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HomeMy WebLinkAbout014-1063-40-000• y Wisconsin DQpartment of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hall,-Bat:ef-Sr~tsh Forest Townshi CST BM Elev: In BM Elev: BM Description: ~ ~ t ~ . o' ~ ~ • o' / ~' ttv,a,~l ~ K ~, ,~ c~'T gvtti 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic S /~ Z~U Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ Dosing Aeration Holdi SOIL ABSORPTION SYSTEM / I ~ 1 ~ u nru.~1 c.c /vLrnitp.L~ ELEVATION DATA county: St. Croix Sanitary Permit No: 420742 0 State Plan ID No: ~~ ~ Parcel Tax No: 014-1063-40-000 Section/Town/Range/Map No: 30.31.15.476 STATION t+ •°~ I FS ELEV. Benchmark 8'•r3a. ~ ~ ~ Alt. BM Bldg. Sewer SUHt Inlet .93 StIHt Outlet S.Z Dt Inlet Dt Bottom Header/Man. Dist. Pipe ® 7 ~ .7 Bot. stem ~ 5~ ~' 3.a 2•B Fina..~-----' i'l of ~ 95" 9 D C St Cover p,~ d.~ ( lJe~t? cR ~•ic~ ~ ~ ~~C"~ 1 " BED/TRENCH Width ~ Length ~ No. Of Trenches PIT DIM SIONS No. Of Pits Inside Dia. Liquid De DIMENSIONS 2 ~b ~Zr ~q• J 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI Manufacturer: INFORMATION CHAMBE OR Type Of System: • mil ?'~ ,v ' (~t _ UNI Mo el Number: ~' 0 ~~ DISTRIBUTIOIy,SYSTEM Header/M nifol N Length Dia_ Distribution Pipe(s) Length Dia Spacing x Hole Size x Hol acin Vent to Air Intake ' ~ ~ I SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlrrench Center Bed/Trench Ed es g To soil p ~ Yes No ~~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 ~~/ Inspection #2: !-~~ Location: 2648 Hwy 64 Emerald, WI 54013 (SE 114 SW 114 30 T31N R15 ac ~ S ~ ~P,arce~ o: 30.31.15.476 f W: 1.) Alt BM Description = ~. ~~ r~ 2.} Bldg sewer length = 3 D~ 92~ ,- S • Zt~ ~. S'p -- ~• S'2 ~, // -amount of cover=~ } "~, ~, ~ ~~l y yZ_~~ s, ~'s i_•~c, • 1/•3~' .,{ ~~ `W Va' l9 .r1K`lr { 3 ~ S ___ o D ' iws~ I raw. ~~~- Plan revision Require ~~ Yes ~I No .O~ Use other side for additional information. ~ ~ pth SBD-6710 (R.3/97) Date Insep~s Signat~~ye .c Cert. No. PUMP/SIPHON INFORMATION Safety and Buildings Division 201 W. Washington Ave.. P.O. Box 7162 Cam' ` ^~+A~~S,n Madison, WI 53707 - 7162 Sine Address De artment of Commerce oZ ~ g Sanitary Permit Appli ! ~"" P"°°" N'mtber In accord with Comm 83.21, Wis. Adm. Code. personal - ; ~ ~~ otm `P~'~ E ~ D (plc if Revision ~a ~ ~ ~ ?j ~><aed~ Law sig. 1 m t. Applitxttion Information -Please Print AII Information ~ A ~ ~ I 2 ~ O ~ State Plan I.D. Number Propertyt~aer'sName ;T.CRO{X COUNTY Parixl Number (y!~/-/D(o3- c/O-DOD I I ~ ~ Prouty Owners Q ~- U ~ ~ U ~ Pro~p-erty I.acation 2 /~ ~ ; S~~ TJ N, R ~,~ Stagy Zip Code Phone Number I.ot Number Block Number .~- _ N e,~,J ~~ ~~ S~ `~0 ~ Subdivismn Name CSM Number _~ _ d of BnOding (check all apply) 21,3 ilk ~ ~~ Deity /1~Da~Yh~ ~ Z Family Dwelling - Number of Bedrooms DV' e ^ Pabiic/Comtnercial -Describe use P ~- ~ /~ ^ State Owned > ~Y~'~'~-C'~~ G~ 1 ~ r 3 XX ~O'~ ~ Nearest Road ~QS¢' a7~ !II. Type f Permit: (Chetdc only one box on line A (numbering sd~te for internal use). Ctmtplete lice B if le) ~ 2 D Replaxmt~ System 3 ^ Replatxment of 6 D Addit~n in For C°'mh use sty Tank seem B. ^ Chtxk if Sanitary Permit Previously Issued Permit Number Dam issued III, of Permit: (Check aII that apply)(numbering scheme is for internal ffie) s' . (~ b t S-~ aa~~ -Pressarizea rn-Grand z1D Mouna a7 D sand Fiber so D eonsttacoea weaand 3~ ,1 ~f~ - 22 ^ pressurised In-Gmund 41 D FIoldiog Tank 48 D Single Pass 51 D Ihip Line / {~ /, I r as D At-Grime 46 D Aerobic Treatment umt 49 D Recirailating 3o D other 3 . S `I. Area Information: ~ S% Design Flaw (gpd) Dispersal Area Dispersal Area Sot? Application Retptired Proposed Rate(GaIs./Da .Ft.) ~ RaBe (Min• System Final Grade Elevation 9,5.2-~, ~~ // ,, f S~ 0 5 8 ~ `~ -` ~° VL Tank Info Capacity m -Total Number Mamr6tcturer Pre Site Steel Fiber plastic C~ilons GaIIons of Tads W/Z2~ A -~~~ Concreu Constructed Glass New F Tacks Tads Septic ae Botdiaa Tank _ ~ Z >~ VII. R~st"bility Statement- I, the assume rbitity for instaliatlon of the POWTS shown on the attached plans. Plumber's Name - ~ MP/I~RS Nuadxr 2zb 9~ Business Phone Number i~ -z ~~~ ~ plumber's Address (stmt, City, State. ) ~ fa r s ~l ent use Approved ^ Disapproved ~~Y Permit Fee (mcitzdes Growtdwttoer Date Issued effi Signature Staffs) ' ~) 8e ^ Owner Given lmtial Adverse ~ as ~~ ~ ~/ ~~~~ i _ n ~dition/s ~ ApprovaUR~~sot,,o~s,,f,~or~D'~sPP ~~ ~i0~ r~~~~ ~f..~rI7T.I' /~qf/ /~,~~G~loin.C.~y ~'.~h . 1 ~G~G%Y-~1.~?it~ ~l'`.GtQ~~`" '`' ' ` GAP' ° U Lt,~- ~ `~,n~-yLvyy. d',3, S~vR~t~ ~GLlt.~2(/ ~~tr ~ D~~ n~a~ s s~ ~ ~Olt1TS ~~~h. ~p~ ,,~h_ • t~ tro the e~ aoa) ree me on papa.at h SBD-6398 (R. OS/01) s t: u toe h< ~/7~ . ~3.-O ' PLO AN PROJECT Doug Hall A D ss P. .Box 381 New Richmond Wi 54017 SE 1/4 SW 1/4S 30 /T 31 N/R TOWN Forest COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE ~ /31 /03 BEDROOM 4 CONVENTIONAL XXX IN-GROUND P SS RE CONVENTIONAL LIFT HOLDING TANK: MOUND SEPTIC -TANK SIZE 1260 gallons LIFT' TANK SIZE DOSE TANK SIZE , HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1586 # of chamber 51 ,BENCHMARK V.R.P. Top of Nail in tree ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM SYSTEM F,LEVATION 91.7/90.5/89.5 Top of Steel Fence Post @ 100.0' State Hw 64 Address is 2648 Hwy 64 Emerald _ . ~ Previously established u Pro 4 Bedroom House 30' 100' Plans Designed Using Conventional Powts Manual Version 2.0 1100' 100' Alt. ~: B.M. 3.M. B-1 c~6.2 ' ~ ' 20' ' 90 70 500 Vents B-2 u a Vents 7% B-3 q3,o Siope Vent 0 ~ 3-3'X107' Cells with >3' Spacing >6" Standard Biodiffuser ~ of Cover Leaching Chamber with 31.1 ft2 of Area 6'tLong 11 "h•~ _ Grade at Svstem Eleva tion ' - YLU'1;' AN PROJECT Doua Hall A D ~ Ss P. .Box 381 New Richmond Wi 54017 SE 1/4 SW 1/4S 30 /T 31 N/R~ TOWN FOreSt COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 1 /31 /03 BEDROOM 4 CONVENTIONAL XXX IN-GROUND P SS RE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SI'LE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chamber 51 ,BENCHMARK V.R.P. Top of Nail in tree ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same aS Benchmark SYSTEM ELEVATION 91.7190.5/89.5 Alt. BM Top of Steel Fence Post @ 100.0' State Hw 64 ~ Address is 2648 Hwy 64 Emerald ~ Previously established r~ Pro 4 Bedroom House 30' 100' Plans Designed Using Conventional Powts Manual Version 2.0 B-1 Vents 90' B-3 100' Alt. B.M. .M. 20' 70' B-2 Vents (7% Slope nVent 3-3'X107' Cells with >3' Spacing >6" of Cover 6 kLong111 "h~~i 1100' 500' a~ .~ a. Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area at Svstem Elevation vJisoonsinDeparbnentofConanerce SOIL EVALUATION REPORT Page~of~ Division of Safety and Buildings ~ accaaance wan t.omm esa, vns. Aom. was `/ ~ryJr ~ ~r a ~~ Plan must er nd less than 81/2 x 11 inches in size Attach com l site l on a t . p p p p e e an indude, but not limited to: vertigl and horizontal reference point (BM), direction and Parcel I.D. // ~1 ' /~ % ~~ ~ '~ ~ percent slope, scale or dimensions, north arrow, and location and dista rest road. f 7 O 7 Please print all informatio ~ ~y~ ! 4 t ' evie Date ~S 3 ~~ V 3 ~iYyv ( aq Law. s. 15.0 PerscnN in(ormstion You P~~ ~Y Ne used for secondary ) (m) . ~ . ti / Govk Lot .s~ 1 /4 s,,, J 1 /4 S,~ T 3 N R , E (or Property ddress Lot # Block # Subd. Name or CSMf/ State Code Phone Number ~ ~ ^ City Yilage Town Nearest Road ~ > 1 S) New Cortstrtx~ion esidential / Number of bedrooms ^ Replaoen-ern ^ Pu is or raai -Describe: Parent material reconatwns:vc~~~(2c.-., ~`'i~~jr„~C~.~ Code derived design flow rate~~. ~> U GPO _ _ ~. Flood Plain elevation 'rf pplicable ~~~J~ 8. ~I ~7 (~ ~ 7~ j D ~' J ~'S~ ~ ~~ ~ S 1 ~~ # Pit Ground surface elev. + ~1t. Depth to frmitirtg factor ~~j- in. SoN nation Rate Hofiaon Depth Dominant Cd Redox Description Texdxe 5tnxxure Consistence Boundary Roots G in. MutrseA Qu. Sz Corn. Color Gr. Sz. Sh. 'Eif#1 'Eff#2 ~ ~ / ~~~ ~ /~ Y ~ ~- ~ X13 "~~ ~ ~ .3" ~/~ y2 / '' ~~ 7 / h Boling # ~ Bonng Pit Ground surface elev. ~' z fi. Depth to limiting factor ,~~. '(~._ in. Soti Rats Florizort Depth Dominant Cd Redox Description Texture Structure Consistence Boundary Roots GP DIff fit. Mansell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 r . ~ ~ ~~> ~~ s~ ~ J 2 !~~ ~~ ~ ~ ~ N Z , ~, ESfltlent #1 = < 220 tngil and TSS >30 < 150 " Elntrent fit = t3V'U : Ju mgrr. ana r a5 ~ 3u mgrr. CST (Please Print) _ - ~~ Adder f Date Evaluation Conducted T Numbed Property Owner Parcel ID # Page 2 of ® ~~ # ~~n9 Pit Ground surface elev. ft. Depth to limiting factor ~. SaN Rate Horizon Depth Dominant Redox DesaiPtian Texture Stnichxe Consistence Boundary Roofs GP D/fF in. Munsefl Qu. Sz Cont Cobr Gr. Sz Sh. •Eff#1 'Eff#2 ` ~ / 3~G J"' ~ ~ U i ~ ~ ~ ~ ^ Pit Ground surface elev. ft. Depth to Iunitirg factor in. ~~ # ^ ~~ Srnl ication Rate Horizon Depth Dominant Redox Desciption Texture Stnx~ure Consistence Boundary Roots GP O/ff in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 o ~~# ^ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Rate Horizon Depth Dominant Redox Description. Texture Stnxxure Consistence Boundary Roots GP D/fP in. Munsefl flu. Sz Cont Color Gr. Sz Sh. •Eff#1 'Eff#2 • Effluent #1 = BODs > 30 <_ 220 rrglL and TSS >30 < 150 mglL • Effluent #2 =BODE < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sea-tsw (r~~noo~ . 3 of 3 Soil Test Plot Plan ' Project Name Doug Hall Shaun B' r' Address P.O. Box 381 ~,~,r New Richmond Wi 54017 #226900 Lot ----- Subdivision S E 1 /4 S W 1 /4S 30 T 31 ------- Date 1!16!03 N/R15 W Township Forest Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of nail in oak Tree ,~~~ ~' System Elevation 91.7/89.5 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 100.0' State Hwy 64 X20 ~~z Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being insta{led in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 OwtierBuyer Mailing Address ST CR01X COUNTY _ - - - - - - SEPTICTANK h7AT~'t'B~T~-NCE AG~RBEIVIBIVT- . - AND. ~..: - . OWrTEBSHIP CERTIFIC~-TICSN FORM ,~ ~ ~ s ~ Property Adder .~~ l~~-' (yerificatioa Framing Department f~ new CitylState Parcel Identification Number O/ ~ • I D (0 3 - ~D ~~~~ _ Y,,~A,i~ D CRIP'1'ION ~- Location ~ 1/,, , ~'/., Sec ~ . T~N R~~~N, Town of _~2~~-~~. Properly .~-- ~---~ Lot # ..__ Subdivision _.. ,Volume ~ Page # ' Certified Survey Map # . - Warranty Deed # .Volume _, Page # no Lot lines identifi ~ yes ^ no Spec house ^ y SYSTEM 1tiIAINTENANCE ~m~~ulmetoewasoes.Proper ~md~coa~aeofyaars~CSY'~ a mto flue system og p otrt $ue septic tank evray three Ycazs or sooner if neoded by What y~ ~ can affect the f~metioa of ~ tank as : treatment stage im the waste disposal sy~'- y to saluuit Uo sr. Crrnc Zoning D a that 1 flue onacitie ~va~va~disQ~t sy~- The ovv~r restcidedphmxbarorap~ ( ) on ~ (2) after mspecti~ and p`m~ C~~ ~ ~ ~ 1~ ~sn il3 inn of slmlge• i/~ flue ad.have read the above ~ ~ ~ to maintain ~ > see wifli flte of (ia®aoeree and flue Deft of Nataral Resomees, State of Wisc~n. ~ set forflu, hereiq as set by flu Depa~nt Office 30 ~~ mat ~ septic systiem has been maintaiaod nma~st be completed and to the St. Cc+oix County Zoning of the three year date. J3 ! D3 DATE ICs]. OF APPLICANT OWNER CERTIRICA ON I (~) ctrtify that all sus on this f~m~t~t ~~ Q~~ ~°' ... ,y 'bed above, by virtae of a warranty ~J / ~-`.~ G1~iA OF APPLICANT I (we) am (are) the owner(s) of SI t being revokedby floc Zoning Department. **ssss #*~~t* Any information that is mis-reprereatodmay rat in flu sanitauY P~ s* cation a stamped warranty deed fiom the Register of Deeds office Indnde with this appti a mPy of the certified survey map if reference is made is the warranty deed '•J 1898f' 375 Ll STATE BAR OF WISCONSIN FORM 2 • 1999 Document Number WARRANTY DEED I This Deed, made between Orville L. Kuhn and May E. Kuhn, husband and wife - ----" _ = Grantor, and Dou Ig as R. Hall and Lynette S. Hall, husband and wife Grantee Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Southeast Quarter of Southwest Quarter (SE 1/4 of SW 1/4) of Section I'hitty (30), Township Thirty-one (31) North, Range Fifteen (15) West. Exceptions to warranties: Easements and restrictions of record. Recording Area X68 ~ H~+9 REGISTER OF DEED ST. CRUIX CQ,, MI RECEIVED FqR RECgRD 05-28-2002 9:30 Alt WARRANTY OEED EXEMPT i REC FEE: 11.00 TRANS FEE: 240,00 COPY FEE: CERT COPY FEE: PAGES: 1 Name and Retylq Addtts,. 1J~SVIa`.OCUST ~'88t Hudson. WI 54018 ~ I ~ J - `~~f '~`i 014-1063-40.000 _ __ Parcel Identification tuber (PIN) This is no t _ _ _ homestead property. t6r~ (is not) Dated this _ ~.~, d day of ~y 2002 , ~ ---• ~ Orville L. Kuhn ~i / -- T~-~t-sG ~., / - - -- - -..-. _ _ > Mav E. K hn AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ~) --- ---- --- ) ss. St~Croix County ) authenticated this day of , Personally came before me ~ ~ day of "'--_..-' __--- - 4 '9we named Orville L. Ku nand May E. K ,+v • -- -- ---- ------ ____ '~ '~a. L ..- TITLE: MEMBER STATE BAR OF WISCONSIN -- - . 'r...~_ 4'+ '/' __ (lfnot, to known to be the perstms)~ ~hpp~~e~xec~ed°C rlfGregoing i ment and aeknowledgeil ~~~ahf~.ya.pN authorized by § 706.06, Wis. StatsJ ~ .~ ; "~ , .. r• TH[S INSTRUMENT WAS DRAFTED BY L('P ,'S._~s f•~ ,~r+~` _ Thomas A. McCormack ~ '~'---- --- Notary Public, State of Wisconsin Baldwin, WI 2 ~ My Commission is permanent. not, state exptranon ate: t.Signawres may be authenticated or acknowledged. Both are not necessary.) _~ _ _ _.) • Namcs of persons signing in any capacity must be typed or printed below their signature. Wormetbn Proruxorwts canpanr. Fond a, ~~, wt STATE BAR OF WISCONSIN eooaisssos~ WARRANTY DEED FORM No. 2. 1999 I `"; ~ +FOI~EST PLAT T-31-N • R-15-W ~. ~ ~r (LabdO~VLeIY) POLK CO. See Pase 112 For Additlonal Name. 2t10D POLK / ST CROIX RD 2700 2800 2000 30iX1 9100 3200 ,~ $ Loral & Lcu~a Harold $ a a ~~ PaW A: r a ' N d: SAC h~ R ~e crmaahl Delores Patrick ry ~ g° Cormkan Shdf 1.11' Reed = ~ A R°ER K ~ y 6 Marly~ ~ Cevendoski ~$CeWr~ I ~„~ Ruth tl ~ 102 7 "~ 1 Rae Priebe r ~. + 2UIvl ~~~ a 62 83 167 a day ~ cREE ~ 137 43 CREEK U~~ Trust V i.. r ~g di~ xa~ 133 rn Cormican 224 ~ 161 Dorothy Lot?n m R R R Fuller ~ ta`Q°e Lomie Chad Aaron ~ teats 00 Jo a ( Lautsett Farms i & W di N ~ Y r~ela 10oas- COos- ~- o ~.- s 90 70 ° R Is. BISkLLPBId 80 ~ 40 >fer 40 ~ 4p `ys40 ~ kae do Helen [Juan Todd S °° ~ L 20 Ra4ert f0 sup.- ! ~ I .~ x>ux- 68 Pktz ~a f0~°-°- rent Rrtw ~ P S~bell~a ~ 80 B IBa ~ sQ ' .. s...~ 160 3a 80 50 ~~tl .~ n'" w X60 ~~ 60 Bknnherg Nihhey 80 39 40 l~5 ia![ o ~ "' t~ ~ 3T 230TH VE $ ~,g ~ 156 SYra 00 a "" i ~~ Star WaVoa jj aandaa apes R Yeee6 ' ~~ $ ~ a ~ ~ r.llrt to ProPeraes tt0 40 I11tIrL U 40 ~1 :o Shirla „~ ~ ~® ~ ,~q ~~ ~~ N $ Rose, Wayne I Harold & Brooks ~ fam6aedo ~ i O ~~ ~ ~ . Nv ~~ Shtrlee ~ a a8 Mithul ^ 2 90 80 ~ ~'" ~ ~% 120 Cress 60 BfOO~ 120 160 fop 60 N ~A Helawn ~ Richard g Leon& ~~r~ s~~a WaLl~na d` S Rhonda ~3 NBssen 1S 160 g~ Bergmann ~zI 40 Igesoa ~ ° iaomu 60 ~~ 160 147 eawD WRllam ~ M Denis PatrWc @ p y~ & Kathy dt TraJie t10 .J ~o~~ p L ~ cREFKOrm ~ H~ cape Hall ~ FiSerrt 96 StdnbRSer 160 ~ -_ n rs I 80 80 i Fou~4 ~ r 220th AVE ~ Nell g ~~ ~ O 195 97 M ~ o ~~ ~ I 1 ~ G~k« s Ukkh ~ Ond 40 Sim g 391 N N David a ~' a Kn~fts ~~ David ~ ~ ~ .• WBma Susan ~ aDOrls ~Fl 1 ~ Ccecs Anderwn o ~ 74 ~" 140 20 160 Schmidt ~ ~ u LE o Fouks ~~ s o Lu~ellag 4 ^ ~ u ~ Plus eo° eo° 1~ 1 ~~ ~i~ 1 ~ 158 z ~ m ~ ° Inc I m .0.,.7 Kurt 270 ~ ~ Inc e ~ ~~ ~gg ~ I n'~ ~ A a ~ ®g Farms « M liltl alien Dilt= O~~ 48 ~~i~ ~$ I G~ MontyR d g 52 160 ~~ 340 120 40 ~+~=. 1 220 V ek qD Z a Robert a#5 20 Kurtls g 210th AV~ g S a Scott ~ F leeta - ~ 240 I Z fifer fLert ® ~DavM & & Rita rn stlatR so.ep Z 51 90 40 H e~ p. ~ d1 Ir b O !k U~idlle EBevold ~ f- Dennis David &~ ~ ~w+>~l ~ ~~ Ro~E~ ~~ S ~a e $ I rn iLaurie $ MoR 112 'IYiISt 80 155 ~ 160 I ~_Roxn n r m 120 `~ / 160 40 160 ~ '- " s 205th VE Melissa W'VOi `~ r o ~" ,.IQ, eD ado '~ ~ r- Moll Edwin tJtrka e0ijohn ~ "Qs 49 40 198 ,~ ~ TeBi n S ~ ~ '~ ~' m ~I ~ 60 HaR Dairy '~ ~ ~' ~, Y 1~ ~~ a.- 'Inc b"a~. ~ y NN pZA! o ~a ~ n nines R Fbrence 168 r~unina 160 160 78 °i~ Inc 116 ~wTi a~dlr, Duvall 5 Ilh'kh Terrance r al~fp~ad- aeeR- ~~us'1f` /'~- 200th AVE trap a ~ w r ~- ~ - '~ 8"' & Lawrence am 8 Rhea ~S~P aDob~oar .yJ Bazille 76 ~ fo a 160 40 40 a Alice ~ 80 Lawr~mce 49 Ames a Keith s$ rdBlaha Alfred & Jy Voeltr Rr ~ p C,uy g McNamara John wtr Ludlle '~ K as 7J Maly Strom ~ 40 ~ w ~ 200 ~ 233 il..r~m ~~ )ac~m 75 s 160 111 ~\v,66 ~° n ^ trmpN6 rode a nine a sti.~e-o a~ aoo of 121 OrvIDe I 3 ~. ~ B~ b ~ 40 G B~ ~ Annette m~ aO„` T8 me8 5 p9 j ~ ~ ~~ @ Lisa ~ e tROa h & Fr~ races MID¢ aim s~ 6• ~ u9 ° ~ m a ~~ u ems, Hehibuch °i6S w tJ0 ~~ ~d1~ ~w~ ~ L 4 201 80 120 120 160 ]31 x M "' ~^, aoe 1 O 1 s ro o°o ~ Douglas ~ d' Dale & a Ar7me K Farina ^ 8 ~ I Shelley ~ ,~ ~ ~ ,B a 34 Susan ~ HW g0 Diamond ~ '~ ~~^ ~~~~ A T, s Eadm ~ (;IC JiZ~ ~ S Inc m F 155 40 VsS 220 ~~ 128 240 80 SO G, D cur a C; Sheldon Allen $ ro~ Melvin & g g ~n Forest ~ m o1 B ~ ~@ ~ ~G ~Id gt e$ N ~ i0aOn5On unls5s Wainer ~ Laura Michie 100 HtdinY ~'~~ fps Ludemann ~ $ ~ S' S S g Simonson cp t Ci[nfCl ~~ R ~ ~# Schmidt Club ~~ '^ Huol ~~ If ~~ m ffi 255 '~ ~c t 1 158 F'"'~ 160 80 S 160 so,.to,Zas Abbott ° I'~- Far 120 79 ]21 40 w EMERALD PAGE 54 GLENWOOD PAGE S6 ~~R~ ~ ~,, .~ ` p ~ ~ '~" ,i GI+E1TaIT00D CITY, MITI 84013 (715) 265-4429 (715) 265-4384 (715) 265-7255 FAX (715) 265-7604 ~ 7Z ~ n 3 m a, o m ~ ~ m C ro ~ ~ N 0 a~ v ~ ~ C ~ to Z D m ca D ~' ~ ~ ~ a c 3 ! O Z O o ~ ~ ~i a 3 o ~ m 7 p~ C 7 N 7 ~. Z 0 ~i ~ O N ? 7 fnD ~ O N 7 -~ C W 'O fD a ~ m O_ N Z o ~'- M v v (D O a co m c ZD o a .« n ~ r. ~ o. ~ ~ _. d ~ - m' o a ~ w S X N <_ 7 Vi N O 7 N to O O O ~- c rn o '. 3 ° ~ I coo 3 ~ N y O 'J N p N ~ c ID a a a m rn w m ..l a N N 0 0 W W ~~~o~ O O O W N N ~ v v ~ tD ~ ~ ~ d ~ w 3 ~ .. 7 .r C Z Z ~ D ~ N d1 ~. N N a 5 O C a ~ ~ a 3 °o :' 3 y z ~P C~ m c a ~ d o ~ ~ 3 ~ v c d ~ Rio' O O ~ ~ fa A .N~. ~ ~ p ' W V ~ O ~ O ~ o ~ aO? Q ~. 0 m y ~ N A ? n A 2 O •• ~ 3 m w o Z ~ ~ ~ ~ A d A'+ NI O C !x0 [ 1• O t~~ 0 • A n O O~ ~e ti ti, N O O ;~ ~q C~+a ~ ~ ti ~ ~°,, b ~ ~ i. , ~ '~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of in accoraance cairn t~ornrn a~, vvis. morn. ~,ooe County /' L- ~ lete site er not less than 8 1/2 x 11 inches ih size Plan must Attach com lan on a J _ L~ J p p p p . _ __ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D ~ ~ l percent slope, scale or dimensions, north arrow; and location and distance to nearest road. ® ,~ -D D t y- Please print all information. Revi ed by Date Personal information you provide may be used for seco dory p y (t) (m)). Property Owner rope Location / D U ~ S' ~,~ G Govt. ots~ 1/4,s~j1/4 S.3O T 3~ N R ~,S~W perty ner's Mailing Address Pr o of # Block # Subd. Name or CSM# / ~ / State Zip Code P ne Nur36~'ING OFFICE ^ ty ^ Village ~ Town Nearest Road N6/-c/ New Construction Use: ~I Residential / Number of bedrooms ~_ Code derived design flow rate ~ 5-O GPD -~~ ^ Replacement ^ Public orcommercial -Describe: Parent material ~ ~ / iS ~/ • ~ Flood Plain ation if applica General comments ~~G~~_ and recommendations: ~~~, 1111 e~e 7'LS G'o ~e /~ f ~ ~vR ~'1 a y ~~~ a ~ Boring `~~ Boring # © pit Ground surface elev. . ft. Depth to limiting factor ~ .3 in. Soil lication Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF p in. Munsell Qu. Sz. Cont. Color Sh . G r . S z. *Eff#1 `Eff# 2 / / ( ~ r ~( ~ ( M Q. ~'` ~/ y X ~- Iv-~ 3 o c~ a c R b~ vF.~ ~ S I ~~ - ~ ,~, ~ F s o~ S e ~ ~ M~6 ~ ~ ~s --' v ~ ~ - 6 ® Boring # ~ Boring _ / © Pit Ground surface elev. ~ 6~'ft. Depth to limiting factor ~ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o- l® 3 ~ S~~ M s6 K M~' A- S M , ,~ a- ~/ o ~~ cA6 M~~~ ~S IV , 6 l- ~, s ,~s~ ~~~ s o s G a m ~~ -.~ -- F , ~ * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' tttluent ~1= tic~us < su mgiu ana i as ~ ou mg~c CST Number CST Name (Please Print) Ig ture ~ ~ 2 2~ Address Date Evaluation Conducted Telephone Number r 3~~8 ~f~~. l ~o G~ecY~voa d ~i fi ~ ~ .~~~~.~ ~/ ~r/oz ~i.~a6.~ ~ti~.~~~,~~, !` . , Property Owner ,~0~/~`j{.S /flg~L Parcel ID # O.l~' /0~,~-' Lf0 -!%b0 Page ~- of ~ Boring # ^ Boring ®Pit Ground surface elev. ys; 6 ft. Depth to limiting factor ~ in. Soil A licetion Rate hlorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-/1 /0 3 a-- S/ ~ 6 M f4 ~ S ~ ~ ~" .- f 2- /- ~ v R L c ~6 ~i MvF G S / v ~ .. ~~ 3 ,5 ate' ~ ~ ~~ ScL MA~6k /"//-t -- 1v~ <6 Sf~o 7`S Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil A lication Rate H rizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff o p in. Munsell 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 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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