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040-1306-08-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569578 0 GENERAL INFORMATION 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: Johnson, Barbara L. I Troy, Town of 040-1306-08-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: � 6 /q 1 08.28.19.1835 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (� Benchmark rl_cd 2-1 Dosing Alt. BEM ((` Z• Aeration "=K O Bldg.S wer /) r'l St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 9G TANK TO P/L WELL, BLDG. Vent to it Intake ROAD Dt Inlet �o ltk; ( , r5 6�' Septic 33 / /1? y` Dt Bottom Dosing Header/Man. .7 • 1 9s: 3 Aeration Dist.Pipe 7- C 9S . 3 -7,Z. 75 Z_ Holding Bot.System 8• / C/44 3 PUMP/SIPHON INFORMATION Final Grade 3. 1 Manufacturer GPM Demand St Cover , 7, Q 161-7 2 .2 77• -2 Model Numb TDH Lift Friction Loss ad TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 17b Z 1 C SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM LEACHING ManufactureJJ�� INFORMATION CHAMBER OR ., / Type Of System: Q T � UNIT Mo Nu b% C1 DISTRIBUTION SYSTEM a(A, ✓ltt o f S 2 2.4--ZZ Header/Manifold 7 Distribution x Hole Size x Hole Spacing Vent to Air take Len th Dia I Length Dia acin 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 Bedrrrench Center �{.• -7 Bedrrrench Edges Topsoil 1 � Yes 0 No No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 463 Dylan Court Hudson,WI 54016(SW 1/4 NE 1/4 8 T28N R19W) Sunset View Lot 8 / Parcel No: 08.28.19.1835 �1+I-��. Ga,J a.�. /,5 c,le=.. a 1.)Alt BM Description= G e�..`,�..- ! N• 2.)Bldg sewer length= z(o -amount of cover J1,� n �� d✓t c. .J�, Plan revision Required? F*_1 Yes o Use other side for additional information. SBD-6710(R.3/97) Date InsepctoVgnature Cert.No. PLOT PLAN PROJECT Barbara Johnson ADDRESS 97 210th St. New Richmond Wi 54017 SW 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 5/27/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of 1" iron pipe ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 0 l)v SYSTEM ELEVATION 94.8/94.6 5' below qrade All piping shall be SDR 30/34, within 10' , B- of tank,piping shall be Schedule 40. 100' M *. Ven � Property Line to be>5' from (,. 10' property line I r' B-2 �\ Z4 o 3% S e 85' Vent � -3 5 >6„ Quick4 Standard Leaching Chamber of Cover 9 with 20.0 ft2 of Area 25' 5.,gft^2/pair of end caps 100' 4' Long 12" y- Grade at System Elevation 34 ST " Scale is 1" = 40' 25 unless otherwise noted Pro 4 Bedroom house slab on grade 220' Property Line Town Road County lss `� `t��✓ Safety and Buildings Division A— � 201 W.Washington Ave.,P.O.Box 7162 Santry Permit Number(to be filled in by Co.) Madist �37� 2 if 5(,q � 5 7�6 e� ermit Application State TrrmsaeaonNumber In accordance 1 ), s.Adm.Code,submission of this form to the appropriate governmental �/� Wi is required prteie sanitary permit Nate:Application forms for state-owned POWTS are to Project Address(mf different than mailing address) the Departm" Safety and Professional ServieL Personal information you provide may be used for second vmDoses in accordance with the Privacy Law,s.15. I m Stets. 3 D4 L Application Information-Please Print All Information Property Owner' Nam Parcel# f-7 WTV -off�vv Property Owner's Mailing Address Property Locmion /. /f,2 GovL Lot ` J City,Stab Zip Code Phone Number SL / y,,I/,-y., $eCtipn g vet /�l l ! k ones T_ZZ N. ]t� IL Type of Building(check all that apply) # , 1 or 2 Family Dwelling-Number of L Subdivision Nano / �It.. aA •J'�. Block v[/ ,(% � � ) ✓/ ❑PubGdCommercial-Describe Use ❑City of ❑State Owned-Describe Use Q~ f SM Number 11 State of — own of III.Type of Permit: (Check oalk one box on line A. Complete line B if applicable) A ew System ❑Replacement System ❑Treatment/Holdiug Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to Ne w List Previous Permit/Number and Date Issued Before Expiration Owner 1V ofPOW IS S atem/Com nent/Device: Check all that apply) Js Non-Nmstaized ln-Ground ❑Pressurized ln-Ground ❑At-Grade ❑Mound 2:24 m.of suitable it ❑Motmd<24 is of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Prebratrn at Device(explain) V.Dispersal/Treatiiient Area Information: 5 Design Flow(Wd) Design Soil Application Area Require[ Ds' Am Pro sf) Movati n 6e , --, I . � y � VL Tank Info Capacity in Total #of MMU icturer E Gallons Gallons Units ,, L U° $ New Taoka Existing Tanis `✓ ( /(�.` pep j '§ $ °� a CJ y to U.U a sepae or Holding Tank Dig Chamber VII.Responsibility Statement-f,the undersigned,ass ponsibility for installation of the PO shown on the attacbed plans. Plumber's Nwoe(Print) Plum i MP/MPRS/Number Business Phone Number "V I — _�_ - Plumber's Address(Street,City,State,Zip Code) z z sS ouu /De artment Use Only LW A Permit Fee D"Issued Issuin t Si APPrm M en Reason for Den s q�5 5 DL Con ns for Disapproval 7=007tank,effluent tNWe nd „tfowsal cell must all be servIces I mAltainad as per management plan provided by plumber, 2.,s ,Ms* ck *Mft must W�maintatlF»d is per code 1 adirtaa�. Attach to eomoft plans for the system and submk in the Comty Dail on paper aw than 8 0 x I I iaelm in size SBD-6398(R.11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/27/14 Owner:Barbara Johnson Location: SW 1/4 SE 1/4 S8 T28 N,R19W Lot 8 Sunsetview Troy 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 Specification heet 8-10. Soil Test �f Signature t License nu--M r#226900 PLOT PLAN PROJECT Barbara Johnson ADDRESS 97 210th St. New Richmond Wi 54017 SW 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 5/27/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of 1" iron pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.8/94.6 F below qrade All piping shall be SDR 30/34,within 10' B-1 of tank,piping shall be Schedule 40. 100' M.* Vents Property Line to be>5' from 10' property line B-2 x 3% Slope 85' Vent 25, -3 >6„ Quick4 Standard of Cover Leaching Chamber 99' with 20.0 ft2 of Area 25' S.kft^2/pair of end caps 100' 4' Long 12" y. 34" Grade at System Elevation ST Scale is 1" = 40' 2 unless otherwise noted Pro 4 Bedroom house slab on grade 220' Property Line Town Road 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 Typical Installation 99.81 Vent Grade Vent 3' 411 31 f�30/34 Septic Tank 1" 5' Long 5' S' Long 1" 3619 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90 ' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A-94.8' B 94.6' ST. CROIX COUNT'le SEPTIC TANK MAINTENANCE tV REEMENT AND OWNERSHIP CERTIFICATIO FORM Owner/Buyer 'E)� rCE6 sec_" 70 t!,S, Mailing Address�� n ��f�_�_Qa� ► J 7 Property Address 7' L 3 Co n- (Verificatiolnrerequire om Planning&Zoning Departs nt for a construction.)/ City/State l 1�b5O 0J Y%, Parcel Identification Nurz er '1 ��� 1 LEGAL DESCRIPTION Property LocationSbj 1/4 , 1/4 , Sec.__? T ZI N R Town of Subdivision 5Le A S Lot# Certified Survey Map# _ �,, Vc: ume_ �,Page# Warran ty Deed# ` '�` _, Vol Lune , Page# Spec house yes lot luxe:; identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pry mature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, 0 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 wash: disposal system Owner maintenance responsibilities are specified in§Comm 83.52(1)and in Chapter 12-St. Croix Col Lnty Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zon:ng Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licert ied pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspect on arid 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 main nin the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Departrr nt of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completer I 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 ' form are true to the best of my/our k nowledge. I/we am/are the owner(s)of the property described above,by virtue of a wa anty deed recorded in Register of Deer Is Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being r_.voked 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.08/05 POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page a T'IONS INFORMATION SYSTEM SPEC RCA FILE INFO p NA OWher u cA/ ❑ FTank FManufa urer: Permit# ❑Holding Volume: 10 j� (gel) urer: NA DESIGN P E7ERS Number of Bedrooms- ❑NA e ❑Holding Volume: (gal) Number of Puplic Facili�Flow; ANA Vertical Dida Tank Bottoms)to Service P (ft) Estimated(averag �Q 0 (gauday) Horizontal D' ce Tank(s)to Service Pad: (fi) Spedfic earvk.i mechanics must be provided If vertical is>15 feet or k Flory (estimated x 1.5): 6 6j 0 (gray) N horizontal Is 150 feet spsanc Inetructlona to be provided on back. Design(Pea ) � In Situ Soil Application Rate: , '� (galldayR) Effluent Fi Manufacturer: e4F'*� ❑ NA Standard(Domestic)influent/Effluent Monthly average.. Effluent Fitter Model: Fate,Oil&Grease (FOG) s30•m"11 Pump Mani er: NA Biochemical oxygen Demand (BODs) 9220 pip Model Taal Solids SS 550 High Strength Influent/Ef luent MontPretreatmen Unit (FOG) >30 Manufactur A (BODs) >220 mg . p M apical Aeration ❑Peat Filter SS >150 m ❑Disi action ❑Wetland Pretreated Effluent Monthly average ❑Sa Gravel Filter ❑Other. (BODs) S30 mg/L Soil Systes^ (TSS) s30�mgIL ❑ NA (9ra Y) ❑In-Ground(pressure) 0 NA Fecal Conform(geometric mean) 510 ❑At-G s ❑Mound Maximum Effluent Particle Size 16 in dia.. ❑NA ❑Drip ne ❑e'er Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Evert Servic a Frequency Pump out contents of tank(s) When combined sludge and scum equ one-third(Y�)of tank volume P ❑When the high water alarm is activated mom'( ) (Maximum 3 years) 0 NA Inspect condition of tan k(s) •At least once every: 7Z y ar(s mom' ) (Maximum 3 years) ❑NA Inspect dispersal c;ell(s) At least once every: Sys / month�r(s ) ❑ NA Clean effluent filter At least once every: Inspect Pump,Pump cols&alarm At least once•every: 13 month YeW s ) NA Flush laterals and pressure test At least once every:. p month s) NA yws Other: At least once every: month s) NA ❑ $ Other: NA MAINTENANCE INSTRUCTIONS one of the foNovying licenses or r�rtifications: Inspections of tanks and soil absorption systems shall be made by an individual ng Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS P laintainer or Septage Servicing Operator (Pumper). Tank inspections must include a visual inspection of the tank(s)to identity any miss g or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and sc urn and a check for any back up or ponding of effluent on the ground surf ion effluentt absorption system shall be visually inspected to check the effluent levels in the obs on pipes and to check for any pond' g on the ground surface. The ponding of effluent on.the ground surface may ind to a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equal one-third(%)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator(pumper) nd disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services,including but not limited.to the servicing of effluent filters,mecha lical or pressurized components,pretreatment units. and any servicing at intervals of 512 months,shall be performed by a certified PO S Maintainer. A service report shall be provided to the local regulatory authority Within 30 days of ompletion of any service event. GM1W (02105) Page of START UP AND OPERATION acts, other For new construction, prior to use of the POWT check treatment tank(s) for the presence of painting prod chemicals or sediment that may impede the tree ant process'and/or damage the soil absorption system. If high concentrations are he contents of the tan s)removed a Septage Servicing Operator(pumper)Prior to use detected have t k( Pump tanks may fill above normal highwater level prior to startup or due to pump failures. Start up or restoration of power under these i not recommended as the excess ter will be-,discharged to the soil absorption system in one large dose causing an conditions s have the situation• surfs discharge of effluent.and damage to the system. To avoid this sitiva overload that may result in the backup or su contents of the pump tank removed by a Septage cing Operator(pumper)prior torestoring power to•the pump or contact a Plumber in the tank. or POWTS Maintainer to assist in martuany opereti the pump controls until normal eFfl uent levels are restored with pump System start up shall not occur when soil condition are frozen at the IrdItrative surface. Do not drive or park vehicles over tanks or the I absorption system. Do not.drive or park over, or otherwise disturb or compact,the are@ within IS feat down slope of any mound or at soil absorption.area. Reduction or elimination of the following from the ter stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: adds, antib tics, baby Wipes,-cigaretWbutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants,fats, foundation drain (s p pump)discharge,fruit 9nd vegetable peelings, gasoline, greases, herbicides,meat scraps,medications,oils,painting products,pesti 'des,san4lll�y napkins,solvents,tampons,'and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanandy taki in out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with a. Comm 83.33,Wisconsin Adroiriidbvtive Code`.: • All piping to tanks,pits and other soil abs moon systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage SwAaing Operator(pumper). • After pumping, all tanks and pits shall bD excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN vide a code compliant If the POWTS fails and cannot be repaired th following measures have been, or must be taken, to pro replacement system: A suitable replacement area has been ev lusted and may be utilized for the location of a replacement soil absorption system. The replacement area should be Prot from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed stru ure,lot lines and wells. Failure to prated the replacement area comply with the rot sin for a new soil and site evaluation to esta ish a suitable replacement area. 'Replacement systems must oomtpiY effect at the time of their permit issuance. ❑ A suitable replacement area is not avail ible due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POY TS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to id 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 POWTS. ❑ 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 TREATMENT. TANKS., PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name « Name .k,�•. i, Phone �� J Phone J 7 j SEPTAGE SERVICING OPERA R PUMPER LOCAL REGULATORY AUTHORITY Name E Phone / 0 f —C This document was drafted by the staffs of the Green e,Marquette and Waushars County POWTS regulatory agencies in compliance with sections W n Administrative Code. Comm 83.22(2xbx1)(d)d,(f)and 83.54(l),(2)&(3), FILTER CARTRIDGE INSTRUCTIONS _ °" STEP 1 Dry lx the MW case elite the and at the outlet pipe to ensure it is centered under the-mm open". pipe into the tank thramb the outlet or solvent~veld(glue)addbmW pipe onto the outfit pint- STEP 2 WNW the Case Is stir dry fitted on the outlet pipe,measure the keagth of DA-inch pipe needed to brace the fiiter to the tank and suer if utWMM the optional Awls oerhtei aide support,if side support method.is not ut roil, proceed to step four: 4-FP 3 For installations utilising the optfond=*qden8atW side support: solvent weld the% inch ppe onto the Mu Case. N side support method is not utilised,proceed to step four. t "fir Solvent:weld the Aker case onto the outlet pipe. Insert the Aker .. iy;^''!e+ Owbidge into the case,pressing down until the filter locks bhto the bottom of ry% the use. u� If a VRS switch is utilised:insert into the filar end kook by turning ,•..•�•. dodmise,90'. +.`. . . Maf�tancfs 1. The einuent filter should be cleaned every three the septic tank is serviced. 2- open the outlet access opening to inspect the tank and Aker a 3. Pump the septic tank cemphtsky,making sure to remove the sludge - layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent iwW has ben lowered below the invert of the ` outlet Pipe,firmly Pull up on the MW handle to dislodge the x cub dg*from the cese. S. Slide the cartridge up and out of the case tar cleaning. 6. V a VR5 switch connected to an alarm is present,the switch i should be rwnwred by turv*q ceventerciodtwia gO*and cleaned :f % 1. With water only. 7. While,holding the cartridge on its side (carpe flat surface fedng s.. down)aver the aoeees opwdno,rinse off the csrbfdge V Wh water c only,making sure ON 9"*%*M*WW is rinsed back Into the tank. a. If VRS switch Is udibmd,replace by inserts a We Ater and turnip dociasfae me. S. Insert the Mar cartridge hack Into the Case,pressing down until •" • .. the Aker locks into the bottom of the cue. 10.Rephme and secure the access opening on the tank. r-'lr•.:riblt i'+SL•••.C' :tyf'R_XId '1V£-"f A.:t 1141 0:V;.AM.Y.Y-'. l www.b�sift"= 877•NLNMRS(653-4583) Nov 27 01 03:45p Croix View Remodeling 715-386-7989 p.1 � 17 2 1 S#ate Ba of Wsondn Form 1 2}03 Tx 41 WARRANTY MM 993121 BETH PANS?' i�ooaRNambrr l*= REGISTER OF DEEDS ST.CROOK CO.,W3 TIDS fl3/0-/2014 AM DED,madcb&wen I s W0aomsin E7CENyr#: NA c-axpgZation ('SGna�or,"wLeH►ecorrecarmoce), REC FEE:30.00 and Barbara L.Johinvsn TRANS FEE: 179.7fl PAGES: i f'Gsaat�'°w aoe�mor+e;R Gsa dar,.for a plc oozuderateM owme"to Grsnia the RAowwg dewnbed real $ecmdmg Alta e state,tagetber with the rents,pmfit4 ftft cs and other Vpwftmnt mt=W6 in St Croix cowly,State of Wise ndn(`pmpw3 Crmare space is t' �aamr�aaa�s sexed,plesae amch addend: Rioec vW >faoa Hestara.5t S'aite 201 ]Fads= WI som Let $ Plat of Suaset View Develo m the Twm of Troy, 79[a 420236 St�C*Oi c Cowdy,Wbcoosm. t►�1366-e8�9R raved kUmfificafianNundw(P" Dated February 21,2014 Tug is aut bMffiCdWdVWP0d5r, tX)W-* Grantor wands that the We to the Properiy is good,indcfeaAb1c in fee si*+e and free and clear of mcwnbronm er4ap� Eanwcnts,rest idiam and rfghft-ef- a of rword,if a'W- B&L Land Development,YEW-,:MrWonsiva Corporation �. vZe T Weatherholt.preaddent/lYess[rrer (SEAL) (SEAT.) e # A UTM39MCATION ACKNOWLEDGMENT Sites) STATE aF EM TI'CTGKY ) ss. auk an t= i-=C-ke oc"Li COUNTY ) Pecsooally came Ie*ze mean 1ighEll=nL21 2g'14 - �` �� _ Lvle T Wei* TFTCIi: STATE BAR OF WLSCOl 'IN (�iffsa—r.�� to me bioum t�o_b—ee am pie (s)arlro cyoer�tod.tha ag +by WJS.Stet$706.06) ..csr-.•'•trtss;�� and aC�WIedgpd the sawo- s y: Ails ngsnt DAEN 'DRAFPED BY: i~raniverson 47 =mlt 12oa Hosfwd St suM {• )C _' � � � fi' Ariku+enotaeolmt!) 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Soil Application 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 I •Eff#2 Effluent#1 =BODs>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,<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. SOD-8330(R.6/00) Wisconjintepa ' entoPOAmerce SOIL EVALUATION REPORT Division of Safety d Buildings r1 Page of Q 2 ZMccord nce with Comm 85,Wis. Adm. Code zr Attach complete s e plan n paper no I��,�N1an 8 /2 x 11 inches in size. Plan must County 5 l Cp Q) include,but not lim ted to �reldontal re Fence point(BM),direction and parcel I.D. percent slope,scal or dimS(glid hl w,and location and distance to nearest road. CJ Please print all information. R viewed by ''Date Personal information you provide may be used for secondary purposes(Privacy Law,s,15.04(1)(m)). Property Owner '""""" � Z� Property Location 7�� � S 1�1 1/4.IUL 1/4�S �• T Z'g N R �� E(or) ; Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# P o. fox City State Zip Code Phone Number ❑City ❑Village Town Nearest Road New Construction Use:Z Residential/Number of bedrooms 3, Code derived design flow rate _� S Q – tj QQ-_ GPD ❑Replacement ❑ Public or commercial-Describe: Parent material G L-N-)e) )4 L Itivl�S Flood Plain elevation if applicable N ft General comments and recommendations: oOhilw 3 1w1p ' t l OF e S 1D �L wl tKi .SoN A nip 1^1 X, 60" �u `ls^3o T� QAt M r- a Boring# ❑ Boring . ® pit Ground surface elev. N S ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 j in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 l o _1s Iu�tr23lz - s 1 1 Z`rsbk Z IS_3 to-tfL 316 - si 1 Zwt sbk m`F1- �5. - s �•� 3 1 11 a Boring# ❑ Boring ❑ pit Ground surface elev. 7 ft. Depth to limiting factor '7 in. Soil Application 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 I o_�y ►��(z3lZ - si ; Z`Fs�1c rn�r c_.w -L� •s �� •h Z I y-ql I o'l R- 31 — s l Z sbt t W1 cg S -b 3 Liz-aj I o-trz //6 _ s c�s 9 'Effluent#1 =BODS>30<220 mg/L and TSS>30_<150 mg/L 'Effluent#2=BOD,<30 mg/L and TSS<30 mg/L .. CST Name(Please Print) Si ature 0 3 Z'S Q CST Number Arthur L. Wegerer V 220254 Adder W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St . River Falls , WI 54022 lZ-ZZ.--(33 715-425-0165 Wisconsin Department of Commerce SOIL EVALUATION REPORT Divisron of Safety and Buildings Page \ c b in accordance with Comm 85,Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must County 5 include,but not limited to:vertical and horizontal reference point(BM),direction and C�p) percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. �ti�rvG Please print all information. Reviewed by 'Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). O P Y Property Owner I Property Location S W 1/4IUL 1/4 •S T Za N R �� E(or)V Property Owner's Mailing Address - Lot# Block# Subd.Name or CSM# o, fox 3 3 - Isu r.� I& vii-�,� `�L-v, City State Zip Code Phone Number ❑City ❑Village Kj Town Nearest Road t� lR w) ► 5�� �t0 (I I S )'l$S.33 5 I T�O�. I New Construction Use: Residential/Number of bedrooms_'Z '� - - Code derived design flow rate GPD ❑Replacement ❑ Public or commercial-Describe: Parent material G LNP�)el 54 Flood Plain elevation if applicable f� General comments ft. and recommendations: cpy,� e y limy 1 OF yvt �'�'S �/I!v t=t CIY`N C ' N1Z S " EBoring# ❑ Boring ® pit Ground surface elev. r 1\ ft. Depth to limiting factor 7 in. Horizon Depth :DDo;mmiinant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rare in. unsell I ry GPD/ft� Qu.Sz. Cont.Color Gr.Sz.Sh.1 'Ef#1 'Eff#2 0 -l s t U - -1 l Z W1`Ct -iL 1 Z IS_3y� �OKZ 316 — Si I Zen sbk m-6- 3 Boring# ❑ Boring El I � r ® Pit Ground surface elev. ft. Depth to limiting fatter 0{ in. Soil Application Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz j in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 I O-�Lf t0`�231� — SI1 -2`FS�4z W1'Fti— C lil •S s 1 1 Z�sbi-c r>1 i cg � • S •� 3 U2-°j i b tit yLb 'Effluent#1=BODS>30<220 mg/L and TSS>30_<150 mg/L •Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) Sippature - -A'rthur L: Wegerer Add Q CST Number `L�/' 03 Z1S - Q 220254 s W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls , GI054022 1Z-zz—cl2 715-425-0165 Property Owner 'E� �Et ` vU(�NJ �/j— Parcel ID# Page ;of Boring# ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor 7 in. Soil Application 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 .0-\S lotitZ 31-L Si 1 Z`FS b k tiv1`�� C Z'F , S •8 Z IS _Q loH2 316 u S9 F-1 Boring# E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture I Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color •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/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 I •Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<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-8130(R.6/oo) ' f _ PLOT PLA21 Page of ' Scale 1 ' = so ' r l fly- -7 � r a, l v- Lo T of lJ l� G�P �G �o s� wt It � _�z . c�S 's ©f`, 1 Y`'-TyT't-L i 3h8 Tj 11g i ►1, �• 3715-425-0165 220254 CD3-ZLS- $ CST Signature Date Telephone Ito . CST No . Job NO.