Loading...
HomeMy WebLinkAbout022-1075-60-045 F nty: St. Croix Safety Wisconsin and Building Department of Division it Commerce PRIVATE SEWAGE SYSTEM ary Permit No: 589747 GENERAL INFORMATION INSPECTION REPORT (ATTACH TO PERMIT) te Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Parcel Tax No: City Village Township 022-1075-60-045 Permit Holder's Name: Campbell Rev. Trust (Connie) TOWN OF KINNICKINNIC Section/Town/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: 27.28.1 8.420A-1 6 TANK INFORMATION ELEVATION DATA BS HI FS ELEV. MANUFACTURER CAPACITY g TYPE Septic Dosing Aeration Holding St/Ht Outlet RMATION TANK SETBACK INFO TANK TO PT WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic Header/Man. Dosing Dist. Pipe Aeration Bot. System Holding Final Grade PUMP/SIPHON INFORMATION Demand St Cover Manufacturer GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width Length No. Of Trenches DIMENSIONS P/L BLDG WELL LAKE/STREAM LEACHING =Manufacturer: SETBACK SYSTEM TO CHAMBER OR INFORMATION Type of System: UNIT Model Number: DISTRIBUTION SYSTEM x Hole Spacing Vent to Air Intake Header/Manifold Distribution x Hole Size Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-GradexSSeed d SOod ly xx Mulched Depth Over xx Depth of Depth Over Topsoil es No Yes No Bed/Trench Center Bed/Trench Edges Ins ection #1: Inspection #2: COMMENTS: (Include code discrepencies, persons present, etc.) P Location: 1297 EVERGREEN DR 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. - Cert. No. Date Insepctor's Signature SBD-6710 (R.3197) %0 &W I V Ems County Safety and Buildings Divisioncr JUL a 2016 201 W. Washingt Ave_, P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, A] ST. CROIX COUNTY MMUNITY DEVELOPMENT Z RLD -7#7 PQCERS02JDCA State Transaction_'umber Sanitary Permit Application i In accordance with SPS 38321(2), Wis. Adm. Code, submission of this fomt to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you prDepy be used for secondary urposes in accordance with the Privacy Law, s. I5.0<4(1)(m), Slats. j~~,7 S7, d 1. Application Information - Please Print All Information h K Property Owners Name Parcel Propcrtv Okvner s Mailing Addrers*s^ / Property Location D J Y. 1 M.O A - 1W La4 41 Govt. Lot City, State J Zip Code Phone Number section . 2 7 ~ / / ° 1'k) (circle one T N. R E Rr II. Type of Building (check all that apply) Lot.' OT or 2 Family Dwelling-Number of Bedrooms Subdivision Name OIL. b Block E] r Public/Cotnincrcial - Describe Use a. {+,n/~' ~ ~cJ~~ CSM Number El ❑ City Village of of El State Owned -Describe Use _ y 2 1~ic" t~ 17 -7 6 ' wnof~~j/IiCF III. Type of Permit: (Check only one bo on line A. Complete line B if applicable) A. Pew System ❑ Replacement System ❑ TreatmenUTrolding Tank Replacement Only ❑ Other Modification to Existing System (explain B• El Permit Renewal El Permit Revision ❑ Change of Plurnh- 1 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner LA W. Type of POWTS System/Component/Device: (Check all ti' t apply) 0-7 4b I on-Pressurized In-Ground 0_ Pressurized In-Ground 11 At-Grade ❑ Mound > 24 in. of suitable soil 11 Mound < 24 in. of suitable soil I ❑ Hofdinq Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rate epdsf) Dispersal Area Required (sf) Dispersal Area Pro d (sf) yst Ele lion NIL Tank Info Capacity in Total T of Manufacturer Gallons Gallons Units c w~~ L v v \en• Tanks Existing Tarts r _ i hf ~~L ) Z , v V) Septi or Holding Tank f Dosing Chamber I I l I VII. Responsibility Statement- 1, the undersigned, as m responsib' if for installation of the POWTS shown on the attached plans. P nber's Name (Print) Plumb -s S ~ c MP/MPRS Number Business Phone Number "T7 14- i% Plumber's Address (Street, City, State, Zip Code) Lam_ VUL ounty/De artment Use Only Approved ❑ Permit Fee Date sued Issuing ent Signature ED] caner - en Reason for D ial S Q~~ I ~Q I IX. Condt;BVOWE 4 WW[Reasons for Disapproval 1 /AU* 1 V00 tank, of uwd titter end a~hapertsai ce must all be servicas !_maip_t,,'rec' •aspper,mpnagement plan pronded by plumber. Ga dl +q,. .~O 2 - : krseWOements must be maintzir;edi as per apple" code / erdinanoea. / Attach to complete plans for the system and submit to the County only an paper not less than 3 is x I I inches in size SBD-6398 (R. 11/11) fr rO0 PIC'4% y Plot Plan Pa e,plo Properly Owner T 0 c7 „ t C 6;~+ Vt jC>4Si ~ Legal Description -A~ 4. _ (except where noted) Backhoe pit oU v. Df r,~ o-~ ! I/v North a F i -1f;N /0 C2'1 O l E1 sC _ Rib si. i 3 ~I 7 ~o~~~ Lam!-~or~ ' I i 1 n J Site Location: ' ~~C0 P U PAGE 1 OF In-Ground Gravity Plan J Index & Cover Sheet Component Manual Design References- Version 2.0, SBD-10705-P (N.01/01, R. 10!12) Pg I of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: tEnic osures: T ank Specs Net- TS Application for Review Filter Specs PL zz valuation Report & Site Map r~ EA, I ,eEAA Project Name / Description Owener Name(s): (,tf0Fr3EL ~ VCCA 13~ ~~.~c ST" Phone: Owner Address: _W/1 0 It ~t~~y U~ ~'tl t .Mn~ Zip; Project Address: z«p L t fZ~~1~ tZt Ut✓ ~ t tt t"=~ ~h t~~ Govt. Lot: .~e 1/4 of Ajj5- 1/4, Section i T a N-R ! S' E❑ or W Township: ~ iti~; t~ K i:~lU t Caun : - 3T. Cam.` t Project Parcel ID Designer Information Designer Name: {a rc l j Phone: Designer Address:yKj7 tu7 Ct A tlt€ t ti~ E-mail: ~ Zip: tit, f cc'K. CCU NN,` ,``~Zt t t t t N! N t t; t; rt~ii,, License Number: l CC '7 Remarks: ~ ••MARJO ~ I HUPPERT D 1859 sRIVER FALLS ~ ~ : k s W1 Signature: ( t°t t' Date. Origin ignature required on h submitted copy. M f T i i c Plot Plan Page olqf-~ Property Owner (cASt 4-ar) 40ft. Legal Description (except where noted) - I . Backhoe pit North LINE ti I qZ- to I,5 r ~ 1 ' R~!5 4 q) a o ~J k tl 0,x.1 q~„ I> 1 U ; f lip uT TK i0c >i M.~.~ - 1 .~°raSoy~ G-cnrrr3D n , Site Location: .~C• ~'X Srre U~ PAGE 3OF4 U ~ Z o v~ W U 70 O m QJ Q O O_ c UO m Z _ _ o m > = N c F a } c 70 J- Q Q U 20 ~W oa c vW a .0 ~Q y 11 E ~ 7t ro n Q?) N m W LZ a~ 0- Q d ^ m N -p ca to 0~ maE~ m = ti!1 Al E m LL W a I 4 c~ ° 0 = O ~u \ I (n a N o Z Z cs: ( U co W o ( '2 Q W O 3 I,I 1 Q to _U~ Z > N W a c 0 Q4 o I ~i ) O o ~l a a= o Q U ~ c a r- a) a p a I T3C)- to ~ j Q a > s. CL ° I 4- ry 4-1 v C w U) CL -t v a I I cf) 0 C) 'N I I II u n 11 x o ~ I E- - j m n a F 3 a 3 i a w rn v I Q co E 0 U as U ~ ~ t Z N CL w E z~~ ~ f a l W c~ o L- m a CL > -0 S2 0- 1 © W T I I W 0 11 I7 2 U Y L_ 1 ~ ~ 3 wI J ~c ~ Imo, ~ ~ L of In-ground Gravity Management Plan PAGE 4 4 MPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Fullhermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dislaersai Area Operating Limits: Design Flow gpd, 130135 5 220 m L'• TSS 9 150 tngL-1; FOG < 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served f Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Seotlc and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. i I t System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Deport any component failure or malfunction to_ I Dame of individual or company: ( ACTEje S t t,l iili~~ E,/1 ! Phone: 75- ~7Z--5~5,34, Local government unit: ST, Phone: Local government unit address: t4 u O SOAJ t Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1); Wisc. Admin_ f Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in I accordance with SPS 384, Wisc. Admin. Code. i Contingency Plan I In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal abandoned and replaced by a code-complying dispersal component in a pre-determined area of sui able soils. may be ~ysterri ~4bandoni~ertt if use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. € 1 E i ATI~VWAVIT ti N U yt oow°i \ iL N l Ull~ C'" U O U C) I/ \ 0 0O I W ui -1 CL a vo UQ Z 0 U V v° W O Q \ Q W W 6- 00 ~px \`y\ OU= 00Q- / OIL of Cn Z X p ct~ E! W CV r h I N m w 00 V ti 4- r C'7 7~ffl cn G 0, \0 ' U, ~ ~k -I F - i_ ¢ Q JM JCJ C\i _ _ z0 o to q CN M f- U tij ~I t CL d o° I- ~o i ~%0 LO Lc Z U O I ( e- N W QD O Q - o o Q CO C) LU r ° ° o J Cr Cif LLI w Q I° o Q Z _Z _ O O W g I ~ LO U F- Z I~ o o W cc LU LL C) 221 LL. w U) Q G o t~t iZ:) ~ Z ~o _7 I - W cfl I- I LL) o w Cl) CN C) N N ~ o ~ o 0 tiw W M , Z) -j C13 (6 o o W O c -4 -i w a- i i z~ y, ,7Tt1+N 1 0 Cl C/) LLJ i i o m 1 w i" M o a- co Z C) C6 E- \ v m r w C) ~ (D - - GV j 1 1-- z O N ui W c-) t-J ONLYREMOYF NDENTED l_J O C5 O U-i =D fl- cl~ O FL.11PNIEL N+O FOUR CV N I . F~ i TngS Lf~ ems. `MIEN INSTNIJNG Lu n- LCD -~r CV MULTI FILTERS (y' I O ~ `~~l 0 0 I C ~ v m m m m FOR MULTI FILTER INST.YLATION 1. CUT OUT MD REMOVE j THE FLON'PPNEL 2 'UNCN OUT THE FOUR - SLIDE S SNG HOUSINGS i,. i TOGETHER 1Q POLYLOKI F,wTeo.xlu TEL 1$77-765-9565 MODEL NO. PL422 CID (NSF) W 5 w I ANSI /NSF i STANDARD 46 U Lo F- usoaeTS V.1,[M m i i i z e41~S7 N Q e2 N Ckf 07<EROUSS o ~ oo u- I I ~ j N ~ I I O (D Z~ W w C) C> LLJ I ~ <Cr 1- om I` d_F- mC,4 W V S 0- 1 0- O 1 f; J z I ~ - I • , v ; -o-4 z : ' to .,~y - - ~ d =,.ate.- '~s -r' The Quick4- Standard Chamber fits in a 36" wide trench and is ideal for curved or straight systems- It features the patent-pending Contour Swivel Connection' which permits turns up to 15". right or left. The MultiPort endcap allows a multiple piping options and eliminates pipe fittings. The chamber's four-foot length provides optimal installation x ' 4ryQ flexibility. • Advanced contouring connections swivel up to 15°, , IN right or left • Latching mechanism allows for quick installation ; u • Four-foot chambers are easy to handle and install The Quick4 Standard Chamber supports wheel loads of i 16,000 lbs/axle with only 12" of cover 4 Certified by the International Association 1AP/6 0 ` of Plumbing and Mechanical Officials (IAPMO) ar rye Tear-out seals on inlet ports provide a tight fit to the pipe - • Eight molded-in inlets/outlets allow - for maximum piping flexibility r._. • Eliminates pipe fittings Fits on either end of the Ouick4 Standard Chamber APPROVED in CA Al P ELL- Quick4 Standard Chamber 48" - (EFFECTIVE LENGTH) MuitiPort EndCap ( 34- FRONT VIEW SIDE VIEW TOP VIEW r Typical Trench View INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED WARRANTY (a1 The structural integrity of each chamber. endcap and other accessory manufactured by Infiltrator (-Units'), when installed and operated in a leachtield of an onsite septic system in NATIVE 8ACKF1LL TOPSOIL accordance with Infiltrator's instructions, is :warranted to the original purchaser 1-Holder-) against defective materials and workmanship tot one year from the date that the septic permit is issued for the septic system containing the Units: provided, however, that if a septic permit is not required by / COVER 8Y applicable law. the warranty period %AB begin upon the date that installation of the septic system DESIGN commences. To exercise its warranty rights. Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook. Connectcut within fifteen (15) days of the alleged defect. Infiltrator 12- 12- trill supply replacement Units for Units determined by Infiltrator to be covered by this Limited Ir INVERT Warranty. Infiltrator's liability specifically excludes the cost of removal and'cr installation of the Units. 1_34--f--SPACING PER CODE-- ---3.1" (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH tai ARE EXCLUSIVE. 76 v m[ tae xtn THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS. INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE Icy This Limited Warranty shall be voad it any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential. special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages. Size 34"W x 53"L x 12"H including loss of production and profits. labor and materials. overhead costs. or other losses or (864 mm x 1346 mm x 305 mm) expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear. alteration. accident. nsuse. Effective Length 48" (1219 mm) abuse or neglect of the Units: the Units being subjected to vehicle traffic or other conditions which {p are not permitted by the installation instructions; failure to maintain the minimum ground covers [ " set forth in the installation instructions: the placement of improper materials into the system Louver Height 8 (203 mm) containing the Units: failure of the Units or the septic system due to improper siting or improper I Storage Capacity 43 gal (163 L) sizing. excessive water usage. improper grease disposal. or improper operation: or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holler fails to comply Ei Invert Height 8" (203 mm) (with all of the terms set forth in this Limited Warranty. Further. in no event shall Infiltrator be t responsible for any loss or damage to the Holder, the Units. or any third parr] resulting from installation or shipment. or from any product liability claims of Holder or any third party. For this r Limited Warranty to appty, the Units must be installed in accordance v+ilh all site conditions required by state and local codes: all other applicable laws: and Infiltrator's installation instructions. (dl No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party, other than the original Holder. j The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of 4 business Park Road states and counties have different warranly requirements. Any purchaser of Units should contact P.O. Box 768 Infiltrator's Corporate Headquarters in Ofd Saybrook. Connecticut, prior to such purchase. to Old 57777--7,000 -F 00 - Fa. x 860-577-7001 -3,4-brook. CT 860-41 obtain a copy of the applicable warranty, and should carefully read that warranty prior to the - i 1.800.221-4436 purchase of Units. www.intiltratorwater.com U.S. Patent,_! 4.759-601: S,Ot?.011. 5.1 56.4a8" 5.336.017: 5,401.116.5.401.459 5.511.903:5.716.163: 5.568.778:5.839,844 Canadian Patents: 1.329.959: 2.004.564 Other patents pending. Infttmtor. Equalizer. Uuick4. and Sidewinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Conlow. MicroLeaching. Poty ruff. Chamber pacer. MultiPon. PosiLock. Ot ickCut. OuickPlay. Snapluxk and Straighilock are Vadermiks of Infiltrator Water Technologies- PotyLok is a trademark of PotyLok, tnc. TUF-TITE is a registered trademark of TUF-TTTE. INC. Uhra-Rib is a trademark of IPIX Inc. S- 2013 Infiltrator Water Technologies. LLC. All rights rese *d. Printed in u.S.A. 0250813 0 > >W x Q~ I I J W LL 1 N uj 'a z CD u, Z I OI Y ?m < a I- Q ~ co I ~IOO oF.2 R g -1 m wo Zw z ~ z I <Iz o 9~~ Q ~J LL F- _l1 w~ ~ t I y 20 ~Z 5~W W I I H p ZW 1W- OV yZKW Q Z Z t w Q~U~eW cZ~ W QIIZLL LLl Q¢ I m`~ J~Q ow I I yZ« r, LLWT <4z~~~ O Z I I W~~J s m= w~yF, =4Q_W. _ D J _Z a aJaH E C F O K ~O ~C9 C. G Q I + cote Z?.y d O t I~~ W~¢w hD Q = wa ~t>~i~~ ! a W oZ ~ vj 1\1 eEC WO2L) 5g Z 3 U) Z I t 2?~, I i Zw c ~U IU- 'L LL Q I I COQ8 \ ~O OO tns~ i. mW w U- am: I0~~ t g~~ ° m ~L W o I t < N rn o w I I m~Zy zV co -i W I I w J w MCA "I I I ~ Z)z t W LLJ 4) > CS K I W C I a-..) Q LL yV~IL.~ y tar N I?? w I N Q N 5 ~i : j W F H I fn ~ Wa a, k I mw a w a- Q: N ~ tq~} N Q Q [9 WOW C7 ¢z~xa c~ m H _ Nw~ Q-mglh jx ~j ~ S ° cc R Z a 4/l L4 66 w6/L Lip b co HIGIM 3W0H ~Z-,9L is z m ~ as,~3 a s i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,c-u- Rc-yoe46- Mailing Address GT14b/~L)Ay TZMb L e44 A`W , Property Address 1 Z q l E V~pC~2~E1U (Verification required from Planning & Zoning Department for new struction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location -ZI- y4 , A)6 1/4 Sec. .Z7 , T ZS N R 1 W Town of I lil~r l ~1~1Y Subdivision Plat: ,Lot# Certified Survey Map # Volume - Page # Warranty Deed # (before 2007)Volume Page # Spec house Dyes) n0 Lot lines identifiable ~fvesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on th' form are true to the best of my/our knowledge. Uwe described above, by virtue of a wa anty deed recorded in Register of Deeds Office. am/are the owner(s) of the Number of bedroo s SIGNATURE O APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) OTP w 16,ji I& . bcifh 11 i ~ ifs tK ~ - W ~ L rM7s I SR i _ r - - © Umrrv I0l o - - r - - T.. _ 1 `M NITCHEN_,_,_ BEDROOM •c ® -I MASTER - 1_ - LIVING #3 BA BEDROOM III BEDROOM _f _ ROOM T8"xit'o' BATHZ #2 MASTER 12'-2" x 14'-5' ' 4 I 14'-5' x 94'-6' T-8' x t4'-5' N - BATH - - _ DINING rr 1 fl [r'1 p - p.~gSTER 16'x 76' BATH 'R~j`] BATH c 15 2 I -1 7 • O nxrrv i aulrRn " n+ OPTIONAL SERENITY I OPTIONAL MASTER BATE s y - - BED OM s" B MASTER 91-8. x ne BEDROOM #2 11"E' N LIVING S BEDROOM eATH z BpOOM MASTER orao 1 T-T' X 14'-6' IV-,e x 14'-6' BATH MASTER N BATH - ® DINING COWiER - NDRY - - 15.5" x 5-1' I r TUB A N , opr II } 5 I DRV I ~ OPT. MASTER BATH i I i 16 Wisconsin Department of Safety d Professional Services Division of Industry '{rv SSWG 1 o' cl ~ SOIL -E'VAL{UXATION REPORT 1 9e of in accordance with SPS 383, Wis. Adm. Code Attach complef6 site ply _~m' s than 8 1/2 x 11 inches in size. Plan must County ST. CROIX include, but ,®F% zontal reference point (BM), direction and percent slop~'dM~rQwons, north arrow, and location and distance to nearest road. Parcel I. pM 0 2 - 1075 - 60 - 045 Please print all information. Revi d by Personal information you provide may be used for secondary purposes (Privacy Date Law. s 15.04 (1) (m)) 7 Property Owner CAMPBELL REVOCABLE TRUST Property Location Property Owner's Mailing Address Govt. Lot SE 1/4 NE 114 S 27 T 28 N R 18 E (or) W Lo Block # Subd. Name o CSM# 6096 Otherday Road 6 City State Zip Code Phone Number CSM 26-5989 tiVelch, MN 55089 ( ) itY Village Town Nearest Road Evergreen Drive n New Construction Useo Residential / Number of bedrooms Replacement Code derived design flow rate 450 ❑ Public or commercial -Describe: GPD Parent material sandy General comments Flood Plain elevation if applicable NA ft. and recommendations: Conventional hi-ground trenches 0.7 loading rate Design of system is to be completed before permits are obtained. Property address: 1297 Evergreen Drive 26A , Boring # ❑ Boring r a Pit Ground surface elev. 98.78 ft. Depth to limiting factor >96 in. A. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundar Roots Soil A lication Rate in. Munsell Qu. Sz. Cont. Color y GPD/ft Gr. Sz. Sh. I 0-13 7.5YR2.5l2 `EfF#1 `Eff#2 sl 2fgr&sbk ds 0.6 1.0 13-23 cs h-f-m 7.5YR1 '3 sl i f-mmsbk mvfr cs 1 of-co 0.4 0.7 23-31 7SYR3!2 is lmsbk mvfr gs 1Nf-m 0.7 1.6 4 31-96 7SYR4i6 s Os~ dl 0.7 1.6 r Boring # ❑ Boring Pit Ground surface elev. 98.63 >9O ------_ft Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A lication Rate in. Munsell Qu. Sz. Cont. Color GPDlft Gr. Sz. Sh. I 0-15 7.5YR2.5!2 - `Eff#1 *Eff#2 sl 2fgr&sbk mvfr cs 2vf-m 0.6 1.0 2 15-34 7.5 YR3 i3 sl 1 f-msbk mvfr gs I of--f 0.4 0.7 3 34-90 7.5YR4i6 s Osg dl 0.7 1.6 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:S 150 m /L CST Name (Please Print) - g Effluent #2 = BO 5 < 30 m /L and TSS < 30 mglL MARY JO HUPPERT Hollister's Soil Testing&Design sl f e G %~l CST Number Address Date Ev I "ation Conducted ~~4832 28497 King Arthur's Court. Danbury, XVI 54830 Telephone Number 05-25-2016 715-426-1775 SBD-i 330 (R0 7 13 ) Sao-~??u~ko'1;~ Property Owner Campbell Ti-List Parcel ID # 022 - 1075 - 60 - 045 Page of F 3Boring #,Boring >100 Pit Ground surface elev. 103. }8 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-12 7.5YR2.5/2 sl 2fgr&sbk ds Cs h-f-m 0.6 1.0 2 12-20 7.5YR3!3 sl If-msbk mvfr Cs Ivf-m 0.4 0.7 3 20-100 7.5YR4/6 s Os- dl 0.7 1.6 Boring # Boring n pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODL < 30 mg/L and TSS < 30 mg/L Plot Plata Page -3o J---3 Property LegOwner l " = 40ft al Description .A PL. jj, -,ftE A of (except where noted s ~7z " ) G'' r~'wA n'~~s~s`r'snltc sT c ct Q=Backhoepit ,G R-o-W LW E &-VEKc-P-.FEW DR. North F lfa ®o - - a ' s Nn ~ ~ ~ N ~'nSNO s q~, is I 'Ac, a- I X PRe tae rEO~ 3 g~nRoaM DW~i_Lfa~}~ g(FTVC,,A c~ St9~N6 t3M l ' i ~R®un2D oN .~D .`i4 ~6ou~ - ~~SU,M~~ !Cl?.C1C S}i~D Site Location: St to R , +tk . k d' xww~ w « wx , Y 4 "Arm W, J ` ~~rs M b E ~ inF x- ° MIS 3 l O m u Nor d` •Y.*' 4- to r f! w a ~ o « .aF c'R