HomeMy WebLinkAbout026-1165-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 589763
GENERAL INFORMATION 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:
Steve Dalton TOWN OF RICHMOND 026-1165-10-000
CST BM Elev: Insp. BM Elev: BM Descriptio ,An Section/Town/Range/Map No:
~~d Ir' Co~nt~ L 22.30.18.1276
TANK INFORMATION ELEVATION DATA i1I TYPE MANUFACTURER i Ny CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
13"iIRS Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
9 ~ z ~y Zo 5p,
TANK SETBACK INFORMATION St/Ht Outlet C . S
TANK TO P/L~ WELL BLDG. Ve ,t AilIPtake ROAD Dt Inlet
Septic 7Z 7 Dt Bottom
Dosing Header/Man. • Z / 3.3
Aeration Dist. Pipe
/D. Z• qS • 3
1/b 3 47s .2-
Holding Bot. System Z Z
PUMP/SIPHON INFORMATION Final Grade ~ -5 9
Manufacturer GPlm~and St Covert'
Mode[ Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length --rr--7 Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di=_ IAgy~d Depth
DIMENSIONS 3 71 Z % Q~ `
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma-nyf~ct
INFORMATION CHAMBER OR
Type Of System UNIT
Mod umber
C /JA- Zj 154;.
DISTRIBUTION SYSTEM C? - / 3S ~uS
Header/Manifold Distribution Ix Hole Size Ix Hole Spacing Veto Air Int ke
~ PIPe(s)~~
Length Dia Length Dia Spacing
SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over Depth of xx Seeded/Sodded Mulched
Bed/Trench Center 4.49 Bed/Trench Edges Topsoil l
es I No Yes 1 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1446129TH ST ~Q&~" ~AI~ ~•tr~~, a~
1.) Alt BM Description = , •w l~ w`. t~,~~~"/
2.) Bldg sewer length= ZtT
- amount of cover =
Plan revision Required? Yes o Le,
Use other side for additional information. ( vl
Date Insepctor' ignature Cert. No.
SBD-6710 (R.3/97)
Ecrnrx~~ County,
r Industry Services Division
( 0 S r?~ 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
Ps' M JUL ( P.O. Box 71
115T COUNT Madison, W' 537 1 nj
QE` F-LO MENT
?T~9 State
Sanitary Permit Application TPweFV41VTransactiol \ 'umber
In accordance with SPS 383.21(2). Wis. Adm. Code, submission of this form to the appropriate govern .
is required prior to obtaining a sanitary permit. Note: Application forms for state-ovmed POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. / A~ / e
1. Application Information - Please Print All Information a ti zxTen
Property Owner's Name Parcel #
:~a 14v' 0L& -//&I. -/e -r(Y 0
Property Owner's Mailing Address / Property Location
C") C Govt. Lot
City, State Zip Code Phone Number Section 2
(circle oye)
j ii~t i; t5 1 t l6~ A c.~ T J T 3v N R i g E ofJ/
II Type of Building (check all that apply) Lot
or 2 Family Dwelling - Number of Bedrooms Subdivision 1Name
Bloc k L1'v zt 1 ! f= O ihr t~
❑ Public/Commercial - Describe Use 1 _
I/~O J Iah ❑ Cit} of
❑ State Owned- Describe Use
CS ❑ Village of
~j M Number
1 l .Town ofC j 1 /t!r+ /v
III. Type of Permit: (Check only one bo on line A. Complete line B if applicable)
Za
F.B YNew System ❑ Replacement System ❑ Treatment/Flolding Tank Replacement Only ❑ Other Modification to Existing S} stem (explain)
❑ Permit Rewe al ❑ Permit Revision ❑ Change of ❑ Permit Transfer to Nesm List Previous Permit Number and Date Issued
Before Expiration Plumber O«ner
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
❑ Hol mg an ter ispersal Component (explain) ❑ Pretreatment Device (explain) ~•N~
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation
146D Rate(gpdsf) , .-7 /'1
VI. Tank Info Capacit} in
Gallons Total r of Manufacturer = v
Gallons Units o
Ne~~ Tanks Lykting Tanks
Septic r I IoIding Tank ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
A'II. Responsibility Statement- I, the undersigned. assume responsibility for installation of the PONVI S shomN it on the attached plans.
U bet's Name (Print) Plumbers Signature 9 Jf IJIPR > \umber Business Phone Number
L k' -7 ;7
Plt mberl Address (Street. Cite. State. Zip Code)
VIII. C unty/De artment Use Only
Approved Permit I cc Date sued ISSUin gent Sign tire
Ow ~,,,enReasonforDenial S
c
I\. Condit' ~easons for Disapproval 4 ZA.
ROO
11': , 0ank"40LOMi fi1t~ n i'
r•
tll60er=s,i cell must all a services ! mr+ nnec' 406 Pt `
as.per management plan provided by plumber.
2. All se eGk *44rerslents mysf he mairdEined 6 wi &
as per WPI'
I"= o comp ete p ens or the system and submit to the Count only paper not less tha 8 1/2 s I I inches in size
fie
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: i
Owner's Name: 7
e A-,
Vin- ,
Owner's Address: 3 3
Legal Description: Z t ~E'r . 9 - 2'4
--7)
Township: C hr G N
County: ~f . L/rs. r
Subdivision Name:
Lot Number:
Parcel ID Number: .00 e~
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. 14wti s License Number: 7 7,
Date: 7 7 4 Phone Number
Signature
Designed pursua t the In-Ground Soil Absorption component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
frU a I-o.,J Jv ~l -
1~ d ~ l~l °v l F f
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5f
f tc v . ~ ,,,r, U
00
i
r ~ l a r~ ic
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Soil Absorption System Cross Section
4" Schedule 40 I j Final Grade
PVC Vent Pipe
~3.
j ~ ~PJith Vent Cap
L~aCiiing
Chamber f
System Elevation
r
Scil Abscrotion Syst-m Plar View
,L
~I II~Iilll I Illill!I Illlil; 'I IIII II III!illlliiIll!O N
'
A' 1~
` Leaching I Trench 11
Vent Or Observation Pipe Chambers
Il i ill l,il f lil,lll'III Il►Illil ,i''il III!1lliii II IIIIIIIIIIIIII it 11l i
A" Dia
Trench 2 Header
Le-achina Chamber SceclficaVons
i
Manufacturer And (Mode!
J I Y
EISA Rating sq ft per c;,arnber Soil Application Rate ' gpd/sq ft
gpd Design Flow : Soil Application Rate _ 20, ~ EISA = 'If ~ Chambers I
2 rows cf
chambers each.
Page cf
z
k ~ f
3
i 'a t k.1
Installation and Maintenance Instructions
Installation
Step 1 Dry fit the filter case on o the outlet pipe going to the drain field. Ensure it is centered directly under the
access opening. (if outlet pipe i.s already in a fixed position, additional pipe may need to be added)
Step 2 If utilizing the additional single side support and the two bottom su orts:
Pp While the case
is still dry fit to the outlet iae, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the
hubs that are pre-molded to the case to the side wall and the inside floor of tank. solvent weld pipe into the
hubs that are pre-molded onto the case.
Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case.
Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press
straight down until it locks into place
Maintenance
1) Remove the c- ess lid of the t'ink. Not o sure role solids, do not exit th , tangy dnJ into :n-
drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank.
2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed.
4) Place the filter cartridge 'suck into the filter case pressing down on the cartridge until it locks into place.
5) Place the access lid back onto the tank ensuring it is secure.
Lifetime filter has a lifetime limited warranty:
Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of
time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was
not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not
be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained
properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other
incidental or consequential costs.
Contact: mike/21ifetinnefifterlic.com Phone: 502-724-2231
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Tank Manufacturer: u w ❑ NA
Permit #
,(Septic ❑ Dose ❑ Holding Volume: 0 0 (gal)
DESIGN PARAMETERS Tank Manufacturer: -[;]-t~A
Number of Bedrooms: 13 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: A Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow. - C r (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): 1Vj--C) (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: (gal/day/ft2) Effluent Filter Manufacturer:
' ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model:
Fats, Oil & Grease (FOG) <_30 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (BOD5) <_220 mg/L ~L2<A _-0N-A
Total Suspended Solids (TSS) _<150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BOD5) >220 mg/L :❑'NA ❑ Mechanical Aeration ❑ Peat Filter ~A
(TSS) >150 mg/L
❑ Disinfection ❑ Wetland
Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other:
(BOD5) <_30 mg/L Soil Absorption System
(TSS) <_30 mg/L e <A
Fecal Coliform (geometric mean) <10' J-IrfGround (gravity) ❑ In-Ground (pressure) ❑ NA
❑ At-Grade ❑ Mound
Maximum Effluent Particle Size s in dia. -{T NA ❑ Drip-Line ❑ Other:
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) hen combined sludge and scum equals one-third (%3) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: L- ❑ month(s) (Maximum 3 years) ❑ NA
L~-year(s)
Inspect dispersal cell(s) At least once every: Z El month(s) (Maximum 3 years) ❑ NA
wear(s)
Clean effluent filter
.,5 £d'ee At least once every: El month(s) El NA
fft-year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ANA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) --ANA
❑ year(s)
Other: At least once every: ❑ month(s) El E TINA
year(s)
Other:
❑ 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 the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment 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 (pumper) 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 _<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,
r,nn1A/-nnr, rrom,~i
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, solvents or other
chemicals or sediment that may impede the treatment process 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) prior to 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 one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation 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 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 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: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (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 be taken to insure that the system i~ i ru:.
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:
• 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 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 the time of their permit issuance.
❑ 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.
❑ 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 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
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name y~,~ ~T) A, .S' Name
Phone % j - Y,171
~_~r 3e? Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name << e Name _Tf. eA- 0 . ti d .ti ; lv .
Phone Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer V P D q '
Mailing Address O C -z y e r /'L' e- P'f
Property Address
(Verification required from Planning & Zoning Department for new constructio
City/State A,/ f ~ sc) h ly-- Parcel Identification Number
LEGAL DESCRIPTION
Property Location I ~J V4 , Sec. L z , T 30 N Rift , Town of 1`~',' c h ,-yn, A 'J
Subdivision Plat: / u ,v J !I A'.- d J.N s , Lot # /t,
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house JE yes ❑ no Lot lines identifiable Ayes G no
SYSTEM MAINTENANCE 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. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(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
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this rm are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a wan ty deed recorded in Register of Deeds Office.
Number of bedrooms
0 X_f_
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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RECEIVED
Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page ` of J
Division of Safety and I)J~nT9 2016
lJL in accordance with SPS 385, Wis. Adm. Code
County
Attach com lete r i(
p $.{~In 8 1/2 x 11 inch ;size Ian must
include, but q 6M 1N al reference poin ti on d Parcel I.D.
percent slop`$, scale or dimensions, north arrow, and location ZT19 re d.
_1. A
Please print all information. 7'PVV8FV4 Revi ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 1 b.u- N~ /
Property Owner Property Location
i-
Govt. Lot 14"" %j 4 / 1 /4 S Z a T j t% N R/ E (ol ic>r
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village ~To Nearest Road
~3~ r, ,v`~ ?~i; ~~y~' (~~s ) ~1s0 Zb' f1 , c 1~ M t: / 2,
New Construction Use: [ Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material _ Flood Plain elevation if applicable ft.
General comments `
and recommendations:
17
j F1 Boring
Boring #
® Pit Ground surface elev. 7 G ft. Depth to limiting factor / in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft a
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
✓
dY7
& / /c>y4-1'/Y (-f ( tvi
3y- Y/L,
5-' 3-Pp
t
F Boring # F] Boring ~ -
/ 0 Pit Ground surface elev. 4 ft. Depth to limiting factor in.
Soil Application Rate
z
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2
/ I ' Tf ~t 4 K / r1 / ~/2 e p~,is+~ T ( i
3 4 14/3
Y/ 7z-
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TS 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L
CST N (Please Print) (1 Signature CST Number
-7 J -7
Address Date Evaluation Conducted Telephone Number
o. j
SBD-8330 (RI 1/11)
O' Parcel ID Page ;a of ✓
Property Owner
F Boring # F] Boring ,
Pit Ground surface elev. 3 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. ff#1 ff#2
VA,
V _0 9-7
( - -
~i
❑ Boring # ❑ Boring Pit Ground surfa4eT ft. Depth to limiting factor in.
Soil Application Rate
z
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft
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 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
Effluent #1 = BOD 5 > 30 < 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-3330 (RI 1/11)
PropertyOwner C' d Parcel ID Page °2 of
M Boring # F] Boring
pit Ground surface elev. i 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. * ff#1 * ff#2
Q 15
❑ Boring # 1:1 Boring N ' If E:1 Pit Ground surf ace e 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
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-I ❑ Pit
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
* Effluent #1 = BOD s > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD s < 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)
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