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024-1031-30-195
Parcel #: 024 - 1031 -30 -000 04/18/2007 02:31 PM PAGE 1 OF 1 Alt. Parcel #: 28.28.17.195 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KOSTERMAN, PAUL R & KRISTIN A PAUL R & KRISTIN A KOSTERMAN 1775 18TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 28 T28N R17W SW NE TOWN- SHIP Block/Condo Bldg: PLEASANT VALLEY. Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 11/04/2002 696955 2033/442 EZ 06/07/2000 624384 1517/98 WD 01/18/1999 595919 1396/361 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/20/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,200 224,300 252,500 NO AGRICULTURAL G4 35.000 4,000 0 4,000 NO UNDEVELOPED G5 3.000 1,200 0 1,200 NO Totals for 2007: General Property 40.000 33,400 224,300 257,700 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 33,400 224,300 257,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 024 - 1032 -40 -000 04/18/2007 02:30 PM PAGE 1 OF 1 Alt. Parcel #: 28.28.17.206 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - KOSTERMAN, PAUL R & KRISTIN A PAUL R & KRISTIN A KOSTERMAN 1775 18TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 28 T 28N R17W NW SE TOWN SHIP Block/Condo Bldg: PLEASANT VALLEY. Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 11/04/2002 696954 2033/441 EZ 06/07/2000 624384 1517/98 WD 01/18/1999 595919 1396/361 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/20/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.000 3,900 0 3,900 NO UNDEVELOPED G5 6.000 2,700 0 2,700 NO Totals for 2007: General Property 40.000 6,600 0 6,600 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 6,600 0 6,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420543 0 GENERAL ( NPORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. + s =Tir'Kre jn; Permit Holder's Name: City Village X Township Parcel Tax No: Kosterman, Paul Pleasant Valley Township 024 - 1031 -30 -195 CST BM Elev: Insp. BM Elev: BM Description: M . � aD . o t CST gw� ( = P UL TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Spa. 80°D J [� o '� a Qf� • r3 Dosing � - `I Alt. BM Aeration Bldg. Sewer C A > Z 1'9 • z( Holding St1Ht Inlet I TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r / \ Dt Bottom lZ• S S 9 ,2 yS I Dosing `i < t < <i) -)E Header /Man. 4. 2-1 r Aeration Dist. Pipe 6o•�S Holding Bot. System t I ( eo •1`o PUMP /SIPHON INFORMATION Final Grade Manufacturer e!t Cttl Demand St Cover GPM 01 -M g 3 Model Number 4-1S -Z H Lift Friction Loss System Head TDH Ft 1 01 2 •qfl � � • So Ie ,8b Forcemain Length Dia. I Dist. to Well 2- 17C. SO ABSORPTION SYSTEM I g.1 5, A y S WC 9EPAPWWH Width I Length I No. Of Trenel. PIT DIMENSIONS o. Of Pits I de Dia. Liquid Depth IMENSIONS g' (1 I b A_ SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manu cturer: INFORMATION CHAMBER OR Type Of System: UNIT l07� �� Cam) N er: DISTRIBUTION SYSTEM 5v -6 *,!_ 3a Header /Manifold Distribution t ,c / x Hole Size x Hole Spacing Vent to Air Intake !/ Pipe(s) t / f l I N Length I Dia Z Length Z Dia I l / Spacing Z -� IE L.�p'�" 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/Trench Center Bed/Trench Edges Topsoil n Yes ] No [] Yes Iii No COMMENTS (Inclu c discrepencies, persons present, etc.) Inspection # :// b In #2: 7 1' Location: 1775018th Ave Hammond, WI 54015 (NW 1/4 SE 1/4 28 T28N R17W) NAQ Parcel No: 28 /��/ 1.) Alt BM Description = S -r. 2.) Bldg sewer length = (p) 7- - amount of cover _\ 3.) Contour - aft. � A Plan revision Required? [iij Yes 1 y,No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildings Division County ` Mfg ME 201 W. Washington Ave., P.O. Box 7162 ST. CROIX isconsin Madison, WI 53707 - 7162 Site Address ,� ,p -- Department of Commerce -.f - L 3�Z7 �- T nn '''' 4 � � Sanita P ermit Num be r Sanitary Permit Application 4205 3 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Q Check if Revision may be used for secondary purposes Privacy Law, sl5. I m I. Application Information - Please Print All Information x State Plan I.D. Number TRANS. ID# 797514 Property Owner's Name P;< el Number PAUL KOSTERMAN Property Owner's Mailing Address a P petty Location r/! 500 ETNA STREET #204 v...__,......._.._ - u SE u. S 28 T 28 N R 17W City, State Zip Code Phone Number Lot Number Block Nuralpr VIA ST. PAUL MN 55106 651/774 -8177 Subdivisi Name CSMNumber A)14 H. Type of Building (check all that apply) J s 6� ❑City 1 or 2 Family Dwelling - Number of Bedrooms 4 ❑Village 0 Public /Co 7117 -AP-1 l - Describe Use township PLEASANT VALLEY ❑ State Own "' / Nearest Road t kl D` �.O �IZ So !i _ 18TH AVENUE M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ® New 2 ❑ Replacement System 3 11 Replacement of 6 C1 Addition to .. For County use System Tank Onl Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) JE Ct `k2o 44 ❑ Non - Pressurized In- Ground 2110 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dis ersaMeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation 600 600 600 1 N/A 100.0 101.93 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1280 - 1280 1 WIESER CONCRETE X Dosing Chamber 800 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's Signature MP/MPRS Number Business Phone Number ENNIE HELGESON 2 1 715/772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII. County /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge F e) ❑ Owner Given Initial Adverse. / / Determination IX. Conditions of Appro easons for Disapproval '( • �} .vim - �C ` ��►S `�. del .S Q 1. is l J&A�L .:e- �,o -►�� . Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 tubes In size >: SBD}639 OSIOW 1 PL -- $ _ - (R ) i J ,r a o a 7E o r� s o � m �i h L t � 66 a t y � J 1 ui a J � NJ • Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Nvisconsin www.commerce.statemi.us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 24, 2002 CUST 1D No.220292 ATTN: PO WTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W 1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/24/2004 Identification Numbers Transaction ID No. 797514 SITE: Site ID No. 652130 Paul Kosterman Please refer to both identification numbers, 18TH Avenue above, in all correspondence with the agency. Town of Pleasant Valley St Croix County NW1 /4, SEI /4, S28, T28N, R17W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 875857 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Conditio chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: APPRC General Approval Requirements: DEPARTMENT OF OF S ETY • This system is to be constructed and located in accordance with the enclosed approved plans and with the > "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD -105 - SEE CpRRESi (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal P P P are prohibited. • The pump chosen for the design is at the limits of its capacity. If the total dynamic head is calculated to be g Y higher, at the time of construction, a pump that meets or exceeds the system flow will need to be installed. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat • Comm 83.22(7) 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. BENNIE W HELGESON Page 2 10/24/02 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $; 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 INDEX SHEET PROPERTY OWNER: PAUL KOSTERMAN �F 500 ETNA STREET #204 QC C FA ST. PAUL, MN 55106 -4A � ?o d �� Fjy s PROJECT NAME: PAUL KOSTERMAN 0$4 �� ° �s PROJECT LOCATION: NW 1/4, SE 1/4, S 28, T 28 N, R 17 W MUNICIPALITY: TOWN OF PLEASANT VALLEY • COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Wally Page 4: Septic Tank & Pump Chamber Cross Section & Specifications YED Page 5 W1280/800-MR Tank Specifications p DDMUERCE B DINGS Page 6 Pump Specifications 'ONDENC Page 7 POWTS Owner's Manual & Management Plan - Pg. 1 Page 8 POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed oe Address: WI229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: October 7, 2002 S »bd n � 00 � a 2 u sQ is } v I to o +� 0 i O� G )t �) n � i cA -�� �, e_r ►'yt cx r� - -- Page D f f� Synthetic Covering Distribution Pipe ASTM c 33 ?3 Medium Sand _ G Topsoil _ :H- �-�.�= F _J I D 3 E / S % Slope Plowed CEL�.Of 2�— 2 i Force Main From Pump Layer Aggregate D / Ft. E A `/ Ft. Cross Section Of A Mound F .93 Ft. G , S Ft. A Ft. H �_ Ft. Signed: B 7-5 Ft. License Number: K fl Ft. L _Zl,.?Ft. Date: j 0 /,,) Ft. T , 7 Ft. W Ft. L_ Observation Pipe A I +� ------- - - - - -- ---- - - - - -- - - -- - -- --- 1 . w - �Dis t ribut ion E5l_I- Of Pipe Aggregate Observation Pipe Plan View Of Mound • � � Yl � a!' �CCl a , l�G � �' YY1 rX. h T G �J D f Ea.o� fi Porlorolod Pipe Daloll �' {S✓ C ea" Ov-) / End View Perlorolyd r PVC Pipt End jAj Holes Located on Bottom are Equally Spaced R •1 �ieie �JQJ 4d ItIll-' 9-1 / Q 04111bullon..• Pip, Distribution Pipe Layout p �2 0 .,� 1 R S x Y a Hole Diameter , Inch Signed: 1 Lateral " _ Inch (es) License Number: Manifold " _ Inches Dace: Force Main " _Inches — ,t,) VERRT I e�. ioal t ,lE s Pet - 4 �r6 d y ti9µvv-,6 'ev O L4to' Page-4 - Of L $ V o i F>�' U STG SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS MIN . ABOVE GRADE E WEATHERPROOF u ?LK VENT PIPE 12 JUNCTION BOX APPROVED 2:25 FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E 4 s� WARNING LABEL FINISHED GRADE r 4" MIN. 18" IN.WE INLET WATER TIGHT SEALS ppPROVED A JOINTS WITH F 1 LT ER _ �_ ALM APPROVED PIPE APPROVED ZAg5I_ B ' ON 3' ONTO PIPE 3' (a "'' — I — , SOLID SOIL ONTO SOLID C I SOIL PUMP OFF ELEV .G�I'. —I— OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC 1 DOSE Y, S fQ� 7 (504 TANK MANUFACTURER : t�i ese�- T ��C� GAL. DOSE VOLUME INCLUDING S GAL. TANK SIZES: SEPTIC C DOSE _�, GAL. �- :I.`�'FLOWBACK: /o LARM MANUFACTURER: �y_��F`��" CAPACITIES: A = I��i INCHES = 5/0/ GAL• A 2 INCHES = GAL• MODEL NUMBER +� l 1� / ate B = SWITCH TYPE: ^/�.rr'��r --, C = �_ INCHES = ��J GAL. PUMP MANUFACTURER: GAL• MODEL NUMBER : �� ��o « t' D = INCHES = / , SWITCH TYPE: %�.. REQUIRED DISCHARGE RATE 411. GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • FEET ' + MINIMUM NETWORK SUPPLY PRESSURE . • FEET + �_ FEET FORCEMAIN X (� FT /100 FT. FRICTION FACTOR EET HEAD _ F • WIDTH ; DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQUID SIGNED: LICENSE NUMBER: DATE: 1/88 i a f D CL Z w \ i CL. F 0 CIO CL U- a L Ir L) D V) CY _ J H W � LO a\ z W V• In V 3 M ° WC-) O_ Ye F- F= a - �j? U �p oUW O C� F-- O a O H vv Q CC f/f FQ; �f 0 co a.. N N L U p \� Q 0o �NO t� Q Q V Q Q <n H ° ro w j LLJ O U O ° m O CL jl 0m coo = Z N O Q co - LLJ _ \O°d F mW� MN Z� N Q (n N I ;n ° :7 ° 0 1- Q f- N < M °° O 3: c=i 00 N Me ��'t — C) NN O Q J m til co ? M J.. .. J .. wf' Za' C) cn x N W j Z Z_j °�xS��O —_O �mVI � Q ° N� ZQ Q Waooaw °w° a:r0 a�° ° Z ��a P° f— o3mc��x��m� ° cn W t- ° NC O o Z N a Z Z =3 J OH N D 0 W O0N Z S W W w OMQ Z "£� . M --- - - -1-► -- -- I i \♦ I y � 1 1 ' 1 I " 9* I I I I I I I r l a' J 4. 1 � -- M O m i w jli I w .A In I W P I 1 1 I I I , U I �' m . I I I I . I 1 i I . 1 1 1 � .1 •1 •I i 1 • H "�S TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING o✓ MODEL 152/153 _ _ -__ -. w MOD[ L 152 153 Ui �� _ 50 Feet Meters Col. Liters Gol. Liters 153 5 1.5 69 261 77 291 12 40 10 3.1 61 231 70 265 152 0 15 4.6 53 201 61 231 U 20 6.1 44 167 52 197 30 � 25 7.6 34 129 42 159 1 8 30 9.1 23 87 33 125 20 35 10.7 -- -- 22 85 D• 40 12.2 11 42 4 Lock Volve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 014506 0 20 4 60 80 100 GALLONS �. ?2 LITERS 6 1/4 0 80 160 240 320 3 27/32 4 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. 9 P 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase i systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. 1521153 Series 12 1/8 1521153 MODELS Control Selection Model Volts -Ph Mode Amps Simplex I Duplex 5 1 /8 115 1 Non 8.5 1 2 or 3 BN15 BN152 115 1 Auto 8.5 Included 2 or 3 SQ054 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 1 115 1 Non 10.5 1 2 or 3 8NIS31 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 1 30 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. O CAUTION 2. See FM0712 for correct model of Electrical Altemator E•Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 Z Louisville, KY 40256 -0347 Manufacturers of. . O SHIP T0: 3649 Cane Run Road o Louisville, KY 40211-1961 QuRwr rp�,.� ,SS,verXFI9 • (502) 778.2731.1(800) 928 -PUMP httpYAvww.zooller com f'L/mig z0 FAX (502) 774.3624 ® Copyright 2001 Zoeller Co. All rights reserved. . r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION SYSTEM SPECIFICATIONS PAUL KOSTERIv1AN Septic Tank Capacity 1280 al ❑ NA [ owner Septic Tank Manufacturer WIESER CONCRETE❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL ❑ NA 4 ❑ NA Effluent Filter Model A -100 12" x 20"[3 NA Number of Bedrooms Number of Commercial Units 11 NA P ump Tank Capacity 800 gal ❑ NA Estimated flow (average) 400 gal /day Pump Tank Manufacturer WIESER CONCRETED NA Design now (peak), (Estimated x 1.5) 600 gal/day . Pump Manufacturer ZOELLER PUMPCO ❑ NA Soil Application Rate 0.5 aVda /ftz Pump Model 152 [3 NA Influent/Effluent Quality Monthly average* Pretreatment Unit [2 NA ❑ Sand/Czrave{ Filter ❑Peat Filter Fats, Oil &Grease (FOG) 530 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- ground (gravity) ❑ In- ground (pressurized) ❑ At -grade I� Mound Total Suspended Solids (TSS) 530mg /L ❑ D ❑ Other Fecal Coliform (geometric mean) s10 , cfu /100m1 Maximum Effluent Particle Size Y Inch diameter m Values typical for domestic (non- comercJal) wastewater and septic tank effluent. •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every 2 ❑months Q year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months q year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ❑ months . q year(s) Inspectpump, pump controls & alarm At least once every 1 ❑ months IR year(s) ❑ NA Flush laterals and pressure test At least once every 3 ❑ months Q year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatipment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by'a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. OWNER: PAUL KOSTERMAN a Page 8 of 8 System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer, to controls to restore normal levels within the um assist in manually operating the pump co pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONKMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. 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 properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN in measures have been If the POWTS fails and cannot be repaired the following , or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction, and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to est ablish a sultabie replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances In POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. identify a suitable replacement area. Upon failure of the e POWTS a soil and • The site has not been evaluated to id fy p p site i 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. f& Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative 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 NOT 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 POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Name JOHNSON SANITAT Phone 715/772 -3278 E Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Agency ST'. CROIX COUNTY ZONING Phone 1 Phone 715/273 -5811 P 715 386 -4b80 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets ;he minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2101) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3 Uvision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach'compfete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County C.�Za LX include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 02 Y — ! 0 Z — L l o Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1U r L ��O S71ZTtM Prt j 6oat-1 et M w 1/4 S E 114 S Z,? T Z$ N R E (o W Property Owner's Mailing Address Lot # i Block # Subd. Name or CSM# Soo riv)'a ST, If= 'z0`f — -- City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ST- PPN L M iv Ss10L ( l sl) Z -SSZ P _. LS New Construction Use: ® Residential / Number of bedrooms 5 Code derived design flow rate GPD i ❑ Replacement ❑ Public or commercial - Describe: Parent material _ G L f�.Lpri- _MLA_ Flood Plain elevation if applicabl ft, General comments and recommendations: r'1�VYVfl 1 6 '- 1ZS ' ZjLS`T1ZL 8U`flUl�l L'CZL. `c-) MJPJLw UKI 6 `r or S F ILL sT Boring Boring 9 .. •. s pit Ground surface elev. q. ft, Depth to limiting factor S S in. iS it A W6ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots " _ GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o_ti L o�lrz3t s l �b� � t m . 6 v�P,r• � Z VL -So lfs'-1 n- 316 — s I L c,Sb1� wt v c w • y • b 3 56 -SS '_1.S — 1 o S9 rnv`f eS _ •Z 1. 2 ❑ Boring # Boring Z ® pit Ground surface elev. G o ft. Depth to limiting factor 8 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o -I.Z 1o�23�z � s I leshlz ► e-w - .�( .6 Z tZ -�o to�rZ31� — s L�sbk VK V - ct _ • �{ -� 3 10 -I eSb12 m vd' CS • L/ w \1 8 N Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) igna re CST Number Arthur L. Wegerer 0l'c.7 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, WI 54022 ol 715 -425 -0165 Property Owner Parcel ID # Z — 3 Z —L413— Page Z of F-1 3 Boring # ❑ Boring ® Pit Ground surface elev. L OU. S ft, Depth to limiting factor L 4 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 o - tZ l��rZ 31 z - S i - . g , $ . �s m �►- ew - , s . a 3 33 -�z �•S�irZ31 - S � ` �sb� mv�H- cs - •� . � 41 oy lz S1-3 - 1 •S yt2 S l g s i C- o �. , � .0 a Boring # ❑ Boring ® pit Ground surface elev. S - S ft. Depth to limiting factor in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 10`1 3 L Z. - � L I Z`FS lalz Vv� Ck , Z 10 -30 I O�IIZ 31 b S l t Z� Sb1•t h9'� Cw 3 3 @ -3 7 -31 'Pw - •sy2 SAN S) eshk. y N - l0`T fZ S !3 fl C p — . p 10 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD 130 mg/L and TSS < 30 mg1L 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. SBD -8330 (R.6100) PLOT PLAN Pacre 3 of 3 Scale 1' c-T' "T 0 Iz ° s -1' am *j 'a Cr- 8MrrZ O R- L a V,41, GS • z3 `� � _ — ° �_ �o No eompffpvr OR I LOO :o'.onj gR.wcg 31 D1A_ Pve PtpE > I o 4oL Nit S -IZ - O► 715- 425 -0165 220254 CST Signature Date Telephone 1-do. CST No. Job No. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page � of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Y — Mease print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ? f Vi L ��0 STZTLJL11 I GOYL— et NLJ 1/4 5 1/4 S Z ,? T Z $ N R Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# S 00 Lf - MiYZ� 57, 11� ' Y - _ — City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ST- n�vL ► Sslo6 I ( BSI ) Zg0 -S5 At�-EY Tj+- il�vL, New Construction Use: ® Residential / Number of bedrooms 5 Code derived design flow rate — 1 S (3 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material CEi L Pce L'Pct. TL l.L Flood Plain elevation if applicable g General comments and recommendations: 'N1QVW_sZ) In.1 / b'k LZS wl )rvLwtut� 6 ` nr— s PrXV F1 L-L Q"1. S Boring # ❑ Boring pit Ground surface elev. _ q. q j. ft. Depth to limiting factor S5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell ' • Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 o -L IonR -3t-. - s) L�b� mV .� • 6 2 1't So tp�-t rZ 316 - s ► l 0 sbh m vii- c • y- 5b - S 1. •S 'trz- 31 y — L g O 39 `MV' e S _ • `Z 1. 2 y Ss - I 2s1 C (N h,, mfr - .Z .o Boring # ❑ g ® pit Ground surface elev. C T fL Depth to limiting factor ' 8 p in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o - lZ YZMTz -3 L Z _ s I Les z VYL V'flt^ ec.1 , q _6 CLj 3 L- o Z �s � 1 `t R31 -- a t eSb12 n1 VA- CS L/ 2 S 231 S O S9 ►� \ - .:-Z L. z r \1 UQ N ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BCD, : 5 30 mg/L and TSS < 30 mg/L CST Name (Please Print) igna re CST Number Arthur L. Wegerer 01 '0.7 220254 Address W e g e r e r Soil T e s t i n¢& Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, WI 54022 715 -425 -0165 Property Owner r� EZ h' A N Parcel ID # 0 2 4 — 3 Z — Page of 3 Boring # ❑ Boring ® Pit Ground surface elev. LQ V , S ft. Depth to limiting factor L4 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 33 -L12 ki r2- 3)y bk vnv cS — .L4 , b y2_[, S r'�Ll 2 S13 S per. �' _ Ll . p S — h Boring # F Boring ® Pit Ground surface elev. S - S ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ( 3— I'D toll iZ 3 It — S L I 7.S r231 'Fly 1•SyR. 3 A S) V ctbiL )n t4 .b y 3y -�7 I aIf rZ S 13 C o yvt _ . o , o F-1 Boring # ❑ Boring G ❑ Pit round surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 BOD > 30 < _220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 — 6 _ mg/L and TSS < 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. SBD -8330 ( R.6I00) I y PLOT PLAN Page 3 of 3 ► Scale 1' =Sp ' La 7+ RUE 0 e -3 4i1LZ Lc B .r� Sm* t�111 �o`fNN of qs ��� by tior CAwl.pfseT QR . - DIS'R�2� �lS Af2.C'A. pt pE wl - - -- S�M2 q - t 5 � - -- - -- - _ - - - -- o(. S - - 715 -425 -0165 220254 �tM1 1 o1-q-7 CST Signature Date Telephone ITo. CST No. Job N OCT -02 -02 01:25 PM P.06 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C G S ° r w► Mailing Address ��� t �v� �f X09 (J2 7e3p w Property Address ��`� / 0 /'N F nd•v0 W-1 L 6 f (Verification required from Planning Department for now construction) City /State Parcel Identification Number �a- 1 { L'ECIA.L DESCRIPTIQ property Location N L ' /., Z5 %., Sec., TEEN - /7 W, Town of /� �� ►�� �� ��� Subdivision AJ 1R , Lot #• 1 Certified Survey Map # , Volume . Page # - Warranty Deed # <o,?t - , volume -, Page # Spec house Cl 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 malataataae consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. Wbat you put into the sY*m can affect the fanetion 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 cortMeation form, signed by the owner tad by • mastcr plumber, journeyman plumber, restricted plumber or a licensed punmper verifying d at (1) the on site wtatewatordigxmd symm is in proper operating condition and/or (2) after inspection and pumping (if necessary) the septic tank is less than 1/3 mill of 111140. Uwe, the undersigned have road the above requirements and agree to maintain the private sewage disposal system with the tWtditds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State Of Wlscortsia. Carddc9 sti stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office widds 30 days of a three year expiration date. ,� ' ���� �, 10 t SI dt- SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are taste to the best of my (our) knowledge. I (we) am (are) the Owamt(s) of the pro" desen'bo above, by virtue of a warranty deed recorded in Register of Deeds Office. l/ (' 1 2 51 o .! SIGNATURE OF APPLICANT DATE "•'•• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •••o" •' Include with this application: a stamped warranty daed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed vuL 1517 FAGE 98 oocuMCrir NO. WARRANTY DEED STATE I3AR OF WISCONSIN FOAM 2 —hies 624384 KATHLEEN H. WALSH REGISTER OF DEEDS !I ST. CROIX CO., WI RECEIVEI FOR RECORD it ........................................................................... ............................... Michael, J. and Barbas a L. L1+nskeY. husband 06 -07 -2000 1:30 AN II .... .............................................................. ............................... I EMIPT II OEID ' conveys and warrants to .... .BI l . !.. K0gtA man and OT CO FEEt Kristin...A...ifoat�rnialre .bt and. vi ,Ci..dS..]R6� .... .......... TLVM FEES 444.00 tenants. RECORDING ..... REC FEE: 10.00 ..................................... ............................... .................................................................................. ............................... n 6 P—k •4H.., +� S �S nAv:S R +x is A —1 'Ala sv - r the following described real estate in .... § .... ......................C State Of Wisconsin: iIAIP Tax Parcel No: 024� 1631- 430 i SW} of NE} and NW} of SE}, ALL in Section 28 -28 -17 � This ............ ` } homestead property. (is) is noy Exception to warranties: Datedthis .......................... day of . .............. ........... f ty.................................... ......... .........................(SEAL) ...... .. ............................... .........................(SEAL) • /��C • .....�i. .. ... Michael Barbara L. Lynskey ....... ......... ..................... (SEAL) (SEAL) • . AUTBBNTICATION AQBNOWLBDOMENT Minnesota Signature(s) ............................. ............................... ' STATE OF W11114"iSH9 ........................................ ............................... Washington } I� .............. ........................County. authenticated this ........day of ........................... 19...... Personally came before me this ..... 4. � -.`........day of X ............... Es:. 0DOLhe &bore named �I ...................................... ............................... JI'nske Ly Michael J. L and Barbara L. skey!l. .husband and wife ' ... .................... TITLE: MEMBER STATE BAR OF WISCONSIN .............. .............................. ... ............................... (If not .............................. ............................... ................................................. ............................... authorized by 1 706.06, Wis. State.) to me known to be the person .- -......... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY I� Ptecision Closersr Inc. . ...................... ........... 931s'Rttrt2r'Shcsre Drive .............................. •............. .Ct... :....4�.x�ir.n,.......... t1l.Ylntlk..hill.� .� ............. ............................... Notary Public ..... Wa. ......gtO Count sc. (Signatures may be authenticated or acknowledged. Both My Commission is ermanent. (If not, state expiration a» not necessary.) date: ... AAAA�4AAA XlOi........) _._.._ _..... - - -WALEN •Name rat Paso's slaaine In any capadty should M t'�t typed or priaMd bdon their sianalur uv -noin: • Minnesota _ My uanmissioIl Emms WW WS' Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in acc iW S. ILHR 83.09, Wis. Adm. Code ounty i ` t /, C Attach complete site plan on paper not less than 8 inches in ize. ce poi direction p l � include, but not limited to: vertical and horizontal on and• �/1 , S percent slope, scale or dimensions, north arrow, / lion o nearest'road. Parcel I.D. APPLICANT INFORMATION - Pleas pil�nt all it Reviewed by Date Personal information you provide may be used for seco r� Urposes s. 15.04. {i)- (qi)). V l (C(Il Property Owner ti rty Location cc)) C Caw` p i ..J: vt. Lot Aj LO 1/4 SE 1/4,S g T _2 b .N,R 7 E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# '?o l00 1 r Ci I State Zip Code Phone Number ❑ Ci ❑ Village Town Nearest Road nor �k �� SS37a, ( ) �sQ't a) / LY7q , 14 (x, New Construction Use: EJ Residential / Number of bedrooms J Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd / Recommended design loading rate S bed, gpd/ft f ( O trench, gpd1fl Absorption area required 32.5 ed, ft —�7S trench, ft Maximum design loading rate • S bed, gpd/ft L trench, gpd/ft Recommended infiltration surface elevation(s) lcr t o ft (as referred to site plan benchmark) Additional designtsite considerations 4_ S 6 ,r 7S "&_1�11 y Parent material Hood plain elevation, if applicable S = Suitable for system Conventional M M ou - - In -Ground Pressure AT -Grade System In Fill Holding Tank U = Unsuitable for system ❑ S [91*6 [a's 1:1 U El S CK� El S [V ❑ S 0-1 ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fl2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh Bed , Trench 13 �/ 1©' _5 i– CeS lv 5 �o a - S rt Ground _ c Lk v y � r 7 ;+`ao o� vC' b ki, , S Depth to limiting fact r in. Remarks: _ °'� I z `^ ha S S i C' o� �S (mac �S Boring # 66 S 13 G �k " Co Ground �elev. /��it• , Depth to limiting factor �_in. Remarks: n O n I1 C.' S S� 6 t\ - �- �-t CS�TISNMe (Please Print) Si alure Te ephone No. 2 e sew-- - Address Date CST Number W �� �� 7, PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench cts C 5 Ground 3 - o J � elev. :+ 3 P r 5� �1 �ft - 4loYrt 5 Int Depth to limiting ; factor Remarks [0 �ca Boring # C�i - la Sb vvt 'S Lk vri 3W elev.nd C� S' to c C Depth to limiting factor Lin. Remarks: • Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Murisell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # El t i) L) Ground O y !2 C c (M S u r 7 D elev. Depth to limiting factor Remarks: Boring # to a IOC =� ' I f 0 K r/ 3 Ground elev. — ft. Depth to limiting factor • /rte in. Remarks: SBD -8330 (R. 07/96) � A , C)c��o� �I i �xce�Pt �{s •��o�� M • I X00. ©C) �. Tod o� t poc �, p ✓1 �1 00, 4S- t o d k I " poi- P ►° � I, C Orr i I L B•M �� �I g , �l�v . 99- • f�t pc�.cQ Av -c, Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page of 3 F of Safety and Buildings Bureau of Integrated Services Cinacc I R 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 Ian most, County p /� Include, but not limited to: vertical and horizontal � and tance trYf res percent slope, scale or dimensions, north arrow, t ,- Parcel I.D. # APPLICANT INFORMATION - Please p � Reviewed by Date Personal information you provide grey be used for secondas. 15.04 (1 Property Owner A ,d"Ky Location c� TeCkv� p rp Lot U) 1 /4 1/4,S g T.�b .N,R f'7 E (or) W Property Owners Mailing Address Lot # Block# rubd. Name or CSM# G State Zip Code Phone Number El Ci El Village Town Nearest Road �nor �.k M� j 5537), ) P e�sd_�&- -f aI 1 /Fl th /{v, New Construction Use: EReskientlal / Number of bedrooms 3 ? Addition to existing building ❑ Replacement El Public or commercial - Describe: Code derived daily flow �� gpd Recommended design loading rate bed, gpd/f1 trench, gpd/ft� Absorption area required _ bed, ft ft Maximum design loading rate _ bed, gpd*_ trench, gpd* Recommended infiltration surface elevado n(s) on 9 lah a` �' ft (as referred to site plan benchmark) Additional design/site considerations llf< 11� 6 /X 715 / ':?-i Parent material S� dL�f- �' Flood plain elevation, if applicable S = Suitable for system Convenes �Mou In- Ground Pressure AT -Grade System in Fill Holding Tank ,.--, La S ❑ U ❑ S 0 ❑ S 2"f ❑ S M E: S U � Unsuitable for system ❑ S Lod' u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure Op In. Munsetl Qu. Sz. Cont.'Color . Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench I _31I.- h - CAS v 5 61 Ground r / c rev. Depth to limiting fai . yG. Remarks K a I zo v. 4f �a S S i OGJ S Boring # 3 l b-ro o � ; � r►-t -�►- 3► a o 66 S s bk Ground 9 O fL Depth to , limiting II factor q h G 5 S C Ft 6 +� �� �_in. Remarks: 1- drl�o'� ' CST me (Please Print) Si ature Te ephone No. W ele , s0 4(1- -- Address 1 Date CST Number saq 20 iH PROPERTY OWNER y � � '^ac o6sa SOIL DESCRIPTION REPORT Page ::� of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench L j 1 0 -1/ 1 olk CS lak , S , 1 1 - 1 q io YK y �'j I Ground 3 � p K % elev. - ,K P g — tt - I ow, 5 �7 Depth to limiting factor lgf Remarks: � ( int=i- el Boring # a aai s.' I- s .� 3 �� o � Ground _ S vr� 3W _ elev. 1 2 ft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Murisell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ^/O �,� h Li 1r) \1 re Ground u r G� elev. 7, s e p Depth to limiting factor In Remarks: Boring # o w y b O Ground elev. = — f L Depth to limiting factor ) Remarks: SBD -8330 (R. 07/86) . 'I a 0 c ' 1 Top c k Ol t - " " Puc P'.PZ qS or To o�c pocPpoa C crh L i Coh`f"a- r elev.qq -� 61 Ni o- r are a-