Loading...
HomeMy WebLinkAbout042-1011-40-290 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597449 GENERAL INFORMATION 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 NATHAN AMBERG TOWN OF WARREN 042-1011-40-290 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: &A I G-67 05.29.18.73B-90 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -O Benchmark -7-3/67, !Q~ Alt. BM L .sw. t Z --7 Aeration Bldg. Sewer Holding St/Ht Inlet 4k 'r• (o !~s ~i TANK SETBACK INFORMATION St/Ht Outlet / 41 TANK TO 4JP/L WELL BLDG. Ven Air make ROAD Dt Inlet Septic Dt Bottom 167 a Dosing Header/Man. Aeration Dist. Pipe / o vim, Holding Bot. System PUMP/SIPHON INFORMATION Final Grade s Manufacturer Demand St Cover qPM Zi --7 ~a 71 Model Number T /dZ TDH Lift kit5i-on Loss System Head TDH Ft C Forcemai Length Dia. Dist. to Well 7 SOIL ABSORPTIO SYSTEM BED/TRENCH Width Length No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia ]Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:Z.. INFORMATION CHAMBER OR TeOOf System: 315 ~.V O NC1x) .r UNIT Model Number. DISTRIBUTION SYSTEM 7-S•F-7 5 k 7. S 4- Zap- .5 Header/Manifol~r Distribution x S Hole Size x Hole Spacing Vent Air I t ke Length~_ Dia_ Pipe(s) Length Dia Spacing i 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Z. ZC Bed/Trench Edges Topsoil J _ Yes I7 No s ',V~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1142 105TH ST 1.) Alt BM Description = 2.) Bldg sewer length= G..~G.~ - amount of cover = V Plan revision Required? [ Yes o SI Use other side for additional Informal n. 41 SBD-6710 (R.3/97) Date Insepctor's Si ture Cert. No. RECEIVED Ua tub j - County , Safety and Buildings Division _ l / s 8 pOIX CoUNTI 201 W. Washington Ave.; P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) r ay pEVELOPmENT r'adison, M 53707-7162 Sanitary Permit Applicatiot.. State Transact] or In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropri is required prior to obtaining a sanitary permit Note: Appbcation forms for state-owned POWTS are e 'roject Address (if different than mailing ddres as) j the Department of Safety and Professional Servies. Personal information you provide may be used for secot , purposes in accordance with the Privacy Law, s. i5.G4{l m , StaLS I 1 / '1 1 Q L Application Information - Please Print All Informati ~7 0► 1 Property Owner's Name Parcel /J > 10) 46 -aia- Property Owner's Mailing Address / - Property Location b S . a , IT. 13 1 t . C1 .w Govt Lot City> Stater Zip Code Phone Number Section A-/ Ale o4a) pe of Building (check all that apply -7 Lo --v 2 Family Dwelling -Number of Bedrooms Subdivision Name Bloc °T ❑ Public/Commercial -Describe UseI ❑ City of ❑ State Owned - Descnbe Use _ -XonfincA. CSM Number /b ❑ Village of Z- ~ p' cak 1AZ .lP G3 III. of Permit: (Check only ne bo Complete line B if applicable) ~A N i ew System ❑ Replacement System ❑ Treatmenv-Holding Tank Replacement Only ❑ Other Modification to Existing System (explain.) i B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. of POVVTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < in. of suitable soft C Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (e ain) J V.Dis rsaUTrea entAreaInformation: zLo _ tr t~- Deer Flo gpd) Design Soi] A71ication Rate(gpd&A Dispersal Area Required (sf) Dish eral Area Pro d (sf) System Elevan n lilt c? VI. Tank Info Capacity in Total tt of~ Manufacturer o Gallons Gallons Units o New Tanks Existmg Tanta I ~ .m ~ U m 1 ~ c v d a, n u, I !4i 4 U n c; Septic or Holding Tank j Dosing Chamber I i VII. Responsibility Stateme t- the undersigned, as cresponsibility for installation of the POWTS shown on the attacbed plans. Plumber's Name (Print) k" Plum Siattazute MP/MPRS Number Business Phone Number r . r, Plumber's Address (Street, Cuy State, Tip Code) ` F ((1 A VIII CamutyMepartment Use Only proved ❑ Permit Fee Date Issued Issuin ent Signature L1Z Q7 • Z2 1'7 rven Reason for Denr DL Condi ' coMg or Dis pproval 1. i t ~ tank, etfitnt Neu t~h opt riisper.: +i call r ttapt rtq be sal : leas ! r Ita~: / ~4~_ 61J 0 Ss per $+ajr.a plan pro tided by plumber. 2. A11 aswc'regr:;irertent~ rnrrstber r lairt .ir.Ed Z se pet blft cvdL- ! ~rAinri,x laz. ~p ~@•~\ Attacb to complete plans for the system and submit to the Coun only oa paper not less than 81r- z Ili eshin sin , SBD-6398 (R- 11/11) i System PLOT PLAN PROJECT Nathan Ambera ADDRESS 2320 Oakridoe Circle Hudson Wi 54016 NE 1/4 SW 1/4S 5 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 101.5/101.2 2.5'below grade DATE 8/15/17 BEDROOM 3 CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 11 50 # of EZ-Flows23 BENCHMARK V.R.P. Top of rebar ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line 200' 102' 104' B-1 5% Slope B.M.* -2 80' 55' 10' 2-3' X 115' cells with >3' spacing /4' 60' 30' ST 25' Pro 3 Bedroom B-1 House 200' Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/15/17 Owner:Nathan Amberg Location: NE1/4 SW1/4 S5 T29 N,R18W Lot 9 105th St. Warren Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. EZ-Flow Cross Section r:. 4-6. Maintanance a Contingency Plan 7. Filter Cross Sec ` Signature ff License number #226900 System PLOT PLAN PROJECT Nathan Ambera ADDRESS 2320 Oakridae Circle Hudson Wi 54016 NE 1/4 SW 1/4S 5 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 101.5/101.2 2.5'below qrade DATE 8/15/17 BEDROOM 3 CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1150 # of EZ-Flows23 BENCHMARK V.R.P. Top of rebar ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line 200' 102' 104' B-1 5% Slope 0, B-2 80' 55' 1-0 00 B.M+10, 2-3' X 115' cells with >3' spacing 60' 30' ST 25' Pro 3 Bedroom B-1 House 200' Property Line a L m m 0 Z a~i m Fa a) o c _ U- O C~ _ ~ W N R L m o ~L Q~ • . R$ d dj CL L U - U > coo N N Q \ W CD c6 a) m LL > zs a a' o 0 Q C) 0-0 c ti W ao a) .r cv > cn Eoa) C) 0 Q- 0 : : : . cn 0 E- L) n o i o E LL : CD Z W _ O O O V > r a w C7 3 : : . T ti ti v- y O _ cm a~ V ~ co N N O 'L♦ V POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ❑ NA Permit # - +%f Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility Units NA Pump Tank Capacity j Estimated flow (average) al NA X1„7 cal/da Pump Tank Manufacturer NA i Design flow (peak), (Estimated x 1.5) aUda Pump Manufacturer -gy Nq Soil Application Rate - aUda /ftz 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 (BOD5) 5220 mg/L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average ;7n-Ground ersal Cell(s) Biochemical ❑ NA Oxygen Demand (BODs) 530 mg/L (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L -416 ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100m1~ ❑ Drip-Line ❑ Other: (Maximum Effluent Particle Size 36 in dia. p NA Other. rJther, NA A Other: NA "Values typical far domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once every: in ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA linspect dispersal cell(s) At least once every: ❑ month(s} ,-year(s) (Maximum 3 years) ❑ NA 1:*an effluent filter At least once every: ❑ month(s) year(s) ❑ NA nspect pump, pump controls & alarm At least once every: p year(s) s) NA 19ush laterals and pressure test ❑ month At least once every: 11 ears s) NA tither. Y { ) At least once every: ❑ month(s) ether: ❑ year(s) NA 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 -egulatory 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 shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 than 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 nonnai highwater levels. When power is restored the excess wastewater will bl of effluen1t. cetl(s) in one large dose, overloading the oell(s) and may result in the backup or surface dirge discharged this the dispersal To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to ft effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump cords to restore normal levels within the pump tank. the area within Do not drive or park Vehicles over tanks and dispersal oils. Do not drive or park over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the foiloanng from the wastewater stream may improve the performance and prolong the life of the POWTS: anhblotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disumtectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medkatlons; oil; painting produc*; pesticides; san'hM 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 propefly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and 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 fined with soli, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compfi*nt replacement system: 'A-suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeim. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requioed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must conmPly with the rule$ in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologK 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 sal and site evaluation must be performed to lode 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. ❑ Mound and at-grade soil absorption systems may be recortstructed in place following removal of the biomat at the hfdtratKe surface. Reconstructions of such systems must comply with the rules in effed 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 TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DiPFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS iNSTAL -ER POWTS MAINTAINER Name - Name ,r. Phone Phone SEPTAGE SERVICING OPERATOR LIMPER LOCAL REGULATORY AUTHORITY Name Name Phone Phone This dOwnentwas dmaW in compliance with chapter SPS 383.22(2)(b)(1)(d)&(1) and 383.54(1), (2) & (3), Wisconsin Administrative Code. NT. CROIX COUNT'S' SEPTIC TANK MAINTENANCE AGREE &rNT AND OWNERSHIP CERTIFICATION FORM " Owner/Buyer Mailing_ Property Address (Verification required from Planning & Zoning Department for new &ukruction.) City/State Parcel Identification NurnberL''~ LEGAL DESCRIPTION r`? Y4, Property Location Y, Sec. , T - N Rte? W, Town Subdivision Lot # Certified Survey Map # Volume c) , Page # Warranty Deed # 4 ( , Volume , Page # Spec house yes Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTrmcATION Improper use and mainoenauce of your septic system could result in its premature hilure to handle wastes. Proper main a e consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in Worm 83.52(1) and in Chapter 12 - St Croix County Sanbry Ordmance. 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 m proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less fim i/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 act forth, herein, as set by the Department of Commerce and the Department of Natural R.eeourccs, State of Wiscousn. Certification stating twat 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. Uwe certify that all statements form are true to the best of my/our knowledge. I/we am/are the owner(s) of the Property desc aed above, by virtue of a deed recorded in Register of Deeds Office. Number of edroo~ns SIGNATITRF KPPLICANT(S) DATE ***Any information that is mrisrepresented may result in the sanitary permit being rewoked by the, Planning & Zoning Department * Include with this application a recorded warranty deed from the Register of Deeds 0 ice and a copy of the certified survey map if reference is made in the warranty deed. WV. 48/05) I LLLL \l i - ;c de YI {I 9 ' i 1~'lm 1 I 1 I f ` I 1 I 1 ~ ~ O O P O P 00 P O O 1 v v S i T y j Q i ~L 1 LL +.r `vlt - - - I ~a ' Im'NOeam 1~'p~~l~~' ~ jlp t !1 ,p a li Nouofal9Noo ml 9pR lO~ E e 9gy4~ ji!§ ~p§~q ` p 4 - I z= BI§ p I I On! I I i I I I I I III ! I I I { II I _ VI I ~ i l r I III ~IILi,I - i~. ~ I I I III ,I IIIIII I IIII IIII ' VIII I ~ I `_II I Ii III ;III ` - III II 11111111 - - I I III I iII I l i l li - : - - I~ .III. ~ I I I i t I I II II :I - I ICI ~ I III I I I - _ I III I I I.1 IIII II I Q I,IL I I I III II'~ IIII II I~ III I I. I I I F I III; _ " ~i ICI I IL I VII I I ~ I ~ I ~I ~ III I y I I L1.:u Li p I IIII ~I IIII _:i I I 5 II ~FT I' I I ~ I i 111 I I I I' III I IIII B I B i/ I I 'I I I! I IIII I ! ~I I I I III III - I I ~ III, I `III III IIII ~~V I 'I I (IIIIII I~~'~I I-LM I r ~ I IIIIII ill a LI IIII ~ I~ III I~ II~ II I,I I II~~✓ ~~\~I I~:~IIIII111'~L!~.~~II ~I`' I ( I I I I - I I I I I' I I I ~ I< I - i l l l l l V I I I I i I i II I Z ''~lll F X I IIII ~ I'I I I~ Q ill ~ O I I ~~III,I 4 IIII II II I' ~ II 1 Q , i 'I Q I I I 1111 I 71 $ I I. F l i I I !I I I. ~ llliiilll I I I I i1 I I I I i I I - I I 1§?l~I~~~ Ro, 0 !Q e M 'N094fM1 I ~ gq t{ F P~ i= x a 3✓N9Q193O J?!MDW Y Bt~At[~~t"i+ ,p i fta~,~,mi~ey ye ~i°Ai!!~P!y?eg ~41p9,lE~!'ia Q4 CCJ=~~ ! g g Io Q i nolionxLelvm ee3n3>on I Q3,j3 tU ~ ~ 1r,9 l'.6 .e .c I ~~A pp o~ I {y 4 ; f ! 9 ~ Q YIEi i tJI aHe II ~d3S t° Q I j •--w±u-- F e I R[ !Q 1Qs d !It 4t Q ~ 11l a ~~1~ t~ Z I [ 3 !t Ei! t 1 of @a~~ 1 d ii@! i~i Et I! E I !I Q Ea j , I I !u t r S ~ .rF.e l d I b g rc Q I - e ~ I r ~ , e 5 e ; s 7 ME 4 aE .~46 ga 4 ; I ® a 4 ' 4 - . I I d f d~ .-ar..~=~~ d I F ~ 9 I e e 4 S 6, ~ ~ 4 k ; d 4 ~ ~ Ig II e ~ I ~ 1 I X Q I = I G I .6,96 I I I I Q Q Q s!! Q Q Q Q ~0 I a I im'r+oean+ 14s°f~~t~~ 1' {3! ti N ~ i411 3, l Q ~ r F 1 z_ II Iti 1 Oi 33 I ! $ ` .o-,+4 ~ ~ ~ ~ Y ~ I II IlR .Fx i Ip~1 ~ ~ L > jig ~p 1!d Ilk ! € tt ?l~li ave t! g3 t; ~ I 9 1!!~ 9 ~,i,~, n 9 !v .,o..~,o, a el,.@ I e • 1 !ll 1 a: !4 It taq+ ii' ' i ('at i+~ t 1! z ~ 4 y se - o f a Il 1 Pi 1!1!"h r 1 It jr !n ai 11l+ 1 i! ~al t i t i h ei , Jill ~ e! I t ~ , 11. ..1 r of t a! I ~ ~ ! ' f ii' Y ,ol € j ft aii!!f 1 , a It t ~ e - - m - - - - -,a .o-,f .o-0 9 r i!!at ~II3f>ftflli a ~ (aa ~ I a , i;~ I O !r 9 o •..~4, lO r..e~4, E T OiI Jill as 4 sn I I ~4 ~ I ql' o+ : o ]]9 I I C~ I k ~ I z~ I f 1 11! I h per, I I ~ I .Sat,f I .4-.p I .F.t + .C-,p I .FY.4 ' I .0.1 .O.Of I I I I I I I ! 11 jE W I N ~I .11 !t171I 9 I ~ 91I!!! I=1 p~1 I ~ It p s ► 9 !i! El? 'I tl1011! fil ~al` i. I I @ 3A a Im'aosam il E}O~F ~ o~ g~ € $ 3~N3GII$32~ ~3~9W'17` ~i°~~~~f'~~ssp, 1~'~ 9~~~~, 3 ~ ~ 4 ~ WIN N19 9§s 4 ~ I g g I !I I' ~~~axb I - I I g g I I - - - iq I 4 q f} I ~~yy}pqp i 1 1 i81~ I i x I o I U? I~ 0> I I I I i .wadl i .o,r i i I I I Wisconsin Department of Safety and Professional Services Division of Industry Se %ea SOIL EVALUATION REPORT Page 1 of 2 in accordance with SPS 383, Wis. Adm. Code leCounty ST. CROIX A com I td q ~lan pe t less than 8 1 /2 x 11 inches in size. Plan must inude, b limit . horizontal reference point (BM), direction and Parcel I.D. (Pending) t-V to percent sl e, scab ions, north arrow, and location and distance to nearest road. ~ ZIA -0 A W6 7 C) Please print atl information. Revie by Date Perso llnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). tL4 $ LZ j Propert caner Property Location El El NATHANIEL E. & LINDSEYA. AMBERG Govt. Lot NE 114 S 1/4 S T 29 N R 18 Property Owner's Mailing Address Lot # Block # Subd. Name or M# 2320 Oakridge Circle 9 V 28, Pg 6340 City State Zip Code Phone Number ity aVillage ■ Town Nearest Road Hudson, WI 54016 ( ) 105th Street El New Construction Use(D Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 11 Replacement Public or commercial - Describe: Parent material sandy Flood Plain elevation if applicable NA fL General comments Conventional In-ground trenches 0.6 loading rate stem el 2 ft. in ground. and recommendations: Additional pits conducted to extend area from previous test. Lots&Vere combined to create Lot 9. IT] Boring # 11 Boring - Q Pit Ground surface elev. 106.00 ft. Depth to limiting factor 66 in. Soil Application Rate Horizon Depth Dominant Colo 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 7.5YR2.5/2 sl 2fsbk mvfr cs 2vf-m 0.6 1.0 2 8-19 7.5YR3/3 - A 2fsbk mfr cs Ivf--f 0.6 1.0 3 19-34 7.5YR3/4 s Osg ml cs Ivf-m 0.7 1.6 4 34-66 T5YR3/4 sl I fsbk mvfr cs 0.4 0.7 5 66-80 7.5YR3/4 sl Om mf 02 0.6 all horizons have some gr. F 2 Boring # Boring 100.00 72 Q 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 0-18 7.5YR2.5/2 I 2fsbk mvfr cs 2vf-m 0.6 0.8 2 18-36 I0YR3/3 sil 2fsbk mfr cw Ivf f 0.6 0.8 3 36-72 7.5YR3/4 s Osg ml cs 0.7 1.6 4 72-80 7.5YR3/4 sl Om mf 0.2 0.6 * Effluent #1 = BOD > 30:E 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur CST Number MARY JO HUPPERT Hollister's Soil Testin&Desi n 224832 Address ate Evaluation nducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 05- 12 - 2017 715-426-1775 SBD-8 330 (R07 13) D ~ 711 s V Co N \ \ N 1 mp t ALL S tl l a ~ • _ -F- • b t 1 e lit 7 } u , .a Ail, 4 A ~T Air i Wisconsin Department of Commerce S EVALUATION REPORT Page of Division of safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c> rat' Attach complete site plan on paper not less than 8112 x 11 fn es intize. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1.0.0(12 / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all lnfor Revi ed by ;/Z,//O(" Personal Information you provide maybe u d for s >ti>(PFFIacy t aw s. 15.04 (1) (m)). r Property Owner j Prop arty Location RlA0,rd i w' 6 1 0 2006 ovt.Lot fVE 1/4 SW 1/4 5 Ta~ N R 1,0 E Property Owner's Mailing Address of #Block # Subd. Name or CSM# I t©. S ST.GROiX000NTY -21- City State ZIP Code • Phone Num ty 1:1 Villa e ~ ❑ Ci g T wn Nearest Road L.Ra bzYts S b ~)aad--)8q W~r ,~,t P. ' Sr i~& ❑ New Construction Use;. Residential / Number of bedrooms 3 Code derived design flow rate GPO ❑ Replacement ❑ Public or commercial - Describe: Paront material Sd ►sr>l5t 0 ie- Flood Plain elevation if applicable IV ft, General comments and recommendations: 0 a, n/ S'/ _e Qi Vii i.~~ ~'~l ~ nib ~ C~ i~I n Boring # ❑ Boring f r / L _ J pit Ground surface elev. q7, 2. ft. Depth to limiting factor In. Soil ,ADpliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 3 a..g )o. S] t'1ti i Cw' I0 b. (y .C 401-G' `j mSh 06 low ❑ Boring f~ Boring # E' ^ Pit Ground surface elev. ft. r D th to limiting factor in. Soil ADpliption 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 ! 64 lo d I S;1 IAsk cw zu, 42 3022 O ' I'l 0 - T 5 rk 4/, Sc Vin bk Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 rryA and TSS < 30 m9/- CST Name (Please ~P"' t) _ ` Sig erg CST Number Address Date Evaluatic Conducted Telephone Number Lyra ~G`J ~..L/ S vi'✓ • i r L.~ Parcel ID # t't1i Page _ of Property Owner l u t s F37 Borfreg # nng ~In Ground surface elev. ~1 1t• Depth to Ijm+Ung factor Soil p~ jlcayon Rate I Pit ~ Horizon Cepth Dominant Color Redox Description W"~/" structure Boundary Roots .OP'A II In. Munseii I Ou. Sz. Cont. Color 1\ 4 y (D b ;2 M t V AL La-.O ~~.35 S 4 3S -42 C,'2 cal b-,4 C . 6 16 Y i ❑ Boring Q !1 ® ~Y'9 It Ground surface alav. 1 of , it. Depth :o'ImUng factor- in. III Application Rate Honzon Cepth Dcn- nrwt C-2101 Redox Descn:)Lcn Texture Structure Consistence Bwnd3ry Roos GPDAY in. Munsetl Ou. Sz. Cont. Color Gr. Sz. Sh. •Eft1 ~ff#2 GMT i Yi: I s, l 1 K1 cis 0. 4,K 611 C 134.E 4 (;Z 5 G Se( ,~Z in> m,i' O° I 1 Bc^ng It Boring, Ground surface elev. R• Depth to limiting factor In. Soil AgAcirtion Rate Pit Horizon Gepth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots I •ER#1 GPOM •Eff#2 In. Mansell Cu. Sz. Cont. Color Gr. Sz Sh. • Effluent #1 = BOD, > 30 < 220 rnWL and TSS >30 < 150 mg1L ' Effluent #2 = BODI 30 mglL and TSS 130 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. 52C.8330 W6,00) Prot3erty Owner ICf~tC► ld 1 Parcel ID # e-,7, Page _ of Boring, At ❑Bonnfl f.~ Pit Ground surface elev. Al.JE_ tt. Depth to limiting factor y in Sod pppiication Rate , Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots OP 10 In. Munseil I Qu. Sz. Cont. Color Gr. Sz Sh. I 'Eff#1 I 'Eff#2 2 ->s r ' rd+1 ~ v ' A (o r Boning I # -Boring Q U Pit Ground surface alav. ft. Depth tc iintiting factor in. Soil ADpk3bw Rate Honzon Depth Dominant Col Redox Descnotcn Texture Structure Consistence Boundary Roots GPONf in. Munsall Cu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 j 'Eff#2 1 I(~`? I IfY311 i K Q v `0e i ~ ass I; 5,4K A c~ I V 3 -•3 t' ~ ~ SCE ~ m ~K G ~ ~ t v' ~ . I L 2 .S ► G .scl ~ m> 4/: MI) I 1 ~ a Sc"ng # ❑ Boring, ❑ Pit Ground 'surface elev. ft. Depth to limiting factor in. Sod Appilication Rate Horizw.. Gepth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPOJR' In. Munsell Cu. SL. Cant. Color Gr. Sz. Sh. I •Eff#1 'EffiC-~ I i I I I I I ' Effluent #1 = BOD6 > 30 < 220 nx1/L and TSS X30 < 150 mglL ' Effluent #2 = BOO, < 30 mg1L and TSS 130 rrV The Department of Comrzerce 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. SBC-1330 (R.5,07) a GF LOT ~ S2.11 CA LE 10 r . BZ r , r" q o PM z' ► TOP 314 RFBAR AT GRADS 100. 00 ='ti" 2 TOP 3/9" RrFA9 Al GPADF fit, 90,85 i Wisconsin Department of Commerce S EVALUATION REPORT Page of Division of safety and Buildings in ce with . Adm. Code Attach complete site plan on paper not less than 8 112 x In/size. Plan must County --ST, C ir IX ' Include. but not limited to: vertical and h direction and Parcel I.D percent slope, scale or dimensions, north a w, an ste--To ri rest road. v y l D ~i Q Z 30 Please print al Informatlon. Review Y' Date Personal Wormstion you provide may be used fo second~ryqu a Pr w, s. 1 04 (1) (m)). ✓ l /V_j Property Owner Pro arty Location T i l l had ` N) ST. CROIX COUNTY Go o Lot f I ^1/4 .S-WI/4 S, klN R E ( W Property Owner's Mailing Address 4 Lo Block # Sind. Name or CS I I I /0-S -r 17. 1) y City State Zip Code Phone Number ❑ City Village ~7owr Nearest Road New Construction Use: ❑ Residential / Number of bedrooms 3- 4 Code derived design flow rate 4 50 0 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Paront material . s& n& 5 1 0n e_ Flood Plain elevation if applicable AV# ft General comments and recommendations: 1 7 X17#k,n4 5 S7Lm on C_ on-rd 1 AL, 9,04 W:`1~ Yr!+n rnr,, Y-n b 10 d 0.R'c11r.0 _S'24 Boring # ❑ Boring f 1. pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 V4 S; L I -3 Y (Z s. i 4 b, rn v4 W o. 8 d s. n P2 I 0~ s 0$ 1 c, _ a Boring # ❑ Boring ✓ pit Ground surface elev. ft. Depth to limiting factor 1 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 Q' d 2 3 ,t! ) C w ?y . t; C. '2 R-18 0, t s C A4) 1 v : Q 0 ~~'°7 3 s' ~s►k rn r Ccv t W v.l~ b -4 lC s i0Y(~s S`s rn r Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 mgA. and TSS < 30 mg/L V CST Number CST Name (Pi P ' t) A//?_ 41" Address Date Evaluatio Conducted Telephone Number l s rnw s'?.t~ GS ~K IZs 4~s =4~2 0 0 Property Owner ~C~drfi b SQ Parcel 116 it / Page,-- of F-37 Ba~>Q # C3 Boring ✓ Pit Ground surface elev. ~4„1- tt• Depth to 1'rniUng factor In Soil ficatlon mats Horizon Cepth Dominant Color Redox Description Texture Structure Consistence Bt3undery Roots OPI MEff#2 In. Munseli Qu. Sz. Cont. Color Gr. Sz- Sh. a J2 1e ' 1 s i t~V' 4 4 c3. .3 a.~tG~s J~.Cz ~ 10 Y2 ~l n 12- 1J I~Y2 1 lv~2~ .S rn V V Boring At ❑ Boring CJ Pit Ground surface elev. _ ft. Depth to IintiUng factor In. Soil gtlon Rate l Horizon Depth Dcrrwrant Coi Redox Descrioticn Texture Structure Consistence Boundary Roots GPt71if ~i:ffrY1 in. Mansell QU. Sz. Cont. --olor Gr. Sz. Sh. I I I ` I a Scrng it C] Boring. In. pit Ground su,iiace elev. fi• Depth to limiting factor Rate Horizcr Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Rooms PD/! ' ~ER#i 'EPf#2 in. Munseli Cu. Sz. Cont. Color Gr. Sz. Sh. I Effluent #1 = BOO, > 30 < 220 mWL and TSS >30:5 150 mgiL ' Effluent #2 = 800, 130 mgiL and TSS 130 mgiL 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. SW-9330(R.6,00 t Property Owner b ct f lam? b std Parcel 11 10 Page ~ of Boring ®Borkeg # C1 Pit Ground surface elev. i1,,_L ft. Depth to limiting factor In Soil Application Rage , Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Ruots OPCtff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff I I 'Eff#2 r ULT t(~ S to ~i a's~ I I'~7)' C C? t -so 3 6/2 VLI ~ I ~ ~ I { I I ❑ Boring Al f Boring lJ pit Ground surface alav. _ ft. Depth to fimifing factor in. Soil Appiic3bw Rate Homan Depth Dominant Coi Redox Desw:)Lcn Texture Structure Consistence Boundary Rocs GPOM in. Munsati Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 j -I- I f i I i t ! ! ❑ Being 9 ❑1 Boring, L1 Pit Ground surface elev. ft. Depth to iimiting factor in. Sob =ott Rate Homer. Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDM tn. Muruall Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Ef`#1 'Eff#2 f I I ! , I 1 1 I , Effluent #1 : BOD, > 30 < 220 nx,7/L and TSS >30 < 150 mg7L ' Effluent #2 = BO:), :E 30 mg.^_ and TSS 130 mV- 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. sacaaao tRS~oo~ U4" 5 2.3q AC 1 05 Tq ST 8 ~ I B -r p-a l!1' r- v- 1 rrl f_(a ~t I 1 t 3 SM# 1 VRP4HRP 7aP3/4+ REP 7 GRADE FL, 100.00 BK9 2 TOP 319" REBAk / &R5P~ EL. 96.8'1 i i ,l Parcel 042-1011-40-230 07/27/2007 09:31 AM PAGE 1 OF 1 Alt. Parcel 05.29.18.73B-30 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/20/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RICHARD A OLSON O - OLSON, RICHARD A 1134 105TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description * 1142 105TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.340 Plat: 5294-CSM 21-5294 042-06 SEC 5 T29N R18W PT NE SW FORMERLY LOT 2 Block/Condo Bldg: LOT 05 OF CSM 8/2283 FKA LOT 2 CSM 9/2471 5AC FKA CSM 21-5224 LOT 3 (9.88 AC) BEING Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) CSM 21-5294 LOT 5 (2.34 AC) 05-29N-18W Notes: TDate arcel History: Doc # Vol/Page Type 0/20/2006 837104 21/5294 CSM 6/19/2006 827757 21/5224 CSM 05/15/2006 825212 QC 10/13/2005 809306 2908/326 QC more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/08/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.340 38,500 0 38,500 NO 2 Totals for 2007: General Property 2.340 38,500 0 38,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00