HomeMy WebLinkAbout014-1013-70-000
. Croix
.,o- sin ant of Commerce) PRIVATE SEWAGE SYSTEM County: St
Safety and : Division INSPECTION REPORT Sanitary Permit No:
5563590
(ATTACH TO PERMIT) State Plan ID No:
GENERAL IN IOPers onal informatyay be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Forest, Town of 014-1013-70-000
Beckman, Burton & Diane
CST BM Elev: Insp. BM Elev: BM Description: _ Sectionrrown/Range/Map No:
I
100 bD r be4-',0F K&4t S e - SFc ~ i Ak 06.31.15.91 C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY pe~c TATION BS HI FS ELEV.
rk S eptic C~~ t~ gNt l ( c7lU
DosingU Alt. BM
Aeration / BI . Sewer 08 90• q,
g - S t Inlet Il, f
Holdin ~ "(hFlO Q,C> S
SUHt Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 / Sl 33 Dt Bpt~m S ~.re -4)+ , 5'Z
Dosing to K (4- Header/Man. S Z S p5
Aeration Dist. Pipe lii-
c~ (p
Holding Bot. Sy
y r
UMP/SIPHON INFORMATION Final Grade 3 •1S
Manufacturer Demand St Cover , -
GPM $
Model Number
TDH I Lift f Friction Lost System Head TDH I Ft l
D a.4k t~ Sb
Forcemain Length, r Dia., u Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width t Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WELL KE/ LEACHING Manufactu er.~
INFORMATION CHAMBER OR
Type Of f System If -7! UNIT Mode umber-~
ro-
DISTRIBUTION SC SYYSTEM
Header/Manifold Distribution x Hole Size x Ho__le_ Spacing Vent to Air Intake
C~ L Pipe(s)
Lengt e Dia ` Length Dia pacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over f Depth Over xx Depth of /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil xx Seeded
0 Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 MOnspection #2: ---i -1--
Location: 2632 CTY RD Q Clear Lake, WI 54005 (SE 1/4 SW 1/4 6 T31 N R1 5W) NA Lot 1 Parcel. No: 06.31.15.91C
1.) Alt BM Description = Al/
2.) Bldg sewer length = 33 r It
- amount of cover = >,3(p c J, ' L,-,, C$cH ..F91
an revision Required? ❑ Yes No
-
Use other side for additional information. / 74
Date Insepctors Signature Cert. No.
SBD-6710 (R.3/97)
11 County
f `l Safety and Buildings Division i
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707-7162
Sanitary Permit Application State Transaction Number
A)+
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the approp to ernmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
0 purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats.
1. Application Information - Please Print All Info rma ' n
Property Owner's Name Parcel #
+ c ON- 1D 3-7e>
Property Owner's Mailing Address Property Location
G.. / Tf a .a M U/ / C i
Govt. Lot I
City, State Zip Code Phone Nam ING S -A ~t J yg Section (t3'
circle one
e,tedf- LA T T / N; R / Eo
11. Type of Building (check all that apply) Lot #
1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name
R+f✓1~~GLt0. Block
❑ Public/Commercial -Describe Use 1 ❑ City of
CSM Number ❑ Village of
❑ Stattee Owned - Describe Use t:.s 3 y4#ZO
RJt'S'," ~<<~ r../ ! C~W►^~u CQ ~D Z 56 Townof~S7
III. Type of Permit: (Check odily one box on line A. Complete line B if applicable)
A. ❑ New System kReplacemem System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New
Before Expiration Owner A.
A A,
IV. Type of POWTS S stem/Com onent/Device: Check all that apply) S
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 nt Area Information:
Design Flow (gpd) Design Soil Application gpdsfj Dispersal Area Required (sf) Dispersal Area Pro sed (sf) System Elevation
.~c~ 963 • Z q~•3
1 -77
VI. Tank Info Capacity in Total # of Manufactu er
Gallons Gallons Units a o 0
New Tanks Existing Tanks LJ/' /7%
w U in CIO u. C7 ~s
Septic or Holding Tank 1293
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si MP/MPRS Number Business Phone Number
)AIA
Plumber's Address (Street, City, State, Zip Code) GOF
7;, /7Qy ~
VIII. Coun /De ai tment Use Only
pproved Permit Fee Date I sued Issuin ent Signatur
O even Reason Denial
IX. Condit, *Vyeasons for Disapproval A~ y r L : ` } 54~
1. 0eptic tank, effluent filter and J
dispersal cell must all be services / maintained 1JJtGL ct, ~jd ~b hkwWl- •
as per management plan provided by plumber.
2. Aq setbacK requirtaments must be maintained
as per a leable code / ordinances. 4)
Attach to complete plans for the system and submit to the County y on paper not less than 812 a 11 inches in size
5, PA !1 te,5 cool k,%,. GD
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SBD-6398 (R. 11/11) 2Dr 6116 H : a~~' • `dMIC
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HARD
INA SEPTIC SYSTEMS
MPRS/CST 824825
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: ^3 rn CAI W4AI
Owner's Name: q t j ~ W/
Owner's Address:
&6,44 LA LE WJ
Legal Description: .56, Si 3 Le.)
Township: ; 2 (t .4- 5 -r
i
County: t,)c
Subdivision Name:
Lot Number. j/
Parcel ID Number. 1) `f A)13- 70 -eew
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information -4 t4 AIA64 PLA nl
Page 6 -T'an! X f_ Z. f `"1ir1p e-k SLV€
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. 9,6Z7 A40VAIj4 License Number: wieldn
Date: Phone Number -aSb,?
Signature ~
Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
HARDINA SEPTIC SYSTEMS
MPRS/CST 824825
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3
Soil AbsoraBon Svslwn Plan View
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ft Leaching Trench 1
Chambers
4' Die.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model / /J P e A-ra L Q (G
EISA Rating A_ sq ft-per chamber Soil Application Rate - gpd/sq ft
U~ gpd Design Flow + / Soil Application Rate + a 0 EISA = Chambers
rows of, , chambers each.
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity ❑ NA
~1f /2~1J gal
Permit # Septic Tank Manufacturer yt-m ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 0 NA
Number of Bedrooms 0 NA Effluent Filter Model ❑ NA
Number of Public Facility Units WNA Pump Tank Capacity j gal ❑ NA
Estimated flow (average) j1 gal./day Pump Tank Manufacturer '4/k ~C r ❑ NA
Design flow (peak), (Estimated 'x 1.5) (DO gal/day Pump Manufacturer Q NA 411 Soil Application Rate ! gal/day/ft2 Pump Model 373 0 NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit AkNA
Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (SODS) _<220 mgi?_ ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical. Oxygen Demand (BODS) <30 mq/L )g'In-Ground (gravity) ❑ in-Ground (pressurized)
Total'Suspended Solids (TSS) _<30 rng/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) <_10` cfu1100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ya 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: 0 month )(s) (Maximum 3 years) ❑ NA
year(s
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
❑ month(s)
Inspect dispersal cell(s) At least once every: •Q'year(s) (Maximum 3 years) ❑ NA
- ❑ month(s)
1 yEA~~ ❑ NA
Clean effluent filter At least once every: 4U year (s)
r ❑ month(s) ❑ NA
Inspect pum p, pump controls & ai larm At least once every: year(s) a M C6
❑ month(s)
Flush laterals and pressure test At least once every:. ❑ year(s) J~tJA
Other: At least once ever ❑ month(s) ❑ NA
y: ❑ 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 <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 any service event.
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Septic-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer 14. -r°-r Pump Manufacturer Z o U Lt_(
Tank Model Number / -2,5-51 -79-0 Pum Model Number 5-3
Total Tank Capacity 0 v Alarm Manufacturer 6J6 kgarq3w,5
Max. Bury Depth g Alarm Model Number
Switch Type
Filter Manufactrer T S Total Dynamic Head (TDH) - Feet
Filter Model Number 4r 9~a Elevation Head 1P, 3 3
Distal Pressure -0-
Network Loss Z, 06
Minimum Pump Performance Required Force Main Loss
a.' GPM p , Ft TDH Total /v ,-7 l s'
Outlet Manhole Min. 4" Above Grade With
Locking Device. inlet Manhole Manhole Min. Above Grade
< 6" Below Grade Sealed Watertight Securely Mounted With Looking Device
Weather-proof
Junction Box
F' ished Grade ' - am ft
i
Depth of
1 Cover Vent Min. 12„
Disconnect
Ft Above Grade Means
With Vent Cap
t<ss<<sss cct suss <'s-<'<<'a<ts<'ec<s ,c
Outlet
Outlet Filter
Inlet Baffle ~s
Inlet
a~, - - fE .
► _ < <
Switch Settings and Reserve Ca acity A
y4"
Tank Volume = GPI <'< Weep
Hole
a Dimension Inches Volume Gal. B <
<'<
(reserve) A J 01 >
(alarm) B 2 3 , '7 Off Elevation C
(dose) C 161.1 Ft
4" ' Bottom
(dead) D 10 l. 1
D >c
Elevation
Total ti5 <<<<<<<< ~~.a Ft
> : ► a > ► a > > s s s ► s s ► ► > > a a ► ► a s s s a : <►< s
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GFM,RAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 1628 WAC.
02105 LJ Page of
Zoeller Pump Company Page 1 of' l
W
U- PUMP PERFORMANCE CURVE
MODELS 53/55157/59
a fi 20-
15-
z z 4
¢ 10
a
~ 2
5-
0-
10 20 " 30 40 50
GALLONS
LITERS 0 $0 160
FLOW PER MINUTE
Pump Performance Curve Models 53, 55, 57, 59
http://www.zoellerpumps.com/ImageDisplay.aspx?ProductID=89&ImageName=72curve 1 10/8/2012
Zoeller Pump Company Page 1 of 1
C+ry
PUMP PERFORMANCE CURVE
MODELS 53/55/57/59
0 20
c-
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¢ 10
2- 5-
0
10 20 30 40 50!
GALLONS
LITERS $0 960
FLOW PER MINUTE
Pump Performance Curve Models 53, 55, 57, 59
http://www.zoellerpurnps.com/ImageDisplay.aspx?ProductlD=89&ImageName=72curve l 10/8/2012
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer -3 E_z_ e
Mailing Address - 3 " l E A 1
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number
~AQL4~ w ~
LEGAL DESCRIPTION
Property Locations'/4 , _'/a Sec. T _I_]_N RJ~ W, Town of~ t7a
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page # S d
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑ yes no Lot lines identifiable,j~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 thi 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 w 7 ty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE 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. 09/07)
-,..9 6PACE RE9ERYE•~ k~_P REC^4p.`IG OAiA
!~Oe.l!n•Era`e r!i: S1'_\TU 1,.\tt OIL WISCONSIN FORM 3-19S2
QUIT CLAIM DEED
Diane C. Beckman €/k/a Diane C. Lillie and S "I``°r!`
Bunton B. Beckman, husband and wife
NOV 1 7 !99.;
quit-claims W Diane, C. Beckman and Burton B. , ~ g:30 A.
Beckman, wife and husband as 'surv v.orsh.ip
marital property >~i.`~
- -
z 1
the foliowing described real estate in St. CrOiX County. ' o0
State of Wisconsin: :+e u n. To f.~ .r
Tsx Parcel No:
Part of the South Half of Southw*st Quarter of Section 6, ,
Township 31 North, Range 15 Wert, St. Croix County,
Wisconsin described as follows: Ce-tified Survey Map filed
November 7, 1977 in Volume °2", of :ertified Survey Maps at
page 508 as Document No. 344420.
i
~i
This . . .__._..1.S`'______________ homestead property.
(is) (is not)
Halted t; .is . day or . November 19.95
.
(SEAL) (SEAL)
-E C . BECKMAN
DIANE C. LILLIE
(SEAL) (SEAL)
BURTON B. BECKMAN
AUTHENTICATION ACSNOWL)rDGMENT
Signat:ure(s) 'iTATE OF WISCONSIN ss.
- ST, CROIX
...........................County. ~D~
day of
authenticated this .....day of____ 19.... Personally came before me this
19._ 95 the above named
Diane C. Beckman f/k/a
iana
. • -
TITLF,: MEMBrR STATE GAR OF WISCONSIN B2Ckmari 4Ji a anti •husbari
r !It
(If not .
authorized by $ 70606, Wi3_ Stats.) t -
to me known to be the person __g ...f tivha'exL•clted,)the ~
foregoing Instrument and acknowledge, tbq !"A - .l
THIS INSTRUMCNT WAS DRAFTED By
REMINGTON I,AW OFFICES
.
Judith A. Re into
A. Relr,~ngton Judith
A.. --.....g _ :,~a ',QI
New Ricbmond,,._. l?..... 54Q17 St. Cro1Notary Pnhlic C tv;s•
(Signatures may he authenticated or ncknowledged. Both My Commission is permanent.Ilf n i ~tion
? date: - _ _.._.z-+a,~°.. .1 -
14UTT CI,A!M DF:IiD :4T%TV nAu ON W18CONSI\ t4''.e••.~-:n T,~RnI R'.nnk f..s. Ise.
F O,, . - I9R2 Siilwnu k-r• R°.n
34442 0 %9
NpV
xJ' JAMES . 1977
ke~ly of Ds ~ `41 R 1i
w
HAQMON
r
LAKE
S) /
y,
SwY4-Sw14 'SE%r -SW Y4 v
SE.C .6 , T31 N, RIS W 1
h1 {u r ~ O 0 200' 400•
\ SCALE =
Z m °ad O = I" IRON PIPE SET
r r a /0.9497 ACRES Ike wr. 1.13 LQ1LIN. FT.
1 rn 6Ef1R/m6s .PEArerVCED
S TO WEST L/NE' qF
w SEC. & LvIllel f /S ' ~c
Oy r T or S. T. H. 63
GNtpGF
Ck3y c r..y '
i2 -/553.0' SB9°3~'tu - -Q
P.O.B.
CERTIFIED SURVEY
A PART of THE S W %4 of THE Sw %4 AND THE
S E %4 o3 THE S W %4 SEC T/O.~V 6; , 77.3 / Al, t IS W,
ST. CROIX COUNTY, WiscONS-11V
DESCRIPTION
A parcel of land located in the SW4 of the SW-1 and in the
SE-1 of the SW4 of Section 6, T31N, R15W, Town of Forest
St. Croix County Wisconsin more particularily described
as follows:
Commencing at the SgutY_west corner of said Section 6, thence
on a bearing of N89 37'E, a distance of 1553.0 feet to a
point and this being the point of beginning of this survey;
thence Nio32'E 905.14 feet to a point located S1032'W 20 feet
more or less, from the water's edge of Harmon Lake and is
the beginning of a meander line along said lake; thence
S57010'E 571.70 feet along said meander line to a point
at the end of the meander line, said point 'tieing located'
S40036'E 15 feet more or less from said water's edge;
APPROVED
APPROVAL OF THIS MINOR SUBDIVISIONCont. on next page
O C T 19 1977 DOES NOT MEAN APPROVAL FOR
BUILDING SITE OR SEPTIC SY TEAk
ST. CROIX COUr.ITY REFER TO H62.,O.
COMPREHENSIVE PARKS PLANNING
AND ZONING COMMItTEE
Volume 2 Page 508
Wisconsin Depamrf rce"% bIL EVALUATION REPORT Page of
Division of Safety, an ui ings
ith Comm 85, Wis. Adm. Code
[ag~~ county ST. CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical oe point (BM), direction and Parcel I.D. 14-1013-70-0000
percent slope, scale or dimensions, nort a % ;and distance to nearest road.
Please print all information. Rev' ed by Date G
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). V,7*\ 1 /D /5
Property Owner Property Location
BURT & DIANE BECKMAN Govt. Lot SE 1/4 1/4 6 T 31 N R 15 E❑(or)❑W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
2632 CTH "Q" 1
City State Zip Code Phone Number ity ❑ Vllage E]Town Nearest Road
CLEAR LAKE ( ) I FOR EST CTH Q
New Construction UseE] Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD
0 Replacement ❑ Public or commercial - Describe:
Parent material OUTWASH Flood Plain elevation if applicable ft.
General comments RECOMMENDED SYS. ELEV. = 94.83'
and recommendations:
❑ Boring # 11 Boring
0 pit Ground surface elev. 97.33 ft. Depth to limiting factor 96 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
1 0-13 10YR3/3 -o- SIL 2MSBK DFL CW 1M .6 .8
2 13-28 10YR4/4 -0- SL 2MSBK DFL GW IF .6 .8
3 28-96 7.5YR5/6 -0- LCOS OSG L N/A N/A .7 1.6
1I
tI
I T
2 Boring # Boring 97.33 96
❑ 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
1 1-12 10YR3/3 -a- SIL 2MSBK DFL CW 1M .6 .8
2 12-24 10YR4/4 -0- SL 2MSBK DFL GW IF •6 .8
3 24-96 7.5YR5/6 -o- LCOS OSG L N/A N/A .7 1.6
* Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
ROBERT HARDINA~ 824825
Address D9te Evaluation Conducted Telephone Number
477 170th AVE. TURTLE LAKE WI 54889 10-1-12
t
BECKMAN 014-1013-70-000
Properly Owner Parcel ID # Page of
3 ❑ Boring # Boring
0 Pit Ground surface elev. 97.33 ff Depth to limiting factor 96 in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-13 10YR3/3 -0- SIL 2MSBK DFL CW 1M .6 .8
2 13-29 10YR414 -0- SL 2MSBK DFL GW IF .6 .8
3 29-96 7.5YR -0- LCOS OSG L N/A N/A .7 1.6
I
❑ Boring # Boring
Pit Ground surface elev. ff. Depth to limiting factor in.
Soil -Appli 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 # 0 Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L. and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330Test (R07/00)
HARDINA SEPTIC SYSTEMS
M\PRS/CST 824825
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