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Home My WebLink About018-1022-40-100Wisconsin Depa ientof ~rc~nerce PRIVATE SEWAGE SYSTEM Safety and Build~t ,, [9ivision {NSPECTION 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 Anderson, Nolan & Ruth Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: dp . pl ~ C3fl . a ` =CST' QYV~~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic 'F'FLw lvtTD~6 ~ Dosing ~ ~ Aeration kiolding I LANK SETBACK INFORMATION ANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,7 ,~ t „ ~ v i ~-~ Dosing Aer do ~~ `~ ~ ~ .... I / PUMP/SIPHON INFORMATION '~ ~D• Manufacturer ~ Demand ~` 1.•1 ~~ L ~ GPM ~ Model Number ~~ .~ ,/~~ ~~ ,~ TDH Lift Friction Loss System Head TDH Ft Forcemain Length t Dia. Dist. to well ~~ wQSo Z// Sell ORSUKh I IUN SYS 1 tM county: St. Croix Sanitary Permit No: 404987 0 State Plan IC' "'~~ ~Z~ Parcel Tax No: 018-1022-40-100 STATION BS HI FS ELEV. Benchmark Zo LflS ~ do. c7 Alt. BM Bldg. Sewer ~ ~ ~ ~ o -LO SUHt Inlet "') ~ t,L/) T / SUHt Outlet putlet Dt Inlet Dt Bottom ~ ~• 30 3 • `T O l i-leader/Man. ~ ~ ~ ' / ap.(p0 Dist. Pipe . ~ O / ~~~ Bot. System S', • ~ ~ Final Grade ,r st Cover 3 •~ O •6 2/ / V. ~n ~ B ENSIGNS Width t 8 Length t No. Of Ts~ygs ~ ~'J'4.+6 PIT DIMENSIONS No. its Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L WELL LAKE/STREAM LEACH G Manufa INFORMATION CHAMBER Type Of System: r.3 3 t UNIT tuber: r11STRIR11T10N SYSTEM /vii. Q~wk~ d:c..r.1 Header/Manifold •~ t Distribution c~ , x Hole Size) I' x Hole Spacing Vent to Air Intake a 1 - L ~~y Z `t ~ ~ 3! + L ~ t~ rr ~~_ • • Length ~~ Dia Spacing Dia .. ngth C(111 C`C1VFR ., o.e«~.re e..~fe..,~ n.,i.. ,... Mn~~nr1 nr Ar_(;rada Svctems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil r % Yes >. No ', Yes No ~COMMEN~ Sude c e discrepencies, persons present, etc.) Inspection #1:~~''~/ 26 / 2~2- Inspection #2: -•f~'~ Location: 1927 110th Avenue Hammond, WI 54015 (NW 1/4 NW 1/4 11 T29N R 7W) ~A Lot 1 I ~I Parce4 No: 11.29.17.166A M+ 1"~~_ )`~- ~•/1 ` ~C ~„~ i~,~. ~JC ~ ],Z _ 1 n~rd~l C.d~L~Cr Zg 1.) Alt BM Description = Oft_ ST Gets~r-~ 7 Vv~O4iMO1`1 c~ItVS[ , n m, F~ 2.) Bldg sewer length = qs.~ a'Y 1~.Ot ~ I r , t~ ~ o -amount of cover = 3) ~,•~ow-• .*- 98 so ' Csdl,~ «~" 6 ~~{o ~ °~- ice- ~ los-.2~ ` ~t e~ - -- Plan revision Required? ~] Yes ?No ~ ~I -j ' ~ -- f ~ I th r s' for add~'Itiona ' ~~tpn. _ ~_~_! ~~~-' _ I '~ _ `I,~ _ _ _ / . ~ p]~t~~ ,,~ t 1 Insepctor's Signature Cert. No. - 710 (R.3/97~ ~ ~"^^'~'"A~ ~ I ~w. " , Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County~~ ~ r ~°D ~ 79~ -~ t: ` i~er~nsin 162 Maths n, WI 537 Si Address De artment of Commerce 0 ~' Sanitary Permit App 'cation SanitaryPe~o~~~~ In accord with Comm 83.21, Wis. Adm. Code, personal infon~nation you provide ^ Check if Revision ma be used for seco ses Privac w, s I. Application Information -Please Print All Informatio State Plan I.D. Number ~ZoDD 3 Property Owner's Name ~ ~1 APR 0 2 2 0 0 2 Parcel Number ~(. Z°r . /'~ • (o(of~ Property Owner's Mailing Address ST. CROIX COUNTY Z Property Location ~ ~ ONING OFFICE l ~~ ~ ;S T N,R $ City, State Zip Code Phone Number Lot N r Block umber Subdivision Name CSM Number l ~ . Type of Bttiltling (check all that apply) ~ ~ ~ 5 ^City -1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Commercial - De ribe Use ownship c9~-•-~ ~„ f ~ //cS~~D . O ,^, /n~ Nearest Road ~/' / ~~ j/ ^ state owned g r O' 1 " s~ l~ ° ~~~ / ~~ .I7"» ~~~ a -- S~ l . bL c~Q~.k~ x III. Type of Permit: (Check only one box on e A (numbering scheme for internal use). Complete line B if ap cable) A ew 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Exis ' S stem Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Issued of Permit: (Check all that apply)(numbering scheme is for internal use) ~E `~~ ~ - Non -Pressurized In-Ground ~2 47 ^ Sand Filter 50 ^ Constructed Wedand 4¢. 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculatuig 30 ^ Other V. D' ersaUTreatment Area Informati Design Flow (gpd) Dispersal Area on: Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ' Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation ~ S~ ~~ ~J' ~ " ~~ G /. ~ J `~~ ~J ~D.~ ~ ~..J ~ - VI. Tank Info Capacity in Gallons Total Gallons Number of Tanks Manufacturer Prefab Concrete Site Constmcted Steel Fiber Glass Plastic New Existing Tanks Tanks Septic or Holding Tank _ Dosing Chamber ~ '~ VII. Responsibility Statement- I, the undersigned, responsibility for installation of the POWTS shown on the attached plans. MP/M~RS Ni~~ ~ Business Phone Number Pl~r's Name (Print) ~ Pltumber's S' / ./' ` ~~ Y'/ / / ` j Plumber's Address (Street, City, State, Z' e) ~r VIII. Count /De artment Use Onl Sanitary Pemut Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ~-Approved ^ Disapproved Surcharge Fee) ~ ^ Owner Given Initial Adverse 3 Z s. Determination 1X. Conditions of Approv_al/Reasons for Disapproval ' t n ~ ~ ~~ ~ ~_ ~~ ~ S ~adc ~ ' ~ A~ s~ ~- ~ L~ ~ ~ ~nm,rw-~ c ~ ARBCa comp,ae puns ~w .nc a.ouua~ au.7~ •va we a~..w..... rr-- __. SBD-6398 (R. OS/Ol) ~ _ _ _ __- .ter JNoelen Anderson OT PLAN ADDRESS 1927 110th Ave Baldwin Wi 54002 ~,,.~~ , 114 1~17JV 1/4S 1 1 /T 2 N/ 7 ~~~_ W TOWN Hammond COUNTY ST. CROIX MFRS Shaun Bird 226900 3/11/02 3 CONVENTIONAL DATE BEDROOM ~_ IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Post -" ASSUME ELEVATION 100' Filter Zabel A-100 BOREHOLE O WELL *H.R.P. Same as Benchmarfc SYSTEM ELEVATION 101.0' ~* B.M. 11 98' Alt. B. M. 7% B-3 Slope B-2 Area 15' Below System is to remain undisturbed 9 9' Scale = 1 /4" = 10' 10 0' ~ B-1 Tank is to be properly bedded and provided with a lockdown covers with approved warning labels Huffcutt Combo Tank Pro 3 Bedroom House Grading is to be done Well is to meet all to divert runoff setbacks found in away from system. Comm. 83 ~~ ~.~ ~ ~~ ~ -.~~ . ~ '» r . A " isconsin Gepartment of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD Wi 54843 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary Mazch 28, 2002 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/28/2004 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Noelen Anderson 110TH Ave & 190TH St Town of Hammond, 54002 S C C Identificat' ers Transaction ID No. 720003 Site ID No. 642469 Please refer to both identification numbers, above, in all corres ondence with the a enc . P.( Cn~i t roix ounty NW1/4, NW1/4, S11, T29N, R17W FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 834206 i~` r Qa ~n . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Code .~ _.--- and Wisconsin Statutes. The submittal has been CONDTTIONALLY APPROVED. The owner, as defined i c:: CC 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: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10691-P ( N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N.O1/O1). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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 maintenance plan for this system must be given to the owner of the POWTS. Note • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • A soil absorption system should be designed as long and narrow as possible. This system has a high linear loading rate of 8.0 gallons per foot. ~' ! Reminder SHAUN R BIltD Page 2 3!28102 • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. 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 ma~ntenano@ of the POWTS. Sincerely, ,,-'~ ~ P-atricia L Shando POWTS Plan Reviewer , Int gran (715) 634-7810, Fax: (715) 635 pshandorf @commerce.state.wi.us 150,M-F 7:45 am-4:30 pm Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 VJiSMART code: 7633 cc: s . Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date : 3/6f02 Owner: Noelen Anderson System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01f31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Maintance and Contigency plan 10-12 Soil Signature License n~ 3/11!02 P.T.S. 'anally v l~ C ME ~~vod3 ' ~ OT PLAN PROJECT Noelen Anderson ADDRESS 1927 110th Ave Baldwin Wi 54002 .NW 1 / 4 NW 1 /4 S 11 /T 2 N/R 17 ` W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 / DATE3111/02 BEDROOM 3 CONVENTIONAL IN-GRO D PRES5URE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # Of chambers none BENCHMARK V.R.P. Top of Survey Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 101.0' B.M. 110th Ave 98' Alt. B. M. 7% B-3 Slope B-2 Area 15' Below System is to remain undisturbed Well is to meet all setbacks found in Comm. 83 s s' 1 0 0' Scale = 1 /4" = 10' ~ B-1 Tank is to be properly bedded and provided with a lockdown covers with approved warning labels Huffcutt Combo Tank Pro 3 Bedroom House Grading is to be done to divert runoff away from system. Uesigne~~l,Gt^ r~~ __ No l~ ~ ~9~1/ nst~'~ k" Obaervation P~:F~e Perforated Below Filter Fabi~i.c AST![ G-3a 5 a n d ~ " Topsoii - __,_-j t ^'~ ~'. S~ape < < ~' ~k ~'n ~ P( G Ois~ribution pipe C t ~~ r ~o a ti Bed Ottj~-2%: Droin Rock Non--Woven Filter Fabric Forst t~oin Frain Rump Cress Section Ot A Mound'System Us A Bed For TAe Absorption Arco a ~ ~t. S ~ Ft. z ~~~ ft.~ ~ ~ Ft. • K , O Ft.. ;. ~ ft. ua aft: ~ -r-------~ `Flowed Loytr~. .p ~~~. ~~ «..~... F ',$S G I' ~ ,s~ '. 40bservation Pipe r _~____~_____.________ ° A --- ------~-___--__ -----------------____ 1 Distribution Bed 0{ ~p~" 2'= Pipe Crain Rock i 4"O beervolian Pips Permot+ent Marker Pipe or Rads --• K force Moth Ftcm Pump Pten Viev+ Ot Maund e„l~In Abed fat Tie ADsor tion A~eo P/~O E ~..,...OF.-.- Ckq ~ t.oadtid Q~ BotroT~ ~ E quOdr fills •a rtrt~T +te4=. Ktzx~t r• Ca+nsc}bn Slgned:,, . Distribution Pipi f.arovt -- ~~, License er: ~~ t~~~' - Oate~ _ ~ ~~- ~ ~ __ - M~Y~1~1 ~ ~ ~t. a ~... F{. X ~ Inch~t Yc~~ Inches -~IoT® D~a~aeter ~ inch I.aterel ~" ~ ~ inches} ~4enifold ~~ Inches Force Me f n " ~~-.~ - Inches ~'of hares/p~pe~ Invert ETev~tic~n of Laterals /,S''Ft,~~ Perfa~tsd p~pi~~ SEPTIC TANK E_PUMP w" CI VENT PYPE 1~" MIN L?S' FROM DOOR. WtNDOw FRESH AIR xNTAKE ------- PINISM D GMDE "~,ri. ~] r~gl~ r~ CIiAMBER CR05S SECTION AND SPECXfTCATXON9 ABOVE GRADE S MfEATHERPR00F OR JUNCTZpN 90X APPROVED ---" WITH CONDUIT MANHOLE COVEA W/ PADLOCK 6 J. --WARNING .LABEL C_... .."'~ q+' MIN. IN APFROYEO PIPE 3' OfRO SOl. t0 SOIL, WATER TIGHT SEALS F ~ ~~r ~.R --~-+- PUMP OFF ELEV . FT. •y" ' •~ + ~ MIN+ +t ~ ~ , GAS- ; ` T TIGHT ~ ~~ D A SEAL ~ ~10iNTS WiT1i -..~-.- ~ ALM APPROVFA PlPf -~- -.. 4N O ~ ~ + SOL? D SOZI ~ ' "~"' I c OFF 3 " A~PPRaV ED 9EDDI NG UNDER 'TANK ~ ~'` ~ S ~~~CONCRETE PAD SPECIFICATIONS ~ [ ~ sEPTTC i oosE TANK MAMJFACTVRER : ~; l~ ,~, NUMBER DQS ES P£R DAY : ,-,,,,,w,,,_,,.,,~ TANK~SI"~,ES: SEPTIC ~ GAL. DOSE ~ GAL • DOSE ~~~~ , VOLUME INCLUDING F LOWSAC K : ~ ~ GAL . ,,, ,,, J INCHES • ~ Q ALARM MANUfACZURER: ` ~C,1- S+ b} a~ CAPACITIES: A ~ SAL. ~ " "~"~'" MODEL NUMBER : ~ ~.. "' ~ INCHE9 : ~D OAL B = ~ 9~txTCH TYPE: . ~~,?~ PITNP MANUFACTiJRER= +'~t~c~~' C = Lo. ~ INCHES ++ f 1,,,w_ GAL. it00El NUMBER : ~ ~ e. GAL B ~ SWITCH "PYPE: ~ e,r x . INCME D • REQUIRED DTSCFlARGE RATS: ~~ GPM PUMP E aLARM wTRiNG AS PER iL~1R 16.23 wAC VERTxCAL DIfFER£NCE BE'CWEEN PUMP flI'F AMri D ISTRIBiJTION PIP£ /!~ FEET + M.~I+IIIMVM NETWORK SUPP;;,Y PR S URE FEET FORCEMA[N XFT/100 FT + ~ ,~. FE$T FEET FRICTIQN FACTOR . b]~ TO ~ = ~~FEET TAL DYNAMIC HE11D INTERNAL DIMENSION Of PUMP TANK: LEtdGTF! . /~ LIQUID ~ DIAMETER ~r,"~ ~'~~. SIGHED: LICENSE NUMBER: ~__ G~,~ DATE c~y~~ ]/89 P~rfarrncinc~ Data Pumas Charoctie>la~istecs r"e!L ~ ..._.___..r,_~_..._ seAiaerathle IaaaOal ahidels 51~40M1 SIlEF4!QMZ AeMUreSc Models SMfF4QA1 ^~ SNEF4UA2 x« _ ~ to M 1001 a _ IF 6.5 ahNer Shard Pale (4 Poles ~a~ asso lhaaa 18 Y I 1 S Y30 Ilerf= _ 60 ~ zo• P Naix. ttodd r NErMA A r hwdaUOn Chess A spa 1 1 r' ITT - ~~yy~~,,,, i~Y• i +~ w za a>s. Power Lord is/9, SJIYII, 20' atd. (90' opMead) llAaterials of Canstructia~n Mtat Seel Pons: Shah Seal Seel ladq( 40 34 ~ i ~ 20 l0 io ~0 30 43P 4o so so ~a Total Head (tl.e>R) 10 14 I 17 st sa ~ a0 ss (m) 0 4.3 5. b. .! 10. ~pM (us ~i >a ,ao sa ao as ~o so a ( 0ex) 4.4 3.8 3. S 1, 0 3•x/8" (38.42) ~. s` 'lll~ , (2$8;$2;, . .:l..w .'~.: ,. i ': CIn}s.~ w. ...~k. I~ NYDROMAT~C'~ • •~~ 1840 8anry Raa1 Askland, Ohio 449Qi Tel' 414.289.3042 Fuaw 419-281.4081 Web Site: www.pertlalrpunTp.cirm SALES OFFICES IN Alt MAJOa CITIES AND COL'ItTRIES Re{er to "pumps" in the yalkw poges o4 your pharx directory for vnur local Distributo+ !temM: w-G2~d48G ! ! 98 $M -., ,~ 1. Ail ~nwnstoas in Inches. (Metric far interrtotional use). 2, CampoF~ent dimensions may vnry * l/8 Inch. 3. Not for contraction purpose 013CHA ,•S!2"+v artlascorNfied. ~•s °rf"c>a 4. q~rNnsion and weighb are a~proxxlessale. f:. W.e reseYVe tha; t,(ght la .make rev~ioaf .lo our praduet: nad Their spkal~n~ wllfiout mzt(tr+: . , i ~~ tQ i , f- ~C7a8 ~ 781 y',, ~ ~~ ~~~ d I' ~ ` ~'4a:.. ~ic'r pimps, .R{ is Rlsarwd. `' . b, ~A , ''~ ^~pur Aui}+orized Local OTftribufor - J '^~1 .. /Z~ '. ~~ /~_ R ' .. , /'V \Art44`=~~ POWTF.i OWNER'S MANUAL 8e MANApEMENT PLAN p~fla.~.~oe t.E INFORMATION _ Owner' /'V~nJ A, 0 ~,_, Perittk *. t1ES10N PARAIRlT'ERS Number of Bsdrogm: ~ d NA Number at Cornmendal Units Es6rr,atad flow {.n-erar~3 _ cv Oestgn flow (Estimated X T.5) _ soN ~ppuaauort hate _ , ~ aria InfiuentlEflkte~nt C1UaitY hAorNhty evendge• F#tS. O~ di (3feaS~e (~CN3) ~ rrlg/L t3lodhentica Oxygen Demand (BOC3,} 5220 rt>q/[. Total Suspended Solids (Tt3S) s150 m PretreaOed Elfkrtertt Qualfty ~[p- Monfhy average" Biodtemktal Oxy~ Demand (BO[)b) 530 mglL ~totad Suspended Solids (7';iS) 530 mg/l Fecal Cotifarm eor»etric mean r s10' efu/100m1 Maximum [-fftuent Partlde Size K Inch diameter s1r8TSeM srPece~-wA ~ n,~.~ septlc Tank Capacih O al a NA 8eptlc Tank Manufisaourer ^ ~ EftNwrn f'INer Martttfaalc~urer ~ ~ O NA Etflusnt Flfter Mode ~ a NA pump Tank Capadq- O I O ~ Pump Tank Manufacturer NA . ManlJt~tlfrer ,/p ^ NA ~„~ t „~ a Na pn~+satment Unit ~ ~ fl~y~ ~ ^ P88t ~~~tOr ^ Meohank~d Aenatlon O Welland o Dtanfedton o Other. nufacbtr+er' s ~ Ir-~gnourid ( 9~IlY) O In~round (pressurized) O At-grade ,~~+~ O Dri ne o Other. • values hrak~ for Este G,oa*-aamrr~~aq wastew^tK .od « Va~lu+~ typir~l for plot pfstAatsd wastrw/bt. SsNlce Event Service Frequency Inspect oondltion of tanks} At least once every Q months ,~I ye+ar(s} (Maximum 3 yrs.) _ of tank volume When combined sludge and scum equals one-third {Y,} Pump out contents of tank(s) ~~- Q months ~ year(s) (Maximum 3 yrs•) inspect dtspetsa cell(s) At least once every ~ o mates ~, year(s) • Clean adflktent tikes At least once every < O months s) O NA Inspocet pumQ- Pump controls ~& alarm . At lee~st once every ve ar(e) ~ O months O NA sure test Rush Mtera4s ark Ares _ ry At least once e s, f D months O year(s) o NA ~, At test once every ~ months D years) ~ NA _ _ At least or-ce every _ ._.~---- MAIN'T'ENANCE INSTRUCTIONS one of the bNoN-1n911canses or lilspeCti011g Of tanks 8rtd dispersal cells shall be made by an ktdiVlduQaO~ ~YVTS Maintainef', $eptage tester plumber; Master Plumber Restrk~ed Sewer o f ~ ~k(8) ~ ~~tny ~y missing or broken ions must inchtde a visual inspec~lon and scum and to check for any backup ~ Operator. Tank inspect volume of combined sludge ~~ to ~~ iris effluent levels hatdwaree identity snY cxadcs a Ieaka~, measure the mal c~tl(s) mhsA be vtsusaY ~ ,~ ~;~ of effluent on the or pondln9 of eNluent on the ground t.u~ae. T ~ ~ e~fuent on the ground surface. fury authcxitY• pipes and to ~ any pon Eton of the Local regale ~ fire obOMVation d,bion and reVukeS the lmmediabe notif~a ground swfiaoe may ind'~ate a fading con ~ ~ sctxn in airy tank squats one-third (K) or moos of the tank vow hec ~ NR VVttelt the Combined aoatmtafation of sludge Servicing Opero~' and disposed of in accardareCe entire COrtteMs of the tank shalt be ~smoved by a Septage . !rest Components, and any 113, Wisconsin Administrative Gods. urtted POWTS comAonents• ~ ~ a ~~ PpYV'rS Maintainer. of eMuent RRers. med'an~al or Pis etion of any service avant. The servicM9 ~ ntervals of 12 mouths ar less shah be i>~ ~~ other mantenanoe °r mOr'hO~ utatory authority within 10 days A servlge ~~ shall ~ pravlded tc the local rag noe of painting Products or otter START UP ANO ~RpTION fitment tank(s) for the Pie It h Goc-centratbns are or to use of The pOW't'S cheek gte d~ cellos). ~9 For new oonsbvctior-, pri sand/or dam~9e o t~ ~r to use. chemicals chat may impede the treF~tment pry b a septage servicing ~ detected have the contents of the t~ank(s1 removed y r ~ 1 M . . SyBtetn stall up shag not occur whec~ soil Conditions a~ f-ozon at the inttftr8tirre surieae. Pale of _ Dr.iring Per OtrtttQ~ Pump tanks may bit above' normal higAwater levers. When power is restored the eaCCe8l; wastewatat Wdl be disc~targed to !h®disperAet earl(s) in one large dose, ovetioedins Ltae oetl(e) arw may r'eeLHt in th9 p ~ discharge of sfR~xtt. To avoid this albraitiort have the contents of the pump tank romoved by a SeiP~9e Sendcktg OP~~' p~'.e> i~st~orMp t~'er ~ the ef!lrrent pump or oontad a Plumber or POWTS Malnfainer to sestet In matwaNy opprattng the ptnmp oonEfpls be restore normal levels wlttatn the pump tank. Do not drive ar park vshiolee over tasks and dlspersel Dells. oo not drive or park over, ar otltetwlss dtattx6 Or oorttpact, the eroe w i s het dawn stops oaf any mound a at~grade sail abeorptieort area. RedticHort rx•eNminatkan of the fsoikkriA~ from the vvaisbwvr3iter stream tray Improve the perforrnancos and ptotonp the life of the P01AITg: aifdblo~ wipMr atpal~toe mitts; oondoEns; cotton swabs; degcsipets: dental Bow; drapers: dis>nt+da8nts; ~ fiwrida~fon drain~~sumP Pulrt~-y wa~or; fruit end vepetaibla Peetinpa: pasoNite; ~rop~ flsrbiokfes,~ meet ticxapi:r tltedk~Ytlans; oA; jNit~ttln$ plrodtbts; pesttddw; sartikary napkins: tampora;:'and water sofierler brkte. ABANDONNMlrNT tNltert ttae P01MPS taps andlor is pe-n'nanently taken out of service the t~Ottawlrp steps shall 4s taken h tnsrxe tltat the system fs property and safely abandoned M compttanoe wMh ch. Comm 89.99, Wisconsin AdrrlirtteMettvs Gxte: AW plpirtS b tanks 8rrd pits riharil! tae dtsoortnedad and the abandoned pipe openktps aeaNd. ~ The oattents of aR tar>fcs and pits sfal~~~bs rsrrtoved and properly disposed of by a 8eptaps t3sMdrig Opaswr, Alter' pt~mpMg, 81! tattles and ~~ shalt be slacavalttsd and removed or tttelr covers rentovad stul the vohl t11paCe flNsd MAIN tt~olt, grave! or snottier inert soNd material. CONTIPtQ~NCY MAN !f the PC1WT8 tsiits and cannot be rcrpelred the fioNowing measures have been, or must be falcon, b pravlde a code compliant repteroerrtent system; O A sutErit~le replaoement'area: lease been valuated and may be utl8zed kx the location ofi a roplaoamenl aoN absorption system. The trepl6icement area should be protected from disturbance and otampaetbn and should not be inMlitged upon by t+equirod setbacks from existing and proposed stttirclure, lot Uses and wells. FaNuro to protect the replaoerrient ara~ wpl result in the need for a new soil and site eva~iuatbta to sstatattsh a ettltatale replacernertt area. Reptaoarriertt systems must campy- with the rotes in effect at that Hine. ^ A suibrble r+epleoarnent area is not avakable due tp setback andlor sole ttmltatlorts. t3arrlrig advances in POWTS technology a holdMg tank may be Installed as a last resort to replace the falleed POVYi'S. The afro has not been evattxtibed to k#entlfy a suitable reptaoemerti area. Upon fa~trr+e of the POWT'S a soft end site evatrmtion must be perfc>trrtod W karate a suitable replacement area. if no replacement arcs is avaNabls a g tank ttmy be MstsUed as a fast resoR ~ replace the faded POVYT'S. /~~ and at-gnAde eoill a~bacrtptlon systems may be r+eoonstrvded in place folkawirq t+emovai of the biornat at the ktflllriaittvve surface. Reoor!elnrotloras cf sud- systems must cornpy wkt- the rules in gifted at that time. ccWARNINCi» SEPTIC, PUMP AND OTHLR TREATMENT TANKS MAY CONTAfN LETHAL GAS8E8 ANDI~OR tNSURFICIENT OXYGEN. DO NOT ENTER A 8EPTICr PUMP ~C)R OTNER TREATMENT TANK UNDER ANY CIRCUMBTANCf38. DEATH MAY RESULT.. R~CUE OP A PERSON i=ROM THE INTERIOR OF A TANK MAY 6E p{Fl+ICUI.T OR NNP088t6LE. AOQITtONAI. COMMENTS POtNT8 lN3TAl.LER ~ ~,_,,,_.,_„ Name ~ iz,1,r.~n-~ ~J Phone ..; ' ~ ~,~ "' L~~,'I ~~.w.ne Qee~nMUee narsQeYAR /IPItIAPERa Jiif ~.'llvr Name vim. ~ ~. ~ -i~i~~.w.~ri ~r~r~ ,~ Phone r ~•~- 02/~~ ~ S ~ ~~~ ^....rr w ~ueb rv~^ . v ,we Name y.~ r rr....s. ,~, ' Phone .~ ,~ - -l I.OeC~Ai.ryR/EGUCUiT/ORY AUTHORITY ~7vn`.T V ~(. ~d~ Phone ~~, r~ jcS~~ "~ t<~~ This doaurtrsnt wars dialled by the stags Ar they Crean Lake, MaigrrMta and Wauahara County zonlrty and setN,etlori apertoNsf. This doatn+arn nwOq the mNtimum requksmerrts or dr. Comm s3.xi~x1 xd~ and es.se(a), (2} s t3), iNbooaaln AdrrrtntsFratka Cads. tJw at lltk doaurtent des sot . c~+f rt~on quareatee the petfarmanoe of the t~OMITS. `' W,sconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ...J....... .. :ate n_~~ er \111. I\J~ f~~J~ Page of .., vwv. ~v..w ...~, vv.....• vv •..v. ..v ~vvv County ~ ~ ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must l D ~ include, but not limited to: vertigl and horizontal reference point (BM), direction and Parcel l.D. percent slope, scale or dimensions, north arrow, and location and distance to road. Please print all info ~CE~VE® Reviewed by Date Personal information you provide may t>e used for second pu es (Privacy law, s. 15.04 (1) m)). ?) ZOt) Property Owner MAR 1 `5 I~erty L cation Govt. Lot /4~~4 S T ~ _ N R ,~ E r) W Property Ow~r's Maiti~ Address ~ ST CRp1X C ING O f~ FI B ck # ~ Subd. Name or CSM# ZON .,, City State Zip Code Phone N ~ City ~ Village ~'fown Nearest R ad !- ~ /, " New Construction Useesidential /Number of bedrooms >~ Code derived design flow rate ~ G GPD Replacement / ~ Public or mmercial -Describe: Parent material L Q/C ! Gt% Flood Plain elevation if applipble A/~ ~ ~ ft. General comme and recommendations: , L'd~,v Boring # ^ Boring L/~ ~~~, ~" Pit Ground surface elev. ',~,_~ ft. Depth to limiting factor _~~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence .Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 7 J I~y/~. ~~ ~ mil` ~ /~-- l~ (// ! • ~ / / l Borin # ^ Boring ~, / ,-~ 9 pit Ground surface elev,/ ~ ` ~ ft. Depth to limiting factor ~ J ,in. 7 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a ~ c~ ' Effluent #1 = BODS > 30 < 220 mg/L and TSS 30 50 mg/L `Effluent #2 = 80D5 < 30 mglL and TSS < 30 mglL CST ty~m (Please Print) Signature CST Number Address C ~ Date Evaluation Conducted Telephone Number - _ SBD-8330 (R07/00) ' .~ Property Owner Parcel ID # Page of Boring # ^ Boring ®pit Ground surface elev. _ ft. Depth to limiting factor ~C~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ a=-t 3 ~ ~ ~~~ ~ ~ ~ ~ ~ --, .W , r- , ~ ~ 3 a~ ,, s~~ ~ r' ~ ~ . 5~ A / Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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.07/00) v ~ Soil Test Plot P project Name Noelen Anderson Address 1927 110th Ave Baldwin Wi 54002 ~.~~ Lot Subdivision ------- Date ATM #226900 3/11 /02 N W 1 /4 N W 1 /4S 11 T 2g N/R1 ~ W Township Hammond Boring Q Wel! PL Property Line BM or VRP Assume Elevatio 100 f County ST. CROIX Top of Steel Survey Post System Elevation 101.0' ~' *HRpSame as Benchmark Alt. B Base of Survey Post @ 96.5' 110th Ave ~ Scale = 1 /4" = 10' 7 1 0 0' B-1 ,~ B-2 ~`_ Pro 3 Bedroom House • OwnerBuyer ST CROIX COUNTY SEPTIC TANK 11~IAIl~I'TENANCE AGRBEMBNT AND O~l EE~.SHIP CERTII~ICATION FORM d11~ _ n4 ~ ~ /1„__ _~ Mailing Address Properly Address ;1~+J~ S~ ~6 Z City/State Parcel Identification Number ~Fi I ~ ' t ~S ZZ,•- `~ '~ ~ LEGAL DESCRIPTION Location ,/~~ ,~/4, ~~/., Sec. ~~N-R~W, Towa of Property ~'L~~ ' -,~-F- --- Lot # ` Subdivision Certified Survey Map # ~ Volume ~ Page # Warranty Deed # ~~` ~ 1 ~ .Volume%~ Page # ~~~ Spec house ^ y~~ ae-- Lot lines identifiable~'ges ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is 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 effect the function of the septic tank as a treatment stage in the waste disposal system. ent a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Departm mastocphunber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal 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. Uwe, 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 Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT ~~~ ~ DATE OWNER CERTIFICATION 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. ~_ ~ / SIGNA OF APPLICANT DATE ««**«« «««««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map ff reference is made in the warranty deed (Veriticatton requu~ea from riannmg Leparuncu~ ~~~ ..`.. . - vot~0'~6r~,~595 '~ ~, DOCUMENT ,STATE E3AR (~P WISCONSIN FOR91 ~-1989 'j rH~s sr~c[ Rcs[RV[o row R[conoino oArA ;~ L1UiT CLAIM DEED I _ _ 'I ___ __ .. ------ _ _ _ --~~ ST. CR~3tX CO., --- .. --- ----- -- ,.____-- - ~_ ___~____ yh ._ ._ _ '~; ..-..xFl3...P......an.de.zao.n.,...a.Lk1a.-Nel.a..~n.d~s-s4~-.a.~d.•------- SEP 2 8 1994 ..... ~ d ' ....Nn.rma..Acid.e`zs.on.,_..s.Lk/a...No.r.ICa-_.?-,....~nderson...-.--. I 9:30 quit-claims to .......-.No.lazl..k.....,Esnd.~x.sQS1, a.[ls1-.-R4.1:.1i-..An.?4........--• I , ~ ~ d' ~M it ......Aadar-so.a.,...buaban.d..s.nsi..-~!.i,~e.,._.~.g..suryivor~hie.... I 'I mar-ital... r.n e.rt. - ~" °t~ i ~I ~I !~ - S t . C•i' o i-ic Couni.il. !! ,_i, the following described reap estate is .............. _- --.-•--~----••••--••--•----• ! ' R[TURN Te ,1 State of Wisconsin: II ~j !~ ~, ~ I ,~ The Northwest Quarter (NW's) of the Northwest I~ T own sh i ~' ---- - - -~:- = __ _-- -- ~. tjuarter (NWhc), Section Eleven (11), P ~~ ~~ Twenty-nine (29) North, Range Seventeen (1~) ~` if Taz Parcel No :.................•----•---••-- ii West. l~ '!t ~. {%~ ~+ This ...---.-tg----....- •---. homestead property. (is) (iQxrlt4d Dated this ..-....21st----------------•------ ----..... day of .._.-.. --------•--- - -•--------•-------------------••--------•---•-----(SEAL) - -• ..........................•---------•-•----(SEAL) AIITHSNTICATIOPI Signatnre(s) --------------------•---....-------••-------------------- authenticated this --------day of----..-._--°.°--------°• 19_---.. TITLE: 3SEMBER STATE BAR OF WISCONSIN (If not, ....--•-------°----.......-•-------•--•----•----------.. authorized by ;i 7(16.08, Wia. Stats.) THIS INSTRUMENT WAS DRAFTED BY BAKKE NORMAN, S.C. Menomonie, WI 54751 ____- (Signatures may be authenticated or acknowledged. Both ~2 ---------------------------------• 19..94.. . ......................•--•--.... (SEAL) Nels P. Anderson • ----... Norma P. Anderson ACSNOWLSDC4MSNT STATE OF WISCONSIN _ ST ._ CROI%_____________Connty. 1 ~ I, Peraonslly came before me 94 ------•-----°•;~5~:°f y, ---September ................. 19......_. the abo~,ngF,ea.w, ...---- Nels P. and Norma P. AndeX•don to me known to be the person .5..._._... who a=ecu'~ thpf ` foregoing instrument. and acknowledge the serge. ~~ `: !. ' ' ..~~-... '-- - -...lgw.-_.C_S. - - - Notary Public ....ST ~_~~ ............. . ~.,unty, Wis. 1Hy Commissionrs permanent. (If not, state ezpirahon n c~ _ -a Q~ ~ , ~" ~ ' olyd ~/a2Z _,c~...I~ 2 ~o- 2cso (off- 3 659SS9 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR RECdRD 10-23-001 11:10 AM ~ ~`~ ^ 3"~ COPY FEE: 3.00 RECORDING FEE: 13.00 CERTIFIED SUR VEY MAP Located in the NW '/a of the NW '/< of Section 11, T29N, R17W, Town of Hammond, St. Croix County, Wisconsin. OWNED BY: NELS & NORMAANDERSONLE C/O NOLAN & RUTH ANDERSON 1927110TM AVENUE I I WI BALDWIN, WI. 54002 ~ i~ ~~ c ~~ c I~ -r zll= r ~I~~ w° ~~ ill I3, ~I NW CORNER, SECTION 11 LOT 4 OF CERTIFIED SURVEY MAP 12~~ glZl (1" STEEL SURVEY NAIL FOUND) lo' y, ~ QI I UNPLATTED VOLUME 13, PAGE 353_3. ~ Z J i - LANDS-~- 11~H - - AVENUE NORTH LINE OF THE NW1/4 - I I i ~ - - S 89° 32' 37" E - 1,304.31'- - I I - - ~ 473.14' - CENTERLINE - 440.78' - - 390.39' _ c~ S 89° 40' 00" E 1,043.18' ' _ _ N 87° 54' 28" E -441 OS' - - v - - - 441.05' ~ rn 161.08' • - 2~9.37T ui I b~ h- LOT 1 ~ ~ LOT 2 f 6G1~ ~~ ~ tcr~ND .. M I ~ 129,092 SQ. FT. (2.964 AC.) N co ~ 119,980 SQ. FT. (2.754 AC.) ~ kqV/ /p ~! c INCLUDING-RIGHT-OF-WAY--N ^ c,- - -INCLUDING RIGHT-OF-WAY- --o,-`_'? ~ '~•W,~~B(F Np- - -- - - - - - - ti I N 98,084 SQ. FT. (2.252 AC.) N c N 98,084 SQ. FT. (2.252 AC.) N. c~°i ~ _ . c~ ~ N EXCLUDING RIGHT-OF-WAYoo ~ EXCLUDING RIGHT-OF-WAY .N'oo N . I ~ 884.62' Z • 31.27' 442.31 442.31' Z ~' ' ' ' ' ' ' ' S 89° 40' 00" 915.89' I ~ BENCHMARK =1"IRON PIPE ' SET AT NORTHEAST CORNER ~ OF LOT 2, ELEVATION = 100.00 100' BOIL ING SETBACK LINE WE7Z.AND BOUNDARIES (O.H.W.M) AS I j IDENTIFIED BY THE ST. CROD~ COUNTY i ZONING OFFICE ON 04/27/01. ~ 75' SETBACK FROM NAVIGABLE POND/WETLAND ~' ~ I ~~C ~ ~ Nip ~ T3 o~ N .~ •w ~~~ i o> I ~~ i I II O O I z~~' zl II W ~ = 1 it H ~ ll O I w. ZI I ~I ~ 1 W I ~~ I I x-27.14' ~ 1,452,680 SQ. FT. (33.349 AC. ) INCLUDING RIGHT-OF-WAY ' 1,404,767 SQ. FT. (32.249 AC.) ' EXCLUDING RIGHT-OF-WAY ~: BEARINGS REFERENCED TO , ' THE NORTH LINE OF THE NW 1/4, PREVIOUSLY RECORDED AS AND a . ASSUMED TO BEAR .' S89°32'3T'E. A~I~ED ~~ • ST. CROIX COUNTY Planning Zoning and Parks Commltee OCT 2 3 Z~Qt N If not recorded within 30 days of „ _ , approval date approval shatl be null and void ' Scale 1 200 ~ •'• ~,. 1,299.98' S00°01'37"E ~, W1/4 CORNER, SECTION 11 ( 1" STEEL SURVEY NAIL FOUND ) o ~ ' QZ~o ~i J ~ \ m ° Qa~ x ~ ~ o ... Z W O v •~ u W H LL O W z w ~~ ~~ ~ M m ~ 0 z O ~ J W Z v7 ~ ~~ W ~ Z ~ ~ ~ O ~ U W H z ~ io °0 4~ ~ `~I w JJJ ~ WI N ~ ~I 0 a ~I SOUTH LINE OF THE NW1/4 OF THE NW1/4 1,286.71': N 89° 32' 27" W 1,313.85" U-NFLA7T'EU LANDS I ~- BENCHMARK = 30d NAIL SET IN EASTERLY GATE POST, ELEV. =100.00' . SCALE IN FEET t ~~ = 200 0~ 100 200 400 .~ ~gC NSA °......°, ,y h r ~°J SE N W. °'; l !~ 1~ L6l~ Z 7 ~. Wisconsin r~elaartment of Commerce Divis~an of Safety and Buildings SOIL EVALUATION REPORT ~~~ ~ ~~7"~v f Page ~ of J m accoraance wrzn ~.omm oa, vvis. warn. ~.vue County Plan must er not less than 8 1/2 x 11 inches in size let lan on a om it Att h - p p . p ac c e s e p include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale ordimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location -~ e t1 Govt, Lot. A/ f,~ f 1 /4 1 /4 S ~ T R N R ~ ~- E (or~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone NumbeP ^ City ^ Village ®Town t~zarest Road ~a~ w' "~ w t S^Yoo Z (7iS) 48N- ZSL ~.- P`,, .. ,_~,, [~ New Construction Use: I~ Residential I Number of bedrooms 'Z^e ^ Replacement ^ Public orcommercial -Describe: Parent material ~' ~ ~ _ _ General comments s~/S~e rv( 2 (-e. J. 9 ~. Fs G and recommendations: (,0~~ ~r e/t v. ~~, a o derive,~ies~n flow ra~e ~S'O/G O 0' GPD ~loaff Plain elevation if appl01ble c;~', ST ("~2C ~~ ~.~ ~ ,_ ft. 1 Boring # ~ Boring ~,,;C~ ~ ~ ~ ® Pit Ground surface elev. V ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef f#2 ~ (~- a 3 Si ~ Z rib L S ~v ~' • 5 Q .8 2- -3 ~ ~t 4 `-' S i cl Z c S • ~-l 3 -moo `i~3 FtF -1.5 ~ `i ~~ Sc.1 Zmsh1~ t~t' - . ~f • ~n Boring # ~ Boring ~ -1 ® pit Ground surface elev. qS/o ft. Depth to limiting f~ ;tor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure C insistence Boundary R.:~ots GPD/ft' in. Munsell Qu. t:~z. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o- tv y si 1 2 ~. ~r c5 t ~-~ •5 .~ z $-2~ ~ 5-~) mfr ~ - • `I . 3 Z 1- I~ `I F - ~ .5 r ~f `E Sc-1 k rte( _ - . t4 • (o * Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #~ = BODS < 30 mg/L anc^ TSS < 30 mg/L CST Name (Please Print ignature CST Number T 30 Address Date Evaluation +;onducted Telephone umber Z/ ~S. uz ~0-/6- o/ 7/SZ ~- l0 Property Owner ,4ndersa~ Parcel ID # Page 2 of Boring # ^ Boring • pit Ground surface elev. gy. ~ ft. Depth to limiting factor 3~ in. _ Soil lication 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 E t~ - 1 3(`~ Si ( Zmab rY~r' c 5 1 v~ . 5 . $ 2. 9- 31 10 r `k ``~ ~ 5 i c_I 2mab c 5 - . '~ ~ So 3 t-~4o t0 ,r 413 F 1 ~ `1.5 (`t y sc1 gbk m ~ ~ . _ , y . C~ ^ Boring # ^ Boring . ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication 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 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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.07/00) ~" . ..' PAGE ~ OF .~ NAME ~. n ~ c•~~o ~ LOT# LEGAL DESCRIPTION ti/ w'~4 N~l4,S // T zR N,R ! ~ E (or J~ SCALE: 1"= yO BM 1 ELEVATION ~~' ~ BM 1 DESCRIPTION 7b Po.~ Z ~u~ P: Q~ BM 2 ELEVATION 9$• YD BM 2 DESCRIPTION 1a ~o ~' Z " D~e~c- .D~ SYSTEM ELEVATION % 7 9a ALTERNATE ELEVATION ti/!4 9G•ae ~ CONTOUR ELEVATION O Q `~~ o° 0 aG' aq/ a.v 8~ \~ 0 ,~ t ~. a~Z ~~~ ~ gMl - .~ SIGNATURE ~j -- ~'~~~ - DATE ~ _ ~ - d ~ ,.