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HomeMy WebLinkAbout020-1356-15-000 P l* Cpl WisconsiA Department of Commerce PRIVATE SEWAGE SYSTEM v' Count Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarMVo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ Cit y If E] ❑ Vill T wn of: State Plan ID No.: Bast, Kernon u Township ,�--- CST BM Elev.:- Insp. BM Elev.: B GST M Description: Parcel T x No.: I CID t I �p, r _ � ( 6 20- 1356 -15 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Z. (a0 Benchmar ,50 104,61 lco- Dosing lt. BM Ifl g io'+• 60 Aeration Bldg. Sewer �.�a oSl 6Z' Holding St/ Ht Inlet 3.�{p TANK SETBACK INFORMATION St/ Ht Outlet 3•b o 3.86 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ? Z NA Dt Bottom Dosing NA Header/ Man. 1 00 . Aeration NA Dist. Pipe V , _ LS- 00 ,$�� Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 5.3$ o Z. 1 z ' Manu cturer and Stcover - 106 qs " Model Nu ber G M TDH Lift ction System TDH Ft Force mai Length H oweu SOIL. ABSORPTION SYSTEM gyp, e � K4ilk4 RENQP Width r Lengt� No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth _ DIMEN L2 DIMENSION Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING 2 INFORMATION TypeOf CHAMBER Model Number System: CAKlt. X25 32 � OR UNIT — DISTRIBUTION SYSTEM s f 1, Header / Manifold IL Distribution Pipe( x Hole x le Spacing Vent To Air Intake Length. Dia. gth Dia. pacin 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: y9 / °b/ 0 ( Inspection #2: - -T-- �� Location: 728 Paul Burch ive, Hudson, WI 54016 (NE 144 NW, 1/4 14 T29 R19W) - 1429192077 Grass Rang. II - Lot 15 ��J4(�•a ` �a.,c�y f�.�w.t 1.) Alt BM Description 2.) Bldg sewer length = 2 - amount of cover = 'g . Pla revision required? ❑ Yes ,No Use other side for additional information.' 13 � SBD -6710 (R.3/97) Date Inspector's Signature Cert. No t ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: 44� E E E g t { g i 1 i t t f i n. 2 i 9 E Sanitary Permit Application Safety & Buildings Division + In accord with Comm 83.2 1. Wis. Adm. Code 201 W. Washington Ave. N* See SCO/fS reverse side for instructions for completing this application PO Box 7302 Department of Commerce Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 [Privacy Law, s. 15.04(1)(m)J (Submit completed form to county if not Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 1 I inches in size. state owned.) County State Sanitary' Permit Number ❑Chec C m k if r' U .previous application State Plan 1. . Numbe T. 310 396 - I. Application Information - Please Print all Inform ation �,�� Location: wner Na Property Ome r Property Location �^ •. I ! ;7 P `! /t/ 1/4 /4, $/ ro T,1 N, 11119 (qrjg petty Owner's Mailing Address ___ 1 n cr, !,� - �) Lot Number Block Number Ci ty, state Lip Code Phone Subdivision Name or C*A-Nmnber / z Ory;IV G II. Type of B ilding: (check one) _ ,' I �I �, i c, ❑ Cit 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village O Public /Commercial (describe use):_ T / `,7,� (ot� �� [/Town of .3 T . 2 — ❑State -Owned ,v £ T z s AT Nearest Road s Y Parcel Tax Number(s) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) mba • a' A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. E3 Addition to System Syste _ Tank Only Existing System B) Permit Number Uate Issued ❑ A Sanitary Permit was previously issued IV, Type of POWT System: (C heck all that apply) fft t -- Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland - Pressurized In- ground ❑ holding Tank ❑Single Pass, Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: t V. Dispersal/Treatment Arca Information: r 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil AppLcalion 5. Percolation Rate 6. System EI ation 7. Final Grade ys� Required Proposed Rate (Gals. /day /sq. 11.) (Min. /inch) T / Elevation �fX/ 3 i �� � 7 � 9 . .o VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks t, ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersignstd, assume responsib for installat of the PJATS shown on the att ached plans. umber's Name (print) Plumber's Signature (no Pl st MI'lMPRS No. Business Phone Number vsp 6 _ T I z v - 63s = 60� Plumber's Address (Street, City, State, Zip Co c IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Sharge Fee) Determination oZ2S av —/b — Z90D X. Conditions of Approval /Reasons for Disapproval: a O Ltd u+ r k&Q-t4 _ , IJ sB _S osI 9h S�,xctwllr b� T - -x T3 I fe Q # r = /3�►+, Top ofTSr�b'�K� i (] = rot's TR �� � /„ �,e7-- tfs�• T Z � <.�.5 I >CPO' I /v,O 7,E7 : *kC �rz .� u •n - c d vrR E t7- YLabo� and Human Relations Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 nt of Division of Safety 8 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 St. Croix not limited to vertical and horizontal reference ction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a '$"laic ad. 020 - 1020 -90 WED APPLICANT INFORMATION — PL I BY DATE INT QLL Idi� TION VE PROPERTY OWNER: , kUUjLl7U - ` PROPERTY LOCATION Ker non Bast " `j GOVT. LOT NE 1/4 NW 1/4,S 14T 29 AR 19 for) W PROPERTY OWNERS MAILING ADDR S,S . LOT # BLOCK # SUBD. NAME OR CSM # �,�, ST.cRox r_''� 948 LaBar a 15 1 Grass Ran a Sec. Addn. CITY, STATE 7 E W BER , ❑CITY [ &]TOWN NEAREST ROAD Hudson WI. 5401 �, -- Hudson McCutchen Rd. [x] New Construction Use [x] Residen ty*r f ms � 4 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) area A =99.8 area B=99. 3 t (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [3 ❑U 4:1S ❑U CR ❑U ❑S ®U CR ❑U 0 fl SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure G P D /ft;e Boring # Horizon in. "Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0 -11 10 r 2' 2 none' 1 2 f 1 mfr 2f n .3 ................. 2 I ll-40 10 r 5/4 none sil lcsbk mfr gw if .2 .3 Ground 3 40 -84 7.5 r 4/6 none ms osg ml na na .7 .8 elev. 1 03.8 ft. Depth to limiting factor Remarks: Boring # 1 0 -10 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 .........:::: 2 10 -24 10yr 4/4 none sil lcsbk mfr gw if .2 .3 ................ Ground 3 24 -31 10 r 5/4 c2d7.5 r 5/6 sil lcsbk mfr gw if .2 .3 . 1 6ff • t. 4 — 7. r 4/4 n ne ms os ml na na .7 .8 fi Depth to limiting factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. Now Richmond, Wli Signature: Date: 8 -25 -98 CST Number: m02298 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page2_L-V - 1 PARCEL I.D. # 020 - 1020 -90 . v Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncbry Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-11 10yr 3/3 none 1 2f 1 mfr qw 2f n .3 2 11 -40 10yr 5/4 none sil icsbk mfr gw if .2 .3 Ground - 4 7.5 r 4 6 none ms os ml na na .7 .8 3 0 8 / g elev. 1 03. It. Depth to limiting factor +84 11 �. y® " �` ) Remarks: Boring # 1 0 -11 10yr 2/2 none 1 icsbk mfr gw 2f .2 .3 4 none sil lcsbk mfr qw if .2' .3 Ground 3 29 -38 10 r 3/4 c2d7.5 r 5/6 sil m na gw if np € .2 elev. 10 ft. 4 _ 7.5 r 4/6 none ms osg ml na na 1 .7: . 8 Depth to limiting factor +80 i Remarks: Boring # 5 1 0 -10 10 r 3/3 none 1 2msbk mfr gw 2f .5 .6 sil icsbk mfr w if .2 .3 ................. 2 10 -30 10 r 4/4 none g I 3 30 -80 7.5 r 4/6 none ms osg ml na na .7 .8 Ground elev. '- 1 02. It. Depth to limiting 3( Z factor +89 i Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Kernon Bast CSTM2298 New Richmond, WI 54017 MPRSW - 3254 NE4NW4 S14- T29N -Rl9w (715) 246 -6200 town of Hudson. lot #15 -Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM. top of elec. transformer C el. 100 Alt. BM. top of 2 pvc pipe @ el. 102.00' a t 2 if T- �, -2 #` 9` 2 133 Gary L. Steel 8 -25 -98 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number - 5 t(� Number of Bedrooms Design Flow - Peak (gpd) L &0 Estimated Flow - Average (gpd) 4 Septic Tank Capacity (gal) d0 �. Soil Absorption Component Size (ft) 5 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) / z eo 5 "-- Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The utle filter hall be cleaned as necessary to ensure proper operation The filter cartridge show not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 , R ST CROIX COUNTY 5 - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1CC ZeS% Mailing Address L,c & %g2 - j�� Property Address PWAK AGtXcil kPM ,4!2_: (Verification required fro Planning Department for new construction) City /State (/�ks� -, tom-- f% 0 1 4 Parcel Identification Number did -/354- / S OO d LEGAL DESCRIPTION Property Location, '/4, ,V r / a, Sec. /y . TAN- R,4o_ @4t, Town of Subdivision C i^i Lot # Certified Survey Map # , Volume � 'J — , Page # r Warranty Deed # _ s . !2 7 y� , Volume //- 7 , Page # S Spec house ❑ yes no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber 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 Zoning Office within 30 days o the three year expiration date. ;�-' k"'b_ SIGNAtURE OF A&LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF AAiLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUFAEINT rvd. WARRANTY DEED THIS ­ACE RESERVED FOR RErp RDiNG DA-. STATE BAR OF TOISCONS R.4 2 —1982 529`745 vo�� 4pasE �: ST. f.L RAY..G,_.BRQWN. and ELEANQRE_BROWN aikJa_ E1_irlor .J. Brown, husband.- and - .wife... .... - _ JUN 5 1995 .. -- .... ... ... --- .. - - -- . -- u} 8:00 A conveys and warrants to .. DQNA �DA..� $PEER- BAST -- - -- / �+ .... -- . - - -- ' - - -- _ - y t. 1 i I _. .. . .. ........... ... ... fI RETURN -D /O •_-.. .... .. .... . ..... .. .. for_$1,00 and_.other_valua....a consideration .... - . - I. l - ....... - ... - -- A4 i fit. Croix _ _ the following described real estate in ..... ........ . -_.- -- -. - - -- • - ..County, - _ - _ I 020 - 1019 -40 State of Wisconsin: 020- 1020 - Aax Parcel No:....._._.. NWk of NE'k of Section 14• -29 -19 EXCEPT part to Hudworth, Inc. in Vol. 604, Page 226. NEk of NWT( of Section 14 -2S -19 EXCEPT part to Thomas Wiley in Vol. 958, Page 577. i? Subject to torn road right -of -way along the southerly line of said lands,, i� ' Grantee is responsible taxes for the year 1994, payable 1 ii I I This ---- - - -is. _QQt ......... homestead property. l (is) (is not) Exception to warranties: j I! i Dated this 1St.. day of -- - - - - -- June 19_9.5. i �I( (SEAL) _...._..... -- (SEAL) Rav'G. Brown - _.. a- _.......... �I (SEAL) .(SEAL .... -- -- . ---- •- ---.... ------ - -- --- -- - - . Eleanore Brown I �I AUTHENTICATION ACSNOW LBDGMBNT Siguature(a) .. Ray_. G. ...Brown..and-- ElgaRQre . ...... STATE OF WISCONSIN as. ' Brown County authe ca ..d y .._ ..... 1995_ Personally came before me this ................day of ;i ................ , 19........ the above named i .... . . . . .. .... . .. .... ••• -- -- --- ------ -- ----- •--- -- -- - - -- -• .- -••--- --•------••----- ....-- -•-•-- ---••- -- ••-- ••- --•- j ' Wil iam J. ilbert ----- - - - -•• - - -- ......... ... ----•---•----•---._.....-•------------ •-------------- ------ ------ it TITLE: MEMBER STATE BAR OF WISCONSIN _._•------- ---------------------------------------- (If not. •.. --- ------------- - - - - -- ------- - - ---- -----•. ... ............................ j authorized by 708.08, Wis. Stata) to me known to be the person - ---------- who executed tine it foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY William J. Gilbert. Attorney ........................................... ................... •................ - - - -- ......... 2Q6 ... econd Hudson WI 54016 Notary Public --------------------- - ._.__County, Wia. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not state expiration are not necessary.) date: � Mr I - to �g. S 0 LL- /� a 14 o ° N \ L ei Q cu a / `° e A • •� (V) N W L� 1 i w L o a v • 0 t� ' S ��' j ` (7000 N ¢ N w W ti O Ol xw 3 0 I N N ° W = oo CU W Of b N 3H1 30 IF/13N 3H1 30 3NII IS LO I h 0 ! / IF/TA Hl 30 b /IMN Hl 30 3NI 1S'd3 � .l 'os��` w ' W . N S ¢� co �.~ � U-) 0 m N m O A` cu \�h 4 � F 213' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page /of� Division of Safety and Buildings in accordance with Comm 85, 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 .20 6 — Av e Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). IZrip p Property Owner Property Location Govt Lot 1 /4 S / T29 N R E (oro ropeity Owner's Mailing Address Lot # Block # Subd. Name or CSM# s y City State Zip Code Phone Number Ity ❑ Village f7(Town Nearest Road ( * T .. ......... New Construction Use: ❑ Residential ! Number of bedrooms Code derived design flow rate Ado GPD ❑ Replacement ❑ Public or commercial - Describe: - Parent material Flood Plain elevation if applicable ^' �! ft. General comments and recommendations: Ci�� "�i�� �f,�1�f/ #47; -E '7 Poll mi STt ❑ Boring \ F/ Boring # Pit Ground surface elev. ft. Depth to limiting factor //Z I ' ' % ,• j *&AMicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 o - --- L 2 G of 14 2 L z 3 _ 4 -- © Boring # ❑ Boring Pit Ground surface elev. fL Depth to limiting factor L ` �_ 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 Z" & - G i IRr 4 44) �l[ L A> ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si nature.---- CST Number Address Fogerty Plymbing & Perk Testing ' Dat e Evaluation Conducted Telephone Number 28288 McKenzie Spooner, W154801 4 s Property Owner Parcel ID # Page of Boring F Boring g # ❑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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 • Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth .Pprhihant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff#1 •Eff#2 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/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 f I ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 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.6/00) y� Fogorty Plumblat #221180 28288 McKenzie Rd. Spooner, " 54801 (715) 635.9609 l Lu4,Gltc °uT YU' D A); r �—{ V V � / Y