Loading...
HomeMy WebLinkAbout032-2176-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 584715 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: City Village Township Parcel Tax No: Baillargeon Properties TOWN OF SOMERSET 032-2176-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: to l/Z ~j 12.30.19.1505 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing / Alt. BM Aeration Bldg. Sewer SY qr, ~ Holding St/Ht Inlet l0 yy TANK SETBACK INFORMATION St/Ht outlet j TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom v + > Dosing Header/Man. 1~17 75 X3.85 Aeration Dist. Pipe '4;1, N t x'3.85 Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Man cturer De and St Cover GP - 1z~~CC1' G~ 0~•~u Y~ /Qh.LO Model Num TDH Lift riction S stem Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS •4~t a_ - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR 2 CLvt) UNIT Model Number: ] 3 COf✓1 - DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing j ent to Air Intake ' It Pipe(s) Length Dia Length Dia Spacing - SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over t Depth Over xx Depth of reeded/Sodded xx Mulched Bed/Trench Center 1 Bed/Trench Ed es - I _ _ l Topsoil - g Iv4ale El Yes k No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: L 06 ~ S L ~lf3~w~ /ti~51 ~l CC7 L~ Location: 1605 83RD ST 1.) Alt BM Description = , U~ t YGtrGr4~! 7u~fJ`~ G~ 2.) Bldg sewer length = aQ - amount of cover Plan revision Required? ❑ Yes V No 7 v Use other side for additional information. L 119 f L~ ` Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) County RECEIVED I'- A$ . Safety and Building ivision ? Q R, 201 W. Washington Av B x 7162 Sanitary Permit Number (to be filled in by Co.) S P S yJJ APR 18 201- Madison, Wl 5370 / ~j fib. ST. CROIX COUNTY v v ! 7` State Transaction Npttlber anitary ermit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Ad ess (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide maybe used for second C ~j y S purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. !J 1. Application Information - Please Print All Infoyffi ion Propert Owner's Name Parcel # I'll? r -t 'It C>S2 7~ ~v L~cc1 Property Owner's Mailing Address Property Location i F. S J r S CZ U Govt. Lot City, State Zip Code Phone Number Section Z trcle ones • l In c' t L'.~ ✓ T_30 N; R lkorll~J' II. Type of Building (check all that apply)` 1 or 2 Family Dwelling - Number of Bedroo(ns ) r Subdivision Name _ ~k CA Bloc L sr c- sr~ l ~S tA, ❑ Public/Commercial -Describe Use Cw A. 1 44-1 r~ ❑ City of El State Owned- Describe Use ec ' CSM Number El Village of 1ATown of It n N •n.~ • III. Type of Pe mit: (Check only one box on line A. Complete line B if applicable) Zp A. Xew System El Replacement System b Only AI 11 Treatment/Holding Tank Replacement Onl El Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner 7 IV. Type of POWTS S stem/Com onent/Device: Check all that a I) ~ on-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: Design Flow (gpd) Design Soil Application Rate(gpds Dispe sal Area Required (sf) Dispersal Area Proposed (s System Elevation c~ L Y2 L C7/ Ctk %0 7 -2 (7 VI. Tank Info Capacity in Total # of Manufacturer Y c Gallons Gallons Units New Tanks Existing Tanks L U „ a U w w. Z ° Septic or Holding Tank / (5) 0 CI 60 ~ , -C Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. r Plumber's S g ature y MT RS Number Business Phone Number Plumber's Name (Print) 3 t7/CL`~'//~=~S~T >ZG23 Plumber's Address (Street, City, State, Zip Code) VIII. unt apartment Use Only pproved ❑ D appro Permit FQee DI,a[te ;sued Issuing nt Signature I/ 5, 46 It ❑ O, iven Reaso r Denial IX. Condi4y►$'90ryp2easons for Disapproval aQ , 4 11 $eptic'tartk, effluent filter atfd 3) & J~ ^ e / tlisperri cell must all be s~i vicrrs _rn. _.rnjginec' Aw- -4.~ do es';w merasement plan pro sided by plumber. 2. A%,-il It regt$m ..t nts rnusi.Oe rlaint~.iHid /f - I _ as per applicable node / .rdinaru~$. 46 ou- 4- , C_ fie. tCL- AM t'w^. Attach to complete plans for the system ands mit to the County only o paper not ITV than 8t/ x 11 inches in size f , ~x fan 0bl'W~ • rg 4" .r1JNA.V~ V SBD-6398 (R. 11/11) Pac 3 0 3 `Brian--Parnell idCST 2. 3`1 14 -Date y ~enc!u .ark '1 ''roe /c(D, bZI1C,ii laI'1i %C : ? Te% f= G~ j S;~;l i0:lro L!IIL! - ~rcL'. 7 I , - I I , L/ l Z o i I ti I - - 7 7 ...i : I S i I 1 i I I I o , T I I I ' I ~l L - --t--l----^ -jam'/ I I I f ~ ~ i ~ I I- I I CONVENTIONAL COMPONENT DESIGN Residential Application /INDEX AND TITLE PAGE Project Name: G2 , `1 ~t~~' c~~- 2 Owner's Name: lz r ~11ce t' •7 ~~J ~l i~~ Owner's Address: S_eYY' I S57 fi 4 Legal Description: i ~c~ C~ 2 C f Z. Township: County: t C 6'' / Subdivision Name: C. C Ice Lot Number: Parcel ID Number: 0 F 2 76/'2 0 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer/Plumber: /u,E' License Number: 2 Date: V /7 AG Phone Number Z `r7 = BUJ Signature GEC.. Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 uW,NFR N:role Page 3 of 3 s Brian--Parnell CST 23131=4 'Date TO; I ' SOf1 [~v~l1L° SliItul lC ,~1'CC: 1 = 40' 5,.:al,e I ' I I I NT I ~ I a , I _ _ r-. I I j I I I I I , i T--- 1 , I --t--t i I : I T- I T I I I ~ /7) t I I I ! I 1 1 ? -T 71- t- r-_ _ _ _ _ ---t- - I I ~ I i : I I ~ I I I j I I r I I I i I ' i S ~ 00 t 6z ~ f .4 eS I 700 I Date: 5/27/2014 12: dmoesl Time: 9:00:59 AM do- 0 ~ I~ ~I SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page--of- Project Name: rte. No. of Cells / Per Ceii it Cell Width Total No of sq it EISA Per Cell 70 it Celt Length sq ft Total EISA V ft Cell Spacing Manufacturer Model Laying Length EISA Rating Infiltrator Q1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' / 50.0E Gravelless Leaching Unit Manufacturer: Gravelless Leaching Unit Model: L- Typical Cross Section Finished Grade,~~'.3ft Observation Pipe with approved cap or vent -::<:<'>>>>:':;:•:;::::<>>Pi Soil Backfill qg in • <::< :<<, Geotextile Fabric ft Infiltrative Surface 12 in 761,9,9 ft Limiting Factor s in Slotted and Anchored Ventl - Observation Pipe with Cap .e. aa /{~///ms's) gy' Plumber/Designer Signature: License - Date: / pD~W NO INSTALLATION INSTRUCTIONS &wWaNdff PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS Center filter 1 I ' with opening E COO Vi, -RiQ -d i = I~ddif~onaf p~p_ PnCytok Erte & l o7t'" Glue forcenfenng ~ - Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCT IONS ~F T7K Lis -e~. }S Cr c -l r Step 1: Step 2: Step 3: Locate the outlet of the septic tank (A) Remove tank cover and pump (A) Insert the filter cartridge back i if necessary. into the the housing making sure BI D (B) Pull the filter out of the housing. the fitter is properly alighed NOT USE WHEN FILTER IS REMOVE (C) Hose off the filter over the septic tank and completely inserted. a USE F2UBBER tjLOVES Make sure all solids fall bade into the (B) Replace septic tank cover WH€N CE_EANih1G` FlLi ER septc tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM "SPECIFICATIONS Owner Septic Tank Capacity /~©C1 al ❑ NA Permit rg Septic Tank Manufacturer 6r- j es ei Q NA DESIGN PARAMETERS Effluent Filter Manufacturer 2G l~ Ciu C ❑ NA Number of Bedrooms Q NA Effluent Filter Mode( ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity at ❑ hA Estimated flow (average) O C: gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer ❑ NA Soil Application Rate ' _i aI/day/ft2 Pump Model ❑ NA Standard influent/Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Grave( Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L 0. NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) NA Biochemical Oxygen Demand (BOD5) S30 mg/L ❑ In-Ground (gravity) ❑ in-Ground (pressurized) Total Suspended Solids (TSS) S30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y$ in dia. Q NA Other: ❑ NA Other. Q NA Other ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: Liltmonth(s) (Maximum 3 ears) ❑ NA ti ear(s) y Pump out contents of tank(s) When combined sludge~and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA $ year(s) Clean effluent filter At (east once every: ❑ month(s) ❑ NA .IR:-year(s) 'nspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) = `aterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) ❑ month(s) At least once every: O year(s) ❑ NA Garter: a 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 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. 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 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 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 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 setba&k 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 3i.I ~'Grh e /l Name Phone /.s - Z Y 7- 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was dra`:eJ -_-~iiance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. Page o 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 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 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 peeiings; 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. aONTINGENCY 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 fines 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 trust comply with the rules in effect at that time. ❑ A suitable replacement area., is not available due to setback and/or soil imitations. 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 aOWTS INSTALLER POWTS MAINTAINER Name Name Phone -7 k t 7 ZC. Phone >EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone Phis document was draget = -z.iance with chapter Comm 83.22(2)(b)(1)ld)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code- ST. CROIX COUNTY SEPTIC TAN-i-Kr _Nj_A_LN7E_ENAI'CE AGREaMENIT AND O-ir.lTRSt P CERTIRCATIONN FORM 0 AMM"Buyer -Mailing Address ' In (J ~ ~ Ivey ~ C ~(11M 01A u 51 ~ 1 / O ue % A C1 ~-yrerificmon required from planning & Zoning Department for now construction.) City"State,~/~~ ✓ K C ~'1y(.~-~ W.TParcei Identification Dumber 0 17& -a 0 LEGAL DESCRIPTION Property Location V,, Sec. : T _~Q N R_Lq_W, Town of ~'C~1y11 S-dbdiv-ision Plat: N e CSI S~'l f C , Lot JIG) Certified Survey Map r , Volume , Page Warranty Deed - (before 2007)Volume , Page # Spec house yyes 0 no Lot lines identifiable 0 yes 0 no SYSTEM MALNTTENANCE A_h7D OVYWER CERTIFICATION improper use and maintenance of your septic system could result in its premature failure to handle wastes. ?roper 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 °esponsibilities are specified in §SPS. =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 !be owner and by a master plumber, journeyMan plumber, restricted plumber or a licensed pumper veri- g that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping Cif necessary), the septic tank is Less than 113 fu of sludge. Uwe. the undersigned have read the above requirements and agree to main in the private sewage disposal system with the standards set fortis, herein, as set by the Department of Safety And Professional Services 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 Planuiua & Zoning Department within 30 days of the three year expiration dais. Iiwe cerdly tba*_ all statements on :`orm are tie to file best of my/our knowledge. Uwe am/are the owner(s) of the property descnbed above, by virme of a ~ ; deed recorded is Register of Deeds Office. Number of bedrooms & SIGNAMRE OF APPLIC_40ONT(S) DATE z Y= nY information that is misrepresented may result in the sanitary permit being revoked by the Plannigg & Zones De erit_ x include witu this application a recorded wairanry deed from the Register of Deeds Office and a copy of the certified survey mm if of ,rence is made in fie warranty deed. '_RREV. 0411_7) 3qF~ ~'ih la~ I I a~~ ~y rO ~ o r~~3 2 LL ~ E26 -R'110 AAC`1 (;iTW' u~ i~?+JC9'0 C31C~t9.OdID!'PJ J ~G FFF~ ~ ~ y V ~sr I t y t i YY S ~mejd ~Ys 3aN V ~ ~ M ~ i L'9YC N4LY.v..00N C Se ~ F ~ ~ #5~ a ~ ~~p w i( Y~'~gSa ga i ~ Y~ :ti~S 6 eP fli =Yi Q ~ m Wii d', zl 1 i g d 17 ~ep W >s ~i3 ~ ~I <I _ 1lgy5 rE "`III___ ~6~ ~i L?S n ~ 3E 56 t e h ~ it .d J tyt } I g I ~ i~1 ~A ~i 1ff[ u 1E x S ( ))pp gg q - iR 1 E~ SS6 Fb~ L y • aq 2 3 ! • +te' ? ~ ~ ~ ~a ~ ~ ~ a E d A e , b ~ ,1413 Y f d l ~~i \i; ~~e L n 9" k R N& 1! % q R: ~ ~ 51 c 1. ma.. Z 1 fill t o a mma ~J10'IatL N1.YC.CLAON 690115'~3i~6 ~d0 ~ a E)'~ ~~t trz Vs 206 6e3089 C®IlEtfdm ~ ~ ~ Rp~ ~L a' 41 I L------- j i ~jl I I I I I I I I I I I I i I I I i KI I I i ~I I I I ~I I I I I I I I I _ I I i ~ I I l I I I I I I I l 1 1 I I I I I I I 1 1 I l i I I 1 1 I i i i f I I I I ' I I I I i 1 I i I I I i I I I I ! I I I I , I I i I I I I I I l l i I I I I i i l I I I I LNJ L-J I I o I I ~ I I I I I ~ I I I I I I I I Q I~ I I I I i i I I I I I ~ I rJ l I I i I I z i I I I I I I ~ I I i l I i I I i I o Nl i I i I I I 0 1 I I I I I ~~I I I I I I 1 i ~CIJi I 11 1 I I I oul I y i I i I i I n 1 I I I i i I i I I i I I I I I I I I I i I I I i I I I I I I I I I I I i I I I I I I y I I I I I I I I I I --1 I r I I i i I I I Ii , I I I I o - 11 l I -61 o I I I it / I I ®NII 1-~~ ~ I I I X13, I II Q ~_J I I I l I I I L_---- I i I T 111 RECEIVED _ L OL13 /~pP[~ qR 38'70 S Wis. Dept of Saffbty'Ad 4IWsional Services SOIL EVALUATION REPORT Page of Division$tjS~tf ~OMMUNITY~f~ f Y in accordance with SPS 385, Wis. Adm. Code , DEVELOPMENT County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. / 1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. `k )J Please print all information. Rev' by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 Property Owner Property Location G~ fi j,~ • " f Govt. Lot S W 1/4 SG -1/4 f 2 T 3 C N R Iq I3 (or) Property Owners Mailing Address Lot # Block # Subd. Na CSM# 6 O - / S J all e ~ U & cz e it cV e J>~~' few city State Zip Code Phone Number ❑ city ❑ Village ®Town Nearest Road r ~l2,~~'f Wy _~y0 } ( ) S~,Yic''~er- 2 s S'>< Ej New Construction Use: a Residential/ Number of bedrooms Code derived design flow rate ~ U GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material C- 't' 6-&-f -o Flood Plain elevation if applicable T ft. General comments e c/, : ->t c>lj~ ay and recommendations: Boring # Boring F711 ❑ 0 pit Ground surface elev. S ft. Depth to limiting factor 7 / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 *lfff#2 l /l 107-% / SG /h! j6/c /7-1 X42 % ,.z s 2- 2,`( Jr 5)r i S/ /I",G ~/h l•5/~ Jh t C w /J,L (j , g, a Boring # ~ Boring J-- pit Ground surface elev. ft. Depth to limiting factor?__ Sari Application Rafe I Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 01 ff#2 2 j 2-3Z -7 5 /L;d s i' / 2 r-1 JAk- Mr's C t,- yz-sG rears ivy s ~1 0~ c L,~, `t 5 G- I z iG/ 1- /V n, s os ' A Effluent #1 = SOD . > 30 < 220/m~ g/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD . < 30 mgt and TSS < 30 a/L I Address Date Evaiuation Conducted T eie hone Number A/ 7/S Property Owner Parcel ID # Page of 131 Boring # El Boring ® Pit Ground surface elev. 3 ft. Depth to limiting fact ?r in_ Horizon Depth Dominant Color Redox Description Texture Soil licatian Rate Structure onsistence Boundary Roots GPDt t 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 r 0--a- 1V A L J/nS~k v ~ s 2- yr y ! 7 /Y/ n S 0s IMF 0,7 1 1,6 >R I 1 _T~~ l 1 i 1 ~ t l i i 1 ~ t 1 Boring lA/ i t Boring Pit Ground surface elev, ft. Depth to iimitincg factor in. i #ar {i o i t t:~u•.;.•: r - t i I f € # j 3 4-- i i t i i i s x i f f i i . 1 I t ~ f } i 4 i 1 1 1 1 i i I t { ~ ~ u iaCtvr uaNiii t' to lil t'^g R41?P.C - f Lin, Surface eiav, ,-Zuur i R. =te t ! t ..~......'n i eZ ^ti ,^„`.P~.~_ t E i i ! 't t I i t i t 4 - - I j ~ 1 4 1 # ( f ~ 1 - { ,c / .a : - et~n > ^n 7c _ _ 3 ? tgtL L...;ie at ? = °i~a } _ ^r na nr! TSS . r ,i , - - - t. Ql JHi elt an LTI oi eJrJ f0i i:"+°( Services is an Cl$Uaj Op i f Z Der access services or need material in an alternate format. contact the department at 608-'-)66-3 151 or T T y through Relay. Property Owner 2 / 72-- 2c- Oc-- Page 2- Parcel ID of Boring # Boring ® pit Ground surface elev. ft. Depth to limiting factor Z~ in, Soil Aooiicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPDfft 2 in. Munsell Qu. Sz- Cont. Color Gr, Sz. Sh. _ ff," ff#2 v~ ~ S z f' Cir y , 7 i I 1 i i ! ~ 1 • i 1 J 1 t! z ~ i - 7 i Sorine t i__ )11 i 1 i i I i L-j eL ci't Ground si.tfaCc ''c1£F_ i~ i.iF'L)I7 to Ii tiiir3g S2.^.tQi IR - - So,. ,A ~t D4i° . - vi :ii•xu G7 ' i i 1 j ° ] ; I t f i t 1 T t f t S i 1 S f t 1 I i t 1 i i f i i i i t i 3 t i i 1 j I i L_.1 ,=ii . _ - -eTa : jar=: -fir`- ~ - - _-cr;-6 t t ~ n i f t z 1 r S t i i ! t ( ; i ~ ` ` { f L I i i f t ( 6 ~ 1 S 1 3 _ ~ i s s ; I 9 s , The Dept. of Safet.v and Professional krvice3 iS an £^ual oSliJil ~ and ~ T u t :iZzllti JLt T lt£ px Utz'. iid .t£; and £Il LL (I1Gt tr. :t :~OU if'.~.ed 6c ..s-: SC4nC4 t/ access sen.ices or need matenal in aa~ alternate forrnat- contact the department at 609-2616-315! or TTY th-roach, Rela. - SBP °339 (°i; , Page Name E Brian Parnell Address S~3'- / S S cz CST 231314, A Benchmark 1 -ro l !z Pu c p p e Z. /0 U, e-) 11 , A Benclunark 2 TOZ y ❑ Soil Boring Suitable Area 1 " = 40' Scale I Ly- I I m ! . i tU ! E f I i i i 2~~0 f f ~~kyn I i I A I~ 1 ! I i i I i I i i~yP, I ( I ~ ~Cl^ 1 Ai 570.18' iN+f N I AAA I ! W i C.B.A. z.3 ACRES N Q f 0 LOT 16 O Q~ ~I 3I ACRES rp ® C.B.A. = 3.7 ACRES Gl I I ® I I ; ® tr f 575.47' "D I t N OT 17 N If t 3.0 ACRES p \ C.B.A. = 3.OACRES 642.ST If wq 388.95' LOT 18 ~l,0 ACRES C,fT.A = 2.4 ACRES F r i. / LOT 19 / 'A By 3.0 ACRES ~ Q N m C.B.A. = 21 ACRES 926.4 ® 663.71' ~ 291.23' . A. LOT 20 13 3.OACRES ti r r C.B.A. ~ 2.7 ACHES ~4"dyA L.B.O. > 926.4 r r C.B.A. = 1.9ACAES ~ 1D 71.48' 336.96' $89°34'47'W 372,54' . S LOT 22 a ® 3,0 ACHES j ~j f9 LOT 2t a 00ACPM y t~~l Uhl w 0 O Z I C.B.A - f, iG AC]7[S POLE SHED HWSE FIELD DRWE EXISTING DRIVE 24 0& 160TH A1lENUE S391 408'W 223.78 SSV14'MW E7STINGCEN7EfNa SWTHIINEOF THESWtl4,SECIMQ ` NER.s: DEVELOPERS: