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HomeMy WebLinkAbout022-1085-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578959 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: Lansing & Haberman, Jane Marie&Jo Ann Kinnickinnic Town of 022-1085-20-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 29.28.18.458B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,5 CAPACITY STATION BS HI FS ELEV. Septic ' 1� 7% Benchmark / 35 /6/ 3 160 1 Ste_ f:,-k 4A a a tz S Z s Alt. BM ,1 C�J ,�f5 4-j_s Aeration Bldg.Sewer 9 L'' 1 7. 1 7 Holding St/Ht Inlet S. S .77 5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent Air Intl ake ROAD Dt Inlet 1 Septic `J 55 /d " — Dt Bottom -� Dosing Header/Man. t I �f � Aeration Dist. Pipe Holding Bot.System PUMP/SIPHON INFORMATION Final Grade Manufacturer GPM nd St Cover /� J 3 97S Model Number �f' TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM uid Depth BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liq DIMENSIONS SETBACK SYSTEM TO P L D LL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedrrrench Edges Topsoil Rel Yes Efl No � Yes No i COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 949 Quarry Rd. River Falls,WI 54022(NW 1/4 SW 1/4 29 T28N R1 8W) NA Lot 1 Parcel No: 29.28.18.458B 1.)Alt BM Description= J �,�,-S 2.)Bldg sewer length -.amount of cover= Plan revision Required? ❑ Yes ��o additional for i final information. ✓ !� Use other side Date Insepctor's Sig ature Cert.No. SBD-6710(R.3/97) >b` �iaarT� �a County ECEiVED ing vision C 1 E r; < 201 W Bu BOx 7162 Sanitary Permit Number(to be filled in by Co.) MAY 2 2 2015 Madison,WI 53707-7162 ST.CROIX COUNTY °0MMUNI'y§ffl J EP&mit Application State Transaction Number J in accordance with SPS 38321(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 ftrDiect Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary �/�/�j purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. / / 1 C Lo c o"'y 4'a z) L Application Information-Please Print All Information / Property Owner's Name Parcel# Property Owner's Mailing Addres �/ Property Location U 0 Ile /'TVA/e Govt.Lot Ci (� City,State Zip Code Phone Number AIL L 14 S(,J 14, Section -}- (circle one T 0-0, N, R P_E mO II.Type of Building(check all that apply) Lot# Subdivision Name or 2 Family Dwelling-Number of Bedro Block# ❑Public/Commercial-Describe Use ❑ City of CSM Number ❑ Village of ❑State Owned-Describe Use .7 -�7 �Townof A.vv� n v l� I 1j• / III.Type of Permit: (Check only one bo line A. Complete line B if applicable) A. ❑New System ❑Replacement System Treaimeni/Holding Tank Replacement Only ❑ 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 IV. Type of POWTS SYstem/Com onent/Device: Check all that apply) on-Pressurized In-Ground ❑Pressurized In-Ground ❑ oun _ le soil ❑Mound<24 in.of suitable soil ❑ Holding Tank er Dispersal Component(explain) 0 Z �i Pre ent Device(explain) V.Dispersal/Treatment Area Information: Desi ow(gpd) Design Soil Application Rate(gp f) Dispersal Area Required(sf) Dispersal Area Pregessd(sf) ystem El ation C�a c �y>e30 ,�� Lo , Oct VL auk o Capacity in Total #of Manufacturer y Gallons Gallons Units U °_ . o New Tanks Existing Tanks d c r' U in m 8;5 w t7 D Septic or Holding Tank /000 /�S'�'4 Dosing Chamber (/V VII.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum i MP/IvIPRS Number Business Phone Number Al, a , Qeur � Plumber's Address(Street,City,State,Zip Code) X28 S 06 4 a SS 12(L/en A l�S Ge%y S Q z z VIII CountylDepartment Use Only Approved Permit Fee Date su�eed Issuing t Si�rature teen Reason for 'al 5 Z" 5 DL CondiftTj Reasons for Disapproval 1:.4epW tank,effluent fiiter and ✓ /1 T' �O disoftal call must all aintain ,1 a*per management plan provided by �: A►��i,�d'e�tenEs tnu�tb�lMai�d as per spplfearils i�de/o�iqux�s: Attach to complete plans for the system and submit to the County only on paper not less than 8 1/1 s 11 inches in siu SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE 11 Project Name: ..- mE MflRiF � U swG / A H,+BExNI!- A Owner's Name: C sane E� Owner's Address: .2pg'n W&LL E'sL.EY A y EA u E 'Sr PAI,tL, Mrs f)51040 Legal Description: _ PP-T. Or N W'lq OI=Ttt& 5W' 4, � Tzg al, R 191A/ Township: I niN I el I PJ.A}L 6 County: 511 C'ROIX Subdivision Name: Lot Number. LO* Csyt VOL. 77 Parcel ID Number. OZ.z- /0$S,- ZO 000 ```````````ttgtllttlY111►►►/JJiJi�����' Page 1 Index and title ONS/M '�ii� Page 2 Plot Plan ••'•�••••• ��� Page 3 System Sizing &Cross-Section * . MARY JD'••.• �C Page 4 Filter Specs 0. HUPPERT a Page 5 Maintenance Information D 1859 .RIVER FALLS,, Page 6 Management Plan 3, 0"0.. W11 Page 7 St. Croix Cty Septic Tank Maintenance Form O •••-••'*„ \```����� Page 8 Warranty Deed i �. � iiF S�O� ��� Page 9 CSM or Plat nnnu+ s Attachments: Soil Test TANK D ' ne lumber. AAP-y —�ro �+JAppEAT License Number l g�9-007 Date: Q5--/y-15 Phone Number -715-,q2k 177.'- Signature A4&t 0 Designed pursuant to the In-around Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 Plat Plan Page 2of 9" Property Owner -rAAlg fA.Aiv5 LAA s w--o AAW �-,q 1�� 40 ft Lega l De don T^dZ I. 1 4 7fr'C ' - -� f®wept where noed a =Backhoe pit s7 �orx cc�u,V—r\/ lNI-SCOAJsfnJ, • .� �r:,e�� ` North J S�s�tEM EL=QO.Gr, c> co , ca qy,,s flL• 4G o 4b•yo� C p S.M y,746 aeN•y� ..OUT,-&T EL _ ISTrnl4• NK CODE $�,pRDOM ml $��-rOP DF WEB 1.45 i1-SOVE�UN�+ Site Location• Zsl _ Ivy.nR• . R fi` 949 Quarry Road River Falls, Wl Existing System Sizing: 3 bedrooms = 450 gpd — 0.7 loading rate = 642.80 ft.2 required for drainfield. It was observed to have aggregate 12 ft. from the existing vent. Assuming the drainfield is sized at 24' x 30' = 720 ft.2. Alt 15&C ell��,44✓ r'�lv ���e�s fz 6e v�o/� ►5 ®`�®eily . ��/l� 73/,987" n . 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II l II. ,i �!o, I III �..,• � SIA 1l �� lI:III I II,i � • I • l l/I r/ 'l f-,1/'l!/ r,-- ��, � i! 1,t, .ci, � ,��il� • l' f/ / Auz r ( ,� /� /i , ,, r %, r/ ? , d ,�%/ i' � �/,� '/ '�1 r�,/i jli�'!eft • .. l r IL POWTS OWNER'S MANUAL & MANA09MENT PLAN Begs Zfof , MILE INFORMATION SYSTEM SPECiFICATICNS Owner JANE 1C-At6lX D A 9 J4 Septic Tank Capacity al q NA Permit S Septic Tank Manufacturer U731 0 NA DESIGN PARAMBYM Effluent Filter Manufacturer ©� O NA Number of Bedrooms ❑NA Effluent Filter Model Cl NA Number of Public Facility Units 16 NA Pump Tank Capacity al 'R NA Estimated flow(average) aUday Pump Tank Manufacturer QA Design flow (peak), lEstimated x 1.61 1q5Q a111d Pump Manufacturer J4 NA Sall Application Rate pW * Pump Model L"A Standard influent/Effluent Quality Monthly average* Pretreatmant Unit 30A Fab, Oil b Grease IFOG) 590 mg/L 0 Send/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SODS) sa2O mg/L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (T133) 6150 mg/L 13 Disinfection 13 Other: Pretreated Effluent Qualitjr Monthly average Dispersal Cali(s) ANA Biocharnloal Oxygen Dsmand (BODO) 530 mg/L 0 in-Ground (gravity) 13 in-Ground (pre ) Total Suspende' Solids (TSS) 580 mg/L Ad NA O At-Grade 0 Mound Fecal Codfform (giernstrio mean) $10'ofu/100ml 0 Drip-Line C3 Other: Maximum Effluent Particle Ske Ye in die. 0 NA 5-ran p NA Othan 0 NA Other. 0 NA "values typical for domestic wastewater and sspdo tank efftnuvd. Other: 0 NA MAINTENANCE SCHEDULE Service E%ant Ssrvlce Frequency Inspect condition of tank(ii) At least once every: �j e Is! (Maudutwm$years) 0 NA Pump out contents of tarills) When combined sludge and scum equals one-third (K)of tank volume 0 NA Inspect dispersal oell(s) At least once every: eerie (Maximum 3 years) 13 NA Clean effluent filter At least once every: i j 13 months) 0 NA eerie) inspect pump, pump controls!k alarm At least once every. 0 manth(s) iZNA (a earls) Flush laterals and pressure test At least once every: 13 month(s) NA Other., At least once every: month(s) Jk NA b serfs 0 rc a A MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or aertitlostions: Master Plumber; Master ('lumber Restricted Sewer; POWTS inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must Include a visual Inspection of the tankle)to Identify any missing or broken hardwarmm, Identify any cracks or leeks, measure the volume of combined sludge and scum and to check for any back up or pmtding of effluent on the ground surface. The dispersal collie) shall )o visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground aurface. 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 scou.nulation of sludge and scum in any tank equals one-third (K) or more of the tank volume, the entire contents of the tank shel' be removed by a Saptage Servicing Operator end disposed of in accordance with chapter NR 113, Wisconsin Administrative!.:code. Ali other services,includin; but not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units,and any servtoing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. A service report shall be w ovided to the local regulbtory authority within 10 days of completion of any service event. START UP AND OPERA?ION page to to-L For new oonetruadon, prior to use of the POWTS chook treatment tank(@)for the presence of painting products or other chemloWs that may Impede the tr eatment process mWor damage the dispersal cell(&). if high concentrations are detected have the contents of the tank(a) removed by a septage aarviogtg operator prior to use. System start up shag ra)t occur when moil conditions are frozen at the Infiltrative surface. During power outages Bump tanks may fill above normai highwater levels. When power is restored the exosso wastewater will be discharged to the dispersal collie) 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 oontents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntelner to assist in manually operating the pump controls to restore normal levels w':thln the pump tank. po not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 18 feet down slope of any mound or at-grade Boll absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; taby wipes; cigarette butte; condoms; cotton swabs; degreasers; dental flose; diapers; disinfectants; fat; foundation drain (sumii pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;pest=cides;am"napkins;tampons,and water softener brine. ABANDONMENT When the POWTS fails and/or to permanently taken out of service the following steps shall lie taken to Insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Adminietretive Code: • All piping to tat+lks 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system; C3 A suitable ropl;woment area has been evaluated and may be utilized for the location of a replacement soil absorption system. The re placement 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 was will result in the no id for a new soil end site evaluation to establish a suitable replacement area. Replacement systems must comply with tht.r rules in effect at that time. 13 A suitable rep,acement 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. nt The sits has net been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and alts ,evaluation muff: be performed to locate a suitable replacement area. if no replacement area Is available a holding tank may be InstatlaiI as a left resort to replace the failed POWTS. 0 Mound and at-grade soil 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 a 9 SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND108 INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMII 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 COMMENT!; POWTS INSTALLER POWTS MAINTAINER Name .E SnM.)�LD Name M Phone 15 4?S—&ZzD Phone (`7/S) 4 Z�.y- b Z 6 SEPTAGE SERVICING O-PI BATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name DARRELLS 5EPM- 6LK +E Name ST CMX(2DUfkn1 Z0141grEz.) 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CROIX COUNTY SEPTTC TANK MAINTENANCE AGREEMENT AND // OWNERSHIP CE�RTIFIICATION FORM OwnerBuyer ��/Y S/•� 7� XN> �A 6 e✓'.i•.r7✓ Mailing Address r�4�C Property Address •- (Verification required from Planning&Zoning Department for new construction.) City/State �faet)( 11.5 Parcel Identification Number. d?2 —1QK'-Z0 06( LEGAL DESCRIPTION '%, Sec_ , N Town of 2� RPro p Property Location - Subdivision _ , Lot#_ Certified Survey Map #_�v� ,��• a L 1/77- Volume_ , .Page#i Warranty Deed # _ , Volume_ Page # Spec house yes not Lot lines identifiable c s no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its p"emature failure to handle wastes. Proper maintenance consists of pumping out the septic rank every thrcc years or sooner,ifneeded,by a licensed.pumper. What you put into the system can affect the ttmction of the septic tank as a treatment stage in the waste disposai system, Owner maintenance responsibilities are specified in§Comm. 83.52(l)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to subrnii 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 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 year expiration elate. Uwe certify that all statements on this form are true to the best of nay/our knowledge, i/we ant/arc the owner(s)of the property&c scribed above,by virtue of a warranty deed recorded in Register of Deeds office. SIGNATURE O LTCANT DATE *** Any information that is 111isrepresented 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 tjie certified survey map if reference is made in the warranty deed. (REV.08105) U 2577 P 066 7632439 KATHLEEN H. NALSH STATE BAR OF WISCONSIN FORM 2-2000 REGISTER OF DEEDS DocumentNumbm WARRANTY DEED . ST. CROIX Co.. MI RECEIVED FOR RECORD This Deed,made between Christine Wolf,a single person Grantor, 05/21/2004 08:08AN and Jane Marie Lansing,a single verson and Jo Ann Haberman a single person. Q join+ -tknayrK %f eL, Grantee. WARRANTY DEED Grantor, or a valuable considerlion,conveys and warrants to Grantee EXE?PT # the following described real estate in St.Croix County,State of Wisconsin(if REC FEE: 11.00 more space is needed,please attach addendum): TRANS FEE: 510.00 CERTIFIED SURVEY MAP IN VOLUME ONE (1) OF CERTIFIED COPY FEE: SURVEY MAPS,PAGE 77,AS DOCUMENT NUMBER 325641,FILED CC FEE: PAGES: 1 IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON FEBRUARY 10, 1975, BEING LOCATED IN THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER(NW 1/4 OF SW 1/4)OF SECTION TWENTY NINE (29), TOWNSHIP TWENTY EIGHT (28) NORTH,RANGE EIGHTEEN(18)WEST,TOWN OF KINNICIQNNIC. Together with easements for ingress and egress as described in Volume Recording Am 1476, pages 276-279, as document number 615043 and in Volume 1476, pages 282-284,as document number 615045. Subject to Quarry Road and Name and Return Address East Quarry Road rights of way. :"v:r Vail Ittt�Services,Inc. Falls,WI 750 JCS 15rn�{ _3y3a �le.lsant l{ 1;5 N 55401 022-1085-20-900 Parcel Identification Number(PIN) This is homestead property. (is)(is not) Exceptions to warranties:easements,restrictions and rights of way of record,if any. Dated this day of May,2004. (, ,� { * * Christine Wolf * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. PIERCE Countv. ) authenticated this day of day of Personally came before me this Mav , 2004 the above named Christine Wolf ,TITTLE,•MEMDE FATE BAR OF WISCONSIN LARSONto me known to be the persons)who executed the foregoing ' "bV&71l,9.06.Wis. Stats.) Notary Public inswun t d aclrnow edge a same. RUMENT WAS DRAFTED l pte of Wisconsin Ja r Attbr v at Law iddr' s X54022 Notary Public,State of W) / 'Sq My Commission is De nt. f not,state expiration date: Sign r,may'b'e authenticated or acknowledged.Both are not necessary.) D 4�7 ) "Names of persons signing in any capacity must be typed or printed below their signature. INFO-PRO (800)655-2021 www.infoprofomis.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No.2-2000 ; t), 4 t CERTIFIED SURVEY MAP Part of the NW 1/4 of the SW 1/4 of Section 29, Township 28 North, Range 18 West, Town of Kinnie-lkinnic, St. Croix County, Wisconsin ICE I L E D fir'\ m FEB 1 O 1975 -.j W y.� Gorrsa JAA4ES O CONNE[L S¢e ,29-T28/V-/P/8�Y Sam+-0/o'av"�✓ sZZZ-00 Resister o? p_�d, W s. Go,x ��r. VA r M 3 c 0 0 v YY`ss�- �i`sa of L� o Scc z9, T28N, 'o ? ti Scale: 1" = 100, vl•+-E-_-_�_� - Indicates 30" - - iron pipe stake N8�%GOE 27 .00' weighing 1..13#/ft. Description: That eertpin parcel of land located in the NW 1/4 of the SW 1/4 of Setion �9* Township 28 North, Range 18 West, Town of KinnickInnlc, St. Croix County, Wisconsin, more fully described as follows; Beginning at the West 1/4 corner of said Section 29, thence go S 000 00* 00" E abong the west line of said Section 29 a distance of 322.00 feet; thence N 890 10 ' 00" E 272.00 feet; thence N 000 001 00" E 322.00 feet to the north line of the SW 1/4 of said Section 29; thence S 89b 10' 00" W along said north line of the SW 1/4 a distance of 272.00 feet to the Point-of-Beginning, the above described parcel subject to easements for road way purposes along the North 33.00 feet of the above described parcel and the westerly 33.00 feet now being used for Town Road, and subject tD and easement for driveway purposes across the North 15 feet of the South 25 feet of the West 165 feet of the above described parcel. Certification: I, James L. Murphy, surveyor, hereby certify that by direction of the Owner I have surveyed and divided the lands shown hereon and that the map and description thereon are a true and correct representation of and description for the lands as divided- and that I have complied with all the provisions of Chapter 236-34 of Wisconsin...$t4; rtes in our-re i�, dividin g, mapping and describing said lsrid 3 _, ' Dated: 10 February 1975 James s #.. t!ltirphy. G ResiLster-i�d Land Surveyor Document No. 1, Vol, Page 77 Certified Survey Maps, St. Croi'mi;; '�Malli3Y, Wis. r C s CEfq Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT Page I of 2 in accordance with SPS 383,Wis. Adm. Code County ST.CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D 022- 1085-20-000 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Reviee by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Z S Property Owner Property Location ft JANE MARIE LANSING/JO ANN HABERMAN Govt.Lot ----NW 1/4 S 1/4 /29 T 28 N R 18 E(or)W Property Owner's Mailing Address Lot# Block# Subd.Name Or CSM# 2083 Wellesley Avenue 1 -- V1,P77 City State Zip Code Phone Number aity Village own Nearest Road St.Paul, MN 1 55106 1 ( I Kinnickinnic I Quarry Road New Construction UseE] Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD Q Replacement Public or commercial-Describe: Parent material sandy Flood Plain elevation if applicable ft. General comments Pit conducted to verify soil conditions 3 ft.below bottom of the existing drainfield. and recommendations: New septic tank to be added with filter. Property Address: 949 Quarry Road Boring# 0 Boring a pit Ground surface elev. 93.95 ft. Depth to limiting factor 100 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 *Eff#2 I 0-13 10YR2/2 1 3fabk mvfr cs 2vf-m 0.6 0.8 2 13-19 10YR3/3 I 2fabk mvfr cs Ivf-m 0.6 0.8 3 19-39 7.5YR3/4 sl 2fa&sbk mvfr cs lvf-f 0.6 0.8 4 39-100 10YR5/6 s Osg ml -- lvf-f 0.7 1.6 F2 Boring# 11 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/fe in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Ef1#1 *Eff#2 *Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) CST Number M Jo Hu ert Hollister's Soil Testing&Design) Signatu 224832 Address Date Evaluat Conducted Telephone Number W9875 690th Avenue,River Falls,WI 54022 05-09- 15 715-426-1775 SBD-8330(R07/13) i Plot Plan Page Zof z Property Owner ,-rAuE AftP,15 L.-+AL-S)�,,- I" = 4o ft Legal Description Nw'/4 op-me (fit where noted) .1 Ed Z4 720) R ,$�, - �� }�,� Fix,u,�tc� a =Backhoe pit s-l; acv;; COVA)7 4 wis(!.ar)s!AJ , " 2.oJ ¢Ickes North �J )A"-, elV q�•as ,-}- DR,��P � o fl 4 gj � � c� �'.. 6us•H Oc X 91o•yG� X. OUTLET El []-�l3T?A)a7 -rAAiA BL��?uGf'Gr' D �,�fI�ANDOlJ6� gEDIZOOM plc SP5 CODE en ®WEL- � l,yS�ASGVE $TUIID AsSu Mr-z Site Location: I VEIL b9.