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HomeMy WebLinkAbout040-1320-00-003 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 592236 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 Township Parcel Tax No: Brian Tienor TOWN OF TROY 040-1320-00-003 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /pp ism ~ CST 24.28.20.2150 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t J L I Z~0 Benchmark 17,45 An ~lcsipg.. v Alt. BM .7 Aeration Bldg. Sewer I.7 131• Holding St/Ht Inlet 7k Co•~ ~Zlo •4 TANK SETBACK INFORMATION St/HtOutlet G 15 ZtA - TANK TO P/L WELL BLDG. Vent t Intake ROAD Dt Inlet / S Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe aw Z_ • 3 J ' t0 - Z • -7 Holding Bot. System 40 • Z //.3• "25 , 48 PUMP/SIPHON INFORMATION Final Grade," fh Z. 3 A 7 Z Manufacturer _y Demand St Cover( J 3.7 1 27. (o GPM (,p Model Num r TDH Lift Friction Loss System H Ft !i Forcemain Length Dia. Dist. to well SOIL ABSORPTIO SYSTEM BEDITRENCH Width Length No. Of Trenches `",PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' ZZ f Guy SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION A CHAMBER OR Type Of SJyste ^ 8 Iv , J UNIT Model Numbers 41 - A4 s. 7 DISTRIBUTION SYSTEM py(1, 3~ (3~,0,~J~►; Header/Manif d ibull ion x Hole e Ix Hole Spacing Vent A Pipe(s) Length (O Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 2,~►. Depth Over Depth Over xx Depth of xx Seeded/Sodded - Mulched Bed[Trench Center Bed[Trench Edges ` Topsoil es No Yes L] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 291 CROIX RIDGE ;DR 1.) Alt BM Description = t 2.) Bldg sewer length = Z-7 - amount of cover = y d h.. Plan revision Required? ❑ Yes o 7 ~ ZT 7 Use other side for additional information. L 1 l /lf~II SBD-6710 (R.3/97) Date Insepctor's i ature Cert. No. Al J j Safety and Buildings Division County 5 C p K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, Wl 53707-7162 ~s ~6201~ A ~9z z WX9ROE33ARMEA -State Tr 'E'S2k ermit Appllcaiivu VW~ ber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note, Application forms for state-owned POWTS are submitted to Project Address tf different than mailing address) the Department of Safety and Professional Servies. Personal information you prow' be used for secon uses in accordance with the Priv Law, s. 15.04 1) m), Stats. 1. Application Information - Please Print All Information G( Property Owner's Nam Parcel # <6 (lr r T r 0.L111 -13Z0 -~v- Properttyy Owner's Mailing Address Property Location l I r ~ j l~ - wvt. Lot t~ ~o~ ` ~.`~G• ~k I so city, Stare Zip Cod Phone Number ✓ Secti~ ✓~t IC M1 TZ9N R &Eo i If. ~ Type of Building (check all that ap y) L 4_;3'__~ Family Dwelling - Number of Bc oms Subdivision Name 2 ol~- 1~ Blo El Public/Commercial - Describe I.Jse ❑ City of CSM Number ❑ Nrillage of ❑ State Owned -Describe Use I O Own OI III. Type of Permit: Check only o4bx n I ine A. Complete line R if applicable} ew System El Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit N her and Date Issued Before Expiration Owner /7 1V I IV. Type of POWTS System/Com ouent/Device: Check all that a 1 lion-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Cmde ❑ Mound 24 in. of suitable soil Mound <C2-'4 m. o suitable 7 r ❑ Holding Tank ❑ er Dispersal Component (expl ) ❑ treatment Device (explain) / Z V. Dis rsal/Tre ment Area Information: j Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose sf) System Elevation ` o~ 07) VL Tank Info Capacity in Total # of Manufacturer u Gallons Crallons Units New Tanks E):LSLIng Tanks m / U 'C' cn L Septic or Holding Tank i I Dosing Chamber VII. Responsibility Statemen I, the undersigned, a e responsibility for installation of the POWTS shown on the attached plans. PI s Name (Print) Pl Signature MP/MPRS Number Business Phone N her is % -Z 7- ~ 71 6 Plumber's Address (Street, City. S te, Zip Code L13z s '7~ a V VIQ nt- e artment Use Only 5 y~ Date ed Issuing. _Signature Approved isapp Permit fee (V Z ve4 :m,,, for lal 4/ ~ IK Conditi for Dis pproval etA1teT lvt,~ (Asper ai cell mUSt dfl bjAgl :Ic; s rro+ int" fSe! ?'tar:sgemen: plan pt o Acerl by plus :klr 4100-rmra~s must kla Mb1*rXq ~a r~gdr: 1 : rtt;!hanrlq~, Attach to compkrse plans for the system and submit to the County only on paper not less than 8 12 z 11 inches in sat SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Brian Tienor ADDRESS 141 4th St. E Aot 1320 St. Paul Mn 55101 SE 1/4 SE 1/4S T 28 N/R 20 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 114.0/112.5' 4' below grade 10/25/16 4 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1211 # of chambers 60 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line Scale = 1/4'1 = 10' 65' B. M,,* 90' S 30 5 -1 45' Pro 4 Bedroom House B-3 a 120' 18% Slope 2-3' X 122' cells with >3' spacing Vents 10' 119 B-2 117' 113' 115' All piping shall be ASTM SDR 30/34, within Croix Ridge Road 10' of tank, piping shall be ASTM F891 t ji3 Quick4 Standard Leaching Chamber with 20.0 ft2 of Area Property Line 5.6ft^2/pair of end caps 4Grade at System Elevatio n Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/25/16 Owner:Brian Tienor Location: SE1/4 SE1/4 S 0T28 N,R20W 291 Croix Ridge Drive Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Sec 'o 4-6. Maintanance an o ingency Plan 7.Filter Cross Secti Signature License nu er 226900 System PLOT PLAN PROJECT Brian Tienor ADDRESS 141 4th St. E Ant 1320 St. Paul Mn 55101 SE 1/4 SE 1/4S X LT 28 N/R 20 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 114.0/112.5' 4' below grade DATE 10/25/16 BEDROOM 4 CONVENTIONAL X00C CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1211 # of chambers 60 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line Scale = 1/4" = 10 65' B.M 90' S 5 -1 45' Pro 4 Bedroom House B-3 120' 18% Slope 2-3' X 122' cells with >3' spacing Vents 10' 119 B-2 117' 113' 115' All piping shall be ASTM SDR 30/34, within Croix Ridge Road 10' of tank, piping shall be ASTM F891 Vent >6„ Quick4 Standard of Cover Leaching Chamber Property Line with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ftA 2 pair of end plates Finish grade elevation Typical Installation 118' Vent G rade Vent 3' 4" 3' .A~30/34 Septic Tank 5' Long F, 5' Long 1 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 122' Cells Same on other end Observation tube/Vent At end of cell A B 30 chambers per cell System elevations: A_114.0' B-1 12.5' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE INFORMATION SYSTEM SPECIFICATIONS Owner j Septic Tank Capacity I j al ❑ NA r Permit # Septic Tank Manufacturer ❑ NA [Estimated ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ~NA Pump Tank Capacity al NA flow (average) aUda Pump Tank Manufacturer NA I i Design flow (peak), (Estimated x 1.5) aVda Pump Manufacturer NA Soil Application Rate . S al/da /fe Pump Model Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter © Peat Filter Biochemical Oxygen Demand (BODS) <220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BODs) <_30 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ 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 IAINTENANCE SCHEDULE Service Event Service Frequency ont linspect condition of tank(s) At least once every: ❑ ear s(s) (Maximum 3 years) ❑ NA !Pump out contents of tank(s) When combined sludge and scum equals one-third (f6) of tank volume ❑ NA (Maximum 3 years) ❑ NA (Inspect dispersal cell(s) At least once every: ❑ month(s) -75-year(s) ~ m Clean effluent filter At least once every: 36 onth(s) ❑ NA ear(h) 1 ❑ month(s) NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) 19ush laterals and pressure test At least once every: p earth(s) NA Y ether. At least once eve: ❑ month(s) NA rY ❑ year(s) ~?ther. 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 lincude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of =mbined 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 -egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (f6) or more of the tank volume, the entire contents of {:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. IN[ other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the pOWTS check treatment tank{s} for the Presence o painting products or other chicais tt><}t cell(s). If high concentrations are detected have the contents of thb may impede the treatment eroces,~an9 ~~o ~o~a use~~ tank(s) removed by a septa9 System start up shall not occur when soil conditions are frozen at the infiltrative surface. ter will bis hwater levels. When Power is restored the excess wastewater To rface discharge of effluen.L outages pump tanks may fill above normal hig in the backup or surface overloading the cell(s) and may result i. O r prior to restoring power to thle discharged this the situation dispersal have { the ) is of the pump tank tae Servicing perat° normal levels avoid this assist in by manually, operating the pump controls to restore During effluent p pump or contact a cells Plumber er or or in one large POWTS dose, Maintainer to o assist within the pump tank. the area within Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soli absorption area. rolong the life of the POWT : dralin Reduction or elimination of the following from the wastewater Stream may improvq the performance di and sut prolonts, fat; foundation f T$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; dental floss; diapers; asoline grease; herbicides; meat scraps, medications; oil; Painting products; (sump pump) water; fruit and vegetable peelings; 9 pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT taken out of service the following steps shall be taken to insure that the system is propetlY an permanently with chter Comm 83.33, Wisconsin Administrative Code:. and When the safety POWTS abandoned fails in compliance • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. disposed of by a Septage Servicing Operator. • The contents of all tanks and pits shat{ be removed and properly fined with soil, • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space gravel or another inert solid material. CONTINGENCY PLAN must be taken, to provide a code crornpGrrt If the POWTS fails and cannot be repaired the following measures have been, or rep ent system: of a tacemerrt soil absorption system. itable replacement area has been evaluated and may be utilized for the location be infringed upon by sequined ~ The replacement area should be protected from disturbance and compaction and shiould not ed must area will comply result with in the the a rule~ ne in setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement for a new soil and site evaluation to establish a suitable replacement area. Replacement systems effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS tech ogK a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluation ed to locate a suitable replacement area. If no replacement area a available a holding tank may be installed) as must be perform a last resort to replace the failed POWTS. removal of the biomat at the infiltrative ❑ Mound and at-grade soil absorption systems may be reconstructed in place following surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> INSUFFIC tAOT SEPTIC, PUMP AND OTHER TREATMENT TANKS Y UCONTAIN LETHAL GASSES NDER ANY IC RcU STANCESa DEATH MAY IRESULENT REESCUE O~ A ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN~ PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS NIAtNTAUNER E Name CA ~ r 7e Name 't z~J/ k~ PhW1e Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATO Y AUTHORITY Name Names Phone I J . Phone ~l This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&M and 383,54(1), (2) & (3), V sconsin Adminis~ Code. I y•, It ~r i I "Ohl i ;i Q , ~ V P C^J ~ -C- O ~ it OJ----._ - P I ~ O G I I I is ! I IMP' ~ M t. . 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/I3uyer t t ~'1 t ( ul-- Mallmb Addres 4- Afi Property Addr C V- r 1) ` Q. (Verification required fr Planning Department for new construction.) City/State 4 %11 0 tq Parcel Identification Number 0 ~-i 0 0 60 ' OQ LEGAL DESCRIPTION Property Location %4 ,J 1_ la , Sec. , T 2- ' N R 2 0 W, Town of /J"I Subdivision l D Lot # . Certified Survey Map # , Volume Page, # Warranty Deed # Volume , Pagel# 3 Spec house yes no Lot lines identifiable yes no I 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, I Vhat you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner matenance 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 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 Nkwteivatcr disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank: is less than 1l3 full of sludge. Uwe, 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, Stat6 of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix iC ounty Zoning Department within 30 days of the three year expiration date. O1(b SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe anvare the oiyner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office j i ~ C 1 l° 1 SIGNATURE OF APPLICANT j DATE Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. ry i I vv~i-;f 9~0~° BOTH THAT N T28NHAVE 19W, SURVEYED, THE E NE DIVIDE( C 1.681 ACRES COUNTY OF ST. CROIX, AND STATE °o jj ~6~~8~00 \ 73,221 S.F. / / 7 ! 41 CERTIFIED SURVEY MAP, VOLUME 1, E o~ro j p'^F THAT I HAVE MADE SUCH SURVI 95 MORE OR LESS, BEING 2,031,948 SQt a 3 j Q`~ ^i o (BEARINGS REFERENCED TO THE SOU N 00°35' 04" E 325.32' TO THE PC IN VOLUME 20, PAGE 5033; THENCE % 9 7 'Op Gtiti g5a0 /~0 J ! i 4o THENCE WESTERLY 42.10' ALONG A 1.693 ACRES V4 k' j a0 ° s s~ a~.\ j7 o M SURVEY MAP, VOLUME 8, PAGE 219C 73,757 S.F. 00 SAID LOT 1; THENCE N 88041' 060' ti ?z s1o~ j / ~2 0 F PREVIOUSLY RECORDED AS N 51-57 y l / 65.53' ) ALONG A WESTERLY LINE M LOT 1; THENCE S 10°06' 56" W 977 LOT 46 AND OUTLOT 3 OF SAID PLC y / ` a2o??2j;' / ° " / t 0 N 36°35' 00" E 163.04' ALONG AN cv f) N 34°42' 52" E 340.30' ALONG AN / ~.po• / ! I i r< co / 73,531 S.F. t o^, ° 300.17' ALONG AN EASTERLY LINE d 1.519 ACRES A SOUTHEASTERLY LINE OF PARCEL 66,163 S.F. v E / / . • N t ^ M, 0 v LOT 2; THENCE SOUTHEASTERLY 18£ \ / ow°o j ss o j ° ' RIGHT-OF-WAY LINE OF SOUTH COVI Nw PAGE 5033, DOCUMENT NUMBER 8021 v, t o s s W CONCAVE SOUTHERLY WHOSE CHORD \ S 8726' 25" E o LOT 7; THENCE S 00°37' 00" E 457 _ 224.76' LOT 6 TO THE POINT OF BEGINNING, - o SW 1 /4 OF SAID SECTION 18, SUB, n 1 4 ° ( THAT SUCH PLAT IS A CORREC" 7 _ _ t or 1 _ z THAT I HAVE FULLY COMPLIED 1.455 ACRES ! ¢ S 2.000 ACRES o s9? sso I o COUNTY OF ST. CROIX, IN SURVEYING 63,389 S.F. 87,133 S.F. II R=80' C 4 ccILn~'~ 8g?4~.~ .•~6~, i 195.07 6g2q 0~~ C'' p 00 \ 16 MIN . goo, aa" O 30p I eoq ~ ~ ~ W 31m `~°04 C~ Ego o° 5 nIm REGISTER'S OFFICE o 1.674 ACRES ~j' \ ,ra, ST. CROIX CO. WIS. I I - I Fj- _ J L I - I I Ilu r-1 ELI]I III I _ I - ~ I _ F I ~r~ i °N~ I L ,n•~A: ~~;~,~W 3 I gym' x.~ ~ ~ W Jg Z~ i j on _ III ~ I O 9 I !!owe a ` 3 b 9 p~ i I ~ I Q 10' ❑ as a_--I J a .a ~ 9m a _ a- I ~ ~ ...,a.b, ~ »~Aw Ag _ w~ Nv~i~~ i 'a ~ & c F a u~ 3 3~LL __.._9 ~ --mac,- ~ 3~ O 1 W _ 1_~ ; \ , $4 9z 1 I \ a , ' I. ~ _ i ~ u ~ RECEIVED OCT 31 ?010' Wisconsin Department of Commerce S~t`r"I `ETf>~P Vl'JT4RF~(1~T Pages of Division of Safety and Buildings in accordance A P(MMr~ WT iP~A~~L2&W D 0.CN M A82BYZF 68 vw~ ny Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must cl include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 6'- Please percent slope, scale or dimensions, north arrow, and location and distance to nearest road. A Z4 Q 0 print all information. 72by Dace Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location Se to Govt. Lot 1/4 - 1/4 T Ls ?S N R E (or Property Owner's Mailing Address Lot # Block # Subd. NamjVor. CSM# C P4 City lI State Zip Code Phone Number ❑ City ❑ Village `Town Nearest Road New Construction Use~esidential / Number of bedrooms Code derived design flow rate (J GPD ❑ Replacement ❑ Public commercial - Describe: Parent material y t:f71 i Flood Plain elevation if applicable 'ek General comments ) f U, u~ and recornmendations: System Type U 'W System Elevation s 44 112 , J Boring # Boring M [.gpit Ground surface elev. ft. Depth to limiting factor / ID--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 1 Q-i 0 0.3 to ! s L 7 U Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor inSoil 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 Z 12- m 34- 1 hj / O Effluent #1 = BOD. > 30 < 220 nxA and TSS >30:5 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54 1 5-•/ 715-246-4516 Property Owner Parcel ID # Page of Boring # 11E]&,pit Boring ¢~~4 Ground surface elev7HP 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 td 1,1-2 3, 36 1 ~ ^111Z IAW ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor 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 F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. 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 = 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 (Rb/00) Property Owner _ j - . 7 Parcel ID # Page of n Boring # Q Boring 6 J SPit Ground surface elevt _ ft. Depth to limiting factor J in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 l a-~ U s/ m C,-~ 1 , f Boring # ❑ Boring ' ❑ Pit Ground surface elev. ft. Depth to limiting factor i/ 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. Soil ~Appficafion Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDIff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BODS - 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD, < 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. SB"330 (8.6/00) Project Name Brian Tienor Soil Test Plot PI n Bird Address 141 4th St. E Apt 1320 St. Paul Mn 55101 STM #226900 Lot 3 Subdivision Cove Ridge Date 10/25/16 SE 1/4 SE 1/4S 1 T 28 N/1320 W Township Troy F-I Boring Q Well L Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 114.0/112.5' *HRpSame as Benchmark Property Line 65' M* 1 ' 5' -1 45' B-3 120' 18% Slope Croix Ridge Road 10' 119' B-2 117' 113' 115' Scale is 1" = 40' unless otherwise noted Property Line