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HomeMy WebLinkAbout040-1312-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600320 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 Delta Construction Inc. TOWN OF TROY 040-1312-07-000 CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town/Range/Map No /GYM . 35 8-3 G5 T 04.28.19.2037 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 146 ,35 /a. ~ ~'G.~~•( /k.L. • ~ Alt. BM /4 Aeration Bldg. Sewer / f L rr. Holding St/Ht Inlet 4.7 St/Ht Outlet / TANK SETBACK INFORMATION 4 .1 y►3 TANK TO P//L~ WELL BLDG. ent o Airylntake ROAD Dt Inlet Septic Dt Bottom ~ Dosing Header/Man. 7. q2 . . 8 Aeration Dist. Pipe . ~O gZ Holding Bot. System cY PUMP/SIPHON INFORMATION Final Grade a `7.3$ Manufacturer GPMand St Cover ; ! bG 7 Model Nu r v TDH Lift ystern Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di1. Liquid Depth DIMENSIONS ` 7 ` SETBACK SYSTEM TO V P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer P I av n INFORMATION Typ Of System: CHAMBER OR _ err ~-7 w/ UNIT Modelllumber:w DISTRIBUTION SYSTEM 6~ ZZt-Z Z_ = J44( Header/ManifoloP Distribution x Hole Size x Hole Spacing Vent to Air In ke Pipe(s) e=ab Length & Ilia Length Dia Spacing` \ jr1a CIA 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 Bed/Trench Edges Topsoil ~P es U No ---~es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 522 OLIVIA CT 1.) Alt BM Description 2.) Bldg sewer length = S - amount of cover = J 7 00 `TEL Q Plan Required? -Yes X (o 1 Use otherlside for additional informatioNo 7- _1(1J oature L SBD-6710 (R.3/97) Date Insepctor's Cert. No. 06 MEE s{om mr~r i_.._ Coun....-t d Q[~~J V V~ r 1 - Safety and Buildings Division t i f 201 W. Washington Ave., P.0.. Box 7162 Sanitary Permit Number (to be filled in by Co.) < 8 K 171-P o 2018 Madison, Wl 53707-7162 M~~ ~b~3Zd ~t 25ERVWJDXV4MR State Transaction fumber unitary ~ it Appiication in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to jest Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secon e_-°- r, purposes in accordance with the Mvacy Law, s. 15.04(l m , Stars. L Application Information - Please Print All Informado 1 Property Owner's Name .a Parcel ITT t-) 2 Property Owners ling Address Property Location 64 , Q W t'I (p; t.% (C yl' " c~1 Govt Lot City, State Zip Code Phone Number ;i.+/y, Section circle on T N; REor ype o Building (check all that apply) t. S vision Name Family D-welling-Number of Bedrooms rCCJ' 1 ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ 'Village of ZZ 4- ZZ Town of III. Type of Permit: (Check ont one box on line A. Complete line B if applicable) p y~_ A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 10 B- El Permit Renewal El Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous P Number and Date Issued Before Expiration Owner P,' . IV .Type of-0 WTS System/Component/Device: Check all that apply) s `r Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 ❑ in. o le soe 11 HoldingTank Other Dispersal Component (explain) Pretreatment Device (explain) V. is rsaUTrea ent Area Information: Design Flow (gpd) Design Soil Application (gpdsf) Dispersal Area Required Dispersal Area Pro d (sf) System Elevation 1.0 O V L Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units / 2 c New Tanks Existing Tanta r ',Y d o d a o Septic or Holding Tank Dosing Chamber Ell VII. Responsibility StaterneAPI~j the undersigned, asst a sponsibility for installation of the POVM shown on the attached plans. Plum,b;r's Name (Print) I Plumb ature ::I,!Nlv1PRS Number; Business Phone Nurpber rPhrm)er s Address TStreet, city, S)atyt Zip Code t VIII! uatv/De artmentUse Only Approved Perm t Fee Da ~fsu l Issuin . ent Si~rature v on for Denial_~~' / DL Condoa J1 S pproval rk, c+ t;;vnt ~ 3 u 5{+et.: ,cell t-+ust all be s~_ic^s rrz ntL_ as per imar.3gemenl plan pro iiaeri by plu,nbe:. I 2. 'Atae!wk ns J0W,^enis merit a iTa"'itnta Soper Ppri=WR c»rb: / :rd;enn+;s.t: Attach to complete plans for the system and submit to the County only oa paper sot less irons S i2 x 11 inches in size SBD-6398 (R 11/11) System PLOT PLAN PROJECT Delta Construction ADDRESS 602 W 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 95.8/95.7 4.5' below grade DATE 2/2/18 4 BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE ` HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. top of 1/2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 194' Property Line 30' Scale , 1/411 = 10' 13 85' 5` 2 - B-3 Vents 0% Slope 100' f-03' X 90' cells with >3' spacing A+eo-- 1 M. * 5' 15' ~J 7-j 30' ST Pro 4 Bedroom House Vent 366' Property Line >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 6^2/pair of end caps 12" 5. ft 4' Long „ Grade at System Elevation ,11-0 p 34" Olivia court All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/2/18 Owner:Delta Construction Location: NE1/4 SW1/4 S4 T28N,R19W 522 Olivia Court Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Leaching Chamber Cross Section Contingency Plan 4-6. MaintInan 7. Filter Cn Signature Li cense n 6900 "e System PLOT PLAN PROJECT Delta Construction ADDRESS 602 W 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4s 4 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 95.8/95.7 4.5' below grade 2/2/18 BEDROOM 4 DATE CONVENTIONAL )00( CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. top of 1/2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 194' Property Line 30 ' Scale = 1/4" = 10' 85 5 -2 B-3 Vents 0% Slope 100' 2-3' X 90' cells with >3' spacing B-1 B.M.* 5' 15' 30' ST Pro 4 Bedroom House Vent 366' Property Line >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" 4' Long Grade at System Elevation 34" olivia court All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ftA 2 pair of end plates Finish grade elevation r Typical Installation 100.3' Vent Ael Grade Vent 3' 4" 3' ,A ~~30/34 Septic Tank 5' Long 1 5' S' Long 1 36 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: A-95.8' B-95.7' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 7 Septic Tank Capacity Ia al ❑ NA y Permit # Septic Tank Manufacturer ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer 1`. ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model r ❑ NA i Number of Public Facility Units NA Pump Tank Capacity al NA j Estimated flow (average) aVda Pump Tank Manufacturer 13 NA i i Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application Rate avda a Pump Model NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter v Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L . ~l in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ✓❑'At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu9100ml ❑ Drip-Line ❑ Other: iMaximurn Effluent Particle Size X in dia. ❑ NA Other. ❑ NA Other: A _ Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE _ Service Event Service Frequency month(s) linspect condition of tank(s) At least once every: ears (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (f6) of tank volume ❑ NA llnspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA. year(s) (.lean effluent filter At least once every: ❑ month(s) ❑ NA ear(s) i nspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) 1=lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Pther. At least once every: ❑ month(s) NA ❑ year(s) ether: 11 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 iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of icembined 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 I-eguWory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) 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 <12 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 presence of painting products or other chemicals ttult For new construction, prior to use of the pOWTS check treatment tank{s} for the ow are detected have the contents of the the treatment process and/or damage the dispersal cell(s). high may impede tank(s) removed by a septage servicing operator prior to use. at the infiltrative surface. System start up shall not occur when soil conditions are frozen lode surface excess discharge of wastewater will will nl. tanks may fill above normal highwater levels. When power is restored the DuToring avoid this power outages pump dose, overloading the cell(s) and tray result in the backup to restoring power to tL discharged this the situa h a tion tion haiave cell(thes) in one contents of large the pump tank removed by a Septege Servicing Opel prior normal levels effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore the area within within the pump tank. disturb or compact, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. life of the pOWT$: Reduction or elimination of the following from the wastewater stream may improve the perforniance and prolong g t lif ; fat foundation drafi - cotton swabs; degreasers; dental ficss; diapers; antibiotics; loci by ter: cigarette butts; condoms; asollr grease herbicides; meat scraps; medications; oil; Ping Pry. (sump pump? water, fruit and vegetable Peelings: g pesticides; sanitary napkins: tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall betaken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing operator. and the void space filled with soil, • After pumping, all tanks and pits shall be excavated and removed or their covers removed . gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code cartplirrt replacement system: system. suitable replacement area has been evaluated and may be utilized for the location of a should rat be replacement infring soil ed upon absorption requited The replacement area should be protected from disturbance and compaction and moment area a will result in the need setbacks from existing and proposed structure, lot lines and wells. Failure to protect the must with the the ruIe0 nee in for a new soil and site evaluation to establish a suitable replacement area. Replacement system comply effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sail and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. removal of the biomat at the infiltrative ❑ Mound and at-grade soil absorption systems may be recoratnucted in place following surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNiNG>> SCEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO O ENTER A SEPTIC, PUMP OR OTHER TREATMENT MW UNDER O IMPOSSIBLE. MCIp~IMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER t - - / ~,(/C I Name 7 g;E / f Phone J 1 AUTHORITYLOCAL SEPTAGE SERVICING OPERATOR (PUMPER) REGULATORY Name L E=e Phone 6 -y6----- This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)$(1) and 383.54(1), (2) & (3), WWconsin Administrative cone. F 'tlc :1 i O j i ' • f ' ~ Uo - i c I~ v i _ L CAI fit' \ i ST. CROIX COUN YY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 0 CLI LR A~ 5 C , f ~p~y c=- r`%t (Verification required from Planning & Zoning Department for ~f construction.) City/State Parcel Identification Ntunber ✓ 7' f i' ~r f ! ?~~7 LEGAL DESCRIPTION Property Loeatios/t` (-x>'/< Sec. TN Town of 1 ~l Subdivision C-41 , Lot # Certified Survey Map # Volume Page # r-- Warranty Deed # 22 Volume page, # ~J Spec house es no Lot linen identifiable no SYSTEM MAIlV'i'ENANCE AND OWNER CERTIFICATION Improper use and r te^ =TM~ of your septic system could result in rte premature failure to handle wastes. Proper mamtenaace consists of pumping out the septic tank every three years or sooner, -a needed, by a licensed pum4=. 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 Ordmsace. The property owner agrees to submit to St Croix County Planning & Zoning Department a certif cation form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undezsgped 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'WisconshL 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. Uwe certify that all statements on ' form are true to the best of my/our knowledge. Uwe am/am the owner(s) of the property described above, by virtue fa deed recorded in Register of Deeds Office. Nuapper of bedroom SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if refirence is made in the warranty deed. (l~v. a8ros} RECEIVED 02/0112018 03:50AM Feb 01 18 02:13p p.4 I 1 I z i Im ti m O O s ~ I~ Ia ' cl) r- a O w z z a o D A oz I F I r ~ c O O D n's ;e@s~s '=3;35?i°`S?c'~ DELTA CONSTRUCTION EExt_ sQF ,;o, gcz TYLER M zz" s~ Ne J Grp 1i3 IFr= ARIE KRISIK a y ~'o x z z 522OLIVIA COURT. HUD a3p o c SON, WI 54016 m - E:\so9-SVVVIO-oo2\✓aw real\slo-9o2_Ewu n'A1— a/IA/2an5 4:2- r9. E 1 R ~ ii phi 4g ~g i All • I' I Ala i 3 ~ lip lip off ~q F ' ee a 7 C I a C S 9 pp g 1 E uHa..nE I.° s 22.21'13' w 2}).96 uNPUTap LNOS R II ~I 13P~za~ gyp" ~EcW9 9 I - 2a.e9' - ~ - -3=00_ _ me.n' griy$p"B RR1S'a~ MI a \ g Sr° / MS - - S z - - i P R 6 Fit FR l(ISa ( N>.yz. ~ O r \ ~.c ~ / 1 FFI H Xii 9t Gam''-3 ~.8"8:~ 9~E~~Rd~ M ~d~,~l9" ~ ~ \~e`?•.F O• d K~~F $S I$i~i9~`Y~~~~i i~F~~ daSll inR!e!Ra R^~ s S~I6i EDI$11.=3 f,•e 81 ~~H I Fal¢~",N I~ ~I 2~§ 6 ° ~ ~ R9t Iu, $ ^ \110" i \`C~Pj, `;9 t~` \5e t~ S 02'4,'1}.0• W r16.B9 a 53!ayn I - ° / _ AJ~ ,I FC tr 155.4I' rsi.s9' ° t OsUTAT 3 9~ N 01'16'H' E 190.0} [9'BfiZ M .YS,YZ.YO N < ~ N~ III ! - q e A SOLBERG ROAD-'$gNl Ilo m u R S 0129'24' W 579.16 O IIC7 i9 , -,2__-__-so6,93._____ 12,AI S 09']2'29• W2 4 Z ggZ W. S 00'07'20' W 367.38' Wam 4 $ FAff ° s 's >29•Eo -------263.e2'----- -63.2,ti I' Ii p{kR ~ g~ ~~1~6. 1r, R o I I' 8&5~,~_ ~'.1" I z lj I \epa i,W / ~ Sae.e E _I°~ I ''Iem~ I o ~2S \I yy\r' o T P: Fra o\f ; I I g$H 91 I i O :H - :F I 0 / ~1 p 53!aV 2~1 N, J E\ I~ v `'Y8 19i~'~,K', ~-3 rl Lr.\ \1 She .I I I~ ss \ O la " ~(D $ BkH I I~ j e +U N `9E ~dMYt018 50 Y4', 'W 274.23 wrvLAV<vW NO. lY'~32 g ~ No. i tom/ FFF~ u O I Ij IT1 vaa° / tRR 8°w H $ 161 A I ° ■ (.,°y~oa i~ /i 1 I W oy~^ Y-~ H 12- I 1 a Q LI-IJ 199 I`_ S $~o~ N021312 E , -CIA N02'13'11'E 366.31' ' - - OLD HIGHWAY 35 rn - - n o=R ~I---~ UNPUT1sD l.AN05 L9T F. TU~3Y MAP m UNPlEO ~NOy I l~L p m A 00 LZ (C) 0 : h tK LL C) N CO 03 co CY) ~99,qu~p LL. 00 00 (0, LfD 9 L-: 6 &-4 IA 0 N 00 C6 C4 I-,-) cli # LO 00 ~ 0 E LO CC) v ~Y 9 f nniao L RECEIVED 02/01/2018 03:50AM Feb 01 18 02:12p P•1 I IF- ®l~l a m `r ® _ _ ' m m S_Saa 111 r- a r,ll it I J ` m E Q m Nit I~ { I I~ i ~ N I ? I- R \ f I i j. I 1 li ~ I ✓j ~Yij~ Ili II P 1 i I ~~¢si o°, 1 c ~ A I I I" t T o €,I}~~'BSg o ' 4 ^ Q.i9~ lax Z-v =Edr4 .'-_°sS 6-v0 DELTA CONSTRU ' T ~ eQZ,b' des r.s ~kx.rF~3i~~~=€ G-ION i '>Fpa ~ . -,S m =:z'zysipE TYLER KRISIK ==Q e N, m MARIE E v P Z EsF i. £e ~ r c z a t l SE^~$~ 6G RiCo~x jo F O~ ^ b p z c R..#wE~eSs3a:gFS, 527- gW3A COURT, HUDSON, YJ1 54p15 __L, o m ; ~anoo bw1o zzs s, .`f z-~- = W m 7Y 9XV3VA'NosanH n 2 1 Tru ry k ° i MIQQ VIN)i 3 radw `may. o L° "u NOllafi2315N03 V1134 ;°y~ .gyp a~d,yt- _ ;g - M ~ o g- I ~ t F 3. O ~ B ' 19 . TT o I X ~ n - ~ I ~ b QL i 4F ti Y 4 S2 t R Ilk { . 4' •ItFIflbtSA = ~d ~ S I ~ L xw C 3z _ 5A i , M+, zS'3 II - ; b d• b ~ LLJ -y Y pt! fir 1 I dis G_'.P 0. I+ I ' I J ~___r_ I 1 _ 1 I ~ I I I I 1 ~I .IYL b I I t I I t - ^ 6 x p > t 7t4 ~ e - I - Y~ i eeb.x t6 y r. ; ~a ~ e 1 r t ' 1 ~ -.YD ZJN a~ 3 ~ s .Pt - qi •T d21 n 2 r an n o 2358 = W b y u - _ ~a V ~ 0. e¢n I Nf - C ,T Sal 8H nt I A-J+ a_ 1 { £'d dZl Z086 60ga3 Wb05:E0 8I0Z/I9/Z0 Q3AI3038 ~y R `o 0210 ~ 9C06SIM'NgSgllk'!T~np~ylN'10ZZS SE__rf aq~s;`SS:a ~_,a.- e z in a~ a a - ~IVlaJ I1 ~Se~`ac3x 1 vv ~ ~2a L. 35i~_.1 0 ~Jy■ N3-1,u u$~ 31b MKW IR q3}S~3d: aY~ a "~'E Y~ • Q o a' a i ° 3 e?a NOI 7Es 3~#!w~'r5+..., 5s.6'di25~p m C 4 lofl?11SN0o V1130 Wsu~`-~~3 9s@ a,3e = - . s v `o S 3~= ~ II r, ~ o rr ,r 'r lQ g Q~u°S JSy I o i i8 i 3; s e z~ § S - - - - V N r J, z, i F 9; r • - - oR - 6J kt; 'r I 3$ ~ - - A.>2 I •5 m I '1 - - - x~a i Z'd dZ L:ZO 86 l0 Qa3 WG09:60 8TOZ/T0/Z0 Q3AI3036 k RECEIVED t-WisoorWn Department of Commerce !N SOIL VALUATION REPORT Page / of3 Division of Safety and Buildings 1 } in accordance with Comm J5. Wis. Awn. Code G• Attach complete site plan on Pape than 9Wx 1 I inches in size. Plan must C""y J % C R O 1 X include, but not meted to. vertical and horizontal reference point (W). drection and Parcel l.D 3/ 7 b Percent slope. scale or danensioas, north arrow. and location and distance to nearest road. Please print all information. Revlewed 711016,51 Peksoriai kxame6on ym Provide retry be used for --dwy pwpasm (Privacy taw. s. 15.04 (1) (m)). Properwowner Property) ocation G1Da P_~) t `f2sT~ T' Gaut Lot N E 114 :5W 1/4 S 4J3 N R E (or Property Ownees Making Address Lot # Block # Subd. Name or CSW 3c12- OMAHA C:7 "T - G0 -rT4 V-,4VADOPV CRY State Code Phone Number ❑ City ❑ Village [RTown Nearest Road N-14b50W1 540/( ( Rzo O L/V/A C4u2T CINew won Use: P ResidenW / Number of bedrooms 3- Code derived design flow rate SO - 7 k7 GPD ❑ Rent ❑ Pubic or commercial - Describe Parent material o V ;e . fy i'w S i E Flood Plain elevation if applicable Ll l I it, General comments and recommendations: Area _L Spot Tested suitable for a oomrenNonal inground system (ROAT.S.) &4_ 6.7 q~pJ ® Pit Ground surlaoe elev_ jf -13 R Depth to G Wit factor 1 q 2- im Sod Application Rate Horhm Depth Dominant Cakx Redox Description Texture Sire Consistence Boundary Roots GPM In. Munsell QL Sz. Co nt. Color Gr. Sz Sh. 'ERI 'Eff#2 / 0-13 Iv YR '-/z- - r2 2 -F r M -h^ s ✓f 2 I •ZS luYti4/~ - SC► 2 K rvrifl CS v4 ft .(V 3 g' 2 10 - 0j3 - S 1 bK M f r Gl W 1 Vf . o Z9- 9 I OYR 5/ S m 1 - - .7 I 0 5C, i~ ~r a . yl F2--] ❑ e«~~s ® Pit Ground satiate elev. ft. Depth to x n ft factor `1 in. Sod Appkaftn Rate Horiarxn Depth Dominant Color Redox Description TeAure Shucture Consistence Boundary Roots GPDiff? in. Munsell am Sz Cont. Color Gr. Sz. Sh. •EfF#t 'Eff#2 R 0 -9 R oYtz Z/a .9 Z f r Mfr C S 3 Yf . g 2 C1 -Z2 10 Y2 N - ic/ 3 b x Mt-l 5 v4 .4 . 3 22-33 '7.5 VK 4/( _ S/ 2 W bK rA f r q l Jf . t• o 4 33- i ork'5/ _ S O s ro f - - •-7 t . b u Effluent #1= BOD > 30:5 220 nvlt_ and TSS >30:5 150 mglL ` EMuard #2 = BOD < 30 nglL and TSs < 3o mq& CST Nopcqp1saw P" I U ~ 59q Address Date Evatkrafion CondkK*id Telephone Number ZSRZ- '0 :5P92tJ161 V''i f 44 -13-Zkxr" ` IS7 772_31+42 .GvJ ~ l C n" !J'':: r" 1.I l's and J::sigri a...n .ssOCiatE.''t'sr Contact: Ulbricht & Associates i - rite ate Spwage C©nsultcaxnts Registered private wastewater consultant and OURUF, 2812 11)th Ave. 2812 10th Ave. ` 1'"" !'/154767 Spring Valley, WI 54767 715-772-3442 1 P K` r L. v T '7 property C+wne -B J F PI 5TED7' Parcel tD # ~ l burl - l o o page Z of 3 Pit Ground surface elev. /0 ',2xlrft. Depth to kffv&V factor>- i- f #orizon Depth Dominant Redox Sod Rafe i Desaiptiorr Texture Structere Co v;Wetm Souredary Roots GPD fF ¢ in. MunseP Qu. Sz Comet Color Gr. Sz Sh. 'Eft#7 'Eff12 I 4O -17 t 0 yS 2 r~A mfr t 2- 2 1 OLeR G.7 3YT i •C! W 2 3 22.96 ! YR S/g _ S M f -k - - •-7 1 • b n # D tG.B Pit Ground surfaceelev. ff- Depth to kmWV factor €n. Horizon Depth Dominant s`coii ieation Mate Color i Redoxc Description TextLwe ShIckbre Consistence Boundary Roots GPDtff im Munsel Ou. Sz- Con. Color Gr. Sz. Sh. 'Eif#1 'E ? 0~t~ OIA Boring. F-I r~~ E..t Pit Grocrnd surface elev. ft Depth to limiting factor in. Depth Drxr>tttatrt Color Redox Sol Appkadon Rate Texture Structure Consistence Borrrdary Roots GPDff In. Museselt Qu. sz. Cent Cola Gr. SZ Sh. 'Etf#1 ffdf2 t s P g F-I Boring m `I 'svn^iy pit Ground surface elev. ft. Depth to Wnift far for in. Safi Appkmtion Rate 1 t-larizm Depth Dotninan# Color Redox Description. Texture Struettae Consistence Botardary Roots GPM in Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Ef#1 'EMQ i t r CO T T4 67e c. o T '7 0 = X30t:~ i 4 car ~ f {3~'NC.it ~crty~ / K 30 > em#2 ° /00- 90 1P SE-r` G-~ A D 1 t ' i n~ loa•3s 82 /0 4, -7 V 10 a s 10 Q ~ F3 t = lvo.13 n 11Z Z P 567- r Associates t3a VE, P iV2,r „ Szavvacge Consultants 2812 QMh Ave. 0!19 a-fle V1,11 547(,Z7 Q For issuance of p€:rrnfrs and designiog Contact: Ulbricht & Associates Registered private wastewater consuftant and pludevc: 2812 10th Ave. r~ Spring Valley, Wl 54757 Kl \ 715-772-3442 r f