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Home My WebLink About020-1376-16-000Wisconsin department of Commerce Safety and Butding Division :s f.- ~;, PRIVATE SEWA ~ YSTE#A INSPECTION R~RT GENERAL INFORMATION (ATTACH TO PER)1AIT) ~.. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(nr)]. Permit Holder's Name: City Village X Township Me er, Jeffre Hudson Townshi CST BM Elev~• O ~ Ins~MOE~ v: B~ escriptio~n,. ~~ ~ / Q ~~J. ~ t~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~~~ Dosing ~ !r f `.~,`,~,`> ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ .~,~ t ~ ~D [ Dosing ~~ +~ .~ ~ ~ 2 Aeration Holding ~+ PUMP~PHON INFORMATION ~L . ELEVATION DATA County: $t,~ P~~( Sanitary Permit No: , 399603 0 State Plan ID No: ~" t Parcel Tax No: 020-1376-16-000 STATION BS HI FS ELEV. Benchmark Z_ ~ ~ ~ q ~ /+ Alt. BM ~j `7+2 I -{I c~,p 1~• i1 ~ , Bldg. Sewer , 2 ~ _ + ~ S 1 J 92 } ( r M St/Htlnlet -Z~_ ~, ~S t 4Z- sl SbHt Outlet Dt Inlet DtBottom '6+~ ,~.~ ~ • Header/Man. C+ q • ~8 r Dist. Pipe ~+~ t-~ 77 ~+ +~~i Bot. System + O ~ / Final Grade o,r. Ir+C 3, St) ~ ID • b ~ St Cover Nil Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 9 ~ ~S r f2~ SETBACK SYSTEM TO P/L DG WELL LAKE/STREAM LEACHING Ma~iufa r~ ~ INFORMATION fS t T CHAMBER OR ` ~ ` .i: l ype ys ev ~t ~~ ~ ^„ UNIT M INu~t~: G DISTRIBUT ION SYSTEM , fua is ~ oe.~ll'_ Header/Manifold y '~ Distribution p• e(s) x Hole Size ole Spacing Vent to Air Intake ~ ZS r Dia Length Le Dia Spacing SOIL COVER x Pressure Systems ~nlv xx Mound Or At-Grade SYStems OnIY Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No [] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection ~k1~~/ C$ / O~ Inspection #2: ~-! L_~ Location: 935 Fraser Lane Hudso~n~,~W~I~ 5~40,1j6 (NE 1/4 SW 1/414 T30N R19W) Sweet Grass Farm Lo Parcel N1o: 14.29.19.2277 1.) Alt BM Description = ~ ~(~°~r"_""'~"'ve:o''`- e'r,^- ~• ~aw~ S i~ - ~~ ~'~^~'~ ~'6u'V ~srT o~~o~.S~" S~~) 2.) Bldg sewer length = ~~ ~' ~ _ f LY _ n -amount of cover - ~ 3L say ( ,,y,s'~Q~ C2~ 3 k 9 3 • }~ "f~'~Glrts 71 aI~ .~ IJudS "~- ~sr~ ry LC~ " ~ ~ J ~~Sou[1 d'~) ~ x(r S J Plan revision Req a ®Yes No OB ~ Z r de r diti9nal infyrrj~i~ ~• ~w`+- ~~'' ~ Date Insepctor's Signature Cert. No. SOIL ABSORPTION SYSTEM 93.s r~s~2. L~~ o • • Sanitary Permit Application Safety & Buildings Division • ~~ In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this a plication 201 W. Washington Ave. PO Box 7302 SCO/fSin p WI 53707-7302 Madison Department of Commerce personal information ou rovide ma be used for second oses y p y ~ p~ [Privacy Law, s. 15.04(1)(m)] , (Submit Completed form to County if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County ~ ~ ~ (' State Sanitary ® it Number ^ Check if revision to previous application State Plan I. D. Number ~ 7L I. Application Information -Please Print all Information Location: Property Owner N'ame~ P/rope~rty Location t ~ ~'~~ ~ (or) /VLl/4~~1/4, 5 ~' T ,N, R` Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Pho unpbrtr ~ Subdivision Name or CSM Number ~ co '•~~~ . <~ II. Type of Building: (check one) ~ ^ City ~ 1~E 'v 1 or 2 Family Dwelling - No. of Bedrooms : ~ 1'~ CE G `';-' -' 1 ^ Village J~'Town of ^ Public/Commercial (describe use):_ n cv °i N ~~ ~ ~ ~:' ~ ^ State-Owned I X ./ ~ ° y Nearest Road ^ ,~ ' 3 X `Z , s ~ ~ 3a Parcel T Number(s) O ZO /6 400 III. Type of Permit: (Check only one box on line A. Check box ifa'p~1i / . Z A) 1. New 2. ^ Replacement 3. ^ Replacement of 5. 6. ^ Additi n to System System Tank Only Existing System B) Pennit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ~~ - ~rTD ,f ~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: ~' ,~,/ / ~ 1. Desi n Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil App nation 5. Percolation Rate 6. ystem Elevation ` 7. Final Grade ~ Required Proposed Rate (Gals.( y!s . ft.) (Min./inch) q 7 Elevation ~'6o S~ ~ ~ 4 ~ i° . VII. Tank apacity in otal # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks ~L ~~~ Con- Con- glass New Existing Crete structed Tanks Tanks / ^ ^ ^ ^ ~ ~ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (print) Plumber' Signature (nos s): MPR-4f~''RS`No. Business Phone Number Plumber's Address (Street, City, State, Zip Co ~~ ~ uJ lX. County/Departmeat Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surc arge Fee) ~ _ // / . Determination f2, j . 3 0 O/ ~ X. Conditionn~~of A~P proval /Reasons for Disapproval: . ~~,~•0.:ttnstou u~.~ ~.e.~ 1Md~t, ci° R-- .2.~+Aszrw.e.K~ts ~.~- ~, W, L. a-~~ ,F~ll Se%~~ ~ ~ai~n t~ 1 -~ - s c,~-- cr.s ~St~ ~ ~./IM~t~y~~ S~~-~~- ~ 1~--~ 1 .mss SBD-6398 (R. 07!00) _ J~~~ ~ y ~~ y~~ ~ 3 ,~'°~ ~" °'" ' c 1 ~~ ~ ~~~ ~~ - ~ l~° ~L s~,~..~ ,.~ ~. $,~ / 2~~ ~ ~~ ~ .~ $~s ~ ~~ ~~ ~ e r.~ ~~f / ~ ~ ~ ~ ,6 /~ ~ ~ ~ ~~ ~-~--®, ,~,~jl,..i,~-~~ t~ ~ ~...•2 ~ ~ ~,- ~s~~~ ~ ~a~~ 1~ ~ ~. ~ / ~Df ~~ ~ r~ ~ ~ ~, ~ ;. ~~ti ~'' i ~ofl~ ~~~ .tea ~~ ~~ ~ .. --- '~" ~~ z Z,~ ~9~ i- .. J~~~ ~~ y ~L~ y~~ ('`:~ ~'o ~ ~ T ~P~~ l.a*~ LOf l6 ~} ~~ z~,d ~9~ ~~~ ~ r.R-~~~`~S r~ ~~ - ~ ~,b,. ~ / ,~ i/ ~,, ~-i ~~ ~~ ~,~,~ j ~-~f! ~ / '~ ,~ ~~ ,~ ~' _. _ __ ,~ .' Ihiscensin Department of Commerce Divisi8n of Safety and Buildings u ~ po(~ czo(paz SOIL EVALUATION REPORT Page I of in accordance with Comm 85, Wis. Adm. Code ~„ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ...,.. ~ 5T- e~ l inGude, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. (J ZQ _ 1 ~j~ 6 , ~ 6 Please print all information. Personal information you provide may be used for seconds u oses Priva Law, s. 15.04 1 m rY P rP ( oy ()( U• Re 'ewed by Date < «,~/~ Property Owner ~r~ ~~>D ~~ „{~ ~ ~ ~Z Property Owner's Mailing Address ~~°~q n~-~A L~ ~r~ c.~. City State Zip Code Phone Number 1"titi~`P~-~ p~~~ -~'1 rv SS l u9 ( ) Property Locati n Geut.l.ot ~ ~ 1/4 S W 1/4 S 1 ~ T Zg N R ~~ E (o W Lot # Block # Subd. Name or CSM# 1 b - s-~1 ~1-sr~-ss ~.~ s ^ City ^ Village ~ Town Nearest Road ~UD S 0~ ~S~Z 1.1~ New Construction Use: ® Residential / Number of bedrooms ~_ Code derived design flow rate 0 O GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~UTt~./ R`S ~~ S~.t~ "~ Flood Plain elevation if applicable ~ . tit ~ ft. General comments ~. '~._~ - - -• ~' and recommendations: Rye Q1~ W1 ~1J~ 3 D US ~ CtZ.IS , ~~'-~ ~ ~ X 1, Z_ S '` w~ 0 UA1 L~'` F ~~- t G t~- eri Y r~>.`~y s 1 ~ cw ~,~ ~ ~-r~e.N CH~t M s ~ ,... ~ ZR~ `~_ Z3o1~-OV~t Ot= °L~S `Tb l3tr 1''lthl- X18 ~~ `t~ Y`ilR~ 1 Z ~~ b ~~ ~ ~i Boring # ^ Boring _ ~ `r-t `, ST GROIX Pit Ground surface elev. 1 O 1 Z ft. Depth to limiting factor 3 .tn. Z~~~ V i on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence B " d i'y. , Roots ~ /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '~ ~ 1 ~` 1 'Eff#2 o _9 10~1.~- 31z - s ~ 1 Z,~s bk -n'F~- ~.w ~Z_ , _ . , s . $ Z Q 3~ l~~t-ZS/6 - sit ?,~-shk 1M•'~h elv ~U~ • S _~ 3 36-b~F ~° ~~`~~ v~ ct~: Z.S~t2 s/s3 ~' sicl tiesbn ~ _ Boring # ^ Boring Z ®pit Ground surFace elev.) 02., ft. Depth to limiting factor ~ 11y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0- l 1 (. 0`Z IZ312 - S i. ~ Z.`FS ~ ~ wl`F~- ~w L'~ -S . 8 Z ti~-36 102 ~6 - S, ~ Z'Fsbk m~Fr e~ ~v~ . s _e 3 3~=~z ~•s~2:.~t~ - S d sg c~.~ ~S - .-t ~. ~ ~{ ~2.-ily ~SY231y _ S~61- C)Sg p~.l - _~ L. 2. cnweni ~ ~ = ovus ~ su ~ uu mgiL ana i ss >3u _< 1 au mg/L ~ ernuent #Z = 80DS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number Arthur L. tdegerer ~ ~ ~-~~~' 220254 Address 4d e g e r e r S o i l Testing & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 i1. i~iain St. River calls, [TI 54022 11-S-01 715-425-0165 Property Owner M ~~ ~Z Parcel ID # ~ Z~ ~ 13~ b - 1'lj Paae z of 3 Boring # ^ Boring ®Pit Ground surface elev. ~ O 6- S ft. Depth to limiting factor ~ ~ 2-O in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 ~ o- l o ~ ~ ~ 2.31z - s ~) Z.`Fs b k mfr- ck, z-~ • s - s Z l 0 3o to ~ R- 3L6 - s ,? 1 2`~sbk r-t'F~- cw 1 ~~ - S - g; 3 -4~ -t.S `L2 3 ~ ~' S O S9 ~- ~ ~ - .. ~ L Z qo_1 l0~~~16 - s og9. cal ,~ ~_Z ~.,f- 9q•o ~ 90 Boring # ^ Boring ® Pit Ground surface elev. 1 e z- 0 ft. Depth to limiting factor ~ ~ Z~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munse-I Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o .- ~ o io~t iZ 31 z _ s i I Z`Fsb~ vn~.- cfv Z`~' - s • 8 Z tp 3 Z ~ o~. R ~1l ~ - s ~ 1 Z'(1s h1z Y~t`FJ~ c.i,J 1 v~ • s - 8 3 ~z_tzy -~syR3ty - s o sg ~.l _ .-~ ~-~ ~ ~9 8 ^ Boring # ^ Boring ^ Pit Ground surface elev. ~~ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 'Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODa < 30 mg/L and TSS < 30 mg/L 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. SB0.8330 (R6/00) ~. -. ~ PLOT PLAPd Scale 1' = U~ ' \~ ~~ ~- i r CST Signature ~DL L~r t5 ~ - Qo ^,~ Page 3 of 3 ~{ 1F.11~'~Prl. ~ C.L'l..LS _ _~ 1S' l ~S d/9 6Z.5~ B:Z / t~ ~ a' 1 . / 7 Q y,,~ ~ / ~~~ 8 1 ~~ / ~~ / / ,.,~~ /v ~~ /~ ~ ~~ ~ ~ 6 / ~~ / ~ / / .o ~ / ~ o ~ '~ / / % j 1~-5-0) 715-425-0165 220254 p!-:Z88 Date Telephone i1o. CST Alo. _ Job PiO. wT ~~ ~~"I_- ~-~ 100:0 `OtiJ _1'~:1Ri~N._1~.1PE _.LQr.~-0]i~1J ~rt2:_- -- _--- -- _____ -- 3M't~Z.~, ~t_ ~t4-=O' o-v ~t"Z'Pct,G;-31~(a DCA~=T'v.C _PI P~ wlt~}-~--_ ' ~. Combinatio.n SEp.>r,~.c~ Tank and ' PUMP CHAM~~R CROSS SECTI0~1 At`lD SPECIFICAT10~1S ' • ~ '~• THER PFCOOf ~sP~o>J n IPA w / ma-'n s ~- ~rrtia ~, ti~C.I. VEAIT PIPE ~ jQ' FROM DOO1C, •.;~NOOw oR FRESH ~IUT,~KE -"""~ ,. 6uI +'W,7c ;. i 6R ,ntw z, ~, l~~ T L ' ;I ,8•r,IN. 1 il! L E T APPROVED JOIAJT W~C.T. PIPEaR ~ 0.~L~ Zf~c8~1. T t~.~^~ Tank construction shall comply with ILH;3. I',3.15 and 33.20 VEuT CAP WEA ' JuuCTlO-.1 SOX . ,APPROVED LC)CKI-.lC. l~l~l}J}fC1LE COYER 1•vl"!1{ ~ waRNl>JG Lr~BEL. ~ . cor.~lw~r I ~ I y' HIA1, I ' ~, Ie~Mlu. ~__ ~\~~ • . ~ ~~, PROVIDE I ""'j"AIRTIGHT SEAL I ~ I I Ili _ A i ICI III _ I I I ALARM rs I I I I I I oil G 'I I I PUMP -~ ""'~ OFF ~., /' y~ D COUCRETE ~L.. 1_ U ~ HI.OGK--- APPROYEO .lOtuT: W/C.T, PIPF~p'~ L ' 3" AAPf~~: ~• RISER EXIT PERMITTED OIJLy IF TA-JK MAIJUF~CTCJRER HAS SUCH APPROVAL B.EDOtNG SEPTIC f SPECIFICATIC)t~1S POSE ~ W ~~~ COA~C.~z.~j'-~ A1t1MBER OF DOSES: P1;R DAY TA-.1K MA>`JUFACTURCR.: _ TA1JK :,IZC: ~ ~ vy "- o~ GA~LO-~1S DOSE VOLUME AL,~Rf'1 MAUUFACTURER: S~S~~~--~~0 SLIS~T~~''1~ INCt-uDt1aG 6ACKf!•oW: ~q?GAl4oNS MC)DCL DUMBER: L OI. Nw CAPACITIES: A. ~~ lJCHES OR ~c~L~.~`~^ GAILOyS SWITCH T~PC: ~~Z~'-I`"_' 9= Z IuCHES'pK ~.LL;=G~LLOU$ PUMP MA3JUFACTURCA: 1^~~~~°S _/ __ C;_,~._IUCHES OR ~~LLQUS MDDEL f`1UM6ER: ~t'~ `7"y D= ~ IAiGHES OR ~3~GALlOlJS . SWITCH TJPE: ~1~~C~ uOTE: PUMP A1.lp ALAFI!'t ARE To dC MIIJIMUM DISCHARGE ~RATE~GPM INSTALLED OtJ SEPARATE CIRCUITS VERTICAL DIFFEREIJCF OETWCEk1 PUMP OFf AIJO..DISTR16uTI0FJ PIPE.. ~ FEET + nluiMUM IUETWORK SUPPLY PRESSUR~E~, : ..... ~z FEET -I- FEET OF FORCE 1'1AIN X ~` fpo FCF~tCTl01.1 FACTOR.. // FEET ' ._.... . TOTAL Oy1JAMIC MEAD ~ FEET As per manufacturer ~7 gal/in. ~ ' ,_, . ,, ' ~~ •~~ .' M E40 Series 4/10 HP Effluent and drain Water Pumps Performance Curve W Z ; H J 4 H O F- 12 10 ~ 8 Z Z H 6 J Q 4 ~o H 2 ., 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 ~~. K3326 7/91 Printed in U.,~.A. MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) l1D Estimated Flow -Average (gpd) Septic Tank Capacity (gal) 2 p Soil Absorption Component Size (ftz) _ r Type of Wastewater mestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 2$'O ~'( Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service o ce every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septi and outlet filter shall be assessed at least once every 3 years by inspection. T outlet fil r shall be cleaned as necessary to ensure pro er operation. The filter cartridge of be removed unless provisions are made to retain soli sin the tank that may slough off the filter when removed from its enclosure. If the u ~~~~ ' , ' ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole 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 one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within fhe septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 . ~ `° Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division o~ Safety ahd Buildings Bureau of Integrated Services in accordance with Comm 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 $ "~' C.~c~ . X percent slope, scale or dimensions, north arrow, and location a~di$tapce to nearest road. parcel I.D. # APPLICANT INFORMATION -Please pri~,ell /nforrrtion ~ ~`, t'~~, Reviewed by ~, Personal information you provide may be used for secondaty```purposes (~bi~acy ~+,~. 15.0{a)' ( )• Page I of k Property Owner ~+A $'t'U.s~ ' P •--. r ~, P-F Prope~Location 6Govt..i-ol~J_ 1/4 sC~i/4,S /~/ Tz'~ ,N,R ~G( E (or~ Property O2wner's Mailing Address r ,, `~ Lot # ` ~, Block# Su Name or CSM# City I-1~ ,.~<~,r, State Zip Code P#`ione Number ~ ~ 114>- I ~"Un-i~ I ('-1y~>ti"~-~„~.fi~. [] ,City ~ 4 Village ®. Town Ui ~ri~.nr~ i Nearest Road Fra2~r In . ®-New Construction Use:-Residential /Number of bedrooms 3-~- Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~~~ gpd Recommended design loading rate ~ bed, gpd/ft2 ~ ~ trench, gpd/ft2 Absorption area required bed, ft2 ~S~ trench, ft2 Maximum design loading rate ' 7 bed, gpd/ft'-~ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) v,yP-~ `r2. G f! G~w{~ 4'O' ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations !~~ `'~1~-e~ 4 3' SCJ ~~ `/~ ~ ~ 2~ ~~ Parent material UC1 ~~~ ~ 5 ~ Flood plain elevation, if applicable _~/ ~-- ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = unsuitable for system ^ s ^ u ^ s ^ u ^ s ^ u ^ s ^ u ^ s ^ u ^ s ^ u RAiI 1'fFSCRIPTIAN REPORT Boring # Ground elev. ~~$ft. Depth to limiting factor t~ in. Boring # .2 Ground elev. q ,~o ft. Depth to limiting factor 4 / in_ Horizon Depth Dominant Color Mottles Structure e B d R t GPD/fi2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistenc ary oun s oo Bed ,Trench t o- ~0 3 ,- L s ~,,.~ rs c.s 1 ~~ ~- ~ ~- Z 6 I o 2 6 - 1~5 Os lam- 1 S - ~:~ Remarks: Remarks --- - - - ;ST Name (Please Print) Signature Telephone No. 1~ m Sc..h k ~~~~)zy7 ~~ 4ddress Date CST Number Z.tl FSO~ ~. Some,-set- 1,~1 S~EoZ,S`- ~/~ -ov ~Z533a9 PROPERTY OWNER ~ ~ C.f ~' SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3 Ground elev. Depth to limiting factor Quin. Boring # `>+ Ground elev. qS - ~nft. Depth to limiting factor ~(~in. Boring # Ground elev. 5 ~~ft. Depth to limiting factor 1' in. Boring # Ground elev. ft. a . ,Page ~_~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ 03 ~o Z - LS 1~s -ti.~~ ~s ~~~. ~-~ ~' Remarks: 1 a- to cL 3 Z ~--' LS ~ ,~. t.~ ~- L ~ °~- ; ~- ~6 fo r~3f z -- o ~1 - ~- ; ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fib in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. B e d ,Trench ~~ ~ (+ ` ~ Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) ~ ~ ~ r PAGE~OF~ NAME STU y ~'" LOT# ~ ID LEGAL DESCRIPTIONNE '/,Sw'/4 S 1'~ T~q N R !9 E or ~V SCALE: 1"= (~O~ BM 1 ELEVATION ((~O . U BM I DESCRIPTIONna; I ;,. (y°p;n~t~Flag~~ BM 2 ELEVATION ~ V ~ • O BM 2 DESCRIPTION hH; I ~ ~ IN ~~ P;,ne ~ Fla~~ed SYSTEM ELEVATION~pp.cr QZ(~D Lewt ~`90.(9D ALTERNATE ELEVATIONupp-~.~-Y3•S°Lower92.S0 CONTOUR ELEVATION ,,(~~(~}- Si• it~~ ~~'Gi3 pvr• t35 .` ~yv 1 QZ• pr,~ary ~~ ~ to [.r'Ir:~~( Sloie ~; {.~ h pt~rt Ttc~S 1 (~ Ix -- -}-- - r A. 1 ~t/.t•1f~s~j ry~ t 1-~3-D1 3:2G?M;P/tea~aba a, r 11/9?/1999. ]9:31 65168791!1 FROh1 ,~tiel2fl~t b~J::'1 T; g;+a,;y?7p& ' i L. ;o « 5; a t~4I ~-I=,E' . i J~'EWOHLHOPAES PAGE h1 F~ !gyp, Dee. ~8 2000 ®9: ~~Alq P2 6T CROYX CQ~~~"['~~ K ~.INTBi~a'~~`~ ACREEMS~`'T AND bglP C1S~'TtFIG~TIUN FC3RM G P~R+~.~uyoo-J ~~ v~10y ~~~ 4 ~~g _ ltetoirt aertlbnsnt Bor tuFw Ctin:ttietion; ~- Sp.P'TI~ T ,il~i:! 3 ~ti~; way _~ P~-RC. p~giy ~~ ~„u,,,,,.9 35~~L~1 (Yerii'leetioa -~egislctd tio~ ~irg~lSaca ~ ~~ asp-°~ -~--~-~• Pins] islt~S3fsication Nt~stbet _ ~ ? ~..~: 3 76 _ -' OISO ~, T~w.~~W~ i'owr, of ~ ~S G nom,,. ., Volw~ g~f~ ~ .r•, ~ ~L VotusaA L,.C',...t.~.~~..~ Ps6t ~ ,,,,o--- 8p~e hout,- Q Y~ ~~ 1„Gt ISaca i+senliS~bk~y~ C no ~IplMert~s~t~o~y~'r tic aystus,av~ldrs~ltia-~eptat#e~~~~lleuu~sl0ki~dlewaale~.Properti~~inte~nce eggplltt 4~}t~IN~ t1d Irs MpYt uok ~ Y~ ~+ea~ee~-. sC ewd~d tiY ~ Ue+ss~d W~lr~ WhNt yo-~ 1.+ Mme tt~ .pan say. «~os ~- lb~a •: ~ a~ r.x s.. ~ err isr ~ r.rrF 7~ I~Iw spell b ~ - ~epa~ltllt t Io~a611t10118eR~. ~~ed by tbt eswt-e: Ord by t riwtl~FiPl~~}~IM~Ye-~eA~~'<< ~f~iiemaLQul~psr'vM~3lyi~i~~S)i6aod•1~Nirrrthwtle!'~iiPa~+l1~Ni/ut! a is ymyu a~snrdos wd/o~' G+~ a~.r +~'~ >~ (~E e~eNl~tYy.1d aepcia sank tl 11M ~ YI! 4ul- Irf s.a4~,+. ,rva, tls usddd~ed 1Y11w+1 awsE ~ abews +md ~pria W ~ P-svs4 s~~+ dsap4Mi rYat•fb wish the rtandasSi t 11l,aewos, $at! sd'~'uaoaaia, Cerif3aatsue ail lst1~ tura~, t, iet by tlr DrpllMetpo<Of ~~3e ~ ~ i+eio tlsa 3t Csa=x Cewtty zal+ssf Offict wIWtA ao :ut~ tYst ~rwr npllo ~1lMNt Lai bex+- a+P d+IJq of tlwr tae, ~ ~, ,... _ A.1~L..-- s6r W ~ Of r~~ by ris7ui ~~ a lbtm an bud pe the beta ds~,~ (awl iuwwisc~s I (ws} iQ- ipM) ~ ov~nc*rA1 0l' rob' deed r~e4,dt~ m R,Irii~ar sFDetdo Dtllcs. ~~~ DATE v Illy rrssll+ fu b+! ~~ t~""j- ~aW re.vatdld by sl+t Zorna` DspafrraA+ • • • • • • nary ~ iroeK tke ~~iaose d Aud. oSOce ~~ AIF~~A~ may! ~ ~ ids $i ikr.NKRiRRy QNi r~r~, Awr ~rwlipirttat irYdite~r~r11 •• iart~ rr•IM t-b aswife~Nan: a ita7tNd i llli~ et ' • ~~~ 1b l4PAGE5U4 `~ STATE BAR OF WISCONSIN FORM 2 - 1998 650299 ' WARRANTY DEED Y.RTHLEEM H. WRLSH FEGISTEk OF DEEDS Document Number !iT. CROTX CO. ~ WI RECEIVED FOR RECORD This Deed, made between _ _,_ 07-05-2001 ~:00 P!I RTCHARn n CTnt1T anrg TANFm D CTAriT husband and wi fP,, __ piRtRANiY DEED Grantor. EXEMPT # CERT CDPY FEE: t . and __,IIEF'.~iFtE]LJ-.--N1I'i~IiF~ai36I M]1RLEEDI @d p4~Ir.S COPY FEE: MFVwR, husband and urife, _ - TR{WSFER FEE: 167.70 ______ RECORDING FEE: 10.00 -._ _~__ ~- --. Grantee. PR&E5: ! Grantor, for a valuable consideration, conveys and warrants to Grantee the follow(ng described real estate in S _ rni x _ County. Stale of Wisconsin: r'i .. ... r1:...~ Lot 16, Plat of Sweet Grass Farm, Town Of Name and Return Address Hudson, St. Croix County, Wisconsin, ~~ /~~ ~~~,~ fb(~-16 GAO, /-4 ~~Dp 020-1376-16-000 Parcel Identification Number (PIN) This i s riOthomestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. ~ .-- Dated this a8' day of y vim. , aa~ r , _ ~ ~ ~ . (-~ `' ~ (SEAL) /~~~t / t __- (SEAL) „Richard O. Stout Janet P. Stout Signature(s) AUTHENTICATION (SEAL) authenllcated this day of TITLE: MEMBER STATE BAR OF WISCONSIN ([f not, authorized by §706.06, Wls. Slats.) THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr. Hudson, wI 54016 (SEAL) ACKNOWLEDGMENT State of Wisconsin, 55. St. Croix -County Personally came before me this day of . ~~, the above named Richard 0. Stout and Janet_P. Stout me known to T~h~ r`^j~{el{•rtecuted the foregoing lnstrume ~R{>a CONSIN KER ON J. BA~ lY) (Signatures may he authenllcated or acknowledged. Both are not necessary) ' Names of persons signing in any rapacity must 6e typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1998 PubJlc, Slate o isconsin ttmi ion is permanent. (If not, state ex~pjl~ratlon ale: WI$COn51n Legal Blank CO.. Ind, MAWeukae, WiS. '' ' ,t, 1 1 v tl~i LL WQ ~~ ?W Z a' W 3~ WLL =0 ILL- Oa aZ W~ ~. 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