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HomeMy WebLinkAbout030-1004-90-000(2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567212 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Beer, Richard L. & Philli ine St. Joseph, Town of 030-1004-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 6111 I 6-)j 02.29.19.24A TANK INFORMATION ELEVATION DATA Oct TYPE MANUFACTURER , A CAPACITY STATION BS HI FS ELEV. . r~ /OZ Septic -X✓, 3. Benchmark 2-0 Dbe+r Alt. BM 14:5 .-7 Aeration Bldg. Sewer 1/, c14 97• a Holding St/Ht Inlet 5.c. 9G..3 TANK SETBACK INFORMATION St/Ht Outlet S• T 9G -45 TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet \ Aft fro- Septic Dt Bottom Dosing Header/Man. 14-77 ZS Aeration Dist. Pipe G.77 5S• Z'S Holding Bot. System 7. If PUMP/SIPHON INFORMATION Final Grade 3.7 77. Z Manufacturer GP nand St Cover ~~t Z ZI. Model Number .1• TD Lift Friction Loss System Head TDH Ft Forcemain a Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 'tL Z I Lw &L-0 l SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer- 1 t _ INFORMATION CHAMBER OR •~"~r'7° "~s T Type OfSystem: J 66 i) 4 UNIT Model Nu er: 9, DISTRIBUTION SYSTEM ak..j Z3 IL 2~ = *&P " /'0/j- 5-Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ` Length Dia Length \ Dia 1 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over i xx De th 011 xx Seeded/S ded Jxx hed Bed/Trench Center ~I 1 S Bed/Trench Edges \ Topsoil Yes ~ No Yes TNol COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1: Inspection #2: Location: 1150 County Road AA Hudson, WI 5440016 (SE 1/4 NW 1/4 2 T29N R1 9W) >3 acres Lot Parce No: 02 .19.24A 1.) Alt BM Description = Z; `CA- '6 y 1 ~ L 2.) Bldg sewer length = 24 V (I.-- GooX~ , - amount of cover = 30 .04- JV Plan revision Required? Yes z 340 / $ i13~ Use other side for additional information. SBD-6710 (R.3/97) Date Insepcto Sig a Cert. No. o~a'tk' v~ .i~b}►~ ~ ~ hQ a i o, 3 c i W,- K t3 ? O As 7m pyanTAW.. County 4 ~ ~I Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 - t.y1QLJRS.7 ry Permit Application State Transaction Number In accordance with SPS.2 2), Wis. Adm. Code, submission of this form to the appr %ber l unit W IA is required prior to obtaining a sanitary permit. Note: Application forms for state-owned ed to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide mndary _puToses in accordance with t he Privacy Law, s. 15.04(1)(m), Stars. L Application Information - Please Print All Information Property Owner's am R ) ^ ST <9 Parcel # 4. 1 -46 -400 Property Owner's Mailing Address ' Utiry Property Location / 21 1S (D CQ ( `7 Govt. Lot City, State ^ Zip Code Phone Number S F y4, N W /4 Section AUPS W.- O { S L S y V, Q ctrcle one) TN; REorW vrly2 pe of Building (check all that apply) Lot # Family Dwelling -Number of Bedrooms Subdivision Name Block,# ❑ Public/Commercial - Describe Use t ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of c -NTown of S fi Ose D III. Type of Permit: (Check.ouly-enebtox olii line A. Complete line B if applicable) A. ❑ New System a placement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Owner ~y(, y l9F,6- R7 W. Type of POWTS S stem/Com onent/Device: Check all that apply) L(7!7 S Melon-Pressurized In-Ground ❑ Pressurized In-Ground At-Grafle ❑ Mound> 24 in..~._o,, suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explains ` t -'i4 ~iL.fAfett~Ca dent Device (explain) V. Dispersal/Treatment Area Informa 'on: V 41 Design Flow (gpd) Design Soil A pli ion Rate(gpdsf) Dispersal Area Required (sf) Disoers Area Proposed (sf) Syste Elevation i CK- V4 1Q ✓ ~ - S/ 1115V 4 1 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tariks Existing Tanks 0 0.i V1 y V] 4z. CJ` t]. Septic or Holding Tank U ~`1 t Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) er's Si re MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 760 -Q// U`?o lbw S ~Jubsb isc.- SY~ VI Count epartment/Use Only Approved ❑ Disapproved Permit Fee Date Issued Tssuing Agent ignature $ 1 - fYD r , ❑ Owner Given Reason for Denial f I,' 4._.1.~ IX. Conditions of ApprovaUReasons for Disapproval F • r- , SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be served / maintained as per management plan provided by plumber. 2, All setback requirements must be maintained as per applicable code,6ndiflAfpQE 02as for the system and submit to the County only on paper not less than 8 1/2 x It inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application l INDEX ANb TITLE PAGE Project Name: )/U, ~ Owner's Name: Owner's Address: I (S V Co , Legal Description: Township: County: -~Lr_ CRblx Subdivision Name: Lot Number: Parcel I'D Number: Q30 Page 1 Index and title P_~2a2 Plot Plan Pa p-3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Informatiotl Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Forth Page 8 Warranty Deed Page 8 CSM or Plat Attache omits: Soil Test & House Plans Designer/Plumber: h~ OU 1Y~~~S Lic~nse Number: _ Date: Phone Number 1 1 5 7 3,-8 r4~a b Signature r Designed pursuant to the In-Ground Soil Absorption Component Manual for PCWTS Version 2.0 S©D-10705-P (N.01101). Page 1 p 4103r=-Alan ))SO Co~R~ A beti ~1b ~l~ r~~~10~ ~I b 1 N l w ~ 1v _lub OWN ~t V Vol X)vPL4 ,o ~.5 fpm o" V IV ti Sail Absorption System Cross Section 10ft ft , 4" Schedule 40 Final Grate PVIC Vent Pipe With Vent Cap SOfk Leaching Chamber - ( I• b it i~ " ' System Elevation . ft Soo Absorption System Plan Vie iCI~1. Leaching 1 Trench 1 Chambers Trench 2 Header Nfent Or Obsentation Pipe FT en Leah'inq Champ ^ t~ c~flcations Manufacturer And Model ERSA Rating, sr ft per chamber Soil Application Rate gpd/s ft 9Pd Design Flow Soil Application Rate ~0-- EI sA r _ . Chambers 01 rotors of - o chambers each. Page of PL-525.1Eff1ixrt Filter- Effluent. Fijtex, _ Pof.yjok jAc. Page I of 2 N9z~fe gin. tfre: '5,; , j P aly'lok Inc, 3 Fairfield l3lvd, Wallingford, CT 06492 Gall Toll Fr • ` ~ ea, ~•~8-765-95$S Email,. pealylok,corn you air! ere.. , PrOuot Details EFF"LUENT FILTER Raisins l the bar In filter tachnolo PL-625 Effluent Filter Description Ef ent Filters Flolylok, inc Is.pleased to add its new commercial filter to its existing lino of g(iallty effluent i Extend L okTm filters- The I~'L•-525 is rated for over 110,000 GPp (Gallons Per Day) msfcing it qne of the ! largest commercial filters in its class. It has W5 linear feet of 1116^ {filtration slots. Qks line Risers ~ Risser Goners Pglylok PL-122, the new Polylok PL-626 has an automatic shut off bell installed with every - „ - filter,10en the filter is removed for cleaning: the ball will float a and temporarily shut off Distribution Boxes amF 7 ' l'jii~iltGrlr, till i'I'`li the system 4p the affluent won't leave the tank. No other filter on the market can make that I Accessories 111,~r: ;r r claim! 111a~s,.»,.,....,.........,....,_... ij, ,~Pulall, lns, Pram:p r':° ~rderirrg Inflormatiorl Request ea Quote ' Related Products I Qanydyam/ y~~y~~tsp/~~~~ t ,i! • „.,,.,,.r,..•,.,,._,,,,,,,,,,,,,,,~,.w,W_,.,.,.,,...,..,,........M..._.w..._..._..... .'.-.+"nnnnsYYTmrvHM.exwFw».+mr M^N~i1Sal / A.7tllSRkG1.AY Features i afflers, Sanitary Tern (1,1~~IFlRS11C7!'~a s Rated for 10,000 GPD (Gallons Per Day) . 571 linear feet 01`1/16" filtration ~ Reber Spacers Enlarge for details * Accepts 4" and 6" SCHD, 40 pipe„ » * Built in Gras npfiPgjg)r Handles and Receiver, R Automatic shut off ball when filter is removed e Alarm accesslblllty Signs + Accepts PVC extension handle Land ape I Drainage The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. it is recommended that tho filtel' be cleaned every Forms lamps time the tank is pumped or at least every three years. if the installed filter Contains an optlonal 21@1-M, the nwner will be notified by an alarm whon the filter, needs servicing, i BW.--.1Sealants. should be done by a certified septic tatik pumper or ins%llsr. - --l- Servicing a A+;~ast~ori'es Maintenance instructions. wresstare F'ii~rs 1. Locate the outlet of the septic tank. ~de!rXYtIGrC3l Product 2, 'Remove tank cover and pump tank if necessary, _C 3. Do not 140 piumlaing +Olten filter is removed, i Reber" ` and CiV~ti 4. Pull PL-525 out of the housing. I a6'eet~rie9 5. Hose off filter over the septic tank. Make sure all solids fall k aCk into saptir tank. Re'bar Safety and 10 Gr< 6. Insert the filter' cartridge back into the housing making sure the filter i5 properly aligned compiptely inserted. I 0e0or0tive, Lanftora,pe' 7. Replace septi6 tank cover. PL-525 Installation; Ideal for residential and r.,ommPrcial waste flows lap to 10.000 Gallons Per Day (GPD). Te?chniooli S . »»igol ~ P~i'~kc'atlcf Il~lstailation lnstrewlrticarrls, - F Z toted Plrga4M I. L.orata the audaf. of the se tip: Rank. i Pump, Filter and Surt 2. Remove tank cover and pump tank if necessary, i 2411 x '12" Riser 9. Glue 'Lila filter Itar.tsing to the 41" or 6" p4rtlat piles, if the filter is not centered under smartni to rPanel an the aocesa aPen0e usIP a Palytok E4grj t & i,pkTim or piece Of pipe 08 nter fill ter. Control 4. Insert the PI_-525 filter into its housing. to hrtn //~x;th-~~; YG nlr r99lIC Ni,u-9'k, fgp,tg91c saQn7K~rnrl ,n. 11 t-1 4 ! ICIHII;( hr t n (1 1 n 7 u,I, i4 ZU1G 9:12AM No, 3066 P. 2 m ~ -Xn 0u'm rm +~1 z > FJ -I p Q? rn ct~ Q o -4 m C, o A x s~ c> z~ ~ .w as d I-AME ca nD ~b in p u M N IV W C N ~ n gg ~ 0.9 . Uc t, 14. 1010 9 ;12AM No. 3066 P. 3 C P r- ~ ~ - A C-n EO F:i 0 r- Ca ~ ~ m ' rn =M J ~ W C3} 'hJ ~i J ~y un Gh :y o • M~} P MfM Nov-11-2010 10:45 AP1 St. Croix County Plan/Zoning 715-386-4686 1/2 IPOWTS OV NER'$ MANUAL & MANAGEMENT PLAN Pega- of F11:1* INFORMATION SYSTom SPOCIlaimw&L0 t3 owner Septic Tank Capacity ~ (tibu a! C1 NA Permit # Z Saptio Tank Manufacturer W,jSftR Cl NA 09811 2N PA#(AM AS dffiluent Filter Manufacturer ~1 lp A NA Number of edrwame Q NA Effluent Fitter Modal ~a A NA Number of Publlo Facility Units -ANA Pump Tank Capacity of -W NA 5at(mated flaw (average) 3 60 al d Pump Tank Manufacturer -73) NA S Pump Manufacturer ---t-41A bosign flow (pack), (Estlinatad x 8i d Z'FNA Pump Model :tail App(IaatlOn F111800 Sta Influent/Effluent Quality Monthly average* pratrestment Unit 19 NA Fats, Oil & Gore Q(2) X80 mall. CI 6an0aravel Filter Cl peat Filter Bloc ism' %ygen Demand iROOs) X220 ma/i. 0 CIA a Mechanical Aeration C] Wetland A DtairifNation G3 Othsr; Total Suspended Soilds (TSS) :760 MOIL plsperssl Oal{(e) i~ NA Preir66i6d Effiwant 4weilty Monthly avarape to In•Craund (gravftyp C7 in-Ground (pressurized) Qitaaherniaal Oxygen Demand tt30DZ g0 m8l~ / A Oi At-Grade I~ Nlraurnd Total Suspended SSolids (TSSI mg/l, ptharc Aso S 1QGlml C3 Drip-LIne 0 NA Fecal Cvlifartxt (geometric mean) tlkttbr: Yd In dla, b NAt NA Maximum Effluent Perllal6 Stxe 0 NA C?th&rs war; Cthsr: 0 NA *Valuaa typioal for domestic wastewater said 66ptlo iRnk effluent. MAiN1TEN"A :O at3eiEQWI Seruflre P"Unney garvlae Event me this) (MISAMumta 3 years) . ANA inspect a+andt'dan of tankiel A,% least once every, - ear ) p NA tents of rankle) When combined sludge and seam equals tlnsathlrti of tank uoluma PUMP out assn ~ rldrrthW (N alflMum a years) 0 NA At least once every; •I &11. ❑ HA inapeot dispersal call(s) GI Months! At least 0106 6vsryr -l his NA 0 Yee InaAaox Clean puefflumpents filter mar A controls & alorm At least onoe every: q rncn'~hte) NA p Flush laterals and pressure test At least anae every; Cl ry NA rice ntontol At least Once ovary; NA Lrthgr; Other; inspections of tanks and dispersal cells shall be rflada by an Individual urrying one of the fallaswtng 1)0102"308 or certifications: MAINTENANCE )NSTRUQIU3 1nt3itler;ckar tmks, Mastor*1At9ln r, M1~tere iden eTt~fify)ntn a OPa inspect Plumber; unclu Plumber Rastrioted tSewer: POWTS Inspector; PpWTS NI of re,Iden an the cracks sacs, Measure r is must Includ* de >a bins inspectlaa of the rank(s) kle) identify any missing measure the volume of combined s10,0rdge and scum and to o check,ck fns any beak rap or pen g Onsoe tae may indicate ln and to g condition hoe for an gta red the The fluent at rthe g and be face. ty to p check the effluent 16vsis in the ObAsIvation pipes y of effluent an the roWrld surface. The pondt9 of affluent on the ground surf immediate notification of the local regulatory authority. scmimuletion of sludge and scum in any tank equals one-third (Ys) Or more of the tank valWrne, the entire When the combined aster and disposed of in accordance with chatter NR 113, contents cAdminlstrar."raae tCaderernoved by a SRp'tags Servicing tip Mechanical or pressurised aamponants, pretreatment Wisconsin All other ,$r3r 1062, (~c(ud)ng l,wt not limited to the s srvla11 bb perfcrrna effluent filters, unite, and any $6rviaing at intsrvala of ~s9 2 months, shall e d by a certtft6d Pi"11NT~ Maintainer. tenon of r, assns. emw W01) ,q setVlca report shall be provided to the )seal regulatory authority within 10 days of comp 'epa sn alxalulcuA4' ulmuoosrM'1r~) V W '(0t's-22 pug 1~? llp)rL)i9JI) ~r`~e wwo raxinga 4aIM eaueffdwaa ur p8%e4p seen ;uawnCO e O)Q C I euc4d p 14Jr aweN ~ h ~ - ~`e eua4,d S ht?1 0weN .~J rarr L w J<ao.~v'~trr r rao-1 app s : r 3 I La ~a aucstld ew~>~ °1~ - S t L eucyd b arc n v w I euaaN Ibp4l,f1111 S1M15d 1911V1 f1 ,4Mord ssluSMV-00 FO11021tr n ao ancam '11F182d J6''R W MISS 3014 Lamina o ANNo OW)) )lN%1.L..(3w w3w L M 10 wo dW ndlor~W a y asu d ION 00 'NORAX r .1.rSL~l~Iddd73N1 U01ONb' 008SVO WH.I31 NIb'1N00 AVVV S)INb'.L INSWxb IU. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1 C Puy 4 h) ) N -Q Mailing Address S U Property Address (Verification required from Planning & Zoning Department for new construction.) City/State A ,.,.95.W W' Parcel Identification Number ©34 - N6 -10 ` 60b LEGAL DESCRIPTION Property Location 5 1 / 4 , N 1 / 4 , Sec. a , T c N R W, Town of S~ - `1oSLp Subdivision Plat: Lot # Np . Certified Survey Map # oaltw d"; , Volume , Page # Z2 2 Warranty Deed # Sao Q SZ5, (before 2007)Volume '/66 , Page # Spec house 0 yes. o Lot lines identifiable"hyes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms_ SIGNATURE F 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. 0910') DOCUMENT NO. TlARRANTT 0190 e eo.a~ 460 PA-E222 STATE OF Vn=o SIN-FORM 9 A O I= SPAM tZRA a F02 8t"I i5 DATA Tins -DwwCuRE,made by Leonard J. Beer, also RtGISTERS OFFICE mown as Leonard Beer., a si ngl a man ST. CROIX CO., WIS. Recd for Record this-6.t?? gmntor of St - rrpi x County, Wisconsin, hereby conveys and warrants day of-April A.D. 19-70 to Richard L. Racer and Philippine Ti Beer, hnchan at-- WP Al M. and wife as faint tenants R 4z"i 1 s 9=tw R RETORV TO of St. Croix County, Wisconsin, for the sum of OnP dlnllar and other valuable consideration the following tract of land in St rrni x County, State of Wiscoaein; The Northwest Quarter of Section Two (2), excepting therefrom: Commencing at the Northwest corner thereof; thence South 159.6 feet; thence Easterly rj.0 chains to a point on the East line of said Northwest Quarter (NWT) :which is 121.3 feet South of the Northeast corner thereof; thence North to said Northeast corner; thence West on the North line of said Northwest Quarter (NWk) to the point of beginning; also The Southwest.Quarter of the Northeast Quarter (SWk of NEB); the Southeast Quarter of the Northwest Quarter (SEA of NWT), except a parcel of land described as follows: Commencing at the Northwest corner.of said Southeast Quarter of the Northwest Quarter (SEA of NW t); thence East on the North line thereof 815 feet to the place of beginning; thence South 33 feet; thence East 100 feet; thence North 33 feet; thence West on the North line thereof for 100 feet to the place of beginning; also an easement for roadway purposes 20 feet wide on the West side of said excepted parcel; also a right of way easement over the roadway asnow traveled in a Northerly-Southerly direction over the Northeast Quarter of the Northwest Quarter (NEB of NWT), all in Section Eleven (11).;- all of the above located in Township Twenty-nine (29) North, of Range Nineteen (19) West. also The Southeast Quarter of the SouthwestQuarter (SE4 of SWk) of Section Thirty-five (35), Township Thirty (30) North, of Range'Nineteen (19) West. Subject to easements and highways of record, and containing 275 acres, more or less. Grantor rigserves the right to live in dwelling house on premises for his natural life.- Subj,6ct to mortgage to Federal Land Bank in the sum of $11,450.00, which g r a &L+ $SVT~ffi esaa ggreai'tort0 UL-_ hereunto set hi s hand - and seal- this 2nd day of April _ , A. D., 19 ~Q . 1 J SIGNED AND SEALW IN PRESENCE OF 2~ b (SEAL) (SEAL) J (SEAL) "1 61 - Ruth A. Johnson (SERI.) STATE OF WISCONSIN, St Crni x County. } ss' EXEMPT Personally came before me, this 2nd day of April A. D., 19-D. theabovenamed Leonard J BPtr, also known as Leonard BPPr, -a single man to me known to be the person-who executed th _ oigg y~ftuin ~ d ackn edged the same. 0.lvo AitY . 'q Jose Joseph Hu h e SEAL This instrument drafted by NotaryPublic St. Croix County, Wis. Joseph W. Hughes, Attorney' yr 'yr-,'~h§yr,' y My Commission=F>i(I8) Permanent is on Wisconsin"" (Soction 59.63 W of the Wlarnnain Statutes Provides eab to be reoerded shaD have vletn49 printed ea typewritten thereon the namee of the grsators, grantees. wltatsaoa and nicety). WARRANTY DEED--STATE OF WISCONSIN. FORM NO. 9 U. e. w,ura CO.- aat.uttr , ` i 2329 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Aditk A.C.E. Soil & Site Evaluations Attech complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix web include, but not limited to: vertical and horizontal adonjoWoint (6M), direction and JUN Parcel I.D. percent slope, scale or dimems' in and distance to nearest road. Plea a M MIMI 2-go n. Sr 0-1 pJ -90-000 7 ri CRp4 RevieweQ By Date Personal iMormadon you prov b6a+oodiePS9 n~dary purposes (P~ivacy Law, s.15.04(t) (m)1• ' ~.~OU l Property Owner Property Location Richard & Philippine Beer Govt. Lot SE 1#4 NW 1/4 S 2 T 29 NR 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1150 Co Rd. A nor nor Na uJ l 12d City State Zip Code Phone Number _j City Village 16 Town Nearest Road L~ft M . Hudson I WI 54016 St.Joseph Co. Rd. A ew onstruct n Use: id Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD e Replacement -J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na Gene 1-comments and recommendations: Site suitable for conventional POWj5111,"ersal cell with 0.5 gpd/sq.ft./day loading rate. Proposed infiltrative surface elevation to W= 94.50'. Boring # -I Boring g7" in. Soil e Pit Ground Surface elev. 99.08 ft. Depth to limiting factor > Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. Murrsed Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "E 1 0-6 1Oyr3/3 none sit 2fgr mvfr cs 2fmc 0.6 0.8 2 6-14 1Oyr4/4 none gr sl 2f&msbk mvfr cs 2fm1c 0.6 1.0 3 14-19 7.5yr4/6 none Is Osg ml cw 1vf,f 0.7 1.6 4 19-97 1Oyr5/4 none s Osg ml - - 0.7 1.6 Boring # J Boring } Pit Ground Surface elev. 98.71 ft. Depth to limiting factor >93" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-8 1Oyr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 8-23 1Oyr4/4 none gr sl 2f&msbk mvfr 0s 2fm1c 0.6 1.0 3 23-36 1Oyr4/6 none Is Osg ml cw 1vf,f 0.7 1.6 4 36-93 10yr5/4 none s Osg ml - - 0.7 1.6 " Effluent #1 = BODS> 30 < 220 mg/L nd TSS >30 < 150 mg/L. ' Effluent #2 = BOD <30 mg/L and TSS <.30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson / 5.--- 3602 Address A.C.E. Soil & Site Evaluation Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/24/2013 715-248-7767 Pro~pertyy Owner Richard & Philippine Beer Parcel ID # 030-1004-90-000 Page 2 of 4 F 3 i Boring # Boring I Pit Ground Surface elev. 97.18 ft. Depth to limiting factor >88„ in. Sod Application Rde Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 8-33 1Oyr4/4 none gr sl 2f&msbk mvfr cs 2fmlc 0.6 1.0 3 33-39 7.5yr4/6 none Is Osg ml cw 1vf,f 0.7 1.6 4 39-63 10yr5/4 none s Osg ml aw - 0.7 1.6 5 63.88 1Oyr4/4 none Its Osg ml - - 0.5 1.0 4 ] Boring # Boring 01 Pit Ground Surface elev. 98.83 ft. Depth to limiting factor >95" in. F Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 8-14 1Oyr4/4 none gr si 2f&msbk mvfr cs 2fm1c 0.6 1.0 3 14-17 7.5yr4/6 none Is Osg ml cw 1vf,f 0.7 1.6 4 17-95 10yr5/4 none s On ml - - 0.7 1.6 F-sl Boring # J Boring L✓f Pit Ground Surface elev. 97.12 ft. Depth to limiting factor >83" in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots GPDMt2 in. Munsell Qu, Sz. Cont- Color Gr. Sz. Sh, *Eff#1 *Eff#2 1 0-8 1Oyr3/3 none sii 2fgr mvfr cis 2fmc 0.6 0.8 2 8-37 1Oyr4/4 none gr sl 2f&msbk mvfr Cs 2fm1c 0.6 1.0 3 37-51 7.5yr4/6 none gr Is Osg ml ci 1vf,f 0.7 1.6 4 51-62 1Oyr5/4 none s Osg ml cw - 0.7 1.6 5 62-83 1Oyr4/4 none gr Ifs Osg ml - - 0.5 1.0 Horizons #2 & 3 contain approx. 500/6 gravel, cobbles & stones by volume. * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS <_30 mg/. '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. SOD-8330 (IL07/00) XCE. SON & Site Evakell m PF rooprt`e'~y Owner Richard & Philippine Beer Parcel ID # 030-1004-90-000 Page 3 of 4 g l Boring # Boring III M Pit Ground Surface elev. 97.19 ft. Depth to limiting factor >85" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 1Oyr3/3 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 12-48 1Oyr4/4 none gr sl 2f&msbk mvfr cs 2fm1c 0.6 1.0 3 48-61 7.5yr4/6 none gr sl 2msbl ml ci 1vf,f 0.6 1.0 4 61-71 1Oyr5/4 none s Osg ml cw - 0.7 1.6 5 71-85 1Oyr4/4 none gr ft Osg ml - - 0.5 1.0 Horizons #2 & 3 contain approx. 50% gravel, cobbles & stones by volume. F-1 Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Doninant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # J Boring F-1 J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GRIDNIF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = SODS> 30 < 220 mg/- and TSS >30 < 150 mg/L * Effluent #2 = 8005 s 3Q mg/L and TSS <_30 mg& 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. 3BD-8330 (R07100) A.C.E. SON & Sibs EvdludtlM c.4 ellalUA4'0,110,~_' i ✓Q✓L( ' ¢ rxj, n t, : 60&-a '1 , ,q s5urnc e( ~v7 ~c~w/'d 8ec/P~or ~lccd s o~, .53Y0/6 ` ~ SCy~ncv~ Sec. Z, T'Z9?, clca6r.~ Scrr%c~ D /9ccJ; T. of SE. ~s4e'~, oil '1444 6¢%•~ .39. //4cres bs z, qr~¢ Cxrs£ ■ 3 be boon. ~Qes,dtt~Ge. ~ c~~a va sec so o,' ■ 82 ■ B,~ d~;deway EX:.sf;.~ ~-raolr a.L` 6u: .xi .4Ppro,~. Bade cL6 6yo oFbce~d,; 5c" 97. propose e! 0(,:5,0 C. et ~5 yon y