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030-1029-40-000 (2)
k6k-lep I S I D r. Wisconsin Department of Commerce P R I�. SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Jannifer Maria & Michelle Campos TOWN OF SAINT JOSEPH CST BM Elev: Insp. BM Elev: BM r'rjcription: IL ne) Ag 6(A1&.LA0Mjft&1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic i Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATIONS , Manufacturer Demand M Model Number TDH ILift lFriOion L ors i System Head JTDH Ct 117 Forcemain Len Dia. Ao I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length DIMENSIONS SETBACK SYSTEM TO INFORMATION T�. Of System: .& _ . _. t If DISTRIBUTICIN SYSTEM Dist. to Well ELEVATION DATA County: St. Croix Sanitary Permit No: 648491 State Plan ID No: Parcel Tax No: 030-1029-40-000 Section/Town/Range/Map No: 07.29.19.108E STATION B HI FS - JtLEV.— Benchmark �r•� 100 Alt. BM Bldg. Sewer � %-)tl':It Inlet S�/Ht Outlet l �� Dt Inlet Dt Rottom Header/Man. - Dist. Pipe Bot. System lies is rinal Grade sw 41 ( � St Cover sly rour"mf 0L QA&A Lmao� 1 00- Afi. a r U No. Of Trenches PIT DIINOCNSIONS No. Of Pits Inside Dia. Liquid Depth P/L BLDG WELL LAKE/STREAM LEACHING Mar j,actur�-- CHAMBER OR UNIT Model ".,gym"er: Header/Manifold Distribution x Hole Size x Hole Spaci g Vent to Air Intake Pipe(s) Length_ Dia Length 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 Bed/Trench Edges Topsoil —] Yes No Yes F_ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1093 GOLDEN OAKS LN 1 1.) Alt BM Description ='� iewJ 2. Bldgsewer length - g _ . RIM -amount of cover - G� 0130 Plan revision Required? Y No ID 5 40000 t 14A Use other side for additio ' ormation. SBD-6710 (R.3/97) Date 6/epctor's Signature Cert. No. 41 52 jo 21if die z211 Job 40 ",, f z t vc IPA oil 71 0001 �..� 17 V2 IV r 4 LL Kt.U1VU U PS AUG 1 �4 ?073 4� Tj JNL Industry Services Division 4822 Madison Yards Way Madison, W1 53705 P.O. Box 7162 Madison, W1 53 707-7 162 County St. Croix Sanft;ary Pe; rmi Nu mbcr (to be fi I led in by Co.) Ll I X N t W-1 W P S'Sftitary.reftnit Applicatioll In accordatice with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropfiate govcnir,acni:fl uriilt is rcquirW prior to obtaining a -sanitary permit, Note: Application forms for state-ownod POWTS are submittud to the Department of Safety and Professional Scrviccs. 111ursonal information you p rovi de may be used for sec adaLy purposes in accordance with, the Privacy Lary, s. 15.04(l)(m), Sum Mate TFansLiciion Number NA Project Address (I r d i ffere nt than mailing address) (same) 1. Application Information — Please Print All Information pToparty owner's Name Parcel tf Jennifer & Michelle Campos 030-1029-40-000 Prope rty 0 wner's M a i I M& Add re. ss PTOPCOY LGeR6011 1093 Golden Oaks Lane Govt. Lot NA NW NE 07 1P 1/40 seclion City, Slate Hudson, W1 54016 Zip Code (612)229-1155 Pho-ne Number T29 N R 19 Eorw 11. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number -of Bedrooms 5, 13 Lot 4 SubdiviBiWiNa me 11P u b I ic/Co rnn ierc i al - Describe Use F1Slate Owned - 11c8cribe Use Trout Brook Hills Biock ff NA FIcity of Ovillage of CSM Number IV 547; P 578 Z, row,, of St. Jo:seph qftm� I__ UL Type of POWTS Permit: (Check either "NoW or "Replacement" and otherap plicable o n fine A. C h ock one box an line B. Complete line C 1i a Ileable.) A. oNew 'Syswm Rt lacemeni syslern ther Modification to Existing Systeni (explain) A d diI i'o riz,' 1'0 c rT c a I inent U nit (explain) ETI in T,., n k In-CproLmd 0\1-�;radc EINIou-nd Individual Site Design Othi�r T�po (cxplikin) E]C 110, 1 ige of Plumber EIVriLLEL46 Lo ""L�%y Ownef Rr.111NV,11 Bero Expi ra Ll()r% List Previous Permit Number and Data Issuied 648491 JV. D ispersaVTreatment Area and Tanic Information: X PC)' &:5?_ FLO\A) 4�mA_aJWs uw�mx [)..,sign Flow (gpd) VDU Dc5lgn Soil Application Ratc(gpdlso 19, M—persat Area Rcquired (SO / � Dispersal Area Proposed (0) Systhm Elevation 1, �fl� 9�s� g�.� ��,,�-v Timk 12fl-OMIaL.100 capacity ill Gallons Now Tanks Existing TaAs Tolal Oallorls #or 1Jnl I.q Mann ra ct ure r Ntv c CA N l LZ Q ;7 7fo 7(f-0 1000 /Ald _Itlesrl TZ14= V. R i�sponsibHity Statement- 1. the undcrsIgned, as rcspong1hilify for hl5t.1lla001L0f 111C PM�7S S11,0WR On 01C attacked Marrs. I t i i i i b,t r'� Name (rl ri n P11p4q' 'Signature MPIMPRS NuTiibcr Basinc_es thornNunibcr S�Cwvtv Zr-j eo, zqe5 4,-vs &5yy Addrcsti (Strut, (:ily. Stale, Zip co(fc) u. 3 0 � 5 I-PD VT County/Departnicitt Use Ouly ['j ,�iTrf"VL�.j wncr Given or Nnial '0 PCF111iT Fc,.e Dale tm-tuw (15- Issuiaj Agerit Sigiiawre Collditluns,dfAjiprova ela4t +r4? SYSTEM OWNER: , 11. okrl.. Cr� jjj�lc tank, effluent filter and dispersal Coll must be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained c X CUr 2ef ct-65-Al e_� L as ter anDlicable code / ordinances. lystem And lmlpottt to Om Cuqlaly 11-nly 4111 PELPTr "Ill I.Q$.1 flian 0 its A I I inches in sizu VL Cgz Q �11; I� t�; � �� S can s -� co aA-aa.. Ctj 7/13126,5,3 96 5 Page �-i a n qL r 2 40 FT. R-",-y 0 hi i E 2 (--ccapt where noted) bzack'hoe pit Lega! Description- 7g !3 Lqv� TCLjA� L-f 4L LAW L. 6? tcr-1 Lit. OL PAGE 1 OF 5 In -Ground Dosed -Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWfS Version 2.1 (May 2022-2027) Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross -Section & Plan View Pg 4 of 5 Pump Tank Specifications Pg 5 of 5 Management Plan Attachments: Enclosures: Pump Curve _ POWTS Application for Review _ Previous.oaoerwork _ Soil Evaluation Report 8 Site Mom_ Tax statement Sanitary Ownership Form Warranty Deed Project Name /Description Owner Name(s) s ; ,1ENNIFER MARIA & MECHELLE CAMPOS Phone: 612 - 229 _ 1155 — Owner Address:_ 1093 GOLDEN OAKS LANE, HUDSON, WI zip:- 54016 Project Address: (SAME) Govt. Lot: NA NW 114 of NE • 1/4, Section 07 , T 29 N-R 19 E or W � Township: ST. JOSEPH county: ST. CROIX Project Parcel ID ##: 030 - 1029 - 40 - 000 Designer Information Designer Name:� MARY JO HDPPERT Phone. 715 - 426 _ 1775 , Designer Address: 27520 FIREFLY LANE, WEBSTER, WI Zip: 54893 �. p E-mail: hollisterdesign@outlook.com outlook.com _ . • License Number: 1859 007 Remarks: Ma RY JO •'•, � f remove mercury switch (if not completed at last instal; j install pressure filter New Septic Solutions 324•'�•.;;�';,,.'� Gt Signature: �-� K . �� `�' 2 22 g —� � � Date.. 0 Ongi-, signature required'd each submitted copy 07 - 22, 2023 REVISED an Page Aicif 5 ■ YT- R 'Jrjrq'■y7,1, .� I YI _ ul v A41k f1c 40 FT. 14- (--cempt where noted) ja y1� r� Leg!LL[ Description— # f _"F Tif 1--, 1 " h ............ T Ne Ai� 4L LAW loll 1 41 SDIL (.,.DVER TYPICAL TRENCH PLAN VIEW IN -GROUND DOSED -GRAVITY DISPERSAL AREA Elevation Trenches with EZ1203HP Bundles 3-ft Tmnch (down -sizing credit) __ f 'i - — - '.�: - cove 12" T min, Irenc-h dep'h Systern Elevation - 94.50 it, (typiccll) qZ. W je r ej 1. 'Fie TYNCAL TRENCH CROSS SFCTION VIEVV ,N(,) Scale) Provide, minimum 3 ft separation between trenches. (Shaw lacation. of inleA Oi outlet pipe connection on plan view.) OBSERVATION PIPE DETAIL No Scale,, crew- f ypu o, Finished Gmda slip cap wse I f mul &ed & seeded) 4"0 PVC Pipe T. Cover �min. 1 fool) Top of pipo 10 tor X-1 Of.- al or above finished rar (4) 114"A . .... - @ Ancho kNOz)caie) 4110 tr,;erva fic)n p ip a shall be in 51a 11&d at juncthn betWeOfl l-WO L, nil ft Perforated La:eral observation Pipe, ( (typicaitypicall) _j ty i, FC Z Z ft INSTALL PER TRENCH: 1 0-1t bundles @ 50 ft E ISA/u nit 5() 0 ft. + 5-ft bundles @ 25 ff EISAiunit v Y Q EZ -1 2203H Bundle (typical) (mfd by Infiltrator Systems Inc,), Install pursuant to manufacurews instructions. Pro d I tt Req u [red Inflitratlon Area 1500 pc)sp F SA ppr renc 3 tren,,hes roposed Total EISA = 1500 MMMMFIM� RESET wit Distribution Method: branched manifold M 0 In Un GRAVITY-DOSED�. SEPTIC / PUMP TANK SPECIFICATIONS 4"o ve-t Pipe (No Scale 06ing ) J EI&;Mcal mu'st CO Mply with B, CCWM 15 and NEC 300 12' P.1i". or 2.0 ft above Exterd war-ele -iisiar as riecessa-y- F-slablitille,_," Flood Elevation 'Nuatherproof (typical) Approved junctiun Box ApVoved Locxm -.9 Manhole VeTil Cao 41h Warning Label At lach:ad I T, MPORTAN (typical) Anchor tank(s) aq 4" PAn. or 2.0 ft above pursuant to SPS 383,43(8)(9) Estabfished Fkxd E4eva0o,n Flr,i�^ed Grade CAPA (d 25-00 gal/in r rl D_ P-,)t h (ifl I Volume (gat) 0 550,00 B- 2 50-0 [C] 6,0 150.0 D 250,00 IC K I am Min. (typical) Apr; rm emc JOi weeD A pv,-wed Plpe a r� GM1, Hole SOfid C3FOUnd FForce Main ;type Filter* Liquid A. Depth E3 * 40 Pump Tank Liquid Level — in D 4 Force Main Diameter 2 in Ar 3 ft 3" Approved E�ed d irig ki aleri a I Be. r eat ri �i, Force Main Length = cfo -2 Force Main Void Volume gal C� "'�'-�� Total Dose Volume (T gal/dose I4 < G '.X aesign fio%,. -r- force main void volume) SON Verticai Lift ft ; e.,< PUMP TANK: 0-- Volume = 000 gal MIDWESTERN PRECAST Man ufactu rer: Pump Manufacturer. GOULD PP 41 Pump Model'. 'See -eQ;3&,TPd. PLI-1p curvo.� Contrais;fAlarrn Manufacturer, 5JE RHOMBUS Cori tT ols/Alarrn Model: AB TANK ALERT Float switches containing mercury qre prohibitod. 3;&q q 6�- Insta 0 and rn aintain 01i rsij-ant to manufactUrer's instnjc§ons PUMP-OFF Cn ELEVATION= ft mmmwmmmm�� INSIDE BOTTOM 8270 ELEVATION - .ft 63-.�6 _53619 � q,0.5q q z 77 Y + .5 SEPTIC TA Total VOILIme= 1750 gal MIDWESTERN PRE CAST ManLlf@CtUrer(S): Install approved force main filter pursuant to manufactureAs instructions. Filte,r Manufac.tkir-er-- NEW SEPTIC SOLUTIONS 324 Filter '�jv a s to,,iv ate r METERS m FEET I-r PE 35 PE41 2 GPM I 7r-7 FT MODELS: PE-31. Kal, PE31 I . - 20 0 0 10 20 40 60 70 GPM SO 15 M3/h CAPACITY PERFORMANCE RATINGS PE GPM (f�&.A 0 vva ter) 52 29 16 PE41 Total Head (fec-t of water) GPM 46 20 33 PE51 Tof--'sl Hoe:w GPM j4p&t of �rvrIL',r-r) 013mom PAGE 4 OF 4 In -ground Dosed -Gravity Management Plan IMPORTANT: The owner of this in -ground dosed -gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 750 g pd; BO D5 <_ 220 mg L"1 ; TSS <_ 150 mg L"1 ; FOG <_ 30 mg L"1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tanks) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filters) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit: PAUL STEINER PLUMBING phone: 715 - 425 - 5544 ST. CROIX COUNTY COMMUNITY DEVELOPMENT Phone: Local government unit address: HUDSON, WI 715 - 386 - 4680 ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. For CDD Intertial Use Only: Sanitary Systern Application arid Attachments Submittal Checklist Per St, Croix County Code of 0rdinances 2005E ChajDter 12, Section 12-3,13 Application Administrative Support Stc-ps: Choose new or replacement and then &eck items present LJ P0fI su bmitta 1. Nestem Submittals: Ij Signed Sanitary permit application 0 Plans and specifications intended to meet the requirenierits of § SPS 383.2.2.(2),. Li Ownership/address form 0 Property Deed I House plans with the room layout iw.Or ginal soil test(s), or copy I vvareviously er a LISed to design the sy�Jem ['"I Copy of recorded lot of plat /CSM F1 Current fee according to St. Croix County CDD Fee Schedule .KQplacement/ReiDair/Reconot.cti +r sern Sularnittals: Signed Sanitary permit applicatiorl Plans and specifications iinte'ocftjd to meet the reqUirements of SPS, 383-22(2) Ownership/address form Property Deed Vpreviot Uriginal soil test (s), or copy itorigiihal.was isly submitted, used to design the systern Manac geryient Contingency Plan Copy of recorded lot of olat/CSIVI Certification of existing tank'or components if re-,ised F1 Current fee according to St. Croix C(-),.j, ty edCDD Fee Schule Signak_--e of Person receiving apj)licatI();.I flicItHrials F) ri t fla SUbmitta' Missinq Items: Make a copy of the dpplication and this form . Return original [)aperwork and the co[)y of this checklist to tJie aplllic;int. Do nat recelp't fees or Bold original ap[)licatiun i_;a[j(_-,rvvork_ Pl,-ICC the COPY Of dIC 3l3f)[ICation arid this form it) a folcier for, cotripai'-I-w)n wr-h �ijhmittals_ Suh;nittal No Missing Items- 0 Re(,elpt. submittal * Creatc. paper file foldcLi, * Price f eceII)t acid tfiiis completed ch e-cklist in -the frorit criver of the s.,:-wtary file. Creite skelel-On file M Tt-iickkig system If tlfftev tech nica I rpvt'rw by certified stoffif is thm, try v I' 4ill t'I'?(]fvir6'(7IS are. r-eqtie d to 17 ift the appficant will be contacted b�.i -1 menih, o� 4):,( tc 1 -2022) ST. CROIX COUNTY ZONING OFFICE CERTiF7CATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) JEN,UIFEK AviPo S This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (S treet address) 10 q 3 CaLIQ� OA K-S Lv�k-Z located at: s '/4, '/4, Section ...... .... ... .. , Town_ - N, Range e w, Town of G} , St. Croix County Wisconsin. Upon inspection, 1 certify that I have found the tanks), to the best of my knowledge, will conform to the requirements of S P S _ 3 84.? S, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system.) Yes No (if no, skip next Tine.) Approximate volume or ien of time: ga l lons r�n i notes Tank Capacity: UM ' 7� Construction: Prefab Concrete Steel Other Manufacturer known :(if Al.� f5�'E Age of Tank (if known): r yy'FVic tt '.5 Pe number (if known) a�w� C.' Cam► n tAe (1-Acensed Pt ber Signature) (Print Name) p r-ts 27,5451 (Title) (Date) (License Number) MP/MPRS Form to be completed by licensed plumber ( Dept of Safety and Professional SCi vkx,s Cltdptct 305 dud s. 145.06, WiSL IINIII Statutes) ut fiCCUbcd dispuscl (N R 11.3 Wisconsin Administrative Code) Rev. 42/2012) 11 IL rofessional Services -rzc 4�-T—j �"nt 6f §ifek Page ofs. 4 i,-iio of n lr;�Ust��'S' ervices 4 .25 ISOIL EUAT VALION rFORT ,3 - 21 S In ac ordance with SIPS 3,85, his,Adm. Code COLMtY T. CROIX erl not 8 1/2 11 inches in si e- Plan must include, Atta eh row P1 ete s tte P I ar or 1 LZ butnotlimftedtove���i2- &Z(BM), direction: and percent slope, Parcel I-D. scale or dimensions - north arrow, and to and distance to nearest road. 030 - 1029 - 40 - 000 Please print all information. Rev1 wed by Personal information yoti provide may be used for secondary purposes (Privacy Law. s. 15-04(l)(m)). c,� �2 Property Owner Property Location JENNIFER MARIA CAMPOS/MICHELLE CAMPOS Gout. Lot 'lAr 1/4 S T N R E (or) W Property ova ner"S Mailing Address Site Address or CSM and Lot #: 1093 GOLDEN OAKS LANE (SAME) #13, VOL 547, PG 578 City, State, Zip Phone Number El C it} El Village N Town dearest Road HUE)SON, W1 54016 612 229 - 1155 ST. JOSEPH GOLDEN OAKS LANE New Construc;bon U:5e, Res identiall Number of bedroorns 5 Code derived design flow rate�. 75.0 GPD Replacement Pu b I 'I c or commercial — Describe: Flc)c)d Plan elevation if applicable - NA ft- Parent material LOAMY GLACIAL TILL General cornments and recommendations: conventional ifi-ground trenches 0-5 loading rate Boring # Boring 76 Q Plt Ground surface elev. ZY V, Z- �J ft Depth to limiting factor in. / elev.-89.92 k - " '63 F—S61 Anolication Rate I Horizon Depth Dominant Color M um'58brourid Redox Description RiftdFe [q@0- Color Texture Structu re Gr- Sz- Sh- Consistence Boundary Roots GPD/Ft2 "'Eff#1 6Eff#2 -7 0--10 5YR312 3f-msbk dsh CS 2vf-clo 0-8 2 10-20 sil 3fabk dsh CS 1 vf-rr 0.6 0,8 3 20-40 7,SYR4/6 Is Os o mi gs 1 VF-f 0.7 1-6 4 40-76 7.5YR sl lfsbk mvfr as I vf-rr, n 4 0.7 5 7M1 7.5YR3i-'+' f 1 f 7 5YR41-'6 s[ Qm mfr 0.2 ---0,- 0 layer of g r1c obs between &wns 2&3: 2% gr in Hori H 1 on 3 241,1,01 Bofing# []Boring gpit 93.15 'k Depth to limiting factor in. I elev.-87.32 ft. 5.83 ft, I Soil ADDlicatior Rate Horizon Depth In- Dominant Color Munsefl Redox Description Qu. Az. Cant. Color Texture Structure Gr- Sz- Sh- Consistence Boundary Roots C-PD.'F'L- Eff# 1 --fr'#� I 0-3 -2 3ta&sbk ds C 0. 8 2 B-16 7.5YR114 2fsbk ds vf-co 0,6 0,8 3 16-30 7-5YR3/4 2sbk mfr C5 1 of-ni 4 0-6 1.0 4 30-50 Is Osg MI CS 1 Vf-f 0.7 1.6 6 50-70 7.5YR416 MI 0.7 1.6 Olt ler of aygi/etween cabs b Ho 11j ons 2 & 3 (3') k7n CST Name (Please Print) Signature T Number MARY JO HUPPERT (Holly ter' Soil Testng & Design) 224832 Address Date Evaluation ed Telephone Number 25720 FIREFLY LANE, WEBSTER, W1 54893 1 07-18,2023 715-426-1775 Effluent #1 = BOD > 30 s 220 mg1L and TSS > 30 5 150 mg/L xEffluent #2 -- 130D, 5 30 mg�ll- and TB S -s 30 mg/L SBD-8330 (R03/22) CAMPOS, JENNIFER MARIA AND MICHELLE Boring Boring # Pit Ground surface elev._2_5.�ft. Page —2— of 4 Depth to limiting factor 66 in, / elev.-92.55 ft. 11 AnnfirAfion Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 ... Eff# I .......... ..... .. . . Eff#2 1 0-21 7.5YR4/2 I 2fabk dsh cs 1 Vf-f 0.6 0.8 2 21-44 7.5YR4/3 2fa dsh cs 1 vf-CD 0.6 0.8 3 .44-66 7.6YR4/6 Is —bk Osg ml c 1 Xjf_f 0.7 1.6 Horizon 1 is fill/ w or. old as ure site,- A horizon is 20 e. . .. .... ..... Horizon 3 as some r. Boring # [] Boring F1 Pit Ground surface -elev. ft. Depth to limiting factor in. / elev. Soil Application Rate Horizon Depth In. Dominant Color MUnsell Redox Description Qu, Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Ell Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft *Eff#1 *Eff# 2 . ...... ...... * Effluent #1 = BOD > 30 5 226 mg1L and TSS > 36:s 150 mg/L * Effluent # 2 = BOD, :5 30 mg/L and TSS :5 30 m g/L R R7 ff � cy• 73 A � n19 cr) (NA :uoadi os;aCi jmDa j �N a. � P cal 0 815 40 e e ar t�j "46it", �Fo 13 C7 z y q T. ez"w- A/ cl 10 AC 7b, Aw tap, Jii FROAl otxNQ� T OF ��l 0 6-6 Yo 7X- 7- 7e-;�!4,(Nz;K 0 r e � nx III �v E A ASP. M � ' ate u. aY e Ne, Kevin Grabau M011-1cil < Monica @.stc-?i [I('TI-I`X.1Iet > Sent: M0rI&IY,,,LNUgLast 14, 2023 8-53 AM To.. Kc�vin Gt-abat.i Subject. E. Cal TI [DOS 1093 G-olden Oaks Attachmetits: St Croix County Zoning - Campos Revision.pdf Vollovv Up Flag: Foilov.,r up Flag Status- Flagged Thank you Kevin, just called in the payment. Please see attached revision ap[)Hcation. When this is a[-)[�rc)ved, will there be a hard copy pei,ri-iit we shoLil(] plan on I)icking up along with the pe-rniit for" Faricy-14 Dry Min Rmid? PI as c k (--, P [� rt,i e. 1) o s I c d. I- h a n k s a j-.; a in i 1 moor c-,-) Steiner Plumbing, Electric, & Heating N8230 945"' Street River ValIs, \N1 54022 (71 1-)) 4 2 5 .. � � 4 4 From: Kelvin Grabau <Kevin.GrabaU(�PSCCWi.00V> Sent: Tuesclay, ALIELISt 8, 2023 10-58 AM To: [Vori'ica <rnonica@steinerinc.net: SUbject. RE: Can-i[Dc)s 1093 Golden Oaks YOU CJBI email me the revision application pa g- e if YOU want. I(evin GirabaU I Commtinit y Development - Land Use Plantier -1 S-rw C. VINTY IF From; I(evin �Grabau <Kevin. Grabau@,sccwii.gqv> Sent: Tuesday, August 8, 2023 10:57 AM -Fo-. Moniczi <rnonica@ teinerinc.net> Subject: RIF: Cinipos 1093 Golden Oaks Hello M0111ca, just need a Sanitary Pen -Tilt application page filled out for the Revision. T'he Revision fee is $95.001 and you care call Matthew at 715-386-4680 and make payment over the phone with a ci-edit carci if yoi-i v-jant- Or someone COUld mail or drop off a check. Thanks, I(evin Grabau I COMMILInity Development - Land Use Planner CR �PNTY I ;A A From: Monica <mon1ca@ste1nerinc.net > Sent: Tuesday, August 8, 2023 9:03 AM To: Kevin G ra ba u <'Kev i n. G ra ba q@ rLgov> Subject: RE, Campos 1093 Golden Oaks Importance; High Good ivoriflng Kevin, Mary Jo vilth Hollister Design wars poi nE to send you some UpdMe(] i nforn-iatio n for this Campos project. When Paul went to scope things OLA, rather than install drain field in het eon the exilstiinF, drain field, we really need to plan on a new location. Mary Jo pe rfo ri-nod so n-i e a c.] d iti o n a I ba ring to co nfi rm the new lacat on wi II work - Please see attached what she sent us ancl I assume what she. suhmitted to you. Is there anything else you need frorn us before we can move forward with this project? Please let us know. Thank you. Monica Steiner Plumbing, Electric, & Heating N8230 9451" Street River Falls, W1 54022 (715)/125 5544 From: Kevii-i Gt'abau <Kevin-Grabau CW1,gov I _@SC > Sent: Monday, 'JUne 26, 2023 1:33 PM To: Monica <monic.a@steineripen p.i> Subject; RE: Campos 1093 Golden Oaks Hello Monica, Sorry for the This one is a bit odd. Thant . I(evin Grabau I ornmun t Development - Land Use Planner 10' C a I C h a e I Rd 1-1 u d so n W 1 54016 T : '/11.-; - 3 8A - - Al'-3 Kevin.6rabau@sccwi.gov 6 UNTY. From- Kelly Becker <KIly.Becker@sccwl.gov> Se rat: Tu esday, J une 13, 2023 11- 15 AM To: Kovin Grabau <.Kevin.Grabau@sccwi.gov Subject: FW-. Cai,n[)os 1093 Golden Oal(s Hi Kevil'if I can't i'ei-iicfi-iber If this is one I already seat to YOU, it SOL11101S. like i-naybe this was an emet-qe'ncy replacement situation. I<elly Becker I Comrnuiiity Developiiiewic - Vi-Irld lk( Ilk"lill';.A. 1101 Carmichael Rd Hudson WI 54(J'1(.,, T: 715-386-4676 Kell y.Becker9scmi.clov am . na-CMV ST, CR NTY From: Monica on ica @steinerinc.net> Sent: Tties(.Jay, JUne 13, 2023 11:01 AM To: Kelly Be(,'ker <Kelly.Becker sccwi.9ov> Subject: CarTipos 1093 Golden Oaks This email originated from an external source. Verify the legitimacy before dicking links or opening attachments. I Good morning Kelly, A liffle over' a n-ionth ago we subniitted a Sanitary Pern-iit Applic�tinn for the Can'i[)os residence at 1093 Golden Oaks Lane in Huclson. They are in need of a drain field replaceniorat; to'Lho point where there is currently ponding in their front yarc] that they are anxIOUS to resolve as score as possible. Attached is what we -)tihniltted fn, r reforms c, Can you please IeL me know status and if anythki�; n-lore is neecled for this to be approved? Th r-i n k yo u! [VI o n i (-a Steiner Plumbing, Electric, & Heating N8230 9451" Street River Falls, W1 54022 3 f4 Page_— t . rtiner.t D1 Safety & PrDfessional Services - _9tr e f ti,+!c� EVALUATION REPORT In aeCordance with P 365" is. Adrn- Cade C�I�!�!ty T. CR +I r paper no# less than B 11 X 11 !aches Err size. plan must in udo, tta�1� cOmPlete site Play �lo�°�', �''l�'i�� ,�� ��" ��� � parcel i.D. 0 - '102 - D - 3 � ���C��rl'� riC1t iRrl'1lted to YeF't1�7 and �rorlz�'T-t��k t ��� l�r'i �f�� d��#il�� �� n� Date R�{1e�1��d b''�� please print all information. '+� fCr 5eCond'afy PurPC�5es Tr'vacy Law, S. �i5. (1)(n)') b ;'� t11.3 i 2 Lt pry �� �,�. � � Property Location Property owner MARIA C P / MELEE CAMPOS JENNI�--� FER Site- A -,.4-dress of cSM and Lot Property owner's -W�Ing ddTe (SAME) # 13"VOL 7, � �$ 1093 GOLDEN DADS LANE Number � CItY ®, "ail Ioge Town Nearest Road OAKS LANE City, tat i Phone T. JOSEPH GOLDEN _. ._.�.. Cade der_._.. ��e� dsifly+ rate NewConstruct'on : E) Reside N ,r-Pberaf bedrooms 5 �]Flood plan e9eva#�o� if a�I�I��abl ft, epla�:ei�111t P��lio �r �-r�r`r�erci�l — �nt�e; F� r r7l c�atorial LOAMY IAL TILL re omi ndations: oonuer�bonal in -ground trenches 0-5 loading rate General o�r°n��ent� end - El ft. Boling RrtGrounds surface Ie r.� 1i Depth to I'mitiin factor' 76 in. I elev._89.92 ft 6,33 ft. 0 Application ion Fate on s ri t on Depth �om�n�r�� Color dodo P Texture Structure � Cr. �. �_ consistence �r��tnd�r� � �"D Ft -- Rood} � - E f* j �E� Hlvfii ors In. M unsel` rou d f � .� t. Color t -1( sbk sh CS s� fable dsh CS 1vf 0.6 2 1 0 7_S R MR __ y ' A' Y 1.6 d � f l .5yR4R6 j sq f s 0. 0-76 7.5�R-4�� lfsbk T��� mvfr q t5r� 7.5YR3 4 r1 f ; sl Omlayer Y7 of grjcobs betweer Ho ons &3- % gr In 1-=C]ri on, []Boringft orin+ # 911 ft_ Depth to liml,tIr1 t r I in. eleV_s 7. _ _ pit PsLoilApp[iication t Horizon Crept � CJ!o�'nNn!ant �1or ----------- F��d�x �+'i,�ttor� Texture Structure Cr° Sz, h_ Consistence Boundary 11C)Yts i GPD/Ft� Eff#1 Eff In Munsell Qu_ Az, Coat_ Color a 8 a 'f-co 0.6 1 0a 1 fs�bk ds r -M _ 0,6 ,8 8-16 75Y`R3� mfr tv-_ 3 1 �-0 7 JrN1,5 �s� MI� CS 1 _ f �'� rq,, rn i -1 1- -- --7 7- 0. 7 1-5 5 -70 7.5YR41 R s P 9 R la=Of !g between l---D ins 2 & 3 ( " CST Narne P;ease Print) f T Nomber 224832, 30 HUPP ERT (l� Its. t �Sl T t� � n �Yal�iab t Address DateT2 Telephone Num0er 715F4 6-1775 FIREFLYLANE. V�" EB 7L , 4� vll 5489 07 - . ...,.�� ff uer-! t Bob > 30 s 220 m L and TS �* 30 �-- 150 rng Effluent #2_ Son, :5 30 L and T :5 30 rnglL Page 2 of 4 CAMPOS, JENNIFER MARIA AND MICHELLE 0 Boring Depth to limiting factor, 66 in. i e1ev._92.55 E3U Pit Ground surface elev.—aLo—ft- 5.50 ft, Boring C3 Boring elft. Sonng:A; ID Pit GrOUnd surhce e-le --ft. Depth t c h mftl ng factor in, ev. Boring # E -1 Ground surface --24V ft, to I i m iti ng factor in. I elev., t - Effluenl;;l = SOD > 30:s 220 mgtL and TS5 > 305 161) mg/L ' Efflu"t #2 =- 50D. -s 30 mg/L and TSS � 30 mg/L A4 PROt VVNER: Tttc I C % -Z g. Cq C L b.-L OC� K'r> 40 FT. (except where noteci','T North M A4 PROt VVNER: Tttc I C % -Z g. Cq C L b.-L OC� K'r> 40 FT. (except where noteci','T North M as of ()7/2112023 ()1-42 PM Parcel 41: 030-3-029-40-1300 -T JOSEPH 1 OWN cDj;, QAIN �,VJSCONSiN Alt. Parcel sq. cpux COUN7Y, owner and Malhr)g Addres�s: RAc p - A* J. �os JE-NNkFE'l,�N11A I ,' miaiELLE CAMPOS 1_()93 GG-DEN OAKS LN HUDSO';'4 54016 D is I t CA s D I St A i)t--scription 26 11 SCH DIS"T OF HUDSON .1,700 NORTHWOOD TECH -7-7 co-owner(s)'. ICHELLE M)bt-� iated Description: Acres; 2.780 SEC 11 T29N R.19W PT N 112 NE AS DE SC IN VOL 547 P,578 At - SO REFERRED TO AS PAR CELftI3 (OTHER PT IS IN 020-3-000.50 IF) p[lysicai r-,roperty Address(es): 1093 GOLDEN OAKS LN PaTcel HiStOrY: r Doc 4 vollpage Type 1ate QCD 0910112021 WD ng/01/2021 QCO 0310112016 1212212011 TD Plat Tract (S-T-R 401/416DY4 GQ elock,lCondo Bldg NIA -NOT AVAILABLE 07-29N-19W NW NE NIA-NO'T"AVAILABLE 07-29N-19W NF- NE 2023 Valuations: Values Last Changed oil 09/1412022 Class and Description Acres Land improvement Total GI -RESIDENTIAL 2.780 152,500-00 531.300-00 683-800,00 ToWs for 2023 Geneyal Property 2.780 152,500-00 53-1-200.00 683300-00 Woodland 0,000 0.00 0.00 0.00 Totals for 2022 General Prope-rty 2,iW 152,500-00 5315300,00 683.800-00 Woodland 0-000 oko 0.00 000 2023 Taxes, Taxes; have, iiot yet been calculated. Key PrIMILIFY STATE BAR of WISCONSIN FORM WARRANTY DEED Document Number This Deed, made between Jaffrey S. McClurg, a single person (Grantor), and Jennifer Maria Campos, a married person and Michelle Campos, a single parson, (Grantee). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate together with the rents, profits, fixtures and other appurtenant interests in SAINT CROIX County, State of Wisconsin. SEE ATTACHED EXHIBIT A 1138200 BETH PABST REGISTER OF DEEDS ST. C ROIX CO., WI RECEIVED FOR RECORD 09/01/2021 11:30 AM EXEMPT#: REC FEE 30.00 TRANS FEE 2,025.00 PAGES: 3 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Name & Return Address Bumet Title 1301 Coulee Rd Hudson, Wl 54015 03D-1 D29-40--000, 020-1000-5D-000, 030-1 D28-90-1 oD -- Parcel Identification Number (PIN) This IS homestead property. Exceptions to warranties: municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, present uses of the Property that violate the foregoing where such violations were disclosed by Grantor in its Real Estate Condition Report and in Grantee's purchase contract, and general taxes levied in the year of closing and thereafter. (Sigr;Mres may be authenticatec or acknowiedged. Both are net necessaryr) NOTE: TH515 A STAKDARD FORM. ANY MG U I F I LA T 10 NS r0 TH1S F0RW 5hOUL© BE CLEARLY IDENTIFIED WAMIANTY DEED 1� 2003 STATE BAR Of WISCON51N FORM No. Z-ZO03 'TVpe name below signa[uitn,. St Croix County 1138200 Page 1 of 3 im I ON WI WAI WWII �i 4 ��. Q q`FI , [ LI I �,T U 1.1 1_!== _ Depni-tiiiew of Sdifetv Ctmni v ST. CROIX o� e MAY 08 2023 & PI-ofessioll"11 services, hi(hisliy Seiwices Di)-isioii S.-ini.t'Llry Pcrnili Numhvr (w bc filled in b�- Co, 'n (.1 a Y "Pellt Application State NIL11111.1cl .7— [I it 141S3S1 I 12) i4. AiL,i : h l� L u1n,NAWleS i-liiniitot11Cp1, Pr.0JCL( A.L.[&�.:,, iit dik'L�icnl ikmi mhmliuL, lb [Nutmd prim w obumimng di S-a 111 WJ N p; n i i. 11. Nt)tc � A p V I i I rms for s La ie-o i� ned I P) I T k; L11 YL L'aitted it- Aw Derallincill ofsarct� Jilr Plfo�otiajicllnaPci-4,1, mpON hC UNCL.1 1'01 qCCt,0ndiTN, 11!j)0%CiIl I khLl' IIllJ[[: J'jiv 15(14f T1S (SA'ME) 1. A111flc.,161111, 111G)II-111-1tion -jljkw�e Print A11 1111"I'wnlatifili Parud L N i\ I ITIZ 1%1AIZIA & MICHELLE CAMPOSP 030 1029 40 000 1 1 L 1 11 V.- I 1 1: �- I Li I 1113 y, A J J rt!;s 1.0catio'n 109--') 60LIDEN 0AKS LANE NA Cltv. SlAtt: Z i ji Code N4.1111171!1` HUDSON, W1 5.4016 612 - 12-9. 1155 _N.W� NE Section 11. t)f Ruilding (check all that apply) X D%k 5 13 N 1431 1 1 1 N.-unc TROUT BROOK HILLS ICI 10 Sliatc Owlicd DC..;d.,r1hC T.rsc� Zzo Ar6c `47' P 578 1 CXOIAII,�I' ST..[()SFPH 111. "j),I)c Ill' II(AN"I's Permit: (Check either "New" or "Replacement" ntiel alq-ilit:.1111V till HIIIIV A� ("1l1VC1%' OFIC box online B. Complete linc if -AlIt P1 ic;l 1) It.- I SYSTEM OWNER: Additional Ili ctrcAnicni 'i ni I f cxplaw I 1. Septic tankuent filter and dispersal cell JJOILIML, hank An-( FO L11 111.0 iv. 'sit;: llc.,11) vl-' I k'xj%1,1111 must b serviced / maintained as Pei* RL!Liom-al Bel -Ore J Rmanagemnt plan provided b lumber. w Ivilki 11crim1 Ntwil-wi ind DLLW kNUCLI l� )142 'TT'4,-:1I[.T1l .4 All setback requirements must be maintained TN I t ill%, t"Al Ctlf A!VA "H11d .1 T DL:,1L!11 I 1.,%N 1vp1h n ,No; I II •I " I n7nnm $OsCki (sn sv,lclli �I as rw applicable code ord.1 Carm'.1w 111111 1 01A 1: (1 f 111 u 1.1,: L I I e L It JjJ10111 lilt, J T I an��L jr 1000 & 7 5 MIDWES -1 F RN x A..,00 f II -It 1000 1000 1 MiM\ 1-�TFRN x V i P (I I I GIkII I N S I I I v t I I t I I T r Ili e u a d e r s i g n c d. 3*T i 11 e r e s, po III i i b I I I I - - r -4 wk t; j I ht t I i j n i i If t h r P I L I I [ I [ I L :II I I j I k L1 fa1anS. NJI I tL' I LI I I I IlLi fI N111KS Nkllikll�:I Hu. Phouc N823094�Tll STREET'. RIVER FA __S, W1 540 i u n fyll).Ll J)j J'j ill (LIJ TSe ()nl /24(0/,� 23 ................ 11 SYSTEM OWNER: r hA,"O f f MA4 JU D' a, I Septic tan k, effluent filter and d is pe rsall cell 1 5:114, t _11• Li % I UuXe_ OfQ& W,, — Qx must be serviced / maintained as per w �9 It# CeMAZ4,t- management plan provided by plumber. b(omal- 15 OeAAA- 2. All setback requirements must be maintained L as per applicable code / ordinances, \'1.1 'i 141 h,fl"IfIvit, plall., For. tlu mill niotmw 41. 111k4 c moots ..n13 -m jb:qwi u-ii I.-s, di it 4 1 , N I I lwhv ,. In,.ifk- 5D'Ca-4A, Q , I k , !", I J� if's 12) e n I d u st r j,ab,j-r iari-0 Hunian Relations Safety And Buildings Divisilull GENERA). INFORMATION pefmft �To_ldeCs N� !e. WORKMAN ANN E & CHARLIE S -CST BM Pev TANK INFORMATION TANK SETBACK INFORMATION PI SIPH-ON INFORMATION PRIVATE SEWAGE SYSTEM, INSPECTION REPORT (ATTACH TO PERMIT) city villa gen I OWn OT.- ST. JOSEPH P� CST 24� ELEVATION DATA A9700458 DISTRIBUTION SYSTEM I/,/, '.KS pev" Alf.00" Hadei — V Holesize x Hole �paong t To Air intak 0 _ r I ani o�d Distribuution JiDn: 3c) r Levilyttl SOIL COVER x Pressure Systems only xx Mound Or At -Grade Systems Only xx See(je(j,.1Sod Oe)th Over I)p w h Ova r xx Depth P Sod xx Mulched N c) yes g kf,e. ' T re n Ji E d, Lit S bed I Trench Center C_()MMENTS: (include code discrepanc . ies, persons present,, etc- LOCATIONIP ST. JOSS PH 7P29,19.107IrNEfNE 1093 GOLDEN OAKS L&NE ge p4i c, i ton 4 6 6,0 0 747C P?d re- *o 4 ine I.P7 6 xh 0 �� C �be eo", 3)1;izdalkor��/�cecf 4y _rf, 00-r1k Ar yes 71 use ot�)er stide for addlitIO a informatiorl, Cpft No. —PUT PLAN u T, -OA;s mmffm� 131 E s 05 1 c 40- '� (c C mmpow� . �7 LAME dr B 3 IT, �O 40 "I �r 'd 'Wi dr 5- jq Iz- OF 00-� L'yj S7 i � (- P/c f 4e2 11 fw ................. dp_� ML011or --- d ........ JW jloMlr—%19W A 4ft 1 1 . 01_� .m APO- 7(p j&v OF ti C 44POOF —To 0 6-6 E 57-4� _016441OPkw 1�40e471,12,o_S 5 7- 4� 4) 7)TA CP4, I�PL440S 7- 7 Y lffimaln Dejm*nm# of Indtory. SOIL AND S EVALUATION iAbw and Hurnan Ra4atbns Nvwwi o? Sitfety wW EkAdngs in awordance with s. ILHR 83.091 Wis. pap.. / Of -3 Al -ch complWe Me p4an on papeor rKA less twn 8 112 x 11 Inches In size. Plan must County r'. 6)f kv�ude, but rpot WrOod to: ver" arW hodzoMl Mf"W" PDint (8M), directon and permit s]",ate or c1menskos, rath arrow, and location and distance to mreW mad. Parcal I.D. APPLICANT INFORMATION - Pt"Se print &H Infaffnation. P t Dgft Personal Wormatkm wedsecorsd yOu provkle rrmy be Apr ary purpcmn (Privacy Leer,, 15,04 (1) im)). 49 A rje7j JA P"Wty 0WW Property Loy Qwt. Lot /AC, 114 /V� 1/4jS T 21AR E (or) W Property OwrwWs Wing Address Lot # 810*# ubd. Nome of CSMAV 71p, .00,Av 13) &010e.-00 0*'5 4ka.,q CRY state Zip CAade Phone Number yra Neareg Road fi(V1?10A-.) 1 60 / * I I ( 715 ) 3 oO6 60b C lty!g TO j"41-PA, T~ I , 5 f, p 1pe, v 0, 44v.' NOWonuwiden I Number of bed.oAd UM to edsttad ,kq E�)-Aeplacwnent C] Pubk or commercial - Desalbe: .04 4ff"WP8!FD - Code derived dEdly flow 90 Ftecocvmnded design keding rate gpwfte yerch, gpd&? Abscmpflon am required 4Y J g bad, tt2.ram,hhAmurn dWgn loadng rate gpde__L_(;_trench, WW FtewrnumndW Infiftraflon surface e4evabw(s). �- -3 ft (as reterred to site plan bendynark) AddtfioniW! design/site owwWwatk)ns 5-e-e, Parent matedel Fkod piain elevabon, if epolcaNe ft in Fill enftrmW hkAff4 I rou r uftble for systern Wrm1ure AT -Grade Sysftm Hokfing Tank Umtwe for swern ml� El L) [IsaU� [�Ys Elu U Os El s 9,6' EJ Conv I I 1 71 1 13OHng # Depth to Hrm*v fact(w ��In. 7 Ano zu. Hoflwn Depth in. Dominant Cc4or Munson Mottles Ou. Sz. C051. color Texture Structure Gr. Sz. Sh. Estenoe' BouWary Fboft Gpo/rt� eW Trench I OW YX- 21 W� PAP O;oc/ • /U op :'o P to vx 5_4 2 7's Yje .6 Remarks: dj. G"Wrld elev. 7 7 d�11. Depth to 11miflng *7 Remarks: 2— 17'g 1 44041" 4 0 P Ab5 P �. - � o (X 5/4q �%� 1 SSG � s .f' n� v{,' Q5 "P A33 10 TS Y SL -2 -f fX3 1.z 7 S Yje W !Y AlrIZAC !�Sft'E 4 4W let sue^ 2ew SST Nan* (Psmss Nnt) Signature ToiephoneAo R 0 at jV? L Uie,4T- 71,5 , 366 It 9 1,6 S Asa Date CST Number IwWchl A A36"MiAlAx ts- Wit@ Sawege ConsuRants MRA CVMMM ALd. A .0 PROPERTY OWNER PARCEL 1.04 Boring 9 V. lclnr BL'Fing # l' t to limt1ing factof .. - in. b!-)ring it Ground Depth to Ta c 10 r Ifs Remarks Boring 4q - Iv, Ground calf�v Ule Ih to �a cl Df Rerriark:3'. SRDW-w�30 (R e2ams) TMPnPTA,�JT lrj-% I 1v rk c- v V lo ir c- m r T r- V'% MMIMM Remarks. SOIL DESCRIPTION REPORT Page z I -If rip&) LLL C.-C.0 5. �13, It, �' L *MOD 6A/Y5 2r i7o ?5 # / fo r r — 0 �,Aj : * . ter, �- • �s �� � ���'"" �L� 30 TOO 01V 31 —few 4000 � 13 ,�� r ,� 1 to 5 + awn low - `1 f FK0,41 OLbgNj Owl &OOF OWAI Of • l,o 0)" iP 7XA a& Sr ..0 • w C2- AVZ� a ?-L 27 /-Z ��w 7 C) too 40P 47C7/ '10 01 5,4V PO bb� IJ7 — sp- 7 dM— YO 'I 71 11 11 -67)rJj l? 420023 �. CERTIFIED SURVEY MAP LOCATED !N PART OF THE NE' OF TEE EVE OF SECTION 7. T29N, RIM, TOWN OF ST. JOSEPH t , f ST CROIX COUNT Y, WISCONSIN ALSO BEING PART OF THAT PARCEL KNOWN AS LOT 9 OF TROUT BROOK HILLS. NJ CORNER NE CORNER SON 7 F C T �'TL SECTION 7 T29N E19W T29 R19W _roch lin 1-tfie NEZ —sRgGnql2 akL--- 131D.521 4 AVE P0140 R It NN, SCALE IN F-EET 40 20 0 OWNERS P-AolpL F, Kathleen Slakeman AREA OF LOT I 1222 Gold -en Oaks Lane 2,4co squarie feet Hudson, Wi. 54016 O.Ob acres LEGEND County Section �.urner Monument - a + Cr 0 Cr eb m w w 7 ell -1 (n m :7 Go LO am LA CD rry ME tv 0 a n 0 Lol rD 4'1986 Cp ow"" ftoww IN got& 4� awftp Ir 0 %vwm* - 45� N 4p 0% 0 0 �. `� LOT I PAGE 1 of 5 In -Ground Dosed -Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POVYTS Version 2.1 (May 2022-2027) Pg 1 of 5 Index &Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross -Section & Plan View P 4 of 5 Pump Tank Specifications Pg of 5 Management Plan Attachments: Pump curve Previous paperwork Enclosures- POVYTS Application for Review Soil Evaluation Report & See Nap Sanitary Ownership Form Warranty Deed / Projec. Name / Description � Owner Name(s): JENNIFER MARIA & MICHELLE cAMPOS Owner Address: 1093 GOLDEN OAKS LANE, HUDSON, WI Project Address: (SAME) Govt. Lot: NA NW H.1/4 of NE [j1/4' 5 �t n 07 , T 29 N-P 19 E or W Township: ST. JOSEPH County: ST. CROIX Project Parcel ID #. 030 - 1029 - 40 • j 000 Def igner Informati Designer Name: MARY JO HU PEST Phone: 612 _229 _ 1155 Zip: 54016 one: 715 _ 426 - 1775 Designer Address: 27520 Fl FLY LANE, WEBSTER, NI zip: 54893 ,I��y#rlili roil r E-rnai : hollisterdesign a� tlook.corn�. License Number. ._� • • • �`'�,. f Remarks: M.A P, Y io to l��ii ` PCs r � LL..• replace trenches 1 ft under existin trenches 1 v r 1 �� l G t k L U�tt t �%2022 Signature: — . l gate . origin signature required or oac h submitted t opy- f S . ryle?2 Ca � v Tj— �d Ad0O 5 8L of Ic Ina a, 004ol lo 15 rx '- lld0O --9 ry z S - Ah-�r 0 or S c2a�7 1 _ . s•�-�` I sw/ I <2 ...._ ........ _. 1 Kevin Grabau From: Mary Jo Hu p 1D e t t < hol I i sterd es i g ii(LO o Litic ok,co m > Sent: S LJ i� d ay, J LJ 11 e� 'I 'I.. P. 0? 3 1 P.: 5 7 P M To: Keviii Grabau Subject: Camj)os d� igri Follow Up Flag: Fo I I nw I I Flag Status: Flagged Hello Kevin, trenches are ffOjllp ,_, Under the existing trenches or can be placed under the 6 ft. separation. IN -GROUND DOSED -GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) Geotextie Cover , SOIL COVER TYPICAL TRENCH PLAN VIEW No Scale} 4000 Perforated Lateral (typical) t /B= ftical) r 1 12' min. trench depth (ty Pica 1) L �. . ,.� .� • • System Elevation = 50 ft. (typical) ' Prvvld?etween nimL 3 ft sZvlew.) trenches. (Show location of inlet 1 outlet pipe conr,*Action on min. 1 2' (typical) INSTALL PER TRENCH: TYPICAL TRENCH CROSS SECTION VIEW (No Scale) O servation pipe shall be installed a► function between two units. Observation Pipe ---` oe'0000� OBSERVATION PIPE DETAIL (No Scale) Screw -Type or Slip Cap (loose) 4-0 PVC Pipe Top of pipe to tem* at or above fished C (4) 114 l lg x 6" Slats apart Anchoring Device 10 ft (typical) 750 gpd ft = 5UU . \-- EZ1203H Bundle (typical) 1 1 o-ft bundles f EISAlunit - ft2 I I" TI.Z 1 5U U Z)/-V U Ni I = 3U (m ay Infiltrator Systems, Inc.) 30 units x 10 ft. = 300 Install pursua to manufacturers instructions. + "" 5-ft bun @ 25 ff EISAIunIt = -_ ft (3) 3 ft. x 100 ft. trenches A = 3.0 ft (typical) — Finished Grade f mulched JL seeded i Topsoil Cover (min. 1 foot) lnfritration Surface Proposed E ISA per trench = 500 ft2 Required Infiltration Area = 1500 ft2 Distribution Method: � - _ 1 Epp x trenches Proposed Total EISA - ft2 branched manifold RESET GRAVITY —DOSED SEPTIC / PUMP TANK SPECIFICATIONS 400 Vent Pipe (No Scale) > 14 ft from Building Electrical must comply with 12" Min, or 2.0 ft above COMM 16 and NEC 300 Established Flood Elevation WeatherproofExtend manhole riser as necessary. (typical) Approved .(unction Box Approved Locking Manhole IM PORTANT: , ���'� r�� ._.... - _ Anchor tank(s) as nec,mssary pursuant to SPS 383.43i8}(g) FinishecNrade ..... - ------ �. ■� D:p(gal)■ �s �w ::. • �■Hole Force Main Filter Alarm on i.� *Pump Tank Liguld Level = 40 in Force Main Diameter = 2 in Force Main Length = 78 ft Force Main Void Volume = r .7 gal [C] Total Dose Volume TDV'i _ 150 { < 0.2X design flow + force main void volume) Vertical Lift = 11.97 ft 0 C t: Concrete Block 3" Approved Bedding Material Bene Tank PAGE 4 OF 5 ■ ■caq t.r: ey iuvur r11.u2", :%j (typical) -�-- conduit 4" in. or 2.0 ft above Es fished Flood Elevation (typical) Airtight Seal n Disconnect 18" Min. (typical) Approved Joints with Approved Pipe 3 ft onto 5oiid Ground (typical) *Install and maintain pursuant to manufacturer's instructions. PUMP --OFF ELEVATION - 83. 53 ft INSIDE BOTTOM ELEVATION = 82.70 ft [_� 78 FT. X .1.39 FTI10X- 1.08 FRICTION Ft�(=: i-C 78 FT. X .163 G , F`FT _- 1 �?. 1 C_3,Ai._ �_ L.�:)':�JBACK gal/dose D GAL/DOSE - 71 = 1 3. -} j _D0S 750 GALS r` �137'.2� DOS LS-_ 94.50 - 83.3 PUMP OFF 9.. t F: IN11ET .50 FILTER LOSS = 11.97 Volume = 1000 gal Manufacturer: MIDWESTERN PRECAST Pump Manufacturer: GOULD Pump Model: PE 41 h m �,� See attached pump u ) Controls/Alarm Manufacturer: SJE RHOMBUS Controls/Alarm Model: AB TANK ALERT Float switches containing mercu are prohibited. SEPTIC TANK(S): Total Volume = 1750 gal Manufacturers}: M IDWESTERN PRECAST Install approved farce main filter pursuant to manufacturer"s instructions. Filter Manufacturer: NEW SEPTIC SOLUTIONS Filter Model: 324 r a Dated this : - day o 4 Jeffrey $- McLAturg Vf f> I (SEAL) *BY: A#fey S. 46CIurq AUTHENTICATION ACKNOWLEDGEMENT Signature(s) State of Wisconsin � Authenticated this day of C ty Of SS• TITLE- MEMBER STATE BAR OF WISCONSIN Personally came before me this r=-- y day of (If not, 0 ;- the above named Jeffrey S. Authorized by §706.a5, Wis. Stets.) ,.,,....,,_"..,......,.� `'•. Mcclur , a single person, to me known to be the 'instrument person(s) who executed the foregoing and THES wSTRUMEt4T WAS DRAFTED BY: ..� Burnet Tale -Andrea Noble, 7550 France Ave.,�db,.Fr +r a`' „ ;1 5543512134021-10265 acknowledged tl a same. �� ► f ., �. f ..4 • CC ......... c L •'•.•., t�''Y ' Notary Public, State of Wisconsin •'••........,,..•• ..� �3v Co rn�� his (expires - _ permanent} St In -ground Dosed -Gravity Management Plan IMPORTANT - PAGE 4 OF 4 The owner of this in -ground dosed -gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area [] eratin Limits: 750 "'; TSS � 150 n L"; FOG 5 30 mgL"Desi n Flow gPd; BODg � m L Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (t e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., le s, breaks, corrosion, etc.) o solids volume in anaerob treatment tank(s) and any distribution appurtenance(s) (i.e., distri Lion ! drop boxes) o neglect or improper use (i. , exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribut n cell prior to dosing o dosing irregularities - if appli le (i.e., pump re -cycling, float switch seftings, etc.) o electrical components - if applica a (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice gging (measure lateral distal pressure-.ompare to design specification) o surface discharge of effluent or sews back-up into structure served Maintenance Checklist MAINTA14 EVERY 3 YEARS (or t;ohen necessary) o Septic and dose tankLs3 shall be pumped by certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tanks exceeds ones -third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of conten shall b pursuant to NR 113, Wisc. Admin. Cade. o Effluent fllter(sl shall be inspected every 3 years anXsll be cleaned when necessary to remove any accumulated solids according to manufacturer's specifi Lions. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted t SPS 383.55 Wisc. Admin. Code. Report any c Name of individual or company: PAUL STE)om Local government unit: o�[he proper local government unit in accordance with �onent failure or m• function to: R PLUMBING phone: 715 - 425 - 5544 ST. CROIX COUNT ,YCOMMUNITY DEVELOPMEN% Phone: 715 - 386 - 4680 Local government unit address: HUD�JN, WI zip: 54016 Any defective part of this system shall repaired, replaced, or removed pursuant to St--'S 383.51 (1), Wisc. Admin. Code. Repair or replacement of faile or malfunctioning components shall comply with SFAS 383, Wisc. Admin. Code. No product for chemical or physical estoration of the POWTS may be used unless approve��i by the department in accordance with SPS 384, Wisc. min. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. EXHIBIT "A"' Legal Description File No. 2134021-10266 A parcel of land located In the North Half of the Northeast Quarter and part of the South Half of the Northeast Quarter of Section 7, Township 29 North, Range 19 West, Towns of St Joseph and Hudson, St. Croix County, Wisconsin, described as follows: Commencing at the NE corner of said Section 7; thence S3`39'50' IN (true bearing) 330.46 feet; thence SUb46`W 1174.86 feet along the centerline of an existing Town Road; thence S88*55'34'W 1011.05 feet to the paint of beginning; thence S88'55'30"W 533.78 freet; thence NU°46'E 284.49 feet; thence N58007'40'W 193.36 feet; thence N31 °52'20 "E 107.21 feet along the Southerly right-of-way of the Town Road; thence Northeastedy along said right-of-way line 186.90 feet on a 146.83 foot radius cure concave Southeasterly whose chord bears NG8`3V20"E 174.37 feet; thence S74°41'40"E 34.40 feet along said right-of-way line; thence S54'010"20"E 132.95 feet along said right-of-way line; thence Southerly 96.64 feet along said right-of-way line on an 85.00 foot radius curve concave Northerly whose chord bears S86°44'40"E 91.52 feet; thence S29"29"E 504.49 feet to the point of beginning; AND Lot 1 of Certified Survey Map Bled in Volume 6 of Certified Survey Maps. Page 1753, as Document No. 424423, located in the Northeast Quarter of the Northeast Quarter of Section 7, Township 29 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin. 5t Croix County 1138200 Page 3 of 3 Wastewater METER 10 0k PERFORMANCE RATINGS PE31 Total Head of water GPM 5 52 10 42 15 29 20 16 25 D -�A L4 K41 Total Head (feet of water) GPM 8 61 10 � 57 15 46 _. 20 33 25 16 Ed 70 GPM Sd 15 m3/h PE51 Total Head (feet of water) GPM 10 67 15 59 20 50 25 30 39 26 L�35 $ --PAG14L 3 I r% Uep4f T M feAt c)f I nd ust r y, A xa 6.,.,t a nrq i i urn an Rela I tons S of ezy and B u i idinq � Divnoun GENERAL INFORMATION PRiVAT E S E WAG E SYSTE M INSPECTION REPORT' (AT7ACH TO PERMIT) [—j Cily vk1jage V Pier n i: PicAd,&r'% N-am,o WORKMAN ANNE & CHAP-LES Sri JOS EPli CST 9M Fliev I ns; - )'6M Eiev B M [>eSt F 15A ko n �4� 0 t -J ) 0 + It - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER septic g Aeration Holding TANK SETBACK INFORMATION CAPACITY TANK TOE P / L WELL BLDG Air Intake ROAD septic 170 NA DosEn Aeration x 17(7 NA N A Holding (Ovnty ST. CRIX ,dng.ary Permit No 299142 State P an ID Ili P,5t(,L1; T dA No 030-1028-90-100 VC819RIMEM6 RUMP / SIPHON INFORMAYION -2,7 5" qq.& Manufacturer Demand Model Number .7 2- 0 C TEOHLINq Friction, sclem, r,% TTDH1e4.LC&Ft Loss a -, ,` � d Force ai n Lenny th D 1. . V ousl 'ro Well (U SOIL AIPWRPTION SYSTEM 100 1 4cse, BED RENC wi,C L ength No 1— T01 Trench*-% No Of Pits i 11i-a Liquid DePTh IL WMEN ULML_ YSTE SM TO P 8 L DG WELL LAKE I STRE/-IkVL LF--ACHING fX:rer- SE-TEACK INFORMATION CHAMBER OR UNI T Type Of DISTRIBUTION SYSTEM 71e�a_er) M-ansfold DisiTTUt', x i ale L_je x Hoe spacing vent To Air Intak e Did Did 3o SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only, ic. 1) 10 %, 4- r Depth Over wit Seeded i Sodded xx Mukhed LD10 Bed ; I renc, h Centec 84?d 17 r(ench E dqes Y es No yetN COMMENTS: (include code diiitrep-ancies. persons present, etc 1.0CA11ON". ST. JOSFPII 7.29.191.1071lNEINE 1093 GOLDEN OAKS E 6- V_1F (Itp 1.15 /1 r, bik wl b e Q(ec/y r r, VC or I io,� OVCZ f tn C, C C :>/a) 7 L LI reciijifed) Yes (01 a jr0offlicition t_j,s,c4 oi 1w r sid P f or add k lk o N1, �DD 600(p OV91� Of kwuaty, SOIL.. AND SITE EVALUA71ON Labs and Heut�rn � . Mi 6 o'sever ands in aowMam wfth s. ILHR 83.09, Wis. /1tOsch a!s plan an paper not teas Mien B 1t2 x / 1 Mxdbs in size. Plan must COL"* irMchWe, but not iNtYcf b: vertlCai and hotFzaMrl Ieferona p'oirt (BMi, dndlon and Pe►cent sbpe. OcWe of dtnetxlorro, raN► arrow, and bCaiior► end da{erxx b numst goad. P�rcol 1A_ e O 3 0 . /p zP . ,�Fp APPLICANT NiFORMATION - Pleias prNit,�� lrttorma!lort. ps,s�r ra�,serw+ � provide�+.r o. �.w �w s.c�«.a.n vwvo..+ tn+n�.y u... � s.a t+� tm��. Owrw Ity P Cff • '-R,44 I*V (3ovt. Lot 1N 1/4.S IT _2-,t.N.R E (a) W Property Owner's Ma" !Address Q�.� Lst% . Lots 8fodcf! Subd. Non at CSMN /093 coo o�.�.� •,ku c� s r%State 23p Code Phone Number NOW" %��itJ i W /. I ,f'y0/�O 1(�/S j 3?6 ' �$'A � �'S T� ImamTot F P TOM I CnO�9� G,�('S' L t! C] t on Lfte: 0" r Mx.ntw of - #A G�eoftmneftt 0 Putft or - cab: =A14o e4,4 � Cade da+t�ed AvMr Reoarrrnded rate �// tied, (0 marchgpofir pr -AbwTftn am I required , �z S �,� zMaAmum dasign bacfuV � * red. buch Rom, w v M-4-R "ed h fdb s W w0we ate aw(s) r% ..3 tt (as maned to she plan benctrMk) I ! litkmwW d*WwVw1w1 %AXwkhmMftw AOW+Ai Ij %C low Parent nu te" .r! 4r OI Xt ► 4-At 0 Flood plain atevalvn, N --ft S She ior system C.orAwdond A Cxxxi essur�e AT -Grade Sy"n in Fib HMft Tank U_ �� C�Ca u Ca no"S u ;S,❑ u ❑ S u7T 0 s C] S C� Boring # I Ground FA9. ever. Horizon Depth in. Doff*mrd CA*x Mxwefl mots" Qu. Sz. C.oior Texture Struck Gr. Sz. 5h. BwndwY f ooft Bed . Trench 16 /0 Voe YZ- 2 7. Remarks: Depth to lip Remarks: � o•g �oy/ rirl) 5-/1- Hof 0 P.A-%P 45 3 3(o 7. 5 YR -Z -f -fik AA 7W e.5 -fo 14/ 7 Sye mC G S �►+a �y►+.� 4-C � . "1 - 6L 24". SST Name (Please Prktt) Signature Tetephor» Rn�R� Z/G6RicG�i— 7tS- 38G•�SS Dale CST Number fit* L 5- q C* S 7- f PCN*ta Sawag* Consultants rKO; fVMoV Rd. r _ - - -A . . %.Lj..a1■ a i .>uairinV VsL I�-LVN ►LNV.LdVi.lh1 (s&w kid cru o - motiS � a )Upe f AS� pumiju ;#A x r. it auu% :s)Pewau�.w.w 01 4jdap ' A$t8 punoj&) rr - # fsuuoe Iim ZS JID ainpruiS X*O W8uPjOQ 4VJsG UOZPOH -u, X)Pej 014000 pUrK)Jf) BUUOg 0•0•1 13rrd • . A MOdSkJ NOLLMHO'S30 IIOS R rr..11 oy,ol Z)Z 420023* J P �5 7? .. . .. ... ......... CERTIFIED SURVEY MAP LOCATED 1N PART OF THE NE} OF THE NE} OF SECTION 7. T29N9 R19kt TOWN OF ST. JOSEPHT - ST. CROIX COUNTY, WISCONSIN ALSO BEING PART OF THIN PARCEL KNOWN AS LOT 9 OF TROUT BROOK HILLS. ur 1'�► i N} CORNER NE CORNIER SECTION 7 SECTION 7 T291R19k �. ` rnorth line of thip NFJ 4ng I v T�9 R19Y :- ch 1310.52' C1 v Cr �r 4 cv w v � cl ew o -+s . � Go a ae e• v • cti � 4 Got Of# rr a #r C C 85 rn 1" r a w• ► 4 1 FUND DEC 4 1986 SCALE IN FEET MAM 01ON"& w M asaw 4* gawk 40 20 O 40 ��'v oww am*& OWNERS Rudolph C Kathleen Blakeman AREA OF LOT �',,�'v� '� ea.�' 1222 Golden Oaks Lane r ',?a ��� 2,400 square feet �- r' - l,a� *,. •�' ��7��f. Hudson, wi . 54016 �o t°' 0.06 acres • �' .S, ., p..1r .'� m LEGEND ` County Section Corner Monueent '►� i� . D' LOT 1' r-1 b TAT ANI r L,. S TAR V PERM11 I A or AJ U, he purpose of the sanit.-j r,,- permit's to affirm- instalia t i-on 0 f the p r -L Va tCS eNvage sy s re. [ii des r i h c d j n Lh c p c r mit. h.) Tkhe approv"d of tho sanitary po..rmu is ba3i-A on 1 e ir LI'la tj u n N I P, fn r c t, 4) 11 61V d 'Ll I t Off- 1t V P I-OVa']. (c) The sa n rta ry n c- r 111 j t is � 'alid an d may ire re.newed J'(j ir i L LICe# Z2,541b) spe.65m(IPL�T--ald_ 5 0WN OF 14 (,) Ru ji c -mul of flie, � a yn I t2 n- 1) er r n i t will b,--, 'b. t � L;J on SEC 2a�9T Nq R r ecyul at! f) n,, i,n fo re e at I'l 2 t. tires r-c n cvv a I E� s o vphi, a u Li i I],,,% c h an U Cd V 1� 0 11121 jO � 1!� IT1,J N' j [11 p �2 d e I -ell e W.-j (f) T'Res:m1tary pormi-tis j['.Stj]rV- 1917 C-._ 1 L:. -11 2 1: 1 91 I -A19N V/ %j n _Lj V I I,:� IWL"UA, 11 rfi AUT' ORIZED ISSUING ulT-Tv" - 4 - 7L_'_,e -Rd. N c i 1'0 U IV I S 11 tO tT' 11 th t 1) emit, 0 r t T_2L n S I'Q T f)Wu ersf I i p 0 f 4- Lhe-. p,rniit, PI -ease con Ear , the couaty audlorityr. 03 13-A.7-0 F�4 r-� , 71. T IN PI 1,77 T DURINC N