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HomeMy WebLinkAbout020-1454-00-090 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division ` INSPECTION REPORT Sanitary Permit No'. 499223 0 GENER INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Rudesill, Brian & Lisa Hudson, Town of 020 - 1454 -00 -090 CST BM Elev: Insp. BM Elev: BM Description Section/Town/Range/Map No: iono /J n4 1 G c5 ( 36.29.19.2905 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER '`:,ri5 CAPACITY STATION BS HI FS ELEV. 1 Septic 1.5 Benchmark (,J: e. -i..-._ _ e , ! S (05 3. 103 /ern Alt. BM Pd t o k- 5z' F 'k.r , \k� G..:'e,.. 3.,5 /4 .3 5 Aeration Bldg. Sewer Holding c _________��� St/Ht Inlet ( 17.(./ St/Ht Outlet TANK SETBACK INFORMATION (o. I/4 7. 3c, TANK TO P/L WELL, BLDG. Vent to Air Intake ROAD Dt Inlet • W P/5'F' 117 Septic , ,'I AO / ) 6 / r Dt Botto Dosing Header /Man. 7.9 ss• Aeration Dist. Pipe 9 9S.9 Holding _ Bot. System $ • QC 7 s Final Grade �� y d� 3 , PUMP /SIPHON INFORMATION Manufacturer Demand nd St Cover 1 c c . 3 L t�.. `{ �1� d . 3 J Model •'umber TDH (Li Friction Loss - • em He.. TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width , Lengths f No. Of Trenches / PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 -7 / _ P - 72. i 3 ewU^LQ .. SETBACK SYSTEM TO ` P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: -- - / „ INFORMATION CHAMBER OR _j� P7 Type Of Systern t n /5 / - ',( c 7 /114- UNIT Model Number: Q / e,U D, .rmX 2- ( 57 C J C a∎AU DISTRIBUTION SYSTEM l„/e64.- / °I f" 11'.14- /� = S<o Header /Manifold t � Distribution x Hole Size x Hole Spacing Vent to Air Intake I Pipes) \ \ \ Fi. 4-4. - Length /5 Dia 4 Length \ Dia \ Spacing L0•1 -4 -A-- SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center � .i• 5 Bed /Trench Edges \ Topsoil \ .Yes No \yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 830 Riley Lane Hudson, WI 54016 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge Lot 90 Parcel No: 36.29.19.2905 ' . C404...__ C.L.c.,,,`n.S d 1-- ou1z -S o" 1.) Alt BM Description = / 2.) Bldg sewer length = ) c - amount of cover = / Z Plan revision Required? Yes �83 Use other side for additional information. ' I t I Ill" ; Date Insepct. 's Sign. re Cert. No. SBD -6710 (R3/97) i Safety and Buildings Division Cotmty f'7 e 201 W. Washington Ave., P:O. Box 7162 . CR per)(' ` n i Madison, WI 53707 — 7162 (608) 266 - 3151 L Sanitary Pemtit j� ; Z 2 (to be filled in by Co.) 1 Department of Commerce I J Sanitary Permit Application State Plan ID. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you . ,. -, r--- may be used for see ondery proposes Privacy Law, s15.04(1 Xm) Pr Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Name R V 1 O 41 • # - Block -4P - �t Property Owner's Mailing Address OUT T 2 3 ZOO. Property Location G 3 > R/ fifit. 07 /.4/. .5-ca is 444.y., 444.y., Section a 4. Code City, State Zip Code ST. Ow wicritheiN 1 Y / Q . c l /Gib 5 if/ Pfi-t. S Y j _ n T 3 9 N; R 7 7 E Vr II. Type of Building (check all that apply) , . 1 ' co "'deg( l7 i or 2 Family Dwelling - Number of Bedrooms S' k : , . ; 0 0 - / Q445 , Subdivision Name CSM Number ❑ Public/Commercial - Describe Use Cl1PrI 7A/ LeiJW itzp 0 state owned- Isciibe Use ❑City ❑Village@fownshipof Gf NOW III. Type of Penuit: (Check only one box on line A. Complete line B if applicable) 020 - 1 4ff - 00 - 0 70 (. a 9 O I A. I Iew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Perm i t Transfer to New Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T A I of POWrS m: Check all that a , . ' S. mktm: l 6'lain1 ' ... ! . = "4iI1t 'tL f E on - Pressurized In- Ground El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter 111 / r ' Constructed Wetland El Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel- 4 Other (explain) V. DispersaVrreatmentArea Information: 2. LGt EN. ..xy '* iuy1c 1 .— QuaeiX 4' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro(osed (sf) System Elevation i 75 . 7 1 e 7/ . V !o dz 7 ys,o VI. Tank Info - Capacity in Total Number / Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units La 14. , Concrete Constructed Glass ' New Existing Tanks Tanks SA 70,eV LP 'A Ggre. A 149 Septic or Holding Tank /11-S ----' /SLS" / __0t / .x4S$e- Aerobic Treatment Unit ..-- Dosing Vii. Responsibility Statement- 1, the undersigned, assume respoasi ilitj for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PhunKs Si guah p j 4tW/MPRS Number Business Phone Number fdh /.3% i a 13 7 l a.1.11po ?,r- 4%— aovo Plumber's Address (Street, City, sint,e, Zip Code) zezdaP z,E . - -0 , 6uRt - , - o &/‘ - /— VP—' County/Department Use Only Approved ❑ Disa Sanitary Permit Fee (' t Groundwater Date Issued Issuing • - t`igne o Stamps) �-�( "1P Surcharge Fee) ,/ )j ❑ Owner Given Reason for Denial r• 1 d, , IX. Conditions ofEiaov al 3 ` r ( ' " r 1 ^ r� 9 ._ Q SYSTEM OWNER: ) "fib G �1t� 1 Septic tank, effluent filter and 4 C� �tIX b ` /1 dispersal cell must all be serviced / maintained 1 as per management plan provided by plumber. e fit ;l�� Q . a 4 –A - 2. All setback requirements must be maintained 1 r� as per applicable code /ordinances. G ' 041 'R >r Attach complete plans (to the County only) tore m pnQer' qtr i �c 11 inches in slue lee. (.L� \_iu \`�iO ,il SBD -6398 (R. 01/03) • 90 j � Fogerty P lumbing � # ` �� � . " , f "/� 01� cAL,E I a f i 28288�McKen Rd. . _ / .. Spo9ner, WI $4807. � .,•, o \ (715) 635 -9609: D, — QiN � �f /� �F4s, sl�k'4� / o a o 11 ,01 ,se47 Jm►. 7?, *f "T k,,T, / /1./ --- ./ 1\ AU etr 0 /,5 Li 44 Z otoncsaEX 7,44,x Al / r = wcLL 1 ``t � c,R•.gT,tc.m-L CLop t! 1 ...40 0- afii r'- ---___ 6i,K ( 9 i /fsc_ c Go-Ai-cif- i iit, iy ■ x - ' \6 44, / i ii.EV-Ilf 4 ‘ j c vki G 0 Fogerty Plumbing °` „ '' ` r --4 : #221180' , z- �� t �, ri l c A t L,� 1 � 28288 McKenzie Rd. K Spogner, Wl 54801 D / = criN, T if / ,� Si.'"/Qt .0 /GO . (715) 635 -9609 S �� ; W Q *1 ALGA • - fAS „ A. • T"'1T , /0.1./ f / jam X „A-wG- �_ A cgcr4. f( 0 r// - r s T 9s% , ■Per Q /0i30 0 4 e�40, z K Ai . p 1C Z.4 7 1 LI GIST /1-L C4°,4. ! , i ■ • • 0 ,0 _� -C" A.4 /1.ci".. c 04-PEA- . ,...E X '10 J ti'l( Y'\ . \ yQ ' �'16 , 4 eAEvlvul P''14 ? / /AA-At ■ El ,V fro I), • Wisconsin Department of Commerce SD IL EVALUATION REPORT Page / of - Division of Safety and Buildings , - ,..•� in accordance with Comm 85, Wis. Mm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must s' CRUX' horizontal reference 8 direction and Parcel I.D. include. but not limited b: vertical and point t � . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. eP.1 — //P9 -to -0s Re " we by Date Please print a "• •• .,, ion. / ��yr. ( /�. Personal information you provide may be used • seaon . s. .04 (1) (m)). ,. Q /' "r �' 2 t . ( - `z , Property Owner P Location 0/ 1 4F5/4 / 2140 a C T 2 3 2(106 Lot S,,,..) 1 X114 S 3,6 T 2, N R /? E (o Property Owners Mailing Address - # Blodc # Subd, Name or CSM# 3 2. /'fit • fa. - ytSTrttOlx COU — s . - - — . City State A Code : . Number ■ City ❑ Village own Nearest Road �� u/xr?� 1 �x-1 ,�uDSo� 1 wt I � yD /lv 1 ( ) �� [ r ar New Construction Use: Q- tesidential / Numberof becRooms Code derived design flow rate 7. GPD ❑ Replacement ❑ Public or commercial - Describe: - -- - - - - -- Parent material ourrdOS Flood Plain elevation if applicable .t/`A ft. General comments and recommendations: Ce.t/YX/VT - O/t//9• L 1 ❑ Boring I # Ground surface elev. f/ . 5 ft. Depth to limiting factor /// in. Soil Application Rate ©Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu. Sz. Corti. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I m' -/l /0 „?/z sz•L /.srs3iX 41YFA- .4s -F . `/ • \ ,`P L // /V /o yJL yr/ — s= L .'t .xs/J'X isf �..s i /` . C. /. n .3 > -` S 7.; y1Z /' S L / msrsi3.e in -i - c — , y , 7 yy� //i 7.;47 0 " /1iS vS 4 nrL - . 7 f z, Boring ❑ Boring Pit Ground surface elev. /O/. / ft. Depth to limiting factor /1 y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mtnsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 B /L /P ye. .0 .7...=4 !kr cd/ fu dP/t Ats 3 F . ` • • � 2- /2 2 �, 4 r iTz. ! t — SrL 7 .s. sr3/J ice. FA C-S / f t 1. a 2L - 7.� y/� /7 - s` /aucaiz talon cs — .7 . y • 4 /� �/9 7.S e ---- so s o- L — ? 1. t ar k - '7'M ' Effluent #1 - BOD and TSS >30 < 150 rrg&L • Effluent #2 = BOD < 30 mg/t. and TSS < 30 mg/L - CST Name (Please Pmt) s > 30 < 220 mg/L Si we CST Number D Awn f3. ,GzrM .7zi/ed Address D/ 1 / Date Evaluation Conducted Telephone Number 973 ,e8 ter-X/ 4 aAteAll I'.D. / cfrove1 f w.r cs 7A = VAI —0000 1 Fogerty Plumbing • . • #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 - 9609 /7 ."'' 1 1 SGAL,F / ''r yo / / . 0 Ler ", 4 4 ( = g,a , 7D9 JP / Y laT ?Li STf, '! / 00, ' i ,d 4-i - eftr A..1, 7•p if "T ?J% /•3./ X — 13di< -= 1 = 74 pIST l 1 i Cp....c7-zG4L S . 4 4 116 I 1 4 _______N_ , �� � , a` ±, O No tANO 7 1- Y , :\\\\\ , 3 l EL x 4 - 1 99. �. I N I 1 o.o ' X_y 0/.7 /0i'G \ 207' ■ � , ,trt y LA/ • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of ?-- • FILE INFORMATION SYSTEM SPECIFICATIONS Owner i$eatHu ` LIS � . D R.l E-S ( L, L Septic Tank Ca /9°-S. ga l ❑ NA Permit # L/?p 22 '"fir' 11 Septic Tank Manufacturer (jJtt.SC—e. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Fe, LY pK ❑ NA Number of Bedrooms 5 ❑ NA Effluent Filter Model PL C7.Sr— ❑ NA Number of Public Facility Units ZNA Pump Tank Capacity gal �VA Estimated flow (average) J 5tT0 Pump Tank Manufacturer gal/day AA N Design flow (peak), (Estimated x 1.5) 3 gal /day Pump Manufacturer CIA Soil Application Rate 0 - 30 gal /day /fe Pump Model - O NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit f fNA Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD . .220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L I n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE , Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) ti(year(s) y (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 J$ year(s) (Maximum ❑ month(s) (Maxi 3 years) ❑ NA Clean effluent filter At least once every: /— 2. pr year(s)(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ N 4 Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) _ Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 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 (Y 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, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of 2/ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall 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 cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the 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 the following measures have been, or -must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized 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 structure, lot lines and wells. Failure to protect the replacement area will result 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. • IVA - •• 'n' aluaf • • •• a o . mg ank • . be', • _ . ..um �. erWa al ..I •1 • 1 lle, Oi2 lhaV Colvsnalc?tp ❑ 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 SEPTIC, 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 IMPOSSIBLE. ADDITIONAL COMMENTS t POWTS INSTALLER POWTS MAINTAINER Name £ I JCO `�� it l� Name Phone ZH5 46 • pxpp Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name St ce.0 l y (could-r,/ 20,1/AJG Phone Phone 'J ( — 3e �1„ sp This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ■ ST. CROIX COUNTY 4 ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM )( OwnerBuyer L, / 5 , 4 ') 12 r 1, fu p o / -j) // 0 x Mailing Address p 3 2 (I I / t ar y Fa rm r J , // D Fox/ r v c-yo Property Address ✓1..e.--e � Pv� y1.-./...14...-.z - (Verification required from Planning &GZ +hing D� > � epartment for new constructs nd ) City /State Parcel Identification Number 0 20 - I ctS 4 CT0 - O9 O ( 0 °s ) LEGAL DESCRIPTION Property Location 6 r„/ 1 /4 , d/s) 1 /4 , Sec. 3 , T ../7 NR /f W, Town of //gD; . Subdivision ce .,n/ cvm0,c7 ,z) N- 2 , Lot # fa . Certified Survey Map # , Volume , Page # . Warranty Deed # Pi y ri , Volume # . Spec house yes ® Lot lines identifiable (9 no 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 §Comm. 83.52(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. 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Numb r of bedrooms 6 iL(motertA(Ai 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. 08/05) 0 SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM Owner/R*1,er 7i7.N /i.' yor[ ,l3Ltiiic atOoet et CAa`7r..,3 Mailing Address r Property Address `g 30 //fl oh ; k,. & _5 ,_ e (Verification requi fro Tanning & Zoning Department for new construction.) �- City /State Parcel Identification Number eizo — //D 9 lv - o s LEGAL DESCRIPTION Property Location Sig 1 /4 , ,vw 1 /4 , Sec. ?C ,T 2? NR 77 W, Town of //,,,,, fe,41 . Subdivision c40 -7,,t/ et/002) A66 z d , Lot # 6 10 . Certified Survey Map # , Volume , Page # . Warranty Deed # „ p/1 sz g , Volume , Page # . Spec house yes ® Lot lines identifiabl.- ! - no 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 §Comm. 83.52(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 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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. Numb of d oms ,.... J 9 - LA Vi '& 2�� DATE * * *Any • or mation th i 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. 08/05) d / ,,-,,,c,..k_ ...c.„4,-.., . • P <..____._---------- S;on$jn SOIL EVALUATION REPORT #1639 Departmqnt of Commerce in accordan with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Soil Service, Inc. < ..� . County on Pe P plan P Attach complete site lan paper not less than 8% x 11 inches i -4 - Ian must St. Croix include, but not limited to: vertical and horizontal reference point .' n and I mcl percent slope, scale or dimensions, north arrow, and location and di n. - rest road. Parce I. Please print all information. / O Reviewed By Y Personal information you provide may be used tsr secor dRE0EstAref Law, . (1) (m)). Property Owner Pro rty Location Bast, Kemon APR 14 24305 Go . Lot na SW1/ Property Owner's Mailing Address Lot Block # Subd. Nar 948 Labarge Rd. ST. CROIX col INTy 0 na Cottonw _ City State Zip bode ZiZflOtitaINAPIgE City ❑ Village ❑ Tow! Hudson 1 WI 1 54016 1 715 - 386 - 7775 Hudson 1 Cty Rd N 4 New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Stream terraces and pitted tx.ivt ' ' /c Flood plain elevation, if app -ble na ft. General comments Conventional syste r , system elevation 97.95ft. Trees spaced and depth to i and recommendations: code 6.35ft belo grade 1 1 Boring # El] Boring ❑ Pit Ground . - ► elev. 104.30 ft. Depth . • • • • - . 1 in. Soil Application Rate, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell , Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -10 10yr3/1 none sil 2msbk mfr cs lvf .6 .8 2 10 -32 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 32 -64 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 64 -120 7.5yr4/6 none cos /ms osg ml na na .7 1.6 2 Boring # El Boring ❑ Pit Ground surface elev. 103.90 ft. Depth to limiting factor 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Munsell Qu. Sz. Cont. Color *Eff#1 •Eff#2 1 0 -28 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 28 -39 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 39 -67 7.5yr4/4 none sl 2msbk mfr cb na .6 1.0 4 67 -130 7.5yr4/6 none cos /ms osg ml na na .7 1.6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < _ 30 mg /L and TSS <_30 mg/L CST Name (Please Print) ignature: CST Number � _ _ .s - ' David J. Steel 248956 Address A - Date Evaluation Conducted Telephone Number dd Steel's Soil Servi . 994 200th St. Baldwin, WI 54002 4/11/2005 715 - 760 - 0347 SBD -8330 (8.07/00) i Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3 • 3 Boring • # ' ❑ Boring ® Pit Ground surface elev. 101.90 ft. Depth to limiting factor 120 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 1 0 -9 10yr3/1 none sil 2msbk mfr cs if .6 .8 2 9 -15 10yr4/4 none sil 2msbk mfr cs na .4 .6 3 15 -31 10yr4 /4 none scl 2msbk mfr gw na .4 .6 4 31 -60 7.5yr4/4 none si 2msbk mfr cs na .6 1.0 5 60 -120 7.5yr5/6 none cos osg ml na na .7 1.6 Boring # El ❑ 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 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 = BOD 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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. SBD - 8330 (8.07/00) Steel's SON Service, Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kernon Bast 994 200 St. CST - POWTSM SW1 /4,NW1 /4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. CeII (715) 760 -0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449 Lot,90 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1 " = 40' • = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 101.75 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 104.30 ft B2 = 104.30 ft B3 = 101.90 ft B4= 0.00 ft i l t" k J ' — .der pry \ '44 6 kf �.. ICI.y �c, r © ��jo� - X33 tcii•3 5/ore' 3 tl ' ' NE OF THE SW1/4 OF THE NW1/4 OF SECTION 36 -- - - - �G°1Lf -- -- a x a x • 586.59' 156.21' 3151 1107.40' CV m LOT 9 H.W.L = 986.00 . 2.07 ACRES 90292 SQ. FT. �� L.B.O. = 988.00 '\'� Iv- 4 61,4* > <'• g 44 , LOT 90 R / • / / °sao7w 263.7; 2.57 A C R 2 / // \ -\ 1 Q. F / / LOT 89 \ L.B.O. = 988.00 / / / / 4.78 ACRES \ / / / 208279 SQ. FT. / / L.B.O. = 988.00 \ ` �. / / ".. // // \ • / / / 08 "/ / BENCHMARK + ,. TOP OF REBAR p 0 ' / / ELEVATION = 1039A1 � � / y S68 A: 'rr 4 a s�� / / \,\ r >S � 4\ • . / � '� /---.. . \ ` \ \ ., • + / / i. ( t . ��. - ..43 `\ Cj3. . / / \ P. " �` // \ \ O '� / . / ! \ LOT 94 / � / / LOT 95 y� \ 2.02 ACRES 87992 SQ. FT. ✓/ 2.02 ACRES - n / 88007 SQ. FT. \ \ / A , / \` :"- / , ■ J , . / /0`L / N68 .e 0, 7 1 4 4 � 1 1 / / '''v 119 . j i • / „t) / ig $I 1 4', a i/ -13 o o ° l / � A , - -- 0° I 89 � J / Y • / �' a / 4 L O T 96 y ;! s °. /a 2.00 ACRES _ i G�$ o _ — /` /�, 87197 SQ. Ff. / / / - DEDICATED TO THE /.?,g / � a Q / % / p19 _ 61.42_ - / / - - /,\''■ , / . - - ' ' 1 / / ce • / f r o / 1 /yam AI' / - — - /✓ " #1639 + - Wisconsin SOIL EVALUATION R T- Department of Commerce in ac Gordan • with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings O Steel's Soil Service, Inc. complete site plan on paper 8% County Attach com p p p per not less than 8/ x 11 inches i . • Ian must St. Croix include, but not limited to: vertical and horizontal reference point : •7 - can and percent slope, scale or dimensions, north arrow, and location and di - -46 - rest road. Parcel I.D. O Pending Please print al _nfnnna>rion. Reviewed By Date Personal information you provide may be used for secoiR iVED Law, L .' (1) (m)). Property Owner Pro >erty Location Bast, Kemon APR 1-3 2005 Gout. Lot na SW1 /4, NW1 /4, S36, T29N, R19W Property Owner's Mailing Address Lot It Block # Subd. Name or CSM# 948 Labarge Rd. ST. CROIX COUNTY 90 na Cottonwood Ridge 2ND Addition City State Zip 3ode ZRJttftVCIgE J City E Village ® Town Nearest Road Hudson 1 WI L 54016 1 715 - 386 - 7775 Hudson 1 Cty Rd N ® New Construction Use: ►1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Stream terraces and pitted as h ID A,:7c Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 97.95ft. Trenches spaced and depth to and recommendations: code 6.35ft below grade 1 Boring # ❑ Boring ® Pd Ground surface elev. 104.30 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color `Efr#1 *Eff#2 1 0 -10 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 10 -32 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 32 -64 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 64 -120 7.5yr4/6 none cos /ms osg ml na na .7 1.6 2 Boring # Boring ® Pit Ground surface elev. 103.90 ft. Depth to limiting factor 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f in. Munsell Qu. Sz. Cont. Color *EMI • E 1 0 -28 10yr3/1 none sil 2msbk mfr cs lvf .6 .8 2 28 -39 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 39 -67 7.5yr4/4 none sl 2msbk mfr cb na .6 1.0 4 67 -130 7.5yr4/6 none cos /ms osg ml na na .7 1.6 Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD 5 < 30 mg/L and TSS <30 mg/L CST Name (Please Print) .____ CST Number David J. Steel — / ■IL101011111& 248956 Address Steel's Soil Servi.. -- Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/11/2005 715 760 SBD -8330 (107/00) • Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3 3 Boring # ❑ Boring ® Pit Ground surface elev. 101.90 ft. Depth to limiting factor 120 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 1 0 -9 10yr3/1 none sil 2msbk mfr cs if .6 .8 2 9 -15 10yr4/4 none sil 2msbk mfr cs na .4 .6 3 15 -31 10yr4/4 none sci 2msbk mfr gw na .4 .6 4 31 -60 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 5 60-120 7.5yr5/6 none cos osg ml na na .7 1.6 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 I 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 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 5 < 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. SBD -8330 (R 07/00 Steers SON Service, Inc. I { 3of3 ' STEEL'S SOIL SERVICE INC. David J. Steel Kernon Bast 994 200 St. CST - POWTSM SW1 /4,NW1 /4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Cell (715) 760 -0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449 Lot,90 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N l " = 40' I • = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 101.75 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1= 104.30ft B2 = 104.30 ft B3 = 101.90 ft / B4 = 0.00 ft 1 ' r ' too.Crt- 4-P / z. 1....f r ._"--- I k &7^ NIIIIIp i ____,_< 5,, d 5 • 3' ,�` ■ 1 --- ,---- : ■ , ' - 7,.„‘______Stg- Olt t /7 _17 6 5' .. ,, , ((f .. . . � �I i lr /r � I� m ' o I tir (RI xi SO N 1 / /. /1,r / /, /h / 4 � r I I /1/♦ /. .! / _Am.. / �, II / ,�I.j�jII ✓ Ii'I I rfr" .rv.4 .ii I . G..I. /., ., �, r I. ,-; r ;_: % ,•. - _ r1 — . ____ . _ le r/ , 04 ,../ . ..: — , 14 .-:*:::.::::...::::*/ . !:. 0 ; 0 .•) , ‘.7 ,1 ; 4 . '+ mss •% % /!`• :'.` 4 - � r% � � /� / ' - . 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"O l F f::/# 4 ' ; V e e." - 4 ,./; i 0,24 i 44, 9 4 t % - -0/0 , ,,,•::::::::::::::::::::-* T:' t: / te. . 8 . „7„. ... , , ,; „,,,,,, e -..„..t.., 4 '. 4 l A 4i lAtite4 i t #61 0 L al es • ....''''''i:: : . ., , _ . • r ,�, rr l /J � • ii + � i r / 9 + 4 , 1t ..t; r"�', I' I „...,,, /� p •100 ,Ii li , "0;�� ''f1 s: ire: 441 �rii 4%.-4... ' l O� CU • ..igrilr, ii �, U ..: r�r�i,11.f1 11 • �+ .III +�i�i +ii, 1p, / -'. . i��� ✓iii + %�'j� O r p F' y ii i j %E /f Q''' yy : :•'°$ • • OF . Atv ,,.. ` .: x x � . j /f� 03 (U Pi • • + '► 1 0 0 01 . ,-. - i to, . % . . tri br 19 t i l l% 't.. 0 r a. f , a. .:.. n :1.0) , ,,, • iil v cu i CI — ►ct 1 - ; 1-1,, _ r' .. - Ori i s VI is • y t i CO I ' _ .i.. tCr r - -- i- - :*'3 _ ` ! n FAA. - - ._ \ 4 ' e-t- • - - • t d am _ — 01 r 1-3 yrs .� ' I.- �. _ . ! ' 'ti 04 1.-- 1 ki_ : •-� a 4 . .• �t„tt= � co ' d el. O 51 t fi m _ :, ` ` 6 i _ - � • _ _ - - .; ♦ . 1. - r a j I-I ta 0 to r . 1 0 - c . ''' i 0 1.4a Ili v c i 0. a` t N A ; � ` v o co o a fl N ¢ v ~= a4 0 Ea ¢ Q t]I 3. � N N es o N tn_o r co O � , Q p C 7 9 tow . 011l V- 0 cr 40 0 X1 2 E3 1 6 S28 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 02/13/2006 02:00PN THIS DEED, made between Kernon J. Bast and Donalda J. Speer- WARRANTY DEED EXERT 1 Bast, husband and wife, Grantor, and Brian R. Rudesill and Lisa M. Rudesill, husband and wife, as Survivorship Pro erty, Grantee. REC FEE: 11.00 Gr n or, for a valuable consideration, conveys and warrants to Grantee TRAYS FEE 305.70 COPY FEE: t • allowing described real estate in St. Croix County, State of Wisconsin: CC FEE: Lot 90, Cottonwood Ridge 2 Addition, St. Croix County, Wisconsin. PAGES: 1 Recording Area Name and Return Address: Ed' Realty Title, Inc. A.( Ll 400 . . — Suite 115 \\ Exceptions to warranties: Hu n, 54016 Easements, restrictions and rights -of -way of record, if any. 49 938 j■. Metro Legal Services 020- 1109 -10 -050 ":,'D1RET 491938 A Parcel Identification Number (PIN) 042.516 \VD 401326 This is not homestead property. Dated this O to * Ke on J. Bast * Donalda J. S er -Bast * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this Personally came before me this ,2S day of o yy , A b or- the above named Kennon J. * Bast and l�`onalda J. Speer -Bast, husband and wife to me TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person(s) who executed the foregoing (If not, ins. : r t and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY etyma *Pamela A. Willman Peterson, Fram & Bergman — Steven H. Bruns Notary Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not, state expiration date: 2/25)2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature Pamela A. Willman Notary Public State of Wisconsin WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 818528 1 of 1 . COUNTY PLAT OF: COTTONWOOD RIDGE 2ND Al ■TED IN PART OF THE SW1/4 OF THE NW1 /4 AND PART OF THE NW1 /4 OF 36, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WIS Ua117L.,n77' D LQ[k]D@ IRTH LINE OF THE SW1 /4 OF THE NW1 /4 OF SECTION 36 N89 °26'58 "E 1182.70' 586.59' ° x 156.21' x 1 31.5 ° x 1107.40' I LOT 91 w 1 2.07 ACRES v H.W.L. = 986.00 90292 SQ. FT. N I L. B.O. = 988.00 "∎` z° I i. �`'° a �^ DRAINAGE I at Z , 03 / J EASEMENT .\ LOT 90 a 4' / 1 // N86°50'07"W 253.31' ----- • j •• 2.57ACRES / - -- F ♦ \ 112036 M. / • .00 o � / LOT 89 , . \ 6 w 1P / 4.78 ACRES �\ • 4/, = , 208279 SQ. FT. \ 4, e, / , 0 L.B.O. = 988.00 -, ,, ' \ • .`., . • • • .. cb. ,,,- . . , 4 9 �\ \\ // / BENCHMARK • / 'q / / / ° � — TOP OF REBAR ` \. `� ELEVATION = 1041.66 o / LEV ION �� \/ / \ \.1' Tyr/ ,$ • • • • . / -'■..... a • ' . . . ......- / .--,..a. i '_... 4 - ........... -.. • .... . . / . . . . --:!:.;,1;:*;;-:7:::`,1*;:41:;;;;?.::;:fi ct F: fr/i /./,e. . • • ... w.-....•__.. _ / �/ � / ��/ Q / ' . ` LOT 94 1 / / 2.02 ACRES ►, // LOT 95 87992 SQ. FT. °� ? 2.02 ACRES 4 • 88007 SQ. FT. / el, ,4 , / P / , Attach complete site plan on over ace less Man 8 112x 11 itches in Plan must -V eKteir t- :eagle. but not Busied to: verhcal and horizontal reference point (BM. dreamt and Parcel IJ3_ _ percent slope, scale orrionensions. north avow. and In and distance to neatest road. 40.2e -- fief --Vel -19,5r Radevard by qate Please print all information. Persona! information you powidemay he used fersecoodary proposes (prisacyLaw.s_15.0 MOS I Property Owner Property Locarron _ _ . C Let _s 11 114 'S T ... --- . N R . E (e fr .., .2 .• ar . a _ , Z r _ Propeity Owner's Mang Address Ili Block* Soled. NNW. or CSIAS ‘. •■ h .e.; - - .... _ a a I • ...--.. Gr., , _,..---- , .... '0 - ..2... Crly . . -., , . 210 .1 • • ' " ai City 0 Vilbge Worm Nearest Road /11122jo At X ...31 / - I ...i e e . • Wel • ,,,ti . . New C o n s i r u c t i o n , , Use: aReadenfral I' - - . - - • - • • . - Code derived design low ode 75-0 GM 0 Replacement EI Public or commercial - Describe: Parent material /WA/M-6i tiOadflak deVarES r appricalie 4///7 - ft. General coMments . .. „ .. . f and recommendations: , Gclef/f/rEW= r ':_. , .. _ . .. . 4,.., , , .,' - :•:',,',.. ' ' * i/b1/Xjfi7 p7 # . _ 0 ear I 5 .--• I Boeing ig pa Ground surface elev. Art.z . / it. Depth to Raring factor /* ' in. Soil Applicadon RaU Horizon Depth Oominant Color Radon Descdplon Texhse Structure Consistence Bounden. Roots GPINIP in. Mosel OIL Sr_ Cont. Color Gc_SzSli. SIM ¶f#2 z s — i- 40 rigirimin a AfAilree MIIIIMM X o .. i - ,- t oei$ _ • 4t 6.1 /fp 7 cyit 0 _ — ME MI — 1111111111111111111111111111 • .7 111111111111111110111111 111111 , . . . . , El Bogie . 6 Boring ft El Erd Ground surface akar_ /13 8. Depth to fereIng factor /sr in. son Application Rah Horizon Depth Dorainant .- Rados fl.'-4.- t Teat= Slacken Consistence . Baundaw Roots * GPD/fta ---..........--- in_ Monsen - Clu.Sz. Cont. Color lEff/t1 TOM _ - 7 3 z --- ,,rx Z. /Am s 1st •C/E ,IS . E ,,g--LZ- Z 7-1 i," y e VS" — s.L m. dos. AC Ifoitcie- ZS 4 /. o 3 - 77 715 yx y 1._ ____ S L Ars ', if ei/F/ I GS .6 . 7 7 - 7. s - pr. VI — 1_,...e.f — ..--.-- , - ' . I wamgamaawlallIIIIII ' 1 • Effluent /ft =BON > 30 < 220 moiL and TSS >30 < ISOM& - • ; PS T (Please Print) , CST Weber At - I 1 -,....-" .2 oi Ad dress Foierty Plumbing & Perk T 'ag -.....-7-_-_217 - Date r;altrinriducted Tebephone Number ' 64; rftttE WS 5 -- 4 7 0- f - -r: - : ' : •;- :- --'' • - ..-v 7.7 - .- 1 te-a- - - - — ..:410; ..Ik 0 0 .., -igelferf u -rVisrpt 1 / off , Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 L (715) 635 -9609 A / . 7 -1's iLNDw si-L i fGYML.e / fir_ 4/0 I / . o LeT # w 44 f = l3Af , TAf sl /' / ?r ?t- STA-,[.A) /00,0 ,Ll iff->. = /►-LT $Ni TOP if u T "Per% / / ' X — .80/4-=.4u 1- = TEE pt 5T' 1 G1r-r7 -zeA L SLOB 4 1 c., c a A C S E- Q ,Ni N1) ELF v: x -i 'S \ j7. x -3 yes ' I� , D X_y , /DI., s IF Lo7' \ /n3.0 ° •I N itrLAry LI