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Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar 03 Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: []City ❑ Village ❑ T6Wn of: = 16-4 ID No.: w Madsen, Randy Klnnlcklnnlc Tonsh p 1WZ L ( CST BM Elev.:- Insp. BM Elev.: BM Description: 'Parcel Tax No.: r r G RM A± 022- 1064 -70 -130 t5� o I ) . D o lN� `� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - p s7p Benchmark I t. 2 0`(. Z< ( 0 - O r Dosing Alt. BM p 6� v - s,i o Aeration Bldg. Sewer . 4 - �r Holding St / Ht Inlet 3 Q •i'D ' TANK SETBACK INFORMATION St / Ht Outlet — TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic 0 -, 8 r NA Dt Bottom (3-D+ .64- Dosing L' L ` -e. r NA Header / Man. („ o •SS Aeration NA Dist. Pipe Holding Bot. System c ito -S� PUMP / SIPHON INFORMATION Final Grade 3 Manufacturers Dem nd St cover Cn Model Number ✓bl>✓ r' 4 f p �lGPM NO 5� TDH Liftct,-�i Lriction System3 2S TDHk2•� Ft ead oss 0 Forcemain Length Dia. H 2 Dist.Towell SOIL ABSORPTION SYSTEM G n [ z. n BED/TRENCH width D r Length I No. b PIT No. Of Pits Inside Dia. th DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI u acturer: SETBACK CHAM INFORMATION Type Of / r System: 3 b O IT DISTRIBUTION SYSTEM dv wi L L Header ! Manifold Distribution Pi e(s) p x Hole Size x Hole Spacing Vent To Air Intake Length JC.L Dia. `�_ Length D .� Spacing /cf z. 7 r � 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 /TrenchCent r s �5 Bed /Trench Edges Topsoil ❑ Yes [] No C] Yes E] No COMMENTS. (Include code`discrepancies, persons present, etc.) Inspection #1: 10 /(2'I Inspection #2: to /I'a o0 Location: 1268 River Drive, River F lls, WI ,54022 1/4 SE 1/4 22 T28N R W) - 222818350 0 -Lot 3 1.) Alt BM Description = g d 2.) Bldg sewer length= 5 - amount of cover = >4 ` 56A ter ti 3) ��;v,Q "Ik o,•lt � / e - Plan revision required? ❑ Yes No 02 3 o t l Z (o Use other side for additional infor ation. SBD 6710 (R.3197) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: - ---._. } � > � gg __�.�......._.«....� .,tea.,..,, _.........3 �.... {- �.�...« ........ ................ ,...b......... .�.... ... ,p,........_.,..... ...._.._ ,............, �.,.,_. ,�.... .,_,..._.� y E a a Sanitary Permit Ap lica ib>h _, ( Safety &Buildings Division / � "'" . 201 W. Washington Ave. In accord with Comm 83.2 Vlyi�;A'dm. Code See reverse side for instructions f ompletingAr licatbomp' PO Box 7302 • ` iseonsin Personal information you provide m :1il usedFit EQ( purpbse5. Madison. WI 53707 -730^ Department of Commerce [privacy Law, . t5 " , (Submit completed form to county if r state owner Attach complete plans (to the county copy only) f r syst 2n r n ess than - 8 - 1/2 x 11 inches in size. County State Sanitary Permit Number ❑ ecl. -if re iit6n tp pr applicatign' State Plap 1. . Iber I. Application Information - Please Print all Information Location: Prope wner Name " , i Property Location y'. W 1 /4 1/4, S T R W Property Owner's Ma0ing Address Lot Number Block Number L w-er G rov e City, State Zip Code PhoniVNumber Subdivision Name o CS Num II Type of Building: (check one) 3 D t_a� e I& 1 or 2 Family Dwelling —No. of Bedrooms: Town of ❑ Public/Commercial (describe use): JO ❑ State -owned In tc c. III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Ne est Roa vet Jeasi A) I. New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System 1 0.2 2. f 0 &Y — 76 " 130 $) 11 Permit Number Date Issued A Sanitary Permit was previousl issued IV. Type of POWT System: (Check all that apply) .2,Z 40 A o /P _Mh - 3 ❑ Non - pressurized In- ground 4Ivfvt11d' ❑ Sand Filter ❑ Constructed Wetland ❑ Pressuri=4 In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation / 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) ►/ Elevation 7 6 -3 7S, o VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic _ Information Gallons Gallons Tanks Con- Con- glass New Exist ing �� /� crete structed Tanks Tanks / Mw /G 0a ❑ ❑ ❑ ❑ Se i/c '000 We I S rr ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility f ^r installation of the POWTS shown on the attached plans. PI bets Name (print) I P er's Signatur (n stamps): MPfif 4tM. Business Phone Number C S e P 2,z — 7 /,� — y z 4'f elq Plumber's Address (Street, City, State, Zip Code) /V 0.7 9 ' 5t 17, Pr f is UU z VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I suin gennt (No stamps) pproved ❑ Owner Given Initial Adverse Surcharge Fee) CJ S O� 42 Determination o IX. Conditions of Approval /Reasons for Disapproval: ` " e, -r�wwnei - is Irc�Pa� .ro✓ �t a �/1i41feNrtrrre Vejel i i5 e441toiishor ( � :y`1 � bXVAU��� - b-l� wlw�ew� K pjuv) . SBD -6398 (R. 07/00) Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 *6consin www.commerce.state.W.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 05, 2000 —�-- `� N.• POWTS INSPECTOR CUST ID No.691727 TT .��, �`" - " �� ; � ARTHUR L. WEGERER �� RF �E��E `iC&ING OFFICE 421 N MAIN ST ST # OIX COUNTY SPIA PO BOX 74 _ Zc� 1101 CARMICHAEL RD RIVER FALLS WI 54022 ', at� �_ HUDSON WI 54016 CL '; S` 0�. E . I �G C� F t -.� l`�F LAN APPROVAL XPIRES 08 05(0 ZOh` ~G / \ Identification Numbers Transaction ID No. 409824 Site ID No. 196147 SITE: Please refer to both identification numbers, Site ID: 196147, Randy Madsen above, in all correspondence with the agenc St. Croix County, Town of Kinnickinnic NW1 /4, SE1 /4, S22, T28N, R18W FOR: Description: Three Bedroom At -grade System Object Type: POWT System Regulated Object ID No.: 752821 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the At -grade Component Manual Using a Pressure Distribution System for Private Onsite Waste Treatment Systems" SBD- 10570 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P R.6/99 Y . ( ) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at -grade component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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 Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. I ARTHUR L. WEGERER Page 2 8/5/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 07/19/2000 Mgt FEE FEE REQUIRED $ 175.00 A'lp RECEIVED $ 175.00 eerar Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us WiSMART code: 7633 I TITLE SHEET Page of _7 AT -GRADE SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the At -Grade Component Manual SBD- 10570 -P and the Pressure Distribution Manual SBD- 10573 -P LOCATED IN THE MW 1/4 OF THE S 1/4 OF SECTION Z Z ,T: Z8 N,R ) W, TOWN OF ST (2—Ro tX COUNTY, WISCONSIN. INDEX PAGE l of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE y A PREPARED FOR __. %jo r Lt ql o FMS 4 Let Iry . 1�? e1 o y CA t .r•r )mV GmUs tt' 6 Lt " iv � o v G PREPARED BY WEGERER SO I L- TEST I N G AND . DES Z C3" SERV = CE • P.O. Box 74 421 N.Main St. SC O River Falls, WI 54022 �s /', Phone 715- 425 -0165 1 { Fax 715- 425 -6864 BLLSWORTH. ON "'SIGN P M ay C0� U11.U►UGS p�PAR SN A SSE C'0V t JOB NO. SYSTEM.MANAGEMENT Page Z of - J Management and maintenance of this system is critical to its proper operation and longevity. The system owner must be provided with a complete set of plans including the management section. GENERAL Proper functioning of any type of on -site waste disposal system is dependent on the amount of water entering the system and the quality of the water. The lower the volume of water and the lower the level of contaminants, the more efficient and longer lasting. the system will be. Typical system components include a septic tank 'to settle out and break down solids, an effluent filter at the septic tank outlet to filter out small particles, a pump tank with an effluent pump and controls and an absorption cell to dispose of the water in a manner which will protect the groundwater and public health. RECOMMENDATIONS 1. Install water saving devices when and where possible. 2. Repair any water leaks as soon as possible. 3. Do not pour greases, oils, chemicals such as paint or paint thinners into the system. 4. If you have a garbage disposal, use it sparingly. 5. Do not dispose of any paper products other than tissue into the system. 6. Try to avoid excessive flows of water in short periods of time Spreading clothes washing throughout the week is recommended. MAINTENANCE I. The septic tank should be inspected by a licensed pumper every three years or less and pumped if necessary to remove solids and scum. 2. The effluent filter must be cleaned periodically to remove any accumulated particles. It should be washed back into the septic at 6 month intervals or as per the manufacturer's recommendation. 3. Periodic inspections at the observation pipes should be made by the owner to determine if any ponding is taking place in the absorption cell. Also check for any seepage to the ground surface. If consistent ponding or seepage is noted, a licensed plumber should be contacted. 4. This sytem.contains an alarm which must be installed on a separate circuit from the pump. If the alarm activates, minimize water use and contact a licensed plumber immediately. CONTINGENCIES Monitoring of the volume and effluent quality may become necessary if problems develop. Monitoring must be done as per the requirements of COMM 83.54(2). Pumping and disposal of wastewater by a licensed pumper may be necessary while analysis and repairs are made. 1. Failed mound systems may require removal and disposal of the existing sand fill and replacing it new sand or installing an aerobic pre- treatment unit to reduce or eliminate any clogging mat .that may be present. 2. In- ground soil absorption systems or at -grade systems may require the installation of an aerobic pre - treatment unit or replacement of the system. Additional site and soil evaluations may need to be done 4nd additional plans may need to be ,prepared and approved by the Safety and Buildings Division of the Department of'Commerce. PLOT PLAN 3 7 ' Scale 1"= ��' Page of 1w OF WooD CORJJ�M po 9 T OT L IhJL 1 2 U - a -5 I \ zS' y�IN. 8.S '� Will �4 BE P fr l.z$T So FVO-1 Sri$i� 9x^11+ / 8 KPvG�,n- oY f�T LIZ IS FZ4 H ..`rf7 I�L91•S8 ory VP 2 p S 5 l r ar Z&VIF t 1u1i I Nom X Vo �r - - r b NOTES: —�- 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( 2 required). 3. Septic tank to be l 000 /Goo gallon capacity manufactured by 4. Bench mark -5 S9i K OV 5. Divert surface water around system to prevent ponding at the uphill side. C.ZA S S_ S _ Irm 0 N Page !-L ° . L >5� B > 5 � � 2' • W 1tZy_Z� l —G4f_ L —0 > 5' o as�ev �•ry w etL _ Z r" o . 1/6 B I/6 B A= ZO Feet B= �.S Feet - -- Linear Loading Rate= 61 GPD /LN FT L= — 1 S Feet Design Loading Rate= p • '7 GPD /SQ FT W= Feet Fabric Distribution • LatemaI a 6.8 Observation , 0 �Soil Cover W e l l 12„ VVQ e\k >5' q >5� Plan View and doss Section of Wisconsin At-grade Unit with a Single Absorption Area on a Sloping Site Distribution Pipe Layout pA&e 5 of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lat up with the use of Iong turn or 45 firting to a point rvithin six inches of the final grade. Te.mmate the ends of the laterals with a valve,: threaded cap or threaded plug. Provide access from final grade for the valve; threaded eap or threaded plus. f ftl t= Ct� L ,mss s FV C PV C Lateral hU C `7 Lateral X z x x xT (x4 z x z x : Lateral Length Lateral Length = P Distribution Line i P s �o Fc�t,..a.L n�p�►ry Fo2C� i�tfcltJ . P 3 Ft. Hole Diameter `� Inch Lateral " Inch(es) X 'Z.V._ Inchr=s Force Main " Z Inches # of holes /pipe 1 Invert Elevation of.Laterals q $ Ft. " Combination Sepr,3c: and PUMP CHAMBER &055 SECTION AND SPECIFICATIONS ' PAGE OF -VEIJ7 CAP WEATHER PKOOF JUNCTIOW BOX . 'i C.I. VENT PIPE APPROVED LOCKING — " -" -- MANHOLE COVER curM ,10 i FROM DOOR. yuAttNl1JG L.i4gFC.. .WIAJDOW OR FRESH ` ut3P1otJ t'IPE A.JK IAJTAKE c S cor.�culr {,`+mow. . �. 1J3 i"llu. IAJLET `'_ PROVIDE I - - - -- - • AIRTIGHT SEAL � •� I i 8 I I APPROVED JOIIJT A I I I ( W /C.IYP PE4tPDc WIC. PIPEaR Tank construction I I I I ALARM shall comply with ILH&t 1;3.15 and 33.20 b 0M C ! I I LLCV. � -�.�FL OFF D COtJCRETE t'Z.�V• 0 b' CLOCK 3" APPJ2�e RISER EXIT PEFAi7rED 0QLy IF TAWK MAIJUFACTU HAS SUCH APPROVAL gEDOtNG SEPTIC f SFECIFICATIOUS DOSE TA1JK MALIUFACTURER: �E �Z � IJUMBER OF DOSES: 6 PER DAy TANK SIZE: lUOiQ t! OO GALLOAJS DOSE VOLUME r ALARM MAWUFACTUILJiR: S•S. z�L X120 LS IMCLUOING BACKFLOW: GALLONS MODEL IJUMBEK: ��� 1 � w CAPACITIES: A= $ UJCHES OK AOI. -7 GALLOUs SWITCH TYPE: B= Z 11JCME!00R ' S G( LLOUS HUMP MAJJUFACTURER: M S C= 5 IIJCHES OR 8 3 '� GALLOWS MODEL WUMBER: MZ D� INCHES OR 1 8�t:4 GALLO In1vt- l- SWITCH TYPE: )JOTE: PUMP ARID ALARM A E 51 MIMIMUM DISCHARGE RATE 3 �' GPM INSTALLED ON SEPARATE CIRCUITS VEKTICAL DIFFERENCE 15ETWEEW PUMP OFF AIJO..D15TRIBUTIOLJ PIPE.. " I S FEET • + MILAMUM WETWORK SUPPLY PRESSURE . ; ... FEET F T z, - 8S OR �/ FRICTIO►J FACTOR_. 3 FEET + FEET OFF CE J"U1 X /tpOfL TOTAL DtWAMIC. HE = vs-o 6 FEET As per.manufacturer f gal/in. Liquid depth 36c' ■ M E40 ri M Se es 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N 30 �j IL W H 25 6 Z M l 20 g W J = l i 5 a F- 4 p 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. f Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 D'nrisi6n of safety and Buildings In accord with Comm 83.05, Wis. Adm. Code I;nvirormxntat By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, bid riot limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsns, ro qF - -bon and distance to nearest road. `;t. G TOLX o Parcel i.D. APPLICANT iNFORMA ea enbt Sr i °formation. Personal information 5i#Y►t P t user, s. 15.04 (t) (m)). /3 Z Rbperty Owner -_ 1- O r Property Location Madsen. Raft Q� Govt Lot NW 1/4 SE 1/4 22 T 28 N,R 18 W Property Owner's Mailing A --e L1' - ;s Lot # 1 Block # I Subd. Name 5 G rr Madsen City s =, tale Zfi nelyd - ( I tidy I 1 Vilage hi Town Newt Road y yc ` X 1.'rnruc tcindic River Drive New Construction Use: x epit'leipti umber of bedrooms 3 ''Addition to existing building u Replacement ubl or commercial describe Code Derived daily flow 450 gpd Recommended design loading race .7 bed, gpoltP .8 french, WW Absorp area required 643 bed, fP 562 trench, ff Maximum design loading rate .7 bed, gpd/ff .8 tr ench, WN Recommertded infiltration surface elevabon(s) It (as referred to site putt benchmar Addlfional design / site consideration At grade system Parent material Outwash 1s over bedrx Flood plain elevation, if appkjMe NA It S= SuitaWe for system Conventiunal i Mound I in -Ground Pressure I AT -grade ( system in Fill i l-1 wkv Tank u= Unsuitable for system i ❑ s u S U ❑ s ;� u �; S❑ u ! � s ;� u ❑ S u SOIL DESCRIPTION REPORT Wing# Horizon! �� ! ;; ! ,,.. c. ! Texture !Consistence Boundary 1 Root I GPD/fF a in. muu�r %cu. vc. vvnI. ..n. vc. vi . i3ecf 1 0-19 i Ov. _ In '1...a.1.L ,� '1� 1 ■ 1 � /A '7 J I YIIIJVI� lL � L V rt irl 1 2 19 -36 10yr4 /6 - is 2msbk mvfr cw if .7 Ground 3 36-43 , 7.5yr5 /8 ! - ! is 2msbk i mvfr , cw ! - .7 elev 98.t a !4 3 -50 j 10yr7/8 ! - j BRX I I I I I Depth to I i limiting factor I I I I ! I I l 50 I I ( I I I ! Remarks: 2 1 0-16 I 10yr4/4 - is 2msbk mvfr cw 2f .7 i ■ / , ■ -1— I 3 42 -50 7.5yr5/8 - is 2msbk mvfr cW - 7 _,_.. nor 100.91 k 4 50 -54 10yr7 /8 - BRX I I { Depth to 1 I l I ! I I I limiting I I I I I I I factor 50 Remarks: CST Name (Please Print) Signature: � Telephone No. Thomas C. Nelson 715 -246 -2454 Address Environmental By Design Date CST Number Ref# 1432 120th Strcct, New Richmond, Wq 54017 06/13/2000 227387 300 PROPEFdY OWNER: Madsm Randy SOIL DESCRIPTION REPORT 1 3ff Page 2 of 3 PARCELLI)l Euviimimtal By 2!sig Depth Dominant Moffles Horizon 1 Texture Oonsislerwel, Bounday I Roo. Miff in. Munsell Qu. Sz. Cont Color Gr. Sz. a Bed 1 Trench • 1 0-15 1 Oyr4/4 Is 2msbk MV& cw 2f .7 i .8 3 1 2 1 15 -27 10yr4/6 Is 2msbk mvfr I cw If .7 .8 Giuuiid elev 3 27-46 I 7.5yr5/8 Is I 2msbk nwfr cw 96.34 ft 4 40-50 i 1 Uyr7/8 13-KX Depth to limfflng for 46 Remarks: 1 0-19 1 Oyr4/4 Is I 2msbk mvfr cw I 2f .7 .8 Ground 'I 'lA-A7 7 '�—;/Q 7 Cloy -.. 95.99 ft 4 1 47-50 j 1 Oyr7/9 BRX Depth to limiting -4 factor 47 Remarks: 5 1 04 Is 2msbk mvfr cw 2f .7 .8 2 7-50 10yr4/6 Is I 2msbk mvfr cw 7 .8 Ground elev 3 i 50-54 7yr4/6 BrX 91.66 ft Depth to limiting factor 50 Ground elev Depth to limiting factor Remarks: 1 e Q p F Jbod Coine�Qo�,S ! £.� t! ( �•� t t t f� e t � a r u` c . ✓1 r r t e 12) l 1 r Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites RF r E L ACGbM .... A. Chapters �I, 20' & I of the WasCOnSrtt 1 mi(vRm ellutg Code, tt sotl iosi . ....: 06404 .: r rteeds Yarbexubmitted and approved prior to the tssuance of bniliTliig ... ...... erm(ts iot 18c 2 family ztar ling in j hseuri+dtCttons �vhete lie $tla�v$ton' control pr+crvxonSt LmfoiiAwirUutg Gc�d are enf his E dard:' >Er+ sion: ontrQt 'lan s? ro.... to assist n tia :silos:; : utremetYt s P:<.:;.: ::::... . ..:......:... ...... >s >aiildin ns `: orshave< u:thon :to:::r. uest erastpn ?aintzol lmeasuces: }fact s caYly r utred by:Cadevhn >:: measures::are;deemed= necessa to, meet theodeyovet2ili X . ? standatcl >fkeptnxoti on site. t <<; Con$tzuctlon ro eets that d>stutb more than 5 acres, or are park q �levdlopment t1iaY rl>st rb ?> , .. , .than 5 a . >_ ut ed;::t �btai a .construetton.Sit rtn:wrater ,dtehar Cntt > i' ; te5, ..;::: s0 req [ Q ct _ , .....Q::::; :.::.:.......:: <::: ......... rtaien f:Naturat Re otircds..... ..:... :::::: >:: >: ><::: <;: >:::: <:: >::: >: »:> ::::::::.....::>:>: ::; »:< >:;:::::::::. >::::;;::.:; t.o : :.:.........:.........;: ;.:..:.:.;:.;::,:... :.:.. :..::.:.....:...::::.:::.::.. . .......... _ ... &6 ys's -i/743 CND Applicant: pvjp rylP.A5C/o 6/ -Sao fs Z6 7 (PA6Ni) Name Daytime telephone number Street address, city, zip code �j M &s y S� it 73 00 Landowner. (?n A) i' I ' � A&SGJ — tfZ 6 7 0RG&O Name Daytime telephone number -V9 7 0 As ALE t 4 I ,mot- iv y -l�.v� �� 6 a cF Ae his MAI S 7 7 Street address, city, zip code Location of the building site (complete as appropriate): ix) a) /w 77 uN quarter of Section _ . Town - Range E. Lot Block Q lamp- ©e, K,.vti 4 L l(4u,V<< 7 44 -St- C&O' x Street address Instructions: 1. Complete this plan by filling in requested information, marking (. appropriate boxes, and completing the site diagram. 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. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW - Extension publication Erosion Control for Home Builders can be referred to for assistance in completing this plan. The Wisconsin Uniform Dwelling Code and the Wisconsin _Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266 -3358. Erosion Control for Home Builders (GW0001) can be ordered through Cooperative Extension Publications, 608/262 -3346. 4. Submit this plan at the time of building permit application. ap bones below and co the site diagram with n information: Check (� P l� t7' . CP � Site Characteristics 2( North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. V ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ 1f Location of storm sewer inlets. d The gradient and direction of slopes before grading operations. 0 The gradient and direction of slopes after final grading operations. til Location of existing and proposed buildings and paved areas. ❑ 12( Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices U( ❑ Location of temporary soil storage piles. Note. Although not specifically required by Code, it is recommended that soil storage piles be placed behind a sediment fence or more than 25 feet from any downslope road or drainageway. !� Location of gravel access drive(s). Note. Recommended gravel drive design is 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick Drives should extend from the roadway 50 feet or to the house foundation (which ever is less). e vegetative [� E3 Location of sediment fences (filter fabric fence, straw bale fence) ) or strips that will p revent eroded soil from leaving the site. ❑ ( Location of sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specifically required by Code, it is recommended that concentrated flow ( drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ❑ M3 Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ 13" Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod and rock rip -rap. When used a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area In- channel practices should not be installed in perennial streams. 13 fa' Location of other planned practices not already noted. -Site Diagram - Note: Any base map of useable scale can be substituted for this sheet. Top 01 eA +0 l am, a S po M 0 JU G 4"- F ` 0.t C UU y e (' r AS in r. 5 a ' A � i y 1 ~Y (r, K/ Site Diagram Legend Please indicate north direction PROPERTY SILT LINE FENCE by completing the arrow. ��' -� EXISTING STRAW DRAINAGE BALES -�-- TD TEMPORARY F *ri GRAVEL DIVERSION '"' FINISHED TREE -' DRAINAGE PRESERVATION LIMITS OF STOCKPILED GRADING TOPSOIL VEGETATION 1O SPECIFICATION Scale: AREA 1 inch= / 0 feet Indicate management strategy by checldng (.0 the appropriate box: 40 - 10 O Management Strategies @S ❑ Temporary stabilization of disturbed areas. Note: Although not specifically required by Code, it is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Qf` Permanent stabilization of site by re- vegetation or other means as soon as possible. ❑ ( Use of downspout and/or sump pump outlet extensions. Note: Although not specifically required by Code, it is recommended that)low from downspouts and sump pump outlets be routed to stable areas such as established sod or pavement. ❑ d 'Napping sediment during dewatering operations. Note: Although not specifically required by Code, it is recommended that sediment -laden discharge water from / pumping operations be ponded behind a sediment barrier until most of the sediment settles out p7 Proper disposal of building material waste so that pollutants and debris are not carried off -site. l� Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off-site due to storm events will be cleaned up before the end of the next workday. • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. t hereby certify that T understand the construction site erosion control privistons of 'the W tscbnstn Uniform Dwelling Code, and t- ha[ i accept responsibility for carrying out the b6 ' - s ' plan approved by' the' enforcement a t t atur l` nt Dat P . A publication of the University of Wisconsin - Extension, Ron Struss, UWEX Water Quality Education Specialist (12192). This publication may be freely duplicated Additional copies are available through the UWF.X Environmental Resources Center, 216 Ag Nall, 1450 Linden Drive, Madison, WI, 53706. 6081262 -3652 EROSION C014TROL FOR HOME BUILDERS Preventing Erosion Is Easy Erosion control is important even for home sites of an acre or less. The materials needed are easy to find and relatively inexpensive - -straw bales or silt fence, stakes, gravel, plastic tubes, and grass seed. Putting these materials to use is a straightforward pro - ! cess. Only a few controls are needed on most sites: • Preserving existing trees and grass where possible to pre- vent erosion; �' : °` • Silt fence or straw bales to trap sediment on the down - slope sides of the lot; By controlling erosion, home builders keep our streets • Sod piles located away from any roads or waterways; and waterways clean. • Gravel drive used by all vehicles to limit tracking of mud onto streets; Erosion Is a Costly Problem *Cleanup of sediment carried off -site by vehicles or Eroding construction sites are a leading cause of water storms; quality problems in Wisconsin. For every acre under con - struction, about a dump truck and a half of soil washes • Downspout extenders to prevent erosion from roof into a nearby lake or stream. Problems caused by this sedi- runoff; and ment include: • Revegetating the site as soon as possible. Local taxes — Cleaning up sediment in streets, sewers and ditches adds extra costs to local government budgets. Dredging —The expense of dredging sediment from lakes,' harbors and navigation channels is a heavy burden for taxpayers. Lower property values — Neighboring property values are damaged when a lake or stream fills with sediment. ' Shallow areas encourage weed growth and create boat- ing hazards.` Poor fishing —Muddy water drives kMettles, sh like north- ern pike that rely on sight to feed. sediment smothers gravel beds where fish likouth bass find food and lay their eggs. � 3 r oe x Nuisance growth of weeds and algae — Sediment carries fer- tilizers that fuel algae and weed growth. Erosion Con For Hoi STRAW BALE or SILT FENCE • Put up before any other work is done. • Install on downslope sides of site parallel to contour of land. • Extend ends upslope enough to allow water to pond behind fence. SAMPLE EROSION ' • Bury 8 inches of fabric in trench (see back page) CONTROL PLAN • Stake (2 stakes per bale) FOR 1 OR 2 ® •Leave no FAMILY r \ gaps. Stuff straw between bales or overlap sec- DWEL LIN G S tions of silt fence. \ • Inspect and repair once a week and after every %z inch rain. Remove sediment if deposits reach half the fence i \\ height. Replace bales after 3 months. t \ • Maintain until a lawn is established. \ SOIL PILES \ • Locate away from any downslope street, driveway, \� stream, lake, wetland, ditch or drainageway AREA TO BE TOPSOILED • Temporary seed such as annual rye or winter wheat is SEEDED AND MULCHED recommended for topsoil piles BY OWNER AT THE HOUSE COMPLETION OF I GARAGE CONSTRUCTION (TD TC GRAVEL DRIVE • Install a single access drive using 2 to 3 inch aggregate. • Lay stone 6 inches deep and at least 7 feet wide from \ ` the foundation to the street (or 50 feet if less). To • Use to prevent tracking mud onto the road by all Tc vehicles. �•;� • Maintain throughout construction. R/W LINE SEDIMENT CLEANUP S OIL TYPE: SILTY CLAY STREET NAME • By the end of each work day, sweep or scrape up soil SLOPE: 3% tracked onto the road. • By the end of the next work day after a storm, clean up the soil washed off -site. SEWER INLET PROTECTION ¢' • Protect on -site sewer inlets with straw bales, silt fences i e or equivalent measures (see back page). • Inspect, repair and remove sediment deposits after every storm. ee s n r o DOWNSPOUT EXTENDERS aoe ari • Not required, but highly recommended. ° ! Install as soon as gutters and downspouts are completed n s to prevent erosion. from roof runoff. 1 • Route :water ao a, grassed .or "paved, area. o •F • Maintain'iintil a lawn is established. oI Practices e Sites PRESERVING EXISTING VEGETATION • Wherever possible, preserve existing trees, shrubs, and other vegetation. EROSION • To prevent root damage, do not grade, place soil piles, CONTROL PLAN or park vehicles near trees marked for preservation. LEGEND . Place plastic mesh or snow fence barriers around trees PROPERTY to protect the area below their branches. N LINE 1 • EXISTING �— TOPSOIL — — r DRAINAGE REVEGETATION — TD TEMPORARY DIVERSION Seed, sod or mulch bare soil as soon as possible. _ DRAINAGE FINISHED SWALE - -� DRAINAGE LIMITS OF SEEDING AND MULCHING GRADING • Spread 4 to 6 inches of topsoil. SILT FENCE • Fertilize and lime if needed according to soil test (or apply 10 lb. / 1000 sq. ft. of 10 -10-10 fertilizer). STRAW BALES • Seed with an appropriate mix for the site (see table). GRAVEL o Rake lightly to cover seed with '/4 " of soil. Roll lightly. CONSTRUCTION VEGETATION • Mulch with straw (70 -90 lb. or one bale per 1000 ENTRANCE/EXIT SPECIFICATION sq. AREA • Anchor mulch by punching into the soil, watering or ® TREE by using netting or other measures on steep slopes. PRESERVATION . Water gently every day or two to keep soil moist. Less STOCKPILED watering is needed once grass is 2 inches tall. SOIL SCALE: 1 " = 40' PROJECT LOCATION: SO DDING . EXISTING CURB PROPERTY OWNER: • Spread 4 to 6 inches of topsoil AND GUTTER ANTICIPATED STARTING DATE: * Fertilize n and lime if needed according to soil test (or CONTRACTOR: ANTICIPATED COMPLETION DATE: apply 10 lb./1000 sq. ft of 10 -10-10 fertilizer) PREPARED BY: DATE: - Lightly water the soil • Lay sod. Tamp or roll lightly. * On slopes, lay sod starting at the bottom and work toward the top, overlapping like shingles on a roof. Peg each piece down in several places. • Initial watering should wet soil 6 inches deep (or until 1 water stands 1 inch deep in a straight -sided container). Then water lightly every day or two to keep soil moist . but not saturated for 2 weeks. o If construction is completed after September 15, final seeding or sodding may be delayed. Temporary seed (such as ry a or winter wheat) may be planted until October 15. Mulch or matting may be app lied after. October 15, if : r weather permits. Straw bale or silt fences must be main- �F tained until final seeding or sodding is completed in spring (by June 1). P.. �7 r Sewer °Inlet P rotection � �* �. t. r.�7 N" .� � � . ':' ,y.. Kf , S • d� .`a'..1. , �r�ijr�` -;. �:.: •�' -} �`'•:.5., F7� f_� G:, .�'. � C autions Consider public safety when using inlet barriers. These barriers create ponding and mud deposits on streets. Frequent maintenance is essential. After every storm, remove sediment deposits and repair barriers. Repairs may be needed several times a day during major storms. Curb Inlet 1. Place concrete blocks on their Figure 6 —Curb Inlet Block sides around inlet. and Gravel Barrier Block & Gravel 2. Put a 2" x 4" wood stud through _ _ /—Curb Barrier outer holes of side blocks to support front row of blocks. 3. Put wire mesh with half inch _ openings on outside of blocks. wre me sh Cover mesh with filter fabric & filter fabric Concrete block extending fabric 12 inches onto Gravel filter Runoff pavement. water With over Di water sediment 4. Pile 1 to 3 inch washed gravel on fabric to top of blocks. Sedi ment !:[ 1�''• Note: Allows overflow to prevent Wire mesh 2" x 4" Curb inlet excess ponding. s finer fabric wood stud Drop Inlet 1. Place concrete blocks on their Figure 7 —Drop Inlet Block sides around inlet. Adjust height of and Gravel Barrier Block & Gravel barrier by stacking rows of various wire mesh concrete block sizes of block. afilterV� - - Barrier - y 2. Put wire mesh with half inch `e openings on outside of blocks. Cover mesh with filter fabric extending fabric 12 inches onto _ pavement. Gravel facer 3. Pile 1 to 3 inch washed gravel wat w�, o „ er,,,N, Wire mesh 6 filter fabric Petered water Note: Allows overflow only when water on fabric to top of blocks. sediment - r_ or 4 • reaches top of blocks. Adjust height to t4 ark• prevent traffic hazards or damage to •'y Drop inlet structures. Sediment with grate Drop Inlet 1. Build a frame of 2" x 4" wood Figure 8 —Drop Inlet Filter around inlet. Drive stakes into Fabric Barrier Filter Fabric ground at least 12 inches. 2• x 4' wood frame Barrier 2. Dig an 8 inch deep trench 24• maximum outside frame. 3. Attach wire mesh to frame I extending mesh 2 inches into 12" minimum I ii II trench. l,! U. 4. Attach filter fabric to frame Wire mesh & filter fabric extending fabric at least 8 inches _ ~� into trench. Overlap joint to next overlap ends of fabric stake. S �- between Note: Allows overflow only when water 2 stakes reaches top of frame. Adjust height to 5. Backfill and compact soil in trench. prevent traffic hazards or damage to structures. - -� ZsellE os EYE moi r ! s Straw Bate Figure 2 —How to Install a Straw Bale Fence Fences 1. Excavate a 4" deep trench. 2. Place bales in trench with bind- ings around sides away from the ✓ ground. Leave no gaps between Figure 1 —Cross Section °� �"'� , bales. of Straw Bale Installation! low Bale i• t I I w 1 I• Width Staked and Entrenched l I Straw Bale Binding Wire Compacted Soil to 3. Anchor bales using two steel re- or Twine Prevent Piping bars or 2" x 2" wood stakes per Filtered � i Sediment laden bale. Drive stakes into the ground 4. Backfill and compact the Runoff l Il t I I Runoff at least 8 ". excavated soil. . �� n t � I ;�4� , f - •t gyp. Source: Michigan Soil Erosion and 's Sedimentation Control Guidebook, 1975. Silt Fences Figure 4 —How to Install a Silt Fence 1. Excavate a 4" x 4" trench along 2. Stake the silt fence on downslope Figure 3- -Cross Sections the contour. fabric into the trench. 8" of of Trenches for Silt Fences Filter Fabric a" ru III Flow flow 11 3. When joints are necessary, over - Vtrench j� � I lap ends for the distance between 4. Backfill and compact the two stakes. excavated soil. Filter Fabric • �IIG�a" ►ill i� "1 /�����j i i j Source: North Carolina Erosion and Sediment Control Planning and Design Flow I Flow Manual, 1988. Gravel Entrance 1. Install as soon as possible after Figure 5 —How to Install a Gravel Entrance start of grading. � O 2. Use 2 to 3 inch aggregate stone. Hard surface road 3. Drive must be at least 7 feet wide 5 0' or distance to foundation and 50 feet long or the distance to the foundation, whichever is less. 6" minimum depth 4. Replace as needed to maintain 6 inch depth. s F c _ V . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer fnaos Mailing Address 4J1 70 A ,51f L67' Z-, 4 p i� y ,T�� (�2v�G 6�vtiTC 4 ssa�� Property Address (Verification required from Planning Department for new construction)-_ City /State 1S' a62 1 "4 cLs 6 Parcel Identification Number LEGAL DESCRIPTION Property Location _ %s, 5 , -U V4, Sec. Z Z . T K N -R / FS W, Town of Subdivision , Lot # Certified Survey Map # , Volume .Page # . Warranty Deed # C a `� 7 , Volume Page # Spec house ❑ yes ❑ no Lot lines identifiable [- yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of 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 function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the ou 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 undersigned 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 Wisconsin. Certification stating our septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f three year exp' ' n date. &dNA9JW0F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pe described above, by virtue of a warranty deed recorded in Register of Deeds Office. G FA F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL 1532 FAGE 77 p 627604 KATHLEEN H. WAL.SH Document Number WARRANTY DEED REGISTO OF DEEDS S].. CkOIX CO., WI RECEIVED FOR RECORD This Deed, made between Howard E. Madsen and 06 -03 -2000 9:30 AM Garda M. Madsen, husband and wife, Grantors, and Randal WARRANTY DEED C. Madsen, a married person, Grantee. EXEMPT N 8 Grantors, for a valuable consideration, convey to PERT COPY FEE: COPY FE: Grantee, the following described real estate in St. Croix TRANSFER FEE: County, State of Wisconsin (the "Property'): REGORDINO FEE 10.00 PAGES: I Lot Three (3) of Certified Survey Map filed July 27, 2000, in Vol. 14, Page 3912, as Doc. No. 627161 of Certified Survey Maps, Register of Deeds' office, St. Croix County, Namme a and Retu Address Wisconsin. Located in the Northwest % of the Southeast A C. L. Gay lord of Section 22, T28N, R1 8W, Town of Kinnickinnic. A001ne at Law P.O. Box 46 River Falls. Wt 54022 Part of 022-1064-70-000 (Parcel Identification Number) This is not homestead property. Together with all appurtenant rights, title and interests. Grantors warrant that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, covenants, and rights -of -way of record, if any. Dated this / ' day of _ &gg-sf 2000. (SEAL) sY� / /N/r— (SEAL) 'Howard E. M � - adsen • (SEAL) : c�J � al, f IO LWj (SEAL) •Garda M. Madsen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Perso ally c me before me the / day of authenticated this _ day of , 2000. 2000, the above named Howard E. MadserLdnd Garda M. Madsen to me known to be the persons who executed the foregoing instrument and acknowledge the Signature Sam Type or print name 'Karen V . Engel, Notary Public, Stat If Wisconsin. TITLE: MEMBER STATE BAR OF WISCONSIN I commission expires -1Gt2 (If not, authorized by §706.06, Wis. State -) C/r'�d► N oTAR y t< THIS INSTRUMENT WAS DRAFTED BY _ C. L. Gaylord i ?� parsons signing in any capacity should be typed or Attorney at Law i tkeir signatures. P. O. Box 40 s9J' yea ' River Falls, WI 54022 Fr '"' +'•''' (Signatures may be authenticated or acknowledged. Both are not W15 wry) ......•. INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WISCONSIN 800 - 6552021 I F G27161 CERTIFIED SURVEY MAP Howard Madsen Located in the Northwest 1/4 of the Southeast 1/4 of Section 22, T 28 N, R 18 W, Town of Kinninkinnic, St. Croix County, Wisconsin An erosion control plan will be required by the St. Croix County Zoning Office Prior to construction on this lot. West Quarter Comer Section 22, T 28 N, R 18 W ... N 88'46'46" W 5253.71'... (Found 1" Iron Pips) �` i LOT # fAt. 1316.75- East Quarter comer Vole Section 22,128 N, R 18 W " E 298 y (Found Serntsen Aluminum aI & – – – – Monument) I W e U Pt�TTED IANDS W ■ u �� c 204.74' N u S 88 E _ ,,� 51 3.625 ° 3.825 saes or 1 R. ind. RIW Ems) – W '" o a3 �o Z 470 aces or 1,151 sq. R.(e R/W) w a_ - � N ' 75 " C1l resnd E ppssr i. k l.i!!s >I Vol. 1529, pop Ings Egress �'• ,'`• °' l pe UNPLATTED LANDS 155.95' N �89'40' W W ;�3j% --•, ' 41.94' ' N 88'38'58" rye & 1 154.76' South Line NW 1 /4 -SE 1/4 UNPLATTED LANDS OWNER'S ADDRESS- 1214 River Drive River Falls, Wl. Scale in Feet 1" = 200' L EGE ND 1 0- eo 6 160 260 360 460 Bearings are referenced to the East -West uarter section — re . 0 Indicates V x 24" Iron Pipe Set sN�4er�rre (Min. Wt. -1.13 Ibs./IIn. ft) , ,�`ss ® Section Corner Monument •�,� �� C 0 tv ' s / X10 (as noted) `,• . 10 - --M- -- Indicates Fence ° ••'' m r W MU " y i • ae " S Indicates Soil Boring 113 'Z r r �,,, R FALLS (R = } Recorded As " '.,� tC` wlsc.•,,.• J� ••• D ated: June 19 20 CFO L A D 00 $4A46/9e "` Revised: July 21, 2000 This Instrument Drafted by Mark W. 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Adm. Code Gl-vironmerrtal By 1]esig► Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), dkection and $t. CLQIX percent slope, scale or dimm rs esio, north arrow, and location and distance to nearest road. Parcel LD.# APPLICANT INFORMATION - Please print all information. Date Pars M Mffration yW pravrds may be U&W for se=WWy pu p� (Privacy LaW, S. 15.04 (1) (m)). Property Owner Properly Location MadsM Randy Govt. Lot NW 1/4 SE 1/4 S 22 T 28 N,R 18 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# Madsen City State Zip Code PhoneNumber ❑ City ❑ VIW.ge NTown Nearest Road Kinnicledm is i River Drive New Construction Use: Residential / Number of bedrooms 3 Addition to existing building Replacement ❑ Public or commercial describe Code Derived daily flow 454 gpd Recommended design loading rate •7 bed, gp&1F 8 trench, gp6le Absorption area required 643 bed, W 562 trench, W Maxi num design loading rate •7 bed, gpdr .8 tr ench, gpd Reownmended infiltration surface elevation(s) 96 ft (as referred to site plan benchmar AddMonal design / site consideration At grade system Parent material Out%vash 1s over bedrx Flood plain elevation, if app licable NA ft S= Suitable for system Conventional Mound In-Ground Prere ` AT -Grade j System in Fill Holduig Tank U= Unsuitable for system CIS N u N S❑ u l ssu S H U N S U ❑ S 01.1 ❑ s N U SOIL DESCRIPTION REPORT RAM (& Horizon i �� Dom + Color j �. c Moities n -�... Texture ; Structure !Gonsistencei Boundary Roots , — . . Ii 1. ivrulta4a �KU. vL Wrr4 v~ V1. Va- v■■. 1 0 1 n I lly 1A 1.. '1..+e1.1. ..I..F. 1F 7 Q •f ■ A 1 v - ai I i v ,-u -r r - ,v i a.,aaav,� ,a raa vvi i a.a , ■ 1 2 19 -36 10yr4 /6 - Is 2msbk mvfr cW If 7 8 C Ground 3 36-43 7.5yr5/8 - Is 2msbk mvfr cw - .7 .8 elev 98.16 ft 4 j 43 -50 10yr7/8 _ ( BRX ` Depth to r i limiting factor i 50 Remarks: 2 1 r 0-16 10yr4/4 - is 2msbk mvfr cw r 2f .7 .8 I 2 2 i'ii J i i�rr�Iuc i i ii ! n • Ground I 3 1 42 -50 7.5yr5 /8 I is 2msbk mvfr av - .7 .8 -r-.. WOY 100.91 ft 4 50 -54 10yr7 /8 - BRX i Depth to I I limiting i factor so Rema:is: CST Name (Please Print) Sgnature: Telephone No. Thomas C. Nei," 715 -246 -2454 Address Environmental By Design Date CST Number Ref# 1432 120th Stmxt, Ncw Richmond, W1 54017 003/2000 227387 300 , 4WNER MadsmRand,' SOIL DESCRIPTION REPORT k I.D f —- ]Page 2 of 3 Horizon Depth Dominant Color Euvlr�xu►utul B nom; in. Mansell Qu. Sz Cont Color Texture S nsistencel Boundary Roots GPD/r M. Bed :Trench Z 1 0-15 IOyr4 /4 - Is 2msbk mvfr cw 2f .7 ; .8 L2:: 1 - Is 2msbk mvfr cw if Givumi 7 g I elev 3 27-46 7.5yr5/8 _ I 2msbk mvfr cw _ 7 8 86.34 ft 4 46-50 10yr7/8 _ BRX Depth to f I f i j IltnRing factor I l 46 Remarks: I i I I I 4 1 0-19 1Oyr4/4 - Is 2msbk mv& cw 2f 1 .7 ��/. rrA /l. G roun d bk g ■ Li - JT 1 1 1.1 Llll.) IU�LL VrY 1 LL % .V ■ �w1 N 48 Z 34-47 7 Sy 5 /tt l0 2mo1rL ��. I .7 .8 '''`' ft 4 47 -50 i 1 Oyr7 /8 _ BRX Depth to Wing bcbr 47 4 Remarks: 5 F - 1 1 0-7 10yr4/4 - Is 2msbk mvfr cw 2f 7 8 2 7 -50 1 ' GmMund Oyr4 /6 - Is 2msbk mv& cw .7 .8 i elev 3 50-54 7yr4/6 - Brx 91.66 ft i Depth to Gmiting � factor I I Onm -,.{,n! ■ 1 � ■ 4 , Ground elev I I I , I j I Depth to i !� I I limiting I I factor Remarks: C, h TO (212 tA ?o Z 9 Tie - 3 y -