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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 582009 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2613335 Permit Holder's Name: City Village Township Parcel Tax No: St. Croix County Glen Hills County Pad TOWN OF SPRINGFIELD- 1 034-1025-30-000 CST BM Elev: Insp. SM Elev: BM Description: Section/Town/Range/Map No: / 60 140 11.29.15.171 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ' CAPACITY STATION BS HI FS ELEV. Add Septic , i Benchmark AZL bl-z es cr 12 Az P iwM Dosing S~.r SLS Altl ; 0 3 '1 If S A~t+ep• Bldg. Sewer 1 7 0/0 qi Holding ~ Z~ SUHt Inlet /0, 35 96, Z5 TANK SETBACK INFORMATION St/Ht Outlet 16.5 ?0, It TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet 1/-Z 89 Septic h11600 Ae N A Dt Bottom 6 Tr (41 -116 - Dosing 7,400 74 / A- 7 q6" Header/Man. t•9t bC 7 7 7 7 Aeration Dist. Pipe t•95, I0S Holding Bot. System PUMP/SIPHON INFORMATION Final Grade x•95 95 • ~5 Manufacturer ) Demand St Cofer 9,~•Zoe ~ ` ' . 7•• V Model Number GPM tog. G ~6 f Z 7-3 TDH Lift•1 Friction Loss System H a • C 7DH I ` ~t '7 .7 f Forcemain Lengt / Dia.2 It Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~0 drp ZS e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O ystem: / CHAMBER OR 7 ` 1Q5 /Op UNIT Model Number: DISTRIBUTION SYSTEM Sr• ole Size 7pacing / Ve o Air Intake Header/Manifold Length Dia ID istribution / 3 / x H 7 N ` Pipe(sLength) 5 Dia_- Spacing~~+ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded LOOLIF xx Mulched Bed/Trench Center V Bed/Trench Edges Topsoil t;RZ Yes 77 Yes 7FENo COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /O f2 7 /S Inspection #2: Location: No Address Av( ila (111A I n nI` /_DV~ C~i-%4k AD,,) CC77/j" 1.) Alt BM Description = d,d~ v~yc.v~ ~~syf © . yyd~ nG 2.) Bldg sewer length = r f1 61/ 5~ 5.~ J - amount of cover 5 GeJtrt, Ulf ~t Mai++~. t~~S~J ~ct~-ti~ ~I w: L'N1 Plan revision Required? ❑ Yes )(No Use other side for additional information. 16 J SBD-6710 (R.3/97) Date Insepctor's Si lure Cert. No. L oypnarAt .g. Industry Services Division County 1400 E Washington Ave ± 1r P.O. Box 7162 ~ O CT 13 Z 015 Sanitary Permit Number (to be filled in Co.) Madison, WI 53707-71 ST. CROIX COUNTY 3OMMU ROWTV wit Application to Tran~chon Number In accordance with SPS 38311(21 Wis. Adm. Code, submission of this fort to the appropriate governmLotal unit Aq .33,35 is required prior to obtaining a sanitary permit Note. Application forms for state-owned POWTS are submitted to Project Address (if diffmad than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary ores in accordance with the Privacy jaw, s. 15. 1 m Stats. 1.A lication Information - -Please Print All Information A,54-4~ Property Owner's Name C/o-", 1115 ~ Parcel # Property Owner's Mailing Address Property Location 9, 115, 17 I 3 eesr ~e- Goy Lot city, state Zip Code Phone Number :]1~ _.~.LV., GLl Section f C " " A "S"L/ D l-3 (-7 /S) --k,, S-- e-11,13 circle one) IL Type of Building (check all that /apply) Lot # T-~!Z N, R1 E or W ❑ 1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name CJ Public/Commerciai -Describe Use lock # AafeS D City of_ D State Owned - ieseriibbe Use CSM Number D Village of / 111. Type of Permit: (Check only one boa on line A. Complete fine B if applicable) A. New System ❑ Replacement System ❑ TreatnteriMolding Tank Replacement only D other modification to Existing system (explain) B • D Permit Renewal D Permit Revision ❑ Change of plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / IV. Thm of POWTS stem/Com nent(Device: Check all that apply) 6 ❑ Non-Pressurized In-Ground D Pressurized in-Ground D At-Grade PMound> 24 in. of suitable soil D Mound <24 in, of suitable soil D Holding Tank D other Dispersal Component (explain) D Prelnatme nt Device (explain) V. Dis rsaVCrea nt Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (System Elevation 893 6- / 4/ Y~ 33 V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tans Existing Tanks , V y 1-5 v 8 S on Gn Septic or HoWing Tank Dosing Chamber 5N~ Vll. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Pri n ( Plum ignature MPiMPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi Code) A),76 ;&J ~4 1- g rlh- l~4C s y7~ VHL o fDe rtment Use Only proved ❑ Disaryp roved rPermit Date ued Issuing Kit Signature n Reason for Denial ~3 M CondilW&T pWbUltReasons for Disapproval / r t:` Septid tank, effluent fiNec kcal 3, l h i.~ i G a dispersal cell must all be servlGes / maintain d r d! W/ //11 "'Per,managem®nt plan provided by. plU ~ n r n Wq*1c" 00th / 9*nnnm, ~e L I r v b ac.. ti ~I•a Atlaeh to complete plate for the system and submit fo the ewnip only os paper Ittka than 8 112111 iuehex in stze r SBD-6398 (R 08/14) P)cdpta_n pal 4 C l~e h -k ilev r lBU !'lc j. C q13. G ~S CJ 1/ 1. 1. 100 ,00 i a , sp , k-e X04: ~ ~ R, bba.~ < < ~1J f b't D~ ei , Oa~C ?r~~~ v 1 ` ~ ~ it ~ / C3c.u ✓t G+ ~ S~C~i'!gy ~ / q6~ Hwy Sec_, 1 a., sac b 83 ~o p C ~ec+atcaj ► l3®x 333 ~;Jttrs~~-s Is6S ~f , ~ ~ Ele~r 9~~45" C P C t~ ct b~ 4 Top c i b~-, v%k I VA t=own f(3L I ELL l F~ LLi i-k-Sev-.5f"?C)CV goo Sep~,c luh1 CI 6, & P. I 7 ( o k- S Ft 1,4,e.- r n S' 00 Cc aTE, C_c 7 ' ~~pnxTnr;~._ DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN HOLMEN WI 54636-9466 Contact Through Relay PS http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~o ssiol' Scott Walker, Governor Dave Ross, Secretary October 07, 2015 CUST ID No. 220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767-8709 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/07/2017 Identification Numbers Transaction ID No. 2613335 SITE: -Site ID No. 817806 Glen Hills County Park Please refer to both identification numbers, 1049 Rustic Road 3 above, in all correspondence with the agency. Town of Springfield St Croix County SW1/4, SWIA, S11, T29N, RI 5W FOR: Description: Mound / Commercial (Park Restroom & Showers) /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1558498 Maintenance required; 893 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Commercial System, Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. ,,t~~ Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and ONE dispersal are prohibited. pppR pS of S • The well must be a minimum of 25 feet, from any POWTS tank, and a minimum of 50 feet from the absorption DE sskotN area. chs. NR 811 & 812c Flo Op ~N~ • A Sanitary Permit must be obtained from the county where this project is located in accordance with the DXV S1014 requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SEE BENNIE W HELGESON Page 2 10/7/2015 • SPS 383.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. of All permits required by the state or the local municipality shall be obtained prior to commencement construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 2, Division of Industry Services WISMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm i BENNIE W HELGESON Page 2 10/7/2015 i • SPS 383.22(7) A copy of the approved plans specifications and this letter shall be on site during construction and open to inspection by authorized representatives of the Department which may include local inspectors Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 2 , Division of Industry Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm INDEX SHEET SEP 2 1, 2015 PROPERTY OWNER: ! e t-~ i l 1 s- ou K {pct k Sf Croy k ~oc~ n S~ o W-1. PROJECT NAME: PROJECT LOCATION: jL7 MUNICIPALITY:. 5 r! n ~t C l cX COUNTY: Sf . C12 6/y DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N. 01 /01) MOUND COMPONENT MANUAL VERSION 2.0" SBD- 10691-P (N.01101) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound-- 51 x in.) C'cY/~ /~~ia>4s Page 3: Distribution Pipe Layout Page 4: Chamber Cross Section and Specification gPage 5: WL.P Tank Specifications 70.1&_6 W 1S-6_S'-MR ~Ccv~~ Chap.,, bey- ~roSS Sa~GE7c7.~ Page J : Pump Specifications Page r; Observation Pipe Detail Page `!f POWTS Owner's Manual & Management Plan- Pg 1 Page !_Po,. POWTS Owner's Manual & Management Plan- Pg 2 DALLY VED Name: Bennie Helgeson Signe : ND Address: N7649 Hwy 128 i.L SERVICE JSTRY SERVICES Spring Valley, WI 54767 Credential Number: 220292 .RESPONDEN ~T P) Of pa 10410 (411 Co-_ . /J ~Vf• i ,Q ! 1 $7•Q j~.~~ loo Ot3 ,Q Oak Tm-e- 1 1 + 1 ,Qcs~ 1 ~ 1 ~ n 4r 1,;/v SOrl 1 ` ~VG 1 A pee ,MAia + t) 83 Top of E lec v1ca/ ~3 o~c 33 3-> ~,Jtcs~b Is65 Gal, Ele~s- 9.45 / Top oF'bri~k,h F-OwnfaLI Slab y owe / l -I t~ 13~ i e i 0 t7 l• C a W~ Gt W I11cV\+ c. Fi 14.e,- C~ , Wes 4- o; B f 10/06/2015 21:06 7157723387 BEN PAGE 0a/05 701 u,Gcr, SyMthetfo Covering X15*Nl C- 33 glstrl-bution Pi e Mod-lum Sand Topsohf o sy~.~, E 3 J. p . Con v . Elea. -9 3.0 /3 'A Slope. ' CS:Y.Of a 2 %Z Force Main Pi.owe d Aggregate From Pump Layer Dam/ F~. Cross Section Of A Mound E - Ft- F S20 Ft. G Ft. PARK U- I-14 10(LET-5 6A0 cryERS A Ft. N F . To~ I-JS..0G;.' - l.4o 3,5'D~~L► S -25~P t. 7'©iA net s 1,~►ed- _ 3Q_Ip c~~-r-c,.~ s X~ qS-1, P1~ J~6 ~7'/ `t Ft. ( r,s x /7VIFt, Q bn- Obse,r,'va lan P•1p-e K r~ TJ F T-----.~. _-~l Distributlonla.;: p'f z 2 %2 Pipe Aggregate Ob$Oruation Pipe CD Ron View Of Mound I b/ bb/ 11J 15 21: bb dt I( 2~. U t-AULCC IJ4/ U5 Perforated Pipe Detail Clcanou.t Access 0 Thrca.ded End VI s I Cleanout. P Or(wo I td PVG Pipe ~r End Manifold Jot `00 / Holes Located on Bottom / Are Equally Spaced Force Main From Pump First Hole Next to Manifold Cleauou.ts Distribution Pipe Layout R 7~ x r Y a Hole Diameters . Inch Lateral " Inch (es) Manifold. " Inches Sigzxed License Number: Forec Main Inches Date: Invert Rlevation 9.114 S Holes Per Lateral Number of Laterals -3 Total:Holes / a a. of u~f Lu.J L11. UU f LJ f I LJJV f LLiLIY L/)r Hl/7,.G riii CJJ PUMP CHAMBER CRO&S SECT-OU AA1p SPECIFICkTI0W5 VELIT CAP -TPvc- oe.,+ L F' WCATHE'RPROOF APFRpYEO LQC.I({(V& l a ' a~O~ JUQCTIOU DOX MAAJHOLF COYER W t~ I. 2~5~Rt'i!"1 DOOR 12"MIU. w~r~'~~ (`46G~ WIKJDOW OR FRESH AIR IAITAKE GRADE I 4" MIIJ. I r~' NI IJ, GOE.IDUIT n IM LET PROVIDE I I 7r--F AIRTIGHT SEAL I I I APPROVED JOIIJ'F A I III APPROVED JDIUT~ W/C.,X. PIPE I III W/C.X. PIPE EXTENDIUC- 3' I II ALARM EXTEUOIUG 3' 01JTO SOLID S'DIt_ c b I 11 OE1T0 SOLIb SOIL I I I I ow 41~ I i LLEV. FT. PUMP-~„ OFF w PC C-K T0 RISER EXIT PERf1I7fED OQLy IF TAMK MAUUFACTURER HAS SucH APPROVAL . SEPTIC E SPGIFIGATIOtiiS 2,y,/SM S~ , /Ea DOSE e TA►JKS MAQUFACTUR-R: ~ ~ F:1" ~GG~'~IO~I~ VOIU.W~ ~ ~ • S~ 130 ) TAUK SIZE: <r GALLOQS DOSE VOLUME ALARM MA►JUFACTUR.GR: ~R kakftn l -91 ToJC,I Doggy Volt q,'y~~~~GA1 L 0 K S AODEL !`JUMPSER: /h J01 CAPACITIES. A UJCHES OK LQ.Ze_-SGALLOU5 SWITCH TYPE: M -<C_.lti 0.hl ca 1 r 1 ~ OA 8 = ►JCHES OR ~ ii GALLOUS PUMP MAQUFACTURFR; G= 4 .IUf:HEb ORS ^'gGAILOAJS M00CL UIJMIDEK: Imr-HEsOR_y q~6~liAL.10115 SWITCH TYPE; CA OLIN OLIN A _ C _GL 1 I MOTE: PUN'P AUD ALARM ARE TO 6E MIQIMUM DISCHARGE RATE 1 GPM IAISfALLED OU SEPARATE CIRCUITS VERTICAL IMFFEREAICE bETWEEU PUMP OFF AUD 015TIZIESUTIOLJ PIPE., LFEET + MII..JIMIlM METWORK SUPPLY PRESSURE . , . , . _ r 5 rF-CT A0 FEET OF FORCE P'1AIIJ X` C' F/ 7 FEET Ipo tf FRICTiO►1 FACTOR...,,._L TOTAL 01JWMIC, HEAP FEET IUTI- RKJA~ DIMI!-WSIoUc OF TAIJ yLEC:TH ;WIDTH ~L•IIQUID DCPYH f 0. 6 9 ~ , P. -T SIGIJED, LICE.AJSF UUMOERi:~~ 8M-00e OOZId-M31U 99tl8-SZ~-008 t OOZ 'N`df 'n38 d\ p LOOZ ),avnNVr :31VO 0sc4S M 'NOON N301VW 'OUIMH Sn 9tam idf1NdW 3I1d3S Z 1n~sue NMVao 3138B110D 13531M ~ p :31VO 'ON A3a l4 l '-31VOS 8W-009/OOZLdIM \ LU m w Z W Z U W z W uj J O ck: © VI Q UQ O W Q CL 7- ^ WQ _J w a ~ 0_ W 0 U) LL W CD U) x Q O co O Q U a N p 0 0° co LL U t O N O U 0 U ° J Ul 00 J . Li (O V1 lei \ O 0 i W Q Q 0 -t N O Q = 0 Q C) r) Li . O U ci . 'o W to m M N p F- (N N 0 ~ J W CL W O Ne ~ H W J H U W N a _j F- CL r V/ M ~QJF-=mZJ~ OQ O0 Q m m p V) = w Z Jod=x f-xoox 0U 0 w er 0 o_ U o Y °aooaWwQwOw Z' Q V) U U Q N O y m~ Z Z ?i m U= J m m Q 0 Z U w Q ~ LLI O °a Z QV 0 Z Z d O a F- O N Y N_ Q W D D 1 U Z ~.L Q< W 1 ~ 6£ Q V~ ~ to 0. , =o Y Z Q d I I I as LLJ t 3 ° 3 u W z . W a. ;j w f-I 6) -j I (n Qw-iN tWi I N ZOW JO Q i ~ZU ~Om aaa 02 ~ 1 I I I I I 1 II w .e J M IcV Z V - „96 II! 8w-999W3113 9S~8-SZ£-008 IVOOZ 'Nv '~3a o\ tool k8VnNVr :31VO 094V9 PA ')13021 N301Vk1 'otkmH sn 9K£M ivnN Y4 OIld3S oO 1MS:.CB NMVaa 31318903 = O .31VO A321 :31VOS 13531M ~IW-S9SlM ' 'oN N F- w Z LLJ J ~ w z U Z W O C-) LLJ 0 fn J Z uwi N m O w N i o w o m ;E ~ a z V) CL V I O O O U N F- U H J O U W J _ J I- o a 0 0 , o F- • 0< W to ° z cn o 0 O-< Z ,n F zd o a F= L) J° J W N w W F- 0- to O° O (n m J W W (7 O Z° W m J EL o cn rn 5 : tii 0 7- a N _ J F- z • ° ,i UZ e \ ~N~A0 N m N WW aQ o Z> a -J N O ~~'Y///~~~- J V [V d-J d' p) O a0 F- I F-. Q M J a. m O a w O V F co wA \W O_ NcDo_ W~p' Ja JZI-- °U m (n 2 W LL I N i I LLj c0 - z W F- F~ ' F, _ (Z~ J W U fjj m w Li N~ J = -JI- 00N f- Dow U Z Wa N Z (X ZJO >zo 052 OU OO~ a d- 2 ~ O NJO Z W QV O °ao oaww°-W~ a~° U O o¢ O z~ a U U) ~C ° L Z ?i m U 2 J 3 in m o z Z O Y F- F- a Q J J f='1 0 a0 Z Z N a U ~ lai O Z Z J J F•- O N D ~ Z a U ~ w Q N Y Z a r Fw- FJ- ~ O r R a / I w \ JW -i XQ 1 3 II II z o N From I Li 25, o = w „l9 _ S o I aav I s I o m< I a. W J Q J 1\ - N N v Fn \ I ~ i I1 W N J Z „L6 6 „ 69 7 ! 0 a~ W w MEAD CAPACITY CURVE TOTAL DYNAMIC HEAD/CAPACITY ' PER MINUTE 3 7/8 6 t/4 MODELS "140/4140" EFFLUENT AND DEWATERING a 5/8 Ft. Meters Gal. Ltrs. 14 45 5 1.52 91 344 0 3 7/8 o 10 3.05 84 318 + 40 15 4.57 76 288 0 12 (140)140 20 6.10 68 257 1 1/2 - 11 1/2 NPT 35 25 7.62 59 223 10 30 9.14 49 185 30 35 10.67 38 144 40 12.19 21 79 8-- 25- 45 13.72 5 19 12 5/B 9 20Lock Valve; 46' = 6 p 15- IT U 4 5/16 t I+ SK1524A 4 Q H 0 10 2 3 7/8 6 1/4 • • Design Seal 5- Weight 73 lbs. 4 5/8 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 0 37/8 LITERS I 80 160 240 .320 400 0 + 0 FLOW PER MINUTE 010904 0 1 1/2 - 11 1/2 NK CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with 1613/32 an alarm. • Mechanical alternators, for duplex systems, are available with or without alarms. 5/16 • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. sK1524e • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. SELECTION GUIDE • Sealed Qwik-Box available for outdoor installations. See FM1420. 1. Single piggyback variable level float switch or double piggyback variable level float • Over 130°F. (54°C.) special quotation required. switch. Refer to FM0477. • Refer to FMO806 for 200° F. applications. 2. Mechanical alternator M-Pak 10-0072 or 10-0075. 3. See FM0712 for correct model of Electrical Altemator E-Pak. 4. Variable level control switch 10-0225 used as a control activator, specify duplex (3) 140 Series - 53 lbs. 4140 Series - 73 lbs. or (4) float system. 14014140"' MODELS Control Selection Model Model Voks•Ph Mode Amps Simplax Duplex N140 N4140 115 1 Non 15.0 1 or 1 & 5 2 or. 3 & 4 E140 E4140 230 1 Non 7.5 1 or 1 & 5 2 or 3 & 4 A CAUTION BN140 BN4140 115 1 Non 15.5 1 or 1 & 5 2 or 3 & 4 All Installation of controls, protection devices and wiring should be done by a qualified BE140 BE4140 230 1 Non 7.5 1 or l &5 2 or 3 & 4 licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0. P.O. BOX 16347 t'O Louisville, KY 40256-0347 Manufacturer, of. . SHIP TO. 3649 Cane Run Road Louisville, KY 40211-1961 r&4UrY/-!/MPB S*CE /c9c7c9~ http://www.zoeller.com PUMP !O. ® (502) 778-2731 - 1 (80928-PUMP FAX (502) 774-3624 © Copyright 2001 Zoeller Co. All rights reserved. Water tight cap 4" rein. dia. 7A Piping materi al cari be ASTM D2665, D1785 or D3034 , lot 6" 6`` rain. min. Infiltrative surface Water Closet Collar Bar (3/8" rain. dia.) Obser'7.o6 + plebs musf: - • be located such that there are a minimum of two installed in each dispersal cell at opposite ends from one another • be located near the dispersal cell ends 0 be at least 6 inches from the end wall and sldewall • be installed at an elevation to view the horizontal or level Infiltrative surface within the dispersal cell Observation pipes may be located less than 6 Inches from end walls or side walls if specified in state-approved manufacturers` installation instructions. i POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of FiLEJNFORMATION • Owner SYSTEM SPECIFICATIONS kn ills Ckrr►'. Tank Manufacturer: wlvvses-- 0 NA Permit # B'Septic O Dose .,O Holding Volume: _aOp 0 (gal) DESIGN PARAMETERS - Tank` Manufacturer: wleSct.- ❑ NA Number of Bedrooms: 17 IA ❑ Septic l irbose ❑ Holding Volume'. j (gal) + Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottom(s) to Service Pad: / cy (ft) Y Estimated (average) Flow : s -9 (gel/day) Horizontal Distance Tank(s) to Service Pad: ,S" (ft) Design (peak) Flow = (estimated x 1.5): Speciflc servicing mechanics must be provided if vertical is >15 feet or O S ya . S (gal/day) If horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gaUday/ft) Effluent Filter Manufacturer: my Standard (Domestic) Infiuent/Effluent ❑ NA J' I anthly average Effluent Filter Model: Fats, Oil & Grease (FOG) s30•mg/L Qr Pump Manufacturer: Biochemical Oxygen Demand (BODS) s220 mg/L El NA -11 al Ole ~~e r O fwtSusp.hded,§,viids.(TSS) „'s180m'IL -P-U- I>M©del:.--- O ❑ NA t c~ High Strength Influent/Effluent Monthly average Pretreatment: Unit r~ rm (FOG) >30 mg/L Manufacturer: (aODr,) >220 mg/L N NA S (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ®HQA Pretreated Effluent Monthly average ❑ blsinfection ❑ Wetland b ❑ Sand/Gravel Filter ❑ Other: Q (BODE) s30 mg/L (TSS) 530 mg/L eNA Soil Absorption System Fecal Coliform (geometric mean) sW ❑ In-Ground (gravity) ❑ I -Ground {pressure El ) NA yC ~ p Maximum Effluent Particle Size /a.in dia. ❑ NA ❑ At-Grade ound f~O © Other: ❑ Drip-Line [3 Other: . ❑ NA Other ❑ NA MAINTENANCE SCHEDULE. Service Event Service Frequency Pump out contents of tank(s) .gWhen combined sludge and scum equals one-third O of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) • At least once every: a ❑ month(s) ears (Maximum 3 years) ❑ NA Inspect.dispersal cell(s) At least once every: ❑ month(s) 'year(s) (Maximum'3 years:) ❑ NA Clean effluent filter At least once every: 13 O myears) ont(hh(s) ❑ NA Inspect pump, pump controls & alarm At least.once'every: month(s) l 3 0 -Year(s) El NA Flush laterals and.pressure test °Atleast once eve month(s) Other: ryW'.year(s) [I NA. At least once every: ❑ montfi(s) . Other: p:year(s). , ❑`NA NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS 'Maintainer or Septage Servicing Operator (pumper), 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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;ahe immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third or more of the. tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with. chapter NR 113, Wisconsin Administrative Code: Allother services, including but not limited-to. the servicing of effluent filters, mechanical cr•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 30 days of completion of any service event. GMW-005 (02/05) Page _ZQ • a or. other START UP AND OPERATION .For new constructl prior to use ofi'the pOWTS check treatment" tank(s) for the presence of painting products, soMari - chemicals or sediment that may impede the. treatment proCoss 'andlor damage the soil absorption sytem. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior under power oration Start lures. pump these Pump tanks may fill above norm ashthe excess. was ewater, :bill be discharged to the soil abs rption systemtln one la ge dose causing an overload is not recommended, ' that may result in the backup or surface discharge of efflaent. and damage. ;to the system. To aypum'thi contact a Plumber contents of the pump tank removed bye Septage Servicing Operator (pumper)-priorto-restoring power to-the pump or POWTS Maintainer to assist In manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil. conditions are frozen at the infiltrative surface. Do not drive.or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area. within IS feet down'slope of any mound or at grade soil absorption area. the the life treat m-en Reduction or te butts c ndom% cottonnswabs, -degreasers, dental foss, fsystem, acids from the ntibioticst babyr pes,'cigaretImprove tanks and soil il absorption Y diapers, disinfectants fats, foundation }l pump) discharge, fruit and vegetable peelings, gasoline, greases:, herbicides, meat . rin (sump scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.- ABANDONMENT- When the POWTS fails and/or is permanently taken out-of service in Admirt st ste l ode shall be taken to insure that the system is properly and safely abandoned "in compliance with s. Comm "83.33, s e All piping to tanks, pits and other soil absorption systems 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 (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLA14 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 r ysu red 'upon The replacement ara a hd ou(do. OSedr structures fom disturbance- an lot I nes and wells aFat u e oiprotect t eshould placement area wdil) xesultbin the need setbacks from existing p P for a new soil and site. evaluation to establish a suitable replacement area. `Replacement systemsmust comply with the rulesn effect at the time of their permit Issuance. resortptlon system cannot be p. A suitable replacement area is n WTS technology, a holding tank may be installed as a l as. rehabilitated and barring advances in PO ure soil POWTS the a and Z3 The site has not bon locate a suitable replacement area pIf relacement area. an a is 'a ailable a holding tank may beiinstalled .aion must be performed last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the bbmat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY" CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY. CIRCUMSTANCE. DEATH MAY WESgtltT ESCAPE'•OR,,R6SGUE:FROM:'t" fE#iVTERIG.R A MAY NOT, E ~ ADDITIONAL INSTRUCTIONS: pOWTS INSTALLER POWTS MAINTAINER. Name O~c-~Sa ~0 Name v► ~ s 81,'` " Phone 7 1 Phone SEPTAGE SERVICING OPERATOR P.UMP.ER LOCAL REGULATORY AUTHORITY r ENarn- Name - k z> M6 -3 s- Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushera County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page ZQ of ~Q START UP AND OPERATION For new construction, prior to use of -the POWTS'oheck:-.treatment. tank(s) for the .presence of painting products, solvents or other chemicals or sediment that may impede the treatment.proeess'and/or damage' the. soil absorption system. If high concentrations, are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) priorto use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures.. Start up or restoration of power under these. conditions is not recommended, as the. excess wastewater will be-discharged to the soil absorption system In_ona large dose causing an overload that may result in the backup or surface discharge of effluent. and damage.;to.:the system. To avoid thlsosituation`have.the contents of the:pump tank removed by a Septage Servicing Operator (pumper) -prior to -restoring power to.the pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil.conditions are frozen at the infiltrative surface. Do not dhve.or park vehicies.over tanks or the soil absorption system. Do.not drive or park over, or otherwise disturb or compact, the area. within .15 feet down "slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acidst antibiotics; baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation firain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, :pesticides, sanitary napkins, solvents, tampons, 'and water softener brine. discharge. ABANDONMENT . When the POWTS fails and/or is permanently taken out of service the following steps shall betaken to insure`fhatthe system is properly and safely abandoned 'in compliance with s. Comm 83.33; Wisconsin Adnii6istratl3e .Gode:': a All piping to tanks, pits and other soil absorption systems 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 (pumper). a After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAb If the POWTS fails and cannot be repaired the following measures have been; or must be taken, to provide a code compliant ...replacement system: Q 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 and site evaluation to establish a suitable replacement area. `Replacement system's must comply with the rules:in effect at the time of their pen-nit issuance. 0. A suitable replacement area is not available due to setback and/or soil' limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort [3 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement.area is available a. holding tank maybe installed as a last resort to replace the failed POWTS. P 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES` OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY. CIRCUMSTANCE. DEATH MAY ' :<RES'i7L~' ~~APE FOR ~RESGl'iE::FR011A'f`~3~4;TER1'CI:R~~'K`ttfiAl~ f~}OT:13~Ei~S`S~L'E: ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS M•AINTAINER.. Name Z -L Name C) Phone 7 Phone l -7 _P SEPTAGE SERVICING OPERATOR P:UMP.ER LOCAL;REG[JLATORY, AUTHORITY. EName - Name 6(~ f S" Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm B3.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. • z LD Wisconsinp SOIL EVALUATION REPORT Page ~of Division of a ety and Buildings A,1 12015 in accordance with Comm 85, Wis, Adm. Code County Attach compfe el,plan o r not less than 8 1/2 x 11 inches in size. Plan must include, rizontal reference point (BM), direction and Parcel i,D, r p C3 percent s~ y~ a m arrow, and location and distance to nearest road. 3 © ' Utv► Please print all information. Revi d by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)), 16 1` Property Owner 6 e f 5 C~-t nv- Property Location 6r, (f r,O/i COL If - s` e Govt. Lot 5 1/4 1/4 T 9 N - R f S E (or 1 Property Owner's Mailin Address Lot # Block # Subd. Nance CSM# o a 3 - - City Slate Zip Code Phone Number 0 City 0 Village, wn Nearest Road (6/enCf'~y Ut)S ~'~l0/3 (-1ls a65-5~6/3 S rt^ t-~ 1c 1 J Cgr'New Construction use: 0 Residential / Number of bedrooms Code derived design flow rate 7o be. Le e 1 A p PD 0 Replacement OPublicor commercial - Describe: i~07(e- I"S , !Sit\D'vers GO'r (~-o.r k Parent material L O 4 SS ti-09W-1 Y( L_ t-- Flood Plain elevation if applicable ^)VA General comments s d,N i5 Foot S a-tc~ CA~i1c'l-elr- C.-OD/0-eu- 'ectU e. a Cel and recommendations: GCSE . kk "M Cobj-~Our- 'r3, ,Sys fevK ~le.~. 9y, o Boring # trtg 8. ft. De th to limitin factor in. rpit r~ Ground surface elev. p g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Etf#2 / p -7 © t?- _ L h C L~ irk /W e 6 'Y L sb rl ~U.F 4- 7 e-n 0 1 ."9 6 5~ -`!I2 CL l Il cl r -71- y-3 /©y c L C s r~- 2 3 /C -",-/g, 3 ~a p 7, "k 2 L l u c s bk, Mc." u~ r l2 0 c,.j 5 Coil X40 t-+ 5° SS o6h ❑ Boring Boring # Pit Ground surface elev. 23 , 0 ft. Depth to limiting factor~l 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 t, f k -)4 Ski q-1 i D'a -S L lk :E2 S d- Pk2f 7, '5 i s (fMF 1v o 2©~ f-cs 20s C 6/ Effluent #1 = SOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 130 mglL and TSS 30 mgll CST Name (Please Print) Signature CST Number Address Date Evaluation Conducted Telephone Number X 76 9' S f~ I~~r 1 s 011 UA U)Z, g (13) 77 - ~U ;2 e S Property Owner Gk- VT` tf tl f I ~6t1- S Parcel lD # #n. .Wripn3 cf .A..apQn y~-x»,5.y-Ne - 3Q-000 Page:. ~ of Boring # ❑ Boring F-1 3 ❑ pit Ground surface elev. 3 ft. Depth to limiting factor in, Soil A tication 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 J J Boring # ❑ Boring 1.--J ❑ Pit Ground surface elev. ft. Depth to limiting factor in. - Soil A Ncation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 i i i Boring # ❑ Boring F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor _ in. Sol Aggicallon Rate Horizon Depth Dominant Color Redox Description Texture Structure . Consistence Boundary Roots P /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2' I f ` Effluent #1 = BODE > 30 < 220 mg/- 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. S111), 8330 (R.07/00) Property Owner GIB v (l I ~ l- F-S 3~ 0 -DO0 Parcel ID # 0J Boring # 0 Boring Page. ~ Of,- uPit Ground surface elev.. ft. Depth to limiting factor, in, Horizon Depth Dominant Color Redox Description Texture Structure Crinsistenc SOU cation Fati3 ftundW In. Munsell Qu. Sz. Cont Color GRpI/f~.',. Gr..Sz. Sh. ` val Tag: 0-2 lo'M I, ZSYA. 25;V, C F-7 da o ~IIL a ,S- Boring # Q Boring ❑ pit Ground surface elev. h. Depth to limiting factor in, Sofl Application <Rate Horizon Depth DomfnantColor Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. $z, Sh. ~ 'Eff#'1 Boring # ❑ Boring ❑ pit Ground surface elev. ft Depth to limiting factor~.in. .RB#•. Horizon Depth Dominant Col Soil Ieatlort or kedox Description Texture Structure Cpnsts;tonW Boundary Roots P /fP In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh: '0101, '1502 j ; Effluent #1 = BOD, > 30.5 220 mgA_ and TSS >30:5 150 mg/L ' Effluent.#2 = BCD, < 30 mg/Land TSS s 30 mWL The Department of ommerce is an equal opportunity service provider and employer, Ityou ne a sssistanee to access S'Ovicot or . need material in an alternate format, please contact the department at 608-266-3151 or TTY ,608.264.8777. S IM-9330 (R.07/00) Wisconsin Department of Commerce SOIL EV ft PORT Page ~ of Division of Safety and Buildings in accordance with Comm 85, Adm. Code A$21 015 CountyT Attach complete site plan on paper not less than 8 1/2 x 11 Inr Plan us include, but not limited to: vertical and horizontal reference poidl w ~ P®roel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearer 'rbV)~ , Please print all Information: Reviewed by Date Personal' information you pr3Wdw maybe used for secondary. purposes•(Privacy Law, s 15.04 (1) (m)). Property Owner 6 2 r MIS C©r,r„ V 'Property Location 7; e ro C4c 2 S Q e n Govt. Lot S Zia Ira s l T 9 N R S E o Property opOwner's Mailing Address ~ ~ Lot # Block # Subd. Name or QSM# S t c ®a. City State Zip Code Phone Numbed • D city ~ ❑ Village Cglown Nearest Road Men ~p4. C 7 Wr -410/3 0-115 j a6S"- ~f 6/3 ~ r ~I °e ~ fct~~ c A!o /~Lcr~ ( New Construction Use: 0 Residential /Number of bedrooms Code derived design flow rate To loc.. ~ e { PR ❑ Replacement ff-Public or commercial -Describe: 'Ol(C-4-Is s),owei-5 F~)r- OLr Parent material L C1 es-s 6 t),5k `rt L 1 Flood Plain elevation If applicable ft General comments and recommendations: C-t5 ' d.•t1 i~7 toad CA.J1 I" ✓ _1 .Sys f.~~ ~,~>J. 9y, c~ Boring # B ng Ground surface.elev. O -D ft. Depth to limiting factor in. Rate F -/1 to . Sod-A IicaUOn Horizon Depth DominantColor Redox Description Texture Structure ..Consistence Boundary Roots _GPD& in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. v1#1 4E02' . love 3 . I V b c~ 15 31-119 v `1 3 -C~ D Y& 5,1c I u c s bG: VnJl' //2DH S Co ~7b f f ~o r...5 f7o„5 ~ t~ ~ ~o SS Le,~ ~j Boring # ~ Boring l i g ❑ pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil ApplicationRate Horizon [Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots . GPDO in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. iEff#1 401ft 154 L) L 1,11:ck L LL) Ito yr /r L f l < 1-6 1M N-3.1 ID Jk- '5 Zp sK C L 1 5 b 1~-/~ 6, , 20~ 5- is 20 b/ Effluent # 1 = BQD > 30:5 220, mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 50D 130 : mg/L and TSS < 30 mgll. CST Name (Please Print] Signature C&T NuCnber Address Date Evaluation Conducted Telephone Number 746 U)Z ACV( /D8~ • e $q~ Vo 93~ 95v 7-0 LOA) OF 5PPtJ~&~La U S dp. ! yl_ 1 ' 1 1 L§ 63 f3`A, q7,~5 \ Cvner~~ Slc'.~ A CA 0 L-14_1 A R E,~ kr,))T~ t7s ~E PQc~x, 0,, .r- Q i . ,7,5-