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HomeMy WebLinkAbout018-1099-34-010- - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Ulferts Famil Trust Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic 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 Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well ELEVATION DATA County: I St. Croix Sanitary Permit No: ! 506243 G I State Plan ID No: i Parcel Tax No: 018-1099-34-010 Section/Town/Range/Map No: 09.29.17.844A STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet , Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATION Type Of System: UNIT Model Number: nICTCIQ11T1(lAl CVCTGM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing' Coll rn\fCC .. r,____..__ c.._......... n.. r.. ..., nn....., rl !lr A4_Rratla Svctemc Ur11V Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes '`io COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / i Location: 1743 102nd Avenue Hammond, WI 54015 (SE 1/4 SW 1/4 9 T29N R17W) Pheasant Ridge Lot 34 Parcel No: 09.29.17.844A 1.) Alt BM Description = 2.} Bldg sewer length = - amount of cover = Plan revision Required? ! Yes No ~ i ~ i Use other side for additional information. - ~ --- --~ -" Date Insepctor's Signature Cert. Nc SBD-6710 (R.3/97) COmmerct:.Whgov Safety and Build' s Dt ' County~J /I ~ C ' ' ~ 201 W. Washington Ave., .O. 716 • t ~) 2 ~,,+ Ct3 ~ ~ ~ Madison, WI 5370 62 Sanitary Permit Number (to be filled in by CoJ 1)epartrttorrt of cotnmeroe ~O Z Sanitary Permit Applic tiolRE~ Wis. Adm. Code, submission of this f rm to the approprC'~o ental !n accordance with s. Comm. 83.21(2) State Transactions~Number ~ ® l , unit is required prior to obtaining a sanitary permit. Note: Application rms for state-owned POWTS are eflndary submitted to the Department of Commerce. Personal information you p ovide ma-n, be rysd$ fa/' Proj~(t~,Addre~fdtfferent an[n~ingss) . // ,'L'\ [" ~!Y/' 33 ~® LL ~ u ses in accordance with the Privac Law, s. 15.64(1) tn), Stats. J 11~V G / L / !` I 1~ .J iii"'JJJ 1. A lication Information -Please Print Alt Information Property Owner's Name ST. CROIX COUNTY Parce! # tg-- o~g.~3~~ a!~ Property Owner's Mailing A dress Property Location / ~1 T Govt. Lot City, State ~ Zip Code Phone Number ~ y,J_~ y., Section 1 i ) I/U,/ / b ~~ cle o N; R E r W ' 6k p ype of Building (check all that apply) IT L ~ p, . 3 Subdt st Name r 2 Family Dwelling- Number of Bedrooms ___ _ ~~ Sub,M, ~. tra2. Block # eCA-4 ^ Public/Commercial -Describe Use P,Q""' ,r ^ Ciry of ^ State Owned -Describe Use CSM Number ^ Village of / ~ / e J / $ ~~ f C J Town of ltl. Type of Permit: (Check only one box on line A. Complete line B if ap licable) A. w System ^ Replacement System ^ TreatmenUHoldin Tank Re lacement Onl g p Y ^ Other Moditication to Exis[in S stem ex lain g Y ( p ) B. ^ Permit Renewal ^ Permit Revision ' ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POW'CS S stem/Com onent/Device: ;Check all that a I O ~ Gv ^ Non-Pressurized in-Ground ^ Pressurized In-Ground t-G~zde ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersatlTreatment Area Information: Design Flow (gpd) ~ Design Soil Appiicati Rate(gpdsf) Dispersal Area Requir sf) Dispersal Area Propose sf) System levation / ~ ,/ ~ s-v ~ ~ ~ ~ ~ ii3o $ ~ Vl. Tank Info Capacity in ' Total # of Manufacturer ~ Gallons Gallons I3nits ~ ~ V ~ y Ncw Tanks Existing Tanks n ,! ~ B ~- u` i c 0.U :; ~ v, ~ ~ rn ~ ~ iF V a ('^ ~ Li/ , (, . Septic or Holding Tank Dosing Chamber /' y D VII. Responsibility Statement- 1, the undersigned, assn r sponsibiliry for installation ofthe POWTS shown on the attached plans. Plumb 's Name (Print) Plumber' azure /MPRS Number P M Business Phone Ntunber C Q / J G L.C~ ~'~ "l ~' Plumber's Address (Street, Ci[y, State, Zip Code) ` ~~ VIII Coun /De artment Use Onl Approved ^ 'approved Permit Fee Date I sued lssuing nt Signature s ~ OO ' ~° ~ z~'f a~ ^ en Reason o enial O IX. Condit'o easons for Disa royal ^ S~~Z?YYNER: pp 3~ QJ.\dlp~.. ~QCJ2~op~- tr,p aa~ ~o ~ J~d~E.. ~~ 1. Septic tank, effluent fliter and I ~ ~~-. dispersal ceH must all be services / W ~ ~ ot,rJ~.w Mme: ~'e~Q., . as per management plan pro~ded by.ptumber, i..nu s~baac requirements must be mewed ~,, ~~ 10~.~-, o,~. l~.e. t`~ "' ~" -'"~"A'tiach to"complete plansYor the system and submit to the C only only on paper not less than 8 t!! x I l inch i size SBD-6398 (R. 01/07) Valid thru 01/09 5 ~~ (~Ql ~~E a1/~, G~ ~,~ W~l-v~. • '~• PLOT PLAN PYtOJECT Ultert's Family Trust ADDRESS 1011 170th St. Hammond Wi 54016 SE^i/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 96.8' .4 loading rate CONVENTIONAL BEDROOM 3 AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 125 # of chambers none ,BENCHMARK V.R.P. Top of wood post ^ BOREHOLE • WELL * H. R. P. Same as Benchmark 102~Ave Scale = 1~/4" = 10' 1.5 acre lot Pro 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels B.M.* Golf Course ~ SETCigc.~G (suitable for sanitary system) Well is to meet all setbacks found in Comm 83 Grading is to be done to divert runoff away 6 - 2 from system 7% Slope B-3 Area 15' below system is to remain undisturbed P ASSUME ELEVATION 100' Filter BEST GF10-8 Property L Huffcutt Combo Tank B-1 96.8' 96' ~, ~ PLOT PLAN PROJECT Ulfert's FamilvTrust ADDRESS 1011 170th St. Hammond Wi 54016 SE 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 96.8' .4 loading rate 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 125 # of chambers none ,BENCHMARK V.R.P. Top of wood post ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE WELL * H. R. P. Same as Benchmark 102nd Ave Scale = 1~/4" = 10' 1.5 acre lot Pro 3 Bedroom House B.M.* Golf Course EaSZ'n~en~ SETSigcK (suitable for sanitary system) Well is to meet all setbacks found in Comm 83 Propei'fyline Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading is to be done to divert runoff away B - 2 from system 7% Slope B-3 Area 15' below system is to remain undisturbed Property Li Huffcutt Combo Tank B-1 96.8' 9 6' commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 21, 2007 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: 06/21/2009 Identification Numbers SITE: Transaction ID No. 1404908 Ulferts Family Trust Site ID No. 726526 102nd Ave Please refer to both identification numbers, Town of Hammond above, in all corres ondence with the a enc . St Croix County SE1/4, SW1/4, S9, T29N, R17W Lot: 34, Subdivision: Pheasant Ridge FOR: Description: Three Bedroom At-grade System /New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1136048 Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual -Version 2.0, SBD- 10706-P (N.O1/O1) 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 component manual(s) referenced above. • 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. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Filter access must be provided per Comm 84 product approval conditions. • 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. Note: The proposed well location for this lot appears to be affected by a well advisory setback distance of 1200' that must be maintained due to a nearby landfill. See the certified survey map filed with the county fof^' P 0•W 7. the exact location of the setback. `-'~nl~ltlOfJ 1~PPR~1 DEPARTMENT OF COI f SHAiJN R BII2D Page 2 6/21/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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 soil absorption 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 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 maybe 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, 7:15 am - 4:00 pm j erry. swim@wisc onsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 6/2/07 Cover Page ~FcFi /i, ~/~ sqF~ ~ ~sz O ~~~ oo~ ~~~~~N ~s Owner: Ulfert's FamilyTrust Location:SE1/4 SW1/4 S 9 T29 N,R17W Hammond Lot 34 Pheasant Ridge 102nd Ave System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test Shaun Bird Signature License number 226900 f/ fj.. J.~/ Y 7 SCE .LDINGS SEE CORRES DENCE y~i ~ ~ _ --- ~ y "" ~ putt ~ar~~~ u .~..~ 1 M .r 'S,YI~B~d.tZ~~D' ti$..'gZ7ii4I'i~N if~£li. > ~~ . Il6 B l~~ ~' ~ ~ - ~ ~'~- s = -t~~~.~. t l3 x ~t~err.,~vt~a SY~~t ~'t~$3~fC ~ ~`ss~~~u~i~r~ ~..a~er~~ s~8~~.~~~.~ ~}~s~e~~c~~~~~---..,,~ ~~~ ~~. ~ Snit ~~er . ~~~ ~~~~ =-~ _~____. ~3an V~.sv arsa3 ~rnss Section of i.7isersr~aixr. A~-gx~~ ~'-~ wiz~s a S~YSg~.~ ~hsasptiazz eta azt a Sloping Site , ~Lb . - "~~ •• - ~ .. ro ...~ • ., ~.. ~ _ . ~ .. •-. _ -.... s Page t~ ~~~E~3 ~et~k ~Pce s~' ~, 3~; s Ftfr+Ce l~tn PYC fl~stt~~et;o~ Wipe - _ .. _ _ P . i i * Est ~e'~e Sid Se Next Ta T~Rti-~3P ~ ' . 1 H~~ a €~~~et~ ~ ~~~' ~ I~ac#~ X ____ t_'. r, des i.aterall ~iaa~ei~ea' ~. f~'t{es~ . 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CL)I~tIIt1EGENCY PI_~ #~ f~Ec3 rneasurps leave been, cr azstsst be fz~. ~ Pie a code if fhe PO~"S fa~S ~ be r.~. comma€rep~ ~" _ ansi rs~ay be ui~":zed f~' S~ ~ a~ a n~ ~ . ~ ~ ~ -~ ~p~rr~erst asez s t~ pc~sre ern d'~rrbas:ce aid webs- Failure to ~ be ~ ~ by ~ ss frarrr s ~ ped.sar:sdt~ 4a ~ . azsa ~II ~slt In the seed {nr a new soiE e.r~d s?te=svaEssa~ost ~~t s must t~P{Y',~ ~e ;ales to at S~ fie- ~ ~ P451~t'1~'' II A suttaWe ~A~ ~'~ ~ rsc2 avasTal~te' due 3p setbactc arsdlor saiE ~,rsifiat~~ ~ a ~ ~~ ~ ~ as a last resort to rsptace tfte ~~ - t~ idenfifY a sui~ia rep~ern®r:t anew t3pott fas~sycs a~ fbe PDV~tTS a sa~.2rsd °-~The ~ has raoL bees, eraTssated ~ Ion a suitabie ~giaceme~ area- if tsa r+ap asa8 i5 ~abte a / 'Sits e++atua~ tZStss~ be p~ t~se f2E'irirf PO~Y~S ~ tandc rssat+' be wed as: a gast~scsrt to be ~nstruded lrc rsia~ ~O'i°`~g sett a€ ~e bbarr~t at n~s~s-y~erxzs must carn€slY vvl~ See rtFfe~s ~ ~ ~fi~~. ccVfFA~' 'T~iNK'~.s EIIAY GO~1rt~AEt1 LE'f H1~- USES ~kfiE1310R WSt7~I~ET OXY~. ~ FUlf3~ AAF1? OrfHI:R TRFRT~T TiZEATY~t[Ei~T" TRl~tK UiKDER AI~tY ~~~' t7,EATH If~AY D~U HC3T ~ A $~~"fCr PLt1f~P ~ OTHER . ~3L.Z , ~ES£ISfE•OF A ~~ THE FOR fl~ A TAI~[K i'~EAY BE I3tFFK~fi-T C3R 9~fP.t)S518L~. . RDDIfiONAt_ t~ElE1YEEl~tTS • P~Stlt~'S11VS'1rAiLEt? PUSS N!'AI~tTA~ Name ,f~a. ~~ P~r~e ~ ) ._ ~ `7 .~ ~O S~PT1~ SEE~~G t?P~RATOR iflfl~ FZ,EfiUL~T~3Rr~Y!€€t~Hg~f~' Nary ~ ,~'h„ ~ A9~~Y cS~ C `r' / ~9LG r- Pt~cns /J ;'' ~'S ~ ~~ ' Ei Phone ~ ! J r~ ~ ~ ~ new F1rFs ~sdr~ttsd bjCtka st>~s a~t~ t~tt ~: ~ ar~d YV~uslsar~ CoutstY Zzs~tg s~sd ' '~ ,~ ate ssszC33fb}ttX~1 ~ ~-~t~3. C~ ~ f~. fir. A,'frs~ Coida Ease of Ks1s Qom s~K g~su~ae the ~ cf tt~e ~ 1(~fj .~ ,win Departrrseniof Commence SOiL EVALUATION- REPORT Page of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code Co~Y :. ~" {'vi-a Attach complete sits plan on Paper not less than 8112 x 'i 1 inches in size. Plan must iradude. bat not Gmifed to: vertical and horizorrtai reference point (BM), direction and Parcel ).D. percerrtslope. scaly or dimensions, north arrow, and location and d'wtanoe to nearest road. Please print all Informat7on. Reviewed by Date PersaW hdorrrsation yw, vrovida may be cared tar socondary puyosae {Privaq uw, s. t S.oC (1) (m)). Y ~, Property Location (~,,~ ~ . "'~ ~ ~ a'W~ t'1. ~ + Govt Lot ~, S/4,~(„y~14 S T ~ N R E ( W t prppettyOwner's 9 ~~. ~ ~ J Bfodc # Subd. hf~r~e or CSM# ~' T 1 r rte.. State Code Phone htumber ©City 0 Vitla9e Town Nearest Road ~ n Residential l Number of bedrooms ~ Code derived design Row rate ~,/J Z~ GPD ParentParettt rnateriat ~ D Pubfac or cammertxai - Desabe~ Flood Plain elevation if app6c~bte /1~/ R t3et~erai ttorrrnerrts and teoorrvnandalions: g f Q System Type System Elevation l L~ - t ~i _. ~g~~~tt Y/ `nt Pit c~urra surer elev. . ft Depth to 1'nniting facto ~• ~ ~ (~ Fforirmn Dapit- ~ORnlnirrt RedoX Desafption Texture Structure Caisistence 8oe,r,aary Roots G in. Munseti {lee. Sz. Cont Color Gr. Sz. Sh. 'F.fffitl 'Efffi2 !~ "" ..mot L- "_'_'~-' L~J"~ ( J „'7 3 ~ ~ ~ r ~ ~ ~ _____ - fr v ~ ~i~ j~ ~ ~ J , 7 ~~ ~.... m '~ ~, Pit Ground Surfaceelev. / ~' / ft Depth to )inviting factor J y ih. th Dominant Redox Dasc:iption Texture Stnxxeue Consistence Boundary Roots • D ti i So0 Rsts GPD/f? or x~ ep In. MunseU flu. Sz. Coat Color Gr. Sz. Sh. 'Eff#2 'Efif il / ' ~-- ~ r ~, ~r i • r -- ~ ~ ~ Eftluerlt S9 = BOD > 30 <_ ~ tnglt. ana T ~ >30 _< lisi3 ' tmueru Est = tsvu _ ov rregn. ana a a~ ~ su rrgy~ CST l~l8tnfl (Please Prirs~) CST Number Bird Plumbing, inc. Shaun Bird 226900 Address date Evaluation Conducted Telephone Number 1008 792nd Ave, New Richmond, Wl 54017 ~~r~ 715-246-4516 ,ply Ovs~er Pacrsi .iD # ~ ~ ~9 # Pit Gnwnd swface elev. ~~' ` De{~h to limiting tailor ~ ~ Rafe hiorimn Dep'tl~ r)on»nant Redox Desatption Textisue Stn~ure Con~ste+x;e Sot~y Roots in. Mansell Qcs. Sz Cont. Cobr Gr. Sz Sh. 'Eif#t 'Efr#2 ~~ i ~ r31~ _----~ r~ ,~' Q Pit Ground sustace elev. ft. Depth to limiting factor ~ Scd Rafe ~~ # Q ~~ tiot~Dn Depth Dominant Redooc Desatption Texture Ststxture Consistence Bot~Y ~'~ GPDIfE in. ilAunseU Qu. Sz Cone Color Gr. Sz Sh. 'Etf~'t 'Ef!#2 ^ ~ B«fnsg # D syiit . G,o~,nd surface elev. ~. ` ~ ~'• ~ ,~.. -(iorizon ')epth Dominant RedoaDesalption. Texture Stuchue Consistecx~e 8oundaty Rooms G in. Munsed Qu. Sz Cont. Color Gr. Sz Sh. 'E!i#1 'EtE#2 ` Etltt #1 = 84Da > 30 < 22D mgtl ac-d TSS >30 =150 mglt. • Elflueni #2 =BODE <_ 30 mglL and TSS _< 30 melt. The Deparcmeat of Commerce is an equal opportuaity service provider sail employer. If you need assistaace to access services ar need material is an alternate format, please contact the departcne3ti at 608-266-3151 ar TTY 608-264-8T1~. seaaaa3otasroo~ ~. .. Soil Test Plot P Project Name Uiferts FamilyTrust Address 1011 170th St. Hammond Wi 54016 - Lot 34 Subdivision Pheasant Ridge Date ATM #26900 6/2/07 SE ~/4 S W i/4S 9 T 29 NIR17 W Township Hammond [] Boring ~ 6~'ell PL Property Line County St. Croix 'Assume Elevation 10© ft. Top of Wood Post BM or VRP System Elevation 96.8° *HRP Same as Benchmark r.-!'7q~ - r ? RECEIVED Wisconsin DepartmentofC marts S IL EVALUATION REPORT Division of Safety and Buildi gs _ ~ n n 7 Page ~ of ~UN ii ar~-,ury~naaz wnn mm oa, vvis. Murn. ~.uue ~ County t Attach complete site plan paper not less than 8 1/ 11 in has in size Plan must ' ~ v ` . include, but not limited to: rtical~rdbp~q(ifa(3 ~ce po t (BM), direction and parcel I.D. percent slope, scale or dim nsions, north an-ow, and locatio nd distance to nearest road. P ass print all information. eviewed Date Persons! itdormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). . ~ ~f ~ ~ ~ .ry Property Owner Property Location _ r "~ S~ ~ {~~ .-~ , Govt. Lot S~ 1 /4Sj,,, J114 S T ~ ~ N R E ( W Property Owner's Mailing Address ~ Lot # Block # t me or CSM# Suut ~ J ~ ~ ~ CRy State Zip Code Phone Number ^ City ^ Village Town Nearest Road New Consirudion Uses Residential / Number of bedrooms ,,.~__ Code derived design flow rate ~J~Z~ GPD ^ Replacement ~ ~ (~ ^ Public or commerclal -Describe: ________ __-_~____~___.__ __~ Parent material ~C-C>C ~ Flood Plain e4evation if applicable ~~ ~ ft. General carrxnents ~Q~ ~ ~m i~ and reconunendadons: System Type~~F E System Elevation ~ • U `/hC~ "~' ` ~~ # ~ Boring l Pit Ground surface elev. ~ ft. Depth to limiting factor ~/ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. MunseN Qu. Sz. Cont. Cdor Gr. Sz. Sh. `Eff#1 `Eff#2 Z g- s' ~--~ C l-J l r 3 a , ~ ~------ ~ ~,~ ~ f 7 #op~~ ~°ri^~ g CI. pit Ground surtace elev.! ~~ ~ ft. Depth to limiting factor ~ ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~ ~ 31 ~-------- ~ '--, ~' ' ~ , ~- - Z ~ r.~ ~~ G ,cam r/ `' ZZ-~ , S ~~ -~ t .~ S ,- ..- ,` • Effluent #1 = BOD > 30 < 220 rrxyl and TSS >30 < 150 `Effluent #2 = BOD < 30 mglL and TSS < 30 mglL CST t~art-e (Please print) - - Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~~~~ 715-246-4516 't Property Owner Parcel ID # Page of Boring # Boring Z pit Ground surface elev. ~ ft. Depth to IimiGng factor Orin. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2. 1l-2 5 ~„ ~ s r~ 3 ~ ~z ?,~ ,Y ----~ S' ,~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ^ gyring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/if in. Munsell Qu. Sz, Cont. Odor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' EftlueM #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sao.s3ao nt.~noo~ ~ , t Property Owner ~ Parcel ID # Page of Boring # Boring ~ ~ _ ~~ pit Ground surface elev. " ' ft. Depth to limiting factor in. r-;-- Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots ~~ww~i rcaie GPD/ff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eft#1 •Eff#2 ~~1 ~ G' ~ 3/z ~~ .~' 3 ~ Y ?» ,Y -----, S ~ ~' ^ Boring # ~ Boring n oar Ground surfacE Plav ft no„w. ~., a:...:«..,, f.,,..,,. Horizon Depth Dominant Color Redox Description Texture Structure -- - Consistence ~~~~ Boundary Roots Soil li GP cation Rate D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 (, p;, Ground surface elev. ft. Depth tg limiting fader ar, Soif ication Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/i'f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eti#1 •Eff#2 ' Effluent #1 =GODS > 30 < 220 mg/l and TSS >30 < 150 mglL • Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBQl330 (8.6/00) s, Soil Test Plot Pla~l~ Protect Name Ulferts Family Trust Sh~.~n ird Address 1011 170th St. /~, Hammond Wi 54016 NCST #226900 Lot 34 Subdivision Pheasant Ridge Date 6/2/07 SE 1/4 S W 1/4S 9 T 29 N/R17 W Township Hammond Boring Q V~'ell PL Property Line County St. Croix BM or VRP Assume Elevation 100 ft. Top of Wood Post System Elevation 96.8 *HRP Same as Benchmark Scale = 1 /4" - 10' 102nd Ave - Property Lin 1.5 acre !ot r v••. Golf Course ~ (suitable for sanitary system) X17, a B.M.* Prop ne B-2 B-1 ~ ~ 97' 96.8' 9 6' 7% Slope ~ B-3 i • , RECEIVED APR 1 5 2004 ST. CROIX COUNTY ZONING OFFICE CERTI FLED SURVEY MAP LOCATED /N THE NW 1 /4 OF THE SW 1 /4, THE SW 1 /4 OF THE SW 1 /4 THE NE 1 /4 OF THE SW 1 /4 AND IN THE SE 1/4 OF THE SW 1/4 OF SECTION 9, T29N, R 17W, TOWN OF HAMMOND, ST. CRO/X CO., Wl. BEING LOTS 33, 34, 35 AND 36 OF PHEASANT RIDGE FIRST ADDITION. PREPARED FOR: RON BONTE ~ / ~ . saT2s'o1"E~ 3eso2'~• ~ I /NN h ' f I I NOTE: BEARINGS ARE REFERENCED \\ LOT 135 ~ TO THE WESTERLY LINE OF LOTS 35 AND 36. ' 50' i I I RECORD BEARING. \ 1.99 A~RES :• ,1; I o. \ 86,669' SOFT. ~ ~ ~ • \\ ~ •~. o. N1\ 1` LOT 52 LOT 54 ~~ W~p \ I o., \ 0 ~[i ,~~ \\ ' ~E 302 ~0-~ ~; ~ . \\ THIS MAP SHDfIYS AN BEIWEE7V ~ 5' %~ ~ ABr;/i7AVG ~R'OPERr-E~ NO NEW L015 ARE co N ~2\1 j .~ r;~ ~\ \ CREATED B1' THIS INSTRUMENT. ~~ \ Off` a ~•\ • ..........:................ ~ ~ ~ LOT 35 ••:`- ~ • ' \• ., ~ \ M w 1.79 ACRES •' `~ \ s ~ ~. u5 k N ~' I \77, 987 SO. FT.. • ••'• ~~ o~ \ \ rr Z 30 01 = '~~ ~ \ r~"Ip ~, Jed<s~~~ I ~21~o'2a"~,_ 2'`- ' ~,`~~ \\ LOT 51 o ~ .•••• \ ~, i a . • LOT 34 ••:~ ~ \~ w I ~ • ~ ~ \ Ss0 23 19 E ~ ~ ~ '~ •I ~ 1.82 ACRES ••. +~ \ `\ 27.03' / :0 ,~ \ 79, 221 S0. FT. '' ~ ' \ / ~ \ ~ / • I ~` / o~ N 6 ~~ ~ / •~ ~ 4 \ LOT 33 % O // 5 t. 73' •~ oo I ~a, \ 2.61 ACRES:' • ; ~ ~ / ~ • • . • LOT 49 ~ i ~ \ 114, 620 SQ. FT. ~ ~ d~\ ~ ~ I a -SET 1 " O.D. X 18" IRON PIPE I N ~\ ~ ~~D,i - ~"~ I WEIGHING 1.13LBS PER LINF~,R FOOT. + ~~ ~.\ ; ~. p I o = 2° IRON PIPE FOUND. •c1~ \ ~ OI ~ ~ ~~~CO~S~~ Z s, \\ i N l 0 1 JAMES M. • = 1 ° IRON PIPE FOUND. I \ i ; ~ I ~ WEBER Ob O oL0 ~£ ~ ~ _- .O~:g~ - • ~® I '^ ~ M • ~ vJ y ~ W ~~o W I Q y ''rip ~t I ~N~ ~C ' I O': ~ o', °~ II J,~ ''~,~e- ~,, I ~ ~ z ~ ~ ~~ ~, ~~o I ,~~~~ ~ I ~~ z .$Z2 b L~ o I •o~ . LgL M „~~ 92 yIN I ~~~ yly ~ ~ I ~I ~i: 2 ~~ ~~ o Q y O oD N / J- ~ ,'~9y~s . ,, ;- N i N ~ i O ~ i i "6~ i /. .p6~ ~~ . Lg 'r1~. pp .~ .~a, ~~ yo''~ r M N' • ~y ~6~_ ___ bil MS b~ 1 MS ~~Nn . Ob °bzi ~~,~- ~'- •~N`~~ ~ 4 ~ do ~ N ~ Q m ~~ ~ ~ ~ ~~~~~~ "~ ~- _~ ~- I S' ° S ~~~ ti ` ~ Lu O ~ ys, u7 N I ~Q O ~~ ~ ~s~- ~ .<' s ~- 1N ~ ~ _ 92oy , ~ W K1 M ~ 0 l~` $ A ~~ nLl~ r _ _.1 .. ~: 6lnr? M_ 6J3ser::n e:. Ra~trica G. iTAderES, a16/n RacE,aeZna G. ;' 7i€ec:~s., a99cds '~ar::esi3a I+1€arMs, elk/e 6ace ;? €ects, a/k/a Gatlaaris~ t"c€es s ca_~ .:e ~~i~_.-,a as s~t~:rots~_:y xari_aE p ~e=`-~• ~~_: ~_a_°:; `J E:14Cm !:. 43?YGrt3 dRC: G,i:C'L+d C?@3 G. Olt:@CE~I ?d.'3e 3`d :~rLSt, - Li~i l'l~^? C:t_ (!~i;Qzr~ 'yC': d~1'I,3 eiS:... rdi~?3, rFc :~?-~."rte.-y ?~.~._751.~-d s^s: t ~'. ..:~ ._. 32 °~__% ~ .coif.. ~c;~...; Ssa-.z cz nisro~^s^: ~. ..'.e r~['~+~si- ,,. .S 1=:. isa; ~r~ s _crc._rw_~ -?;at .-~gs2rr^: ,~'z ~y ..~...-s: :~sz:.-~ ~yy ,:i v:a.~-o°f: Lti~ cre/a5 criz~:~aez~, .5'i _ _•t'~.=,}t:7 ..~ :u''F~C ~t _ :~ 2E.~_er~~ ~= i:~EL'9 .. ., ,. ~:..=i'C _. ~-:i. `3. ~!,° d..... .. ~8. 'S~?BG =` ~ •7 `Ai~,i,~CLDa'1f5. P'a'~c'`5 "-~ _t. .y ~'h. .°.'"6,i'L' ,. i'«° _ pi ~~~a 54'~l YC.':a~iG s'tl'Z+:: :?: -£+'ti'_- i_~L~._'"~".n~95: e: ::~ ~4..t•; :~s^ '?: 'C"~7~ P- .. ;ir 3'.. u: 'y:@1~J J.C.. ::'F :!8!d.'3S-'_-•VI ~J6 ,.~•e5c._SS~S. :r~r~r off; Vii. -~~ ..°±•cr,* ti~.~::h•:. d4;9:~ ~.S~.O~~T ~s8 4~71;~"U~;<:~ ST~'TL"fE 7?.21(1) veer ,.;f ~s,:. 3:30 ('~,~ ` ~~r ~ ~ ~~~ !!~'-0~' :~-tC 4t~191'+.PO ;+s'S'SFR :-'ms`s _ . T..Lr; r°i. B~~ELar r ~1iCOSRCy RUO?.? . rZ~BKw Lt, f3t1i,ES ~ t~.Rlf ~'f £R , S . C . ?19 ~artrl 4ai:± Str~~C, ~~. ~. 'r3rax i13 P.=g1i!1 Co11nt'} O1G-42~-0000; 010-X10-OOJO; U10-507-0000 Sc. Lrc~ix ~Cr~urity 002-1026-30; 002-IONS-~0: 018-10 i:3-.0; 018-1O1o-3G: O1~-1012-;U; 92.8-1.01.3-50; A18-141.8-54; 018-1.018-70; U18-10:8-80; ~asz~: €~nCt~:CsTt2QC1 €Qisafe:r r't>[c1P+Qp ass-ic:s-~o: ova-ioi,-64; 01+8-1615-7U; ~.Jie-1015-8G: U18-1015-90: 918-IOi'1-UU uaa:s ,5 crr!~s:F~d~3rpcsr._. SutFw a^:s _ ~~` r:a~ - a*sye~e, 1998. i ~,(' ~1 4 ,s~i~~~ _.___._~,_.__.__,__~_.~______._._, --• Ratberioa G. rJlferts ~' i Pi.CFg'~Eh'1'ZCA i tOt+ ACRNOid[.tiDGMENY ~.uo.r,ures a4 Bari a4. OlEacte and _ at srina G. r33Eerta au-.hecatic 'c.' e."s _ da~oE A~gusC, ;999. _._._.__.~~_4eo A,~Besf;~r- ~__ '~'ii_.E_ lh~io~F. ::-,A'S'E F:1;F. l"!r" >7~hC'rJtdStti aur~:orize4 t} 5't?6.U~, 6:s. State- TBFS FNSTAiRSEAT' FPkS ORAETiEG BY: ,eo R. fieskar, Actoraey ~r-_1. P;g;Ss:!<K, 30L~S & YRUE-cr . S.C. ~I~ f:;:rth st..as+ SCr?e-, P. O. Qox i38 Sti~tet ?aid:;. 'A: S83_~ ST.A'iF. Oc 4•t7S000lSit 1 ss. CiIISFiT'i ~ersenaily came be.ore mz tF.is _ dsy o€ _ :9 the a'r~•:e na7ed to me Hno•,m ~.o be the person(s) :iho e:cecu:.<d the faregaing instrcment and acknu<.aedge ttie s-+me. Nota_y PLblic Count;, 41.,. a.,~it~ rcr, ezoirati.n date: Gvti ~.` :~~~~~~~ w~wt Real Estate (St. Croix Cour2t~v, Wisconsin) Northeast (quarter (NIE 1/~) of Sect-ior: laignt (8) , To~rnship T~ver:tj= Mine (~9) h[orth, Range Seventeen (1.?) Wiest. k,~i~ west Half (4i1 1J2) of Section mine (9j, ToS.+nship 'l'~aeaaty Nine (29) North, €?aztg~e Se;rentee_~t (i7) truest, l;:~CIrPT Car~nencing at tkae Southeast corner of said west B.a? f o€ Sect ian 9; thence t~o~h on quarter section line 3~€]L.3 feet, thence r_i82Qw 34 J.0 tezt; thence S52`'W ? ?0.0 feet; thence S39~W L7,:. 0 feet : tteer~ce SS6~€~ X03 . ? feet to section lire; :hence East cTa sectic~; ? ine 'l~}o .7+~ feet. to >rlace of Begitning. ~.~D; Sauth i#aif v;_ South;~est Quarter of Saut??west auarte (S 1/2 of SW i/4 0¢ S~+ 1/4) of Section T~-el~re (12) ; end NoY~tt-awest Quarter of l~or_thwest Quarter (ltiW 1/~3 of tr`W 1J4) cf Se.ction Thir~teer~ (13) ~~i2 ir, Township '~en~ty N:~ne (2'9) North, Range Si~ctean (l~) West. Real. Estate (Pepin. County, Wisconsin) Got Five {S} , Block T~~o (2) , Klarpe Sulldi+.-ision eo To~,~n of Pepin, Pepin County, Wisconsin. !~i Q , Lot 4, Block 4 of the Klampe Subcdivision in the Town of Pepin, YL~lli1 t.DU,i1G~I, trtlic.:::U(i51t4i .AND Part of L-et ? , Block. 5, .E'irst A~!di tiara to Kszi~pe Subdivision, described as foJ.lows: Corvnencing at the Sou`hwesC corner of said Got, which is ti,e Point of Bevinninc~: thence North 4G°8' East, 135 feet; thence So~.~th 43 S2' I;dSt, 91.40 Feet; thence South 9014 ` t~+Test, i63. 03 fee} to the >?oint c€ Beginning. Located in Gcvernmen~ i,ot 2 of Suction Twenty-One (21), Township Twenty-three (23} North, Range Fifteer, (15) West, all in TC4r'?~T O>; pEPIN, Pepin County, Wisconsin. ST. CROIX COUNTY ANK MAINTENANCE AGREEMENT AND ERSHIP CERTIFICATION FORM OwnerBuyer 1,(_1(-~(~'i Mailing Address / ~ ~' Property Address City/State e (Verification LEGAL DESCRIPTION Property Location F/4 ,,s~l/a , Subdivision Cer#ified Survey Map # Warranty Deed # Spec house > z r..~.~ Planning & Zoning Department for new construction.) Parcel Identification Number D l ~' - ~G 9 ~ - 3~ - 6 ~ b . ~, T ~N R~W, Town ofle ~5~3~' Lot # Volume -`, Page # r Volume ~ ~~ Page # 7 ~ I _. no Lot lines identifiabl yes no Improper use and maintenance of yo 'septic system could result in its premature failure to handle wastes. Propea 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 as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52( )and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit tp St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman pl~mber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operati~-g condition and/or {2) after inspection and pumping (if necessary), the septic teak is less than 1/3 full of sludge. 7/we, the undersigned have read the ab~ve requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Dep nt 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 ear expiration date. Uwe certify that all statements on this ~orm aze true to the best of my/our la~owledge. Uwe 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 ~7 ~~" i SIGNATURE OF APPLICA~1'I'(S) ***any information that is misrepresented Include with this application a recorded reference is made in the warranty deed. 6 /a~l~ DATE result in the sanitary permit being revoked by the Planning & Zoning Department. *** deed from the Register of Deeds Office and a copy of the certified survey map if (REV. 08/oS~ ,. ~-~.: Qu,oor,awf g •~ 0 ~ .aw... t ~ ~ al ~~ ~ :' Q~C Y rz ~I ~ ~( a .o-,9 Pj 'v Q ~ ~ 1~ - _~ ~ ,- r- - .d-~~-- -------- i .9-,t .r,r .r,t ~ ,0,9 .t~ _~ f t .r,~~ .r,a .0.9 i .o.f .o•.c .9•,r '~~ o i ~ i V ~ ~ _ ~ i + s~ F $ al ~ ~~@ ~ ~~ ~ ~~ 1 i y}P ~ D• ~ ~ ~ ~ i ~ LL .o-c r4 i y q gg ~ _ yy4aa ~ W -! yfl ~ A.f ~ .. ' ~8 ~ D! 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S A , •____ ___ _____________________ __________ ______ ___ _ _ __J . , Wisconsin Department of Commerce SOIL EVALUATION REPORT [)ivisroncf Safety and Buiklings Page _! of rn accoroance wrm eromm [sa, vvrs. ram. woe County C Plan must er not less than 8 1/2 x 11 inches in size l a Att h l t it Y 1 . an on p p ac comp e e s e p include, but not limited to: vertical and horizontal reference point (BM ,direr ' Parcel f.D. percent slope, scale or dimensions, north arrow, a t~F~ Barest oad. ~ ° . ~ ....c r:,f Please print all in at on. 04 (1) m)) P i c La 1 b d f R ewe y ~ Dace Q 3 . r va y w, s. . or secon ry purposes ( e use Personal inforrna[ion you provide may Property Owner ~ '' r ~~~71 ~(' ~ ~ CROI~~. ~u rtyL cation '~~~• Lot ~ E 1/45~J 1/4 S ~ T 2~ N R I~ E (or W Property Owners Mailing Address ZO!`dl iJG OF 10~ I D~ S~ . ~" I # lock # Subd. Name or CSM# , Ph 2~ 1sT ~~, City State Zip Code Phone Number ^ City ^ Village (~ Town Nea st Road Nammorci ~R_)~ ( ) ~ Th [~ New Construction Use: C~ Residential / Number of bedrooms 3 _~__ Code derived design flow rate _ `7r s0 l O O ___ GPD ^ Replacement ^ Public or commercial -Describe: _________J_ ~~2s~ ~f ~~ Parent material __ T ~ ~ I _______ __ ___ __ /_ Fbod Plain elevation 'I~f1a-pp`li?cable _ _.!l/1 ~' _/~ -1 _ ft. General comments S t /S f .>m f ~"~ J . f Cj ~ 5 ~ --~ --7'~ ~~c / U~ ' ~d Zy ~~ Z6 ~~~lW and recommendations: j" C%6[Ar~ ~3/y! /ocwfzv~~s C0"~~`~ ~* >-,~.ea~,un~d c~~a-~+'~sj~sluu~.~a-ti L.oT~s~a~-tirl~- f1,v~..e~ • ~' -yt-~3T.NJ.~e-s~.o- ~' 9d'~ ~ ~ S~cx~.d tae u~,c~ d Z (/~ ~• o/~Z- 7~0 ,IfL[- SyJ' Boring # ~ Boring ~~ ® pit Ground surface elev. _______ ft. Depth to limiting factor _ ~~__ in. Sod A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlffz in. Munsel Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff #2 ~ (~ - I p l/ ~ ~ ~ .~I Z- r S ~ ~ ~ h(1 ~r C. `~ ~ v~ 5 Q - U 2 I~-2U -0 , 4Iy -' Sic t hn5bl~ rn~r c ~ - - ~o 3 2p- ~ U / - L m k rn~~- c 5 - . g 5-1 ~~ 3l FI P~.S r4(c~ c r~bk ~~, - ~ . ~( . C~ f 9S '. 28•x ' ~~ ~„ Boring # ~ Boring ~ ~ ~ 2 Pit Ground surface elev. ,__~~ ft. Depth to limiting factor _____ in. Sod lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 t o -~ 1 - z ~--- S; Z ~ ~ c- l v -~ ~ 5 - 8' l - j rJ I ~ ~ c l 2ms -~,~ ~ - . y . ~ 3 29 ~t /t~ ~ 2ms v~r ~ s _ , 5 , 9 J ~ / ~ ~ ~ Q h 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and T55 < 30 mglt. CST Name (Please Print) /~~ "ature CST Number ~.'~i.n. Sc.h umc•_((_er `~i ~~---~~-~ 2 5~330q Address Date Evaluation Conducted Telephone Number 2l(3 ~ ~ ~~ - So~~e ~_ (~11 ~~ ~ 1 Z -S ' o,~ ~ 7~ 5~ Z ~ 7- ~fcx~~' ~~ ~ ~,~ r l Property Owner ~-tf~~>L!p~!~ ~C ~ Parcel ID # Page _ ~_ of _ Boring # ^ Boring ® pit Ground surface elev. ~~ ~ 20_ ft. Depth to limiting factor _ ~ ! __ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GP D/ff° in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ O_l 10 31 z - S ~ ~ 2t~.bk m-~r c S ~ v -~ . $ Z ~3-Z8 ~ ~~ I 2 ~~ ~ s - ~ 3 -(~-I I o, ~/ - s~ 2 r~ ~ S - 5 / ~ ~ A ~ ~I..~ ~(O ~. Boring # ^ Boring ^ Pit Ground surface elev. _________ ft. Depth to limiting factor ______ in. Soil A Ibation Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GP Dlftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring Boring # Ground surface elev. ________ ft. Depth to limiting factor ______ in. ^ P)t Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL • Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOU-8130 (R.07/00) r ~ r PAGE~_OF 3 NA1~~IE C/ ~ T.~~~ ~ LOT# Jy LEGAL DESCRIPTION s~ ~5~ t4 ~~q T Z~,N,R, / ~- E(or)~ SCALE: 1"= `I~~ BM 1 ELEVATION /D d . v BM 1 DESCRIPTION -~~ ~ j,~ ~ She c / ~o c~ BM 2 ELEVATION 9 ~~ 4 U BM 2 DESCRIPTION {u~ %y ~~ S'~e e~ ~'o~ SYSTEM ELEVATION 9G • S~ SYSTEM TYPE ~ ~ n ~~ t ~ ~-~ e .~ Q- l CONTOUR ELEVATION q~ . o ~ ~ 4S• o v u 6 1 ~~1 lY J ~~ ~~ SIGNATURE d N ~ ~ Z ' ~„-S°~' ~ eC• _ ~ I DATE ~-~~ ` 03 ~ i-~. v ~ ` w PAGE~OF 3 \, / .. • _ J ~i// J ~~ 0 ~~ 6 ~~~ ~~ o N ~ ~ ~~ ~~ N _~_ ~/ ~~Lo ~ 3S ~' ~~ ~~2. \~ .2 NAME ~J ~ ~~r~ S T.OT# 3`~ L . T T. DESCRIPTION S~ ~Sw ta,Sq T Z~j',rI,R, l ~- Elor)~ SCALE: 1"= y4 ~ BM 1 ELEVATION /Dd ~ v BM 1 DESCRIPTION -Ivy ~% ~ S~< </ ,(oc~ BM 2 ELEVATION 9 % 0 U BM 2 DESCRIPTION ~p 0-~ %y ~ S~e ~~ ~o~ SYSTEM ELEVATION 9G . S° SYSTEM TYPE C6 n i ~ ~ ~-~ 01 a CONTOUR ELEVATION q(, . o ~ ,~- qs, o V SIGNATURE DATE ~-~~ ` Q3