HomeMy WebLinkAbout020-1466-21-050
m~e~:nsio:lop::nm..eriefcc--erce PRIVATE SEWAGE SYSTEM C.t..nty. St. Croix
Salcty anc till. 11-a Civisicn
INSPECTION REPORT SanaaryPer- INc
605154
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 10 1
Pe-sonal ie`ctmaaon you ple'etee maybe by `c'secorday oar oses (Pr yacy '-m. S 1:0 34 (Ijimil. 3150001
-1p" t -iolder's l C ly Vi gage Tannsh p Pa'cel Tax No.
David Maas TOWN OF HUDSON 020-1466-21-050
C,S I BM E ev 1 1 I- S5. IW E eY BI'l f.eSCI[:e on SEL40N l cvm., Range Map NC.
5,fo, Ili l 27.29.19.2983B
TANK INFORMATION E VATION DATA
EK,al MANUFACTURER ~•.i< CAPACITY STATION BS III FS ELEV.
Benchmark
~ F tv z. 8 z ~o lez i ~
c An l 3.57 • / 3
Bldg Sewo
G.7 9~-
ong SGHI Inlet -7 l G~j S
~S.
TANK SETBACK INFORMATION SuHt Out'et 7 14 ZS
TANK TO l 'v,El BLDG. 1-2 t An I-• Ike ROAD DI IFlet
Sep- .c 23 / 5 / g _ of Bottom \
136 -
Losing Headedtlan
Aeravon Dist. Pipe /tj . 1 Z
Hold rg Bot. Sys!em ll. 6 q
Final Grade
PUMPISIPHON INFORMATION g' O
I'll nufactl.rel Demand St Cover/ I 3. S'7 +3
Mcoel Number 4'" - -
TDH l Frichcn Loss S•st ITCH F:
rorcemain Lergth Da D, r,. to'Wel _
SOIL ABSORPTION SYSTEM
BEDrTRENCH ',V M1 Len;t^ No O`Tro whes PIT DIMENSLONS No. Ot Inside Dia. Liquic Depth
DIMENSIONS 3 S 1 Tl~l
SETBACK SYSTEM TO P.1 BLDG WELL I LAKEISTREAM LEACHING tlanatac'ry,`
INFORMATION CHAMBER OR nY1 a~~
NUrnofj.~ LAC
Type Of S)51lrrt 3, UNIT ii
j /14
Co n tG e 1 LaJ r / w
DISTRIBUTION SYSTEM 1.3 n.
Iluader~h`2r tole 1l I`~<I•ih~.l on x HIle Size Ix ltctr spa, ng vent to Art_Int/ake
LengP ~ nie • Lc r;1:r Cia spj ln9 _
SOIL COVER x Pressure Systotns Only xx Mound Or At-Grade Systems only ill o' 150
Deplh Cver DuoPr Oycr xx Deatn J' xx Seedcd: SOdCee xx NLlched
Bee,treocr Certer eedfTrcnch Edges Ie'.:uml 1 __Ye-1 Nd Yes No
COMMENTS: ill code disc•epenc.es, persons preserf etc j Inspection#1 Inspection #2:
Location: 752 EXCHANGE pFYI. ~_e~ `-"ACM r r^OH"a to
1 1 All DM Descnpt cr = f/^ /
2.i Bldg sever length =
- amount of cover = / g O.^- Gt1lAV J Q~~,~yl7
Plan revision Required? Yes NJ<`No I Z f - g _ (71.1 / •I~
Use other side for additional intorTaUCn. _ _ _
Dale I-seF=1c"s rgracwe Ce-I No
S .1: ~L{ sgw s OR Fro
Indushy Services Division
' ~lg Px ~ ; U 2019 1400 F Wnshing;on Ave Sawary Permit Numbcr (to be lillr•' Iu by CO
:r P 0 Box 7162
Madison, Nn 53707-7162
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,c L'on dittonall}~ DIVISION OF INDUSTRY SERVICES
APPROVED 2331 SAN LUIS PI. STE 150
DEPT. OF SAFETY AND PROFESSIONAL GREEN HAY WI 54304-5211
S SERVICES Contact Through Relay
PS DIVISION OF INDUSTRY SERVICES htIp:Ildsps m gov/programs;Industry-services
wwwwisconsul gov
f/.GI/I 7/oCYl.6,~ Scot Walker, Governor
Laura Guti6rrez, Secretary
SEE CORRESPONDENCE
August 27, 2018
C'l IS1- ID No. 139,162 A7T.V: POWTk; Inspector
TODD L. SIN/ ZONING OFFICE.
'1'I, SINZ PLUMBING INC S'1' CROIX COUNTY SPIA
1.5609708'111 AVE 1101 CARMICIL I-1. RD
NIF\OMONIF. WI 54751-5520 IIIA)SON %VI 54016-7708
CONDI'I ZONAL APPROVAL - -
PLAN APPROVAL EXPIRES: 08/27/2020 r- Identification Number,
r Transaction ID No. 3150001
SI'I L: Site ID No. 853169
Please refer to both identification numbers,
Maxchange Drive above, in all correspondence with the agency.
752 Town o1' I ludson
St Croix County
N L I /4. N \V U4, S27, T29N, R MV
FOR:
Description: Gravity In-Ground (Employees & rloor Drains)
Object type: POWI S Component Manual Regulated Object ID No, 171) t(),';
Maintenance required; 368 CPD Flow rate; 115 in Soil minimum depth to Iimiling factor from original grade;
Systengs): In-ground POW'TS Component - Ver. 2.0, SBD-10705-P (N.01!01, R. 10+'12); Commercial System, I-:ftLtent
Piltcr
I he submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDI'T'IONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above.The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Depium ent per s. 1,15.06,
slats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and during construction to avoid (1kanhance, compaction and use of the site.
• With new construction; it is recommended not to activate the pump in (tic duce tank until the tanks are
pumped prior to homeowner occupancy.
• NVastevyaler generated front contractors cleaning of equipment and tools an([ (it left over construction
products shall not be discharged into the drains discharging to the private onsite wastewater treatment system
LI A, I S). Waste generated shall be properly disposed of on-site or off site.
• Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches
below the system elevation. Smearing and compacting of wet soil will result in reducing the infiltration capacity
of the soil. Proper coil muislurc content can he determined by redline a soil sample between the hands. If it rolls
into a I r4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too
wet to prepare, do not proceed until it dries.
• Divert surface water from POW'I'S Area.
• All piping shall conform to SPS fable 384.30- ; and SPS I able 184.30-5
• Insulate building sewer beyond 10 feet per SPS 382.:10 ( I I lie)
TODD I. SIN7. Page 2 8+27,'2018
• Wank Installation to fellow all manufacture's recommendations.
• Verify properly line(s) prior to installation.
Owner Responsibilities
• 1 he current owner. and each subsequent owner. shall receive a copy of this letter including inslructionv relating
to proper use and maintenance ofthe system. owners shall receive a copy of the appropriate operation and
maintenance manual and+'or owner's manual for the POM N described in this approval SPS 383.53(1).
• In the event this ;nil absorption system or any of its component parts malfunctions so as to create a health
h mard, the property owner must follow the contingency plan as described in the approved plans.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by aulhorired representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construcl ionr'instal lation.'operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats Ill l .12(2), nothing in this review
shall relieve the designer of the responsibility for designing a sale building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POW'I'S management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely- Fee Required S 250.(14)
This Amount Will Be Invoiced.
When You Receive That Invoice,
Please Include a Copy With Your
I nl Vander Lccsl Payment Submittal.
Private Sewage Plan Reviewer, Division of Industry Scrv ices WiSM.A R'I' code: 762
(608)516-61 34 , Mon- Fri. 6:00 a.m. - 1:30 p.m.
ilri inau1-ud., ni. 01
cc: hdwin A Taylor. Waste"ater Specialist, (715) 634-;484, Mon-}i. 8:00 N.M. - 4:30 PM.
Cond+unall~
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
D IVI$ION OF INDUSTRY SFRVICFS
m 97.d, A1111
SEE CORRESPONDFNCE
Construction Materials K Techniques
SPS 384
All materials must comply with 6DrmmwU and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manual:
In-ground Absorption (v, 2.0) SBD 10705- P
Location: NE 1,4 SWI I S27'I29NR19W
Town of I ludson
County: St Croix
Date: 8-16-2018
Owner: David Maas
Address: 5115 Starfish Ave
Naples F1 34103
Plumber: Todd Si Awt,
Signature:
U
License N MP 139462
Attachments: 6748 Plan Approval Application
SPS 381-385
Page 1: Cover
2: Design criteria and sizing
3: Plot plan 6: Effuent Filter
4: Plan view!system cross section 7 :Owners Manual
5: Septic Tank 8: Management Plan
`l
Page 1 of 7
Design Criteria
Yes Wastewater Contaminant Load: 30 ingi1. < BODS _ 220 me,/L
Anticipated septic tank effluent 30 mgiL < TSS - 150 mg].
Fecal Coliform > 10,000 cfu1100 ml,
Fats, oils, grease S 30 mg1l.
15 FTE 15 x 13 x 1.5 = 292.5 gallonsiday
2 Floor Drains 25 x 2 x 1.5 = 75 gallons'day
Min.Design Flow = 367.5 gallons/day
Drainfield Design Flow = 367.5 Gallons/day
Design Calculations
In situ designed loading rate 367.5 gallons/sq. it. pcr day
Depth to estimate high ground water >120 in.
Depth to bedrock >120 in.
Cross slope at system Flat%
Septic tank Huffcutt 800 gallons
New Effluent filter Lifetime IM/8
Septic Tank Sizing And Liftstation.
Minimum septic tank size required for 3 years service frequency is 767 gallons by spreadsheet
Calculation; Using Huffcutt 800 gallon septic tank. .
Trench Sizing
367.5 gpd/.7 per sq fl = 525 sq. ft minimum effective area for medium sands
Install 26 infiltrator, Quick 4-W shells which (r;; 20 sq. ft each EISA plus 2 x 5.8 sq ft for it pair
of end caps gives 531.6sq ft EISA. System loading rate is 307.5 gpd ;'531.6 sy ft =.691 gpd per
sq. ft.
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Soil Absorption System Cross Section
ft
ft
4' Schedule 40 Final Grade
PVC Vent Pipe
With Vent Can ft
f- _ ft
System Elevation
~ft
1
Soil Absorption System Plan View
i v
ft
_ft Leaching Trench 1
Chambers
19 4' Dia.
Trench 2 Header
i Vent Or Observation Rue _ - -
Leaching Chamber Specifications
Manufacturer And Model
EISA Rating "t sq ft per chamber Soil Application Rate gpd(sq ft
gpd Design Flow+ = Soil Application Rate + ;7 EISA = -6 Chambers
;t rows of chambers each.
51 4" M~
Page ` 4 of '
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The Best Just Got Better
T
Vfib7MrR#WM
The most efficient, the lowest
maintenance, the most economical
effluent filter!
• Nearly Twice the Filtering Capacity •
f • Estimated to go 3 Times •
Longer Between Cleanings
2' • Cleaning Made Easy •
• Does Not Retain Solids Between Plates •
• Lowest Price •
- Eliminates the collection of solids inside the cartridge.
- Nearly twice the filtering capacity of any other filter.
0 0 ~ • h~C~ ~ 0
- By eliminating solids between plates
drastically reduces the need to clean.
- Cleaning made simple and efficient. r
0
LT 1/8: 3500 GPD/Residential Strength
Filtration 1/8"
- LT- 1/16: 3350 GPD/ Residential Strength
Filtration 1/1611
- LT - 1/32: 3000 GPD/ Recommended for Commercial use with Residential
Strength - Filtration 1/32" ~~b
- LT - 1/64: 2500 GPD/Recommended for Commercial usage with Residential
Strength - Filtration 1/64"
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity U al O NA
/ r
Permit p Septic Tank Manufacturer 1-7' O NA
DESIGN PARAMETERS Effluent Filter Manufacturer/_; ,11l 7-/ ❑ NA
Number of Bedrooms Effluent Filter Model LTJ O NA
Number of Public. Facility Units 0 NA Pump Tank Capacity _ T al '$*A
Estimated flow (average( 4S79allday Pump Tank Manufacturer -44-NA
Design flow (peak). (Estimated x 1.51 3~ I pl/da,lr Manufacturer -8*A
Soil Application Rate a al)da !it` Pump Model 4$-AA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 4"A
Fats, Oil & Grease (FOG} S30 m9A 0 Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand IBODst 5220 mg/L 0 NA 0 Mechanical Aeration O Wetland
Total Suspended Solids ITSS) 5150 mg(L ❑ Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Cellist O NA
Biochemical Oxygen Demand 1800,) s30 mg/L ,.1&fnGround Igravity) O In-Ground (pressurized)
Total Suspended Solids ITSS) 5530 mgrL U NA O At-Grade O Mound
Fecal Coliform (geometric mean) s10' cfu/t00ml O Drip-Line O Other:
Maximum Effluent Particle Size Ya in dia. 0 NA Other' v O NA
-
Other: O NA Other: O NA
'values typical (of denmsuc wastewater and sentic tank ellluect other. 0 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tankls( At least once avers: 3 _ Wyearlsl onth(s) (Maximum 3 years( ❑ NA
Pump out contents of tankls) When combined sludge end scum equals one-third IY,) of tank volume O NA
Inspect dispersal call(s) At least once every: O month(,( (Maximum 3 years) ❑ NA
rrYyearls)
Clean effluent filter At leas[ once every: O month(s) figr jlj O NA
yearls)
inspect pump, pump controls & alarm At least once every: 0 y arlsj(sl NA
~ 14
Flush laterals and pressure test At least once every: O monthlsl NA
❑ yearlsf
Other At least once every: 0 month(s) NA
❑ year(s)
Other. A
MAINTENANCE INSTRUCTIONS
l:,spections of tanks and dispersal cells shall be made by an Indrwduai carrying one of the following licenses or certifications:
tsaster Plumber; Master Plumber Restricted Sewer: POINTS Inspector: YOWTS 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,
,,asure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface.
The dispersal cellist shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending
of effluent on the ground surface. The pending 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 (Y.) or more of the tank volume, the entire
conrenis of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113.
:."isconsin Administrative Code.
other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
riois, and any servicing at intervals of 512 months. shall be performed by a certified POWTS Maintainer.
A cvr w. sport shall be provided w the local r. gulator, authority within 10 days of completion of any scrvire overt-
_ of
, STARTUP AND OPERATION Page
For new construction, prior to use of the POINTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process andfor darnage the soil dispersal cell(s). If high concentrations are
detected have the contents of the 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
Outing extended power outages pump tanks may fill above normal ntghwater IevalS, When power rs restored the excess wastewater will
be discharged to the dispersal celgs) in one large dose and may overload them resulting in the backup of 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 the
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 cells, Do not drive or park over, of otherwise disturb or compact, the area within
11 feel down slope of any mound or at-gfade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics: baby wipes, cigarette butts, condoms. cotton swabs; cegreasers- dental floss; diapers, disinfectants; fat: foundation drain
(sump pump) discharge; fruit and vegetable peelings. gasoline, grease; herbicides, rneal scraps, medications; oil, painting products.
pesticides; sanitary napkins; tampons. and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps she" be taken to insure that the system is property
and safely abandoned in compliance with chapter SPS 383.33. Wisconsin Administrative Code:
a All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil.
gravel or another inert solid material.
CONTINGENCY PLAN
if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a
sAnitaDr permit for a code compliant replacement system:
A 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 riot 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 need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at the time of their permit issuance
-
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locale a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POINTS.
❑ Mound and at-grade soil absorption systems (nay be reconstructed in place following removal of the biomat at the Infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT
OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY
CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY
DIFFICULT.
ADDITIONAL INFORMATION:
POWTS INSTALLER POWTS MAINTAINER
b-
Name.: ~~L-~i1•-L L/vj~'.//.~" !%a~ Name.
Phone: Phone- w-.!
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name: ~O
Name. >T !_"~/O,
r
X71 Y
Phone: c-/~ Phone -71S-" Sa - t?~L/nU
This document is intended to meet minimum requirements of Ch. SPS 383.?2t2)(b)(1)(dj&(t) and 38354(1). (2) 8 (3). Vdrsconsin Administrative Code. Use
of INS document dos not guarantee the penounance of the vow/ S 1/1~ (Rev. 313)
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ST. CROIX COUNTY
c G!'FIC TANK M AIN'TEN.NNCE AGREEMENT
AND
oWNERSHIP CERTIFICATION FORM
Owncr. 'ftuvcr David Maas
MailingAddr ss 5115 Starfish Ave, Naples, FL 34103
Addf 752 Exchange Dr
Property
fA Vcr]lcni: r: ,,ir cd from Planning&Zon4Deut for new cn:uoucaor:.)
C'itvatate Hudson, WI Parcel Identification Nurnbcr020-1466-21-050
LEGAi. DESCRiP 1'lt)N
' . 27 29 19 hudson
Proprny Lot anion ! 5 . Sec. . I _-N R___--R , Town of
Subdiv--cioa Plat. Lo: ft Z-_ .
Certified Survey )i:y? Volume r, Page It 5
Warrant}Deed«_ (before2007)Volunte Paga;j
S-:c he ns:: ❑.,-s4n1o Lot lutes identifiable ❑yesQuo
SYSTENI NIAINTFNANCE AND OWNER CERTIFICATION
;tnp.opcr use an~, nlai;r,:aa:;cc ra yonr septic system could result in its premature failure to handle wastes Proper
claintenanc.^ consists of pumpir._ oat: tae sc;aic tank every three years or sooner, ifneeded, by a licensed pumper. Whai,,ou put iiao
i'ic syFtcol tan allect the I:ur.:t: n of tl:e iii- :ank as a treatment stage m the waste disposal system. Osoncr tnaimenancc
resnonsioilitics arc spccJcd :n ¢SPS. 353.:2:1 ) and in Chapter 1' - St. Croix C'oaniy Sanitary Ordinance.
The prupcav o<.:r.-_ suhmi: to St. Croix County Planning & Zoning Department a certification form, signed by the
o,vacr anal by a masts: I::_nbrr, :tlun:ber. restricted plumber or a hceused pumper verifying that (1) the on-site
onstewater disposal sys.en. i> ; ro;tcr;.;:cr.cing condition a,ldtor (2) after inspection and pumping (if necessary), the septic a:ix is
iess that. P3 felt of slude,-
I'NCC, tlr.: andccst^,icd I'ava read :Lc.ti:ove requiremcrti and agree to maintain the pnva-,e swage disposal system uilh the
+:::ndards set I:,rth, herein.::, srt In
di, Ucnai!ment of Safety And Professional Services and the Depanmatd of Natural Resource,
State of Wisconsin Ccc.; ii: mi :1 st::cte Hoar septic system has been rnaintairiM must be comphctcd and returned to the is 0aix
County Planning, & Zo n:n,- Depruunciv w;: ii:i 31) days of the t i cc year expiration date.
1; we ccrrify thz: all s:otar.:nr_s ;hi.. Conn arc true to dic hest of myWa knowlce.Lc .'.tine m?>•'arc the owner(sj n c:e
tropcrl N' Icscnhed Owns , b-, v::'ltc of .a P-::^ :11Y d recd:dcd in Rcft:3ter of Deeds OMcc.
Number ofbedroonis lJ
SICiNATC kL= OF A I'P LICANT(S) DATE
'Acy i:iforn?:tuwr tea: r::~n rca resch in the sarmary permit being revoked by the Planning & Zoning De,Wlmuu.
include wttl1 this app.ic:u! 'in r,:,nrdca ,:.::;:;ty deed from thu Register of Deeds Office mid a copy of the certified survey map if
N 1, V. 114121
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Willtcis Buildings O, ie Doa]plaas
C ukr 14, 1 Duty 4/311 ' P1 r 1
r\I{u ILb; ~I x:'11 Re%ind R~'hn L~ I,r Hrfl ,or .el
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Wisconsin Department of Safety and Professional! Services Page of Z
Division of Industry Services
SOIL EVAL ATION R RT
In accordance with SPS 385, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 112x 11 inches in size. Plan must include,
but not limited to: vertlcal and horizontal reference point (BM), direction and percent slope, Parcel I.D.
~
scale or dimensions, north arrow, and location and distance to nearest road. 6Z
Please print all Information. Revie d by DDa►te S
Personal information you provide maybe used for secondarv22rp2ses (Privacy Laws s_ 15.04 1 )(m)), Property Owner Property Location ❑
'r~-~ Q..O ZC 0.Q.. S - Govt. Lot A3 S R 7 A 4 R / E (or) W
Property Owner's N]ajhni~ Address Lot # Brock # Subd. Name or CSM#
City State Zip Code Phone Number ❑ city ❑ ViU a ✓1
k JgTown Nearest Road N QXbk4.S F2 j3Y 03 a
V
New Construction Use.❑ Residential /Number of bedrooms --Code derived design flow rate- GPD
❑Replacement ~Publicorcommercial - Descnbe: _ T Z
Parent material nu ao~~ _ _ " Flood Plan elevation If applicabIA-4k ft.
General comments and recommendations:
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i
LE Boring # ❑ Boring pF
® Pit Ground surface elev. I~Cft. Depth to limiting factor YZITI-1.
Soil Application Rate
Horizon Depth Dominant Color Redox Description. i Texture Structure Consistence Boundary Roots GPDIFP
In. 1 Munseil -Ou. Az. Cont. Color Gr. Sz. Sh.
•111101 'Eff#2
o-r , 3 I °aIt- 'lore--- ! s4
2-- 42 -;k?F 01 T 6.0
6-
r ii ? stR /y -'V-_ - Z~
,
1 __--I - o~,,~ -
f 1#-Boring# jin Q~
111===III PIt Ground surface elev.[) ^0 ft. Depth to :imiting factorZ/
r- - - - - Soil A lication Rate
i Horizon Depth Dominant Color Redox Description Texture Structure j Consistence Boundary Roots GPD/Fe
In. Munsell Do. Az. Cont. Color Gr. Sz. Sh. j •Eff#1 'EfNf2
O~ 45yK I -y~o ~om»,~ ~r- O-K
Io I v"_
6-Y 0.17
5-- 6 Z 5Ye- y rt S _
a- 1
~lq
Effluem #1 = BOD > 30!; 220 /La dn- TSS > 30 5 150 ma/L 'Effluent #2 = BOD > 30 S 220 moll- anA TSS > 30 s 150 ,n%(LL
CST Name (Please Print) Sig to CST Numocr
2z ~
. Address Date Eva uatlon Conduc tl / / / Telephone Number S~ o SgBD3Q30
3 Boring
Boring # w PR Ground surface elev.,-L, ft. Depth to limiting factor
Soil AvDbca Rate
Horizon Depth- I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FP
In. i Muneell , Qu. Az. Conti Color Gr. Sz. Sh. •Sff#1 •ER#2
v'JU 3/. Dr} ww~-
3 5-33 25" H O-Y 6 •'I
-Vs •5Y Y W I t o- ~d
I 3-Z~ 7-5W 17 5 f l 6
~5Y / s I Cam.
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I Bortng
! I Baring #
❑ Pit Ground surface elev. _ft. Depth to limiting factor IN_tn.
Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIF'e
In. Munson Qu. Az. Cont. Color Gr. Sz. Sh. •Eff#1 •ER#2
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I I Boring # ❑ Boring
L_J ❑ Pit Ground surface elev. _ R: Depth to limiting factor In.
~
Soo A Road Rater
Hor zon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/F?
In. Munsell Qu. Az. Cont. Color Gr. Sz Sh. •E02 EfW Effluent #1 = BOD, > 30 s 220 mglL and TSS > 30 s 160 mg1L • Effluent #2 = BOD, > 30 5 220 mglL and TSS > 305
150 mg/L
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