HomeMy WebLinkAbout006-1059-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 556347 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:
Svacina, Scott & Leslie C Ion, Town of 006-1059-40-000
CST BM Elev: Insp. rrBMM Elev: BM Description: Section/Town/Range/Map No:
' J.' a~y J11 27.31.16.409
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
915
Septic 0 OZ Benc ark
z 99 5 3
Dosing /o 3 6) Alt. BM 3O3
(sb (O 56%d Yo a
Aeration Bldg. Sewer `
Ot,D udVS6- KL i g. 75 -7 3', V2,-
Holding St/Ht Inlet 7cwt
SGl-f Yo - la D d+.
St/Ht o7t ~'go S/
TANK SETBACK INFORMATION S5
TANK TO P/L (N L BLDG. Vent to Air Intake ROAD Dt Inlet aIA--Q-4-
Septic Z vb, ~ 1 } ' Dt Bottom cc
13-C)
Dosing
Head an. J144
Z Jr
y~
lid alj=
Aeration Dist. Pipe
3 a I Slo e 2.5 9 7. U
Holding Bot. System
a K-- 3. I ~O 9~. 3 ~ o/c
Final Grade
PUMP/SIP INFORMATION L 6 we . d
Manufacturer GPM be and S over , ~~'52.Y5
Model Number
TDH Lift Friction Los Syste Head TDH Ft
3' ~.9 1t
Forcemain L Dia. i~ Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ' I ,
SETBACK SYSTEM TO P/L BLD W LAK EAM LEACH Manufacturer:
INFORMATION B OR
Type Of System: + U
M CV / Model Number. .
. " _ I DISTRIBU ON SYSTEM e-
Header anifold Distribution x Hole Size x Hole Spacing Vent to Air I[nt/ak
Pipe(s) ~ • 2L+ SC TD
Length Dia Length_ Dia Spacing_~ -271 I (o I ~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/S dded xx M hed
Bed/Trench Center Bed/Trench Edges Topsoil )
D lrv~' Yes 0 No J Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Q Inspection #2:1A0/
Location: 1956 240th Street Deer Pa WI 54007 (SE 1/4 NE 1/4 27 T31N 1R116W) 40 acres o ,P~,rceI No: 27.31.16.44009p I ✓ `-C
1.) Alt BM Description =o ! I~ ✓1'l ~I Ce'1~LV~
2.) Bldg sewer length = fl,57k Zy w hb 4,e 17 v- Y, ~{-a9vnd"-t
- amount of cover =
~ S aj-
Plan revision Required? Fa~ Yes No _i I___
L/~ IBS z 1 D'~
Use other side for additional information.
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
PLOT PLAN
PROJECT Scott Svacina ADDRESS 1956 240thSt. Deer Park Wi 54007
ST 1/4 NE 1/4S 27 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX
SYSTEM ELEVATION 96.6' 1.4' sand lift BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
1000 gallons DOSE TANK SIZE 630
MOUND XXX SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 1001
❑ BOREHOLE SWELL *H.R.P. same as benchmark
a~lS ~
I/ , u
E i i NA
0 . A/
se
~ pil~hs~~s~
240th St.
B. M. Cleanout 4p~
i
Gradi ng is to be done Scale = 1/411 = 10'
to divert run-off
away from system tiHuffcutt Combo tank
95.2' 40 Acre Parcel
Area 15' below
B-1 system is to remain
~;''j ❑ undisturbed
Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
❑ B-3
2% Slope
~T_
95.5'
B
94.5'
1320' 0d
Property Line 800/a-7 ro66 -
N
i
eommerce.wl.guv Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 /-r
sco n Sin Madison, Wr 53707--7I62 Sunitury Permit Number (to be filled in by C on )
trioepartment of t;omrnerae 5 54 3 y
Sanitary Permit Applicatio ~ State Transaction
in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the up pr ovemmental / /
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned WTS are Project Address (if different than mailing address)
submitted to the ante Department of Commerce. Personal information you provide may be use for secondary
purposes in accordance with the Privacy Law, s. 15.04 l m , Stafs.
1. A lication Information - lea Print All Information
keh_ t e, A Parcel # r
Property Ow er's Name
SU tC"~> LF 00 _ r Ur
Property Owner's Mailing Address C t 0! Property Location
19 Olk Govt. Lut 7
City, state f f • Zip Code Phone Number O,k ~ y, ~ Section
f (c cle o
cee T N; R or W
A,/ e_Z_, f <S~ ~
19
IL Type of Building (check all that apply) Lot # e-
Subdivision Name
❑ I or 2 Family Dwelling -Number of Bedrooms
Block #
❑ Public/Commercial - Describe Use A r _ ❑ City of
CSM Number ❑ Village of - 01
❑ State Owned -Describe Use Town _
X57 ov n-
-in. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System eplacentent System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New f
Before Expiration Owner
' 1V. Type of POWTS S stem/Cem Went/Device: Check all that appli AN OJ
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil Mound < 24 in. of suitable sail
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) Z 7"'
V. Dis ersaUTreat ent Area Information:
Deal Flow (gpd) Design Soil Application e(g ds f) Dispersal Area Require sf)) Dispersal Area Pro) pos em -levation
v o p. .sz~ ii 2 2 r
VL Tank Info Capacity in Total # of Manufactur
Gallons Gallons Units
New Tanks Existing Tanks E 8 ly
i / ~i' [L V c%~ w Vf W C7 C4
Septic or Holding Tank
Dosing Chamber Q
VII. Responsibility Statement- 1, the undersigned, as responsibility for installation of the POWTS shown on the attached plans.
Plumber's ame (Print) Plu s Signature lvlp/MPRS Number Business PhongN ~J^
Plumber's Address (Street, City, State, Zip i /
VI . Count /De artment Use Onl
Permit Fee Date Issued Iss t Signature
Approved El C~bttOEr~~"e! $ aO
[I t ~ 27 ~Z
v on for Denial
IX Condit gowww easons for Disapproval 3 ~t 3 r A Z) fbL
e / f-Gt
tank, effluent filter and rG r A P~iM. r
1. Septic I Irv, 1.
dispersal cell must all be se- fees / maintained C C_1 `
{
as per management plan provided by plumber.
2. Allsetback regt*ements must be maintained
as per applicable code / ordinances.
Attacb to complete plans for the system and submit to the County Only an paper not less than 11.12 x 11 inches in am
! SBD-6398 (R. 02109)
o~pART Safety and Buildings
g roe 141 NW BARSTOW ST FL 4TH
0 r WAUKESHA WI 53188-3789
Contact Through Relay
www.dsps.wi.gov/sb/
v
~ w www.wisconsin.9ov
sSION[+L~Q Scott Walker, Governor
Dave Ross, Secretary
September 21, 2012
CUST ID No. 226900 ATTN: POWTS -Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/21/2014 Identification Numbers
Transaction ID No. 2149111
SITE: Site ID No. 784103
Scott Svacina Please refer to both identification numbers,
1956 240TH St above, in all correspondence with the
Town of Cylon, 54007 a encv.
St Croix County
SE1/4, NE1/4, S27, T3 IN, R16W
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1392329
Maintenance required; 450 GPI) Flow rate; 20 in Soil minimum depth to limiting factor from original grade;
System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component
Manual - Version 2.0, SBD-10706-P (N.01/01); 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per x.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0"
SBD-10706-P (N.01/01).
The building sewer and distribution network piping shall be of material listed in Table 384.30-3 and
384.30-5, Wis. Adm. Code.
O
In the event this soil absorption system or any of its component parts malfunctions so a health hazard,
the property owner must follow the contingency plan as described in the approved plan sS' on, the owner
must comply with the operation, maintenance and monitoring duties as described in section II of the mound
component manual. A copy of this information must be given to the owner upon completio9t of the project.
All holding/treatment tanks are to comply with SPS 384.25(7)(a).
1 SHAUN R BIRD Page 2 9/21/2012
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.
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. 145.20(2)(d), Wis. Stats.
Owner Responsibilities:
• SPS 383.52 Responsibilities. 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).
• SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. SPS 383.54(4) shall be considered a human health hazard.
• SPS 383.55 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.
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. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
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
This Amount Will Be Invoiced.
When You Receive That Invoice,
Julia Lewis-Osbome Please Include a Copy With Your
POWTS Reviewer 2, Integrated Services Payment Submittal.
(262) 397-6005, Fax: (608) 283-7481 WiSMARTcode: 7633
julia.lewis@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.
t
Cover Page RECEIVED
SEP 14 2012
SAFETY & BUILD ~G>
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 9/11/12
Owner:Scott Svacina
Location:SE1/4 NE1/4 S27 T31 N,R16 W 1956 240th St. Cylon
System type: Mound System
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9-12. Soil test
13. Filter Specifications an oss section
Shaun Bird
Signature
License numb 6900
a+
Z,6
v~
v ~
C~
PLOT PLAN
PROJECT Scott Svacina ADDRESS 1956 240thSt. Deer Park Wi 54007
SE 114 NE 1/4S 27 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX
SYSTEM ELEVATION 96.6' 1.4' sand lift BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
1000 gallons DOSE TANK SIZE 630
MOUND XXX SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Existing 3
Bed roo m
Ho use
0
Well
B.M.* Cleanout 240th St.
Grading is to be done Scale= 1/411 = 10'
to divert run-off
away from system Huffcutt Combo tank
95.2* 40 Acre Pa rce l
Area 15' below
B-1 system is to remain
❑ undisturbed
Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
❑ B-3
2% Slope
LT_
95.5'
B-2
94.5'
1320' 300'
Property Line 800'
Mound System Cross Section and Plan View
~ Dimension Feet
~ A
13
J
T
IY
4.1,y
I7
'•L y .
S •ti ••f
f•
L
r r
1
L _
rJf { { { ♦ •r 11
y~, •Li •f i r r
'05?
.+.:..i } rFr~
•}iy' :i J !M'• r }~}l`} i }fie'{Y{} Ftid ~ r Yr~j•ry : -
.i.. ~ } ~ Yr X".r}J•1 Jay{~ }
r.f. i }ik!'{•{ i%S v{{ti i r.r r f:'ia 7 ~j
rr} . } r•J J.r F}r•1.1 { .l' r CJ~
A I ! y tr, }+L~~yi~'y}S .r i{i{}fti }r}jir}S~µ!!i~J{F i}f; {r f~J:}} kff,
f
is s (
t
G
V
r
II
i
1
I J'
i
I
Im L
Sloe
L
J.}•J
1 Clean aggregate = 4 in. sch. 40 pvc
= Topsoil = ASTM C-33 •=,}r is -
'h to 2 °/z in. dia. 0 observation pipe
Cap Material LLJ sand fill
Geotextile _ H
Fabric
r Ft
D
L
Plowed Surface
2. Ft Contour-
Slope Direction
GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing basal area (L x W) is lowed with a moldboard or
vegetation is mowed and raked off teed fttherso ~'nOunenough at the plow depth to form a''/4 inch soil. wire
chisel plow. Plowing mw,, not proceed imm when a sample is rolled between the palms of the hands. AsTm T -33 ualitys calf sand la der the t diately
more inch unracks
after plowing. Sand is placed with a tracked machine keeping 12
is placed overhead by a backhoe. Special care must be used when placing
cap is placed, less term one ibot
thickness to minimize compaction of the plowed surface. After t topsoil is freezi • seeded and mulched to promote vegetative growth, limit eros
e withdrebrote a closet flanging The
observation pipes are slor.ted in the lower 6 inches and secured in place
!gj Page of
Pressure Lateral Layout
rC'wo Laterals - End Manifold
Cleanout
Lateral Turn-up Plug
Manifold
M
X
I - l , f r Long
Force Main Sweep
90
Bend
Distribution NetworL Specifications_ _ --pressure System Construction
Lateral Diameter In.
Manifold Diameter Laterals are constructed of Schedule 40 PV C
Orifice Diameter In. pipe. Orifices are drilled perpendicular to
X Urttice 5 acin In, the pipe with a sharp drill bit and face down.
- L- J-- Lateral turn-ups terminate with a threaded
L Lateral Lent Ft.
en th) _ Ft• cteanout plug and are enclosed in 6_8 inch
M (Manifold- L- 5 diameter lawn sprinkler valve box accessible
Force Main Diameter _ z- In. _
from finished grade.
Force Main Length Grade
6-8 Inch Lawn
Sprinkler Valve - -
Box
Page of
03/0519i
Septic-Dose Tank: Cross Section And Pump Performance Specifications
Pump Manufacturer
Tank Manufacturer l Number
Pum Mode -
Tank Model Number Marttufacture2. [ C ` _
Total Tank rity MaX$u[y 1 Switch Type lam' wrr E Gt
I
Total pyn nic Head (TDH) - Feet
Filter Manufacturer Elevation Head
Filter Model Numler 1 Distal Pressure C~
'
Netwot'k LOU
M
erfo.nanae Required Force Main Loss
inimum Pump ~ /
GPM ;Ft TDH Total ( v
outlet Manhole Njin. 4w Above Grade With Manhole Min. V Above Grade
Looking Dece inlet Manhole Securely With Locking Device Securely Mounted
5" Below Gr~& Sealed Watertight weadm -proof
Junction Box
a.n .r. Firiighe~;l G'aade " •._...rr
Vent Min. IT, Disconnect
Above Grade Means
a with Vent Cap
<,f,f, Y,Y,Yf•{,•a.: +•,Y,`a•a•,ra`,Y,t,Y,iars•<
. Y . r'i Y r r Y . • ~ '1
"at Filter
Wet Bade
Inlet .A.
a'" - g~rve Capatcity
Switch Weep
: • a ~ . .
• ` ^.7fpI Hole
Tank Volume
incheS Volume Gal.
s Dimension:
(reserve) A. - ; ; Off Elevation C
0
{alarm B Ft Bottom
715-
(dose) Elevation
D
dead) D •,•1•...`rra~: r,'; l/V~`~""...»...~
i y,, sass < a r < r f i•1 f`f`f1i"• •a•' , 1,">
Total 21
i t 4 . 1 f •af Y~ Y~ ,1 r ~ ~ . Y . a a . <':•t , < a
•,'~a / 1`a,a Fafl,a, <•a,a,a; 1< a,", a,c, , la'a•a'a'i 1 i ri'ai's•<•a 1 a < 1 a
~"y.ral4 itar < i f l a a f i. s 1 1~" and back !1' accordance ~
i t•f a',•~ ~ r•r'<~f•~ f•f•a < { i Y i 1 a < { i { • i f f f and filled in YIVV.IllVynW(''`~~ with the
GENERAL INSTALLATION. The se~otic/dose tank• is bad e N ~•s ~ofacturer may not
'yla as, have span,ecifiedefewfi Icvy e, locking device (padlock)
vat speci$cstions. Maximam depth of bttai'
manufacturer "s product.approval. Manhole covers imposed to to the tank with watertight fittings, and
be ewceeder> without }►ir~; aplo v~ material, connected 4„ Soh, 4 p'VC to bridge the tank
installed. Piping at Che t and outlet is of approved
. 16.221.
The forte raain-ss aZodvecl ~vifh - .
prevent Sewing or 3856:108.
laid on stable soil to pig t. 8lec jcal service complies wiihNEC 300 and Comm
excavation and the sleeve is sealed ,w Page of -
02105
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20 - manic facts
5 - = f0 s (Jpper Sleeve and Lower
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FLtty- (iALLONS/141141'rE Little giant rump Co.
PUMP PERf_ ORMANCE:.._C RVE Fry am tai►tY«OMoesACtit OK'13157
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13OWTS OWNER'S MANUAL & MANAGEMENT PLAN Page----- of
FILE INFORMATION _ SYSTEM SPECIFICATK)NS
Owner c- c Septic Tank Capacity ~LrL al El NA
Permit # Septic Tank Manufacturer.
Lj L D NA
DESIGN PARAMETERS Effluent Filter Manufacbrrer ,t 11 NA
Number of Bedrooms _-_r - LI NA Effluent Filter Model ❑ NA
Number of Public Facility Units f NA Pump Tank Capacity J v - al O NA
Pump Tank Manufacturer ~ El NA
~
Estimated flow (average)
_ _ ~.:~fTC7 gal/da~r- _-.~~LL~--/~►--; 'I
Design flow (peak), (Estimated x 1.8) I jV _gaU" -Pump Manufacturer LJ NA
Soil Application Rate z Pump Model el/❑ NA
Standard Influent/Effluent Quality Monthly average` pretreatment Unit ,XNA
Fats, Oil & Greasz (FOG) <30 mg/L 11 Sand/Gravel Filter IJ Peat Filter
Biochemical Oxygen Demand (BODs) 6220 mg/t. C1 NA O Mechanical Aeration ❑ Wetland
'Total Suspended Solidt (TSS) <150 mglL ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) E] NA
Biochemical Oxygen Demand (BODr,) <-30 mg/L EI in-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Soliac (TSS) <30 mg/L _„NA 0 At-Grade >Wmound
Fecal Conform (geometric mean) 5104 efu1100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size in dia. Ll NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: C7 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
~ ❑ months)
Inspect condition of tank(s) At least once every: ear s! (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume El NA
Q month+s)
Inspect dispersal cell(s) At least once every: ear s, (Maximum 3 years) ❑ NA
- - -
Clean effluent filter At least once every: months s) Cl NA
Inspect pump, pump controls & alarm At least once every: ❑ wonthis) F1 NA
-dye
ar(s)- ❑ nthf s) LI NA
Flush laterals and pressure test At least once every:
r(s7
❑ month) s)
Other; At least once every: El year(s) CI NA
Other___------------------------
D 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 Restricied Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. 'T'ank inspections must
include a visual inspection of the iank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and o check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effuent levels in the observation pipes and to check for any pondirrg 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 accumulatior; of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
the tank shell be removed by a Septage Servicing Operator and disposed of in accordanc~3 with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but nest limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of s 12 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 an%, service event,
Page of
START UP AND OPERATION
,For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals 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 sonricing 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 colt(:,) 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 i::ontenis 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 Gump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles oval 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 scrap: ; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine,
ABANDONMENT
When the POINTS 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:
w All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tank:, and pits shall be removed and properly disposed of by a Septagu Servicing Operator.
After pumping, all tank, 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 cannoa. 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 ihould 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.
I'he site has not been e~laluated 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 tho failed POINTS.
Mound and at-grade soil absorption systems may be reconstructed in place following rrtmoval of the biomat at the infiltrative
surface. Reconstruction.; 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/OFD, INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR O'T'HER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DNATH 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
r-
Phone Phone ~~J c
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name ,/7 '
Name
Phone I Z_ - Phone/? n c7
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383-54(1), (2) & (3), wisconsin Administrative Code.
FILTER CARTRIDGE INSTRUCTIONS
Installation
sTR m x Dry fit the filter case auto, the and of the outlet pipe to ensure it is
centered under the access opening. If not, then either Insert more pipe into the
tank through live outlet or sole Lut weld (glue) additional pipe onto the outlet
plpe_
Er' .1 While the case is still 41V fitted on the outlet pipe, measure the length
(it'i4-inch pipe needed to bracta i:h* filter to the tank and wall if utilizing the
optional supplemental side support. If side support method jr not utilized,
proceed to step four.
',.•e.F' :i For installations utilizing) the optional supplementat side support:
solvent weld tine die-inch pipe ono the filter case. If side support method is not r
utilized, proceed to step four. e r pb'~ ; r
Solvent weld the filter .:use onto the outlet pipe. Insert the filter
cartridge into the case, prezinq down until the filter locks into the bottom of ; i
the case. ;s xy r~
If a VRS switch is utili:,rad_ insert into the )liter' and lock by turning gyn.,,,,,, • ~;'`:i
clockwise 900. w:: x. K• ! 'r ,
Maintenance
i.• The effluent filter should he .:leaned every time the septic tank is
serviced. '
2_ open the outlet accoss gpen mg to inspect the tank and filter-.
9. Pump the septic tank compio=tel% making sure to remove the sludge
layer on the bottom of the t.,nk and not just the scum and effluent. 4;,;'
A- Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up on the fitter handle to dislodge the
cartridge from the case. :g
5. slide the cartridge up and w it. of the case for cleaning.
6. If a VRS switch connected is an Morn) is present, the switch
should he removed by turnit:.g cuuinterdockwise 90° and deaoed
with water only. t
•,t ryip,„
While holding the cartridge rn its side (large flat surface facing tt. ,
down) liver the access openKilg, rinse off the cartridge with water
only, snaking sure all septag, _ material Is riflsed back into the tank- ,•z
s. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 90".
9. Insert the filter cartridge ba.:k into the rase, pressing down until
the filter locks into the bottu rt of the case.
Iu. Replace and secure the accEl;s opening an the tank.
..r t:-•av '•ax "7 c; ;,tAY";dd?r,rr ~la'Q:'.,I rt.r ~K~at'~.K'!-v:,T.t.i.7..;... .
www hearonsite.cfisiln 877-WILFXLTURS (653-4583)
12-^-
i
ST. CROIX COUNTY
SEPTIC TANK MAIN'T'ENANCE AGREEMENT
AND
j OWNERSHIP CERTIFICATION FORM
Owner/Buyer JAG Su a
Mailing Address
5/
Property Address
(V'erification required from planning & Zonin De
g partmen# for new construction.)
City/State
Parcel Identification Number
j
.LEGAL DESCRIPTION
i
Property Location %a~ t/ y st2. r
N R _ qW Town of .v~.~
Subdivision
_
Lot #
Certltled Survey Map #
Volume Page #
Warranty Deed #
Volume Page #
Spec house yes Lot lines identifiable Ws 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 ofpumping out the septic tank every three years or sooner, if needed, by a li,,ensed pumper. Wha you ut in
the system can affect the function of the septic tank as a treatment stage in the waste disposal s atf m. Owner p to
maintenance
responsibilities are specified in §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance,
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification for
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper rn, signed by the
wastewater disposal system is in proper operating condition and/or (2) after inspection and pu verifying that (l.} the on-site
less than 1/3 full of sludge. pping (if necessary), the septic tank is
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 Certification stating that your septic system has been maintained must be completed tand returned to the t.Croiix Co Wisconsin.
Zoning Department within 30 days of the three year expiration date. unty Planning &
I/we certify that all statements on this form are true to the best o.fmy/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a wa~amy deed recorded in Register of Deeds Office.
Number of bedr ms J
i
- OF APPLICANT (S} Z
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
preference is made in the warranty deed. y
.j'REV. 08/05)
i
State Bar of Wisconsin Form 1-2003 8 0Tx34025141 4
WARRANTY DEED 940140
DMMMNmata3 DomamName BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
08/15/2011 2:56 PM
THIS DEED, made between Patrleia Thornbv. Kathleen Sand and Duane J. EXEMPT*: NA
Wright REC FEE: 30.00
CTIrantor,"wbether one or morel TRANS FEE: 744.00
and Seatt W. Svu ina and Leslie C. Swaeina. husband and wife
PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Remit Ara
estate, together with the rants, profits, fixtures and other appurtenant interests, 01
Q& County, State of Wisconsin ("Property'l (if more space is needed, please attach Ldd
amen(lunly treen
The Southeast Quarter of the Northeast Quarter (SE 1/4 of the NE 1/4), the Street
Southwest Quarter of the Northeast Quarter (SW 1/4 of NE 1/4), the North Half of
the Northwest QuarteroftheSoutheastQuarter(NI/2oftheNW 1/4oftheSE114), 54 16
1 North, Range 16 West, St Croix County, Wisconsin
all is Section 27, Township 3
06-1059.40.000: 006-ISS94 0400: 006406046050
PmW idaaitiafim Nmnba (PBS
This Is not hm=Mmd p mty.
(is) (u not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and fee
and elm of eaannb ances accept: easements, restrictions and reservations, if any, of record.
Dat«, y zo r
`f (SEAL) (SEAL)
'Patricia Thornby • Saga
(S (SEAL)
• e J. right
AUTHENTICATION ACKNOWLEDGMENT
Signa<une(s) Patrhda Thorebv and Kathleen Sand
STATE OF )
authenticated on (y ) ss.
COUNTY )
Z" kl~- it
+ n Personally came before me on ? d29->- ✓I ~ r U(/
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Duane J. Wright
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) humnent and acknowledged the
THIS INSTRUMENT DRAFTED BY:
a
Kristine Ogland. Estreen dt Ogland Notarybloc, State of Lam-
304 Loeust Street Hadson. WI 54016 My Commission (is permanent) (ecpires: Q Y-19-- 01A
it
(Sisaatmu may be aetheattated or adw wkdaed. Beth are not seen y.) F, fi r,
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO TATS FORM SHOULD BE CLEARLY MENT1F1BpC L .
WARRANTY DEED O 200.1 STATE BAR OF WISCONSIN FO$A[„lMt(~ I- 0
tt • ~7 : t
•'type ramie bd w slpm% INFO-PRO- tapal Foma 0004a6.202t www
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~Wiswnsin epartment of Commerce SOIL EVALUATION REPORT Page of 3
Division of fety and- ~uitd'
u m 2 0 11 in rdance with Comm 85, Wis. Adm. Code
Q
Attach co plate an 8 112 x 11 inches in size. Plan must Y
include, tal reference point (BM), direction and a
Q~ ( f
percent slope, scale or dimensions, north arrow, and location and distance to near aNd'
O L
Please print all information. rte, viewed Date J
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). C~~ Z
Property Owner Property Location
k S Govt. LotJZ-- Pr 1/4/VC1/4 T ~ N R ZE ( 6)W
operty s Mailing Address Lot # Block # S Name or CSM#
0
City State Zip Code Phone Number ❑ city ❑ Village wn Nearest Road
❑ New Construction Use Residential / Number of bedrooms _ Code derived design flow rate ~y GPD
Replacement El Public or commercial -Describe:
Parent material Flood Plain elevation if applicable
General corrxnerns S~ 2 q - l ~ SO L.t Ie,~.~-m n ^ G<.
and recortunendations:
System Type JJ~OU_ / S~~~Gr~ System Elevation
M Boling # 1~. Bnng Pit Ground surface elev. 3 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
IL~V." 51z-
n Boling # El Boring
I I pit Ground surface elev ft. Depth to limiting factor 0~ in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1-0-// 3 z- (.r'
Z G s
Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900 '00~ Address Date Evaluation Conducted Telephone Number
4 7 _ 1 715-246-4516
1008 192nd Ave, New Richmond, WI 5467Z
+ .A
a
Property Owner _ Parcel ID # Page of
❑ Boring
Boring #
a Pit Ground surface elev. ' ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
e
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
❑ Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
E] Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 30 mg/- 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 (8.6/00)
Property Owner Parcel ID # Page of
a Boring # ❑ Boring
~j Pit Ground surface elev. ft. Depth to limiting factor in. Soil icetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsljell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
1 a-1 0 0, 31 Z <I-;.- r
'o, IY
2 S . S
1A I
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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring
E Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon ')epth Dominant Cola Redox Description. Texture Structure Consistence. Boundary Roots GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODO > 30 < 220 mg1L and TSS >30 < 150 mgA- ` Effluent #2 = BOD, < 30 mgA- and TSS 5 30 mg1L
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 (8.6/00)
Soil Test Plot Plan
Prdject Name Wright Estate Shaun Bird
Address 1956 240th St.
Deer Park Wi 54007 CSTM #2269
Lot Subdivision Date 717/11
SE 1/4 NE 1/4S 27 T 31 N/R16 W Township Cylon
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe
System Elevation TBD *HRpSame as Benchmark
Scale is 1" = 40'
unless otherwise
noted Existing 3
Bedroom
House
15
25
80
Well
(inside
B.M. * shed)
100'
75'
95'
B-1 overflow
40' 3 0'
0'
Area of 80'
poor soils n--w 50'
area of poor soils
B-3
2% Slope
2% Slope t-2
95.5' 95'
94.5'
300'
240th St.
1320' Property Line
800'
Parcel 006-1059-40-000 07/27/2011 12:42 PM
PAGE 1 OF 1
Alt. Parcel 27.31.16.409 006 - TOWN OF CYLON
ST. CROIX COUNTY, WISCONSIN
Current ❑X
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
O - WRIGHT, DUANE O
DUANE O WRIGHT
1956 240TH ST
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 1956 240TH ST
SC 3962 SCH DIST NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 27 T31 N R1 6W 40A SE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-31N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/14/2010 924656 PR EZ-1
10/14/2010 924653 DOM LET
10/14/2010 924650 EZ - 1
07/10/2003 729645 2309/398 TI
more...
2011 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/10/2010
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 23.000 3,700 0 3,700 NO
UNDEVELOPED G5 3.000 1,000 0 1,000 NO
AGRICULTURAL FOREST G5M 12.000 18,000 0 18,000 NO
OTHER G7 2.000 15,000 151,500 166,500 NO
Totals for 2011:
General Property 40.000 37,700 151,500 189,200
Woodland 0.000 0 0
Totals for 2010:
General Property 40.000 37,700 151,500 189,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/19/2011 Batch 11-02
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Ilk
e~aro°asrn-Dep nReltofIndustry, SOIL AND SITE EVALUATION REPORT Page-of
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
" COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL l.. #
dimensioned, north arrow, and location and distance to nearest road. o 06 - 1 o Q 6zz
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R EW DATE
~ Q
PROP TY OWNER: PROPERTY LOCATION
GOVT. LOT ' - 1/4 114 S T N,R fl(orrl
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NA E OR CSM #
Iq 7,"
CITY STATE ZIP CODE PHONE NUMBER ❑CI ❑VI GE .®TO NEAREST ROAC)
[ ] New Construction Use Residential / Number of bedrooms ] Addition to existing building
I P W26&1 61~4
~Q Replacement [ ] Public or commercial describe 9ua~ Z -hry
Code derived daily flow ~ gpd Recommended design loading rate gibed, gpd/ft2 2_2 trench, gpd/ft2
Absorption area required, bed, ft2 trench, ft2 Maximum design loading rate 2 bed, gpd/ft2 J,~ trench, gpd/ft2 Vjfj
Recommended infiltration surface elevation(s ~tJ It (as referred_ to site plan benchmark)
Additional design / site considerations 14 1-/
Parent material ~ ! - Flood plain elevation, if applicable ft
~AG S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable forSys m e❑ S 51 U [OS OU ❑ S O U ❑ S El U ❑ S Mil ❑ S W U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizo Munsell Qu. Sz. Co t. Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed Tmnch
elev.
_
ft.
610 A60
Depth to
limiting
factor C
9"S egg a
.3 u - 11
Remarks: _r
Boring #
-'t > -
9-19, JA 5e--9116
~
el 'e~) VP A1,P
Ground
elev. 5
ft - - -
Depth to
limiting
factor
Remarks:
CST Name:-Please Print- Phone:
Address:
(J r i / j 1
Signature: Date- CST Number:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page.-,~2 of!
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground
elev. y s 5~~/~
ft.
-'3 Aldo AIP
Depth to
Z~Z -3
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
\•ii
"t
11-1 -11-KAN
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
47
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