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HomeMy WebLinkAbout020-1411-05-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 597421 Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 1 m State Plan ID No: Permit Holder's Name: Cit Village Township Keith Bloomquist y Parcel Tax No: TOWN OF HUDSON 020-1411-05-000 CST BM Elev: Insp. BM Efev: BM Description: Section/Town/Range/Map No: Ova- 13.29.19.2575 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (JCS Benchmark Y4, 1 .15 0 Qaw-. ' ~ Alt. BM G eration , _ •as Q A 1, -7 / Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet 7.4 "1 3* TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. at~ 77 9S, a Aeration Dist. Pipe Holding -7--7 0 Bot. System 4,`r q7.0 o~C PUMP/SIPHON INFORMATION Final Grade 3.? /03 Manufacturer Demand St Cover Model Nu er GPM Z Q ~6 ~ TDH Lift ead Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 4en; th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S ETBACK SYSTEM G EM TO P/L BLD WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T ype Of System- ~t CHAMBER OR c7 Z~ -1715 UNIT Model Numb C4 S. DISTRIBUTION SYSTEM Header/Manifo16 1 Distribution Z Ix Hole Size., x Hole Spacing ent tQ Air Intake P pe(s) flJ~-~1e~ `L S iLength-/D- Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over T-)o(Depth of xx Seeded/Sodded Bed/Trench Center 95 Bed/Trench Edges soil xx Mulched p Yes No Yes L~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 830 HILLSIDE TRL F. 1.) Alt BM Description = 2.) Bldg sewer length = 6 L 6644A.., L~ -;;p" -amount of cover = ' Plan revision Required? ❑ Yes o 17/ ~ L Use other side for additional informa on. Y SBD-6710 (R.3/97) Date Ins/Sigg Cert. No. .00 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Stre t ddress) '53 4'l 4, . at: 1/4, D(,J 1/4~ ection located Town of /3 , Town Z9 N, Range W, fan , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service .J ii N C 17 Did flow back occur from absorption system? Yes-x No (if no, skip next line.) -*21 Approximate volume or length of time: - gallons Tank Capacity: 060 minutes Construction: Prefab Concrete- Steel Manufacturer (if known): Other Age of Tank (if known): S Permit number (if known) (Lice s ber Signature) (Print Name) (Title) Z- (License Number) M MPRS a~ (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 p~++ County R V Y rely and Buk"s Division I ` 201 W. Washing Ave., P.O. Box 7162 Sanitary Permit Number (to be tIllad in by Co-) a ,.fe fiA 53 -7 !9V0(jX6'f'rGJWRj Staw Transaction N AA+ >ti accordance with S 2iRwi s. Ad m Code, am of this fay to the spprrpaiste governmental unit is required prior to obtaining a sanitary permit Note: Application farms for state-owned PO'R'TS are submitted to Project Address C dafferetd than 'nailing adds the Department of Safety and Profegaionsi Servies. Personal information you pmvidt may be used for secondary zg2n Q is W,=det ce with the 1.ew s. 1§. I m1, Stara. /.~-,~el I. A lkat*x Information - Flew Print All bfarm Property Owner's Name Parcel U S i C~Z4 d~ ('X.1Q Property Owner's Mailing Address Property ration 13. a 9. 17. 67 75 ,>3o ~ ILLS 1 DIE city, stw zip Code Phone Num vs Section T _~~E 13 V:%fijy~ Bding (chec k all that applLot welling - Numbs of Subdivision Naar ❑ PubliclGo¢ntnerciai - Descabe Use ❑ City of ❑ State Owned - Describe Use CSM Number 13 wage of Z ► ~ own of l1 >D~ 1y' III. Type of Permit (Cheep duty one box on fine A. Complete (toe B if applicable) A. ❑ New System System ❑ TreanneatfHolding Tank Replecc rmt Only ❑ Other Modification to Existing System (explr B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Dat; Issued Before-Expiration I N03609 Owner 3 u IV. Type of POWTS 8ystem1Comp2neatADeviee: (Check all that apBW) jWNon-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable sail ❑ Mound < 24 in of suitable soil ❑ H mg Tank Dispm,,W Campoent (exPlain) ❑ h?q Device (explain) V. IAi$ r eat Area Information: t 1 DelWE (gpd) Design Sail Application RatdAp/d Dispersal Area Req isf) Area Propor System Elevation 16 I W / e VI. Tank Info Capacity in Total # of Nfaludsoturcr (iallons Gallons Units New Tales Ensting Tanks o`. C3 ~ ~ rn ' a. G7 5qp& or Holding Tank C ~ , Dosing C h mbar VII, Resp oasibility StnUment- 1, the undersigned, assume responsibility for installation of the PQiS'T5 sh on the affachM plans. Plumber's Name (Print) Plumber's Si c 13,,5 N ber Business Phone Number Plumber's Address (Street, City, Stine, Zip Code) UJI nf 4 men Artment Use WY r-4-1 FAff roved 11 Praait FM Dawsignature g=qPn!5Tn'T Reason for De nisi $ o5, °a -711-5 l 7 DL COMM Wild t rs kf#,%g0m tkeT / Adis{a- °lyf~,r airMt that alt be s it;-n-ber es',per mar al06ment plan p, c side 1 by Niwnbe. 2. aelb0A(*4brectenzs mustloe rn&ntr•ir.Er! r its per rpFlisnrbla cods: / erdinaxer. Attach to caatplew ph= for the syshm and sn-bosit to the Coa Ay oaWy on paper aw less thia 8 in i Il incbm is sb* SBD-6398 (R. 11/11) (Y~(1 1(~, 4 ILA' I E M ! f~1JL-1`t~ A ~C ~ ~+rfF~illt~c''C KS tJ 3 W~ j i ~~(C` ~3c.,~► ~,j it ~ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: V f V`~ Legal Description: _ AI lky ~)I I / 1~ ~ q r`'l0 Township: County: C • L Subdivision Name: Lot Number: Parcel ID Number. (100 Page 1 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 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. X License Number: M P~S* 2 2 3 Z_ `f ~ Date: -7 Phone Number ci Signature i~ Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Sw ~~N S -.r ZKj t lIP iii 4v r i I~ r I rG ` 9 i 1 L Z'C► t` C ~i f~Kt' L ICS(' 1 I t' Si~(l_ 13t +KI G ~ SC't1L~ f ~ ~1ILLS1]~. _ !t✓ISZ ~ - 4'Sdoduk 0 Final Grade PVC Vent P4M W th Vent Cap ft Leaching Clamber 6 fl L Systern Ekmftn . ft ft on V$ Trench Vent Or Oboveno&m Pipe Chest MUNI, e Dia. Trench 2 deader MAMA - chins hambiw A Mcdg Man mr And Model _,T.y F t L-Q(,i t 'i(- J E$SA Rating Z sq ft per chamber SOU isoan Bate gpd/sq ft pd Design Flow Scif AppUcatw Rate $ C E! _ Chambers 2 r of 22 -4 chambers each. page of M cAr Bit )Fa~bes &dam~a0lcttttrtti Z L ~ Cs rrAR ANXTJW 1 3iA of '1 D fl NA Notiba Of conamcw U " NA 'rank 1 NA t~ r NA 4lo~v es ' x 1.5° Uai pump A+I+1 ®NA Soil Rals s Preftesonew Usk Q Ian - (N~A®) W=Wy Aver V_, 13 Sand Ckavel Filmy 13 PW FMW Fats. Gil A 5 30 mBlL D 'cal A,adaa t3 W4ftnd BiocbcmiW Ostysm Demand Oxw S 220 WSIL ® DkhdmdM Q Oftr Toed SuRm3ded Solids (TSS) 5 250 pispeasal Cell(s) Emu= Quw* Mo~+lir AretaOe°O0 L7 (BMV4) D TOW Cry) ) s 30 m~ ® At=Blade D Fecd Co ) 1 cfullot>ttitl D I G 140 le S' 118 is wwadawmer mow V don and Cale Soil App ' Rato ,L2 Am PAq.`~, _ (ether tl>sn ) Int'alive ESdA F~ltiaimum Alumber of t3 Desigp Rm- mss Vaim typksl Sae dommadc (aonc d all mate:;t 6 mmt GOGOy wi&Wl =Code sad septic took a and be ' nw&Bed psr D " WIT' At-Fade Sad AWmptWa S t tip Mumr (C myuw "19M D A CMW=bm Mume Caaavamo, 3.C- sand 18.1, TOW PubUcadan 15.23 D for Septic Ta* Son sy 9.6 D -Dadp of cawiendona SSWAbompdm Tnmbn and Beds". RJ. Gtk - ASAE Publkadow 5-97 and Onske WmWwa EPA 62511-40-012 OcWba 1980 D SOD -1057" (X6") - Ma=W U*g Prewum DistnUtdoe CI SBD -1i?%7-P WM) nn Gw and - 10705-F (Yd OVOI) -In Gmmd Soso Vies W s 2-0 ® SBD --1009-P (N-6W) Iaf*9 Swd Filter Sys COUPOncs Ate' . D SBt3 --1 (A1.(d99) "S* Bad Rec=Ubting Sand FUW Sysaem Cow MwJlr D SBD -10572" (8.6199) "Mound Co D SqD -10691-P (P1.01101) Vadm 2.0 -1 (R• ) SBD - 0573-P (R I O6_p Aloe[ C3 SBD - ) ANC A Stye Emp®t a ; ° of a At !lost oar+o ® I/3 0f0mk out a >od ttt~n 3 At lust e» s a ! tssm ® s is do At least Omm every- D a WA a NA. tit A:1Ma MW MM Cl e axwr raawv t'9 mag6s 0 Vt(s) 0 IAA 20 17 1.35 ,t Cro x CeGovt Cr,q te Nr. 4490 P. START UP AIIIp GPIftTION', Y.:. ~ Pot new conatruodan, prlar to Pepa uN Ot ~ ; POWTS check treatment tank,&) for the the atchatthqmaytahktelImptemovedttsat prooesa and/or damage the use. eder by arrtensepteQet eefrriding operator prior to to use. ceillal. If high canaent q are detected have the canton System yteft up shall riot ooeur when soil conditions are frozen at the infiltrative surface. During Pow* outagee pump tanks may fill above normal hlohwat r levels. When discharged to the dl power is restored ehiiitoaes wastewater win b epersal cells) M one let" dose, overbading the oeHrsl end may reavit in•the backup effluent. To "old, this Mort haw dw,contents of the pump tank removed by a soptags Swvlo)n power to the ptfltrent pump or oontoot a plumber or POWTS Melnteiner to eeslst In manually oWating the dam , 0 opoilaw ptb/ to restore normal levels within the Do not drive of pump tank. pup onttole i Park vahict" over.tanks and dispersal Celle. Do not drive or park over, or•otherwisexilsturb*orcompact, the are within 15 feet down slope of any mound or. alt-grade soil absorption area, Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of th. POWTS' antibiotics: baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; apes, foundation draln I sump pump) water, fruit and vegetable peelings; gasoline; grease: herbicides;, moat, acraa:. madbaUons; ail painting products; paatlcides; ssnltery napkins; tampons; and water softener brine. - diapers; disinfectants; fat 18ANDONMPsNT When the powrs f&4 avid/or to permanently taken out of service the following steps shelf tie taken to insure that the system i properly end wily abandoned in compliance with chapter Comm 83.33. Wlsoonsin Administrative Code, • All plpkng to tank$ and ptta shall be disconnected and the abandoned pipe openings ss±eked. • The contents of eft tanks and pits shelf be removed and properly disposed of by a Se ; • Attar y ptaoe 8ervbino Operator. pumploo,'•all tanks and pits shall be excavated and removed or their covers removed and the Vold epaoe filled with soil, gravel or another Inert solid materiel. ,ONTINGENCY PLAN If the POWTS falls end cannot be repaired the following measures have been, of must be taken, to provide a code compliant -•eplaaement system; A suitable repieoement area has been evaluated and may be tatlllzsd for the location' of a replacement absorption system. The replacement area should be protected from disturbance end compaction and should not br frs cod upon by required setbacks from existing and proposed structure, lot ilnea and wells. Paiiura to protect the repisoement area Witt result in the need for a new soil and site evaluation to establish a suitable replacement was. O upon by comply with the rut" In effect at that time. Repieoemsnt systems must E3 A suitable replacement area"Is not available due to setback and/or soil limitations. Barring advances In POWYS t ohnologv a holding tank may 4 installed as a at resort to replace the failed POWTS.-•- • ah 15 Fir s nor sn evaitftltsd to lldendiy e e Itebie n soeni° t e ail ust be psrforjrtetf to lot: s s sultabt ~tlca~" Upon ire of the g # ° feAi>ltoefn +aepl bneri areIa a and to le: ; if no e ° ea as fe ~m o rapt l~i 9s rise fauovir 4- w, k /n Mound and et-grade sop absorption systems may be reconstructed in lace following surface, Reconstructions of such systems must comply with the rules In effect at tthatatilme. the blame} at the < WARNING> > SEPTIC, PUMP AND OTHM TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR INBUFMCiENT'OXYGEN, DO NOY ENTER A SIEPTIC, PUMP OR OTHER T'RE'ATMENT YANK UNDER ANY CIRCUMSTANCES, BATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY }Ills pimiCUtr aR iMPOgSN a. uOITIONAE COMM .3VYTS iNXtT - ¢1ri 7-777-70011 WTS MAINTAIN R Noma Phone ' Name f Phone .Praae s ' vrcliva aPERAr R i'UMPER) . ~ . . Nam* LOCAL. RE IJLAT_... »r r. >r•.•:x. Name , , :77 Phone Mid phone is document war *efterdyn 04itr esnc~ with chapter Comm 83,22121(bitiild)AIf) and 83,8411), iii (3), + NAaeer►aNt AdrrlMtkstretlve Coda. Jd 1 2017 1 ')4PM I.~ 5t C" x Co Govt Center No, 4471,. F, u Cc V O N8T37'24'E &338.33 - - N89°3T24"E 2671.29' 2 1( FAST-WEST 1J4 IDLE 313.07 F4RCMNTION ----~34 ATER G AREA H.W.E. = 952.0 rn m LOT 2.094 ACRES h 2.191 ACRES (91.213 SO. Fr) %4M :0. FT.) u~ L.B.O. = %4.0 S8V4'9WV 375.82 ti. t HILLSIDE TRAIL C" 576.82' . _ 201. _ C7? W W to LOT 17 2.313 LOTS 2.462 ACRES (100.745 SO. FT) (tMOM $0. FT.) LOT 1 2.604 AC,R (113,43490 US. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer E' T11 tS I Mailing Address I 4\1h% C, Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION I~ it Property Location M6 Sec. ;3 . T z cf R, Town of Subdivision Plat: AU: L1W (,t 1S" Lot T Certified Survey Map # Volume . Page # Warranty Deed # (before 2007)Volume . Page # Spec house = yes - no Lot lines identifiable - es _ 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, b) 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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. i 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 Commerce 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 this 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms S ATU 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. 09/07) Division of industry -services SOIL EVALUATION REPORT Page of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev ed by Personal information you provide may be used for second Date ary purposes (Privacy Law, s. 15.04(l) (m)). ffPropertyOwnnee.r~'ss Property Location Govt. Lot 1/4 1/4 S i ling Address N R E (or) W Lot # Block # S. Name or M# State Zip Code Phone Number itY Village Clown Nearest Road ® New Construction Use[D Residential / Number of bedrooms i 'Replacement Code derived design flow rate ' GPD © Public or commercial -Describe; Parent material Flood Plain elevation if applicable General comments ft and recommendations: E Boring # Boring Q Pit Ground surface elev. k tt, Depth to limiting factor in. Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots Soil A lication Rate in. Munsell Qu. Sz Cont Color GPD/fF Gr. Sz_ Sh. *Eff#1 *Eff#2 i S s 7 6 1 Boring # ® Boring ❑ n Pit Ground surface elev. 1 ~P L r~ a Depth to limiting factor in. Horizon Depth Dominant Color Redox Descriptio a ure Structure Consistence Bounda Soil A Iic /fF Rate in. Munsell Qu. Sz. Cont. Color is GPD Gr. Sz. Sh. *Eff#1 * Eff#2 1F 7 S * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L CST Name (Please Print - Effluent #2 =SODS < 30 mg/L and TSS < 30 mg/L Signature r CST Number Address c , to vpluation Conducted ~hd L- Telephone Number 7 SBD-8330 (R07/] 3) Wisconsin Departrnent of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County St. Croix INSPECTION REPORT sanitary permit Nc, GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for second State Plan ID No: 463009 p secondary purposes [privacy Low, s.15.04 (1)(m)], Permit Holder's Name: City Village X Township Parcel Tax No. LaCasse Develo ment Hudson Township 020-1411-05-000 CST BM Elev. Insp. BM Elev: BM Description: lob /da Section/TowNRange/MapNo: TANK INFORMATION <ST 13.29.19.2575 TYPE ELEVATION DATA MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing ✓d6 Alt. Bk a Aeration ~,^a+°:-c^ ~p rJ/ i~`I , 7 9 Bldg. Sewer a(p qq , ~ St/Ht Inlet f ~ I I o Holdi TANK SETBACK INFORMATION St/Ht Outlet 1`~• 35 TANK TO PJL WELL EBLDG Vent to Air Intake ROAD Dt Inlet septic yd 1 t~ Z r 7 Dt Bottom Dosing Header/Man Z 1 . Aeration JZ • Z Dist. Pipe G~ Holding /Z - Z 19 . eot. System I3.7,D % g • 1 PUMP/SIPHON INFORMATION Final Grade + 1-6Z Manufacturer Demand St Cover ~ GP Model Nu ber TDH Lift Friction Loss System Hea T)H Ft Forcemain Length Dia. Dist, to Well LEEd= SOIL ABSORPTION SYSTEM BED/TRENCH Width j Length / No. Of Trenches DIMENSIONS PIT DI SIONS No. f Pits Inside IQ a. Liq ' Depth SETBACK SYSTEM TO P/L BLDG WELL INFORMATION LAKE/ST REAM LEACHING Manufacturer , Type Of System: CHAMBER OR r i' UNIT Model Number Q J i A UQ ( 0 r(p ~g Ali' DJc, ISTRIBUTION SYSTEM 'v ~ ZA 46 ~ Header/Manifold rl Distribution x Hole Size x Hole Spacing Vent Intake r~ \ Length Dla t eng h > r'~ ngt Dia Spacing V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only w Depth Over / Depth Over Bedlfranch Center ~ Bed/Trench Edges 1Topsoil e~ of , ~ SeededlSgdded roc Multied Yes Dix jNo COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspection #2: I / Location: 830 Hillside Trail Hudson, WI 54016 (NW 1/4 N1/4 13 T29N R19W) Alexander Meadows Lot 5 Parcel No: 13.29.19.2575 1.) Alt BM Description = tSU w 3 ~dyJr~ ( 2.) Bldg sewer length = Z t♦ A `u - amount of cover = 1 I 4.5 Plan revision Required? - #eepotoeegnature Yes f No ~ Use other side for additional information. Data SBD-6710 (R.3/97) Cert. No. .7fr1/- I I i I I i i + i - I i i. I 1 ~ t I I i ~ • i i I I I y - : IS+/.e l,,e I j- -7 1 I i I I - I I-T-- ~ I t I 1 : - i I I rma rX - 1uS I ~ I I i I - ~ i , I I S,cPlti e ?~aJX- GtJ,c~.cjKs' /p ~t _ I ~ I I~ : Wseonsln Department of Commerce SOIL EVALUATION REPORT 1043 Division of Safety and Buildings Pape 1 of 3 in accordance with Comm 85, Wis. Adm. Code stem Sod Service At" cw0 to site flan on paper not Iwo it= 8% x 11 inches in me. Plan mum County indrde, but not limited to: vertical and tror¢oritai reterenee poird (pN). daectim and St. Crooc percent slope. scale or dimmisions, north anow, and location and distance to rwrest road. Parcel I.D. 600 Please print all iMonwiffon. R 0 ZO Date Pbr=W idannslim You Provide may be used for eaoondM 1 (Privacy Lew, s.15.04 (1) (m))- e Property Owner 3 2!0 LaCasse Development, Inc. v Pr ~10f 1 Lot NE 114 SW 1/4 S 13 T 29 N R 19 W Property Owner`s Mailing Address L # Block # Subd. Name or CSM# 573CtyRd "A" AUG 1 4 2002 City 5 na Alexander Meadows state z cone A Village Hudson WI 16ORl1fi~ rvrY City Hudson Town Nearest Road Alexander Rd. NetConsftmation Residential /Number of bedrooms 4 Code derived design flow rate 600 GPO RePublic or commercial - Describe: Parent Glacial Drill GeneraFood plain elevation, N applicat>fe na and recommendations: system elevation99.80 it, trenches spaced and depth to code 4.00 it below grade Fq !A Boring # 89 //0 Pit Ground Surface elev. 03.80 H % ft Depth to limiting factor 96 in. Sol "_k2bw Rate or¢on Depth Domirat color Radom Texture bmimu a Consistence Boundary Roots GPp/(t+ 1 Q8 1 'ETf#I 'EfM2 Oyr3/2 none ad 2msbk mfr gw If . ` 8 2 8-29 1Oyr4/4 none set 2msbk mfr gw na .4 ✓ 6 3 29-40 1 Oyr4/4 c2d 7.5y5/6 sl 2msbk mfr 9w na 5 . to g 4 40-48 7.5yr4/4 none all 2msbk mfr cis na .5 j o .9 1,b 5 48-98 /q none sills 2msbk mfr na na .5 _g Horizon # 5 has stratified layers, molding spots noncontiguous Baring # Boring Pit Ground Surface elev. 103.80 ft. Hor¢on papttr Dominant Color MCI= Depth to limiting factor 96 in. Soil p Rate Texture shicbxe Cornisterxe Borrdary Roofs GPD/M 'Eff#1 'Etf,T22 1 0-5 10yr&2 none all 2msbk mfr gw if 5 .g 2 9-15 10yr414 none scl 2msbk mfr gw na .4 ,g 3 15-51 1 Oyr4/4 c2d_ 7 5v5/6 at 2msbk rnfr 9w na ,5 , L .9 4 31-98 7.5yr4/4 none sft 2msbk mfr na na .5 ,g Horizon # 4 has stratified fayers,m ottling spots noncon iguous Effluent #1= BOD 30 c 220 mg/- and TSS >3o < 150 mg/L • Effluent 02 = CST -Name Signature- t30D and TSS <,30 mg/L David J. Steel ig-~ CST Number Address Stem Sol248956 1564 CR Richmond WI 54017 T Date Evaluation Conducted Telephone Number 7/31/200 175-246-5085 Property Owner LaCesse Development, Inc. Parma ID # pending 3]'Baft # Boring Page 2 of 3 to Pd Ground Surface elev. 101.10 ft. Depth to limiting factor 96 Hor¢on Depth Dominant Color Redoz Sol Application Rate Texture Stnrctrrie Consistence Boundary Roots GPDAE= 'Eff#1 'Etftf2 1 0-6 10yr3/2 none sd 2msbk mfr cs 1f 5 (o .8 2 6-13 10yr4/4 none scl 2msbkf mfr cs 1 of .4 _g 3 13-29 10yr4/4 none sl 2msbk mfr 9N► na .5 . {o .9 4 29-96 7.5yr4A3 none svis 2msbk mfr na na 5 .9 Horizon # 4 has stratified layars 4] Boring # Boring pit Ground Surface elev. 101.10 ft. Depth to Wmitrrg factor 96 in Horizon Depth Dominant Odor Redox Descr Sol Application Rate f10^ Texture Stnrctuie Coreistence Boundary Roots GPDfiF 'Ef1#1 'Eff#2 1 0-9 10yr3/2 none i 2msbk mfr 9w 1f .5 • L .8 2 9-17 10yr4/4 none act 2msbk mfr gw 1 of A, .6 3 17-29 7.5yr4/4 none al 1csbk rrn/fi' gw na .4 ✓ .6 4 29-64 7.5yr4/4 none 2msbk rnir 9w na .5 .9 5 64-96 7.5yr4/6 none slurs 2msbk mfr na na 5 .9 Horizon # 5 has stratified layers ❑ goring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Appk;abm Hor¢on Depth Dominant Color Redox Description Texture structure Consistence Rate Boundary Roots GPDflt' 'Eff#1 'Eff#2 ' Effluent #1 = BOD S> 30 < 220 mg& and TSS >30 < 15o mg/L. The Dcpartmcnt of Commct cc is an aal `Effluent #2 =GODS < 30 mgt and TSS c_p mg/L c4 oPPorbmrtY Pro-dcr and ctnpl y., If you nccd assistance to acccm scm,= or