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HomeMy WebLinkAbout020-1305-10-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 597412 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: Donald Rindo TOWN OF HUDSON 020-1305-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: e_V--~-- 11/12.29.19.1519 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benc mark a~ , ~0?• Alt. BM 3. Z) /66 4") rr P'r"j y Zgo C74 Goy Aefe"n Bldg. Sewer, t of 1 i Holding St/Ht Inlet f • TANK SETBACK INFORMATION St/Ht Outlet 77 TANK TO 4.~/t WELL BLDG. a Air Intake ROAD Dt~~ Q Septic -7 S6 Oi.Bekesn TI f a D Header/Man. g • tP • Q$ Aeration J Dist. Pipe "I CY Holding Bot. System 4 g 3 : n (ol ~ • PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM 3' o ib~ Model Num TDH Lift u em Head TDH Ft ry, - Forcemain Length Dia. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Lengt4 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia~.- Liquid Depth DIMENSIONS 3 Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer•T.Ip ~r^• INFORMATION CHAMBER OR , a Type Of System: 4Z '3.7 ®O UNIT Model NumAr: , !L o,n.J r o ~ a DISTRIBUTION SYSTEM I.Je5t- •Z : tO'A-L zz a rLe eader/Manifold 11 Distribution Ix Hole ize Ix Hole S acing Vent Air In ake Pipe(s) ~ Q n gth Dia_ Length Dia Spacing ` Q SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center 6' '1 Bed/Trench Edge Topsoil Yes ~ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1075 TANNEY LN~i r G~ ~•t ~OG.1~ 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes D Use other side for additional information. >11 Date Insepctor's S' nature Cert. No. SBD-6710 (R.3/97) RECEIVED 2> CB78 county JUL 19 N' 2 46QDEB61 . oux 1162 Sanitary Permit ttfmberto fled inb}'Co.) T 4 P. » S-r. CROIX COUNTY madison, W1 53707-7962 Sanitary Permit Application Stare Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit A) is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Proje Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary pinposes in accordance with the Privacy Law, s. 15.041 m , Stats. L Application Information -Please Print All Infor Property er's Name ! Parcel # 0d0- 3 0,5 -r I Property Owner's Mailing Addr s Property Location _ / a~ 19 _ 19 D 7. 5 J Govt Lot City, fate Zip Code Phone Number 5-, I Section (X,/ 1 /n (circic e II. Type of Building (check all that apply) 5V LrA/ T N, W 1 or 2 Family Dwelling-Number of Bedr Subdivision Name B r, ❑ Public/Commercial-Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 2. w ZZk-- z- Town of v~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' [A,,, System t 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 Permit Number and Date Issued Before Expiration Owner Z $ 3 W. Type of POWTS S stem/Com onent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Hold g Tank Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rat dsf) Dispersal Area Required (sf) Dispersal Area jo sed (sf) System Elevation VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U New Tanks Existing Tanks ' / s; d u m W o ~ m U vm v~ L Septic or Holding Tank v P&V 2.200 r7 Dosing Chamber L- VII. Responsibility Statement- F undersigned, ass a esponsibility for installation of the POWTS shown on the attached plans. PI Name (Print Plum a Number Business Phone her Plumber's Address City: fate, Zip VIII. C tv/De artment Use Only p 'roved sappro Permit Fee Date sued Issuing . Signature er Given Reason for ial 5 [ v ✓ 712411-7 Q /Z DL Condit3gW6QVAp V easons for Disapproval L 4.1 1. .5epti~ tack, e far sn; i iltF r a,.n.i 3) d v u Spers,l cell must all be s , rc s ! nt 'r ec *S per management plan p side i uv plu,nbet. Q~f-tp 2. `AY ill~billrlc'iregtenes;rrttJrt t,~ r-l~irrt ir':ed Attacb to complete places for the system and submit to tie Coup only paper not less tban 8 in x I I Aches in sin SBD-6398 (R- 11/11) V System PLOT PLAN PROJECT Donald Rindo ADDRESS 1075 Tannev Lane Hudson Wi 54016 ST. CROIX SE 1/4 NE 1/4S 11 /T 29 N/R 19 w TOWN Hudson COUNTY SYSTEM ELEVATION 93.5/93.2 5.5' below grade DATE 7/18/17 BEDROOM 4 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter BOREHOLE O WELL *H.R.P. same as benchmark Tanney Lane ~ C~aln~ = 1 /d" = 1 n, Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12 Grade at System Elevation 34" W 2-3' X 90' cells with >3' spacing 60' 118' To be >3' from exising system B-3 21' B-2 9-5' 5' Huffcutt 280 ST Vents 5 Existing 4 T Bedroom 45 B-5~ 8' X 40' bed 15' House Vent Valve 95' _ B-1 B-4 8°Io Slope I Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/19/17 Owner:Donald Rindo Location: SE1/4 NE1/4 S11 T29 N,R19W 1075 Tanney Lane Hudson Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Leaching Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Cross Sectio 8. Existing Septic T n m Signature License n ber 226900 System PLOT PLAN PROJECT Donald Rindo ADDRESS 1075 Tannev Lane Hudson Wi 54016 SE 1/4 NE 1/4S 11 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 93.5/93.2 5.5' below qrade 7/18/17 4 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter r ❑ BOREHOLE O WELL -H.R.P. same as benchmark Tanney Lane Scale = 1/4" = 10' Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps Long 12" Grade at System Elevation 34" Well 2-3' X 90' cells with >3' spacing 60' O 118' To be >3' from exising system B-3 21' B-2 95' 5' HHuffccutt 2280 ST Vents 5' Existing 4 T Bedroom 45 B-5~ 8' X 40' bed 15' House Vent Valve 95' B-1 B-4 8% Slope Property Line All piping shall be ASTM SDR 30/34, within ip~mg 10' of tank, piping shall be ASTM F891 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 0 Vent ACI G rade '**~4 Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1 5' S' Long 1 Grade at System Elevation 3 6 " Grade at System Elevation v Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A &9-62 9~- -J' B_8902-' z ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/]Buyer -Do a c a- Mailing Address Property Address (Verification required from Planning & Zoning Departamt for new construction.) City/State Parcel Identification Number QdQ /D LEGAL DESCRIPTION e Property Location '/a Sec. , T ~NR V- A L W, Town of '1A ri e't;1- IL Subdivision N Lot r f Certified Survey Map # Volume , Page # Warranty Deed #w .1=. , Volume L✓ I_., + Page # Spec house yes Lot line` identif iabl yes no SYSTEM MAINTENANCE AND OWNER CERTMCATION Improper use and maintenance of your septic system could result m its premature failure to haisdle wastes. Proper mamtenance consists ofpunipMg out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the fi mchon of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibes 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fortes, herein, as set by the Department of Commerce and the Departr aent of Natural Resources, Stage of Wisconsin. Certification stating that your septic system bas been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of 762ny deed recorded in Register of Deeds Office. Number of b ms 1~7 SI IIU 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. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a O a ❑ NA Permit # Septic Tank Manufacturer ` 3ESIGN PARAMETERS Effluent Filter Manufacturer t ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility UnitsA Pump Tank Capacity a1 NA j Estimated flow (average) 5 ~ aVda Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) ~0 gal/day Pump Manufacturer NA ~-1 Soil Application Rate / avda /ftz Pump Model NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats,'Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dis ersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) . Total Suspended Solids (TSS) G30 mg/L ~NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m ❑ Drip-Line ❑ Other. !Maximum Effluent Particle Size Ya in dia. ❑ A Other. ❑ NA (Other: NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent Other: ❑ NA AINTENANCE SCHEDULE Service Event Service Frequency month(s) linspect condition of tank(s) At least once every: ~j 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 cell(s) At least once every' ❑ month(s) ear(s) (Maximum 3 years) ❑ NA 3Atly Clean effluent filter At least once every: month(s) ❑ NA ALOar(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA . ❑ year(s) 19ush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Dther. At least once every: ❑ month(s) NA ether: ❑ year(s) NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: aster Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspection must iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ic;ombined 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 or more of the tank volume, the entire contents of {:he tank shah be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin 14dministrative Code. Ill other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. Ik service report shah be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION uCts oftw chemicals thr{t For new construction, prior to use of the POWTS check tre matent tank(s) for the presence of painting prod may impede the treatment process and/or damage the -dispersal cell(s). If high concentrations are detected have the contents of thO 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 ble discharged to the dispersal cen(s) in one large dose, overloading the oll(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 withln 15 feet dam 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 POWf.113: antibiotics; baby wipes; ciganKte 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 produc ils; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS faits and/or k, permanently taken out of service the following steps shall be taken to insure that the system is properly and safety 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 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 sail, . 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 node ccmpGi~nt 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 requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the ncled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule;I 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 POWTS. site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalua#on 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 time failed POWTS. ❑ Mound and at-grade soft absorption systems may be reconstructed in plane following removal of the biomat at the k itrative 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANIF UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name E Name Phone / J oZ Phone SEPTAGE SERVICING OPERATO (PUMPER) LOCAL REGULATO Y AUTHORITY Name Name -i 4~i.l' Phone - ~J 6 Phone / This document was dratted in o0mp6ance with chapter SPS 383.22(2xb)(1)(d)&(f) and 383.,54(1), (2) & (3), Wisconsin Administrative Code. i W a a j r I ~ ~fltiliik i _ i j iL a qo a i f ' i .i i La ! 00 ~r i ! ST. CROIX COUNTY ZONING CERTIFICATION pFFIC~ FOR UTILIZATION OF STATEMENT AN EXISTING SEPTIC TANK to certif Y the :,ervin I have nspeCted g e th the septic tank - present..Lir N- _ se resi coon.., T ence located st:: N Ft W, Town c; f: the tank Upon inspection, T , and baffles to be certify that I have foturjcl f"nct.ionin9 in goad condition properly. and it appears to he i..'d st time serviced: P4.2 _ 0 l)id L-low back occur from Yes Nabsorption system? (If no, skip next Approximate volume or length of timer l ine). e~ ''rIpacit-y: gallons C'onstr-uction : Prefab Concrete r'1'aillufacturer: Steel Other (If known) : Age of Tan If known 9IC2 / {Si a re) (Name) Please print mt,,9) V ? . (License Number} 1) a to t'aL-In to be completed b Statutes) or License by licensed plumber Code} d Disposer (NR 113 (s.1.45.06, Wisconsin Wisconsin Administrative !'Lumber (applying for sanitary p Cri ermit certification: accepting the condition, I above statement regar ' certify that the tank to th g existing septic tank conform to the requirements of LHIR 8 est of my knowledge w.il.l 1f1spection open n over outlet baff 3' is• Adm. Code ( except for lvanle~. Signatu MP/MPR5g0- j'`v / i 184,613 SO. FT. I X23 3~, / cP 10 1 h~ \ 9 1 812, T ;D DEDICATED K, gNNEY- TO T"E 5 21 . I-A E 330.4 ~ _ 22 zo _ 3 SII°4800"W LOT -..14 • 66.00 .O~ 2.85 AC. 123,933 SO. FT. 'to PLAT LOCATION LOT 15 SECTION SEC" pp 2.95 AC, p0' I I T29N', R19W I' 2eE 126,376 SO, FT. v v zz NWI/4 NEI/4 -NWI/4 903 1 365.00' 1 110.00 Fl/4 CORNER SWI/4 S EI/4 - SWI/4 1 SECTION II C~96lNCiaCti, ~3o w r J _LEN NY~-~;aL~ ~ 457 Z 1 z i;L`CSD 1, a la- McCLLTCi-IEON ROAD °~a Np ~ul~"~' SCALE IN FEET • 200 100 50 0 I( r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor ind Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX Sanitary Permit No.: GENERAL INFORMATION ATTACH TO PERMIT) 268561 Permit Holder's Name: City ❑ Village Town o : State Plan ID No.: MILLER, SAM HUDSON CST BM E ev.: Insp. BM E ev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - . r- CSC. Benchmark Dosing V a . Z) A'. ©~79~ Aeration Bldg. Sewer Holding St/)K Inlet (0,33 901./d~ TANK SETBACK INFORMATION St/ I# Outlet G,(W y/~ TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet irl Septic 0 a 7 NA Dt Bottom Dosing NA HeaderlAftm Aeration NA Dist. Pipe -7 ` 9Y 97 Hojditig Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer DemandF ? 1 S. 3 a9' 9Y, / Model Numb GPM TDH LTfi Fri 1 S stem TD Ft Forcemain Length Dia- Dist_ To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 8 / Length'/, No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ENSIONS Y anu adurer. SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM~ INFORMATION Type ne'w 11 CHAMBER.- o e Num gv System: ' ci "'7dcJ 3 °J OR UNIT DISTRIBUTION SYSTEM Header/Manifold N Distribution Pipe(s) zI Hole Size x Hole Spa Ty-e,t Intake Length ((/J✓ Dia Length ~s Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At- a System` ibMy--•.~.> ' Depth Over Depth Over xx De xx Seeded / Sodded T xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes 11 No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hp/UDSON.1op2.29.19W, SW, NW, TANNE~Y/LANE a '5,~d ~,VyK-, Jr~/~ t4 Ida -1/-- Q c y p,P.P? GC ,,y~~. o~ tom' t 1 Plan revision required? ❑ Yes o Use other side for additional information. So SBD-6710(R 0519 1) Date Inspector',Signature Cert. No. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3- Labor t i4uman Relations Divssion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code < COUNlY Attach complete site plan on paper not less than 81/2x 11 inches in size. Plan must include, but ) -f,6 Ix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance Wtone PPLICANT INFORMATION-PLEASE PRINT " REVIEWED BY DATE A PROP RTY OW R: P TY LOCATION p Q ~jAM /L(,~~ J t rF~~f• GO %T 15,t- 1/4N/k 1/4,S T Z / N,R /9 E(or)W PROPERWOWNER':S MAILING ADDRESS LOT BLOCK#k SUBD. NAME OR GSM TANNty ~Gr CITY, STATE ZIP CODE PHONE NUM ❑C PILLAGE OWN NEAREST ROAD New Constriction Use I,# Residential / NumbBt oof,ISe; [ ] Addition to existing building j ] Replacement j ] Pubic or commercial dens ' ' Code derived daily lbw gpd Recommended design loading rate bed, gpdfft2 trench, d1ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/0 trench, 2 f Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations - A e-Ui4Y/ -j bOut FtaR I-, AAi° r2O .KL Parent material Flood plain elevation, if applicable It S s Suitable for system 19VENTIONAL MOUND IN ROUND PRESSURE AT GRADE S TEM IN FILL HOLDING JANK U= Unsuitable for stem S❑ U 91" U RS ❑ U S ❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounctiry Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed tgrx h INNEREM AQ -3 ! log/ D3' 2 L j m 'r-,r r►~i r C m 6 •S U , Ground $ 1-124 16 Y 4 4 S r 0 ,1 $ qe06ft. Depth to limiting factor > ~D.33 I Remarks: Boring # O-fn /o~ 3 2 L 1 s~~ yy~r / q l .S 9J aZZ 7sYe 414 e w 0,4 0 . now B1 L-2-39 16ve- 4 s C) 9 tvl Ground I It Depth to 1 II limiting Remarks: T Name:-Please Print Phone: A2v'EY UN N-►°%J est.: .Q. ~ U~Sp~ / CST ftnature: Date: fl J~ 94 Number: /p~ PROPERTY OWNER SAM AOL(Af- SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Lcm1Q' `rAtvtuCY ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax lary Roots GPD/ft In. Munsell Qu. $z. Cont Color Gr. Sz. Sh. Bed rer 3 0-g /o ae / c m 7-,4 o. q-/7 Si L 1 m qg k M Tr C tw 0 0.3 Ground 17-46 1 D e 4 S Q r 4, C w 0.1 (5.% elev. S,C I S~~ ~r Cw 6zl:.b,3 2.~vs v 3 c 2a Depth to 8 .2S Dy a/ S r n~ 0.7 '•;0.8 limiting 1 factor Remarks: Boring # r_ mVr 2- 0,4 0S 1b-24 k4 4 S,L I 6k rnl~r Cw Z o3 Ground $2 4.43 2.SY4 4 - S,L MSbk n,Tr cw 2 0.3 9 77- fL g 3-6 10` e, 4 9 S r n, I C w a,~ 's0 Depth to t_12n \ oe 4~3 s r limiting factor 71.D;Q~ Remarks: Boring # - is L. / n t-!~ m C S IT o h o S 1& 32 16,14 414 S ; C 1 'h S .b K rv, ~Fr c w 0 . Z 0.3 Ground k 414 S © rv1 C~,? €0.$ `1 hz fL j i Depth to limiting tt factor > ,1 Remarks: Boring # I Ground elev. it Depth to Nmiting factor Remarks: SEINW0(R.05M) 14NNt Y ~4A/e PAZ, 3 of 3 ' ps►~cillhwR,c _ 2 A-r IJ0 2T ►.LJ &5T Lem C.o'Q►a L',2 i i 9s _ - - - _ _ g ' e Ar rv) ~I I 101, Zo~, Zo1D~ 5~,az~ I = 3a'