HomeMy WebLinkAbout036-1078-90-000 (3)
n,i cepanloerlolCOmme•ce PRIVATE SEWAGE SYSTEM noll-ty St. Croix
Sarery snr. 6u di^g Division
INSPECTION REPORT Saq¢ary Penr nn
(ATTACH TO PERIAIT) 606986
GENERAL INFORMATION Sta:c Plan ID nc
Perse•.o It., - a!in- "l,11""Ce nni be ~sco'e- socur7a•y ewocses (Pnvac•; I s.' S 04 i I`Im~) 3173332
Pe•mi: l Va"e CIN Villayo lawcs•np Pa'ccl Tax No.
Riverside Park LLC TOWN OF STANTON 036-1078-90-000
CST Bf I Pic, Insp R'.11 46' 1 er Sec. icnrTown' RangeR.tap No.
a~j, ((J 31.31.17.487F
TANK INFORMATION ELEVATION DATA
TYPE MANU=ACTURER CAPACIIY STATION BS HI FS Ll
Septic Benchmark fee
411163.44 Ao
,tA- 3606
Ahi25
l e
Ae*aC6h r,n.' Bldg. Sever
N~~ I ~z5o i xx•~
I lolding ~r " ST Inlet 7,0
TANK SETBACK INFORMATION St Outlet
9,yb B.U. ciy.8
TANK TO Pit VI'll L Bt DG c-n I. •a, i. o.e ROAD Dt Inlet
Scotto Dl Bmtorn \ \
12 5D 7 J
D Sing F Ilea;:e?PAan.
7 36b 015 - All
Aeial,on Dist Pipe 9.7 .7
Holding Bo: System
Find Grade
PUMPISIPHON INFORMATION f.Z
rclanufaclr.rer Demaad St Covvoo' G
GPF.I
FAode1 Nmnbe
TDIY Lik Frieder Loss System Hea TDH Fit
Fcrce'rai•f - I.e-lgth-- - -7- 1 Dist to -,*,,el
SOIL ABSORPTION SYSTEM
BEDiTRENCII •rrd'h INn Of lterones PIT DIMENSIONS No. O`Pi:s 1•rsde Lie Liceic Dep'h
DIMENSIONS 3 ~ Ise - -L- A 1 1
SETBACK SYSIFWI TO I BLDG G VVELLLL I.AKF:S I HFAF:1 LEACHING I.4 knac'e-er
INFORMATION
~r L
_ l1I 1ol/ c,~1 CHAMBER OR
Tx O✓11I51, 'tOM~JC-+ JCI UNIT I.ACCeWIMbf~• 50
DISTRIBUTION SYSTEM I`fw E 3 L s~
I eaded6l a'iQ(1 7 Junea'ien Size zHole SPac•Ig ve, Ir:irlnt<
Lenglr (06 Dia D, Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Lott Over 7eptn C'-f xh UOpI^ of xx Seeeen+Sodded xx Ia1eIC'1eC
BCd71e90I1 CCn:Cr 5'S BecrTrenct• Edges Topse ---FYes No NC
COMMENTS: Include code discreperies, persons p•esera etc) Inspection -V I: Inspection 02
Location: 1442 CTY RD K / L pc l,~~-~ ill
1 ) Alt Bill Descr•. phcn = I ZSa ` -
2.1 Bldg se•.ver length = Still P!il
- amount of cover = 7 /
1$ 6/~ ~ yf ,,,111
/ yf ~/17V
Plan revision Requned7 i Yes X No 1 2- 146
Use other side for additional mforma: on) U _ _ - iQ f(/ 7 Y /II
Date - - I-sepelc sSiynal ce'I NC
SIT() 6.''C R '!r't A
R=;P O
S:dily' and Build inns Division St Croix 17 (0
IS 2(II AAA. U3slYnglon rAsc. l' 0. Bux'IG? Sanitun Permit Number (to lk Filled in by Co.)
Nladt n, 162
!0 (Q (J
Sanitary Permit Application Slate Transaction Number
In . nlartc'all s. NP,; is 21:2:. n. \ Im (',dc. nlhmi„ion ..•f 1111, Ibn Fat 91-23337-
unit is icyuired Print to „Maiui r ..l:uuuv prn m Nolo App Iwation timn, lor. nlc-owned PO\slS are wbmiltcsl Pmlecl AddmNs lif t if cent than nwiling a dins)
loth, Depanmmnl etSat1 an 1 Pw!,,,vnel Scnres. Pcnonal mlonnation yuu pnnidc nwy hcuull I ni wconlin'
u cases in accordance wish the I'macv I a,.,. I50411 ain1. Slal,.
1. Application Infor ion Please Print All Information 1442 Olt K
Pfopcm O\rncr', Name Parcel k
Riverside Park I.LC' 036-1078-90-000
31,31 17. `187)'
Plopens Owner's Mailing :Address Propctxy Wcalion
446 Iliehland View
(il. led
Shoe Zip Oxie Phone Numhcr SF. Section 31
1loultov WI 54092
r31N: R17 W
11. Type of Building (check all that apply) O Lul a_
❑ I or'_ Family Dwdhng - Nu nt"I of Bc,lromns l •f, -3y- S* 7 1 Sutxln iron \amv
1 i
® Public: Cun incicial Dscribe Llsc Tmilet Park - -
('nv of
❑ State Owned Describe Ilse ('SM Wmhcr ❑ Village of
2 1 1 ®-l iwvn of Stanton
_ +~,I .S l r.✓ 3 C1nw...toe L7 P_uC-1,.
Ill.'fype of Permit: (Check onl one booko line A. Complete line B if applicable) 2,o li J 6/~
\ Nov Syaan Replacement ❑ Treatment liulding Tank Replacement Only ❑ Olh, Moddieation to Fsisling c .explain
Sy,tan
I
t
R. ❑ Pumil ❑ Permit Revision ❑ Change of Pcnnit'I ralnfer to I+st Previous Pmnil Nundxi and Doe Issued
Row,al Below Plunder \ew Owncr
L y,i:ae:un` -I~
_ --1v.'fc a of POWT". yaht : omplonenVDevice: (Check all that aRU1y) J
®Non Prc,.urii;~_I_I_m (iTUUnd~ Prsunlcl ln-6round---0 AI-fund, ❑ Mound __24 in. ofsui6Fble wit \lourd., 24 in. of suitable wile-)I
I1 4din1~ Tank ❑ other Dgx7,al C'ompno,+n t,,phinl ❑ Prorcatmcnt Ilewc(esplain)
Dlspersalrl' atmcnt Area Infor ation: uick 4 Plus
D _
e -siknll oaI' Is D,aign Soil AP l ton Rimepd: lI Dispersal Arca Require Isll Drspclal Alca Prolx,' 11sf I System Lierali
ca
- 1714 1730', ~ 94.5
100
V1.1 ank Info ('opacity in final 4"1 N(anul'a urer ,
Gallons Gallon, Units
Naw-tanks 6sistin~ Janke y/1F - y m i^a
bept"err n<ddma`i;nk _ 1250 2000 2 wteser - ❑ II
VII. Responsibilils Statement- 1, the undersigned, assmne responsibilit) far installation of the PO\VT\ shown on the attached plans.
Plumber's Same lPrint i 1'lund 1 N1urnwc - 04P WTS Number Rusin Phone Numbc-r
Travis Butterfield _ S=-z 6~?8?9 (7 15) 634-8176
11Iunl6cl , ,'\ddre„ . Ntrca. Cll\, Ntatr- /1P ('ode;
14346 \k Slate Road „llavwaid, WI 54843 _
\'lll C oull(N'Departmew l ac Only
(\PPmvcJ L1 J)"rPrr.j Penna. Fee Dale I mcd Icsuin' g"I Signat rc
\ 455 • a' 30
(hvn\tbi-) 1(i:u.,n I.,, Denial
IX- Condi"T i*VbWdRcasons for Disapproval
t. Sapp tack, tdlbun; IRtc- end 3 ~(u, nl ,3y67-~ G, cw•.
aA~~ :,cr11 r t all be k- c n+: krt=: r ec IU1 ~a}[\~ I
as P°f 9iar 3yemerl. 10.1Vv nbe.
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as per apFi¢nb! u)C, rd zal... 4\ a L~ Glad cY1 `rn/~ f~ Pp
\nach to mmplrtr pbm far Ihc ryvrm and .uhmil In 1I/ny~)r'IIII nlC VIII., it. halivr nal It. than 81L t 11 inrhrc to cia /I
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jZ\VERSIOE PARK ll.C-
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TOWN OF SS'ph1TIDN
ST GRo~x Go.~NTY 81"1 I O O- cc)
1~c,1, o3lr 10'78- q0-000
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30°D G i
DIVISION OF INDUSTRY SERVICES
_ 10541 N RANCH RD
HAYWARD WI 54843.6462
S _ Contact Through Relay
P httP.;asFS:,vi.gov+programs+m cstry-services
vnvvsvisconsin.gov
Scott Walker, Governor
Laura Gutierrez, Secretary
October 11, 2018
CUS 1 ID No. 652879 .17 TV: P0II'7S Inspector
TRAVIS ANTHONY [It I I LKIILLD 7ONI\G OFFICE
BU I-I LRFILLD EXCAVATING INC S I' C'ROIX COUNTY SPIA
14346 W ST RD 77 1101 CAKMICI IAFL RD
HAYW'ARD WI 54843 HUDSON WI 51016-7708
CONDITIONAL APPROVAL r
PLAN APPROVAL EXPIRES: 1011 P2020 Identification Numbers
Transaction IU No. 31-3332
SITE: Site ID No. 85.1713
Riverside Park Units 1, 3, 5, 7 Please refer to both identification numbers,
1.1.13 Cth K ahove, in all correspondence with the agency.
"I own of Stanton
St Croix Counh
SE114. SWI 4, S31, 13 IN. R17W'
FOR:
Object Typc: POWTS Component Manual Regulated Object ID No.: 18013,11
Maintenance required: Replacements ystem; 1.200 GPD flow rate: System(s): In-ground POWTS Component - Ver.
2.0, SBIMO705-P (N.01!01, R. 10!12): Efllucnl Filter'
"fhe subnlilhd described above has been reviewed for conformance with applicable Wisconsin Administrative Code,
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plan< and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10). Wisconsin Statutes, is responsible for compliance with all code
requirements.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Uepaltment, which may include local inspectors. All permits
required bk the state or the local municipality shall be obtained prior to commencement of
Construction) installation; operation.
ht granting this approval the Division of Industry Services reserves the right to require changes of additions should
conditions arise making them necessat) for code compliance. As per state stats 101.12(2), nutting in this review
L•ON
shall relieve the designer of the responsibility for designing. a safe building, structure, or component.
Inquiries concerning this correspondence nma be made to me at the telephone number listed below, or t tlt~2cj¢~SSF SAFETY A
on this letterhead. ~r t V ANI
1 he above left addressee shall provide a copy of this letter and the POWTS management plan to the o 'ner and env DIVISION OF
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required S 325.
This Amount Will Be Invoiced.
` When You Receive That lnvoice, EE- ORF
Edwin A Taylor Please Include a Copy With Your
\4 astcwater Specialist , I)Msior of Industry Services Pa) Intent Submittal.
( 715)634-3484 , Mon-fri, 8:111) a.m. - 4:30 p.m. WiSNIAR'F code: 7633
edwin.taylorw:wi.rov
'
In-Ground Gravity Plan PAGE 1 OF 4
Er;
- V
Index & Cover Sheet R
Component Manual Design References rj 1 0 2018
Version 2.0, SBD-10705-P (N.01/01, R. 10/12)
.~rnrlr~
^1Dl ICTo
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pig 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Riverside Park - Units 1,3,5,7
Owner Name(s): Riverside Park LLC Phone:
Owner Address: 446 Highland View ; Houlton, WI Zip: 54082
Project Address: 1443 County Rd K
Govt Lot: SE 1/4 of SW 1/4, Section 31 T 31 N-R 17 ED or WWI
Township: Stanton County: St Croix
Project Parcel ID 036-1078-90-000
Designer Information
Designer Name: Travis Butterfield Phone: 715 -634 5176
Designer Address: 14346W State Road 77; Hayward, WI Zip: 54843
butterfieldinc hotmail.com U SLPV.CLS
E-mail: @ V:CLS
License Number: 652879
Remarks:
Sized for future expansion (units 5 & 7) 'ND NCE
L-
Signature: f--- - Date: /l~ ~G -mss
Original signature required on each submAted copy.
SCRLE= i s GO ~Gor NJ
6n= NMI- ,N EtECTw,c~
fb%.E
KN'JERSlpE PARK LLC
$ec.31r T31r.11R\17W ELEVATI0IQ
Tow" or- STNoT,DIV
ST GRo, x COUNTY BM 1 O O . 00 R4
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PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383 52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 1200 gpd; BOD5 220 mgL-'; TSS 150 mgL-'; FOG 30 mgL'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
O age of system
nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc,)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution I drop boxes)
o neglect or improper use (i.e.. exceeding design capacities, prohibited activities, etc.)
u extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e, pump re-cycling, float switch settings, etc.)
o electrical components - if applicable (i e. wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281 48 Wis
Slats, when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company Butterfield Inc Phone: 715-634-8176
Local government unit: St Croix County Planning & Zoning Phone: 715-386-4680
Local government unit address: 1101 Carmichael Road; Hudson, WI ZIP: 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
in the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
if use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code,
ST. CROIX COUNTY
SI 1) 1 W l'ANK NIAINI I•NANCF AGREEMENT
AND
OWNERSI IIP CERTIFICATION FORM
O%nnerlBmer
Mailing Addreti . ties, ~ 3 ! Ya % / fb .~iy 4 k J rr
Property Address /`/'/.1 l'~ AleC. X' i 4 ~L yo i 7 > v 4 2
(Verification repaired from Planning bt Zoning Department liar new construction.)
CitN!Stalc /C r/ Parcel Identification Number
LEGAL DESCRIPTION
Property Location Sec. T -3 I N R7 \4', fown of
Subdivision Plat: Lot
Certified Survey flap it Volume . Paee
Warranty Decd N (before 2007)VOlu111e Page
Spec house Nest -no Lolline;idcmifiablc scs no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Irrpaopir use and maintenance of your septic yctem soul,i reap in its prunawrc I ulure w landle Mattes. Proper
mainicnunce consist, of pumping out the septic lank every three News or sooner, if necdcd, by a licensed pumper. U'haa saw put into
the system can affect the function of the septic tank as a neatm.•nl stage in the avaste disposal sislent. Owner mainlcnan:c
rc,pomibilitics are specified in sSPS. 3S3. 2f I ) and in Chapter 12 ofthe St. Croix County Sanitary Ordinance.
The property owner agree, to submit to St. Croie County Plannine & Zonin e Department if certification loon, signed by the
owner and by a master plumber, lourn.•Nman plumber. resu'icted plumber or a licensed pumper vcril\ ing that f I ) the on-site
aaslowalcr disposal system is in proper operating condition and or 12) after inspection and Pumpin_ (ff necesary). the septic tank i,
:ass than 1 ? full of sludge.
I/we. the undersi ned have read the above requircvtcnis and agree m maintain the private sewage disposal system n ith the
standards set loath. herein Ns set by the Department of Salcly And Professional Services and the Department of \atural Resources.
State of AVisconsm. Cenitication stating, that Nour septic system has been maintained nnSI be completed and returned to the SL Cron
County Planning d"•.Zonis I)eparoucnl +irhin 30 dmsof file three yearexpiration date.
I Ave certify that all statements on this Cant arc true to the best ot'my!our know lethic. I/we ant are the nwneliS) of -tire
propcrl~ described above, bN virtue of a xarranq decd recorded in Rceistrr of Dead, Olli::c.
Number of bedrooms
SIGN 1TIIRF OF APPLICANT(S) DATE
;Ary information that i_ misrrprc.entcd may resell in the 'anilm permit beine tcvokcd by the Planning l Zoning Department.
INlJude with this application a recorded warranty deed fiom the Resister of-Decd Office and a copN of the certified survey mull it'
rehrence is made in the warranty deed.
(REV. Oa.72)
State of Wisconsin Scott Walker. Governor
DEPARTMENT OF NATURAL RESOURCES Daniel L. Meyer. Secretary
--~i
West Central Region Headquarters Dan Baumann, Regional Director
1300 W. Clairemont Avenue -elephonE 7-<: ~4-3700-1~•~
Eau Claire WI 54701 - ^~~•^sl^
7 al Free 1-l!RH-935 462
DiltD nlWioL R: ~OJflCE£
TT" Acces3 vna Ictav 711
Septemher6,201R PWSID: u5ool294
OC St, Croix Coumv
RIVERSIDE PROPER] WS, LLC
10VERSIDE1 OBFITHONI-. ("I
P(1 BOX 2?
SU 1EitSET \k'I >I}o2;
Sl14IEC-1 :,SiJz tilohiiz 1loN.c CI - I-Mg:ll aled Water ti:::Inn]
Dzar Riverside Properties. LLC:
7Hhe Department of Natural Resource: (Deparment) has jurisdiction ovzr a alit d nkine water supplies per
Wisconsin Administrative Code, Chapters NR 809, Sale Drinking Water, and NR 811. NR 812. 1Vell Construction
and Pump Installation. These Administrative Codes and other drinking and ssoundwaler infbimation are availabir on
our DNR weI ile a: h tp:;7tinr.wi.gov;to ic.T)rink ns\Vatc 1Hie definition of an O:her-'Than-Municipal water
system IOT\'1i i, "a water system that rcz ularA* serves at least 15 servic=e connections used by year-round residents
or regularly serves C least 25 year-round residents. Am water system serving 7 or mores i n -I - Rtmily hornes. 10
or more mobile homes, 10 or more apartment units. 10 or more dupinx laving units or 10 or more conciominiutn
units shall lie considered a conununity wat z. svsleln unless inibrrnation i, proviJed by the owner indicatinc that
2S year-round residents will not be seacd. Examples of OT.\9> inc;ude mobile homz park;, subdtytsioas. zparmten!
b:rildines. and condominium a.:sociationn
Riverside has neen regulated as a public water suppA since 1975 when it 2e_ ca:nplin its water. Over brie it has
had the capacity for 36 homes but cur, ency iu e :•tomcs. 8p921 was the pr man xve'I fQr the facility until ; 2-31-
201 ~ when XT367' was dT.dlcd as a replacement well. Lead ievels beean to increase in the distribution system and at
the -nun point Riverside. Properties decided to drill shallower wells with hopefullc different water chemisu•y than
well X'1'36-. '['his was listed as the connective action on the Corrosion Contro' Recommendation Workshcel
submitted to the Department on 08+082018 wish a due date ofoVl l 2018.On o8i31i2o1S, water supp]N, specialist
Anna A7ares conducted an onsite visit of Riverside Mobiie I Ionic Ct to verify corrective actions. At that time it was
xrrific(i that:
1. fou- near wells were instailed: ZS>48. ZS459. ZS 3';9. and ZS3 9. All four wells are 65' deep with casing to
and gra hula, Mntoaitc to 20'. See araclieci well constnrctiot)repurls
each well had a separate water line from the pitless adapters into the well house i4 totah
each water line from file wells had a separate pressure tank, conventional pressure switch. and a sample tap
L each pressure switch had a separate power line coming from the electrical box
all four lines had water in there and water pressure going out io the dstribution system
6. -.our water lines exited the building to dirferent ponicirs of the distribution system
each ray of Ilorncs had a separate linehxell feeding it
8. each line4ell had nine or less homes or service; connections that it fed
9. well XH'36? did not have pressure and way not connected to tie sx'sten: an.nxnz. It will be abandoned ill lite
Naar amore.
from the 831 YIS site visit it was fougd thal the fa:iIi I% no longer nc_ti c definition otan Other-Than-Municipal
tearer system itnd wouhl no: he conAered a nuitli; seater sapp'•y.
Future expansions were discussed as it is like'y that pore homes will be added. Ten or more mobile homes on one
tael: will qualik this system as being a public wale- supple. Subsequent site visits maybe necessan if additional
homes (more thaw 9 homes pe:' writer line) are observed on the properly.
It way also discussed that the Drinking and Groundwater prou7wn encourages ;!It private well owners to sample yeariv
for baete-iii and nit--•ate. These two tests are inexpensive and very beneficial f,,,: protecting puAic health In addhio:i to
those two to>ts. lead and copper sampling a encosa red to see how the ;npui Iesnonds to c-h mees i-. source water.
Please consider these Icsts for each of the wells on art aanua; basis.
Thu. thank you fb, your cooperation Ir. un, matte... anc it was a piers-',re tvorl.in-_ v.it v;nr. !(you I-,uvc arty ormkm<<
wail::r questions. please do not heshatc•'.t Lk -
sincerely.
D\F. Dnn;,:n=_, acd Groundwalcr'~o_ra~'. - Ear. c_j.ore
r mm .he S~'S',.'2C 1 S elm visi_ t was firund t°q: the ulilit% no Ioneer met the (jefhti;ion of-an Other- i :;an-1vlunicina7
uatersvstem anc would not be. consider o:: ~ ubiic_wate- sumiN
re m'c expansions were discm sec t1c it is like)% that more homes will be added. Tcn or more moiile homes on onc
w'el: uiI: quaiifi this systm as tx:inf a public water suppi\. Subsequent silo visits maybe necessan a aadmonai
names ;more titan ° home; per water iine; are deserved on the propet•n.
I; war. aiso discussed that the Drinking. and Grotmduater, program encourages all private wcl- owners w smnple }'utrh
l. I
o-bate t and slvatc These nvo less arc in xpemivc asp l ven bcn •Gcia'' for nro ,ctr nubk h zod It adaittu
thos...wc tests., lead and copper samplul t- encouraged to sec hmi $te pipm.: re,.Dond t :han2e It ~ottrcc u,ar.
Piea;c wnsioer C+ese tests for each of tits wells or. an annual ban.
Tin., t ad; :.•ou for your coopera'ton i° L ruarter an' i .va t, PI:4r urc "V - nz I1 .01.1. 7f v,ou r cy; at,, tire'.1nr,
\Kal::r UIIe SL::41S. Fie:~',= ~C' iP:rf n: Slt;llc 10 ;Lim ~
lI:lCere]V,
°.nnt fare,
r'up.l, V. alcr Supph S➢CClaas:
Jnk Drinking anc Urpl:r)t]vtalCr lho._ra~'. h.au CIa
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CER IIFIC ~TION S l ~TFNiFNI
MR I I ILIL ~ I IO% OFF IA IS HNG NI.P I K TANK(S)
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\ It I , Knownit: ld:r.ir iz:-:'.:i\ a Coda I
Rw\. 11M,
ucm ntSafetyandPro4ssrnal Ecrv¢es SOIL (=VALUATION REPORT age I 3
1'~1 'ion or Safety a•id 5mldngs of
_ n accordance wde SPS 385 ''Alps. Adm Code
Count' St Croix
19 - '¢Jr Gaper not less than 8 v7 x 11 inches in size. Plan must
I' 4 qe Ti '1Dtlt.li v meal and horizontal reference point (BA1j, direction and
1 1 -fit Parcel LD
0 6-I ?$-90-000
li S perCErt slope, scale or dim nsions, north avow, and location 4dslco par oad} PI ase print all information. Review by Dale
oc• - al worVac^ u pro,rrcry Cc ufed le' secpndari CVn / I ~a IO
Property Cw*f'rt'-" -
OroDerty Location
l rnVgl p^'r'er1C
-
I Cdrr'T,~n1° Riverside Park LLC Govt t_ot SE 114 S1N'ti4 S T -1 N k 1?E(or}VJ
Property Owner's Maine Atltlress Lol # Block # Subit Name or Mli446 1lighland View
City State Zip Code Phone Number Lj~lly village L!jl own Nearest Road
Houlton WI 54082 ( I Stanton
E]New ConsvucpDr Use Residential I Number of bedrooms 32
I-- Code derived design flow rate 4800 GPD
OReplacement L'1 1 Public or commereat. Describe Trader nrrk
Parent material Flooo Plain elevation if applicable
General comments
and recommendations.
FTI Borng# 11 Boring -
Pit Ground surface elev. 99--5 It Depth to IimAing factor 144
0
Soil Application Rate
Horvon Depth Dominant Color Redoz Description lexture Structure onsistence oundary Roots GPDA ;
_ in. Mansell Od Sr. Cont. Cokr Gr. Sz. Sh. •Eg#1 •EH#2
1 0-4 IQyr2'1 s1 2msbk mfr gw' Im .6 I.0
2 4 20 7.Svr4.,4 scl
2msbk nrvft gw If .4 ,f,
3 20-144 7 5yr.5%4 s
nsg rnl 7 1.6
1 2 1 Boring Of ❑ Boring r
I8.2.5 144
Pit Ground suface elev. ft. Depth to limding facto, in.
SoilA 6calnn Rate
Horvon Depth Dominant Color Redoz Description Texture Stricture onsislence oundary Roots GPD/e
in. Munsell Cu. Sz Con!. Colo, Gr. Sz. Sh, •Eff#7 •EN#2
_-1 0.4 l0yr2;l sl 2msbk mfr gw Ln -6 10
2 4-22 7.5vr4'4 scl 2msbk nlvft gw' 1f 4 6
3 22-144 7.5yr5.4 s osg ml ? 16
~I
' Effiuenl #f = SOD , > 30 < 22C mga and TSS >3 1 rr.gr _ -A E41 erl #2 = BCD 30 mg& anc ? SS < 30 ml
CST Name (Please Print) " S_ CST h'moer
IF_ Travis Butterfield
652879
Address Date Evaluation Corourted etcpnone Number
?d6yV State Rd Havw2rd,lNi 5481 y.i4
24-.8 (±49I76
3 Boring # ❑ Boring
Pit Ground surface elev 97_75 If Depth to limning factor >144 in
Sodate
Horizon Uepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIFt'
In. Munsell Qu Az Cont. Color Gr. Sz. Sh. ' 'Eff#1 'Eff#2
3 4 10YR 2.1 sl 2msbk mfr gw 1m 0.6 1,0
2 4-18 7.5YR 4.4 set 2msbk mvfr gw if 0.4 0.6
~~18-144 - / 5YR 514 5 Osg , T ml 0 7 _ 1.6
- - - _
Boring
4 Boring #
L _ [X~ Pd Ground surface elev 98 OS it Depth to limiting factor >144 in.
Soil Apphwtion_ Rate_
Horizon Depth Dommant Color Redox Description Texture Structure Consistence Boundary Roots GPD_/Fe
In. Munsell Ou. Az. Cont Color Gr. Sz. Sh. ' 'Eff#1 'Eff#2
1 04 10YR 2/1 sl 2msbk mfr gw 1m 0.6 10
2 4.19 7.5YR 4/4 scl 2msbk mvfr gw if 04 06
3 19-144 - 7.5YR 514 5 0sg ml ! 0.7 1.6
Boring # U Boring
l~~~JJJ ® Pn Ground surface elev. 98.92 fl. Depth to limiting factor >144 in.
_ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD,Ft'
In Munsell Ou. Az Cont Color Gr. Sz. Sh
LLL _ 'Eff#i 'Eif#2
1 -0-0 t0YR 711 s 2msbk mfr gw ----im ---0.6 1.0
2 4 21 I SYR 414 scl - - - 2msbk mvh 9w it 0.4 0.6
3 21-144 7.5YR 5!4 s 0sg ml - - 07
1 6
73 0 - -f1
' Effluent #1 = BOD. > 30 s 220 mg11 and TSS > 30 150 mg!L ' Effluent #2 - SOD. > 30 s 220 mglL and TSS > 30 < 150 mg/L
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