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026-1133-02-000
> _ 5E/ tea Cd (L « k��o � E+ tc0 � 000 % \/) & » / .e }jcV\j\ \ Cl)} 2 £RR 2 ■ CL«==- ) z \ Eco SEE§$ -' � \ §)\ � M) 1 7 Ica � f (D - z b ) U)z & ƒ 4.; 2 /(D $ ) I B z 2 R ! J U) $ k / 7 ƒ § Q - @ d in 0 \ \ � ) \ z k $ � .� j E§ 2 a 7 c q m m g 6 L E ~ D § § § - t z m a a f CL « ' � I / / z a 2 \ \ \ � C', \ E © I . § < A W m a � 2 � ^ ® R � ' 2 § E $ �_ ) r Q / / G & 6 ° \ # @ � S 2 e e \ \ E \ ■ k § k a - 6 r g ) « 0 § I k a - - § § E o S o z _ a ■ m CL . k L % / 4, c a , k k a. ) 3 $ J Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM\ County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Per i 56958' 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Gess, Brandon & Melissa Richmond, Town of 026-1133-02-000 CST BM Elev: Insp.BM Elev: BM Descri ion: Section/rown/Range/Map No: 106). U Q ' L 06.30.18.915 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 .75 /0 3.7' �+pa o Dosing V✓ L D Q U Alt. BM Z• / / !- S Aeration ( Bldg.Sewer Holding S Ind. t /D -7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / t s qr�. 3 Dosing yel Header/ an.) "r tf. Coo,>Z� Z 3 Aeration Dist.Pipe 2 r/4 8 9 7 Holding Bot.System �y Final Grade PUMP/SIPHON INFORMAT O Manufacturer Demand St L;0 GPM •3 /D/.� � /OO Model Number -B /> / `, •� (�,_��� �, TDH lift,v Friction Loss System H a A TDH Ft Forcemain Lerlgt r Dia.,ti Dist.to Well SOIL ABSORPTION SYSTEM z BED/TRENCH Width Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/Le JBLDG WE L 6 LAKE/STREAM LEACHING [Model an er/r INFORMATION Ty Of System: CHAMBER n C C D Number: DISTRIBUTION SYSTEM_ J sl` aye h"j Header/IvJ�ni�ol�l Distribution / x Hole Siz x Hole Spacing Vent o�Airr ;take /p �' Pipe(s) / / ,G6i Length Dia Length Dia Spacing (Q SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center , Bed/Trench Edges Topsoil E] Yes R No Z Yes L] No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / A Inspection#2: _1 / Location: 936 172nd Ave New wRRiic,,h,�mond,WI 51017(SE 1/4 SW 1/4 6 T3[0N/R1 8W) Pine Valley Lot 2 Parcel No: 06.30.18.915 1.)Alt BM Description= ��/'°'-' I � /p(��•�. 2.)Bldg sewer length= 157 -amount of cover= Z�,S'/'1X � 3 / �x^ � �1 L • , � � , � , �/ _�/ Swb ,Aa Plan sl Required? No 0�Use other for additional information. 7� F SBD-6710(R.3/97) Date _ Insepctor's Sig a �I , Cert.No. 02 � S - ---- < —,— .- - ___..____..._-- --r-_ Tank Manufacturer W(9$5 Pump Manufacturer Z Qat nz Tank Model Number Pump Model Number Sty /S T Tank Capacity 20 Alarm Manufacturer ({' AX&BuryDepth Alarm Model Number- I Switch Type Ao IF L-1 RZ11 N Total Dynamic Head(TDH)-Feet S el Number Elevation Head 5-Jai Distal Pressure � Network Loss [::�:Minimuin Pump Performance Required Force Main Loss GPM r Ft TDH Total Outlet Manhole Min 4"Above Grade With Locking Device. Inlet Manhole Manhole Min.4"Above Grade <6"Below Grade Sealed Watertight Securely Mounted With Locking Device Junction Box `� ••• ` Finished Grade . — No •••... ... Depth of Cover Vent Min. 12" Discomiect Ft Above Grade Means With Vent Cap Y` Outlet Outlet Filter Inlet }` �._ Inlet Bale St ----- - ------ ?<> t A 'i t Switch Settings and Reserve Capacity }< 't y4" fr' Tank Volume= GPI ;< >= Weep Hole 22.'2 >i3 Dimension Inches Volume Gal. ` s B ?i /� > a (reserve)A !i >< (alarm) B 2 ,� t>s Off Elevation _ C }; }t3 dose C Ft '<! Bottom (dam) D Z o`2 s >f D >s Elevation Total 3ro 8Gb >< ' t f i i < ! ! ! ! } Y 3 ! > f > 3 1 3 3 Y ! Y S } f a 3 ! ! f } ! S S > > > 3 3 ! 3 ! ! 3 3 ! } S } > ! } } Y > > S ! ! 3 ! 3 GRNERAL MSTALLAnON: 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. 02/05 LJ Page of t� M`� PUMP PERFORMANCE CURVE PUMP PERFORMANCE EFFLUENT MODELS • ■■■■■■SOLID MIN ®®® K ME Own 111MIll 111011 low illEillillUll lll[jlll 1112111" 1110111 ■■■■■■o11131■°°eee°°is°e Mil °■m�°°e©tea©® =111110111 Mil ELIM mall o° °°° ■\■111 ■\■■■■■■■ mo �.aEMIR= MEN 11IM" mmov©o ■�►11■I■■\ ■■■■■ 0°o°ovaamv0■0®00■° 'i\■■1�■I■■■■■■■■■ oIllm omo®oo°m°oo° ON No .o°0®®o00om0m:mm= 01W mclmmm� �� � aeaam0aa0°om�®�v�■ �:®�I1�li■■■■■■■■■ e�°si°ai°s°°■°s°e°°0oaa°�aoo® ..ice■►I1�,■■■■■►■■■ °°aea°e°°®°a°°v° .\\002-.\■\■■■■\■ VIN OMWI �■■■IS�t. MEMO ■■■■ _ ,. SEWAGEANDE., DEWATERING o®o.00®�000�©moo®m�v�©.e.som•©o 0oom000®000.o..�000�o®oesoovo moo.®o.00�000�©o0.® 0000.© 0.00 :. ■■■■■■■omssasovo•o0oo®©0omo©0v©v0o omssasassasso.0000°°°o°®o®° omsosssasssasssso.0o®o•vov©o 75 � o.mssssssssasassassovoomvo° ■■■■■■©®ssasssssssassass000voo®° ®ssasssassasasossssoso•vo� pi�asasssossossssssassss®oov 60-11■��\�■►�MONO■■■■■■■■■■■ \�\■■\►�■►\■ENO ■■■■■■■■ ■\►�■■\►\\`\ONE ■■■■■■■■ orb\�►\■■\\\\■■■■■■■■■■ . . . � . ■:�\�O■\■\�\■■■■■■■■■■ MOOMM ■�'��■■\���■■■■�.\■■MOON subjected to less than 15 feet TDH. o .. zza?1Z v vvuk �I l� Y FI(tiC TP,re I<L = IC-.) ` ts SO L 90IR(O b fi© ITIV-"t I r�r Q� r and BWWW MvWM . _ 201.W_WadfttonAva.,P.O.; Boot 7162 Sa�mty Permit er(to belled is by()o OQ�N Al`rte S 9 5_b a \� OQ Permit Application `T n TnsMJca�x w r 383�t{�3.Wa 1 a tbdes sabmissioa ofd£ma�nS�e a opri�e �t /v firequiredprWtDottaiftait, 1y pew Ndm Apphcadm fmm far stdoom=d l'OWT3 aye ID Project r,A6C35(- ° } the DePsEtwet ofSafty and RoEcs6anal SwTws. Pemonal-mfummb=yw pwnde maybe used Ew seomdwy J 3sJ I nd Famews igmanrdaDc�e$ltibe Law.&IS m);stws L A - - $—Please PdmtAllh&nwatiea Pam# PropwyOrs NMC (o— /133 ZF-RIONO 55 Cx P;apedyOwnces ((. cf / S) 6 ,aZNO AVA s a Cimsuft 14G��k! Q 6Cttmo No T. 0 It . U,TRw(if Bwldft(check aIItlmtapply) � _ Lots SwAvisimINUMIC $1(K2 Fan*D —Namia;rGfBetbooms y ?. Blodkf Q Pub idCamwguW—Dembe Use Q(Sty of C SMI*mmber ❑Vil)ageof Q Stet Ovmed—Destaibe Usc $Yawn of (U K O1J D IIi,Type afPer (Cbeck only ase box an Kne A. Complete line B if ate) A. 15&=syM= Q Rqjw=Cut3yA= ❑T Tak Rq&mmcnt 0* Q olberMo � t ) B. 0 fat R me � - Revisin C§Hq I rbu gTes&FWkw LetPnei�us PemaitlJaeo�6er aad il0oe l ueA o� aefte Exphadou --T of POWES Cheek aII t rl�-P a I�Cxoaeal Q P=wdwd kW=md Q M-Caade Q h%wd>24 is ofsodd*sDH O jAo®d<2s in.of Ala saij Q HgWMTmk Q OtherDim (c9d=) __ O pr b mu"LD mm{ems V - t Area� f t'L rr nesgpF w{WM D�� DiRa�area Ret (so Pmp�ed(s� gs� .2 . .� k, /COO MOO VL Tank We in Tdd #of - C�IIam GaUaw Unf u° WMTMM DosingChmber gp B�xJ VII.RespoadbirRy Sbftmeat-I tbs of the POWTS dMM MLOS a . PlmdbdsName finO PImuWs ' ` Z4-4 T5 ZSS-ZY(o I fqumWst s � 65 LE 'cnr� o Pes3mitFeed-v DWlsml Agwt " 11 Q e ( b DL CwdWeM 4gAF «sue iew Disapprwal C. -7 ��ie�eg�iatitee�aand m>ioitt.tie`coa�t�F m>>� SBD-6398 UL 11/11) f�Y S w '/4/ N E TRH C-L = fy-) f S©(Lt>Rf L I =s -7/31/ 1y Soil Absorption System Cross Section �_ ft ft 4"Schedule 40 Final Grade PVC Vent Pipe / grf,2 With Vent Cap ".6 ft gq•ZS Leaching --♦► Chamber CfaZSft System Elevation .3 ft 44 ft ft %.Zo 91.`0 Soil Absorption System Plan View ft 3 ft y ft Leaching Trench 1 Chambers 4"Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model EISA Rating s ft per chamber Soil Application Rate ( gpd/sq ft 6pW gpd Design Flow+ Soil Application Rate + ZZ:) EISA= _Chambers 3 rows of 1 7 chambers each. Page 7- of &—V*A-y PA M QT!/ED ` ---Se&+E ALUATIO #1207 I _ W1 + Dqm trnent of safety and Professional Services JUN 13 2014 Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85,Wis. Keith E.Stoner Attach complete site plan on paper not less than 8%x 11 inches in size. Pis NiTY L PPOENT St.Croix include,but not limited to:vertical and horizontal reference point(BM),direion and percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. Please print all information. 026-1133-02 4000 Re ' Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). ► Property Owner Property Location Brandon&Melissa Gess Govt.Lot SEIM,SWIM,S6,T30N, R18W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 936 172nd Ave 2 Pine Valley Sub City State Zip Code Phone Number City ❑Mllage ® Town Nearest Road New Richmond WI 1 54017 1 651-214-2096 Richmond I 172ND Ave ®New Construction Use: ® Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Glacial Oulwash Flood plain elevation,if applicable NA ft. General comments Prc�OSe 3 Dells usiffl a.5 SAR mately 3x87. Upsk)pe cell centered over the 100.00'contour w/SE--%.25'. Center middle and recommendations: cell over 99.35 contour w - 7�slope cell over 98.65'contour w/SE=96.20'. Centerlines of cells staked onsite. C F-1 Boring# ❑Boring ®Pit Ground surface elev. 98.40 ft. Depth to limiting factor 59 in. 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. *081 'Eff*2 1 0-5 10YR3/2 - sil 2msbk mvfr CS 3f-CO 0.6 0.8 2 5-10 10YR4/4 - sil 2msbk mvfr gs 3f-co 0.6 0.8 3 10-17 10YR4/4 - sd 2msbk mvfr gs 3f-eo 0.4 0.6 4 7-5 5YR4/4 gr sl 2msbk mvfr gs 3f-CO 0.6 1.0 5 52-59 5YR4/4 - sd 2fsbk mvfr gs 2f-Co 0.4 0.6 6 59-76 5YR4/4 f2d5YR5/8 sd 2msbk/lmpi mvfr gs lf-CD 0.0 0.2 7 76-96 5YR4/4 sand bands sil m mvfr - - - 0.6 2]Boring# ❑Boring ®Pit Ground surface elev. 98.35 ft. Depth to limiting factor >77 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f12 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'EfM1 MW 1 0-5 10YR3/2 - sil 2msbk mvfr Cs 3f-CO 0.6 0.8 2 5-9 10YR3/4 - sil 2msbk mvfr gs 3f-M 0.6 0.8 3 9-16 10YR4/4 - sd 2msbk mvfr gs 3f-co 0.4 0.6 4 16-21 5YR4/4 - gr sl 2msbk mvfr gs 3f-co 0.6 1.0 5 21-59 5YR4/4 - Sr s Osg ml gs 2f-C4 0.7 1.6 6 5YR4/4 - 2msbk mvfr gs lf-CO 0.6 1.0 7 65-77 5YR4/4 - sl lmsbk/m mfr - - 0.2 0.6 'effluel4#1=BOD?30<220 mg/L and TSS>30< Effluent#2=BODS<30 mg/L and TSS<_ CST Name(Please Print) Signature: CST Number Keith E.Stoner 224059 Address Keith E.Stoner &te Evaluation Conducted Telephone Number 23220 Wood Creek rd.Siren,WI 54872 5/28/2014 715-653-2324 ssn-8330(n.11nc) property Owner Brandon&Melissa Gess Parcel ID# 026-1133-02-000 page__Z_of 4 [i] E]Boring Boring# Pit Ground surface elev. 100.65 ft. Depth to limiting factor >72 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 *Ef#2 1 0-8 10YR3/2 - sil 2rrgr/msbk mvfr Cs 3f-co 0.6 0.8 2 8-15 10YR3/4 - sd 2msbk mvfr gs 3f-W 0.4 0.6 3 )5-24, 10YR4/4 - gr sl 2fsbk mvfr gs 3f-w 0.6 1.0 4 24-67 5YR4/4 - Is I Osg ml gs 3f-w 0.7 1.6 5 67-72 5YR4/4 - sl lmsbk mvfr - 2f-CO 0.4 0.7 #4-bands of 5YR3/4 Is F ❑Boring 4 Boring# Pit Ground surface elev. 94.40 ft. Depth to limiting factor >116 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR3/2 - sil 2f-msbk mvfr Cs 3f-m 0.6 0.8 2 12-23 10YR3/4 - sil 2msbk mvfr gs 3f-m 0.6 0.8 3 23-36 10YR3/4 - sid 2msbk mvfir gs 3f-w 0.4 0.6 4 36-46 10YR4/4 c2d5YR5/8 sid 2msbk mvfr gs 3f-m 0.4 0.6 5 46-55 10YR5/4 - gr sil 2fsbk mvfr gs 2f-oo 0.6 0.8 6 55-61 7.5YR4/4 gr Is 0s9 ml gs if-m 0.7 1.6 7 61-116 7.5YR4/4 °'d sr s 0s9 ml - if 0.7 1.6 ❑Boring 5 Boring# Pit Ground surface elev. 95.15 ft. Depth to limiting factor >72 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 *Ef#2 1 0-6 10YR3/2 - sil 2msbk mvfr Cs 3f-co 0.6 0.8 2 6-24 10YR3/4 - Sid 2msbk mvfr gs 3f-m 0.4 0.6 3 24-28 7.5YR4/4 - sl 2fsbk mvfr gs 2f-m 0.6 1.0 4 28-34 7.5YR4/4 - Is osg ml gs 2f-m 0.7 1.6 5 34-49 7.5YR4/4 - s 0s9 MI gs 2f 0.7 1.6 6 49-55 7.5YR4/4 - Ifs m mvfr - If 0.5 1.0 52"bands of Is-massive like structure *Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=SODS<-30 mg/L and TSS<_30 mg/L The Department of Safety and Professional Servicese 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. P/L Page 4 of 4 ' 2.00 Acres PIL 0 25 50 or""3-10 (F-Q +, ABM I inch - 50 R ID ss ID 114 10% 98.65, Sanitary Site Plan 99.35' 97.00' For: Brandon and Melissa Gess �$ Lot 2 in the Pine Valley Sub. 98.65' SE1/4-SWl/4 99'35' IB •3 Lathe Stake onP/L Sec.6 T30N-R18W 10000 Norway Pines D.Stark BM= Town of Richmond-St.Croix County P/L Top of I"Steel � 101.15' 10.E shot Prpe —�0=9995, IB #6 Four Garage Bedroom Home 100.15' Note:Maintain well and waterline setbacks per SPS 383.43(8)(1) P Elevation Data B#1 =98.40' B#2=98.35' B#3= 100.65' B#4=94.40' 13#5=95.15' B#6=97.25' Norway Pines Top of D. Stark BM=100.41' Proposed Foundation lev.=—102.55' FN#936 May 28th,2014 A BM=Nail w/Pink ribbon in a 14"DBH White Pine w/Orange Ribbon Keith E.Stoner CST#U059 HRP=Same CIL 172nd Ave. ASSUMED ELEV.- 100.00' =Backhoe Pit Safety and Buildings Division County C Rh/.fit 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,Wl 53707 7162 S� C r nit Application __._ State Transaction Number In accordance witkg� (2),Wis.Adm.Code,submission of this form to the appropriate governmental unit ! A is required prior tdobtaining 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 purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. / , L A lication Information—Please Print All Information 931 NO ��� Property Owner's Name Parcel# 0ekQoca(J z. J\=LK<-N Gczs ©26- It 33- d2 -con Property f Owner's Mailing Address ,\ Property Location q3 IC? ) V xP b A V-i5 Govt.Lot City,State r� k Zip Code Phone Number S 1✓ y,, S Vl/ '/S Section �'��►\1rvJ d , ►�1 �5r1 fL� T 3n N. R A(circle o(y U.Type of Building(check all that apply) Lot# 01 or 2 Family Dwelling—Number of Bedrooms aAyx 2 Subdivision Name amc•t / �Oyr, 0 Bl f(i1i li� VAIU-9y ❑Public/Commercial—Describe Use ❑City of ❑State Owned—Describe Use CSM Number ❑Village of n U[Town of I N A� 3 +1�1;,s— Cc�l �✓ LD �-ZO+-?O GI�,4, T III.Type of Permit: (Check only one box on line A. Complete line B if applicable) c � A- New System ❑Replacement System ❑Treatment/Hold- Repla t Only Other Modification to Existing ( lain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Pl Permit Transfer to t Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that apply) g 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.Dis ersal/Trea ent Area Information: L)10 K- Design Flow(gpd) Design Soil Appli e(gpdsfl Dis uired(sf) Dispersal Area Proposed(s System Elevation VI.Tank Info C in Total #of Manufacturer , Gallons Gallons Units �, v° L New Tanks Existing Tanks /n/ / 2 cj K �K. c U va v3 Septic or Holding Tank Dosing Chamber CSC J VIL Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP RS ber Business Phone Number 223ZyZ 715-ti55_21 .�`FF Foy / (01 Plumber's Address(Street City,State,Zip Code) 0. a X SlI bK R, I 1 0,0 Alf VIII.Coun /De artment Use Only proved Eterfe.:R Per/miit Flee Dlate Issueed Issuing Ag Signature eason for Denial $ �/'/5' cO J M V,1-24� IX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1.Septic tank,effluent filter and dispersal cell must be seryi(;ed/maintained as per management plan provided by plumber. 2.All setback requirements must be maintained as per applicable Pffi$rlans for the system and submit to the County only on paper not less than 8 In x 11 inches in size SBD-6398(R I i/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: IR RAQW10 4L Owner's Name: Owner's Address: 9,3L I7Z m6 &6 New I(IfAIAOIJ(J VJ Legal Description: _se Icy SW l/y 51 `T-t) N)R!8 Yki Township: i�ININN_N4JI) County: S( V281 f. Subdivision Name: f 11\lr" VALLE y Lot Number: z Parcel ID Number: 62L III--- 6 z Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cry Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: -I FF Fib X.- License Number: MPILS 22-92 LIZ Date: L1 Phone Number "715 _-75:5-- Zhl61 Signature I/ —;Jx Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 2-kkK%b0 d Mr ,N GFSS 5E: liy S- 14 S1, T ae-� 1"4 vJ -rcw B- -R ic�lmD"o 'VkL-L Y i �Et�(��ItrAK�C :1 -TOP bF 2p3oiA KvkOC Q2-- -M j IZSo CAL, VV(Z:SC'2 -rAN r N UZ �o SUE -P. 2 Aug-15-2013 08:53 AM St. Croix County Plan/Zoning 715-386-4686 3/4 ' �aY Abaamt�sramim t�s S�ttoh I ��sft S ft e 8918"40 t Areda ��� 911 s c >w SY31em EW49km 308 AbsorDIGBAWIM Man Eff '5 o ft � f i Chembem Trench 1 I CCU Trench 2 Header Vera it won Elm 1111111 RI[=MIIIII 111 IN Trench S Leaching Chamber ARNAMM Menutaoturer And Model EISA Rating,2Q_SR ft per chamber SoN Appfk'rafcn Rate �� gpd/sq ft .�gpd Oesign Flow a Solt Apploadon Rate 4. 83A a Chambers 3 n3m of 26 _ chambers each. Page Or�.. 'n FILTERAT .......... IIGE TRUC.- IONS S �a -774 Installation STEP 1 Dry. fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not,then either insert more pipe into the tank through the outlet or solvent weld (glue)additional pipe onto the outlet pipe• length STEP 2 While the case is still dry. fitted o n the outlet pipe, measure t he len r to the tank end wall if utilizing the of 3/4-inch pipe needed to brace the filter optional supplemental side support.If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: ? solvent weld the 314-inch pipe onto the filter case. If side support method is not t utilized rotes to step < , P P four. e " STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. , 2 STEP 5 If a VRS switch is utilized: insert Into the filter and lock by turning clockwise 900. Maintenance i � li 1 ent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. s „ 3. Pump P the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. �w - 4. Once the efflue nt level has been lowered below the invert of the outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. case for cleaning. he cartridge e u and out of the g 5. Slide t g p 6. If a VRS switch connected to an alarm is present,the switch should be removed by turning counterclockwise 900 and cleaned > with water only. t: 7. While holding the cartridge on Its side(large flat surface facing ! down) over the access opening, rinse off the cartridge with water only, making sure all septag e material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. BEAR R ONSITE FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY T RI ER CAR Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from t he date of consumer purchase. BEAR ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper will instructions provided with Inst P care or malfunctions resulting from units not installed,operated,or maintained in accordance all warranty claims.Bear Onsite with tY sales receipt)must be provided to Bear . fof purchase(original ) P h warranty.Proof P dte vo Y P Onsite is not responsible for labor charges,removal charges,installation,or other Incidental or consequential costs. 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aout,ualu yew pule uoilmado alp joj algisuodsaj st jaumo Siladojd alu NOLLVHHa0 aOL,jms angErljgui alp 1t,uazoig ajE saogipuoo p OO os uagm mO lou jjEgs do=s tualsiCS •asn of joud jolwado 2utaWas aftidas E Aq panotuaj(s)*m ag13o slu21UOO aql anEq paloalap aje suop"uaOUOO ggTg3I'(s)lloD jesjadsip otp o2rump jo/pue ss000jd luouipan aq1 opo&m Amu IM slEonuagO impo jo slonpojd iiupupd jo aouasajd agl jo3(s)*m luatulEarl 3132gO S LMOd agl;o asn of joud uoUOnjlsaoo Mau ro3 an.L1V.LS POWTS OWNER'S MANUAL AND MANAGEMENT PLAN r FII.E INFORMATION SYSTEM SPECIFICATIONS Owner lV Septic Tank Capacity Z 1 ❑NA Permit# g Septic Tank Manufacturer /� ❑NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑NA Number of Bedrooms 100gpd/bedroom ❑NA Effluent Filter Model ❑NA Number of Commercial Units Pump Tank Capacity gal qNA Estimated flow(average)* �6jal/day Pump Tank Manufacturer A Design flow(peak),estimated x 1.5* aUday Pump Manufacturer L3 Pump Model ❑ Soil Application Rate . 1=> gal/day fI Pretreatment Unit ❑NA Influent/Effluent Quality(NA❑) Monthly Average** ❑ Sand/Gravel Filter ❑Peat Filter Fats.Oil&Grease(FOG) < 30 mg/L ❑ Mechanical Aeration ❑Wetland Biochemical Oxygen Demand(BODS) < 220 mg/L ❑Disinfection ❑Other: Total Suspended Solids(TSS) Manufacturer: Model: 5 250 Dispersal Cell(s) Pretreated Effluent Quality❑ Monthly Average*** KIn-groom(gravity) ❑In-ground(pressurized) Biochemical Oxygen Demand(BODS) < 30 mg/L ❑ At-grade ❑Mound Total Suspended Solids(TSS) < 30 mg/L ❑ Drip-line ❑Other. Fecal Coliform(geometric mean) _<10 cfu/t 00m1 ❑ Leaching Cham er Manufacturer 2 Maximum Effluent Particle Size 1/8 inch diameter Model CV I I? Laying Length/Chamber *Wastewater Flow Verification and Calculations: Soil Application Rate-Ngpd/fe Area Req. !a Q ft' (Other than bedroom based) Infiltrative Surface/Chamber-ESIA Rating Minimum Number of Chambers d ❑Aggregate Design Flow/Loading Rate= fe min ** Values typical for domestic(non-commercial wastewater Materials:all materials must comply with WI Adm.Code and septic tank effluent COMM84 and be installed per manufacturers specifications ***Values typical for pretreated.wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At-grade Soil Absorption System,Siting,Design&Construction Manual"(Converse eta1.1990) ❑ "Wisconsin Mound Soil Absorption System:Siting,Design&Construction Manual"Converse,J.C.and E.J.Tyler. Publication 15.22 ❑"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems"Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds". R.J.Otis-ASAE Publications 5-77 and"Design Manual- Onsite Wastewater Treatment and Disposal Systems".EPA 625/1-80-012 October 1980 ❑ SBD- 10570-P(8.6/99)"At-Grade Component Manual Using Pressure Distribution' SBD-10567-P(R.6/99)"In Ground Absorption Component Manual" ❑ SBD-10705-P(N.01101)"In Ground Soil Absorption Component Manual"Version 2.0 O SBD- 10628-P(N.6/99)"Recirculating Sand Filter System Component Manual" ❑ SBD- 10656-P(N.6/99)"Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572-P(R.6/99)"Mound Component Manual" ❑ SBD - 10691-P(N.01 101)"Mound Component Manual"Version 2.0 ❑ SBD - 10595-P(8.609)"Single Pass Sand Filter Component Manual" ❑ SBD - 10657-P(R.6/99)"Drip-line Effluent Disposal Component Manual" ❑ SBD - 10573-P(R 6/99)"Pressure Distribution Component Manual" ❑ SBD - 10706-P(N.01101)"Pressure Distribution Component Manual"Version 2.0 ❑Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months s) (Maximum 3 Pump out contents of s) When combined sludge and scum equals one-third 1/3 of tank volume Inspect dispersal cell(s) At least once every ❑months s Maximum 3 yrs-) Clean effluent filter At least once eve ❑months s Inspect controls&alarm At least once eve ❑months ❑ s)ANN A Flush laterals and ressure test At least once every ❑months ❑ s A Valves At least once eve ❑months ❑ s) A Other: At least once eve ❑months ❑ s A Page of ❑Mind,At-Grade,In-Ground Pressure The inspection shall include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory aud.grity..Ponding greatef than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. �.. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing.The laterals should be flushed at least once every three(3)years.Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance,inspection,and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch.COMM 83.33,Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,gravel or other 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 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 syst ems must comply i with the Hiles 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. area.Upon failure of the POWTS a soil and site evaluation to identify a suitable replacement p ❑ The site has not been evaluated tify 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. ❑ 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 CONTIAN 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-ffG // Phone e Phone I S-`Z 55' q(0 Phone SEPTAGE SERVICING OPERATOR(Pumper) LOCAL REGULA ORX.A RITY Name Agency rb i Phone Phone 716 - 4 lo 10/2006 K:\WPDATA\EH\POWTS OWNER'S MANUAL.doc Page of ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Brandon & Melissa Gess Mailing Address Property Address 936 172nd ave (Verification required from Planning&t ing Department for new construction.) New Richmond 026.113302,000 S Cit /State Parcel Identification Number �t t Y ,—T LEGAL DESCRIPTION Property Location Se 1/4 , sw '/4 , Sec. 6 _J30 30 N R 18 W,Town of New Richmond Subdivision Plat: Pine Valley Lot# 2 Certified Survey Map# , Volume , Page# Warranty Deed # � (before 2007)Volume , Page# -T— Spec house 11yes0no Lot lines identifiable❑yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(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 Safety And Professional Services 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 wit ' 30 days of the three year expiration date. I/we certify that all statements o 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 arranty deed recorded in Register of Deeds Office. Number of bedrooms 4 �— 5 /8 /14 S T OF PPLICANT(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.04/12) Il i ll 111 1111 l ll 111 l DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003 8 1 7 7 4 9 1 WARRANTY DEED Tx:4146567 984486 . BETH PABST THIS DEED,made between Marc G.Halle m arn C c ("Grantor" / REGISTER OF DEEDS whether one or more)conveys and warrants to Brandon Gess and Melissa Gess, husband and wife("Grantee",whether one or more),the following described real ST. CROIX CO., WI estate in ST CROIX County,State of Wisconsin: 08/20/2013 11:43 AM EXEMPT#: NA Lot 2,Pine Valley Addition,Town of Richmond,St Croix County,WI REC FEE: 30.00 TRANS FEE: 74.70 *a/k/a Brandon R. Gess and Melissa PAGES: 1 A. Gess RETURN TO St.Croix County Abstract&Title Co.Inc. 219 S.Knowles Avenue New Richmond,Wl 54017 Tax Parcel No: 026-1133-02-000 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them,recorded easements for the distribution of utility and municipal services,recorded building and use restrictions and covenants,and further except 2013 real estate taxes. Dated this 9th day of August,2013. Marc G.Halle AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20 ss. COUNTY OF S+C IBC * I TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me this 9th day of August,2013,the above i (If not, named Marc G.Halle,Wrlij W01 to me known to be the authorized by§706.06,Wis.Slats.) person(s)who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert L.Loberg/Loberg Law Office Notary Public County,Wis. 1315329/asc My Commission is permanent. (Signatures may be authenticated or acknowledged. Both are If not,state expiration date: not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures. `7`.+"" `y p Nth•:.,� � �w M; e W,p O��NTY DEED ft!'1111111fo�rm No.1-2003 wl Parcel #: 026-1133-02-000 05/16/2014 03:54 PM PAGE 1 OF 1 Alt. Parcel M 06.30.18.915 026-TOWN OF RICHMOND Current ❑ ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-GESS, BRANDON &MELISSA BRANDON&MELISSA GESS 143 N ARCH AVE NEW RICHMOND WI 54017 Property Address(es): '=Primary *936 172ND AVE Districts: SC=School SP=Special Type Dist# Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 2.020 SEC 6 T30N R18W PT SE SW PINE VALLEY ADD'N LOT 2 2.020AC Parcel History: Date Doc# Vol/Page Type 08/20/2013 984486 WD 07/13/2004 268632 2615/251 WD 06/25/2002 682535 1915/484 WD 08/07/2001 653155 1694/568 LC more... Plat: *=Primary Tract: (S-T-R 40%1601/4) Block/Condo Bldg: *08-051-PINE VALLEY ADDN 1/17026-01 06-30N-18W SE SW LOT 02 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/27/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.020 21,800 0 21,800 NO Totals for 2014: General Property 2.020 21,800 0 21,800 Woodland 0.000 0 0 Totals for 2013: General Property 2.020 21,800 0 21,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 4 Wisconsin Department of Commerce SOIL TI ON REPORT Page L of Division of Safety and Buildings in accordance wp tbomm 85 Wis. AdMi de County C>To I Attach complete site plan on paper not less than 8 1/2,�c b inches in,siz*Ian mus#-'r include,but not limited to:vertical and horizontal refeo tee"point(B @F ft and`; ' Parcel I.D. Q.ZIa-//'3'3 ��—C,C� percent slope,scale or dimensions,north arrow,and/Inc�ion and distance to nearest koad. ' Reviewed by Date , Please print all info rrinaf�on. 7 Zt?Q� -- 1 J C )� Personal information u rovide may 2 rd f r s nda purposes(Privy � 15.04(1) Property Owner ~� �l1NG �o_perty , c ion Q S GoEE. of 1/4!3W 1/4 S �•j T 3 N R , E(or W Pro e Owner'LsrMailin Address r> q c j° Block# Subd. Name or CSM# V pT• O. Sic . g lO6ca (P�,j e�at" 'e ISOn ��VG f eye 0 City State Zip Code Phone Number ❑City ❑Village ®Town Ned est Road clear 5511 O ( S t ) -7 q 2-0y k j c�YN--1 ,-\ 1 d a New Construction Use: Residential/Number of bedrooms .3 Code derived design flow rate GPD ❑Replacement ❑ Public qr commercial-Describe: Parent material 'act C`n Flood Plain elevation if applicable ft. General comments and recommendations: 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 I *Eff#2 O- S IOVR 31a L aFG-R mrR a s a F , �5 ,'S C*� Z-30 hoit y 4 - -- --- (2 L amseK rnrR CWJ IF •y . b Boring# ❑ Boring pit Ground surface elev. .�J 3 ft. Depth to limiting factor I off,Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. I Eff#1 I *Eff#2 I o-)6 mR 31a - L aF�r Mr (2 Iv-Ira zN R 4 13 ----- L aF5Q k mr R c i F . 5 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L CST Name(Please Print) Sign ture CST Number Address Date Evaluation Conducted Telephone Number SBD-8330(R07/00) r a , Wisconsin Department of Commerce SOIL TI ON REPORT Page L of Division of Safety and Buildings 'A,t > in accordance wi mm 85,Wig , itaS. de c� ,y County J/ ��C1► }�+ Attach complete site plan on paper not less than 8 1/2 13 inches i g L4lan must include,but not limited to:vertical and horizontal refe itmpoint(B� and` ? Parcel LD.percent slope,scale or dimensions,north arrow,and I�;y ion aA,nrd dis to Barest load Please print all info r :aOn.'fr4Y © J' f - Reviewed by Date rj Personal information u rovide may b u d f s nda oses(Price �6i(cksl(15.04(1) oGa1� Property Owner �N#VG t�o�perty ion (� �' r)C. Go o 1/4 SW 1/4 S r� T 3� N R '� E(or(@ Propert Owner's Mailing Address C'a n A c f Block# Subd.Name or CSM# V 70. � A) a i c ar a Soil r'l ua Ile 0 e e10+m 11FAT City State Zip Code Phone Number ❑City ❑Village ®Town Nea est Road ar L SS 110 c 691 ) 7 y 9-04 U$ c�rn 1 a M QVt New Construction Use:PK Residential/Number of bedrooms .3 Code derived design flow rate —1 0 GPD ❑Replacement ❑ Public Comm rcial-Describe: Parent material �UC�a { Flood Plain elevation if applicable ft. General comments M ate- � 5 v e:� " 3 — �� •5 I I R�If1k:.-1�,� (V 5' ►-�S i h �� � "r►�',';Ut"'S and recommendations: `� 55 SS Boring# ❑ Boring Q c pit Ground surface elev. l 7. ft. Depth to limiting factor (�Z 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 I *Eff#2 0-$ joy 31a L 3F&R MER CIS o1 F a -30 Io K y Iq L'L amsBK m,-,R CW I F 3 7-54R 'R - SL _aFSak Mrf ew I VP , s ,9 yg—I� 75 y y - LS 0-Sq fAVFR - F - � • s ® Boring# ❑ Boring pit Ground surface elev. ,5 3 ft. Depth to limiting factor oZ Q 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 )o R .3/Q - L a F R M GL5 2 F , s 3 a� ��-IS 8 1413 - L aaak mr P, cw j r- 3 K-36 a y (-' L a m 5 8 k, m rR Cv) I r q 6 A -7,5 4k 41q SL RrSA K I( *Effluent#1 =BOD5>30<220 mg/L and TSS>3 _<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L CST Name(Please Print) Sign ture CST Number 1JohY,q S-�~ol r(,c 1-74 6 Address Date Evaluation Conducted Telephone Number alb ao� � S+ Scat' ,khn& �A� s �a6 y-a�-01 -,�s-aM-3a? SBD-8330(R07/00) Property Owner 4- 14.11s . rx Parcel ID# Page of a1� F3-1 Boring# ❑ Boring Pit Ground surface elev. ft-11 ft. Depth to limiting factor_c 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 t o-g MYR 31a a F a g-la `1's o-y -------°M--- SL OFS& C W IF • S •9 3 ia-a� 7,5 � y Iq SL msQ IIIF c t le, . 5 , 9 ,s s o-s rAy 7 .a if ,I Fq—] Bodng# ❑ Boring N, Pit Ground surface elev. .SS ft. Depth to limiting factor f,> 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 10(4f,31a 5L (3 F&t, m s aF . �5 .9 o� '7-3q -1,5 2ii q °ivy a Msev- C Vj P '9 3q-1 `I,s y y L S o-s — .-7 i, a 1 t F-1 Boring# F1 Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz. Cont.Color Gr. Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.07/00) • r SE X1 Sw %y Sec., �, +► 3ai'V, R t 8 t4. ►� i S" S art a,cvl yo Q�rfl 1 -T°p 44r } i If s�Gt I ADO / o Ana K� t10' ciz a` V1 - + .:� o�bC�,U L IBM I loo,00 ' ucti +����� m 91,4-a' ��-C Fe f,e-" f-C fts) ;k 99,53 (3 ioa� i� r • .L t ONVI 43J-LVIdNM DDS as 9 03S 'a0� ti/L N .li.�.'l Q�Li►� r �88� �i�9 S.44N— — — - - - -- -- ---- 'S TR6 \ 1N3YY3Sb.3 bla�Ol - W J Z W tp ---------- �--- LL 1 w $ tos °° I 90 8 ,z9• F I w NO < O I w ?\3 II g h w 3 ° O m N N ' � owo Q 8 ,- j m C �z N N V)o 0 t lt;JL.�.01 CL x E-4 I �' 0 t-H O U` 0 g o O ,� J U i < / 8 N I \ m to C14 g j 000 1 F- 0 N r � Z vii ��I M.t�Z.>➢c.Ot I Q A Z ^ J W <#i I P Uw zw ASSUMED BEARINGS REFERENCED TO THE WEST LINE �o OF THE SW 1/4 OF SECTION 6, TOWNSHIP 30 N., RANGE 18 W., ASSUMED TO BEAR NOO'25'01"E. 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