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Home My WebLink About020-1376-31-000~> ~~~ ~RF~KE 1-hN E' - Safety & Buildings Division ' ~ Sanitary Permit Application 201 W. Washington Ave. ~ ~ ~ S`,"~ j~s j j' In accord with Convn 83.21, Wis. Adm.. Code Po sox 7302 Madison WI 53707: 7302 Department of commerce Personal information you provide. may be used for secondary purposes , (Submit completed form to county if noC [Privacy Law, s. 15,04(1)(m)] state owned. Attach com lete cans to the coup co onl for the s em a ~+o han 8-1 /2 x 11 inches in size. Coant3' ~,x State Sanita Perrnit Number [] Check if n i\dt~'3 ; previous appiic~t~ 3~0 , State Pian i. D. Number L A lication Information -Please Print alt Information L~ ;'~ ,.~; '~- '~ ocation: rty Owner Name ~y ~i:; s 'P perty Location 27 t Z - 1 . _ ~^~~,~ ~ ~ t/4.`Jliil/4,S/ T N R/ or Property Owner's Mailing Addross ~ -3 L`~ ~ ~ r ~ ~;;,r.>; ~ ~ ~bo Number Block Number ~.. ~~ cc~ ~.;-~, ' =- o (~ 1~-R, iJ CR b ~ City, Stage Zip Co d e Pho T~Iuinber -' C~FFtCE , Subdivision Name or CSM Number 11 ~~ ~ ~~ ~ ~ l ~ ~ la e ~- •S Phr II Type of Building: (cheek one) fl city 1 or 2 Farruiy Dweiting - No. of Bedrooms: ~ ^ Village ^ PublicJCommerciat (describe use): .1>~'Town of ^ State-owned lt~5-O III Type of Permit: (Check .only one box on line A Check box on line B if applicable) Nearest [toad A) t. ,,New System 2. D Replacement 3. D Replacement of 4., D Addition to Parcel Tax Number(s) S tem Tank Onl Existin S stem ~ - - " B) Permit Number O p~~~ O A 5anita Permit was reviousl issued (~ ~ _ f 9. ~~ IY. Type of POWT System: (Check all tharapply) - , on-pressurized In-ground ^ Mound O Sand Filter ^ Constructed Wetland Pressurized ln:ground ^ Holding Tank ^ Single Pass O Drip Line S ~ r ,, n p ~ro D At-grade 3/ x bQ Tr tme Unit `~ Recirc la ing ^ Other: ~~` ~ _ f 3 _ S 7> ~ . ~J 1ao,J~" V Dis ersallTreatment Area Information 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Perc to .System Elevation 7. Final Grade O T Requir~ Proposed !! ~ `I' Rate (Ga{s.lday/sq. ft.) (Mi ; inc'h~])' 1 ---- ~~. ~~ Elevation ~' ~. S'~ VI Tank Capacity in ` Total.. # of Manufacturer Pr b Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New `Existing Crete struct~ . Tanks 'Tanks ~ S~ l~• ~ j aS9 ,~ o o v o 0 0 0 0 ^ VII Responsibility Statement 1 the undersi ed assume res nsibili for installation of the POWTS shown on the attached tans. Plumlxa's Name 'nt Plumber's Sig no stamps : MPlMPRS No. Businga khone N z . ~ ~tiJS U ~~' -~ Plumber's Address (Street, City, State, Zip C ) ~ t <5 C~ ~ ~,rvv VIII County/Dep rtment Use Only . Approved Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater charge Fee) Date Issued issuing Agent Signawre (No stamps) r Determination ~.~'- ~ -( Y 2~ UC,`CronditiRns v p~raval /Reasons, for Disapproval: ~._ . .. F~ ~° a,..~"-~. ~ ~ ~'° ,+2-„ctwi-'l~a~"~S~ Io-t~tt.o t-h.~z ~ o~ t,rt~wt+n, ".~: d!~-sr8v~a~L ~~ ~ .~t~. sus ~ s ~;~^0~0~-. C~~~. 'lesf-~~ N'~l~U `~~,~,Z. _~ p~~ ~ ~~~,~ `-~'- oa ~""~4,c~ut,P,,CS ~c.a.^'~.-~~a~ t~sgs F ,.~ . /* , Wisconsin Department of Commerce Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s~15.04 (1)(m)] Permit Holder's Name: ^ City ^ Vi~~II~~g ^ T" wn of: Johnson, Brian & Lisa Huedson '~'ownship CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (L Dosing Aeration Holdin TANK SETBACK INFORMATION TANK TO P/. WELL BLDG. vent to Air Intake ROAD Septic 2 p ` ~ -1 ' NA Dosing NA Aeration NA Holding PUMP /SIPHON INFOR ON Ma cturer errand Model Number GPM TDH Lift L Ion TDH Ft ai n Length Dia. Dist. To well SOIL ABSORPTION SYSTEM .. ,~ C _ _~ "` _ ,. BED / ENCH width t Lengt ~ No. Of renches DIMEN I ~ ~ DIMEN I N ` SYSTEM TO / L BLDG WELL LAKE /STREAM LE Manufacturer: S ~ SETBACK ~ INFORMATION Type O ~ , (~ ~ ~-` MBE T Mo el Number: ~ „ r System: idh > 0 DISTRIRIJTION SYSTEM I,~S Pi ® f/i ~' Header / M ifold u, '' ~~ ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 2S ~ Dia- ' Length en ^,_ ia. Spacing N /(~ ? SOIL COVER x Pressure SysterZns Only xx Mound Or At-Grade Systems Only Depth Over ' Depth Over xx Depth Of xx Seeded /Sodded xx Mulched r' Bed /Trench Center '~i J ~ Bed /Trench Edges Topsoil ^ Yes No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Ins ectio ~~~/ /~ Ins ection / Location: 906 Florence Lane, Hudson, WI 5-4016 (SW 1/4 SW 1/ T\29N R19W) - 1429192292 Sweet Grass Farm -Lo 31 ~ 6 """' ' ~J ~yt~.~rio S ~' 6 1 ~ ~ C 1.) Alt BM Description = ~ w .F~-{, ~~~ ~ ~ ,_(~ _ 2.) Bld sewer, l~en_gth = ~+ j~"~' - 2Z~ ~tit~. ~f"-^~ `""o"M"_F n - ~~""''~ b ~-amount o~over = ~ i S ~ `pp ~- ot~tRtt, •T`~+o ~•v~'" ~ ~S I re Is+on r_ squired? Yes ^ No ti ~ S • Use others+de for additiona ormation. SB 6710 (R.3/97) ! c ~ a ? ~~D~at~ -t Inspector's Sign to~oeD ~ /I ~ r~s~ NQ~-- ~4./+~~iaw ~- ~~- I ~ ~ ~Y"""'9c-- , ~,,r^., d~~l3k.l~gr~ I~eSd) t `~S'T`~ ~ Q,Q,d[ ~ ~~`P'~'~ ~;. CountySt. CroiX San ita rya P_errp~tNo.: State Plank IVVD44NUUllo11.: Parcel T~~~IoI~376-31-000 ELEVATION DA TA ~`1~Uf~ !'~ . ~~~ v STATION BS HI FS ELEV. Benchmark A t. M ~ ~ a .~~ 4 o Bldg. Sewer ~ L~ Uk ~•S ~`•• /Sr '~ .~7 S Ht Inlet ~ / ,~ '~(®3 g~~ St/ Ht Outlet , °/~ q~ Dt Inlet ~- ~------+ Dt Bottom Header /Man. fv .d Dist. Pipe ~+~ 9. go ~4'" .g Bot. System ~ ro' +~ .2v ~' Final Grade ,~ r o ~~.0 St cover 0 S Z ' n o d --. ~•~ >~ ~/Q /~ 7 S~ r'T`~j ~'~,(1 cl {I~UC- rl.`Lcl v'' ' "~' ~'ri,,,~f.~,o ~-!' PIT No. Of Pits Inside Dia. Liquid Dept - ~- ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ,~ ~ ~ ~ «~ property Owner Brent Johnson Parcel ID # 202-1376-31-000 _._ Page 3 of 3 Boring # = Boring - Pit Ground Surface elev. v 98.50 ft. Depth to limiting factor > 125" in. ~ Applies Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-11 10yr3/2 none sl 2fsbk mfr as 2f,1m 0.5 0.9 2 11-24 10yr4/4 none Vs 1msbk mvfr cs 1f 0.7 1.2 3 24-41 10yr5/4 none Is Osg dl cs 1f 0.7 1.2 4 41-68 10yr5/4 none 7 sil 2msbk mfr aw - 0.5 0.8 5 68-125 10yr6l4 none Osg dl - - 0.7 1.2 ' ~~ 1, p, /i r Boring completed as an addendum to original report to allow relocation of system uphill to avoid sil inclusions found at system elevation ass originally designed. , Boring # =~ i3oring h to limitin factor > 128" in. Pit Ground Surface elev. 99.55 ft. Dept 9 Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-14 10yr312 none sl 2fsbk mfr as 2f,1m 0.5 0.9 2 14-30 10yr4/4 none Is 1msbk mvfr cs 1f 0.7 1.2 3 30-60 10yr5/4 none Is Osg dl cs 1f 0.7 1.2 4 60-73 10yr5/4 none sil 2msbk mfr aw - 0.5 0.8 5 73-128 10yr6/4 none s Osg dl - - 0.7 1.2 Boring canpl~ed as an addendum to original report to allow relocation of system uphill to avoid sil inclusions found at system elevation as originaly designed. --~ Boring ^ Boring # _] Pit Ground Surface elev. ft. Depth to limiting factor in. gal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure 'sten n(-a Roots .,~ r , f _ .~ `,, ._ ~:+ i_- .._.; a ~~ ~ _ • i ~~ ' , -~c~t~ ,-y ., --• ~ . ., , . , , '_ ~~< ~ ; .....: _ \~1~ ....L .-.......• * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L 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. 90G x'/or'encc Le-ne, lof 3! Swe-P-~Grass~ai'rt, Scc. /~; T.of L~alsar,, 5E . GoiX Ce., ~~ Stake. E/e~'= i0o.c~' /' .8 I B5 ^ ~ ~ 'f % slope. 83 ^ ~_ !o ^ 8'F ^ 82 ~, 3~ ^ Soi / Obserc/a~'~ P.'E ~,_ ~, Sc~l~-~ .~/dor-~be ; /QO.G3 15 i gn~Yt~¢. ~-d--- Prof os~ c/ bedrmr» d we//;ng (o L ~ . ,a . ~ a~ o,~, rorl /o ~ 9.~~ ~~ v .~ .~.~~.. ~ ~ . ~l N_ 11. _ _ . _ J~ m. _ ~v u r.~.,~..e.~.~e/''. l .. ~ ~ ` __ __ __. . iw ~N~~m~~~ ~ ~ Sfip~~ ~- R~ '' S~pkQ ~I ' , 1325 • Wisconsin Department of Commerce SOIL EVALUATION REPORT pie 1 of 3 Division of Safety and Buildings ,,,,,,,,,,,,~.,,.e,.,;*,, r.,,,,,,„ a~ +nr~ n~.., r~ A.C.E. Sal & Site Evaluations - - Cou _ _ _ ~ Attach complete site plan on paper not less than 8'/: x 1 t inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BMj, direction and parcel I D percent slope, scale or dimemsions, north arr a,,~d I `ovation and distance to nearest road. . . 202-1376-31-000 Please ntt'.~/ r ~~ , ,~......_ eviewed By Date Personal information you pro ' ~ sed for secondary purpoyes ~ Law, s. 15.04 (1) (m)). (_ ~ 6 _ ~D s i ~`. ~ Property Owner /"~~ J ~ r f i } ~~ ~ Property Location , Brent Johnson 1,_'.'%` "~`'"~ '~,'~' Govt. Lot SW1/4 SW1/4 S 14 T 29 NR 19 W Property Owner's Mailing ~ s + ti--.• LSQ~ a - Lot # Block # Subd, Name or CSNt1J: .-__-~ r ~ ; ~ ~ ~_~ 499 Country View Roa ' .. 31 _ Plat Of Sweet Grass Farm City ' ~~~ ~ Mate Zip ~ Numb l City _j village Town Nearest Road Hudson %.,j7y `f~ CF~T~- - 85 Hudson Florence Lane Use: `'`- ~1~ New Construction ~fe;xj ~' T bedrooms 4 Code derived design flow rate 600 GPD Replacernerft r 9nuf9e vial -Describe: Parent material Glacial outwash Flood plain elevation, 'rf applicable na General comments and recommerld~ions: Install 2 trenches at 3' x 93.75' using high capacity sidew inder infiltrators. Suggested system elev. to be 90.50'. Boring # _J Boring " ~~ > 118 i Pit Ground Surface elev. ~~ 96.87 ft. Depth to n. limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ * *Eff#1 Eff#2 1 0-9 10yr3/2 none sl 2fsbk mfr as 2f,1m 0.5 0.9 2 9-19 10yr4/4 none sl 2msbk mfr cs 1f 0.5 0.9 3 19-24 7.5yr4/4 none Is 1msbk mvfr cs 1f 0.7 1.2 4 24-32 10yr5l4 none s Osg dl cw - 0.7 1.2 5 32-118 10yr6/4 none s Osg dl - - 0.7 1.2 QO -S'~ 2 Borirfg # --~ Boring 1~" Pit Ground Surface elev. 95.38 ft. Depth to limiting factor > 111" in. Sal Application Rate orizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz *Eff#1 * ff#2 1 0-16 10yr3/2 none sl 2fsbk mfr as 2f,1 m 0.5 0.9 2 16-29 10yr4/4 none Is 1msbk mvfr cs 1f 0.7 1.2 3 29-40 10yr5/4 none s Osg dl cs 1 f 0.7 1.2 4 40-56 10yr5/4 none sil 2msbk mfr aw - 0.5 0.8 5 56-71 7.5yr4/6 none s Osg dvfr cw - 0.7 1.2 6 71-111 10yr6/4 none s Osg dl - - 0.7 1.2 5~ •se g . "Effluent #1 = BOD 5> 30 < 220 mg/L and TSS 0 < 150 mglL = BODS< 30 mg/L and TSS <~30 mg/L CST Name (Please Printj Sig ure: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Nurr~er 340 Paulson Lake Lane Osceola, WI 54020 1112/00 715-248-7767 property Owner Brent Johnson Parcel ID # 202-1376-31-000 Page 2 of 3 Boring # ~ ~"~ Pit Ground Surface elev. 94.28 ft. Depth to limiting factor > 106" in. Sal Application Rate Horizon D th Dominant Caor Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eft#2 1 0-28 10yr3/2 none sl 2fsbk mfr as 2f,1m 0.5 0.9 2 28-41 10yr4/4 none sl 2msbk mfr cs 1f 0.5 0.9 3 41-60 7.5yr4/4 none Is 1 msbk mvfr cs 1 f 0.7 1.2 4 60-81 10yr5/4 none s Osg dl cw - 0.7 1.2 5 81-106 10yr6/4 none s Osg dl - - 0.7 1.2 .3 Boring # ~ Boring 1/ Pit Ground Surface slay 92.00 ft. Depth to limiting factor > 101" in. ~ ,gppl~~ Rate H rizon De th Dominant Color Redox Descri tion Texture Structure Consistence Boundary Roots : o p p 'Eff#1 *Eff#2 1 0-30 10yr2/1 none sl 2fsbk mfr as 2f,1 m 0.5 0.9 2 30118 10yr4/4 none sl 2msbk mfr cs 1f 0.5 0.9 3 48-56 10yr4/4 none Is 1msbk mvfr cs 1f 0.7 1.2 4 56-78 10yr5/4 none s,ls,sil Osg dl cw - 0.2 0.3 5 78-101 10yr514 none s Osg dl - - 0.7 1.2 orizon #4 consists Gf an unsorted mixture ~ Osg s, 1 msbk Is, & 1 csbk sil. Redox concentrations observed within sil inclusions ~ interface with wars m~erials and are not indicative of ground water. Boring 5 Boring # 1/ Pit Ground Surfane elev. 95.89 ft. Depth to limiting factor > 109" in. ~ Appl~ce Rate Horizon De th Dominant Caa Redox Descri tion Texture Structure Gonsistence Boundary Raots p p 'Eff#1 *Eff#2 1 0-12 10yr2/1 none sl 2fsbk mfr as 2f,1m 0.5 0.9 2 12-20 10yr4l4 none sl 2msbk mfr cs 1f 0.5 0.9 3 20-26 10yr5/4 none sil 2msbk dsh as 1f 0.5 0.8 4 26-34 10yr5/4 none Is 1 msbk ds cw - 0.7 1.2 5 34-65 7.5yr4/6 none s Osg dl cw - 0.7 1.2 6 65-109 10yr6/4 none s Osg dl - - 0.7 1.2 'Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <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. i~ S 9oG ~/o~e~cc to-~~e, /ot 3/ Sw~~G~asS>~~, ~E . Cra;,r Ca., ~~ ~mna/, I'1'jur~f': ~jo off' /ron /off ^ 83 ^ ^ 84 Co % S/o~e- ^~2 .g r ^ sro~~ i,~ ~~ ~~~ ~~~_~ ~~~~ L___. Proposes ~/.bedr'c~orn cf wt// n9 ~~ j~, 3~3 ^ so; i obi/~ ~ P.~~ • /ocA7Eed ~oP S-6a,~ / A I ~,w ~, >c~(~: .Pet.' ~/.3,Z5 l 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: Svstem Design Specifications Sanitary Permit Number o'o Number of Bedrooms Design Flow -Peak (gpd) O'a Estimated Flow -Average (gpd) Septic Tank Capacity (gal) tro C Izs`3 Soil Absorption Component Size (ftz) ,5' 2 -~ r~ Type of Wastewater Domestic Tabie 2: Soil Absorption Component -Limits of Reliable Operation w~ Septic Tank Component Soil Absor tion Component Design Flow -Peak (gpd) ~,ap Sr 2- Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once 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 septic and outlet filter shall be assessed at least once every 3 years by inspection. Th ou let filter shall be cleaned as necessa to ens re _oroper operation. The filter cartridge shou d not be remove unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the t ~` 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 the 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 Nisconsin Department of Commerce $Q AND SITE EVALUATION Division of Safety and Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must """"`r include, but not limited to: vertical and horizontal reference point (BM), direction and S''~ ~ C r ~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # ~ ~ _f APPLICANT INFORMATION -Please print 3~n~armat~on. Reviewed by Date Personal information you provide may be used for secondary ~ipose§ (Privy Lath, S` f§.04 (t) (m))., Property Owner Property Location C ~ ~ ••. ~ ~ Govt. Lot ~[„~ 1/45~f 1/4,S ~U~ TZ~( ,N,R ~~( E (or~ Property Owner's Mailing Address ~ of # ~lock# Su Name or CSM# I~ A~-luk~e ~• ~. ~:~', ~ :' ~ e-~ ASS City State Zip Code Phbne Numbi?fk`' `' `~' '~' ' ^ Cipj` ^ Village [ Town Nearest Road ll) ( ~ {C~ I (~t5 . ~jy ~~.~ ...: , ~ o ~/o/~e rt c~ l c~ ~.~ [~ 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 ~ 7 bed, gpd/ft2 ~ ~ trench, gpd/ft2 Absorption area required FSS 77 bed, ft2 ~.5~ trench, ft2 Maximum design loading rate bed, gpd/fl2~trench, gpd/ftz Recommended infiltration surface elevation(s) gs' ~ ~ / / ft (as referred to site plan benchmark) Additional design/site considerations ~ 9 ~' ~ Q o w -e ~7• ~ ~ // Parent material ~ U-F L-~ ~ S ~ _ __ 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 C(lll r1FCCRIPTIAN RFP~RT Boring # i Ground elev. 98, g o ft. Depth to limiting factor ,(Lin. Boring # Z Ground elev. 9~•9aft. Depth to limiting factor in. Horizon Depth Dominant Color Mottles Structure B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench I o-t l id l2 5~ ~ mc~b~. r~ c i v ~ ~ S 2 I ~- i y ____- 5~- I n-,sbl~ ~r c - • y ~_ ~ rlo to y -- ~ S C~< ~ c s - ~ ~ - g Remarks: Z ~- fd ~ `~ `~ L m -' - y ; . s .3 - IU y co m5 D . ~ . Remarks: ;ST Name (Please Print) Signature Telephone No. w~ S~~.u hn.c~.~.a./ 7.s--zrl7-ypc~~ 4ddress Date CST Number Z// G %~ S~. sc~.r.~-e ~-- /iv S'`''GZ S-- G/-G/-OCR ZS-33UC( PROPERTY OWNER s ~° ~T SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground c/~' S~ ' tt. Depth to limiting factor ['- _in. Boring # y Ground elev. 9!o~ft. Depth to limiting fgctor ~_in. Boring # Ground elev. 9X~ qo ft. Depth to limiting factor ~/ in. Boring # Ground elev. tt. ~• A __ 4 Page ~ of J Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench I o- l0 r 12 5 ~ r cs v . t-I ~ - s 3 4-~i b c~ m5 0 ~ ~- •"1 ' g Remarks: t d-to 1~ r:3f ~ .--- I ~bk n,~r c ~ - Y ~- - Lf- ; - ~- Z r~-~o ~-- s 5~k - , 3 t~-~ ( ~f ~ mS ~ cs - . ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench o - I U ~ ~L _- (YYLe tY7~r ~ • `~ ~ ~S 2 8-t lU y ~ --~ S I m ( - - `-f ; - 5 3 i~-~ ~n y/ -' ms 5 mt ~s -' ~ ~ . Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) PAGE ~ OF~ NAME `~~ U y~ LOT# 3~ LEGAL DESCRIPTIONSc.~ '/,Sc.y4,S1 `( TZ~t,N,R)~T E (or)( V~ SCALE: I "_ ~~ 6 BM I ELEVATION ~ ~ ~ ~~'j BM 1 DESCRIPTION ono-~~2''~vc. p~pc lu~{,urF6~ BM 2 ELEVATION ~~ ' ~ l„ BM 2 DESCRIPTION~p d ~ ~ ~~ ~4~h wlh/~ SYSTEM ELEVATION ~,5. ALTERNATE ELEVATION~pp~r 9~•0 ° c~,<~- y~ U ~ CONTOUR ELEVATION /U ~~' /~` 1 _~ - 1 s t ti` _/ ~--~ DATE Z~ y = ~C' sT cltolx covN~r~r SEPTIC TANK MAINTBNANCE AGREEMENT A~'Jt~ OWNERSHIP CERTtFiCATION FORM .r- Owner/t3uyer _ 4- . 21 r~ "~~ ~-.~ Mailing Acidress Property Addre~ „ ~ ~~ .-~. ~ ~ d Yt h. CG. ~ h~~ ~ --~-- __ _. ~' ~.~ (Yerifcatiaa regn-ired iron' vt$~ ~=rwcat ic: Y~r v+`,'ISttliCtiOiij,,,,r„ _- - Cti.+~r/Staic ~'~ ~t~5o-..t ~,4~/ F~:ae::3e~tiE~.,:son Numbs,~,~.~ ~ .~ ~~_ _~~ ~~j Property Location f ~ '/., .~... `/s, $eo..L,~_._,, T~..~...N•R,,,,(~..V~1. Tows of _, _ -~~ Sutsdivision ~ ~`.~g ;S ~cx,2.~1 _ . IAt # ~.,,(,.~. tyerttited St~tcvcy Map # . Vatutnc . 'Page # 'iNax~raaty Deed # _~ ~ ~~~ . Votttme ~`L,~,..., Page # ._L~.._.--r Spec house O yes no I,at lines identifiabte.~ C! tt~ = Fa~a~s c~~ a~ m~s~at::a:r:,o: yon systGmo~ ~ is hx pneu~aS~cr €~~!~~r a~t k t~st~. ~ _~rx aoe oozx.~ist~: of 1~, ~ ~ sew: taalc evexy thtee yearn or u~cn~rs, B` aood~'yy ~ ~~ Wipes. What ys~ ~: ~Lolu~e au sic ffia n o~'tlye septic; +tmlrss a treatment ~ ~ is ~ r~scm Tl+e ~r o~^t• shoes oo ~ to bt. t~ 'Loaiag Depattatert to eertiSattioa ~. by the owaes sad by : ~P3~y+~P pl~oralivtasedpaatper~that(I) theme-site wsate9vaterdisposal agatem fs is proper operating won and/or (~) niter hlspoctioa and ~ws.C~nocessagr), the scptuc taaYr is less than 213 ~ of sledge. . rive, the m~iga,od have read the above regaitm>~s sad agree to maimtaia the priv:co sewage disposal sys#em ~t the rtaadards sa fasda. Mein, sa set 6y the D~ea# of Oommeox sad the Departaaart of Natuatl R+~aart~; State of Wiseoasia. Csct~ia-tion t~tiag tint year septic syrtem has boar maiamiaed must be cam~pletod sad rcasmed to ~ 3t. GY~oix County Zoaiag Office vrithia 30 days of timx year capon date. /0 13 ~ia~ ~tA?URB OF CANT DATE ., OWI~R~ s~R_~FI '~~ I (rue} oe~fj- +tirst alt :tatcme:ots oa this forces axr; true to tlu bz;.t a[ my tour) lcnowkdge. I (we) am (are) the owner(s) of etas eieccrinod above, by victise of a ~nsoty dxd roco:+ded in rtegister of Deeds Offices SIGNATtAtB OF PI:ICAbIT DATE ssssss ,may iafotmstian that is mi:-rept+esen#ed may tc+esolt to the susltuY pecualt bcitg revoked by the Zoning Department. sssss. ss ~~~ ~#h this applications a stamped wamrary deed from the Regittec of Deeds otYloe a copy of the certiiled sarvey map if r+efcrenre is trade In the vvarraary deed STATE BAR OF WISCONSIN FORM 2 = 1998 WARRANTY DEED Document Number yQ~ 1556PAGE 42 __.. This Deed, made between R Il'HARLLQ ST4TLT and JANET P_ STOUT. husband and wif_~ Grantor, and uRTnr\t R .Tn#INS9N a-nd I,~S11 1'4. JEIHNSCIIV-, husband and wife-, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St _{'rpi x County, State of Wisconsin: j Lot 31, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. /o Es3.Z906 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD 11-0-400 10:50 AM MARRANTY DEED EXEMPT q CERT COPY FEE: COPY FEE: TRANSFER FEE: 140.70 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address /'i'ce __ _ _ . _ .020-1376-31-000 Parcel Identification Number (PIN) This i ~ not homestead property. (is) (is not) !i i it ~. i I Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. '' Dated this day of 2 Q Q 0 CC, ~, J (SEAL) /~^~l/lJ" (SEAL) *_Bi_chard O_ Stout (SEAL) * AUTHENTICATION * Janet P_ S_ou * ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St_. t^rni x County. ';~ Personally came before me this day of 2 0 0 0 , the above named Ri~ar~ L1 Stout and Janet P. Stout 'i is to 1i ' Signature(s) authenticated this day of * Z V 0 i N m OD o;c~ ~ ~~ ~ i~ ~ i~ iii ~ ~~ i~ ~~ i~ ~o ill ~ i~ i i G~ i~ i~ ip ~~~~ o~~~ ~~o~ g m _~~ v~~ C $~~ Z~ ~ 5~D Z° ~~ V ~ V • -r - • - MIN gtJILDING A A Mme/, = 884.0 I p I ~ LOT 34 ! ~ , 2.00 ACRES { yl I 87~lf5 eo Fr I a4 ~, i 5°' . :i i ~i N89°49'S9'E 564.41' jq I 111 I 25' i i I~1 I i I ~ I LOT 33 i s ~ ~ i 2.00 ACRES a I : 87757 SO FT - - ~ ~ A_ : I I ~. ~ c2o ~-r . ~: ~ 268.58' ~ ~ ~ ~ ~, ~ ~~ ~ LOT 32 '. •~ ~ '. 2.00 A~ ~ ~ ~ ~ LC 87278 SD ' . ~ ' . MIN BUILDING ELEV.:900.0 / LOT 31 2.0~ ACRES 87442 80 FT ;; E 1~ ul~ o ,~,~d °~ LOT 30 2.00 ACRES 87224 8G FT y_- N •. I .\ '1:~'~~ . •~/.~ ~- \ 16,ppr j ~ ,ctaQ`~t. _.~f4~ \ , ~.~• IA ~ ~ ~.. ~ .a ~. •~ ~ ~1. ~ \ _. ' \ ~. ~,. •~ ill~i~o ~ ., \ ~ \~ . ~ ~ a ~ \ ~' ~. $ •, . \, MIN BUILDING \ ELEV. =900-0 ~ • ~ • ~N ' ~ $1d1,fp'~"N ~ ~ ~• ~ a ~•