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HomeMy WebLinkAbout020-1395-34-000 ~ o s ~ n i m ~ Q ~ p ~ ~ c 7 ~_~ it C. N = i ~ ~ _ ~ ~ N I ~ A D p ~ W ~ . o ~. O ~ ~ ~ .~ a ~ 40 5. N fD a i ~ a ~ ~ Z C '0 ~ _ ~ c I iu 4u I~ I p' a ~ CD O W l i N a I ~ N ,a Z 0 ~. o a~ s m c ~ w n m ~ O ~ N O. I i I m c~ = o ° 3 D ~~o Q QW _ Q O ~ ~ -~•~ ~ ~, ~ ~~ ~ ~ ~ a O. 1 OD 0 ~ (7 ~ T.~a~m~ v v o ~°_- ~,~m m o n u;m~ a3 A N fD O ' `f 417 ~ 4D S 41 C (n ~ N ~ . f1 ~ f D . C ~ 0) f~ F ~ C . d d 7 ~' n ? v _ m ~~v~ a 3 ocn7 0. o ~~ O O A ZO ~ ~ N ~ b _ ~ ~ A C ~ O ~j ~ N ~ N O W N_ U7 Q ~ _ O _ ~ ~ ~ ~ ~ 7 -' I p 0 ~ O ~ ncnO 3~n d O ~ ~ ~ o C ~ O = ~ 3 `i1 A r* ~ '9 ~ ~ ~ c C ~ eo ~ w ~ A ~ ~ ~ ~,, ~ .. ~ O O CAJ7 p7 N O C CJi N ~ ~C ~ • .~ y 40 O' ^~ W ~~ O W ~ ~ ~ 7 ~ N ~ n ~ O N ~ = OD 7 N p j ~ O O w _ ~1 ~ ~ d a a s !Y a ° 4~ ` w ~ ivy w ~ ~ , c n O c N ~ w ~ ~ _ ~ ~ ~• ~ fd N N ~ v _v O = C1 4D w y ~ d ~ _ ~1 • (~V d ~ f%7 N D o O u ~~ o ~ ~. p c = c • m A d _ ~ ~ ~ N 3 ~ p Z t9 ~ ~ ~ fD fl. ~ A ~ ~ .. ~ ~ ~ A o, -. z ~ ' ° ~ A o ^ z ~ ~ z ~ A A c a S A `~~' A b m O A w ;O a a' 0 ~ ti ti y Safety and Buildings Division County ` ~ ~ 201 W. Washington Ave., P.O. Box 7162 S ~', ~~1..(jc.(.et;, ,~~O~~~ ~ Madison, WI 5370? - 7162 Sanitary Permit Number (to be filled in by Co.) i Department of Commerce (608) 266-3151 L~ ,._ J Sanitary Permit Application .°. N°mbe` State Plan I In accord with Comm 83.21, Wis. Adm. Code, personal information ou provi may be used for secondary purposes Privacy Law, s15.04(1 Project Address (if different than mailing address) [. Application Information - lease Pr' formation Property Owner's Name 5D '/ f, Lot Block # rcel # `:tit' ~Q G.~ J 1 Property Owner's Mailing Address ^ J J roperty Location / ff^ ~ ~1. CROIk CGUNTY `'/ %. ~~ Section State Ci Zi ode , , ty, p /~ (C ~/ ~~t~ p T r~ 1 N; R~Eoe~y ) II. Type of Building (check all that apply) Subdivision Name S Number ~or 2 Family Dwelling -Number of Bedrooms ~ ^ Public/Commercial -Describe Use ~ ~ ^StateOwned-DeseribeUse ^City_^Village~ ownshipof III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) ~ _ A' New System p y ^ Re lacement S stem ^ TreatmenUHoldin Tank Re lacement Onl g p y ^ Other Modification to Existin S stem g Y B• ^ Permit Renewal ~'ermit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner s 7 2 6 _ O ~~a3-a - / J J / N. T e of POWTS S stem: Check all that a I - (~ d Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in, of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Ching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/TreatmentRrea Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) - Dispersal rea Proposed (sf) ~ - System Elevatio 9 t ~ O r-! ~ CEO ~ .~ ~ - ~ r VI. Tank Info Capacity in Total Number anufacturer Pre ab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Ta~ilcs Septic or Holding Tank ~ „~ f~~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersign d, assume responsibility for installation of the POWTS shown on the atUrched plans. _ Plu e ' e (Print) Plumber' ignatu P/ PRS Number Business Phone Number ~a~~s~ ~~~Y ~~s- a~~-~~f Plum/tier's Address (Street, Ciry, State, Zip C {e~ J ~ ~ l 1 ~C/ . L%~~ ~ ~ VIII. unt /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ / Q` Oy (Q ate Issue G1~~~ ~r- Is g Ag t Signature tamps) ^ Owner Given Reason for Denial Q IX. Conditions of Approval/Reasons for Disapproval `„ ~ ~ ~ .~ea~d. ~ ~ 6~ d e~ ~l/~ ~~z ~ y ~O~-t.~/ ~~w~ ~~n~ .- Attach complete plans (to the County only) for the system on paper not less than Sl/2 x tl inches in size SBD-6398 (R. 01/03) ~/- ,L.~- N~ u,u~ ~- -~o© z~ ~t l f ~D ti~ ~~ ys q ~ ~ ~-L. li-a~7 i ~~~ ~'- ~~-~. a3 ~~,~ ~-~~ ,i }~~,` S ~~ ~~ r-~ /4-/~ ~-y ,,~ 3~y ~'~v~ T~ ~ 3jy'~v~ ~a a~~~-7 ~ /_ 9~aD~ . ... _ _ . ~~ x Z Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings ~ irraDrd~n4e ~{omm $5, Wis. Adm. Code County 1404 Page 1 of 4 Steel's Soil Service Inc. Attach complete site plan on paper n t less Sian 8Y: x 11 inches m size. Planr~ must St. Croix indude, but not limited to: vertical an horizontal referenbe`pomt (SIN), direction and percent slope, scale or dimemsions, orth arroGl~ end Idwtibn arfd~istance ~ nearest road. Parcel I.D. -~ Pending Please print all information. eviewe Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). < 2 Q Property Owner Property Location McCabe Homes Inc. Govt. Lot na SW 1/4 NW 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 935 Osprey Bivd 34 na Scenic Hills City State Zip Code Phone Number ~ City ~ Village ~ Town Nearest Road Bayport ~ MN 55003 651-351-1018 Hudson Highlander Trail New Construction Use: _y~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement _J Public orcommercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system. Syste ele ation 99.60ft, trenches spaced and depth to code 4.OOft below grade. Boring # ~ Boring Pit Ground Surface elev. 103.60 ft . Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 1 0-9 10yr3/1 none sil 2msbk mfr cs 1f .6 1.0 2 9-23 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 23-37 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 37-100 7.5yr4/6 none ms osg ml na na .7 1.6 Boring # ~ Boring ,/,~ Pit Ground Surface elev. 103.60 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/itz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10yr3/1 none sil 2msbk mfr cs 1f .6 1.0 2 10-22 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 22-34 7.5yr4/4 none ms osg ml cs na .7 1.6 4 34-100 7.5yr4/6 none cos osg ml na na .7 1.6 'Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/Land TS5 < 30 mg/L CST Name (Please Print) r 'nature: CST Number David J. Steel c 248956 Date Evaluation Conducted Telephone "'••^^~^r Address Steel's Soil Service Inc. 1564 CR GG, New Richmond, WI 54017 4/1/2004 715-246- ~ 1'~ Property Owner McCabe Homes Inc. Parcel ID # Pending Page 2 of 4 Boring # ~ Boring t~}/ Pit Ground Surface elev. 101.20 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/1 none sil 2msbk mfr cs 1f .6 1.0 2 9-24 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 24-37 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 37-48 7.5yr4/4 none ms osg ml cs na .7 1.6 5 48-100 7.5yr4/6 none cos osg ml na na .7 1.6 Boring # J Boring Pit Ground Surface elev. 100.20 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs 1f .6 1.0 2 12-24 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 24-38 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 38-49 7.5yr4/4 none ms osg ml cs na .7 1.6 5 49-100 7.5yr4/6 none cos osg ml na na .7 1.6 ^ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 "Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel CST-POWYS Lic. #248956 McCabe Homes Inc. SW 1/4,NW 1/4,S25,T29N,R19W Town of Hudson, St. Croix Co. Scenic Hills Lot, 34 y/ 6Y w-Qs~ ti6 ~ ~ ~ ~ /3~' ~ ~ la~~ ,23 ~ I / 7~ ~~ aa~' ~2 ~/r ~7' 20, ~~ /v z5/ a ~- 1564 Cty Rd GG New Richmond,Wl 54017 Bus.(715) 246-6200 Fax (715)246-9372 Legend 1" = 40' • =Benchmark Ele. 100.00ft Top of 3/4" PVC Pipe • =Alt Benchmark Ele. 101.25ft Top of 3/4" PVC Pipe ^ =Borings Boring Elevations B 1 = 103.60ft B2 = 103.60ft B3 = 101.20ft B4 = 100.20ft ~r"' SSA S/~- ~. ~6 ~ ~~ -~/off, zoo 3 ~~._ _~ ~• lo~ ~; ?',!T ,~a`~ // ; 1 ~ ~ ~ rig .~ i A~~r ~ ~, ~ /~ ~ "-;---~ t ~ ~ ~~ ~ ~~~ ~j} ~ ~ ~ ~ ? W r ? ~ }V i ~ r ~,, ~ ~ ; '' _ ~ ~ `~ ' '_'' ~ ~ C ~ ~ `~ ~`_/i-+ ~~ ~ i i a 4 ~ ,~' ,' '1 ~ ,,,~ ~ ~ ~ ' ~,,,,,,~ ~ ' ' l ~j,,,~~ ~1 ~ t , i ~ ~ '~ ~~ t ~ ~ ,, f k ~ _ _. _ k` 1 1 ` t .~ ti,,,- ~ ~~~ ~ ~, T~1 ~ ~ ~~ A ,, .~ - ~, ~-r ~ - i I t r ~ ;. .--- l ti 'A C `i F ._ FT' AGE > \ E ~~ i I, ~ ~ J ~ { A~4t ~ .~ ~ ~ ~ - ~• ~ ___L ' . ~~\.~_ ~~ ' .~, `~ ~4 Q ~ `~".~ ` t~ >~,,,.f~-~, H• • ~ 1025. ' ~ H.W. -~_'-•-~~ `'. f ~~ ~~?' _ c" 3.9 ~ ~ 7024.$ e . ;~'~ ~: ~ --~._ , ~~ ~~~. ~ ~ - ; r ~, ~~ ~ ___.__~ - ~ , ~ ~-- _, - _ r ~ 1 -_ ~~ //'~~ ,' I r ~ ~ i - -- -- -, ~tJ . ` ~ ,_ l 5~ ~4 ~~ a x .. ! T'y ' t 1 I ! ~ ~ t ~ ~ _ . f . ~ ~ r /ff ~ ~ I i { f f ''~ ~ ,. ~ . ~ ~~ z - .. .. __._ f J ~• .... ,,' . i f i = t ' s '~' _ ~ ~ .T \ 1 ~. f a r _ ._ .- f ,, - - ~ f ~ ~ _..-- - 4 +. ~ it ~ ~ { ~x " ! ~~ ~.~ aL~ ~ /' j !? ` ~, ~ ~ 7rGT i1 t 1 ~~J. 's t ~ ~, i t ~ ~ x '~ ( „""~` '1 ~ a . '. !!! 777 _ _ T '~-,., T r .._ _. _ __ ,,,,._ ., ~ ~ - ~ _. .-° , ,• 1 _ __ f~ f ~ i ~ r ~ ~ i + ` r +, ' w e i 4 ., t 1 yt 4}a ~{ ~4 ~ ~ ~'~ ~ s i ref $ ~ 7 I~TG ~ ~ ~'rL `1 ,, r t ,~~ - R ~ ~ ~~ ~i ~ 1 ` } r \`~ ,z , ~~ • { t \ y t -, t . ~T d .~` ~_ ~~ . f ~ ~ \ ,- i . -- !~ 1/ ~J .._ x t ? t ~ ~ f: }} 1 ~j ~'' ~ ` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Bast, Kernon Hudson Townshi CST EI v' , a Insp. BM Elev: ~~,. ~ BM Description: /~ ~-~' ' ~VG- ~' x ~ ~I ? fi - iy~-C¢_ U '~- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic f' Dosing w ~-10~ ,. Aeration Holding TANK SETBACK INFORMATION TANK TO ~ WELL BLDG. Vent to Air Intake ROAD Septic \ ~ / I 2~ ~ ,~'1 ' t/h- Dosing o .eee. Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand PPA Model Num TDH Lift Fricti System He TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 453036 0 State Plan ID No: Parcel Tax No: 020-1395-34-000 Section/Town/Range/Map No: 25.29.19.2428 STATION BS HI FS ELEV. Ben h~mar ~ ~t.tJ ~• 7 I o n ~ / 0 D. D Alt. BM a ~. 10 /Q S' ~ Bldg. Sewer SGI~~ rl ~.(o /0I, ( ~ S Ht Inlet S t Outlet 5.3 S /b ~ Dt Inlet ~-1 Dt Bottom ~ i-~ Header/Man. J ~~ S s' (~D '~ Dist. Pipe .3 t oa- ~ ~ Bot. System ~ ~. ZS $•. Final Grade St Cover ~ Z ~ err , I (a3 . ~ BED/TRENCH Width / Leng th ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ A ~ b ~~ ~ 1 SETBACK SYSTEM TO P/L S BLDG WELL LAKE/STREAM EAC anuu~a uCer:^ INFORMATION CHA BER OR f Ty e Of System: "~ / ~ S- U e Model Nu l o i~ r I DISTRIBUTION SYSTEM ~ ~1 [Ul,(~ ~ - 2~ ~•- Z Z = ~f S 1X71 • I l /odv++~6~- ~. Header/Manifold Length~_ Dia_ Distributi n / Length "! Dia "Spacing x Hole Size x H Spaci Vent to Air Intake ~. I _. _.rli~'L~ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ . ~ Lj Bed/Trench Edges Topsoil Yes ,_I No Yes No rJ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ / / Inspection #2: / ! Location: 826 Highlander Trail Hudson, WI 54016 (SW 1/4 NW 1/4 2~~5--,T,2~9N,,~R19W) Scenic Hills Lot 34 ~Q Parcel N~/o:~~25.29.19.C2/428 ~Lq~ 1 J Alt BM description = ~~~~~J (i`~~`! .Sys` ~ ~ 5~~~ Gt.II YISz--- T b~ J 2.) Bldg sewer length = 2 3 ~ -~j vv ~(~._ -amount of cover = ~s ~- Y~ ~~~ - ~..C..P1 ~ ~revL`sed- a I • _ra,-h b~ °rv ~_~02~~ _ _ '' Use otheriside for additional information. No ~ " ~ I ____- ____- _ _ __ _ __`~,j'~!(/j~ SBD-6710 (R.3/97) Date Insepctor's Signat re Cert. No. S~ ~4~ ~~ -~ ~z Z ~a1 ~ ~~ £z ,,,p el .~ ~' X21 ~ ~~~ ~ ~~~ -,~"~'~ ~~~y~' 1 r-6`~~ ~~r~-~ ~, Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 sconsin Madison, WI 53707 - 7162 (608) 266-3151 pep rtment of Commerce `~ ~ Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information may be used for secondary purposes Privacy Law, s15.04(I L Application 1 nformation -Please Print All Information I Property Owner's Name O M 'r Ada r .. ou prt~ ~ ,~ ~~~ m) i Y P~ O Parcel , COUN 'r Lot9/ ~Bleelt~Y 3 020 - t39S-3`f-- d Locatio Property weer s at tng {dress j~ y ~ ~ ~7 ~ / t G ~ ,r ~/~ y, /~ ~/., Section City, State 'V~ L Zip Code / ~ ~ b~Ca Phone Number p G ~s ~ Gs ' !!~ T ~ ~ N, R /~oEcle W ) l h k ll th t ildi 5 r^^~~ app y) ~ n ~ ec a a ng (c II. Type of Bu ~(~ ...~~~. l'°'~ or 2 Family Dwelling - Number of Bedrooms Subdivision Natne , CSM umber << .~1 J/ J jJ" -'-" ^ Public/Commercial -Describe Use ^ State Owned -Describe Use 2 3 k ' ~ S ^City_^V' lage ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Q Q ~ `~' New System ^ Replacement System ^ Treaunent/Holdin Tank Re lacement Onl g p Y Other Modification to Existing System B. ^ Permit Renewal Before Expiration ^ Permit Revision ^ Chan ge of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Date Issued IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/TreatmentRrea Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) S, stet Elevation V1. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Tanks Existing Tanks Septic or Holding Tank ~`S-D ._ / 7~~ /CY ~ ~~` Aerobic Treannent Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Address (Street, City, State, Z'p ode) V v ~ ~~ lu ._G" , ~D e YI11. Count ~/De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss in Agent Si nat a (No Stamps) Surcharge Fee) ~ 25D ~ ~~ ~ ~ ^ Own ven Reason for Denial JC/ IX. Conditions t pprova ` YSTEM OWNER: r~~~~~~~ '~'~ ./J,, ,~- /~/ 1 Septic tank, effluent filter and ~ ~(',eao,C2p Y 0~ ~IZ~~ /'[ C • T/~. dispersal cell must all be serviced /maintained C~rvw,1. 3.~ _ 0 Q ~~~/ as per management plan provided by plumber. ~--- ~ 2G~i 2. All setback requirements must be maintained as per applicable code/ordinances. /~~YLti!'+t. ~~. ~3J~ Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in siu County ' ~S ~`. Sanitary Permit Number (to be tilled in by Co.) ~~3 03~ State Plan I.D. Number roject ddress (if different than mailing address) Q"?1 ~~ 60 i¢z4 SBD-6398 (R. 01/03) y-~~-- ~ 7=1= 9y~~ G-o~3y T-a = ~3,y ~ ~ ~ju-l = /oo (T~~~ ~~a-~ ag-~ -~ ~a"~. ~ 5 ~1i,,,,-.tom ,~.G~ ~3-a ~•~ ~ , ias~ - ~ 7 = l = 9y ~' ~-~ 3 y 7=a ~ 93,y , ~ Oyu - a = 99.oy~T~°~~„l~~ ~3- t ~~~ ~5 ~ ~3-~ ~3tr1 ~~ ~ ~ ~ l~lst ~ o3S7 °~ ~I3.vo Yy n~ ~ I • ~' ~ ~-- ~ t `~ j rte, ~--~~_ _ `. ~ ~ / ~J ,~-__~- r ~~ o ~ 1 x_ i .~ ~, ~_ _._--_.<---~ ~ o .. ~ ~_ ~ ,\~ ~,_ ~~ ~ ~-~ .-~ ,SOS ,~ x v_ ie W ~, ~ / / o p ~ o ,V ~ -.1~ n ~N ~ A v ~ ' ~~ _ \ ~ ~ i~ o ~ m ~~ ~ ~ ~ D i ~,~ ~~ i _~ 'o _ .~ .. .. ~G o :. ~._ . ~ . \ i / 305' I v` \ i /!45' ~ ~ \ x° x - - -~---1- ~^ ~ _ ~ --o - - - -- -- - - 4 - -- -- - - ~ i,~ __ G ~. ~. ~ f ~ ' ~J J ~ \ \ r N ~ ~~u Q~ ~ !~ ) p ~ C~ \ ~ \ ~ ~ I ~ ~D x ~ l c A .\ ~, ~ ~~ ~~ ~, v~ ~ i ~ .Q, ~ ...•- \0~ ~ ~ ~ .. o ~ ~ ~ ~~ o , ~ z x ~ ~.-~~~ x ~ ~ ~ ~ `. ~ ~ , ~ .. ._ Ylflsoon~inoepartmentofCommerce - SOIL EVALUATION REPORT Page 1 of~ Division of Satiety and Bui~ings m aocoraanoe wmr ~orrrnr ~, was. rwm. ~.oae Pla t i 11 i h ¢ 8112 A CamtY 11 ~ T • C r0 l n mus nc es n s e. x ch complete site plan on paper not less than indude, but not limited to: vertical and horizontal reference point (BM), drtec~ior- and Parent I.D. ' 3 %S~ .3 ~~' -' ~'~ peroentslope, scale ordimensions, north arrow, and location and distance to nearest road. l d~6 ' o~iF~ j ~ .y Please print aU fnfo R by Date . ' R Personal in<orrnaUon you provide mey be used for ry case (i~'rivae~/L,awr 15.04 (1) (m))• . G~~.L G(~h- ~ ~ ~ Q Property ONrner ~; © n q` I®Lly~.~~~?J `P Ky ~~ ~ Lot ~~ 1/4,(~ccJ1l4 SZS T Z 9~ N R~ E(or) Ot~1 Property Openers Maiflng Address ---~ , Lot# Block # Subd. Name or CSNYt ~ City Stabs Zp Code , ~ r ,. ; N U tv~r' ^ Vfllage ~ Town Nearest Road ~Sti: I l w«.~-~cr -M v~, . ~"Sa ~Z '' '=') z~~o~~ y ~` s ~, ~~ ~ c~q~ ® New Construction Use: ® Residential I Ntun S Code derived design flow rate ~Sd ~(o O O GPD ^ Replacement ^ Public or commer+aal -. De Parent maberia! OU fc.Ja.s (~ Flood Plain elevation if appflcable /ti/!~- ft General comments SAS ~ w` e.l eJaf.b n - '~° ~ ~~ ~~?-~w and recarlrrrendations: ~ (..~ e? 1.e, J al, ~-.`o r~ -q~P ~{ - G~~.~ ~ ~ 3.~ ~ ~~ Sw~~ ~., - i3~-1 ~,02 ~.e~Yl4~ w~- n _ _ .... Boring # Bonng ,/~ i:pr Pit Ground surface elev. ~/~ 2 ~ ft Depth to limiting tailor ~ in. Sal ' n Rabe Horizon Depth Dominant Cobr Redox Descxiption Texture Struc~re Consistienoe Boundary Roots GP D/fC~ . in. Mansell Qu. Sz. Copt Color Gr. Sz. Sh. 'Efflfl 'E1f#Z ~ o-~ ~ 3~ - ~~ I 2mc-bl ,mfr' ~s ~ ~~ . s Z ~4-31o rd ~~~ -_- s-1 2 ,~r--~- Ls _ ~ 5 • ~ 3 3l0- 5 ID ~~ ~ " w, s Os m 1 ~ . ~ ~ . 2 ~~ ~ ~ ~ - ~. Bonne # ^ ~~ ® Pit Ground surface elev. 9~ 8U ft Depth to limiting factor ~/ ~ in. Sod Rabe Horizon Depth Dominant Cobr Redox Description Texture SWdure Cons~tenoe Boundary Roots GP DJf~ in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. _ 'Eti#'1 ` 'Etf#2 t -I 31.3 -- 'j 2mc_hk. ~ s 1 v~ . S z ~ ~ v ~ ~~t ~-( ---' ~ .l: 2 abk m~~ ~ - . 5 . B 3~1-trio `...~~ m ~ - - .-1 I•Z ~~ ~ ~ 's • Effluent #1 =13~D_ > 30 < 220 ma/L and TSS >30 < 1 50 mo/L ' Effluent #2 = BOD . < 30 melt. and TSS < 30 mglL CST Name (Please Print) rgnature CST Number ~G vv~ ~• ~~ w~c..k e.r- ~_~__~ ~ -- ZS 330 ~ Address Date Evaluation Caxtucbed Teleptwne Number Z~l 3 8'a~' S~- Same~-.set~ w~ 5yo2S' ~ -~-0/ ~l5-2Y7-`{dU $' - __ . _, ~ Properly Owner l~. r ~~ ~ ~ Parcel ID # P~ z . ~~~ Boring # ^ Boring Pit Ground surface elev. ~ q' 4 fL Depth to limiting facbr _..~..Ll.lz, in. Soil lication Rate H ri D th minant Color D RedoxDescription Texture Structure Consistence Boundary Roots GP D/ft? zon o ep in. o Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh: 'Eff#1 *Eff#2 a-IZ ~~ -- ~ Zmobk ~s ~v•~ .5' Ib t~ ~" - ~ 3. D~ __ ._ _ _ ~ . Lt S - ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. ~~ ication ~~ Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft p in. Mansell ~ Qu. Sz. Cont Cobr Gr. Sz. Sh. *Eff#1 "'Eff#2 Boring # ^ Borrng ^ pit Ground surface elev. eft .Depth to limiting factor in. Soil licatron Rate Horizon Depth Domm~ant Cobr Redox Description Texture SUuc~ure Consrstence Boundary Roots GP D/fP in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efi#1 *Eff#2 'Effluent #1 = BODE > 30 _< 720 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL 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 60&264-8777. SBD-8330 (R07/00) .~ • PAGE ~ OF~ NAME 14 Y` Kam-- ~ ~ LOT# 3Y LEGAL DESCRIPTIONSw '/4 A,Gu'/4,S ZST~q N,R ~Q E (or~ ' SCALE: 1"= yO BM 1 ELEVATION /OU • ~ ~ BM 1 DESCRIPTION -Fv ~a ~ ~ G.~ Co • ` ~(~ ~ BM 2 ELEVATION 9 ~ ~ O ~ X ~ Sft.-Z ~ BM 2 DESCRIPTION -Fo P o •~ ~ a 1-ti ~ ~ ~ t-(~~ 6. SYSTEM ELEVATION -Fop 4~• 3c~ Lo~+~'' q 6'.~ a ALTERNATE ELEVATIONS 9 y S'o t..o-w ~- ~ 4y a ~ ,1 CONTOUR ELEVATION 9 ~- • S d, q S~ • ~d ` 1(~U 1 rnZ ,~n l Iv 2 pU e~~ ~~ ~ 1 ~t~~~~~I 5~~ ~ rs-Z M ~~ I(~~ ~. t®'' P~- J O V ~ N~ d J1lJ1Vt11 Vl\D ~' G---~~ /G-•--~ Y_-~- ~w~ - ~ ~~ C~~~~^ _~. -~ -~~ ST CROIX COUN'T'Y SEPTIC TANK MAIN'TENANCB AGRBEMBNT AND OWNERSIiIP CERTIFICATION FORM OwnerBuyer KE~P~a~ ~~~J'~~ Mailing Address 9~f~ r L-~y~'~~ ~ , ~d/+/~'~~ ham'"" S~/o/ Property Address (Verification required Erofn Planning Department for new Ciiry/State ~y,~~so~/ G-r/S Parcel Identification Number f~2o - 139 S- 3 `{~- ~ ~ Z `f Z$~ LEGAL DESCRIPTION property Location .~ l.t,~( '/s, ~ ~ '/~, Sec. ~S . T ~ (N R~W, Town of Subdivision ~c ~/!~ ~S' .Lot # ~. Certif ed Sarvey Map # ^-~ ,Volume . _ Page # Warranty Deed # r`?5 7 ~/ ~ ~ .Volume ~ ~~ C~~ .Page # ~~.~ Spec house ja'yes ^ no Lot lines identifiable yes ^ no SYSTEM M[AINI~NANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every throe years or sooner, if needed by a licensed pumper. What you put into the system can affect the fimdion of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mass'Plumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 sladge. Uwe, 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 Zoning Office within 30 days of the three y xpiratioa date. 3 i~~iaY AP CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this foam are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property above, by virtue of a warranty deed recorded in Register of Deeds Office. 3i~i~dY A OF APPLICANT DATE ««*««« Aay information that is mis-represented may result is the sanitary pernut being revoked by the Zoning Department. *«*«** 't* iinclade with this apglication: a stamped warranty deed from the Register of Deeds office a copy of the certified sarvey map if referencx is trade in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner Permit ~Jr3 0 3 (~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units '~--~"' ^ NA Estimated flow laveragel 7~~ al/da Design flow (peak), (Estimated x 1.5) ~ (..~-~ gal/da Soil Application Rate t al/da /ft2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand IBOD51 6220 mg/L ^ NA Total Suspended Solids (TSS( <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD51 <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. u w ~w~ewi w wine enucn~ u c SYSTEM SPECIFICATIONS Septic Tank Capacity ~~ al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model - /(1v ^ NA Pump Tank Capacity al ~IA Pump Tank Manufacturer [J~NA Pump Manufacturer ~jNA Pump Model ~ ~ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: I~VA Dispersal Cell(s) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ monthls) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^ yea~(s11s) (Maximum 3 years) ^ NA Clean effluent filter At least once every: /`/ ^monthls) ~J year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthls! ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ earl 1(s) Y ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ 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 tankls) 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 celllsl 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 (Y31 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 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 512 months, 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. __.....°.^'.`.'~"'.t:: _ .%k'aucs"..:['~ ^4.L*°"tom.. ~.... ..~. ... _.,~,. »..w+.~y w.w.w. I - - _w,_ _ _.. .. __.. _._....._ _ _ _. Page Z of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the contents of the tankls) 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 cellls) in one large dose, overloading the cellls) 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. 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: • 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. ~~ T _ a o in an aluat' g~ be ' e ai a ~RD+~18 Tf~L~ ~2- H/~1~/ CpNS7RU~?tD ^ 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 __ I POWTS INSTALLE ~ Q ~' `t ~QQ~~~ POWTS MAINTAINER Name Name Phone ~ ~ ~ ~_ Phone eGOTer_F cGRVrerNr. na~anTnR rPUMPERI LOCAL REGULATORY AUTHORITY Name- - - - - - - --- --- Name ~'r. ~ l dV 2011~1~(.~ Phone Phone ~ / s- 3 ~(~_ (p (~ This document was drafted in compliance with chapter Comm 83.221211b11111d)&If1 and 83.5411), (2) & (31, Wisconsin Administrative Code. V 2530 P 109 Number STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Carriage Homes XXI, Inc., Grantor, and Vernon J Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 34 nd Lot 35, Scenic Hills, St. Croix County, Wisconsin. Recording Area 7~7'~6~ KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED F'OR RECORD 03/19/2084 10:35A1t NARRANTY DEED EXEhfG? # REC FEE: 11.00 TRANS FEE: 392.40 COPY FEE: CC FEE: PAGES: 1 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. l~tame and Retum Address: Edina Realty Title, Inc. r 400 S. 2"~ St. -Suite 1 I S Jr 1~ Hudson, WI 54016 423403 020-1395-34-000 f ~Za- i~9~ 3~ D0o Parcel Identification Number (PIN) This is not homestead property. Dated this 10th day of March, 2004. Carriage How XXI, Inc. B r, * ellei St. Martin, Vice President of Carriage Homes Development AUTHENTICATION Signature(s) .~~1;..~~.... w,...,.. _.... .. .... i authenticated this lOthay o ~IbiIC State of Wisconsin * ... TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Signatures may be authenticated or aclmowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY. ) ss. Personally came before me this March 10, 2004 the above named Kellei St. Martin, Vice President of Carriage Homes Development to me known to be the person(s) who executed the f going instrument and acknowledged the same. ~~ D3:ane M. Barron _ Notary Public, State of Wisconsin My commission is permanent. (If -n~o/t~, state expiration date: ~~ WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 I . ~ ~ ~ ~ moo- -~ ~ %" x --~ ~ ~ ~ Q .~ d ~ , ~ ~ '. .---1 ~ ~ ~~ 1 ~ ~ i y~ ,d ~• ~ ` ~ ~ N ` ~ ~° ( ~ ~ x ~ ~ , ~ ~ e--1 ~1 ' 1 , \ '• cv - J ' v ~ '.o ~ 1 l ~ _ x o 9G-~ X J ~ ~ ~ o ~ _ -_ ~ ~ ~ - --p- OI - - - i ox ~~ \ ~/ ~ ~ '- - 1 -- -- -- - ~ - - .SOE %1~ - - - ~ -- ~ ; 1 ~^ ~ i o s>w. ~ ~ o /' ~~ i U ~ - a ~" ;; ~ , o 1 Q ~ ~~ m ~ i W' ~ s ~ ~` v ~ ~ ~', ~ e---1 v ~~ Nr~ F- , N ~~ ~ _ ° U v o ~/ ~ ~ /~~- ^ , ~ NW o by N \\ ~ O ~ ~ ., . ~ x 305 ~ ~ ~'~/ _~ ~~~ -- ~ ~ ~ ~~~ . 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Plan must qty 5 C O ~ 1 indude, but not firnited to: vertical and horiaontal reference paint (BM), direction and percent slope, scale or dimensions, north arrow, and location and distarrxxe to nearest road. Parcel I.D. d Z~ ~ / 3 9.~' 3 -~ ~ -----~..~ Please print all Info ~ ~ ; ~~ ' . R by Date ~ e - I (CI L,awk 15.04 (1) (m)). , Personal information you provide may be used for r~ (p?ivacy Q GG'I" "~ .G G~!/y~i^ Property Owner ,~ ~ ' `1-~~;`pL ~ "pr~erty Gg~ Lot ~~ 1/4,(~cc~ 1/4 S Z S T 2 ~J' N R l E (or) p~- property Owner's Mailing Address --l i, ~ l ai. ?f~~$ Lot# ~ Block # Sutxl. Name or CSMif S C~ ~ Z O 5~ ~ I I (,~ - e City Stale Zip Code ~ -~Pttpne N '' ur~Tv ~ " ' ' ,~ ^ Pillage (~ Town Nearest Road ~G~ • ~ '' ~ `"1)1~t~~:~~l~Y ~S1% I l wa..~-cr Y11 v~ . ~ o ~Z ( ~ , ~ ~ s ® New Construction t]se: ® Residential 1 Ntrm - ~ Code derived design flaw rate ~ Sd 1 ~o O O GpD ! J ^ RepMacement ^ Public or commercial - Parentmalarial OU fc~10.8 (~ Flood Plain elevation if appfic~ble ~ General corranents S ~ S ~..~ ri1 e/ t C J0. f ~ b n - 'FO / and recommendations: 1 a ~ ; - ~ v ~ ~ ~ -~aa GI ~ ~~-{ ~ ~ ~ ~ ~, U~ e, l •e.i - d n ' ~6P (3. ~c /A. .~/w.In // _. ^ Boring -U ,/~ r ~ Boring # r~ I tpl Pit Ground surface elev. ~~ 2 ~ ft Depth to limiting tar~or ~ in. Soil ication Rate Horizon Depth. Dominant Colo Redox Oesgiption Texture Stricture Consistence Boundary Roots GPDIt~ in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eti#2 / O-f ~ 3 3 -- Si l 2i---,~-bl rn~r ~s I v y . 5 ,~ C~ ` • ilia ~ - , ^ Boring ~s # ® Pit Ground surface elev. q~ gU ft. Depth to limiting factor (/ ~ in. Hor¢on Depth Dominant Cob Rt:dox Description Texture Swdure Consistence Boundary in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. _ Sod ' n Rate Roots GPD/fi? •Efi#1 •Eff#2 ~ -/ D 31.3 ~ ~j Zrr~hk. c s I v~ . S c~ ! ~ 's Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 1 50 mglL ' Effluent #2 = BOD _< 30 mglL and TSS < 30 mglL CST Name (Please Print) ignature e.r^ G ~- - CST Number ZS 330 9 A~~ 21~ 3 gds 5-~- Somer-Se-f, w/ 5yo2s Dale Evaluation Conducted (9 -~-a/ Telephone Number -7lS-2y7-`fDV 8' Property Owner Q r ke. l ~ Par+cel ID # Page z ~_~~ a Boring # [] Boring ® Pit Ground surface elev. q~ q4 ft. Depth to limiting factor~~~ in. Soil nation Rate Horizon Depth Dominant Cobr Redox Description Texture Struchrre Consistence Boundary Roots GP D/tl? in. Munsell Qu. Sz. Cunt Colo[ Gr. Sz Sh: "Eff#1 •Eff#2 ~ b-I Z ~ ~ -- 2mabk ~ s ~ v~ . 5~ z ~ 2- y ~+ _ s' 1 k ~'r L ,_ ~ 8 3 b ~ --- trS ~S I -- , ~ / . 2 3, ~~ _ . .._ lr ~ - ,, ~~ # ^ Boring ^ Pit Ground surface ebv. ft. Depth to limiting factor in. Soil. Rate Horizon Depth Dominant Cob Redox Descxiption Texture Struchme Consistence Boundary Roots GP D/l~ in. Munsell ~ Qu. Sz. Cont Cobr Gr. Sz Sh. 'Eff#t "Eff#2 Bonng # ^ Borng - ^ Pit Ground surface elev. ft .Depth tD limiting factor in. Soil lication Rate Horizon Depth Dorninarrt Cob Redox Description Texture Structure Consistence Boundary Roots GP D/fEt in. Munsell Qu. Sz. Coat. Cobr Gr. Sz. Sh. 'Etf#1 *Eff#2 • Effluent #1 =-BODE > 30 < 7L0 mg/L and TSS >30 <_ 150 mg/t. ' EftlueM #2 =GODS < 30 mglL and 'f 5S _< 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. ssa$sso rrtmroo~ PAGE ~ OF~_ NAME -~ Y~ K -2. ~ ~ LOT# 3K LEGAL DESCRIPTION.S~ ~~4 ~lI4,S ZST~q N,R ~q E (or~ SCALE: I"= yU BM 1 ELEVATION /OU • ~ BM 1 DESCRIPTION -fv P o ~ I ~.j-6. Co • • !-(~(~ BM 2 ELEVATION 9 ~ • ~ BM 2 DESCRIPTION -b Po ~ I a tk ~ ~ ~ 1-~~• l~ SYSTEM ELEVATION -fop qS• 3a Low-°~' 9 6•aa ALTERNATE ELEVATION{a F 9 y S'o Lcw ~- 4y o ~ EVATION ~ 0 9' ~~ CONTOUR EL 9 • S ~ 1 rn Z ~ l n ., ~ `2~ ISM ~, oY ~ h J~,,:>, t ~, ~~, "~ o~ M ~- Ui d ~ ~CR- ~s, ~ ~~~~ ~~' -~ -cal