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HomeMy WebLinkAbout016-1017-40-120Fax Memo Code Administration 7L5-386-4680 Land Information fT Planning 715-386-467 Real.Pro perty 7L5- X86-4677 ~,. Recycling 7~5-386-4675 ~~ ~ ~ ~, Date: U To: (~~(-~ Fax Number: From: ~~ ~ ,~~. GCl VJ ,~ Fax Number: 715-386-4686 Phone Number: Number of pages, including cover sheet: Re: ,~ 8.371 •/S. (3 ~A - z.v ~t~?v!(~ ~~~~ ~~a.-z~ ~~( ~~ ~""~ r ~-- 7/ S~- Z~ s 3 7 S 3 ~~'?~ /boa=~` ~.~ . ~,~~~~ ~lvss --~,,,~ (~J~s d ~ C-~J~ S~~ I~,~~w~ t:.. .ar.~ t w ®_ ~,, ~ .., , ~;,. s..~.~ _. r. .~ ~ = s. sa Wisconsinp~partmentofCommerce PRIVATE SEWAGE SYSTEM Safe+y 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 Olson, Ste hen H. Glenwood, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY < <S~'~ - ~~ ~~ bD0 Dosing Aeration Holding ~©~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lif Friction Loss System Hea TDH Ft Forcemain Leng ia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 118 State Plan ID No'. Parcel Tax No 016-1017-40-110 Section/Town/Range/Map No: 08.30.15.138A10 STATION BS HI FS ELEV. Benc ma~, aw~C. Z~Z'K 57.5 9y.`iS Alt. BM ~J Bldg. Sewer ~~~,5,5 SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Head an. Di t. Pipe ot. System Final Grade St BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK EM TO P/L BLDG WEL LAKE EAM LEACHING Manufacturer: INFORMATIO MBER OR Type Of System: UNIT Model Number: n ICTGIQI IrlnAl CVCTCM ---- Header/Manifold Distribution x Hole Size x Hole Spacing V'eny to Air Intake ~ ___. Pipe(s) _ .------_ ___ _ VG [71/~ Length Dia Length Dia Spacing _ i ~ enn ~+nv~o i -- ^--_-..__ ~_._._...._ .,_~.. .,., ee,,..~-n.- a*-r_r~.~o s..~-o.,,~ ~ntv r i ~. , a Depth Over Depth Over Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~~; Yes No Yes °' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:____/__~_ Location: 2874 160th Avenue Glenwood City, WI 54013 (SW 1/4 SE 1/4 8 T30N R15W) NA Lot 1 Parcel No: 08.30.15.138A10 Cl,. ~.,.',,.~ ~- L o ~. s a ~ 1.) Alt BM Description = q / 2.) Bldg sewer length = S Q Q ~.~ <~~~~,s ~ ~ 5 $si c,} Z - amount of cover = ~ ~ ~ P Plan revision Required? fl, Yes No ~ L5 O-l ~j 3 7 Use other side for additional information. .l Date Insepcto Signat Cert. No. SBD-6710 (R.3/97) i~ ~~ County Sanitary Permi P~1 1 ST. CROIX COUNTY WISCONSIN GpV~ f ~ In accord with Chapert 12 St. Croix County S ry Or nc PLANNING- & ZONING DEPARTMENT ~O~ b ' Personal information you provide may be used for seco ry pu ST. CROIX COUNTY GOVERNMENT CENTER ~ i ,p9 ~ ~ [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road ~ Hudson, WI 54016-7710 (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8-112 x 11 inches in size. County Sanitary Permit # ^ Check if revision to previous application ©~ I. Application Information -Please Print all Infor ion Location: Property Owner Name ~ 1/4 1/4, Sec -'~ ~ Q ~ so'~ 2 1 2007 S -- ~~ EP N, ~ E(or w Property O er's Mailing Address Lot Nu r Block Number 7/ f ~ ~ "F" ~ J~ ST. CROIX COUNTY City, State Zip Code Subdivision Name or CSM Number Glert~eac~ C~-~ (J~ ~/s- 977-~~8T II Type of Building: (check ne) amity ^ Village own of ~ 1 or 2 Family Dwelling - No. of Bedrooms: 3 ^ Public/Commercial (describe use): ^ State-owned Nearest Road II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number(s) A) 1.^ Repair 2~Reconnection .^Non-plumbing 4. ^Rejuvenation ~'""-~ 01) _ /01,7 ~~ ~ / /~ f0 Sanitation B) Permit Number [,leeltrr"s`Zted / ^ State Sanitary Permit was previously issued y z '~~~~ `/ IV. Type of POWT System: (Check all that apply) ^ Non-pressurized In-ground ^ Mound ? 24 in. suitable soil ^ Mound <- 24 in. suitable soil ^ Mound A+0 ^ Sand Filter ^ Construe d Wetland ^ Peat Filter ^ Drip Line ^ Pressurized In-ground Holding Tank ^ Single Pass ^ Other ^ At-grade o is reatment Unit ^ Recirculating . Dis rsal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade ~~~ Required ~-- Proposed (Gals./day/sq.ft.) (Min./inch) ~, Elevation --~. VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks Z `f d~Ob 2 ^ ^ ^ ^ ^ ^ ^ ^ ^ II. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenatioNinstallation of non-plumbing for the POWTS shown on the attached plans. A icense is not required for terralift repair or the installation of non-plumbing sanitation system. Pl~yr~ber's Name (print) ,a,z~.,,~ 4 ~ Plumber's Si nature (no st ps): P ~ MP/MPRS No. Business Phone Number 3 j~fv.,Gr.. ~ 1j~7 akd 1 v?30 7/0(0 7/S' 3Q~- 3S7/ Plumber's Address (Street, City, State, Zip Code) /l/S~00 ~zFd'`` Sf rKd~«~:,.ze u.J-% ~"`f7S< III. Coun Use Only ` / d Sanitary Permit Fee Date Issu d issuin ent Signat e ( sta Approved Owner Gi In ' dverse ~ ~7 Z ~ a~ Li ~7 21 ~ ion g IX. Conditions of Approval/Reasons for isapproval: ~ re ~. a,ti ~ ~ ~. c~~~ ~ P~ d- ~~ ~ C e.~• ~ ~ I ~- ~ ~e 5 Lvo «~' n. , Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Olson, Steve Glenwood Townshi CST BM Elev: Insp. BM Elev: BM Description: Q . 0 / b b - o /1j 1-w ~- / ~ a -f.~h-, ct~ S/ ol. "n i Hrvn ~rvr~rcmHi ivrv TYPE MANUFACTURER CAPACITY g -- Aeration olding , f- SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent t 'r Intake ROAD mg Aeration olding ~ Z~i .~ O,y-/ G~° PUMP/SIPHON IN RMA~I N I Ma cturer Demand GPM Model Number TDH Lift Friction Loss a TDH Ft Forcemain Lengt Dia. Dist. to Well SOI BSORPTION SYSTEM tll_tv~-livrv u~-iH County. St. CfOiX Sanitary Permit No: 430421 0 State Plan ID No: 2~~ Parcel Tax No: 016-1017-40-110 Section/Town/Range/Map No: 08.30.15.138A10 STATION BS HI FS ELEV. Benchmark ~ ~1 / ~~3 /OO,C> - Alt. BM Bldg. Sewer ~ .'! Y' <~` Dd S t Inlet ~~ rtR J ~~~9s ~~~35 S H Outlet - ` r 87~ ~~ j~ nlet ~~ ~~-~a om 1 ~- ~ Header/Man. Dist. Pipe Bot. System Final Grade St C vetr T BED/TRENCH Width Length No. Of Trenches NS No. Of Pits Inside Dia. Liquid Depth DIM SETBACK SYSTEM TO LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: ~- ,-° IT Model Number. D I ST R I BLLT1t31~SYS T E M Header/Manifold Distributi x Hole Size x Ho{e Spacing Vent to Air Intake Pipe(s) Length Dia Length is Spacing SOIL COVER ` x Pro¢¢uro Cv¢4um¢ Anly Yu Mnund [)r Af.Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ® No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ~ /Q7 / ~ ~ % Inspecti~ofn #2: / / Location: 2874 160th Ave Glenwood City, WI 54013 (SW 1/4 SE 1/4 8 T30N R15W) NA Lot 1 / Q ~/~~~7'N~G~NSt~ .15.138 0 ~1`~G4y~~- GL ~ 1.) Alt BM Description = y 2.) Bldg sewer length = ZQ ts.J.r ~ 1rt-oti---Q- -amount of cover = ~ J "'y~ ~ ~ _ L ~~~~ /~~U' Plan revision Required? ^ Yes No ~ ~ ~ (J 2 G~~~r ~ Use other side for additional informal on. l Date ~ ~ - Q / sep~tor's Signature Cert N4._ SBD-6710(R.3/97) ~/,r1„~n 1 `l/~ ~(,(,~~~j/l~t~.C_~GZ~"'~%~, _ •~ -~~(/yr~ ~j6'2~~ ~/~/ C/!vf' ~~]' W ~ "v Y .vw~v ~ ' U PROJECT Steve Olson SW 1/4 SE 1/4S 8 PLOT PLAN ADDRESS 2874 160th Ave Glenwood Citv Wi 54013 /T 30 N/R 15 w TowN Glenwood covNTY ST. CROIX MFRS Shaun Bird 226900 DATES/7/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE ~~' TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2-2000 LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION none 1 B-3 Please note: driveway may have to be extended to make the 25' setback from a service road _ B-1 Scale = 1 /4" = 15' B-2 6% Slope 9% Slope -~ 3~~1 ^ rJ 1 anks are to be properly bedded and provided with lockdown covers with approved warning lalbels ~'~\ Overflow ~--- Area of Saturated soil conditions . uring a spring, onded wa e e o served in spring 26 ~~ 8°l° Slope ~~~ ~ ~`~,s ST aBAN1boN TltE E~tST. ~Q~3i'S ~~~ Existing 3 Bedroom Trailer ~. Wel B ~25'~25' rn 0 0 .o 0 -~ m ~B-4 -~~ -." - Safety and Buildings Division ~°~~ ~U~'1W. Wa}Shington Ave., P.O. Box 7082 City ~ ~ f j ~G iseon >in Mad ison, WI 53707 - 7082 Sanitary Permit Number (to >x filled in by Co.) De artment of Com ere ., ° (608) 261-6546 LJ/ ~(j C f~~ Sani ary ermlt ppli ation State Plan I.D. Number In accord with Com g3.2~~1YEs~ ~~ lC '~`>pta'fo~ ' ormation you provide 2 , maybe fw seo~fy~q{gs~~vacY La s 15.04(1 xm) Project Address (if different than mailing add s) ~287y t ~o ~ I. Application Information -Please Print Ali Information O - /DI - D~-//~ Property Owner's Name Parcel.# Lot # Block # Property Owner's Mailing Address ~/1 ^~ , ,,7 ~-`1 ~ ~ / fj ill"' ~ rJ Property Location ~ / j~1~~~ O ,~ o ~C~ ,~ ~~~-/ti Section City State ~ Zip Code Phone Number ) ~ -' 1 ~~ n ., ~ ~ / ~ ~ ~,~ /, ~ ~~ ~ _ 7l~ > / T .J~ N, ~.,./ E r W ItI. +oI'Building (heck all t apply) - - ~ ~, ~S~ ~ ~ or 2 Family Dwelling -Number of Bodrooms ~ ~ Subdivision Name CSM Number ~ ~a~ ^ Public/Cortutteroial -Describe Use S ~~ ~ ^ State Owood - Describe Use ^Ciry ^Yi11ag~'fownship of IIL T ype of Permit: (Check only one box on line A. Complete line B if applicable) - A. ^ New Systan ephicement System ^ Tteatment/Hoiding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permii Renewal ^ Permit Revision ^ Change of ^ Permit Tntnsfer to New ~~ Previous Pam-t Number and Rate issued ^ f ~ , Before Expiration Plumber Owner v ~ / {- IV. of POWTS S stem: Check sll that a 1 ^ Non -Prrssuriud In-Ground ^ Mound > 24 is of suitable soil ^ Mound <24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filtu ^ Constna'xed Wetland ^ Pt~essutized In-Ground din Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) Y. Dis enaVTreattttent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufiuxttrer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glans New Existing Taaka Tanks Septic or Holding Tank •_ ,~ ~ 1 Aerobic Trcumeat Unit Dosing Ct+amber VII. Responsibility Statement- I, the undersigned, responsiblfity for inatallatioa of the POWTS shown on the attached plans. Phimber's Name (Fria[) P!t-mba's S' re ',.i" MPlMPRS Number ~ Business Phone Number " ~ Plumber's Addrtss (Street, Ciry, State, Zip e / .~ r ~~ r '`~'/I ."~~ ~~~ t:y~...:~c~ ~ ~' ~ ! ~~` ~ `-fi VIII. Dort 1De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fce) ~~ ~ ~ ~--~° Date Issued (Q ~•) ssuing Agent 'gnature (No ) ^ Owner Given Reason for Denial L2 i~ IX. Conditions of ApprovaliReasons for~jDi~sapp`rovahy- ,/_ _ ~? ~t-~'~/1 G O /~~G~~%~" Z c ~ `~'1'~ `L ~ (~Q vt'!/t y < ' ^~N, ~Q ~ J _ / ~ ~ ~ ~ Q / ` y ~ ~ 7-~{ W'(~CR 1WT ~d ~W r J ~ ~CttC~ic~ilZ~(J ~(/u~~~ %Xf~- /~ ~~~ tiY~ h,`, _ ~ s (tom ary Daly) for the system oa paper 81/2 : 1 xhes la ~tt / O lO ~ w ~ n ~, , `~aB ~5~98 (R. 0 JO) ~~_ d~ S~,S~>~2-P/~/ ~~n~.-- ~ 3.33 ~~ ~ ~~i~,~'-t-p~~t,~- nub-1~- ~o~.Odu-c~-~' ~-~a~-.~~d.~,.~ ~ O I °c ~ ~ W ~ ~ ~ I W 3 :. ~ ~ z o w O I 3 fD ~+ ~ ~ I c o cn 7 < I m N I ~ W ~ ? I to W ~ I ~ D y a°•' ~ I a W ~ < I Q = o o m ~ o o ~ I z o o ~ I ~ °w °w I n I 000' I s ~ ~ O O I ~~ ~ ~~ ._._. W I ~ ~ ~ ~ W V i » I 3..m ~~ I 7 ~ O ~ 7C `~- I ~ N ~ ~ $Og 7 i I c ~~ ~ 3 ~ I O ~ .. ~ 7 ~ ~ I ~... ; ~~ x J/~~~ ~~ °. ;~ S`77~-~-' I °~ o- °-' m I ~~s.~ I 3~~ ~~~ I ~ ~ B I m' I m ~o .~ ~~ ~ ~o g ~. so y m I ~ _ `'' fa i I fD 7 V~ ~ ~~1 ~ ~lli~'v ` I ;v ~ coo a ~ -n I <°-'°-o a C~, D ~ ~d_',~ll. ~S I ~, ~ ~ m '~L" ~~~~-- I o~; N ~, I o ~ ~ I d -~' f7 ~ N 01 I ~ o. O I '~O 7 i ~ O I ~ rn ... W I y ~ C I I y O ~ I 3 I fD I ~ 2 °o s. 3 ~ o ~ c3 3 n ~? v ~ ~ ~ ~ ~ o ~ o ~ :, o ~ V O D Q O o y o c 3 :'• d ;.. 2 ~ D V t0 N ~Z~ ~~ ~~~ ~ o J Z ~~ m ~ A m, A+ m d 0 O 0 ~• ~i fi y ~a O l0"0 1 O V N O W ~u ~Q N ~ A ti ti ~°.,, b ~, .s a « 0 `o to ~ ~ ° ~- m ° ~ t ~ 5 a $~' ~ o g~ ~ - H S~ `~ ~ m a ~ o ~~ O ~ u~ A $ ~«mr ~ ~~ ~ ~ H ~9 ~. e E € ~ C ~ ~ ~~ a m~ ~ m~ c> r R pm ~ W a w ~ ~ ~ ,~ ~ .~. 60 ao w /~ _ _ pp ~ o V LU C M o ,~ g p~~ m~ m~ ~ m • a ~ A Q~~ ~a.o~ ~~ ~ ~~ ~W ~o ~~ ~ ~~mmm~YY~~~~~m ~ o~ s w o ~° ~ ~ '~ ~ r' 'x z N Z 0 > ~ W .9 - ~ N ~ a N o ~ ~ V W ~ ~ J J C.? Q Q J ~ Q~ m W ~ Aa ~ z J ~t ~ ~ ~ ~ ~~ z ~ 4 3 ~ ~ ~ n= ~ Z ~. o p'Z ~ v W a q w~ ~ ~,- ~ ~,Y `^ vi O v ~- u. ~ . mQ ~ ~ ~ ~ W ^ ~z °- z ~~~o J Q W Z o a~- Q . ,.~.n n H O ~i. V 0 z N w N i a 0 Q OWC O m W Z J w a w W a W z Q J d Z H cn O a Z U LL~ 'f^ V J Z O U Z 0 0 w ~- Z I- Z O 0 Q 0 w H O J m ~_ 0 a 4 A ' ~ ~ PLOT PLAN PROJECT Steve Olson ADDRESS 2874 160th Ave Glenwood City Wi 54013 SW i/4 SE i/as 8 /T 30 N/R 15 w TowN Glenwood COUNTY ST. CROIX MPRS Shaun Bird 226900 DATEg/7/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK ~~ MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2-2000 LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION none Ave B-1 Scale = 1 i4" = 15' B-2 6% Slope Please note: driveway may have to be extended to make the 25' setback from a service road Existing 3 Bedroom Trailer ST ae~~oN Tt~+E >rkcsT. i°q,~.sTT 9% Slope _•, Pry cr~.ts-t 83.3.3 w. q. c . B-3 8% Slope ' a s are to be properly bedded and provided with lockdown covers with approved warning lalbels 11/\ Overflow Area of Saturated soil conditions for during the spring, ponded water can be observed in spring v Wpe l _ U25 ~25' m 0 0 -o 0 v c~ K r m ~6-4 ' ~ HflLDIhIC TANK SERV[C[NG CONTRAC~~ __. ontrad Date _ ~ 'Ttt'ts contract is matte betva~er. the _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ,~ Pumper's Name t tot TankOYrnerts} tvame{s) ~ t t s, ~ ~ _ _ ~~~e1ze ~ ~ .~~ win ro ert : (Provide legal descnpt~ons.} it he fo o Y nt P , I tank s o 4 p Je acknowledge the mstailatlon of (a} hoidrng (~ r- (,'/ < 4' /I 'i"he ovrner agrees to file a copy of this contract with the focal govemmentat uni t spas signed the pumping agreement 3.18 ~ b ,Wis. Adm. Code and with the County of~~ ' ~~ ~ required in Ch. ILHR 8 () ( } !. The o~v.ner 2erees to have the holding tanks} servii ed`b~ ~ ldinmpank(s} Thee onwner agreesntotmainUa nthe access oad oand to enter upon the property for the purpose or s~i v+~ ~ 9 drive sa that the pumper can service the holding tanks} with the pumping equipment. The owner further agrees to pay the " the owner and pumper.' pumper for all charges i:~cLrred in sen'iang the holding tanks} as rrtutualiy agreed upon ~y ;. The puhperagrees to submit to the total governrstental unit which has signed the pumping agreemer+i required ily s !~~' 83.18 (4} i;b}, Wis. Adm. Code, and to the County, a report for the seivicing df the holding tank(s) on a semiannuatbasis. The p~.mN~rf~+rthpr agrees to include the fo;;owing in the semiannual report: a. The r.~rne and z~+~~2ss of the person responsible for serricinglhe hoidino tank; b. Tile Warne o"r are u;:ner o; the holding tank; c. The location o{ the property on v.c"ri iii ~ trvtdir~g ,v t= :s '-=!ted; c. The sanitary perr~~;~ ++um}~,er iSSUc~ forttle'h0ldinc tank; e. Tile dales on which the holding taat< vvas serviced; . ~- -- ~ ~~ ^' the ooretents pumped from the holding tank for each servicing: r, lilt VGiU+i1c~ i:4 yy,- ~.~ 4: a. The disposal sites 'o which the contents from the holding tank were delivered. , 4. i his agreement titi~ill remain in effect unt7 the o~^rner or pumper terminates this con{ractQ lncthte ~~e ~intract with the ttocatoontract, the owner agrees to file a copy of any dzas't9es to this service cvnirac~ ur d co ~~ a ~~~ govEmmental unit and the County n2rnnd above within ten (~d} bush+ess days from the date flf change to t1'ris service contract... p~rmer(s} ttiameEs} {Print} ~_ ~~ ~ ~ en.t ~~- ~~S~~i~ Pumpers t.'ame (Pant} Pumpers Registration Number t pwner's'Stgnature(s} ~ I t t t t i t G ~~ t~ t ~~~ t t Pumper's Signature. t 1 r t ~ r Subscn'bea and Svrorro to me on this date: og-til-aoo~ - Toda}~s Qate Notary Public S'rgnaiuce JOFM1 E. L111~~ 9uls dd Whooi~ Commission E~q~iratan Drafted by J~i~%~ vim' - -___--._ ~---- Sep 08 r3? t?_n~ ';~ ~ ~ 3 3 P ,..; 5 i '.r;~,i :.i::, iti'~. ~ ~~$.. {.J7i~~/ ~J'^;:JT = *Y ~~A w~~-.~~~C ~~~ ` j ~G ~t'~ ~ i~ /~ sand Return Address c~~/% C' ~ : ~ Cam(/ r ~ i iiS a(J, rBE it~ill ti ~ ~c:~.f ~f?iv'4'~ t-ii ~h~r ~ A~c~ ;l[; It'I1~i ~,V unit and hofding tank owners . L~ ~^-~ "~ r---- RECEIVED FOR RECORD 10/10/2003 09:30AM HQLDING TANK AGREEMENT. EXEt~'T # - `3` t^Y.~-~j'+~ REC FEE: 11. 00 -_ic3~~~.- ~':! -~?1 ,~ TRANS FEE: r COPY FEE: -,.- r-- ~~~~i,' ~i,'~/ -~/ ~~~~, ~' CC FEE : -/~ J PAGES: 1 (r//'~ `~~~~~ ~~ ~- . acknowledge that application is being made for the installation of (a) holding tanks} on the n}'ing property: (Provide legal land description. Use reverse side if additional space is needed) r~ :~ ~ -/ ~~%,~.~ r ~~ O Mf r+1~GSr- ~~ .1a+=[3~1AD~ lti Yo •. ? ~~_ 'tiy 2~_a~~ No. `L• .'__._._.--_- ha~ continued use of "~lle Cklst,ng r~errliSes requires that a holding tank be installed on the property for the purpose of proper containment of seµ ~, the propezty cannot now. be served by a alunicipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. ~ ;e, or Ch. 14d, Stats.. ' ar. inducement to the. -mil ~,~~'~ to issue a sanitary permit-for the-above described Properly, we_agree u> do the following Owner agrees to conform to all applicable requi er t'ssued by the governmental unite L apreventnn abate a humansheal h hazard as de=c~ibede holding tank prope>ly serviced in response to ord s 254.59, Stars., the governnlentai unit ma}:.enter ~_tpc,n the property and service the tank or cause to have'the tank to be serviced and charge o~i~ner by placing the charges on the tax bill as a special assessment for current services rendered. 'fhe charges will be assessed as prescribed I 6G.6Q, Seats. ` ,'he oti~~ner agrees; pursuant to s- :Clip. °3.18 (1G), ~'+'s 4dm. Code. w have a water meter installed in a new buildirl; or new• structure- The'y' meter shall be installed by a plumber authorized by the State to conduct such installations, with said instaliatior, co[nplying •sith State regular and manufacturers specifications. The otivner agrees to be finally responsible for the pvrchas ulaz basistto read and/or inspects the water•met;or meter, and agrees to allow the governme..ta: unit to enter' the above described. property on a reg Owner agrees to pa}- all charges and cost incurred by the governmzntal unit for inspection, pumpir.b, i,auling, or othen1•ise ser.icinr maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused b}' the holding tank. The governrsenta. shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner dae: pay the costs ~,vithin thirty (30) days, the owner specifically agrees that all the costs and charges may be placed or, th< tax roll as ° special assessi for the abatement of a human health hazard, and the tax shall be coilectad as provided by law- . mtiry .,..,,.o* Psce t as provided fsy s. 16.24 (3) (d), •Seats., agrees to contract with a person who is licensed under Ch. NR 113, «'is. Adm. Code, ,to tne no[a[ng tans serviced ante to uie a copy [:, ,.a:,= ~~[,~u~t ~~ t= = cq'ngr's reglstratlon w•lth the governmental un1Y._ T'Ze owner ~lrther agrees to _ , .. - copy of any Changes to the Service contract, or a copy of a new service cartract, rclth tl:e governmental unit tivtthin ten (lU} bustness ds s fro= date of change to the service contract. The owner agrees to contract wit;, a Berson licensed under Ch. ~R 1i3, '`fis Arlin <~ndP whn ~1'alT cuhmit. to the r,avernme:l:al unit-arid then: - ~ ,- - - - ar. asemiannual basis a report in accordance with s. ILHI~ 83.18 (4) (a) 2., VVis. Adm. Cede, or rase. registration under s. 14G.20 (3) (d), 5tats., the owner shall submit the report to the .governmental unit and the county. The governrnenral w _ _ , ,;. :;.2r upon the property try investigate the eondition of the holding tank when pumping reports and ineter readings may indicate the holding tank is not being properly maintained. This agreement will remain in effect only until the governmental unit responsible for_the regulation of private sewage systems certifies flit property is served by either a inuiiicipal Ggtvar er a soil absorption system that^complies with ;ChRTLHIt`83, Wls Adm Code ^~In addition :agreement may be canceled by executir.,; _-- - - existence. of the certification to be determined by reference w the property. - -- - . - .• - ,~.„ .,,,+.,n* rho-hgirs tff the owner, and assigrtees of the owner. The owner shad submit the agreement ,cola [.G1 of uCCUS, iiltu uac urjaccaaat. aa~ .T1161a ue riuai t3Cl.1 Uy [,[,c a C~[S ICr C:1 U~e115 !n a [Rii1111C1 Wlli~.ii wll[ parlll[t the eX35te nee.Of rile agreestent determined by reference to the property where the holding tank i9 installed. ,neris Name(s) - tea;:: P•::: Gova**?~+~^'^t t tnir Official Name -Pease Print Subscribed"andsworr`i to before me tint is date: p~,~~1- a©o3 otarjas~d' _ or(s) Si at e(s) r Govcmmental Unit OPFicisl Title - Please Pr-nt ~ - l /J ,. .. ~ _ ~.I~oaaM G.,. °rnmental Unit Ofl'i~ ~_ ~'~ i~~ .__ 1 ~ _ This +~ _ homestead P-oP~nY (is) (is not) 743293 ,~ { KATHLEEN H• WALSH REGISTER OF DEEDS ST. CROIX CO., NI 16-b~i~~'S- 'J 2311P 278 S'i'AT'i; HAR OF WttiCONti1N FORM 3 • Iyy$ QUIT CLAIM DEED 'this heed, made hehveen Stephen H. Olson a/k/a Stephen Olson, _ . single, Grantor, and Stephen H. Olson and Beverly A: Kloss, .. ..... ---..__ .._..._._-.... ___.. ----._.._....W---_--------- Grantee. Grantor, quit claims to Grantee the following described real estate in St. Croix _ Counq•. State of Wisconsin: ~~~91i XATNLEEk N. MALSH REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD 07/11/2003 11:15A1! WIT CLAIM DEED E%EI1PT i REC FEE: 11.00 TRANS FEE: 105.90 COPY FEE: CC FEE: PAGES: 1 Name aad Return Address James H. Krave Attorney at Law P.O. Box 304 Glenwood City, WI 54013-0304 016-10_17-40-00(1 _ ParcelldentificationNumherlPlNj --- This is ^_ homestead property. (is) (is not) Part of SW'/. of SE'/. of Section 8, Township 30 North, Range 15 West, St. Croix County, Wisconsin described as follows: Lot 1~of Certified ~I!rvey~dat~_f;teri January 13 2003 in Vol. 17 page 4442, Doc. No. 705669) 'together with sll appurtenant rights, title and interests. ti Dated this a~~_ _ dayof ____..__~h~._.__.__..,,2003 AUTHENTICATION tiignamrcts) authemicatcd this day nl' t~ __ ' _______ : ephe H. Olson ACKNOWLEDGMENT STATti OF WISCONSIN ) ss. St Croix County. ) _ __~ _.__ Personally came before me this O~~ day of _._ . ~N~ , 2003 the elxlvc nemrd Stephen H. Olson tt/k/a Stephen Olson_ _ . __ I'Il'Lt-.: MF.MBF.R S'tATG HAR OF WISCONSIN (If not. authorized by ~'1t16.OG, Wis, titats.l ~I'IIIS IN3TRl1MF,NT WAS DRAFTf:D AY James H._Krave, Attorney at Law Glenwood City, W! 54013-0304 (signatures may he authenticated nr acknowledged. Both are not necessary•.) to me known to he the person(s) who executed the foregoing instrument and acknowledge the same. --- d01+IwF~.,tiAMOH lie, State of W isconsin omm sion is ant. (If not, state expiration date: !! •Nemcs of persons signing in alry espaeity alxRdd he typed or printed below their sigMurd OMIT ('I.AI~) DrLD aTATa aAR O- WIaCOrySla FORM N•. 7 - Hfa nVF(1RMATl(1N PR()FFS51()NALf CUMPANV F(1Nn mI IAC. Wl aafl-(.S~.7n11 GENERAL SPLIT FOUND ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF GLENWOOD COMPUTER NUMBER 016 - 1017-40-110 Parcel Number 08.30.15.138A-10 Claimed 1 Date Re-certified / / Relate Number: OWNER NAME: First STEPHEN Last OLSON CO-OWNER Mailing Address 2874 160TH AVE City GLENWOOD CITY State WI Zip 54013 - Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY QC 1107/ 221 07/23/1997 862/ 411 07/23/1997 PROPERTY ADDRESS: Hse # 1/2 PD --Street Name- Type SD Apartment Post Office 2874 160TH AVE School District: 2198 - GLENWOOD CITY Special District: (1) 1700- (2) - (3) - WITC Plat Code: Last Changed on: 06/24/1997 Book Number: 1 SECTION 8 TOWN 30N RANGE 15W '/.160 '/<40 Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers F4-Prev, F5-Next, F6-Legal, F7-Value, F8-History, F10-Exit, F12-More ~1 2175 F 29~f STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Stephen H. Olson, a single person Grantor, and Lawrence Meyer, Jr., a single person Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): The West'/z of the Southeast'/., Section 8, Township 30 North, Range 1S West, Except the South 600 feet of the West 800 feet of the Southwest'/. of the Southeast'/. of Section 8, Township 30 North, Range 1S West and Except Lot 1 of Certified Survey Map recorded on Jan orume 7, Page 4 o e t to urvev aps as Document No. 705669 oca e m part o e ou west uarter of the Southeast Quarter of Section 8, Township 30 North, Range 1 S West, Town of Glenwood, all in St. Croix County, Wisconsin. Recording Area 7 L 3 E/ "7 ~::. KATHLEEN H. WALSH REGISTER OF DEEDS sT. cRUIx co. , wI RECEIYEG FOR RECORU 03/19/2003 08:00Att WARRANTY DEED REC FEE: 12.00 TRANS FEE: 235.20 CC1PY FEE: CG FEE: PAGES: 1 Name and Return Address Edina Realty Title 400 S. 2nd St., #115 Hudson, WI 54016 i ~, i~ ~ a8~~~-9 016-1017-30-0 016-1017-40-000 Pazcelldentification um This is not homestead property. ~) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~~ ~ day of March 2003 * Stephen H. Olson AUTHENTICATION Signature(s) authenticated this day of * ®IAN~ M. BARRON o ary u Ic TITLE: F.~ ~~'~{/~ ISCONSIN (If , authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or WARRANTY DEED * ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this ~I/f~1 day of March , 2003 the above named Stephen H. Olson, a single person to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: rl- ~q-a~~~) STATE BAR OF WISCONSIN FORM No. 2 - 1999 Informalan Professionals Company, Fond du Lac, Wt 800$55-2021 `~. . ,~ i isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 30, 2003 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN.. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/30/2005 Identification Numbers Transaction ID No. 920830 SITE: Site ID No. 665490 Steve Olson Please refer to both identification numbers, 2874 160th Avenue above, in all correspondence with the agency. Town of Glenwood St Croix County SW1/4, SE1/4, S8, T30N, R15W FOR: Description: Three Bedroom Replacement Holdin Tank System Object Type: POWT System egulated Object ID No.: The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). • Comm. 83.54(2)(c) - A meter, with remote reading device, shall be installed by a properly licensed plumber, on the water system, that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat ~t. • Comm 83.52(3) -The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. ~;(~ , ., F' ~ _ "> ~' ~.. ~ '~ ~ ~ C ~ dA". ^"'" SHAUN R BIRD Owner Responsibilities: Page 2 9/30/03 • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this holding tank system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M, Swim. POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 ~~ s SF ~Fi 9~ A j ~F ~;~ o O ~OV so~~ Date: 9/7/03 Owner: Steve Olson Location: 2874 160th Ave SW1/4 SE1/4 S8 T30 N,R15W Glenwood System type: Holding Tank Manuals Used: Holding Tank Component Manual Page# 1. Cover Page 2. Holding Tank Plot Plan 3. Holding Tank Cross Section 4. Maintance and Continaencv Plan Signature License number Dww~ui~ U' tAFE71't,hdu 6U(L~;?'t~S J l_L Gut«:~ I~IVL.:=~V~L Q ~ V (y J. J. c-r n cn c~ ~ ~ •.• ~ sv N ~-F !D C z r~ ~ .. ~I Z r c 3 Q m Q m H Z m "c~ --i r y O O O fD d ~ c ~ co n. ~ C ~ O~ 'T (D ~ ~ J N ~ • ~• D Vf N 'p ~.. . ~C "5 ~~ J• ('~ ~'!. J.'~ ~~ ~-} ~. o. '-, a ~ ~ -~.4a Y ``1 ~~ f ~~~ ~, 1 A r r 3 m r ~ ~ ~ o m s z ~ cn -~ 3 z o cn 3 3 sv n, rD 7~ W c+ ~ C -h m n -~ -n cn o+ D O S W J. C) 'a Q 'S fD cn rn ro ro -s m ..~-s x • ~ ~ N ^~ ~ J (a cn 't7 r*~ i H n n --~ Z N J a o ~ ~ ~ ~ -+ LU J. n J 0 "'~1 m sv n 30 a6~d -~ r+ ---t / / cis. c-F F-' ~ a ro C f7 0 n ~"~ J f 1+ a J• N E $ G+ J• ('} ~-} fD n S 1 ~ 1 I i w fi W lD a d J. C Q. ~ N w ~ ~ D ~ ~ O • a n '~7 - -~ o rn ~ 0 ~ rr m D < o x -v ~ r, ~ a o ~ o ~- -a< o - -• cc -• a~ ate, ~ ~ D -n -s 0 (fl Q 0 "d ~"d b b O N ~ a J 3 J. J. <y c't 'S 0 ~ ~ 'L7 d -c .a ~ n H ~ • ~ ~ ~ Q7 ~ Ct rr I't ~.. (fl 1 W 0 O O )C T 'r'1 a. w a rD J N 3 ~ ~ ~ ~ O ~< ¢~ fp -S O.. J. ('~ n J. -~ 3 a D ~ `~+ o J n ro ~ ~ ao r~ 3 J. C O C Z -I D Z c-> 0 m n J 1--1 O Z .. ,. HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWYS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6/11/1999), and the ~~ ~?~~ ~ ~ County Sanitary Ordinance. 1. This POWYS is designed to accommodate an estimated domestic wastewater flow i~ ~~? gpd. f ~~~~ 2. The owner of this POWYS is responsible for system operation and maintenance, including al! provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of tFie tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking dfavices are present. Discrepancies are reported to the owner in a timely manner for corrective action. Ali corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Cade. 5. All service events or inspections of this POWYS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWYS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance v-rith OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWYS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed availabFe to the property. 9. If this POWYS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. if there is a problem with, or question about t 's installation, he following persons should be contacted: ~, a. Insta{ler ........................... ~ ~~-/z`= Phone: ~Z~ ~M` ~~ b. Service Provider ................ `~ ~` ~, Phone: 7~, - Z '' - c. County Zoning or Health Dept...~i~ C ~~ 1'~ C~~~ ~-i Phone: ~ ~- ~ D 11 Project: Transaction Number: Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accoraarrce wnn ~.ornm oo, vvis. ham. t,cwe Plan must er not less than 8 1/2 x 11 inches in size Attach com lete site lan on a County ~~[ /l~~ I ~x [ . p p p p indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. P 4 Re ' ~ Date (1) (m)). Personal information you provide may be used for secondary purposes ( rivacy Law, s. 15.0 Property Owner `- Property Location ~ N R ~ (o~ 4 5 ~'I /4 S ~ T ~ 1 ~ a ~1/ ( , / Govt. Lot Property O~mer's Mai~,tg,Addr ss v'`/ ~ Lot # Block # .~. Subd. Name or CSM# City /~ ~ State p Code Phone Num/bier' ^ City ^ Yllage own Nearest Road ^ New Constru 'on Us~Residential /Number of bedrooms Code derived design flow rate .~ GPD Replacement ^ Public or t:ommeraal - e 'be: __._____ ___ ___ _____.__ ___ Parent material ~Y.l7-c~/~,e~ D1lt! / .~rs~~ Flood Plain elevation if applicable ~~/~ ft. General corruner>ts and recommendations:i ~~ ~O/G~ j~2•vvG- ,~ ~- ~~~ (~t~~ L'~ ~~~`~ a~~# .., n ft. Depth to limfing factor ,~ in. ,G.. Soil ication Ra / ~~ ~ ~hucture Consistence Boundary Roots GPD/fF C.. ~ a.~~ ih. •Eff#1 •Eft#2 _ rT ~~, ~ s ~~~ Pi' Oa ©~~ ~ Horizon Depth Dominant C:o~~, in. Munsell Qu. ~, ~ ~ f ~ ~ i Depth to limiting factor in. ire Structure Consistence Boundary Roots Gr. Sz. Sh. ~ r 91ii/ N/ Soil lication Rate GPD/fF •Eff#1 •Eff#2 --- ~ 02 - 3 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 'Effluent #2 = BOD < 3p rrxyL and r 5.ti < 3U rrlg/L CST Name (Please Print) - lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 17 ._., ,~ ~ ~ 715-246-4516 Property Owner Parcel ID # Page Ong # ~ Boring (~ ~j ~l r l/ Pit Ground surface elev./ ~ L ft. Depth to limiting factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DJfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z a- ~z o . " ~ ~ ~/ ~ - ~ - ~ Boring # ^ Boring Gl 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. 'Etf#1 •Eff#2 ,-~ ~''~ U ~ ~/ ,off °3 ~ Bong# ° Bong ~ ~' Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 11 • Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6N0) Soil Test Plot Project Name Steve Olson Address 2874 160th Ave Glenwood Cit Wi 54013 ird y IC,,~TM #226900 Lot ----- Subdivision ------- Date 9~1 /03 S W 1 /4 S E ~ /4S $ T 30 N/R15 W Township Glenwood Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation none *HRpSame as Benchmark B-1 Scale = 1 /4" = 15' B-2 6% Slope Existing 3 Bedroom Trailer Woel~ B.M. 0 8% Slope ST 9% Slope --- B-3 / I/` Overflow Area of Saturated soil conditions for during the spring, ponded water can be observed in spring rn 0 0 0 m r 5' m ~B-4 ti ~ o ~ ° I N 1 ~ ~ N ~ I o 'y' c ° ~ f ~ a~ ~ ~N I ~ coo ~ • m n n ~ ~ I ~ ~ U a fA c N -p O N C y C O ~(pL tp~L mp ~ I m ~ o ~D b O~ N U O~ L ca._myyc-a ' ° o i voa~ cc~~cQ ~ ~ N ~ a; c o,o'o y Y f6 'O f6 IO ' I vc`4o~.~°~3~ I >, '~ N . D1 y >, ~OQ v ay ~'c c m ~ , C ,; ;a~v~:pa>>o~~ ~ ~ a I m ° o o L m c ~ O U L U L O N N m mL' ° ~ o o z ~ nm I 7 C d N T.D y E N 'O LL . ~+ (Q O y > ~ N O m p y N _ `6 ~ ~ 0 ~ o-° Q ~ ~ c~ O ~' '_ y O O= U d N I M V~ ~ I ~ W W y I ~ p V o z a m I ~ ~ ~ o I _ ~ U O Z '~ y ~ ~ w - o I to H ~ aci Z I ~ ~ N M I -Y ~ I I~ ~ ~- ~ c •~ c ~ '~ !~i :~ O C `° ~ N z Z Z _ I ° z ~` 2 ! 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