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HomeMy WebLinkAbout028-1021-20-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 597495 state Plan ID No I Personal information Yuu Provde may be used foi secondary purposes (Privacy Lew, s_15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No JAY & BARBARA NEWTON TOWN OF RUSH RIVER 028-1021-20-100 CST BM Elev Insp BM Elev BM Description Sect(onrTown,Range/Map No 14.28.17.114B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man Aeration Dist Pipe Holding Dot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover , GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemair Length Dia. Dls;_ to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside ,a Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/ST REANt LEACHING Manutacturer INFORMATION CHAMBER OR Type D' Systcrn. UNIT Model Nurrnber. DISTRIBUTION SYSTEM Header/Manrfuld Distr,bution z Hole Sze Hule Spacing Vent to Air Iwa,e Pipeisl Lenglh Dia Length_ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Deptr Over xx Depth of xx Seeded/Sodded 1.<x MjI~ned BedrTren in Center F) ed/Trench Edges r Topsoil Yes No Yes No COMMENTS: (In,:lude code disr._repencies, persons present, etc) Inspection 411 ~ Inspection #2: Location: 1961 CTY RD N J t ~C' i r ) Alt BM Description; _ ~U~j , } \'t{~ ~t~jAp yi►/pi1 i~/~y~ .1 v t, , 2 Bldg sewer length - amount of cover = L. 9 pK ~~1~ 1 d Plan revision Required? Yes -No Use other side for additional information Date insnpctors Signature Cert No SBD-6710 (R 3/97) r 1~ ` ~ 4 1 f i ti i I { T ti,e rr~,l C;ount}~ RECEIVED Safety and Buildings Division 1 lc 209 W. Washington Ave_, P. D, Box 7162 Sanitary Perntit Number (to be filled'in by Co.) e SP 2d 21117 Mpiison, M 53707-7162 . h~stcirant 5`17 Lf 35 E State Transaction Number d0MMU WW'FMRffzt APP1:lt✓a.4n„w_~ EHYA In accordance with SRS 383.21(2), Wis. Adm_ Code, submission of this foam to the appompriatc~ova,su i<_ required prior to ohtaining a sanitary Petnnir. Note: Application forms for state-owned PO AITS are submitted to Project Address (if different than mailing address) the, l cPHIlm nit of Safely and Professional Servies Personal information you providc atay be nsrd lta secondary CTY 1?-D A purposes n7 accordance with tile PKiivac"j1.ay s. 15.04(I m zStats I ICJ 1. Alipbc anon Information - Please Print. All Information i'topraly Owner's Nanle 1. Parcel # Oat.~"~ ~Q ~a~'• ~0 _Td_ ~ - - - - j_q_) 3 ~ 117 _1I I Property (3tt.ncr's Mailing Address Property 1. ocatiott s- Govt. Lo, (:it}'. Slake, - _ lip Code 1 hone Number Section LlJ ~7 Goa j~ a(c,rcl one - -N; R 11. 'd':YPe of Bilildmg (cheep all that apply) v l.ol ff - - 1 1 2 Family Dwelling--Numbct of Iledrooms OY ~1 .*6r 4^ Cd Suhdivistnn Name 131ock tl 'n t tr, Corntnc:rrial L)escrihe Use. - - L) city of•_- - - Stair.Chvnr:d-T)escrihelJse CSMNumber village of Town rr. [LS/f tcL1e'S~ r-~- 11 04-, _ F1 X35'3 - - Ili 'T'ype of I"erinit (Check only one box on line A. Complete line R if applicable) Nc~' System Cl ReplacCment System -1 '1 rcanttetat/iloidmp, "Tank heptac_cineut Only ❑ Other Modification to Existing System (explain) I rrnat. Renewal j Prtmtt. Revision ❑ Change of Plumber List Previous Pcnnit Number and Date Issued _ ermit i iansfer to New P [before Txpn'atIon ()wnet I'V. Type of POW T S System/Com~onent/Device` (Check all that AP1)(Y) . - - - - - Nnn-Pressurized Ira-Ground ❑ I'ressurt7rd In-Ground 0 At-Cirade IJ Mound > 24 iR of suitahic Soil ❑ Mound < 24 in. of suitable soil 1 I l lowing, rank Othct Dispcrsal Component (cxplarn)_ Pretrea vice (explain)-- L - i V I)espet cal/ 17r al meat Area Information: a ~ - _ ~ Q tP) J t)c acr 1<f ci l nestFn S'tI Application Raie(gpdst) -UtgpaE Area Re cared S TJis - - ( f; BU Y V I. Tank Info Capacity in Total 4 of Manufa rrer Gallons (iailons Units o - , Nrw Tanks Lxasting Tanks P u m u. in ;n rc c~ Srpur nr 17otdrnP Tank - 1 V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the 1101" FS shown on the attached plans. 1'lamhca s Name; (Print) Plumber's Signature - f- - /MPRS Number Business Phone Number - _ a _ Plumber's AdrJress (Sere et, etty State, Zip Code:) - t--- ViTI. (.'Dainty/1)~arl:mcnt I)se pnh-- - Alrprovecl )isapprovcd Pctlttit Pec T Date Issued lssninn A ent Si^rtature IX. nditions of A.pproval/Reasons fol- Disapproval --SYSTM 0*14R.,, { 1. Stpth: tank. alitluant t~►I~ ciiapN su crN rMA d l~ete'itashst l m and vnbmit to tiro County only on paper not less than 8 112 s 11 inch -9 in sis-e MIw~Itr01t / . WIPM www `iHl)-11398 (R. 11 /1 1 } 4,) 0- a2 .2 -12 A 3 ~ v 01117 I Soil Absor Lion S stem Cross Section 4'I Schedule 40 Final Grade PVC Vent Pipe th Vent Cap ft Leaching 1 Chamber System Elevation 3 ft ft Soil Absorntion Svsfem Plan View ft I ft ft Vent Or Observation Pipe Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Leachin.9 Chambers ecifications Manufacturer And Model _ C2 , !~r YS EISA Rating ,2© sq ftper chamber Soil Application Rate ~7_ gpd/sq ft 4`0 gpd Design Flow Z SDII Application Rate _ EiSA = a v2 Chambers 2 rows of chambers each. Page of CONVENTIONAL COMPONENT' DESIGN Re.sicl,EO I Application INPEX ANO TITI„E FIAGE, 1 1 m ~I c)uaner's Na ,__,J_..c~-_.~_---~'~'~%.J-L.c~,~.-.-..._...,____•...._------- ___...T.-.w-----------___--__~, f)~nrnar'., f4~c~C~q ~ T~ I - - I ewal i.laerriwinn- - - _Y. 1 ~~ti~rrghif~. r ~ut 111t.~t; ~~G J/cs ~ ~ ;1ltictivi~ir~r1 Na(TIF: ! of Numbor - - - 1 '~1rc.ei 11~~ Nlt~rti~Pr: leg 1 Inoex and title n a F'lok Plan i' ~qe 3 ~rstr~n I . I 119 & f-Foss-Section F'age q f f lt~r hper~s;..._ Pager T-_,_.._•~aintanl~n~~ tnf~rmatian~_ _ page _ Mans~~mnnt Flan l C'.rc>ix Gtv Saptit- Tank Maintenance Form Warrant Deed _ t]a, 9 CSM of' Piat Alt~41~1>?~rtts; ~nil'C'r~:~t ~ Har~~ea Clans aq*rens Nu17 h Cram d r ~r,~tct,rFC.I ~„rrr,uAnl to t(~r: Itl~(irrnlllrY ~inll Ahkot nn CorYipalr-ant 1Aranr+Al fnr r'QIr1l1-`-; \rnfsinn 2_a SSQ.10708-P (N.01109). F's9e ? ST. CROIX COUNTY SEPTIC TANK MAIN-1ENI,\~NCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Oviner,/Buyer DDS /lading Address w cj - ,2 Le Property Address _ OV a Department for new construction.) (Verification requited from PlanninZ i 6 1 Cit-v'Stage Parcel Identification Number LEGAL DESCRIPTION Propet-tti Location /V IL 1/` , V_r 4 , Sec. _~Y, T AZ N R 7W, Town of Subdivision Plat: o2 61 e_?-e C Lot Certified Survey Map 9 _ Volume _ Page arrant<l Deed # _ (before 2007)Volume . Page Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result 41 its premature failure to handle wastes. Proper maintenance 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 §SPS. 383.52(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 li3 full of sludge. l/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 Safety And Professional Services 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 q- ✓ / SIGNAT - F AP CANT(S) DATE *Ai1v information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. k 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. 04/1.2) POWTS OWNER'S MANUAL St MANAGEMENT PLAN Page o' FILE INFORMATION SYSTEM SPECIFICATIONS Owner cx ~e cl~ Septic Tank (rapacity r ~-NA Septic. Tank Manufacturer 0 NA DESIGN PARAMETERS S'~~~ Effluent Filter Manufacturer p NA Number of Bedroorns DNA Effluent Fitter Model 11 NA N umber of Public Facility Units _ 0 NA Pump Tank Capacity 13 NA 1 Estimated flow leverage) Es flow - aQd Thal da Pump Tank Manufacturer U NA Design flow (peak), (Estimated 1.5) - - Pump Manufacturer ❑ NA coil Application Rate Prtmp Modal El NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit L7 NA F=ats, Oil & Grease (FOG) <_:30 mg/L C Sand/Gravel Filter Q Peat Filter Biochemical Oxygen Demand (BBD,) x220 mcg/t ;KNA © Mechanical Aeration ❑ Wetland rota( Suspended Solids ITSS) X150 mg%i.. _ U Disinfection 0 Other; .'retreated Effluent Quality^ Monthly average ~ Dispersal Collis) ~ -----~0 NA Biochernicai Oxygen Demand (30D,,) <_30 mg/L iA,n-Ground (gravity) 0 In-(round ipressurized) Total Suspended Solids (TSS) X30 Mg/t. J(~iA G7 At-Grade 0 Mound Fecal Coliform igeornetric mean) _10, cful100rri1 _ 0 Drip-Line ❑ Other: Maximum Effluent Particle Size 13 in dia. 0 NA Other-- - _ - - ❑ NA i C] NA Other: d NA 'Values typical for domestic Gvastewater and septir tank affluent. Q NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s)' fMaximum 3 years) 0 NA urnp out contents of tankls) i When combined sludge and srurn equals one-third ('a,) of tank volume F] NA Inspect dispersal cell(s) At least once every; month(s) (Maximum 3 years) L3 NA S yWyaar(s) Clean effluent filter At least once every. Cl r s/ © month(s) ❑ NA inspect pump, pump contmis & alarm At least once every: month(s) kyear(s) L7 NA Flush (stare)s and pressure test At least once every: U month(s) _ D year(s) NA At least once every: 0 month(s) U NA - - - - ( L7 year(s) then. i ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the foflowing iicanses or certifications: Master Kimber; Master Plumber Restricted Sewer; PQWTS Inspector; PGWTS Maintainer; Septage Servicing operator, Tank inspection's must include a visual inspection of the tank(s) To identify any missing or broken nardware, Identify any cracks or leaks, r7moasure the voh;rnc of combined sludge anc9 Poem and to check for anv hack up or pondrng of ottliisn1 Or, the groimd surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to cheek for any pondinn of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the irt}med;ate nctification of the local regulatory authority. When trio combined accumulation of sludge and scum in any tank equals one-third ('/3i or more of the tank voiume, the entire contents of the tank shall be remover( by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. I All othor tservicn9, including but not limited to the servicing of Effluent filters, mechanical or pressurized coniponents, pretreatinOnt knits, and any servicing at intervals of 02 months, shall be performed by a certified POUVTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Of START UP ANO OPERATION Vor new construction, prior to usA of the POWTS eheok treatment taoklal for the presence of painting products or other chemicals that may impede the treatment process and/or dam., tfia {~isa~seli~(t! califs). If high Concentrations are detemad have the contents of the tanklsl removed by a septags servicing operator, prior tq use. System start up shall not: occur when soil conditions are f Ozan at the infiltrative surface. During power outages pump tanks may fill above normal hiqhvvatvr lovele, When power is restored the excess wastewater will bn discharged to the dispersal cell(s) in one large dosa, aycfteding the gblllsi qnd may result in the backup or surface discharge of effluent. "To avoid this situation have the contents Of "H 'pulitR farlk removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumbttr or mots, t ilnthwar to assist in manually operating the pump controls to rpstore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal colis. fie r gt,c~rlvs or park over, or otherwise disturb or compact, the area within 1 S feet down slope of any mound or et-grade soil r bsnrptloo area. Reduction or elimination of the following from the Wagtoodater ®troam.rrlay improve the performance and prolong the life of the POINTS: antibint.irs; baby wipes; cigarette butts; tar~Nt c►i71gI . tfdn $Watis; degreasers; dental floss; diapers; disinfectants; fat; 66 loundation drain (qump pumpl water; fruit and vim6oiabla pealirtgi3; jaaniine; grease; Herbicides; meat scraps; medications; ail; fainting products; pestlcides; sanitary napkins; tamflrinij and watat s6ftorfer brine. ABANDONMENT When the f OWTS fails and/or is permanentiv taken out ,of seCVipa the followinq steps shall be taken to insure that the system is pmperiy and safely abandoned in compliance with ehaptor CoMm 83,301 Wisconsin Administrative Code: a All piping to tanke and pits shall be disconnected and the akaan4onbd pipe openings sealed. 0 The contents of all tanks and pits shall be removed and proporly disposed of by a Septage Servicing Operator. ^ After pumping, all tanks and pits shall be exaeivatsl and removed or their covers removed and the void spare filled with soil, gravel or another inert solid material. CONTINGENCY PLAN tf the POWTS fails and cannot he repaired the following rnaasiaras hAye been, or must be taken, to provide a code compliant replacement system: I:1 A suitable replacement area Ilan been evaluated and may be ut►lized for the location of a replacemem soil absorption sy9tom, The replacement area should be protoated from disturbance and compaction and should not be infringed upon by required setbacks from existing and prope§4d gtrWbtur6i lbt linse and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to Mto00h a suitable replacement area, Replacement systems must comply with the rules in effect at that time. C.7 A suitable replacement area is not availaWp due tp patbpok and/pr sail limitations. Barring advances in POWTS technology a holding Tank may be installed as a lost reeprt to replace the failed POWTS, 1'11L)13 The sito`klas nq~en evaluated to identify, 4 lsvital lb roplagemerlt area. Upon failure of the POWTS a soil and site 11' evaluation ~le performed to locate a suitable rripll¢gtttettX ei'Ha. It no replacement area is available a holding tank may bq,irr~tafle s a last resort to replace the fall4d f 0witi, CJ Mound and at-grade soil absorption systerhp May be repopetruated in place following removal of the biomat at the infiltrative surface. Reconstruction% of such eystsrns must tiartlply with the rules in effect at that time,. < <WARNINi3> > ?AIVTAIrN W L SASSES AND/OR INSUFFICIENT OXYGEN. DO NOT SEPTIC, PUMP AND OTHER TREATMENT TANKS MW ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDO ix4~~ ~CUMSTANCES. DEATH MAY RESULT, RESCUE OF A PIERSON FROM THE INTERIOR OF A TANK MAY IRE 01001 UL t1R 1N1p~8s31111 E. fXODITiONAL COMMENTS 'OWTS INSTALLER oarnP ; 17-7 ~WAINER 5~•_.._ _ j~ja "..."'ey~",M,s... wkl•L~410 "7 _T `3 CK 11 tea ~w OPEnATOn IPUMF l ~ :i16n ,tlMXi';tinMd,mtnit ~ ~ x:. ,yt 40 X I, I l i ' I I I I~i~, li I Ili! 'I I I I II :r Right Elevation Top Eletion -71 - ~ II (ice jr .d .~v~_~i~n _ ~:~vy~ _t_ .ems - _~r_L+ r_~✓ ~G~`Urs~ .i~„cc ~ u .r _ _ .i ~ Y'~ti r i, a Left Elevation Bottom Elevation Customer Signature Wick WckBuildings.com Rick Ellis Date Jay and Barb Newton 10' Jay & Barb Newton 532 W Main St e-16-2017 ceilings T- 211 PM Buildings Ellswo th, WI 54011 po NOT SCALE 42'-0" x 80'-0" x 10'-4" ICH Baldwin, WI 54002 104 V p u4'xz N•N7)W tiY. OOV" K iF m a, x $ : tit N c~ C~^° ~ r q r ~ y ~ t F g Z r.. x w c , IV OD M r x Z x 0 1 0 a LJ y 0 c~ 3: c, s 2 m 8 z F CO n c _ av~~cxoe J n o x T{ wC' u q x r 6 u C? c i = m . iU 70 -c to r A p ate. ° x n r x ' i'o- 1T1 c`~' Y W ~ ~ r 'may ~ .ta to Q t'x3'l~JItIDOW 4'X3'WN6CW E3 O 0 PORCH u 8'x8o'x8' - - - - - F u _ 6' WALK DOOR 4'x3' WINDOW 3' WALK DOOR 30.6„ 60. .y O 3 n~ c 3 I ° i pI LIVING AREA PERSONAL STORAGE 3 42'x80'x10' ° 3! 3 O I I i 1 o I I I I o 33'WND0W 4'.3'WNDO~fiWALK DOOR 4~3'WINDOW II 1250OVERHEAD 13 KOOOR ~ iZ~a 9'OVERHEAD ICI PORCft r 8'x40'x8' Customer Signature Wick WckBuildings.com Rick Ellis Hate Jay and Barb Newton 10' Jay & Barb Newton 532 W Main St 8-16-2017 ceilings Ellsworth, WI 54011 nme: 210 PM Buildings 42'-0" x 80'-0" x 10'-4" ICH Baldwin, WI 54002 DO NOT SCALE I , //~\i/j~~/i~///~~/~//i✓~~/~/ //i~/ice i / ~i%~~i~~i'~i~/~//i:%~~%i~ ~/~l/s%il✓.~//i~/~~/i~~:~/i//i~/.~~\/i,%~%i~//.//~~ j~~i~\ To Elevation Customer Signature Wick WckBuildings.com Rick Ellis Jay and Barb Newton 10' Jay & Barb Newton oete' 8.16-2017 532 W Main St rime Ceilings BuildingsEllsworth, WI 54011 211 PM Baldwin, WI 54002 42'-0" x 80'-0" x 10'-4" ICH y DO NOT SCALE i. i _ - 7- 1 rill ~;~i~;i,! ~i ~i~~i~ii~!i i~~i_ ~~i`!i;!i .i~✓i'i~ti!i~~ii~i~~ii~ii!i,!i~~i~!i~~i~!i<!~ ~i~!i~!~!i ~i`~i`ii ✓~;i iii✓!i iii ~i~~i~ ~i`~i`~ii%~., Bottom Elevation Customer Signature *Wick WckBB-1620 7 .com Ja and Barb Newton 10' Rick Ellis 532 W Main St Date- ass-eon y Jay & Barb Newton Buildings Ellsworth, W 54011 T- 2:11 PM ceilings 42'-0" x 80'-0" x 10'-4" ICH Baldwin, WI 54002 DO NOT SCALE 12 4- - 12 12 41 14 Eli ~ MH E L _ KEE - - - Left Elevation Customer Signature Wick WckBuildings.com Rick Ellis pate Jay and Barb Newton 10' Jay & Barb Newton 532 W Main St a-is-zon r e ceilings Ellsworth, WI 54011 2:11 PM Baldwin, WI 54002 Buildings DO NOT SCALE 42 X 80'-0° X 10'-4" ICH 12 12 2 _ \\i4 _71 IT Right Elevation Customer Signature WckBuildings.com Ja and Barb Newton 10' Jay & Barb Newton *Wick Rick Ellis Date y 8-16-2017 532 W Main St T- C2111ngS Ellsworth, WI 54011 2.11 PM 42'-0" x 80'-0" x 10'-4" ICH Baldwin, WI 54002 Buildings, DO NOT SCALE RE ENE Wisconsin Department of Comm~pr ~n Page of Division of Safety and Buildings m U ~r~ COUNTY ce with Comm 85, Wis. Adm. Code CC County Attach complete site plan On O Mh~W inches in size. Plan must include, but not limited zon reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Z 2-1 2.6 6rj I 16 Please print all information. Re ' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r _ Property Owner Property Location Govt. Lot v"J 1/4 t JVA S T N R E (o P rty Owners Mailing dress Lot # Block # Subd. Name or CSNW / /IT TD l Mc u' -A city State Ziip/ ode Phone Number ❑ City ❑ Village (],Town Nearest Roa 51. New Construction Use: [Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pu lic or commercial -7~be: Parent material Flood Plai n elevation if applicable ft. Ala- General comments and recommendations: System Type System E~vation I -7' Z r`! f~ r 0^" f1b _ Boring # ❑ Boring Y, FT I R1 Pit Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 " > ' L Boring # ❑ Boring n a Pit Ground surface elev.l00. Lft. 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 iiff Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 540 - r 7 715-246-4516 Property Owner _ Parcel ID # Page of 3 Boring # ❑ Boring ❑ S4-pit Ground surface elev ~U ''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 > E) /0 Z 0 D o 5 r~ - 4 I -)A ❑ Boring # ❑ Boring - ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil 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 F1 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon •)epth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mgA. and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB"330 (8.6/00) Property Owner _ Parcel ID # Page of F3-1 Ong # ❑ Boring 1 s JA-pit Ground surface elev tJ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 40 / 7 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil 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 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 i Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBo-8330 (86100) _ Soil Test Plot Plan Project Name Jay Newton Shaun Bird Address 210 W. Maple St. Roberts Wi 54023 6TM#226900 i Lot Subdivision Date 4/11/17 NW 1/4 NE 1/4S 14 T 28 N/R17 W Township Rush River ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 98.2/97.2 *HRPSame as Benchmark Cty Road N Scale is 1" = 40' < unless otherwise noted n B-3 102' 30' 600' 40' B-2 100' B-1 500' ' 10' 70' 10' 8, Slope B.M.* 1320' Property Line RECOVED M 91 0, ST. CROiX COUNTY ,OMMUNITY DEVELOPMENT CERTIFIED SURVEY MAP PART OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF SECTION 14, TOWNSHIP 28 NORTH, RANGE 17 WEST, TOWN OF RUSH RIVER, ST_ CROIX COUNTY, WISCONSIN. UNPLATTED Northeast Corner Oi` Qoi ~4i Q~i LANDS ~q Section 14-28-17 o i 2615.92' 1" Steel Survey Nail ~i County Trunk Highway N - 293.77'--- ---w-'-----,~--w----,----------__1340.9_6' e- - - . W N88'S6'4 ~ E w 981.19 nt rlin ~ N8 56 46 E r N 4 L5 _ w_ - - - - - - - _ 33•QQ' P~88'S6'46'E~ w 250.Q0- 10.40' - - N88'56'45°E 706.77 ~rth 1/4 Corner tis ~6 N88'56'45°E N01'03"14"W Salon 14-28-17 ';r ,3 6 The road right-or'-way is N Steel Survey Nail RRti monumented with 3/4' rebor, o .4 L'UNPLATTED oz / I m _ 10T LNPLATTED LANDS v o LANDS cr~ 871 871,682 sq. ft. C 20.011 acres - incl. r-o-w a Line Data ° 836,806 sq.ft. w N01'03'14"W I 72.85' ~ 19.210 oUr , es U Easy 1_rn2 N01'03'14"W 33.40' soil tests excl. r-o-w ~of NW/NE NO 1'03'14"W 39.85' ! °o j N88'56'45"E 24.23' 501'03'14"E 10.00' 4 PREPARED FOR s88.56'46"W 847.01' Jay Newton 210 W Maple St. U_N_PLATTED Roberts, WI LANDS Each parcel on this map is subject fo State and County laws, rules and regulations(i.e. wetlands, minimum [of size, access to parcels, etct Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and Town Board for advice DRAFTED BY: Jowl A Rrandf -