HomeMy WebLinkAbout030-2128-40-000 L W*consir " Department ofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
514904 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:
Knutson, Steve & Darcy St. Joseph, Town of 030 - 2128 -40 -000
CST BM Elev: � y � � Insp. BM FJe� BM Descriptio : � ^� ��� Section/Town/Range/Map No:
�
25.30.20.1046
TANK INFORMATION ELEVATION DATA Inf Z
TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV.
Septic / / p �� Benchmark r2
Dosing (�(/ J C/ AI r D 15
Aeration Bldg. Sewer ':� /�
Holding S" Inl 7Ja9 � 3 1v ' 0 '7
2�
TANK SETBACK INFORMATION SUHtOutlet �U� �� .
TANK TO BLDG. Vent to Air Intake ROAD Dt Inlet �
Septic 5� ( 1 Dt Bottom 90 ra 0
Dosing L10 JAW Header /M'+!�� -f v ) Z
7 7 .
Aeration Dist. Pipe ' f
D Q C air. AXA
Holding Bot. System (J
L 2 Q,
Final Grade
PUMP /SIPHON INFORMATIO ct g /03.1 U /�
Manufacturer Demand St Cover /
Z 13
Model Number
TDH Lift Friction Lo System Head Ft �l
1 1 7 �
Forcemain l_ _ Dia. Dist. to Well
SOIL ABSORPTION SYSTEM 23
BED /TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 2
SETBACK SYSTEM TO BLDG WELL IjCrr LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER O
Type f System: / Ar UNIT
-> O Model Number:
DISTRIBUTION SY TEM j -,3 _t > " t S
Header /Man' Distribution x Hole Siz I X
Hole acing Vent to Air Intake
7 Pipe(s)r �� t Vil�jt� JtQ,
Length Length Dia Spacing
SOIL COVER r 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 7 (,� —� 7��` Bed/Trench Edges Topsoil Yes ❑ No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�Z /J/ 0 Paspection #2:
Location: 1334 Birch Park Ridge Houlton, WI 54082 (SE 1/4 SW 1/4 25 T30N R20W) Ridge at Birch Park Lot 4 Parcel 2
1.) Alt BM Description = t vF WA,�GQ� Q4 t „ �� u // / �� 4
2.) Bldg sewer length - 3/ ' G / , 7c.- v
- amount of cover = � I ��r � � � � /_ . ' L > �lf/r�UVVdZ�!"��,
Plan revision Required. [, Yes E&KIO/ te
Use other side for additional information.
Date Insepctor's gnature (� .
SBD -6710 (R.3/97)
t
Safety and Buildings Division County C
l v i sconsi 201 W. Washington Ave., P.O. Box 7162 OF Madi ` `' WI "3 707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Dep artment of Commerce (6 315 gb
Sanitar Permit A nn lica >! State Plan I.D. Number Q U
In accord with Comm 83: 1, Wis. Adm. Code, personal information you provi 0 3 ® t 2 Q - 1 a V ��
may be used for secondary purposes Privacy E 1 V E D Proj Address (if different than mailin address)
I. Application Information - Please Print All Information
Property O er's Name Parcel # t Block �ivufS oN
Property Owner's Mailing Address ZONING OFFICE Location ,
z 3.R /�y A- 41V • N O�V 4, �w �,, sect on
City, State /�/� /� f ipp Code 'l 3O Phone Number
�� U " v ✓ I r ' V Zi .7 33 V ' ss T N' RZtrcor W
II. ype of Building (check all that apply)
t or 2 Family Dwelling - Number of Bedrooms p Subdivision Name 2 C/S�M(N�umber /
public/Commercial - Describe Use tS{L ate-. / O�� ,,�t� r ' `+ ,` — _` P `
State Owned - Describe Use ❑City_❑Village ATownship of
❑S 1 G/ 0
III. Type of Permit: (Check only one box on line A. Co ptete line B if applicable)
A. &ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of C1 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner '��
IV. Type of POWTS System: Check all that apply) `f
on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required, (st) Dispersal Area Prop ed (st) System Elevation
✓� �s ✓ �k ��a �3• o e -L
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units ��� \�/ �/�j, Concrete Constructed Glass
New Existing A swG.aGr 1 / t
Tanks Tanks
Septic or Holding Tank 1 Z
Aerobic Treatment Unit •7 /�j� & 4
Dosing Chamber �
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
R OB 50-7 1 bR i( 7/s • ?7.)-' 3 �/
Plumber's Address (Street City, State, Zip Code) n /N
VIII. County/Department Use Onl
Approved El Di ppro Sanitary Permit Fee (includes Groundwater Date Issu Issui gent Signa (No ps)
Surcharge Fee dO y�
❑ O ven Reas Denial !"
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1. Sgttic tW*,.effluerd filter and
dispersal cell must all be serytis'/ maintained
as per management plan provided by plumber.
2. AN setback tequilrements must be maintained
as per applicable code / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size
SBD -6398 (R. 01/03)
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SYSTEM S ALL Ulbricht & Associates
THIS POWT RATA C MM' Private S wage Consultants
PER BEL 2812 10t Ave.
INCORPO PROPER
83.44(2)c Spring Val ey, WI 54767
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S POWT SYSTEM COMM Private Sewage Consultants
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INCORPORATE PER OMM' 2812 10th Ave.
83.44(2)0 A PROPER Spring Valley, Wi 54767
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Wisconsin Department of Commerce SOIL TION REPORT Page / of
Division of Safety and Bcsidings
in Comm . W Code
Attach onptete site plan an paper k than 81T1 k �1 es In must y S 7 - G' R O (
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irx*x* but not united to. vertical horizomrtal reference Pmirt (E" Parcel I.D. 12- - 'Yo. 000
percent slope. scale or north j� ! y and
p ,
PI@8S@ priAt el! iIflf���p. R t►Y Z Pomona Monsoon you provide bs Low. s. 15.04 (1) (mN !�
P f / A1v7-S ,0 � FFI CE Govt. Lot 1/4 1M S 5 T N R 2-0 E
Ropedy Ownees �� �',) $ i Lot # Block # Subd Name a CSM#
l Z g 3 e 17 N� MTV V. S S 33 0 y R (06-6 tr F3
State MpCode Phone Mxnber ❑ City ❑ Village ® Town Nearest Road
RA1 5533 o ( 7&3P3 ( 1 • !lass 5 - r - f31^4 P'vx Ai'
New construction Use-Y4 Residential / Number of bedrooms Code defined design flow rate f'v Q _ GPD
❑ Replacement ❑ Public or commercial - Desalm
Parent m S,4.yD Flood Plain elevation if applic :
General commem>ts
and reoormnermdatiomnuK
Area ' ` Spot Tested suitable for
a conventional inground system (P.O.W.T.S.)
a # Ground s �8•y0 to f8 in
RalJe
Horizon Depth Dominant Color Redox Des ripffon Texture Structure Consistence Boundary Rook
In. Munsel Qa. Sz. Cont. Color Gr. Sz. Sh. 'f 1 •E(f#2
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J Pit Ground surface elev. / R. Depth to tim"Fedor , ! in.... sbl Rate
Horfaon Depth Dominant Color RedIM Description Texture Strucdue Corwis(enoe Boundary Roots GPM
in QMnsel (lu. Sz. Cart. Color Gr. Sz. Sh. •Eff#1 MW
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• 0110emrt #1 = BoD 30 < 2Z0 mnglL and TSS < 150 mgn • EANiemrt #2 = BoD < mmglL TSS 5 30 mnglL
csr Name (P t2o" ERr ?�I L.(3 R 1 C (tiT' 4e 3 S
A� Date evaluation Conducted Telephone Number
Ulbricht & Associates I q(• 09 7 (S' • 7 72 • 3 y4
2812 10th Ave.
Spring Palley, Wi 54767
ORICrINAL
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Property Owner Parcel ID # Page of
# ❑ �3.o C�
3 Pit Ground sr bm Oev. ft. Depth to lindri factor ` 8 in,
Horizon Depth Dominant Color Description Texture Structure Con Boundary Roots GPOW
in. Munsell Qu. Si- Can! Color Gr. Sz V sisterroe 'EM ftr t o• y ioyR t Sc A w V4 • � / a
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F - I ❑ Pit Grt uod wrface dvv. ft. Depth to factor in. Rate
Horizon Depth DovrinardColor Redox Description Texture Structure CorWdwm Boundary Roots GPOW
In. Mursell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etilh2
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F-I #. ❑ '
❑Pit Grou surface stay. R Depth to �rniting ir>.
Sol Application Rate
Hariaon Depth Dorrdrrmrt Color Redmc Description. Texture Canoe Boundary Rods GPOW
in. Mu>seti Ou. SL Cont Color Gr. Sh 'Etf#I *am
❑ # ❑ ❑ Pit Ground sufeoe abv. it Depth to irnitirg factor h.
Soil Apykellon Rafe
Had= � Dpi cdm Redox Desotpeon. Texture Structure Conroe BmmdBfY Roots GPM
im MunseM Qu. Sz cqk Color Gr. Sz. Sh 't Ali 'Etf'#2
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Property Owner Parcel ID # Page of
a V eoring # El "g �
Pit Ground surface plev. • o ft. Depth to ImbV tadtor 7 V in. Sob Application Rate
Hortim Depth Dorrdnant Color Redox Description Texture Structure Consistence Boundety Roots GPDRF
in. Munsell Qu. SL+ Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2
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Boring F] # ❑ �s
❑ Pit Ground surface elev. ft. Depth to, fmti N factor In.
Sod Application Rate
Haig Depth Dw*wdColm Redac Description Texture Stuchme Consistence Boundary Roots GPD/fF
IrL Munsell Qu. SL Cont Color Gr. Sz. Sh. 'E01 'E02
Boring F-1 # ❑ Bofh+g
❑ Pit Ground surface elev. ft. Depth to l&nMV in.
Sag AppllcWon Rate
Horiaon Depth Dominant Color Redox Description. Texture Carsistenoe Boundary , Roots GPDVfi?
in. Munsell Qu. Sz. Cont Color Gr. tZSh. •E01 'Eff#2
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❑ Bodng 0 ❑Pit Ground surface elev. ft Depth to limiting factor in.
Sort Application Rate
Haim n Depth Dominant Color Redax plicn. Texture Structure Consisted Boundary . Roots GPDHI<
Im Munsell Qu. SL Color Gr. Sz Sh. *m 'Eff#2
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Private Sewage Consultants
2812 10th Ave.
Spring Valley, WI 54767
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LEGEND
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BIRCH_ I PARK LOT , X � 7
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Sf�ET I0F2SIU;E'I'9
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ULBRICHT & ASSOCIATES CO.
2812 10th Ave. - Spring Valley, WI 54767 Reg. Designers of Engineering Systems
715- 772 -3442 Private Sewage Consultants
PROJECT INDEX ,
PLAN ID � 1 DATE �/
OWNER s>�P,�� K NVfSO•� PHONE 743 2 7 /•� sf
ADDRESS Z lag q fY^' LN . 6!� /ey - 5 3 G
LEGAL DESCRIPTION /,0�_ #_ Y 19!/P� � -��
, 2 - yo • ea -a i5 12- sw /y sue Zs.. 7- r l' Z w
TOWN OF s r h S' J/•
� COUNTY
CSTM
LOCAL AUTHORITY/ SUPERVISION 51` 4 4el ' l
PROJECT DES '
C�
Ulbricht & Associates
Private Sewage Consultants
2812 10th Ave.
Spring Valley, WI 54767
o psG IN 8j.A
37
Pg.l INFILTRATOR SIZING WORKSHEET
P9.2 SYSTEM PLOT PLAN
Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS.
Pg . 4 if it of
P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS
Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK.
PG.7 (OPTIONAL) PUMP PERFORMANCE RMANCE
SPECS.
The attached plans and specifications are based on "In- Ground
Absorption Component Manual For Private Onsite Wastewater
Traatmant fivGtPm.q (VPrcinn 2.0) gTtn- 1075— P(Nn1 /nl.
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r ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer SDI�1
Mailing Address 24 `j'A � LokN L N _ 111 l2. t V [:
Property Address V33 `t i &LcA e AAK Qxo ( S . SbSc LLl1,
(Verification required from Planning & Zoning Department for new construction.)
- 71 o 3 2-41- t(sS
City /State Parcel Identification Number
LEGAL DESCRIPTION
Gt1
Property Location r 1 /4 , y '/4, Sec. 2 -- s , T. 3 N R Z (9 W, Town of
r' 9 tr5 A 7 — ,� /�e G Lt. p4 Lot #
Subdivision -�
Certified Survey Map # lame , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lorlines ide$tifia a yes )no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 Owner maintenance
responsibilities are specified in §Comm $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property desc 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number f bedroo
SIGNATURE OF APPLICANTS) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08 /05) Ulbricht & Associates
Private Sewage Consultants
2812 10th Ave.
Spring Valley, Wl 54767
7 Is 7 .3 �yZ
STATE BAR OF WISCONSIN FORM 1 — 1998 6 gig 1 14
WARRANTY DEED
KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
This Deed, made between Riley Ruby LLC. a Minnesota limited DI CO. wI
liability comp nv ,Grantor, and Steven D. Knutson, Darcy J. REECC EIVVEED F FOR RECORD
03/03/2008 Oi3:40AM
H_ autala.husband and wife _, Grantee.
Grantor, for a valuable consideration conveys to Grantee the following WARRANTY DEED
described real estate in St. Croix County State of EXE at
Wisconsin (the "Property"): REC FEE : 11
TRANS FEE: 420.0.
00
PAGES: 1
Recording Area J'
Name and Retum Address
buy Yl ei' -- n+tA-
- t
Y✓Li 55 35
030 2128 40 000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Lot 4, Plat of Ridge at Birch Park in the Town of St. Joseph, St. Croix County, Wisconsin
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this 25 day of February 2008
7 (SEAL) (SEAL)
I
Riley Ruby LLC, a Minnesota Limited Liability Company
Paul DeWitt as President
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Minnesota,
) ss.
Ramsey County
authenticated this day of
Personally came before me this Z3 day of
February 2008 the above named
Riley Ruby LLC. a Minnesota Limited Liability Company
Paul DeWitt as President to me known to be
TITLE: MEMBER STATE BAR OF WISCONSIN the person who executed the foregoing instrument
(If not, and acknowledge the same.
authorized by §706.06, Wis. Slats)
THIS INSTRUMENT WAS DRAFTED BY AAA, C � 4t —
Coldwell Banker Burnet/Robert Nicholson Notary Public, State of Wisconsin
1301 Coulee Road
Hudson, WI 54016 My commission is permanent. (if not, state expiration date:
8 -02248
(Signatures may be authenticated or acknowledged. l
Both are not necessary.) N•'• *z.; IMNNESOTA
31 20tO
` Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis.
1 of 1
2-
Wiscbnsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
A in accordance with Comm 85, Wis. Adm. Code
`� County St Croix
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. 7
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. rJ
Please print all information. Revi e y
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner f� ,�(J, ed Property Location
1:1 El
Quest Development, Inc Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Suite 150 10700 Old County Road 15 4 Ridge At Birch Park
City State Zip Code Phone Number aity nvllage ■ Town Nearest Road
Plymouth MN 1 55441 ( 7¢3 -595 -9512 County Road E
Q New Construction Useo Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
E] Replacement 11 Public or commercial - Describe:
Parent material f .oess over o twash sands Flood Plain elevation if applicable _ ft.
General comments �.
and recommendations: This site is suitable for a conventional system
* with bands of find sand that are 10yr4 /3, 1 fsbk, ri1 �wED
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F-1 Boring # ❑ Boring ' SS u pp1X !
Q pit Ground surface elev. 96.17 ft. Depth to limiting factor > I „!
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Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound -,' GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` * ff#2
1 0 -9 10yr3 /1 1 2msbk mfr cs 2 8
2 9 -19 10 r4/4 sil 2msbk mfr cs if .5 .8
3 19 -38 10yr4 /4 - sil rnfi cs - .2 •3
4 38 -98 7.5yr5/6 fs imgr mvfr _ - ,5 .9
S
Boring ri n g 99.61 >98
2 Boring # °
❑ Q pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3 /1 1 2msbk mfr es 2f .5 .8
2 10 -20 10 r4/4 sil 2msbk mfr cs If .5 .8
3 20 -43 10yr4 /4 sil �, mfi cs - .2 .3
4 43 -98 7.5yr5/6 fs lmgr mvfr - - .5 .9
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = D, < 30 mg /L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 10/16/01 715- 246 -2454
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Quest Development, INc 2 3
Property Owner Q p Parcel ID # Page of
3 Boring Boring
g Q Pit Ground surface elev. 94.42 >98
ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2
1 0 -4 10yr3 /1 - 1 2msbk mfr cs 2f .5 .8
2 4 -18 1 r4/4 - sil 2msbk mfr cs if .5 .8
3 18 -39 10yr4 /4 - Imsbk mfi cs - •2 .3
4 39 -102 7.5yr5/8 - fs* Ifgr vfi - - .4 .6
*With ! OS
❑ Boring # Cl Boring
M 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 I *Eff#2
F
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/ff
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
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need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD- 8330Test (R.07 /00)
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Private Sewage Consultants
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v !/ r/ Hudson, Wis. 54016
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