HomeMy WebLinkAbout022-1020-50-000 ST. CROIX COUNTY ZONING DU- ARTMENT
AS BUILT SANITARY 6A
Owner lc - 2-
G
Property Address I r law QJ
City /State 9 � v t, t j
Legal Description:
Lot 8 Block N o Subdivision/CSM # "/ e ra i .,
%4 N _lam t /4, Sec. 2, T aG N -RAW, Town of e� w>v = h' ` A- . P D z Z �! o as -,-60 -o o c
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer r A , d L o ✓ e to ,' Size ST/PC ),;2 oa / 7s o Setback from: House I 5-- Well AL P/L >� Go
Pump manufacturer r,;� d Model w F v a
Alarm location `
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: m oL, h / Width 4 Length _ Number of Trenches >y y
Setback from: House ► 3.5 Well P/L 7 -� - Vent to fresh air intake
ELEVATIONS
Description of benchmark Too � � �'w -'4 ��� L n e Elevation )00,6
Description of alternate benchmark To ; 2 w 1_�� 1�, �1 Elevation 106
Building Sewer 9 8, 9 $ ST/HT Inlet ST Outlet 87,73 PC Inlet qS', a
,57 1 o I
PC Bottom G 1 Header/Manifold q6, 8q Top of ST/PC Manhole Cover PC 1 bo . ) 7
Distribution Lines O � 8 . 9 ( ) ( )
Bottom of System () 9 $ .1 ( ) ( )
Final Grade O c c , J i ( ) ( )
Date of installation I l i /q 9 Permit number 3 4 3 State plan number a 3y S,f
Plumber's signature 0,ad License number Date 3 13a l 00
Inspector
Complete plot plan �
I�
1
2
NOTICE: Please : rovide the following:
g
• 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
0
A
St
INDICATE NORTH ARROW
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CR IX
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Per rYi llll((::i2,}�nik' N eL ❑ City ❑ Village Town of: State Plan ID No.:
GGAAIRC ttiill KINNICKINNIC
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � �Z C20 Benchmark ,
Dosing Zd D orf -1 Zd /0#2,
aF v L 4,
A ation Bldg. Sewer A a 90 y�
Holdin �/ Ht Inlet � p Q(p Z
T K SETBACK INFORMATION / Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet d g O
Air Intake 7. 0
Septic L I Z'� / NA Dt Bottom Z • �Z (
Dosing j IVIZ� > / NA Header / Man.
A Dist. Pipe
Holdi Bot. System d `�
0
PUMP / SIPHON INFORMATION Final Grade
f . Manufacturer S 5 emand r, A OCR 2 2-
Model Number L T PM 1 d a Z _, (n _ 0 . 1 &1
TDH Lift 43 Friction System TD Ft
Forcemain Length / Dia. Fi �/ Dist. To Well
SOIL ABSORPTION SYSTEM
/ gMTRENCH Width Length No. Of Tr nche PIT No. Of Pits Liquid Depth
EN f N / DIME
SYSTEM TO P/ L BLDG WELL LAKE /STREAM LE Manufacturer:
SETBACK CHAMBER
INFORMATION Type O r
System: 7 �S � OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s)� / r x Hole Size x Hole Spacing Vent To Air Intake
Length 2 1 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.)
LOCATION: KINNIC I IC 8.28.18.117 468 SLEEPY HALLOW ROAD — LOT 8
z(�
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� ao sWr L 6n t at 'K�q� \ /G C-ar. r te► ^ ''' S 1 W 1", 4 4;Vt4./
Plan revision required? ❑ Yes No v C/
Use other side for additional information. Iq 3 6 d
SBD -6710 (R.3/97) Da a Inspector's Si ture Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
f SANITARY PERMIT APPLICATION 201 B 0
Washington Avenue
Visconsin
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the s r 9 ss County
than 8112 x 11 inches in size. S j , y n
• See reverse side for instructions for completing this a I tion /p� y� State Sanitary Permit Number
F 4��
Personal information you provide may be used f � sec d� urpos � qqq / /�; � '. ❑ Cnec rf revision to previous � application
[Privacy Law, s. 15.04 (1) (m)].� j ;__
�� State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRIIJ K L N 0 985
ProDe6rty ner Name rop L al!tillin
" o 1/a y[( a, S g T a ? 40, N, R I S E (or)@
Property Owner's Mailing Address R t r 1 \ ; F ' Block Number
f
Cit , State t Z ip Code Phone Number ision Name or CSM Number
II. TYPE OF B I ING , check one) ❑ State Owned ❑ Itr Nearest Road
❑ Vil age >
Public JZ 1 or 2 Family Dwelling - No. of bedrooms 4 sr Town OF K W I C k w�'c S e 901101-
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) T.1
g �
1❑ Apartment/ Condo I o 2 2" p Z 0- ED - M
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ 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. ICI New 2_ ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an
ystem ...... System ___ ^ _________Tank Only______________ Existing System ________ Existing 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 IM Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r r n 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill C ,f- ci*— q :v 3
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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
t� 0 ® O r a U l . 2 »V )9L . 3 Feet 1 00. �S Feet
Ca acit
VII. TANK in g allons Total # of Site
INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic App.
New Existin Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank 1 2v O J(vrs R. CO, IR ❑ ❑ ❑ ❑ ❑
L ift Pump Tank /Siphon Chamber 7 so — 7S G h! [ esfet e[tr ® 1 ❑ 1 ❑ I ❑ 1 ❑ 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) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
b e )S e I CV.I/ S 1S -4.; 17.E
Plumber's Address (Street, City, State, Zip % de):
)'h r- &',- 5 Y . ( G ' S4
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssu e Issu ng A Signature (No Stamps)
pproved E] Owner Given Initial Surcharge Fee)
Adverse Determination !D0
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11 197) 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 maybe 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 apprppriate 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 8 112 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
1 2226 ROSE ST
N A LACROSSE WI 54603 -1905
TDD #: (608) 264 -8777
V scons�n www•commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
July 28, 1999
CUST ID No.220554 ATTN: POWTS INSPECTOR
ZONING OFFICE
CARL P HEISE ST CROIX COUNTY SPIA
1042 S MAIN ST 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 07/28/2001 Identification Numbers
Transaction ID No. 236885
Site ID No. 177222
SITE: Pleas-e refer to Both identification numbers,
Site ID: 177222 above, in all correspondence with the! agency..
St. Croix County, Town of Kinnickinnic
NEIA, NW1 /4, S8, T26N, R18W
Subdivision: Sleepy Hollow - lot 8
Facility: Bill Oczak Proposed Residence
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 481508
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. Stats.
• 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(2)(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 07/15/1999
a FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
jswim @commerce.state.wi.us WiSMAR'1 �I, 6�
l MOVE THE EARTH
CARL HEISE EXCAVATING
1042 South Main
RIVER FALLS, WI 54022
CARL P. HEISE }� (715) 425.2175
Owner MOUND SYSTEM. ti 1999
FOR
BEDROOM RESIDENCE TY &
A
LOCATED IN THE VU E V
4 OF THE !Nwy4 OF SECTION P3 , T?LN, R_12_W
TOWN OF _�l1rl►y�t hswwic , S7, ,ro l 15 COUNTY, WISCONSIN.
INDEX
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLAT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION
PAGE 4 of 6 DISTRIBUTY N PIPE LAY -OUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
�N I S. t
o... 1, y
PREPARED FOR GO l a t' j1�
LE N E_ 0 C ZA K cn�R
ON
OLR zl� Y
Carl P. Heise,
CST 3314 MPRS 337$_',...,2�..� .5.5q.
1042 South Main Street
River , Fal'ls,W2 54022
P 1 6T PL d %
Scle 1;4o`
2 D ac. 'pa rCt 1
r�
- 10
EL {00,00
G sue
v
a_
5�
d �
G � •
)Zg
Q lcCati7 f'"rP �� \_�.
To
S re V
�uw►y
1 200 r A o.'"'4e c�• f4
,�' `� QrI.CaSfi SCptl
Designe 'T_ No
Date
Non -Woven Filter Fabric
4" Observation Pipe Perforated ,DisIribvIion Pipe
Below Filter Fabric
ASTK C -33 5 o n d --..�
Topsoil
I 1
slope forte Moin ��FIa e
Bed Of �`� 2 %2
Drain Rock From Pump Layer
Q 1.0
E 1.12
Cross section Of A Mou nd'SyStem Usin F X15
A Bed For
The Absor tion A rea
A Ft.
Ft.
I 1 0 Ft.
.S_ Ft.
K 10 Ft.
Alternate Position L 101_ Ft.
of W 24 - Ft.
-- Force Main
1 L -
14:Observation Pipe—,-N
A I
I
Force Main
- -- ------- - - - - -- ------------------ - - -
From Pump
Q Distribution Bed Of
Pipe Oroin RocK
I �
4 Observation Pipe Permanent Marker
Pipe or Rods
I
Plan iew Of Mound Urine A Bed For The Absorption Area
T�1. f: C new
I
Po P ipt Dololl
E nC Vir
.. (FtrlorolcG � .
[n0 Coro •},` • PVC Prpt �Pc�R}1A�gUi NF,ZK,r - Y
1 eat.
0
��►) Joi tiro "�� t% oto b Gn 6otlom,
err E ovolly Spoced
S
Q
PVC fprot:'µoin
From Pump
P
/ 1don:lolG P:vt yam,
• �Gritrlu�lror• �
Ytpt �.
Lost Holt Should Be I
10 End'Cop
�.,.s Cnn Nkiribuiion Piot LoYoul '
P
S _3
X � r
Y
Hole Diameter y 4 Inch
Manifold . " 3 Inches
Force Main " Inches
Lateral " 14 Inch(es)
Holes Per Lateral 9 Pq -27 -! 95 2 L 2.41. 3!9.329 4 35- q 43
PUMP .CHAMBER .CROSS. SECTION. AND SPECIFICATION ?S
' vent cap
4" Vent Pipe
10' from door, weather proof
approved locking
junction manh box a cover &
.ndow or fresh i warning_ label
.r intake 12" min
grad
� 4" min
1
conduit �\
18" min �: 18" min
provide
I
inlet airtight 'seal �� -•- - -
, rov ed i eep - - -
o ed 3oin A hole
. ending ' � � � VALAPJ
o solid s oil .' B a pprove d
C i xtending 3'
ON
92 5 . nto solid
— pum '�� P oil
OFF
D'
92 6 concrete b oc
3" Approved Bedding Under Tank
SPECIFICATIONS
.)tic and
;e' Tanks Manufacturer: 1AtJW' e5'tew► P�acw1_/ : Number of Doses:'' 9 _per_ day
Tank Size':' 1200 , 50 Gallons Min Dose Volume: )G gallons
Alarm Manufacturer': V e(, ov Capacities: A_ _9 gallons
Model Number: * OL V B= inches 36,9 gallons
Switch,Type : Ca inche's 5 gallons
Pump Manufacturer: D' = o� q.749 allons
Model Number: 2885 u)Czo 3L . NOTE:
PDMP AND ALARM ARE TO BE
Switch Type: Gr INSTALLED ON SEPARATE CIRCUITS
Pump Disc 9, r Rat t x 9 ') 7-G PM 9e,
*tical Difference Betw Pump Off and Distribution Pipe'- capacity
dinimum Network -Supply Pressure. a,� feet
........................
F.e.e.t Of. For,cd Main X�t j�$al /in
_
/1.0.0, f t Fr.i.c.ti.on F.ac.to'r , o I 1 fee
t
3b �
Total Dynamic Head - 9 feet ` `
:ernal Dimensions of Tank: Length Width Liquid Depth i
Signed No. Date
�6 LJ6
Goulds
Submersible
•` Cj
3885
CANADIAN STANDARD ASSOCIATION S P
APPLICATIONS • Three phase:'' /2 HP — FEATURES Motor: Fully submerged in
1' /z HP 200/230/460 V,
Specifically designed for the 60 Hz, 3500 RPM. Class B Impeller: Cast iron, semi- high -grade turbine oil for
lubrication and efficient heat
following uses: insulation, overload open, non -clog with pump- transfer.
• Homes out vanes for mechanical seal
• Farms protection must be Designed for Continuous
protection. Balanced for
• Trailer courts • within the motor manufacturer's
provided in starter unit. Shaft: threaded, 400 series smooth operation. Silicon operation: Pump ratings are
• Motels bronze impeller available as
stainless steel. , recommended working limits,
• Schools •Bearings: p an option
all bearings can be operated continuously
• Hospitals upper and lower. Casing: Cast Iron volute without damage.
• Industry • Power cord: 20 foot type for maximum efficiency. Bearings: Upper and
• Effluent systems standard length (optional 2" NPT discharge adaptable lower heavy duty ball bearing
. available
leng for slide rail systems.
ff ) construction.
SPECIFICATIONS Single phase: V and'' / 2 HP Mechanical Seal: Silicon Power Cable: Severe duty
Pump: —16/3 SJTO with three carbide vs. silicon carbide rated, l and water
• Solids handling capabilities: prong plug. % -1'/2 HP sealing faces. Stainless Steel Epoxy seal n motor end
S /1 maximum. —14/3 STO with bare leads. .metal parts, BUNA -N provides secondary moisture
• Discharge size: 2" NPT. , Three phase / - /z HP elastomers. barrier in case of outer jacket
• Capacities: up to 128 GPM. -14/4 STO with bare Shaft: Corrosion - resistant damage and to prevent oil
• Total heads: up to 123 feet leads. On GSA listed stainless steel. Threaded wicking.
TDH. models - 20 foot length design. Locknut on three
SJTW and STW are phase models to guard 0 -ring: Assures positive
• Mechanical seal; silicon p sealing against contaminants
carbide -rotary seat/silicon standard, against component damage
carbide= stationary: seat, 300 on accidental reverse rotation. and oil leakage.
series Stainless steel metal
parts, BUNA -N elastomers.
• Temperature: METERS FEET
104 °F (40 °C) continuous 90 _ T- SERIES 3885
140OF (60 °C) Intermittent. SIZE: 1�r SOLIDS
• Fasteners: 300 series 25 80 - E1 H RPM: VARIOUS
70 5
stainless steel. _ - }. — —
• Capable of running dry 20 _ E1 H r~r ._.. ,..... _......_ ._._........_. _._ _ —._...
'without damage to _ -
components. 2 60
EO 11
Motor v 15 50 - — - - -- —
• Single phase:' /3 HP,115 - —'
or 230 V 60 Hz, 1750 RPM; 0 40 ED H
'/2 HP,115 V, 60 Hz, 10 _
3500 RPM; %2 HP - 1'/2 HP, 9 30 -
230 V, 60 Hz, 3500 RPM. 20 e
Built -in overload with 5 s
automatic reset. 10
Class B Insulation.
0 0 0 10 20 30 4 50 60 70 80 90 100 110 120 130GPM
I
E p 1 0 20 30 m
CAPACITY
Effective May, 1994
0 1994 Goulds Pumps, till . 11 83885
V!.- Scons�'Department of Industry SOIL AND SITE EVALUATION tr
�.a%or an Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in s' 10 County
include, but not limited to: vertical and horizontal reference point (B i ion a P d ' a�2 I
percent slope, scale or dimensions, north arrow, and location and a to ofd. cel I.D. #
4.F,a'..i
APPLICANT INFORMATION - Please print all inf tior..,,- t I A F wed by Date
Personal information you provide may be used for secondary purposes (P aw, 8` d4 (1� (m�. W r'
Property Owner ipYeFtY'K.ocY "' " °� f
/4 1 1/4,S T N,R 1(orO
Property Owner '§ Mailing As : �'' (.off # a Subd. Name or ZC# s/� �
a Z r)
City State Zip Code Phone Number Neare t d
El Ci Village Town
X 4Z
S� -
New Construction Use: Residential / Number of bedrooms Addition to existing building
Replacement N Public or commercial - Describe:
Code derived daily flow a gpd Recommended design loading rate,G gpd/ft gpd /ft
Absorption area required bed, ft _ trench, ft Maximum design loading rate ) -2 bed, gpd /fl — 4 - ;2 — trench, gpd /ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site consi 5 erations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure
AT System in Fill Holding Tank
U = Unsuitable for system ❑ S jI U ,® S E] U ❑ S U ❑ s ® U ❑ S ®U ❑ S (� U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed Trench
13 AZ
— 1
Ground "' Xy
7 7,42
42 . 4Z
9 �� lev y � .
aa ft•
A1, Al/
�.�
Depth to
limiting
factor
Remarks:
Boring # ,
1 Aljl-
X" /
Ground
elev.
Depth to
limiting
� fact r
in. Re arks:
CST Name Ple a Pri Signature Telephone No.
Address �� 1 Date CST Number
/ ��� SOIL DESCRIPTION REPORT '
PROPERTY OWNER 14 0.z x Page J of
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cgnt. Color Gr. Sz. Sh. Bed , Trench
Al
�a
- I -
Ground
elle�v,. 7,S
Depth to 7 1
limiting
factor
n.
Remarks:
Boring #
All.
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
n
Ina
Ground
elev.
ft.
Depth to
limiting
factor
in, Remarks:
Boring #
F`
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW -8330 (R. 08/95)
;
AIA
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ST CROM COUNTY
SEPTIC 'TANK MAINI'INANCE AGREEMENT
AND
OWNERS11111 CERTIFICATION FORM
Owner /Buyer
Mailing Address �G,C� �/
- —
- - -- - - - -
Property Address _
verification r +
( equrred from i 1 nnir U for new construction) �_-
1
City /Slate Parcel identification Number da - /Oa3o - JO —0 00
L EGAL DESCRIPTION
Property Location _IYE_ ' /,, _AIW ' /�, Sec: F_, 'T j_L - IZ �U W, 'Town of
Subdivision S /ee 0 112W , Lot #
Certified Survey Map # 7 L� 7 $ , Volume � , Page # 336 .
Warranty Deed # , Volume , Page #
Spec house ❑ yes/k no Lot lines identifiable JV yes 0 no
SYSTEM MAINTENANCE
Improper nse and maintenance of your septic system could result ill its premature failure to handle wastes. Proper maintenance
consists of pumping out tite 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 se(rtic tank as a Ucatment stage in tine waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
trrastcr plurnirer, 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 rnrdetsigned 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 Coinnrerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained artist be completed and returned to the St. Croix County Zoning Office within 30
days,,of ree ration date.
1QY
" OF A L1C T DATE
OWNER CER rIFICA'TION
I (we) certify that all statements on this form arc tore to the best of my (our) knowledge. I (we) am (are) the owner(s) Qf
the > > escrib d c, l) virtue of a warranty deed recorded in Register of Deeds Office. R A2 1/9
SIGNATURE OF A .'L 1' DATE
* * * * ** Any information that is mis- represented nnay result in the sanitary permit being revoked by the Zoning Department. * * * * **
** of Deeds office
Incr +rde with this alrplicalion. a stamped warranty deed from the Register
a co PY of the certified survey map if reference is made in the warranty deed
W 1�7"99 11:08 FAX 715 425 0377 FIRST NATIONAL BANK RF 002
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THIS INSTRUMENT WAI DI FTET) BY Notary p State Of %I, if noE slatr ex piration elate:
N4Y CLTjjm is per inaneffi.
Attorney Kristine 0 9'" (1
Hudson, NVI 54016
(Signatures may b q v acknowledged. Both are riot
V 01-11
or printed bulow their Sigrffll'"5
& Narncj (i r persons signing in any n',-itY should be typed
STATE AAA OF �%IKOWTN
NIVARF-k'rrY MED root Nn. z • 199M
jr 4Fr . )g&4A7jON PRoKS310NAO GOWFAN"'
FILED \2
L M AR22 t..
JAMES 9� I
9 g of 00 .S
W!
CERTIFIED SURVEY MAP -p
LOCATED IN THE NE1 /4 OF THE NW1 /4 AND THE NW1 /4 OF THE NE1 /4 OF SECTION 8, T28N,
R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN
LEGEND
ST. CROIX COUNTY SECTION CORNER
MONUMENT, FOUND. \�� C S_M L 2
• 1" IRON PIPE, FOUND. bb
a 1 "x24" IRON PIPE WEIGHING \ �� LOT
1.68# /LINEAL FOOT, SET. �~ �U?' �� L T l l
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OWNER AND SUBDIVIDER
Robert Richter
1152 Riverside Dr. N.
Hudson, Wisoconsin 54016 b
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N
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N1/4 CORNER ~ `V�
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SECTION 8
T28N, R18W
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fi ° v W
1' U M
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LOT 8 �
' 20.001 AC.± H W W
871,240 S.F.t w w P4
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W I m ap
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W SCALE IN FEET
OEM
CD -It 0' 200' 400'
O M ,
.o
W It \D � POINT OF
N -It z BEGINNING
w CY^) ASSUMED BEARINGS REFERENCED TO THE
o `O 246.20' 368.35' NORTH LINE OF THE NW1 /4 OF SECTION
N o t " o t tt o t "
z NO 45 55 W NO 25 46 W $ WHICH BEARS S88 34 57 W
H
'� SO ° 34'11 "W 611.24'
WEST LINE OF THE NE1 /4 S74 °45'02 "E
OF THE NW1 /4 12.57
z
z
UNPLATTED LANDS
NW CORNER
"zSECTION 8 This instrument drafted by James T. Swanson
T28N, R18W
Vol. 8 Page 2336
11 :07 FAX 715 425 03r77 FIRST NATIONAL BANK RF (j001
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aka
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Regi ; m � of
f� Ct 74'� 1 �, St Cro►x c ,
�---- 11 "tt r._� f , CEFtTIF•IEei SURVEY MAP
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LOCA:CI:.D IN 7'Flr,,.i1E1 /t ()r THE W AND THE Nld , �
Z1014, TC\1 OF KINNICKINNIC, ST. CROIX COUNTY,WZSCONSjNNEl /4 OF SECTION R, T28N,
I,r91 NR
ST. CROIX COUNTY StCTIO ' CORNER
MONUId.ENT, FU1jI.10,
• 1" lROu Pips, FOUND. � ��` CSA1 —LOT-2—
0 1 "x::4" if ?UN PIPE WEIG111re.
1 .68MINEAL .FOOT, SE'f . CS1.1
O
OWNER A23D SU JDIVIDER
Rcberl Rirl)cez ______. f
13.52 Riverside Dr. N. •-
Iludson, Wisoconsi.n 54016
v .
V _
c+,
u1/4 CORKER
SECTION 8
7'28N, R1SW
, � Z
cn ai
LOT $ Fn x
20.001 A . ± w y
871,240 S.F.± �� H l w
L p
14 tn
y .•3 � c7
r�
W
- $- - CA l E I FEET
200 GGU'
�) •1 C ; m POINT OF
• iv .r H BEGINNING+ -'
rr
w 246.20' 1 ASSUMED BEARINGS REIN ENCED TO THE
3ii$.35 NORTH TjNg OF THE N141/4 OF .SECT.ION
N0 55 "W NO ° ?5't15 "Id 1 $ WHICH BEARS 988 0 34 1 57 11 11
nun
y 6i • . — _ Ic
ua ea _WEST LINE OF T1 1,1EL; 1 1 , $74 '45'02"E
OF T11r
lY) '
UNPLA't 1.A1.1as
141•1 CUP +IJER •- •.. �- -- -- — -• ..
* XSECTION 8 This instrument drafted by James T. SW21190t•1
T2811. R3.814
8 rage 2336
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