HomeMy WebLinkAbout651311 030-1090-60-000Wisconsin Department of Commerce PRIVATE 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:
LTLM LLC - Michael Leverty
City Village Township
TOWN OF SAINT JOSEPH
CST BM Elev:
Insp. BM Elev:
BM Description:
TANK INFORMATION
TYPE
MANU TURER
CAPACITY
Septic
tom,
Dosing
Aeration
9
TANK SETBACK rNFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
ON 1IIFORMA
Ii %l l%%%�IIII/I■
�fI ltl��
�ZmfimvlwF"Mm
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651311
State Plan ID No:
Parcel Tax No:
030-1090-60-000
Section/Town/Range/Map No:
31.30.19.326A
�=a•�r�FAirn
nnM
�{�ti3�hLi7E�
F,1�r1�167G�ic'
WE MESi!Ml��RL1�
BED/TRENCH
Width
Len
No. Of Trenc
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
I
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LEACHING
t rer.
INFORMATION
T Of System:
2
CHAMBER OR
UNIT
o e umb
DISTRIBUTION SYSTEM - I f. Af. Mra.lnr A
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Ve t to Air Intake
c �
Pipes)
Length Dia
Length Dia Spacing
SOIL COVER x Pressure SIvstem9,Only. _xx Mound Or At -Grade Svstems Only
Depth Over ti
Deptj Oveyr
x D of
xx S d/Sodd
x Mulched
Bed/Trench Center
Bed/ re Edg
oil
Yes No
❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: No Address Available
2.) Bldg seDwer length = `escription �`�r � —�w`�� ���a��
- amount of cover =i
Plan revision Required? ❑ Yes It No
Use other side for additional information. � �- � g ;M� �
Date p s Signa ure Cert. No.
i, a _. _
C 1nu11e r,2
e
Safety and Buildings Division
,S/,v,A•
St. Croix
' 0 i�C ; Q2 ���
201 W Washington Ave_. P.0 Box 7162
�anu+ln i'ernvt \umfhr no 1k lilted n, 1,\ (`,, t
Madison, WI 537Q7-7162
Sanitary Permit Application
Stale Ir.In ilL114111\urnhCl
In alciii-Janc¢ will tiI'S X; ' fl'1 111s \dnl (',1lle. `.uhniiw, ir1 of this 6Lli111 lei Ihc.Ipproprrdtc I%L7-ntnrnt.11 unit
Na
I, fetlrrnYii hflo,t110htall ln'-- .I 1:1r111:U1 per1r111 \kite 11,t,Llcanon looks lur ;ra[c-caned lit M I S sire aihmltted nl
Project \Jules, 111 di11ercnl thail nlarlIn,• .rd�irr;s1
l Y kill ` ltth �rl l f rnll s nnl, tl',Lrn 1Lc; I'enkirlal illlilnll,tuon 1nu pro%IJL, 1ndl he useJ 1'or ;cco[l,1an
the1j
3QS—
,l,lrtln'`n,
;, I+ I ; uSI 1 t11n 1 ',t'it 5
)ld F 14 est
ilicatioit loforot kIitrrt - V lease Pr`[Itl All Information
'1�1'+C11', II•, �, 1'CI �t.;llle � P5"rC= � �„{.
IAl 1 �
L I M. LI.c Michael Ltvem 030-1090-60-000 —>,nj loc4}ia�
I'll+lleM 01%11421 : \tdrlln,-, \ddie.i; I%i.+pc•r1G I ki[all[+rl
201 2"" St S. Gorl. Lot
( Ilk ',it1le L` Plll+Ile \il rllhl'r -_ _' 4 Y►' , N r.. n, tiL-e't kill 7 1 ,
onrl
Hudson. ll 1 54016 I 30 \ N 19
11. 1-,lpe of Building (check all that appl►) 1.a1 ri —
® 1 or-' Iannh DN%ellln+_ - \unlhei of liedrootns \reeiaor\ Stl ne(Lll L• �a ti11l,,l1\1sloln \ar1,c
131n:k \a L
❑ 1'tlhllr i omnurr,al - Ih°�nhl• l x' \:1
❑ CM oI
❑ SI,1R [ hided - I)e olhe I ,e• ('SV \Maher ❑ 1'II Lrs c n[
-
Na 0 tomn ,I' St. Joseph
ill. I ►pe of Permit: (( heck}} only line ho-, on line .\. Complete line 13 If h appllcale)
\
ry ell',ltilenl
LJ Relll-wonwiit',\,t L'nl ❑ I[caiwivlt Ilol,lllig Intl. Repl.[rcnlclli d.Yrll%
❑ I. Yt ller Modlfi::Illoll [i, I \],[In- tit ;tcln le\plJlrli
B.
❑ I'L'rrnn Nenellal
❑ Permn NL•l l,lotr Q (`hams of i'lunlher
❑ I'ennrl I r.Ill, ter t,, te,l
I I re11, M, feria rl \ Lill) l,er And I)ale I„ned 1
Be rIII 'e I cp IIX Kr 11
[ lu ner
I\ . I .pe of 1'()1\ I'S ti,%►tem/( onlponent/I)e►ice: (( heck all that apply) �2
❑ I loldlllC ]ant,
(,ri+lund ❑ Prc\,tlrw"i Ili-1 pound ❑ \I•(,rade ❑ xlowld _ -'a ill of Su1t.111Ie u111 ❑ \10llrl:r k Ill ill'alltjblc ,lal
[ llher I)Isperti,rl ('orrlponelll iv LPI,lur) ❑ l'relrca(lncn[ Der Ire Ic\p1.11nt
I)icnercal/`f resrtment \rea Informalion- I'rlh -1 III. III -"i 011111rnl Illh•r :11 '4 1 c,lltlrr Int hr.,l u r )-7 I,•.,,+ ill" , h ir„h,•„
I)csr n f Imt IL�pdI ITr\I Ir',kill Arphc.ltlou Nalel-'Pds 1 Ih,per.rl Irre Nryuu'�I (,I) t)ispervl Ir 1 f Inl,l„ed t•l`I ti stem f Ie\jIloII
I �0.0 Gpd 0.4 Gpd sq. It. native sail 17�;.00 5(. It, hoo,40 sqj fll. Q2.4;0 4 ')c1.(H)'
1 1. I ank InGI C'apacn\ in Iolal = of 11.1'1, 11.:, 1,1 C1
Gallurls (iallunti l nuts
\;n lank; I: \,slink. Tank:, 5z���.c _. .� •r r r _ r
srt,n: ,n Iloldin�. T.ulk
7501300
Na
1.000
1
I\ le er Concrete
1 II. Res lrnntiibility Statement- 1. the undersigned. aklume responsihilih for inclallaIion of the t'ON 11% %ho"n on the apaehed plan..
Oli;ivl-ci \amelPrintl f'I ulnher SStolatule i11' VI'la \ nnhrr liu,lne„ Phalle \ulilhCr
Gar\ Zappa \1PRS 2217, l71 I +86-28;0
I'lillilher , 'Iddre„\Stied Cll( SIAC 711'( oiler
715 6"' St. N. I iud,on. \\ 1 540 16
1 111. ( nunt►/_ 1)cpartment l cc 0n1%
1,.4pprl Perll,lt I ee 1),111' l\wcd I. llln_- V-Mll tiIL•rl:lrllrc
wplo%ed
(`
� 53�� �°1!g
L; .,,[, to • I;,I ?,�23
IV ( onditiorna pl ro►a I`o►a1
3��tGQ55ortx2.�"Crt�tvrT floe: 1C�Ib�`E.
SYSTEM OWNER: 1°L[o(rerm�
1. SID* lank, effluent filter and dispersal call if _ -0
must be serviced + maintained as per "l J AN-1% — - - r
management plan provided by plumber.
2. All setback requirements must be maintained
as per appllcable, core I ordinances.
►flach m complete pbins ror the .1Nein anti submit rn [he ( \stunts, anh an paper wit Ie,s than k 1 2 s 114whr+ in sin•
ti 111)-6,99 1 R. I I I 1 I
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Q?Gln/ :0a121 /9
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7W.-2 910r }ou
rn/-ors -oi of -OE'O #
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14
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p¢raS- �Or.-oFOrI
;�� jo •}� sue.' '�%'d Qas'j''S.SBL' P-wlsl,!,1'�
✓r4„`sy.� P„Tj� �'a(ir"°?-'� �i'•� �"m/mod
A �ImQSL-dam •a������s'�+� pasodo.�
'o�•doP'y's„hil
,07jEi vo,p,5 ibc Svo+�-�pola�' aJ-/- -S
C--" x; '?j D � s
+�. d7v .OL
1yi,?v�ic+�ir� hr�u �r(r�S
,014=„ /te/a�/�'S
Accessory Structure POWTS Index & Title Sheet
Project Name: LTLM, LLC Accessory Structure
Owners Name: LTLM, LLC -Michael Leverty
Owner's address: 201 2nd St., Hudson, WI 54016
Site address: xxx Old Hwy E West, Houlton, WI 54082
Project Location:
Subdivision: Na
Legal Description: SW 1 /4 NE 1/4_ Sec. 31, T.30N., R.19W., Town of St. Joseph, St. Croix Co., W1.
Parcel I #: 030-1090-60-000
Page I
Index and Title Sheet
Page 2
Site Plan
Page 3
Dispersal Cell Sizing Calculatons
Page 4
Dispesa Cell Cross Section
Page 5
Infiltator "Q-4" Specification Sheet
Page 6
Septic Tank Cross Section
Page 7
Filter Specifications
Page 8
Conventiuonal POWTS Management Plan
Page 9
Ownerhip/Address Form
Page 10
Accessory Structure Affidavit
Page I 1
Parcel Map
Page 12
Warranty Deed
Attachments: Accessory Structure Constrution Plans
Mater Plumber Restricted Service: Gary Zappa, DSPS Credential #222373
Signature: Date:
Page I of 12
Design pursuant to In -Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N_01/01)
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Pn/-ors -oi o/ -OE'O #
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4
4
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t
Ryro'i-c�ni-oFo►+\ ors 105.�
'as4-7
aJ oor
pasodo��
p¢raS- �Or.-oFOrI
;�� jo •}� sue.' '�%'d Q�'j''S.SBL' P-wlsl,!,1'�
✓r4„`sy.� P„Tj� �'a(ir"°?-'� •'�ir'•� �"m/mod
A �ImQSL-dam •������s'�+� pasodo.�
\
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,014 /te/a�/�'S
LTLM Accessory Structure Dispersal Cell Sizing Calculations
1. 150.00 Gpd design flow
2. Infiltrative capacity of native soil = 0.4 gpd/sq. ft.
3. Absorption area required: 375.00 sq. ft.
4. Absorption area as proposed: 650.40 sq. ft. (32 chambers + 2 pair end caps)
Infiltrator "Quick 4" = 20.00 sq. ft. EISA per chamber, Infiltrator "Quick 4" end caps = 5.20 sq. ft, EISA/pair
625.00 sq. ft. — (2 pair endcaps)(5.20) = 614.60 sq. ft.
614.60 sq. ft./20.00 = 30.73 chambers required
Number of trenches: 2 q(, 16 chambers per trench (/"Kchambers total)
Trench width: 2.83'
Trench length: 67.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 12.00'x 67.00'
Pg. 3 of 12
IN -GROUND GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down -sizing credit)
0 SOILCOVER
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
a d
sa- p
ilvPlr.np .
Septic Tank(s) Manufacturer
Wieser Concrete
Sc[4ic Tank(s) Volume(s):
`000 gal gal gal goal
Effluent Filter Manufacturer;
PolvLok
Effluent Filter Model At PL-5525
Provide minimum 3 ft
separation between trenches -
Highest Trench Lowest Trench (as applicable)
System Elevations = 92.50 ft; 90.00 ft; ft; ft; ft
Quick4 Standard-W
wl End Cap {Show location of inlet I outlet
(typical) pipe connection on plan view,}
W-- —————- ;�4_------------
8 = 67 ft
INSTALL PER TRENCH:
QbS9rvatk)n Pipe
{typical!
Install Per rnanufacturer's
inslruct¢ons,
A= soft
(ly€-acal)
TYPICAL TRENCH
PLAN VIEW
(No Seale)
WI
Wulurk Standard-W Chamber
(typical)
(mfd by Inflltralar Systems, Inc.-)
Install pursuan! - rnariufactureel instructions.
16 Quick4 Std-W @ 20 fr EISNchamber = 320,00 ft
+ 1 Pairs of end caps @ 6 ft' EISArpair = 6.00 ft.
Proposed EISA per trench = 326.00 ft` Required Infiltration Area = 375.00 ft` Distribution Method:
x 2 trenches = Proposed Total EISA = 652.00 ft` branched manifold
CN
v
a
Quick4 Plus Standard Gliamber
Quick4 Plus All -in -One 12 Endcap
�Sj ��l ZED D�DE UFIIH
J71 LOCATIONS
Pt 4C.
J_
33
FRONT VIEW SIDE VIEW
Quick4 Plus All -in -One Periscope
OUICK-1 PLUS
ALL -IN -ONE PERISCOPE
1360 SWIVELI,
J-1 -
t:1k
2,,INVEW
_#Wc*4
INFILTRATOR WATER TECHNOLOGIES. LLC ('INFILTRATOR")
InfiRrator Water Technologies, LLC STANDARD LIMITED Drainfield WARRANTY
il T,,- it-?q- t� 71 ay,I 7,a,ber F701o, expanded po"Iyrerie and,or other
I il llia'x j i tj i w,,t�,, x,d operated Ina learhfield of an
:ws,t�! i ?'II I A " 1"! .: wa-antect to the anginal mr-
--a3e! ,at- al, a- - Iv. p ',- j .tea, J3 -al tv,e
Sep, C SS,,Cp 1�, Ser C Siste co,ta 7 1,7, -I'C J, IS ;yo,'ded. noo;,2"2, . j! !1 2 sp, I .! It, -,)I'-
pvjI-1 1,-, 5 11 JPDI ca. -J.? Iar. `he &x.v-!, Dt'e �d e. 11 171,!1gill �,IDQn t',2, JJ` "al IS1,1113-
e Send i. ; v it el ,w -r. hs. -,,- e a er,- ,e Ito xar, -I - 71 y r,g I, j tr', If I r II 1,.-ilw
,I l'ilgat iS Coq:,-1,31a Heajq_1,fS in "IC a� S -.1
'11- alttazicr: _Ie'ec' Infill,3ia, -.N 11 SUQDI) reoljeeerit Jnls'o- Jorts de'ern o,ea bN 1t'ia!Dr to
ed by 11, s Lmte..., W3`3-%, Ilifillutlor s kabdil. Spec lic3ll. cost Dt!efr-rv313rC
),,!-5taIIzt,or ol I,, uimis
in, THE , miirED %%ARIqAN'Y A14D HEMLOILS IN y[,RPAqA'GRAPH al 4REIHEHE
ARE NO OTHER WARRANTIES WIT- PESPECT TO THE UNITS IN-, JI)ING NO IMPLIED
,'.`-AARA1JTIES OF VERC,iAlFTA811 ITY OR FITNESS rOR A PARTI�ul LIP PLRPOSE
qhall,Dc 111tDalt fl 't- -i m-t- Is �an,'aci�,(?:� b; aiyone
er iar, I 1 , T �
r1, It a loI, r, L I - I I'd I' .,! , .: ' , I it Or
111:1, 'r .,t!All i,jr b- .,I, - lot P:, III - j, 1; t3l
pojljcl,ap ancl D,LY IS 3,c: Ma'-,iji, 3ts 3, o-1 nc.,j,,ej I]-,
r
Tie or 311y I- ' J L, r, te;- v ig-2 are "3,-aqj? tc
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tie Jmrs :,,e to j- I' .'J !ear. aiteia* ;eni, mist--- :Ir Dt tie .,..nits:
Jr,ts beira s:;n,e_led c le C o, ons .& ❑L,e .5. I
silljz' or 5 I' I,, -3 tO mv ,fa, te ,i n d covers sal ,sIrc
5
on 5: 1 h :1 DI i 't 1,i s% Stem co-7amrig Of the JmIs
;Jr 'tie se.W lue 1" ;ffrAI er 51, Ing -'. X Ueti -TI;)'0PfF
y we ; , ,i, )'hff ?Venl nOl GaUsecI 111" 1' tw, LOA i,G
0jarraw, if-,,h t3 - i . . . i,; tI, wtn ;111 ""r :. , , . � . , `, vIvl I, t -NI,
tj2rraln!.. '"Fine, I i. -- .:'I 'rWW III or v, ige to t,e HQIder
!ne Jr',!s, o, iT y iA par' re._j:jcmj irain-, -i,,ialhit or- ;i- ,Lp,iert jen ar,� hatmlily
la ms -it Holder o, any !11 d oar-,v. - o, 'Iis L.,n,17�.' &:ii,,3v tr) 3poly the W1,118 1'uqt :3e ristalki �r
3co,ja',_- wrrl all -eaL,red o% s'.3tp, _wc lci'.:] ::odes. all othe, 3r-%pl Maple I-I.vs, ar,a
Intilvator s insraltat,on :nsif,r! 'lls.
B�yvsPark Road
cjNc repre5i,I!37-�- of li,':IT a'a., nay the 3utiDrr% trange x 262rtr.s L,m !t?,� Warwl�. No
*afrar!-, :Lpplies to 3n� part, Th� -z S!-,,,,Jarc
RrJir,8
i,T �)64r5
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bm,leC WarF3r,,y bv 01 53Tt!5 a'"'It ,,, -a%—it %ar•
F.— 360-577-70011
rar!, requreAP, r ror!a.: I ' !', -j, I -: - :porate HeaCqj art e f s r
INFILTRATOR 1 -80 0-2 2 1 - 4 43 6
Old Sa,lo,o, � __, 1,p,, i�to cb3 1 i'), f:,' '• aQj-*cabIe warranly. and
WWW.InfiffiatorwaleF.aOrrl
0ould ;',Ir,!! 11, react th,)t prior to ;he owcJa,3e W Un is.
J_S 9 '361. 1 1 J6 136. 01 i a. to, 116 J- 159: 1
_-KIq ti.1-1 Ca,,ao,a,, 329 959: 2.OG4„ 6,' jll,er paler r5 pei6r,4.
h,kl an-1 lra,j,ma*, Th-I.xp Irihl(ritm ;s i reg+ rr..c 1lnG . IrditilratarWatw Tet:h—fiIgi-,ig a regsii—d rnaclei,ars, n klc�
.imvo-,, II,c,;Axach,g PJI%T,Jf Molhp art P.,IyIl � k Uij-rkC1.,I Snip[
,.,,k 11 SIrjighll �Xk 1,4,11rate. Water Tech"oliogies.
PolyL jk S d wI P,,,IyJjk I-w TUF-TFTE 1 <1 ryri,t d ,,t TT.TITE INC rjhr,j-R-t,
Is 4 lrdd-wwk al IPFX
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P1 ljs,75 j8lr.
Pg 5 of 12
4" CAST -A -SEAL
4" CAST -A -SEAL
FILTER OR
BAFFLE
Ln
_II - OUTLET
II
Q
U
---�-- ---II
(TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
WLP700/300- M R
TANK SPECIFICATIONS
DIMENSIONS:
o
WALL: 2 1/2"
a
a
BOTTOM: 3"
COVER: 5"
w
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
a
HEIGHT: 53 1 /4"
LENGTH: B'-B"
WIDTH: 7'-2"Li
BELOW INLET: 42"
LIQUID LEVEL: 36
o
E
WEIGHT: 6,790 LBS.
l
o
0
INLET AND OUTLET:
u
v
3
�
00
0
4" CAST -A -SEAL BOOT OR EQUAL GASKET
m
o
a
INLET AND OUTLET BAFFLE AND FILTER:
a
Z
a
o
-
3
w
WISCONSIN, SEE DETAIL #10
v"
o
o
u-
(OTHER STATES SEE CHART)
W 0
LIQUID CAPACITY: 26.79 GAL/IN
W
LOADING DESIGN: B'-0" UNSATURATED SOIL
G�.1
CO
TANK CAN BE USED AS:
z 00
SEPTIC / HOLDING
o
a �
COVER: MIX DESIGN #8 (NO FIBER)
NO
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
W I
O
CUSTOMIZED TANKS:
_ 00
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
W
3
cr-
J
o
O
z
Z
Q
�
I
oo
�
c)
REVIEWED BY
REVIEW DATE
a
CL w
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
SHEET NO.
APPROVAL DATE:
Z
PRODUCTS NEEDED BY:
/
OF
IMPALYAOMDX
�7r [ r
11,_-525 l_1 fI �r L�i'i del ltt��t
P1-;2; I filter
F11L' I'1.-32; Filtl'r i, rateLI for 10,0110 (,I'1) (rallon, Per Liat
y makins; it one tit (lie largest tiltel•s ill its class. It has
;2; linear feet of 1 i In" filtrotioi slots. Like tilt' 1'Ol� Itch P]
-122, the I'nI1'Ink. PI -5-2ti has an AlItOMatir tihLIt-otf ball
irl�lalled %, ith every Iilter. Whetl the filter is tLrr tleanin�,. the ball IL ill float uP anti tC111porarih' shut Oft
tilt' �1'~teTll YI tilt' ettluOnt won't IeJVC tilt' tank.
I e,lltlre�:
1/16" Filtration Slots j
• RateLl for 10.000 <_,I'1? I ;allor,s per Liav).
1E,Irna �L.'itrh
t()ptionaf)
0000 GPD
• y25 linear feet of I 1/10" tiltl',16 11
• Accepts 4,. alid (i" ` C I IF) Oil pipe.
• Built it, gas deflector.
• AUtonlatit shut -Orr 11,111 %%}lL't1 filter is renloveti.
• rllarttl ar(essIbIIitN.
lIlstcfta t,i'I �
• AL-cePts I'1( ttenSioll haIldIe.
Pi -;2; I I l a t a l 1, It 14)11.
ltloaI for rOsiLiOnti ]I a1)d torIlII)eri ial t- rite t I o uP to
l U,t)t)t) 1;allr+1ls Pt'r Liav (C I'17}.
1. I ocate the nutlet of the septic tank.
2. Rt,rnw t, (fit' tank (over died pult,}1 tank it neCL'Y;L G.
(,lut• tht' tilter hnutiing to the d" or n" Outltrt PIPS:=. If
the' tiltOr is not (t'ntOrt'd 1111del, the at(Oys opening use a
Polvlok 1 \tend & I_ok Or piece Of pipe tt} (enter tiltOr.
4. Insert the I'i -323 tilter into its housing.
3. I-Zeplace and secure the septic tank cover.
i'l -�i'_� llainten.rnte:
I he PL-7223 1411.tent f iltct•s L+'ill operate CffiLientl� log,
several years unLier normal Conditions before requiring
Cleaning. It is rOtOnlntendt'd that the tiltt'r IV k lt'aneti
Over4' tinge the tang. is Purllpt'Li, Or at 10ast every three
Years. if the installed filter Contains an optional alarm,
the OWN ner',�, ill be tlotifted by an alarm "+-hen the IiltOr
IleeLIS St4A Kill,',. LlCfA SllOLlld bC Liorlt' by a rCI'trtlC'd
septic tank p11111Per Or inst,lller.
1 . I oCato tilt' outlet tit the aeptic tang..
2. ROMOVC tdilk COVOr anti Pun1P tank if rtecessarl .
1)0 not ust' plumbing ti hen filter is rOrllnvOki,
d. full l'l -323 Carlridl;r out of tilt° housing.
7. 1lost' tilt filter, over the septic tank, %lake sure all
solids fall bark into septic tang..
t,. Insort the filter cartridge baik into the housing making
sure the tilter is Properly aIignL<i anti COWPIetely in t'rted.
7. Replace and wcure s?ptw taA (over-
-_�flnrnllt
I IItr.rti„n 4't.
III 4
Certified to
NSVANSI Standard 46
t ati 1 04 , for
Oft b a l l
t lutai iio ti,t,.,tlt ill, I X1.11 m I rand & I ok'"
�t IIII, r.:r rht I .,sill° install,
!hr martk IltL'I tiu It, h :,nd alarm mt,, emsting tanks
POlvlok. ITIC. 31 I'airtiCIL) 1310. %k';Illin41Tford. ('T 0049'' 'lull Fret•: 877.705,1):65 Fax: 'll;?44.h314 www.pohlok.rom
Pg 7 of 12
Conventional Septic System 'Management Plan
Pursuant to SP5 383.5• , 11 i- Ad[n. Code
General
I he conventional septic sy stern ;hall he operated in accordance %kith SP5 3,82- 38-1 11 i,. Adnl. Code. and shall be maintained
in ac,:ordance Niilh component manual SBD-I0701 -P INA1 01 ). All local and or slate rule, pertaining to system
maintenance and maintenance reporting shall be complied lkith. Questions oil till' operationor maintenance elf the sy stein
should he directed to the installing plumber, Cary /appa at (715) 386-2850 or the St. Croix- Count\ 70ning Department at
(715) 386-4680,
Septic Tank
Septic tank ,emicing mechanics cotllply %kith SPS 383,541 11ie1. Septic tank to he located kvithin 1,50' of service pad. with
boito ll of tank to be 1 5` below se" ice pad elevation. The opermin-, condition of ilic wplic tank andoutlel filter :hall he
a, e„ed at least once every tvvo years b� inspection. I he septic tank contents shall be removed �%hen the ,Itld-e ,lnd scrim in
the tank exceed 1 ' y the liquid volume of the tank. The content, ot'the septic tank shall he disposed of in accordance �N it \R
13, lt'is. Win. Co& by an indiv idul lI ccrti tied to scry icc :epric t.lnk, under .'S 1 ,48. 51;n,. It' the contents of the tank are
not removed at the time of a biannual a„essinent. maintenance perm nncI ,hat I ads Ise the owicr of when service \kill he
needed to maintain less than 1 3 scum and sludue accumulation in the tank. I he outlet tiltcr shall be cleaned as necessarx to
ensure proper operation. I he filler cartridge should not be removed tlnlc„ prop i,ions are Made to retain solids in the tank
that Ills[\ ,Iou. h off (lie tiltcr \�hcn removed Crow it, enclosure. If the Wier is equipped wi0i an alarm. the titter shall be
serviced il'the alarm is activated. Septic tank manhole, riser,. acccs, riser,. and covers should he inspected for mater
ti4-lltness and soundness. :access opening, u,ed for service and assessment shall he ,enled vvaterti ht upon the campletiorl of
service. Am opening deemed Lnlsound. defective, or ,ubjecl to failure [Must be replaced. l_xposcd accc,v openin_p greaier
(flan S inches in diameter shall be secured by in effective locking device to Core%rot accidental or unauthori/ed cnlr� into llre [mils
\o indiv idtl ll 4hould ever enter the septic tank as dangerou, _.tses nlay he prevent that could cause dcatll. Septic tank
abaudomilem shall he in accordalrce with Comm` l,33. 11 i,. Adnl. Code %%heel the tank is tit, lonucr used as a PU11 I S
componerit. T_he addition ol'biolo,ical or:hcmical additives to enhance tieptic tank pertorm, mcc 1,1_'er)er;r11y not required. It'
such prriducts are used they shall he approved for septic tank use by the Deportment ofCornnicircc. ':A`ctl and Iluildings
Division.
Soil Absorption Cell
Trees or shruhs should not he planted directly on 111C ,oil ah„+rption „,tern. I he area ahOv c and art*llnd the ,tern should
he seeded and mulched as necessary to prevent ero,iOn and pros ode ,omc dc,-;ree of trot protection. I raftic (other than Ior
ve_etatl�l' ilia ttltenatlCC) o7 er the system is to be a\oided. 4oil e0nlhn 11011 nla\ hinder aermion nfthe inliltralive stirface
1,ithin acid above the system and v%ill promote t'rost penetration during crust \%rather month,. Cold weather ili tmllations
(October- \larch) dictate that the s}stem he heavily mulched li,r frost protection.
Influent quality into the vysiem ilia,, not exceed 220nlg L BOD5, I iO 1ICi I_ I'4S- and 30 mw, L_ FOG Influent this% may [lot
exceed maxnnum design Ilovv speciiicd in the permit for the installation.
Observation pipes v%ithin the dispersal cell ahall he checked for efTluent ponding. Pondinti levels above d inches indicate an
impending hydraulic failure requiring additional. more frequent monitoring.
C'nntingenc% Plan
If the septic tank or any of'its Components bc'c'onic delecme the tank or cornpiinent shall be repaired or replaced to keep the
system in proper operating condition, f xccssive pondinr; \vilhin the dispersal cell will be elinlinated by installing a ne\y soil
absorption cell to brim, the ,%stem iwtt proper olicratlr'tg condition, `
Pig. 8 of 1'_
S-[. SANITARY SYSTEM File #:
Office Use Only
OWNERSHIP/ADDRESS FORM Creared212027
Community Development Department will utilize this information 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.
Owner/Buyer
OWNER/BUYER INFORMATION
LTLM, LLC - Michael Leverty
Mailing Address 201 2nd St.
City/State/Zip Hudson, WI 54016
Phone Number (required) (612) 775-9318
Email Address (required)
MichaelLeverty a@Gmail.Com
Parcel Identification Number 030-1090-60-000
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location SW 1/4 , NE 1/4 , Sec. 31 , T 30 N R 19 W, Town of St. Joseph
Subdivision Plat: Na 0LkAAv.f_r&LQ_.L
Certified Survey Map #
Warranty Deed # 148863
Number of bedrooms Na
Lot # Na
, Volume
Page #
(before 2006)Volume . Page #
Spec house 0 yes E no Lot lines identifiable fill yes 0 no
OFFICE USE ONLY
New Property Address 3�S oe� L&—ak— — an Der ("I
(Wnfjcat�on of new address required from Community Development ❑ partment for new construction-)
[a Iq23
(staff Initially (Date)
This form must be submitted with all Private Onsife Wafer 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.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwt, ov
Pg. 9 of 12
Nambet l Document Title
St. Croix County
Accessory Structure Affidavit
Name — (Owner) Typed or printed
He/she is the legal owner of the following parcel of land located in tit.
Croix County, Wisconsin, with their deed or document of ownership
interest recorded as Document Dumber St. Croix Count\
Register of Deeds Office.
This property is described as follows (include lot no. and subdivision/CSNl
or detailed legal description);
OR:
io See attached deed copy for legal description
.area
`wmr and Retuni 7ddrem
Parcel Identification Number (PIN)
As owner of the above described property. I acknowledge that the Private Onsite Wastewater Treatment System
(POWTS ) serves an accessory building on this lot and is sized For a future L_) bedroom home. or a design flow of
gpd. This accesson- building may not be used as a residence on this parcel. i also acknowledge that 1 will
disclose this information and stipulation to any future parties interested in purchasing this property.
Dated this !! day of 4v�Z'� 3
AUrIIENT [CATION
Signature(s)
authenticated this ,day of
x
HTLE MEMBER STATE BAR OF WISCONSIN
(lrnot..—
authorized fir 706 € 6, W'ts St' ?
'rms fN%TRUMENT w'AS DRAFTED BY:
St Croix County Community Development
,S.�in,,r,,,..:, a� be authenticated or acknowledged Both are not
ncrs:�ary
ACICNOW LEDC MESH
SE ATE OF RISC ON4l % }
1es
�. 4 Croix Cuunt� 1 ,j{ yy ��
Prmonall% came before me this 25-'—. day of'LUZPZ3
the atfvs•e Warnemed
I , e r 1 / -f i r_�
to me known to be the
_
penon(si whu esecutcd the foregumg mstntment and acknowledge the
same
Nutar% Puhhc. State of 11 iutrnsin
%1k C`01111%sswo is pernianent Ir last
r`,H �1�IU tItNlrrry
.r
�C. PIZ2/
r•� ?
exViratl kAla\``
Pg 10 of 12
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State Bar of Wisconsin Form 1-2003
W ARRAtYTY DEED
I)ocument Number 11 Di.,: u inenI \' rrm
THIS DEED, trade bemeen Steven E. Erickson. a sinale person
("Grantor,. whether one or more).
and I_TL%I. LLC , a vqisconsin limited liability company
("Grantee." whether one or morey
Grantor, for a valuable consicioration. Conveys to Grantee the following described real
estate" together with the rrcnt.. oro,its, fixture; w::d other appurtenant interests, in
St. Croix County. State of Wisconsin (''Property") (if more space is
needed. please attach addendum):
See attached Exhibit A
1148863
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
02/22/2022 02:23 PM
EXEMPT#:
REC FEE 30.00
TRANS FEE 5,655.00
PAGES: 3
**The above recording information
verifies that this document has
been electronically recorded
& returned to the submitter
Rccardins Area
Name and Return Address
Land :nfe, Inc
2200 west Court. Road C. Suitc 22'.15
Rosesdle.NIN j5113
LT Pile No, 652402
U_i!]-1083'-St}-l1i,Y�,('70_i0ai'1.:ii.:i•f1,00i:loth-10-100,00-ltival-?C
J3U-IO�ifl-b,�C�70 _+i-�l+-;Q0•'�37-109?-�('-I�i+) ;3G-liro"".1,0.{li}!5
Parcel Identification Rumber iPIN r
7'ms is not homestead propert}
d1,0 ii, not)
Grantor warrants that the title to the Property' is good, indefeasible in fee simple and free and clear of encumbrances except
Easements. Restrictions and Covenants of record. if any.
Dated February I I th, 2022
(SEAL.) tSEAL1
Steven E. E.rieE"�,I:.
(SEAL) (SFAL)
Striature(s)
authenticated on
*
AUTHENTICATION
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not.
authorized by Wis. Stat. S 706.06)
TiIIS INSTIiUMLWT DRAFTED BY:
Larry S. Mountain. Attornc at I.aw
ACKNOWLEDGMENT
STATE OF Wisconsin
St. Croix
i
Personal;, cable hefore rnC or 1 Chrr:ar, 1 1'". 202
the above -named Steven E. Erickson, t sinale vtr
to me knu«❑ to be the person(s) vvho csecuted the Icr:e_oin
i R_s7 r nd ackr Eel •ci �k � ;a4lacs
" 4crr tce .1. Buns
Notarl PtlhiiC, State itf i'v iSt•r 'tiln
My Cumr'i�sion is perm.ttien'a )expires: 10 17 202�
ilmonature may be authenticated or acl.no"Ii deed. Both are not necessar%j
\0TE: TIiIs [S > i kti6 U211 1 OHM- k\1 \10DIFIC.1"t`ioNs 36 ritis FORM SHtll I.D 131" (`I E,LRI.1 IDFN I'lf IFDT
"ARFt1ti 1) HEED C 2003 SIA1 E 13AR 01 1115Cf1\Sf\ F0RNI NU. I-'-oq3
Type name beioa signatures
St. Croix County 1148863 Page 1 of 3 Pg 12a of 12
LT File No. 652902
EXHIBIT A
Parcel A
A parcel of land being the Northeast Quarter of the Southeast Quarter, the Southeast Quarter of the
Northeast Quarter, part of the Northwest Quarter of the Southeast Quarter, part of the Southwest
Quarter of the Northeast Quarter, part of the Northwest Quarter of the Northeast Quarter and part of
the Northeast Quarter of the Northeast Quarter, all in Section 31, Township 30 North, Range 19 West;
Town of St. Joseph, St. Croix County, Wisconsin; described as follows:
Beginning at the East Quarter corner of said Section 31; thence along the east line of said Northeast
Quarter of the Southeast Quarter, S00°20'00"W a distance of 1323.61 feet; thence along the south line
of said Northeast Quarter of the Southeast Quarter and Northwest Quarter of the Southeast Quarter,
N89°49'36"W a distance of 1560.41 feet; thence along the east line of that parcel of land described in
Document No. 1006824 as recorded in the office of the St. Croix County Register of Deeds, N00°34'57"E
a distance of 1323.05 feet; thence along the north line of said parcel, N89°50'54"W a distance of
1027.61 feet; thence along the easterly line of that parcel of land described on that deed recorded as
Document No. 589797, in said office, N01*13'12"W a distance of 1257.72 feet; thence continuing along
last said line, N00°47'12"W a distance of 550.59 feet; thence along the west line of said Northwest
Quarter of the Northeast Quarter, N00°34'57"E a distance of 161.17 feet; thence along the north line of
that parcel of land described on that deed recorded as Document No. 803748, in said office,
S89°35'08"E a distance of 224.04 feet; thence along last said line, S15°41'57"E a distance of 257.94 feet;
thence along last said line, N89°10'16"E a distance of 705.00 feet; thence along last said line,
N33°57'15"E a distance of 156.24 feet; thence along last said line, N86°07'04"E a distance of 168.56
feet; thence along last said line, N89°09'30"E a distance of423.16 feet; thence along the east line of last
said parcel, S00°46'24"W a distance of 593.86 feet; thence along the south line of said Northeast
Quarter of the Northeast Quarter, N89°07'47"E a distance of 963.62 feet; thence along the east line of
said Southeast Quarter of the Northeast Quarter, S00°47'O1"W a distance of 1304.41 feet to the point of
beginning. Containing 144.892 acres of land.
Together with that easement for access as reserved in that deed recorded as Document No. 1006824,
St. Croix County Register of Deeds. Subject to all easements, restrictions and covenants of record.
Parcel B:
An undivided % interest in and to a 66 foot strip of land as measured at right angles located in part of
the SE % of the SE % of Section 30 and part of the NW'/ of the NE % and part of the NE % of the NE
both in Section 31, all in Township 30 North, Range 19 West, Town of Saint Joseph, St. Croix County,
Wisconsin, further described as follows:
Commencing at the N % corner of said Section 31; thence N 87'41'39" E along the North line of the NE
of Section 31, 1379.28 feet to the point of beginning of this description; thence S 05°53'09" W along the
Westerly side of said parcel, 354.51 feet; thence S 25°37'11" W 381.18 feet; thence N 85°42'12" E 76.15
feet; thence N 25°37'11" E along the Easterly side of said 66 foot parcel, 354.68 feet; thence N 05°53'09"
E 375.49 feet; thence N 00°09'19" E 265.29 feet to the Southerly R/W of "Old C.T.H. E"; thence
Northwesterly 118.44 feet along the arc of a curve which is concave Northeasterly having a central angle
of 8°58'16" and a radius of 756.42 feet, and whose chord bears N 34°06'42" W and measures 118.32
St. Croix County 1148863 Page 2 of 3 Pg. 12b of 12
LT File No. 652902
feet; thence S 00°09'19" W along the Westerly side of said 66 foot strip, 365.93 feet to the point of
beginning.
SUBJECT TO a 66 foot road easement as measured at right angles and is located in part of the N'/: NE
of Section 31, Township 30 North, Range 19 West, Town of Saint Joseph, St. Croix County, Wisconsin,
further described as follows:
Commencing at the North % corner of said Section 31, thence North 87°41'39" East along the North line
of the NE'/. of said Section 31, 1379.28 feet; thence South 05'53'09" West, 354.51 feet; thence South
25'37'11" West, 381.18 feet to the point of beginning of this easement description; thence South
20°22'49" East, 623.40 feet to the South line of the N %2 NE %; thence North 88°44'38" East, along said
South line 69.86 feet; thence North 20'22'49" West, 618.27 feet; thence North 25°37'11" East, 9.96
feet; thence South 85°42'12" West, 76.15 feet to the point of beginning.
ALSO SUBJECT TO AND TOGETHER WITH the right and obligation to share with present and future
adjoining owners in the costs of maintenance and improvement of the aforedescribed 66-foot roadway.
St. Croix County 1148863 Page 3 of 3 Pg. 12c of 12
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Wisconsin Department of Safety and Professional Services Page 1 of 3
- -)-iof Industry Services
'J u 7rl SOIL EVALUATION REPORT CST ZCCJ
In accordance with SIPS 385. V\As. Adm. Code County
Attach complete site plan on paper not less than 8 1 r2 x 11 inches in size Plan must include. St. Croix
but not limited to: vertical and horizontal reference point (BIM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road 030.1090-60-100 Ref #2721
Please print all information. Reviewed by Date
Persona l information you provide may be used for secondary purposes Privacv Law, s. 15-04 1 m .
PropW, :r ner Property Location
LTLM, LLC Govt- Lot SW '/. NE %a S 31 T 30 N R 19 E (or) W
Property Owner's Mailing Address Lim Lot # Block # Subd. Name or CSM#
201 21" St.S I Na Na 7 Na
City State Zip Code Phone Number ❑ city ❑ Village 0 Town Nearest Road
H .:' sc WI 54016 ) I St. Joseph Old E West
❑ Residential; Number of bedrooms Code derived design flow rate 100 GPD
L .: Public or commercial L Describe: Private Accessory Building
Paron: ;11--lial GiaC;ai Outwash A-L,-Y Goav . Flood Plan elevation if applicable na ft.
General comments and recommendations: Site suitable for in -ground POWTS with 0 4 gpd/sq. ft. design leading rate. Recommended infiltrative surface
elevations to be 91.50' centered on 94.0' contour and 8 90.00' centered on 92.5' contour. i;Wex
Boring #
❑ Boring
® Pit Ground surface elev. 93.88 ft.
Depth to limiting factor >99' in.
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'
'Efh#1
'Eff#2
1
0-10
10yr3/3
none
sil
2fgr
ds
as
2fine
0.6
08
2
10-26
10yr4/4
none
sil
2m5bk
ds
gw
2fm1c
0.6
0.8
3
266¢?_
7.5yr416
none
Is
Osg
dl
gs
1vf,f
0 7
1 0
4 42-;;_
_
1Oyr4/4
none
gr s
Osg
di
aw
0.7
1 6
5 52-66
7 5yW4
none
sl
1 msbk
dsh
gw
04
0.7
6
66-96
7.5yr4/4
none
sl
Om
dsh
0.2
0.6
2• SO �
3el/&
ng # L] Boring
® Pit Ground surface elev. 95.30 ft-
Depth to limiting factor >106' in
•
Soil Application Rate
Honzc;r.
Depth
In.
Dominant. Color
Munsell
Redox Description
Qu Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/W
'Eff#1
'Eff#2
1
0-10
10yr3!3
none
sil
2fgr
ds
as
2fine
06
0.8
2
10-43
10yr4 4
none
sil
2fsbk
ds
cw
2fm1c
06
08
3
43-65
7.5yr4.+6
none
sl
imsbk
dsh
cw
1fm
04
4
55-74
10yr4:6
none
Is
Osg
dl
cw
07
1 6
5
6
74-78
7.5yr4/4
none
none
sl
Om
Orin
mfr
dsh
gw
02
0 6
06
78-106
7 5yr4/4
sl
02
r=rrruent. w i DLJu. ' 3u 'ZU rng;L a i aJ aV s Ipy MAf rL ' tmueM bUU, > 3u s b-'U mg.•L and 155 , .iu r 17y..] mg!L
CST Name (Please Print) Sig re _ CST Number --
James K Thompson /Ic r yy•'1� rUc9iL 300^ 1
Address Da valuation Conducted. Telephone Number
34C P, -.ake Lane Oscecl , VVI 54020-5413 July 12, 2023 (715) 248-7767
- - - 2, so SBD-8330 (R04'15)
301&r,
1
F 3 ] Boring #
❑ Boring
® pit Ground surface elev. 89.77 ft. Depth to limitin�g� factor in.
Cnil I Annlin�4inn I��}c�
Horizor
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
1
0.10
10yr3/3
none
sil
2fgr
ds
as
2vf,fm
0.6
0.8
2
10-21
10yr4/4
none
sil
2msbk
ds
ow
2fm1c
0.6
0.8
3
21-60
7.5yr4/4
none
sl
1msbk
dsh
cw
1vf,f
0.4
05
4
60-92
7.5yr4/4
none
sl
Om
dsh
cw
0.2
0.6
5
92-102
7.5yr4/4
none
sl
Om
dh
-
0.2
0.6
2• SO `�- ce-n�
u�
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limitingfactorin. 7
e..il n....c..�a..., o..a,. I
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
F-1
Boring #
❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
I 'Eff#2
' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L
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Wisconsin Department of Safety and Professional Services
Division of Industry Services
SOIL EVALUATION REPORT
In accordance with SPS 385, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Croix
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. 030-1090-60-100
Please print all information. Reviewed by
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m
Page 1 of 3
Ref #2721
Date
Property Owner Property Location ❑
LTLM, LLC Govt. Lot SW 1/d NE '/4 S 31 T 30 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
201 2nd St.S Na Na I Na
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Hudson WI 54016 St. Joseph Old E West
® New Construction Use: ❑ Residential/Number of bedrooms Code derived design flow rate 100 GPD
❑ Replacement ® Public or commercial - Describe: Private Accessory Building
Parent material Glacial Outwash Flood Plan elevation if applicable na ft.
General comments and recommendations: Site suitable for in -ground POWTS with 0.4 gpd/sq. ft. design loading rate. Recommended infiltrative surface
elevations to be 91.50' centered on 94.0' contour and & 90.00' centered on 92.5' contour.
❑ Boring
1 Boring # ® Pit
Ground surface elev. 93.88 ft.
Depth to limiting factor >98" in.
C-il A-6-fi- Roto
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
1
0-10
10yr3/3
none
sil
2fgr
ds
as
2fmc
0.6
0.8
2
10-26
10yr4/4
none
sil
2msbk
ds
gw
2fm1c
0.6
0.8
3
2642
7.5yr4/6
none
Is
Osg
di
gs
1vf,f
0.7
1.6
4
42-52
10yr4/4
none
gr s
Osg
di
aw
-
0.7
1.6
5
52-66
7.5yr4/4
none
sl
1msbk
dsh
gw
-
0.4
0.7
6
66-98
7.5yr4/4
none
sl
Om
dsh
0.2
0.6
❑ Boring #
❑ Boring
® Pit Ground surface elev. 95.30 ft.
Depth to limiting factor >106" in.
Cnil Annliratinn Rata
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
1
0-10
10yr3/3
none
sil
2fgr
ds
as
2fmc
0.6
0.8
2
10-43
10yr4/4
none
sil
2fsbk
ds
cw
2fm1c
0.6
0.8
3
43-65
7.5yr4/6
none
sl
lmsbk
dsh
cw
1fm
0.4
0.6
4
65-74
10yr4/6
none
Is
Osg
dl
cw
0.7
1.6
5
74-78
7.5yr4/4
none
sl
Om
mfr
gw
0.2
0.6
6
78-106
7.5yr4/4
none
sl
Om
dsh
0.2
0.6
- trmuem irl = t)l)U_ > 3n s "t) marl anti titi > :in s imi man ' i-rutipm it7 = K( )i ) > :in < vyn mnn nntl 1 titi > "in < 951 mnn
CST Name (Please Print)
Signature
CST Number
James K. Thompson
30021
Address
Date Evaluation Conducted
Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020-5413
July 12, 2023
715 248-7767
SBD-8330 (R04/15)
E
Boring # ❑ Boring
® Pit Ground surface elev. 89.77 ft. Depth to limiting factor >102" in.
L—M" n�srrt=zns
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
1
0-10
10yr3/3
none
sil
2fgr
ds
as
2vf,fm
0.6
0.8
2
10-21
10yr4/4
none
sil
2msbk
ds
cw
2fm1c
0.6
0.8
3
21-60
7.5yr4/4
none
sl
1msbk
dsh
cw
1vf,f
0.4
0.6
4
60-92
7.5yr4/4
none
sl
Om
dsh
cw
-
0.2
0.6
5
92-102
7.5yr4/4
none
sl
Om
dh
0.2
0.6
El
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
c ;il
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
I 'Eff#2
El
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limitin�g—factorin.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
* Effluent #1 = BOD, > 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 <_ 150 mg/L
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6rC,01 ® b_513f1
STATE SANITARY PERMIT
R rr " 't -XT 0 MS' OL-L 15 Wc-'>r
PREVIOUS NO.
OWNER L-rL M , L(.c-—1M.ttafREL Leturl
PLUMBER Gq�,Y ��pP�} LIC.# 222373
TOWN OF 5T ,joSEPE}
;iEC IT ` Nq R.
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.
AUTHORIZED ISSUING OFFICER - DATE
THIS PERMIT EXPIRES- UNLESS RENEWED BEFORE THAT DATE
SBD-06499 (R11/20)