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HomeMy WebLinkAbout032-2176-09-000 Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County: St. Croix INSPECTION REPORT Sanitary Permit No. GENERAL INFORMATION Personal information you provide may be used for seconds (ATTACH TO PERMIT) 592286 Permit Holder's Name: r1 Purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID No: A ' CLIFFORD HENTZ City Village Township '1V1 CST BM Elev: Insp. BM Elev: BM TOWN OF SOMERSET Parcel Tax No: Des°ript 032-2176-09-000 TANK INFORMATION Section/Town/Range/Map 12.30.19-1494 TYPE MANUFACTURE ELEVATION DATA 30.19.1494 f~ ~L CAPACITY STATION Septic , BS HI FS EL V. G Ir1= 257 1 Benchmark 1 _ Alt. BM ~w► ' ( ~d~.' 9 5%.0 o• V °1(v. Q BS!sr ldg. Sewer C(. is- T L~ 2 S t Inlet 7 TANK SETBACK INFORMATI N • U St/ t Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1 / ~ to Septic ( (~i fi NA Dt Bottom Dosing ration He an. ding Dist. Pipe r Bot. System PUMP/SIPHON INFORMATION Final Grade• y~- Manufactur S r 2. Demand St Cover g ¢c••- Model umber G • v TDH ift Friction Loss System TDH Ft Forcem in Length Dia 4 l Dist. to Well l SOIL AB TION SYSTEM ' BED/TRENCH Width DIMENSIONS G Length t No. Of Trenches .~Z^L J Il _Z PIT DIMENSIONS No. Of Pits SETBACK Inside Dia. Liquid Dep INFORMATION SYSTEM TO P/L BLDG ~ Type Of System: WELL LAKE/STREAM LEACHING Manufacturer: U1•1IN AL ~ Ot ± ! CHAMBER OR DISTRIBUTION SYSTEM o UNIT Model Number- Header/Manifold Distribution Pipe(s) x Hole Size Length Dia Length x Hole Spacing Vent to Air Intake SOIL COVER - x Pressure ' Spacing ~U Depth Over ssure Systems Only xx Mound Or At-Grade Systems Only Bed/Trench Center q t Depth Over ` Bed/Trench Edges Topsoil Depth of xx Seeded/Sodded 111111111. 1 T xx Mulched COMMENTS: Yes 0 No (Include code discrepencies, persons present, etc. Inspection #1: t fnQ Location: 1624 83RD ST ~ ( /Vl~l I not AS ;~C~//. / Inspection #2: ! , J Iv ' ~ 1.) Alt BM Description = F1 LT~..L`c cf, 2.) Bldg sewer length = ~.J ~ ,]a _ ~ ~ • - amount of cover = 'i'~, ( ` t", CaU~C`~ 30` 0 CA~M,~ can, 0aI are`, i,~ v . Plan revision Required? Yes No Use other side for additional informafy/n. SBD-6710 (R.3/97) Date Inse Dr's Signature Cert. No. RECErvet) 5 w_-ao J I OSS 01 z 4yV.~g~Rrbr~TO ST. CROIX CO Coanty II UNffy O Safety and Buildings Division JS t S DEVEW 201 W. Washington Ave.; P.O. Box 7162 S anitary Permit Number (to be filled in by Co.) t Pyr v M5 07 162 ~9zzsCo ~FE3SFOv0.t. Sanitary Permit ~i~,~ttVa~tv~~ 1 State TraAn .o~Number accordance with SPS 333.21(2), Wis. Adm. Code, submission of this form to the appropriate govzmmental u * ! / V required prior to obtaining a sanitary permit. Note: Application forms for state-oiNued POWTS are submitted to Project Address (if different than mailing address) Department of Safety and Professional Servies. Personal information ou provide may be used for secondary rposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. rD Application Information - Please Print All Information :)perty Ow is Name Parcel 03, )perty Owner ling Address Proper, Location W30, 1 q t y q C)o 16111 ~ Gov-t. Let y, State t (Zip Code / Pho-:z ti a rber /V 6U &-J y,, Section j el, (4~" s-~~~ 1 - dg . ~7l(0 T 3 C~ cir~le on - 7 Type of Building (check all that apply) Lot- N; R E o s> Ki or 2 Family Dwelling - Number of Bedrooms Subdivision Name -L-. A PubliclContmercial - Dzscribzuse ~p (~I City of I State Owned -Describe Use q CS\i Number Vi11a2z of ~L~~ 2 t o* ZZ ar ZZ ~ TORn of S - e-po-Qk A Type of Permit: (Check only one box on line A. Complete line B if applicable) Y'New System a Replacement System 7r _ _Holdin, Ta~~~ Replacement Onl; 0 Other Modification to Existing System (explain) I ❑ Permit Rene«at Perm is R.~ slot: p I List Previous Permit .ber and Date Isca,:d ❑ Ct nz- ira..sferto Az~N Before Expiration Type of POWTS System/Component/Device: (Check all that a h) a loft 11 "L 17b son-PreSSUrized In-Ground ❑ Prz55urizzd In-Ground At-Grade Li N.'ound 24 in. of suitable soil ❑ A4ound <24 in. of suitable soil 3oldin2 Tank ❑ Otber Dispersal Component (explain)u : y Pr„r,atment Device (explain)-- Dis ersal!Treat t Area Information: r► ign Flow (gpd) Design Soil Applicatior Rate( dsr~ Dispersal Area Required (s* D.-5p,rsal Area Propose sf) j System Elevation _ f _ G~pr p (go a 7 Tank Info Capacity in Total P of ? Afafacturer a i 1 ~ Gallons Gallons 1 Units - 1 _ r W Pe ~a ~25 Cr U s d - i t: :c cr Holding Ta.l- Chamber Responsibility- Statement- I, the undersigned. assn respons' ility for installation of the POTS shown on the attached plans f nber's'Name (Print) Plumber' ignarire \'P,11PRS Number B. siness Phone tiumber nber AddreStreet, tv tate, 7_ip Code) .I. Con /Department Use Only, i Permit Fee Date sued Iss-~ a , t Si;na'u.e ovzds XXK time n Rzason for Denial Conditions of Approval./Reasons for DisapprovAl u o 3 -7 4 are, ' up~ Z61 418, N* C). r© H` S~ 4,e-~ 4 ;33 o y( B/x Air&, 13Y T1-9,~),sO CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 'ILI Owner's Name: Owner's Address: 41 w y Legal Description: N s S 7-30 Township: County: Subdivision Name:` Lot Number: / Parcel ID Number: J o2 ' f 76 w U9 M Page 9 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page g CSM or Plat ` Attachments: Soil Test & House Plans Designer/P(umber: License Number. t~ Date: Phone Number Signature Designed pursuant to the Ground Soil Absorption Component Manual for POWTS Version 2.0 S8D-10705-P (N.01/01). Page 1 I 1( lit C / I ~Sp sr ~ T-,R Xe3 A B/x r T--1 Soil Absorption System Cross Section 9 ya~ft Final Grade 4' Schedule 40 PVC Vent Pipe 9 r, Sd With Vent Cap ft Y b r Leaching Cja -5-0 Chamber y 90 ft System Elevation 3 ft ft Soil Absorption Svstem Plan View ~u ft ft { ft Vent Or Observation Pi Leaching Trench 1 Chambers F 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model . L. EISA Rating o~ sq ft per chamber Soil Application Rate gpolsq ft gpd Designflow ~ 7 Soil Application Rate = c7® EISA~-~~2d - .o Chambers 2 rows of~ chambers each. Page of 13 2 1 11041- d x 48" (EFFECTIVE LENGTH) 12" 11.2" a 8" INVERT 13" 8" INVERT M5.33"' INVERT i tom- 33" QUICK4 PLUS ALL-IN-ONE PERISCOPE—" (360'SWI VEi ) 12.7" INVERT 6'- l J r QUICK4 PLUS TU~ ALL-IN-ONE 12 ENDCAP Quick4 Plus Standard Chamber Specifications Sze (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 em) Invert Height 0.611, 53", 8.011, 12.7' Effective Length 48" (122 cm) (1.5 cm, 8.4 em, 18.5 cm, 22.6 cm) m INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY nhe .,c - °a )at "h p'a %e ae and . -,e, . - - *,,en i, staled and cperateo in - s of art Or s tern accordance th m _a a'r,std = = o -ease ( H ; o, r.,e ye tre be - r of ~0 be c (o)THE - . _ rrj ARE EX , - _ ' r,ER t'!JAFR!,Pi tS b,✓'. TO THE .nTS IN; ~i ~RCHAN A6 ~AarICULARPURPOSE , w L e e t,a ,nF t INFILTRATOR 055 w pr, 4en_ it ✓ti Cif..Jrre Cl ' a,!- Vie e of f g e ,ce: 6 Business Park Road • P.O. Box 768 o Prooter operatic - t be Old Saybrook, CT 06475 a es t cg c n or ,,j m y 860.577.7000 • FAX 860-577.7001 tin j-," Units r, US, Lc , FC ac - J X'.. C 7 rE - o ruct (y.S - _ 4 221.y436 (~y -sentati,e o c :fitra2or has li,e n.y to cFa exl 'd this e r -i. v'✓a:racty No e www.infiltratorsystems.com Tt.& above represents the Standard nrted VJ ,,t eq rra or. A t e d r b u states 'r;i - en n A.,, r , .---,ase. c c cc e Ja r.t_r d hrr K Cc to cbt a c..,, , appi bb _c , U$- Parents a 7:1.661 S 01__ _ o'er Ca ad,an Pa,e -s . 1,329 95'3. 200 pe„c.ng 839 844 . In°I' c. Er Q., c 4 and C =red r ao -a, 1 'er i - "a a reg s er o trade, ar; in France. inf9d,ator Svstems r Is regie_aren , aden~a a M° C( r nrect _ _ _ ade ark c - - i.c. _ ; ..01:1 Ir,:: ra[or Systers Inc. p'Ted in U S.A- PriJS0510101S1- r Q - -Q y i - ' rte----, - -1 y i LO N CY3 i C k - 7`7 ~l i• j NJ Z C) co CEO / W x x Lij U3 F- CD a) LLJ LLJ CL :r w w a C/) CO " Q U x o m~ _ O LU m uj ` \ O z m O cam, W co - (j ~uC? ZOcd LL- C-J F- L ^ Q POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Permit # Septic Tank Capacity jp?-j Q al ❑ NA Septic Tank Manufacturer LLAAx, j_ . ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA 4-1 Number of Bedrooms ❑ NA Effluent Filter Model o~J ❑ NA Number of Public Facility Units / I NA Pump Tank Capacity al 6NA Estimated flow (average) /Q6) al/day Pump Tank Manufacturer 42 NA Design flow (peak), (Estimated x 1.5) 100 gal/day Pump Manufacturer NA Soil Application Hate s gal/day/ftz Pump Model NA Standard Influent/Effluent Quality Monthly average's Pretreatment Unit NA Fats, oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand {HODS) 5220 mg/L ❑ 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 (BOD,) 530 mg/L k In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L hO 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: ❑ 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: ❑ month(s) (Maudmum 3 years) ❑ NA year(s) Pump out contents of tank(s) FAt combined sludge and scum equals one-third (Yl of tank volume ❑ NA Inspect dispersal cell(s) t onc e every: p~ ❑ monthis} year(s) (Ma)imum 3 years) ❑ NA ~ Clean effluent filter At least once every: ) JKlmonth(s) ❑ NA 13 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) 13 At NA year(s) Flush laterals and pressure test At least once every: ❑ month(s) k~ NA D years} Other: ❑ month(s) At least once every: ❑ year(s) A~ 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 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 (Y) 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 START UP AND OPERATION Page Z of _Z 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 setback and/or soil limitations. Barring advances in POWTS jj technology a holding tank may be installed as a last resort to replace the failed POWTS. alua " lv T be • o cng ank e a~ ?RD44iSl7~ noe-N CflNiSTRU~Om~ ❑ 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 rG Name Phone &0 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name C' ( U 2!)il(t~U Phone Phone -7 j S-- 3 FCo- <tl&q CD This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. a . SEE LOT LOT 10 AREA TABLE d.OhLR NO] E 3.00 ACRES 70 CWMO ! 4' LIM Lo . a.0 tlaaa LOT 8 i ' -F L OT AREA TABLE & DW NOTE ! Q ' 3.0 ACRES TO Or11MM , BMW 2.0 ACRE S +1. 70 OHWM . EXCLuDwG EASEMENT LOT 9 I 1 L 3.0. - W 3.06 ACRES (132,701 $0. FT) t . SOV4013'W 29738 6 e LC a,t fiEVat:ON .•914 24 27606 LOT 6 Le \ ~ t133,r a ,site sy GOUS SU'LCABLE AREA I r S8B'3P5T W336.96 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwmerBuyer 1F~~SL Y ctTZ Mailing Address( 1lQ P0SsvV"-\ Property Address' 1 kC2 6.3 : 5 ~r e.e L i2, ctIw"v J W x S-ti o i /I (Verification required from Planning & Zoning Department for new construction.) City/State ~-ek~ ai c "Or-j' W'I Parcel Identification Number Q~~ ~ " I'7 (Q 4 0 00 LEGAL DESCRIPTION Property Location 1/4 , 1/4 , Sec. 2 , T L N R 19 W, Town of SvM~ ~2 5 t f Subdivision Plat: ~}k S 1GS'k~ Lot # Oct. Certified Survey Map Volume , Page # Warranty Deed # 1®02(a 7.-f (before 2007)Volume , Page # Spec house ❑ yes/no Lot lines identifiable/yes 0 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(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 s form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w arty deed recorded in Register of Deeds Office. Number of bedrooms `T /SfGNXTtf9E OF APPLICANT(S) _DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) 1P nTServices § wscons~ Departmentp 4FI #1327 Division of ladustry Services SOIL EVALUATION Page 1 of 3 JUN 0u,= Keith E. Stoner ST. CROP( COUNTY in accordance with SPS 385, Wis. Adm. Code r~n/ QIELOPMENT County Attach Coe*" ape? not less than 8%: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 03 17 09-000 Please print all information. Revi By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f Ti / Property Owner Property Location Clifford Hentz Govt. Lot NW1/ , SW1/4, S12, T30N, R19W Property Owner's Mailing Address Lot # Block # Sutxt. Name or CSM# 1641 Possum Way 9 Lakeside Estates City State Zip Code Phone Number ❑ City Village ® Town Nearest Road New Richmond WI 54017 651-308-2716 Somerset 1624 83 Rd. St. Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ® New Construction ❑ Replacement ❑ Public or commercial - Describe: Na ft. Parent material Loess over Sandy Outwash Flood plain elevation, if applicable General comments Propose 2 Dispersal cells 3' x 90' using a .7 SAR Center the upslope cell over the 94.00' contour w/a System Elev. of 90.50'. Center and recommendations: the down slope cell over the 92.20' contour with a System Elev. of 88.90' Centerline of cells staked. ro Ao- r-0, a Boring # ❑ Boring Pit Ground surface elev. 95.00 ft. Depth to limiting factor >108 in. Soil Application Rate ® Consisten Boundary Roots GPD/ftz Horizon Depth Dominant Color Redox Description Texture Structure `Eft#1 *Eff/r2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-8 10YR2/2 Sil 2msbk mvfr a 3f-co 0.6 0.8 A429-108 8-17 10YR4/4 sid 2msbk mvfr gs 2f-co 0.4 0.6 17-29 10Y R4/6 1 2f-msbk mvfr gs 2f-co 0.6 0.8 10YR4/4+5/4 s Osg ml 2f-m 0.7 .6 1 1 ❑ Z Boring # Boring Pit Ground surface elev. 89.33 ft. Depth tdlimiting factor > 109 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW 1 0-9 10YR2/2 sil 2msbk mvfr a 3f-co 0.6 0.8 2 9-14 10YR4/4 Sid 2msbk mvfr gs 2f-co 0.4 0.6 3 14-25 10YR4/6 I 2f-msbk mvfr gs 2f-co 0.6 0.8 4 25-32 10YR4/4 gr S Osg ml gs 2f-m 0.7 1.6 5 32-109 10YR4/4+5/4 s Osg ml if-m 0.7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/L and TSS <-30 mg/L CST Number CST Name (Please Print) Signature: 224059 Keith E. Stoner Address Keith E. Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 4/27/2016 715-653-2324 SBD-8330 (8.07/13) PrnPertY Owner Clifford Hentz Parcel ID # 032-2176-09-000 E3j Boring # Boring Page 2 of 3 rn® Pd Ground surface elev. 90.00 Horizon Depth Dominant Color ft' Depth to limiting factor Redox Description Texture > 106 _ in. Munsell Structure Consistence Boundary Roots 1 0-5 10YR2/2 Gr. Sz. Sh. GPD/ft2 sl 2msbk *Eff#1 'Eff#2 2 5-12 mvfr a 3f-m 0.6 1.0 10YR4/4 ~ 2f-msbk mvfr 3 12-16 10YR4/6 9s 2f m 0.6 1.0 Is S Osg MI 4 16-106 10YR4/4+5/4 gs 2f-m 0.7 1.6 OS9 ml if-m 0.7 1.6 ElBoring # El Boring ❑ Pit Ground surface elev. ft Horizon Depth Dominant Color Depth to limiting factor in Redox Description Texture in. Soil Application Rate Munsell Qu. Sz. Cont. Color Structure Consistence Boundary Gr. Sz. Sh. ROOD GPD/ft2 *Eff#t *Eff#2 ❑ Boring # El Boring Ej Pd Ground surface elev. ft Horizon Depth Dominant Color Depth to limiting factor in Redox Description Texture in. Soil A li Munsell Qu. Sz. Cont. Color Structure Consistence pp cation Rate Gr. Sz. Sh. Boundary Roots GPD/ft2 *Eff#i *Eff#2 c~ 2- Effluent sy 1 SOD5> 30,c 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOps- < 30 m g g/L and TSS <30 m /L ' Soil Test Site Plan Page 3 of 3 For: Clifford Hentz Lot 9 of the Lakeside Estates Sub. P/L NW1/4-SWl/4 + SWl/4-SW1/4 Sec. 12 T30N-R19W ° 20 1 40 Town of Somerset - St. Croix County Grapme 8-k (frost) 1 imh - 40 tt Garage Open Grass Slope 3.05 Acre Parcel Proposed FN# 1624 Walk-Out Four Proposed Basement Floor Bedroom = 96.00' or 944.70' Home X Note: Maintain well and waterline setbacks per SPS 383.43(8)(1) 20% 83rd. St. 1 X B Site is an Open Grass Slope \ \ O BM \ x 21 96.00' \ 94.00' P~ 13% \ 92.00' 88.00' #2 90.00' Elevation Data Cut Edge from B41 = 95.00' Original Road B#2 = 89.33' Construction B#3 = 90.00' BM = Top of 11/4" Iron Pipe w/Pink Ribbon by Steel T-Post * E RP = Same ASSUMED ELEV. = 100.00' WAS, April 27th, 2016 ' = Backhoe Pit Keith E. Stoner CST# 224059 -0,/~'v ~f-r7 & ./f-141A--' ST R15 l7 Cv/:vG- ~Gl~v. S,S~ G!~ (o SI. 3 88 /Co od Wlsocrosln Department of Commerce SOIL EVALUATION REPORT page / of 3 Division of safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach oomplete site plan on paper not less than 8 1/2 x 11 inch gEPfV6 1 C~0 x Include, but not limited to: vertical and horizontal referen point 8 dfredion and percent slope, scale or dimensions, north arrow, and loca ion and distance to nearest road. Panel I.D. Please print all Informal n. J U N 2 4 [ C 03 eviewed Date Personal Information you provide may be used for secondary p as (Privacy Law, s. 15.04 (1) (m)). C Property Owner - Z(p b Z O N I Locati ~/0,6 JeFF) 3zVAeGovt. Lot 114 iM S 1A T 30 N R (or) W Prorty Owner's Mailing Address Lot p 131" # Subd. Name or CSM0f gzZ_ /boo 41-140.9 • C/ city 1,-w State Zip Code Phone N ❑ City ❑ Village (a Town Nearest Road /PWVW,vJ? ~v/. syo~7 7is, z~G •.Sr3~G sa,~,~-~PSEr- /~o •9u,2 New Construction Use X Residential / Number of bedrooms Code derived design Now rate 445_to r7~ _ GPD ❑ RWact•rsent ❑ Public or commercial - Describe: ,f. Parent material SAN D flood plain elevation If app Ncable General comments and recommendations: 4Re f 7Z-5 TZD S o /2W /F /~~R / Ong # ❑ Boring S 1 Lv T /0 F Pit Ground surlaceelev. ~j / • 30 8. Depth to ItmUtrlg fads ~*etf In. D Horfmn Rate :!In. Dominant Color edox Description Texture structure Consistence Boundary Roots GPDpp MunseA Qu. Sz Cor1t Color Gr. Sz Sh. •Efyl~ L 17SAe ntit 3 f- y ks~ Boring 0 p Boring ~ oor /o ~ F =J ~d Pit Ground surface elev. i_ ft. Depth to limiting factor r 0 in. Sol AppIcallon Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDAF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EfRt1 •EIMI2 1,) 2- A0 Ple IN/ 41 3 1". L3 /o SQL f s/~•~ ~n cc~ 3 2 •y /o • 3 . - ~O s s 7 • b Effluent Of = SOD > 30 < 220 _ mglL and TSS >30 < 150 mglL Effluent !12 = BOD < 30 mglL and TSS < 30 rtigil. CST Name (Please Print) - - I R a~R T- 7!/~ Signature Z 3~ S Address Date Evaluation Telephone Number Ulbricht & Associates (7- 7IS• 77r7- • 3y/Z 2812 10th Ave. Spring Valley, WI 54767 A~~,,~ S 41 g/se Sec. 63 2.- 20 5,1 • 00 • M 5e /5,C see. For issuance of permits and designing Contact: Ulbricht & Associates s•~ S~ SEG / Z _ 03 2 ' o'YS • So • 02-5 Regis~ered private wastewater consultant and plumbers / t r)th Ave. O A ---y yGv / 2812 / Z Spring balley, WI 54767 715-172-3442 N4015V ? S 4//iV to Sic. / Z 30.67. 3 Z - ~o yS • yd A• Page -of Parcel 10 A Z'j Prop" Owner _ G F El go" 7 7 , pit Ground surface elev. it. Depth to Iimitkrg factor In. Sol fie F torizon Depth Dominant Color Redox Description Texture Sinrdtxa Consistence 8otmdarY Roots GPM Gr. Sz. Sh. 'EIfg1 '097 In. Mansell ()u. Sz. Cont. Color G ,She /niTR ~ 3-r- ' z1- ' 0-/& 10YR3111- A .2, ,3 a7 • ~oyR y s~L zf~b~ ~ ~~a. s • s . , r-- Boring ❑ Baring Ll R. El Pit Ground surface elev. Depth to limiting factor In. S04 Ap- icaNpn Rate flotiZon Depth Dominant Color Redox Description Texture SWdrxe Consistence Boundary Roots GPDIiE Gr. Sz. Sh, 'Elfp1 'Elt(12 In. Munsell Qu. Sz. Cont. Color L] Boring In. lion Rate U Ong Ground surface elev. R. Depth to Nmitlng factor SON ❑ Pit GPDIff Dominant Color Redox Description. Texture Stnichlra Consistence Boundary Roots M.t4odzonDepth Gr. Sz Sh. 6091 #002 r Mansell Qu. Sz. Cont. Color ❑ a Boring Ground surface elev. R. Depth to WrftV fads - In. Sol Rate ~n9 if ❑ Pit Roots GPDM Redox Description. Texture Sbudtxe Consistence Boundary •EHg1 ~Rq2 Horizon Depth Dominant Color Sz. Cont. Color Gr. Sz. Sh. M. Mansell , 5 30 nVL Effluent #1 = BOO, > 3o :s 220 mgA. and TSS >30 1150 -9& Eflklent 92 = BOD. < 30 rngA and TSS TTY assistance to access services or The Department of Commerce is an equal opportunity service provider andemployer. 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