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020-1402-12-000
II/ /~/ . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sa(ety 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 X Township Delta Construction Hudson Township CST BM Elev: '~ (oa TANK INFORMATION nsp. BM Elev: BM Description: !~ ~ ~~n TYPE MANUFACTURER CAPACITY Septic ~- ~~ tz.o/7 0 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ ~ ~ , i ~ ~ ~ ~ O -f (,trp Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~•1 ~ ~b o~- TDH Lift Friction L ss System Head T H Ft t3 ~ ,c.'~ ~~ ~ 4 • G3 Forcemain Length Dia. air Dist. to well I/D• SAIL ABSORPTION SYSTEM ~~~• FI FVATION DATA G 1 i 1_~7 1 14 1 c.~ ~ county: St. Croix Sanitary Permit No: 420627 0 State Plan ID No: Parcel Tax No: 020-1402-12-000 STATION BS HI FS ELEV. Benchmark X03 (oob3 lots Alt. 8M ~ Bldg. Sewer ~$,,)~ ~.~~ Y o~.~~ SUHt Inlet roo, la •ss ~~-orr SbHt Outlet Dt Inlet Dt Bottom ~ ~Z 6 .~ g P' Header/Man. ~ .4 c/ !3 ~ G 9 Dist. Pipe %/~/Z 7.~ . 43'y9 ya o Bot. System T ~ Y • ou Q• 6 ?•b Final Grade ? ~f a z • ~ y.~ ~O°' 9f•o3 it Cover -~ ~'. g.~, r `1 ~.1 g.~ . c¢ 90. S<</ Cn w (,t,~ ~•~ (.~ f 5~ q 3.6Ff ' ca~a to3 1 ~ ? s~ ~.3 BED/TRENCH idth Length No. Of Trenches PIT DIMENSIONS Plo. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 t~ ~r ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM Manufactur ON CHAMBE R N 1 ~ ~ N r-'- INFORMATI Ty e Of System: ~ ~~ 3~~ I ~ ~ ~ Model Number: A ^ISTRIHUTION SYSTEM "i '~ - t~ Header/Manifold Distribution x Hote Size x Hole Spacing Vent to Air Intake I [(~ Pipe(s) _i - 2°~~ ~ Length [~ Dia -[ Length Dia _~ Spacing ~ J _ SOIL COVER Y Prpssnrp SVSfP_mA Anly Yx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es g To soil p ®Yes [] No L Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7f /1! /~ Inspection #2: / /, ~~ o•q Location: 1029 Crescent Circle Hudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) Misty View Lot 12 1~ y Parctel No: 11.29.19.2523 1.) Alt BM Description = ~ P""^'p ~iGa~,.~rG'CD'!K~- 4'~ rL~~o~~~J~ ~o~~tdflc~ ~IQ,v-i~~ '" 'r~P A~~(y}~ (1 W w~[~'~< 2.) Bldg sewer length = SOr ~~`7'',Iv+~'w `"f~ ~~~ p~ ~r~'avt°d />.W'G~il~-"d - amount of cover =C 4~ "~ "~ "~ yy ~^~~ ~ln~.l ~ J~$ip~ p4_ i''_- ~~ D1erlrv~Dvt.~~ wt.e, d~ '~ ywtfw/ `~.N,,e~d I ~ --- f _ ~~ Plan revision Required? [] Yes '®. No I Use other side for additional information. ~, ~ ~~ "`~ ~ ~ - Date I epctor's Signature e . No. SBD-6710 (R.3/97) Safety and Buildings Division County ~ ~ 20I W. Washington Ave., P.O. Box 7082 ~, ~ ~scons~n Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled is by Co.) De artment of Commerce 08)261-6546 ~`.2 Sanitary Permit Application ~D State Plan I.D. Number [n accord with Comm 83.21, Wis. Adm. Code, personal information you provid may be used for secondary purposes Privacy Lavv~s+5:9d(t~1) ";,' ~ "~- n-... Project Address (if different than mailing address) 8 I. Application Information -Please Print All Information Property Owner's Name , ,." ~~ ,~s - ~- ^~ 1 Parcel # Lot # Block # 7"/~- p Property Owner's Mailing Address ~ Property Location ~ ( S ti ~ ~~ ~ ~~ City, State Zip Code Phone Number ec on ~_ + '' - '' O~ ~ l ~ / J ~ ~/ cucle T ~2 N; R~E II T il f B . ype o u rig (check all that apply) ~{ or 2 Family Dwelling - Number of Bedrooms - Subdivision Name CSM Number ^ PublicJCommeroial -Describe Use ^ State Owned -Describe Use ,, ~~,-,~~ ^City ^Vrllage Ial=lownship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) - A' ^ New S tem Ys ^ R Iacement S tem ep ys ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ,,~~,, // LkJ'Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a I ~IOn -Pressurized in-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe, ^ Other (explain) V. Dis ersal/1'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requirrd (sf) Dispersal Area Proposed (sf) System Elevation -/ ~ G-2 yr. s ~ X57. B.8 G-3 2. VI. Taak Info Capacr y m " oral Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Z 3.8~ ^' t'd ~~` ~`~ n 3130 E ~ ~- ~.--~- Dosing Chamber $, ~ VII. Responsi lity Statement- I, the underslgaed, assume responsi ty or installaHoa of the POWTS shown oa the attached plans. Plumber's Na (Print) Plum 's Si store MP/MPRS Number Business Phone Number , / Gd 2,t O~ Sl` 1.-Z P be~ ' A s d ress treet, qty, State, Zip Code) h } . ~ ~ r G Lv f0 / ~~'/Z~ t VIII. Coon /De artment Use Onl ~kpproved ^ Disapproved Sanitary Permit Fee (includes Groundwater S h F Date Issued Issuing Agent Signature (No Stamps) \\ urc arge ce) ~j ~ ~ ~ !II a~ (~ C ^ Owner Given Reason for Denial l~ J (~ ~ '~(x IX. Conditions of Approval/Reasons for Disappro val r /~ I~ Attae4 compkte pleas (to the Coaaty oaly) [or the system as paper sat ku thaa 81/2 x it IaKtua is eta! i _ SBD-6398 (R. 08/02) f,,~ ' ~ ~ ~ ~,.~ _ ~~~~~ Cla~y- P_Q Boos 7062 Wasttia~ Arm X01 W = dL ~~~~~ . . llvduo~. Ili 5370x/ -7062 siklliieas of Com~oe - /OZ-'~ ~1`' ~cc~ ~nl~i'y L~-PpII ~~~Zp ~ aooaa aii tJaaaw t3.=1, vrjs. Ai. C1o~q ~erooael taArutowla P~ - ~ Clieet tf lrti~ier be Ihr taev ' L Ap~alle~ biw~ - ll~e lhi~t A! iile~netiaa Sleee 1~ `D. liaier ~--- . Arapaq Owaa^t tre aae ~ ,~ ~' RECEIVED P [ 1~lnod lia^ier i_ Aod .x.523 ~ ~ acc~c _ _ o.a.~~c ~~eaeeg - t~r.~jlocee~a. DEC 1 ? 7002 ,~ a aq, swe ~ °vde S ep oix~ ~ , timber ttret Ptar6er ` .Z oN~r~c ~~ice esx Al.a~eer Q. 7l~pe rEe.~C ~~ ~ e!~'ra Y ~S '"~ ~- ~ 6t'f orsl~.~ijrDaiefbe-linlerd6ea~.a.s v -neaa+A~euee t] sane oMned ~ S--/ - ~. r ~ ~~ of ? ~ ~~t 6z• S -- ~C t!Eaeae aaei Gl~E - _- . 1II.1}pe~harei~ (Clrerl~~o^etl~Ali~eA. $ariieeol~ 10~ ~fieE,it~a A. 1 ZOO >Ae~aetae,taf it?/li~fore ~~~ ~. t]OixtifSaeirYtla~lreaiarsi~i~ llxitl~laa~er - 1>~e>siaad '-~ IIY.1yee et P~1~11!' 9,~sie~ i~Cl~eek a! iet ate. i~ is fair i~rl eta~,+a ],p N per _i~1oq -Pra~oei 1~-0~a~d 21 Oliwi - ~R ~ Sid Pis ~~ Qo~twaed M~i~ '`~ 22 l3 Pnsserimei idol 410 Helia~ ~ ~t 0 ~ A®c Sl ~ Uiip 13ne t] ~O ~ `~/ "i` ~ ' ~ Miv __ 30 ~ Miabi¢71~ererret Ilan ~A 45 t] /1e~talraAe 4f V A~ p~ Remo ~~ /~ ~ llrra 9ai /1~pie~a~_ llseodria ~ Hwaefat 1'ird Gwae ~ (lfi.lia~) - ~ ~Y?e. c~=2- 9~G~ . c-~ ~~/ 7. / S'- • \-L 11ert~ Ido t~ipr i Bart Pi~ber borer Prs~b See sled 10tia 1Mastic f~io~s QrNos af7aks Cba~ae auasrraed ciess Iles lS.la t?.6i~ tr.la ~~~~ v ~~ ~iseee~--Lure aw~a idaltitt~trehdl~'l7isi~eww~ealreiri YQ p ~ F Pid~ ~ ~fk ~ "f6lIY!!S llr^irr lir4iaaes rtroae i~ia~ier ' z~/! l/ ri 7~i-~'Y~-'3~-i r.4 ~ - s ooner +~ 51801 - p . r~C-- F- --~e6 vm. tux ol:appevwrl ~ Appm'~ ~ leiatA~aAa: ~~ x~ee ~ Hale Isea~ siDoereie tNo slew ` ~ /~ v2 ~i~.,~-. u ~~~ C.I'tM.~M~iN/~ ~ d~Cl~7e . ~ec~~~ `6wt.S. JIIrb ~wa1 s a3e /~~.~~ ~"`~ r ~ ~.> ~% - - ~og~ty Plumbing --- - - - -- ~ - - - _ ~ . ,__ #221180 - -- :28288 McKenzie Rd: _ - _ _ ..... _ - . Spooner. ltltl 5401 -- - - - -- ---- -- ~ . - . _ _ - (715) 635-9609 .. _ ~ - . - - ;~-, !~l_?~__ tcwsT.--..... __ .._ --- - _._ _.._ ~- - _... ___.._ __ tt-~~Z-_ - - - -. _ _ ---- - f~• _ _ _• S~~ l _t~y J1u~L .. ~ ~f:Il~~ _-.. _ ..-yam ~ - - - ~ - _... 1114 del. 1~ ~ kT~ - - -/+~aa.~o t- --/ ~-/~i.. ~ ~ ___ _ -- -- ~ - - -- -- - ----- -- _. ~ _ ..... k ~ ~- - ~ ` -- ---- - _ . _~,_ att. ~ ~ ~ _f7~~ ~ ~i~ "- e!'~f~~!r ___ _ _ --- _ - - ~br- ~ . _ .. :_ _ - - - --- . _ - ~~r r~ Q.~s ' - __ _.. _ _. _ _- - -- - - ~ - - - - - d~'~'! tlp~_ _ - -- - - - -- - - - - - - --- _.. _ e`~t 3 _ . r __- - - l ~ - - - .. -- - - -- ~ - - ~ ~ / d - ~,. x - _ ---- - -~ 'ti . .- - ~ --_ ~ - - - - - - - - f^' - - - - - ~/ _... - ~:.r :. . ~ ~ . . ._ 6 3 '1 _ _ ~ . - - _ --_ - ~r ~ _.- - ~-- -4--_ -- _ - ~ - - -- ~r.~ _ ~ f • F ~M~ .. _ . .SY- ` j~ #221180 ~_ _ _ _ ..... _ • ,~''- , ~ 28288 McKenzie Rd: - - . - Spooner. WI 54801 --- --- - - . - (715) 635-9609 _. - ... _ _ _ __ -., - ,, ~r_~__ ~T.-.-.. - -...- . --- - .. ~ ... _ -•- _ ~ l - -- * - -- - - _. _ .. _ - -._-_ _ - - t .-~r~ ~ w ~ ~~ ~ X = ~ ~ ~ -- - - ` - ---- - - =- - a -.. - f~~ ~~~~ ~o ~ .z cacr svr Z •Xi~s' ... - - - - -- ------ .- .. _ . _ ~ 13~,~ - •~+'~'L' 11-:p.• -- - - - --- - - - - - - - ._ -- - .t -- - -- -- - ~ --- - - l . _ ~~_ ._ C~Lt ,3 - - -- --- -- - - - - -- -- __.- . ~ .. - ---- -- ~ -..l_. 0 ti - - - ~ t .. - ~ Q -- -- - - '` -_ to , / - 4° ~ . -- ~ ~ ~ --~ -. .. •~ I ^ -,~ r-• - - ~ -. . - .-_^ - - --- - - ~ x ~ - ~ /~- ~ E'~ . - -- ~ p~-o - - . _ _ _~ _ ~ - -- _ ~ ~. -- -~-„c -.. ~ _ s ~ t,o, , -t ~~. ~,~r . ~~ _ ~ /~ sr~ -/i~-- -.Fogerty Plumbing #221180 28288 IiAcKenzie Rd. Spooner, WI 5801 (7i5j 635-9609 ;' Cross Section of an Inground Component Cell Using Leaching Chambers Go r #~.Z Finished Grade = mss. . ' Slope % _ -~~ / , Original Grade = rs: ~ ; %~ Top of Shell = -~~ ti' , ~ -~-~ - yam. System Elev. = Q2. ~ ~ :3 L~ n `~ d ~ ~ o `S ,1 7 .~ Observation/Vent Pipes Finished Grade = 1'6.4 Original Grade = ~~O Treatment and Dispersal Zone ~~~ __ Limiting Factor Observation/Vent pipes to be constructed and capped with approved materials for the particular use. 6 ,r Fogerty Plumbing #22118Q rAt-.r• c:F _._,, 2828$ McKenzie Rd. pUPf~P CHAMBER CROSS ~ECTIOtJ At~IG SPECiFiCA•fIOA!5 Spooner, WI 54801 (715) 635-9609 VEAIT CAP - 'i~C.I. vEU7 PIPC WEATHERPROOF APPROVED LOCKIAIG JUAJCTIOAI DOX MANHOLE COVEF, -'_ 25' zao.M oooa. WIAIDOW OR ~RCSH i2"MIU. I AIR IIUTAKE I GRADE I ( `1" MIAJ. It3' I"CIN. cououlT ~-- ---------- 1$'MIN. ~~ ---------- ~ ~ ___ PROVIDE I - --- IAJLE T ~ AIRTIGHT SEAL i i I ~ - ~ *~ *~ A I III . B~~~Z I I t _ I (I ALARM i 11 e ( I *APPROVED I I ou • • ~ JOINTS WI7H,. ~ ELEV FT. APPROVED PIPE PUMP-.~ "-'~ 3 ONTO ~ oFF D SOLID SOIL _- CONCRETE DIOGK • •~• RISER EXIT PERMUTED C)ULy IF TAAIK MA-,IUFACTURER HAS SUCH APPROVAL SEPTIC f SPEGIFI•GATIOI~IS oosE ~ ' - ~~~~-~ TAAIKS MAIJUFACTURER:~'~~Z IJUMDER OF DOSES:-PER OAy TAAJK SIZE : ~~~ - CALLOUS DOSE vot.uME /,moo f' ~ 2~ - ~s'7•.i F ALARM MANUFACTURER: ~~ ~~ ~ - IAICLUOIAl6 (SACKF{.OW: •~~.L'_~ CsAC~ MODEL I.IUMDER: l~Ql~ CAPACITIES: A=~~,.IAICN£SOR .2~=LGAIti '~~~~~ g = Z- IAICNES OR Z 2 GAlli SWITCH TYPE: _~l~J~rs~.r~ PUMP MAWUFACTURCR: /~ l C =~-IAItHES OR ,~~5• ~GALLi MODEL NUMDER: ~/~'~ ~ 0 s -..iL_ IIQCNES OR _,li:_ GAIL SWITCH TYPE: ~~~~~ NOTE: PUMP Atilt) ALARM AR[ TO DE 3~ 6PM INSTALLED OW SEPARATE CIRCUITS MIUIMUM DISCHARGE RATE VERTICAL DIFFERENCE D>LTWE[N PUMP OFF RAID OISTRIDUTIOA! PIPE.. ~ FEET /~ / M~ -}- MIUIMUM NETWORK SUPPLY PRESSU~tE .. .. .... .. `~- FCET • ZS FEET OF FORCE MAIN X 3.3o F/oo ~xFRICTIOiJ FAtTOR..~ ~G FEET - J - TOTAL yWAMiC HEAD = LLStt~ FEET ,' MITER-tA1 1'11MC\ICIA\1 _ \If TN ~~~•W111T\J ~ •1 IA11111 f1CPTN ~~ ~ 1 . ~ Pump Specifications. 'h HP Up to 40 GPM Discharge size 1'/: NPT Solids:'Y: maximum Motor Sillg~ ptlase:l'!5V Maiecia~ of Brasshhermoplastic Feaittt'~ a1H! BettefElS +Top suction elimirraFes impeller do~mg. • Corrosion resent construciial. ~Floatxtirated swifich. L~:'S; s ~ ~ fd +g 4 ~ a 10 2 b 1 0 2 - 6 i 1DIOl~1 G~ # ~Z t~urtp tms `h and'h HP Up to 60 GPM AAa)Orn1Ar1 head fiD ~ S~ 1'h NPT Sofids:'h' maudmum rr~ors~~tea~l5,ure~t.~ ~~" t''41J1tJY1~JY ~- MtBtS Of tBE~011 Cast Iron Stale t-eai>~s ama ~ser~ • EP04 brgleller-semi-open design med>anirp~ seg. to profit ~ t~J Iirlpe~f - design for Improved pel'f0(RlanCe. ""!"^ "" • Cast ~Orl motor t10USN'1~ for elf Heat . Strength, ~~ • Av~able f~ autana~c and manual operation. • CSA mods available. All Models are designed forravrrtinuous operation and features stain~ss steel Hardware. Marion Standaert Subject: 420627-Fogerty- Delta Construction- Misty View Location: Hudson Start: Mon 8/11/2003 10:00 AM End: Mon 8/11/2003 11:00 AM Recurrence: (none) c ZZ3 ? (- / °/\ y, \ (-97' 5 J2,w Safety sad Buildings Division ~' _ . 20I W Wachiagtoa Ave., P.O. Box 7'082 a a rs~ans~n ~ ~Iad~, WI ~~ - ~ _ ~~ . De artmertt of Commerce L ~ ~ ~ ~I~Gt~~.~JI" crc cG~ Sanitary Permit A plication ~ ~' m atxord with Comm 83.21, Wis. Adm. Code. persw~al itdornuuioa yea provi~ ~ [] Check if Rcwision ma be wed for Law s15. 1 L Applicetlon Inform - Plane Print All Idormatiau Store Porn I.D. Ntamber ~--- --- Property Owner's Na me ~-......... Parcd Number ~. RECEIVED ® _ 2 _ s_ nod .~s23 Property Owner's M ailLtg Address y ~~ DEC 1 7 70~1I ,~ ,~ _ u;S N R E City. State Zip Code Phone Number Lot Number' Bkrck Number S . CROIX CUUiv i ? „Z --~- ONING OFFICE Subdivision Name (~ Number • / II. Type of Banding ((:heck aU that apply.) v «~ ~ T "^' per, 6f'1 or 2 Faou~y Dwe9atg - Nwnber of Bedrooms ~ O V~7lage ~ Public/Commarial - Descnbc Use - O O state owaea / ~/~~,~' •~ • _ Lr Nearest Rom _~ III. "i`ype of Permit: (Check ataiy o~ btnc on line A. Ntamherhog is for Internal ttse.) (Campi ste 6tae B, II appli~ble.) A' S stem 20 Repbtceruenc System ~Repiaodmeataf 6O Addition m ~, C~ the B' OCheck if Sattitary Fertnu Previously Issued Permit Number Date Issued ~(~' IV. 'I~pe of POWT System: {Check all that apply. Ntmtbeaing is far internal tore.) 441~Nat -PresAUia~ed ln-cmtmct 21 ~ Mound - 47 o sam rtter so D Q~trttceed Wemm _ e+~1 1" ~ 22 0 Pressurised In-Gtowtd 410 Holding Teak 48 ~ Sigglc Pas 51 ~ Drgt Liue Ji ~ 2 1 '~ 45 ~ Ac-Grsde 4G DAaobiC Tttsmateat unit as 0 Reciratladag 3o Odder / //~- Y. Area Informat iat: ~• Design Flaw {gpol Area Arta Sat Appiiatim Perm System Elevation Fiml Glade Required Proposod Raoe(G~sJDays/Sq_FcJ (Min./Indt) __1-- Ekvatioo Qy~ , ~-r VI. Tank Info Capacity is Total Number Matufacquer Prefab Sine Smd Fiber Plastic Gapoas Galtoas of Tadts Coacreue Coasontceod Glass I~evr Taal~s Tacks ~ a' ~ ~~ Dmie$ E]amba VII. Respons~lity Statement- I, the mdasigaed, aasaeare lan~atian of the POW15 aLa+ra at the attaxhaa phas. Pfittobar's Na (Print) Fogerty P~umbing & Perk Phanb~'s estin~ 7t1P/li1PRS Numbs Busioma Phone Ntmtber ' zz~i ~® ~ 7~; --~ y9-36j Plumber's ss fret. ; Ztp / .~ = Spooner, WI 5A$Ol ClrLt- ~.SF- D~^2r4~ YIII. Use ~ Approved ~ Owner Given Initial Adverse ~ ~e Gramdwater ~ ~ ~ ~ ~ ~) Detarmi~n ~ 22S r 1 ~- 02 IIC. CaatBtions at A UReavaos far val t~n o ?~ ~S . See S s~..~~.~t~ cep u~-s a-Qreve Y a ~ ~co~t~ 'f--r'~" Q~J Aa-- v~ At1acY ooh p an oet>1 _ x ai:e ~e c.~`~ C `mss . - - '1 -.~- `Fogerty Plumbing - - - - - - - _ _ ~ ~ `_ .. _ #221180 _ X8288 McKenzie Rd: _- Spooner WI 54801 _. - --.. -. ----. .-. - -- - (715} 635-9G09 -. - :~: f~~ .r pis - - - - - --- _ ~.- ./ ~- ---- - - t ---- _ - _ - t ~. 7- , t/ ... ~e tt< _.. . . _ ~ . __. - . _-.- J _ ` -_ . pro ~ ~ cut ~- z ~xi~s' ~~/ L~~'~ -- ~ / ~~~.~ ~ ~ - - ---- -.. _. _. - - __ l_- ~ - / d t - _ _. _ - ~~ ~r _ _ . ~ _ ~ x - ~ ~' ..- r .. i _.~ .-- i - - i .. x -~ - -_ !Yr - - _ _ .. ~_~ . _ _ _ _. - - ~ -- - ____ _ ~ _ _- ~ - /~ ~._ - ._ _ r ~: r - ~ -- _. _ ~j - , - ~s'N ~t.~_ .~ 63 ~. .. .. - ~ ~. - -- - -- - - - r - -- - - - - - - --- w ~ •~ - -_ ~ ~t _ _ '~ _ _ , . ~~' ~ - - sue` _ ~ • • . Fogerty Plumbing --- - - ___ .-_ • - #221180 _ _ _ _. - - _ ~ ~ ~- • _ 28288 McKenzie Rd. W1 54801 _.-.. --. Spooner,. . (715} 635-9609 _. :--~: __. .._ _ I~~~'~__. ccv~T-.. - - __.- --- - _ --- - -- --- - --- --_ - f~~ _. _ ._ ... _ ._ ~ _ - - V Sc,~cl,~' / "= 4b' -'/X,tt _..T+D tCil-~~sE _ _ _ _. _ _. - yam' r .at~gSt _ _ ~rcy: ,~tw,-, - _ ,r ~' "' , r-'A,- QTY ~ ` -_ - - - - X ~ ~_. '.._ ._ ~ _ ___ __ ~ - -- - _..... __ -- _ . --. ` . , . __ .~ - _ _ _ -- .1.._ f / d - _ _ ~ -~ x \' A•1D ~ ~ _ ~ ~~ _ •~ .~- _ _.___ - _ -_ , ~ - - x ~ ~ ~ i ~ ..._ - - ~ . ___ __ _ ~ • ~ ~~ _. _ tom ~,~.8 ~ ~ -- 9 _ ~I / _ .. --- _ ~ _ -- - - - -- - - -._ ~''" _ y 8 T "~ K~~ ~ ct~ect.~ --~-~'~ ._" _ t~6 _ _ ~ ' t SOIL EVALUATION REPORT Page ~ of _ -3 . tnftsaorrsin pepartlment of CorrWnerce s in d B t r g y an oiuision ~ safe ~ a~cordarrca v~h Comm 85, Wis. Adm. Code ~~ -~ _ ntra~h complete sde ~+ «, riot ~ than 8 ~rz x 1 t ind~es in size. Plan must nd Iwrizarta- retererx~ p~ tee), airedio^ and ti l ParoeF tfl. a ca irrdude. but rat irr~ed to: ver and location and distance ~ nearest mad. h v D 20 --- O 2 •- - ~ arrrw . sole or ~. noA percent slope , by Date Please print all information. ~ ~ 2/~ }/per Personal ~ Ya+ P~ ~ fre used for secaWaty Pu~P~~ lP*N~r ~'"'. ~ 15.M (t) (mp- . OMRrer Ply .. _ PrOpertyLOCauOn 114 - 1M S // T Z9 N R ~ E (qQ~' Govt tat SE ~ ~ # Block 4 subd. Name a~88hMt- y ~ ~ C_ _ '9~~9 ~ 2 ~ m ' ~' Code Phone Number ^ CdY ^ ~ Nearest Road I~Naw Corrstruc~on tlse: ^ Residential I Number of bedmans ,L_-- cone derived flow rate ._ ~Dd GPD Pubic or carrunerciat - Desai~e: ^ R ~1 P matenal ~/~•v/nn taood Plain lion rf recarrllrlendaaions: C "l ~' i3 ~ ~~ ~~.P- ,~ DEC 1 7 2002 c-z 9.~-r g~ 3 _~ ST. CROIX COUNTY ^ Borkg ~ /2 G in. a ~9 ~ ~ Pit ramurrd surface elev. _~_::~. ft- ~ to 1~9 far~or Soi R~ e ~ t C Boundary Roots Horizon Depth Dominant Redox Desaiptiort Texture Stnxture enc or s 'EtT~1 'Effa12 ~. Munsei Qu. Sz. Cont. Cabr Gr. Sz. Sh. .. s _ '~ 3 - '- ~ _ ._ 9/• bo ~ 33• ~ (,R• ~ ~~ i D/ Horizon ~- Dqt Redox Desaip6on T in. t~Aunsei Qu. Sz Cont. Color r o - __-- L 0- o '~ B- y r -y ~zE s ~ a. b ~4.~ .-~s--- -. ~u _ o/V1 ~ u - ~ mn .,M,n a~ut TSS >30 < 1 50 n L a # ~ ~.~.tt. ~~ ~,ZZ in. Pit Dots ~ ~~'ing & Perk Testlag ndbress c e e spooner, wi 548oi exture StnrcUxe Corrsister-ce Boundary R - - Gr. Sz. Sh. 'EttAF1 .1 ~ - -.- --- ~_ ~. „~ -rte • Efllue<lt #2 = BOD < 30 mgll. and TSS <_ 3o mgA. CST Number ~Zt'/ ~ Oate Evak~lior- Corldrrc~ed Tefephorle Nunes z - -oZ / /S"-ati3~ _ 9!w /-Gs`~- y~z-.~i and ~ Property Owner ..~xl~__.~1rt~. Parcel ID # ______._ Page _,~__ of .~ Pit Ground surface elev. _ ~'. 3 ft. Depth to 1'miting iador , l3L in. Soi Rite ~~ # ~ ~~ > t•f riz n Oe ft- Dominant Color Redox Descr~tion Texture Stnrcirre Consistence Bourdary Roots GP QII~ o o p ~. MunseA Qu. Sz. Cont. Color Gr. Sz Sh. 'E1f#1 'Eft i ~_ ~ '' Z _ --~ F m- _ L --- t Pit Ground surface elev. ~• ft. Depth to Gmi6ng factor ~ /3~i in. ~ Rabe ~~# ~~ Florizar- Depth Dominant Color Redox Description Texture Stnx:ture lonsistence Boundary Roots GPD/tf MunseN Qu. Sz Cont. Color Gr. Sz. Sh. 'Ett#1 'Effp2 in 2 . _s. _ z ..._ .~ c s ~ S. . S .1 . 9 3 v - s old- ~ -- - . Z.. # ^ Bonng ~ Pit Ground surface elev. ft. Depth to 9 factor irt, ~ Rate Florizon Deptlt Dominant Golor Redox Description Texture SUrccture Cor~stence Bourxlary Roots GPDI~ in. Munsefl Qu. Sz Coot Color tx. Sz. Sh. 'Etf#1 'Ef~2 ' Effluent #1 = BODE > 30 _< 220 mg/l. and •TSS >30 < 150 mg1L 'Effluent #2 =• GODS <_ 30 mglL and TSS ~ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at b083151 or'[~lY b08-264-8777. soo-amtx.aao- ~. ,__ - - • N Fogerty' Plumbing • ~ #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~!~ /~ ~~ Gr,~ c©~vsT / ~ ~N ~mr #~Z ~ -- - 1 d{~.. AZT d~~ ~~ o~ ~-~ ~T Fi-o, r~7Y ~ ~ I ~ ,~~ST [rrv~ • = r~cav/~ LOT Ca~~~J' cv/,e~ A y~' ~`'~ -~ = L~/',rw~cc~roiz NDT ~uNl~ \ / r ~ r r /~ - r ~ r ~ /, / / ~ ~ / \ ~ ~ d ~ ~ ~ ~ ~ ~ ~ " -, -~ ~ / / n ~9.to ~ ~ ~ ~ ~ ' ~ ~ i~ ~ ~ ~~7~ ~ x '~ i / _, --- - / - ~ ~ / jy3r p fs% ~ / f- _ ~ o ---_ - G~~3'c,E~tt ' ~ ~ ,pj S"G~"''"S ~ ~ `~'~ ~ aq~ l _E \ (.ALE ~so.c ~ ~. ~i....,.~ ~~ ~ '',~ ~ ~ ~ Y ~"` ~,. , ~ / 'bt- -- ~ 2P3 6 ~ .~ (• U ~~ MU .-, ~ ..~ o~ U 3 ~ ,,Ha ~!-d o •~ ~ ~ .~ U 0 m -rl.-~ _~ flcoa, ~ N ~ ~ E~ ~~~, ~ ~ ~~ d .-. ~ ~ r~ :~ ~~ #~ `~~' d N ~ .~.. ~ N~ a a c 0 i ~ A r Il _ ..a 'd ~ ~ «S ~ fl 11 ..., h .. c i .~ ~ ~ ~ .a ~ '° . , , , a •~ V~ ~ o u ~ ~ t: ~ U h ~ ~.' o o o" Il CQ •~, a ~ .. ,. ~ ~ ~ ~ .t w C. .~ y ~ ~ a ~~ ~'C M\ ~ .~ ~ ~ . .~ ~ ~ •- \ ~~1 ~ ~ , - i. . ~ i .. ~ . I _ : . ; ~ ..f"~ ~ j ~ + ~ Q a ~ • •, ~ . . ..; + . n a •, ~ .. ~ ~ ~• ~ ~ ~ _ ` ~ ~ ~ ~ ~ ~ w w ~, 11 ' l u a ~ ~~ U ~ ;. ° ~ .~ ~ ~ 4 ~ - - ~ E . . POWTS OWNER'S MANUAL & MANAGEMENT PLAN .u.w~r~~ w7•tnYQ FIt.E INFOI~NATION ~_ Owner ~- Permit ~ tf.~ ~ ~~ Number of Bedrooms 7 ^ NA Number of Public Facility Units ~NA Estimated flow (average) ~ aUda Design flow (peak), (Estimated x 1.5) ~ al/day Soil Application Rate aUda /ft~ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (GODS) 5220 mg/L ^ NA Total Suspended Solids (TSSi 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) 530 mg/L Total Suspended Solids (TSSI 530 mg/L ^ NA Fecal Coliform i9~m~ mean) 510' cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other. ^ NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE Service Event Inspect condition of tank(s) Pump out contents of tanklsl Inspect dispersal cell(s) Clean effluent filter {nspect pump, pump controls & alarm Fhish laterals and pressure test At least once every: (Maxanum 3 years) ^ NA When combined sludge and scum equals one-third 1Y31 of tank volume. ^ monthlsl (Meuchrtum 3 years) At least once every: 3 $ year(s) At least once every: At feast once every: At least once every: At least once every: Service Fn3quencY ^ month(s) 1- Z ~ yearlsl ^ monthlsl ^ year(s) ^ month(s) ^ year(s) ^ ^ NA ^ NA ^ NA AJdA Q NA ~j NA Q~NA MAINTENANCE fNS'fRUCT10NS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cert~cations: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation Pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 1Y31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmem units, and any servicing at intervals of 512 months, shall be performed by a certified POWT5 Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~ of Z'~'" ~....r......--°---------- Septic Tank Capacity _ al ^ ~` Septic Tank Manufacturer r ^ NA Effluent Filter Manufacture( ~L ^ NA Effluent Filter Model /~ ~-~~ ^ NA Pump Tank Capacity al Pump Tank Manufacturer Lfl NA Pump Manufacturer L~ NA Pump Model Q NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeratron ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~NA Dispersal Celllsi In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground )pressurized( ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA . •~ Page Lof Z T UP AND OPERATION Far new construction; prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentagtons are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shalt not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. 7o avoid this situation have tfie contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not. drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails. and cannot be repaired tha following measures have been, or,must be taken, to provide a code compliant replacement system: A suitable replacemenrt area has been evaluated and may be utifaed for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed stricture, lot lines and wells. Failure to protect tfie replacement area wilt resuk in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIG, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR pY1POSSIBLE. SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~j 1 (~ (X CA~t~ll, 1 ~N Phone ~'(~ -- ~ " This document was drafted in compliance with chapter Comm 83.221211b11111d)&lf) and $3.54(11, 121 & (31, Wisconsin Administrative Code. __ SDOOner wl sn»r~~ POWTS INSTALLER POWTS MAINTAINER (715) 635-9609 J Name I (1~~ v Name ~ ,~'%L7- Phone S"'_ - ~~ Phone ~~' = ~ j - ~ PI v , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM l ~"^ Owner!$~}eF I ~"L Ti~- Mailing Address 1~G 2 '~~ ~ ,~~d~,~/ ~cr 3.. yo/~ Property Address l o Z `~ ~,Q~ ~,F,~ ~~~ ~,~~~~ rte. _ ,. (Verification required from Planning Department fo new City/State _ ws. ~- yp~~ Parcel Identification Number p~ n.• 1 yD1._.. ~s-~' LEGAL DESCRIPTION (, • ~'S~3~ Property Location ,~ ~/,, ~ y<, Sec. I/ . TAN-RAW, Town of Subdivision _ ~.--.w~ j f ,~ ~-~ - Lot # 1 Z Certified Survey Map # "-- Volume _ ,Page # Warranty Deed # _ / P.5-3Z 9 Volume /~j~ ,Page # .SoL Spec house (~ yes O no Lot lines identifiable ~ yes O no SYSTEM MAINTENANCE Improper use. and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and%or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three ar expiration date. ,~. , ; Z / DL J c' ;~- SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. C ,r SIGNAT RE OF APPLICANT ~ ~f DATE- ****** 'Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ~~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed . ~ ~t°af;~ommerce . Division gf Safety and Buildings Pd r~~~:j~ ~ t~ l l ~ L SOIL EVALUATION REPORT Page ~ of 3 • in aocorgance vvrnr c;omm rta, wrs. nam. wce Couniy t ( Attach completesite plan on paper not less than 81J2 x 11 inches in size. Phan mus but not limited to: vertical and horizontal reference point (BM), direction and include Parcel I.D. , scale or dimensions, north arrow, and location and distance to nearest road. percent slope , Please print all infonrrafion. by Date Personal information you provide mey be uaed for secondary PurPo~ (Privacy Law. s. 15.04 (1) (m)). G~l/(/LI~-' /O a / D pr~lty O~~ Property Location h ~~~ Govt Lot jE 1/4,S ~ 1/4 S f/ T Z ~f N R J r/ E (or)b Property Owners Mailing Address Lot # Block # Subd. Mane or t~Nt<t c~ a ~ 3..! ~ 12 r~ Vie~J Phone Number Tp S City ^ City ^ vUage ®Town Nearest Road L-4uc15~1_ UJI U ("115) ~ - ~~ ohs ~ .~ n /¢ (~ New Cor>,stntt~ion Use: (Residential ! Number of bedrooms 3 ~'` Code derived design flow ram °ir~~ ~a~4 d GPD ^ Replacement ^ Public or corrrmeraal -Describe: ~ ~ ~ ~'~~ "~ `~ \. Parent material CT ~ '4'v--a S Flood Plain a jcab~ .~~ ~" `~ cR ft: General comments ~/ $ f t v-q -2 /-~ / • ~ P 9 3• Qv Gower z . o d . ~~ I ~`~~~~( ~: and recommendations: ~G 2/-c,'/ • P 9 •s c ° t-o ~./ < ~' . cs o "`"' -~Y11Yr~ Sol /~ ~ t~-"" ~ ST CRC~tX ..~ -_ ~_ ti «s,.,.., ...... -- o - Btxing ~ / ~ •- l Bonng # ~ Pit Ground surface elev. 9G • o a ft Depth to limiting factor 1 ~~'• .. ~ ._. --~'~~ oil ication Rate Horizon De th Dominant Color Redox Description Texture Stnrcture Consistence Bou is GP Dlft'- p in. Mansell Qu. Sz. Cunt Cobr Gr. Sz. Sh. *Eff#1 ~Eff#2 1 d-2`~ f0 312 - Sil ~. ~r GS IV .5 .8 Z Zv-4s i y ly - s~ ~ 2 cbk ~-~ ~- - . 8' 3 45- 2~ l0 `i I~ - m_S QS ( -" - . ~ 1. Z i ~-~.e ~Z. o ~/. S~ ~ ' ..scv,~ ~2 ~ ~' ieC~ o ~~# o ®Pit Ground surface env. 9G -~ tt. Depth to IKrtiting factor ~Z I in. Sal lion ~~ Horizon Depth Dominant Color Redox Desa'iptiorr Texture Structure Consistence Bourxlary Roots GP Drfr= in. Mansell Qu. Sz. Cont. Cola' Gr. Sz Sh. 'Eff#1 ~Eff#2 I o-Zc~ 312 Sir c..bk m-1^r ~ 5 l v~ . 5 ~ $ Z -yy io 4 ~y - 5. I ma-b IC m r c . 5 . ~ ~ Effluent #1 = t30D_ > 30 < 220 mdL and TSS >30 < 1 50 ma/L ~ Effluent #2 = BOD< < 30 mg/L and TSS < 30 mg/L u CST Name (Please Print) Signature ~ ` ~~ ~ I ~m ~c hunnak r ~- I Address Date Evahration Conducted Telephone Number 211 Y4'~' `~• CinY,er~-4 ,~,~~ 5y07.5 lG-~~-G / C115~ 24`1- yoy 8 Property Owner ~'f ) -~- Panel ID # ... . ` Page ~ ~ of 3 a ~~~ # ^ Boring ® Pit Ground surface elev. ~~' ~~ fk Depth to limiting factor ~Q g in. Sal lion Rate Horizon Depth Dominant Colo Redox Description Texture Stn3dure Consistence Boutxiary Roots GP D/f@ in. Mansell Qu. Sz. Conk Color Gr. Sz Sh. 'Eff#1 'Etf#2 Z lD ~~{l~ Si I ~ ~ - 3 I -~ 1~ r~ ~ -' mS as m / - - . ~ /. z ^ Bonng # ~ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Redox Description Texture Sfrudure Consistence Boundary Roots GPD/fi? in. Mansell Qu. Sz. Conk Caor Gr. Sz. Sh. "Eff#1 `Eff#2 ^ Boring # ^ Boring ^ Pi# Ground surface elev. ft. Depth to leniting factor in. Soil licatbn Rate Horizon Depth Dominant Cobr Redox Description Texture Sure Consistence Boundary Roots GP D/ff in. MunseA Qu. Sz Conk Caor Gr. Sz. Sh. "Eff#1 "Eff#2 Etiluerrt #i = GODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mglL arui TSS < ~ mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) c L •Properly, Owner ~ ~3ThC ~ ~ Paroel ID # Page Z ~ 3 B"ri"s # ^ ft Depth ~ factor /°g in. ® Pit ~~r~ surface elev. ~~ ~~ Sa'I Rate Horizon Depth Dominant Redox Description Texture: Sbudure Come Boundary Roots GP DAf; in. Mansell Qu. Sz Cont Color Gr. Sz Sh. `Eff#1 `Eff#2 - ~0 3~Z -- s; k ~ S ~ . s .~' Z _ ~ ~~ r~l `- Si I ~ S _ 5 3 I - i ld ref co -- rnS 0s ,~-, / - - . ~ ~. z ^ ^ Pit Ground surface elev. ft Depth to limiting factor in. eor~'g # ~ ~~ Soil nation Rate Horizon Depth Dominant Redox Description Texture StnrGure Consistence f3ourrtfary Roofs GP D/ff in. Mansell Qu. Sz. Cart. Cobr Gr. Sz. Sh. `Eff#1 `Eff#2 ~9 # ~ Boring ^ Pit ~~ surface elev. ft Depth to Igniting factor in. Soil nation Rate Horizon Depth Dominant Cobr Redox Description Texture Stnrc~ure Consistence Boundary Roots GP DIfP in. Mansell Qu. Sz Cont. Cobr Gr. Sz. Sh. `Eff#1 'Eff#2 Eflluent #1= GODS > 30 < 220 mgll. and TSS >30 < 150 mglL ` Effluent #2 = GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBU-8330 (R.07)00) PAGE 3 OF~ NAMF 5 ~ ~ t LOT# I~ T EGAT. DESCRIPTION S E ~S ~' ~ ,S 1 ~ T Z 4 ~N,R, ~ `t E(orY~ SCALE: 1" = yG BM 1 ELEVATION lOV • o BM 1 DESCRIPTION ~ p Q -~ 1a-E'~ 7_ ' ` f~'u 1, BM 2 ELEVATION `~ ~. 3 0 BM 2 DESCRIPTION ~+ p a .~ ~~ ~Z„ /,~~ u ~ SYSTEM ELEVATION !ap 93. oo Lc,u,< r~ 7 Z ~ O U ALTERNATE ELEVATION fop gS.oo Lu w~ r• 94~• o 0 CONTOUR ELEVATION 1G •~ q ~. So. /va -.So N S~c~• // 1 - + ..._. x ~~~ a V / a _. ___ _, _..__._ -- _. __ _. 1 ~,` } ~~~ 83~ ~ M~, ~ ~ ~ha~ ~~ii~ '~. a° q~.s a-Z ~ 8~-t ~r_ _ _ __~ ~.. • BM ~ ~ s~ ~_ w. _.._ __..,._,_.•,. 1 ~~~ ' ` ~-ar t,~j~ /~ ~~~,.9 GNATURE ~,~~~~~__~ `~-.---~ DATE /l - 2/ - o~ . ~ J 1J3;.~~' `~02 STATE BAR OF W[SCONSIN FORM 2 - 1998 ' WARRANTY DEED Uacumer}t Number This Deed, made br.iwecn _ - ---- _RICxARn Q~g,T~T dnr7 TANFT_...E.-STnclm -hllSband aRt) wi ---- r_ -___._.. ---- -- -- Grantor. and _- DELTA_S.._Q.i9~TRi]LTSi~NTSN-C_.---------_------ -----._._____ -- -- -_ - -- - ___--_------------ --- -- Granee. Grantor, for a valuable considerauor,. conveys and warrants to Grantee the following described real estate in __ St.~-_~~~1X __ County. State of l'Jisconsur Lot 1 Plat of Misty View, Town of Hudson, Croix County, Wisconsin. 66~ H2XgSH REGISTER OF DEEDS ST. CROIX CO. , yI RECEIVED FOR RECORD 07-29-2002 10:00 A!t NARRANIY PEED EzE~wr I REC FEE: 11.00 TRANS FEE: 177.00 COPY FEE; CERT COPY FEE: PAGES: 1 Nano and Return Addryss ~ti~ ~ovsTR~~ion~ aZOly o~ "g' S7' /~.vDSo,J, ~' Selo 020-1013-30-000 020-1014_10_x_00 _______ Parcel Identification Number iP'M This 1S riOt hornestcad property (is) (is noQ Exceptions towarrantics; Easements, restrictions, rights-of-way and covenants of record. 'p(- Dated this _L_ 7 _ __ da of --- t'^C-~~-{}-~___ (SEAL) ~ ~~-f~_ `'~ (SEAL) • Richard_ 0.__Stout ~ Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signar~re(s) -_ State of Wisconsin, s~ St . Crp1X ____ County authenticated this __,___ day oC___ _, _ Personally carne before me [his -_ ~~ _ __ day of ,7tt1y __._______, 2002-,thc above named - ----R.icharr~ n c-tout--and Tar_-__-=____r p - -_S_tout - _ _ _- - - - - '- - - - _. ___ _ _ .-1~7OTAi~_Y Furii~IC --- - --_ TITLE: MEMBER STATE BAR OF WISCONSIN _.___~ ___ _ _ ;~ (If not• _~_-__- rrte known - -r_5[_~4 ~S~itQN~~ed the forel;oin}; authorized by §706.06. Wis. Stets.) inst~ THIS INSTRVMENT WAS DRAFTED BY ______ Janet P, Stout 1353_Awatukee Tr. _ _ __ Hudson, WI 54016 T Notar My v (Signatures may he authentica[ed or acknowledged. Both are not __ _ necessary) ` Names of persoro signing In any <apacirv mus, be typed or primed Uelow their signature. STATE BAR OF WISCONSIN N'ANNANTY UEFD FONM No. 2 - 1998 ~InrBAST Public, State of Wis. in ~- nmission is permanent. (If not. stale cxplralion <L,:c W~sco~ci~ Laga~ Bianw G4, m ~n~w,auk«e. tas ~~ N1.LZ~OZo00N ~~ ~~ ~I O~ i ~~ oa ~ o~ ~~ ~~ i ~I QQ i ~~ °' a, ~~ i ~~ ~~ ~' i a~ ~~ ` ~ J I r t; ~ ~ ~, ( c- c ~ ~ -- t~~v~o~an ~na~~d~ ~~ao~ ~ ~ ~ i ~ ~~aanb ob aoo~oaan b~~o~ ~ ~ ~ i ~ ~ o ,z~~seG ~ .vs~o~z ~'9SZ ---- m O Z o .9['69t+ ~ .[e ~ ~ - ~~ _ ~ ~_~ ~" ~ ~ ~ N ~ ~ ~~~ O$r ~ ~ t ~ ~8 ~ r W zs - ,~; ~ ~ .. p ~~ Z i Vy i ~ u ~ Nm ~O ~ N J N ~ ~_~.'~ .\ ~ ~ W LL I' / 04! ~ : ; \. ~~ O, . h 21,p4"B 374•~~~ ~, ~ ~ ~ h ~. \ ~ _ _ ~ b/~ ~-t jai F- ~ a 8 o s ~'~. O ~t ~ Q$~ 3~ ~ W~ ~~~ ~~ti~ -~ W ' ~ Nap e~~ r VW Z ~ ~ ~ ~ ~ 7-7~ ~ ~ ~ ~ W O ~, ryb ~`. ~ ' ~a -~ . ^ ~ ~` ~.