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HomeMy WebLinkAbout026-1141-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and "Building Division. INSPECTION REPORT sanitary Permit No: • 420626 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Richmond Township 026- 1141 -23 -000 CST BM Elev: Insp. BM Elev: BM Description: (t) e) 1 D &10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic l O &6 1 Benchmark ,, Q ld -- /00 - Dosing Alt. BM Aeration �� . Bldg. Sewer rZ low H g S Ht Inlet y.� a (! Ht Outlet TANK SETBACK INFORMATION Y 90 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic G( / Dt Bottom osing Header /Man. Aerati Dist. Pipe Holding Bot. System n t PUMP /SIPHON INFORMATION Final Grade acturer Demand St Cover GPM Model Number TDH Lift ction Loss System Hea TDH F For in Length Dia. I Dist. to Well SOIL ABSORPTION SYSTEM t7 4—LL/I BEDITRENCH Width r Length jNo.Of renches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 2--5', SETBACK SYSTEM TO I P/L JBIDG IWELL LAKE /STREAM L G Ma (acturer INFORMATION C MB OR 1 Type Of System: /fit U Mod I Numbe _� DISTRIBUTION SYSTEM 30' Header /Manifold Distribution / x Hole x Hole Spacing Vent to Air Intake / rt Pipes) p/ y l� c� �� ( �' ) Length LI Dia Length a I �� Di �� Spacing__[ _ ` —� SOIL COVER x Pressure Systems Only xx Moun Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 /2 / Inspection #2: Location: 1168 121st Ave New Richmond, WI 54017 (SW 1/4 E /4 33 T30N R18W) Duck Pond Es Lot 23 Parcel No: 33.30.18.1027 1.) Alt BM Description = 1 •�w wt lI a4 2.) Bldg sewer length = 70' r(sttWA� µ ( � 5.�, S - amount of cover " 6�9 SC►v ez �b 6 J �a5� CN .f7er r k r. IaIQ 1 t` h i S �9 3Z �(eo , / v , � AJ 7 t&— P inS�1/far lr. P .�Jd-_ w. r I . Plan revision Required? Yes No Use other side for additional information. Z 3Q 1 A7 Date Insepctor s i nat �y Cart. No. SBD -6710 (R.3/97) \ 'C /� �� utr+— Swl(� hCl7 `t / . XG ' Safety and Buildings Division Cry 201 W. Washington Ave., P.O. Box 7162 , Visc6nsin Madison, Wl 53707 - 7162 Site Address eif Department of Commerce z3 r)Z— / S m g 1 2 l A j& . Sanitary Permit Applicatio `''°" N umb" In accord with Comm 83.21, Wis. Adm. code, Ian Y '"`��+E� VE if Re si h 2 may W used for secondary purposes Priv Law s15. m L Application Information - Please Print All Information Plan I.D. Number Property owner's Name DE Number /I ST. CROIX COUNTY T ov, - 4' - Z3" Mb 1 aclll E I Location Property Owner's Mailing Address �C), ) p� (�/ if u ;S �' N.R A City, State Zip Code Phone Number L otl4umber Block Number N a do ' ' ion N CSM Number \ U. Type of Building (&C& su that IVA') � � 5 OCiny 2 Family Dwelling - Number of Bedrooms v Dye ❑ Public/Commercial - Describe Use �n" ❑ State Owned Nearest Road UL Type of Permit: (Check only one box on line A (numbering schmle for internal use). Complete line B if applicable) Ar 2 0 Replacement System 3 0 Replacement of 6 0 Addition to For County use Tank B. 0 Check if Sanitary Permit Previously Issued permit Number leoe i ssued 7 No. of Permit: (Check all that apply)(numbering scheme is for internal use) - Preswrized ht-Ground 210 Mound 47 0 Saud Filter 50 0 Constructed W 22 0 Pressurized In -Gm%md 410 Holding Tank 48 0 Single Pass 510 Drip Line o - C9 45 0 Ant -Grade 46 0 Aerobic Treatment Unit 49 0 Recircu aft 30 0 Other V. Area Information: D Flow ( Dhpersal Area Dispersal Area Soil Application Percolation Rate System Final Grade Required Proposed Rate(Gals.MayslSq.R.) (Min✓lnch) �' 5 90, / l Elevation I ,V/ Sf )? 11 0 VL Tank Info Capacity in Total Number Mamifitcturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Esistnug Tanks Tmft zy� Seput or Hotd"mg Tack �� 7 boft Cbaober J VII, Responsibility Statement- L, the responsibility for imtallatiou of the POWTS shown on the attached plans. C = ��s Name (Print) - Plumber' � � N umber � � ✓`� �_ phmber's Address (Street, City, State. ) � ,/� /�d�:/L✓ ���/L /C ���' -� � � �" VIII. Use Only y � APPovrd ❑ Disappmved Sanitary Permit Fox (includes Groundwater Date Ltsued lssumgAgent Signature (No Sumps) I Surcharge Fee) 0 Owner Given Initial Adverse 12 1�� /pZ Determination IS. , � , Conditions of PProvaU�te�s�� ppro�l rD Tt ,t nack eo®Pa¢e ph= 00 the Counq may) for the s item an paper not kqdlm sln : u hKber to size SBD-6398 (R. 05101) 5�� ! tu�� PLOf PLA PROJECT P.C. Colloya Bldrs. Inc. DDRE P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1/4S 33 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/15/02 BEDROOM 3 CONVENTIONAL XX)C IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 IL BENCHMARK V.R.P Top of Power Box I : ASSUME ELEVATION low: Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTE VATION 90.5/90.1/89.7 4' Below Grade Alt. BM = Top of Telephone Box @ 99.6' lans Designed Using �--� entional Powts Man Version 2.0 u 4% Slope � B-3� 25' ter f Dr ' e Easement 30' V ents tss d' 0 Ven , B -2 f 15 �� B-1 3 -3' X 82' Cells >3' pacing 45' >10' t 30' 30' 46' P 6 ' "t 50 ' 10 0 , Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long �— 3 4" Grade at System Elevation N B. 121st. Ave i PL PLA LA PROJECT P.C. Collova Bldrs. I nc. DDRE P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1/4s 33 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/15/02 BEDROOM 3 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 BENCHMARK V.R.P Top of Power Box 3M* ^ ASSUME ELEVATION LQD!- Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTE VATION 90.5/90.1/89.7 4' Below Grade Alt. BM Top of Telephone Box @ 99.6' lans Designed Using r entional Powts Man Version 2.0 a� >, 4% ` � ~ L Slope 3 �� 25 , ter f Drai a Easement 0' -/ 20' V ents Vents 0' B -2 15' 30 3-3'X 82' Cells >3' Spacing 45' >10' T 30' 46' Pro 3 Bedroom 6' House 50' 100' Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11 " -- �- Grade at System Elevation 3 4 1 Lk* Alt. B. 121st. Ave tl%vcxinsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code county Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan Froad. ' indude, but not limited to: vertical and horizontal reference point (BM), direction b percent slope, scale or dimensions, north arrow, and location and distance to ne Please print all information. Reviewed by Date Personal inform f l ation you provide may be used for secondary Purposes (Privacy Law, s. 15. �02 02— Property Owner /� r Prop rtyLoM 1 CO (�• Go S T N E( W Property CWnees Mailing Address Lot # Block # 0 3 City State Zip Code Phone Number ❑City ❑ 2e wn Nearest Roa Zkow �S`oPl T( ) ,C Construction Use; Residential I Number of bedrooms Code derived design flow rate - Q GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ��1,i'� Flood Plain elevation if a plicable General cominents e� y'�3P� and recommendations: zZ Boring # Boring L7j �- Pit Ground surface ele J J . ft. Depth to limiting factor in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sr- Sh. •Eff#1 •Eff#2 Z 1 � 3v �s f 3 Boring �8 # Boling Pit Ground surface slew. /' v ft. Depth to limiting factor l/ in. Sod Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •042 .s . 3 �-8 Effluent #1 = BO > 3o < 220 mwt- and T < 150 mglL • Effluent #2 = BOD < 30 mg/- and TTSSS 130 rng/L CST � ('Please Print gnature Address to Evaluation Conducted Telephone Number R y i J Property Owner Parcel ID # Page 2 of 3 ® Boring # •� pit Ground surface slay. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 eJ F cot Boris # ❑ Bow ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # C] Boring 11 Pit Ground surface slay. ft. Depth to limiting factor in. " Sal Awpoication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 Effluent #1 = BOD, > 30 < 220 nV/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L d The Department of Commerce is an equal opportunity s e rvice provider der an 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. SOD -8330 (8.600) P 3 Soil Test Plot Plan 3 Project Name P.C. Collova Bldrs. Inc. Shau d Address P.O. Box 489 Somerset Wi 54025 #226900 Lot 23 Subdivision Duck Pond Date 12/12/02 SW 1/4 SE 1/4S 33 T 30 N /13 W Township Richmond [] Boring Well PL Property Line County ST. CROIX kL 0 BM or VRP Assume Elevation 100 ft. Top of Power Box System Elevation 90.5/90.1/89.7' *HRPSame as Benchmark Alt, BM Top of Telephone Box @ 99.6' a 4% o B-3 Slope 25' enter of Drainage Easement 30' r - ' o � 3 20' 0' B -1 85 B- 9 15' 45' D 4 , 94' ' A� 6 Pro 3 Bedroom 6' House 50' 100' * Alt. B. 121st. Ave I Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent fitter is to be cleaned once a year. Please note: a larger fitter is being installed in order to extend the maintenance interval of the fitter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system falls, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900\ I I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P O Box 489 Somerset, WI 54025 Property Address S � 6LC (Ver required from Planning Department for new construction) City/State � t.� �iA c C 1� e WT Parcel Identification Number 02b - IN - 1 2 1 - " OZ - 7 LEGAL DESCRIPTION Property Locatior (-2N %,, Sec. T _I&W, Town of Subdivision � � Lot # 6_.� Certified Survey Map # _�-� / Volume , Page # Warranty Deed # 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 masterplumber, journeyman plumber, restdcted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. I/we, 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiratio SIGNATURE OF 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 r property described above, by A of a arranty deed recorded in Register of Deeds Office. 1. w P ` r / /1 SIGNATURE OF APPLIC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. r� ** 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 FROM P C Cot I nup BURS, INC PHONE N0. : 715 5 5911 Nov. 16 2001 0' --': M tM PI rAIr.3ARUFWtSCUMINFUMM2.1"ll K Q=44 -- H N3t9 1 • WARRANTY DEED REGISTER OF DEEPS y e St CRV U Co. , IdI This Dead, autde letvreen Kenncsh L. BL*,rn and YuUlleen B. R=.Y B FM AEt'ORD Brava, Ilusbaad Dad Wire —� 0�•I8 -c0"1 1:45 AN �aatlatTr cEa —�_ EA �T 1 Grantor, and P. C• Collova nuiiders. Inc M-CWT FEE! Clay qr! ,; =M FEE- 521. ° REMIYB FLL, 10 Ocantae. Grantor, For a valuable eonsidaatico, corveys and WUM1113 to L' n Grinttee the follovin; dmitcd ml C512to in S1. C. ois T}� CountT, Stxk of Wiswttain, u : rrc +n AtH 4.ma and vn ,Davla 1. F - Areen That port of SE Il4 $1V 1i4 and SAN 1/4 SF 1/4 Scc. 3'ri 0�' -R131V deaerioai 304 Lxast St. as follows: Lots 1, 2 and : of Cartitiad Survey i•1 9 reeerdsJ in t /ol. ; of i Iuclton, WT ;aC t6 C-cttifieci SUrvny T.1aps, page 1698 as loc. Nil. 50"'S91. v tY'i $L Croix Catan•, Wlaconabt 020-1 GYrco cx10.'1:c tv5ur+,o-zva. 0 iC96•10.000 Fwcci Nowncation NuMra iPt:l) T ois � net hotnest :d properly. (is+ (is not) i Exzcptiora to rtr-smiest Sxsting hirhwa! !, r. uemcnts A ri3itis ni may of rcro ;d. I Catcd thir : I " day of .Awril Not . iCcnneth L. 3r otvlr v 1 KAthicca B. Brown MATH & TI ON ' %CXTIO W LZDGMENT STA72 OF Wkcensln l ss. Stanatum(r) St. Croix County. ) percoratly came 6eiore -c this _ 1 day of t2t6eslkarsd thin day of Aprtl , 3001 the above named enneth L. Btol a Dad KArSktn B. Brcwa .l WAS OKAY rBtt NY TITLE: 4 SK Of 'A/ISCONSI?t Ay .� . to I S jt4 to be the persoo(t) -b6 Ozeevted the ,'cce ;eimj p ' I C1LL tad ae4nowteo¢o the same. �CbdL, Wts. Stars.) Att ¢� � avid J. Estretn 304 Lotta!*S(: Hudmu wl 54016 Nnutry Fvhtie, State of wisconain (Slgiuturolssy be aadtattiatet er xknewi.dsad 3olh ere tol my CanYnt3lon IS pennvtat +a — ;II not s; a expuauoo au: ' Namtts of pafesa 11152016 is am ==Very dmid be iy0rd a priMN b-f +heir .iprsw VAre R Aa Or 71eCAe5 wANUMTT 12X7 nSa N.: • IH2 1111- MIIATION 1• VV%33MNAL1 CWAFAW 17117 OV tAC. 'yl SODASS•DOOt r NT (TO 1G S 89'52'17 E OF' 2048.98' Z 228.44' I 184.27 218.76' LA ° I � " 21.56' LOT S 84'25 5 3 LOT 24 W I v \2 115.5 w co cV 0 S F - shy _ � LOT 22 I I' 2 5 . N S �" I s S 83 29'22" 64.38' E o 2AC Ft 00, DRAINAGE ` W I 91325 Sq. Ft. 7 � I s\ 146. 72' 70. 80' 2.10 Ac. \� S 89'02'19" E 217.52 o N� 76886 Sq. Ft. w►-� 2� 1.77 Ac. z ° s ' LOT 23�o,� \ - ooft ry \ `(98 >e 90394 Sq. Ft. — \ 411 6 \ \ 2.08 Ac Cn ro 66 ^ 6�� "W 6 — 6 59$ 9 2 �21 — y- r— / O 2 0 6� /�o z A ) / \ — 25.25' S 00'46' 42.47' \G• p i = L T 7 J OT 16 co /19580 Sq. Ft. / 1.83 Ac. LOT 8 LOT J I � , � � I c W }� c 95551 Sq. Ft. c A .J 94754 Sq. Ft. I 2.19 Ac. 2.18 Ac. - /�* ID N � / r C ,; A 90086\ Sq. Ft. ��/ Lo � 2.07\ Q h� a� ^(bo^ 74' - 74.45' - 4) °'^�� ` F 23.25' 262.26' 41.06 . _ 2' - _ ^`� - 1 � — — • - 7$4$ — 116.99 —1 D7.7i' — 38.78' — — ------- - - - - -- PUBLIC COUNTY ROAD E SOUTH LINE OF THE SE 1 /4 OF SECTION 33 KI Rq'43 W 2638.57' R.A. 2638.72' 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 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal ref ), direction and Parcel I.D. percent slope, scale or dimensions, north arrow �rld o nf7 dls, ce to nearest road. Please print a J. \ ati�. Reviewed by Date Personal information you provide may be used pR' nda vacy Law s. 5.04 (1) (m)). Property Owner K rty Location �� C DI Y S�1 t; 2 D ��� I Go . Lot , $ 1/4 1/4 S 33 j T 3 0 N R E (or�l Property Owners Mailing Address 4T ( ;R0iX o # I Block # Subd. Name or CSM# City State Zip Code Phone Ndthber ❑ City ❑ Village f.Town Nearest Road dLLQ S t I Slot Ly 1 ( t5,Efi h on [a New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate �7'.S�o /G C7 d GPD ❑ Replacement Public or commercial - Describe: Parent material r Flood Plain elevation if applicable - zll ft General comments S,/S�ewt el-cu /Qo• and recommendations: ~. e r'C Y_ /Q o , d Coo ✓ffa�lr © Boring # Boring 9 9 a pit Ground surface elev. ft. Depth to limiting factor AO in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6 -( z 3t' z I 2 rnc bk m fir lt� I v+ 5 8 Z IL -3a I y �y Si. Zmsbk mFt C — S 9 '.� �'(ou l X1 C 1.5 �� � 5� Zms k m-Fr — — . s • 9 a Boring # El Boring 2 S pit Ground surface elev. /() /- 30 ft. Depth to limiting factor 3q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r o - , 3Z s,I 2 k m ( VC S 1 1 - 3 4 10 vf9lq 5c 2m5bk a14 e- -3 3y -y IU ,-yI c2P�•S r`l/y Zrrsbk ►SFr _ r s 9 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mglL CST Name (Please Print Signature CST Number zS 3 3 0 9 Address / Date Evaluation Conducted Telephone Number Zl /� ate- f� ,So S-e7` ��• UL � �Z Z —G/ 7 /S— z y,�— S�Go� Property Owner 6o l l a v Parcel ID # Page 2 - of 3 a Boring # ❑Boring g pit Ground surface elev. `� - co ft. Depth to limiting factor 5— in. Soil App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 c) - t - t 3 Z SO Z m-F C. v 2 - is I C-'s - s Lk c I 5L 1 k rn CA F -1 Boring # E] E] ❑ Pit Ground surface elev. % Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDK? 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 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 (W07 /00) PAGE 3 OF 3 NAME LOT# Z 3 LEGAL DESCRIPTION ,SW' /'S'0 /a S 3 3T3o,N,R ( s E (or)(0 SCALE: 1 BM I ELEVATION /00 BM 1 DESCRIPTION �e _ BM 2 ELEVATION 9 $ec • 33 BM 2 DESCRIPTION f*o a Z' yc- DT_ SYSTEM ELEVATION /oo . Sy x ALTERNATE ELEVATION 1 CONTOUR ELEVATION /00 D/�l Aacat. � nsc rwn�' Bw� Z \ B m� ■ J. C7 o \ SIUNATURE v- DATE - 1 - 1 �r S�