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HomeMy WebLinkAbout040-1316-11-000 County ~r Safety and Buildings Division e Crol, ~i Lf ' _ 201 W. Washington Ave., P.O. Bo 16 Sanitary Permit Number (to be filled in by Co.) I Madison, WI 7- 62 ti~ t 57c, State Transaction Number :,OMMUNJTY DEVE Per YTllt Application ifary in accordance with SPS 383.21(2), Wis. Adm. Code; submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary J u oses.in accordance with the Privac Law, s. 15.04 t m Stats. ~l~Ze TQ~ I. Application Information - Please Print All Information Property Owner's Name n r Parcel # 0 .410- /15 ,.Address Property Location Property -4109' Owner's Mailing L70 rd h .1-47 Govt. Lot City, State Zip Code Phone Number sr y, Section / / ~ 1 circle one / 7 (iif / T_ N; R E or II. Type of Building (check all that apply) Lot# JR 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ) ,ok Block # Cedor 0 ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z tlJi~' 2Z.kZZ. vwlO ~ Town of III. Type of Permit: (Check on one box on line A. Complete line B if applicable) 170 Nr 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 P IV. Type of POWTS S stem/Corn onent/Device: Check all that apply Non-Pressurized In-Ground El Pressurized In-Ground 11 At-Grade 11 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ~r ❑ Holding Tank Other Dispersal Component (explain) ❑ PretreatmentDevice (explain) V. Dis ersal/Trea ent Area Information: Design Flow (gpd) Design Soil A plication Rate(gp f) Disp al Ar a Required f) Dispersal Are Ptop d (sf)aa_ System Elevation 99(~ coo '41 *1 VI. Tank Info Capacity in Total # of Manufacturer t. Gallons Gallons Units U u ti New Tanks Existing Tanks c u r sz'~ a U v) m V1 w C7 LL Septic orHoldin-Zwk 1~ L✓ ~~r Dosing Chamber conc re_ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum r Signature MP/MPRS Number' Business Phone Number en a s ~t?Gl l ~ .~~rv ~~3 /,r ~ - X68 Plumber's Address (Street, City, State, Zip Code) VII County/Department Use Only Permit Fee Date ssued Issuing gent Signature Approved $ /r =We~n Reason for Denial IX. Condie &T4.tAVppJNWl Reasons for Disapproval 4*1 I.,: Septic tank, effluent filter and 3~ t'aaa vet cs ar eci dispersal cell must all be selVtMj t 0*1t 'ne as-per management plan provided by plumber. 4, lay- tt.t~ 1~Cf i Ci e " Y. 0 sgQtec(c n *lrgmertta must O mairtt il6d. as per applc" code i cldintrtoaa. Attach to complete plans for the system and submit to the County only on paper not less than I v2 x 11 inches in size 5> 5116CC141i fit,t.~„J ~ - G raft:.. ~ be, SBD-6398(R. 11/11) !eA ' t Pg c?? of Private On-Site Wastewater Treatment System (POWTS) PLOTPLAT FILE INFORMATION PROPERTY LOCATION Owner 1/, ,Section T_2L_N, R l E or W PIN # OCity, OVillage, MTown of 220 ~z 121~ N 0> F © 4X L170 Sjbrii a d~ elev. f ~Ytusf ink ~ I 'Z074 kSl. E 9' . I ~ C;c a #0 7Z u m~ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: sned I , Owner's Name: 91. Adrl Pa C' Owner's Address: C/ Legal Description: Township: ~1~ i0 County: ..a L cto ! X Subdivision Name: 12 r 0)1),o C/S Lot Number: l~ Parcel ID Number: 0100 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 Attach//ments: Soil Test & House Plans Designer/Plumber: ~_I1nI S TI Z°L(/1 License Number: Date: Zza Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Pg0? of Private On-Site Wastewater Treatment System (POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner SO)_ '/a Section k'a c A(a A cA l l T_Z~N, Rj~ E or W PIN # / OCity, OVillage, gTown of 0.4 - / O //X yd -gym . _6_ de&P r ® elev. 871 I l ~ ~ ~ Cd►7~0~~' e~EV4~/d'n S~'rCq-/ ~/e~~~ I ,n usf m~ I r l ` ~ ~.DrI~eu)dy a ~x }~v~uhrn,~faYe-Tra P( ~ y 810;;Fe If-ill 1- or 2- Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) _ -44 # of bedrooms x 150 gal/day/bedroom = 61z- gal/day Design Loading Rate (DLR) or Soil Application Rate = gpd/ft2 (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF 160(') gal/day . DLR ® .7 gpd/ft2 = ft2 # Chambers = Required Distribution cell area F-4-17 ft2 ft2/ unit EISA Chambers Chamber Manufacturer and Model: ~0 A / -iro '7' Actual Distribution cell area = Required cell area ft2 + ft2/ unit EISA End Cap Pair= ft2 Cross-Section In-ground Soil Absorption System (2-cell): 4" Schedule 40 PVC -vent pipe with vent cap -~y 12 inches minimum 12 inches minimum inches Soil Cover Trench 1 Sys- f / tem Elevation 7- /q inch Chamber Height -BAeft Trench 2 System Elevation ft ft Trench Separation Leaching Chamber Width * 40 -7'~' ft to limiting factor Plan View In-Plan View In-ground Soil Absorption System Absorption System (2-cell): Trench 1 0A Modify ft header/ design as ft Leaching Chambers needed. Trench 2 4 inch HeadeYrr Sch. 3U~ ~Qft with end camps Draw Q for a Vent and for Observation Pipe above. They will be located 0.3 ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page ~ of / Technical Spec if catio s PL-525 EFFLUENT FILTER (COMMERCIAL) f-- 61tr KL0= soa tt]6 { FORKO Rt1ETE7fiBitlgN i11RFTaISMGL7Qf➢1t1-• y ~ ` p t110 321 vr -far- y y f• jam'' . 1} PL45 I'VER HOUSING PARTNO.- MG-0 - NATEIUAL• HOUSING -POLYPROPYLIX OURETBUSfING-PVC WALL -HDPE l- 800~TEtC~isR.0AT6~1iQ1 ~ T f t y ~ tRZ1 EILFFIS Y8CN t0 - Im Q' FOIIKMEEXTB1110M ~ pool losm~ 1 IL T -.TavaFtra6tvl9 ~ ` I_ - ~ - SOCKETDCEFM _ WUR191ROD oPBiMC _ • GF9.16 aK n • POLY<.OK P4ffi5 FI.1Bl Ci'RTRIDG'E PARTNO.-1014144 MAtER1A1.-P'OLYPRO YMNE POWTS OWNER'S MANUAL & MANAGEN;` `JT PLAN Page _ of _ FILE INFORMATIVN SYSTEM SPECIFICATIONS Owner Septic Tank Capacity MV- al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer I k ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units 50 NA Pump Tank Capacity gal NA Estimated flow (average) 11~~ gal/day Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x 1.5) D gal/day Pump Manufacturer 0 NA Soil Application Rate a it gal/day/ft2 Pump Model 50 NA Influent/Effluent Quality i%':onthly averagc* Pretreatment Unit 19 NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BQDr,) <_220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality NA Monthly average** Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) 530 mg/L '0 In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) <10, cfu/100m1 ❑ Drip-line ❑ Other: Maximum Effluent Particle Size Y8 inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every 3 ❑ months J6 year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume inspect dispersal cell(s) At least once every ❑ months 87 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months 0 year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) PJ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) 14 NA Other: At least once every ❑ months ❑ year(s) JR] NA Other: At least once every ❑ months ❑ year(s) R 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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. Page A6- of 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. ABANDONEMENT: 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 ch. 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: )k 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 tank 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 ennf Name Phone WE- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency `-1 i cro(` Phone '7 Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not ni,-,rq.-.top the nerformince of the POINTS. Page -6- of to luring power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will e discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge f effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to :storing power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump ontrols to restore normal levels within the pump tank. )o not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area rithin 15 feet down slope of any mound or at-grade soil absorption area. ;eduction or elimination of the following from the wastewater stream may improve the performance and prolong the life f the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; isinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat craps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ~BANDONEMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to isure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative :ode: • 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. 'ONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, o provide a code compliant replacement system: lk 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 fines 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 tank 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. kDDITIONAL COMMENTS: :1OWTS INSTALLER POWTS MAINTAINER Namenf Name Phone - jyf Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency -4rCr-q ..'4nih Phone Phone t7, ~ - 6' -,3 cc This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not ,.-t........--- .,f tk. PrI%NTS ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ire 1c 'v. 1~Q r" li PClC-A/ Mailing Address 76 z 0-r- '1 Z_dwe Property AddressJ~ ,1 (Verification required from Planning & 7_oning Departmen r new construction.) City/State T7U0~S,1,,,7 Parcel Identification Number 04 -/3A6 OX LEGAL DESCRIPTION Property LocationS,"- '/4 ,S&) '/4 , Sec. , T N R_/?_W, Town of 7ro ce a r W d i d"s Lot Subdivision Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable es 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 Comm. 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 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 date. I/we certify that all statements 'n this f'rm 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 warr ty deed recorded in Register of Deeds Office. Number of bedrooms 4_'~ T - LA ~u k ~ . (P /28 / Z01 j SIGNAT 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) ' vsn-~a ~ ~ 14 ~ I A 3 I I I p I 9Y9Y9Y I I Ali S I b 1 I I I I 9`~e a . I. I 1 I I I I I I 4 I 9 M I I III V I , ~ II I + ' ICI I C _ I I I I i' I. I - - II i'I - I I I I I - 1 j .I I - I I ! I I i~ I I 1 I I I I~ 4 0 I r. » ill I f I I I:I 'Ii l 1 + I I I C I I I I I I _ - I i 1 I I I E3 I II' I 6 I III ,I I I'I I ' I l,l; I I 'I j+ D ~ I ~I m I , I I ' I I I r vsn-NMNODGIM sy ¢ With 1~ 999 e ~ ' 60Q' y , C s a 2 , 4 . R 9 6~~ ~ ` it rr . ¢ pp i. rl I IIA~~~ t , F - - - - - - - - - - - - - - - - ' ! - b03At~900HZmN' all I. / ' r I E.! e I i~"~• C 'ell - - YF i ]a9 ~ , 1 pp~ yg 8 s , , I I o I I I I I 1 i I I i I 9 ' VBn-NISNOOMM a IHOW W" V 31VN z` 1 y ■■atFp Y I 9 in 7 V~~R~ 1 ° ®p I inv I 1 I I ROM 2 k 7j I b~ ~ s S 1 tl M in: xw ~ , I 1 z ' t I I R I ^aax.s~• a 1 . ` 1 I I 1 01 - - v p,~ N~ I,•~•. I N y Fp f, ~ I ppp N ! ' I 1 I 1 N f ~ I / i ~ f I I I I I ~ ! H3Vd RMI T 31V/N lo 1. 11 di! ll I I t7 ~ ' s s ~ I w ~ 4 H . A . I / I v Q 9 s - ~J ee I LL 5 ~ - f I I i I I k~ I 5 I ~p I II H 'Rik I r 1 ~ ■ I I aim j I I a - z t I b I I I I I I ~ 'CE F I e ~ - I ± ■ I I, I I b I ' I I .ftl-A .XP~1 .Xl-A died Al-i ~ I i i i L I 0 1 _ I o o I 3b s a ab4 I fig a d fly - L-l 3 I I AVA -f- - I - I RECEIVED r Wis. Dept. of Safety ari fOf;trM ~roices SOIL EVALUAREPORT Page of Division of Safety and I In n accordance with SPS 385, Wis. Adm. Code ST. CROIX COUNTY County s C'rmr` Attach corrWM6i Wd k oQPToWRMEMWan 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 1 - le(/n Please print all information. Rev wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. LotSZ 1145V 1/4 T- -ty N R/ E (oQ Property Owner's Mailin Address L~ # 1131ock# Subd. Name or CSM# '7`V f1©r , n Lei /J C.'~_Qj r City State Zip Code Phone Number _ ❑ City ❑Village RjTown Nearest Road Ar /Zero` ® New Construction Use: Residential / Number of bedroom . Code derived design flow rate t GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material / Flood Plain elevation if applicable ft. General comments -Z~7 ,S fall 7"re.7 cfi6,S 5-,3 ~ O/eep Fr,1&7 Soy' dace e%ve-/-/B,7 fd 0 let,- and recommendations: any -°//"d , ,dsc, C'otiveilw, a/ -Tn Grov4d ` r-egc/i~s d - _ -/761-S dd-e 00/ Boring # Boring 71 ❑ / ® pit Ground surface elev. ft. Depth to limiting factory /Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1.01 * ff#2 / - a F o? y/ _ Y, d' u - o 1/21 Z~2g -&6 260 310 ~ o~i ~h s o~10.5 Boring # Boring n~ ❑ Pit Ground surface elev. YJ`~ ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 1 - F l✓ C/- /C d /a ~~y w _ 6 s CY/ c~ / r i& -5- to - ,v~ 6 * Effluent #1 = BOD > 30 < 220 mg/L and TS >30 < 150 mg/L Effluen = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature _ CST Number G Address Date Evaluation Conducted Telephone Number SBD-8 0 (811/11) Property Owner,4Y- d r1 Parcel ID # Page J of,_ E] Boring M Boring # 0 Pit Ground surface elev. 7/r~ ft. Depth to limiting factor`f7 ` in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 A VW -41 c~-Y ?-4g mw .3 6 _ C/ C/ G!1 a e o X13 5 v c Boring # ❑ Boring Qom" pit Ground surface elev. ft. Depth to limiting facto 4 7/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 « ff#2 S14 lpdr C/ a s' 7~sv!~Z4 C-/ ❑ ® Boring # Boring Pit Ground surface elev. Depth to limiting fact 9~ 7C/Gin. Soil Application Rate Structure onsistence Boundary Roots GPD/ft 2 Horizon Depth Dominant Color Redox Description iTexture in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. « ff#l ff#2 , 1) YA1,1,144 /cc/ bizkeiz H It - OS o// - r ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 n19/L ' Effluent #2 = BOD e < 30 rng/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SM-8330TW (811/11) Property Owner,~& w ea r / Parcel ID # 046 - zs* 'loo Page 'I of,_ 1&7 fR Boring # [ ~ Boring /r- Pit Ground surface elev. 7/t~ ft. Depth to limiting factor~tbWin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 - / - S` A0 6i Q/s h j / n 'r Cl ' C// ` klolq 11,57' Boring # F~ Boring p o/) pit Ground surface eiev. 7~E(/ ft. Depth to limiting facto ,44 7/,g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 s° 7 'V14 C it 4~ /A r Xockefs (z F-I Boring # Boring r/> Pit Ground surface elev. r ft. Depth to limiting factof~~9~ Gin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 24 /F r ash ` 0 M r ° 0 P? C * Effluent #1 = BOD 5 > 30 < 220 mg/- and TSS >30 < 150 mg/L * Effluent #2 = BOD a < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330Tmt (RI1/11) PLOT PLAN OWN 'R Ate 1.6 r l Pctc SCALE 1"= AFT . ~a c~ ~ df BORING ELEVATIONS BENCHMARK ELEVATIONS / B-1 BM #1 f0Q,0 ' DESCRIPTION OF #1 /A B-2 = BM #2 1~90,t, ' DESCRIPTION OF #2 B-3 B-4 C' LEGEND--- = BM (BENCHMARK) O * SOIL BORINGS ® = WELL UJe~~ NORTH wvad~~ VO-T w /c ~cd ars~nvs~-1~ "a~ ~a - Irh~ ~a pose ~ma C~ cr) y 7 ~ofl6 .Lo 7L of 9 fps ~ edars Ce~Q;~ ~Or1~S ce-a ar ~ CAS , co LsL-A d~ 1710 221483 . U_r ncrmnnn QTtIATATIM ('.qTM()/# CREDINTIAL# TELEPHONE # DATE CROIX COUNTy f L LZONING"OFFIC E CO UNTY PLAT OF CEDAR WOODS sw 0 Section' -v / sw TIIE SOUTHEAST Vs a THE swTRHEsT Vs Ale PART OF THE SOUTUMEST Vs OF THE NE / 19 3 Survey 16 1 SOUTHEAST Vs. OF SECTION S• IftUNIP 7E IIORTK RANGE 111 WEST. AND PART OF THE J ~2a' 5,2$` 9 I 1atli.tio~ NORTHEAST Vs OF THENOI1nNITVS•AMPART OlTIENORTHIWESTVsOFTIENORTHEAST eN , VA Ol Mell N i, Tow" lO NORTHL RUM"WEST. Lot 12 G F~oiN~s~~ I Lot 13 TOWN OF TNT. ST. CNN CO UNTYMISE0Nf111. - Frontier Subdivision recorded easemenl~ Frontier Subdivision M 00 Frontier Subdivision V) . N89.01'10" E STORMWATER 1Z 1321,12' (S89'54'54"W) MAINTENENCE ACCESS (1321.17) OUTLOT 1 r,'^ JN1?'l' ~awd I STORMWATER 1\ Water Elevation = 820.5' sF,/sw g , 670,010 sf. RETENTION AREA lcti~d , ~ ► measured 6/13/05 28~ 19 R 15.38 acres \ ) S` 8 NOTE: Outlot 1 contains a stormwoter easement over the entire area to preserve all I to the / stormwoter related facilities. /4 "E"fca sw, Sect. 5-3line yew , Seect 2-16 ,S ~ 231.38 226.12 ~J-2' 2 1,188'4311"E 'S6•W. - r N88'43'1E - S6ey~ grid System) O . J 341.07 -1 -7 g OD n vi LOT 10 (LOT 11 ( /S N 25' drainage easement 00 28.19 a \ LOT 9 83,369 sf. m 73,585 sf. ' N W +vo'"/ \ \ 114,241 $f. I 1 1,91 acres ' 0 1'I 1.69 aere$ LOT 12 719E V \ \ 2.62 acres 101 1 M ' 92,446 sf. / o ry~ \ \ I_t 2.12 acres / IN RED FOR: Z ~y~ \ \ I o w 1 ( f / o / 10 QED lent, INC ry LOT 8 ti~~ I£ 1 J J 22 97,783 sf. 10 0 1 d. , u i \ot~ai " \ 2.24 acres move, otdJ( fa\ / LOT 13 Y P.E.; RLS r \ 4,\ 85,176,.,4f: CONSULTANT. LLC !2I IN 1.96 acres 725 3 W t lit \ \ \ / / / \ / J N 'L VJ,yr.~ 9 ~g J\~\\\ • ~t N ~i/ N N $ T o LOT 7 15 O I Z1 68,605 af. \ oti~/ LOT 14 1~ 1.57 acres 9 ya/ \ \ 11 49,868 sf. I+ OUTLOT'"1 1.15 acres /P~OS~ N iv792ssr ® / ^ "1 I L, - - - J NO 259.4E !I /Y\ I ;4 ~N88.42'T5 E Q r "I I as I ' ~ o Q-~ T LOT 3~ \ , I , 55,202 af. I 1 LOT 15 LO 6 / 1.50 acres > 127.08 ! I I S exceed the 33' P ` 69,265 sf. 5 =E I s~jr I 61,367 af. nt at the z° \ 1.59 acres yL LBO=908.Oti 4~ / I $ ul I I j 1.41 acres + \ 10'•00 Jy ~/ry IF• L --Jo f slopes 20X or greater not YS•124s~~ _ / ~ 83.66' tat and not covered by Js, V / \ oeyjJyof I f I I tS.D '-x.. N88'42' 15"E to apply for and :receive a - LOT 5 LQT4 v # ' I LY788.42`1aS"~- OG -252:61 owner nreit. This is applied for „°Dj \ 1d is reviewed through a 76,597 sf. I 64,315 af. / r LO T 2 I S Crpis Board of EUty[$ air ~i.I e St. - 5~ I I .48 acres 73,392 af~ Alun Mon in \ X76 acres Z 1 _ a icated to the public" south~une of SE/SW l 1.158 acres f. o N 99 r N88'4215 E 362.29' I On - - \ \ \ H Io N!I .~rv \ LBO=908. a----- N ' 4, °r~,JSO~ \ I¢ ^ytiyn°^ \ asJ \ / ' - LOT 16- - $ I mop Is suelse4 to Slob. A rubs and reguiolbas(Le., A s, oeeess to.Porad. eia.). `s' V I / dj~4r \ \ T~ 0yry~ 72.945 sf. Noptng any lot. oontoct the \ \ 1 01 . L., a 1.67 acres O' •0 and Zoning Department and OT.1 I ^a I` Lot_6 \ \ss V /2^flry 66,603 sf. 'B' - - - - -J (A W L \ 1.53 acres/ ry,~o• / ` ~,ra , )PCs ENIST ON THE PLAY. Vo1.17,P 1.4567 I \ NO. C / , Qy a /1(1` / 589'02'17"W 319.9 w rv / C% D / yh' (N88'S9'39"E) (320.00') 1T EJECT AREA TABLE J~~u°`o ,n ; oeaNaoa ulutr srr r \2R. oa / I )rot t` I ;n 8' wear O r.. (AC" \~is'• ♦ 0 • TS \ 2, a D / tn . O \/y 4p8 ,64 , , Vo1.7,Pc~201f o NIA 71e,. 1.N /4w ~8/ N A 6 126 /LOT 17 _i . I.ea 9 L~t-7 \ Tf/ 42 a /"S 1~ NIA 2se7 28.E 1 angle / i ? 89,408 sf. ('1 - NIA 1/4 N A + Vol. 17 P 4567 .r W N A 1 .5,13 .1.18 i~--~ y I O Section a-Z :76 . / \ e~ ',P \ 2.05 Ocre$ O n N A 1 1.sa N A 7 ale. + / 1~ / y i r a Alum Mon. N A 1 ae7 121 / \ SS \ ~ /\.8 \ N/A ton. -a APPROVE By the Town o o °1 Tn7.lY AC TanV N A 2 n9 i:eaW • - Z . stw gm t a Chia - do of rit4tl^_-- t a Wisconsin Department of Commerce SOIL EVALUATIOlE R Page I of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. St- Croix County complete site plan on paper not less than 8'/2 x 11 inches in size. Plan mCounty Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road. 040- e nr*nt sill *nforMation D Personal information you provide y be oses 'vary Law, s. 15.04 (1) (m)) Property Owner Property Location 1111V - G&L Land Develo ment, c. Govt. Lot SE v4 SW /4 s 5 T 28 R 19W E (or) W DEC 9 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# W12491 890`x' Ave. T CROIx COUNTY 11 Cedar Woods City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road River Falls WI 54022 715-386-2928 Troy Coulee Trail / FF 0 New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Flood Plain elevation if applicable ft. General comments and recommendations: B-1 was completed during the preliminary soil assessment on July 22, 2005. The lot lines were not clearly marked during completion of the final soil assessment. Sufficient area is available for installation of the POWTS, however the plumber prior to installation of the system must confirm the location of the lot line. 9 6(- f..~d-t'~ Gln,a,r-.1.~.~-~ r~v►'te ,4- SGL. 1 Boring # ❑Boring =600 0 Pit Ground Surface Elevation 100.5 ft. Depth to Limiting factor 31 &>130 in. Soil A lication Rate ' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-10 10YR3/2 None SL 1-f-gr dsh gw 2f 0.4 0.7 2 10-20 10YR3/2 None SL 1-co-sbk dsh gw 1f 0.4 0.7 3 20-31 10YR4/4 None LS 0-sg dl gw 1f 0.7 1.6 4 31-93 10YR4/4 None SL 1-c-sbk dh ai None 0.4 0.7 pockets 31-93 10YR4/4 c-2-d 10YR4/6 & 5/3 SCL 0-m mfr - None 0.0 0.0 5 93-130+ 10YR5/4 None S 0-sg ml - None 0.7 1.6 a Boring # 13 Boring OPit Ground Surface Elevation 100.3 ft. Depth to Limiting factor >135 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-14 10YR3/2 None SL 2-f-sbk mfr gs 2f 0.6 1.0 2 14-27 10YR3/3 None SIL 2-m-sbk mfr gs 2f 0.6 0.8 3 27-41 7.5YR4/4 None S 0-sg ml gs 2f 0.7 1.6 4 1-135+ 10YR4/4 None S 0-sg ml - None 0.7 1.6 * Effluent # 1= BOD5> 30:5 220 mg/L and TSS > 30:s 150 mg/L * Effluent #2 = BOD5 30 mg/L and TSS 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 December 20, 2005 715-796-5664 t Property Owner G&L Land Development, Inc. Parcel ID# 040-1022-70-000 Page -2 -of 3 F 3 ] Boring # Boring >120 QPIt Ground Surface Elevation 96.8 ft. Depth to Limiting factor Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10YR2/2 None SL 2-f-gr mfr gs 2f 0.6 1.0 2 12-21 10YR3/3 None LS 0-sg ml gw if 0.7 1.6 3 21-40 10YR4/3 None LS 0-sg ml Cw 1f 0.7 1.6 4 40-120+ 10YR4/4 None S 0-sg ml - None 0.7 1.6 a Boring # 0 Boring OPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 El Boring # Boring OPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent # 1 = BOD5 > 30 5 220 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 or Need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. A Site Diagram 0 ft. 24 ft. 40 ft. 80 ft. Page 3 of 3 N L - yl I h` 'f ~ . f I i LOT I I x b_ 1 1 Sul - f 1 A I IA L 1 }j a 'I 1 1 R c9S j f ? It ! c9 ~S: l+ 1 1, ' 'SA O ~ ~ r B-it 1i 96.8' i~ _ f r B-1 100.5 r" ti- i+ B-2 BM#4 -Top of 1/ PVC Pipe L tl' 106:0' =Lot Lines BM# & Description Bench Mark B-1 Elevation - 100 =Boring Location & Elevation House and well location to be determined Owner: G & L Land Development Inc. Site Information: Completed By: Mark Iverson, PSS #197 W12491 890th Street SE 1/4, SW1/4, S5, T28N, R19W 680 Larcom Street River Falls, WI 54022 Town of Troy Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-386-2928 CST# 46672 W 'o 0%. ~ma UI 0 0 ' WN L w Q ~ r i i r i r r i r i i i r r r r r i r i m a O xk o 0 o o P ~ I cr H ~o I U cn u L'I W I W a C co O U- . co w Al I 0 N > C to w 0 N 0 0 / I -Ni y N / O Q 0 4.1 v > c wa~•L L w O}' r r r rr r rr r rrr cu co 1 0 to * 0 0 I I IV) \ ' I O r~ to oA N = i W O t~ r r r r r r r r r r r r r r CD CL N c° N o o (so