HomeMy WebLinkAbout026-1294-27-000
""°I"'''"`''" PRIVATE SEWAGE SYSTEM St. Croix
d.-ty :un1 Falcma Grn,
INSPECTION REPORT
607046
GENERAL INFORMATION A•T '4`''i C OF RMIT s::n-=`I:m to Na
:oua m4:° r,LU` n I:: uvr. r. -rw he v,,d fcr v, -onparv 0u ~5t`. IFrcsy :rw s 15 a4 t rn
Frrmr. tlnanrs Na, GI. .1L5ue Iaeusp¢ Parc:rl Tex r.n
Oevering Homes TOWN OF RICHMOND 026-1294-27-000
RV Fur: ns EN c ev i!td I:mbnn q;:cLnn ^cvrm'nanpcr!Aa;; br.
~0O Mkbl- 10♦- Corew K 28.30.18.1509
TANK INFORMATION ELEVATION DATA
-YPF NT=ANJFACTUREP STAW)N W, HI F S LLL4
i1
FePe:: 1 n I Benchmark
0"4 10 Jo- l0.
gun d ( 1 ),It 31,1
(,D~
{ P (11W 61) VW
Acralun' Bldg Sewe_I .e ^ 05.
Lmno SO I: In.cl `
.~5 C)4. ('05
TANK SETBACK INFORMATION SwcOuticl ~.IO
TANF -O F9 I I H_ I, qn m:akr RJAC J4 Inlet
l.•k.51~ $~J61CrIn
7D 1. (0 100 :)I Button -
Dosmg HeadeNlAar.
7, to i
Aeration pl,;. PIPC I t _
H 001'r0 Bot. Sysleru
Nnal Grade: pN
PUMP/SIPHON INFORMATION p(p,3 S~
Iota ulaelulcr tf SIClwm'T 1,gO 1D8.7
Mnfel No
T ~ g.'bo (OZ,3
Tor. ,ti r 8y:Icrr H arf -F: g, v c~Z,o
iUr:emaln Lvnatlo~ UIa Gs'. •.c '.a J ~-~I 0:75
SOIL SORPTION SYSTEM J
BED/TRENCH Vanla~ 3 ) L,-pt, t -o r?ncnrs. PIT DIMFNSIONS 'tf = o. n,d, i~.: _ c Ueptt
DIMENSIONS ~O 10 O 3 ~1
SETBACK ;SYS'H,I P: P^L L+_JG V6- IAK,!!SI4FAV LEACHING Van_)anu-?- 1N('
INFORMATION CIIAMER OR 1 R l~Gll
-epr 3yste c, 1 y UNIT V,d,
u fw4w h I 74D' N k- Ntr Q H
DISTRIBUTION SYSTEM I- -2,r
-ICaOCN JamCd ?iSIriDuuun .mole _;'r ri, _ 'went :u Ar Intake
J DfiSi CO4M
enpN J.a "1,gth rn.~ _ -:.acm0 -
SOIL COVER x Pressure Systems Only xx Mound Or At Grade Systems Only
Gopf fluor Jeedhi Cep;h or nracd'Scs'vcd xx Wtlehes:
vr.
E<~ r_nr :.rrtr. 4( 95 1- Bntl:l"-rrL dget. T - ~
r Nc Ls
COMMENTS: Iinclude cude discrepencies persons present, e,,. i In"DeCaOn I" Insrecbnn tt7
Location: II e t 1347- AV,-- t it; C, jo pfltr bu J
~,IICr tos~✓ or
' i.Al; HM Deseuation =
? i Bldg sewer cover - Z,♦1 .0 ~ ( 1 .M , / tom. (v.
amount ol f cover - J"'aOL- r'7 dd'~
ti2.o ,n.
rtie e.G` [f
Plan revision Required? Yes 'c O 3 -1 75
Use other side for addl0u•Ial Intounatroc. l0
Jam
$3D hse=ors gnat~f ".en No
h'IG ik . 557r
5fl~ -aciq
"u t r r Safety and fiud.ln9s r'siur, ~ N272019 I I C Jf
ar
sf jDS 201VV -N/as'urlgoP .AvE -°.l. GOX71V `.cnl•try'YcmnN.l.nlxepoMnL•vlr.hYQ..)_-
1 PS ~lejison. LVI -:1~c -
&6704(o
Smitan Permit fica1{'(1rl SLUCT:,-=oa rnlhr,.
11A:::ur.lll C lid, A
3P~ L I tY L (-C. ini f t I 1910 `r Ci I t tl t'yl: • P/ 1
'N[l.lir J lr U. O_U WIre 9 ,dn13 pCMf r UC At [ II J "K IJmK f~,, , i -cw,,0. kl l\\ S yt,y xl.. C :U [ ff .,Ydd.» IL U•Ifl:"Cnt 1t1;ff 'tWI1l0 3dd![$$I
u TY_T lrta tR. 1 Safc : f Pr ,c-.inlLd \'[al[~ ?zl r tvumffi1 r v 1 mI idc. mn he used f.) d.uY '
_tr~_ue lr r rdanc, alil ul rivac I u -:Al! A; IV q ~Q
I Applncatim Information Please Prull 411 four ri_on ~-L~ //WW
Yn+xxn uw le > Icem ' / ~.vc<I » , / r~- _
kt. cttt rnr r . Mm'm pwpcn.' I.otanno t) JQ. p . 1 Q t~
rty, C. rt r 17
OPhone Number ~ ' ),j Z LL./ ts.l - v: I1.'Iype o(Building lrheck al rbaBec",.1 0-D
Belo m; ~r :3
} ulr 0
I•an•rt .vr'..Ikur•M l<f. t:vAKtenL^ \l laec.~i _
r an u'
3 ~+a,- C.e..(lS w-1i z-5yZ5a✓LS
Ill. Typed
IC htek un I one box on line \ Complete lmr B it applicable)
uwrm F1 Hcpla. J cr 1 ti see. "r: atmcntR .11L., _.ani kg9n.n:wnl on v i _1 UJIV M1(odificL- n to Lxis.SnA .G)Sktn texpLl,r~'
R. i P MK R=1111 I P rml Timm',r f ~'cm~r o.'?iunihcr i`6T..i: ?:._41a :n `<:r l.i.- frntnv~ parr-ni[(t~:lmtttt a .J lM, st
A-C ae xpi por' !Mm _L 1-v`1't I ~NM~
~RCom1 orient Un'ice IC'heck all that a{3plr i
_ lcvnl .r:7~1[-r(-i~e tr. ❑ I~ l vec in-(n ur l v.:~l slr L blou> m f $1.1.3b1 sri! M1mtnt-- incl j uuii.:vC ehii~j r--
1(om 1k '-)U2<t I~LYt$J:( lp n.n.ifxu131I--_ _ Illtrt•ecr-1 h:r: rtc%p12i-a)~~~~-/
Dislxr<ni beat ent Area Information:
-
I IY 1txP .:1'_1cs ~o' 4 h mHate daf Dts
T---
".A - YY I fct eI tr Rmuire Il r spersal ~ Ft pt>sed/tap 19vp^rr I.levy
270
%T,rank Info "+x tr U, I 10.11 ,f- 4 - T `J 'r/
fal uta:urttr
_ .rallcn. >eJlous I l,:mn
anL- _anf ..i
,j 4~, 41' Alt
II. Responsibility' Statement- 4 the tinder:tined, as tac respuosibiliq for lmmllauon of the PoWT\, showy on the attached plaa>
P:'`tgrcfae .'•Jmc iRinfl Ilts.b . lie:urc - _ -^4.tr ~5 `illmb:x •suc - _
..nest Phenc \ b.
1'Iuthcr'. ,nrll in SLr.c. ?.ip t']clZ f 4- ! _1v kC \ v~
\lTl. Couu[r:Dcparrinent Ure (Tplr - _ - - ` ~
Fe: llale Let-:
i t s Op . oo / p _ f t
Ik. Cnndlfi ANNWisonl for Dirapproaal - - - - 1
1. Ir tsrk c&cn ntte tnl1
al"l: m cell oust till be, as per.aaragemer' plar l~ oe^
T. AN w(tWk requiwoos mast u:,,
r pR P*-&Mtc rd .ti Yics
am[I• to enmpvtr nsn, fur ene qa+m .aJ :vFmit u. nw (,.mn o n ya L: tier lra rLu S 1 r a Priebe- m- _
SB"t4"Q*; k I I I I
System PLOT PLAN
PROTECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond W. 54017
NE P4 SW 1145 28 IT 30 NIR 18 VOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 102.0'101.5'101.0 4' below grade 3'27'19 BEDROOM 4
DATE CONVENTIONAL XXX CONVENTIONAL I.IIrr HOLDING 'PANE
MOEND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE. LOAD RATE .4 ABSORPTION AREA 1516 # of chambers 75
BENCIINIARK V.It.P. Top of survey iron ASSUME EI,I:VATION too' Filter Lifetime Filter
❑ BURE(IOLF O WELL "II. R. P. same as benchmark
Scale = 1/4" = 1 a
Pro 4
B-_ 20 ST 30
Ouse
? X 102. Cells with 3' spaying
100,
6`.z SIOn Vent
,10' 5 Quick-1 Standard
B 1 VC11B of Cover 1-eachin, Chamber
106' with 20.01 ft2 of Area
';.6ft^2!pair of end caps
4' Lont• 12
104 Grade at System Elevation
34,....
A' piping shaC be ASTNI SUR 30.,'34, within
I of tank, piping shall he AS'1'%I F891 _
v.M.' O
170' Property Line R r .
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 3/27/19
Owner:Oevering Homes
Location: NE1/4 NW1/4 S28 T30N,R18W Lot 27 Richmond Acres Richmond
Manuals Used: In-ground absorbtion system (version 2.0)
Pageu
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintance and Contigency Plan
7. Filter Cross Sec
Signature
License num
r 226900
System PLOT PLAN
PROJECT Oeverino Homes ADDRESS 1433 Cemohous Ave Suite A New Richmond Wi 54017
NE t14 SW 114s 28 30 N/It 18 w'TOWN Richmond COUNTY ST. CROIX
SYSTEM ELF.VAT1pN 102.0/101.5/101.0 4' below grade 3/27/19 BEDROOM 4
DATE
CONVENTIONAL XXX CONVEN'17ONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1516 # of chambers 75
BENCHMARK V.R.P. Top of survey iron ASSUNIE ELEVATION 100' Filler Lifetime Filter
BORE1101Y, O WELL *H. R. 11, same as benchmark
Scale = 1/4" = 10'
Pro 4
B-2 20' ST 30' Bedroom
HOUSC
3-3' X 102' Cells with 3' spacing
_3
100'
6% Slop. cn1
40' 5 Quick-1 Standard
B-1 Vents of Cover L.eachingChajubcr
106' with 20.0 ft2 of Area
S.6ftn2/pair of end caps
135' 4' Long I2"
10,1' lip Grade at System Elevation
34"
All piping shall he .ASTINI SDR 30/34. within
10' of tank, piping shall be ASTM F891
170' Property Line
Cross Section of Quick 4 Standard Leaching Chamber
Typical cross section for 2 of 3 cells
Quick 4 Standard
Leaching Chamber with
20.0 ft2 of Area pcr
Chamber 5.6fl^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 106.0'
Vent Vent
Grade
4 X30/34 Septic Tank 4
4' Lon- t 5' 4' Long t
4" Grade. at System Elevation ; 1 . Grade al System Elevation
Spacing- 5--
3-3' X 102' Cells
Observation tube/Vent
Same on other end To be located on end of Cells
25 chambers per cell
A
B
System elevations: C
A_102.0'
B 101.5'
C_101.0'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of
?ILE INFORMATION SYSTEM SPECIFICATIONS
Owner
rte' JL~ fl _ r Septic Tank Capacity /
Pem:d # - _ gat Q NA
I Septic Tank Manufacturer li NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA 13 Number of Bedrooms-❑ NA Effiuer.t Filter Model
Number of Public Facility Units NA Pump Tank Capacity gas NA
Estimated flow (average)
- Pump T
ank Manufacturer NA
aUda
Design flow (peak), (Estimated < 1 S) al/oa Pump Manufacturer
fl_L NA
Serf Application Rate
-j ~aUoay/f!` Pump Model NA
Standard InfiuenUEffluerd Quality I Monthly average' Pretreatment Unit
❑ A
Fats, Oil & Grease (FOG; 530 mWt, ❑ Sand/Gravel Filter ❑ Peal Filter
Biochemical Oxyger. Demand (BOD:.) '220 mg/L a NA ❑ Mechanical Aeration ❑ Watland
_ Total Suspended Solids (TSS) 50 mg/L Disinfection ❑ Other
Pretreated Effluent Quali -i. - - -
ty N+onthly average Dis an3al Celt(s) ❑ NA
Biochemical Oxygen Demand (BOD,) ,3p mg/(. - round (gravity) ❑ In-Ground
(pressurized)
Total Suspended Solids (TSS) s30 mg/L A _ At-Grade U Mound
Fecal Colrfotm (geometric mean) <_d10` ckdloOrr1 ❑ prip-Line 0 Other.
Maximum Effluent Particle Size ik m dia C NA Other: -
❑ NA
Other: - - - -
NA Clher -
❑ NA
"values typical for domestic wastewater and optic tank eftluen' Other - -
CJ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tark(s) At least once eve• 71 month(s)
Y: (Maximum 3 years) p NA
_ -~~ZL~ear s) _ _
Purnp out contents of tank(s) Wien combined sludge and scum equals one-third (~6) of tank volume
iinspect dispersal coil(s) At roast once every: months}
gar(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every / ❑ month(s) -
- - - - - r. year;s) Ll NA
nspect pump, pump controls & alarm l At least once every: C ❑ momh(s; NA
- year(s)
`lush laterals and pressure test At least once every❑ month(s) NA
Q year(s)
Other -
A: east once every. ❑ month(s)
~JIr10C - Z year(s) NA.
NP.~
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal rails shall be made by an individual canying one of the following I:censes or certifications. 11'r
Ptumoer, Master Plurnber Restricted Sewer; POWTS Inspector, POWTS Maintamer• Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identity any an ss.ng or broken hardwaie. identify any cracks or teaks, measure the volume of
:ombined sludge and scum and to check for any back up or punning of effluc•ii on the ground surface. The dispersal cell(s) shall be
visually inspected to chock the effluent evels in thu observation pipes anc to eneck for any pending of effluent on the ground surtax.
The Pending of effluent on the ground surface. may ireicate a `ailing
-egulatory authority condition and requires the immediate notification of the ly„o•I
.
✓vhen the combined accumuiation of sludge and scum in any tank equals onethird (yi) or more of the tank volume, he entire contents of
be tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wiscons,n
Administrative Code.
All other services, including but not limited to the servicing of eYruen! filters, rnechanlcal or pressurized components, pretreatment unrs,
rind any servicing at intervals of 12 months shall be pertornted o a M11fied POL'YTS Maintainer.
4 service report shall be provided to the local regulatory autnerp within 10 days of comoletion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for time presence of painting products or other chemicals t t
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 septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be
discharged to the d"rspersel ol(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal lave s
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 comp, the area with n
15 feet dawn 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 We of the POWTS:
antibiotics; baby wipes: cigarette butts; condoms; cotton swabs: degreasers; dental floss; diapers; disinfectants: faL, foundation drain
(sump pump) water, fruit and vegetable peelings: gasoline; grease: herbicides; meat scraps: tnedicaWS; oil; painting Products;
pesticides; sanury napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/of is permanently taken out of service the following steps shall be taken to insure that the system is prope+ly
and safety abandoned in compliance with chapter Comm a3.33, 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 end 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 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:
j6--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 requi0ed
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 ruled in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POW TS.
❑ The she has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed/ as
a last resort to replace the failed POWTS.
❑ Mound and at-grade sell absorption systems may be reconstructed in piece foilowing removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Ok A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS - -
POWTS INSTALLER POWTS MAINTAINER
Name < Name
Phone C Phone f,
SEPTAGE SERVICING OPERATOR UMPER _ LOCAL REGULATORY AUTHORITY
F y-
Phone I~ - L Phone
6 This document was drafted in Compliance with chapter SPS 383.22(2)(b)('j(d)&(P and 393.54(l).(2) a (3), Wisconsin Administrative Code.
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ST. CROIX couN'f'y
Sh'1`1'IC TANK NIAINTLNANC E AURI*,MENT
AND
OWNERSHIP CERTIFICATION FOR-M
Owner/Buyer
Mailing Address
A / J/164 l - L_ -1 ~L•<.~/ l r( G~ cm` I
Property Address lg4
(Vcrtication retpured from planning & 7.olull bepatfruem r IWw' construction.)-
City/grate
Parcel Identification Ntunber
LEGAL DESCRUITION
Properly Location- - t Sc2 C T0
N' RVd -W, Town of jl _ I NLr~
Subdivision _R
L Esc' - -
1.01
Certified Survey Map # _ ^ _ - -
- C _ Volume
- - - - - -,page #
Warranty Deed N
Volwne
- , page #
`;pcc house yes no _
flit lines rdeatifiabl ye, no
SYSTEM MAINTENANCE AND OWNER CERTIP7CIT ION
nraurtenanc ttconsiso ofpunrpulk oilt1 sc 'n~ s~ho swstr..^,r could result in its prrnmrm r, iailute IO handle waFICS Prop,.,
the system call affect tilt: function o)'Otc septic tanktas a treater 1 stage int-lite l waste ceded, by a licensed pumpe,. what yon put un„
recpnnsibililies arc slx;cificd in §Cou>m. p
disposal system. owner.nainterwncr
83.52(1) and n: ('hapter 12 - St. Croix Corrnly Sanitary (),dinanw.
The properly owner agrems to submit to S[
Waster and b Croix County i'lwtuiug Zoning Department a certi
y a master plumber, journeyman plmnber. iteatictcd plu,nbct of a lircused pumper verifying that (1) the, Oil site
w~axtewatcr disposal system. is in r'O fication fang signed by the
less than li3 full of sludge. P Pet' operating condition andun' (2-1 after inspection and pumping (if neces,auy), t}le septic tauk is
Uwe,
-lei the, berrsipned have read the, above reyuacmrnLC and agree to uraintau, the privare ..wage disposal systrttt with the
standards set firth, hercir.. as set by the r)epamneur of Commerce and tlic D.punurem of Natural kcsamces, State
Cctltfcation stating that your septic system has 1>cer.,uaiutained roast be c omPfeted a)td relmncd to the SL Croix
lotting Department within 30 days of the lhicc year expuatiert dales of Wisconsin
County planning
<4
1lesc scribed ibcd y that 411 .testa o t.a oil wanthis . n. f9
propertydrut arc Intr. h) the best of nrv,•'our knowledge.. 1/we. alutille the owner(s) of the
, byvirhte of [njy decd recorded in Register of Deeds Onice.
Number of bedrooms J/
A-46N. -M OF APPLfCAA'T(S)
f)ATF
"Any infonnatiou that is rristepresenred may result in the sanrtar7; pennithcinp revoked 6y the Planning M Jomug Drp;uYrnwu
In i'ren with this application a recorded wart arh decd
reference Is made in the warranty deed. Beau the Rcgistor (it'Decds C)ffict: and a copy of the ccrtilied stu Vey snap it
(RVV. 08/Os)
' S455r _29~t -
51777803 W ~ CI7 286.12.
C15• Yw J 318 h8 • - S7g72,Or~~G+~ _ •C73 S86"40'24"'N
C16 ~~193 77 N86'4p'24'E
CIB
I N
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~ m
29
2G` e 1.68 acres N
CJ P.
25 72,979 sq. It.
27 28 U
2.26 acres ,Z o w a o
1.97 acres o 2.14 acres
5 acres 98, 419 sq. ft. a~ 85, 736 sq. ft. N 93, 348 sq. ft.
3 sq. ft. m
m
219.24
S84-22'09' W
~ Z \
964.6 1
966.9 ~ r 968.7 - \
58933'36"W 170.00 \
~t 203.35' / N8177•01.W
)3.34 50 OV" - - - 236.92'
6=0=4
r ° ~o ! 969.6
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Wisconsin Department of Commerce _ SOIL EVALUATION REPORT page of y.
Divisionof safety and Buildings
in uecOrdaace wi:n Comm 85. Wis. Aam. Clue
Attach complete site plan paper not loss than 8 er pot j. ~-Y[en-meet---. County &t. C U 1 X
include, , but but not limited to: vertical and horizontal
th andlonce t>v nn d n 1 j parr:el I.D. 6l~' G _
percent slope, scale or dimensions, north arrow, , andowt:on and distance non arost roe `
Please print all information Reviewedb Dam
Persona: inleanaeon you provide may 0e used fur secondary purl sal (Pr 'acy t.aw s 15.04 ;1; Im; 9 - ;nr
ProFOrt}•Ow•ner ~ P Lo io
y L` sd~ ~i Sw
Gerald 3. SM/ I~ u''Qbvt La 41/a~E 1M Sag1 N R~ E(or~h
Property Owners Mailing Addre Lot # Dlock # sutx) Name or CSM#
J/I too 190 Aoe. Nw a-_.i.._. at cF-R,_-hMONa Ar- rc
C7cy Stale Lp Code Phone NurriLer ❑ C,[y 'i V:Ilage 91'"n Nealusl Road
(GJK R•\/CR i KINj $5.53D,(7(e3)YY/-My I R~GI1MONCK N3L)
c .
MNowCorlslruclion Use-(!•ResidentialINumburofbedrooms.__ Code derived design flow rate lisp GPD
Replacement
❑ Public or commercial - Describe: _
Parent material -_OAZ W e, I . Irb , $
_ Flood Plain elevation if applicable n.
G moral comments 75v5Si 5"r -'j re,,l,, S C.4) FJ,- c.ac t, s,4e
and recommendations: T.1 101. d4', T.y 09 95') '7~ L) K) lam' t+u~.J„~ r
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T.3 (1po. I0'~ r- I, (99 05 i 'l?l _.'~T
Boring # ❑ Boring
t9 Pit Ground surface elev. 1 ~-13 ft. Depth to limiting faclur in.
- SoilAnpl,catcn ate~
Horzon Depth Dominant Color Rodox Description Texture Structure Consistence Boundary Roots GPDiff
in. Munsell Du. Sz. Conl. Color Gr. Sz. Sh- 'Eff#1 'Eft12
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® Boring # ❑ Boring r
Pit Ground surface elev. I D 3.3$ ft. Depth to limil:ng ladcr in. Soil icauun R_te
Horizon Depth Dominant Caor Rodox Descnpbon 'roxDUre Structure Cons.>wnce I Boundary Rcots Gpc-+F
In. Munso:l Cu. Sz Cont. Color G:. S2. Sh. 'Fff#1 F.fl#P
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• Effluent #1 = BOD > 30 < 220 mgi- and TSS >30 150 mg,1. • Effluent #2 = DOD < 30 rrxpt and 1 SS < 30 mv-
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I Page ~ of parcel 10 0 P:openyOwner C
3 Boring 105.98 m. -
Boiling q F1 _ ft. Depth m bm.liny [actor. _ oil T •I„^,alioc Ralf
pit Ground surface olev. _ j
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Redox Desfrplion Texture S. Sz. re Sh Consistence
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LJ Pit
~HOrizor: Depth Dominant Color Redaz UCSCnp ion Texture Structure Consistence Boundary' RWIS F`fo,ryt Fnn2_
In Munseli Ou. Sz. Con:. Cn!or (3t Sz. Sh
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Borng If Bonng Ground surface elev. It, Depth to limit rig favor -n
pit Soil A aLwl,on Rale
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lh Dominant Color Rodox Ocscriptian Texture Swc:ure Cv;tsistenco oundaryToots .E
t 'Eff!t2
r Uup
Du. Sz. ContColor
in. Munsoll
Gr. Sz. Sri. ' Efluent #1 = DOD, > 30 5 220 mg+L and TSS >30 150 nigR ' Effluent p2 = BOD, < 30 mgtL ano TSS < 30 nxy'L
I he. Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need matenal in an altematc format, please contact the dcpantnent at 608266-3151 or 'rry 608-2648777.
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Horizon Depth Dominant Color Redox Descnplior Texture Stricture Consistence Boundary Roots
' in Munsoll i]c. Sz. Cont. Color Gr S:. Sh 'F.Y#t 'EY;C
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In. I Munsoll Ca. Sz. Cont. Color G:. Sz. Sh.
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Boring #
❑ pit Ground seduce elev. _ Depth t:: iir:ii6:ig factor
$OI. rpRl:2tiOn Ra:C Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary, Roots ;P:XIF _
in. R9ursell Qu. Sz. Cont. Color Gr. Sz. Sh I '=fTl
IF_
Effiumt kt = BQD, > 30 < 220 mp^- and TS_ :•30 < 15C rnar ' EI'luent 7r = BCL'., < K mgtL ane SS 1 30
The Department of Commerce is an equal opportunay scrvicc provide. and umployer if'you need assistance to access s --I I:.: ~r
aced matenai in an ahemate fiirrna:. nlcasc 70ntac: the dnanmt,:it 'r.: o(;S-266-+15: or 'F7)' 605-^_64-F'7'
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