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HomeMy WebLinkAbout040-1312-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St, Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 572814 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: Delta Construction, Inc. I Troy, Town of 040-1312-03-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 9q , 7 04.28.19.2033 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t ` CAPACITY STATION i SQ DHy FS '7�V. Septic U J �. d ( Benchmark I ,D -F 9 g Aeration Bldg.S er �dd Holding St/Ht Inlet 5• 9l7.9 St/Ht Outlet TANK SETBACK INFORMATION V TANK TO P/L WELL BLDG. Vent t Air In ake ROAD Dt Inlet �\ Septic Z 3 -76/ ` Dt Bottom ` �r Dosing Header/Man. 7. Z Aeration Dist. Pipe 7• Z. 9 L 7. S qL .S Holding Bot.System $• Ci 45 g 'T.g 3 ,5 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover t 1 / GPM Z•� O� �+�. GD Model Number TDH Lift Friction Loss System Hea TRH Ft Forcemain ia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No f Pits Inside Dia. Liquid Depth DIMENSIONS 2 �7 SETBACK SYSTEM TO P/L jt3LDG WELL LAKE/STREAM LEACHING Manufactur n fl INFORMATION CHAMBER OR /,t^r�l r�Gv Type Of System: a 7z �C //► /. UNIT Model Number � J �U_lJ� w DISTRIBUTION SYSTEM Barg, fibill.-r.\1 Z,T }'?�Z— u`� Header/Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intakf Pipe(s) V es Length_Dia _ Length �—Dia Spacing _— `� ✓� SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seede 7&es xx Mulched Bed/Trench Center ! Bed/Trench Edges ` Topsoil E No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / ection#2: / / Location: 518 Edie Court Hudsn,,WI 54016(NE 1/4 SW 1/4 4 T28N R1 9W) Cottage Meadows Lot 3 Parcel No: 04.28.19.2033 1.)Alt BM Description= �;Jam- `�'' L�., a"" 2.)Bldg sewer length= Z3 -amount of cover= 7— Plan revision Required? 0 Yes No F/6 3� Use other side for additional information. Date Insepctoes Sig ture Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 96.0/95.8 4.5' below grade 10/10/14 BEDROOM 4 DATE 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 1/2 pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Contours on soil test dont make B.M.* Scale = 1 4" = 1 0' any sense, system is to be Vents 244' Property Line installed along a contour at 4.5' 10' below grade P P B-1 2-3' X 90' cells with>3' spacing 60' B-3 140' 100' 90' B-2 10' S 10' Pro 4 Bedroom House 322' Property Line Edie Court 189' Property Line wa County s t'rr Safety and Buildings Division 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to a filled in by Co.) a D$g { K Madison,WI 53707-7162 s1 RECE VE® 5 �g " «,�• State Transaction Number Sanitary Permit Application =DQJ 2014 /I,l� In accordance with SPS 383.21(2),Wis,Adm.Code,submission of this form to the appropriate gov t' is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to projN�ess(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be use�f�r OUNT purposes in accordance with the Privacy Law,s.15.04 1 m Stats. ` L Application.Information-Please Print All Information Parcel# Property Owner's Name . Property Location / 205 Property Owners Mailing Address / 3 J Z �� . Govt.Lot C i City,State Zip Code Phone Number ��/�, ,�jLJ'/�, Section ' • ) � cle o W ) Dl TN; R E U. ype of Building(check all that apply) L Subdivision Name 2 Family Dwelling-Number of Bedrooms / M Ok 4A JS G. Block . ❑Public/Commercial-Describe Use ❑City of CSM Number ❑Village of ❑State Owned Describe Use .�►�� wn of A0 2- D,ai- lL 2,;7j- ZZ 5 III.Type of Permit: (Check my one box on line A. Complete line B if applicable) er(,,x, A. System El Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New Before Expiration ;nom W.T e of POWTS System/Component/Device: Check all that a I ?.Ton-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil 1 El Holding Tank El Other Dispersal Component(explain) ❑Pretreatment Device(explain) r , S V.Dis ersal/Treat ent Area Information: Design Flow(gpd) Design Soil Application Ra dsf) Dispersal Area Required(sf) Dispersal Area Proposed f) Sys JElev o s,Total #of Manufacturer VI.Tank Info CGGallonsm Gallons Units n U' b N New Tanks Existing Tanks Septic or Holding Tank ✓' V Dosing Chamber VII.Responsibility Statem nt—1,the undersigned,assume sibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' a MP/MMPRS Number Business Phone Number / ,. 7 C — !.r / r �b Plumber's Address(Street,City,State,Zip de) ) / „ , /� / VIII ountv/De artinent Use Only Permit�Fee C� Date Issued Issuing t Signature PProved rsa ed $ tI!✓' ven Reas Denial i IX Condysasons for Disapproval 3> a��` t0d, r tank,effltt�nt filter and .�'G ;r-rrio r dispersal cell must all be servtoeS!rnaintairted t J► ^- l'e`<� ' as per management plan provided by plumber. 2 .A jsekaq�pqulremerft must bw maintained c6dil ordinances. Attach to complete plans for the system and submit to the County on)y on paper not less than R 12 111 iochcc 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: 10/10/14 Owner:Delta Construction Location: NE 1/4 SW 1/4 S4 T28N,R19 518 Edie Court Troy 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 ontingency Plan 7. Filter Specificatio heet Signature License num #226900 PLOT PLAN PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 96.0/95.8 4.5' below grade DATE 10/10/14 BEDROOM 4 CONVENTIONAL XXXX 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 1/2 pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark AL All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. B.M.* Scale _ 1 /4" = 10' Contours on soil test dont make any sense, system is to be Vents 244' Property Line installed along a contour at 4.5' 10' below grade B-1 2-3' X 90' cells with>3' spacing 60' B-3 140' 100' 90' B-2 10' S 10' Pro 4 Bedroom House Edie Court 322' Property Line 189' Property Line 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 To be >1' above rade 5.6ft^2 pair of end plates g Finish grade elevation Typical Installation 100.5' Grade Vent 4„ 3' x/30/34 Septic Tank ,tv,en' 5' S' Long 1 Grade at System Elevation 3 6 Grade at System Elevation Spacing 5' 2-3' X 90 ' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-96.0' B 95.8' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Ovrner Tank Manufacturer: /�tT ❑ NA Permit# �{ 2 tic ❑ Dose ❑ Holding Volume: /� (gal) Tank Manufacturer: DESIGN PARAMETERS Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: NA Vertical Distance Tank Bottom(s)to Service Pa�:/ (ft) Estimated(average)Flow: �Q 6 (gauday) Horizontal Distance Tank(s)to Service Pad: (n) / Specific servicing mechanics must be provided'rf vertical is>15 feet o Design (peak)Flow=(estimated x 1.5): t��V (gauday) If horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: -7 (gaudayn?) Effluent Filter Manufacturer: �/g�'� ❑ NA Standard(Domestic)Influent/Effluent Monthly average. Effluent Filter Model: Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer: NA Biochemical Oxygen Demand (BODs) s220 mg/L NA Pump Model: Total Sus ended Solids(TSS s150 m L High Strength al uenUEffluent Monthly average Pretreatment Unit (FOG) >30 mg/L " Manufacturer. A (BODs) >220 mg/L >t<NA ❑Mechanical Aeration ❑Peat Filter SS) >150 mgr- ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other. (GODS) 530 mg/L Soil Absorption System (TSS) 530 mg/L round(gravity) ❑In-Ground(pressure) ❑ NA Fecal Colifom(geometric mean) 510' ❑At-Gra ❑Mound ❑ dia_ r. ❑ NA ❑Drip-Line other: Maximum Effluent Particle Size X in ❑ NA Other. A Other: MAINTENANCE SCHEDULE Service Event Service Frequency hen combined sludge and scum equals one-third(%)of tank volume Pump out contents of tank(s) ❑When the high water alarm is activated months) (Maximum 3 years) El NA Inspect condition of tank(s) At least once every: WI) Inspect dispersal cell(s) At least once every: �yeanh(s) (Maximum 3 years) ❑ NA months) 0 NA Clean effluent filter At least once every: /� ear(s) ,•,� ("l month(s) ❑ NA Inspect pump,pump controls&alarm At least once every: ar(s) ❑month(s) NA Flush laterals and pressure test At least once every:. p year(s) ❑month(s) NA Other: At least once every: ❑year(s) NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shalt be made by an individual carrying one of the following licenses or certifications: er, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Master Plumber, Master Plumber Restricted Sew Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, r ponding of e measure the volume of combined sludge and scum and a check for any back up offluent on the ground surface. The soil absorption system 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 treatment tank equals one-third ('�)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113, Wisconsin Administrative Coder 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 5512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or of her chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be-discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of efflaent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when sal conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the _ n area. within 15 feet down slope of any mound or at grade soil absorption area w t Reduction or elimination of the following from the wastewater str eam may improve the performance and prolong the Irfe of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge,fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,sanitary napkins,solvents,tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently of service the following steps shall be taken to insure that the system is properly tly taken out and safely abandoned in compliance with s. Comm 83.33,Wisconsin Administrative Code: • All piping to tanks,pits and other sal absorption systems 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(pumper). • 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 provide a code compliant If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to Pr replacement system: utilized for the location of a replacement soil absorption system. A.suitable replacement area has been evaluated and may be The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area viii result with the rules for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at the time of their pennit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ surface and Reconstructions absorption systemsm systems comply with the rules in effect atothat gme.�oval of the bianat at the infiltrative WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT RESULTS ESCAPE OR RESCUE LIFE. OFRA ANY TANK TANK MAY UNDER STANCE. DEATH MAY OT BE PO POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name /, `I-,FName Phone ��= This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. FILTER CARTRIDGE INSTRUCTIONS Installation G ` outlet pipe to ensure it is ca se o onto the end of the p P filter STEP e pry fit the into the centered under the access opening. If not,then either Insert more pipe tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning .. clockwise 901. Maintenance 1. The effluent filter should be cleaned every time the septic tank is r rte•" Ew serviced. ng to inspect the tank and filter. 2. Open the outlet access openi 3. pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning, 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned with water only. 7. While holding the cartridge on its side (large flat surface facing iI down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. k • 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until ill Y the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY s in flea;rJnsite fiter Cartridges are�t%arrantec to be free of defect n�aterial a:,d •:crkr*�a^shit fo?five i ±"a`5`rorr consumer purchase. BEAR.ONSITE"Filter Case-Lifetime Limited Warranty e pe.,od c.Jrne Bear:insite warrants the niter case•::Ill be free of defects inn-a+te r,a':a.^.r:y.orkr��a;:si3rp:i urrrr;normal±se f ,tic or!g!1 4 purcraser owns the product <c or, p n the a r a emeni part or p od Ur r a .Bear product caused e - a'+ p Im oD_ If a oefe -is found": normal us h s v a -'h approC i ad.]usbrlent,Damage to a product Ld�S£d by d�c+�E"1 T1Kuse O d�use i5 rot O`�4rh InS IV tt�n ro-� t i ill care or malfunct;,ns resulting from units not install h ne yea ne prov aed t,5ro•�On.,i�e with all war a t i�irrs. ar void the warranty,Prcof of pw chase;a-iaina sales e eip;. - Onsite!s not responsible for tabor charges,rerrmvat cha!ges,installabon•o:other i:odental or_onsLauehtai in no event shall the liability V Bear Onsite exceed the purchase price of the product. � ST. CRO0X COUNTY SEPTIC TANK M AND OWNERSHIP CERTIFICATION FORM Owner/Buyer TV,A MailingAddress- Pznoev �d�c " Property�� (Verification i7equired ftorn Planning&Zoning Depait, e t for new construction..) City/State Parcel Identification Nur-lber LEGAI, DESCRIPTION Property Location I/. . ] ~7 � 7- Subdivision a, Lot# Certified Survey Mmp #_ . \/o1uom "--- Pugu#___________ W � �� (� m���De�# - Vo[time Page# ------ _ Spocboo no Lot line: idextifiuh no SYSTEM MAINTFNANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could restilt in its pr',mattire failure to handle wastes. Proper maintenance consists of pumping out the xnydc tank every three ynmm or sooner, b'uendud.by u licensed pumper. what you put into the system can affect the fiinction of the septic tank as a treatment stage in the wasie disposal system. Owner maintenance responsibilities are opecifiodio6(�nozo` 8J.5%(1)and iu Chapter]2 St. Croix Coundy Sanitary Ordinance, The property owner agrees to submit to St. Croix County Planning&Zon ng Department a certification form,signed by the owner and 6yu master ylumbez.jonzooyomo plumber,restricted plumber o, uUcoaood pumper verifying that(\)the on-site wastewater disposal system ioio proper operating condition and/or(2)after iuxpxcdoo and pumping(i[zecomyu/y),the septic tuok-ix less than 18 full n[sludge. l/wu'the undersigned 6avvrnuJthm^6ovorugui,oumuuz'`duumvmozuutaini6oprivauoovv'uurJ6opooalxyvm,u*/ith0/o standards set forth,herein,as set by the Department of Commerce and tile Departir,riat ofNatuiai Resources,State of Wisconsin. Certification stating that your septic system has been rnaintairled must be complete,I and returned to the St. Croix County Planning& JouingDupurtnmeot within 30 days of tile dbneo year urpiouiuo 6Wn. lhwo certify that all statements are uo;to the best ofnuy/onzboo, ludgv. Dvc uo/uro the ovzor(x) of tile property duxo�6udabove,6yv "'of Jnud recorded b Register ufDoo.tsOffice, N ue M °�y— �T(�� �� ����T��r�T/�\ DATE �� z^^u,^/� APPLICANT(S) ***Aoy information that is misrepresented may result in the sanitary permit being z,:vokedbythe Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Registei o Meeds 0 ffice and a copy of the certified survey map if � reference iu made jo the warranty deed. (REV.08/05) U. 2 8 6 8 P O 4 y KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI DOCUMENT NO. RECEIVED FOR RECORD 08/16/2005 02:00PH WARRANTY DEED This Deed made between CORNERSTONE EXOPT # PARTNERS,a Minnesota limited liability company, REC FEE: 11.00 Grantor,and DELTA CONSTRUCTION,INC., a TRANS FEE: 3120.00 COPY FEE: Wisconsin corporation, CC FEE: PAGES: 1 Witnesseth,That the said Grantor conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: RETURN TO: TVA' -;40a3 '-/0t0 Lots 1-13, inclusive,Plat of Cottage Meadows_in the Town f of Troy, St. Croix County,Wisconsin. This is not homestead property. Tax ID# 040-1014-20-000; Together with all and singular the hereditaments and 040-1014-50-000 and g 040-1015-80-000. appurtenances thereunto belonging; and Cornerstone Partners,LLC warrants that the title is good,indefeasible in fee simple and free and clear of encumbrances except easements,restrictions and reservations, if any,of record. Dat th day of August ,2005. CO TONE P RS,LLC (SEAL) Its: AUTHENTICATION ACKNOWLEDGMENT Signature of as STATE OF WISCONSIN ) of Co y}gtAtyy�arhtets, )SS LLC authenticated this day of August, GUL ,,� COUNTY OF ST.CROIX ) TITLE: MEMBER STATE BAR OF Wjgge•S �tiS Personally came before me this 1 5 t]jay of August,2005,the _ �� *Y above named (Signatures may be authenticated or ackftdged. B.*.not � of Cornerstone Partners,LLC,to me y7CC = known to the person who executed the foregoing instrument and necessary] y AU BLDG acknow d d the same. THIS INSTRUMENT DRAFTEW) t•' 0X-,�`� ,^ D.Peter Seguin '11; OF W%5 0 r J MUDGE,PORTER,LUNDEEN&SEdt"!19t. 110 Second Street,Post Office Box 469 Notary Public,state wilco s' . Hudson,Wisconsin 54016 My Commission(expires): ��'11-200 5 . ., . �If LB TED ' 'LO HII 43667 S.F. r 1 .00 Ac. L ., ;;. ZIr ` IZO m LO 'A J 43560 S. a/ #� 1 .00 ff i f t awn t. V Z , LO 4 a s 43582 R � CIV '. 1 . 00 .. 4 i Ogg -__ -__ o s �l� JUN, 9 X00 SOI TION REPORT Page of ce with m 85, Attach complete site plan on Z zy11' in size.Plan S-T C R D I X, Include,but not limited to:vertical and ha nce po (BM),direction and = Parcel I.D. f percent slope,scale or dimensions,north arrow,and to distance to nearest road. Please print all Information. penw7 Dale Personal brformeron you Provide cry be used for sego WM papom(Pmacy Law.s.15.04(1)(m))• /d (J Properly Owner pp Property Location p 3 —Taxn> 191 EI?$TE%DT' Govt.Lot Nf 114 Svc 1/4 S 4' N R /9 E(or) Owner's MaNtrtg Address B # Sut Name or CSW 2— bM-4 HA- LI C0T-r-9CXE MC�t�W5 City State Zip Code Phone Number ❑city ❑Village [$Town Nearest Road l-1 L4>5101") W I 6' 01 New Construction Use:[ Residential/Number of bedrooms 3"$ Code derived design flow rate 450— 7 rj0 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material 6 uT w A s1-t //�GtFt}�DV�'lt Flood Main elevation if applicable L- * ft. General comments Area X Spot Tested suitable for / �# •ClQ fL Depth to limiting factor 99 in. © Pit Ground surface elev. q Soil Application Rate Horizon Depth Dominant Color Redox Description Textrre Structure Consistence Boundary Roots GPnfft? In. Murrseti Qu.Sz. Cont.Color Gr.Sz.Sh. •Eif#1 '01102 0_/0 f 0Yrz 3/2 - k 3 _f qr m 4, a 5 3 v-� . b 2 16.23 /0YRy/4 - 5Cl 20Sbw- Mff aw 24 mot- 3 23-99 ��YR /` - 5 o s / - - 77 l # ❑ Boring a � ® Pit Ground surface elev.16 1.00 ft. Depth to limiting factor >�/fo in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDd(t: In. Munseti Qu.Sz. Cont Color Gr.Sz.Sh •Eff#1 •Efr#2 / 0-15 1 vra 2/z gr M r g5 3vf . 4 8 2 15'-31110 YR 4'/4 — C/ 2 M e,bk fn JC; a w 2-of --f - k °3 3 C Iv YR 5/4 S Q 5 C( I - -7 1 n •Effluent#1=BOD >30:5 720 mg1L and TSS>30<150 mgA_ 'Eflluent#2=BOD 130 mglL and TSS<30 mg& CST c—MK) t_r3(2-iLH-r Number�S93� Address Date Evaluation Conducted Telephone Number 2012- l U?-H 4✓E SPR IN f-7 LE;'j- 14� /H�ty 1D-2a1115- 67/C) 772.- 34'y-Z For issuance of permits and designing Utbricht & Associates Contact: Ulbricht&Associates Private Sewage Consultants Registered private wastewater consultant and pitatrlb8ts 2812 10th Ave. 2812 10th Ave. Spring Valley, VVI 54767 Spring Valley,WI 54767 715-772-3442 ORIGINAL 1 i3J' 2 s-tE•r�-r eo-rTA&Te mv.4 .W 5 pal&iE 3 *F 3 i-o-r 3 U bricht &Associates Private sewage Consultants 2812, 10th Ave. tzrir?c� Valievt Wl 54767 O A = CoNTouP, A L-E For issuance of permits and designing Contact:Ulbricht&Associates Registered private wastewater consultant and plobw 2812 10th Ave. Lt Q Spring Wley,Wl 54767 715-772-3442 A �► - a c �3M p•0O 2 p �• >��� P s E-r 2-1 D 100-03 A A 13Z OL yz � T p 507 2" �t3ov� C-rRovnl p � �' 101 •b tc QO �0Vk f LO �q'