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Home My WebLink About020-1106-11-200Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be used for si Permit Holder's Name: Oevering Homes CST BM Elew Insp. BM Elev: l�Z•�o TANK INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) [Privacy Law, s.15.04 (1)(m)1 TOWN OF HUDSON ' c ��n ELEVA ION DATA TYPE MANUFACTURER CAPACITY Septic - r 0 Goo Holding TANK SETBACK INFORMATION M® ,- _7® UMP/SIPHON INFORMATION a qrq n• IJ M nufadurer lE ( and Deml�+ GPM rr1 ll Model Number ,r O L riction L ss System Head 1 TD F� len jF,TLe,gt'h -10 Dia. Z If Dist. to Well N STATION BS HI FS ELEV. Benchmark Aft. B r 1. So 103, (Po Bldg. Sewer StlHt Inlet `10 (417D S Outlet Dt Inlet Dt Bottom 12e3o R3.8o Header/Man. .bo 7, C O T/J Dist. Pipe r 0O y!,8-'<b Bot. System I t �,5 "I qj. 40 Final Grade ,3 0 102.50 St cover i I,C 2 S a 103. tp C) •Sa for ao v UIL ALSJUKr' I IU1N AT01 CM BED/TRENCH Wdih /� Length I No. Of Trenches DIMENSIONS J Z L PI7 DIMENSIONS No. Of Pit s^ Inside Dia. Liquid Depth (� SETBACK SYSTEM TO P/l LDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: r ti ."l`e.•Vrtff 1 I 0 CHAMBER OR UNIT I C1 \T' uiC1' Model Number DISTRIBUTION SYSTEM 2--r 23 4 L4 (o H+wl . Header/Manifold Lengtn Dia u N Distribution Pipe(s) (��j r� l Length �1 4 Dia Spacing z Hole Size Hole Spacing Vent to (7 v Intake A 1 N6 Cr1 SOIL COVER x Pressure Systems Only ound Or At -Grade Systems Only Depth Over I Becarench Center -1 VI i Depth Over Bed/Trench Edges z<Depth of Topsoil / xz Seeded/Soddetl Yes ® No x Mulched es No s COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 2/ G (9/ qP Inspection #2: location; MAGOO RD /_'' 1.) Alt BM Descd tion — co")�eir' 2) Bldg sewer length - amount oT cover = 3y$�r CO JP (� tl^c Plan revision Required? L,. Yes XN, Use other side for additional information. (� V Date SBD-6710 (R.3/97) �AIV -�nan _ oI-� - Safely and Buildings D...s. - - 201 W."Washingbn Ave., P.C. Bete 7.162 Madison, Wl 537 162 s®®ry Pamir Number (to be fined in by Co.) �7 Sari Permit Applica on - TrmsectionNumber r in Swic�3E391(p!)y Wm. Code, subm® ission of Ails foto the appropriate gov fat i4 t�i Note: Application forms for smmowned PORTS ate subm=d m the Department of Safety ap civics. Personal iafommion you provide may be mad for secondary = (idiSciem Aran mailing address) fr DIIsea in accordance with the Privacy law, S. 15.04(1 m Stats. 0 ( ' Ce L Application Information - Please Print All Information Property Owner's Name (%ir�•h5 �.�. Parce(A OaiD'NtYb'- 64-ono Property Owner's Mai'mg Adams Q of-- I 9: '7i "nperty'.oa"°° 3 s74 C -, � OIN ZiP Phote Number Z ��(�de T�N' R — W 7�T�' IL Type ofSaildiag eckallthatapply Loth um r to 2 Family Dwelling -Number ofBWmo ak { Subdivision Name B ❑ Public ComIDercial-Describe Use ❑City of slywl ❑ State Owmed - Describe, Use ❑ Village of CSM Number Z. 6 w z34rZ3 dU M. T Check only one PDX on line A. Complete Hoe B if applicable) A. System ❑Replacement System ❑ TreamentlHoldmg Tank ReplacertnenOnly ❑ Other Modification m Foisting System (explain) B• ❑ Pamir Reoewat ❑Permit Revision ❑ ChmgeofPlumber ❑PamitTroaderm New list Previous PercaaNmnbcr and Dae Issued Before Exp'nstion owns t v om onat/Devicec Cheek ail that apply) Nam-PresaavW In -Ground ❑ mired Ia-Gro rid ❑ Ai4rade ❑ Masud > 24 m. of suitable soil ❑ Mound <24 in. ofs.tabl. soil ComDooem (.Plain) 1',aressinicat Device (explain) V. Du rent ent Ma Ioformadoo: Ded@l Flow (ad) S3 Dai®�Application dst) Dispersal Aria Re4uced (a Dispersal! (sty S ypJ►s�d ® 1 a VL Tank Ida Capacity in Total g of Manufaenaer Gallons Gallons Units s Neer Taub Etdwng Tanks All '• y s/ta.(a in rn ETV a septic. HW&M Taws Damag Tsmhn 7 VIL Respoosibi ity Statement- k the and c respona'ality for imtallatim of the PORTS ahuwa a the atmcbed plants. Phmber's Name (Print) Pl s Sigmaurc MP/MPRS Number Busimras Phone Nuobw Phmber's Address (Sheet, City, State, ) ant Use Pe�mli�t Fce Issued Issuing t Si f�KApproves m S JkQwc;A Reason for Denial DL Con~LaM%*voMWeasoas for Disapproval 1. Septic tank, effluent filter and rM 0/y a dispersal cell must be serviced / maintained Imo+ as per management plan provided by plumber. n 2. All setback requirements Jj' y 4w must be maintained vC rtit arsaa aW sabmn w the canto( w wp leas Hsu P :11 ircis m suer SBD-6398 (R. 11/11) �J 'j' Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1 /16/20 Owner:Oevering Homes Location: NW 1/4 NE 1/4 S35 T29 N,R19W Lot 2 011ie Court Hudson Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance ,Contigency Plan 7. Filter Cross on �g� 52ti✓ 4,, Signature License System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NE 1/4S 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 98.6/98.3 5' below grade DATE 1/16/20 BEDROOM 3 CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 ,`, BENCHMARK V.R.P. Top of Survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL sH.R.P. same as benchmark Scale = 1 /4" = 10' 182' ALong Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ftA2/pair of end caps 2 Grade at System Elevation 34" All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Property Line B.M.* 164' 100, Huffcutt ombo Tank 40' 30' z f B-2 L �r 0 Pro 3 Bedroom House 3% Lt Q,7S 2-3' X 94' cells with >3' spacing B-3 n �/( 45' lFE 103.5' Kinney Road System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017 NW 114 NE 1/4S 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 98.6/98.3 F below grade DATE 1/16/20 BEDROOM 3 CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL sH.R.P, same as benchmark Scale = 1 /4" = 10' DGrade �6„ick4 Standard of Coveraching Chamber h 20.0 ft2 of Area ftA2/pair of end caps 4' Lon at System Elevation All piping shall be ASTM SDR 30/34, within 169- 10' of tank, piping shall be ASTM F891 Property Line z.M.* 164' Huffcutt Combo Tank 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 5.6f A2 pair of end plates Typical Installation Vent Grade ,A/30/34 Septic Tank 5' Spacing 5' System elevations: A 98.6' 5' at System Elevation 5' To be >1' above grade Finish grade elevation 103.6' Vent t" at System Elevation 2-3' X 94' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell 0- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Number of Bedrooms ❑ NA Number of Public Facility Units -2 NA Estimated flaw (age) 3 aUda Design flow (peak), (Estimated x 1.5) q_) v mal/dav Application Rate aUda /flz hdard Influent/Effluent Qusitly Monthly average* Fats, Oil fi Grease (FOG) s3o mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L rested Effluent Quality Monthly average Biochi mical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) G30 mg/L Fecal Colifonn (geometric mean) 1 510° cfu/i00ml Imum Effluent Particle Size I K in dia. ❑ NA typical for domestic wastewater and septic tank efltuenL SCHEDULE sysTr-M CDFrrrFrrerrnur Page _ of _ Septic Tank Capacity aaj O-NA Septic Tank Manufacturer O NA Effluent Filter Manufacturer ` p NA Effluent Filter Model ❑ NA Pump Tank Capacity �� ❑ NA Pump Tank Manufacturer NA Pump Manufacturer ❑ NA Pump Model ❑ NA Pretreatment Unit ;NA ❑ SarWGravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other. ❑ NA Other. O NA Other. ❑ NA Service Event Servioe Frequency pect condition of tank(s) At least once every: ❑ month(s) ea (Maximum 3 years) ❑ NA s I ump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Y kspect dispersal cells) At least once every: ❑ 0 9)a) (Maximum 3 years) ❑ NA Ilean effluent fitter At least once every: �nth(s) NA aspect pump, pump controls d alarm At least once every: O month(s) 1 ush laterals and pressure test At least once every: ❑ month(s) ❑ ear(s) I �fter ❑ month(s) At least once every: ❑ year(s) EEFNAr 4TEHANCE INSTRUCTIONS pections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master mhber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank' s must kids a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the lume of nbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ualty inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. s ponding of effluent on the ground surface may indicaie a failing condition and requires the immediate notification of the local lulatory authority. ien the combined acmimulation of sludge and scum in any tank equals one-third (36) or more of the tank volume, the entire contents of tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin ministrative Code. other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, i any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. ,ervice report shag be provided to the local regulatory authority Mthin 10 days of completion of any service event Page _ of _; 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 ti"Ot may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(e) reproved by a septege servicing operator prior to use. 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 call(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 assist in mentally operating the pump controls to restore normal levels within the pump tank. Do not drive or park yehides 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 POWT$- anfibiotics; baby wipes; cigarette butts: condoms; cotton swabs; degreasers; dartal floss; diapers; disirdectants; fat foundation drain (frump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is prope(lY and safety 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 owdents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space fifled with smil. gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to pnrride a code compliant replacement system: 1 " suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption systegn. The replacement area should be protected from disturbance and compaction and Mould not be infringed upon by requbled 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 establish a suitable replacement area. Replacement systems must ounpty with the ruled 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sot 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 sod 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. <cWARNING>> 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 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name �%-F, j Tt Phone ; _ a POWTS MAINTAINER Name SEPTAGE SERVICING OPERATOR QWMPERI LOCAL REGULATORY AUTHORITY _ Name � Name ` j Phone 1 j 1- Phone This doaanent was drafted in ow"ance with chapter SPS 383.22(2)(b)(1)(d)a(f) and 383.54(t), (2) & (3), Wiscouskn Admtnisbatve Coda 20140048A ? fj_;4 SECTION A -A 1921 Septic -Dose Wank Cross Section And Pump Performance Specifications 9 I ♦/ r r: yr. y_� -/�Y �� :r ♦b- nrr �I� Filter Manufacturer Filter Model Number Inlet Minimum Pump Performance Required ,T 3 GPM I Q I ; L2, S— Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight Switch Sett�tsgs and Reserve Capacity Tank Volume = / GPI Dimension: Inches Volume Gal. (reserve) A: I (alarm) B : 2. 3 (dose) C � , r (dui) D' Total 3 L u 1 • 1 ' U 1'" � -� Total Dynamic CMM - Fat Elevation Head Distal Pressure Network Loss Force Main Loss Total I Manhole Min. 4" Above Grade With Locking Device \ GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with manufacturees product approval specifications. Maximum depth of bury as specified by the manufacturer may be exceeded without prior approval. Manhole covers exposed to grade have an effective looking device (padh installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, laid on stable soil to prevent settling or sagging. The force main is sleeved with r Soh. 40 PVC to bridge the excavation and the sleeve is sealedwatertight. Electrical service complies with NEC 300 and Comm 16.2 t. Fal 250-SERIES 113 hp Sump/Effluent Pumps for Professionals! ALL MODELS FEATURE: • Rugged 1/3 hp motor, oil filled with thermal overload protection. • 1/2" solids handling. • 1-1/2" discharge. • Hermetically sealed motor and switch cavities, and permanently lubricated bearings. • Liberty's UNI-BODY casting - a solid, one- piece housing that eliminates the lower motor seal ring found on other pumps. • Epoxy powder coat finish • Vortex style impeller for superior solids -handling. Made of high temperature engineering polymer. • Fasteners - all non -corrosive stainless steel. • 416 stainless steel rotor shaft. 250-series Cord Lengths Model 10' 25'(-2) 35'(-3) 50'(-5) 250 Standard Optional Optional Optional 251 Standard Optional Optional Optional 253 Standard Optional Optional N/A 257 Standard Optional N/A N/A 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 250 with 35' cord, order 250-3 Model 250 Model251 Manual, no switch. Quick -disconnect wide-angle float, mercury4ree. s�e Dual safety certification for C4RIIFED c us Certified the United States andcanada. Specficatioris are subject to change without notice. MOTOR SPECIFICATIONS: 1 /3 hp 115V 5.2 amps 60Hz Thermally Protected & Permanently Lubricated (PSC) Permanent Split Capacitor Maximum Fluid Temperature;140OF DIMENSIONAL DATA: Weight: Model 257: 20lbs. Height:10.5" Major Width: 9.6" (manual model 250) PERFORMANCE CURVE PERFORMANCE CURVE 6 br 0 0 10 20 30 40 50 U.S. Gallons Per Minute 38 78 114 156 192 Liters Per Minute Model 253 Model 257 VMF Wide-angle float with VMF switch, magnetically series (piggy -back) operated vertical float - plug, allows manual operates in a 10" operation of pump. diameter sump. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright m Uberty Pumps, Inc. 2017 All rights reserved. LUT2500-Rs117 Mailing Adds R. 0 City/State [F Tent IFUTTOr a ST. CROIX COUNTY SEPTIC TANK MADMWANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM & Zoning Dgwtmmt Parcel Identification Number Property Lough tdLy./v_� Y. , sm.T 2,�' N RM W, Subdivision Cerdfled Survey Map # new cotutumon.) Town of. Lot # Volume � Page # ImpWper use and mamtename of your mpOc system could result to ih Facost re failure to bandle autos. Proper oabticunu a oamists of pumping out the septic twk every three years or sooner, it Headed, by a bocowd puutper. What you pat into the ayshm o n affect the fnnchm of etas septc halt u a trannmt stage in the waste disposal syseatu. Owner mawtataxe responsibilities we specified in 4Co mr. 83.52(l) and in C bsptar 12 - St OYo x County Sanitary Ordb*wa. ILe property, own= Fgraas to submit to St C mix County PlannmS & Zoning Department a catffiution foray signed by the owner and by a rnuter Phan bw. jo®eynm phmber, rahietod ptmbor or a House d pmopor var4ina that (1) the on -she wastewater disposal system is in pmpa operating oanditoa and/or (2) alter inspection and pimping (if neon nary), the septic task is lea than 1/3 full of sludge. Vwe, tba undersigned bave read the above requirements and agree to maintain the prism sewage disposal system with the standards set Rntk herein, As set by the DepQtroant of ComHnme and the Department of Natal Raousoa. State of Wisoccabl Certificate m staring that your septic system hu been maintained must be completed and returned to the St Croix County Pl> x,g & Z.00iug Departntmt within 30 days of the Have year wq*a ion date. Uwe oertfy that all stahmmH on tlaa' rm am true to the bat of my)m koowlcdge. Uwe amhm &a own*&) of the property deaerihed alwve, by vhtre of a dad recorded a Register of Deeds Office. Number f bedrooms _ SIGNATURE OF "PUICANT(S) DATE "'Any mfa mation date miampramted may result in the sanitary permit being revoked by the Pbmning & Zw" Dopumumc '•' I—Jode with this applic elm a recorded warranty deed from the Register of Deeds Offrce and a copy of the certified survey Cusp if rofirence is made in the warranty deed. (RBV. 0&" G3C,�D '=RSw m.a Daparntor mgAy 22 N S ILEVALUA Division of Safety and Bui s with 85 Wi Ad Code CST ' jolq'O&y Page —a— St. 09i r ent m , hs. M.--- Attach complete site plan - in size. Plan must include. but not limited to: ontzahtal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. PerserW informebon You WoNde my be used for secondwy Purposes (Privacy taw. s. 15.0/ (1)(m)I. T— Parcel I.D. PW-A- 0 20- IP -9-0-Ow Re ' by Date I ) Property owner c Property Location z -- GovL Lot 114Wr 1l4 S 7 j T Z9 N R E (or Property a M '-" Address , Loh# Block p Subd. Name qrCSW,, State , Zip Code Phone Number 5 0 ( ) ❑ City ❑ Villa a Wows Road ),I ,�f okr Consct1w Use :.KRiisidentlal/Number of bedrooms Code derived design flow rate y s"Y.i GPD ❑Replacement ❑ Pu fc or errct Describe: Parent material A - *1 Flood Plain elevation if applicable N R General oamtanta �'t fftl'/f�- and noonanerWaean�sl: of -'Nrfl" System Type l 0 A"J {iLttij System ElevationBodr Mj (jl Boring 1 � * �1- Pit Ground surface elev. �Z • n. Depth to knitng factor / / U in. soil Application Rate Hodzan Depth h. Dominant Color Munsel Redox Desaip&xh Ou. Sz. Cont. Color Teod re Stnichn Gr. Sz. Sh. Consistence Boundary Roots GPM •EfRi1 •092 �. � # ❑ Boring BPit Ground surface elev. I oZ, Zft, Depth to Writing factor y in. Sol Application Rate Horimn Depth h. Dominant Color Munsel Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Bwndary Roots GPDIfF •E1f#1 I •Eff#2 777 -3 C n t� 6 s 4 1 , • Effluent #1 = SOD. > 30 < 220 mg& and TSS >30 < 150 • Effluent #2 = BOD, < 30 mg& and TSS < 30 mWL CST Name (Please Print) CST Number Si a Bird Plumbing, Inc. Shaun Bird 226900 Address Date E luaton Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 c— f 715-246-4516 121 Property O.vner Parcel 10 # Page _ of Red, Description I Sz' Cont. Col 7M-M Molno ROMMOM. MEMUMME ❑ Boring # ❑ Boring ❑ Pit Ground surfaceelev. ft. Depth to limiting facto in. 75oilApplication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. ConL Cola Texture Stnxxure Gr. Sz Sh. Consistence Boundary Roots GPD#F -Eff#1 •Efi#2 Boring ❑ Boring❑ Pit Ground surface elev. ft. Depth to limiting facto in. Soi Application Rate Effluent #1 = BOD5 > 30 < 220 rnglL and TSS >30 < 150 ml ' EBluem #2 = BOO, 5 30 ml and TSS 130 mglL 7'he 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'ITY 608-264-8777. We M(a.sanJ . Soil Test Plot Project Name Dick Stout Address 1353 Awatukee Trail Hudson Wi 54016 Lot 2 Subdivision --------- N W 1/4 NE 1/4S 35 T 29 N/R19 W ❑ Boring Q Well PL Property Line L� BM or VRP Assume Elevation 100 ft. 3TM #226900 5/19/19 Township Hudson County ST. CROIX Top of survey iron System Elevation TBD *HRpSame as Benchmark Scale is 1" = 40' unless otherwise noted