HomeMy WebLinkAbout042-1085-50-400 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 579061 0
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:
Madaris, Shane & Julie Warren, Town of 042-1085-50-400
CST BM Elev: Insp. BM Elev: BM Description:
Section/Town/Range/Map No:
TANK INFORMATION 31.29.18.478A04
ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding
St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
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
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand
St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length 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
Type Of System: CHAMBER OR
UNIT Model Number:
DISTRIBUTION SYSTEM
FHeadth er/Manifold Distribution x Hole Size x Hole Spacing
Pipe(s) Vent to Air Intake
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
Bed/Trench O Center Bed/Trench Over Edges Topsoil
0 xx Mulched
Yes Fu-] No ~ Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:
Inspection #2: / /
Location: 948 65th Ave Roberts, WI 54023 (SW 1/4 NE 1/4 31 T29N R18W NA Lot 4
) Parcel No: 31.29.18.478A04
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes [0] No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
. i I. A J -D
1
a ety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
2015 Madison, Wl 53707-7162
,wT= 5 776
COUNrf
(c I
ani Permit Application stateTrancacxi°nNu~ber
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 pemrit. 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 secondary , l p
ourposes in accordance with the Privacy Law, s. 15. 1 m , Stats. may' O lf~
L Application Information - Please Print All Information
Property Owner's Name Parcel #
A
Property owner's Mailing Address /J Property Location
~~7
( Govt Lot C 1~1' '
4 - b J
city, State Zip e Phone NumberSection Ie D
vv Z N; R/ orW
II ype of Building (check all that ap Lot
or 2 Family Dwelling - Number of Bed ms 1 Subdivision Name
1Nsl>I.C., Blo #
akaa
❑ Public/Commercial - Describe Use City of
❑ State Owned - Describe Use CSM Number /6/ ~ / 53 Z ❑ iUnge of 2 ~J b G t,J ZZa^ Z Z G V8 Z ! `T 12, Town of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable}
A" ew System ❑ Replacement System ❑ Treatment/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 Owneri ~-f q_ Jr z4
fV.-Zype of POWTS System/Component/Device: Check all that a 1 S / 05
Pr In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil C 5
❑ Holding "Tank ❑ u Dispersal Component (explain) ❑ Pretreatrrtent Device (explain)
V. Dis rsaVrrea ent Area Information:
Desi Flow (gpd) Design Soil Application Rate(gp Dis Requ (sf) Dispersal Proposed (sf) Systc evati
` /
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units a $ _
New Tanks Existing Taa1~
lk-u
Septic or Holding Tank J e^ I
Dosing Chamber v~ J
VII. Responsibility Statement:-)I, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans.
Plumber' Namc (Print) Plum ignature MP/MPRS Number Business Phone Number
c Z~ ~,~"=off
Pltrmber°s madras (street, City, ,Zip
VDIX6unty/Department Use Only
Approved Permit Fee Date Issued Issuing. Signature
vfor Denial $ 1475 ' 0
DC CondSdSMJ 1PWlasons for Disapproval //11
1. Septic tank, effluent fixer and 3) R~ (,.c..¢. W.e,~" GL~e a- 1v
/
dispersal cell must all be servk es !'maintained /
as per management plan provided by plumber.
2. lowcom.0 rnegt n taunt t0& Malnt2iin~iC1-
M ar ~pp c6di / o~dir>alrto~s.
Attach to complete plants for the system and submit to the County only on paper not less than 8 trz s 11 inches in siu
SBD-6398 (R. 11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/6/15
Owner: Julie Madaris
Location: SW /4 NE1/4 S31 T29 N,R18 Lot 4 65th Ave Warren
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Co i gency Plan
7. Liftetime Filter Specif' tions
Signature
f"
License number 2266990000
PROJECT Julie Madaris PLOT PLAN
ADDRESS 724 159th St. Roberts Wi 54009
SW 1/4 NE 1/4S 31 /T 29 N/R 18
W TOWN Warren COUNTY ST. CROIX
SYSTEM ELEVATION 94.0/93.2 5' below grade
8/6/15
DATE BEDROOM 4
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 1" pvc pipe
EIBOREHOLE ASSUME ELEVATION 100' Filter Lifetime Filter
O WELL ~ g, R. P. Same as benchmark
All piping shall be ASTM SDR 30/34 within
10' of tank, piping shall be ASTM F891 Pro 4
Bedroom
House
713' Property Line 25'
S
96'97'
Scale = 1/4'1 = 10' B-
25 899,
5'
10% Slope
2-3' X 90' cells with >3' spacing
B-3
5'
B-2
60'
40' Vents
100'
B.M. *
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
60' with 20.0 ft2 of Area
12 5.6ft^2/pair of end caps
4' Long
3491 Grade at System Elevation
~Y
65th Ave
PROJECT Julie Madaris PLOT PLAN
ADDRESS 724 159th St. Roberts Wi 54009
SW 1/4 NE 114S 31 /T 29
N/R 18 W TOWN Warren
SYSTEM ELEVATION 94.0/93.2 5' below grade COUNTY ST. CROIX
8/6/15
CONVENTIONAL XXX DATE BEDROOM 4
IN-GROUND PRESSURE
CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE
HOLDING TANK SIZE DOSE TANK SIZE
LOAD RATE .7 ABSORPTION AREA 891 LBENCHMARK V.R.P. Top of 1" pvc pipe # of chambers 44
BOREHOLE O WELL * H. R ASSUME ELEVATION 100' Filter Lifetime Filter
R. P. Same as benchmark
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891 Pro 4
Bedroom
House
713' Property Line 25'
S
9697
Scale = 1/4" = 10' B- '
25 85
99,
5'
10% Slope
2-3' X 90' cells with >3' spacing
B-3
5'
B-2
60'
40' Vents
100'
B.M.*
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
0 with 20.0 ft2 of Area
4' Long 5.6ft^2/pair of end caps
12"
3 4" Grade at System Elevation
65th Ave
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
Vent / Typical installation 99.01
/eGrade ~ Vent
3' 4„
e~30/34 Septic Tank 3'
"
5' Long 1 5' 1 "
5' Long
Grade 3699 Grade at System Elevation 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_94.0'
B_93.2'
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:A
Number of Bedrooms: -1 NA ❑ Septic C3 Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: A Vertical Distance Tank Bottom(s) to Service Pad: el (ft)
Estimated (average) Flow : 1 (gal/day) Horizontal Distance Tank(s) to Service Pad: / (ft)
Specitic servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): GG (gal/day) if horizontal is > 150 feet. Specific Instructions to be provided on back.
In Situ Soil Application Rate: , (gal/daye) Effluent Filter Manufacturer:,/,,; ~J ❑ NA
Standard (Domestic) lnfluent/Effiuent Monthly average Effluent Filter Model: t
Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer:
Biochemlcal Oxygen Demand (BODs) s220 mg/L ❑ NA NA
Total Suspended Solids (TSS) 5150 mg/L. Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BO05) >220 mg/l- ANA [I (TSS) >150 mg/L / Mechanical Aeration El Peat Filter
Pretreated Effluent Monthly average El Disinfection El wee
Y 9 ❑ Sand/Gravel Filter ❑ Other,
r.
(BODs) 530 mg/L Soil Abso tion System
(TSS) 530 mg/L AA Fecal Coliform (geometric mean) 5510` -Ground (gravity) ❑ In-Ground (pressure) ❑ NA
Maximum Effluent Particle Size X in dia. C1 NA C1 At-Grade ❑ Mound
❑ Drip-Line ❑ Other:
Other, NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) hen combined sludge and scum equals one-third (36) of tank volume
ETWhen the high water alarm is activated
Inspect condition of tank(s) At least once every: 3 ❑ o r(s) s) (Maximum 3 years) ❑ NA
yea
Inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA
ar(s)
Clean effluent filter At least once every: I' e nth(s) [I NA
Inspect pump, pump controls & alarm At least once every: ❑ 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
❑ year(s)
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certificate s:
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:
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 5_12 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 be=discharged 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, sanitiry 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
replacement system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
Th 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.
Na ? Name
Phone A r. 2 -2, -l r Phone L /J
SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTH0131
TY
Name Name'
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) 8, (3), Wisconsin Administrative Code.
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ST. CROI_X COUNr1 `SEPTIC `I"ANK MAfN11"N ANCE Y LGRE M13NT
A.NE)
OWNER.SI4111 CE.1; Tj1jCA,rii-,N FORM
Mailing Address
Property Address 4t e,
(Verification required korn Planning & Zonrn 1)c;T)` - - -
aht,nent 1'01 1 constitrcuou) -
Parcel 1del~tif:icatiot~ `~ttr il~er 56 -
LEGAL DESCRIPTIOIN
Property Location-50 _ 1 / d/ E y, , ,scu. 3 / I' 1V 1: ~V Town of
- f
Subdivisiou Lof
Certified Survey Map
Vc lurne' It
Warranty Deed # Page 11
Spec house yes no l.erl lines identifi able (L/_C>/YI0
SYSTEM MAINTENANCE AND OWN1,,R CERTIFICATION
Improper use and inainualance of your septic system could result in its pr:Mratn.re fallrrre to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, i7 needed, by a licensed pumper- What you pui into
the systern can affect the function of the septic tank as it treatment stage in the waste. disposal system. fawner maintenance
responsibilities are specified in §Comm. 83.52(1) and in C liapter 12 - St_ Croix. County Sanitary Ordinance.
The property owner agrees to subrrrit to St. Croix C:cnmty PkLI)rurie & Zowng Deparimcm a cettiiication ionn, signed by the
owner and by a inaster plrmber, 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 rrrspce:i(Jrr and pumping; (if necessary), the septic tank is
less than 113 full of sludge.
I,/we, the undersigned have read the, above: reyuiremenis anti agree: io n-mir~tain tire. private suvvage disposal systeun with the
standards set forth, herein, as set by the Department of t_:onruieice and the Deparlm-m of Natural Resources, State o lvisconsir.h.
Certification stating that your septic system has been rrutintained must be complete, l and ,.eu rued io the St. ('Ioix Comity Planrnng S-
Zoning Department withilr 30 day;; ofthe three. year e rriration date.
l/we certify that all statements on th.'form rrt. tIu.c to ilx' best of mylour k uowledge. 1/we ant/are the owner (s) ot'die
property described above, by virtu; of a war arty deed recorded in Register of Dee, Is Office.
iNur r of bedrooms
f1 - rt. -
1
-
-
S1CrNA'i' J ZE? C).l AP'L1CA N'I'(S) -
Dq'rt.
Any information that is rnisrepiesented may result in the sawtaiy permit being o-:voked by the Plarminb r & 7,01) ing 1)e}-~arement.
Include with this application a recorded warranty deed 'groin the Regism of 1)a uds _ hce and a copy of the certified survey map i r
reference is made in the warranty dried.
(REV. 08/05)
Exhibit A
Legal Description
I
Lot 4 of Certified Survey Map filed June 29, 2015 in Volume 27 of
Certified Survey Maps, page 6128, as Document No. 1014532, located
in Part of the SE 1/4 of the NW 114; Part of the SW 1/4 of the NE 1/4 and
Part of the NW 1/4 of the NE 1/4 of Section 31, T29N, R18W, Town of
Warren, St. Croix County, Wisconsin, Being Part of Outlot 1 of Certified
Survey Map Vol. 24, Pg. 5685, Doc. No. 912384.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000
St. Croix County 1017305 Page 3 of 3
Parcel 042-1085-50-400 08/24/2015 01:23 PM
PAGE 1 OF 1
Alt. Parcel 31.29.18.478A-04 042 - TOWN OF WARREN
ST. CROIX COUNTY, WISCONSIN
Current [X]
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
06/29/2015 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - STOUT, RICHARD O & JANET P
RICHARD O & JANET P STOUT C - ROSCON PROPERTIES LLC
ROSCON PROPERTIES LLC
1353 AWATUKEE TRL
HUDSON WI 54016
Property Address(es): Primary
948 65TH AVE
Districts: SC = School SP = Special
Type Dist # Description
SC 2422 SCH D ST CROIX CENTRAL
SP 1700 WITC Notes:
NEW FOR 2016. CSM TOOK PART OF
042-1085-50-025 & 042-1086-10-051 FOR
LOT 5 AND PART OF 042-1086-10-051 &
Legal Description: Acres: 8.000 042-1086-40-071 FOR LOT 4. ALSO
REMAINDERS OF 042-1086-10-055 &
SEC 31 T29N R18W PT SE NW & PRT SW NE
BEING CSM 27-6128 LOT 4 Parcel History:
Date Doc # Vol/Page Type
06/29/2015 1014532 27/6128 CSM
11/26/2014 1004801 LC
07/30/2013 983266 26/5944 CSM
06/23/2006 828166 WD
more...
Plat: Primary Tract: (S-T-R 40% 160% GL) Block/Condo Bldg:
N/A-NOT AVAILABLE 31-29N-18W SE NW
2016 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/06/2015
Description Class Acres Land Improve Total State Reason
Totals for 2016:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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RECEIVED P-AJL-1)
MAY 2 8 2015
wroonsigfpe" ~rce SOIL EVALUATION REPORT Page of
Divic fgWVc6 ( PMENT
I in accordance with Comm 85, Wis. Adm. Code county ,
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.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. NZ -
Please print all information. Revie by Date
Personal information you provide may be used for secondary purposes (Priva w, s. 15.04 (1) (m)). F z /
Property Owner Property Location
r Govt. Lot ✓ LJ 1 /4 114 ~/T!7 N R E (AW
Property Owner's Mail' Address n L Block # St M Name or CSM# /O/ 5G 53r Z
414., ✓ol 7-7 (,p /Z$
State Zip Code Phone Number City ❑ Village own Nearest ad
16410&1 ( ) S 11/2
ew Construction Useesidential / Number of bedrooms Code derived design flow rate 600 GPD
❑ Replacement ❑ PublicI or commercial - Describe:
Parent material L"Jff (.iCGQ~C'. / FI lain elevation if applicable ft.
General comments
and recommendations:
System Type L 70 A.,! / cm-,~ System Elevation ~ ~+lJ
Boring # Er-7g ]1 Boring
a G pit Ground surface elev. v ' R ft. 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 •Eff#2
1 -r 1- c L ,
Z A-3d 211
t S ,
Boring # ❑ Boring
RLPit Ground surface elev2t F-- ft. 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 'Eff#2
-2- IU.,Oil IV
• Effluent #1 = BOD. > 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent = BOD, < 30 mg/- and TSS < 30 mg&
CST Name (Please Print) Sig 10 CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 - 715-246-4516
Property Owner _ Parcel ID # Page of
® Boring # Boring
it Ground surface elev. ' ft. Depth to limiting factor.,., in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1
a~
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/ff "
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.
Sal Application Rate
Horizon 7epth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etf#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA. • 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.
SBD48330 (8.6/00)
Property Owner Parcel ID # Page of
12 Boring # ❑ Boring g
Pit Ground surface elev. C ! ft. Depth to limiting factor.. in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDlff
in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
/I I
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff
in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring # El Boring
❑ pit Ground surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDAf
in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mglL
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.
SBD-8330 (RAW)
Soil Test Plot A
Project Name Roscon Properties n Bird
Address 1353 Awatukee Trail
Hudson Wi 54016
CSTM #226900
Lot 4 Subdivision ate 5/26/15
S W 1/4 NE 1/4S 31 T 29 N/R18 W
Township Warren
[-j Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1" pvc pipe
System Elevation TBD *HRpSame as Benchmark
Scale is 1" = 40'
713' Property Line unless otherwise
noted
96'97'
B- 98'
99'
10% Slope 5'
B-3
5'
B-2
60'
40'
100' MOL
B.M.*
0'
65th Ave