HomeMy WebLinkAbout040-1292-00-000 County r
Safety and Buildings Division
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7` Il r 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be fi led in by Co.)
S �� Madison,WI 53707-7
ST.C;,ROiX CviJi`iTY -NT 7Z-737 �0
'O `,1 anitary Permit Application tateTransact�nNumber
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ��� l In
purposes in accordance with the Privacy Law,s. 15.04 1 m,Stats.
I. Application Information-Please Print All Information
Property Owner's Name / Parcel#
Property Owner's Mailing Address ,J Property Location
Ile S C' Govt.Lot
City,State Zip Code Phone°Number �J y4 s�r y, Section!
9( C�e'til`'/ / Z �Q�- 1a ✓ ! - ��(� .I�N R ��irc1E-40
H.Type of Building(check all that apply) Lot#
0--1.r 2 Family Dwelling-Number of Bedrooms / Subdivision Nam/e� /
L`Y -e Siz&
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
0-'rown of
1lv+-11,o
III.Type of Permit: (Check only due box on line A. Complete line B if applicable) o
A. E-K-ew System ❑Replacement System
❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain)
B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner -- ' f�_ D
C..
IV.Type of POWTS S stem/Com onent/Device: Check all that appi
R'on-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil 1()5
❑Holding Tank ❑Other Dispersal Component(explai ❑Pretreatment Device(explain)
V.Dis ersaUTreat nt Area Information:
Design Flow(gpd) Design Soil Anplication Rate(g f) Dispersal)A/Tea•Required sI) Di s rsal Area Pro s o(sfJ� System Elevation
VI.Tank Info Capacity in Total #of Manuf/ac e
Gallons Gallons Units /G / ° o O„
New Tanks Existing Tanks O V/ C
19f7
a 0
` U rn w C7 0.
Septic or Holding Tank
Dosing Chamber L(J
VII.Responsibility Statement- I,the undersigned,assuipe responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plu igna MP/MPRS Number Business Phone Number
Plumber's Address(Street,City,State, ip Code)
Ll IGG
V Coun /De artment Use Only If
Approved Penn it Fee Date sue Issuing ent Signa
tven Reason for ial
IX.Cond' PAft
TJK9 Measons for Disapproval
1. Septic tank,effluent filler and .
dispersal cell must all be services/rtaaititairaed
as per management plan provided by plumber.
2. Aksetl lack.regal!`eMlfttmlastl>gx(}illlntalFted.
as per apO aftotiW orb,
Attach to complete plans for the system and submit to the County only on paper not less than 8 rn x 11 inches in size
SBD-6398(R. 11/11)
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KNUOTSON PLUMBING-
CONTRACTING,LLS
927150TH ST.648447WiPRS
ROBERTS,WI 54023-6523
CELL 6 1-4 -1737
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Forliti Sewer
Owners Name: Ed Forliti
Owners Address: 1894 110th Ave.
Baldwin Wi. 54002
Legal Description: SE 1/4 SE 1/4 S. 24 T. 28N R20W
Township: Troy
County: St. Croix
Subdivision Name: Troy Village 5th Add
Lot Number. 139
Parcel ID Number: 040-1292-00-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing&Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test&House Plans
Designer/Plumber. Keith Knudtson License Number: 648443
Date: 12/09/2014 Phone Number (651)470-1737
Signature
I
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01).
Page 1
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KNUDTSON PLUMBING&
CONTRACTING, LLB
827150TH ST.648447MRRS
ROBERTS,Wl 54023-8--23
CELL 1-4 -1737
z
Soil Absorodon Svstem Cross Section
102.90
ft
Final Grade
4'Schedule 40
PVC Vent Pipe 5.00
With Vent Cap
Leaching 97.10
Chamber ft
J 5.0 ft System Elevation
Soil Absorodion Swtem Plan Vlew
i
ft
3.00
ft
5.00
ft Leaching Trench 1
Vent Or Observation Pipe Chambers
4'Dia.
Trench 2 Header
Leachina Chamber Saectflcatlons
Manufacturer And Model quick 4
EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.70 gpd/sg ft
450.00 gpd Design Flow+ 0.70 Soil Application Rate + 20 EISA= 32.00 Chambers
2 rows of 16.00 chambers each.
j Page of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ° �2
FILE INFORMATION SYSTEM SPECIFICATIONS
Ov ner 1 c Tank Capacity al ❑ NA
U
Sep
Permit# Septic Tank Manufacturer c�Ser' ❑ NA
DESIGN PARAMETERS Effluent Filter Manufactures L I a.l� ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Faciltty Units �8 A Pump Tank Capacity al *-NA
Estimated flow (average) allday Pump Tank ManufacturerA
Design flow (peak), EEstmmated x 1.5) e74f 6_eLdM Pump Manufacturer X9A
Soil Application Rate y aUday/ft2 Pump Model A
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit A
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) <290 mg/L ❑ NA ❑ Mechanical Aeration ❑Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated EfHuerit Quality Monthly average D'e al Cells) QV.ck-4 ❑ NA
Biochemical Oxygen Demand (BODE) 530 mg/L round (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) S30 mg/L ❑ NA ❑At-Grade ❑ Mound
Fecal Coliform (geometric mean) <104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size s in dia. ❑INA Other ❑ NA
Other: ❑ Other` ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3 ❑ yeartS(s) (Maximum 3 years) ❑ NA
Pump out contents of tanks) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cells) At least once every: 3 ❑pnonth's) (Maximum 3 years) ❑ NA
years)
Clean effluent filter At least once every: rnth(sl ❑ NA
yearls)
Inspect pump, pump controls & alarm At least once every: ❑ m )
❑yeaar((ss)) A
Rush lat Y
erals and pressure test At least once every: 0 yeearr(ts)s) NA
Other. At least once every: ❑ month(s) ❑ NA
❑ 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 teaks,
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 componerrts, 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.
0
Filters
y_
EFFLUENT FILTER
'L-525 Filter is rated for
10,OQO GPD (gallons per day) 1116" Filtration Slots
. rtg it one of the largest filters --��
= class.It has 525 linear feet f i
= € 16"filtration slots. Like the
AQMW PVC
PL-122,the Polylok
-52 tins-an automatic shut
off ball installed with every filter.
r the filter is removed for
":moaning,the ball will float up and
rarity shut off the system so
Ahka effluent won't leave the tank.
FL of Inr
No other filter on the market can F&rAwSkft
inake that claim. ]1i - I
-525 Maintenance. SM.
40 F"
The PL-525 Effluent Filter should `
operate efficiently for several years
onder`normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at:least every three years. If the
installed filter contains an optional
alarm,the owner will be notified
by an alarm when the filter needs
servicing. Servicing should be ll
done by a certified septic tank
pumper or installer.
1. Locate the outlet of the U.S.Patent Nod so15,488 -�--®W VA=FWm is
5,871,640
septic tank.
2. R
Remove tank cover and pump
tank if necessary.
PR -525 i 3. Glue f
et et
terhousing
to
3.Do not use plumbing when the 4" or 6" outlet pipe. If
i
P 9 PP
filter is removed. Ideal for residential and com- the filter is not centered
mercial waste flows u to under the access opening
4. Pull PL-525 out of the housing. P use a Pol lok Extend &
5. Hose off filter over the septic
10,000 Gallons Per Day (GPD). y
Lok or P
iece of pipe to
tank. Make sure all solids fall
P
7. Local center filter. See page
Locate the outlet of the p g
back into septic tank. septic tank. 19-21 for Extend & Lok i
6. Insert the filter cartridge back 2. Remove the tank cover and information.
into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter
the filter is properly aligned into its housing.
and completely inserted. 5. Replace and secure the
7 Replace septic tank cover. septic tank cover.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Edward & Cindy Forliti
Mailing Address 1894 110th Ave. Bald in Wi. 54002
Property Address 313 Lindsey Rd. V::� d
(Verification required from Planning&Zoni partment for new construction.)
Number 040-1292-00-000
City/State Parcel Identification
Y
LEGAL DESCRIPTION
Property Location S E 1/4 , S E 1/4 , Sec. 24 , T 28N R 20 W, Town of Troy
Subdivision Plat:Troy Village Fifth Add. , Lot# 139
Certified Survey Map# , Volume , Page#
Warranty Deed # (before 2007)Volume ,Page#
Spec house Dyes[Zino Lot lines identifiable Byes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&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.
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 Safety And Professional Services 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 Planning&Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on is form 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 w anty deed recorded in Register of Deeds Office.
Number of bedrooms 3
NATURE OF APPLICANT(S) DATE
I+
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.04/12)
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20136 4
State Bar of Wisconsin Form 1-2003 /1004307
WARRANTY DEED
BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
11/17/2014 12:09 PM
THIS DEED, made between Darcy Jerome, a married person ("Grantor," EXEMPT#: NA
whether one or more), REC FEE: 30.00
and Edward J. Forliti and Cynthia J. Forliti, husband and wife as survivorship TRANS FEE: 300.00
marital property ("Grantee,"whether one or more). PAGES: 3
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate, together with the rents, profits, fixtures and other
appurtenant interests, in St Croix County, State of Wisconsin ("Property") (if Recording Area
more space is needed, please attach addendum):
Name and Return Address
SEE EXHIBIT"A"ATTACHED HERETO Title One Premier Group,Inc.
706 19th Street South
Hudson,WI 54016
040-1292-00-000
Parcel Identification Number(PIN)
This is not homestead property..
(is)(is not)
Grantor w ants t at the title t the Property is good, indefeasible in fee simple and free and clear of encumbrance
except- oadways, asement d Restrictions of Records.
Da ed November 2014
(SEAL) (SEAL)
Darcy Jerome
(SEAL) (SEAL)
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO.1-2003
*Type name below signatures.
File No.:30101 Page 1 of 3
St.Croix County 1004307 Page 1 of 3
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin}
}SS.
authenticated on 13th day of November, 2014 St Croix County}
Personally came before me on 13th day of November, 2014
, the above named Darcy.Jerome, to me known to be the
TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who a eeated the foregoing and acknowledged
(If not, the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY: :��ar. •,,-''Nancy chmitt
Michael H. Forecki NOTARY'•, I�}otary ublic, State Wiscons•
----- : * Commission Ex y 01, 2017
�.•
PUBLIC.
I
Ili
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO.1-2003
'Type name below signatures.
File No.:30101 Page 2 of 3
j St. Croix County 1004307 Page 2 of 3
EXHIBIT "A"
LEGAL DESCRIPTION
Lot 139, Troy Village Fifth Addition, Town of Troy, St. Croix County, Wisconsin
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO.1-2003
*Type name below signatures.
File No.:30101 Page 3 of 3
St.Croix County 1004307 Page 3 of 3
1
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Wisconsin Departrnant of Ccxmm= SOIL EVALUATION REPORT Pape of 3
phAsbn of Safety and Buildings
In accordance with Comm 85,Ms. Adm. Code
Attach complete site plan on paper not less then 8 1/2 x 11 Inches In size.Plan must COtX>ty 25T, C�D�
Include.but not Nmited to:vertical and horizontal reference point(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O y0--/2__4 2-DO- o 0 0
Please print all Information. vie Date
Personal information you provide may be used for secondary purposes(Privacy Low,a.13.04(1)(m)).
Property Owner Property Location
eLy'l-V L i cV�lA T mlel°• .SF- 114 SE 1/4 Spy T z8' N R 20 W
Property Owner's Ma81ng Address Lot p I Block 0 Subd.Name or CShW
I IQ 0 13 Ko i`' �, /0 r-, SU rTI-- Iw� 13 — TArj Q I LLfl6�- F IF 4i ALD,
State ZIP code Phone Number []City ❑Village Town Nearest Road
3t_Pr(NE MN 55y`� (7l' 757-75�g T�0 LtA1)SA RbATJ
New Construction Useo Residential/Number of bed p derfv design Bow rate __�..�..._GPD
❑Replacement ❑ Public or oorrunarclel-
Parent material b LJCT V-V6\-`
O f lood LIU evat n ii sppllce�Gl
General comments 1 4 __-,
and recommendatons: CONU EJJT t W A L_ p
R,
S ZpNING OFFICE
s�
❑ Boring 'd�-
t �* �. ft. Depth to limit) factor In.
Pit'
it Ground surface elev._�2!_ limiting
Soil Application Rate
Horizon Dep -0-
onilnant Color Redox Description Texture Structure Consistence Boundary Roots PD/ff
In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh, 'Efflll •Efflf2
0.b Y L1,6 D.t{ 0,
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P
M 9 it Ground surface elev. $R Z. I ft. Depth to Nmlt)ng factor----In. SoM Application Rate
Horizon Dep Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf
in. Munsell Ou.Sz. Cord.Color Gr.Sz.Sh. 'Eff/11 'EI1*2
'0-4q lb\I 2-j 0 b 1�•m 0,5 Wi
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Effluent tf1 ■SOD >30:5 220 mg4.and TSS 30 150 nVk 'Effluent 02 a BOO,;!30 nv&and TSS<30 rng/L
CST Name(Plea P(int) Sl atu►e CST Number
10 H L.L. STIL ZZ48i>?-
Address Date Evaluation Conducted Telephone Number
Wq�75 e9p+ Ave, RvE FAU.S WT 54022 ()q-0 Z- 0 7- -715 yZb-��75
6I,� oyo- )291-4o-oad Pa z
P �Owner Cofst I N�A1�AL �TcL• I Perael ID 0 Page of
F;�l Boring# ❑ Boring
�( Pit Grw,r+d turfeoe ebv._8y Z_ o n. oepth io rlmlbng rector_ �Z% in. sou Ncanon Rabe
Horizon Depth Dominant Color Redox Descriptioo Texture SbXIure Colutatenee Boundary Roots GPDRf
In, Munsel Ou.Sz. Cunt Color Or.Sz.Sh. r •Eftt'l 'E"2
-y lb 15 Z -! `jt` -Mt70.b dS ��T Yn O 0.8
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Boring i ❑ Boring 0�
❑ Pit Ground surface elev. R. `�VOepth o limiting Is _ In. Shc Application Rite
Horiton Depth Dorrrinenl Color Redox Description a re SIn d.ure Consistence Boundary Roots GPOM
In. Munsell Ou.Sz. Cott Color GGr, z,Sh. 'Eftdt 'Effp2
1 I
I
0[�� Boring
}Boring ra Ground surface etay. _R. Depth to limiting factor In.
❑ pit Sou tion Rate
Horizon Depth Dominant Col Redox Description Texture Stricture Consistence Boundary Roots G
In. Munsetl Ou.Sz. Cont.Color Gr.Sz,Sh. 'EftMt TIM
Effluent p1 ■BOO/>301 220 mp/L and TSS>30<150 mg& ERluenl K2■8001<30 mg&and TSS 30 rngtL
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 608-266-3131 or TTY 608-264.8777.
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PROPERTY OWNER CL)KM tbPtL 'Z)ZV. SOIL DESCRIPTION REPORT Page(?ot•3
PARCEL W.# X rz))ly C�
Bo.rinq# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmrd3y Roots GPD/ft
.� in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh.
:<:•: Bed Trerxh
W4` Z- 31b 10 rt M VF cam, S -
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Ground 3 33-y1 lu`�� S13 '1,S`IRS�4� Si CI l �Sbk ►+�`�i c�,S ,Z 3
elev.
(i°JZ,Fp. yl_1Z0 -1.S`tR 3l — SM6h ® S9
Depth to
limiting
factor i
Bgi i�g #
Remarks:
,> >� � o_�� ���tz 3 tz - si 1 1w1 ab12 ash cg _ •-z - 3
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Remarks:
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Remarks:_
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Wisconsin Department 4ustry,
Labor and Humari Relations SOIL AND SITE EVALUATION.REPORT Page I of '3
Division of Safety&Builclings in accord with ILHR 83.05,IALIs.Adm.Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size3 Plasr must include,:btit
not limited to vertical and horizontal reference point(BM),direction and�'of slope,scale or PARCEL I.D.# p t,u G
dimensioned,north arrow,and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI"OIN REVIEWED BY _ DATE
PROPERTY OWNER: PROPERTY)*r PION-
CO U'11 tU �3C�L'�l.UP► 1 C°-0��, 5 E 1/4 S 12_� 1/,,SZY T Zb YR, Z.0 E( W
PROPERTY OWNER':S MAILING ADDRESS• L T# BLOCK# SUBQrNAME OR CSM#
\Z3ot Ca t i�U�►J.�. *� Z3� 8 T'%0`f U LP f- PrDD .
CITY,STATE ZIP CODE PHONE NUMBER CITY ❑VILLAGE [MOWN ' TEAREST ROAD
B L f•�LfU ,t`'t fv S S 4'1y ( ) TQ-0K t.JpS PM �►g'D
[XL New Construction Use Residential/Number of bedrooms_ 1/ [ J AdditiQn to existing building
( ) Replacement [ J Public or commercial describe
Code derived daily flow 6U0 god Recommended design loading rate bed,gpd/ft2 _`d trench,gpd1ft2
Absorption area required 8 S$ bed,ft2-ASo trench,ft2 Maximum design loading rate •1 bed,gpd$ •8 trench,gpd/ft2
Recommended infiltration surface elevation S ft (as referred to site plan benchmark)
Additional design/site considerations S Yv oTe TM ON k 6 e 3
Parent material L S o y N�FZ G LP01 prt.. UVT1j1*3 Flood plain elevation,if applicable N A ft
S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE ( AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ®S El IRS ❑U ®S El U ®S ❑U Gl S ❑U O S �U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color I Mottles (Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. Bed Tntd1
YvT:v:1jt::i+x
;., i C' to�tZ 31-Z
p Y — stl Z�sbk S cs
s o S �� ct,� •� -1d
Ground 3 ZD-t2 S -1.S`M '31Y S> 61-
elev.
c5Q2.8 ft.
Depth to
limiting
factor
>VL S''
Remarks:
Boring#
C5-1 1 L S 1 \'M 0..12 a S
Z ►I-3� 1.S �Ryl6 ZCSb1Z MU'�h cf.J S ,
3 3-a-\-?-o - S `12 31Y y` S 6ti v S9 w1 I •1 •u
elev.
� 1 ft
Depth to
limiting
factor
> l Ltd+
Remarks:
CST Name:—Please Print Phone:
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River .Falls,WI. 54022
Signature: cl_Z c)•7 _ ( Z$ Date: L I - 3 0`Q q CST Number:.
220254
Wisconsin u a ti Industry, SOIL AND SITE EVALUATION REPORT Page I of 3
Labor and Human n Rel Relations
Diviswn of Safety 8 Buildings in accord with ILHR 83.05,Wis.Adm.Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must incl.00,but
not limited to vertical and horizontal reference point(BM),direction and%of slope,sc or .� P ELL" �C-wp IAJ�
dimensioned,north arrow,and location and distance to nearest road. '
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
-
RV , DATE
PROPERTY OWNER: PROPERTY LOCATIO
CO�-3-Ti N ep� 681 S E 1/4 S E 1/4,S-Z9 $ N.R Z0 E(
W
PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME
\Z3o� � Zm t�v�tJ•t. *} Z3� \Z8 _ i'RO`i VtI.�.PcGE LLY�f' PrpD .
CITY,STATE ZIP CODE PHONE NUMBER 0CITY (]VILLAGE [MOWN ' NEAREST ROAD
B�-KLfU ,Wt N SS q'�y ( ) Ta-oY Lw'C>S PM �►�YD
[XL New Construction Use Residential/Number of bedrooms 1/ [ j AdditiQn to existing building
j J Replacement [ ] Public or commercial describe
Code derived daily flow 6LQ gpd Recommended design loading rate — bed,gpd/ft2_-`a trench,gpd/ft2
Absorption area required 8 Sa bed,ft215o trench,ft2 1 Maximum design loading rate • bed,gpd/ft2 •8 trench,gpd/ft2
Recommended infiltration surface elevations)n�0 1(12!c �}`S cttL�S� ft (as referred to site plan benchmark)
Additional design/site considerations S0 Y_)tST1�7 TO l fv sTA-tt►Z 001
Parent material Lp ASS 0 V k=_,Z GLPV01 prL UvTW"9 ' Flood plain elevation,if applicable tJA ft
S=Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT-GRADE I SYSTEM❑INFILL I ❑HOLDING TANK
U=Unsuitable fors stem RI S El I RS ❑U I ®S ❑U I ® SY
S ❑U
SOIL DESCRIPTION REPORT
Depth I Dominant Color I Mottles I I Structure I GPD/ft
Boring# Horizon Texture ConsiistencelBaxidary Roots
in. Munsell Ou.Sz.Cont Color Gr.Sz.Sh. Bed Trerxft
z
Z 11-7� -S 1--t2 VL
Ground 3 Zp-a S -1.5'm 3 L V M1 — •� .8
elev.
89i18 ft.
Depth to
limiting
factor
>lz.s"
Remarks:
Boring#
Z 11-3� -1.S -1fi-yl6 lcsblz W1 cW s
3 3-L� �•S `1lZ 31 `
`
Ground � S 6►. U S9 yt7 [ - ,1 •u
elev.
�FdL-1 ft
Depth to
limiting
factor
> lLt)+
Remarks:
CST Name:—Please Print Phone:
Arthur L. We erer 715-425-0165 '
ergerer Soil Testing & Design Service-P.O. Box 74 River .Falls X. 54022
Signature 9 j_Z 4 7 — I ZS Date: 3 0`4 p CST Number:.
! 220254
s
PROPERTY OWNER CUKMQt iJM. 'Z�kV . SOIL DESCRIPTION REPORT Page?- of 3
PARCEL LD.# fit;JUp)/y�
Borin # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
�z in. Munsell Qu.Sz.Cont.Color Consistence Boundary Roots
Gr. Sz. Sh. Bed ITiench
lo`l1Z 7- 1 Sl lwt gb12 "v1�t �S - . -2 .3
::> C _
Z °1-33 10`-l2 3!L - g'1 J teSblrL rvl F'r cam•
Ground 3 33 5 L3 11,51 tRS�� SAC, 1 �Sb1z ►v1'Fi Ct,S
elev.
53°IZ,8ft. y1_1ZZ -1'S`1R 3l ly - Se161. c� S9
Depth to
limiting
factor
� t zb• �
Er
i
Remarks:
Bgzri�g#
t Z z�; t 6ti u gg wt
Ground
elev.
Molt.
Depth to -
limiting I
?factor
l_ZZ" I
I
Remarks:
Borg #
�.»` "":>1I:::: 1 0-t 0 �0'1 D- 3 1Z _ s ► 1 Z.`� J�12 0�s h �S - .s � .6
!b L -Y 10`t 2 -31L S t d Z wl S b 1T
3
Ground Vs S9 (C.`
elev. y S6-t�u 1 S rL 31 y _ S Gt_ o w► i
Depth to
limiting
factor
Remarks: Ll
3oring#
,round
Nev.
ft.
)eplh to
imiting
actor
Remarks:_
PLOT PLAN Page 3 of 3
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CST Signature Date Signed Telephone No. CST#
PLOT PLAN Page 3 of -I
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