Loading...
HomeMy WebLinkAbout040-1064-70-150 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597349 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] -7 Permit Holder's Name: City Village Township Parcel Tax No: MICHAEL & MARGARET HARMON TOWN OF TROY 040-1064-70-150 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 16.28.19.241 B-50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER . CAPACITY STATION BS HI FS ELEV. 7 3 J673 /.6Septic 215 6 Benchmark /6-0 / O beeinel Alt. BM i 32 ~ /afy. b 7 Aeration Bldg. Sewer A 4, VO /4iier Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet ddb TANK TO ~dP/ 4 WELL BLDG./ Cent to it Intake ROAD Dt Inlet \ Septic -7 Z 4t 2,7 ' .Z 7 Dt Bottom Dosing J Header/Man. 7 /aZ5 Aeration Dist. Pipe e.-7 y T - 01 It T•"7 Bot. System 10 97• Holding 1 13, 7,105 t~ L PUMP/SIPHON INFORMATION Final Grade 16Z • ~7 Manufacturer Demand St Cover GPM la-el, Model Number gvw s~ TDH Friction Loss System Baecr- TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width "ngth, N o. Of Trenchhes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DL. 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: F l INFORMATION CHAMBER OR 4-4r- Type _~SQLD ~ ,Z UNIT Model Number:~~ ~n• DISTRIBUTION SYSTEM Al Z:54- 9~5 = Z~ Header/Manifo1/J Distribution x Hole Size Ix Hole Spacing Vent Inr ~ Pipe(s) t Length Dia Length Dia Spacing I _I___~ i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded T Mulched J!j!j:V J~~ I Bed/Trench Center Bed/Trench Edges Topsoil -Irslyes No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1r: Inspection #2: Location: 391 N GLOVER R 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover Plan revision Required? ❑ Yes >r No Use other side for additional information. Date Insepctor's Sig re Cert. No. SBD-6710 (R.3/97) L pECEIVED .S ~a I;`S fey q;~Q srv - ~G ~7 I Sy Industry Serv ices Division County 140 Washington Ave J r ~Ro/X S P = I B . 716 Sanitary Permit Number (to be filled in by Co.) Alp~ , S 16210 ST. CROIX COUNTY'. LOPM anitary Permit Application State Transaction Number 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 Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(i)(m), Stats. I. A lication Information - Please Print All Information 41 0! ~v' /V L7 LovEt Property Owner's Na e l / Parcel # le 11A Property Owner's Mailing Address Property Location ~ icl, aN 1 16-5 C, 3 9 N. 17 zov--,t Wo. Govt. Lot City, State Zip Code Phone Number 1 _ 1/E 1/4, Section tl.~ son/ Gv 1 ~yp/ /s a~~ circle on T o?B Iv; Ro II. Type of Build mg (check all that apply) = Lot # (rl or 2 Family Dwelling - Number of Bedrooms 7 Subdivision Name ~k r.9 a }+yE , Block # ❑ Publ is/Commercial - Describe Use 8-eity f ]~Owned - Describe Use CSM Number V411 e- 64-*4ftage of ❑ State IJ t cS l r ig •ro- of nda J III. Type of Permit: (Check only on box on line A. Complete line B if applicable) 2,66.g" X New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B List Previous Permit Number and Date Issued El Permit Renewal ❑ Permit Revision El Change of Plumber ❑ Permit Transfer to New Before Expiration y Owner IV. type of POWTS System/Component/Device: (Check all that apply) gNon-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/Treatutent Area Information: , Design Flow (,pd) Design Soil Application Rate(gpdst) Dispersal Area Required (st Dispersal Area Proposed (sf) Sy nation L G L !rJ Goo' -/1 /oo o /009..? 97 8 197. __4 1 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units L o Nely Tanks Existing Tanks v J iZ ; 6, ri U c. Septic or bleldeeg.T4uL-. Sd Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si r MP/M**W Number Business Phone Number -J o / ELKE 23/3V4 5 G7W-5,?G4 A . 17-I Plumber's Address (Street, City, State, Zip Code) G.29'8 Sr. w r, t a?6- . /DURA,tIv C,JT 6- Y734 VIII Coun /De artment Use Onl Approved ❑ Disapproval Permit Fee Date issued Issuing A$ " t Signature e~en Reason or Denial $ 111-7 IX. Cond ~v sMfpgfiDisapproval I. per: n cell rust all be ~C.CA Is,per management plan p, c, ided w plu,be(. 2 I e r * rCW15 t ;en s must ct as , a.r :;r:• '9 ^f ~ Gf t ~tl rt/ f d'(~ ////C~ i jt~ as per ~Ilcxlblt~ c.r9<< x / .rd.:a rn, ' .v Attach to complete plans for the system and submit to the County only on p er not s than 8 112 x 1 inches~fn size r l '1 ~"vJ1 r JL SBD-6398 (R. 08/14) a a ti- Q Q R Q 13 ! ll, v Z n Z \ n a ~ ti ti IV\ 14 o W W a c\ ^ ~1 h o 1 1C irj +o- O 14 e Vq $~W 0 W y \400 o 3 o p ~1 Q$ vl 0 W ~ ~ 3 @ o Q ~ v v 1y~ o v V d V` \ ~ v R 1 w op l ~ \ OQ v y w ~ wQ tM .I j\ cp a4 a a ~ y 1~ ti W es. cr Private .site Wastewater Treatment stem Index and Title Page Project Name: ~/kE ~ /'yAGwE /J'A~c,vo,~ - ~ ,~s ~.✓sto4.~o ~orrrs (.,,eyr Owner's Name: Owner's Address: jff /V 1, LodE,C ~D /PuD.So.y. 4/ S s'yo/6 7is aao - Z -7 a Legal Description: il/E NE /G ®?8 N /9 ~.1 Municipality: TOW. Vie, - 6iyoi 4/LoY County: SST 1-1 /1o i x Subdivision Name: Lot Number: Block Number: Parcel LD. Number: Page 1 /AID-rX f~tf6E Page 2 _ Icr A" ~-AAw aUIW Page x"Orle- ~.Rva 40--ex Page 4 6~oc~ T S d s,1 +1 E~ 's t'`1AnJof.1t A~A1E~+lEnTT Pt.~ ✓ _ Page •5 , Page 6 Page 7 Page 8 Page 9 Name of Designer: :Z ©H,,j A-z e License Number: /1P- ~1 3 3 yG Signature: Dare: .S ?O - jai 7 Designed Pursuant to the Fallowing POWTS Component Manual and o,-,4 s 81-85: ~d L lLo4~0 ~ cic ~,B.Sa.t/P rio.J ~o~/odBa r ~ANu,~G fava ~°owf S ~116,e. a?.a~ S'/D -/oroS-/p n ? \73` _ Z~ M ~ 13 W T ~ a ~ ~ a. e b \9 W 41 \n a o! \ hp o-'~ 1C o 0 14 ~~Vy cn- 1 `C C tj ~ O0~ o 00 lq~ 1A u ale k I OL. T ~ W y V r 00 r NI) v $ a~ Q S 3 ti 0 3 J @~ o@ h v v fi ~ x V R Q; \ n Ll Op ! \ , o~ pa~~ C~1b^ w ~ \ \ Ilk ® si a e ~ 3 a< G WLP1250-MR TANK SPECIFICATIONS 120}° DIMENSIONS: WALL: 2 1/2* o BOTTOM: SEPTIC 3" a a COVER: 5" 10 MANHOLE: 24" I.D. PRECAST CONCRETE RISER ° _ HEIGHT: 52 1/2" O.D. n - - - - \ LENGTH: 120 1/4" O.D. r / WIDTH: 84" O.D. y \ BELOW INLET. 41" O.D. j 4" CAST-A-SEAL \ 4" CAST-A-SEAL LIQUID LEVEL: 36" Q _ I WEIGHT: 8,810 LBS. ~2A \ \ INLET AND OUTLET: 4" CAST-A-SEAL BOOT OR EQUAL o TYP ` GASKET, CAST-A-SEAL BOOT OR EQUAL 3 ° FILTER OR INLET AND OUTLET BAFFLE AND FILTER: m' o \ BAFFLE / WISCONSIN, SEE DETAIL #10 z ° (OTHER STATES SEE CHART) LIQUID CAPACITY: 34.81 GAL/IN a HOLDING TANK: Li.l OUTLET HOLE PLUGGED H TOP VI ACTUAL CAPACITY: 1,323 GALLONS - W 3 LOADING DESIGN: 8' 0" UNSATURATED SOIL G7 fl Q o L z ~ C7 o I Lf7 N o TANK CAN BE USED AS: M a SEPTIC/ HOLDING/ PUMP OR SIPHON W C~ CD COVER: NO FIER) TANK: XX ESSIGNJ #10 ~STRLICTURAL FIBER) INLET - CUSTOMIZED TANKS: 3 OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE u v n a 21" I ~ I ~ z _J Z - - - N a v " DRAWINGS SUBMITTED w v, SIDE VIEW FOR APPROVAL APPROVED BY: SHEET NO, APPROVAL DATE: PRODUCTS NEEDED BY: j F TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner i 44vwd Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer GJ es Cove, ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer SF 7- ❑ NA Number of Bedrooms (100 d/bedroom) Effluent Filter Model Z, O NA Pump Tank Ca aci gal NIA NA Number of Commercial Units p Pump Tank Manufacturer NA Estimated flow (average) yoo gal/day Design flow (DWF , estimated x 1.5 Loa Pump Manufacturer E3 NA ) o Sal/da Pump Model ❑ NA Soil Application Rate gal/day ft4 pretreatment Unit {)gl NA) Influent/Effluent Quality NA) Monthly Average p Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L p Mechanical Aeration El Wetland Biochemical Oxygen Demand (BOD5) 220 mg/L ❑ Disinfection C] Other: Total Suspended Solids (TSS) Manufacturer: Model: 150 mg/L Soil Absorption Component NA) Pretreated Effluent Quality (p NA) Monthly Average In-ground In- Biochemical Oxygen Demand (BODO < (gravity) C3 ground (pressurized) Total Suspended Solids (TSS) ~0 mg/L Q At-grade [3 M Mound Fecal Colifonn (geometric mean) ~ 30 mg/L• ❑ Dri -line ❑ Other: <I0 cfu/I00m1 Vertical Distance Tank Bottom to Service Pad: Maximum Effluent Particle Size 1/8 inch diameter Horizontal Distance Tank(s) to Service Pad: Dispersal Unit Mfg./Model Number: /nlF~i rtAToit 4,- ica y 1.,oO L~iow,Stti 5 ❑ NA Calculations: Soil Dispersal End Cap (Dispersal Unit EISA) or DWF _ Application rate = Area Required - EISA - (Trench Width) _ # Units or Total Length of Trench(s) Ld0_ . G = /OoO - a. V) SO LNA1oYAW45 DESIGN CRI'T'ERIA. ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 p "EzFlow Mound Component Manual" Version 3/20/2007 ❑ SBD - 10854-P (R_1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 0 SBD - 10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 p SBD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - I0657-P (R.6/99) "Drip-line Effluent Disposal Component Manual" p SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Other - MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event Service Frequency Pump/inspect tank(s), inspect dis ersal cell(s), clean filter At least once every: lid 13 months JZ 3 years p Other - Ins ect pump & pump controls, alarm, pretreatment unit At least once every: p months p 3 years pff NA Flush and pressure test laterals At least once every: p months ❑ 3 years 10 NA _ 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 startup shall not occur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page y of START UP Ai SD OPT; T IOM Page S o; For new construction, prior to use of the POIAITS 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 JAMI 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 etilueriL 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 POWrS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or pant vehicles over tanks and dispersal cells. Tao not drive or park over, or otherv,4se disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimiinaUon of the foliow4rlg from the wastewater stream may improve the performance and prolong the life of the P01rrrrS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; fad foundation drain (sump pump) water fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitany napkins; tampons; and water softener brine. ABANDONMENT When the POWIrrS fails and/or is permanently taken out of servics the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter SPS 383-33, Wisconsin Administrative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. ° Ater pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space tilled with soil, gravel or another inert solid material. uOINITINGENC': P=._AIA If the POIrit'IS ;ails 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 utifized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time- A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POUG t S- Cl The site has not been evaluated to identify a suitable replacement area- Upon failure of the POINTS 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- Q 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 imith the rules in erect at that time. ~<i1UA„ILII~tIg>5 uEPTIC, PUMP AND OTHER 7.REATMEILi ►:;MKS MAY CONTAIN >~19AL GASSES 6.NDIOR HS€ FFCi1=►1T OaX GEiI- DO irlOT ENTER A SEPTIC, PUMP OR OTHER TREAT MENT TANK UNDER ANY CIRCUMSTANCES- DEATH MAY RESULT. RESCUE OF A PERSON i=R0€i0 T HE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. A DDl i iONAI_ COMMENTS FOWI"S INSTALLER PODUTS MAIN T AIMER Name J o~y,~ ~E cKE I~ - .Z 3J3 yG dame ( ~ ~ j ~ e ONn~ /~6 L~eE ~PEtt'E P 4iY.B1.J4 { Phone + 1 - Phone ' i SEF T AGE SERVICING OPERA T OR. (T?UMrE;~ LOCAL RE.GULr T Obit AUTHORITY # Mama ! blame i .J r /16/JC ~O ~oryM~.J_ ~~u~'t 3 Phone Phone n 711- A7 i his document is intended to meet the minimum requirements of ch. SPS 383.22(2)(b)(1)(d)&(T and 383.54(1), (2) 8-1 (3), Vsconsin Administrative Code- Use of this document does not guarantee the performance of the POWTS. Rev.(3113) -,aCll Cal - ~ Q ~ tY0 T a1 ai i •R fi L » a~ d » o vsr~v a Q y v am 4 N ~ - w M K'm c W E u' o $ - 5 3: u 3 c .t_+ O u. Y c _Y m c N mo n 83 C k~ i s' _ c Y O ep .R. U a m m H d LLI • CL T 'Q V R i t m A61 ag` -0 .1 aBvasya iiw sn ~ R E p n > O R o O O 4- %A u m C CL CL a, ♦ J ~ l7 ~ ~ p~ y N O i y O.a Y R r Q Al W N i k 0-0 Qj C E c '~p~ t T d Q L - ~*t Y Y f tc • v-4 c T o a O m '0 » R a c 3 a ° w ¢ E a m a l a N m m u Oat 'c d 'a r g L O F.{ ~r " 7 N O d t ~ a~fl~v +a+ m O OC_ N Q. _o N O N t m .DO Oo Q. lo: C n 6 ~Vi R= 3 R c • R c - a _ ~.7 i - o . i ;r am. v 0a -C -u o a m e CD= C _ a' C LC: c co j IN:-& N c y o v z 'o a` j `m • t. m v O .-o E r~1 ..._..W._ C O v C d O d~ m p r O «0 X 0 3 W li ~ C d r 'o j= Q m N R G. -0 tLJ C. ® f ` C R :E O a rc `6 w Z1 U - w V UI .O .L E 4-h -a E c C m N yr V yR. a ` a m N C! O7 oo A 7 _ O ac m TA O m u i j}+j . 4d c a _ .Y i V vai ~ Uj AM a y~ c i I .v. Gl R£ m fl c 0 i L as.. » Y J •i.i C; 4e al C: CL is ~uG m v R e~ y v Y w• r 0 N L v vc C h®/ N " tfit~ ST. CROIX COUNTY SEPTIC; TANK NdALNtTENANCE ACRE N I ENT AND OWNERSPIP CL-RTTFIC'ATTON FORM Owner/Buyer Margaret and Michael Harmon NZailing Address 399 N Glover Rd, Hudson, W1 54022 Property Aadre1*39.7AL Glover Rd Hudson. WI 54022 (Verification required from Planning & Zoning Departrrtent for new constntctilro Parcel Identification Ntunber CitylSta,e Q40.106-4.70-150___ LEGAL DESCRIPTION 51W :'a Sec. T_N IZ_u' Town of nV }'ropert:y Location. ~11ixC1tV+StQr1 Lot n , Certified Survey Map #853736 Volume Warran ty Deed # 1042197 Volume Pagt tl Spec house yes Lot liars identifiable yes no SYSTEM MAINTENANCE AND OWNER chR:rj1iWA:V10N Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prope., maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What `r the system can of€eet the function of the septic tank ns a treatment stage in the waste disposal system- Ov - responsibilities are specified in §Comm. 83.52(3) and in Chapter 12 - St. Croix County Sanitary Ordinanc: The property owner agrees to submit tr, St, (,mix County Planning Zoning Department a cert W"Mer and by a trlaster plumber, joumLyrnan plumber, retstricted plumber or a licensed pumper ve ifvirln v.+tt.4tetvater disposal system is in proper operating condition andlor (2) after inspection and puntpin iess than 1(3 full ofsludte. Uwe, the undersigned have read the above requirements and agree to rttaintain the private. matte dis p s r v32c.l, "):1 0,-, standards set forth, herein, as sex by the Departinerit of f'orrimerce and the Department of Natural .Resources, State of Wircorrsilt. Certification stafing that your septic system has been maintained must be completed and returned to the St. Croix County Planning 7,aning Department within 30 days of the three year expiration date. liwe certify that all statements ,~rz this form are true to the best of my/our knowledge. l Ave amrare the owner(s) of the property described above, by virtue of ~ warranty deed recorded in F,egistei of Deeds Office. ea Rummer of Bedrooms ~3 y SIGNA!URE OF A-PPL.IC-ANT(S) DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Planning Sti Zoning Department_ Include cyith 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 -marranty deed. (REV. 08;051 -0 95 Wis. Dept. o 4tm(dMrfessional Services )RT Page / Of Division of Safe ~a ~a Q~'~Plin accordance with SPS 385, Wis. Adm. Code County `r J Lao/ AQ~plete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must x include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.~// 6 (o 4 y 7.6 - /,5(-- Please percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6, i//~y ~ ' print all information. Revd ed by Date 1 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location D F1 / //~E ~L►G/E 4) Govt. Lot & - 114 NE 1/4 S/ /G T,,? N R (or Property Owner's Mailing Address Lot # Block # Subd. Nama'or CSM# 3 99 /2 tauE.t 1A, " City State Zip Code Phone Number E]Gtty ~e [Nrown Near t oad , ~osa~ 4; .SI0/G ( 7/s) ao-`.732 r /Y li2ovcr 1,,4 New Construction UseQ Residential I Number of bedrooms 3 - y Code derived design flow rate ~/S6 - G b a GPD F1 Replacement 0 Public or commercial - Describe: Parent material `oEss 6 uc~ ourc✓9sr/ Flood Plain elevation if applicable General comments and recommendations: ~^/G ou d0 100 w r L a AOn~4 ~t,~rE /4 °Io S [e/6~ G a 45 S fiE~ 0 e re t'ES/ EGO IMMEND ~YS. EL. - va f y 'd E•Lar✓ 6i1AOF on/ Go J To w2 / Boring i Boring # ❑ Pit Ground surface elev. ~d,7• S ft. Depth to limiting factor ~ 93 in. V\j Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsisience Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 d -/a /a Yr& 3 3 - Iv C S oTu~= 3 Y- y8 /o roc y/6 - l / ~'s6k s - . Y 7 Y8 -,9j . s- rc S/6 ct L/ if SOMfE /S f NGLNS/O ,s /•J Jr / rOd °7a GlL9uaL /z - .3 Boring # FIBoring pit Ground surface elev. 14-0.0 ft. Depth to limiting factor > 93 in. Soil Application Rate z Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ` ff#2 / 6 7 /4 ti - c s d u G a 7-31 /a y L YlY "V V .7 F~'~✓ sc q rr it r,0 ~ u /Y'3 * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Michael I Hassett Address 1503 Fairway St. Da Ev nducted Telephone Number Eau Claire, WI 54701 x7,07 (H) 715-834-8610 (C) 715-5774383 SBD-8330 (RI 1/11) CST, MPRS-224974, D-1152 r f 3 Property Owner ~G LIE WIV6A) Parcel ID # Page 1~ of a Boring # Boring pit Ground surface elev. 9 d ft. Depth to limiting factor 9 9.7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 16 Y& S13 A , S L-3 - s/ 4 n y 7 .3 j V-YV 6 Y.L Y/ fY- 2-3 Ax 5-11, Boring # Boring 9 y Pit Ground surface elev. d . S ft. Depth to limiting factor in. 17 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 16YX 313 - / / y 3l -3Y3 6 Y A, ,L Y393 G 7,SY1 s/6 S 0 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *W2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. S 13 D-8330"rest (RI 1/11) M' r n W ` l n o T h c h ~ y ro~ j: c u all 'I) I 4 Q i Q ~ o o c r y o `a Nj v, ° V V r o. a ti v 11 Ts J1 1 h Q do 3 x V J ~ O O Z ~ l ! Q ` W 4 a ~ tut ~ 0` a •L`. $ ~ C ova ~a lu 0 N i as '4, W M V U L9 v i R oo d IV, L9 14 C~ H ~ U U F-+ H ~ j ~,e: 1 U to C RE+V OVED 1 - 01 Wisconsin Department of Commerce _ E F1C T Page 1 of 3 Division of Safety and Buildings ? 2~ or ance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not leWh4K(8l 4RWhTi~ches in size. Plan must include, but not limited to: vertical and horizontal rerence point (BM), direction and Parcel I.D. ~4n ~1 nra'i n~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 040-1064-70-p6S--6 Please print all information. Revi ed by Dale Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 113 Property Owner Property Location Paula Estlund Govt. Lot SE 1/4 SE 1/4 S 16 T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 393 North Glover Road NA vaft tg CSM City State Zip Code Phone Number ity E]Village ■ Town Nearest Road Hudson WI 54016 ( 715 ) 425-5852 Troy North Glover Road New Construction Use Residential / Number of bedrooms Unknown Code derived design flow rate Unknown GPD rl Replacement Public or commercial - Describe: Parent material Glacial outwash Flood Plain elevation if applicable NA ft. General comments and recommendations: k~~-j S\/s,~,~jy~ A~~.QIt/~i 1Z ,~yt~ SG(~ ~,~i~~S,~.,,rN• B 1 Boring # 11 Boring >96 Pit Ground surface elev. 931.6 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffl- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR 3/2 sil 2mgr mvfr gw 3vf-f 0.6 0.8 2 9-15 1OYR 4/6 sil lmabk mvfr gs 2vf-f 0.4 0.6 3 15-28 YR 4/6 Scl lmabk mfr gw if -0.2 0.3 4 8-42 5YR 4/6 grs Os ml s 1 f 0.5 0.5 5 42-65 l OYR 5/8 Cos Osg ml gs 1 f 0.7 1.6 6 65-96 1OYR 6/4 s Osg ml 0.7 1.6 FB2] Boring # Boring 926.2 >99 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 1 0-7 10YR 3/2 sil 2mgr mvfr gs 3vf-f 0.6 0.8 2 7-19 1OYR 5/4 sil 2mabk mvfr gs 2vf-f 0.6 0.8 3 19-29 4/6 scl lmabk mfr gs if 0.2 0.3 _4 29-48 7.5YR 5/8 cos Osg ml gw lvf 0.7 1.6 5 48-78 10YR 5/8 Cos Osg ml CS 0.7 1.6 6 78-99 10YR 6/4 s Osg ml 0.7 1.6 * Effluent #1 = BODS > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Daniel P. Kugel ~IanJ 11~2 7L/ 250693 Address Ogden Engineering Co. a..fl f Date Evaluation Conducted Telephone Number 1234 S. Wasson Lane, River Falls, WI 54022"x\ April 25, 2007 (715) 425-7631 040-1064-10-000 2 3 Property Owner Paula Estlund Parcel ID # 040-1064-70-100 Page of Boring # Boring 926.9 >96 Q Pit Ground surface elev. ft. Depth to limiting factor in. P'l 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 1 0-8 l OYR 3/2 sil 2fsbk mvfr cs 3vf 0.6 0.8 2 8-17 1OYR4/3 sil lmsbk mvfr gs if 0.4 0.6 3 17-27 5YR 4/6 sl lmsbk mvfr gs lvf 0.4 0.7 4 27-44] 5 4/6 scl lmabk mfr gs lvf 0.2 0.3 5 44-56 7.5YR 5/6 s Osg ml cw 0.7 1.6 6 56-96 10YR 6/4 s Osg ml 0.7 1.6 ❑ Boring # E]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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2 Boring F-I Boring # Ground surface elev. ft. Depth to limiting factor in. Pit 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Test (R.07/00) 040-1064-10-000 Property Owner Paula Estlund Parcel ID # 040-1064-70-100 Page 3 of 3 r' SITE PLAN e{~ ~ ` - 4 r:. ~ 1 \ \ - \ A ` 8 x. n OGDEN ENGINEERING CO. DANIEL P. KUGEL CS #250693 Civil Engineering & Land Surveying / 1234 S. Wasson Lane, River Falls, WI 54022 DATE: (715) 425-7631