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026-1143-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 569501 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: Stacken, Kenneth I Richmond, Town of 026-1143-50-000 CST BM Elev: Insp.BM Elev: BM Description: �, Section/Town/Range/Map No: goo A/e,./ �� /a/° °�.,,�4 �,0 20.30.18.1046 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , ,� S CAPACITY STATION BS HI FS ELEV. Septic F-1 13 / Benchmark G ,7`� 7 iDb Basing SZ S Alt. BM_ � 11-x. Go .-3 o /a/Z Aeration V Bldg.Sewer Holding St/Ht Inlet , TANK SETBACK INFORMATION St/Ht Outlet /Z.7 9`7/ TANK TO P/L WELL BLDG. LYW44b Ai Intake ROAD Dt Inlet \ ea Septic 32- 1 73 Z7 U g 7 / Dt Bottom Dosing Header/Man. /6-7/ , 7 3• 5;:Y Aeration - Dist. Pipe of /a .73.4-0 )000 /0,91 9•.3 . 5Af Holding Bot.System C- 7Z - d� Final Grade 7.3z °/.7./3 PUMP/SIPHON INFORMATION ; Manufacturer Demand St Cover GPM 1✓�(e} 7 % �. Model tuber TDH ft Friction Loss System Head TDH Forcemain Length Dia. I Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z 't'r SETBACK SYSTEM TO P/L , WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: 4' UNIT Model Numb r: Cow�� t a 3z '1Z /2� 9a_' o,,.• ZL+ /'s DISTRIBUTION SYSTEM Z Z. +- ZZ 4/y OLX--Q Header/Manifo)d il IDistribution x Hole Size x Hole Spacing Ven to Air ntake Pipe(s) \ \ Length Length_ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center L.! �y3 Bed/Trench Edges Topsoil Yes C No Yes JI No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:_J_/ /7 /—/z4Inspection#2: Location: 1041 144th Ave. New Richmond,WI 54017(NE 1/4 SW 1/4 20 T30N R18W) Wald offMadows L5 Parc o: 20.30.18.1046 1.)Alt BM Description= 'o�n La�f'ra ��f✓'rye 2.)Bldg sewer length= Zg -amount of cover= , o CJS_ CsJ cam, SG.�e..�S Plan revision Required? 0 Yes No r 7- 7 Use other side for additional information. Date Insepcto ignature Cert.No. SBD-6710(R.3/97) �L "J Vc LL J - w �c f L� 4 t`l y ate r 4 i�A "'r�r�-" /=c; .i➢A �- °' Meek • s � > je-� o uj n� A6R.+.A`E^'TO County _ Safety and Buildings Division L' //V- 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) it Madison,WI 53707-7162 State Transaction Number ry Permit Application In accordance with SP 1( ,Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to ob l g a$anitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04 1 m,Slats. `� t A/l{ Var R I. Application Information-Please Print All Information (J Property Owner's Name Parcel# Property Owner's Mailing Address Property Location /6 0 6 p � Govt.Lot City,State r Zip Cod e Phone Number �1(=+/, %, Section 2 C d lM W� 5 ®�� 612 Z9� C�✓� cleone TN; REo ' H.Type of Building(check all that apply) Lot# Subdivision Name JLor 2 Family Dwelling-Number of Bedrooms / �® dk- a� BIQck# A, p 1 W ❑Public/Commercial-Describe Use P .� ('Oij T 'J J� I' ity of P' CSM Num / Q ��Vlillage of ❑State Owned-Describe Use ��pG� ,� Town of e--/* ore�® 2 CJ 5 L� Z 1 Z Z Cl�, Joers III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A ❑New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only I,` ❑ Other Modification to Existing System(explain) List Previous Permit Number and Date sued B. ❑ Permit Renewal A Permit Revision ❑Change of Plumber ❑Permit Transfer to New ��j Before Expiration Owner E.Jt/ X13 �L I IV.Type of POWTS S stem/Corn onent/Device: Check all that a I RKNon-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(exnlain) ❑PreUcatin ent Device(explain) V.Dispersal/Treat nt Area Information: J43 &W e I°LUS /L4 44-02 Design Flow(gpd) Design Soil Application Rate(g s Dispersal Area Required(sf) Area Proposed(s System Elevation/ U L,/ 4 C - e 5-53 56 0 9z. S VI.Tank Info Capacity in Total #of Manufacturer y Gallons Gallons Units a °_ H New Tanks Existing Tanks kl.) U c i a Septic or Holding Tank S v /Z JC U t L4ys(re-m Dosing Chamber '- VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's ame(Print) Plumber's Signature MP/Nfi4t Number Business Phone Number e� EC;t), 71s Z73 Plumber's Address(Street,City,State,Zip Code) L-Lf&J4-&4/f 14,11 VIII Coun /De artment Use Only Approved sappw d Permit Fee Da Issued Issuin ent Signature ' I(S. ) en Reason or nial IX.CondialweA441p11b161 Reasons for Disapproval p / t: SSeptic'tank,effluent filter and' 3) Mjfl- dispersal cell must all be servk:es I maintained j f , as per management plan provided by plumber. A1W 3..All 60'ack regt*errlet ft must be,maiMairf§d ee per a' ie coder ordtfttr'ttes: / P.11— -al Attach to complete plans for the system and submit to the County only on paper not less flifin 8 12 x 11 inches in size SBD-6398(R 11/11) r &/j S+ /* (� vg7 �L J IA f� o 80 4tP A4 J > � k Wisconsin Department of Safety and Profeservices Division of Industry Services �4,;+ "10 A t SOIL EVALUATION RE Page of 6�rdar�wit S 383,Wis. Adm. Code County r� l"4 . Attach complete site plan on pa 91'1c le 1 inches in size.Plan must CR�1 X P� p p P� include,but not limited to:vertical and rence point(BM),direction and Parcel I.D. percent slope,scale ordimensigd*.1 ow,and location and distance to nearest road. 0 1p_ %I U 3" t50-- M Plrint all information. Re ' wed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04 Property Owner � " - Property Location X"mCTII 5TAKE / 8.,t.Lot A/C- 1/4 SO 1/4 S Z© T -7 N R E(or) Property Owner's Mailing Address Lot# Block# Subd.Nam or CSM# PO- ,got 154 --5� - WAU--')FMf-F Mews City State Zip Code Phone Number []City ©village JZTown Nearest Road IV Euf gjaf,440001 kjj 1 5401-1 1 ( ) RICH 1 yy ��- New Construction UseE] Residential/Number of bedrooms Code derived design flow rate Co®6 GPD Replacement [:] Public or commercial-Describe: Parent material 0KT U1 ASt't Flood Plain elevation if applicable / i General comments and recommendations: AjD,0%- IDjkj,AL FITS R OWROD `TD 1V\'0v0 SV-''T�/� �R 'Vk b Ls.rr✓11-1�� t���' S�� 74�PoR'r DA-TS,D GYo-zO-00. /D39 19YA,4t1"u6 ,' &LL� V 11V L"Boring# 0 Boring ('/L(k 7 M Pit Ground surface elev. 95-769 ft. Depth to limiting factor //9 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft° in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 ! D-/0 /OYx 21Z — 5 i! zf SaX ►•H►Ir 45 3 -m 0.6 /,d D- ,5 YK31Y - s 051 fkd w -m 0. 7 J16. ++9 l0 YK S/y — s rn — 0.7 /6 hkRIZQV 3 has 20-Z5 r. 2 Boring# ❑ Boring ❑ © pit Ground surface elev. q3.2-& ft. Depth to limiting factor_LZ�in. Soil Application Rate i 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 I 0–)0 /D ylZ — 51 Z 6bK ry►ufr 45 W-m 0-ill 2 /0SO 7,-5Y93 S D rnl ttl n D. 7 /,(o 3 o-iz/v >oYX tF — s p rhil - - 9,7 /.6 gr- *Effluent#1=BOD >30:<220 mg/L and TSS>30:E 150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Si ture CST Number NLAPPKr A46i�� zZZl g3Z Address Date Eva ion Conducted Telephone Number WQ875 -�` -j- AVE-0 RtvEK FA! _ T -5%2 Z SBD-8330(807/13) Plot Plan for Site and Soil Evaluation Page Property OwnersN�rtt Legal Description L4T ei cvA LCDKF Mews, (except* jW �, Rlgw. 7own3 I' = koepit �'�� o� � sw�� s 20 7"30 ' �- i� 1Z)CNMDA)D S"r, c-E-Olx Col Ati lV _ wcSeOJUSIA) 2 5 1h �Z+p G� To a i 't t � Feu.,v -n cri MOMS -tear �A° S3.Zi. Site Location: a Ii St. Croix County 8 2 0 5 8 0 AFFIDAVIT OF STORM WATER Tx:4169961 MANAGEMENT&MAINTENANCE 991419 Document Number Document Title BETH PABST J REGISTER OF DEEDS ("Owner"):Real Estate Owner "Owner" t- YA S7�4C�°i� ST. CROIX CO., WI RECEIVED FOR RECORD Local Municipality("County"): St. Croix County, Wisconsin 01/14/2014 10.51 AM On this _day of --ra wr 2014, the Owner(s)agrees to ensure that EXEMPT #: the stormwater runoff manage ent structures(s) installed on the property REC FEE: I described below continue serving their intended purpose of infiltrating runoff in Recording Area 1 perpetuity in accordance with the stormwater management plan filed as a requirement of the land use permit File#LU88177 that was approved by the Name &Return Address: Zoning Administrator on January 2. 2013 a copy of which is on file at the St. Ken Stacken Croix County Community Development Department. P.O. Box 154 New Richmond, Wi 54017 This Affidavit applies to the following real estate, herein referred to as the "Property": Parcel No. 026-1143-50-000 Lot 5, Plat of Waldroff Meadows in the Town of New Richmond, St. Croix County, Wisconsin Through this Affidavit,the Owner hereby subjects the Property to the following covenants, conditions, and restrictions: 1. The Owner shall be responsible for the routine and extraordinary maintenance of the stormwater management facility(s)that were installed in accordance with the approved stormwater management plan on file at the St. Croix County Community Development Department. 2. The County, or its designee, is authorized to access the property as necessary to conduct inspections of the stormwater management facility(s)to ascertain compliance with the intent of the stormwater management plan and the practices and procedures prescribed in the plan's operation and maintenance agreement. 3. Upon notification to the Owner by the County of maintenance problems that require correction, the specified corrective actions shall be performed by the Owner within a reasonable time frame as set by the County. 4. The County is authorized to perform the corrective actions identified in its inspection report or its notice if the Owner does not make the required corrections within the specified time period. The costs and expenses of such corrective actions shall be the responsibility of the Owner. 5. The terms and conditions contained in this Affidavit shall run with the Property and be binding upon the successors and assigns of the parties to this Affidavit. Upon the conveyance of the Property by the Owner or by any of the Owner's successors in title to the Property, the grantor of the Property in any such conveyance shall be relieved of the obligations provided for herein. Dated as the first day written above. Owner Signature(s): Owner Name(s)Typed Here: AlG' Acknowledgement STATE OF WISCONSIN):ss County of St.Croix) Personally came before me this day of 0+044P400ve named to me known to be the person(s)who executed the foregoing instr;- nt)anffla4ly�NJged the same. ta0 Tiq cn . 'Ql• = ' �l A Notary P I' t.Croix County WI �BL�� .•� My comp 'ssion ex pires:-D •� ,pF•........••0�`�� This docuMe yI"Id ed by: Pamela Quinn.COD Land Use Specialist "THIS PAGE IS PART OF THIS LEGAL DOCUMENT-DO NOT REMOVE" This information must be completed by subnritter: document title.name&return address.and PIN(jrequired). Other it forma/ion such as the granting clauses,legal description,etc.nray be placed on this first page ofthe document or inay be placed on additional pages of the document.Lvig_ Use ojihis o�t+elC{f Xefc76N-lbl { �}li7j`'>3t� &u�e�iTf and 52.00 m the recording fee. 6Visconsin Statu/es,59.5/7. Safety County 5 �' ) and Buildings Division to be filled in by Co.) re �3 T roF T � 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number A w..4- K Madison,WI 53707-7162 �a D ) ss" f441,..11/4- State Transaction Numbe Sanitary Permit Application In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 647 PC prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if differ.•t an mailing address) is the Department e /O �! �// /j I / �, the Departnment of Safety and Professional Servies. Personal information you provide may+'be used for secondary 7- 1T�/ u .oses in accordance with the Priv• Law,s.15.04 1 m,,Stats. ./y $ Parcel I.I, A••lication Information-Please Print.All Information s0 o d O Property Owner's Name �/ /� 'T ' ` Property Location / '`O� ! 0�f 6) Property Owner's ailing Address �' OG Govt.Lot / A 1 E y4 �(�'/4, Section�0 Zip Code Phone Number CY-`= l��( e(� (cycle one) City,State `� W I ✓ ! o 7 Z� Z�O ��� T 3 ON. R_Eor® BUJ �Ct ✓kv�� Lot# II.Type of Building(check all that apply) Subdivision Name 1 or 2 Family Dwellin -Number of Bedrooms W/-�„ Q /"' r� g � ,./ Block# ©l`� YLe L r Z�¢- `1Q ❑ City of ❑public/Co ercial-Desc d Use l�a v+/�n' is) ❑ village of CSM Number (e- f✓l P ❑State Owned-Describe own of III.Type of Per_• (Check only one box on line A. Complete line B if applicable) ❑ Other Modification to Existing System(explain) A. P)141 New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only List Previous Permit Number and Date Issued ❑Change of Plumber ❑Permit Transfer to New B. ❑Permit Renewal-..-❑-Permit Revision Owner Expiration IV.T •e of POWTS S stem/Com•onent/Device: Check all that a .1 Non Pressurized In Ground 0 Pressurized In Ground ❑At Grade ❑Mo d>2W4 �Y sui�le soil ❑Mound ai<n)2 4 in.o suitable soil l ❑ Holding Tank ❑Other Dispersal Component(explain) i retre • aevb s Area"Information: Proposed ✓�`v8 f 020-i c/c y! /' l 5 /i✓ �l t r�rcME k D esit Flow(gpd) D esign Soil Application Rate(gpd�, Dispersal Area Required(sf) Disp`��ea Pro osed(sf) System Elevation � O ✓ 6• VI.Tank Info r Capacity in Total #of Units llGaons Gallons o B New Tanks Existing Tanks a U � " w C7 0. Septic or Holding Tank Z SD x Dosing Chamber MP/MPRS Number Business Phone Number VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Signature l 26 7 779-- Z?3 S tOt 61-5 Plumber's Name(Print) 7` Plumber's • •dress(Street,City,State,Zip Code) (/ 6-L C- Ole 4-64 (A)( V O Permit ��� VI 1 Coun /De•artment Use Onl Pit Fee Date ued •mg Agent Signatu U Approved ❑Disapproved $ 231 20 / ❑ Owner Given Reason for Denial L v �� -to IX.Conditions of Approval/Reasons for Disappipval 3 Lioti /rte"' SYSTEM OWNER: �J� 1.Septic tank,effluent filter and '�� � �J mQ dispersal cell must be serviced/-maintained N,�, OvvL / / as per management plan provided by plumber. �+- , 1 __ 2. as setback applicable cableements must be maint for the as per applicable Gat6S1U�14vsPl��►ans rot the cyst and submit to the County only paper s than 8 In z 11 inches in size V 0 ag c=erAlAi.'11" SBD-6398(R. 11/11) `W / ....-..Land Use _ .. ST. C R O I-y-� C ' {{U T Y Planning&Land Information �t/ /_S t : __ 11' Resource Management Community Development Department January 2, 2014 File#: LU88177 Ken Stacken P.O. Box 154 New Richmond, WI 54017 Re: Land Use Permit, Filling &Grading < 10,000 sq. ft. in the Shoreland District 1041 144th Ave., lot 5 of Waldroff Meadows Subd. Parcel #20.30.18.1046, Town of Richmond Dear Mr. Stacken: This letter confirms Community Development Department (CDD) approval according to the plans you have submitted for filling and grading an area of approximately 5000 square feet within 300 feet of the Ordinary High Water Mark (OHWM) of Ten Mile Creek to construct a driveway, single-family dwelling, and private on-site wastewater treatment system (POWTS) on the property referenced above in the Town of Richmond. CDD staff finds that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and Shoreland overlay District with the following findings: 1. Filling and grading less than 10,000 square feet in area less than 300 feet from the OHWM on slopes less than 25 percent is allowed with a land use permit in the Shoreland Overlay zoning district pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance; 2. The filling and grading will consist of excavating for the foundation of a single-family dwelling with attached garage, driveway and turnaround, and for the POWTS, all of which will meet the 75' setback from OHWM of Ten Mile Creek and other required setbacks and dimensional standards contained in the St. Croix County Zoning Ordinance; 3. The applicant's agent, Lund Builders, Inc., will implement an erosion and sediment control plan. A storm water management plan will specify areas designated to infiltrate runoff from impervious surfaces (-3800 sq. ft. total). With conditions to install appropriate erosion control and sediment control measures e.g. silt fence or sediment"logs" between the construction area and the creek prior to beginning excavation, to maintain erosion control measures until self-sustaining permanent vegetation is established on all disturbed areas, to prohibit the use of phosphorous fertilizer to maintain a lawn, to submit and implement a storm water management plan that infiltrates 478 cu. ft. of runoff, and record a maintenance and monitoring agreement against the property for the infiltration devices, negative impacts to the water quality of the creek will be minimized; 4. The creek OHWM is -165 ft. from the proposed house and the owner will be required to maintain vegetative cover within a minimum 35'shoreline buffer zone; Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cddPco.saint-croix.wi.us Community Development Department Page 2 5. A sanitary permit application was submitted for review on December 26, 2013; 6. Approval of the land use permit will include a condition that an affidavit documenting the stormwater management plan be recorded against the property; and 7. The Wisconsin Department of Natural Resources staff has reviewed the application and had no specific comments on conditions of county permit approval. A DNR grading permit will not be required for land disturbance less than 10,000 sq. ft. and outside the 75' OHWM setback. Based on these findings, approval of the land use permit is subject to the following conditions: 1. The applicant or their agent shall submit a stormwater management design for review and approval by the CDD staff prior to project completion. It must include specific details for and location(s) of infiltration devices that provide a minimum capacity of 478 cu. ft. to handle stormwater runoff from impervious surfaces. The applicant shall record an affidavit referencing the approved stormwater management plan with the Register of Deeds prior to commencing construction, before the pre-construction meeting (see enclosure). 2. A pre-construction on-site meeting must be scheduled with the county staff to verify placement of erosion and sediment control measures and recording the stormwater affidavit. The applicant will be responsible for directing contractors to implement storm water management and erosion control plans, which include installation of silt fencing, straw waddles, and/or sediment logs between areas of exposed soil on the construction site and the lake or neighboring property to control contaminated runoff. Photos will be taken to document pre-construction site conditions for enforcement purposes. 3. The applicant shall obtain all applicable permits and approvals required for construction of the driveway and house. A sanitary permit has been issued for installation of the POWTS. The contractor will need to provide the erosion control plan to the town's building inspector for compliance with Uniform Dwelling Code requirements. 4. The sanitary permit issued for installation of the POWTS will require compliance with all conditions of the land use permit and contractors must be made aware of the conditions regarding erosion and sediment control. 5. The applicant shall maintain all erosion and sediment control measures until permanent, self-sustaining vegetation is successfully established on all disturbed areas of the site. 6. No phosphorous fertilizers shall be used on the disturbed areas of the site, unless a soil test confirms that phosphorous is needed for establishing permanent vegetative cover. 7. Within 30 days of completing the project, the applicant shall submit photos of the stormwater infiltration devices and stabilized disturbed areas for documentation of compliance with conditions. Photos may be sent to the CDD office electronically via e-mail attachment. This approval does not allow for any additional construction, structures or structural changes, grading, filling, or clearing of vegetation beyond the limits of this request. Your information will remain on file in the St. Croix County Community Development Department. It is your responsibility to ensure compliance with any other local, state, or Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd(a co.saint-croix.wi.us Community Development Department Page 3 federal rules or regulations, including obtaining a building permit from the Town of Somerset. Please feel free to contact me with any questions or concerns. S /44„.46._ Pamela Quinn CDD Land Use Specialist Enc: Land Use Permit LU88177 Stormwater Affidavit form Cc: Todd Dolan, Building Inspector, Town of Richmond Lund Builders, General contractor Mike Wenholz, Wisconsin Department of Natural Resources Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd@co.saint-croix.wi.us . ♦ r ,`. ,�.' LOT 15 . 1\ Iti.'� n •: S rid /° -- mss. it' , •# 3 yy , oo..ma 5t f'� !!. :i�.8'• I• -a t y TOWN LOT " 1 * .. , NE IMAM— .9 OT 4--......, # 0, C/ t .I 1.11 * , M." a FT4 Y., V .+....,. 5.- -t.-,...„.....,...,I r" i -' .ti. `'- ti 0%231.:,o.r*`.) 1 1 �� .,� mac,*.: .W, . 1 i , ; I i 4 tv' •OT 1 • ♦' .""' ; ; w on,+ rr'. T'01.S.,W,M: 7 4 \ . . ••. . r MoM�IL7a80. t v, 0 Ne104 ce THE l 10 CArii4 Yf-: 411, 041V1(4)40,211 .. w.'�.r..1�`IIFMMMI,,.r.w'.u. .. .•r..r.rr+wJV r.r—.,,,r:......,.....s:..p ,w.M-�y.y" '.' ..:4.02 .. . l CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: • Owner's Name: KE ) cl-A C- 6./l/ Owner's Address: � d 0jD X /✓- /IJC�w' i2( eH eo r./k) (N r s d ( 7 • Legal Description: ./U kV 5 c 2c) .f 30 2 ( g o Township: if/0 dip, rtJ P County: 5f C R 0 / X Subdivision Name: W A L ( 20 rte.. A1c,¢46 J5 Lot Number: Parcel ID Number: //413 —5-0 000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section 09 p(J�lL4enAFiy( QuicK Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7. St. Croix Cty Septic Tank Maintenance Form Page 8,' Warranty Deed Page 9, CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: Ref 4J License Number: Ati° z z b c(cr 7 Date: / Z-- L L- C 3 Phone Number 7/3— 273 S'Y >e Signature AtA,.. fri;/( — Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 i 0 . 0.U _. J k._ .. N.t.., , L,_ _. t 1 0. i P 7:7_,..c.:_....._ ti ti • • 4?t. • t • /80 1/2 Q 1 n C 0V 1 P'fy f.,..,\I"''\,, 7IL ' , t \ \ \ 2 0 {c Nt 'a ti i,ta-1_,' k • a r a • ,..,..., , 1...,,.._z rs..,........_, , 3 / , 21'S 4 $S 1 4 0 1 Soil Absorption System Cross Section ! • . ° . 7,-15ft ■ Final Grade , 4'Schedule 40 PVC Vent Pipe ft With Vent.Cap -4._.__ Leaching —_•,. 91. Chamber 4— System Elevation ', rte 3 • ft . 5• ft • Soil Absorption.System Plan View '1 a ft O I II I III III II I # . -- ft Leaching Trench 1 Vent Or Observation Pipe Chambers --I C_ \ . 1 ,I I I I . . I I ¢ 4"Dia. Trench 2 Header : II, !Leaching Chamber Specifications Q Lt..( c fc ( �-l. i Manufacturer Arad Model /� F�L+12��� � � S i, EISA Rating 10 sq ft per chamber Soil Application Rate , 7 gpd/sq ft I 66[0 gpd Design Flow+ i 7 Soil Application Rate + g✓rO EISA= i(3 Chambers 2Irows of Z ( 4- 2 Zchambers each. Sr f ( I '1 0 (° > k'. "' ,.) i !I C/ , , 1!IL Page of 1': 3 h 1t 2 ai "Yi 1 Yn s t W k "u "., n,,r',4. .u. �� 0 : a ,;r r -'rt+»' -' �,: HE ' < STANDARD'.'' '' N d;"rY •- ■ , uick4 Pius Standard Chamber Side and End Views 3 Ad , L 48" (EFFECTIVE LENGTH) t 112.. ...ial gi i =i i r:r 7:... =iii _I rte- r r. . % 7/71fillir_ __l._ I 1' 34" a ,`tin k4 Pius All-irL One 12 Encap Front, Side and End Views r_ii..2.1„ i . . .. I 1 8”INVERT �%, II� 13" 8"INVERJI�I I 11111111` 5.3"INVERT - 18.2„ I- 33" 1 Quick4 Pius Ail-in-One Periscope OUICK4 PLUS ALL-IN-ONE PERISCOPE k (360'SWIVEL I 12.7"INVERT /1111110111 r I,A, F OUIPLUS "11EL '� ALL NE 12/� 15„ 1-90-] ,i Quick4 Plus Standard Chamber Specifications Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height' 0.6", 5.3", 8.0 12.7" Effective Length 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm) ' INFILTRA441,YSTEMS,INC.STANDARD LIMITED WARRANTY (a)The structural integrity of each chamber,end plate,wedge and other accessory manufactured by Infiltrator("Units"),when installed and - operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions,is warranted to the original purchaser("Holder") against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided,however,that if a septic permit is not required by applicable law,the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights,Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, 'rr Connecticut within fifteen(t5)days of the alleged defect.Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. ' (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS,INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c)This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty I N F I LT RAT 0 R® does not extend to incidental, consequential,special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, systems inc, s s including loss of production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. s}' i Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse or neglect of the Units;the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions;failure to maintain the minimum ground covers set forth in the installation instructions;the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768 I the Units;failure of the Units or the septic system due to improper siting or improper sizing,excessive water usage,improper grease disposal, or improper operation;or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 terms set forth in this Limited Warranty.Further,in no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units,or any 860.577.7000• FAX 860.577.7001 Y third party resulting from installation or shipment,or from any product liability claims of Holder or any third party. For this Limited Warranty to j apply,the Units must be installed in accordance with all site conditions required by state and local codes;all other applicable laws;and Infiltrator's installation instructions. 800.221.4436 3. (d)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the WWW.infiltratorsystems.com original Holder. 4` The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook,Connecticut,prior to such purchase, • to obtain a copy of the applicable warranty,and should carefully read that warranty prior to the purchase of Units. i I " y I w z 4 w � .-#i x t .:t, � .t ,.4.4'.N.,4-',: Y p A a�"c �m4 w r k 5 � ' 41r 7.", '4't ro.' ,k r "�n t Ie �f,,, ,.,,,b,, y , I 1 ,� k)C i � ro 7 t ` � . ;40)N W r x ,) y a_ g el r U S Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents.1,329,959;2,004,564 Other patents pending. Infiltrator,Equalizer,Cuick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark in France,Infiltrator Systems Inc. is a registered trademark in Mexico.Contour Swivel Connection is a trademark of Infiltrator Systems Inc.CO 2009 Infiltrator Systems Inc.Printed in U.S.A. PLUS0510101SI-2 POWTS OWNER'S MANUAL &•MANAGEMENT PLAN 0. • FILE INFORMATION SYSTEM SPECIFICATIONS a ( Owner K.,6....._'A� s cl:A� Septic Tank Capacity 1 Z S0 gal ❑ N Permit# (` !J'/„q ' Septic Tank Manufacturer i-6i5- ., ❑ N DESIGN PARAMETERS xK/� 11 • Effluent Filter Manufacturer z A a 6-L ❑ N. Number of Bedrooms ❑ NA Effluent Filter Model pl., t sv ❑ N. Number of Public Facility Units 'NA Pump Tank Capacity " gal N. Estimated flow(average) 7-" - gal/day Pump Tank Manufacturer m Nd Design flow (peak), (Estimated x 1.5) /06-0 gal/day Pump Manufacturer Vi Ni Soil Application Rate s -2 gal/day/fts Pump Model NI Standard Influent/Effluent Quality Monthly average• Pretreatment Unit • ❑ N/ Fats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOW 5220 mg/L ❑NA ❑ Mechanical.Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: - Pretreated Effluent Quality Monthly average • Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L XIn-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑NA ❑At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. ❑NA Other: ❑ NA Other: ❑NA ' Other: • ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: I ❑ NA MAINTENANCE SCHEDULE • Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s)year(s) (Maximum 3 years) ❑ NA Iiii Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal califs) At least once every: 3 0 months) (Maximum 3 years) ❑ NA ® year(s) r ❑ month(s) Clean effluent filter At least once every: / 0 I ® year(s) ❑ NA ❑ month(s) x Inspect pump, pump controls &alarm At least once every: 3 H year(s) ❑ NA Flush laterals and pressure test At least once every: 3 la yeaarr(s)(s)❑ m ❑ NA Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) . Other: • ❑ NA MAINTENANCE INSTRUCTIONS - • • Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s)to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent qn the ground surface. The dispersal c:011(s) shall be visually inspected to check the effluent levels In the observation pipes and to.check for. any ponding of effluent on The ground surface., The pending of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory! authority., When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the. entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services,Including but not limited to th. servicing•of effluent filters, mechanical or pressurized components,.preireetment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GNAW (4/01) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the content of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the arei within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain,(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat.scraps; medications; oil; painting products;•pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed., • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures'have been, or must be taken, to provide a code compliant replacement system:- yA suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. .Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. It no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 . Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A -PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS • POWTS INSTALLER POWTS MAINTAINER • Name -1 0.3 2 E.L_50A/ Name Phone 7/S - Z 73 - 1T14YT Phone . SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s4-- ca.04 t,D AJ 1,oG Phone Phone • 7i5•M 4486 • This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT Nof- AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ken S71-ct cyre h Mailing Address PO: go X /✓- /, mow T,Chn9-n2I?d, WI 3-e/O / 7 Property Address /0 41/ /y� ' �v�. .1 /re re, /?i C`'I n'70 n d; {'I/'T .5 4/d/? (Verification required from Planning&Zoning Department for new construction.) e 4 City/State //eW Pith/mini/ h/z' Parcel Identification Number Q.R k - //VS - ,5 O - 000 LEGAL DESCRIPTION Property Location NE 1/4 , SW 1/4 Sec. oZ O , T 30 N R /g W, Town of R/C Li/'h-0 al Subdivision Plat: /leadO WS , Lot# S Certified Survey Map # , Volume Page# Warranty Deed # 731r6. 45---Y (before 2007)Volume , Page# Spec house Dyes5ano Lot lines identifiable❑yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(I)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedro. s A'II i/./2� •►,�.W��,� /2 /23/Zo� `,NATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) 1oOi3oO/6oOTM- " Series 0 The original ZABEL® Disc Dam Filter was patented in 1959. The 12"series filters have been filtering wastewater longer than any filter in the wastewater industry. In 2000 Zabel made the best even better by introducing a complete redesign of the original with more great features and finer levels of filtration. A100-12" Series ,� The A100-12 is the commercial filter chosen by more engineers and installed in m : . _ more localities than any other filter on the market. The reliable performance and tiliv flow rates from 3000-6000 gpd allow this filter to be utilized in almost every iso application. The new ZABEL®Versa-CaseTM is available with built-in reducer and Ork .LIMETto, outlet hub that accepts either 4" or 6" SCH 40 pipe. The A100-12 Series is also popular in many areas for residential use due to its high quality effluent and large ii,i, , capacity. Independent research has shown the A100-12 decreases TSS by 50-90% and CBOD5 by 20-40%. r , ��° I�70 Filtration r Ill",` Available lengths 20", 28"& 36" t�jy g Si' 1 I A300-12T M Series , s] : : it Long heralded as the ultimate grease trap filter, the .e A300-12 provides 1/32" filtration and has been shown to reduce FOG by as much as 50-98%. The A300-12 is also used for onsite wastewater systems which require ;w a finer level of TSS removal, such as Laundromats and dog kennels. As with all ZABEL Filters extra filter cartridges are available to speed service time and allow offsite cleaning of the used cartridge. •r la 132"Filtration My. Available lengths 20", 28"& 36" + ; A600-12TM Series The newest addition to the ZABEL Filter line incorporates the proven performance of the disc dam design with the finest level of filtration available on the market. The 1/64" filtration of the A600-12 provides optimal filtration levels for those unique applications with very fine particulates and suspended solids. Every A600- ' 12 Series filter includes the exclusive SmartFllter®Alarm switch to alert the owner of required maintenance. 41.16 7/64"Filtration Available lengths 20", 28"& 36" For further technical information: r - . www.zabelzone.com 050103-244 =AI 1111111111111 ' 8194342 STATE BAR OF WISCONSIN FORM 2 - 2000 Tx:4161588 Document Number WARRANTY DEED 988954 BETH PABST THIS DEED, made between David J. Waldroff and Julie A. REGISTER OF DEEDS Waldroff, husband and wife, Grantor, and Kenneth J. ST. CROIX CO., WI Stacken, a single person, Grantee. 11/12/2013 2:07 PM Grantor for a valuable consideration, conveys and warrants to EXEMPT#: NA Grantee the following described real estate in St. Croix County, REC FEE: 30.00 Wisconsin: TRANS FEE: 119.10 PAGES: 3 SEE EXHIBIT "A"ATTACHED HERETO AND MADE A PART HEREOF Recording Area Name and Retur Address: 3 .i- 41I I63 400 o ,u' on' Str et, atiit0'Y5 H d •MR, 4► 6 g • La1-,d 'Trf-1-e. /in C' 2200'w.• Co c . . d .fl Exceptions to warranties: 026114350000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number(PIN) This is NOT homestead property. Date• this October 31, 2013 AI .4 David J. Waldroff `! le A. Waldroff % WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 1 of 3 Exhibit A 101; Legal Description Lot 5, Plat of Waldroff Meadows in the Town of New Richmond, St. Croix County, Wisconsin. WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 3 of 3 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF (Ai/S con 5(r COUNTY OF S—CjC authenticated this October 31, 2013 Personally Personally came before me this l the above David J. Waldroff and Julie A. Waldroff, TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife to me known to be the person or (If not, persons who executed the foregoing instrument and authorized by§706.06, Wis. Stats.) acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY ' Martin D. Henschel A �� 6800 France Avenue South, Suite 410 Cheri Brown Edina, MN 55435 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My commission is permanent. (If not, state the Both are not necessary.) expiration date: 03/01/2015) *Names of persons signing in any capacity must be typed or printed below their signature. s7-A, NOq-r# O pvetC /SC() WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 2of3 i I •hsconsn Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings , .- in accordance with Comm 85, Ms. Adm. Code CixiniY S4 Attadn complete site plan on paper not less than 81/2 x 11 inches in size.Plan must • BYO 1 Y include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. /I percent slope,scale or dimensions,north arrow,and location and distance to nearest road. ,2 -1�V3_ o�U Please print all information. Date Personal information you provide may be used for secondary purposes(Privacy Law,x.15.04(1)(m)). 1 1 y Y61 Property Owner `- Property Location o►ve Li X�IdrCJ='` Govt Lot f.ti 6 1/4 ./J1/4 Szo T N R ( E(or)i& Property Owner's Mailing Ad ress Lot# Block# Subd.Name or CS W 12. / T Aril W►ver �►ct 5 lea 1d,revf-C r earl' s City State Zip Code Phone Number ❑City ❑Village [ .Town Nearest Road 14tiolscn 1031 i51-tat, I (zi5)t9-tdnni kka-m-'ond 1 C-i-y. Rd. A ® New Construction Use:52 Residential/Number of bedrooms 2,-4T Code derived design flow rate 9SC)/C?CO GPD 0 Replacement `'`` `.❑ Public or commercial-Descrloe: Parent material 0O#t JCL S(f\ r 0 Flood Plain elevation if applicable �, 'r✓ - ft. General comments S/S Yh -RA�:J• q6 and recommendations: A_t:--}_ -0 e_4.. qS•Cl? C) 1 >,LCL!VCiJ 1 ..;11 CCUNT`� I Boring# Boring m '2 f� ZONING OIFICE ® Pit Ground surface elev. 77.26 ft. . Depth to limiting factor �7 i$all.APPliCation Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence BoundarKRoots - GPD/ft in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. *Eff#1 *Eff#2 I o—i Z. 11)yr3IZ S;) 2r ibk rncr cs I Y.0 .'S • 8 • 2 12-Z8 Jnyr 4)y si 1 2rmthli mfr -5 — �5 . 8 3 .: ) 10yr4k, ms . Os9 ml -- C. '� 1-2 a 3(a 1Z " a Boring# �❑ Boring R I Pit Ground surface elev.% It Depth to limiting factor I 2C) in. Application Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary. Roots GPD/ft' in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 O-I1 10yr312 5A 2rrrik IT)Cr c5 ' I yr S • S 2 3 11-?9 !Ow 41g Si I 21-nab k rr,Fr c5 -- . 5' . g 23-10I _ w 1 yr4to ms bs5 mI -- •7 / Z *Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mgIL and TSS<30 mg/L CST � jName(Please Print) • fr Z5 3o9 ni l�y ►J(Pr Address Date Evaluation Conducted Telephone Number 2113 gn. 3€ ,fir +, u » 61-102, -- 6 -z0-c ll5)ZLi 1-u03g Property Owner. Parcel ID# Page 2 of 3 3 Boring ❑ g 210_# mi.Pit Ground surfaceeiev. ft Depth to finning factor log in. I Apprication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJW in. Munselt Qu.Sz. Cont Color Gr.Sz.Sh. *MI *EM 1 o-16- 101(3I2 Si) Zillah); S cs t4 • `J . 8 2 15'-33 t o y1y Iy — 511 2r'rc b k m?r cS . 6— • 8 3 wog Oyr4ib rns ts.3 , nr,( - . 7 42 �j # ❑ mss 1 Q 1 Pit Ground surface elev. 9 ft Depth to limiting factor 1, 1 in- , Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu.Sz. Cont.Color Gr.Sz Sh. *Eff#t *Efi#2 1 0-12 /0 yr31 5;! 2n.la4k in4- e5 /v4' , S _g 2 1Z-32 10 f41y S11 2malak _rra r c5 .S .B 3 32-119 (0 yr 4ho ms _e5s.5 net I • Boring# ❑ 99. to limiting factor /2-I in. Soil Application Rate 5 ® Pit Ground surface elev. 77 w..� ft. Depth g Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *E *Effrl2 I 6-141 101r312 Si I 2.rryxhi m-Fr C5 1vC . . 5 •1 , 2 /y. 3 t&yr 414 511 & milk m-Fr cS _ -5' - g , 3 33-121 lt)yrylto nas dsrj mt - -7 1. 2 *Effluent#1=BOD,>30<220 mgIL and TSS>30<150 mglL *Effluent#2=BO;<30 mg/L and TSS<30 mgll service provider and employer. If ou need assistance to access services or Commerce is an equal opportunity pro Y The Department of Com eq ppo ty need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. s8D4330(R.07/00) � a • PAGE 3 OF 3 NAME (NQ/d/ro.+c LOT#tc LEGAL DESCRIPTIOIWJE '/4S41/4,SZOT3QN,R!$E(or) SCALE: 1"----- (o 01 BM 1 ELEVATION /00 .0 BM 1 DESCRIPTION+ 64; JZ Q.�Ocif BM 2 ELEVATION (VI. Z Z. Z BM 2 DESCRIPTION3oP 4 i " eo Pp.r p;pc SYSTEM ELEVATION 16.4 v K SCo g ALTERNATE ELEVATION CONTOUR ELEVATION Q lf•5o ?q. S'C Ac o SkaPe ‘4P r.e tit 5,. ro* A. 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