HomeMy WebLinkAbout038-1036-60-030
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 597376
GENERAL INFORMATION State Plan ID No.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
tjA-
Permit Holder's Name: City Village Township Parcel Tax No:
Joseph Smaker 7 TOWN OF STAR PRAIRIE 038-1036-60-030
CST BM Elev: Insp. BM Elev: BM cion: , Section/Town/Range/Map No:
D p ( Q ` 08.31.18.158H-30
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
CPn~k'ir , Benchmark
DMI"S Alt. BM
A f Bldg. Sewer 49,C~
Holding S nlet
i
^ S t utlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
S"t-- Dt Bottom
pg9 Header/Man.
AQ"a Dist. Pipe
Holding 5.2., l ` T Bot. System
{'607'$ ~ Final Grade
PUMP/SIPHON INFORMAT " I
Z, I Mse S1-
Manufacturer Demand St Cover
G 7 V
Mo I Number )~2
TD Lift Friction Los System Head H Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORP SYSTEM
BED/TRENCH/ idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid De
DIMENSIO
SETS K SYSTEM TO P/L BLDG WELL LAKE/BYRE LEACHING Podel anuf r:
INFORM TION C OR
Type Of System: U Number:
DISTRIB TION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to take
Length Dia Length Dia Spacing
-1- _ I i
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seed d/Sodded xx Mulched
Bed/Tren ❑ Yes ❑ No ❑ Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /n (L~- s tns 2:
Location: 2208 100TH STTj,
1.) Alt BM Description = I~/n ~d ~~C ,4- 15 g' we oy\. Pm Per /
2.) Bldg sewer length = O
- amount of cover = 0li ~n' Q~S -ro 6'e
I( oll
214 0vtc 1* ptc
Plan revision Required? ❑ Yes ❑ No C/✓ - /
Use other side for additional information.
Date sepctor's Sign a Cert. No.
SBD-6710 (R.3/97)~~
l-fd.A L oy~n nc~~ %S D~
County
sr°~ Safety and Buildings Division
201 W. Washington Ave., p.0. Box 7162 Sanitary Permit Number (to to ed in by Co.)
Madison, Wl 53707-7
~sv C~ Stale Trans, on Number
Sanitary Permit Appli N .
Wis. Adm Code, submission of th:. mate governmental unit o address
In accordance with SPS 38321(2), Address if different than mailing )
is required prior to obtaining a sanitary permit Note: Applica* wried POWTS are submiired to psi eer
the Department of Safety and Professional ServieS. Personal i ,,,u provide may be used for secondary r C , S?
St
oses in accordance with the Priv Law, s. 15. 1V-),
I. A. lication Information - Please Print All Information Parcel # _ 3 (vQ 103o
Property Owner's Name p
0!51 1) J°%/ Jv,\ Property Location
Property Owner's Mail' dress
~ Govt Lot
2, Z n i C , Section
city, State Zip Code Phone Number
e le off)
T~N> R E W
II. Type of Building (check all that apply) Subdivision Name
2 Family Dwelling-Number of Bedrooms
Block #
❑ Public/Commercial - Describe Use 1 ❑ City of
CSM Number ❑ Village of
❑ State Owned - Describe Use Town of l c
J
111. Type {{of Permit: (Check only one box on line A. Complete line B if applic I
A_ Z ew system eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System P
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Owner
Before Expiration
IV. Type of POWTS System/Component/Device: Check all that apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
El Pretreatment Device (explain)
oldin Tank ❑ Other Dispersal Component (explain)
V. Dis rsaUTreat ut Area Information: Dispersal Area proposed (sf) System Elevation
s d (
Design Flowl(gpd) Design Soil Application Rate(gpdsf) DisPerea Require s~
Capacity in Total # of Manufacturer _
VL Tank Info
Gallons Gallons Units
New Tanks Existing Tanks U rn ~ ~ Cam-
Septic or Holding Tank ^ i
Dosing Chamber
VII. Responsibility Stateme 1, the undersigned, ass onsibility for installation of the POWTS shown on the attached plans.
Plum 's e MP/MPRS Number Basiness Phone Number
Pl~ber's Name (Print) „ ~ l =
.wj ~ ✓ Z V , ~ J
Plumber's Address (Street, City, Tate, Zip de) 4 + ~ / ~ r
VIII un1V/De artment Use Only
Permit Fee Date sued Issuing . t Signature
PProved rove S 6 5 6.4.6 Q f -
v eason for Denial i
aJ,M
►k i ,w
a oval
IX 3 I4 t!+ I Oc 11
Conditi9ns ~p ov onsor Dtsppr
1e
Far , Er n •i e tE
Pon-
t per. cell rust ell be soiylc'nty Q ~l O
as per management. plan pro riae t by plumber.
2. AN "S rqi sLou rant: r.e . ~
«i pot opp!ael li oodlt 1 v^td mms. to J 2.
Attach to complete plans for the system and submit to the County only on paper not less than 8 V =12 es in size
SBD-6398 (R. I1/11)
Site Evaulation and System PLOT PLAN
PROTECT Joseph Smaker ADDRESS 2208 Cabin Lane Somerset Wi 54025
SE 1/4 SE 1/4s 8 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION none 6/10/17 2
DATE BEDROOM
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX
MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 3000 gallon LOAD RATE ABSORPTION AREA # of chambers
BENCHMARK V.R.P. Bottom of house siding ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
I
Scale = 1/4"= 10'
The area east of cabin lane is all pot holes and irregular slopes, the soils
in this area are not conventional, and a mound system design would not work
due the irregular slopes
20,
Steep Slope to privy Areas of irregular Slopes
lake Driveway Valleys and pot holes
Existing 2
Bedroom Cabin 20' 10' not enough room for testing
quaw Lake
B.M.* 15,
75 0 Well
• . To cabin Lane
35'
5'
35' roperty Line
I In
W,
Neighbors Well
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/10/17
Owner: Joseph Smaker
Location: SE1/4 SE1/4 S8 T31 N,R18W 2208 Cabin Lane Star Prairie
System type: Holding Tank
Manuals Used: Holding Tank Component Manual Version 1.0
Page#
1. Cover Page
2. Holding Tank Plot Plan
3. Holding Tank Cross Section
4. Maintance and Co tingency Plan
5. Holding Tank an ring sheet
Signature
License numbr 226900
L'
PROJECT Joseoh Smaker Site Evaulation and System PLOT PLAN
ADDRESS 2208 Cabin Lane Somerset Wi 54025
SE '1/4 SE 1/4S 8 /T 31 N/R 18
W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION none
6/10/17
DATE BEDROOM 2
CONVENTIONAL AT-GRADE
CONVENTIONAL LIFT HOLDING TANK XXX
MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 3000 gallon LOAD RATE
ABSORPTION AREA # of chambers
BENCHMARK V.R.P. Bottom of house siding
❑BOREHOLE ASSUME ELEVATION 100' Filter Lifetime Filter
O WELL *H,R.P. same as benchmark
Scale = 1/4"= 10'
The area east of cabin lane is all pot holes and irregular slopes, the soils
in this area are not conventional, and a mound system design would not work
due the irregular slopes
20'
Steep Slope to Privy Areas of irregular Slopes
lake Driveway Valleys and pot holes
Existing 2
Bedroom Cabin 20 10' not enough room for testing
quaw Lake
B.M.* 15
75' 01 Well
To cabin Lane
10' 35'
HT
5'
35' roperty Line
Neighbors Well
Single Holding Tank Cross Section and Plan View
Plan View
>S
'SS{}SY{}SYG>G>t}<>G}`3{St}t}`'<Y{3<}G}<}S>t}<YGYG}t't}`Y<}S}`}S}S}`}S}<Yt>G}G YG't't'S'G'S'S'S>S><Yt'SY<'S'G i3<Yi}S
{ }
3 S <
< {SS
Y i t
} { Typical t <
{ }
24" I.D.
Inlet Manhole Vent Pipe
Opening i y {
t t
Y{ ts<
S Y
} { t
i Y
t y
! { t
7j S}{
tY;
} S S
i S
Y Y S>! Y S Y> Y! Y>!>} Y Y Y Y>}} Y} S> Y} Y>! S Y 7 S}} S! S Y} Y Y Y> S S Y Y Y S! S iY i
{ i L 2 L t<< i<< t i t; t<< t t L t<< t i<{ i t{ t t t i t t i t t i t t< t t< t t t{{<< t{ S }t
Cross-Section
4 in. Dia.
Finished Grade - Vent with
Min. 4" ~ ~ - - - - .
1 Above Cap 12"
Grade With Ft Cover Above
Locking Manhole Cover Grade
Device Sealed Watertight
' T > } } > > } Y > } > > } S Y } } } } Y > Y > } } > ! } } } Y } } } 3 Y > } }
} S> S S S S< t<{{{ S S{{ C{ S L< L S S L i{ S S S S S G<< S S S t t S
L
>
-t Tether Tank Manufacturer:
Y > ;
Weight }
Tank Capacity:
}<T _j Gallons }t
YtY y~
Y > Tank Maximum Depth of Bury: Ft
s Alarm } i
{
> t } Switch Depth of Soil Cover Over Tank Ft.
} t' C)n
YtY Y;
} { } Tank Outside Dim.: Width 7 J~Ft, Length Ft, Y {
~<y Height-- Ft >t
{
} i } Alarm Switch Type: D Mercury Mechanical `
< S { { { { { { ; { { { < < t i { S i { { t { { t { i < < { S { { S t t < C { { S t < { { { ; { < { { i S S G < { {
GENERAL INSTALLATION: The tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the
manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an
effective locking device (padlock) installed. Manhole covers below grade are sealed watertight. Piping at
the inlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to
prevent settling or sagging. Electrical is as per the National Electrical Code and applicable Wisconsin
standards.. Electrical is as per the National Electrical Code and applicable Wisconsin standards.
03/05 lgj Page of
HOLL it r ` TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POINTS) has been designed, and is to be installed and
maintained according to Cq= 83, Wis- Admin. Code, the Holding Tank Component Manual (S6D-10511-P
611/9998), and the C, ; 9 I County Sanitary Ordinance.
1. This POWTS is designed to accommodate an estimated domestic wastewater flow of ~ z gpd-
2. The owner of this POWTS is responsible for system operation and maintenafm. inrluding ail provis mw in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3- Each time the wastewater in the second tank reaches a level of IT below the inlet invert (at which time the
alarm will activate), the pumper fisted in the current Servicing Contract must be called to empty the tan3~s
contents and dispose of there in accordance with NR 113, Wis- Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers' aid
manhole cover(s) and verify that time alarm system functions and manhole locking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. All Corrective actions
shall comply with the county sanitary ordinance and Comm 83 and 84 Wis.- Adm. Code.
5- All service events or inspections of this POWTS sha I be reported to the county within 10 business days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
from this holding tank to the ground surface, including intentional discharges and discharges caused by
- -
neglect constitutes a failing POWTS and may result in issuance of correction orders or a citation by the
county or state.
7. No one should enter a holding tank for any. reason without being in full compliance with OSHA standards for
entering a confined space. T~a`atmospheie within these tanks may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible. -
8- In the event that this POWTS fails and cannot be repaired, a code compliant -replacement holding tank may
be installed in the same location (a new sanitary permit is required for such a replacement). Connection to
municipai.services would also be considered at this time if they are deemed available to the property.
9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with Comm 83.33 Wis. Adm. Code.
10. If there is a problem with, or question about this installation, following persons should be contacted:
a Installer. ;i/J-=~
~.k h'i Phone
d. Service Provider
. J Phone-
c. County Zoning or Health Dept ( ('hone:
11.
Project:
Transaction Number.
Septic Tank Dimensions & Weights
Septic Tank Size Dimensions Weight (lbs) Anchor Weight (lbs) Soil Cover (in
5000 gal 204"L x 96W x 93"H 41,400 30,850 24
3000 gat 165" L x 92"W x 76H 20,300 23,320 23
2600 gal 1471 x 90"W x 73"H 18,100 20,625 24
2000 gal 1621 x 78"W x 64"H 16,100 15,675 19
1600 gal 1451 x 78"W x 61 "H 14,000 11,270 16
1200 gal 111"L x 78"W x 61°H 11,400 9,532 17
1000 gal Low Profile 120" L x 67W x 5TH 9,500 8,705 17
1000 gat Heavy Duty 96L x 78V x 61"H 9,200 8,945 18
800 gal 96L x 67W x 5TH 8,000 6,560 16
600 gat 781 x 56W x 60"H 6,600 3,810 14
1600/1400 gal 1741 x 90"W x 73"H 23,000 22,410 22
1250/750 gat 1621 x 78"W x 64"H 16,400 15,725 19
1000/600 gal 145"L x 78"W x 61"H 14,700 12,705 17
Document Number Document Title I I
St. Croix County I II II II Ili Iill I I II!
Holding Tank Agreement 8 4 4 0 0 5 8 1
Tx:4370236
IPermit Number- .1046955
M. BETH PABST
Name- (Owner) Typed or printed REGISTER OF DEEDS
being duly sworn, states, under oath, that ST. CROIX CO., WI
. 1. He/ails is the owner/pail owner of the following parcel of landN RECEIVED FOR RECORD
05/01/2017 10:5' AM
loc i S t Croix County, Wisconsin, recorded in Volume
Page ocumentNumber S Croix Coun Register EXEMPT
of Deeds Office; c Recordln Area REC FEE: 30.00
A par 1 of land located in thev4 of the of Section Name and Return Addreae PAGES: 1
TN - R~ W, Town of 0-
/,S/ .S Spruce c.T cwt, a3 t-(i`
St. Croix County, Wisconsin, being SSl
duly described as follows (include lot no. and subdivision/CSM or
detailed legal description); 1.0t v C73~ (p -~b~0
Y Parcel Identification Number (PIN)
Agreement Date: 6 e r h,f ,1t j u r v4r- cf map vol. a POY 61
We acknowledge that application Is being made for the installation of (a) holding lank(e) on the above described property or that continued use of
the existing promises requires that a holding tank be Installed on the property for the purpose of proper containment of sewage. Also, the property
cannot now be served by a municipal sewer, or any other type of private onslle wastewater treatment system as permitted under Ch. SPS 383, Wis.
Adm. Code, or Ch. 145, Wis. Slats.
As an Inducement to the county to Issue a sanitary permit for the above-described property, we agree to do the following:
1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tanks. If the owner falls tc have
the holding tank properly serviced In response to orders Issued by the governmental unit or the Department o1 Commerce to prevent or abate
a human health hazard as described In e. 264.59, State., the governmental unit (Town) may enter upon the property and service the tank or
cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill' as a special assessment for current
services rendered. The charges will be assessed as prescribed by s. 56.0703, State.
2. 1 he owner agrees, pursuant to a. SPS 383.54 (2), and SPS 382.40(3)(e), Wis. Adm. Coda, to have a water meter Installed In the structure.
The water meter shall be Installed by a plumber authorized by the Department to make such Inataliallons, Win said Installation complying
with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation,
maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the Above-
described property on a regular basis to read and/or Inspect the water meter.
3. Owner agrees to pay all charges and costs Incurred by the govemmeintal unit or county for inspection, pumping, hauling, or otherwise
servicing and maintaining the holding tank In ouch a manner as to prevent or abate any human health hazard caused by the holding tank.
The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In
the event the owner does not pay the costs within thirty (30) days, the owner speclficaNy agrees that all the costa and charges may be placed
on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
4. The owner agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file
a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of
a now service contract, with the governmental unit within ten (10) business days from the date of change to the service contract.
5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual
basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the
condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank Is not being property maintained.
s. This agreement will remain In effect only until the county office responsible for the regulation of private onsite wastewater treatment systems
certifies that the property Is served by elther a municipal sewer or a private oneits wastewater treatment system that compiles with Ch. Comm
83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording sold certification with reference to this
agreement In such manner which will permit the existence of the certification to be determined by reference to the property.
7. This agreemant shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement
to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the
agreement to be determined by reference to the property where the holding tank is Installed.
wner(a) Name(s) - Please Print Subscribed end's om before me on this date:
osc~rH m 5M41z4A Y- ,
NOwner's Signature(s) otary Public E A INDA
OTARY PUBLIC • M Nf TA '
MY COMMISSION XPI $ 01
1118
e I Un it Official Name, Title -Please Prlnl My Commission Expire
Govern vial Unit Officl Slgnatur OP Drafted by:` 0 S L do m
11
P onal rmallo u provide may he used for secondary purposes (Privacy Law s. 15.04(1)(m)]
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE"
This Infomratlon must be,complated by submltfer. document title name & return address ands (it required). Other Information such as the
granting clauses, leagal description, etc. may be placed on Ihls I/rst page of the document or may be placed on additional pages of the
document. Akdor Use oribls cover-page adds one page to your document and $Z 0_tQfhelsonrdlun tae- Wtsconsln Statutes, 5D.43.
St. Croix County 1046955 Page 1.of 1_
I
SEPTIC or HOLDING TANK SERVICING CONTRACT
Contract Date
This contract is made between the
Tank Owner(s) Name(s) and Pumper's Name
We acknowledge the installation of (a) septic/holding tank(s) on the following property:
(Provide legal description). _....1 [ 1 ~j, ti.,.-,
1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County
Planning & Zoning Department) to document maintenance by a certified septage servicing operator as
required in Comm 83.52(1)(c)2. Wis. Adm. Code and the approved Component Manual.
2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to
permit the pumper to have access and to enter upon the property for the purpose of servicing the
septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can
service the septic/holding tank(s) with the pumping equipment. The owner further agrees to pay the
pumper for all charges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the
owner and pumper.
3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of
the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the
monthly report:
a. The name and address of the person responsible for servicing the septic/holding tank;
b. The name of the owner of the septic/holding tank;
c. The location of the property on which the septic/holding tank is installed;
d. The sanitary permit number issued for the septic/holding tank (if known);
e. The dates on which the septic/holding tank was serviced;
f The volume in gallons of the contents pumped from the septic/holding tank for each servicing-,
g. The disposal sites to which the contents from the septic/holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a
change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a
new service contract with the local governmental unit named above within ten (10) business days from the
date of chance to this service contract.
Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date:
.0 Z) A/ lee
Today's Date
Pumper's Name (Print) Pum ' 's Sig ture Notary Public Signature
Pumper's Registration Number iration
NOTARY PUBLIC MINNESOTA
MY COMMISSION EXPIRES 01131/18
(
IT
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f
Property Owner Property Location
~ E (or W
Govt. Lot ✓ r 1/45 1/4 S T3/ N R/
Property Owner's Mailing A r sq Lot # Block # Subd. Name or CSM#
I 60 /9
7-C) g f r, 6 14t15
City State Zip Code Phone Number ❑ city ❑ Village own a rest oad
e A-1 716 ~Zy
❑ New Construction UseiResidential / Number of bedrooms Z Code derived design flow rate GPD
Replaoement ❑ Public or commercial - Describe:
Parent material tFlood Plain elevation if applicable ar y ft.
General comments
and recommendations: (f s
System Type c System Elevation
r
Boring # ❑ Boring 11o,~.Q,~ ate d~ ,t tit
F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F] Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 5401 715-246-4516
Property Owner _ Parcel ID # Page of
❑
Boring # Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
F-1
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/_ 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.
SBD-8330 (8.6100)