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HomeMy WebLinkAbout020-1004-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 579090 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Virgil Neubauer TOWN OF HUDSON 020-1004-30-000 CST BM Elev: 1 '11 Insp. BM Elev: BM Description: Section/Town/Range/Map No: 6 rA Z 45T- 07.29.19.813 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURERZ~ 3 / CAPACITY STATION BS HI FS ELEV. Septic i Y / Benchmark 3. rG Yd I d 9L, 5Z Alt. BM (p 161. 950 Aeration Bldg. Sewer ~'&5 9S . g Holding St/Ht Inlet 7.5 TANK SETBACK INFORMATION St/Ht Outlet 3.'g 9~ . TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet \ IJe~d- s ~ Septic 9t~ / 135 41 151# 1 Dt Bottom Dosing Header/Man. Aeration Dist. Pipe f. 9 *5 (f W% 94•t 5 Holding Bot. System , q (o .7 7.45 15. Z PUMP/SIPHON INFORMATION Final G ~ ~ 5 • Z 9 7. 5 dr~ Manufacturer Demand St Cover y 3 sC ' Model Numb 7G ZA Lek- TDH Lift Friction Loss System Head DH Ft Forcemain Lengt Dia. Dis ell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L i• BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR __ZA I ll y, ~"4 L Tyf Of System: , UNIT Model mber: C~ D A.J evo"oAJ, 18 '5r Z 3 ri DISTRIBUTION SYSTEM ~ Itf ~Jc z4 s~~ ~ l v S / 3 Z- Header/Manif Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Qetd" ie - LengthDia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over F-D epthof xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges oil ~ Yes No ~1(gy Fpg] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 339 KRATTLEY 1.) Alt BM Description = 1 2.) Bldg sewer length - amount of cover = 1 &6 0 Plan revision Required? F&I Yes No ' Z S Use other side for additional information. Date Insepctor Signa Cert. No. SBD-6710 (R.3/97) RECEMW County g~3 Safety and Buildings W ion s C~' r >D 201 W. Washington Ave., DIFBO 16 Sanitary Permit Number (to be filled in by Co.) ST. CRtOIX COUNTY Madison, WI 53707- 'OMMUNITY E)EVE,L©PM NT S 7 ! O / Sanitary Permit Application tate Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ' 0 " is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 ] m , Stats. SUS -vow-_ 1. Application Information - Please Print All I mation M7 aA Property Owner's Name Parcel # rv~qfl A-oloLuef- 100Y -0 6P JA Property O is Mailing Address Property Location 33 7 /T 17 V_ Govt. Lot City, State Zip Code Phone Number 15 Section 7 circle one) h /Cl T oC 7 N; R E or® II. Type of Building (check all that apply) Lot # / Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms (Z - 'tGCQ~ Block # _ ❑ Public/Commercial - Describe Use ❑ City of ❑yStateOwned-Describe Use CSM Number El Village of ~f I 1-7 D ~f 3 L _ Jot 1 ~ Town of ~/y OSor) A 0 !r, d III. Type of Permit: (Check only a box on line A. Complete line B if ap licabl 2 A. ❑ New 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 Owner 4Z7 - ` Q%J4 4 IV. Type of POWTS S stem/Com onent/Device: Check all that apply) ~fV Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: ou f Design w (gpd) Design Soil Application Rate(gpds Dispersal tquired (sf) Dispersal Arb a Piposed (st) System Elevation 11 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o New Tanks Existing Tanks w = ,U, " m M'a zo Ir. 5Z a U ~;5 J5 u. 5 P. Septic or Dosing Chamber 60 V VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI is Signatur MP/MPRS N tuber Business Phone Number nr~"1s H eal i 6 & Plumber's Address (Street, City, State, Zip Code) 4~3 q 5017Se,~ Orwe I-VaC~~0~ V4 / Af I . ount /De artment Use Only Approved ❑ p ove Permit Fee Dat Issue Issuin ent Signature r rven Reason Zr Denial J$ 475. 00 IX. CondidiM$TO.9VOlMeasonsfor Disapproval j.,~__ 1. Septic tank, efOL4 t f JW OW 3) 6[ 8 6• ` CL A• alisoemaial can must all s per management plan prove Cd y ph~m f. • jt req.IT11i0 as per ~paambls Coda / CnUranas, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. I1/11) Pg of / Private On-Site Wastewater Treatment System (POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner I I .~C C -C CjG~ %a, S4~! 'A , Section T~N, R~E or W PIN # OCity, Village, JMTown of N W T - S \ i / v vad 801 l(; Gay l exi~ ~h~~ -Xa4cl 71~ ~l " t CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: , 4 C Owner's Name: Owners Address:~~,~ Legal Description: Township: County: S~ cy-Q f)C Subdivision Name: A . Lot Number. Parcel ID Number. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans DesignedPlumber.%s License Number: •s~ Date: Phone Numberr Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SOD-10705-P (N.01/01). Page 1 Pg of Private / On-Site Wastewater Treatment System (POWTS) PLOTPLAN FILE INFORMATION PROPERTY LOCATION Owner ~ r51 / wea~aaef_ %a, S _ I/4 , Section T-a 91'-N, R~E or W PIN# OCity, OVillage, figTown of t6 f road 42i t) ~w A~ 6 - - Bi 40019a exts t iq `7a4~ a i +~1~~ sr 5eC 4~~~7C!(?~ SY ~~1/P i k33 I- or 2- Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) _ !1017 # of bedrooms x 150 gal/day/bedroom = _0!3O gal/day Design Loading Rate (DLR) or Soil Application Rate # z gpd/ft2 (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF_ gal/day _ DLR_ gpd/ft2 =3 ft2 # Chambers = Required Distribution cell area 4~ ft2 _ a v ft2/ unit EISA = -Chambers Chamber Manufacturer and Model:// g Maly r lX t1lG~.~ aQ'r Actual Distribution cell area = Required cell area ft2• f /;2 ft2/ unit EISA End Cap Pair = ft2 Cross-Section In-ground Soil Absorption System (2-cell): 4" Schedule 40 PVC -vent pipe with vent cap 12 inches minimum 12 inches minimum inches Soil Cover Trench 1 Sys- tern Elevation inch Chamber Height i ft ~ft Trench 2 System i~ oi I I l/ Elevation Co ~~e~~ ft ~ft Trench Separation Leaching Chamber Width ~ft to limiting factor Plan View In-ground Soil Absorption System (2-cell): Trench 1 Modify ft header/ design as ft ~Leaching Chambers ~ 0 needed. Trench 2 4 inch Header Sch. e6,U}e!S v7` I (pf Cft with end camps 1AS Draw O for a Vent and for Observation Pipe above. They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page of Technical Specifications PL 525 EFFLUENT FILTER u~*x:~,.,~x~.:.nk a.~~~ ~.w~~.~~..~x•,.w~*,..v,... v,,~ ~ .a,~gsN~ri~#~LL~..~~~...~Q,v~.. N~,.~~nv~.~Y.~~~~:~a~,~:a. - ea~TSrsoa ~ '1 j• FMKVEXTINTlOM 1435 f ~ I OUttETRIS M1EWIS f 4 sm -car- `I ! tau ~ PL-0 FILTER HOUSING PART NO- 30142525 MATERIAL HOUSING-POLYPROPYLENE r g OUTLETBUSHING-PVC 0BAll -HOPE R c . ~_-800~TElt$+TSR.OAT61NT01 ~ ~ I ~ ~ i t - FORfiNOlEE10OWEX+r i u w ~ j may 8M f _ Ar r r' a2. - 54CKETETMM - an` E ale" w~ a12'22µ POLYL% PLZ3 FILTER CARTRIDGE PARTNO.- W415Z5 MATERIAL - POLYPROPYLENE" : _ ti„ - -71 POWTS OWNER'S MANUAL & MANAGEMESIT PLAN Pag of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r~ r- Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer / ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model s ❑ NA Number of Commercial Units ❑ NA Pump Tank Capacity gal ZNA Estimated flow (average) gal/day. Pump Tank Manufacturer 19 NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer a NA Soil Application Rate i 7 gal/day/ft2 Pump Model JF{l NA Influent/Effluent Quality Monthly average* Pretreatment Unit lK NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BQD5) <220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality ❑ NA Monthly average** Dispersal Cell(s) Biochemical Oxygen Demand (BODO <30 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) <30 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) 510, cfu/100ml ❑ Drip-line ❑ Other: Maximum Effluent Particle Size Y. inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. MAINTENANCE SCHEDULE * * Values typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months 9 year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume Inspect dispersal cell(s) At least once every ❑ months K year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑-months W year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) Z NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) 50 NA Other: At least once every ❑ months ❑ year(s) A NA Other: At least once every ❑ months ❑ year(s) ZI NA MAINTENANCE INSTRUCTIONS: Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System startup shall not occur when soil conditions are frozen at the infiltrative surface. Page 6 of wastewate During power outages pump tanks may fill above normal' highwater levels. When power is re ored the k p excess or charge surface d sr will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT: When the POWTS fails and/or is permanently taken out of service the ollowi stes shall in compliance with ah Comm 83f33, Wnsconspn Admi b stmt veto insure that the system is properly and safely abandoned Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. A suitable replacement area has been evaluated and may be utilizee for the and compact location replacement not soilin b raged upon system. The replacement area should be protected from disturb should be d wells . Failure to rea wi required setbacks from existing and ad site oevaluation to structure, establish at able replacement arotec rea t Rthe eplacpement systems will result in the need for a new soil must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. the P WTS and site ❑ _ The site has not been evaluated to identify a suitable no replacementfarea s0avai able allholding tank replacement area f area. evaluation must be performed to locate a suitable p may be installed as a last resort to replace the failed POWTS. lace remova owing of the ❑ Mound and at-grade soil absorption systems m reconstructed with the roulles in effect atl that t meomat at the infiltrative surface. Reconstructions of such systems must comp < <WARNING> > TIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASC RCUMSTANCES.F KITH MAYGEN. SEPTIC, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER AN DEAH RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS MAINTAINER POWTS INSTALLER Name Name Phone Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PUMPER) 000 deli E y dP/ ENa Agenc . This Phone This docum document me ent was drafted by the staffs of the Green Lake, Marquette and Waushara Count ning n sSan Cation agencies of this document doeetnot the minimum requirements of ch. Comm 83.22i2)Ib111l1d►&(f) and 83.64(l), l21 & 13L. Wisconsin Ave Code. Use a -fnrml of the POWTS. Page 6 of During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation-have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN: If the POWTS fails, and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ _ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name , Name Phone 72 - ! Phone SEPTAGE SERVICING OPERATOR.(PUMPER) LOCAL REGULATORY AUTHORITY Name Agency Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not miaranree the nerformance of the POWTS. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address S~~yly`~ 3 (Verification required from Planning & Zoning D artment for new construction.) City/State#6/ Parcel Identification Number Qlfe) LEGAL DESCRIPTION Property Location '/4 , ;'/4 ,Sec., T ALN R~W, Town of Subdivision X, Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this orm are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warr my deed recorded in Register of Deeds Office. Number of bedrooms IGNATURE 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) ;WR S,gptmerce SOIL EVALUATION REPORT Page 1 of 3 TIM &*X In accordance with Comm 85, Wis. Adm. Code 11A ~epp site plan on paper not less than 8'/z x 11 inches in size. Plan mus ty St. CTO1X bJ~ un da}+nb limited to: vertical and horizontal reference point (BM), direction and? a q Sa' I.D. Perc a or dimensions, north arrow, and BM referenced to nearest road 020-1004-30-000 LOPMEN'i` Please print all information Revie by Date rV1Y<~{ na~ iifo® att~'on you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location Virgil Neubauer Govt. Lot ~i, SW s UT 9 N /R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 339 Krattley Lane 1 7/2053 City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road Hudson WI 54016 651-329-1440 Hudson Krattle Lane 0 New Construction Use: 0 Residential / Number of Bedrooms____3_ Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Outwash Flood Plain elevation if applicable N/A ft. General comments and recommendations: Z o 0r 1 Boring # o-nng 0 Pit Ground Surface Elevation 98.7 ft. Depth to Limiting factor 71 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E02 1 0-14 10YR3/3 - S 0-sg ml CW 2 f-co 0.7 1.6 2 14-35 10YR3/4 - S 0-sg ml gs 1 m 0.7 1.6 3 35-71 10YR4/4 - S 0-sg ml gs 1 m 0.7 1.6 4 71+ 10YR4/4 7.5YR4/6 f-1-f S 0-m mfr - - 0.7 1.6 Boring # 0 Boring OPit Ground Surface Elevation 97.9 ft. $DeD Limiting factor 56 in. Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots Soil Application G Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10YR3/2 - S 0-sg ml gs 3 f-co 0.7 1.6 2 8-56 10YR4/4 - S 0-sg ml Cs 2 m 0.7 1.6 3 56+ 10YR4/4 7.5YR4/6 f-1-f S 0-m mfi - - 0.7 1.6 ' Effluent # 1 = BOD5> 30:5 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Mark Iverson c~✓If 46672 Address to Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 Jul 9, 2015 715-796-5664 Property Owner Virgil Neubauer Parcel ID# 020-1004-30-000 Page __2 ,_of 3 D Boring # 0 Boring EfPit Ground Surface Elevation 93.0 ft. Depth to Limiting factor 49 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GI D/inn Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR313 - S 0-s Ml 9 gs 2 f 0.7 1.6 2 9-49 10YR4/4 - S 0-sg ml as 1 f 0.7 1.6 3 49+ 7.5YR4/4 7.5YR4/6 c-2-d (wet) S 0-m mfr _ - 0.7 1.6 4 ❑ Boring Boring # Wit Ground Surface Elevation ft. Depth to Limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A G i Dtilon Rate in. Munsell U. Sz. Cont. C for Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # 0 Boring Wit Ground Surface Elevation ft. Depth to Limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD/ikon Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#l *Eff#2 * Effluent # 1 = BOD5 > 30:5 220 mg/L and TSS > 30:s 150 mg/L * Effluent #2 = BOD5 < 30 mg/T- and TSS < 30 mgJL 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. d t Page 3 of 3 0 ft 24 ft 40 ft 80 ft N g a a v Cn 0 CL BM#2 - Top of 39"PVC Pipe Property line ~ 00' 100.0' House (according to owner) ; B_1 (there are parts of an old 98.7 98 fence here) B-2 dy 97.9 96 to 94' 0 cD B-3 92, 91.1 Ground surface at comer of house 103.7' = Ground Surface Elevation BM# & Description 1!!J~ Elevation =Bench Mark B'1 =goring Location & Elevation 100' Owner: Virgil Neubauer Site Information: Completed By: Mark Iverson, PSS #197 It Lane SW1/4 339 Kra It S7, T29N, R19W Hudson, WI 54016 Town of Hudson 680 Larcom Street St. Croix County Hammond, V1/I 54015 Phone:651-329-1400 715-796-5664 CST# 46672