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HomeMy WebLinkAbout020-1066-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 582020 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID No: Permit Holder's Name: City Village Township Parcel Tax No: Alan & Karen Duray TOWN OF HUDSON 020-1066-60-000 CST BM Elev: Insp. BM Elev: SM Description: Section/Town/Range/Map No: 3 S (3--3 C-6T 24.29.19.256C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z /Z Benchmark S S v c.rr~ op 4g• 93 • S F; l L-117 M.L_ Alt. BM~,I GbJ 0. Z 9 3 Aeration Bldg. Sewer Holding 3 . 7Z, St/Ht Inlet 3 4T• TANK SETBACK INFORMATION St/Ht Outlet ~l 4 c1s .9 TANK TO P/L WELL LpG. ent t it Intake ROAD Dt Inlet 50 tiiLL.. a ~ ~ Septic S Dt Bottom IDL Dosing Header/Man. Aeration Dist. Pipe •D C114 •S 11 Holding Bot. System T. G 9b , PUMP/SIPHON INFORMATION Final Grade 3.61 Manufacturer Demand St Cover' GPM r'i J M, CO • Z- Model Number TDH ift Friction Loss System Hea H Ft Forcemain Leng la. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width J Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:~~ INFORMATION Type Of System:I n CHAMBER OR Z^ i- GOy1J~~.•` ja ~X-~ 74 33 d UNIT Model Numbr: DISTRIBUTION SYSTEM A.ta ZL 4- z-- Header/Manifold d Distribution x Hole Size x Hole Spacing P to Air I take Length / ! Dia 4 Len Dia Spacing e 5 SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No es ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 807 BADLANDS RED ex (~J_a K 6 v~ 1.) Alt BM Description= r `fl ` ^ "~J y t I ( ~~•~~JJ 2.) Bldg sewer length = Z~ e><1,~~ C ~q,J4 t" /.•O G.1~.. a rr~ - amount of cover = 3~ / n n `7 d h 0.~CX. Plan revision Required? ❑T Yes )~'No Use other side for additional information. J T~ SBD-6710 (R.3/97) Date 4=Zsepcitor's Sig ure Cert. No. PROJECT Alan Durav PLOT PLAN ADDRESS 807 Badlands Road Hudson Wi 54016 SW 1/4 SW 114S 24 /T 29 N/R 198 W TOWN Hudson COUNTY SYSTEM ELEVATION 91.0/90.2 4.8' below grade 10/15/15 CONVENTIONAL )OCX IN-GROUND PRESSURE DATE BEDROOM 4 CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of lowest wood step BOREHOLE ASSUME ELEVATION 100' Filter Lifetime Filter ❑ O WELL * g. R. P. same as benchmark Badlands Road All piping shall be ASTM SDR 30/34 within Cale = 1 4 '1 = 101 10' of tank, piping shall be ASTM F891 W 24' Vents Existing 4 27' Bedroom House 20' B-2 10% Slope 30' 60' 68' 30' 2' B-1 3 , D %d 0 S B-3 40' ` b. 1b W 94 W 2-3' X 90' cells with >3' spacing Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation Safety and Buildings Divi 8~A ` K 7015 Sanitary Permit r 0 201 W. Washington Ave.; P. 79 (to be fillod in by Co.) Madison, W1 53707-7162 Q1couv0 TY7 1 6 Z OZ Sanitary Permit Application . raonN In accordance with SPS 38321(2) Wis. Adm. Code, submission of this form to the appropriate governmental wit is required prior to obtaining a sanitary permit Note: Application farms for OX-owned POWTS are submitted to Project Address the Department of Safety and Professional Servies. P (if different than mailing address) Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15. 1 in Stats. 16 -7 / J -L- A lication Information - PI int All Informati q, `q Properly Owner's Name rt~t JI„ J\ ! Parcel # Property Owner's Mailing Address 0 © J~ 1 Property Location Cny State Zi Code Phone Number Govt Lot a "V D CJ /Glircle II. Type o Buildiag (check all that appl Lot # N; R _ or W f ~l , G G ✓VO 2Family Dweifing-Number ofIielro ms ion Name PublidCommercial-Describe Use Block t Y - i`~ ❑ City of ❑ State owned - Describe Use CSM Number ❑ Village of ZL Ti2 Town oft in. Type of permit: (Check my a box on line A. Complete line B if applicable) iiji, `q ew System System El Treatmett/Holding Tank Replacement Only ❑ Other Modification to Existing Systei (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change ofPlumber ❑ Permit Transfer to New Dart Previous Permit Number and Date Issued Before Expiration Owner IV. ofPOWTS S stem/Com onent/Device: Check all that apply ~Ion-Pressiaized In-Ground ❑ Pressurized In-Ground ❑ At-Crrade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaVrreat ut Area Information: Design Flow (gpd) Design Soil Application dst) Dispersal Area Required Dispersal posed , (sfl System El n VI. Tank Info Capacity in J Total # of / f) Gallons Gallons Units v New Tanks Existing Tanks L U I,~/ f.~G~ d °O 2 w a 3 Septic or Holding Tank • _ 1 Y e ` 4` U iii „ v~ ii C' p Dosing (~ramber Ca S VII. Responsibility Statement- I, the undersigned, assum risibility for installation of the POWTS shown on the attached plans, Plumber//'s Name (Print) , Plumber' a MP/tvTRS Number Business Phone ber Plumber's Address (Street, City, State, Zip ) -ZY,3 Z- d-O~ VIII. Coun /De artment Use On roved appr~ove~ Perrixi Fee Date sued Issuing Ag Ill ❑ want-rm ea Reason fur Denial -T !b 7•~ S IX. Coaditi 1QVasons for Aisapproval 1. Septic tank, effluent filteril l 3) at 3 S 6^^, a 0. dispersal cefl must all 4a serve es!'maintained as per management plan provided by plumber. G~dL~t. Wk reglliNe W is must be nlaintair as per spplicable code'/ offlinarlM. Attach to compete plain for the syste m amd submit to the Coriory only oa paper mot less ehsn 8 trz z ] 1 inches im sin SBD-6398 (R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/15/15 Owner:Alan Duray Location: SW 1/4 SW 1/4 S24 T29 N,R19W 807 Badlands Rd Hudson Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Secti 4-6. Maintanance and C gency Plan 7. Filter Cross Section Signature e License number 900 K , PROJECT Alan Durav PLOT PLAN ADDRESS 807 Badlands Road Hudson Wi 54016 SW 1/4 SW 1/4S 24 /T 29 N/R 198 W TOWN Hudson COUNTY SYSTEM ELEVATION 91.0/90.2 4.8' below grade 10/15/15 DATE BEDROOM 4 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 ,BENCHMARK V.R.P. Top of lowest wood step ASSUME ELEVATION 100' Filter Lifetime Filter ❑BOREHOLE O WELL *H.R.P. sameasbenchmark Badlands Road All piping shall be ASTM SDR 30/34, within cafe - 1/4" = 10' 10' of tank, piping shall be ASTM F891 24' Well Existing 4 Vents 27' Bedroom -0010 House 20' B-2 10% Slope 30' 60' 68' 30' 27' 2' B-1 30' 13' DW 0 T B-3 95' 40' S 94' 20' 2-3' X 90' cells with >3' spacing Vent >659 Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area N 12" 5.6ft^2/pair of end caps 4' Long -3491 Grade at System Elevation 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 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent _ Typical Installation ~ 96.0' Grade Vent 3' 4" ~~30/34 Septic Tank 3 5' Long 1 ~9 5' S' Long 119 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A-91.0' B_90.2' ST. CROIX COUN'ry SEPTIC TANK MAINTENANCE AGR RRMRNT AND OWNERSHIP CERTIMATIUN FORM Owner/Buyer lo,-, Mailing Address 1~ ~t Property Address -~)U, (Verilicatim required from Planning & Zoning Departarrent for new construction.) City/State Parcel Identification Number 4 - A G - LEG___AL DES Property Location SLL) Y. Y., Seca, T ~?_N R -W. Town of Subdivision - Lot # J Certified Survey Map # Volume Page # Warranty Deed # / volume . Page # Spec house Y"(;) Lot linos idea ifable ® no SYSTEM MAINTEU Na AND OWNER CERTIFICATION use and maintenance of your septic system could result in its premature faibire to handle wastes. Proper mat arienance consists ofpuarping out the septic tank every throe years or sooner, it needed, by a licensed pumper. What into the system can affect the fiction of the septic tank as a treatment stage in the waste disposal you put tem. maintenance Owner des are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix Co~Y 'Sam ry Sanitary Ordinance. The property owner agrees to submit to Sk Croix County Planning & Zoning Department a certif cation form, sped by the owner and by a master plumber, journeyman Plumber, restricted plumber or a licensed pumper verifying that (1) the on-site . ~ &RxxW system is in pmper operating condition =d/or (2) after inspection and pining (if ~c y). o septic tank is standards set ,the undaszgned have read the above requirement$ and agree to maintak the private sewage disposal system with, the forth, herein, as set by the Department of Commerce and the Dot of Natural Resources, State of Wbconsit,L Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Depamment within 30 days of the three year expiration date. I/we certify that all statements on form are trot to the best of /our la howlfi property described above, by virtue of a 7 deed recorded in Register of Deeds Office. ' Uwe am/are the owner(s) of the Number of bedrooms _ GNAT'URE L ANTS DATE ***Any information that is Inkrepreseoited may result in the sanitary permit being revoked by the Pkm=g & Zoning Department. Include with this application a recorded warranty dad from the Register of Deeds CIfg. and a copy of the certified survey amp if reference is made in the warranty deed (REV. 08/05) F"OWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of J FILE INFORMATION SYSTEM SPECIFICATIONS Owner S Septic Tank Capacity 1:3 NA Permit Septic Tank Manufacturer 44~WO NA 3ESIGN PARAMETERS Effluent Filter Manufacturer j Q NA Number of Bedrooms O NA Effluent Filter Model ❑ NA Number of Public Facility Units V~JA Pump Tank Capacity al NA j Estimated flow (average) aVda Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) Q aVda Pump Manufacturer NA Soil Application Rate i aUda /ftz Pump Model NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 13 NA Fats,' Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 6220 mg/L ❑ NA D Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dis ersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: !Maximum Effluent Particle Size Ye in dia, ❑ NA Other: ❑ NA (Other: NA Other. O NA "Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once every' month(s) ears (Maximum 3 years)'? ❑ NA !Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA (Inspect dispersal cell(s) At least once every: 13 month(s) esr(s (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ,I meonth,s) ❑ NA Inspect pump, pump controls & alarm At least once every: 7~❑lYmonth(s) ❑ year(s NA I=lush laterals and pressure test At least once every: 13 month(s) ❑ ear(s) NA 3ther: At least once every: 13 month(s) tither. ❑ year(s) NA 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 immbined 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. I+Nhen the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. III 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 of painting products or other chemicals thelt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of ft. 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 ble 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 withln 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 POWT:13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dram (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; 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 propetly 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: '7~-y4- Itable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon; by requiiled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nEled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulesi in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologN 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 soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNiNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O1 F A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Phone ~)J L~; Phone _ j SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY E Name Name Phone IJ 5- o~ Phone 7✓,'- ' 2~b fro This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. N 411 i t .yl(Iti; i cq a a g 0 I d i i c c °o P- N h N c co 3 Z f= c U W i { i MINION 8 8 4 6 7 7 2 884677 State Bar of Wisconsin Form 1-2003 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 11/24/2008 11:30AM WARRANTY DEED THIS DEED, made between Gale A. Sober (also (mown as Gale L. Sober) as EXEOPT t 17 Trustee of the Leonard A. Asher Irrevocable Family Trust, REC FEE: 13.00 ("Grantor," whether one or more), PAGES: 2 and Alan D. Duray and Karen M Duray, husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area R estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): Amber Dunham Riverbank - Hudson See attached legal description 880 6'h St N. Hudson, Wl 54016 This deed is given in fulfillment of the Land Contract between the parties dated January 15, 1991, and recorded on January 17, 1991, in Vol. 891 of Records on Pg. 106 as Document No. 465736, and as amended by Document No. 535442, Vol. 020-1066-60-000 1146, Page 91 and as amended by Document No. 687479, Vol_ 1952, Pg. 299, and as Parcel Identification Number (PIN) Assigned to Gale A. Sober as Trustee of the Leonard A. Asher Irrevocable Family Trust, Document No. 727707 recorded in Vol. 2292 Pg. 007. 'this is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, highways, utility rights, reservations and restrictions of record, and any encumbrances created by the Grantees, Alan D. Duray and Karen M. Duray. Dated PPg G/ (SEAL) (SEAL) * Gale A. Sober, Trustee (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) ' ~ STATE OF WISCONSIN } authenticated on - , / } ss. t.r y COUNTY ) * P P U R 1'...) a Personally came bef a me o & 5 /o TITLE: MEMBER ST SIN the above-named (If not, OF W 1 aG authorized by Wis. Stat. ' t e kno e t s) who executed the foregoing ttvme d aVwd t he same. THIS INSTRUMENT DRAFTED BY: Terrence L. Dunst Bakke Norman S. C. - Baldwin, WI 54002 Notary Public, State of Wisconsin My Commission (is permanent) (expires: (Signatures maybe authenticated or acknowledged Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 1 of 2 Wis. Dept. of Safety and Professional Services C LWALUATION REPORT Page / of 3 Division of Safety and Buildings rr~~ ,)r 4, L, in accord vQthi~~0 105, Wis. Adm. Code County _ST, t✓ 12 ©l X ttach complete site plan on paper not less thSr(,80Fj0JX100b% 'size. Plan must clude, but not limited to: vertical and h®r~~ lUi d"tion and Parcel I.D. ercent slope, scale or dimensions, norM arrow, and location and distance to nearest road. 02 (O 66 -X00 -0900 Please print all information. Reby D ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r"M /operty Owner Property Location rL ` Pm~~ 3J~q Govt. Lot 'SW 1/45 61 1/4 S 7 e2.7 N R ~9 E (or)~ Pro erty Own rs Mailing Address Lot # Block # Subd. Name or CSM# 07 I P,DI.~~DS EcTS f3DVArOv 44-0 - Ci State Zip Code Phone'Number ~DSonl W 5yo/4 ❑ City ❑Village CATown Nearest Road -L(715 J11 2- 7// 9 tl u pso~ , FAST PO w r ,~A04A)Vs ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate o GPD Replacement ❑ Public or commercial - Describe: Parent material OES,S oiyeA $/{wDy 0 U f ' Flood Plain elevation if applicable _MIA- ft General comments WAS k and recommendations: Arn -LSpot Tested aWW* ter Area Spot Tested suitable for e CONSMlonel inground system (P.O.W.T.S.) ,,atom rP 0 W .T.4 ) TI El Boring -70 , 9 Boring # J 1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 l 0-11 0YR 3/2 - Gy 61 5 wv f R S Z- . 7 I. 2- ll-i? loyR y 3 5L /-F5bw- o-PR. 5 • y . 7 3 11.31 /0 yR 5 - SL 5bk mtr2 cS o .5 ~-19 /O yR o~ , ►I Boring # ~ Boring ~ Pit Ground surface elev. 0 ft. Depth to limiting factory in. Soil Application Rate IN Dominant Coior Redox Description Texture Structure onsistence Boundary Roots GPD/ft z Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ' ff#2 ~a yR 3l~ s u., 7 6 i0 vR 5? D s s • 7 6 Z /0 OR &Ie /o 7Q. s 4 I `Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _ 150 mg/L * Effluent #2 = BOD z < 30 mg/L and TSS < 30 mg/L CST Name Please Print) Signature CST Number ROBERT Z!L2,RICAT yoy4twl~ i 6_~ ~ 2.z&37S Address / PR1 N ' vJ Date Evaluation Conducted Telephone Number 7r1~ y SEPT. 9015 7(5. 77A' y?f 7 SBD-83M (RI 1/11) ~UQgy ozo- 106(P-60 - 000 Page Z of Property Owner Parcel ID # 3 ❑ Boring# Boring 9 3.S4 ~CO ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 l D C$ o YR .3/2- 54 lf5,dk /mu-Fk s!' . G z 3/ /a 3 5L L-~Sh)k,' Ao-FR w 6 o 3 yo -7, 5 yR y s s f s - i. o 6 7.5 YR 6* ❑ Boring Boring # im El I [-I pit Ground surface elev. ft. Depth to limiting factor t Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff #2 Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots ff#1 GPD/f2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = BOD 5 0 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternatA- format, contact the department at 608-266-3151 or TTY through Relay. SBD-9330 (RI 1/11) Property Owner DI L) g ~ Parcel ID # 0 ZO - 10 tD tP L 0 . 0 oo Z Page of a Boring #❑,7 Boring q 2 ~ S~ ~ 4al pit Ground surface elev. J ft. Depth to limiting factor Y6 In. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence jound ary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 /o YR 3 z SL /~S,dk n~►vf~ 2. 3 hK A*f 2 - r. o 3 y0 S' yR s S 5 AM r2 c S 71/c/9 S R - rvq -5 d , s '011 7 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ti ff#1 ff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 Effluent #1 = BOD 5 0 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 1/11) _ 15APl-A,Aj DS . KAREN AlAki D U RAy Home . tZ$ TAP of :._.---5 ~w i FIA116 IEVA*f well r 3 T3EPRM. HM • 1y' ~ 90 0 (3Z i ~o • 9EcK r r 6% , p!,'~~r ?jp' L.. 27' ~XiSTiN 19100 5 !7 1 (3M 5 EPTi c T• ° F uivKN°wa cwaoiT/0x S)ZE o ; ° a BRAVE lo98. ~y 93 83 aywe 11 S:f t uc.ET = 14-50 . Sp /0 a ysb' s 4 73.50 (31`1 # = Top o F 15r LowEsr wool DEGk 5rep. ~ ~EVRT"lar.~ = /DD, O 5CALE' 1%'=30 • BAGktioE TI rs -----,a, = c oN - o~ VhVE 61EVArIo,3 c.lAaee `P 3 e-F 3