HomeMy WebLinkAbout018-2021-08-000
apartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
3uilding Division INSPECTION REPORT Sanitary Permit No 600234
:RAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
al information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
City Village Township Parcel Tax No:
,t Holder's Name: 018-2021-08-000
.=VERING HOMES TOWN OF HAMMOND
Descripti n : Section/Town/Range/Map No:
,T BM Elev: Insp BM Elev: BM 08.29.17.1289
/ ate AA 1 ~
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
-r
Benchmark
Septic I /O a0 • `7 A c
Alt. Bt
, 7
t~s R.4.
LA te- Aeration Bldg. Sewer'
C,
Holding St/Ht Inlet 163.
St/Ht Outlet ~~Q ~b
TANK SETBACK INFORMATION
TANK TO P/L \E-LL/ BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 _7 Z' Dt Bottom
Dosing Header/Man. eY 9 C' q
Dist. Pipe
Aera n q d 99 7
Holding Bot. System 9 0 C, Ck
Final Grade , ~d3 r7
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover 16G ,
GPM I A 114, 2
r
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Le Di st. to well
SOIL ABSORPTION SYSTEM
PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
BED/TRENCH Width 1 Length No. Of Trenches
4.
DIMENSIONS 47
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manutacturer~ / ~vL
CHAMBER OR
INFORMATION Type Of S tem: 4 153 A)A- UNIT Model Number:
(6j0r1%.VV4-.---6 aj
DISTRIBUTION SYSTEM
X Hole size x Hole Spacing Vent tt4 Air Inta
Header/Manifold Distribution a _ SO J e S
Pipe(s)
Length / Dia_ Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Mulched
Depth Over xx Depth of xx Seeded/Sodded
Yes No Yesj No
Depth Over Bed/Trench Edges Topsoil
I 7s..2
Bed Trench Center
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 4 I ~dInspection #2:
~9~- L- " 7
Location: 1655 102ND AVE/;, 1
1.) Alt BM Description = I YL ljbh,t„ 1-~- 'Sd
2.) Bldg sewer length= (,03
- amount of cover
Plan revision Required? 1 Yes "No 5 Z s
Use other side for additional information.
Date Insepctor's gnat ure Cert. No.
SBD-6710 (R.3/97)
<A rV
~9«u W ~ County--
Safety and Buildings Division l
t 8 J 201 W. Washington Ave.,' P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707-7162
ROD(COU T ENT _
44Y DUMORM
FrITY&V an~+ , pe1'I111~ 1 State Transaction Number
In accordance with SPS 383.217(2), Wlis. Ad ym Code, submissi__C RCPB06KVX40 mit
is required prior to obtaining a sanitary permit Note: Application forms for state-owner ruw iJ S to Project Address (if different than mailing address)
the Department Safety and Professional 1s. Personal information you provide may be used for secondary
purposes in accord rdance with the Privacy Law, , s s. . 15. 1 m , JtatS.
1. Application Information - Please Print All Information
Property Owner's Name 6 Parcel #
Property Owner's Mailing Address Property Location J a g y jJ y
7 4 Govt t
C ,St~ate~ Zip Code Phone Number'/,, Section All, Lu, J ~-r /LJ 1. T N; R /~7Ec o W
4
H. Type of Building (check all that apply) Lot n
Family Dwelling -Number of Bedrooms Su4vision Name
.m Bloc /X,
❑ PubliclCommercial - Describe Use le► k
City of
❑ State Owned - Describe Use CSM Number 9wno
llage of V-6A ea I -
f i
t
111. Type of Permit: (Check on y one box on line A. Complete line B if applicable)
A. ew System El Replacement System System (explain)
❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing B. ❑ Permit Renewal El Permit Revision Change of Plumber El Permit Transfer to
New List Previous Permit Number and Date issued
❑
Before Expiration Owner Ste` t r Sf
IV. Type ofPOWTS System/Component/Device: Check all that apply) lea
3114-Pn,essurtzadln-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 rsal/Treatment Area Information: ,
Design Flow (~rpd) Design Soil Appli 'on Rate(gpdsf) Dispers Area Required (sfl Dispersal
Art~a Propose f) System lev on
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units
M v U ,
New Tacks Existing Tanks
a U rn " V) C~
Septic or Holding Tank ;
Dosing Chamber
VII. Responsibii➢ty State nt- I, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans.
PI ber's Name (Print) Plum Mature MP/MPRS Number Business Phone Ntunber
`t>
`
,V . I xXxi -0
PIum's Address (Street, City, State, Zip Code
[ h
t7 C
VIII. Countv/De artment Use Only
X 1 pproved ❑ PejrrmiittjFee Date Issued Issuing. t Signature
A
Reason enial $
7 0 5 IY 1(1 , 1- Jam,
DL Conditions of Approval/Reasons for Disapproval
3~►~n~. tea,,. ~o P•~xucdl
SYSTEM OWNER:
1. Septic tank, effluent filter and
dispersal cell must be serviced / maintained
as per management plan rovided b lumber.
2. All setback require' 1tto 1? fi 4II~iP[ and submit to the County only oa papernot less than 8 v7 x 11 inches in size
as per applicable code/ordinances.
SBD-6398 (R. 11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/10/17
Owner:Overing Homes
Location: SE1/4 SW1/4 S8 T29N,R17W 1655 102nd Ave Richmond
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Leaching Chamber Cross c on
4-6. Maintanance and Confn~ cy an
7. Filter Cross Section
Signature
License number #22 00
System PLOT PLAN
-PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
SW 1/4 SE 1/4S 8 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 98.1/98.0 4.5' below grade 10/10/17 BEDROOM 3
DATE
CONVENTIONAL )00( CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DgQE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 of chambers 32
BENCHMARK V.R.P. Top of survey iron P ASSU ELEVATIO 100' Filter Lifetime Filter
M-E .0
❑ BOREHOLE O WELL -H.R.P. same as benchma k
Scale = 1/4" = 10'
~o
r Pro 3 1
Bedroom
House
ST B-,
0' 4 ,
0% Slope
40'
166th St.
-3
2-3' X 66' Cells with >3' Spacing
Vents 40'
Vent
B-1
>6" Quick4 Standard 50'
of Cover Leaching Chamber
with 20.0 ft2 of Area
12 , 5.W2/pair of end caps
Long
Grade at System Elevation
34"
*
B.M Scale is 1" = 40'
B.M. unless otherwise 100'
noted
180' Property Line
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
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
Typical Installation 102.5'
Vent At/ Grade Vent
3' 4" .A~30/34 Septic Tank
5' Long 5' ;3)
ng 1
36" Grade at System Elevation Grade at System Elevation
Spacing- 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-98. 1'
B-98.0'
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ~e v~; l n a
Mailing Address
Property Address
(Verification
City/State required from Planning & Zoning Department fornew construction.)
-
Parcel Identification Number ®
LE l
GAL DESCRIPTION 67c~Od-L-~~- J
Property Location
Subdivision T-' L._N Rw, Town of -
Certified Survey Map # r-- Lot # _
Volume
Warranty Deed # f image
Volume Page #
SYSTElb111 Spec house 'yes no Lot lines identif`rab1 no
EIyANCE A O ye
lvjl
WNER CERTIFICATION
Proper use and maintenance of
maintenance consists of pumping out the your septic system could result in its Pre
the system can affect the function of the s tank every three years or sooner if needed by to handle wastes.
responsibilities are specified in §Com . 83.52 1 trrte t stage in the waste dis PUmper- Wha
P into
12 t yon ut
()and in Chapter - St. Croix Co posal stem' -ma
The Property owner agrees to sub t'i'ty sani Owner in nance
owner and b mit to St. Cro ~ Ordinance.
wast ewater disposal master plumber, Journeyman Plumber, ix tPlumber p Planning & "Lorin De cation fo
system is in rrestiiCounourt or a licensed pump$ ear verifying mn, signed by the ted less than I /3 full of sludge. Proper operating condition and/°r that (1) the
(2) after inspection and pumping (if necessary), Septic tank is
'/we, the undersigned habyve he read bthe standards set forth, herein, as set p above requirements and agree to rnain
t
Certification stating that our s eartment of Connnerce and the De"' d7e Private sewage disposal 'Lorin D y eptic system has been Pa mem of Na r s ate
system with the
g Department withitt 30 days maintained must be comp i~al Resources, State of Wisconsin.
of the three feted and returned to the St_ Cro'
Year expiration date. County Planning &
Uwe certify that all statements on this form
Property described above by virtue of a are true to the best of myfo
warrantrdeed recorded in Register ar knowledge. Uwe am/are the owner(s) of bedro.-- of Deeds Office. of the
IGNA OF APPLICANT S
-A-uy information that is misrepresented DATE
Y result in the sanitary Permit being revoked by the planning & lowing Depai invent.
reference "'Glade wi is th trthisade in the application a recorded warranty deed from the Register of Deeds
Wanan .
ty deed, Office and a copy of the certified survey neap i f
(REV. 08/OS)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 9C. n
Permit # Septic Tank Capacity al
El NA
Septic Tank Manufacturer El NA
7ESIGN PARAMETERS Effluent Filter Manufacturer J ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units :~XNA Pump Tank Capacity ~ al NA
j Estimated flow (average) L'7Z7 NA
aVda Pump Tank Manufacturer
i Design flow (peak), (Estimated x 1.5) NA
J gal/day Pump Manufacturer
Soil Application Rate , ai/da /ft2 Pump Model NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) Q20 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA
Biochemical Oxygen Demand (BODs) 530 mg/L_ Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L XI-NA ❑ At-Grade ❑ Mound
Fecal Colifnrm (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
!Maximum Effluent Particle Size Ya in dia, ❑ NA Other ❑ NA
Other Other:
NA ❑ NA
*Values typical for domestic wastewater and septic tank effluent Other. E7 C.] NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
[inspect condition of tank(s) At least once every: ? month(s)
.1 ea s (Maximum 3 years) 13 NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA
[Inspect dispersal cell(s) At least once eve _P[ month(s)
(Maximum 3 years) ❑ NA
every: /10-year(s)
--lean effluent filter At least once every: ❑ onth{s}
ear(s) NInspect pump, pump controls & alarm At least once every: ❑ month(s)
❑ year(s) f=lush laterals and pressure test At least once every: 13 1:1 month(s)
ether. year(s) At least once every: ❑ month(s)
17ther: ❑ year(s) NA
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
(Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectoo s 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
tcombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
!visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
Pegulatory authority.
I,Nhen the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of
I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
INII other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS ohei-k treatment tank(s) for the presence of paining products or other chemicals theft
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thO
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will ble
discharged to the dispersal cep(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to ttVe
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park Vehicles over tanks and dispersal calls. 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 foilowing from the wastewater stream may improve the performance and prolong the life of the POWTfi'
antibiotics; baby wipes; cite butts; -condoms; cotton swabs; degreasers; dental floss; diapers; disinfedards; fat; foundation drain
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; ping produc*;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propetly
and safety abandoned in compliance with chapter Comm x3.33, 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, ail flanks 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 fads and cannot be repaired the following measures have been, or must be taken, to provide a code c ompfi*nt
replacement system:
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 neled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule$ in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWI•S technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a 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 biornat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone l Phone
r-
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name < 'q
Phone fF l 7/,;,--
'-"j s -n Phone 3 c~P
This doasnent was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)8 (f) and 383. 1), (2) & {3}, Wfscorrsin Administrative Code.
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Wisconsin. Department of Commerce SOIL EVALUATION REPORT page ~ oT"~
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County 1 i7 t
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. p
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. G 0 - 20 ' Qo
Please print all information. Revie by D711e16 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7
Property Owner Property Location' r
oe- cl re Govt. Lot 51 ) 114
1/4 T21 N R E (o W
t~ /
Pro rty Owner's Mai Address Lot # Block # S .Name or CSM#
79' illekfw*011-1~
City late Z~p Code / Phone Number ❑ City ❑ Village 'JKTown Nearest Ro 66,115-
New Construction Use Residential / Number of bedr ms _-E l" Drived sign flow rate J~ GPD
C1 Replacement ❑ Pu/~is or commercial - D s be:
Parent material C 3/ L s Flood F~~r~levatio if applicable
1 J
General comments
and recommendations:
4 ST. CROIX COUNTY
System Type
FT I fff Boring # El Boring / , pit Ground surface elev. ft. Depth to limiting factor in.
Soli 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
r)
I
f
Boring El Boring I
C` Bon # R pGround surface elev! (7? ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. °Eff#1 `Eff#2
` Effluent #1 = BOD > 30:5 220 mg/L and T >30 < 150 ! ° Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Si na _ CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, Wl 54017 715-246-4516
oC' o
Property Owner _ Parcel ID # Page of
Boring # ❑ Boring
;1 ~✓1 11 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
10
n-2i 0,1171 A I-,
1
i
q2
F-1 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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh- 'Eff#1 `Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil ication Rate
Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
i
' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' 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 altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.6=) .
M
Soil Test Plot PI
Project Name Oevering Homes LLC u Bird
Ad(6ess P.O. Box 179
New Richmond Wi 54017
CSTM #226900
Lot 8 Subdivision Hammond Hills Estates pie 6/2/07
S W 1/4 SE 1/4S 8 T 29 N/R17 W Township Hammond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 98.1/98.0 * H R PSame as Benchmark
Please note: survey was not
complete at the time of testing,
installer must check all setbacks
prior to installation.
B-2
40'
0% Slope 40'
Scale is 1" = 40' 166th St.
-3
unless otherwise
noted
40'
B-1
50'
B.M.
100'
180' Property Line
I
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division Of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code wr
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County <5
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Review by D;//10/6
Personal information you provide may be used for secon 15.04 1) (m)). 7
Property Owner / Prope Location
. d rt~4 t - ovt. L tri~ 114 1/4 g T 2 ~ N R l E (o Q W
Pro rty Owner's Ma4rig Address ,ffl# # Block # IS Name or CSM#
/ ) r -
1 ~7` !i rrr
City late Zip Code ~j Ph e N C' [:1 village Town Nearest Roa
All A4 17e-
New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Pu is or commeraaI - D scribe:
material 'CZ G C Cdr t:7~' Flood Plain elevation if applicable
Parent ft.
General comments
and recommendations: L i
System Type a System Elevation
BoriN# ❑ Boring
.fff
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appilication 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
,
r o-
Z j
)
Ci
rt
Boring # ❑ Boring
Z7 Pit Ground surface elev. ft. Depth to limiting factor Oin.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
✓'i 3/7- - 1 n C` r
-----i
Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 ` Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
CST Name (Please Print) S atu CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 540 _ 715-246-4516
Property Owner _ Parcel ID # Page of
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.'q Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
1
❑ 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/fl=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Etf#2
~J a Boring # Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Applicat Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ft?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
s
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 30 M91L 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-6330 (R.6=) .
t
Soil Test Plot Plan,,
Project Name Oevering Homes LLC Shauj r
Address P.O. Box 179
New Richmond Wi 54017 C M #226900
Lot 9 Subdivision Hammond Hills Estates Date 6/2/07
S W 1/4 SE 1/4S 8 T 29 N/R17 W Township Hammond
❑ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 1 oo ft. Top of Survey Iron
System Elevation 98.9/98.5 *HRPSame as Benchmark
Please note: survey was not
complete at the time of testing,
installer must check all setbacks
pri or to i nstal I ati on. 444' Property Line
103.5'
B- 8% Slope
3'
Scale is 1" = 40' 30'
'
unless otherwise B-3 45'
noted
B-1
3 0'
101.5'
300'
180' Property Line
B.M.