HomeMy WebLinkAbout020-1105-10-075 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 60507$
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j.
Permit Holder's Name: City Village Township Parcel Tax No:
Kirk & Lisa Nelson TOWN OF HUDSON 020-1105-10-075
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
C NI 33 0 34.29.19.413F-30
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER S CAPACITY STATION BS HI FS ELEV.
A M 12 7
Septic tJ v Z~ O G 0O 19 Benchmark ' e,b 1-Z /e 0 '74-3
Aeration Bldg. Sewer 1,66
Holding St/Ht Inlet
~.l ,y
TANK SETBACK INFORMATION St/Ht Outlet ~p• 9$ -Z _NL TANK TO P/L WELL BLDG. Air Intake ROAD 9~IMeto
Septic *7 /66 /Z9 ( T, Dt Bottom KI
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer GPMand St Cover s dad
i
Model Num
TDH Li Friction Loss Syste TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System:11100 UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold 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 Depth Over [7 -Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
Yes E] No 0 Yes Ej No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 615 NORTHERN LIGHTS TRL
1.) Alt BM Description = r., LL, CaJ•t+- a
2.) Bldg sewer length = Zc
- amount of cover = 'L d it
Plan revision Required? Yes No -7
.F1 ~
Use other side for additional information. VV
SBD-6710 (R.3/97) Date Insepcto/gnature Cert. No.
0) 0
County
Industry Services Divisi
onIT
ory f q 2018 as ngton Ave Jy~
a = 1u` 0 u P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
J Madison, WI 53707-7162 7t L~ y~ Q
ti Croix°UntYment 44Ud V~CJ
c0mmu y ary Permit Application State Transaction umber
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit AA-
Is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Addref different than ling address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
~ ~ /t~
purposes in accordance with the Privacy Law, s. 15.04(l m Stats. (UA
I. Application Information - Please Nut All Information `
Property Owner's Name t Parcel #
1 0
Property Owner's Mailing Address Property Location 3Y. a 9~ 11, / 13 ~ 30
6)1
17 ~ Ir N ~ 1 c-I -k G vt. Lot
Xm Zip Cod Phone Number y., '/y Section
E r w
II ype of Building (check all that apply) +r~1 Lot # T N; R E
K%LLaL2 Family Dwelling - Number of Bedrooms Subdivision Name
lock
❑ Public/Commercial - Describe Use~-
❑ City of
❑ State Owned - Describe Use CSM Number ❑ illage of
r f a own of
III. Type of Permit: (Check my one box on line A. Complete line B if applica e) Y A. ❑ New System ImAt-ement System reatment/Holding Tank Replacement Only ❑ Other
Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem/Com onent/Device: Check all that apply)
n-Pressurized In-Ground 101 Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treat nt Area Information:
Design Flow Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pry posed (sfJ System Elevation
.i--
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units a V v
New Tanks Existing Tanks cls c ecJ
I^~ 1►1 ~ {r U in H in tz. C7 a
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersig sume responsibility for installation he POWTS shown on the attached plans.
Plum is Name (Print) er's Signature MP/MPRS Number Business Phone Numb r
11~)Aztl_%_i~> :~r 1:2
PI ber~d ess (Street, City, State, Zip ode
oun /De artment Use Onry-
, I Permit Fee Date Is ed Issuing nt Signature
I Pproved $
❑ 5 D ,
iv Re for Denial
IX. Conditi n - r.D' pproval
~II~@tr9%iY'N IZ'ttJflt tlA l~~:tni>~l5:
Z 'A~~'~4+~i1+sfiawS:iue:taJr.E.~
M pK txida 1 +:fdilliNtOlfi:
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398 (R. 08/14)
System PLOT PLAN
PROJECT Kirk Nelson ADDRESS 615 Northern Liahts Trail Hudson Wi 54016
SE 1/4 SW 1/4S 36 IT 30 N/R 20 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 88.6'3 Drywells 6/30/18 3
DATE BEDROOM
CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers none
BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Property Line
0'
Well
Existing 3
Bedroom
House
DW
B .M. * 15 T 5 120' 60'
ST
20' 25'
W F1
D
B-1
Pro Accessory
Building 0 GPD
277' Property Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/28/18
Owner:Kirk Nelson
Location: SE 1/4 SW1/4 S 36 T30N,R20W 615 Northern Lights Trail Hudson
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3-5. Maintance ontigency~ Plan
6. Filter Cross on
Signature
Licens nu er #226900
I
System PLOT PLAN
PROJECT Kirk Nelson ADDRESS 615 Northern Liahts Trail Hudson Wi 54016
SE 1/4 SW 1/4S 36 /T 30 N/R 20 W TOWN Hudson COUNTY ST. CROIX
SYSTEM ELEVATION 88.6'3 Drywells 6/30/18 BEDROOM 3
DATE
CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers none
BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Property
0'
Well
Existing 3 yY
Bedroom
House
DW
N
B.M.* 15 T 5 20 60'
DW
20' 20' ST 25
r DW ❑
B-1
Pro Accessory
uilding 0 GPD
277' Property Line
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner i~ Septic Tank Capacity al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms s ❑ NA Effluent Filter Model ❑ NA
i Number of Public Facility Units ❑ NA 'Pump Tank Capacity al NA
j Estimated flow (average) gal/day Pump Tank Manufacturer 13 NA
i
I Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
i
Soil Application Rate S aUdaz Pump Model NA
i
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA
Fats; Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Fitter ❑ Peat Filter
Biochemical Oxygen Demand (BOD$) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wedand
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L 416-1411A ❑ At-Grade ❑ Mound
Fecal Coliforrn (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other
iMaximum Effluent Particle Size Sk in dia. ❑ NA Other ❑ NA
(Other. NA Other: 0 NA
*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: D month(s) (Maximum 3 years) ❑ NA
ear s
(Pump out contents of tank(s) When combined sludge and scum equals one-thins {3~} of tank volume ❑ NA
linspect dispersal cell(s) At least once every: ❑ ,month(s) (Maximum 3 years) ❑ NA
ear(s)
I3lean effluent filter At least once every: month(s)
/ M~War(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ mo(s) ❑ NA
. ❑ year(s)
❑ month(s)
Mush laterals and pressure test At least once every: NA
❑ year(s)
ether. At least once every: ❑ month(s) NA
❑ year(s)
ether: '
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 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
i::ombined 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
Regulatory authority.
When the combined.accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
{:he tank shall 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,
land any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer.
Ik service report shall be provided to the local regulatory authoritywithin 10 days of completion of any service event.
Pop of
START UP AND OPERATION treatment tank{s} for the presence painting PrOduds or other chemicals ~t -prior For new construction, to use ndlorr damam~ ~1(s). If
high con MtOm are d9Wcted have the 0°n of thO
may impede the treatment process rotor Prior to use.
tank(s) removed by a septa servicing ore
System start up shall not occur when soil conditions are frozen at the infiltrative surface•
will by
During power outages pump tanks may hwater levels. When power is restored exces a ofs will bp
fill above normal hig re" in the badarp or surface drsc~rarg affluot
discharged to the dispersal cell(s) in one lar'$e dose, overload'rn9 the cell(s) and may Servicing Opera ~ to restoring power to the
To avoid this situation have the contents of the pump tank removed by SePth9e Se the pump corrfrr~ to More nocrrrai levels
effluent pump or contact a Plumber or POWTS pypatrrtainer to assist in manually operating ~ or compact, the area within
within the pump tank.
Do not drive or park Veh~ over tanks and dispersal ells. Do not drive or park over, or otherwise d~
15 feet down slope of my mound or at-grade soli absorption arse. and prong the We of the POWT$= perfornance Reduction or elimination of the fdlovwng from the w~ stream
may rm ~t~ floss; direr: disnfedarrts; fat: foundation drafin
antibiotics: baby wipes: cigarette butts; -condoms; cotton swabs: deg herbicides; meat scraps; medications; on; painting P~~'
(surrip Pump) water; fruR and vegetable pceiings; gasoline; grease;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT out of service the following std shall betaken to insure that the system is prope(ty
with ermanently chapter Comm 83.33, Wisrmnsin AdmtnWtrative Code..
and When the safely POW abandoned fails s in and/or compg permanently
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
Operate'.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Opera
and the void space fitted with soil,
• After pumping, all tanks and pits shag be excavated and removed or their covers removed
gravel or another inert solid material.
CONTINGENCY PLAN
If the POVYTS felts and cannot be repaired the following measures have been, or must be taken, to provide a code canplint
replacement system:
O A suitable replacement area has been evaluated and may be utilized for the location a reply ircnt soil solid upon absorptioion r systdrrr•
ystelM
The replacement area should be protected from disturbance and compaction and shod not be oleo will upon in by ed
the ni4ed
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement result with the rules[ in
for a new soli and alts evaluation to establish a suitable replacement area. Replacement systems must comply
etfed at that time. advances in pOWTS technology a
D A suitable replacement area is not available due to setback and/or soil limitations. Barring
holding tank may be mauled as a last resort tD replace the failed POWTS.
~ area. Upon failure of the POW'TS a sal and site evalua*on
~ The site has not been evaluated e r a sortable replacement be Pew to locate a suit t identify
able replacement area. If no replacement area is available a hokUng tank may be installed as
a last resort to replace the failed POWTS. may be reconstructed in place following removal of the biomat at the mfiittra'iive
D Mound and at-grade sog absorption systems system
comply with the rules in effect at that time.
surface. Ram of such syst
eNVARNiNG»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO T
R CIRCUSANCES. DEATH MAY RESULT. RESCUE O~ A
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER
T O IMPOSSIBLE
PERSON FROM THE INTERIOR OF A TANK MAY BE
ADDITIONAL COMMENTS
POWTS INSTALLER PONRS MAINTAINER
Name
Name ~cc~•-- s
Phone I = Phone
SEPTAGE SERVICING OPERAT (PUMPER) LOCAL REGULATORY AUTHORITY
c.
Name ~tr~.~-- Name
Phone 3 7 i5 Phone 7C
and 383.54(1), (2) 8 (3). wisconsin Administrative Conde.
This doasrrerct was dratted in cxrmmptiiettce with chapter SPS 383.22(2Kb)(1)(d)a(f)
ST. CROIX COUNYY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address--Q--
(Verification required from Planning & Zoning Department for new construction.) `
City/State Parcel Identification Nur lber i= /D - a75
LEGAL DESCRIPTION
Property Location,~ r/4 ,~t.t/ 1/4 , Sec., T Lr) N R- Town of
Subdivision Lot
Certified Survey Map # Volume Page #
Warranty Deed # 10
~
Vo [tune , Page #
Spec house ye no Lot line;: identifiabl yes no
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, .d-"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 vast-e disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zomng 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 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.
I/we certify that all statements on this form are true to the best of my/our k_ao/c I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deet:ls O
Number of bedroo ~1 SsGS tti3r
4,UN ATURE
OF APPLICANT(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)
? 111111111! ~II~II~II111~1
I
Document Number Document Tide 8 5 2 8 0 2
Tx:4447304
z St. Croix County 1068089
Affidavit for a single POWTS BETH PABST
servicing Two Structures via Private Interceptor Main REGISTER OF DEEDS
ST. CROIX CO., WI
L ~c5 sV RECEIVED FOR RECORD
? Name - (Owner) Typed or printed 07/13/2018 03:30 PM
being duly sworn , states, under oath, that: EXEMPT
REC FEE 30.00
He/she is the owner/co-owner of the following parcel of land located in St. Croix
PAGES:
County, Wisconsin, recorded in Volume - , Page Document Number
106U%(5 St. Croix County Register of Deeds Office: Recordin ,1,ea
Name and Return Address
A parcel of and located in the~,E of the4fay/, of Section , TaN,Rf W, r.1P.2„ WG80~J _Zq Town of St. Croix County, Wisconsin, being duly described as g32.Q
C~&43 CGT,
follows (include lot number and subdivision/CSM or detailed legal description): `N UE" evvIp+ *ft;fA..rN AJ
Lod- c$ GSM. ;w W1. t9, Pker.Lc83a.
Qap-1105- 0-07.6
Parcel Identification Number (PIN)
As owner of the above described property, I acknowledge that a Private On-site Wastewater Treatment System (POWTS) serving the
primary residence is sized fora bedroom(s) with a design wastewater flow ofallons/day (DWF is based on 150 gpd /bedroom @ 2
persons per bedroom). A maximum of& occupants are permitted; if the number of occupants exceeds the maximum for POWTS
design, the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to
prematum failure. An accessory structure NOT to be used as a 2' dwelling has been connected to the POWTS via Private Interceptor
Main Sewer (DIMS) in compliance with SPS 382.30(12). I understand that disclosure of this information will be made to any parties
interested in purchasing this property in the future.
105
Dated this day of (A L 7 2,0 1
AUTHENTICATION ACKNOWLEDGMENT
'Signature(s) STATE OF WISCONSIN )
)ss-
St. Croix Countv )
authenticated this day of rsonally came fore me this fday of
(Y) the above named
TITLE: MEMBER STATE BAR OF WISCONSIN wn to
(If not, person(s) who executed the fo
edge the same. *
Authorized by § 706.06, Wis. Stats.) wl PETERSON
THIS INSTRUMENT WAS DRAFTED BY \ V
(Signatures may be authenticated Or aclmowledged Both are Notary Public, State of Wisconsin
not necessary.) my p 4i permanent. If not, state expiration date:
Date: A
"THIS PAGE 1S PART OF THIS LEGAL DOCUM ST - DO NOT REMOVE"
77as it formation must be completed by subminer: document tale. noose d return address. and E (if requiriedl. Other imformation such as the granting
classes. legal description, etc. mm, be placed on this fast page of the document or may be placed cur additional pages of the document. Note: Use o this
cover page adds one page to your document and 12.00 to the =end= fee Wisconsin Statutes. 5q.43.
i
St Croix County 1068089 Page 1 of 1
Wisconsin Departrnent of Safety and Professional Services Page 1 of 2
Division of Industry Services
SOIL EVALUATION REPORT
i
In accordance with SPS 385, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Croix
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel LD.
scale or dimensions, north arrow, and location and distance to nearest road. 020-1105-1 7 Ref #2489
Please print all information. Reviewed Dat
Personal information you provide may be used for seconds purposes Law, s. 15.04 1 m .
Property Owner Property Location
Kirk & Lisa Nelson Govt. Lot SE SW % S T 30 20 E (or) W
Property Owner's Mailing Address Lot # Block # Sub d. N &e or CSM#
615 Northern Lights Tr. 03 na CSM Vol. 19, P g. 4872
City State Zip Code Phone Number City ❑ Village ® Town Nearest Road
Hudson WI 54016 651 717-5977 Hudson Gilbert Rd.
0 New Construction Use: ® Residential / Numberof bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe: 4 ?j, e
Parent material Glacial Outwash Flood Plan elevation if applicable na ft.
General comments and recommendations: Evaluation completed to determine soil suitability to allow connection of accessory building restroom facility to
existing residential POWfS drywells. Bottom of DWW1 = 88.58', bottom of DW#2 = 88.65', bottom of DW#3 = 88.76'.
1 I Boring # ❑ Boring
t__1 ® Pit Ground surface elev. 95.79 ft. Depth to limiting factor 127" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
'Eff#1 'Eff#2 _
1 0-12 10yr3/3 & 5/4 none Ifs fill 2fgr mvfr di Ifmc 0.0 0.0
2 12-34 10yr3/4 none Ifs Osg ml cw 1fmc 0.5 1.0
3 34-53 1Oyr4/4 none Ifs Osg ml cw lira 0.5 1.0
4 53-62 7.5yr4/6 none ffs Osg ml cw 1frn 0.5 11.0
5 62-86 7.5yr4/4 none fsl 2msbk mvfr cw 1fm 0.4 E.8
6 86-127 10yr4/6 none Ifs Osg ml cw If 0.5 1.0
7 127-148 10yr4/4 c2d 7.5yr4/4 Ifs & fsl Osg &I msbk ml & mvfr - - 0.2 0.6
I I Boring # ❑ Boring
L_I ~ao
4 Wr %6'L- El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Descriptio Texture Structure Consistence Boundary Rocts GPD/Fe
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 5 220 La d TSS > s 150 m !L " Effluent #2 = BOD, > 30:5 220 nV& and TSS > 30:5 150 mg/L
CST Name (Please Print) natur CST Number
James K. Thompson 30021
Address ate Evaluation Conduct Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020-5413 September 26, 2017 715 248-7767
SBD-8330 (R04/15)
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