof sludge. condition and/or (2) after inspection and peunpin (if necesa (l) the on site i ary), the septic tank is T/we, the undersigned lu►ve read the above requirements and agree to maintain the private iaewage disposal system with tI10 standards set forth, heroin, as set by the Department of Comrrterce and the Department of Natural Resources, State of Wisconsin. Certification stating that ng your septic system has been Maintained must be completed and returned tC- 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. Uwe am/are the owner(s) of the j property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedr'" s i OF APPLICANT(S) - DATE - 't'**Any hdormation that is misrepresented may result iu the sanitary permit being revoked by the 1?'lttnrung & Zoning Department. i jlnclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey ma if preference is made in the warranty deed. p ~ tEV•. 08/05) -6Y I~...._-......._._., I - __....._.f-............ - . i V V z x I III IR x , l - I ; .I Ali p r-n r. r n I .f 11 y~. , g I >r; _ , - 1 ~1_ d1-1 ~u IaIA~E,>_> ~''T-_"'ffff fr 1 F. III x ?I~... r,.! f - - x r Pil, _ F _ ri I IL_. - - n ¢ ~ s . Hk It , g I n T R 1 I i I ~ ^ q I 1 I I . a M I I I I r-.....-I. i...._~ _ Irr... wIr D M - A ~r ............._-.__._...._.-..........;M._-... _ _..,r_.__... r r. i ~ i C y S1Ii y I~ U ~ i ,rt - Orr rr _ . j ~ ~ h ' . ~ o.r ~n ul .nuFr. ' f ~ I ff... -If {$T ~ al •~f ~ a ~ f141 • , Y A' 1111111 ' k • I , I 1 rr~ j. rt• Y o r gg, r.5 I r. h I fill 1-'-" {9~ Imo; Ir k i- t,rn• rth ,41.E m - F ~ 1 i ~ r „ te• is _ - K I~ d~~l ik r i x ~1 ~ ~ rr ~ sr 9i I ' Ylr, l~ , 4 1 11 :/A ~un _ 1~~1CS'1\i'\ll'~\\ll\S~ i'1\11Si~,'ti 11 1S1"\vRl1SSl~llll~t J rI ~l I r(__ r, yy n A ~ C........._ 5....... x. .......1 r K IA I i rr ur ns _ _ i........ - ❑cIQ III Qo~ I~ . ~J100❑ MOOD MOO MOOD hr WOOD - _ _ SCI®CJ MOC30 mingnif am 1 y-- M OOD aq MOOD MOOD N RPM u -JI -fit,, - ~ . IMsconsin Department of Commerce SOIL EVALUATION REPORT 3 ►Ivisionmt Safely and Buildings Page of In accordance with Comm 85, Wis. Adm. Code Attach cornplele site plan on paper riot less than 8 1/2 x t t Inches In size. Plan must County Include, but not limited lo: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Q7 U- Please print all Info"naflon, Date Personal informalioo you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). MZ(U/-W L 1 01 2 Property Owner ~Q Property Location p q ~0 G Govt. Lot SW 114 5~ 114 S 7 T ~b N R (or)W Property Owner's Malling ddress Lot # Block # Subd. Name or-~ cu 3 9 9 N- 6-100 W G/o 0ER G/47ti 2 j6,as y Slafe Zip Code Phone Number City []Village ® Town Nearest Road HUP50AI /U/. s yoi6 , ~~s , y~~ ' ~2 y3 ~.eb ~~ts G~DV~~ New Construction Use: 7C Residential / Number of bedrooms 3 ' Code derived design flow rate ~SO GPD Replacement Public or commercial - Describe: 01 Parent material _ ~Q~S S DGf ~~,(J~/ d(J fw Flood Plain elevation It applicable ry, Genera( comments CD and recommendations: S .3 v~~ -~-~-f~ ^ Scud. MAY i 1 5 Of 4414,1 sr 2402 oIR F BoringL] Boring 111 pi( Ground surface elev. ✓ R. Depth to limiting factor 1> in. Soil Application Rate - Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ry: In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eft#2 / 0•11- /0 ,e 2 3 L :fshx %o -fl? w 3 f _ S , 9 Z 3 /0 y/Z 311 51- /rvt -FR a s / f - y ad 171 A i) U Boring # L] Boring O f --j pit Ground surface elev. / ft. Depth to limiting factor ,~~4 - < ` - Soil AppUcalion Rate florizon bepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0.17 /ay/? i3 SL zfsh/c ~••If%2 ~u Zf s 2 ~l A0 12 3 - S e L / f5 r~ ~►-f fi ' cs /v z 3 -s6V /a R sc ~ f ,e ~ fe Q s r- , Y . G 0 S. E& y l s % .SoiG ~j~G C~1` T/o /elf E Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = SODS < 30 mg/L and TSS < 30 rng/L CST Name (Please Print) Signature ~ E r CST Number Address /J ~ `3 ?s Date Evaluation Conducted Telephone Number 30 ~is•3~~• ~i~S Private Sewage Consultants ZOQ L 655 O'Neil Rd. Hudson, Wis. 54016 • j G/ovFi2 Gleam - 7 i Property Owner r 1/0 106 y - yC, lJV'~ 3 Parcel ID N 3 Boring # ❑ Boring Page of 'll Ground surface elev. fl. Depth to limiting factor In. tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ApplicaDMI In. Munsell Qu. Sz. Cont. Color GPI Gr. Sz. Sh. 'Eft#t ' Eff# 2 2i 10yp z sic 2 s z Zz • / f h~ ,,.aft 4J 1+'~ s .8 Yle (3 3 /,0 yle S<L / fS nM~'~' 2 iv 1, '7.6 Log C-S LIZ- Boring # ❑ Boring ❑ Pit Ground surface elev. Depth [o limiting factor in. I lorizon Depth bominant Color Redox Descrl lion Soil Application Rate P Texture Structure Consistence Boundary Roots Gpp/n: In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eltlf2 777-7- Boring # ❑ Boring ~____J ❑ pit Ground surface elev. It. Depth to limiting factor In. Horznon Depth Dominant Color Redox bescrl tlon Soil Application Rate P In. Munsell Texture Structure Consistence Boundary Roots Gpp/n: Ou. Sz. Cont. Color Gr. Sz. Sh. 'E%#1 'Effl12 Effluent #1 = Bops > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 02 = BODe < 30 mg/L _ mg/L and TSS < 30 The Uepar(Inent of Commerce is an / equal opportunity service provider 4nd 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. SPn-RJ 10 rR 6RR1) I Properly Owner /0 • ~zo 2 3 killIng Parcel ID # 8oring # Page of Ground surface elev. fl. Depth to limiting factor > `Q In. Soil Application Rale 1lorizon beplh bornInant Color Redox Description Texlure Slruclure Conslslence8ounda Roofs WWI' In. Munsell qu. Sz. Cont. Color ry Gr. Sz. Sh. TIM 'Eft#2 0. 2Z /DYR / 2 -sic z 7`sh,~ ,►.uf/~ 4J 3 , s , 8 L- Zz 30 y/~ Stc 2 "C'M't 7w w 3 7c , S e /0 Ye 0' • '7 I. 2.. 8oring 0 Boring IJ ril Ground surface elev. Depth to limiting factor In. Horizon beplh Dominant Color Redox Descrlptton --Texture Slruclure Conslslence Boundary Rools Soil Application Rate In, Munsell GPD/H2 Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r 8oring # [j 8oring U hit Ground surface elev. fl. Depth to limiting factor In. tlorizon Sofl Redox Description ApplicationRale Depth Dominanf Color ---Texture Slruclure Consistence Boundary Roots GPD11t2 In. Munsell Qu. Sz. Cool. Color Gr. Sz. Sh. 'EH#1 'Efl#2 Effluent #11 = 130D9 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent 02 = 8009 < 30 mg/L and TSS < 30 mg/L r 7 he Department of Commerce is an equal opporhrnity service provider, rind 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. SPr1-R,In rR 6lIN1) . I 3 0 3 o T 8 Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. 1 Hudson. Wis. 54016 I PIJIJI- AO ~te t 3D flu J 1 • ~z o ~ 330 d 9'9- SD ' Cov ox 0 x/71 o Z0 131 • - 13.9c~~ ~,'TS L 13m clow -/,0 0,,e -rtolp of -31f /00, O ~~~1 !J ~9 T%4 •~J S So, Go T L- - 2 / y " ~a T 7 rMsconsin Department of Commerce SOIL EVALUATION REPORT 3 livision bf Safely and Buildings Page of in accordance with Comm 85, Wis. Adm. Code _ County s?'• Attach complete, rile plan on paper not less than 8 1/2 x f 1 inches it, size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Q,7r.1 , Please prinf all infonnaflon. Reviewe by ale-°°~- Personal Informallon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location p p 9 Govt. Lot sW 1/4 s~ 1/4 S / T ~b N R (a) W Property Owner's Mailing ddress Lot # Block # Subd. Name orA41f., 3 9 9 N- 6/oU lL--R 13 - G/o DER G/~.v A(V City Slate Zip Code Phone Number City ❑ Village © Town Nearest Road HUP56A) !U/. s yoi~ 1(7/-S') y~~ • !z Y3 ~lPo s G/ov~~ ~D New Construction Use: Residential / Number of bedrooms 3 ^ Code derived design flow rate ySO " (p d a GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material /Q~~S Q ~ ! ~ rlood Plain elevation if applicable n, General comments and recommendations: S R~~+C'1 i 3 C VEo MAY S 224n q) Boring noting 07 c 2 CROIkC~ pit Ground surface elev. " SZ fl. Depth to limiting factor ' 7,:Y In: N/NG O UNry Iicall Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 #002 ! n p _ /O Y/? z 57/ Zfs b,~ ~►-►~~P w zf . ,S , y /0•17 n /7.3 L f5Ae API f'i' e? s /U f Z A~ U Bodng # Boring 1403.20 Pit Ground surface elev. - it. Depth to limiting factor > Co In. Soil Application Rate I forizon Depth Dominant Color Redox Description Texture SImclure jj Boundary Roots GPD/111 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#i 'Eff#2 01 2 /o yR y/3 L /fs hK 2- ia•z io R33 s/~ 2f b c s zf . s 3 2,38 /o S iL If 5h& /hi -f a s f , Z . 3 Y- 3 9 - 66 2-5 )(le s D /D S S D V7 l•Z Effluent Of = 80bs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature f Nu er RCJ/3F/c' C~T f ~Z7() e^~1 ~~.~i%e~r.~v--,4 - Z Z4, 3 S Address Dale Evaiualidn Conducted Telephone Number 3o- Private Sewage Consultants 655 O'Neil Rd.a Z Hudson, Wis. 54016 ANAL LOT f Pr y /ni y CC~, operl Owner Parcel ID t.7 7 t~ • /v~ / U(J`' 3 1130fing # u boring Page 2 0l Lam! Pit Ground surface elev. it. Depth to limiting factor ~ in F::2 Depth Dominant Color Redox Desc►i Icon Soil Application Rate p Texture Structure Consistence Boundary Roots GPD/tt' In. Munsell Qu. Sz. Cont. Color ~ Gr. Sz. Sh. 'Elf#1 •Eff#2 /Q 2 $~/L _,yr S`J~ ~ I w i9 ~o y 3 sip 3 /fshx /HMI f f . 8 !D 1A boring # boring ff V0%a P! 7- 7'~6 17"- S'~if O.tJ S S ~ 4 Pit Ground surface elev. ft. Depth 10 limiting factor 3 In. Horizon Depth Dominant Color Redox Descri lion Soil A MG llcallon Rale In p Texture Structure Consistence Boundary fly Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#2 Z 4~ fiw 3 cz~ M oTs SiL • 3 djr'o !~S 1117Cr • Cv - . Z 3 Boring # boring pit Ground surface elev. ft. Depth 10 limiting factor in. i 1loriron Depth Dominant Color Redox Descripfion Soil Application Rate In. Munsep Texture Structure Consistence Qu. Sz. Cont. Color Gr. Sz. Sh. Roots GPD/fh •EfI#i 'Eff#2 Effluent #t = BODs > 30 < 220 mgt. and TSS >30 < 150 mg/L Effluent #2 = bODs < 30 mg/- and TSS < 30 mg/l. The Department of commerce is an equal o y provider, service 4 1 need.material in an alternate formal, please cont. ct the department at G08r2GG31S1 or TTY G082G4--g777 services or SDn-~Iln (R 6Hxr) i r 4 Go T Properly Owner I K ~1 J 0 1/0 • /0/ ~ • ~7 Z 131 r t Parcel ID a Boring a U Boring Page of bd Pit Ground surface elev. it. Depth to limiting factor / 3 _ In. Horizon Depth borninanl Color Redox bescri Zion Soil Application Role p Texture Slruclure Consistence Boundary Roots C,pp~n: In. Munsell Qu. Sz. Coral. Color Gr. Sz. Sh. Erra1 D • /2 /O •Erra2 3-F 8 Z ~ 7fX h w z . Z 3 X9.3 /o y~ S/L 6 3' 7•S ih, Pill . S s q- a2 C'S io i • Z Boring a ❑ Boring 1/0/'10 7- 716 pit Ground surface elev. ~ d (l• Depth to limiting factor 00 In. horizon Depth Dominant Color Redox bescri tion Soil Application Rafe In p Texture Slruclure Consistence BGpp/ti Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Pi /D ~ .1511#11 'Efia2 d s/L 2 FSh,~ /mar f2 s 8 Z fig' 3 /D 3/3 f 15% c 441-Fl w .3 c z M ©TS / ,~,N 7c/ ' Cv L . 3 p • p ~lv TS e z ` Boring a U noting U pit Ground surface elev. it. Depth In limiting factor in. Iorizon Depth Dominant Color Redox Description Texture Structure Consistence Soil Application Rate In. Munsell Qu. Sz. Cont. Color Roots GPD/II' Gr. Sz. Sh. TIM •Effa2 Effluent at = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent a2 = B OD 30 m /L and TSS < e< _ g _ 30 mg/L The UeparUnent of Commerce is an , equal opportunity service provider, qnd employer. If ou need asst need.mnlerial in an alternate formal, please contact tlr y stance to access services or e department at 608-266-31 S 1 or TTY 608-264-8777. SDn-R)10 IR bmn 1 I H IN, `C W • CQ 11 M~ 1 o = r- Irbo I T M ? O A ~M M m o ~ od cr M 0 00 07 -/-.-9-7