HomeMy WebLinkAbout026-1173-44-000
,ro," SlnDepartriofCommi PRIVATE SEWAGE SYSTEM „o~rrq St. Croix
811,1, and Ba tlvg Dim Sion
INSPECTION REPORT Saritar. Pelmit No
GENERAL INFORMATION (ATTACH TO PERMIT) State Plar ID No 605016
PC.SJral i-for-ehor "I p°r. ido 1114 be'- SVC for seccndanI pr.rpogeS IPevaCy Law. s 15.1-:".
Per-it Homers Na Cry VI age Tawn9hip Parxl Tax Nu
Bert & Debra Luedlke TOWN OF RICHMOND 026-1173-44-000
I I Bbl L cv. losp RM Flee 190 Dora .dmr . SCCionlTOmn9tange~ Mao No
203-0.18.1398
TANK INFORMATION ELEVATION DATA
I YPE MANUFACTORE _ CAPACITY STATION BS HI FS ELEV.
Septic Benchmark )!I
I Alt. BM of
Aeraion Bldg. Severer -
Holding SvH: Inlet ,.5Z > c~ Z
r 5•/
TANK SETBACK INFORMATION STH: Out 'et _~L)
TANK TO P1 VVL LL BLDG Vert rc Art I•take ROAD Or Inlet
Septic DI Botton)
Dcsing Ilcaar: ^PAan. G7 7
Aeration _ Disl. Pipe
Holding But System
F ral Grade
PUMPISIPHON INFORMATION L` Si !e .10 7z (p
blanufaeturer Demand SI Cover 7G .
PIA 2,60
Model Nwnb r 9
IIH1 If'. Fr K>\I.oss 5'. em Head T Ft x~u
Forc:ernam Iength___- `i3
SOIL ABSORPTION SYSTEM
BED:TRENCH trill ) ..ength No Of Trernhee PIT DIMENSIONS Ne. CI PIIS IglAce Ora Linn:: CepV
DIMENSIONS - -
SETBACK SYSTEM TO P4 HI. DG '.VFLL [AKFiSTREAM H LEACHING bla-u'aau'er
INFORMATION CAMBER OR --L
(I r:.rnr 1 _ ,I r UNIT hAxel N:.^~6er.
(-I.Lr LII.cl.''
DISTRIBUTION SYSTEM
H.aCOr'PAen k!h ILSlnbdhC'i _ 1 illy t; zv x HC a Snaei-g Vent IoAr Iola~kC
C7t q POC'SI . - - ~ ~l
.myth (1 ca Lengr fi 3 tip.,r:mg - ~ ~ r
SOIL COVER it Pressure Systems Only xx Mound Or At-Grade Systems Only
1 _p-h C .Iii- i)eatn C"ter x )'wh rl xx Seetlea Ft tle _C x.. 1I uhetl
r!I ~e Ce°der ' f Bed! Ncr¢h EjCQS Tc coil --li No Yes No
COMMENTS: (Include code discrepencies, persons present. etci Inspection #t Inspection #2:
Location: I V90 1<'JH AVER
1.) Alt BM Description= YflkrC.^'r
2.) Bldg Sevier length= (A'+)-~
- amount of cover = 7 C4 13 :r
Plan revision Required? Yes No
Use other side for additional infcmtation.
SBD-G?10 IR.5:(r?' Date C r ~iarahr Gcl N
County
°1~r4 Safety and Buildings Division ~ J n
2 1 W. W2shin9ton Ave.. P.O. Box 7152 Sam -
mry Peanit ucs
Nba( robe iillof inb Cc
-~i
Madison, VA C3707-7152x
FFp4Y
$9 SaeT:aA )1t oaNwba
- milt ZTGVN~
e
!a acuadan;;, ui'di SPS 533-2 1i=1>''is .Atla CN:c, wb;nr-ss•.•.:.,: v as fal6Tothc appropriate govamuectai wit / v~
ix required prior to ob.auviig a saciro" petmsL Now Applicatinr. fnnus foi Catctismc. PO Wi'S are mbmiued m Project Address (if diHaem than mating address) I~
:bc:y parer u o'Safm and Professional S rvirs Personal mfbn. m. yvwyvw provyiddee nL* be used for scrond: jJ//)
1. Ap s m acwrdatnx w•iLh the Pm l Law, s__5_0l Information
_ p
_IApplicatiop Information-Pleas i All J-/ 1- 1 1 1_
'I Pnrpa;y Unaas Nape-., ^ Pnx2 M'
T'ropeT.v (A-= s Marley; Address Property Lonatioo • I 3`/ r'
I Lh_C_1 ~K-t Govt hot _
Cly. State - Zip Cale baste Nmnber r^
,_i ~ ,~h Section
I ' , ' -ack
Il Type of Building (check all that apply)
m 2 Fam ly DweLbor Number of Bcdn 2 sin - ! 7 7 ^S,wdivtstoo Name
3;ock
U PubEi::Y:ammaaai - Iksvnbe Use City of
~ I State (hvaW - Uesw:hc rue I CSM Vr undim 1 Village of 2 2Z~ ZZ Gnu +~ek t~ { own / , - - -
llr 1. Type of Permie ((:beck only one ox on line A. Complete line B if applicable)
A. 16ew Sys;em _ U iecplacc=w Sfsirn ❑ TrramseuV 3ofdiug Tank Reel.-. eroenr, i}yv ❑ `Other Modlficauoo w F.xN-tiae Sysrau (expiamj
B. C Pcail kinrv, al ) Pa_-mtl Rrvisim ] CSangc o: Pfunber Permit f:a:isfa w Ncw List Previous Permit Number and Date L.aued 'I
3eimc [-xpint:n I'.1+MC
LR' of POWTSSvsreWComponenc/Device: (Check all that applyl L
Non -P-Cau-it_dU cr...tr I~ e.miicd;i-;round 7AI-(o.de F-'Mwmd-1224m. ofsuitablesod ❑ Nlound < 24m. 11`2ashie>7i1 S
Holsi:n~ u rt.: ar:i ruin?'roa t ;ezp::
V. Dispersal rfreatioent. ea luformauon - :S - '
ks-pa Flew I dl Jf 1%rai ~ Sail ! ppli actor ppdsfr _-Disposal AreaRequired (s Dispesai Arn o_ tzq --$VSItlT.
V1 Tank Into Capan.y of Tool a of - - Man mbua
Gallons ~fI rial om Units ` u o
S w Tml 'xisrn sane - 1//° u
p
L i~ V v e in o
Sq<i.x Heldiae a -T--. 1 .
%TI Responsibility Statement- L the wdersigned, e 4 ome responsibility for mismlladoc of the POW I S Shown on the attached plate.
limibe,'s Name vPnnt} PI Signanee VfPMJ'R.S Number Rtoioess Yhone Nirnba
f_ D !/J '0
Plwoba's Adk_35 (SUeet, Ur Swte, Gp Code q - -
N'lll. Count y.De artment Lse Ooh
Issuing ent.S:gn
su
pptpvrd ppiove ocrosi/:occ` 7i,
Lti Condit anon. r pproval
unpar::.. cA must all
E ni_y~'$:SLN(tltt 4S.
ys per aarayemen! plan p-(. daen by Ou.nlxi. I , A.
e per #PF6rb+ pYb4 i Cr6011,10oe.
mace U. rnmtade plan for the system and sahmit to nx ComU Sal - w pa per Ys than A e: x'l l'i 1 m sire p- _ l
i~ ~6~V CIO fti! WL
SBD-6398 i2 11.11; ~(n r w/J-(MO ° ht •'r 1
System PLOT PLAN
P2c).If c"1' Bart Luedtke ADDRLSS 1253 140tn St. Nee, Rrnmonc Wi 5407
NE I14 SE Ii4S 21 rr 30 N;R 18 ti TowN R!chmonc coUN7 ST.CRO;X
SVSTLVI ELEVATION 97.0`90.0 5' below grade 3:28118 BEDROOM 4
DATE CONVENTIONAL XXX CONVENTIONAL 1.11"1 HOLDING TANK
MOLSD SEP'T'IC 'f:1NK til'/.E 1255 gallons LIFT TANK SIZE. DOSE 'TANK Sill
HOLDING TANK ti17_E LOAD RA'CL'. ABSORPTION AREA 891 , ft of chambers 44
BENCHMARK V.R.I'. Top of survey I(o0 ASSUME LLEN ATION 100' filter Llfeumc Hier
❑ BOREHOLE NT.LI. x:H.R.P, same': as benchmark
Scale = 1/4" = 10'
114' 9S.
19>' 12(,( Slon
1(!2
Vents 171
\ B-2
X 90' ccl'.~ with snacins
Vent
>6- Oui,::4 Standard
of Cover 1 -aJi mp Chamfer
u°ith 20.0 ft2 of Arca
5.6VI pL r of end caps
4' Long, 1
Grad. at S\ ;(cm Eiev ation
114* ,4
Pic, 4
Bedroom
Ilousc
All pipm_ .hal: be Al Tb1 SDR 301'34. within
Iq' n' ,ani- p)piM: Nhall he ASIM 1 S91
E3.Ni."
145th Ave
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 3/26/18
Owner:Bart Luedtke
Location: NE1/4 SE1/4 S 21 T30N,R18W 1090 145th Ave Richmond
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Leaching Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Cross Section /
Signature
License number 4226900
System PLOT PLAN
PRQIEC I- Bart Luedtke ADDRESS 1253 140th St. New Richmond Wi 54017
NE 1/4 SE 1/45 21 !T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 97.0/96.0 5' bolow grade DATE. 3/28/18 BEDROOM 4
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND S 1255 Gallons IAF]''I'ANK SIZE DOSE TANK SIZE
SEPTIC TANK SIZE IIOLDINC TANK SIZE LOAD R,XTE .7 ABSORPTION ARIA 891 # of chambers 44
BENCIIVIARK V.R.P. Ton of survey iron ASSCME ELI:VA1ION I00' Fillcl' Lllclilllc Filter
❑BOREHOLI, 'O WELL *II.R.P. sameasbenchmark
329' Property Line Scale = 1/4" = 101
114' 13-3 9S'
111111-0
195' 12'-, Slope 100'
102'
Vents 171'
13-2
t 52'
2-3' X 90' cells with >3' spacing
Vent
>6" Quick4 Standard
of Cover Leaching Chamher
with 2011 ft2 of Area
10' S.6ft^2/pair of end caps
_ 13-I S 4' Lone 11„
(trade at System Elevation
114' 3-'1"
Pro 4
Bedroom
House
All piping shall he ASTIM SDR 30134, within
10' of tank, piping shall be ASTM F891
B.A4.*
1,15th Ave
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 A2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 102.0'
Vent ACI Grade vent
3 X30/34 Septic Tank 3
t
5' Lung 5 Long
Grade at System Elevation
36- Grade at System Elevation
Spacing- 5'_
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
22 chambers per cell B
System elevations:
A-97.0'
B 96.0'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of
=1LE IerNFORMATION SYSTEM SPECIFICATIONS
Own T i.
Septic'ank Capacity i S S al ❑ NA
Permit #
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Fitter Manufacturer
❑NA
Number of Bedrooms = - O NA Effluent =filter Model O NA
Number of Public Facility Units I Ear NA Pump Tank Capacity
al G NA
-
Estimated flow (average) ii L aVda Pump Tank Manufacturer NA
I Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer NA
Soil Application Rate Purn Model
gaVday/ft, p NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 0 NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Fitter ❑ Peat Filter
Biochemical Oxygen Demand (6006) 5220 mg& ❑ NA O Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/1-
. Z Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) IJ NA
Biochemical Oxygen Demand (BODs) 1530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (rSS) 530 rr.g/! C NA O At-Grade ❑ Mound
Fecal Coll (geometric mean) 510° efu/100mi ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size ~e in dia. ❑ NA aher. -
❑ NA
❑ NA Other:
❑ NA
Values typical for domestic wastewater and septic tank effluent aher ❑ NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
(inspect condition of tank(s) At least onto
every' ❑ month(s)
_'.R year(s) (Maximum 3 years) ❑ NA
!Pump out contents of tank(s) - When combined sludge and scum equals one-third (X) of tank volume ❑ NA
'Inspect dispersal cep(s) At least once every:
>EI 4 year(s) month(s) (Ma)imum 3 years) ❑ NA
_
~~Ieaneffluent filter At least once every: C rr.onth(s) O NA
yeaI E3 r(s)
nspect pump pump controls & alarm At least once every' month(s)
❑ year(s) NA
=lush laterals and pressure test At least once every: ❑ month(s)
❑ yearls NA
eastonce very-- 0 month(S) ❑ NA
❑
homer Y- r )
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; POVkTS Maintainer, Septage Servicing Operator. Tank irspections must
include a visual inspection of the tank(s) to identify any missing or broker hardware, identify any cracks or leaks, measure the volume of
cembined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shag be
visually inspected to check the effluent levels in the observation pipes and to crick for any ponding of effluent on the ground surface.
fie pording of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Yu) or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsm
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
IA service report shall be provided to the local regulatory authontywithin 10 aays of completion of any service event.
Pape _ of
START UP AND OPERATION
For roaw construction, prior to use of the POWTS check treatment tank(s) for the presence of Painting products or other chemicals fhrlt
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 normal higtwrater levels. When power is restored the excess wastewater will be
discharged to the dispersal cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent
To avoid this situation have the contends of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$:
antibiotics; baby wipes: cigarette buts; condoms: cotton swabs; degreasers; dental floss; diapers: disinfectants: fat foundation drain
(sump pump) water, fruit and vegetable peelings: gasoline. grease: herbicides; meat scraps; medications: di; painting products;
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 be taken to Insure that the system is properly
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• Ali piping to tanks and pile 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 Septege Servicing Operetor.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filed with soil,
gravel of 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 compliant
replacement system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon toy required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the ncled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must Don" with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be hmtalled as a last resort to replace the failed POWTS.
❑ The $ite has not been evaluated 10 identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tarhk may be installed as
a lest resort to replace the failed POWTS.
❑ Mound and at-grede sot absorption systems may be reconsmnced in place following removal of the biomat at the ihfiltrairve
surface. Reconstnutlons of such systems must comply with the rules in affect at dud time.
<<WARNIN sh>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANKt UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMLV-M
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone ! Phone
SEPTAGE SERVICING OPERATOR (PUMPER) rLOCAL REGULATORY AUTHORITY
Name e PhonThis document wee drali m in compliance with chapter SK 383.22(2)(bX1)(d)a(t) and 383.5 (1), (2) & (3), WWconsn AAnlnbhatiwe Code.
I
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ST CROIX COUNTY
SE'PT'IC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CFRTIFICATION FORM
Owner/Buyer a✓~ _LuejKe
Mailing Addr _ Ia1tiO N 5Trttt rUQ,,j K I~ fYl u z
~J` f7
11^~/i~(~\
Propem AddresTs 1090 I'-1 S ~ Qe Qt,J R Ic h hy~ 'r T10 I
(Verification required from Planning Department for new construction)
City/Stare hW Q is h r4#-4 U-A Parcel Identification Number LOT' LiL
L,AL DESCRIPTION ~r~4 -/~I173 ~I`I-t?fXJ
Property Location 1/., Sec. I , T~_N-R IA_W, Town of R(ge
Subdivision UJa 18 rte _ (M qc p [j Li S Lot #
LLL
Certifies Survey Map # Volume Page #
Warranty Deed # Volume Page #
Spec ho'tse O Yes" no Lot lines identifiable K yes O no
MM&NAMEEMNU
Improper use and maintenauceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consists o,`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 ftmction of the septic tank as a treatment stage in the waste disposal system.
I he property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber,journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system
is in propts operating condition and/or (2; after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the rutdersigned have read the abov requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein. as set by the Deps I of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has maintained must be completed and returned to the St. Croix County Zoning Office within 30
Ob" of the a year expiration da
6/
IONA' RE OF APPLICANT DATE
O YWNE I CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) just (are) the owner(s) of
property d scribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
ONATLItE OF APPLICANT DATE
Any information that is mis-repmsented may result in the sanitary permit being revoked by the Zoning Department.
Includ s with this application: a stamped warranty deed from the Register of Deeds office
■ cop) of the certified survey map if reference is made in the warranty deed
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WiisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in ecrurdance with Comm 85, Wis. Adm Code
County St. Croix
Attach complete site plan on paper not less than 8 1:2 x 11 inches in size. Plan must
include, but not limited to vertical and horaontal reference point (BM), direction and Parcel I.D. Pending
-1JuU
percent slope, scale or dimensions, north arrow and location and distance to nearest road. Z _ _7 3
Please print all Information. Rev' d by Date
Personal information you pmNde maybe used for secondary proposes (Privacy Law, s. 15.04(1) (m)).
Property Owner Property Location
David Waldrof Govt Lot NE 114 SE 114 S Y 30 N R 18 E (or) W
Property Owner's Mailing Address Lot # Bock # Subd. Name or CSM#
398 River Road 44 - Waldrol7Meadows IV
City State Zip Code Phone Nurruei iy E]Village L2jTown Nearest Road
Hudson WI 54016 ( 715-549-6601 144th Avenue
New Construction UseO Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement ❑ Public or commercial - Describe: _
Parent material Loess over outwash sands Fbod Plan elevation if applicable ff.
General comments , ".fill a large pocket orsicl, 2.5vr5+3, c2d5yr5;8, dsh. Recommendation is to install system below this restriction.
and recommendations: > 72 ,v, q _
I❑ Bon # ❑ Boring
Ground surface elev 102.10 ft. Depth to limiting factor 29-60 in
0 pit .
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Ou. Sz. ConL Color Gr Sz Sh. 'Eff#1 •Eff#2
1 0-14 10yr32 sit 2nlsbk dsh as 2f .6 .8
2 14-29 _ 7.5vr4.4 sl Oil] dsh a", .2 .6
3 29-60 -5yrfiA asicl OsF~Irnsbk* dl/dsh* ci .2* .3*
4 6 110 7.5yr5,14 s Os dI .7 1.6
a Bonng # ❑ Bonng 102.05 17-45
Q pit Ground surface elev. ft Depth to limiting factor in.
Shc Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Cut. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-7 IOyrY2 sil 2msbk dsh as 2f .6 .8
2 7-14 I0,r4;4 sil Imsbk dsh ew if -4 6
3 14-17 7.5yr4'4 sl 0111 dsh cw .2 .6
4 l7-}5 -y-5yr5,,4 s;sicl* Osg;lmsbk* dl.dsh* .2 .3
5 45-100 7.5yr4;6 s Osg dl .7 1.6
Effluent #1 = BOD, > 30 < 720 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD- 30 rrg/L and TSS < 30 nVL
CST Name (Please Print) Signature 9 CST Number
'Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
Property Owner Waldroff Meadows IV Parcel ID # Pending Page 2 of 3
Boring
Boring # 95.15 ->95
pit Ground surface elev ft Depth to limiting factor in.
Soil -Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-II IO~T3i2 sil 2msbk dsh as 2f .6 .8
2 I1-29 10vr4a sit Imsbk dsh ew I1' .4 .6
29-95 7.5yr5ia s 0sg dl - - .7 1.6
a
5
❑ Boring # Boring
pit Ground surface elev. R Depth to limiting factor in.
Sail Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD.ff
in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Q Boring
# Ground surface elev ft Depth to limiting factor in.
Pit Soo Application Rate
Horizon Depth Dominant Color Redoz Description texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mgrL and TSS >30 < 150 mgrt ' Effluent #2 = BOD, < 30 mg, L and 1 SS < 30 mg/L
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need material in an alternate format, please contact the department at 608-266-3151 or TlY 608-264-8777.
an~xurzr,.,. r. mm.
* Waldroff Meadows
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Scale 1"= 30'
BM1 Top of iron pipe 100.00'
BM2 Top of iron pipe 98.80'
B1 102.10' Thomas Nelson
82102.05' 227387
B3 95.15'
I
standard Erosion Control Plan
for 1- & 2-Family Dwelling Construction Sites
According to Chapters Comm 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion
control information needs to be included on the plot plan which is submitted and approved prior
to the issuance of building permits for 1- St 2-family dwelling units in those jurisdictions where
the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard
Erosion Control Plan is provided to assist in meeting this requirement.
Instructions:
1 . Complete this plan by filling in requested information, completing :he site diagram and marking
appropriate boxes on the inside of this form.
2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and
after grading. Water runoff patterns can change significantly as a site is reshaped.
3. Submit this plan at the time of building permit application. ~ , ~ ~
PROJECT LOCATION, )u [1___I_' kvQ o v E V1 '0 LSD+-Lmllite~ ease $ {ca1e north
BUILDER OWNER Qfr V ~J t 6- by =nrpletinc -he arrow
DATE 5 - i _r`
0 11
WORKSHEET COMPLETED BY ~Earr
-N-
-3 Io f ,SITE DIAGRAM Scale:1 inch=-feet
1 I -
I f ~ ~
j
EROSION
_L - CONTROLPLAN
LEGEND
--I-~ `y - 1T - - - - PROPERTY
UNE
I
I_. _.-I
EXISTING
- ~ I h DRAINAGE
TD ?EMPORARY
DIVERSION
yl f I _
FINISHED
DRAINAGE
1 70i I, I I LIMITS OF
1 -
- GRADING
7
I -
SILT
~ i I i I I I FENCE
STRAW
- - ! - - I. ~,wt-T--•- - SALES
' I ~CII I
II - GRAVEL
t.
:7 VEGETATION
i
I
o SPECIFICATION
I~
F TREE
_E7D I .I PRESERVATION
'--f _ I STOCKPILED
i
SOIL
I i it
. I I 111