HomeMy WebLinkAbout026-1115-10-000 (2)
Wisccnsin Department of Commerce PRIVATE SEWAGE SYSTEM Ceunry: St. Croix
safety and Bluloiry Division
INSPECTION REPORT santaiyPer nut No
(ATTACII 10 PFRMIT) 607001
GENERAL INFORMATION stale Plan ID No
persmal intnrmation yVU Pravide dray be used for secondary purposes [Privacy Law•, s. 15.a4 1' iirn}I
Pceer IlUde- s Name City Village 1ovn$Nr. Parcel tax No
Russell & Christina Patten TOWN OF RICHMOND 026-1115-10-000
CSI HM Flev
I 1100 Insp. BM Lev B10 Descent on p secennonwroRange-Vap No.
65 J11 01.30.18.663
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS 1-1 FV.
Septic r 5 /OO Benchmark /00
3zo At 15 l : dz /.55 101.5
r ! ! Bldg. Sewer L r
F;I p
L 7 L ut
PC)L~j
Holding _ St/Ht Inlet I
TANK SETBACK INFORMATION SUM OUllet 9 7 ~(w
LANK TO P!L WELL BI em Air Intake ROAD Dt Inlet , r 97
IF zo, Y
Septic Dt Bottom
g /7 56' ~3 I r- Ileadcr!Man ir. VZ q7 43
Aeration Uis! Pipe
/S s.c,z 97•L3
Holding Rot System a~
7.25 (o s
Final Grade
PUMPISIPHON INFORMATION V
Manufacturer Deem~tand St Cov r ~ , 3 /r7 r
/UE7 )
Model Number
TDH C Fdcbon Loss Sys TDH F
-
Forcemain I myth Did. Dist. to We 'I
SOIL ABSORPTION SYSTEM
BEDRRENCH 5Vtl1•r Lcnytb No. UI Ileech os. PIT DIMENSIONS Nn Of Pits lusce Ura Liquid DepP.
DIMENSIONS ~O a7 - `_I', ~
SETBACK SYSTEM TO PfL BLDG JWFFIII' LAKC!STREAM I. EACHING Man~la;lufor
INFORMATION 1 (~/I CHAMBER OR Z
TrCrD yW eQ./~~rr7 xna I q UNIT I.todrl Namt:er
DISTRIBUTION SYSTEM G 4- (0 f- = / V 441
❑cador:MamlMd/ f I Disuihulun X Hclc Szc x Hcle Soactr•y Vent so Air Intake
PiPe(sj ✓ A-
I ergth U. a 1 engh_ Din - Spac...9
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Dep1h Over DijoW Over xx Depih of xx. SeedeoiSnodetl xx Mal train
Be:1.TC^.t0 Genler ( < Bcd•Trc icn EUycs Topso ~y No s No
COMMENTS: (includes code discrepencies, persons present, etc.) Inspection #1 Inspection #2:
Location: 14361/6711 AVE GKO.J hoJL-6Jbr"
1. AN BM Descr tion _ t
4 , n54t~G
V~
2J Bldg sewer length _
- amount of cover = t~
Plan revision Required? Yes X No I2- ZV I G ?3q7
Use other side for additional mfounahon. _
Dale Irsepcier'. i... Gen No.
SBU-5/f a (R 3'97)
- County
Safi - and Buildings Division llri~'
;1@ `1 201 VY Vs'eshlnator. Ave.. P.O. Box 7152 Sam, -.truu. N Wuoc (it, be filled Ln by C:.)
e`t ps ~v Ivladisorl, Q 53707-7162
zw 66-7061
Sanitary-Pemit Application J Y ~ Sate Trani mr: ba
in axord,nc:c wile SPS F, 211 0A''i._4dm :4111t, Wbu wo of this fn .nuTuty: _
L iwmrcc onw to orimmutg is saruw. pemue Notc. Apnlmamr form: fm smu-owatcc WoA7S arc submitted to Not= Aaamss ldctSr^r. than mailing addressi
toe flcp+mswns: n Sateq' arse Proiesswrnl Srromes ner I::al mformmon you provior nmy to usrt fo• seavndwy
:nun.,M it a:•coraenec m1th the tic m. I.aw . I m . Sta¢_
1. Application I formation Plcasr it :\I, information - r _4 l(/ I { u~J a"vN
Yropcrn c o-'': Vold ' t i.~ Parx;o
Pmpern Ouom'7s N'f/ai:atg Adarm Pro_.~m I=mon G 1 , 3 U p la la S :
GovL Lot
Zip C.ck Phox Nttmt:rr Section L
(:try, State
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IL'lvpc of Building Ichrck all that app)y) Lag
SUVd)4u""IOL
or 1 pmuly Lhsnl:¢mg Noatbcr of Rcarwm Nm.
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Li PtL.IICtl am9CK):d DC5C:1~a I~aC ~ l_ Ltt)ot
`•rdiagf Oe
❑ Scat Owned - Describe Lse CS.MNurnDr: L
~j Town of
ICI. Type of Perrin[: (Check on one box on line A. Complete line B if apphcablel
A.
[I Sm Systm Rcplarnmear S_.strma 7rz:am~cno3nld:ne :uu. Rcmlmxn.cw O ON, 0yer ModLficabon to hxisung System Icxalamni
li R. [ Pe.mi: Rcncwa Peumr Remim C (inner .(?lumber 7 Peon 7r nfcr m New Lie Prn•mnu. Permit N:an*(7/q ud ate Issued
Below xpaanor. Owner !71/4 49Z
[\•.'LYpa otRPli"FC S3'sEerdComDanrnt7>cvicr. (Check all that applvl l J
~NUm-Plcssutncd In-Ground L'17V:.:uriicd ir-Grnurld ~ At-i:.'adc _ )dn.n~_ 2t in otsuni~lc sal - IrSotcmd in u_ surulble sod
m r ar f"CffiGz>sp -1 C.mpo:r:r lrs{~;:aril [Prntrcauncnl'kvicc icxpitaw
Dispersal.Trcal enl Area Information
Uc-i,2 Pow (f.l* I / Dcster. Soil Apllic:aiol f aei,yfld::`? Dlvpcai Arco ltc4ui%rc all Dlsx:sal Ana }toposed' 'System ovation
6 ~C7 / i 7 ~fl \T. Tank Info C'4.; 11 In "otal 8 of A4ami:Bcmra _
Galiu Cniin:cc I:mm
New :auks i~nmme'alirs Po lei - c _ _
v. z; rn .a. O
Srntiamlinl6mE':avi ~ ~l'r / ~ ~l lt/CC~~
7acn£ c snlba
\71. kesponsibilit) Statement- 1, the umderst`ued. assume r"P.msihilih for Stall atioo ofthe POa'7lishown om the atw-hed plum.
Piuana's. Namr TInCI Y4k t--'s St~y,ylue AfPTEPRS Numha Redrmess Phanc 1:Ton&r
15tunbrl3 A"sress (Sweet Cip. Stale. l.ip Codc)
J'2/~ lei Cc~ 1-7 .i'
ountv7De artment Use Only
Yermr. .:r Diu. I suet lss:dn -nit Slitnawre
ApprameG sap f
Ciw.c - ~vcn Reason lur Lis list T a oc:>
LX, C-ondidt, i Mcasns for Disapproval
1. Sepf^ lark,.tic-~: n I
u'.._,e II r'LS: ell be r Ic s ...-',ttz : ec
4s per,aar.3yemen' p.s c o'lue't Lv ~jiu,nbe..
2. AI iseftgt;l( ft!ClN9~."P.OcS rmnil LC 1:ic: If E
so ptr PWAGr6h p16! l,rd wlr7rf.
Ataeb m eumptete ph'i` Im the o. and Pl bunt m the C.,, oN! m pater not hz than 8 L: a 11 mrbn m see
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Patton replacment
Owner's Name: Russ Patten
Owner's Address: 1436 176th ave
New Richmond Wi
Legal Description: SF 1!'4 NV4' 1!4 S 1 T30 R18 W
Township. RICHMOND
County: ST CROIX
Subdivision Name: WILLOW RIVER MEADOWS
Lot Number: 1 I
Parcel ID Number: 026-1 1 15-14-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 _ Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: PAUL R KOEHLER License Number: 225410
Date: 12119;2018 Phone Number (715) 246-2660
Signature
Designed pursuant to the in-Ground Soil Absorption Component Manual for POwrS version 2.0 S80-10705-P (N.01/01)
Page 1
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SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-
-of--Project Name: RUSS PATTEN
3 No. of Cells 6 Per Cell
3 ft Cell Width 18 Total No of H -1 0F1
60 ft Cell Length 300 sq it EISA Per Cell
3 r Cell Spacing 900 sq ft Total EISA
Manufacturer Modal La In Length EISA Rating
L Infitrato, EZ1203H-5ft 5.0' 25.0
FZ1203H 10ft 10,0' 50.0
Graveness Leaching Unit Manufacturer: INFILTRATOR
Graveless Leaching Unit Model: EZ 1203 H -10 FT.
Typical Cross Section
Finished Grade 98.8 ft
Observation Pipe with
approved cap or vent
n
Soil Backfill
L7 In
Geotextile Fabric
W
ft Infiltrative Surface
12 in 1 0 f
{ / . Limiting Factor
16 in I Slotted and Anchored Vent/
y Observation Pipe with Cap
Plumber/Designer Signature:
Licenses: 225410 Date: 12/20/2018
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page? of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner RUSS PATTEN Septic Tank Capacity 1000/320 al O NA
Permit k Septic `ank Manufacturer WEEK$ SERNA
DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOCK C NA
Number of Bedrooms 4 0 NA Effluent Filter Model
525 DNA
Number of Public Facility Units
V, NA Pump Tank Capacity al X NA
Estimated flow (average) 450 aliday Pump Tank Manufacturer X NA
Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer JQ NA
Soil Application Rate .7 gal/day/l`12 Pump Model (X NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit C NA
Fats, Oil & Grease (FOG) 530 mg,L C Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BODr) 5220 mg/L D NA O Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA
Biochemical Oxygen Demand (BOO,) S30 mg/L X In-Ground (gravity) O In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L 0 NA C At-Grade 0 Mound
Focal Coliform Igeometric mean) . S10` cfu/100ml C Drip-Line 0 Other:
Maximum Effluent Particle Size ye in dis. 0 NA Other: 0 NA
Other. C NA Other: 0 NA
'Values typical for domestic wastewater and septic tank effluunt. Other: 0 NA
MAINTENANCE SCHEDULE
Service Evert Service Frequency
Inspect condition of tank(s) At least once every: 3 0 month(s)
Z year(al (Maximum 3 Years) p NA
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume 0 NA
Inspect dispersal cell(s) At least once eve Gl monthlsl
3 F9 mono year(s) (Maximum 3 years) 0 NA
Clean effluent filter At least once every: 1 a l 0 month(s) ~
13 NA
year(s)
Inspect pump, pump controls & alarm At least once every: 0 monthls)
)j NA
D yearsl
Flush laterals and pressure test At least once every: 11 month(s) X NA
O yearls)
Other: At least once eve 0 month(s) -
C year(s) Q!'I NA
Omer.
RI NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Piumber, 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 combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cellls) 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 Iota' 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 the 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, and any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided tc 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 o` the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a soptage 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 be
discharged to the dispersal cell(sl 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 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, or otherwise disturb or compact, the area
withir. 15 feet down slope of any mound or at-grade 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; cigarotte butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain Isump pump) water;, fruit and vegetable peelings; gasoline; grease; herbicides; meat 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 shall be taken to insure that the system is
oroperly and safely 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 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 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 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 need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POI&I
technology a holding tank may be installed as a last resort to replace the failed POWTS.
aloe i o mg tank
IV~ T
rllS I11111:1 all a Ii! be a aue ~/ZDF/11SITQ~ ~oiQ~JEW Co"STRUC-71
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of suott systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AI I INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name COUNTRYSIDE PLUMBING Name PAUL R KOEHLER
Prone 715-246-2660 L Phone I 715-246-2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name POWER SEPTIC SERVICE Name sT ~t I p L 20A t
Phone _ Phone ~(ORID
~jf
lids rise ument was orahxc in campiiance whn chapter Comm 83.2212)(SI(1)ldl&IfI and 83.54111. f2i & (3). Wisconsin Administrative Code.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 1436 176TH AVE NEW RICHMOND WI located
at: SE /4, NW /4, Section 1 Town 30 N, Range 18 W,
Town of RICHMOND St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yesx No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1000
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): WEEKS
Age of Tank (if known): 22
Permit number (if known) 171449
PAUL R KOEHLER
(Licensed Plumber Signature) (Print Name)
MASTER PLUMBER MP 225410
(Title) (License Number) MP'MPRS
12/19/2018
(Date)
Forn1 to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 1 13 Wisconsin Administrative Code)
Rev. 212012
1.00' S try ~
13
~S 2d0 00 E
.00
95,031 SO. FT.
2.18 ACRES
Js j
3q,
22
i9 e3 \
3q.
S89°25' 52"W 361.13'
(o 161.13' 200.00'
3
87, 325 SO. FT. OD
2.00 ACRES 0 rn
~ M
Z
O1
87, 247 SO. FT. N
CP)
2,00 ACRES o ~O
2 v 12
~
87,422 SO. FT.
2.01 ACRES
- 214,00' 135.29'
555.29' O . \ \
S340 50'00"E
50.00'
~ 00
` . A9 • 00
00
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Ow.ner:Buycr RUSS PATTEN
Mailing Address 1436 176TH AVE
Property Address 1436 176TH AVE
(Verification required from Planning k Zoning Department for new construction.)
NEW RICHMOND WI 026-1115-10-000
City'State _ Parcel Identification Number
LEGAL DESCRIPTION
Property Location SE'i,,NW '/4,Sec. 1 T30 NR18 W, Town of RICHMOND
Subdivision Plal:WILLOW RIVER MEADOWS Lot # 11
Certified Survey Map # Volume _ Page #
Warranty Deed # _ (before 2007)Volume Page
Spec house 0yes0to I,ot lines tdenliliable❑ycs❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failtuc to handle wastes. Proper
maintenance consists ol'pumping out the septic tank every, three years or sooner, if needed, by a licensed pumper. What you put into
the svstertt can affect the Junction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 393).52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning h 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 necessaryj, the septic lank is
less than 13 full of sludge.
I/wc, 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 Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. C'erlification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning R Zoning Department within 30 days of the three year expiration date.
I;we certify' that all statements this form are true to the best of my lour knowledge. Iwe anv'are the owner(s) of the
property described above, by virtue of warranty deed recorded in Register of Deeds Office.
Number of bedro s 4
12 19 2018
SIGNATLIRE OF A JCANT(S) DATE
"`Any information that is misrepresented may result in the sanitary permit being revoked by the Planning K Zoning Department.
Include with this application a recorded warranty decd from the Register of Deeds Office and a copy ofthe certified survey map if
reference is made in the warranty deed.
(REV. 04112)
y 1 / r
Wis. Dept. of Safety and P~D*sional Services SOIL VALUATION REPORT 3
Division of Safety and Bmldrngs Page of
in accordance with SPS 385. Wis. Adm. Code
Attach complete site planar µfper-not less than 8 112 x 11 inches in sire. Plan must County ST CROIX
include, but not united to. vertical ana horizontal reference point (BM), direction and Parcel I,D_ 026-1115-10-0()()
percent slope, scale or dimensions, north arrow, and locatron and dstance to nearest road.
Please print all information. Re by Date
Pe: sunal n'om.1 e, ye:~ provide may be used Im 5aconde-y y,MoSe5 (Privacy law, s. 15.04 i l i Im 1212:2018
n ZI
Property Owner Property Location
RUSSPAITEN ~
Govt. Lot SE 114 N%% IM S T 10( R 18E (orJW❑
Property Owners Mailing Address Lot # Block # Subd. Name or C 91M
1436 176TH A\`E
1 I.j;qo~ Q:✓c.. enNe
City State Zip Code Phone Number ity Village own Nearest Road
NE AN RICHMOND Wf 54017
New Construction UseEj Residential: Number of bedrooms 4 _ Code derived design now rate GPD
600
0 Replacement Public or commercial - Describe;
Parent material _ Flood Plain elevation if applicable ry.
General comments SF°I' THE BO'I'f0M OI: '1'RENC'11 APPROX 40 " DEEP AT THE 86 INCH MARK SAND STONE OR SHALE
and recommendations. START 'FO APPEAR.
I❑ Boring # 11 Boring
❑ Pit Ground surface elev, 9226 _ fL Depth to limiting factor MR( b6 iSoil lica0on Rate
Horizon Depth Dominant Color Redox Description Texture Structure GP/h
in. Munsell Our Sz. Coml. Color Gr. Sz. Shf #l 0#2
A 0-12 10YR32 SIL 2MABK B 12-28 7.5YR 4+4 SICL 3MARK 4 .6
C 2840 7.5YR56 7 1.6
CI 4( 8 10YR6!4 USG 1.6
S'
F "I Boring # Boring r 92.85 8(i
pt Ground surface elev N. Depth to limiting factor _ in.
Soil ADDliCatil
Ratc
Horizon I Depth Dominant Color Redox Description Texture Structure onslstence oundary Roots GPD/n '
in. Munsoll Ou. Sz. Cont. Color Gr. Sz. Sh, ff#1 ff#2
0-12 IOYR 3.'2 SIL 2\f.ABK \1PR C'S IF
6 .8
B 12-24 7.51'R4;4 - SICI, SMABK MFI C'S I\'F 4 .6
C 24-10 7.51'R5 ,I -
LS USG \1\'FR C'S L6
Cl 4 - ~ 10 YR C> 4 S OS(' Ml. C'S
1.6
5
Effluent #1 = BOD > 30 < 220 m91 and T . >30 < 150 m94 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 rrgil
CST Name (Please Print) Sionature CST Number
PAUL R KOEHLER KIP225410
Address Date Evaluation Conducted Telephone Number
321 WISCONSIN DRIVE NEW RICHMOND WI 12:`1212018 715-246-2660
SBD X130 (RI I +I I I
Properly Omer ILUSS PATTEN Parcel ID 026-1115-10-000 Page ? of 3
-11-3t Bonne# ring yA_R.S Aft
Q Pit Ground surface elev. R. Depth to limiting factor rtl.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPDM >
in. Mansell Ou. Sz. Cont. Color Gr. Sz. Sh.
' Mill f#72
A 0-12 10YR3;'2 SII. 2M.ABK MFR CS IF .6 A
B 12-29 7.5YR4.~4 SICL 3NfABK MFI CS 1\T .4 ti
C 2840 7.5YRS!h LS I'S \f\'I'R CS - ' 1.6
C-1 40- 86 10YR6r'4 S S A11. CS .7 1.6
I
I ~ 1
F] Boring # Bonne
B Pit Ground surface elev PIP, v
Depth to limiting factor in.
Soil ADDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDlft '
in. Mansell Ou. Sz. Cent- Color Gr. Sz. Sh. ##1 ft#2
❑ Boring # Boring
P t Ground surface elev. ft. Depth to limiting factor in.
Soil Aonlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence unitary Roots GPDfft
in, Mansell Ou. Sz. Cont.Color Gr. Sz, Sh. If#1 ff#2
Efthtenl #1 = SOD , > 30 < 220 mg1 and TSS >30 < 150 mgt ' Effluent #2 = BOD 30 mgrL and TSS < 30 mg.'L
The Dept. of Safely and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate formal, contact the department at 608-266-3151 or TTY through Relay.
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