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040-1231-10-000 (2)
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic �C, 9 n I �D r-¢] ( J� Dosing ttIV Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic S 3�1 v qf e/ Dosing It It Aeration Holding PUMP/SIPHON INFORMATION Manufacturer r L-1g6a GPM Model Number -3D TDH Lift , r Friction Loss System Head TDHH t lS.b 2.2.fl .7_. 20.3 Forcemain Length I. Dia. r '1 Dist. to Well r 1> o t 2 63 SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 648428 State Plan ID No: Parcel Tax No: 040-1231-10-000 Sectionfrown/Range/Map No: 03.28.19.1137 • ®mm® St/Ht Outlet BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _ SETBACK SYSTEM TO BLDG 1WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number: DISTRIBUTION SYSTEM I " Header/Manifold Distribute n ` Pipe(s l x Hole Size x Hole Spacing Vent to Air Intake Length Dia Lengt Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil 0 Yes 0 No 0 Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /{//f /2pZ3 Inspection #2: Location: 549 TRILLIUM LN R-I� c�cc _ y. 1 — /p�,�//� ^-� 1.) Alt BM Description = 51kLt,-9s /"4-��yjp'a rn�S�Lw��j��(,g'�t l�r ems 6' 9R.,l! & 10 2.) Bldg sewer length �n'�4J 3 - amount of cover = - .n _ ..�`av� a"oeQ 49W Tin'rh- LAI Y\n B �L Plan revision Required? ❑Yes �z No Use other side for additional information. SB -6710 (R.3/97) Date Insepctor's Signature Cert. No. SAN-2023-037 Industry Services Division 4822MadisonYardsW� County C��%/�. I Madison, WI 53705 �. Sanitary Permit Numberfilled in by Co.) P Box71 2 l P.O. Box 7162 (tobe Madison, 16 Sanitary Permit Application o ^ State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit cl -ropy'. ft.. Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for stateowned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. ,1 me. I. Application Information Print All Information -Please Property Owner's Name Parcel # JACK & JANET LOEBLEIN 040-1231-10-000 Property Owner's Mailing Address Property Location 549 TRILLIUM LN Govt. Lot City, State Zip Code Phone Number HUDSON WI 651-253-3756 NE y SE ySection 3 T28 N R 19 E or W II. Type of Building (check all that apply) Lot # Subdivision Name ZI or 2 Family Dwelling -Number of Bedrooms s 1 COU NTRYWOOD Block # Public/Commercial - Describe Use ❑City of ❑State Owned -Describe Use Village of CSM Number ❑Town of TROY III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A. ❑New System l--I., []Replacement System LJ v" her Modification to Existing System (explain) ::]Additional Pretreatment Unit (explain) TIC/PUMP TANK,,FILTER, TURNUP B' ❑Holding Tank ❑In-GroundMkt-Grade Mound dividual Site Design Other Type (explain) (conventional) W C. ❑ Renewal Before ❑Revision Change of Plumber ❑Transfer tirriew Owner t Previous Permit Number and Date Issued Expiration 320210 8/31 /1998 IV. Dispersal/Treatment Area and Tank Information: Design Flow (grin Design Soil Application Rate(gpd/sf) Dispersal Area Required (at) Dispersal Area Proposed (sf) System Elevation 450 375 400 1.2 100.20 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units ,L P I,.J,k �ZS �C tj- � g $ U New Tanks Existing Tanks l '� c a �+ 'a a u � Septic or Holding Tank 1000 L650 1 COMBO WIESER ✓ Dosing Chamber 650 Q V. Responsibility Statement- I, the undersigned, assume respo ibility f r installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb 'gna re MP/MPRS Number Business Phone Number MICHAEL RODEWALD 931384 715-425-6200 Plumber's Address (Street, City, State, Zip Code) 285 COUNTY ROAD SS RIVER FALLS WI 54022 BETTENDORF@DISHUP.US VI. County/Department Use Only D4 Approved ❑ Disa pl �Giv Pe'r')mit Fee $ Date Issued Issuing gent Signature onfor De ❑O .s' 2^ Conditions o A prova I4easongfot`BiSiR art, " - SYSTEM OWNER: 7j� I rw5 P¢,f-nti"r� "r$ Cr PIVA `� lvcs sefP_ +*Ak g 1. Septic tank, effluent filter and dispersal cell R i rl� a 1 WD/6V TD W : eft ce. - S��QT kscl' � q Vyv�o_+. must be serviced / maintained as per +,ups'� ^ A � ct k U management plan provided by plumber. nP•L!� 2. All setback requirements must be maintained �� s-j— Q� 0 6p y L aL,., as per applicable code / ordinances. Attach to complete plans for the system and submit to th ounty only on paper not less than 8 11. 11 inches in size �r c�,&a SBD-6398 (R. 03/21) Page 2 0 a ST CROIX COUNTY REPAIR SEPTIC TANK REPLACEMENT AND TURNUP INSTALL FOR A THREE BEDROOM RESIDENCE Owner's Name Jack & Janet Loeblein 549 Trillium In Hudson, WI 54016 Located in the NE & SE Section 3, T29N, R19W. TOWN OF TROY ST CROIX COUNTY WI Parcel # 040-1231-10-000 Lot # 1 COUNTRYWOOD INDEX Page 1 Index & Title Page 2 County Permit application Page 3 Project Summery Page 4 Site Plan Page 5 Septic/pump tank detail Page 6 Dose tank cross section Page 7 Pump curve Page 8 Filter info Page 9-10 Manual and Management Plan Attachments: Drain -field Certification, Ownership & Address, Deed, Plat, Relevant info from Permit file. Prepared By Signature, Michael Rodewald 285 County Road SS River Falls WI, 54022 715-821-6229 MPRS 934384 Page 1 of 10 285 COUNTY RIVER FALLS 800-828-3723 715-425-8466 4/4/2023 St Croix County Community Development RE: Request for expedited Sanitary Permit review Owner: Jack & Janet Loeblein 549 Trillium In Town of Troy Reason: Septic tank cover collapse... Public health hazard. Project Summery. Replace 1000 gal septic tank and 750 gal dose tank with a Wieser WLP 1000/650-MR combo tank. Install a Polylok PL525 filter, replace effluent pump with Liberty 283, Install a turnup cleanout in the mound lateral. Michael Rodewald MPRS 931384 Page 3 of 10 COPY 51 ec PZ,4/t,/ ln;,01 5 y� i R f l(,u Ar, I-d jOwa) c� 7ie4 /J XOJ COCAAAywca CX Nj- 66- Sec, a TZo�/f19r,J UNO - r231- /0 -600 -ro ?1211,uw, w _ o f ` Foi- 9 f \ o 21 kxydny ,uaaf� ' /yJriSaft /600�1.� co.4Lo ,y.�,+lr tJlPol y �ok',S2s f"f�t r z"4y SeR �0 qsf� D2GLS � iNslAtf r4,&vf4t4 /dl AfOUA/b �f� wS�iw4 COPY Page 4 of 10 Oi 3° TV aid tr 21 °� Qj,+rJn/y /y/ d�ovbgl. J/i"jSN/ or a Sa?z a WMI ot, r s„ h h- Z .12 t d u b' dNMa E$z y p I°d1M>Irvf°gi"°� ��i� os'l�oofl/ ^yasa�pi/M c xa (v1 QSG � °�� a�bldaZ L� 41 pp9— o/ ~/£ZJ - 0%O (n -j- �aoavw�✓//wv,ad r-7 h/)/ , e! bh S Lo'l 11vd7- 1257 rAr`I►�Z�' 01 � WLP1000/650—MR TANK SPECIFICATIONS o o a 12'-2" DIMENSIONS: o WALL: 3" a 4" CAST -A -SEAL 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" w MANHOLE: 24" I.D. PRECAST CONCRETE RISER a HEIGHT. 541/2" 0 I LENGTH: 12'-2" WIDTH: 7'-0" mti" r ,� 7 I, BELOW INLET: 43" .EyP LIQUID LEVEL38" d WEIGHT: BOTTOM 9,615 LBS. o i �� i �� i f' COVER 5.325 LBS. II •i II°I L INLET AND OUTLET. m o TILeAF oR TillE 4" CAST -A -SEAL BOOT OR EQUAL GASKET 3 La (D �} -- III -- __ {., INLET AND OUTLET BAFFLE AND FILTER: � o WISCONSIN, SEE DETAIL #10 LIJ o (OTHER STATES SEE CHART) O LIQUID CAPACITY: 26.32 GAL/IN (SEPTIC) C fi TOP VIEW 17.00 GAL/IN (PUMP) v Y co Lo ~ co LOADING DESIGN: 8'-0" UNSATURATED SOIL 0 p v w I TANK CAN BE USED AS: < `o N SEPTIC/SEPTIC, SEPTIC/PUMP, o Q OR SEPTIC/SIPHON �' o 0 4" VENT 3 0 COVER: MIX DESIGN #8 (NO FIBER) 00 TANK: MIX DESIGN #10 (STRUCTURAL FIBER) ---- ____ ---- �- CUSTOMIZED TANKS: 3 INLET ---- FOR CUSTOM TANKS CONTACT WIESER CONCRETE OUTLET -� --- � P.I 1I Lo Z 0 REVIEWED BY a F PUMP PAD REVIEW DATE a w SIDE VIEW DRAWINGS SUBMITTED N FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: OF TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: / Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer WIESER Tank Model Number WLP 1000/650MR Total Tank Capacity 1,650.00 Max. Bury Depth 8.00 Filter Manufacturer POLYLOK —� Filter Model Number IPL525 Minimum Pump Performance Required 30.00 GPM I @ 119.54 Ft TDH Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight 4- — — — -y � Finished Grade ' Depth of Cover Ft C C S<<; C C C C S Inlet >i> i >> >S> t>C i C yiy Switch Settings and Reserve Capacity >s> Tank Volume = 17 GPI s'`< >;'> Dimension Inches Volume Gal. < < S >s> (reserve) A 19 323.00 {,< y;y (alarm) B 2 34.00 ;? (dose) C 6 102.00 �} (dead) D 11 187.00 <; < :t> Total 138 646.00 {}{ < Outlet Filter 4------- Inlet Baffle Pump Manufacturer LIBERTY Pump Model Number 283 Alarm Manufacturer Existing Level Alarm Co Alarm Model Number DUL Switch Type IMechanical float switch Total Dynamic Head (TDH) - Feet Elevation Head 15.59 Distal Pressure 2.50 Network Loss Force Main Loss 1.45 Total 19.54 Manhole Min. 4" Above Grade Securely Mounted With Locking Device Weather-proof __Ap Junction Box EZZZZZZZ= Vent Min. 12" Disconnect Above Grade Means With Vent Cap <; i t;<< S C i i i S i Outlet AS i ' Weep > B ;< Hole Off Elevation C }i S Ft ' < >` Bottom >{ D >< Elevation < ' r Ft r > > < < < > i < i { ; i >i >i {{ i i iai GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page 6 of 10 fibaPumps° 0 40 + 30 10 01 0 280 P1 R010/7/2015 LITERS PER MINUTE 50 100 150 200 250 30 10 20 30 40 50 60 GALLONS PER MINUTE ®Copyright 2015 Liberty Pumps Inc. All rights reserved. Specifications subject to change without notice. Page 7 of 10 12 10 8 4 2 i 0 70 Z111e Pumps PZ)LY MaX ,�r.:�.D� 2abeI• ewnn aarn•a.n � n�araA*1i PL-525 Filter PL-525 Effluent Filter The PL525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL 525 has an automatic shut off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent wont leave the tank 1 A Features: • Rated for 10,000 GPD (gallons per day). • 525linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut off ball when filter is removed. Alarm accessibility. Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4' or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL525 cartridge out of the housing 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank 6. Insert the filter cartridge back into the housing making sure the filterispmperly ahgnedandcompletely inserted. 7. Replace and secure septic tank cover. 1/16" Fi Accepts 4" SCHD 40 l Outdoor SmoutiltrKDAlarm Extend &burro Polylok Zabel& Best filters accept Easily installs the SmartlinterlD switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 w .polylok.com Page 8 of 10 10 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4 of - FILE INFORMATION Owner , fk SirN�{ Lr Permit ii DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units ❑ NA Estimated flow (average) 3O6 gal/day Design flow (peak), (Estimated x 1.5) Q gal/day Soil Application Rate 1, Z gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BODa) :=0 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODa) <30 mg/L Total Suspended Solids (TSS) <30 mg/L ❑ NA Fecal Coliform (geometric mean) <10° cfu/100m1 Maximum Effluent Particle Size Ya in dia. ❑ NA Other: _ 0 NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity iWJ0 al ❑ NA Septic Tank Manufacturer 1'J/e,3tA ❑ NA Effluent Filter Manufacturer f d ❑ NA Effluent Filter Model 4(:? ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer &JfeSe2 ❑ NA Pump Manufacturer G/ f ❑ NA Pump Model 3 ❑ NA Pretreatment Unit A ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cell(s) ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade iilg sound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tank(s) p At least once eve every: moy nthlsl (Maximum 3 ears) �year(s) ❑ NA Pump out contents of tankis) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ yeamonthrs)lsl (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) Iii-year(s) ❑ NA Inspect pump, pump controls &alarm At least once every: �? monthlsl Bare ❑ NA Flush laterals and pressure test At least once every: A • ❑�ri)�ronth(s) W year(s) 11 NA Other: At least once every: ❑ m ❑ year(s)r(sl) ❑ NA Other: ❑ 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 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 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 (Y) 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 <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. p 10 Page � of 1Z.- START UP AND OPERATION For new construction, prior to use of 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 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(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 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 within 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; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump 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 properly and safely abandoned in compliance with chapter Comm 63.33, 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 POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. .IV T alua ' a o ing ank be' a aye ''�RDi-IiBTT�� '�D�L-hJ$1✓ %hlS7RCl�7-LD ❑ Mound and at -grade soil absorption systems may 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. < <WA.RNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR 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 Name g-'4';1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name 4,cfe, . S'cD ag / t- . Phone �� POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name S"f . CIW l GUL ZfJrl�l�' Phone %IS— 3W6P- Gi/(,p (D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.540), (2) & (3), Wisconsin Administrative Code. CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING DRAIN FIELD/MOUND This is to certify that I have inspected the existing drain field/mound presently serving the following residence: (Street address) 549 Trillium In located at: _NE_'/4, _SE_'/4, Section _3_, Town _28_N, Range_19_W, PI own of TROY St. Croix County Wisconsin. pon inspection, I certify that I have found the drain field/mound to the best of my knowledge, is not failing as per WI 145.01(4m), and it appears to be functioning properly. Date of inspection 4/4/2023 Original Permit riumber (if known) 320210_ Permit issued date (if known) 8/31/1998 _MICHAEL RODEWALD_ icensed Plumber Signature) (Print Name) (Title) 4/5/2023 (Date) 931384 (License Number) MP/MPRS ST CRO IJFile #: NTY SANITARY SYSTEM Office Use Only �`� OWNERSHIP/ADDRESS FORM Created212021 Cccc Community Development Department Al'Gir!iYAhts itYfblYr Pon to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer JACK & JANET LOEBLEIN Mailing Address City/State/Zip 549 TRILLIUM LN HUDSON WI 54016 Phone Number (required)651-253-3756 Email Address (required)JJLOEBLEIN@GMAIL.COM Parcel Identification Number 040-1231-10-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NE 1/4 SE 1/4 , Sec. 3 T 28 N R19 W, Town of TROY Subdivision Plat: COUNTRY WOOD ,Lot # 1 Certified Survey Map # Vo Page #. Warranty Deed # ! f7� (before 2006)Volume Page # Number of bedrooms 3 Spec house E3 yes ■ no Lot lines identifiable ■ yes E3 no OFFICE USE ONLY New Property Address (Verifica ion of n w address required from Community Development Department for new construction.) (Sta �De) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form 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. Community Development Department- Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd(d)sccwi.ciov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.aov Document Number State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Name THIS DEED, made between Jack H. Loeblein and Janet J. Loeblein husband and wife. ("Grantor," whether one or more), and Jack H. Loeblein and Janet J. Loeblein as Trustees of the Jack and Janet Loeblein Joint Revocable Trust dated March 16, 2022 ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures, and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 1, Plat of Country Wood in the Town of Troy, St. Croix County, Wisconsin. Dated March 16, 2022 R SEAL) * ack H. Loeblein (SEAL) Janet J. Loeblein AUTHENTICATION Signature(s) Jack H. Loeblein and Janet J. Loeblein husband and wife. authentictited on March 16 2022 * Am I Gre k TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706,06) 1150599 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/25/2022 10:40 AM EXEMPT#: 16 REC FEE 30.00 PAGES: 1 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Attorney Amy K. Greske O'Neill Elder Law, LLC 2424 Monetary Blvd., Suite 201 Hudson, WI 54016 040-1231-10-000 Parcel Identification Number (PIN) This is homestead property. (is) (is -net) L) (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. COUNTY ) Personally came before me on the above -named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: m Attorney Amy K. Greske, O'Neill Elder Law, LLC Notary Public, State of Wisconsin 2424 Monetary Blvd., Suite 201, Hudson, WI 54016 My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 * Type name below signatures. St. Croix County 1150599 Page 1 of 1 r- (S890 49' W ) '26"E 730.76' w EAST -WEST 1/4 LINE (WEST) —r4f)a If 33' 33' co n z 00 d to U w f THE a PUBLIC _ - N89 50107"Er— 364.42' - - — - - -�' (1329 q.o IRON PIPE FOUND 0.96' FROM COMPU_ I v Gh — --- co 8°. N }� / ` y 'I N V U CD 2. ACRES °D g101,487 SO. FT. v ° I c I g U W m I 1 N89041' 26"E 363.02' I 289.55' o I/C I" IRON PIPE FOUND 0.88' FROM COMPU' 73.47' 181.53 255.00' mg 953.02' Visconsin SANITARY PERMIT APPLICATION Safety and Buildings Division 201 E. Washington Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, W1 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 4,tvl• X • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs �� 10 (Privacy Law, s. 15.04 (1) (m)]. ❑ Check if revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION //.3It < PropName /oaen 'L a 3*A)&lL&!� �-�i/p1/4, S 3 T 2' , N, R /� E (or� Property Owner's Mai 'ng Addres Lot Number ck Number City, Stat�' n Zip Code (hone ;umber S� i ision Name or CSM Number O II. PErltF(�� ILDING: (check one) El State Owned !ty Nearest Road ' Public 1 or 2 FamilyDwelling- No. of bedrooms vlllan OF 1;e0y %//ll%U� Liv 111. BUILDINGUSE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo d yI� ' r23 / --/ Q 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Mote( 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box online A. Check box online B, if applicable) A) 1. lew 2. ❑ Replacement 3_ ❑ Replacement of ------- System Tank Only 4 Reconnection of an ❑ 5. ❑ Repair of ________System _ ___y______________ Existing System Systst em B) ❑ A Sanitary Permit was previously issued. Permit Number __Existing Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 EY&und 30 12 ❑ Seepage Trench ❑ Specify Type 41 [:]Holding Tank 22 ❑ In -Ground Pressure 13 ❑ Seepage Pit 42 ❑ Pit Privy 14 ❑ System -In -Fill 43 ❑ Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1 _ Gallons Per Day SD 2. Absorp. Area Requi ed (sq. ft.) 3. Absorp. Area Pro�/osed (sq. ft.) 4. Loading Rate (Gals/day/sq. ft.) 5. Perc. Rate (Min./inch) 6. System Elev. U 7. Final Grade Elevation 33 /�D�Z Feet Feet VII. TANK to INFORMATION i�g s Total Gallons # of Tanks Manufacturer's Name prefab. Concrete site Con- Steel Fiber- plastiTEper New1, Tnnlrc T�..L� structed glass Lift Pump Tank /S�r 7SU ? ❑ El❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat re: (No Stam �0::MP/MPRSW No.: I Business Phone Number: 201_k7eT Z1ri11L--,yK726P7 71Y-3,P6'A315 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a Approved []Owner Given Initial Surcharge Fee) Adverse Determination �� . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: !� dw Agent Signature (No Stamps) SBD-6398 (R.11/96) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Division, owner, plumber Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM ` INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law s.15.04 (1)(m)J. Permit Holder's Name: ❑ Cit Village Town of: LOEBLEIN, JACK & JANET TR'V CST BM EIev.: Insp. BM Elev.: BM Descriptinn- C C Zia v6 I8rh t+ I TANK INFORMATION TYPE MANUFACTURER CAPACITY Se t*ADosin 5-� Aeration Holding 1 PUMM 210It I tSALK INFORMATION TANK TO P/ L WELL BLDG. Ventto Airintake ROAD Se pjj NA �'' 1v/' ' NA rAera!tion NA ding runny/ bIPHUN INFORMATION Manufacturer Demand Model Number ?_'jOGPM TDH LiftI5. Friction' S Systeml TDH S t Me Forcemain Length 9L( Dia. 2" Dist. To Well w tSbUKNIION SYSTEM DIMENRENN H Width �r Length O D/ No. Of Trenches SETBACK SYSTEM TO P/ L BLDG WELL INFORMATION S�pe��o , (G ELEVATION DATA County: ST. CROIX Sanitary Permit No.: 320210 State Plan ID No.: Parcel lax No.: 040-1231-10-000 aoQnA'1no STATION BS HI FS ELEV. a.ar� Bench rr c{. 35l o , job am 24,9 3•77G 103. foa Bldg. Sewer I-Inlet l 13,,qSt i17 q_1 W Outlet Dt Inlet Dt Bottom l8 /3 S',L Header / Man. Dist. Pipe 2• ,J' Bot. System l� Final Grade SL �a • �y •4i E +�'1 n , g'� may. NI 1 No. Of Pits Inside Dia. Liquid Dept DIMENSIONS I N _ LAKE / STREAM LEACHING Manufactur CHA OR U DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s)� Hole Size Hole Spacing Vent To Air Intake Length � Dia. �_ Length Dia. ,ZN Spacing x 1/ * a x & A Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center pj Bed /Trench Edges 12� Topsoil G` jYes ❑ No WYes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) �j'q . Z� . 9-3 LOCATION: TROY 3.28.19,NE,SE 549 TR LLIUM LANE — COUNTRYWOOD LOT ]l$'3 b u4ecS i;a� rro L e block �c%r l Ao W-f, ( ot.T � Y1 rt �� cnvi mv� wive- ✓cq del - du" h AK40/ all Plan revision required? �] �es Y No / Use other side for additional information. 1 �� �j�' / SBD-6710 (R.3/97) Date Inspector's Signature C ST- CIZOIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT i Owner j %�.t1 ET G bE/3GEi�v $ Address City/State, ytJ/G� Legal Description: Lot / Block Subdivision/CSM # 4F0,0 � l�. l�,, Sec. Town of 7 2 d IVE�L NT Cc;'(JN7-y y' L�N'116 01FIGE Ell PIN # O /Z / /p 3, -�8- /1. 1137 IG TANK INFOR lure grrnw. Tank manufacturer Size ST/PC 10160, 1 y D W - 7 Pump manufacturer GpvLp Setback from House �� Well N/ P/L SO Alarm location �, Slv Model '% / C ©s (HOLDING TANKS ONLY) Setbacks: Service road ___-___ Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: P00,0D Width 5 � eO Setback from: Souse �� Well'--- Length Number of Trenches P�- 20 Vent to fresh air intake _? 2� ELEVATIONS: sv,evEYo e's / "' -rr 4-7- 5•,• � Description of benchmark Cp,P,v� /pD •O Description of alternate benchmark top of e-eu Elevation GfC�-e dlo` t' C - �l'IriP g� � ��'�f�f/� Elevation Building Sewer p ST/HT Inlet ST Outlet-- PC Inlet PC Bottom ° S �3 Header/Manifold �0�' Top of ST/PC Manhole Cover Distribution Lines () loe ' 70 Bottom of System () 100 ' ZD ( ) Final Grade ( ) /0 Z • 3 0 ( ) 50 T • 'Z �- - f l? ( ) ,l Date of installation / / Permit number 32 02 State plan number Plumber's signature O License number 2-2 e37s Date Inspector koeq Complete plot plan or LDE�7i3LiL--(A-) , pro r L-1 T, JAC (C 5 y � �i/�/U•� G,v 3 Sb , G O T- ToT�� / c �o or s- N*isconsin Department of Commerce July 22, 1998 CUST ID No.259518 ULBRICHT & ASSOCIATES 655 O'NEIL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 07/22/2000 SITE: Site ID: 14056 ST CROIX County, Town of TROY NEIA, SETA, S3, T28N, R19W JACK LOEBLIEN FOR: Description: MOUND Objecit Type: POWT System Regulated Object ID No.: 29859 Safety and buildings 15837 USH 63 HAYWARD WI 54843-8107 Tommy G. Thompson, Governor William J. McCoshen, Secretary Identification Numbers Transaction ID No. 113464 Site ID No. 14056 Please refer to both ideutificatiownurtibets, above, in all correspondence with the.agency: The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan approval is for a 450gpd mound. The following conditions shall be met during construction or installation and prior to occupancy or use: • This plan action is subject to designer comments on the plan • Correspondence Note: • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the Zabel filter will be required. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to P. O 1A inspection by authorized representatives of the Department, which may include local inspectors. All permits Conti.7h required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. A P R, bEPARTMEI}T 0 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the addresy[VIS'ON Of SM ET on this letterhead. Sincerely, TOM BRAUN , PLAN REVIEWER Integrated Services (715)634-3026 , M - F 7:45 AM TO 4:30 PM TBRAUN@COMMERCE. STATE. WI.US DATE RECEIVED 07/14/1998 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 1i ' .ULBRICHT & ASSOCIATES CO. 655 O'Neil Road •Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 'Private Sewage Consultants PROJECT INDEX DIL.HR Plan I.D. # 113464 Owner Jack & Janet Loeblein Date July 22, 1998 Phone 715-425-2464 Address c/o Mann Vagley Contracting, Paul Paulson, 14 Dry Run Rd. Legal Description Lot #1, CS PIN # NE, SE, Sec.3, T28N, R19W. Town of Troy C.S.T. Gary Steel, CSTM2298 County St. Croix Installer Robert Ulbricht Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION s New construction. For a proposed 3 bedroom home. S Estimated daily wasteflow: 450 gals. Soils are permiable (.5/.6 GPD/ft2) but seasonally saturated at 40" as evidenced by mottling. A long narrow T.S. mound system using 12" sand fill is proposed. wally For ultimate clarification and pretreatment of the )VED effluent, a Zabel filter system shall be fitted to the COMMERCE AND BUILDINGS septic tank. Requirements for filter and tank maintaince shall be provided to the owners. DENCEE �ht &Ass°e �o�solts�ta % b: a geweg PtN 060'081% W►$. 64016 D16 n. 3 ?S Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS - - cv-W 'R� 7; `' 4- �iL T��' 1/0 S PR88U6i AP CODES PROVAL SC ,, _ ' PAR PI�UMSIN6 PVC A L ApOVE•GROUND � � PIPING, (FROM "NKSUST BE SG�.40 'C YSIENG ASt) the 31e3 "ch It. below the douslope 1111 d h _ %jftC��ae PI ��S M1185 OR D2665 StANUARDS. p Soil Absolool System mod Imim aoditili. io .5o . �-o i . 7'0 I O F S �` • TO/) OF- CROSS SECT 100 of M0oAJD w i r ti Be P5 . Z of Cj � �+ DI ST Ri f3uT� a,V `� r r Ise c k,s F s s P i P N 6- °F Tc'PS0iL I Uui FoRM TOE L-1'll-P E j� Rmfo p l O w E o T o P Z '7o SIoPE .v /. D F r. E / / F r. FZ FT. G FT. H i-s FT. N OEv -OF % " ro :x" A 33 a c-JATE 6YsrEM f; IEvA rioo 1 FORCE V►.) FORM HAW t; t MONTtioa UN MR REP Ff. z 0 • . LLEVArioNJ S -- l"VERr of 2- TO p o F • TdP of r )ATERM S ioa• 70 R o ck /O/ O(o IATERA IS /00. PLAN VIEW OF Mou-�oD - wi rtt t3E FvRaz MAW A 5 FT• I-• I B 0 Fr I< / o F r I• a - -i IT - - k �� x /y F r w t`z Q- w 20 N ( Fr Pvc. cAPPEp 11Vv of To 1 y" ro�V5U R 1 uTooN Plpt✓ uETwoR k TOTAL V (9c L)H ti- o F L A TE"RAC._ w o 12. � 12 • VC Wr. D%SIR I130T10 LATERAI. eoo cAP Y x _ // X /Y� i (BUG V=oRCE 1v�,c i Ta /I�ow M h i' N LAST No I E 5 H R 11 13E "FEVr To END CAP VOID VvIuME F'oR dF .2, FoRcE MAW �uvERr t✓ IEvAr�v� 100. 70 PERFvRATED (PIPE DETAi L NolEs locATt;v OJV G OTT*0M SH All BE7 I- Y `) VARiA(3L IF y sphc.ep . UtST�NcE p Fr Hn1E t)"AKETe R r- ATERA L- 2, MANI FOLD FoRcE MAik) i �g i►�cl,� s # or lioleV p i p E, 20 4"C.I. VENT PIPE � 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE v'lI -/on/ lQoi • 0 � Q. �IEU�+n o�v �yo ' INLET G _ APPROVED JOINT W/C.I. PIPE ZXTENDING 3' OAlTO SOLID SOIL R�•gs ELEV. FT. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS -VENT CAP WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER tv,4i(A)/A)6- /A/3E� GRADE ,Ir✓ Y°MIIJ. ►� CONDUIT--' I v PROVIDE I AIRTIGHT SEAL i I PUMP BLOCK I III III APPROVED JOINTS III W/C.I. PIPE II ALARM EXTEN6IAIG 3' ONTO SOLID SOIL I OIJ I OFF wsis 3 O,e A/014E eF 5/f vp RIStR EXIT PERMITTED ONLY IF TANK MANUFACTUR6.R HAS SUCH APPROVAL SEPTIC E //-- 5 P E C, I F I CAT 10U 5 DOSE TAIJKS MAIUFACTURER: W/r �� ��� IJUMBER OF DOSES: 3 PER DAy TANK 51ZE : %50 GALLONS DOSE VOLUME. �S ALARM MANUFACTURER: L�VEl '411VI, INCLUDING BACKFLOW: GALL01J5 MODEL NUMBER: X)U L— CAPACITIES: A= ��•� INCHES OR GALLONS SWITCH TYPE: )L'ER (.v P-Y F (o ArT— B = Z. INCHES OR 3 GALLONS PUMP MANUFACTURER: �q0 E/lei C = INCHES ORCALLOUS MODEL NUMBER. n / n� Ili- ,,Nll ` D = INCHES OR GALLOUS SWITCH TYPE: p�S��/(3f}CL- AfaC- Flo r NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM QINSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTION PIPE.. FEET fiAx)k SECS / M INIMUM NETWORK SUPPLY PRESS RE • . • • • . . • 2.5 FEET EAC,(A I o/� + FEET OF FORCE MAIN X r - 5VFYo IrT.FRICTION . FACTOR.-2 FEET ooA t 7+ ZS TOTAL DYNAMIC HEAD = r)�•(po FEET '' 3 9 INTERNAL DIMEIJSIONS OF TANK: LENGTH _._;WIDTH --(-;LIQUID DEPTH Wisconsin Department of Industry Labor and Human Relations .,Divisinr_of Safety & Buildings SOIL AND SITE EVALUATION REPORT in 7rrnrri wifh ii wm R4 nr, 1A/ia Aram r`^A^ of 3 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St . Rw LZx not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. (�� i �g95 APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION WEDBVT CPQx D `� COtyNTy PROPERTY OWNER: PROPERTY LOCATION Richard Stout _ -.. GOl(T, LOT NE 1 /4 SE 1/4, 2 (or) W PROPERTY OWNER':S MAILING ADDRESS POT # LOCK # SUBD. NAME OR 1353 Awatukee Trl. '�r na (Q}]1t �vdQd CITY, STATE ZIP CODE PHONE NUMBER []VILLAGE EITOWN NEAREST ROAD Hudson, Wi . 54016 (715 549-6731 Troy Tower Rd. New Construction Use [ :1 Residential / Number of bedrooms 3 [ J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/0-6 trench, gpd/ft2 Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate • 5 bed, gpdtft2 •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 100.19 ft (as referred to site plan benchmark) Additional design / site considerations sustem el. based on contour line of 99.19' Parent material limestone uplands Flood plain elevation, if applicablena ft S = Suitable for system CONVENTIONAL U = Unsuitable for system ❑ S ®U MOUND 91 S ❑ U IN -GROUND PRESSURE ❑ S ®U I AT -GRADE © S E7 U SYSTEM IN FILL ❑ S CCU HOLDING TANK ❑ S ® U Boring # Ground elev. 99.94t. Depth to limiting factor 401, Ground elev. 99.94t. Depth to limiting fa 72 SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Gu. Sz. Cont Color Texture Structure Gr. Sz. Sh. ConsistencelBotnclety Roots GPD/ft Bed Trench 1 0-10 10 r3/3 none 1 2msbk mfr qw 2f .5 .6 2 10-29 10 r4 6 none sil 2msbk mfr cfw if ..5 .6 3 29-40 7.5 r4/4 none sl lmsbk mfr qW na .4 .5 4 40-80 7.5 r4/4 2 5 r5/8 sl lmsbk mfr na na .4` .5 Remarks: 1 0-12 10 r3/3 none 1 2msbk mfr cs 2f .5' .6 2 12-23 10 r4/4 none sicl 2msbk mfr gy if .5 .6 3 23-33 7.5 r4/6 none sl lmsbk mvfr CfW if 1 .4 .5 4 33-60 7.5 r4/6 none sl m na na na .4 .5 5 60-72 10 r5 6 none is osq mfr na na .7 .8 Remarks: Name.=Please Print Phone: 715-246-6200 1554 200th. AVe. New STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NEaSE4 S3-T28N-R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246-6200 l lot #72-Country Wood N 1"=40' BM.= top of 1" steel pipe by SE lot stake Alt. BM.= top of SE lot stake marker wooden post C el. 105.251 ,r . Gary L. Steel 10-19-95 3) �GQoi�c COUNTY j-LP Ott-,, a,v%.4 L�U- T,C i / T T it S � v OWNER �A� r�4ni�'r t"..06guelni, PREVIOUS NO..IZD21D al� PLUMBERM W-6 �DWwMI-A LIC.# 7313V TOWN OF THY 3 N9 AND/OR LOT I BLOCK • +•\ w SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. O�au AUT RI D PISSUING OFFICER - DATE 'W"'?,yaj THIS PERMIT ■ EXPIRES ■ I ■ , BEFORE DATE SBD-06499 (R11/20)