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HomeMy WebLinkAbout008-2002-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 556305 0 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: Ho'em, Wayne & Rita Eau Galle, Town of 008-2002 -000 CST BM Elev: I au Insp. BM Elev: T'm Description(1, Section/Town/Range/Map No: G5 36.28.16.5486 TANK INFORMATION u: ELEVATION DATA + °1y /b(P,,Sq 165.9 TYPE MANUFACTURER t l CAPACITY STATION BS HI FS ELEV. Septic , Benchmark / / ,07 .I Dosing ~ 600 7.03 9-~, 3 / • 90 . `1#4 + ~p la 1L` 5~ Bldg. Sewer ~•Z 51-14 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y 25 Ft Bottom Dosing ZS Z rJ Zd Z~ / Header/Man. ! Aeration J. / OZ. Z Z Dist. Pipe (.7 Holding Bot. System ZI L6 PUMP/SIPHON INFORMATION Final Grade 3 L,-7 Manufacturer Demand /~3. ZZ `7 a St ver !mod 3 5 7 g a s~ 75.77 Model Number 53 Ga., -cam r / TDH Lift (pti% Friction Loss System Head TDH Ft r 2 6 -3 1 Forcemain Lengt~h~ , Diaz e / Dist. to well 25 SOIL ABSORPTION SYSTEM 7 /61. 56. / 60.7 7 BED/TRENCH Width Length No. f Tr hes PIT DIMENS` No. Of Pits Inside "a Liquid Depth DIMENSIONS <9 6j + ZG SETBACK SYSTEM TO `D JP/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type System: CHAMBER OR a J UNIT Model Number: _ DISTRIBUTION SYSTEM Header/Manifold Distribution rle Size' ( x Hole Spaeing, Veto Air Intake / P O Length /+ZS Dia Length ~f Dia 1,26 Spacing 3Z SOIL CO x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlrrench Center / y Bed/Trench Edges Topsoil f V z. 1 , Q G Yes No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: V /~-Z- In pectin 2: Location: 2642 PIERCE ST CROIX RD Spring Valley, WI 54767 (SE 1/4 SW 1/4 36 T28N R16W me es & boundsLot~Parcel No:6.28.16.548a 1.) Alt BM Description= V JtJ~. l ~e 2.) Bldg sewer length= 4-o 60 I ~5 f - amount of cover = ( J G~ ~ ~ Plan revision Required? Fail Yes No C/ h ' r ~~~r,7i5 Use other side for additional information. " O I L \ SBD-6710 (R.3/97) Date Insepctor's gnatur 1 Cert. No. 1 commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 J( i sc o n s i n Madison, WI 5 3 70 7-7 1 62 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 55(,305 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the app ipri to go mental y 7,9 g unit is required prior to obtaining a sanitary permit. Note: Application forms for state- ed 15OWTS are Project Address (if diff ent than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary t purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. I C.rCJ2. 1. Application Information - Please Pri for tion .r...-.. (ilp r Cf`a~ PRL. roperty Owner's Name Parcel # DOB --.23 y/a _10&Y_ 6j. Wa e vti C- M 74n O 8~ 0000 ..~S/ Property Owner's Mailing Address C Property Location . robe ~P. City, State Zi de b r Govt. Lot U, I I Zip SI /.-i A IpIIItIG . QF E ~ Section 3~0 n 7d4~ /41 (circle one) N; R ~T, E or W II. Type of Building (check all that apply) Lot # T Xr 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - Describe Use CA- El City of CSM Number ❑ / ge of El State Owned -Describe Use Villa d/ )r. SIp. Z►C Er Town of dt. 62 L/t 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 Modifi tion to Existing Syste xp )1~ B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List revious ermtt Number and Date Issued Before Expiration Owner A f O IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: t Design Flow (gpd) Design Soil Application Rate (g sf) Dispersal Area Required (s Dispersal Area Proposed (s System Elevation ~tso . 6 75 /a 6 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o v New Tanks Existing Tanks f A o /[V1' a U v~ y v w V e Septic or Holding Tank 00 lboO a W f eSe,-- Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) rr Plumbif~ MP/MPRS Number Business Phone Number Plumber's Address (Street, Cit , State, Zip Code) l~ Ca L I e C.t 3 49 VIII. County/ eartment Use O 1 Approved tsappr Permit Fee Date I ued 7 Issuing ent Signatur tven Reason o enial $ 625 • IX. Condi*M71JAI Measons for Disapproval 1. Septic tank, effluent finer and 3r) (.e ~-►~o r. / ti Spa a-~ ; dispersal cell must all be services I maintained as per management plan provided by plumber; exc~ wl S p 2 AN setback requ(rements must .be maintained / ~ ad as per applcable code / WdinaricW { a "-.-16 Attach to complete plans for the system and submi to the County onl on paper not less than 8 1r2 x 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 CD Vim r l v m a ~a ~ ~ s ~ dq a s ~ Ovi~° ~ v N ; 1 c1 14 Al 11AZ ~9 ~ r s o g -Air O r LU -2- j- ~ s.u~,~ css 9tiP~TME~T Safety and Buildings °N 3824 N CREEKSIDE LA u { 0 HOLMEN WI 54636 3 $ s~ Contact Through Relay P S y www.dsps.wi.gov/sb/ www.wisconsi,n.gov A h ~OSSION Scott Walker, Governor Dave Ross, Secretary May 22, 2012 CUST ID No. 220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/22/2014 SITE: Identification Numbers Wayne HojeSt Transaction ID No. 2084788 2642 Pierce St Croix Rd Site ID No. 779427 Town of Eau Galle, 54767 Please refer to both identification numbers, St Croix County y SE1/4, SW1/4, 536, T28N, R16W above, in all correspondence with the agency. FOR: Description: Three Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1372159 Maintenance required; Replacement system; 450 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD=10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. $r~.sf The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. a . No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. e The following conditions shall be met during construction or installation and prior to occupancy or use:: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145Z0(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • The existing POWTS shall be properly abandoned per SPS 383.33, Wis. Adm. Code. • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. 1 BENNIE W HELGESON Page 2 5/22/2012 Owner Responsibilities. • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swirn@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. I I BENNIE W HELGESON Page 2 5/222012 Owner Responsibilities. • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the PO WTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WIS1v1ART code: 7633 jerry.swim@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Y 0 7 2012 INDEX SHEET F7Y,3 PROPERTY OWNER: WAYNE HOJEM 2642 PIERCE-ST.CROIX ROAD SPRING VALLEY, WI 54767 PROJECT NAME: WAYNE HOJEM PROJECT LOCATION: SE'/a , SW '/a , S 36, T 28 N, R 16W MUNICIPALITY: TOWN OF EAU GALLE COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N. 01 /01) MOUND COMPONENT MANUAL VERSION 2.0" SBD- t 10691-P (N.01/O1) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound AD U iL., ~ ` 0 Page 3: Distribution Pipe Layout ~NoEr" Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: W 1000/600 -MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan- Pg 1 Page 8: POWTS Owner's Manual & Management Plan- Pg 2 v Name: Bennie Helgeson Signe Address: N7649 Hwy 128 Spring Valley, WI 54767 Credential Number: 220292 Date: 05-03-2012 III- [ ♦ f 4-7 -0 CO r. s.r .7' .,a L C *1 OA s 40 y 'q'" ,J Cie NE ! 7- QC m `V G i J a o 43 / t~`Q / n LU a- ~ ~ 1c-' 3 I l 2) 7 ! i kDner: 1 nom. floIe-wL Page Ofd Synthetic Covering Distribution Pipe ASTM C .33 I~i ~bJy Medium Sand H AAA Topsoil 3 E b C ont V • -00 s' % SIOpe- . eaof Force Main Plowed Aggregate From Pump Layer D 1(_ Ft. E P. 0 Ft. Cross Section Of A Mound F 80 Ft. G . S Ft. A Ft. M 2,0 Ft. Signed: B Ft. License Number: - K /04 Ft. L 77 P&Tt. ' Date : J Ft. Ft. W 7, Ft. Observation Pipe J B _ K - - - - - - - - _ _ . - .f-.~ - - - 1 - W g` - 7 .7 - --7----------- j Distribution Of 2 - Z Pipe Aggregate b~ Observation Pipe QaSal Areo- = lloe'l- I N. Plan View Of Mound t,Ll ri ~r ; o_~ vi a ~rn eck C) F - Perforated Pipe Detail Cleanout Access 0 Threaded e o e vi Cleanout ~ PVC Nor End Manifold Okl%o Holes Located on Bottom Are Equally Spaced r Force Main From Pump ~ S First Hole Next to manifold X i e Cleanouts~ Distribution Pipe Layout p ~y 1 R ~y s .3:) X Y Hole Diameter Inch Lateral " Inch (es) Manifold " r r Inches Signed: 04 Inches Force Main " License Number: Invert Elevation r) . Date: Holes Per Lateral Number of Laterals .3 Total Holes 75- l1 PJY ~.C~r~v n Cl0 i e ""'14 Page SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" fLk-VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK 6 WARNING LABEL M IN. 18" LIN. 18 MIN. INLET WATER TIGHT SEALS GAS. TIGHT: APPROVED FILTER A SEAL JOINTS WITH APPROVED --I ALM APPROVED PIP,; PIPE 3' S B ' ON 3' ONTO ONTO SOLID ' SOLID SOIL SOIL PUMP OFF ELEV. FT. V'UOFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE -2t° l~-~ S =v. L~~ rn TANK MANUFACTURER : (A~ e S-e v- 10-,3-7 X S" l TANK SIZES: SEPTIC_ GAL. DOSE VOLUME INCLUDING DOSE 6©c) GAL. 35-• tab GaI;-~FLOWBACKz 97.71 GAL. ALARM MANUFACTURER: 6,T E RA o CAPACITIES: A = INCHES =,?b/.LLGAL. -MODEL NUMBER: 'InI SWITCH TYPE: B = 2 INCHES = 33. s. GAL. -,me, h4-4141ril PUMP MANUFACTURER: :Zp,o_//.~- j- C = INCHES = GAL. MODEL NUMBER: SWITCH TYPE: D INCHES = ~ CAL. REQUIRED DISCHARGE RATE,1!2 5 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE I~~y FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . .S- FEET + , )Do FEET FORCEMAIN X x,07 FT/100 FT. FRICTION FACTOR 4. FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH •34" SIGNED: LICENSE NUMBER: DATE: 1/88 a + O L~ 0 0 D== W D- W Z Or J ~YLn wZ , LLJ U "4- of m 000 10 F ri CO ci a Y Q p,0 a: ¢ aN to-(L N" mm X. zZ O~~ ' 0'J _,2 p _O W c O U O (n O. N W F- W 0 0 Z l_=JCJ = 00 0 U) W M o 0 O Nto C9 F- V Q °u ~O ? ~7 (n0 }0: °OO q- K) I QWW DOn O fro w a CL LO `VJ iNOOOF=_In (~/7 ~tWF- N~ I~ p Z O' n r)~~L~~ZW~- JWU W -N j ~J3 a O vi . oo===~ ..Ztm 0OW 0OW a v) o ° z°a~oaw z sowv~' °z ma zEn~-• a F-~ Z3mUm=JgM:3 Q 0. U Z W 1- F- Q J J O Q O Z - 0 v O z , ' W W n o ' Q ~ N v7 R ' W „1~8 0 „sC „99 TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N MODEL 152/153 w MODEL 152 153 :2 U_ 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3:1 61 231 70 265 0 15 4.6 53 201 61 231 s 20 6.1 44 167 52 197 30 z 8 25 7.6 34 129 42 159 } 30 9.1 23 87 33 125 0 a 2p 35 10.7 22 85 ° 40 12.2 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 014609 0- 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 s t/a 3 27/32 4 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing Panels available. ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase I - systems. I . • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. I 1521153 Series 12 1/8 152115 3 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex S 1/8 N152 115 1 Non 8.5 i 2 or 3 8N152 115 1 Auto 8.5 Included 2 or 3 8K2064 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or3 + BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2or3 switch. Refer to FM0477. A_CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Louisv#le, KY 40256.0347 Manufacturers of. . SHIP T0: 3649 Cane Run Road 4). Louisville, KY 40211-1961 r=ffYPad/P9 SN6E 10F 0 ® (502)778-2731-1(800)928-PUMP http.lAvww.zooller.com A/ T . FAX(502)774.3624 0 Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of A FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 1000 al 0 NA Permit # Septic Tank Manufacturer WIESER ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer .ZABLE ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A=100 12{x) x 16" ❑ NA Number of Public Facility Units IN NA Pump Tank Capacity 600 al ❑ NA Estimated flow (average) -Ano gal/day Pump Tank Manufacturer WIESER ❑ NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer ZOELLER PIMP CO ❑ NA Soil Application Rate 0.6 al/day/ftz Pump Model 153 0 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit M NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BOD6) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L I.X NA ❑ At-Grade EX Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 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 every: [3 month(s) (Maximum 3 ears) ❑ NA y: 2 year(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2 ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: 13 13 month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: 13 E1 month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: 3 13 month(s) [3 NA month(s) ❑ NA Other: At least once every: ❑ 0 year(s) 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 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 (Y3) 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. OWNER: WAYNE HOJEM START UPLAND OPERATION Page 8 of 8 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 f5 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 available a holding tank may be installed as a last resort to replace the failed POWTS. IM 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 Name Phone 715-772-3278 Phone 715-273-5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name ST. CROIX COUNTY ZONING Phone 715-273-5811 Phone 715-386-4680 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. OR I ~ . 'At J~ D RECEWED lb Wis. Dept of Safety and Proft nal Services S IL EVALUATION RE Page of 3 Division of Safety and Buildin s MAYjn with S 385, Wis. Adm. Code County Attach comPiete site plan Mi f VWX 11 " es in size. Plan must include, but not limited to. (BM), direction and Parcel I.D. an=u. I Percent slope, scale or d" and distance to nearest road. _ 2 - Z~ y1 ~ - ~ 0 U~ Please print an irotliDRns~Or►. Reviewed Date Personal udarrne~on+ proNde mfr be used for saoafdery pMpos~s (privacy Lahr, s. 75.04 (1) (m)). 5 Property owner / Property Location 0TE/y Govt. Lot `C 114Sa1/4 ST e?8 N R ~c(o W Property Owner's Mailing Address Lot # Block # Subd~Naree or CSM# City State Zip Code Phone Number -8-C4 age ®Town Nearest Road S !l/~/ 4,1&e-,Y I L✓I 5' 7G 71 ( /S') y8- 7,74 N ❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate yS0 GPD [SReplacement ❑ Public or commercial - Describe: Parent material Sl i rY tE.O/~E.✓/ o dE.c G cAuvt T/LL Flood Plain elevation if applicable 1414 ft General comments i /O u,rp Y°oW )-S and recommendations: / G SANG G /F /I E60~1i7~ErtJ~O S. El. o /o!. G a,✓ /ao . o S~ SGo6~Ej FED j',4Lt ~J/Y/T6 Pi.✓Et ro 6E REi•i•oe.*O co.✓roo~t © Boring # © Boring pit Ground surface elev. 40.0 ' ft. Depth to uniting factor ?O Soil Application Rater Horizon Depth Dominant Color Redox Description Texture Structure onslstence Boundary Roots GPD/It 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. f D-8 oY2 2 T s 8 . _ . _ C s G 8 3 13 a /o R ! _ s.l .y a61 xi k - - G 0q lot, _5'o/G UE'S~ AFL/a s✓ ~/ci its o f ►`sJoR o ~t ~f,/q NS a Boring # Boring ® Pit Ground surface elev. 98.6 _ It Depth to limiting factor /B in. soa Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 D-S /oYit -?/Z - Z 02 'm t, v aS 8 " a .S o /oYe 3 - S a ~'sd,~ r+~'~ c s , d 8 3 0 - o Y4 / - S/ l ,3 cr6k - G 8 8- o o .t s t/ o/ ors ts- a rr 6k JOY `Effluent #1B OD >30: < 220L and TSS >30 < 150 mg/L * Effluent #2 BOD < 30 mg/L and TSS 130 mg/L CST Name (Please Print) n CST Number /Gf/AEL A sSErl y Address Date Evaluation Conducted Telephone Number /So3 .11tA Y Sr, ~,Ocs ~[,pia~ S5'7o/ y-/d :Iola /S 83 %-8C/o SBD-8330 (R11/11) Property Owner Zlxywr A-0 Tay Parcel ID # Page of 3 Boring # ❑ Boring F31 Pit Ground surface elev. /OD.O ft. Depth to limiting factor /7 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Struc lure nsWence Boundary Roots GPDM 2 in. Munsed Ou. Sz. Cont. Color Gr. Sz. Sh. 391 ff#Z / 0-4 ,0 ,t d12 _ v v - A 8 -0 7ql IV 2 N-7 o ye 6/3 - S+ i,F ,A c s ;P-,q B d 3 o u 3 - S 6k ,'r - co 8 /o Y,t J-ca At SAW I' S•/a 1 Xkk - ley Al G /Y f, a Boring# ® Big ❑ pit Ground surfaceelev. 99. z ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. NMI N11#2 - O oYa 6 3 - -~i 3 0-8 a A / 8 a7 o Yet Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence Boundary Roots GPD/ft 2 in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. ff#I ff#2 F • Effluent #1= BOD 5 > 30:5 220 mg& and TSS >30 150 mg& ` Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 rngR The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SB"30(RIcn1) wopeA~r oo r .E/r~y.~E fi~o ~ra.,~ Po od IDm rvm _,gLor-J-- . 51 P atound:vtFa~ deer. 1ee_a Jf a Oepw m g bw /r " i~. w A 1, 0, PAP Ebthpt El11I& Oonioold Cob► Re do~ Dolt Teodom Stroca londwy bale GO= IL Mond Qo.OL Molt Oobr OG SL Ste. ' O- o s ".Z L d 2 r e i c -#b A& 913 LAM k c 3 /O-/Y AM t 6L a 1 1 soft* ' Ho lom1 51A. I~dvrD~oee TeKWS Bkct r ;aOddium PAM GPM L J 13 soft D 0 Abe,■et_a.~+➢_~. ia. Ra00 ' Flaieon am* Dmvft cdw t~edmcOeoa ir4* s audow iilunsd QX St Copt COW 6r. Sr. SR •ArentS'l~80D ~>804?~~~R.apd't$aa~10~13Dnglk• 'plvopR!',2meOD •c~Ongll.aodTS3=S0~epIL DOPL of Sir and PwOmioml Wvieeo is in egad aPPomft mviee R°' '°d'mspt°~"r' ifyai need arda<aeoe to aooete~oasamaLm~+eLiom~~~~6Qa"~6b-313i arTIYR~►~ £d Wdzz : eo z L0z £I '-ldu K"-PM914 : 'ON MA uass r,13t*o I W : wodi ml w~ ~o 4 x b 00 c- ~e Q ti o e 00 v^ i Q~ v bt2 N r z a ° w to V V ~ H H ~~UV QJ w w a w a o°e fit at U to R ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND yy 11 OWNERSHIP CERTIFICATION FORM Owner/Buyer c- Mailing Address y P r r e - 5 4- C r a u o a Q' ~p r r~ V Gt 4e r` t~ 54F7 ~c? - 8~ ~7 as f Property Address ~ ~ 'O- e rc - S h. C ro ; x ~ o a d sp rr r ~ yn j fir L JS S e/767 - P'KK (Verification required from Planning & Zoning Department for ne of 9 w construction.) DO v / - 2CO Z ~4-- City/State '5 U~ 1 ~ y r s~Cti, S ~ Parcel Identification Number 608- - 2,cO z ZD -(S&o LEGAL DESCRIPTION Property Location C % , S1-~_i/ , Sec. , T,-)&_N RjoW, Town of q-~ $Q Subdivision .~v y? g Certified Survey Map # , Volume Page # syFv = 3a3.5- e9 5, 5- isq Warranty Deed # 3'q98 = 3 i'13 lA , Volume S-o S , Page # Spec house ❑ yes jQ no Lot lines identifiable k 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. 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 property described above, by virtue of a arranty deed recorded in Register of Deeds Office. Number of bedrooms 3 , c 4 5'/ / l 0701 :SIG TUBE OF APPLICANT(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. 08/05) Parcel 008-2002-20-000 04/26/2012 10:48 AM PAGE 1 OF 1 Alt. Parcel 36.28.16.548B 008 - TOWN OF EAU GALLE Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C Current Co-Owner WAYNE J & RITA HOJEM O - HOJEM, WAYNE J & RITA 2642 PIERCE/ST CROIX RD SPRING VALLEY WI 54767 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2642 PIERCE/ST CROIX RD SC 5586 SCH DIST SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 36 T28N R1 6W 5A E1/2 OF W1/2 OF E1/2. Block/Condo Bldg: OF SE SW & 1/2 INT IN WELL EZ-U-1499/317 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-28N-16W SE SW Notes: Parcel History: Date Doc # Vol/Page Type a > 2012 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/07/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 29,700 147,600 177,300 NO PRODUCTIVE FORST LANDS G6 3.000 13,500 0 13,500 NO Totals for 2012: General Property 5.000 43,200 147,600 190,800 Woodland 0.000 0 0 ' Totals for 2011: N General Property 5.000 43,200 147,600 190,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 No. S-IO. Warrontr Dood-By Corporation. (STATE OP WISCONSIN) Publbbed by Eau OMJu Boox s Stailanati Ca ShortForm. (Sec. 236.16, win, statutes) germ No.}„q 3 1- 9312 X1#9 ,Nf UbMlurk Made by . Tiae Graslie Company a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, grantor, of Pierce County, Wisconsin, hereby conveys and warrants to • Wayne J. Ho jezn and Rita %•i. Ho jean, h- ;s ;rife • grantee s , of St . Croix County, Wisconsin, for the sum of Ten Trlousand Five Hundred Dollars (_~y 0,'_'00.00) the following tract of land in Ste Croix County, State of Wisconsin: The East Half (i_:z) of t:1e West r_al f (V;z) of tlie Ias t zial.f (Z~:? of the Southeast quarter (:3 of the South-vrest .Harter (Sji Section • 11rty-six(36), iow-r_s lp 28 7-:orth, Ran-;e V). -lest, reserving, :iowever, to cI:.e grantor, its s-iccessors ar-It ass ;-fin-., an undivided one half interest In a i5 i ' ~*rilleci ~rel1, .)~~•p, and electric pu-ap:in ; sy s t e.•i. TRANSFER $0..50, ~'EFa ` REGis-reRs OFFIGF-- ST. CROIX CO.. WIS• Recd for Record this__5th - day of_Nov~mber _q.D.2973 Re'gi'ster g/ (7gDds 31a MttnZOO CMDZU0t, the said grantor has caused these presents to be signed by Kat_-.erIne K. Buss , its President and countersigned by Jaeies S. Vedder ,itsSecretary, at a.~)rink; Valley Wisconsin,andits corporate seal to be hereto aMxed, this ~1 day of Se )ter• oer , A. D., 19 73 Signed and Sealed in Presence of _ ara~.lie Cor-ioan:; Tit Ra ierlnc Bj~s4.,J > Counter ed: . • • ~ • . Secretary Jaz.ies S. Vedder ~tiite ut ~tScl~n~tn, - ' t fierce County. ~Personally came before me this 30th day of September , A. D., 19 73 Katherine K. Buss President, and James S. Vedder Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such President and Secretary of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as th f said Corporation, by its authority. James Vedder G _ 1Votary Public, State of W_ is* P U ia:• My Commission a&,p $AXS _ is permanent. Draf#edbys F. Vedder Elmwood, Wisconsin 54740 BaoK 05 wE 71 (x a_-cs. as wsn- sae.. yr,.ta.. tree .n tea. to ti. ~ra.a aeon brow, saatw mutes or tss.w ss.re. the M.,... of the wt~ arant.er, Witn•na~ And aotar~a DOCUMENT NO. i STATE DAR OF 16,7ISCON'SI4'1-FORIL.1 1 Et p•p NOX 'L,C 3 t1Y ;AGES. h j TIiis SFACk R£SE.IVED FO,R RECORDING DATA .32358 REGISTERS OFFICE James SC Vedder ersonal re-P=e- TBIS DEED, made between p ~ 5T. CfcoI:C co, w1.... sentative of the Estate of John H. Gras lie j6-,'d 747 Record thls--~2 Grantor _ Jayoff__ 11-930&x%_-A.D.19!1 - and Wayne J. Hojem and Rita M. Hojem, husband and -71fe P,.3(} gam. pq - as joint tenants Grantee 1 W itoe s s e th, That the said Grantor for a valuable consideration one d0 lar and other valuable consideration conveys to Grantee the following described real estate in St o CrOix County, RETURN TO State of Wisconsin- TRANSFER ~e 0 Tax Kay # FEE This is not homestead property. The West One-half of the West One-half of the East One-half (V-2 W-2 3Ek2) of the Southeast Quarter of the Southwest Quarter (SE2 SW-4), Section Thirty-s!L.x (36), Township Twenty-eight (28) North, Range Sixteen (16) West, including an un- •s3ivided one-half interest in a 151 foot drilled well, pump and electric pumping system located on the East One-half (E 2) of the West One-half (102) of the East One-half ( k22) of the Southeast Quarter of the Southwest Quarter (SFl SW-4), Sec- i! tion Thirty-six (36), Township 'T'wenty-eight (28) North, Range Sixteen (16) West. :t i• si Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining, And James S. Vedder, Personal Representative •of the Estate of John H. Graslie ( warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Executed at Elmwood, Wisconsin this 4th day of June - • 19 74 t - d , SIGNED AND SEALED IN PRESENCE OF (SEAL) James S. Vedder (SEAL) (SEAL) - I (SEAL) jj ~f,Ir Signatures of James S. Vedder li authenticated this 4th day of `'June 19 74 li ~ Jam ~ F V dd r Title: Member State Bar of Wisconsin or Other Party 1. Authorized under Sec. 706.06 viz. STATE OF WISCONSIN 1 JY ~s. County. Personally came before me, this _ day of 19 , the above named ~i is to me known to be the person who executed the foregoing instrument and acknowledged the same. 1 i t! This instrument was drafted by i James F. Vedder Notary Public County, Wis. I The use of witnesses is optional. My Commission (Expires) (Is) Names of persons signing in any capacity should be typed or printed below their signatures. - KcM7ierc«nc.-ry~ WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1 - 1971 yy • I Wisconsin Departm t of Cerrce SOIL EVALUATION X PT Page of Division of Safety an Buildings - ~ ir►Ardance ith Comm 85, Wis. Adm. Code Attach complete site Ian onqi~er not I 1(81!2 x 1 inches in size. Plan must include, but not limite to: verp5a 1 ;4 point (BM), direction and Parcel I.D. n percent slope, scale dimen ocation and distance to nearest road. P QQ Z Za `2~'Ja 5 ie Date se print all information. Rev Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property 1Ow1ner Property Location WC"- n, H 8 J{ Govt. Lot S E 1/46 b)1/4 S36 T ~ V N R 1 ~ E (or) Property Owner Ma' ing Address Lot # Block # Subd. Name or/C~SM# `-1 l e rC e S Cf a~ y `'y(),t0 6UCVn~ o city State Zip Code Phone Number ❑ City ❑ Village grown Nearest Road erze Sf C'roi' rl~ rrn Uo~(e ~s Sy767 (7/S~'77 -57ab yak Cry (l Ito/ ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate y SD GPD [Replacement ❑ Public or commercial - Describe: Parent material L~S~SS n U-err -ri ( Flood Plain elevation if applicable AM ft. ~I General comments n *a d li' 1 e P Fz~ jl~ e a C e- and recommendations: as A 0 Coot}ou.- 97.9 cam. M b t,t_~ S S ~-e v~ i`\e..s.. C/ ~ , O s IIII R Boring # Boring 2 "-pit Ground surface elev. 7• g ft. Depth to limiting factor a ( 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 b--~ o - L 3 f Sb ds e W ate. ~ e2 O - 3.rn s r t g r -a \]k IL 3- - C 561C ds k a- LJ r v r uf 10 ~ ~ I Y -Fad 7. Sy L 1 vc. alas 3~ ~o s per ,6b ® Boring # ❑ Boring C it Ground surface elev. 9s- ft. Depth to limiting factor Q in. Soil A plication 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 i 8 0-(0 O L Lu-) 3 ;z fu ll II 3 11- 5 10 y 3 lvFr ~ , to 257-YR y- .s L s~ C l v~1 , c 3a7~ 'Sf-b 3o 410/01 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pri!Eev., Signature CST Number t .C2 HIA PS ovl 9 Address D ndu ed Telephone Number NA,~ ~a~ rl~ U" ii l(e w r !b-~l-ll ~7~s1 ~~~~3~7f1 Property Owner "'-f 14 Q 1A©'l-e~ Parcel ID# Page -_of F3-1 Boring # ❑ Boring 2Pit Ground surface elev. -9 Z IV 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 0-7 0W b w ' G * g o 9- 1 S Lj I g 3 -ay to c 2 c UJ i v c y-3 Y2 ~D ZS-Y L (S6 S 7-y8 Io J2 L D - - C~ 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I Effluent #1 = BOD4 > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD4 < 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 at, please contact the department at 608-266-3151 or TTY 608-264-8777. need material in an alternate form SBD-8330 (R.07/00) f P/6 f- Plan 9 ~ Dwher, ~a~ vt~►ti. \ q9. $ \ S.M. (©0' s' `tai o f l `.O. p'P e\ ll90 ' slope 'q ®62 Slope. ~ t y ~ \93 \ lD AC-re5 B.!"I, too'0 ~ C Rd/X COQAITy Tel 1' of jam" PUC p~pi 7h 0--F Ecu. 6-11e- LL) o~ S LL) Sc c. 3(. Ta A) R l b w s s i v a A i ~ SfeL~ ~ S 1 apL ? 35 a 00--t- FIOLO Eu~s~,y v T M41 a, welt ~G[i1P l ~I' l~~J y ~kcep~ ~s ~ho~:~t 44, r7 ZO 6-F Black Top ` 0 N 0 3-0 n d C f C M - 1 7 N C1 N 'p A7 (D a ik 2) (D chi d o o CA C ° o m 9) 0 k. 3 C (p C N FBI 90 O d~ d d fD y 3 00 N N 0) O c fD (D 7 N O jCL 3 3 3 CD N A O O C a m O (D Co O y r U~ Z D m 41 t~ D c• y w O. N C rn 3 n co o o O ° o o m a 0 o ;I 3 r~ v n v v v O O O O c -a x f~/l N O CY v o v N m (DD rn o < ai a y N D D o O O m 0 =r j 0 0) N n 07 3 3 ' cD vI11 ° .7. C N Q 3 o z m ~ < A 2 7 W CL O W CD m (D N m m = m (D au Z CD a 3 ° fn ° co f 0 N Z o F a 0 I a v Q- CD 3 m - 0 0 0 I ° m I A O 1 N O i ~ ti Q o b a CD ti I o ~ c ° I o m !i ~ C) a ti