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HomeMy WebLinkAbout008-1042-10-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACK TO PERMIT) Sanitary Permit No.: Personal information y provice may be used for secondary purpo [Priv Law, s. (1)(m)). 353220 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: Kitchner, William Town of Eau Galle .2 5 .1 CST BM Elev.: Insp. BM Elev. BM Desf Des ription: Parcel Tax No.: Bp �� 0 0'0 , p' S 008- 1042 -10 -000 TANK INFORMATION ELEVATI& DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing — Alt. BM A/ Aeration Bldg. Sewer 6 96 E6 , -2S Holding _ 3�l7 H Inlet �,� TANK SETBACK INFORMATION St Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Se A Dt Bottom NA Header / Man. NA Dist. Pipe Holding >5d ' a6 Bot. System PUMP/ SIPHON INFORMATION Final Grade M an ! u cturer mand St cover r/ Q6•Q9 Model Number GPM TDH I Lift Fricti stem TDH Ft Force main ngth Dia. Dist.To ells SO ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER mo Number: System: OR UNIT DISTRIBUTION SYSTEM Header /manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: U /t x /tq Inspection #2: Location: 2559 County Road N, Woodville, WI (NW 1/4, SE1 /4, Section 14 T28N -R16W) - 14.28.16.214C 1.) Alt BM Description /� /} 2.) Bldg sewer length = ^' 10.0 - amount of cover= > `g" f � dava%—. /� r�f� -� _�QQ 17, oy oil Plan revision required? ❑ Yes ®' No Use other side for additional information. IL 2 y SBD - 6710 (R.3/97) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e Safety and Buildings Division V iconsin S ANITARY PERMIT APPLI ATt9N_._ 2 01 W. Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. m. Code..: ` Madison WI - 7302 • Attach complete plans (to the county copy only) for the systeT', on papeKx}* `T count than 8 1/2 x 11 inches in size. :.:.. P CROIX • See reverse side for instructions for completing this application State Y San itary Permit Number ; 317 z z 0 Personal information you provide may be used for secondary purposes ;r CRO A ❑ Check 0 revision to previous application [Privacy Law, s. 15.04 (1) (m)]. r OUNTY Z. � sI z�' ,,�;� �FICE state PI M .D. Number Site ID 182741 I. APPLICATION INFORMATION - PLEASE PRINT AL RM' s ID 252920 LL Propert Owner Name Property Location W KITCHNER NW 1/4 SE 1� 14 T 28 , N R16 W Propert Owner's Mailing Address Lot Number Block Number 2916 Sandpiper Lane N A I N A City, State Zip Code Phone Number Subdivision Name or CSM Number Woodville WI 54028 1 (715)698-2657 N/A II. TYPE OF BUILDING: (check one) ❑ State Owned E C 1. .ty Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms --33— Io w a n OF Eau Galle County Hwy N 111 BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 008- 1042 -10 -000 �y, Z , S'. i(o. zrYL 2 ❑ Assembly Hall 6 E] Medical Facility/ Nursing Home 10 El Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ff Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ______System System __ ____ ____ _ __ Tank Only______________ Existing System ________ Exlstlnq System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [3 Holding Tank 12 ❑Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day / 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 450 / Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) in. /inch) Elevation 0 0 N/A N/A N/A met N/A Feet Capacit VII TANK in Ca gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Manufacturer , s Name Concrete st ucted steel glass App- Tanks Tanks S tieTeak � ing Tank 3000 3000 1 Huf f cutt © ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ 1 ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum s Signature: (No 5 mps) MP /MPRSW No.: Business Phone Number: Bennie Helgeson 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip Code). W1229 770TH Avenue, Spring Valley WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued --- Iss Agent Si nature (No Stam Approved C] Owner Given Initial Surcharge Fee) Adverse Determination Gy_ <--) 0 1 ' 10 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11I97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years_ 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. - IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic; pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 \*isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 28, 1999 CUST ID No.268093 ATTN: Rod Eslinger ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 10 /28/2001 Identification Numbers Transaction ID No. 252920 Site ID No. 182741 SITE: Please refer to both identification numbers; Site ID: 182741 above, in all correspondence with the agency. ST CROIX County, Town of EAU GALLE NW 1/4, SE 1/4, S14, T28N, R1 6W Facility: WILLIAM KITCHNER residence FOR: Description: Repl. 3BR HTank Object Type: POWT System Regulated Object ID No.: 496938 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/15/1999 — FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 Dennis R. Sorenson BALANCE DUE $ 0.00 Wastewater Specialist (608) 785 -9336 dsorenson @commerce.state.wi.us WSMART code: 7633 f CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project William Mchner three bedroom residential holding tank Owner William Kiitchner Address 2616 Sandpiper Lane Woodville, WI 54028 Legal Description NW1 /4SE1 /4, Sec. 14, T.28N., R16W. Township Eau Galle County St. Croix Subdivision Name NA Lot No. NA Parcel ID Number 008- 1042 - 10-000 Plan Transaction Number 4 Index and title sheet Page 1 Holding tank specifications Page 2 � Site plan Page 3 . k fi � V Holding tank agreement Page 4 SAFETY & BLOGS OW, Designer Bennie Hei eson Signatur ` Phone No. 715 -772 -3278 License Number 220292 Date Sept. 23, 1999 Notice: Tampering with this file by unauthorized persons Is prohibited. Deliberate modification will result In disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law. s.15.04 (1 )(m)]. SBD- 10463-E (12.0598) Page 1 of 4 HOLDING TANK SPECIFICATIONS Single Concrete Tank Option I Complete Red Boxes Only In- pounds Metric If one- or two-family, number of bedrooms 3 And/Or .... Non-residential flow per day 0 gpd or Lpd Minimum holding tank volume required 2000.0 gal or 7570 1L Holding tank capacity proposed 3,000 gal or 11355 L Manufacturer Huffcutt Alarm manufacturer JLevelArm Alarm model number I DVL Depth from inlet invert to service alarm 12.0 in or 30.5 cm Liquid depth of tank below inlet invert 57.0 in or 144.8 1 cm HOLDING TANK CROSS SECTION mwhde cover with lo&ing device and warning label vent finished junction cap � 12" (30.5 cm) grade box 4" (10 Cml min. vent pipe conduit 18" (46 cm) Electrical as per NEC 300. __ _ _ _ ___ _ 12.0 in. or building sewer 30.5 cm, service inlet bNrd plug alarm on to seal Note: All tank outlet 45.0 in. or joints, and 114.3 cm joints between Manhole and vent locations tank openings may be reversed. and piping are sealed water tight. 3 in. (75 mm) bedding under tank. €° ,' = i~ SEWAGE SYST Tank is anchored as necessary to negate buoyant forces_ ENI .v Project: William Kitchner three bedroom residential holding tank_'" } Transaction Number: � VE 1) S Illy AND BUILDINGS C,C)R'iESPONDENCE =ISO ■ Soil Obserr/a�o�� r . �---- ci a a a iAG� SYg 'TEM ) c� NDENCE P d oive coojr o �a C Ci 1 Zp w .� w ell cn 1 c rN o Wisconsin Department of Commerce SOIL AND SITE EVALUATION ; � a Page ___1___of 3 _ Division of Safety and Buildings 3.05 W is. Adm. Code •1 In accord with Comm 8 A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ Parcel I 8 - .____- -_ -- p op , Parcel LD.# _ 0 - 104 - 10 0 00_ APPLICANT INFORMATION - Please print all Information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 1 5.04 (1) (m)). Reviewed By Date f Property Owner Property Location Bill Kitchner Govt. Lot NW 1/4 SE 1/4 S 14 T 28 N,R 16 W - - -- Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 2616 Sandpiper Lane l i I t - -- - -- - city State Zip Code PhoneNumber City [J Village Fjown Nearest Roa Woodville W1 54028 715- 698 -2657 Eau Galle County Highway "N" U New Construction Use: Residential / Number of bedrooms 3 UAddition to existing building Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 0 _bed, gpd /ft 0 trench, gpd/ft Absorption area required 0 bed, ft 0 trench, ft Maximum design loading rate 0 bed, gpd/ft 0 trench, gpd /ft Recommended infiltration surface elevation(s) None It (as referred to site plan benchmark) Additional design I Site considerations Site does not contain area suitalbe for PO WTS as allowed by W L Admin. Code Chapter Comm. 83 due to limited Parent material loess over glacial till Flood lain elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding an U= Unsuitable for system J S C] u L l SF-1 U LJ S N u i_1 S LX7 U ` LI S MU O S Fl U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots -- _ GPD /ft2 Horizon Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -6 10 y r4/2 None sit 2fcr mvfr cs 2f 0.5 0.6 1 2 6 -12 10yr4 /1 ctp7.5yr5 /6 sit l thin pi mvfr cs If N.P. 0.3 Ground 3 12 -28 1 Oyr4 /4 c2p7.5yr5/8 sil 2msbk mfr cw - 0.5 0.6 elev - -- — -- - -- - — 98.78' ft 4 28 -41 1 Oyr6 /3 m3p7.5yr5/8 sicl Om mfi - - N.P. 0.2 Depth to limiting factor - - -- — - -- - -- �- — — 6" Remarks: -- -- — - -- - - 2 1 0 -6 1Oyr4 /2 None sit 2fcr mfr cs 2f 0.5 0.6 2 6 -15 1Oyr4 /1 cIp7.5yr5 /6 sil 2 thick pl dsh aw if N.P. 0.3 Ground 3 15 -25 1Oyr5 /3 c2p7.5yr5/8 sicl Om mfi - - N.P. 0.2 elev -- - -- - _ -- 99.16' ft Depth to limiting factor - - - -- - - .._ -- ---- ; - - --- 6 . Remarks: _ _ .- __ -- -- - - - - -- -- - -- -— - -- CST Name (Please Print) Signal Telephone No. James K. 'Thompson 7 15- 248 -7767 - 7.__ -- Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola,54020 9/18/99 3602 1104 I PROPERTY OWNER: _ Kitchner SOIL DESCRIPTION REPORT Page 2 - of 3 PARCEL I.D.# r, -1 A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Texture Structure �nslstence Boundary Roots - GPDIft2 oots GPD1ft2 Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _e _d'. Trench c h 3 1 0-6 1 Oyr4/2 None sit 2fcr mvfr cs 2 f 0.5 0.6 2 6-12 1 Oyr4/1 None sit I thin pt MVfr CS I f N.P. 0.3 - -- - ------ ---------- Ground mfr 0.5 0.6 elev 3 12-28 1 Oyr4/4 c2p7.5yr5/8 sit 2msbk cw -- ------ -- ------- ------------- 90.111 ft 4 28-41 1 Oyr6/3 m3p7.5yr5/8 sict 0M rnfi N.P. 0.2 Depth to limiting ------ factor 12" Remarks: 1 0-5 1 Oyr4/2 None sit 2fcr m vfr cs 2f 0.5 j 0.6 2 5-12 1 Oyr4/1 None sit I thin pi mvfr cs if N.P. 0.3 Ground 0.5 0.6 elev 3 12-16 1 Oyr4/4 None sit 2msbk m fr cw 83.44'ft 4 16-24 1 Oyr6/3 m3p7.5yr5/8 sic] 0M in fi N.P. 0.2 Depth to limiting factor 16" Remarks: 1 0-6 1 Oyr4/2 None sit 2fcr mvfr cs 2f 0.5 0.6 I thin pi mvfr cs I f N.P. 0.3 2 6-10 1 Oyr4/2 clp5yr5/6 sit Ground elev 3 10-20 1 Oyr4/4 c2p7.5yr5/8 sit 2msbk m fr cw 0.5 0.6 91.57' ft 4 20-28 1 Oyr6/3 m3p7.5yr5/8 Sicl 0M M rl N.P. 0.2 Depth to limiting factor 6" ---------------- Remarks: I Oyr4/2 None sit 2fcr 0-6 mvfr CS 2f 0.5 0.6 2 6-14 1 Oyr4/1 c1p7.5yr5/6 sit I thin pl mvfr cs I f N.P. 0.3 -- -- ------ Ground elev 3 14-24 1 Oyr4/4 c2p7.5yr5/8 sit 2msbk mfr cw 0.5 j 0.6 101.83 ft 4 24-39 1 Oyr6/3 m3p7.5yr5/8 sid Om M ft N.P. 0.2 Depth to limiting - ---- --- ------ factor 6' ------ Remarks: 1} Sca(e.: ■ Sol ( 0,6wVa ■ tA C p 4 l tL d r ve ,ma u l t7o ' �-o e � �• 13, Q ) E o � � u o k N w Uk F o � •� °ci � nk sy Woconsin Department ofCommerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations 'Attach complete site plan on paper not less than 8' /s x 11 inches in size. Plan must County include, but not limded to. vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Pleas � 0p3 1 ihfi� 008- 1042 - 10-000 Personal information you provide may be used for purl os (Privacy s. 15.04 (1) (m)). Reviewed By Date I Property Owner ::. ` roperty Location Bill Kitchner vt. Lot NW 1/4 SE 1!4 S 14 T 28 N,R 16 W Property Owner's Mailing Address to # Block # Subd. Name or CSM# 2616 Sandier Lane ` 1 City State -Zip "Code P tiNeW bier `' City ❑Village ❑Town Nearest Road Woodville WI 28f -2657 f. Eau Galle County Highway "N" ❑ New Construction Use: ❑ R `al -/ Number of bedro)4ms 3 []Addition to existing building ❑ Replacement ❑Public ` ' rne[cla� Code Derived daily flow 450 gpd Recommended design loading rate — 0 bed, gpdVft 0 trench, gpd/ftz Absorp area required 0 bed, ft 0 trench, ft Maximum design loading rate 0 bed, gpd/ffz 0 trench, gpd/fF Recommended infiltration surface elevation(s) None ft (as referred to site plan benchmark) Additional design /Site considerations Site does not contain area suitalbe for POWTS as allowed by WI. Admin. Code Chapter Comm. 83 due to limited Parent material loess over glacial till Flood plai n elevation, if applicable NA ft S- for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S M U El ®u [I S NU ❑ S® U E] S® U E] S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistence GPDHfz goring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Boundary Roots Trench 1 1 0 -6 lOyr4 /2 None sil 2fcr mvfr cs 2f 0.5 0.6 2 6 -12 1Oyr4 /1 clp7.5yr5 /6 sil I thin pl mvfr cs 1f N.P. 0.3 Ground 3 12 -28 IOyr4 /4 c2p7.5yr5/8 sil 2msbk mfr cw - 0.5 0.6 elev 98.78' ft 4 28 -41 1 Oyr6 /3 m3p7.5yr5/8 sicl Om mfi - - N.P. 0.2 Depth to limiting factor 6" Remarks: – 2 1 0 -6 10yr4/2 None sill 2fcr mfr cs 2f 0.5 i 0.6 2 6 -15 10yr4 /1 clp7.5yr5 /6 sil 2 thick pl dish aw if N.P. 0.3 Ground 3 15 -25 1Oyr5/3 c2p7.5yr5/8 sicl Om mfi - - N.P. 0.2 elev 99.16' ft Depth to limiting factor 6' Remarks: — -- CST Name (Please Print) Sign Telephone No. James K. Thompson 715- 248 -7767 Address A.C.E. Soil & Site Evahiations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 9/18/99 3602 1104 i PROPERI V OWWEP- Bill KiWJma SOIL DESCRIPTION REPORT page 2 of 3 PARCEL I.D.# 008- 1042 -104M AXE. Soil &Site Evaluations Depth Dominant Color Mottles Structure GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz Sh sistence Boundary Roots Bed Trench 3 1 0 -6 1Oyr4/2 None A 2fcr mvfr cs 2f 0.5 0.6 2 6 -12 1Oyr4 /1 None sil 1 thin pl mvfr cs if N.P. 0.3 Ground elev 3 12 -28 1Oyr4/4 c2p7.5yr5/8 sil 2msbk mfr ew - 0.5 0.6 90.11' ft 4 28 -41 l Oyr6 /3 m3p7.5yr5/8 sicl Om mfi - - N.P. 0.2 Depth to limiting - factor 12" Remarks: 4 1 0 -5 1Oyr4/2 None A 2fcr mvfr cs 2f 0.5 0.6 2 5 -12 10yr4 /1 None sil 1 thin pi mvfr cs if N.P. 0.3 Ground elev 3 12 -16 10yr4 /4 None sil 2msbk mfr cw - 0.5 0.6 83.44' ft 4 16 -24 l Oyr6 /3 m3p7.5yr5/8 Sid Om mf - - N.P. 0.2 Depth to limiting factor 16" Remarks: 5 1 0 -6 1Oyr4/2 None A 2fcr mvfr cs 2f 0.5 0.6 2 6 -10 10yr4 /2 clp5yr5 /6 sil 1 thin pl mvfr cs if N.P. 0.3 Ground elev 3 10 -20 1Oyr4/4 c2p7.5 yr5/8 sil 2msbk mfr cw - 0.5 0.6 91.57' ft 4 20 -28 1Oyr6/3 m3p7.5yr5/8 Sid Om mfi - - N.P. 0.2 Depth to limiting factor 6 " Remarks: 6 1 0 -6 10yr4 /2 None A _ 2fcr mvfr cs 2f 0.5 0.6 2 6 -14 10yr4 /I clp7.5yr5 /6 A 1 thin pi mvfr cs if N.P. 0.3 Ground elev 3 14 -24 1Oyr4/4 c2p7.5yr5/8 A 2msbk mfr cw - 0.5 0.6 101.83 ft 4 24 -39 10yr6/3 m3p7.5yr5/8 Sid Om mfi - - N.P. 0.2 Depth to limiting factor 6 " Remarks: t,�e yep. I; ne � 33 V II '* z tA � Soi/ Obserrlcz�o - - � s a I p � Q 1 �, d,•rve ``�aY r w h � Q e � J ,t o � � U T U plJ ba �� C �, ST ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buycr IJ l.t^i a rn 4, L Mailing Address a Co p , ,ter. Z-&, L0'0oc4 v" Ua Property Address C, (Verification required from PU=iag Dcpartouat for new coastiucaoa) City/State _ Wn-ld u LLe- ly Parcel Ideatification Number Oo 8 - /o - D6 LEGAL DESCRIPTION Property Location kO %, ;56- ' / <, Scc. TAN -R W, Town of r- - 6&41C Subdivision Lot #_ # Volume . Page # Warranty Deed # y Volume 116 . Page # a 7 ! Spot house ❑yes IN no Lot lines idadifiable. ® yes ❑. no c=md (Ifyom� codd�tmits eoaus�� P .. tobandlewastcs.Proper - canaffcd 5mdionofdiems.tank�Yft&t y�orsooaQifaeododbgt ieeasedpampca :�tymp .mta�egV= rq' tic�taak• as- =ti�ratm�srig�eia>5e�easte& .. - - - The. property owner agx= to submitlo St CEO& Zdaing DVaremcat h an foam. signed by the away and by = - P7�eymanl' plumberoriGacasod�fy° gt5at( I) dieoaaitcarasfeavaterdispasalsystcaa u m proper opcmdag Condition andkr(2) afx ram and p=Wg .(f y). die septic -bzk is 1= tbaa W fin of s edge. Y'co die have zcad die above rcqqk= and a&= to aQai�a die � fml . b� set by din t of Oommaue and the =wage disposal system wig ft standards �tyoursepti�csyA =basboeamaidjacd�tbe ofNaeacalRrsonr State ofWisoonsin. Qectifieaticn days- of do d= year expiAtioa date. Coatpkicdsnd rcW= d to die SL Cmix•Couaty Zoning •Office widik 30 SIGNATURE OF APPLICANT DATE OWNER• CER MCATTON dLe Y (we) ecthfy that all statcmeats on this form arc hue to the best of my (our) kmowledge. I (wc) am (arc) the owncr(s) of property dc=xW above.. by Virt= of a wamwq deed mc*rn ed in Regklcr of Deeds Office. /0 LZI Z2 SIGNATURE OF APPLICANT DATE sss«ss Any inf"=tjon that is mik4v=mtcd=ymwkiadcsgnituypmmtbcinrovokedby the Zoning ssssss " Iactude Witti this applicatfoa: a stampod vm anty deed fiiom the Register of Deeds office a Copy of the oatifiod curacy map if roforcnoc is made in the wamaty decd HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the - ---------------------------------------------- Holding Tank Owner( )N Name(s) and Pum r Name We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) /? tv /s! SEl�y, c . / y T. 2� rl /G 0- w Aar, QA - St d r6l to �o <,c'/ I 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of e,7 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b: The name of the owner of the holding tank; C. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Willia Kitchner Owner(s) Name(s) (Print) I Owners Signature(s) Subscribed and swum to me on this date: October 4, 1 999 I 1 1 Today's Date 1 1 1 i K Pumpers Name (Print) 1 Pumpers Signature Notary r'ubl:c Signature tr6l __11 .S L Eve- S t Notary Public -State of Wisconsi My Commission Expires Fah_ 17.2()02 Pumpers Registration Number Commission Expiration Drafted by VOL :461 PAGE 19 I)octrmentNumbedPlanl. HOLDING TANK AGREEMENT 61 1490 KATHLEEN H. WALSH This agreement is made between the government REGISTER OF DEEDS unit a nd holding tank owner(s). ST. CRO_X CO,, WI Name and Return Address RECEIVED FOR RECORD 10 -04 -1999 1:00 PM HOLDING TANK AGREEMENT EXEMPT 0 � SS/o,ZB CE6:T CORY FEE: CORY FEE: Parcel identifier number (PIN) Agreement &W TRANSFER FEE ed e- / .0 $/.Z - /D- &vo C RECORDING FEE: 10.00 RAGES: 1 Governmental Unit Holding Tank Owner(s We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description. Use reverse side if additional space is needed) Y Sec A G 40, T . o au Caere st- QVZJ� G Vii.,. 1-217 An ..Pd. �I _ t� L aw s ---------- or that cdntinued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. � /� As an inducement to the _ . D t n �� A C to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR, 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in a. 254.59, Stats., the governmental unit may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by a. 66.60, Stats. 2. The owner agrees, pursuant to a. IIM 83.18 (10), Wis. Adm. Code, to have a water meter installed in a new building or new structure. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be finally responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit to enter the above described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract or the owner's registration with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the governmental unit and the county on a semiannual basis a report in accordance witn s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under a. 146.20 (3) (d), Stats., the owner shall submit the report to the governmental unit and the county. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be canceled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. William Kit hller Owner(s) Nantes) - Please Print povernmental Unit Official Name - Please Print Subscribed and swo to a pn this date: 0 1899 Ngtarized Owner(s) Signature(s) Governmental Unit Official Title - Please Print Q i Notary Public / • !f� J vern ntal Unit Official S. My colli ptMsc&sln liv,�j� �. • ion Expirgs'F . 1,7 9W2 Drafted by M P S F►-, o rnP S 0-� Personal information you provide may be used for secondary Purposes (Privacy Law, x.15.04 0 X m)]. DOCUMENT' NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 i 524444 ___. yoL I)UrAOf271 — REGISTER'S OFFICE - -� ST. CROIX CO., M John Hampton and Myrtle L. Hampton, husband j` Rec "d for Raw .- ------ .. . ........... . .. an . ife, as joint tenants I___ + -- - -. . .. ......... .• - - -- . D 19 1994 . --- - - - - -- •- •- •---- • - - - -- � i2:3o P. .... .... . .. ...... ........ ... .. _. _._....- i _ -._._ .__. _.. __... _ _ .. __.__....... .-.7` o /I William L. Kitchner and ' � conveys and warrants to ..................................... ........ •---- - -•---- ••-•- -----...- - -- - I: C1�Q ..Maz.i.e...Ki.tchrieX,...kl>� band - -- and -- wife -- r Re&MffOfo9sdt as.._slaxxivQxs}ai g_..ma_r ta1__.propgty- - - - -- •----- -• - - -- - --------------------------- - -------------------------- - - - - -- -------- - - - - -- --- - - - - -- ................... - -- - - - - -- RETURN TO .................................... ......................... .... .. __ _._...__._- _- ___- _._....__.._._ I� the following described real estate in ----- St..._.crolx . .....................County, State of Wisconsin: Tax Parcel No: .............................. All that part of West Half (Wk) of Northwest Quarter (NWh) of ` Southeast quarter (SE4) of Section Fourteen (14), Township Twenty -eight (28) North, Range Sixteen (16) West lying Sly of ! centerline of County Trunk Highway "N ". TRANSFER '7 This ---------- is homestead property. (is) (Xsxl Exception to warranties: Easements and restrictions of record. Dated this --- _--- ----- ------------ -- - - - - - - l,---- -- - - - -- day of ------------------------------------- -- C.C�%n- b&e- -- - - -- -, 19..94.. ------ ••-- -• - - -- - - - - -- --------------- (SEAL) /� r O _" �C7tZ� (SEAL) ohn Hampton - - - -- ---- - ----- - - - - -- t� ---------- --• - - -- ------ - - - - - -- (SEAL) `�Jf_.(SEAL) * Myrtle L. Hampton ------------------ - -_ - -- ------------------ - - - - -- -------- - - - - -- ------ - - - - -- AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN ss. St. Croix ............................... County. authenticated this ........day of ...___- _- ._.•--- -- --- -- - - -- 19...... Personally came before me this ................ day of ---------------------------------------- , 1994... the above named ------------------------------------------------------------- •------------ - - - - -- John Hampton and_ Myrtle L. `---- - - - - -- -----------•--------------------- •---------------- - - - - -- ---- -• - - -- Hamp ----------------- - - - - -- ----------------------------•--- TITLE: MEMBER STATE BAR OF WISCONSIN ........................................... ............................... (If not- ............................................................ -------------••-- •-- .. ........................ ............... ................ authorized by § 706.06, Wis. Stats.) to me known to be the person S ---------- who executed the foregoing instrument nd acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 0 " Thomas A. McCormack ----•--•---------------------------------------------------- -• -• -- Baldwin, WS 54002 ---------•-------------------------- •- -•---- •--•---- -- ------ • - - - -•• Notary Public - -- - My Commission is •------- - - - - -- permanent. -. If not, 1�� state expiration County, Wis. T (Signatures may be authenticated or acknowledged. Both ( are not necessary.) date: L " S •Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FARM Nn. 2 2 Milwaukee, Ws consin Parcel #: 008- 1042 10-000 11/02/2004 10:35 AM PAGE 1 O 1 Alt. Parcel #: 14.28.16.214C 008 - TOWN OF EAU GALLE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * SANCHEZ, MIGUEL S MIGUEL S SANCHEZ 2559 CTY RD N WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2559 CTY RD N SC 0231 BALDWIN- WOODVILLE AREA SP 1700 W ITC Legal Description: Acres: 9.000 Plat: N/A -NOT AVAILABLE SEC 14 T28N R16W THAT PT OF W1/2 NW SW Block/Condo Bldg: LYING S OF CEN LN CO TRK N Tract(s): (Sec- Twn -Rng 401/4 1601/4) 14- 28N -16W Notes: Parcel History: Date _ Doc U - -- o age 12/0 /174 � �W D 7 1106 D 07/23/1997 459/518 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 122,000 Valuations Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 68,300 90,800 NO UNDEVELOPED G5 7.000 3,200 0 3,200 NO Totals for 2004: General Property 9.000 25,700 68,300 94,000 Woodland 0.000 0 0 Totals for 2003: General Property 9.000 28,800 68,300 97,100 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount 010- GARBAGE SPECIAL ASSESSMENT 138.00 Special Assessments Special Charges Delinquent Charges Total 138.00 0.00 0.00 vas 1475PAGE 174 "' 614765 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between 12- 01-1999 11:10 AM William L. Kitchner And Cleo Maria Kitchner husband WARRANTY DEED and wife. EXEMPT N Grantor, CERT COPY FEE: and Misatal S Sanchez a aiRgla v COPT FEE: arson TRANSFER FEE: 300.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in st . Croix County, State of Wisconsin: All that part of the Wast [calf of the Northwast Quarter of the Southwest Quarter of Section 14, Recording Area Township 28, North Range 16 West, lying southerly of the centerline of County Trunk Highway "N ", St. Croix County,Wisconain Pj ETURN TO T i.-E ONE 706 19TH STR E' T G UTH HUDSON, 006- 1042 -10 -000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Exceptions to warranties: Essements,Roadways, And Restriction of Record Dated this , d day of ar 9G� , • * * William L. Kitch / * * Ci eo Marie Kitchner AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix Coun Personall came before me this day of authenticated this day of ESL the above named W_ ill-tam L Kitoh_ner Cle Maria Kitchner * TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed (If not, the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * �rt�c y T(�crr Michael Foracki Attorney Notary Publi , State of Wisconsin Eau Claire, Wisconsin My Commission is pe a t. )f not, state expiration date: (Signatures may be authenticated or acknowledged. Both are j&)nL,-Q&Nt.� -r } not necessary.) Tracy L. TUMer Note P UNIV a a Of Wisconsin *Names of persons signing in any capacity must be typed or printed below their signature. 4 STATE BAR OF WISCONSIN 11 -t0 twa WARRANTY DEED FORM No. 2 -1998 ST. CROIX COUNTY ZONING DEPART,NT-- AS BUILT SANITARY REPOR < \ Owner l , � .w. ETC � _1 Property Address , City /State Legal Description: G - t , Lot Block — Subdivision/CSM # `— '/a 1 /4, Sec. f , T N- R_&,W, Town of U -dace SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: ,T Tank manufacturer Size ST/PC Setback from: House /D Well L P/L /moo Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road �p L� Vent to fresh air intake as Water Line j :Z5' Meter location Alarm location 4Jmt X- SOIL ABSORPTION SYSTEM Type of system: Width Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark s #o ti.,. Hou s C s; d ,, n. a Elevation / b Description of alternate benchmark Elevation Building Sewer S ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System () () ( ) Final Grade O O ( ) Date of installation // / �1 f9permit number � State plan number 7 / Plumber's signatur icense number QEQOr� i Date Inspector Complete plot plan � I I � I i i NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW tit 1 �1 6 �v INDICATE NORTH ARROW