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HomeMy WebLinkAbout020-1483-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572875 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: Waldschmidt, Travis Hudson, Town of 020-1483-01-000 CST BM Elev: Insp. BM Elev: Description: Section/Town/Range/Map No: 16b BM ( G ~T 16.29.19.3070 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /.03 a1.3 ioa Septic O Benchmark 97-64 /466 LL Alt. BM~ 1., Go 016- (o . (S 15, is Aeration 7 Bldg. Sewer 74 1 C1 3, -VT Holding St/Ht Inlet * /5 93 /5 TANK SETBACK INFORMATION St/Ht outlet -p5 -72'.25 TANK TO P/L WELL BLDG. Vent t it Intake ROAD Dt Inlet Dt Bottom Septic 1-7 Dosing Header/Man. Eck ZZ -_2 4e 1 Aeration Dist. Pipe 81 2Z $ , 22 VV, 4Z. ,faL Holding Bot. System U• x.Z C1 zL. 4? Z. Final Grade PUMP/SIPHON INFORMATION t~ q~-tz, Manufacturer GPImNand St Cover , 9S . f S Model Number TDH Li Friction Loss Syste DH Ft Forcemain Length Dia. Dist. to Well I I I I I I =i:_ _1 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 74 3 -1 j e..% c, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: r CHAMBER OR ; S^d`L vi 6A- ; C 21 7/~, JGa J /v UNIT MS umb e. rd~ Ip I J 5 DISTRIBUTION SYSTEM $'4 /..b Header/Manifold 11 Distribution Tole Size x Hole Spacing 7 to Air Intake Pipe(s) i 0/ IrL, 11-ength A+'ODia Length \ Dia Spacing \ e~ 3 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx Se "N® No E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 534 McCutcheoonn Rd Hudson, WI 54016 (NE 1/4 NW 1/4 16 T29N R1 9W) South Fork Addition Lot 1 Parcel No: 16.29.19.3070 1.) Alt BM Description o t, 2.) Bldg sewer length = 1 - amount of cover 71g off. Plan revision Required? ~ Yes No Use other side for additional information. Gi✓T]/ SBD-6710 (R.3/97) Date Insepc rs Sign re Cert. No. 1 `~`~4l, ar4~r County uildings Division l Y 17 MIS olo shington Ave., P.O. BOX 7162 Sanitary o Permit Number (t be filled in by Co.) P$ Madi^s VWI 53707-7162 kje) State Transacts n Number Sanitary Permit In accordance with SPS 383.21(2), Wis. Adm. Code, submis is form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Al on forms for state-owned POWTS are submitted to Project Addrrrgggs (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary yin ~y~C~ euh u oses in accordance with the Privacy Law, s. 15.04(1 (m , Stats. ► Y l / 1. A lication Information -Please Print All rmation Property Owner's Name Parcel # 620 - 40 3 - 61 - odic> r wit Property Owner's Mailing Address - Property Location 476 Govt. Lot I City, Sate Zip Code Phone Number ~ Af W V4, Section 1~ ~7) //N D i~ 4 0/ 5 y 36 9 ircle one T ~ N; R / E or i 3o'76 ~ II. Type of Building (check all that apply) Lot JJJ ) - J4 1 or 2 Family Dwelling - Number of Bedrooms 67 o k- " Subdivision Name Block # LJ 1 O / e5- 0 Public/Commercial - Describe Use (e. ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of _ 3 u Sk & 1 ® Town of M4 4 S o III. Type of Permit: (Check only one box on line A. Complete line B if applicable) c0 vt_- A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ( IV. Type of POWTS System/Component/Device: Check all that apply) ffi Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soiiG(,~ --,61cf' ❑ Holding Tank ❑ Other Dispersal Component (explai ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(g dsf) Dispersal Area Required (s f) Dispersal Area Propose (sf) I System Elevation *e /j `7 5a 0111 ) 0 ~ 0 9 Z q1.0 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 9 ~tG g New Tanks Existing Tanks ,c 3 7 U V la o Septic or Holding Tank q 5 L Dosing Chamber w t 5 p ~UY~ Ys ss VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature 7:;~7ber Business Phone Number Cyr n ~erS:✓ 9 ~ 4 9Z - 65 Plumber's Address (Street, City, State, Zip Code) f 9 U s 1,2J O 170e R1. e /45 J-- 54o Z VIII. - oun /De artment Use Onl pproved sapprove PerLmiitt Fee Date Issued Issuing ent Signatur en Reason for Denial $ r75 06 IX. Condif "WMEWReasons for Disapproval 1. Septic, tank, W,,uwt (Ater atad . dispersal ceN must all t1e services / main aln 4 as par tmaAitpotn@rit p40 pirgvided by plu nbg Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 11/11) DFlGN.E C3' _!~-RAu 1s WAGD S.Ct-1 M IAT r? L-aT -PZA_N ~ P1 1 *95__ 2-Z 0531 5C 14 40 B~ To I DA G G~ 'Sign a~ ' 3 SE pric 4 S~'o~33- O Q AS7M 8 4 ga 5 Bp~Pvn Rs C~c~ e Ir't 2 4'saK3~ rrrv►n SOr 4 p~c~ q ~5 . n v ~ 4 0 0 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 1 ►^O~01 S (A) 291 J9 j) EKDT Owner's Name: Owner's Address: Legal Description: W z41 S Zo 1i Township: p County: c Sr Crd /A Subdivision Name: _5o,,14 wl,*116ti Ac Lot Number. 1 Parcel ID Number: 67-6-11'P3- 6/ - O 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 fuL License Number. 622d Js _ Date: - / p / S Phone Number 1o i l jo7 qs1~4 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 r' uls WAlV erjqMjor _ PLOT_ PLA N E)FS)a vcp ay da~ WPBS __2 2 oss 9 StAL 40 F ~,SS't.ir►t ~L I DG.Dp Blr1 To ~ N ; ~ a~.c1 .63 X9'0 - 1615-L P W I CSE6 SE PTI C Pry l1t0K-S2 , _FIM9 6 4'? h qo $ epic VA As o1w e 3 2 3 M!~► q: S HR3 5 "row- Ser7"• 4 HOC/ q ' Csh fv ZO - 3 L'LL,S W re Q u I C,~ - Q 141FIL 7 077605 _EAW H - - Ft C5 Ta 6E _ j N 0, 7 9091 4 ~,c C -TA eop ~z 111 'I p O O O O O II cc U O C N O N c, E NO O O r co N u u E N U O U oS M N c r CO CO Ln r I~ U LO cn ~_W I O u (D U O O r ~1 I OPlDdgpAq 1 m m qE ti m CO W O u U Q ~ U ~ o g cn m U Q N W ~I III lunl 'i N N O U ~ N O U F= ZO ~ (n O C~fl y O Cl) w N c0 ti U w !n LO CO vi J F- _ q) co LL 0 a¢ O_JQOv CF) C) w = - w a O0 u1 Y ~F-U C) U- w C LU W in LL? U LO W FA w N M 0 W O YC5J000 Z o Q Q u\\\\\\u\\\\\\\\\\ > F- w cl~ CL (L D r N Z Cn r p') C) C,3 cn C O o ~MZ C!n0 00 G) Cn C ~ z mzr C-') M +n S -Ti r m iU co c, c _0 C) c :;7 X z m n m c) ~ Z m 02 - m o = m z cn 0 o O Z v 0 0o cr ~ W N ~ W A C-J ~ f O Ul N O qsq ~ i r" POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner rdv~s walar-Mhn Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer cr 6,4 c ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units I NA Pump Tank Capacity gal 2-NA Estimated flow (average) gal/day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) 250 gal/day Pump Manufacturer LtJ'NA Soil Application Rate 0'1 gal/day/ftz Pump Model B -NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit CENA Fats, Oil & Grease (FOG) :_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) _<30 mg/L %4n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 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: ❑ month(s) (Maximum 3 years) ❑ NA t!" ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume b NA Inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: Ei-fffonth(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ~-NA ❑ year(s) ) A Flush laterals and pressure test At least once every: ❑ 13 month( yeaar(s) r(s) 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 leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A"service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) y t 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 or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal 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 area 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 the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • 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: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption 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 lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been 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 tanj( may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat 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 NOT 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 BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name e c Name Phone 4f $ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Q rr S <'r Name yoik Cu 7- o YJ,t~ s Phone b ~S Phone 1 -1 ?/j W 414L This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r Oct-19-2010 01:59 PM St. Crcix County Plan/Zon,ng 715-386-4686 1;1 ST. CROIX COUNTY SMITICTANK MAINTENANCE AGRE-EMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 411, ;s l _G f GPI J'~'1 / C~ Mailing Address _ 115-8 j~' esC>n Property Addivss c G~ ~ ~vJ eJlcs~ /V/ 54/0/4 (Verification required fran Planning & Zoning Department for new construction.) City/State v oy Parcel Identification Number e:2 L9 =AL D>E PTI O N 6Z6 a / - Property Locatiolz 14 Sec. A-, T aN R~W, Town of /i't S 6 Subdivision Plat: Scr ) o c, rc 5 Lot # Certified Survey Map # , Volume, Page # Warranty heed # (before 2007)Volunte Page # Spec house yes no Lot lines identifiabio , yes : 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 liconsed pumper. What you put into the system can affect the fttnction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in Wontnt. 83.520) 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) tale on-site wastewater disposal system is in proper operating condition tend/or (2) after inspection and pumping (if necessary). the septic tank iv less than A frill ofsludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot forth, herein, us set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certifloation 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. 1/we certify that all statements on th' form are true to the bast of my/our knowledge. We am/are the owner(s) of the property described above, by virtue or a wa my deed recorded in Register of Deeds Office, Number of bedrooms 5~ _ _ n._-_...._......,._......_... z /S 113 SIGNATURE OF APPLICANT(S) DATE ***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. 08/05) ! I ll IIII II II~ I~I~~ I~IIIAiIII IIIIIII 8062130 State Bar of Wisconsin Form 1-2003 Tx:4044888 WARRANTY DEED 959010 BETH PABST Document Number 11 Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Diane Beckman and Darrel Rothe 06/27/2012 3:07 PM EXEMPT#: N/A ("Grantor," whether one or more), REC FEE: 30.00 and Travis Waldschmidt TRANS FEE: 669.90 PAGES: 2 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title 1200 Hosrford St. Suite 201 Hudson WI 54016 SEE ATTACHED LEGAL DESCRIPTION File: 2808790 020-1028-70-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated May 31, 2012 (SEAL) ,_I (SEAL) LI * Diane Beckman * Darrel Rothe (SEAL) (SEAL) * * AUTHENTICAT44l~1JE L : De4f, ACKNOWLEDGMENT '9 ~i Signature(s) ti`s O, STATE OF WISCONSIN ss authenticated on r . ; + Y ST CROIX COUNTY ) . - AU B ~ ~G z . * %'9J ' • Personally came before me on May 31, 2012 TITLE: MEMBER STATE BARN, the above-named Diane Beckman and Darrel Rothe tnni~itut (If not, to me known to be the person(s) who a uted he!~regomg authorized by Wis. Stat. § 706.06) instrument and knowledged the THIS INSTRUMENT DRAFTED BY: Doug Berg /1* Lorrie . DeMars~ 1200 Hosford St. Suite 201 Hudson WI 54016 Notary ublic, State of My ommission (is p anent) (expires: March 20, 2016 ) (Signatures may be authent a 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 TA name below signatures. i ATTACHED LEGAL DESCRIPTION All that part of the NE 1/4 of the NW 1/4 in Section 16, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, lying North of the public highway running over and across said NW 1/4 of said Section 16. All that land lying between a line which is 33 feet North of, and parallel to the South line of the NE 1/4 of NW 1/4 of Section 16, Township 29 North, Range 19 West, extending West 500 feet from the East line of said NE 1/4 of the NW 1/4; and North line of the old town road right of way. EXCEPT Part of NE 1/4 of NW 1/4 of Section 16, Township 29 North, Range 19 West described as follows: Commencing at the North Quarter of Section 16; thence N89002'1 3"W, 198.00 feet along the North line of said NW 1/4 to the point of beginning; thence continuing N89°02'13"W, 155.04 feet along said North line; thence S00°57'54"W, 453.12 feet; thence S89°02'13"E 327.36 feet to the West right of way line of a town road; thence N00°02'22"E, 187.18 feet along said right of way; thence N89°02'13"W, 165.12 feet along the South line of Certified Survey Map recorded in Vol. 2, Page 400; thence N00°03'53"E, 266.00 feet along the West line of said Certified Survey Map to the point of beginning; and EXCEPT a parcel of land located in the NE 1/4 of the NW 1/4 of Section 16, Township 29 North, Range 19 West, Town of Hudson, described as: Lot 1 as shown on the Certified Survey Map recorded in the office of the Register of Deeds for St. Croix County, Wisconsin, in Volume 2, Page 400, Document No. 340973. Parcel I D:020-1028-70-000 2 of 2 COUNTY PLAT of SCE UTH WILL 0 W A CRES PART OF THE NE 1/4 OF THE NW 1/4 SECTION 16, T29N, R19W, TOWN OF HUDSON, ST. CROIX COli ORIGINAL SCALE L)Arp~! I INCH - 100 FEET ~rILLGy✓ h__- o so Eoo 200 8M +w MV %064 'r ,rim' C7L !!t~D ('~t~'D S SCALE IN FEET S89° MP OF L4VV PIPE 11, _ sa9•~rz.4•E S89°11;Z5'E 966.11' ASV awe ~ Szm~ X 33.G 13J9J9 h At99'1r13"E 310A CQAWCmLravLUr AL - -AGA/fM - y M- OF LB7N PIPE OTRNEP / SRTDN AS , -Ey~ ~ Tr9N, RISIV I ' o~~ I ~ ~ ~ / a,,,,w K LBO 907. 0 / .p / o , h qp1 D F✓ / Low OPENIMi FLEI/gIIYJN Dd~IpE y-- ✓ O f/ LBO 9051 0~ 7 I _ _ 589'0213 E 327-:4 •I a ° 22x°115 Acees FYI !,0542,82 a~ . ~ll~l____MMMM~~99449999~~''''~~l~~!J!l!~Jj111~z5555~~WWWW- - -lssz P n<c NR IS1J2(SXoJ 1 all 3 I I I / ` 1; rS ' C rt / / 1 '40*-41W TAM- 0 \ ; 1ii1►' I I 1 ooB AceEs I lt) r 1 1 •Mlf srss ' I i 87T~J~0 sQ fT i~/ i'~ A499'S'1'S'1 E 306.18 8-41 ELB! TOP OF ZWA Axes SB9.19bT'W Y i 87,172f sQ fT ~~II .ves~11<i'w__ _ _ LBO 8s~f JJ7 110 0 F1 h 2,051 Ace P,,-- ~ I 2.013 Acees - ~ _ ` 87,,~7~g6 sy4 fr ti ~ CZ9~t7 sa ,Aj Euiroi if'p`nJy ~O yf3'W -MY,YGYtl E ~ ~s I 2.lJV ACi~s 97 L - Isar- 4 - cem LBO - YWS I 93,03 SQ f7 LBO 89 a f. ' - r BM +r3 ElEI! A9J9Z ~ Ipc I 71 EL6! 897.33 i'367• '~irrr~ y ' Jp 393.5 f' TOP OF MN PIPE- I. M TOP OF L@9N 10" ~fzv3 n -'rte` q f yd Ourer Euew.v in ?26~' ! A~9'3918'W 81341' e NEg9°l_'W 50005' c 71 M iry N89.194°3'W ",&r n -N891295l-M 81379' llEHED~6LR6D - L-f Ill Sa 11,W c T,re NE G&AWr S00°1719'E _ of rw AW ONAm of Scan .b'- ,.~1Si.''f 5 PA.£Kwe"L> vf~-,~la,:alrr I s `'V a~ Wisconsin Department of Commerce SOIL EVALUATION R'E'014 Page of~ Division of Safety and Buildings c EJ Zol 1 aEP ® in accordance with Comm 85, Wis. Adm. Code C6f unty ,4, r [ Attach complete site plan on paper~i s0kvn"it1f>I f 1' inches in size. Plan must uvrti/ include, but not limited to: verti6if", pit} nzontal reference point (BM), direction and Parcel I.D. ( 29-7 percent slope, scale or dimensions north arrow, and location and distance to nearest road. Please .print all information. Reviewed Oat -7 Personal information provide may oe used for n a purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location / ' S° Govt. Lot li 1/4/1 14 S TL N R c~ E (o W Property Owners Mailing Address Lot # Block # 84bd. Name CSM# City State Zip Code Phone Number ❑ City ❑ Village MTown Nearest t3gad A L/' r ew Construction Use.X-Res,dential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Put,lic co ' De crib Parent material- S . F`loo/d,Plain elevation if applicable '41-~ ft. General comments / ; 1 ' X 2, l et _ C~ zit- G7 /7lt f and recommendation . 0 System Typet~04System Elevation-__ Tt~ Boring # Boring ❑ [ pit Ground surface elevft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eft #2 i Gf ( r J CI ' Z '3fo S S rte-- ' U/ma t Boring # E] Boring 0 Pit Grot nd surface elev - ft. Depth to limiting factor gyn. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 'Eff#2 Z I co) Eflluent #1 = BOD, > 30:5 220 mg1L and TSS >30 < r ffluen = BOD 130 mg/L and TSS < 30 mg/L CST Alarms (Please print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, 54017 --j 715-246-4516 Pr IHI operty Owner _ Parcel ID # Page __of _ Boring # Boring 2{ pit Groui id surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 lD r z 1 o- C 4- J t- F-1 Boring # ❑ Boring ❑ Pit Grour,d surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/- and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 rng1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an a)temate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Soil Test Plot Plan Project Name Travis Waldschmidt Shaun ird Address 476 Cty Road A ; Hudson Wi 54016 #226900 Lot 1 Subdivision Date 8/31 /12 NE 1/4 N W 1/4S 16 T 29 N/R19 W Township Hudson ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of DNR Sign System Elevation TBD *HRPSame as Benchmark 75' B M * 966' Property Line 15' 55' B-3 B-1 I I 8% Slope 7595' B-2 93' Scale is 1" = 40' unless otherwise noted 1319' Property Line McCutcheon Road i SOUTH W Major ILLOW 7 { -Prelrn I Subdivision Hudson Townshlp, Wise H can' t' / All `jrlt~I" ij s r S~9°l1;ZS" 66.. I w 100, -2-~ - I~ . I ~ ~f ~SB-2 I 7 ~ , 1 l c, i r ` / LAWPENIrI/G If I I ~ ~ E ,EI~i9lIC~N Dll+'IDE ! / f r` 40, 4 f s o ~ + /~r/ ~ W W WW ~ I / , t , 1 1 1 W W W W W W W W W w t t ► er 1 1 1-1 _7 \ cL \