HomeMy WebLinkAbout040-1316-15-000
/isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No:
589759
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:
Brandon Cernohous TOWN OF TROY 040-1316-15-000
CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town/Range/Map No:
8 L G.6-r 05.28.19.2071
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER /4, .1 CAPACITY STATION BS HI FS ELEV.
Septic =r 3 Benchmark R q~ 5 ~f 5
' ` 1 7 oD
Alt. BM
o ~ak. Z 5
Bldg. Sewer J9O
S7~ '
1 11-11,
Aeration ~ ~
Holding St/Ht Inlet v/
TANK SETBACK INFORMATION St/Ht Outlet 43 03 '17J t -7
TANK TO P/L WELL BLDG. Vent t it Intake ROAD Dt Inlet
5,6 ~
Septic Dt Bottom ~
/V
Dosing Header/Man. 7.7 v
Aeration Dist. Pipe T-33 %d ` /C
Holding Bot. System ?.33 -?9, 1
~ 17, 5• 1
PUMP/SIPHON INFORMATION Final Grade 3 k,1
Manufacturer DePmm~and St Cover ~1, . A ~ 84
Model Numb
TDH Li Friction Loss System He Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION *YS EM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
v _C"
DIMENSIONS Z %(4P
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Fla
INFORMATION CHAMBER OR G
^ K
Type CSystem-
J~ UNIT Model Number:
DISTRIBUTION SYSTEM N 1'--c,"
Header/Manifoy Distribution Ix H019 e Ix Hole S acin~ Vent t Air Intak
Pipe(s) ` tJ~
Length 7 Dia Length- ~ , Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only S
Depth Over Depth Over 1XX Depth f xx Seeded/Sodded r Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2:
Location: 505 AUTUMN B E TRL "~"r- ~ • C ~Q~ ~S / O~ 5 6
1.) Alt BM Description = It 2.) Bldg sewer length
- amount of cover = i
> ~
3 a h C`JU(C) \XI
Plan revision Required? YesNo~ y
Use other side for additional information.
-_e Cert. No.
Date Insepctors ignatur
SBD-6710 (R.3/97)
Safety and Buildings Division county C
xg ; r~ 201 W. Washington Ave. P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
P JUL Madison, WI 537 ~16 QG~
ST. CROIX COU ~ U / 75
COMMUNITY DEVELOP ENT
Sanitary Permit Application "'JZCF7Fy8J°'ateTransactio Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental um.
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to ;~56!5 t 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 ats. •arwl1 Slitsc
1. Application Information - Please Print All Info ma n Prop
erty Owner's Name ( Parcel #
ell 4y~
Property Owner's Mailing Address
Property Location .oIp rye. i1 , a L ~ t
Govt. Lot
City, State Zip Code Phone Number v,, Section __f-.01 G~~ ~t~r= ~~t f T circle one
T
J ~ N; R~Eo r6V
11~.. Type of Building (check all that apply) Lot #
{IC$1 or 2 Family Dwelling - Number of Bedrooms 6 ) Subdivision Name
6k. auD Block # c' lP eJi,
❑ Public/Commercial - Describe Use ❑ City of
❑ State Owned -Describe Use CSM Number El Village of
'
Town of 0,
L-6k Ce-d-5 L-)/
III. Type of Permit: (Check only on box on line A. Complete line B if applicable)
A. Ni New System El y Replacement S System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that a 1
X Non-Pressunz n-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 nt Area Information:
Design Flow (gpd) Design Soil Application Rate( dsf) Dis rsal Area Required (s Dispersal Area Propose sf) System Elev nA
G«y
) 1,71
VI. Tank Info Capacity in Total # of Manufacturer Y 49 ' r BA
Gallons Gallons Units r 0 v
New Tanks Existing Tanks o
Y ` 0 in - v v t7 w
Septic or Holding Tank t f
9 L
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbe 'ature MP/MPRS Number Business Phone Number
~ -y
Plumber's Address (Street, City, State, Zip Code)
.f
VIII. un /De artment Use Only
Approved ❑ p Permit Fee Dat Issued Issui gent Signa e
rov c.
ven Re n for Denial Cf7 7 7 ZZ ' T
Owne
IX. ConditShcaww( easons for Disapproval l1 _ " L
1. Septin tank, effluent filter and
disper s, cell must all be sandc?s rtt<; nec r_ n _6 J .77
as,pec management plan pro aided by plumber,
2. AllliA~ tMW,beMail*kkd
as per q*bxbia codes / alyd i wl rm. i a
tio my on p" not less than 8 1/2 x 11 inchessiz A
Attach to complete plans for the system and submit the Coun
l n . -W_d %-t--
S BD-6398 (R. 11/11) i- lei 01".1
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: 4/-A, n/v r
Owner's Address: ~~J~ N% sr rr
r
L
Legal Description: (<7
Township. County:
G 4/~;~en
Subdivision Name: Ce11_1
Lot Number: A-
Parcel ID Number: t;ye azz,
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: sl-E: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).
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SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-of
Project Name:
No. of Cells Per Cell
ft Cell Width _Total No of
ft Cell Length Z/. _ sq ft EISA Per Cell
ft Cell Spacing sq ft Total EISA
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft `10.0' 50.0
Gravelless Leaching Unit Manufacturer: ,C 2
Gravelless Leaching Unit Model: 2 -el"? Z
Typical Cross Section
Finished Grade I"-'>, ft
Observation Pipe with
approved cap or vent
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Soil Backfill
in
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12 in
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ink Slotted and Anchored Vent/
7~~~Observation Pipe with Cap
• ■ • •
Plumber/Designer Signature:
License Date:`,/
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ::l + 7Gi%_1 r%IZ- 1 o.5
Mailing Address
Property Address s =3~;~ AV(-j'V1tV'%1-4
(Verification required from Planning & Zoning Department for new constructi
City/State t7~=~ Parcel Identification Niunber ` N ' " G Q
LEGAL DESCRIPTION
Property Location %a , Sec. T `l. N R W, Town of
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 1. 'C! Volume , Page #
Spec house yes Cno, Lot lines identifiable no
a.-
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 §Comm. 83.52(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 andlor (2) after inspection and pumping (if necessary), the septic tank is
less than 113 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 Commerce 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.
Uwe certify that all statements on this f are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a wawa deed recorded in Register of Deeds Office.
Number of bedrooms
f-~
r ,
l:
_ NATURE OF AP LICANT(8 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. QW05)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Tank Manufacturer: T ❑ NA
Permit #
Septic ❑ Dose ❑ Holding Volume: (gal)
DESIGN PARAMETERS Tank Manufacturer: ❑ NA
Number of Bedrooms: ❑ NA [1 Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: J4 NA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow : 1 (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): R/f,i4 (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: (gaVday/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 DNA 46 NA
Total Suspended Solids (TSS) <150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BODO >220 mg/L ❑ NA tC3 ..NA
(TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter
❑
Pretreated Effluent Monthly average e Disinfection El Wetland
Y 9 ❑ Sand/Gravel Filter ❑ Other:
(BODO <_30 mg/L Soil Absorption System
(TSS) <_30 mg/L ❑ NA
Fecal Coliform (geometric mean) <_10` In-Ground (gravity) El In-Ground (pressure) El NA
Maximum Effluent Particle Size %a in dia. ❑ NA At El Mound
❑ Drip-Line ❑ Other:
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When 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: fa Ye r~s~s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
-0 year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
At Ij year(s)
Inspect pump, pump controls & alarm At least once eve ❑ month(s) ❑ NA
every: W year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ 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 (X) 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 512 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.
GMVV-005 (02/05)
START UP AND OPERATION Page of
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 is properly
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 C: oe,' 1452 Name
Phone 2 5' Phone /7
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name s ✓ t%(r` , Name
61-- cfo i
Phone Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara 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.
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SHEET 1 of 2
Wisconsin Department of Commerce SOIL EVALUATION Page 1 of 3
Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 %I x 11 inches in size. Plan must St. Croix
Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 040-
Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road. '
Please print all information Rev' ed by Date ~J
Personal information you provide ay be Vr= oses Privacy Law, s. 15.04 (1) (m)) ~(jyv
Property Owner Property Location
G&L Land Development, nc. Govt. Lot SE v< SW v< s 5 T 28 N R 19W E fort w
Property Owner's Mailing Address u _ ` Lot # Block # Subd. Name or CSM#
W12491 890th Ave. 15 Cedar Woods
City State Zip Code Phone ❑ City ❑ Village El Town Nearest Road
River Falls WI 54022 715-386-2 28 Tro Coulee Trail / FF
0 New Construction Use: 0 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: B-1 was completed during the preliminary soil assessment on July 22, 2005. The lot lines were not
clearly marked during completion of the final soil assessment. Sufficient area is available for installation of the POWTS, however the plumber prior
to installation of the system must confirm the location of the lot line.
Boring # ❑Boring
0 Pit Ground Surface Elevation 85.2 ft. Depth to Limiting factor >110 in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
1 0-8 10YR3/2 None L 1-m-sbk dh gs 2f 0.4 0.6
2 8-21 10YR3/2 None GRSL 1-co-sbk dh gw 1f 0.4 0.7
3 21-110+ 10YR4/4 None S 0-sg ml - if 0.7 1.6
I
1
-Al
Boring # ❑ Boring
OPit Ground Surface Elevation 85.1 ft. Depth to Limiting factor >110 in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
1 0-12 10YR3/2 None SIL 2-f-sbk mfr gs 2f 0.6 0.8
2 12-24 10YR4/3 None SICL 2-m-sbk mfr gw 2f 0.4 0.6
3 24-34 7.5YR4/4 None GRS 0-s9 ml gw 2f 0.7 1.6
4 34-110+ 10YR4/4 None S 0-sg ml - None .7 1.6
* Effluent # 1 = BODS> 30 1220 mg/L and TSS > 30 5 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS 30 m
CST Name (Please Print) atur CST Number
Mark Iverson t 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 December 20, 2005 715-796-5664
Property Owner G&L Land Development, Inc. Parcel ID# 040-1022-70-000 page 2 of 3
3 ]Boring# ❑ Boring
Opit Ground Surface Elevation 81.3 ft. Depth to Limiting factor >110 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-12 10YR212 None SIL 2-f-sbk mfr gs 2f 0.6 0.8
2 12-18 10YR3/2 None SIL 2-f-sbk mfr gs 2f 0.6 0.8
3 18-33 10YR4/3 None CL 2-m-sbk mfr gs 2f 0.4 0.6
4 33-40 10YR4/3 None SL 2-m-sbk mfi CS 1 f 0.6 1.0
5 40-46 7.5YR4/4 None S 0-Sg ml gs 1f 0.7 1.6
6 46-110+ 10YR4/4 None S 0-Sg ml - None 0.7 1.6
I
❑ Boring 3 v
Boring # ppit Ground Surface Elevation ft. Depth to Li sting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring
5 Boring # spit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2
* Effluent # 1 = BODS> 30 < 220 mg/L and TSS >30:5 150 mg/L * Effluent #2 = BOD5 < 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.
Site Diagram 0 ft. 24 ft. 40 ft. 80 ft.
Site 3 of 3
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6 B-3
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7~OO2A. _ -
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B 2 1,
51'
=Lot Lines
Bnn# & description = Bench Mark B-1 - Boring Location & Elevation House and well location to be determined
Elevation 100'
Owner: G & L Land Development Inc. Site Information: Completed By: Mark Iverson, PSS #197
W12491 890th Street SE 1/4, SW 1/4, S5, T28N, R19W 680 Larcom Street
River Falls, WI 54022 Town of Troy Hammond, WI 54015
St- Croix County 715-796-5664
Phone: 715-386-2928 CST# 46672