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020-1016-06-000
Wiscon>in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569514 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: Cievering Homes LLC, aka Clevering Pro ertie Hudson, Town of 020-1016-06-000 CST BM Elev: Insp.BM Elev: BM Description: 11 Section/Town/Range/Map No: nb 6.5 1 �� ` 12.29.19.71F10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,r CAPACITY STATION BS HI FS ELEV. Septic . / Benchmark tJ G rl 3' Q 60 Z . '--p OZ. • �6 Alt. BM /. e 7 ..7 `7 T.C r,--t eCU. r-'� I F-��1.. Y' J r Aeration Bldg. Sewer 4' ..7 '75 .1 Holding St/Ht Inlet -7 -7 q Y. TANK SETBACK INFORMATION St/Ht Outlet S.6 -7,{. C.o TANK TO P/ WELL BLDG. Vent to 'r Intake ROAD Dt Inlet /gyp A S 64 Septic /J A— Z/ �� � Dt Bottom 57 Dosing Header/Man. 9►3 9?• Z Aeration Dist. Pipe o /.Sp I L. 3 C/.D Holding Bot.System W PUMP/SIPHON INFORMATION Final Grade A- 1- 6r•5 JMF 97. 1 Manufacturer GPM St Cover 1 / J 3 - 7 Model Nu er — J.�-�- c.. / /6,4 9z. Z TDH Li Friction Loss System Head TDH Ft 4k 1 <76. co Forcemain Length Dia. Dist.to Well � /3. 3 X7. 3 SOIL ABSORPTION SYSTEM lam (v4 BEDITRENCH Width Lengthl �Z INo.0f Trenches PIT DIMENSIONS No.Of Pits Inside Dia, Liquid Depth DIMENSIONS 3 S$ ? 71-1r, � �` �_SETBACK SYSTE✓M TO V P/L \J BLD G WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR L�✓t�� �f w Type Of Sys tem (� 3IQ UNIT Model�Jumber: /Q CenJC � d I� /V �J C� 0 DISTRIBUTION SYSTEM c 'eo_� d-/s '0�-- Header/Manifold Distribution x Hole Size Ix Hole Spacing IVent to Air Intake 74' � Length ` ing `^ __ �e S�— Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth TSeeded/Sodded jxx M ched Bed/Trench Center 5 Bed/Trench Edges Topsoil � ❑ i Yes No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 1020 Moonbeam d. udson,WI 54016(SW 1/4 SE 1/4 12 T29N R1 9W) NA Lot 6 Parcel No: 12.29.19.71 F10 1.)Alt BM Description 2.)Bldg sewer length= Zy t1oa �u__J1A j'�� -amount of cover= 7 44Z /1 6 (�n T l ��•ft" { a�-- r Plan revision Required? Yes No Use other side for additional information. __ SBD-6710(R.3/97) Date Insepctor's ignatur Cert.No. Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 12 /T 29 /R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 6/26/14 DATE BEDROOM 3 CONVENTIONAL XXX IN-GR r' PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 916 # of chambers 45 , BENCHMARK V.R.P. Top Of wood post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.8/91.8/90.8 6' below qrade Moonbeam AL All piping shall be SDR 30/34,within 10' of tank, piping shall be Schedule 40. Scale is 1" = 40' unless otherwise noted 3-3' X 62' cells with>3' spacing 175' 30' B-3 ST 10' 15' Pro 3 Bedroom 60' House 98' Vents 96' B-2 B.M.* 0' IF 94,B- 12% Slope 85' Old Fence and marked by surveyor Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area Property Line 5.6ft^2/pair of end caps ov 4, Long 12„ 34” Grade at System Elevation G� Safety and Buildings Division ""Y64` J 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(m be fiIIed is try Co-) Madison,WI 53707-7162 nly COUNTY State Transacxion Number n vN� ai Permit A i In accordancx SPS 38321(2),Wis.Adm.Code,submission of this govemmeuta(unit is required prior to obtaining a sanitary permit Nate:Application farms for state-owned POWTS am submitted m Project Address(If different than mailing address) the Department of Safely and Professional Servies. Personal information you provide may be used for secondary (�Z sm in accordance with the Law s.15. 1 m Stat4 L Application Information—Please Print All In tioe Parcel property Owners Name 3 Q 0 cLepv e P ;r,, 1p y� Property Owner's Mailing Addres ^ Property L ocaaion '71 �i V Iq lb�J �Q l✓LO/I Govt.Lot 1/. City,State Zip Code Phone Numbs �5,J_ %,�_'/a, Section e —L T N; R or W Lot# II.Type of Building(cheek sU that app)y) Subdivision Name 2 Family Dwelling—Number of Bdn 6 G P1 % A Block# ❑PublicJCommercial—Describe Use ❑City of CSM Number ❑Village of -- ❑State Owned—Describe Use of III.Type of Permit: (Check only one bo ou line A. Complete line B if applicable) A Syy= ❑Replacement System ❑Trearmenr/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal -t Revision ❑Change of Plumber ❑Pemut Transfer to New List Previous Permit Number and Date Issued Before Expiration --. Owns ti r IV. of POW'I'S S atem/Com nent%evice: Check all that a 1 - ln-Ground ❑Pressurized in-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in of suitable soil$ ❑Holding Tank ❑Otber Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis rsal/Trea at Area Information: S ovation tgn Flow(gpd) Design Soil Application Dispersal Area Rcquir (sf) Dis Area (sf j Ystam Carty in Total #of Manu B VL Tank Info Gallons Gallons Units „ New Tanlca E>ustia8 Tanks 41) 11 �j ( �' $ w w U v� a vt li C7 a sepae or Holding Task x Dosing Cbamba VII.Responsibility Statement-1,the anderaigaed, a responsibility for installation of the POWTS sbown on the attached plans. Plumber's Name(print) Plum Signattm MP/MPRS Number I Business Phone Number 74r -V`6 Plumber's Address(Street,CAY,State,Zip Code) v- 17-0 . our /De ant Use 0 IL It Permit Fee Date Issued Issuing t Signature ed l en for Denial S S5- 0) 36 i� DL Cord as for Disapproval t �-p (� C Z2� In CA..-) NOW tank,effluient fifer and 3) �► dispersal cell must all be servtces I in Lit as pt r management plan provided by plumber. 2 inUst beAsintaifted 3A►l c, j I/lo tK2 a thcD to complete plena for the sputum and sabmk m County only M paper Not lees tl,aa a w z II inches in else SBD-6398(R.11/11) �`b 6r6- ,,, ex 4, '�5 ,Q Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW '1/4 SE 1/4S 12 /T 29 /R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 6/26/14 BEDROOM 3 CONVENTIONAL )00( IN-GR PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 916 # of chambers 45 BENCHMARK V.R.P. Top of wood post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.8/91.8/90.8 6' below qrade Moonbeam All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Scale is 1" = 40' unless otherwise noted 3-3' X 62' cells with>3' spacing 175' 30' B-3 10' 15' ST Pro 3 Bedroom 60' House 98' Vents 96' B-2 B.M.* 0' 94'B-1 12% Slope 85 Old Fence and marked by surveyor Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area Property Line 5.6ft^2/pair of end caps 4' Long 12" 3491 Grade at System Elevation Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.hft^2 pair of end plates To be >1' above grade 1�-- Finish grade evation Typical Installation Grade Vent 4" 3' ��30/34 Septic Tank ,jV.ent 5' S' Long 1 Grade at System Elevation 3 6 Grade at System Elevation Spacing 5' 3 �Z 3' MNA ' Cells Same on other end Observation tubeNent At end of cell A chambers pe B System elevations: L B M.' I I �e6 �D -6 r✓<�ty�i� , .� PAID Wisconsin Department of Com 2� ���� �AOIL EVALUATION REPORT Page of Division of Safety and Buildings Y GQ 'yo Gip\ i%_ak rdance with Comm 85,Wis. Adm. Code County Attach complete site plan on��t less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:�� and horizontal reference point(BM),direction and parcel I.D. percent slope,scale or d IYn'sions,north arrow,and location and distance to nearest road. a. -Ind_ Please print all information. R by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location Q f r Govt.Lot.50 1145 1!4 S/j T N R E(or) Property Owners Mailing Addret4 # I S9 Name or CSM# C e r R' °- City State Zip Code Phone Number ❑City Villa a Town Nearest Road N 2� �► S 01 7 ( ) A-billaw Construction Use: Residential I Number of bedrooms Code derived design flow rate Jv GPD ❑Replacement ❑ Public r commercial-Describe: --- Parent material Flood Plain elevation if applicable General comments 6 '60 I..,> and recorturlerxiations: � �y n/ J ;0j C� System Type 0 System Elevation%:( '73/ �� Boring# ❑ Boring pit Ground surface elev. •� ft. Depth to limiting factor y in. Soil Application 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 _1L f-M z �s Z- , -t- 60-13 to 0 s � PIN Boring# t❑ Boring -f 4t. a 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/fg in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 —1 Effluent#1=BOD >30<220 mg/L and TSS>30:E 150 mg/L uent#2=BOD 130 mg/L and TSS<30 mg/L CST Nwm(Please PMQ Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Condu pted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 � �— 715-246-4516 r Property Owner_ Parcel ID# Page of 1-31 Boring# [)fg Boring Pit Ground surface elev.9�, g ft. Depth to limiting factor V in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 �s • a 2 s s (c- a Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. –go—ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mgA- 'Effluent#2=BOD,<30 mgA-and TSS<30 mg1L 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(8.6100) of of abed S l'IOA z N 2 n _ O O °� a U Li ° `�!y S2 W UJ uj 4 n r' ; J ` x N RTH 156. ° �1; \ °j 156.74' 30 �i �jwy . . . . . . . . . �� \ • O ON f�+ 4'. `� o cc CU c< cgcq cis W CL G� / + L N I S00°064TE 483.12' + cc D A fA Lu C9 m" s z ® x to Lu Q+ 4¢ ��Z¢ °DiaiN 6L_SEl3.lSESS $wz�rito WO m H O ON u0i o vOi IA pm: U ..,�w � � Fd � w� w r �; x� i C3 44 7 - t /�� +, C. LL WE>- NOr coN '� 23.9's v e LLJ F—U W U(L(4 of A N w r O W A o ? °°" w► as 1 °OV 1A o LO Ln Z IOOZ 9 Z 93-4 II Lw o M. .� HV38 Ol �'- a3Wf1SSV'Zl N011.03S 304/L3S 3H1303Nn Z H.LnOS 3Hl 01 a3ON3H333U 3HV SE)NI>1b3E Z l0/9Z/ZO O3SiA3W LOOZ/6W l0 31VO 841-00'ON so 3NVN WVI1llM :Ae 431_�VHO IN3vinulSNI SIHI Yl / i County/ Industry Services Division (� j 1400 E Washington Av Sanitary Permit Number(to be filled in by Co.) P.O.Box 7162 �'a► Madison,WI 53707-7162 1 /\ 10 f . i Lary Permit Application q Pd/ Sta saction Nu ber In accordance witA§�S 3.21(2),W is.Adm.Code,submission of this form to the Avs, .. mental W6 is required prior to obtaining a sanitary permit. Nofe:Application forms for state-own ed to Project Address(if event than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be u r purposes in accordance with the Law,s. 15.04(1 m),Stats. V 7/ I. A lication-information-Please Print All Information D M00 & Property Owner's Name Pa # ve, n Duo 6 - Property Owner's i Address Property Location 3 Cler i1. x Govt.Lot City,State Zip Code Phone Number /. Section N�l�,) t-, - �j _ le I Type of Building(check all that apply) Lot# R._R or W or2Fa '1y Dwelling-Number 'f Bedrooms < Su ivi 'on Name ��"" A� ,tv ��[- 4-- d Block# 6f/Y✓I tJ./r/y( r"t ❑Public/Commercial-DescribekJse ❑City of ❑State Owned-Describe Use CSM Number (� ❑Village of `Vvf. I L_/ I wn of III.Type of Permit: (Check only one box on line A. Complete line B i a licable) A. w System Replacement System Treatment/Holding Tank Replace t ❑Other Modification to Existing System(explain) 10 B. ❑Permit Renewal ❑Permit Revision ❑ an of Plumber MI P nsfer to New List Previous Permit Number and Date Issued Before Expiration er IV,Type ofPOWTS'S stem/Com onent/Device:. Ch all slat a -Pressurized In-GroAd ❑ Pressurized In-Ground, e d>24 i/n,.¢of�sui�table soil ❑ ound< 4 fi.of uitablpgspril ❑ Holding Tank ❑Other Dispersal Component(explain ' o l`�PFeTreatmenlvice ea am) +CQiY�'•O `-u V.Dis ersaareatment Area Information: Design Flow(gpd) Design Soil Applicatio (gpdsf) Dispersal Required(sf) Dis r Proposed(sf) b"o m Elevati s' Vi.Tank Info. Capbeify in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks �( �yt ✓ Qty v�f! U n U Septic or Holding Tank Dosing Chamber VII.Responsibility Statement-I,the undersigned,assu ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumbe' gnature MP/MPRS Number Business Phone Number zo �=ys Plumber's Address(Street,City, t ;Zip Code) n 7. Z c II, oun /De artment Use Onl pproved 11 Disapproved Permit Fee Date sued wing Ageni ❑Owner Given Reason for Denial $ 75 °2 2 Z /y IX,Conditions of Approval/Reasons for Disapproval �� �� /� SYSTEM OWNER: SGZU `(JLXiGt� �tT :°) tl > 1.Septic tank,effluent filter and . t h WAbA Mvvrt dispersal cell must be serviced/maintained_ N d( �j Ja" _ _i40 as per management plan provided by plumber. lets lens-for'ffi'iy-s subi-nittodgUoun only on paper not Its n g tlx x 11 inches 17n:eMw as per applicable Zf- SBD-6398(R0313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/22/14 Owner: Oevering Homes Location: SW 1/4 SE1/4 S12 T29 N,R19W 1020 Moonbeam Rd Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8-10. Soil Test 1 Signature. License�mber#226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 12 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 2/22/14 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1130 # of chambers 56 , BENCHMARK V.R.P. Base of power box ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 99.0/98.0 4' below qrade of tank,piping shall be Schedule 40. Moonbeam Rd House is to be located >300' from Pro 3 Bedroom House navigatable water. Soil test is to be 30 Scale is 1" = 40' verified prior to unless otherwise installation.A more S accurate drawing noted will be provided. No scale was 150' B-2 provided on soil test! 103' Vents 2-3' X 116' cells with>3' spacing B-3 101' Property Line 99' 15% Slope B-1 105' B.M.* 144' 63' Property Line 30' im Property Line 160' 110' 55' ' - Wr [Cil e, A-KI J e s Souk KACS-- Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent _/ Typical Installation � 103' Grade Vent 3' 4" A�30/34 Septic Tank 3 5' Long 1 5' S' Long 159 3699 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X114 ' Cells Same on other end Observation tubeNent At end of cell A 28 chambers per cell B System elevations: A_99.0' B 98.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS IICATIONS Owner n� f�n Septic Tank Capacity _ _ gal ❑NA -Permit# t 9 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer _ �! ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model —— NA Number of Public Facility Units AUNA Pump Tank Capacity al NA Estimated flow(average) gal/clay Pump Tank Manufacturer NA Design flow(peak),(Estimated x 1.5) �J� aUda Pump Manufacturer Soil Application Raise 4 aUda /ftz Pump Model NA Standard Influent/Effluent Quality Monthly average" Pretreatmont Unit NA Fats,Oil&Grease (FOG) :530 mg/L ❑Sand/Gravel Filter Q Peat Filter Biochemical Oxygen Demand (BODs) 5220 rng/L O NA ❑Mecharical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 tg/L ❑Disinfection ❑Other: Pretreated Effluent Quality Monthly average Dispersal t3ell(s) ❑ NA Biochemical Oxygen Remand (BODr,) <_30 mg/L -Ground(gravity) ❑ In-Ground(pressurized) Total Suspended Solids (TSS) :530 mg/L ❑At-Grade ❑ Mound Fecal Coliform(geometric mean) 5104 cfu/100ml ❑Drip-Line — ❑Other: Maximum Effluent Particle Size )b in dia, ❑NA other: ❑ NA Other: — --- NA Other. -- ❑ NA *Values typical for domestic wastewater and septic tank effluent. ❑NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks) At least once every: ❑earls s) (Maximum 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one-third(k3)of tank volume ❑ NA �" -- - -- — manth�s) Inspect dispersal cell(s) At least once every: (Maximum 3 years) ❑ NA _ _ ear(s,' _- // ths s) Clean effluent filter At least once every: < mon n s NA Inspect pump, pump controls&alarm At least once once eve_ry: _ . Li month(s) NA ❑year(si — _ __ Flush laterals and pressure test At least once every: ❑monthi s) NA _ _ ❑year(s, _- Other: T At least once every: — ❑monthl s)— NA 13 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 ServifAng Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cr=acks or leaks,measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground wirface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chest:for any ponding of effluent on the ground surface. The ponding 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 or more of tl ie 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 the servicing of effluent filters, mecharical or pressurized components, pretreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWT3 Maintainer. A service report shall be provided to the local regulatory authority within 10 days of cc mpletion of an!:,service event. Page of START UP AND OPERATION For new construction, prior to use of the POW1'S'check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or darrage the dispersal cell(s). If high concentrations are detected have the contents 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 ab3ve normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose, overloading the cell(s)and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of thin pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the Frump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal eels, Do not drive or park over, or otherwise disturb or compact,the area 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; condoins; 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 watt+r 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 chaptor Comm 133,33,Wisconsin Administrative Code: e 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. 0 After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filed with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: uitable 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. ❑ 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. ❑ 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. If no replacement area is available a holding tank may be Installed as a last resort to replace the failed POVIWFS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such sysbims must comply with the rules in effect at that time. «WARNING>a 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 7 ,LLB Name / Phone J Phone SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORI Name �� Name r / ` Phone �� Phone � ^r Y_w__ .0jZ2 "r This document was drafted in compliance with chapter,','PS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wlscaisin Administrative Code. a F II T CARTRIDGE INSTR 0flg nr Installation STEP i Dry fit the filter case onto the end of the outlet pipe to ensure it is x centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. " STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. r # STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter 7 $> cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 1 .> ` 4. Once the effluent level has been lowered below the invert of the outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. A a& 6. If a VRS switch connected to an alarm is present, the switch x � ' should be removed by turning counterclockwise 900 and cleaned t with water only. Z' 7. While holding the cartridge on its side (large flat surface facing , cep down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. �JI S. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until = # , the filter locks into the bottom of the case. ` 10.Replace and secure the access opening on the tank. BEAR ONSITETM FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITET Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment. Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. ^'c t ST.CROlX COUNTY SEPnC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bayer Mailing Address l l Property Address IOZ v (Verification required from Planning&Zoning Departmant for new co shuWon.j City/State Parcel Identification Number�o2y _EGAL DESrluiwrtON Property LocationS4.- / Z- T .�N YL/—W,Town ofZ4 Subdivision Certffied Survey Map.# (0 _ 'Volume � � ,Page# Warranty Deed# Volume ,page# Spec house yes no Lot lines identifrab yes no SYS�'TM rizAIlVTENd-"-AND OWN�g��CATioly >mProper use and maintenance of your septic system could result in its maintenance consists of pumping out the septic tank every Premature failure to handle wastes. r the system can affect the fur�tion of the septic fauk a treatments or sooner,if needed,by a licensed pumper•. What you put into re4*""I lities are specified in§CouuA.83.52(1)and ian Chapter t22-gt GYo xxwaste disposal system, Ogmer ramie County Sarriiary Ordinance. T�PrOPenY owner agrees to submit to St,Croix County plug&Zoning ownerand waste a master Plumber. Plum,restricted Plumber or a licensed Department a certification) four,signed b the sposal system i$in r y Jew than 1/3 full of sludge, P ° condition and/or(2)after inspection and Pumprneig t gneeeat(sary) the septic tank is standards set fob undersigned have read the above requirements and agree to maintain t1,e forth,herein,as set by the Department of em me and agree D prime sewage disposal system with the Certification stating that your septic system has been q'�m of Natural Resources,Stage of Wisconsin. Zaniog Department within 30 days of the three year expiration t be completed and returned to the Croix.County planning& Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the Property described above,by virtue of a warranty deed recorded in owner(s)of the Register of Deeds Office. Number of bedrooms IGNA F APPLICANTS) ° k?0?1 DA *"`*Any information that is misrepresented may r esult in the sanitary permit being revoked by the Planning&Zoning Department *** IncWe with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cer ifiied survey map if reference is made in the warranty deed. (REV,offs) I IIII STATE BAR OF WISCONSIN FORM 1 —1998 II II�IIIIIIII7IIIIII��I�IIIII�� WARRANTY DEED 8 Tx84149945 3 985640 Document Number BETH PABST This Deed, made between Jerome Weiskopf. married Grantor, REGISTER OF DEEDS and Oeverina Homes.LLC. a Wisconsin limited liability ST. CROIX CO., WI company Grantee. 09/09/2013 4:38 PM Grantor, for a valuable consideration conveys to Grantee the following EXEMPT*: NA described real estate in St. Croix County State of REC FEE: 30.00 Wisconsin (the"Property"): TRANS FEE: 174.00 PAGES: 2 j i t Recording Area Name and Return Address i I I SC A- 020-1016-06-000 Parcel Identification Number(PIN) This homestead property. (is) is not) SEE ATTACHED LEGAL. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this day of L4 2013. (SEAL) (SEAL) n i ero a Weiskopf (SEAL) i (SEAL) 1 AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, i } as. St. Croix County authenticated this day of Per,s onally came before me this �Z day of c Jf/Il v 1,2013 the above named Jero Weiskopf married to me known to be the ec n who executed the foregoing instrument TITLE: MEMBER STATE BAR OF WISCONSIN an a led a the e. (If not, authorized by§706.06,Wis. Stats) i THIS INSTRUMENT WAS DRAFTED BY Notary Public,State of Wisconsin Burnet Title-Scott Tranby 1 1 5151 Edina Industrial.Blvd, #500 My commission is permanent.; (If not, state expiration date Edina, MN 55439 ) 13-11899 (Signatures may be authenticated or acknowledged. Both are not necessary.) LINDA KRAEMER 'Names of persons signing in any capacity must be typed or printed below their si t TARY PUBLIC We OF WIS ONSIp WISCONSIN Wisconsin Legal Blank Co Inc. STATE BAR OF W 9 WARRANTY DEED FORM No. 1 —1998 Milwaukee,Wis. 1 of 2 EXHIBIT A Lot 6 of Certified Survey Map filed February 28, 2001 , in Vol. 15 of C.S.M, pg, 4040, as Doc. No. 639453 located in part of the SW'/ of the SE'/ of Section 12, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin; also being a part of Lot 4 of C.S.M. filed in Vol. 5, pg. 1417. 2 of 2 Wisconsin Department of commerce SOIL EVALUATION REPORT rn Page—L of•3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must dZ _/�// include,but not limited to:vertical and horizontal reference point(BM�ni�ttii nearest road. Parcel I.D. t� 100 percent slope,scale or dimensions,north arrow,an Date ' ? Re ewed b Please print all ' n. ' . s(Privacy t.aw;'s.15.04(1)(m))• lf Personal information you provide-ape used f se dary purpo ( Y Property Owner j CEIV Property Location Go, Lot S(.� 1/4 S�, 1/4 S IZ T Z. N R l y 'E'(eF)W Block# Subd.Name or CSM# Property Owner's Mailing Add ss f ( 4 2001 ' mr� n d22 (�0011 ell M e NL4)O yTY city ❑Village. .Nrrown Nearest Road City State Zip Cod OI L �� -.,;?0l+iA0FipIGE ti cQ s v Moon eck I`'\ ' Code derived design flow rate S U GPD New Construction Use: Residential/Num 6f ❑Replacement ❑ Public or comm rcial-De cn e ft Parent material C.0 0 G ood Plain elevation if applicable / I General comments e 4 � `0 M c.Q, No and recommendations: :�I A QS Q Boring 4/ Fl Boring# Pit Ground Ground surface elev. S 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. __rr 6-1f7 Iv rq4' hC� 51!1 �.Mg>,W, Ivt('- C-u) Z - -7-51P-6/c- h C- t I �,r sS t( 3 -5 -5V r 6 n ti � l \M sb►� M�1 . `� 0 Boring# Boring 2- pit Ground surface elev. —ft• Depth to limiting factor 9 G in• mil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots +E GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. s f r Ct� Z I ()-a 10 y1 ,s _ •Effluent =BOD <30 mg/L and TSS<30 mglL Effluent#1=BOO >30<220 mglL and TSS>30<150 mglL CST Number - r 7 CST Name(Please Print) Signature( . (n 0 Pik S ` O � Tele hone Number Address Date Evaluation Conducted P 1432 r Property Owner Parcel ID# Page Z of 3 ❑ Boring# ❑ Boring ❑ pit Ground surface elev. 101 GS ft. Depth to limiting factor in. Soil ication 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 4-12 to ,,r (, h SI ->msbL- tMFr C,_j Z� ►2-33 �,S �S n4 SI l! thr QQJ 1 Z 3' ,S v r Y +. r\P, C 1 M S k D) t V �Gr) c s eA,— vtP�tt F-1 Boring# ❑ Boring ❑ 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 F-1 Boring# Boring ❑ 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mgA- •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-6330(R6,00) L o+ S w SV/q SR I c 12 T 25 N R 19 0 eN a�Qk`�� Yrlaan6eG�t 12�' 102 bl ; g 3� 0� Awwiz bQ--x oleo DO eO(Lvvk& t1Qj 100,03 a1 g5 .711 �� lbl - Vs Parcel #: 020-1016-06-000 01/12/2005 10:01 PAGE 1 OF F 1 1 Alt.Parcel#: 12.29.19.71 F-10 020-TOWN OF HUDSON Current OX ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): `=Current Owner WEISKOPF,TIMOTHY J TIMOTHY J WEISKOPF 1623 NAMEKAGON ST 35 HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description * 1020 MOON BEAM RD SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 2.254 Plat: 1223-CSM 15/4040 020/01 SEC 12 T29N R19W PT SW SE BEING PT CSM Block/Condo Bldg: LOT 6 5/1417 LOT 4&NKA CSM 15/4040 LOT 6 2.254AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-19W SW SE Notes: Parcel History: Date Doc# Vol/Page Type 03/29/2001 641573 1609/430 WD 03/29/2001 641572 1609/429 QC 01/07/2000 616680 1482/549 QC 07/23/1997 1112/130 WD more... 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 47687 70,600 Valuations: Last Changed: 04/26/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.254 54,600 0 54,600 NO Totals for 2004: General Property 2.254 54,600 0 54,600 Woodland 0.000 0 0 Totals for 2003: General Property 2.254 54,600 0 54,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 MAY 3 2001 THIS INSTR FF£ ,M KANE JOB NO.00-148 DATE:01/09/2001 REVISED 02/26/01 W O 0 Z m TA mp O 7° O s BEARINGS ARE REFERENCED TO THE SOUTH v s ro LINE OF THE SE1/4 OF SECTION 12,ASSUMED m Z TO BEARS "W O fTl m II FILED a c I FEB 2 8 2001 ► ° Z to d 30 3 O SRCrocco,Yl � 0-ri 0 m O C 0 0111 c y �oX ti � ile p� sr z Cyr C o N So !�_ I m. mom: H I� 3: CO EL z u, - CZ�� o z D H — 0 -0 m� (coo N. X, m rri m Om I � �b g� n - \ fri \ m -m_HM n I� w j 5i�i0� ° _� £•P I w I NyC3 w s z n I X p M 7D D y 6 n N05°53'51"E 235,79' -r1 -On VJ S mm K i� _ cn�ZCn� N� IQiP Z m D —1 3 i cc i� i� Vl=-71 `� �� 0 IQ i m m F0 mz �g �I� mZm/V w j caZ �A �0 c �O m �° I� r• H p N &)m I I m v c`8P X 1 0 m _ � 0 I�° I� 14 r m� W ig N Or m a 8 i�io vy\I m s i W S 0 ODD I id ig m y 5 W p I m to� ;m i r1 ZVC94 3£4-90.00S Z y ca �r w Q� m m A DO� I� m .�z m j c°n I o w Ica) ;0 J /' N p c tU cn C3 P \ X T : 0 0 . . . . . . . . . • . y� � ,o� I �� ,rod }�� o 11c an f one t '0000 0, -a v' O O O r 69'W RI HldON ��a i 0 `� z o _ c me rn _ _ —_ — I d I�1 t, m co Tu :mu c A K p Z I �Q o�o o _ I 0 c" T z c z I � u 4 n vN D 0 m n , w x o z g -G ; Sm 0 m ?� 00 ' 00 z� D , C ', i i �•o ry O oo � "� z `1 0, c, a ' 0 m m G) c: z M O z z m m n V .._. i 0) 33 +nOj nn cry o TI 0 O C.0 z roZ ' ;0 Nam Vol.15 Page 4040 �1L ED MAY 81984 w CERTIFIED SURVEY MAP `°°" Located in the SE 1/4 of the SE 1/4 and in the SW 1/4 of the SE 1/4 of Section 12, T29N, R-19W, Town of Hudson, St. Croix County, Wisconsin Surveyed for: B. & H. Excavating APPROVED 836 St. Croix St. No. Hudson, Wi. MAY 0 81984 N >:s y S1. '20JX GOUNtY 061,.� ��,�}dflNflNSIVE PARKS PLkNMG m m a AND ZONING COMhanO m>W Ns2o M i Ce w mz[M e%:jr%. �� °i 00 UNPLATTED kANDS D o m y 0 pp 'A O .. m m •.,'•• .�r mz C. v my Iz m 145,961 SQ.FT. , •� z m � 3.351 ACRES 3p •pb q O m t I o ✓�^ 0 R'�2 o,0 0 O I r ;?o IP m o ` '2 ?F�ry m �./ ^ 1059 884 SQ.FT. 0-4 � N 88°32'39"W 4, ?ry 2.431 ACRES , -' I ? i m 00�Jo 343.301 2 V z z Y SO 0 32' "E - loll • aF. �(�6 6 A (1%M 320.66 \ 2 W 0� k6 4 .Off` 's O -4 . Q 159°17'4t' W a• b� Ic N 8S°32'40"W \ p p2 b pg° Q?' ��I P' jr /S 367.68' _ S D 3 116 437 SOFT Z Q�. �p?�F,iy9 211.6mACRES (p `P ys p I O o•/,1 A J F?O 1 F,4y l� t)6 FENCE l 00, r� 66' roadway easeme 3 690 57'16"E , by �TX W.� • ()EAST �(� N J�;eo C.e_rtified Survey Mai_ 156°25'53' �, V_ol_._1 ,Page 174 - 507,028 SQ.FT. 11.640 C S wx (� INCLUDING PRIVATE ROADWAY �t V" EASEMENT 6, "Of-WAYLINE HE RLY R16MTbp A� NORT t4 e 0 vZ0 '�0/&-07-0oa i o (0, _ POINT OF BEGINNING 1071.32' S 89056'43"E L __- $1/4 CORNER SECTION 12 S.E.CORNER _OCATIOtl FROM TIES-CORNER � / �0�� � ��// i � SECTION r'ALLS IN LAKE 7r i � NOTE, THIS MAP IS INTENDED TO REVISE AND REPLACE r t THAT CERTIFIED SURVEY MAP RECORDED IN VOLUME 5,PAGE 1388. SCALE IN FEET 1"=200' *4*0 200 IQO 0 200 400 LEGEND • I"IRON PIPE FOUND t SECTION CORNER MONUMENT,'SERNTSEN CAP NOTE:THIS MONUMENT NOT " a SET DUE TO ITS FALLING LINEAL ROFOOTISET PIPE WEIGHING 1.68 LOS./ IN THE ROADWAY (R) SLANT DATA INDICATES PREVIOUSLY RECORDED ip Sol INFORMATION ao Q9 s 3/4"STEEL BAR FOUND ��' 46.72 15,11E 50 log. cll,�..� EXISTING BUILDING 3 p9„ N61 32 � o A . 5 Page 1417 .. _._. AM af%a 0 o I © S IIIIIIII �` � IIIIIIII HH9f _ � illlllllill��llli IIVIIII s _=;.s,�_ � IIII IIi911111111111 N tI 71 11 oll t INN thill Ems IBM IIIIIIIIIIIIIIIIIIIIIIIIIIIG C d IIIIIIIIIIIIIIIIIIIIIIIIIIIG ITY Y.0 i•P i•P 9# 1 i . �. P1 IIIYYY 1 Y�IllnocslNO � ��YAw �jyjy X I � e -�-MIlm1WLLYlC --- , 1 • • ; ° I i�Nlii1�MNMIHf �� � ; __j x e1 • 9 • pq L6 . � Y.�YP f.Y 1'. • E Y ; q ' • 1 ° � 1 � Y • 1 i I , I i g y� Pa.Y 2 O M21 Plfi[ Mill 'sill CO 9 Z N og R x�e 8 r�s 'r•r �� I I Y.W I ? — AiR NxMl�a 4 I j I . I I 4yQy II 1 � �I 1 T- 1 I I _—_—_ rnlW r•r � � r I r -1 r l I I 1 , I I - -_ I a•v _____J J,_ 17 1 l�1 r I 1 -- r 1 J I I •.1 ---- 9 j j ��57 1�� �� � 1 R j1 _ _}I�• ' �;R Z�Y 11 1 I IG @! ti a I 1 I I 1 I 11 I Mw ----- --- --- -- ------- - ------------ I �lowVL1Nlw i I I I '1 ;� aaI ' ■ 8 R j I �•,I S i ���� f a I 1 ! I 888 ______________________ ________________________ 1 �ai � Eat le 1, trilq Iffill ill ill mill 1 86 slie go 4 �� Property Owner M 0 n Parcel ID# Page Z of 3 Boring# ❑ Boring 1 ❑ pit Ground surface elev.J o 1 GS ft. Depth to limiting factor in. Soil Application 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 4-12 1 Ir (, t\- S t) 2MSb�" rnpt- C,-i Z� ►2-33 �,S �s c, �4 S r r, !-1 r��r �� 1 32-90 S I 1 M S Ok r�-Pl F—I Boring# F] Boring ❑ 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/ff 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 GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2 Effluent#1 =BOD5>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(8.6/00)