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HomeMy WebLinkAbout042-1076-90-300[nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563881 0 ERAL INFORMATION State Plan ID No: nal information you provide may be used for secondary purposes[Privacy Law,s15.04(1)(m)]. t Holders Name: City Village X Township Parcel Tax No: is, Cara L. Warren, Town of 0421076 90 300 M Elev: Insp.BM Elev: BM Description: �� �s/� _ //Section/Town/Range/Map No: /JG�.J •'t/l '�/`!� 28.29.18.437C K INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Y` 5 a Ate, Benchmark 3 Z 1 / �+ L/ Dosing // T / Alt. B. GO CO�� ` ,t�w Go.it� l4.2% F33Z ar eNJ 2.a �f-iJ /6O Bldg.Sewer IG 74°- 7 Holding St/Ht Inlet l7.?1 71", St/Ht Outlet TANK SETBACK INFORMATION , •A TANK TO �/�r WELL BLDG. (yenZoir Intake ROAD Dt Inlet Septic 7 56 76 Z 4 / Dt Bottom 21.7 75. Dosing 7 S6 ' 75 / 1 Header/Man. S.$ 47 1. Aeration Dist. Pipe s•ad 9 Holding ------ Bot.System 7, a Final Grade PUMP/SIPHON INFORMATION ,�(� 2, • SS 95-dS Manufacturer �( ,-)l. n� 6 Demand� St Cover rlL _44../........ / z .a� Model Number (' 4 (((JJJ 15 !t; I T _ r/ ----- ---- 4 DH Friction Loss System Hea TDH Ft �� fLift/S•� 2.9( / '� /g•gl Forcemain Length I Dia.Z/I Dist.to Well 15- SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No.Of Trenched PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 �l Z. (fE & i` �� \ SETBACK SYSTEM TO lQ P/L G'B-LDG WELL LAKE/STREAM LEACHING Manufaer: //�'� INFORMATION— 1 / ,-�- CHAMBER OR ,h,✓t Ih,•( toLi ,4 ON. /� Type C�G System: 7g f3Z. 7 Sad UNIT Modeldv J.eGIZ I 5�.......L..,Y DISTRIBUTION SYSTEM /tjo r41-- /(p 4-/L 3 Z 1-a 4-.,51._/al✓5 Header/Manif l 4 i/ Distribution x Hol ¢e x Hole Spacing Vent ytn it IInta�k ie Length Co Dia � 't Pipets) \�• a` t� / Length \ Dia Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only (~,� Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center s/, /L Bed/Trench Edges ` Topsoil \ Yes p No Yes e No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 751 112th Street Roberts,WI 54023(Gov't Lot 1 28 T29N R18W) NA Lot 3 Parcel No: 28.29.18.437C 1.)Alt BM Description= s '1 wt.lko e-Z e;JdS 1.../,SG/e. /� 2.)Bldg sewer length= 34 -amount of cover= /I If o.r"- cr-e-12. / / Plan revision Required? M Yes '( 1' i 1 4 ._ Use other side for additional information. �__,. 3 1 Date Insepctor' ignature Cert.No. SBD-6710(R.3/97) H li !i ! , .....,,,,... 1 , ...,. , , r _. 1 c 7 , ' , F '''J - '' p-, :......; i , it 1 r... ..../ 1 ' ._ ... ''' /# , . , 1■ 1 — 1 ' 14 i or,, licf,' 11) il al, , , v1 ..,) ...,.. ! I ■ ° i 3( i 0 .-- i 1 ..k1 f 4)1 50/ Vli) 1 1' ---f 11...-, 1b, ',A/W I / // ' A0- \I\ 36 -'*-- LSI —. 4 , . i ilt , 41. - I , 1 i•- i , N I h , 1 , i 1 oo 1 11. g. .71 2 0 3 7 -hi4 , 4 • jj 1 r " 1 kr) o a * • . : ' ... TII' L\ , - - - c .,--v.4.6: — 0 • , .. t- -, - -716 C"Iti-- 0 e e - A - 1 :) .-- N Z; I \ \ ‘ ' . , , 1 r-7 I / - 'A , l'5-Viso-alt --- alliiiiiillgitinallilin : „L811; 1 1 1 \ 12111111 Z 9 g.i 1 1 1 i ji......_! 7.C. : ,*1 . 1°I I ..........„..-------*t ,n., J 9 cf-44- ■ 14/ _1[44, ------ -Z,Y ------- .....-- , ?._-- -1-- ---- -- , _------- - - -1:-.1-1---- '-'-------" - - ...,...., - - ....-- .._ .--,- --,_ - County E+ f J~ Q / 9L 3v~"" r Safety and Buildings Division SanJ" 201 W. Washington Ave., P.O. Box 7162 itary permit Number (to be filled in by Co.) S- K Madison, WI 53707-7162 3 °JNA` State Transaction Number 1 permit Application 4g e t SP it. , Note: submission of this form to the appropriate Bov Project Address (if In accordance with different than mailing address) SAM. A Code ani Application forms for state owned pOWTS are submi Prof / ft d / is required prior to /ylpsd fpr secondary the Department o and P sional Servies. Personal information you provide may U oses t actor w' e priv Law s. 15.041 m , Stats. I. A lication Information - Please Print. All Information ^o/kc0~ Parcel # Property Owner's Name G Nn a 2- Q 0 © O 1 C A l J Property Location L13 _7C Property O 'wiling Address UJ Aye ItA) Govt. Lot `Phone Number Section g Zip Code (circle one) City,Sta T Z-9 N; R -Eorec . /V1 Lot # Subdivision Name ti /A II. Type of Building (check all that hat apply) 0y11 or 2 Family Dwelling - Number of Bedroomyy -Block # ©/L El City of ❑ Public/Commercial -Describe Use ❑ Village of CSM Number 1-5--7 U Z 7 T 7 -Town of Atf2 R E N ❑ State Owned -Describe Use III. Type of Permit: (Check only one bog on line A. Complete line B if applicable) [I Other Modification to Existing System (explain) A. ~Iew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only List Previous Permit Number and Date Issued ❑ B. El Permit Renewal- _--Q-Permit Revision Change of Plumber ❑ Permit Transfer to New Owner Before Expiration IV. T Le of POWTS S stem/Component/Device- Check all that a 1 ' of suitable soil ~f,❑ =X-f 24 in. of ui/ so Non-Pressurized In Ground ❑ Pressurized In-Ground At Grade 11 \ M d - 24 . pr eM. Dev_____ _,L-------- ❑ Holding Tank ❑ Other Dispersal Component (explain) ~tin~ DisPers Ar a Required (so Dispersal oposed (sf) System Elevation Soil Information: w (gp reatme esign Area V. Dis ersa Desi Fl d) Des Rate(gpdsf) i Total # of Manufacturer Capa ity in ~ ~ Y VI. Tank Info Gallons Gallons Units New Tanks Existing Tanks w U h is 2 0. Septic or Holding Tank r-PA Dosing Chamber Natt Bplans. usiness Phone Number VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTSh shown afore 7 `7 Plumber's ame (Print) Plumber sSi ` / (i Plumber's A ess (Street, City, State, Zip Code) VIII. oun /Department Use Only Permit Fee Date sued Iss g Agent ignatur proved ❑ Disapproved $ 0~ ~ I Owner Given Reason for Denial 7-1 lu+u~~ IX. CoCdYi8304>QY*~a~easons for Disappi'cival 0 1. Septic tank, effluent filter and ce", ~ dispersal cell must ~erYiSAd / msirLtain e~ i_ as per management plan provided by plumber.-T ~-OF 2. All setback requirements must be maintained as u,~,M- as per applicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than g 1/2 z 11 inches in size SBD-6398 (R. 11/11) ST. CROI_y EC TY. Land Use ~c? Planning & Land Information { Resource Management Community Development Department August 21, 2013 File#: LU88000 Cara Rubis 1415 Broadway, Unit #10 Hammond, WI 54015 Re: Land Use Permit, Filling & Grading < 10,000 sq. ft. in the Shoreland District 751 112"' Street, lot 3 of CSM Vol. 10, Page 2747 Parcel #28.29.18.4371 Town of Warren Dear Ms. Rubis: This letter confirms zoning approval according to the plans you have submitted for filling and grading an area of approximately 5000 square feet within 300 feet of the Ordinary High Water Mark (OHWM) of East Twin Lake to construct a driveway, single-family dwelling, detached garage, and private on- site wastewater treatment system (POWTS) on the property referenced above in the Town of Warren. Staff finds that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and Shoreland District with the following findings: 1. Filling and grading less than 10,000 square feet in area less than 300 feet from the OHWM on slopes less than 25 percent is allowed with a land use permit in the Shoreland Overlay zoning district pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance; 2. The filling and grading will consist of excavating -1200 sq. ft. for the foundation of a single-family dwelling, 2400 sq. ft. driveway and turnaround, 800 sq. ft. for the garage, and 650 sq. ft. for the POWTS, which will be located within 300 feet of the OHWM of a navigable wetland. The proposed driveway, single-family dwelling, and POWTS meet the 75' setback from OHWM and other required setbacks and dimensional standards contained in the St. Croix County Zoning Ordinance; 3. The applicant's agent, Lund Builders, Inc., will implement an erosion and sediment control plan. A storm water management plan will specify areas designated to infiltrate runoff from impervious surfaces (-3200 sq. ft. total). With conditions to install appropriate erosion control and sediment control measures e.g. silt fence or sediment "logs" between the construction area and the lakeshore prior to beginning excavation, to maintain erosion control measures until self-sustaining permanent vegetation is established on all disturbed areas, to prohibit the use of phosphorous fertilizer to maintain a lawn, to submit and implement a storm water management plan that infiltrates 409 cu. ft. of runoff, and record a maintenance and monitoring agreement against the property for the infiltration devices, negative impacts to the water quality of the lake will be minimized; 4. The lake shore is >150 ft. from the proposed house and the owner will be required to maintain the native vegetative cover within a 35' shoreline buffer zone; Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd co.saint-croix.wi.us Community Development Department Page 2 5. Approval of the land use permit will include a condition that an affidavit documenting the stormwater management plan be recorded against the property; and 6. The Wisconsin Department of Natural Resources staff has reviewed the application and commented that an appropriate infiltration system for runoff must be a condition of county permit approval. A DNR grading permit will not be required for land disturbance less than 10,000 sq. ft. and outside the 75' OHWM setback. Based on these findings, approval of the land use permit is subject to the following conditions: 1. The applicant or their agent shall submit a stormwater management design for review and approval by the Zoning Administrator prior to project completion. It must include specific details for and location(s) of infiltration devices that provide a minimum capacity of 409 cu. ft. to handle stormwater runoff from impervious surfaces. 2. A pre-construction on-site meeting must be scheduled with the county staff to verify placement of erosion and sediment control measures and recording the stormwater affidavit. The applicant will be responsible for directing contractors to implement storm water management and erosion control plans, which include installation of silt fencing, straw waddles, and/or sediment logs between areas of exposed soil on the construction site and the lake or neighboring property to control contaminated runoff. Photos will be taken to document pre-construction site conditions for enforcement purposes. 3. The applicant shall obtain all applicable permits and approvals required for construction of the driveway and house. The sanitary permit has been issued for the POWTS. The contractor will need to provide the erosion control plan to the town's building inspector for compliance with Uniform Dwelling Code requirements. 4. The applicant shall record an affidavit referencing the approved stormwater management plan with the Register of Deeds prior to commencing construction, before the pre- construction meeting (see enclosure). 5. The sanitary permit issued for installation of the POWTS will require compliance with all conditions of the land use permit and contractors must be made aware of the conditions regarding erosion and sediment control. 6. The applicant shall maintain all erosion and sediment control measures until permanent, self-sustaining vegetation is successfully established on all disturbed areas of the site. 7. No phosphorous fertilizers shall be used on the disturbed areas of the site, unless a soil test confirms that phosphorous is needed for establishing permanent vegetative cover. 8. Within 30 days of completing the project, the applicant shall submit to the Zoning Administrator photos of the stormwater infiltration devices and disturbed areas for documentation of compliance with conditions. Photos may be sent electronically via e-mail attachment. This approval does not allow for any additional construction, structures or structural changes, grading, filling, or clearing of vegetation beyond the limits of this request. Your information will remain on file in the St. Croix County Community Development Department. It is your responsibility to ensure compliance with any other local, state, or Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686 www.sccwi. us/cdd www.facebook.com/Stcroixcountywi cdd(cDco.saint-croix. wi.us Community Development Department Page 3 federal rules or regulations, including obtaining a building permit from the Town of Somerset. Please feel free to contact me with any questions or concerns. Sincerely, Pamela Quinn Land Use Specialist/Zoning Administrator Eric: Land Use Permit LU88000 Stormwater Affidavit form Cc: Brian Wert, Building Inspector, Town of Warren Mike Wenholz, Wisconsin Department of Natural Resources Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wi 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd(@co.saint-croix. wi. us CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE .L Project Name: CQ ev,J (A) ~ (2 Lu y(6 W L ~ ~ 1 Owner's Name: Q t-f b S Owner's Address: TlS ?ao A0 WAY u Al l-- /a l Legal Description: E G Z 7- Z 'I Township: County: C O x Subdivision Name: cJ /h ! 217 7E7 Lot Number: Parcel ID Number: 6) 82-,,,1076 l y -300 Page 1'', Index and title P"/f~ f/4N~ ~QotS-SK Page 21 Plot Plan ~ovvtp SpEc S Page 3! System Sizing & Cross-Section Page 4Filter Specs PA9r ~2- Coq Page 5' Maintenance Information Page 6' Management Plan Page 7' St. Croix Cty Septic Tank Maintenance Form Page 8' Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Q c(-So/y License Number: /Wjo Z 2 6 ~eL7 Date: °-C2 -(3 Phone Number Z7 3 9,mK Signature ~ Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 7~w J-o )og s ~ F.,•1 t - t Q'; r 1Y)._ 51-1 Joe W4 7 ~,v -TN k A c ► ISO 11 Absorption System Cross Section ft 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching Chamber 9ft System Elevation -ft ft :soil Absorption System Plan View b~ ft ft { Vent Or Observation Pipe Leaching Trench 1 ft Chambers 4" Dia. LTrench 2 Header !L.eachina Chamber Specifications Manufacturer Ag7d Model r~ f~! L f /~,q -~a7L Q WC(I- ~1.I1 S ~ EISA Rating sq ft per chamber Soil Application Rate gpd/sq ft gpd Design Flow + Soil Application Rate + EISA = Chambers 2.rows of chambers each. e C~qo z o ~y 5ys i page of Di pion of Safety and Buildings 11k nsin Department of Commerce ;LLa..~ TION REPORT` ~g K of in Code Attach complete site plan on paper not les'S must County ` include, but not limited to: vertical and horiz and Parcel I.D. l~ G percent slope, scale or dimensions, north a arest road. ( o - 3c Reviewed by DaPlease print aPersonal information you provide may be used fy 15.04 (1) (m)). Property er Property Location l l~ Govt. Lot 1 /4 1 /4 S ~ N R E( ) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# n , 0 C-,4" 7 ,J city fate Zip Code Phone Number ❑ City ❑ Village ~To 01 Nearest Roa J New Construction Userpublic sidential / Number of bedrooms - Code derived design flow rate ~d-zl GPD ❑ Replacement or s mme aal - Describe: Parent material Flood Plain elevation if applicableft. aYe X General comments 7 and recommendations:i Boring # ❑ Boring aZ1 7Pit Ground surface elev. ft. Depth to limiting factor l~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color r. Sz. Sh. 'Eff#1 'Eff#2 SI•~ ~Bonng # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L q~d TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST h(arrte (Please Print) Signatu CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Dat Evaluation Conduct d Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of 'Boring # Boring Ground surface elev. A-1 ft. Depth to limiting factor// 12 in. Soil -Application 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 4 A qA -7 ~vZ-- T ❑ Boring ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/_ • Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seD4330 (R.6=) Soil Test Plot Plan Protect Name Garrett Conover Shau i AJess 931 Ridge Pass Hudson Wi 54016 C M #226900 Lot 3 Subdivision Date 4/7/05 Govt Lot 1 S 28T 29 N/R18 W Township Warren Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 90.6/90.7 *HRpSameasBenchmark Alternate Benchmark Top of Survey Iron @ 95.4' A1t.B.M. 112th St. Scale is 1" = 40' unless otherwise B-3 noted 90' B-2 40' 10' 40' 20' 0% Slope B-1 i 509' Property Line Twin Lake • i. .a " A A1001300160Mmm12#1 The original ZABEL® Disc Dam Filter was patented in 1959. The 12" series filters have been filtering wastewater longer than any filter in the wastewater industry. In 2000 Zabel made the best even better by introducing a complete redesign of the original with more great features and finer levels of filtration. A 100-12T M Series the A100-12 is the commercial filter chosen by more engineers and installed in rte, more localities than any other filter on the market. The reliable performance and flow rates from 3000-6000 gpd allow this filter to be utilized in almost every application. The new ZABEL® Versa-Case' is available with built-in reducer and ' outlet hub that accepts either 4" or 6 SCH 40 pipe. The A100-12 Series is also popular many areas df research haslshuse due to its own the Al00-g2 decreases decreases by 0190% 12 capacity. Independent and CBOW by 20-40%. 1/16~~Filtration i Available lengths 20", 28" & 36" A300-12T M Series Long heralded as the ultimate grease trap filter, the A300-12 provides 1/32" filtration and has been shown to reduce FOG by as much as 50-98%. The A300-12 is also used for onsite wastewater systems which require a finer level of TSS removal, such as laundromats and dog kennels. As with all ZABEL Filters extra filter cartridges are available to speed service time and allow offsite cleaning of the used cartridge. 1/32"Fiitration Available lengths 20", 28" & 36" I` A600-12T M Series The newest addition to the ZABEL Filter line incorporates the proven performance of the disc dam design with the finest level of filtration available on the market. The 1/64" filtration of the A600-12 provides optimal filtration levels for those unique applications with very fine particulates and suspended solids. Every A600- 12 Series filter includes the exclusive SmartFilter® Alarm switch to alert the owner of required maintenance. 164"Filtration Available lengths 20'; 28" & 36" For further technical information: www.zabeizone.com 050103-244 START UP AND OPERATION content For new construction, prior to use of the POWTS check the d(persal call(s)for If highrconcentra tons ~a are detected have other that may impede the treatment process and/or damage of the tank(s) removed by a septage servicing operator prior to use. System start lip shall not occur when soil conditions are frozen During is restored the excess wastewater will b levels. When power. ill above normal highwater discharge o t Y f the backup outages power pump auks may discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in th P or surface tage effluent; To avoid this situation have the POWTS Maintaine rtodasby a s t in pm nually opa rating therpurmior p icontrols' U power to the effluent pump or contact a Plumber or restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the arei 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 -prol ngi t ec life of fate POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers, napkins ;an vegetable peelings; w ter softener brine ase; herbicides; meat.scraps; medications; oil; foundation drain-(sump''pump)* water; fruit painting prodycts; -pesticides; sanitary ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall ba taken to insure that the system is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed,, • . The contents of all tanks and pits shall be removed and properly disposed of by' a Septage Servicing- Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures'have been, or must be taken, to provide a code compliant replace ent system: A suitable. replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and. proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a now soil and site evaluation to- establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. El A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS.:. ❑ . Mound and at-grade soil absorption systems may be reconstructed in place following removal of the b)omat at the Infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER:A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. 00 ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name X Q Cc r?- ~ Lr 5,D.,`V Name T T Phone Phone S- Z 7:3 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY L Name G Q z D/✓ ,V Noma Phone Phone ~Lo This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL MANAGEMENT PLAN SYSTEM SPECIFICATIONS. FILE INFORMATION al /Q Owner (,k Septic Tank Capacity 13 N Permit # Septic Tank Manufacturer s ❑ N Effluent Filter Manufacturer L ❑ N• DESIGN PARAMETERS ❑ N, Number of Bedrooms 3 ❑ NA Effluent Filter Model )WNA Pump Tank Capacity al Q N, Number of Public Facility Units Pump Tank Manufacturer C.JIGz~ ❑ M Estimated flow (average) 3 60 gal/day 1~ 4-T Pump Manufacturer p u L 0 ❑ Ni Design flow (peak), (Estimated x 1.5)~ gal/day z s ❑ N~ Pump Model Soil Application Rate al/da /ft ❑ N~ Standard influent/Effluent Quality Monthly average" Pretreatment Unit Fats, 011 Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5160 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) [I NA Biochemical OxygenDemand (BODE) 530 mg/L Ain-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound 510` cfu/1Oom ❑ Drip-Line ❑ Other: Fecal Coliform (geometric mean) ys In die. ❑ NA Other: ❑ NA Maximum Effluent Particle Size Other: 0 NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank affluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA p ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At Ipast once every: ❑ month(s) (Maximum 3 years) 13 NA .3 ® ear (s) At least once every: ❑ month(s) NA Clean effluent filter ® ear(s) month(s) ❑ NA Inspect pump, pump controls & alarm 0 At least once every: 3 ear(s) • month(s) p NA At least once every: $i. ear(s) Flush laterals and pressure fast ❑ Other: At least once every: 13 month(s) ❑ NA ❑ ear(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent qn the ground surface. The dispersal,goll(s) shall be visually inspected to check the effluent levels in the observation pipes and to. check for. any ponding of effluent on the ground surface., The. ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority.)` When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the. entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code, All other services, including but not limited to thD-,servicing•of effluent filters, mechanical or pressurized components,, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ark, ~ud 1 t Mailing Address IY15 &Oadh/l~ t1 Unl _f Pa,097,1"-On 0 `'1✓I S11-101-5- Property Address ,~S_ +h Sfv Pe f r'iS (Verification required from Planning & Zoning Department for new cons ction.) r-r City/State. ~~rf,5 T Lr~s Parcel Identification Number D - /D 76 - 9Q- 36o LEGAL DESCRIPTION Property Location 1/4 , 1/a ,Sec., TN R W, Town of rren _Zg Subdivision Plat: f T 61 .Z 6e.,41 g lo l- 3 pl- es m 101a 7 $1T Lot # 3. do(- I* Certified Survey Map # 415 7a 14 Volume /o Page # 7 5 7 Warranty Deed 970 5 93 (before 2007)Volume , Page # Spec house ❑ yes P(no Lot lines identifiable, yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms --11311I_3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) State Bar of Wisconsin Form 7-2003 8 Tx:4 95333 2 TRUSTEE'S DEED 970593 i Document Number Document Name BETH PABST REGISTER OF DEEDS THIS DEED, made between Deborah M. Conover ST. CROIX CO., WI 01/02/2013 1.25 PM as Trustee of Deborah M. Conover Revocable Trust EXEMPT#:NA REC FEE' 30.00 TRANS FEE: 258.00 ("Grantor," whether one or more), and Cara Rubis, a single person PAGES: 1 ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St. Croix County, State of Wisconsin ("Property") (if more space is Name and Rcturn Address needed, please attach addendurn): Cox o- Rpt~bi 5 1O Lot Three (3) of Certified Survey Map in Volume Ten (10) of Certified Survey Maps, Page 14116 prOC.&Wv 2747, as Document Number 515724, filed in St. Croix County Register of Deeds Office on ~d thr two 1 I :5,4o(5 April 22, 1994, being located in part of Government Lot One (1) of Section Twenty Eight i Q-54 B (28), Township Twenty Nine (29) North, Range Eighteen (18) West, Town of Warren. Subject to 112th Street right of way. 042107690300 Parcel Identification Number (PIS Dated (SEAL)U✓Ct/! Y ~UC~✓ (SEAL) * * Deborah M. Conover, Trustee (SEAL) (SEAL) *w . aK ~x rl 1 ;.t. .AUTHENTICATION ACKNOWLEDGMENT ibiiatije(ti)'`_ STATE OF WISCONSIN ) V5 ) ss. Pdblie }a n ^fl V,,!iSr0rc:jn PIERCE COUNTY) Personally came before me on CE> tri t ~O 1 Z the above-named Deborah M. Conover TITLE: MEMBER STATE BAR OF WISCONSIN (if not. to n3c known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrun i t and ackno lecl e the same. AN THIS INSTRUMENT DRAFTED BY: Leo A. Beskar, Attorney Notary Public, State of Wisconsin Rodli, Beskar, Krueger & Pletcher, S.C. My commission (kxptatxxxxomt (expires: 119L- o1~'S - ~y ) (Signatures may he authenticated or acknowledged. 130th are not necessary.) NOTE: THIS IS A STANDARD FORiNI. ANY A9oDIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED (02003 STATE 13AR OF WISCONSIN FORM NO. 7-2003 'Type name below SlgllatUrcS. INFO-PROD www-infoprolorms.com 1 of 1 07/3112013 15:05 17154259559 LUND BUILDERS PAGE 05 LAF: 4 ARV G o 1129 y- t o~ fir + Apr 1 ~ c~i1 1~ AMP A Or y zv i MIN Combination Sept~i.c:Tank and - PUMP CHAMBER CRO55 SECTION AMD SPECIFICATIOWS VE1JT CA,P WCATHER P)Z~OF JuQr-TIOIJ 90X 'i` C.I. VEtJT PIPE APPROVED LOCKIMG MAIJHOLE COVER wl jjQ' pROM OOOIC, yvA4ttJIIJ4 LP.6EC.. •./IIJDOW OR FRESH pp~ ~pu1T ~~sp~no~ P tpE A R imTAKE r aj w / rYtC~-T1 s tt•T` r:rr'P ~ i ;r I 6`t lQ4 T I I le'Mlu. 18'MIIJ. i., PROVIDE I1JLE T AIRTIGHT SEAL I III V eAL~ I (I APPROYED JOWT: APPROVED JOIUT Zft$ L FtLC A I III W/C.1.I'IPE09 P'' Wf C.T. PIPER Tank construction I I I ALARM shall comply with ~I II ILHR ()'3.15 and 33.20 ° I I ou C I I I OFF COIJCRETE k~(ICJ 1 BOCK 3" A9PFN R15ER EXIT PERMITTED OIJLy IF TAIJK tAkwuFACTURZ7, HAS SUCH APPROVAL UDDING SEPTIC f SPECIFICATICUS DOSE WI Cp,UC~ WMbER OF DOSES: PER DAy TAuK MA>JUFACTURE:R.: TAWK 51ZC GA,LL0-WS DOSE VOLUME II.ICLUDIIJG 6AGKFLOW GALLON$ ALARM MAWUFACTUR.LR: S`S ~c• 211 ~j MODEL QUM6ER, t 0L Nw , l CAPACITIES. A=Z~itSCHCS OR ~r~ GALLOU5 SWITCH TyPC: GD f B - Z WCHWOR J.~[__2G~LLOU5 PUMP t%%AMUFAC.TURER: 1 S ~O u'C"o C =ZIUCHES OR 6Y-_ „ - LLOUS MODEL NUMBER: __e S Q= IAiGHES OR SWITCH TYPE: ELO 44 IJOTC: PUMP AMD ALARM ARE TO OL M1Q1MUM-DI5CKARGE 'RATE^.~GFM INSTALLED OIJ 5EPARATE CIRCUITS VERTICAL DIFFEKEWCE BETWEEIJ PUMP OFF A1J0,D15TRIBUTIOU PIPE.. Z~ I-EET -t- MOMIMUM NETWORK SUPPLY PRESSURE . ; , - FLET f FEET OF FORCE I'' IM X r~ ► FfIoofLFKICTIOW FACTOR.. z~FEET TOTAL DYNAMIC. HEAD FEET As per. manufacturer gal/~n. a APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 RGOULDS PUMPS Submersible Effluent Pump PE ~ • ~Jr~ ,Nw ►uM► ems" SPECIFICATIONS MOTOR FEATURES Pump - General; GeneraL• ■ Corrosion resistant • Discharge: 1''A" NPT • Single phase construction. • Temperature: 104°F (400C) • 60 Hertz ■ Cast iron body, maximum, continuous when • 115 and 130 volts X Thermoplastic impeller and fully submerged. • Built-in thermal overbad pro., cover, • Solids handling: lh,, tection with automatic reset t Upper sleeve and lower maximum sphere, • Class B Insulation, heavy duty ball bearing APPLICATIONS • Automatic models include a • 011-filled design, construction. float switch. • High strength carbon steel ■ Motor Is permanently Specially designed for the • Manual models available. shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation, • low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the ( • Basement Dralning • Maximum head: 25' TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM IN Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design heavy duty 16/3 M with !E 51 Pump: PE51 Motor. 115 or 230 volt grounding Maximum capacity: 70 GPM • .50 HP, 3400 RPM plug. • Maximum head: 37' TDH • 115 and 230 volts 0 Complete unit is heavy duty, METERS FEE PSC design portable and compact • ■ Mechanical seal is carbon, 40 I , ceramic, BONA and stainless ~EI51r I I I i I " I MOD,,HIS: PE31, PE41, PEST steel. , 35 ' I I l Hw .33..40, .so ■ Stainless steel fasteners. 10 30 i_ i I I I , .I ~ I 1 2 GPM III 'AGENCY LISTINGS FT •i • , i , 25 I I I i ` I i I! I I U Ck 4 20 s Tested to UL 778 and 15 I I _ III I I CSA 222108 Standards o I -I' I _ By Cana" Standards ftodwon I' I I. I. ! I I File #txsssay 10 Goukis pwnps is ISO 9oom Reijtnered ° ° to° III 20 30 40 50 50 70 GPM so 0 $ 10 15 m3/h Goulds pumps ® 2004 nT Water Technology, ine. CAPAClN Eff•ctr"* June, 2004 •'E$"°' ITT Industries d uick4 Q STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) g' _ V~ rm CHI a 34" SIDE VIEW SECTION VIEW MultiPort End Cap R O 16" 12" 34" SIDE VIEW TOP VIEW FRONT VIEW r~{F~ Quick4 Standard Charmer or iinal;S ecifications' MultiPort End Ca Nom! S .e,Clf cations Size (W x L k,H) 452 fiSize W x L x. H X34',; x.16"x 12 Effective Length inert Height - `u 8~or 1::25 Invert Height: ~fi ~ ,r5 INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, and plate, wedge and other accessory manufactured by Infiltrator ( "Unfis1, when installed and operated in a Ieachfield of an onsite septic system in accordance with Infiltrator's Instructions, is warranted to the original purchaser ("Holderl against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic'permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise Its warranty rights, Holder must notify Infittrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) . . • - days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. O (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS IN C TO THE UNITS, INCLUDING NO IMPUED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. (c) This Limited Warranty shall be void it any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite Wastewater Solutlone production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third parry. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation Instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth in the Installation instructions; the placement of improper materials into the system containing the Units; failure of the Units or the septic-system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or Old Saybrook, CT 06475 any other event not caused by Infiltrator. This Limited Warranty shall be void If the Holder falls to comply with all of the terms set forth in this Umited 860-577-7000 • FAX 860-577-7001 Warranty, pOO Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or ship- man -ZZ 1-4436 u, or from any product liability claims of Holder or any third party. For this Llmfted Warranty to apply, the Units must be installed in accordance 8 with all site conditions required by state and local codes; all other applicable laws; and Infiltrator'; installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the origi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator.. A limited number of states and counties have different warranty require- ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Did Saybrook, Connecticut,*prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and Sidewinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Contour, Contour Svdvel Connection, MicroLeaching, PoIyTuff, SnapLock, ChamberSpacer, Posit-ock, QuickCut, QuickPlay RECYCLEDYAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. Q011203HP-0 ' Ne-rF) ye n 2 ~!J JC /Vtr.~ 7 rye r 9, 19, S•,po t8 r2RAt ("1111-) P7' &0"+ t- 't 51572 eSr,~ IL)l , r-- cb BILE®.~: AFR 2 2 1994 > j7 JAMES O'CONNELL 1V ^ L" t_1 . Register of Deeds I f „c a r• `Y` ° St Croix Co., WI' O N 8 tD H A r1r O ~~~I~ J w r. rD - p ao m 0 N 'A O c H t~ S08 °43'31"E 232. O 0 :C 0 W 37.26'- 0 rv o , 31"E 232. w ~h p, W S08 43 Co sv G T o o° 0 C) m m fi co)< ~ N to z - H (D 0) l~ fi n 2r n 2 Cu aICr1 t°o Co r.5 . N ...r z IC cn 0 CD 0 -4 Co e u+ V r N ° m t0 10 K > I> 1- m. o N N I-~ 0 (D r -n - M -I rn -n 1j I-1 Lo x :-t E 1171 0 rn 55 -M C" 10 PI) C) (D 1U F r-t.. '0 -Ln 0G rn C> C~ 1~ - i a ZK G rt C> s Iv N Ir- I~ Co ° IA 0 C) 0 I~ C -i 1 (t -10 < O I z fTl cn N. -C cn 0 0 + m 0 M, W (D • n ®ci.ltQ4S 1enoiddt N It 169. a ep ten0.AdC1V I 11 0 • 0 A r4 ;o• SAeP aE k". ^ o I /A LO a o 3 x Cr _ X- N w j papmej IOU Jf ti Co 0 W 00 !A O '9' w a m v N o 0 trJ W 0 ~8}IWLLItl~ S'`ti11, j 00 tD N ~G > > N •P C Z % 6"/• w 't. C/) r - B d C) Pue BUIU0Z t7* CD C-) CD ri 0 o A c o \ lllpd~}~ BAISUE3l~31dUJC o r; x UNnoo XIOuo ' . F z o r a o cn rD m o rD o. m ~ ~ ~ a o ~ ~ cc 99 u y C", Co fD rr rt rt ~v~ 4 U~Y a o E o ~ T a Co o a6. !'.dY,~ t tr O O) G Co 14 Bearings are referenced to the ((\)\\V~i east-west I line of Section 28, assumed to bear N90000100"E. VOLUME 10 PAGE 2747 I •r.r V:&onsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT JJ P ge_.of t,~r and Human Relations , rP !Ci Y1 0 ? c + " t]ivi Tbn of"bafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 9 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ~ I.D. # dimensioned, north arrow, and location and distance to nearest road. io76! APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE DA E (yam 3 ~ ds- PRO7,0' Y OWNER: PROPER LOCATION M_e LL GOVT. LOT ~W 1/4 W 1/4,SZ~ T N,R E (or PROPERTY OWNER':S MAILING AD RESS LOT BLOCK # SUBD• NAME OR M # 40, D o27 CITY, STATE ZI CODE PHONE NUMBER ❑CITY ❑VILLAGE GOWN ~ EAREST CAD - S (~/2) 771- ff44 1 - 94 New Construction Use [X] Residential/ Number of bedrooms [ ] Addition to existing uildin j ] Replacement [ ] Public or commercial describe Code derived daily flow ~s 0 gpd Recommended design loading ra a_bed, gpd/ft2 trench,gpd/ft2 2 Absorption area required .3 75' bed, ft2 373" trench, ft2 Maximum design loading rate , s bed, gpd/ft2 . 6 • trench, gpd/ft Recommended infiltration surface elevation(s) s• ft (as referred to site plan benchmark) / l Additional design / site considerations DNS `I Parent material ® Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL ROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S W U Jkl U ❑ S ®U [I S ®U El S V[ II It CR N REPORT Depth Dominan (Oo r o es Alai ture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Mun Q*r Gr. Sz. Sh. Bed Trench 4, ; 49 Ground 2 m -2q o &'i- elI 3 ' x~' S~ he S~/~ hrv r w v elev. 1AS1 ft. d 6 S D h"f tir / cW . 7 Depth to S s'd a ` 3 2 s vc S6/~ Ak v ti limiting , factyor,, S's-fJ S^ /S Remarks: Z w ,c e~ 6 5l w r e.1 f 6 ~'rr P 4 - 3" s o c Boring # Ground elev. 3 -s7 J /°ly ft. ZP Depth to ~7'so 7s S K v r _ •s limiting s t C c /C factor,, yS' s6 ~ 1; "1&"' S o S . 7 Rema CST Name:-Please Print Phone: 7 SG Address: 0 1 d 2 Pr Signature: Date: CST Number: ? 9~ 3 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of, PARCEL I.D. # ,ice Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots -GPD/gt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground Z /0 6ff 3 S~ m fdk x, -~r' cv l v~ • S- elev. /oft. 3 /Q-yi ~.S y ( ~s / v~ r h+ e - - - Depth to -60 ~a d S a s < , - . 7 . D limiting factor Remarks:3 507. ~r~ r,r Boring # l o^ o v ~ i S ~s6 `u~r S nv ~ Z o^29 l0 3 /ss6/~ ~r cw Ivy S144 - Ground elev. 3 ft. epth to Sf l7/ S^ s G~ ~s m /i► l c,' _ , L-V 4-1 D limiting C factor Remarks: 3 3 ^ y`~ SC R !/t S w Irro7/'~~N mow, `~~irrc~ w G S Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) s a a 1 3 ~1 a 11 N 11 v Jc ~ ~ N z- 41 ILE k-l e X M ` ~k ~ v ti V• d y `T _ V M S `y