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HomeMy WebLinkAbout020-1464-11-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 589778 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: Zachary & Nicole McCabe TOWN OF HUDSON 020-1464-11-000 CST BM Elev: Insp. BM Elev BM Description: B_ B Section/Town/Range/Map No: • ~ 11.29.19.2954 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ; Jvg CAPACITY STATION BS HI FS ELEV. Septic 4 i'^ Benchmark 3. 3 '01 J / `(.J Alt. BM 1 /046 Aeration Bldg. Sewer Z •7 161 Holding _ St/Ht Inlet ,r5 rj9 • S pQr TANK SETBACK INFORMATION St/Ht Outlet 'l ' 3 Air take ROAD Dt Inlet \ TANK TO A Pt WELL BLDG. rven,~ µ 1 Dt Bottom Septic /"k z4 36 / Dosing J Header/Man. 7.(o c)4 Dist. Pipe 9 V Aeration S•S Holding Bot. System - Final Grade eG • PUMP/SIPHON INFORMATION Manufacturer Demand St Cover er~; Q r d GPM t";'I 0 u ' U Model Nu TDH ift Friction Loss Syste ad TDH Ft Forcemain L a. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di' Liquid Depth DIMENSIONS 3 RV Z `j SETBACK SYSTEM TO v P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION Type Of System.f ~PF A CHAMBER UNIT OR Mld mbar: e DISTRIBUTION SYSTEM «A, ZZ4-T L Header/Manifoy Distribution x Hole Size x Hole Spacing VPipe(s) Length DiaLength Dia Spacing Q.*-.A S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded jxx Mulched Bed/Trench Center (0 1 Bed/Trench Edges Topsoil Yes No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 767 MOUND VIE ~J_ (051 Q✓~, /~~/O~ l Yr/~ P/c6ck., IL, 1.) Alt BM Description ~ 1 o(/~/ _ n~ / ~/lJ erv 2.) Bldg sewer length = 29 - amount of cover r D O I~. Qe,>I(S[~ V tea,. 4u Plan revision Required? Yes o I 1*XN - I I ~55' Use other side for additional information. sepctor's Cert. No. SBD-6710 (R.3/97) Date In o~ County Safety fgngs blv A) 4 I I 201 W. Was in 62 Sanitary Petmit Number (to be filled in by Co.) < t 3NW Madison, W1 53707-7162 tl U L 2 X1710 1 J 5$ ~ECypQaA~~ Sari' Permit A State Transaction uWber PI ~ DEVELOPMENT 1't- In accordance with SPS 383.21(2), Wis. Adm_ Code, submission of this form to the appropriate governmental unit 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. 15.0,4(l m), Stats. L A lication Information - Please Print Al Infor ation 4-76 f a. yltv_ i Jf~ Property Owner's Name < <.O Parcel # 4,4~ 011 T Property Owner's Mailing Address y Property Location Govt Lot City, Zip Code Phone Number y., Sectil/ ~ / ~ (7 ~ circle o ✓~.J r L ~ 6 T N; R W lI, ype of Building (check all that apply) Lot / 1 or 2 Family Dwelling - Number of Bedroo Subdivision Name ~t ~ Block y IJ~~~ ❑ Public/Commercial - Describe Use ~~((~-ALA J ^ 4~ ❑ City of ' ❑ State Owned - Describe Use (/IV CSM Number ❑ Village of Q ► e~t(5 ZL LZ G e9 Town of .z 161~Q!5 III. Type of Permit: (Check only on box on line A. Complete line B if applicable) AA- A' ew System Q Replacement System Q Treaunent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B Permit Renewal Permit Revision El Change ce of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued ❑ ❑ Before Expiration Owner ^ otv4' TV. Type of POWTS S stemlCom onent/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of su 4W ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (expl V. Dis rsaVTreat eut Area Information: Des' °Flow (gpd) Design Soil Application Rat f) Dispersal Area Required Dis al Area Proposed s v on VL Tank Info Capacity in Total # of Manufacttser 63- Gallons Gallons Units New Tanks Existing Tanta ) ~ o a m at U Septic O Holding Tank J I s Dosing Chamber VII. Responsibility Statement- the undersigned, • um responsibility for installation of the POWTS shown on the attached plans. PI 's Panne MP/MPRS Number Business Phone Nuripey Plrm~ Name (Pri lm t AL Pl Address (Street, City; Zip Code) lL VIII. untv/De artment Use Only Approved ❑ rove Permit Fee Date ued Issuing t Signature ❑ van Reason for Denial ' IX Condifi asons for Disapproval n 1. Sept tank, Erflu<:n,, iilte- and 3 oisper- cell must ill be se_ic?s ! m2~inta!nec as per macagement plan pto tided by plumber. f 2. ~kq:setbeick ~eq iram is mg t k>e r aiM~,.l~~~e1 s~l ~a t fj AA_ ~ 1 ~ plt ~No11NM l+ofMl ! ~IIMeM, J ~ I Attacb to complete places for the system and submit to the ounty only on paper of s tha to es in • h ~ s~ a /4.1- ! SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Zach McCabe ADDRESS 131 Carmichael Road Hudson Wi 54016 SW 1/4 NE 1/4S 11 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 94.5994.2 6' below grade DATE 7/26/16 BEDROOM 4 CONVENTIONAL XXX 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 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Mound View Road Scale = 1/4" = 10' Drainage Easement F 10 5' 99.5' Please note: Vents -1 drainage IV AL easement will B-3 20' be staked by a 100' 3-3' X 90' cells ~ with >3' spacing surveyor prior 160' to installation 4 lope 06. 60' 10' All piping shall be ASTM SDR 30/34, within 60' B M * 30'B-2 10' of tank, piping shall be ASTM F891 ST 1 Drainage Easement 21 Pro 4 Vent Bedroom >6" Quick4 Standard House Leaching Chamber of Cover with 20.0 ft2 of Area Property .6ft^2/pair of end caps 1 Line 4' Long 2 34" Grade at System Elevation Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/26/16 Owner:Zach McCabe Location: SW1/4 NE1/4 S11 T29 N,R19W 767 Mound View Road Hudson Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. MaintInancea ontingency Plan 7.Filter CrSignature License n00 System PLOT PLAN PROJECT Zach McCabe ADDRESS 131 Carmichael Road Hudson Wi 54016 SW 1/4 NE 1/4S 11 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 94.5994.2 6' below grade 7/26/16 4 DATE BEDROOM CONVENTIONAL XXX 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 Ilk BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Mound View Road Scale = 1/4" = 10' Drainage Easement 99.5' Please note: Vents -1 drainage -*r easement will 100' 3-3' X 90' cells B-3 20' be staked by a with >3' spacing surveyor prior 160' to installation 4% Slope 60' 60' 10' 60' All piping shall be ASTM SDR 30/34, within B.M.* 30' B 10' of tank, piping shall be ASTM F891 ST Drainage Easement 20' Pro 4 Vent Bedroom >6" Quick4 Standard House Leaching Chamber of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps Property Line 4' Long 12" Grade at System Elevation 34" 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 A CI Typical Installation ~ 100.0' /CGrade Vent 3' 4" 3' ~~30/34 Septic Tank 5' Long 1 5' 1 " 5' Long 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A 22 chambers per cell B System elevations: A_94.5' B-94.2' POINTS OWNER'S MANUAL & MANAGEMENT PLAN P"e of ILE INFORMATION SYSTEM SPECIFICATIONS owner Septic Tank Capacity ❑ NA Permit # Septic Tank Manufacturer 0 NA IGN PARAMETERS Effluent Fitter Manufacturer p NA Number of Bedrooms IJ NA Effluent Filter Model ❑ NA Number of Public Facility Units Jim Pump Tank Capacity NA gal P Estimated flow (average) =yday Pump Tank Manufacturer NA 1 Design flow (peak), (Estes x 1.5) - af/da Pump Manufacturer NA Soil Application Rate i aU Pump Model NA i Standard Influent/Effluent Quality Monthly average Pretreatment Unit NA Fats; Oil & Grease (FOG) 530 mg/L 13 Sand/Gravel Fitter © Peat Fitter Biochemical Oxygen Demand (BODS) 5220 mg& 13 NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 515o mylL ❑ Disinfection O Other. !Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Bid Oxygen Demand (BODs) Seca mglL PZ(07Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids OW) <_3p mgt! NA ❑ At-Grade ❑ Mound Fecal Codform (geometric mean) 5104 cfufl00ml ❑ Drip-Line ❑ Other. !Maximum Effluent Particle Size 313 in dia. p NA e'er 0 NA Other. Other © NA *Values typical for domestic wastewater and septic tank effluent Other ❑ NA NTENANCE SCHEDULE Service Event Service Frequency 4nspect condition of tank(s) At least once every. v n &(s) (Maxinvu r 3 years) 0 NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume 13 NA Ilnspect dispersal cell(s) At least once every: C) 13 month(s) ( years) [I NA yeaK(Maximum 3 Clean effluent filter At least once every: month(s) O NA Inspect pump, pump controls & alarm At least once every: 0 ms(s) ❑ NA 1=1ush laterals and pressure test At least once every: 0 morith(s) NA year(s) At least once every: Q moil g)s) A r. NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be madeby an individual carrying one of the following licenses or certifications: Master Flumber; Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude 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 scrim and to check for any back up or p ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to deck 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 fading condition and requires the immediate notification of the kcal regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (16) or more of the tank volume, the entire contents of the tank shad 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, Wnd any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report strati 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 ducts or other chemicals th~}t 'or to use of the POWrS check treatment tank(s) for the presence of painting products the contents of tht impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected h may a septage servicing operator prior to use. tank(s) removed by ' 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. Operator prior to restoring P~ to the eToffluent avoid this pump or situationhave the contents of the pump tank removed by a manually Servicing Pu pm controls to restore normal levels contact a Plumber or POWTS Maintainer to assist in operating within the pump tank. with n disturb or compact, the area I Do not drive or park Vehicles over tanks and dispersal teas. Do not drive or park over, or otherwise 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 perforrnancs and prolong the We of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dra.in (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 propetiy 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 fined with sell, gravel or another inert solid material. CONTINGENCY PLAN code compliant If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a replacement system: A suitable 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 requirled setbacks from existing and proposed structure, lot lines and welts. Failure to protect the replacement area will result in the noW 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 technologl/ a holding tank may be installed as a last resort to replace the failed POWTS. E3 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal 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 ANDIOR INSUFFICIENT OXYGEN. DO f4OT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER w Name ~r- w 2 Name as'hG* ci Y Phoneh =c Phone SEPTAGE SERVICING OPERATOR (PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone Phone This dome nerit was drafted in compliance with chapter SK 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. U ' h ~ err` I I P t a j \ I ~ 1lUl r~(,i~ i I ~ i I .ififl~ / I i v I p I { i I ~ J i I Y7 4 1 LAJ I C~ ~ o ~ I - p s hhoi ~ I r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE .AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer~ Mailing Address ~ L ~ Property Address (Verification required from Planning & Zoning Department far new construe n.) City/State Parcel Identification Nutuber LEGAL DESCRIPTION Property Location i~ Y4 , ✓E '/a , Sec. , T 7 ~R~ W, Town of -Ilao-,~~ Subdivision 4110 avyo"k-) ; c' T - Lot Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes( n¢ Lot line,, identifiable On~ 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 wasir disposal system Owner maintenance respon abilities 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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, 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 ' form are true to the best of my/our knowledge. Itwe am/are the owner(s) of the property described above, by virtu of a deed recorded in Register of Deeds Office. Number of b oms --a a / 1~k SIGNATURE F LICANT(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. 08/05 BENCH MARK: ' TOP OF 2- IRON PIPE, @ W " M x ~ ELE VA r yp~ A 6 ~ ® 9 910a2 ~ .E na s~ ta ~~~0. 75.22` 6 6 ~--'sooooloolw .3 3' 33 ?sk m 6 ~ 01,00 0 Nt a ~ 0 ~ a z met s 4 A ~ LOT 12 2,09 ACRES 91,215 SO. . LOT m 03 ACRES 88,570 SQ. a r L3,0R 904. 9 E5 x"11 q~k G "M 0 DRAINAGE 0 EASEMENT 'E' i 6 0 qp3 HXEE = 902.5 E2 S b MwMfaf 6@ V➢1WIEE ~1 d 199- ~ e Uxpoy, e e MR~Y ~ b OeNRYn x c DRAINAGE EASEMENT "E" TABLE BENCH A I R N 77ON DISC O/ E 77O 015T L' ELEVATION El N07 201000F 19 68` E'N90 0'001' 20 64' 589W21OW 210.51 E-9 N9 0 *00 10 0 T 24-980 16 :~7"~ 470 54~ 9~`~~q V 574 75. *58`*W . 120K 49 E"4 N44 Ell 566 M *49 It 16-72 " E-5 S86 V9 *4 9 5724' F12 559 UJ 221C J804' E6 N 14 75 '58 77 11908 A E'13 S01:20 100 OW 127 8J p QQaa qq i N91534 ltlIlN34153tl I ~ ~;qy3+jz'e~ ;7 ~ I ~ ~4~t iect 4 x t~i4~ ~ t, tl n F sna I ~ ~Sl l I t I I I ~ ~ ,~~1 O xis II ~ Ii ® W I ~ I~ w I 7E a x as I Li a I I I. I I s ~a 811011 e ~ ~ Y I 0 I'II' O I III - I i Tt:: z I - p t~ ~ ~ ~ II I I ~ 1 ~~I v ZO ~ i `gt~ II z I t z I w w F uW7 ~ C7 ' - rx t' ID s. sa a,, - t N91S34 ltlI1N301S3b I I L33,AN35 ~;aya~~~ N OVY ; r a~Is fi J11 ?fi t{{~ ! O O O O O O O w_ ao - _ b L) 6 # ~ Ji b ncs ~ iu or oa < n .nua b oa a[ i 11 F s i bia p i b n YY - F mu _ 1 I i.~rd N91S30 IVI.LN30lS3U ,Iy f. ii ; L3:)ina3S ill Y~HZr~il~ > u UVV a O .r» ~ o b a c..o-r Az~.o-r t ~ a >1 .r. s.r YO ~.z~ ~ li ~~HH b t ax.a ~ b y l~ - ,Hill a k d E t k aL .uo~~ .o-e n„ Wn y a E i{ Q a m A., # a.„~~ ~ a a Q a a b a u h b L . 1~ N91534 ltlI1N 301S3N w L 3JIAN3S 7 ~Ei~a9z~ ~ ~ rs f l~sf u~ ?-F ~ Q W S$~~ S~aq3~ a qq ,If . at P a ~ a a ag su ys ~ ~35 <da:4 3~ I'M z 1 _ g r e~ ggg gxf9 ~ - 3Yi ggg d~ 33 ME .1h z,. . O a a Hill, ~ ~ }.r + a a a Sa Bit }z f~a * f ai f g rv n Y sj z 0. a if j ~ ~e Jul 8 W , ~a a ~ _ 3 a r r L a a i I 7 Page o-i ~_CrG.. :`..~it. ivL)" ~~1 Ui _ iri accordance vs;Ei Comer 35, Vfis. Adm. Code - County O t Y Attach corrirplete site plan un r,aper riot tens than 8 1i= x I ) inches in size. Flan rnCrst - F it uu `ru r nt 1; to o vortical and horizontal referarcra point (",M), d racoon and Parcza I.D. north ariovr and lCju;ation anu Jistarice to mares: road. Rev, - Date 'r k r y *iO: GE 'CS.- F "`'ses(PAa- -,y Law 15G1(:)(rir)j. 7 pF4 rropertyOv. no, - i Prcperi I_oca:ion ^ Ii 5 u 1_; i l4,bC 1 i4 5 - i Z~ N R Q E (oi)l 2 3 _l1 _~~L~~~ I rroperty oHfjc 's Msiiing Adurea3 - _ s r~ i Su ro. Narrie o GShrt` ~CRv-- S to Co er . V City [_1 V..iage ov; n wez-ost Road ~a New Constjuction Use: ' Rosideriti3l! ?dumber 0 bedroonis Code de-ivied design u,r ra'it: GPD Replacement ~ i uu's_- ui commercial Describe: i- Parent material ~)c~~cl G S-h----------------~ Rood P(ai,i e;evadon r applicable ----,n G~--~/- ft. General corn ,ants s yS~rIY~ e 1/ . ~41' - - S~/S~P/y~ ¢ Ul~t J /GLe Tr~L and recorrlr::arii afivns: L-1 Goring Goring t in. Y o Tr pit Ground surin~ eluv it. Depth to irnidng factor _n Rase i - , foots I o_,r dory i Horizon G q :n ;Don a i olor Rcdox Desc_ p 'n Texture Stiuct i ; C,onss`w ;e GPDifQ - _m Ou. Sz C.um.'~ .'or Gc ~ S'n. - 'Eff#1 r 'Efit12 2 2rn5bk- mfr---- C.~) lv_-== ~ %3 4L - Vi 1is fy) _ ' --t-- 1 j . SI u ~y Goring it Goring Ibb 9 . u L Pit t,rou ic. ui lace elc~__ f. bey:h to luni5„g itzeior -iri. Sol A licairon Rate F Horizon DF.pth i L)ar i i3,1t .olor iRedox Desc p' m Te,.Tur ; Siru ~u a consiste 1 ; GCundary Roots GPDtft' _ ir.. rpunsei QL. Sz Cori C. )fir Gr. S• 'EffV 'En#2 r( ~p ~t 5~ ►--j2rnSbk -L,~r -i c , - - t- i 1 Z- ----30 L!i 10 4 r (P - ' 72 "fil- - - - - 1-- - o - - Eff}ue:it #1 = )D~ 3t C 20 rig;L ;.a 1, : 30 <'la 3 m= i Effuent #2 = E :'D, < 30 mc/L and TSS < 30 rng/L 5T Nama (Pie Print) Signature CST Number Address Date Evaluation Conducted Telephone Number oz 2(l3 1,-5_-7__? Panel ID) # Page --2- of Property Owner ~ ❑ _ Boring # 3oring Depth Yo IG~ifing factor in. Pit Grcurui swIace ele,' _Soil Application Rate Horizon Depth Dom!'rant- Color - Redox D= scripiorf Texture structure Consistence 5oundary Roots •E 37. x#GPCIftEff#2 c r r .Sh. - - in. m' nail Chu. Sz. Cont i3 ltd ..r S~ ( i 2m5bk -Fr C.5 I yr .'J 2 I 44 4, 2- I3( _ -I LR I ~~Cn C 3 .5 Y r -,I P 5; c- l-~ Bonny Borng # U n ft. D : tc.r to limitin factor in. LJ Fit Ground suriaca elev-_ g Soil A iicafion Rate HorTZOn Depih Dornin~rit Cofo` Redox Descril v:ion Texture STru---uruu Con a i stce Bcu^d !y Roots GPDttt' Cyr. Sz. Sh. I I 'Eff#1 Eff#2 ir. l,r.rnseli Cu`u. Sz. Cont. Go:or - - - I I I Borng Boring tl Ground surface elev. _ ft. to iim tiro f factor tn. - .J ❑ Pit - Soil Application Rate T r Consstence Boundary Roots GPDlft2 Horizon Depth Dom"sr,ant Cc!orI Redox t"ose;:;-' •~n Text !re Struciu 'Eif#1 'off#2 Cu. Sz. Gont ;;olor Gr. Sz_ Sh..r- in. P,fiinsA cent #1 = QODS> 30 < 2~0 m91 and T:; 30 < t 50 mg'L Effluent #2 = BOD. < 30 mg(L and TSS < 30 mgfL C'otr;rcrce fs <..z goat ~uairy scrvin f vizier and (,MPl0" f ,rou need assistance to access services or ,.x.~ ..~:~c, conruta i:E cpart;,..~..,~ ~.-•:i _ _ . - iRl`-.:110;8 li'nA i! Parcel ID # Page 2- of Property Owner __e~ ❑ Boring Bering tr Depth to iim_Eng factor n. Pit Ground surface e.t,. Soil A f ;a6on Rate Horizon Depth Dominant Color Redox Dsscripuon Te; ture Stn;cture Consistence Boundary Roots GPD,'ff Gr. Sz Sh. 'E+1#1 I 'Elf#2 in. P-Iu ,sell Qu. Sz. Cant. o'-w - j?) ltd m5b1~ rr-~-~r e5 I v~.-J ~ 2 4J ~ Z (3-3D ( 1 7 .2 - 3 t C) S_~_..__ I -4 ❑ Boring ❑ Boring # - - cation Rate li- L Fit Ground surface elev. ft. to ii '~ng factor in. Soil App Si c • re Bcunda;Y Roots GPDi1' Horizon Dept Gominzr+': Co@cr Redor: D scr `;gin Tc.ture ~r v, - Gr. Szru. Sh. Consist+'c 'Eff#1 'cff#2 in. i4~iunseff CU. S7. Cone Ce`,r - I I I _~I ~ l I I I I I I ❑ Borne Lj Boring # ❑ Pit ft. Dodgy h to iim;tirg ~,cior in. G; ound surface elev. Soil ir,r,n?:cation Rate Horton Depth Dominant Ccior Redox Dsscrl: i•: n Texture I St:uuura Cons's?ence eoundary Roots GPD/ff Eifi#1 Effn2 rO^'olor Gr. Sz Sh. in. f,4u:~ Qu... Sz. ~ I I I I - I I I i_ I ~ Etf!uen? #1 = BO D5> 00 < 22;, mg!L and TES >30 < 150 mg1L Effluent r- = BOD, < 0 mg 1L and T SS < 30 mglL The Depa Ument c; Commerce is an equal opRpo 'iuniry service pruvider and rmplo fen. f you need assistance to access services or need material in art alternate forr::at please contact the department at 608-266-3151 or TTY 608-264-8777. s B r). X3 3 n r rt.07/0()) - SCALE: I 1 BM ELEVATION:--jf,-_ R- p c l ISM z DESMPTIO14: SYSTEM FI-EVATION: U C' SYSTEM TYPE: u e n ~r i I)b 7 ~ Ja 1 01 0 Z SIGNATUI?E: - i I _