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HomeMy WebLinkAbout040-1306-04-000 Visconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix safety and Building Division Sanitary Permit No: INSPECTION REPORT 597404 1 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No, Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: CREATIVE HOMES TOWN OF TROY 040-1306-04-000 ;CST BM Elev: Insp. BM Elev. BM Description: t Section/Town/Range/Map No A) ~J &7~ 4fe) (1041-_ 08.28.19.1831 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic l Benchmark / /h.00 g Alt. BM ^ 3, (UL • D Aeration Bldg. Sewer p~ - Hol St/Ht Inlet l 6 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. Vent to Air Int e RO D Dt Inlet Septic ~ `-IC 0 IDosing Header/Man. L~ 1 Aeratio Dist. Pipe Holdin Bot. System Final Grade PUMP/SIPHON INFORMATION 5.3 ((o,OO Ma facturer mand St Cov ~.4 lot, lo Rry G -q odei Num r `TDH Lift ion System Head TDH Ft Force main ength Dia' SOIL ABSORPTION SYSTEM BEDITRENCH VVidth~t LengltLD No. Of Trenches PIT DIMENSI S Ne..Of Pits Inside Dia Liquid Dlepth DEMENSIONS r~ SETBACK SYSTEM TO P/L BLDG WELL LAK /ST M LEACHING Manufacturer INFORMATION CHAMBER OR ~l T e Of System. 1 ~I UNIT Model Num DISTRIBUTION SYSTEM Header/M`annifold Distribution x Hole Si e x Hole Spacing VIntake Pipe(s) 1k Length Dia Length Dla~ Spacing V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only IDepth Over Depth Over xx Depth r xx Seeded'Sod led xx Mulc d jBed7rench Center Bed/Trench Edges ` Topsoil \ ~ Yes No Yes i E COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2: Location: 468 DYLAN CT r _ 1.) All BM Description = d~t~4 Loco On 2.) Bldg sewer length= - amount of cover = 1 jyj It +~'~OC~C Plan revision Reqwired m Yes No / _ - - Q Ip 1 G v Use other side for additional formation. Date L7sionat re Cent No. SBD-5710 (R.3/97) s 4. ty~ ? Ji =<1 Safety and Buildings Division Coun 201 W. Washington Ave., P.O. Box 71/'" anitary Permit Number to be fined in by Co.) Madison, W] 53707-71 59 7 zr a yt Sanitary Permit Application A Numbpr f? In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governor I (!r7 is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS at the Department of Safety and Professional Servies. Personal information you provide may Project Address (if different than marling address) + oses in accordance with the Privacy Law, s. 15. 1 in , Stats. y be used L A heation Information - Please Print All Informatio ~t ~i c~ Property Owner's Name 1 ~ Parcel # Property Owner's Mailing ~ dress n Property Location 1 M ~`f Glad'. City, State Govt Lot Zip Code Phone Number ) It 'IlJ . ! L /a Section a~ J l , cle n IL Type of Bailding (c k all that apply) Lot # T~ N; R E W or 2 Family Dwelling Number of Bcdroo Subdivision Name Block S )i El Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number Village of \ b~ vim/ 2!. ~zZ G~ own of tr+ 111. Type of Permit: (Check only on box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous P Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a t - 'ion-Pressurized hr-Ground ❑ Pressurized In-Ground ❑ At-Grade 5 ❑ Mound > 24 ire. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Otber Dispersal Component (explain)_ ❑ Pretreatment Device (explain) / V. Dis rsaUTreat ent Area Information: Design Flow (gpd) Des, S l Application Rat dsfl 4ox l . Cti Dispe •ai Area Required (sf) Dispers oposed Csf) System stem Elevavation ^ S Z VL Tank Info Capacity in Total # of r r Gaflons anufacmrer Gallons Units New Tanks Existing Tanks InJ s M t. 1 v n v Septic c- C, a Holding Tank - Dosing rbamber VII. Responsibility State a t- I, the undersigned,, me responsibility for installation of the POWTS shown on the attached plans. Pmt miler's Name (Print) s Signature MP/MPRS Number Business Phone Number Address (Sweet, City Statep Z 6 J-d VIII tv/De artment Use Only = Approved ❑ Di rove Permit Fee Date sued Issuing - Signature Giv Reason for Denial y $'S, cp 7 I~ l7 IX Condrtl 1 r` at. , 6i lGn¢llft wpprovai uisper.:t,i cell must ell be c s ! nt4 er 3 as per i-nar.agement plan p:o ridelt ov alumbe; • 2. 'At;Att~r*V' atilV=9nmmustue .Egntcire! as por Gill s wdf-, / zrdinano°'r. Attach to complete places for the system and sabmit w the County only oa papa not less than 8 i2 z I I inches in sift l SBD-6348 (R. 11/11) System PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 SW 1/4 NE 1/4s 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.8' 5' below grade DATE 7/9/17 BEDROOM 4 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE r HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Ground at lot corner ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P, same as benchmark Z41, 10 A-L v~ai°c = i i ii = i Oi 10' B-1 2% 1 e 110' B-3 1 220' Property Line B- 20'. ST Pro 4 Bedroom House Vent >6„ Quick4 Standard All piping shall be ASTM SDR 30/34, within Leaching Chamber 10' of tank, piping shall be ASTM F891 of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps 11 4' Long 12 34" Grade at System Elevation Cover Page Shaun Bird Bird Plumbing inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/9/17 Owner:Creative Homes Location: SW1/4 NE1/4 S8 T28 N,R19W 468 Dylan Court Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Leaching Chamber Cross Section 4-6. Maintanance n ontingency Plan 7. Filter Cross Se i n Signature i License numbe~226900 System PLOT PLAN PROJECT Creative Homes ADDRESS 707 Commerce Drive Suite 410 Woodburv Mn 55125 SW 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.8' 5' below grade DATE 7/9/17 BEDROOM 4 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE r HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Ground at lot corner ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 10, 10Scale = 1/4" = 10' B-1 50' 2% Slope 110' B-3 100' 220' Property Line B-2 20' ST 30' r Pro 4 Bedroom House Vent >6„ Quick4 Standard All piping shall be ASTM SDR 30/34, within Leaching Chamber 10' of tank, piping shall be ASTM F891 of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12 34" Grade at System Elevation Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1, above grade Finish grade elevation Typical Installation 102.0' Vent Grade Vent 3' 4" 3' .A~30/34 Septic Tank 5 ' Long 1 I 5' S' Long 1 Grade at System Elevation 3 6 " Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: A 97.0' B-96.8' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity S S a ❑ NA Permit # Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer Allr ❑ NA Number of Bedrooms Z ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity al ❑ J. NA Estimated flow (average) q06 gal/day Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) 6 6o gal/day Pump Manufacturer NA Soil Application Rate , avda /e Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats; Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA 13 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other. ! Pretreated Effluent Quality Monthly average Dis rsal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids JSS) 530 mg/L ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) s104 cfu/100m1 ❑ Drip-Line ❑ Other: !Maximum Effluent Particle Size :k in dia. ❑ NA Other. ❑ NA (Other. NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent Other ❑ NA IAINTENANCE SCHEDULE ? Service Event Service Frequency ❑ month(s) linspect condition of tank(s) At least once every: ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA (Inspect dispersal oell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) / C,7 month(s) Olean effluent filter At least once every: ear(s) El NA nspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) s) 1 :1 1=lush laterals and pressure test At least once every: [I ❑ year(s) month( NA ether. ❑ month(s) At least once every: ❑ year(s) NA I~ther. 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 Iegulatory authority. ,When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of :he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. I NI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of <12 months, shalt be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals tl*t may impede the treatment process and/or damage the..dispersal cell(s). If high concentrations are detected have the contents of thp tank(s) removed by a septsge 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 ble 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 *0 effluent pump or pct 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 withln 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 POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; dis'infectants', fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting Produc0s; 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 propetly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Cade:. • 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 property 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 ff the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compfisnt replacement system: -~A satiable replacement area has been evaluated and may be utiiized 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 requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nged for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the miles in effect at that time. 13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWrS technologic a holding tank may be installed as a last resort to replace the failed POWTS. 13 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. 0 Mound and at-grade soil absorption systems may be rued in plane following removal of the biomat at the infiftfive 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 TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS S INSTALLER POWTS MAINTAINER L Name r j , Name v Phone .i~_ I _ 7 hone E P J~ 7 SEPTAGE SERVICING OPERATOR MPER LOCAL REGULATORY AUTHORITY Name Name _57~l Phone t Phone _ r This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383..54(1), (2) & (3), Wisc=~ Administrative Code. t a a Il i L ~ 141~fSIl j ~ I~ ii~ii!Ilt r . ZA a - - IL o , a ao a ip 10 1E( 1 o i CD h 'y i C~ v S~ L i i I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address t % ~v r L~ lf/ Property Address C~ DL. (Verification rcq ' om Planning & Zoning Department foftjv construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location~Le-) V., V4, Sec. , T N R _W, Town of / E7 c~ Subdivision ~L/ dI' s ~'i E'~r✓ Lot # Certified Survey Map Volume Page # Warranty Deed r , Volume Page # l Spec house yes no Lot line- identifiable (f(*) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maiiftnance consists of pumping out the septic tank every three years or sooner, it'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 wasLv disposal system. Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by 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. 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retuned to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a deed recorded in Register of Deeds Office. C Num r of edrooms SIGNA 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 wazranty deed from the Register of Deeds 0fce and a copy of the certified survey map if refm== is made in the warranty deed (REV. 08/05) lot v-4 %0 40 0 Pni AA 7 4.77' og; 000 `fir k~ i • ~fi AX ill ry ODD I N iZ • JL W rJ CV 6~ CO) h / rt +CD ~ rr] ~ ctil 0 L3 u- 1322.98' r-, S W 5V4 6 D*y 7: 77 / N W'461W 1 I CSM VOL,. b PAGE 1653 CSM VOL, 10 PAGJ f LOT 4 LOT f 5 1 + 0 1 SE :g YY Ma1A lasWs !Y lol ld CJ6 LLI H7210d'i - e 3 ~'e d € ~ ~ j y g "M 11M 1N3.35I. - - O wI ~ ~ e~~~F4 s$ £"b F @a H t 91oilS IM 'NoGanH w w p 'lj'06 LIL ~30VaVO I- ~ ~ n m s @ Y g"~ p ~4 E ~p $ 1. 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Code Attach complete site Ilan on ARer ~Ot;ess` i'a t 8 1/ County x 11 inches in si Plan must include, but not limiteto: vertical and horizontal reference point (E`.1), direction and Parcel I.D. 0 percent slope, scale tr dimensions, rcrth arraw, and fccr"t cn anc dis'ance to nearest road. Please print attirrfefFhation. Reviewed by Date Personal information you provide may be used for sescndary pur~cses (Prvacy Law, s. 15 04 (1) (m)). 1 2)0 S- Property Owner I Property Location C~ 1 t_ i~ ~~au:et S~~ 1/4 N E 1/4 S T u N R E (cr) I.,/ Property Owner's Mailing Address Lot Block # Subd. Name or CSM# - 3 City State Zip Code Phone Numcer City ❑ Village 21 Town Nearest Road New Construction Use: ® Residential / Number of bedrooms - Code derived design flow rate C - OCR - GP" ❑ Replacement ❑ Public or commercial - Describe: Parent material G t_y~C 11~ L C~ U7 Flood Plain elevation if applicable I~ h1 General comments and recommendations: L-) f u'c L_ l~ t 1 1,j t_ fi RJR 1~ iz i~ a Boring # ❑ Boring ❑ Pit Ground surface elev. - ft. Depth to limiting factor 7 ~ 0 o in. i So.i A.ppiica?~cn P,a;= V~ Horizon Depth Dominant Color) Redex Descripticn Texture Structure Consistence Boundary P,ccw j GPDrft in. Munsell Cu. Sz. Cont. Cclcr Gr. Sz. Sh. i T I I I ~ I Boring Boring # ❑ a ® Pit Ground surface elev. (U ft. Depth to limiting factor in. Soil Applicat;cn Rate Horizon Depth Dominant Color Redox Descipticn Texture I Structure Consistence Boundary Roots GPD/ftz - in. Munsell Qu. Sz. Cont. Color Gr. . Sh. 'Ef #1 'Eff#2 Z t 10 3I ' i ~ ~P S ~ S g ~n ~ I t- • I~ i i 1,7 Effluent #1 = BODS > 30 < 220 mg/L and TSS >36'< 150 g/L ' Effluent #2 = ODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ign ture CST Number Arthur L. tlegerer CL 03 Z 1S - 220254 Address t:I e g e r e r Soil T e s t i n g & Design Service Date Evaluation Conducted Telephone Number 4 2 1 N. Nain St. River Falls, tdI 5 4022 715-425-0155 qL Property Owner L T Parcel ID # ~k~r%. iN-)J -V Page a Boring # ❑ Boring of © Pit Ground surface elev. Z• ft. Depth to limiting factor b Hin. orizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soll Application Rate in. Munsell Qu. Sz. Cont. Color GPD/ft Gr. Sz. Sh. 'Eff#1 "Eff#2 1 ~ _ Z Z 10`1(2.- 3 /Z ~ ~ 1 { Z w, S .~~Z yyl • i 'r- C ~ vSg ~i - ►.Z a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate in. Munsell Qu. Sz. Cont. Color ry GPD/ft Gr. Sz. Sfr. "Eff#1 'Eff#2 100.00 a 9f lou ❑ Boring # ❑ Boring ❑ Pit Ground surf: In. Horizon Depth Dominant Color F Soil Application Rate in. Munsell :nce Boundary Roots Q GPD/ft2 'Eff#1 •Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODY < 30 mg/L and TSS < 30 mg/L 'I7ie Departrment of Corrurrerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact lice deparlruent at 608-266-3151 or'ITY 608-264-8777. SBD-8330 (1.6/00) L "r Property Owner parcel ID # j ❑ Page of ❑ Boring # Boring ® Pit Ground surface elev. ft. Depth to limiting factor 7 V in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate in. Munsell Qu. Z. Cont. Color ii Gr. Sz. S h. 31 i ~11t S ~r~-I 1" C.IiU ^Effj#1 `•E) f#2 U %9 f ,I n Boring # ❑ Boring -J ❑ pit Ground surface elev. ft. Depth to limiting (actor _ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD ft2n Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Ef(#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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `E(f#2 ` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 rng/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L "I7re Departnient Of Couunerce 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 YFY 608-264-8777. SIM-8330 (R.6/00) Wisc.onsMDepai'mentof Ccr7merce SOIL EVALUATION REPORT Division of Safety and Buildings Page cf in accordance wits, Co,;,r, 2 s. Acm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P !an must County include, but not limited to: vertical and horizontal reference point direction and percent slope, scale or dimensions, north arrow, and I=itucn anc cistar,ce to nearest road. Parcel I.D. `P J\ \ Please print all information. Reviewed b Date Personal information you provide may be used for se: ;ndary pur,;cses !Prvacy Law, s 15.04 (1) (m)). Property Owner ~ I -Prcpemf Lccaucn J 5W 114 N)El A S T v N R E (cr)'~, Property Owner's Mailing Address Lot # Block Subd. Name cr CSM# Ctty State Zip Ccce Phone Numcer I City ❑ Village ~ Town Nearest Read New Construction Use: Residential / Number of bedrooms - Code derived design flow rate O - yU0 GPc ❑ Replacement ❑ Public or commercial - Describe: Parent material G Lti~CI ~ S~ ;.vY~ ,=rood Plain e!evaticn if applicable N 1`1 r General comments and recommendations: ~ Jy 11U f Lam, ~.F-~-JR L 1 r Boring # ❑ Boring ® pit Ground surace elev. Depth to limiting factor ? Q b in. i A Horizon Depth Dominant Color Recex Deso^pucn Texture Structure Consistence Boundary Roos Sci GPicartO P,a in. Munse!I Ou. Sz. Cont. Ccicr Gr. Sz S 3 42 C) 14,rL VAI - I ~ I I I I I I I Boring # ❑ Boring L ® Pit Ground surface elev. Depth to limiting factor L S in. Soil Application Rate Horizon Depth Dominant Color Redox Description I Texture I Structure Consistence Boundary Roots GPD/ftz in. Munsell Cu. Sz. Cent. Color Gr. Sz. Sh. 'Ef n1 'EfrY< 0-17 1 oLt R-31 !0`~IZ - , `7 I Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) 1 Sign ture CST Number Arthur L. Edegerer x, 03 Z 1S - 220254 Address 4,i e g e r e r Soil Testing & D e s i. n Service Date Evaluation Conducted Telephone Number 421 N. iiain St. River Falls, E-,-,1054022 _ZZ-03 715-425-0145 PLOT PLAN Page or Scale 1'= gam) I B•I 7 ~d d ; ylj/ \ Hof ~jz D, LG~1J~~1~ . ~~C` P 01 tv ti Or= C'JV2V 715-425-0165 220254 CST Signature Date Telephone ,,To. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Countyt r Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Oyrner Property Location Govt. Lot-~~ 1/ 1 14 S T N R1q P/)'~Q/ Property Owner's Mailing Address Block # Subd. Name or CSM# i a~i /cam ~U E' J i E? City T State Zip Code Phone Number ❑City F:lVillage wn Nearest ad r I-) New Construc on Ls Residential / Number of bedrooms Code derived de i flow rate U GPD ❑ Replacement s ❑ Public o ommercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations eY r; nC ~--t Boring # 11 Boring I ) I 171 pit Ground surface elev. W ft. Depth to limiting factor --~~---L-~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 * ff#2 /4 Boring # Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication 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 = B > 30 < 220 mg/L and TSS >30 < 150 mg/ * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L `CU,Name (Please Print) N ber Address to Evaluation Conducted Telephone Num er