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HomeMy WebLinkAbout022-1042-90-000 4 0 a c °p ti p ° I p o� Mi Go y I y I C Ca i °c m I X c a> � r NL I I CL m E a 3 rn h y o t v, I o 3 a�€ p o o �oaa)a I z o r Z t r c I a Z o m c 0 I ca LL c _� « L y LL c ,p ID aS f0 I I 3 3 a� CL Z — aa) Co Co z E E Z °o 8 z € I € ` d d 0 0) �� j am I am I I o I o z c I y Z� o � I � • o I H r i E I E ch N a) 5 S Q� m (D Co • N 1 fC N 00 C a c� O Z m Z O � I Z Z O N I Z I d @ I N M C. . C I N C. • « ) to to 1 0 a O « � C N d N O M` N O O O G G a E y I O O a E= N N h„ z —mv�v� a V I —mtnu� aZ oo z I zoo •N _ ccaac. ILLn.aa f �a IL 0 0 (n ��� I��a) } la0)� } to 0 0 N I t p �_ O O O 0 O p O O O m y m N (D p) 0 0� Q fn I -6 0 O •O d Q} fn m p t o o l 0 7 O N N C I N O O :, r N CD > >O O m H C U y C U C cc a1 O O O O 0 y fe6 y I Q N C N N N v N Q N O O O N N t, a� rn v Z I m w :: 'v co to as I x ('y O 0 O C C L • �V ) O Y m N O Co p I O M O y O A U Z y z - 2 to I = I r I V � d •R €a I oa #t L I I • ' c a d 'v ! d d c I ° m e E c « 0 i A tia� o o3vit0 s COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX - 715 962 - 4030 ST. CROIX C OUN TY GMRNMENT REPORT NO,! 53679/01. PAGF 1. CENTER REPORT i7ATE4 12/06/93 1101 CARMICHAEL ROAD DATE RECEIVED** 12/03/93 HUDSON, WI 54016 ! ATTN! THUM C. NELSON OWNER** john Bradley LOCATION! 309 N. River Rd., River Falls COLLECTOR2 Toe Nelson DATE COLLECTED! 12 -01 -93 THE COLLECTED! 10200am SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZEDl12.03 -93 TIME ANALYZEW211200am COLIFORM,WCC! 0 /100 ml INTERPRETATION! Bacteriologically SAFE- NITRATE -N! 6 ppm Above 10 ppm exceeds the recommended Public- Drinking Water Standard, Coliform Bacteria /100 ml d Nitrate- Nitrogen, mg/L�� S , LAB TECHNICIAN*' Pam Woe O4 .WOEPEgp EN WI Approved Lab No. 19 0 F D Means "LESS THAN" Detectable Level Approved by! PROFESSIONAL LABORATORY SERVICES SINCE 1952 i 9 ST. CROIX OUNTY WISCONSIN Y�4w.,`.. .L i r`' ZONING OFFICE I ST. CROIX COUNTY COURTHOUSE 0 HUDSON, W154016 (715) 386 -4680 SEPTIC INSPECTION f WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 �( Septic $25.00 JZ Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: 1 6N/ 1� ?Aj &T-V Requested by : - 6.4r/ 4L��C Address: 26f 4) ;?, Address: falb e. 41 � City & State: .rd�.e ccS , City & St. f�u�2 Fps , Z ip code: cild z z Z ip code: 5 cky a - ,r- Telephone N°: (2ti) eIZ5 •-5 Telephone N ((S") irZS"- 45°31 Property address (Fire NQ &Street) : ' Location: S'Gt/ VM) ,, Sec. , T ZI N, R _L?'_ W, Town of ��n�ic�,,,ii✓�c St. Croix Co., WI. Tax ID N Parcel ID N House color: Realty firm: Lock Box Comb v.. Water sample tap location: TO BE COMPLETED BY :PROPERTY OWNER * PROVIDE A SKETCH - OF HOUSE & SEPTIC SYSTEM ON REVERSE- OF THIS FORM* Is the dwelling currently occupied? ❑ Yes ❑ No If vacant, date last occupied: _ Septic system installed by: Year: Septic tank last serviced by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y W Slow drainage from house. ❑Y RN Sewage Back - up into dwelling. ❑Y qN Sewage discharge to ground surface, road ditch or body of water. ❑Y VN Slow drainage from the dwelling. ❑Y NN Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: ,� Z DATE: �11� 33jg66 ���� OWNERS DRAWING OF HOUSE & StPTIC"SYSTEM LOCATION f I N TO BE COMPLETED BY INSPECTION AGENCY i� 1 �? System design & /or permit on file? OYes ONO Soil series per SCS Soil Survey: sheet # Tape of soil absorption system OBelow grd OAt -Grd OMound Approx. size_ 'X I OGravity ODose OPressurized Ft . 2 OBed OTrench ODry - Well _._ OHolding Tank 00utfall pipe OBSERVED DEFICIENCIES 00ther OUnknown Septic tank Setbacks: OHouse OWell OProp. -Tine 00ther Dose tank Setbacks_: OHouse OWell OP`op:..'line 00ther 'OLocking cover OWarning label OPump /Floats OAlarm OElec. wiring Soil Absorption System Setbacks: _OHouse OWell -OProp. line 00ther OPonding. ODischarge: General comments INSPECTORS SKETCH OF'SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN -- -- -__ ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road — =� Hudson, WI W16-7710 (715) 386 -4680 December 1, 1993 Dan Wallace 1216 Co. Rd. J River Falls, WI 54022 An inspection of the septic system on the property located at 1216 co. Rd. J, River Falls, was conducted on December 1, 1993. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, y� Tom Nelson Zoning Administrator mi' J I Parcel #: 022 - 1042 -90 -000 01/03/2007 03:57 PM PAGE 1 OF 1 Alt. Parcel #: 15.28.18.231 B 022 - TOWN OF KINNICKINNIC Current [X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Ma # Sales Area Application # Permit # Permit Map pp Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DANIEL F & JACQUELYN R WALLACE O - WALLACE, DANIEL F & JACQUELYN R 1216CTYRDJ RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1216 CTY RD J SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH i Legal Description: Acres: 2.110 Plat: N/A -NOT AVAILABLE SEC 15 T28N R1 8W 2.11A IN SW NW LOT 1 Block/Condo Bldg: CSM VOL 4/990 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15- 28N -18W I Notes: Parcel History: Date Doc # Vol /Page Type 04/07/2005 791675 2780/073 EZ -U 07/23/1997 1058/356 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 178962 212,800 I I Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.110 40,000 156,400 196,400 NO Totals for 2006: General Property 2.110 40,000 156,400 196,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.110 40,000 156,400 196,400 Woodland 0.000 0 0 I Lottery Credit: Claim Count: 1 Certification Date: Batch #: 146 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges I Total 0.00 0.00 0.00 I AS BUILT SANITARY SYSTEM REPORT OWNER - �, ,i+�Y E3 seho �t-y TOWNSHIP ,r , iA, . % s T 1 yr N, R ✓N ADDRESS aT: - �, ,� .� « _ ST. CROIX C LINTY WISCONSIN. SUBDIVISION LOT LOT SIZE / �.rr►r cF ij �,�« PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHTNG WITHIN 160 FEET OF SYSTEM i 'c3 . to 1 20 Ole 71 � 13 y O I rd' i �C' Rr s r A x 3 a ►� • • A N� I di a e 4o th Arrow LE SCAL I i SEPTIC TANK(S) I MFGR.c �,,�j,�� �'� ��rt't - rY+' CONCRETE STEEL N0. o? rings on cover a Depth 2V4 PUMPING CHAMBER SIZE PUMP MFGR _ RML NO. GALLONS Per Cycle TRENCHES NO. of width — � r length area BED NO. of lines ____ width Z/ . length ��, area d3c dep - tai to top of pipe NUMBER OF SEEPAGE PITS Outside diameter total pit area AGGREGATE (jr PERK RATE S A QUIRED ! i ., AREA AS BUILT "j v Disclaimer: The inspection of this system by St. Croix Cdunty does not imply complete compliance with State Administrative Codes. There ate other areas that it is not possible to inspect at this point of construction. St. Croi County assumes no liability for system operation. However, if failure is no d the County will make every effort to determine cause of failure..... GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THI SYTEM. �. INSPECTOR DATED ,7 iq��: -- 'LUMBER ON JO r LICENSE NUMBER m �, , a s ;►t y 'd3mmm 3SN33I1 r " a or NO ?imwia Q3S'{fiQ wimasxi., _ •Jd ySJCS SIHI H9 n OdU aaSOaSIQ 38 TOH a'L10HS S'IIO a�ro • •alrkjTvj To asnea auTmla�z 03 310339 Aaana DIM TTTM Aaunoo ag3 pa3ou ST aanTTV3 3T 'aanaM.oH •uoT3eaado ma3st 20 3 faTTTgvTT ou samnsse 4a unoo xiozo •as.•uoT3onaasuoo go 3 uTod sTga ae 3aadsut c aTgTssod -3ou ST T 3ugz sea.zs 2a1130 DIe alags '•sapoo aaT3B astu-,mpy Davis g3Tri aouslT�e! a3atdmoo old Sou .saop 0c) *IS Aq mans qa 3 uoTaoadsuT aqI :aamTeToStj ZIl1 Sy . yaw a3?i - � , X • 3Z�'93?IJ� adTd jo do3 o3 gjda Valle gaSuaT gipTm sauTT TO 'ou r 1 Baa t�a�uaT gapTA "_' 30 •OH S3Fioh'3+I ZZ3M b Sa gadoa ;DAQa uo sSuT.Z TQ - ;Oj- zasis 31 (S)MWI 3ujj zrs I 7N A a Moz y!u:3xo�[ a4E zp I LIT J 4 - r i i e c r . x - - j NaZsbs 3o Z333 001 ;KIHZ.IM OftIHZ.I2I3A MOH$ ,,.._ .... .......... . OZ•Z9H 3O s3uamaaTnbaz 3aaz o} ,suoTsuam-Tp 9 . so:)u T(V m3In M - • nIS z 0'I 10 h0ISI1LIaL: • HISK OOSI M ' XIMOO X IOUD *IS _ __ .._ SS3?IQQy .0 , M 21 `N Z •3 aiHS moll -- Z2 OM wassis J XVIINV 1 Sd - REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM .; Sanitan� Pehmti State Septic NAME Towns hip St. Cnoix County Loca on ! w SeZi on Is Lot # Sub div.ision SEPTIC TANK Size *y : , __ gatto nos Nci-mb e a 'cb mpak,tmen-ts Di,s Lance 6nam: wetf- f� b j L (,t-- ftit k g 1:2 o ' 'gap PUM PING CHAMBtR,'- size gatto'A.& ump "'Ma 6acxuneH Mode. Numbers 7 yy// ,1..s .. a. HOLDING' g °Numb ~ eta �. am.aH.trvit�s S L ze a�2a na _ . Pumen ;'" A.-anm �S ystem 'Dtis tan, i -e 6HVm: Wett _ Building 12 6tope Highwate& ABSORPTION SITE _ Bed .. _' Tne'neh Di.6tance Ho m: Wetf - Bu.itd>ing 1.20 .6tope H:ighwateH ABSORPTION SITE- DIMENSIONS _. w,icbr o trttn J ,� / . .: t Requited anea '�,� bt g 6t Depth b 6 ; Ha ek b etow tite n Len �h a, each Ltine ? -'' Number a' Etinels Depth a6 Hach avers xi te L in _., _ . _ Tot-at -;Q-e gth ab Einez � -._.� Depth o� � �e be�aw gHade n Dti� av ice b�twee' 't "ne�s bt S2ape ab xneneh gin. pen 100 q To a2 ab6 aHp ion one i' :• '�; w . Type' a� Coven: PapeH on e " Zna�) PIT Numb en a Lpit's Gl . ek hound pit,6 yeb no Ou �Stid dti`" �n '� -� Dee 'tow .intet 6t Anea nequ�.Hed 6a, _.. INSPECTED /yG 7 TITLE APPROVED /" L DATE 19 8 REJECTED DATE 198 REASON FOR REJECTION f - qq PLB 67 State and County State Permit Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: T0,0 .v 4 I.,-k & IPA T R. Orr 4a c viS B. LOCATION: t u/ Y A V 1 /4, Section eL, T N, R E (or) W Lot# City AAAr o s A Subdivision Name, nearest road, lake or landmark Blk# / .ry oeA&r A &&, Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY /o v v Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass__._— Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: - No. of Lineal Ft. Width Depth Tile depth (top — No. of Trerrches Seepage Bed: — — Length *7 ke Width 1 Depth- Mf _Tile depth (top) of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private ® Joint ❑ Community ❑ Municipal ❑ Owners name as li on EH 115 i other than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME f'jPAept,p tr kg it. +.w1"' C.S.T. # Ss - 4y%V iX and other information obtained from 0,,.v* (owner /builder). Plumber's Signatur - mss- MP /MPRSW# - - Phone # . W9 A&-Y -2i , 2V Plumber's Address - Wi .F/t y- raw ow.w. w *S_ ..r1rooX.— PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E E O m�.. l .. _. . E r" 3 F 1 I� s t E 5 E . i _ — i Ir E .� E 3 t Ao , ­ , - a ...� O E a l � 3 ; 3 it's E 3 i Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY l Date of Application a '�0 Fees Paid: State � °� County � Da — 4c) Permit Issued /1390cted (date) 4 - d - Issuing Agent Name Inspection Yes . 4 State Valid# Date Recd 1.- county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 E 5 Rev. 9/78 � 2— REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 �✓ 4> 9 1 0 LOCATION: �✓ Section ,T g'/N,R_ , D E (or) W , T ownshi p or Municipality �'VN It t f Lot No. , Block No. Afi , J2 A ��7 PRWZ County * Owner' /Buyers Name: I . So#,V PLE u 3ivlsl Name CO �G 6 Mailing Address: - / Ilt/Q �1 if Cc> /.f - TYPE OF OCCUPANCY: Residence No. of Bedrooms `3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM ER DATES OBSERVATIONS MADE: IL BORINGS 30 Z9J PERCOLATION TEST / � o f 0 SOIL MAP SHEET �C NAME OF SOIL MAP UNIT PERCOLATION TE r1flpQov -� TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES Num- DEPTH CHARACTER I SOIL SINCE HOLE HOLE AFTE INTERVAL RATE BER INCHES THICKNESS IN NCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P— SOD S t B o O ' /s ' - ✓1 - P— P— Z w M J- P— P— AJ Srt�v SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES // B- /V DAN£ > /f *"&. /S /D "Lr�,e� S !v "1��►�/ dot V aA.e -14,.,, SAV B— B - Z 0 & , t • ate, S[. S " f %NE /oor� ✓ ..et 7s B— N fd S " 1-699 f�f 7 "13,v, L / " / • &J. L AA �6-)- It S8 " fu„z /oo B- aD w •, w;�B ,v s o. �s PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil ar as.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ��,�+ -SO. Icy rd4e .'Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 61CP B�4it N P m. ....m�. E 47 o IY _. a .m . �. _._ Z YE S ;mot _ a7 p o � i N ! f . �� _ 44� 4 __.....� . �, _...— i x E �. — Lw .1... _—L—AL s i I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief: Name (print) Ah"7_ 7411 47— Certification No. �S �O2_ 4/,PZ� Address Rf • .3 d / /VgIL APP dGC(. SOAol �S . Name of installer if known E - bti Copy A —Local Authority CST Signature �0�1� -c,l� C - d ` 5 Rev. 9/78 4� 2 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION : '/<,'/, Section Ar ,T Z�N,R �a E (or) W, Township or Municipality / Lot No. , Block No. County sf fi(�p /X " 4. , S ubdivision Name Owner's •Buyers Name: �J Mailing Address: �140 TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X ___ R� n► E •• PLL�ACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE OIL BORINGS 30 1 PERCOLATION TESTS 3 �20 SOIL MAP SHEET C NAME OF SOIL MAP UNIT N && /%y , d4%N `Ic Q", Df PERCOLATION TESTS B& (rAi1 _5p64)-- A EL,4,Q r-> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P_ EAEMP P - / / o BM 7- .P ASE I - O P _ " P_ + a _ • d/JE1 A, A i p/ /30 ga d SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES r NONE ? "&tJ L t1 � { . Q,J Si I Jb "L -14A) t- '� %N� I/Elt' A/E f O SE.S. w A> CIE B- 1 314AJP .$ LS B- " ' "Q,✓. S l- B- A,v /oosE 5, w S "w %DE / wpf O l B- L NO NE — �'S� S[ ^ " /6R PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. IV � � I eea.T f F 3 E 9 i s o m iL I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. ,l AD Name (print) A AAC, Z�/ ` zfl?4r Certification No. S4 Address �� 3 O�UE /G ReP , Il UpSD.✓ IV /s' . Name of installer if known V �`X / /AI C A —Local Authority CST Signature PY , . w HOMESITE SANITATION CO. SEPTIC CLEANING - SEWER SERVICE ROUTE 3, O'NEIL ROAD HUDSON, WISCONSIN 54016 6. 54ep;W *4p �foiL T� 50 - 3 1 /g �o T � , A 4 0 a J2/Y, �i c i3�`�n -T •T . fl'n- r�; =�� Sc •y .? n. s'rrra.. Z.: r2 , � i'vl PR S. o�� 3-"1 • I l- V �' � J I1 � � • I,, IY 1 `�• � 1. a?/ x 3r ' I ti , I OY � I 0 t c�r1n.' r � L � ry L it 5 / r7 � h ,i6ur \ " Al • Plb. tA WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Syste ON -SITE WASTE DISPOSAL INSPECTIMN REPORT i Name.of Premises 7 Street City County I f - Master Plumber " ?— -� , Address z r t } rt iii 4 - r t 4 Owner ] Address r ❑ County Permits Appropriate Sate Permits Type of Building: ❑ Public Single Family or-9CtMe Z' CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREA - MENT SYSTEM ❑ Building Sewer BConventional oil Absorption System El Septic Tank El Conventional ystem -in -fill ❑ Holding Tank ❑ Alternate Mo nd System ❑ See Bed P� ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: 3i _ri t1 }i y.��� - 0 1 s € E � i I E � e E i � - E ❑ SEE ATTACHED DISCUSSED WITH PLUMBER (') Yes ( ) No SIGNATURE (Voluntary t, 7- r77, i DATE OF INSPECTION Signature of In;¢ector White - Inspector Yellow - Local Inspector Pink Plumber or Responsible Party 7 1 REPORT ON INSPECTION OF SANITARY PERMIT # 2 1 2 (1) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection ame, ress, is se o. o ns a in Plumber Time of Inspection a.2 3 INSTALLATION CONSIST OF: ❑ Septic Tank []Seepage Trench []Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System B ermanen reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? []YES ❑ NO Wired? ❑ YES []NO 8 HOLDING TANK: Manufacturer of gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? C3 YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES []NO; Locking device on cover? [ ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE T . Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? []YES [] NO (13) Has system been installed in floodway? ❑ YES []NO Floodplain? ❑ YES ❑ NO DILHR -SBD -6095 N.0 /80 Signature of Inspector , ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT` Owner Q caw.,, L3 Pro a Address / 9 16 p rt3' City /State - ST CKOXA - C.OUNTY Legal Description: - r-NN GOFFICE ' Lot Block Subdivision/CSM # IL I S 1 /4 IVIO 1 /4, Sec. t , T Z 9 N -R W, Town of PIN # Q oZ / t� q a- — 4 0 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer " A Size ST/PC 0 -0 / $ao Setback from: House Well P/L s* Pump manufacturer Model N IS Alarm location ` (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location d k�v Alarm location I SOIL ABSORPTION SYSTEM Type of system: Width � T to Length 1 2 t Number of Trenches Setback from: House / 3 I Well t �. 5 P/L w, ' Vent to fresh air intake ,S A1-1Q ELEVATIONS Description of benchmark / YA �' V C P a-� P Ax Elevation Description of alternate benchmark 5 -�`� �"� _ _ Elevation / Building Sewer E ST/HT In g ST Outlet t a 7 . � 3 PC Inlet t o c2. 7 PC Bottom 29 OO Header/Manifold Top of ST/PC Manhole Cover ttd�4 �o r�l ,63 Distribution Lines (t) J 0 ( ) ( ) Bottom of System Final Grade Date of installation /?9 Permit number 3 3101 1 D ° State plan number a a S 9 a3 Plumber's signature License number of a - - / o Date `-/ 4 9 Inspector Complete plot plan a 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. w PLAN 'VIE At".. ', j 0 , 0 - w I �1 / 10 3 LJ�a. 8 0 0 f i t q7 9s a " pvc ZOO P INDICATE NORTH ARROW C o ; lJ w y ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the p am. tA�) residence located at: 50 ;, 1U4J ;, Section tS T 2 N R ig W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: 6 - Did flow back occur from absorption system? _- Yes No (If no, skip next line) Approximate volume or length of time: nl,�, gallons A(,,A, minutes capacity: / 0 0 0 0. Construction: Prefab Concrete X Steel Other Manufacturer: (If known) : tZ II - Age of Tank (If known): N R, P e-- (Signature) (Name) Please print `-- P R S a a- - 7 `z l c5 (Title) (License Number) 10- -4-- IT Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name lJe�c -kL.>. t<< Signature -';?-7 "71 i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. GRO X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: []City ❑ Village § Town of: State Plan ID No.: WALLACE, DAN KINNICKINNIC CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: DD ' " z r,� TANK INFORMATION V f 7 ELEVATION DATA A9900194 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 6 p enchmark 13 S Z 11 3,5 D D Dosing YA �O l •D3 �yd3 X60 Aer ion Bldg. Sewer Holding St /Ht Inlet o z TANK SETBACK INFORMATION (/ Ht Outlet �, Q Ido TANK TO P/ L WELL BLDG. Air I to ntake ROAD Inlet Air Septic �� ' -E �� � Z9 S � 3 � � NA Bottom Dosing S f c I NA Header /Man. tr 0 Aera ' Dist. Pipe 9 �� 3 Holdin Bot. System T.d(o lv PUMP/ SIPHON INFORMATION Final Grade a°1'ti\ Manufacturer �( Demand ¢ Z � eZ_ &_� Model Number 36GPM TDH Lifts Friction System Z TDH&,641`t oss Head Forcemain Length ZGj ! Dia. Z /` Dist. To Well SOIL ABSORPTION SYSTEM BED / EN Width Len No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N d Z Z PIT DI MENSION S SETBACK SYSTEM TO P/ L I BLDG I WELL LAKE/STREAM LEACHING manufacturer: INFORMATION Type O f CHAMBER Mode Number: System: Wta r (p 131 + 1'�d OR UNIT DISTRIBUTION SYSTEM Header/ Manif d Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- z_ 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 El No ❑ Yes [] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KI 15.28.18.231 ,SW,NW 1216 COUNTY J JG 0CDV4Of�l.r 1 G ./ , 2- Z / g) r - `.q {1!\ &.f6 k6b �K A p�OGJ(� (1/ qt CG�f 7�d f�G Z Yd2a�/"'r �l V K V.�l aAA riSPt' 4o" kohk&r (1,) 64 on+ allro- BA1 q + E �, / 5 . v nxS W � t a_ ;4 A Week I ��� aha y pL� �V 6w- U 11CCIti roc Wa'S Plan revision required? ❑ Yes No Use other side for additional information. D6 lj SBD -6710 (R.3/97) Dat4 411 1 spector's Sign. Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: F i F E > i t a I •� E 1 r E m r t t 7 r ! € t a € .. — i f I i �.... �. r Y B % f } € 1 F a F t d F .. 8 f $ t g ea: ° 5 . { ° w r I 4 Safety and Buildings Division r.••a`r•rt SANITARY PERMIT APPLICATION Bureau of Building Water S 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 5T P m • See reverse side for instructions for completing this application State Sanitary Permit Number you provide may be used b other government agency programs O The information y p y y g g y p g ❑Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 2ZS�1 Z� Property Owner Name / � Property Location 0�N W fi� TCf'" 5 1 ,3 1/4 WW1 14, 1. TA9 ,N,R / V*) W Property Owner's Mailing Address Lot Number Block Number / 2 / (, c- 7'k °3' City, State Zip Code Phone Number Subdivision Name or CSM Number R ;u�- FaIs wl st0� -1 ( 115 )gIr4, s31 it- 5PA 36(, .5 0,49 P, C Qd II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C Nearest Road El Vll age �r A jG.K h h-r -- r/LI< S Public 1 or 2 Family Dwelling - No. of bedrooms - Town of III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) - o 'a - L - /0Lla— 9° I5. Z8. 18. Z3►f3 1 ❑Apartment/ Condo 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. ❑ New 2 g Replacement 3 ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an System 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 MMound 30 ❑ Specify Type 41 ❑ 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) r Elevation 0 2 o S g /I!!ti , /off Feet 10 7, 32,Feet Capacit VII. TANK in allons Total # of Prefab. .Site Fiber- Ex per. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic A p p New Existin strutted Tanks Tanks Septic Tank r Holding Tank /00 / ao 0 ❑ ❑ ❑ ❑ ❑ ift Pum T r got 1 800 1 ® ❑ ❑ ❑ ❑ ❑ 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) I MP /MP No.: Business Phone Number: t,jo,I+el— Al e. C.kVj L-) ` 197 7ts 7Y4 -- 33a ,;- Plumber's Address (Street, City, State, Zip Code): 4 (. - 7 d = to S #. off -. C,�: S 2 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (In dudes Groundwater D ate Issued Issuing kcantsignature (No Stamps) A roved I S urcharge fee) pp ❑Owner Given Initial 1 1& /� o A dverse Determination �� I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber F . y 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 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL 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 isto 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 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 bythe 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. f Safety and Buildings PO BOX 7162 MADISON Wl 53707 -7162 TDD #: (608) 264 -8777 Iscons www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 24, 1999 CUST ID No.259518 ATTN.• POWTS INSPECTOR ZONING OFFICE ULBRICHT & ASSOCIATES ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 05/24/2001 Identcausn. Numbers Transaction ID No. 225923 Site ID No. 172458 SITE: Please tefdr to both identification numbers, ST CROIX County, Town of KINNICKINNIC above, In ail corresppndencevithtlte ageancy SW1 /4, NWl /4, S15, T28N, R18W Facility: DAN WALLACE FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 468411 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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. Sincery DATE RECEIVED 05/07/1999 FEE REQUIRED $ 180.00 (� , FEE RECEIVED $ 180.00 E R E PAGEL , S PLAN REVIEWER II BALANCE DUE $ 0.00 Integrated Servic s (608)266-2889, - F, 0745 - 1630 HRS PEPAGEL @COMMERCE.STATE.WI.US�, U.LBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants rMCEIVED M AY 0 7 1999 PROJECT �. DILHR Plan I.D. # Date May 6, 1999 Owner Dan Wal Phone 715- 425 -6531 Address 1216 Cty. Trk. "J" River Falls, Wis. 54022 Legal Description TaxPIN 022 - 1042 -90. Located: SW1 /4,NW1 /4, SEC-15, T28N,R18W. Town of Kinnickinnic County St. Croix C.S.T. Robert Heise 226153 Installer Local Authority/ Supervision St. Croix C ount y Zonin Dept. PROJECT DESCRIPTION Replacement septic system, for an existing 3 bedroom home. Estimated daily wasteflow: 450 gals. Soils are slowly permiable (.2/.3 GPD /ft in the upper 12 but are seasonally saturated at 30" as reported by the CST. A very long narrow trench type mound system is proposed, using 12" sand fill'. Proposed: re -use the existing precast 1000 gal. septic tank (approx. from 1985). Tank shall be inspecncted and certified for re -use by a licensed plumber or licensed septic hauler who shall confirm code compliance for size and condition. Otherwise a new 1000 gal. septic tank shall be installed (Weeks Concrete Products, New Richmond, Wis.). 'g o.- 0 0 tti ALL NON - CONFORMING G 01% TREATMENT TANKS SHALL �N� +�+a+ +++wrxtp�, BE ABANDONED PROPERLY �►tiN�� G ����SCONSl FOR ILHR 83.03(2). now"V L uLSWcMr GD�r �J = � D716i Pg .1 PLOT PLAN VIEWS � s I G��' ''''' //Z ��� Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION P9.5 PUMP PERFORMANCE SPECS This design for installation is based entirely on measurements, elevations, landscape conditions (slopes etc, ations, 71le accuract of his s ) and soil suitability provided by CSTM of the CSTM. -sp ecs, reported, shall remain the sole responsibility Any use of this POWTS design t an relat Y licen ted unlicense Y sad plumber, or d parties or persons any P ons 11 (excav not be construed as an assumption espon laborers) shall the designer for the +;orkmanshi const uc responsibility by substitution or selection of any construction, placement, any assumptions by the plumt-er that many eunspecified ccomponents are state approved or proper, or the effects of poor judgement If working under adverse damaging weather soils) by any such parties or persons. conditions (wet /frozen _ J O (,vE�G N 6- lope . S P T11 c •vf u> s� . 3a3y L Nt P I G �ZfNi�ot o = C 5T 13144 's 70 �n The area 15 ll. below the dowollo a til nl the 61 o Anil 1110 0101 11111m must mmaiw WO N$ � l r �0 ' r 9A 7 arts E `` C'S7 - viN £ C S ?'S SAI AP-Z Trq of / y IVE�5T SrDE /BUG �/pe_ aAL Gv r �l.�U X03 • y� �/,�G, = /d p. 0 PER PLUMBING PRODUCT APPROVAL CODES, ALL ABOVE- GROUND PVC PIPING (FROM TANKS & SYSTEM AREAS) MUST BE SCH.40 PVC MEETING ASTM D1785 OR D2665 STANDARDS, r� r a kjt R't o f Z (�T� R >41 s 10.5 ' Sa • T op of ��2. I,�Ti =Rai s To P 6F R oc k / US'. �Z. g la u A i oAj Page 2 Of S Straw, Marsh Hay, Or Synthetic Covering Medium Sand Distribution Pipe H — �G Topsoil ____, ___,__�, 3 ' a ' uuiFDR , /{ 6 /6 Slope Trench Of Z -2�2 Force Main Plowed ���/ D Aggregate Layer Undisturbed D /' d Ft. Soil E 1• Ft. Cross Section Of A Mound System Using F • 62- Ft. Trenches For The Absorption Area G /' 0 Ft. A y Ft. H /:-4 Ft. B QCo Ft. K /D Ft. L / /Co Ft. J 13 Ft. Alternate Position of Force Main I /ft Ft. W 2 Ft. L J I K A �____ W Observation S Pipes Distribution Trench Of 2 ~ _ 2 2 - Pipe Aggregate Mound Using Trenches For Absorption Area Daily Wasteflow = y - _ 1 - 17 � REQUIRED BASAL AREA: Soil infiltrative Cap. 3 Sq.Ft. PROPOSED BASAL AREA: B x - (A +I) _ x + 172 ,0 Sq.Ft. I r T f ey V I-I t-'I 1 1 - , 1 1J U 1 AJ p I 1 a U E r (.t.1 o R rC To rh L LO O LVAj& N� T 1 P _ ................ R 1 13uT I0IJ _ LATERAIS Y X i pUG V=oRCE MAW LAST "olE s HA 11 f3E W�Vr To �Np CAP . VOI VvluMt FoR 35" uvERTJ �Ir= vA dF eta FoRce MAW PERFORAVED PIPE DETAi L HolEs 1 0cATrry ox3 I G OT I-OM S A BE7 I Y L.� VARiA y e go hlly SP bfsT� Hol Di A ,K9 T R /- -- LATERAL �' 2 - 1 � R - -- MAm FOLD rN. roRct=_ MAik) 44 o (401E p; P.E. /-2- DISTRi f3uT'IoN DtScHARvE RATE PER L.ATERAI. `�•� CAI /Mi Ta1'Al. - D15GkAR vE PATE MErWOR k �g .� / Cry L, MI-k) POMP CHAMBER CROSS SECTIOIJ AND SPECIFICATIONS Pi4yE I OF 5 VENT GAP 4 "C.I. VENT PIPE _T -fr WEATHER PROOF APPROVED LOCKING _T 25' FROM DOOR, MA JUNCTION BOX NHOLE COVER W WINDOW OR FRESH &lf,G0lNl' I A13EI 12 MIU. •• AIR INTAKE �E p^T /ON GRADE ��AD� � U I -•- 0 � 18 "MIU. /0 COAIDUIT -- - - - - - -_ 3 0\\\ _--- - - - -__ �/6-V'4fT oti .` PROVIDE I INLE AIRTIGHT SEAL I / I I APPROVED JOINT y I DG I I APPROVED JOINTS IJ /C.I. PIPE IN 'I r � l�M I III W /C.=. PIPE EXTENDING 3' �0� I ( II ALARM EXTENDING 3' ONTO SOLID SOIL B 1 �� / I I ( ONTO SOLID SOIL i 0" T. 2 �� PUMP —� -- OFF VSE ✓ o,Q k 'gt, D0w 6- 4� e v f i0P1 BLOCK j4010 G n� RIStR EXIT PERMITTED DULY IF TANK MANUFACTURER, HAS SUCH APPROVAL SPEC.IFICATIOUS DOSE W �wca/ f K9 • TANKS MAN UFACTURER: IJ UMBER SO OF DOSES: PER DAY. TANK SIZE: ��� GALLONS DOSE VOLUME /O ALARM MANUFACTURER: LLVL �4Gi�M INCLUDING BACKFLOW: / V O GALLONS MODEL MUMBER: CAPACITIES: A= I V 1 6 INCHES OR GALLOAIS SWITCH TYPE: F, �� I 5 w I t B= 2- INCHES OR .LC_ GALLONS PUMP MANUFACTURER: z / 4Q C =!� INCHES OR D GALLOIJS MODEL NUMBER: d 1 H II t/ D= ff IN CHES OR 2 - GALLONS 1 SWITCH TYPE: 'I T p J dlf -« MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 3 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE S ' 1 FEET -r Ao / � STfG . �{ + MINIMUM NETWORK SUPPLY PRESSURE - - , , , - - , , .. 2 . 5 EET EAGGI„ 10 -' -F 3S FEET OF FORCE MAIN X �� F Y oF TFRICTIOU FACTOR.. FEET = TOTAL DyIJAMIC HEAD CL. ! N INTERNAL DIMEIJSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH n PER PLUMBING PRODUCT APPROVAL (CODES, ALL ABOVE- GROUND PVC PIPING (FROM TANKS & SYSTEM AREAS) MUST BE SCH.40 PVC MEETING ASTM 01785 OR D2665 STANDARDS, ZOLLER EFFLUENT PUMP MODEL 98 E' READ CAPACITY Cunv MODEL E s 3 5/e 0 + —4 te_ e 4 3/le 4 L — e- 1 I/2 -11 1/2 NPr U.l. WONS 1 _p 20 30 4 o 50 ae - 19 80 so 0 160 210 FLOW PER MINUTE lotµ DYN+Wq NIM'tIDW ►/lt /r 11rlVINt AND DtWAtt MMA I�as avACrlf 12 1 • _ VNtI4MrN , IIt7 If t It pt Ml� 1 t.1> it P73 1p 109 $1 ,» 11 to 10 65 / 20 9 to PI /� leckv.lw ;�; 3 a /le CONSULT FACTORY FOR SPECIAL APPLICATIONS e El9ctricel eAerrlelors, for duplex systems, are avallable and euppllsd with an alarm. - • Mercury Iloat switches are available for controlling single and , .M•ch**W sllsmstme, I& duplex systems, ere ovallable with a • IN so phase systems. w Ahoul Harm ewllchse. Double piggyback mercury Iloal swdchea are available for variable Isvel long cycle controls. 9lendsrd oil mode - lea W•I ht 39 tbs. . 1. a,le ralRoaf o rued? ( ELECTION OUIOE Olfer 0 - 39lbs, _.� �I�.P. a Pe pole► rwcherJcalewaeh , noe>Aerndeonbol► ulred. Mode C ontrol 3elee !. elnpte pl°OYback mercury Roal switch or double ' W Y h " -- IAode �mP — ewhch. Met to fA1o171, P Yb.ck mereury, e� !im lest �-_ 11� ulo 0.6 , 1 « P L Cu let 0. Meehanlcal aherne 100072 of 100071 1 _Z 1. Bee 1Mo?l2, lot coned moiler or Elecbkar Ilkernalor,' E. 091 230 -�•_ �14i_2 -L 1. Mereury c,raoo Roar switch 10 -OQ2y Pdc "• Amo 7 90 130 1 Iron 1' - t, 1 « 1 t duplex (31 « (1) pool syelerm Rt • ooMrol acllvelor .Reside �x ll) h* "1 lunerbri OMe «duple* 6",Mk % to opt M on «wired in /4n• hale `1 Pak". 7« waoM101t) ° • -_•. a 1ptlq. 1. N.weh " " a l lo w tee tar 10 Air rl nrw b w c "Mill 11061ta MtrnUa Ib, V "Mi r►lotlll; 11111111 �' P�e9 f kvchenicd Merneld, AN IruhRellat M eomtale de CAUiIs 0 au6y Ab+el ; ens pin,py11 Caned 9oti �1'nNd et.odkhD. AM i uf� � eAerW (N done ► e'wE : �.1 nerd N.IIeD.I tl.e4b C 'h eed�e eAcuW ►� IetewN Inelu�. ' H.etA Ad (O /NAI, °� (HtC) eM IAe f, eeupegeael •a1Nr e ,N For bnusual conditions n reserve RESERVE POWERED calety (actor fo DESIGN do (neared 9 Into Ills design of odery Zoeller pump, /( 5W1 7a• cas vif�,KY 10236 0317 Manulaclurers 0l. SHIP 10: 3 80 01 Offers lane ?'A 11a. ?73x :. Glr;S01) 771.3621 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to cent ^^ ify that /d Ihave inspected :the septic _tank presently _ serving the UQ,,,L Wa -1/ f residence located at: , ; , Section 1Y , T , S N, R _LL_<q) Town of ;XIV C _ zc- . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Q Did flow back occur from absorption system? j k Yes No (If no, skip next line) Approximate volume or length of time: �_ gallons _� minutes Capacity: /0 ®o a Construction: Prefab Concrete 4 Steel Other Manufacturer: (If known) : Age of Tank (If known) : (Sign ture) (Name) Please print Cr -oW Nor ©3,P S- S' (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature r Wisconsin gepartment of Industry SOIL AND SITE EVALUATION REPORT Page _L_ of j.tr and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but CRO r not limited to vertical and horizontal reference �? ion and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location an ist?e. r� road. D a — D IEWED BY ATE APPLICANT INFORMATION -PLE 3tE7 INT A&L INFORMATION `4 PROPERTY OWNER: ` "' - PROPERTY LOCATION _... `'j GOVT. LOT 1/4 1 /4,S T 7 ,N,R AW W PROPERTY OWNER MAILING ADDR LOT # BLOCK # SUBD. NAME OR CSM # Aa n ' `Z "T 'T Cf Gi }: MiTv CITY, STATE Z1 OOE_ ;.;'� ❑CITY OVILLAGE SOWN NEAREST ROAD (j New Construction Use Residenti ` ' ms 3 [ ] Addition to existing building Replacement (] Public or commercial describe Code derived daily flow 5 "0 gpd Recommended design loading rate . n2 bed, gpd/ft 3 trench, gpd/ft Absorption area requiredbed, ft / trench, ft Maximum design loading rate . z bed, gpd /ft . 3 trench, gpd/ft Recommended infiltration surface elevations / , /O 5. ft (as referred to site plan benchmark) Additional design / site considerations 7,N Y&eV �iu� L�.�i�r�P 94A EVE d* arm in e ea - t4 e Parent material 4/c, GreJ 44ZI olzdnr/a,r <oads4w0 plain elevation, if applicable - Ij !� S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ®U JE S ❑ U ❑ S a t ❑ S U ❑ S 911 I ❑ S 18 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerx� rYdYv Y. ?� G 5 3vf 12 3 ti sl C z nn s k F R s Ground 3 ^36 "],'`f �1 Z m 5 1, jh (_ t.2 A-5 V elev. v V1 %v FR Depth to limiting factor f /v Remarks: I L'UY1i v4'�a N i O Boring # : lo Z/ i -1= Ak TY) IF ►2 C 5 15 :3$ 10, g 3l .S Z ivi .5 M -s z of S .� .. >. 3 --44 -7, 14/ Ground /elev - 3 T 8 b f S' 0 V F'5CA A d F • �'{ . S ft Depth to limitin C ove l � c7v►s ►� e,12-OR R - fact, ' 5/m v a AV u Remarks: CST Name : — Please Print Phone: 7/S- .235- ,931-9 A ddress: Signature: K. Date: j ` CST Number- 1� PROPERTY OWNER - DAN WcAOLCE SOIL DESCRIPTION REPORT Page of ✓� PARCEL I.D. # 11020+ / O 'yo2 ^ 90 Depth Dominant Color Mottles Texture Structure Consistence Bourdevy Roots GPDlft - Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rencfi x <xK k sbk CS 3 of 2, 3 Ground 3 -'� , R . �Sl`�o ►� S m �l2 S 1 Yf .,'y . S - elev . /0 ft. e ' 53 9, s 8/3 5 v Y �2 - . y , S Depth to limiting , AL factor ( �, ` . E _ N4 Remarks: Boring # - Ground elev. ft Depth to limiting factor Remarks: Boring # AMA Ground elev. ft Depth to limiting factor Remarks: Boring # `• Ground elev. ft . Depth to 1 Grniting factor Remarks: ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address %[Ges tc1 �c� /c5 �✓✓l Z Property Address S�m� (Verification required from Planning Department for new construction) City/State Fl�S. (.�i Parcel Identification Number 4 A LEGAL DESCRIPTION Property Location Sw ' /., ' /,, Sec. IS , T,"2 N -R 15 , Town of A/: NN 4 4 - NI�Zc Subdivision 0, S/n .3� S Lot # Certified Survey Map # 9: � , Volume 4 A , Page # 2 / Warranty Deed # S / 3 3 , Volume J D �� , Page # S . Spec house ❑ yes ❑ no Lot lines identifiable E yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 Zoning Office within 30 days of the three year expiration date. 4 ' z � K , "/ /'� � / / / f9 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 pro rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. lol�l9� SIG ATURE OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed `! • DncUh1ENT No. STATE BAR OF WISCONSIN FORM 1 -1952 TM-E SPA� RESERVED vOR R[:ORC—G DA . WARRANTY DEED x.133 4 1058PA', 356 REGISTER'S OFFICE This Deed, made between . AgrU0Qi3lics, lnG.. a _ .. -------- ST. CROIX CO., yW1 Wisconsin. _Corporation __ _ - Rec'dfnrRecord Grantor, JAN 3 1994 and Daniel F- Wallace and. Jacquelyn R. Wallace, 12 P. husUand and wife as survivorship marital property _ - - at �c�''`�' �• M Y _... Grantee, Re$IstaofDy Witnesseth, That the said Grantor, for a valuable consideration. _._ .. .. . -.... _ .. . -... - RETI RR TO 1 conve,,s to k.rantee the following described real estate in St. CColi County State of Wisconsin: qQ Lot One (1) of Certified Survey Map, Vol. 41990, being part of the Southwest Quarter of the North Tax Parcel No: .------- _----------- _-------------- Quarter (SW.b of NWF) of Section Fifteen (15), Township Twenty -eight (28) North, Range Eighteen °• (18) West. If Grantee decides to sell premises within three (3) years from the date f transfer, Agronomics, Inc. is granted an Option to purchase the property hereinabove referenced. Exercise of the option by Agronomics. Inc. shall be given to Wallace by written notice at least thirty (30) days before the purchase date. The purchase price shall be $50,000.00, plus depreciated value of improvements added by Grantee, payable in cash at closing. L J. `a This is nut.. ------ homestead property. (is) (is not) T.,p,etner with all and singiiiar the hereditaments and appurtenac.ces thereunto belonging; ;r And . . w r ;ants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all easements, restricitions and rights of way of record. and will warrant and defend t a same. Dated this -t . _ d,,. of December -- -- - .. _ 19 • +r - (SE. \L) 6j - t5EAL1 Inc. by Aonomi4�5, M. s. ll-r, .President. _ #` �. _. ..._. - ----- --- - .(SEAL) ± . (SEAL) Agronomics, Inc. by • _. _ - -- - -_ ....._ _ _ Lois G...Bradley, S.ecretar.y- _ ¢ AUTH ACKNOWLEDGMENT CALIFORNIA ;:ignature(s) . - -- Ei a0!, X -- - STATE OF WISCOWae ---- - ----------- - -- ------ County . , 19.93. Personal] came before me ' th is - .../ d. is ay of_.DeCembel `' y tP.- ---- . day of t - -- December-- - ------------ - -- --- 193._ . the above named ! - - - =_ - - - - - _.... r Qr ------ - - - - -- - --- --- - -- - ---- - ---- - - - - Rob t J. Richardson - -.. - - -- - - -- -- .... . -- . TITLE:. Ebi13ER STATE BAR OF WISCONSIN ---------- -BETTE E.-RACiK1 (If not- ----- ------- -------- ---- - ---- - - - ---- ----------- - -- -- -- -- -- -- - - - V C.Orllllk lie authorized by 5 706.06, Wis. St 'its.) to me known to be the pe 1ElAU*tM11P0111�A foregoing instrument andac A Fie �: t ��» >: THIS INSTRUMENT WA D121F'ED BY " ''�� ROBERT -- J- ._RI ^N- - -__ - _ Attorney at Law •.�-� - __ Spring. V-alley,.- .Wl._5.4767 -_. ................... Votary Public to- - - - Couclty SVf s.CA \t%- Commi ernla t —ion is4 o nen. no, sae er - rno (Si, nature, may be authenticated or acknowledged. Both - j � �,•'t ( Ir t state -'i p' � /41l, ` are not necessary.) date: _ l4i� 1! �- _- -- - - - ---- - - - -• 19't ^'._.) •Naai.g of p.••son: signing in any eapacity sh.,:.'. r: be toed .,, pri n!.il below .heir siK'st_res. WARRANTY DFED STArr B: %R OF WI-CONS N W.--in Loral Blank rn Ina - .. FORM No. 1 -1232 M,i::aokee, Wis. � n�No m 2 � �, , CERTIFI3D SURVEY MAP d; of Z I JOHN BRADLEY �aey a Part of the Southwest 1/4 iv�0 °oo 00 E Z Al of the Northwest 1/4 of zO `70' Section 15, Township 28 = 00 North, Range 18 west, I Town of Kinnickinnic, v /� St. Croix County, Wis. m �� 0 jn o Indicates 1" x 24" iron pipe weighing 1.13 lbs /ft n -S U j set. L O T W / \ '0 `` � \ \11111 ,, ¢ A •1 A. N n e JAMES L. 0 O I MURPHY _ I �JI � �� �•• RIVER FALLS, ;�O Q N 80.00" WISC. J� C o A �V LANG /�j D, $ ` EA SE �nE.0 T I N ' 0 �0 0 0 S A Z - i = i 00" © oo'oo'� 8 �) I - - � Z O�.S E / Ali //4 G iivE r C - 7 Description: That certain parcel of land located in the Southwest 1/4 of the Northwest 1/4 of Section 15, Township 28 North, Range 18 west, Town of Kinnickinnic, St. Croix County,.Wisconsin, more fully described as follows; Commencing at the West 1/4 corner of said Section 15, thence go N 90 11 E 701.17' to the POINT OF BEG - GINNING of the parcel to be herein described; thence go N 00 "E 440.18'; thence N 90 11 E 208.70'; thence S 00 "W 440.18 thence N 9(; "W 208.70' to the POINT OF BEGINNING, containing 2.11 acres, more or less, said parcel being subject to easement over Southerly portions for C.T.H. J purposes as it now lays, also including an easement for ingress and egress described as follows; (For purposes of this description all be�.rings are referenced to the E.W. 1/4 line of Section 15, T 28 N, R 18 W, assumed N 90 11 E) State of Wisconsin) County of Pierce) I, James L. Murphy, Registered Land Surveyor, do hereby cevtify that by direction of the Owner, John Bradley, I have surveyed and divided the lands shown hereon according to official records and in accordance with provisions of Chapter 236 of Wisconsin Statutes and the ordinances of St. Croix County, and that the map and description shown hereon are a true and correct representation thereof. APPR OVED Dated: 27 June 1980 ````������ =, ✓S C 0 AlS� S EP 1 � JAMES • ` 1980 L. MURPHY •`�� Sr. CRO COU �= S 1 0 4 2 COMP -'r WA NE PAW KANW O �.� AM zon"a co"WTfE RIVER L +�' FALLS, • p WI SC Vol. j ,Pak,e 990 Certified Survey Maps James L. Murphy LAND S �� `��� ``` St. Croix County, Wisconsin Registered Land Surveyor -- 1,00 .. +"`` \ � ( EASEM.ENT DESCRIPTION ON REVERSE) V, IJL c rV + S "' P pp r -ppp, � Lh n 1 •. . a Q k - j z 3 r /aid r s. r oa' 6 4 ry rk `Y %,.00 r 1 > � Iy r si a 7 1 9 ai o f ,p j i ,i �f c 4 !• Qj Do ti U'. J NN r fir � � ,��, �:� �'f •. � ,. 9 � wx x r � �''s� 4 f A 1 4 4 4F�r Yy� 4 'r 'A d - � •Y 4 : / f.,( +rl 4: h"� `t �4�7l.�Mi 4 ,'7 '-� C • d T'iS''� ^�1�: . - F 5. '`f,V y `t. .1°;�.%'�, ?. 'Fly �tr.�• 4 '�.`i�. ?F �.'� IA,,.��j.r�p+�'f• '1 � 1 :� ls'� _ . N I T rk � ys.s' r r� t , r t ri" . - , >J ti R`Y S, ,'��• ""'`9•i' �axFC�" }`?s:: . ..- ... ..... t y.. :�n . ... ,. .. f ta� t N,. - ° '� ' .W F 7fr''�J i .. •. a a. .�. i �N^ � .iJ�>� f.j.kr .� 9 v �