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HomeMy WebLinkAbout040-1312-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 600361 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: Delta Construction TOWN OF TROY 040-1312-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: G5"r 04.28.19.2040 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f, J J / Benchmark rdt .t C r ~J Alt. r BMK1 ~ d Z Aeration Bldg. Sewer 3.7 S . Holding St/Ht Inlet cY L /7• TANK SETBACK INFORMATION _§t/Ht Outlet 9 J 7 TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet \ 70J A- III - ( Dt Bottom Septic (.3 _ ) 2 rT- Dosing c,c Header/Man. / .5 11 V J 9~a.3' Aeration Dist. Pipe r0• ~o• .3L ti . ~O • Z Holding Bot. System ~•'J~ 9 ' Final Grade PUMP/SIPHON INFORMATION 3• a Manufacturer Demand St Cover Q GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Lengt I Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z _4 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuia"e INFORMATION CHAMBER OR L_;~r+ f Typ~OOf~S•yJstem: UNIT Mode Numbef: 44 DISTRIBUTION SYSTEM p ZZ ? Z Header/Manifold/ of Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over " I Depth Over xx Depth Qf xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil No r ~ Yes~No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (.0 ~c V , $ Inspection #2: Location: 528 OLIVIA CT 4~ J{~ 1.) Alt BM Description = 1 1•~ 2.) Bldg sewer length - amount of cover = , d Plan revision Required? ❑ Yes N(o Use other side for additional information. YJ v V Date Insep aSignaturd' Cert. No. SBD-6710 (R.3/97) . ON County Safety and Buildings Division t1 s ? 13 2.018 a 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) K Madison, Wl 53707-7162 '~a antb • , y (Q60 3 State Transacxt n r er Sanitary Permit Application ' In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to app ate overcmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are subtniue. to Pro'ect less (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Z U,~ nm , Gam oses in accordance with the Privacy Law, s. 15.04(1) m), Stats. L Application Information - Please Print All Information _ Property Owner's Name _ Parcel Cam, s l i 2- (111 Property Owners Mailing Address Property Location is jX, 1 `j C j G) I Govt Lot City , State Zip Code Phone NmIDber I 1/., i 6J '/y Section sole o 11. Type of Building (check all that apply l or Lot # Subdivision Name 2 Family Dwelling-Number of Bedroo ~ ,I99 L/ PA- ~GcY~G~ Block # ❑ Public/Commercial - Describe Use - ❑ City of CSM Number ❑ Village of El State Owned - Describe Use of z 8~s4-'~_ Z2~ ZZ III. Type of Permit:-(C-hiecckk only o e box on line. Complete line if applicable)A. ew System ❑ Repacemenz System I El Treatment/Hol&n ;Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued ~r ~ B- El Permit Renewal El Permit Revision ❑ Change of Plumber ❑~Permit T7ansfer to New I - Before Expiration I A4(4/ 3,~ IV. Tkpe of POVVTS System/Component/Device: Check all that apply) e:,suzized In-Ground ❑ Pressnru L:-Ground ❑ At-Grade ❑ Mound > 21 in. of suitable soil ❑ Mound < 24 in. of i ble sow 5 ❑ Holding Tank Other Dispersal Component (explain) ❑ etcratrnent Device (explainj V. Dis ersal/Treat ent Area Information- - /I e .1 V ~ To Area R sired (sf1 Dispersal Arcs Prop red { f) System Elevation Design Flow (gpd) Design Soil Appli cation gpdsf) Dispersal rer Y J c VI. Tank Info i i Capacity in tal # of hTanufactu Crallcns G ions units j 2 U y Nrw Tanks °o m m Septic or Aoldiag Tank T Dosing Chamber i ~ VII. Responsibility Statem t- L the undersigned, a. r ponsibility for installation of the POVM shown on the attached plans. Plumber's Name (Print,) -"~Pi s afore MPMtPRS Number Business Phone Number Plum rs Address (Street, Crty: State, Zip Code) ntylDe artment Use Only _ - ou. VIII. A roved _ Permit i ee Date sued Issuing t Signature =77. Reason for Denial ]x conaiti : 'dsous jpkVk jipproval 3J T biWsrttW 00 MW dill e"1 ic?s_ly+~ink-ec i ~s per gW.3yerrt W plsn n'v ltle~f by plumber. d 2. ,t18•At!Irrxk rec,:^.en~a m+n>fPbe rKl.rt: ir.E: U per t►pF c bus rr>6 - 1 : rdlna.r,r=. Attach to complete plans for the system and submit to the County only on paper not less than 3 it z 11 inches in size SBD-6393 (R. 11/11) System PLOT PLAN PROJECT Delta Construction ADDRESS 202 W 2nd. St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 96.0/95.9 4' below grade 4/18/18 4 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 Gallons LIFT TANK SIZE DOSE TANK SIZE i HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 / BENCHMARK V.R.P. Top of IP ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale=1/4"=10' 268' Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Pro 4 Bedroom House f~ 10' B-3 0% Slope 103' ST 10' V ~60' 2-3' x 90' cells with >3 spacing B-2 A~ °6t 100'ts Vent >6„ Quick4 Standard -1 W of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" s Grade at System Elevation 34" 1 ~{5 80' 1 L~ 311' Property Line t4IC0 F Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/10/18 Owner: Delta Construction Location: NE1/4 SW1/4 S 4 T28N,R19W 5 Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and ~ntingency Plan 7. Filter Cross Section' ` Signature ~ License number` , 26900 System PLOT PLAN PROJECT Delta Construction ADDRESS 202 W 2nd. St. Hudson Wi 54016 NE 1/4 SW 1/4s 4 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 96.0/95.9 4' below grade 4/18/18 4 DATE BEDROOM CONVENTIONAL X0( CONVENTIONAL LIFT HOLDING TANK 1255 Gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chamb s 44 L~ BENCHMARK V.R.P. Top of IP ASSUME ELEVATION 100° Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' 268' Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Pro 4 Bedroom House 10' B-3 103' 0% Slope ST 10' 60' 2-3' x 90' cells with >3 spacing B-2 100' Vents Vent B M * >6„ Quick4 Standard B-1 1 90' of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" 80' 31 1' Property Line 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 To be >1' above grade 5.6ft^2 pair of end plates Finish grade elevation Typical Installation 9S~'" r 7fi Vent Grade Vent 3' 4„ 3, ~~30/34 Septic Tank 5' Long 1 5 5' Long 1 Grade at System Elevation -10 " Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: B S5,2~- S, r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of PILE INFORMATION SYSTEM SPECIFICATIONS Owner ..7 _ , Septic Tank Capacity al NA Permit # Septic Tank Manufacturer - ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity al NA j Estimated flow (average) L C,) `J gal/day Pump Tank Manufacturer ItI NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application Rate auda lftZ Pump Model NA i 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) x220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L _ ❑ Disinfection ❑ Other. `Pretreated Effluent Quality Monthly average Dis ersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size is in dia. ❑ NA Other. ❑ NA (Other. NA Other: ❑ "Values typical for domestic wastewater and septic tank effluent. Other ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency linspect condition of tank(s) At least once every: 0~.montl (Maximum 3 years) ❑ NA earls) (Pump out contents of tank(s) When combined sludge and scum equals one-third ('fa) of tank volume ❑ NA Ifnspect dispersal cell(s) At least once every: D month(s) ar(s) (Maximum 3 years) ❑ NA (Clean effluent filter At least once every: 9 month(s) ❑ NA zq-year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) 1=1ush laterals and pressure test At least once every: ❑ month(s) ❑ NA I] year(s) ether. At least once every: ❑ month(s) ❑ NA ❑ year(s) ether: T ' ❑ NA MIAINTENANCE 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 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 icembined 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 I-egulatory 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 I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ikll 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. i~ service report shall be provided to the local regulatory authority Mthin 10 days of completion of any service event. Page of START UP AND OPERATION nt tank(s} for the presence of painting products or other chemicals tt~lt For new construction, prior to use of the POINTS Check treatme concentrations are detected have the contents of the may impede the treatment process and/or damage the.dispersal cell(s)- If high tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when sal conditions are frozen at the infiltrative surface. bie During power outages pump tanks may fill above normal highwaer levels. When power is restored the excess wastewater dil in the backup or prior to surface restoring of will will power l t nL discharged to the dispersal cep(s) in one large dose, overloading the oell(s) and may result To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator to restore normal levels or contact a Plumber or POWTS Maintainer to assist in manually operating the pump Wnftis effluent p AP within the pump tank. disturb or compact the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. the We of the PONV f$: Reduction or elimination of the following from the wastewater stream may improve the performance and prolong antibiotics; baby wipes; cigarCtte butts; 'condoms; cotton swabs; degreasers dental floss; diapers' ' disrrtfectarft, fat; foundation drain k~tiorts oil; painting Pn~~; (sump pump) water, fruit and vegetable peelings; gasoline; grame; herbicides; meat scraps; rrted 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 propeftY and safety 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 property 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 filled with sail, . gravel or another inert solid material. CONTINGENCY PLAN code oompfirrt 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 reptacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requinled setbacks from abating and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neied 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. Barring advances in POWTS technologW 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 ~ evaluaoon as must be perfumed to locate a suitable replacement area. If no replacement area is available a holding tank may ast 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 Reconstructions of such systems must comply vvith 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 T AN ~~LS O ,NY CIPIRC BLEANCES' DEATH MAY CULT. RESCUE 0 A PERSON FROM THE INTERIOR OF A TANK ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAlNTA1NER s,- Name / Name c.. ` r.. - r Phone phone c` SEPTAGE SERVICING OPERATOR MPER LOCAL REGULATORY AUTHORITY Name 1~ 17 Name Phone Phone A f ti cf ~i . r1 L This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(I) and 383,54(1), (2) & (3). Wisconsin Administrative Code. I yy! Y~~ I cl j..; ~ I \ - ~ ! I Q, I o I _q I I I o a I(' ~ a I °o g ' e-I I ti c I ~ J C}S I v: W ~r j _ 1 I LOT 9 50 43560 S.F. ~1..00 Ac. 4-f 29" E B x got- LOT 10 43565 S.F. eo- 1. 00 Ac. C8 /0 -10 10 1\ LOT 12 LOT I 43577 .F. 43560 S. F. 1.00 c. 50" ~ 1 00 Ac. NQ~ 386.778'... 184M' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE t'iGREEMENT AND OWNERSHIP CERTITIC IC)N FORM Owner/Buyer Mailing Address 24-) Property Address _ (Verification required from Planning & Zoning Departin for new construction.) City/State _ Parcel Identification Number --a 1/'q r LEGAL DESCRIPTION Property Location'' 1/U ,,ljL.c> 1/4 , Sec. , T 2 N R. W, Town of'460Q Subdivision of # Certified Survey Map # _ # __s Volume , Page Warranty Deed # Volume Page # r , Spec house yes no Lot line,; identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its promature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, ii 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 Plamung & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departrncnt of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on thi form are true to the best of my/our knowledge. I/we arrVare the owner(s) of the property described above, by virtue f a wa anty deed recorded in Register of Deeds Office. Nu ebedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being tovoked 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) - - - - - - - - - - - - - a~ - I does hT, '>vo~can-1 'lanoz) rrn lc 9 s kj r ~ < a 73C, Q I }./~'9 }~~/~v~ - : ' (~eX~ OW l l/ I I1f'iOD S ~'011711Z1SN0~ V'1~i0 I LL a~j~ i FlY~i<ga:1Ef~.~ J~~•ri , •at ~ k t 5 ; 91 1 S ~ 1- I;LLE.. V., 1 _ I I O ~9 ~ I ~ ~ I I A i t I x~ ~.~II ~ x6T i ~ I ~ I, I j ~ I I I ac ~ I I II ~ I 3 - I, I ( LLv', ~ I~~I II i ill III ~!Ll Ij ~ I ~ I II II III .i I I I I I i I I - ~i~ I~ II I ~fj I I I - z ~ff I I1 ; I I~ ~I 1 I it I ~ II O 1 I I. o. , 'I I FLO ® III ►i ®DM „ I II I Q , ~ I 7 17 FRUE I I ~ ~ it 1 I ~l ® w ;III! w ~ I ~b p. 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NON y7~~sFyr ~~p 9 f C~~?i^E'~3: SR 1 u i ) ! S f N0117 21SN~~ V1730 k ! y ~ i1 b?~3EV. -Gip'Re .544 L 2 I -ef ~ t ~e I I , ~ ~ a 9 A i I i 4 ~-.J _ o S y a I I ~ „'Y.GI 0 P - .II-.5 .q .,9'. C! •A w M ' ~ i I r °~y Qpy~e I I ~G ;t: - ull 1 ~ Ir` a 4 dlLcr~~Ozo t pwv,~Nw w 1 1 u:_ =~11w 'r ~ GQJ 1 o z O 1g I ,H-.v 1 .9-.S - ~ 1V,/1 O z z I m a s v 14 - v -::zw.: w~ -sue . w = 1 I i ¢N I ^ f, r0 1 I ;9 i ~ ~ nr V W m I iv I Ch 0 y z=L I '9 I 11 I I ~ Q¢ II ~ a - I. "_~s ~Q I - i - is I~ - - p •a 61 p Q I rII I -S i'~ ~i ~ S O d~ 1\ r _ a x47 1 - I ' I I _ :3 s I I I m z 4 1 I ~ " 1 I - I 1 ,~,6Y I 1 I 1 I I E•d e09:LO S L Z L add WdLE:OT 8Z©Z/TL/b9 Q3AI3032i r Wisconsin Department of rorl R, L G SOIL EVALUATION REPORT Page ! of 3 Division of Safety and Buildings in acaocdance with Com 85. Wcs. Adm Code Attach complete site plan on paper not less than 8112 x 11 inches' size. Plan must cmmty 677 . C R&, f X Include. but not limited to: vertical and horizontal reference po"{8tuij. curection and Parcel t.D. 1 3 Penant slope. scale or Vow. and location and distance to nearest road. O Please print all information. Reviewed Date ~U ds Pemorut inroamu6on you provide may be used for secondary proposes (Privacy taw. s.15.04 (1) (m)). 6zy) , Properlyowner Property Location 20 6 -rV DD BjVI&Tw~T Govt. Lot n/F 1/4 SV 114 S T N R 9 E (or V~ PnOPerty owners Malting Address L&# Block # Subd_ Name Or CStbt# 3,37- OM A H,• (--r l b C 07TA•bc- Ali t tows City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road H tlDSoAI wI 9401 ( -T90 aLI ✓ 4 t: -f- JSINew Construction Use: 99 Residential / Number of bedrooms 3-5 Code derived design flow rate n7 GPD ❑ Replacement ❑ Public or cornrneraal - Desaibe: Parent material S/f Z Y LVC-SS O PVOC !y &J -r" Ate Flood Plain elevation if applicable P, fit- R• General comments and recommendations: Area -.Y- Spot Tested suitable Eo( a conventional inground system (P.4.W.fiS.) 5 6 Boring # ❑ 0 ® Pit Ground surface etev_ qq' 82 iL Depth to limiting factor > Qh ~ in. [sjAppkslion Rate HMlMon Depth Dominant Calm Redox Desaipfion Todwe Structure Consistence Boundary Roots GPDM In. Munseff Qu. Sz. Cod. Color Q. Sz. Sh. •EM1 -Eff#2 0"11) IDYK 212, - 2 f bK m 1A .41 .9 Z 10.23 1 oWle+ - I mf i 2-4 -2 w) M 3 3- 29 i o yp, 13 nit ~-i a I J .,e+-so-,I 2- m iox 2q-go 10YR s/ - .-7 1.(0 d 1 It Boring # ® P Ground surface elev. ✓ t ft. Depth to iimi6ng factor } (3 in. Sod Auilication tie tforimn Depth Dmnkk nt Cookx Redox Desaiptim Texture Structure Consistence Boundary Roots GPDM in. Munsd Qtt Sz Cord. Color Gr. Sz. Sh. •Eff#1 *0112 1 YOZ 211 it v-!r i a Iz- 10Y94/ - sci M+0 2V-E •~t- . 3 ~9-~•4 /DVot - S1el m Mkt C, S 2V4 . b '9 29- / 0 fe- 'h - SW 3M 17A h) -P OL tit! - . W-1- 0 q3 YR sl - S s m 1 140 • ellluent #1 = BoD > 30 < 228 mg& and TS~ >30 < 150 mg& ' Eflluard #2 QB& 3o mglL and TSS 30 rnglt. CST Name (Please Prird) Signature Nrrnber J Ea O U e ~ti:.tc~e(1 Y5"3.51- Addrm Date Evaluation Conducted Telephone Number 2~31z jUTr~ /4jv SPRJ1I V414Ctr,w( 5-•13-0S_ (?/S) 77Z-34--2 i i or issuance of p- L-rmii; an 'acsjgnin(, Contact: Ulbricht & Associates Ulh, is;nt & Associates Registered private wastewater consultant and plumbers Private Sewage Consultants 281 2 10th Ave. 2812 10th Ave. Spring Valley, NIVI 54767 Spring Valley, WI 54767 715-772-3442 LoT /o Proms Dvrner I3JST~p7' Parcel #d # o -/o/4 - /0' do0 a 2 ?age of 3 Boring # 0 Boring ff~~ §q pit Ground surface elev. /00-0 ft. Depth to firnbV factor') in. Soil Appkmdm Rate_ t Horizon Depth Donxnanf Color Redox Description Texture Structure C insistence Boundary Roofs GPDXF ~ in. Munseff Qu. Sz Cott Color Gr. S2. Sh. -Etf#'l -0142 0 --M IOM Z& e 1 rn-F r C S 3~F •fP . % Z /2 lv k3 - 1 2-4'( .2 :3 IL-25 2-C `F 25- t o YR s r S D m l .'"7 L # J # Boring # Q Boring Fit Ground surface elev. + O fl Depth to knifing factor in. Sol Application Rate horizon Depth Dominant Cokx Redox Description Texture Structure Consistence Boundary Roots GPDM tn. Mt>nsel# Qu. Sz. Cant. Color Gr. Sz. Sh. *MI 'Eft d is ► / /71 l p Boring ' Pit Ground surface elev. ft. Depth to finning factor in. Sol koplicatim Rate Noizot Depth Dominant Color Redox Description. Texture Sftx* a Consistence Boundary Roots GPOM in. munsel Qtr. Sz Corti Color Gr. SZ Sh. 'EM -Etf#2 t # 9 e r t Boring# Boring t - t Ground stahace elev. R Depth to Witting factor in. t_t Pit Sot Applicaition Rate 1 Horn Ort Depth Dominant Red= Description. Texture Stucttxe Consistence Boundary Roots GPDM t in. mun"Q Qu. Sz. Cott Color Gr. Sz. Sh. 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