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HomeMy WebLinkAbout030-2145-08-000 voi::non,in ccoartr*wn: :,l (trrnmrra PRIVATE SEWAGE SYSTEM St. Croix Skrvt a-.c Sudomc Dwrncri INSPECTION REPORT !'.10."' NC GENERAL INFORMATION (.ATTACH TO PERW I slate Plar In Ne 607064 .nsaual i,iolmator Jo_ p'b.Kll .av be used 101 !1 1:' dal; dUtF•S'Yl. IPUV:u:v La'H. 1..G< I',',-,:l 041900319-C Fe ^,n: MJldn: Na:ee: CA, vlllapr Toxnsn,y pe¢:e Tax Ne Michael & Elizabeth Gobis TOWN OF SAINT JOSEPH 030-2145-08-000 liv 1 e:v Insp. Bxt Elev It•d pcscnptor Sdctore'1 or,mRange;lluc Nc 30.30.19.2099 TANK INFORMATION ELEVATION DATA Ty-1E A!HNU-ACTJR6R `..I-,.,. ,..k CAPACIT" SiAIION BS III FS ELf_^ K Septic ] i . 1~.)C7 6cnrnmark ")osing rv AL' 61.4 _ (All AeraUor 91ag. Sevxr Holdinc tt Inlc' 1• ~Y.y') TANK SETBACK INFORMATION 3UR Outlet -ANK T,: .1 tNLLL 6. ;)6 vc-t to Air Inlaee ROAN T, Inlet I Septic r 1, I~ r r~. UI 6olloir Dosing I leader/ ,tar 7 1 Aeration Dist Falw Holding •so: SYSten•. 7 yu J tl . U~ PUMP/SIPHON INFORMATION rival Graar i r V~ ~0 I c t.4anufanarc, - i--- Demand S7 Cover N!nnM Numtwl - - I:)H Friction Lasxx Sv aem Icau ? ~l TDt• FI ! 11 ~ ~ora:eLength, , :ha r, vve t~ SOIL ABSORPTION SYSTEM BEDITRENCH Yvlcin Lenpm _ Nr [r ire °es PIT DIMENSIONS Nr:. at =v, ns cc D,a I s:nC r pi, DIMENSIONS SETBACK `P'; IF M T:: Pll_ IJ BLDC. LAK'=.'S I4F AN LEACHING Lradu'ac;ure- INFORMATION, CHAMBtR UR ~La~~ UNIT L., In~lnl ~-~L; 61eoel NUmoer DISTRIBUTION SYSTEM ac cr'IdsnirolC DISttiDUto(' ~ ,1 x HoE ;Cf yg., '-{acma ; cu' tr. A. a:akC Caa i nnefh :Ta_ 1 h_ JFdan^ SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only D._.utr t~.,.-, f CaVt.. •,,.r. x.: ~eFtt, ci xr smtlrdr3c»etl r: Mulchce EodQ cn n Gent- ' 6edri :L Fd Tca;o rr:. tJr Yrs Nc COMMENTS: (Include code (imcrepencles, peisuhs, present. etc InstR.chon Y`. Inspecimn It", Location: -14L 13RT- i Alt RM Desalpt,or - 2 , Bldg sewer length= - amoaim of rover = I 1 J' Plan revl Sion Required, Yes No Use other side to' aadaional information_ 7I l a~ 1.1 I. / 1 - , SBt}6: to (R 31Wi Uale Inseaaur a Sipnahuc y~~-.I'~ - r ,w Na lr6Usl S•rvlccs DlVl5uJn Cuunty D IGO 1` Nnilm ton Ave Cr , APR 09 2019 s p 11. Box . 162 ~Sznity y F•r~r;lt Nwrdsc pn he filled in by Co.) S vladisoa, W7 53707 7162 - _ ut Application State !Mnste ,N,enbR In accordance with SPS i4 ni(s ,Kris. ldn• Code, ::ubmjsslat of this fam to the anproDcline 0 H ( ( U o 3 / 9 - Is requited prior to nhui oventmentai unit »mg nmtaty pegnq Note: Appji ,on, fortes Yor sure-oaneJ PON1,7 S are submmed W projecs\, r the Ucpanme n urs'le'y and Professional Services. Pas.mui iufolmation you prosidc may L: u.,a7 fbr scmidary 4drR; if win, U+mt ura,lma address) u resin acoorda m r„th the !'rieaey Few. s_f S.WjI m Y )Sots, I ation i. Applic Ldurtrat;_m_i_feate Print All in('ormatiog 3Yo /✓78 r!f qJ~ Property Owner's NStm: y-f-1- n;IrcJY I L/ /cN~EC t El/z~bCn~ GoB/s Odo~.7/YS-aB- 00 499 Pmpeny Utvner's iAading Address - - - 00 4 ropeny l.oauian -..2=yG //„icuary 44 City Suatc -r - - { Guw- Zrp Code (Yhonc ~rmbv Section 30 ~F (A %/N -J s?G.Z ~/S.7 7003 T 310 u; R (circle on IL Type of Belding (check all tha r apply)S t 1 nr 2 Femily thvelling Numbr. r;f F3;(hnonr 0 G SuLdniema - tilocf: - - ~RO/J,J tJ osO ESTAI ES Q PttblielComntaeui - Desenbe 01C 0.6 ~TCny et 4ambcr a•c C] Stale Orvaw- Ucscna4 U c C n: IM Tmm of I [i . T}nc »f Pe*mit- (Checl, oily one ons ou' ~ ~ _ ' u-nnl e i ne ~ _ppiicablc) n ip \v ti Item ~ ] R_plucemult Jy s:an ~ I'.'r n.mz t l<ha~"mta k iaeemcnt (M ~ 7 '711 r t,hfi umt m husw )ysnn iaplain) Pcrmn Rasaval . I.us C:.rn it ~mn^e; arr : r ❑ 1 cmnt Revision ❑ Qungc of Plombv Permit Trnsftt to Nee Is,crd -'Rclixc Fapimhan I Oancr IV. Tic of PORTS SMC-cwVComuonent/Dev(c(e (Check all theta uiv (~0_ T 4L' nn-Prccsurizcfl (n-Ground t7 p,,,mi,,ed in-Gmuao DI Ar-(Fmdc ]found %?4 in. of suiuhic sin; and <?y 1 r,; .;li6ihic sell l Hddiny'1'milt ❑ Other Dispersal connnmcm (cxplain)_. F¢ncamlcnt Dc-t icz Lr il::in DisucssalfI'rcatment Arc. Infurmatiou: Doti zn flow (ypA) I O:atgr7Soil ApPha4e 1 r ta_epds> ?-Disxz I A= R_yz,r-c 1 Dispcfsal Atca FruP' z i+:i TS' [luu GMfs.,,l ysa- L t5 9So RaD I S'So qSa 99_. 3 9aT aqk Info C pa n - To,i ! d m:nnuractul (a Ia s O.tllms tid:+ - - ken Ta;L f.. n:; I / ° L R c r IO U N L V L L SCpIfC Of w'~ea~. ✓oeo- - /10001 ! i_ LJi sCA 6ONZAJrEt nodmK.bamba ~ - I VII. Responsibilicv Statement- i, thn andersigned, assum,,, ~•._,ansibliC; fur irsiallatien of the• PO~)TS slaw, an the almehed Wads. Piwnba's Nnmc (Print ~~77 Phtmber's Ssgr.,m ` /`y/, NP,aa$BS Nwnbr+ 13usinas Phone Num'ttr Piutrlbr, i Address (Street, City, Stmc, Zip Codc) G.T 98 S T. W w o , NU/LA JD l:i ! :J :/J.% Ja Vtfi. ntv/Deparrmcut Use Onll' + I ' _ .-hrnnn Frc link sad su:nf cal. itua. - 150 • c ! 1. S pOt . , 914M Ar r6i, 3) C.o.•~ld: cti5 t ti $ K.. ps 'j-L- , (,;spar:+:n call rwst aB R436ViLc ' nr; lnta tL r , I 's per ,-.W ayarrlen' Wan ao ncsm by 1 I ` `•"Q N/ /~'fAd ~~iL~v ~ 2. AM me%w k rec.0iitran s m r'st Le • rt M Per tKtcr"I r:'r r1..tr. , r L o:mi r u. li' ss I- : ~ n-;n.:::.IC _auci lah ue pa7cr nm las then I I l ..A" in s Z w ~ 1 v V i -S~ \ c `i , v d V ~ti T ♦ < _ i it v / t C ~ C F r.. ~ o IT z ♦ r V C 1p 0 r r ^ c ? w` ~ Y DIVISION OF NDUSTRI SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 S P Contact Through Relay S http.Udsps wi_gov/programs/industry-services wNw.VAS onsin. gov Tony Evers - Governor Dawn Crim - Secretary April 4. 2019 CONDITIONAL APPROVAI. PI.AN APPROVAI. EXPIRES: 2021-0.1-04 Plan Rcricw: PALrFS-0419003319-C 1011V 1'LIXIi \6298 State Iliehwav 25 Durand WI54?l6 SITE: Michael Gobis ;u1- I,,1[: Town of St Joseph Saint Croix County Total Amount: S_150.00 FOR: Picssure D] s!rihotit'll Cu!upuncnt Manual A'cl 21l, SIM-10706-P(N.I11;01,R 11) 12) 1 /1-1osa \10111 rd ( Ongxmcnt Nlanual - Decclllbcr 201? Vcrslcnr Description: 450 GPI) (3 Bedrmmtc - Vetr Construt lion) M:IIIaCIIIIncc Rcquurl the subilrinal deccr!bed :!Lm e lia, bccn !es Icsccd Irr aml"lloat!ee ss'tit appheable i>xrurmn Ununi+tratnc (o C. and Wisconsin Statute l tic suhmi0al his, hcen ( ONDI I IUNAI LY APPRt 1VI.) _ I tits sysicnt is to be c,mstructed and located in accordance evh the enclosed approved plans and faith any component manual(s) rcleienced Assoc_ t he owner, its dclined in chapter 101.111(1)), Wisconsin Statutes, i. responsible tin conipti:uwc uidt all code requircments_ No person may engage in or work at plumbinc in the state unless licensed it, do so b.v the Department pet + 14s 06. spas. he tolluwurg conditions shill) he tile[ during construction or installation and prior to occupancy or a+c. • Prescrrc dispersal area prior and during constniction [o avoid disturbance, compaction and use ollhe site. • NVith new construction; it is reconrniended not to actteate the punnp in the dose lank total the lank, :tic pimped prior to huntcow net occupancy. • \\'astewater generated from contractors cleaning of eytnpment and tools and of tell over constn!cuon products shall not he discharged into the drains dnschargin to the prtaatc onsitc wastewater treatnicnl s,.lem i l'(AV I S). Waste generated shall he properly disposed of nu-sic or off site, • -\m tall 1wassek, Ieaces and shrubs lull be cut short and removed prior to tilling the surface lair Installation t" pIC%col In!Urlig tinder rile dispersal area All lose orginnie material to he remised IFom N AV I S dispcrs;II arc.! • Prior to construction of the dispersal area, check the moisture content of the iol a depth ,I S etches. Smea11ng and eumpacung of wet sod will result nil ieductne life infiltration capacity of the sutl. Proper sal nn,i,turc content cant be determined by rolling it soil vtmple between the hands, If it rolls into a 1!4- inch wire, the site is tun wct to prepare. 11 it crumbles. site preparation can proceed. If the site i, too wcl to prepare. do it(,[ proceed until it dries. • The distribution pipe being inserted into the 4" enrrugated pipe located in the EZIIo%N product shall have lake )ill of csrry [lye orifice, installed at the 6 o'clock position. t he remaining Ibur orifices shall be installed at the 12 o'clock position. I It,- Literals shall drnn lidIv alter every dust • The lateral turn-up ends hall extend out past tine exterior end of the cells a1 both ends. The obwrvation pipes ,hull be located nt bclweel) where bundles come together. Ihese requirements must be Billowed so []fat file a>•gregate baidles will not be d:nnaged during file iustallauun process • Dit ert surrace water from POW I'S Arca • All piping shall cuntinm to SPS Table 184.300 and SPS fable 384?0.5 • Insulate building sewer beyond 30 feet per SPS 382.31) (11 )(c) • Tank Installation to Ibllow all wamdaclure's recommendations. • Well setbacks to meet ch,. NR 811 K 812 • Verify pruperiv line(s) pilot to installation. • 'gulp I luaI tt. he eh :uhd scripted per appr u, CJ plan. k11, k11A11 , mAN Ic,ult ill pump 1P,iiinq lu inert 11H and GpNI Speer licalilal,. - • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual fill Private fhh,ite Wa,leteater'Ireatmem Systems Version 2.0" SBD-10706-l' IN Ill 01) • This system is to be constructed and located in accordance wtfh the approved plans, and (lie "Utluw Mound Component Manual " (R.7~ 12). • \I .I, th:u a11- wCu pica 1 '1 1,. e I i 'i, i i't'irel i..ie:. ::derv fltc I't iurf 11 n11 I_.J.r. I I I . I I I I i_i n' 1 1[, Ills 111. 11.t i..., I p i. „_.u I;._ui Im; ,,I, al • SPS 383.54(I)(c) The manaueulcnl plan for a POW IS ,hull specific lb, athlress (Ire servicing mechanic, of tin aerobic or anaerobic treatment tank tit a holding tank where either of the following conditions exist: 1. The bov,im of the tank is located more than 15 kcl below the elevation where [he servicing pad is locoed. 2. The bo0nw of file tank i, located more [[fail 150 feel horizontally Iinm where the wivicinp pad is III a ,t Owner Responsibilities • The current owner, and each subsequent aw net, hall receive ;1 copy (A fill, letter includin;, insnuchon, relatIll eto pi i,pcr n,e ; inJ ur:unlenuncc of I hC , Nmtcm. Ohh ner,,]],I rCCCI":;iCol r"oftIt e pp; uprla tc npCnl n,p:1 ,11.d ai;nnlCn,Mt C nruura .:1111 or rrvnc', 11cmuA t0i the N M I S I hcd ill thi, appi o,:d SPS 383.54( 11. :A . Bpi 111 I It: uppr,". ud Irl;us, ,peer ti,; It 11111, and III[, ICI ICI ,11.111 he 111- 4tC JLH! 111' ,',111,11 (,,111111 Anil open l,, inspecuon bye audiort/ed representanves uftlic Dcpurlmcnt, which uwt nl~lude local in,pectot, 1111 pcuuits squired bg 1he tale or life local ntnicipallt% hall be obtained prior n, contnichhcement or ,onstmetion installation operation. In gr:mlmp this approval life Division TlAnduslm lercicc, te,ci v.•, the 11,01! IT, leyuit: change, nt dd.inioa„hoeld conditions arise makinu them necessary fin code conq?hunce A, pci i,Ifc .(ill, 101 1oolong ill tlns u:% ieo ,hall Ichcvc the 41 e,hcucr „I'fbC ie,ponsib i l i IN tin 11c,1011un! it ,ale huilJinr ,nuclurc. or conhpron•nl. Inyuirir* canceniiu_ lln, "ntey,nndrncr nwc he nuidc n. nu w the lckphunc oomhcl li,ied bA,,., . 1 :a the addiv" on dii, lclici brad I he ahoce left addressee shall provide a copy of this letter and the POW IS management plan to the owner and any other, with are responsible till the installation, operation or maintenance of (lie POW IS. Sincerely, l!!n T/uHl~7~C "eeil I Im Vander Leest Pn\ me Scwaac Plan Reviewer . Division oC t» dustrv Sen ices 920A92-2214 . Mon- I ii, 600 a.m. - ?:?0 p_nt. ',ryc~ P1,V S,S'icS T r :se,X ~q s~: 2>' i ~ . i n ~ ~ i - y ~ ® -nom ~ r ti~ ~ v ~ ? A O ~ f~ i ~ ` o ~ a ~ •i o ,y, . ~ 4. 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I'll tl 1'. \v011111112 !NI 1!\11+.1 I \\6\ 110, (U\It%\ LEIll Al t, \\H+ 1VIIIlt 1\1I Ills 11'\l UA)(,[ N. list Att; IN A'i I R I. 1IT11, . 1'I %I['.:lk !,lit! R 110 W N ; I IINK I A11112 Vv't ! Ik1 ( \IvI VA! I III, 1II! \t\1 8111 11.121.], I I fn \1.11!]1 IN 1 iill\I IIll t\II Hit is I'l i - \\h \L\1 tit [111111 ! I I I'll I\II'I 11\1191 i tj, +'l1U TSAyrt;_i 1 k ;•UV11} ll liy 1 tivI.lt SFpIV;LAC_RV I C'1 A C OPL 1tA IOk! l'umpcl. I_.(1( 1L kLl.i I VII1It 1 ll III(Ikll+ y 1 .a io E. I N ST. ('ROIS COUNT) SEPTIC TANK MALtTpENANCE A(i;(f_t NIL-, ; ANT) OWNERSHIP CERTIFICATION FORM OwncrBuvet M I R it a = G o I c Mailing Address (5 17 C7 r i c s a K c C S r r t t^ , CitGgL _ cri icatien required from Planning k Zoning Department for new construction) Parcel Identification Nufnber LEGAL DESCRIPTION_ , I'mperty Location '7; , Sec. ')-30 , T N R M W, Town of 9_ j (I`af'.d k~.__. 'Ubdivision vh~UdUL~ e, A-s Lot ~4~- - - - Certified Survey Map Volume Page f: i \N' arrant, peed # . Volume Page SJ I,, Spcr. house oo Lot Iuscs idenlifubl(yes ) no SYSTEM MAINTENANCE AND OWNFR CERTIFICATION I lrspropcr use and =m1coanee of four septc syttern could rcali in rp preonture f dust to handle wastes Proper 1111i cox.Ists of pumpa:t; 0111 tim septic lank every lhacc vows cr sac net. tf needed, by a It=med ptmrpcr What •(n j pct mi-. e:c systc:n can alfcct he ruavilon of the septic tha w a trcarmcm siege in the waste disposal synrm Owner mamterunce s;wm:btiaics a_ spccsfie3 m ¢Conu Si 520) and in Chapter 12 - St. Crest Coucp• Samtarv Otiimnce. ,b:: pwpF ny ow nci agices to sui:mn to St Croix County Planning Q L-^ uog Uepamnrnt a censficalton fonm st ncd by ihx ~,vmer aad by s rmster plumber, 3utaneymau plumber, resuicted plumber or a licemed pumper verifying that (1) the on-site •.t aste.AA r disposal system r, us proper operating ;oudiuon atsd'or (2) after inspection and pumping (B necessary), the septic tar]; t; i-.s ,hero iii full of sDsdmc fiwc, the undersigned have read the ubuvc re0tuuemenrs aryl apice to rstabtum the private sewage disposal system wi!h the 'rai'Aards set forth, hutm, as w by the Jcpaarncni of Cure erce and tie Deparrrnont of Naluol Resources, Slate of K'bscuasc:. Ccr,:;l.~ti, n: swing Cut yow 3"';'. syafnm has been nvintarned must be completed artd retu:ncd to the St. Croix County Plarauug & Zucmg !xr rtrznt wtthlu 3U days o: the three year espualiou date. " c<rtrfy ;It, I all snztnments on form arc ttuc to the best of my/our lmowledge. i/we anslare the owner(e) of the v:,;, r t I-s:nmcd above, by vul'uze~of a w ranty dced :ccurded in Rcgrste; of Deeds Office .Number of bedrooms J . Y S!G vATURF OI" A d,111 I(iAN k (SI DATE "'Any mlomusiun that i, sr:>iep: o,e:i ed Inn, rc>ult it t:e +anlu y pelmet bong revoked by tke planning & Zorun4 Deparrmtnt. in_ -bade w•ttf. shit applicanon a treorded warranty dced from file Remster of Deeds Office aad a copy of the certified survey reap :f rcFrence is made in the warranty deed 1.KP.V. oP"os; l LEGEND F, I I c ;rn I - FI GI JH f C If' J yU rto - 1 e I IF -.I '.il'rrl 4T ! L 11141-N • t _ I P~II rLH P •ri ] r! « r~rv y. F1v oN.lr LLn-Inn 00 p(~ tom- ~wn•I V.FFlPuFLOV y.t~µ sITF.An NF I n<cn" ..J.F _ sl1•I IT LI'Y Fn4Fl\=t1 I i r I I!L ~pUE AFixor DRAINAGE irsr L ASEMENT AREA ARIA - s .TO,- a., zc LOT 8 - + 131.015 sq. h. 3.01 Al - LBO-9;1424 vF y _ 2~ ~ > -on utie nt ~ InL~li r. I i of i n rrm~.. '.I \I irntllr I I?-61° Y N r _~.I T 5 H l l ETAO I T F'. %?J Ill., So LI npnl~ 69-1ez06 VJ \ j `I J.64 AC. I l \ ~J ~I LBO 930.33 I \ LOT 6\~ 0~ ~I W V c° \ 132409 S.F. qaY OD , CD p \ ` \ 3.04 Ac. V, ti m + Q \ \ LBO - 930.53 ! / m ^ J \ \ `3~ \ / / a j~ /X025?/ ! = J \ y rte, p. .32 a aa, ~.~j2i '•aa,. Z 1 \ tr~~Gj, (n ® HVE - 93124 C' r ~D Is" 2 \ \ ~o~ ps \ \ LOT 8 .F. \ \ >PS r✓~ 131015 S.F. w \ 3.01 Ac. O11 LBO- 93424 W I \ I m • 922.77 't \ \ 0.~ C;l 00 ✓ Er /:26~"' 66' JOINT _ % o ~~0•~4'DRIVEWAY ~i 1 EASEMENTS W ri i ~ - ooq ul lo,. % i I ` 1 1 +F :11. I 1 3 I f r i ! iL f 'i { ( I I I k l - uuq~~i 1 unJ N ~issel7 >t++'~°J 35f101A 51809 i v II I t- _ II qm I ~ j\L~~I__flj1 1 , Asnow SI80`J ~IsselJ M~ w~o7 I! a Q v - - I I ' ~ I I 1 I I I I 1 r' ' I 1 1 ; I i I I I I I 1 I I 1 I I I I ~ I 1 I 1 i 1 I 1 , 1 3: 1 I I I I I ~I , ~ 11, ^ I I I 1 I 1 II II It .I R~ I ~ 1 it 1 , I I I S~ 1 I I vE _ I ~ i I I I 1 yl ' I ~ , II I~ II I I I l I I - uoq,n~l uo'- _ e' re ~ Il -Lf I -ISf10H S190:1 17 rxw In EP +i I nd x ,I I l F, L( Ij s ,ia II ' fry y a f ? a w S - 1 ~1 I I i YI - ~ 11 !h~i ? f li 1 I 1 1 It •..li 1 - i:F so till g t~ py r M 1 f - Y I Ir I . P: ~ is I f 1 ~Msmnsin Department of Commerce SOIL EVALUATION REPORT Page -L-,f _L Division of Safety and Buildings in accordance with Comm . Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inche size. m County S- YU include, but not limited to: vertical and horizontal reference point (B irecti Parcel I D percent slope, scale or dimensions, north arrow. and location and distan o nea t Please Prin a r Iten,ED Re' Date Pononal mlamaaon Yau Wovde may u nw s<ry yurpefer IPrlvrtcy Uw, 15 04 mp. / / b f Property Owner roparty Location p h rX S - . Lot 114 A' w 114 S 30 T N R E (or) 0 Property Omens Mailing Address of If Block # Suq. Name or CSM# _ SI.C F 0 I X CU Ur, i/ _ vC ZON NG CFFICE L), % -,/n J. City Slate Zip Cade e NUMIDIN ❑ City ❑ Wage © Tam Nearest Road r1 ® New Construction Use C) Residential / Number of bedrooms Code derived design flow rate ;yl 3" GPO O Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if appplicable and erairecorimendations: ?Y I e/< v. y 3 / ru'1'U-fi velu (III "-uA 7:? 0 wAkhw, f ~ 1'v:-,lam 4 ~ Qp„~ 1 ~-{FiY~t 5-1 Boring # Boring ? T pit Ground surface elev. i R. Depth to limiting factor _ n. Soil Application Rate Horizon Depth Dominant Color Redox Desorption Texture Structure Consistence Boundary Roots GPD#F In. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. •Effpt 'ER#2 1 6, lUvT7? 1i - L 7-w~Sbk 1M+~ t S - G G lkj- I , r .'y Ivy p i F Boring # ~C~11 ~g LLt Pit Ground surfaceelev.,~~.-j- R. Depth to limiting factor 3 Y(i n. Sea Application Rae Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPIMF in. Munsell Gu- Sz. Cont. Color Gr- Sz. Sh. 'ER#1 'E1f#2 1 ~4' (a,/f n ~11 l-dC 'y\ J -C'` 1G 7/'. ,S~ ~ ~ .SrC.) [ uhf( t l _ ~ Effluent #1 = SOD > 30 < 220 nxyL and TSS >30 <150 rng,,L ' EMueM #2 • BOD < 30 nwA and TSS < 3D mgr, CST Name (Please Print) - - Signature .G-- CST Number Address Date Evaluation Conducted Telephone Number tt J, Ilk I n Property Owner ParcellD# Page L of ❑ Be" Bow # Pit Ground surface elev. i~K Y ft. Depth to limiting factor - ~ in. Sol Iration Rate Horizon Depth Dominant COW Redox Desor"on Texture Structure Consistence Boundary Roots GPDM in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'E##1 'Eff#2 C' Lrn Sb/C L C' 3 J f tZ -7 is r'/y ❑ Bodng# ❑ 8on^8 - ❑ Pit Ground surface elev. ft Depth to lim" factor in. Sol -Applcabm Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD#t in. Muneea Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground sunhats elev. R, Depth to limiting lector in. Sol Application Rate Horizon Depth Dominant Co Redox Description. Texture Structure Consistence Bourxlary Roots GPWtP in. Mtmsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Mani 01 = SOD, > 30 1220 mg'L and TSS >30 < 150 mg& ' Effluent #2 • SOD, < 30 mglL and TSS < 30 nVk 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. taPr1N10.~1 Proporry Owner ParcellD# Page Z o! -l a Boring # Boring ® pit Ground surface elev. it. Di:pth to fimhing taarx Soil Itcation Rate 11 Honzon Depth I Dorninanl Color Rooox Description Texture Structure Consistence Boundary Roots GPDaf in. Munsell Qu. Sr Con. Color G;. Sz. Sh. 'Eff#1 'Eff#2 ,Yl C i I h - - J 21 1 ' I fig" Bonng pit Ground surface r9ev- f, Death to limitin;r favor in. Soil Apaiption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munselt Ou. Sz. Colt. Cola Gr. Sz. Sh. 'Eff#1 'Eft#2 i I J Bori Pit Ground surface elev. ft Depth to limiting factor in. F-1 ~~g" ° ~ Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. SR 'Eff#1 'EW i i i Effluent #1 = BOD, > 30 < 220 nrgfL and TSS >30 < 150 mgr_ ' Effluent #2 = ROD, < 30 mg/L and TSS 130 mgr_ 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 nr T1Y 608-264-8777. EBA1tb tY.MU1 PAGE OF 3 NAME LOT# ~ LEGAL DESCRIPTION 6'C1/4b'-..'A,ST ~_x_' ,N,R i 5 E(OR SCALE: 1" BM 1 ELEVATION BM 1 DESCRIPTION BM 2 ELEVATION (n.~0 BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE I'~1 Cif n C;( f t 1 a- r 'r la o- SIGNATURE - - 'Z DATE I LBO = 930.53 • " f O Sr s i BO = 925.00 k. s 12 ~6' = r s - 1 51 39 -~.F~ LBO= 934.24 F x VL =",-9277 . v F n Teo- < 4 r / F, 74.;s` LBO = 934.21 V { 934:70 i a 3 L H` IWL ',9,3221 > r Zxr ti .I LBO = 934.21 /i ~ LAS - ♦~~J Y ~ Y r kt 299.97 N 89°57'01 E 549.91 N 89°31'12 W N 00'42'55" E 17 79 1 Wisconsin Dopaor mepae RECEIVED SOILL EV LUATION REPORT Page of Division of Safety rta.In 'nn/" • - wpbti ~ncOwtth Ifd 85, s. Adm. Code _ . county Attach complete site plan-on f5aper s than 8 12 x l l inch yip Plan must 1 Include, but rat limited to: vertical and zkxFYrfdNf6 d and Parcel LD ~ / / percent slope, scale or dimensions, n arrow7QrtQtOCbt>) to nearest road, v ld•~ '1 ~~(_I~7 Please prim all information. Reviewed by Date Personal rMorrrmaeon you prov a maybe uaad Iw wcondary purposes (Privacy Lnw. e. 15.04 (1) (m)). Property Owner Property Location Govt_ Lot Ai - 114 .d'.i.114 S X-) T_ ) N R E (or) Properly Owner's Mailing Address Lot # Block # Subd. Name or CSM# City Stele zip code Number Phone ❑ City ❑ Village 1®Tovm Nearest Road S a l ) x 4i k 13 Q4-' l--r , New Construction Use. [;B~ Residential I Number of bedrooms 3 y Code derived design flow rate f G GPD ❑Replacement ❑ Pudic or commerciat - Describe: Parent material (>i_ f i-~ r-~ `j Li Flood Plain elevation if appl cable !~;1 R. General comments c.•, ~y1 Cdr V % ~7i CJ 1 . and recommendations: (o61 eU✓ Lt P1) q >V tf l C~ ✓ i M Boring a .0 'ng 0 !l -Pit Ground surface elev . fl Depth to Imiibrg factor in. Sal Rate Horizon Depth Dominant Color Redox Description Texture Stnatura Consistence Boundary Roots GPDM in. Munsell .y Qu. Sz. Cont. Color Gr. Sz Sh. 'EMI 'Eff#2 ILI a ~O - I Y C I r - 5L m l; Boring # Boring ~T 54 Pit Ground sudaoe elev. / y; ;zc) ft. Depth to limiting factor 1.~ in. hication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf in. Munsell Cu. Sz Cont. Color Gr. Sz. Sh. 'EB#1 •Ert#2 1 I~ tc L _ _ - Effluent #1 = BOD > 30 1220 mWL and TSS >30 < 150 mg& ' Effluent #2 . BOD 130 nVL and TSS 130 mgrL CST Name (P4~06 ' t) -Wnatu _ = CST Number if Address °p Date Evaluation Conducted Te Number C, 0 71,f -C Property O.vner ParcellD#___~..._.i=) Page-,:Q. of D Boring # ~Boring C'l u-u Pit Ground surface elev,z_ o_ R. Depth to limiting factor 3 in. Shc ication Bale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf in. Munses Ou. Sz. Cont. Colo Gr. Sz. Sh. •091 -E##2 IG p, - - ❑ Boring # ❑ Bong ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Tedtre Structure Consistence Boundary Roots GPDAIF in. Munsee Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#t •E"2 F-1# ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sou Appkation Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDflf in. Munsell Ou. Sz. Corti. Color Gr. Sz. Sh. *Ent •Ef#12 I -T Effluent #1 = BODr > 30 < 220 mull. and TSS >30 < 150 mgt ' Mont #2 - SOD$ 130 mgt and TSS c 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. SP lw Ckb ) Property Owner Y\----- FarxI IDK.._ 11 7e Fug, of IN Boring k ❑~Boring 7.. tL.~ ait Ground surface elem. :2, -7 it Depth to limiting factor T~ ire. Soil Application Rate I Horizon i Depth Dominant Color Reaox Description Texture ! Structure Consistence Boundary Roots GPDfFt` in. Munsel: Ou. Sz Con: Cob. I Gr. Sz. St. 'Efrk1 'Eff#2 IC C. - j CAF 5.Y sL ly-\ - i-n I i Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. . Sal a~ 'ipU'on Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary. Roots GDDMF f in. Munsel. Ou- Sz. Cmt. Color Gr. Sz, Sri 'Eff#1 'EH#2 f ! i I i i -3 I I Boring F-I Borg # Pit Grounc surface elev. ---ft. Depth to itmitir.3 factor in. ❑ . Soil Application Rate Hpnzon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf nn. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 'Eff#2 i I I ' i I I Effluent #1 = 800, > 30 < 220 mgOL and TSS >30 < 150 mglL ' EfnuerK #2 = BODr < 30 mgIL and TSS < 30 mg& 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 ire &partment at 608-266-3151 or TTY 609-264-F.717, sxwa>o ixsm~ PAGE - OF S LOT# LEGAL DESCRIPTIONpf-_'/4 G'w/a,S YET SC ,N,RiCE(ORLW) i SCALE: I" BM 1 ELEVATION N B M 1 DESCRIPTION O IT_ ' e 4,gc BM 2 ELEVATION qf, 5Z~ I BM 2 DESCRIPTION Q ~C/p~ ( R O~L- k2< SYSTEM ELEVATION l / UC~ LL SYSTEM TYPE t~z+c.f~Q - I G; - C~U/lGl i ~i q'6 \ tai _ , _ SIGNATURE L- \DATE 6 J l