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HomeMy WebLinkAbout020-1335-80-000 (2) ? r"aT'"QV T County °' 1 �9�® Safety and Buildings Division St.Croix f ' as :; ‘ V 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) 1\ _ FEB a { Madison,WI 53707-7162 40 t kvs"` T. CROIX COUNTY moo, 572 �711 o I Y �' —'" State Transaction Number �` ilxf i ermit Application- _____....__�-.-- In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit Na is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing addres the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. Same 0 7/O ty /w ^�& il'(.Pr i I. Application Information-Please Print All Information 1 Property Owner's Name O Parcel# Mike&Cassie Krueger 020-1335-80-000 Property Owner's Mailing Address Property Location 769 Wilfred Road Govt.Lot City,State Zip Code Phone Number SW 1/4, NW '/, Section 27 (circle one) Hudson,WI 54016 (612)759-6174 T 29 N; R 19 E or WL 7g II.Type of Building(check all that apply) Lot# ❑1 or 2 Family Dwelling-Number of Bedrooms 38 Subdivision Name C5-----''') Block# Plat of Badlands Prairie ❑Public/Commercial-Describe Use 4 Na ❑City of CI State Owned-Describe Use CSM Number 0 Village of Na ❑Town of Hudson III.Type of Permit: (Check" my one box on line A. Complete line B if applicable) A. ❑New System Replacement System ❑Treatment/Holdin g Tank Replacement Only 0 Other Modification to Existin g System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number an Date sued Before Expiration Owner 3 / 5/4846 7 /9 9� IV. ype of POWTS System/Component/Device: (Check all that apply) on-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component a III Pretreatment Device(explain) V.DispersaUTreat nt Area Informa 'on:54 Infiltrator" Plus"Standard eh rs&6 endcaps,PolyLok PL-525 effluent filler t Design Flow(gpd) Design Soil Application ' rsal Area Required(sf) Dispe al Area Proposed(sf) System�levat on t, 750 Gpd 0.7 Gpd/Sq.Ft. 1,071.43 sq.ft. 1,50.60 Sq.Ft./6% 9 . 0' VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units t c $ Y ,,g New Tanks Existing Tanks `'� g u z ` gU in , va 1C7 G, Septic or Holding Tank 750 1,000 1,750 1 Wieser Concrete X Dosing Chamber VII.Responsibility Statement- I,the uncle tgned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signatu e MP/MPRS Number Business Phone Number i James K.Thompson 5-- MPRS 30021 (715)248-7767 Plumber's Address(Street,City,State,Zip Coder 340 Paulson Lake Lane,Osceola,WI 54020 / VII ounty/Department Use Only pproved leap Permit Fee Dat Dat Issued Issui gent Signature en Reason for Denial $ 475-- Z ZiN /5 IX.Condit ll1011 lGUVABReasons for Disapproval 2 ��/► Alp 5 sf t ,�Illpt I.':Septic tank,effluent filter and 3) f I l dispersal cell must all be services/maintained ��,�� as per management plan provided oy plumber. A-,i�t' t �tYir/0te a„4-:�-� 1?lL. eogt- 2. AM-setbectt requirements must be maintained .� as per applicable-code'/ordinances. 5 ri -r`� et e� �j ,�v‘ Attach to complete plans for the system and submit t the County only on r not less an 8 112 x 11 inches in size 4J ( /614)6 SBD-6398(R. 11/11) A e-7�/'s6.770ack ele. 5cAje: /"•do' Praposc.e/c4S Q/GL//, TitcetW trene c. a 3'x 7S',//B err /6-z,6,r "a)_4"Chuen6w'3 t �s5.e>�/u ey- /0.4.64.rc . 27 - 4 'c 5kr 4 ce Q/cam; 7(vyu�,'/fred.Qo 60 6c =n.�,'7-e,�ckes 6 6e s/ecci c-67 ' p l�u.dso,, w/. s'cfa/k q'on 84.:��i 19.6v 5w/y/JwY Sec . Y L7 l9il., /�'w �' N •I T. or f/ son, 6b.Cr-eX �/. ' .�✓-,o `; I ! 1c-(. C.W-/3.3580-LCO ! ,1 V°' ♦ ■ '___/____._____.___._.____. l'ra(�ose�(e+��Qie / A � 1 t/x.IJe. t r Sao i 1 r �?,5e4iwies„-e.ne. 1 / 7o70.4.5.Tw/ CO / Po/ycoA'A-S z5 1` / Cf{Iu..,6 F;/ter. ' . EX.W.escrCorm. • . � i� r- -- /,oavc, a,T I t • 1.. � :� 0 ,ID 41 EXiS�In Rcs,dence ""� -----' E,ris d3�OCr /eci/ T,t,o(�� we! �t 1 K /�,IKC tre nail 4t 3'Y,5-4• zS")/Ar:ze 4J _______ ___t__ -7-46.44„nii<V6-4,4,,r,r-E,‘")---/;_1,.n,-.3 :•-t c1,-,--* aCmrSN, e%=/OZ.iL' 6y5E4.+-: elute =ei5187' ti, a 4//ow M �4 rQ 5545 /Y(a,nc.' u/'e.ci /awel 1 1 Conventional POWTS Index & Title Sheet Project Name: Krueger 5 bedroom Replacement Conventional POWTS Owners Name: Mike&Cassie Krueger Owner's address 769 Wilfred Rd.,Hudson,WI 54016 Site address: Same Project Location: Subdivision: Lot 38,Plat of Badlands Prairie Legal Description: SW1/4 NW/4,Sec.27,T.29N.,R. 19W.,Tn.of Hudson,St.Croix Co.,WI. Parcel ID#: 020-133540-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calculations& Distribution Media Cross Section Page 4 System Cross Section Page 5 Septic Tank Cross section Page 6 Filter Specifications Page 7 System Management Plan Page 8 Septic Tank Maintenance Agreement Page 9 Certification for Utilization of existing septic tank Page 10 Parcel map Page 11 Warranty Deed Attachments: Soil Evaluation Report Mater Plumb 'cted Service: James K.Thompson,DSPS Credential#30021 Signature: ,arpt 1?t!)s_ _ Date: F . Page 1 Of 11 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.01/01) A e7(/66.7 prude e%v5 Scale: /". •' h�lopascd�5p tt5a/CG//. Titre c(4.) ��dncAc ii�ir��ie at 3'x 7�5'�///B zaf:/etz,dv- "(i- "Cha n4ors r�,eL C'�ss e 1�ct2t cY' 6c =n.cir)�enckes fa 6e s/rta ecd c.--6 7b y r,J• fted good` 9'0,, cam., .u: N /-/e.eoLson, ev/, S 4:, ,_ ___ - • sw'/ygwYy, Sea.2-7 ��9if., e./fw., ,' '�p c„,,.�,✓-_1_ � • 7n. of,A4d5on, 6t.Cr 4.,„)/. • Pc-I, '� G.2Cl-/3.35 BO-az0 i I 1 eKu • NrOpoStxrd;dePwt-_ / ,� t 8� t t A t 76'0 7.P.3.T w/ t n Po/y4A1A-5 i5 — i a- k tf{/u�,E Aitt i GolatJt' >sX W.-cue Cond. ■ ti 0 0 EXiS6nct : �v ,- - �i :Z -' d,3Pcr,sa/ca. 7 oC4-J 13 a __—/ = t ' 44 efencaf at 3‘.Y.6-4.-26-'.--Y/(,ic 44_4 1 -«_ ,r i C )�t �n(c/ LY .5,do of n d u tie-- ia� ����� • ^ - �, � c Y cv: =95.$7 , al.or5∎l/, Ow._/o2.4/1 4</ao , a 5 ra 654s In afa.n;cared f'4 /a we; 1 KRUEGER DISPERSAL CELL SIZING CALCULATIONS 1. (5 bedroomsx100 gallons estimated flow)(1.5 design factor)= 750,00 Gpd design flow 2. Infiltrative capacity of native soil=0.7 gpd/sq.ft. 3. Absorption area required: 1,071.43sq.ft. GG 4. Absorption area as proposed: t'ti'A,62,sq.ft�54 h hers total) �ai T Infiltrator"Quick 4 Plus"= 0 00 sq.ft.EISA per chamber,Infiltrator"Quick 4 Plus"end cap=540 sq.ft.EISA 1,071.43 sq.ft.—teen ca sx5. 0)= 1,040.83 sq.ft. 1,040.83 sq.ft./20.00=52.04 c bers required Number of trenches: 3 @ 18 chambers per trench Trench width: 2.83' Trench length: 75.00' Trench spacing: 9.00'on center Total system area w/9'center spacing: 21.00'x 75.00' mnw 1/u/ok'!STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) MIMI e i 8" 34" SIDE VIEW SECTION VIEW MultiPort End Cap mom i R II 007(4) 1 16 ( 1�� __.____ iii " 1 11: A Vitii114.1111* 34" SIDE VIEW TOP VIEW FRONT VIEW mow, 'r7 itF((, I 'III a(� �3 i`''�' t"jm 1 LiJ 'ti:2 . rtriii 01' 1 „c,.._ �L �r ' Y' ".L� '' r 3 to � �: Ids t ' k {a ..a G pry' : Pg.3 of 11 Soil Absorption System Cross Section ft in k- IN rt''g.fiO/ I /e , Final I Final Grade 4"Schedule 40 I PVC Vent Pipe 611 With Vent Cap __ 97O ft Leaching Chamber I-- 96'•O ft System Elevation 3 ft _..gyp .ft (o ft Soil Absorption System Plan View 75" ft C. ft Leaching J Trench 1 w iChambers I ll m 0 E 1\ 4" Dia. Trench 2 Header Vent Or Observation Pipe 01- i Trench 3 Leaching Chamber Specifications Manufacturer And Model . vi 6',. "Q— ?`S6.ia4rdfa/cs.,s' EISA Rating ,2o.0 sq ft per chamber Soil Application Rate o,7 gpd/sq ft 76-0 gpd Design Flow÷ 0_7 Soil Application Rate ;. 10.0 EISA = S'y Chambers 3 rows of /$ chambers each. Page V of // D Z X U, > XI M r z C 54" AS REQUIRED 84" > 0 z 42" - O N ir-r1 m II M in -� I r m J III` Illilliirra c) to I _ o 3" I 37" I 5.• ° II m 1- Ii. vai S I� I m �I D �� �k rn x m it E Iv c III■—i___ .1.' m D c 4-.c 0 40" 1 C z _ rn > N 1 > I m m > r o <0 r x != 0 u) z-n p ".mom. " 0 — p 'r-' g z Pa� rm N D 0 Cnc) n *a c>-Na r?l0rCm>oo>— N xx 1 Z 0 a Nv vai 0 oo0 2=AlEz D p .9 Z vCiO m0 CC) m N -Irz 0 mop ..." Ti. O*v-=1o•• ; --1> 0GI \ G7 7C ANC �iu)c CCZm.. 4. N �u ZZ p m Z 0�.. DZM yD� ommDDN s`'N zN o > v� o mu) u)-N+ o �-�� -0 -D a v 0 T` i-.--' 0 to ps C N a D c,4 N O �TI �I NZ c m I r IS' 0Ui c o -o > c� �0 Z m� c� m-rm mm om71v p 0 a o z n� a ca 0° ='-z �� v�wm I m D Z 7 ��171 -0 D Z A 4k O OW p • N D-i w 1 0o m -< -I > 0 om p F � co 7:1 , s 0 DN m ° - Q 0 N z p 27 - "V V) m m I cn `� x oC) Z C 0 D r m (J)O CO p C tM* 3 z > DH 0 N z P1 0 \O m WLP750-MR WIESER C�IICAETE DRAWN BY: WCP REVLE: 1/4'=1'-0" PRE-POUR: -n -I SEPTIC MANUAL DATE: 00/00/00 DATE: POST-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 , 0 800-325-8456 FILE: nS750-ufi PO. 50F/> ' 4 A Filters /'r4,NP aq 99 e it w, PL-525 EFFLUENT FILTER (LLg '° ) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm 71r'' (gallons per day) making it one of accessibility ;'�---- Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4"& 6' SCHD.40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified �7 by an alarm when the filter needs servicing. Servicing should be --i< Gas deflector `41/(~Sl+h done by a certified septic tank Automatic shut-off pumper or installer. `z= i " t ball when filter 1. Locate the outlet of the U.S.Patent No#6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and corn- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. aro u. Conventional Septic System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall be maintained in accordance with component manual SBD-10705-P(N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber,Jim Thompson at(715)248-7767 or the St.Croix County Zoning Department at (715)386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad,with bottom of tank to be<_ 15'below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code,by an individual certified to service septic tanks under s.281.48,Stats. If the contents of the tank are not removed at the time of a biannual assessment,maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank.The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated. Septic tank manholes risers,access risers,and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33,Wis.Adm.Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce,Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic(other than for vegetative maintenance)over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March)dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS,and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional,more frequent monitoring. valve. Effluent to 1 cells on two-year schedule by use of diversion Effluent flow shall be alternated between disperse ce s n a y y be diverted from new cell to old drainfield at 2 year anniversary of new system installation. Old drainfield to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a three year rotating basis thereafter. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg.7 of 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mike & Cassie Krueger Mailing Address 769 Wilfred Rd. Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State Hudson, WI Parcel Identification Number 020-1335-80-000 LEGAL DESCRIPTION Property Location SW '/4 , NW '/o, Sec. 27 , T 29 N R 19 W, Town of Hudson Subdivision Plat: Badlands Prairie , Lot# 38 Certified Survey Map# Na a ,Volume Na a , Page# Na Warranty Deed# (before 2007)Volume ,Page# Spec house Dyes Cho Lot lines identifiable ri yesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&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. I/we,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 Safety And Professional Services 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 Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on th' form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a w ty deed recorded in Register of Deeds Office. Number of bedrooms 5 SIGNATURE OF APPLICANTS) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application 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. (REV.04/12) fie,s00/ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address)769 Wilfred Road, Hudson,WI 54016 located at: SW 1/4, NW 1/4, Section 27 , Town 29 N, Range 19 W, Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it(they) appear(s) to be functioning properly. Most recent date of inspection or service June,2014 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,000 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete A,- e Tank(if known): 16 years, installed 10/02/98 :ermit n i ber (if known) 315988 L °j. James K.Thompson 'censed Plumber Signature) (Print Name) MPRS ,4 , j ° t---- MPRS#30021 (Ti - (License Number) MP/MPRS Feb. 16,2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 pb. ?co/ I I III III III III IUIIIII 8270920 Tx:4221924 WARRANTY DEED 1004934 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 12/02/2014 12:17 PM THIS DEED,made between Wayne C.Bystrom and Luree R.Bystrom f/k/a Luree EXEMPT#: NA R.Langevin,husband and wife ("Grantor,"whether one or more), REC FEE: 30.00 and Michael K.Krueger and Cassie M. Krueger, husband and TRANS FEE: 774.00 • wife ''("Grantee,"whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests,in St.Croix County,State of Wisconsin("Property")(if more space is needed,please attach addendum):Lot 38,Badlands Prairie in the Town of Hudson. Name and Return Address David J. Estreen 304 Locust Street Hudson, WI 54016 020-1335-80-000 Parcel Identification Number(PIN) This is homestead property. (is)(is not) Exceptions to warranties:Easements,restrictions and rights-of-way of record,if any. Dated i f/21 y \/ Ca-8 r71✓� (SEAL) i (SEAL) *Wa ne C.B strdm y *Luree R.Bystrom f/kra .Langevin *Vayie(. L y5 (SEAL) 1^U,`('C-e— J IS+Y-Ot-) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on . STATE OF T n 06 S SE e ) �SS. vi-her-Ford COUNTY * AI I TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me on `)V ove.m ix( - (If not, the above-named Wayne C. Bystrom,Luree R.Bystrom f1JgtN og1 authorized by Wis. Stat. §706.06) Luree R.Langevin J, .••-.a7) +8 to me known to be the person(s) who executed the fgg' �ttfg S T THIS INSTRUMENT DRAFTED BY: instrument a d acknowledged the same. e o OF E TNONESSE = s Attorney Kristina Ogland /.�,ii/ Tq Ea o Hudson,WI 54016 • "0 'UBL,CY •/A. Notary Public,State of * ' My Commission(is permanent)(expires: 1 6I�t/ ( st1 OR C2.' • (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED, WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.2-2003 •Type name below signatures. INFO-PRO"Legal Forms 800-665-2021 www.infoproforms,com St. Croix County 1004934 Page 1 of 1 `/^�// "l- 5 1 / L. ‘-.11 Ii IL 11. V ,- 7 T 19w I TOWN OF HUDSON , ST. CR ' ... . .,. n,Ki 1,1,i 2 WN ' ' COUNT y WISCONSIN . f LINE 5E.= .:1--r_t.. 1 U7 • 0■ ...., , __....., • . . , -, _ • 3 `"4- c.i _-' . •s6 ,.--.7"--' .C. 7; ' . Z • • 1', . 395.2' F _ ,---..- - L, ) r•-,i E . if'1 -I 1 • 38 ■ , • • `-.D 37 , , . •7,'• 2. 9 ATE / .S -D C J ' 374 `..7).C, , 0- 3: .7_ -"' -').\/e- ■ , --c•:. „ , . 0 0.4 , , ii ,.-\.,., 33' ' ''`'- , i , .. . • ,,--- -: ''', - . ...._ _ — --_ ........._.. • isconsfn Department of Industry, SOIL AND SITE EVALUATION bc4and Human Relations page 1 Division of Safety and Buildings in accordance with s. ILHR 83.09,Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include,but not limited to: vertical and horizontal reference point(BM),direction and St. Croix percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.If O.N o - � 7a -90 APPLICANT INFORMATION-Please print all-information.-: • Date Personal information you provide may be used for secondary purposes(Privacy Law,s.151:4(,)(m)). yAA`0 I ,� 8 Property Owner ;'<�. A'' ct\ Pro rty Location - / Richard Stout / T.w dpvt.ljot SW v4 NW 1/4,S 2 7 T 2 9 ,N,R19 R(or)w Property Owner's Mailing Address /. ,r. rr?1 Lott/ ; Block# Subd.Name or CSM# • 1353 Awatukee Trail r, 1 ''tX 38. Badlands Prairie City State Zip Code , one Numt&� VNC' e Nearest Road ; e FIG ® •ty E] Village [� Town Hudson WI 54016 ( 15 )54 F31 ,..,•uds,,r1 State Hwy 12 J 7 I i�!• ®New Construction Use: ®Residential/Num :_ _ . ..- 3-4 Addition to existing building ❑ Replacement ❑Public or commercial-Describe: Code derived daily flow 600 gpd Recommended design loading rate •7 bed,gpd/f9 •8 trench,gpd/ft2 Absorption area required R 5 R bed,ft 2 7 5 0 trench,ft 2 Maximum design loading rate •7 bed,gpd/ft2 •8 trench,gpd/1t2 Recommended infiltration surface elevation(s) 54- i1 '7 6 z-,6?-74 64- ft(as referred to site plan benchmark) Additional design/site considerations Parent material Glacial deposit Flood plain elevation,if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank • U = Unsuitable for system M S u a s U 2)s U ®s U ❑S ® U ❑s ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPDnt2 in. Munsell Chu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed ,Trench 1 1 0-2( 7. 5vr2.5/1 none L 2mabk mfr cs 2m .5 ' .6 2 24-52 10yr3/A none .sl 2mbk mvfr cs if .5 1 .6 Ground 3 52-98 10yr4/E none ms osg ml Cs -- .7 : .8 elev. - 99.-1-0--t I Depth to — - - cj —._.— ; limiting /( factor — • - 98 in. Remarks: Boring# 1 0-70 7 -5yr2_ 5/.1.__.._ nonce._. L 2mabk mfr cs 2m .5 .6 2 2 20-40 10yr3/L- none sl 2mbk mvfr cs 1r f _5 , .6 3 40-$9 10yr4/6 none ms osg ml CS -- .7 : .8 Ground , elev. 98-211k _- ._ - Depth to r limiting factor 89 in. Remarks: CST Name (Please Print) Signature Telephone No. lid.r`/ 4%eIn- SCZ4-#0•-14.lifer W .-- ?<S-3?C--3! • Address Date CST Number e, i a . 7 - . y .J - Q 2 a s �•9d ■ PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# 3oring# Horizon Depth Dominant Color Mottles Structure D/ft2 g in. Munsell Ou.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots G P Bed .Trench 1 0-12 7.5yr2.5/1 none L 2mabk mfr cs 2m .5 . .6 2 12-48 10yr3/4 none sl 2mbk mvfr cs if .5 ; .6 around 3 48-90 10yr4/6 none ms osg ml cs -- .7 : .8 31ev. 99 .tin . tt. )epth to ' imiting actor - r , a_11._in. . Remarks: 3oring# - - 1 0-12 7 .5yr2 .5/1 none L 2mabk mfr cs 2m .5 ,.6 2 12-42 10yr3/4 none sl 2mbk mvfr cs if .5 ;.6 4' 3 42-96 10yr4/6 none ms osg ml cs -- . 7 ..8 around a1ev. , 99,6-0. )epth to . imiting ; actor 16_in. • Remarks: 1 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f12 in. Munsell Ou.Sz.Cont.Color Gr.Sz.Sh. Bed .Trench i Boring# 1 ,0-12 7 . 5yr2 .5/1 none L 2mabk mfr cs 2m .5 .6 5 2 12-42 10yr3/4 none sl 2mbk mvfr cs 1f .5 ; .6 ''`. 3 42-92 10yr4/6 none ms osg ml cs -- .7 , .8 Ground elev. , 100 .05ft. , Depth to limiting . factor -9-2--'n' Remarks: Boring# - - • . . Ground , elev. ft. ; , Depth to . limiting , . factor 'n' Remarks: SBDW-8330(R.08/95) • isArSes caa -c l ``-YQ gm I a",obc AAe eo J3)1721"Aorp6oG 0. 1 t 6 gr, 4 e ' 1-61-39 ■ el x 6. s. T3g •e't T37