HomeMy WebLinkAbout038-1092-10-100 Esanitary St. Croix
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM mit No:
Safety and Building Division INSPECTION REPORT 538795 0
(ATTACH TO PERMIT) State Plan ID No:
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No
Permit Holder's Name: City Village X Township 038 - 1092 -10 -100
Kralewski, Allen Star Prairie, Town of
Section /Town /Range /Map No:
CST BM Elev: Insp. BM Elev: BM Description: 22.31 .18.379A10
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Benchmark
Septic
Alt. BM
Dosing
Bldg. Sewer
Aeration
St/Ht Inlet
Holding
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Dt Bottom
Septic
Header /Man.
Dosing
Dist. Pipe
Aeration
Bot. System
Holding
Final Grade
PUMP /SIPHON INFORMATION
Demand St Cover
Manufacturer GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to well
SOIL ABSORPTION SYSTEM
FINFORMANTION /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
ENSIONS P/L BLDWELL LAKE /STREAM LEACHING Manufacturer:
TBACK SYSTEM TO CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM x Hole Spacing Vent to Air Intake
Header /Manifold
Distribution x Hole Size
Pipes)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only xx Mulched
Depth Over xx Depth of
Depth over To soil 0 Yes � No Yes No
BedlTrench Center Bed/Trench Edges p
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / /
Inspection #2: / /
Location: 2068 & 2070 110th Street New Richmond, WI 54017 (SW 1/4 NW 1/4 22 T31N R18W) metes & bounds Lot Parcel No: 22.31.18.379A10
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
�I
Plan revision Required? Fa� Yes Ed No
Use other side for additional information. - -� --
Cert
Date Insepctor's Signature
SBD -6710 (R.3/97)
Safety and Buildings Div ision County
. Washington Ave., P.O. Box 7162
/I/ / 5 2 Madison, WI 33 A Sanitary Permit Nu (to filled in by Co.)
J L (608) 7T De artment ce.
• �...-- � ---- -- State Plan I.D. Number
pplication
In accord with Comm 83.21, Wis, Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, sI5.04(l )(m) Project Address (if different than mailing address)
1. Application Information — Please Print A formation
,�_ 20cp8
Property Owner's Name p; r Lot # Block #
IT
f /f
Property Owner's Mailing A dress operty Location NI
` Section
City, State Zip Code Phone Number
(���� r.7- circle one)
f t+k k e ((61� D 7 T� N; R�E od>
I1. Type of Building (check all that apply)
,_/ Subdivision Name CSM Number
NJ 1 or 2 Family Dwelling —Number of Bedroo 14 eJL
❑ Public /Commercial — Describe Use •
El State Owned — Describe Use ` (� 41 ity_ ❑Village Township
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. El New System to Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Penn it Renewal El Permit Revision El change of ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV.TypeofPOW TS System Check all that appl
P Non — Pressurized In Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed ted Wetland I Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
Recirculating Synthetic Media Filter El Leaching Chamber El Drip Line El Gravel-less Pipe El other (explain) PA4_ I
V. Dispersal/Treafment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispers Area Required (sf) Dispersal Area �Proposed �System atio, /
Vt. Tank. Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units / Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Ho'
low 1
Aerobic Treatment Unit
Dosing Chamber
VII Responsibility Statement- 1, the undersigned assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) PI is Signature MP/MPRS Number Business Phone Number
d o Or - z 3 /,,/ 4 Z
Qg2127 I � Plumber's Address (Stree City, State, Zip Code)
t ?� ( 0U,V� S�y
VIII. County /De artment Use Onl
Sanitary Permit Fee (includes Gro dwater Date sued Issuing t Sign Stain
Xrp proved Disapprov Surcharge Fee) sf /�
er Given Reason Denial �(( T CCC///
IBC. Conditions of Approval/Reasons for M. approval 3\ ell
SYSTEM OWNER'
J
Septic tank. effluent finer and p c 1 mot' L
dispersal ;ell must all be servfeea / maintained VCT�� • ,./� I !
as per management plan provided by plumber. � , s ue_ t ic-0 — , lI
Z, All sertback requifements must be maintaineQ IeC�
as per "Vicablecode / ordi Nmn.
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)
CONVENTIONAL COMPONENT DESIGN
Residential Application
r INDEX AND TITLE PAGE
4 e 5 Project Name: 7 rU,� N S�
Owner's Name: AM oU IS- (ai.J
Owner's Address: {
Legal Description: -
c
Township:
County:
Subdivision Name:
Lot Number. - n
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross - Section
Page 4 Filter Specs
Page 5 Maintenance information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenanc Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer /Plumber: ►' Wt)t QJJ License Number:
Date: 9_a l.. l I Phone Number - 6 63 X
Signature
Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01 /01).
Page 1
-6 Q In
o6 b t I
Z C
O
/-V l� ,
- 011
l
Soi ( AbsoMIRn tem Cross Secdon
� ft
Final Grade
4° Schedule 40
PVC Vent Pipe ft
With Vent Cap
Leaching
Chamber ♦, �'y {���
J System Elevation
-_ ft 3_ ft
Soil Absorption Simtem Plan Aew
ft
_ft
Leading Trench 1
ft 7Vent bsery ation Pipe Chambers
4' Dia.
Trench 2 Header
Leaching Chamber Slaecificafions
Manufacturer And Model r I& 7 �
EISA Ratin s ft per chamber Soil Application Rate _� gpolsq ft
gpd Design Flow + _ Soil Application Rate + I�j _ EISA --.L -- Chambers
2 rows of I � chambers each.
j Page of
i
Application: Single family homes not to
j exceed three bedrooms and two and 112
baths in size.
r F et of 1116° filtration ZOELLER SEPTIC TANK RISER
Filter Area 61 Linea e
Flow Rate: 850 gpd.
Material: All materials are noncorrosive in
J C
the septic tank environment.
OUTLET
Easy to install or retrofit: The Zoeller
Septic System Filter fits inside any 4" sani-
tary tee. Slide the filter cartridge into the FILTER GASKET
4 "SANITARY TEE
sanitary tee at the tank's outlet. The drain
field is now protected from solids greater # NOTE
a
than 1/16 ".
a
Ea , :,y to n1ainta in. The Zoeller filter should 24
TOTAL LENGTH
be cleaned each time the septic tank is OF FILTER
4 ° DRAINAGE PIPE
pumped. More frequent cleanings will not , /, 6 "—
FILTER SLOTS
hurt the filter and could even improve the
performance of your septic tank. For instal -
lations that exceed the design flow rate of '
the filter, more frequent cleanings may be CY INCER sK,
required or manifold more than one sanitary *NOTE: State and local plumbing codes may require
tee to accept more than one filter a specific liquid penetration. For example, 25 % -45%
into the liquid depth or 9" off the tank bottom.
tl� «s N�t,t Every Zoeller filter is guaranteed to be free from defects in materials and workmanship for
the lifetime of the homeowner /purchaser. Free repair or replacement, excluding labor, will be made on return of
the filter prepaid to the factory. This warranty is limited to product proven to be free from abuse or improper
installation.
ALL ZOELLER ON -SITE WASTEWATER PRODUCTS MUST BE INSTALLED IN ACCORDANCE WITH LOCAL AND /OR STATE PLUMBING
AND /OR HEALTH DEPARTMENT CODES.
AMA TO: P.O. 80X 16347
Louise, KY 40256 -0347 Manufacturers of..
O SHP TO: 3649 Cane Run Road
Laasv&, KY 40211 -1961 P l/MP6 51,YCE YL Y" r .
(502) 778-2731 2 1(600) 928-PUMP
http: / /www.zcelfer.com FAX(502) 774.3624
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner �' 4 t' Septic Tank Capacity 60a ga l ❑ NA
Permit # L Septic Tank Manufacturer (, j)%0 ,,` ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer �I ❑ NA
Number of Bedrooms Z. ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units )R�VA Pump Tank Capacity — ga l ❑ NA
Estimated flow (average) bU gal /day Pump Tank Manufacturer _ ❑ NA
Design flow (peak), (Estimated x 1.5) O� gal /day Pump Manufacturer ❑ NA
Soil Application Rate Q , 7 gal/day/ft' Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit -
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD :5220 mg /L �&NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :_150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) . -YY44� ❑ NA
Biochemical Oxygen Demand (BOD :_30 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever ?� ❑ month(s) (Maximum 3 ears) ❑ NA
p y' ✓ year(s)
y
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: onth(s) (Maximum 3 years) ❑ NA
years)
Clean effluent filter At least once every: / onth(s) ❑ NA
year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month ❑ year (s) ) A
ls)
❑ month(s) Q NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: ❑ month(s)
At least once every: ❑ year(s) ❑ NA
Other:
❑ 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 cells) 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 chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of :512 months, 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.
GMW (4/01)
START UP AND OPERATION Page of
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.
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 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 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.
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
properly and safely 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 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 availabje a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ 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 o�. L Name
Phone 7!5 — (-4(p_ ZG Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer m 1 fu-1s k .
Mailing Address ,.
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State S In Parcel Identification Number 2,9 , � 1 -A� y�
LEGAL DESCRIPTION
Property Location %4 , - V,, Sec. _2� T _N R W, Town of 5;7 fke. f /-,�
Subdivision Plat: Z,2 , Lot #
Certified Survey Map # , Volume Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ 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. 83.52(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.
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 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. I /we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 0\
NATURE OF ICANT(S) 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. 09/07)
6434iD 3 13
STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Kenneth A. Hecht, a single person
Grantor, and Allen L. Kralewski Grantee. 01/29/2007 11: 40Afi
Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED
the following described real estate in St. Croix County, State of Wisconsin (the EXEMPT I
"Property") (if more space is needed, please attach addendum): REC FEE: 13.00
TRANS FEE: 390.00
SEE ATTACHED LEGAL DESCRIPTION COPY FEE:
CC FEE:
PAGES: 2
Recording Area
Name and Return Address
Casterton Title & Closing Company, Inc.
P.O. Box 746, 13264 Lake Blvd.
Lindstrom, MN 55045
Our File: 6409
Together with all appurtenant rights, title and interests. 038- 1092 -10 -100
Parcel Identification Number (PIN)
This homestead property
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Dated this 23rd day of January 2007
enn A. Hecht
it
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) // _ — — — _ -- _ — STATE OF Wi sconsi n _, _ )
) ss.
- - - -- -- - -- --- -� ---- � P_olk___ _County )
authenticated this 1/ —.day of //
Personally came before me this 2 _ day of
SHANNdN M. JACOBSON
fitotary- public January 2007 the above named
— -- — — -- -- - - --
-- — - --
State of Wisconsin Kenneth A. Hecht, a single P erson ^ __
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, /1 _ ___ _ to me known to be the person(s) who executed the foregoing
authorized by § 706.06, W is. Stats.) Wa%kn e ed the sa e.
THIS INSTRUMENT WAS DRAFTED BY James S. Casterton, Attorney at Law Shbson
1_32 Lake B lv d ., P.O B ox 7 Lindstrom, MN 55045 Notary Public, State of Wis nsin
My Commission is permanent. (I to expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) 3/28/10 )
* Names ofpersons signing in any capacity must be typed or printed below their signature. (NFO -PRO (RO0)655 -2021 www.mfoprofoniwcow
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. r - 1000
File No.: 6409
SCHEDULE C
LEGAL DESCRIPTION
All that portion of: Southwest Quarter of the Northwest Quarter (SW1 /4 of NW1 /4) of Section Twenty -
two (22), Township Thirty -one (31) North, Range Eighteen (18) West, lying to the West of that certain
public highway running in a general Northerly and Southerly direction and intersecting the said SW1 /4
of the NW1 /4 of Section 22, Township 31 North, Range 18 West EXCEPT a part of the SW1/4 of the
NW1 /4 of Section 22, Township 31 North, Range 18 West described as follows: Commencing at the SW
corner of said SW1 /4 of the NW1 /4 of Section 22; thence East along the South line of SW1 /4 of the
NW1 /4 to the Center line of Town Road transversing said forty acre tract; thence Northeasterly along
the center line of said Town Road a distance of 700 feet; thence directly West to the West line of said
SW1 /4 of the NW1 /4; thence South along the West line of said SW1 /4 of the NW1 /4 to the point of
beginning; AND EXCEPT Lot 1 of Certified Survey Map filed June 19, 1975 in Volume 1 on page 141
as Document No. 327659; AND EXCEPT Lot 2 of Certified Survey Map recorded in Volume 14 on page
3969, St. Croix County, Wisconsin.
-4-
IVED
P
y Department ofComme SOIL ALUATION REPORT Page of
DivWM of Safety and Buildings
in � an vnth �omm , Wis. Adm. Code County
S7. CROI�X C1
Attach complete site plan on pa i ize. Plan must
include, but not limited to: vertical , direction and Parnel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
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
r Govt. LotsW 1/4 4� 1/4 S ��T r �N R E (o W
Fkdperty Owner's Mailing Address Lot # Block # Subd. Name or CSM#
S
C' State Zip Code Phone Number ❑ city C�7 Village ❑ Town Nearest gad
❑ New Construction Use: ❑ Residential / Number of bedrooms i Code derived design flow rate ) .i GPD
�Replacemerd ❑ Public or commercial - Describe:
Parent matbrial Flood Plain elevation if applicable ft
General comments -S` ,S £. t' ` ✓ '� - '� .'
and recommendations:
❑ Boring #
❑ Boring
Pit Ground surface elev. ! �` � ft. Depth to limiting factor � 1 �l J� in. Soil A Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF
in. Mupsell Qu. Sz. Cont. Color Gr. Sz. Sh. " Efi#1 *Ei<#2
ALI
L � �• t► I� ,� 6 S ��S t�
a Boring # a Boring
lci Pit Ground surface elevC�ft. Depth to limiting factor �,d g � in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsefl Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
r 4• '
3 CZ- iNr D
If
* Effluent #1 = BOD > 30 220 mg/- and TSS >30 _< 152M qppent #2 = BOD _< 30 rrgA- and TSS <_ 30 mgA-
N ame � lgn tune ----) j 3 3 9 V
�N� ,.
ate Evaluation Co uded Telephone Number��. ,
Address
U��+°���< t•�s �-
I <{t fF , .s z Z / / o ` -. A - - /' Page C _ of
Properly Owner P arcel ID #
a Boring # ❑ Boring Ground surface elev. 7 ft. Depth to limiting factor / in.
> So�7 Application Rate
' - Pit
Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPI>f
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
ham, 2
�,.L Cs r'
2 °
/0 '112 m..,.
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. R Depth to limiting factor in. Sod cation 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
❑
Boring
Boring # ❑ -
❑ Pit Ground surface elev. ft Depth to limiting factor in.
Sod Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Etr#1 `Eff#2
Effluent #1 = BOD > 30 220 mglL and TSS >30 150 mg& ' Effluent #2 = BOD < 30 mg/L and TSS _5 30 mg&
The Depa#mag of Commefee is an equal oppett ity service v i ovidei and Gust; bUrvicub U1
need material in v altemate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777.
SBD -6330 (807/00)
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