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HomeMy WebLinkAbout020-1407-06-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INtORMATION (ATTACH TO PERMIT) Personal infonnation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson, Town of CST BM Elev: Insp. BM Elev: BM Descri ion: a l~Z~' ~ ~L ~- a"tiC. ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ~~„ ~~ Dosing ~6v Aeration --- Holding TANK SETBACK INFORMATION TANK TO P/L ~ WELL ~~ BLS.,. Vent Air Intake ROAD Septic ~ (DU ! ~„ V 1 Dosing Aeration Holding PUMP/SIPHON INFORMATION ~ r: 'Ylt~'I,t~ Manufacturer mand GPM Model Number TDH Lift Friction Loss ys ad TDH Ft Forcemain Length Dia. Dist. to well ELEVATION DATA county: St. Croix Sanitary Permit No: c I 479376 J~ Q State Plan ID No: Parcel Tax No: 020-1407-06-000 Section/Town/Range/Map No: 10.29.19.2553 STATION BS HI FS ELEV. Benchmar /• 4 ~ ~o~• ~ /ad. d Alt. BM /~diYr ~2a-t~ Z Bldg. Sewer 3, Q / ! t~ ~ „~ Ht 1~1et-- ~; ~ ~'' ~'G. d ~ S Ht Outlet Dt Inlet Dt Bottom ,,,~ ~ ead /Mar ~' 7 ~ ~ ~ Z Dist. Pipe ~ {~ 1 . K ~~! `o ry//• 7 ` ~ Bot. System a A /J~ ~ • b ~ ~ • Z~ Final Grade ~ ~ rs~ ~ •SS ~~ Z St Cover ~ K Z.. Gq• p 7 / G Cnll ARCnRPTInN CYSTFM ~ "~ n .~ _ L /YO ~~ ~~ 2 ~ U ~ /~ ~ ~ ~ ~ ~0 TGCU BED/TRENCH Width ~ Length ( No. Of Trenches PIT DIMENS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /~ Y~ SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM CHING Manufactilrer.~-' L~,~ y - ` 1NFORMATION CHAMBER OR Tom Type S stem: ~~ ! , ~ r - t / UNIT Model Number. I'fIST1~IRUTION SYSTEM rru~blt..._L__ Bade anifold ~ .~ I ~~ ~ Distributio/n,, /'~! Pipe(s) / ~'~ ! x Hole Size '~_-_ x Hole Spacing ~~ Ve/n~ ~.,Ai~r,I,/ntake C. /O~_ Dla Length !rJ C Length Dia Spacing cnu r_nvFR .. o..,~~...e Cv<<smc Anly Depth Over ( Depth Over - xx Depth of Bed/Trench Center /_ ~. /' rench Edges Topsoil ~ ~ Yes L] No [] Yes l:~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~---~lnspection #2: / ! Location: 711 Zephyr Lane Hudson, WI 54016 (SE 1/4 NE 1/4 10 T29N R19W) Shepher Park Lot 6 Parcel No: 10.29.19.2553 1.) Alt BM Description = 2.) Bldg sewer length = frwL S - amount of cover = 3! i 000~2~ r --T - i _- ;_ _- --~~~~_ Plan revision Required? ~ j Yes I ' No I~ ~ I Use other side for additional information. L_~ ~ 1~ _' ~ ~ SBD-6710 (R.3/97) Date Insepctors !7C xx Mound Or At-Grade Systems Only Z. 1'+- xx Seeded/Sodded xx ulched Cert. No. r rogeriy r....uw..~ #221180 28288 l`.'IcKenzie Rd. Sp~Qner, WI 54801 (715) u35-9609 ~~~ ~~ l~sOs LmT ~ ~ Sc~G~ / ` -,~ ~ LILY/ = a,,y , IAA BF CovcR.~r,~' ~b)ec/,L , ~mvo ' -.U~z = grGj-.d~l, C~.tv~'R LaT ~oo~ .~fsxt- ~ T ~sT~ y'~s""' ~ = 4~ coyt.,vF~c ~t~ w =~ f CaT ~F/C~',q !- w~ ~/(~ ~ydwF ~ ' ~,tytdl'E ~.cK _ 3S' K/ __ - .- ~~ r - ~~ \ r f .~ QQ~ ~ jo Z' NtP ~~ ~~r ~f " ~I ~ 1 r . 1 ~ ~, e - r se ~ e :~~~. G 2 (r6 ~ sei'' ~ /,s' ~ ~ y /tB 9~ ~ - 9/ y d~[ow ~ ZS''f~ ~/L c-3 60 93. ~ - 9/ y 1 ~ 33 ~ ~Q,~QS ~''~ T 97~~ ,~"''A ` Safety surd Buildings Division Corm 201 W. Washington Ave., ..-•... 5 ... ,~~~~~~ Madison, WI 5370 - 71 t~ ~ ~° ~ ~ y Pemipt Number (to be filled in by Co-) Department of Commerce (~) 266-31 1 r `~ ~ 3 7 Sanitary Permit Application ' ~° ~° L `. Nmnbe~ In at:cord with Comm 83.21, Wis. Adm. Carle, personal inforrttation you de may be used for secondary purposes Privacy Law, s15.1>4(1 xm) .~-! ~ I? ~' <X C _. (if diffea+mt than mailing address) I. Application Information -Please Print All Inforntatdon ••~- ~~- • - ~ - " .., , Property Owner's Name 1 # Lot # 8leelr# O// fir-S/ ~ Property Owner's Mailing Address Property Location r ~ '/. f«Y. section 1~ . City , State Zip Code Phone Number _ , , , ~/ / 6Y`NDSOff~ S t9 .1 `3 ~ - 71 T ~~ N; R~~ (E t~) ~ z SS Type of B riding (check all that apply) II . ~ / a /C o.11 a C ~ ~ ~ Subdivision Name CSM Number _ ~ ~` ~ ~ 0'I or 2 Family Dwdling - Number of Bedrooms `J ~/~ ~ , 9° ^ PubliclCornmercial - Descn'be Use ^ State Owned -Describe Use ^City ^Village (~wttship of Gt B~ III. T ype of Permit: (Cheek only one box on line A. Complete line B if applicable) `~' New System ~---- ^ Replaceernera System ^ Treamtertt/Holding Tank Replacernant Only ^ Other Modifitxtitm to Existutg System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Ttattsfa to New List ~vious Permit Ntmtbtx and Date Issued Before Expiration Plumber Owner /Y N. T of POWTS S stem: Check all that a (Ion -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mormd < 24 in. of suitable soil ^ At~ade ^ Single Pass Sand Filter ^ Conswcted Wetland ^ Pressurized In-Ground ^ Holdiug Tank ^ Peat Filter ^ Aerobic Treatm~tt Unit ^ Recirculatng Sand Filter ^ Recirculating S~ttthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ (&rtvel-less Pipe ^ Other (explain) V. D' ersaVTreatment Area Information: L E S ~ ' Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Requ' (sf) Dispersal posed (sf) System Elevation ~ mU . J ,~ 7. ~ P6~ . e c - ~ ~j3. Z VI. Tank Info Capacity in Total Number MamttacGaer Prefab Sine red Fiber Plastic Gallons Gallons of Units Concrete Construcaed Glass New Taolcs Existing Taolcs G/ Z /~ L ~ ^ /O t/ ~o< 1 v -' .~~ v Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the andetsigtted, assume r'mPo~ ' ' hrstsllatlon of the Pt)W'I'S shown on the attached plate. Pltrtrtber's Name (Print) Plum s Signature ~/I~RS Nrmtber Business Phone Number f~/.,tn B .z O T/S~ 6- ~mO D Plumber's Address (Street, City, S Zip .Z~.zz~F ~,E - o ~- ~lTv~ ono /D artment Use On PProved Disapproved Sanitary Permit Fee (includes Groundwater F t S Date Issued Issu' ~ t Signatum S ^ owtt~ Giv f~ ratge urc ee) ~ ~ ~ . ~ /'D ! 0 5 1X. Condition al/Reasoas for Disapproval /2 a.~ „`,d- ,,~~ J ~~. a ~.J~.t~ r:J~ ~ l~ ~'0 5 c, ~~ SYSTEM OWNER: 1. Septic tank, effluent filter and ~, r ~ ~-- ~ - 1sz~\ l ~0~ ~ 0 t.J+~P~- . ' _ __ _ ` dispersal cell must all ~¢ services ! makltekf•d ~ as par manapament plan provided by plumbst. 2. AN talbaek raquirerttst><s must be ntshlRaitted ~ ~ljd ; ~ ~L~' ~ et^,~ as per appiicablsgods / ardinartoss. Atmea tompeae perm tm me w®ry omyt mr me aya~em w paper Doer .os ...... o+.... •, SBD-6398 (R. 01/03) . rvgersy raiuww~ #221180 2821x8 !`.1cKenzie Rd. Sp~ener, WI 54801 (715)/u35-9609 __ ~/~ ~~" l~~f G,7' ~` da4'/ _ l~~, !~~ BF ~cvc~r,~ ~Iv)ec1,L , /goo ' J1~6.2 = olGT .d~7, C~•w~iQ dvT ,eoo, ~'S~r rd T ~sT~ pis ' X = ~~•d ~ • = 4r' ~aF,c Rau w ; d - t, ~ ~ s,t., s. T CaT iH~,q 7 -r Et~v: G 2 c-3 s` 93•T -9i•y Lo s~'r ~ /, s'• 9~7-9~ y d~'~ 60 • ~v,~.L ~o~ . 93.x- 9/~/ ~, a .~ (~1-S d~~ I _ _ Y/ .~~`~~ s 33' T .1* J 97~ /vsP ~D_ C B ~ ,~ ~'_ ~ ~ n ~* ~ "" ~; n ~ ~ ~, ~ n II a '~ ''' co 0 ~ '~ • .~:.. •. tiv III""^` ~ II II :•~: • ., .. y --- -11-•~. w . ~'~• •• \ ~ ~ boy .~ ::~° ..° •~..~+: r 0 ~.. ~. ~ • . ~' (D '. `~ ~ ~, G .• .~ ~ a .. ...._s... ..~ ~.. ~ <. ~, :. ~~: t. ...~.~. \ ca••. •~ • ~. ..:. • ,n_... - •-• ---+ Fes' ~~+.~~ :..:.••y-, ~ ~ ~ r^~ c ~ N v~ rte. ': •' ... 4. •~ v ~~ ~ II ~*. •s ~~ R' . ~• .i' CD +.~. .• '~ v p~ .~~~ ..• N O ~ N ... m ~ r". tC ~ C. O a cD 3 C ~ II W ` Na ~ ~ II II w V ~ in accoroar+ce wiuruarmT a~, vri~. rw~~s ~.u,o .-'~ County Roach ootr~plete site plan an paper Trot Ness than 812 x 11 iothes in size. Ptah rp~t-_. -~~"'~ ~' C~~~ include. tNrt riot fvr~ted to: vertical and ttori¢ontat relerertce i 1 excel tD. percent slope. scale ~ d'mtertsions. rrortlt arrow. and tocat~'r~e~test road. ~ B ... - -~ Please print all informaho,~. ~ ia~armatian,,a, ~ ~ de rsed for p~rp~ (~i+~- t.aMr. a ,S.aa {t f (ml). Property Owner , ~,~ Properl~- -, ~ ~ 1/a ~ i 'S T ~ N R / r- CtioNt. ~:`:~ ~._ PropeRy Owners Mailing Address f, Lot it 8toctc ~ Subd. N•dme or CS1J!# -- < City A ~ State cTtp Code ('~ C+t, f ^ Vrllage own Nearest Read (~~ /a iZ o S ,g E ~a~ ~lew ConstnrGion Use: ~ttesiclerttiat t tahrrrtber ~ Cade derived design Bow rate L,o/J GPL ^ Replacement Q Public or comrttercial -Describe: Parent material ®~i~`crl/l<S ff Flood Ptatit e3evatian d app6cahte T~~ ~ General cornrnen~ . . and re.Carurrendations: ~Od(/FN17D/UiK~ ~` / ~ L .~ ~~ ~ P7 Ground surface elev. Y'7. ~ R t~epfn m onauny rauw - •• • °~ Horizon Depth Donratartt Color Redox Descriptioft Texture Strtr~ure Ctem~e 85+ Roots in. Mum Uu. Si Conk Color Gr. Sz. Sit. Soil AppNcatlat RaN GPDJfl= 'Elf~i 'EffAR2 Z - 7 O `- ,4.xL Diu - • ~' 7- // v ~ /HS L .- i~ I~ ~ ~~~ Q eaina a # ©Pit Ground stufdee elev_ . L !k Depth to !aniGng fadq' ~ „f 'min. ~ gpon Rate Horizon t}epth Donrnant Color Redoz Dexaiptiaft Texture Structure Cortsisliertce Batrndary R°°ls 6PD~ irt. Mansell Qu_ Sz. Calk Color Gr_ Sz Sh. 'Etl81 'Et!#2 ~ - /8 L kt Fib c. 2 F ~1 2 ~,. Z -- ~. ~ r. - . g' ,~ 1 - / ~ --- /!t S L ~` t Il l~ ,-n.~ _ ~., _..,._. ' Etlltfertt #1 =GODS > 30 < 2ZO tflQll. afar r ss >.iU ~ i.'w'rrtgre_ w.w ,..~ - ..v s_ .,.....a - -.- ~ -- _ _ _ _ .. ,_r__r. CST Number SST (Please Prin!t~s. I pp 2 2~i~PlJ "i .~ ~ N ~'~A~riw 4~l~IC sir vow ....w........ ~~..~~~__ Fogerty Ptum6ing & Perk T sting l0 o S ~~~' 715- ~,~- 9fp~ 28288 McKenzie R ~ ~~~~r, ~ s~~d/ ~~ #221180 28288 t'.7cKenzie Rd. Spooner, Wf 54801 (715) X35-9609 ~~~ ~~ ~~~f GsT ~` ~ lJ~l / = DA%, l7~ Btu CO.~/tdZ~T~ p/~cl~ , /~D.D ~.t = grGT .d~I, ~,W.eE,~¢ GoT ~/1), .s~5~r T~ T ~Ti Pis Y = /30,~ ~ w ~~ X-°/ P7~ x_S q~ i CaT iFJ~EA 7 ,8isi J ~c yL ~~irifCS' . ~ . y~ ,~-~ yew _ ~~~ ~.~ ~__..~ fI''~ Q.b! I ~ j, r~ ,~~ Xy 1~ S 33' ~ o ~ r n'1~ - ~~~ ~~~ ` ~~~~~~~ . 201 Vii'. a Ave.,'P.O. Box 7152 _ ~ ar _ 7I Number (to be fitted in by Co.) !v'~"C~l iS!!! ~ ~ ~ a ~6 I~ , ~ ,~~`'' y 753 ~ Department of Commerce - _, .{ ' .D. Ntttttber • lica~o ~T, CROIX C unitary PeTlnlt APP ZONING OF iCE In accord with Comm 83.21. Wis. Adm. Code, Pecsa LaW. sla ~ p~j~ Address Cf different than arailing address) i may be used for secondary purposes f. Application Information -Please Print AII L~ormatian L Parcel ~ Lot ® Block q property-owners Na me / 3 6 - property «on property Owner's M ailing Address ,g ~ 54.~.14,Section ~_ D Phone Nmaber' City. State Zip Code / / ~~~~ .T Y~~ ~/,~ 3~` "" ~'~~ (circle one) C s/I'l T ~~ N, R''~-E ~ ~ ,II~,.~Type of B " ( that ~) O ~ ~.'S ~ ~ ub +rv ~ subdivision Name CSM Number iN I or 2 Family Dwelling - Nu of Bedr~r~ 1 0 pnblic/Comtr~rcial - nescribe use _ __. _... _ _ ^~, ^vitlage ~owtship of /~h+ ^ state Own~l - Describe use - I1I. Type of Permit: (Check only otuve o7tt line A. Conaplebe )ram B if ~) A. ^ 1'r'eatatenNliolding Tanlt acement Only ^ Other Modifmation to Existing System ~,/ S ^ Replacement LN New ystem ~ ^ Trattsier ~ New List Previa~ Petrttit Nmtttler and Date Issued B. ^ Permit tteneara[ ^ Permit Revision ~ Before Expiration ~ IV. T of POW1S System: (Ctmck all that ) (~'B(on -pressurvxd In-Ground ^ Mound > 24 in. of suitable Mond < 24 in. of suitable soil ^ At-Grade ^ Sin Pass Sand Fiber ^ Constructed Wetland ^ Pressurized LrGrtwnd ^ Fioidm8 T ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirgtlating Sand l:<Iter ^ Itecirculati~ Syntbedc Media FBmr ^ f~mba ^ Gratrel-less lope ^ Odter (turn) ~ JI V. Dis sallTreatmeat Area Infotwation: Area (s~ Arw (~ System Elevation Design Flow {gpd) Design Soil Appiication Rate(gpdst) ~s7 / lGy.d / -~ c-z Mast Prefab Site Steel Fiber Plastic VI. Tan6 Info Capacity in Total N ~~~ Gass Gapes tsallons of / ~ . ~ Z/5+~ 3EL /f~ - •/ Tatucs Tatda $cptic oriteldtllg't'3nk a ~ ~ Z..SV / - ~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Stat~tt- I. the-- - -ed, ~~^° ~ far of tlx PO ~o"D ~' Bus ~ Number pltun(1er's Na rue (Print) Pht Si mre -idfP'ftriPRS Number _F'ogerty Pinmbing ~ ~x f 7/~ - .~s - 9Lo I' Plu--- G~eli~ ~ __-_ WI5480~ 6s/- vt- .~ v6 . Spooner, - y7o- ~ VIII. C p~ ~ mt3nda crwodwater Dane ~'~""` C Approved ^ Sandary rsa~ Slarcharge Fee> d o $ cJ l)5 teen Reason for Denial IX. Conditions of ApprovallK fm Disapproval 3\ n J' I J~ ~/~~Sd.' S~/i j, _ Ot~~a-.. /~VLa.~~vt. ~-~+2- pA. ~IbMi, ~ANIwIR fl~r at+Al J {~J~o~-tea,,J.. l~I.ou~2. o~...I " "7V(~n-e~_ . V dr>IjNrsrsl eeN ofd ~ ~,~ ' ~~ ~"~'n'.'~' 's, ~ tif~BttF rat~1J1-t1rr1'Of1T5 nri'ust tA"' ma:nt~it red _ _- t~ (7!r applicable Code /ordinances. _ Attach complete plans (to the Cotmty aaIyi rot 11U system tm paper not kss than 81fL x 11 inclees in sae Fogerty Plumbing - ~22i180 28288 ~icKenve Rd. Spac~ner, WI 54801 (71,~"i) 635-9609 ~r ~ ~/`~~ . ~~/vrV ~sl'~ ~,~1 f OS"~ L ~ T ~ 6 ~ s~~ i^'~Sa / ~O~.o' 9d ~' X Svc ~ u~ = cv ~ L G r r Sys = ~ - ~ 9~..0 95.6' ~• 90.7 ---- 9s.D ~ ~o qa.7 -~_ _ _,,._ _ . r ,- ~-_ ~ /s ~ ~ Adz ti ~ I ~o` ~ ~~+~i -so ~^~ ~ f ~ xs' l tai ~ ~ ~~ ~ r 1ST - ~ , \y ' / - fr l /' ' ~~ ~LrV . • ~ /'30 % Xi ~s ~ ,(~>T~ D. L,~~FX</i-T~fJN ,~o,~~'~- .,+~ ll~r~AEit- ~ F_~vD ro ,~TF~r~riv~ p/~.®~-~t s%1y-,~ r1- ~ ~crd• ____ S~'~ SBA lz,E'paRT .. ~ 5S'' . Z77' C ~ P ~( fogeriy Plumbing ' X221180 282~~3 P~~lcKenzie Rd. Spcvner, WI 54802 (715} ;35-9609 ~ ~~9~r ~. /r~c~®,v ~rsr ~,~os y ~~~ !.~ ~,r ~i /o>.p 9~ ~' k /?vim 6t/ - ~, . L L STS = C - ~ 9s,o ~. 9S•6' ~~ 9a, 7 t 9S: ~ ~ ~a qv. 7 -~ _~- ~ ~.. ~~a' .- / ~ - / _ ~rs' ~ ~z tii ~'~' ~ ~a~l_so T ,~ r ~ f / Zs` r . ~,~ 15~ - .7 ~ ~ ~ i - /`~: ~~T ~ t~ x.30 ~. ~ ~ Xa )S' ,v6T~' D ~ L,~~~x~.p-T~oN ~oc~~vG .,+~ H~~rLtFit- ~D T'a LLclfic/%~riY~ /~/c r®E'/~- s~f'T~ i+'~- ~ ~crt/. ._. 5,~,~ s®~~ ~Z,E'.peRT ~ ~ SS's X77' ., ~:_ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arrnrrlanro with (`nmm A~ VU~ A,1... ~...~.. Page ` of 3 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County l..I'7>I include, but not limited to: vertigl and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . p Zp _) ~p~- - ofo - ~ (, 2 S~S'3 Please print all information. ev' wed by Date Personal information you provide may be used f Law, .15.04 (1) (m)). ~ ~ I Property Owner roperty Location - ovt. Lot ~L 1/4s` 1/4 S1(~ Tz N R l~ E (or)® Property Owner's Mailing Address t # Block # Subd. Name or CSM# ~{" ~ ~ ~ Y `i? ~ (~ PC~(~ City State Zip C Pho OFFICE City ^ Village ~ Town Nearest Road t~JI UI c ) - 1~ 5 H-ucr n ~~ ~ . ew Construction Use: [~ Residential /Number of bedrooms .3 ' 4 Code derived design flow rate ~.~SU' ~eUU GPD ^ Replacement ^ Public or commercial -Describe: Parent material Ck)kl~~G- 5~., Flood Plain elevation if applipble /y~/~ ft. General comments s~(S.T-efM Pl et! / %` U-p and recommendations: / ~` ~c _ ~I-e ~ , ~y, d d Boring # ^ Boring Pit Ground surface elev. 6U- ~ ft. Depth to limiting factor~_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ~ o-lo I 3 2 - ~ Sal Z m c 5 Ivy • 5 .$ 3 Zg- u~l 10 4 `- rr)S D5 1 ~" - . 7 ~, z y.a~ ~..~-- z o Q Boring # I^~ Boring 9~~ (~ pit Ground surface elev. / d ft. Depth to limiting factor ~ Z. 5 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 C~-21 IL> ~Z _ S%1 2 k e 5 1 v~ , 5 $ Z ZI -toU lr7 ~~{ ~ Si 1 Zmabk tm~'r ~ s ~ , 3 _, lv ~ ~to -' m5 D - -- . -7 ~, 2 (,~.~ os. ~muem ~ i = esws ~ su < r1u mgrL ana i ss >su _< 150 mg/L 'Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Pleas~Print) ,,,Signature w / CST Number Haaress - Date Evaluation Conducted Telephone Number 2113 &~~' ~ . ~ i /-~~ -UZ CSI ~ z - mod SBD-8330 (R07/00) -r. _,~ .. Property Owner ~~ Parcel ID # Page ~ of Boring # ^ Boring Pit Ground surface elev. ~GQ~ SO ft. Depth to limiting factor ~ ~ 0 in- Soil Application Rate tion x Descri d R Texture Structure Consistence Boundary Roots GP D/ftz Horizon Depth in. Dominant Color Munsell p o e Qu. Sz. ConL Color Gr. Sz. Sh. ~ 'Eff#1 'Eff#2 1 O-I 5 /a 2 5r 1 ~mrzbk rvi~r c s I v ~ . 5 - g Z ~ 5- ~ ~~ ~ i 1 2 mobk t~r C S -" _ 5 -III t'0 `(~Co ~ n s I ..._ / _ 2 9 t~ ~ II`f ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate tion Descri d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p ox e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil Application Rate tion Descri d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p ox e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) * _, Properly Owner ~~ Parcel ID # Page ~ of J ^ 3 Boring # ^ Boring p~ ®, pit Ground surface elev. !~~ so ft. Depth to limiting factor ~ ~ 0 in• Soil Appliption Rate H ri th D Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 zon o ep in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef~1 •Eff#2 I 0-15 /a 2 5rl ZmQbk nn~r cs I v~ . 5 $ Z i 5- ~ ~ i ~ 2 m~bk tmtr C S -~ ~ 3 -Iii ~~ `i/Co ~ n s I - ~ ' 2 9 1J ~ III{ Boring # ^ Boring pit Ground surface elev. ft. Depth to limiting factor in• coil Appliption Rate i H D th minant Color D Redox Description Texture Structure Consistence Boundary Roots GPD/ftz zon or ep in. o Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell 12u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL '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 (R07/00) ~- ' . . ~._ PAGE~OF~ NAME ~~ S t LOT# ~ LEGAL DESCRIPTION s~ ~ 514 ,S l~ T Z`T ,N,R, l ~ Elor)~ SCALE: 1"= yG r BM 1 ELEVATION ~C3 ~ - 6 BM 1 DESCRIPTION -toy 6~ % ~~~c~ ~° ~ rQ BM 2 ELEVATION `ISL. ~Sd `- a BM 2 DESCRIPTION -~ Q Q~ ~y s~--~C ~ K o r~ SYSTEM ELEVATION q ~r O O ALTERNATE ELEVATION qy~ 00 CONTOUR ELEVATION_/CS(}.Ov ~- foo. ~ ~-L r I i N L eC~ /0 I - ~-- ~~^ o ~r 6~^ Z SIGNATURE /~~ -_~- I c~ -/ DATE ~- ~ ~ ~ d Z' 0~~'- I O t~ ~' 0 0 N a. a a 0 m ~ o o p a c~ ~ ~1 ~ ~ , =f~- ~ ~ '~ _ _ _ --~- ~ :-~ ~~--- l _ ~ _ _ ~ a e { _ _.~= - n i-' ~• ~z ~' _ - ~ i _ _ ..__ ~_ ~ 4 s = ,~ :~ ~:_..~.d~_ 1 =~ •~ ~ .i 1-- - - .. - ' {- ~ ------ .- ~- ~ `~.i'~j-. ~ _ _ , ;iii ~ V~ _ .,- _ _ ~ _ s _ ~' °+ ~ .: '.e ~' • _~ ~' a _~ o -~ t-' ~ ;' v~ t o . ~ 1 0 ;Y:f II ~~~~ ; ~~ ;,~ •~ --._ ~~, ti _... _. _... ,.! i ~ o ~~ ~ e .,~ ~ O ~._ ` _, as - ~_ :.__ ~' . o ~ ~ ~ •-t Q ~' ~ ~ N _ o ~; a Y i t O f 4 1 i nw ~" a. m =p Q ~ ~ 1 o~ rr --.. ~ ~ ~• ry ~ o /y~~~ ^ W ~.i n ~ 0 .+ v o ^~' o ~ ~ m s N v~ ~~~ A tn~m'~c ~~N O~ ~YQ ~ FILE q~FORMATION owner z Permit ~ ~. 1 iJWra7ar rwwan~aa...v Number of Bedrooms ^ NA Number of Public Facility Unrts ~~ Estimated fbw aaverage- gallday Design flow (peak). lEstmated x 1.5) Q day Soil ApPr~t~ Rate _ af/day/ft2 Standard Influent/Effhient IIuaGty Monthly average` Fats, Od & Grease {FOG) SSO m9n- &ochemical Oxygen Demarxi (BOD51 ~~" 20 mgd- ^ NA _ Total Suspended Sofds (TSS1 <_150 mg/L treated EffMient QuaCrty Pre M~thh~ average _ giochemicaf Oxygen Demand tBOD51 ~ m9n- Total Suspended Sotids tTSS) X30 m9/L ~ NA -Fecal Co6fomn (geometric mean) <~a cfu/1OOmI Maximum Effkrent Particle Size l~ m ilia. ~ NA Other: ~ NA "Values typical ~ do~dc waste°a-aiter and septic tank ernuenr. MAINTENANCE SCHEDULE Inspect co~rtion of tank(s) pump out contents of taNctsl Inspect dispersal c~tsl ~, Clean effluent filter Inspect pump. Pump ccetrols & alarm Flush laterals and pressure test SYSfBM ~{.7-w:warwr~ septic Tank Capacity zs-a ^ NA Septic Tank Manufacturer .. ^ NA Effluent FSter Marwfacgrre r [J NA Effluent Fgter Model ^ NA Pump Tank Capacitl/ gal Pump Tank Manufacwrer ~ ~ Pump Manufacturer ~ ~ Pump Model t7 ~ pretreatmerrt Unit i7 NA ^ Sand/Gr.3nre1 Filter ^ Peat Filter - ^ Mechari~ Aeration ~ 1Netland O D"~ ~ ~= Dispersal Cents) ^ NA [n-Gro~d (gravity) O In-GraNmd i(uessurized) ~ At-Grade ~ Mom, ~ e ~ Other: p~ ^ NA ether: ^ NA O~ O NA Service f-requ~l- ~ monffits) ~ g yearn) t7 NA At least once every= ~ ~yearts) When combined sl~ge and stxrm egva{S one-third tY31 of tank vohsrre ^ NA D month(s) {Nla~orrwrm 3 yam) p NA At least once every: 3 ~ year(:;( o monthtst ^ NA At once e~Y: r . ~ ~ year(s) ~ nwrrthts) ~A At least once every: p year(s) ' O monthlsl [t NA At lease once every= O year(s) _ ^ monthlsi _ rj, NA At least once every. a year(s~ _ ~~ MAl11f.TENANCE IIUSTRUCTIONS ~e of the fopowing arses or certifications: Inspections of tanks and d' ceNs shag be-made by an individual carrying Serv~g Operator. T~k Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintaner, Septage erodes or leaks, of the tank(s) to identifl/ any rrrass;ng a< ~~ Mardvrane, identify any inspections must inchide a visual inspection of effluent on the ground surface. measure the vokime of combined sludge and scum and to check for any bade up of Pig end to d~eCk for any pondin9 The d'~spersal cdltsl shill be visually msPected to check the effluent levels ~ the observation pipes Tres the of effHrent on the ground srface may indicate a fad'mg +~ a~ re4° of effluent on the ground surface- The P~mg immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (~Y3)ofr~ °~~~Ce ~ °~ pt ~~ 3e contents of the tank shall be removed by a Septage Servicing Operator aril dispo Wisconsin Administrative Code. _ All other services, including but not lbnited to the servicing of effluent filters, mechan~WTrS M 'tam ~~components, Pretreatment urirts, and any servicing at intervals of <12 months, shall be performed by a certified A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. , ra1iT UP AND OPER/4TION oducts or other chemicals For new con5tructian; prior to uce of the POWYS check treatment tankls) for the presence of painting pr that may impede the treatment process and/or darrl~ge the dispersal cellist. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior tar use. System start up shall not occur when soa conditions are-fr~z~ at the infihrative surface. Duripa power outages pump tanks may fll above normal highwater levels. When power i-+ restored the excess wastewater will be discharged to the dispersal cell(sl ~ one large dose, overloading the cellis) and may result in the backup or surface doscharge of effinent. To avoid this situation have the contents of the pump tank removed by a Septa9e Serving Operator poor to restoring power to the effluent pump or contact a Plamber or POWYS Maintainer to assist :n rrtanuaflN oPeratin9 the pump controls to restore normal levels within the pump tank. Do not. drive or park vehicles over tanks and d"ospers~ ce~l~. 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. rove the performance and prolong the life of the Reduction or elimination of the following from the wastewater stream may imp POWYS: antibiotics; baby wipes; cogarette butts; condoms: cotton swabs: degreasers; dental floss; diapers: disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peefmgs; gasoline: grease; herbicides: meat scraps; medications; oil; painting Products: Pesticides: sanitary napkins; tampons; and water softener brine. - ABANDONMENT When the POWYS 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 POWYS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code-compliant replacement system: - _ ^ A suttable replacement area has been evaluated and may be trtNzed for the locatiao of a replacerroertt sod absorption system. The replacement area should be protected from d and compact~n and should not be fringed upon by sducture, lot tines and wells. FaBure to protect the replacement area will required setbacks from existuog and proposed a su~~ ~ ~. ~t systems must result in the need for a new sot and site evaluation to establish 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 POWYS technology a holding tank may be installed as a last resort to replace the failed POWYS. f"1, The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWYS 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 fast resort to replace the failed POWYS. ^ 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 TREATMBItT TANKS MAY CONTAIN LETHAL ~~D/O~AMISUUO)Clf ~ CUBE OF A ENTER A SEPTIC, ,IMP OR OTHER TREA7M011T TANK UNDEi1 ANY (~1MST ' PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE- , #221180 - _ ~ c erwe $p~,ner INL~1 (715) 635-9609 ~ POWYS INSTALLER POWYS ~~ ~~t v -Name Name 1 Phone ~7/.S' lv3 ~Oq ~~ ~+ - SEPTAGE SERVICING OPERATOR (PUN{PERI LOCAL >~.ATORY AUTHORITY Natste ~ 1 ~~ ~ X Cbt~Jv~ Name Phone ~-(S - ~b - ~ phone This document was drafted in compGarx;e with chapter Corms 83.22121ib)Illldl&lfl and 83.54(11, (21 & 131, W~~n gtratrve ~. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jt!,~iy; ~?`tST Mailing Address ~~ ~-,~~,~ ~~,,~ ~~ ~-y©/G Property Address (Verification required from Planning Department for new City/State ~[/,t~1/ ` ~.u~,~/_ ~ _ parcel Identification Number ©2D - j Yom _ ©d _,~ LEGAL DESCRIPTION Property Location ~~ ~/,, ~ y,, Sec. ~O . TAN-R,~~ViT, Town of ~Gryfr~/ Subdivision 16~,~//~,c~ ,~,e~rc ,Lot #. U Certified Survey Map # Volume "--, Page # ~---- Warranty Deed # is O Volume 5 a- ~ ~ ,Page # S/,..~ Spec house ^ yes C*~'no Lot lines identifiable Dyes ^ no SYSTEII~ MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification foam, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system rs m proper operating condition andlor (Z) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification. stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration daft. !i/l' ! / SIG ATURE OF ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this forth 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. / / SIGN OF ICANT DATE- ****** Any infornration that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ,~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 'U ~523P 043 75~'1ie'~ ~~ STATE BAR OF WISCONSiN FORM 1-'1998 WARRANTY DEED Nelson. husband and wife, Grantor, and Kernon .1. Bast ana Donaida J. Sneer-Bast. husband and wife, Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 03/08/2004 12:30PM MARRANTY DEED EXE~1 # REC F£E: 13.00 TRANS FEE: 2175.00 COPY FEE: CC FEE: PAGES: 2 Burnet Title 7550 France A~ First Floor Edina. 1vtN ~~~ ~; ~ Pl ~• Post ' i'entral 020 1009 20 000/ 020 1010 80 000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) See Exhibit A attached hereto Together with all appurtenant rights, title and interests. Grantor wawa s that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except ~~~ ~ ^ ,~ Dated this day of t(` Vl \`~'~ C, \ , 2084. (SEAL) (SEAL) Rodney G. Nelson Ma et .Nelson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) } ss. St. Croix County 5~ rsonpl came before me this ~_ day of (; , 20 4 the above named Rodnev G. Nelson and Marv Beth R. Nelson. husband and wife to me known to be the person who executed the foregoing Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ~ .Ar.~i>aAM,t./ Coldwell Banker Burnet Notary Publi fate of Wisco sin 1301 Coulee Road Hudson, WI 540'16 My commissto is ~~fj~f~t, s to expiration date: 4-22808 NOTARY PUBLIC (Signatures may be authenticated or acknowledged. ') Both are not necessary.) PAM A. SPF_NCER • Names of persons signing in any capacity must be typed or printed below their signature. NoTARV PUBLIC STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1-'1998 Mliwaukee, Wis. /,% - U 2523P 04y EXHIBIT "A" Legal Description File No. 4-22808 A parcel of land located in the N'/s of SE'/, and the S'/: of NE'/, of Section 10, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin described as follows: Commencing at the E'/, comer of said Section 10; thence N 00° 01' S1" W along the East line of the NE'/,, 220.75 feet; thence N 90° 00' 00" West, 1312.43 feet to the centerline of a Town Road and the Northerly RNV of abandoned C 8 NW Railroad, said point being the point of beginning of this description; thence North 01° 00' 12" East along the centerline of said Town Road, 248.19 feet; thence North 89° 21' 11" West, 204.63 feet to a'/," iron pipe; thence North 00° 34' 38" East, 15.29 feet to a'/," iron pipe; thence North 88° 14' 28" West, 273.92 feet to a'/:' iron pipe; thence South 04° 09' 18" West, 104.68 feet to a '/," iron pipe; thence South 86° 03' 02" East, 17.28 feet to a'/." iron pipe; thence South 02° 53' 43" West, 282.97 feet to a'/,", iron pipe; thence South 89° 48' 40" West, 846.62 feet to the West line of the NE'/.; thence South 00° 05' 08" East along said West line of the NE'/,, 1334.48 feet to the Northerly RIW of abandoned C 8 NW Railroad; thence North 42° 01' 18" East along said abandoned railroad RIVY,1710.18 feet to the beginning of a 2914.68 foot radius curve concave Southeasterly whose central angle measures 4° 59' 13" and whose chord bears North 44° 30' S5" East and measures 253.61 feet; thence Northeasterly along the arc of said curve, 253.69 feet to the point of beginning. -~ ~~ IP t -~- ..- ?~v' ~G: . ~~ ~v ~ o ~ ~ m ~ I oZ on vn m i ~~Q $m ~ ~~ pQ Q `Z a~ ~ ~ ~ ~ ~ ~ ~ I~ 1 lO 1 I W wj ~ ~ ~ 1 ° W ~~ m I~ m Z ;~ I V I I J __ __ I ,_ 2~~ W $ 1 I I~ f~ W A } +C ~~ I i N w 1 I D 1 i ~ ~ ~ 1 I^ "'~ N G1 .P lO I 1~ I ~~ J j `~~ 0~0 OQ p~~ ~~ ~~ r 900°2821Mr 285.65 O T ~~ "~ r O m m At ~ m gf r ~ \ ~ yp \ O p ~ ~ ~ prnm IP .O ~ ~w ;~ ~ (d Noy °sroy •E Zoo.s~ t .,., ~, m /~ (NORTH 198+/-) t ! ± n KI/~p m ~~ Z ~ 1 ,Np a ~, ~apyr o~ V 0 0 OWN ~~ ~~ 30.15' ~ \ X349' ` OJ V p1 ~'348~ ~v `;~~ ,~oq~Rr '9Y m mN ~II`` W W O D pma ~': m ~~ ~ ~ ~pp_ CA Q D ~ A [~ ~ 1 ~ I M _ ' ~ ~ ~ : --- ~ i i N00°28'21'E 342.30' ~ I :-'1 427.48' ~ m ~_A i iQ ~ ~ ~ ~ ZZ . 207. Parcel #: 020-1407-06-000 08/08/2005 04:55 PM PAGE 1 OF 1 • AI[. rat VGl fI. IV.L.7. 1.7.LJJJ VLV - 1 VYYIY Vr ri lJ/JVIY Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-owner KERNON J & DONALDA SPEER BAST O -BAST, KERNON J & DONALDA SPEER 948 LABARGE RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 711 ZEPHYR LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.460 Plat: 2453-SHEPHERD PARK 1/11 020/02 SEC 10 T29N R19W PT NE SE SHEPHERD PARK Block/Condo Bldg: LOT 06 OT 6 2 460AC L . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-19W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 08/02/2002 685871 9/25 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.460 45,200 0 45,200 NO Totals for 2005: General Property 2.460 45,200 0 45,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.460 45,200 0 45,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin t~epartment of commerce SOIL EVALUATION REPORT 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 include, but not limited to: vertigl and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. oZ Please print all information. ev' wed by Personal information you provide may Ge used f ~ _ pq• Law, .15.04 (1) {m)). _ _ ~ Owners Mailing Address Page ~ of ~ ~ L~l'UI x - ~'f0}-o6- vCO~. 2StS'3 Date 't. Lot j~ 114s~ 1/4 Sly T # Block # Subd. Name or CSM# UI OFFICE I fl City ^ Village ~ Town N R ~~ E (or)® Nearest Road ew Construction Use: (Q~ Residential / Number of bedrooms 3 - y Code derived design flow rate 4.:50' f!oUU GPD ^ Replacement ^ Public or commercial -Describe: Parent material Ck)~~~G- ~~ -j.~"~ ~ °\ Flood Plain elevation if appligble /l1 ~Fl- ft, General comments ~~~~~~ ~ ev ~ - pLf~ ~ and recommendations: ~ ~ - ~~~ ~y. ~~ ; `~/ ~„~,C/,a~~ ~~ 7 y I ' (Boring # L~ Boring ' / I~ pit Ground surface elev_ /cfU- C1 ff ncnrh rn r..,irb,.. f~nr.,. '~ ~ ~-1 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efi#1 'Eff#2 ~ o-io I 3 2 - ~ s;l 2 m c 5 Iv-~ • 5 .$ Z (o -2$ i r 4 `- ~i/ m 'r c ~ ~- . 5 ~.~~ z o ~- Q Boring # I^,t Boring 9~~~ 1~'1. pit Ground surface elev. / fL Depth to limiting factor ~ Z 5 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 Z 3 21- loU -~ l p ~ lv ~flto _' ~ S i d m5 21f-~,abk D tm~r c s - -- _ . ~ , ~. 2 R ~., ~a.t; os, ~•••~~~~. ~~ - ovus ~ vu mcy~ ana 1 JS ~ 3U mg/L reT ni,,..,r,e. ~~~~~~«~ ieiepnvrervumDer I 2l 13 &~' ~ °s~ . ~orr,C- t (~ ~ 2 5 ~-/~ -y2 C?I ~) ZY 7 mod g . 'e. ", Property Owner ~~T Parcel ID # Page ~ of Boring # U Boring 4~ ®, pit Ground surface elev. IG~'' ~~ ft. Depth to limiting factor i ~ o in. Soli Application Rate tion dox Descri R Texture Structure Consistence Boundary Roots GP D/ft2 Horizon Depth Dominant Color p e ' ' in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. ~ Eff#1 r Eff#2 g I o-I `~ la 2 5i 1 2mrzbk f-~1Tr c s I v j _ ' Z ~j_ ~ - it 2mQ.bk ~ r c S .~ . ~ I (`~ U Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in• Soil Appliption Rate tion scri D d R Texture Structure Consistence Boundary Roots GPD/ft2 Horizon Depth in. Dominant Color Munsell p e ox e Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor gyn. Soil Application Rate n i ti Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p o Redox Descr Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mglL 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 608-2648777. seassw tnoTmoi 4 f -, 4 ,. PAGE~OF~ N ME LSD S ~ LOT# ~ LEGAL DESCRIPTION s~ ~ $~`a ,S Ib T Z~' ,LI,R, l ~ Elor)~ SCALE: 1"= y G t BM 1 ELEVATION (C3 ~ ° ~ BM 1 DESCRIPTION ~~ 6~ ~<( iS{~c,~ K ~ ~ BM 2 ELEVATION ~ ~ , g ~ BM 2 DESCRIPTION -~, Q Q--~ ~y ,~ ~~-~C ~ K o c~ SYSTEM ELEVATION Cf eC. d O ALTERNATE ELEVATION q~/~ 60 CONTOUR ELEVATION~C~.l~v ~ ~~~ ~ N ec. /0 _ ~ I 6~Z ~ / Ko . r ~~ ~ ~~ r ~ ~ % so t ~1 , I ~-~o' 1 1 a'3~~3s` ~' ~~~- ~, ______~ z ~~. ~~; SIGNATURE ~~ C® 'L I -1 ' DATE ~- ~. ~-~ d Z