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HomeMy WebLinkAbout026-1143-70-000 ,a,... neFa7,»a:•::,f : „Te:" PRIVATE SEWAGE SYSTEM d• d Eulla St. Croix INSPECTION REPORT Sa` ta•y Per+n' No GENERAL INFORMATION 'ATTACH TO PEf2talrr 615356 gate r~ian iJ No. ~ -.i:' :ai '1c•^,.LC" vcu Frog tlc ma' - _^,.r1 `c- 5eo:nutay F' v,ex IPri:a y Law, s. I PC r 1 HUtlea `Ja'ne C:I'i Villag? 1:nnrhip 'a L'?' fox No Oevering Homes TOWN OF RICHMOND 026-1143-70-000 CST EL, E e. 'nsp GA` E a: R`d C?srr _I r. SecLCN'a.:nrRanger Map No .10 r r. - 20.30.18.1048 TANK INFORMATION ELEVATION DATA T"' L t."I\lC:I HER CADA~'IY STATIOt, PS III FS LL Fv Sc:r.m enchniark aJ 1000 ~ O 0 q. 1753'R1D-- M~ Cj 1~ Y Alt Bt! IMar><w( L6 X00. A=•alian uldq 'sev'er l Ic .ring SUI It Ined Sa l.LI TANK SETBACK INFORMATION SVfIt Oullet O 0 ENK RL 'dbF;L BLDG 'de^I In,Alr lnta<a ROAD I`Inlel lc 4 yr lr 1 U Sotto 1 ~I Ilea. rlh'an. (n Aeration U sc Pip2 30 30! Syslon• 1 4 n - PUMPISIPHON INFORMATION rinalGrade z l V2 !nanufad;cer I•~ Y SI ;;ose• ff ;;I'DA MQrIFO 52.5 o,tnnel Numt:n F Sf. TDH _41 rnet cr SNslem Head TD" Ft T~ oS- oA V70 L xcemn :;la ,y~ to •,;c„ 1-7.75 SOIL ABSORPTION SYSTEM BED.I NENCH :vitl:h I.-;; P' f1J. G hoc PIT DIMENSIONS\ : Of =,5 m:: c1o C a. I u1u Dc:Ah lz~ DIID NSIONS SETBACK SYST=Id 10 INFORMATION If•,KF13'RGila1 LEACHING Idanula ].:c:r. Tv If daLr• r CHAMBER OR (1F~~'~EO l~ ,'I' V-WAX . I nM ~ UNIT `~hwc Nu itt2• III 1~' DISTRIBUTION SYSTEM "I ~ CJl^/ t 1 y" ;:r. rl"an'dl: Ci ra Fp _L+ x Hvlr• Sizc r H. e a:•u¢ • -P J "ent h: A' n I n 7, Jia_ Lc 9 h_ ila CC,unq_ SOIL COVER X Pressure Systoms Only xx Mound Or At-Grade Systems Only .e II, 1 ',a:l t cr -el.h Df et :e;lr$odOCtl sx 1.1_:•ea 3-J' : •Ie• ie:.' r v: Jan: I :':nn ~ZI I Vn;. NO res D!~ COMMENTS: !lncLd:: Code d'saepeVCcS persr.rs present, etc.; Insper.'nn ar Irmedion 42. Location: 1049 1441 H AVL -'N~.I1A'N 7iAh B`d Desc•i:,t or 2 l B cg sewer lenq:n = 3D{i C70.eX~ f V YIOI~ 15 QC~y~- y 3~ 1- - amount of rove- - L yZ ir` hla•1 v son Requr:•c'> Yes N. On 1 Use cll er side for "mll rral infonr. 'on. ~1 l _ I •Y`,y'r 5 -,r _ _ I~ -y-`~rtl~ SEL 5 3r'J:) Ja:e . ~ ~ grslne 5)9f,-acl`I ~ ~ r I 9 I~ 1 t Szety a nu 3.:i.3tngs Dilsiur Sri r<~ps - I( 201W Washington .Ave Box oo/ .,anieen Permit Numi+w ilc he'.Iltti in by Co r F;~ Madisw. vrl ?70 r ,62 1,~3~;1 S ; , ~ , (a 15 3 S (P I I Sanitary Permit ppllc Sse'f a umber tt actodm N;ID .1'b a~ V, - ,1.:m. codc. 1 :d. I -1 III !.Ire. die apprgm v. in u a>d unn A- U ¢ymr :l pn:. t.c ohtl➢¢'li a 'a;.t. rv nma. Nu:c. I ; ti re Yrrm: Sic stax-avTCd P:iFTS we sabr j=d w, to:rei kddr¢S ;d d:ficram man nai:am aualns<i ~ '¢.hn ~mn )sr11 m1 L1t~.[I r \c 1 P Ii.lalmaun`oe p'cs i.ic tnm Fc loci for sn'ondul 1'IPCS['t W 14.L):[ NlJ F llyti~ 1 I II n t t1.~~ ( Applto3¢ul lnforinanrn Pie «e Print All lnfot nation 0 I n,TKa'y r'N'1r 1 Nan N .u:! ,rmpem CraneYa bfaAm Ad lnvs I ryrrn' Wcati~m Q • O , , 8 • 1 0-1 p 'cv. State 7, 'c . hU;iC N=" L Secu:zl v Ntxjj~ ~l fl Type of Building Ichtrk all That apply) f.rcn J N. P e. r`w vnuly )veilta %i I.e. o!Lkaroom ..SUbdowsmn bK BIB ~l/C"l cQ1J~ (S J 5 b[i JN`ICd c D~ ')c ,'-Inc I use )eza'vr al L.-J I ((P--- - - l III. Type - ICheck only o he box on line A. Complete line]; 11 applicable! { 1 - I I 1 Nec. Syauzn _ Kcplae I 1: \vl:rn ❑ 1rC3Gb^n dT .-K Rcplaremcn, <Wv L ;;rd14 Modi:iewim t; laorag Sys o 1 Perini: Nmnbr atsi :he :csuni -J R. ! v u; He¢rval Pnuut dalnnt I r' .:n.ut;•c - L:n.hI:I . ! } <-rr . I':as+ler tc \rv.. LicePrrviaus It 1 cc YPCat1L%1 I '1w➢C - ( I 1 3~ - ~r1-` r 1V 'f~pe of POU'?S1~jtem'Cnmpwirnt'T ice (Check all that applv I 5 L _ Vo 7 naaa r .n < rounu _ i' r. 1 rt< J 'ir'>LL' J r\bC m ! ~d. nl :4 M. of ciilable "J ❑ bt,,und ?44 in. of roiablc mil 5o mutt , sLk ! : (nFc )spersal l ul,.zlrnl ecp.ai,) ❑ h=cabacm Ucviw iez in 1 f a _ - - y V. DispcraabTrrat eof A>'_ea Information, ~ I,v lid, )1>"'n A Appii m:m Ka gpdsf,. - Di:p. .ui \ Rrq.'V c I P; ercjal A;n pi %..ec{' Jynrn n1r, ,a L r♦^~ii//t-~``J 66(4 O It VT. Tank Info C.aaavy is :ai x I htanufat-^ur. 1 t>a.kms aJcw T.L- 3 u r~ - n r 'r„ 'epo<.x H 11 n., /.yy^ - 11. Responsibilih Statement I, the uaderi~ne i i ass respl ntibda• for i¢.uitation of the POWTS shovo on the attached plans, i k'llrnocr s'.amc Pnnti 'AmF \{y \~{'~~un~ ~mcs: phanc~~~ I w:otrcr 1.0.Jatcs. (NVect i th'. CiWy. 71~ .,ndei \'_111 Crum V rDepartmrol l.s.Onlr - ~i.•..a:mr N ,{pproscJ I ,Tpanppt•n-t , _ '<.rmr F„^ Dan L ~eC _q-- L ns~. ,no 1 iy'~ ~.snc.,•rc i ~~+1 n t n at S Sdo IX. CondltSslSIva1rR'eason> for Disapproval 1. Sepl'~I Ir n.t ,3> ~L/Q1GtQ, w~-C A'C~/ O:,p.r . I s r IIr / is per ..,amen p L lue i ur plwntw. '4~ 2. Ad 1Kabw:k recuter:^enss mo.IaA w traftit.91 Li . per PXdcW9 cab! 1:116uxltF. I - 1[u:L to :nmVlrrc Plain iyr dv, 1111m aud>ubmit w the Cuule) oalr M paper oat b> 16an N t9 x l l iaM1R w sue 1 S3U-ti 398 tit i JI : t ' S\':tem PLU I PRO-IEC-T Oevenna ^Iones 4IH)RESS 1 1?,; Cernohos 4v,t NaN: RICnr ixid 'eA'i J40 N~ 1 a SL1' I aN 20 rr N,'It TO44'N Bch one COCNTI CROIX, SYSTIN F:I.E4'ATION 94.5'P4-.:r ~,gIOY: araaF T) 4"P F 6'23 '9 BEDROOM - CON4'ENTIONAE CON\ENTIOSAI. ILIA HoEnnc LANK ~;1G -;a' onR 1,I1'1 LANK SIZE DOSE. 1AN'R SIZ,L 1%u,onD Lf,II JL \ti SI/I HOLDING 'FAST: SIZL LOAD RA 11, ABSORP'T'ION AREA 6`1 k nI chambers r.,~ L 66 RENCHNIARE. N.R.P. 1 D~ Df 1 4'rBibur 4SSUN L EL.E4 01ON LOW Filter L.IimmI I-i'.fi- ~ BOREHOLE ~ t4-t<LI- H.R.P. 82"Yc a, bP-r ChYri9'r. Scale = 1/4" = 10' pre I3cd-r,om L-I'l Sc S7 Fi a 66' cells ~aii space:, Q~CIA- ve-,t I 4 OwcO Stan i)rd r "r Slr.~c L , niP..i t halnhcl xvith'_O.U Area I ~ 6i~'''_irdlr J evil Caps l _ Q;ijt: at Svste:n Elevation : 4.. s 1) r,- tifalI t ySTv9 IR 3p,1 i ur_ -LT d I?' Yrorert\ Line ai "\9 f *'!+1 .11 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/20/19 Owner:Oevering Homes Location: NE1/4 SW1/4 S20 T30N,R18W 1049 144th ave Richmond Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and ontigency Plan 7. Filter Cross Secl Signature! License number 9226900 I Svstcm PLOT PLAN PROJECT Ooverino Homes ADDRESS 1433 Cemohous Ave New Ricnrnora Wi 540!7 NE 114 SW 1146 20 !'1' 30 N/R 18 v1 'IOwN Hichmond COUNTY ST. CROIX SYSrErvl ELEVATION 94.5+•94.0 5' below Grade DATE 61Ml9 11EDRDATE CONVTNTIUNAL XXK COMI•:NTIONAL LIFT HOLDING TANK NIUh ND tilil'TIC "LINK SIZE 1000 gallons 1.111 TANK SIZE DOSE TANK SIZE; HOLDING TANK SIZE L():\D I4LA'17i .7 415SORI'TION AREA 651 # of chambers none- 3 Z- BENCHMARK Y.R.P. fop of 1A" robar :%SSt1ME; E:LEYATION 11111' Filter Lifeinne Filler ❑ BOREHOLE: O same as benchmark Scale = 1/4" = 10' 144th avc Pro 3 Bcdroo» 1 House. 1 ST 180 20' 50' ) B-5 1-0 B_4 66' cells with spacing Vent 10' Qoick4 Standard 35'. Slope '6.. Leaching Chamber B-3 of Cover w1( ith 20.0 112 of Area 5.6ft^2/pair of end caps Vents 4' Long 1 , Grade at Svs[em Elevation 15 34 B 30 All piping shall be ASTN1 SDR 3013.1, within 493' Properly Line B-1 10' of tank. piping shall he ASThI F891 20' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of .Area per Chamber To be >1' above grade 5.611^2 pair of end plates Finish grade elevation Typical Installation 99.5' Vern / Vent Grade 3' 3 X30'34 Septic Tank i' [.on- t 5' S' Lung 1 Grade :u S_vStcm t-Ac ;won z6` Gradc atSv~iem I.Icvalion Spacing- 5' 2-3 X66' Cells Same on other end Observation tube/Vent At end of cell A B 16 chambers per cell System elevations: A 94.5' B 94.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pagel of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Scptic'ark Capacity DNA Perm;tit Septic Iank Manufacturer ~ O NA DESIGN PARAMETERS Effluent Filter Manufacturer ~fj --C_/ 0 NA Number of Bedrooms ❑ NA -tf'Iuent Filter Model El NA Number of Public Facility Units -,L NA Pump Tank Capacity -I- gall NA Estimated flow (average) ~aUdav PornpTank Manufacturer Design flow (peak), (Estimated x 1.5) v oaUdav Pump Man,ifacturer Sod Application Rate ga rd, rw; Pump Model Standard Influent/Effluent Quality Monthly average" Pretreatment Unit - 0 NA, Fats, Oi: & Grease (FOG) X30 mg1L U Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) 420 n l 1 NA C1 Mechanical Aeration C Welland : Iota[ Suspended Solids (TSSj 5150 mg!:. 0 Disinfection O Other Pretreated Effluent Quality Monthly average Dis eaai Cell(s) 0 NA Biochemical Oxygen Demand (BOD,) 530 mgll. Zn-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L U At-Grade 0 Mound Fecal Coliform (geometric mean) •<10' GV1 100ml 0 Drip-Line 0 Other: Maximum Effluent Particle Size !k in oia 0 A ane1' D \A Other. Other. NA !.1 NA 'Values typical for domestic wastewater and septic tank effluent. lobar L NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tanks-~ 0 month(s) At loss: once every: (Maximum 3 years) DNA Pump out contents of tank(s) When combined sludge and scum equals one-third (h) of tank volume ❑ NA ns ect dispersal cell s` . 0 month(s) P (r Ateast once every: ~ (Maximum 3 years) ❑ NA ~Iean effluent filter At least once every: C month(s) ❑ NA - - - - EJ-Xear(s) _ aspect pump, pump controls & alarm At least once every: ❑ month(s) ) - - - - ❑ year(s) - - - ~ =lush laterals and pressure test :A least once every: 0 month(s) NA n years) 9ther: - 0 month(s) least once every C year(s)- - NA Other. - - NP.~ MAINTENANCE INSTRUCTIONS nspections of tanks and dispersal cells shat, be made by an inuividual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; PON/TS rnspectm: POVrrS Mainta nec Septage Servicing Operator. Tank irspecbons ni include a visual inspection of the tank(s) to Aenlify any missing or broken t,ardware, identify any cracks or leaks, measure the volume of :ombined sludge and scum and to check for any Lack uu or poraing of effluent on the ground surface. The dispersal cell(s) shall he visually inspected to chock the effluent levels in the observation pipes ano to check for any ponding of effluent on the ground surface. The pending of effluent on the ground surface may indicate a `ailing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any lank equals one-third or more of the tank volume, the entire contents of he tank shah be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin (Administrative Code. All other services, rncuudmq out not limited to he servicing of effluent filters, mecnanical or pressurized components, pretreatment units. and any servicing at intervals of -;12 montits, shall be :.rtiomted oy a certified POWTS Maintainer. A. service report shall be provided to the local regulatory aotno-.orr. :•nthm 10 nays of completion of any service event. Page of START UP AND OPERATION pro duds or off Chemicals that For new eds trea prior pr use a~P O m~ th treatment s). Ifh~ concentrations are detected have the contents of the may impede the e treatment process tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when sal conditions are frozen at the infiltafive surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b . to surface resdw;har" of toring normal swill be discharged to the dispersal cep(s) in one large dose, overloading the cell(s) and may result in the backup or r to tnt To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior rPowel levees effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore within the pump tank. disturb or complld the area within Do not drive or park Vehicles over tanks and oispersal cells. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS, antibiotics; baby wipes; cigarette buts; condoms; cotton swabs; degreasers; dental f oqW diapers: dis'rdedants, fat: foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; paining products; Pesticides; sanitary napkins: tampons; and water softener brine. ABANDONMENT When the POW TS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is prope` y and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Serwrang Operator. • Actor pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fined with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code complid replacement system: ;16° suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to prated the replacement area wit result in the need area. Replacement systems must comply with the rules in for a new soil and site evaluation to establish a suitable replacenherht effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infilhative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. Do O ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS R POWTS INSTALLER 1 MRame Name / - Phone I) ( ~~I h ING OPERATOR PU ER LOCAL REGULATORY AUTHO TTY SEPTAGE SERVIC Name Name _ _ ^ Phone - Phone = 96 p This doaarherr was drafted in compliance wah chapter SPS 383.22(2)(b)(`)(d)S(f) and 383.Kl), (2) 8 (3), Wisconsin Adnlnfatialive Code. Y~ v IU II ~ INjD alga f f; ,l to Y~ 4 \ p~ \ l ~ I \ N dT I I ST. CROIX COUNTY SEPTIC T NK MAINTENANCE. AGR}iL(M1;NT AND OWNLRS}-tip CERITFICAI'ION FORM Owner/Buyer _ c/lip ✓l' lt,i _ ~r'- - - Mailing Address PropertyAddreas^ A)Y . --//-Zt (Vcrificabon required rr~ latminE • & (amiu U - - - - - g. eP' t Lill new conslntction.) - - ityiState- Parcel Identification Number Q 6 ~I y3 7 LEGAL, DESCRIPTION '14 , tier 1,ocatiort&F-H N R I Sy, 'I'owa of ' '130 Subdivision t- Lets KJ - - Lot # _7_ Certified Survey Map # _ - ' - - - - ,Volume-- page 9~ Warranty Deed tf L U ed ~ - - _ _Page # _ Spec house Cs no l.ed bras tdenlifabl `ye..• no - - SYSTEM r1IAINTF,NAN(:I+; AND OVVA'ER CERTIMCATION Itnproper use and asnatenance of,yo" sgaic'syslero could result in its prculaurle faiturc to lmndlc wastrs. Proper l imullenauce Consists of -pumping out tyre scpuc tank ever y three years or suonct, it ueeried, by a licensed putrgrar- Whal yell put trite [he system call affect the function of the septic tans; as a treatnrrnt stage on the waste drsposai system. Owner mamlcnance rosponsibihhcs arc specified ill §Cuawr. 83.'i2(1) and m Chapter f 2 - `:t. Ctui, (:urtnty Sanitary(-)rdLuance. "fhc property owner agrees to submit io St. Croix Couut v lanumK & Zoning Department a certification form, signed by the owtua ;uvl by a master plmnhcr, jottrneyvran plunraer; resL*icted phrtnbet or a lirensed pntrtper verttging lira[ nc~ trio-sne :wastewater disposal systern is in proper operating condition and/or (2) after inspection and pumping (it'necessary), the septic tank is less than 1/3 full of sludge. llwe, the undersigned have read the above tequorcrocnts and agece to maintaue the private. sewage disposal system with the standards set totth, hersol, as set by the Departuren[ of ( *onartercr will the Department ol"Naurtal Rmuurccs, State of Wisconsin. Ce.affication stating that your septic system has been maintained must be completed and retained to the St Croix County Planning & Lotting Dep"nout within 30 days of the three year cxpirafion date. f/we certify that all stalenrents on this fytrn arc inac to the best of ary/our knowledge. live audate the owner(s) of the property described above, by vu life of a wain y deed recorded in Register of 1)cetts Office. 7 Number of bedrooms v J..<_._ 6 . IUNA'f f O-r APPI,I('ANT(S) DATE ""Any inlbrmation that is rrtisrcpiesented may result in rlic sanitary permit being revokcd by die planning & Zoning Department. I rcludr. with this application a recorded warranty deed front the Regiacr of I teals Ofhex arid a copy of the, certified survey trial) it reference is made in tlw war Canty deed. (REV. 08/05) Cg Li S88°23'30'W 344.41' TOWN ROA N88°234300E 344.41' C9 Op. ca- So "o - - - - - - Tl.32 _ S,- So 0.95 u, I w w MIN FFE = 941 Jam.. j~ LOT8~ .OT 5 I I LO-~7 ) 2.463 ACRES 42 ACRES I 0 (107 304 SQ.FT.) 51 SO. Fr.) :ANDER LINE m ( 1.500 TOTAL ACRES D ACRES 06 I o (55.360 SO. FT.) O.H.W.M. a i 3 1.880 ACRES TO MEANDER LINE LOT 6 1 N (9, ,&76 s0. Fr) ti TOTAL T) - t' 1.861 ACRES I 1.735 ACRES (81,081 SQ. FT.) I (75,568 o I TO MEANDER IMIN FFE = 941.4 r / 0`~2i' ~((~~(e FE = 939.6 ,a MIN FFE = 939.6 I f I z 165.Oa 061 96. (31 t] 223.09' 13391 L16 (sat Ramr_~ -:im rm u i..ecy::.inirn.c l [L. I I-I ~Z I ~ ` I r Y f h C I ~I 111 III u_!r:_'u : pz 5iil;] I IBC 1 l w w f,' ~i ~ I i E3 I n„ I f ~ IJ u-. ~ I I I ilk ~I L r n;cr. .v: ` 1111 f 1 7 ii I y.. ' C_. . _ 1 ~I ~ i6 jF~-~ _ . 1 ` t i i' r ~ ~U.. ,:f 1 f.~ 2' i, ~I 1 ~ I5 ^ R ~ r X416 iy~~ S: ~I~ I ' I ~ 1. E ~I E~ I i I I t4 14 vnut, oraa1e ~ ic, ,i _ , 1 1 l ~ I J I II l J/f II I , r , W ' L ♦ I it r r i II i ~ lrl _ . anvou owxi.ial" vna'nu , i t twdou :v., l 1 11 ih t is +r ~ ~1`. c € t 1 1 E'ia r r:I t8; ~i!~ ~ , I ;I 1: t y Y t E{ ~~r t a Ih ,I !G III` fi ~ It i~l, iii. ` k r ~ ~ ~ I IT E it ~ ~ gg L n u~ ~ 4 3 6 1 I t " tr t i - - ° L~ k u'1 r t L { \ F 1 ' n. u ~ k Nl Wisconsin DjKr-rnt of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1J S l' . Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must county cnoiv - include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. JJ _ - .CC° percent slope, scale or dimensions, north arrow, and location and distance to nearest road Please print all information. Reviewed bj~l Date Personal mnormaeon you povide may be used for secondary purposes (Privacy law. s. 15.04 (1) (m)). /)S Property Owner Property Location ~1'j d(M a _ Govt Lot ,I i- 1/4 114 S T ° ;aC N R 1 1 E (ori Property Owners Mailing Address Lot # Block # Subd. Name or CSM# /r, y 398 k a O {-f / Y)eaa LL s City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road New Construction Use Q Residential / Number of bedrooms - Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material - ' c , j, Flood Plain elevation if applicable General comments { yy~ E- I and recommendations/' C o-o- yLi~r~2.~ (-~tr~le ~ o'~~c1 [<.CC- ~Z~d 1~.t0.~ 1 J 1U~0 I Boring # E] Boring G © pit Ground surface elev. ~17• (.OO ft. Depth to limiting factor //D in. _ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound Roofs GPDHF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef#F1 'Eff#2 J o-8 10 r ~3 - S; I Z I~•~ . 5 . $ 3 0 fy mS O mI - 7 !•Z Ong # ❑ Boring ® Pit Ground surtaceelev. 99-,-V)ft. Depth to limiting factor IZI in. _ SaN Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in Munsell _ Qu. Sz. Cont. Color Gr. Sz_. Sh. 'EfWl •EN#2 6-13 I 13 S;l 2 k Z /3- I - s 2 L - az - m5 0:sq m► - .7 !•2 ! Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD c 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signature CST Number - h/.l fl -~1<' I L _ S CI Address Date Evaluation Conducted Telephone Number propertyOwner ` 9 . _ Parcel ID # - Page L of, 3 Boring # Bonng ® Fit Ground surfaceelev. ca 7c{./Q It. Depth to limiting factor lGg in Horizon Depth Dominant Cob Redox Description Texture re Consistence Boundary jd?T Stiudu a in. Munaell Go. Sz. Cont Color GrSz. Sh. 5fl 2C- ll - a Boring # Boring o, rfaceelev. y9, so it Depth to limiting factor a in. pit Ground su Sod Mcatan Rate Horizon Depth Dominant Color Redox Description Texture Structure Cortsistence Boundary Roots GPDHP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C v~ 5 I r 3 Z k Q-TCr 3 • a-ng D ryllp U - - 2 Boring # ~nn Bonng if D S• Sd ft. Depth to limiting factor in. La pit Ground surface elev. Soil lication Rate Boundary Roots GP Horizon Depth Dominant Color Redox Description Texture Structure Consistence in. Munsell Qu. Sz. Cont. Color Gc_Sz. Sh. 'Eff# Eff#2 ~g 04L313 c IvC 5 B 51 k rrT,r C._ 5 8 Effluent #1 = BOD, > 30 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mglL The Department of<:ommerce 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 TIN 608-264-8777. SNU-63 OMW-L"! Page of Owner Parcel ID # - Property - .Z i Boning # Bonng G Irrr---~ I ® Pit Ground surface elev. ft. Depth to Ivnitirg factor JQg in- -Soil Nua6on Rat-e~1 I nonzon Depth Dominant Cobra Redox Descnptton Texture Structure Consistence, Boundary Roots GPD/ff in. Munsell I Ou. Sz- Cont. Color Gr Sz. Sh- 'EW Eff#2 t I Q-I /D 3 2rr) rrt~r cS v~ 5 i - z I (qtly 5r' 4 - 4t, ry"I 3 - L)5 mf - ? I.2 ~ ti Z i I Bonng # U Boning p~ __J ® pit Ground surface elev. L/'~. SO It. Depth to limiting factor ! d_ M. 1 Soil A k-;anon Rate Horizon Depth Dominant Color Redox Descnpbon Texture Structure Consistence Boundary ! Roots GPDIff in. Munsell Qu Sz. Cont Color Gr Sz. Sh. 'Eff#1 •Eff#2 2 )1- IGyi ' I 3 a-fIg 1D r yllL - G Z Fr) S /I I I r._j Boning ~D h Bonng # I Ground surface elev_ g• SCJ it Depth to lvnibng factor m.. 11 11 pit Soil Nation Rate Honzon Depth Dominant Cobr Redox Descnphon Texture Structure Consistence BoundaryRoots GPD/ff ~in. Munsell Ou. Sz- Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -I9 L` 313 _ Si) 12~k~ ~c c 1 vC 5 Z ~p 5~ k c - 5 8 I I I ~ _ E--7 Effluent #1 = BOO. > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 - BOO, < 30 mg1L and TSS < 31) mg/L The I)epartment 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. $an5.1 +i~ 1R ti I.UUi rf PA(;L_3OF VA\1L: (Jal6 t~ LOW{ 7 I.F:(;AL DI:SCRII' I IONi(/E 'a?'.S OL V Itl F, ur SCAIA : F- (90 - - l3M I LLLVA'PIOK ~~(j•y R\4 I DF.SCRIP'I]ON •tpP p~ y Q,i,pc. r_ FM 2 GLLVAIION Q 9, z C~T_ _ z D 13N12L)LSCRIPTION409 n-> jg- Qe}xk r I SYSLF.M11 L.I.1'.VATION 16,Co x ALII-.RNATF.F.LLVA1'ION q y'(6 - I CONTOUR FLL:VATION Q g~„S'p 3 I I ~ c A I al 5~ • I I ~i gn2 SIGNAIUKf MAIL I I I I I LLJ 0 N ~ a Jrc fLVI i t V ~l - ~71 W `,r i .ti `-Q ~Q . Q II LL m \ t r t e -1,71 aG.,,~pS ~ N .88•S9b, ~ 4 7 a` ~ ~ ~ az rr e ~ s 40 w U. 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