HomeMy WebLinkAbout040-1292-00-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
572862 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)). 1
Permit Holder's Name: City Village X Township Parcel T 'tJo:
Forliti, Edward J. &Cynthia I Troy, Town of 040-1292-00-000
CST BM Elev: Insp.BM Elev: BM Description: (� Section/Town/Range/Map No:
�(� I J ()/\ I C '5 T 24.28.20.1667
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER., 3s CAPACITY STATION BS HI FS ELEV.
Septic �'n d• Benchmark
l•a 1eov
- � Alt. BM
Aeration Bldg.8ewer
3, 2S or a
Holding St/Ht Inlet
5! l 4 9S• 7
TANK SETBACK INFORMATION St/Ht Outlet `7 S
TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet
Septic 57 Dt Bottom
Z /04- --
Dosing Header/Man. /
Aeration Dist. Pipe
Holding Bot.System
�•'S X17• �
PUMP/SIPHON INFORMATION Final Grade Z--7
Manufacturer Demand St Cover Z..� /Q / , C
GPM �'I�,` Co / O
Model Number
TDH Lift Friction Loss Sys a ad TDH Ft
Forcemain Length Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches IT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS / /_ ���`f A
-�
SETBACK SYSTEM TO «IIIJ P/L BLDG WE`LL/L LAKE/STREAM LEACHING Manufacturer: LL
INFORMATION CHAMBER OR ( f�a
Type Of System: 5 S / /n ,/ UNIT Model Number L 4q s 1
DISTRIBUTION SYSTEM 5&44— �(� 4-44 3Z_
Header/Manifolq I Distribution x Hole Size x Hole Spacing Vent Air ntake
Pipe(s)�_ -- (j2S e✓�
Length J Dia Length Dia --- Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over jxx Dept f xx Seeded/Sodded xx Mulched
Bed/Trench Center �� Q� Bed/Trench Edges Topsoil
Yes 5d No Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
i
Location: 313 Lindsay Rd u son,WI 54016(SE 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Lot 139 Parcel No: 24.28.20.1667 (�
1.)Alt BM Description= ' C )4�A_ .k ,_ �-- G O c,l�L...- a ✓ ,
2.)Bldg sewer length= Z
-amount of cover= 0 n !
2-44 ,A.
Plan revision Required? E Yes No
Use other side for additional information. — -
Date Insepctors ignature Cert.No.
SBD-6710(R.3/97)
• �a:v:Sa r.�- mce County c r
Safety and Buildings Division
` 201 W.Washington Ave., P.O. Box 7152 Sanitary Permit Number(to be filled in by Co.)
g S p =+ � r1 tl E Madison,WI 53707-7 7Z-'F /
COUNTY
',,. 11 S S l0
s r.`
O - fate Tran sacn Number
t,4; Permit Application
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 Ythan mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ,1} �1� 5 /�`/n
purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. �/' r
I. Application Information-Please Print All Information
Parcel#
Property Owner's Name
Property Owner's Mailing Address Property Location
/"o tp Govt.Lot
City,State Zip Code Phone Number y, s _'/+, Section +�i
/ �aZ. le - r�� T N; R ��irc1E orlld')—T-
II.Type of Building(check all that apply) 7--N-1, Lot#
/ Subdivision Name
1 or 2 Family Dwelling-Number of Bedrooms
Blo
6�
❑Public/Commercial-Describe Use ❑City of
CSM Number El Village of
❑State Owned-Describe Use 0-rown of
+-1 Cl,� S
III.Type of Permit: (Check only dne box on line A. Complete line B if applicable) Z6
A. ltd-Ke-w System ❑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 El Permit Transfer to New 1�
Before Expiration Owner
IV.Type of POWTS 5 stem/Corn onent/Device: Check all that apply)
R'gon-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil IYO 105
❑ Holding Tank ❑Other Dispersal Component(explai ❑Pretreatment Device(explain)
V.Dis ersal/Treat nt Area Information:
Design Flow(gpd) Design Soil plication Rate(g f) Dispersal Area Required sf) Di rsal Area Pro sesl�sfJ� SysteElevation
�o � �. 5
VI.Tank Info Capacity in Total #of Manufact e
Gallons Gallons Units f�� ,/L / 2 U y
New Tanks Existing Tanks / �jJc�jj/�" J w°' o ,2 2 4'
r�7 a U Cn y DO V.
G7 a
Septic or Holding Tank
Dosing Chamber
VII.Responsibility Statement- t,the undersigned,assu a responsibility for installation of the POWTS shown on the attached plans.
umbe
Plr's Name(Print) Plu m
igna MP/MPRS Nuber Business Phone Number
Plumber's Address(Street,City,State, ip Code)
S- aZ
Vfft,Coun /De artment Use On
P$
ermit Fee Date su Issuing ent Signa
Approved 'f
even Reason for ial
IX.C,
ondiMATNA9041fifteasons for Disapproval
i. Septic tank,eMuOnt fihar afid
dispersal cell must all be services/'rtialritained
as per management plan provided by plumber.
2. .Ak sel6ack rpq*em must,be:4 gir401*
as per applkalb 006%ordi welt,
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I i inches in size
SBD-6398(R. 11/11)
i
one-
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---rl
KNUDTSON PLUtlfic,=9
CONTRACTING, LLS
927150TH ST.648447NMYRS
ROBERTS,WI 54023-GE 25
CELL 6 1- -1737
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Forliti Sewer
Owner's Name: Ed Forliti
Owner's 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
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 54023-8525
CELL 6 1- -1737
�. / n cX S a �C✓
4
Soil Abs„ c W_d9n System Cross Section
102.90
. -^
ft
4'Sciedule 40 Final Grade
PVC Vent Pipe 5.00
Wdh Vent Cap
Leaching 97.10
Chamber �— ft
5.0 ft System Elevation
Soil Absoa on System Plan Vlew
ft
3.00
ft
5.00
Leaching
ft Trench 1
Vent Or Observation Pipe Chambers
4`Die.
Trench 2 Header
Loa-china Chamber Soeciflcations
Manufacturer And Model quick 4
EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.70 gpd/sq ft
450.00 gpd Design Flow+ 0.70 Soil Application Rate + 20 EISA= 32.00 Chambers
2 rows of 16.00 chambers each.
Page of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMATION SYSTEM SPECIFICATIONS
Ov ner d o, _ ( Septic Tank Capacity gal ❑ NA
L
Permit# Septic Tank Manufacturer Lj c5 r' ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer (a ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model l ❑ NA
Number of Public Facility Units lA Pump Tank Capacity al )RrNA
Estimated flow (average) ,�19� al/day Pump Tank Manufacturer A
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer R
Soil Application Rate y al/day/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) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effloerit Quality Monthly average Di al Cell(s) 'Tip,'(}.W-et.. Q,;;c -4 ❑ NA
Biochemical Oxygen Demand (BODE) 530 mg/L round (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100mI ❑ Drip-Line ❑ Other.
Maximum Effluent Particle Size a in dia. ❑ NA Other: ❑ NA
Other: ❑ NA 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 nth(s) (Maximum 3 years) ❑ NA
years)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: �.7 ❑ rMt(s) (Maximum 3 years) ❑ NA
years)
Clean effluent filter At least once every: // nth(s) ❑ NA
l2 Yes)
Inspect pump, pump controls & alarm At least once every: n s) A
Y
Rush laterals and pressure test At least once every: 0 yearn(s)
s) NA
Other At least once every: 0 rr year(s)
❑ NA
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 tanks)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 %) 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
urirts, and any servicing at intervals of 512 months, shall be performed by a certi ted POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
% o Filters
EFFLUENT FILTER
x-525 Filter is rated for
10,000 GPD (gallons per day) 1116" Filtration Slots
?9 it one of the largest filters –'' ►r
ts class. It has 525 linear feet a f
- ' 166 filtration slots. Like the '
HwWW
ok PL-122,the Polylok
3 -525 has an automatic shut
ball installed with every filter.
y_ n the filter is removed for
`. ar�ng,the ball will float up and
rarily shut off the system so
effluent won't leave the tank.
ft of W
other filter on the market can MradmSIM
azak e that claim. ,,Rabd for am
. -525 Maintenance: A="4'&V
SM-+0 Pk* x
-The PL-'525 Effluent Filter should
erate efficiently for several years °
.: under 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 ar,4
sjtalled filter contains an optional
alarm,the owner will be notified
Y an alarm when the filter needs
servicing. Servicing should be
done by a certified septic tank cno
pumper or installer.
A. Locate the outlet of the U.S.Patent Nod so15,488 —tea
5,871,640
septic tank. _
2. Remove tank cover and pump
tank if necessary.
PL-525 Installation:g 3. Glue the filter housing to
g
3.Do not use plumbing when the 4" or 6" outlet pipe. If
filter is removed. Ideal for residential and com- the filter is not centered
. Pull PL-525 out of the housing. mercial waste flows up to under the access opening
10,000 Gallons Per Day (GPD). use a Po{ylok Extend &
5. Hose off filter over the septic Lok or piece of pipe to
tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page
back into septic tank. septic tank. 19-21 for Extend & Lok
5. 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
septic tank cover.
7 Replace 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. ,
(Verification required from Planning&Zoni partment for new construction.)
City/State Parcel Identification Number 040-1292-00-000
LEGAL DESCRIPTION
Property Location SE '/4 , SE '/4 , Sec. 24 , T 28 N 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❑yes ✓ no Lot lines identifiable Elyes❑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.
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 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 t 's 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
AjdNATURE 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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8268854
Tx:4220136
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 y
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 aantst e title t the Property is good, indefeasible in fee simple and free and clear of encumbrance
except- ment d Restrictions of Records.
Da ed No14
(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 Darc Jerome, to me known to be the
TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who a eepted the foregoing and acknowledged
(If not, the same.
authorized by Wis. Stat. § 706.06)
C-sch
THIS INSTRUMENT DRAFTED BY: '"" /4/ rublic,chmitt
Michael H. Forecki NOTgpY': Notary State Wiscons'
-»---
*Commission Ex ' y 01, 2017
. PUBLIC
••Sr�rFOF
(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.FORM NO.1-2003
WARRANTY DEED 2003 STATE BAR OF WISCONSIN
'Type name below signatures. Page 2 of 3
File No.:30101
i St. Croix County 1004307 Page 2 of 3
i
EXHIBIT "A"
LEGAL DESCRIPTION
39 Troy Village Fifth Addition Town of Troy, Croix County, Wisconsin
Lot 1 y g y, Y
(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
5 ` '
t
tlVksoonskt Departrnent of Commerce
SOIL EVALUATION REPORT Page _of 3
otmon of Safety and Buildings In accordance with Comm 85,Ws. Adm. Code ---^—"
cotx,ty 57.
Attach complete ake plan on paper not less then a 112 x 11 Inches In size.Plan must
Include.but not limited to:vertical and horizontal referenos point(8M),direction and , Parcel I.D. O y0-�2 Q Z - D f7
percent slope,scale or dimensions,north arrow,and location and distance to nearest road.
vie
please print all Information. Oate
penroner Inrametion you provide may be used for secondary pwposes(Prhrscy t.eW,s.15.04(1)(m)).
property Owner Property Location
CDIef% SF- 114 SE tra s,zy T Z 2.0$ N R Q W
Property Owners Mailing Address Lot 0 elodr fr Subd.Name or CSMU
1110 K.o E� 5T, N,r-, —c U rT G�- F 1F T+4 r
State a Number (3 City ❑Vttlage Town Nearest Road
city
'FjLA1/UE Mts 55�i`1 (7b� 757-75 8 "Ca�O �lA�`� ��
'°derty design flow rate GPO
New Construction Use Residential!Number of 1»ri-,� --'—�'"'""'•-
0 Replacement C) Pubfic or oorrm orcial- esaibt
Parent material_ Fk)Wf,1�feleva n if oppitca a
cIIU L .-
General comments C� 4
and recommendations: CON-j ENT I W A L.- -11?-
S�ON NG OFF CE - a
Boring 'b�
a Boring# pit Ground surface eiev._��_n• Depth to Ilmiting factor }}I Wn. ation Rate
Dominant Color Redox Description Texture Structure Consistence Bo /ft'
Nodzan Dep 'EM#2
In. Mansell Ou.Sz. Cont.Color Gr.Sz.Sh,
0,o,�
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3 Z-
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M Boling 1% Pit Ground surfece elev. y99Z--I ft. /� Depth to limiting factor-- _in. soil Ii-cation Rate
Horizon Dap
Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf Gr.Sz.Sh. •Eft#t 'Eff#2
in. Mansell t2u.9z Corti.Color m 0.5
ID 2-j
Z Jt� -fob Yvl�1''
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Efihrent#1 BOD >30<220 nVIL and TSS 30 150 mglL 'Effluent#2 800 <30 nq/L and TSS<30 m9k
SI sture CST Number
CST Name(Please Print) L LL4$ -
�� Date Evstuation Conducted Telephone Number
Address W1175 (oqp+KAoI-, RIVE 'FAL.S WT 5422 2 OG-c�Z-o-Z �►t5
C(�1 f'SgI �I►J?rl1�Al S3�a1��- �1�� Paroat 10 0 2__.1—9a---0 0 d Page --wL or
properly owner I
❑ Boring
{ Pit around surlar�s etev._Qq Z ft. Depth{o limiting lector_� !IG -I^ aCGIM'" OA
Fioriz�n Depth 0orninsnt Color Redox Desatpgon Texture Structure COnxtatsm* Boundary Roots Munsel Qu.9z Cont.Color ar.Sz.Sh. 2
3w-(m
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U Ground surface e1ev.--R,� Depth to limiting teGtor_ In. don Rate
❑ Pit
Roots GPOM
Horizon Depth Dominant Color Redox Description a re Structure Consistence 9oundary
In. Munsell Ou.Sz. Cont.Color
Gr z.Sh. •£.fist 'Etfp2
Q Boring 0 ❑ 801ing Ground surface elay.�.�___R, Depth to limiting factor In.
SOU lion Rate
❑ pit
Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary ROOts G
In. Munsell Qu.Sz. Cont.Color
Gr.Sz.Sh. �Rkt 'E"2
•Efriuent 01 ;B00,,301 220 mWL and TSS),30 150 ffVk Effluent 02•800,t 30";&and TSS_<30 nVL
The Department Of need Commerce is an equal opportunity
format, smice
provider and
department need
TTY 60B-264-8777.services or
60B-264.8777
sear,ss{K..00�
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PROPERTYOWNER CUkMlQQKA1V, 'Z)Zkr. SOIL DESCRIPTION REPORT Page?of 3
PARCEL I.D. his Xib)Jy G
Borinp# Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
� a in. Munsell Qu.Sz.Con Consistence Bolx>daty Roots
Gr. Sz. Sh.
0-9 10`tQ 7-LZ Sl lwl 9�1�7 `�t �S - B2. T
Z q_33 W-M- 31(, - S'11 �esblz rv�'F'h cz
Ground 3 33_41 jt34\z SL3 �.S�-fRS�a SICK 1 �Sblt
elev. �'►`�i c� S . Z 3
43°1Z.aft. 41_120 �.S`1fZ 31 - Sd.6h 8 S9
Depth to
limiting
factor
LZ&
Remarks:
Bng #
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- s►' 1 1v� abl-c cis h cS •z . 3
Ground
elev.
g9'b.�fl.
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limiting I
factor y !
i
s
Remarks:
Borin,g #
E L td to,-tR3LZ lb=7� Lc�`t2 3!(e St 1 Zwl Sb1z
i
Ground IL S9 f�•` .1 43
elev, y A-lq u I -S'l IL 31 y _ S e( Gt_ p g w1
Depth to
limiting
factor
Remarks:
3oring#
around j
;lev.
ft.
)epth to
imiling
actor
Remarks:_
Wisconsin Department oflndustry, SOIL AND SITE EVALUATION REPORT Page I of '3
Labor and Human Relations g —
Division of Safety&Buildings in accord with ILHR 83.05,IIViS.Adm:Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size;,Plan}must rrtofuda,but':1
not limited to vertical and horizontal reference point(BM),d-irection and jo of slope,scale or PARCEL I.D.# -17,1 k_-Vqp IN G
dimensioned,north arrow,and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATPON REVIEWED BY _ DATE
PROPERTY OWNER: PROPERTY U IQNr;
C�U�iti1J ��1.U��►� T Camrz. SE 1/4 SV-S 1,4,S T ZO E( W
PROPERTY OWNER':S MAILING ADDRESS• M!F�_
BLOCK# SUBD.�NAME OR CSM#
\)LL ftGE J-t PrpD .
CITY,STATE ZIP CODE PHONE NUMBER []VILLAGE [MOWN ' NEAREST ROAD
B Lrcf fu ,r-t N s s 4�y ( ) �z o`t �>►.ms s wN-t �►°�v
[X],New Construction Use Residential/Number of bedrooms 1/ [ ] AdditiQn to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow 6u0 gpd Recommended design loading rate bed,gpd/ft2 -8 trench,gpd1ft2
Absorption area required 8 S$ bed,ft215o trench,ft2 Maximum design loading rate bed,gpolft2 •b trench,gpd/ft2
Recommended infiltration surface elevation(s)&S-1—U 6%0W-M*g C-f '3 ft (as referred to site plan benchmark)
Additional design/site considerations SEl� VQCl1Z- YO tk.,5m� aks
Parent material Lr.�ASS O V N�Z 6 L"CJ PrL, O TW"g Flood plain elevation,if applicable JJ A ft
S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ®S ❑U ERS ❑U ®S ❑U ®S El G)S ❑U ❑S RU
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. B�d Trey&
31z z13bk S cs
•S `M V1 -13
Ground 3 Zp-a S -1.S`m 31 s Ft 61- (5 g wt 1 - '5
elev.
c�2.8 ft
Depth to
limiting
factor
>VL S''
Remarks:
�oring#
Z tI-3� -1•s �Izylto is lcsblz mv s
3 -v to -)•S Lip- 3iy - S 6h v Sg wt I - .1 •u
Ground
elev.
� l ft
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165
e
rgerer Soil Testing & Design Service-P.O. Box 74 River .Falls,WI. 54022
Signature °1,j-2 9 7 - 12-5 Date: CST Number:.220254
LI- 3o�Q9 -
Labor Wisconsin-Department t4 u tforis Industry, SOIL AND SITE EVALUATION REPORT
Labor and Human Relations Page I Of "3
Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm.Code
e �
COUNTY ,
Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must inclp*ibut- ST' �-��U Vx
not limited to vertical and horizontal reference point(BM),direction and%of slope,sc `or ,t P EL I. .;1 ��-��p L,v
dimensioned,north arrow,and location and distance to nearest road. '
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWS BY _ DATE
PROPERTY OWNER: PROPERTY LOCATIO
COl i-n.tJ �c���1U�+•'l Z- C�t�, -GQ�4.6G; SE 114 SE 1 14,SZy Zb ,N,R Z.0 E( W
PROPERTY OWNER':S MAILING ADDRESS. LOT# BLOCK.4 SUBD.NAME OR
\Z 3 01 C''.��. )� ►J. ►` Z 3 v \Z8 - TTz U`! V l l.�,f�6 E �L PrD D .
CITY,STATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE [I _Q- ' NEAREST ROAD
SS 411y ( ) T Q-0`t LLhJpS P>~-1 �►°f'D
New Construction Use Residential/Number of bedrooms ti/
[ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 6u0 gpd Recommended design loading rate - bed,gpd$ - trench,gpd/ft2
Absorption area required 8 S$ bed,ft2-150 trench,ft2 Maximum design loading rate •1 bed,gpd/ft2 •8 trench d/ft2
Recommended infiltration surface elevation s �•D too 'gp
( ) � Tb4`'C'R�v ctt�S� ft (as referred to site plan benchmark)
Additional design/site considerations_ Skp� tiy M-ZZ7 '•p j Aj 5'lr� . Z_ 0K1 3
Parent material Lp S p V GLL041 TL UvTW pt�t{ Flood plain elevation,if applicable IJ A ft
S=Suitable for system CONVENTIONAL MOUND D ❑U I IN-GROUND❑PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable for system I ®S ❑U I I ®S O U I Q S O U I O S RU
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft
in. Munsell I Ou.Sz.Cont Color I Texture I I Consistence IBar�ry Roots
. Gr.Sz.Sh. rerx�l
.:�� Bed T
Z \1-
_)-
zv S `tfZ yl6 - 1s o S ►�� cl,J - •� -�
Ground 3 zn-a S -1•$K2 3l yr S 61- Q g •� .8
elev. -
84Z.8 ft
Depth to
limiting
factor
>IZ.S''
Remarks:
Boring#
E , o ►' lo�-t tZ
a"S
a
�1 U
Ground -3 3-�ZO -1-S `i2 3t)r - S 6r• U S9
w► I -
elev.
Depth to
limiting
factor
>
Remarks:
CST Name.Please Print Phone:
Arthur L. We erer 715-425-0165
ergerer Soil Testing & Design Service-P.O'. Box 74 River .Falls,WI- 54022
Signature
-L 7 - 12$ Date: L _ 3 `4 4 CST Number:.
! 220254
PROPERTY OWNER CU1�311tJ��1�tcL b�,l►. SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D.# JuD)/y C�
Borin # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft
in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trer>ch
::::::«l o-9 101-1R z1Z si 1>vt -3 b�7- -VI
................. Z °1—33 W-KL 31(, S'1 �eSb\Z wl'Fh ct-
Ground S13 n,S`-iRS!$ SIC, l� 3blz ►►�`E'i a,S . Z . 3
elev.
B°IZ,8f t. �1_1.20 -1..S`t R 3 l � S x161. 8 S 9 tir►. I - •� �cg
Depth to
limiting _
factor t
? L Z.U• j '
Remarks:
B �g#
As 1� �S - •Z j • 3
Ground
elev.
Molt.
Depth to
limiting
factor
? l•�i'
Remarks:
Borin #
�Z� �0`1R3t2 C
— SrI Z�' Jb12 o�Sh $
I,v`t IZ 31L Z w1 S bk
Ground !L
elev. y A-tq u 'I 31 y - S of 0 %9
�°l6•Zft.
Depth to
limiting
factor
>Ig0t,
Remarks:
3oring#
1
around E
;lev.
it.
)epth to
inviting
actor
Remarks:_
PLOT PLAN Page 3 of 3
f
SCALE 1"= S 0
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CST Signature Date Signed Telephone No. CST#
PLAN" PLOT N P Page 3 of 3
SCALE 1"= S 0
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715 ) 2 5-C?1 69 _
CST Signature Date Signed Telephone No. CST#