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HomeMy WebLinkAbout042-1012-80-397 Wisconsin Department of Commoroe PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACI i TO PERMIT) 589735 GENERAL INFORMATION sWtc Plan ID N°' Persatol edomwam you provide may be used for secondary purposus (Privacy Law. s 15.04 (1)(m)I Permit Holi Name- City villagu luwnsh:p Parcel Tax No- Eric & Michelle Aho TOWN OF WARREN 042-1012-80-397: CST DM Llev Insp. BM Elev. BM Description: 6--4 SucunNlowNRangulMup Ni c-g , Lid GS 05.29.18.77C-72 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic T.~ 3 Benchmark C 146•7 e~g v ~.Z > At DM \ GbT 12 IIZ • /ao Aeration Bkkj. Sewer r O //C• L Holding - SUM Inlet .1~ • p ~Idl Lt TANKSETBACK INFORMATION SUHtOutlet ar 7,1 0"'/f TANK TO P! WELL BLDG. ven Air Intake ROAD Dt Inlet i \ Septic DI Bottom Dosing Header/Man. 3 ."1 97, of Aeration Dist. Pipe 3.7 "101 Holding Bot system (a PUMP/SIPHON INFORMATION Final Grade I 3 97-71 Manufacturer Demand St Coverer~ n G 9 GPM N•~1~A..~ Co D Model Number !.1• `7 4.7 o t 7J ~l~ I DH JNIL~ Friction Loss System I I 1 UI I Ft 3 9 L. d 7 / T Forcemain Length Dia. Dist. to Well r Lien, 5 95•d1 SOIL ABSORPTION SYSTEM -r 9r W.LH 0.44 112• Z T BEDRRENCH Width Length pp No. a Trenches PR DIMENSIONS Nu. Of Pits Inside Dia. 1 iemd Depth DIMENSIONS 3, 1 /Uz t.n 4j - SETBACK SYSTEM TO PIL BLDG WELL LAKEISTREAM LEACHING Manufactumr L L- INFORMATION T 01 S lem f CHAMBER OR Tit R 4j I UNIT Model Number 1.0,W4t 't0,,-.(~ 4 /rip DISTRIBUTION SYSTEM p z; } Z S 3 r Header/Mandp ri J 11 11 DisMbutan Ix Hole Size Ix Hole Spacing ven~t tQ/J Aa In e 4~ Pipe(s) / ~d r I engm _ Dia Y l ongth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over •x Depth of SeededlSaldod xx Mulcnetl FiedrTrench Center Z- 3 Bed(irenM Fdges Topsoil xx ` Yas No e5 No COMMENTS: (Include code discrepeneles, persons present, etc.) Inspection #\t/ (n) II Inspection III Location: 1132109TH ST 1.) Alt BM Description - / ti LpLIG„ O fy, 2.) Bldg sewer length = 3 3 4-10 = I- 3 n c..J - amount of cover = / 7Signalut Plan re nston Required? Yes o Z5 ((o /s Use other side for additional information. Oate IncepcCan. No. SOD-6110 (x.:1197) ry afety Courtly - , • S and Buildings Division f iv JUL C ZQ p 201 W. Washington Ave.. P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 707-7162 CROIX COUNTY ) EVELOPMEN 559735 T 8MG886RKQ7VXM Sanitary Permit Application fate "rra saction NumAer~ In accordance with SPS 38321(2), WLs. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application turns for state-owned POWTS arc submitted to roject Address (if different than mailing address) the Dcpanmcol of Safety and Professional Servms. Personal information you provide may be used for secondary purposes in acu)rdance with the Privacy Law s. 15.04 1 m Stats/_~ 7 /~l// 1. Application Information - Please Print AIM AM ti y 7~f1 ` Property Owner's Name parcel p ti'r + 'I J) t;11eL-; AI/~) G -cP~' Property Owoer's Ma ling Address Property Location Q~ 1 A/`, A 'r ^T / L'L,~; , • Govt Lot - Cr:y. State Zip Code Phone Number A/C iV ~5C Section M 7 +t~ rL T N. R /rr1Eo 11. 'T'ype of Building (check all that apply) Lot 8 - .7LX LL_ qCiV) I or 2 Famdv Dwelling Number of Bedrooms Subdivision Name 7Y Hlnck ❑ PublidCormnercial - Describe Use ❑ City of F1 SCtte-O`w~ned-(kscnbe Use ~ CSM Num~bfci / L) Village of _ 3 ' c c U~ a ✓ rr~xa~-k yC~ k 5l Town of s Ill. 'T'ype of Permit: (Check only one box on line A. Complete line B if applicable) A. New S stem /n y ❑ Replacement System 1 reatmenuffolding Tank Replacement Only ❑ Other Modification to Existing System (explore) ❑ Change of Plumber ❑ Permit Transfer to New List Previous Pemtit Number and Date Issued B. Permit Renewal U Permit Revision Before Expiation I I Owner t 1- R'. T e of POWTS Systan/C oinponenNDevice: (Check all that a 1 V Non-Pressurized In-Ground I ) Pressurized In-Ground I I AI-Gradc J Mound %24 in of suitable soil C Mound < 24 in. of su Holding Tank ❑Other Dispersal COmpunent(explain) UPretreatmentlkvice(explain) - ♦ V. Dis ersaff eatm nl Area Information: Design flow (gpd) Desgn Soil .4ppl ration Rate(gpds0 Dispersal Area Required (so Dispersfll Area Proposed ( System Flcvution y Vl. Tank Info Capacity :n Too! on f Manufacturer Gallons Gallons Units New Tanks xing tanks D G e u F. y _ /0 J SU in 5 n r:. C7 O. septic or HolmimrTvft Doang Chamber VII. Responsibility Statement- 1, the undersigned, assume r sibility for installation of the POWTS shown on the attached plans. Plumber's Name (PrinQ Plumber's Sig arctic; ,/7 MPIMPRS Number Rosiness Phone Number Plumber's Address (Street, City, State, Zip Code) VIII Count IDe artment Use Only r Approved Permit Fee Date 1 ued Issuin gent Signature Oi: roved ❑ caner canon for Denial f e~✓' 7 Cond*NWTjfA%j4j"Ressons AtafIAN,for Disapproval 1. Bapfh=tank, eAhlam ant rfisper:sal cell must all ClW.l #A ' ht.,M3Elt5 / as per maragemard plan pro neat Ify plumper. 2 AY aalbticlt qtr RIYN tM MiifdE iFaA j M Dar a coda / OfdlMrlON. Attach to complere plans for the system and submit to the County only on paper not less than 8 1.4 x t t inches in size SBD 6798 (R. I li 11) Pg of Private On-Site Wastewater Treatment System (POWTS) [LiC0 V PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner / r I /1 /I Cn C.Ile , C) la S~5 Y.. Scetion T_VN, R//'`F. or W PIN # OCity, O)Village, OTown of • • m tre- c4, r 0. re 46-, A 2" h` 1 1c~~ ' ~lI PIA e 4r V, s A a ; ~d 4-V 5~r fv //iy~ C5 ~ fhUn /U I , P /yl!'SE Pr jr7c?S~ ~ny P9_./ of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner's Name: 'll X X/ `t~//e ~7 ~ - Site address:=a/ Location: Lot /,Block Subdivision/CSM being part of the 1/4 of thc~ '/s, Section fown,~a N, Rangc/~ W. "Town of 11 ,c f C u, ) Parcel Identification N % 11'a - Design: In accordance with Department of Safety & Professional Services (SPS) Wisconsin Administrative Code ch. SPS 381 through 387 and 391. Design manual (choose one): ❑ Holding Tank Component Manual [VGR 2.0, SBD-10855-P (N. 03/07, R. 1/12)] ❑ In-ground Soil Absorption Component Manual [SBD-10705-P (N.01/01)] Contents: Page I c c x Page 2: Pi- 3: Page 4: ShLr: I Page 5: ('a/Y C_,4 -55 re r ~ Page G: CZ Page 7:-1~ /ui lt(f_K.nF/~ Page 8: 44/✓ Page 9: 27 Attachments: Plumber/Designer: Pr,171115 H c u S f~. Signcd: vo~ Credential Number: Date: _t~ Private On-Site Wastewater Treatment System (POWTS) Pg of PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner.i - - - - 711 t;' V4, `St , Section _ _ 5 T_g~N, R_ E or W PIN OCity, OVillage, OTown or _01A CC i71,/ v /V E II / y J(/ , t~ 1 j h ~K 1c~~ tf 11 /1 ! I CK~~/ 1 1 7 L dl 466) 17 Ci'(i 'S E f > I I I ~/7e I I I ~ 1- or 2- Family Dwelling In-ground Soil Absorption System (3 cell Conventional) Daily Wastewater Flow (DWF) # of bedrooms x 150 gal/day/bedroom _ gal/day Design Loading Rate (DLR) or Soil Application Rate= /J gpd/ft' (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area= DWF -gal/day . DLR gpd/ft' _ 13? ft' #Chambers= Required Distribution cell area - =a6-i.-- ft' 4 ft'/ unit EISA = y~-(. Chambers Chamber Manufacturer and Model: 1-LL2/f17r/C..- Actual Distribution cell area = Required cell area Z%, ft' + -4 ft'/ unit EISA End Cap Pair ft' Cross-Section In-ground Soil Absorption System (3-cell): 4" Schedule 40 PVC vent pipe with vent cap 1 1 ~ f 12 inches minimum r 12 inches minimum J J ~ `L!\ I ft T1 FG y C , ft T2 FG x y J~ ft T3 Final Grade (FG) inches Soil Cover inch Chamber Height Trench 1 System Elevation Trench 2 System Elevation Trench 3 System Elevation " Ji I ft ,~5 ft Trench ft Separation l,:,L, inch to limiting factor Plan View In-ground Soil Absorption System (3-cell): /r 7///" Trench 1 ft Modify header/ 5 ft I design as 1 Leaching Chambers Trench 7 needed. 4 inch Header Sch. J Trench 3 L ft with end camps Draw C for a Vent and 0 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 (COMMERCIAL) ' oc>W>a ►wa FORKI 1RMlg1 S alleneruomn - all ~ cas~av:. t ~ I as 1 Cy u ~ ~ nr PL4bFt1ERWMNG • IUI - j § PMT NQ-V42-53 YA',MX' 1 550ML -IUPE Lit W14 ion -WOK Omi71.1Wq 9 1611 T)r 5savrams wAF7 EMM tw - Muneam ^-_om, 1- Y 10 aeMm ><n t_ . amam o POLVaPLMF1L1ERCNt1F M PMTNC,- 3010.0 IAATMX-POLIPROPADE ST. CROIX COUNTY SEPTIC TANK M.AINTFNANC'E A6R1,FMI{N'I' AND OWNERSHIPCI RTIFICAHON FORM Owncr'Buyer_- ~I-i k_A~ C1 ` m Mailing Address _/~l ✓ _ ~]7 1~~L,~ t / /j] Property Address' (Verification required from Planning K /oil ing p rtment for new construction.) City 'State Parcel Identification Number~/y-~-//// - ~]&1'z LEGAL DESCRIPTION ~ / •77 Property Location 'G , ,Sec. i~ ,'I' N R /-1 W','I own of iG ~l rrC?~Z_ Subdivision Plat:_ Lot k Certified Survey Map # Volume Pare 'I, Warranty Decd M (before 2007)Volume Page Spec house ❑N esZut Lot Imes ulemiliable ❑ycs❑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 cvcrx, three year's or sooner, if needed. by it licensed pumper. What you put into the system can af*tcel the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 3183.52(l) and in Chapter I' - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County planning & Toning Department a certification form, signed by the owner and by a master plumbcr,journcymail plumber, restricted plumber or a licensed pumper verifying that (1) the ou-site wastewater disposal system is in proper operating condition and or (2) after inspection and pumping otlmcessary), the septic tank is less than 1/3 till of sludec. 1~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 Safely And Professional Services and the Deparlmonl of Natural Resource,. State of Wisconsin. Certification statinst 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 1'we certify that all statements on this form are true to the best of ins our knowledge. Itwe am are the owned s) of the property described above, by virtue of a warrant decd recorded in Register of Deeds Office. Number of bedrooms T S 6NATURE OF APPLICANT(S) DA 1Y "`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 deedd (REV. oa/12) IPOWTS OWNER'S MANUAL & MANAGEMENT PLAN paee'!L of FILE INFORMATION SYSTEM SPECIFICATIONS ~ Owner _ ? Septic Tank Capacity ❑ NA Permit 8 7 al Septic Tank Manufacturer e 1 - ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ~f p NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units r J0 "NA Pump Tank Capacity gal Z NA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow Ipeak), (Estimated x 1.51 gal/day p Pum Manufacturer 2 NA 11 Soil Application Rate o gal/day/ft° Pump Model p EI NA Influent/Effluent Quality Monthly average" Pretreatment Unit :P,1 NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (B9Da) 5220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 6150 m /L 1:1 Disinfection O Other: Pretreated Effluent Quality NA Monthly average - Manufacturer Dispersal Cell(s) Biochemical Oxygen Demand (BO Da) 530 mg/L 19 In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu1100m1 ❑ Drip-fine D Other: Maximum Effluent Particle Size %8 inch diameter • values typical tot domestic (non-commercial) wastewater and septic tank effluent. nAINTENANCE SCHEDULE • Values typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every i O months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume Inspect dispersal cell(s) At least once every ❑ months 40 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months Al year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) X NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) M NA Omer: At least once every ❑ months ❑ year(s) 9 NA Omer: At least once every ❑ months ❑ year(s) @ NA 1AINTENANCE IVST$UCTIONS: Inspections of tanks and dispersal cells shall be,made by an individual carrying one of ie following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS-Inspector, POWTS laintainer; Septage Servicing Operator. Tank inspections must include a visual inspection otthe tank(s) to identify any tissing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check x any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the ffluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of ftluent on the ground surface may indicate a failing condition and requires the immediate notification of the local ;gulatory authority. /hen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the itire contents of the tank shall be removed by a Septag&Servicing Operator and disposed of in accordance with ch. NR 13, Wisconsin Administrative Code. ie servicing-of affluent filters, mechanical or pressurized POWTS components, pretreatement components, and any :her maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. service report shall be provided to the local regulatory authority within 10 days of completion of any service event. TART UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence painting produets•or-other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high mcentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System art uo shall not occur when soil conditions are frozen at the infiltrative surface. Page of 8 wring power Outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will t discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to storing power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating.the pump >ntrols to restore normal levels within the pump tank. o not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area ithin 15 feet down slope of any mound or at-grade soil absorption area. eduction or elimination of the following from the wastewater stream may improve the performance and prolong the life the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; sinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat ;raps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. BANDONEMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to sure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative ode: • All piping to tanks and pits shall be disconnected end 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. ONTINGENCY PLAN: if the POWTS fails and cannot be repaired the following measures have been, or must be taken, 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 maybe 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 sail and site evaluation must be performed to locate a suitable replacement area. If no replacement area is avallable 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. t WARNING> > ;EPTIC, PUMP AND.OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. ANY CIRCUTANCES. )0 ER A SEPTIC, PUMP OR- OTHER TREATMENT TANK IESULOT. ERESCUE OF A PERSON FROM THE INTERIOR OF A TANKNMAY BE DIFFICULT OR MPOSSIBLE.H MAY )DITIONAL CO""""' NTS)WTS INSTALLER POWTS MAINTAINER Name Name n Phone Phone LOCAL REGULAT O RY AUTHORITY -PTAGE ERVACING OPERATOR (PUMPER) enc~y r6 r is < n Name phone' S^ ~61i.~'fro.~ Phone ,~.xa and Wbusham County'Zoning and Sanitetioh eganeba. This document meatn^* Page 4~r or 8 (ring power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid his situation have the contents of the pump tank removed by a Septage Servicing Operator prior to ;toring power to the effluent-pump or contact a Plumber or POWTS Maintainer to assist in manually operating-the pump ntrols to restore normal levels within the pump tank. not drive or park vehicles over tanks and dispersal calls. Domot drive or park over, or otherwise disturb or compact, the area :hin 15 feet down slope-of any mound or at-grade soil absorption area. duction or elimination of the following from the wastewater stream may improve the performance and prolong the life the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; ;infectants; fat; foundation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat raps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. tANDONEMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to :ure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative de: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents ofall tanks and pits shalt 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. )NTINGENCY PLAN`. if the POWTS fails and cannot be repaired the following measures have been, or must be taken, 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 replactimentarea 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 maybe installed as a last resort to replace the failed POWTS. The site has not bBen 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 EPTIC, PUMP AND:OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. 0 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY ESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.. DITIONAL COMMENTS- WTS INSTALLER POWTS MAINTAINER Name Name Phone. Phone - aTAGE SERX4CING,OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY N r (jC 1Uiri,~/ Name Agency ^5~1 " 5 Phone EE3 Phone -71 „t nrnnn Lake. Marquette and Waushata Ceuaty Zoning and Sanitation agencies. This document meets - .ar. i i.. of this document does not .b rnir ~.,.,r Ent of dn,l ~ ai 5 r'.,c : _ ✓ hd::,:.y1RMEIVED SOIL EV,vi.''J:iTION REPORT A~p 7(1~~ In actrrdanCe V.'ith PS jd~ 1'u'i9 ^idm Coo" r-0U`1'i ~1 Av L LU 51 Gt~:Y ,411x.:9 complete t, th9 61 - er rn' e'. , , ; I x i Ln>s r size Pan nI mchtde - - - u,,' not imiled !o erti~gZP~(jppViQ,Q~fi'CY!e pow• bV 1. drerli= and percent slope. part"' 1 u scale or dunens0r""" ypEt'Eet0P ante to nearest road rw 1 r 11' .10 /arneor - Ref#1» 1 Cate Please pool all information. Rc,ir' d f': F...; coal mimmabon of, p,;/,Jc may oe red N, ;era^da'y pwposes Wovacy Law s 15 0411 am!i - Prooerly Owner Property Location n E-it s Mlcnelle Rho Gov't. Lot NE V. SE v. S OS 25 e ,nu J• ; -pery Ov.ner s Mailing Andress TL_: # Block Subd 1 SM# INorthwood Dr 14 na _ _i:SM Vol _23. Pg-5566__ c; State ZiD Code Phone Number I Cdy Village Town Nearest Road oaul 111N 55105 J r651 341 8006 PJ, -ddres, bnv Construdwn use ❑ Residential ~ Number of bedrooms 4 Code derived design flow fate 600 GPD Replacefnent ❑ Public or -commercial - Desccbe Pared material al Outwasb _ -food Plan elevation if appl Carle na It ,".lest comments and recommendations Site suitable lot in-ground disperse cell r.rtti :PJ1Sq It. Ioadt9u rat= N.etun, rideL: I9Mtra7ne sjr it E '.o rE inslalied at 24" - 30" below existing grade al elevations 95 25', 0575' 8 94 `r:!' J Bonng Boring # -r - , © Pit Ground surface emv 7 3 it Depth to Iini faclor in Soil A_ppNCaw:r ha'e Hor zon Depth Dotcmant Colo Redox Oescnpuor Texture Structure Consistence Boundary Roots GPD FI' In Munsell Ou Az Cont. o'.or Gr. Sz. Sh y 0 cEff#1 I 'E'f#- _ , 1-. O -_.-IO r9+3- none Its 11 o 9__. rtd I r,- ~2fri 05 - 1 7 17 17-34 ~ 10. y5+4 I none Its I Usg nil cm f f .m 0.5 1 p 34-55 7Sy44 j nore LtsDk - sl mfr 1%fin. 04 i 07 c•w - t. 55-85 I Oyr6!8 none Ms Os- d 04 06 Boring If ❑Bonng L~ I, De G Pit Grcur:l s, ac e. 10.i It pth to limiting lector >9e""' in Soti Apphcauon Ra'_e 1c'Izon Depth Dominant Color Redox Description Texture Structure I Consistence : Boundary Roots GPD Fr - In Mansell Qu Hz Cool Colo, "r Sz. Sn. 'Eff#1 'Hrtt_ ----L. - +g ml cs 2rm1c i 0.5 _ 10 I 0-4 10yr3r4 none its.- 4.11 1Oyi44 none Its Osg mI cs 21mtc OS 1C 3 11-36 110yr r. ,one Its Qsg-- ml cw 2fmc 0_1 0 4 135-60 10+y5~4 none { fs Ng _ ml gs 1 0.5 1 L0 5 60-96 10yr64 _-I none- s _ 0sg ml dl _ 07 16 Ef""tent 91 - BOD. > 30 s 220 and TSS > 30:; 15O Ing L ' Effluent #2 = BOD,, > 30 s 220 mg;L and TSS > 30s '50 I m1L C31 Name (Please Print) Signature `r- CST Number Y y-- tames K Thompson e _ - __43rnP4 ; - 3002• Address *~Dale Eraluahor• Conduc,eo ' Teiephone Nombe, . .11 AL'il I .ilt 340 Pa.115cr .Ake _ dntt ill e -Y•..... - - 1 ~4,o,- R1 a•aU'td surfai ve: 96 49 ft Dep'.n to ImiSinq 1 ar s n Sod Appncation Rate Horizon Dep h Dominant cnlnr Rector r.eunplon texture Structure Consistence Boundary Roots I GPD f In btdrsel Cu Az Cont. Color Gr Sz Sin li •FlIal -Ef71Y2 1's 05,- ml cs 2fmlc 05 to 2 ~ _ 1 Or 4 4 none _ Wane Rs Osg ! ml gw i 2fmc 0 S _ 10 24-66 IOry5.4 none Ifs Osg Ina cs 1fm O S 1 0 4 1 i'5yr44 none ne -sl Imsnk mfr ~ 74 107 l 4 1 Boring # H Boring l Pit Ground surface ele•: 48 71 0 Depth to limiting factor >88•• in 1 Son Application Rate _ Depth Dominant Color Redox Description Te.ture Structure Consistence Boundary Roots GPO Fi Horizon In Munsell Co 1z Cont „o o G Sz S.11 EfMt - I +04 1Dyr,14 none s Dv; I ml es I -1iIc _0.5 1 0 2 4-18 101v-4 none Ifs Oso m! gv 2fmc 05 1 0 3 1836 10vr44 - none I Its Osg m! gs 2fmlc 05 _.i 1.0 4 36-60 Y toy 6A - none- - - Is Os9 ml 5-_-_-- Ifmc--~ 0.7 1.5-- ! Y 9 ~ 5 60-88 10 r54 1 none NIS Osg inl trill 04 0.6 i poling A poling [1 Pit Ground surface elev it Oepth to fimding factor in. Soil Application Rate T _ I Horizon ' Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rouls GPD Ft r ~ i In. Munsel: I Cu Az Cort C D!01 Gr Sz. Sh - Eft#t Eff#2 Effluent #1 = BOO. > 30 s 220 mgrL and TSS > 3C < 150 MC L ' Effluent #2 = BCD, > 30 s 220 mi and TSS > 30 s 150 mgrL Soil Application Rate l iorizoo Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/FT In Muasell Qu. Az Cunt. Color Gr. Sz. Sh 'Eff#1 •E'f#2 1 0-4 10yr3!4 acne Its Osg ml a 21m1c.05 10 2 4-11 10yr4/4 none its Osg all os 2fmlc0.5 1.0 3 11-3610yr5/4 none Its Osg all cw 21mc 0.5 1.U 4 36-6010ry5!4 none is Osg all gs - 0.5 1.0 5 60 96 10yr6/4 none s Osg ml dl O ! ' 8 ' affluent #1 - BOD, > 30 s 220 mg/,. and TSS 33 s 15C mg!I 'Effluent #2 = BDD, : 30 s 220 mgtL arc -SS > 30 5 150 mgrs.. ST Number CST Name !Please Pnntj Signature r3CC2 James K. Thompscn 1Address Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola. WI 540205413 April 15. 2016 SBD-8330 (RC4/151 3 Bonng # Boring Pit Ground surface elev. 96_4e It Depth tc '.rniting factor 187 in Sad Appl-caPen Rase Horizon Depth Dominant COOr Redox Desorption Texture Structure Consistence Boundary Roots GpD!Ft' In. Munsed Qu Az Cant Color Or Sz Sh. 'Eff#1 'Eff#2 1 04 10yr3/4 none Its 069 all cs 21m1c0.s 10 2 4-24 1Ory414 none IN Osg all Ow 21mc 0.5 10 3 2480 1Ory5/4 none Its Osg m! cs I'm 05 I c 4 66-87 75Lr414 none sl 1msbk rnfr - - 04 07 I 4 Boring # ^ 1.~ Boring P't Ground surface elev 98 21 It Depth to limiting factor >88' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft' In Munsell Qu Az Cont. Color Or Sz. Sh 'Eff#1 'Eff#2 1 04 10yr3/4 none its Osg all cs 21m1c 0.5 1.0 2 4-18 10ry4/4 none Its Osg all gw 2fmc 0 5 1.0 3 18-3610yr4!4 none its Osg all gs 2fmlc 0.5 10 4 366010yr5/4 none Is 0sg all gs 11mc 0.7 1.6 5 6043810yr514 none Ivfs Osg ml - 1tm 0.4 0.6 i ~G~,3 kng y~G rlt U<✓ 1 I) SC4/C i °✓D ~ ~rE'~ral w`f. Y tiv ,•Y$s' S6. Pict u.( irtn. 5S/may Oc 0/.z "3e - -31 I r ; / , Q.. n uJad/o.d L'~4,Y L~+ b~; ld~~ 5,'tt L, c L i ~ lap a~ j/t/ Stl. ti0 pu,C. prp~, s u J9 zo~3 2110 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 4 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm Code A C-E. Sod 8 Site Evaluations Attach compete sde flan on paper not less than 8%x 11 inches in we Plan must County St. Croix include, W not limited b- vertical and horizpxal reference point (BM), direction and Parcel I.O. - - , f percent slope, scale or dinlertsrers, with arrow, and location and distance to nearest mad. from 042-1012-80-395 - - Please print all information. Reviewed B/ i Date - Pai9Ma mkvmeli0n Yeti Drm'de maY Oe usoo y -aw. s. 1501:11 imll , . . i Property Owner Property Location White Pine, Inc - H Fogelberg ULT fl} U Gal Let NE 1/4 SF 1/4 S 5 i 29 NR Ix W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 400 South Second Street 4 e "1 -11 one 14 Proposed CSM From CSM 22/5375 ty State Zip CoHdNPh 4umbar - City Village 'Town- - Nearest Road Hudson WI 54016 715386-8236 Warren 109Th St ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or oommeroal - Describe: Parent material Glacial till Flood plain elevation. A applicable Na General comments and recommendations' Evaluation completed to facilitate creation of 3 lot CSM from existing lot 12. CSM vol. 22, Pg. 5375, See memo page for system design and installation considerations. ❑ Boring # Boring ✓ Pit Ground Surface elev 98.82 it Depth to limiting factor >80in Soil Appirauon Rate Horizon Depth Dominant Color Redox Desaiptbn Texture Struck" Consistence Boundary Roots GPD•1v _ in. Munsell Qu. Sr Cont. Calm Gr Sz. Sa 'Eff#1 - -ENN2 1 04 10yr3/3 none sl 2msbk mvfr cs 2fm,1c 0.6 1.0 2 1 4-24 10yr4/6 none its 0 mvfr cvv 2fmc 0.5 1-0 3 24-52 7-5yr4/4 none scl 2fsbk mfr cvV 1fm 04 06 4 52-80 7.5yr4/4 none sl 1csbk dsh - ffm 0.4 0.7 i Boring # Boring ✓ Pit Ground Surface elev 95.92 m. Depth to limiting factor >84 in Sill Applratan Rate Horizon Depth Donwvd Color Redox Description Texture Structure ,Consistence Boundary Rods GPDi1N in. tAunsen a. Sr. Cod Color Gr Sz. Sri 'Efflil 'Eff#2 1 04 10yr3/3 crone sl 2msbk mvfr cs 2fm,tc 0 1.0 _ -c ~ 2 4-26 1 r4/6 none Its 0 mvfr 0 5 5 - 1 0 3 26-50 7-5yr4/4 none sl 1fsbk mfr cw 1fm 0.4 0.6 4 50-84 7.5yr4/4 none sl 1csbk mill - j tfm 0.4 0.7 I I Effluent #1 = BODS> 30 < 220 mWL and TSS >30 <.150 mg/L Effluent 02 = 8005 130 mg/L and TSS <-30 mg/L CST Name (Please Pnnll Sig IV CST Number r r/r<-1 Address A C E SoilB Site Evaluations - r Date Evaluation Conducted Telephone Number 2/12/2D08 Property Owner White Pine, Inc. - H. Fogelberg Parcel ID 0 from 042-1012-80-3.95 Page 2__of -4 Boring 0 Boring ✓ Pit Ground Surface elev 104.30. ft. Depth to limiting factor >91" - In Sox Applkatan Ratc Horizon Dept DonwramColor RedoxDescnow texture Structure Consistence Bouncary Roots GPDT Munsell Du. Sz. Cora Color Gr Sz Sh 'ERkt 'ERM2 1 0-4 10yr313 none at 2fsbk mvfr GS 2f,1mc 0.6 1.0 27 4-14 1Gyr314 none sl 2fsbk mvfr cW 2fmc 06 1.0 3 14-52 7-5yr4/4 none sG 2fsbk mfr cW 2f,1m 0-4 0.6 4 52-70 7.5yr3l4 none sI Icsbk mfi gi tfm 0.4 0.7 5 70-91 7.5yr3l4 none sl Om mfi tfm 0.2 06 Boring 0 Boring PR Ground Surface elev R. Depth to limiting factor in. Spit Apyxalan Rate Horizon Depth Dominant Color Redox Ceson{tion Texture Stature Colsswnce Boundary Roos _ GPD1t' in. Mansell Ou Sr. Gait Cola G( . St. Sh. 'ERA'1 'ER02 ❑ Boring 0 Boring Pit Ground Surface elev. R. Depth to limiting factor in. Sob Apotcalion Rafe Horizon Depth Dominanl Color Redox Description Texture Structure Corsater of Boundary Rods GPDN in. Mursell Du. Sz. Cant Color Gr. Sz. Sh. 'Etfpt 'EfT02 I 1. ' - - 'Effluent Ot = BODE' 30 < 220 mg1L and TSS s30 150 mgA. ' Effluent 02 = BODS j i.30 m9A_ and TSS < 30 mg/L The Department of Commerce is an equal )pprmunitN +cn ice provider and empluycr. It'you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or 1'IY 6118.261-8777. sari-x~rorx ullxn Act. Soil 6 Sltr fwhMVn Page 3 of a PROPERTY OWNER: N'hncl'ine, lnc.-li.lgGdhcrg SOIL AND SITE EVALUATION 2110 ' PARCEL LD.0 Irwu Og 1-1012_-x0.295 A ('.I`. SmI a Site Lvalu Il , REPORT MEMO Soil evaluation completed for subdivision creation. Dense tree cover limits ability to explore soil conditions throughout parcel. Further soil testing after building site is established and cleared may result in more suitable system area Soil conditions appear to be very uniform throughout immediate area. Soil in lower horizon approaching massive. Recommend designing system with 0.3 gpd/sq ft loading rate and utilizing pressurized effluent distribution or installing aeration treatment unit- An at-grade or mound system may be a better installation on this site for long term system operation and life expectancy. - j1 //cC /3 0 Jo;! FvU/u4fion /,,1£ lot \ C'SM Z2~S3~ . - l1S Ca/ i 5ca/e cc )A.6e, ~ne-r-:,c. °Fr szd /CC/S/a-/fCc;CSr7 //EYySC/P 'y Sec. 5, r2Y/f. e.lgco. " , 7n. er' -S fl eq v,7y c(; eSe/+c✓ ~Ofw ,9igrS Yc.c' _ (37. YXO" ~,p ( t 22 ! he4 ui ly wCCa'ty JUP', o - ~ ,y ~ G `I` 1`/!~ SIB 4/iN 63 14L; (7 sL/ Y ~ h3 , u- BenchiyA. C!:7ojo oe' 316 ' /c 6a Asskmcd c!.ea` /eV.60' ,c ;ot /S Parcel 042-1012-80-397 ';1, " PAGE I. Or AIL Parcel 05,29.18 77C-72 042 - 10':'L'N 01- V:n tllt Current X ST RC IX COUNTY ^,i SC. NSI% Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type is of Units 09/19/2008 00 0 Tax Address: Owner(s): , O - EVERSON, RANDY C RANDY C EVERSON 385 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Type Dist # Description ' 1132 109111 Si SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC i i Legal Description: Acres: 5.9130 Plat: 5566-CSM 23-5566 [;42-20%P SEC 5 T29N R18W PT NE SE AND BEING PT BlocklCondo Bldg: -01 '4 LOT 12 CSM 22-5375---BEING LOT 14 CSM 23-5566 Tract(s): (Sec-Twn-Rne, 40114 IF. C: 1!41 05-29N-18''4 NE SL Notes: Parcel History: Date Doc # Vol/Page Ty1.c 11/04/2005 906456 . 11/04/2009 906454 09719/2008 881655 23+5566 Saa 03/22i2OO7 84(3986 22/5375 CS'.1 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: O&O&2) '0 Description Class Acres Land Improve Total Stale Reason RESIDENTIAL G1 5.900 55.200 0 Lb 2,"U 11, Totals for 2013: General Property 5-900 55.200 0 59.200 Woodland 0-000 0 0 Totals for 2012: General Property 5.900 55.200 0 65.26 Woodland 0,000 0 C Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges DeBnyuent Chnrgc :r r i; Total 0 00 J co