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HomeMy WebLinkAbout020-1420-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 572864 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Schmitt, Jared I Hudson, Town of 020-1420-70-000 CST BM Elev: �� Insp.BM Elev: BM Description: Section/Town/Range/Map No: rWr,1 S S 1 kt 20.29.19.2675 TANK INFORMATION y06-_l ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` 0 c 1000 Benchmark Des+" L J '5�� Alt. BM _1 b5. I Aocatipn Bldg.Sewer 4 25 l w , Nelding StAirinlet 5.11 1 0"D,(o8 .I TANK SETBACK INFORMATION St/Ht'Outlet w 1 I Co , 3z TANK TO P/L WE4 en 1 BLDG. t o Air Intake ROAD IaHniet J Septic 4 IOU, 9E-Be#ecn Desirtg (� HeaderRAen- �� p•' Awetie;, Dist. Pipe O Ho mg Bot.System J ,I$ L 01-M 01 to. 7k- Final Grade PUMP/SIPHON INFORMATION 5.�J Vbd •(0 Manufacturer Demand St Cover Model N t ber TDH Lift Friction Loss Syste ad TDH Ft Forcemain gth a. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length O' No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid De th DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: t �Lb INFORMATION Ty p Of System: t t t CHAMBER OR L V 2 Q O )U NIT UNIT Model Number:��12 DISTRIBUTION SYSTEM J �� J 2 SO I Lt un It Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Lengthr`Dia Length Dia Spacing o(` [ l SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over I xx Depth xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trenc opsoil J IIIJJJ 5flYes ® No A_Ces No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 467 Wren Lane Hudson,WI 54016(SW 1/4 NE 1/4 20 T29N R1 9W) The Glen Lot 81 QJ Parcel No: 20.29.19.2675 1.)Alt BM Description= �I+V C 2.)Bldg sewer length -amount of cover= p��' �t 11 h�� ,��S ��L\ �1M( 0� Plan revision Required? ® Yes /!" No ( . � � F/n8 Use other side for additional information. 3(o SBD-6710(R.3/97) Date Insepctoes Signature Cert.No. �r• —C 0 ARED & REBECCA SCHMITT Z 67 WREN LANE UDSON, WI 54016 W 1/4 NE 1/4 SEC 20 - 29 NR19W l _ 0T #81 � r YSTEM ELEVATION: 96.5 r` {{ a P(-5 o I tA I 3 N�rOO'h7 � do aq�y 4 r � I i ✓e n i I1 �i l I II , „4.� County Safety and Buildings Division ST. CRBIX 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) /�*l,�n, ., Madison,WI t, err 157ZS(, 4/ •_ - State Transaction Number Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code,submission of this form to thsip tt(,4�a-U0 "_ al unit is required prior to obtaining a sanitary permit. Note: Application form srgnP1�$tom roject Address(if different than mailing address) submitted to the Department of Safety and Professional Servies. Personal info=16T-�rovide may be us 467 WREN LANE for secondar u ses in accordance with the Privac Law,s. 15.04(1)(m),Stats. I. Application Information-Please Print ALtrdf9rination HUDSON, WI 54016 Property Owner's Name / Parcel y JARED AND REBECCA SCHMITT 020f14204704000 . 2(075 Property Owner's Mailing Addressy Property Location 1628 HALLEWOOD BLVD Govt, Lot 81 City,State Zip Code Phone Number SW y., NE �/4, Section 20 NEW RICHMOND, WI 54017 N/A (circle one) T 29 N; R 19 E or�J II.Type of Building(check all that apply) Lot# Ek1 or 2 Family Dwelling-Number of Bedrooms 3 >�< 11�_6_ t Subdivision Name oL � Block# THE GLEN El Public/Commercial-Describe Use /�-- ` �' oJ,,st_, cc: N/A ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of 6Z_ �- N/A C5j Town of HUDSON III.Type of Permit: (Check only(one box on line A. Complete line B if applicable) A. KI New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B List Previous Permit Number and Date Issued ❑ Permit Renewal El Revision ❑ Change of El Transfer to New Before Expiration Plumber Owner 1 IV.T of POWTS System/Component/Device.! (Check all that apply) F/'� �t-✓ KI Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in.of suitable soil ❑ Mound < 24 in.of suitable soil ❑ Holding Tank El Other Dispersal Component(explain) ❑Pretreatment Device(explain) V. Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required sf) Dispersal Area Proposed( System Elevation 50 .7 643 1 700 96.5 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units o New Tanks Existin g Tanks y o w �� dale. 5zs a U- in v, w Septic or Holding Tank Dosing Chamber N/A VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber'sjS' Lure MP/MPRS Number Business Phone Number PAUL KOEHLER /•�� � ��_ 225410 715-246-2660 Plumber's Address(Street,City,State,Ztp Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII.County/Department Use Only pproved �U�31.��ved Per mit Fee Date I sued Issuing nt Signature Reason o al $ IX.Con Reasons for Disapproval [3 t. Septic tank,effluent filter and 3 CG ce,V"�G dispersal cell must all be services I rliWdaintiil C I ( t Jy✓P� as per management plan provided by plurrtb 2. A k lagttirements mast tt��ntiN l t as p«'appAcatbl►t�dti%ofa: Attach to complete plans for the system and submit to the County only o0jpaper not less than 8 t/2 x 11 inches in size IN SBD-6398(R. 11/11) f� 0 ARED & REBECCA SCHMITT Z 67 WREN LANE UDSON, WI 54016 W 1/4 NE 1/4 SEC 20 Ff 29 NR19W i � 1 OT #81 d � � 1 YSTEM ELEVATION: 96.5 ij E i P .ems O N I i NN , �px 4 4 t "v- CA p. r J � � �a� ° e I 1 �• • ' cc N j C I. I ��,cc) 4 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JARED AND REBECCA SCHMITT Owner's Name: JARED AND REBECCA SCHMITT Owner's Address: 1629 HAT T.FWOOT) BLVD NEW RICHMOND WT 54017 PROPERTY .ADDRESS: 467 WREN LANE, HUDSON, WI 54016 Legal Description: SW 1/4 NE 1/4 SEC 20 T 29 N R 19 W Township: HUDSON County: ST. CROIX Subdivision Name: THE GLEN Lot Number. 81 Parcel ID Number: 020-1420-70-000 Pagel 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 i Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber: PAUL KOEHLER License Number: 225410 Date: 12/26/14 Phone Number 71 5/246/2660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01 101). Page 1 Q JARED & REBECCA SCHMITT Z 467 WREN LANE HUDSON, WI 54016 SW 1/4 NE 1/4 SEC 20 T29NR19W _ LOT #81 SYSTEM ELEVATION: 96.51 d lop I' N-5 F to II 'AS I ' ryu y.� u-rl (r1 SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page_of Project Name: No. of Cells Per Cell �� \ It Cell Width Total No of p �•J p it Cell Length _.a sq ft EISA Per Cell _ft Cell Spacing e�,D sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 �EZ12031­1-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: LL 2 / /�6 Gravelless Leaching Unit Model: •V6 Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent •::: >:<;>> <>:?:. : >>>::<:< Soil Backfill <i. 12 in :<;:;; ::;:;;:;:.:;.:;.:; Geotextile Fabric ,50 ft Infiltrative Surface 12 in it S ft Limiting Factor in Slotted and Anchored Vent/ Observation Pipe with Cap .r.■■..■.a....mass see...an*.........■■.■■■.. ........sense... Plumber/Designer Signature: License#: Date: Occ, 2oc �d/`� �t INSTALLATION INSTRUCTIONS ..Inc +xnons.nc. ,mmse Aflivisic"g Potabet° PL-525/PL-625 FILTER 6WastewaRr RoduGt lyl°k MC. PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: .Fated for 10,000 GPD •PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 *Accepts 4"and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently •Built in Gas Deflector for several years under normal conditions before ,Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every,time the tank is pumped or at least every •Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a C ertified septic tank pumper or installer. RECOMMENDED PRODUCT poiytok PVC Fitter Extension Handle _._. IF Y;{ Risers.&Riser Corners Extend&LokTM Riser Safety Screens Fitter Alarm Panel and SmartFitterTm Control Polylok risers bring your Polylok Extend:&Lokw Polylok safety screens Switch septic:tank cover to grade. is a simple, easy to use prevent tragic accidents pot lots fitter alarm panels This allows locating and solution that can extend from happening by children Y servicing your filter easier the inlet or outlet pipe and and pets falling.into open and svAtchs prvvid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of rating digging to find tank installation a snap: impending filter and tank entrance. Fits 3"and 4"pipe_ servicing; For a full list of Polylok products please visit our web site at: www.polyl'ok.corn: D Z N rn m 61" 86" z c y 42" � z m ;a 8 0 m UP o 41" / _ \ m 0 x D n � En m 3„ 36., I 4" D r En = f rn n D UP 38" 4" CAS \r' / N 4 I m c � rrn �"i0 D Oc ;a D:=I rn z ° 39" 0 v*O D rn OK r D m>r Ccl 0r-r D Om-D+ m m o r m 15= xW x D Z 0 m 0 �o � z y ° Fn Fn m mO y - — 'v ;a F4 �� m> z �� G7 nC0 C7 O*z D�'z 11-'�moz r=-*1DO ODD Z moo co om -0 C mO c�im � = N �-�z > mOO mD0 -1r�" �0•• �- �� yN \C FD O =X - �(C --4c O�r'i200� vF; N V � z5 xcn Z yO --IJ AD -4 •o �ON off\ v a v D N alz, v C Z Oo y m N N -1'19 11 O 50 i 1'i 6 ^' I"1l O v v a Z OCo D A m 4-o v (nRW> rw4•. o 00- 'z0 O o a m " n O 7C �v. �N �C pp D Dr C9�1i pOOV G7W O r Ln m m °' 0 NO \ Z c �� C) rn-i�1� NW N O A,�� � n v v v z 3 O C < � ov c�DD �O cna,m D S. -ai v m A H -zi o w x r*1 O D Go \ x r z -+ (A-0 ^y -_-� m Dv O ; D D Z 0:0 00� \pO� a O r ; r -4m '�o Z 0 22 m F 0 0 0 w m 2 09 (4 vzi �D n o0 D � O --1 O m r m z '- c r�* 60 Oz 0 r vii Z z m z Fn -i N WLP1000-MR DRAWN BY: SME SCALE: 1/4"-l'-O' RE-POUR: SEPTIC MANUAL MIEBER COIICAETE DATE: JANUARY 2010 DATE:• POST-POUR: -n 4\Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 O REVISED JAN. 2010 800-325-8456 nLE: moo-I01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2, FILE INFORMATION SYSTEM SPECIFICATIONS Owner JARED & REBECCA SCHMITT Septic Tank Capacity 1000 qa( ❑ N< Permit # - Septic Tank Manufacturer WIESER 13 NF DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK d Nib Number of Bedrooms 3 Q NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units qNA Pump Tank Capacity gal X0 N 4 Estimated flow(average) 300 gallday Pump Tank Manufacturer ? N.4 Design flow.(peak), (Estimated x 1.5) 450 qN/da Pump Manufacturer ? NA Soil Application Rate .7 al/day/ft2 Pump Model X7 N.4 Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 11 NA Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOOS) 5220 mg/(. ® NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) $150 mg/L O Disinfection ❑ Other. _ Pretreated Effluent Quality Monthly average Dispersal Call(s) _E NA Biochemical Oxygen Demand (SODS) S30 mg/L El In-Ground (gravity) ❑ In-Ground Ipressur�zed) Total Suspended Solids (TSS) <30 mg/L [A JNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510'ofu/100ml 13 Drip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. IR Other: 0 NA Other: ❑ Other: 0 Nei *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: 0 m°nthls) (Maximum 3 years) ❑N�� 3 Exyear(s) Pump out contents of tanks) When combined sludge and scum equals one-third (Y)of tank volume ❑ NA Inspect dispersal cells) At least once every: ❑month(s) (Maximum 3 years) ❑ NA years) Clean effluent filter At least once every: 0 month(s) ❑NEB 1. 21 ear(s) Inspect pump, pump oontrois & alarm At least once every: ❑months)0 eaarlrl ) Flush laterals and pressure test At least once every. ❑m°nth(s) (R W. 0 year(a) cyther At least once every: 0 month(s) ❑ N�� . []year(s) other: W. 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 an the ground surfac o. 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 sour 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 11:3, 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. Page Z of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic that may impede the treatment process and/or damage the dispersal ceif(s). If high concentrations are detected have the conteri 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 I discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage servicing Operator prior to restorir power to the effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the pump controls ' restore nominal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the or( within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of th POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants, tt foundation drain (sump pump) water; fruit.and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; ill 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 be taken to Insure that the system i 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. s 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 POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system C� A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorpton system. 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 tines and wells- Failure to protect the replacement area vt ill result in the need for a new soli and site evaidation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soft limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. ---.L-.m slue " o mg pr►k e a - �!Z DKt 8>•TLT� ��A! CaNS77�v�v� 0 Mound and at-grade sod absorption systems may be reconstructed In place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO NCT (ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POINTS INSTALLER POWTS MAINTAINER Name OUNTRYSIDE PLUMBING & HEATING INC Name PAUL EHLE Phon® 7.15-246-2660 Phone SEPTAGE S VICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name 'POWERS LIQUID WASTE MANAGEMENT Name •.] Phone 715-246-5738 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54411. (21 &(3), wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � -ry Mailing Address �1.�-7"ga Property Address'X'4 ka-1 (Verification required from Planning&Zoning Department f ew construction.) City/State `�� Parcel Identification Number 0ZQ L+_2-0 P_14 --4(3Q LEGAL DESCRIPTION Property Location y4 ,t4F % , Sec._L'© , T 7-9 N R 19 W,Town of �Au O S d N Subdivision C-=l L. ="t,) j , Lot# I. Certified Survey Map# , Volume ,Page# Warranty Deed# 14- , Volume , Page# Spec house ves no i.vt lines identifiable�ye�s o 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§Comma.83.52(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 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 is in proper operating condition andlor(2)after inspection and pumping(if necessary),the septic tank is less than 113 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 system has been maintained must be completed and returned to the St. Croix County Planning& Zoning Department within 30 days of the three y ar expiration date. Uwe certify that all statements on form are true to the best of my/our knowledge. Uwe amlare the owner(s)of the property described above,by virtue of a wa my deed recorded in Register of Deeds Office. Na ear a e ours SIGNATURE OF APPLICANT ) 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.08105) i r / / 1 ill ll _ _-- 57 ti' I II : y(I Att 417' A°• 'll' 7 q � � ' • f77 t - ' t , ,•• _ t , J /�i s 78 r -•: : , "1 '!!. i tp , C - :! /�Ih•: I _ 67). . r t..?t•- — _._S r-J\ `,+a• +." 69 ---6- , 203 r'' 138- ...332 , 1 I; t .1 1 j41 Ali 2M I( I :26- tlr ' r ' 1 ' -- .. ` 1135 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,W is.Adm.Code Steel Soil Service Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County St.Crob( include,but not limited to:vertical and horizontal reference point(BM),direction and percent slope,scale or dimemsions,north arrow,and location and distance to nearest road. Parcel I.D. 0'_b—/�4 JL,(),- Please print all information. R By r peR�ipg Date Personal information you provide may be used for secondary purposes(Priv (m)). 5_a2,13 , Property Owner 9 s�_ Prope Location �� t SWwa-M oration �� Govt_L NE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address ;3 6 �� gpt# Block#C- Subd.Name or CSM# 4940 V_ilking Dr.Suite 608 81 ad 1 The Glen ( Z& 7 5) city ���� State Zip C Phone Nur'"., c o!,' Ctaiy Village V Town Nearest Road «: ��,..99 MN 55435 95� 8 _ Hudson . New Construction Use: Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD ._! Replacement Public or commercial-Describe: Parent material Pitted outwash Flood plain elevation,if applicable na General comments and recommendations: System elevation 96.50ft,trenches spaced and depth to code 3.75ft below grade Boring# Boring Pit Ground Surface elay. 100.25 ft. Depth to limiting factor 96 in- Soi Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 I *Eff#2 1 0-9 1Oyr3/3 none sit 2msbk mfr cs 2f .5 .8 2 9-24 7.5yr4/4 none Is osg mvfr cs na _7 1.2 3 24-96 7.5yr4/6 none ms Osg ml na na .7 1.2 1 Fil Boring# . Boring imz Pit Ground Surface elev. 100.25 ft. Depth to limiting factor 96 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 I *Eff#2 1 0-9 1Oyr3/4 none sicl 2msbk mfr cs 2f .4 .6 2 9-24 7.5yr4/6 none ms osg ml na na .7 1.2 q SI g'f *Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature: CST Number David J.Steel LC��� 248956 Address Steel Soil Service �/ Date Evaluation Conducted Telephone Number 1564 CR GG,New Richmond,WI 54017 9/12/2002 715-246-5085 Property Owner Sienna Corporation Parcel ID# pending Page 2 of 3 3] Boring# Id Boring Ig Pit Ground Surface elev. 97.75 ft. Depth to limiting factor 96 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *EfM *Eff#2 1 0-12 10yr3/3 none sil 2msbk mfr cs 2f .5 .8 2 12-32 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 32-40 7.5yr4/4 none Is osg mvfr cs na .7 1.2 4 40-96 7.5yr4/6 none ms osg ml na na .7 1.2 F—I Boring# Boring 1 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/ft' *Eff#1 *Eff#2 F—I Boring# Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 *Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services o—, Page 3 of 3 STEEL'S SOIL SERVICE David I Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. #248956 NW1/4,NE1/4,S 20,T29,R19W (715) 246-6200 Tovai of Hudson,St.Croix Ca (715)246-5085 The Glen lot 81 TW soil evaluation•was conducted to satisfy a_zoning requirements it may-or may not be suitable for your use.The location of the test may or may not be as shown as permanent lot lines were not established at the time the soil test was c tedr Legend N I"=40' Benchmark El. 100.00Ft of '/2"pvc pipe •C Aft Benchmark EL98.90Ft op of 1/2"pvc pipe o=Borings Boring Elevations B1 =10Ek25Ft B2=100.25Ft B3 97.75Ft B4=00.00Ft 8,9aFf q Iq 4-if-toz �53.�St 5 s� too 6�'O�-