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018-2001-18-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579072 GENERAL INFORMATION 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: FCity Village Township Parcel Tax No: Bryan Jeanne Hawkins TOWN OF HAMMOND 018-2001-18-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: CST 14.29.17.882 1 166 1 - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic y Benchmark Dosing J Alt. BM i "•P a 440 F► ~ 3.5 10. nHolding Bldg. Sewer Z.. St/Ht Inlet 7• t D to 9~l • r TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent t it Intake ROAD Dt Inlet Septic Z ) Dt Bottom 30 /l• (P q S Dosing Z7 / /vW 36' Header/Man. Z I d Aeion Dist. Pipe 64- rat Holding Bot. System ry 3•a /63.7 PUMP/SIPHON INFORMATION Final Grade ,t O S l! Manufacturer to Demand St Cover GPM , #j 4A.- 3r 5 L . 163, L, Model Number (6nt.,J ` ' 46 CoAk p Jr Ilk O 102.7 TDH Lift Friction LossZ System Head TDi F .3 ,o , Forcemain Length6 / Dia.Z ► Dist. to well SOIL ABSORPTION SYSTEM 066 p 3. $ 09, 0,(f yt) S BED/TRENCH Width / Length No. re; s PIT DIMENSIONS No. f RIP-, Inside Dia. Liquid Depth DIMENSIONS Q Ll e SETBACK SYSTEM TO 7 P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Ollystem: Q UNIT OJ I O Model Number: ~s DISTRIBUTION SYSTEM Si O 041 Header/Manifo)d Distribution x Hole Sx Hole Spacing/ VFo Ad intake Pipe(s) I~ v Length__ Dia Z Length I Dia Z Spacing V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only /111 4L4 K v-JVJ-A%.w ~ Depth Over Depth Over xx Depth of xx Seeded/S ded U Mulched Bed/Trench Center -7 Bed/Trench Edges Topsoil A-k l Yes ® No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 16 t7 IS Inspection A: Location: 939 193RD ST~) p,l) 1.) Alt BM Description 2.) Bldg sewer length = 3$ - amount of cover 7 NZ PI Plan revision Required? [al Yes No re-i Fl~ Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signa a Cert. No. RECEIVED fl& ~j Safety and Buildings D a 201 W. Washington O. Box 71 Sanitary Permit Number (to be filled in by Co.) COUNTY Madison, WI 5 7- ' ~s NITY DEVELOPMENT D 4110 7 31 '5`796 ~7Z- l'f Y Sanitary Permit Application State Transaction Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 2..5 b lzl_ is required prior to obtaining a sanitary permit Note: Application forts for state-owned POWTS are submitted toed Address (if diffcrcm the mailing address) 11, the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes m accordance with the Privacy law s. 15. 1 m , State. Cf z r n L Application Information - Pleas Print All Information 4731 73 dK Property Owner's Name ~H Parcel # t ` CJI~S-boo 00 a Property Owner's ling dress Property Location 134 1 IVES Lot city fate Zip Code JJ Phone Number ~ t~~ Section 5'l©? tfi ~N; R~cor W 1Z le T pe of Building (check all tha Tg t app ~ 1 or 2 Family Dwelling-Number of tJ Subdivision Name ❑ Public/Commercial - Describe Use D 4 ❑ City of ❑ State owned - Describe Use CSM Number ❑Village of /w of Ne .1 3( 57 Q, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) a A' System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) Iasi Previous Permit Number and Date issued B. El Permit Renewal El Permit Revision ❑ Chan of Plumber ❑ Pernut Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Component/]Device: Check an that apply) / Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At Grade ound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) ! l V. Dis ersaVIrea ent Area Information, a Deli Flow (gpd) Design Soil Appli dsf) Dispersal Area Requir sf Dis Area o sf) System Elevation VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 1, o g o New Turks Existing Tanks qqe d A ~f e~l 0.V rn m v~ t% C~ C., Septic or Holding Tank ~y ~U Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass a esponsibility for instsliation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum S' ature MP/IvfPRS Number Business Phone Number ' r' f Plumber's Address ( Crty, State ip Code VIII. Coun epartment Use Only proved rsapprov Permit Flee Daate su Issuing ent Sign von Reason for Denial $ `oL✓ ' ` Z' DL Conditi6ilf Gasons for Disapproval 1:. Septic tank, off hient MW and J Cie AdC . . a ti 5 r a, fd 4~ real coil must an 06 Paw J11Wo ment plan pmidad by pW Off. eAl ~ ordifaftaa, n w. 46- owe/ Attach to complex plans for the system and submit to the County only on paper not lava than S 0 111 inches in size SBD-6398 (R. 11/11) PLOT PLAN PROJECT Brian Hawkins ADDRESS 136 19th st. Hudson Wi 54016 NE 1/4 SW 1/4S 14 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 102.8' DATE 8/13/15 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none 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 Scale = 1/4" = 10' 266' Property Line 193rd st. Scale = 1 /4" 10' Grading is to be done to divert Property Line 1.5 acre lot run-off away from system Pro 3 f } Bedroom Ho use Tank is to be properly bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank 'Fell is to meet al I WDNR setbacks 102' B-3 101.8' 101' 100' B_ B.M 347' Property Line B-2 Area 15' below system is to 6% Slope remain undisturbed z__ 0 r orTUF DIVISION OF INDUSTRY SERVICES ~ti? Tom 10541 N RANCH ROAD HAYWARD WI 54843 3 U S l Contact Through Relay ` F1 http://dsps.wi.gov/programs/industry-services \9~ S www.wisconsin.gov ssror*l Scott Walker, Governor Dave Ross, Secretary August 27, 2015 CUST ID No. 226900 ATTN POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/27/2017 Identification Numbers Transaction ID No. 2591652 SITE: Site ID No. 816528 Brian Hawkins Please refer to both identification numbers, Lot 18 192ND St above, in all correspondence with the agency. Town of Hammond St Croix County NE1/4, SW1/4, S14, T29N, R17W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1552745 Maintenance required; 450 GPD Flow rate; 35 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, .R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. t , SHAUN R BIRD Page 2 8/27/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm r Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/13/15 Owner:Brian Hawkins Location: NE1/4 SW1/4 S14 T29 N,R17W Lot 18 193rd st. Hammond Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout ; 5. Pump Chamber Cross SectionA, ?I C T 6. Pump Curve Dr. l Ls It~C~UBY ~y~ay 7-8. Maintance and Contigency plan P thisos of 9. Filter Spec' ications and cross section 3i Attachments oil Test ~SPONDEi~CE S Shaun Bird Signature License nu ber 226900 Page 1 of 9 PLOT PLAN PROJECT Brian Hawkins ADDRESS 136 19th st. Hudson Wi 54016 NE 1/4 SW 1/4S 14 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 102.8' 8/13/15 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none 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 Scale _ 1/4" _ 10' 266' Property Line 193rd st. Scale = 1/4" = 10' Grading is to be done to dirrert Property Line 1.5 acre lot run-off away from system t Pro 3j Bed roo m L House Tank is to be properly bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank Pfeil is to meet all WDNR setbacks 102' B-3 101.gB-2t! 10100B- B.M.* 347' Property Line Area 15' below system is to 6% Slope remain undisturbed z_ D / Mound System Cross Section and Plan View - - - - - - - - - ` Dimension Feet A i i J B i D / tJ i i 1:ti:ti:ti:~:ti: .f•r•r .1r • •f•: •r•!•f•f•f•r•r• .r r •r•f•r•r •f.;.r•r •r•: •r•r Ij♦ •f 1.4.1.1.1.4•L• •f•;•f•f 1•L• . f•;•!•r 4•L• f•;•f•f•;•f•r• '.;.!•r• 1.1.4.1.1. I ~ 1.4.1.1. .4.4.1.1.1.1.4.1.4.4.1.1.4.4.1.1.1.4.4.1.1. 1r~F.f•f.r.f.r.r.f.r.r.r.! 1.~r~;.f.f.f.f : i E 1, S r•r•r• •r.r•r.f•f•f•f•r•;•r.f.r.;.;.r.r.f.r.r.f.f~iy:i:i:i. 1.1.1. 1.1.1.1.1.1. 'g •f L 1.4.1.1.1.4•L•L•L•4.4.1.1.1.1• .1.1.4.1.1.1.4.1.. M1j114~.11f1t11411j11.f.r.f f•f•!• '.f:f' r•f•!•r•f•;•r•f•f•f•r•f•t•!•;•fyf•r•l•r•f•!•!•f•f•!• 1.4.4.1• rti.1.1.1: 1.1.1.1.1.4.1.1.1.1.1.1.1 4.1•ti•'••1•~•ti•'.•L• ' 1.1.1. 1.1.4.4.1.1.4.1.1.1.1.4• .r.f.;.ryf.r.f.r.l:f A •1.4~ r•f•!•f.f•f.r•f.r•l•;.l.f•f•f•f•f•!•r•f•f•r•!•f•f•r f•f•l.f f.l.f.f.f•f.r. •!•f••• 1.L•L.1.4.1.1.1.1.1.1•M1•4.1.1.1.1.4.1.1.4.1.1.4.1.1.1.4.4.1.1.4.1.1.1.4.1.1.4.4.4.1.1.1.1• F f1f4j1jtf1~111.4•L•'• r.f•f.r•f.f.r.f.r•!•f•r•!•f•f•!•ref•f•;•r•r•r•r•f•l•r•r•r•f•;•f•f ' r•r•f:!•f•r•f•;.!•r•f.f•r;r•f•!• ' W l G i i Z -T` i ~ H e„2 I i i I J i i 6:0 K ~r 1 L S W 5,$ K -L B 1 Z Slope % L 1-1 = Topsoil F7:7:7: 71 = ASTM C-33 Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill 1/2 to 2 1/z in. dia. 0 observation pipe ` - J •\.111?1 Geotextile G H Fabric r~rr ''4.1.4.1.1.1. . . . . F L•41 4.4•L•1• j..t D E Plowed Surface Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj Page of Pressure Lateral Layout Two Laterals - End Manifold .4 -'T'hreaded Cleanout Lateral Turn-up Plug Manifold db -0 R M X 1J Long Force Main Sweep 90 /y Bend ^ Opel- Distribution Network Specifications Pressure System Construction Lateral Diameter In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 3~j In. pipe. Orifices are drilled perpendicular to X Orifice Spacing). ,,2 In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M (Manifold Len th) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter _ In. diameter lawn sprinkler valve box accessible Force Main Length 170 Ft. from finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 19j Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number Pump Model Number S Total Tank Capacity 3 Alarm Manufacturer Max. Bury Depth ° Alarm Model Number Switch Type ~G f Filter Manufacturer ; i *ork tal Dynamic Head (TDH} - Feet Filter Model Number j ' Head ssure C eLoss Minimum Pump perf ormance Required Force Main Loss GPM: y Ft TDH Total outlet Manhole Mi. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Locking Device < 6" Below Grede Sealed WatertijZht Weather--proof l Junction Box - Finished Grade Vent Min. 12" Disconnect Above Grade Means • With Vent Cap Outlet Filter Inlet ' Inlet Baffle X. A Switch Setgngs and Reserve Capacity Weep Tank Volume =1-5 GPI B Hole > Dimension: Inches Volume Gal. (reserve) A' yS'- -5~ 7_3 O Off Elevation C (alarm) B 2 l 3 Ft Bottom (dose) , _5 7s Elevation (dead) Ft Total r... . . y>`,t>~,;>~,•>~,±>~r` t•a•` {y::i : i .•a :a•:i•: <>a•<•i>t>. ` GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer a may ay not no be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (p) installed. Piping at the inlet and outlet is of approved material, connecte ed th 4?' e tank with h 40 PVC to watertight the tank laid on stable soil to prevent settling or sagging.. The force main sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. excavation and the sleeve is seal Page. of 9 02105 U IO?AL DYNAMIC rEAp/CA..' AC!TY HEAD CAPACitY CURVE IT AND DEVJ DE'W Ei~FLUtNT AT``RING ~l MODEL 152/153 w MOIDEL 52 153 w 50 e Meters Ga,. Liters i GOI tern 153 I F t 69 26 77 29i 1 I 1 0 3-. L3 i 70 r 26'- 121 40 152 I ' '15 j_ 4.6 53 i 201 j 61 231 w ( I 6.1 44 167 I `,2 197 I~_ 30 j 25 1 c J4 129 4L y~'I :zi -i z 8 r i 8' ?3 5 o r- 20- o I 40 i 12 i - - 42 4j lal . ~ S4.G 4r 0 i 10- , 45oa i i I i II 1 ( 0 20 0 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE i CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. 27i32 • Electrical alternators, for duplex systems, are available and supplied with a an alarm. • Variable level control switches are availabe for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. T-_- Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130"F. (54°C) special quotation required. _ 1521153 Series z a-- I~ 1521153 MODELS Control Selection - Model Volts•Ph Mode inks Simplex ! Duplex I tai -II - N152 115 1 Non 8.5 7 2 or 3 1 8N152 115 1 Auto 8.5 Included or 3 E15r 2 ~23p_-1 Non r 4.3 1 2 or 3 _f SK2os4 B tE 52 230 Auto 43 Included 2 or 3 N153 115 Non 10.5 2 2r" BN153 115 1 Auto 10.5 Inclu eedd 2-or 3 SELECTION GUIDE E153 1230 1 Non 5.3 1 2 or 3-1 BE153 i 230 1 Auto 53 Included 1. Single piggyback variable level float switch or double piggyback variable level float 2 or 3 -j switch. Refer to FM0477. D CAUTION-i 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float System. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P. U-, BOX 16347 L!~ Lowsvil!e, KY 40256-0397 Manufacturersof. . L: ZZ/ SHIP TO: 3649 Cane Run Road L OO ® ouisisvilieie, K KY 40211-1961 Q01/'"'CUMPS a yf'1/MP !O. (502) 778-2731 • 1 (800) 923-PUMP http.llwww.zoeller.com FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. 609 POWTS OWNER'S MANUAL MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS Owner f r 1 Septic Tank Capacity Permit # Septic Tank Manufacturer at ❑ C3 NA NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model -r ❑ NA Number of Commercial Units A Pump Tank Capacity 6 ~ L7 at ❑ NA Estimated flow (average) ~ aVda Pump Tank Manufacturer _ ❑ NA Design flow (peak), (Estimated x 1.5) q jv aVda Pump Manufacturer Zvc NA Soil Application Rate 1. U aVda /ft2 Pump Model O NA Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 420 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) rMonthly L ❑ Disinfection ❑ Other. Pretreated Effluent Quality age" Manufacturer Dispersal Cell (s) Biochemical Oxygen Demand (BODS) ❑ In-ground (gravity) n-ground (pressurized) Total Suspended Solids (TSS) ❑ At-grade Mound Fecal Coliform (geometric mean) 00m1 ❑ Drip-line ❑ Other. Fm-;;i-mum Effluent Particle Size Y 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 ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every months,>9ry,ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ear(s) Inspect pump, pump controls & alarm At least once every 01 months ear(s) ❑ NA Flush laterals and pressure test At least once every months year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ 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 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, pretreatgment components, and any other maintenance or monitoring at ir6rvals 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. ?49 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thrat may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thp. tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. 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 withln 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 POWT:13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produciss; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail 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 scull, 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 compliiiint replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requiijed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologN 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 evalual]ion m t be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as last resort to replace the failed POWTS. and 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 O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name J4 Phone jy° L, f Phone TX SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name , yn Name J~ ®l1 Phone ~~J f IF Phone 174 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. r a ti r L_?_ 1 I w t i I a a ; C i O C \s `r`~; ~ f~ N LU i i i i I i ST. CROIX COUNYY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM C 11'~ 4aUP Owner/Buyer r L/ ~ 5 _ Mailing Address 13,4 Property Address 9- ?5 (Verification required from Planning & Zoning Department for new con tion.) City/State Parcel Identification Number f' LEGAL DESCRIPTION Property Locat[or~ Y. t/4 , Sec. T Z( N RL/ W, Town of -r Subdivision L / G_~~Q~~~~a~Lgn Lot # Certified Survey Map # -o , Volume , Page # Warranty Deed # to / 6Z~~ , Volume , Page # Spec house yes no Lot line., identifiabl yes o 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, ifneeded, 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 Departrnont of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retuned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on s form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by ' e of a deed recorded in Register of Deeds Office. Number of bedroo SIGNA 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) ,OT 7 H 89'38'57" E 600.9V )422 S.F. .45 Ac. / 4//~, )s'3a" w 523.13' LOT 19 / 155732 S. F. Q 3.58 Ac. / a S-8,3'42-56- E 754.46 01 $ 21o. 205 S. F. Lo T Jam., I - I 94 Ac, 66455 S.F. I i Y. 1OP OF 314" 1.53 Ac. r r IRON MN ELEV. t ~ LOT is £ 425.36' - f t S 20.0 W 347.24' 68048 S. F. " ff a 80' RAD 1.56 Ac. I CUL-DE, fuREwova I 1 Lo T 17 I I EXTENSI{ l ti 1 71946 S. F. ° t 1.65 Ac. .,oT 9 t5304 S. F, oAD3.11 Ac. .~R Q N B.M. TOP OF 3/4 o IRON F4N ELEV. - \ N - :r- 5 JP. 6 aE s" 10. r r r , ~ I o N A~ 3JN34IS321 N9IS34'8 9NI.LJt>ZId SNDIMVH SNIHMVH c v` a 31tl0 A9 NOIIdM-G ON 311LL 133H5 :NOlld[N05301]3CONd AB O301AOHd SONIMtltlO O VI N ~ m ` Q A-. L ~ Oo I I m I I N X I `m I I - < C O tV Q~ " S r------- -"C % I I I I I I I I it a m =Y I I n Q x $ I ( I I m~ a Wm in L------- lV " X V Z/L o-.9 N r rv I I I I R I I c ~ Q~ I I o m ~ x 's -v ry I I a ^ I I L B/L L-,L- ..Lll 6-, „Bll CA 6-.5 * W V m m° - "I~ Q y6j a I m $ Zv 8 X Y ~ Z r O_ ~o mo ~ 7 ^ O ~ $ woc Rl W o y"~ Sr r .,5 .4 i i m ui ~ a ~ esvc N ~ o E m --T\ v R IN 4F " iV m Z X : ~ " m _ ac~el ~ i(f jn L W ca ;t \ F Qv in lY x O W m Luv 4 ° = U1 x LU a oL-,9x,.oL-,L $ a g o 135017 ° in / ,BILL/L E-d"Q-'Z .,Q/L l-.l ..b/£ Q ..4/L 9-.6 „Z/L L-.S 4- .Q/£ L-.5 „Q/L £-.Q .7-4 ~~bl£ 5-.L RECEIVED _ ? ?us7U Wisconsin Departrd~tkdf t ZU5 SOIL EVALUATION REPORT Page of Division of Safe and B6it i GRI OUNTY in accordance with Comm 85, Wis. Adm. Code n . O MUMTY DEVELOPMEN` ; County . l I^~9i Attach oorn ate 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. (J j /-~F 6Op Please print all Information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z Property Owner Property Location 3 r- Govt. Lot 1 /4 (J 1 /4 T Z N R E( r) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# , City State Zip Code Phone Number ❑ City ❑ Village 42 Town Nearest Road r0 16q Ot (0 1 (w" Z) Y60 w-,r►1 alla "':5 l S-~ O-New Construction Use Residential / Number of bedrooms Code derived design flow rate yJV GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recwrnmendations: System Type ~,,~2 System Elevation F Boring # 2 Boring 1 pit Ground surface elev. Z ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 Z a 7~ l~ i Boring # a Boring a 91 Pit Ground surface elev/Zie ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 31-2 pyo, Effluent #1 = BOD_ > 30 < 220 mg1L and TSS >30:5 150 ` Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L m9y CST Name (Please Print) S' re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 Z-/3 -1-3- 715-246-4516 Property Owner _ Parcel ID # Page of 1751 Boring # ❑ Boring V-Pit Ground surface elev. ft. Depth to limiting factor -30q 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- lo" .5J4 c2y,~h K -51 /M 1-0 A116 .51 &JA W),4 ❑ 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 F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence . Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS 130 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. SBD-9330 (8.6100) Parcel ID # Page --of Property Owner r 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 'Eff#I GPDHfEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 10 0 11 1 J ! l ®Boring Boring # I El Pit Ground surface elev. - ft. Depth to limiting fader in Soil lication 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 F-I Boring Boring # Ground surface elev. ft. Depth to limiting factor rn. ❑ pit soil ication Rate Horizon -)epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Co. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 nt Effluent #1 = BODS > 30:S 220 mg/L and TSS >30:S 150 mg/L ° Effluent #2 = BODS < 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. SED-8330 (R.6=) Soil Test Plot Plan Project Name Brian Hawkins Shaun d Address 13619th st. Hudson Wi 54016 #226900 Lot 18 Subdivision Forest Ridge Estates Date /13/15 NE 1/4 S W 1/4S 14 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 102.8' *HRPSame as Benchmark 193rd st. 266' Property Line Scale = 1/4" = 10' Property Line 1.5 acre lot N 102' B-3 101' 100' B- B.M.* 347' Property Line B-2 6% Slope H Wisconsin Department of Commence SOIL EVALUATION REPORT Page of DlvWon of Safety and Buildings In accordance with Comm 85. Wis. Adm. Code County Attach complete site plan on paper riot less than 8 1/2 x 11 Inches In size. Plan must T. ~l1S~ Include, but not limited to: vertical and horizontal reference point (BM), direction and parcel t O percent slope, scale or dimensions. north arrow, and location and distance to nearest road. Nprt+to Please print all Information. Re wed Data Parsonei infonnstion you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m))_ C~ r✓~"-~ I / Property Owner Property Location Ak LLA a'--"Ij NV 114Syj 1/4 S f'1 T 2Q N R f7 w Property Owner's Mailing ddress lot IS x :k # Subd. Name or CSM# 1 t 1 LI W. Ord 1510M 0_KR!5T' QI O~E~S7`/4'1'ES City State ZIP Code P5 a Numbs - City ❑ village Town Nearest Road RWER FALLS Wr ._.51(02 -24 `tZ (o-"f 20 Nit MRQ Q , O-T.li: E New Construction Ilse:]Q' Residential / Number of bedrooms Code derived design flow rate _ 1000 GPD ❑ Replacement ❑ Public or cominerciai - Describe: A Parent material -it- L 0 Flood Pi efevatkm if applicable A) 7t , _ fl. General comments I/IJ67- I /S 1 andrecommendatlons: SVS~"cM 4Or SRND t=it`. - fV n f' t any LolkD)N6 (2J4T~ (V~L-Ci~f'i~ p , Boring # F] Boring - - I r `J 1e~,} Pit Ground surface elev. it. Depth to limiting factor 7-7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description 7oxture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2 0- 3 1oyr~3lz - '\X s ~s eb o.s 0.9 -ZEWK Z 10 U - ' 511, ms d51q 5 3 -do 0.5 0.6 1o-zS - s( - sb d s - as -do 0.4 0A0 4 y _ s -fn sb S Q5 14-all o-q &(-p -30 o cich 0.o mo 3# 4 V Sop's c e- Boring # ❑ Boring Pit Ground surface elev. -CL ,13 ti. Depth to Nadting factor in. SoN clion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. T11#1 'Eff#2 / 0-7 4'4 3 - sit s V - -!M O - A& z ~3 - s1 f -5f&b c b J).S 10 M 3 C -ZO ,S - 51 z-~abit 0.utsi ~f-~Ga 5 d.~ -Z 7 Y 3 ~S m d5 CtJ~ Z. 7 7 5 7M _ 7'S 4 c z s 0 d i c(ruJ P 1 AI X -tt Nl - (Hon Ak) .5 15 s AK- t_ E A ' Etttuent 91 = 090, > 30 < 220 mg/L and TSS >30.< 150 mgA. ' Elltuent #2 - BOD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number R) A JA H tt STl~ Address We Evalua0on Conducted Telephone Number W9975 (aqD-i AVE, UE -FAtls WI 5402Z -09'7 ►s yob-1-115 KDJV1 'ED: Oq-1W-02- ReVts0): 0-3.-cZ. -CLt ~~.v (sED ~ r 1-zy=o`I f IJOfi trfi) Z of ~ nnt,~ =`K S4l_l ParcsliD#~ fJ~~DlI~~~ P.J. Bodng property Owner a # Q Bodw Ground surface elev. E 172.12 ft. Depth to Ikrritirrg factor Z s in Sop Rate Pit Texture Structure Consistence Bounday t~OOts GPDMM Horizon Depth Dominant Color Redox Desaiptfon in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh •Eff41 'E1T#2 t 0-Id 10y2~ is L 0 -5 0. ~-o0 0. ~ z Z It)-18 10 -if-3) - - 3 IY-2S 0 3 _ ~ 5 ~ abK n..l-~r gS ~4'-m 0 1. Z 7.5 ~~eE ativf a sort Boring In. S cation Rate Pit Ground surface elev. it' Depth to Orniting factor Texture Structure Consistence Boundary Roots GPOM Halton Depth Dominant Color Description Gr. Sz. Sh. 'Eft4f1 •Etf#2 In. Mrmseil fir. Sz. Color 1 0-10 love-47- _ Z 10-17 to Q'~3 - stl Gs .Z O. &bK 5 t s 1, 2 4 2-1-3 .5-4 7 q~Zd l i S 3b-y~ vrGy! ~5 ~v I 5 D N~F; as -M Boring # ❑ Boring in El Pit Ground staface rev. ft. Depth to limiting factor Depth Sop x;ation Rate Redox Oesrxiptlon TexAxe Structure Consistert~ Boundary Roots ColOr Horizon GPD/ft< Dominant •EfflF1 'Etf#2 in. Mtmsetl Qu. Sz. Cont. Color Gr. Sz. Sh. = Effluent #1 = 80D, > 30 1220 mg/L and TSS >30:5 150 mgtL Effluent #2 SOD, 130 mglL and TSS< 30 m9k 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 608-266-3 151 or TTY 608-264-8777. S804MtR.61'00) i L N i o nya. N - - . Z~ C'UJIi 000 u,S SEC 14 TZ9x1, K~~w A _ i~~ht6 oq-1 -QZ _ L - (A A) / t LOT- rylAks / 66-4155 S~ - / 1.5 3- A 0,a _ a 02 00 V rc~z. r N. B. 66.455 S.: - - N.B. 1.53 Ac. 05347 Q S!55,~ S 86_.2_ - = - 1-7 to L_oT j - - 0 /r r 1 I ° II I 11 II II \ \ \ ~1 B RNARr& 1 1 I N I 1 1 1 i ~ X / 1 I 138.12 131. 8' - 1 -L 21. 40:~ r I fi-- / I I 1 I I I \ \ 4~ r--- f- -y Lr) I a\ Lr) C/i / N T 11 I ` ~N qIp \ \ \I 1 U W / ` I I W CN LO Lr) \ \ I m \ I 1 , as \ \ z 1 1 RN i o TO z 0) j.7 \ 212 1 011 CN `N Q ` \ --74 \ I 11 I I`1 C-4 co n 00 11 LLI 00 do z I \ \ col 1`~ 1Q I 11 11 11. \z 1 1- y t`~ \\z{ ,if\1 it 11 ------t---- - \ \ ~300.9~a 1 I 1\ \ 11 ~ _ iJ I I 11 III ~ 11 \I 1 \ \ ~ ~ ~ \ ~ ~ .c / ~ is / I r I I \ o 1\ Z ~ ~ 1 1 ~ \ ~ \ \ / ~ III I ~ l l \ C \ / ~V~ Q X /Q Lo Lo ~a ~ ~t ICJ \ \ /CO / 6 /-I II ~ I I~1 \ \ \ \ sic \ / / z Z / I ` I \ I I Z \11 I .5 .r Z LL: vi Li 00 _ C3- A 00 r" 0) to C3 1 • a s , RECE(V D HOLLISTER'S SOIL TESTING ) Mary Jo Hollister MAR 0 4 2004 I W9875 690th Avenue River Falls, WI 54022 ST CRO,X (715) 426-1775 OFFIC' 004 St. Croix County Zoning Pam Quinn, Zoning Specialist 1101 Carmichael Road Hudson, WI 54016-7710 RE: Soil Evaluation Reports for Forest Ridge Estates, Town of Hammond Dear Ms. Quinn, After our meeting on February 13th and further review of the reports that were submitted here are the findings and facts: 1.) Lots 4, 5, 6 and 28 will need to be extended to allow for the 0.2 loading rate for longer mound systems. We have agreed to do this with hand borings that will be completed as soon as possible. The position of the driveway for Lot 30 can be worke around. A licensed plumber has reviewed and stated that lots 1 1 , 13, 14, 1 7 an 18 ve enough Q.~ area or a sys em. O.2 ldad,.`~ b"It, Ys LC.,R. 2.) As per our discussion, driveway locations were not an issue at the time the tests were completed as it was requested by the County to complete these tests before approval. These will have to be addressed at the time the driveways are located. ALL mound areas were staked and taped as requested previously. 3.) Elevations were corrected on lots 7, 10, 16, and (8 and have been resubmitted. For many years now, my reports have had the accurate readings for BM #2 based on informatiori#rom your office. Now I will report them a different way. A new report for lot 15 was submitted on 11-25-03 due to location of lot line. The elevations for lots 20 & 21 are not the same due to different reading locations of the boring (Le. upslope vs. downslope side) due to site clearance. 4.) The notations for the Structures were corrected in the office. The "L" for "large" structure instead of "CO" has been reported on my reports for years. Thank you for clarifying that for me. If you have any further questions or comments, please call. Thank you for your time and attention to this matter. i r i ~ Page 2 - Forest Ridge Estates Sincerely, Mary Jo Hollister CST #224832 Cc: Mark Sylla, property owner Leroy Jansky, State of Wisconsin Wastewater Specialist e' Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Salary and Buildings Page of In accordance with Comm 85, Ms. Adm. Gods Atlach complete site plan on paper not lees than 8 1/2 r 1 t Inches in size. Plan must County T, include, bvt not [ImIted to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel IA. PCNPf►Yn PI@RS• Pant ,rp InlOrmetlon. viewed Persons, inlo"6aan Date you PrOrlde may be used for seeon6ery purposes (Privacy le,r, s. 15 04 t n Property Owner _ r Property lontlon R ~A R 17 P t/dsyf 1/4 S f`f T 2 N R roPerty Owner's Mailing Address W Lot I IoGt a Sutxt. Name or CSM# III W 0\J t`Jl ON ST , G4 Stale 27p Code Phone Number' o+ S7- RI o~~ ~srAT>~5 AWER FAU - Wr sy02 CIry ❑ village Town Nearest Road (715 `tzb-484 Nit E New Construction User Re"riliai / Number of bednloms Code derived design flow rata (000 C Replacement Q Pudic or commercial • Describe GPO Parent material (L t---. Flood Pialn elevation if applicable General comments ft. and recommendations: ( SalSttcM r01 G6 - ?,102- Lo r AbINC RAT rVt i41caks 1'fand su. 102.y3~ ba f b.&IOW b Sr S Ori~r C ~~G r , f~ A Boring a Boring p! Pit Ground suriat a elev. ft. Depth to limiting factor _Z7 in t Horizon Depth Dominant Color Redox Description - Texture Structure Consistence Boundary Roofs Soil GPD fiori"Rgte =n v in. Munsell Ou. Sz. Cont. Color_ Gr. Sz. Sh. F.' 'Eftiit 'Effp2 '40 _.PQ~ I 0-:5 10`1 3 L : (V/"~ s ds c:b 0.5 0~ 8411 10 .51, rns d h s 0,5 016 ~5 10- - b d 5 0.5 -Co 0.4 0.(' 5 QS +r 0,Y 0.(0 d ch - 0 •V 0.0 3 4 V 1- Boris if ❑ Boring 9l,44ZK rr IS >?il~VP 6 oY-Wr K .2 0 ~ ✓ O Pit Ground surfece, e Y. _10Z.-15 n Depth to Ymiting factor _•In. cation ~v i/ V Horizon Depth Dominant Color Redox Description ' Texture Structure Consistence Boundary Roots SoU GPD/ff Rate In, Munsell Cu. Sz. Cont. Color S I a - s Gr. Sz. Sh. •Ett# 1 'E112 ~l eww- Q OVK3 L 3 5;11 - t f 3 ab v ~ b.5 OX -5,41f - 0,57 0, ~~,y~ 1{ st i 1 a w g to 0.1 S L _ N.P. .P• _ 4I rL M Effluent cal • BOO > 30;! Z20 mg/L. and TSS >30 < 150 `r'/L CST Name (Please Print) mg /L #2 ■ BOD < 30 mW.- and TSS < 30 mg/l mA ignature CST Number 10 1 t t_ s-_ Address 17S qDA U E , Data Evaluairu" Goriduded Telephone Number W 9 6 _ RF#,L. S, WT 5402Z 77iS L42.6- \-77,5 G B- r l oar- n, Property Owner M AV-K . S4 L-Ut reel ID # PENDIPic, Page -4m e Boring # A Bo'`'g 102. ~ ZS ~r0 Qr© ❑ Pit Ground surface elev. n. Depth to limiting factor in. Sol Icetlorl Rats Horizon Depth Dominant Color Rsdox Description Texture Stricture Consistence Boundary Roots GPM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eif#1 •Eff#2 any I Q-10 IDYKZz/z y L -Z -m r m4ir -cn 0.5 0, Z )0-1$ I0'40j ~S _ 3-4-f f-a 0. 1 z iy, 3 IY- 0 3 5 r abK n..l-Pr . V- -n 6.-7 1, z -7.5 Y it 5 5CA b iC -r+~ 0.2 0,-5 N o CIA- ojn w414) @ Ph Grounds _ A. Oeoth to tk+ *V feefor _ . / in. Sol A fiele Horizon Depth Dominant Color Redox scrtpfion Texture Structure Cons) rice Boundary Roots GPORf In. Munselt Qu. Sz. Con. oior Gr. St. Sh. -EIVN1 EfrN2 1 0-10 IDytZ1z - ~ t~ ms rn orb 0.5 0.$ Z 10-17 ID *1 K 11~3 Stl S s 2- 3 17-21 K3~ 1~ 1 oJOK m4 r GS Zg-rn_ 0,7 1,2 --NL 7. 5`1K'I_ S 05 ."7 I Z 7,0 s ~,-`f 2 NK4I -7, vR ~b 5 Nei 0-5 -M I L4 z- a Boring a ❑ Spring pit Ground surface elev. ft. Depth to limiting factor in. 1:1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO In. Munsell Qu. Sz. Cot. Color Gr. Sz. Sh. •Eff#1 •Eff82 Effluent N1 a BODO > 30 1220 mglL and TSS >30:5 150 ntg& • EMuerA #2 = 800, 130 nV& and TSS 130 mgrs. 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. SaD~SSO (R.N00) &-t8A 4 1813 $ ! -6of :5 a AV*. SEC. ICI - - - - ZI ~J~fT011Q ~Il r► ( _ -TOP Of Pre rim I-AWAPOdVe Gr1~LAtLA).p Di- /L 0 6 6 455 .S. F . _ Ego 1 5 3,,- . A' an n Y-N 00 N . B. 66.455 S. r. - N.B. 1.53 A'c:. o - - - - oa-- V 0' 0 5" W 347.22 -8 6 0 2 _ _ - . - _ - _P _ - - - -P c~ 10 U -I - - - _ . _ - -j-oo~ co 171 0 /I J __v ' Fn Srt' ~Z{ oG.~ G,5TAleS - LpT, ' y•6 19°5 0 AHG, I i c4 - _ Z COAYTtuK REd1_<*. D : 01 -1-7-8Z of .10 Vlt -joe )BA a lViii I -lop OF Pry PIPE Zk~ 1 v'I - (((111 r YY~MT2% SV r-I A) I) RtM _ 1,x4'AFdVP, ` A) 103,to7 ~f n r ,LO 664.55 S.F 10 t 5 3", A-~ ~ 11 0 \ 'l l{z• L Loa- N.B. 66,455 S. : 53 Ac - S 86°2005-" W --347 2 2' a OT_ - L t m Q0 a 71 q 4 F