HomeMy WebLinkAbout032-2136-80-000 � e ,
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 420768 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:
Haines, Donald I Somerset Township 032 - 2136 -80 -000
CST BM Elev: , Insp. BM Elev: ! B Description: Section/Town /Range/Map No:
"D . Q l90 , p p N takL 13.30.19.1210
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark i
V,S Ec,.1t. 2&p
Dosing Alt. BM r 'QQ sy l
Aeration Bldg. Sewer
SO
Holding St/Ht Inlet
�
TANK SETBACK INFORMATION St/Ht Outlet q.3 ! 65 •�
TANK TO P/L WELL gBLDG. Vent to Air Intake ROAD Dt Inlet
Septic � Dt Bottom
Dosing Header /Map.
C Olt "E �!►�� .
Aeration I) •� t
nini
Holding Bot. stem S. I a • O r
Final Grade ' �
PUMP /SIPHON INFORMATION Z. o -12
Manufacturer and St Cover
GPM
Model Numb
TDH Lift ction Loss System Head TDH t
Forgarifain Length 1 . Dist. to Well
SOIL BSORPTION SYSTEM
RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man c r ry
INFORMATION Type Of System: ��� 5.I -k. � �' CHAMBER UNIT OR Model Number. �l
DISTRIBUTION SYSTEM LV w -•r' L
Header /Manifold it Distribution x Hole Size x Hole Spacing Vent to Air Intake
' sl
Length Pipe(s) Dia_ Len is Spacing J V
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 „
Yes [ No Yes I No
COM E TS: (Include de disqWp yes, persons prg zent, tc. . Inspection #P ?,w lnspecti n #2:
VCAAJLIA 4;,
L: 1560 84th St New Richmond, WI 54017 (SE 1/4 NW 114 13 T3 N 1
La Mon: 9W) Stonewoo of Parc I No: 13.30.19.
1.) Alt BM Description = c lwo'�"`i ►
2.) Bldg sewer length = so � ` h p
- amount of cover ka t 4 ?. A- �+ ATV
3� �tx� - iM E MA4 -� IA* - - --
Plan revision Required? i Yes No -}--- I �,( I - -2-
Use other side for additional information.
V
SBD - 6710 (R.3l97) Date Insepctor's Signature Cert. No.
i,
Safety and Buildings Division County
m 201 W. Washington Ave., P.O. Box 7082
�seonsin Madison, WI 53707 - 7082 Sanitary permit Number (to be filled in by Co.)
Department of Commerce (608) 261.6546 q'z0 -7-fo 8
Sanitary Permit Application State Plan LD. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Lew, s 15.04(1 xm) Project Address (if different than mailing address)
I. Application Information - Please Print All Information
/5 4 0
P
1/_1 � hZ
roperty Owner's Name Parcel # Lot # Block #
Property Owner's Mailing Address (1, Property Location
a
C ity, State Zip Code SL= =. yes L�ldL /•, section /
�- circle
S . CR � - T3Q N� REo /
II. Type of Building (check all that apply) ZONING OFFICE
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM - NUMW
❑ PubliclCommercial - Descrbe Use z . - 1
❑ State Owned - Describe Use 2 X 12 `j . „ ❑City ❑Vil Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. 13 Permit Renewal ❑ Permit Revision 11 Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply) �§t - 0D . ,
Non - 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. Disp ersal/Treatment Area Information:
Design Flow (gpd) ign Soil Application Ratc(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (at) ystem Ek46M
Z Im VI. ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New I Existing
Tanks Tanks
Set tic or Holding Tank e / _
Aa obit Treatment Unk
Dosing Chamber
VII. Respoqslbillty Statement- I, the undersigned, apsume responsibility for Installation of the POWTS shown on the attached plans.
MPlub er's me ( 'mt) Plumber's Si MP/MPRS Number Business Phone Number
(Strout, ity, State, Zi Code)
Z_
VIII. Coun /De artment Use onl
P ,Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued Iswi g Agent Signatur Stamps)
Surcharge Fee) r
❑Owner Given Reason for Denial 2.27 �. -/ t (� Cl
IX Co nditlo�ns of Ap easons for Disapprove � 0� -
� b �,,,. — 2k42.wte4t,4
Y
CM
S u _St4r
� Attach complete plans (to tho County only) for the system ea apes aot less this 91/2 111 Inches is a n
l4 4 l Sexes rv�.0 + L. Z� od � O�flfl -t l ci9.&& C oo& 4tL�ta_fccles.
SBD -6398 (R. 08/02) /
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Wisconsin 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 8 1/2 x 11 inches in size. Plan must - -� L%
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.
Please print all hil &VE D Rev wed by Date
Personal information you provide may be used for secondary purposes (Privacy w, s. 15.04 (1) (m)). Z 3
Property Owner 2 Property Location
A) Z�L I Govt. Lot 1/4 '' 1/4 S/ 3 T N R (or�
Property Owner's Mailing Address ` OFFICE Lot # Block # Subd_N a or CSM#
- _
City St to Zip Code Phone Number ❑ City ❑ Village 2 Town Nearest Road
7 Ll 25 75 - 9 S S'=
�J New Construction Use: ❑ Residential / Number of bedrooms - _ S Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 4,. Flood Plain elevation if applicable ft.
General comments //
and recommendations: / �Y _t,J /� r / /� USE 5�•
D Boring # ® Boring
❑ Pit Ground surface elev. Ja2,, 86 ft. Depth to limiting factor > / /_� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Al
�� ><
a 4- oo •o�
2-
Boring # Boring
❑ Pit Ground surface elev. J ft. Depth to limiting factor > / /.S 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 I *Eff#2
(f) - 9 A/� 025
Irl el <1Y 11
. 3 1
" Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg /L Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name lea Pri , Signature ) CST Number
Address Date Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
Property Owner/- Parcel ID # ( -,� /. - u - �%D� Page of
Boring #
F-31 JZ Boring
❑ Pit Ground surface elev. /61,,2 ft. Depth to limiting factor Z,-�4Z in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. j Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
Alz J
-
S° - s
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 Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring # ❑ Boring
El 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 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 (R.07 100)
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4
I 601,195 SO. FT �� 0
13.80 ACRES �j�0 " i j `� °►
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L
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Z—of
FILE INFORMATION SYSTEM SPECIFICATION
Owner —� Septic Tank
Capacity al ___ NA
Permit # �(?�(o Septic Tank Manufacturer o NA
Effluent Filter Manufacturer o NA
DESIGN PARAMETERS Effluent Filter Model - o NA
Number of bedrooms o NA Pump Tank Capacity al Z NA
Number of Commercial Unit ONA Pump Tank Manufacturer .6 NA
Estimated flow (average) gal/day Pump Manufacturer .®-NA
Design flow (peak), (Estimated x 1.5) 0 al /d Pump Model 6 NA
Sol] Application Rate gal/day ft Pretreated Unit
Influent /E,ff•Itien( Qualily Monthly Avcrage* a Sand /Gravel Filter o Peat l"ilter
Fats, Oils & Grease (FOG) <30 mg /1 ri Mechanical Aeration Lt Wetland
Biochemical Oxygen Demand (BODs) <220 ntg /L o Disinfection O Other:
Total Suspended Solids (TSS) < 150 m /L Manufacturer
Pretreated Effluent Quality ❑ NA Monthly Average" Dispersal Cell(s)
y X In- ground (gravity) ❑ In- ground (pressurized)
Biochemical Oxygen Demand (BODs) <30 mg /L o At - grade o Mound
Total Suspended Solids (TSS) <30 mg /L ❑ Drip-line o Other
Fecal Coliform (geometric mean) <10' cfu /IOOmL
Maximum Effluent Particle Size '/6 inch diameter * Values typical for domestic (non - commercial)
wastewater and septic tank effluent.
** Values typical for pretreated wastewater.
MAINT SCHEDULE
Service Event Service Ffwuency
Inspect condition of tank(s) At least once every o month jg year(s) (Maximum 3 rs)
Pump out contents of tank(s) When combined sludge and scu Is one third ' /3) of tank volume_
Inspect dispersal cells At least once every o month ears Maximum 3 rs)
Clean effluent filter At least once ever o month W year(s
Inspect xun ), nntt) controls & alarttt At Fast once ever u months o year(O d NA
Flush laterals and pressure test At least once every o months o ear(s) er NA
Other: At least o nce every o months o year(s) A NA
Other: At least once every o months o ears z 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 ('/3) 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 pressuri•red POWTS components, pretreatment 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 my impede the treatment process and /or damage the dispersal cell(s), If high concentrations are detected have
the contents of the tanks(s) removed by a septage servicing operator prior to use.
1
Owner: � -�
- h94;2of2
System start up shall not occur when soil conditions are frozen at the infiltrative surface;
During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater
will be discharged to the dispersal 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 assist in manually operating the pump controls to restore. normal levels
within the 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 soft absorption are.
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; moat scraps; medications;
oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONEMENT
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
If the POWTS fails and cannot be repaired the following measures have been, 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 establish a suitable 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.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding
tank maybe installed as a last resort to replace the failed POWTS.
C3 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 the time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTALL R POWTS MAINTAINER
Name - / Name
Phone - - Phone
SEPTAGE SERVICING OPERATOR PUMPER)
LOCAL REGULA ORY AUTHORITY
Name Name
Phone Phone
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
0` `v'N[:RSHIP CERTIFICATION FORM
Owner /Buyer
Mailing Address
i �`trS� s�1 f
I ro �erty Address � �� ,e,,_�
(VeIiticalion required frorn Planning Department for new construction)
ity /State r .: r = -cf Parcel Identilica Numbor F : 2
I EG AL DESCRIPTION
1 roperty Location '' /a, ZUy& X,, Scc, __Zd_ 'I'_N -R _W, Town of wmz-r� t7
Subdivision `'7Xl 11z)? 5 a , 12C.0co , Lot #
Certified Survey Map # , Volume , Page #
Varranry Deed # ln% /L3 Volume�.._._� Page # ..,�
Spec house C3 yes Xno Lot lines identifiablexyes Q no
S YSTEM MAINTENANCE
Improper use and maintenanccof your septic system could result in its premature failure to handle wastes. Proper maintcnwii
consists of pumping out the septic lank every three years or sooner, if needed by a licensed pumper. What yuu put into the systcu►
can affect the function of the sapltc tank us a ueattncnt stage in the wustc disposal system.
The property owner agrees to submit to St. Croix 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 Zoning Office within 30
da s of the three year expiration date,
� t�r «�u� ��l yl ev 3
SIGNATUR!" OF APPLICANT DATE
OWNER CERTIFICATION
1 (we) certify that all statements on this form are true to the best of my (our) knowledge.. I (we) am (are) the owncr(s) of
the roperty described above, by virtue of a warranty decd recorded in Register of Deeds Office,
S1 ' A Af PLICANT
U N ! UR1• Ql DATE
Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * ***
** 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
I ,
J 2036P 259
STATE BAR OF WISCONSIN FORM 1 — 1998 6 7 9 a
KATHLEEN N
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., MI
Document Number RECEIVED FOR RECORD
This Deed, made between Hermie Enterprises, LLC Grantor, 11 - 05 -2002 9 :10 An
and D nald J. Haines Nangy K. Klaas sin le Grantee.
Grantor, for a vacua a consideration conveys to Grantee the following WAAR DEED
described real estate in St Croix County State of
Wisconsin (the "Property"): REC FEE: 11.00
TRANS FEE: 330.00
COPY FEE:
CERT COPY FEE:
PAGES: 1
Recording Area
ame end Return dress /
D I
, Ha ines
eet
Somerset, 1540261IS l � kuk
032 2136 80 OOO
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Lot 8, Stonewood
Together with all appurtenant rights, title and interests. none
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this 30th day of October 2002.
(SEAL) A (SEAL)
ermis Enterprises, LLC -
_. i
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) WENDY SWATZINA state of Wisconsin,
NOT MSIN ss.
}
g I I ,- F WISrn —.
St.Croix County
authenticated this day of
Personally came before me this 30th day of
October 2002 the above named
He le Enterprises LLC bv: Barb Geving and Jeny
Geving Presidents to me known to be
TITLE: MEMBER STATE BAR OF WISCONSIN the person who execu d the foregoing instrument
(If not, and knows ge the same. //� 11
authorized by §706.06, Wis. Stats) � ;�� w - ' Mr
THIS INSTRUMENT WAS DRAFTED BY j'P e( Lv Yl�
Coldwell Banker Burnet Notary Public, State Of Wisconsin
1301 Coulee Road
Hudson, WI 54016 My commission Is
( �p8rtnanen . (If not, state expiration date:
2- 47140
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
Names of persons si2nin2 in any ca act must be ed or printed below their signature.
STATE BAR OF WISCONSIN N IN Wisconsin Legal Blank Co, Inc.
[ WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis.
111 UIVI I I LU LAINUJ GRAF
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1 601,195 SO. FT. .;; �� °�,.
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w iscons?A Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and ( '
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please Reviewed by Date
Personal information you provide may be used for sesoAciaW purposes 4&acy LaWi's,_'r5Q4 (1) (m)).
Property Owner ; Yoperty Location
cilvt. Lot 1/4 1/4,S T • N,11 (or)�(1L,
Property Owner's Mailing Address # Block# Subd Name or CSM#
ST C+301k J
f
City State Zip Code PhoMoj6 *FiCE ❑ City ❑ Village ® Town Nearest Road
New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow g l eO gpd Recommended design loading rate l bed, gpd/fe __0 trench, gpd/ft
Absorption area required � g bed, ft C trench, ft Maximum design loading rate bed, gpd/ft r 9-- trench, gpd/ft
Recommended infiltration surface elevation(s) Q3 g� ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material �% Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system U S❑ U S❑ U [A S ❑ U I JZj S❑ U I ❑ S D ❑ S ,O U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
0
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
abd
S
Ground
elev.
Depth to
limiting
factor
-in.
Remarks:
Boring # ZL
C 7
,
t -
Ground r -
elev.
Depth to
limiting
factor
> - &r - in. Remar :
CST Name (Pie se rint) Signature Telephone No.
Address ate CST Number
( S _
SOIL DESCRIPTION REPORT "
PROPERTY OWNER `' " Page of
PARCEL I.D.# `
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
�Y
3
Ground
g elev.
Depth to
limiting
factor
n.
Remarks:
Boring #
-
7
Ground
elev.
Depth to
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
Depth to
limiting ,
fact
746 in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in
Remarks:
SBD -8330 (R.9/98)
_, tt
n
T -_
�av
✓ 3