HomeMy WebLinkAbout040-1308-00-158 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
� Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
574323 0
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:
Ku hal, Ryan & Shelby Troy, Town of 040-1308-00-158
CST BM Elev: Insp.BM Elev: BM Descri on: Section/Town/Range/Map No:
D
OU.v �/✓ k'k— 24.28.20.1977
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic Benchmark
Dosing Alt. BM �
Aeration Bldg.Sewer o • n I
C a 8. / !�
Holding St/Ht Inlet g 9 9:19✓ b 3
TANK SETBACK INFORMATION St/Ht Outlet • I� 9$• 7
TANK TO P -/ W BLDG. Vent to Air Intake ROAD Dt Inlet �—
!
Septic y (�+ I ! # _ Dt Bottom
Dosing Header/Man. /s • 3 '0 5
Aeration Dist. Pipe-rA�o � s 9 V qp• S-V
Holding s Bow t.System o.2P 7+4 ✓
Final Grade d
PUMP/SIPHO INFORMATION 6 7
Manufacturer Demand St Cover -;,(�! ` S D �OZ.a7
Model Number V-411 W
TDH Lift FridN ss System Hea6 TDH Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM ( 's
BED/TRENCH Width I Length No.Of Trenches PIT DIME NS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 10 3
SETBACK SYSTEM TO P/Lf7V#LDG IWELL LAKE/STREAM EACHING Manufactu r;
INFORMATION �, 0 ♦ CHAMBER --r-4 Typ Of S�V •lJ� >� ��' / Model Number:I Z
DIST IBUTION SYSTEM t
ader/ if dr Distribution x Hole Size Ix Hole Spacing Vent Air Intake
y��/ n Pipe(s) Q
Length `" Dia Length �" Dia Spacing + M '""
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 �/- �/� Bedlrrench Edges Topsoil � l Yes 1 No �-' Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 60/�T/�_Llf%!, Inspection#2:
Location: 206 Muirfield,T,ra'il Hudson, ,WI 54016(SE 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Lot 158 Parcel No: 24.28.20.1977
1.)Alt BM Description= wu�w s��`��,�L�h
2.)Bldg sewer length= is' (4,D �l�"„'�'
-amount of cover
Plan revision Required? Yes 0 10 / / -
Use other side for additional information. _ L
Date Insepctors Sig ture Cert.No.
SBD-6710(R.3/97)
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Coutriy
Industry Services Division
n 14.00 E Washington Ave Sanitary,P Number(to be filled in by Co.)
` 1, P.O. Box 7162
Madison,W! 53707— Z3
�, State Transaction 'umber
Sa ( ermit Application ��
In accordance with SPS 383.21(2��Fidm-Code-submission ofthis form to the appropriate govarrrrental tmit
is required prior to obtaining a sanitary pemlit Note:application forms for state-owned POWTS are submitted to Ned Address(if different than mailing address)
the Department of safety and Professional Services. Personal information you proAde may be used for secondary � /
u oses in accordance with the Privacy Law,s. t 5.04(1}(m) Stars.
L A licationInformation—Please:Print Ail rmation Parcel# Mv:l'�':6 Via:
Property Owner's Name
jLocation 77
Prop-y s Mailing Owner' ailing A dress property- /
/ Govt.Lot
Zip Code Phone Number 'a $� '1a Section
City,St a (cirr e
`
Lot TC2� �
N REo
r
II.Type of Building(check all that apply) Subdivision N
1 or 2 Family Dwelling-`umber of Bedrooms
r
Block R
❑public/Commercial-Describe Use ❑city of
I/�O � ❑
❑State Owned-Describe Use Village of
CS?%l number
n Toaxt of
)IL Ty a of Permit: { heck:only one box on line A. Com t tine B if ap licable)
A. New System ❑ Repinr emettt System ❑ Treatment/Holding Tank Replacement Only E] Other Modification to Existing Systetn(explain)
❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit dumber and Date Issued
B. Plumber Owner
Before Expiration
IV.T of POWTS System/Com nent/De�rice: (Check all that a I r}
® Non-Pressurized ln-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ llound>24 in.of suitable soil ❑ �+tound<2��i1n.of/suitable if
Holding Tani: Other Dispersal Component(explain)
Q Pcetreatm�tt Device(captain) .ysrt Ct �'f"2+��� ` Z
J
V.Dis ersaUTreatment rea Information:
Design.Flow(gpd) Design Soil application Dispersal irra Requirui(s� / Dispersal.aria Proposer((s System Elevation
Rate(gpdsf) ✓
. a
Capacity in �' C
VL Tank Info Crallons =
Totul =of 1-tattufPr tpr+
Gallons Lltuts A—
�(GL,
tiea'Tanks Existing Tangs J :n
❑ ❑ ❑ ❑
Septic or Holding Tank
❑ ❑ ❑ ❑ ❑
Dosing Chamber
VII.Resoo iibility Statement-I,the undersigned,assume tesponsib t ar installation of the PCtEVT5 shown on the attached plans.
Plumber's Si MP111IPRS Number Business Phone Number
Plumb 'am Pri / !>
Plumber's ddress(Street,City,State Zip Code
e✓v
VIM Connt+r/De artment Use Onb'
:approved it Fee DatF Issuep Issuin ent Signature
en Reason for Denial 5 I D� Z J I
IX.Condteasons for Disapproval
ptic't2nk,efHtisnf filtert hit`
4i#i6mal cell.must all be services f ma!Mained
as per management plan provided by plumber.
2. s !egtta errtetUs miter De-;ttt7ainEaine�
c o comp the system and sabmit to the Cou�rty only on paper not tens than S i!Z x l t tnel+es to size
CONVENTIONAL COMPONENT DESIGN
Residential application
INDEX AND TITLE PAGE
...�:...:<:::::::.;_:::::::::.:..:.;.:::.�:..,..........:....:::::::.:.......: .......::::. Project
>_
Name:
Owner s
Name:
Owner's
er s
? Ir Ca .,
Address:
-€� —
Legal Description: ��F/ ;s�/ sic.. � ��✓ -�� rc�
Subdivision: Lot#
Town: ��
County:
Parcel ID#
Designer/Plumber: License # �3
6
Signature: Date: y
g
Comments
nocianorl n.irct,ant to tha In_(,-rni mrl CniI Ahcnrntinn Cmmnnnant Manual fnr PnVI/TS Version 7-0
L
• f�
�V
�3 ,
:
Soil Absorption System Cross Section
�_ ft
ft
4°Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
Leaching
Chamber ft
_ System Elevation
ft ft
x
Soil Absorption System Plan View
ft
_ ft {
ft Leaching Trench 1
Chambers
4°Dia.
Trench 2 Header
Vent Or Observation Pipe
av,s
Trench 3
Leaching Chamber Specifications
Manufacturer And Model ,,mss/ s,,P,o
EISA Rating cZ/ sq ft per chamber Soil Application Rate _gpd/sq ft
,/,no _gpd Design Flow+ `Soil Application Rate EISA= Chambers
3 rows of __Z 7 chambers each.
Page '-of
��
lonoww'.� 11
War
=525 L 25 FILTER
INSTALLATION INSTRUCTIONS
xK '''�.'
Step 1: w Step 2: Step 3.
(A)Locate the outlet of the septic flank. (A)Before installation,Dace the (A)Glue the f�ter housing on the
(B)Remove tank cover and pump tank titter housing on to the outlet pipe. outlet pipe.
If necessary. (B)Make sure that the housing (B)Insert Me ftltw cec'b'Idge in the
is positioned so the filter can be housing,snaking sure the Uff
removed from the tank fbr cartridge is properly aligned and
maintenance and service, completely inserted in the housing.
MAINTENANCE INSTRUCTIONS
26 Cry' • 't�{-a. �`4,. `'`'
•-:+1y�F t rr ` yt `
Rg
+. . x, i
Stop 1: Step 2: Step 3: carbidge back
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the RW
necessary. into the the housing making sure
DO NOT (B)Pull the ow out of the housing. the tom'is propedy aligned
WHEN FILTER)SREMOVHP 1]
(C)Hose off the t�owttte septic ft* and completely inserEed-
:' `UGC OYES"Y Make sure all solids fall back into the (8)Replace septic tat*cover
iiH FI=1 :._.. saw#a k
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_:�fot
FILE INFORM TION SYSTEM SPECIFICATIONS
Owner c}r Septic Tank Capacity al ❑ NA
z3•'
PBrmit# 23 Septic Tank Manufacturer, _ ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS ,
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units &NA Pump Tank Capacity gal A NA
Estimated flow (average) al/day Pump Tank Manufacturer 1Z[NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate _ gallday/ft2
Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ONA
Fats, Oil & Grease (FOG) !_30 mg/L ❑ Sand/Gravel Fiftbr ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑Wetland
Total Suspended Solids (TSS) 15150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s)
❑ NA
Biochemical Oxygen Demand (BODr,) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L JtNA ❑At-Grade ❑ Mound
Fecal Coliform (geometric mean) :5704 cfu/100mI ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size YB in dia. ❑ NA
Other: ❑ NA
Other: ❑NA Other: ❑ NA
Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
❑.month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: )4 year(s)
❑ month(s) ❑ NA
Clean effluent filter At least once every: )�year(s)
❑ month(s) O NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
❑ month(s) IS NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: ❑ month(s) ! t NA
At least once every: ❑year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The 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 (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW(4/01)
i
Page 4 of
START UP AND OPERATION
construction, prior to use of the POWTS check treatment tanks)for the presence of painting products nave the contents
For new impede h p
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected
of the tank(s) removed by a septage servicing operator prior to use. !
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cel(s)have the contents of the pump cell(sl and
eemoved by a Septage Servicing discharge of
effluent. the avoid this situation h
power to the effluent pump he pump tank.Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels w P
Do not drive or park vehicles over tanks and dispersal cells. 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. ve the
Reduction or elimination of the s; cigarette butts; condoms; cotton swabs: degreasers; dental floss• diapers; disinfectants; the
POWTS: antibiotics; baby wipes, g
foundation drain (sump Pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall lie 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.
• moved and properly disposed of by a Septage Servicing Operator.
The contents of all tanks and pits shall be re
•
d and the void space filled with
After pumping, all tanks and pits shall be excavated and removed or their covers remove
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: and ma
A suitable replacement area e area should be valuate d from dis urbanae and compaction and should replacement
be infringed upon bn
system. The replacement
required setbacks from existing and s oe evaluation establish lines a suitable ell replacement area. Replacement systems must
result in the need for a new
comply with the rules in effect at that time.
[3 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 formed to locate to t identify suitablert eplacemlent area.area.
lf no replacement area is available a holding tank
evaluation must be performed
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption of such systems bmust comply with the rules nlleffect at that time.the biome; at the
infiltrative surf ace. Reconstructions
<<WARNING>> EN
SEPTIC, PUMP AND OTHER TREATMENT TMENT TANK UNDER(ANY CIRGUMSTANC SD/DEATH MAY RESULT. RESCUE OF A
ENTER A SEPTIC, PUMP OR OTHER
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS MAINTAINER
POWTS INSTAL E
Name =771
Name
Phone
Phone
LOCAL REGULATO Y AUTHORITY 4
SEPTAGE SERVICING OPERATOR(PUMPER) ,
Name
Name
Phone
Phone
4
This document was drafted in compliance with chapter Comm 83.22(2)(bl(1)(d)&(f)and 83.5 (1), (2) &(3),Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer L�
Mailing Address
Property Address 2 d
Verification required from Planning Department for new construction)
City/State / Parcel Identification Number
LEGAL DESCRIPTION,
Property Location_lr '/a, %a, Sec. 'F &_N-R,�W, Town of--�I�dt
Subdivision �i4 .-'L
Lot # .
Certified Survey Map # , Volume . Page #
Warranty Deed # ,9 97 , Volume , Page #
Spec house ❑ yes J0 no Lot lines identifiable yes ❑ no
SYSTEM 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 form, 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
is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification
stating that your septic Wx intained must be completed and returned to the St. Croix County Zoning Office within 30
days three year=ERTIFICATION OF APP D ATE
we)certify that all statements on this form are true to the best of my(our) knowledge. I (we)am(are)the owner(s) of
the described o ,b o a warranty deed recorded in Register of Deeds Office.
SI OF APPLI DATE
° : . Any OF
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
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998497
BETH PABST
REGISTER OF DEEDS
State Bar of Wisconsin Form 1-2003 ST. CROIX CO., WI
WARRANTY DEED RECEIVED FOR RECORD
07/14/2014 09:15 AM
EXEMPT # NA
Document Number Document Name REC FEE: 30.00
TRANS FEE: 157.50
THIS DEED,made between Tribella Properties,LLC,a Wisconsin limited PAGES: 1
liability company **The above recording information
("Grantor,"whether one or more), verifies that this document has
and Ryan H Kuphal and Shelby D Kuphal,husband and wife been electronically recorded
&returned to the submitter
("Grantee,"whether one or more).
Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area
estate,together with the rents,profits, fixtures and other appurtenant interests,in
Name and Return Address
St. Croix County,State of Wisconsin("Property")(if more space is River Valley Abstract&Title
needed,please attach addendum): 1200 Hosford St. Suite 201
Hudson WI 54016
Lot 158, Plat of Troy Village Sixth Addition in the Town of File: 4004646
Troy, St. Croix County, Wisconsin.
040-1308-00-158
Parcel Identification Number(PIN)
This IS NOT homestead property.
(is)(is not)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:
Easements,restrictions and rights-of-way of record,if any.
Dated June 26,2014
Tribella Properties,LLC
_.__. (SEAL) (SEAL)
*Jose ewicki,Member
(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) I ORRIE L.-DEMARS STATE OF WISCONSIN )
ss.
authenticated on SWE OF WISGONSIN ST CROIX COUNTY )
* Personally came before me on June 26,2014
the above-named Joseph Klewicki,Member of Tribella
TITLE:MEMBER STATE BAR OF WISCONSIN Properties,LLC a Wisconsin linlited4iabili company
(If not, to me known to be the perso s)who exe ed the foregoing
authorized by Wis.Stat.§706.06) instru cknowl d t sa
THIS INSTRUMENT DRAFTED BY:
*Lo ie L.Della
Fran Iverson N ry P blic,S e Wisconsin
1200 Hosford St. Suite 201 Hudson WI 54016 y Come n(is permanent)(expires:March 20,2016 )
(Signatures may be a thend ed or acknowledged. Both are not necessary.)
NOTE:THIS IS A STANDARD FORM. ODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
Y DEE ®2003 STATE BAR OF WISCONSIN FORM NO.1-2003
Aq�g�g�y7s Page 1 of 1
Property Owner Parcel ID# fly= f3•-I��—,L� Page �� of
Boring# '� Boring /
Pit Ground surface elev. /, ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2
P a
3 .5
q Q
�- 99 q
❑ Boring# Boring
® pit Ground surface elev. -5/ ft. Depth to limiting factor 97 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Qont.Color Gr.Sz.Sh. ff#1 ff#2
1
/
74 q
3 -
s- 44
� a
�l
11
aBoring# Boring ✓
Ipl pit Ground surface elev. ft. Depth to limiting factor in.
1� Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2
Z2 Z
*Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD s<30 mg/L and TSS <30 mg/L
The Dept.of Safety nd Professional Services is an equal opportunity service provider and employer. If you need assistance to
Y
access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay.
SBD-8330(Rl1/11)
l
a1Q P
Wis.Dept.of Safety and Professiona�$&v � t4p�� L'EVALUATION REPORT Page of
Division of Safety and Buildings ls1L)x1
in accordance with SPS 385,Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must ✓
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I
percent slope,scale or dimensions,north arrow,and location and distance to nearest road.
Please print all information. Rev' wed by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 71z 1
j
Property ner Property Location
t `5J Govt.Lot 1/ 1/4 S T N R E(or
Prope Owner's Mailing Ad ess Lot# Bloc # Subd.Name, CSM#
City State Zip Code Phone Number ❑City []Village Town Nearest Road
New Construction User Residential/Number of bedrooms Code derived design flow rate GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material G� �fish Flood Plain elevation if applicable ft.
General comments
and recommendations:
MBoring#
Boring /
® Pit Ground surface elev. ft. Depth to limiting factor 97 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh./J * ff#1 ff#2
Y�C
/ q 4
V
If
❑ Boring# Boring
pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2
r
-2 AS AJ
a
9Z 44�
9Z 67
i
*Effl nt#1 =BOD >30<220 mg/L and TSS>30 <150 mg/L Effluent i'f2=BOD <30 mg/L and TSS <30 mg/L
CST Nam ease Prin Signature CST Number
Address Date Evaluation onducted Telephone Number
SBD-8330(R11/11)
Property Owner Parcel ID# _3zfa--zin•- Page of
Boring
Boring#
lai pit Ground surface elev. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. :ff#1 -ff#2
� 4 a
-:5' - 7
S g
99
F71 Boring# Boring
® Pit Ground surface elev. ft. Depth to limiting factor 17 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. ont.Color Gr.Sz.Sh. ff#1 ff#2
a
4
Af
',e , _ a
a Boring# o Boring
10 Pit Ground surface elev. /0 .p ft. Depth to limiting factor� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * f{##1 tff#2
a"5
*Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L
The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay.
SBD-8330(R11/11)
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SOIL EVALUATION REPORT Page_ �- --
wisoonsin Department of Commerce i
Division of Safety and Buildings i
In aa:ordartce Meth Comm 85,Wis. Adm. Code l
�.cr �/ ST. C
Attach complete site plan on paper not less than 8 112 x 11 Inches In slze� n 6 Y c
include,but not Ifrnited to:vertical and horizontal reference point( M),cur Ion sn Parcel I.0 A30 Q �
percent slope,scale or dimensions,north arrow.and location and istance to nearest road. ��/ Dais +
20 9 2 e
Please print all information. OCT 3Rovj d b Zb Is
Panonar tNOrtnm+on you ProvWa may Da uw0lor sacondary Dwposes(Pr acy Law.S.15-04
i
Property Owner IN OFF E � N R W
i/4 S �� T
CONTI Nr m7'kL OE ELoopM EM %WWWr.
Property Owner's Meiling Address Lot If Block p Subd. Name or CSMq
1 X00 AB EKD sT. E SutTE 100 S$ — TRO`{ U 1 L LAGS (oAD3•
City Slate p Code Phone Number ❑Clry C3 Village Town Nearest Road +
Ltt1NE 55449 (7V3) 7"-75(0$ oY ' M 1 1
Code derived design flow rate��_ ----
GPD !
(� New Construction Use-.,M Residential 1 Number of bedrooms
❑Replacement ❑ Pub#c or commercial-Describe: _ ti
—
Parent matenal__� W/L t I L-+- wIAI- __ Flood Blain elevation if epplicabie --
General comments S Cf2' g gg�
and recommendatlons: TKMNC 4e-s
0.1 Ci)ADW6 RATc J
Boring
R Boring# {� Ground surface Slay. Depth to limiting factor_ — —
m. }
T' Pit a�• Spit IicaGon Rata
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff
Sit.Sz. 'Effa1 Eltp2
in. Munsell Qu.Sz. Cont.Color• Gr. i
?-;-m abg Js 0% 0•q
Z -!3 so KAz S 0: dl - 0 I.Z
! -is !owzzir — s►1 LfabK d �`
S wf4 6. O.Z
ds 0.S 0.3 0.5 I
7 y!- y _ s d s cL s — o. I,z
Boring
:A] Bo6nG>s I
(cow.) Pit Ground eurbace alov. �3 42,8 ft Depth to IImIUng factor- n• �(l Icatlon Rata r
1 -J GPD/tf
Horizon Depth Dominant Col Redox Description 'exture Structure Consistence Boundary Roots ,Eftitl 'Eft#2
n. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh.
if-L7 ,csl — s O rr\
r
o w 7/
+ rr
Effluent 91 =BOO,>30 1220 mglL and TSS>30< ISO mg/L 'Effluent 92 BOD _<30 mglL and TSS 130 mg/L
Numbo
CST Name (Please Pfint) Signature CST
/V)Alkj JO HOLL S-Ti✓ 8�
Address Data Evaluation Conducted Telephone Number
�J9g75 c�4o�``�,le, F.IUE FikLLS LoI 5`!022 (-�
�g-Z4-03 t5 y2 5
L42.6-
+
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Z.
Property Owner f 4Nj 1 yac t 5 N L DF-VU ^T-- T Parcel ID#_ Pem D -�0 --_-- Page of
Boring coKP•
® Boring#
pit Ground surface elev._�4.f.-.�- n. Depth to Limiting factor IZ�!i^• Soil Application Rata
)
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
n. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. Eft#1 'Eff#2
1 b-7 o z/z L - Gefo ds C-10 - o•S 0.8 {
Z -IZ 3 L -` fC b Z -m 0,S O. i
3 fz-l�s o y
ry,3 SI Z - ab dS zuk4 D•S
�{ IC�-7-8 0 jjL1 4114 — 5 ` d 1 �uJ 2J -� 0 -7 I,Z
5 z8-Il yrc5/y cw — 0, 7 ►,Z
LO Boring# ❑ Boring v5-6-�1 5�� yy in. T �� pC
Pit Grounds v.�� . 1—ft. Depth to limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary Roots GPO/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'E1Hi1 Eft#2
ti
Q-3 0 X3/3
Is I -m d 5 Gib - 0.7 I.2
Z -14 10-115-414-1 S 5 C T ,Z
.7 h k
�4 3K Rs/y — s I c-5 — f.z
5 -58-044 104r-214 I - S p I (. Z
�t 1 0 70 R °/0 (olE:. Iu, RS L/f) O Gs 1I - (ell'
012 5 ftA5 A 10 410 6
El VBoring a Boring# Ground surface elev._—__ft. Depth to limiting factor___ in.
Pit Soil A fication Rate t
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Etf#2
4
4
Y
If
4
V
V
4
r
Effluent#1 =BOO,>30:<-220 mg/L and TSS>30:S 150 mg/L 'Effluent#2=BODE<30 mg/L and TSS<30 mg/L
1 � i
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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.
Sao-r ISO(K 6/00)
e
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ELEV. $q5Z
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ELEV. SSS.Iv
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ELEV.
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A, nESC9IPION: r nT 159 TtKOY y IW4
I TOWN OF T"V ST (I Cam — . t Da _ SST Co s I r FAD epSeo CON
-SOIL f�OtZING W/ 3AGKNGI; I ,
jyrr NO COMM 83 5Etl3ACK pRODI.EMS
92 71.44' ELEV 894.26 LEV. 896.52 ", r
/ 134.
9 � � f
i
B 158C ELEV. 894.1 I
i
B 158A �'
ELEV 92.8 E
8.1588 I rt f
El FV 891.2 -tom B 1 t9A ELEV88.6
I'hc
w comhlete�l as graded
tticr soil
S�'stcnp (sec l,agc«nh fmalc raluar'ons��cre
cicons,, trade
depthbclo�� 1) notb cic�ations).
based _tade will nc, c a-tc
.vy ` on the, c d to be etcd, but
o �o ele'ation.� an�l n of cut or till. B,14tmincd
howl
1 i � e remained t
constant.
8 /
l 9 t
w
892
158 h
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