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HomeMy WebLinkAbout020-1485-08-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600225 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: KERNON BAST TOWN OF HUDSON 020-1485-08-000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No: 91 . 1 ct; 21.29.19.3083 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ;f.3 CAPACITY STATION BS HI FS ELEV. I Septic Jr. ~ Z56 Benchmark A Z T9, 3 • ~2 S Alt. BM W N) J. ~i~ ~a T Aeration Bldg. Sewer an, Holding St/Ht Inlet I 9 ` V TANK SETBACK INFORMATION St/Ht Outlet 6.17 54,13 TANK TO WELL WELL BLDG. Ve o Air Intake ROAD Dt Inlet ` ` Septic Dt Bottom 5n 33 /o s Dosing Header/Man. 7.71 y 4 9 Q Aeration Dist. Pipe 7. $1 01 I I Holding Bot. System 7331 93, 77 ax Final Grade d' PUMP/SIPHON INFORMATION Manufacturer Demand St Cover' Z,Lf. /6,6 Model TD Lift Friction Loss System Head TDH Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z 1T~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur r* INFORMATION CHAMBER OR Sys Typo Of tem: _ t~ / t O UNIT Model Number: '4 Q /I DISTRIBUTION SYSTEM t JS Header/Manifo If Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ~ ~ ebd- Length~_ Dia / Length Dia Spacing 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 443 Bed/Trench Edges Topsoil ` -r vow ~ No ZL7 ]N, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 841 CEDARBERRRYY CT 1.) Alt BM Description = s , 2.) Bldg sewer length - amount of cover = r.,~(LJ~(G'~ Plan revision Required? ]YesNo ! I v Use other side for additional information. Cert. No. #gna SBD-6710 (R.3/97) Date In r ~ofi- :c - y S cones RECEIVED Safety and Buildings Division st CK.B I% x 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ' K OCT 0 a 2017 • Niads W) s7cz ~1sz per,, mots~0MMUN9M%K*W it p_V__ 9CFT3J StatL r lion 'umber In accordance with SPS 38321(?), Wis. Adm. Code, submission of this form to the appropriate Govern,., _ is required prior to obtaining a sanitary petruit. Grote., Application forms for stare-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the privacy Law, s. 15.04(1 (m), Slats. W of t-b-t ( r ` G .ppl L A ication information-Please P 'nt it Information Property Owner's Name ` Parcel FU Pmpe OWIs M-ling ► JAddress property Location City Slate Govt Lot ~ v, Seed 'VI tX,S 1 ► Zip Code Phone Number .l- circle on IL Type of Building (check ail that a ! Lot Y / T a N; R C E or pP Y) ~l 1 or 2 Family Dwetting- Number of Bedrooms Subdivision?: c k- 4 l ❑PublielCommercial-DescribeUse Bloc (JF- ❑ City of ❑ State Owned -Describe Use CSM Number ❑ Village of gTown ofs , p-{ O III. Type of Permit (Check only one box on line A.: Complete line B if applicable) ZW SYStem1 1 ❑ Replacement System TmatmetrttHoldina Tank Replacement Only ❑ Other Modificgrion to Existing System (explain) g 11 Permit Rene 0 Permit Revision II Change of Plumper 11 List Previous Permit Number and Date Issued Permit Transfer to New Before Expiration Owner IV. a of POWTS S stem/Coat onentlDevice: Check all that apply) Nun-Pre'csrtri rlt ln_ ro „,d ❑ Pressurized ln.Ground ❑ At-Grade ❑ Mound > 24 in- of suitable soil ❑ Mound <24 m of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (etigtlaul) V_ Dis rsaVl r cu Area %formation: Design Flow D7 esign Soil Application Rate(gpdst) ispcrsal Area Required (sf) Dispersal Area Propose S Z L~) S ~`uD ' 9 ICA L VI. Tank Info Capacity in Total of Manufacturer _ Gallons Gallons Units 2 Aicav Tanks FsatingTanks a 05 a; s cs o A, Septic or Holding Tank ` d C h Dosing Chamber V VII, Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) P[ ' Sign MPIWRS Number Business Phone Number Plumber's Address (Street, City. State, Zip Code) -AU N l~ u U VM. County epartmedt Use Only pproved isapp Permit Fee Date Issued Issuing AgCxtt re v" 0 Ora or Denial ! 86 - 1b, 11 17- IX. Conditions of Approval/Reasons or Disapproval 12 SYSTEM OWNER ,,11 1. Septic tank, effluent filter and 14-~ IDWwot JO 6a. dispersal cell must be serviced / maintained u 2. a as per management plan provided b plumber. require DIM V0Offy fj swn and abfpit to the Caaa Gal as h y f"~Pa not tea Hun $ ir_ x 11 ineHcc in stet as per applicable code/ordinances. SBD-6398 (R_ I1/1.1) Soil Test Plot PI n Project Name Kernon Bast S aun Bi Address / ~'r 948 LaBarge Road Hudson Wi 54016 CSTM #226900 Lot 8 Subdivision Date, 4/15/15 S W 1/4 NE 1/4S 21 T 29 N/R 19 W Township Hudson Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Survey Iron/top of 3/4" pvc pipe System Elevation TBD *HRpSame as Benchmark Scale is F = 40' unless otherwise noted 100 313' Property Line 100' B. b1.' 82' P.L. 50' B-2 98.5' 30' B-1 60' ~0. 101.5' B-3 ISlope 255' Property line t ~ f. 1 awe: er nNOu b sops Tay* v9 y ' Ago 0 MA f~er,^~it T i i~ep'kin ?ar* Iska W%ZUW l J.iIK P NA _ t f ; A 6 f»ura i artk aga &t 14A mummer ac PMZtIQ FelOtY UnIV' t yVU TEn~k _N'M MST MA ~ ru, ~ f~~i~:, :i31~d f?~3r ii„3t2rFl+v`.aG n 2.Y~ I 1~ ~ .~LtIZ,T}. f~a[T~~~ u ~ t~SfA. } t V per' p fyJirs~vi MA, • ~TI~a3, r" Saii A;~~tf1~-f4t7 f'=~ s ID NA c ;ti,rXhIV s~ntsotr. i Pr~21M, erno Unit fuarr: M PW T-1hr a rrds;d lr~iL'Mntll r sT3I &f ? x rt.:. , FM, ail & er {F-a} so §jl f f"E 'M zMM t3;crpharrtY ~i t5> 511 f= r„ n>' ~D £~1f 0 WA s ~ 1'~I~Irf°au;,iLA7 ❑ ~~~r Taaai t et;cia?~ ac fds a, t f c~ f^ a L!i&cer~=1 Goff{sS C1 NA ltftirr~llfy avara_ f.! I~~raratT~es°I flIgahenif G~tarn~ f3}~~5 n{I, ar.da_ cr~f'ria ti . Q. Fs'$f Cuir,ft'Mt i E'{2''c MM"I ztt E. SdR _ k y t3~ti®h it i ~li$, l--1 -par', NA n F2 nR ~~Im~ ~41sr~cfe .~rf~a ~ "B . r T~;hEfi Q NA 0 WA lar a ion s s ~'R?'Sf eft` 11 & ma_ ovals) MNAI ct°;a~kfs1 fix i~3S:nn~a = Vaa sa fir yr~:amp Q MA. iti ry a ant cif aMO1: 49V3 ~ tj~412k1 ct~tr4tsLri~tt ?ttdgsy a ifs} rgj. CS AIR f7 uFSrSGet t~ t t'!fG(t Fi`'_ OKs _I x t ti taAfl778 A'c f^on wi,8~ EVa1y= 44 I~ MA NA G6azil 3ilfl izznt 51tur a iTi tIff aS f:; i6M rncs RON! f",t rJ Ellfv} a RA 8 Ila?aac pw7;•;p*rn t;als~i~ y x? At few once nzrary; . .7r, NA AL tapes'; ama. ever1{= t32t)nr`_ • Stirs i sf? as h= n izr s~rtd ' 40WbA? e~~ £ x~ F?sA w t t't4~f DP inapsoMe of and 4» raal~& wt tsa r i t~> $c , P1ct~ ar Pis i >ad s 7s us~p3 sa es ~a „Etfc{sldto any O °rtrak lirS £~~r{SrC 4r ~f'a~F' P, is t4r r ea zisrs ^.dla v, f~ *p?a c tt3A3bfA & I sG v^sx gt d fr Fa aY eiv 14 hhw h %T 'PmIft9 c 3 d i4 a'hsPk ttla 5„ Uc-I? T~ fn a ~c'tV4 . a~_'~n and Mgtfiras the he di°_p°t l eflSsf s s,c a s 1 nra andin a ash =nt ,;n t a grAztt „ rna fmRrrodltea rr,~r'cian cn c, the t=,at ds-m-', Af thw tar* Velma, %be ar)' i'M 'qjudge ena.w sYi In sf I ars!s> r and anslhwd } R '9 a=ajd ftj;e oh Vnen the 1 , ~azs`.PrtS a` IT& =nk Shari fxe cets~veti s . _pHa $ serai~it?B Fop lAri5Ct9't2tt4. 31.IrTllilf9Cr3CnA9 CCSYI~`.. I; ult$~f -.r:o All If~t,:ft~i fi. err llmi6a '~77,,,,rtillt'fs~ 'i o~,is~acL ~LtitaT>,,,+.agi~at#a ryS/~Fgf~Jpr rx..- fte All ~At~Fir ~f2 Qr~~t:';) IVI I be (SE ~1 ad by tiWrltii~W K'l'~~'N . units, and any ~rvlt ikq eit ~tardal~ Ma c sl R sY ~x A gararfaa MPc5J-I. shsS it araeidad to the 11=.Ri MMu a'tM a tb"'"' wnj~in 14 d~ ek3lLU t4jol) 2-1 ART up A"-jz -CtS nEVV .'t'S15Li'[iT~ t• arc pi far try C75s of The PC33Vj a Gaeck treatMerst tanklsi far the -rte itt3y ir%tpsCE t€?=.zrsaFtt0a38 presence «f psis O the t t a tnr € m arfd/crr mar~a CIS dispersal €lts},thigh oan r~ra r~,,~ ~ ~r other ohem9cals by a septap r.MiatmS eAardrar Mr=or zo Me, ~ hen the =re,*axs; S+'S'CSM Star- up Shen na-t Ozzur wi?ai sell aC-f dkluns Erd ftpnn ST the ?nflimtIve gurfPca. u r psws: ~an :wnp t~nz~s mr TI(1 above rarrr&f nic? vvaOr I;Yets_ Mien power ir}'rsre _^'rsChar5ari TO the ai r-~# califs} in are a bass, nGsrtaaci7n he ca}i1 }std may remu€~ ~ ~r w uar WTI] be o`1)Uclli, 70 &ifiiq tn€s S€$Gta J4R have tils g0 C3mS OT E9 pLfi2 Irt?C 1Atf7BV~ W b2GY31 pt 93ro3$_t~tt'L"~13r(& !3 power tQ the e iw~:~`tl p>r or =n-, „L 2 s 1~~n or 4 r -a fay a ` Gi gar 3i` Mast-lnRr is ~=2 "71"~tt i ~?sr;~ ra5~ar1^~ ~'Estcrsa norm levels :AJf hrn -ta DUMP '!3nC. 25-' M -:10Y psradfTq t?'t5 La nct dri'v'e or park u8i'~ic}a's oVj ,r 2mt1:~ are,; dlsisarSat ceBz. Do not dt,lVa or p 1si his i 5 feet down site; of an mouse cr ^i ra[fa saril absorption arse, ark obi; or °2hat rie3 d tit csr acs .s - , rra arsa f=e-disctlan or s1i?t~n~~;s of 61-a 71-t5 o Y409 fro.n the +Naa BVi~at? r sham rniay rova the Per'I'm matte csi 17 F0141 S; zr, biat? baby wlpaa, atummtte butts; ccndnnas n a i .rnddr.-In ame -vuabs; dacraaSm r dantpj , s'n9'w`!s ifs tile 1"cu datiaa Er d~S+*;(at.mp pun p) SIVa e r fret and v=gat.ble pasUnga, 4aaetina.T ar'82&Hr~.+~ dicissrs; dis*y~~L~~ltSj iE2; t~aS t8a^r 13i. r iyE1??CtF18~ LMrAp -is; Zia 'vVn =t SL ' TC&'; ? I3mz . Y CE IYS` ^Il. i1 i 37i he PC34itT° lai15 c`,i74lar i$ pe latlentli/ Mzlmn out Lsf sani[4- i^'c `DIIpVY1t1~ 5` ap Shen 6L. tf j InS~r -]Bt ttls S GM urcaerl-v af:d safafv O bred In compliance by i~ , cf~-r COMM ES-23, UUisWcnG AdtTt;,iis-tragva Ysto-t:!t a r~6: ~:rr i`IPina W tanks and l4h Khall crs disaonrec -=d a tr3 she abalidansd t ae o. 31f7~ 7 -he cyY7tGrT..- G` ar, t=.n-~= r ~ 5'acslsrYi, ;r.'d ,ppm S E: be ?r e.mved and ;=P ar1't ffL~ G,1` by 2 ~ jEPVtiC. L"i.+ ~STyW :..1 =Fm~ Z-d p3~ E~ ! bs 1Y tu: .ilr'"9C. "T!Y i=,,•i or aTtrdnr Men scsila ` i_ _c t t ~ nr saff, gt a I?c:r ~ ~'i~ r ~~c: at2d ins VG=V ~sGS tt'c23 L3114Y4 =-nrTei. 1- fte ?Of V { C~ru'~ +'•f1 • Can, 'rte r~pfr:id h fC!?*tylf! j~MG-len z 13?SU ES YY;~Ie 132c'17r u. \-}47s s,t.--r3 TJ~ 'c=zi~er•-•S''~.. r:'L'UN.~'3"c $ `~;`L~•~ i.°.+"27.,'~' ~:$F9t A s: kabie :Ir enz a:ae has been, evaluated and may be Crtifted fbr the Inotlan of a ,g M- at4 syetAnl, Tits al ?Trert AT-ea a aTac!tid ba pFGi ELtSgr.3 irtstr „is br = am cart~padflrrrt aTSr~ SI;pr9ld 7Trst~ti,~a in. raqutr getbasl Ertl $X4?ice anti pr; pzsad sxutura: its,' IIlies sz ' C , _ gptnY rasult 6r Willa neEd or a neW el i! and'sfte avenue inn to R~^ 'w.3112' PailtaP^ l5lo, F'tl'j . rapfacstrart, area WIT Cc:-;yhr wiih the t-Was in s«:Qet at -Eht ti T w t~(,1I8,a Suit~?JE ;E~?3Gr RYiS?]t arm. ?S,1~3&iLYct2~ 3' Yli~ ?YYL3Y Ct A suitable rap'lnamemA area Is not aVallaniE dzve tc sett:bacgk s,^ci/or sal? IiraitEr&na< -11q irg advance-a in POI-18 tacF101agY a hzTCM3g xunriC -may be 1n51 a c I1e~I as a _ , ~a..t resort to ravaea fn° xaH3d PL"rWe S. L~ The sits has r:cR baa,t Silalu~''ua`d tc iden_ssI S etu to n l3s a sQj4zbJE rapl=cametr are:. i~aj -,.aura tlf ~e I'G~VVr e, edit ar3d alts RarFmrnm to locate a Multabla -eplacemant area. If nza rsplaswnent ama is available r 11cfdIng tar.4 :naV be ir.staitei as a lest resort to rapt=_ce the fallad POWTS, 11/iaiind and ti ~ Merle sa?I ab~ a i 011, d ev-gl r rptlon SYStPMS fra-V be rscz atruot-3d 1,11 plamm afis;rairg er:cl ~(9CSClt ,r~"uriuns uf at of 3-wa 7 o r a. ms; ftril- CtlTT ply with `ha juleg it, flf:act a fame bI~ a "E 5 t~ IM, a, S5PTIG, PUMP AND 01149-R `"FMAZO 1k€T TANKS MAY G"Jc NTAIn, E.MWAL C-A $ ANDIOR lYI`+I"~TER A S=Px1cr PFL:lP 9H OTHER TREAT vll=?,I3 TA-MR UNDR~ ANY ~~i~~ ~ ~~~~~r DO PERSO5i x CbiV:: E: €idTE Pj OF ,B. T. --AX iiM B D;. , '-LI On wrtoasMs. ; 3P rt AJ:01110tl AL COMM WTS POW-M slams t+ Y,,, b P`~1~J 6"S I~Atl9T~I~~~*. FpL-arte "113~ 4~lama ~r SEPIrt-INN OP M:, tRT-j. p=. Name U aS This dog ;x,;.: e,~:Ed d hcsr:C w '7 r 'and fro,r:L(fl, 17} gi ('s), !1 lsac rtsiri Acffr[7tCIF3V2twi• 1fL~ L-,,243. 4" SMOCIE118- 4D PVC vent Pipe ~ Final Oracle + frui(t)1fg%li Cap LeaMing tahaMhei ~ystrt~ ~~`vatic~rt Slgfam. Rim Leaching f rnzc3ch i 1 j~' vf'+a3ipJ7E~'i3 i ~I.. 4' Dia. v6n, Jr ohse vavon Pipe Tranch 2 Header t Trench ~#ia r.Bs 3ck;fes And Model ,EISA Ratina. U per cttarnbL Soil. Appf'rc4011 Pate • -9Pd Design Ftouu I Soil Application pate ~a S U.A FISA Page of Technical. Specifications PL-525 EFFLUENT FILTER(COMMERCIAL)e1.7 B&I. DECK it - EXCEPTS S'"'A FCR INLET E%1EN1104 it~51 ~ ~ I' 11,35 OUTLET BW"EUPTS •~1;,~ :50: 40d ' SCH 4G d1a I _ _i-i-1 3z ~ lp Z \ R~ j ' I+ t lif j ! i tl~ I PL-525 FILTER HOUSING \ 1"34 e` t PART NO. -30142-525 % • j MATERIAL HOUSING -POLYPROPYLENE { I, ( L - OUTLET BUSHING -PVC 6.58Ait •HDPE--~.-Jj ! ! It r- SOCIiZETEXCEPTS FLOAT SWTDi 1? _ - -4 10.25 i ~J ! ? - EXCEPTS t'SCHQ .98 Wl~ ( 1_ t X131 ~ Fa1A*,OLEExminot? ft \ - I l1) i ~ra~Fy~ 1 i f~l 624 t')F In3'SLOTS 530' I, 4 -SOCKETE%CEPTS E04955 3N1 POSH ROO r- OPEN WO - OPE_ xtc i x1i 1 it i 1902 2841 I I I I !f I { I ~ POLYLOK PL-525 FILTER CARTRIDGE .t PARTNO. - 30141-525 MATERIAL -POLYPROPYLENE -J i to t0 it ia~ CO ENT ?Oi' AL "O'AAPO'NENT DESIGN yident?~i its}aiir.,~rfir?n INDEX AND TITLE PAGE Prrjjc)r_.t !lame: Owner's Name: Legal Dos ~i~ikatior,: (J ~ 1 N ~ Township VA s 0A County: S l , LQ % F,uhd'ivision ~arxlk ~i 11 I'rrrcri IC? !~lurrthr~r: Q*lad d$ -0 oo a 9 InclG~thd title r Itat t fin Page 3 a~3n7 Page 5 I~'(aIn't~n n'c°P l; t.;r~rrr~a i ~ Pan'(.' G _ - l~Jlx~ f ir~r :L?Til L'17i Plan Page 7.. G,tstx c;yo'atic Tanhraitan~c F~r>Y Page t3 Warranty C~ee, Pogo 9 Cs m, tzr Plai All' ch'MP.;-MLS: Sot Tast a H ine pl;, :s C?~:stgne; /l~'Itrr~'rt:;er: i ~ f r.tY1 tJt L i~yl a LiG`~ Drd'iF3: Phario Number ~3it~ n a; ~.rre LirSir~r!eN, riutsuan* to .hr. fr- r uncl S01: , Absw Lion i on~pe,,en; r~t~n„ra! rnr POVVTS version 2!> "01) 107b5.P (rJ.~'t/0!}. r'ttcc^.. 7 I I *f A 78 r~ or,, 11 IkK K T r C, ~ jy„ Ilp cd 1. B~ y ~IS c° r ±J I I i r r ST. CROIX COUNTY SEPTIC TANK NMARiTENANCE AGREEMENT AND OWNERSHIP CERTIFICA ION FORD N-tler/Buyer 2 akua 5. Qom! Mailing Address ~41 LA &a QnAA NcrDSo~J , our moerty Address 04/ CtW&M Ctr , l~vpscw ~wL _ ;Verification. wired from Plarming & Zoning Departnxnt for new construction.; C <tS=ate ASoni ~hl~ Parcel Identification Number 020 - lgts- d9 000 LEGAL DESCRIP ON yroperty Location NU z /4 , W ; Sec. 21 , T Oq N R I q Q Town of 14vORM3 Lot $ Certified Survey Map # , Volume . Page Warranty Deed # s Volume , Page # - Spec house 0 no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER ~ER'~i14ICA -ON Improper use and rnaiut-enance of your septic system could restlit in its mrnatm failure to hale wastes. Proper maintenance consists of paring out the septic tank every three years or sooner: if needed, by a licensed pumper. R'hat you put into the system can affect the function of the septic tank as a treatr~t Stage ip late waste disposal system. Owner maintenance responsibilities are specified in §Cor_mz. 83.52(2) atxi in Chapter 12 - St. Croix County Sanitary Ordinance. _ The propeny owner agrees to submit to 5t. Croix 'County Planning & Zcr-Ing Departmmmt a centor forar_ sign:cd by the owner and by a taster plumber, joumeymat: _eluzri>er_ restricted plumber or a hcensed pumper ~,rifyhsg that (1) the on-site wastewater disposal system is in proper operating condition atzd,'or (2) i£fter inspection and pumping (if necessary), the septic t=--k is less than 213 full of sludge. Uwe, the tmdersigned have read the above requirernemtts and agrft to maintain the p:-it2te sewage disposal system with th!! standards set forth, herein, as set by the Department of Commerce and the Departruent of Natural Resources: State of Wisconsin. Certifcation stating that yow septic system has been maintained mast be conwleted and retmmcd to the St. Crow County Planning & Zoning Deparuner_t within 3€3 days of the three year expiration date. llwe certi 11 statements an this fonn are true to the best of m}iour knowledge, l'we am/are the ONMer(s; Of 'be property desc above, y viru:e of a warrmty deed recorded in ROW-e-r of Deeds Office. Nu r of bedroo /o ; OZ At T RE OF APPLICrMN'T'(S) DATE ***Any info tion that is n srepreseuted may result in the sanitary permit bemg revoked. by the Planning $ Zoning Depar~A=- Include with tiffs application a recorded wwarra-.c1Lees Lrom the Register of Decc ds Ofticc and a copy of ike certified surrey Trap if reference is made in the warranty deed. LSD - b(7 I i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in.accordance with Comm 85, Wis. Adm. Code County ti Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must ` V include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Ge.*tGi ArD IA) Property Owner Property Location _ O I Govt. Lot 5 1 /4- 1 /4 S L I T L j N R I E (or W Property Owner's Mailing Address n Lot # Block # Subd. Name X CSM# IAllp City State Zip ode Phone Number ❑ City ❑ Villa Town Nearest Road New Construction Use. Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public, or commercial -Describe: Parent material C ~r 7~ ✓f Flood Plain elevation if applicable f✓ i ?t ZVA)~5 X ft General comments and recommendations: J ~ System Type_ 4-/ p `i; J System Elevation_ - ` - QE EL : -fva -,01 0 ❑ Boxing # gy Ground surface elev. (,ft Depth to limiting factor in pit ring Soil lication Rate © Fionzon 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 YY" a Boring ' Ground surface elev. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 < 220 rng/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD. < 30 mg/L and TSS < 30 nxVL CST Name (Please Print) Sign CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 L Property Owner Parcel ID # / Page of F-I ~ ' Boring # ❑ Boring ~ 2L pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 G d 3( 5 Ut ~ > > C' n (j -2- 17-14 jdVA161 i 1 ❑ Boring Boring # 1 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 ri '6L /01., 3/v Z LJ sr C 3 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence BoundaryRoots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. °Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 220 mg/L and TSS >30 < 150 mg/L ° Effluent #2 = BOD, < 30 mg/L 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. SBD-8330 (RAM) Soil Test Plot Plan Project Name Kernon Bast Shaun 'rd Address 948 LaBarge Road Hudson Wi 54016 #226900 Lot 8 Subdivision Cedar View pa e4'115/15 S W 1/4 NE 1/4S 21 T 29 N/R 19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Survey Iron/top of 3/4" pvc pipe System Elevation TBID *HRpSameas Benchmark Scale is 1" = 40' unless otherwise noted 313' Property Line B-4 100' M.* 70' 82' P.L. 50' Rention Pond Area 105.5' B-2 98.5' 103.5' 30' B-1 > 101.5' 60 B-3 30 10°10 Slope 255' Property Line s El 1 F LEFT ELEVATION RIGHT ELEVATION O ROOF PLAN \ z" \ U a.; 'y1~` -{11~-III 4. Naen T,6 ® 1~ ~ O N ~V iy W - REAR ELEVATION F z o W . s F U I u " F ~ a W C' W i o^ LUX= EE iLiu~~ r } p ti FRONT ELEVATION PLAN ~o PAGE OF3