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Home My WebLink About042-1016-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 582065 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: Daniel & Jennifer Freeman T TOWN OF WARREN 042-1016-50-000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No: ~1 tA_- 07.29.18.998 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark d Dosing Alt. B 1/ ell J ~f~C Bldg. Sewer j(.42- CK(o•~f 1'- IJ 5T Z L7 Holding St/Ht Inlet a , O$ • ' 2 a '$3 59 TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELj BLDG. Cent to it Intake ROAD Dt Inlet Septic Dt Bottom • Dosing / Header/Man. r " 17 Aeration O Dist. Pipe °l to • Z Holding Bot. System )t 943 .S ' . -Z- ~w Final Grade 7 PUMP/SIPHON INFORMATION A l Manufacturer L emand St Cover u • f~ Z me. of A/, 7 S J GPM OC-)4 LIT- Model Number 09 • 3 F PC -5 L Li tion Loss- - System H a TDH Ft Y !,1 /7,oc Y Force /to 7FMIN 1 7- mair~ h Dia. Is Dist. to well ?6' SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia_Liqu Depth DIMENSIONS 3 ?o Ffewt SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manuf,~`, INFORMATION Type System: 6~51 UNIT Model Numb 'Oo S 0,t~ 1-7 DISTRIBUTION SYSTEM E V~]-~- 11-7 3 Ve~ Airke Header/Manifov / Distribution ix Hole Siz~ Ix Hole Spacing Pipe(s) Length (0 Dia Length ~ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only A e-~ ~s Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Iched Bed/Trench Center Bed/Trench Edges Topsoil LJ No No ~ G7 2 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I3 Flo Inspection #2: Location: 971 107TH AVE , 6,lv._ I 1.) Alt BM Description = / I CL 2.) Bldg sewer length - amount of cover = ` 5 O, Plan revision Required? Yes ❑ No JI ~L~ Use other side for additions information. f ! r 11 Cert. No. Date Insep ors SBD-6710 (R.3/97) cfr~ars yr County _ f e ~ ~VIdingsDivision -75 J 1, =1 ` d 20 t VI Box 7162 Sanitary Permit Number (to be filled in by Co.) 3 ~ PS Madison, WI 7-7162 JAN 2 8? 6 5 d p~P~FE7.SlOh~ ~r Sanitary Perm State Trai ton Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this fWto t go vernmental unit ~ 11 fpWI is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary , ~ purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. / / ` v ~r 1. Application Information - Ple a Print A nformation 17/ ` ` e- Property Owner's Name f~ 4- Parcel # Property Owner's Mailing Address Property Location Cl / 0 l7 Govt. Lot l ! City,. State Zip Code Phone Number J 0,e /4 t /4, Section /rcle one T ~ N; R C~ E ot~ II. Type of Building (check all that apply) Lot # Subdivision Name 3 k1 or 2 Family Dwelling - Number of Bedrooms -C C- Block # i ❑ Public/Commercial - Describe Use i ~ ~ ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z b,'isV CPA L-J t } 1-7 CINA.-Le~5 Town of [e>,~-%'`\/'~~✓\ III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable) 2.8 i&L, A. New System WReplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ' 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/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation 7 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o New Tanks Existing Tanks Pa ' ~ y y a 0 P- U rn V r~ w C7 ~ Septic or Holding Tank Dosing Chamber Cy VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe gnatgre KIP/3APRS Number Business Phone Number 7 6 Plumb 7 's Address (St t, City, State, Zip Code) VII ount /Department Use Only Approved ❑ D' annrn-ii PermitQFee w, Dat Ilsssuueed Issuing ent Signature 10, ~en Reason for Dent 1 $ U ' w I f~ D ' IX. Condit P#KfReasons for Disapproval \ 1. Septic tank, effluent filter and 3) Q`~, J y~r o dispervai cell must all be services I mmaintainec 1111 Lr c as per management plan provided by plumber. (~wr a 2. Ap s r atilt requirements must be riaint€ined ^ ~A as per applicaWs rode / c-rtiinanrr.;:. 4-6 -A Attach to complete plans for the system and submit to the County a yon piper not less than 8 I!2 x 11 inches in size Go , SBD-6398 (R. 11/11) o-~ gr( C A-) le LL-( qc) lob 1o/.37 ' , J I f rA v Soto J-Q' Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Required Tank Model Number ^^I, GPM Total Tank Capacity CvDP` 5 @ 17i Ft TDH Max. Bury Depth Total Dynamic Head (TDH) - Feet Pump Manufacturer Elevation Head Pump Model Number Et Distal Pressure Alarm Manufacturer Network Pressure Loss Alarm Model Number Force Main Pressure Loss j 1,15-OR Switch Type 2i Total 12,07 Manhole Min. 4" Above Grade With Locking Device Vent Min. 12" Above Grade Weather-proof With Cap Junction Box Finished Grade - - - - - - - - Depth of Cover Ft Disconnect Means ' Outlet rt Inlet Switch Settings and Reserve Capacity II < Inlet e rr S `y{ Tank Volume = GPI - - Dimension Inches Volume Gal. A (reserve) A 7U ( 7 > C~ <'< 14» r{r ;r< t ' (alarm) B 2 B { Weep (dose) C < Hole ` / 01 y r° r (dead) D 5 Off Elev. C > > 7 Ft J J < > Total ► t > > D Bottom of Tank Elev. FS { s r , { r > > > r : > r > > r r > > r r > r > : r r > r > s r r r r > r > > > r r > > > r r r r > r > > > r > > > r > r~rt < K{{ K{;{ S{{{{ t S K S<< K t K S t t t t K<< K t t< K{ S S< t G<<;; t< S{ S t t{ S<; t S GENERAL INSTALLATION: The 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 excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/051gj Page of 17 GO►ULDS PUMPS Submersible Effluent Pump MODEL PE t-ua+r rump, SPECIRCATIONS MOTOR FEATURES Pump - General: General: ■ Corrosion resistant • Discharge: 1'/z" NPT • Single phase construction. • Temperature: 104°F (4000 • 60 Hertz ■s Cast iron body. n awmciurn' lVn..u.ous W.~nC 11 S unite ThPrmnnlaetir imru>tiar anr! uni, "-------r--- - ---'r--'-- fully submerged. • Built-in thermal overload pro- cover. • Solids handling: 'k° tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty hall bearing • Automatic models include a • Oi"lled design. construction. APPUCATIONS float switch. • High strength carbon steel E Motor is permanently • Manual models available. shaft lubricated for extended Specialty designed for the • Pumping range: see PE31 Motor: service life. following uses: • Mound performance chart or curve. • 33 HP, 3000 RPM ■ Powered for continuous Systems operation. • Effluent/Dosing Systems PQ1 Pump: • 12.0 Maximum a~ ■ All ratings within the • Low Pressure Pipe Systems • Maximum capacity. 50 GPM • Shaded pole design Basement Draining • Maximum head: 25` TDH PE41 Motor: woridng limits of the motor. • ~ Quick discmrneQ power • Heavy Duty Same/ PE41 Pump: • .40 HP, 3400 RPM cord, di standard length. Dewatering • Maximum capacity- 60 GPM • 7.5 Maximum amps heavy duty 1613 d SJTW length, with • Maximum head: 24` TDH • PSC design NEMA 5-15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capad)r 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 4.5 Maximum amps portable and compact. • PSC design ! Mechanical seal is carbon, FEEr M~ERS 40 ceramic, BUNA and stainless r - 1--'-- - ' - ' = -`F 1 MODELS' PE31. PE41, PE51 Fes _33_40, sleet. - _ _ - 56 ■ Stainless steel fasteners. - 35 r r- - - 10 E T - ; - - - - T 2 GPM - AGENCY EAGENCY llSTIh1CxS 25 C~p us Q 20- ter-. ; ~ - - i - Tested to 18.778 and r - -i- z - - CSA 22.2108 Statdards 15 Fie #t.R38549 p -T - ' fi- - TTY hnnps is ISO 9001 RookselL 10 - ` + -j--- -r--~ - - - -_f 0 0 0 10 ` 20 30 'W ; 50 601 70 ' GPM ' 80 L , 0 5 10 15 m3/h Goulds Pumps ACfTY 0 2002 G«,ias Pumps / ~ ITT Industries CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: C Owner's Address: 171 4~ Legal Description: Township: County: S f Subdivision Name: Lot Number: Parcel ID Number. - L~/ -5 U >C CSC 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 Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: ` License Number: Date: - Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 _ 1"x•.7 ~ , o 15 i -131-- /vl;'ll -j = l ~xa t r~ 5T c I O Y d 1 I Soit Af2sorpfiion System Cross- Sec-t~~,n ft 4" Schedule 40 Final rade PVC Vent Pipe I Vent Cap Wth Leaching --i► Chamber J System Elevation j ft ft Soil Absorption. System PEan View ft aft ft Vent Or Observation Pipe Leaching Chambers Trench 1 4n Dia. Trench 2 Header Leachin Chamber S ecifications Manufacturer And Mode( EISA Rating sq ft per chamber Soil Application Rate e- 7 gpd/sG ft gpd Design Flow _ 7 =Soil Application Rate - O_ EISA = Chambers 2 rows of~ chambers each. Page of I 3 s r I 7 - ° r - - - a v c- i I M II--~~-- N n.-{ ~f. U"3 W ~I co t~ - - o - ~i - I --JL 'ZD CD _ CD U Z f= / / / j N C) Cl- j' [11 co U) Lij L.LJ 2f _ 52 W uj v3 o6 U X 2 o w O CO O ~ S Cif t a. CD co U3 LLJ cv U Q0 A Z (D U) \ \ C/) N O m c) E75 UJ :a-j m O Lo ~ 1 zO~ F- -71 i~_ t Jul 22, 30:14 EDT by: OptioFAX Server (IU:1y) Page t oa J V R a ~ o~ N o S w J Z ? w z Z Z 0 o _ cr F- d iv rIM U p w ■I/A■ CI a _ m Ooo U Z 0 LL _ w twY z a Z o / ta- w Y w w > C X co co w s ST, CROW COUNTY 1 SEPTIC TA-N-K' IA-INTEN- -.A CE AGREE'VLE~+T A'4 D T O Vv-NE S % C RTI IL <""~T1 T 71'' € Owner; Bayer - J z 1401 Property Address 7~ Z~C 2 equurvd from P'arn;n & Zoning Department for new construcnon.l Cit'State Parcel Identification Number _ t/l D~ LEGAL DESCRIPTION D opertti Location 4 Sec. j I R vi Tv y to - -CKA Subdivision Plat: Lot Certified Survey Map ri I> v Warrantv Deed -9 (before 2007)Volume Page Spec house yesAo Lot lines identifiable ves no SYSTEM NLAINTENANCE 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. 'X ha` 711/steal can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance ,esponsipilities are specified in §SPS. 383. 2(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 caner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site ;;TE:water disposal System !s in proper operating condition and/or after Inspection and pulnpln~ (if necessary), the septic tank is less -ban l,'3 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 Safety And Professionai Services and the Department of Natural Resources, Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix Count-, Planning & Zoning Department within 30 days of the three year expiration date. !,,we certify that all statements on this - rm are true to the best of my/our knowledge. !/we am/are the owner(s) of the ~n3c r . described above, by virtue of a warn r deed recorded in Register of De, dS Cf ice. Number of bedrooms ~IGNATLRF_ OF -kPPLICANT(S) DATE .n% hiformation that is misrepres- _Ted may --.suit in the sanizar,, permit being revoked by the Planning & Zoning Department " ice with this apohcarion a recorded %vaTTan i Qee n'OIT the and ' ~Opy u. the CC.m,7ed Su ,'-'N filar r r~nce a inacie in the warrant ~,e.d 1) 4 ~i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity > Permit # fCC~ gal ❑ NA Septic Tank Manufacturer C~2 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 0 NA Number of Public Facility Units ❑ NA Pump Tank Capacity NA gal Estimated flow (average) 7500 gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) Lgal/day Pump Manufacturer ErNA Soil Application Rate t gal/day/ft2 Pump Model fi<NA 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) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L &n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 7 ❑ month(s) (Maximum 3 years) ❑ NA ~ year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: year(s)0 month(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ) month(s) N ❑ NA / _3 Oyear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) *NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) t Ivf NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 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 -2i of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter 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 another 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 and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules 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. T rJ aluatiRDI,a ~-t A/~n/ be i e failed CaN5T7eU~C~ gank ❑ 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 CONTAIN 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 Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name St C(Z ( (q(j 20AJI A Phone Phone _711s;__ 3R/(O_ (0 a D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(fl and 83.54(1), (2) & (3), Wisconsin Administrative Code. rn/is. Dept of Safety and Professional Services S`O" ;_~`~/',-a. ATION REPORT Page _ of _ Division of Safety and Buildings it accordance with SP °5 tr1ls. A-fnr. Code - County S n ,y Attach complete site plan on paper;iot less Than 8 112 x i 1 inches ir. size. Plan must include, but not limited to: vertical and horizontal reference poi r `3M), direction and Parcel I.D. ne.rcent slope, scale or dimensiors_ north arrow. and location in d c!iMpnce to nearest road. cc) Q 4' Please prism all informatim-, Revie r d by - Date Personal ir`ormabon yeu pro'.d^-. n?ay ,o.isea r er;nda nurpn;, Law. s. i5.(,A i) q~/ 4 7 Property Owner F'rr,oer;y Location CA10EIE ~A-K/ o, t.Lois(J 11 4Ei14S7 T N R! E(or1%U Property ONmer's Mailing Address i_ot # Block # Subd. Name or 09M# City State Zip Cade Pllnne Nui be y Village Town Nearest Road City ty o Coy _ 7-11 Ile, New Consiructlon Use: Residar,iial 'Number of beds op ,cz ~rzde derided design flow rate GPD RenlacEmen~ n Pi.rbhc crcnn~m_rcial nesc.ihe _ Parerli ma;ena' Y ail. C~. r t9 t l1 i. n , n t-_ _ ~.iE ,aiiiii it applinable General comments ~ j and recommendations St7g ~5 a--rrenc-I- s 41 - -r. a - _ F4 ~..a i 1 ' Boring Boring Cpy,^ dt~ 0 in. # W Ap,J G&M""~. - Pit s i, ac r,•,i b M L Croup. ~cutl tin li ~ ui~ltiliy fiartor 'Soil A. lication Rate Horizon Depth Dominant Color Rcdux Descno u i Sri is uie consistence Boundary Roots GPD/ft Munsell 1u S,' ('ont- Coln[ SZ. f Sh _ O 5L Ivy 23~a~ - d F,% W- ! - w v to `SRS/.; 1_ ss ! I yP- Y/~ _ D 7 5 `S L dFSIv v F,r (o 7.5 l L) 5cL (41 Boring # Borrna r „ C -oir+ sui , ^iev. W - v f 4/ 3 7`-_ J. •li`! I m!!,nq .actor - 1 d D - ih. - Soil Application Rate Horizon Dcp,h ~Dnn-imar.tColor °cdo Descrp_on _zfui Suncture consistence oamdary Roots GPD/ft' n Mansell Cu - Coni- r "lor l Gr. S: Sh ff#I I11t'2 E- ► ~ apt-,-: L _ - s_ I~~ ad o 1 '.2 F5oIw G9 1.0 L - 45 IOF 1.0 sc. k t4irf- F IUe t'- Il(lD - n #J = ROD 30 mg/L and 7:SS = 30 r~ I Name (Please Print) Q , CST Number l Add gy I ate Evalriation Conducted Telephone Number a ! p7pLl f h $ -t i _s-N a__ a-,, - 3 b- Q C>i .5 c sr3n-~3~o (Rl l~l t ~ q~L n 1~~ nt^,tg r^ Page c-N' of 3 - Parr:ei iD Property Owner ce. e Borinq v0 cation Rate Pit - Dcp`,h to limiting factor ~aa in. Soil A li Boring Ground rn ace elegy;. Roots #t GPD/f ~ 5z structure onsistence oundary Horiz Io Depth Dominant Coior~ Redox Descnp'ion tire. Mansell ~~I- S . Con t. Colo 51i ~ ~ &"S ~ rn fr q w a F v /6 jp3 7S7R/~ i- 5 t °?FSbr? I vh~~ f v~ a V I -a L Boring Boring # Depth to limiting factor in. P;t Ground surface eiev_ Soil A plicaCion Rate Horizon Depth Dominant ColorjRedox Desenptlon -exiuin Structure onsistence oundary Roots GPDIf~ GI Sz.Sh n. Munsell' ! )u. S<-_ Cont..;eloi i ~T { 5 -T e r ; i a - - - ! ; 8orina Boring # Ground surface =1ev. a:pthio lirliiinq factnr in, i u pi., Soil A lication Pate r I` Horizon Depth Dominant Color Redox Descnptlon f ex~u F structure onsis~ence _oundary Roots GPD/ft 2 ff#1 M Mansell ( C?1.:. Sz. Cant. color - GI. Sz. S h. 7 1 F ~ i j S BOG tfluent #2 = BOD < 30 ma/L 2nd TSS < 30 mg/1- si,,l~ ,,1, . _td,r and mj-)1 ,:cr l f voii need rl~si~'ta,ncc io 1 ill(, p'lrtillcnl. if 6081 ?`?6-? i 5l of I I'YJlhlUEjl Rcl3V. ~G,h ~ ~t n r', t e r~ R ~ Property Owner ci. G r- 4 k Parcei ID Page --j of Boring 3. ~ 0 Boring C Pit Ground surace elev. 10 R r Depth to limiting factor eta in. Soil Application Rate Horizon Depth Dominant Color Pedox Description & -ex"ure Structure onsistence Boundary Roots GPD/ft n. llunsell C2u- Sz_ Cont. Color Gr. Sz. Sh_~ ff#1 f2 31 ~stt~ €St i - ~'1 G h~ r1 ~ Boring # Bonng j pit Ground surface elev Depth to limiting factor in. Soil Application Rate Horizon ~ . Depth Dominant Colorj Redox Description Texture ( Structure ,onsistence Boundary Roots GPD/ft n. Munsell' OLL Sz- Conl- Color E Gr. Sz. Sh. ff#1 ff#2 i ! Boring { Borino ijil # rr~~ LJ pit Ground sui ace elev, ft. ___')epth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color! Pedox Description -exture Structure onsistence Boundary Roots GPD/ft In, M,unsell OU, Sz. Cont. Color i Gr. Sz. Sty. If f#2 E I 9 I I e 1 F I k ~ I 1 I ~ E I ~ Effluent # i = BOD 30 f 220 mg/L ane TSS >30 - -f; jc,/i_ ' Effluent #2 = BOD , < 30 mg/L and TSS < 30 mci/L The Lieut. ni'.S r--i and Pmics In a. Se i .cs is 3 ar ~irh<~1 s 1 c ?"I'M !der anti cnrpiovc~: Ihl ou need ass?stance ¢r, BCCeS~ act v1C£S 0" nC.f.,i InBiel the Ci Ci)~i'til'1 elll M 608-2bC ! I O" FPtT thl'ouch PciaV aG rt E'/y~ 5 cc,-7 a91v R Igw par~,cl 0V%0 `S*k fV 5r-ale', I#, yp„ 6 of 177 Y Ev aoot• Q. (To 0$ Pek', L~ 65 0 c o P 4 ~ 5 p r% 5 1 A a~ ~ 4 Pees ewt + ~L 4 r'TD V S G U`` ~ j 5 AO I no i I