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HomeMy WebLinkAbout040-1306-17-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579053 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: Creative Homes, Inc., C/o Nathan Hidde Troy, Town of 040-1306-17-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No: 08.28.19.1844 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL 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 Mulched Bed/Trench Center Bed/Trench Edges Topsoil ® Yes ® No T ® Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 446 Jordyn Lane Hudson, WI 54016 (SE 1/4 NE 1/4 8 T28N R1 9W) Sunset View Lot 17 Parcel No: 08.28.19.1844 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Ful Yes Fn~ No ~ Use other side for additional information. I=Ej Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) RECEIVED 4 Nib Safety and Buildi ivi ' ounty - 201 W. Washington Ave., P.O. 1 unitary Permit Number (to be fined in by Co.) K IX COUNTY Madison, Wl 5 162, ay DEVELOPMENT 7j C 7c165,3 A Sanitary Permit Application State Transaction Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit /JA- is required prior to obtaining a sanitary permit. None: Application fortes for stat"wned 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 purposes in accordance with the Privacy Law, s. 15. 1 m Stats. L Application Information - Please Print All Informati 0 / C , Property Owner's Name Parcel # er `i,1- / p/ 6-/3041/1 Property Owner's Mailing Address Property Location / m IV\,ei N, /0 !Gorvt. Lot City/, State Zip Code Phone Number J G 1/._ y4 won T t) k IL Type of Building (c all that apply N; R~-t- or W or 2 Family Dwelling - Number of / Subdivision Name Qk aA k0l-e B / -S4l ✓l s (~p \e~ ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z 3 2Z tk- ~.L ~ ¢ Ts own of ` 111. Type of Permit: (Check only one oz on line A. Complete line B if applicable) Za A. New System ❑ Replacement System ❑ Treatrnent/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 ❑ Permit Transfer to New Type Before Expiration Owner O IV. of POWTS S stvWCom nent/Device: Check all that a 1 Nos-Pressurized In-Ground ❑ Pressurized 1n-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soIl ❑ Mound < 24 in. of suitable soil/~s / ~ _ 5 Holding Tank ❑ Other Dispersal Componcat (explain) ❑ PnetreatnmenY Device (explain) ! v~`~t V. Dis rsaUl'rea cot Area Information: Design Flow (gpd) Design Sol) Application dsf) ~ Rcquured (sf) D~isnmersai Area Propose s fl Systan Elevatio VL Tank Info Capacity in Total # of Mmuulacdaet Gallons Gallons Units Now Turks FxLlftg Tanks w Ou U ~ r 4L U rn 'e ~ i% p., Septic or Holding Tank ss Dosing Chamber VII. Responsibility Statement- I, the undersigned, ap4e responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pt Signature MP/WRS Number Business Phone Number 7/1 Plumber's Address (Street, City, State, ) t 6/3 z- 12o7 2ic40 Gc,) 59~91 7, VIII. Countv/De artment Use Only Approved ❑ Permit Fee Date Issued Issuing 46t Signature ason fo 4175. DD DL Con ' sons for Di pproval 1'. Se a tank, emuent niter an 3 ( mc-Ap rec, f2sG!✓e dispersal cell must all J?g se0/less rrtaintained as per management plan provided by plumber. 2. _0yt'A uk`rr1lenta 1!+aind: = per'app l e t dda / W&WIM, Attach to eompiete plans for the system and submit to the County only on paper not less than g 1rz 111 inches in size SBD-6398 (R. 11/11) PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 SE 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 95.8/95.6 5' below grade DATE 8/13/15 BEDROOM 4 CONVENTIONAL )00C IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. same as benchmark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 C a f e= 1/4" = 10' Jordyn Lane 75' Pro 4 40' Bedroom B-1 House B-3 100' 30' T .5% Slope 15' Vents Vent 2-3' X 90' cells with >3'spacing >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation B-2 34" 15' Property Line B.M.* Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/13/15 Owner:Creative Homes Location: SE 1/4 NE 1/4 S8 T28 N,R19W 446 Jordyn Lane Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cro ection 4-6. Maintrdontingenc fd n 7. Filter CrSignature License n PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 SE 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 95.8/95.6 5' below qrade 8/13/15 4 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cale _ 1/4" _ 10' Jordyn Lane 75' Pro 4 40' Bedroom B-1 House B-3 100' 30' T .5% Slope 15' Vents Vent 2-3' X 90' cells with >3'spacing >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 3 Grade at System Elevation B-2 15' Property Line B.M.* Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation ~ A(I 101.0' Vent Grade Vent 3' 4" 1 X30/34 Septic Tank 3 5' Long 119 5' S' Long 1 17 3617 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A-95.8' B_.95.6' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ❑ NA Permit # Septic ❑ Dose ❑ Holding Volume: / (gal) DESIGN PARAMETERS Tank Manufacturer: ANA Number of Bedrooms: 4- ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: A Vertical Distance Tank Bottom(s) to Service Pad:/ ///7 O ~ (ft) Estimated (average) Flow : 0 V (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Design estimated x 1.5 Spark servicing mechanics must be provided If vertical is >15 feet or 9n (Peak) Flow = ( (gallday) If horizontal Is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: , (gal/day/ft2) Effluent Filter Manufacturer: i Standard (Domestic) Influent/Effluent Monthly average., Effluent Filter Model: ❑ NA Fats, Oil & Grease (FOG) :gW mg/L Pump Manufacturer: Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA q Total Suspended Solids (TSS s150 m L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/11 mg/ Manufacturer. X-NA (BODs) >22 220 mg/L NA (TSS) >1 50 mg/L ❑ Mechanical Aeration [I Peat Filter Pretreated Effluent Monthly average C1 oisinfection El Wetland Y 9 ❑ Sand/Gravel Filter ❑ Other. (BODs) 530 mg/L Soil Absorption System (TSS) s30 mg/L -,ZNA Fecal Colfform (geometric mean) 510' n Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ AT-Grade ❑ Mound Maximum Effluent Particle Size ;k in dia. ❑ Drip-Line ❑ Other: Other: A Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 'PpWhen combined sludge and scum equals one-third (X) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every' 32 month(s) year(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Year(s) Clean effluent fitter At least once every: month(s) year(s) ❑ NA Inspect pump, pump controls & alarm At least once ev ❑ month(s) NA ❑ year(s) Flush laterals and pressure test 'At least once every:. ❑ month(s) NA ❑ year(s) Other. At least once every: ❑ month(s) NA Other: ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code.. ff All other services, including but not limited to the servicing of effluent fitters, 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 30 days of completion of any service event. GMW-005 (02/05) 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, solvents or other chemicals or sediment that may impede the treatment process and/or damage-the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be4scharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to-the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanity napkins, solvents, tampons,'and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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 repla ent system: '7ble 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name Name ~j u Phone 7) J-_ Phone 6- SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name a Name ~j n el) Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. i i n b ~ a 6 ^qD .r C3' J m CID LL- d ' c~ c~ r ti r M= S ~`t~ LU ST. CROIX COUNYY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C te., ;oe Mailing Address - -Z- Property Address lip, /j /1/ A f ' (Verification required from P ng & Zoning Department for new construction.) City/State Parcel Identification Number 6" LEGAL DESCRIPTION r4 Property Location ~ /4 ,Sec;. _9,T ZgN RL? W, Town of Pnv Subdivision Su ,t. S-e4y; , Lot # 17. Certified Survey Map # Volume Page # _ Warranty Deed # Vo [tune Page # Spec house es no Lot lines identifiable 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, 0 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 §C:omm. 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 Departrr.ent 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 Plarmurg & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on ' 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 my deed recorded in Register of Deeds Office. Number of bedrooms SIGN F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being rtvoked 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 I I N N, 10-l n I ~ . CI•S{., 1'~ r• 4.45"E 275-86.. t;.l ry o, O jy~• /,~r~~ S 105 I L_ lk N 00'00' ~ -~6 f 04 E--l I I C) CO 00 W AW L LZ 3«00.00.00 N i \ N 'N pq 1,00 00 ' N 00 cli I H a I °OD 1w) -4 CS l o ~ ~ •B'g N OOr42'1W"W 271.61 0o I 4 - - _ ,7=- 1 - CO j I ~a~~y - I 40 4$6.21 } 49 `~2~-'~ \ Cv w 1\ to 0-~ on J 10. O CO \0 -I C) 00 0 -In V9, c) \9 j-4 n , \ \ c 6\ 0 \ ;m -'t Vm \jib } 50 50' .525' C", i Wtj Cc) i . ~~r► -4 -1 a s S ! 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Plan must County S C~ include, but not lim ed to:~W~rtical and rXtal ref enca point (BM), direction and percent slope, seal or dime )G w ocation and distance to nearest road. Parcel I.D. /1-0~ P1 N nt all information. Revi ed by 'Date Personal information Property Owner yo provide may be used for seconds , ry purposes (Privacy Law, s. 15.04 (1) (m)). Z Z ~ ,1- Property Location q~' Property Owners Mailing Address Jr 1/4 Q1/4 S T Z8 N R ~E()wl Lot # Block # Subd. Name or CSM# ~ • o. fox 3 3 ~ City State Zip Code Phone Number S U N Ste' ~f L EN) B fr~h~ 5 Cl 1:1 City Village Town Nearest Road I New Construction Use: .3 Residenti~pl / Number of bedrooms 3=~ Code derived design flow rate ~ S Q ❑ Replacement Public or commercial - Describe: GPD Parent material G fie) 54 ~--L Flood Plain elevation if applicable N General comments ftand recommendations: ``~1vy i~J~J 3 Lvt , ~D`T'TLIIV/ CAF i°2~ ~CZ C_l ~t~ PTT I i I El Boring # ❑ Boring 2AMO ® Pit Ground surface elev. ft. Depth to limiting factor 2 in. , Horizon Depth Dominant Color Redox Description Soil Application Rate P Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I l o --q ~ z 4v-, 31-z s l z- .1, Z q-30 tp`22 316 Cyv Z~' _ 8 3 3~.~b ioyrz VA a~' `Z'6 •.Sa I El Boring # ❑ Boring ® Pit Ground surface elev. lib- Z ft. Depth to limiting factor ~ R g in. Horizon Depth Dominant Color Redox Descri lion Soil Application Rate I P Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o -l t Dlp 3 t Z 71 'Ps b tin`s- C.w Z,`p , s Z ) D-3 r3-f i - s i I Z ~1 s b~r- 3 6 -98 I0`2 L V16 m~" cS Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg-& ' Effluent #2 = BOD < 30 m Name (Please Print) - s _ t~L and TSS < 30 mg/L CST furs CST Number Arthur L. yWegerer sag O 3-2.1 S 1 `1 220254 Address W e g e r e r Soil Testing & Design S e r v 1 C e Date Evaluation Conducted 421 W. Main St. River Falls, NI 54022 Telephone Number 715-425-0165 i 4 Property Owner Et ` C*Nj ~1 Parcel ID # V-::1 k~!~ Z) K/ G Page of , F~] Boring # ❑ Boring ® Pit Ground surface elev. 00' 8 ft. Depth to limiting factor p 7 ! in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ti In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o- I O 0.1 2 Z ~ 1 s `I C1~ Z 10-3 3 vpy IZ 3Lfj s I Z in s b lz~ yyl ~'y eS l , S 3 33 -a9 o~ R Y~C s c~ s m 1 - . z. l 3 F Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODa < 30 mg/L and TSS < 30 mg/L "The Department of Conunerce 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. SM9330(R.6100) ' Property Owner ` U glop (DJY Parcel ID # hJ (S Page of ❑ Boring # ❑ Boring p ® Pit Ground surface elev. ft, in Depth to limiting factor I In. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ApGPD flon Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 )x`12 31Z S 1 I Z~S~~ Y~`F~ C)n.) Z~ - 8 Z 1 p ~3 3 ~ 3lC~ - s a l Z try s b m `f')- e S ~ , 3 33 -01`) 10 Y~~ - S S m 1 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate in. Munsell Qu. Sz. Cont. Color GPD/f Gr. Sz. Sh. •EN#1 * Eff#2 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil Application Rate in. Munsell Qu. Sz. Cont. Color ry GPD/N Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L 'I7ie 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 tic department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6100) Wisconsin Department of Commerce SOIL EVALUATION REPORT 'Division of safety and Buildings Page \ of in accordance with Comm 85, Wis. Adm. Code r _ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD.~(v1~ rvG Please print all information. Reviewed by 'Date Personal information you provide may be used for secondary purposes (Fmvacy Law, s. 15.04 (1) (m)). cnpv Property Owner Property Location ~C 1/4!~.114-S.E• T Z- &J N R (q) W Property Owner's Mailing Address Lot # Block Subd. Name or CSM# P o. Sox 3 3 - ISUrvsi~-F v 1 City State Zip Code Phcne Number ~ `RS't-~ ILV I 5 ~l g'Z~ I ~1 ` t~~S _~s ❑ City ❑ Village ©Town Nearest Road New Construction Use: Z Residential /Number of bedrooms - L; Code derived design flow rate (4 S Q - `j UCH GFD ❑ Replacement ❑ Public or commercial - Describe: Parent material G L.N-,L) rI ri Flood Plain elevation if applicable I~ F1 General comments ft• and recommendations: rJ? iv` 3 ~ ~t Q ~ ~l//hJ l~L~j~2P~j2 LSE t~ C~i . rat ~ ~~S b`T ll'~I UI= i°~L '~'ZL l_ 'M f"Ti ~Z v . a s Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor 2 in. Soil Application Race Horizon Depth Dominant Color Redox Description Texture Structure I Consistence I Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 O-q `O~LtZ ~!Z I - Sl) pr rr~``~' Cyv Z' S (.8 Z ~►-30 1p-1 2 316 I S') ( ? tiy, I n1`I 4- I CS 1 . S - 3 3D-C?6 )D,~ri- uAO - ( +11 1 - I Z I a Boring # ❑ Boring ® Pit Ground surface elev. 1 t- Z fL Depth to limiting factor in. Soil Application 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 I o-1.0 10,22.3cz. - sit Z`f s L-1~J Z )0~ LpY2.316 S1 1 ZM sb~- Y(1'P- ~S l •S .S 3 6-Q8 )011 V-- ~16 s ass Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig tune CST Number A:rthu'r L iWegerer 03=Z1S - .1`1 220254 Address W e g e r e r Soil Testing & D e s i g n Service Date Evaluation Conducted Telephone Number 421 :1, tiain St. River Falls, 1-1I'54022 1Z-ZZ-O 3 715-425-0165 PLOT PLAiT Pace 3 of 3 Scale 1'=SC) ' ' --FsS Lam- vl 0 l 15 08 1008 Svc, / ao 'M ee!2t_S n a° lop 3 ti Ib~ 3 1 i Lo T is L~ T ~~w)~k=1 ;10.0_.0 oN 1'~ L~> 1R. > ~rJ p1 P~ t-oT1 ~.~t2,~:.J~12 , ~gi 7z-1'Z, 00, 7 _CKI GV?ZL4t-y SU1-LPIA ~ f BUT- COYZnJ 15-425-0165 2 20254 03 2- -1S- a7 CST Signature Date Telephone No. CST No. Job NO.